Gamification and neurological motor rehabilitation in children and adolescents: a systematic review.

INTRODUCTION: Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment. METHODS: We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale. RESULTS: From a total of 469 studies, 11 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6 studies), followed by developmental coordination disorder (3), neurological gait disorders (1), and neurological impairment of balance and coordination (1). CONCLUSION: The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage.

Translation, cross-cultural adaptation and validation of the Rett syndrome motor evaluation scale (RESMES): Spanish version.

OBJECTIVE: To develop a Spanish version of the Rett Syndrome Motor Evaluation Scale (RESMES) for the locomotor function of Rett Syndrome (RTT) using a transcultural methodology. METHODS: The RESMES was cross-culturally adaptated and validated in the Spanish language (RESMES-sp). This study was divided into two well-differentiated phases: 1) a cross-cultural translation and adaptation; 2) psychometric characteristics analysis of the RESMES-sp (reliability, test-retest, construct validity, criteria validity, error measurements). For criteria validity, PAINAD questionnaire, the scoliosis values and PedsQL™, were used. RESULTS: A total of 63 girls and women diagnosed with RTT participated in this validation study. The total value of the RESMES-sp correlates significantly with all its dimensions, with the correlation value oscillating between 0.645 and 0.939. The correlation value with PAINAD ranges between 0.439 and 0.805; the scoliosis values ranges between 0.245 and 0.564; with PedsQOL™ questionnaire, the correlation values range between 0.273 and 0.663 for the PedsQL™ dimensions, and between 0.447 and 0.648 for the total value of PedsQOL™ questionnaire. The reliability values of Crombach's alpha ranged between 0.897 and 0.998 for the intra-observer analyses and between 0.904 and 0.998 for the inter-observer reliability. The SEM showed a value of 2,829, while the MDC90 showed a value of 6601. The Exploratory Factor Analysis showed 6 factors and values of variance of 86.163%. CONCLUSIONS: The Spanish version of the RESMES is a reliable and valid tool for the functional assessment and follow-up of patients with RTT.

Cerebral amyloid angiopathy-related inflammation: clinical features and treatment response in a case series.

INTRODUCTION: Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to ß-amyloid deposition in the walls of cerebral microvessels. METHODS: We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS: The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS: Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.

Limbic encephalitis secondary to neuro-Behcet disease: an uncommon presentation. / Encefalitis límbica secundaria a neuro-Behçet: una presentación insólita.

INTRODUCTION: Limbic encephalitis (LE) can have a wide range of etiologies, most frequently infectious (especially viral) or autoimmune. Behcet's disease (BD) can present with heterogeneous neurological manifestations. However, LE is not considered a typical presentation of neuro-Behcet's disease (NBD). CASE REPORT: A 40-years-old male presented with new-onset subacute headaches, memory problems and apathy. A review of systems revealed an unrecorded past history of recurrent oral sores for years, recent malaise and fever, as well as an episode of bilateral panuveitis four months before presentation. His general and neurologic examination revealed slight fever, an isolated oral aphtha, anterograde amnesia and signs of bilateral retinal vasculitis. Brain magnetic resonance imaging displayed a pattern of limbic meningoencephalitis, and his cerebrospinal fluid showed mononuclear inflammation. The patient met BD diagnostic criteria. Considering LE is a very rare presentation of NBD, alternative etiologies were thoroughly assessed and excluded, including infectious, autoimmune and paraneoplastic encephalitis. Therefore, he was diagnosed with NBD, and he recovered well after immunosuppression. DISCUSSION: Only two cases of NBD presenting with LE have been previously reported. We report a third case of this rare presentation and compare it with the previous two. We aim to highlight this association and contribute to enlarge the rich clinical spectrum of NBD.

TITLE: Encefalitis límbica secundaria a neuro-Behçet: una presentación insólita.Introducción. La encefalitis límbica (EL) puede tener un amplio abanico de etiologías, más frecuentemente la infecciosa (sobre todo viral) o autoinmune. La enfermedad de Behçet (EB) puede presentarse con manifestaciones neurológicas heterogéneas. Sin embargo, la EL no se considera una presentación típica del neuro-Behçet (NB). Caso clínico. Varón de 40 años que consultó por cefalea de novo subaguda, problemas de memoria y apatía. La anamnesis por sistemas reveló una historia no conocida previamente de aftas orales recurrentes durante años, fiebre y afectación general reciente, así como un episodio de panuveítis bilateral cuatro meses antes de la presentación. Su exploración general y neurológica reveló febrícula, una afta oral aislada, amnesia anterógrada y signos de vasculitis retiniana bilateral. La resonancia magnética mostró un patrón de afectación de meningoencefalitis límbica y su líquido cefalorraquídeo presentaba inflamación mononuclear. El paciente cumplía los criterios diagnósticos de la EB. Considerando que la EL es una presentación muy rara del NB, se buscaron exhaustivamente y se excluyeron otras etiologías alternativas, incluyendo las encefalitis infecciosas, autoinmunes y paraneoplásicas. En consecuencia, el paciente se diagnosticó de NB y mostró una buena recuperación con tratamiento inmunosupresor. Discusión. Sólo dos casos de NB con presentación en forma de EL se han publicado previamente. Comunicamos el tercer caso de esta rara manifestación clínica de la EB y lo comparamos con los dos anteriores, con el objetivo de destacar dicha asociación y contribuir a expandir el rico espectro clínico del NB.

[Impact of the "daily huddle" on the safety of pediatric hospitalized patients]. / Impacto de los «daily huddle¼ en la seguridad del paciente pediátrico hospitalizado.

INTRODUCTION: In 2017, the Joint Commission proposed daily meetings called "huddle" as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved. MATERIAL AND METHODS: Prospective, longitudinal and analytical design (June 2020-February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated. RESULTS: Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n=103). Drug prescription or administration errors stood out (n=103), especially those related to high-risk medication: acetaminophen (n=14) (×10 doses of acetaminophen; n=6), insulin (n=6), potassium (n=5) and morphic (n=5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7-9.5)/10 was obtained. CONCLUSIONS: Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.

Resultados clínicos en la reparación artroscópica de manguito rotador con la técnica de Mason-Allen modificada / Clinical results in arthroscopic rotator cuff repair with the modified Mason-Allen technique

Resumen: Introducción: la lesión del manguito de los rotadores es una de las lesiones más comunes del hombro. El tratamiento por elección es la reparación artroscópica con uso de anclas. La técnica Mason-Allen modificada, que integra los beneficios de las suturas puente y colchonero, ha demostrado resultados satisfactorios. El propósito de este estudio es reportar y analizar los resultados clínicos del uso de dicha sutura en rupturas del manguito de los rotadores. Resultados: flexión activa media 126o inicial, 169o a tres meses, 175o a 12 meses (p < 0.0001), abducción activa 98o, tres meses 159o y 167o a 12 meses (p < 0.0001), rotación interna valor prequirúrgico 4.4 ± 3, a los tres meses 7.1 ± 1.7 (p < 0.05) y 12 meses 7.6 ± 1.1 (p < 0.001). Constant Score 45.76 ± 16.35 con un valor de p < 0.0001, a tres meses 87.27 ± 10.94 y 12 meses 91.30 ± 6.00. SSV 41.30 ± 20.89, tres meses 81.43 ± 18.31 y 12 meses 94.37 ± 6.90 (p = 0.0001). EVA media inicial 6.6 ± 1.6 y 12 meses 0.63 ± 1.02 (p < 0.0001). Conclusión: en rupturas del manguito de los rotadores, el uso de hilera simple con técnica Mason-Allen modificada es una opción recomendada y replicable con resultados satisfactorios y mejoría clínica estadísticamente significativa a los tres y 12 meses postquirúrgicos.

Abstract: Introduction: rotator cuff tears are one of the most common shoulder injuries. The treatment of choice is arthroscopic repair with the use of anchors. The modified Mason-Allen technique, which combines the benefits of suture bridge and mattress sutures, has shown satisfactory results. This study aims to report and analyze the clinical results using these suture techniques in rotator cuff tears. Results: preoperative mean active flexion 126o, 169o at three months, 175o at 12 months (p < 0.0001), active abduction 98o, 159o at three months and 167o at 12 months (p < 0.0001), internal rotation preoperative value 4.4 ± 3, at three months 7.1 ± 1.7 (p < 0.05) and 12 months 7.6 ± 1.1 (p < 0.001). Constant score 45.76 ± 16.35 (p < 0.0001) at three months 87.27 ± 10.94 and 12 months 91.30 ± 6.00. SSV 41.30 ± 20.89, three months 81.43 ± 18.31 and 12 months 94.37 ± 6.90 (p = 0.0001). Initial mean VAS 6.6 ± 1.6 and 12 months 0.63 ± 1.02 (p < 0.0001). Conclusion: in rotator cuff tears, using a single row with the modified Mason-Allen technique is a recommended and replicable option with satisfactory results and statistically significant clinical improvement at three and 12 months post-surgery.

Fatal intracerebral haemorrhage associated with thrombosis with thrombocytopenia syndrome after ChAdOx1-S vaccine. / Hemorragia intracerebral fatal asociada al síndrome de trombosis con trombocitopenia tras la vacuna ChAdOx1-S.

INTRODUCTION: The COVID-19 pandemic has had a devastating impact on health, society and economics worldwide. Therefore, vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recently emerged as an important measure to fight the pandemic. ChAdOx1-S (Oxford-AstraZeneca) is an adenovirus-vectored vaccine that expresses the SARS-CoV-2 spike protein. It shows an acceptable safety profile. Nevertheless, several cases of unusual thrombosis and thrombocytopenia have been reported after initial vaccination with ChAdOx1-S mimicking autoimmune heparin-induced thrombocytopenia. This condition has been called thrombosis with thrombocytopenia syndrome (TTS) and complications such as intracerebral haemorrhage have been described. CASE REPORT: We present a case of intracerebral haemorrhage after ChAdOx1-S vaccination. Middle-aged patient with no prior medical history was seen in the emergency room 16 days after the first dose of ChAdOx1-S vaccine with sudden onset left hemiplegia and severe holocranial oppressive headache. She did not receive heparin treatment in the previous 100 days. Blood test showed moderate thrombocytopenia and a right frontal lobar haemorrhage was seen on computed tomography scan, computed tomography venography was negative for thrombosis. The presence of antibodies against platelet factor 4 was confirmed. The patient's neurological condition progressively worsened. She developed a treatment resistant intracranial hypertension syndrome and she died three weeks later. CONCLUSIONS: TTS is a rare adverse effect of ChAdOx1-S vaccine, defined by the presence of thrombosis in uncommon locations. In our case we report an spontaneous intracerebral haemorrhage probable due to the thrombocytopenia related to probable TTS. It represents a rare clinical presentation of TTS.

TITLE: Hemorragia intracerebral fatal asociada al síndrome de trombosis con trombocitopenia tras la vacuna ChAdOx1-S.Introducción. La pandemia por COVID-19 ha tenido un impacto devastador en la salud, la sociedad y la economía en el mundo. Por ello, las vacunas contra el coronavirus del síndrome respiratorio agudo grave 2 (SARS-CoV-2) han surgido como medida importante para combatir la pandemia. ChAdOx1-S (Oxford-AstraZeneca) es una vacuna vectorizada por adenovirus que expresa la proteína de espiga del SARS-CoV-2. Se han notificado varios casos de trombosis y trombocitopenia inusuales tras la ChAdOx1-S que imitan la trombocitopenia autoinmune inducida por heparina. Esta situación se denomina síndrome de trombosis con trombocitopenia (STT), y se han descrito casos de hemorragia intracerebral secundaria. Caso clínico. Presentamos un caso de hemorragia intracerebral tras la vacunación con ChAdOx1-S. Una paciente de mediana edad sin antecedentes médicos de interés fue atendida en urgencias 16 días después de la primera dosis de ChAdOx1-S con una hemiplejía izquierda de inicio repentino y una cefalea opresiva holocraneal grave. No recibió heparina los 100 días anteriores. El análisis de sangre mostró trombocitopenia moderada y en la tomografía computarizada se observó una hemorragia lobar frontal derecha sin trombosis en la venografía por tomografía computarizada. Se confirmó la presencia de anticuerpos contra el factor 4 de las plaquetas en la sangre. La paciente presentó un síndrome de hipertensión intracraneal resistente al tratamiento y falleció tres semanas después. Conclusiones. El STT es un efecto adverso infrecuente de la vacuna ChAdOx1-S que se define por la presencia de trombosis en localizaciones infrecuentes. En nuestro caso, describimos una hemorragia intracerebral espontánea secundaria a la trombocitopenia desencadenada por el STT. Representa una presentación clínica poco frecuente del STT.

Social environment as a modulator of immunosenescence.

Immune system aging, a process known as immunosenescence, involves a striking rearrangement affecting all immune cells, resulting in an increased rate of infections and a major incidence of autoimmune diseases and cancer. Nonetheless, differences in how individuals of the same chronological age carry out this immunosenescence establishment and thus the aging rate have been reported. In the context of neuroimmunoendocrine communication and its role in the response to stress situations, growing evidence suggests that social environments profoundly influence all physiological responses, especially those linked to immunity. Accordingly, negative contexts (loneliness in humans/social isolation in rodents) were associated with immune impairments and decreased lifespan. However, positive social environments have been correlated with adequate immunity and increased lifespan. Therefore, the social context in which an individual lives is proposed as a decisive modulator of the immunosenescence process and, consequently, of the rate of aging. In this review, the most important findings regarding how different social environments (negative and positive) modulate immunosenescence and therefore the aging rate, as well as the role of stress responses, hormesis, and resilience in these environments will be explained. Finally, several possible molecular mechanisms underlying the effects of negative and positive environments on immunosenescence will be suggested.

Outcome measurement instruments in Rett syndrome: A systematic review.

OBJECTIVE: The aim of the study was to identify and characterize outcome measures for objective and subjective assessment in persons with Rett syndrome (RS). METHODS: A systematic review was conducted consulting the EBSCO, Cochrane, Web of Science, Scielo, MEDLINE and PsycINFO databases for published studies describing the use of patient-reported outcome measures (PROMs) and other outcome measures in persons with RS. Validation studies and observational studies were included. The PROMs were first described, and then the measurement properties were evaluated using predefined criteria according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN). The outcome measures were then grouped according to the International Classification of Functioning, Disability and Health (ICF) to establish a relationship between outcome measures and ICF domains. RESULTS: Twenty out of 2327 articles were appraised, and seventeen different outcome measures were identified and described. Ten outcome measures corresponded to evaluation questionnaires, while the remaining seven assessed functional outcomes: walking distance, physical activity level and ability to interact visually. A relation between these outcome measures that assess RS and the ICF allows understanding that most of the instruments (fifteen) include the assessment of activity limitations. CONCLUSIONS: The findings of this study seem to be promising for their use by clinicians and researchers, although they have methodological limitations. The accuracy and quality of these individual outcome measures should continue to be assessed in an attempt to gather a consensus on the best tools used in RS.

Subconjunctival human dirofilariasis by Dirofilaria repens in the Mediterranean Basin.

Purpose: Human dirofilariasis cases have increased in Europe for the last few decades. We document an autochthonous case of dirofilariasis infection in the subconjunctival space of a 60-year-old Spanish man. Observations: The patient presented with pain in his right eye, which was diagnosed as epi-scleritis. In spite of the treatment administered, no improvement was reported. An external exam showed conjunctival congestion on the temporal part of the right eye bulbar conjunctiva. The anterior chamber showed no flare or cells in both eyes and dilated fundus exam was normal. Nevertheless, a long whitish vermiform mobile mass was detected under the conjunctiva in the temporal part of the right eye. The worm was surgically removed and diagnosed morphologically and also molecularly as Dirofilaria repens. This species uses dogs and wild canids as definitive hosts and principal reservoirs, while mosquito species are transmitters. Humans act as accidental hosts, and clinical manifestations depend on the location of the worm in the organs and tissues. Conclusions and importance: The correct diagnosis and control of subcutaneous/ocular dirofilariasis by D. repens require several professionals under the One Health approach to deal with this zoonotic disease, which poses a serious public health problem, at least in the Mediterranean Basin.

[Clinical results in arthroscopic rotator cuff repair with the modified Mason-Allen technique]. / Resultados clínicos en la reparación artroscópica de manguito rotador con la técnica de Mason-Allen modificada.

INTRODUCTION: rotator cuff tears are one of the most common shoulder injuries. The treatment of choice is arthroscopic repair with the use of anchors. The modified Mason-Allen technique, which combines the benefits of suture bridge and mattress sutures, has shown satisfactory results. This study aims to report and analyze the clinical results using these suture techniques in rotator cuff tears. RESULTS: preoperative mean active flexion 126o, 169o at three months, 175o at 12 months (p < 0.0001), active abduction 98o, 159o at three months and 167o at 12 months (p < 0.0001), internal rotation preoperative value 4.4 ± 3, at three months 7.1 ± 1.7 (p < 0.05) and 12 months 7.6 ± 1.1 (p < 0.001). Constant score 45.76 ± 16.35 (p < 0.0001) at three months 87.27 ± 10.94 and 12 months 91.30 ± 6.00. SSV 41.30 ± 20.89, three months 81.43 ± 18.31 and 12 months 94.37 ± 6.90 (p = 0.0001). Initial mean VAS 6.6 ± 1.6 and 12 months 0.63 ± 1.02 (p < 0.0001). CONCLUSION: in rotator cuff tears, using a single row with the modified Mason-Allen technique is a recommended and replicable option with satisfactory results and statistically significant clinical improvement at three and 12 months post-surgery.

INTRODUCCIÓN: la lesión del manguito de los rotadores es una de las lesiones más comunes del hombro. El tratamiento por elección es la reparación artroscópica con uso de anclas. La técnica Mason-Allen modificada, que integra los beneficios de las suturas puente y colchonero, ha demostrado resultados satisfactorios. El propósito de este estudio es reportar y analizar los resultados clínicos del uso de dicha sutura en rupturas del manguito de los rotadores. RESULTADOS: flexión activa media 126o inicial, 169o a tres meses, 175o a 12 meses (p < 0.0001), abducción activa 98o, tres meses 159o y 167o a 12 meses (p < 0.0001), rotación interna valor prequirúrgico 4.4 ± 3, a los tres meses 7.1 ± 1.7 (p < 0.05) y 12 meses 7.6 ± 1.1 (p < 0.001). Constant Score 45.76 ± 16.35 con un valor de p < 0.0001, a tres meses 87.27 ± 10.94 y 12 meses 91.30 ± 6.00. SSV 41.30 ± 20.89, tres meses 81.43 ± 18.31 y 12 meses 94.37 ± 6.90 (p = 0.0001). EVA media inicial 6.6 ± 1.6 y 12 meses 0.63 ± 1.02 (p < 0.0001). CONCLUSIÓN: en rupturas del manguito de los rotadores, el uso de hilera simple con técnica Mason-Allen modificada es una opción recomendada y replicable con resultados satisfactorios y mejoría clínica estadísticamente significativa a los tres y 12 meses postquirúrgicos.

Validation of the inverse method for the determination of the access flow with thermodilution. / Validación del método inverso para la determinación del flujo de acceso con termodilución.

INTRODUCTION: Thermodilution is a widely used method for measuring vascular access flow (QA). Among the possibilities of thermodilution, the reverse method (RM) can be beneficial in the execution time, without impact on the dialysis efficacy (Kt). However, it is not a sufficiently studied technique. METHOD: Transversal study of 117 arteriovenous fistulas. Two QA measurements were taken with the method described by the manufacturer (MR) and another with RM. RM is based on the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen's Kappa index were used. RESULTS: Very good concordance between MR and RM was evidenced for QA below 700ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (-17.13). This value did not differ from the median variability generated between MR and RM (inter-method variability), which was 2% (-14,12) (P=.287). The degree of agreement between the 2 to identify arteriovenous fistulas susceptible to intervention was very good (Kappa=0.834). The time spent using the RM was significantly shorter (P=.000) without evidence of variations in the Kt of the measurement sessions (P=.201). CONCLUSIONS: The thermodilution RM is valid to determine the flow of the vascular access, especially in QA lower than 700ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and RM is similar to that of MR. The concordance between methods in identifying potentially pathological arteriovenous fistulas is very good.

Gamification and neurological motor rehabilitation in children and adolescents: A systematic review. / Ludificación y neurorrehabilitación motora en niños y adolescentes: revisión sistemática.

INTRODUCTION: Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment. METHODS: We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale. RESULTS: From a total of 469 studies, 10 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6studies), followed by developmental coordination disorder (3), and neurological impairment of balance and coordination (1). CONCLUSION: The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage.

Cerebral amyloid angiopathy-related inflammation: clinical features and treatment response in a case series. / Inflamación relacionada con angiopatía amiloide: características clínicas y respuesta al tratamiento en una serie de casos.

INTRODUCTION: Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to ß-amyloid deposition in the walls of cerebral microvessels. METHODS: We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS: The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS: Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.

[Influence of nutritional status on clinical outcomes in hospitalised children]. / Influencia del estado nutricional en la evolución clínica del niño hospitalizado.

INTRODUCTION: Paediatric malnutrition during hospital admission is a prevalent comorbidity, which it is estimated around 31.4% in our environment, and could influence the clinical outcomes of paediatric patients. OBJECTIVE: The aim of this study was to describe the malnutrition risk in hospitalised children using STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics), and to study its relationship with clinical outcomes. METHODS: A single-centre, analytical and prospective study was conducted on children aged 1 month to 15 years hospitalised in a tertiary hospital between October and December 2017. An analysis was made of the clinical data and anthropometric measurements (weight, height, Waterlow weight classification). Patients were classified according to STAMP, which is a validated screening tool used to classify the risk of paediatric malnutrition during hospital admission. Multivariate statistical analysis was used to identify predictive variables of illness severity. RESULTS: An analysis was made on a total of 200 patients (55% male), with a median age of 15.8 months (IQR 2.5-42.8), and a median length of stay of 3 days (IQR 1-18 days). Almost half (48.3%) of them had high risk of malnutrition at admission (STAMP ≥4), and 48.2% showed medium risk (STAMP 2-3). A higher STAMP score was associated with longer length of hospital stay (P<.01) and greater severity (P<.01). Multivariable analysis showed that STAMP could be a predictor of illness severity (OR 1.48, 95% CI: 1.18-1.86, P<.01). CONCLUSIONS: Nearly 50% of hospitalised children have a high risk of malnutrition at admission according to the STAMP screening tool. Risk of malnutrition at admission measured according to STAMP nutritional screening was associated with a longer length of stay and greater severity of illness. It is important to evaluate the risk of malnutrition as this could be related to illness severity.

Orthotopic Liver Transplantation With Elderly Donors (Over 80 Years of Age): A Prospective Evaluation.

BACKGROUND: Our main objective was to assess the clinical outcomes obtained in a single orthotopic liver transplant (OLT) hospital with donors ≥80 years of age compared to a control group of patients subjected to OLT during the same period of time with donors who were under 65 years of age. METHODS: A prospective analysis was carried out on all the OLTs performed using liver grafts from donors in a state of brain death and with an age of ≥80 years (study group) between April 2007 and January 2015. The results of the study group (n = 36) were compared with those of a control group of patients less than 65 years of age receiving transplants with grafts. RESULTS: A total of 51 potential donors ≥80 years were assessed, with a total of 36 liver transplants being carried out and their results were compared with a control group of 283 patients receiving transplants. The median follow-up time of the patients in the series was 36 months (range: 24-120 months). Graft survival at 1, 2, and 3 years was 77%, 72%, and 62%, respectively, among the patients in the study group and 79%, 73%, and 65% among the patients in the control group, and there were no statistically significant differences. Patient survival at 1, 2, and 3 years was 86%, 82%, and 75%, respectively, among the patients in the study group and 82%, 76%, and 72% among the patients in the control group, also without there being any statistically significant differences. CONCLUSIONS: There is no age limit for liver transplant donors. The use of octogenarian donors makes it possible to increase the pool of donors while providing enough safety for the recipient.

Superimposed visceral leishmanial infection aggravates response to Heligmosomoides polygyrus.

BACKGROUND: Polyparasitism is the rule in all animal species, including humans, and has an important role in pathogenicity, diagnosis and control measures. Among them, co-infections by gastrointestinal helminths and protists are very prevalent under natural conditions but experimental infections are relatively scarce. Thus, despite the frequent association of visceral Leishmania infections and intestinal helminth parasitism the experimental co-infection has not been addressed. Heligmosomoides polygyrus, an intestinal nematode of mice, is related to other helminths causing important pathologies and is a model species for immunological studies. Mice are valuable experimental model for visceral leishmaniasis. METHODS: BALB/c mice infected with H. polygyrus (200 third-stage larvae, L3) were subsequently infected seven days later with Leishmania infantum (107 promastigotes) with the aim of determining the effect of the overinfection on the host response to the primary infection with the helminth. RESULTS: Overinfection with the protist did not affect the establishment rate of the nematode but induced a higher fecal egg output. Helminth burdens in co-infected animals were significant at the end of the experiment. Early unspecific immune suppression induced by the nematode in mesenteric lymph nodes was not switched by L. infantum infection. Co-infection elicited a higher serum antibody (IgG1) response against the helminth. CONCLUSIONS: Visceral leishmanial overinfection aggravated the early host response against primary infections with the intestinal helminth. This effect was evidenced by an increased longevity and higher production of non-protective antibodies.

Liver Transplantation in Patients With Hepatocellular Carcinoma Outside the Milan Criteria After Downstaging: Is It Worth It?

BACKGROUND: The outcome of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) is excellent if it is performed within the Milan criteria (ie, single tumor less than 5 cm or 3 tumors less than 3 cm each one and no macrovascular invasion). However, after a few studies, it has become possible to have a similar survival expanding those criteria. The aim of this study is to evaluate the survival of patients with advanced HCC who, after downstaging, did not met the Milan criteria although they were within the "up to seven" benchmark, and were transplanted at our center in the last 5 years. PATIENTS AND METHODS: This is a retrospective study of patients who underwent OLT for HCC in the last 5 years in our center exceeding Milan criteria despite remaining within the "up to seven" benchmark. An observational study of associated factors with overall survival based on patient characteristics after OLT was performed. For the statistical study, the statistical program SPSS v. 17.0 (Chicago, Illinois, United States) was used. RESULTS: We studied 95 patients who had been transplanted for HCC in this period, 11 of whom met the study requirements. There were 10 (91%) males and 1 female. The mean age of the patients was 54.73 ± 8.75 years, with an average waiting list time of 279 days. Nine patients had a Child A status, with a mean Model for End-stage Liver Disease score of 9.64 (range, 6 to 16). The most frequent etiology of cirrhosis was hepatitis C virus infection in 6 patients (50%) followed by hepatitis B virus infection and ethanolic and cryptogenic cirrhosis. Ten patients (91%) had at least one pretransplantation transarterial chemoembolization. The survival of patients after 1 year was 75%, whereas after 4 years that rate decreases to 25%. At this time, we do not have any patients with a 5-year survival rate. The longest survival rate is 55 months. CONCLUSIONS: Although the expanded indication of transplantation in HCC raises controversies, especially after downstaging, it is possible to provide acceptable survival rates for patients within the expanded criteria of "up to seven" after locoregional therapies. The performance of a liver transplant in the patient profile shown in this article should also be evaluated from the perspective of the relative lack of organs for transplantation.