Incidence and Severity of Community- and Hospital-Acquired Hyponatremia in Pediatrics.

Hyponatremia is the most common electrolyte disturbance in hospitalized children, with a reported incidence of 15-30%, but its overall incidence and severity are not well known. The objective of our study was to determine the incidence, severity, and associated risk factors of community- and hospital-acquired hyponatremia on a general pediatric ward. Data of 5550 children admitted from June 2012 to December 2019 on plasma sodium and discharge diagnosis were analyzed by logistic regression model. Clinically relevant diagnostic groups were created. Hyponatremia was classified as mild, moderate, and severe. The incidence of community- and hospital-acquired hyponatremia was 15.8% and 1.4%, respectively. Most of the cases were mild (90.8%) to moderate (8.6%), with only two cases of severe community-acquired hyponatremia. There were no clinical complications in any of the hyponatremic children. Age and diagnosis at discharge were principal factors significantly correlated with hyponatremia. Community-acquired hyponatremia is more common than hospital-acquired hyponatremia in clinical practice. Severe cases of both types are rare. Children from 2 to 11 years of age presenting with infections, cardiovascular disorders, and gastrointestinal disorders are at risk of developing hyponatremia.

Mortality predictors in patients with COVID-19 pneumonia: a machine learning approach using eXtreme Gradient Boosting model.

Recently, global health has seen an increase in demand for assistance as a result of the COVID-19 pandemic. This has prompted many researchers to conduct different studies looking for variables that are associated with increased clinical risk, and find effective and safe treatments. Many of these studies have been limited by presenting small samples and a large data set. Using machine learning (ML) techniques we can detect parameters that help us to improve clinical diagnosis, since they are a system for the detection, prediction and treatment of complex data. ML techniques can be valuable for the study of COVID-19, especially because they can uncover complex patterns in large data sets. This retrospective study of 150 hospitalized adult COVID-19 patients, of which we established two groups, those who died were called Case group (n = 53) while the survivors were Control group (n = 98). For analysis, a supervised learning algorithm eXtreme Gradient Boosting (XGBoost) has been used due to its good response compared to other methods because it is highly efficient, flexible and portable. In this study, the response to different treatments has been evaluated and has made it possible to accurately predict which patients have higher mortality using artificial intelligence, obtaining better results compared to other ML methods.

Diseño y validación de una escala observacional sobre el estilo motivador docente / Desenho e validação de uma escala observacional sobre o estilo de ensino motivador / Design and validation of a scale for measuring motivational teaching style

La metodología observacional permite analizar el estilo motivacional que despliega el docente en clase y proporciona una nueva perspectiva para interpretar la influencia de las interacciones docentes en el proceso de instrucción. El objetivo de este trabajo fue diseñar una escala de estimación ad hoc para la Medida del Estilo Interpersonal Docente (MEID) y validarla Participaron 30 docentes universitarios (16 mujeres y 14 hombres) con una edad media de 46.1 años (DT = 5.8) y con una experiencia docente de 15.71 años (DT = 6.9). La calidad del dato fue alcanzada a través de la técnica de validez de contenido y el aspecto cuantitativo fue tratado por medio del análisis del W de Kendall, ajustando un modelo final de 60 ítems agrupados en 4 dimensiones exhaustivas y mutuamente excluyentes: apoyo a la autonomía, apoyo a la estructura antes de la tarea, apoyo a la estructura durante la tarea y apoyo a la relación. Las evidencias iniciales de la escala MEID lo presentan como un instrumento psicométrico robusto y fiable para poder ser empleado como técnica observacional del estilo interpersonal docente. Los resultados obtenidos abren nuevas líneas de estudio en las que la escala MEID podría ser empleada en programas formativos encaminados a la optimización de patrones motivacionales docentes adaptativos. (AU)

The observational methodology allows the analysis of the motivational style displayed by the teacher in class and provides a new perspective to interpret the influence of teacher interactions in the instructional process. The aim of this work was to design an ad hoc estimation scale for the Measure of Interpersonal Teaching Style (MEID) and to validate it. 30 university teachers (16 women and 14 men) with a mean age of 46.1 years (SD = 5.8) and with a teaching experience of 15.71 years (SD = 6.9) participated. Data quality was achieved through the content validity technique by expert judgment and the quantitative aspect was treated through Kendall's W analysis, fitting a final model of 60 items grouped into 4 exhaustive and mutually exclusive dimensions: autonomy support, pre-task structure support, on-task structure support, and relationship support. The initial evidence of the MEID scale presents it as a robust and reliable psychometric instrument to be used as an observational technique of interpersonal teaching style. The results obtained open new lines of study in which the MEID scale could be used in training programs aimed at optimizing adaptive motivational teaching patterns. (AU)

A metodologia observacional permite-nos analisar o estilo motivacional que os professores exibem na aula e fornece uma nova perspectiva para interpretar a influência das interacções dos professores no processo instrucional. O objectivo deste trabalho era conceber uma escala de estimativa ad hoc para a Medida de Estilo de Ensino Interpessoal (MEID) e validá-la. Trinta professores universitários (16 mulheres e 14 homens) com uma idade média de 46,1 anos (SD = 5,8) e com uma experiência de ensino de 15,71 anos (SD = 6,9) participaram no estudo. A qualidade dos dados foi conseguida através da técnica de validade do conteúdo através do julgamento de peritos e o aspecto quantitativo foi tratado através da análise W de Kendall, encaixando um modelo final de 60 itens agrupados em 4 dimensões exaustivas e mutuamente exclusivas: suporte de autonomia, suporte de estrutura pré-tarefa, suporte de estrutura na tarefa, e suporte de relacionamento. A evidência inicial da escala MEID apresenta-a como um instrumento psicométrico robusto e fiável para ser utilizado como uma técnica de observação do estilo de ensino interpessoal. Os resultados obtidos abrem novas linhas de estudo nas quais a escala MEID poderia ser utilizada em programas de formação destinados a optimizar os padrões motivacionais adaptativos nos profesores. (AU)

Systemic oxytocin increases glutamate efflux in the nucleus accumbens core of cocaine-experienced male and female rats but only increases dopamine efflux in males.

Oxytocin attenuates cocaine-seeking when administered both systemically and directly into the nucleus accumbens core. This effect is blocked by intra-accumbens antagonism of mGlu2/3 and, together with our finding that intra-accumbens oxytocin increases glutamate concentrations in this brain region, indicates that pre-synaptic regulation of glutamate release by oxytocin influences cocaine relapse. However, mGlu2/3 receptors also regulate dopamine release in the nucleus accumbens. Here we aimed to determine whether systemic oxytocin increases glutamate and dopamine concentrations in the nucleus accumbens core of cocaine-experienced and cocaine-naïve male and female rats. A subset of rats self-administered cocaine (0.5 mg/kg/infusion) and then underwent extinction training for 2-3 weeks. Rats were implanted with microdialysis probes in the accumbens core and samples were collected for a baseline period, and following saline (1 mL/kg), and oxytocin (1 mg/kg, IP) injections. Locomotion was assessed during microdialysis. In cocaine-experienced rats, oxytocin increased glutamate concentrations in the accumbens core to the same extent in males and females but only increased dopamine concentrations in male rats. Oxytocin did not alter glutamate levels in cocaine-naïve rats. Oxytocin did not produce sedation. These results extend previous findings that systemic oxytocin increases nucleus accumbens dopamine in a sex-specific manner in cocaine-experienced rats. These data are the first to find that systemic oxytocin increases nucleus accumbens glutamate after cocaine experience, providing a mechanism of action by which oxytocin attenuates the reinstatement of cocaine seeking in both male and female rats.

Bemiparin as a long-term treatment for venous thrombosis in cancer patients: the ELEBAMA study.

INTRODUCTION: Low-molecular-weight heparin (LMWH) is the standard treatment for cancer-associated venous thromboembolism (VTE). There have been no specific studies evaluating bemiparin for VTE in people with cancer. The aim of this study is to evaluate the effects of bemiparin for long-term treatment of VTE in routine clinical practice. METHODS/PATIENTS: Prospective observational study. Consecutive patients with active cancer and VTE, under treatment with bemiparin for at least 6 months, were recruited. RESULTS: We included 89 patients. The 6- and 9-month cumulative VTE recurrence rates were 2.4% and 5.9%, respectively. The 6-month cumulative rate of major bleeding was 1.3%, and of clinically relevant non-major bleeding, 8%. CONCLUSIONS: The incidence of events in this study is lower than that reported in randomized trials. Bemiparin is effective and safe for the long-term treatment of cancer-associated VTE in routine clinical practice.

A comparison of two clinical scores for bronchiolitis. A multicentre and prospective study conducted in hospitalised infants.

BACKGROUND: There are a number of clinical scores for bronchiolitis but none of them are firmly recommended in the guidelines. METHOD: We designed a study to compare two scales of bronchiolitis (ESBA and Wood Downes Ferres) and determine which of them better predicts the severity. A multicentre prospective study with patients <12 months with acute bronchiolitis was conducted. Each patient was assessed with the two scales when admission was decided. We created a new variable "severe condition" to determine whether one scale afforded better discrimination of severity. A diagnostic test analysis of sensitivity and specificity was made, with a comparison of the AUC. Based on the optimum cut-off points of the ROC curves for classifying bronchiolitis as severe we calculated new Se, Sp, LR+ and LR- for each scale in our sample. RESULTS: 201 patients were included, 66.7% males and median age 2.3 months (IQR=1.3-4.4). Thirteen patients suffered bronchiolitis considered to be severe, according to the variable severe condition. ESBA showed a Se=3.6%, Sp=98.1%, and WDF showed Se=46.2% and Sp=91.5%. The difference between the two AUC for each scale was 0.02 (95%CI: 0.01-0.15), p=0.72. With new cut-off points we could increase Se and Sp for ESBA: Se=84.6%, Sp=78.7%, and WDF showed Se=92.3% and Sp=54.8%; with higher LR. CONCLUSIONS: None of the scales studied was considered optimum for assessing our patients. With new cut-off points, the scales increased the ability to classify severe infants. New validation studies are needed to prove these new cut-off points.

Atypical eye lesion in a human immunodeficiency virus-positive patient.

AIDS-related Kaposi sarcoma (KS), nowadays known to be an angioproliferative disease, occurs in several clinical-epidemiological forms, all of which are associated with infection by human herpesvirus-8. KS can affect the eye, with the bulbar conjunctiva and lacrimal gland being rare sites of occurrence. We present a case of AIDS-related KS of the conjunctiva and also discuss recent literature.

Herpes zóster en pediatría. Revisión de la bibliografía a propósito de un caso / Herpes zoster in pediatrics. Case report and review of the literature

El herpes zóster está producido por la reactivación del virus de la varicela zóster tras una primoinfección varicelosa. Es infrecuente en pediatría. En la mayoría de las ocasiones que aparece en niños, tiene unas manifestaciones benignas en comparación con los adultos. El diagnóstico es clínico y los estudios de laboratorio no suelen ser necesarios. El tratamiento debería ser sintomático en la mayoría de los pacientes, reservándose el aciclovir oral o intravenoso para situaciones de riesgo. Respecto a otros antivirales empleados en adultos, debido a la falta de estudios al respecto, no existe consenso sobre su uso en niños. Aprovechamos la comunicación de un caso clínico para hacer una revisión y actualización del tema, incidiendo sobre todo en los aspectos diagnósticos y terapéuticos (AU)

Herpes zoster or shingles is caused by reactivation of varicella-zoster virus long time after the primary infection, varicella. It is unusual in pediatrics. Contrary to the way it can affect adults zoster manifestation is mild if it appears in children. Diagnosis is based on distinctive clinical appearance and laboratory tests are not usually required. Symptomatic treatment of skin lesions should be the best choice to take while systemic oral or intravenous acyclovir should be restricted only to special cases. Regarding other antiviral drugs of proved efficacy in adults, no evidence is gathered for their use in children. To sum up, our main aim is to review and update this subject stressing diagnosis and treatment (AU)

Fibroma desmoplásico de la mandíbula: un tumor de presentación muy infrecuente / Desmoplastic fibroma of the jaw: a rare kind of tumour

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No disponible

In vivo evaluation of a new sustained-release formulation of morphine.

The pharmacokinetics of a novel sustained-release oral formulation of morphine have been evaluated. The formulation consisted of tablets containing a morphine-EudragitL complex (MEC) which had shown good sustained-release properties in previous in vitro dissolution studies. MEC tablets were administered orally to beagle dogs and the morphine plasma levels and pharmacokinetic parameters obtained were compared with those obtained with MST Continus, a commercially available sustained release form of morphine. Blood samples were withdrawn up to 12 h after dosing and plasma morphine concentrations were determined by HPLC with electrochemical detection. Both formulations presented a relatively rapid absorption of morphine with similar values of Cmax (MST: 53 ng/ml; MEC: 50 ng/ml) and Tmax (MST: 86 min; MEC: 88 min), and prolonged morphine plasma levels. Mean plasma morphine concentrations were higher for the MEC tablets than for MST tablets during the terminal phase of the corresponding curves and the mean AUC(0-12h) for MEC tablets was 138% of that obtained with MST tablets. Our findings indicate that MEC tablets can produce prolonged plasma levels of morphine and could be an alternative to commercially available morphine sustained-release forms.

Pharmacokinetic interaction between efavirenz and ketoconazole in rats.

1. It is well known that efavirenz and ketoconazole act as an inducer and inhibitor of CYP3A4, respectively. As a result of these actions, co-administration of these drugs may result in changes in the pharmacokinetic parameters of one or both of them. 2. Duodenum-cannulated rats have been used to compare the effect of intraduodenal (KC(i.d.)) and intravenous administration of ketoconazole (KC(i.v.)) on the pharmacokinetics of efavirenz after intraduodenal administration, as well as the potential effect of efavirenz as a CYP450 inducer on ketoconazole pharmacokinetic profile. 3. While KC(i.v.) did not show any significant effect on efavirenz pharmacokinetic profile, KC(i.d.) increased significantly (p < 0.05) the peak concentration (C(max)) and the area under the plasma concentration-time curve (AUC) of efavirenz by 25.5% and 44.5%, respectively. In addition, the time necessary to reach peak concentration (T(max)) increased markedly by 71%. However, the mean total clearance (CL/F) of efavirenz was significantly decreased by 45%. Efavirenz did not produce any alteration in ketoconazole pharmacokinetics. 4. These findings suggest that when the treatment starts with enteral administration of ketoconazole, the inhibitor effect on CYP450 prevails over the inducer effect of efavirenz.

Pubertad precoz completa isosexual: hallazgos clínicos, de laboratorio y ecografía pélvica / Complete isosexual precocious puberty: clinical, pelvic ultrasound and laboratory features

Objetivo: El objetivo de este estudio ha sido determinar si la forma de presentación inicial de la pubertad precoz central (PPC) varía en relación con la etiología y permite el diagnóstico diferencial entre formas idiopáticas y orgánicas (neurogénicas), lo que haría innecesarias las pruebas de imagen del sistema nervioso central (SNC) en determinados pacientes. Pacientes y métodos: Los niños con PPC evaluados fueron incluidos de forma consecutiva en un estudio prospectivo observacional. Se recogieron los hallazgos clínicos, de laboratorio y ecográficos. Se compararon los hallazgos de PPC idiopática (3 niños y 49 niñas) y orgánica (2 niños y 8 niñas). Resultados: No hubo diferencias en cuanto al estadio puberal, edad de inicio puberal (7,0 [5,8-7,5] frente a 7,3 [5,1-8,3] años), cociente edad ósea/edad cronológica (1,26 [1,2-1,3] frente a 1,23 [1,1-1,3]) y menarquia materna (11,7 ± 0,2 frente a 11,7 ± 0,6 años) entre PPC idiopática y orgánica, respectivamente. Los pacientes con PPC orgánica presentaron una menor desviación estándar (DE) de la talla (0,35 ± 0,4 frente a 1,6 ± 0,1; p < 0,01), predicción de talla adulta y DE de la velocidad de crecimiento (0,8 ± 0,9 frente a 3,7 ± 0,7). Las niñas con PPC orgánica presentaban de forma significativa unas mayores concentraciones plasmáticas de estradiol (47,5 [25-68] frente a 27 [14-43] pg/ml) que las niñas con PPC idiopática. La ecografía pélvica realizada en el momento del diagnóstico reveló la presencia de cambios puberales en genitales internos en el 43,9 % de las niñas (el 37,2 % en la subpoblación con PPC idiopática frente al 62,5 % en el grupo de PPC orgánica; p = 0,18). Conclusiones: Existe un solapamiento clínico-ecográfico entre PPC idiopática y orgánica. Las pruebas de imagen del SNC siguen siendo necesarias en todos los casos de PPC y los estudios ecográficos no pueden sustituir a otras investigaciones diagnósticas (AU)

Objective: To determine whether initial presentation varies according to aetiology, whether such differences allow differential diagnosis between idiopathic and organic forms, and whether CNS imaging can be avoided in some patients with central precocious puberty (CPP). Patients and methods: Children referred for evaluation of precocious puberty were evaluated, and the subpopulation of children with CPP was enrolled in this prospective observational study. Clinical, laboratory and ultrasound features of 62 consecutive patients with CPP (5 boys and 57 girls) were recorded. We compared the characteristics of idiopathic (3 boys, 49 girls) and organic (2 boys, 8 girls) CPP. Results: There were no differences in pubertal staging, age at puberty onset (7.0 [5.8-7.5] vs. 7.3 [5.1-8.3] years), bone age/chronological age ratio (1.26 [1.2-1.3] vs. 1.23 [1.1-1.3]), maternal menarche (11.7 ± 0.2 vs. 11.7 ± 0.6 years) between idiopathic and organic CPP, respectively. Organic CPP patients had a poorer height SD (0.35 ± 0.4 vs. 1.6 ± 0.1; p < 0.01), predicted adult height, growth rate and growth rate SD (0.8 ± 0.9 vs. 3.7 ± 0.7). Girls with organic CPP had significantly higher oestradiol levels (47.5 [25-68] vs. 27 [14-43] pg/ml) than girls with idiopathic CPP. Pelvic ultrasound at the time of diagnosis revealed the presence of pubertal changes in internal genitalia in 43.9 % of girls (37.2 % idiopathic versus 62.5 % organic CPP subpopulation; p=0.18). Conclusions: There is a clinical-ultrasound overlap between idiopathic and organic CPP. Imaging remains necessary in all cases of central precocious puberty, and ultrasound data should not be replaced by other diagnostic investigations (AU)

Similarity and discrimination learning in humans.

In an experiment involving a new behavioural preparation the role played by similarity in discrimination learning was examined using visual patterns (i.e., paintings) that might share common elements (specifically, A, BC, and ABC). A-C were small stars of three specific colours (target colours), which were intermixed with other stars of two different colours (distracting colours). The target colours were balanced through A-C. Students received discrimination training in which a fictitious painter was the author of paintings A and BC, while paintings ABC were assigned to a second fictitious painter. During training, the students had to make a choice, in the presence of each pattern, between two response keys, each of them indicating one of the painters. The time taken to respond was also measured. Feedback was always given after each key-press. The results showed that while at times the A+ ABC- discrimination was acquired more readily than was the BC+ ABC- discrimination, on other occasions the reverse was also true, the critical factor being the way in which the colours were combined.

[Complete isosexual precocious puberty: clinical, pelvic ultrasound and laboratory features]. / Pubertad precoz completa isosexual: hallazgos clínicos, de laboratorio y ecografía pélvica.

OBJECTIVE: To determine whether initial presentation varies according to aetiology, whether such differences allow differential diagnosis between idiopathic and organic forms, and whether CNS imaging can be avoided in some patients with central precocious puberty (CPP). PATIENTS AND METHODS: Children referred for evaluation of precocious puberty were evaluated, and the subpopulation of children with CPP was enrolled in this prospective observational study. Clinical, laboratory and ultrasound features of 62 consecutive patients with CPP (5 boys and 57 girls) were recorded. We compared the characteristics of idiopathic (3 boys, 49 girls) and organic (2 boys, 8 girls) CPP. RESULTS: There were no differences in pubertal staging, age at puberty onset (7.0 [5.8-7.5] vs. 7.3 [5.1-8.3] years), bone age/chronological age ratio (1.26 [1.2-1.3] vs. 1.23 [1.1-1.3]), maternal menarche (11.7+/-0.2 vs. 11.7+/-0.6 years) between idiopathic and organic CPP, respectively. Organic CPP patients had a poorer height SD (0.35+/-0.4 vs. 1.6+/-0.1; p<0.01), predicted adult height, growth rate and growth rate SD (0.8+/-0.9 vs. 3.7+/-0.7). Girls with organic CPP had significantly higher oestradiol levels (47.5 [25-68] vs. 27 [14-43] pg/ml) than girls with idiopathic CPP. Pelvic ultrasound at the time of diagnosis revealed the presence of pubertal changes in internal genitalia in 43.9% of girls (37.2% idiopathic versus 62.5% organic CPP subpopulation; p=0.18). CONCLUSIONS: There is a clinical-ultrasound overlap between idiopathic and organic CPP. Imaging remains necessary in all cases of central precocious puberty, and ultrasound data should not be replaced by other diagnostic investigations.

Brain ethanol levels in rats after voluntary ethanol consumption using a sweetened gelatin vehicle.

A novel procedure for initiation of voluntary ethanol consumption in the rat was evaluated in terms of ease of initiation, consistency, and resulting brain ethanol levels. The "jello shot" consists of 10% ethanol in gelatin along with a caloric source (Polycose). Initiation of "jello shot" consumption in Sprague-Dawley rats required no food or water restriction and resulted in initial daily (8.4+/-0.6 g/kg body weight) and eventual hourly (1.1+/-0.1 g/kg body weight) intake of ethanol comparable to other procedures using either alcohol-preferring or non-genetically selected rats. Rat intake of ethanol via "jello shots" recovered quickly from environmental alterations and surgical implantation of a guide cannula. During 1-h free access sessions, consumption of the "jello shot" occurred during the initial 10 min and resulted in a dose-related increase in ethanol levels in nucleus accumbens measured using microdialysis. These brain ethanol levels were comparable to those achieved using other self-administration methods. However, when 0.5 g/kg ethanol was gavaged either in "jello shot" or saline, there was about a 20% decrease in brain ethanol concentrations after gavage of the "jello shot" compared to saline. Even so, lack of a need for initial food or water deprivation and the rapidity with which stable self-administration can be achieved both suggest utility of the "jello shot" as a completely voluntary ethanol procedure.

Patología infecciosa periamigdalina en pediatría: actualización del tema / Peritonsillar infectious disease in pediatrics: review

El flemón y el absceso periamigdalinos son pocofrecuentes en la edad pediátrica, conociéndose biensu etiología y manifestaciones clínicas. Su manejoinicial es llevado a cabo en los servicios de urgenciapor parte de pediatras y otorrinolaringólogos paracon posterioridad y ya con el paciente ingresado instaurarun tratamiento definitivo. Ciertos aspectos referentesa su diagnóstico y tratamiento no gozan deunanimidad de criterios. En este trabajo hemos pretendidoactualizar los avances desarrollados en estapatología y sobre todo tratar de unificar criterios respectoa su manejo diagnóstico y terapéutico

Peritonsillar cellulitis and peritonsillar abscess areuncommon in paediatric population. Aetiology andclinical manifestations are well known. Its first assintanceis done by paediatricians and otorhinolaryngologistsin emergency departments and a definitivetreatment is started after the patient is admitted. Someaspects around diagnosis and treatment remainunclear and no consensus exist. In this report afteran exhaustive review of the literature we pretend toupdate the knowlegement and getting an standardway of managing on this illness