The effect of a combined rehabilitation program on the temporomandibular joint in systemic sclerosis evaluated by ultrasound exam.

PURPOSE: Temporomandibular joint (TMJ) involvement is frequent in Systemic Sclerosis (SSc). Dysfunction and X-ray changes of TMJ were described only in few observational studies. Treatment as well has been seldom considered. Aim of the present study was to evaluate the effects on TMJ of two specifically designed physiotherapy protocols. METHODS: The study group included 26 SSc outpatients (22 females and 4 males with mean age ± SD 59.08 ± 10.31 years). Thirteen patients were randomly assigned to a treatment (protocol 1) including home exercises for TMJ and thirteen to a treatment (protocol 2) including home exercises and a combined procedure. The rehabilitation effects on the TMJ were evaluated by ultrasound examination (UE) in static and dynamic phases. UE was performed in all patients before and at the end of the treatment and after a follow up (8 weeks). RESULTS: Both rehabilitation protocols induced a significant improvement (protocol 1: p < 0.01 and protocol 2: p < 0.005) of mouth opening with a long-lasting effect. Protocol 2 was more effective than protocol 1. A significant increase of bilateral condyle-head temporal bone distance was detected by UE at the end of both treatments. It was maintained at follow-up in patients treated with Protocol 2. CONCLUSIONS: The present investigation shows that a rehabilitation program characterized by home exercises with a combined procedure is useful to recover the function of TMJ. The data also show that UE is helpful in the evaluation of TMJ in SSc and in the assessment of the efficacy of the rehabilitation programs.

[Assessment of adherence to antibiotic treatment in Primary Care by determining levels of the drug using a liquid chromatography technique]. / Valoración de la adherencia al tratamiento antibiótico en Atención Primaria mediante la determinación de niveles del fármaco utilizando una técnica de cromatografía líquida.

OBJECTIVE: The lack of adherence to antibiotic treatments is a matter of special interest, which has important clinical implications, as it is associated with therapeutic failure and increased bacterial resistance causing a high sani-tary cost. The objective of our study was to assess the degree of adherence to prescribed antibiotic treatment in outpatients through the detection of these in blood, urine or sputum. METHODS: Concentrations of antibiotics prescribed in 39 patients (34 with clinical suspicion of urinary tract infection and 5 with clinical suspicion of low respiratory tract infection) treated in Primary Care consultations of the Sanitary District of Almería (Spain) were determined by ultra-high performance liquid chromatography coupled to tandem mass spectrometry. RESULTS: A 48.7% of the patients did not comply correctly with the indicated treatment due to the complete or partial omission in taking the prescribed antibiotics. This lack of adherence was independent of the age and sex of the patients, the number of daily doses of the antibiotic, and whether or not they were receiving another medication. CONCLUSIONS: Precise analytical techniques such as liquid chromatography can be useful to detect inadequate or incomplete treatments as well as the degree of adherence of outpatients. Thus, adequate measures could be established that affect the control of therapeutic compliance.

Preoperative embolization of meningiomas with polyvinyl alcohol particles: The benefits are not outweighed by risks.

PURPOSE: The purpose of this study was to define the feasibility, the efficacy and the safety of preoperative embolization (POE) of meningiomas using polyvinyl alcohol (PVA) particles. MATERIALS AND METHODS: Between January 2006 and June 2014, 191 consecutive patients were referred to our institution for the treatment of meningiomas; of these 57 patients were excluded from the study. A total of 64 patients (22 men and 42 women) with a mean age of 58.4±10.8 [SD] years (range: 14-82years) who underwent POE with PVA particles, achieving extensive (>90%) devascularization were ultimately included and compared to 70 patients who had surgery without POE. Surgical time and intraoperative blood loss were compared between the two groups. The duration of procedures and complications related to POE were analyzed. RESULTS: No differences were found between the two groups with respect to intraoperative blood loss. A significant reduction in surgical time was observed for the group who had POE (207.4±79.5 [SD] min vs. 226.9±117.6 [SD] min; P=0.028). In a subgroup analysis, the size and location of meningiomas did not influence these results. The duration of procedures was 41.4±10.5 [SD] min. Minor complications related to POE occurred in 3 out of 64 patients (4.7%). CONCLUSION: POE of meningiomas using PVA particles is effective in reducing surgical time, when extensive tumor devascularization is achieved. However, radiation exposure, the duration of procedures and complications related to POE with PVA particles do not justify this technique in most patients.

Managing atypical and typical herpetic central nervous system infections: results of a multinational study.

There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection.

Ruminococcus gnavus E1 modulates mucin expression and intestinal glycosylation.

AIMS: The molecular cross-talk between commensal bacteria and the gut play an important role in the maintenance of the intestinal homeostasis and general health. Here, we studied the impact of a major Gram-positive anaerobic bacterium of the human gut microbiota, that is, Ruminococcus gnavus on the glycosylation pattern and the production of intestinal mucus by the goblet cells. METHODS AND RESULTS: Our results showed that R. gnavus E1 specifically increases the expression and the glycosylation level of the intestinal glyco-conjugates by goblet cells in the colonic mucosa of mono-associated mice with R. gnavus E1 as well as in human HT29-MTX cells. Such an effect was mediated through induction of the level of mRNA encoding for the major intestinal gel-forming mucin such as MUC2 and various glycosyltransferase enzymes. CONCLUSIONS: This study demonstrates for the first time that R. gnavus E1 possess the ability to modulate the glycosylation profile of the glyco-conjugate molecules and mucus in goblet cells. SIGNIFICANCE AND IMPACT OF THE STUDY: Furthermore, we demonstrated that R. gnavus E1 modified specifically the glycosylation pattern and MUC2 expression by means of a small soluble factor of peptidic nature (<3 kDa) and heat stable in the HT29-MTX cell.

Expanding the Living Donor Pool "Second Act": Laparoscopic Donor Nephrectomy and ABO-Incompatible Kidney Transplantation Improve Donor Recruitment.

BACKGROUND: To safely expand our living donor pool, we recently decided to work on 3 areas: analysis of causes of exclusion of potential donors, the results of which we recently published, introduction of laparoscopic donor nephrectomy (LDN), and ABO-incompatible (ABOi) transplantation. We sought to determine the impact of the new strategy on living donor recruitment and transplantation during over a 10-year period at a single institution. METHODS: From January 2005 to September 2014, we evaluated 131 living donors. Of these, 80 (61%) were genetically related, 51 (39%) unrelated, 119 (91%) ABO compatible (ABOc), 12 ABOi (9%). The analysis was divided into 2 eras: era 1, 2005-2010 (n = 53) included the use of open lumbotomy and acceptance of ABOc only; and era 2, 2011-2014 (n = 78), which saw the introduction of LDN and ABOi transplantation. RESULTS: Forty-five (34%) potential candidates successfully donated, 67 (51%) were excluded, and 19 (15%) were actively undergoing evaluation. Overall, 53 potential donors were evaluated in era 1 (8.8 donors/year), 78 in era 2 (19.5 donors/year). There were fewer excluded donors in era 2 vs era 1 (62% era 1 vs 44% era 2), and living donor kidney transplantation (LDKT) significantly increased in era 2 vs era 1 (3.3/year era 1 vs 7.1/year era 2). The establishment of an ABOi LDKT program led to a 15% increase of evaluations in era 2 (12/78 donors). CONCLUSIONS: LDN along with ABOi LDKT allowed for an improvement in recruitment of living donors and corresponding LDKT.

[Nutrition and Metabolism Group of the Spanish Neonatology Society: recommendations and evidence for dietary supplementation with probiotics in very low birth weight infants]. / Grupo de Nutrición y Metabolismo Neonatal, Sociedad Española de Neonatología: recomendaciones y evidencias para la suplementación dietética con probióticos en recién nacidos de muy bajo peso al nacer.

Clinical practice guidelines are an important tool for improving healthcare. In recent years there has been accumulating evidence on the impact of nutritional supplementation with probiotics in the very low birth weight infants. With no uniformity in microorganisms and strains used. The Spanish Neonatology Society (SENeo), through its Nutrition and Metabolism Group has undertaken to develop recommendations that will be useful as a guide for the neonatologist in this field.

West Nile virus transmission through organ transplantation in north-eastern Italy: a case report and implications for pre-procurement screening.

PURPOSE: West Nile virus (WNV) transmission through organ transplantation occurs rarely and screening of organ donors for WNV infection remains controversial. This report describes the case of WNV encephalitis in a kidney recipient and the case of asymptomatic WNV infection in the organ donor, both observed at Treviso Hospital, northeastern Italy. After briefly reviewing the literature, we discuss the implications for WNV screening. METHODS: We reviewed medical, laboratory and epidemiological records at our hospital, and the literature concerning cases of organ-transmitted WNV infections and WNV screening of organ donors in Italy and worldwide. RESULTS: The kidney recipient was the first confirmed case of WNV infection notified in northeastern Italy in 2011, and the first case of WNV infection in a cluster of four transplant recipients who acquired the infection from a common organ donor. The organ donor, whose WNV infection was only retrospectively diagnosed by IgM detection, represents the index case of a WNV outbreak in the Treviso Province. Screening of her blood prior to organ recovery did not show detectable levels of WNV nucleic acid with the use of quantitative real-time polymerase chain reaction. CONCLUSIONS: This report emphasizes that transplant-acquired WNV neuroinvasive disease can be particularly severe. We suggest that pre-procurement screening of organ donors by testing blood with both WNV IgM capture ELISA and a sensitive nucleic acid testing should be adopted during the transmission season in the present Italian epidemiological setting.

Efficacy of the "body movement and perception" method in the treatment of fibromyalgia syndrome: an open pilot study.

OBJECTIVES: Group exercises may be useful in fibromyalgia syndrome (FMS). The 'Body movement and perception' (BMP) method is based on low impact exercises, awareness of body perception and relaxation, aimed at treating small groups of patients following the Resseguier method (RM) and integrating RM with exercises derived from soft gymnastics. We assessed the effects of BMP method on FMS. METHODS: 40 women with FMS (age and disease duration: 51.7±7.2 and 4.9±3.8 years) participated in an open pilot study. BMP sessions were performer twice a week (50 minutes each) for 8 weeks. Patients were assessed at enrolment (T0) and at the end of the study (T1) by a self-administered questionnaire (temporal characteristics of pain, pain interference in working and recreational activities and in night-time rest, awareness of pain, fatigue, irritability, well-being, quality of movement, ability to focus on perception and to perceive whole body, postural selfcontrol, ability to relax) and a clinical evaluation (tender points, assumption of analgesics/NSAIDs, distribution of pain, pain in sitting and standing position, pain during postural passages and gait, postural body alignment, muscular contractures). RESULTS: At T1, FMS patients significantly improved with respect to T0 in pain, fatigue, irritability, well-being, quality of movement, postural self-control, ability to relax mind and body, movement perception, tender point scores, assumption of analgesic/NSAIDs, body alignment and muscle contractures (p<0.05 for all the comparisons T1 versus T0). CONCLUSIONS: In FMS patients, rehabilitation with BMP improves pain and well being, reduces the number of tender points and muscle contractures, thus it is useful in FMS management.

Indeterminate, subcentimetric focal liver lesions in cancer patients: additional role of contrast-enhanced ultrasound.

PURPOSE: To evaluate whether the use of contrast-enhanced ultrasound (CEUS) could improve the characterization of indeterminate subcentimetric focal liver lesions (FLLs) seen with multidetector computed tomography (MDCT) in cancer patients. MATERIALS AND METHODS: For 12 months all patients with extrahepatic tumors showing small (< 10 mm), indeterminate focal liver lesions on whole-body or abdominal computed tomography (CT) underwent immediate, targeted ultrasound (US) to rule out a cystic lesion. Whenever unenhanced US demonstrated a non-cystic lesion or failed to recognize any focal abnormality within the suspected area, CEUS was carried out. During the arterial phase, CEUS was focused on the area reflecting the CT finding, while the entire organ was explored during the portal-sinusoidal phase. RESULTS: Among the 132 patients with MDCT evidence of indeterminate, subcentimetric focal liver lesions (206 lesions), US proved the cystic nature of 138 lesions in 87 patients. In 45 cases US failed to recognize any abnormality or cystic image and these subjects underwent CEUS. The CEUS results were confirmed by further assessment or follow-up for 43 / 45 patients (3 cysts, 8 hemangiomas, 47 metastases, 2 areas of focal steatosis, 2 eosinophilic necroses, 1 granuloma, 1 abscess, 1 fistula). CEUS failed to detect 3 lesions (1 metastasis and 2 benign lesions). In 8 cases CEUS recognized additional liver metastases. CONCLUSION: CEUS can be helpful in demonstrating or excluding metastases in cancer patients with MDCT evidence of subcentimetric, indeterminate focal liver lesions.

Rotura prematura de membranas antes de la semana 28 de gestación y resultados neonatales / Preterm premature rupture of membranes and neonatal outcome prior to 28 weeks of gestation

Objetivo: Describir las características y el pronóstico del manejo conservador en gestantes con rotura prematura de membranas pretérmino (RPMP). Material y métodos: Estudio observacional descriptivo de 65 casos de RPMP < 28 semanas, entre 1995 y 2005. Resultados: Características principales: gestación múltiple (29,3%), exudado positivo para Estreptococcus agalactiae (Streptococcus del grupo B) (14,85%) y RPMP anterior (16%). La mediana de días de bolsa rota (BR), cuando el índice de Bishop es < 7 es de 14 para gestantes con RPMP < 24 semanas y de 5 para gestantes con RPMP ≥ 24 semanas (p = 0,01). El manejo conservador no aumenta la morbimortalidad, salvo que presenten oligoamnios moderado-severo: el 100% de las corioamnionitis y el 69% de la mortalidad perinatal ocurrieron en gestantes con oligoamnios. Conclusiones: Las gestantes con RPMP < 24 semanas e índice de Bishop < 7 presentan mayores períodos de latencia, pero la morbimortalidad maternofetal no aumenta si el índice de líquido amniótico es normal (AU)

Objective: To describe the characteristics and outcomes after conservative management of pregnancies with preterm premature rupture of membranes (PPROM). Material and methods: We performed a descriptive, observational study of 65 cases of PPROM at less than 28 weeks of pregnancy between 1995 and 2005. Results: The main characteristics were twin pregnancies, positive culture for group B Streptococcus agalactiae (14,85%) and previous PPROM (16%). The median number of days with broken membranes, when the Bishop score was < 7, was 14 for pregnancies with PROM < 24 weeks and 5 for pregnancies with PPROM ≥ 24 weeks (P=.01). Conservative management does not increase morbidity or mortality, unless there is moderatesevere oligohydramnios: 100% of chorioamnionitis and 69% of perinatal mortality occurred in pregnancies with oligohydramnios. Conclusions: Pregnancies with RPMP < 24 weeks and a Bishop¿s score of < 7 have a longer latency period and maternal-fetal morbidity and mortality are not increased if the amniotic fluid index is normal (AU)

Symptoms accompanying fibromyalgia.

OBJECTIVE: The objective of the study was to investigate the relationship between spontaneous and provoked pain in fibromyalgia and to evaluate the frequency of disturbances associated with muscle pain, including some disturbances which are not usually considered as typical symptoms associated with pain in fibromyalgia. METHODS: In sixty-seven patients with fibromyalgia the severity of spontaneous pain was assessed by a visual analogue scale and the severity of provoked pain by an original method, which includes the evaluation of the number of tender points and the evaluation of the intensity of provoked pain. The method used to assess the severity of provoked pain is more sensitive than other methods currently used. The occurrence of accompanying symptoms was also evaluated. The investigation included the occurrence of paresthesias of the upper limbs, hemorrhoids and epistaxis, which are not usually considered as typical symptoms associated with fibromyalgia. RESULTS: No significant correlation was observed between the severity of spontaneous and provoked pain. The following disturbances were more frequent in the examined patients than in general population: headache, chronic fatigue, sleep disorders, irritable bowel syndrome, restless legs syndrome, paresthesias in the upper limbs, hemorrhoids and epistaxis. CONCLUSIONS: Spontaneous and provoked pain should be considered two independent clinical features of fibromyalgia. Paresthesias in the upper limbs, hemorrhoids and epistaxis should be considered as typical symptoms associated with fibromyalgia. Hemorrhoids and epistaxis are frequently due to a diathesis characterized by laxity of connective tissues and fibromyalgia could be a consequence of such a diathesis.

Sensing X chromosome pairs before X inactivation via a novel X-pairing region of the Xic.

Mammalian dosage compensation involves silencing of one of the two X chromosomes in females and is controlled by the X-inactivation center (Xic). The Xic, which includes Xist and its antisense transcription unit Tsix/Xite, somehow senses the number of X chromosomes and triggers Xist up-regulation from one of the two X chromosomes in females. We found that a segment of the mouse Xic lying several hundred kilobases upstream of Xist brings the two Xics together before the onset of X inactivation. This region can autonomously drive Xic trans-interactions even as an ectopic single-copy transgene. Its introduction into male embryonic stem cells is strongly selected against, consistent with a possible role in trans-activating Xist. We propose that homologous associations driven by this novel X-pairing region (Xpr) of the Xic enable a cell to sense that more than one X chromosome is present and coordinate reciprocal Xist/Tsix expression.

[Nurse's coworking to electronic medical record]. / Il contributo dell'infermiere all'informatizzazione dell'azienda ospedaliera.

Nephrologists need to register and look at a great number of clinical data. The use of electronic medical records may improve efficiency and reduce errors. Aim of our work is to report the experience of Villa Scassi Hospital in Genoa, where a "patient file" has been performed to improve nephrology practice management. The file contains all clinical records, laboratory and radiology data, therapy, dialysis clinics, in addition to reports of out-patients department. This system allowed a better efficiency in diagnosis and treatment of the patient. Moreover experience of nurses in employing electronic medical records is reported. A reduced number of errors was found in therapy administering, because of a only one data source for physicians and nurses.

Low power radiofrequency electromagnetic radiation for the treatment of pain due to osteoarthritis of the knee.

OBJECTIVE: To investigate the analgesic effect of low power radiofrequency electromagnetic radiation (RF) in osteoarthritis (OA) of the knee. METHODS: In a randomized study on 40 patients the analgesic effect of RF was compared with the effect of transcutaneous electrical nerve stimulation (TENS). RF and TENS applications were repeated every day for a period of 5 days. The therapeutic effect was evaluated by a visual analogue scale (VAS) and by Lequesne's index: tests were performed before, immediately after and 30 days after therapy. RESULTS: RF therapy induced a statistically significant and long lasting decrease of VAS and of Lequesne's index; TENS induced a decrease of VAS and of Lequesne's index which was not statistically significant. CONCLUSIONS: A therapeutic effect of RF was therefore demonstrated on pain and disability due to knee OA. This effect was better than the effect of TENS, which is a largely used analgesic technique. Such a difference of the therapeutic effect may be due to the fact that TENS acts only on superficial tissues and nerve terminals, while RF acts increasing superficial and deep tissue temperature.

Accurate prediction of autologous stem cell apheresis yields using a double variable-dependent method assures systematic efficiency control of continuous flow collection procedures.

BACKGROUND AND OBJECTIVES: Stem cell collection is a standard procedure for the procurement of autologous grafts to rescue myelosuppression induced by high-dose treatments. Accurate prediction of collection yields may contribute to optimize planning and quality control of collection. MATERIALS AND METHODS: Data of 313 autologous haematopoietic stem cell (AHSC) evaluable collections performed in 208 patients with haematologic and non-haematologic neoplasms from seven centres were prospectively analysed to test the accuracy of yield predictions generated by a formula that required the input of peripheral blood (PB) CD34+ cell precount and desired PB volume to be processed. Data were matched in a standard linear regression, in a zero-point regression analysis and tested for prediction accuracy. Further 165 AHSC collections were analysed on a single-centre basis, using yield predictions as reference standards. RESULTS: Analysis showed high levels of correlation between measured collection yields (my) and predictions (py) (R = 0.85; P = 0.000000) as well as high degree of prediction accuracy (my vs. py at paired t-test: P = 0.114781; median my/py ratio = 1.23). Analysis of additional 165 AHSC collections on a single-centre basis showed that the analysed centres had 70% or more measured yields comprising the 0.6-1.8 interval of the my/py ratio. The observance of the 'efficiency' my/py interval assured collection quality control in these centres confirming the reliability of the method. CONCLUSIONS: This prediction method generates accurate and immediate yield predictions allowing collection planning and rapid efficiency control. As a consequence of our study, four centres out of seven use the described method to plan both leukapheresis number and single-procedure blood processing volume while the remaining three centres plan leukapheresis number on the basis of our predictions, maintaining a fixed single-procedure 200 ml/kg blood volume processing, according to their centre AHSC collection policy.

La perinatología del recién nacido hijo de inmigrantes en el Hospital Clínico San Carlos de Madrid / Perinatology of newborns of immigrants parents at Hospital Clínioc San Carlos in Madrid, Spain

Objetivo: Conocer algunos de los aspectos perinatales de los recién nacidos hijos de inmigrantes, en el Hospital Clínico« San Carlos» de Madrid, con el fin de profundizar en el fenómeno migratorio. Material y métodos: Se analizan comparativamente los aspectos perinatales de 2.759 hijos de inmigrantes con los de 3.990 hijos de españoles, nacidos en el hospital en los últimos tres años. Se analizan: el orden de nacimiento, el curso y control del embarazo, el tiempo de ingreso y de rotura de la bolsa anteparto, el tipo de parto y la anestesia empleada. Resultados: De los inmigrantes nacidos en este hospital, más del 53% son primogénitos, y un 34% nacidos en segundo lugar. Casi el 10% de las inmigrantes no controlan el embarazo. El tiempo medio de ingreso anteparto es de 30 a 36 horas y el de rotura de bolsa de 5 horas. El porcentaje medio de cesáreas de estos tres últimos años ha sido de un 18%. Conclusiones: El porcentaje de recién nacidos hijos de inmigrantes va en aumento, y en este hospital se acerca actualmente al 50% de los recién nacidos. Cuanto mejor conozcamosto dos los aspectos relacionados con la inmigración, mejor podremos atender a estos pacientes en todos los aspectos, incluido el sanitario

Objective: To identify certain perinatal features of the newborn of immigrant parents at Hospital Clínico «San Carlos» (HCSC)in arder to acquire deeper knowledge about the immigration phenomenon in Spain. Material and methods: We studied certain perinatal characteristics of 2.759 newborns of immigrant parents as compared with 3,990 Spanish children, all of them born at HCSC in the last threey ears. We analyzed: birth order, course and health care monitoring during pregnancy, length of hospital stay, length of time between sac rupture and delivery, type of birth and type of anesthesia used. Results: More than 53% of the newborns were first born infants and 34% were second-born. Nearly 10% of the immigrant mothers underwent no monitoring during pregnancy. The average duration of the predelivery hospital stay was 30 to 36 hours, and the average length of time between sac rupture and delivery was 5 hours. Eighteen percent of the births were cesarean. Conclusions: The number of newborns of immigrant parents is increasing, currently accounting for almost 50% of the births at HCSC. The more we know about every factor related to this phenomenon, the better we will be able to assist the immigrant population

El recién nacido hijo de inmigrantes en el Hospital Clínico “San Carlos” de Madrid / Newborns frominmigrants copules at the Hospital Clínico “San Carlos”, Madrid

Objetivo: Conocer con precisión las características principales del recién nacido, hijo de inmigrantes, en el Hospital Clínico “San Carlos” de Madrid. Material y métodos: La población de estudio la forman 2.759 recién nacidos de inmigrantes, delos que 264 son hijos de africanas, 2.008 de americanas, 258 de europeas y 229 de orientales. Sus datos se comparan estadísticamente con los 3.990 recién nacidos hijos de españolas. Se analiza: sexo, edad gestacional, vitalidad y destino del recién nacido, tipo de lactancia, cribado metabólico y auditivo, y adopción. Resultados: El 52% de los recién nacidos hijos de inmigrantes son niños y el 48%, niñas, y más de la mitad, primogénitos. De lso que después del parto se han quedado con su madre, un 3,91% fueron pretérmino, un 93,72%, a término, y un 2,37%, postérmino. Los africanos y orientales fueron los que nacieron con más vitalidad. Casi el 94% recibió lactancia materna, frente a un 6% que tomó fórmula. A todos los recién nacidos se les efectuó un cribado metabólico y auditivo. El porcentaje de hipoacusias en ambos oídos fue similar en todos. Las madres que entregan más a sus hijos en adopción son las europeas, seguidas de las sudamericanas y de las españolas. Conclusiones: El recién nacido hijo de inmigrantes, po la Ley de Extranjería, tiene el mismo derecho a la asistencia sanitaria que el nacido hijo de españolas,a sí que, cuant mejor le conozcamos a él y a su antecedentes, mejor se le podrá asistir para garantizar sus salud

Objective:To study accurately the main characteristics of te newborns from immigrant coples inthe Hospital Clínico “San Carlos”, Madrid. Material and methods: 2,759 newborns from immigrant couples were studies. 264 of them were African, 2,008 American, 258 European and 229 Oriental. This population is statistically compared with 3,990 newborns from Spanish couples. We analyze: sex, gestational age, newborns vitality at birth, destiny of the newborns, type of lactation, metabolic and auditive screening, and adoption. Results: 52% of the children were male and 48% female. More than 50% primogenital. 3.91% of the children that stay with their mothers after birth were preterm; 93.72% were normal and 2.37% posterm births. African and Oriental showed more vitality at birth that the rest. Almost 94% were breast fed. The rest were formula fed. Every children went under metabolic and auditive screening. Hipoacusia was similar in both ears. European mothers show the highest percentage of children given in adoption, followed by Southamerican and Spanish mothers. Conclusions: Newborns from immigrant mothers have the same right to sanitary ais as newborns from Spanish mothers, according to the Immigration Law. The more we know about the immigran children and their background, the more we shall be able to assist them in order to guarantee their health

Gemelos: antropometría al nacimiento según sexo y edad gestacional. Curvas y tablas por desviaciones / Twins: anthropometry at birth according to sex and gestational age. Curves and charts according to standard deviation

Objetivo: Realizar unas curvas y tablas de crecimiento intrauterino de los gemelos, según sexo y semanas de gestación, a la vez que conocemos los aspectos perinatales de estas gestaciones. Material y métodos: Se estudia la antropometría al nacimiento (peso, talla y perímetro craneal) de 1.116 parejas de gemelos, vivos, sanos y procedentes de embarazos sin patología, nacidos en el Hospital Clínico "San Carlos" de Madrid, mediante análisis descriptivo transversal. Resultados: Se presentan las curvas y tablas de crecimiento, por media y desviación estándar (+2DS, +IDS y -2DS, -IDS) de 1.056 niños y 1.084 niñas gemelos. Conclusión: Cada grupo poblacional debe contar con sus propias curvas de crecimiento fetal, para poder catalogar a los recién nacidos en pretérmino, a término y postérmino, y en grandes, adecuados y pequeños para su edad gestacional (AU)