Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

New fabrication method for producing reduced graphene oxide flexible electrodes by using a low-power visible laser diode engraving system.

The fabrication of bendable electronic devices is a scientific-technological area of very rapid advance in which new materials and fabrication techniques are being continuously developed. In these kinds of devices, the fabrication of flexible conductive electrodes adherent to the substrate is a key factor. Further, eco-friendliness, low cost and fast production are essential requirements for the successful progress of new technologies. In this work, a novel method for obtaining graphene-based flexible electrodes is presented. Conductive films were obtained by means of the visible laser irradiation of graphene oxide layers deposited on polyethylene terephthalate substrates and self-standing membranes sandwiched between glass slides. Despite the low power of the laser system, the numerical simulations indicate the development of temperatures over 1000 K throughout the irradiated material. The laser-induced spatially confined heating leads to the reduction of the graphene oxide material, whereas the glass-based sandwich assembly avoids reoxidation from the surrounding air. By scanning and pixelated modes, reduced graphene oxide electrodes, up to 100 µm in thickness, and with a resistivity as low as 6 × 10-4 Ωm, were obtained in an easy and versatile way. Proof-of-concept microsupercapacitors and electrochemical sensors were fabricated with this technique, showing promising performance.

Achieving extremely concentrated aqueous dispersions of graphene flakes and catalytically efficient graphene-metal nanoparticle hybrids with flavin mononucleotide as a high-performance stabilizer.

The stable dispersion of graphene flakes in an aqueous medium is highly desirable for the development of materials based on this two-dimensional carbon structure, but current production protocols that make use of a number of surfactants typically suffer from limitations regarding graphene concentration or the amount of surfactant required to colloidally stabilize the sheets. Here, we demonstrate that an innocuous and readily available derivative of vitamin B2, namely the sodium salt of flavin mononucleotide (FMNS), is a highly efficient dispersant in the preparation of aqueous dispersions of defect-free, few-layer graphene flakes. Most notably, graphene concentrations in water as high as ∼50 mg mL(-1) using low amounts of FMNS (FMNS/graphene mass ratios of about 0.04) could be attained, which facilitated the formation of free-standing graphene films displaying high electrical conductivity (∼52000 S m(-1)) without the need of carrying out thermal annealing or other types of post-treatment. The excellent performance of FMNS as a graphene dispersant could be attributed to the combined effect of strong adsorption on the sheets through the isoalloxazine moiety of the molecule and efficient colloidal stabilization provided by its negatively charged phosphate group. The FMNS-stabilized graphene sheets could be decorated with nanoparticles of several noble metals (Ag, Pd, and Pt), and the resulting hybrids exhibited a high catalytic activity in the reduction of nitroarenes and electroreduction of oxygen. Overall, the present results should expedite the processing and implementation of graphene in, e.g., conductive inks, composites, and hybrid materials with practical utility in a wide range of applications.

Fast and sensitive optical toxicity bioassay based on dual wavelength analysis of bacterial ferricyanide reduction kinetics.

Global urban and industrial growth, with the associated environmental contamination, is promoting the development of rapid and inexpensive general toxicity methods. Current microbial methodologies for general toxicity determination rely on either bioluminescent bacteria and specific medium solution (i.e. Microtox(®)) or low sensitivity and diffusion limited protocols (i.e. amperometric microbial respirometry). In this work, fast and sensitive optical toxicity bioassay based on dual wavelength analysis of bacterial ferricyanide reduction kinetics is presented, using Escherichia coli as a bacterial model. Ferricyanide reduction kinetic analysis (variation of ferricyanide absorption with time), much more sensitive than single absorbance measurements, allowed for direct and fast toxicity determination without pre-incubation steps (assay time=10 min) and minimizing biomass interference. Dual wavelength analysis at 405 (ferricyanide and biomass) and 550 nm (biomass), allowed for ferricyanide monitoring without interference of biomass scattering. On the other hand, refractive index (RI) matching with saccharose reduced bacterial light scattering around 50%, expanding the analytical linear range in the determination of absorbent molecules. With this method, different toxicants such as metals and organic compounds were analyzed with good sensitivities. Half maximal effective concentrations (EC50) obtained after 10 min bioassay, 2.9, 1.0, 0.7 and 18.3 mg L(-1) for copper, zinc, acetic acid and 2-phenylethanol respectively, were in agreement with previously reported values for longer bioassays (around 60 min). This method represents a promising alternative for fast and sensitive water toxicity monitoring, opening the possibility of quick in situ analysis.

[Burns in adolescents]. / Quemaduras en adolescentes.

INTRODUCTION: The aim of this study was to know the epidemiology of burns in teenagers. PATIENTS AND METHODS: Burn patients over 11 years old admitted in our Institution in the last 10 years were included. Etiology, burn size, hospital stay, quirurgical interventions and long term sequelae were registered. RESULTS: One thousand and eight patients were admitted, 89 were over 11 years (8.8%), 70.7% were boys and 29.3% girls. Fire was the principal agent in 58 cases (65.1%), due to fireworks in 13 (22.4%), alcohol in 7 (12%), explosion of flammable containers (spray) in 4 (6.8%) and gasoline in 3 (5.2%). Fireworks injuries and spray explosions affected face and hand in 88% cases. The median hospital stay was 8 days after admission (1 to 90). 83.1% required surgical treatment with mean of 1.8 +/- 1.4 interventions and 21.3% had long-term sequelaes that required at least one surgical intervention. CONCLUSION: Fire is the main cause of burns in adolescents. Fireworks injuries represented a quarter of that lesions, and highlights paint spray explosions as new causative agents. Considering the high morbidity in this age group, with permanent functional and aesthetic sequelae, prevention campaigns are needed to reduce such accidents.

[Thrombosis of the cavernous sinus following prone-position spinal surgery in a patient with factor V Leiden]. / Trombosis de seno cavernoso tras una cirugía raquídea en decúbito prono en un paciente portador del factor V de Leiden.

INTRODUCTION: Non-infectious thrombosis of the cavernous sinus has sometimes been reported as a complication following neurosurgical procedures and, in one case, after carrying out the operation in a prone position. Factor V Leiden is a genetic risk factor for presenting an intracranial venous thrombotic disease. We report the case of a patient who suffered thrombosis of the cavernous sinus following prolonged surgery in the prone position and in whom a mutation of factor V Leiden in a heterozygotic state was discovered. CASE REPORT: A 64-year-old male, with arterial hypertension as the only known vascular risk factor, who, after prolonged surgery in a prone position, presented amaurosis in the left eye accompanied some hours later by ocular pain, conjunctival ecchymosis, proptosis and abolition of extrinsic ocular mobility. An angiography scan confirmed the existence of thrombosis in the cavernous sinus. Treatment was established with low-molecular-weight heparin without the occurrence of any other kinds of complications. The patient gradually recovered extrinsic ocular mobility but not visual acuity. A heterozygotic mutation for factor V Leiden was found in a hypercoagulability study that was later performed. CONCLUSIONS: The coexistence of a risk factor for presenting a venous thrombotic disease and a mechanical phenomenon, venous statis, due to the posture adopted for the surgical intervention together account for the complication presented by the patient.

[Severe acquired aplastic anemia: historical outcome of patients treated by allogeneic bone marrow transplantation from matched sibling donors. A study by the Spanish Group for Bone Marrow Transplantation in Children (GETMON)]. / Aplasia medular grave adquirida: evolución histórica de los resultados obtenidos con trasplante de progenitores hematopoyéticos de donante familiar. Estudio del Grupo Español para el Trasplante de Médula Osea en Niños (GETMON).

INTRODUCTION: Allogeneic haematopoietic stem-cell transplantation is the treatment of choice for acquired aplastic anaemia in children. Experience with this approach from Spanish Working Party for Bone Marrow Transplantation in Children in two sequential time periods (1982-1990 and 1991-2004) is reported. PATIENTS AND METHODS: Sixty two consecutive patients with a median age of 10 years were transplanted; 18 in the 1982-1990 period and 44 in the 1991-2004 period. Conditioning regimen consisted mainly of irradiation and cyclophosphamide in the first period (72 % of patients) and cyclophosphamide +/- anti-thymocyte globulin (62 %) in the second. Graft versus host disease prophylaxis consisted of cyclosporine in most patients (57/62). RESULTS: Fifty one patients are alive and disease-free at a median follow-up of 127 months. Five years probability of event-free survival is 82 %. The survival increased from 61 % to 91 % during the two time periods. Eleven patients died from graft failure or rejection (3), acute or chronic graft versus host disease and infection (4) or multi-organ failure (4). Univariate analysis identified two significant prognostic factors: interval diagnostic/transplant and time period of transplant (for both p = 0.03). CONCLUSIONS: This experience corroborates that allogeneic haematopoietic stem-cell transplantation is the best treatment for severe acquired aplastic anaemia, with a current disease-free survival of 90 % of patients.

[Heterogenicity of Gorham-Stout syndrome: association with lymphatic and venous malformations]. / Heterogenicidad del síndrome de Gorham-Stout: asociación a malformaciones linfáticas y venosas.

INTRODUCTION: Gorham-Stout syndrome is a rare disorder of unknown etiology characterized by osteolysis and microscopic proliferation of abnormal vessels. We report two cases of this syndrome associated with lymphatic and venous malformations. CASE REPORTS: The first case is a 5-year-old boy with disseminated lymphangiomatosis of poor prognosis, with significant pleural involvement and osteolytic lesions. The second case is a 5-year-old girl with a diagnosis of Klippel-Trenaunay syndrome with significant skeletal involvement of the lower extremities and secondary pathological fracture. CONCLUSIONS: Gorham-Stout syndrome may occasionally be associated with various lymphatic and venous malformations. Osteolysis and bone resorption may be induced by lymphatic bone involvement.

Persistencia de anti-HBs en ancianos inmunizados con una vacuna ADN recombinante anti-hepatitis B: dos años de seguimiento / Anti-HBs persistent to immune aged with a DNA recombinant anti-hepatitis B vaccine: two years of follow

Se aplicó la vacuna recombinante cubana contra el virus de la hepatitis B Herberbiovac HB a un grupo de individuos mayores de 65 años, pertenecientes a un hogar de ancianos de Ciudad de la Habana, a la dosis de 20 ug, con el esquema 0,1 y 6 meses para estudiar su inmunogenicidad, la cual fue evaluada a los 2, 7, 12 meses y 2 años después de aplicada la primera dosis. A los 60 días se obtuvo un 47,1 por ciento de títulos protectores (>10 UI/L) y media geométrica (TMG) de 6,04 UI/L. Cuando se evaluó la respuesta inmune a los 7 meses se logró un 100,0 por ciento de seroprotección (>10 UI/L); 78,6 por ciento de buenos respondedores (títulos antiHBs >100 UI/L) y media geométrica de 136,93 UI/L. Al año, la seroprotección también fue del 100 por ciento, y se logró 61,5 por ciento de títulos >100 UI/L y la media geométrica de 204,61 UI/L. La persistencia de niveles de anticuerpos protectores y TMG 2 años después de aplicada la primera dosis de la vacuna fue de 71,4 por ciento y 24,73 UI/L, respectivamente. Estos resultados evidencian el alto poder inmunogénico de esta vacuna, lo que la hace recomendable para la protección de este grupo de edad contra el virus de la hepatitis B

Liver transplantation in patients with homozygotic familial hypercholesterolemia previously treated by end-to-side portocaval shunt and ileal bypass.

Familial hypercholesterolemia is the result of mutations in the gene that encodes the synthesis of the cellular receptor for low density lipoprotein (LDL). In the homozygous form of the disease (HFHC), cellular LDL receptors either do not form, or, when present, cannot bond LDL and mediate its cellular uptake LDL, and the cholesterol that it transports accumulate in plasma, producing severe premature atherosclerosis and death from coronary artery disease usually before the age of 20. Currently, the only effective treatment is liver transplantation, which, alone or in association with medications, normalizes plasma cholesterol levels. The authors report the cases of 2 siblings with HFHC who underwent portocaval shunt at the ages of 2.5 and 1.5 years, respectively. Portocaval shunt produced an immediate, but insufficient decrease in cholesterol (by 40% and 35%, respectively), leaving them with cholesterol concentrations of about 500 mg/dL. One year later they each underwent ileal bypass without obtaining any significant response. Liver transplantation at the ages of 18 and 16 years, respectively, reduced plasma cholesterol concentrations to 129 and 225 mg/dL, respectively. The earlier operations seriously increased the technical difficulty of liver transplantation and did not produce a favorable effect on the natural course of the disease, so portocaval shunt and ileal bypass are not indicated in HFHC, not even for the purpose of delaying liver transplantation.

Portable data acquisition system for EKG measurements in marine environments.

In the present paper, an electronic prototype designed to acquire electrocardiographic signals from marine mammals has been developed. The system consists of a portable device that allows the on-line acquisition of EKG signals through a parallel port interface that is connected to a laptop computer. The EKG waveform, the voltage level, the bandwidth and the most relevant information from this type of signals is stored and analysed under real-time conditions by means of specifically implemented software. The whole system has been successfully tested to obtain the EKG from captive dolphins. The characteristics of the equipment presented here, with its low cost, size and energy requirements accomplish a portable system suitable for the acquisition of this type of signals in conductive media such as the seawater.

[Evaluation of the effectiveness of a new vaccine against human leptospirosis in groups at risk]. / Evaluación de la efectividad de una nueva vacuna contra la leptospirosis humana en grupos en riesgo.

In order to evaluate the effectiveness of a new vaccine against human leptospirosis, a prospective cohort study was done with persons in the Cuban province of Holguín who were at risk of becoming ill with leptospirosis. The study included 118,018 persons from 15 to 65 years old who were considered to face either permanent or temporary risk. The vaccinated cohort consisted of 101,137 persons. They received two vaccine doses, 6 weeks apart, of 0.50 mL via deep intramuscular injection into the deltoid muscle of the nondominant arm. The unvaccinated cohort consisted of 16,881 persons. Epidemiological surveillance began 21 days after the application of the second vaccine dose and continued for 1 year. The same criteria for suspected and confirmed cases were maintained throughout the study period. At the end of the surveillance period effectiveness was calculated as being higher than 97%. It is estimated that the vaccination program prevented eight out of ten cases that would have otherwise occurred. Vaccine reactogenicity was also measured in a subsample of 1,500 persons between 15 and 65 years old. The observed symptomatology was low. Slight pain at the injection site was the most frequent symptom (25%). The results of the study indicate the usefulness of the vaccine for disease prevention among people at risk, and its use is thus recommended.

Crystalloid architecture of a sialolith in a minor salivary gland.

A sialolith from a minor salivary gland of the mucosa of the upper lip was studied morphologically and analytically. Under stereoscopic microscopic visualisation, no core or any concentric laminar structure was found in the sialolith and it had a transparent glassy appearance. Scanning electron microscopy revealed differences between the internal structure of the sialolith and its external structure. No microbes were observed but some mineralized inclusion bodies were seen. X-ray diffraction indicated the absence of inorganic crystals in the sialolith, while energy dispersive x-ray microanalysis revealed a high content of S followed by Ca, Si and Na and little and scarce P on the fracture surface, with S, Na, Ca and P being distributed throughout the external coating of the sialolith. The results suggest that the sialolith was young and consisted of a crystalloid body with an incipient coating undergoing calcification.

[Immunogenicity of the Heberbiovac-HB vaccine in doses of 10.5 and 2.5 micrograms in 6-9-year-old students]. / Inmunogenicidad de la vacuna Heberbiovac-HB a las dosis de 10,5 y 2,5 micrograms en niños escolares de 6 a 9 años de edad.

The Heberbiovac-HB recombinant hepatitis B vaccine was administered at dosages of 10.5 and 2.5 micrograms in 3 groups of children aged 6-9 with a vaccination schedule at 0, 1 and 6 months of age. The immunogenecity attained between dosages was compared. The seroconversion with protective titres obtained at 2 months varied from 88.9% with 10 micrograms to 79.4% with 2.5 micrograms, whereas at 7 months it was higher than 98% in the 3 groups. The geometrical mean with 10 mg was 136.63 and 2,356.8 UI/L-1; with 5 micrograms, 77.62 and 1,958.9 UI/L-1; and with 2.5 micrograms, 32.15 and 376.3 UI/UL-1, at 2 and 7 months, respectively. A high immunogenic power of the vaccine is observed at dosages of 10 and 5 micrograms with similar results. In spite of the fact that the dosage of 2.5 micrograms is immunogenic, the response is not desirable. These results state the possibility of using a lower dosage (5 micrograms) for a low risk infantile population, which favors the cost-benefit.

[Infection/immunity by hepatitis B virus in an adult population of Havana City. Cuba 1995]. / Infección/inmunidad por el virus de la hepatitis B en una población adulta de Ciudad de La Habana. Cuba 1995.

The results of a study of markers of infection/immunity by hepatitis B virus in a community of the health area in "Cristobal Labra" polyclinics, City of Habana in 1995. The studied healthy adult population was not included in any vaccination strategy with hepatitis B vaccine. Two markers were studied: Hepatitis B surface antigen and its corresponding antibody (anti-HBs). HBsAg-positivity was 1.05% and anti-HBs positivity was 13.39%. Of anti-HBs-positive cases, 13.39% had titers from 10-50 UI/L and the rest (43.68%) had titers over 50 UI/L.

[Epidemiological study on Hymenolepis nana infection in Ciego de Avila Province, Cuba]. / Estudio epidemiológico de la infección por Hymenolepis nana en la provincia de Ciego de Avila, Cuba.

An epidemiological study on H. nana infection was carried out in Ciego de Avila province, Cuba, from 1981 to 1995. In this 15 years period 3,108,422 stool samples were examined for parasites, H. nana eggs were found in 250 (0.008%). Seasonal influence of this parasitism was not detected. There were more cases in children than in adults, with males prevailing over females. The more frequent symptoms and signs were abdominal pain, diarrhea and anorexia which relationships with food habits, dwelling characteristics, children day care center and school orchards are analyzed.

[The reactogenicity and immunogenicity of the first Cuban vaccine against human leptospirosis]. / Reactogenicidad e inmunogenicidad de la primera vacuna cubana contra la leptospirosis humana.

A controlled double-blind trial was conducted with the participation of 80 adult volunteers of both sexes, who were randomly divided into groups of 40 individuals each one. The case-base study received the vaccine and the control group was administered placebo to know the safety, the behaviour of reactogenicity, and to star the immunogenicity studies of the first Cuban vaccine against human leptospirosis. The vaccine used in the case-base study was an inactivated and trivalent vaccine containing strains of Leptospira canicola, icterohaemorrhagiae and pomona, since they have the highest circulation in the country. The results obtained showed the inocuity of the vaccine as no adverse severe reactions were detected. The general symptomatology observed was low, where as febricula was the most common general symptom. It appeared during the first 3 days of observation and there were no significant differences between the 2 group. Only a mild pain at the site of the injection was reported as a local symptom, which was more frequent in the vaccinated group than in the control group (7.8 against 1.5%, respectively). The seroconversion obtained was of 29% by microagglutination, and of 34.2% by ELISA. The final results allowed to conclude that this vaccine is safe for human adults at the ages under study, and give the possibility to continue other studies in more advanced stages to complete the requirements for obtaining its license.

[Cryptosporidiosis in children with acute diarrhea from Ciego de Avila province, Cuba]. / Criptosporidiosis en niños con diarrea aguda de la provincia de Ciego de Avila, Cuba.

An epidemiological and clinical study of criptosporidiosis in children from Ciego de Avila province was carried out from 1987 to 1994. During this period 14,895 children with acute diarrhea were studied. Cryptosporidium sp. oocysts were found in the feces of 1,256 (8.4%) of them. Isolated cases prevailed over outbreaks, being the incidence rate proportional in both urban and rural areas. Seventy nine point seven per cent of infected children were less one year old, predominating the age group 6-11 months old. No influence of seasons on the occurrence of the parasitose was observed. The most frequently detected symptoms and signs were diarrhea, vomits and loss of weight. The main epidemiological factors were: 81.0% of ill children drank water directly from the aqueduct, 12.8% lived in overcrowded conditions, 11.0% had animals and 10.7% attended nursery schools.

[Immunogenicity of the Heberbiovac-HB vaccine in the physically and mentally handicapped]. / Inmunogenicidad de la vacuna Heberbiovac-HB en impedidos físicos y mentales.

The recombinant DNA Heberbiovac-HB vaccine against hepatitis B was applied to 2 groups of children at 2 homes for the physically and mental disabled at doses of 10 and 5 micrograms with the scheme 0, 1 and 6 months to study its immunogenicity, which was evaluated at 2, 7 and 12 months after the first dose was administered. On the 60th day it was obtained 80.9% of seroprotection in children who received 10 micrograms, whereas in the group that was vaccinated with 5 micrograms 65.0% of seroprotection was attained and there were no significant differences between the groups. 100% of seroprotection (> or = 10 UI/L) was obtained in the 2 vaccinated groups when the immune response was measured 1 month after the third dose was applied. A year later, seroprotection was 100% for the 2 groups of children. The geometrical mean of the antibody titres (TMG) reached levels above 10 UI/L, which is the minimum protector, in the 2 study groups 30 days after the second dose. A month after the third dose, the TMG attained values of 527.7 UI/L in the group of 10 micrograms and of 324.7 UI/L in that of 5 micrograms. No remarkable differences were found between the groups (p < 0.05). Finally, 365 days later, the TMG descended to 139.7 UI/L and 57.3 UI/L in the same groups, respectively. It was demonstrated the high immunogenic power of this vaccine, which makes it recommendable for protecting the physical and mentally disabled children from hepatitis B virus.