[Medial discoid meniscus in a pediatric patient. Case report and review of the literature]. / Menisco discoide medial en paciente pediátrico. Presentación de un caso y revisión de la literatura.

Discoid meniscus is a congenital morphological variant of the meniscus, which tends to occur more frequently in its lateral form than in the medial form. This anomaly is characterized by central hypertrophy of the meniscus and a larger diameter than the normal meniscus, resulting in an abnormal shape and greater coverage of the tibial plateau. The clinical presentation of this condition varies depending on the stability of the meniscus. In pediatric patients, in particular, it is common to experience progressive and atraumatic symptoms, such as pain and limited mobility. Diagnosis is based on imaging studies, with magnetic resonance imaging being the preferred tool, where the "bowtie sign" is a classic finding. Surgery is recommended for symptomatic patients, with a focus on preserving the peripheral portion of the meniscus. Saucerization is the most commonly used technique, followed by stability assessment to determine if additional procedures are required. In this case, a 9-year-old patient with a medial discoid meniscus presented symptoms following trauma. Despite this atypical presentation, a successful outcome was achieved through arthroscopic surgery, underscoring the importance of accurate diagnosis and proper management of this condition in pediatric patients. Understanding the anatomical and pathophysiological characteristics of the discoid meniscus is essential for an effective therapeutic approach.

El menisco discoide es una variante morfológica congénita del menisco, que suele presentarse con mayor frecuencia en su forma lateral que en la medial. Esta anomalía se caracteriza por la hipertrofia central del menisco y un diámetro mayor que el menisco normal, lo que resulta en una forma anormal y una mayor cobertura del platillo tibial. La presentación clínica de esta condición varía según la estabilidad del menisco. En pacientes pediátricos, en particular, es común experimentar síntomas progresivos y atraumáticos, como dolor y limitación de la movilidad. El diagnóstico se basa en estudios de imagen, siendo la resonancia magnética la herramienta preferida, donde el "signo del corbatín" es un hallazgo clásico. Se recomienda la cirugía para pacientes sintomáticos, con un enfoque en preservar la porción periférica del menisco. La saucerización es la técnica más utilizada, seguida de la evaluación de la estabilidad para determinar si se requiere un procedimiento adicional. En el presente caso, se describe a un paciente de nueve años con un menisco discoide medial que manifestó síntomas después de un traumatismo. A pesar de esta presentación atípica, se logró un resultado exitoso mediante una cirugía artroscópica, lo que resalta la importancia de un diagnóstico preciso y un manejo adecuado de esta condición en pacientes pediátricos. La comprensión de las características anatómicas y patofisiológicas del menisco discoide es esencial para un enfoque terapéutico efectivo.

EEG Interchannel Causality to Identify Source/Sink Phase Connectivity Patterns in Developmental Dyslexia.

While the brain connectivity network can inform the understanding and diagnosis of developmental dyslexia, its cause-effect relationships have not yet enough been examined. Employing electroencephalography signals and band-limited white noise stimulus at 4.8 Hz (prosodic-syllabic frequency), we measure the phase Granger causalities among channels to identify differences between dyslexic learners and controls, thereby proposing a method to calculate directional connectivity. As causal relationships run in both directions, we explore three scenarios, namely channels' activity as sources, as sinks, and in total. Our proposed method can be used for both classification and exploratory analysis. In all scenarios, we find confirmation of the established right-lateralized Theta sampling network anomaly, in line with the assumption of the temporal sampling framework of oscillatory differences in the Theta and Gamma bands. Further, we show that this anomaly primarily occurs in the causal relationships of channels acting as sinks, where it is significantly more pronounced than when only total activity is observed. In the sink scenario, our classifier obtains 0.84 and 0.88 accuracy and 0.87 and 0.93 AUC for the Theta and Gamma bands, respectively.

Consensus and recommendations on vaginal-cuff Brachytherapy of the Spanish Brachytherapy Groups of SEOR and SEFM.

PURPOSE/OBJECTIVE(S): On October 5, 2018, a meeting of the Spanish Society of Radiation Oncology (SEOR) Brachytherapy Group was held, in collaboration with the Spanish Society of Medical Physics (SEFM), with the aim of preparing a consensus document on postoperative vaginal-cuff brachytherapy (VCBT). MATERIALS/METHODS: A survey including 42 questions was sent to Spanish Radiation Oncology Centres before the meeting. The survey items included: experience in VCBT, technique indications, previous patient preparation, applicator type, implant procedure, computerized tomography (CT) simulation, definition of target volumes and organs at risk (OAR), dose prescription, fractionation, treatment planning, dosimetric parameters and constraints to OAR. Thirty-three centres answered the survey. Statistical analysis of the survey considered that there was consensus when there was ≥ 85% of agreement related to a survey item, otherwise an item with < 85% of agreement would be discussed during the meeting to reach consensus. RESULTS: The results of the survey are reported here. The mean number of patients treated per centre in 2017 was 52 ± 41 (range 7-175), and the mean number of procedures per centre was 175 ± 150 (range 24-701).There was consensus on: the indications, applicator type, the OAR to be considered, the prescription point, standardisation and dosimetric quality parameters. There was no consensus on: patient preparation for the implant, the need for performing CT simulation and the frequency, the length of the vagina to be treated, if CTV should be delimited, the definition of the clinical target volume, fractionation, overall EQD2, active source length, separation between dwelling stepping source positions, if considering the uniformity/maximum values for dwelling stepping sources, the optimization mode, and the limiting doses to the OAR. After presenting the results of the survey, the consensus meeting discussion focused on the issues for which there was no consensus. CONCLUSION: A consensus document on postoperative VCBT of the Spanish Brachytherapy Groups of SEOR-SEFM was elaborated.

[Study of the introduction of the European Credit Transfer System (ECTS) in pediatrics and modification of the teaching methodology]. / Estudio sobre la introducción del Sistema de Transferencia de Créditos Europeo en Pediatría y modificaciones de la metodología docente.

INTRODUCTION: Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. OBJECTIVES: To test the introduction of the ECTS in pediatrics and modify the teaching methodology. STUDY DESIGN: The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. RESULTS: Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. CONCLUSIONS: Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated.

[Metabolic control, C peptide and lipids in insulin-dependent diabetes mellitus]. / Control metabólico, péptido C y lípidos en la diabetes mellitus insulin-dependiente.

Total cholesterol, HDL cholesterol, triglyceride, glycohaemoglobine and plasma glycoprotein levels were measured in 67 diabetic children and 40 nondiabetic ones. A dynamic study on C peptide secretion was also made in 28 diabetic patients. It was checked the fact that diabetic children showed normal whole cholesterol (172.1 +/- 32.1 mg/dl), HDL cholesterol (48.1 +/- 18.8 mg/dl) and triglyceride (58.3 +/- 26.8 mg/dl) levels, demonstrating no relationship with sex, age, length of diabetes, nor with the degree of metabolic control of disease, classified taking into account several clinical and biochemical indicators. C peptide concentration was found to be within normal levels in the whole group of patients under clinical remission phase of diabetes and also in 75% of children during the first 6 months of disease development. C peptide levels were higher in male than female diabetic children, showing an inverse relationship with duration of disease (r = -0.577, p less than 0.001) and with daily insulin requirements (r = -0.532, p less than 0.005). Discriminant analysis and multiple regression analysis results showed that the patients with a higher risk of bad control of diabetes were the older, those with a larger duration of disease, specially female, those with no remission phase of diabetes during clinical course of disease, and those showing bad motivation in relation to treatment.

[Clinical evaluation of glycohemoglobin and serum glycoproteins using affinity chromatography in children with type I diabetes mellitus]. / Valoración clínica de la glicohemoglobina y glicoproteínas plasmáticas medidas por cromatografía de afinidad en niños con diabetes mellitus tipo I.

We measured in 67 diabetic and 40 non-diabetic children glycosylated haemoglobin levels by both affinity chromatography (Gly Hb) and cation exchange chromatography (Hb A1), glycosylated plasma proteins by affinity chromatography (Gly PP) and glycosylated serum proteins by the colorimetric method of thiobarbituric acid (PSG). There was in the diabetic children a significant linear correlation between these four determinations, as well as between them and the values in mean glycaemias and mean glycosurias. The average Hb A1 over a 20-month observation period was 11.7%; the mean Gly Hb, 12.7%; the mean Gly PP, 5.3%, and the average PSG, 0.77 nmol HMF/mg protein. Glycohaemoglobin levels were within the normal range in only 5% of the cases. About 25% of the diabetic children showed a bad therapeutic compliance, which progressively deteriorated when age and duration of disease increased. Daily insulin requirements and glycosylated haemoglobin levels were significantly higher in diabetic girls than boys, but these differences between sexes did not exist where concentration of glycosylated proteins was concerned. Values in glycohaemoglobin and glycoproteins increased together with age, duration of disease and insulin requirements, existing an inverse relationship with both duration of clinical remission period and socioeconomic level. Motivation, dietetic obedience and, above all, self-control compliance were the variables that exerted the greatest influence on glycohaemoglobin and glycoprotein levels.

[Effect of roasted wheat flour on the intestinal absorption and zinc metabolism of rats]. / Influencia del gofio de trigo sobre la absorción intestinal y el metabolismo del cinc en ratas.

24 experiences have been carried in 8 younger Wistar female rats that been submitted to three different diets considering fibers and phytates, with the purpose to demonstrate if "gofio de trigo" of popular consumption in Canary Islands, and rich in these substances affects intestinal absorption of zinc in the diet. Authors have observed a very significant elevation of zinc in feces, during the control period. An important decrease of zinc in hair has been observed indicating a deficit of corporal ion although zinc in serum remained in its normal limit. Authors emphasize the fact that under these circumstances, removal of urinary zinc is not a useful guide for diagnosis of deficiency state.

[Urinary excretion of N-acetyl-beta-D-glucosaminidase and microglobulin 2 in type I diabetes mellitus]. / Estudio de la eliminación urinaria de N-acetil-beta-D-glucosaminidasa y beta 2 microglobulina en la diabetes mellitus tipo I.

We studied the urinary elimination of two indicators of renal proximal tubular function. N-Acetyl-Gluosaminidase (NAG) and beta 2 microglobulin (beta 2m) in 23 healthy and 67 diabetic children aged 2-15 years and with disease evolution times between 1 month and 12 years. In order to obviate the variations of glomerular filtration present in the diabetes, both proteins were evaluated in the form of indices of excretion (IE). It was found that the diabetic children as a whole presented higher values of NAGIE than the controls (p less than 0.001), and that this increased as the degree of metabolic control worsened, the latter being judged by either fructosamin or HbA C (r = 0.59 for both). The increase in the urinary elimination of NAG had a directly proportional relation with the evolution time of the diabetes. With respect to the beta 2mIE, no significant differences were found on dividing the children according to the degree of metabolic control, although the values did increase with longer evolution times. Thus it may be concluded that NAGIE was shown to be a more useful parameter than beta 2m for evaluating the renal proximal tubular function in infant and juvenile diabetes.