[Iatrogenic botulism: a complication to be taken into account in the treatment of child spasticity]. / Botulismo yatrógeno: una complicación a tener en cuenta en el tratamiento de la espasticidad en la infancia.

INTRODUCTION: During the last decades the use of botulinum toxin for management of muscular disorders and spasticity associated to cerebral palsy has become a widespread practice. CASE REPORT: A 6-years female suffering of cerebral palsy secondary to a partial agenesis of the corpus callosum who was receiving bolulinum toxin since October 2001. One week after the last dose (Dysport 46 U/kg/dose) she started high grade fever, malaise, food refusal, choking, constipation, eyelid ptosis, absence of deep tendon reflexes, and abundant mucous discharge. Such features were so progressively severe that ventilatory support became mandatory. After a previous dose five months before, she developed similar features but they were less severe and thought to be related to a respiratory infection. CONCLUSIONS: At the present, there are two forms of botulinum toxin commercially available: the British brand Dysport and the American brand Botox. Bio equivalences are 1 U Botox to 2 or 6 U Dysport. Dosing (U/kg per session) has been established as follows: 5 U for Botox, 35 U for Dysport. Safety limits are a wide range with a therapeutic toxic index rate of 1:10. Generalized side effects after diffusion to blood of locally injected botulinum toxin are rare.

[Necrosis of undescended testis caused by incarcerated inguino-scrotal hernia in a newborn]. / Necrosis de testículo no descendido por hernia inguino-escrotal incarcerada en recién nacido.

Presentation of an uncommon case referring necrosis of an ectopic inguino-femoral testis caused by an incarcerated inguino-scrotal hernia in a 15-days old baby with a permeable peritoneum-vaginal process. In this case, the hernial incarceration episode was responsible for the organ necrosis due to an haemorrhagic infarction. Orchiectomy was performed, and the pathoanatomical diagnosis was testicular haemorrhagic infarction. Review of the pathogenic mechanisms of testicular ectopia, associated anomalies and likely acute complications: torsion, hernial strangulation, traumatism and infections simulating acute abdomen which, in spite of their rarity, may have serious consequences with regard to testicular viability.

[Dynamic and plastic expression as a method of accident prevention during infancy (author's transl)]. / La expresión plástica y dinámica como medio de prevención de accidentes en la infancia.

Authors review the importance of fostering suitable methods at infancy, as a prophylaxis of accidents at such stage in life. They propose the use of plastic expression handed-out as a sequence of pictures, ordered in the form of a story or tale, rigorously studied from the psychological point of view and which limelights the most frequent risks. Likewise they value the importance of dynamic methods of expression and summarise their experience with puppet theatres. A prototype show is described and psychological result evaluation analized.

[Health examination of children from the Democratic Sahara Republic (North West Africa) on vacation in Spain]. / Examen de salud de niños de la República Arabe Saharaui Democrática (noroeste de Africa) de vacaciones en España.

OBJECTIVE: We present results of a global health evaluation of groups of children from the Democratic Sahara Republic who came to Spain for vacation. PATIENTS AND METHODS: Clinical and analytical tests of 242 Sahara children from refugee camps in Tindouf (Algeria) that were adopted temporarily by Spanish families between July 1993 and July 1997 are reported. We have used standard groups graphics from the World Health Organization. RESULTS: The results were as follows: sex, 53% girls; mean age, 11.1 +/- 1.6 years and age range, 7-16 years (mode 11). Sixty percent of the children had a weight lower than the 10th percentile and 28% less than the 3rd percentile. Fifty-one percent of the children had a height lower than the 10th percentile and 32% less than the 3rd percentile. The corporal mass was lower than the 10th percentile in 19% and less than the 3rd percentile in 8%. The mean hemoglobin was 12.7 +/- 1.2 gr/dl (17% Hb < 12), iron 66 +/- 32 micrograms/dl (23% Fe < 40), and ferritin 28 +/- 24 ngr/ml (26% Fe < 12). Between 1 and 3 intestinal parasites were found in 75% of the children. Isolated were: Entamoeba coli (38%), Blastocystis hominis (22%), Lamblia (18%), Endolimax nana (17%), Hymenolepis nana (11%), and Oxiuros (5%). Sixteen percent of the children had dental caries and 54% dental malocclusion. Ophthalmological problems were found in 28%, generally myopia. Mantoux > 9 mm was found in 5%. Other pathologies included: 5 kyphoscoliosis, 2 cardiopathies, 2 poliomyelitis sequels, 1 gastric ulcer, 1 epilepsy, 1 spherocytosis and 1 euthyroid goiter. Those with weight in p < 3 and/or functional murmur had Hb < 12 in 61% of the cases and Fe < 40 in 48%. CONCLUSIONS: Anamnesis is difficult because of ignorance of the pathological antecedents and date of birth. For physical exploration and collection of parasites they were extremely modest. Feeding and conditions of life would explain low weight and height percentiles, ferropenic anemia and intestinal parasite rates. It would be better to give anti-parasite drugs and systematic ferroprofilaxis as routine and perform blood tests only in those with weight p < 3.

[Medical responsibilities concerning maternal breast-feeding]. / Los cargos sanitarios ante la lactancia materna.

OBJECTIVE: The objective of this study was to determine the knowledge of high ranking officers in Servei-Valencià-Salut (SVS) about breast-feeding (BF) and national and international regulation related to it, in addition to determining what sanitary policies were undertaken by them to promote BF. PATIENTS AND METHODS: A survey was sent by mail to all high ranking officers (HO) of SVS and all pediatric chief staff services (PC) in our community. To analyze data between both groups a Chi square test and odds ratio in the qualitative variables and variance in the quantitative. RESULTS: Of the surveys sent, 100% were answered by the PC and 44% the HO. Breast-feeding was ranked as superior to artificial feeding by 100% of PC and 73% of HO (p < 0.05). Both groups believed in the necessity of carrying out policies to promote BF in developed countries. Only two PC seemed to know the 1981 OMS's code. All PC carried out policies of BF promotion in their area of influence, while in the HO the percentages varied from 64% to 0% according to their position in the health service organization. CONCLUSIONS: It is necessary to spread the knowledge of and to apply the OMS/UNICEF normatives and to involve al HO with real decision-making power in the development of sanitary policies.

[Patterns of use, popular beliefs and proneness to accidents of a baby walker (go-cart). Bases for a health information campaign]. / Patrones de uso, creencias populares y accidentabilidad por andador infantil (tacatá). Bases para una campaña de información sanitaria.

Baby walkers are a potential cause of accidents in infants from 6 months to 1 year of age. We conducted a study to determine the patterns of walker use, the different points of view of the parents and the baby walker-related injuries in our health district. For this purpose, between November 1, 1992 and January 31, 1993, a questionnaire was given to 207 parents of infants between the ages of 3 and 24 months in order to evaluate the socioeconomic situation and to determine the patterns of walker use. We found that 42% of the infants between 4.3 and 13.4 months of age had a baby walker and 46.7% of them used it daily. There was a significant inverse relationship between the walker usage and the maternal level of education. Of the infants who used walkers, 24.9% had experienced an accident (falls 76.2%, injuries 14.3% and hospital admission 4.8%). The accidents were significantly more common in boys. The advantages reported by parents (for using walkers) were: 46.3% none, 34.2% comfort, 10.9% infant amusement, 12.9% help to walk earlier. Dangers reported by the parents included: 27.2% none, 33.5% leg deformities, 43% accidents (33.5% injuries and 12% falling down stairs). In conclusion, our results show a slightly lower number of walker users and walker related accidents when compared to other reports. Parents have mistaken notions about the use of baby walkers. Hence, the need for continued health education campaigns related to this subject remain.

[Breast feeding: knowledge, attitudes and sociocultural ambiguity]. / Lactancia materna: conocimientos, actitudes y ambigüedad sociocultural.

OBJECTIVES: Found sociocultural attitude with regard to breast-feeding (BF) between the sanitary (SP) and no sanitary personnel (NSP) of health centers. DESIGN: Descriptive, cross-sectional study. SETTING: 4 health centres and 3 hospitals of Valencia. PARTICIPANTS: 442 workers of these centres. INTERVENTION: Structured questionnaire. MAIN RESULTS: 88% of SP and 76% of NSP (p < 0.05) believed that BF has many advantages comparing with artificial-feeding in a developed country. SP said more advantages of BF than NSP (p < 0.0001). Most renowned advantages were immunological, affective relationship and comfort. Main inconveniences were dependence, work reasons, aesthetic nature and insecurity in the ingested amount. 56% of SP and 86% of NSP (p < 0.0001) believed milk's analysis necessary. 56% women and 38% men (p < 0.001) didn't see correct give BF in public. Men were more concerned than women (p < 0.05) for local problems of chest, aesthetic results, milk's quality and transmission of illnesses. CONCLUSIONS: It's necessary to support knowledge and re-evaluating the trust in the nutritious capacity of maternal milk between the personnel of health centers and hospitals. Generic ambiguity toward functions of feminine breast exists and public'BF isn't acceptable. It's necessary recover socioculturally the image of BF and keep in mind the existent ambiguity upon designing campaigns of promotion.