[Study of the introduction of the European Credit Transfer System (ECTS) in pediatrics and modification of the teaching methodology]. / Estudio sobre la introducción del Sistema de Transferencia de Créditos Europeo en Pediatría y modificaciones de la metodología docente.

INTRODUCTION: Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. OBJECTIVES: To test the introduction of the ECTS in pediatrics and modify the teaching methodology. STUDY DESIGN: The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. RESULTS: Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. CONCLUSIONS: Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated.

Estudio sobre la introducción del Sistema de Transferencia de Créditos Europeo en Pediatría y modificaciones de la metodología docente / Study of the introduction of the european credit transfer system (ECTS) in pediatrics and modification of the teaching methodology

Introducción Las Facultades Médicas españolas han comenzado el nuevo proceso de reforma curricular en el marco del proceso de implantación del Espacio Europeo de Educación Superior y deben incorporar el Sistema de Transferencia de Créditos Europeo (ECTS) a los nuevos planes del estudio antes de 2010. Objetivos El objetivo del trabajo fue experimentar la introducción de los créditos ECTS en la asignatura de Pediatría y modificar la metodología docente. Diseño del estudio Adaptación del programa teórico y práctico, estableciendo unos objetivos docentes y un sistema de evaluación. Se realizaron encuestas a los alumnos al inicio del segundo cuatrimestre del curso 2004-2005, antes de realizar el examen teórico de la asignatura y al finalizar el curso académico, utilizando para las respuestas una escala de tipo Likert con 5 grados. Se comparó la priorización de las competencias genéricas y específicas de los alumnos con la de los profesionales médicos en la encuesta de la Conferencia Nacional de Decanos (CND). Para el análisis de los resultados se aplicaron pruebas no paramétricas. Resultados Los 15 créditos actuales se transformaron en 11 ECTS, con 297 h de trabajo para los alumnos. Se redujo el programa teórico de 80 a 52 lecciones. Los alumnos prepararon y presentaron 14 casos clínicos, bajo la supervisión de sus tutores. Los profesores consideraron que el aprendizaje teórico había sido similar al de cursos anteriores (66,6 %) y había sido mejor el práctico (73,3 %). Los alumnos opinaron que el proyecto debía continuar (73,2 %), pero el 98,8 % consideraron que la carga de trabajo había sido excesiva. Los alumnos apreciaron de forma estadísticamente significativa que mejoró la docencia práctica y su capacidad para preparar y presentar casos clínicos. El rendimiento académico de los alumnos fue significativamente mejor que el de los alumnos del curso anterior. Los estudiantes estuvieron de acuerdo con la prioridad de competencias de la CND para 9/9 de las generales y 4/17 de las específicas. La estimación de horas de trabajo de los alumnos fue mayor por los alumnos que por los profesores. El 73,3 % de los alumnos contestaron que el proyecto debía mejorarse, reduciendo la carga de trabajo de los alumnos y mejorando el sistema de evaluación. Conclusiones La introducción de los ECTS mejoró el rendimiento académico, la formación práctica y el autoaprendizaje de los alumnos. La experiencia fue satisfactoria para profesores y alumnos. La estimación de la carga de trabajo de los alumnos fue subestimada

Introduction Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. Objectives To test the introduction of the ECTS in pediatrics and modify the teaching methodology. Study design The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. Results Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. Conclusions Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated

[Quantitative aspects of osmotic opening of the blood-brain barrier in experimental hyperbilirubinemia]. / Aspectos cuantitativos de la apertura osmótica de la barrera hematoencefálica en hiperbilirrubinemia experimental.

The presence of a number of interesting factors in kernicteric newborns with low serum bilirubin levels has lead us to study one important aspect, the reversible osmotic opening of the blood-brain barrier. Initially, an experimental hyperbilirubinemia was developed by the infusion of a crystalline bilirubin solution. Next, an increased serum osmolality state was generated by the injection of two different levels of urea (348.9 +/- 12.4 and 388.9 +/- 11 mOsm/kg). The bilirubin binding reserve capacity was not affected; however, we found a significant elevation in bilirubin concentrations in the homogenized brains of the hyperosmolality groups (2.92 +/- 0.54 and 3.4 +/- 0.43 mg/gr versus control of 2.43 +/- 0.63 mg/gr, F = 8.43, p < 0.01). Cerebral125 albumin was increased to similar proportions in those groups submitted to hyperosmolality.

[Acute perforated sigmoid diverticulitis in childhood]. / Diverticulitis aguda de sigma perforada en la infancia.

Colonic diverticulosis is a pathology of high incidence in normal population during the last decades of life. About 2-5 per 100 of patients admitted because of this disease are below 40 years old, and in this group of patients diverticulitis tends to be very aggressive with a high number of complications. We report a clinical case of acute perforation of sigmoid colon due to diverticulitis in a ten year old child who was treated surgically by means of resection of the sigma and primary end-to-end anastomosis. We did not find in the literature consulted any cases of this illness under twenty years of age.

[An approximate survey of the state of vaccination of the infantile population of Tenerife]. / Estudio de aproximación sobre el estado de vacunaciones de la población infantil de Tenerife.

This is a study of the level of vaccination in a group of 5,909 schoolchildren from three municipalities in Tenerife, in which various methods of collecting information were used, obtaining different results (p less than 0.02), between the schoolchildren of 6 and 7 years old in schools where informative talks on the importance of vaccinations were given for parents before collecting the information on the level of vaccination and those in schools where talks were not given. We point out that the response of parents was much better in two schools within the area covered by the health centre where letters were sent out to the parents. No important differences were found in the groups of children between 12 and 15 years old. We propose that to keep up the level of vaccination the best methods are informative talks and letters to parents and that the (FAT) should be responsible for this.

[Electroencephalographic maturation in preterm newborn infants]. / Maduración electroencefalográfica en el recién nacido pretérmino.

We have studied 51 preterm infants [gestational age (GE) less than 32 weeks] by: a neurologic examination at 40 weeks of postconceptional age, serial cranial ultrasonographies, weekly electroencephalograms (EEG) until 42 weeks of postconceptional age, and Brunet-Lezine test of psychomotor developmental at 1 year old. Our objective is the longitudinal study of EEG maturation in preterm infants with or without neurologic injury. In preterm infants with the less gestational age are present the EEG characteristics reported for the older infants, the typical EEG pattern is the "sawtooth" (27-30 weeks GE). If these infants are "normal", the EEG maturation get adjusted to the previous reported pattern, except for the earlier presentation of transitory acute frontal waves and the disappearance of the preterm's discontinuous trace. The EEG maturation of preterm infants with perinatal neurologic injury are significantly delayed in contrast with "normal" preterm infants until 40 weeks of postconceptional age; this fact have a poor prognosis for these infants.

[Acute monocytic leukemia as secondary neoplasia in a girl with acute lymphocytic leukemia]. / Leucemia monocítica aguda (LMA-M5) como segunda neoplasia en una niña con LLA-L1.

The presence of second malignancies in children suffering from acute lymphoblastic leukemia (ALL) is becoming increasingly frequent. Nevertheless, the appearance of M5 type acute myeloid leukemia (AML) in patients being treated for ALL is very rare. We report the presence of AML-M5 as a second malignancy in a girl diagnosed of ALL-L1 56 months before. The clinical course of this rare association is discussed.

[Extrinsic allergic alveolitis: apropos of a case in a child]. / Alveolitis alérgica extrínseca: a propósito de un caso en edad pediátrica.

We present a young male (12 years) with low grade fever, weight loose, anorexia and progressive dyspnea. The clinical, roentgenological and pulmonary function pictures are close with interstitial pneumonitis. The patient had a pigeon loft on his house, thus we tried confirmed the diagnosis of extrinsic allergic alveolitis: pigeon breeder's lung. We believed at any patient age the pigeon breeder's lung must be considered in the differential diagnosis of interstitial pneumonitis. A good anamnesis will avoid unnecessary complementary test.

[Transient neonatal hyperthyroidism in the child of a treated hyperthyroid mother. Subsequent appearance of sexual precocity]. / Hipertiroidismo neonatal transitorio e hijo de madre hipertiroidea tratada. Posterior aparición de precocidad sexual.

We report a newborn female with neonatal hyperthyroidism, born to a mother with Graves disease treated with potassium iodide and carbimazole. At four months she had some breast development, a bone age advance of one year, and elevated levels of FSH and estradiol. Later on the prolactin level was also raised, while LH and TSH values continued low. Posteriorly, irregular cutaneous pigmentation, brown in colour, was evident on the neck and trunk, and a McCune-Albright syndrome was suspected. The relationship between these conditions and treatment of them is discussed.

[Effects of the administration of a diet with a low content of calcium and vitamin D derivatives on mineralization in pregnant rats and their fetuses]. / Efectos de la administración de una dieta con bajo contenido en calcio y derivados de la vitamin D sobre la mineralización de ratas gestantes y sus fetos.

Calcemia and calcium content of femuri has been determined in 88 female adult Wistar rats, distributed in four groups: Group A was given a normocalcic diet, group B a hypocalcic diet and groups C and D were also given the same hypocalcic diet, but at the same time were administered DHT and vitamin D (CC) respectively (15 mcg 3 times weekly). They were all killed 21 days after having been with a male for 24 hours; four rats were pregnant in each group A, B and C with a total offspring of 26, 22 and 35 fetuses respectively. Three pregnant rats in group C, gave 19 fetuses. Rats on hypocalcic diet showed a lower bone calcium content referred to 100 mg as weight, in comparison with those on a normocalcic diet (F = 5.51; p less than 0.01). Administration of CC or DTH did not hinder bone calcium depletion, which was more noticeable in pregnant rats (p less than 0.05). Concerning to calcemia, no differences existed between pregnant and non pregnant rats, there was a significant lowering of calcemia (F = 14.3; p less than 0.01) in rats on the hypocalcic diet (group B), but when administration of vitamin D (group D) and DHT (group C) was done, calcemia remained respectively equal and higher (p less than 0.001) by comparison to group A. Total calcium content in the ashed fetuses was similar in all groups. Fetuses acted as parasites of their mothers in respect to quantities of calcium deposited in them.

[Seasonal variation and diagnostic value of plasmatic levels of 25-hydroxycholecalciferol (author's transl)]. / Variación estacional y valor de referencia de los niveles plasmáticos de 25-hidroxicolecalciferol (25OHD3).

Plasma 25-hydroxycholecalciferol (25OHD3) has been measured by means of gas-liquid chromatography (HPLC) in 23 healthy mothers and their normal full term babies. It was measured as well in twelve infants, nine children of 1.5-5 years and in 57 schoolboys of 5-12 years. Infant population showed a wide variation of plasma 25OHD3 (m +/- SEM) being 16.4 +/- 1.45 ng./ml. Children 1.5-5 years old showed 12.7 +/- 2.3 ng./ml. which is lower than expected. Schoolboys showed a normal values of 22.9 +/- 1.3 ng./ml. These differences are believed to be due to a great sunshine exposition. In perinatal group, births taking place in winter showed a very low level of 25OHD3 (m +/- SEM) in mothers (6.9 +/- 1.8 ng./ml.) and consequently in their newborns (5.3 +/- 1.6 ng./ml.). Those taking place in summer showed significantly higher figures for both mothers (18.9 +/- 2.7 ng./ml.) and newborns (12.9 +/- 2.4 ng./ml.). A good correlation (r = 0.83) between plasma levels of mothers and newborns is found.

[Iron absorption in low birth weight and anemic infants (author's transl)]. / Absorción del hierro en recién nacidos de bajo peso y en lactantes anémicos.

A total of 35 iron balances were performed using a milk formula containing 6.25 +/- 1.23 mcg./dl. of iron. Twenty balances were done during the first 3 days of life (group 1) in low birth weight infants with 36.2 +/- 2.6 weeks of gestation and with birth weights of 2.13 +/- 0.28 kg. Thirteen of these infants received a calcium lactate supplement of 800 mg./kg./day. Ten balances were carried out at 13.9 +/- 4.12 days of life (group II) in LBWI with 36.0 +/- 2.1 weeks of gestation and with birth weights of 2.08 +/- 0.22 kg. Five balances were performed in a heterogeneous group (group III) of patients with iron-deficiency anemia (transferrin saturation: 6.3 +/- 2.9%). In group 1, the absorption coefficient for iron was 48.5 +/- 13.6% and of the 562. +/- 155.9 mcg./kg./day of iron ingested, 577.7 +/- 277.7 mcg./kg./day were retained. There were no statistically significant differences between groups I and II, but there were significant differences for ingestion, excretion and iron retention (p less than 0.001). In group I, iron absorption was not modified by the addition of calcium lactate. There was a positive significant correlation (p less than 0.001) between ingestion and net iron retention in groups I and II. Balances performed on five anemic children showed absorption coefficients of 10.5, 11.5, 41.6, 60.0 and 74.2% respectively. In view of our data, recommendations as to the optimal iron supplementation of cow's milk and as to the most desirable time to initiate it are analyzed.

[Hypothermia, respiratory distress and umbilical catheterization as risk factors in necrotizing enterocolitis (author's transl)]. / Enterocolitis necrotizante neonatal. Valoración de la hipotermia, "distress" y cateterización umbilical como factores de riesgo.

Fourteen patients diagnosed of neonatal necrotizing enterocolitis (NNE) admitted into the neonatal unit since August 1977 are presented. They were matched to a control group of 130 newborn infants born during that same period of time for sex, weight and gestational age. All patients were formula fed except for three who followed mixed feeding. NNE was closely associated to hypothermia (p less than 0.005), respiratory distress (p less than 0.001) and umbilical catheterization (p less than 0.005). Umbilical catheters introduced for reasons other than distress did not increase the incidence of NNE. Low birth weight infants were more frequently affected than those weighing over 2,500 gm (ratio, 27:1). Evolution was lethal in six cases. The remaining eight are presently under follow up with no evidence of disease.

[NBT test evaluation during the neonatal period (author's transl)]. / Valoración del "test" de nitroazul de tetrazolio en el período neonatal.

161 determinations of NBT performed according to the technique described by Park et al. on 67 patients of ages ranging from 1 hour born to 66 days, with weights between 1,610 to 4,600 g, and gestational ages from 34 to 41 weeks. During neonatal period, reduction of NBT is increased. Birth weight, fetal distress and neonatal asphixia do not seem to affect the NBT index during the first week of life. There is an inverse correlation (r = -0.557, p less than 0.001) between days of age and NBT test. Comparison of NBT test among infected and no infected newborns of various ages, showed significant differences (p less than 0.001). While NBT test may not be the key to detection of infection in neonatal period, according to results, it seems to be a fast and relatively simple test when seriated controls are performed on newborns believed to be infected.