Mud-packing frog: A novel breeding behaviour and parental care in a stream dwelling new species of Nyctibatrachus (Amphibia, Anura, Nyctibatrachidae)

Reproductive modes are diverse and unique in anurans. Selective pressures of evolution, ecology and environment are attributed to such diverse reproductive modes. Globally forty different reproductive modes in anurans have been described to date. The genus Nyctibatrachus has been recently revised and belongs to an ancient lineage of frog families in the Western Ghats of India. Species of this genus are known to exhibit mountain associated clade endemism and novel breeding behaviours. The purpose of this study is to present unique reproductive behaviour, oviposition and parental care in a new species Nyctibatrachus kumbara sp. nov. which is described in the paper. Nyctibatrachus kumbara sp. nov. is a medium sized stream dwelling frog. It is distinct from the congeners based on a suite of morphological characters and substantially divergent in DNA sequences of the mitochondrial 16S rRNA gene. Males exhibit parental care by mud packing the egg clutch. Such parental care has so far not been described from any other frog species worldwide. Besides this, we emphasize that three co-occurring congeneric species of Nyctibatrachus, namely N. jog, N. kempholeyensis and Nyctibatrachus kumbara sp. nov. from the study site differ in breeding behaviour, which could represent a case of reproductive character displacement. These three species are distinct in their size, call pattern, reproductive behaviour, maximum number of eggs in a clutch, oviposition and parental care, which was evident from the statistical analysis. The study throws light on the reproductive behaviour of Nyctibatrachus kumbara sp. nov. and associated species to understand the evolution and adaptation of reproductive modes of anurans in general, and Nyctibatrachus in particular from the Western Ghats.

Dynamics of pneumococcal nasopharyngeal carriage in healthy children attending a day care center in northern Spain. Influence of detection techniques on the results

8 p.

Situación de la salud materno-perinatal en 2 Centros de Salud de Bizkaia

Introducción: La salud reproductiva y, en concreto, todos los aspectos relacionados con los cuidados de salud durante el embarazo, son temas de especial relevancia, tanto para la sociedad como para los servicios sanitarios. De modo que es necesario asegurar una adecuada atención de la mujer durante el embarazo, parto y postparto. Objetivo: Analizar y determinar la satisfacción de las mujeres con el seguimiento de su embarazo (gestación, parto y postparto) y comparar las diferencias existentes entre los 2 Centros de Salud (C.S) en los que se ha realizado dicho seguimiento. Metodología: Se realizó un estudio a 32 mujeres atendidas en los C.S. de Bombero-Etxaniz y Arrigorriaga, en el periodo transcurrido entre el 15 de enero del 2013 y el 15 de marzo del 2013; las encuestas se llevaron a cabo en el primer trimestre postparto. Se desarrolló un análisis descriptivo de los datos y un estudio de asociación entre las diferentes variables. Resultados: La media de edad de las mujeres estudiadas se situó en 34,75; se encontró asociación entre la edad y los embarazos de riesgo. El 50% de los partos fueron eutócicos; se estableció relación con la edad y la paridad. A más del 50% de ellas se les realizó una episiotomía, buscando una relación con el hospital se halló que cuanto más grande era el hospital más episiotomías se realizaban. Así mismo las encuestadas mostraron una mayor satisfacción con la atención prestada por los centros hospitalarios privados; en referencia a los C.S. no se hallaron diferencias significativas, mostrando en ambos casos una satisfacción subjetiva percibida alta. Conclusiones: Los cambios sociales, culturales, económicos e ideológicos ocurridos han favorecido el aumento de la edad materna y consigo el aumento de embarazos de riesgo, además de la disminución de la media del número de hijos. Se aprecia una necesidad en materia de apoyo e información a las mujeres en el periodo postparto debido al gran cambio personal, físico, social y psicológico que puede suponer.

Clinical factors associated with a Candida albicans Germ Tube Antibody positive test in Intensive Care Unit patients

Background: Poor outcomes of invasive candidiasis (IC) are associated with the difficulty in establishing the microbiological diagnosis at an early stage. New scores and laboratory tests have been developed in order to make an early therapeutic intervention in an attempt to reduce the high mortality associated with invasive fungal infections. Candida albicans IFA IgG has been recently commercialized for germ tube antibody detection (CAGTA). This test provides a rapid and simple diagnosis of IC (84.4% sensitivity and 94.7% specificity). The aim of this study is to identify the patients who could be benefited by the use of CAGTA test in critical care setting. Methods: A prospective, cohort, observational multicentre study was carried out in six medical/surgical Intensive care units (ICU) of tertiary-care Spanish hospitals. Candida albicans Germ Tube Antibody test was performed twice a week if predetermined risk factors were present, and serologically demonstrated candidiasis was considered if the testing serum dilution was >= 1: 160 in at least one sample and no other microbiological evidence of invasive candidiasis was found. Results: Fifty-three critically ill non-neutropenic patients (37.7% post surgery) were included. Twenty-two patients (41.5%) had CAGTA-positive results, none of them with positive blood culture for Candida. Neither corrected colonization index nor antifungal treatment had influence on CAGTA results. This finding could corroborate that the CAGTA may be an important biomarker to distinguish between colonization and infection in these patients. The presence of acute renal failure at the beginning of the study was more frequent in CAGTA-negative patients. Previous surgery was statistically more frequent in CAGTA-positive patients. Conclusions: This study identified previous surgery as the principal clinical factor associated with CAGTA-positive results and emphasises the utility of this promising technique, which was not influenced by high Candida colonization or antifungal treatment. Our results suggest that detection of CAGTA may be important for the diagnosis of invasive candidiasis in surgical patients admitted in ICU.

Somatisation in primary care: experiences of primary care physicians involved in a training program and in a randomised controlled trial

Background: A new intervention aimed at managing patients with medically unexplained symptoms (MUS) based on a specific set of communication techniques was developed, and tested in a cluster randomised clinical trial. Due to the modest results obtained and in order to improve our intervention we need to know the GPs' attitudes towards patients with MUS, their experience, expectations and the utility of the communication techniques we proposed and the feasibility of implementing them. Physicians who took part in 2 different training programs and in a randomised controlled trial (RCT) for patients with MUS were questioned to ascertain the reasons for the doctors' participation in the trial and the attitudes, experiences and expectations of GPs about the intervention. Methods: A qualitative study based on four focus groups with GPs who took part in a RCT. A content analysis was carried out. Results: Following the RCT patients are perceived as true suffering persons, and the relationship with them has improved in GPs of both groups. GPs mostly valued the fact that it is highly structured, that it made possible a more comfortable relationship and that it could be applied to a broad spectrum of patients with psychosocial problems. Nevertheless, all participants consider that change in patients is necessary; GPs in the intervention group remarked that that is extremely difficult to achieve. Conclusion: GPs positively evaluate the communication techniques and the interventions that help in understanding patient suffering, and express the enormous difficulties in handling change in patients. These findings provide information on the direction in which efforts for improving intervention should be directed.

Efficacy and safety of autologous platelet rich plasma for the treatment of vascular ulcers in primary care: Phase III study

Background: Vascular ulcers are commonly seen in daily practice at all levels of care and have great impact at personal, professional and social levels with a high cost in terms of human and material resources. Given that the application of autologous platelet rich plasma has been shown to decrease healing times in various different studies in the hospital setting, we considered that it would be interesting to assess the efficacy and feasibility of this treatment in primary care. The objectives of this study are to assess the potential efficacy and safety of autologous platelet rich plasma for the treatment of venous ulcers compared to the conventional treatment (moist wound care) in primary care patients with chronic venous insufficiency (C, clinical class, E, aetiology, A, anatomy and P, pathophysiology classification C6). Design: We will conduct a phase III, open-label, parallel-group, multicentre, randomized study. The subjects will be 150 patients aged between 40 and 100 years of age with an at least 2-month history of a vascular venous ulcer assigned to ten primary care centres. For the treatment with autologous platelet rich plasma, all the following tasks will be performed in the primary care setting: blood collection, centrifugation, separation of platelet rich plasma, activation of coagulation adding calcium chloride and application of the PRP topically after gelification. The control group will receive standard moist wound care. The outcome variables to be measured at baseline, and at weeks 5 and 9 later include: reduction in the ulcer area, Chronic Venous Insufficiency Quality of Life Questionnaire score, and percentage of patients who require wound care only once a week. Discussion: The results of this study will be useful to improve the protocol for using platelet rich plasma in chronic vascular ulcers and to favour wider use of this treatment in primary care.

Perinatal hipoxic ischemic injury in the auditory pathway and the effect of several neuroprotective agents

192 p.

Mães em UTI neonatal: a experiência da maternidade diante do bebê em situação de risco

Esta pesquisa teve por objetivo compreender as vicissitudes da experiência de tornar-se mãe de um bebê em situação de risco neonatal. Emergiu da experiência da autora no acompanhamento psicológico prestado às mães e familiares de recém-nascidos de alto risco internados em uma Unidade de Terapia Intensiva Neonatal (UTI Neonatal). Foi possível perceber ali que a puérpera que tinha seu filho internado em situação de risco logo após o nascimento vivenciava uma experiência de intenso sofrimento, permeada por conflitos e angústias específicas, tais como: o sentimento de incapacidade pelo parto prematuro e/ou pela malformação fetal, a dor/luto diante da situação de risco e eminência de perda do filho, o medo e a ambivalência na relação afetiva com o bebê. Tais vivências podem representar uma ameaça para a construção do vínculo inicial entre pai/mãe/filho, bem como para a própria saúde psíquica da mulher e do bebê em constituição. Para uma aproximação da experiência subjetiva destas mulheres/mães, optou-se pela pesquisa qualitativa na abordagem psicanalítica. A compreensão do fenômeno foi possibilitada pela análise do discurso das mães que tiveram seus filhos internados na UTI Neonatal, através do método de observação participante dos atendimentos grupais prestados pelo Serviço de Psicologia da instituição, bem como pela análise documental das fichas de acompanhamento psicológico destas mulheres. Participaram do estudo, as mulheres/mães que acompanharam seus filhos internados na UTI Neonatal do Núcleo Perinatal do Hospital Universitário Pedro Ernesto (HUPE), da Universidade do Estado do Rio de Janeiro (UERJ) e que receberam atendimento psicológico grupal: Grupo Mães Presentes durante um período de três meses. A compreensão e interpretação dos aspectos essenciais do fenômeno foram fundamentadas nos pressupostos psicanalíticos da teoria do amadurecimento pessoal de Donald W. Winnicott e em outros autores atuais de referência no campo materno-infantil. Acredita-se que este trabalho servirá de reflexão e contribuição para a construção, na assistência neonatal, de um lugar de acolhimento para a experiência subjetiva dessas mulheres/mães e suas repercussões, a partir de uma perspectiva de cuidado humanizado e integral a saúde, tal como preconizado pelas políticas públicas atuais.