Golpe doble

Formato PDF. 3 p."Hasta los papeles de Valencia hablaban de lo que sucedía en la huerta, donde, al anochecer, se cerraban las barracas y reinaba un pánico egoísta, buscando cada cual su salvación, olvidando al vecino. Y a todo esto, el tío Batiste, el alcalde de aquel distrito de la huerta, echando rayos por la boca cada vez que las autoridades, que le respetaban como potencia electoral, hablábanle del asunto, y asegurando que él y su fiel alguacil, el Sigró, se bastaban para acabar aquella calamidad."Libros Digitales"

El papa del mar

Formato PDF. 123 p."Ella dudó un instante mientras exploraba mentalmente su pasado. Luego se apresuró a decir sonriendo, como si le regocijasen sus propias palabras: —Lo conozco. Usted es el caballero Tannhäuser, que tuvo amores con Venus."Libros Digitales"

La Caperuza

Formato PDF. 4 p."Vivía yo entonces en el piso segundo, y tenía por vecino, en el primero, a don Andrés García, fiscal de profesión, figura arrogante, con muchas canas en la barba, el más buen mozo de cuantos vestían toga con vuelillos en la Audiencia: un hombre, en fin, que realizaba en su aspecto fisico ese ideal de la justicia serena, majestuosa e imponente. Todas las tardes, al bajar la escalera, oía los mismos gritos a través de la puerta: «Pillín! ¡Vida mía..., rey de los pillos! ... ¡Ven aquí, príncipe de Asturias!» "Libros Digitales"

La Condenada

Formato PDF. 4 p."Catorce meses llevaba Rafael en la estrecha celda. Tenía por mundo aquellas cuatro paredes de un triste blanco de hueso, cuyas grietas y desconchaduras se sabía de memoria; su sol era el alto ventanillo, cruzado por hierros; y del suelo de ocho pasos, apenas si era suya la mitad, por culpa de aquella cadena escandalosa y chillona, cuya argolla, incrustándose en el tobillo, había llegado casi a amalgamarse con su carne... "Libros Digitales"

The Polycystic Ovary Syndrome: A Position Statement From The European Society Of Endocrinology

Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.Wo

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56\u20131.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion