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Justification: Breastfeeding provides the best infant food, and closeness to the mother is crucial for successful breastfeeding. However, sharing parents' beds and sleeping on the stomach poses a high risk for sudden infant death syndrome (SIDS). There is little information on these practices regarding the Spanish population.Objective: To explore breastfeeding and bed-sharing practices in the study populationMaterials and Methods: A cross sectional observational study was conducted through an anonymous telephone survey with a representative random sample of babies born in the Health Area of La Marina Baixa, Alicante, between 2018 and 2019. A previous-day strategy was implemented to determine the feeding and bed-sharing variables.Results: The total breastfeeding and formula-feeding rates were 47.0% and 52.9%, respectively. The overall bed-sharing rate was 66.5%. The breastfeeding rate was 86.4% with bed-sharing and 13.6% without bed-sharing. The rate of prone sleeping position in children younger than 6 months of age was 9.3-3.5% with breastfeeding and 5.8% with formula feeding. Lower frequencies of tobacco, alcohol, and nonsupine sleeping positions were observed among mothers who practiced breastfeeding and bed-sharing.Conclusions: We found a close relationship between breastfeeding and bed-sharing and a lower frequency of SIDS risk factors associated with both practices. Families should be informed about the risk factors associated with SIDS to encourage safe bed-sharing while avoiding recommendations that discourage breastfeeding.

AIMS: Temporary cardiac pacing with active-fixation leads (TPAFL) using a reusable permanent pacemaker generator has been shown to be safer than lead systems without fixation. However, TPAFL requires the off-label use of pacemaker leads and generators. We designed a fastening system to ensure the safety and efficacy of the procedure: the KronoSafe System®. To demonstrate the safety and effectiveness of the KronoSafe System® for temporary pacing in a series of patients receiving TPAFL. METHODS AND RESULTS: A prospective cohort of 20 patients undergoing TPAFL between August 2019 and June 2020 was recruited in a Spanish region. The temporary pacemaker was implanted through jugular access and secured with the KronoSafe System®. R-wave detection, lead impedance, and capture threshold were assessed every 48 h. Complications associated with the procedure or occurring during TPAFL were recorded. There were no complications associated with temporary pacing, and the therapy was effective in all cases. TPAFL was used for a mean of 7.6 days (maximum 25 days), and 84.56% of the time in a cardiology ward. CONCLUSION: TPAFL secured using the KronoSafe system® provides safe and stable cardiac stimulation for patients requiring temporary cardiac pacing.

Background:Thyroxine (T4) to triiodothyronine (T3) deiodination in the hypothalamus/pituitary is mediated by deiodinase type-2 (D2) activity.Dio2((-/-))mice show central resistance to exogenous T4. Patients with resistance to exogenous thyroxine (RETH) have not been described. The aim of this study was to identify hypothyroid patients with thyrotropin (TSH) unresponsiveness to levothyroxine (LT4) and to characterize the clinical, hormonal, and genetic features of human RETH. Methods:We investigated hypothyroid patients with elevated TSH under LT4 treatment at doses leading to clinical and/or biochemical hyperthyroidism. TSH and free T4 (fT4) were determined by chemiluminescence, and total T4, T3, and reverse T3 (rT3) by radioimmunoassay. TSH/fT4 ratio at inclusion and T3/T4, rT3/T4, and T3/rT3 ratios at follow-up were compared with those from patients with resistance to thyroid hormone (RTH) due to thyroid hormone receptor-beta (THRB) mutations.DIO2,including the Ala92-D2 polymorphism, selenocysteine binding protein 2 (SECISBP2), andTHRBwere fully sequenced. Results:Eighteen hypothyroid patients (nine of each sex, 3-59 years) treated with LT4 showed elevated TSH (15.5 +/- 4.7 mU/L; reference range [RR]: 0.4-4.5), fT4 (20.8 +/- 2.4 pM; RR: 9-20.6), and TSH/fT4 ratio (0.74 +/- 0.25; RR: 0.03-0.13). Despite increasing LT4 doses from 1.7 +/- 1.0 to 2.4 +/- 1.7 mu g/kg/day, TSH remained elevated (6.9 +/- 2.7 mU/L). Due to hyperthyroid symptoms, LT4 doses were reduced, and TSH increased again to 7.9 +/- 3.2 mU/L. In the euthyroid/hyperthyrotropinemic state, T3/T4 and T3/rT3 ratios were decreased (9.2 +/- 2.4, RR: 11.3-15.3 and 2.5 +/- 1.4, RR: 7.5-8.5, respectively) whereas rT3/T4 was increased (0.6 +/- 0.2; RR: 0.43-0.49), suggesting reduced T4 to T3 and increased T4 to rT3 conversion. These ratios were serum T4-independent and were not observed in RTH patients. Genetic testing was normal. The Ala92-D2 polymorphism was present in 7 of 18 patients, but the allele dose did not correlate with RETH. Conclusions:Human RETH is characterized by iatrogenic thyrotoxicosis and elevated TSH/fT4 ratio. In the euthyroid/hyperthyrotropinemic state, it is confirmed by decreased T3/T4 and T3/rT3 ratios, and elevated rT3/T4 ratio. This phenotype may guide clinicians to consider combined T4+T3 therapy in a targeted fashion. The absence of germlineDIO2mutations suggests that aberrant post-translational D2 modifications in pituitary/hypothalamus or defects in other genes regulating the T4 to T3 conversion pathway could be involved in RETH.

2015 es el año del centenario del nacimiento de Josep Maria Sostres. Se habían enterado, en Catalunya ha habido modestísimas iniciativas, muy poco para quien fue -en palabras de Quetglas- el “ crítico más profundo y, por lo tanto, menos influyente en las cuatro últimas décadas de la arquitectura catalana1”. Los grandes homenajes se dejan para los mediáticos y suelen ser ampulosos, poco reflexivos; con Sostres hagamos lo contrario, no seamos mediáticos, seamos poco influyentes: estudiemos su obra, leamos sus textos. Este es el intento del presente estudio, al abordar la relación de Sostres con uno de las principales problemas de su tiempo, la transformación del paisaje litoral en los albores del turismo. Sostres se ocupó de este tema desde su doble condición de crítico y arquitecto práctico. El presente trabajo pretende mostrar la aportación teórica de Sostres desde un texto inédito y el conocido “ paisaje y diseño” contrastándolos con la práctica de Sostres en Torredembarra. The article is focussed on the relationship of Sostres with the touristic architecture developed at the littoral. This analysis is made with three works of Sostres: a building –four apartments at Torredembarra- and two writings –“landscape and design” and another reproduced at the end of this article that was remained not published until today. Sostres had not the possibility of building a lot and most of his buildings he builds are dedicated to the architecture of the free time –secondary residences, rental apartments, and a hotel. That is why is relevant his production as a critic on the use of the territory for this architecture of the free time. Sostres seems to understand that this abuse of the territory is because of this new type of buildings and he made a new statement in the one that building is not the devil because landscape needs this building. The writings of Sostres state that when one has to build in this surrounding has to have some continuity with the Mediterranean tradition. In the apartments at Torredembarra we can see this tradition in the use and transformation of the type of building -botigues- with the use of the ground floor and the kind of plotting he uses. But to understand the Mediterranean tradition is not a just a reinterpretation of what he has on the surroundings, Sostres understand the landscape as a cultural tradition. That is why his buildings, I understand, are a lecture of the Greek architecture that is the architecture of the Mediterranean in Sostres mind. He was professor of History of Architecture at the Barcelona school and one of the main books he recommend was The Idea of Space in Greek Architecture of Martienssen. This article uses this text as a touchtone in relation to the four apartments at Torredembarra. In Sostres mind, the transformation of the landscape seems to be unstoppable. This transformation should have the same principles that have buildings that build the building until then.

Las férulas o planos oclusales han sido utilizadas desde hace más de un siglo, generando controversia acerca de su verdadero valor terapéutico. Esto motivó una revisión histórica y actualizada que permitiera evaluar sus efectos de acuerdo a la evidencia científica. Se discuten múltiples aspectos como el concepto de relación céntrica y su determinación como punto de inicio de tratamiento en la rehabilitación oral; el uso de las férulas para deprogramar; su efecto sobre la conducta motora oral que conocemos como bruxismo; su efecto en la actividad electromiográfica tónica, durante la deglución y el máximo apriete en los músculos masticatorios y cervicales; su influencia en la eficiencia muscular; su efecto en la carga articular y las evidencias experimentales del uso de distintas férulas sobre signos y síntomas especíicos como dolor y ruido articular. Se plantean desafíos para la investigación sobre cambios degenerativos en las articulaciones, en la relación craneovertebral y en la curvatura e inclinación de la columna cervical. Se concluye que es necesario utilizar una férula diseñada para el trastorno específico del paciente y que su verdadero valor terapéutico queda demostrado al mejorar algunos signos y síntomas, en músculos masticatorios y cervicales. El conocimiento parcial del mecanismo de acción de las férulas contribuye a que persista la controversia de su utilización en el tratamiento de ruidos articulares y para revertir cambios degenerativos en las articulaciones. Persiste el desafío de nuevas investigaciones, que sustenten el uso de estos dispositivos como un método eficaz para tratar a nuestros pacientes, utilizando protocolos de manejo y controles periódicos. Occlusal appliances or splints have been used for over a century, generating controversy about their real therapeutic value. This led to an updated review to assess their effects according to scientific evidence. The concept of centric relation and its determination as a starting point of treatment; the use of splints to deprogram; their effect on the oral motor behaviour known as bruxism are discussed. Their effect on EMG activity during resting, swallowing and maximal clenching in the masticatory and neck muscles; their effect on muscular eficiency; their effect decreasing the joint overload; and experimental evidence of the use of several appliances on speciic symptoms such as pain and joint noise, are also treated. The true challenge is to generate new knowledge about joint degenerative changes, the craniocervical relationships, tilt and curvature of the cervical spine. In conclusion, it's necessary to use an occlusal appliance designed for the specific condition of the patient, and its real therapeutic value is demonstrated by the improvement of some signs and symptoms in masticatory and cervical muscles. However, the action mechanisms of occlusal appliances are not fully understood. The lack of scientiic support contributes to the persistent controversy of the use of these appliances in the treatment of temporomandibular joint sounds and reversing degenerative changes. It is still a challenge to carry out new researches supporting the use of these appliances as an effective method to treat our patients using management protocols and periodic evaluations.

Introducción: Varios estudios han sugerido que el contacto precoz del estudiante de medicina con la realidad asistencial puede tener unos efectos beneficiosos sobre su motivación, el conocimiento de la relación médico-paciente y la aceptación de la importancia de las materias médicas básicas. En el nuevo grado conjunto de Medicina de la Universitat Autònoma de Barcelona y la Universitat Pompeu Fabra se ha incorporado una asignatura denominada 'Prácticas de Grado' que se imparte durante los tres primeros años, destinada a permitir el contacto de los estudiantes con la asistencia primaria, los equipos de enfermería y los centros sociosanitarios. El presente artículo describe la experiencia y la opinión de los estudiantes que la cursaron durante el primer año. Materiales y métodos: El artículo describe las características académicas de la asignatura. Se realizó una encuesta a los estudiantes al finalizar la asignatura para evaluar su grado de satisfacción y su percepción sobre el cumplimiento de los objetivos y las competencias que debían alcanzarse. Resultados: Existió una elevada satisfacción con la nueva actividad y una percepción entre los estudiantes de que las competencias preestablecidas se habían alcanzado en su mayor parte. Conclusión: El contacto precoz con la realidad asistencial es un elemento esencial para la comprensión de la actividad médica por los estudiantes de medicina de primer año. Introduction: Several studies have suggested that early contact of medical students with medical care may have beneficial effects on their motivation, knowledge of doctor-patient relationship and acceptance of the interest of biomedical sciences. In the new joint degree of Medicine of Autonomous University of Barcelona and Pompeu Fabra University we have incorporated the subject 'Prácticas de Grado' during the first three years. It is devoted to permit the early contact of medical students with primary care, nursing teams and chronic care facilities. The present paper describes its academic features as well as the opinion of students during the first year of the experience. Materials and methods: The characteristics of the subject are described in this section. A survey was performed in the students who completed the first year of the experience to get their degree of satisfaction and the perception with the achievement of pre-established competencies and educative objectives. Results: Students were highly satisfied with the new subject and they believed that planned competencies and objectives were fully achieved in most of cases. Conclusion: The early contact with health care is an important contribution to the understanding of the medical professions by medical students of first year.