Burnout, resilience, and subjective well-being among Portuguese lecturers' during the COVID-19 pandemic

Background

Lecturers face a large wide of occupational stressors. If the prolonged stress and the symptomatology associated with the working conditions to which lecturers were exposed were already a concern before the pandemic, the pandemic may have exacerbated this psychosocial vulnerability. Burnout is a psychological syndrome that develops in response to chronic work stress. This study aims to describe burnout amongst lecturers working in Portugal and to analyse potential determinants of burnout during the COVID-19 pandemic.

Methods

A cross-sectional study was performed using an online questionnaire distributed via social networks. The survey collected sociodemographic and sleep patterns data in addition to applying the Copenhagen Burnout Inventory (personal, work- and student-related burnout), the Resilience Scale, the Depression Anxiety and Stress Scales, and the Satisfaction with Life Scale.

Results

The sample included 331 lecturers from 35 different colleges and faculties. Three significant models explained personal (R2 = 54%), work- (R2 = 47%) and student- (R2 = 19%) related burnout. Lower levels of resilience and higher levels of depression and stress were significantly associated with personal and work-related burnout. Changes in sleep patterns were additionally associated with both personal and work-related burnout.

Conclusion

Higher education institutions must recognize the impact of the work environment and organizational culture on faculty mental health and take proactive measures to improve this environment. These institutions can implement support strategies such as educational technology training, professional development programmes, emotional support resources, and workload flexibility. Implementing measures to enhance lecturers' resilience and overall life satisfaction could potentially help mitigate burnout and improve the well-being of educators, ultimately contributing to the overall quality of education.

Exploring ureteroscope design with computational fluid dynamics for improved intra-pelvic pressure

High intra-pelvic pressure (IPP) during ureteroscopy can lead to complications including pyelovenous backflow, bleeding, and infection. Our primary goal was to identify the best cross-section and orientation of a ureteroscope within a Ureteral Access Sheath (UAS) to minimize IPP and maximize outflow. Our secondary goal was to validate our findings with a UAS prototype. To determine the optimal ureteroscope cross-section within a UAS, four ureteroscopes of equivalent cross-sectional area were simulated within a 10 Fr UAS using computational fluid dynamics software COMSOL. We then created a corresponding prototype by securing a 3-0 monofilament suture at the inferior aspect of the 12 Fr outer UAS, inducing an offset to the ureteroscope. Mean flow volumes through a 10/12 Fr UAS occupied by a 9.5-Fr single-use flexible ureteroscope were compared (17 iterations) to those through our prototype UAS. During the simulation, the lowest IPP and highest outflow were seen with an offset circular ureteroscope (41% resistance) compared to a ureteroscope centered in the UAS. The unmodified UAS had an average volume of 30.0 mL/min (SD ± 0.35) compared to 33.76 mL/min (SD ± 0.90) for the modified UAS (p < 0.05). We found that using a circular ureteroscope positioned along the sidewall maximizes outflow through a circular UAS. We made a prototype UAS to offset the ureteroscope and observed a 12.5% increase in outflow. This approach can potentially decrease IPP during ureteroscopy without impacting inflow or the working channel. Although modifying a ureteroscope is more difficult, it could create an offset without reducing UAS cross-section.

Single and multi-hit PIK3CA short variant (SV) genomic alterations (GA) in clinically advanced prostate cancer (CAPC): A genomic landscape study

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Background: Tumors harboring 2 or more PIK3CA Short variants (SV) (“Multi-hit”) have been described in breast cancer as linked to enhanced clinical outcome from anti-PIK3CA targeted therapies including alpelisib and investigational agents in clinical trials. The landscape and clinical implications of multi-hit PIK3CA alterations in other tumors, including in CAPC, are underexplored. Methods: 19,978 CAPC samples underwent hybrid capture based comprehensive genomic profiling (CGP) to evaluate all classes of GA and determine tumor mutational burden (TMB), microsatellite instability (MSI), genomic ancestry, signature and loss of heterozygosity (gLOH). Tumor cell PD-L1 expression was determined by IHC (Dako 22C3). Results: 18,741 (93.8%) CAPC were PIK3CA wild type (WT), 1,155 (5.8%) featured a single PIK3CA SV and 82 (0.4%) featured multi-hit PIK3CA SVs. The median ages of CAPC patients with single hit (69.1 yrs) or multi-hit (68.7 yrs) PIK3CA SV were older than the PIK3CA WT (67.6 yrs) CAPC (p<.0001 for both). At 14.0%, African ancestry was more frequent in PIK3CA WT CAPC than in single-hit (10.4%; p=.001) and multi-hit (10.2%; not significant). Single-hit (81.4%; p<.0001) and multi-hit (85.2% p=.05) PIK3CA SV CAPC featured significantly more MMR trinucleotide genomic signatures than PIK3CA WT (64.8%). Single-hit (2.7%; p=.02) and multi-hit (5.8% p=.05) PIK3CA SV CAPC featured significantly more POLE trinucleotide genomic signatures than PIK3CA WT (0.4%). MSI high status was significantly more common in both PIK3CA single-hit (12.4% vs 2.5%; p<.0001) and multi-hit (35.4% vs 2.5%; p<.0001). Mean TMB was also significantly higher in single-hit PIK3CA (11.1 vs 3.5 mut/Mb; p<.0001) and multi-hit (42.9 vs 3.5 mut/Mb; p<.0001). Noteworthy differences in GA of potential importance for CAPC pts included significantly higher frequencies of GA in BRCA2 in multi-hit vs WT (18.3% vs 8.5%; p=.019), ATM in multi-hit vs WT (13.4% vs 5.6%; p=.02) and PTEN in single-hit vs WT (40.2% vs 30.1%; p<.0001) and lower frequencies of GA in CDK12 (3.6% vs 5.6%; p=.009) and SPOP (7.4% vs 9.8%; p=.012) in single-hit vs WT. There were no differences in gLOH or PD-L1 expression among the 3 groups. Conclusions: Although uncommon, the identification of multi-hit PIK3CA GA in CAPC highlights a potentially unique subtype of this disease that may be associated with enhanced responsiveness to anti-PIK3CA targeted therapy strategies.

Impact of COVID-19 on Medicine Lecturers' Mental Health and Emergency Remote Teaching Challenges

COVID-19 has presented a novel pedagogical challenge in dealing with the sudden shift from classic instruction to emergency remote teaching (ERT). It had an impact on the well-being and mental health of lecturers, increasing burnout risk. A cross-sectional, quantitative, qualitative and analytical online study was conducted to collect participants’ sociodemographic data, responses to ERT open-ended questions and mental health assessments using relevant instruments (CBI for burnout, Resilience Scale, DASS for depression, anxiety and stress, SWLS for satisfaction with life). High personal burnout levels were found in 41.2% of participants, high work-related burnout in 37.3% and high student-related burnout in 15.7%. Satisfaction with life, sleep routine changes and stress were determinants for personal burnout; stress and resilience for work-related burnout; satisfaction of life and sleep routine changes for students-related burnout. Opportunities for pedagogical innovation were pointed out as the main advantages to ERT, while the main negative impacts were on practical lessons and social interaction. Students and lecturers’ safety and adequate institutional support might be insured, considering their expectations and needs, promoting mental health. Combining the advantages of online and traditional methods in a so-called “blended learning” approach, with close collaboration and communication between all those involved, appears to achieve better results.

Drug interaction in psycho-oncology: antidepressants and antineoplastics

BACKGROUND AND OBJECTIVES

Although there is a growing impact of psychiatric and depressive disorders in cancer patients, literature on the idiosyncrasies of antidepressants (ADs) used in those conditions and their interactions with antineoplastic agents (ANs) is scarce. Sharing the same biotransformation pathways enhances the risk of drug interaction between ADs and ANs, specifically when compounds are inducers, inhibitors or substrates of cytochrome P450 (CYP 450). In cancer patients, such drug interactions may result in less efficacy of the drug and/or increase of their side effects. Therefore, the choice of AD should be cautious (safe and effective) and well supported. The main purpose of this review was to analyze the individual pharmacokinetic properties of the most used ADs and ANs in order to summarize the risk of possible drug interactions between them, anticipating the consequences of their coadministration.

METHODS

The authors reviewed books and PubMed online articles published in the last 6 years.

RESULTS

Most of the ANs are subject to transformation by CYP 450 3A4 and their coadministration with ADs, that have inhibitory properties of this CYP isoform, such as fluoxetine, sertraline, paroxetine and fluvoxamine, may result in the loss of the AN's efficacy or higher toxicity.

CONCLUSION

Among the ADs, escitalopram, citalopram, venlafaxine, mirtazapine and milnacipran stand out for their weak CYP 450 inhibitory potential and their safety profile in those patients.

Impulsivity spectrum disorders as a risk factor for cocaine-induced psychosis

Introduction

Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations. This is typically prevented by abstinence. The term Cocaine-Induced Psychosis (CIP) has been used to describe this syndrome. Impulsivity has been hypothesised are likked with CIP.

Objectives

This study examined the relationship between CIP and substance consumption variables and impulsivity disorders including ADHD (Axis I) and Borderline personality disorders (BPD) (Axis II), and attempted to evaluated their link as a risk factors for CIP.

Aims

Trained psychiatrists systematically conducted a structured interview in which the conclusions from the psychotic symptoms were summarized. We used the CADDID to evaluate Adult ADHD, SCID II for axis II disorders, and the Barrat Impulsivity Scale (BIS-11).

Methods

We evaluated 163 (34,16 yo, 85,80% men) cocaine-dependent patients, according to DSM-IV criteria.

Results

We found statistically significant association between CIP and Early age at onset of cocaine addiction (p = 0,04), cocaine use per day 6 months before starting treatment (p = 0,03), Barrat cognitive impulsivity subscale (p < 0,004), and Adult ADHD (p < 0,041). No relationship between BPD and CIP was found.

Conclusions

We confirm previous findings that Impulsivity disorders as ADHD or high impulsivity trails are liked to CIP. Coinciding with our previous findings, relationship between early age of onset cocaine dependence or high amounts of cocaine use and CIP was found. CIP are related with impulsivity disorders spectrum.

[Osteomyelitis after septic trochanteric bursitis - clinical case]

We report the clinical case of a 76 years-old woman with a subacute trochanteric inflammatory pain with low-grade fever and laboratory markers of acute inflammation, associated with the ultrasonographic evidence of bursitis and radiologic evidence of femoral erosions, that resolved after intravenous antibiotherapy. Although rare, the infectious etiology should be considered in patients with clinical manifestations of bursitis and signs of systemic involvement.

[Perceived pain and weather changes in rheumatic patients]

INTRODUCTION

Rheumatic patients with chronic pain describe in a vivid way the influence of climate on pain and disease activity. Several studies seem to confirm this association.

OBJECTIVES

To evaluate and compare in a population of rheumatic patients the perceived influence of weather changes on pain and disease activity

METHODS

This is a retrospective cross-sectional study. For three weeks an assisted self-reported questionnaire with nine dimensions and a VAS pain scale was performed on consecutive out-patients in our clinic.

RESULTS

955 patients 787 female 168 male mean age 57.9 years with several rheumatologic diagnosis were evaluated. Overall 70 of the patients believed that the weather influenced their disease and 40 believed that the influence was high. Morning stiffness was influenced in 54 high influenced in 34 . Autumn and Winter were the most influential periods as well as humidity 67 and low temperatures 59 .

CONCLUSION

In our study as well as in literature we found that a high percentage of patients 70 perceived that weather conditions influenced their pain and disease. Fibromyalgia patients seemed to be strongly influenced by weather changes. Our study confirms that patients perception on the influence of climate on pain and therefore their disease is an important clinical factor and it should be considered when evaluating rheumatic patients.

[Adenoid cystic carcinoma of the breast]

OBJECTIVE

To review the clinical presentation and imaging findings of adenoid cystic carcinoma (ACC).

MATERIAL AND METHODS

We performed a retrospective study of the period between January 1990 and July 2004, comprising five cases of ACC of the breast, all in women, among 4,036 malignant lesions diagnosed (0.12%). We reviewed the available imaging studies (mammography in all five cases, ultrasound in four, and magnetic resonance in one). We also reviewed the clinical presentation and evolution in all patients.

RESULTS

Three patients presented with palpable lesions. Mammographic findings consisted of irregular, ill-defined nodules in three cases, a well-defined rounded nodule in one, and an asymmetrical density in the other. No microcalcifications were observed in any case. Ultrasound examination showed ill-defined polylobulated nodules in three cases and a well-defined, rounded nodule with small cysts inside in the remaining case that showed intense vascularization in the Doppler study. The only case studied by magnetic resonance was seen as a rounded nodule that showed heterogeneous contrast uptake, well-defined margins, and an enhancement curve considered highly suspicious for malignancy. Treatment was tumorectomy together with radiotherapy in all cases. Four patients remain asymptomatic at present (mean follow-up = 64 months) and one presented lung and liver metastes twelve years after the diagnosis of ACC.

CONCLUSION

ACC is an uncommon breast tumor with varied radiologic appearance, although moderately or highly suspicious lesions predominate. We consider the absence of microcalcifications in these tumors to be noteworthy. The prognosis is generally good, although the possibility of remote metastasis exists.

Unequal treatment access and malaria risk in a community-based intervention program in the Philippines

This study assesses the influence of several malaria risk factors and volunteer health worker (VHW) accessibility on parasite prevalence and treatment-seeking in a remote area of Mindanao, the Philippines. An anti-malaria program in the area seeks to devolve malaria diagnosis and treatment to the VHWs. Firstly, the relationship between malaria and demographic factors, bednet use, and access to treatment was investigated. Secondly, adults from villages with and without resident VHWs were questioned on historical and proposed treatment-seeking for fever and the capacity of the communities to support more health workers was assessed. Parasite prevalence was significantly higher among patients living in villages lacking a resident VHW (adjusted OR=3.88, p=0.02), where proposed delays in consulting VHWs and the official health service, and the use of alternative medicine, were also significantly higher. Kinship or social closeness to VHWs appears to play a role in accessibility. The educational and economic requirements demanded of VHWs impede potential expansion of the program to non-serviced villages. If the effectiveness and equity of community-based treatment strategies is to be increased, increased flexibility allowing use of local, less-educated, drug dispensers needs to be considered.

Metallothionein concentrations in a population of Patella aspera: variation with size

The determination of metallothionein (MT) concentrations in species with different feeding habits is important from the ecotoxicological point of view because it provides a better understanding of the role of these proteins in metal uptake pathways. The main objective was study the variation of MT and metal (Cd, Cu and Zn) concentrations with size and weight in the limpets Patella aspera. In addition investigate the relationship between MT and metal concentrations in limpets from different metal load environments of the south coast of Portugal with the aim to use MT in P. aspera as a biomarker of metal exposure. MT concentrations in the whole soft tissues of P. aspera increased with size and weight while metals decrease with size and weight. MT concentrations showed no significant relationship with Cd or Cu concentrations in the limpets from the South Portuguese Coast. However, a negative exponential relationship detected between MT and Zn concentrations suggest that Zn bound to MT might be displaced by Cd or Cu ions. The ability of limpets to store both Cd and Cu bound to MT may be responsible for the tolerance of this species to contaminated environments. The relationship between MT concentrations and Zn indicates that MT seems to play a minor role in binding Zn in Patella species.

Diagnosis of malaria in a remote area of the Philippines: comparison of techniques and their acceptance by health workers and the community

OBJECTIVE

To compare the efficacies of remote symptom-based diagnosis of malaria, rapid diagnostic tests and microscopy in an area of low endemicity in the Philippines.

METHODS

In Trial I, 350 symptomatic patients were tested within their villages using malaria Plasmodium falciparum (Pf)/Plasmodium vivax (Pv) immunochromatographic tests (ICT tests) and blood films stored and read under local conditions. The slides were later restained and read. In Trial II, unsupervised volunteer barangay health workers prepared ICT tests and slides after brief training. These slides were read at rural health units. Twenty-seven barangay health workers and 72 community members were later questioned about the three diagnostic strategies.

FINDINGS

A history of fever alone was sensitive (95.4%) but poorly specific (16.5%) for predicting parasitaemia. The inclusion of other symptoms reduced the sensitivity to below 85%, while specificity remained low. The axillary temperature was poorly predictive. ICT tests achieved high sensitivity (97.9%) but many cases indicated as positive by ICT tests were negative by microscopy. Further analysis of these cases in Trial I indicated that ICT tests were detecting low-level parasitaemias missed by microscopy, and that local microscopy had poor accuracy. ICT tests were well accepted and accurately performed by barangay health workers.

CONCLUSION

These tests meet a strong desire in the community for blood-based diagnosis and may increase the compliance and treatment-seeking behaviour of patients.

Dual role of PKC in modulating pharmacomechanical coupling in fetal and adult cerebral arteries

This study tested the hypothesis that protein kinase C (PKC) has dual regulation on norepinephrine (NE)-mediated inositol 1,4, 5-trisphosphate [Ins (1,4,5)P(3)] pathway and vasoconstriction in cerebral arteries from near-term fetal ( approximately 140 gestational days) and adult sheep. Basal PKC activity values (%membrane bound) in fetal and adult cerebral arteries were 38 +/- 4% and 32 +/- 4%, respectively. In vessels of both age groups, the PKC isoforms alpha, beta(I), beta(II), and delta were relatively abundant. In contrast, compared with the adult, cerebral arteries of the fetus had low levels of PKC-epsilon. In response to 10(-4) M phorbol 12,13-dibutyrate (PDBu; PKC agonist), PKC activity in both fetal and adult cerebral arteries increased 40-50%. After NE stimulation, PKC activation with PDBu exerted negative feedback on Ins(1,4,5)P(3) and intracellular Ca(2+) concentration ([Ca(2+)](i)) in arteries of both age groups. In turn, PKC inhibition with staurosporine resulted in augmented NE-induced Ins(1,4,5)P(3) and [Ca(2+)](i) responses in adult, but not fetal, cerebral arteries. In adult tissues, PKC stimulation by PDBu increased vascular tone, but not [Ca(2+)](i). In contrast, in the fetal artery, PKC stimulation was associated with an increase in both tone and [Ca(2+)](i). In the presence of zero extracellular [Ca(2+)], these PDBu-induced responses were absent in the fetal vessel, whereas they remained unchanged in the adult. We conclude that, although basal PKC activity was similar in fetal and adult cerebral arteries, PKC's role in NE-mediated pharmacomechanical coupling differed significantly in the two age groups. In both fetal and adult cerebral arteries, PKC modulation of NE-induced signal transduction responses would appear to play a significant role in the regulation of vascular tone. The mechanisms differ in the two age groups, however, and this probably relates, in part, to the relative lack of PKC-epsilon in fetal vessels.

Biosynthesis of mannosylglycerate in the thermophilic bacterium Rhodothermus marinus. Biochemical and genetic characterization of a mannosylglycerate synthase

The biosynthetic reaction scheme for the compatible solute mannosylglycerate in Rhodothermus marinus is proposed based on measurements of the relevant enzymatic activities in cell-free extracts and in vivo (13)C labeling experiments. The synthesis of mannosylglycerate proceeded via two alternative pathways; in one of them, GDP mannose was condensed with D-glycerate to produce mannosylglycerate in a single reaction catalyzed by mannosylglycerate synthase, in the other pathway, a mannosyl-3-phosphoglycerate synthase catalyzed the conversion of GDP mannose and D-3-phosphoglycerate into a phosphorylated intermediate, which was subsequently converted to mannosylglycerate by the action of a phosphatase. The enzyme activities committed to the synthesis of mannosylglycerate were not influenced by the NaCl concentration in the growth medium. However, the combined mannosyl-3-phosphoglycerate synthase/phosphatase system required the addition of NaCl or KCl to the assay mixture for optimal activity. The mannosylglycerate synthase enzyme was purified and characterized. Based on partial sequence information, the corresponding mgs gene was identified from a genomic library of R. marinus. In addition, the mgs gene was overexpressed in Escherichia coli with a high yield. The enzyme had a molecular mass of 46,125 Da, and was specific for GDP mannose and D-glycerate. This is the first report of the characterization of a mannosylglycerate synthase.

[CHARGE association]

Posterior choanal atresia is a congenital malformation which can occur isolated or in combination to additional malformations. In CHARGE association the other anomalies are: coloboma, heart disease, retarded development/growth or central nervous system abnormalities, genital hypoplasia or hypogonadism and ear abnormalities or deafness. The authors present three cases of CHARGE association and they also review the clinical findings required for the diagnosis.

Dyssegmental dysplasia: a case report of a Rolland-Desbuquois type

Two different forms of dyssegmental dysplasia, mild and severe, can be distinguished on clinical, radiographic and chondro-osseous morphologic grounds. The milder Rolland-Desbuquois type is frequently characterised by survival beyond the newborn period. The lethal Silverman-Handmaker type has distinctive and more severe findings. In this paper, a rare case of the Rolland-Desbuquois type is presented. The case is unusual because although it was the milder form, the child died on the 10th day of life.

Isoform-specific effects of apolipoproteins E2, E3, and E4 on cerebral capillary sequestration and blood-brain barrier transport of circulating Alzheimer's amyloid beta

Cerebral capillary sequestration and blood-brain barrier (BBB) permeability to apolipoproteins E2 (apoE2), E3 (apoE3), and E4 (apoE4) and to their complexes with sA beta(1-40), a peptide homologous to the major form of soluble Alzheimer's amyloid beta, were studied in perfused guinea pig brain. Cerebrovascular uptake of three apoE isoforms was low, their blood-to-brain transport undetectable, but uptake by the choroid plexus significant. Binding of all three isoforms to sA beta(1-40) in vitro was similar with a K(D) between 11.8 and 12.9 nM. Transport into brain parenchyma and sequestration by BBB and choroid plexus were negligible for sA beta(1-40)-apoE2 and sA beta(1-40)-apoE3, but significant for sA beta(1-40)-apoE4. After 10 min, 85% of sA beta(1-40)-apoE4 taken up at the BBB remained as intact complex, whereas free sA beta(1-40) was 51% degraded. Circulating apoE isoforms have contrasting effects on cerebral capillary uptake of and BBB permeability of sA beta. ApoE2 and apoE3 completely prevent cerebral capillary sequestration and blood-to-brain transport of sA beta(1-40). Conversely, apoE4, by entering brain microvessels and parenchyma as a stable complex with sA beta, reduces peptide degradation and may predispose to cerebrovascular and possibly enhance parenchymal amyloid formation under pathological conditions.

Thermonema rossianum sp. nov., a new thermophilic and slightly halophilic species from saline hot springs in Naples, Italy

Six slightly halophilic, thermophilic bacterial strains were isolated from saline hot springs along the Bay of Naples, Italy. These strains produce bright yellow colonies and have a filamentous morphology and an optimum growth temperature of about 60 degrees C. Lipid composition and 16S ribosomal DNA sequence analyses showed that these strains belong to the genus Thermonema, a member of the cytophaga-flavobacter-bacteroides phylum. Growth was observed in medium containing 1 to 3% NaCl. The DNA G + C content was 50.9 mol%. DNA-DNA hybridization studies showed that these strains represent a new species of the genus Thermonema. We propose that strain NR-27T (T = type strain) and the other strains represent a new species, Thermonema rossianum. Strain NR-27 (= DSM 10300) is the type strain of this species.

Laparoscopic cholecystectomy in the third trimester of pregnancy

Laparoscopic cholecystectomy has become the method of choice for symptomatic cholelithiasis. Laparoscopic cholecystectomy during pregnancy is also becoming more accepted, as illustrated by several recent publications on this subject. In the third trimester, however, laparoscopic cholecystectomy has been less commonly attempted, with only a few case reports. We present a series of four patients who underwent laparoscopic cholecystectomy during the third trimester of pregnancy without complication. We describe a safe and effective technique for this procedure, and review the literature on this topic.

[Small for gestational age newborn infants. The effect of standard curves of birth weight on the calculation of the prevalence and of the risk factors]

Sampling decisions, statistical methods and criteria for dating pregnancy all influence birth-weight percentiles and the ability to classify a newborn as growth retarded or small for date. Consequently the prevalence of small for date, the type and the magnitude of risk factors associated with this condition, and the evaluation of preventive interventions are dependent on the standards used. In this study we established birthweight standards for sex and gestational age (36 to 41 weeks) in a sample of 7518 singleton newborns delivered from 1989-92 at Famalicão Hospital. Later, these reference percentiles were applied to a sample of 2210 to calculate the prevalence of small for date, to evaluate associated risk factors, and to compare these estimates with those obtained using Thompson or Lubchenco published charts. The prevalence of small for gestational age was significantly higher using local standards (9.9 or 10.0%) when compared with those obtained using Thompson (8.8%, p < 0.005) or Lubchenco (4.4%, p < 0.005) percentiles. However, the risk factors identified and the magnitude of the point estimates for odds ratios were similar regardless of the reference percentiles. This study shows a significant misclassification of newborns as small or adequate for gestational age that may affect individual prognosis, but this is not reflected in the type and the importance of detected risk factors at a group level.

[Growth and development of children with low birth weight at their first birthday]

The aim of this prospective study was to evaluate the effect of low birthweight on growth and development at one year of age, in a cohort of infants born between March 1992 and March 1993 at Hospital de Famalicão. Information was obtained from 199 children, 89 low birthweight cases and 110 born with a normal (> or = 2500 g) weight. The infant mortality rate (56 vs 9 per 1000), the frequency of growth (32% vs 4%, p = 0.0000003) or developmental delay (30% vs 11%, p = 0.002) were significantly higher in low birthweight babies. However, all cases of developmental delay corresponded to minor impairments. At age one, children born with a normal weight presented mean higher values for weight (10.0 +/- 1.1 kg vs 9.2 +/- 1.2 kg; p = 0.000005), length (74.2 +/- 7.1 cm vs 72.9 +/- 3.1 cm, p = 0.0006) and head circumference (46.4 +/- 1.9 cm vs 45.8 +/- 1.6 cm; p = 0.004). Prenatal characteristics such as the planning of the pregnancy, gestational birth weight, diseases during the pregnancy, gestational age or twining, significantly affected development at one year of age, showing that delays can be prevented before a child is born. In addition, post-natal exposures, such as home conditions, energy and nutrient intake, or coping with vaccination schedules and the occurrence of diseases during the neonatal and post-neonatal periods were significantly associated to developmental delay.(ABSTRACT TRUNCATED AT 250 WORDS)

Local control and survival of Ewing's sarcoma in children with radiotherapy and chemotherapy without radical surgery

The present study was undertaken in 27 children with localized Ewing's sarcoma treated at our hospital. In 9 cases the lesion was central and in 18 peripheral. Treatment consisted of: 1) Chemotherapy with 6 drugs (vincristine, cyclophosphamide, methotrexate, bleomycin, dactinomycin and doxorubicin) for one year in all patients; 2) Radiotherapy in 24 patients at a dose of 30-40 Gy in the entire bone with a booster dose of 10-15 Gy in the lesion. In 7 patients debulking surgery was performed followed by irradiation. Two cases with tumor in expendable bones and one with extensive destructive lesion in the tibia underwent radical surgery. One patient suffered local recurrence (femur) and 6 developed distant metastases. The remaining 20 (74%) patients were alive and tumor-free after follow-up periods of 17-80 months. Among the 12 patients with extremity lesions who were alive, 7 (58%) had minimal or mild treatment sequelae, 2 moderate, and 3 severe sequelae but no amputation has been required. Our study shows that local control can be achieved in almost all patients without radical surgery and with acceptable extremity function in the majority.

A study of the capacity of soils to induce nodules in Alnus glutinosa (L.) Gaertn. and Myrica gale L., with special reference to the specificity of the endophytes

One hundred soil samples from sites in North, Centre and West of Spain were examined for their capacity to induce nodules in alder (Alnus glutinosa) and bog myrtle (Myrica gale). Soils from A. glutinosa communities particularly from places where Myrica was absent, were checked for their infectivity towards M. gale. There was a good correlation between the results, since there was not one single sample which could induce nodules in Myrica which did not do the same in alder. The nodules formed on M. gale plants grown in soils collected from alder habitats showed acetylene-reducing activity at a level comparable to that described in the literature, in the case of other Myrica species. Considering together the results now obtained and in previous work, the possibility of cross-inoculation between M. gale and A. glutinosa, is again put forward and it is thus held that no specificity can be assigned, for the time being, to the respective endophytes.