PREMATUREZ: NOCIONES RELEVANTES Y RIESGO NEUROLÓGICO DEL PREMATURO

La prematurez es una condición relevante en salud pública, no sólo por su magnitud, afectando a alrededor de 15 millones de bebés en el mundo más de uno de cada 10 nacimientos, sino también por los estados comúnmente asociados que incluyen complicaciones en todos los sistemas y secuelas expresadas  principalmente  en alteraciones del neurodesarrollo, discapacidades cognitivas y alteraciones comportamentales. Este artículo expone una revisión actualizada de los conceptos básicos para el abordaje de la prematurez, s u  m a g n i t u d  e  i m p a c t o  e n e l neurodesarrollo del niño escolar, a la vez que resume el programa madre canguro como  un  método  costo  efectivo  para  el tratamiento del bebé prematuro. La revisión brinda estas conclusiones: Las principales patologías propias de la prematurez van de la mano de las patologías neurológicas, asociadas fisiopatológicamente a la inmadurez del sistema nervioso central del prematuro; las secuelas de la prematurez son comunes y requieren ser evitadas o sino tratadas con un programa de rehabilitación adecuado; el  programa  madre  canguro  permite  al  bebé prematuro o con bajo peso establecer conexiones con el medio ambiente por medio de lactancia materna adecuada y continua, y el amor y el calor de la madre, para lograr un alta temprana, con un adecuado seguimiento de su desarrollo

The Impact of Different Lung Ultrasound Protocols in the Assessment of Lung Lesions in COVID-19 Patients: Is There an Ideal Lung Ultrasound Protocol?.

Background In the past months, several lung ultrasonography (LUS) protocols have been proposed, mainly on previously validated schemes independent of coronavirus disease 2019 (COVID-19). Objectives The main purpose of this study was to determine the impact and accuracy of different LUS protocols proposed in COVID-19. Methods Patients were evaluated with a standard sequence of LUS scans in 72 intercostal spaces along 14 anatomic lines in the chest. A scoring system of LUS findings was reported and then analyzed separately according to each proposed LUS protocol zones. This score was then correlated to a validated Pulmonary Inflammation Index (PII) on chest Computed Tomography (CT). Results Thirty-two patients were enrolled. The most frequent pattern was ground-glass opacities in the chest X-ray (53.1%), chest CT (59.1%) and subpleural or lobar consolidations (40.8%) in the posteroinferior areas (p < 0.001) on LUS. The Interclass Correlation Coefficient (ICC) was significantly correlated with almost every protocol analyzed except the 8-zone (p = 0.119) and the 10-zone protocol that only included one posterior point (p = 0.052). The highest ICC was obtained with a 12-zone protocol (ICC 0.500; p = 0.027) and decreased as more points were included. Conclusions In conclusion, our study results suggest that performing an ultrasound protocol with 12-zone scanning, including the superior and inferior areas of the anterior, lateral and posterior regions of the chest was consistent with higher ICC and higher degree of concordance with CT. We emphasize the need of a more standardization technique to further implement and develop this imaging modality in COVID-19post-print1035 K

Quantification of pulmonary opacities using artificial intelligence in chest CT scans during SARS-CoV-2 pandemic: validation and prognostic assessment

Abstract Purpose To assess whether the analysis of pulmonary opacities on chest CT scans by AI-RAD Companion, an artificial intelligence (AI) software, has any prognostic value. Background In December 2019, a new coronavirus named SARS-CoV-2 emerged in Wuhan, China, causing a global pandemic known as COVID-19. The disease initially presents with flu-like symptoms but can progress to severe respiratory distress, organ failure, and high mortality rates. The overwhelming influx of patients strained Emergency Rooms worldwide. To assist in diagnosing and categorizing pneumonia, AI algorithms using deep learning and convolutional neural networks were introduced. However, there is limited research on how applicable these algorithms are in the Emergency Room setting, and their practicality remains uncertain due to most studies focusing on COVID-19-positive patients only. Methods Our study has an observational, analytical, and longitudinal design. The sample consisted of patients who visited our emergency room from August 5, 2021, to September 9, 2021, were suspected of having COVID-19 pneumonia, and underwent a chest CT scan. They were categorized into COVID-19 negative and positive groups based on PCR confirmation. Lung opacities were evaluated separately by a team of radiologists and a commercial AI software called AI-Rad Companion (by Siemens Healthineers). After 5 months we gathered clinical data, such as hospital admission, intensive care unit (ICU) admission, death, and hospital stay. Results The final sample included 304 patients (144 females, 160 males) with a mean age of 68 ± 19 std. Among them, 129 tested negative for COVID-19 and 175 tested positive. We used AI-generated opacity quantification, compared to radiologists' reports, to create receiver operating characteristic curves. The area under the curve ranged from 0.8 to 0.9 with a 95% confidence interval. We then adjusted opacity tests to a sensitivity cut-off of 95%. We found a significant association between these opacity tests and hospital admission and ICU admission (Chi-Squared, P < 0.05), as well as between the percentage of lung opacities and length of hospital stay (Spearman's rho 0.53–0.54, P < 0.05) in both groups. Conclusions During the SARS-CoV-2 pandemic, AI-based opacity tests demonstrated an association with certain prognostic markers in patients with suspected COVID-19 pneumonia, regardless of whether a PCR-confirmed coronavirus infection was ultimately detected

Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study.

BACKGROUND: In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain. METHODS: This multicentre, prospective, observational cohort study was done in three sexual health clinics in Madrid and Barcelona, Spain. We enrolled all consecutive patients with laboratory-confirmed monkeypox from May 11 to June 29, 2022. Participants were offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected by means of interviews conducted by dermatologists or specialists in sexually transmitted infections and were recorded using a standard case report form. Outcomes assessed in all participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV status, exposure to someone with monkeypox, travel, mass gathering attendance, risk factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first presentation, virological results at multiple body sites, co-infection with other sexually transmitted pathogens, and clinical outcomes 14 days after the initial presentation. Clinical outcomes were followed up until July 13, 2022. FINDINGS: 181 patients had a confirmed monkeypox diagnosis and were enrolled in the study. 166 (92%) identified as gay men, bisexual men, or other men who have sex with men (MSM) and 15 (8%) identified as heterosexual men or heterosexual women. Median age was 37·0 years (IQR 31·0-42·0). 32 (18%) patients reported previous smallpox vaccination, 72 (40%) were HIV-positive, eight (11%) had a CD4 cell count less than 500 cells per μL, and 31 (17%) were diagnosed with a concurrent sexually transmitted infection. Median incubation was 7·0 days (IQR 5·0-10·0). All participants presented with skin lesions; 141 (78%) participants had lesions in the anogenital region, and 78 (43%) in the oral and perioral region. 70 (39%) participants had complications requiring treatment: 45 (25%) had a proctitis, 19 (10%) had tonsillitis, 15 (8%) had penile oedema, six (3%) an abscess, and eight (4%) had an exanthem. Three (2%) patients required hospital admission. 178 (99%) of 180 swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs. Viral load was higher in lesion swabs than in pharyngeal specimens (mean cycle threshold value 23 [SD 4] vs 32 [6], absolute difference 9 [95% CI 8-10]; p<0·0001). 108 (65%) of 166 MSM reported anal-receptive sex. MSM who engaged in anal-receptive sex presented with proctitis (41 [38%] of 108 vs four [7%] of 58, absolute difference 31% [95% CI 19-44]; p<0·0001) and systemic symptoms before the rash (67 [62%] vs 16 [28%], absolute difference 34% [28-62]; p<0·0001) more frequently than MSM who did not engage in anal-receptive sex. 18 (95%) of 19 participants with tonsillitis reported practising oral-receptive sex. The median time from onset of lesions to formation of a dry crust was 10 days (IQR 7-13). INTERPRETATION: In our cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak. FUNDING: None

Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain : a prospective observational cohort study

In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain. This multicentre, prospective, observational cohort study was done in three sexual health clinics in Madrid and Barcelona, Spain. We enrolled all consecutive patients with laboratory-confirmed monkeypox from May 11 to June 29, 2022. Participants were offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected by means of interviews conducted by dermatologists or specialists in sexually transmitted infections and were recorded using a standard case report form. Outcomes assessed in all participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV status, exposure to someone with monkeypox, travel, mass gathering attendance, risk factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first presentation, virological results at multiple body sites, co-infection with other sexually transmitted pathogens, and clinical outcomes 14 days after the initial presentation. Clinical outcomes were followed up until July 13, 2022. 181 patients had a confirmed monkeypox diagnosis and were enrolled in the study. 166 (92%) identified as gay men, bisexual men, or other men who have sex with men (MSM) and 15 (8%) identified as heterosexual men or heterosexual women. Median age was 37·0 years (IQR 31·0-42·0). 32 (18%) patients reported previous smallpox vaccination, 72 (40%) were HIV-positive, eight (11%) had a CD4 cell count less than 500 cells per μL, and 31 (17%) were diagnosed with a concurrent sexually transmitted infection. Median incubation was 7·0 days (IQR 5·0-10·0). All participants presented with skin lesions; 141 (78%) participants had lesions in the anogenital region, and 78 (43%) in the oral and perioral region. 70 (39%) participants had complications requiring treatment: 45 (25%) had a proctitis, 19 (10%) had tonsillitis, 15 (8%) had penile oedema, six (3%) an abscess, and eight (4%) had an exanthem. Three (2%) patients required hospital admission. 178 (99%) of 180 swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs. Viral load was higher in lesion swabs than in pharyngeal specimens (mean cycle threshold value 23 [SD 4] vs 32 [6], absolute difference 9 [95% CI 8-10]; p<0·0001). 108 (65%) of 166 MSM reported anal-receptive sex. MSM who engaged in anal-receptive sex presented with proctitis (41 [38%] of 108 vs four [7%] of 58, absolute difference 31% [95% CI 19-44]; p<0·0001) and systemic symptoms before the rash (67 [62%] vs 16 [28%], absolute difference 34% [28-62]; p<0·0001) more frequently than MSM who did not engage in anal-receptive sex. 18 (95%) of 19 participants with tonsillitis reported practising oral-receptive sex. The median time from onset of lesions to formation of a dry crust was 10 days (IQR 7-13). In our cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak