Environmental and health implications of Pb-bearing particles in settled urban dust from an arid city affected by Pb-Zn factory emissions.

Metal-rich particles originating from non-ferrous metallurgical activities are the primary source of atmospheric metals in urban environments. These particles vary in size, morphology, and elemental compositions and they undergo weathering processes that alter their composition and affect their toxicity. This study focuses on lead (Pb)-rich particles in settled urban dust within an arid and dusty city, Torreón in North Mexico, affected by Met-Mex Peñoles complex, one of the world's largest Ag-Cd-Pb-Zn smelting and refining facilities in operating since 1901. Torreón is characterized by arid conditions, temperature fluctuations, and low humidity. Dry atmospheric particles were collected in 2015 and 2017 from Torreón's urban area within a 3 km radius of the Met-Mex Peñoles complex. We used various analytical techniques, including scanning electron microscopy (SEM), Energy Dispersive X-ray Spectroscopy (EDS), and X-ray powder diffraction (XRD) to determine the size, morphology, elemental composition and mineralogy of Pb-bearing particles. Our analysis revealed a range of Pb-bearing particle sizes and morphologies with varying Pb (0.3 to 51-87.2%) and other element contents, such as As (0.04 to 1-3.4%), Cd (0.4 to 3.3-5.1%), Cu (0.51-14.1%), Hg (ND-0.6%), and Zn (1.7 to 79-90.3%). XRD analysis confirmed the presence of Pb and Zn sulfides, Pb carbonates, Pb sulfate, and Pb oxides in urban dust, both as individual particles and agglomerates. Primary Pb minerals were linked to fugitive feed concentrates and smelter flue gas at Met-Mex Peñoles, while secondary Pb minerals, like Pb carbonates, Pb sulfate, and Pb oxides, resulted from direct emissions and weathering processes. Compared to galena, secondary Pb minerals exhibit higher chemical availability in the environment, posing greater risks to the environment and human health. As the particles analyzed are presumed to be resuspended rather than freshly emitted by Met-Mex, the presence of secondary Pb minerals in settled urban dust is predominantly linked to weathering processes. The physical and chemical transformations in Pb-rich particles contribute to increased Pb bioavailability and toxicity in urban dust, with substantial implications for environmental and human health. These findings highlight the potential consequences of weathered Pb-rich particle in urban areas, particularly in the arid and dusty city of Torreón.

[Association of morphological variables of acromion type with rotator cuff lesions by nuclear magnetic resonance]. / Asociación de variables morfológicas de tipo de acromion con lesiones del manguito rotador por resonancia magnética nuclear.

INTRODUCTION: the acromion is a small portion of the scapula that extends towards the anterior region from the spine of the scapula. Traditionally, the acromion is classified by the shape of its inferior surface in a sagittal plane. Acromial morphology has been found to be related to rotator cuff injury. OBJECTIVE: to determine the association between the type of acromion with a higher incidence of rotator cuff rupture. Study population: patients who come to the Traumatology and Orthopedics Service of a third level hospital at Monterrey, Mexico, due to a painful shoulder and who have undergone a simple magnetic resonance of the shoulder. MATERIAL AND METHODS: a cross-sectional, retrospective and descriptive study was carried out, in which 273 magnetic resonance studies were reviewed in patients who met the inclusion criteria. The type of acromion was reported according to the morphological classification in type I to IV and the state of the rotator cuff: without rupture, partial rupture or complete rupture, making a comparison between right and left shoulder. RESULTS: in this study we found a value of p = 0.473 which concludes that there is no relation between the type of acromion and the injury of the rotator cuff. CONCLUSION: in the present study, unlike what has been published in the literature, it was found that type II acromion was the one that was associated in most cases with a rotator cuff tear.

INTRODUCCIÓN: el acromion es una pequeña porción de la escápula que se extiende hacia la región anterior desde la espina de la escápula. Tradicionalmente se clasifica al acromion por la forma de su superficie inferior en un plano sagital. Se ha encontrado que la morfología acromial está rela­cionada con la lesión del manguito rotador. OBJETIVO: determinar la asociación entre el tipo de acromion con una mayor incidencia de ruptura de manguito rotador. Población de estudio: pacientes que acudan al Servicio de Traumatología y Ortopedia de un hospital privado de tercer nivel en la ciudad de Monterrey por hombro doloroso y a los cuales se les haya realizado una resonancia magnética simple de hombro. MATERIAL Y MÉTODOS: se realizó un estudio de tipo transversal, retrospectivo y descriptivo, en el cual se revisaron 273 estudios de resonancia magnética en pacientes que cumplieran los criterios de inclusión. Se reportó el tipo de acromion según la clasificación morfológica en tipo I a IV y el estado del manguito rotador: sin ruptura, ruptura parcial o ruptura completa, haciendo una comparación entre hombro derecho e izquierdo. RESULTADOS: se obtuvo un valor de p = 0.473 por lo que se concluye que no existe una asociación entre el tipo de acromion y el estado del manguito rotador. CONCLUSIÓN: en el presente estudio, a diferencia de lo publicado en la literatura, se obtuvo que el acromion tipo II fue al que se asoció la mayoría de los casos con ruptura del manguito rotador.

[Pain control with local infiltration transsurgical in postoperative total knee replacement]. / Control del dolor con infiltración local transquirúrgica en postoperados de reemplazo total de rodilla.

INTRODUCTION: 15-20% of patients undergoing total knee arthroplasty were not satisfied and the most common causes were residual pain and limited function. Epidural analgesia or peripheral nerve blocks have traditionally been used as analgesia. OBJECTIVE: To evaluate the efficacy of infiltration with epinephrine, ketorolac, morphine and ropivacaine solution in postoperative total knee replacement patients. MATERIAL AND METHODS: Observational, cross-sectional, retrospective and analytical cohort study. We included patients with gonarthrosis aged 18 to 100 years scheduled for total knee replacement surgery from May 2018 to August 2021; with documentation of their clinical, demographic, baseline, pre-surgical and postoperative pain data at 24 hours. Infiltrated patients were compared with those receiving intravenous analgesia. RESULTS: A total of 66 patients with a mean age of 69.1 were included;65.2% were women. Forty-three point nine percent had left-sided involvement, 50% had a classification of Kellgren-Lawrence III and 31.8% had a grade IV. Thirty-six patients (54.5%) formed the control group, while 30 (45.5%)received the intervention with the analgesic cocktail. With regard to pain,a lower median pain was found by visual analog scale in patients with the intervention (2 vs 8 points, p < 0.001); most with the cocktail they found no pain (66.7%) or mild pain (23.3%) and no patient in the control group reached it (p < 0.001). All patients of the control group required rescue analgesia, while only 30% of the intervention group used it (p < 0.001). CONCLUSION: The use of trans-surgical local infiltration decreases postoperative pain and the requirement of analgesics and rescue analgesia during the first 24 hours.

INTRODUCCIÓN: De 15-20% de los pacientes sometidos a una artroplastía total de rodilla no quedaron satisfechos y las causas más comunes fueron dolor residual y función limitada. De manera tradicional se ha utilizado analgesia epidural o bloqueos nerviosos periféricos como analgesia. OBJETIVO: Evaluar la eficacia de la infiltración con solución de epinefrina, ketorolaco, morfina y ropivacaína en pacientes postoperados de reemplazo total de rodilla. MATERIAL Y MÉTODOS: Estudio de cohorte observacional, transversal, retrospectivo y analítico. Se incluyeron pacientes con gonartrosis de 18 a 100 años de edad programados para cirugía de reemplazo total de rodilla de Mayo de 2018 a Agosto de 2021, con documentación de sus datos clínicos, demográficos, basales, prequirúrgicos y dolor postoperatorio a las 24 horas. Se compararon pacientes infiltrados con los que recibieron analgesia intravenosa. RESULTADOS: Se incluyeron un total de 66 pacientes con una media de edad de 69.1; 65.2% fueron mujeres. Cuarenta y tres punto nueve por ciento tuvieron afectación del lado izquierdo, 50% tuvieron una clasificación de Kellgren-Lawrence III y 31.8% tuvieron un grado IV. Treinta y seis pacientes (54.5%) formaron el grupo control, mientras que 30 (45.5%) recibieron la intervención con el cóctel analgésico. Con respecto al dolor, se encontró una menor mediana del dolor por escala visual análoga en pacientes con la intervención (2 vs 8 puntos, p < 0.001); la mayoría con el cóctel se encontraron sin dolor (66.7%) o dolor leve (23.3%) y ningún paciente del grupo control lo alcanzó (p < 0.001). Todos los pacientes del grupo control requirieron analgesia de rescate, mientras que sólo en 30% del grupo de intervención se utilizó (p < 0.001). CONCLUSIÓN: El uso de infiltración local transquirúrgica disminuye el dolor postoperatorio y el requerimiento de analgésicos y analgesia de rescate durante las primeras 24 horas.

Control del dolor con infiltración local transquirúrgica en postoperados de reemplazo total de rodilla / Pain control with local infiltration transsurgical in postoperative total knee replacement

Resumen: Introducción: De 15-20% de los pacientes sometidos a una artroplastía total de rodilla no quedaron satisfechos y las causas más comunes fueron dolor residual y función limitada. De manera tradicional se ha utilizado analgesia epidural o bloqueos nerviosos periféricos como analgesia. Objetivo: Evaluar la eficacia de la infiltración con solución de epinefrina, ketorolaco, morfina y ropivacaína en pacientes postoperados de reemplazo total de rodilla. Material y métodos: Estudio de cohorte observacional, transversal, retrospectivo y analítico. Se incluyeron pacientes con gonartrosis de 18 a 100 años de edad programados para cirugía de reemplazo total de rodilla de Mayo de 2018 a Agosto de 2021, con documentación de sus datos clínicos, demográficos, basales, prequirúrgicos y dolor postoperatorio a las 24 horas. Se compararon pacientes infiltrados con los que recibieron analgesia intravenosa. Resultados: Se incluyeron un total de 66 pacientes con una media de edad de 69.1; 65.2% fueron mujeres. Cuarenta y tres punto nueve por ciento tuvieron afectación del lado izquierdo, 50% tuvieron una clasificación de Kellgren-Lawrence III y 31.8% tuvieron un grado IV. Treinta y seis pacientes (54.5%) formaron el grupo control, mientras que 30 (45.5%) recibieron la intervención con el cóctel analgésico. Con respecto al dolor, se encontró una menor mediana del dolor por escala visual análoga en pacientes con la intervención (2 vs 8 puntos, p < 0.001); la mayoría con el cóctel se encontraron sin dolor (66.7%) o dolor leve (23.3%) y ningún paciente del grupo control lo alcanzó (p < 0.001). Todos los pacientes del grupo control requirieron analgesia de rescate, mientras que sólo en 30% del grupo de intervención se utilizó (p < 0.001). Conclusión: El uso de infiltración local transquirúrgica disminuye el dolor postoperatorio y el requerimiento de analgésicos y analgesia de rescate durante las primeras 24 horas.

Abstract: Introduction: 15-20% of patients undergoing total knee arthroplasty were not satisfied and the most common causes were residual pain and limited function. Epidural analgesia or peripheral nerve blocks have traditionally been used as analgesia. Objective: To evaluate the efficacy of infiltration with epinephrine, ketorolac, morphine and ropivacaine solution in postoperative total knee replacement patients. Material and methods: Observational, cross-sectional, retrospective and analytical cohort study. We included patients with gonarthrosis aged 18 to 100 years scheduled for total knee replacement surgery from May 2018 to August 2021; with documentation of their clinical, demographic, baseline, pre-surgical and postoperative pain data at 24 hours. Infiltrated patients were compared with those receiving intravenous analgesia. Results: A total of 66 patients with a mean age of 69.1 were included;65.2% were women. Forty-three point nine percent had left-sided involvement, 50% had a classification of Kellgren-Lawrence III and 31.8% had a grade IV. Thirty-six patients (54.5%) formed the control group, while 30 (45.5%)received the intervention with the analgesic cocktail. With regard to pain,a lower median pain was found by visual analog scale in patients with the intervention (2 vs 8 points, p < 0.001); most with the cocktail they found no pain (66.7%) or mild pain (23.3%) and no patient in the control group reached it (p < 0.001). All patients of the control group required rescue analgesia, while only 30% of the intervention group used it (p < 0.001). Conclusion: The use of trans-surgical local infiltration decreases postoperative pain and the requirement of analgesics and rescue analgesia during the first 24 hours.

[Interposition hemiarthroplasty using extensor hallucis brevis for the treatment of hallux rigidus with lateral unicompartmental involvement: a case report]. / Hemiartroplastía por interposición utilizando el extensor hallucis brevis para el tratamiento de hallux rigidus con involucro unicompartimental lateral: reporte de un caso.

Hallux rigidus is the degenerative pathology of the metatarsophalangeal joint of the hallux. This pathology causes pain and decreased movement. There are multiple surgical treatments for this pathology, all with their respective indications. We present the case of a 54-year-old patient diagnosed with hallux rigidus who had only the lateral aspect of the metatarsal head affected. This patient was treated with a novel surgical procedure, performing an interposition hemiarthroplasty using the hallucis brevis extender associated with a cheilectomy and exostectomy. The patient had a favorable clinical evolution with improvement evidenced by clinical scales, with resolution of the symptoms and without complications. Interposition hemiarthroplasty using the extensor hallucis brevis is a successful joint and movement preservation treatment for hallux rigidus in young patients with lateral unicompartmental involvement of the metatarsal head, in whom it is important to preserve movement.

Hallux rigidus es la patología degenerativa de la articulación metatarsofalángica del hallux. Esta patología provoca dolor y disminución en el movimiento. Existen múltiples tratamientos quirúrgicos para esta patología, todas con sus respectivas indicaciones. Presentamos el caso de un paciente de 54 años de edad con el diagnóstico de hallux rigidus quien tenía afectación únicamente del aspecto lateral de la cabeza del metatarsiano. Este paciente fue tratado con un procedimiento quirúrgico novedoso, se realizó una hemiartroplastía de interposición utilizando el extensor hallucis brevis asociado a una queilectomía y exostectomía. El paciente tuvo una favorable evolución clínica con mejoría evidenciado por escalas clínicas, con resolución de la sintomatología y sin complicaciones. La hemiartroplastía de interposición utilizando el extensor hallucis brevis es un tratamiento exitoso de preservación articular y del movimiento para el hallux rigidus en pacientes jóvenes en los que hay afectación unicompartimental lateral de la cabeza metatarsiana, en quienes es importante preservar el movimiento.

Neuritis óptica en pediatría: experiencia en 27 años y protocolo de actuación / Optic neuritis in paediatric patients: Experience over 27 years and a management protocol

Introducción y objetivos: Se presenta nuestra experiencia en neuritis óptica (ON) y se elabora un protocolo diagnóstico-terapéutico, que contempla descartar otras causas, principalmente infecciosas y se elabora una hoja informativa para padres.Material y métodoEstudio descriptivo retrospectivo de los pacientes con ON en 27 años (1990-2017). Revisión de evidencia científica para elaboración del protocolo y hoja informativa.ResultadosEn nuestra sección de neuropediatría se valoraron 20.744 niños en 27 años, 14 con ON: 8 ON aisladas, una esclerosis múltiple (EM), un episodio clínicamente aislado (CIS), 3 encefalomielitis agudas diseminadas y un paciente con ON aislada que el año anterior había sufrido una encefalomielitis aguda diseminada. Edades entre 4-13 años, 50% varones. Mayores de 10 años, 8 pacientes: 7 ON aisladas y un EM. Bilaterales 9, retrobulbares 3. Resonancia magnética cerebral normal en 7, solo afectación del nervio óptico en 2 y con desmielinización del SNC en 5 casos. Recibieron corticoterapia 13/14. Un caso vacunado de meningococo-C el mes anterior. Todos evolucionaron favorablemente, salvo la EM. Se presentan el protocolo y la hoja de información.ConclusionesHabitual curso favorable. En niños a partir de 10 años, con factores de riesgo de desarrollar EM o neuromielitis óptica (presencia de hiperseñales en RM cerebral, bandas oligoclonales, anti-NMO, recurrencia de ON), se consensúa con Neurología el inicio de tratamiento inmunomodulador. Utilidad del protocolo para la toma de decisiones diagnósticas, de seguimiento y tratamiento, de una patología poco frecuente pero con posibles repercusiones importantes. Importancia de la protocolización y hojas informativas. (AU)

Introduction and objective: In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents.Material and methodsWe conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet.ResultsOur neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients’ age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided.ConclusionsON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important. (AU)

Optic neuritis in paediatric patients: Experience over 27 years and a management protocol. / Neuritis óptica en pediatría: experiencia en 27 años y protocolo de actuación.

INTRODUCTION AND OBJECTIVE: In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents. MATERIAL AND METHODS: We conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet. RESULTS: Our neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients' age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided. CONCLUSIONS: ON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important.

Calcificación de discos intervertebrales como causa de tortícolis dolorosa en edad pediátrica / Intervertebral disc calcification as a cause of painful torticollis in children

No disponible

Síndrome de Claude secundario a traumatismo craneoencefálico / Claude syndrome secondary to head trauma

No disponible

[Familial MECP2 duplication syndrome]. / Síndrome de duplicación MECP2 familiar.

TITLE: Síndrome de duplicación MECP2 familiar.

[Correction of the pre- and post-surgical rotational component of the first metatarsal secondary to modified Chevron osteotomy]. / Corrección del componente rotacional prequirúrgico y postquirúrgico del primer metatarsiano secundario a osteotomía de Chevron modificado.

INTRODUCTION.: Hallux valgus (HV) is a complex forefoot pathology, in which interest has recently been shown in the distal rotational component (CR) of the first metatarsal due to its relationship with postsurgical relapses of the deformity. The selection of surgical technique is controversial with little current literature on the correction of rotation with common osteotomies. The aim of this study is to evaluate preoperative and postoperative radiological characteristics regarding CR of the first metatarsal using long Chevron osteotomy for moderate to severe HV. MATERIAL AND METHODS: An observational, prospective and comparative study was carried out in which the CR of the first metatarsal was evaluated in nine feet belonging to six patients with a mean age of 45 years. The RC was evaluated based on the proximal metaphysis of the first metatarsal in axial fluoroscopies of unloaded metatarsals and standing AP. Measurements were performed by an Orthopedic and Traumatology resident and a Foot and Ankle Surgery subspecialist. RESULTS: Significant differences (p = 0.05) were documented in the preoperative and postoperative pronation angle when using long Chevron osteotomy. The functional result of the evaluated patients was excellent at 11 months of follow-up. CONCLUSIONS: Radiologically, the rotational correction is variable and has not previously been reported in the literature with this osteotomy. We establishes the morphological bases for the performance of subsequent studies in the evaluation of head rotation of the 1st metatarsal with different osteotomies.

INTRODUCCIÓN: Hallux valgus (HV) es una patología compleja del antepié, recientemente se ha mostrado interés en el componente rotacional (CR) distal del primer metatarsiano por su relación con recidivas postquirúrgicas de la deformidad. La selección de la técnica quirúrgica es controversial con escasa literatura acerca de la corrección de rotación con osteotomías comunes. Nuestro objetivo es evaluar características radiológicas prequirúrgicas y postquirúrgicas respecto a CR del primer metatarsiano en la cirugía de corrección de HV moderado a severo usando osteotomía de Chevron largo. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo y comparativo en el que se evaluó el CR del primer metatarsiano en nueve pies pertenecientes a seis pacientes con una edad media de 45 años. El CR fue evaluado con base en la metáfisis proximal del primer metatarsiano en fluoroscopías axiales sin carga y AP de pie. Las mediciones se realizaron por un residente de ortopedia y traumatología y un subespecialista en cirugía de pie y Tobillo. RESULTADOS: Se documentaron diferencias significativas (p = 0.05) en el ángulo de pronación prequirúrgico y postquirúrgico al utilizar osteotomía de Chevron largo. El resultado funcional de los pacientes evaluados fue excelente a 11 meses de seguimiento. CONCLUSIONES: Radiológicamente, la corrección rotacional es variable y previamente no se ha reportado en la literatura con esta osteotomía. Se establecen bases morfológicas para la realización de estudios posteriores en la evaluación de rotación de cabeza del primer metatarsiano con diferentes osteotomías.

[Neurofibromatosis 1 and multiple familial cavernomatosis in an infant with episodic profuse sialorrhoea]. / Neurofibromatosis 1 y cavernomatosis multiple familiar en un lactante con sialorrea profusa episodica.

TITLE: Neurofibromatosis 1 y cavernomatosis multiple familiar en un lactante con sialorrea profusa episodica.

Cerebelitis aguda en Pediatría: nuestra experiencia / Acute cerebellitis in paediatric patients: Our experience

Introducción: La cerebelitis aguda es una rara afección inflamatoria con curso clínico muy variable: desde proceso autolimitado benigno hasta presentación fulminante con riesgo vital por compresión de fosa posterior, hidrocefalia aguda e hipertensión endocraneal. Métodos: Revisión de los hallazgos clínicos, analíticos y radiológicos de niños diagnosticados de cerebelitis aguda en el periodo comprendido entre mayo del 2007 y noviembre del 2016. Se analizan los tratamientos empleados y la evolución clínica y radiológica. Resultados: Nueve niños cumplían criterios de cerebelitis. La cefalea, los vómitos y la somnolencia fueron los síntomas de presentación más frecuentes; la ataxia, la disartria y la dismetría fueron los signos cerebelosos más frecuentes. La resonancia magnética fue el método diagnóstico mostrando afectación cerebelosa (uni o bilateral), mientras que la tomografía computarizada fue normal o solo mostraba signos indirectos como hidrocefalia triventricular por compresión extrínseca del acueducto de Silvio. Los corticoides fueron el tratamiento más empleado, administrados en 6 de los pacientes. Un paciente requirió intervención quirúrgica por hidrocefalia triventricular. Ocho pacientes tuvieron recuperación completa, mientras que uno presenta déficits neurológicos. Conclusiones: La cerebelitis es una urgencia médico-quirúrgica. Precisa un alto índice de sospecha y la realización de resonancia magnética cerebral urgente. Es un síndrome clínico-radiológico: encefalopatía aguda o subaguda, con hipertensión endocraneal y síndrome cerebeloso junto a hiperintensidad en córtex cerebeloso (uni o bilateral) en secuencias T2 y FLAIR y posible dilatación triventricular. El tratamiento es con corticoides a dosis altas y puede precisar derivación ventricular externa y cirugía descompresiva

Introduction: Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. Methods: We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. Results: Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. Conclusions: Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery

Methodology for the non-destructive characterization of jadeite-jade for archaeological studies.

The present paper proposes a methodology that complies with the requirements of identifying and characterizing jadeite (and its associated minerals) for archaeological studies, avoiding the acquisition of samples and ensuring the integrity of the object. The methodology exploits a carefully selected array of techniques (optical microscopy, UV fluorescence photography, X-Ray digital radiography, infrared and Raman spectroscopies, X-Ray fluorescence and particle induced X-ray emission spectroscopies) that, despite not definitively replacing laboratory procedures, provides a first mineral and elemental evaluation of jadeite archaeological objects. The proposed methodology was applied in the characterization of twelve different jade tones, allowing the identification of major - jadeite, albite and omphacite - and minor - pumpellyite, actinolite, analcime, rutile, grossular and titanite - mineral phases. To display its advantages and limitations, this methodology was also compared with a characterization employing specific gravity measurements and with an invasive methodology based on petrography and scanning electron microscopy with energy dispersive spectroscopy.

Acute cerebellitis in paediatric patients: Our experience. / Cerebelitis aguda en Pediatría: nuestra experiencia.

INTRODUCTION: Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. METHODS: We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. RESULTS: Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. CONCLUSIONS: Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery.

[Neurofibromatosis type 1 and attention-deficit disorder. Our current experience]. / Neurofibromatosis tipo 1 y trastorno por deficit de atencion. Nuestra experiencia actual.

INTRODUCTION: Patients with neurofibromatosis type 1 (NF1) have a high predisposition to develop attention-deficit disorder. The aim of this study is to determine the prevalence of NF1 patients with attention-deficit/hyperactivity disorder (ADHD) diagnosis attending our Child Neurology Department. We assess patient adherence and medical treatment outcomes. PATIENTS AND METHODS: Identification of patients with NF1 being followed up from December 31 2015 to June 31 2017 with ADHD diagnosis. Clinical and treatment data were collected. RESULTS: 56 patients with NF1 were enrolled in the study with a mean age of 9.83 ± 4.17 years. 23 patients (41%) were diagnosed with ADHD, mean age at ADHD diagnosis of 7.53 ± 2.46 years. School-age children with ADHD represented 48.8% of cases. All but one of the children received treatment, mean duration of treatment was 3.85 ± 3.04 years. 19 out of 22 patients (86%) continue medical treatment. Positive effects were reported by eleven patients with a moderate response in eight patients. CONCLUSIONS: Prevalence of ADHD in patients with NF1 is high. Early diagnosis and treatment of ADHD in patients with NF1 is highlighted by this study. Our study reveals good patient adherence and medical treatment outcomes in most patients.

TITLE: Neurofibromatosis tipo 1 y trastorno por deficit de atencion. Nuestra experiencia actual.Introduccion. Los pacientes con neurofibromatosis de tipo 1 (NF1) tienen una gran predisposicion a desarrollar deficit de atencion. El objetivo del estudio es determinar los pacientes controlados en nuestra seccion de neuropediatria con NF1 y diagnostico de trastorno por deficit de atencion/hiperactividad (TDAH), valorando la adhesion y respuesta al tratamiento. Pacientes y metodos. Se identifica a los pacientes afectos de NF1 que siguen controlados entre el 31 de diciembre de 2015 y el 31 de junio de 2017, y de ellos, los que presentan diagnostico de TDAH, revisando datos clinicos y de tratamiento. Resultados. Se ha controlado a 56 pacientes afectos de NF1, con una edad media de 9,83 ± 4,17 años. De ellos, 23 (41%) presentan diagnostico clinico de TDAH, con una edad media de 7,53 ± 2,46 años en el momento del diagnostico. El 48,8% de los niños en edad escolar esta afecto de TDAH. Todos los pacientes menos uno recibieron tratamiento con estimulantes, con un tiempo medio de tratamiento de 3,85 ± 3,04 años. Continuan con el tratamiento 19 pacientes de los 22 tratados (86%). Once casos refieren una clara mejoria, y ocho, una mejoria moderada. Conclusiones. El TDAH es muy prevalente en niños con NF1. Se destaca la importancia de la identificacion y el tratamiento del TDAH en niños afectos de NF1. Nuestra revision muestra una buena adhesion al tratamiento con estimulantes, con mantenida buena respuesta en la mayor parte de los casos.

Alteraciones auditivas y desarrollo del lenguaje en niños con síndrome de Down: revisión sistemática de la literatura / Auditory alterations and language development in children with Down syndrome: Systematic review

Introducción: El síndrome de Down (SD) es la anormalidad cromosómica más frecuente; hasta dos tercios de los niños con SD presenta una posible pérdida auditiva que puede comprometer el desarrollo del lenguaje. El objetivo de esta revisión es describir la prevalencia de la pérdida auditiva en niños con SD, los factores de riesgo y su relación con el desarrollo del lenguaje. Metodología: Revisión sistemática de la literatura. Se identificaron 69 artículos a través de las bases de datos PubMed, Science Direct y Scopus. En función de los criterios de inclusión, se escogieron 35 artículos. Resultados: La prevalencia de pérdida auditiva en niños con SD oscila entre el 34 y el 36%. La alteración de tipo conductivo asociada a otitis media con efusión y un canal auditivo estrecho son los factores de riesgo más frecuentes. La implantación de tubos de timpanostomía demuestra unos índices de curación de la otitis media y una mejoría de la agudeza auditiva significativamente menores que en la población general. Otro tipo de implantes, como el BAHA (bone anchored hearing aids) y el coclear, muestran beneficios sobre la calidad de vida y el desempeño físico y social; sin embargo, los estudios realizados al respecto adolecen de una muestra limitada que no permite sacar conclusiones. Finalmente, no existe evidencia de una relación directa entre la pérdida auditiva y el desarrollo del lenguaje en niños con SD. Conclusiones: Se debe realizar un cribado auditivo en el periodo neonatal y un seguimiento con un diagnóstico adecuado de las in-fecciones del oído durante toda la infancia en los niños con SD, lo que permitiría establecer un tratamiento apropiado y disminuir las posibles alteraciones del lenguaje (AU)

Introduction: Down syndrome (DS) is the most frequent chromosomal abnormality; nearly two-thirds of children with DS may develop hearing loss and delayed or abnormal language development. The aim of this review was to describe the frequency of hearing loss in children with DS, its relationship with language development and risk factors for its clinical presentation. Methodology: Systematic review of literature. 69 articles were identified through database searching on PubMed and Scopus. 35 articles met selection and inclusion criteria. Results: The prevalence of hearing loss in children with DS ranges between 34% and 36%. Conductive hearing loss is frequently as-sociated with effusive otitis media, and a narrow auditory canal. The implantation of tympanostomy tubes showed lower success rates in otitis media and improvement of hearing in comparison to healthy children. Other type of hearing aids such as BAHA (bone an-chored hearing aids) and cochlear implants have shown possible benefits in quality of life, physical and social performance. Finally, there is no evidence of a direct relation between hearing loss or other disabilities in language development in these children. Conclusions: Hearing screening should be done in the neonatal period and follow-up with a timely diagnosis of childhood ear infections in children with DS in order to provide accurate and timely interventions (AU)