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Antecedentes: Numerosos factores han sido implicados en el proceso de implantación, entre ellos se destaca la presencia de glicoproteínas de superficie. Se ha demostrado en ratones, entre otros, que los tipos y cantidades de azúcares de superficie varían según el período del ciclo reproductivo en el que se encuentran, lo que podría sugerir un importante papel de estas variaciones en la mayor receptividad del útero al blastocisto. Objetivos: Describimos los carbohidratos de superficie del aparato reproductor de la coneja, correlacionándolos con los cambios en sus genitales externos, y con los distintos períodos de su ciclo reproductivo. Métodos: Se usaron 15 conejas, ovuladoras coitales, en las que se identifica el período del ciclo según cambios en sus genitales externos; 5 tenían vulva blanca (poca receptividad al macho y bajo índice de embarazos), 5 tenían vulva rosa, y 5 roja (máxima receptividad al macho y alto índice de embarazos). Se estudiaron variaciones en los azúcares de superficie en el oviducto, útero distal, útero medio y cuello uterino, representados por el grado de tinción de 5 lectinas: eritrina cristagalli (ECL), dolichos biforus agglutinin (DBA), ulex europaeus aglutinin-1(UEA-1), pisum sativum agglutinin (PSA) y artocarpus integrifolia (Jacalin). Resultados: Hubo predominio del disacárido N-acetilgalactosamina α 1-3N-acetilgalac-tosamina (DBA) en todos los períodos y lugares del aparato reproductor, exceptuando el período de vulva roja en útero medio, donde prevalece la beta galactosa (Jacalina). Los residuos de manosa/α glucosa (PSA), presentan alta reacción en los períodos de vulva rosa y roja en el oviducto y útero distal. La galactosa β1-4 N-acetil glucosamina (ECL) y la L-fucosa (UEA-1) tienen bajo nivel de expresión en todos los sitios y períodos. Conclusión: La ausencia del disacárido N-acetilgalactosamina α 1-3N-acetilgalac-tosamina en el período de vulva roja y en el útero medio y la prevalencia de la beta galactosa en el mismo período y lugar es consistente con los datos encontrados por otros autores, lo cual ayuda a confirmar la importancia de estos residuos para regular el proceso de implantaciónBackground: Several factors have been implied in the process of implantation, among them the presence of glicoproteins of the surface is the most outstanding. It has been showed in mice; among others; that the kind and quantity of sugars of surface varies according to the cycling reproductive period in which they are found, which it may suggest an important role of these variations in a major receptivity of the uterus to the blastocyst. Objectives: It describes the surface carbohydrates of the female rabbit reproductive system making an analogy with the changes in the outer genitals, and with the different cycles of the reproductive period. Method: In this study 15 the female rabbits were used which ovulated during coitus, and in which it could identify the cycling period found according the changes of the outer genitals, five had white vulva (low male receptivity and low index of pregnancy), five had them pink, and the other five had them red (high male receptivity and high index of pregnancy), it was studied variations of surface sugars in the oviduct, distal uterus, middle uterus and cervix of the rabbits represented by the degree of tinción of 5 different lectinas: eritrina cristagalli (ECL), dolichos biforus agglutinin (DBA), ulex europaeus agglutinin (UEA-1), pisum statibum agglutinin (PSA), and artocarpus intergifolia (Jacalin). Results: It was found superiority of disaccharide N-acetylgalactosamine α 1-3 N- acetylgalactosamine (DBA) in all periods and places of the reproductive system with the exception of the red vulva period in the middle uterus, where the β-galactose prevails (Jacalin). The residues of manose/α glucose (PSA), present in high reaction in the pink and red vulva periods the oviduct and distal uterus. The galactose (β1-4 N-acetyl glucosamine (ECL) and the L-Fucose (UEA-1) have a low level of expression in all places and periods. Conclusion: The absence of disaccharide N-acetylgalactosamine α 1-3 N-acetylgalactosamine in the red vulva and the middle uterus period and the prevailing of the β-galactose in the same period and place it is consistent with the information found by other authors, this may help to confirm the importance of these residues to regulate the process of implantation

Introduction and Aims: Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic., Materials and Methods: A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared., Results: The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6, [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died., Conclusions: During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher., (© 2022 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A.)

The renin-angiotensin-aldosterone system (RAAS) is the main plasma volume regulator, which maintains cardiovascular and hydrosaline homeostasis. In the classical pathway, the angiotensin converting enzyme (ACE) generates Angiotensin II (AngII), which is powerfully inflammatory and vasoconstrictive. This classical pathway is also regulated by ACE2, which converts AngI to Ang 1-9, and degrades AngII to Ang 1-7, whose vasodilatory and anti-inflammatory functions balance out the effects of AngII. ACE2 has been associated with the pathogenesis of respiratory infections such as RSV and severe acute respiratory syndrome coronavirus (SARS-CoV and SARS-CoV-2). Recent studies have shown that ACE2 corresponds to the main SARS-CoV-2 receptor, which together with other receptors such as the TMPRSS2, allows the virus to attach, fuse, and enter the host cell. These studies have shown that in animals infected with coronavirus there is a drop in tissue concentration of ACE2 and Ang 1-7, leading to overexpression of AngII and its vasoconstrictive and inflammatory effects. Experiments with recombinant ACE2 have shown a protective effect against overexpression of RAAS in coronavirus-infected animals, which is similar to that demonstrated with the use of AngII receptor blockers (AT1). Evidence on the protective role of ACE2 seems to support the recommendations re garding not discontinuing these drugs in COVID-19 infection. In this article, we present the current knowledge about the role of RAAS in coronavirus infection, based on physiopathological concepts, molecular bases, and experimental and clinical evidence.

End-stage renal disease (ESRD) has an incidence of 5.5 to 9 pmp, and a prevalence of 23 to 65 pmp in children under 15 years of age. Chronic peritoneal dialysis (PD) represents the most widely used renal replacement therapy in children before kidney transplantation. There are two PD modalities, the manual one (CAPD) and the automated one (APD). The choice is based on the peritoneum characteristics, evaluated through the peritoneal equilibrium test (PET), which divides patients into high transporters (rapid exchange membrane), high average, low average, and low transporters (slow exchange membrane). This test basically evaluates the solutes transport rate, and the MiniPET has been added which evaluates peritoneal free water transport. The amount of dialysis (Kt/V), which represents the dose of dialysis administered also must be evaluated to assure a minimal value of 1.7 related to morbidity and mortality. These parameters should be evaluated periodically to ad just the PD and whenever suspected an inadequate clearance or ultrafiltration. The objective of this review is to provide basic concepts on peritoneal transport physiology, PD modalities, free water transport and peritoneal solute transport evaluation, and the dialysis dose to be applied according to the patient's needs, as well as reviewing the correction mechanisms and procedure adjustment whenever required.

Introduction: Patient Safety Culture is based on learning from incidents, developing preventive strategies to reduce the likelihood to happen and recognizing and accompanying those who have suffered unnecessary and involuntary harm derived from the health care received. To go ahead on patient safety culture entails facilitating the implementation of these behaviors and attitudes in healthcare professionals. Objective was to describe the regulations of some autonomous communities and national proposals for regulations changes., Material and Methods: Search of normative changes made in the autonomous communities of Catalonia, Navarra and the Basque Country. Proposals for legislative changes at national level were agreed., Results: Activities and normative changes made in the autonomous communities of Catalonia, Navarre and the Basque Country are described and proposals for normative changes at the national level at short-term and long-term changes are made. In such a way that it is easier to advance in creating culture of patient safety in the whole National Health System CONCLUSION: Currently there is no global regulation that facilitates to advance in patient safety culture. Changes at the national legislation level are essential. It is at the Inter-territorial Council where the proposed legislative amendment should be defined, promoted by the representatives of the health systems of the autonomous communities., (Copyright © 2019 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: A surgical technique for a double medial and lateral overlay autologous fascia graft myringoplasty is described in this paper along with its indications and results., Material and Method: The presurgical and one year post surgery characteristics are analyzed for 100 cases with the double medial and lateral overlay autologous fascia graft technique. The anatomical and functional results are analyzed., Results: The results are analyzed one year post surgery. The probabilities of obtaining a graft take using this methodology are 95%. The incidence of persistence of the perforations is 12.5% in children under 10 and 2.5% in children over ten years of age and adults. The complications are 4% of epithelial pearls with blunting of the neo-tympanum, 1% of retractions and 3% of epithelitis which is resolved with a topical medical treatment. The average residual air/bone gap is less than 20dB in 85% of the cases. Less than 10dB in 38%, and between 10 and 20dB in 47%. The causes for incomplete closure of the gap are analyzed; possibly related to fibrosis and sclerosis of the tympanic remnants and/or the ossicular chain., Conclusions: It is concluded that this methodology provides the best results in comparison with other methods we have used and have set aside for very specific situations related to the size and location of the perforation., (Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Available evidence assessing the impact of small intestinal bacterial overgrowth (SIBO) following gastrectomy is limited., Objectives: To evaluate the prevalence of SIBO after gastrectomy and its association with malnutrition. To describe the antibiotic treatment required to correct it and if nutritional status improves., Material and Methods: A prospective cohort study was performed at the Agencia Sanitaria Costa del Sol (Costa del Sol Health Agency) from 2012 to 2015. A hydrogen-methane breath test with oral glucose overload was performed. Demographic variables and nutritional parameters were collected at baseline and one month after effective treatment of SIBO. The antibiotic regimens and the number of treatment lines used were assessed., Results: Sixty gastrectomy patients were analysed, 58.3% of which were male. A sub-analysis of the curve was performed at 45min to minimise possible false positives, and SIBO was identified in 61.6% of cases. SIBO patients tended to have a lower BMI, although this trend was not statistically significant. After treatment with rifaximin, 94.6% of patients were still positive for SIBO, which fell to 85.7% after metronidazole. The rate of total antibiotic treatment failure was 67.6%. No statistically significant changes were found in nutritional parameters after treatment., Conclusions: SIBO was identified in 61.6% of patients after gastrectomy. No correlation was found with any malnutrition parameter. Rifaximin and metronidazole were found to be largely ineffective in eradicating SIBO. When treatment was effective, the impact on malnutrition was negligible and may have been associated with other factors., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

Background: Both environmental pollution and smoking affect the respiratory epithelium, causing cellular adaptation changes. Therefore, this work explores the presence of metaplasia in smokers compared with non-smokers from Mexico City., Methods: A prospective cohort study was performed. The sample was performed through a home interview covering the five Mexico City zones delimited to the study and monitoring of air quality. We searched metaplastic cells and inflammation in sputum cytology stained with Papanicolaou technique, and we assessed the air quality in Mexico City. We calculated relative risk (RR) and attributable risk (AR) in relation to the presence of metaplasia and smoking., Results: We performed 1897 home interviews obtaining a final sample of 30 participants. There were no significant differences between smokers and non-smokers with the presence of metaplastic cells (p = 0.269), although the association of metaplastic cells and inflammation showed a significant difference in the non-smokers group (p = 0.010). The RR in association with the presence of metaplasia in sputum cytology and smoking was 1.6, and the RA was 0.2., Conclusions: The air quality in this city has led the population to undergo changes of cellular adaptation in the respiratory epithelium by the simple fact of being exposed to environmental pollution. Metaplastic changes in non-smokers suggest strongly that pollution causes the same effect as smoking.

Unlabelled: Podocin is a protein located in the glomerular slit diaphragm where it takes part in the regulation of glomerular filtration. Mutations of the NPHS2 gene that codes podocin are the main cause of autosomal recessive steroid resistant nephrotic syndrome (SRNS)., Objectives: To identify the NPHS2 mutations in Chilean children with SRNS, and to determine the prevalence of the most common variants in a group of healthy adults., Patients and Methods: Mutation analysis of NPHS2 in 34 Chilean children with SRNS. Once the two most common variants of NPHS2 were identified, screening for these mutations was performed on 233 healthy adults. The mutation analysis was performed by the direct sequencing of the eight coding exons by polymerase chain reaction amplification. The DNA sequencing was performed using a fluorometric method, and then evaluated with SeqPilot software. The relationship between the presence of NPHS2 variants and SRNS was calculated by comparing the allele frequency between patients with SRNS and those of the healthy volunteers using the exact Fisher test. A P<.05 was considered significant., Results: Pathogenic NPHS2 mutations were detected in 7 (21%) of the 34 patients studied, of which 6 were heterozygotes for p.R229Q and p.A284V. The presence of p.R229Q was 2.46% in the healthy volunteers., Conclusions: This study shows that p.R229Q and p.A284V are the most frequent variants in Chilean children with SRNS. It is the first time that this relationship has been reported in Chilean children. Based on this, a screening strategy is proposed for the genetic study in patients with SRNS and their families. A parallel or sequential search strategy for p.R229Q and p.A284V in these patients is proposed., (Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

An evaluation of the characteristics of peritoneal solute and water transport is essential to assess the suitability of prescribing dialysis in patients suffering from chronic renal disease. There are currently a series of models to perform this evaluation. The peritoneal equilibration test (PET) evaluates the peritoneal transport capacity, classifying the patients into four transport categories: high, high-average, low-average, and low. The short PET enables the same evaluation to be made in only 2hours, and has been validated in paediatric patients. On the other hand, the MiniPET provides additional information by evaluating the free water transport capacity by the ultra-small pores, and the Accelerated Peritoneal Examination Time (APEX) evaluates the time when the glucose and urea equilibration curves cross, and has been proposed as the optimum dwell time to achieve adequate ultrafiltration. An analysis is presented on the current information on these diagnostic methods as regards free water transport via aquaporins, which could be an important tool in optimising solute and water transport in patients on chronic peritoneal dialysis, particularly as regards the cardiovascular prognosis., (Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Caustic or peptic esophageal strictures in children are the main cause of multiple dilations, which involve an important anesthetic risk and esophageal trauma. The placement of an esophageal stent can be an advance in the treatment of these patients. The objective of our work is to analiyze the efficacy of self-expanding stents for the treatment of esophageal strictures in children., Material and Methods: Three patients with esophageal strictures, one due to caustic and two to peptic esophageal injuries have been treated with esophageal stents. Metal stent covered with nitinol has been used in the first patient, and biodegradable material stent in the rest., Results: After a year of serial dilations, we placed two consecutive metal stents in one patient with caustic stricture. After its withdrawal, new dilations have been needed, but with longer asymptomatic period. The other two patients had peptic strictures; biodegradable stents were placed after months of serial dilations, before performing antireflux surgery. None of them needed further dilation., Conclusions: Esophageal stent placement has solved the problem without further dilation in peptic esophageal strictures. Asymptomatic period was significantly increased in caustic stricture. The results obtained with self-expanding stents are promising.

Objectives: To determine whether the intent of career mobility is associated with the frequency of job stressors and burnout syndrome experienced by emergency nurses., Specific Objectives: to assess perceived frequency of job stressors and burnout syndrome prevalence and its possible association with demographic and occupational values of the sample analyzed., Method: We performed a cross-sectional study. We used a survey of sociodemographic and occupational variables, and two validated questionnaires: the "Nursing Stress Scale" validated by Escriba et al. (1999) and the Inventory to assess Burnout Syndrome (MBI-GS, Schaufeli et al., 1996)., Results: The total Stress score mean was 32.88 +/- 12.67. There was a Burnout prevalence of 2.34%, while 23.4% of the sample expressed high levels of cynicism/depersonalization. The frequency of job stressors was significantly associated with burnout syndrome dimensions. The frequency of stressors and intention of career mobility were significant predictors of emotional exhaustion and cynicism, while the fixed night shift was associated with lower professional efficacy., Conclusions: This study shows a moderate frequency of job stressors in the unit analyzed, and a low prevalence of Burnout Syndrome. The intention to leave or career mobility is an important predictor of burnout process, so it should be something to take into account by human resource managers, in order to prevent the development of the burnout process in health organizations.

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.--Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.--To guide the growth of the segments in which the jaw is divided. 3.--Improve lingual function. 4.--Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby's crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero.

Objectives: Application of the theorem of Bayes for the study of the usefulness of complementary quantitative and qualitative assessment of the effectiveness of ultrasound diagnosis in order to provide the clinician with a tool to accurately assess the effectiveness of these tests in diagnosing abdominal pain appendix subject box., Methods: Retrospective cohort of 184 patients treated from January 2009 to June 2010 for abdominal pain suggestive of acute abdomen, of which 145 were operated. Were established as predictors of appendiceal disease abdominal exploration, ultrasonography and plasma levels of CRP and leukocytes. The statistical methodology developed by the systematic Bayesian prior determination of ROC curve and calculation of odds and post-test probability as pretest probability based on physical examination., Results: The ROC analysis cut-points set of quantitative tests on the values of WBC >12,800 and CRP >1.8 mg/dl. Applying the model to the white cell count increased clinical certainty of this test in 11.3 points and 13.9 PCR. The combined use of both the index rose 32 points. The effectiveness of ultrasound method showed a statistically significant 94% and an increase in diagnostic certainty of 48 points., Discussion: It is recommended to base the development of protocols and clinical guidelines in practice of test ultrasound as first, and joint determination of inflammatory markers, when that was questionable or negative. Further studies are proposed to increase the clinical certainty to reduce laparotomy white and diagnostic delays in this condition.

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy may be necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, minimum.

Background: Hypovitaminosis D has a high prevalence among patients with chronic kidney disease (CKD)., Aim: To determine the prevalence of 25 hydroxy vitamin D (25(OH) D) insufficiency and deficiency in pediatric patients on dialysis and kidney transplantation., Material and Methods: Serum calcium and phosphorus, parathormone (PTH), alkaline phosphatases and 25 (OH)D were measured in 13 children on hemodialysis (HD), 18 on peritoneal dialysis (PD) and 53 that received an allograft (Tx), aged 9.8 ± 4.6 years (51% females)., Results: Fifty four percent of patients had height Z score less than -1.88. Patients on HD had the lowest values. The average time of replacement therapy was 2.9 ± 2.8 years. Mean 25(OH)D levels in all was 18.7 ± 10.7ng/ml (HD: 21 ± 16.8, PD: 18.9 ± 8.5, Tx: 18.1 ± 9.72 ng/ml). Eighty eight percent of patients had levels below 30 ng/ml. Mean of serum calcium was 9.5 ± 0.64 mg/dl, serum phosphorus 5.03 ± 1.02 mg/dl, calcium-phosphorus product 48 ± 11.8 mg/dl and alkaline phosphatases 300.5 ± 171.3 IU/L. Average PTH values in dialyzed and Tx patients were 724.6 ± 640.5 and 107.7 ± 56.2 pg/ml, respectively (p < 0.001). A positive correlation between 25 (OH) D and calcium levels among PD patients was observed (r = 0.490, p = 0.04)., Conclusions: Hypovitaminosis D is highly prevalent among children on renal substitution therapy, regardless of the type of therapy used and the stage of renal failure.

Unlabelled: Non-medical health transport has great health, media and social repercussions and requires a very considerable amount of human and economic resources., Objective: To describe the quality, evaluated by external users of our Health Department, in order to know what are the most important elements for external users., Methods: Cross-sectional, descriptive observational study. Population to study: patients with a social security health card who come to the Hospital of Alicante and are non-medical health transport unit users., Results: Waiting time to be delivered to hospital in 92.7% of the cases was less than an hour, and was between one and two hours for 7.2%. The most frequent destinations were rehabilitation service and outpatient clinics. When users were asked if the would recommend this service, 60.9% said "for sure" and 39.1% said "probably yes"., Conclusions: This study allows us to know patient needs and expectations, as well as the factors they value the most and which of our work areas to improve., (Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.)

The gut is constantly exposed to a high antigenic load coming from the diet and commensal bacteria. The Gut-Associated Lymphoid Tissue (GALT) constitutes the most extensive and complex part of the immune system and is capable of efficiently distinguishing invasive pathogens from innocuous antigens. The knowledge of its unique structure consisting on organised tissue, inductor of the immune response (Peyer's patches and mesenteric lymph nodes), and diffused tissue, effector of the immune response (intraepithelial lymphocytes and lamina propria lymphocytes), allow us to understand the development and regulation of the immune response in the gut and how this one can be extended to the rest of the organism.

Introduction: the burnout syndrome (BS) is common among physicians, affecting their behavior, personality and professional goals; thus deteriorating the quality of their performance., Objective: to determine the BS prevalence among physicians affiliated to a tertiary care hospital and its associated risk factors., Material and Methods: The study was conducted through a cross-sectional design. The sampling was nonprobabilistic. Participating physicians were interviewed using the Maslach Burnout Inventory and the Beck's depression inventory. The analysis included ascertainment of the BS prevalence and use of chi(2) and logistic regression analysis. The local Internal Review Board and the Ethics Committee approved the project and all participants gave their informed consent., Results: 166 physicians participated; the average age was 42 years, most were men. The response rate was 87.4 %. The prevalence of depression with more than 10 points in the Beck inventory was 18.6 % (95 % CI: 12-24). Depression in the last two years was 38.6%; the prevalence of BS was 26%; 15. 2 % scored above 27 in emotional exhaustion and 19.3 % scored more than 10 points in depersonalization. The risk of being depressed due to BS was five times higher (OR 5.163; 95 % CI 2.130-12.5). Working in the night shift, living without a permanent couple and being depressed were the main risk factors for BS., Conclusions: BS is common among physicians and is associated with organizational and personal variables.

Background: Stunting is common among pediatric patients on peritoneal dialysis., Aim: To establish the best profile for urea kinetic variables associated to growth in children on chronic peritoneal dialysis (PD)., Patients and Methods: Twenty patients, aged 1 month to 14 years, 13 males, were followed for 6-12 months, with monthly measurements of weight/age and height/age Z score; plasma creatinine, BUN, protein and albumin and urine and dialysate urea nitrogen, creatinine, protein and albumin. Minimum total Kt/V was 2.1. Dialysis dose (Kt/V), Protein Equivalent of Urea Nitrogen Appearance (PNA), Protein Catabolic Rate (PCR) and Nitrogen Balance (NB) were calculated. To identify the variable(s) associated to growth, the Tree Classification Model (CART) Enterprise Miner 8.1 was applied., Results: Mean total/residual Kt/V: 3.4+/-1.3/1.69+/-1.27; Daily Protein Intake (DPI) was 3.25+/-1.27 g/kg/day. nPNA, PCR and NB were 1.37+/-0.44, 0.84+/-0.33 and 1.86+/-1.25 g/kg/day, respectively. Mean height/age Z score was -2.3+/-1.19. Eleven patients showed a positive height/age delta Z (mean 0.55+/-0.38) and nine showed a negative growth (mean -0.50+/-0.42). The main variable explaining the positive growth was a Nitrogen Balance between 0.54 and 2.37 g/kg/day, mean 1.55+/-0.21 (p <0.001). The second associated variable to growth was a residual Kt/V between 0.43 and 4.6 (2.02+/-0.49) (p <0.05). Kt/V and nPNA showed a significant correlation, but no correlation could be found between Kt/V and NB., Conclusions: Nitrogen Balance was the main variable associated to growth in pediatric PD, with values between 0.53 to 2.38 g/kg/day. The second variable was a residual Kt/V between 0.43 and 4.6. Therapy should be reassessed with NB values less than 0.54 or above 2.37 g/kg/day.

Ki-1 anaplastic large cell non-Hodgkin lymphoma is a well recognized clinical entity. The main clinical feature includes lymphadenopathy with mediastinal sparing. In the extranodal disease, which occurs in approximately half of the cases, the skin is the most common site; bone marrow, lung and central nervous system are generally not involved. Anaplastic large cell lymphoma is more common among young people, in whom the prognosis is more favorable. Primary anaplastic large cell lymphoma of the lung is a rare clinical entity. Its clinical expression is similar to a high grade malignant lymphoma, and in most cases the diagnosis is made in advanced stages. We present a pediatric case with ALK-1 positive anaplastic large cell lymphoma of the lung.

Intestinal lipomatosis is a rare entity and few cases have been reported in the literature. The condition is usually asymptomatic. Symptomatic cases usually present as obstruction or, less frequently, as bleeding. Intestinal barium studies, ultrasonography and computed tomography are useful diagnostic techniques. We present the case of a 47-year-old man with no relevant medical history who presented with intestinal obstruction of several months' duration. Complementary investigations yielded a diagnosis of intestinal obstruction due to ileocecal invagination secondary to endoluminal tumors of the ileum. Surgery and pathological analysis revealed the latter to be intestinal lipomatosis. This rare clinical entity has been associated with diverticulosis and intestinal volvulus.

Streptomycin was the first antibiotic to be used against Mycobacterium tuberculosis. It was used for years in monotherapy regimens, thereby resulting in the appearance of resistance and the relegation of its use. The resistance detected against drugs currently employed has led to a renewed interest in streptomycin. Its mechanism of action is centered on the ribosome, inhibiting the protein synthesis of the microbacteria. Resistance appears when mutations in the genes codifying for rRNA 16S and for protein S12 are produced. We studied the use of streptomycin against 899 M. tuberculosis strains, 713 of which were from pulmonary and 186 from extrapulmonary isolates. The BACTEC 460 TB system was initially employed as was the ESP II system. As controls, the ATCC27294 pattern strains (susceptible to streptomycin, rifampicin, ethambutol and isoniazid) were used. The results showed 2.1% secondary resistance in all the cases. Multiresistance was observed in 12 strains.

Unlabelled: 391 requests of collaboration to our ENT Department during 1996 have been collected. Twelve variables were analysed: number of request, age, sex, date of emission, type (ordinary, with priority, urgent), time elapsed from emission until valuation of the patient, source, reason's request, pathology, complementary tests, treatment and destination (discharge, re-examination during admission or as an outpatient and admission to ENT-Service)., Results: 1,58 request were attended per working day, 80 percent were resolved during the first 48 hours, the Internal Medicine Department was the most frequent source, fever without focus or recalcitrant was the most frequent reason from Paediatric Department. We report the epidemiologic features of the most frequent variables.

Unlabelled: Wilson's disease is a rare autosomal recessive disorder of copper metabolism. Kinnear Wilson described the entity in 1912 and considered it to be a degenerative disorder of the central nervous system associated with asymptomatic cirrhosis. Gene linkage analysis has localized the genetic defect on chromosome 13., Clinical Case: Woman of 15 years of age. She began with amenorrhea at 8 months of evolution, and acholia and hepatomegaly 1 month before her death. The viral serology panel was negative. She evolved with severe hepatic insufficiency and died. The quantitation of copper dose postmortem in hepatic tissue by atomic absorption spectrophotometry resulted in 250.57 micrograms/g. Electronic microscopy showed dense bodies in the mitochondria. Young adolescents frequently develop hepatic insufficiency as a first manifestation of Wilson's disease. Histologically, some morphology data such as the glucogenized naked nuclei, microvesticular fatty change, Mallory bodies, and hepatic regeneration, but the definitive diagnosis was decreased serum ceruloplasmin level, quantitation of copper in tissue, electron microscopy, and more recently, the molecular biology or genetic alterations.