Salidas laborales de los residentes de Pediatría. Datos del periodo 2014-2017 / Employment outcomes of residents of Paediatrics, 2014-2017 period

Introducción: dada la escasez de pediatras de nuestro sistema de salud y la necesidad de estos en Atención Primaria, donde cerca del 25% de las plazas están ocupadas por no especialistas en Pediatría, se quiso conocer el destino laboral inicial de los residentes que habían finalizado su periodo de formación en los últimos cuatro años. Metodología: se han recogido las salidas laborales de los residentes que han finalizado su periodo de rotación durante los años 2014-2017 en los hospitales españoles. La recogida se ha realizado por medio de los representantes de residentes de las comunidades autónomas y los vocales autonómicos de la Asociación de Pediatría de Atención Primaria. Resultados: se han recogido datos de las salidas laborales del 75,7% de los residentes, lo que supone conocer el destino laboral de 1263 residentes de los últimos cuatro años. La elección de Atención Primaria en el transcurso de estos años ha disminuido del 30,77 al 24,5%; igualmente han disminuido los trabajos en hospitalización o consultas hospitalarias que han descendido de un 43,8 a un 32,85%, mientras que la realización de guardias o cobertura de Urgencias ha aumentado y también ha subido el porcentaje de los que se dedican a la medicina privada. Conclusiones: el porcentaje de residentes que acude a Atención Primaria es insuficiente. El trabajo del pediatra está siendo de peor calidad, con aumento de los contratos de guardias y Urgencias. Está aumentando el porcentaje de residentes que se dirigen hacia la sanidad privada

Introduction: given the shortage of paediatricians in the Spanish health care system and the high demand for them in primary care, where approximately 25% of positions are filled by non-specialists in paediatrics, we wanted to know the initial employment destination of residents who had finished his training period in the last 4 years. Methodology: the work exits of residents who have completed their rotation period during the years 2014-2017 in Spanish hospitals have been collected. The collection was made through the representatives of residents of autonomous communities and auton mous members of the Primary Care Pediatric Association. Results: data were collected on the work exits of 75.7% of the residents, which means knowing the employment destination of 1263 residents of the last 4 years. The choice of primary care during these years has decreased from 30.77 to 24.5%, while hospitalization or hospital consultations have decreased from 43.8 to 32.85%, while the realization of guards or emergency coverage has increased and the percentage of those who dedicate themselves to private medicine has also increased. Conclusions: the percentage of residents who attend primary care is insufficient. The work of pediatrician is being of worse quality, with increased contracts of guards and emergencies. The percentage of residents heading towards private healthcare is increasing

Secondary asplenia as a complication of severe Meningococcal Sepsis.

We report the case of an 11-month-old infant who had a medical history of meningococcal septicaemia 6 months prior to this admission and presented to hospital with an episode of fever due to Streptococcus pneumoniae bacteraemia. During this second admission, an abdominal ultrasound scan revealed secondary asplenia.

Atuação do psicólogo no acompanhamento de pais de neonatos com malformação fetal / The psychologist's work assisting parents of newborns with fetal malformation

A gravidez é um momento importante na vida da mulher. Notam-se os desejos e as expectativas da família. A mãe imagina o bebê, relaciona-se com o feto, projeta como ele será, enfim, sonha um lugar no mundo para aquele que paradoxalmente não nasceu embora já esteja vivo e presente. O período de gestação é acompanhado por ansiedades específicas, assim sendo, o impacto da notícia de uma cardiopatia congênita no bebê pode tornar-se avassaladora. O bebê real tem um problema cardíaco o que desperta desamparo e regressão materna. Notam-se profundos desejos e expectativas ameaçando a dinâmica familiar. Objetivos: Refletir sobre a atuação do psicólogo junto à família de neonatos com malformação fetal. Métodos: Revisão narrativa da literatura na base de dados da Biblioteca Virtual, no período de 2009 a 2014. Conclusão: A atuação do psicólogo consiste em acompanhar a mãe, o bebê e a família desde o impacto da notícia da malformação. Trabalhar as emoções e fantasias, o luto simbólico do bebê imaginário e a possibilidade de morte. Reconstruir a história do bebê, o lugar que ele ocupará na família e detectar possíveis quadros psicopatológicos. A constituição de uma equipe multidisciplinar é fundamental para oferecer espaço de troca e rede de sustentação

Pregnancy is an important time in a woman's life. It is a time of desires and the family expectations; the mother imagines the baby, connects with the fetus, predicts what the baby will be like, and dreams about a place in the world for the one who, paradoxically, has not yet been born yet is already alive and present. The gestation period is accompanied by specific anxieties, therefore, the impact of the news of a congenital heart disease in the baby can be devastating. The real baby has a heart problem that provokes abandonment and maternal regression. Deep desires and expectations are observed that threaten the family's dynamics. Objective: To reflect on the psychologist's work with the family of the newborn with fetal malformation. Methods: A narrative review of the literature in the Biblioteca Virtual database from 2009 to 2014. Conclusion: The psychologist's work consists in assisting the mother, the baby and the family, from the time they receive the news of the malformation; working with emotions and fantasies, the symbolic mourning of the baby of their imaginations, and the possibility of death; reconstructing the history of the baby and the place he/she will occupy in the family; and detecting possible psychopathological conditions. The formation of a multidisciplinary team, which provides space for exchange of experiences and a support network, is crucial

Overview of the structure of all-AT oligonucleotides: organization in helices and packing interactions.

We present the crystalline organization of 33 all-AT deoxyoligonucleotide duplexes, studied by x-ray diffraction. Most of them have very similar structures, with Watson-Crick basepairs and a standard average twist close to 36 degrees. The molecules are organized as parallel columns of stacked duplexes in a helical arrangement. Such organization of duplexes is very regular and repetitive: all sequences show the same pattern. It is mainly determined by the stacking of the terminal basepairs, so that the twist in the virtual TA base step between neighbor duplexes is always negative, approximately -22 degrees. The distance between the axes of parallel columns is practically identical in all cases, approximately 26 A. Interestingly, it coincides with that found in DNA viruses and fibers in their hexagonal phase. It appears to be a characteristic distance for ordered parallel DNA molecules. This feature is due to the absence of short range intermolecular forces, which are usually due to the presence of CG basepairs at the end of the oligonucleotide sequence. The duplexes apparently interact only through their diffuse ionic atmospheres. The results obtained can thus be considered as intermediate between liquid crystals, fibers, and standard crystal structures. They provide new information on medium range DNA-DNA interactions.

X-ray diffraction analysis of internal wool lipids.

Polarised optical microscopy (POM) and X-ray diffraction techniques were applied to intercellular lipids extracted from wool to study their structural arrangement in order to determine their role in the diffusion properties of wool fibre. Intercellular wool lipids (IWL) arranged as concentrated liposomes were shown to be a good intercellular lipid model, allowing their study by X-ray diffraction techniques. The results confirm that intercellular lipids of wool fibre are organised in a lamellar structure of 5.0-8.0 nm width, termed beta-layer, which had been assumed to be lipids arranged as a bilayer. Structurally, internal wool lipids are distributed at least in two domains at low temperatures: an ordered phase made up of ceramides and free fatty acids (FFA) alone, arranged in crystal orthorhombic states separately, and a liquid crystal state when mixed together. At 40 degrees C there is a reversible phase transition produced by the melt of the crystal orthorhombic states, whereas the liquid crystal state remains until 65 degrees C.

Comblike complexes of bacterial poly(gamma,d-glutamic acid) and cationic surfactants.

The ability of microbally produced poly(gamma,d-glutamic acid) to form stable polyelectrolyte-opposite charged surfactant complexes was investigated. A sonicated sample of polyacid with a molecular weight about 10(5) Da and a content of d enantiomer higher than 90% was used in this study. Nearly stoichiometric complexes of poly(gamma,d-glutamate) anions and alkyltrimethylammonium cations bearing linear alkyl chains with even numbers of carbon atoms from 12 up to 22 were "synthesized" by precipitation from equimolar mixtures of aqueous solutions of the two components. All complexes were found to adopt stratified supramolecular structures made of alternating layers of poly(gamma,d-glutamate) and surfactant with a periodicity increasing from 3.2 up to 4.3 nm according to the length of the alkyl side chain. No definite evidence indicative of the conformation adopted by the main chain in these complexes could be afforded. In all cases, the alkyl chains are in an extended conformation and oriented normal or nearly normal to the layer planes. Polymethylene chains with more than 16 carbon atoms were partially crystallized in the complexes in a separated paraffinic phase, whereas no crystallinity was detected for shorter lengths. The crystallized paraffinic phases were found to melt reversibly at temperatures between 40 and 70 degrees C. This process was found to happen with a concomitant expansion-contraction that amounts between 2 and 8% of the long period of the structure but without significant alteration of the layered arrangement.

U3 snoRNP associates with fibrillarin a component of the scleroderma clumpy nucleolar domain.

Serum from patients with scleroderma recognizes the clumpy autoantigen. The present studies addressed the issue as to whether the clumpy nucleolar autoantigen recognized by scleroderma serum is fibrillarin-U3 snoRNP. Clones encoding for clumpy autoantigen were immunodetected from a lambdagt11 HeLa cell random-primed library with the serum from a patient with diffuse scleroderma and autoautoantibodies against clumpy autoantigen. Sequences from the recombinant phages were amplified by PCR and subcloned into a pCRII vector. The DNA was sequenced by a dideoxy termination reaction. Ten lambdagt11 clumpy clones were detected by immunoscreening. One containing the glycine-rich and RNP2 fibrillarin domains was expressed in lysogenic bacteria. The recombinant proteins were used to elicit antibodies in rabbits, and these exhibited clumpy nucleolar reactivity. The recombinant fibrillarin tested by ELISA was recognized by the clumpy scleroderma serum from the majority of patients. In situ hybridization assays showed that the fibrillarin tagged by the elicited antibodies was colocalized with U3 snoRNP in the nucleolus in a clumpy manner and coprecipitated the U3 snoRNP. In conclusion, the fibrillarin-U3 snoRNP complex is the major component of the clumpy subcellular domain. Therefore these molecules constitute an important target of scleroderma autoantibodies.

Complicaciones crónicas de la diabetes: enfermedad de Moenckeberg / Chronic complications of the diabetes: disease of moenckeberg

Analiza que las micro y macroangiopatías periféricas presentes en diabético, afectan a las extremidades inferiores a consecuencia de la enfermead metabólica crónica de base. En la actualidad, la diabetes puede provocar la muerte por las complicaciones vasculares de la enfermedad. Se ha establecido que, las arteriopatías y neuropatías son causas de las lesiones necróticas e infecciosas del pie diabético, más frecuente entre la sexta y séptima décadas de vida. Se presenta un estudio de la calcinosis que caracteriza a la enfermedad de Moenckeberg, que afecta a las capas diferentes capas arteriales y provocan la obliteración de las mismas, en relación con los factores metabólicos y biológicos de las complicaciones de la enfermedad de Moenckeberg a nivel de miembros inferiores y especialmente a nivel medio. El universo lo conformaron 80 pacientes con diagnóstico de diabetes mellitus, atendidos en el Servicio de Cirugía Vascular del Hospital Quito No. 1, perteneciente a la Policía Nacional.

Trombosis venosa profunda, Hospitales de Quito, período ene. 1992-dic. 1996 / Deep venous trombosis, Hospitals of Quito, period ene. 1992 dic. 1996

Expone que la trombosis venosa profunda (TVP) es una patología vascular de relativa frecuencia en nuestro medio. Con un universo de 839, mediante un estudio retrospectivo realizado en hospitales de Quito (Enrique Garcés, Pablo Arturo Suárez e Isidro Ayora pertenecientes al Ministerio de Salud Pública; Hospital Quito No. 1 de la Policía Nacional; y, Hospital General de las Fuerzas Armadas) se pretende demostrar algunas características de esta enfermedad. Los resultados demuestran condiciones propias de nuestra idiosincracia. Se analizan 839 pacientes en diferentes ámbitos.

Avaliaçäo dos níveis de ansiedade dos pacientes assistidos no Serviço de Reabilitaçäo Cardiovascular do Instituto Dante Pazzanese de Cardiologia / Evaluation of the levels of anxiety on patients assisted by the Service of Cardiovascular Rehabilitation of the Instituto Dante Pazzanese de Cardiologia

A ansiedade tem sido mencionada como um dos fatores relevantes para o desenvolvimento e manutençao das coronariopatias. Neste estudo avaliaram-se os níveis de ansiedade traço e estado de l00 pacientes assistidos pelo Serviço de Reabilitaçao Cardiovascular da Divisao de Diagnóstico e Terapêutica do Instituto Dante Pazzanese de Cardioiogia. Submetidos à aplicaçao do Inventário de Ansiedade Traço-Estado (IDATE) antes das atividades físicas, os pacientes que apresentaram estado de ansiedade acima da média populacional foram reavaliados após as atividades, com o objetivo de verificar se estas colaboravam para a diminuiçao dos níveis de ansiedade estado dos mesmos. Pelos resultados obtidos, pôde-se deduzir que os pacientes se beneficiaram com este procedimento, quanto à diminuiçao dos níveis de ansiedade estudados. Destacaram-se, também, a hostilidade e a sociabilidade caracterizando as formas de interre-laçoes. Em nível psicológico, os autores sugerem o uso de técnicas de relaxamento, dinâmicas de grupo e orientaçao psicológica como recursos utilizados para mudança de comportamento e estilo de vida do indivíduo, auxiliando-o a estabelecer um melhor funcionamento de seu psiquismo, bem como o equilíbrio homeostático.

Traços psicológicos dos pacientes submetidos a angioplastia transluminal coronária / Psychological profile of patients subjected to transluminal coronary angioplasty

Este trabalho teve por objetivo a identificaçao de traços psicológicos e características emocionais comuns aos pacientes que foram, pela primeira vez, submetidos a angioplastia transluminal coronária (ATC), no Instituto Dante Pazzanese de Cardiologia. Foram analisados 84 pacientes, de ambos os sexos, com idade média de 55 anos. Foram realizadas, pela equipe de psicólogos, duas entrevistas semidirigidas, durante cada uma das quais foram aplicados o Inventário de Ansiedade Traço - Estado (IDATE) e a Escala de Hamilton. Essas entrevistas foram realizadas imediatamente anterior à ATC e um dia após o procedimento, na alta dos pacientes. Os resultados permitiram-nos concluir que a grande maioria apresentou padrao comportamental tipo A, próprio do coronariano, alto estresse constitucional e ambiental e ansiedade - traço acima da média. Obtiveram alta porcentagem, também, as variáveis tensao, depressao, grau de competitividade e labilidade de humor.