Social Support and Mental Health in the Postpartum Period in Times of SARS-CoV-2 Pandemic: Spanish Multicentre Cohort Study.

BACKGROUND: To explore the depression and anxiety symptoms in the postpartum period during the SARS-CoV-2 pandemic and to identify potential risk factors. METHODS: A multicentre observational cohort study including 536 women was performed at three hospitals in Spain. The Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI) Scale, the Medical Outcomes Study Social Support Survey (MOS-SSS), and the Postpartum Bonding Questionnaire (PBQ) were assessed after birth. Depression (EPDS) and anxiety (STAI) symptoms were measured, and the cut-off scores were set at 10 and 13 for EPDS, and at 40 for STAI. RESULTS: Regarding EPDS, 32.3% (95% CI, 28% to 36.5%) of women had a score ≥ 10, and 17.3% (95% CI, 13.9% to 20.7%) had a score ≥ 13. Women with an STAI score ≥ 40 accounted for 46.8% (95% CI, 42.3% to 51.2%). A lower level of social support (MOS-SSS), a fetal malformation diagnosis and a history of depression (p = 0.000, p = 0.019 and p = 0.043) were independent risk factors for postpartum depression. A lower level of social support and a history of mental health disorders (p = 0.000, p = 0.003) were independent risk factors for postpartum anxiety. CONCLUSION: During the SARS-CoV-2 pandemic, an increase in symptoms of anxiety and depression were observed during the postpartum period.

Conventional and digital Ki67 evaluation and their correlation with molecular prognosis and morphological parameters in luminal breast cancer.

Digital counting methods were developed to decrease the high intra- and inter-observer variability of immunohistochemical markers such as Ki67, with most presenting a good correlation coefficient (CC). Since Ki67 is one of the major contributors to Oncotype DX, it is conceivable that Ki67 expression and the recurrence score (RS) obtained by the multigene panel are positively correlated. We decided first to test to what extent conventional and digital Ki67 quantification methods correlate in daily practice and, second, to determine which of these methods correlates better with the prognostic capacity of the Oncotype DX test. Both Ki67 evaluations were performed in 89 core biopsies with a diagnosis of estrogen receptor (ER) positive HER2-negative breast cancer (BC). Cases were, thus, classified twice for surrogate subtype: first by conventional analysis and then by digital evaluation. The Oncotype RS was obtained in 55 cases that were subsequently correlated to Ki67 evaluation by both methods. Conventional and digital Ki67 evaluation showed good concordance and correlation (CC = 0.81 (95% CI 0.73-0.89)). The correlation of Oncotype DX risk groups and surrogate derived subtypes was slightly higher for the digital technique (rs = 0.46, p < 0.01) compared to the conventional method (rs = 0.39, p < 0.01), even though both were statistically significant. In conclusion, we show that digital evaluation could be an alternative to conventional counting, and also has advantages for predicting the risk established by the Oncotype DX test in ER-positive BC. This study also supports the importance of an accurate Ki67 analysis which can influence the decision to submit ER-positive HER2-negative BC to prognostic molecular platforms.

Síndrome de OHVIRA: reporte de 3 casos / OHVIRA syndrome: three case report

ANTECEDENTES: el síndrome de OHVIRA es una malformación uterina caracterizada por un útero didelfo, una hemivagina ciega total o parcial y agenesia renal ipsilateral. Se describen 3 casos diagnosticados y tratados entre 2015 y 2017. CASOS CLÍNICOS: Caso 1: paciente de 11 años con agenesia renal izquierda, que consultó por dismenorrea intensa. En la ecografía se objetivó un útero didelfo, hematosálpinx y hematómetra que se drenaron en quirófano mediante incisión en el tabique vaginal evolucionando favorablemente. Caso 2: paciente de 16 años con síndrome de Rett y agenesia renal izquierda que consultó por amenorrea tras menarquia de 4 meses. En la ecografía se descubre un útero didelfo y hematocolpos. Se realizó drenaje y apertura del tabique vaginal con éxito. Caso 3: paciente de 16 años que acudió por dismenorrea e intenso dolor anal. Se diagnostica por ecografía útero didelfo, hematosálpinx y vagina izquierda ciega con hematocolpos. No se puede drenar la colección por la alta densidad del material por lo que se decide, junto con cirugía pediátrica, realizar hemihisterectomía, colposalpinguectomía y exéresis de hemivagina ciega izquierda por laparoscopia. CONCLUSIONES: ante el hallazgo en una paciente de una malformación o agenesia renal se deberían investigar posibles malformaciones genitales asociadas como el síndrome de OHVIRA, ya que el diagnóstico y tratamiento tempranos de estas últimas reducen el sufrimiento y previenen complicaciones

BACKGROUND: OHVIRA syndrome is a uterine malformation characterized by uterus didelphys, total or partial blind hemivagina, and ipsilateral renal agenesis. Three cases diagnosed and treated between 2015 and 2017 are described. CLINICAL CASE: Case 1: 11-year-old patient who consulted for intense dysmenorrhea; ultrasound showed a uterus didelphy, hematosalpinx and hematometra that were drained in the operating room by incision in the vaginal septum, making good progress. Case 2: A 16-year-old patient with Rett syndrome and renal agenesis who consulted for amenorrhea after menarche of 4 months. On ultrasound was found a uterus didelphy and hematocolpos. Drainage and opening of the vaginal septum were performed successfully. Case 3: A 16-year-old pacient who came for dysmenorrhea and intense anal pain; by ultrasound she was diagnosed of uterus didelphy, hematosalpinx and left blind vagina with hematocolpos. The collection could not be drained because of the high density of the material so it was decided, together with pediatric surgery dept, to perform a hemihysterectomy, colposalpinguectomy and exeresis of left blind hemivagina by laparoscopy. CONCLUSION: Given the finding of renal agenesia or renal malformations, possible associated genital malformations as OHVIRA syndrome should be investigated since early diagnosis and treatment could reduce suffering and prevent complications

Clival Chondroid Chordoma: A Case Report and Review of the Literature.

Chordomas are rare, slow-growing, and locally aggressive malignant neoplasms derived from primitive notochord remnants. The chondroid variety represents 14% of all chordomas mainly developing in the spheno-occipital region and presenting between the third and fifth decades of life. When developing intracranially, symptoms can range from headaches and neck pain to cranial nerve neuropathies and facial numbness. We illustrate a case of an adolescent woman who presented with excruciating facial pain, otalgia, decreased visual acuity, quadriparesis, headache, nausea, and dysphagia. Radiological studies revealed a large heterogeneous mass in the spheno-occipital region with clivus destruction. Biopsy and histopathology confirmed the diagnosis. Proper identification with prompt surgical resection and adjuvant radiotherapy remains critical to prevent complications.

Pertinencia intercultural de la atención en salud. El camino a seguir en Leishmaniosis Tegumentaria Americana / Intercultural relevance of health care. The way to follow in American Tegumentary Leishmaniosis

La Leishmaniosis tegumentaria americana (LTA) es considerada un problema de salud pública por su elevada incidencia. Además, es una patología abordada en muchos países a través de programas sanitarios con estructura vertical, sin contacto social y sin considerar la cultura de los grupos poblacionales, a sabiendas que existen diferencias en cuanto a ésta en el tratamiento de la enfermedad. El objetivo es la descripción y análisis de la pertinencia cultural del proceso de atención en salud en el caso de LTA, con base en la revisión bibliográfica de literatura científica sobre esta patología y sobre el papel de la cultura sobre la misma como aporte de ideas y de conocimientos para el debate necesario en el diseño de políticas y programas sanitarios de control de patologías parasitarias.(AU)

American tegumentary Leishmaniasis (LTA) is considered a public health problem because of its high incidence. In addition, it is a pathology addressed in many countries through health programs with vertical structure, without social contact and without considering the culture of the population groups, knowing that there are differences in the treatment of the disease. The objective is the description and analysis of the cultural relevance of the health care process in the case of LTA, based on the bibliographical review of scientific literature on this pathology and on the role of culture in the same as contribution of ideas and of knowledge for the necessary debate in the design of health policies and programs to control parasitic diseases.(AU)

Concausalidad en un caso clínico de hematoma subdural / Concausality in a clinical case of subdural hematoma

ResumenLas ciencias forenses, a través, de su cuerpo de conocimiento, debe encaminar de manera precisa, por medio del aporte de suficientes datos, la ejecución de la leyes en función de la justicia con especial interés en homicidios concausales, donde la existencia en la víctima de una condición desconocida por el atacante agrava el efecto de su acción, que termina con la vida de la víctima. En este reporte se presenta un caso en que un traumatismo facial ocasionado en una disputa entre atacante y atacado degenera en hematoma subdural agudo con muerte súbita de este último, atribuido a debilidad intrínseca de la pared de los vasos sanguíneos y/o defecto en el grosor de la concha del temporal e incluso a la sumatoria de ambas circunstancias anatómicas. Se concluye que la experticia forense con base en la sustentación de la evidencia es clave para el establecimiento de responsabilidad de autoría de un hecho ilícito.

AbstractThe forensic sciences, through its body of knowledge, must accurately direct, through the provision of sufficient data, the execution of laws in function of justice with special interest in killings, where the existence in the victim of a condition unknown by the attacker aggravates the effect of his action, which ends with the life of the victim. This report presents a case in which a facial trauma caused in a dispute between attacker and attacker degenerates into acute subdural hematoma with sudden death of the latter, attributed to intrinsic weakness of the wall of the blood vessels and / or defect in thickness the shell of the storm and even the sum of both anatomical circumstances. It is concluded that forensic expertise based on the support of evidence is key to establishing responsibility for authorship of an illegal act.

[Prenatal diagnosis of fetal aortic stenosis with mitral insufficiency. Review of the ultrasound diagnosis and perinatal prognosis: a case report]. / Diagnóstico prenatal de la estenosis aórtica crítica con insuficiencia mitral. Revisión del diagnóstico ecográfico y pronóstico perinatal. A propósito de un caso.

This is a report about a case of prenatal diagnosis of critical fetal aortic stenosis with severe mitral valve insufficiency in a 35+6 weeks fetus. Aortic stenosis represents 3% of congenital heart diseases, but its association with mitral regurgitation is quite unusual. Thanks to the latest advances in fetal ultrasonography we can now achieve a more precise diagnosis and we have been able to improve the understanding of its physiopathology. Based on this case we have reviewed the most recent literature about fetal aortic stenosis and mitral valve insufficiency, with the aim of summarizing its main physiopathological features, highlighting the clues and key points for its intrauterine diagnosis, describing its principal complications and summarizing its current treatment options.

Sepsis puerperal grave por piomiomas uterinos múltiples / Severe puerperal sepsis due to multiple uterine pyomyomas

La infección de leiomiomas uterinos o piomiomas es una complicación poco frecuente que afecta en ocasiones a mujeres embarazadas o puérperas. Por ello resulta difícil su diagnóstico y complicado su tratamiento. Desde 1945 se han publicado 19 casos de piomiomas asociados a embarazo. Presentamos el caso de una paciente con sepsis puerperal grave tras la infección de varios miomas uterinos, que fue tratada mediante histerectomía urgente y antibioterapia (AU)

Infection of uterine leiomyomas or pyomyomas is a rare complication that sometimes affects pregnant or postpartum women. Its diagnosis is therefore difficult and its treatment is complicated. Since 1945, there have been 19 published cases of pyomyomas associated with pregnancy. We report the case of a postpartum patient with severe sepsis following infection of several fibroids. She was treated with urgent hysterectomy and antibiotic therapy (AU)

Tumor fibroso solitario de la vulva / Solitary fibrous tumours of the vulva

El tumor fibroso solitario (TFS) es una tumoración mesenquimal poco frecuente identificada inicialmente en la pleura, pero que puede presentarse en prácticamente todas las regiones. En los últimos años, se han descrito algunos casos aislados originados en el tracto genital femenino. Presentamos el caso de una mujer de 35 años de edad que consultó por una tumoración vulvar, a la que se le practicó exéresis quirúrgica. En el examen anatomopatológico la tumoración medía 20mm de diámetro, presentaba características típicas de TFS y estaba constituida por una proliferación fusocelular sin atipias, con áreas alternas hiper ehipocelulares, abundante colágena y un patrón vascular hemangiopericitomatoso. En la inmunohistoquímica era intensamente positiva paraCD34 y bcl-2 y negativa para S-100 y actina. El TFS presenta un comportamiento agresivo en alrededor de un 25% de los casos y debe considerarse siempre un tumor potencialmente maligno, por lo que es preciso un seguimiento clínico. Por tanto, su correcta identificación y diferenciación de otras lesiones del área genital femenina con características similares son de importancia crucial (AU)

Solitary fibrous tumour (SFT) is a rare mesenchymal tumour initially identified in the pleura, but that can be present in virtually all regions. Isolated cases arising in the female genital tract have been described in recent years. We report the case of a woman aged 35who presented with a vulvar tumour, which was resected. On pathological examination thet umour measured 20 mm in diameter and showed typical features of SFT, consisting of spindle cell proliferation without atypia, alternating with hyper- and hypo-cellular areas, presence of abundant collagen and with avascular hemangiopericy tomatous pattern. Immunohistochemistry was strongly positive forCD34 and bcl-2 and negative for S-100 and actin. SFT shows aggressive behaviour in approximately 25% of cases and should always be considered a potentially malignant tumour fusiforand requires a clinical follow-up. Therefore, the identification and differentiation from other lesions with similar features in the female genital area is essential (AU)