Development of Clinical Radiomics-Based Models to Predict Survival Outcome in Pancreatic Ductal Adenocarcinoma: A Multicenter Retrospective Study.

PURPOSE: This multicenter retrospective study aims to identify reliable clinical and radiomic features to build machine learning models that predict progression-free survival (PFS) and overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC) patients. METHODS: Between 2010 and 2020 pre-treatment contrast-enhanced CT scans of 287 pathology-confirmed PDAC patients from two sites of the Hopital Universitaire de Bruxelles (HUB) and from 47 hospitals within the HUB network were retrospectively analysed. Demographic, clinical, and survival data were also collected. Gross tumour volume (GTV) and non-tumoral pancreas (RPV) were semi-manually segmented and radiomics features were extracted. Patients from two HUB sites comprised the training dataset, while those from the remaining 47 hospitals of the HUB network constituted the testing dataset. A three-step method was used for feature selection. Based on the GradientBoostingSurvivalAnalysis classifier, different machine learning models were trained and tested to predict OS and PFS. Model performances were assessed using the C-index and Kaplan-Meier curves. SHAP analysis was applied to allow for post hoc interpretability. RESULTS: A total of 107 radiomics features were extracted from each of the GTV and RPV. Fourteen subgroups of features were selected: clinical, GTV, RPV, clinical & GTV, clinical & GTV & RPV, GTV-volume and RPV-volume both for OS and PFS. Subsequently, 14 Gradient Boosting Survival Analysis models were trained and tested. In the testing dataset, the clinical & GTV model demonstrated the highest performance for OS (C-index: 0.72) among all other models, while for PFS, the clinical model exhibited a superior performance (C-index: 0.70). CONCLUSIONS: An integrated approach, combining clinical and radiomics features, excels in predicting OS, whereas clinical features demonstrate strong performance in PFS prediction.

The impact of radiomics in the management of soft tissue sarcoma.

INTRODUCTION: Soft tissue sarcomas (STSs) are rare malignancies. Pre-therapeutic tumour grading and assessment are crucial in making treatment decisions. Radiomics is a high-throughput method for analysing imaging data, providing quantitative information beyond expert assessment. This review highlights the role of radiomic texture analysis in STSs evaluation. MATERIALS AND METHODS: We conducted a systematic review according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in PubMed/MEDLINE and Scopus using the search terms: 'radiomics [All Fields] AND ("soft tissue sarcoma" [All Fields] OR "soft tissue sarcomas" [All Fields])'. Only original articles, referring to humans, were included. RESULTS: A preliminary search conducted on PubMed/MEDLINE and Scopus provided 74 and 93 studies respectively. Based on the previously described criteria, 49 papers were selected, with a publication range from July 2015 to June 2023. The main domains of interest were risk stratification, histological grading prediction, technical feasibility/reproductive aspects, treatment response. CONCLUSIONS: With an increasing interest over the last years, the use of radiomics appears to have potential for assessing STSs from initial diagnosis to predicting treatment response. However, additional and extensive research is necessary to validate the effectiveness of radiomics parameters and to integrate them into a comprehensive decision support system.

Bloodstream Infections by Pantoea Species: Clinical and Microbiological Findings from a Retrospective Study, Italy, 2018-2023.

(1) Background: The widespread use of MALDI-TOF coupled to mass spectrometry has improved diagnostic accuracy by identifying uncommon bacteria. Among Enterobacterales, Pantoea species have been seen to be implicated in several human infections, but their clinical and microbiological framework is currently based on a few anecdotal reports. (2) Methods: We conducted this five-year (2018-2023) single-center study aimed at investigating the prevalence and clinical and microbiological findings of Pantoea species bloodstream infections. (3) Results: Among the 4996 bloodstream infection Gram-negative isolates collected during the study period, Pantoea species accounted for 0.4% (n = 19) of isolates from 19 different patients, 5 of them being pediatric cases. Among Pantoea species isolates, P. agglomerans was the most frequently detected (45%; n = 9) followed by P. eucrina (30%; n = 6) and P. septica (15%; n = 3). Malignancy (35.7%) in adults and malignancy (40%) and cerebrovascular disease following meconium aspiration (40%) in pediatric patients as comorbidities and shivering and/or fever following parenteral infusion (36.8%) as a symptom/sign of Pantoea species bloodstream infection onset were the most frequently observed clinical features. Among adults, primary bloodstream infection was the most frequent (50%), whereas among pediatric patients, the most commonly identified sources of infection were catheter-related (40%) and the respiratory tract (40%). Overall, Pantoea species bloodstream infection isolates displayed high susceptibility to all the antibiotics except for ampicillin (63.2%), fosfomycin (73.7%), and piperacillin/tazobactam (84.2%). Targeted antibiotic treatment was prescribed as monotherapy for adults (71.4%) and combination therapy for pediatric patients (60%). The most prescribed antibiotic regimens were piperacillin/tazobactam (21.4%) in adults and meropenem- (40%) and aminoglycoside-containing (40%) antibiotics in pediatric patients. The overall 28-day all-cause mortality rate was 5.3% (n = 1). (4) Conclusions: The prevalence and 28-day mortality rate of Pantoea species bloodstream infections were low. The prescription of targeted therapy including broad-spectrum antibiotics could indicate an underestimation of the specific involvement of the Pantoea species in the onset of the disease, warranting further studies defining their pathogenic potential.

The Impact of Edema on MRI Radiomics for the Prediction of Lung Metastasis in Soft Tissue Sarcoma.

INTRODUCTION: This study aimed to evaluate whether radiomic features extracted solely from the edema of soft tissue sarcomas (STS) could predict the occurrence of lung metastasis in comparison with features extracted solely from the tumoral mass. MATERIALS AND METHODS: We retrospectively analyzed magnetic resonance imaging (MRI) scans of 32 STSs, including 14 with lung metastasis and 18 without. A segmentation of the tumor mass and edema was assessed for each MRI examination. A total of 107 radiomic features were extracted for each mass segmentation and 107 radiomic features for each edema segmentation. A two-step feature selection process was applied. Two predictive features for the development of lung metastasis were selected from the mass-related features, as well as two predictive features from the edema-related features. Two Random Forest models were created based on these selected features; 100 random subsampling runs were performed. Key performance metrics, including accuracy and area under the ROC curve (AUC), were calculated, and the resulting accuracies were compared. RESULTS: The model based on mass-related features achieved a median accuracy of 0.83 and a median AUC of 0.88, while the model based on edema-related features achieved a median accuracy of 0.75 and a median AUC of 0.79. A statistical analysis comparing the accuracies of the two models revealed no significant difference. CONCLUSION: Both models showed promise in predicting the occurrence of lung metastasis in soft tissue sarcomas. These findings suggest that radiomic analysis of edema features can provide valuable insights into the prediction of lung metastasis in soft tissue sarcomas.

Predicting risk of metastases and recurrence in soft-tissue sarcomas via Radiomics and Formal Methods.

Objective: Soft-tissue sarcomas (STSs) of the extremities are a group of malignancies arising from the mesenchymal cells that may develop distant metastases or local recurrence. In this article, we propose a novel methodology aimed to predict metastases and recurrence risk in patients with these malignancies by evaluating magnetic resonance radiomic features that will be formally verified through formal logic models. Materials and Methods: This is a retrospective study based on a public dataset evaluating MRI scans T2-weighted fat-saturated or short tau inversion recovery and patients having "metastases/local recurrence" (group B) or "no metastases/no local recurrence" (group A) as clinical outcomes. Once radiomic features are extracted, they are included in formal models, on which is automatically verified the logic property written by a radiologist and his computer scientists coworkers. Results: Evaluating the Formal Methods efficacy in predicting distant metastases/local recurrence in STSs (group A vs group B), our methodology showed a sensitivity and specificity of 0.81 and 0.67, respectively; this suggests that radiomics and formal verification may be useful in predicting future metastases or local recurrence development in soft tissue sarcoma. Discussion: Authors discussed about the literature to consider Formal Methods as a valid alternative to other Artificial Intelligence techniques. Conclusions: An innovative and noninvasive rigourous methodology can be significant in predicting local recurrence and metastases development in STSs. Future works can be the assessment on multicentric studies to extract objective disease information, enriching the connection between the radiomic quantitative analysis and the radiological clinical evidences.

Radiation Exposure during Fluoroscopy-Guided Ozone Chemonucleolysis for Lumbar Disc Herniation.

Introduction: Radiation exposure is a frequent drawback of spinal surgery, even if X-ray guidance plays a pivotal role in improving the accuracy and safety of spinal procedures. Consequently, radiation protection is essential to reduce potential negative biological effects. The aim of this study was to evaluate patients' radiation exposure, the radiation dose emission during fluoroscopy-guided ozone chemonucleolysis (OCN), and the potential role of patient characteristics. Methods: The radiation dose emission reports were retrospectively evaluated in patients who underwent single-level OCN for lumbar disc herniation. A generalized linear model (GLM) with a gamma distribution and log link function was used to assess the association between radiation emission and patients' characteristics such as age, sex, BMI, level of disc herniation, disc height, and site of disc herniation. Results: Two hundred and forty OCN cases were analyzed. A safe and low level of radiation exposure was registered during OCN. The median fluoroscopy time for OCN was 26.3 (19.4−35.9) seconds, the median radiation emission dose was 19.3 (13.2−27.3) mGy, and he median kerma area product (KAP) was 0.46 (0.33−0.68) mGy ⋅ m2. The resulting KAP values were highly dependent on patient variables. In particular, sex, obesity, and residual disc height < 50% significantly increased the measured KAP, while levels of disc herniations other than L5-S1 reduced the KAP values. Conclusions: The radiation exposure during OCN is low and quite similar to a simple discography. However, patient characteristics are significantly related to radiation exposure and should be carefully evaluated before planning OCN.

Trueperella bernardiae bloodstream infection following onco-gynaecologic surgery and literature review.

Trueperella bernardiae is a Gram-positive commensal bacillus of the human skin and oropharynx. It is known as an opportunistic human pathogen causing surgical wound, skin, and soft tissue, osteoarticular, and bloodstream infections (BSIs) with severe complications. We report a case of surgical wound related T. bernardiae BSI following onco-gynaecologic surgery together with a comprehensive literature review of T. bernardiae infections to alert clinicians about this emerging pathogen.

Development and external validation of a non-invasive molecular status predictor of chromosome 1p/19q co-deletion based on MRI radiomics analysis of Low Grade Glioma patients.

PURPOSE: The 1p/19q co-deletion status has been demonstrated to be a prognostic biomarker in lower grade glioma (LGG). The objective of this study was to build a magnetic resonance (MRI)-derived radiomics model to predict the 1p/19q co-deletion status. METHOD: 209 pathology-confirmed LGG patients from 2 different datasets from The Cancer Imaging Archive were retrospectively reviewed; one dataset with 159 patients as the training and discovery dataset and the other one with 50 patients as validation dataset. Radiomics features were extracted from T2- and T1-weighted post-contrast MRI resampled data using linear and cubic interpolation methods. For each of the voxel resampling methods a three-step approach was used for feature selection and a random forest (RF) classifier was trained on the training dataset. Model performance was evaluated on training and validation datasets and clinical utility indexes (CUIs) were computed. The distributions and intercorrelation for selected features were analyzed. RESULTS: Seven radiomics features were selected from the cubic interpolated features and five from the linear interpolated features on the training dataset. The RF classifier showed similar performance for cubic and linear interpolation methods in the training dataset with accuracies of 0.81 (0.75-0.86) and 0.76 (0.71-0.82) respectively; in the validation dataset the accuracy dropped to 0.72 (0.6-0.82) using cubic interpolation and 0.72 (0.6-0.84) using linear resampling. CUIs showed the model achieved satisfactory negative values (0.605 using cubic interpolation and 0.569 for linear interpolation). CONCLUSIONS: MRI has the potential for predicting the 1p/19q status in LGGs. Both cubic and linear interpolation methods showed similar performance in external validation.

Pain in Women: A Perspective Review on a Relevant Clinical Issue that Deserves Prioritization.

INTRODUCTION: Gender equity and gender medicine are opportunities not to be missed, and this Expert Group Opinion Paper on pain in women aims to review the treatment of pain conditions mainly affecting women, as well as the fundamental aspects of the different clinical response to drug treatment between the genders, and what can be done for gender-specific rehabilitation. METHODS: Perspective review. RESULTS: Genotypic and phenotypic differences in pain between the sexes are conditioned by anatomical, physiological, neural, hormonal, psychological, social, and cultural factors, such as the response to pharmacological treatment to control pain. The examination of these factors shows that women are affected by pain diseases more frequently and severely than men and that they report pain more frequently and with a lower pain threshold than men. Some forms of pain are inherently related to gender differences, such as pain related to the genitourinary system. However, other forms of chronic pain are seen more frequently in women than men, such as migraine, rheumatological, and musculoskeletal pain, in particular fibromyalgia. DISCUSSION: Research is needed into the pathophysiological basis for gender differences in the generation of acute pain and maintenance of chronic pain, including the factors that put women at higher risk for developing chronic pain. In addition, different specialties need to collaborate to develop gender-related diagnostic and therapeutic guidelines, and healthcare professionals need to upskill themselves in the appropriate management of pain using existing diagnostic tools and therapeutic options.

European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1: Role of opioids in the management of chronic noncancer pain.

BACKGROUND: Opioid use for chronic non-cancer pain (CNCP) is complex. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). METHODS: The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. RESULTS: The key clinical practice recommendations suggest: (a) first optimizing established non-pharmacological treatments and non-opioid analgesics and (b) considering opioid treatment if established non-pharmacological treatments or non-opioid analgesics are not effective and/or not tolerated and/or contraindicated. Evidence- and clinical consensus-based potential indications and contraindications for opioid treatment are presented. Eighteen GCP recommendations give guidance regarding clinical evaluation, as well as opioid treatment assessment, monitoring, continuation and discontinuation. CONCLUSIONS: Opioids remain a treatment option for some selected patients with CNCP under careful surveillance. SIGNIFICANCE: In chronic pain, opioids are neither a universal cure nor a universally dangerous weapon. They should only be used for some selected chronic noncancer pain syndromes if established non-pharmacological and pharmacological treatment options have failed in supervised pain patients as part of a comprehensive, multi-modal, multi-disciplinary approach to treatment. In this context alone, opioid therapy can be a useful tool in achieving and maintaining an optimal level of pain control in some patients.

European clinical practice recommendations on opioids for chronic noncancer pain - Part 2: Special situations.

BACKGROUND: Opioid use for chronic non-cancer pain (CNCP) is under debate. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). METHODS: The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. RESULTS: The European Clinical Practice Recommendations give guidance for combination with other medications, the management of frequent (e.g. nausea, constipation) and rare (e.g. hyperalgesia) side effects, for special clinical populations (e.g. children and adolescents, pregnancy) and for special situations (e.g. liver cirrhosis). CONCLUSION: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. SIGNIFICANCE: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. A collaboration of medical specialties and of all health care professionals is needed for some special populations and clinical situations.

Crosstalk between estradiol and NFκB signaling pathways on placental leptin expression.

Pregnancy success requires a proper fetal maternal interaction at the establishment of implantation. Leptin has been described as a multitasking cytokine in pregnancy, particularly in the placenta, where it acts as an autocrine hormone. The expression of leptin in normal trophoblastic cells is regulated by different endogenous signals. We have previously reported that 17ß-estradiol upregulates placental leptin expression through genomic and non-genomic mechanisms. To improve the knowledge of estrogen receptor mechanisms in regulating leptin gene expression, we examined transcription nuclear factor kappa B (NFκB) effect on estradiol leptin induction in human BeWo cell line and human term placental explants. We demonstrated that estradiol induction effect on leptin expression is blocked by the inhibition of NFκB signaling. We also found that the overexpression of p65 subunit, the active form of NFκB, induces leptin expression. Moreover, downregulation of estrogen receptor alpha (ERα), through a specific siRNA, abolished NFκB effect on leptin expression. We also demonstrated that ERα enhanced NFκB signaling pathway activation in trophoblastic cells. Estradiol treatment significantly increased p65 expression and phosphorylation of the inhibitory protein κB alpha (IκBα). A reporter plasmid containing NFκB elements was also induced in response to estradiol stimulation. Localization experiments revealed that estradiol treatment induced nuclear localization of overexpressed p65. Moreover, the overexpression of ERα produced a complete displacement of p65 protein to the nucleus. Finally, immunoprecipitation experiments showed the presence of a complex containing ERα and NFκB. All these evidences suggest a cooperative behavior between ERα and NFκB transcription factors to induce leptin transcription.

Mortalidad materna: Hospital Profesor Alejandro Posadas, Buenos Aires. Evolución 2003-2015 / Maternal mortality. Hospital Profesor Alejandro Posadas, Buenos Aires. Evolution 2003-2015

Revisamos las historias clínicas de las mujeres cuyo fallecimiento fue notificado como muerte materna entre agosto de 2003 y diciembre de 2015 en nuestro hospital y calculamos índices, tendencias y años de vida potencialmente perdidos. La información aportada por los certificados de defunción fue exigua. Un total de 52 casos cumplía con los criterios de muerte materna. Dos fueron muertes "incidentales" y dejaron siete huérfanos: una fue causada por embolia grasa por inyección de siliconas en mamas post-cesárea y la otra fue consecuencia de un femicidio que incluyó al feto de 24 semanas. De las 50 muertes maternas restantes, 11 fueron tardías (> 42 días post-parto). Las otras 39 ocurrieron durante el embarazo, parto y puerperio (≤ 42 días): 20 tuvieron causas obstétricas directas, 18 causas indirectas, y la causa de la restante fue indeterminada. La causa más frecuente de muerte fue el aborto séptico. Las muertes maternas directas presentaron como antecedentes más del triple de cesáreas y el doble de gestas que las indirectas, y dejaron el doble de huérfanos. La muerte por placenta accreta tuvo relación directa significativa con el número de cesáreas. El índice de mortalidad materna total varió entre 25 y 150 (media: 72) por 100 000 recién nacidos vivos en el período, con tendencia ascendente. Los años de vida potencialmente perdidos fueron 1576. Se destaca la necesidad de mejorar el sistema de registro de defunción y reforzar las medidas de prevención y asistencia a fin de disminuir la mortalidad materna en el área de influencia del hospital.

We reviewed the medical records of women with maternal death reported from August 2003 to December 2015 in the Posadas Hospital (Buenos Aires Province, Argentina), and calculated indexes, trends and years of potential life lost. A total of 52 cases fulfilled the criteria of maternal death. The information provided by death certificates was meager. Two deaths were incidental: one occurred post-caesarean section and was caused by fat embolism following liquid silicone breast injection, and the other was the consequence of femicide which involved also the 24-week fetus. Of the remaining 50 cases, 11 were late deaths (> 42 days postpartum). In 39 women, death occurred during pregnancy, childbirth, or puerperium up to 42 days: 20 were due to direct obstetric causes, and 18 to indirect, non-obstetric causes, the cause of the remaining death was not determined. The most frequent cause was septic abortion. Direct maternal deaths had had more than twice pregnancies, thrice caesarean sections, and orphaned twice as children as indirect deaths. Death caused by placenta accreta was directly related to the number of previous caesarean sections. Throughout the period, maternal mortality index varied between 25 y 150 (mean: 72) per 100 000 live births with ascending trend and 1576 years of potential life were lost. The study exposes the need to improve the death registration system and, most importantly, strengthen prevention and assistance measures to reduce maternal mortality in the area of influence of our hospital.

Human amniotic membrane conditioned medium inhibits proliferation and modulates related microRNAs expression in hepatocarcinoma cells.

The placental stem cells have called the focus of attention for their therapeutic potential to treat different diseases, including cancer. There is plenty evidence about the antiproliferative, antiangiogenic and proapoptotic properties of the amniotic membrane. Liver cancer is the fifth cause of cancer in the world, with a poor prognosis and survival. Alternative treatments to radio- or chemotherapy have been searched. In this work we aimed to study the antiproliferative properties of the human amniotic membrane conditioned medium (AM-CM) in hepatocarcinoma cells. In addition, we have analyzed the regulation of pro and antiOncomiRs expression involved in hepatocarcinoma physiology. We have determined by 3H-thymidine incorporation assay that AM-CM inhibits DNA synthesis in HepG2 cells after 72 h of treatment. AM-CM pure or diluted at 50% and 25% also diminished HepG2 and HuH-7 cells viability and cell number. Furthermore, AM-CM induced cell cycle arrest in G2/M. When proliferation mechanisms were analyzed we found that AM-CM reduced the expression of both Cyclin D1 mRNA and protein. Nuclear expression of Ki-67 was also reduced. We observed that this CM was able to promote the expression of p53 and p21 mRNA and proteins, leading to cell growth arrest. Moreover, AM-CM induced an increase in nuclear p21 localization, observed by immunofluorescence. As p53 levels were increased, Mdm-2 expression was downregulated. Interestingly, HepG2 and HuH-7 cells treatment with AM-CM during 24 and 72 h produced an upregulation of antiOncomiRs 15a and 210, and a downregulation of proOncomiRs 206 and 145. We provide new evidence about the promising novel applications of human amniotic membrane in liver cancer.

Coartación de aorta y su asociación con la patología mitral / Aortic Coartaction and its association with the mitral pathology

Coartaction of the aorta is characterized by a localized deformity narrowing the aortic lumen. The zone of coartaction is characteristically located beyond the origin of the left subclavian artery. Most of them are located in the zone of the posterior wall of the oposit aorta of the invertion of the ductus. The coartaction of the aorta amounts up to 5.1% of the congenital cardiac malformations and constitutes the eigth cardiac malformation in frequency; Is a malformation tipically associated with the Turner syndrome. The aims of this report were to describe and to analyze the mitral pathology and the clinicosonographic experience in patients with coarctation of the aorta associated to congenital mistral pathology during the last 10 years. An observtiona, descriptive and retrospective study was performed. The history of 103 patients with a diagnosis of coartaction of the aorta assisted in our Hospital were studied. All the patients were confirmed by color Doppler echocardiography. Assuming that the mitral pathology is a frequent association that affects strongly the morbi-mortality and the prognosis of such patients is an indisensable condition to investigate its presence in, front of a diagnosis of coartaction of the aorta (AU)

Compromiso cardiaco en pacientes con Mucopolisacaridosis tipo II (Enfermedad De Hunter) / Cardiac commitment in patients with type II Mucopolysaccharidosis. (Hunter's disease)

This report describes the cardiac involvement of patients with mucopolysaccharidoses Type II (Hunter disease). Mucopolysaccharidoses Type II are an uncommon group of about 50 rare inherited metabolic disorders, that result from defects in lysosomal dysfunction, usually as a consequence of deficiency of a single enzyme required for the metabolism of lipids, glycoproteins or so called mucoplysaccharides. Most of this diorders are autosomal recesively inherited such as Hunter syndrome Mucopolysacharidosis. Tuype II is a lisosomal storage disease caused by a deficiency of the lysosomal ensyme iduronate 2 sulfatase. its frequency is 1 to 100.000 to 150.000 male births; is farmore common in boys. Clinical, electrocardiographical and sonographical variables were determined. As a result 18 patients were evaluated; all the patients presented cardiac involvement. Color Doppler sonocardiogram was pathological in the 100% of the patients, and 4 of them, showed mitral/and or aortic, and 4 patients with miocardic hypoertrophy, and 1 patient, pulmonary hipertension. A clinical review is prsented, and a guide for management is detailed (AU)

Tendencia de edad gestacional y cambios en la práctica obstétrica en un período de 10 años / Gestational age trend and changes in obstetric practice in a period of 10 years

Introducción: La edad gestacional, definida como semanas de gestación completas, es el principal predictor de resultados perinatales. El monitoreo de las tendencias en la distribución de la edad gestacinal puede ser un indicador importante de los resultados de salud y desarrollo a largo plazo. Objetivos: Primario: Examinar la tendencia de la edad gestacional de los partos asistidos en el Servicio de Obstetricia del Hospital Nacional A. Posadas durante el período comprendido entre 2008-2017. Secundarios: Evaluar la tendencia en la edad gestacional según forma de inicio del parto. Determinar vía de finalización del embarazo según edad gestacional. Establecer complicaciones perinatales asociadas a la edad gestacional. Material y Métodos: Estudio observacional descriptivo y transversal. El relevamiento de datos se realizó a través del SIP. Criterio de inclusión: edad gestacional igual o mayor a 37 semanas. Criterios de exclusión: faltante de datos para la variable principal de interés. Las variables se presentan a través de medidas de frecuencia (%). Las comparaciones se realizaron con test Chi cuadrado/Fisher exact test según la conformación de la tabla de doble entrada. Se consideró un p valor<=0.05. Stata 12.0 Resultados: Durante el período de estudio se registraron 38977 nacimientos, de los cuales 28835 cumplieron con los criterios de inclusión. El mayor porcentaje de nacimientos se produjo a las 39 semanas, variando entre 27% (2008) y 35% (2016). Se encontró una disminución gradual de los nacimientos a las 40 semanas, siendo de 12% en 2008 y 6% en 2017. La edad gestacional más frecuente de finalización programada, hasta el 2014 la edad gestacional más frecuente fue 38 semanas (25%-33%) y a partir del 2015 se postergó a las 39 semanas (29%-37%). En cuanto a la vía de finalización, la prevalencia de partos vaginales fue mayor en todas las semanas, aumentando la frecuencia a mayor edad gestacional (p=0.001). Al analizar las complicaciones perinatales se encontró que la tasa de mortalidad perinatal fue en disminución hasta las 39 semanas, con una diferencia mayor a menor edad gestacional al comparar nacimientos programados y espontáneos (24.5%00 vs 13%00; 13%00 vs 7%00; y 4%00 vs 3%00 a las 37, 38 y 39 semanas respectivamente). El 39% de los nacimientos producidos a las 37 semanas de modo programaado requirieron ingreso a terapia intensiva neonatal, disminuyendo a 19% a las 38 y 14% a las 39 semanas. Conclusión: La distribución de la edad gestacional al término del embarazo ha cambiado en los últimos 10 años a expensas de un aumento de la finalización espntánea a las 39 semanas y a un cambio en la práctica obstétrica con respecto a la postergación de una semana en la finalización programada en aquellas mujeres con patologías materno fetales o cesáreas iterativas. Este cambio constribuye a disminuir la morbimortalidad perinatal ya que fue observado que a menos edad gestacional aumentó el ingreso a terapia intensiva neonatal luego del nacimiento programado, así como también contribuye a la disminución del gasto en salud (AU)

This article details trends of the gestational age and changes in the obstetrical practice during a 10 yr, period. We can define gestational age as weeks of complete gestation, as the main predictor of perinatal results. The monitoring of the trends in the distribution of the gestational age can be an important indicator of the results of the health and development in a long term. Objectives: Primary: to examine the tendency of the gestational age of the deliveries attended in our Hospital between 2008-2017. Secondary to evaluate the tendency of the gestational age according to the start of the delivery. To determine the route of ending of the pregnancy according to the start of the delivery. To determine the route of ending of the pregnancy according with the gestational age. To establish perinatal complications associated to the gestational age. With this study it is proposed to evaluate the tendency to the gestational age at the birth, in a 10-yr. period in our institution and if changes in the obstetric practice in that period influenced in it. In conclusion, the results obtained in this investigation, justify the change of behaviour in the programmed ending of the pregnancy, contributing to the decrease of the perinatal morbi-mortality, and in consecuence, to the diminishing of the waste in health (AU)

Detección prenatal de cardiopatías congénitas y factores relacionados. Experiencia en un hospital nacional / Prenatal detection of congenital cardiopathies and related factors. Experience in a national hospital

The authors present a estudy related to the prenatal detection of congenital heart diseases. The congenital anomalies (CA) are morphological or functional disorders of prenatal origin, present since the birth, even they can be detected later on, during their lifes. They constitute the second cause of infantile death in our country, following, prenatal diseases (prematurity, perinatal infections, etc.) The most severe CA have relevance for the health and require usually clinical a surgical treatment. Congenital cardiopaties (CC) are the most frequent and represent a great impact in the mobimortality both neonatal and pediatric. Foetal echocardiography is a sensitive and specific method of investigation for prenatal detection of cardiac malformations. Experience has shown that echocardiographic screening can demonstrate, the presence of probably various cardiac disease in the foetus as early as 18-20 th weeks of pregnancy. It is recommended that screening should be carried out as part of other forms of obstetric ultrasonic screening. Our aims were to analyze the characteristies of the pregnants at risk factors to CC. To determine the associated factors to the fetal pathology of the fetal electrocardiogram, and to correlate the postnatal diagnosis by cardiac echodoppler, which impoves neonate survival and reduces morbidity. The results obtained are detailed in the article (AU)

Experiencia en la colocación del DIUPP / Experience in the placement of the Diupp

Family planning is a key intervention to decrease the mortality rates and maternal morbidity, and neonatal mortality rates of children by mean of the preventiion of unwanted pregnancies, the same as pregnancies that happen very clsely to another previous one with little space between them. Several studies performed in different parts of the world have demonstrated adverse results related specially with the spaciament of the pregnancies. The risks are particularly higher with women wich get pregnant les after than a previous deliver, spontaneous abortion or induced abortion. The instrauterine device (ID) is a family planning higly efficacious with a prolongued action and reversible, that offers security to most postpartum women, including those who are still nursing. The primary aim of the present report was to determine the frequency in the placement of the DIUPP in our Obstetrical Department between 01/06/2017 and 30/06/2018, and in a second instance, to describe the method for placement of the DIUPP, to determine the curve of learning, to measure the rate of expulsion of the device, and to evaluate the conformity of the users of the method. Unplanned pregnancies have strongly increased, and for that circumstance, we believe that with new strategies, such as it is with the post-event anticonception, we can improve the reproducive health (AU)