Infecciones por Clostridioides difficile en pediatría. La visión del laboratorio a partir del diagnóstico microbiológico / Clostridioides difficile infections in pediatrics. The view of the laboratory based on microbiological diagnosis

La infección por Clostridioides difficile (ICD) es la principal responsable de diarreas nosocomiales en adultos. En los últimos años se registró un aumento en la incidencia de la ICD en la población adulta que, en cambio, no fue bien caracterizado en pediatría. El objetivo de este trabajo es analizar los datos resultantes del diagnóstico microbiológico de ICD en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". Materiales y métodos: se realizó un estudio retrospectivo observacional descriptivo que abarcó desde el 01/01/2018 hasta el 31/12/2021. El diagnóstico se realizó mediante enzimoinmunoensayo para glutamato deshidrogenasa (GDH) y toxinas en materia fecal (MF). Cuando sólo se detectó GDH, se realizó un cultivo toxigénico (CT) de la MF para la detección de toxinas in vitro. Se registraron: edad, sexo y procedencia de los pacientes y recurrencias de las ICD. Se efectuaron estudios de sensibilidad de 387 cepas de C. difficile a metronidazol (MTZ) y vancomicina (VAN). Resultados: en 6632 muestras (1764 pacientes) se registraron 649 estudios positivos (9,8%) (139 pacientes), la mayoría correspondieron a pacientes internados en áreas no críticas. Edad promedio: 7 años (7 ± 4,7). Sexo: 55% masculino. Recurrencias: 62 (45%). Positivos detectados mediante CT: 43%. Sensibilidad antibiótica: 100% a MTZ y 99,7% a VAN. Conclusión: Nuestra población presenta un bajo porcentaje de positividad. Se destaca el rendimiento del CT que permitió el diagnóstico de más de un tercio de los casos. MTZ y VANCO tuvieron excelente actividad in vitro frente a C. difficile (AU)

Clostridioides difficile infection (CDI) is the main cause of nosocomial diarrhea in adults. In recent years there has been an increase in the incidence of CDI in the adult population; however, CDI has not been well characterized in pediatrics. The aim of this study was to analyze the data resulting from the microbiological diagnosis of CDI at Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Materials and methods: a retrospective, observational and descriptive study was conducted from 01/01/2018 to 12/31/2021. Diagnosis was made using enzyme immunoassay for glutamate dehydrogenase (GDH) and toxins in stools. When only GDH was detected, toxigenic culture (TC) of stools was performed for in vitro toxin detection. The age, sex and origin of patients and CDI recurrences were recorded. Sensitivity studies of 387 strains of C. difficile to metronidazole (MTZ) and vancomycin (VAN) were performed. Results: In 6,632 samples (1,764 patients), 649 positive results (9.8%) were recorded (139 patients), most of which corresponded to patients hospitalized in noncritical areas. Mean age: 7 years (7 ± 4.7). Sex: 55% male. Recurrences: 62 (45%). TC-positive results: 43%. Antibiotic sensitivity: 100% to MTZ and 99.7% to VAN. Conclusion: A low percentage of positivity was found in our population. The performance of TC was outstanding, allowing for the diagnosis of more than one third of the cases. MTZ and VANCO had excellent in vitro activity against C. difficile (AU)

Rethinking the 'one-stop' neck lump clinic: a novel pathway beyond coronavirus disease 2019.

OBJECTIVES: UK guidelines advocate 'one-stop' neck lump assessment for cancer referrals. This paper reports the pilot of a novel pre-clinic ultrasound pathway, presents outcomes, and discusses strengths and limitations in the context of the coronavirus disease 2019 pandemic. METHODS: Two-week-wait cancer referral patients with a neck lump were allocated a pre-clinic ultrasound scan followed by a clinic appointment. Demographic, patient journey and outcome data were collected and analysed. RESULTS: Ninety-nine patients underwent ultrasound assessment with or without biopsy on average 8 days following referral. Patients were followed up on average 14.1 days (range, 2-26 days) after initial referral. At the first clinic appointment, 45 patients were discharged, 10 were scheduled for surgery, 12 were diagnosed with cancer, 6 were referred to another specialty and cancer was excluded in 19 patients. Retrospectively, four ultrasounds were performed unnecessarily. CONCLUSION: Pre-clinic ultrasound scanning is an alternative to the one-stop neck lump pathway. This study demonstrates fewer clinic visits, faster diagnosis and a low proportion of unnecessary scans, whilst minimising face-to-face consultations and aerosol-generating procedures.

Actividad física en mujeres jóvenes chilenas durante el confinamiento por COVID-19 / Physical Activity in Young Chilean Women during Covid-19 Lockdown

Objetivo: El presente estudio da respuesta a la pregunta: ¿Existen diferencias en el nivel de actividad física de mujeres chilenas antes y durante el confinamiento por COVID-19? Método: El estudio tiene un diseño no experimental longitudinal de tendencia con un n=1.051 mujeres chilenas jóvenes. Se midieron las diferencias en el nivel de actividad física entre los grupos pre (preCOVID) y post (COVID-19); y de la muestra COVID-19 con los datos teóricos tanto de estudios de actividad física previos como de encuestas nacionales gubernamentales. Resultados: las mujeres del grupo COVID-19 presentan niveles de actividad física significativamente más bajos que las mujeres de la muestra preCOVID-19; y que las muestras de mujeres de estudios empíricos anteriores. Conclusión: en tiempos de COVID-19 las mujeres jóvenes chilenas presentan un nivel de actividad física significativamente menor en tiempos previos al confinamiento. (AU)

Objective: The present study answers the question: Are there differences in the level of physical activity of Chilean women before and during confinement by COVID-19? Method: The study has a non-experimental longitudinal trend design with n = 1,051 young Chilean women. Differences in the level of physical activity between the pre (preCOVID) and post (COVID-19) groups were measured; and of the COVID-19 sample with theoretical data from both previous physical activity studies and national government surveys. Results: the women of the COVID-19 group present lower levels of physical activity than the women of the preCOVID-19 sample; and the samples of women from previous empirical studies. Conclusion: in times of COVID-19, young Chilean women present a lower level of physical activity, in previous times without lockdown due to the pandemic. (AU)

Pronóstico de pacientes nonagenarios ingresados por fracaso renal agudo / Prognosis of in hospital nonagenarians with acute kidney injury

Fundamento: El desarrollo de un fracaso renal agudo(FRA, definido siguiendo las guías KDIGO) durante unahospitalización en pacientes nonagenarios ha sido pocoestudiado. El objetivo del presente estudio es analizar lamortalidad en pacientes nonagenarios hospitalizados quedesarrollan un FRA. Métodos: Se recogieron todos los pacientes nonagenariosque desarrollaron FRA durante el ingreso hospitalarioentre 2013 y 2014. Basalmente, se recogieron variablesepidemiológicas, comorbilidades y, durante el ingreso, variables analíticas y mortalidad. Se analizaron las variablesasociadas a mortalidad durante el episodio de FRA y lospredictores independientes mediante regresión logística. Resultados: Se incluyeron 264 pacientes nonagenarioscon FRA. La edad media fue 93±3 años, siendo 73 (27,7 %)varones. Durante la hospitalización fallecieron 79 pacientes (29,9 %). Las comorbilidades asociadas a mortalidadfueron la insuficiencia cardiaca (p = 0,018), la disfuncióndiastólica (p = 0,042) y un mayor nivel o grado de dependencia (p = 0,003). Las variables clínicas en el momentodel ingreso que se asociaron a mortalidad fueron presiónarterial sistólica y diastólica más baja (p = 0,016 y 0,013,respectivamente), leucocitosis (p = 0,003), mayor severidad del FRA valorado por AKIN (p = 0,003) y valor deácido L- láctico más alto (p = 0,005). Los predictores independientes de mortalidad fueron la insuficiencia cardiaca(OR = 2,31; IC95%: 1,07-5,00; p = 0,036), la dependencia valorada por el índice de Barthel modificado (OR = 0,80; IC95%:0,67-0,97; p < 0,016) y el L- láctico al ingreso (OR = 1,31;IC95%: 1,06-1,61; p = 0,005). Conclusión: La insuficiencia cardiaca, el nivel de dependencia y el ácido L- láctico al ingreso son predictores independientes de mortalidad en pacientes nonagenarioshospitalizados con FRA.(AU)

Background:Ñ There has been little in the way of studyof nonagenarians with acute kidney injury (AKI, definedin lines with KDIGO guidelines), but the rise in their lifeexpectancy makes further study of this population necessary. The aim of this study is to assess mortality in nonagenarians with AKI during hospitalization. Methods: In this retrospective study, patients with AKIduring hospitalization between 2013-2014 were included.At baseline, epidemiological variables, comorbidities andtreatments were collected. Analytics and mortality werestudied during hospitalisation. Univariate analysis wascarried out to evaluate mortalityssociated variables.A logistic regression analysis was carried out to demonstrate independent predictors for mortality. Results: Two hundred and sixty four nonagenarian patients were included. Mean age was 93±3 years, 73 (27.7 %)of whom were men. During hospitalization, 79 patients(29.9 %) died. Comorbidities related to mortality werehistory of heart failure (p = 0.018), diastolic dysfunction(p < 0.042) and higher dependence according to the modified Barthel index (p = 0.003). The clinical variables related to mortality at hospital admission were lower systolic(p = 0.016) and diastolic blood pressure (p = 0.013), higherwhite blood cell count (p = 0.003), greater severity of AKI(p = 0.003) and L- lactic (p = 0.005). In an adjusted multivariate analysis, history of heart failure (OR = 2.31, 95%CI:1.07-5.00, p = 0.036), dependence according to the Barthelindex (OR = 0.80, 95%CI: 0.67-0.97, p = 0.016) and L- lacticacid (OR = 1.31, 95%IC: 1.06-1.61, p = 0.005) were independent predictors of mortality. Conclusion: Heart failure, dependence according to theBarthel index and L- lactic acid at admission are independent predictors of mortality in nonagenarians hospitalizedwith AKI.

[Prognosis of in hospital nonagenarians with acute kidney injury].

BACKGROUND: There has been little in the way of study of nonagenarians with acute kidney injury (AKI, defined in lines with KDIGO guidelines), but the rise in their life expectancy makes further study of this population necessary. The aim of this study is to assess mortality in nonagenarians with AKI during hospitalization. METHODS: In this retrospective study, patients with AKI during hospitalization between 2013-2014 were included. At baseline, epidemiological variables, comorbidities and treatments were collected. Analytics and mortality were studied during hospitalisation. Univariate analysis was carried out to evaluate mortality-associated variables. A logistic regres-sion analysis was carried out to demonstrate independent predictors for mortality. RESULTS: Two hundred and sixty-four nonagenarian patients were included. Mean age was 93±3 years, 73 (27.7?%) of whom were men. During hospitalization, 79 patients (29.9?%) died. Comorbidities related to mortality were history of heart failure (p?=?0.018), diastolic dysfunction (p?

The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism.

BACKGROUND: The success of minimally invasive parathyroidectomy (MIP) relies on accurate localization of the abnormal parathyroid glands. Concordant findings on ultrasound (US) and 99mTc-scintigraphy (sestamibi) are currently considered the 'gold standard'. Computed tomography (CT) has also recently been used in preoperative planning. We sought to assess the accuracy of CT for localization of abnormal parathyroid glands in such patients. METHODS: An audit of 75 patients with primary hyperparathyroidism (PHPT) who underwent neck US and CT between 2017 and 2019 at our center as their first-line imaging. RESULTS: All 75 patients underwent US and CT and 54 (72.0%) also had sestamibi. CT alone identified a potential target in all patients, of which the location was correct in 63 (84.0%). The overall combined sensitivity of US and CT was 88% (95% CI 78-94) and was higher than the combined sensitivity of US and sestamibi (65% [95% CI 53-76]; p < 0.001). Twenty-one patients (28.0%) had an ectopic gland, and the sensitivity of US and CT was 86% (95% CI 64-96) versus US and sestamibi (57% [95% CI 34-77]; p = 0.016). For adenomas < 1.0 g (n = 36; 48%), the accuracy of CT was 81% (95% CI 64-91) compared with 62% (95% CI 44-77) for US and sestamibi (p = 0.04). The correct preoperative diagnosis of multiglandular disease (n = 9; 12%) seemed to be the most difficult, with similar accuracy for US and sestamibi (40% [95% CI 14-73]) and US and CT (50% [95% CI 20-80]) (p > 0.99). CONCLUSION: The combination of US and CT was able to correctly identify the location of the abnormal parathyroid in 88% of patients and, in comparison with US and sestamibi, had better diagnostic accuracy, especially for smaller and ectopic adenomas. This finding suggests that US and CT could be considered as a first-line imaging modality in patients with PHPT considered for MIP.

Imaging of palatal lumps.

Palatal tumours are relatively rare and of variable aetiology, rendering radiological evaluation a daunting process for many. A systematic approach to the imaging of a palatal lump is therefore essential. The hard and soft palates are oral cavity and oropharyngeal structures, respectively. They have different tissue compositions, and therefore, lesions occur with different frequencies at each site. The hard palate has the highest concentration of minor salivary glands in the upper aerodigestive tract and most tumours here are salivary in origin, whereas most tumours at the soft palate are epithelial in origin, i.e., squamous cell carcinomas, in line with other oropharyngeal subsites. The most common malignant tumours of the palate, after squamous cell carcinoma, are minor salivary gland tumours, predominantly adenoid cystic and mucoepidermoid carcinomas. These tumours have a propensity to spread perineurally; understanding the anatomy and imaging features of perineural spread is vital, as it can have significant implications for patient management and tumour resectability. When confronted with a palatal lump, it is important to consider the following: its location on the hard or soft palate; whether it is mucosal or submucosal; the frequently occurring lesions at that site; the most suitable imaging techniques (ultrasound, computed tomography, magnetic resonance imaging); whether there are typical imaging features for any of the common lesions; and whether there are aggressive features, such as bone erosion or perineural spread. This approach allows the radiologist to narrow the differential diagnosis and assist the clinicians with planning treatment.

Molecular characterization and clonal diversity of meticillin-resistant Staphylococcus aureus isolated from the community in Spain: emergence of clone sequence type 72.

Sequence type 72 meticillin-resistant Staphylococcus aureus (ST72 MRSA) was recently detected in our hospital. Although in Europe this clone is rarely isolated, it is the leading cause of community-associated MRSA infections in Korea, spreading also into hospitals, where it has also emerged as the main MRSA clone recovered from raw meat. We studied MRSA isolated from outpatients in Spain during a nine-year period. More than 70% of the isolates belonged to predominant clones found in hospitals. There was a significant increase in the ST72 prevalence. It appears that boundaries of dominance among MRSA clones have become blurred, demanding continuous surveillance.

Comparación de datos anatomopatológicos entre biopsia de próstata y pieza de prostatectomía radical en pacientes con cáncer de bajo y muy bajo riesgo / Comparison of pathological data between prostate biopsy and radical prostatectomy specimen in patients with low to very low risk prostate cancer

Objetivo: Analizar la correlación entre los datos anatomopatológicos encontrados en prostatectomía radical y la biopsia previa realizada en pacientes con cáncer de próstata de bajo riesgo. Material y métodos: Se ha realizado un estudio descriptivo transversal para valorar las características de las prostatectomías radicales realizadas en nuestro centro desde enero de 2012 a noviembre de 2014. Los criterios de inclusión fueron pacientes con enfermedad de bajo riesgo (cT1c-T2a, PSA ≤ 10 ng/ml y Gleason ≤ 6). Fueron excluidos aquellos con menos de 8 cilindros en la biopsia, número de cilindros afectos no especificados, tacto rectal no recogido en historia clínica o biopsia realizada en otro centro. Resultados: De las 184 prostatectomías realizadas en este periodo, 87 pacientes cumplían con los criterios de inclusión y 26 de estos presentaban < 3 cilindros afectados y un PSAd ≤ 0,15 (muy bajo riesgo). Encontramos en la muestra total un porcentaje de infragradación (Gleason ≥ 7) del 18,4% (IC 95%: 10,3-27,6%) y de afectación extracapsular (pT3) del 10,35% (IC 95%: 4,6-17,2%). El porcentaje de márgenes positivos fue del 21,8% (IC 95%: 12,6-29,9%). En el grupo de muy bajo riesgo no encontramos ningún caso de afectación extracapsular y un solo caso de infragradación (Gleason 7 [3 + 4]) representando un 3,8% del total (IC 95%: 0-12,5%). Resultaron ser variables predictoras de no correlación (estadio ≥ pT3a o infragradación) el grupo de riesgo inicial, volumen, PSA densidad y cilindros afectados. Conclusiones: El volumen prostático, el valor del PSA densidad, el número de cilindros afectados y el grupo de riesgo inicial del paciente influyen en la aparición de datos de mal pronóstico anatomopatológico en la pieza de prostatectomía radical (afectación extracapsular y Gleason ≥ 7)

Objective: To analyze the correlation between pathological data found in radical prostatectomy and previously performed biopsy in patients at low risk prostate cancer. Material and methods: A descriptive, cross-sectional study was conducted to assess the characteristics of radical prostatectomies performed in our center from January 2012 to November 2014. The inclusion criteria were patients with low-risk disease (cT1c-T2a, PSA ≤ 10 ng/mL and Gleason score ≤ 6). We excluded patients who had fewer than 8 cores in the biopsy, an unspecified number of affected cores, rectal examinations not reported in the medical history or biopsies performed in another center. Results: Of the 184 patients who underwent prostatectomy during this period, 87 met the inclusion criteria, and 26 of these had < 3 affected cores and PSA density ≤ .15 (very low risk). In the entire sample, the percentage of undergrading (Gleason score ≥ 7) and extracapsular invasion (pT3) was 18.4% (95% CI 10.3 − 27.6) and 10.35% (95% CI 4.6 − 17.2), respectively. The percentage of positive margins was 21.8% (95% CI 12.6-29.9). In the very low-risk group, we found no cases of extracapsular invasion and only 1 case of undergrading (Gleason 7 [3 + 4]), representing 3.8% of the total (95% CI 0 - 12.5). Predictors of no correlation (stage ≥ pT3a or undergrading) were the initial risk group, volume, PSA density and affected cores. Conclusions: Prostate volume, PSA density, the number of affected cores and the patient's initial risk group influence the poor pathological prognosis in the radical prostatectomy specimen (extracapsular invasion and Gleason score ≥ 7)

Desmoid-type fibromatosis.

Desmoid-type fibromatosis is a rare, locally infiltrative, mesenchymal neoplasm that is associated with high rates of local recurrence but lacks the potential to metastasise. The disease affects younger individuals, with a peak age of 30 years, and is the most common cause of an anterior abdominal wall mass in young women of childbearing age. It may, however, involve nearly every body part, including the extremities, head and neck, trunk, and abdominal cavity; as such, desmoid-type fibromatosis may present to a range of general and subspecialty radiologists. These rare tumours have a widely variable clinical presentation and unpredictable natural history, hence input from a soft-tissue tumour centre is recommended, although much of the imaging may be performed at the patient's local hospital. The consensus for treatment has changed over the past decade, with most centres moving away from primary radical surgery towards a front-line 'watch-and-wait' policy. Therefore, imaging has an increasingly important role to play in both the diagnosis and follow-up of these patients. This review will discuss the typical imaging characteristics of these lesions and suggest diagnostic and follow-up magnetic resonance imaging protocols, with details of suitable sequences and scanning intervals.

Comparison of pathological data between prostate biopsy and radical prostatectomy specimen in patients with low to very low risk prostate cancer.

OBJECTIVE: To analyze the correlation between pathological data found in radical prostatectomy and previously performed biopsy in patients at low risk prostate cancer. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted to assess the characteristics of radical prostatectomies performed in our center from January 2012 to November 2014. The inclusion criteria were patients with low-risk disease (cT1c-T2a, PSA≤10ng/mL and Gleason score≤6). We excluded patients who had fewer than 8 cores in the biopsy, an unspecified number of affected cores, rectal examinations not reported in the medical history or biopsies performed in another center. RESULTS: Of the 184 patients who underwent prostatectomy during this period, 87 met the inclusion criteria, and 26 of these had<3 affected cores and PSA density≤.15 (very low risk). In the entire sample, the percentage of undergrading (Gleason score≥7) and extracapsular invasion (pT3) was 18.4% (95% CI 10.3-27.6) and 10.35% (95% CI 4.6-17.2), respectively. The percentage of positive margins was 21.8% (95% CI 12.6-29.9). In the very low-risk group, we found no cases of extracapsular invasion and only 1 case of undergrading (Gleason 7 [3+4]), representing 3.8% of the total (95% CI 0-12.5). Predictors of no correlation (stage≥pT3a or undergrading) were the initial risk group, volume, PSA density and affected cores. CONCLUSIONS: Prostate volume, PSA density, the number of affected cores and the patient's initial risk group influence the poor pathological prognosis in the radical prostatectomy specimen (extracapsular invasion and Gleason score≥7).

Conocimientos sobre ética asistencial de los residentes de pediatría / Knowledge of health care ethics in paediatric residents

INTRODUCCIÓN: La enseñanza de la bioética se ha incorporado a los planes de estudio de medicina y al programa para médicos residentes. Sin embargo, la transmisión de conocimientos basados en la práctica clínica habitualmente no se realiza de una manera bien estructurada. OBJETIVO: Valorar los conocimientos de ética de los residentes de pediatría españoles y analizar su relación con la formación recibida durante la licenciatura y el periodo de residencia. MATERIAL Y MÉTODOS: Se diseñó una encuesta con 20 preguntas tipo test destinada a evaluar conocimientos éticos básicos con repercusión sobre la clínica. Se valoraron la formación recibida durante el pregrado y la residencia, y los principales conflictos éticos afrontados. RESULTADOS: Se obtuvieron 210 encuestas remitidas desde 20 hospitales: 47 correspondientes a (R1), 49 a (R2), 57 a (R3) y 57 a (R4). La media de respuestas correctas fue de 16,8. No hubo diferencias entre los residentes de distinto año ni entre los que manifestaron haber recibido o no formación específica. Se contabilizaron más fallos en preguntas relacionadas con el consentimiento informado, ley de autonomía del paciente, los principios implicados en la calidad de vida, la sistemática del análisis de casos y la dimensión de la justicia distributiva. CONCLUSIONES: La limitación del esfuerzo terapéutico se ha identificado como el principal problema ético en la práctica clínica. Gran parte de los conocimientos sobre ética se adquieren en el pregrado y varían poco durante la residencia, lo que hace necesarios mayores esfuerzos organizativos y docentes durante este periodo

INTRODUCTION: Bioethics has been recently incorporated in to the educational programs of both medical students and medical residents as part of their curriculum. However, its training based on clinical practice is not well structured. OBJECTIVE: To evaluate the knowledge of bioethics in Spanish paediatric residents, and to analyse how this relates to the medical education during graduate and post-graduate training. MATERIAL AND METHODS: A questionnaire with 20 multiple choice questions was designed to evaluate the knowledge in basic ethics with potential implications in clinical practice. We evaluated the education received during graduate and post-graduate training, and the main ethical conflicts faced. RESULTS: A total of 210 completed questionnaires were received from medical residents in paediatrics from 20 different Spanish hospitals, of whom 47 of these were first year residents (R1), 49 were second year residents (R2), 57 were third year residents (R3), and the remaining 57 were final year residents (R4). The mean number of correct answers was 16.8 out of 20. No differences were found between residents in different years of training, nor were there any differences between the group that had received specific training in bioethics versus those who had not. Residents were more likely to give wrong answers related with informed consent, the law on the freedom of the patient, principles of quality of life, the case analysis system, and the dimension of distributive justice. CONCLUSIONS: Limitation of therapeutic efforts was identified as the main ethical problem faced in clinical practice by Spanish residents in paediatrics. Most of the knowledge of bioethics is acquired during graduate training, and improved very little throughout the period of medical residence. Our results suggest that efforts are required in organising and structuring the education in bioethics during the training of residents in paediatrics

[Knowledge of health care ethics in paediatric residents]. / Conocimientos sobre ética asistencial de los residentes de pediatría.

INTRODUCTION: Bioethics has been recently incorporated in to the educational programs of both medical students and medical residents as part of their curriculum. However, its training based on clinical practice is not well structured. OBJECTIVE: To evaluate the knowledge of bioethics in Spanish paediatric residents, and to analyse how this relates to the medical education during graduate and post-graduate training. MATERIAL AND METHODS: A questionnaire with 20 multiple choice questions was designed to evaluate the knowledge in basic ethics with potential implications in clinical practice. We evaluated the education received during graduate and post-graduate training, and the main ethical conflicts faced. RESULTS: A total of 210 completed questionnaires were received from medical residents in paediatrics from 20 different Spanish hospitals, of whom 47 of these were first year residents (R1), 49 were second year residents (R2), 57 were third year residents (R3), and the remaining 57 were final year residents (R4). The mean number of correct answers was 16.8 out of 20. No differences were found between residents in different years of training, nor were there any differences between the group that had received specific training in bioethics versus those who had not. Residents were more likely to give wrong answers related with informed consent, the law on the freedom of the patient, principles of quality of life, the case analysis system, and the dimension of distributive justice. CONCLUSIONS: Limitation of therapeutic efforts was identified as the main ethical problem faced in clinical practice by Spanish residents in paediatrics. Most of the knowledge of bioethics is acquired during graduate training, and improved very little throughout the period of medical residence. Our results suggest that efforts are required in organising and structuring the education in bioethics during the training of residents in paediatrics.

Implications of parent and child quality of life assessments for decisions about growth hormone treatment in eligible children.

OBJECTIVE: To determine differences between parents and children in ratings of child health-related quality of life (HRQL) prior to growth hormone treatment. METHOD: HRQL measures were collected from 144 children and their caregivers. Inclusion criteria were aged between 10 and 16 years, diagnosed with Turner's syndrome, acquired or idiopathic growth hormone deficiency (AGHD or IGHD) and eligible to begin human GH treatment (GHT), or non-growth hormone deficient (GHD) short stature. RESULTS: Parents rated children to have poorer physical and psychosocial HRQL than children rated themselves. Differences depended on the measure used. Parents rated children with IGHD and non-GHD short stature better than children rated themselves, but they rated children with AGHD or Turner's much worse than children rated themselves in terms of physical but not psychosocial functioning. CONCLUSIONS: Decisions to prescribe GHT should include children's perspectives of HRQL whenever possible. Differences between parents and children are most likely in conditions that involve more complex medical needs (AGHD and Turner's). Generic and disease-specific HRQL measures may vary in sensitivity to HRQL differences between groups. More work is required to evaluate HRQL among younger children.

Longitudinal study of neurological soft signs in first-episode early-onset psychosis.

BACKGROUND: In recent decades, the assessment of neurological soft signs (NSS) in patients with psychosis has become a subject of special interest. The study of the progression of NSS during adolescence will provide valuable information about the role of NSS as endophenotypes or biomarkers and about brain development at a stage in which brain maturation has not yet been completed. METHODS: Neurological soft signs were assessed in a sample of 110 first episodes of early-onset psychosis (EOP) and 98 healthy children and adolescents at two different times in a 2-year follow-up period. RESULTS: Patients with EOP showed more NSS than controls both at baseline (p < .001) and the 2-year follow-up (p < .001). No differences were found in the number of signs among the different diagnostic subgroups (schizophrenia, bipolar disorder, and other psychoses). When we examined the changes in NSS over the follow-up, the reduction of NSS in the patients was greater than the controls for 'Motor coordination' (p = .032), 'Others' (p < .001), and 'Total score' (p < .001) of the NES. CONCLUSION: Despite the greater reduction of NSS in patients than in controls along the follow-up, patients still have more neurological signs than healthy controls; therefore, these signs may be considered a trait marker. NSS do not seem to be specific to schizophrenia as they are present in different EOPs.

Assess, compare and enhance the status of Persons with Multiple Sclerosis (MS) in Europe: a European Register for MS.

OBJECTIVES: Persons with multiple sclerosis (PwMS) experience health-related quality of life (HRQoL) problems greatly differing across Europe, and the European Union (EU) faces deep inequalities in MS management from country to country. Through the establishment of a European MS Register (EUReMS), an effective action is proposed to improve the overall knowledge on MS and support effective intervention programmes at EU and national political level. EUReMS aims to achieve consensus on its mission and vision, to define existing data providers, to develop models driving future MS health policies and research, to develop an information technology (IT) infrastructure for a data set, to develop a European shared governance and to secure providers' data provision into EUReMS. MATERIALS AND METHODS: EUReMS is meant to build on a minimum set of core data from existing national and regional population-based MS registries and from PwMS' perspectives. EUReMS' main partner is the European MS Platform (EMSP) acting in collaboration with associated and collaborating European partners. RESULTS: EUReMS was launched in July 2011. A Consensus Statement on purposes, vision, mission and strategies was produced in December 2011, and a comprehensive survey on existing MS data collections in Europe has been performed, and the EUReMS data mask is currently being discussed. CONCLUSIONS: EUReMS will represent a tool to provide up to date, comparable and sustainable MS data through an effective and credible register, which will encourage extensive knowledge building of MS, more equitable policies and higher standards in MS treatment and services.