Toxicity of three rare earth elements, and their combinations to algae, microcrustaceans, and fungi.

Rare earth elements (REEs) are naturally distributed in the environment, and are increasingly being used in agriculture and high technology materials worldwide, thereby increasing anthropogenic contamination and environmental risks. There exists scarce and contradictory toxicity information about REEs; hence, more studies are required, especially on their mixtures. Thus, this study aimed to assess the toxicities of La3+, Nd3+, Sm3+, and the combinations of these elements (binary 1:1 and ternary 1:1:1), to organisms from different trophic levels: producers (the microalgae Chlorella vulgaris and Raphidocelis subcapitata), primary consumers (the microcrustaceans Daphnia similis and Artemia salina), and decomposers (the fungi Penicillium simplicissimum and Aspergillus japonicus). Ecotoxicological bioassays were performed, and toxic concentrations were determined. Thereafter, toxicities of single and mixture REEs were classified as slightly to highly toxic according to their toxic units. Finally, a concentration addition (CA) model was used to estimate how REEs interact upon combining. Nd3+ was the most toxic element for all organisms, especially D. similis (48 h LC50 9.41 mg.L-1), and was therefore classified as highly toxic. Sm3+ promoted cell agglomeration in Chlorella vulgaris and was the most toxic of the tested elements for this organism (72 h IC50 25.78 mg.L-1). The CA model revealed synergistic responses for most of the combinations, principally Nd3+ + Sm3+, which was the most toxic combination for the tested organisms. Both fungi were the most resistant organisms, and A. japonicus produced exudate and sclerotia, which help in the detoxification of chemicals. Owing not only to the fact that fungi displayed a higher resistance to REEs, but also due to the absence of regulations for REEs released from the agricultural or industrial sector, and the lack of methods to treat effluents or to dispose of technological items containing REEs, these organisms should be considered as a model for the biosorption or bioremediation of REEs. Finally, the toxic effects of REEs, particularly Nd3+, on the biota and human health should be the focus of future studies due to their increased use in technology.

Towards light-mediated sensing of bacterial comfort.

UNLABELLED: Bacterial comfort is central to biotechnological applications. Here, we report the characterization of different sensoring systems, the first step within a broader synthetic biology-inspired light-mediated strategy to determine Escherichia coli perception of environmental factors critical to bacterial performance. We did so by directly 'asking' bacterial cultures with light-encoded questions corresponding to the excitation wavelength of fluorescent proteins placed under the control of environment-sensitive promoters. We built four genetic constructions with fluorescent proteins responding to glucose, temperature, oxygen and nitrogen; and a fifth construction allowing UV-induced expression of heterologous genes. Our engineered strains proved able to give feedback in response to key environmental factors and to express heterologous proteins upon light induction. This light-based dialoguing strategy reported here is the first effort towards developing a human-bacteria interphase with both fundamental and applied implications. SIGNIFICANCE AND IMPACT OF THE STUDY: The results we present here are at the core of a larger synthetic biology research effort aiming at establishing a dialogue with bacteria. The framework is to convert the human voice into electric pulses, these into light pulses exciting bacterial fluorescent proteins, and convert light-emission back into electric pulses, which will be finally transformed into synthetic voice messages. We report here the first results of the project, in the form of light-based determination of key parameters for bacterial comfort. The ultimate goal of this strategy is to combine different engineered populations to have a combined feedback from the pool.

Decolorization of different textile dyes by Penicillium simplicissimum and toxicity evaluation after fungal treatment.

The objective of this study was to investigate the capacity of decolorization and detoxification of the textile dyes Reactive Red 198 (RR198), Reactive Blue 214 (RB214), Reactive Blue 21 (RB21) and the mixture of the three dyes (MXD) by Penicillium simplicissimum INCQS 40211. The dye RB21, a phthalocyanine, was totally decolorized in 2 days, and the others, the monoazo RR198, the diazo RB214 and MXD were decolorized after 7 days by P. simplicissimum. Initially the dye decolorization involved dye adsorption by the biomass followed by degradation. The acute toxicity after fungal treatment was monitored with the microcrustacean Daphnia pulex and measured through Effective Concentration 50% (EC50). P. simplicissimum reduced efficiently the toxicity of RB21 from moderately acutely toxic to minor acutely toxic and it also reduced the toxicity of RB214 and MXD, which remained minor acutely toxic. Nevertheless, the fungus increased the toxicity of RR198 despite of the reduction of MXD toxicity, which included this dye. Thus, P. simplicissimum INCQS 40211 was efficient to decolorize different textile dyes and the mixture of them with a significant reduction of their toxicity. In addition this investigation also demonstrated the need of toxicological assays associated to decolorization experiments.

Mortality due to acute adverse drug reactions: opiates and cocaine in Barcelona, 1989-93.

Drug-related deaths have become a major source of premature mortality. This paper presents an analysis of deaths due to acute adverse drug reactions caused by opiates or cocaine in the city of Barcelona over a 5-year period during which figures were stable. Annual mortality rates due to adverse drug reactions of city residents for the 1989-93 period were estimated to be 15.3 per 100,000 people in the 15-49-year age group. Mortality rates for men (25.0) are consistently higher than mortality rates for women (5.8). Mortality rates by age group show different patterns by gender. Males in the 25-29-year group have the highest mortality rate (62.8), almost doubling the rates for the 20-24 (36.1) and 30-34 (33.3)-year groups. The highest differential in age-specific mortality by gender is seen in the 35-39-year age group, where mortality rates for men (21.5) are eight times higher than for women (2.6 per 100,000). The distribution by place of residence, stratifying data across city neighbourhoods and municipal districts displays wide differences between districts in the mean annual rates, ranking between 77.3 and 8.3 per 100,000, a nine-fold magnitude. Differences are even steeper when we break down data by neighbourhood. Although all areas with high adverse drug reactions mortality are areas of low socio-economic level, a more complex association between deprivation and drug use must exist, as other areas with similarly low socio-economic indicators do not suffer from such high mortality. A cross-tabulation of place of residence and district of death shows that for most adverse drug reaction deaths, death takes place in the district of residence but patterns related to districts who attract drug-related deaths and districts who export them may be observed. These results provide new insights into the epidemiology of substance abuse in Barcelona, where it follows patterns that may be similar to those of other major urban areas in Spain, but also in other Southern European countries.

[Change in health-related problems of cocaine consumption in Catalonia, Spain]. / Cambio de los problemas de salud provocados por la cocaína en Cataluña.

BACKGROUND: Our aim was to study the evolution of cocaine-related health problems in Catalonia, Spain. METHODS: Analysis of first treatment admissions, emergency-room episodes, and mortality recorded by information systems on drug abuse in Catalonia and the city of Barcelona (Spain) in 1999. RESULTS: In 1999, cocaine was the illegal drug most frequently reported among drug-related emergency-room episodes (1,093 episodes in the city of Barcelona). In addition, cocaine was the illegal drug most frequently found among fatal drug overdoses (80% of all deaths in the last quarter of 1999) and the one that caused the highest number of treatment admissions (1,547 cases in Catalonia). CONCLUSIONS: There is an increase in cocaine-related health problems which means that it is needed health to improve the diagnosis, health education, treatment and prevention of complications associated with the use of this substance.

[The epidemiology of the acute adverse drug reaction in Barcelona in 1983-1992: a mortality analysis]. / Epidemiología de la reacción aguda adversa a drogas en Barcelona, 1983-1992: análisis de la mortalidad.

BACKGROUND: Mortality caused by acute adverse drug reactions (AADR) increased in Spain over the eighties and has become one of the major causes of death for youth. This paper presents the results of a study in the city of Barcelona during the 1983-92 decade; based in the city drug information system. METHODS: The study includes all deaths caused by AADR autopsied in the Forensic Institute between 1983 and 1992. Mortality of city residents is analyzed by cohort, grouping data in two-years and adjusting Poisson regression to mortality rates by age group, birth cohort and period of study. RESULTS: During this period a sharp increase in AADR mortality is seen, as there were 19 deaths in the city in 1983 and 160 in 1992. The increase concentrates in the years 1987-89. Although previously the increasing mortality of drug users was related by some observers with the progressive deterioration of their health status, linked to their increasing age and to the cumulative effects of years of substance dependence, the mortality analysis points to a clear period effect, resulting in an increased mortality across all age groups, for cohorts born after 1960. CONCLUSIONS: These results point to changes in the illegal drug market in the city or in the patterns of abuse as most likely causes for the increase. The results also suggest that since 1989 there is a stabilization in mortality due to AADR, which deserves further study.

[Methadone maintenance programs with supplementary services: a cost-effectiveness study]. / Programas de mantenimiento de metadona con servicios auxiliares: un estudio de coste-efectividad.

OBJECTIVE: Methadone maintenance programs (MMP) currently offer the best treatment for opioid-addicted patients. The aim of this study was to examine the cost-effectiveness of three MMPs that offered varying levels of supplementary services. Health-related quality of life was used as a measure of effectiveness. METHODS: A 12-month follow-up study of 586 patients beginning methadone treatment in Drug Care Centers in Barcelona was performed. The Nottingham Health Profile was used to measure quality of life. Standard unit costs and total cost per patient were calculated from activity registries. Sociodemographic, health-related and toxicological data were collected through a semi-structured interview. A cost-effectiveness analysis was performed through two multiple linear regressions with the same adjusting variables. RESULTS: The greater the number of supplementary services involved, the higher the costs. The adjusted models revealed a significant increase in health-related quality of life (an increase of 8% in the Nottingham Health Profile) and in costs (17%) between low- and medium-intensity programs. CONCLUSION: The medium-intensity program showed the best cost-effectiveness ratio. However, the study's limitations preclude categoric generalization of the data.

[Coping with the toll of heroin: 10 years of the Barcelona Action Plan on Drugs, Spain]. / Afrontar los estragos de la heroína: evaluación de diez años de un programa integral en Barcelona.

INTRODUCTION: The epidemic of heroin use began in Barcelona, as in the rest of Spain, in the late 70's, to reach its peak by the end of the 80's. In a first period, responsible officers experimented difficulties to define the specific objectives of opiate control policies. This paper reviews the effects of the adoption of an explicit policy on drug dependence grounded on a wide consensus in the City of Barcelona (Catalonia, Spain). SUBJECTS AND METHODS: Over a period of twelve years, from 1986 to 1997, both demand and offer of care and harm reduction services were analyzed, as well as the evolution of the adverse effects of drug use, such as mortality from acute adverse drug reaction, human immunodeficiency virus (HIV) infection, aids incidence, and incidence of tuberculosis. Data for city residents was compared through four different stages in this period. RESULTS: Despite the lack of data in initial years, relevant changes are apparent. Treatment offer changes clearly, with significant increases in initial treatment, coverage of methadone maintenance programmes, and sterile syringes distribution. Therapeutic compliance of tuberculous intravenous drug users IVDU and risk of HIV infection improve. Emergency service use linked to heroin, overdose, or withdrawal syndrome decreases. Mortality rates decline, although this decline does not reach statistical significance. DISCUSSION: Service offer shows a clear increase, reflected in treatment initiation, while harm reduction services expand. With the development of this process, outcome indicators change, both reflecting changes in the toll of the heroin epidemic (cases of tuberculosis and aids among IVDUs, HIV infection). and changes in a more comprehensive care (better treatment compliance of IVDUs with tuberculosis). There is a lower distortion of emergency services. These changes occur although the predominance of white heroin in Barcelona favors parenteral use.

[Portfolio of services in a public health organization]. / La cartera de servicios en una organización de salud pública.

Health services in Spain are currently being improved. Definition of the services portfolio has been one of the elements in this process, from which public health services have been largely left out. In the present article public health services are examined from the perspective of the Public Health Agency of Barcelona. We propose a scheme to classify services into productive public health services, health care services, services that are intermediate products, support services, and liaison or coordinating services. Indicators of productivity, result, impact, and cost are explored, and a catalogue of services for a public health organization with a well defined population and area is proposed.

Atresia de esófago: estudio descriptivo de una serie de 34 pacientes / Oesophageal atresia: descriptive study of a 34 patients serie

Introducción: La atresia de esófago (AE) comprende un grupo de malformaciones congénitas digestivas por un defecto en la continuidad del esófago. Supone una urgencia quirúrgica neonatal, y requiere un diagnóstico y un tratamiento inmediatos. La incidencia en las distintas series revisadas es de 1:2.500-3.500 recién nacidos. Objetivos: Conocer la epidemiología, la clínica y la evolución de los pacientes con AE tratados en nuestro centro. Pacientes y métodos: Estudio descriptivo y retrospectivo de pacientes ingresados por AE en un hospital terciario en los últimos 6 años. Resultados: Se incluyeron 34 recién nacidos, 15 de los cuales nacieron intramuros (incidencia de 1:1.833); un 61,8% eran varones y un 38,2% mujeres (relación de 1,5:1); la media de la edad gestacional fue de 37,12 ± 2,6 semanas, y la media de peso de 2.516,56 ± 599 g; la edad materna media se situó en 32,76 ± 5,78 años; el 11,8% presentó diabetes gestacional y un 38,2% abortos previos. En las ecografías prenatales, el 47,1% presentó polihidramnios. La distribución por tipo de AE fue la siguiente: I (14,7%), III (82,4%) y IV (2,9%). El síntoma guía principal fue la hipersalivación (38,2%). Un 30% presentó complicaciones postoperatorias; el esofagograma postintervención fue normal en un 80% de los casos. Un 38,2% de los pacientes asoció otras malformaciones; el número medio de días que los pacientes permanecieron sometidos a ventilación asistida fue de 7,66 ± 6,34, y el promedio de días que recibieron nutrición parenteral de 11,27 ± 7. La tasa de fallecimientos fue del 11,8%. Conclusiones: En nuestro medio encontramos una incidencia mayor que la documentada en la bibliografía, aunque una concordancia en la distribución según el tipo de atresia, el sexo y las malformaciones asociadas. También fueron mayores las tasas de diabetes gestacional y abortos previos en nuestra serie. La mortalidad dependió del peso del recién nacido y las malformaciones cardiacas asociadas; en nuestro estudio encontramos uno o ambos factores en los fallecimientos de nuestra serie (AU)

Introduction: Oesophageal atresia (OA) comprises a group of digestive malformations caused by a defect in the continuity of the oesophagus. It entails a neonatal surgical emergency, requiring immediate diagnosis and treatment. The revised incidence in different series is 1:2500-3500 newborns. Objectives: To determine the epidemiology and clinical course of patients with OA treated in our center. Patients and methods: Retrospective and descriptive study of patients admitted for OA in a tertiary hospital in the last 6 years. Results: 34 infants, 15 of whom were born in our hospital (incidence 1:1,833), 61.8% male, 38.2% female (ratio 1.5:1); gestational age 37.12 ± 2.6 weeks; weight at birth 2,516.56 ± 599 g, the average age of their mothers was 32.76 ± 5.78 years; 11.8% had gestational diabetes and 38.2% had previous abortions. In prenatal ultrasound, 47.1% had polyhydramnios. The distribution by type of OA was: I (14.7%), III (82.4%), IV (2.9%). The main guiding symptom was hypersalivation (38.2%). 30% presented postoperative complications; postintervention esophagogram was normal in 80%. 38.2% of patients had other malformations; they pointed an average of assisted ventilation were 7.66 ± 6.34 days and parenteral nutrition 11.27 ± 7 days. Exitus rate: 11.8%. Conclusions: In our area we found a greater incidence than reported in literature with consistency in distribution by type of atresia, sex and associated malfomations. Gestational diabetes and previous abortions rates were higher. Mortality depends on birth weight and associated cardiac malformations, finding one or both criteria in the exitus of our serie (AU)

Atención a los recién nacidos en 2009 y a sus madres en un centro de salud urbano de Zaragoza. Oportunidades de mejora / Care to neonates born in 2009 and their mothers in an urban health care center in Zaragoza. An opportunity of improvement

Introducción: en los últimos años ha cambiado considerablemente la composición de la población y la procedencia de los usuarios del Centro de Salud (CS) Torrero La Paz de Zaragoza. Este trabajo pretende analizar los datos sociosanitarios y de atención de los recién nacidos y de sus madres correspondientes a la zona de salud de Torrero La Paz a lo largo del año 2009. Los autores están especialmente interesados interesa en analizar las tasas de prevalencia de lactancia materna (LM) y su evolución en el tiempo, así como su relación con otras variables. Otra cuestión es estudiar las oportunidades de mejora que se plantean a partir del análisis de estos datos y de proponer las medidas correctoras adecuadas. Finalmente, se pretende, si es posible, fijar algún criterio de calidad fácilmente mesurable que pueda servir de indicador de calidad de la atención prestada. Material y métodos: se analizan los datos de la atención sanitaria recibida por 105 recién nacidos nacidos a lo largo del año 2009 y por sus madres en un CS de la ciudad de Zaragoza (España). Se estudian las tasas de LM. Se describen las oportunidades de mejora estableciendo medidas correctoras. Resultados: la primera visita del recién nacido al CS se realiza a los diez días de vida de media. La tasa de LM o lactancia mixta cuando recibieron el alta del hospital fue del 85%, y del 51,9% a los seis meses de vida. En esta población se observó una tasa de cesáreas del 19,65% y el porcentaje de madres fumadoras durante el embarazo fue del 20,95% Las madres más jóvenes y las procedentes de países en vías de desarrollo tuvieron tasas de LM superiores a las de las madres españolas. Los niños de menor peso al nacimiento y menor edad gestacional tuvieron tasas comparativamente inferiores de LM. Conclusiones: se proponen medidas correctoras que se inscriben dentro del contexto de medidas denominadas CS "amigos de los niños"(AU)

Introducción: in recent years has significantly changed the composition of the population and the origin of users of Torrero La Paz Health Primary Care Center of Zaragoza This work aims to analyze the social data and attention of the RN and their mothers corresponding to area of health of Torrero La Paz and throughout the year 2009. Authors are especially interested on rates of prevalence of breastfeeding (LM), its evolution in time and its relationship with other variables. Another issue is to study the improvement opportunities that arise from the analysis of these data, as well as propose appropriate corrective measures. Finally authors pretend to set some criteria easily measurable quality which can serve as indicator of quality of care. Material and methods: we analyzed data from the health care received by 105 newborns and their mothers born during the year 2009 in a primary care center in the city of Zaragoza (Spain). We studied breastfeeding rates. It describes the opportunities for improvement by establishing corrective actions. Results: the first visit of newborn care to health primary care were done within 10 days of age. The percentage of breastfeeding or mixed feeding when they were discharged from the hospital was 85% and 51.9% at 6 months. In this population there was a caesarean section percentage was19.65% and the percentage of mothers who smoke during pregnancy 20.95% younger mothers and those from developing countries had higher rates of breastfeeding than spanish mothers. Children of lower birth weight and gestational age had comparatively lower rates of breastfeeding. Conclusion: corrective measures are proposed which fall within the context of measures called Baby friendly Iniciative for health primary care centers(AU)

Readiness to change questionnaire: reliability study of its Spanish version.

The present study explored the reliability and validity of a Spanish version of the Readiness to Change Questionnaire (RCQ) (12-item short form) as it might be used for opportunistic intervention. The test has three scales to allocate patients to a stage of change: pre-contemplation (P), contemplation (C) or action (A). The RCQ was translated and back-translated prior to pilot administration to 15 patients. From two settings (a general hospital ward and a primary health care centre), 201 patients were identified as excessive drinkers on the Alcohol Use Disorders Identification Test. Patients known to be alcohol-dependent and attending for alcohol-related reasons were excluded. Patients completed the RCQ. Test-retest reliability after 2 days was assessed in 35 patients. A components analysis was performed. Patients were classified on RCQ scores to a stage of change. Two experts separately interviewed the patients and made an allocation to stage of change, blind to the RCQ score. Test-retest reliability was good (P: r = 0.81; C: r = 0.87; A: r = 0.86). Within the three scales, RCQ items showed fair consistency in terms of Cronbach's alpha (P: 0.58, C: 0.75, A: 0.80). Component analysis showed that together the scales accounted for 57. 4% of the variance. The experts agreed between themselves on patients' stage of change (weighted kappa 0.92) but much less with the stage of change according to RCQ (expert A, kappa = 0.44; expert B, kappa = 0.52). Omitting patients with low consumption did not improve internal reliability, and omitting those with low educational level who might have filled in the questionnaire wrongly did not improve internal reliability or agreement between RCQ and the experts. We conclude that the Spanish RCQ did not function efficiently in a population of opportunistically identified excessive drinkers.

Prevalence of problematic cocaine consumption in a city of southern Europe, using capture-recapture with a single list.

This study aims to determine the magnitude and characteristics of problematic cocaine consumption in the city of Barcelona, Spain. Capture-recapture with a single source was used to estimate prevalence. Log-linear regression models with interaction terms were fitted to the total sample and to subgroups according to other drugs consumed. Emergency room indicator data were obtained from the Barcelona Drug Information System. Drug-related emergencies of Barcelona residents for 1999 were analyzed. During 1999, a total of 4,035 drug-related emergencies were seen in Barcelona hospitals. Of these, 1,656 (41%) involved cocaine consumption; 41% of these patients had consumed cocaine with an opiate; 29% used cocaine with other substances; and 30% used cocaine alone. It was estimated that there was a total of 25,988 problematic cocaine users (95% confidence interval 11,782-58,064), yielding a rate of 31.27 per 1,000 inhabitants aged 15 to 54 years (95% confidence interval 14.2-69.9). The number of cocaine-related emergencies was high enough to allow capture-recapture to be applied, thus obtaining an estimate of the prevalence of problematic cocaine consumption, and high enough to characterize users according to different profiles. The use of capture-recapture with a single source can be interesting for problems related to the urban context.

Decolorization of different textile dyes by Penicillium simplicissimum and toxicity evaluation after fungal treatment

The objective of this study was to investigate the capacity of decolorization and detoxification of the textile dyes Reactive Red 198 (RR198), Reactive Blue 214 (RB214), Reactive Blue 21 (RB21) and the mixture of the three dyes (MXD) by Penicillium simplicissimum INCQS 40211. The dye RB21, a phthalocyanine, was totally decolorized in 2 days, and the others, the monoazo RR198, the diazo RB214 and MXD were decolorized after 7 days by P. simplicissimum. Initially the dye decolorization involved dye adsorption by the biomass followed by degradation. The acute toxicity after fungal treatment was monitored with the microcrustacean Daphnia pulex and measured through Effective Concentration 50 percent (EC50). P. simplicissimum reduced efficiently the toxicity of RB21 from moderately acutely toxic to minor acutely toxic and it also reduced the toxicity of RB214 and MXD, which remained minor acutely toxic. Nevertheless, the fungus increased the toxicity of RR198 despite of the reduction of MXD toxicity, which included this dye. Thus, P. simplicissimum INCQS 40211 was efficient to decolorize different textile dyes and the mixture of them with a significant reduction of their toxicity. In addition this investigation also demonstrated the need of toxicological assays associated to decolorization experiments.

Evolución del desarrollo neurosensorial de los recién nacidos de peso extremadamente bajo (<1.000g) en nuestro medio / Evolution of neurosensory development of very low weight newborns (<1.000 g) in our setting

Objetivo. Estudiar la situación y evolución neurológica de los recién nacidos de peso extremadamente bajo (<1.000g) en nuestro medio. Material y métodos. Estudio retrospectivo sobre la evolución de 148 RNMBP nacidos entre 1993-2004 después de un período de seguimiento de aproximadamente 27,5 meses. Se realizó estudio estadístico con el programa SPSS 15.0 para Windows de un amplio número de variables correspondientes a gestación, parto, edad gestacional, peso al nacimiento, complicaciones postnatales y evolución neurológica. Las secuelas se clasificaron leves, moderadas y graves según las alteraciones funcionales y necesidades del paciente y las alteraciones ecográficas por la gravedad de las lesiones. Se analizaron también la incidencia y mortalidad de los recién nacidos de peso extremadamente bajo. Resultados. La incidencia de los RNEBP se ha ido incrementado en los últimos años, alcanzándose un máximo de 11,3% en el 2007 así como su supervivencia, siendo esta del 45% en el 2005, 62,5% en 2006 y del 82% en el 2008. Resaltaba alto porcentaje de pretérmino de bajo peso gestacional (BPEG), gestaciones múltiples, embarazos por reproducción asistida, patología obstétrica, cesáreas, complicaciones neurológicas y extraneurológicas y tratamiento recibidos. El porcentaje global de secuelas fue del 42%, clasificándose como leves el 55,9%, moderadas el 25,5%, y graves el 18,6%. En relación al tipo de secuela, predominaron las motoras puras (45%), seguidas por las mixtas 824%) y plurideficiencias (14%). Hipoacusia neurosensorial en un 4% de la población y de retinopatía en el 43,2%. El 27% cumplían criterios de parálisis cerebral, predominando la tetraparesia. El 53,7% presentó alteraciones en la ecografía transfontanelar (HPIV 31,7%, LPV 12,8%, ventriculomegalia 26,3%, hidrofelaia posthemorragica (4,1%). Tuvieron alta correlación estadística con la aparición de secuelas especialmente la edad gestacional y las alteraciones ecográficas, así como los días de ventilación mecánica y de ingreso en UCI, la membrana hiailina, displasia broncopulmonar, persistencia de ductus arterioso, enterocolitis necrotizante y diversos tratamientos. Conclusiones. Se observa un incremento en la incidencia y supervivencia de los prematuros de pesio extremadamente bajo en nuestro medio. La proporción de secuelas es alta en relación con otras series, predominando las leves o no discapacitantes y se relacionan principalmente con la edad gestacional y la patología que presentan, principalmente del sistema nervioso central (AU)

Objective. To study the neurological evolution and situation of extremely low birth weight (<1.000 g) newborn in our area. Patients and Methods. Retrospective study of the evolution of 148 ELBW born between 1993-2004 after a follow up period of approximately 27.5 months. The statistical study was done with SPSS 15.0 and Windows. Many variables were studied related to pregnancy, delivery, gestational age, birth weights, postnatal complications and neurodevelopmental evolution. The disability was classified as mild, moderate and severe according to functional alterations and patient needs; and ultra sound abnormalities depending on severity of injuries. The prevalence and mortality of ELBW newborn were also analyzed. Results. The ELBW incidence has increased during the last years, reaching a maximum of 11,3% in 2007 and as well as their survival, this being 45% in 2005, 62,5% in 2006 and 82% in 2008. It is remarkable the high percentage of low weight, multiple gestations, assisted reproduction, obstetric pathology, caesareans, neurological and extraneurological complications and treatments received. Neurodevelopmental disability was detected in 42%, being mild in 55,9%, moderate in 25,5% and severe in 18,6%. In relation to the type of disability, pure motor predominated (45%), followed by mixed disabilities (24%) and multiple disabilities (14%). Neurosensorial deafness in 4% of the population and premature retinopathy in 43.2%. Cerebral palsy in 27%, being the most frequent the tetraparesis. 52,7% had abnormalities on transfontanelle ultrasound (intraventricular hemorrhage 31.7%, 12.8% leukomalacia, ventriculomegaly 26.3%, post-hemorrhages hydrocephalus (4.1%). Te sequelae had high statistical correlation with the gestational age, the ultrasound abnormalities and the days of mechanical ventilation and ICU stay, membrane hyaline disease and bronchopulmonary dysplasia. Conclusions. We have observed an increment in the incidence and survival of the ELBW newborn in our area. The proportion of sequelae is high in relation to other series with a predominance of mild sequelae. The most predictive variables are gestacional age and pathology, especially in the central nervous system (AU)

Sepsis y meningitis neonatal por «Streptococcus bovis» biotipo I («S. gallolyticus» subsp. «gallolyticus»). Comunicación de un caso y revisión de la bibliografía / Neonatal sepsis and meningitis caused by "Streptococcus bovis" biotype I ("S. gallolyticus" subsp. "gallolyticus"). Report of a case and review of the literature

Streptococcus bovis es un microorganismo del grupo D no enterococo, que produce habitualmente infecciones en adultos inmunodeprimidos y, de forma excepcional, casos de infecciones invasivas en neonatos, generalmente causadas por la variante 2 del biotipo II. Es importante la correcta identificación microbiológica, ya que su tratamiento y pronóstico son muy diferentes respecto al resto de estreptococos. Presentamos el caso de un neonato de 9 días de vida, con un cuadro clínico de sepsis y meningitis con convulsiones y hemorragia intracraneal, aislamiento en sangre y en el líquido cefalorraquídeo de S. bovis biotipo I, y buena respuesta clínica al tratamiento con ampicilina y cefotaxima. Este caso es el primero registrado en nuestra unidad, y posiblemente también el primero documentado en la literatura según la revisión de la bibliografía realizada. Se comentan aspectos de interés de la afección (AU)

Streptococcus bovis is a nonenterococcal, group D streptococcus, which frequently causes infections in immunocompromised adults and exceptionally cases of invasive infections in neonates, often caused by the variant 2 of the biotype II. It is important the correct microbiological identification because the treatment and prognostic are very different from other streptococcus. We report a case of a 9-day-old neonate with sepsis and meningitis with seizures and intracranial bleeding, with CSF and blood isolation of S. bovis biotype I, with good response to ampicillin and cefotaxime treatment. This is the first case in our service and probably the first documented in the literature according to the bibliography review. We comment the most interesting aspects of the affection (AU)

Hemorragia intracraneal por sangrado debido a una deficiencia de vitamina K tras un parto en el domicilio / Intracranial hemorrhage due to vitamin K deficiency bleeding after homebirth

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