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Background: In women with a singleton pregnancy and sonographic short cervix in midgestation, vaginal administration of progesterone reduces the risk of early preterm birth and improves neonatal outcomes, without any demonstrable deleterious effects on childhood neurodevelopment. In women with twin pregnancies the rate of spontaneous early preterm birth is 10-times higher than in singletons and in this respect all twins are at increased risk of preterm birth. However, six trials in unselected twin pregnancies reported that vaginal progesterone from mid-gestation had no significant effect on the incidence of early preterm birth. Such apparent lack of effectiveness of progesterone in twins may be due to inadequate dosage or treatment which is started too late in pregnancy. Objective: The Early vaginal progesterone for the preVention of spontaneous prEterm birth iN TwinS: A randomized, placebo controlled, double-blinded trial (EVENTS) was designed to test the hypothesis that, among women with twin pregnancies, vaginal progesterone at a dose of 600 mg per day from 11-14 until 34 weeks’ gestation, as compared with placebo, would result in a significant reduction in the incidence of spontaneous preterm birth between 24+0 and 33+6 weeks. Methods: The trial was conducted at 22 hospitals in England, Spain, Bulgaria, Italy, Belgium and France. Women were randomly assigned in a 1:1 ratio, to receive either progesterone or placebo and in the random-sequence generation there was stratification according to participating center. Primary outcome was spontaneous birth between 24 +0 and 33+6 weeks’ gestation. Statistical analyses were performed on an intention-to-treat basis. Logistic regression analysis was used to determine the significance of difference in incidence of spontaneous birth between 24+0 and 33+6 weeks’ gestation between the progesterone and placebo groups, adjusting for the effect of participating centre, chrorionicity, parity and method of conception. Prespecified tests of treatment interaction effects with chrorionicity, parity, method of conception, compliance and cervical length at recruitment were performed. A post hoc analysis using mixed effects Cox regression was used for further exploration of the effect of progesterone on preterm birth. Results: We recruited 1,194 women between May 2017 and April 2019; 21 withdrew consent and 4 were lost to follow up, which left 582 in the progesterone group and 587 in the placebo group. Adherence was good, with reported intake of ≥80% of the required number of capsules in 81.4% of the participants. After excluding births before 24 weeks and indicated deliveries before 34 weeks, spontaneous birth between 24+0 and 33+6 weeks occurred in 10.4% (56/541) participants in the progesterone group and in 8.2% (44/538) in the placebo group (odds ratio in the progesterone group, adjusting for the effect of participating center, chrorionicity, parity and method of conception, 1.35; 95% CI 0.88 - 2.05; p=0.17). There was no evidence of interaction between the effects of treatment and chorionicity (p=0.28), parity (p=0.35) method of conception (p=0.56) and adherence (p=0.34); however, there was weak evidence of an interaction with cervical length (p=0.08) suggestive of harm to those with cervical length ≥30 mm (odds ratio 1.61, 95% CI 1.01-2.59) and potential benefit for those with cervical length

Congenital cytomegalovirus (CMV) infection is one of the most common during pregnancy. The infection, particularly in the first trimester, is associated with important sequelae in up to half of the children. Valaciclovir and immunoglobulin have been tested separately for the treatment of fetal CMV infection with relative success. Nevertheless, there is no experience with the simultaneous use of both therapies.combination therapy (oral valaciclovir 2 g/6h until the end of pregnancy and intravenous hyperimmune gamma globulin 200 UI/kg) was offered to pregnant women with CMV infection acquired during pregnancy and viral load (VL) in amniotic fluid above 1015 pregnant women were enrolled: primary infection, 14, non-primary infection, 1; first trimester, 11, second trimester, 4. Mean gestational age at the start of combination treatment were 23.2 weeks and 29.3 weeks, depending on the infection being diagnosed in the first or the second trimester, respectively. Median VL of CMV-DNA in amniotic fluid was 62.5 × 10Combination therapy with immunoglobulin and valaciclovir may be a useful alternative in CMV fetal infection, particularly if changes in cerebral echography or high VL in the amniotic fluid are present.

Twin pregnancies are considered a risk factor for preeclampsia, an obstetric complication with high maternal and infant morbi-mortality. We hypothesize that alterations in maternal hematocrit, plasma lipid peroxidation and nitrates in the first trimester of pregnancy are associated with preeclampsia development in twin pregnancies. Blood samples were extracted from 102 healthy women with twin pregnancies at tenth week of gestation to assess hematological parameters and plasma levels of malondialdehyde and nitrates. Logistic regression model showed an association between red blood cells (OR = 38.8; p-value = 0.009), hematocrit (OR = 1.6; p-value = 0.017), malondialdehyde (OR = 1.5; p-value = 0.002), and nitrates (OR = 1.1; p-value = 0.045) and preeclampsia development. These parameters are potential biomarkers for early preeclampsia detection in twin pregnancies. Future research is needed to assess their value in predictive algorithms., This work was supported by Multidisciplinary Research Project [CEMU, 2013-10], Universidad Autónoma de Madrid) and collaborative project Universidad Autónoma de Madrid-Khon Kaen University [KKU: 0514.7.I.12-1948].

Objectives Osteoarticular infections are infrequent in pediatric patients, although their incidence seems to be increasing. They usually affect children younger than 5 years and tend to localize in the lower limbs. Because of their nonspecific symptoms, especially at onset, a timely diagnosis is difficult to achieve, with the subsequent risk of a delay in treatment. We hereby report the management of osteoarticular infections in our pediatric emergency department. Methods This is a retrospective descriptive study of patients diagnosed with osteoarticular upper limb infection in the pediatric emergency department of a tertiary hospital from January 2011 to December 2016. Results From an initial global sample of 170 patients diagnosed with osteomyelitis or septic arthritis at any location at the pediatric emergency department, 32 children (18.82%) with upper limb involvement were included in the study. Of them, 22 were male and the mean age at diagnosis was 14.5 months (interquartile range, 2-106). Eighteen patients (56%) were diagnosed with septic arthritis, and 14 (44%) had a diagnosis of osteomyelitis.The most frequent symptom was pain (50%). More than one third of patients (11) had received a different diagnosis in a previous hospital visit. A traumatic etiology was suspected in 7 cases (21%).Regarding acute phase reactants, the mean value for C-reactive protein was 21.3 mg/L, and erythrocyte sedimentation rate was elevated in 27 cases (84%). In 28 patients, blood cultures were obtained, 24 of which came back negative. All children received antibiotic treatment and achieved a full recovery. Conclusions One third of patients were misdiagnosed at the first consultation, which stresses the importance of a high clinical suspicion to avoid delays in diagnosis and treatment of osteoarticular infections. This study also shows a lower mean age of children with upper limb infection as compared with those with lower limb infection. All patients recovered fully with oral antibiotics.

The covid-19 pandemic has meant a change in working protocols, as well as in Personal Protective Equipment (PPE). Obstetricians have had to adapt quickly to these changes without knowing how they affected their clinical practice. The aim of the present study was to evaluate how COVID-19 pandemic and PPE can affect operative time, operating room time, transfer into the operating room to delivery time and skin incision to delivery time in cesarean section.This is a single-center retrospective cohort study. Women with confirmed or suspected SARS-CoV-2 infection having a cesarean section after March 7th, 2020 during the COVID-19 pandemic were included in the study. For each woman with confirmed or suspected SARS-CoV-2 infection, a woman who had a cesarean section for the same indication during the COVID-19 pandemic and with similar clinical history but not affected by SARS-CoV-2 was included.42 cesarean sections were studied. The operating room time was longer in the COVID-19 confirmed or suspected women: 90 (73.0 to 110.0) versus 61 (48.0 to 70.5) minutes;There were no significant differences in the operative time, transfer into the operating room to delivery time and skin incision to delivery time when wearing PPE in cesarean section. The COVID-19 pandemic and the use of PPE resulted in a significant increase in operating room time.

Resumen: Introducción: SARS-CoV-2, responsable de la enfermedad por coronavirus 2019 (COVID-19), fue detectado por primera vez en España el 31 de enero de 2020. El 14 de marzo fue declarado el estado de alarma con el objetivo de controlar la pandemia. El objetivo de este estudio es analizar las consecuencias de esta crisis sanitaria sobre el patrón de demanda asistencial, así como el manejo y las características de los pacientes con sospecha de COVID-19 en el Servicio de Urgencias Pediátricas. Pacientes y métodos: Estudio retrospectivo observacional en niños y adolescentes menores de 18 años, atendidos en nuestro Servicio de Urgencias Pediátricas durante el periodo comprendido desde el 14 de marzo hasta el 17 de abril de 2020. Resultados: Durante el periodo de estudio se atendieron 1.666 pacientes, un 65,4% menos que en el mismo periodo de 2019. La edad media fue de 5,4 años y el 51,2% eran varones. El 39,9% fueron clasificados con niveles de alta prioridad, un 6,5% más que en 2019. Los principales motivos de consulta fueron fiebre (26,5%), síntomas respiratorios (16,1%) y traumatismos (15,2%). Un total de 218 pacientes (13%) fueron diagnosticados de posible COVID-19, confirmándose la infección en el 18,4%. El 44% (96/218) fueron diagnosticados de infección respiratoria inferior y el 33,9% (74/218), superior. El 23,8% (52/218) fueron hospitalizados. Conclusiones: Durante el brote epidémico SARS-CoV-2 disminuyó la demanda de asistencia pediátrica urgente, aumentando la proporción de casos con niveles de triaje de alta prioridad. La mayoría de los pacientes con sospecha o confirmación microbiológica de COVID-19 cursaron con clínica respiratoria leve. Abstract: Introduction: SARS-CoV-2, coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in Spain on 31 January 2020. On 14 March 2020, a state of emergency was declared in Spain in a bid to control the spread of the COVID-19 pandemic in the country. The aim of our study is to analyse the impact on emergency medicine attendance after the national lockdown, as well as the clinical presentation and the management of patients with suspected COVID-19 in the Paediatric Emergency Department. Patients and methods: This retrospective observational study included children and adolescents under the age of 18, attended in our Paediatric Emergency Department during the period March 14 to April 17, 2020. Results: A total of 1,666 patients were attended during the study period, 65.4% less than in the same period of 2019. Just over half (51.2%) were males, and mean age was 5.4 years. In triage, 39.9% were high priority levels, 6.5% more than 2019. Most frequent reasons for consultation at the Paediatric Emergency Department were fever (26.5%), respiratory symptoms (16.1%), and trauma (15.2%). A total of 218 patients (13%) received a diagnosis of possible COVID-19, with SARS-CoV-2 infection confirmed in 18.4%, and 23.8% (52/218) were hospitalised. At discharge, 44% (96/218) were diagnosed with lower, and 33.9% (74/218) with upper respiratory infection. Conclusions: During the SARS-CoV-2 outbreak, the demand for urgent paediatric care decreased, with the proportion of cases with high priority triage levels increasing. Most of the patients with suspected or microbiological confirmation of COVID-19 had mild respiratory symptoms.

A 6-year-old girl presented with fever, skin rash, anuria, and conjunctivitis that rapidly progressed to toxic shock syndrome. Following hospital discharge, she developed a staphylococcal abscess on the lower extremity. She had recently received the first two doses of the interleukin-17 (IL-17) inhibitor secukinumab for resistant plaque psoriasis. IL-17 is known to be essential in host defense against Staphylococcus aureus. To our knowledge, this is the first reported case of staphylococcal toxic shock syndrome (STSS) associated with an IL-17 inhibitor.

The study of placental lipid metabolism in uncomplicated pregnancies has not been developed in the literature to date. Its importance lies in expanding the knowledge of placental function to enable comparison with pathological pregnancies in future research. The aim of the present study was to compare the lipid metabolic activity and storage of the maternal and fetal sides of the placenta in healthy pregnancies. Moreover, we compare singleton vs. twin pregnancies to determine if placental metabolic needs differ. We analyzed placental explants from uncomplicated pregnancies, 20 from singleton and 8 from bichorial-biamniotic twin pregnancies (n = 28). Six cotyledon fragments were collected from each placenta at different distances from the umbilical cord, three close to the chorionic plate (hereinafter, we will refer to them as “fetal side”) and another three close to the anchoring villi into the decidua basalis (referred to as “maternal side”). The samples were analyzed for quantitative assay placental fatty acid oxidation (FAO) and esterification (FAE) activities and triglyceride levels. The location of lipid storage in the chorionic villi was assessed by Oil red-O staining. Placental fatty acid oxidation did not show differences when comparing the maternal and fetal sides of the placenta or between single and twin pregnancies. When comparing placental sides, FAE was increased twofold in the maternal side compared to the fetal side of the placenta (P = 0.013). The tendency for lipogenesis in the placenta was exemplified by the FAE/FAO ratio, which was a 37.1% higher on the maternal side (P = 0.019). Despite this, triglyceride levels were five times higher in the fetal side than in the maternal one (P = 0.024). When analyzing singleton vs. twins, FAE was superior in the fetal side in multiple pregnancies (× 2.6, P = 0.007) and the FAE/FAO ratio was significantly higher in twins than in singleton pregnancies, on both sides of the placenta. Despite this finding, triglyceride levels were similar in twin and singleton pregnancies. Comparing the placentas of twins in the same pregnancy, there were no differences in lipid metabolism (FAO or FAE) or placental triglyceride levels between the two co-twins. Using Oil red-O staining, lipid storage in chorionic villi was found to be located on the syncytiotrophoblast cells and not in the connecting axis. The maternal side of the placenta is more active in the esterification of fatty acids, while the storage of neutral lipids concentrates on the fetal side. Moreover, multiple gestations have increased esterification without changes in the concentration of placental triglycerides, probably due to a higher transfer to the fetal circulation in response to the greater energy demand from twin fetuses., This study was funded by Instituto de Salud Carlos III (Madrid, Spain), project PI12/01947.

Aim: To evaluate obstetric and perinatal outcomes of twin pregnancies obtained after in vitro fertilization with donated oocytes.Methods: This is a case-control study comparing 50 women with twin p...

Objective: This is a prospective observational study whose goal was to compare the effectiveness of carbetocin and oxytocin for prevention of postpartum hemorrhage (PPH) when they are administered ...

Resumen Este articulo aborda una investigacion sobre el valor predictivo del conocimiento de las grafias para el rendimiento lector. Los estudios precedentes han mostrado una fuerte relacion entre el conocimiento de las grafias en edades tempranas y los procesos de decodificacion. Nuestro estudio indaga sobre el proceso de aprendizaje del codigo alfabetico espanol centrado en los grafemas y analiza el poder predictivo del conocimiento de las grafias para las habilidades de decodificacion en la lectura inicial. Para ello, se apoya en una metodologia longitudinal prospectiva y en el uso de instrumentos estandarizados (PROLEC-R y BIL) aplicado a 362 alumnos y alumnas de 4 y 5 anos. Los datos obtenidos se analizan mediante regresion multiple, utilizando modelos de ecuaciones estructurales. Nuestra investigacion subraya la relevancia de la secuencia de aprendizaje de los grafemas en edades tempranas, diferenciandose la secuencia de aprendizaje en espanol con respecto a la lengua inglesa. En espanol, la secuencia de aprendizaje de los grafemas es independiente de la secuencia de aprendizaje de los fonemas. Asimismo, este articulo subraya la importancia de una secuencia de aprendizaje de estas grafias para predecir el desarrollo de las habilidades de decodificacion. Este estudio concluye que las practicas educativas tempranas que consideran el nombre y fonema de las grafias y la secuencia determinada en el aprendizaje de los grafemas optimizan el rendimiento lector de los ninos y ninas de lengua espanola.

We describe two cases of monochorionic twins with severe anemia in the surviving twin after cord occlusion. The first one was a case of discordant malformation (anencephalia) and the second one was a case of early severe selective intrauterine growth restriction type II in a dichorionic triamniotic triplet pregnancy. In both cases, the cord of the occluded fetus had a marginal insertion. Both of them presented hydrops 2 d after the occlusion, having measurements of the peak systolic velocity (PSV) of the middle cerebral artery (MCA) above 1.5 multiples of the median (MoM). In the first one intrauterine transfusion was performed with pretransfusion measurement of fetal hemoglobin of 3.3 g/dL. An extensive area of destruction of brain tissue at the right parietal-temporal-occipital level was diagnosed at 300 weeks. In the second one, expectant management was decided and a grade 3 intraventricular hemorrhage associated with moderate ventriculomegaly was detected at 22 weeks' gestation. We hypothesize that the surviving fetus after the occlusion can become bloodless and hypovolemic when its blood is poured into the placental and umbilical circulation of the occluded twin through the vascular anastomoses between them. It should not be assumed that cord occlusion removes the risk of transfusional brain injury in surviving-cotwins.

Introduction A considerable increase of imported Zika virus (ZIKV) infection has been reported in Europe in the last year. This is the result of the large outbreak of the disease in the Americas, along with the increase in the numbers of travellers and immigrants arriving from ZIKV endemic areas. Methods A descriptive study was conducted in the Tropical Medicine Unit of Hospital La Paz-Carlos III in Madrid on travellers returning from an endemic area for ZIKV from January to April 2016. Demographic, clinical and microbiological data were analyzed. Results A total of 185 patients were screened for ZIKV (59.9% women, median age of 37.7 ± 10.3 years). Main purpose of the travel was tourism to Colombia, Brazil, and Mexico. Just under three-quarters (73%) were symptomatic, mostly with fever and headache. A total of 13 patients (7% of those screened) were diagnosed with ZIKV infections, of which four of them were pregnant. All of them were symptomatic patients, the majority immigrants, and mainly from Colombia. Diagnostic tests were based on positive neutralization antibodies (8 cases, 61.6%) and a positive RT-PCR in different organic fluids (7 cases, 53.8%) The four infected pregnant women underwent a neurosonography every 3 weeks, and no alterations were detected. RT-PCR in amniotic fluid was performed in three of them, with negative results. One of the children has already been born healthy. Conclusions Our cases series represents the largest cohort of imported ZIKV to Spain described until now. Clinicians must increase awareness about the progression of the ZIKV outbreak and the affected areas so that they can include Zika virus infection in their differential diagnosis for travellers from those areas.

Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.

Due to the global COVID-19 pandemic, ICT has been urgently introduced in education systems in a generalised manner. In this context, it is essential for teachers to master a spectrum of basic digital competencies and manifest digital leadership in the classroom. In addition, it is necessary to consider the relationship between digital competence development and social sustainability, that is, social and cultural heritage, and to what extent they contribute to improving social cohesion and living conditions in a community. This study presents a systematic review of research on teacher digital competence and social sustainability based on the PRISMA model and a review of 22 studies indexed in SCOPUS. The review reveals that most are intended to measure the digital competence level of teachers, usually in compulsory stages of the educational system and through quantitative studies based on virtual questionnaires comprised of closed-ended questions. However, the studies tend to ignore questions related to social sustainability (access to resources, heritage culture, intergenerational transmission, employability, or gender equality). It is therefore urgent to develop research committed to a sustainable society that is oriented towards social justice.

The aim of this study is to determine the perceptions of university students toward teaching–learning processes during the COVID-19 pandemic. This research gathers inquiries made worldwide on the perceptions of students in higher education during a state of alarm. The proposed objectives were (a) to analyse the perception of students toward teaching–learning processes in university, (b) to determine the assessment given by students about the changes that took place in university teaching as a result of COVID-19, and (c) to explore resources (hardware and software), professional collaboration, digital pedagogy and student empowerment (motivation) regarding digital education and recent changes in university teaching due to the pandemic. This study used a non-experimental, descriptive design based on opinion polls or surveys. The results show a positive correlation between digital pedagogy, student motivation and digital environments. As a conclusion, we encourage the scientific community to continue delving into the motivation, collaboration and reflective exchange of experiences, self-learning and promotion of initiatives that foster the development of competencies in future teachers. It is also important to continue the research on integrated designs in training processes in university, tutoring and continuous evaluation, as they are key for digital transformation in universities.

Objective This study aimed to evaluate the evidence of mother-to-child transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods This is a descriptive, multicenter, observational study in nine tertiary care hospitals throughout Spain. The study population was women with COVID-19 during pregnancy. Mother-to-child transmission was defined as positive real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) of SARS-CoV-2 in amniotic fluid, cord blood, placenta or neonatal nasopharyngeal swabs taken immediately after birth. Results We included 43 singleton pregnant women and one twin pregnancy, thus we obtained 45 samples of placenta, amniotic fluid and umbilical cord blood. The median gestational age at diagnosis was 34.7 weeks (range 14 to 41.3). The median interval between positive RT-PCR and delivery was 21.5 days (range 0 to 141 days). Fourteen women (31.8%, 95%CI 18.6-47.6%) were positive at the time of delivery. There was one singleton pregnancy with SARS-CoV-2 RT-PCR positive in the placenta, amniotic fluid and umbilical cord blood (2.2%, 95%CI 0.1-11.8%). Nasopharyngeal aspiration was performed on 38 neonates at birth, all of which were negative (0%, 95%CI 0-9.3%). In 11 neonates the nasopharyngeal aspiration was repeated at 24-48 hours, and one returned positive (9.1%, 95%CI 0.2-41.3%). Conclusions The presence of the SARS-CoV-2 in placenta, amniotic fluid and cord blood shows that mother-to-child transmission is possible but uncommon.

Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Data about the management of CMV infection in pregnant women are scarce, and treatment options are very limited. The aim of the study is to investigate the effectiveness of cytomegalovirus hyperimmune globulin (CMV-HIG) for the prevention and treatment of congenital CMV (cCMV) infection.A retrospective observational study was conducted in three tertiary hospitals in Madrid. In the period 2009-2015, CMV-HIG (CytotectThirty-six pregnant women were included. Median gestational age at birth was 39 weeks (interquartile range: 38-40) and two children (5.5%) were premature (born at 28 and 34 weeks' gestation). Amniocentesis was performed in 30/36 (83.4%) pregnancies and CMV PCR was positive in 21 of them (70%). One fetus with a positive PCR in amniotic fluid that received one dose of HIG after amniocentesis presented a negative CMV-PCR in urine at birth, and was asymptomatic at 12 months of age. Twenty-four children were infected at birth, and 16/21 (76.2%) presented no sequelae at 12 months, while two (9.5%) had a mild unilateral hearing loss and three (14.3%) severe hearing loss or neurological sequelae. Seventeen women were included in the PG and 19 in the TG. In the PG 7/17 (41%) fetuses were infected, one pregnancy was terminated due to abnormalities in cordocentesis and one showed a mild hearing loss at 12 months of age. In the TG, 18/19 children (95%) were diagnosed with cCMV, while the remaining neonate had negative urine CMV at birth. Eight out of the 19 fetuses (42.1%) showed CMV related abnormalities in the fetal US before HIG treatment. Complete clinical assessment in the neonatal period and at 12 months of age was available in 16 and 15 children, respectively. At birth 50% were symptomatic and at 12 months of age, 4/15 (26.7%) showed a hearing loss and 3/15 (20%) neurologic impairment. Fetuses with abnormalities in ultrasonography before HIG presented a high risk of sequelae (odds ratios: 60; 95%CI: 3-1185; p = .007).Prophylactic HIG administration in pregnant women after CMV primary infection seems not to reduce significantly the rate of congenital infection, but is safe and it could have a favorable effect on the symptoms and sequelae of infected fetuses. The risk of long-term sequelae in fetuses without US abnormalities before HIG is low, so it could be an option in infected fetuses with normal imaging. On the other hand, the risk of sequelae among infected fetuses with abnormalities in fetal ultrasonography before HIG despite treatment is high.

Esta investigación pretende analizar la influencia del nivel educativo de los padres y madres, la profesión y el rol educativo de los mismos en el rendimiento lector de sus hijos e hijas de forma comparada entre países de lengua iglesa y española. El estudio se aborda desde un análisis multinivel y de regresión logística binaria. Los resultados muestran que el contexto sociofamiliar aporta una predicción entorno al 20% en países de habla española y el 15% en países de habla inglesa. La incidencia más significativa se produce por el nivel de estudios medio de los padres y la muestra de interés de los padres en las actividades escolares y el apoyo educativo hacia sus hijos en ambos bloques de países. This study aims to analyse the influence of parents’ educational level, profession and their educational role on the reading performance of their sons and daughters in a comparative way between English and Spanish-speaking countries. The study is approached from a multilevel analysis and binary logistic regression. The results show that the sociofamiliar context provides a prediction around 20% in Spanish-speaking countries and 15% in English-speaking countries. The most significant incidence is produced by the average educational level of the parents and their interest of the parents in the school activities and the educational support to their children in both blocks of countries.

Objective: Establish reference ranges for the Elecsys® soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) immunoassay ratio in twin pregnancies. Methods: Data analyzed were from 3 prospective studies: Prediction of Short-Term Outcome in Pregnant Women with Suspected Preeclampsia (PE) (PROGNOSIS), Study of Early-onset PE in Spain (STEPS), and a multicenter case-control study. Median, 5th, and 95th percentiles for sFlt-1, PlGF, and the sFlt-1/PlGF ratios were determined for normal twin pregnancies for 7 gestational windows and compared with the previous data for singleton pregnancies. Results: The reference range analysis included 269 women with normal twin pregnancies. Before 29 weeks’ gestation, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios did not differ between twin and singleton pregnancies. From 29 weeks’ gestation to delivery, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios were substantially higher in twin versus singleton pregnancies. sFlt-1 values were higher in women with twin pregnancies across all gestational windows. PlGF values were similar or higher in twin versus singleton pregnancies; PlGF concentrations increased from 10 weeks + 0 days to 28 weeks + 6 days’ gestation. Conclusions: Reference ranges for the sFlt-1/PlGF ratio are similar in women with twin and singleton pregnancies until 29 weeks’ gestation but appear higher in twin pregnancies thereafter.

OBJECTIVE Morphological and functional right ventricular (RV) changes during normal pregnancy remain poorly characterized. Similar to left ventricle, RV load and function are expected to change, and establishing reference values for RV during a healthy pregnancy is critical for the evaluation of pregnancy-related heart disease. The aim of the study was to describe RV adaptation in a prospective cohort. METHODS Serial echocardiographic examinations were performed in second trimester (24 ± 2 weeks), third (32 ± 2 week) trimester, and postpartum (>3 months after delivery). Nulliparous women were evaluated as control group. RV linear dimensions, areas, and function were assessed and compared. RESULTS Forty-three pregnant women were evaluated and compared with nineteen nulliparous women as control. Function parameters decreased along gestation. RV fractional area fell from second to third trimester (52.01 ± 0.92 vs 48.73 ± 0.97, P

Male fetal sex associates with higher rates of materno-fetal complications. Inflammation and inadequate vasoactive responses are mechanisms implicated in obstetric complications, and alterations in maternal plasma cytokine profile and nitric oxide (NO) metabolites are potential predictive biomarkers. We aimed to assess if these parameters are influenced by fetal sex. A prospective, observational study was carried out in 85 healthy pregnant women with singleton pregnancies in the first trimester of gestation. A blood sample was extracted at the tenth week of gestation. In plasma, we assessed: 1) cytokines (micro-array): pro-inflammatory (IL1α, IL1 β, IL6, TNFα), anti-inflammatory (IL4, IL10, IL13), and chemoattractant (IL8, MCP1, IFNγ), and 2) NO metabolites (liquid chromatography–tandem mass spectrometry and Griess reaction): L-arginine, ADMA, SDMA, nitrates (NOx). Women with a male fetus (n = 50) exhibited, compared with those with a female (n = 35): higher IL1β (OR = 1.09 with 95% CI: 0.97–1.28), and lower IL13 (OR = 0.93 with 95% CI: 0.87–0.99), and higher plasma NOx (OR = 1.14 with 95% CI: 1.03–1.31). Our data suggest that fetal sex influences maternal plasma cytokine profile and NO in early pregnancy. Women with a male fetus may have a worse capacity to counteract an inflammatory response. They may have better vasodilator capacity, but in the presence of an oxidative environment, a higher nitrosative damage may occur. These data reinforce the need to include sex as variable in predictive models., This research was funded by Universidad Autónoma de Madrid; Multidisciplinary Research Project (CEMU, 2013-10; Spain), Ministerio de Economía y Competitividad (FEM2015-63631-R; Spain) and Ministerio de Ciencia y Universidades (RTI2018-097504-B-I00; Spain), co-founded by FEDER funds.

This investigation set out to analyse the relation between parents’ academic qualifications, profession and role in educating their children and their children’s level of efficacy in reading at the end of the adolescent stage, in three states with different socio-cultural contexts, namely Canada, Finland and Singapore. The study is carried out in three countries with differing socio-cultural contexts and uses multilevel analysis and binary logistic regression to measure the predictive value of socio-family skills in these three countries against a range of student reading ability profiles. The results show that the parents’ academic qualifications, profession and educational role are the most influential aspect of the predictability in the variability of their children’s reading skills. Parents with a low level of education predict poor student reading ability, but when it is the mother who has a medium or high level of education, the results of the students are better than when that level is only achieved by the father. Therefore, the educational role of mothers and fathers, as shown by the interest they take in their children’s schoolwork, is a predictor of students’ reading skills, regardless of the sociocultural and academic context of the students.

Selective intrauterine growth restriction (sIUGR) is a complication observed in about 10-15% of all monochorionic (MC) pregnancies, causing a significant increase in perinatal mortality and morbidity.To evaluate clinical management options and perinatal outcomes of sIUGR in MC pregnancies monitored in a single tertiary center.A retrospective study was performed on 55-MC pregnancies with sIUGR between January 2012 and May 2018 at the Fetal Medicine Unit of La Paz Hospital. Cases were classified according to the umbilical artery (UA) Doppler pattern as type I (positive end-diastolic flow;Gestational age (GA) at diagnosis was progressively lower with each type. Severe sIUGR cases delivered significantly earlier than type I, showing lower birth weights and higher intertwin biometric discordance. Unintended fetal demise occurred in 14% (6/25) of severe sIUGR pregnancies as opposed to 0% (0/19) in type I,Given the good prognosis of type I sIUGR, expectant management is the first approach to consider. However, due to the poorer clinical evolution of types II and III sIUGR, the decision-making is challenging and needs to be individualized depending on the UA Doppler pattern, GA at diagnosis, severity of growth restriction and biometric discordance, technical issues and parents' preferences.

Background: Pertussis immunization during pregnancy is recommended in many countries. Data from large randomized controlled trials are needed to assess the immunogenicity, reactogenicity and safety of this approach. Methods: This phase IV, observer-blind, randomized, placebo-controlled, multicenter trial assessed immunogenicity, transplacental transfer of maternal pertussis antibodies, reactogenicity and safety of a reduced-antigen-content diphtheria-tetanus-three-component acellular pertussis vaccine (Tdap) during pregnancy. Women received Tdap or placebo at 27–36 weeks’ gestation with crossover ≤ 72-hour-postpartum immunization. Immune responses were assessed before the pregnancy dose and 1 month after, and from the umbilical cord at delivery. Superiority (primary objective) was reached if the lower limits of the 95% confidence intervals (CIs) of the pertussis geometric mean concentration (GMC) ratios (Tdap/control) in cord blood were ≥ 1.5. Solicited and unsolicited adverse events (AEs) and pregnancy-/neonate-related AEs of interest were recorded. Results: 687 pregnant women were vaccinated (Tdap: N = 341 control: N = 346). Superiority of the pertussis immune response (maternally transferred pertussis antibodies in cord blood) was demonstrated by the GMC ratios (Tdap/control): 16.1 (95% CI: 13.5–19.2) for anti-filamentous hemagglutinin, 20.7 (15.9–26.9) for anti-pertactin and 8.5 (7.0–10.2) for anti-pertussis toxoid. Rates of pregnancy-/neonate-related AEs of interest, solicited general and unsolicited AEs were similar between groups. None of the serious AEs reported throughout the study were considered related to maternal Tdap vaccination. Conclusions: Tdap vaccination during pregnancy resulted in high levels of pertussis antibodies in cord blood, was well tolerated and had an acceptable safety profile. This supports the recommendation of Tdap vaccination during pregnancy to prevent early-infant pertussis disease. Clinical Trial Registration. ClinicalTrials.gov: NCT02377349., This work was supported by GlaxoSmithKline Biologicals S.A.

Los estudios en alfabetización temprana han analizado las relaciones antecedentes entre las habilidades cognitivas en la Educación Infantil y el logro de la lectura durante el proceso de aprendizaje instructivo. Esta investigación describe la capacidad de predicción de ciertas habilidades cognitivas en las primeras etapas instruccionales del aprendizaje lector en español. Los participantes de este estudio fueron 362 niños españoles evaluados por primera vez en 2o y 3o de Educación Infantil. Los instrumentos empleados en las evaluaciones de las competencias lingüísticas han sido la Batería de Inicio a la Lectura, la Batería de Evaluación de los Procesos Lectores, The Rapid Automatized Naming Test y el Test de Lectura y Escritura en Español. Los resultados delimitaron un modelo de ecuaciones estructurales para la predicción del rendimiento lector inicial en 1o y 2o de Educación Primaria. El modelo alcanzado, Modelo de Aprendizaje en la Lectura Inicial, delimitó las relaciones entre las habilidades del lenguaje oral y las habili- dades relacionadas con el código escrito que actuaron como precursores del rendimiento lector inicial. El desempeño en la tarea de velocidad de denominación de letras en Educación Infantil se presentó como el mejor precursor de la eficiencia lectora en 1o y 2o de Educación Primaria. Los hallazgos del estudio realizan una contribución significativa a la investigación en alfabe- tización temprana en español como referente para el desarrollo de actuaciones pedagógicas y el logro de éxito lector. Early literacy studies analyzes the antecedent relationships between cognitive skills in preschool education and achievement of reading during the instructional learning process. This study describes the predictive capacity of certain cognitive abilities in the early instructional stages of Spanish learning. The participants of this study was 362 Spanish children evaluated in 2nd and 3rd year of Early Childhood Education (children aged 4 to 6 years) at the first time. The instruments used in the assessments of language skills have been the Beginning Reading Battery, the Reading Process Assessment Battery, The Rapid Automatized Naming Test and the Reading and Writing Test in Spanish. The results delimited a model of structural equations for the prediction of initial reading performance in 1st and 2nd year of Primary Education (6 to 8 years). The model reached, Learning Model in the Initial Reading, delimited the relations between the oral language skills and the skills related to the code that acts as precursors of the initial reader performance. The performance in the task of letters-naming speed at 2nd and 3rd of Early Childhood Education was presented as the best precursor of reading efficiency at 1st and 2nd year of Primary Education. The findings of study make a significant contribution to early literacy research in Spanish as a reference to develop of pedagogical actions for the achievement of reader success.

Neonatal herpes simplex virus infections are rare, but are associated with significant morbidity and mortality. Most newborns acquire herpes simplex virus infection in the peripartum period. For peripartum transmission to occur, women must be shedding the virus in their genital tracts symptomatically or asymptomatically around the time of delivery. There are evidence-based interventions in pregnancy to prevent the transmission to the newborn. Caesarean section should be performed in the presence of herpetic lesions, and antiviral prophylaxis in the last weeks of pregnancy is recommended to suppress genital tract herpes simplex virus at the time of delivery. The diagnosis and early treatment of neonatal herpes simplex virus infections require a high index of suspicion, especially in the absence of skin lesions. It is recommended to rule out herpes simplex virus infections in those newborns with mucocutaneous lesions, central nervous system involvement, or septic appearance. The prognosis of newborns with skin, eye, and/or mouth disease in the high-dose acyclovir era is very good. Antiviral treatment not only improves mortality rates in disseminated and central nervous system disease, but also improves the rates of long-term neurodevelopmental impairment in the cases of disseminated disease. Interestingly, a 6-month suppressive course of oral acyclovir following the acute infection has improved the neurodevelopmental prognosis in patients with CNS involvement. Resumen: La infección herpética neonatal es una entidad muy poco frecuente pero que se asocia a una alta morbimortalidad. La mayor parte de los neonatos afectos adquieren la infección por virus herpes simplex en el periodo periparto. Para que ocurra esta transmisión es necesaria la excreción viral genital, con o sin síntomas, alrededor del momento del parto. Existen intervenciones basadas en la evidencia para prevenir la transmisión del virus herpes simplex al recién nacido. La realización de una cesárea en presencia de lesiones herpéticas, y la disminución de la excreción viral administrando en las últimas semanas del embarazo tratamiento antiviral a gestantes con herpes genital activo, son las mejores medidas preventivas de las que se dispone. El diagnóstico y tratamiento precoz del herpes neonatal requiere de un alto índice de sospecha, sobre todo en ausencia de lesiones cutáneas. Se recomienda descartar la infección por herpes neonatal en aquellos recién nacidos con lesiones cutaneomucosas, afectación del sistema nervioso central o cuadro séptico de origen no aclarado. El pronóstico de los neonatos con enfermedad cutánea en la era del aciclovir a dosis altas es excelente. El tratamiento antiviral disminuye la mortalidad de las formas diseminadas y con afectación exclusiva del sistema nervioso central, pero también mejora el pronóstico neurológico en los casos de enfermedad diseminada. De forma notable, la introducción del tratamiento supresor con aciclovir oral durante los meses siguientes a la infección aguda ha mejorado el pronóstico neurológico en los pacientes con afectación del sistema nervioso central.

Desde la corriente de Alfabetización Emergente se investiga sobre los predictores de la competencia lectora. Uno de esos predictores es la conciencia fonológica. Nuestro estudio pretende comprender la secuencia normal de desarrollo en el mecanismo de adquisición lectora averiguando el grado de dificultad de distintas tareas de conciencia fonológica y su relación con la competencia lectora posterior, en 125 alumnos prelectores. Las evaluaciones han sido realizadas en dos momentos: 1) Educación Infantil de 4 y 5 años, y 2) 1º de Primaria y 2º de Primaria; respectivamente. Los instrumentos empleados han sido la Batería de Inicio a la Lectura (BIL 3-6) y el Test de Lectura y Escritura en Español. Los datos han sido sometidos a análisis de los descriptivos, a análisis correlacional, a análisis de regresión y ANOVA; y a análisis factorial. Los resultados muestran que a los alumnos prelectores les resultan más sencillas las tareas de aislar sílabas y fonemas junto con las tareas de contar sílabas, que la tarea de omisión de sílaba y la tarea de rima, resultando esta última la más difícil. Los resultados avalan que existe correlación entre el nivel de competencia lectora y las tareas de conciencia fonológica.

Este artículo aborda una investigación sobre el valor predictivo del conocimiento de las grafías para el rendimiento lector. Los estudios precedentes han mostrado una fuerte relación entre el conocimiento delas grafías en edades tempranas y los procesos de decodificación. Nuestro estudio indaga sobre el proceso de aprendizaje del código alfabético español centrado en los grafemas y analiza el poder predictivo del conocimiento de las grafías para las habilidades de decodificación en la lectura inicial. Para ello, se apoya en una metodología longitudinal prospectiva y en el uso de instrumentos estandarizados (PROLEC-R yBIL) aplicado a 362 alumnos y alumnas de 4 y 5 a˜nos. Los datos obtenidos se analizan mediante regresión múltiple, utilizando modelos de ecuaciones estructurales. Nuestra investigación subraya la relevancia de la secuencia de aprendizaje de los grafemas en edades tempranas, diferenciándose la secuencia de aprendizaje en español con respecto a la lengua inglesa. En español, la secuencia de aprendizaje de los grafemas es independiente de la secuencia de aprendizaje de los fonemas. Asimismo, este artículo subraya la importancia de una secuencia de aprendizaje de estas grafías para predecir el desarrollo de las habilidades de decodificación. Este estudio concluye que las prácticas educativas tempranas que consideran el nombre y fonema de las grafías y la secuencia determinada en el aprendizaje de los grafemas optimizan el rendimiento lector de los niños y niñas de lengua española. The current article addresses a research on the predictive value of knowing the letters within the ini-tial reading performance. Recent studies have shown a strong link between the knowledge of letters atearly ages and the decoding processes. Our study deepens into the learning process of the Spanish alp-habet code, focused on the graphemes, and analyzes the predictive power of knowing of letters for thedecoding abilities in initial reading. To this end, the research relies on a longitudinal prospective met-hodology and makes use of standardized instruments (PROLEC-R and BIL) applied to 362 students aged4 and 5. The data obtained are analyzed through multiple regression, using structural equation models.Our research outlines the relevance of learning the sequence of graphemes from early ages, differen-tiating the sequence of learning in Spanish with respect to English language. In Spanish, the learningsequence of the graphemes is independent of the learning sequence of phonemes. Moreover, this articleemphasizes the importance of a learning sequence of these letters, in order to foresee the developmentof the decoding abilities. This study concludes that the early educational practices that take into accountthe letters name and phoneme, as well as the concrete sequence in graphemes learning, optimize thereading performance of Spanish speaking children.

La alfabetización temprana debe adecuarse a los hallazgos de la investigación del siglo XXI. En esta dirección, la formación continua del profesorado adquiere especial relevancia para la puesta en marcha de programas de intervención educativa pertinentes en las aulas. Este estudio consiste en el análisis de eficiencia de un programa piloto de alfabetización temprana que ha sido desarrollado con alumnos de Educación Infantil de 3 años y de 4 años, y ejecutado por los profesores tutores de un centro educativo de la provincia de Cádiz (España). Este programa se encauza hacia una intervención educativa pertinente para la estimulación de las habilidades cognitivas precursoras del éxito lector y la prevención del fracaso lector desde los inicios de la escolarización, y supone una oportunidad para que el profesorado acoja en sus prácticas educativas, de manera consciente, sistemática e innovadora, los descubrimientos de los estudios recientes sobre la alfabetización temprana., Early literacy teaching must take in to account the findings of 21st century research. Therefore, the continuous training of teaching staff acquires special importance for the implementation of relevant educational intervention programs in the classroom. This study consists of the efficiency analysis of a pilot program for early literacy which has been developed with 3 to 4 years-old pre-school students. It was carried out by the tutors of an educational center in the province of Cádiz (Spain). This program is directed towards a relevant educational intervention thought to stimulate the precursor’s cognitive abilities for reader success and to prevent reader failure at school entry. It also supposes an opportunity for teachers to include the findings of recent studies about early literacy in their teaching practices in a conscious, systematic and innovative way.

Background From the first Zika virus (ZIKV) description, it has progressively widespread worldwide. We analyzed demographic, clinical, microbiologic and travel-related characteristic from returned patients from a ZIKV endemic country in a referral Tropical Medicine Unit. Method A prospective cohort study performed in a Spanish referral center with the aim of determining the significant factors associated with confirmed Zika virus (ZIKV) infection. Results 817 patients, (56% women, median age 36 [IQR, Interquartile Range: 32–42]) were enrolled. Most had returned from Latin America (n = 486; 59.4%), travelled for tourism (n = 404; 49.4%) and stayed a median of 18 days (IQR: 10–30). 602 (73.6%) presented symptoms, but only 25 (4%) were finally diagnosed with confirmed ZIKV infection (including two pregnant women, without adverse fetal outcomes), 88% (n:22) presented with fever and 92% (n:23) with rash. 56% (n:14) arthralgia and/or myalgia and 28% (n:7) conjunctivitis. The presence of conjunctivitis, fever and rash were associated with an 8.9 (95% CI: 2.2–34.9), 6.4 (95% CI: 1.2–33.3) and 72.3 (95% CI: 9.2–563.5) times greater probability of confirmed ZIKV infection, respectively. Conclusion Travel characteristics and clinical presentation may help clinicians to optimize requests for microbiological testing. Diagnosis of arboviriasis in travellers arriving form endemic areas remains a challenge for clinicians, but must be detected for the possible transmission outside endemic areas, where the vector is present.

A peripartum hysterectomy is associated with significant morbidity and mortality. The incidences of an emergency peripartum hysterectomy have been reported in 0.224–5 per 1000 deliveries (Rossi et ...

Introduction The soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio is CE-mark approved for short-term prediction of preeclampsia in women with clinical suspicion of the syndrome (gestational age 24weeks+0d–36weeks+6d). Objectives We evaluated sFlt-1/PlGF as a predictive marker for early-onset preeclampsia in women at high risk of preeclampsia. Methods STEPS (prospective/multicenter) included pregnant women with preeclampsia risk factors (including history of IUGR/preeclampsia/eclampsia/HELLP syndrome, pre-gestational diabetes, antiphospholipid antibodies, and abnormal uterine artery Doppler). Primary objective: to show that sFlt-1/PlGF was predictive of early-onset preeclampsia ( ® sFlt-1 and PlGF assays, cobas electrochemiluminescence platform, Roche Diagnostics, Germany); bilateral uterine artery Doppler; blood pressure/proteinuria/preeclampsia status assessment. Results were compared by ANOVA/Dunnet and Wilcoxon signed-rank test. For prediction of early-onset preeclampsia, the area under the curve (AUC) of receiver operating characteristic curves (ROC) was calculated. Singleton pregnancies are reported. Results 819 subjects were enrolled. Of 442 women with singleton pregnancies 42 (9.5%) developed preeclampsia (14 early-onset/28 late-onset). The mean (SD) sFlt-1/PlGF ratio at 20, 24, and 28 weeks was: 7.86 (8.61), 5.9 (12.38) and 4.59 (5.65) for subjects who did not develop preeclampsia (control); 53.15 (61.79), 69.25 (105.53) and 180.37 (241.83) for early-onset preeclampsia; and 7.81 (4.45), 5.09 (3.34) and 13.39 (34.52) for late-onset preeclampsia. Compared with early-onset preeclampsia the sFlt-1/PlGF ratio was significantly lower for control, chronic hypertension, transient hypertension, and late-onset preeclampsia (Figure). Prediction of early-onset preeclampsia (ROC AUC [95% CI]) was best for sFlt-1/PlGF plus clinical data (0.94 [0.90–0.98], 0.94 [0.89–1.0], 0.94 [0.86–1.0], at 20, 24 and 28 weeks) vs sFlt-1/PlGF alone (0.78 [0.62–0.95], 0.82 [0.65–0.98], 0.86 [0.72–1.0]) or Doppler alone (0.71 [0.56–0.86], 0.73 [0.54–0.91], 0.87 [0.74–1.0]). Conclusion The sFlt-1/PlGF ratio can improve prediction of early-onset preeclampsia for women at high risk of preeclampsia.