New magnetic chelating sorbent for chromium speciation by magnetic solid phase extraction on-line with inductively coupled plasma optical emission spectrometry.

A novel sorbent material employing magnetic nanoparticles (MNPs) coupled to graphene oxide (GO) functionalized with 4-aminobenzenesulfonic acid (M@GO-ABS) has been synthesized and applied to develop an inexpensive and automatic method for Cr(III) and Cr(VI) speciation in environmental samples; the developed method combines inductively coupled plasma optical emission spectrometry (ICP-OES) with on-line magnetic solid phase extraction (MSPE). Two magnetic-knotted reactors containing M@GO-ABS were installed in the eight-port injection valve of a flow injection (FI) manifold. Two different eluents were used, one for Cr(VI) (the most toxic chromium species) and one for total Cr concentration. Cr(III) concentration was calculated by the difference between Cr(VI) concentration and total Cr concentration. The optimized method presented detection limits (LOD, peak height) of 0.1 µg L-1 for chromium (VI) and 0.08 µg L-1 for total chromium, and enrichment factors of 15 and 23, respectively. Certified reference materials (TMDA 54.5 fortified lake water and SPS-SW2 surface water) and spiked aqueous samples were used to validate the developed method. The developed method was fruitfully applied to chromium speciation in environmental water samples such as seawater, well water and tap water collected in Málaga (Spain). The obtained values were in good agreement with the certified values, and the recoveries were found in the range of 91-108% for the spiked samples.

Semiautomatic method for the ultra-trace arsenic speciation in environmental and biological samples via magnetic solid phase extraction prior to HPLC-ICP-MS determination.

A novel magnetic functionalized material based on graphene oxide and magnetic nanoparticles (MGO) was used to develop a magnetic solid phase extraction method (MSPE) to enrich both, inorganic and organic arsenic species in environmental waters and biological samples. An automatic flow injection (FI) system was used to preconcentrate the arsenic species simultaneously, while the ultra-trace separation and determination of arsenobetaine (AsBet), cacodylate, AsIII and AsV species were achieved by high performance liquid chromatography combined with inductively coupled plasma mass spectrometry (HPLC-ICP-MS). The sample was introduced in the FI system where the MSPE was performed, then 1 mL of eluent was collected in a chromatographic vial, which was introduced in the autosampler of HPLC-ICP-MS. Therefore, preconcentration and separation/determination processes were automatic and conducted separately. To the best of our knowledge, this is the first method combining an automatic MSPE with HPLC-ICP-MS for arsenic speciation, using a magnetic nanomaterial based on MGO for automatic MSPE. Under the optimized conditions, the LODs for the arsenic species were 3.8 ng L-1 AsBet, 0.5 ng L-1 cacodylate, 1.1 ng L-1 AsIII and 0.2 ng L-1 AsV with RSDs <5%. The developed method was validated by analyzing Certified Reference Materials for total As concentration (fortified lake water TMDA 64.3 and seawater CASS-6 NRC) and also by recovery analysis of the arsenic species in urine, well-water and seawater samples collected in Málaga. The developed method has shown promise for routine monitoring of arsenic species in environmental waters and biological fluids.

Identification and validation of endogenous control miRNAs in plasma samples for normalization of qPCR data for Alzheimer's disease.

BACKGROUND: MicroRNAs (miRNAs) are noncoding RNAs that are highly relevant as disease biomarkers. Several studies that explored the role of miRNAs in Alzheimer's disease (AD) demonstrated their usefulness in clinical identification. Nevertheless, miRNAs that may act as endogenous controls (ECs) have not yet been established. The identification of ECs would contribute to the standardization of these biomarkers in AD. The objective of the study was to identify miRNAs that can be used as ECs in AD. METHODS: We evaluated 145 patients divided into two different cohorts. One was a discovery cohort of 19 women diagnosed with mild to moderate AD (Mini-Mental State Examination (MMSE) score ≥ 20) and with confirmed pathologic levels of Aß42 in CSF. The stability assessment cohort consisted of 126 individuals: 24 subjects without AD or any kind of dementia and negative for all core CSF biomarkers of AD, 25 subjects with MCI and negative for CSF biomarkers (MCI -), 22 subjects with MCI and positive for CSF biomarkers (MCI +), and 55 subjects with AD and positive for CSF biomarkers. In the discovery cohort, a profile of 384 miRNAs was determined in the plasma by TaqMan low-density array. The best EC candidates were identified by mean-centering and concordance correlation restricted normalization methods. The stability of the EC candidates was assessed using the GeNorm, BestKeeper, and NormFinder algorithms. RESULTS: Nine miRNAs (hsa-miR-324-5p, hsa-miR-22-5p, hsa-miR-103a-2-5p, hsa-miR-362-5p, hsa-miR-425-3p, hsa-miR-423-5p, hsa-let-7i-3p, hsa-miR-532-5p, and hsa-miR-1301-3p) were identified as EC candidates in the discovery cohort. The validation results indicated that hsa-miR-103a-2-5p was the best EC, followed by hsa-miR-22-5p, hsa-miR-1301-3p, and hsa-miR-425-3p, which had similar stability values in all three algorithms. CONCLUSIONS: We identified a profile of four miRNAs as potential plasma ECs to be used for normalization of miRNA expression data in studies of subjects with cognitive impairment.

Circulating MicroRNA Profile Associated with Obstructive Sleep Apnea in Alzheimer's Disease.

The diagnosis of obstructive sleep apnea (OSA) in Alzheimer's disease (AD) by polysomnography (PSG) is challenging due to the required collaboration of the patients. In addition, screening questionnaires have demonstrated limited usefulness with this subpopulation. Considering this, we investigated the circulating microRNA (miRNA) profile associated with OSA in AD patients. This study included a carefully selected cohort of females with mild-moderate AD confirmed by biological evaluation (n = 29). The individuals were submitted to one-night PSG to diagnose OSA (apnea-hypopnea index ≥ 15/h) and the blood was collected in the following morning. The plasma miRNA profile was evaluated using RT-qPCR. The patients had a mean (SD) age of 75.8 (5.99) years old with a body mass index of 28.6 (3.83) kg m-2. We observed a subset of 15 miRNAs differentially expressed between OSA and non-OSA patients, of which 10 were significantly correlated with the severity of OSA. Based on this, we built a prediction model that generated an AUC (95% CI) of 0.95 (0.88-1.00) including 5 of the differentially expressed miRNAs that correlated with OSA severity: miR-26a-5p, miR-30a-3p, miR-374a-5p, miR-377-3p, and miR-545-3p. Our preliminary results suggest a plasma miRNA signature associated with the presence of OSA in AD patients. Further studies will be necessary to validate these findings.

Neuropsychiatric symptoms and quality of life in Spanish patients with Alzheimer's disease during the COVID-19 lockdown.

BACKGROUND AND PURPOSE: The COVID-19 epidemic is affecting almost all individuals worldwide, and patients with Alzheimer's disease (AD) and amnesic mild cognitive impairment (MCI) are particularly at risk due to their characteristics and age. We analysed the impact of the pandemic on these patients' neuropsychiatric symptoms and their quality of life after 5 weeks of lockdown in Spain. METHODS: A total of 40 patients with a diagnosis of MCI (n = 20) or mild AD (n = 20) from the Cognitive Stimulation Program of the Cognitive Disorders Unit were evaluated. All patients had undergone a previous evaluation during the month before the lockdown, and were re-evaluated after 5 weeks of lockdown. The Neuropsychiatric Inventory (NPI) and EuroQol-5D questionnaire (EQ-5D) were used to assess neuropsychiatric symptoms in patients and the quality of life in patients as well in caregivers. RESULTS: The mean (SD) total baseline NPI score was 33.75 (22.28), compared with 39.05 (27.96) after confinement (P = 0.028). The most frequently affected neuropsychiatric symptoms were apathy [4.15 (3.78) vs. 5.75 (4.02); P = 0.002] and anxiety [3.95 (3.73) vs. 5.30 (4.01); P = 0.006] in patients with MCI, and apathy [2.35 (2.70) vs. 3.75 (3.78); P = 0.036], agitation [0.45 (1.14) vs. 1.50 (2.66); P = 0.029] and aberrant motor behaviour [1.25 (2.86) vs. 2.00 (2.93); P = 0.044] in patients with AD. We did not observe differences in EQ-5D scores during the re-evaluation. The 30% of patients and 40% of caregivers reported a worsening of the patients' health status during confinement. CONCLUSIONS: The results of this study show the worsening of neuropsychiatric symptoms in patients with AD and MCI during 5 weeks of lockdown, with agitation, apathy and aberrant motor activity being the most affected symptoms.

Cognitive-motor interference during gait in patients with Multiple Sclerosis: a mixed methods Systematic Review.

BACKGROUND: Cognitive-motor interference (CMI) has been proposed as a valid marker of daily life impairment in Multiple Sclerosis (MS). The heterogeneity and scarce number of studies regarding CMI in MS has hampered the synthesis of the existing evidence. The present systematic review employed a mixed methods approach with the aim of identifying and describing variables under which CMI is particularly useful to assess patients with MS. RESULTS: MS patients showed significant CMI. The motor variables that were most sensitive in detecting significant CMI were velocity (m/s), cadence (steps/min), and double support (% gait cycle), which was also specific for MS. Among the cognitive tasks, Alternate Alphabet and Serial Subtracting 7 s were sensitive, whereas Verbal Fluency were both sensitive and specific to CMI in MS. CONCLUSIONS: CMI should be assessed in MS with a standardised dual task such as the Verbal Fluency task while walking, with measurements of the double support time and the effect on the cognitive task. The clinical usefulness of CMI in the assessment of patients with MS is discussed.

Surgeons - Anatomists of the 'camp de Tarragona'. Soldiers equipped with an academic plan

At the end of the 17th Century the university training of surgery in Spain depended on the traditional faculties of medicine in the universities. In these faculties ‘teaching continued to be conceived as an oral apprenticeship based on memory, and the theoretical principles of the Renaissance’ (Granjel, 1979). Training in surgery was dependent on the badly equipped Departments of Anatomy, where anatomy and surgery were taught. The work ‘Institutions of Surgery’ of Luis Mercado, published in 1599 by order of Felipe II, continued to be recommended. Felipe II prohibited ‘foreign travel to study or learn or reside in foreign universities or the study in their colleges …’ (Ferrer, 1968). These Departments trained many university surgeon - so called ‘Latin surgeons’ because they spoke Latin - who were ill prepared (Massons, 2002), with the result that the greater part of the population were treated by barbers or romance surgeons - surgeons without university training who had learnt from another surgeon (Vallribera i Puig, 1987). There was also much 'practice' with no training at all (Bustos Rodriguez, 1983). The evolution of a surgery eminently practical at the beginning of the 18th Century to surgical practice based on a solid training programme and scientific principals cannot be explained in Spain without the participation of an interrelated group of surgeons, all of them from the same birthplace, the ‘Camp de Tarragona’ (AU)

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Thermoresponsive microgels at the air-water interface: the impact of the swelling state on interfacial conformation.

Poly(N-vinylcaprolactam) (PVCL) is a new temperature-responsive type of polymer microgel with improved biocompatibility as compared to more commonly used poly(N-isopropylacrylamide) (PNIPAM). Both polymers swell at low temperatures and collapse at high ones, showing a volume phase transition temperature (VPTT) around the physiological temperature. Exploring the interfacial characteristics of thermoresponsive microgels is important due to their potential application in emulsion based systems with tailored stabilities and controlled degradation profiles. In this work, we study the properties of charged PVCL particles at the air-water interface by a combination of adsorption, dilatational rheology and Langmuir monolayers. Although PVCL particles adsorb spontaneously at the air-water interface in both, swollen and collapsed conformations, the interfacial properties show significant differences depending on the swelling state. In particular, the total amount of adsorbed microgels and the rigidity of the monolayer increase as the temperature increases above the VPTT, which is connected to the more compact morphology of the microgels in this regime. Dilatational rheology data show the formation of a very loose adsorbed layer with low cohesivity. In addition, collapsed microgels yield a continuous increase of the surface pressure, whereas swollen microgels show a phase transition at intermediate compressions caused by the deformation of the loose external polymer shell of the particles. We also provide a qualitative interpretation for the surface pressure behavior in terms of microgel-microgel effective pair potentials, and correlate our experimental findings to recent rescaling models that take into account the importance of the internal polymer degrees of freedom in the rearrangement of the conformation of the microgel particles at the interface.

Encuesta sobre el manejo perioperatorio de la hemostasia y transfusión en el trasplante hepático / Survey of hemostasis management and transfusion in liver transplantation

Objetivo. Conocer el manejo de la hemostasia y la práctica transfusional entre los anestesiólogos españoles en el ámbito del trasplante hepático. Método. Se elaboró un cuestionario dirigido a los facultativos especialistas en anestesiología y reanimación de todos los centros que realizan trasplante hepático en España. Los datos requeridos hacían referencia a los 12 meses previos a su distribución, desde el 1 de enero al 31 de diciembre de 2011. Resultados. Se recogieron datos de los 24 centros. Solo el 46% respondieron disponer de protocolos o guías de actuación para el manejo de la hemostasia. El 83% de los centros respondieron conocer el porcentaje de pacientes transfundidos, pero solo el 57% conocía la media de hemoderivados. La mitad respondió estar nada satisfecho con el manejo realizado. La tromboelastometría fue utilizada como método adicional de monitorización en el preoperatorio solo en el 8% de los centros y en un tercio durante el intraoperatorio. El 46% de los centros realizó corrección preoperatoria de los déficits de coagulación basados en test convencionales. En cuanto al consumo de hemoderivados, en el 57% de los centros la media de transfusión de concentrados de hematíes fue ≤ 4. El consumo de plasma fresco congelado fue muy variable, mientras que en el 100% de los centros se consumieron menos de 4 pools de plaquetas por paciente. Conclusiones. Existe una amplia variabilidad en el manejo de la hemostasia y en la práctica transfusional entre los centros españoles. No existen guías de manejo perioperatorio o no son utilizadas ampliamente. Las medias de hemoderivados transfundidos siguen siendo elevadas. Se aprecia un descenso en los centros que utilizan los nuevos métodos de monitorización (AU)

Objective. To determine the management of haemostasis and transfusion practice in the field of liver transplantation in Spain. Methods. A questionnaire was developed for physicians in anaesthesiology of all centres performing liver transplantation in Spain. The information required made reference to the 12 months prior to its distribution, from January 1 to December 31, 2011. Results. Data were collected from 24 centres in which liver transplantation is performed in Spain. Only 46% reported that they had protocols or practice guidelines for the management of haemostasis, and 83% of hospitals responded that they knew the percentage of transfused patients, but only 57% knew the mean transfusion. Regarding the degree of satisfaction with the management of haemostasis/coagulation, 50% said they were not satisfied. Thromboelastometry was used as an additional method of preoperative monitoring in only 8% of the centres and intra-operatively in one-third. Less than half (46%) of the centres performed preoperative correction of coagulation deficits based on conventional tests. The mean number of packed red cells used was ≤ 4 in 57% of centres. Consumption of fresh frozen plasma was highly variable, while 100% of centres consumed less than 4 pools of platelets per patient. Conclusions. There is a wide variability in the management of haemostasis and transfusion practice among Spanish centres. There are no guidelines or they are not widely used. The mean use of transfused blood products remain high. There was a decrease in centres using new methods of monitoring (AU)

Survey of hemostasis management and transfusion in liver transplantation.

OBJECTIVE: To determine the management of haemostasis and transfusion practice in the field of liver transplantation in Spain. METHODS: A questionnaire was developed for physicians in anaesthesiology of all centres performing liver transplantation in Spain. The information required made reference to the 12 months prior to its distribution, from January 1 to December 31, 2011. RESULTS: Data were collected from 24 centres in which liver transplantation is performed in Spain. Only 46% reported that they had protocols or practice guidelines for the management of haemostasis, and 83% of hospitals responded that they knew the percentage of transfused patients, but only 57% knew the mean transfusion. Regarding the degree of satisfaction with the management of haemostasis/coagulation, 50% said they were not satisfied. Thromboelastometry was used as an additional method of preoperative monitoring in only 8% of the centres and intra-operatively in one-third. Less than half (46%) of the centres performed preoperative correction of coagulation deficits based on conventional tests. The mean number of packed red cells used was ≤4 in 57% of centres. Consumption of fresh frozen plasma was highly variable, while 100% of centres consumed less than 4 pools of platelets per patient. CONCLUSIONS: There is a wide variability in the management of haemostasis and transfusion practice among Spanish centres. There are no guidelines or they are not widely used. The mean use of transfused blood products remain high. There was a decrease in centres using new methods of monitoring.

Ion permeation inside microgel particles induced by specific interactions: from charge inversion to overcharging.

In this work we have performed a theoretical study of a system formed by ionic microgels in the presence of monovalent salt with the help of Ornstein-Zernike integral equations within the hypernetted-chain (HNC) approximation. We focus in particular on analysing the role that the short-range specific interactions between the polymer fibres of the microgel and the incoming ions have on the equilibrium ion distribution inside and outside the microgel. For this purpose, a theoretical model based on the equilibrium partitioning effect is developed to determine the interaction between the microgel particle and a single ion. The results indicate that when counterions are specifically attracted to the polymer fibres of the microgel, an enhanced counterion accumulation occurs that induces the charge inversion of the microgel and a strong increase of the microgel net charge (or overcharging). In the case of coions, the specific attraction is also able to provoke the coion adsorption even though they are electrostatically repelled, and so increasing the microgel charge (true overcharging). Moreover, we show that ion adsorption onto the microgel particle is very different in swollen and shrunken states due to the competition between specific attraction and steric repulsion. In particular, ion adsorption occurs preferentially in the internal core of the particle for swollen states, whereas it is mainly concentrated in the external shell for de-swollen configurations. Finally, we observe the existence of a critical salt concentration, where the net charge of the microgels vanishes; above this inversion point the net charge of the microgels increases again, thus leading to reentrant stability of microgel suspensions.

Uso de la metodología Seis Sigma en la preparación de mezclas de nutrición parenteral / Use of the Six Sigma methodology for the preparation of parenteral nutrition mixtures

Objetivo: Usar las herramientas de la metodología Seis Sigma para el control estadístico de elaboración de mezclas de nutrición parenteral en el punto crítico de control gravimétrico. Métodos: Entre agosto de 2010 y septiembre de 2013 se realizó análisis gravimétrico al 100% de las mezclas dividiendo los datos en dos grupos adultos y neonatos. Se determina el porcentaje de aceptación, las gráficas de tendencia y el nivel de sigma. Se realizo análisis de normalidad con el test Shapiro Wilk y se calcula el porcentaje total de mezclas dentro de límites de especificación. Resultados: Los datos de gravimetría entre agosto de 2010 y septiembre de 2013 cumplen con el test de normalidad (W = 0,94) y presentan mejoramiento en el nivel de sigma a través del tiempo llegando a 6/6 en adultos y 3.8/6 para neonatos. Se logra que el 100% de las mezclas para adultos y neonatos cumplan con límites de especificación, estando siempre dentro de los límites de control del proceso. Conclusión: Los planes de mejoramiento junto a las herramientas de la metodología Seis Sigma permiten controlar el proceso, garantizando la concordancia entre la orden médica y el contenido de la mezcla

Objective: To use the tools of the Six Sigma methodology for the statistical control in the elaboration of parenteral nutrition mixtures at the critical checkpoint of specific density. Methods: Between August of 2010 and September of 2013, specific density analysis was performed to 100% of the samples, and the data were divided in two groups, adults and neonates. The percentage of acceptance, the trend graphs, and the sigma level were determined. A normality analysis was carried out by using the Shapiro Wilk test and the total percentage of mixtures within the specification limits was calculated. Results: The specific density data between August of 2010 and September of 2013 comply with the normality test (W = 0.94) and show improvement in sigma level through time, reaching 6/6 in adults and 3.8/6 in neonates. 100% of the mixtures comply with the specification limits for adults and neonates, always within the control limits during the process. Conclusion: The improvement plans together with the Six Sigma methodology allow controlling the process, and warrant the agreement between the medical prescription and the content of the mixture

[Use of the Six Sigma methodology for the preparation of parenteral nutrition mixtures]. / Uso de la metodología Seis Sigma en la preparación de mezclas de nutrición parenteral.

OBJECTIVE: To use the tools of the Six Sigma methodology for the statistical control in the elaboration of parenteral nutrition mixtures at the critical checkpoint of specific density. METHODS: Between August of 2010 and September of 2013, specific density analysis was performed to 100% of the samples, and the data were divided in two groups, adults and neonates. The percentage of acceptance, the trend graphs, and the sigma level were determined. A normality analysis was carried out by using the Shapiro Wilk test and the total percentage of mixtures within the specification limits was calculated. RESULTS: The specific density data between August of 2010 and September of 2013 comply with the normality test (W = 0.94) and show improvement in sigma level through time, reaching 6/6 in adults and 3.8/6 in neonates. 100% of the mixtures comply with the specification limits for adults and neonates, always within the control limits during the process. CONCLUSION: The improvement plans together with the Six Sigma methodology allow controlling the process, and warrant the agreement between the medical prescription and the content of the mixture.

Objetivo: Usar las herramientas de la metodología Seis Sigma para el control estadístico de elaboración de mezclas de nutrición parenteral en el punto crítico de control gravimétrico. Métodos: Entre agosto de 2010 y septiembre de 2013 se realizó análisis gravimétrico al 100% de las mezclas dividiendo los datos en dos grupos adultos y neonatos. Se determina el porcentaje de aceptación, las gráficas de tendencia y el nivel de sigma. Se realizo análisis de normalidad con el test Shapiro Wilk y se calcula el porcentaje total de mezclas dentro de límites de especificación. Resultados: Los datos de gravimetría entre agosto de 2010 y septiembre de 2013 cumplen con el test de normalidad (W = 0,94) y presentan mejoramiento en el nivel de sigma a través del tiempo llegando a 6/6 en adultos y 3.8/6 para neonatos. Se logra que el 100% de las mezclas para adultos y neonatos cumplan con límites de especificación, estando siempre dentro de los límites de control del proceso. Conclusión: Los planes de mejoramiento junto a las herramientas de la metodología Seis Sigma permiten controlar el proceso, garantizando la concordancia entre la orden médica y el contenido de la mezcla.

Development and validation of the Spanish Hazard Perception Test.

OBJECTIVE: The aim of the current study is to develop and obtain valid evidence for a hazard perception test suitable for the Spanish driving population. To obtain valid evidence to support the use of the test, the effect of hazardous and quasi-hazardous situations on the participants' hazard prediction is analyzed and the pattern of results for drivers with different driving experience--that is, learner, novice, and expert drivers and reoffender vs. nonoffender drivers--is compared. Potentially hazardous situations are those that develop without involving any real hazard (i.e., the driver did not actually have to decelerate or make any evasive maneuver to avoid a potential collision). The current study analyzed repeat offender drivers attending compulsory reeducation programs as a result of reaching the maximum number of penalty points on their driving license due to repeated violations of traffic laws. METHOD: A new video-based hazard perception test was developed, using a total of 20 hazardous situation videos plus 8 quasi-hazardous situation videos. They were selected from 167 recordings of natural hazards in real Spanish driving settings. RESULTS: The test showed adequate psychometric properties and evidence of validity, distinguishing between different types of drivers. Psychometric results confirm a final version of the hazard perception test composed of 11 video clips of hazards and 6 video clips of quasi-hazards, for which an overall Cronbach's alpha coefficient of.77 was obtained. A lack of ability to detect quasi-hazards and distinguish them from hazardous situations was also found for learner, novice, and reoffender drivers. Learner drivers obtained lower average scores than novice and experienced drivers with the hazardous situation videos, and learner drivers obtained lower average scores than experienced drivers with the quasi-hazardous situation videos, suggesting that the ability to correctly identify hazardous traffic situations may develop early by accumulating initial driving experience. However, the ability to correctly identify quasi-hazardous situations may develop later with the accumulation of further driving experience. Developing this ability is also difficult for reoffender drivers. CONCLUSION: The test has adequate psychometric properties and is useful in distinguishing between learner, novice, and expert drivers. In addition, it is useful in that it analyzes the performance of both safe and unsafe drivers (reoffenders who have already lost their driving license).

Afectación pulmonar en recién nacidos prematuros: asistenciarespiratoria, características perinatales y comorbilidad / Pulmonary affectation in premature newborns: breathing support, perinatal characteristics and comorbidity

Introducción. La patología respiratoria es muy importante en los recién nacidos prematuros, viéndose en ocasiones agravada por la asistencia respiratoria empleada. La morbilidad respiratoria continúa en estos niños durante la edad escolar, e incluso en la edad adulta. El objetivo de nuestro estudio fue estudiar la patología pulmonar en los recién nacidos prematuros de edad gestacional inferior o igual a 32 semanas y la asistencia respiratoria proporcionada. Material y métodos. Estudio descriptivo y retrospectivo de los neonatos prematuros (≤ 32 semanas), ingresados en el Complejo Asistencial Universitario de León entre 2005 y 2010. Se recogieron datos acerca de la patología y asistencia respiratoria, morbilidad asociada y otros tratamientos. Resultados. Se incluyeron 64 neonatos, 25 varones y 39 mujeres, con un peso medio al nacer de 1.240 gramos (rango 578-2.660 gramos) y una edad gestacional media de 29,11 semanas (rango 23-32 semanas). Se realizó maduración pulmonar prenatal con corticoides en 44. Fueron tratados con surfactante 33. Precisaron oxigenoterapia 56, ventilación no invasiva (cPAP) 18 y ventilación mecánica convencional 34, siendo su uso y duración mayor en el grupo de prematuros menores de 30 semanas de edad gestacional. Fueron diagnosticados de displasia broncopulmonar 15 pacientes. Presentaron sepsis durante su ingreso 34 y persistencia del ductus arterioso 12. El tiempo medio de hospitalización fue de 50,07 días y al alta precisaron oxigenoterapia domiciliaria 8 pacientes. Dos neonatos fallecieron durante su ingreso. Conclusiones. Los prematuros de menor edad gestacional presentaron mayor morbilidad y precisaron mayor asistencia y terapéutica respiratoria, a pesar de que dicha asistencia se realizó siempre de manera que se minimizara la posible iatrogenia (AU)

Introduction. Respiratory diseases are important in preterm infants, being sometimes aggravated by mechanical ventilation. Respiratory morbidity persists at school age, and even in adulthood. The aim of our study was to study the lung pathology in newborn infants of gestational age less than or equal to 32 weeks and provided ventilation. Methods. Retrospective descriptive study of preterm infants (≤ 32 weeks) admitted to Complejo Asistencial Universitario de León between 2005 and 2010. We collected data on the pathology and respiratory care, morbidity and other treatments. Results: We included 64 neonates, 25 males and 39 females with a mean birth weight of 1,240 grams (range 578- 2,660 grams) and a mean gestational age of 29.11 weeks (range 23-32 weeks). Prenatal lung maturation was performed in 44. 33 were treated with surfactant. 56 needed oxygen, 18 non invasive ventilation (CPAP) and 34 conventional mechanical ventilation, witch was longer and greater in the group of infants with gestational age less than 30 weeks. Bronchopulmonary dysplasia was diagnosed in 15 patients. Sepsis during admission was diagnosed in 34 and patent ductus arteriosus in 12. The average time of hospitalization was 50.07 days and at discharge 8 patients needed oxygen at home. Two infants died during their admission. Conclusions. The lower gestational age infants had a higher morbidity and required more respiratory assistance and therapy, although such assistance was always performed so as to minimize the possible iatrogenic (AU)

Epidemiología de la neumonía adquirida en la comunidad en pacientes pediátricos hospitalizados / Epidemiology of community acquired pneumonia in hospitalized pediatric patients

Objetivos: Identificar las posibles etiologías infecciosas bacterianas en los niños ingresados con neumonía adquirida en la comunidad en el Complejo Asistencial de León a lo largo de un año y conocer sus características epidemiológicas, clínicas y tratamientos pautados. Materiales y métodos: Se diseña un estudio observacional, descriptivo y transversal. Se incluyen niños, con edades entre 1 mes y 14 años, hospitalizados con diagnóstico de neumonía adquirida en la comunidad o bronconeumonía durante el período comprendido entre el 1 de junio del2005 y el 31 de mayo de 2006 en el Complejo Asistencial de León. Se recogieron datos demográficos, ambientales, clínicos, radiológicos, analíticos y de tratamiento. Resultados: Forman parte de la muestra 78 pacientes. La edad media fue de 45,8 ± 31,3 meses. La mayoría de los episodios se produjeron en los meses de otoño e invierno(37,2 y 29,5%, respectivamente). 18 pacientes presentaron una neumonía bacteriana típica (23%), y 5 pacientes una neumonía atípica (6,4%), quedando un 70,5% sin catalogar su etiología. Comparando los 2 primeros grupos no se vio ningún dato que mostrara de manera significativa diferencias entre ambos. Sin embargo el primer grupo mostró un porcentaje mayor de neumonías necrotizantes que precisaron drenaje pleural. Conclusión: La neumonía adquirida en la comunidad o la bronconeumonía en niños presenta una elevada morbilidad. El diagnóstico etiológico es una tarea difícil. El neumococo tiene un papel muy importante en este tipo de infección (AU)

Objectives: Identify the possible bacterial infectious etiologies in hospitalized children with community acquired pneumonia in the Complejo Asistencial of Leon during one year and know their epidemiological and clinical characteristics and treatments prescribed. Materials and methods: An observational, descriptive and cross-sectional study was designed. Children whose ages ranges from 1 month to 14 years who were hospitalized with the diagnosis of community acquired pneumonia or bronchopneumonia during the period ranging from June 1, 2005to May 31, 2006 in the Complejo Asistencial of León was designed. Demographic, environmental, clinical, radiological, laboratory analysis and treatment data were collected. Results: A total of 78 patients made up the sample. Mean age was 45.8 ± 31.3 months. Most of the episodes occurred in the months of fall and winder (37.2% and 29.5%, respectively).A total of 18 patients had typical bacterial pneumonia(23%), and 5 patients atypical pneumonia (6.4%), and there is 70.5% in whom the etiology has not been classified. Comparing the first 2 groups, no data that significantly showed any differences between both were found. However, he first group showed a greater percentage of necrotizing pneumonia that required pleural drainage. Conclusion: Community acquired pneumonia or bronchopneumonia in children has an elevated morbidity. The etiological diagnosis is a difficult task. Pneumoccocus plays a very important role in this type of infection (AU)

Características perinatales del recién nacido hijo de madre inmigrante en el Complejo Asistencial de León / Perinatal characteristics of the newborn child of an immigrant mother in the Health Care Complex of León

Antecedentes y objetivos: Conocer las características perinatales de los recién nacidos hijos de madre inmigrante en el Complejo Asistencial de León. Métodos: Se recogen datos de los neonatos nacidos en nuestro Hospital, hijos de madre inmigrante, durante un periodo de cuatro meses. La muestra consta de un total de521 recién nacidos, de los cuales 60 son hijos de madre inmigrante(11,5%). Los datos analizados son: sexo, nacionalidad, edad materna, paridad, control, edad e incidencias de la gestación, tiempo de amniorrexis, tipo de parto, riesgo infeccioso, características antropométricas, incidencias y duración del ingreso. Resultados: En nuestra muestra de recién nacidos hijos de madre inmigrante predomina sexo femenino (34/60 vs222/461), mayor número de partos prematuros de ≤ 36 semanas(6/60 vs 15/461, p:0,011, OR: 3,38, IC-95%: 2,39-4,37),menor edad de las madres inmigrantes (25,9±5,1 vs 31,6±5,3,p<0,001) y menor número de primíparas entre las mismas(31/60 vs 273/461). Predomina en inmigrantes el embarazo no controlado (6/60 vs 1/461, p<0,000), mayor tiempo de amniorrexis (8,0±9,8 vs 5,4±7,2, p:0,055) y de riesgo de infección vertical (37/60 vs 164/461, p:0,000, OR: 2,83, IC-95%: 2,27-3,39). Las inmigrantes presentan menos hipotiroidismo y diabetes gestacional y más infecciones de orina y amenazas de aborto, siendo los resultados no significativos. En inmigrantes son más frecuentes los partos eutócicos(38/60 vs 262/461). Los recién nacidos hijos de madre inmigrante tienen características antropométricas similares a los hijos de madre española y padecen las mismas incidencias durante su ingreso en la Unidad de Neonatología. Conclusiones:- El 11,5% de nuestros recién nacidos son hijos de inmigrantes.- Las madres extranjeras son más jóvenes y con una gestación menos controlada que las nacionales.- Tienen mayor número de partos prematuros y mayor riesgo de infección por transmisión vertical (AU)

Background and Objectives: To determine the perinatal characteristics of the newborn son of immigrant mothers in the Complejo Asistencial de Leon. Methods: We collected data from infants born in our hospital, children of immigrants, over a period of four months. The sample consists of a total of 521 infants, 60 of whom are children of immigrant mothers (11.5%). The data analyzed are: Sex, nationality, maternal age, parity, control, age and incidences of gestation, amniorrhexis time, type ofdelivery, risk of infection, anthropometric characteristics, incidence and duration of admission. Results: In our sample of immigrants dominates female(34/60 vs 222/461, p: 0.27), a greater number of miscarriages of ≤ 36 weeks (6/60 vs. 15/461, p: 0011, OR: 3.38,-95% CI:2.39-4.37), younger mothers immigrants (25.9 ± 5.1 vs 31.6± 5.3, p <0001) and fewer primiparous (31/60 vs 273/461).No controlled pregnancy predominates in inmigrants (6/60vs 1/461, p <0.000), longer time of amniorrhexis (8.0 ± 9.8vs. 5.4 ± 7.2, p : 0.055) and risk of vertical infection (37/60vs 164/461, p:0.000, OR: 2.83, IC-95%: 2.27-3.39). The immigrants have less hypothyroidism and gestational diabetes, and more urinary infections and threats of abortion, with no significant results. In immigrants are more frequent eutocicdeliveries (38/60 vs 262/461). The newborn children of immigrant mothers have anthropometric characteristics similar to the children of Spanish mother and suffer the same incidents during his admission to the neonatal unit. Conclusions:- 11.5% of our newborn is son of immigrant mother.- The foreign mothers are younger, with more children and a less controlled gestation than national ones.- There is a greater number of premature births and a higher risk of infection by vertical transmission (AU)