Assessment of fetal cardiac function in early fetal life: feasibility, reproducibility, and early fetal nomograms.

BACKGROUND: Fetal cardiology has shown a rapid development in the past decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly in the second and third trimesters. The study of fetal cardiac function at the end of first trimester has not been investigated properly, and there is a lack of reference values at early gestational weeks. OBJECTIVE: This study aimed to assess if the measurement of time-related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13+6 gestational weeks. STUDY DESIGN: We conducted a prospective observational study from March to September 2022. The study was carried out in 2 hospitals (Hospital Universitari Dexeus, Barcelona, and Hospital VITAHS 9 Octubre, Valencia, Spain). The scans were performed by 3 specialists in fetal medicine. The exclusion criteria were fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight <10 percentile, diabetes, and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction, and filling time fraction. We study the feasibility and intra- and interobserver reproducibility of these parameters using the interclass correlation coefficient. Nomograms were created and the percentiles of the values of the different parameters were calculated. RESULTS: A total of 409 cases were recruited but only 296 could be included in the statistical analysis once the exclusion criteria were applied. The intraobserver reproducibility study was excellent (interclass correlation coefficient >0.900), and the interobserver reproducibility study was good (interclass correlation coefficient >0.700). The data regression analysis showed that cycle time, filling time, isovolumetric contraction time, and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean, 0.43±0.08), isovolumetric relaxation time (mean, 0.04±0.01), and ejection time (mean, 0.16±0.01) remained constant from 11 to 13 weeks. CONCLUSION: The study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.

Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía / Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia

Objetivo: Conocer las repercusiones del confinamiento por la pandemia de COVID-19 en los autocuidados de personas con enfermedades crónicas y en su salud percibida, e identificar factores para el manejo y la gestión de su enfermedad en situaciones de emergencia. Método: Estudio cualitativo realizado en marzo-abril de 2020, durante el confinamiento por la pandemia de COVID-19, en Andalucía (España), mediante grupos focales virtuales usando la herramienta telemática Zoom. Se realizaron tres grupos con 34 pacientes (17 hombres y 17 mujeres) con enfermedades crónicas: artritis, diabetes, enfermedad cardiovascular, enfermedad inflamatoria intestinal, cáncer de mama y fibromialgia. Resultados: Las personas con enfermedades crónicas refirieron repercusiones del confinamiento en relación con su vivencia emocional, sus recursos de afrontamiento, la información recibida, las dificultades para el autocuidado y el contacto/acceso a los servicios sanitarios, además de sugerir aprendizajes para el futuro. Más y mejor información, formación de pacientes, colaboración directa con asociaciones de pacientes por parte de los gestores y una mejora de la accesibilidad telemática a los servicios sanitarios destacan como las principales líneas de mejora para minimizar el impacto de futuros confinamientos en el autocuidado y en la salud de las personas con enfermedades crónicas. Conclusiones: Durante el confinamiento, las personas con enfermedades crónicas experimentaron dificultades más allá del riesgo de contagio: interferencias en el cuidado y en la atención sanitaria recibida. Es necesaria mayor información y más formación a los/las pacientes y mejoras en la accesibilidad a los servicios sanitarios en situaciones de crisis sanitaria. (AU)

Objective: To understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations. Method: A qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia. Results: People with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases. Conclusions: Besides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions. (AU)

[Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia]. / Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía.

OBJECTIVE: To understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations. METHOD: A qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia. RESULTS: People with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases. CONCLUSIONS: Besides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions.

[Senior-friendly hospital: The hospital of the 21st century]. / Hospital amable para la persona mayor: el hospital del siglo XXI.

The current health system must be revolutionized to meet the specific and real requirements of the largest population attended, older adults, and tailor the hospital to their needs, not the other way round. This is the goal of Hospital Universitario Infanta Leonor: senior-friendly hospital. The project was established as a business process management system integrated into the management's hospital map. Four subprocesses were defined, as were all activities and tasks to be performed. The subprocesses are health care (delirium and functional decline prevention and the identification of frail older patients), training, the environment and its structures, and patient and family involvement. The leadership corresponds to the geriatricians who coordinate a multidisciplinary team of the project's referents. Actions must be scientific, evidence-based, rigorous, and evaluable, and they should be audited. The final aim is to change established mentalities, routines, and habits to convert the hospital to a friendlier place for older adults.

Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía / Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia

OBJETIVO: Conocer las repercusiones del confinamiento por la pandemia de COVID-19 en los autocuidados de personas con enfermedades crónicas y en su salud percibida, e identificar factores para el manejo y la gestión de su enfermedad en situaciones de emergencia. MÉTODO: Estudio cualitativo realizado en marzo-abril de 2020, durante el confinamiento por la pandemia de COVID-19, en Andalucía (España), mediante grupos focales virtuales usando la herramienta telemática Zoom. Se realizaron tres grupos con 34 pacientes (17 hombres y 17 mujeres) con enfermedades crónicas: artritis, diabetes, enfermedad cardiovascular, enfermedad inflamatoria intestinal, cáncer de mama y fibromialgia. RESULTADOS: Las personas con enfermedades crónicas refirieron repercusiones del confinamiento en relación con su vivencia emocional, sus recursos de afrontamiento, la información recibida, las dificultades para el autocuidado y el contacto/acceso a los servicios sanitarios, además de sugerir aprendizajes para el futuro. Más y mejor información, formación de pacientes, colaboración directa con asociaciones de pacientes por parte de los gestores y una mejora de la accesibilidad telemática a los servicios sanitarios destacan como las principales líneas de mejora para minimizar el impacto de futuros confinamientos en el autocuidado y en la salud de las personas con enfermedades crónicas. CONCLUSIONES: Durante el confinamiento, las personas con enfermedades crónicas experimentaron dificultades más allá del riesgo de contagio: interferencias en el cuidado y en la atención sanitaria recibida. Es necesaria mayor información y más formación a los/las pacientes y mejoras en la accesibilidad a los servicios sanitarios en situaciones de crisis sanitaria

OBJECTIVE: To understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations. METHOD: A qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia. RESULTS: People with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases. CONCLUSIONS: Besides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions

Satisfacción en pacientes sometidas a conización ambulatoria con anestesia local intracervical / Satisfaction in patients under conization ambulatory with local intracervical anesthesia

La técnica de la conización es un procedimiento muy empleado actualmente para el tratamiento de lesiones neoplasicas del cuello uterino; sin embargo, en la literatura sigue existiendo controversia acerca de cuál es el mejor método analgésico para su realización. OBJETIVO: conocer el grado de satisfacción y tolerancia al dolor de las pacientes sometidas a conizaciones ambulatorias utilizando anestesia intracervical. MATERIAL Y MÉTODOS: se llevó a cabo un estudio observacional de 55 conizaciones realizadas en nuestro centro; los criterios de inclusión fueron todas aquellas pacientes candidatas a una conización ambulatoria. Se hicieron un total de cuatro cuestionarios: dos a las pacientes y otros dos a los médicos que intervinieron en el procedimiento, uno el día de la conización y otro en la consulta de revisión. RESULTADOS: la mayoría de las pacientes definieron el dolor durante la intervención como tolerable o inferior, siendo la duración del dolor posquirúrgico muy escasa. El grado de satisfacción tanto de las pacientes como de los profesionales al realizar la técnica fue muy bueno. El sangrado posquirúrgico se limitó a la primera semana en la mayoría, lo que se correlaciona con una buena cicatrización objetivada en la revisión, sin que esto supusiera una disminución del tamaño del cono obtenido. CONCLUSIONES: la conización ambulatoria con la aplicación de anestesia local intracervical como método de analgesia es una técnica catalogada como de fácil aplicación por los profesionales y con muy buena colaboración y tolerancia por parte de las pacientes

The conization technique is a procedure currently used to treat neoplastic lesions of the cervix; however, in the literature there is still controversy about which is the best analgesic method for its realization. OBJECTIVE: To determine the degree of satisfaction and pain tolerance of patients undergoing ambulatory conization using intracervical anesthesia. MATERIAL AND METHODS: An observational study of 55 conizations made in our center was carried out; the inclusion criteria were all those patients who were candidates for ambulatory conization. A total of four questionnaires were made: Two to the patients and another two to the doctors who took part in the procedure, one on the day of the conization and the other one in the review consultation. RESULTS: The majority of the patients defined the pain during the intervention as tolerable or inferior, the duration of the postsurgical pain being very scarce. The degree of satisfaction of both the patients and the professionals when performing the technique was very good. Postsurgical bleeding was limited to the first week in the majority, which correlates with a good healing objectified in the review, without this implying a decrease in the size of the cone obtained. CONCLUSIONS: Ambulatory conization with the application of intracervical local anesthesia as an analgesic method is a technique cataloged as easy to apply by professionals and with very good collaboration and tolerance on the part of patients

Do young people with asperger syndrome or intellectual disability use social media and are they cyberbullied or cyberbullies in the same way as their peers? / ¿Las personas jóvenes con síndrome de Asperger o discapacidad intelectual utilizan las redes sociales y son ciberacosados o ciberacosadores como sus padres?

Background: The aim of the present study is to explore how youth with intellectual disability or Asperger syndrome use new technologies and social media in comparison with their peers without disability. Method: Participants were 181 adolescents with a mean age of 16 years old (SD=3.7) who completed the "Cyber-aggression Questionnaire for Adolescents", the "Cyber-victimization Questionnaire for Adolescents" and a questionnaire on social media and new technologies. Results: Percentages of use of new technologies (61% tablets, 93% computers, 97% mobiles) are similar among groups but adolescents with Asperger syndrome or intellectual disability have been using them since more recent times and their uses are more limited. They also use social media less; the group with Asperger syndrome uses them the least. There are no significant differences in the frequency of cyberbullying. Conclusion: Despite using social media less, the frequency of cyberbullying is similar to their peers. Besides, the observed prevalence of cyberbullying is higher than that mentioned in previous studies in which informants were not the youths themselves

Antecedentes: este estudio se centra en explorar el uso que hace la juventud con discapacidad intelectual o síndrome de Asperger de las nuevas tecnologías y las redes sociales en comparación con sus pares sin discapacidad. Método: los participantes fueron 181 jóvenes con una edad media de 16 años (DT= 3.7 años), quienes cumplimentaron el "Cyber-aggression Questionnaire for Adolescents", el "Cyber-victimization Questionnaire for Adolescents" y un cuestionario sobre el uso de redes sociales y nuevas tecnologías. Resultados: los porcentajes de uso de las nuevas tecnologías (61% tablet, 93% ordenador y 97% móvil) son similares entre los grupos, pero los jóvenes con síndrome de Asperger y discapacidad intelectual las usan desde hace menos tiempo y hacen un uso más limitado de ellas. También usan menos las redes sociales, siendo el grupo con síndrome de Asperger el que menos las usa. No existen diferencias significativas en la frecuencia de ciberbullying. Conclusión: a pesar de que utilizan menos las redes sociales, la prevalencia de ciberbullying es similar a la de sus iguales. Además, la prevalencia observada en todos los grupos es más elevada que la apuntada en otros estudios en la que los informantes no suelen ser los propios jóvenes

Evaluating the characteristics of the grieving process in people with intellectual disability.

BACKGROUND: The aim of this study was to examine the characteristics associated with the grieving process among a population with intellectual disability and the influence of particular variables. MATERIALS AND METHODS: The sample was composed of 380 participants with intellectual disability, on whose behalf 149 professionals completed a 20-item questionnaire with four Likert-type answer options, developed to evaluate the grieving process: Inventory of Grief and Coping Strategies in Intellectual Disability (IGCS-ID). RESULTS: The IGCS-ID shows adequate levels of reliability. It covers three dimensions: understanding of the concept of death, coping with the loss and post-bereavement reactions. The level of intellectual disability, the time elapsed since the loss and the residential setting gave rise to significant differences in the three dimensions based on the participants. CONCLUSION: An assessment of the grieving process would help to put in place effective resources to help people with intellectual disability overcome the loss and cope with the changes that it brings.

Lipid profile and bone mineral density in heavy alcoholics.

BACKGROUND & AIMS: Some studies have illustrated the association between serum lipid profile and bone mineral density (BMD) or fractures. None of these studies was performed among alcoholics, despite the fact that alcoholism may affect both bone mass and lipid metabolism. We here analyse the relationship of serum lipid profile with bone mass among a population of 280 heavy alcoholics (29 women). METHODS: patients underwent a densitometric assessment of BMD and determination of a serum lipid panel. Castelli index (Total cholesterol/HDL cholesterol) and the LDL/HDL cholesterol index were calculated. RESULTS: There was a direct correlation between both total cholesterol and LDL-cholesterol and femoral neck (r = 0.17 and r = 0.20, respectively) and lumbar spine (r = 0.16 and r = 0.20) T score, total BMD (r = 0.14 and r = 0.18) or pelvis BMD (r = 0.16 and r = 0.23; p < 0.025 in all cases). HDL-cholesterol showed no relationship with BMD. Serum triglycerides were also directly related to T score at the lumbar spine (ρ = 0.13; p = 0.032) and pelvis BMD (ρ = 0.13; p = 0.037). Pelvis BMD was significantly related to Castelli index (ρ = 0.15) and LDL/HDL index (ρ = 0.18; p < 0.015 in both cases). Multivariate analysis showed that the association between the serum lipid panel and BMD was independent of liver function and body mass index. CONCLUSIONS: Therefore, BMD was directly related to total cholesterol and LDL cholesterol in heavy alcoholism. This counter intuitive observation adds to others derived from several similar studies conducted in different population groups but not in alcoholics as of yet. The mechanisms that explain the association between serum lipids and bone metabolism need further investigation.

Seroprevalencia de anticuerpos frente al virus de la varicela zóster tras la introducción reciente de la vacunación infantil universal en la Comunidad de Madrid / Seroprevalence of varicella-zoster virus antibodies after the recent introduction of the universal childhood immunisation schedule in the Community of Madrid

FUNDAMIENTO Y OBJETIVO: En la Comunidad de Madrid se incluyó la vacuna frente a varicela en el calendario infantil en noviembre del 2006 a los 15 meses de edad. Dicha recomendación se retiró en enero del 2014. Se estima la seroprevalencia de anticuerpos frente al virus tras los 2-3 primeros años desde la inclusión de la vacuna y su evolución desde 1999. MATERIAL Y MÉTODO: Estudio descriptivo transversal. La población diana son los residentes en la Comunidad de Madrid entre 2 y 60 años. La medición de anticuerpos IgG se realizó mediante técnicas de ELISA. Se estima la seroprevalencia según características sociodemográficas mediante regresión logística múltiple. Los resultados se comparan con encuestas previas. Asimismo, se presentan la seroprevalencia y la media geométrica de anticuerpos según el estado vacunal y los antecedentes de la enfermedad. El nivel de confianza utilizado es del 95%. RESULTADOS: Participaron 4.378 sujetos, con una tasa de respuesta del 69%. La seroprevalencia estimada es del 95,3% (IC del 95%, 94,6%-95,9%). Más del 90% de los niños a partir de los 10 años de edad presentan anticuerpos. La seroprevalencia fue mayor en personas con menor nivel educativo. La seroprevalencia de inmunidad vacunal supera el 90% en el primer año tras la vacunación pero en el segundo año desciende hasta el 82,6% (IC del 95%, 56,0-94,7). Se encontraron diferencias significativas con las encuestas anteriores atribuibles a la vacunación universal. DISCUSIÓN: Es necesario continuar la vigilancia epidemiológica para valorar el impacto de la retirada de la recomendación de vacunar a los 15 meses de edad

BACKGROUND AND OBJECTIVE: In November 2006, the Community of Madrid included the chickenpox vaccine into the immunisation schedule for children from 15 months of age. This was withdrawn in January 2014. Seroprevalence of antibodies to the virus is estimated after the first 2-3 years from the inclusion of the vaccine, and as well as its evolution since 1999. MATERIAL AND METHOD: A cross-sectional study was conducted on the target population consisting of residents in the Community of Madrid between 2 and 60 years of age. Measurement of IgG antibodies was performed using an ELISA technique. Seroprevalence was estimated according to sociodemographic characteristics using multiple logistic regressions. The results are compared with previous surveys. Also, the seroprevalence and geometric mean of the antibody according immunisation status and history of the disease are presented. The confidence level used is 95%. RESULTS: A total of 4,378 subjects were included, with a response rate of 69%. The estimated seroprevalence was 95.3% (95% CI: 94.6% - 95.9%). Over 90% of children from the age of 10 have antibodies. The seroprevalence was higher in people with less education. The seroprevalence of immunity vaccine exceeds 90% in the first year after vaccination, but in the second year decreased to 82.6% (95% CI 56.0 - 94.7). Significant differences, attributable to universal vaccination, were found compared to previous surveys. DISCUSSION: Continued surveillance is needed in order to assess the impact of the withdrawal of the recommendation to vaccinate at 15 months

Three dimensional ultrasonography for advanced neurosonography (Neurosofe-3d). Analysis of acquisition-related factors influencing the quality of the brain volumes.

OBJECTIVE: To evaluate the acquisition-related factors influencing the quality of the brain volumes for further study of advanced neurosonography. METHODS: This was a prospective multicentre study. Five centres were asked to include five cases each, acquiring two volumes per case, at different gestational ages. Ten operators performed an advanced neurosonography per case. The potential influence of the following factors on the number of evaluable structures was assessed: vaginal/ abdominal acquisition, position of the head, gestational age, subjective quality of the volume and the acquiring operator itself. RESULTS: Four hundred and thirty-two evaluations were included in the study. A total of 80% of the structures were evaluated satisfactorily in the axial plane, 67.1% and 55.1% in the coronal and sagittal plane, respectively. Sagittal volumes acquired transvaginally had a better quality than those acquired transabdominally. Gestational age affected the quality of axial and sagittal volumes (p < 0.001), and the best quality was obtained between 20 and 27 weeks. In axial and sagittal volumes, the head position influenced the percentage of structures visualized (p < 0.001, p < 0.001). CONCLUSIONS: Factors affecting the quality of the volume for advanced neurosonography are gestational age, fetal head position, transvaginal acquisition in sagittal volumes, the acquiring operator and the subjective quality of the volume. © 2016 John Wiley & Sons, Ltd.

[Seroprevalence of varicella-zoster virus antibodies after the recent introduction of the universal childhood immunisation schedule in the Community of Madrid]. / Seroprevalencia de anticuerpos frente al virus de la varicela zóster tras la introducción reciente de la vacunación infantil universal en la Comunidad de Madrid.

BACKGROUND AND OBJECTIVE: In November 2006, the Community of Madrid included the chickenpox vaccine into the immunisation schedule for children from 15 months of age. This was withdrawn in January 2014. Seroprevalence of antibodies to the virus is estimated after the first 2-3 years from the inclusion of the vaccine, and as well as its evolution since 1999. MATERIAL AND METHOD: A cross-sectional study was conducted on the target population consisting of residents in the Community of Madrid between 2 and 60 years of age. Measurement of IgG antibodies was performed using an ELISA technique. Seroprevalence was estimated according to sociodemographic characteristics using multiple logistic regressions. The results are compared with previous surveys. Also, the seroprevalence and geometric mean of the antibody according immunisation status and history of the disease are presented. The confidence level used is 95%. RESULTS: A total of 4,378 subjects were included, with a response rate of 69%. The estimated seroprevalence was 95.3% (95% CI: 94.6% - 95.9%). Over 90% of children from the age of 10 have antibodies. The seroprevalence was higher in people with less education. The seroprevalence of immunity vaccine exceeds 90% in the first year after vaccination, but in the second year decreased to 82.6% (95% CI 56.0 - 94.7). Significant differences, attributable to universal vaccination, were found compared to previous surveys. DISCUSSION: Continued surveillance is needed in order to assess the impact of the withdrawal of the recommendation to vaccinate at 15 months.

Adipokines, cytokines and body fat stores in hepatitis C virus liver steatosis.

AIM: To identify patients with or without liver steatosis and its severity in treatment-naïve patients affected by hepatitis C virus (HCV) infection. METHODS: We included 56 HCV infected patients, and assessed the amount of liver fat by histomorphometry, and its relationships with fat and lean mass at different parts of the body (by densitometry), hormones [insulin, homeostatic model assessment (HOMA)], adipokines (resistin, adiponectin, leptin), and cytokines (tumor necrosis factor α, interleukin-6). RESULTS: Although the intensity of liver steatosis is related to trunk fat mass and HOMA, 33% of patients showed no liver steatosis, and this finding was not related to body mass index or genotype. Besides trunk fat mass, no other factor was related to the presence or not of liver steatosis, or to the intensity of it, by multivariate analysis. Lean mass was not related to liver steatosis. Adiponectin levels were lower among patients. No differences were observed in leptin and resistin. CONCLUSION: Steatosis in HCV infection is common (67.2%), and closely related to trunk fat, and insulin resistance, but not with leg fat mass or adipokines.

Prenatal Evaluation of the Fetal Conus Medullaris on a Routine Scan.

OBJECTIVE: To assess the ability to identify the conus medullaris (CM) and measure the conus-sacrum distance (CS distance) on a routine scan and the relationship with maternal and fetal factors. METHODS: This was a prospective study. The assessment of the CM and the CS distance and the influence of the body mass index (BMI), gestational age (GA) and fetal position were analyzed. The correlation between the femur length (FL) and the GA with the CS distance was evaluated. RESULTS: A total of 696 fetuses were analyzed. The CM could be visualized in 82.3% of the cases, and the CS distance could be analyzed in 81.2% of the cases. The CM assessment was statistically associated with BMI and fetal position but not with GA. The CS distance assessment was statistically associated with BMI and GA but not with fetal position. We determined a significant association between the FL/CS distance and between the GA/CS distance. CONCLUSIONS: Assessment of the CM is possible on most routine scans. The CS distance could be introduced to routine scans for the assessment of prenatal skin-covered spinal dysraphism. High BMI, advanced GA and breech presentation could be potential factors limiting the feasibility of evaluating the CM.

Riesgo ante el consumo colectivo de alcohol entre los jóvenes: Percepciones desde el entorno educativo / The risk to the collective alcohol consumption of among young people: perceptions from the school

Objetivo: Conocer cómo perciben el riesgo para la salud los agentes educativos (padres, profesores y compañeros) de los jóvenes participantes habituales en actos colectivos de consumo de alcohol del tipo del botellón. Metodología: Estudio cualitativo descriptivo. Muestreo teórico intencionado que incluyó a 109 participantes: 57 jóvenes, 27 padres y madres y 25 profesores. Se realizaron 14 grupos focales entre febrero de 2012 a mayo de 2013 en 4 Institutos de Educación Secundaria de la ciudad de Granada. La estrategia de análisis se realizó a través de la teoría fundamentada y siguiendo las etapas propuestas por Taylor-Bogdan. Resultados: Del análisis de los datos se obtuvieron 5 categorías: la percepción de los riesgos sobre el consumo de alcohol; condicionantes internos y sociales que influyen en la decisión de los jóvenes para consumir alcohol; actitudes y conductas en el entorno familiar frente al consumo de alcohol; diferencias intergeneracionales de las formas de divertimiento asociadas al alcohol y el papel del entorno educativo frente al consumo de alcohol de los jóvenes y su influencia en los cambios de conductas. Conclusión: comprender el botellón como un fenómeno complejo y dinámico donde intervienen factores tanto internos como sociales, reitera la importancia de potenciar estrategias integradas y sustentadas en la corresponsabilidad de los actores involucrados. Así, desde el contexto educativo como eje articulador se destaca la necesidad de un trabajo interdisciplinario e intersectorial que implique de forma activa a los propios jóvenes

Objective: Knowing how they perceive the risk to health (parents, teachers and peers) of the usual young participants in the botellón. Methodology: A descriptive qualitative study. Intentioned theoretical sample include 109 participants: 57 youth, 27 parents and 25 teachers. In 4 Centers of Secondary Education of the city of Granada, were made 14 focus groups between February 2012 and May 2013. The analysis was conducted by grounded theory and following the steps proposed by Taylor-Bogdan. Results: Were obtained 5 categories from the data analysis: perception of risk on the consumption of alcohol; internal and social factors that influence the decision of young people to consume alcohol; attitudes and behaviors in the family related with the alcohol consumption; intergenerational differences in the forms of entertainment associated with alcohol and the role of the school to the consumption of alcohol by young people and their influence on behavior change. Conclusion: Understanding the botellón as a complex and dynamic phenomenon which involves social factors both internal and reiterates the importance of promoting integrated and supported on shared responsibility of the parts involved. In this sense we emphasize the need for an interdisciplinary and intersectional work actively involving young people themselves stand out from the school as the linchpin

Initial experience with non-invasive prenatal testing of cell-free DNA for major chromosomal anomalies in a clinical setting.

OBJECTIVE: To evaluate non-invasive prenatal testing (NIPT) of cell-free DNA (cfDNA) as a screening method for major chromosomal anomalies (CA) in a clinical setting. METHODS: From January to December 2013, Panorama™ test or Harmony™ prenatal test were offered as advanced NIPT, in addition to first-trimester combined screening in singleton pregnancies. RESULTS: The cohort included 333 pregnant women with a mean maternal age (MA) of 37 years who underwent testing at a mean gestational age of 14.6 weeks. Eighty-four percent were low-risk pregnancies. Results were provided in 97.3% of patients at a mean reporting time of 12.9 calendar days. Repeat sampling was performed in six cases and results were obtained in five of them. No results were provided in four cases. Four cases of Down syndrome were detected and there was one discordant result of Turner syndrome. We found no statistical differences between commercial tests except in reporting time, fetal fraction and MA. The cfDNA fraction was statistically associated with test type, maternal weight, BMI and log ßhCG levels. CONCLUSIONS: NIPT has the potential to be a highly effective screening method for major CA in a clinical setting.

Sonographic evaluation of the fetal conus medullaris.

OBJECTIVE: The aim of this study is to determine the most reproducible method in the sonographic evaluation of the conus medullaris (CM) and its relationship with gestational age (GA). METHODS: This is a prospective study of singleton structurally normal fetuses between 20 and 30 weeks' gestation. Sonographic evaluation of the CM was performed using two methodologies: a qualitative assessment of the CM level in relation to the lumbar vertebrae and a quantitative measurement of the distance from the CM to the last spine ossification centre (conus-sacrum or CS distance). Both parameters were analysed offline by two operators using 3D stored volumes. Interobserver variability of methods, the relationship between CS and femur length (FL) or GA was evaluated. RESULTS: We analysed 101 3D volumes. Interobserver concordance was low for the CM level (k = 0.4, P < 0.05) and high for CS distance (ICC = 0.950). A significant correlation between CS and both FL and GA was observed. CONCLUSIONS: CS distance but not CM level is reproducible. CS distance is significantly correlated with both FL and GA. CS distance could be useful in the assessment of prenatal skin-covered spinal dysraphism.

Resultados de las 100 primeras colecistectomías por puerto único en un hospital de segundo nivel / Results of the first 100 single port laparoscopic cholecystectomies in a secondary care hospital

INTRODUCCIÓN: Aunque los resultados de la colecistectomía laparoscópica estándar son excelentes, se continúa intentando minimizar el número de puertos con el objeto de disminuir el dolor postoperatorio, conseguir una recuperación más temprana y mejorar el resultado estético del paciente. El objetivo de este estudio es presentar los resultados de los primeros 100 casos de colecistectomía por puerto único practicados en un hospital de segundo nivel. MATERIAL Y MÉTODOS: Estudio prospectivo, observacional, unicéntrico. Se intervino a 100 pacientes entre enero de 2010 y abril de 2012. CRITERIOS DE INCLUSIÓN: pacientes mayores de 16 años con colelitiasis sintomática operados por colecistectomía simple mediante incisión umbilical única. Criterios de exclusión: antecedentes de colecistitis aguda, colangiopancreatografía retrógrada endoscópica, pancreatitis o sospecha de coledocolitiasis, IMC > 35 y laparotomías previas. Se estudiaron distintas variables epidemiológicas, quirúrgicas y de seguridad. RESULTADOS: La edad media de los pacientes fue de 39,89 ± 11,5 años. El tiempo quirúrgico medio fue de 67,94 ± 25,5 min. Presentaron complicaciones postoperatorias 2 pacientes: seroma y fuga biliar. En 2 casos fue necesaria la utilización de trocar accesorio. La estancia media fue de 1,13 ± 0,8 días. El 35% de los pacientes fueron tratados en régimen de cirugía mayor ambulatoria. Todos los pacientes se mostraron muy satisfechos con el resultado estético. CONCLUSIONES: La colecistectomía mediante incisión umbilical única es una buena técnica cuando se utiliza en casos seleccionados y por cirujanos expertos. Puede facilitar la práctica de la colecistectomía en régimen ambulatorio. No se han presentado complicaciones graves. El índice de satisfacción estética es muy elevado

INTRODUCTION: Despite the excellent results obtained with standard laparoscopic cholecystectomy, the efforts for minimizing the ports needed to reduce postoperative pain, for a quicker recovery and to improve the patient's cosmetics continue. The aim of this study is to report the results of the first 100 cases of single port laparoscopic cholecystectomy performed in a secondary care hospital. MATERIAL AND METHODS: Prospective, observational and unicentric study including 100 patients between January 2010 and April 2012. Inclusion criteria: symptomatic cholelythiasis patients over 16 years of age on whom a single port laparoscopic cholecystectomy was performed. Exclusion criteria: history of acute cholecystitis, pancreatitis or suspected choledocholithiasis, Endoscopic retrograde cholangiopancreatography, BMI > 35 and previous laparotomies. We studied epidemiological, surgical and safety variables. RESULTS: The mean patient age was 39.89 ± 11.5 years. The mean time of the surgical procedure was 67.94 ± 25.5 min. There were 2 cases of postoperative complications: a non-infected seroma and a biliar leak. In 2 cases the use of an accessory trocar was needed. The mean hospital stay was 1.13 ± 0.8 days. A total of 35% patients were included in the major ambulatory surgery program. The overall patient satisfaction survey rating showed a high level of cosmetic satisfaction in 100% of patients. CONCLUSIONS: Single port laparoscopic cholecystectomy is a good technique when performed in selected cases by expert surgeons. It is feasible to include the single port laparoscopic cholecystectomy in a major ambulatory surgery program. We have not had serious complications. There is a high cosmetic satisfaction index with this technique

Concordance between prenatal ultrasound and autopsy findings in a tertiary center.

OBJECTIVE: The aim of this study was to evaluate the ultrasound (US)/autopsy concordance in elective termination of pregnancies (TOP) due to fetal causes. METHODS: We performed a retrospective evaluation of elective TOP from 2004 to 2012. Inclusion criteria were gestational age at termination <24 weeks, fetal pathology and availability of US/autopsy data. Based on the US-autopsy concordance, cases were divided into four groups: Group 1: agreement; Group 2: autopsy confirmed all US findings but provided additional information; Group 3: autopsy didn't confirm all US findings; Group 4: disagreement. RESULTS: One hundred and fifty-one patients fulfilled the inclusion criteria during the study period. Central nervous system malformations (91.5%), cardiovascular anomalies (90.2%) and renal system malformations (91.3%) were confirmed by autopsy. We found less concordance in the abdominal and musculoskeletal anomalies (61.5% and 66.7%, respectively). There were 130 (86%) fetuses in group 1, 7 in group 2 (4.6%), 3 in group 3 (1.9%) and 11 in group 4 (7.2%). In 5.29% of cases, the autopsy added relevant information to the diagnosis and counselling. CONCLUSIONS: Diagnosis concordance between US and necropsy is achieved in almost 90% of cases. An autopsy may help to adjust the diagnosis and help in counselling the parents for a future pregnancy.