Currently, organ donation rates are insufficient to cover the transplant needs in our population. This has led to the design of a hospital program of organ donation after circulatory determination of death (Maastricht type III donation). Potential donors for this program are those whose vital support is decided to withdraw due to their very severe vital prognosis, given that there is not medical contraindication and the family is not opposed to the donation. These patients will die within 2 hours of withdrawing their ventilatory and circulatory support.
Although the main source of organ recovery for transplantation must still be patients with brain death, organ donation after circulatory determination of death offers more chances for obtaining organs (especially kidneys) and tissues. This situation requires a multidisciplinary team, specific techniques and hospital guidelines and protocols for this donation process. This must be protocoled following the guidelines of the ONT (Organización Nacional de Trasplantes) and the OCATT (Organització Catalana de Trasplantaments).
We report the case of a patient treated in the paediatric ICU for acute intracranial hypertension related to cerebral venous thrombosis in the setting of an acute middle ear infection. The severe clinical situation evolved to withdrawal of life support. She became donor as a type III in the Maastricht donor classification. To the best of our knowledge, this is the first case of asystole donation in a paediatric ICU in Catalonia.

Introduction: Acute confusional state (ACS), also called delirium, is a transient organic mental syndrome in which cognitive functions are altered in a variable way, especially attention. It is more frequent in the elderly and children, although about children literature is still scarce. The causes of ACS can be classified into three main groups: systemic processes, drug intake and neurological diseases. Intoxication, epilepsy, traumatic brain injury (TBI) and central nervous system infections are the most common causes in children. Before an ACS in the pediatric age, a correct history and an adequate differential diagnosis should always be made. Before an abnormal or aggressive behavior with an abrupt onset, it´s important to always rule out the possibility of an organic pathology and not attribute it to behavioral disorders or psychiatric pathology.

Clinical cases: We present four clinical cases of ACS of different etiologies that occurred in the Pediatric Emergency Department of a secondary hospital.

Conclusions: Although ACS is more frequent in adults, pediatricians must be prepared to identify it, treat its symptoms and find out the underlying cause in order to establish early treatment.

Introduction: The onychocryptosis in the pediatric population is a highly prevalent pathology. The surgical approach is the treatment of choice in advanced stages with two different techniques, onicectomy with matricectomy by chemical or mechanical abrasion. The purpose of this study is to compare the local recurrences in these two different approaches.
Material and methods: This is an ambispective cohort study between 2010 and 2017 in two groups. Group A: partial onicectomy with matricectomy by chemical abrasion with phenol. Group B: matricectomy by mechanical abrasion. Demographic, surgical, immediate postoperative variables and long-term complications are compared. The statics was performed with the SPSS Static 22 software. P value < 0.05 is consider statistically significant.
Results: The study included 87 patients. In group A (12 patients), or chemical matricectomy two cases (16.7%) presented local cellulitis, 4 cases (33%) presented a local recurrence and one of them suffered from a second recurrence. Group B (75 patients) or mechanical matricectomy, did not show immediate postoperative complications and 7 patients (9%) suffered from an ipsilateral recurrence. A second recurrence appeared in three of them. The differences in the recurrence rate between group A and B were statistically significant (p = 0.04).
Conclusion: In our experience partial onicectomy with matricectomy by mechanical abrasion in onychocryptosis has a low rate of complications and local recurrences compared to phenolization in pediatric patients. It is necessary to perform new randomized and prospective studies to confirm this difference.

Correspondencia: C. Leganés Villanueva. Servicio de Cirugía Pediátrica. Hospital Universitari Vall d’Hebron. Passeig de la Vall d’Hebron, 119-129. 08035 Barcelona.
Correo electrónico: cleganes@santpau.cat

Open fractures are rare in pediatrics, most of them secondary to high-energy trauma; initial stabilization of the patient is essential, together with a clinical history and adequate neurovascular exploration. Early antibiotic prophylaxis constitutes a key piece in the initial management of these fractures by the pediatrician, fulfilling in the child some special characteristics, due to a faster recovery and a lower infectious risk. We present a clinical case, through which we will review the most appropriate antibiotic prophylaxis according to the type of open fracture presented by our patient according to the classification of Gustilo and Anderson modified.

A. Martínez Sebastián. Servicio de Pediatría. Hospital Universitario Doctor Peset. Av. Gaspar Aguilar, 90. 40017 Valencia.
Correo electrónico: aliciamarsebastian@gmail.com

Aim: To analyse the level of knowledge of paediatric advanced life support (ALS) among paediatric personnel of the island of Lanzarote (Spain) and to evaluate the efficacy of ALS courses on the island.
Method: A cross-sectional analytical study was carried out on paediatric and neonatal ALS training courses conducted on Lanzarote from 2016 to 2018. Scores were collected during the theoretical evaluations performed at the beginning and end of the course as well as during the practical stage. The scores were evaluated according to multiple sociodemographic variables describing the trainees. The Wilcoxon signed-rank test was applied to compare the theoretical scores before and after the course and a multivariate linear regression model was used to examine the relationships between the scores and the different sociodemographic variables.
Results: A total of 77 students participated in the courses, and the median score increased significantly (p <0.001) from the initial to the final evaluation (from 14 to 18 points out of 20). In the practical evaluation of both basic and advanced paediatric and neonatal life support, the median scores exceeded 4 out of 5, with the minimum requirement being 3. Medical doctors scored higher than nurses in performing both basic and advanced life support techniques (p < 0.05). Younger trainees performed better ALS (p < 0.05).
Conclusions: Advanced paediatric and neonatal life support courses are effective short-term teaching methods for the theoretical and practical training of health professionals. Future studies are needed to determine their medium- and long-term effects.

M. Inguanzo Ortiz. Servicio de Pediatría. Hospital Dr. José Molina Orosa. Carretera Arrecife-Tinajo, km 1,3. 35550 Arrecife (Las Palmas). Correo electrónico: maritxueps@yahoo.es

This article commemorates the centenary of the passing of Manuel Tolosa Latour (1857-1919), a doctor from Madrid, one of the pioneers in the creation of paediatrics as a medical speciality in Spain.
A search is made in digital press repositories: ABC-Blanco y Negro, La Vanguardia, Hemeroteca Digital de la BNE, Biblioteca Virtual de Prensa Histórica and other secondary sources.
Tolosa stood out for its scientific contributions, for its initiatives for the protection of children, for its activities as a reformist hygienist, as well as for its actions in the institutional, social and legislative spheres. He contributed decisively to the formulation and approval of the Child Protection Law of 1904, the first protectionist law in Spain, known as the Tolosa Latour Law. He created maritime and mountain sanatoriums. He worked in the Hospital del Niño Jesús in its beginnings, in the first Gota de Leche of Madrid. He participated and chaired scientific societies, among them the recently created Pediatrics Society of Madrid. He contributed to give international visibility to Spanish children’s medicine. Manuel Tolosa, together with Elisa Mendoza, his wife, and their closest family and professional environment contributed to the development of social protection networks for children, and also, in providing a route for women to gain presence in the public space.

M.A. Zafra Anta. Pediatra. Hospital Universitario de Fuenlabrada. Camino del Molino, 2. 28942 Fuenlabrada (Madrid).
Correo electrónico: miguelzafraanta@gmail.com

The main objective of this work is to show how the correct application of cybermetric techniques to Pediatrics can provide a huge amount of information that, properly analyzed and contextualized, can allow and facilitate strategic decision making to the different agents involved directly or indirectly with Pediatrics. To do this, two complementary analyzes are proposed. The objective of the first analysis is to determine the online presence of Spanish pediatric societies. To this end, various online metrics related to the presence, visibility, impact and connectivity of 39 associations were collected. The results indicate that the Spanish pediatric societies do not have websites of great impact and that they mainly use Facebook and Twitter, although the use of these platforms differs widely among Societies, reflecting the existence of different web communication strategies. The objective of the second analysis is to evaluate the impact of the hashtags related to vaccination on Twitter, for which we analyzed hashtags in Spanish related to the systematic vaccines recommended by the Spanish Association of Pediatrics (a total of 18). The results show a low volume of content (few tweets), that arouse little interest (few comments) and that obtain a diffusion (retweets) and impact (likes) moderate.

This paper describes the Scimago Journal and Country Rank portal, created by the Spanish research group Scimago, which calculates a series of metric impact indicators through the analysis of the journals indexed in the Scopus database. The four possible search options are explained, both the specific analysis of a journal individually or through the comparison of journals (Journal Ranks), the classification of the countries evaluated according to their scientific production (Country Ranks) as well as a new tool of information visualization (Viz Tools). Using the journal Acta Pediátrica Española as an example, Scimago Journal and Country Rank portal provide together with the bibliographic information of the journal, the SJR metrics, index H, documents, references, citations, citations by document and country obtained annually for the period 1999-2016.

This paper presents the possibilities offered by the Scopus bibliographic database for the calculation of scientometric indica-tors through an analysis of publications whose subject is pediatrics. The article shows the different search possibilities by doc-uments, by author, by affiliation, advanced search and search by journal, as well as the visualization of the retrieved records. The main tools for the analysis of the retrieved records are exposed, highlighting the analyze search results function, of special interest for the calculation of scientific production indicators, and the citation overview function, necessary for the calculation of the citation impact based indicators. Finally, the metrics used by Scopus are briefly described using the Acta Pediátrica Es-pañola journal as an example.

Paediatric critically ill (CI) patients are characterised by a high nutritional risk, due to the hyper-catabolism and the inflammatory state secondary to the stress response to critical illness in the acute phase. Malnutrition prevalence in these patients remains high and it is associated to a higher mortality rate. In addition, both malnutrition and obesity are associated with a worse clinical evolution. Nutritional support (NS) should focus not only in the achievement of an adequate nutritional status, moreover it can also modulate the metabolic, neuro-endocrine and inflammatory response, optimizing the benefits of this response in the short term and reducing the adverse outcomes in the medium and long term. Despite the importance of NS in the paediatric CI patient, the evidence available is scare, so international consensus-based guidelines mostly rely on expert opinion, studies in adults or non-critically ill children. Nevertheless, during recent years several studies have provided more data regarding NS in these patients; to adjust the energy provided depending of the illness phase, to avoid overfeeding and hyperglycaemia, the choice of appropriate route of feeding, the necessity of overcoming several barriers to start enteral nutrition and its importance in the CI patient or the timing to initiate parental nutrition, are topics that will be covered in this review.

The blog «Pediatría basada en pruebas» is a source of proven information and training after 8 years around the Spanish pediatric blogosphere and the social web. In this article, 2,486 public entries in this blog from August 2008 to July 2016 are analyzed, with a detailed study of the 59 posts with more than 5,000 visits.

From the quantitative point of view, the life of a blog and changes are confirmed over time. The three most visited post over this 8 years are: «Por una sanidad Google Style», 71,418 visits (publication date: 08/04/13); «Cine y pediatría (210): El milagro de Carintia, el milagro de cada día en una guardia», 27,361 visits (publication date: 18/01/14); and «Que no. Que la leche no produce mocos», 19,850 visits (publication date: 21/07/11).

From the qualitative point of view, the subjects that interest the most to the readers of «Pediatría basada en pruebas» blog gather around six groups, consolidate in this top 5,000: 19 posts as established sections in the blog (mainly Cinema and pediatrics); 11 posts as Social subjects (smoking, injuries, immigration, bulling, etc.); 9 posts as Controversies (subjects of special social and/or healthcare debate, such as abortion, anti-vaccination groups, medical malpractice, etc.); 7 posts as Infectious diseases (flu, meningitis, septicemia, measles, chickenpox, vaccinations, etc.); 7 posts as Perineonatology (pregnancy and newborn subjects), and 6 posts a Guidelines and reports of scientific societies.

The initial best possible way of improve in a blog is to know our readers’ dynamics (from both areas, quantitative and qualitative) and webmetrics is a good tool. And with these results of the blog to build the information and training in the best possible way to our colleagues, patients and families, and to society in general.

Parenteral nutrition has become a more and more frequent nutritional support in pediatrics. Continuous investigations and standardization of this nutritional alternative have improved this technique making it more safe and tolerable. However it is not exempt from complications which may add morbimorbidity to the patients under treatment. In the present article we review two of these complications associated with long term parenteral nutrition: parenteral nutrition-associated liver disease and parenteral nutrition-metabolic bone disease. Concepts, aethiology, risk factors, mechanisms of production, treatment and prevention are reviewed.

World Kidney Day 2016 focuses on kidney disease in childhood and the antecedents of adult kidney disease that can begin in earliest childhood. Chronic kidney disease (CKD) in childhood differs from that in adults, as the largest diagnostic group among children includes congenital anomalies and inherited disorders, with glomerulopathies and kidney disease in the setting of diabetes being relatively uncommon. In addition, many children with acute kidney injury will ultimately develop sequelae that may lead to hypertension and CKD in later childhood or in adult life. Children born early or who are small-for date newborns have relatively increased risk for the development of CKD later in life. Persons with a high-risk birth and early childhood history should be watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or treatment. Successful therapy is feasible for advanced CKD in childhood; there is evidence that children fare better than adults, if they receive kidney replacement therapy including dialysis and transplantation, while only a minority of children may require this ultimate intervention. Because there are disparities in access to care, effort is needed so that those children with kidney disease, wherever they live, may be treated effectively, irrespective of their geographic or economic circumstances. Our hope is that World Kidney Day will inform the general public, policy makers and caregivers about the needs and possibilities surrounding kidney disease in childhood.

The widespread use of mobile devices has led to the development of a wideand varied application catalog, which has spread to the health sector. These applications aidmedical professionals in the medical practice, while helping in developing a proactive role by the patients in the monitoring tasks. The context and featuresof theapplications used in the health sector aredescribed and a list of some of the most outstanding applications in the field of pediatrics is provided, including updating practitioners’ knowledge, help in management tasks, consultation ondiagnostics and those most used by parents to facilitate tracking and monitoring. A list of the main directories and search engines for apps is also presented to help findingproper applications among the wide range of available applications.Besides, national and international initiatives to assess the quality and reliability of these applications are also presented.

Takayasu arteritis is a chronic inflammatory disease that affects the large vessels, with a predilection for the aorta and its branches. We describe the case of a 14 year-old boy, consisting in moderate supra-aortic stenosis and aneurysmal dilatation of the ascending and descending aorta. The base treatment was corticosteroids, in combination with immunosuppressive drugs and biologic agents (infliximab and tocilizumab). During treatment period, the patient suffered a pulmonary tuberculosis, who was treated without problems.

Abbreviations (abbreviations, acronyms and symbols) are widely used in all scientific fields, especially in health sciences, usually used as a resource to gain time and save space. However, they can cause communication problems between professionals from different levels of care and may incur misunderstandings that can lead to serious consequences, especially in drug prescriptions in childhood. This article revises the rules that define their construction and use, describes problems of their use in scientific communication, proposes solutions to avoid acronyms and details some search engines about acronyms on the internet.

Before a new diagnostic test and before the use in clinical practice, it is necessary to know its validity. And to validate studies of diagnostic tests it is necessary they have methodological rigor in the design and applicability. In diagnostic tests we can consider two checklists: STARD for validity and QUADAS for quality.
The STARD statement defines a list of 25 questions and one flowchart to be followed for an appropriate study design, given the inclusion of patients, the order of performing the test, the number of patients receiving the test and the selected refe­rence.
The QUADAS statement consists of four key areas including: selection of patients, test under study, reference standards, and patient flow and timetable.

Currently, quality systematic reviews (with or without meta-analysis), and with a well-defined methodology, has been considered one of the best sources of available scientific evidence. They have great value (and popularity) in the cycle of generation, transmission and implementation of knowledge, both for its value per se as being the starting point of clinical practice guidelines and/or reports of health technology assessment.
But a systematic review is not good per se (as neither is a clinical trial). To have quality, it should describe the methodology in a complete and transparent manner. To check the quality of systematic reviews we have the PRISMA statement, a checklist for this type of study that replaces the QUOROM previous statement. Therefore, we already have the "prism"; now we have to use it and we have prove that it improves the quality of systematic reviews.

Background: Our goal was to assess the experience of Spanish pediatricians training overseas. Secondly, we compared the assessment from pediatricians training in low-income versus high-income countries.
Material and methods: A nationwide multicenter cross-sectional survey was conducted from January to March 2014. Members from SEIP (Spanish Society of Pediatric Infectious Diseases) were included. Countries of destination were divided in two groups: low and lower middle-income (LLMI), and high and upper middle-income (HUMI) countries, according to the 2013 World Bank income classification by GNI per capita. The experience of trainees in LLMI vs HUMI countries were compared.
Results: Forty-seven trainees (61%) were interested in infectious diseases training. All pediatricians were satisfied during training. Twenty-five trainees (35%) were in LLMI countries. There were no significant differences between the assessment from pediatricians training in LLMI vs HUMI countries. Twelve residents (17%) developed their training within a cooperation and development aid, most of them in LLMI countries (44%).
Conclusions: Training overseas is fully valued by pediatricians. Pediatric training in low-income countries may be also training in global health.

Clinical trials are considered the gold standard in therapeutic interventions and the key factor in these studies is randomization. The germ of these lists guide comes from the standards applied to randomized clinical trial, the gold standard of biomedical publication, and it needs to be described in detail, accurately and transparently, both the design, implementation, analysis and results. However, the information provided in the publications is often inadequate or inaccurate, and these deficiencies motivated in 1996 the development of the CONSORT statement. We are in the third generation of the CONSORT statement and we review the 25 items that are considered critical and that should be included in any report of a randomized clinical trial.
Nonrandomized intervention studies are needed when there are reasons that prevent the realization of a randomized clinical trial, but the TREND checklist should be used to communicate transparently the results. In this article we also review the 22 items of the TREND statement with a brief description of each one.

To publish less and publish better, we need good training and good resources. One of these resources is some good practice guidelines for the preparation of papers (both formal and ethical aspects). They must be guidelines disseminated and available for publishers, authors, reviewers and readers. These guidelines are known as "checklists".
These guides lists form a sea of acronyms (AGREEE, CONSORT, COREQ, MOOSE, PRISMA, REMARK, SQUIRE, STARD, STROBE, TREND, etc.) defining initiatives to improve the conduct and publication of experimental, observational diagnostic accuracy studies, forecasting, economic evaluation, clinical practice guidelines, etc.
There is considerable published information on checklists for scientific articles. In addition, some Internet resources offer useful information to readers, reviewers and editors, among highlights EQUATOR Network, acronym of Enhancing the QUAlity and Transparence Of health Research.

Introduction: Writing and publishing require a methodology, organization, and systematics that all pediatricians should know.
Objective: To evaluate the level of training on biomedical publications among pediatricians and other medical specialists who work in pediatrics in our area, as well as their personal experience in publishing.
Material and methods: An opportunity survey with 13 closed questions and another mixed question on training, experience, and motivation to publish. Sample: physicians attending to a lecture about "How to publish articles" from a course aimed to pediatricians, family physicians, pediatrics residents (MIR-pediatrics), and residents in family medicine (MIR-family physicians). Descriptive statistics: SPSS version 15.
Results: The target population was 53 physicians. Thirty four (64.1%) fulfilled the questionnaire. Only 13 (38.2%) from the people who answered were trained in publication techniques (through courses and seminars): pediatricians 9 out of 21 (42.8%), MIR-pediatrics 2 out of 6 (33.3%), MIR-family physicians 2 out of 7 (28.6%). Experience: a) published at least one article in the last 5 years: pediatricians 18 (85.7%); b) more than 5 articles: pediatricians 5 (23.8%), MIR-pediatrics 2 (33%, both <6 articles), MIR-family physicians 5. Motivation: publishing was experienced as "too difficult" for 5 (20% of those who had published). The main reason for publishing was personal curriculum (94.1% of 34).
Discussion: This pilot study offers a glance at reality and let us know the necessity to train on how to write biomedical article. This work is a proposal to extend this kind of studies to other districts or sanitary areas. A considerable percentage of people didn't remark publishing as emotionally positive, instead, they found it "too difficult".
Conclusions: In our sample, a lack of training in scientific writing has been proven. We recommend enhancing tools such as these surveys, in order to discover, promote, and guide through training skills to teach biomedical writing.

As in a theatre play, an article has a beginning (Introduction), middle (Methods and Results) and outcome (Discussion). In the Discussion we analyse the significance of the study findings, we highlight new and important aspects of the study and key conclusions, analyse and interpret research data according to the methodology and we specify a response (conclusion) to the question research (objective). In the Discussion we address four key areas: scientific validity, clinical relevance, novelty and clinical utility.
Care in selecting and transcribing bibliography in a scientific paper focuses on many aspects, but one essential is the rigor with which a study was conducted. References are a prominent section in a scientific paper, where the careful selection of relevant documents is an element that gives strength to theoretical exposition of the text, as well as an important source of information for the reader. It is important to know the requirements to make the references based on the "uniform requirements" (Vancouver style is the most widely used in medical science).
And finally, four sections that usually go at the end of the document and which are also of interest must be taken into account: Acknowledgments, Funding, Conflicts of interest and Annexes.

Material and methods and Results are the central and most important sections of an article, as they include the essence of critical reading, where it is possible to assess the validity (from a scientific point of view), relevance (from the clinical point of view) and applicability (in clinical practice).
The Material and methods section is the «operating instructions» of the investigation, so it is essential to expose it precisely to the extent that this section of the article is the one that causes most rejection publication. The writing of this paragraph may be literal or, perhaps better, can be structured in several sections, among which we could include the following: type of study design, subjects or patients, type of variables, population and sample, interventions and measures, statistical analysis and ethical standards.
The Results section is the «heart» of the article, but a heart that should beat at the same rate of Material and methods and always be consistent. Here we select, organize and present data using two stylistic forms: the text (with a very efficient stylistic form, clear and precise) and auxiliary elements of the text (tables, charts, figures, photographs and diagrams). Therefore, in the Results section there are two key points: to do a good data the analysis and present themselves well.

Each section of an article must be dissected in depth to understand their opportunities and threats when reading (and writing) a scientific paper. This article will address the first three paragraphs of an article: title, abstract and introduction.
The title is the first thing to read in an article, hence its importance. We must find good titles and we must know the characteristics that advise and mistakes to avoid. In the title (and throughout the text) we must observe two basic issues: the sentence length and word length, which is known as "fog index".
The abstract is a key part of the article, their business card. It is the text that usually focus the initial interest to read the full text, with the title. Its purpose is to identify the contents of the document quickly and accurately, with few words (150-250) and with a precise and concise stile. We must carefully choose appropriate keywords and translate them into English correctly. The introduction is the presentation of the work and is like a promotional text. We must know well the recommended sequence, the proper use of the literature and correct statement of objectives, but we must also avoid the most common mistakes made in this section.

If reading is a necessary step to writing, to read well scientific literature is the first step to write (and raise) properly scientific articles. Critical reading is the process of assessing and interpreting evidence from the scientific literature, systematically considering the results presented, and learn to judge whether the scientific evidence is valid (scientific rigor), important (interest in clinical practice) and applicable (in our medical environment). In this way, critical reading allows us to discriminate articles according to the strengths and weakness of the methodology used, and its purpose is to help professionals to take appropriate decision in clinical management situations.
In this article we state the basis to acquire the necessary skills for successful critical reading, as well as major resources available to learn and improve critical reading of biomedical papers: CASPe, Grupo de Trabajo de Pediatría Basada en la Evidencia, etc.

Title: Scientific communication (XIII). Basic knowledge to develop a scientific paper (8): Where to publish? The quality, relevance and impact in biomedical publications. 
After answering the two basic questions in the process of publishing a scientific paper (why and for what?), it is necessary to answer a key question: where to publish the article? Choosing the right journal in which to publish a work depends on various aspects to be taken into account, without losing track of the research process: before assessing the impact of the journal, it must have previously considered the scientific quality and clinic importance.
The essence of scientific publications should not be doing curriculum but to advance and improve healthcare. And although it is permissible to choose high impact factor journals (in the first quartile of the Journal Citation Reports), we must not fall into the "impactolatry" and its variants ("impactofilia", "impactofobia" and "impact what?"). 
The evolution of the scientific publication since the beginning of the XXI century has tried to answer the following questions about where to publish: publication in printed journals or in digital journals?, publication in Spanish or in English?, payment for publication or open access journals?; and publication in impact factor journals or other bibliometric indicators?

Peer review is an essential link in the process of publishing of the best journals and is a key quality control mechanism. It consists of the critical assessment of manuscripts submitted to journals by experts who are not part of the editorial staff, in order to measure their quality, feasibility and scientific rigor.
This article discusses the various forms of review (single-blind, double-blind and open), the criteria to become a reviewer (subject knowledge, impartiality, academic behavior, innovation and responsibility), the strengths, weaknesses and limitations of the system (slowness, arbitrariness, anonymity, lack of agreement between reviewers and differential treatment) and some fallacies that should be banished.

Besides methodologically correct, biomedical research must be ethically good, and it must meet the requirements of the four principles of bioethics: non-maleficence, justice, autonomy and beneficence. We start from the premise that "everything that is not correct from a scientific point of view is ethically unacceptable" although it is true that "not all the right things from a scientific point of view is acceptable from an ethical point of view".
The main ethical aspects of the most important scientific publications concern authorship, originality, the peer review process, publication bias, good clinical practice in research, scientific misconduct and conflicts of interest.

Statistics is an essential section for both, authors and readers of scientific literature, that offers the basis for the scientific rigor of the study and the validity of the conclusions. Knowing the subject of a scientific article helps to understand the work and knowing the principles of statistics helps to understand the methodology.
The main assumptions of the statistic that should be taken into account in the preparation of a scientific paper are: 1) describe the scientific methods with enough detail; 2) quantify the results; 3) know the meaning of the p value p; 4) does not depend exclusively of p; 5) analyze the inclusion and exclusion criteria; 6) provide the details of the randomization process; 7) provide the details of the masking process; 8) report on the complications of the treatment; 9) specify the number of observations and indicate losses; 10) specify the statistical software and statistical references; 11) define the terms and avoid using non-technical statististical terms in statistics, and 12 ) handle errors in clinical research.
Statistics should not become a religion that leads to salvation through the ritual of finding significant values of p, and then the authors reaching the promised land of publication of the paper in a high-impact journal, but properly used is a useful tool for the design and conduct of medical research.

Introduction: The Pediatric Society of Madrid (SPM) was founded one hundred years ago (1913). Besides, the first Spanish National Congress of Pediatrics will be commemorated next year (2014). Children received a new social protagonism in the late nineteenth century. At the same time, the medical specialty of children, institutions, scientific societies, and pediatric meetings were created.
We performed this historical study of the general press in the early twentieth century to analyze the presence of the boards of the SPM at that time. We make a historical reconstruction with the first pictures.
Material and methods: Search in repositories of digitalized media (ABC-Blanco y Negro, La Vanguardia, Digital Newspaper NBS, Virtual Library of Historical Press). Keywords: pediatric society, Madrid, conferences, names of presidents. Press period searched: 1/1/1910-31/12/1925.
Results: We studied 29 articles that were significant in extent and scope in the general press about pediatric activities, meetings, courses, topics, people and institutions in Madrid during that period. The founder board was established on 29 May 1913. The opening meeting took place on 16 October 1913. First president: Criado Aguilar.
Conclusion: Press information is useful to rebuild the SPM activities at the foundation time, at least in part. General press provides a good approach to the history of pediatrics, and it gives great historical and humanistic value images, although they are not of high quality. A deserved tribute to the early days of the SPM demands further studies.

When a scientific paper is drawn, it is necessary to organize the data so that they must be clear and patent to the reader. There should be a perfect balance between text and graphics (tables and figures) to avoid redundant information. Thus, the tables and figures are as scenery where tables work as "image data" and figures as "the image of ideas". If they are well designed and performed, they enhance the work, streamline the evidence and provide visual relaxation throughout the text. Otherwise, they get bored and distract the reader from the message.
Graphic elements should not simply be added because we have them, but we must think objectively its utility in improving the quality of information from scientific text.

Caring for the form of the article (i.e., the scrupulous respect to the specific instructions of the journal; good distribution of sections; a clean, well organized and coherent prose) is the best attribute to enhance the scientific merits of the work, and ultimately promote the acceptance, readability and ensure that the message of the study reach the readers. This article reviews the key of "form" to improve the quality of scientific publications. These are 5 qualities to be cultivated (fluency, clarity, conciseness, simplicity and attraction), 5 defects to be avoided (artifice, emptiness, claim, monotony and ambiguity), and 5 common mistakes that we must consider (abuse acronyms, foreign words, barbarisms, redundancy and grammatical problems of morphology and punctuation).

Scientific papers of biomedical journals are divided into two types: on the one hand those the authors write in a spontaneous way and then send to the journal for its publication (e.g. original articles, case reports and letters to the editor) and on the other hand those requested to the authors by the journals (e.g. editorials and reviews). While the former are subjected to peer review system, the latter have a perfect passport for publication due to their commission nature.
In this paper we review the «background» (what is said) of each major type of article, reviewing with particular depth the different sections of original articles: title, abstract, introduction, materials and methods, results, discussion, bibliography. Knowing the "background" of the articles is key to start the preparation and submission of a manuscript to a biomedical journal.

The ethics of scientific communication implies that scientists gather and transmit information, so that publishing is something inherent to the work of the scientist. The publication and dissemination of research results is, therefore, a necessity. This involves a prior process of reflection and self-criticism before starting work in a scientific paper. Once considered useful publication, the preparation of an article can be summarized in ten key steps: 1) review the scientific literature; 2) select the appropriate journal to which to send the article and check the "Instructions for authors"; 3) advocate the authorship; 4) gather research data; 5) select the type of item; 6) write the first draft; 7) write the following drafts and the final version of the article; 8) send the article; 9) know the editor's decision, and 10) correct the proofs.

We can perform a scientific showing in three different ways: transparencies, blackboard, video or without other support than with words, ideas and the presence of the speaker. But the most widely used in medicine and health sciences is, without doubt, the PowerPoint. But you need to make proper use of PowerPoint (leveraging its strengths and opportunities, and avoiding the weaknesses and threats), and reflect upon the abuse and misuse of PowerPoint. That is, we must prevent the PowerPoint could become our enemy.
The five fundamental concepts in the preparation of slides for oral communication are: large, simple, clear, progressive and consistent.

We report the case of a 6-year-old girl who was recounting abdominal slight pain of 2 months of evolution, in which the X-ray picture of thorax allowed us to do the diagnosis of Chilaiditi's syndrome.

One of the most important and exciting ways of communicating our scientific activity and to disseminate our knowledge is presenting a communication or a scientific conference. The most important thing of oral communication is to use their full potential and be efficient in its presentation. The success will depend not only the content but also the skills of the speaker to convey information and make it attractive. In this paper we propose a decalogue (imperfect and improved) key to make a good scientific communication: 1) prepare to speak; 2) organizing the communication; 3) adapting to the audiovisual information; 4) practice; 5) verify fundamental points; 6) verbal and nonverbal language; 7) answering questions; 8) handle the auditorium; 9) show enthusiasm, and 10) keep in mind what to avoid.

The presentation in poster format of scientific papers in national and international conferences is one of the most effective ways of scientific communication. One of the most important things is to use their full potential and be efficient in its presentation. To do this, we will give some key ideas, divided into two sections: content of the poster (the background) and poster presentation (the way). The goal is to achieve a poster of scientific quality, intelligible, legible, organized and succinct. And that the poster becomes, for all that, the prelude to a subsequent scientific article.

Scientific meetings are important for the training and information in health sciences. Streamline and improve the quality of conferences in pediatrics is a current challenge. The improvement of scientific rigor starts improving the quality of scientific communications. This objective is achieved initially by the base: developing good scientific abstracts. To this we should bear in mind the following four steps in developing effective scientific abstracts: standards, writing, content and quality.

It is clear that there are no universal keys to good scientific communication, since it depends on the transmitter, the receiver, the subject and place. But it is clear that there are tools to get the PowerPoint or you yourself do not be the worst enemies of scientific communication.
In this series we will discuss oral and written communication, how to read and write articles, medical language, etc., as well as the importance of scientific communication in the care, teaching and research on Pediatrics.

Introduction: The main treatment for acute gastroenteritis is oral rehydration solutions. Non compliance due to rejection of the organoleptic properties is an obstacle in the management of paediatric acute gastroenteritis. This article analyses the satisfaction with the new oral rehydration solutions with enhanced flavour and texture in healthy children aged 7 to 10.

Materials and methods: A study of satisfaction in two phases was conducted. In the first phase, we assessed the preferences for different flavours, for both gel and gelatine texture, as well as the children's perceptions about the product similarities with a medicine. In phase two, we evaluated the texture. Additionally, children's parents/tutors were interviewed in relation to administration of paediatric acute gastroenteritis treatment.

Results: 156 and 155 children were included in phase 1 and 2, respectively. The elected flavours were strawberry and coke, both in gelatine and gel textures. The product organoleptic properties similarities to a desert minimized the effect of a medicine in children. Tutors' opinion on the treatment was very favourable: 97% considered that the flavours were attractive, and 90% of them would take the product if needed. The gel texture was the most elected.

Conclusions: This study suggests that a new oral rehydration solutions formulation with optimized organoleptic properties facilitates the rehydration treatment in children, which favours the acute gastroenteritis therapeutic management due to high satisfaction level.

Introduction: Pediatric walking-out patients are an important concern for the emergency department (ED) staff. Premature departure rates are 0.2-5.5%.

Materials and methods: We have performed an observational, prospective case control study. We studied children visiting pediatric emergency departments (EDs) and leaving before being seen by a physician, for an eight month period. Each child was matched with the next child arriving at the emergency department with the same priority and type of pathology that was seen by the doctor. Data was compiled from medical records and by a telephone survey within 96 hours of their premature departure.

Results: During the study period 45,105 children were seen in the emergency department, 184 (0,4%) were walk-outs. Patients used to leave the pediatric emergency department without being seen at the weekend (75.5%), in the afternoon shift (81.2%) and between November and December (73.1%). Among children who left without being seen 51.6% of them were taken by their families elsewhere for medical care, four of the walk-outs were admitted to hospital, none in the control group. The average time of stay was 26 minutes more in patients who stayed than in walk-outs. The main reason for premature departure was waiting too long.

Conclusion: Patients leaving the emergency department without being seen, used to seek further medical care, and sometimes required hospital admission. It is therefore important to take the appropriate measures to reduce this problem. Waiting too long is the most frequent reason for premature departure.

There are several standards and laws that attempt to establish basic regulations to control the relationship between the doctor and the patient and the rights and obligations of each during the process. Therefore, many organizations (such as the United Nations Educational, Scientific and Cultural Organization [UNESCO], the World Health Organization [WHO], the European Union. etc) have issued statements or legal standards regarding this issue. All these precepts have been summarized in law 41/2002, promulgated by the Spanish Parliament. Likewise, a number of autonomous regions in our country (Catalonia, Galicia, Navarre, Castile-León, etc.) now regulate these aspects by law, with special emphasis on clinical information and informed consent.

The doctor-patient relationship in pediatric cases is different, and other individuals are involved in it (mainly parents or legal tutors).

Law 41/2002 establishes special characteristics for this doctor-pediatric patient relationship and specifies the legal limits relative to the relationship among the health worker, the child and his or her family or tutors. However the debate nowadays goes beyond this. The new concept of the "mature minor" comes into play. In this concept, the limit for establishing the age of majority regarding decisions concerning his or her own self becomes blurrier. Thus, the decisions to be made over the health of the child are standardized: when the physician considers the patient "mature" enough, the child himself will be allowed to make decisions, or at least suggest what he considers better for himself/herself.

Herpes zoster or shingles is caused by reactivation of varicella-zoster virus long time after the primary infection, varicella. It is unusual in pediatrics. Contrary to the way it can affect adults zoster manifestation is mild if it appears in children. Diagnosis is based on distinctive clinical appearance and laboratory tests are not usually required. Symptomatic treatment of skin lesions should be the best choice to take while systemic oral or intravenous acyclovir should be restricted only to special cases. Regarding other antiviral drugs of proved efficacy in adults, no evidence is gathered for their use in children. To sum up, our main aim is to review and update this subject stressing diagnosis and treatment.

The community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is a bacterium that is frequently involved in severe infections and various locations. In this article we describe the actual state of CA-MRSA infections in pediatrics, and we illustrate it with two examples of virulent infection in healthy pediatric patients. The first case is in a patient with septic arthritis and necrotizing pneumonia caused by CA-MRSA, and the second one is in an unweaned baby with pleuropneumonia caused by CA-MRSA. Both cases are a clear example of the importance of this emerging infection in pediatrics.

Foundation and objective: The constant increase of the welfare demand in the departments of general hospitalization and more concretely in the pediatric department justifies the interest to know its real situation in relation to the needs of pediat­ric attention by part of the population. The objective of this study is to determine the adequacy of the stays and admissions of the infantile hospital La Fe (Valencia).

Materials and methods: Transverse descriptive study with analytical components. The unit of analysis was a day of hospitalization (05/13/2007) before the reports of discharge of the general emergency unit of the infantile hospital La Fe during the third week of October 2007, to those to whom the pediatric version of the protocol of adequacy of admissions and stays (Pediatric Appropriateness Evaluation Protocol) PAEP was applied.

Results: The inadequacy of admissions was of 10.5%. The percentage of inadequacy of stays was of 18.4 %. The more frequent reason of inadequacy of admissions was "the diagnostic and therapeutic needs can be conducted as external patient". The most frequent reason of inadequacy of stays was "problems of programming test or surgical procedures".

Discussion: We confirm the hypothesis of the existence of unnecessary hospitalization in pediatrics. The percentage of inadequate admissions and stays was similar to that of other studies. The procotol PAEP turned out to be an easy to use instrument. The knowledge of the risk factors for inadequate admissions and stays will allow us to introduce correcting measures to optimize the use of the hospital pediatric resources in environment.

The last few years have experienced an important growth of genomics and its different applications in biomedi­cine. In part, this has been possible due to the sudden develop­ment of the new genotyping technology and ultra-sequencing. The study of the genetic basis of the complex disease has been the main beneficiary of such technological development. There are a good number of pediatric diseases that can be approach­ed following the same strategies employed in the genomic study of the multi-factorial disease. Thus, the present article aims to review the different applications of genomics to Pediatrics as well as to discuss the different strategies available and the preventions needed to avoid false positive associations.

A cohort study was done with the objective of investigating the hospitalization risk and some related indicators in children with cleft lip and palate (CLP), compared with previously healthy pediatric population. We followed (since 1986) 98 infants with CLP (patients) and 196 previously healthy children (controls) who were first admitted at the "Hermanos Cordové" Pediatric Teaching Hospital in Manzanillo, Cuba, all of them of two years or less, they were included consecutively from their first hospital admission. The data collection finished when they were 14 years old. The relative risk of readmissions, causes of readmissions and average stay at the hospital were estimated in each group. Children with CLP had high risk of readmissions compared with previously health pediatric population. The risk was greater in the first (0-4) years of life, stage of malnutrition (RR= 7.3), acute respiratory diseases (RR= 3.44) and acute digestive diseases (RR= 3.3) were the principal causes of readmissions. The stay average in patients was more than twice the controls average. The study has a special reference in the pediatric importance in the total attention of these patients.

The choice of the correct nutritional formula is the most important phase when establishing enteral nutrition. Given that children´s energy and protein requirements are not the same as those in adults, there are different formulations adapted to the pediatric stage and within this, to different age groups. Furthermore, in recent years new types of formulas have been commercialized, as special foods or polymeric formulas for infants. This variety of formulas has allowed us to individualize nutritional support in pediatric patients. The aim of this article is to review, classify and establish the indications for the different formulas available at this time in the Spanish market.

Introduction: Bronchiolitis is a disease of the respiratory tract that takes place during the first years of life.
Methods: In February 2008- December 2009 the bronchiolitis pediatric population from 0 to 3 years of age was studied. 1,012 nasal aspirates were processed for the rapid antigen detection of RSV and 753 for the technology of amplification of nucleic acids of hMPV.
Results: In 1,012 samples the rapid antigen detection of RSV was carried out showing 195 (19.27%) positives, corresponding to 185 patients. In 763 samples the detection of hMPV was carried out, showing 60 (7.86%) positives and they corresponded to 50 patients. The major percentage of the cases were given in patients.
Conclusion: In our environment, the hMPV show a minor incidence than the RSV and the epidemiological distribution of the RSV precedes, and with more sudden sharp point, than to the hMPV.