[Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: Time matters]. / Impacto de los días transcurridos desde el inicio de los síntomas hasta la hospitalización en la mortalidad hospitalaria por COVID-19: el tiempo importa.

Background: COVID-19 shows different clinical and pathophysiological stages over time. Theeffect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospital-ization and how other independent prognostic factors perform when taking this time elapsedinto account. Methods: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online datacapture registry. Univariate and multivariate COX-regression were performed in the generalcohort and the final multivariate model was subjected to a sensitivity analysis in an earlypresenting (EP; < 5 DEOS) and late presenting (LP; ≥5 DEOS) group. Results: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in theLP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortalityin the multivariate Cox regression model along with other 9 variables. Each DEOS incrementaccounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93---0.98). Regarding variationsin other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index onlyremained significant in the EP group while D-dimer only remained significant in the LP group. Conclusion: When caring for COVID-19 patients, DEOS to hospitalization should be consideredas their need for early hospitalization confers a higher risk of mortality. Different prognosticfactors vary over time and should be studied within a fixed timeframe of the disease.

Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: time matters.

BACKGROUND: COVID-19 shows different clinical and pathophysiological stages over time. The effect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19 prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospitalization and how other independent prognostic factors perform when taking this time elapsed into account. METHODS: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online data capture registry. Univariate and multivariate COX-regression were performed in the general cohort and the final multivariate model was subjected to a sensitivity analysis in an early presenting (EP; <5 DEOS) and late presenting (LP; ≥5 DEOS) group. RESULTS: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in the LP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortality in the multivariate Cox regression model along with other 9 variables. Each DEOS increment accounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93-0.98). Regarding variations in other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index only remained significant in the EP group while D-dimer only remained significant in the LP group. CONCLUSION: When caring for COVID-19 patients, DEOS to hospitalization should be considered as their need for early hospitalization confers a higher risk of mortality. Different prognostic factors vary over time and should be studied within a fixed timeframe of the disease.

Mejoramiento de arveja (Pisum sativum L): avances del programa de mejoramiento genético de la Universidad Nacional de Rosario / Pea (Pisum sativum L.) breeding: advances of the breeding program at Universidad Nacional de Rosario

RESUMEN En 2005 se inició un programa de mejoramiento de arveja para aumentar la producción en cantidad y calidad en la Facultad de Ciencias Agrarias (FCA), Universidad Nacional de Rosario (UNR). Los primeros pasos fueron reunir una colección activa de germoplasma de todo el mundo y analizar la variabilidad genética a través de rasgos morfo-agronómicos y moleculares. En 2014, el Instituto Nacional de Tecnología Agropecuaria (INTA) y la FCAUNR unieron esfuerzos para promover el desarrollo local de genotipos de arveja adaptados a la región. Este programa, utilizando metodologías convencionales, ha obtenido hasta el momento una nueva variedad comercial (Primogénita FCA-INTA) de color de cotiledón verde, semi-áfila, con alta adaptación a las condiciones agroecológicas locales y alto potencial de rendimiento. El mejoramiento genético, sin embargo, es un proceso lento. El desarrollo de nuevas variedades requiere una década o más utilizando metodologías tradicionales, por lo que se propusieron diferentes alternativas para la reducción de este período. Los haploides duplicados y el cultivo in vitro han sido algunas de las metodologías desarrolladas, sin embargo, en legumbres no se han podido implementar de manera eficiente en los programas de mejoramiento. En este contexto, Speed Breeding surge como una tecnología que permite incrementar la eficiencia de los programas, reduciendo los costos y el trabajo requerido.

ABSTRACT A pea breeding program to increase production in quantity and quality was started in 2005 in the College of Agrarian Sciences (FCA), National University of Rosario (UNR). The first steps were to gather an active collection of germplasm from around the world and to analyze genetic variability through morpho-agronomic and molecular traits in order to set objectives. In 2014, the National Institute of Agropecuarian Technology (INTA) and the FCAUNR, joined forces to unite inter-institutional efforts for promoting the local development of pea genotypes adapted to the region. This program, using conventional methodologies, has so far obtained a new commercial line (Primogénita FCA-INTA) of green cotyledons, semileafless, with high adaptation to local agro ecological conditions and high yield potential. Breeding, nevertheless, is a slow process. Developing new pea varieties usually takes a decade or more when using traditional methodologies; thus, different alternatives were proposed for the reduction of this period. Doubled haploids and in vitro culture have been some of the methodologies developed; in pulses, however, they have not been efficiently implemented in breeding programs. In this context, Speed Breeding emerges as a technology that allows increasing the efficiency of the programs, while reducing costs and the required labor.

Herramientas complementarias utilizadas en el programa de mejoramiento de arveja (Pisum sativum l.) de la Universidad Nacional de Rosario / Complementary tools utilized in the pea (Pisum sativum l.) breeding program at Universidad Nacional de Rosario

RESUMEN El mejoramiento convencional puede ser complementado mediante diferentes estrategias que incrementen la eficiencia de las metodologías y la tasa actual de aumento de los rendimientos a fin de satisfacer la demanda. El uso de marcadores moleculares con el objetivo de desarrollar mapas de ligamiento de la especie, el uso de Blup (Best Linear Unbiased Prediction) para una selección eficiente de progenitores a hibridar, el uso del cultivo in vitro para incrementar artificialmente el número de plantas F1 o el uso de fenotipificación digital para una eficiente caracterización digital que puede realizarse durante la regeneración periódica y rutinaria de accesiones en colecciones de germoplasma.

ABSTRACT Conventional breeding can be complemented by different strategies that increase the efficiency of the methodologies and the current rate of increase in yields in order to meet demand. The use of molecular markers with the aim of developing linkage maps of the species, the use of Blup (Best Linear Unbiased Prediction) for an efficient selection of progenitors to hybridize, the use of in vitro culture to artificially increase the number of F1 plants or the use of digital phenotyping for efficient digital characterization that can be performed during the periodic and routine regeneration of accessions in germplasm collections.

Características clínicas de los pacientes hospitalizados con COVID-19 en España: resultados del Registro SEMI-COVID-19 / Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry

ANTECEDENTES: España ha sido uno de los países más afectados por la pandemia de COVID-19. OBJETIVO: Crear un registro de pacientes hospitalizados en España por COVID-19 para mejorar nuestro conocimiento sobre los aspectos clínicos, diagnósticos, terapéuticos y pronósticos de esta enfermedad. MÉTODOS: Estudio de cohorte retrospectiva, multicéntrico, que incluye pacientes consecutivos hospitalizados con COVID-19 confirmada en toda España. Se obtuvieron los datos epidemiológicos y clínicos, las pruebas complementarias al ingreso y a los 7 días de la admisión, los tratamientos administrados y la evolución a los 30 días de hospitalización de las historias clínicas electrónicas. RESULTADOS: Hasta el 30 de junio de 2020 se incluyeron 15.111 pacientes de 150 hospitales. Su mediana de edad fue 69,4 años (rango: 18-102 años) y el 57,2% eran hombres. Las prevalencias de hipertensión, dislipemia y diabetes mellitus fueron 50,9%, 39,7% y 19,4%, respectivamente. Los síntomas más frecuentes fueron fiebre (84,2%) y tos (73,5%). Fueron frecuentes los valores elevados de ferritina (73,5%), lactato deshidrogenasa (73,9%) y dímero D (63,8%), así como la linfopenia (52,8%). Los fármacos antivirales más utilizados fueron la hidroxicloroquina (85,6%) y el lopinavir/ritonavir (61,4%). El 33,1% desarrolló distrés respiratorio. La tasa de mortalidad global fue del 21,0%, con un marcado incremento con la edad (50-59 años: 4,7%; 60-69 años: 10,5%; 70-79 años: 26,9%; ≥80 años: 46%). CONCLUSIONES: El Registro SEMI-COVID-19 proporciona información sobre las características clínicas de los pacientes con COVID-19 hospitalizados en España. Los pacientes con COVID-19 hospitalizados en España son en su mayoría casos graves, ya que uno de cada 3 pacientes desarrolló distrés respiratorio y uno de cada 5 pacientes falleció. Nuestros datos confirman una estrecha relación entre la edad avanzada y la mortalidad

BACKGROUND: Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONS: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality

Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry. / Características clínicas de los pacientes hospitalizados con COVID-19 en España: resultados del Registro SEMI-COVID-19.

BACKGROUND: Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONS: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality.

[Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry]. / Características clínicas de los pacientes hospitalizados con COVID-19 en España: resultados del Registro SEMI-COVID-19.

BACKGROUND: Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥ 80 years: 46.0%). CONCLUSIONS: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality.

Absence of the choroid plexus of the fourth ventricle in the first trimester / Ausencia de plexo coroideo de cuarto ventrículo en el primer trimestre

Objectives: There is an increasing interest in the sonographic detection of posterior fossa (PF) anomalies in the first trimester (1T) of pregnancy. However, there is poor agreement in the diagnostic criteria among different investigators. Our objective is to describe a qualitative reproducible sonographic feature that can be useful to predict pathology in the PF during the 1T of pregnancy. Methods: Two experienced operators, blinded to the final clinical outcome, retrospectively analysed stored 3D volume data sets from 68 1T fetuses (11 + 0‐13 + 6w), including 14 with abnormal PF that were randomly added to the sample. The choroid plexus (CP) of the IV ventricle was assessed in midsagittal and axial planes by multiplanar navigation. It was classified as present or absent if the echogenic line between the brain stem and the cisterna magna was visible or not in both planes. Results: 3D volume data sets were acquired transabdominally in 58 (85%) cases and transvaginally in the other 10 (15%). The CP of the IV ventricle was classified as present in 53 cases and as absent in 15 cases, with total agreement between the two observers in both axial and sagittal planes except for one case. The CP was absent in: 10 fetuses with aneuploidy (triploidy: 5; trisomy 13: 2; trisomy 18: 2; Turner syndrome: 1); 4 fetuses with CNS anomalies (open neural tube defects: 2; encephalocele: 1; Dandy‐Walker malformation: 1); and 1 normal fetus (false positive). Conclusions: Qualitative assessment of the CP of the IV ventricle seems to be highly reproducible. This simple sonographic feature can facilitate the detection of PF anomalies, which are frequently associated with aneuploidies

Objetivo: describir una característica cualitativa y reproducible de la fosa posterior para predecir anomalías cromosómicas y patología del sistema nervioso central durante el primer trimestre del embarazo. Métodos: 54 volúmenes 3D fueron adquiridos en gestantes a las que se realizaba la ecografia del 1ºT (11- 13+6 semanas). 20 volúmenes con ecoestructura de la fosa posterior valorada como anormal fueron analizados retrospectivamente e incluidos aleatoriamente en el grupo de estudio. Dos ecografistas experimentados, que desconocían los resultados clínicos finales, analizaron todos los volúmenes. Mediante la navegación multiplanar evaluaron el plexo coroideo del cuarto ventrículo en el plano axial y en el sagital medio. El plexo coroideo se clasificó como presente o ausente si la estructura ecogénica que existe entre el cuarto ventrículo y la cisterna magna era visible o no en ambos planos. Resultados: el plexo coroideo del cuarto ventrículo se clasificó como presente en 53 casos y como ausente en 21 con acuerdo completo entre los observadores en los planos sagitales y coronales, salvo en 1. De los 21 fetos que tenían ausencia del plexo coroideo, en 9 había una anomalía del sistema nervioso central (6 espinas bífidas, 1 encefalocele, 1 megacisterna magna, 1 malformación de Dandy-Walker) y/o alteraciones cromosómicas en 15 casos (5 triploidías, 3 trisomías 13, 6 trisomías 18, 1 45X0). Hubo un falso positivo, con el plexo coroideo clasificado como ausente en un feto normal. Conclusiones: la evaluación cualitativa del plexo coroideo del cuarto ventrículo es sencilla y reproducible pudiendo facilitar la detección de aneuploidías y de algunas anomalías del sistema nervioso central

Non-visualization of choroid plexus of fourth ventricle as first-trimester predictor of posterior fossa anomalies and chromosomal defects.

OBJECTIVE: To assess non-visualization of the choroid plexus of the fourth ventricle (CP-4V) as a simple, qualitative and reproducible first-trimester ultrasound feature of the posterior fossa for the prediction of central nervous system (CNS) anomalies and chromosomal defects. METHODS: First-trimester three-dimensional ultrasound datasets of the fetal brain were obtained prospectively from 65 consecutive normal singletons and retrospectively from 27 fetuses identified as having an abnormal posterior fossa on first-trimester ultrasound examination, and randomly combined to form the final study group. The stored ultrasound volumes were analyzed offline by two accredited sonologists, who were not aware of the final diagnoses. The CP-4V was assessed by multiplanar navigation and classified as visible or non-visible in its normal position depending on whether or not the echogenic structure that separates the fourth ventricle from the cisterna magna was identified in both midsagittal and axial planes. Correlation with subsequent second-trimester ultrasound, fetal magnetic resonance imaging, or postmortem or postnatal findings was performed to determine the predictive value of the first-trimester findings. RESULTS: Among the 92 ultrasound datasets analyzed, 73 (79%) were acquired transabdominally and 19 (21%) transvaginally. The CP-4V was classified as visible in 64 cases and non-visible in 28 cases, with agreement between the two observers in both sagittal and axial planes in all but one case. Twelve of the 28 (43%) fetuses with non-visible CP-4V were subsequently diagnosed as having a CNS malformation (open spina bifida (n = 6), Dandy-Walker malformation (n = 2), Blake's pouch cyst (n = 2), cephalocele (n = 1) and megacisterna magna (n = 1)). In addition, 20 of these 28 (71%) fetuses had aneuploidy (trisomy 18 (n = 10), triploidy (n = 5), trisomy 13 (n = 3), Turner syndrome (n = 1) or trisomy 21 (n = 1)). There was only one false-positive case, in which the CP-4V was classified as absent in a normal fetus. CONCLUSIONS: Non-visualization of the CP-4V in the first trimester appears to be a strong marker of posterior fossa anomalies and chromosomal defects. Qualitative evaluation of this anatomic structure is simple, feasible and reproducible, and its routine assessment during the first-trimester scan may facilitate the early detection of CNS anomalies and associated fetal aneuploidy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Classification of Uterine Anomalies by 3-Dimensional Ultrasonography Using ESHRE/ESGE Criteria: Interobserver Variability.

OBJECTIVE: To evaluate the interobserver repeatability of the coronal view measurements and classification of the uterine malformations (UM) according to the ESHRE/ESGE consensus by transvaginal three-dimensional ultrasound (3D-US). METHODS: 89 transvaginal 3D-US volumes acquired during the last two years at Delta Ecografía in Madrid, Spain, were selected from our archive by convenience sampling. Two expert operators blinded from each other, performed post-hoc analysis using render mode and multiplanar-Volume Contrast Imaging (VCI) navigation. Uterine wall thickness at the fundus, indentation of the cavity and indentation of the fundus were measured, classified and sub-classified following the recommendations of the ESHRE/ESGE consensus. The reproducibility of interobserver measurements and classification was examined by calculating intraclass correlation coefficients (ICC) and their 95% confidence intervals (CI) and kappa statistic (k). RESULTS: Repeatability in the measurements: uterine wall thickness: ICC = 0.93 (95% CI, 0.90-0.96), P < 0.0001; indentation of the cavity: ICC = 0.93 (95% CI, 0.86-0.96), P < 0.0001; indentation of the fundus: ICC = 0.93 (95% CI, 0.90-0.96), P < 0.0001. Level of agreement in the classification: overall (U0, U1, U2, U3, U4, U5): k = 0.73 (95% CI, 0.61-0.84), P > 0.0001; U2 (U2a, U2b): k = 0.56 (95% CI, 0.31-0.80), P < 0.001 (0.78 observed agreement compared to 0.49 expected); U3 (U3a, U3b, U3c): k = 0.69 (95% CI, 0.16-1.00), P < 0.05 (0.85 observed agreement compared to 0.53 expected); U4 (U4a, U4b): k = 1.00 (95% CI, 1.00-1.00), P < 0.0001. CONCLUSIONS: Transvaginal 3D-US examination of the uterus allows assessment and classification of the UM by the ESHRE/ESGE criteria showing a good interobserver repeatability and reproducibility in most cases.

[A descriptive study of substance abuse and mental health disorders in intimate partner violence abusers in prison]. / Consumo de sustancias y trastornos de salud mental en agresores de violencia de género ingresados en prisión: un estudio descriptivo.

OBJECTIVE: To obtain data on substance abuse and mental disorders amongst a population of inmates imprisoned for gender violence. DESIGN: 106 intimate partner violence offenders were recruited in our study, all of whom were prison inmates. The study is descriptive and statistical comparison of percentages was used. RESULTS: the percentage of substance abuse was 61.3%; most of which consisted of alcohol and cocaine. According to DSM-IV R, 25.5% of the inmates had at least one psychiatric diagnosis at the time when entering prison: 11.3% adjustment disorder with depressed mood, 6.6% personality disorders, 2.8% psychosis, 1.9% major depressive disorder, 1.9% bipolar disorder and 1.9% psycho-organic disorder were encountered. The average age of the men of the sample was forty years old. The most common nationality was Spanish. The percentage of immigrants was significant greater than the global percentage of the general population. The percentage of global substance consumption and psychopathologic problems is greater than data obtained in IPV from other populations, like samples of men charged by their partners with gender violence. CONCLUSIONS: depressive symptoms, personality disorders, alcohol and cocaine consumption need to be investigated as gender violence risk markers in Spain. Attention should be paid to the role of consumption prevention when entering prison.

Oftalmología, historia y humanidades / Ophthalmology, history and humanities

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Shock séptico debido a la infección por Clostridium difficile adquirida en la comunidad. Estudio de un caso y revisión de la literatura / Septic shock due to a community acquired Clostridium difficile infection. A case study and a review of the literature

La epidemiología de la infección por Clostridium difficile ha cambiado en la última década, aumentando la incidencia de los casos adquiridos en la comunidad en pacientes sin factores de riesgo clásicos. Presentamos el caso de un varón con infección por Clostridium difficile adquirida en la comunidad que ingresó en nuestro centro por dolor abdominal agudo, y desarrolló un cuadro de insuficiencia renal aguda y shock séptico. Se describe el diagnóstico, tratamiento y evolución y se realiza una breve revisión de la bibliografía (AU)

The epidemiology of Clostridium difficile infection has changed in the past decade. The incidence rate of community acquired cases has increased in patients with no typical risk factors. We present a patient who was diagnosed with community-acquired Clostridium difficile infection who presented with acute abdominal pain, and subsequently developed acute renal failure and septic shock. We describe the diagnosis, treatment and outcome and brief review of the literature (AU)

Three-dimensional ultrasound and magnetic resonance imaging assessment of cervix and vagina in women with uterine malformations.

OBJECTIVES: To investigate the accuracy of three-dimensional ultrasound (3D-US) with respect to magnetic resonance imaging (MRI), and compared to clinical examination, in the assessment of cervix and vagina in women with uterine malformations. METHODS: In this prospective study, 16 patients diagnosed with uterine malformation with cervical involvement underwent 3D-US examination. The acquisition of cervical volumes was transvaginal, with four cases repeated in the peri-ovulation period, while vaginal volumes were acquired by transperineal imaging following filling of the vagina with gel. MRI was performed in 13 patients using endovaginal gel. All cases underwent clinical examination, comprising bimanual gynecological examination and speculoscopy. Diagnostic concordance of each of the methods with the gold standard was calculated. RESULTS: 3D-US cervical examinations revealed 12 cases of duplicate cervix, two of complete septate cervix and two of incomplete septate cervix. Images of the cervical canal in the peri-ovulation period were judged subjectively to be better in quality, but did not lead us to change any diagnosis. 3D-US vaginal examinations revealed four cases with a vaginal dividing wall and two with a blind hemivagina. None of the 3D-US findings contradicted the clinical findings of the cervix; however, clinically we observed two cases with vaginal dividing wall that had not been diagnosed with 3D-US. MRI diagnosed nine cases of duplicate cervix, three of complete septate cervix, one of incomplete septate cervix, five of vaginal dividing wall and two of blind hemivagina. One case diagnosed as complete septate cervix was in fact a duplicate cervix on 3D-US and on clinical examination. Compared with the gold standard, both 3D-US and MRI were highly efficient in the diagnosis of anomalies of the cervix and vagina. The overall diagnostic concordance of 3D-US with clinical examination (kappa, 0.84; 95% CI, 0.62-1) was slightly inferior to that of MRI with clinical examination (kappa, 0.9; 95% CI, 0.72-1), but this difference was not statistically significant. CONCLUSIONS: The acquisition of isolated cervical volumes, without including the uterus, defines the extent of the ectocervix and the limits of the cervical canal in uterine malformations. The use of endovaginal gel makes possible the diagnosis of associated vaginal anomalies with 3D-US.

First-trimester assessment of nasal bone using retronasal triangle view: a prospective study.

OBJECTIVE: To examine the feasibility and accuracy of fetal nasal bone (NB) assessment in the retronasal triangle (RNT) view for aneuploidy screening in the first trimester of pregnancy. METHODS: Consecutive women with singleton pregnancies undergoing sonographic screening at 11-13 weeks' gestation were prospectively evaluated. In all cases, assessment of the NB by using the RNT view was attempted and classified as present (if one or both of the NBs were clearly seen) or absent/hypoplastic (if the NB was not visualized or if it was small and less echogenic than the surrounding bones). The detection rate of fetal karyotypic abnormalities by the assessment of the NB in the RNT view was calculated. RESULTS: In total, 1977 women were scanned. The RNT was successfully examined in 1970 fetuses (99.6%). Fetal outcome was available in 1767 (89.7%) of evaluated cases, and of these, 39 (2.2%) cases of aneuploidy were documented (trisomy 21, n=17; trisomy 18, n=8; trisomy 13, n=5; Turner syndrome, n=5; and triploidy, n=4). The prevalence of absent/hypoplastic NB was 12/1728 (0.7%) in chromosomally normal fetuses and 12/17 (70.6%) in trisomy 21 fetuses. Sensitivity, specificity and positive and negative predictive values of absent/hypoplastic NB for trisomy 21 were 70.6%, 99.3%, 50.0% and 99.7%, respectively. The positive and negative likelihood ratios of NB assessment were 101 (95% CI, 53-193) and 0.3 (95% CI, 0.14-0.62), respectively. CONCLUSIONS: The RNT view is a useful technique for assessing the NB during the first trimester of pregnancy. With this new approach, performance of absent/hypoplastic NB as a marker of aneuploidy, mainly trisomy 21, appears to be similar to that previously reported by using the mid-sagittal plane.

[Septic shock due to a community acquired Clostridium difficile infection. A case study and a review of the literature]. / Shock séptico debido a la infección por Clostridium difficile adquirida en la comunidad. Estudio de un caso y revisión de la literatura.

The epidemiology of Clostridium difficile infection has changed in the past decade. The incidence rate of community acquired cases has increased in patients with no typical risk factors. We present a patient who was diagnosed with community-acquired Clostridium difficile infection who presented with acute abdominal pain, and subsequently developed acute renal failure and septic shock. We describe the diagnosis, treatment and outcome and brief review of the literature.

First-trimester diagnosis of cleft lip and palate using three-dimensional ultrasound.

OBJECTIVE: To determine whether systematic examination of primary and secondary palates using three-dimensional (3D) ultrasound aids in the identification of orofacial clefts in the first trimester. METHODS: 3D datasets were acquired prospectively from women undergoing first-trimester ultrasound screening for aneuploidy. Multiplanar mode display was used for offline analysis of (1) the primary palate in the coronal plane at the base of the retronasal triangle and (2) the secondary palate by virtual navigation in the axial plane. In addition, 3D datasets from three fetuses with a cleft palate diagnosed in the first trimester were retrospectively identified and included randomly in the study group. RESULTS: A total of 240 3D datasets from 237 pregnancies (including three sets of twins), 89% of which were obtained transabdominally and 11% transvaginally, were examined independently by three operators. The quality of the 3D datasets was classified subjectively as good, fair and poor in 76%, 20% and 4% of cases, respectively. Seven fetuses had an orofacial cleft; all involved both the primary palate and the secondary palate. Using 3D offline analysis, the primary palate was classified as intact in 229 (95%), cleft in nine (4%) and indeterminate in two (1%). Seven of the nine fetuses suspected to have a cleft affecting the primary palate had the cleft confirmed at birth or at postmortem examination (false-positive rate 0.9% (2/231)). The secondary palate was classified as intact in 217 (90%), cleft in six (3%) and indeterminate in 17 (7%). Clefts of the secondary palate were confirmed in all six suspected cases and missed in one, which was diagnosed at 16 weeks. The visualization rate was affected by the quality of the 3D dataset (P < 0.001) and gestational age at evaluation (P < 0.01). CONCLUSION: In our series, all cases of clefting of the primary palate and 86% of cases involving the secondary palate were visualized using 3D ultrasound with a satisfactory false-positive rate. Virtual navigation of the fetal palate using the multiplanar mode display seems to be useful in the diagnosis of clefting in the first trimester.

Infecciones en el paciente oncológico en tratamiento paliativo / No disponible

Objetivo: describir las infecciones de los pacientes ingresados en nuestra Unidad de Cuidados Paliativos (DCP). Método: estudio retrospectivo de las infecciones presentadas por los pacientes ingresados en la UCP del Hospital General de Ciudad Real durante un año de seguimiento (diciembre 2008-noviembre 2009). Se recogió edad, sexo, localización del tumor, tipo de infección y germen identificado. Resultados: durante el tiempo de estudio ingresaron en la unidad 181 pacientes. En 36 (20%) la clínica y los hallazgos analíticos y radiológicos fueron compatibles con el diagnóstico de patología infecciosa. En este grupo la edad media fue de 70,27 años (40-86), 20 (55,5%) eran varones y 16 (44,4%) mujeres. La etiología de la infección fue respiratoria en el 44,4%, urinario en el 33,3%, de la herida tumoral en el 11,1%, y otras localizaciones en el 11,1% de los pacientes. En el 88,9% de los casos se utilizó antibiótico. Los más utilizados fueron levofloxacino (31,3%) y amoxicilina-clavulánico (31,3%). Se administraron por vía oral en el 34,4% de los casos e intravenosos en el 65,6%. El 58,3% de los pacientes evolucionaron bien y fueron dados de alta. Conclusiones: en nuestro estudio, el tratamiento antibiótico fue beneficioso en la mayoría de los casos. La decisión de pautar antibiótico debe tomarse de forma individualizada en cada paciente (AU)

Objective: to describe infection in in-patients at the Palliative Care Unit (PCU). Methods: a retrospective study of infection in-patients at the PCU in Hospital General de Ciudad Real during one year of follow-up (December 2008-November 2009). We collected age, sex, cancer, infection, and germ. Results: patients hospitalized for 1 year were 181. Thirty-six (20%) patients were diagnosed with infection using clinical laboratory and radiology results. In this group, mean age was 70.27 years (40-86); 20 (55.5%) were men and 16 (44.4%) were women. Infection sites included the respiratory tract (44.4%), urinary tract (33.3%), skin (11.1%), and others (11.1%). Antibiotic treatment was used for 88.9% of cases. Antibiotics more commonly used included levofloxacin (31.3%) and amoxicillin-clavulanate (31.3%). Oral antibiotics were used by 34.4%, and parenteral ones by 65.6% of patients. Outcome was good for 58.3% of patients, who were discharged. Conclusions: in our study, antibiotic treatment was favorable for a vast majority of patients. In any case, the decision to use antibiotic treatment should be made on an individual basis (AU)