Exploratory Analysis of the Role of Radiomic Features in the Differentiation of Oncocytoma and Chromophobe RCC in the Nephrographic CT Phase.

In diagnostic imaging, distinguishing chromophobe renal cell carcinomas (chRCCs) from renal oncocytomas (ROs) is challenging, since they both present similar radiological characteristics. Radiomics has the potential to help in the differentiation between chRCCs and ROs by extracting quantitative imaging. This is a preliminary study of the role of radiomic features in the differentiation of chRCCs and ROs using machine learning models. In this retrospective work, 38 subjects were involved: 19 diagnosed with chRCCs and 19 with ROs. The CT nephrographic contrast phase was selected in each case. Three-dimensional segmentations of the lesions were performed and the radiomic features were extracted. To assess the reliability of the features, the intraclass correlation coefficient was calculated from the segmentations performed by three radiologists with different degrees of expertise. The selection of features was based on the criteria of excellent intraclass correlation coefficient (ICC), high correlation, and statistical significance. Three machine learning models were elaborated: support vector machine (SVM), random forest (RF), and logistic regression (LR). From 105 extracted features, 41 presented an excellent ICC and 6 were not highly correlated with each other. Only two features showed significant differences according to histological type and machine learning models were developed with them. LR was the better model, in particular, with an 83% precision.

Gynaecological Causes of Acute Pelvic Pain: Common and Not-So-Common Imaging Findings.

In female patients, acute pelvic pain can be caused by gynaecological, gastrointestinal, and urinary tract pathologies. Due to the variety of diagnostic possibilities, the correct assessment of these patients may be challenging. The most frequent gynaecological causes of acute pelvic pain in non-pregnant women are pelvic inflammatory disease, ruptured ovarian cysts, ovarian torsion, and degeneration or torsion of uterine leiomyomas. On the other hand, spontaneous abortion, ectopic pregnancy, and placental disorders are the most frequent gynaecological entities to cause acute pelvic pain in pregnant patients. Ultrasound (US) is usually the first-line diagnostic technique because of its sensitivity across most common aetiologies and its lack of radiation exposure. Computed tomography (CT) may be performed if ultrasound findings are equivocal or if a gynaecologic disease is not initially suspected. Magnetic resonance imaging (MRI) is an extremely useful second-line technique for further characterisation after US or CT. This pictorial review aims to review the spectrum of gynaecological entities that may manifest as acute pelvic pain in the emergency department and to describe the imaging findings of these gynaecological conditions obtained with different imaging techniques.

Pilot Study for the Assessment of the Best Radiomic Features for Bosniak Cyst Classification Using Phantom and Radiologist Inter-Observer Selection.

Since the Bosniak cysts classification is highly reader-dependent, automated tools based on radiomics could help in the diagnosis of the lesion. This study is an initial step in the search for radiomic features that may be good classifiers of benign-malignant Bosniak cysts in machine learning models. A CCR phantom was used through five CT scanners. Registration was performed with ARIA software, while Quibim Precision was used for feature extraction. R software was used for the statistical analysis. Robust radiomic features based on repeatability and reproducibility criteria were chosen. Excellent correlation criteria between different radiologists during lesion segmentation were imposed. With the selected features, their classification ability in benignity-malignity terms was assessed. From the phantom study, 25.3% of the features were robust. For the study of inter-observer correlation (ICC) in the segmentation of cystic masses, 82 subjects were prospectively selected, finding 48.4% of the features as excellent regarding concordance. Comparing both datasets, 12 features were established as repeatable, reproducible, and useful for the classification of Bosniak cysts and could serve as initial candidates for the elaboration of a classification model. With those features, the Linear Discriminant Analysis model classified the Bosniak cysts in terms of benignity or malignancy with 88.2% accuracy.

Renal Angiomyolipoma: A Diagnostic and Therapeutic Challenge.

BACKGROUND: Angiomyolipomas (AML) represent less than 10% of renal tumours. They are most often detected incidentally during imaging tests, but there are several histological variants that pose difficulties in the radiological differential diagnosis. Their identification should allow the loss of renal parenchyma due to embolization or radical surgery to be prevented. METHODS: Retrospective study of patients undergoing kidney surgery with post-surgical pathological diagnosis of AML at the Álvaro Cunqueiro Hospital (2016-2021). Patients with a radiological diagnosis of AML who underwent surgery based on clinical criteria were excluded. RESULTS: 18 patients were registered, allowing for the assessment of 18 renal tumours. All of the cases were diagnosed incidentally. Preoperative radiological diagnosis was: 9 lesions suggestive of renal cell carcinoma (RCC) (50%), 7 cases suggestive of RCC vs. AML (38.9%) and 2 lesions suggestive of AML vs. retroperitoneal liposarcoma (11.1%). Histological variants of AML were found in 61.1% of cases (n = 11). The most widely used surgical technique was partial nephrectomy, in 66.67% of cases. CONCLUSIONS: The radiological differential diagnosis of AML, and particularly its variants, with malignant lesions have important limitations either due to the predominance or scarcity of any of the AML components. Some cases can also pose difficulties at the histological level. This fact highlights the importance of the specialization of uroradiologists and uropathologists and the performance of kidney-sparing therapeutic techniques.

Renal Angiomyolipoma: A Diagnostic and Therapeutic Challenge

Background: Angiomyolipomas (AML) represent less than 10% of renal tumours. They are most often detected incidentally during imaging tests, but there are several histological variants that pose difficulties in the radiological differential diagnosis. Their identification should allow the loss of renal parenchyma due to embolization or radical surgery to be prevented. Methods: Retrospective study of patients undergoing kidney surgery with post-surgical pathological diagnosis of AML at the Álvaro Cunqueiro Hospital (2016–2021). Patients with a radiological diagnosis of AML who underwent surgery based on clinical criteria were excluded. Results: 18 patients were registered, allowing for the assessment of 18 renal tumours. All of the cases were diagnosed incidentally. Preoperative radiological diagnosis was: 9 lesions suggestive of renal cell carcinoma (RCC) (50%), 7 cases suggestive of RCC vs. AML (38.9%) and 2 lesions suggestive of AML vs. retroperitoneal liposarcoma (11.1%). Histological variants of AML were found in 61.1% of cases (n = 11). The most widely used surgical technique was partial nephrectomy, in 66.67% of cases. Conclusions: The radiological differential diagnosis of AML, and particularly its variants, with malignant lesions have important limitations either due to the predominance or scarcity of any of the AML components. Some cases can also pose difficulties at the histological level. This fact highlights the importance of the specialization of uroradiologists and uropathologists and the performance of kidney-sparing therapeutic techniques (AU)

Skeletal malformations and growth disturbances in fetuses of mild diabetic rats / Malformaciones esqueléticas y alteraciones del crecimiento en fetos de ratas con diabetes moderada

Introduction: Currently, diabetes mellitus represents one of the medical conditions that more frequently complicates pregnancy affecting the fetus's growth and development. Objective: To determine the skeletal malformations and growth alterations in fetuses of diabetic Wistar rats. Materials and methods: We used a neonatally streptozotocin-induced mild diabetes model (STZ 100 mg/kg body weight - subcutaneously) in Wistar rats. In adulthood, healthy and diabetic rats were mated with healthy males of the same age and strain. On day 20 of gestation, a cesarean was performed under anesthesia. Fetuses were removed, weighed, and classified as small (SPA), adequate (APA), and large (LPA) for the gestational age. Selected fetuses were processed for skeletal anomaly and ossification sites analysis. Results: In the offspring of diabetic rats, there was a higher percentage of fetuses classified as small or large and a lower percentage of fetuses with adequate weight; the fetal weight mean was lower and there were fewer sites of ossification. Alterations were observed in the ossification of the skull, sternum, spine, ribs and fore and hind limbs; and also, there was a direct correlation between fetal weight and ossification degree. There were congenital malformations associated with fusion and bifurcation of the ribs, as well as changes indicative of hydrocephaly, such as the dome shape of the skull, a wide distance between parietals, and the width of the anterior and posterior fontanels. Conclusion: Moderate diabetes during pregnancy alters fetal growth and development with macrosomia and intrauterine growth restriction, as well as skeletal malformations.

Introducción. En la actualidad, la diabetes mellitus representa una de las condiciones médicas que complica el embarazo con mayor frecuencia, lo que afecta el crecimiento y el desarrollo fetal. Objetivo. Determinar las malformaciones esqueléticas y alteraciones en el crecimiento en fetos de ratas Wistar diabéticas. Materiales y métodos. Se utilizó un modelo de diabetes moderada inducida neonatalmente con estreptozotocina (STZ 100 mg/kg de peso corporal, por vía subcutánea) en ratas Wistar. En la adultez, las ratas sanas y diabéticas se aparearon con machos sanos de la misma edad y cepa. El día 20 de gestación se practicó la cesárea bajo anestesia. Se extrajeron los fetos, se pesaron y clasificaron como pequeños (PAG), adecuados (AEG) o grandes (GEG) para la edad gestacional. Los fetos seleccionados se procesaron para el análisis de anomalías esqueléticas y sitios de osificación. Resultados. En la descendencia de las ratas diabéticas, hubo un mayor porcentaje de fetos clasificados como pequeños o grandes y un menor porcentaje de fetos con peso adecuado; el promedio de peso fetal fue menor y había menos sitios de osificación. Se observaron alteraciones en la osificación de cráneo, esternón, columna vertebral, costillas y extremidades anteriores y posteriores; y también, hubo una correlación directa entre el peso y el grado de osificación fetal. Hubo malformaciones congénitas asociadas con la fusión y bifurcación de las costillas, así como cambios indicativos de hidrocefalia, como la forma de domo del cráneo, una amplia distancia entre los parietales y la anchura de las fontanelas anterior y posterior. Conclusión. La diabetes moderada durante la gestación altera el crecimiento y el desarrollo fetal, que se ve afectado tanto por macrosomía y la restricción del crecimiento intrauterino como por malformaciones esqueléticas.

Malformaciones esqueléticas y alteraciones del crecimiento en fetos de ratas con diabetes moderada / Skeletal malformations and growth disturbances in fetuses of mild diabetic rats

Resumen Introducción. En la actualidad, la diabetes mellitus representa una de las condiciones médicas que complica el embarazo con mayor frecuencia, lo que afecta el crecimiento y el desarrollo fetal. Objetivo. Determinar las malformaciones esqueléticas y alteraciones en el crecimiento en fetos de ratas Wistar diabéticas. Materiales y métodos. Se utilizó un modelo de diabetes moderada inducida neonatalmente con estreptozotocina (STZ 100 mg/kg de peso corporal, por vía subcutánea) en ratas Wistar. En la adultez, las ratas sanas y diabéticas se aparearon con machos sanos de la misma edad y cepa. El día 20 de gestación se practicó la cesárea bajo anestesia. Se extrajeron los fetos, se pesaron y clasificaron como pequeños (PAG), adecuados (AEG) o grandes (GEG) para la edad gestacional. Los fetos seleccionados se procesaron para el análisis de anomalías esqueléticas y sitios de osificación. Resultados. En la descendencia de las ratas diabéticas, hubo un mayor porcentaje de fetos clasificados como pequeños o grandes y un menor porcentaje de fetos con peso adecuado; el promedio de peso fetal fue menor y había menos sitios de osificación. Se observaron alteraciones en la osificación de cráneo, esternón, columna vertebral, costillas y extremidades anteriores y posteriores; y también, hubo una correlación directa entre el peso y el grado de osificación fetal. Hubo malformaciones congénitas asociadas con la fusión y bifurcación de las costillas, así como cambios indicativos de hidrocefalia, como la forma de domo del cráneo, una amplia distancia entre los parietales y la anchura de las fontanelas anterior y posterior. Conclusión. La diabetes moderada durante la gestación altera el crecimiento y el desarrollo fetal, que se ve afectado tanto por macrosomía y la restricción del crecimiento intrauterino como por malformaciones esqueléticas.

Abstract Introduction: Currently, diabetes mellitus represents one of the medical conditions that more frequently complicates pregnancy affecting the fetus's growth and development. Objective: To determine the skeletal malformations and growth alterations in fetuses of diabetic Wistar rats. Materials and methods: We used a neonatally streptozotocin-induced mild diabetes model (STZ 100 mg/kg body weight - subcutaneously) in Wistar rats. In adulthood, healthy and diabetic rats were mated with healthy males of the same age and strain. On day 20 of gestation, a cesarean was performed under anesthesia. Fetuses were removed, weighed, and classified as small (SPA), adequate (APA), and large (LPA) for the gestational age. Selected fetuses were processed for skeletal anomaly and ossification sites analysis. Results: In the offspring of diabetic rats, there was a higher percentage of fetuses classified as small or large and a lower percentage of fetuses with adequate weight; the fetal weight mean was lower and there were fewer sites of ossification. Alterations were observed in the ossification of the skull, sternum, spine, ribs and fore and hind limbs; and also, there was a direct correlation between fetal weight and ossification degree There were congenital malformations associated with fusion and bifurcation of the ribs, as well as changes indicative of hydrocephaly, such as the dome shape of the skull, a wide distance between parietals, and the width of the anterior and posterior fontanels. Conclusion: Moderate diabetes during pregnancy alters fetal growth and development with macrosomia and intrauterine growth restriction, as well as skeletal malformations.

MRI of female genital tract congenital anomalies: European Society of Urogenital Radiology (ESUR) guidelines.

OBJECTIVE: To develop imaging guidelines for the MR work-up of female genital tract congenital anomalies (FGTCA). METHODS: These guidelines were prepared based on a questionnaire sent to all members of the European Society of Urogenital Radiology (ESUR) Female Pelvic Imaging Working Group (FPI-WG), critical review of the literature and expert consensus decision. RESULTS: The returned questionnaires from 17 different institutions have shown reasonable homogeneity of practice. Recommendations with focus on patient preparation and MR protocol are proposed, as these are key to optimised examinations. Details on MR sequences and planning of uterus-orientated sequences are provided. CONCLUSIONS: The multiplanar capabilities and soft tissue resolution of MRI provide superb characterisation of the wide spectrum of findings in FGTCA. A standardised imaging protocol and method of reporting ensures that the salient features are recognised, contributing to a correct diagnosis and classification of FGTCA, associated anomalies and complications. These imaging guidelines are based on current practice among expert radiologists in the field and incorporate up to date information regarding MR protocols and essentials of recently published classification systems. KEY POINTS: • MRI allows comprehensive evaluation of female genital tract congenital anomalies, in a single examination. • A dedicated MRI protocol comprises uterus-orientated sequences and vaginal and renal evaluation. • Integration of classification systems and structured reporting helps in successful communication of the imaging findings.

Economic Analysis of the Use of Anti-DFS70 Antibody Test in Patients with Undifferentiated Systemic Autoimmune Disease Symptoms.

OBJECTIVE: In patients with antinuclear antibodies (ANA) and undifferentiated features of systemic autoimmune disease, the coexistence of monospecific anti-dense fine speckled 70 (anti-DFS70) antibodies is associated with a lower risk of progression to overt disease. Therefore, they might help in correctly classifying ANA- positive patients and avoiding unnecessary followup diagnostic procedures. The aim of this study was to analyze the economic effect of the introduction of the anti-DFS70 antibody test in a hospital setting. METHODS: A case-control study was performed to detect monospecific anti-DFS70 antibodies in ANA-positive subjects with undifferentiated features (cases, n = 124) and with a defined systemic autoimmune disease (controls, n = 290). Based on current clinical practice, a decision tree was developed to represent the disease course of patients with undifferentiated features in the subsequent 3 years. A budget impact analysis (BIA) was performed to estimate the effect of implementing the screening for anti-DFS70 antibodies in the case group on the total costs. A sensitivity analysis was conducted to calculate the effect of the uncertainty of the input variables on the results. RESULTS: Among the 124 patients in the case group, 5 (4.0%) tested positive for anti-DFS70 antibodies versus 4/290 (1.4%) in the control group (p = not significant). The mean cost per patient under the current clinical practice decreased from €3274 to €3192 in our scenario. The BIA reports cost savings of €10,128. CONCLUSION: The introduction of anti-DFS70 antibody test would avoid unnecessary followup diagnostic procedures and minimize the use of health resources generated by suspicion of a potential systemic autoimmune disease.

Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology.

OBJECTIVES: To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI. METHODS: The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to 81 questions regarding the details of patient preparation, MR imaging protocol, image interpretation and reporting were collected, analysed and classified as "RECOMMENDED" versus "NOT RECOMMENDED" (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts). RESULTS: Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended. CONCLUSIONS: These consensus recommendations should be used as a guide for endometrial cancer staging with MRI. KEY POINTS: • MRI is recommended for initial staging of endometrial cancer. • MR imaging protocol should be tailored based on the risk of lymph node metastases. • Myometrial invasion is best assessed using combined axial-oblique T2WI, DWI and contrast-enhanced imaging. • The mnemonic "Clinical and MRI Critical TEAM" summarizes key elements of the standardized report.

Association of T and NK Cell Phenotype With the Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a pathological condition characterized by incapacitating fatigue and a combination of neurologic, immunologic, and endocrine symptoms. At present its diagnosis is based exclusively on clinical criteria. Several studies have described altered immunologic profiles; therefore, we proposed to further examine the more significant differences, particularly T and NK cell subpopulations that could be conditioned by viral infections, to discern their utility in improving the diagnosis and characterization of the patients. The study included 76 patients that fulfilled the revised Canadian Consensus Criteria (CCC 2010) for ME/CFS and 73 healthy controls, matched for age and gender. Immunophenotyping of different T cell and natural killer cell subpopulations in peripheral blood was determined by flow cytometry. ME/CFS patients showed significantly lower values of T regulatory cells (CD4+CD25++(high)FOXP3+) and higher NKT-like cells (CD3+CD16+/-CD56+) than the healthy individuals. Regarding NK phenotypes, NKG2C was significantly lower and NKCD69 and NKCD56 bright were significantly higher in the patients group. A classification model was generated using the more relevant cell phenotype differences (NKG2C and T regulatory cells) that was able to classify the individuals as ME/CFS patients or healthy in a 70% of cases. The observed differences in some of the subpopulations of T and NK cells between patients and healthy controls could define a distinct immunological profile that can help in the diagnostic process of ME/CFS patients, contribute to the recognition of the disease and to the search of more specific treatments. However, more studies are needed to corroborate these findings and to contribute to establish a consensus in diagnosis.

Creencias y actitudes de adolescentes españoles hacia el consumo de tabaco en pipa de agua / Beliefs and attitudes of spanish adolescents regarding waterpipe smoking

Objetivo: Identificar las creencias y actitudes de los estudiantes de educación secundaria obligatoria y bachillerato de la provincia de Las Palmas respecto al consumo de tabaco en pipa de agua. Dicho objetivo responde a la reciente y rápida expansión del consumo de tabaco en pipa de agua entre los adolescentes europeos, la relativa escasez de datos acerca de sus determinantes y la falta de estudios al respecto en los adolescentes de nuestro país. Método: La muestra, constituida por 1770 alumnos de la provincia de Las Palmas, se obtuvo estratificando cada bloque académico por áreas geográficas, agrupando a los alumnos en tantos clusters como grupos había en el centro por cada uno de los cursos. Se utilizó un cuestionario ad hoc para la recogida de datos, realizándose un análisis descriptivo de los mismos. Las proporciones se compararon utilizando el test de la χ2. Resultados: El 70,7% de los adolescentes consideró que fumar en pipa de agua es menos perjudicial que fumar cigarrillos y el 71,3%, menos adictivo. Los estudiantes manifestaron que es una práctica muy aceptada por sus amigos (63,7%) y por la sociedad (78,9%). El 27,8% declaró percibir que sus padres le permitirían fumarla en casa. Todas estas creencias y actitudes fueron más frecuentes entre los fumadores (p<0,001). Conclusiones: La mayoría de los estudiantes considera menos peligroso y adictivo este consumo que el de cigarrillos. Estas creencias, la percepción de la aceptación social y de la tolerancia familiar han aumentado su popularidad entre los adolescentes

Objective: To identify beliefs and attitudes of high school students in Las Palmas regarding waterpipe smoking. This objective responds to the recent and increasing waterpipe smoking among European adolescents, the lack of data on its determinants and the absence of research on this issue among adolescents in Spain. Method: The sample, which comprised 1770 students of the province of Las Palmas (Canary Islands, Spain), was obtained by stratifying each academic block by geographic areas, grouping the students in as many clusters as existing groups in the school for each year group. An ad hoc questionnaire was used to collect data and a descriptive analysis of the data carried out. Proportions were compared using the χ2 test. Results: 70.7% of adolescents considered that waterpipe smoking is less harmful than smoking cigarettes and 71.3% believed it to be less addictive. Students asserted that it is a generally accepted practice among their friends (63.7%) and in society (78.9%). 27.8% of the interviewees perceived that their parents would allow them to smoke waterpipe at home. All of these beliefs and attitudes were more common among smokers (p<0.001). Conclusions: Most students consider waterpipe smoking to be less dangerous and less addictive than cigarette consumption. This belief, the perception of its social acceptance and family tolerance towards it have increased its popularity among adolescents

Rule reactivation and capture errors in goal directed behaviour.

In everyday life people may act automatically, following "unwanted" lines of action which are triggered by contextual cues and may interfere with current goals. Such occurrences are known as "capture errors" in reference to errors that occur when a more salient behaviour takes place when a similar, but less salient, action was intended. Clinical neuropsychological studies suggest that reactivation of previous rules may play an important role in behavioural interference, but such reactivation has been little studied in normal subjects and simple experimental tasks. In the present study we develop this theme, presenting data on 4 subjects who spontaneously showed capture errors in verbal fluency tasks, and developing a new experimental paradigm specifically designed to elicit such interference in normal subjects. In the new paradigm, 101 normal subjects performed a simple series of working memory tasks, including occasional stimuli whose answer matched both the current and the previous rule. We found that normal controls indeed tend to commit more mistakes after the presentation of a stimulus whose answer is consistent with a current and preceding rule. In this case, however, the errors produced are not necessarily associated with a shift back to the old rule, suggesting that rule reactivation leads to a more general interference effect. We discuss the importance of our data from both theoretical and clinical perspectives.

Estrategia educativa dirigida a incrementar la resiliencia en madres de niños con Síndrome de Down / Educational strategy aimed to increase the resilience of mothers with Down syndrome children

Introducción: el nacimiento de un niño con Síndrome de Down puede desencadenar una crisis sin precedente en el seno familiar y ser causa de estrés mantenido, lo cual puede afectar a la familia, en especial a las madres. Es necesario aumentar el conocimiento sobre esta enfermedad genética para fortalecer conductas resilientes en las madres y mejorar su capacidad para sobrellevar con éxito tener un niño diferente. Objetivo: incrementar la resiliencia en las madres de niños con Síndrome de Down a través de una estrategia educativa. Métodos: se diseñó y aplicó una estrategia educativa con diseño ambispectivo (Pre-test y Post-test), sobre algunos aspectos relacionados con la resiliencia en las madres de los niños con Síndrome de Down que asisten a un círculo infantil especial. El estudio se dividió en tres fases: en la fase inicial se aplicó una encuesta, evaluada y avalada por expertos, sobre diferentes aspectos del conocimiento, la salud de los niños y la resiliencia en las madres; en la segunda fase se aplicaron los talleres a todas las madres; y la tercera consistió en la aplicación de la encuesta inicial. Resultados: la mayoría de las madres (54,2 por ciento) tienen 35 años y más, el nivel de escolaridad es alto (70,8 por ciento), el 50 por ciento son trabajadoras, predomina el estado civil casada (37,5 por ciento) y unión estable (33,3 por ciento), el ingreso económico de la familia es regular (41,7 por ciento) y dominan las condiciones constructivas satisfactorias en los hogares (62,5 por ciento). Después de recibir los talleres aumentó significativamente el conocimiento de las madres (91,7 por ciento); el mismo porcentaje tuvo expectativas positivas sobre la inclusión social de sus hijos, 23 (95,2 por ciento) reclamaron una información continuada y se incrementaron en las madres las conductas resilientes (87,5 por ciento). Conclusiones: aumentó el conocimiento y la resiliencia de las madres a partir de la estrategia educativa aplicada a las mismas(AU)

Introduction: the birth of a child with Down syndrome may trigger an unprecedented crisis within the family and be the cause for maintained stress, which may affect the family, specially mothers. It is necessary to increase the knowledge about this genetic disease, to strengthen resilient behavior in mothers and improve their capacity to successfully bear having a different child. Objective: to increase resilience in mothers with Down syndrome children, by means of an educational strategy. Methods: we designed and applied an educational strategy with an ambispective design (pre-test and pro-test) about some of the aspects related with resilience in mothers with Down syndrome children who attend a special kindergarten. The study was divided into three stages: in the initial stage we conducted a survey (assessed and validated by experts) about different aspects of knowledge, children health and mother's resilience; in the second stage we held the workshops with all the mothers; in the third stage we conducted the same initial survey. Results: the majority of the mothers (54.2 percent) were 35 years old or older, schooling is high (70.8 percent), 50 percent of them are workers, status of married (37.5 percent) and stable engagement (33.3 percent) predominated, regular family incomes (41.7 percent) and satisfactory constructive conditions (62.5 percent) prevail in the houses. After attending the workshops, the mother's knowledge increased up to 91.7 percent; the same percentage represented positive expectations about the social inclusion of their children, 23 mothers (95.2 percent) demanded continued information, while their resilient behaviors increased (87.5 percent). Conclusions: the mother's knowledge and resilience increased from the educational strategy applied to them(AU)

Estrategia educativa dirigida a incrementar la resiliencia en madres de niños con Síndrome de Down / Educational strategy aimed to increase the resilience of mothers with Down syndrome children

Introducción: el nacimiento de un niño con Síndrome de Down puede desencadenar una crisis sin precedente en el seno familiar y ser causa de estrés mantenido, lo cual puede afectar a la familia, en especial a las madres. Es necesario aumentar el conocimiento sobre esta enfermedad genética para fortalecer conductas resilientes en las madres y mejorar su capacidad para sobrellevar con éxito tener un niño diferente. Objetivo: incrementar la resiliencia en las madres de niños con Síndrome de Down a través de una estrategia educativa. Métodos: se diseñó y aplicó una estrategia educativa con diseño ambispectivo (Pre-test y Post-test), sobre algunos aspectos relacionados con la resiliencia en las madres de los niños con Síndrome de Down que asisten a un círculo infantil especial. El estudio se dividió en tres fases: en la fase inicial se aplicó una encuesta, evaluada y avalada por expertos, sobre diferentes aspectos del conocimiento, la salud de los niños y la resiliencia en las madres; en la segunda fase se aplicaron los talleres a todas las madres; y la tercera consistió en la aplicación de la encuesta inicial. Resultados: la mayoría de las madres (54,2 por ciento) tienen 35 años y más, el nivel de escolaridad es alto (70,8 por ciento), el 50 por ciento son trabajadoras, predomina el estado civil casada (37,5 por ciento) y unión estable (33,3 por ciento), el ingreso económico de la familia es regular (41,7 por ciento) y dominan las condiciones constructivas satisfactorias en los hogares (62,5 por ciento). Después de recibir los talleres aumentó significativamente el conocimiento de las madres (91,7 por ciento); el mismo porcentaje tuvo expectativas positivas sobre la inclusión social de sus hijos, 23 (95,2 por ciento) reclamaron una información continuada y se incrementaron en las madres las conductas resilientes (87,5 por ciento). Conclusiones: aumentó el conocimiento y la resiliencia de las madres a partir de la estrategia educativa aplicada a las mismas(AU)

Introduction: the birth of a child with Down syndrome may trigger an unprecedented crisis within the family and be the cause for maintained stress, which may affect the family, specially mothers. It is necessary to increase the knowledge about this genetic disease, to strengthen resilient behavior in mothers and improve their capacity to successfully bear having a different child. Objective: to increase resilience in mothers with Down syndrome children, by means of an educational strategy. Methods: we designed and applied an educational strategy with an ambispective design (pre-test and pro-test) about some of the aspects related with resilience in mothers with Down syndrome children who attend a special kindergarten. The study was divided into three stages: in the initial stage we conducted a survey (assessed and validated by experts) about different aspects of knowledge, children health and mother's resilience; in the second stage we held the workshops with all the mothers; in the third stage we conducted the same initial survey. Results: the majority of the mothers (54.2 percent) were 35 years old or older, schooling is high (70.8 percent), 50 percent of them are workers, status of married (37.5 percent) and stable engagement (33.3 percent) predominated, regular family incomes (41.7 percent) and satisfactory constructive conditions (62.5 percent) prevail in the houses. After attending the workshops, the mother's knowledge increased up to 91.7 percent; the same percentage represented positive expectations about the social inclusion of their children, 23 mothers (95.2 percent) demanded continued information, while their resilient behaviors increased (87.5 percent). Conclusions: the mother's knowledge and resilience increased from the educational strategy applied to them(AU)

Hyponatremia in a Teenager: A Rare Diagnosis.

INTRODUCTION: Hyponatremia is a common electrolyte alteration which has the potential for significant morbidity and mortality. Endocrine disorders, such as primary hypothyroidism and adrenal insufficiency are uncommon causes of hyponatremia. We present the case of a teenager with symptomatic hyponatremia caused by a rare disorder. CASE: A 17-year-old boy was admitted to the emergency department with abdominal pain, nausea and vomiting, asthenia, and weight loss. He was in poor general condition, hypotensive, and he had dry mucous membranes and skin as well as mucosa hyperpigmentation. The laboratory findings showed severe hyponatremia, hyperkalemia, and renal dysfunction. The patient started inotropic support and antibiotics. Plasma cortisol and corticotropin levels allowed the diagnosis of primary adrenal insufficiency. He began replacement therapy with hydrocortisone and fludrocortisone, with gradual symptom resolution. An abdominal computed tomography scan showed adrenal hypoplasia. Findings for antiadrenal and antithyroid antibodies were positive, allowing the diagnosis of autoimmune polyglandular syndrome type II. DISCUSSION: Adrenal insufficiency is a rare disease, especially in children, and its clinical manifestations are due to glucocorticoid and mineralocorticoid deficiency. In most of the cases, symptoms are nonspecific, requiring a high index of clinical suspicion. If the diagnosis and treatment are delayed, acute adrenal insufficiency carries a high morbidity and mortality.

Microfluidic lab-on-a-chip derivatization for gaseous carbonyl analysis.

We present a microfluidic lab-on-a-chip derivatization technique for the analysis of gaseous carbonyl compounds using O-(2,3,4,5,6-pentafluorobenzyl) hydroxylamine (PFBHA) as the derivatizing reagent. The novel microfluidic lab-on-a-chip derivatization technique has been developed to measure nmol per mole (ppbv) mixing ratios of gaseous carbonyl compounds, which are of particular importance to atmospheric chemistry. The technique utilised a planar glass microreactor comprising three inlets and one outlet, gas and fluid splitting and combining channels, mixing junctions, and a 2.0m long, 620µm internal diameter reaction microchannel. The microreactor integrated three functions, providing: (1) a gas and liquid mixer and reactor, (2) reagent heating, and (3) sample pre-concentration. The concentration of derivatization solution, the volumetric flow rates of the incoming gas sample and PFBHA solution, and the temperature of the microreactor were optimised to achieve a near real-time measurement. The enhanced phase contact area-to-volume ratio and the high heat transfer rate in the microreactor resulted in a fast and high efficiency derivatization reaction, generating an effluent stream which was ready for direct introduction to GC-MS. Good linearity was observed for eight carbonyl compounds over the measurement ranges of 1-500ppbv when they were derivatized under optimal reaction conditions. The method detection limits (MDLs) were below 0.10nmolmol(-1) for most carbonyls in this study, which is below or close to their typical concentrations in clean ambient air. The performance of the technique was assessed by applying the methodology to the quantification of glyoxal (GLY) and methylglyoxal (MGLY) formed during isoprene photo-oxidation in an outdoor photoreactor chamber (EUPHORE). Good agreements between GLY and MGLY measurements were obtained comparing this new technique with Fourier Transform InfraRed (FTIR), which provides support for the potential effectiveness of the microfluidic technique for gaseous measurements.

Stromal prostatic sarcoma: a rare tumor with rare clinical and imaging presentation.

Adult prostatic stromal sarcoma is a rare malignant tumor. The main presenting symptom is urinary retention secondary to bladder outlet obstruction. Prostatic Specific Antigen level can be normal. Imaging features show a prostate mass with or without pelvic organ invasion depending on the aggressiveness of the tumor. We present a patient with prostatic stromal sarcoma who debuted with urinary obstruction, leukocytosis and neutrophilia, prostate enlargement, and hypodense prostate areas on CT images, simulating prostatitis with abscess formation.

Adult weight gain, fat distribution and mammographic density in Spanish pre- and post-menopausal women (DDM-Spain).

High mammographic density (MD) is a phenotype risk marker for breast cancer. Body mass index (BMI) is inversely associated with MD, with the breast being a fat storage site. We investigated the influence of abdominal fat distribution and adult weight gain on MD, taking age, BMI and other confounders into account. Because visceral adiposity and BMI are associated with breast cancer only after menopause, differences in pre- and post-menopausal women were also explored. We recruited 3,584 women aged 45-68 years within the Spanish breast cancer screening network. Demographic, reproductive, family and personal history data were collected by purpose-trained staff, who measured current weight, height, waist and hip circumferences under the same protocol and with the same tools. MD was assessed in the left craniocaudal view using Boyd's Semiquantitative Scale. Association between waist-to-hip ratio, adult weight gain (difference between current weight and self-reported weight at 18 years) and MD was quantified by ordinal logistic regression, with random center-specific intercepts. Models were adjusted for age, BMI, breast size, time since menopause, parity, family history of breast cancer and hormonal replacement therapy use. Natural splines were used to describe the shape of the relationship between these two variables and MD. Waist-to-hip ratio was inversely associated with MD, and the effect was more pronounced in pre-menopausal (OR = 0.53 per 0.1 units; 95 % CI = 0.42-0.66) than in post-menopausal women (OR = 0.73; 95 % CI = 0.65-0.82) (P of heterogeneity = 0.010). In contrast, adult weight gain displayed a positive association with MD, which was similar in both groups (OR = 1.17 per 6 kg; 95 % CI = 1.11-1.23). Women who had gained more than 24 kg displayed higher MD (OR = 2.05; 95 % CI = 1.53-2.73). MD was also evaluated using Wolfe's and Tabár's classifications, with similar results being obtained. Once BMI, fat distribution and other confounders were considered, our results showed a clear dose-response gradient between the number of kg gained during adulthood and the proportion of dense tissue in the breast.

Pulmonary artery sling: An uncommon cause of stridor.

Pulmonary artery sling is a rare congenital condition often associated with congenital tracheal stenosis. Untreated pulmonary sling carries a high morbidity and mortality, most of which is due to the airway and other associated anomalies rather than the aberrant artery itself. We report the case of an infant presenting progressive respiratory distress after a viral infection. The workup revealed a left pulmonary sling with concomitant tracheal stenosis. This anomaly was successfully corrected by slide tracheoplasty and left pulmonary artery reinsertion. Conclusion pulmonary artery sling is a rare entity with a nonspecific clinical presentation, a high degree of clinical suspicion is needed in order to obtain the correct diagnosis.