Aplicación de la clasificación de Neff modificada en el manejo de la diverticulitis aguda / The use of the modified Neff classification in the management of acute diverticulitis

Introducción: la diverticulitis aguda (DA) es cada vez más frecuente en los servicios de Urgencias. Es necesario un manejo seguro y eficaz con criterios de clasificación que permitan un tratamiento dirigido. Objetivo: verificar que la clasificación radiológica de Neff modificada (mNeff) asociada a criterios clínicos (síndrome de respuesta inflamatoria [SIRS] y comorbilidad) permite un manejo seguro de la DA. Material y métodos: estudio descriptivo prospectivo en una población de pacientes diagnosticados de DA mediante tomografía computarizada (TC). El protocolo consiste en la aplicación de la clasificación de mNeff y criterios clínicos de SIRS y comorbilidad que permiten tratamiento ambulatorio, ingreso, drenaje o cirugía. Resultados: el estudio comprende el periodo de febrero de 2010 a febrero de 2016, con un total de 590 episodios de DA en 271 mujeres y 319 hombres, con una edad mediana de 60 años (rango: 25-92 años). Grados de mNeff: grado 0 (408 pacientes, 70,6%): 376/408 (92%) tributarios a tratamiento domiciliario; alta 254/376 (67,5%); reconsultaron 33 pacientes y 22 reingresaron; éxito: 91%. Grado Ia (52, 8,9%): 31/52 (59,6%) tributarios a tratamiento ambulatorio; alta 11/31 (35,5%); reconsultaron ocho e ingresaron cinco. Grado Ib (49, 8,5%): cinco cirugías y dos drenajes. Grado II (30, 5,2%): diez cirugías y cuatro drenajes. Grado III (5, 0,9%): una cirugía y un drenaje. Grado IV (34, 5,9%): diez pacientes con buena evolución con tratamiento conservador; 24/34 (70,6%) fueron intervenidos; colocamos 3/34 (8,8%) drenajes percutáneos. Conclusión: la clasificación de mNeff es una clasificación segura y aplicable basada en los hallazgos radiológicos de la TC. Junto con datos clínicos y de comorbilidad, permite un mejor manejo del cuadro de DA (AU)

Introduction: Acute diverticulitis (AD) is increasingly seen in Emergency services. The application of a reliable classification is vital for its safe and effective management. Objective: To determine whether the combined use of the modified Neff radiological classification (mNeff) and clinical criteria (systemic inflammatory response syndrome [SIRS] and comorbidity) can ensure safe management of AD. Material and methods: Prospective descriptive study in a population of patients diagnosed with AD by computerized tomography (CT). The protocol applied consisted in the application of the mNeff classification and clinical criteria of SIRS and comorbidity to guide the choice of outpatient treatment, admission, drainage or surgery. Results: The study was carried out from February 2010 to February 2016. A total of 590 episodes of AD were considered: 271 women and 319 men, with a median age of 60 years (range: 25-92 years). mNeff grades were as follows: grade 0 (408 patients 70.6%); 376/408 (92%) were considered for home treatment; of these 376 patients, 254 (67.5%) were discharged and controlled by the Home Hospitalization Unit; 33 returned to the Emergency Room for consultation and 22 were re-admitted; the success rate was 91%. Grade Ia (52, 8.9%): 31/52 (59.6%) were considered for outpatient treatment; of these 31 patients, 11 (35.5%) were discharged; eight patients returned to the Emergency Room for consultation and five were re-admitted. Grade Ib (49, 8.5%): five surgery and two drainage. Grade II (30, 5.2%): ten surgery and four drainage. Grade III (5, 0.9%): one surgery and one drainage. Grade IV (34, 5.9%): ten patients showed good evolution with conservative treatment. Of the 34 grade IV patients, 24 (70.6%) underwent surgery, and three (8.8%) received percutaneous drainage. Conclusions: The mNeff classification is a safe, easy-to-apply classification based on CT findings. Together with clinical data and comorbidity data, it allows better management of AD (AU)

The use of the modified Neff classification in the management of acute diverticulitis.

INTRODUCTION: Acute diverticulitis (AD) is increasingly seen in Emergency services. The application of a reliable classification is vital for its safe and effective management. OBJECTIVE: To determine whether the combined use of the modified Neff radiological classification (mNeff) and clinical criteria (systemic inflammatory response syndrome [SIRS] and comorbidity) can ensure safe management of AD. MATERIAL AND METHODS: Prospective descriptive study in a population of patients diagnosed with AD by computerized tomography (CT). The protocol applied consisted in the application of the mNeff classification and clinical criteria of SIRS and comorbidity to guide the choice of outpatient treatment, admission, drainage or surgery. RESULTS: The study was carried out from February 2010 to February 2016. A total of 590 episodes of AD were considered: 271 women and 319 men, with a median age of 60 years (range: 25-92 years). mNeff grades were as follows: grade 0 (408 patients 70.6%); 376/408 (92%) were considered for home treatment; of these 376 patients, 254 (67.5%) were discharged and controlled by the Home Hospitalization Unit; 33 returned to the Emergency Room for consultation and 22 were re-admitted; the success rate was 91%. Grade Ia (52, 8.9%): 31/52 (59.6%) were considered for outpatient treatment; of these 31 patients, 11 (35.5%) were discharged; eight patients returned to the Emergency Room for consultation and five were re-admitted. Grade Ib (49, 8.5%): five surgery and two drainage. Grade II (30, 5.2%): ten surgery and four drainage. Grade III (5, 0.9%): one surgery and one drainage. Grade IV (34, 5.9%): ten patients showed good evolution with conservative treatment. Of the 34 grade IV patients, 24 (70.6%) underwent surgery, and three (8.8%) received percutaneous drainage. CONCLUSIONS: The mNeff classification is a safe, easy-to-apply classification based on CT findings. Together with clinical data and comorbidity data, it allows better management of AD.

The Development of Quality Control Genotyping Approaches: A Case Study Using Elite Maize Lines.

Quality control (QC) of germplasm identity and purity is a critical component of breeding and conservation activities. SNP genotyping technologies and increased availability of markers provide the opportunity to employ genotyping as a low-cost and robust component of this QC. In the public sector available low-cost SNP QC genotyping methods have been developed from a very limited panel of markers of 1,000 to 1,500 markers without broad selection of the most informative SNPs. Selection of optimal SNPs and definition of appropriate germplasm sampling in addition to platform section impact on logistical and resource-use considerations for breeding and conservation applications when mainstreaming QC. In order to address these issues, we evaluated the selection and use of SNPs for QC applications from large DArTSeq data sets generated from CIMMYT maize inbred lines (CMLs). Two QC genotyping strategies were developed, the first is a "rapid QC", employing a small number of SNPs to identify potential mislabeling of seed packages or plots, the second is a "broad QC", employing a larger number of SNP, used to identify each germplasm entry and to measure heterogeneity. The optimal marker selection strategies combined the selection of markers with high minor allele frequency, sampling of clustered SNP in proportion to marker cluster distance and selecting markers that maintain a uniform genomic distribution. The rapid and broad QC SNP panels selected using this approach were further validated using blind test assessments of related re-generation samples. The influence of sampling within each line was evaluated. Sampling 192 individuals would result in close to 100% possibility of detecting a 5% contamination in the entry, and approximately a 98% probability to detect a 2% contamination of the line. These results provide a framework for the establishment of QC genotyping. A comparison of financial and time costs for use of these approaches across different platforms is discussed providing a framework for institutions involved in maize conservation and breeding to assess the resource use effectiveness of QC genotyping. Application of these research findings, in combination with existing QC approaches, will ensure the regeneration, distribution and use in breeding of true to type inbred germplasm. These findings also provide an effective approach to optimize SNP selection for QC genotyping in other species.

Inserción velamentosa extrema de cordón umbilical, sin rotura de vasa previa / Velamentous insertion of the umbilical cord without rupture of vasa previa

La inserción velamentosa del cordón umbilical está presente en 1 de cada 100 embarazos, asociando situaciones que comprometen la evolución perinatal; por ello necesitamos un diagnóstico de esta situación, previo al parto, mediante cribado ecográfico, por lo menos en aquellos casos con riesgo de vasa previa, como embarazos múltiples o fecundación in vitro, placentas previas o de inserción bajas, para realizar una cesárea electiva. Presentamos un caso extremo de inserción velamentosa; la distribución vascular recuerda a una jaula de pájaro y, pese a ello, de modo sorprendente, no hubo lesión vascular (AU)

Velamentous insertion of the umbilical cord appears in one out of every 100 pregnancies and can prove life-threatening for the fetus. Consequently, prenatal diagnosis through ultrasound scanning is required, at least in women with a risk of vasa previa, such as those with multiple pregnancies, in vitro fertilization, or placenta previa, who will require an elective cesarean section. We present an extreme case of velamentous insertion of the umbilical cord, in which the vascular distribution was reminiscent of a bird's cage. Surprisingly, there was no vascular injury (AU)