Aberrant right subclavian artery as soft marker in the diagnosis of trisomy 21 during the first trimester of pregnancy.

PURPOSE: Aberrant right subclavian artery is an anatomical variation with a prevalence of around 0.5-1.5% of the general population, being more frequently found among people with chromosomopathies, especially, trisomy 21. Despite being an anatomical finding, and thus, constant through the whole pregnancy, its value in the diagnosis of aneuploidies during the first trimester of pregnancy has been little studied. The aim of this study is to evaluate the reliability of the first-trimester ultrasound in the diagnosis of ARSA and its utility in the early diagnosis of aneuploidies. METHODS: This was a descriptive, observational, cross-sectional study that included all fetuses with sonographic diagnosis of ARSA between 2011 and 2018. RESULTS: There were 257 cases of ARSA diagnosed. The first-trimester ultrasound showed the following results in the detection of ARSA: sensitivity of 68% (CI 95% 60.8%-74.5%), specificity of 99.9% (CI 95% 99.9%-100%), positive predictive value of 93.7% (CI 95% 88.1%-96.8%), and negative predictive value of 99.6% (CI 95% 99.5%-99.7%). Due to the presence of ARSA, two cases of trisomy 21, that would have been missed in the first trimester, were diagnosed, using ARSA as a soft marker and modifying the risk obtained by the combined screening as part of the genetic sonogram of the first trimester. CONCLUSIONS: ARSA visualization during the first-trimester ultrasound is trustworthy and it can improve the detection of trisomy 21 in some cases of aneuploidy missed during the combined screening of the first trimester.

Congenital heart disease in adults (when kids grow up) pediatric geriatric anesthesia.

PURPOSE OF REVIEW: The current review focuses on the new development of adult congenital heart disease (ACHD) patients in the areas of imaging, percutaneous interventions, ventricular assist devices and transplantation. RECENT FINDINGS: Since the last ACHD publication in the journal, several advances have been made in the evaluation and treatment of these patients. As CHD patients' longevity increases pregnancy, comorbities and acquired heart disease become a concern. Recent data show that the incidence of complications in low-risk CHD is not higher that the regular population. In addition, breakthrough research in percutaneous valve implantation has been published showing good outcomes but needing intensive care recovery in a significant number of patients. In the ACHD heart failure population, assist device and transplant fields mounting evidence shows that these therapies should not be the last resort since low-risk ACHD patient may have similar outcomes to those with acquired heart disease. Finally risk stratification is important in ACHD to define better ways to recover from surgery and anesthesia. SUMMARY: The field of anesthesia for ACHD is growing with new indications for diagnostic, interventional and surgical procedures. Tailoring cardiac and noncardiac care to the different risk profile in ACHD patients will be defined in the next few years. VIDEO ABSTRACT: Motta summary clip: http://links.lww.com/COAN/A65.

Isolation and Characterization of Cellulose Microfibers from Colombian Cocoa Pod Husk via Chemical Treatment with Pressure Effects.

One of the current challenges is to add value to agro-industrial wastes, and the cocoa industry generates about 10 tons of cocoa pod husks in Colombia for each ton of cocoa beans, which are incinerated and cause environmental damage. This study characterized the Colombian cocoa pod husk (CPH) and to isolate and characterize cellulose microfibers (tCPH) extracted via chemical treatment and pressure. Chemical and physical analyses of CPH were performed, and a pretreatment method for CPH fibers was developed, which is followed by a hydrolysis method involving high pressure in an autoclave machine with an alkaline medium (6% NaOH), and finally, bleaching of the fiber to obtain tCPH. The tCPH cellulose microfibers were also chemically and physically analyzed and characterized by infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), and thermo-gravimetric analysis (TGA). Chemical and physical characterization showed a decrease in lignin content in tCPH. FTIR analysis showed the absence of some peaks in tCPH with respect to the CPH spectrum; XRD results showed an increase in crystallinity for tCPH compared to CPH, due to a higher presence of crystalline cellulose in tCPH. SEM images included a control fiber treated without high pressure (tCPHnpe), and agglomerated fibers were observed, whereas cellulose microfibers with a mean diameter of 10 ± 2.742 µm were observed in tCPH. Finally, with TGA and DTGA it was confirmed that in tCPH, the hemicellulose and lignin were removed more successfully than in the control fiber (tCPHnpe), showing that the treatment with pressure was effective at isolating the cellulose microfibers from cocoa pod husk.

Emotional contagion in nonhuman animals: A review.

Emotional contagion, the emotional state-matching of an individual with another, seems to be crucial for many social species. In recent years evidence on emotional contagion in different animal species has accumulated. However, despite its adaptative advantages and its presumed simplicity, the study and direct demonstration of this phenomenon present more complexities than previously thought. For these reasons, a review of the literature on emotional contagion in nonhuman species is timely to integrate current findings. In this paper thus, we carry out a comprehensive review of the most relevant studies on emotional contagion in animals and discuss the main problems and challenges of the field. We conclude that more research is needed to broaden our understanding of the mechanisms and functions of emotional contagion and the extent to which this process is present in a wide variety of species. Furthermore, the comparative study of emotional contagion would benefit from the use of systematized paradigms including both behavioral and physiological measures and the simultaneous recording of the responses of the interacting individuals to reliably assess an emotional state-matching between them and reliable controls. This article is categorized under: Cognitive Biology > Evolutionary Roots of Cognition Psychology > Comparative Psychology Psychology > Emotion and Motivation.

The study of aggression and affiliation motifs in bottlenose dolphins' social networks.

Networks in biology have provided a powerful tool to describe and study very complex biological processes and systems such as animal societies. Social network analysis allows us to assess different processes occurring in animal groups. In the current study, we use this approach to investigate how conflict dynamics and post-conflict interactions shape the social networks of groups of captive bottlenose dolphins. We first examined temporal changes and aggression-affiliation motifs in the observed dolphins' network structure. Using the results of the previous analysis, we built two models that simulate the dynamics of aggression and affiliation in a small dolphin group. The first model is based only on the observed statistics of interactions, whereas the second includes post conflict memory effects as well. We found that the resulting social networks and their most common motifs matched the association patterns observed in wild and captive dolphins. Furthermore, the model with memory was able to capture the observed dynamics of this group of dolphins. Thus, our models suggest the presence and influence of post-conflict behaviors on the structure of captive dolphins' social networks. Therefore, the network approach reveals as an effective method to define animal social networks and study animal sociality. Finally, this approach can have important applications in the management of animal populations in captive settings.

Feasibility and Effectiveness of a Workplace-Adapted Mindfulness-Based Programme to Reduce Stress in Workers at a Private Sector Logistics Company: An Exploratory Mixed Methods Study.

There is a high prevalence of stress in the logistics sector owing to very demanding, fast-paced and unpredictable tasks. Mindfulness-based programmes may reduce stress but require considerable practice. Our aim was to evaluate the feasibility and effectiveness of a shortened, workplace-adapted mindfulness-based programme for the logistics sector (WA-MBP-LS) for the purpose of reducing stress. A nonblinded, nonrandomised, two-arm controlled trial was conducted. The WA-MBP-LS (n = 32) consisted of six weekly 90-min mindfulness sessions. The control group (n = 36) attended a psycho-educational seminar. The Perceived Stress Scale (PSS) and Five Facets of Mindfulness Questionnaire (FFMQ) were measured at pretest, posttest and 6-month follow-up. Differences between groups were evaluated using mixed-effects models. Qualitative methods were used to analyse implementation issues. A 64.2% reduction was observed between initial volunteers and actual participants. Attrition at six-month follow-up was 45.6%. Participants attended a median of five sessions. Decreases in PSS favoured the WA-MBP-LS group at posttest and follow-up. FFMQ played a mediating role in PSS reductions. Barriers were disinterest, lack of programming, work overload and absences from work. Facilitators were curiosity, timing, company facilities and audio recordings. The WA-MBP-LS was feasible and effective in reducing stress, but more efforts to improve the practicalities of implementation are desirable.

A computerized tool to assess reading skills of students with motor impairment.

Conventional tests for assessing the early reading skills of preschool children on school entry are not accessible to students with motor limitations of upper limbs. This paper presents a game-like computerized test featuring an appealing scenario that is accessible to these students. It was developed on a platform that creates 2D vector graphics and contains three phases of interactive content accessible through an adapted peripheral. A conventional card-based test was also used to validate the effectiveness of the computerized test. Both tests were performed by thirty-three preschool children without mobility impairment all aged between four years and six months and six years and two months (x¯ = 5,33; σ = 0,44). The Wilcoxon signed-rank test was used to compare the nonparametric data from the computerized test with the card-based test in the first and second phase, yielding results of p = 0.11 and p = 0.21, respectively. The Student's t-test was conducted to compare the parametric data of the third phase of the computerized test with the data from the third phase of the card-based test yielded results of p = 0.07.Three gaming experts considered the computerized test to be fun and engaging, and three teachers concluded that the computerized test meets educational goals. Additionally, seven volunteers with moderate mobility impairment (group T), aged between eight and seventeen years old (x¯=11.8; σ = 3.5), accompanied by two physical therapists, took the computerized test using the adapted peripheral device and performed the required tasks without difficulty and without showing signs of fatigue. Based on the results obtained it can be concluded that the computerized test may enable educators to include students with mobility difficulties in literacy assessments and to design teaching strategies that are appropriate given their levels of knowledge.

The association of renal dysfunction and the use of aprotinin in patients undergoing congenital cardiac surgery requiring cardiopulmonary bypass.

BACKGROUND: The use of large-dose aprotinin during cardiopulmonary bypass (CPB) in adult patients has been linked to postoperative renal dysfunction, but its effect on the pediatric population undergoing complex congenital cardiac operations is not well defined. METHODS: We used a retrospective cohort analysis to evaluate children undergoing cardiac surgery requiring CPB between July 2004 and July 2006. Demographic data and surgical risk quantified by the Aristotle surgical complexity level were analyzed as covariates. Renal dysfunction was defined according to the RIFLE criteria, an international consensus classification which defines three grades of increasing severity of acute kidney injury: risk (Class R), injury (Class I), and failure (Class F) based on serum creatinine values. A univariate and multivariate logistic regression analysis and a propensity score were used to analyze the data. The propensity score was developed using pretreatment covariates associated with the administration of aprotinin. A multivariate logistic regression was then used with the propensity score and intraoperative measures as covariates. A P value <0.05 was considered statistically significant. RESULTS: Among 395 patients who underwent cardiac surgery, 55% received aprotinin and 45% did not. Thirty-one percent of the cohort had previous cardiac surgery; 17% were neonates. According to the RIFLE criteria, 80 of the patients (20.3%) had acute kidney injury in the postoperative period; 53 (13.4%) had risk of renal dysfunction with 23 (5.8%) having injury and four patients (0.7%) having failure. Those receiving aprotinin had a higher incidence of previous cardiac surgery (54.1% vs 5%), sepsis (6.9% vs. 0.0%), heart failure (24.8% vs 12.4%), mechanical ventilation (25.2% vs 2.8%), or mechanical circulatory support (6.0% vs. 0.6%). More patients had an Aristotle level of 4 (26.6% vs 2.8%) and were treated with diuretics (63.8% vs 26.6%), angiotensin converting enzyme inhibitors (21.1% vs 7.9%), milrinone (25.7% vs 4.5%), and inotropic support (16.1% vs 2.3%). Although there was a significant difference in the unadjusted risk of renal dysfunction, adjustment with the preoperative propensity score revealed that there was no association between aprotinin and renal dysfunction (OR 1.32; 95% CI 0.55-3.19). The duration of CPB was the only independent variable associated with the development of renal dysfunction (OR 1.0; 95% CI 1.009-1.014). CONCLUSIONS: Patients who receive aprotinin are more likely to present with preoperative risk factors for the development of postoperative renal dysfunction. However, when associated risk factors are properly considered, the use of aprotinin does not seem to be associated with a higher risk of developing renal dysfunction in the immediate postoperative period in children.

Bottlenose dolphins do not behave prosocially in an instrumental helping task.

Although bottlenose dolphins (Tursiops truncatus) are known for being a highly social species that live in complex societies that rely on coalition formation and cooperative behaviours, experimental studies on prosocial behaviour in this species are scarce. Helping others reach their goals (instrumental helping) is considered as an example of prosocial behaviour. Thus, in this pilot study, we examined whether a group of five captive bottlenose dolphins would behave prosocially in an instrumental helping task. Dolphins were given the opportunity to share tokens that allow their partners to obtain a preferred toy. Dolphins were tested in their free time and they could choose to share the tokens or do nothing. None of the dolphins shared the tokens, instead, they preferred to play with them, ignoring their partners. They did transfer the tokens to other sides of the pool but out of the reach of their partners. Therefore, this group of dolphins did not spontaneously help their partners in this task, showing no preference for other-regarding behaviour in this context.

The comparative study of empathy: sympathetic concern and empathic perspective-taking in non-human animals.

While empathy is a century-old psychological concept, its study in non-human animals has become the focus of much recent scientific interest, as it promises to provide the clues to understand the evolutionary origins of our social and moral nature. A review of the comparative study of empathy is thus timely to complement and constrain anthropocentric views, and to integrate current findings. However, this is not an easy task. The study of animal empathy has developed using different paradigms, different concepts of the phenomena involved, and the absence of a systematic program. Herein, we carry out a comprehensive review of the literature on complex forms of empathy in non-human animals: sympathetic concern and empathic perspective-taking. In particular, we focus on consolation and targeted helping, as the best examples of each category. In so doing, we try to shed light on the current debate concerning whether these phenomena are exclusively human traits. First, we try to clarify the terminology and taxonomy of forms of empathy, providing operative criteria for these phenomena that are applicable to both human and non-human animals. Second, we discuss whether the available evidence qualifies such behaviour as empathic. Third, we aim to provide an integrative view of the field, clarifying the challenges and conditions to satisfy. We also hope to highlight the importance of the study of these processes for elucidating the evolutionary history of this capacity across the animal kingdom.

The late effect of Kinesio Taping® on handgrip strength.

Kinesio Taping® elastic tape is increasingly used in physiotherapy treatment. However, there is a lack of scientific research regarding the late effects of its use. This study quantified the late effects of applying the Kinesio Taping® elastic tape by measuring changes in handgrip muscle strength after 24, 48 and 72 h of application. The Kinesio Taping® elastic tape was applied on the dominant and non-dominant limbs of 36 volunteers randomly assigned to three groups: muscle facilitation, muscle inhibition and control group. The statistical test showed there was a statistically significant difference among all groups of dominant limb and non-dominant limb. However, the analysis on intragroup relationship to periods of application (Initial, 24, 48 and 72 h) and the interaction among repeated measures showed there was no statistically significant difference. This result may contribute to the investigation of the late effects of the Kinesio Taping® elastic tape on the physical rehabilitation.

Intensive care course after stage 1 Norwood procedure: are there early predictors of failure?

OBJECTIVE: The purpose of this study was to review the early postoperative course of stage 1 Norwood with Blalock-Taussig shunt (BTS) or right ventricle-to-pulmonary artery conduit (RVPA) and to identify early predictors of failure. MATERIAL AND METHODS: A retrospective analysis was conducted in 33 consecutive neonates who underwent BTS (n=19) or RVPA (n=14) stage 1 Norwood procedure between 2000 and 2005. Pre-, peri-, and postoperative data included: hourly hemodynamics and blood gases, pulmonary to systemic flow ratio, duration of mechanical ventilatory and inotrope support, intensive care and hospital stay. Failure was defined as death or transplantation. RESULTS: Thirteen patients failed the procedure (39.4%): 10 BTS (52.6%) and 3 RVPA (21.4%). Failure decreased from 61.1% in 2000-2002 to 13.3% in 2003-2005 and was associated with: low systolic, mean and diastolic blood pressure, urine output, pH, base excess, bicarbonates, and high pulmonary to systemic flow ratio within 24 h postoperatively. Arterial oxygen and CO2 pressure, and oxygen saturation did not differ with failure. RVPA had higher diastolic blood pressure and more stable hemodynamics despite similar pulmonary to systemic flow ratio. Duration of mechanical ventilation, inotrope support, intensive care stay were shorter in RVPA. Postoperative echographic ventricular dysfunction and tricuspid regurgitation grade were correlated with failure. CONCLUSIONS: Excessive pulmonary to systemic flow ratio and low blood pressure are associated with failure. High diastolic blood pressure more than low pulmonary to systemic flow ratio seems to account for more favorable outcomes in RVPA compared to BTS procedure.

Extubation after cardiothoracic surgery in neonates, children, and young adults: One year of institutional experience.

OBJECTIVE:: Describe risk factors associated with successful and early extubation in the pediatric cardiac intensive care unit. DESIGN:: Retrospective chart review. SETTING:: University hospital, cardiac intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Review of 212 consecutive surgical admissions from January 2003 to January 2004, excluding deaths. Preoperative, intraoperative, and postoperative variables were studied. Successful extubation was defined as no reintubation at any time during the cardiac intensive care unit course and early extubation was defined as mechanical ventilation 24 hrs after surgery. A history of prematurity (odds ratio [OR], 5.84, 2.29-14.9; p < .001), base excess (OR, 1.47, 1.27-1.70; p < .001), cardiopulmonary bypass time (OR, 1.01, 1.01 to -1.2; p < .05), and the need for surgical reintervention (OR, 18.29, 2.78 to -120.07; p < .05) were associated with intubation for >24 hrs. CONCLUSION:: Extubation without the need for reintubation can be achieved in nearly all children following cardiothoracic surgery. The majority of successful extubations can be achieved within 24 hrs of surgery.

Extubation after cardiothoracic surgery in neonates, children, and young adults: one year of institutional experience.

OBJECTIVE: Describe risk factors associated with successful and early extubation in the pediatric cardiac intensive care unit. DESIGN: Retrospective chart review. SETTING: University hospital, cardiac intensive care unit. MEASUREMENTS AND MAIN RESULTS: Review of 212 consecutive surgical admissions from January 2003 to January 2004, excluding deaths. Preoperative, intraoperative, and postoperative variables were studied. Successful extubation was defined as no reintubation at any time during the cardiac intensive care unit course and early extubation was defined as mechanical ventilation < or =24 hrs. Median subject age was 8 months (range, 1 day-25 yrs), with 57% <1 yr of age and 22% neonates. Fifty-eight (27%) were extubated in the operating room and 122 (58%) were extubated at <24 hrs (mean, 6.1 +/- 7.7 hrs). Only seven patients failed extubation: three in the operating room because of upper airway obstruction and four in the cardiac intensive care unit for acute respiratory failure associated with atelectasis (n = 2), ventricular dysfunction (n = 1), and arrhythmia (n = 1). There were no extubation failures in patients extubated >24 hrs after surgery. A history of prematurity (odds ratio [OR], 5.84, 2.29-14.9; p < .001), base excess (OR, 1.47, 1.27-1.70; p < .001), cardiopulmonary bypass time (OR, 1.01, 1.01 to -1.2; p < .05), and the need for surgical reintervention (OR, 18.29, 2.78 to -120.07; p < .05) were associated with intubation for >24 hrs. CONCLUSION: Extubation without the need for reintubation can be achieved in nearly all children following cardiothoracic surgery. The majority of successful extubations can be achieved within 24 hrs of surgery

A reverse-hybridization test for the identification of 76 pneumococcal serotypes, 42 individually and 34 in pairs.

The S. PneumoStrip test is a recently developed reverse hybridization strip-based commercial assay that allows for the identification of 76 pneumococcal serotypes, 42 individually and 34 in pairs, according to their specific gene sequences. The test was validated with reference strains of 92 different pneumococcal serotypes and with a selection of 75 clinical isolates representing 55 serotypes, showing 100% sensitivity and specificity. The test was also applied to 64 pneumococcal invasive isolates (23 different serotypes) consecutively collected between June 2016 and March 2017, with 60 (93.8%) being serotyped. Four isolates belonging to serotypes 13, 29, and 35B (2 isolates), which are not included in the test, did not produce a hybridization signal with serotype specific probes. The identification of most serotypes causing invasive pneumococcal disease together with the simplicity of performance and results interpretation, and the use of routine laboratory equipment make this test very suitable for most clinical and research laboratories.

Use of dexmedetomidine in children after cardiac and thoracic surgery.

OBJECTIVE: In this report, we describe our experience with the use of dexmedetomidine in spontaneously breathing as well as in mechanically ventilated patients, after congenital cardiac and thoracic surgery. DESIGN: Retrospective case series. SETTING: University hospital, pediatric cardiac intensive care unit. PATIENTS: Thirty-three spontaneously breathing and five mechanically ventilated patients who received dexmedetomidine after cardiothoracic surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thirty-eight patients, age 8 +/- 1.1 yrs old and weight 29 +/- 3.8 kg, were included. Seven patients (18%) were <1 yr old. Dexmedetomidine was used as a primary sedative and analgesic agent, and when its effect was considered inadequate, despite incremental infusion doses, a rescue agent was administered. The initial dexmedetomidine infusion dose was 0.32 +/- 0.15 microg/kg/hr followed by an average infusion of 0.3 +/- 0.05 microg/kg/hr (range 0.1-0.75 microg/kg/hr). There was a trend toward higher dexmedetomidine infusion requirement in patients <1 yr old compared with older children, 0.4 +/- 0.13 vs. 0.29 +/- 0.17 microg/kg/hr (p = .06). Desired sedation and analgesia were achieved during 93% and 83% of the dexmedetomidine infusion, respectively. According to the intensive care unit sedation scale (score 0-3) and two pain scales (Numeric Visual Analog Scale and Face, Legs, Activity, Cry, and Consolability, score 0-10), the mean sedation score was 1.3 +/- 0.6 (mild sedation) and the mean pain score was 1.5 +/- 0.9 (mild pain). The most frequently rescue drugs administered were fentanyl, morphine, and midazolam. Overall, 49 rescue doses of sedatives/analgesics were given. Patients <1 yr old required more rescue boluses than older children, 22 boluses (3.19 +/- 0.8) vs. 27 boluses (0.8 +/- 0.2, p = .003). Throughout the dexmedetomidine infusion there was no significant change in the systolic and diastolic blood pressure trend. Six patients (15%) had documented hypotension. In three, hypotension resolved with decreasing the dexmedetomidine infusion dose whereas in the other three, hypotension resolved after discontinuing the infusion. Although there was a trend toward lower heart rates, this was not clinically significant. One patient had an episode of considerable bradycardia without hypotension, which resolved shortly after discontinuing the dexmedetomidine infusion. No significant changes in the arterial blood gases or respiratory rates were observed. There was no mortality, and the total intensive care unit length of stay was 19 +/- 2 hrs. CONCLUSIONS: Our data suggest that dexmedetomidine is a well-tolerated and effective agent for both spontaneously breathing and mechanically ventilated patients following congenital cardiac and thoracic surgery.

The combination of low dose of naloxone and morphine in PCA does not decrease opioid requirements in the postoperative period.

The continuous infusion of low doses of naloxone has been reported to decrease postoperative opioid requirements and opioid side effects. However, there is no study that evaluates the effectiveness of the combination of a low dose of naloxone and morphine using patient-controlled analgesia (PCA). This prospective, randomized double-blind controlled study sought to determine if the combination of a low dose of naloxone and morphine in a PCA solution decreases postoperative opioid requirements and pain intensity. One hundred sixty-six patients (18-65 years old) undergoing operations of less than 3 h duration with an American Society of Anesthesiologist physical status I or II were randomized to receive PCA morphine 1 mg/cc plus normal saline or PCA morphine 1 mg/cc plus naloxone 6 microg/cc. Initial PCA settings were 0.5 cc per demand with a lockout time of 10 min. The numbers of 2.5 cc supplemental rescue doses and the cumulative dose of each solution were recorded in the first 24 h after the surgical procedure. Pain intensity and opioid side effects were evaluated every 10 min in the post-anesthesia care unit and every 4 h afterwards. Patient satisfaction was assessed at the end of the 24 h of observation. The morphine+naloxone group had more treatment failures (P=0.0001), higher opioid requirements (P=0.0097), greater pain intensity (P=0.04), less pain relief (P=0.004), and less satisfaction (P=0.01) than the morphine group. The incidence of side effects was similar in both groups (P=0.3). Contrary to previous reports, adding low doses of naloxone to a morphine PCA solution increases opioid requirements and pain.

Mesomorphism of a tetrahedral zinc complex.

Thermotropic smectic phases have been observed for the first time in a zinc coordination complex with tetrahedral geometry; this complex, which contains the pyrazole dimer bis[3,5-bis(p-decyloxyphenyl)pyrazolyl]ethane as the ligand, exhibits fluorescence.

Multiple-parameter screening and prevention of preeclampsia: evaluation of a protocol implemented at Hospital Universitario Puerta de Hierro / Cribado multiparamétrico y prevención de la preeclampsia. Evaluación del protocolo implantado en el Hospital Universitario Puerta de Hierro

Objective: To evaluate the implementation in our center of a preeclampsia risk screening protocol in a low-risk population combined with preventive treatment (aspirin, 100 mg/d) by evaluating the variation in the incidence of preeclampsia. To validate the analysis tool and its predictive strength. Material and methods: We studied 310 patients divided into 2 groups: 138 controls (TR) and 172 patients who had undergone screening and received preventive treatment (CI). We collected demographic data, gestational age at consultation, obstetric history, reproductive method, risk factors for preeclampsia (hypertension, diabetes, BMI, kidney disease, and coagulopathy), use of aspirin as preventive therapy, and data on the outcome of pregnancy (hypertension, proteinuria, diagnosis of preeclampsia, and complications). In the CI group, we also recorded the risk of preeclampsia. This was calculated retrospectively in the TR group. Results: The protocol had 80% sensitivity and 98.4% specificity. The incidence of preeclampsia was 3.62% in the TR group and 0.58% in the CI group (p=0.053), with an OR of 0.155 (0.017-1.34). Among patients with a high risk, 66.7% developed preeclampsia in the TR group and 9.1% in the CI group (p=0.027), with an OR of 0.05 (0.04-0.57) and a number needed to treat of 1.74. Conclusions: The high sensitivity and specificity of the analytical tool make it adequate for screening. The protocol reduces the incidence of preeclampsia in high-risk patients, even if that difference was not significant at the level of the study population

Objetivo: evaluar la implantación, en nuestro centro, de un protocolo de cribado del riesgo de preeclampsia en población de bajo riesgo obstétrico, combinado con tratamiento preventivo con 100 mg diarios de ácido-acetilsalicílico, mediante el análisis de la variación de la incidencia de preeclampsia. Validar la herramienta utilizada, analizando su capacidad predictiva. Material y métodos: se estudiaron 310 pacientes, distribuidas en dos grupos: 138 controles (TR) y 172 con cribado y tratamiento preventivo (CI). Se recogieron datos demográficos, edad gestacional en consulta, historia obstétrica, método reproductivo, factores de riesgo de preeclampsia (hipertensión, diabetes, IMC, nefropatía y coagulopatía), toma de ácido-acetilsalicílico de forma preventiva y datos del final de la gestación (hipertensión, proteinuria, diagnóstico de pree-clampsia y complicaciones). En el grupo CI se recogió el índice de riesgo, y en el grupo TR se calculó de forma retrospectiva. Resultados: la herramienta obtuvo una sensibilidad del 80% y una especificidad del 98,4%. La incidencia de preeclamp-sia resultó del 3,62% en el grupo TR frente al 0,58% en el grupo CI (p=0,053), con una OR de 0,155 [0,017-1,34]. Entre las pacientes con índice de alto riesgo, un 66,7% del grupo TR presentó preeclampsia, frente a un 9,1% del grupo CI (p=0,027), con OR 0,05 [0,04-0,57] y una NNT de 1,74. Conclusiones: la herramienta utilizada tiene elevada sensibilidad y especificidad, resultando útil como cribado. El protocolo implantado reduce la incidencia de preeclampsia en pacientes con índice de alto riesgo, aunque la variación a nivel poblacional no fue significativa

Peripheral device to quantify grip and pinch capacity of children

Abstract Introduction Grip and pinch movements are important to perform daily activities and to manipulate objects. In this paper we describe the development and evaluation of a peripheral device to quantify cylindrical grip, pulp-to-pulp pinch, pulp-to-side pinch strength and range of motion of children. Methods Three objects were selected: a door handle, a switch, and a key, which were instrumented with force sensing resistors to analyse the strength. Potentiometers were used to verify the range of motion and micro switches to assure the correct position of the fingers during the movement execution. Thirty volunteers (8.77 ± 1.28), both male and female, were selected to test the peripheral device functionality. Results The results determined the minimum necessary strength values for the object activation and maximum displacement, in which the values are 2.5N, 40°; 2.7N, 55°; and 2.8N, 100%, for door handle object, key object, and switch object, respectively. In the functionally tests, volunteers have shown a superior strength for activating each object and 73.33% of them have completed the range movement in the key object, 86.67% in the switch object, and 93.33% in the door handle object. Conclusion The developed peripheral device enabled the measurement of range and static and dynamic strength of grip and pinch movements of children.