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Nutriscore is a malnutrition screening tool designed specifically for cancer patients. Our objective was to assess its performance in hospitalized cancer patients.Adult patients diagnosed with any solid neoplasm hospitalized in Medical Oncology were included. In the first 24-48 h, of admission they were screened with Nutriscore and Malnutrition universal screening tool (MUST). Both tests were compared using chi-square, kappa index and ROC curve. Nutriscore sensitivity (S), specificity (Sp) and predictive values (PV) were calculated using MUST as a reference.A total of 93 patients were included. The most frequent tumors were lung (36.6%), colorectal (24.8%) and breast (8.6%). MUST identified 69.9% of the patients at nutritional risk, and Nutriscore 44.1% (Nutriscore did not provided better screening results in hospitalized cancer patients than a validated tool such as MUST.

Introduction: the objective was to assess the utility of the Eating Assessment Tool (EAT-10) in hospitalisation units with patients at high risk of dysphagia. Patients and methods: a cross-sectional study was conducted in the Neurology and Internal Medicine wards; patients with admission24 hours and in a terminal stage of disease were excluded. In the first 24-48 hours of admission the presence of dysphagia as assessed with the EAT-10, the risk of malnutrition as assessed with the Malnutrition Universal Screening Tools (MUST), and comorbidities using the Charlson index were screened. Results: a total of 169 patients were recruited (76.0 years, 52 % women); 19.5 % were at risk of malnutrition. The EAT-10 instrument could be administered in 80.6 % of the patients, and was positive in 26.6 % (women 34.1 % vs. men 18.4 %; p = 0.025). When comparing patients with higher comorbidity with those with a lower Charlson index, a lower response rate to EAT-10 was observed (78.4 % vs. 93.9 %; p = 0.038), without differences in screening positivity (28.3 % vs. 19.4 %; p = 0.310). The prevalence of dysphagia risk was higher in the Internal Medicine unit than in the Neurology unit (30.4 % vs. 19.6 %; p = 0.133), as was the percentage of cases in which screening could not be performed (21.1 % vs. 11.1 %; p = 0.011). There were no significant differences in risk of malnutrition, mortality, hospital stay, or readmission according to the EAT-10. Conclusions: The EAT-10 has limited utility in the studied hospitalisation units due to a high rate of unfeasible tests, especially among patients at higher risk of dysphagia.Introducción: el objetivo del estudio fue evaluar la utilidad del Eating Assessment Tool (EAT-10) en unidades de hospitalización con pacientes de alto riesgo de disfagia. Pacientes y métodos: estudio transversal de pacientes hospitalizados en Medicina Interna y Neurología; los pacientes con ingreso24 horas y en fase terminal de la enfermedad fueron excluidos. En las primeras 24-48 horas de ingreso se cribó la disfagia con el EAT-10, el riesgo de desnutrición con el Malnutrition Universal Screening Tool (MUST) y la comorbilidad con el índice de Charlson. Resultados: se reclutaron 196 pacientes (76,0 años, 52 % mujeres). El 19,5 % estaban en riesgo de desnutrición. El EAT-10 se pudo realizar en el 80,6 % de la muestra y fue positivo en el 26,6 % (mujeres 34,1 % vs. hombres 18,4 %; p = 0,025). Al comparar a los pacientes con mayor comorbilidad con aquellos que tenían un índice de Charlson más bajo, se observó una tasa de respuesta más baja al EAT-10 (78,4 % vs. 93,9 %; p = 0,038), sin diferencias en la positividad del cribado (28,3 % vs. 19,4 %; p = 0,310). La prevalencia del riesgo de disfagia fue mayor en la unidad de Medicina Interna que en la de Neurología (30,4 % vs. 19,6 %; p = 0,133), así como el número de casos en que no se pudo realizar el cribado (21,1 % vs. 11,1 %; p = 0,011). No hubo diferencias significativas en el riesgo de desnutrición, mortalidad, estancia hospitalaria o reingreso según el EAT-10. Conclusiones: el EAT-10 tiene una utilidad limitada en las unidades de hospitalización estudiadas debido a una alta tasa de pruebas no realizables, especialmente entre los pacientes con mayor riesgo de disfagia.

Background The Raynaud phenomenon (RP) is very common throughout the world, especially in cold climates, affecting approximately 3%–5% of the population. Most RPs are primary. The risk of the onset of autoimmune disease associated with RP (ADRP) is between 6% and 12%, and the diagnosis is usually made within 2 years of its onset. Capillaroscopy is a simple, innocuous and inexpensive technique that is very useful in the study of RP Objectives The primary goal was to evaluate the capillaroscopic findings in patients with RF as the only symptom and establish their relationship between the subsequent development of ADRF. Methods We conducted an observational, descriptive, cross-sectional study of a random sample of 98 patients with RP as the main manifestation, selected from within the capillaroscopy consult of our Unit. The capillaroscope used was a stereomicroscope (Stereoscope), with a triocular head, zoom range from 1x to 4x magnification, with cold light illuminator and high resolution ocular camcorder. Periungual capillaroscopy was performed in 3rd, 4th and 5thfinger of the right and left hands in each patient and always by the same rheumatologist. We described the sociodemographic variables of patients, and analytical results of the antinuclear antibodies (ANA). After an initial statistical exploration of the data, the same are described. The quantitative variables are expressed as means and standard deviations and if the distributions are asymmetric with medians and quartiles. The qualitative variables with percentages. To assess the validity of capillaroscopy as a diagnostic test, we determined the sensitivity, specificity, and positive and negative predictive value of the test. Results 73.5% were women, with an average age of 45.7 years. The median time of evolution of the RP until the capillaroscopy was 2.5 years. 76% of the patients were ANA negative. The evaluation of the predictive capacity of capillaroscopy for the development of EARP yields the following results: When analysing the relationship between the presence of ANA and the association with ADRF we found that it was independent (p=0.002) of the result of capillaroscopy, being the risk of developing the disease in a patient with positive ANA 8.5 times higher than in an ANA negative patient. Conclusions Capillaroscopy in patients with RP has a high predcitive negative value, which allows us to estimated, with high reliability, the association of this phenomenon with autoimmune disease in patients with normal capillaroscopic patterns. Given the results of our study, capillaroscopy should be protocol in the RP study Disclosure of Interest None declared

Introduction: We propose to demonstrate that it is possible to implement a valid (diagnostic sensitivity for major cardiac malformations 90%), and universal (applied to over 90% of pregnant women), prenatal screening method for congenital heart defects. Materials and methods: Prospective study. A total of 12,478 pregnant women were evaluated between January 2008 and December 2010. Congenital heart diseases were screened using foetal extended basic echocardiography (cardiac ultrasound). Results: The prevalence of birth defects in general and congenital heart disease was 2.5% (2.2–2.7%) and 0.9% (0.7–1%) respectively. Congenital heart disease had a higher rate of association with other structural abnormalities with 11.5% (5.6–17.4%), 21% for major congenital heart disease (9.9–32%), and chromosomal abnormalities of 15.9% (9.1–22.7%), with 32.6% for major congenital heart disease (19.8–45.3%). A foetal cardiac ultrasound assessment was performed on 99.2% of pregnant women. The foetal echocardiography is useful for the diagnosis of congenital heart disease in general, and major congenital heart disease, with a sensitivity of 42.8% (33.5–52.5%) and 90.4% (78.9–96.8%), respectively, and a specificity for both of 99.9% (99.8–99.9%). Conclusions: It is possible to perform a valid prenatal and universal screening of major congenital heart disease. Resumen: Introducción: Nos proponemos demostrar que es posible la implantación de un cribado prenatal de cardiopatías congénitas de garantía (sensibilidad diagnóstica para malformaciones cardíacas mayores del 90%) y universal (aplicado a más del 90% de las gestantes). Material y método: Estudio prospectivo. Hemos valorado a 12.478 gestantes (enero del 2008-diciembre del 2010). Realizamos un cribado de cardiopatías congénitas aplicando una ecocardiografía foetal básica ampliada. Resultados: La prevalencia de los defectos congénitos en general y de las cardiopatías congénitas es del 2,5% (2,2-2,7%) y el 0,9% (0,7-1%), respectivamente. Las cardiopatías congénitas presentan una tasa de asociación a otras malformaciones estructurales del 11,5% (5,6-17,4%), 21% en caso de cardiopatía congénita mayor (9,9-32%) y a cromosomopatías del 15,9% (9,1-22,7%), 32,6% en caso de cardiopatía congénita mayor (19,8-45,3%). Hemos logrado realizar una valoración ecográfica cardiaca foetal al 99,2% de las gestantes. La ecocardiografía foetal presenta, para el diagnóstico de las cardiopatías congénitas en general y de las cardiopatías congénitas mayores, una sensibilidad 42,8% (33,5-52,5%) y el 90,4% (78,9-96,8%), respectivamente, y una especificidad para ambas del 99,9% (99,8-99,9%). Conclusiones: Es posible realizar un cribado prenatal de garantías y universal de las cardiopatías congénitas mayores.

Resumen: Introducción: Nos proponemos demostrar que es posible la implantación de un cribado prenatal de cardiopatías congénitas de garantía (sensibilidad diagnóstica para malformaciones cardíacas mayores del 90%) y universal (aplicado a más del 90% de las gestantes). Material y método: Estudio prospectivo. Hemos valorado a 12.478 gestantes (enero del 2008-diciembre del 2010). Realizamos un cribado de cardiopatías congénitas aplicando una ecocardiografía fetal básica ampliada. Resultados: La prevalencia de los defectos congénitos en general y de las cardiopatías congénitas es del 2,5% (2,2-2,7%) y el 0,9% (0,7-1%), respectivamente. Las cardiopatías congénitas presentan una tasa de asociación a otras malformaciones estructurales del 11,5% (5,6-17,4%), 21% en caso de cardiopatía congénita mayor (9,9-32%) y a cromosomopatías del 15,9% (9,1-22,7%), 32,6% en caso de cardiopatía congénita mayor (19,8-45,3%). Hemos logrado realizar una valoración ecográfica cardiaca fetal al 99,2% de las gestantes. La ecocardiografía fetal presenta, para el diagnóstico de las cardiopatías congénitas en general y de las cardiopatías congénitas mayores, una sensibilidad 42,8% (33,5-52,5%) y el 90,4% (78,9-96,8%), respectivamente, y una especificidad para ambas del 99,9% (99,8-99,9%). Conclusiones: Es posible realizar un cribado prenatal de garantías y universal de las cardiopatías congénitas mayores. Abstract: Introduction: We propose to demonstrate that it is possible to implement a valid (diagnostic sensitivity for major cardiac malformations 90%), and universal (applied to over 90% of pregnant women), prenatal screening method for congenital heart defects. Materials and methods: Prospective study. A total of 12478 pregnant women were evaluated between January 2008 and December 2010. Congenital heart diseases were screened using fetal extended basic echocardiography (cardiac ultrasound). Results: The prevalence of birth defects in general and congenital heart disease was 2.5% (2.2-2.7%) and 0.9% (0.7-1%) respectively. Congenital heart disease had a higher rate of association with other structural abnormalities with 11.5% (5.6-17.4%), 21% for major congenital heart disease (9.9-32%), and chromosomal abnormalities of 15.9% (9.1-22.7%), with 32.6% for major congenital heart disease (19.8-45.3%). A fetal cardiac ultrasound assessment was performed on 99.2% of pregnant women. The fetal echocardiography is useful for the diagnosis of congenital heart disease in general, and major congenital heart disease, with a sensitivity of 42.8% (33.5-52.5%) and 90.4% (78.9-96.8%), respectively, and a specificity for both of 99.9% (99.8-99.9%). Conclusions: It is possible to perform a valid prenatal and universal screening of major congenital heart disease.

Resumen Objetivos Evaluar el impacto de una estrategia de intervención en el patrón de prescripción de la insulina glargina biosimilar (IGBio) respecto al compuesto de referencia y analizar la influencia del perfil del prescriptor y su repercusión económica. Diseño Estudio cuasiexperimental de tipo antes/después, con un grupo control. Emplazamiento Dos áreas de gestión sanitaria (AGS) de Sevilla: AGS Sur (área intervención) y AGS Osuna (área control). Participantes La totalidad de los médicos de atención primaria de cada área: 220 y 100, respectivamente. Intervención Se realizaron sesiones formativas, se envió un boletín farmacoterapéutico e informes de retroalimentación mensual durante los 6 meses tras la intervención formativa. El estudio fue llevado a cabo desde la comercialización del biosimilar, en octubre de 2015, hasta febrero de 2016 (pre-intervención) y desde febrero hasta agosto de 2016 (intervención). Mediciones principales Los indicadores analizados han sido porcentaje de pacientes y porcentaje de dosis diaria definida (DDD) con IGBio respecto al total y el coste. Los médicos han sido analizados por subgrupos de edad, sexo, formación, tipo de contrato, años de experiencia y cupo. Resultados principales Ambos indicadores aumentan al mismo nivel en ambas áreas antes de la intervención. Sin embargo, después de la intervención fueron significativamente diferentes entre las áreas (p

Background Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown and multifactorial aetiology, whose prevalence is around 1% of the adult population. It most commonly affects women between the 4th and 6th decade. Patients with RA have an increased cardiovascular morbidity and mortality (CV) being the main cause of death. “Systematic Coronary Risk Evaluation” (SCORE) allows us to estimate the risk of death from cardiovascular disease as 10 years. Objectives To evaluate whether the presence of anti-peptide citrullinated (ACPA) antibodies is associated with increased frequency of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) or with greater SCORE. Methods observational, analytical case-control study nested in a cohort of patients diagnosed with AR follow-up in the Valme hospital area. Cases were considered the patients who have developed a myocardial infarction or cerebrovascular or ischaemic heart disease and controls RA patients without CVD. They all determined ACPA levels, the classic cardiovascular Results A total of 260 patients were included from a database of 327 patients with AR. In 67 of these, we coudn’t get the main variables of the sutdy, and were excluded. Conclusions In our sample, unlike other published studies, we found no differences in the occurrence of cardiovascular events, or the SCORE in patients ACPA (+) v ACPA (-). While subgroups of patients with ACPA + have a greater tendency to be treated with biological therapy. This lack of differences could also be explained by the early implantation of both primary and secondary prevention of cardiovascular disease in patients with RA. References Results from systematic screening for cardiovascular risk in outpatients with rheumatoid arthritis in accordance with the EULAR recommendations; ARD Online First, published on July 12, 2013 as 10.1136/annrheumdis-2013-20368

Background The head and neck tumours are a heterogeneous group of diseases that affect the otolaryngology (ENT) sphere . It constitutes 2.9% of all new cancer cases. Predominantly affect older men aged 40 years. Smoking, excessive alcohol consumption, treatment with high doses of corticosteroids and malnutrition suffering after surgery and radiotherapy, involves a potential situation of accelerated bone loss in a young population with good long-term prognosis. Objective To describe the characteristics regarding risk factors and osteoporotic disease in patients with head and neck tumours. Material and methods An Observational study of a case series of patients with tumours of the head and neck joint monitoring in consultations of Rheumatology and Medical Oncology Hospital Valme area. We collected the following variables; age, sex, risk factors for osteoporosis and osteoporotic fracture, lateral radiography of lumbar and thoracic spine, and lumbar spine and hip bone densitometry Results 50 patients diagnosed whith head and neck tumours were included. Of these, 100% were male, with a mean age of 62 years at present. The most frequent location was the larynx in 55% of cases, followed by a 7% for those of tonsils and other locations of the oral cavity . Approximately a 16% of patients had a history of gastrointestinal pathology In relation to risk factors for both disease, tumour and osteoporosis we found : Also found two patients with vertebral fractures, one with osteoporosis and the second with osteopenia. Finally in relation to tumour pathology, 10% were stage II, candidates for treatment with radiation therapy compared with 90% remaining subsidiary of intensive treatment with chemotherapy, radiation therapy and high-dose corticosteroids. Conclusions In our sample, we found that up to 16.6% of patients and 7.1% had osteopenia or osteoporosis at baseline. Assuming that during treatment, they will suffer about 16% of loss weight, attached to treatment with high-dose corticosteroids, would justify develop measures for primary prevention of osteoporosis with a study and treatment of these patients.

Introduction Psoriasis arthritis (PSA) is a highly heterogeneous disease. Occasionally it courses with very aggressive forms that requiring biological therapies (TB). Objective To evaluate the effectiveness and long-term safety of TB in a serie of patients with PSA tracking Valme Hospital area. Methods Observational descriptive study of a series of 25 patients with diagnosis of PSA with peripheral affectation according CASPAR criteria, in treatment with TB in the UGC of Valme hospital. Measurement of disease activity using the DAS28 index before and after TB. Survival analysis of each of the biological drugs used. Evaluation of drug safety through adverse effects (EA) collection. Results a total of 25 patiens diagnosied with PSA with TB treatment were reviewed. Etanercept was the drug most used in first line (36%), followed by Infliximab (32%), Adalimumab (16%), Golimumab (12%) and Certolizumab (4%). In 2nd line of treatment, also Etanercept was the most used followed of Adalimumab. A single patient with highly refractory APS was treated with Abatacept in the fourth line and is currently being treated with Ustekinumab in the 5th line. Regarding efficacy data for the first biological: DAS 28 values before the onset of TB were: 20% High, 60% moderate, 8% low and 12% in remission (patiens in remission had the indication of TB by the cutaneous affectation). At the cut-off point after the first biology, we found: All the patients who were in remission and with low activity,becuse were wtih TB due to cutaneous involvement continued with the same values of DAS 28. The rest of the patients with TB, we found after treatment with the first drug 60% were in remission, 24% low activity and 16% remained with moderate activity. By means of the Student’s T for paired samples in relation to the DAS28 before the drug and in the last determination of the DAS28 with that drug, we found statistically significant differences only with the first biological drug, with a p In the case of the following treatment lines, the decrease in DAS 28 does not show statistically significant differences. Moreover, in the evaluation of successive TB, the sample size does not allow us to establish efficacy data with statistical significance. Survival time with the first drug was: the median 14 months (mininum 3 months and max 156 months) The most frequent adverse effects: infections of upper respiratory tract, urinary tract and recurrent cold sores). Reactions at the injection site. We dont have any cases of death. The most frequent reasons for drug suspension in the first line, was secondary failure (40% of cases) followed by a 30% of primary failure and the appearance of adverse effects Discussion TB is an effective and safe option of treatment that should be considered in patients with moderate to severe PAs, who are resistant to classical therapies or who have contraindications to conventional drugs. Although approximately 1/3 of the patients do not respond to these treatments, new trherapies as inhibitor to IL 17 and IR 12–23 pathways are promising and represent another alternative treatment for this patiens.

Background Although there are conflicting data on the subject, it seems that there is a higher incidence of cardiovascular events (CVE) in Rheumatoid Arthritis (RA) compared to population control. Apart from classical cardiovascular risk factors (CV), we must consider the severity of the inflammatory process plays an essential role in accelerated atherosclerosis in this pathology. On the long term security of biological therapies, we find heterogeneous data in different studies and registries. Has observed a decrease in CV risk in RA patients treated with anti-TNF-α agents. Objectives The main aim was to evaluate the CV risk and prevalence of CVD in RA treated with biological teraphies versus RA treated with classics disease modifying drugs (DMARDs). Methods Retrospective cohort study over the CV risk and prevalence of cardiovascular events in RA patients treated with biological therapies. We reviewed a cohort of 260 patients diagnosed with RA (ACR 1987). We recorded sociodemographic variables, classics CV risk factors (smoking history, cholesterol levels, hypertension, diabetes mellitus), immunological profile (presence of RF and/or ACPA), treatment (DMARDs or biological therapy) at the time of the study. The CV risk was measured by the estimated SCORE of atherosclerotic cardiovascular mortality risk in 10 years, for specific values of systolic blood pressure and total cholesterol, according to smoking history, gender and age, calibrated to Spain. Also checked all cardiovascular events occurred since the beginning of RA until time of the study. Results 72% were women, with a current average age of 58.5 years. 48% were receiving biological therapy with or without concomitant DMARDs. Among the classic CV risk factors highlighted: 38% overweight and obesity in 32% of patients, 14% had diabetes mellitus and 39% hypertension; 51% had dyslipidemia and 18% were smokers. Regarding the immune profile had ACPA+61% and 65% FR +. 13% of patients who did not realise biological therapy treatment showed a high Score (5–10) versus 3.7% of patients with biological therapy treatment, this difference was statistically significant. Regarding the prevalence of cardiovascular events we found no difference between groups, 13% and 15% respectively. Conclusions patients treated with biological therapy have lower cardiovascular risk than patients treated with DMARs. WE dont found differences in the prevalence of CVE between groups. Probably the reduction of inflammation with TB has direct relation with cardiovascular risk reduction in patients with RA.

Background Rheumatoid artritis (RA) is a systemic autoimmune disease of unknown and multifactorial aetiology, whoseprevalence is around 1% of the adult population. Anti citrullinated peptide antibodies (ACPA) are the most specific serological markers of RA, with a specificity of 98%–99% in some studies. The presence of autoantibodies such as rheumatoid factor (RF) and ACPA is related to more severe structural damage and joint destruction during disease progression. Objectives To assess whether the presence of ACPA is associated with higher levels of disease activity score (DAS 28) in a sample of patients with RA. Methods We performed a descriptive study of a cohort of patients from Valme Hospital diagnosed with RA. Patients were identified from an electronic database. Demographic data, inmunological profile (presence of RF and/or ACPA),treatment (DMARDs or biological therapy) and disease activity measured by DAS 28 were collected transversely. Results Two hundred and sixty RA patients were included, current average age of 58.5 years, 72% were women, 48% were receiving biological therapy. Regarding serological markers, 61% were ACPA positive, 65% were RF positive and 54.3% were ACPA and RF positive. Mean DAS28 was 2.6 for RF and ACPA negative patients, compared to 2.8 for patients that showed positivity for one or both autoantibodies, without statistically significant difference. With respect to the subgroup of patients receiving biological treatment (n=122), no significant difference of the mean value of DAS28 was seen (regarding to the presence/absence of ACPA): DAS28 2,53 for ACPA positive versus 2.52 for ACPA negative. Conclusions The presence of ACPA in RA patients has been traditionally considered a predictor of radiographic progression and higher clinical activity. But recently, new studies suggest that, although ACPA positivity does maintain relationship with structural damage, there is no association with the severity of clinical activity measured by DAS28. 1 In line with with these results, in our population of RA we found no relationship between the presence of ACPA and/or RF and disease activity, but it should be noted that the present is a cross-sectional study, so further prospective studies will be needed to elucidate this point. Reference M Kaushik R. Anti-Cyclic Citrullinated Peptide Antibodies as a Predictor of Clinical and Radiological Disease Severity in Rheumatoid Arthritis. Curr Rheumatol Rev 2015 Jan 13.

To evaluate the contribution made by fetal echocardiography in identifying Down's syndrome (DS) and other chromosomal disorders in a stepwise sequential screening method (first step: combined test (CT), second step: modified genetic sonography (MGS) (major malformation and nuchal fold)), for DS in the general population of pregnant women.Prospective study. During a 5-year study period (July 2005-June 2010) 17,911 pregnant women underwent CTs with MGS (with fetal cardiac morphological evaluation performed by obstetricians in a tertiary hospital) as a screening method for DS. We evaluated the sensitivity and false positive rate (FPR) (95% confidence interval (CI)) of three screening methods for DS and all chromosomal disorders: CT, CT + MGS, and CT + fetal echocardiography.A total of 17,911 cases were analyzed with 67 chromosome disorders and 45 DS cases being found. For DS, the CT sensitivity was 80% (95% CI; 68.3-91.7) (36/45) and 79.1% (95% CI; 69.4-88.8) (53/67) for all chromosome disorders, with a FPR of 4.2% (95% CI; 3.9-4.5) (752/17,866) and 4.1% (95% CI; 3.8-4.4) (735/17,844), respectively. For CT + MSG and CT + fetal echocardiography, the sensitivity for DS was 93.3% (95% CI; 85.9-0.99) (42/45) and 95.5% (95% CI; 90.5-0.99) (64/67) for all chromosome disorders. The FPR for CT + MSG was 4.8% (95% CI; 4.5-5.1) (860/17,866) and 4.6% (95% CI; 4.3-4.9) (836/17,844), respectively. The FPR of CT + fetal echocardiography was 4.4% (95% CI; 4.1-4.7) (792/17,866) for DS screening and 4.3% (95% CI; 4-4.6) (770/17,844) for chromosome abnormality screening.Fetal echocardiography is highly capable of identifying DS and other chromosomal disorders as a part of genetic sonography in stepwise sequential screening.

A considerable number of patients undergoing methadone maintenance treatment (MMT) are not considered for treatment against hepatitis C virus (HCV) infection due to a possible lower adherence and efficacy in this population. We aimed to compare the response rates to HCV treatment in patients with or without MMT. HCV-infected patients who initiated pegylated interferon plus ribavirin were included in this prospective cohort study. The relation between sustained virologic response (SVR) and MMT was analyzed. A total of 214 patients were included in the study [81 (37.9%) with and 133 (62.1%) without MMT]. No differences in HCV and interleukin 28B (rs12979860) genotype distribution were observed between the two groups. Of these patients, 103 (48.1%) achieved SVR. Among the patients who received MMT, 39 (48.1%) reached SVR compared to 64 (48.1%) subjects without MMT (p = 0.99). The frequency of voluntary drop-out and treatment discontinuations due to adverse events was comparable between the patients with and without MMT [10 (12.3%) versus 14 (10.5%), p = 0.68, and 4 (4.9%) versus 9 (6.8%), p = 0.59, respectively]. The efficacy of HCV therapy in MMT patients is similar to that found in subjects not taking methadone. MMT patients should be equally considered for treatment with pegylated interferon plus ribavirin in HCV-infected patients.

Resumen Introduccion Se ha evaluado el nuevo sistema automatizado cobas 4800 CT/NG test para la deteccion de Chlamydia trachomatis (C. trachomatis) en muestras urogenitales. Material y metodos Se analizaron 696 muestras (488 exudados uretrales y cervicales y 208 orinas) para la deteccion de ADN de C. trachomatis. Los resultados del cobas 4800 CT/NG test (c4800) se compararon con los obtenidos por el Cobas AMPLICOR CT/NG test (CAM). Las discordancias se analizaron mediante PCR convencional y electroforesis en gel de agarosa en microchips, MultiNA. Resultados Se realizaron dos analisis simultaneos, el primero de ellos fue comparar los resultados obtenidos con los exudados en el c4800 y en CAM. En este caso, la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN) fueron del 77,9, el 100, el 100 y 96%, respectivamente. El segundo analisis fue comparar los resultados obtenidos para las muestras de orina con los obtenidos con sus correspondientes exudados en el c4800. Los valores obtenidos para sensibilidad, especificidad, VPP y VPN fueron: 100, 98,9, 92,9 y 100%, respectivamente. Los valores kappa de estas comparaciones fueron: 0,857 exudados en c4800 y CAM y 0,957 para orina frente a exudados en c4800. Conclusiones Los resultados obtenidos con c4800 demuestran que son equiparables con los obtenidos con CAM. Asimismo, observamos una correlacion excelente al comparar las muestras de exudados con su correspondiente muestra de orina en c4800, por lo que se puede emplear dicha muestra de forma sistematica en el diagnostico de estas infecciones tanto en varon como en mujeres.

OBJECTIVES Although the reproducibility of transient elastometry (TE) in hepatitis C virus (HCV)-monoinfected patients seems to be high, this may not be the case in HIV/HCV-coinfected patients because of different degrees of steatosis and/or inflammation. This study was aimed to determine the interobserver concordance of TE measurements in HIV/HCV-coinfected patients. METHODS A total of 188 patients were evaluated in a cross-sectional, prospective study in two hospitals. The interobserver variability of TE results and the rate of unequal classification of significant fibrosis (cutoff value = 7.2 kPa) and cirrhosis (cutoff value = 14.6 kPa) for two observers were evaluated. RESULTS The values of liver stiffness (LS) for two observers highly correlated [intraclass correlation index = 0.976; 95% confidence interval (CI): 0.968-0.982]. The kappa indexes for the concordance of patient classification were 0.60 for significant fibrosis and 0.89 for cirrhosis. Using two cutoff points to diagnose or rule out significant fibrosis (LS >or=9 kPa or

We compared two agar-based methods, the E-test and the disk diffusion method with the Clinical Laboratory Standards Institute (CLSI) reference broth microdilution method (CLSI M38-A; MD). Forty six dermatophytes strains including 30 Trichophyton mentagrophytes, 8 T. rubrum and 8 M. gypseum were tested against three antifungal agents, i.e., fluconazole (FLC), itraconazole (ITC) and voriconazole (VRC). The level of agreement between the E-test and MD (+/-2 dilutions) was 45.6% for fluconazole, 19.5% for itraconazole and 52.1% for voriconazole. The results obtained with disk diffusion had low correlation with the results obtained by the CLSI broth microdilution reference method with azoles.

The disk diffusion method was evaluated for determining posaconazole susceptibility against 78 strains of molds using two culture media in comparison with the CLSI (Clinical Laboratory Standards Institute) broth microdilution method (M38-A). A significant correlation between disk diffusion and microdilution methods was observed with both culture media.

OBJECTIVE To correlate the cytologic grade of breast carcinoma with the expression of E-cadherin/catenin system molecules and the presence of metastasis in regional lymph nodes. STUDY DESIGN Aspirate smears were examined together with histologic sections from the corresponding neoplasms taken from 100 patients with invasive ductal carcinoma. In 50 cases, > or = 1 metastatic nodes were identified. Cytologic grading of the smears was performed using the Robinson method. Immunohistochemical expression of E-cadherin and of alpha-, beta- and gamma-catenin was studied. RESULTS A statistically significant relationship was observed between E-cadherin/catenin expression and cytologic grade (p < 0.0005). This association was particularly relevant to the cell dissociation parameter (p < 0.0005). CONCLUSION The cytological grade established in preoperative studies may provide relevant information on the aggressiveness of invasive ductal carcinoma and its tendency to produce regional metastasis. This finding could be particularly useful in cases of breast carcinoma in which neoadjuvant therapy is the method of choice.

The member organizations of the CETC feel strongly that there are significant flaws associated with the proposed proficiency test and its implementation. The most immediate modifications include lengthening the required testing interval, utilizing stringently validated and continuously monitored slides, changing the grading scheme and changing the focus of the test from individuals to laboratory level testing, as described above. Integration of new computer-assisted and location-guided screening technologies into the testing protocol is necessary for the testing program to be compliant with the current CLIA law. The regulation also needs to be flexible enough to accommodate new technologies that are implemented in laboratory practice, education and administration of the test. The changes recommended in this document address the most immediate technical and scientific concerns with the current implementation of PT for gynecologic cytology. The CETC will be submitting a subsequent document, following full review of the current regulations, with recommendations for changes, justifications and impact.

Introduccion. Describir los resultados obtenidos en el estudio de resistencia en enfermos con virus de la inmunodeficiencia humana (VIH) en tratamiento antirretroviral de gran actividad (TARGA) y comparar los resultados obtenidos empleando dos algoritmos de interpretacion genotipica y el fenotipo virtual. Metodos. Se han estudiado 397 muestras (TRUGENE HIV-1 GENOTYPING kit), interpretando los resultados con los algoritmos Visible Genetics y Retrogram®. Se realizo el estudio de concordancia entre algoritmos de 105 de estas muestras incluyendo tambien la interpretacion por el fenotipo virtual. Resultados. Pacientes en multifracaso (39%), primer fracaso (30,7%) y segundo fracaso (27,1%). El 27,6% de las muestras fueron cepas salvajes. Las mutaciones a los inhibidores de la transcriptasa inversa analogos de nucleosidos (ITIAN) mas frecuentes fueron T215Y/F (37,2%) y M184V (32,9%) seguida por otras mutaciones asociadas a los analogos de nucleosidos (NAMS). La insercion 69 y el complejo Q151M (1,5%) tuvieron poca representacion. Para los inhibidores de la transcriptasa inversa no nucleosidos (ITINN) K103N (25,8%), Y181C (11,2%) y G190A (10,9%). Para los inhibidores de la proteasa (IP): mutaciones primarias L90M (26,1%), M46I (18,1%) y V82AFTS (12,9%); y mutaciones secundarias L63P (50,5%), A71V (27,2%), L10I (25,2%) y M36I (19,2%). Detectamos baja correlacion entre sistemas de interpretacion para ITIAN e IP, mostrandose el fenotipo virtual mas flexible en la asignacion de resistencia. Conclusiones. Las peticiones de estudios de resistencia fueron similares para los tres grupos de pacientes. Muchos fracasos son el resultado de falta de adherencia al tratamiento. El patron de mutaciones halladas se corresponde con los tratamientos TARGA. La baja correlacion entre los sistemas de interpretacion hace necesaria la elaboracion de un algoritmo consensuado en funcion de la eficacia clinica.

Resumen Objetivo Implementacion y valoracion de un programa de participacion familiar en los cuidados del paciente critico. Diseno Estudio experimental, longitudinal y prospectivo, de series temporales y grupo de control aleatorio con tres variables dependientes: paciente, cuidador principal y personal sanitario. Paciente: estado cognitivo del enfermo evaluado con Minimental State Examination Test. Cuidador principal: niveles de ansiedad estado de los cuidadores principales (STAI). Personal: opinion de las enfermeras sobre los cambios introducidos medidos mediante escala tipo Likert. Hipotesis El diseno y la implementacion de un programa de participacion familiar en los cuidados basicos del paciente critico, influyen positiva y significativamente en el enfermo, el familiar y los profesionales implicados en el. Se realizo un muestreo aleatorio sistematico hasta alcanzar el tamano muestral establecido. Resultados Muestra de 117 casos, 49 grupo control, 49 grupo experimental y 19 no validos. El test de STAI obtuvo una media en el grupo experimental de 23,57 frente a 31,22 del grupo control (p Conclusiones Disminucion significativa del grado de ansiedad. No se modifica el estado cognitivo en el grupo experimental frente al grupo control despues de la intervencion. Mejoria progresiva de las creencias del personal de enfermeria con respecto a la visita abierta.

Factor V Leiden mutation (FVL), and the prothrombin G20210A mutation (PT G20210A) are polymorphisms with a weak risk factor for venous thromboembolic disease. The probability of spontaneous venous thrombosis in carriers of thrombophilic mutations (FVL and PT G20210A) was analyzed.We studied 735 individuals (407 were healthy controls and 328 patients with venous thrombosis) with respect to FVL and PT G20210A, determined by polimerase chain reaction in liquid phase, real time. chi2 test and logistic regression analysis were used to evaluate the results. The dates were analyzed with the statistical program SPSS v. 14.0.The carrier patients of PT G20210A mutation whose age was over 40 years had a risk factor for spontaneous venous thrombosis which was 9.28 (odds ratio [OR]) (95% confidence interval [CI], 3.01-28.60; p0.0005) times greater than carriers of the PT G20210A mutation who were 40 year-old or younger. In our patients, being male meant a weak risk factor for venous spontaneous thrombosis (p = 0.021; OR = 1.64; 95% CI, 1.08-2.51) .Our results demonstrate a potentiation of the thrombotic risk by an increase of age in the carriers of the PT G20210A mutation.

OBJECTIVES To compare the Clinical Laboratory Standards Institute CLSI M44-A disc diffusion (DD) and M27-A2 broth microdilution (MD) methods for determining the susceptibility of Candida spp. to micafungin (FK463). PATIENTS AND METHODS A total of 355 clinical yeast isolates including 270 Candida albicans, 45 Candida glabrata, 24 Candida krusei, 11 Candida tropicalis and 5 Candida parapsilosis were studied. The MIC of micafungin was determined by following the CLSI M27-A2 guidelines (MD). Endpoints were defined as the lowest concentration of micafungin resulting in partial inhibition (IC(50)) of visual growth after 24/48 h of incubation at 35 degrees C. Final concentrations were 0.008-4 mg/L of micafungin. DD testing was performed using a CLSI M44-A document with 2.5 mug micafungin discs. Zone diameter endpoints were read after 24/48 h of incubation at 35 degrees C. Arbitrary breakpoints were 4 mg/L for MD and 15 mm for DD. RESULTS The best correlation was observed when we read MD 48 h/DD 24 and 48 h (97%). When the reading was MD 24 h/DD 24 and 48 h the percentage of correlation was 95.2%. CONCLUSIONS The DD method performs well for testing the susceptibility of Candida spp. to micafungin. More studies involving more Candida strains with elevated MIC values are needed.

Melioidosis was first recognized in northeastern Brazil in 2003. Confirmation of additional cases from the 2003 cluster in Ceará, more recent cases in other districts, environmental isolation of Burkholderia pseudomallei, molecular confirmation and typing results, and positive serosurveillance specimens indicate that melioidosis is more widespread in northeastern Brazil than previously thought.

The dietary offer is not always concordant with the nutritional recommendations in the school menus.To review the effectiveness of a diet counseling system for collective catering companies that operate in public education centers of Andalusia.Cross-sectional, observational, descriptive study. We reviewed and counseled the changes needed in the monthly school menus of the companies operating in 1197 centers throughout the scholar calendar. In case of not meeting the required conditions and before being implemented, the improvement recommendations were sent to the companies.78.2% of 209 menus from 21companies did not meet the established criteria and needed adaptations before being implemented. Throughout the scholar calendar, the number of menus needing changes progressively decreased, being 42.9% by the end. The most frequent cause for modification were: insufficient information on the written menu about the foods included in each dish (50,7%), lack of rotation between raw and cooked vegetables (35.4%), insufficient information on the cooking techniques (26.3%), insufficient weekly variety of rice, pasta and potatoes (17.7%), deviation in the energy and nutrients content (16.7%), less than one serving of vegetable per day (15.4%), lack of rotation in the type of fish (14.4%). Finally, 90.9% of the menus revised were approved.Following of the nutritional recommendations of the school menus is high with the implementation of a counseling system aimed at the dietitians of the companies of collective catering.Introducción: La oferta dietética no siempre coincide con las recomendaciones nutricionales para el menú escolar. Objetivo: Revisar la efectividad de un sistema de asesoría dietética para empresas de restauración colectiva que sirven en comedores de los centros públicos de Educación de Andalucía. Métodos: Estudio observacional descriptivo transversal. Se revisan y asesoran los cambios necesarios en los menús mensuales procedentes de empresas que sirven a 1.197 centros, a lo largo del curso escolar. En caso de no de reunir las condiciones necesarias, y antes de ser aplicados, se devuelven con unas recomendaciones de mejora. Resultados: De 209 menús procedentes de 21 empresas, el 78,2% no cumplía los criterios establecidos, y necesitó de adaptaciones previas a su aplicación. A lo largo del curso escolar disminuyeron progresivamente los que precisaron cambios, siendo el 42,9% al final. Las causas más frecuentes de modificaciones fueron: información insuficiente en la planilla del menú sobre los alimentos que componen cada plato (50,7%), no alternancia de verduras frescas y cocinadas (35,4%), información insuficiente sobre técnicas culinarias (26,3%), variedad semanal insuficiente en arroz, pasta y patatas (17,7%), desviación en el contenido de energía y nutrientes (16,7%), menos de 1 ración de verduras diaria (15,4%), no alternancia en tipo de pescado (14,4%). Finalmente fueron aprobados el 90,9% de los menús revisados. Conclusiones: El seguimiento de las recomendaciones nutricionales en el menú escolar es elevado con la aplicación de un sistema de asesoría dirigido a los dietistas de las empresas de restauración colectiva.

Background The combination of transient elastometry with a controlled attenuation parameter (CAP) is available to evaluate hepatic steatosis (HS) along with liver stiffness. Aims To assess the concordance of CAP measurements between two independent observers in patients infected by HIV and/or hepatitis virus, as well as to determine the concordance of classification of the grade of HS using two cut-off values. Materials and methods In a cross-sectional prospective study, CAP-enabled transient elastometry acquisitions were performed by two independent observers in patients with HIV or hepatitis virus infection. The interobserver concordance between the CAP examinations was assessed using the intraclass correlation coefficient and the concordance in the classification of patients in the grades of HS was characterized using the κ index. Results A total of 118 patients were included. Twenty (17%) patients were HIV monoinfected, 44 (37.3%) were hepatitis C virus monoinfected, and 52 (44%) had HIV/hepatitis C virus coinfection. The median (Q1-Q3) of the absolute difference of CAP values between the two observers was 20 (10-41) dB/m. The overall intraclass correlation coefficient was 0.84 (95% confidence interval: 0.77-0.88). The corresponding figures for liver stiffness measurements were 0.9 (0.4-2.6) kPa and 0.96 (95% confidence interval: 0.94-0.97). The κ indexes for the concordance of classification for the presence of HS, cut-off of 215 dB/m, and significant HS, cut-off of 252 dB/m, were 0.53 and 0.62, respectively. Conclusion The determination of HS by means of CAP in HIV and/or hepatitis virus infection represents an observer-independent and easily performable method. However, the use of cut-off values for the classification of patients is suboptimal.

Accurate prediction of sustained virological response (SVR) to pegylated interferon-a (Peg-IFN) plus ribavirin in HIV/hepatitis C virus (HCV)-coinfected patients could improve the management of these patients. We aimed to develop a model to predict SVR to Peg-IFN/ribavirin in HIV/HCV-coinfected individuals combining HCV genotype and baseline HCV RNA load with interleukin 28B and low-density lipoprotein receptor genetic variations. Fil: Neukam, Karin. Hospital Universitario de Valme. Unidad de Enfermedades Infecciosas y Microbiología; España; Fil: Almeida, Carmen. Hospital Universitario de Valme. Unidad de Investigación; España; Fil: Caruz, Antonio. Universidad de Jaén; España; Fil: Rivero Juarez, Antonio. Hospital Universitario Reina Sofía. Instituto Maimónides de Investigación Biomédica de Córdoba. Unidad de Enfermedades Infecciosas; España; Fil: Rallon, Norma. Hospital Carlos III. Departamento de Enfermedades Infecciosas; España; Fil: Di Lello, Federico Alejandro. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Virología; Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina; Hospital Universitario de Valme. Unidad de Enfermedades Infecciosas y Microbiología; España; Fil: Herrero, Rocío. Universidad de Jaén; España; Fil: Camacho, Angela. Hospital Universitario Reina Sofía. Instituto Maimónides de Investigación Biomédica de Córdoba. Unidad de Enfermedades Infecciosas; España; Fil: Benito, José. Hospital Carlos III. Departamento de Enfermedades Infecciosas; España; Fil: Macias, Juan. Hospital Universitario de Valme. Unidad de Enfermedades Infecciosas y Microbiología; España; Fil: Rivero, Antonio. Hospital Universitario Reina Sofía. Instituto Maimónides de Investigación Biomédica de Córdoba. Unidad de Enfermedades Infecciosas; España; Fil: Soriano, Vicente. Hospital Carlos III. Departamento de Enfermedades Infecciosas; España; Fil: Pineda, Juan Antonio. Hospital Universitario de Valme. Unidad de Enfermedades Infecciosas y Microbiología; España

Objective: To assess the sensitivity (Sen) and false positive ratio (FPR) of stepwise sequential screening [1st step: combined test (CT), 2nd step: modified genetic sonography (major malformation and nuchal fold, MGS)] as a screening method for Down’s syndrome (DS) in the general population of pregnant women. Methods: Prospective study. During a 5-year study period (July 2005 to June 2010), 17,911 pregnant women were screened for DS using a stepwise sequential screening method (CT+MGS). We evaluated the Sen and FPR (95% CI) of the two chromosomal disorder screening methods for DS: CT and CT+MGS. Results: Seventeen thousand nine hundred and eleven cases were analysed, including 67 with chromosome abnormalities and 45 with DS. The Sen of CT for DS was 80% (95% CI; 68.3–91.7) (36/45) with a FPR of 4.2% (95% CI; 3.9–4.5) (752/17, 866). The Sen of CT+MSG for DS was 93.3 (95% CI; 85.9–99) (42/45) with a FPR of 4.8% (95% CI; 4.5–5.1) (860/17, 866). Conclusions: MGS coupled with CT increases the Sen of DS diagnosis by 13.3% (95% CI; 2.7–25.9), with an increase in FPR of 0.6% (95% CI; 0.5–0.7).

We propose to assess the contribution of "modified genetic sonography" (MGS) to the combined test (CT) as a method of stepwise sequential screening (1st step: CT, 2nd step: MGS) for chromosome abnormalities in the general population of pregnant women.Prospective study. During a 4 year study period (July 2005-June 2009) 16,548 pregnancies underwent a CT combined with MGS (major malformation and nuchal fold) as a screening method for chromosome abnormalities. We assessed sensitivity and false positive rate (FPR) (95% CI).We offered a chromosome abnormalities screening test to 96.6% of pregnancies (15,995 cases). 14,160 cases are analyzed (1st step: CT, 2nd step: MGS) including 49 chromosome abnormalities and 35 Down's syndrome (DS). The sensitivity of CT for DS was 77.1% [95% CI, 63.2-91] (27/35) and 77.5% for all chromosome abnormalities [95% CI, 65.8-89.2] (38/49) with a FPR of 4.4% [95% CI, 4.1-4.7]. If MGS was combined with CT, the sensitivity for DS was 91.4% [95% CI, 82.1-99] (32/35) and 93.8% for all chromosome abnormalities [95% CI, 87-99] (46/49) for a FPR of 5.1% [95% CI, 4.7-5.5].The addition of an MGS to combined first-trimester screening test for aneuploidy improved sensitivity by 14.3% while only increasing the FPR by 0.7%.

We tested the susceptibility of caspofungin, micafungin, and anidulafungin against Aspergillus spp. isolates by the new Clinical and Laboratory Standards Institute M51-A disk diffusion (DD) and the broth microdilution methods. A total of 65 clinical isolates of Aspergillus spp. were evaluated. The DD assay was performed on nonsupplemented Mueller–Hinton agar using caspofungin 2-μg, micafungin 1-μg, and anidulafungin 2-μg disks. Echinocandin minimal effective concentrations (MECs) and inhibition zones (IZs) were read after 24 to 48 ( A. terreus ) h at 35 °C. Caspofungin MECs for all Aspergillus spp. strains tested were ≤0.25 μg/mL; IZs were ≥15 mm for most species except for A. terreus (11–22 mm) . Both micafungin and anidulafungin MECs were ≤0.015 μg/mL, but micafungin IZs were ≥14 mm while anidulafungin IZs were ≥22 mm. As for caspofungin, the DD method could be a useful method for susceptibility testing of micafungin and anidulafungin against Aspergillus spp.

Antecedentes: La posibilidad de que un recién nacido presente algún tipo de defecto congénito al nacimiento es de un 2-4% y la aplicación de métodos de cribado de cromosomopatías y de malformaciones estructurales puede reducir la prevalencia de estos defectos congénitos al nacimiento. Objetivos: Demostrar que es posible la implantación de un cribado de malformaciones congénitas de garantía (sensibilidad de diagnóstico para malformaciones estructurales mayores y para síndrome de Down del 80%) y universal (aplicado al 90% de gestantes). Proponemos que la implantación de este cribado supone una disminución de la tasa de los defectos congénitos no diagnosticados al nacimiento a menos del 0,5% de los recién nacidos. Método: Estudio prospectivo. Hemos valorado 12.478 gestantes (julio 2006-septiembre de 2009). Método de cribado de defecto congénitos: test combinado asociado a ecografía morfológica (18-22 semanas) Resultados: La prevalencia de defecto congénito fue de 2,26% [IC 95%: 1,9-2,5] (282/12478). Valoración ecográfica fue del 99,2% de las gestantes. Tasa de diagnóstico de malformaciones estructurales fue de 79,3% [IC 95%: 74,3-84,4] (196/247) y 95,6% [IC 95%: 91,8-99,3] (110/115) para las malformaciones mayores. Se ofertó un cribado de cromosomopatias al 95,1% de las gestantes con una tasa de diagnóstico del 88,5% [IC 95%: 79,9-99] (31/35). Conclusiones: Un cribado de defectos congénitos universal y de garantías logró disminuir la prevalencia de defectos congénitos al nacimiento sin diagnosticar a un 0,5%. Background: The probability of a newborn presenting some kind of congenital defect at birth is 2-4% and the application of methods of screening for chromosomal and structural abnormalities can reduce the prevalence of these defects at birth. Objectives: The aim of this study is to prove that it is possible to implement a screening for congenital malformations that is standardised (diagnostic sensitivity [Sen]>80% for major structural deformations and Down's syndrome) and universal (90% of pregnant women). We also want to prove that this screening reduces the rate of undiagnosed congenital defects at birth. Methods: Prospective study. We assessed 12,478 pregnant women (July 2006- September 2009). A morphological ultrasound (18-22 weeks) and a combined test were carried out as the methods for screening for congenital defects. Results: The prevalence of congenital defects was 2.26% [95% CI: 1.9-2.5] (282/12478). The ultrasound scan was performed on 99.2% of the pregnant women. There was a Sen of 79.3% [95% CI: 74.3-84.4] (196/247) for structural malformation and 95.6% [95% CI: 91.8-99.3] (110/115) for major malformations). Screening for chromosomal anomalies was performed on 95.1% of pregnant women with a Sen of 88.5% [95% CI: 79.9-99] (31/35). Conclusions: A standardised and universal screening for congenital defects reduced the prevalence of undiagnosed congenital defects at birth to 0.5%.

To evaluate the new automated system cobas 4800 CT/NG test for detection of Chlamydia trachomatis in urogenital specimens.We analyzed 696 specimens (488 swabs from urethral or cervical specimens, and 208 urines) to detect C. trachomatis. The results of the cobas 4800 CT/NG test (c4800) were compared to those obtained with Cobas AMPLICOR CT/NG test (CAM). Discordant results were analyzed with a conventional PCR assay and microchip electrophoresis system in agarose gel, MultiNA.We made two simultaneous analyses. In the first one, we compared the results obtained with swab specimens using the c4800 system and CAM. In this case, the sensitivity, the specificity, the positive and negative predictive values (PPV and NPV) were: 77.9%, 100%, 100% and 96% respectively. In the second one, we compared the results obtained for urine and its corresponding swab specimens on the c4800. The values obtained were: 100%, 98.9%, 92.9% and 100% respectively. The kappa values of these comparisons were: 0.857 for swab specimens on the c4800 and CAM, and 0.957 for urine versus swab specimens on the c4800.The results obtained with c4800 system were completely comparable with those obtained with CAM. We also noted an excellent correlation with these results when we compared swab specimens with their urine samples in the c4800 system. Therefore this sample type could be used routinely to diagnose infections in men and women.

PURPOSE: Neuromodulation therapies have been used with success in patients with fecal incontinence. Intermittent percutaneous tibial nerve stimulation is a new, minimally invasive treatment option for these patients. This study was designed to evaluate the results of intermittent percutaneous tibial nerve stimulation in patients with fecal incontinence. METHODS: Sixteen patients (11 females; mean age, 59 ± 7.9 years) with severe fecal incontinence were treated with percutaneous tibial nerve stimulation. All patients completed a defecation diary, the Wexner Fecal Continence Scale, a fecal incontinence quality-of-life questionnaire, and a visual analog scale before treatment and during each phase of the study. Endoluminal ultrasound and anorectal physiologic studies were also performed in each patient. RESULTS: Continence was improved in 10 of 16 patients after the first phase. Six patients did not continue to the second phase of treatment because of a lack of initial response. During the second phase, 7 of 16 continued to show improvement. After a six-month period without any treatment, 5 of 16 continued to have good continence. Overall, percutaneous tibial nerve stimulation significantly improved fecal continence. The Wexner score improved from a mean of 13.2 ± 4.1 at baseline to 9 ± 5.2 at the end of the first phase (P < 0.0005), to 8 ± 5.7 at the end of the second phase (P = 0.001), and to 9.1 ± 5 after 6 months without treatment (P = 0.001). Significant improvement was observed in three main domains of the fecal incontinence quality-of-life scale: coping/behavior, depression, and embarrassment. Scores on the visual analog scale improved from a mean of 4.6 ± 1.5 at baseline to 7 ± 2.5 at the end of the first phase (P = 0.002) and to 7.2 ± 2.5 after 6 months without treatment (P = 0.001). CONCLUSION: Percutaneous tibial nerve stimulation is a minimally invasive and effective treatment option for patients with fecal incontinence.

Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for arterial hypertension. Several controlled trials have investigated the effect of continuous positive airway pressure (CPAP) on BP in patients with OSAS, but its effect on hypertensive patients has not been analyzed specifically.To analyze the effect of CPAP on ambulatory BP in patients with OSAS and hypertension who were undergoing antihypertensive treatment.We conducted a parallel, randomized, placebo-controlled trial in 68 patients with OSAS and hypertension, who were receiving treatment with antihypertensive medication. Patients were randomly allocated to either therapeutic or subtherapeutic CPAP for 4 weeks. Ambulatory BP was registered at baseline and after treatment. Antihypertensive treatment was not changed during the study. Changes in BP were assessed on an intention-to-treat basis.There were no baseline differences in the apnea-hypopnea index, comorbidities, or ambulatory BP between groups. Objective compliance with CPAP was similar in both the therapeutic and subtherapeutic groups (5.0 +/- 1.4 h/d vs 4.4 +/- 1.9 h/d, respectively; p = 0.13 [mean +/- SD]). There was a small and statistically nonsignificant decrease (- 0.3 +/- 6.3 mm Hg vs - 1.1 +/- 7.9 mm Hg; difference, - 0.8 mm Hg [95% confidence interval, - 2.7 to 4.3]; p = 0.65) in 24-h mean BP (24hMBP) in both subtherapeutic and therapeutic groups after 4 weeks of treatment. No significant changes in systolic, diastolic, daytime, or nighttime BP were observed. The normal circadian dipper pattern was restored in a higher proportion of patients in the therapeutic group compared to the subtherapeutic CPAP group, although differences were not significant (11 of 32 patients vs 3 of 25 patients; odds ratio, 3.84; 95% confidence interval, 0.82 to 20.30; p = 0.10). There was no correlation between the magnitude of change in 24hMBP and CPAP compliance, OSAS severity, or number of antihypertensive drugs used.Four weeks of CPAP did not reduce BP in patients with OSAS and hypertension who were treated with antihypertensive medication, compared to placebo group.

To correlate the cytologic grade of breast carcinoma with the expression of E-cadherin/catenin system molecules and the presence of metastasis in regional lymph nodes.Aspirate smears were examined together with histologic sections from the corresponding neoplasms taken from 100 patients with invasive ductal carcinoma. In 50 cases,or = 1 metastatic nodes were identified. Cytologic grading of the smears was performed using the Robinson method. Immunohistochemical expression of E-cadherin and of alpha-, beta- and gamma-catenin was studied.A statistically significant relationship was observed between E-cadherin/catenin expression and cytologic grade (p0.0005). This association was particularly relevant to the cell dissociation parameter (p0.0005).The cytological grade established in preoperative studies may provide relevant information on the aggressiveness of invasive ductal carcinoma and its tendency to produce regional metastasis. This finding could be particularly useful in cases of breast carcinoma in which neoadjuvant therapy is the method of choice.

This study attempts to describe the results obtained in the HIV resistance study performed with clinical samples obtained from patients receiving "HAART" therapy and to compare the results using different interpretation algorithms.397 samples have been analysed (TRUGENE HIV-1 GENOTYPING kit). The results were interpreted with the algorithms Visible Genetics and Retrogram. The concordance interalgorithm was done for 105 of these samples, including the virtual phenotype interpretation.The samples corresponded to multi regimen failure (39%), first and second failure (30.7% and 27.1% respectively). A 27.6% of the samples were wild type. The more frequent mutations to the ITIAN were T215Y/F (37.2%) and M184V (32.9%) following by other NAMS. The 69 insertion and Q151M complex had low representativity. For the ITINN K103N (25.8%), Y181C (11.2%) and G190A (10.9%). For the IP: key mutations L90M (26.1%), M46I (18.1%) and V82AFTS (12.9%); and accessory mutations L63P (50.5%), A71V (27.2%), L10I (25.2%) and M36I (19.2%). Low correlation was observed between interpretation systems, mainly for ITIAN and IP, being the virtual phenotype more flexible in the assignation of resistance.The requests for HIV resistance testing were similar for the three groups of patients. Many of the failures were the consequence of a poor adherence to the therapy. The mutation pattern found corresponded with the "TARGA" therapy. The low correlation found between interpretation systems, makes necessary the elaboration of a consensus algorithm.

Objectives. Implementation and valuation of the family member participation in the critically ill patient care.Methodology. Experimental, longitudinal and prospective study, temporal series, with a random control group. This family implication program will be valued according to three dependent parameters: patient, family carer and nursing staff.cognitive state, measured by using the Mini-mental state examination test. Family visitor: family principal carer anxiety state levels, measured using STAI test. Nursing staff: nurses' beliefs about changes introduced in the ICU, valued using attitude Likert type scale.Hypothesis. A family participation program design and implementation in the basic care in the critic patient has positive and significantly influence in the patient, family career and nursing staff.Results. The sample was of 117 cases; 49 in control group, 49 in experimental group and 19 no valid. The STAI test obtained in the experimental group a mean of 23.57 against control group of 31.22 (p.005). Minimental test was a mean of 23.43 for control group and 24.61 for experimental group. Nursing staff thinks the open visit provides emotional support (p =.005). Although they think the pain perception is great with the family presence (p =.013). The family satisfaction grows up (p =.026). Nursing staff thinks they are more prepared to have a better relationship with the family (p =.021). The belief that the open visit produces a bigger physics and psychic burden is decreasing (p =.03).Conclusions. The anxiety levels are decreasing significantly. The cognitive state is not modified in the experimental group against the control group after the intervention. The nursing staff believes are better respect the open visit.