Linezolid-resistant MRSA-CC398 carrying the cfr gene, and MRSA-CC9 isolates from pigs with signs of infection in Spain.

AIMS: To perform the molecular characterization of 23 Staphylococcus aureus isolates from pigs with signs of infections recovered in Spanish farms during 2018-2019. METHODS AND RESULTS: The antimicrobial resistance pattern and virulence profile were determined. The molecular typing was performed by different molecular techniques. The transferability of the cfr gene was assessed by conjugation and its genetic environment was determined by PCR mapping. In all, 21 isolates were methicillin-resistant S. aureus (MRSA) carrying the mecA gene (SCCmecV or non-typeable SCCmec), whereas the remaining two were methicillin-susceptible (MSSA). All but one MRSA isolates (n = 20) belonged to the CC398, being the spa t011 the most prevalent (n = 11). The remaining MRSA and the two MSSA isolates were ascribed to ST9/CC9. The S. aureus isolates exhibited resistance to (number of resistant isolates): ß-lactamics (21), erythromycin and/or clindamycin (20), aminoglycosides (7), tetracycline (22), fluoroquinolones (14), chloramphenicol (5) and linezolid (1). The S. aureus isolates did not carry any of the virulence genes studied. One MRSA belonging to the CC398 showed linezolid resistance mediated by the cfr gene. The cfr gene was co-located with fexA in the Tn558 variant previously reported in the S. aureus plasmid pSCFS7. CONCLUSIONS: Two major livestock-associated genetic lineages were detected among pigs with signs of infection in Spain. The presence of the cfr gene among LA-MRSA-CC398 is of great concern not only for veterinary medicine, but also for humans in close contact. SIGNIFICANCE AND IMPACT OF THE STUDY: This work describes the molecular characterization of S. aureus isolates recovered from pigs with signs of infection and we report, as far as we know, the first description of MRSA-CC9 from pigs in Spain. Moreover, the detection of a MRSA-CC398 isolate carrying the multiresistance cfr gene highlights the need for continuous surveillance and awareness of LA-MRSA.

¿Resulta útil evaluar la fragilidad de los pacientes al ingreso en la unidad de cuidados intensivos (UCI)? / Is it useful to assess patient frailty upon admission to the Intensive Care Unit (ICU)?

No disponible

Trend and seasonality in hospitalizations for pulmonary embolism: a time-series analysis.

BACKGROUND: The existence of seasonal variability in patients with acute pulmonary embolism (PE) has been debated for years, with contradictory results. The aim of this study was to identify the trend and possible existence of a seasonal pattern in hospitalizations for PE in Spain. METHODS: We analyzed the hospital discharge database of the Spanish National Health System from 2001 to 2010. Patients aged > 14 years diagnosed with PE were selected and a time series was constructed considering mean daily admissions for PE by month. The trend and seasonality factor of the series were determined using time-series analysis, and time-series modeling was used for analysis. Exponential smoothing models and the autoregressive integrated moving average test were used to generate a predictive model. RESULTS: From 2001 to 2010, there were 162,032 diagnoses of PE (5.07 per 1000 hospitalizations). In 105,168 cases, PE was the reason for admission. The PE diagnosis rate ranged from 4.14 per 1000 in 2001 to 6.56 per 1000 in 2010; and hospital admissions due to PE ranged from 2.67 to 4.28 per 1000 hospital discharges. Time-series analysis showed a linear increase in the incidence and a significant seasonal pattern with 17% more admissions in February and 12% fewer in June-July with respect to the central tendency (difference from February to June, 29%). CONCLUSIONS: The incidence of hospitalizations for PE showed a linear increase and a seasonal pattern, with the highest number of admissions in winter and the lowest number in summer.

¿Por qué es útil para los intensivistas leer y publicar artículos fisiológicos? / Why is it useful for intensivists to read and publish physiology articles?

No disponible

Análisis de legibilidad de con sentimientos informados en cuidados intensivos / Analysis of informed consent readibility in intensive care

Objetivo Analizar la legibilidad de los documentos de consentimiento informado (CI) utilizados en una unidad de cuidados intensivos y en el Sistema Andaluz de Salud (SAS).Diseño Estudio descriptivo. Ámbito Unidad de Cuidados Intensivos de un hospital terciario y Sistema Andaluz de Salud. Intervenciones Revisión y análisis de los 14 modelos de CI existentes en la Unidad de Cuidados Intensivos y otros 14 modelos de CI ofertados por el Servicio Andaluz de Salud, usando los siguientes índices de legibilidad: Flesch, Complejidad oracional, LEGIN, Fernández-Huerta, Szigriszt e INFLESZ. Resultados Veinticuatro consentimientos (85,7%) no cumplen alguno de los índices y 3 (10,7%) no cumplen ninguno. Hay 4 documentos (14,3%) que cumplen todos los índices analizados y, por tanto, resultan fáciles de comprender. El Índice de Flesch: se cumple en uno de los consentimientos del Hospital (7,1%) y 3 del SAS (21,4%). Índice de Complejidad oracional: se cumple en 11 de los consentimientos del hospital (78,6%) y en 13 del SAS (92,8%). Índice de Fernández-Huerta: se cumple en 4 consentimientos del hospital (28,6%) y en 13 del SAS (92,8%). Índice de Szigriszt: se cumple en 2 consentimientos del Hospital (14,3%) y en 11 de los del SAS (64,3%). Índice de INFLESZ: se cumple en 2 CI del hospital (14,3%) y en 10 del SAS (71,4%).Conclusiones Los documentos analizados resultan, en general, difíciles de leer y de comprender para el ciudadano medio, no cumpliendo el objetivo básico para el que fueron redactados (AU)

Objective To analyze the readability of informed consent documents (IC) used in an intensive care department and in the Andalusian Healthcare System (AHS).Design A descriptive study was carried out. Scope The Intensive Care Unit of a tertiary Hospital, and the AHS.Interventions A review and analysis was made of the existing 14 IC models in the Intensive Care Unit and of another 14 IC models offered by the AHS, using the following readability scores: Flesch, Sentence complexity, LEGIN, Fernández-Huerta, Szigriszt and INFLESZ. Results Twenty-four IC (85.7%) failed to satisfy some of the indexes, while three (10.7%) did not satisfy any of them. Four documents (14.3%) satisfied all the indexes analyzed, and therefore are easy to understand. Flesch score: satisfied by one of the ICU IC (7.1%) and by three of the AHS documents (21.4%). Sentence complexity score: satisfied by 11 of the ICU IC (78.6%) and by 13 of the AHS documents (92.8%). Fernández-Huerta score: satisfied by four of the ICU IC (28.6%) and by 13 of the AHS documents (92.8%). Szigriszt score: satisfied by two of the ICU IC (14.3%) and by 11 of the AHS documents (64.3%). INFLESZ score: satisfied by two of the ICU IC (14.3%) and by 10 of the AHS documents (71.4%).Conclusions The documents analyzed are generally difficult to read and understand by most people, and do not satisfy the basic purpose for which they were drafted (AU)

Enfermedad de Lyme: a propósito de dos casos / Lyme disease: report of two cases

La borreliosis de Lyme es una enfermedad multiorgánica con afectación principalmente dermatológica, reumática, neurológica y cardiaca. La detección y el tratamiento en los primeros estadios son básicos para evitar su progresión. El pediatra, por tanto, debe conocer las manifestaciones clínicas de la enfermedad, así como establecer un correcto diagnóstico y tratamiento. Se exponen dos casos que incluyen las formas más frecuentes de presentación (AU)

Lyme borreliosis is a multisystem disease mainly dermatological, rheumatical, neurological and cardiological. The detection and treatment in the early stages are essential to prevent its progression. The pediatrician, therefore, must be aware of the clinical presentations of the disease as well as to establish a correct diagnosis and treatment. Two cases are presented involving the most common forms of presentation (AU)

[Medial versus lateral plating in distal tibial fractures: a prospective study of 40 fractures]. / Placas mediales versus laterales para las fracturas de pilón tibial: estudio prospectivo de 40 fracturas.

OBJECTIVE: Tibial plafond fractures are one of the most challenging injuries in orthopaedic surgery. Their results could be improved by following the new guidelines for the management, and modern plating techniques. The results and complication rate between anteromedial and anterolateral approach for open reduction and internal fixation of these fractures were compared. MATERIAL AND METHODS: A study was conducted on 40 patients treated by open reduction an internal fixation between 2007 and 2008. The surgical approach was selected by the surgeon in charge, depending on fracture pattern and skin situation. Patients were evaluated clinically and radiographically by an independent orthopaedic surgeon, not involved in the surgical procedure, using clinical (American Orthopaedic Foot and Ankle Society score) and radiological criteria at a minimum of two years. The appearance of complications after both approaches was recorded. RESULTS: Forty patients were included. The mean age was 53 years, with 24 males and 16 females. Seventeen of the injuries were of high energy, and there were 8 open fractures (3 of type i, 4 type ii and one type iii), and 12 of the closed injuries were grade ii or iii in the Tscherne classification. Six patients (15%) had associated injuries. At final follow-up there were 33 (82%) excellent or good results. No statistical differences were found between either surgical approach regarding time to bone union, rate of delayed union and infection rate. Three plates of the anteromedial group and none of the anterolateral group needed to be removed. CONCLUSION: Open reduction and internal fixation of distal tibia fractures produced reliable results, with no statistical differences found between anteromedial and anterolateral surgical approaches. Clinical and radiological results and complication rate were mainly related to the fracture type.

Placas mediales versus laterales para las fracturas de pilón tibial: estudio prospectivo de 40 fracturas / Medial versus lateral plating in distal tibial fractures: A prospective study of 40 fractures

Objetivo. Las fracturas de pilón tibial constituyen una de las lesiones más difíciles de tratar en cirugía ortopédica. Los nuevos protocolos y las modernas placas pueden mejorar los resultados. Comparamos los resultados y la tasa de complicaciones entre el abordaje anteromedial y anterolateral para la reducción abierta y fijación interna. Material y métodos. Se estudiaron de forma prospectiva 40 pacientes tratados mediante reducción abierta y fijación interna entre 2007 y 2008. El abordaje fue seleccionado por el cirujano, dependiendo del patrón de fractura y de la situación de la piel. Los pacientes fueron evaluados clínica y radiológicamente por un cirujano independiente, utilizando criterios clínicos (puntuación de la Sociedad Americana de Ortopedia de Pie y Tobillo) y radiológicos a un mínimo de 2 años. Se registró la aparición de complicaciones de ambos abordajes. Resultados. Cuarenta pacientes fueron incluidos. La media de edad fue de 53 años, había 24 hombres y 16 mujeres, 17 fracturas fueron de alta energía y hubo 8 abiertas (3 de tipo i , 4 de tipo ii I y una de tipo iii ), y 12 de las lesiones cerradas eran de grado ii o iii de la clasificación de Tscherne. Seis pacientes (15%) presentaron lesiones asociadas. Al final del seguimiento hubo 33 (82%) resultados excelentes o buenos. No se encontraron diferencias estadísticas entre ambos abordajes con respecto al tiempo de consolidación, tasa de retardo de consolidación y tasa de infección. Fueron extraídas tres placas anteromediales y ninguna anterolateral. Conclusión. La reducción abierta y fijación interna de la fractura de pilón tibial proporciona buenos resultados; no se pudo encontrar diferencias estadísticas entre los abordajes anteromedial y anterolateral. Los resultados clínicos y radiológicos y la tasa de complicaciones se relacionan principalmente con el tipo de fractura (AU)

Objective. Tibial plafond fractures are one of the most challenging injuries in orthopaedic surgery. Their results could be improved by following the new guidelines for the management, and modern plating techniques. The results and complication rate between anteromedial and anterolateral approach for open reduction and internal fixation of these fractures were compared. Material and methods. A study was conducted on 40 patients treated by open reduction an internal fixation between 2007 and 2008. The surgical approach was selected by the surgeon in charge, depending on fracture pattern and skin situation. Patients were evaluated clinically and radiographically by an independent orthopaedic surgeon, not involved in the surgical procedure, using clinical (American Orthopaedic Foot and Ankle Society score) and radiological criteria at a minimum of two years. The appearance of complications after both approaches was recorded. Results. Forty patients were included. The mean age was 53 years, with 24 males and 16 females. Seventeen of the injuries were of high energy, and there were 8 open fractures (3 of type i , 4 type ii and one type iii ), and 12 of the closed injuries were grade ii or iii in the Tscherne classification. Six patients (15%) had associated injuries. At final follow-up there were 33 (82%) excellent or good results. No statistical differences were found between either surgical approach regarding time to bone union, rate of delayed union and infection rate. Three plates of the anteromedial group and none of the anterolateral group needed to be removed. Conclusion. Open reduction and internal fixation of distal tibia fractures produced reliable results, with no statistical differences found between anteromedial and anterolateral surgical approaches. Clinical and radiological results and complication rate were mainly related to the fracture type (AU)

[Analysis of informed consent readibility in intensive care]. / Análisis de legibilidad de consentimientos informados en cuidados intensivos.

OBJECTIVE: To analyze the readability of informed consent documents (IC) used in an intensive care department and in the Andalusian Healthcare System (AHS). DESIGN: A descriptive study was carried out. SCOPE: The Intensive Care Unit of a tertiary Hospital, and the AHS. INTERVENTIONS: A review and analysis was made of the existing 14 IC models in the Intensive Care Unit and of another 14 IC models offered by the AHS, using the following readability scores: Flesch, Sentence complexity, LEGIN, Fernández-Huerta, Szigriszt and INFLESZ. RESULTS: Twenty-four IC (85.7%) failed to satisfy some of the indexes, while three (10.7%) did not satisfy any of them. Four documents (14.3%) satisfied all the indexes analyzed, and therefore are easy to understand. Flesch score: satisfied by one of the ICU IC (7.1%) and by three of the AHS documents (21.4%). Sentence complexity score: satisfied by 11 of the ICU IC (78.6%) and by 13 of the AHS documents (92.8%). Fernández-Huerta score: satisfied by four of the ICU IC (28.6%) and by 13 of the AHS documents (92.8%). Szigriszt score: satisfied by two of the ICU IC (14.3%) and by 11 of the AHS documents (64.3%). INFLESZ score: satisfied by two of the ICU IC (14.3%) and by 10 of the AHS documents (71.4%). CONCLUSIONS: The documents analyzed are generally difficult to read and understand by most people, and do not satisfy the basic purpose for which they were drafted.

Componente acetabular monobloque de tantalio. Seguimiento a largo plazo / Long term follow-up of tantalum monoblock acetabular component

Objetivo. Valorar los resultados clínicos y radiológicos de un cotilo monobloque de tantalio con un seguimiento medio de 12 años. Material y método. Se siguieron prospectivamente 23 prótesis de cadera en 23 pacientes. Los diagnósticos más frecuentes fueron coxartrosis primaria (9 casos) y necrosis avascular (7 casos). Los resultados clínicos fueron valorados con la escala de Merle D¿Aubigne-Postel. Se midieron la orientación de los componentes, la integración de los cotilos y la presencia de hiatos postoperatorios o aparición de líneas radiolúcidas. El desgaste del polietileno fue medido con el método de Kim. Resultados. El seguimiento medio de la serie fue de 12 años. Todos los implantes se encontraban osteointegrados al final del seguimiento. Los valores medios de dolor, capacidad de deambulación y movilidad en la escala de Merle D¿Aubigne-Postel fueron 5,4, 5,2 y 4,4 respectivamente al final del seguimiento. En un cotilo un hiato postoperatorio no se había rellenado y 4 implantes tenían líneas radiolúcidas no progresivas en la parte de la zona 1 de DeLee. Conclusiones. Los cotilos monobloque de tantalio presentan una excelente supervivencia con seguimientos superiores a diez años en cirugía primaria de cadera (AU)

Objective. To evaluate the clinical and radiological results of a tantalum acetabular monoblock with a mean follow up of 12 years. Material method. A prospective follow up was performed on 23 hip replacements in 23 patients. The most frequent diagnosis was primary coxarthrosis (9 cases) and avascular necrosis (7 cases). The clinical results were assessed using the Merle D¿Aubigne-Postel scale. The orientation of the components, the integration of the acetabula, and the presence of post-operative hiatus, or the appearance of radiolucent lines were evaluated. The polyethylene wear was measured using the Kim method. Results. The mean follow-up of the series was 12 years. All the implants were osseointegrated at the end of follow-up. The mean values of, pain, ability in walking, and mobility on the Merle D¿Aubigne-Postel scale were 5.4, 5.2 and 4.4, respectively, at the end of follow-up. A postoperative hiatus had not been filled in one acetabulum, and 4 implants had non-progressive radiolucent lines in the area of the DeLee zone 1. Conclusions. Tantalum acetabular monoblocks have an excellent survival with follow-ups longer than ten years in primary hip surgery (AU)

Selective role of neuropeptide Y receptor subtype Y2 in the control of gonadotropin secretion in the rat.

Different signals with key roles in energy homeostasis regulate the reproductive axis. These include neuropeptide Y and polypeptide YY(3-36), whose type Y(2) receptor is the most abundant of this family in the brain. We evaluated herein the putative roles of Y(2) receptors in the control of gonadotropin secretion by means of central administration of PYY(13-36) (agonist of Y(2) receptors) and BIIE 0246 (antagonist of Y(2) receptors) to intact and orchidectomized male rats. In addition, the ability of PYY(13-36) to elicit GnRH and gonadotropin secretion in vitro and the impact of fasting on LH responses to PYY(13-36) in vivo were also monitored. Central administration of PYY(13-36) significantly decreased the circulating levels of both gonadotropins, an effect that was observed in prepubertal and adult rats. Yet a dual action of Y(2) receptors in the control of male gonadotropic axis was evidenced as their activation induced 1) stimulation of gonadotropin responses to GnRH at the pituitary but 2) inhibition of GnRH secretion at the hypothalamus. Antagonization of Y(2) receptors failed to modify basal LH secretion in intact males either after being fed ad libitum or after being fasted. In contrast, their central blockade in orchidectomized rats evoked a significant increase in circulating LH and FSH level, suggesting the constitutive activation of Y(2) receptor in such stimulated conditions. In summary, our data evidence a complex mode of action of Y(2) receptors in the control of gonadotropic axis, with stimulatory and inhibitory actions at different levels of the system that are sensitive to the gonadal status.

Fracturas del cuello del astrágalo / Talar neck fractures

Introducción. Las fracturas del cuello del astrágalo son infrecuentes, aunque son graves lesiones con importantes consecuencias funcionales debido a su posición articular y al hecho de verse afectada frecuentemente la irrigación al cuerpo del hueso. Su gravedad depende en gran parte del grado de desplazamiento, siendo pronóstica la clasificación de Hawkins; pequeños desplazamientos pueden pasar desapercibidos(2 mm pueden tener consecuencias desastrosaspara la mecánica articular).Tratamiento. El objetivo del tratamiento debe ser la reducción anatómica, restaurando el cuello a su posición normal, y evitando su acortamiento o desviaciones en varo. Si en las fracturas verdaderamente no desplazadas el tratamiento puede ser conservador, en las desplazadas debe ser quirúrgico y lo más precoz posible para evitar agravar las lesiones vasculares o de partes blandas, aunque no hay evidencia de que cierta demora influya en la aparición de necrosis isquémica del cuerpo. El abordaje anteromedial, con o sin osteotomía del maléolo, es el más utilizado por ser suficiente en la mayoría de las fracturas del cuello, aunque puede ser necesarioasociar un abordaje lateral en las fracturas conminutasdel cuello para identificar acortamientos o desviacionesrotacionales.Conclusión. Constituyen una urgencia las fracturas abiertas y las asociadas a luxaciones, por los compromisos cutáneo o neurovascular que pueden conducir a necrosis cutánea o a un síndrome compartimental. Las secuelas más importantes son la necrosis isquémica del cuerpo, que dependerá de la gravedad de la lesión inicial, y la artrosis postraumática, que dependerá de la excelencia o no de la reducción y fijacióninterna estable

Introduction. Although infrequent, talar neck fractures constitute a severe lesion with ominous functional consequences because of the site at which the joint is affected and the disruption they cause in the bone’s blood supply. Their severity is largely dependent on their degree of displacement. Hawkins’ classification is often used for prognosis. It should be noted that even Hawkins type I fractures, which involve small displacements that could go unnoticed, can pose a seriouschallenge since displacements of just 2 mm could leadto disastrous consequences for the joint’s mechanics.Treatment. The goal of treatment should be anatomical reduction, restoring the neck to its normal position and avoiding any degree of shortening or varus deviation. In genuinely non-displaced fractures treatment may be conservative, but displaced fractures must be approached surgically and as early as possible to avoid aggravating vascular or soft tissue lesions, even if there is no evidence that a slight delay might trigger the occurrence of ischemic necrosis. The most usual approach for most talar neck fractures is anteromedial,with or without a malleolar osteotomy, because it is theless traumatic one although, if the fracture is comminuted, the addition of a lateral approach may be necessary to identify any shortenings or rotational deviations.Conclusion. Open fractures and fractures associated o dislocations must be treated as an emergency given the skin and neurovascular trauma associated to them, which could lead to skin necrosis or a compartmental syndrome. The most significant sequelae are ischemic necrosis of the talar body, which depends on the severity of the initial injury, and posttraumatic arthritis, which depends on achieving a good reduction and a stable internal fixation

Evaluación de un programa intensivo de Educación Conductiva dirigido a niños con Parálisis Cerebral / Evaluation of an intensive program of Conductive Education in children with Cerebral Palsy

Objetivo: El objetivo principal de este trabajo es ofrecer datos objetivos de los cambios experimentados por un grupo de 30 niños con parálisis cerebral, de distinta tipología y grado de afectación, tras su participación en un programa intensivo de rehabilitación basado en el Método Petö o Educación Conductiva. Material y métodos: Los niños fueron explorados en dos momentos, al inicio y al final de las cinco semanas de tratamiento intensivo. En la primera evaluación se cumplimentó la historia clínica y se realizó una exploración motriz, cognitiva y adaptativa. En la segunda evaluación se repitió la exploración de la motricidad y de las destrezas adaptativas. La exploración motriz se realizó a través de la Gross Motor Function Measure (GMFM) de Russell, Rosenbaum, Avery y Lane (2002) y fue grabada en video. Resultados: El análisis de las puntuaciones obtenidas en la GMFM indica que un 70% de los niños con PC evaluados experimentan progresos significativos en su patrón motor grueso. También es interesante considerar otros aspectos positivos, como son la motivación y el interés que presentan estos niños durante el tratamiento a pesar de su intensidad

Objetive: To evaluate the clinical progress in a sample of 30 children with Cerebral Palsy, reciving an intensive therapy program of rehabilitation based on Conductive Education (Petö Program). Material and methods: Thirty children were examinated twice, at the beginning and at the end of an intensive 5- week program of Conductive Education therapy. We adressed motor examination and cognitive and adaptative function. Motor examination was assessed by means of Gross Motor Function Measure (GMFM) by Russell, Rosenbaum, Avery an Lane (2002), and video filmed. Results: Seventy per cent of children showed significant progress in their gross motor patern after treatment, not attributed to natural evolution of Cerebral Palsy

Neuromedin s as novel putative regulator of luteinizing hormone secretion.

Neuromedin S (NMS), a 36 amino acid peptide structurally related to neuromedin U, was recently identified in rat brain as ligand for the G protein-coupled receptor FM4/TGR-1, also termed neuromedin U receptor type-2 (NMU2R). Central expression of NMS appears restricted to the suprachiasmatic nucleus, and NMS has been involved in the regulation of dark-light rhythms and suppression of food intake. Reproduction is known to be tightly regulated by metabolic and photoperiodic cues. Yet the potential contribution of NMS to the control of reproductive axis remains unexplored. We report herein analyses of hypothalamic expression of NMS and NMU2R genes, as well as LH responses to NMS, in different developmental and functional states of the female rat. Expression of NMS and NMU2R genes was detected at the hypothalamus along postnatal development, with significant fluctuations of their relative levels (maximum at prepubertal stage and adulthood). In adult females, hypothalamic expression of NMS (which was confined to suprachiasmatic nucleus) and NMU2R significantly varied during the estrous cycle (maximum at proestrus) and was lowered after ovariectomy and enhanced after progesterone supplementation. Central administration of NMS evoked modest LH secretory responses in pubertal and cyclic females at diestrus, whereas exaggerated LH secretory bursts were elicited by NMS at estrus and after short-term fasting. Conversely, NMS significantly decreased elevated LH concentrations of ovariectomized rats. In summary, we provide herein novel evidence for the ability of NMS to modulate LH secretion in the female rat. Moreover, hypothalamic expression of NMS and NMU2R genes appeared dependent on the functional state of the female reproductive axis. Our data are the first to disclose the potential implication of NMS in the regulation of gonadotropic axis, a function that may contribute to the integration of circadian rhythms, energy balance, and reproduction.

Telarquia precoz como signo guía de pubertad precoz central / No disponible

La telarquia precoz puede ser una patología benigna sin trascendencia clínica o el inicio de una pubertad precoz verdadera. En este artículo intentamos repasar las diferentes causas de la pubertad precoz, haciendo hincapié en las causas tumorales del sistema nervioso central como etiología de este cuadro, sobre todo, desde la introducción de técnicas de imagen como la resonancia magnética. En el caso clínico que presentamos llama la atención la edad tan temprana a la que se desarrolla la pubertad y cómo en estos casos es obligatorio descartar siempre una etiología tumoral; el hamartoma de hipotálamo es una de las causas más frecuente (AU)

The precocious thelarche can be either a benign condition without clinical significance or the beginning of a real precocious puberty. We try to revise, in this article, the different causes of precocious puberty, emphasizing the tumours of the central nervous system as the aetiology of this condition, especially after the introduction of image techniques as the magnetic resonance. In the clinical case we present, it is remarkable the early age the puberty is developed. In these cases, it is always obligatory to rule out the tumour aetiology being the hypothalamus hamartoma one of the most frequent causes (AU)

[Pathophysiology of gas exchange in ARDS]. / Fisiopatología del intercambio gaseoso en el SDRA.

ARDS is produced in a pulmonary edema picture due to increased vascular patency. In this way, the initial alteration consists in an alveolar occupation due to protein rich edema. This occupation reduces the alveolar surface available for gas exchange, increasing the pulmonary areas with poor or null V/Q ratio. As ARDS progresses, vascular phenomena occur that affect the gas exchange differently, giving rise to heterogeneity in the V/Q ratio. This situation worsens due to the appearance of areas with null ventilation in relationship with the appearance of atelectasis in lung dependent zones. All these factors form the hypoxemia picture refractory to the increase of the inspired oxygen fraction characteristic of this clinical entity. In this article, we make a review of these physiological mechanisms and the effect on the oxygenation of different ventilatory and drug maneuvers.