SUMMARY Clinical gout and renal failure was seen in a 9-year-old girl. The family tree showed that 9 out of 11 young females in three generations suffered from hyperuricaemia and normal (n = 1), or impaired (n =8), renal function. One set of twins occurred in each generation and there is only one living male subject. In members with renal failure there was no improvement in renal function after treatment of hyperuricaemia, and in 2 sisters oral contraceptives appeared to precipitate hypertension. This clinical picture may be more common than is generally realised because of failure to compare blood uric acid values with suitable age-and sex-matched controls. The evidence from this family suggests that hyperuricaemia preceded the development of renal failure.Classical gout occurs most commonly in middle-aged men,1 and is extremely rare in premenopausal women or children. In children a specific metabolic abnormality resulting in gross uric acid over-productionsuch as the Lesch-Nyhan syndrome-can often be identified.2 Although at one time renal failure was common in gouty patients3 Berger and Yu4 could find no case in which death might be attributed to renal failure in 524 men with gout. Conversely, in renal failure from other causes, hyperuricaemia occurring as part of the general retention of nitrogenous waste is invariably mild even if there is severe reduction in glomerular filtration rate. Gout is rare as a primary cause of renal failure and accounts for only 08 8% in 69 400 European patients treated by dialysis (A J Wing, 1979, personal communication).

Prevalence of ETEC virulence factors would help in tracking ETEC globally and suggests the need of a multivalent ETEC vaccine.

Proper understandings of local factors related with poor asthma control are fundamental to care givers in order to develop health strategies. Recent literature says that anxiety and depression are common among patients with poor control asthma. It is imperative to acknowledge that cultural differences from country to country may impact in this association. METHODS: It is an Observational, descriptive, anonymous crosssectional survey study, conducted in the outpatient Respirology department of private hospitals in Ecuador. Patients with physician based diagnosis of asthma that agree to participate, filled the Spanish versions of the Hospital Anxiety and Depression Scale (HADS) and Asthma Control Test (ACT) questionnaires, previous or during his Respirology consult. Descriptive statistic was use to asses' demographical data, and chi-square test was use to asses any association between emotional disorders and asthma control. RESULTS: 73 patients finished both HADS and ACT questionnaire; mean age of patients with asthma was 55 years. 75.3% of the patients were female. Almost 70% of the patients had a high school degree or an elementary one. 13.7% of the patients smoked cigarettes', with a mean of cigarettes smoked per day of 15. Regarding to asthma control, 65.8% had a poor control. We found only a 2.7% of patients with anxiety and a 1.4% with depression. After doing the chi-square analysis we didn't find any association among these variables in our population. CONCLUSIONS: There are a high percentage of patients with poor asthma control but depression and anxiety does not seem to be associated with this phenomenon in our country.

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The effects of opioid use on respiratory conditions are mixed-while licit opiates help with cough and the dyspnea of heart disease and chronic obstructive pulmonary disease, illicit opiates may exacerbate asthma. We hypothesized that there would be an increased prevalence of asthma in patients with chronic opioid dependence. METHODS: A cross sectional data analysis was performed using secondary data (ICD 9 and ICD 10) of adults (N51966) treated at Kings County Hospital Center (inpatient, Emergency Department, Ambulatory Surgery) with opioid dependence between 2013 to 2017. Of the 1,966 patients with opioid dependence, 338 patients also had a diagnosis of asthma. The prevalence of asthma was calculated and stratified by gender. Ages ranged from 18 to 79 years old. RESULTS: The overall prevalence of asthma in opioid dependent patients receiving acute care from the services noted from 2013 to 2017 was 17.2% compared to the national prevalence of adults with asthma in 2016 of 8.3% (CDC, 2016). The gender stratified prevalence of asthma in opioid dependent patients was 25% for females and 13.9% for males. CONCLUSIONS: The prevalence of asthma in opioid dependent patients (17.2%) is higher than the national prevalence of asthma (8.3%)(CDC, 2016). Women have a higher prevalence of asthma nationally, 9.7% compared to 6.9% of men, however women with opioid dependence had asthma at 25%. This suggests that women may also be disproportionately affected with asthma in the setting of opioid dependence.