Risk of fetal loss after chorionic villus sampling in twin pregnancy derived from propensity score matching analysis.

OBJECTIVE: To estimate the risk of fetal loss associated with chorionic villus sampling (CVS) in twin pregnancy, using propensity score analysis. METHODS: This was a multicenter cohort study of women with twin pregnancy undergoing ultrasound examination at 11-13 weeks' gestation, performed in eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. The risk of death of at least one fetus was compared between pregnancies that had and those that did not have CVS, after propensity score matching (1:1 ratio). This procedure created two comparable groups by balancing the maternal and pregnancy characteristics that lead to CVS being performed, similar to how randomization operates in a randomized clinical trial. RESULTS: The study population of 8581 twin pregnancies included 445 that had CVS. Death of one or two fetuses at any stage during pregnancy occurred in 11.5% (51/445) of pregnancies in the CVS group and in 6.3% (515/8136) in the non-CVS group (P < 0.001). The propensity score algorithm matched 258 cases that had CVS with 258 non-CVS cases; there was at least one fetal loss in 29 (11.2%) cases in the CVS group and in 35 (13.6%) cases in the matched non-CVS group (odds ratio (OR), 0.81; 95% CI, 0.48-1.35; P = 0.415). However, there was a significant interaction between the risk of fetal loss after CVS and the background risk of fetal loss; when the background risk was higher, the risk of fetal loss after CVS decreased (OR, 0.46; 95% CI, 0.23-0.90), while, in pregnancies with a lower background risk of fetal loss, the risk of fetal loss after CVS increased (OR, 2.45; 95% CI, 0.95-7.13). The effects were statistically significantly different (P-value of the interaction = 0.005). For a pregnancy in which the background risk of fetal loss was about 6% (the same as in our non-CVS population), there was no change in the risk of fetal loss after CVS, but, when the background risk was more than 6%, the posterior risk was paradoxically reduced, and when the background risk was less than 6%, the posterior risk increased exponentially; for example, if the background risk of fetal loss was 2.0%, the relative risk was 2.8 and the posterior risk was 5.6%. CONCLUSION: In twin pregnancy, after accounting for the risk factors that lead to both CVS and spontaneous fetal loss and confining the analysis to pregnancies at lower prior risk, CVS seems to increase the risk of fetal loss by about 3.5% above the patient's background risk. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

New approach for estimating risk of miscarriage after chorionic villus sampling.

OBJECTIVE: To estimate the risk of miscarriage associated with chorionic villus sampling (CVS). METHODS: This was a retrospective cohort study of women attending for routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation at one of eight fetal-medicine units in Spain, Belgium and Bulgaria, between July 2007 and June 2018. Two populations were included: (1) all singleton pregnancies undergoing first-trimester assessment at Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, Spain, that did not have CVS (non-CVS group); and (2) all singleton pregnancies that underwent CVS following first-trimester assessment at one of the eight participating centers (CVS group). We excluded pregnancies diagnosed with genetic anomalies or major fetal defects before or after birth, those that resulted in termination and those that underwent amniocentesis later in pregnancy. We used propensity score (PS) matching analysis to estimate the association between CVS and miscarriage. We compared the risk of miscarriage of the CVS and non-CVS groups after PS matching (1:1 ratio). This procedure creates two comparable groups balancing the maternal and pregnancy characteristics that are associated with CVS, in a similar way to that in which randomization operates in a randomized clinical trial. RESULTS: The study population consisted of 22 250 pregnancies in the non-CVS group and 3613 in the CVS group. The incidence of miscarriage in the CVS group (2.1%; 77/3613) was significantly higher than that in the non-CVS group (0.9% (207/22 250); P < 0.0001). The PS algorithm matched 2122 CVS with 2122 non-CVS cases, of which 40 (1.9%) and 55 (2.6%) pregnancies in the CVS and non-CVS groups, respectively, resulted in a miscarriage (odds ratio (OR), 0.72 (95% CI, 0.48-1.10); P = 0.146). We found a significant interaction between the risk of miscarriage following CVS and the risk of aneuploidy, suggesting that the effect of CVS on the risk of miscarriage differs depending on background characteristics. Specifically, when the risk of aneuploidy is low, the risk of miscarriage after CVS increases (OR, 2.87 (95% CI, 1.13-7.30)) and when the aneuploidy risk is high, the risk of miscarriage after CVS is paradoxically reduced (OR, 0.47 (95% CI, 0.28-0.76)), presumably owing to prenatal diagnosis and termination of pregnancies with major aneuploidies that would otherwise have resulted in spontaneous miscarriage. For example, in a patient in whom the risk of aneuploidy is 1 in 1000 (0.1%), the risk of miscarriage after CVS will increase to 0.3% (0.2 percentage points higher). CONCLUSIONS: The risk of miscarriage in women undergoing CVS is about 1% higher than that in women who do not have CVS, although this excess risk is not solely attributed to the invasive procedure but, to some extent, to the demographic and pregnancy characteristics of the patients. After accounting for these risk factors and confining the analysis to low-risk pregnancies, CVS seems to increase the risk of miscarriage by about three times above the patient's background risk. Although this is a substantial increase in relative terms, in pregnancies without risk factors for miscarriage, the risk of miscarriage after CVS remains low and similar to, or slightly higher than, that in the general population. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Nuevo enfoque para estimar el riesgo de aborto después de una biopsia de vellosidades coriónicas OBJETIVO: Estimar el riesgo de aborto asociado con la biopsia de vellosidades coriónicas (BVC). MÉTODOS: Se trata de un estudio retrospectivo de cohorte de mujeres que acudieron a un examen ecográfico de rutina entre las 11+0 y las 13+6 semanas de gestación a una de entre un total de ocho centros de medicina fetal en España, Bélgica y Bulgaria, entre julio de 2007 y junio de 2018. En el estudio se incluyeron dos poblaciones: 1) todos los embarazos con feto único sometidos a evaluación del primer trimestre en el Hospital Clínico Universitario Virgen de la Arrixaca de Murcia (España), a las que no se les hizo una BVC (grupo no BVC); y 2) todos los embarazos con feto único sometidos a BVC tras la evaluación del primer trimestre en uno de los ocho centros participantes (grupo BVC). Se excluyeron los embarazos diagnosticados con anomalías genéticas o defectos fetales importantes antes o después del nacimiento, los que resultaron en una interrupción y los que más tarde se sometieron a amniocentesis durante el embarazo. Para estimar la relación entre la BVC y el aborto espontáneo se utilizó el pareamiento por puntaje de propensión (PPP). Se comparó el riesgo de aborto de los grupos BVC y no BVC después del pareamiento PPP (razón 1:1). Este procedimiento creó dos grupos comparables en los que las características de la madre y el embarazo que se asocian con la BVC estaban equilibradas, de manera similar a cómo funciona la aleatorización en un ensayo clínico aleatorizado. RESULTADOS: La población de estudio consistió en 22.250 embarazos en el grupo no BVC y 3.613 en el grupo BVC. La incidencia de abortos en el grupo BVC (2,1%; 77/3.613) fue significativamente mayor que en el grupo no BVC (0,9% (207/22.250); P<0,0001). El algoritmo del PPP emparejó 2.122 BVC con 2.122 casos no BVC, de los cuales 40 (1,9%) y 55 (2,6%) embarazos en los grupos BVC y no BVC, respectivamente, resultaron en un aborto espontáneo (razón de momios (RM), 0,72 (IC 95%, 0,48-1,10); P=0,146). Se encontró una interacción significativa entre el riesgo de aborto espontáneo después de una BVC y el riesgo de aneuploidía, lo que sugiere que el efecto de la BVC en el riesgo de aborto espontáneo difiere según las características del contexto. Concretamente, cuando el riesgo de aneuploidía es bajo, el riesgo de aborto después de una BVC aumenta (RM, 2,87 (IC 95%, 1,13-7,30)) y cuando el riesgo de aneuploidía es alto, paradójicamente el riesgo de aborto después de una BVC se reduce (RM, 0,47 (IC 95%, 0,28-0,76)), presumiblemente debido al diagnóstico prenatal y a la interrupción de embarazos con aneuploidías importantes que, de otro modo, hubieran provocado un aborto espontáneo. Por ejemplo, en una paciente para quien el riesgo de aneuploidía es de 1 entre 1000 (0,1%), el riesgo de aborto después de la BVC aumenta al 0,3% (0,2 puntos porcentuales más alto). CONCLUSIONES: El riesgo de aborto espontáneo en las mujeres que se someten a una BVC es aproximadamente un 1% mayor que el de las mujeres a las que no se les hace, aunque este exceso de riesgo no se atribuye únicamente al procedimiento agresivo sino, en cierta medida, a las características demográficas y del embarazo de cada paciente. Después de tener en cuenta estos factores de riesgo y limitar el análisis a los embarazos de bajo riesgo, la BVC parece triplicar aproximadamente el riesgo de aborto en comparación con el riesgo de fondo de la paciente. Aunque se trata de un aumento sustancial en términos relativos, en los embarazos sin factores de riesgo de aborto, después de una BVC el riesgo de aborto sigue siendo bajo y similar, o ligeramente superior, al de la población en general. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Screening for Hepatocellular Carcinoma in HIV-Infected Patients: Current Evidence and Controversies.

PURPOSE OF REVIEW: This review aims to summarize evidence regarding hepatocellular carcinoma (HCC) screening in the specific context of HIV infection and discuss areas of uncertainty. RECENT FINDINGS: It has not been definitely established if HCC incidence in HIV/HCV-coinfected patients with cirrhosis is above the 1.5%/year threshold that makes screening cost-effective. Outside cirrhosis or HBV infection, available data do not support surveillance. The performance of currently recommended ultrasound (US) screening strategy is poor in HIV-infected patients, as rates of early-stage HCC detection are low. Magnetic resonance imaging-based surveillance strategies or liquid biopsy are innovative approaches that should be specifically tested in this setting. HIV-infected patients with cirrhosis are at risk of HCC. US surveillance identifies patients with early-stage HCC who will benefit of curative therapies, although the quality of the evidence supporting screening remains limited. The HIV population should be a priority group to assess and validate new surveillance strategies.

Atención prestada por un Centro de Urgencias de Atención Primaria en el atentado terrorista de 2017 en Barcelona (España) / Care provided by a primary care emergency center in the terrorist attack of 2017 in Barcelona (Spain)

Introducción: el 17 de agosto de 2017 se produce en barcelona un atentado terrorista. una furgoneta arrolla a centenares de viandantes en las ramblas alrededor de las 5:00 pm. El centro de urgencias de atención primaria (cuap) ciutat-vella peracamps, que atiende generalmente entre 70 y 100 pacientes diarios, sobretodo de nivel III y IV, según el sistema español de triaje (set), está situado en las inmediaciones donde se produjo el atentado. Objetivo: determinar el perfil de la demanda y la respuesta de los servicios prestados en el cuap las primeras 24h después del atentado. Metodología: estudio cuantitativo, observacional y retrospectivo. Los datos fueron obtenidos de la trayectoria clínica informatizada de enfermería y de la historia clínica electrónica de los pacientes que acudieron en el ámbito temporal de dicho estudio. Resultados: en las primeras 24 horas, el cuap recibió un total de 70 pacientes, de los cuales 25 estuvieron relacionados de forma directa con el atentado. En cuanto a los niveles de triaje de enfermería, un 4% fueron de nivel I (n=1), un 40% fueron nivel III (n=10), y un 56% nivel IV (n=14). Conclusiones: no hubo una mayor demanda asistencial, pero sí un nivel de gravedad superior. En cuanto a los tiempos de asistencia tampoco se observa diferencia con otros días, pero se ha de considerar que se incrementó el número de personal sanitario, lo cual optimizó la asistencia

Introduction: on august 17, 2017, a terrorist attack takes place in barcelona. A van rolls over hundreds of pedestrians on the ramblas in barcelona around 5pm. The emergency center for primary care (cuap) ciutat-vella peracamps, which generally attends between 70 and 100 patients a day, above all at level III and IV, according to the spanish triage system (set); it's located close where the attack took place. Objective: determine the profile of the demand and the response of the services provided in the cuap the first 24 hours after the attack. Methodology: quantitative, observational and retrospective study. The data were obtained from the computerized clinical trajectory of nursing and the electronic clinical history of the patients who attended in the temporal scope of said study. Results: in the first 24 hours, the cuap received a total of 70 patients, which 25 were directly related to the attack. Regarding nursing triage levels, 4% were level i (n = 1), 40% were level iii (n = 10), and 56% level iv (n = 14). Conclusions: there was no greater demand for care, but a higher level of severity. Regarding the attendance times, there is no difference with other days, but it has to be considered that the number of health personnel increased, which optimized the assistance

Stereochemical aspects and the synthetic scope of the S(H)i at the sulfur atom. Preparation of enantiopure 3-substituted 2,3-dihydro-1,2-benzoisothiazole 1-oxides and 1,1-dioxides.

Intramolecular homolytic substitution (SHi) on the sulfur atom at acyclic N-(o-bromobenzyl)sulfinamides takes place with a complete inversion of the configuration and provides an excellent tool to connect N-tert-butanesulfinylimines with enantiopure 3-substituted benzo-fused sulfinamides (1,2-benzoisothiazoline 1-oxides) and the related pharmacologically relevant sulfonamides.

Intermolecular alkyl radical additions to enantiopure N-tert-butanesulfinyl aldimines.

The sulfinyl group in (R)-N-tert-butanesulfinyl aldimines provides efficient control of the stereoselectivity in the intermolecular reactions with alkyl radicals. The methodology is applicable to aryl, heteroaryl, benzyl, and alkynyl imines, even those containing CN, CO2Me, COR, and OH groups. The best results are attained with hindered radicals (tertiary and secondary ones) without C═N bond reduction. This reaction complements the well-established organometallic additions to N-sulfinyl aldimines to obtain enantiomerically pure functionalized α-branched primary amines.

Incidence of pneumococcal infections among children under 15 years in southern Catalonia throughout the heptavalent conjugate vaccine era, 2002-2009.

PURPOSE: Updating epidemiological studies to document current incidences of pneumococcal diseases are greatly needed in the current era of new pneumococcal conjugate vaccines (PCVs). The aim of this study is to analyze the incidence and distribution of different serotypes causing pneumococcal infections among the pediatric population in southern Catalonia, Spain, throughout the 2002-2009 PCV7 eras. METHODS: A population-based surveillance study was conducted among children aged ≤ 14 years in the region of Tarragona (Catalonia, Spain) during the period 2002-2009. All cases of pneumococcal infections (invasive and non-invasive cases) were included in the study. Incidence rates (per 100,000 population-year) and prevalence of infections caused by serotypes included in different PCV formulations were calculated for the 2002-2005 and 2006-2009 periods. RESULTS: Globally, across the total 2002-2009 period, the incidence of pneumococcal infections was 48.2 per 100,000 children-year (22.4 and 25.8 for invasive and non-invasive infections, respectively). Between 2002-2005 and 2006-2009, the incidence rates largely decreased among children aged <2 years (from 171 to 111 per 100,000 children-year; p = 0.059), but they did not substantially vary among children aged 2-14 years. The percentages of cases caused by serotypes included in PCV7 (60.0 vs. 16.7 %; p < 0.001), PCV10 (75.0 vs. 47.4 %; p = 0.028), and PCV13 (85.0 vs. 70.5 %; p = 0.190) decreased in both periods. CONCLUSION: In this study, which was conducted in a setting with intermediate PCV7 uptakes, a considerable protective direct effect of vaccination occurred among young infants, but an indirect protective effect did not emerge in the rest of the pediatric population. Despite new PCVs with higher serotype coverage, an important proportion of pneumococcal infections is still not covered by these vaccines.

Factores de riesgo de recidiva bioquímica después de prostatectomía radical en pacientes con cáncer de próstata clínicamente localizado. Implicaciones en el tratamiento adyuvante / Risk factors for biochemical recurrence after radical prostatectomy in patients with clinically localized prostate cancer. Implications of adjuvant treatment

Evaluar las variables patológicas predictivas de recidiva bioquímica después de prostatectomía radical y sus implicaciones en la toma de decisiones en el tratamiento adyuvante. MÉTODO: 684 pacientes con cáncer de próstata localizado a los que se les realizó prostatectomía radical entre 1996 y 2007. Previamente a la cirugía fueron clasificados según los grupos de riesgo de recidiva de D'Amico. Posteriormente a la prostatectomía se recogieron las siguientes variables: score de Gleason, estadio patológico, invasión capsular, márgenes quirúrgicos, invasión perineural y porcentaje de afectación en la pieza. Se realizó un análisis univariante y posteriormente se ajustó mediante un modelo de riesgos proporcionales de Cox (método enter). RESULTADOS: La mediana de seguimiento de la serie fue de 61 meses. El 29,1% de los pacientes presentaron recidiva bioquímica. La mortalidad global de la serie fue del 4,9% y del 1,2% la cáncer específica. En el análisis univariante el score de Gleason de la pieza quirúrgica, la invasión capsular, la invasión perineural, la afectación de los márgenes quirúrgicos, el estadio patológico y el porcentaje de afectación de la pieza se relacionaron de forma estadísticamente significativa (p < 0,001) con la recidiva bioquímica. En el análisis multivariante el score de Gleason ≥ 8 en la pieza quirúrgica (HR=3,08), la existencia de márgenes quirúrgicos afectados (HR=2,98), el estadio pT3 (HR=1,61) y la afectación por cáncer de más del 50% de la pieza (HR=3,39) se identificaron como variables predictivas independientes de recidiva bioquímica. Al estratificar según los factores predictivos independientes de recidiva bioquímica (pT, Gleason y margen), los pacientes con al menos 2 de estos factores presentaron una incidencia de recidiva bioquímica a los 5 años superior al 50%(AU)

CONCLUSIONES: Los pacientes que después de la prostatectomía tenían un score de Gleason ≥ 8, afectación de los márgenes, estadio pT3 o un porcentaje de tumor > 50% presentaron un riesgo aumentado de recidiva bioquímica. Los pacientes con al menos 2 factores predictores de recidiva tendrán una probabilidad de recidiva superior al 50% en los primeros 5 años de recidiva y por lo tanto deberían de ser candidatos a radioterapia adyuvante(AU)

To evaluate the pathological variables predictive of biochemical recurrence after radical prostatectomy and their implications for decision making in the adjuvant setting. METHODS: 684 patients with localized prostate cancer who were treated with radical prostatectomy between 1996 and 2007. Before surgery they were classified according to D’Amico risk groups for recurrence. Following prostatectomy the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins, perineural invasion and percentage of involvement in the piece. Univariate analysis was performed and subsequently adjusted using a Cox proportional hazards model (method enter). RESULTS: The median follow up of the series was 61 months. 29.1% of patients had biochemical recurrence. Overall mortality of the series was 4.9% and cancer-specific mortality 1.2%. In univariate analysis the Gleason score of surgical specimens, capsular invasion, perineural invasion, involvement of surgical margins, pathological stage and percentage of involvement of the piece had statistically significant (p <0.001) relation with biochemical recurrence. In multivariate analysis, a Gleason score ≥ 8 in the surgical specimen (HR = 3.08), existence of affected surgical margins (HR = 2.98), pT3 stage (HR = 1.61) and involvement of more than 50% of the piece by cancer (HR = 3.39) were identified as independent predictors of biochemical recurrence. Stratifying by independent predictors of biochemical recurrence (pT, Gleason score and margin), patients with at least 2 of these factors had an incidence of biochemical recurrence at 5 years exceeding 50%(AU)

CONCLUSIONS: Patients who have a Gleason score ≥ 8, positive margins, pT3 tumour or a percentage of >50% after prostatectomy have an increased risk of biochemical recurrence. Patients with at least 2 predictors of relapse have a probability of recurrence over 50% in the first 5 years of recurrence and should therefore be candidates for adjuvant radiotherapy(AU)

Synthesis of 3-vinyl-2,5-dihydrofuran ring system via enyne metathesis.

An efficient route, starting from but-3-en-1,2-diol, is described to synthesize racemic diastereoisomeric (5-ethoxy-4-vinyl-2,5-dihydrofuran-2-yl) methanol derivatives. Acyclic enyne intermediates having the alkyne moiety directly connected to the asymmetric carbon atom of an acetal were obtained in two steps. These reactive substrates were then subjected to ruthenium-catalyzed enyne metathesis to produce the target compounds in racemic form. The relative configurations were determined by NOE proton NMR experiments. Similar strategy starting from (2S)-but-3-en-1,2-diol was proposed to provide pure enantiomers.

[Prevalence and duration of breast-feeding: its influences on the weight and the morbidity]. / Prevalencia y duración de la lactancia materna: Influencia sobre el peso y la morbilidad.

OBJECTIVE: To estimate the prevalence and the average length of Lactation. To describe the development of the weight during the first year of life and the demand of paediatric consultations in relation to the type of lactation. METHODS: A cross-sectional study was done using retrospective data. There was gathered a random sample of clinical histories of born children between years 2000 and 2005. There was estimated the prevalence of breast-feeding from the beginning until three and six months. An index of global desertion was elaborated. The average weight and the number of paediatric consultations were related to the type of lactation. RESULTS: The children initiate exclusive breastfeeding (MEL) in a 63.5% (CI 95%: 58.6-64.5). 22.6% amount them (IC 95%: 18.4-26.9) remained it until six months age. After three months of MEL 43.4% of the subjects gave up exclusively lactation. At the age of six months only 33.6% remained with MEL. Mixed form of lactation (MTL) was kept in 80.5% of the subjects (IC 95%: 75.4-84.6). Children included in the program of MTL (exclusive or mixed) have a minor index of desertion (26.5% and 54.4% up to three and six months, respectively). A higher weight was detected in children with mixed lactation. Those on the MEL up to six months consulted the paediatrician 4.5 times a year, whereas children with artificial lactation did it 6.5 times during their first year of life. There were statistically significant differences found (p < 0.007). CONCLUSIONS: Percentage of lactation in the group studied is far from recommended levels (WHO). Exclusive breastfeeding (MEL) entails a suitable weight development, as well as a minor morbidity in the first year of life.

Prevalencia y duración de la lactancia materna. Influencia sobre el peso y la morbilidad / Prevalence and duration of breast-feeding. Its influences on the weight and the morbidity

Introducción y objetivos: Estimar la prevalencia y duración de la lactancia materna (LM). Describir la evolución del peso en el primer año de vida y la demanda de consultas al pediatra en relación al tipo de lactancia. Pacientes y métodos: Estudio transversal. Datos retrospectivos. Se recogió una muestra aleatoria de historias clínicas de niños nacidos entre 2000 y 2005. Se estimó la prevalencia de lactancia natural al inicio, a los tres y seis meses. Se elaboró un índice de deserción para la duración. Se comparó el peso medio y el número de consultas al pediatra con el tipo de lactancia. Resultados: Iniciaron la lactancia materna exclusiva (LME) un 63,5 % (IC 95%: 58,6-64,5). A los seis meses permanecen un 22,6 % (IC 95%: 18,4-26,9). Un 80,5% (IC 95%: 75,4-84,6) comienzan lactancia materna total -exclusiva o mixta- (LMT). El 43,4 % de los niños que empezaron con LME abandonaron a los tres meses y el 64,4% a los seis; mientras que los de LMT tienen índices de deserción menores, un 26,5% y un 54,4% a los tres y a los seis meses, respectivamente. Los niños con lactancia materna mixta (LMM) suelen tener un peso medio mayor. Los alimentados con la LME hasta los seis meses, consultan al pediatra, un promedio de 4,5 veces durante el primer año. Los de lactancia artificial en unas 6,5 ocasiones. Ambas medias son significativas estadísticamente (p < 0,007). Conclusiones: La lactancia materna en esta población se aparta de las recomendaciones de la OMS. Los resultados apuntan a que la LME conlleva una evolución del peso del niño más adecuada y una menor morbilidad, al menos en el primer año de vida (AU)

Objective: To estimate the prevalence and the average length of Lactation. To describe the development of the weight during the first year of life and the demand of paediatric consultations in relation to the type of lactation. Methods: A cross-sectional study was done using retrospective data. There was gathered a random sample of clinical histories of born children between years 2000 and 2005. There was estimated the prevalence of breast-feeding from the beginning until three and six months. An index of global desertion was elaborated. The average weight and the number of paediatric consultations were related to the type of lactation. Results: The children initiate exclusive breastfeeding (MEL) in a 63.5% (CI 95%: 58.6-64.5). 22.6% amount them (IC 95%: 18.4-26.9) remained it until six months age. After three months of MEL 43.4% of the subjects gave up exclusively lactation. At the age of six months only 33.6% remained with MEL. Mixed form of lactation (MTL) was kept in 80.5% of the subjects (IC 95%: 75.4-84.6). Children included in the program of MTL (exclusive or mixed) have a minor index of desertion (26.5% and 54.4% up to three and six months, respectively). A higher weight was detected in children with mixed lactation. Those on the MEL up to six months consulted the paediatrician 4.5 times a year, whereas children with artificial lactation did it 6.5 times during their first year of life. There were statistically significant differences found (p < 0.007). Conclusions: Percentage of lactation in the group studied is far from recommended levels (WHO). Exclusive breastfeeding (MEL) entails a suitable weight development, as well as a minor morbidity in the first year of life (AU)

Remote stereocontrol mediated by a sulfinyl group: synthesis of allylic alcohols via chemoselective and diastereoselective reduction of gamma-methylene delta-ketosulfoxides.

The efficiency of the sulfinyl group as a remote controller of the chemoselectivity and diastereoselectivity of the reduction of alpha, beta-unsaturated alpha-[2-(p-tolylsulfinyl)phenyl] substituted ketones 1 has been demonstrated in reactions carried out under NaBH4 in the presence of Yb(OTf)3 as the chelating agent. The starting unsaturated ketones have been prepared from the corresponding 2-(p-tolylsulfinyl) benzyl alkyl (and aryl) ketones 2 by insertion of the methylidene group under modified Mannich conditions, exploiting ultrasound irradiation to obtain the aminomethylation adducts and silica gel treatment to produce its complete elimination. Desulfinylation of the reduction products yielded the corresponding vinyl carbinols with high enantiomeric purity.

Cavidol: Calidad de vida y dolor en atención primaria / CAVIDOL: quality of life and pain in primary care

Introducción La valoración de la calidad es vida de nuestros pacientes es un aspecto del proceso patológico cada vez más considerado a la hora de realizar la anamnesis. Por ello, nos hemos planteado realizar el presente estudio con un doble objetivo: • Comprobar si existen diferencias en la calidad de vida de las personas que consultan por cuadros dolorosos respecto a las que consultan por otras patologías. • Conocer diferentes etiologías del dolor consultado en Atención Primaria (AP). Pacientes y métodos Se reclutaron los pacientes de 10 consultas de AP de la provincia de Lugo. Se diseñó un cuaderno de recogida de datos al efecto, que consta de una parte común para los dos grupos objetos del estudio (edad, sexo, antecedentes personales de interés y datos antropométricos) y de otra específica para los casos, es decir las personas que consultaron por cualquier proceso doloroso, (cronología, tipo de dolor, diagnóstico, tiempo de evolución, tratamiento y resultado de la escala visual analógica [EVA]). A todos los participantes se les realizó la encuesta de calidad de vida SF-36. Resultados La muestra se compone de 347 individuos (170 casos y 177 controles) con una edad media de 63 años (+/- 31). Hubo diferencias estadísticamente significativas en todos los aspectos analizados de la calidad de vida entre los dos grupos (función física, función social, problemas físicos, problemas emocionales, salud mental, vitalidad, dolor, salud general y cambios en el tiempo). El diagnóstico más frecuente de proceso doloroso fue gonartrosis/coxartrosis con el 12.69 % de los casos, seguido de osteoartrisis de columna vertebral (10.27 % ). Por aparatos, el más afectado es el músculo-esquelético (37.76% de los casos), seguido del sistema nervioso (3.63% de los casos). Conclusiones • Las personas que consultan por procesos dolorosos tienen su calidad de vida más deteriorada que las que consultan por otro tipo de procesos. • El dolor crónico menoscaba la CV de una manera más amplia que el agudo. • La causa más frecuente de dolor consultado es la gonartrosis/coxartrosis. • El aparato más comúnmente afectado por procesos dolorosos es el músculo-esquelético

Introduction The valuation of the quality of life (QL) of our patients is an aspect of the pathological process more and more considered when carrying out the anamnesis. For it, we have thought about to carry out the present study with an objective double: • To check if differences exist in the quality of people's life that they consult for painful squares regarding those that consult for other pathologies. • To know different etiologies of the pain consulted in Primary Care (PC). Patient and methods The patients of 10 consultations of PC of the county of Lugo were recruited. A notebook of data collection was designed; that consists of a common part for the two groups objects of the study (age, sex, personal antecedents of interest and data antropometrics) and of another specific one for the cases, that is to say people that consulted for any painful process, (chronology, type of pain, diagnostic, time of evolution, treatment and result of the analogical visual scale [AVS]). All the participants they were carried out the survey of quality of life SF-36. Results The sample is composed of 347 individuals (170 cases and 177 controls) with a 63 year-old half age (+ / - 31). There were differences statistically significant in all the analyzed aspects of the quality of life among the two groups (physical function, social function, physical problems, emotional problems, mental health, vitality, pain,general health and changes in the time). The most frequent diagnosis in painful process was gonarthrosis/ coxarthrosis with 12.69% of the cases, followed by spine osteoarthritis (10.27%). For apparatuses, the most affected is the muscle-skeletal (37.76% of the cases), followed by the nervous system (3.63% of the cases). Conclusions • People that consult for painful processes have their quality of life more deteriorated that those that consult for another type of processes. • The chronic pain impairs the QL in a wider way more than the acute one. • The most frequent cause in consulted pain is the gonartrosis/ coxartrosis. • The apparatus more commonly affected by painful processes it is the muscle-skeletal one

Perfil social del paciente con dolor crónico que acude a la unidad del dolor de Cáceres / No disponible

No disponible

Remote stereocontrol by sulfinyl groups: reduction of delta-ketosulfoxides.

The reduction of delta-ketosulfoxides constitutes the first evidence of the efficiency of the sulfinyl group to control the stereoselectivity of 1,5-asymmetric induction processes. The use of DIBAL/Yb(OTf)3 or L-Selectride as the reducing agents provides delta-hydroxysulfoxides with the opposite configuration at the hydroxylic carbon in a highly stereoselective way.

Tuberculosis peritoneal frente a cáncer de ovario: claves para un diagnóstico diferencial difícil / Tuberculous peritonitis or ovarian cancer: keys to a difficult differential diagnosis

Presentamos el caso de una paciente de 41 años de edad y nacionalidad ecuatoriana, en la que se practica una anexectomía bilateral por alta sospecha diagnóstica de carcinoma de ovario, y cuyas lesiones son diagnosticadas finalmente de tuberculosis peritoneal. Las manifestaciones clínicas abdominales inespecíficas, la ascitis, la masa pélvica en ecografía y TC, y la elevación del marcador CA-125 pueden ser comunes en ambas entidades patológicas en muchas ocasiones pero, dados el buen pronóstico de la tuberculosis y la buena respuesta al tratamiento médico, su diagnóstico preoperatorio debería considerarse en pacientes inmunocomprometidas o procedentes de países endémicos. (AU)

Diagnostic criteria of white coat hypertension (WCH): consequences for the implications of WCH for target organs.

In a sample comprising 51 normotensive subjects and 51 subjects with in-clinic arterial hypertension [blood pressures (BPs) > or = 140/90 mmHg), we investigated the prevalence of target organ damage [left ventricular hypertrophy (LVH) and retinal vasculopathy] in white coat hypertension (WCH) groups defined using: (a) the "optimal ambulatory BP" criterion of the Seventh International Consensus Conference (in-clinic BPs >140/90 mmHg, daytime mean BPs < 130/80 mmHg) and (b) the "normal ambulatory BP" criterion proposed in 1997 by Verdecchia and co-workers (in-clinic BPs >140/ 90 mmHg, daytime mean BPs < 135/85 mmHg), and we compared the results with those obtained for the normotensive group and for a WCH group defined as in a 1996 study of the same data. We found that the newer criteria did not alter the conclusions reached in 1996: namely, that WCH constitutes a state of risk intermediate between normotension and sustained hypertension, which demands in-depth evaluation and active monitoring, if not immediate therapy. We also found that when the WCH group was defined as those patients with in-clinic BPs > or = 140/90 mmHg and 24-h mean BPs < 121/78 mmHg, the prevalence of target organ damage was similar to that found in the control group. We conclude that if WCH status is to imply absence of elevated risk of target organ damage, then the ambulatory BP threshold defining WCH should be lower than the upper limit of ambulatory BPs among subjects who are normotensive in the clinic. The desirability of predicting target organ damage in both hypertensive and normotensive subjects using criteria combining in-clinic BPs, daytime mean ambulatory BPs and night-time mean ambulatory BPs is suggested.

[The presence of anti-Chlamydia pneumoniae antibodies in peripheral vascular and neurological disorders]. / Presencia de anticuerpos anti-Chlamydia pneumoniae en procesos vasculares periféricos y neurológicos.

OBJECTIVES: To make a retrospective analysis of the synthesis of antibodies to the MOMPS and LPS antigens of Chlamydia pneumoniae in patients with occlusive disease of the peripheral arteries (ODPA) and multiple sclerosis (MS). PATIENTS AND METHODS: We studied 190 samples of plasma from patients included in the following groups: group 1:66 samples from 66 patients with ODPA; group 2:74 samples from 31 patients with MS (20 remittent-relapsing and 11 secondarily progressive), followed over time; and group 3:50 samples from persons acting as controls. In all cases determinations were made using ELISA, of the IgG anti-MOMP and the IgG and IgA anti-LPS. Comparison of the continuous variables was made using the Mann-Whitney U Test. Discrete variables were analysed using the exact bilateral Fisher Test. The Wilcoxon Test over ranges was used to compare the evolution of antibodies in the patients with MS. RESULTS: The percentage of positive results in groups 1 to 3 for anti-LPS IgG were: 24.6%, 18.9% and 20.8%, respectively, with no differences between patients and controls; nor were there any differences with IgA (29%, 29.7% and 25%, respectively). However differences were seen in the anti-MOMP IgG between patients and controls (group 1:80.3%, group 2:37.8% and group 3: 33.3%). In patients with MS the results of the evolution of the antibodies did not reflect a uniform tendency of the levels of the different antibodies. CONCLUSION: A higher level of IgG anti-MOMP was seen in ODPA and MS, although this did not occur with anti-LPS or IgA.