[Efficacy of lisdexamphetamine to improve the behavioural and cognitive symptoms of attention deficit hyperactivity disorder: treatment monitored by means of the AULA Nesplora virtual reality test]. / Eficacia de la lisdexanfetamina en la mejora sintomatica conductual y cognitiva del trastorno por deficit de atencion/ hiperactividad: tratamiento monitorizado mediante el test AULA Nesplora de realidad virtual.

INTRODUCTION: Lisdexanfetamine (LDX) is the drug for attention deficit hyperactivity disorder (ADHD) undergoing the largest research volume in the latest years. However, no studies certify its usefulness for the improvement of cognitive functioning in ADHD. AIM: To evaluate the efficacy of LDX in the behavioral and cognitive improvement of a group of patients with ADHD. Such efficacy was measured by means of the administration of AULA Nesplora virtual reality test before the prescription of pharmacological treatment and right after the treatment with LDX. PATIENTS AND METHODS: The sample comprised 85 patients between 6 and 16 years, with clinical diagnosis of ADHD, who attended treatment in a neuropediatrics consultation. All patients started pharmacological treatment with the proper dose of LDX after the clinical interview and the first administration of AULA test. After an average treatment of 7.5 months, AULA was administered again and the treatment progress based on cognitive and motor symptomatology was assessed. RESULTS: Results showed highly significant improvements in selective and sustained attention, quality of attention focus and hyperactivity; moderate improvements in impulsivity; and an incidence close to zero in processing speed. CONCLUSIONS: LDX constitutes an adequate treatment for the substantial improvement of attention and hyperactivity; such improvement can be monitored accurately by means of AULA virtual reality test.

TITLE: Eficacia de la lisdexanfetamina en la mejora sintomatica conductual y cognitiva del trastorno por deficit de atencion/ hiperactividad: tratamiento monitorizado mediante el test AULA Nesplora de realidad virtual.Introduccion. La lisdexanfetamina (LDX) es el farmaco para el trastorno por deficit de atencion/hiperactividad (TDAH) con mayor volumen de investigacion de los ultimos años. No obstante, no hay estudios que certifiquen su utilidad para la mejoria del funcionamiento cognitivo en el TDAH. Objetivo. Evaluar la eficacia de la LDX en la mejora sintomatica conductual y cognitiva en un grupo de pacientes con TDAH. Dicha eficacia fue medida mediante la administracion del test AULA Nesplora de realidad virtual antes de la prescripcion del tratamiento farmacologico y despues del tratamiento con LDX. Pacientes y metodos. La muestra estaba compuesta por 85 pacientes de 6-16 años, con diagnostico clinico de TDAH y que asistian a tratamiento en una consulta de neuropediatria. Todos los pacientes iniciaron el tratamiento farmacologico con la correspondiente dosis de LDX tras la entrevista clinica y la primera administracion del test AULA. Tras un tratamiento medio de 7,5 meses, se les administro AULA nuevamente y se valoro el progreso del tratamiento farmacologico sobre la sintomatologia cognitiva y motora. Resultados. Se apreciaron mejorias muy significativas en la atencion selectiva y sostenida, la calidad del foco atencional y la hiperactividad, mejorias moderadas en la impulsividad, y una incidencia casi nula en la velocidad de procesamiento. Conclusiones. La LDX constituye un tratamiento adecuado para la mejora sustancial de la atencion e hiperactividad, y dicha mejora puede monitorizarse de forma precisa mediante el test de realidad virtual AULA.

Brucellosis infection presenting with cholestasis.

Brucellosis is a relatively common disease in the Mediterranean area and may present with prolonged fever without focus, however it remains an important diagnostic challenge to most pediatricians. We report the case of a 10-year-old male patient who presented with fever without a focus of 10-day duration, hepatomegaly, ascites, a small elevation in transaminases and acute-phase reactants indicating cholestasis, leukopenia, and thrombocytopenia. Imaging tests showed many small, rounded, hypodense focal lesions in the liver and spleen. After eliminating a wide range of diseases, positive results for the Rose Bengal test and indirect immunofluorescence assay for Brucella melitensis made it possible to establish a diagnosis of hepatosplenic brucellosis. A review of the family history revealed direct contact with farm animals. The patient made good progress on treatment with doxycycline and streptomycin, with complete resolution of both clinical symptoms and imaging signs. The prevalence of brucellosis is gradually increasing, mainly due to migratory movements. It should always be eliminated as a source of unknown fever in endemic areas and should also be taken into account in other geographical areas where it is not common whenever a patient presents with prolonged fever and unspecific symptoms. Standard therapy is highly effective, even in relapse cases, and early diagnosis leads to a rapid recovery and favorable outcome. The unusual presentation in the case reported here reminds us that it is possible to encounter a Brucella infection in a case of fever without a focus, irrespective of the existence of a clear epidemiological history, which is very often omitted by the family. All differential diagnostic protocols for fever without a focus should include a diagnostic test for Brucella in order to achieve early detection of the disease and initiate therapy promptly.

[Quality of life related to health in caregivers of dependent people in two rural areas of León]. / Calidad de vida relacionada con la salud en cuidadoras de personas dependientes de dos zonas rurales de León.

OBJECTIVES: To study the quality of life related to health and the relationship with the social support, family function and the level of overload for carers of people with a medium/high level of dependence have. METHOD: Cross-sectional study of people in Villablino Palacios del Sil making a Dependence Application in 2007. A questionnaire was administered to explore the socioeconomic characteristics, family function (Apgar Family), social support (Duke-UNC), quality of life related to health (Coop-wonca sheeting) and burden level (Zarit) of caregivers. A descriptive analysis was carried out for each one of the variables, and for the bivariate analysis the Spearman rank correlation coefficient, and Pearson's correlation coefficient were used for the continuous variables. RESULTS: A total of 79.31% of the target population (58 people) answered the questionnaire, with an average age of 55.74 years (standard deviation=11.6), 82.6% (38) women, and 45.7% (21) have a low social support and 76.1% (35) are normal functioning families. A total of 67.4% (31) had an intense burden. There was a statistically positive significant relationship (P<0.05) between the quality of life associated with health and family function and perceived social support, and a negative significant relationship with the burden of the caregiver. CONCLUSIONS: The quality of life related to health in caregivers is better in those with a good social and family support, a good state of health, and they maintained their level of physical activity and positive feelings, but it got worse when the social support decreased and the level of overload increased.

[Unusually high frequency of complications in acute otitis media]. / Frecuencia inusualmente elevada de complicaciones secundarias a otitis media aguda.

INTRODUCTION: Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features. MATERIAL AND METHOD: A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007. RESULTS: Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy. CONCLUSIONS: We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events.

Frecuencia inusualmente elevada de complicaciones secundarias a otitis media aguda / Unusually high frequency of complications in acute otitis media

Introducción: las complicaciones intracraneales (CI) secundarias a otitis media son procesos infrecuentes aunque potencialmente graves. Recientemente hemos encontrado una frecuencia inusualmente elevada, cuyas características clínicas y epidemiológicas describimos. Material y método: estudio descriptivo retrospectivo de pacientes con complicaciones intracraneales secundarias a otitis media ingresados en nuestro hospital terciario durante el periodo abril de 2004-noviembre de 2007. Resultados: 8 pacientes han presentado CI: trombosis de seno sigmoideo (4), trombosis de seno lateral (1), meningitis (2), absceso epidural (1) e hidrocefalia otítica (1); 4 de los pacientes presentaban otomastoiditis. El 87,5% de los pacientes había recibido antibioterapia oral previa a la complicación. Los síntomas más frecuentes fueron fiebre, otalgia, cefalea, parálisis del VI par y parálisis facial. Se aisló el germen causal en 3 pacientes: Streptococcus pyogenes (2) y Proteus mirabillis (1). Los demás pacientes tuvieron cultivos negativos. Se realizó mastoidectomía radical en 2 pacientes y tratamiento médico con antibioterapia intravenosa de amplio espectro en todos los pacientes. Se produjo la curación sin secuelas en 6 casos y ninguna muerte. Conclusiones: hemos detectado un incremento en la frecuencia de CI secundarias a otitis media aguda. Para confirmarlo se requieren estudios prospectivos multicéntricos a fin de valorar si se ha producido un cambio epidemiológico en la incidencia de este tipo de complicaciones (AU)

Introduction: Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features. Material and method: A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007. Results: Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy. Conclusions: We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events (AU)

[Status epilepticus associated with mild rotavirus gastroenteritis]. / Estado epiléptico asociado a una gastroenteritis leve por rotavirus.

BACKGROUND: Convulsions with mild rotavirus gastroenteritis were first described by Morooka in 1982. This is a process of convulsions and gastroenteritis without any changes in complementary tests. They are few cases out of Asia and they are rarely reported in Spain. CLINICAL CASE: They were 2 infants, 4 and 7 months old with no background of interest who suffered from status epilepticus during a mild rotavirus gastroenteritis without resolution after treatment. CONCLUSIONS: Benign afebrile cluster convulsions with rotavirus gastroenteritis is not common and is not often diagnosed in our area. It should be included in the differential diagnosis of status epilepticus and it is crucial to look for a history of diarrhoea. Careful management of diagnosis and treatment is essential given its controversial character.

Estatus epiléptico asociado a una gastroenteritis leve por rotavirus / Epileptic status associated with mild gastroenteritis caused by rotavirus

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Estado epiléptico asociado a una gastroenteritis leve por rotavirus / Status epilepticus associated with mild rotavirus gastroenteritis

Antecedentes. Las convulsiones asociadas a gastroenteritis por rotavirus fueron descritas por Morooka en 1982. Se definen como convulsiones asociadas a gastroenteritis leve y pruebas normales. Se han descrito poco fuera de Asia y son excepcionales en España. Caso clínico. Dos lactantes varones, de 4 y 7 meses de edad, que, sin antecedentes de interés y en el contexto de una gastroenteritis leve a la postre por rotavirus, desarrollan un estado epiléptico con escasa respuesta al tratamiento. Tras la resolución, se aprecia una curación at integrum sin alteraciones del desarrollo psicomotor. Conclusiones. Las convulsiones asociadas a gastroenteritis leve por rotavirus son una entidad poco frecuente o, por lo menos, poco diagnosticada en nuestro medio. Es necesaria su inclusión en el diagnóstico diferencial del estado epiléptico y, por lo tanto, es esencial buscar el posible antecedente de diarrea. Se requiere un manejo prudente en el área diagnóstica y terapéutica dado su carácter controvertido

Background. Convulsions with mild rotavirus gastroenteritis were first described by Morooka in 1982. This is a process of convulsions and gastroenteritis without any changes in complementary tests. They are few cases out of Asia and they are rarely reported in Spain. Clinical case. They were 2 infants, 4 and 7 months old with no background of interest who suffered from status epilepticus during a mild rotavirus gastroenteritis without resolution after treatment. Conclusions. Benign afebrile cluster convulsions with rotavirus gastroenteritis is not common and is not often diagnosed in our area. It should be included in the differential diagnosis of status epilepticus and it is crucial to look for a history of diarrhoea. Careful management of diagnosis and treatment is essential given its controversial character

[Brimonidine intoxication in paediatrics. A presentation as intracranial hypertension syndrome]. / Intoxicación por brimonidina en pediatría. Presentación como síndrome de hipertensión intracraneal.

BACKGROUND: Brimonidine is an extremely lipophilic drug which is absorbed very well through the cornea and thus crosses the blood-brain barrier. This is very important for any potential toxic effects on the CNS. OBJECTIVES: To show the adverse effects of brimonidine and advise the need for caution in its use in the paediatric population. CONCLUSIONS: Brimonidine is prohibited from use in toddlers and infants. Its adverse effects can be severe or lethal. It should be suspected in treated patients with compatible symptoms in whom organic disease has been ruled out. We must stop the use of brimonidine and adopt support measures.

Intoxicación por brimonidina en pediatría. Presentación como síndrome de hipertensión intracraneal / Brimonidine intoxication in paediatrics. A presentation as intracranial hypertension syndrome

Antecedentes: La brimonidina es un fármaco muy lipofílico absorbido muy bien por vía transcorneal, que atraviesa la barrera hematoencefálica, con el potencial efecto tóxico para el sistema nervioso central que esto supone. Objetivos: Dar a conocer los efectos secundarios de la brimonidina tópica y remarcar la necesidad de precaución con fármacos tópicos en pediatría. Conclusiones: La brimonidina se desaconseja en niños pequeños y lactantes. Sus efectos secundarios sistémicos pueden ser graves o incluso letales. Debemos sospecharlo en pacientes tratados con síntomas compatibles en los que se descarta patología orgánica. Debemos actuar suspendiendo el fármaco y adoptando las medidas de soporte necesarias

Background: Brimonidine is an extremely lipophilic drug which is absorbed very well through the cornea and thus crosses the blood-brain barrier. This is very important for any potential toxic effects on the CNS. Objectives: To show the adverse effects of brimonidine and advise the need for caution in its use in the paediatric population. Conclusions: Brimonidine is prohibited from use in toddlers and infants. Its adverse effects can be severe or lethal. It should be suspected in treated patients with compatible symptoms in whom organic disease has been ruled out. We must stop the use of brimonidine and adopt support measures

[Meningioma of the third ventricle. Presentation of a case]. / Meningioma del tercer ventrículo. Presentación de un caso.

Meningiomas of the third ventricle are extremely rare; the authors report a case of meningothelial meningioma located in the anterior part of the third ventricle. The tumor was successfully removed through a trans-ventricular approach. The clinical presentation, radiological findings and surgical management of these tumors are reviewed.