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Molecular epidemiology of circulating clinical isolates is crucial to improve prevention strategies. The Spanish Working Group on multidrug resistant tuberculosis (MDR-TB) is a network that monitors the MDR-TB isolates in Spain since 1998. The aim of this study was to present the study of the MDR-TB and extensively drug-resistant tuberculosis (XDR-TB) patterns in Spain using the different recommended genotyping methods over time by a national coordinated system. Based on the proposed genotyping methods in the European Union until 2018, the preservation of one method, MIRU-VNTR, applied to selected clustered strains permitted to maintain our study open for 20 years. The distribution of demographic, clinical and epidemiological characteristics of clustered and non-clustered cases of MDR/XDR tuberculosis with proportion differences as assessed by Pearson’s chi-squared or Fisher’s exact test was compared. The differences in the quantitative variables using the Student's-t test and the Mann–Whitney U test were evaluated. The results obtained showed a total of 48.4% of the cases grouped in 77 clusters. Younger age groups, having a known TB case contact (10.2% vs 4.7%) and XDR-TB (16.5% vs 1.8%) were significantly associated with clustering. The largest cluster corresponded to a Mycobacterium bovis strain mainly spread during the nineties. A total of 68.4% of the clusters detected were distributed among the different Spanish regions and six clusters involving 104 cases were grouped in 17 and 18 years. Comparison of the genotypes obtained with those European genotypes included in The European Surveillance System (TESSy) showed that 87 cases had become part of 20 European clusters. The continuity of MDR strain genotyping in time has offered a widespread picture of the situation that allows better management of this public health problem. It also shows the advantage of maintaining one genotyping method over time, which allowed the comparison between ancient, present and future samples.

No abstract

Objectives: To illustrate the technical simplicity and additional diagnostic value of looking at the bladder and the ureters during a standard transvaginal ultrasound examination. Methods: We present a case series illustrating ureter and bladder pathology diagnosed by transvaginal ultrasound.

Poster discussion Hub abstracts a gradual reduction can be observed at the end of gestation with a mean value of 0.6 square cm. Enlargement or underdevelopment of the cavum septi pellucidi/cavum vergae area were found in different chromosomal and structural malformations. Conclusions: 3D neurosonography serves as an excellent tool to measure the area of the fetal cavum septi pellucidi/cavum vergae in the median plane. Deviations from the normal size can be precisely detected. P16.11Reproducibility of second and third trimester threedimensional placental measurements

Objectives: Difference in nuchal translucency and T21 risk calculation between mid-sagittal section and mid-sagittal section also showing maxilla and nasal bone. Methods: We evaluate fetus (n = 1242) with CRL was 65 to 84 mms. 2D sections were obtained of NT in mid-sagittal plane as per FMF criteria (maxilla not to be seen) and about 5-degree oblique plane where maxilla along with nasal bone are visible in midsagittal plane were documented. NT was measured by auto NT calculation in GE Voluson E10. Risk for Down syndrome was calculated in Astraia gmbh FMF approved software. Results: We were able to get NT section in 98% and 96% in section showing NB, Maxilla and NT. There was a fixed error of NT of 0.2 mm between both sections. Mid sagittal section as per FMF was lower. Risk for T21 was not showing significant difference. When mother was less than 35 years, calculated risk difference was < 4%. When mother was above 35 years' risk varied up to 6%. As per new algorithm by FMF, NIPT is recommended when risk is intermediate between 1:10 to 1:3000. More than 97% of patients did not shifted from low, intermediate or high-risk group without change in clinical manage. Conclusions: Ease of following fewer rigid criteria will increase the NT users and will be beneficial to society, where less professionals are available who can perform first trimester screening. If NT as per FMF criteria is difficult to be obtained, one can consider NT at a mid-sagittal section where NT and NB are seen with maxilla. It will not make a significant difference in risk calculation for Trisomy 21.

We monitored the prenatal fetal growth, hemodynamics and neonatal outcome in TTTS twins following laser treatment with intrauterine closure of ductus venous in one fetus to identify the perinatal effects of intrauterine closure of fetal ductus venous. The growth and hemodynamics of the twins was monitored by ultrasound every two weeks from16 weeks of pregnancy. The fetal weight and other indicators, the parameters of DV, MCA, UA, UV were recorded. Copy number variations were detected. Hemodynamics was monitored daily and fetal growth was measured weekly after DV closure happened in one fetus at 31 weeks. Body weight, relative liver volume and parameters of DV, MCA, UA, UV were recorded. Caesarean section was performed until 34+4 weeks. After birth, neonatal DV, growth and blood, main organs of the twins were examined. All data was compared retrospectively. The results showed that compared with the fetus with opening ductus venous, in the fetus with closed ductus venous the hemodynamics parameters of MCA, UA, UV kept normal, the body weight and relative liver volume were slightly increased, and after birth, ammonia, galactose, total bile acid in blood, coagulation and liver function were also in the normal range, the degree of anemia was less severe, and the main organs developed normally. No clinically relevant CNV was detected prenatally. The data suggested that fetus with the third trimester intrauterine closure of ductus venous can keep intrauterine growth more than 3 weeks. The ductus venous closure stimulates the increase of body weight and relative liver volume. Neonatal outcomes are better than the other fetus of the twins with delayed closure of ductus venous who has adverse outcomes like acute respiratory distress syndrome (ARDS) and acute necrotising enterocolitis (NEC).

Split notocord syndrome is an extremely rare form of spinal dysraphism with an endoectodermal fistula opening in the dorsal area, associated with gastrointestinal tract, central nervous system and urogenital anomalies. We present a case of split notocord syndrome with meningomyelocele and dorsal herniation of bowels in thoracolumbosacral region.