Clinico-Pathological discrepancies in the Diagnosis of Causes of Maternal Death in Sub-Saharan Africa: Retrospective Analysis

Background Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. Methods and Findings A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n ¼ 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). Conclusions Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.

El recurso a la tiranía como respuesta a la dominación visigoda en la Tarraconense (siglos V-VI)

A finales del siglo V, la población hispanorromana contempló con disgusto el incremento de la presencia visigoda en tierras de la Tarraconense. Entre finales del siglo V e inicios del VI, dos individuos ―Burdunelo y Pedro― se alzaron con el poder de manera ilegal y acaudillaron revueltas contra el dominio visigodo. La fuente que nos informa de estos hechos, la Pseudo Chronica Caesaraugustana, es un texto altamente problemático: interpretado durante mucho tiempo como los restos de la historiola escrita por el obispo Máximo de Zaragoza (c. 599-614/620), en realidad se trata solo de unas anotaciones realizadas al margen de crónicas anteriores. Las vicisitudes de la transmisión manuscrita han provocado, además, el desplazamiento de algunas de estas anotaciones de su posición original, con lo que nos proporcionan dataciones erróneas. En este trabajo estudiamos las noticias relativas a las rebeliones de Burdunelo y de Pedro, realizamos una nueva propuesta de cronología, analizamos sus orígenes sociales y examinamos el alcance que pudieron tener estas sublevaciones en el contexto de un inminente enfrentamiento entre visigodos y francos.

La poética de Juan Carlos Onetti a través de sus artículos periodísticos

El presente ensayo analiza y verifica como en los artículos periodísticos de Onetti, escritos en su primera época, ya se dan las características y la visión de su posterior mundo de ficción. Se traza una línea paralela entre sus crónicas periodísticas y sus novelas o primeros cuentos para llegar a la Poética del autor.

Clinico-Pathological discrepancies in the Diagnosis of Causes of Maternal Death in Sub-Saharan Africa: Retrospective Analysis

Background Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. Methods and Findings A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n ¼ 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). Conclusions Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.

Estudio transdiciplinar de la fosa EE1 de la Cova Colomera (Prepirineo de Lleida): implicaciones domesticas y paleoambientales en el Bronce Antiguo del Noreste de la Peninsula Iberica

El estudio transdisciplinar de la fosa EE1 de la Cova Colomera ha proporcionado un conjunto de datos que aportan importante información sobre las prácticas domésticas y económicas desarrolladas en ella, y sobre las características paleoambientales de esta zona del noreste peninsular en el tránsito III-II milenio cal. AC. Los resultados apuntan a que esta cueva fue ocupada por grupos reducidos, con una economía mixta agropecuaria, que recurrían también a actividades cinegéticas para completar su dieta. En sus cortas estancias en la Cova Colomera, crearon y amortizaron estructuras excavadas en el suelo de la cavidad, como la fosa EE1, bien para almacenar excedentes y después desechar basura, o bien para eliminar residuos de origen doméstico.

El Jardín de Falerina, Francisco de Rojas Zorrilla, Antonio Coello Ochoa y Pedro Calderón de la Barca. Edición, introducción y notas de Felipe B. Pedraza Jiménez y Rafael González Cañal, (Barcelona: Octaedro, 2010)

Parece mentira que una pieza teatral firmada por Calderón de la Barca haya tardado más de tres cientos años en aparecer impresa y que sea ahora,en el 2010, cuando lo haga por primera vez. ¿A qué se debe esta falta de interés por la obra?La respuestanos la ofrecen Felipe B. Pedza Jiménez y Rafael González Cañal en el capítulo que abre el estudio preliminar de su edicion tulado«Razones de una sin razón»

Nihilismo y voluntad de engaño en El astillero, de Juan Carlos Onetti

En este artículo se estudia la novela El astillero de Juan Carlos Onetti a la luz de los conceptos nietzscheanos de"nihilismo" y"voluntad de engaño"

Dual activation of pathways regulated by steroid receptors and peptide growth factors in primary prostate cancer revealed by Factor Analysis of microarray data

Background: We use an approach based on Factor Analysis to analyze datasets generated for transcriptional profiling. The method groups samples into biologically relevant categories, and enables the identification of genes and pathways most significantly associated to each phenotypic group, while allowing for the participation of a given gene in more than one cluster. Genes assigned to each cluster are used for the detection of pathways predominantly activated in that cluster by finding statistically significant associated GO terms. We tested the approach with a published dataset of microarray experiments in yeast. Upon validation with the yeast dataset, we applied the technique to a prostate cancer dataset. Results: Two major pathways are shown to be activated in organ-confined, non-metastatic prostate cancer: those regulated by the androgen receptor and by receptor tyrosine kinases. A number of gene markers (HER3, IQGAP2 and POR1) highlighted by the software and related to the later pathway have been validated experimentally a posteriori on independent samples. Conclusion: Using a new microarray analysis tool followed by a posteriori experimental validation of the results, we have confirmed several putative markers of malignancy associated with peptide growth factor signalling in prostate cancer and revealed others, most notably ERRB3 (HER3). Our study suggest that, in primary prostate cancer, HER3, together or not with HER4, rather than in receptor complexes involving HER2, could play an important role in the biology of these tumors. These results provide new evidence for the role of receptor tyrosine kinases in the establishment and progression of prostate cancer.

Ana Ozores y su papel en el cuarto acto de Don Juan Tenorio

Don Juan Tenorio de Zorrilla está en la raíz de la composición de la Regenta, la extraordinaria novela de Clarín, y él deja pistas en el texto para que el lector pueda verlo.

Garcilaso de la Vega y Pedro Salinas: la voz a ti debida

This paper shows the relationship between two Spanish writers: Garcilaso de la Vega and Pedro Salinas; or better, the influence of the former over the latter. This influence may be noticed in different levels: the use of literary genres (eclogues, elegies or collections of verse), the conception of love, the use of myths and topics, the music of verse, etc. Some characteristics of Salinas’s style come clearly from Garcilaso (the intimacy, simplicity, orality, the dialogue, the use of the present tense and the first person, etc.). Our essay studies the influence of Garcilaso on the book Largo lamento, 1937?, written by Salinas at the same time as an essay about the renaissance poet —in addition of other unpublished works and his personal correspondence—, in order to show the presence of Garcilaso in his mind and all of his production

AR 117: viviendas en Alcázar de San Juan

Postprint (published version)

El Texto literario en el aula de español como lengua extranjera: Propuesta de programación didáctica: Últimas tardes con Teresa, de Juan Marsé

El treball aprofundeix en la importància dels textos literaris originals en les classes d’ELE (Espanyol com a Llengua Estrangera). S’estudien les principals línies de pensament sobre l’ensenyament de la literatura a l’aula d’ELE, i l’evolució de l’ensenyament. Es defensa que mitjançant l’ús de textos literaris originals els estudiants poden percebre una mostra de la diversitat expressiva de la llengua

La Transmisión textual de las Mémories de Philippe de Commynes en las traducciones de Felipe (1636) y Juan de Vitrián (1643)

Análisis de las traducciones de Felipe Vitrián (1936) y de Juan Vitrián (1643) de la obra de Philippe de Commynes “Mémoires”

A topical microemulsion for the prevention of allergic rhinitis symptoms: results of a randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial (Nares study)

Background: Since barrier protection measures to avoid contact with allergens are being increasingly developed, we assessed the clinical efficacy and tolerability of a topical nasal microemulsion made of glycerol esters in patients with allergic rhinitis. Methods: Randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial in which adult patients with allergic rhinitis or rhinoconjunctivitis due to sensitization to birch, grass or olive tree pollens received treatment with topical microemulsion or placebo during the pollen seasons. Efficacy variables included scores in the mini-RQLQ questionnaire, number and severity of nasal, ocular and lung signs and symptoms, need for symptomatic medications and patients" satisfaction with treatment. Adverse events were also recorded. Results: Demographic characteristics were homogeneous between groups and mini-RQLQ scores did not differ significantly at baseline (visit 1). From symptoms recorded in the diary cards, the ME group showed statistically significant better scores for nasal congestion (0.72 vs. 1.01; p = 0.017) and mean total nasal symptoms (0.7 vs. 0.9; p = 0.045). At visit 2 (pollen season), lower values were observed in the mini-RQLQ in the ME group, although there were no statistically significant differences between groups in both full analysis set (FAS) and patients completing treatment (PPS) populations. The results obtained in the nasal symptoms domain of the mini-RQLQ at visit 2 showed the highest difference (−0.43; 95% CI: -0.88 to 0.02) for the ME group in the FAS population. The topical microemulsion was safe and well tolerated and no major discomforts were observed. Satisfaction rating with the treatment was similar between the groups. Conclusions: The topical application of the microemulsion is a feasible and safe therapy in the prevention of allergic symptoms, particularly nasal congestion.