Normal values of the fronto-occipital relationship in fetuses between 18 and 40 weeks at two maternal fetal medicine units: Bogotá, Colombia.

OBJECTIVE: To establish nomograms for linear measurements of the frontal and occipital horns of the lateral ventricle and their relationship, in pregnant patients between 18 and 40 weeks of gestation and having attended 2 units of Maternal Fetal Medicine in Bogotá-Colombia. METHODOLOGY: A descriptive cross-sectional study with an analytical component was carried out on pregnant patients who utilized the ultrasound services at 2 Maternal-Fetal Medicine units in Bogotá, between 18 and 40 weeks of pregnancy who underwent measurement. From the anterior and posterior horns of the lateral ventricles, the fronto-occipital ratio was calculated at each gestational week, and nomograms were created for each of these variables. RESULTS: Nine hundred and seventy-eight patients were included in the study. The distance of the frontal horns ranged between 6.9 and 51.6 mm with a mean of 19.1 ± 5.8 mm; that of the occipital horns had a measurement between 8.7 and 53 mm with a mean of 28, 1 ± 8.9 mm; on the other hand, the fronto-occipital ratio (FOR) yielded a mean of 0.365 ± 0.067 (0.136-0.616) without bearing any relation to gestational age. The trend of normal values for the studied population is displayed, plotted in percentile curves and nomograms for each gestational age. CONCLUSION: The measurement of the frontal and occipital horns, and the calculation of the fronto-occipital relationship is technically possible between 18 and 40 weeks, finding that the anterior and posterior horns have a positive linear relationship with gestational age. Contrarily, the FOR does not correlate with the gestational age, it was possible to establish a table of percentiles that allows determining the normal values for these measurements during pregnancy.

Primary breast cancer and health related quality of life in Spanish women: The EpiGEICAM case-control study.

This study evaluates the impact of breast cancer (BC) in health related quality of life (HRQL) and in psychological distress (PD) during the initial phases of the disease and looks for contributing factors. A multicentric case-control study, EpiGEICAM, was carried out. Incident BC cases and age- and residence- matched controls were included. Clinical, epidemiological, HRQL (SF-36) and PD information (GHQ-28) was collected. We used multivariable logistic regression models to estimate OR of low HRQL and of PD in cases compared to controls, and to identify factors associated with low HRQL and with PD. Among 896 BC cases and 890 control women, cases had poorer scores than both, the reference population and the control group, in all SF-36 scales. BC women with lower education, younger, active workers, never smokers, those with comorbidities, in stage IV and with surgical treatment had lower physical HRQL; factors associated with low mental HRQL were dissatisfaction with social support, being current smoker and having children. Cases had a fivefold increased odds of PD compared to controls. Managing comorbidities and trying to promote social support, especially in younger and less educated women, could improve well-being of BC patients.

Serial Head and Brain Imaging of 17 Fetuses With Confirmed Zika Virus Infection in Colombia, South America.

OBJECTIVE: To evaluate fetal ultrasound and magnetic resonance imaging findings among a series of pregnant women with confirmed Zika virus infection to evaluate the signs of congenital Zika syndrome with respect to timing of infection. METHODS: We conducted a retrospective case series of pregnant women referred to two perinatal clinics in Barranquilla and Ibagué, Colombia, who had findings consistent with congenital Zika syndrome and Zika virus infection confirmed in maternal, fetal, or neonatal samples. Serial ultrasound measurements, fetal magnetic resonance imaging results, laboratory results, and perinatal outcomes were evaluated. RESULTS: We describe 17 cases of confirmed prenatal maternal Zika virus infection with adverse fetal outcomes. Among the 14 symptomatic women, the median gestational age for maternal Zika virus symptoms was 10 weeks (range 7-14 weeks of gestation). The median time between Zika virus symptom onset and microcephaly (head circumference less than 3 standard deviations below the mean) was 18 weeks (range 15-24 weeks). The earliest fetal head circumference measurement consistent with microcephaly diagnosis was at 24 weeks of gestation. The earliest sign of congenital Zika syndrome was talipes equinovarus, which in two patients was noted first at 19 weeks of gestation. Common findings on fetal magnetic resonance imaging were microcephaly, ventriculomegaly, polymicrogyria, and calcifications. CONCLUSION: Our analysis suggests a period of at least 15 weeks between maternal Zika virus infection in pregnancy and development of microcephaly and highlights the importance of serial and detailed neuroimaging.

Diagnóstico y prevención del parto pretérmino. Una actualización de la literatura / Diagnosis and prevention of preterm birth. A literature update

Antecedentes: El parto pretérmino es uno de los principales problemas de la obstetricia, ya que es el causante del 35 % de las muertes infantiles en el primer año de vida y de morbilidad severa a corto y largo plazo en aquellos que sobreviven a la prematurez. En el 2010, Colombia reportó 8,8 % de parto pretérmino, por esto es de vital importancia identificar factores de riesgo, realizar prevención y hacer un adecuado diagnóstico y manejo de este síndrome. Objetivo: Actualizar los conocimientos en la prevención del parto pretérmino. Metodología: Se revisó la literatura disponible en idiomas inglés y español desde el año 2001 hasta abril de 2016 utilizando las palabras clave: preterm brith, pessary, vaginal progesterone, cerclage, pevention preterm birth, parto pretérmino, tamizaje de parto pretérmino. Se accedió a diferentes bases de datos: Ovid, ClincalKey, Cochrane, Pubmed, Medline, EM-BASE. Resultados: Se hallaron 81 artículos de texto completo de diversas tipologías: guías de manejo actualizadas, investigación científica y tecnológica, revisiones, los cuales abordaban la temática de diagnóstico y prevención. Conclusión: Existen múltiples controversias sobres las diferentes técnicas en la actualidad para identificar pacien-tes de riesgo y lograr una prevención adecuada del parto pretérmino.

Background: Preterm birth is one of obstetrics main problems, causing 35 % of deaths in infants on their first year of life and severe morbidity on short and long term in those cases when the individual survives premature birth. In 2010, Colombia reported 8.8 % of preterm birth, thus making the identification of risk factors, prevention, pre-cise diagnostic and care of this syndrome of so great and vital importance. Objective: To update our knowledge on the prevention of preterm birth. Methods: Using different databases such as: Ovid, Clinical Key, Cochrane, Pubmed, Medline and EMBASE, an in depth analysis was performed on the literature available. Cross references in both Spanish and English were performed on publications from 2001 to 2016, using the following key words: preterm birth, pessary, vaginal progesterone, cerclage, preterm birth prevention, preterm delivery, preterm de-livery screening. Results: 81 complete text articles were found, of different typologies: updated management guides, scientific and technological research, reviews; which addressed the issue of diagnosis and prevention. Conclusion: There are multiple controversies regarding the different techniques used to identify high risk patients and reach an adequate prevention of preterm birth.

Embarazo abdominal: caso clínico y revisión de literatura / Abdominal pregnancy: a clinic case and literature review

En este artículo se informa un caso y se revisa la literatura acerca de embarazo abdominal. Se reporta el caso de una paciente joven de 24 años, multigestante, con embarazo pobremente controlado, quien acude al servicio de urgencias de un hospital de III nivel de complejidad de la ciudad de Barranquilla, Atlántico, Colombia con cuadro clínico de dolor abdominal. Posterior a rastreo ecográfico realizado en el servicio y con evidencia de anhidramnios, es realizada cesárea de urgencia con hallazgo de embarazo abdominal con producto vivo a término. La madre es llevada a unidad de cuidados intensivos con evolución satisfactoria y dada de alta junto al recién nacido. Se pre-senta una revisión de la epidemiología, cuadro clínico y manejo

In this article a case and a review of the literature about abdominal pregnancy are reported. The patient was a young multiparous woman with a poorly controlled pregnancy who arrived to emergency room with abdominal pain, which began three days ago, later was perform an ultrasonographic examination that revealed oligohydram-nios. Was performed an emergency cesarean section with abdominal pregnancy and finding a live and term fetus. Mother was followed in intensive care unit with a satisfactory postoperative evolution. Mother and child were discharged a few days later. We discuss the epidemiology, clinical manifestations and management.

SIMBOSPROST: Prevalence of metabolic syndrome and osteoporosis in prostate cancer patients treated with radiotherapy and androgen deprivation therapy: A multicentre, cross-sectional study.

AIM: To assess the prevalence of metabolic syndrome (MetS) and osteoporosis in patients with prostate cancer (PCa) treated with radical radiotherapy (RT) with or without androgen deprivation therapy (ADT). BACKGROUND: Worldwide, the prevalence of MetS is estimated to range from 20% to 25% of the adult population. However, prevalence rates are much higher in PCa patients (pts) who undergo ADT. MATERIALS AND METHODS: Multicentre cross-sectional study of 270 pts in Spain with PCa. Patients were divided into 3 groups based on the duration of ADT (6, 12-18, ≥24 months) and compared to a control group without ADT. MetS was defined according to NCEP ATP III criteria. Osteoporosis was assessed by DEXA. RESULTS: A total of 270 pts, treated from November 2011 to October 2012, were included. Of these, 122 pts (47%) fulfilled the criteria for MetS. The median age of this group was significantly higher (71.3 vs. 69.38 years, p = 0.028). MetS prevalence was 50% in the control group. In pts who received ADT, prevalence was 44.8% after 6 months of ADT, 45.3% after 12-18 months, and 50% after ≥24 months (pns). Most pts (168/270; 62%) underwent DEXA. Of those tested, 78 (46.4%) had osteopenia and only 11 (6.5%) had osteoporosis. CONCLUSIONS: The prevalence of MetS in pts with PCa treated with radical RT was higher (47%) than in the general population. However, there were no significant differences in the duration of ADT administration. The prevalence of osteoporosis was low. These findings suggest that the prevalence of MetS in PCa patients may be higher than previously reported.

Penfigoide benigno de las mucosas: presentación de un caso / Bening pemphigoid of the mucous membranes: report of a clinical case

Fundamento: el penfigoide benigno de las mucosas es una enfermedad que afecta principalmente a la mucosa oral y ocular. El daño a la mucosa bucal es observado en la mayoría de los pacientesy cuando se presenta en la gingiva, produce un cuadro parecido al de una gingivitis descamativa. Objetivo: relatar un caso de penfigoide benigno de las mucosas donde el paciente presenta las lesiones solo en boca. Caso clínico: varón de 30 años, fumador, se presentó con diversas lesiones bucales de naturaleza vesiculoampollar, sangramiento espontáneo y provocado e intenso enrojecimiento de la encía. Al examen físico se observó un estado bucal desfavorable, caries, placa dentobacteriana, sarro, obturaciones caídas, recesiones gingivales generalizadas. No existió toma del estado general y los estudios analíticos dentro de límites normales. Se descartó lesiones oftalmológicas. Se discutió el diagnóstico y manejo de esta enfermedad poco habitual en hombres jóvenes. Se utilizó la prednisonapor vía oral, se dio el alta de los servicios dentales y se mantuvo una óptima higiene bucal por parte del paciente y vigilancia estricta del periodoncista. El penfigoide es una enfermedad grave y de larga evolución. Conclusiones: El paciente está en tratamiento, con una evolución satisfactoria.

Merkel cell carcinoma from 2008 to 2012: reaching a new level of understanding.

Merkel cell carcinoma (MCC) is a rare primary cutaneous carcinoma of the skin who has high aggressiveness, high risk of locoregional and distant spread, a mortality rate considerably higher than that of cutaneous melanoma and a poor survival. Its incidence has increased during the past twenty years. The studies published from 2008 to early 2012 have introduced interesting changes in the understanding of its epidemiology, pathogenesis and consequently in the diagnostic codes and the therapeutic approach. Early and detailed nodal diagnosis with posterior multidisciplinary decision is mandatory. Surgery and Radiotherapy play a fundamental role in the management of this tumor. Both are associated with improved locoregional control and disease free survival; but patients continue to have distant failure because, currently, there is no effective systemic treatment available. Consequently, there remain controversies about its appropriate management, and this review is an attempt to contribute to their clarification.

PITASOR epidemiological study: prevalence, incidence and treatment of anaemia in radiation therapy oncology departments in Spain.

INTRODUCTION: Anemia is the most common haematological complication in cancer patients. OBJECTIVE: Analysis of the incidence, prevalence and treatment of anemia in oncologic patients treated in Radiation Oncology Departments in Spain (ROD) and monitoring of the existing recommendations for the treatment of anemia. MATERIAL AND METHODS: Observational, prospective, multicenter study which involved 19 Spanish ROD. The study was approved by the CEIC Central Defense Hospital. 477 patients with solid tumors, subsidiary of RT with radical intent referred to such centers within a period of one month (5/5/09 to 5/6/09) and gave their consent to participate in the study. We gathered the main characteristics of patients and their oncologic disease. All patients underwent a determination of Hb levels before RT, upon reaching 25-35 Gy and at the end treatment. In patients with anemia we assessed the existence of related symptoms and its treatment. RESULTS: Basal situation: The prevalence of anemia was 34.8% (166 patients). Mean Hb in patients with anemia was 11.17 ± 1.07 g/dl. Anemia-related symptoms were present in 34% of the patients. Anemia predisposing factors were: stage of the disease, previously received chemotherapy, and hormonal therapy. 39% (66 patients) received anemia treatment, with a mean Hb of 10.43 ± 1.04 g/dl. During RT: The prevalence of anemia was 38.9% (182 patients) with a mean Hb of 11.24 ± 1.21 g/dl. Predisposing factors for anemia during RT treatment were: age, male sex, chemotherapy prior to RT, basal anemia and chemotherapy during RT. 36.3% (66 patients) had anemia-related symptoms. 34.6% (63 patients) with a mean Hb of 10.5 ± 1.37 g/dl received treatment for anemia. The prevalence of anemia at the end of the RT was 38.1% (177 patients) with a mean Hb of 11.19 ± 1.18 g/dl. The predisposing factors for the appearance of anemia at the end of RT were: male sex, anemia at basal situation and during treatment and chemotherapy during RT. 34% (61 patients) had anemia-related symptoms and 73 patients (41.2%) with a mean Hb of 10.5 ± 1.22 g/dl received treatment for anemia. The presence of anemia-related symptoms was significantly correlated with the beginning of treatment for anemia. The incidence of anemia (new cases) during radiotherapy was 17.5%. CONCLUSION: The prevalence of anemia in basal situation, during RT and at the end of RT is 34.8%, 38.9% and 38.1%. During RT the incidence of anemia is 17.5%. 39.8%-41.2% of patients with anemia and 64.2%-68% of patients with anemia-related symptoms received treatment. Treatment of anemia starts with Hb<11 g/dl and the goal is to achieve Hb 12 g/dl. In our Radiotherapy Oncology Departments, the treatment of anemia complies with the current recommendations and guidelines in use.

Evaluación de la intervención educativa al paciente anciano con insuficiencia cardíaca, realizada por enfermería a través de un plan de cuidados estandarizado / Evaluation of an educational intervention in elderly patients with heart failure performed by nurses using a standardized care plan

Objetivo. Determinar el impacto de la intervención educativa de enfermería postalta, en pacientes con insuficiencia cardíaca (IC), al aplicar un plan de cuidados estandarizado centrado en fomentar el autocuidado. Material y métodos. Estudio longitudinal realizado entre enero de 2006 y mayo de 2007, con una población de 112 pacientes, seleccionados tras ser incluidos en una vía clínica durante su hospitalización. Durante 5 sesiones programadas a lo largo de 2 meses tras el alta hospitalaria se les aplicó un plan de cuidados educativo mediante entrevista y de forma individual en el hospital de día de IC. El nivel de conocimientos adquiridos por el paciente se cuantificó mediante una escala de medida tipo Likert de 5 puntos. La educación se evaluó en cada una de las 5 sesiones realizadas. Los resultados se expresan en medias, y para comparar las variables se ha utilizado el test ANOVA de medidas repetidas. Resultados. La media de edad de los 100 sujetos que completaron el estudio pre y postintervención educativa fue de 78 años (desviación estándar: 7). La intervención se mostró efectiva al evaluar el nivel de conocimiento adquirido por el paciente con respecto a su enfermedad (signos, síntomas, complicaciones, etc.), y se obtuvieron diferencias estadísticamente significativas acerca de la educación adquirida en cada visita y a lo largo de los 60 días de intervención. Conclusiones. La educación para la salud de estos pacientes y familia (cuidador principal), mejora su adaptación a la enfermedad, se logra una mayor autonomía y adhesión al tratamiento, consiguiendo una mayor calidad de vida(AU)

Objective.To determine the impact of an educational intervention after discharge in patients with heart failure (HF) performed by applying a standardized care plan centered on encouraging self-care and treatment adherence. Material and methods. We performed a longitudinal study between January, 2006 and May, 2007 in a population of 112 patients selected after being included in a clinical pathway during their hospital stay. Five scheduled visits were made in the first 2 months after hospital discharge; during these visits, an educational care plan was applied to the patients individually and by means of an interview in the HF day hospital. The patients’ level of knowledge was quantified by means of a 5-point Likert-like scale. The education was carefully evaluated at each visit. The results were expressed as means. To compare the variables, a repeated measures ANOVA was used. Results. The mean age of the 100 patients who finalized both phases of the study was 78 years (SD: 7). The intervention was effective in evaluating the level of knowledge acquired by the patients about their disease (signs, symptoms, complications, etc.) and statistically significant differences were obtained in the education acquired at each visit and throughout the 60-day intervention. Conclusions. Health education in these patients and their families (main caregiver) improved their adaptation to their disease and increased autonomy and treatment adherence, thus improving quality of life(AU)

[Evaluation of an educational intervention in elderly patients with heart failure performed by nurses using a standardized care plan]. / Evaluación de la intervención educativa al paciente anciano con insuficiencia cardíaca, realizada por enfermería a través de un plan de cuidados estandarizado.

OBJECTIVE: To determine the impact of an educational intervention after discharge in patients with heart failure (HF) performed by applying a standardized care plan centered on encouraging self-care and treatment adherence. MATERIAL AND METHODS: We performed a longitudinal study between January, 2006 and May, 2007 in a population of 112 patients selected after being included in a clinical pathway during their hospital stay. Five scheduled visits were made in the first 2 months after hospital discharge; during these visits, an educational care plan was applied to the patients individually and by means of an interview in the HF day hospital. The patients' level of knowledge was quantified by means of a 5-point Likert-like scale. The education was carefully evaluated at each visit. The results were expressed as means. To compare the variables, a repeated measures ANOVA was used. RESULTS: The mean age of the 100 patients who finalized both phases of the study was 78 years (SD: 7). The intervention was effective in evaluating the level of knowledge acquired by the patients about their disease (signs, symptoms, complications, etc.) and statistically significant differences were obtained in the education acquired at each visit and throughout the 60-day intervention. CONCLUSIONS: Health education in these patients and their families (main caregiver) improved their adaptation to their disease and increased autonomy and treatment adherence, thus improving quality of life.