Really does temperature reduction and norepinephrine have similar effects on the energy metabolism in rat brown adipose tissue?

CONTEXT: Heat generation by brown adipose tissue (BAT) in response to temperature reduction seems to be entirely related to sympathetic nervous stimulation. OBJECTIVE: To analyse if temperature reduction and norepinephrine may differently affect the expression of proteins related to energy metabolism in BAT. MATERIALS AND METHODS: Isolated rats BAT was incubated with/without norepinephrine (10-6 mol/L, 24 h at 32 °C and 37 °C). RESULTS: In BAT, 32 °C increased the protein expression levels of carnitine palmitoyltransferase-I and -II, mitochondrial uncoupling protein-1 (UCP-1) and the expression and activity of lactate dehydrogenase. Mitochondrial F1-ATP synthase α-chain expression was decreased at 32 °C compared to 37 °C. Norepinephrine and at 32 °C exposure, UCP-1 expression was increased but cytochrome-c oxidase and F1-ATP synthase α-chain expression was reduced with respect to 37 °C. DISCUSSION: Sympathetic stimulation seems not to be the only factor associated with heat generation. CONCLUSIONS: Temperature reduction by itself exerts some different effects on the expression of proteins related to the energy metabolism than norepinephrine.

Multiparametric optimization of a new high-sensitive and disposable mercury (II) electrochemical sensor.

An electrochemical sensor for mercury (II) determination was developed by modifying the surface of a commercial screen-printed carbon electrode (SPCE) with a polystyrene sulfonate-NiO-carbon nanopowder composite material. Mercury measurements were performed by differential pulse anodic stripping voltammetry (DPASV). Sensor composition and measurement conditions were optimized using a multivariate experiment design. A screening experiment by using a Plackett-Burman design was first performed in order to determine the main contributing factors to the electrochemical response. The most important factors were employed to establish the interactions between different experimental variables and get the best conditions for mercury determination. For this purpose, a five level central composite design and a response surface methodology were used. The optimized method using the developed NiO-PSS-SPCE sensor presents a very low limit of detection of 0.021 µg L(-1) and a linear response over two concentration ranges with two different slopes, from 0.05 to 2.0 µg L(-1) and between 2.0 and 75 µg L(-1). The sensor was successfully applied to mercury determination in water samples.

Metabolic differences between white and brown fat from fasting rabbits at physiological temperature.

It has been suggested that activated brown adipose tissue (BAT) shows increased glucose metabolic activity. However, less is known about metabolic activity of BAT under conditions of fasting and normal temperature. The aim of this study was to compare the possible differences in energetic metabolism between BAT and white adipose tissue (WAT) obtained from rabbits under the conditions of physiological temperature and 24 h after fasting conditions. The study was carried out on New Zealand rabbits (n=10) maintained for a period of 8 weeks at 23±2 °C. Food was removed 24 h before BAT and WAT were obtained. Protein expression levels of the glycolytic-related protein, glyceraldehyde-3-phosphate dehydrogenase, and pyruvate dehydrogenase were higher in WAT than that in BAT. The expression level of carnitine palmitoyltransferase 1 (CPT1) and CPT2, two fatty acid mitochondrial transporters, and the fatty acid ß-oxidation-related enzyme, acyl CoA dehydrogenase, was higher in BAT than in WAT. Cytosolic malate dehydrogenase expression and malate dehydrogenase activity were higher in WAT than in BAT. However, lactate dehydrogenase expression and lactate content were significantly higher in BAT than in WAT. In summary, this study for the first time, to our knowledge, has described how under fasting and normal temperature conditions rabbit BAT seems to use anaerobic metabolism to provide energetic fuel, as opposed to WAT, where the malate-aspartate shuttle and, therefore, the gluconeogenic pathway seem to be potentiated.

Registro nacional de cáncer de próstata 2010 en España / National Prostate Cancer Registry 2010 in Spain

Objetivo: Estimar la incidencia del cáncer de próstata (CaP) en España para el año 2010 y describir el perfil clínico de los nuevos casos diagnosticados, mediante un registro de base hospitalaria y ámbito nacional. Material y métodos: Estudio epidemiológico en 25 hospitales públicos con área de población de referencia según el Sistema Nacional de Salud. Se recogieron variables sociodemográficas y clínicas de todos los casos de nuevo diagnóstico en 2010, con confirmación histopatológica en el área de influencia de cada centro. Se estimó la tasa de incidencia estandarizada a población española en función de la distribución etaria de la población española a nivel nacional y en Andalucía, Cataluña y Comunidad de Madrid. Resultados: Se diagnosticaron 4.087 nuevos casos de CaP, cubriendo el 21,8% de la población masculina española. La tasa de incidencia estimada estandarizada a población española es de 82,27 por 100.000 varones. La estimación de la tasa de incidencia en Andalucía es de 70,38, en Cataluña de 85,70 y en la Comunidad de Madrid de 92,29. La edad media fue de 69 años (8,15). La mediana de PSA fue de 8ng/ml. El 56,5% presentaron Gleason total≤6, el 26,7%=7 y el 16,8%>7. Según la clasificación D’Amico el 90% presentaban enfermedad localizada. Conclusiones: En las 3 Comunidades Autónomas estudiadas, entre el 80-90% de los casos son clínicamente localizados, alrededor del 50% son de riesgo intermedio o alto. Las tasas de incidencia encontradas en Andalucía, Cataluña y Comunidad de Madrid reflejan una gran diferencia entre ellas de causa multifactorial (AU)

Objectives: To estimate the 2010 incidence of PCa in Spain and describe the clinical profile of newly-diagnosed cases using a nationwide hospital-based registry. Material and methods: National epidemiological study in 25 public hospitals with a specific reference population according to the National Health System. Sociodemographic and clinical variables of all newly diagnosed, histopathological confirmed PCa cases were collected in 2010, in the area of influence of each centre. The age–standardised PCa incidence was determined based on the age distribution of the Spanish population in Spain and in 3 regions: Andalusia, Catalonia and Region of Madrid.Results4,087 new cases of PCa were diagnosed for a reference population of 4,933,940 men (21.8% of the Spanish male population). The estimated age-standardised PCa incidence was 82.27 cases per 100,000 men in Spain, 70,38 in Andalusia, 85,70 in Catalonia and 92,29 in the Region of Madrid. Mean age at diagnosis was 69 years. Median PSA was 8 ng/ml. Gleason score was ≤6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 90% had localised disease. Conclusions: In the 3 Regions analyzed, around 80-90% of the cases are diagnosed in a clinical localised stage. The incidence rates in Andalusía, Catalonia and Region of Madrid show a great difference between them due to several factors (AU)

[National prostate cancer registry 2010 in Spain]. / Registro nacional de cáncer de próstata 2010 en España.

OBJECTIVES: To estimate the 2010 incidence of PCa in Spain and describe the clinical profile of newly-diagnosed cases using a nationwide hospital-based registry. MATERIAL AND METHODS: National epidemiological study in 25 public hospitals with a specific reference population according to the National Health System. Sociodemographic and clinical variables of all newly diagnosed, histopathological confirmed PCa cases were collected in 2010, in the area of influence of each centre. The age-standardised PCa incidence was determined based on the age distribution of the Spanish population in Spain and in 3 regions: Andalusia, Catalonia and Region of Madrid. RESULTS: 4,087 new cases of PCa were diagnosed for a reference population of 4,933,940 men (21.8% of the Spanish male population). The estimated age-standardised PCa incidence was 82.27 cases per 100,000 men in Spain, 70,38 in Andalusia, 85,70 in Catalonia and 92,29 in the Region of Madrid. Mean age at diagnosis was 69 years. Median PSA was 8 ng/ml. Gleason score was ≤6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 90% had localised disease. CONCLUSIONS: In the 3 Regions analyzed, around 80-90% of the cases are diagnosed in a clinical localised stage. The incidence rates in Andalusía, Catalonia and Region of Madrid show a great difference between them due to several factors.

[Impact of nocturia on sleep quality in patients with lower urinary tract symptoms suggesting benign prostatic hyperplasia (LUTS/BPH). The NocSu Study]. / Impacto de la nocturia en la calidad del sueño en pacientes con síntomas del tracto urinario inferior sugestivos de hiperplasia benigna de la próstata. Estudio NocSu.

INTRODUCTION: Nocturia is one of the main symptoms associated to BPH, causing significant sleep disturbances, including sleep interruptions. Such sleep interruptions may significantly impair quality of life. MATERIALS AND METHODS: A multicenter, observational, cross-sectional, epidemiological study was conducted in patients with LUTS/BPH aged 60 years or over. In the study visit, demographic and clinical data were collected and quality of sleep questionnaires (MOS-Sleep Scale and COS) were administered. RESULTS: Among the total 249 patients recruited, 205 had nocturia (82.3%) and 44 (17.7%) had no nocturia. All patients should have an I-PSS score ?13, and patients with mild symptoms were therefore excluded (62.9% had moderate and 37.1% severe symptoms). Patients with nocturia were seen to have more sleep problems than those without nocturia (more sleep disturbances, less sleep adequacy, more daily sleepiness, greater concern about their social and occupational functioning, etc). DISCUSSION: Patients with nocturia reported a worse quality of sleep than patients with LUTS/BPH but no nocturia. Nocturia resulted in frequent sleep interruptions, causing malaise and diurnal fatigue in affected patients. Use of therapeutic approaches to relieve or eliminate this undesirable effect may lead to an improvement in sleep quality and quality of life in BPH patients.

Impacto de la nocturia en la calidad del sueño en pacientes con síntomas del tracto urinario inferior sugestivos de hiperplasia benigna de la próstata. Estudio NocSu / Impact of nocturia on sleep quality in patients with lower urinary tract symptoms suggesting benign prostatic hyperplasia (LUTS/BPH). The NocSu Study

Introducción: La nocturia es uno de los principales síntomas asociados a la hiperplasia benigna de la próstata (HBP). Produce alteraciones importantes en el desarrollo del sueño, dando lugar a interrupción de éste, que puede ser causante de un deterioro significativo de la calidad de vida. Método: Se realizó un estudio epidemiológico, multicéntrico, transversal en pacientes con síntomas del tracto urinario inferior / HBP de 60 años o mayores. Mediante una única visita, se recogieron datos socio demográficos y clínicos y se evaluó la calidad de sueño de pacientes con y sin nocturia mediante dos cuestionarios específicos: Medical Outcomes Study Sleep Scale (MOS-Sleep Scale) y Cuestionario Oviedo del Sueño. Resultados: Se incluyó a un total de 249 pacientes, de los cuales 205 presentaban nocturia (82,3%) y 44 no presentaban nocturia (17,7%). Todos los pacientes debían presentar una puntuación en el International Prostate Symptom Score (IPSS) superior o igual a13, motivo por el cual no se incluyó a pacientes con sintomatología leve (el 62,9 moderados y el 37,1% graves). Se observó que los pacientes con nocturia presentaban más problemas de sueño que los pacientes sin nocturia (más alteraciones del sueño, menos adecuación del sueño, mayor somnolencia diurna, mayor preocupación por su funcionamiento socio laboral, etc.). Discusión: Los pacientes con nocturia indicaron que su calidad de sueño era muy inferior a la de pacientes con síntomas del tracto urinario inferior/HBP, pero sin nocturia. La nocturia era causa de interrupciones frecuentes del sueño, causando malestar y cansancio diurno en los individuos afectados. El uso de estrategias terapéuticas que palíen o eliminen este efecto indeseable puede ser causa de mejora en la calidad de sueño (y calidad de vida) de los pacientes con HBP (AU)

Introduction: Nocturia is one of the main symptoms associated to BPH, causing significant sleep disturbances, including sleep interruptions. Such sleep interruptions may significantly impair quality of life. Materials and methods: A multicenter, observational, cross-sectional, epidemiological study was conducted in patients with LUTS/BPH aged 60 years or over. In the study visit, demographic and clinical data were collected and quality of sleep questionnaires (MOS-Sleep Scale and COS) were administered. Results: Among the total 249 patients recruited, 205 had nocturia (82.3%) and 44 (17.7%) had no nocturia. All patients should have an I-PSS score ¡Ý13, and patients with mild symptoms were therefore excluded (62.9% had moderate and 37.1% severe symptoms). Patients with nocturia were seen to have more sleep problems than those without nocturia (more sleep disturbances, less sleep adequacy, more daily sleepiness, greater concern about their social and occupational functioning, etc). Discussion: Patients with nocturia reported a worse quality of sleep than patients with LUTS/BPH but no nocturia. Nocturia resulted in frequent sleep interruptions, causing malaise and diurnal fatigue in affected patients. Use of therapeutic approaches to relieve or eliminate this undesirable effect may lead to an improvement in sleep quality and quality of life in BPH patients (AU)

Effects of hypercapnia on the electroretinogram in sevoflurane and isoflurane anaesthetized dogs.

To evaluate the effects of induced hypercapnia on the electroretinogram (ERG) in beagle dogs anaesthetized with isoflurane and sevoflurane. Binocular, full-field flash photopic and scotopic ERGs were obtained from six healthy neutered female beagle dogs. In order to determine Vmax and the photopic negative response (PhNR), photopic ERG luminance-response curves were generated with 17 different light stimuli. Photopic flicker ERGs were obtained at 30-Hz temporal frequency. Scotopic ERGs were recorded after 35 min of dark adaptation. For all animals, this procedure was performed once in four different sessions: isoflurane + end-tidal [CO(2)] at 35 mmHg +/- 3 mmHg (ISON), isoflurane + end-tidal [CO(2)] at 65 mmHg +/- 3 mmHg (ISOH), sevoflurane + end-tidal [CO(2)] at 35 mmHg +/- 3 mmHg (SEVON), isoflurane + end-tidal [CO(2)] at 65 mmHg +/- 3 mmHg (SEVOH). In photopic conditions, b-wave amplitudes were significantly smaller in hypercapnic groups (ISON = 170.6 +/- 12.1 microV; ISOH = 132.6 +/- 24.9 microV; SEVON = 170.9 +/- 14.4 microV; SEVOH = 130.2 +/- 22.8 microV). Similarly, in scotopic conditions, b-wave amplitudes were significantly decreased when CO(2) was increased (ISON = 89.4 +/- 14.7 microV; ISOH = 58.2 +/- 17.6 microV; SEVON = 93.4 +/- 24.1 microV; SEVOH = 56.2 +/- 22.2 microV). Flicker peak times were significantly increased in hypercapnic groups (ISON = 25.9 +/- 0.4 ms; ISOH = 27.7 +/- 1.2 ms; SEVON = 25.9 +/- 1.5 ms; SEVOH = 27.2 +/- 0.7 ms). Our results clearly indicate that induced hypercapnia significantly alters the genesis of the electroretinogram at level of ON-pathway and suggest that OFF-pathway is unaffected and that ERGs obtained from isoflurane or sevoflurane anaesthetized dogs are almost identical. Control of hypercapnia must be taken into consideration when ERGs are performed under inhaled anaesthesia in dogs.

Effect of atorvastatin on bone mineral density in patients with acute coronary syndrome.

OBJECTIVE: The aim of this paper is to evaluate the effect of atorvastatin on bone mineral density in patients with acute ischemic heart disease. MATERIAL AND METHODS: Eighty-three patients (52 male and 31 female) with acute coronary syndrome were studied. They received treatment with atorvastatin using low doses (20 mg) and high doses (40 mg-80 mg). Initial and final cholesterol, triglyceride, calcium, phosphorus, 25-hydroxyvitamin D were obtained from every patient. Spine and hip bone mineral density were performed at the beginning and one year later. RESULTS: Atorvastatin treatment increases vitamin D (33%, p = 0.007) and decreases the individuals with vitamin D insufficiency. Bone mineral density increased in the spine (1.31%, p = 0.02), but it was significant only in male and patients presenting vitamin D levels higher than 30 nmol/l. CONCLUSION: Atorvastatin has a beneficial effect on bone metabolism in patients with acute ischemic heart disease (mainly males) by incrementing bone mineral density in which vitamin D levels are required to be higher than 30 nmol/l for the drug to be effective.

[Iodine nutritional status in the school-aged population in Alicante (Spain)]. / Situación nutricional de yodo en la población escolar de Alicante.

BACKGROUND: According to the World Health Organization (WHO), goiter is endemic in Spain. The main cause of endemic goiter is iodine deficiency, which is also the principal cause of mental retardation and avoidable cerebral palsy throughout the world. MATERIAL AND METHODS: We conducted an observational study to determine the prevalence of endemic goiter and nutritional iodine status in the province of Alicante. Urinary iodine excretion was measured in a morning urine sample, and thyroid volume was measured by means of a thyroid ultrasound scan. A case of goiter was diagnosed if thyroid volume was above the 97th percentile adjusted by age, as published by the WHO. RESULTS: No cases of goiter were found. In addition, the median urinary iodine excretion levels adjusted by age were within the normal range, as defined by the WHO's criteria. CONCLUSIONS: Endemic goiter was not found in the province of Alicante and urinary iodine excretion values demonstrated adequate iodine intake. Further ultrasound studies are needed to establish reference thyroid volumes for our population.

Situación nutricional de yodo en la población escolar de Alicante / Iodine nutritional status in the school-aged population in Alicante (Spain)

Antecedentes Según la Organización Mundial de la salud (OMS), España se consideró un país afectado de endemia bociosa. El déficit de yodo es el responsable de dicha endemia además de ser la principal causa de retraso mental y parálisis cerebral evitable en el mundo. Material y métodos Estudio observacional para determinar la prevalencia de bocio endémico y el estado nutricional de yodo en la provincia de Alicante. Para ello se midió la yoduria en una muestra aislada y el volumen tiroideo mediante ecografía. Se consideró bocio todo volumen tiroideo superior al percentil 97 por edad publicado por la OMS. Resultados No se ha encontrado ningún caso de bocio. Así mismo las cifras de yoduria obtenidas también pueden ser consideradas dentro de la normalidad bajo los criterios de la OMS. Conclusiones Se puede decir que la provincia de Alicante no padece endemia bociosa y que además las cifras de yoduria demuestran una adecuada ingesta de yodo. Se evidencia la necesidad de realizar más estudios ecográficos de tiroides en otras zonas para establecer volúmenes tiroideos de referencia para nuestra población

Background According to the World Health Organization (WHO), goiter is endemic in Spain. The main cause of endemic goiter is iodine deficiency, which is also the principal cause of mental retardation and avoidable cerebral palsy throughout the world. Material and methods We conducted an observational study to determine the prevalence of endemic goiter and nutritional iodine status in the province of Alicante. Urinary iodine excretion was measured in a morning urine sample, and thyroid volume was measured by means of a thyroid ultrasound scan. A case of goiter was diagnosed if thyroid volume was above the 97th percentile adjusted by age, as published by the WHO. Results No cases of goiter were found. In addition, the median urinary iodine excretion levels adjusted by age were within the normal range, as defined by the WHO's criteria. Conclusions Endemic goiter was not found in the province of Alicante and urinary iodine excretion values demonstrated adequate iodine intake. Further ultrasound studies are needed to establish reference thyroid volumes for our population

Oral anticoagulant treatment: risk factors involved in 500 intracranial hemorrhages.

Intracranial bleeding is the most severe complication caused by anticoagulant or antiplatelet treatment. The increasing use of this therapy, especially in older people, makes the balance between clinical benefit and bleeding risk an important consideration. A retrospective study of all consecutive 500 intracranial hemorrhages in the West Valladolid area, approximately 220,000 people, during the period 1998 to 2004, was performed. In relation to mortality, predisposing conditions were included, such as age, antithrombotic treatment, arterial hypertension, cancer, blood diseases, vascular malformations, and traumatisms. The incidence of intracranial hemorrhage was 310 per 100,000 per year with a mortality of 30%. Higher mortality was found in antiplatelet-treated patients (44.9%) than in anticoagulated patients (31.1%). This may be related to a different mean age of 78 vs. 71 years. Arterial hypertension was the most frequent risk factor (45.1% in nontreated patients, 60% anticoagulated, and 75.5% antiplatelet). The relative risk of intracranial bleeding in anticoagulated patients was 11.2 (p < 0.001) with an incidence of 0.03% and a median of 14 months since treatment began. The median INR was 3.3. In 40% of the patients the previous five controls were in range. Strict consideration of indications criteria joined to a better control of risk factors may avoid intracranial bleeding episodes.

Cirrosis biliar primaria, síndrome “sicca” y anemia hemolítica autoinmune / Primary biliary cirrhosis, "sicca" sindrome and autoimmune hemolytic anemia

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Dolor abdominal y masa en flanco / Abdominal pain and flanck mass

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[Ethnic difference in attendance at emergency departments. An approximation to the gypsy reality]. / Diferencia étnica en la actividad asistencial de urgencias. Aproximación a la realidad gitana.

BACKGROUND: Demand for emergency services is increasing, especially among children from non-Caucasian ethnic groups. OBJECTIVES: To objectify this observation and to determine the healthcare and social differences between the gypsy and Caucasian populations. METHODS: We performed a descriptive, observational study in the Pediatric Emergency Unit of a tertiary care hospital. Systematic sampling was performed and 420 children were selected. Data on age, sex, compliance with primary healthcare preventive programs, reason for attendance, type of healthcare center, diagnosis and familial characteristics were collected through a questionnaire. RESULTS: The median age of the patients was 24 months. The percentage of patients of gypsy race was 16.4 %. Most of the gypsy population (68.1 %) attended small, local healthcare centers compared with 34.8 % of the Caucasian population (p 0.0001). Only 58 % of the gypsy children were taken to healthcare centers for regular check-ups compared with 96.7 % of the non-gypsy population (p 0.0001). The percentage of gypsy children who had never being vaccinated was 18.8 %. There were no such cases among the non-gypsy population (p 0.0001). The percentage of gypsy children visiting the emergency unit who were hospitalized was 11.6 % compared with 1.9 % of non-gypsy children. Illiteracy rates were 30.4 % and 15.9 % in gypsy mothers and fathers, respectively, compared with 0.6 % and 0.3 % in non-gypsy mothers and fathers, respectively (p 0.0001). CONCLUSIONS: This study reveals significant differences between the gypsy and Caucasian pediatric populations in terms of healthcare and identifies a group at high health risk.

Diferencia étnica en la actividad asistencial de urgencias. Aproximación a la realidad gitana / Ethnic differences in attendance at emergency departments. An approximation of gypsy reality

Existe un incremento de la presión asistencial en los servicios de urgencias y se percibe una importante afluencia de niños de otras etnias. Objetivos Comprobar esta percepción y conocer las características sanitarias, sociales y asistenciales de la etnia gitana frente a la población caucásica. Métodos Estudio observacional descriptivo realizado en un servicio de urgencias pediátricas de un hospital terciario. Se seleccionó una muestra poblacional significativa (n = 420) por muestreo sistemático. Se recogieron mediante cuestionario las variables edad, sexo, adhesión a los programas preventivos de atención primaria, justificación de la consulta, diagnóstico y características familiares. Resultados La mediana de edad fue 24 meses. Pertenecían a la etnia gitana el 16,4% y eran mayoritariamente atendidos en ambulatorios (68,1% frente al 34,8% de los caucásicos) (p < 0,0001). Acudían a las revisiones del programa de niño sano el 58% de los niños gitanos frente al 96,7% del resto (p < 0,0001). El 18,8% de los niños gitanos no habían recibido ninguna vacuna, no encontrando ningún niño caucásico en esta situación (p < 0,0001). Ingresaron el 11,6% de los niños gitanos que consultaron frente al 1,9% de los caucásicos. En cuanto a los padres, el 30,4% de las madres y el 15,9% de los padres gitanos eran analfabetos, frente al 0,6% de las madres y el 0,3% de los padres caucásicos (p < 0,0001). Conclusiones El estudio pone en evidencia las diferencias sanitarias entre la población infantil gitana y la caucásica, identificando un grupo de alto riesgo sanitario (AU)

Aproximación al entorno social y sanitario de la población infantil atendida en un servicio de urgencias y factores relacionados con su mal uso / Approach to social and health care characteristics of the children who attend a pediatric emergency unit

Objetivos: Conocer las características socio-sanitarias de la población infantil atendida en nuestro servicio, y la existencia de factores determinantes en su mal uso. Diseño: Estudio observacional prospectivo. Emplazamiento y participantes: Urgencias pediátricas de un hospital terciario. Sobre una muestra de 420 niños recogimos variables socio-sanitarias relacionadas con el uso inadecuado. Mediciones y resultados: El 59,8 por ciento de los niños eran varones y el 39 por ciento mujeres. En el 90 por ciento de los casos la distancia kilométrica del domicilio al centro era inferior a 10 kilómetros. Acudieron sin ser remitidos por un médico el 82,6 por ciento. Encontramos deficiencias en el estado de vacunación en el 10 por ciento de los niños. Los niños cuyos domicilios estaban a más de 10 kilómetros del hospital suponían un 10 por ciento del total, perteneciendo a éstos el 29,1 por ciento de las consultas justificadas. Asimismo, el 33,5 por ciento de las consultas justificadas fueron realizadas por niños controlados en centros de salud. Conclusiones: El grueso de la patología atendida es banal, corroborado por la escasa petición de pruebas complementarias, y los principales diagnósticos al alta. Entre los factores implicados con el mal uso de las Urgencias hemos encontrado relación significativa (p< 0,0001) con el tipo de asistencia primaria prestada y la distancia kilométrica (AU)