The utility of fetal heart rate deceleration's descending slope in searching for a non-National Institute of Child Health and Human Development parameter for the detection of fetal acidosis.

OBJECTIVE: To identify new parameters predicting fetal acidemia. METHODS: A retrospective case-control study in a cohort of deliveries from a tertiary referral hospital-based cohort deliveries in Zaragoza, Spain between 2018 and 2021 was performed. To predict fetal acidemia, the NICHD categorizations and non-NICHD parameters were analyzed in the electronic fetal monitoring (EFM). Those included total reperfusion time, total deceleration area and the slope of the descending limb of the fetal heart rate of the last deceleration curve. The accuracy of the parameters was evaluated using the specificity for (80%, 85%, 90%, 95%) sensitivity and the area under the receiver operating characteristic curve (AUC). RESULTS: A total of 10 362 deliveries were reviewed, with 224 cases and 278 controls included in the study. The NICHD categorizations showed reasonable discriminatory ability (AUC = 0.727). The non-NICHD parameters measured during the 30-min fetal monitoring, total deceleration area (AUC = 0.807, 95% CI: 0.770, 0.845) and total reperfusion time (AUC = 0.750, 95% CI: 0.707, 0.792), exhibited higher discriminatory ability. The slope of the descending limb of the fetal heart rate of the last deceleration curve had the best AUC value (0.853, 95% CI: 0.816, 0.889). The combination of total deceleration area or total reperfusion time with the slope demonstrated high discriminatory ability (AUC = 0.908, 95% CI: 0.882, 0.933; specificities of 71.6% and 72.7% for a sensitivity of 90%). CONCLUSIONS: The slope of the descending limb of the fetal heart rate of the last deceleration curve is the strongest predictor of fetal acidosis, but its combination with the total reperfusion time shows better clinical utility.

Healthy Lifestyle Is a Protective Factor from Moderate and Severe Relapses and Steroid Use in Inflammatory Bowel Disease: A Prospective Cohort Study.

BACKGROUND: A healthy lifestyle, including good adherence to a Mediterranean diet (MD) and regular physical exercise, may be an important factor during the course of inflammatory bowel disease (IBD). Our aim is to determine whether adherence to MD, physical activity, and the combination of both can impact on IBD course. METHODS: This prospective cohort study includes 693 IBD outpatients who were in remission with a median follow-up time of 27 months (interquartile range 22-29 months). Each patient completed a survey to assess their adherence to the MD and physical activity. Healthy lifestyle was considered to be a proper adherence to both MD and an active lifestyle. Relapse during follow-up, severity of relapses, need for systemic steroids, and therapy changes were recorded. RESULTS: During the follow-up period, 188 patients (27.1%) experienced relapse, of which 56.1% were moderate or severe. Among patients with relapse, 85 (45%) required treatment with corticosteroids, and 15 (7.9%) were hospitalized. Patients with ulcerative colitis (CU) were more adherent to healthy lifestyle than patients with Crohn's disease (P = .011). Healthy lifestyle was associated with lower risk of moderate and severe relapses (adjusted Hazard ratio [aHR], 0.250; 95% confidence interval [CI], 0.093-0.670) and steroids use (aHR 0.292; 95% CI, 0.103-0.828) in IBD patients and with lower risk of moderate and severe relapses (aHR 0.270; 95% CI, 0.093-0.789) in UC patients. CONCLUSIONS: Healthy lifestyle has a favorable influence on promoting a milder disease course, and thus should be a crucial part of clinical management of patients with IBD.

Healthy lifestyle including adherence to a Mediterranean diet and physical exercise has a favorable influence on promoting a milder disease course and thus should be a crucial part of clinical management of patients with IBD.

The Interventions and Challenges of Antimicrobial Stewardship in the Emergency Department.

Over the last decades, we have witnessed a constant increase in infections caused by multi-drug-resistant strains in emergency departments. Despite the demonstrated effectiveness of antimicrobial stewardship programs in antibiotic consumption and minimizing multi-drug-resistant bacterium development, the characteristics of emergency departments pose a challenge to their implementation. The inclusion of rapid diagnostic tests, tracking microbiological results upon discharge, conducting audits with feedback, and implementing multimodal educational interventions have proven to be effective tools for optimizing antibiotic use in these units. Nevertheless, future multicenter studies are essential to determine the best way to proceed and measure outcomes in this scenario.

Programa de optimización de antibioterapia en infección urinaria por cepas multirresistentes en el servicio de urgencias / Antimicrobial stewardship program in urinary tract infections due to multi resistant strains in the emergency department

Introducción. Las infecciones urinarias (ITU) son un mo tivo frecuente de asistencia a los servicios de urgencias hospi talarias (SU), siendo cada vez más frecuente el aislamiento de cepas multirresistentes. El presente trabajo pretende evaluar el impacto de un programa multidisciplinar de optimización de antibioterapia en pacientes con ITU causada por bacterias mul tirresistentes atendidas desde el SU. Material y métodos. Estudio descriptivo de la puesta en marcha de un programa en el que participaron los servicios de urgencias, microbiología y farmacia. El tratamiento antibiótico de los pacientes que consultaron urgencias con urinocultivos positivos para bacterias multirresistentes fue revisado al alta por el equipo multidisciplinar. En aquellos pacientes con tra tamiento inapropiado se contactó con los médicos y/o farma céuticos del siguiente nivel asistencial o con los propios pa cientes en el caso de alta a domicilio. Se evaluó el impacto del programa sobre las nuevas consultas a urgencias a 30 días en comparación con los resultados obtenidos de la práctica habi tual en tres meses previos a la intervención. Resultados. Durante el año de implantación se revisaron 2.474 urinocultivos de pacientes con ITU, 537 (21,7%) causa das por bacterias multirresistentes. El tratamiento empírico al alta de urgencias fue inapropiado en 287 (53,4%) pacientes, realizando modificaciones del tratamiento en 232 de ellos. 73 pacientes (19,3%) reconsultaron el SU a los 30 días del alta, siendo este porcentaje inferior a los resultados obtenidos en los tres meses previos a la intervención (27,9%; p=0,031), sin encontrar diferencias significativas en el porcentaje de nuevas visitas asociadas a infecciones urinarias. Conclusión (AU)

Introduction. Urinary tract infections (UTI) are a fre quent reason for attendance at emergency department (ED). The present study evaluates the impact of a multidisciplinary program for the optimization of antibiotic therapy in patients with UTI caused by multi-drug resistant bacteria treated from the hospital ED. Material and methods. Descriptive study of the imple mentation of a program in which emergency, microbiology and pharmacy departments participated. Antibiotic treatment of the patients who consulted the ED with positive urine cul tures caused by multidrug-resistant bacteria was reviewed up on discharge. In those patients with inappropriate treatment, doctors and/or pharmacists of the next level of healthcare or patients in the case of home discharge were contacted. The impact of the program was evaluated based on new visits to the ED at 30 days after discharge, compared with the results obtained from the usual practice three months prior the in tervention. Results. During the first year, 2,474 urine cultures of pa tients with UTI were reviewed, 533 (21.7%) were caused by multidrug-resistant bacteria. Empirical treatment was inap propriate in 287 (53.4%), making treatment modifications in 243 of them. 73 (19.3%) patients returned to the ED 30 days after discharge, being lower than the results obtained in the three months prior intervention (27.9%; p=0.031), without significant differences in new visits associated with UTI. Conclusion. The implementation of a multidisciplinary program focused on multidrug resistant UTI at discharge form ED correct antibiotic therapy in a large number of patients, be ing a potentially tool to reduce the number of new ED visits (AU)

PREDICTION OF MULTIDRUG-RESISTANT BACTERIA IN URINARY TRACT INFECTIONS IN THE EMERGENCY DEPARTMENT.

BACKGROUND: Urinary tract infections (UTI) due to multidrug-resistant bacteria are a frequent reason for visiting the emergency department (ED). OBJECTIVES: The aim of this study was to evaluate the applicability of a predictive model of infection by multidrug-resistant microorganisms in UTIs treated in an ED. METHODS: This is a retrospective observational study. Adult patients admitted to an ED with a diagnosis of UTI and positive urine culture were included. The main objective was to evaluate the area under the curve of the receiver operating characteristic (AUC-ROC), the scale proposed by González-del-Castillo, considering infection by a resistant pathogen as the dependent variable and the scale score of the predictive model used as the independent variable. RESULTS: The study included 414 patients with UTIs, 125 (30.2%) of which were caused by multidrug-resistant microorganisms. A total of 38.4% of patients were treated with antibiotics during the previous 3 months and a multidrug-resistant pathogen was isolated from 10.4% of the total during the previous 6 months. The AUC-ROC of the scale for predicting UTIs due to multidrug-resistant microorganisms was 0.79 (95% confidence interval 0.76-0.83), the optimal cut-off point being 9 points, with a sensitivity of 76.8% and a specificity of 71.6%. CONCLUSIONS: The use of the predictive model evaluated is a useful tool in real clinical practice to improve the success of empirical treatment of patients presenting to the ED with a diagnosis of UTI and positive urine culture pending identification.

Ambient temperature and atmospheric pressure at discharge as precipitating factors in immediate adverse events in patients treated for decompensated heart failure.

To investigate the relationship of ambient temperature and atmospheric pressure (AP) at patient discharge after an episode of acute heart failure (AHF) with very early post-discharge adverse outcomes. We analyzed 14,656 patients discharged after an AHF episode from 26 hospitals in 16 Spanish cities. The primary outcome was the 7-day post-discharge combined adverse event (emergency department -ED- revisit or hospitalization due to AHF, or all-cause death), and secondary outcomes were these three adverse events considered individually. Associations (adjusted for patient and demographic conditions, and length of stay -LOS- during the AHF index episode) of temperature and AP with the primary and secondary outcomes were investigated. We used restricted cubic splines to model the continuous non-linear association of temperature and AP with each endpoint. Some sensitivity analyses were performed. Patients were discharged after a median LOS of 5 days (IQR = 1-10). The highest temperature at discharge ranged from - 2 to 41.6 °C, and AP was from 892 to 1037 hPa. The 7-day post-discharge combined event occurred in 1242 patients (8.4%), with percentages of 7-day ED-revisit, hospitalization and death of 7.8%, 5.1% and 0.9%, respectively. We found no association between the maximal temperature and AP on the day of discharge and the primary or secondary outcomes. Similarly, there were no significant associations when the analyses were restricted to hospitalized patients (median LOS = 7 days, IQR = 4-11) during the index event, or when lag-1, lag-2 or the mean of the 3 post-discharge days (instead of point estimation) of ambient temperature and AP were considered. Temperature and AP on the day of patient discharge are not independently associated with the risk of very early adverse events during the vulnerable post-discharge period in patients discharged after an AHF episode.

Modeling of Hexavalent Chromium Removal with Hydrophobically Modified Cellulose Nanofibers.

Cellulose nanofibers (CNF) are sustainable nanomaterials, obtained by the mechanical disintegration of cellulose, whose properties make them an interesting adsorbent material due to their high specific area and active groups. CNF are easily functionalized to optimize the performance for different uses. The hypothesis of this work is that hydrophobization can be used to improve their ability as adsorbents. Therefore, hydrophobic CNF was applied to adsorb hexavalent chromium from wastewater. CNF was synthetized by TEMPO-mediated oxidation, followed by mechanical disintegration. Hydrophobization was performed using methyl trimetoxysilane (MTMS) as a hydrophobic coating agent. The adsorption treatment of hexavalent chromium with hydrophobic CNF was optimized by studying the influence of contact time, MTMS dosage (0-3 mmol·g-1 CNF), initial pH of the wastewater (3-9), initial chromium concentration (0.10-50 mg·L-1), and adsorbent dosage (250-1000 mg CNF·L-1). Furthermore, the corresponding adsorption mechanism was identified. Complete adsorption of hexavalent chromium was achieved with CNF hydrophobized with 1.5 mmol MTMS·g-1 CNF with the faster adsorption kinetic, which proved the initial hypothesis that hydrophobic CNF improves the adsorption capacity of hydrophilic CNF. The optimal adsorption conditions were pH 3 and the adsorbent dosage was over 500 mg·L-1. The maximum removal was found for the initial concentrations of hexavalent chromium below 1 mg·L-1 and a maximum adsorption capacity of 70.38 mg·g-1 was achieved. The kinetic study revealed that pseudo-second order kinetics was the best fitting model at a low concentration while the intraparticle diffusion model fit better for higher concentrations, describing a multi-step mechanism of hexavalent chromium onto the adsorbent surface. The Freundlich isotherm was the best adjustment model.

Personalized Model to Predict Small for Gestational Age at Delivery Using Fetal Biometrics, Maternal Characteristics, and Pregnancy Biomarkers: A Retrospective Cohort Study of Births Assisted at a Spanish Hospital.

Small for gestational age (SGA) is defined as a newborn with a birth weight for gestational age < 10th percentile. Routine third-trimester ultrasound screening for fetal growth assessment has detection rates (DR) from 50 to 80%. For this reason, the addition of other markers is being studied, such as maternal characteristics, biochemical values, and biophysical models, in order to create personalized combinations that can increase the predictive capacity of the ultrasound. With this purpose, this retrospective cohort study of 12,912 cases aims to compare the potential value of third-trimester screening, based on estimated weight percentile (EPW), by universal ultrasound at 35−37 weeks of gestation, with a combined model integrating maternal characteristics and biochemical markers (PAPP-A and ß-HCG) for the prediction of SGA newborns. We observed that DR improved from 58.9% with the EW alone to 63.5% with the predictive model. Moreover, the AUC for the multivariate model was 0.882 (0.873−0.891 95% C.I.), showing a statistically significant difference with EPW alone (AUC 0.864 (95% C.I.: 0.854−0.873)). Although the improvements were modest, contingent detection models appear to be more sensitive than third-trimester ultrasound alone at predicting SGA at delivery.

Cefepime Dosing Requirements in Elderly Patients Attended in the Emergency Rooms.

OBJECTIVE: This study aimed to assess the probability of reaching an adequate pharmacokinetic/pharmacodynamic (pK/pD) index for different cefepime dosages in frail patients with bacteremia treated in the emergency room. METHODS: Simulation study based on Gram-negative bacterial strains that cause bacteremia. The probability of reaching a time above the minimum inhibitory concentration (MIC) at 50% and 100% dosing intervals (fT > 50 and fT > 80% MIC) was assessed for two different renal clearance intervals. RESULTS: One hundred twenty nine strains were collected, the predominant species being Escherichia coli (n = 83 [64.3%]). In patients with a ClCr of 30 mL/min, an fT > 50% MIC was reached in more than 90% of the simulations. However, a dose of at least 1 g every 12 h must be administered to reach an fT > 80% MIC. In patients with a ClCr of 30-60 mL/min, the probability of reaching an fT > 50% MIC was higher than 90% with doses of 1 g every 8 h or more, but this value was not reached in > 90% simulations for any of the doses tested in this study. CONCLUSIONS: Standard cefepime dosing can reach an adequate PK/PD index in frail patients. Nevertheless, a high dose or extended infusion is necessary to reach an fT > 80% MIC in patients with a ClCr > 60 mL/min.

Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage.

We report our postpartum haemorrhage protocol focussing on the use of Bakri Balloon, describing its placement and affixing method, effectiveness rates, risk factors that might contribute to Bakri Balloon's failure and complications associated. We designed a retrospective study including 147 cases where a Bakri Balloon was necessary to control the postpartum uterine bleeding to assess the efficacy and to determine which clinical, obstetric or delivery variables could be associated with successful treatment. Failed treatment was defined when surgery or any other technique was needed after a Bakri Balloon placement in order to control uterine bleeding. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.IMPACT STATEMENTWhat is already known on this subject? Postpartum haemorrhage is one of the most severe situations in the immediate postpartum period entailing a major cause of maternal morbimortality if an accurate and quick intervention is not carried out.What do the results of this study add? The use of Bakri Balloon was effective in 94.6% of patients. No statistically significant differences were found in the success rates according to obstetric or delivery characteristics. No major complications occurred due to the placement of a Bakri Balloon. In the failure group, blood loss was significantly higher and all required blood products transfusion.What are the implications of these findings for clinical practice and/or further research? Bakri Balloon is an easy-to-use device that provides an effective therapeutic alternative to more aggressive techniques in postpartum haemorrhages when medical treatment fails. Obstetrics or delivery characteristics should not entail a contraindication in its use. A continuous training system based on an agreed protocol is recommended in order to guarantee the best care possible.

Uterocervical angle as a predictor of spontaneous preterm birth in twin pregnancies.

OBJECTIVE: To assess the ability of uterocervical angle (UCA) compared with cervical length (CL) to predict the risk of spontaneous preterm birth (sPTB) in twin pregnancies and its performance when it was included in a combined predictive model of clinical and ultrasonographic parameters. METHODS: We conducted a retrospective cohort study of twin pregnancies undergoing transvaginal ultrasound between 19+0-21+6 weeks to measure CL during routine second trimester scan from January 2015 through December 2016. Recorded ultrasound images of CL were reassessed to evaluate UCA. Medical and obstetric data were also collected for statistical analysis. A logistic regression model was created for predicting sPTB including UCA and other variables. RESULTS: A total of 177 women were included. The rates of sPTB rate below 28, 32 and 34 weeks of gestation were 4.5%, 6.8% and 12.4%, respectively. ROC curves showed a better area under the curve (AUC) for UCA at all gestational ages compared with CL (AUC for sPTB <28 weeks 0.840 (p = .005) vs 0.627 (p = .388); AUC for sPTB <32 weeks 0.706 (p = .022) vs 0.619 (p = .255); AUC for sPTB <34 weeks 0.674 (p = .008) vs 0.568 (p = .344). UCA >117 degrees was significantly associated with sPTB <28 weeks (p = .002; OR 15.3; CI 1.66-142.37; NPV, 99.2%), <32 weeks (OR 3.84; p = .031) and <34 weeks of gestation (OR 3.10; p = .016). Based on multivariate analyses, the best predictive model included uterocervical angle (p = .032), cervical length (p = .002) and maternal height (p = .001) (Nagelkerke R2 0.944). CONCLUSION: In our study, an UCA > 117 degrees allowed to identify those women with twin pregnancies at risk of sPTB and performed better than CL measurement. Our combined prediction model was able to adequately predict the risk of sPTB in the twin pregnancies of our research.

Total intrapartum fetal reperfusion time (fetal resilience) and neonatal acidemia.

OBJECTIVE: The main objective is to study the predictive capacity of intrapartum total fetal reperfusion (fetal resilience) by itself or in combination with other parameters as a predictor of neonatal acidemia. STUDY DESIGN: A retrospective case-control study was carried out at the Miguel Servet University Hospital (Zaragoza, Spain) on a cohort of 5694 pregnant women between June 2017 and October 2018. Maternal, perinatal, and cardiotocographic records were collected. Two reviewers blindly described the monitors with the American College of Obstetricians and Gynecologists (ACOG) categorizations and parameters and the non-ACOG parameters. Neonatal acidemia was defined as pH <7.10. The parameters analyzed to predict acidemia were evaluated using the sensitivity for specificity 90% value, and the area under the receiver operating characteristic curve. RESULTS: We recorded 192 infants with acidemia, corresponding to a global acidemia rate of 3.4%. Of these, 72 were excluded for lack of criteria, leaving 120 patients with arterial acidemia included in the study and 258 in the control group. The sensitivity (specificity 90%) of detection of acidemia was 42% for the ACOG III categorization (AUC, 0.524: 95% CI, 0.470-0.578), 24% for fetal reperfusion (AUC, 0.704: 95% CI, 0.649-0.759), 27% for total area of decelerations (AUC, 0.717: 95% CI, 0.664-0.771) and 50% for the multivariate model built from total reperfusion time (AUC, 0.826: 95% CI, 0.783-0.869). The total reperfusion time corresponding to a false negative rate of 10% is 23.75 min, with 28% of fetuses above this time. The AUC and sensitivity for a false negative rate of 10% are equivalent for deceleration area and time of reperfusion (p = .504). CONCLUSION: The total reperfusion time (fetal resilience) and total deceleration area are non-ACOG parameters with a good predictive ability for neonatal acidemia, higher than the ACOG III classification and without statistical differences between them. The discrimination ability of total reperfusion time can be improved using a multivariate model. As a cutoff for its use we suggest 23.75 min in 30 min corresponding to an acidemic classification rate of 90%. New parameters in combination with other maternal, obstetrics, or fetal variables, are required for the interpretation of fetal well-being.

Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes.

OBJECTIVE: This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). MATERIAL AND METHOD: It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score <7, arterial cord blood pH <7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01-10.0, 10.01-20.0, 20.01-30.0, 30.01-40.0, 40.01-50.0, and >50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. RESULTS: The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1-40.7) and in pregnancies with APOs 40.3 (49.4-41.0), p < 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (p < 0.001). The RR was 1.63 (95% CI: 1.365-1.944, p < 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were >40 points (RR: 2.036, 95% CI: 1.581-2.623, p < 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56-0.61, p < 0.001). CONCLUSION: Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of >40 percentile points.

Anatomía de la arteria alveolar posterior superior (AAPS): estudio de 32 CBCT / Anatomy of the posterior superior alveolar artery: study of 32 CBCT

Objetivo: El principal objetivo es proporcionar información desde un punto de vista anatómico, evaluar la prevalencia, el diámetro y la posición de la arteria alveolar posterior superior (AAPS), su relación con la cresta alveolar y el suelo del seno maxilar utilizando imágenes radiográficas. Materiales y métodos: Se ha evaluado un total de treinta y dos imágenes de tomografías computarizadas de haz cónico (CBCT) (cuarenta y un senos maxilares en total) de pacientes parcialmente edéntulos en el tramo maxilar posterior, de los cuales veintitrés fueron mujeres y nueve hombres, que se presentaron en la Clínica Universitaria Odontológica de la Universidad Europea de Madrid. Se utilizaron tres tipos de escáneres CBCT que son el KODAK 9000, MORITA 3D y White Fox-Control D-00049. Resultados: La arteria alveolar posterior superior tiene un porcentaje de visibilidad de un 43,91%, se localiza a una altura de 15,9 mm de promedio desde la cresta ósea, en los grupos de 1-2 mm y <1 mm de diámetro se obtienen respectivamente 1,2 mm y 0,7 mm de valores promedio, y su posición es en un 21,13% intraósea y en un 22,76% extraósea. Conclusiones: En nuestro estudio, la AAPS presenta una distancia hasta la cresta alveolar, de mayor a menor altura residual, en primer lugar los segundos premolares, luego los segundos molares, y por último los primeros molares. Es decir, realiza un trayecto en forma de arco, haciendo la concavidad máxima a nivel del primer molar. (AU)

Objective: The main objective is to provide information from an anatomical point of view. To evaluate the prevalence, diameter and position of the superior posterior alveolar artery (SPAA), its relationship with the alveolar crest and the floor of the maxillary sinus using radiographic images. Materials and methods: A total of thirtytwo cone beam computer tomography (CBCT) images (forty-one maxillary sinuses in total) of partially edentulous patients in the posterior maxilla, of which twenty-three are women and nine men, that have been submitted in the University Clinic of the European University of Madrid. Three types of CBCT scanners are used: KODAK 9000, MORITA 3D and White Fox-Control D-00049. Results: The superior posterior alveolar artery has a visibility percentage of 43.91%, it is located at a height of 15.9 mm on average from the bone crest, in the groups of 1-2 mm and <1 mm in diameter they respectively obtain 1, 2 mm and 0.7 mm of average values and positioned in 21.13% intraosseous and 22.76% extraosseous. Conclusions: In our study, the PSAA presents a distance to the alveolar crest from higher to lower residual height, first the second premolars, then the second molars, and finally the first molars. In other words, it makes an arc-shaped path, making the maximum concavity at the level of the first molar. (AU)

Uterocervical angle at 20 weeks: A promising predictor of spontaneous preterm birth in twin pregnancies.

OBJECTIVE: To compare the performance of uterocervical angle (UCA) and cervical length (CL) measurement at 20 weeks of pregnancy for prediction of spontaneous preterm birth (sPTB) in twin pregnancies. STUDY DESIGN: We conducted a retrospective cohort study of 424 twin pregnancies who delivered in our center from October 2014 to December 2018 and who underwent transvaginal ultrasound between 19+0-22+0 weeks to measure CL during routine second trimester scan. Recorded ultrasound images of CL were reassessed to evaluate UCA. Medical and obstetric data were also collected for statistical analysis. RESULTS: A total of 424 women were included. The rates of sPTB rate below 28, 32 and 34 weeks of gestation were 2.8 %, 5.4 % and 10.4 %, respectively. ROC curves showed a better area under the curve (AUC) for UCA at all gestational ages compared with CL (AUC for sPTB <28 weeks 0.902 (p < 0.001) vs 0.620 (p 0.175); AUC for sPTB <32 weeks 0.740 (p 0.001) vs 0.620 (p 0.058); AUC for sPTB <34 weeks 0.676 (p 0.001) vs 0.632 (p 0.047). UCA > 120 degrees was significantly associated with sPTB <28 weeks (p < 0.001; OR 39.17; CI 4.81-319.23; NPV, 99.65 %), <32 weeks (OR 4.23; p 0.002) and <34 weeks of gestation (OR 2.66; p 0.01). CONCLUSION: In our study, an UCA > 120 degrees allowed to identify those women with twin pregnancies at risk of sPTB and performed better than CL measurement.

Factors associated with in-hospital mortality and adverse outcomes during the vulnerable post-discharge phase after the first episode of acute heart failure: results of the NOVICA-2 study.

OBJECTIVE: To identify patients at risk of in-hospital mortality and adverse outcomes during the vulnerable post-discharge period after the first acute heart failure episode (de novo AHF) attended at the emergency department. METHODS: This is a secondary review of de novo AHF patients included in the prospective, multicentre EAHFE (Epidemiology of Acute Heart Failure in Emergency Department) Registry. We included consecutive patients with de novo AHF, for whom 29 independent variables were recorded. The outcomes were in-hospital all-cause mortality and all-cause mortality and readmission due to AHF within 90 days post-discharge. A follow-up check was made by reviewing the hospital medical records and/or by phone. RESULTS: We included 3422 patients. The mean age was 80 years, 52.1% were women. The in-hospital mortality was 6.9% and was independently associated with dementia (OR = 2.25, 95% CI = 1.62-3.14), active neoplasia (1.97, 1.41-2.76), functional dependence (1.58, 1.02-2.43), chronic treatment with beta-blockers (0.62, 0.44-0.86) and severity of decompensation (6.38, 2.86-14.26 for high-/very high-risk patients). The 90-day post-discharge combined endpoint was observed in 19.3% of patients and was independently associated with hypertension (HR = 1.40, 1.11-1.76), chronic renal insufficiency (1.23, 1.01-1.49), heart valve disease (1.24, 1.01-1.51), chronic obstructive pulmonary disease (1.22, 1.01-1.48), NYHA 3-4 at baseline (1.40, 1.12-1.74) and severity of decompensation (1.23, 1.01-1.50; and 1.64, 1.20-2.25; for intermediate and high-/very high-risk patients, respectively), with different risk factors for 90-day post-discharge mortality or rehospitalisation. CONCLUSIONS: The severity of decompensation and some baseline characteristics identified de novo AHF patients at increased risk of developing adverse outcomes during hospitalisation and the vulnerable post-discharge phase, without significant differences in these risk factors according to patient age at de novo AHF presentation.

Comparación del Coeficiente de Estabilidad Implantaria ISQ entre implantes colocados en zona antral sobre hueso nativo frente a implantes colocados sobre hueso regenerado / Comparison of the isq implant stability coefficient between implants placed in the antral area on native bone versus implants placed on regenerated bone

El objetivo del estudio es comparar los valores del Coeficiente de Estabilidad Implantaria (ISQ) de implantes colocados en zona antral en hueso nativo frente a los colocados en zona antral en hueso regenerado, para saber si tras tres meses de osteointegración los valores aumentan, ver si son diferentes entre sí según el tipo de hueso y evaluar la relación entre: torque de inserción, tipo de hueso, ISQ obtenido y sus cambios después de la osteointegración. Se trata de un ensayo clínico de propósito analítico, cuya dirección temporal es longitudinal, el inicio del estudio en relación con la cronología de los eventos es prospectivo, existiendo dos grupos de estudio. Los resultados proporcionan evidencias de que los implantes colocados en hueso regenerado, al analizar valores ISQ iniciales, son iguales a los del hueso nativo y, tras la oseointegración, son mayores que los de éstos, pudiendo rehabilitarse esperando el mismo tiempo. CONCLUSIONES: El valor inicial de ISQ es similar en ambos grupos y después de tres meses de osteointegración fue mayor en implantes sobre hueso regenerado. El torque de inserción de implantes en hueso regenerado es mayor que en hueso nativo y existe relación positiva, pero no estadísticamente significativa, entre los valores de ISQ y el torque de inserción. La pérdida ósea marginal de los implantes es similar en ambos grupos y dicha pérdida no está relacionada con los valores de ISQ ni con el torque de inserción obtenido, aunque este hecho puede ser debido a la evaluación a corto plazo

The objectives of the present study are to compare the Implant Stability Quotient (ISQ) values of implants placed in the antral area in native bone versus those placed on regenerated bone, to know whether after three months of osseointegration period the values increase and see if they are different from each other depending on the type of bone and assess the relationship between: insertion torque, type of bone and ISQ obtained an its changes after 3 months of osseointegration.The study design is a Clinical Trial of analytical purpose, whose temporal direction is longitudinal, the beginning of the study in relation to the chronology of the events is prospective. The results provide some evidence in the fact that implants placed in antral zone in regenerated bone, when presenting baseline ISQ values equal to and after osseointegration greater than implants in native bone, could be rehabilitated waiting for the implant. CONCLUSIONS: The initial ISQ value is similar in implants placed in native and regenerated bone and after three months were higher in implants placed in regenerated bone. The insertion torque of the implants placed in regenerated bone is greater than those placed in native bone and there is a positive relationship but not statistically significant between ISQ values and insertion torque. The marginal bone loss of the implants is similar in those placed in native versus regenerated bone and this loss is not related to ISQ values niether to insertion torque obtained. This fact is due to being evaluated in a short period of time

Worsening renal function during an episode of acute heart failure and its relation to short- and long-term mortality: associated factors in the Epidemiology of Acute Heart Failure in Emergency Departments- Worsening Renal Function study. / Factores asociados con el empeoramiento de la función renal durante un episodio de insuficiencia cardiaca aguda y su relación con la mortalidad a corto y largo plazo: estudio EAHFE - EFRICA.

OBJECTIVES: To identify factors associated with worsening renal function (WRF) and explore associations with higher mortality in patients with acute heart failure (AHF). MATERIAL AND METHODS: Seven emergency departments (EDs) in the EAHFE-EFRICA study (Spanish acronym for Epidemiology of AHF in EDs - WRF in AHF) consecutively included patients with AHF and creatinine levels determined in the ED and between 24 and 48 hours later. Patients with WRF were identified by an increase in creatinine level of 0.3 mg/dL or more. Forty-seven clinical characteristics were explored to identify those associated with WRF. To analyze for 30-day all-cause mortality we calculated odds ratios (ORs). To analyze mortality at the end of follow-up and by trimester, adjusted for between-group differences, we calculated hazard ratios (HRs). The data were analyzed by subgroups according to age, sex, baseline creatinine levels, AHF type, and risk group. RESULTS: A total of 1627 patients were included. The subgroup of 220 (13.5%) with WRF were older, had higher systolic blood pressure, were more often treated with morphine, and had chronic renal failure; there was also a higher rate of hypertensive crisis as the trigger for AHF in patients with WRF. However, only chronic renal failure was independently associated with WRF (adjusted OR, 1.695; 95% CI, 1.264-2.273). The rate of 30-day mortality was 13.1% overall but higher in patients with WRF (20.9% vs 11.8% in patients without WRF; adjusted OR, 1.793; 95% CI, 1.207-2.664). Accumulated mortality at 18 months (average follow-up time, 14 mo/patient) was 40.0% overall but higher in patients with WRF (adjusted HR, 1.275; 95% CI, 1.018-1.598). Increased risk was greater in the first trimester. Subgroup analyses revealed no differences. CONCLUSION: AHF with WRF in the first 48 hours after ED care is associated with higher mortality, especially in the first trimester after the emergency.

OBJETIVO: Identificar los factores asociados con el empeoramiento de la función renal (EFR) y si este se asocia a mayor mortalidad en pacientes que presentan un episodio de insuficiencia cardiaca aguda (ICA). METODO: Participaron 7 servicios de urgencias (SU) que incluyeron consecutivamente pacientes con ICA con determinación de creatinina en urgencias y a las 24-48 horas, y se identificaron aquellos con EFR (incremento de creatinina $ 0,3 mg/dL). Entre 47 características clínicas, se identificó las asociadas a EFR. Se investigó la mortalidad por cualquier causa a 30 días (OR) y al final del seguimiento (HR), esta última global y por periodos trimestrales, que se ajustó por las diferencias entre grupos. Se analizaron subgrupos según edad, sexo, creatinina basal, tipo de ICA y grupo de riesgo. RESULTADOS: Se incluyeron 1.627 pacientes, 220 (13,5%) con EFR, los cuales presentaban mayor edad, presión arterial sistólica, crisis hipertensiva como precipitante, tratamiento con morfina e insuficiencia renal crónica, aunque solo esta última se asoció independientemente a EFR (ORajustada = 1,695, IC 95% = 1,264-2,273). La mortalidad a 30 días fue de 13,1% (mayor en pacientes con EFR: 20,9% vs 11,8%, ORajustada = 1,793, IC 95% = 1,207-2,664) y la mortalidad acumulada a 18 meses (tiempo medio de seguimiento 14 meses/paciente) fue del 40,0% (mayor en pacientes con EFR: HRajustada = 1,275, IC 95% = 1,018-1,598). Este incremento de riesgo fue durante el primer trimestre. El análisis de subgrupos no mostró diferencias. CONCLUSIONES: La ICA con EFR en las primeras 48 horas posteriores a la atención en el SU se asocia a mayor mortalidad, que se concentra durante el primer trimestre.

Factores asociados con el empeoramiento de la función renal durante un episodio de insuficiencia cardiaca aguda y su relación con la mortalidad a corto y largo plazo: estudio EAHFE - EFRICA / Worsening renal function during an episode of acute heart failure and its relation to short- and long-term mortality: associated factors in the Epidemiology of Acute Heart Failure in Emergency Departments- Worsening Renal Function study

OBJETIVO: Identificar los factores asociados con el empeoramiento de la función renal (EFR) y si este se asocia a mayor mortalidad en pacientes que presentan un episodio de insuficiencia cardiaca aguda (ICA). MÉTODO: Participaron 7 servicios de urgencias (SU) que incluyeron consecutivamente pacientes con ICA con determinación de creatinina en urgencias y a las 24-48 horas, y se identificaron aquellos con EFR (incremento de creatinina $ 0,3 mg/dL). Entre 47 características clínicas, se identificó las asociadas a EFR. Se investigó la mortalidad por cualquier causa a 30 días (OR) y al final del seguimiento (HR), esta última global y por periodos trimestrales, que se ajustó por las diferencias entre grupos. Se analizaron subgrupos según edad, sexo, creatinina basal, tipo de ICA y grupo de riesgo. RESULTADOS: Se incluyeron 1.627 pacientes, 220 (13,5%) con EFR, los cuales presentaban mayor edad, presión arterial sistólica, crisis hipertensiva como precipitante, tratamiento con morfina e insuficiencia renal crónica, aunque solo esta última se asoció independientemente a EFR (ORajustada = 1,695, IC 95% = 1,264-2,273). La mortalidad a 30 días fue de 13,1% (mayor en pacientes con EFR: 20,9% vs 11,8%, ORajustada = 1,793, IC 95% = 1,207-2,664) y la mortalidad acumulada a 18 meses (tiempo medio de seguimiento 14 meses/paciente) fue del 40,0% (mayor en pacientes con EFR: HRajustada = 1,275, IC 95% = 1,018-1,598). Este incremento de riesgo fue durante el primer trimestre. El análisis de subgrupos no mostró diferencias. CONCLUSIÓN: La ICA con EFR en las primeras 48 horas posteriores a la atención en el SU se asocia a mayor mortalidad, que se concentra durante el primer trimestre

OBJECTIVE: To identify factors associated with worsening renal function (WRF) and explore associations with higher mortality in patients with acute heart failure (AHF). METHODS: Seven emergency departments (EDs) in the EAHFE-EFRICA study (Spanish acronym for Epidemiology of AHF in EDs - WRF in AHF) consecutively included patients with AHF and creatinine levels determined in the ED and between 24 and 48 hours later. Patients with WRF were identified by an increase in creatinine level of 0.3 mg/dL or more. Forty-seven clinical characteristics were explored to identify those associated with WRF. To analyze for 30-day all-cause mortality we calculated odds ratios (ORs). To analyze mortality at the end of follow-up and by trimester, adjusted for between-group differences, we calculated hazard ratios (HRs). The data were analyzed by subgroups according to age, sex, baseline creatinine levels, AHF type, and risk group. RESULTS: A total of 1627 patients were included. The subgroup of 220 (13.5%) with WRF were older, had higher systolic blood pressure, were more often treated with morphine, and had chronic renal failure; there was also a higher rate of hypertensive crisis as the trigger for AHF in patients with WRF. However, only chronic renal failure was independently associated with WRF (adjusted OR, 1.695; 95% CI, 1.264-2.273). The rate of 30-day mortality was 13.1% overall but higher in patients with WRF (20.9% vs 11.8% in patients without WRF; adjusted OR, 1.793; 95% CI, 1.207-2.664). Accumulated mortality at 18 months (average follow-up time, 14 mo/patient) was 40.0% overall but higher in patients with WRF (adjusted HR, 1.275; 95% CI, 1.018-1.598). Increased risk was greater in the first trimester. Subgroup analyses revealed no differences. CONCLUSION: AHF with WRF in the first 48 hours after ED care is associated with higher mortality, especially in the first trimester after the emergency