A fully automatic method for vascular tortuosity feature extraction in the supra-aortic region: unraveling possibilities in stroke treatment planning.

Vascular tortuosity of supra-aortic vessels is widely considered one of the main reasons for failure and delays in endovascular treatment of large vessel occlusion in patients with acute ischemic stroke. Characterization of tortuosity is a challenging task due to the lack of objective, robust and effective analysis tools. We present a fully automatic method for arterial segmentation, vessel labelling and tortuosity feature extraction applied to the supra-aortic region. A sample of 566 computed tomography angiography scans from acute ischemic stroke patients (aged 74.8 ± 12.9, 51.0% females) were used for training, validation and testing of a segmentation module based on a U-Net architecture (162 cases) and a vessel labelling module powered by a graph U-Net (566 cases). Successively, 30 cases were processed for testing of a tortuosity feature extraction module. Measurements obtained through automatic processing were compared to manual annotations from two observers for a thorough validation of the method. The proposed feature extraction method presented similar performance to the inter-rater variability observed in the measurement of 33 geometrical and morphological features of the arterial anatomy in the supra-aortic region. This system will contribute to the development of more complex models to advance the treatment of stroke by adding immediate automation, objectivity, repeatability and robustness to the vascular tortuosity characterization of patients.

Patients receiving a high burden of antibiotics in the community in Spain: a cross-sectional study.

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient's average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally.

[Transcranial direct current stimulation and speech therapy intervention in people with aphasia: a systematic review of the literature]. / Estimulación de corriente continua transcraneal e intervención logopédica en personas con afasia: revisión sistemática de la bibliografía.

INTRODUCTION: The recovery of aphasia may require adjuvant therapies to speech therapy rehabilitation. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulatory technique that can be used to improve cortical brain activity. AIM: To offer an overview of the tDCS in people with aphasia from a speech therapy point of view. PATIENTS AND METHODS: Thirty-five studies have been analyzed that performed online interventions (the application of tDCS in conjunction with any type of aphasia therapy) and offline interventions (performing speech therapy training before or after tDCS stimulation). The studies were published during the last ten years (January 2009-2019). PubMed, Scopus and Embase databases were reviewed in the analysis. RESULTS: Most studies include heterogeneous samples without taking into account the symptoms of each type of aphasia and without individualizing the treatments used. Anomie is the most commonly treated language deficit. CONCLUSIONS: It is better to perform tDCS in conjunction with online speech therapy. The tDCS is a technique that can help improve the language deficits of people with aphasia. Speech therapy interventions based on neuroscientific knowledge that have an impact on the daily life of people with aphasia should be performed.

TITLE: Estimulación de corriente continua transcraneal e intervención logopédica en personas con afasia: revisión sistemática de la bibliografía.Introducción. La recuperación de la afasia podría requerir terapias adyuvantes a la rehabilitación logopédica. La estimulación de corriente continua transcraneal (tDCS) es una técnica neuromoduladora no invasiva que se puede usar para mejorar la actividad cerebral cortical. Objetivos. Ofrecer una visión general sobre la tDCS en personas con afasia desde una visión logopédica. Pacientes y métodos. Se han analizado 35 estudios que realizaban intervenciones online (la aplicación de la tDCS junto con cualquier tipo de terapia de la afasia), así como intervenciones offline (realización de entrenamiento logopédico antes o después de la tDCS). Los estudios se publicaron durante los últimos 10 años (enero de 2009 a enero de 2019). En el análisis se revisaron las bases de datos PubMed, Scopus y Embase. Resultados. La mayoría de los estudios incluye muestras heterogéneas, sin tener en cuenta la sintomatología propia de cada tipo de afasia y sin individualizar los tratamientos empleados. La anomia es el déficit lingüístico que más se ha tratado. Conclusiones. Es mejor realizar la tDCS junto con terapia logopédica online. La tDCS es una técnica que puede ayudar a mejorar los déficits del lenguaje de las personas con afasia. Se deben realizar intervenciones logopédicas basadas en conocimientos neurocientíficos que tengan una repercusión en la vida cotidiana de la personas con afasia.

Estimulación de corriente continua transcraneal e intervención logopédica en personas con afasia: revisión sistemática de la bibliografía / Transcranial direct current stimulation and speech therapy intervention in people with aphasia: a systematic review of the literatura

INTRODUCCIÓN: La recuperación de la afasia podría requerir terapias adyuvantes a la rehabilitación logopédica. La estimulación de corriente continua transcraneal (tDCS) es una técnica neuromoduladora no invasiva que se puede usar para mejorar la actividad cerebral cortical. OBJETIVOS: Ofrecer una visión general sobre la tDCS en personas con afasia desde una visión logopédica. PACIENTES Y MÉTODOS: Se han analizado 35 estudios que realizaban intervenciones online (la aplicación de la tDCS junto con cualquier tipo de terapia de la afasia), así como intervenciones offline (realización de entrenamiento logopédico antes o después de la tDCS). Los estudios se publicaron durante los últimos 10 años (enero de 2009 a enero de 2019). En el análisis se revisaron las bases de datos PubMed, Scopus y Embase. RESULTADOS: La mayoría de los estudios incluye muestras heterogéneas, sin tener en cuenta la sintomatología propia de cada tipo de afasia y sin individualizar los tratamientos empleados. La anomia es el déficit lingüístico que más se ha tratado. CONCLUSIONES: Es mejor realizar la tDCS junto con terapia logopédica online. La tDCS es una técnica que puede ayudar a mejorar los déficits del lenguaje de las personas con afasia. Se deben realizar intervenciones logopédicas basadas en conocimientos neurocientíficos que tengan una repercusión en la vida cotidiana de la personas con afasia

INTRODUCTION: The recovery of aphasia may require adjuvant therapies to speech therapy rehabilitation. Transcranial direct current stimulation (tDCS) is a non-invasive euromodulatory technique that can be used to improve cortical brain activity. AIM: To offer an overview of the tDCS in people with aphasia from a speech therapy point of view. PATIENTS AND METHODS: Thirty-five studies have been analyzed that performed online interventions (the application of tDCS in conjunction with any type of aphasia therapy) and offline interventions (performing speech therapy training before or after tDCS stimulation). The studies were published during the last ten years (January 2009-2019). PubMed, Scopus and Embase databases were reviewed in the analysis. RESULTS: Most studies include heterogeneous samples without taking into account the symptoms of each type of aphasia and without individualizing the treatments used. Anomie is the most commonly treated language deficit. CONCLUSIONS: It is better to perform tDCS in conjunction with online speech therapy. The tDCS is a technique that can help improve the language deficits of people with aphasia. Speech therapy interventions based on neuroscientific knowledge that have an impact on the daily life of people with aphasia should be performed

[Progressive multifocal leukoencephalopathy and non-specific immune dysfunction]. / Leucoencefalopatia multifocal progresiva y disfuncion inmune no especificada.

TITLE: Leucoencefalopatia multifocal progresiva y disfuncion inmune no especificada.

Reliability of the early syndromic diagnosis in adults with new-onset epileptic seizures: A retrospective study of 116 patients attended in the emergency room.

PURPOSE: New-onset seizures (NOS) are a common reason for emergency department (ED) consultations. Decisions regarding treatment and further examinations are made based on the initial evaluation. We aimed to evaluate the reliability of the early syndromic diagnosis in NOS and find predictive factors to establish a consistent early diagnosis based on the semiology and prompt supplementary examinations. METHODS: We recruited patients attended in our ED for NOS over 2 years (2014-2015), excluding patients with a loss of consciousness of suspected non-epileptic origin. All patients were assessed by a neurologist. A baseline diagnosis was established according to clinical findings and neuroimaging/EEG data. Over 1 year of follow-up in our Epilepsy Unit, a definite diagnosis was made based on clinical progress and further examinations. RESULTS: 116 patients were recruited (mean age 56.5 ±â€¯22.1 years; 50% women). 47% were seizures of unknown cause. The concordance index between the baseline and definite diagnosis was κ = 0.662 (the diagnosis changed during follow-up in 25% of patients). Focal epilepsy of unknown cause was the baseline diagnosis that most often changed at follow-up (diagnostic change, 41.2%; p < 0.001). Lesions detected on CT-scanning and EEG abnormalities predicted the final diagnosis with the greatest accuracy (p = 0.009 and p = 0.026, respectively). Pathological findings in the MRI studies performed and seizure recurrence were not key factors for diagnostic changes. CONCLUSION: Despite prompt examinations, the baseline epilepsy diagnosis changes within a short time period in 25% of patients. The presence of neuroimaging lesions and EEG abnormalities was associated with the greatest diagnostic accuracy in these cases.

[Moyamoya disease: clinical, neuroradiological, neuropsychological and genetic perspective]. / Enfermedad de moyamoya: aspectos clinicos, neurorradiologicos, neuropsicolologicos y geneticos.

INTRODUCTION: Moyamoya disease (MMD) is an occlusive cerebrovascular disease characterized by progressive stenosis or occlusion in the terminal portion of the bilateral internal carotid arteries, affecting both children and adults. AIM: To conduct a review and update on MMD from a clinical, neuroradiological, neuropsychological and genetic perspective. DEVELOPMENT: In this pathology, which occurs with ischemia or cerebral hemorrhage, an unusual compensatory vascular network (moyamoya vessels) develops at the base of the brain in the form of collateral channels. MMD can present clinically with hemiparesis, dysarthria, aphasia, headache, seizures, visual deficits, syncopes or changes in personality. At the neuropsychological level, and even in the absence of obvious strokes, patients usually present impairment of attention, memory, behavior and executive functions. High resolution angiography and magnetic resonance imaging have been a neuroradiological advance towards an early detection of this disease. At the genetic level, the RING (really interesting new gene) RNF213 has recently been identified, and it is considered the most important genetic risk factor known up to now in the MMD. CONCLUSIONS: MMD is a rare pathology that predominantly affects the frontal lobes. The genetic and neuroradiological advances, in addition to a cognitive profile, contribute to early diagnosis and treatment to improve the quality of life of these patients.

TITLE: Enfermedad de moyamoya: aspectos clinicos, neurorradiologicos, neuropsicolologicos y geneticos.Introduccion. La enfermedad de moyamoya (EMM) es una enfermedad cerebrovascular oclusiva caracterizada por estenosis progresiva o la oclusion en la porcion terminal de las arterias carotidas internas bilaterales, que afecta tanto a niños como a adultos. Objetivo. Realizar una revision y actualizacion sobre la EMM desde una perspectiva clinica, neurorradiologica, neuropsicologica y genetica. Desarrollo. En esta patologia, que cursa con isquemia o hemorragia cerebral, se desarrolla una red vascular inusual compensatoria (vasos moyamoya) en la base del cerebro en forma de canales colaterales. La EMM puede cursar clinicamente con hemiparesia, disartria, afasia, cefalea, convulsiones, deficits visuales, sincopes o cambios en la personalidad. Neuropsicologicamente, y aun en ausencia de ictus evidentes, los pacientes suelen presentar afectacion de la atencion, memoria, conducta y funciones ejecutivas. La angiografia y la resonancia magnetica de alta resolucion han supuesto un avance neurorradiologico hacia una deteccion precoz de esta enfermedad. Recientemente se ha identificado el RING (really interesting new gene) RNF213, que se considera el factor genetico de riesgo mas importante conocido hasta ahora en la EMM. Conclusiones. La EMM es una patologia rara que afecta de forma predominante a los lobulos frontales. Los avances geneticos y neurorradiologicos, ademas de un perfil cognitivo, contribuyen a un diagnostico y tratamiento tempranos para mejorar la calidad de vida de estos pacientes.

Test rápido de detección de antígeno estreptocócico en faringoamigdalitis: impacto sobre el uso de antibióticos / Rapid streptococcal antigen detection test in pharyngitis: impact in antibiotic use

Objetivo: investigar el impacto de la utilización del test rápido de detección de antígeno estreptocócico sobre la prescripción de antibióticos en niños. Pacientes y métodos: estudio observacional, de cohortes retrospectivo, a partir de los registros clínicos informatizados de 10 cupos de Pediatría de centros de salud de la provincia de Zaragoza (España) en los años 2012 y 2013. Se hace una valoración del tratamiento antibiótico y de las complicaciones en el mes siguiente al episodio de faringoamigdalitis comparando los episodios en los que se realizó test rápido de detección de antígeno estreptocócico con los que no se realizó. Resultados: de 17 455 episodios registrados, se seleccionaron 851 que cumplían los criterios de inclusión (tres o cuatro criterios de Centor). En los episodios en los que se realizaron test rápidos de detección de antígeno, la reducción en la prescripción antibiótica fue del 42% (reducción absoluta de riesgo: 42%; intervalo de confianza del 95% [IC 95]: 37 a 48; p < 0,001). Comparando el abordaje entre los pediatras que disponían y utilizaban el test (4), con los que no (6), la reducción absoluta de riesgo fue del 29% (IC 95: 24 a 34; p < 0,001). Se presentaron complicaciones infecciosas en el 12% de los tratados y en el 8% de los no tratados (riesgo relativo: 1,49; IC 95: 0,88 a 2,52; p = 0,178). Se prescribió significativamente más penicilina V que amoxicilina cuando se realizó test diagnóstico (riesgo relativo: 1,30; IC 95: 1,10 a 1,55; p = 0,004). Conclusiones: en la práctica clínica, el uso de una prueba rápida de detección de antígeno en pacientes pediátricos preseleccionados por criterios clínicos de faringoamigdalitis estreptocócica contribuye de forma determinante al uso racional de antibióticos (AU)

Objective: to investigate the impact of rapid streptococcal antigen detection test use on antibiotic prescription in children. Patients and methods: observational, retrospective cohort study, based on the computer data from 10 pediatric health centre cohorts in Zaragoza (Spain) from 2012 and 2013. The prescription of antibiotics and complications in the ensuing month are compared according to whether a rapid antigen diagnostic test was carried out or not. Results: 851 cases met the inclusion criteria (3-4 Centor criteria) from a pre-selection of 17,455. In those cases where the rapid antigen test was performed a reduction in prescriptions of 42% (absolute risk reduction 42%; 95% confidence interval [95 CI]: 37 to 48; p < 0.001) was observed. On comparing the approach among pediatricians who had the test available (4) and those who did not (6) a decrease of 29% (absolute risk reduction 29%; 95 CI: 24 to 34; p < 0.001) was noted. Ensuing infectious complications did not vary (12% in treated, 8% in untreated; relative risk 1.49; CI 95: 0.88 to 2.52; p 2 0.178). The prescription of penicillin V was significantly more likely than that of amoxicillin when a diagnostic test was used (relative risk 1.30; 95 CI: 1.10 to 1.55; p 2 0.004). Conclusions: in clinical practice the use of the rapid antigen test in pediatric patients pre-selected through clinical criteria was a determining factor in the reduction of the inappropriate use of antibiotics (AU)

[Neuropsychology of Tourette's disorder: cognition, neuroimaging and creativity]. / Neuropsicologia del trastorno de Tourette: cognicion, neuroimagen y creatividad.

INTRODUCTION: Tourette's disorder is the result of fronto-striatal brain dysfunction affecting people of all ages, with a debut in early childhood and continuing into adolescence and adulthood. DEVELOPMENT: This article reviews the main cognitive, functional neuroimaging and creativity-related studies in a disorder characterized by an excess of dopamine in the brain. CONCLUSIONS: Given the special cerebral configuration of these patients, neuropsychological alterations, especially in executive functions, should be expected. However, the findings are inconclusive and are conditioned by factors such as comorbidity with attention deficit hyperactivity disorder and obsessive-compulsive disorder, age or methodological variables. On the other hand, the neuroimaging studies carried out over the last decade have been able to explain the clinical symptoms of Tourette's disorder patients, with special relevance for the supplementary motor area and the anterior cingulate gyrus. Finally, although there is no linear relationship between excess of dopamine and creativity, the scientific literature emphasizes an association between Tourette's disorder and musical creativity, which could be translated into intervention programs based on music.

TITLE: Neuropsicologia del trastorno de Tourette: cognicion, neuroimagen y creatividad.Introduccion. El trastorno de Tourette es el resultado de una disfuncion cerebral frontoestriatal que afecta a personas de todas las edades, con un inicio en la primera infancia y continuacion en la adolescencia y la adultez. Desarrollo. Este articulo revisa los principales aspectos cognitivos, de neuroimagen funcional y estudios relacionados con la creatividad en un trastorno caracterizado por un exceso de dopamina en el cerebro. Conclusiones. Dada la especial configuracion cerebral de estos pacientes, deberian esperarse alteraciones neuropsicologicas, especialmente en las funciones ejecutivas. Sin embargo, los hallazgos son poco concluyentes y estan condicionados por factores como la comorbilidad con el trastorno por deficit de atencion/hiperactividad y el trastorno obsesivo compulsivo, la edad o variables metodologicas. Por otro lado, los estudios de neuroimagen realizados a lo largo de la ultima decada han podido explicar la sintomatologia clinica de pacientes con trastorno de Tourette, con especial relevancia del area motora suplementaria y el giro cingulado anterior. Finalmente, a pesar de no existir una relacion lineal entre el exceso de dopamina y la creatividad, la literatura cientifica destaca una asociacion entre el trastorno de Tourette y la creatividad musical, lo que podria traducirse en programas de intervencion basados en la musica.

Características de los niños con enfermedad tuberculosa en Meki (Etiopía): el reto del diagnóstico con recursos limitados / Characteristics of children with tuberculosis in Meki (Ethiopia): the challenge of diagnosis with limited resources

Introducción: La tuberculosis (TB), una enfermedad prevenible y curable, es la primera causa de morbimortalidad en Etiopía. El diagnóstico en niños presenta importantes retos, debido al carácter paucibacilar de la enfermedad. Describimos las características de los niños diagnosticados de enfermedad tuberculosa (ETB) en la clínica Let Children Have Health de Meki, Etiopía. Métodos: Estudio descriptivo-retrospectivo de los niños diagnosticados de ETB desde enero hasta diciembre de 2013. Se incluyeron las características antropométricas, clínicas, analíticas y radiológicas. Se clasificó la ETB confirmada, probable y posible según los criterios en el momento del diagnóstico, y la afectación de ETB en pulmonar y extrapulmonar (cualquier forma de manifestación extratorácica, incluida la TB miliar). Resultados: Se diagnosticaron 38 niños: 35 con TB probable y 3 con TB posible. El cultivo de icobacterias no estuvo disponible. La mediana de edad fue de 8 años. El 50% presentó TB pulmonar, el 37% ETB mixta, 4 niños formas extrapulmonares y 1 TB miliar. En el momento del diagnóstico, 32 niños (84%) referían tos, 31 (81%) fiebre y 15 (39%) adenitis; 15 (39,5%) tenían antecedentes familiares de ETB, y ninguno de ellos había recibido quimioprofilaxis como contacto. Se detectó desnutrición aguda (diagnosticada a partir del perímetro medio del brazo o de la relación peso/talla) en 13 niños (31%). Cuatro niños presentaron baciloscopia en esputo positiva (todos mayores de 7 años). En 1 niño se confirmó el diagnóstico por baciloscopia positiva mediante punción-aspiración con aguja fina de adenopatía, y otro precisó cirugía por obstrucción intestinal, con baciloscopia positiva en las muestras quirúrgicas. Se realizó el test de Mantoux a 13 niños, que resultó positivo en 9. Se realizó el test rápido del virus de la inmunodeficiencia humana a 22 niños, cuyos resultados fueron todos negativos. La evolución de todos los niños fue buena. Conclusiones: El diagnóstico de ETB continúa siendo tardío. Debe promoverse la identificación y la administración de quimioprofilaxis a los niños expuestos, además de la búsqueda activa de ETB en programas ya implementados, como el programa de desnutrición local. La presentación extrapulmonar es muy prevalente, por lo que siempre debe tenerse en cuenta (AU)

Introduction: Tuberculosis (TB), a preventable and curable disease, is the first cause of morbidity and mortality in Ethiopia. The diagnosis in children presents important challenges due to paucibacillary character of the disease. We describe the characteristics of children diagnosed of TB at the Pediatric Clinic Let Children Have Health in Meki, Ethiopia. Methods: Retrospective study of children diagnosed of TB from January to December 2013. Anthropometric, clinical, laboratory and radiological findings at the time of diagnosis were included. TB was classified as confirmed TB, probable TB and possible TB for categories at diagnostic. And by involvement: pulmonary TB and extrapulmonary TB (any form of extrathoracic manifestations, including TB miliary). Results: 38 children were diagnosed: 35 probable TB, 3 possible TB; mycobacterium culture was not available. The median age was 8 years. 50% of them had pulmonary TB, 37% mixed TB, 4 children extra-pulmonary forms and 1 miliary TB. At the time of diagnosis, 32 (84%) reported cough, 31 (81%) fever, 15 (39%) lymphadenitis. 15 (39.5%) had a family history of TB, none of them had received quimioprophylaxis contact. Malnutrition (defined by mid upper arm circumference or weight/height) was detected in 13 children (34%). Four children had positive smear sputum (all of them older than 7 years). In a child diagnosis was confirmed by smear-positive in lymph node biopsy, and one required surgery due to intestinal obstruction, smear positive in surgical specimens. Mantoux was performed in 13 children, remaining positive in 9. HIV rapid test was conducted to 22 children, all of them were negative. The evolution of all children was good. Conclusions: Diagnosis of TB continues being delayed. Identification of exposed children and active searching in other programs already implemented such as local program malnutrition should be promoted. Extrapulmonary presentation is very prevalent and should always be considered (AU)

¿Mejora la prescripción antibiótica en pediatras tras una intervención multidisciplinar? / Does the prescribing of antibiotics in paediatrics improve after a multidisciplinary intervention?

El consumo excesivo de antibióticos genera altas tasas de resistencia. En Aragón, los valores máximos de prescripción de antibióticos se alcanzan en los niños de 1 a 4 años, con una utilización que supera el 60%.ObjetivoEvaluar si una intervención multidisciplinar sobre pediatras de atención primaria reduce la utilización de antibióticos y mejora su perfil de prescripción. Método Se analizaron datos de prescripción de antibióticos antes y después de un proyecto de intervención sobre pediatras de atención primaria. La intervención consistió en un taller formativo sobre diagnóstico y tratamiento de las enfermedades infecciosas más prevalentes en pediatría, habilidades en entrevista clínica y adecuada utilización de test rápido de detección de estreptococo en faringe. Se aportaron guías de práctica clínica y documentos de consenso en patología infecciosa pediátrica y material divulgativo para padres. Se utilizó grupo control con pediatras no participantes. Resultados El consumo de antibióticos bajó de 19,17 dosis diarias definida por 1.000 habitantes/día (DHD) a 14,36 DHD entre los pediatras participantes y de 19,84 DHD a 16,02 DHD en controles, aunque la diferencia no fue significativa. Se produjo una disminución de la utilización de macrólidos y penicilinas de amplio espectro en ambos grupos. Conclusión La prescripción de antibióticos de los pediatras disminuyó, no observándose diferencias estadísticamente significativas entre los grupos de estudio. Dado el alto grado de satisfacción de los pediatras participantes, sería necesario continuar con este tipo de actividades para mejorar la utilización de antibióticos en nuestro ámbito

Antibiotics overuse is linked to elevated antimicrobial resistance. In Aragon, Spain, the highest antibiotic prescription rates occur among children from 1 to 4 years old. The rate of use in this age group is over 60%.AimTo evaluate the effect of multi-faceted intervention on Primary Care paediatricians to reduce antibiotic use and to improve antibiotic prescribing for paediatric outpatients. Methods Outpatient antimicrobial prescribing was analysed before and after an intervention in paediatricians. The intervention included a clinical education session about diagnosis and treatment in the most prevalent paediatric infectious diseases, a clinical interview and communication skills, a workshop on rapid Streptococcus antigen detection test and patient information leaflets and useful internet websites for parents. The control group included paediatricians without this educational intervention on antibiotics. Results Antibiotic prescribing decreased from 19.17 defined daily doses per 1000 inhabitants/day (DID) to 14.36 DID among intervention paediatricians vs 19.84 DID to 16.02 DID in controls. The decreasing was higher in the intervention group, but the effect was not statistically significant. Macrolides and broad-spectrum penicillins prescribing decreased in both groups. Conclusion Antibiotic prescribing decreased, but there were no statistically significant differences between the two groups. The high satisfaction of paediatricians in the intervention group makes it necessary to continue with these kinds of strategies to improve antibiotic use in outpatient

[Does the prescribing of antibiotics in paediatrics improve after a multidisciplinary intervention?]. / ¿Mejora la prescripción antibiótica en pediatras tras una intervención multidisciplinar?

UNLABELLED: Antibiotics overuse is linked to elevated antimicrobial resistance. In Aragon, Spain, the highest antibiotic prescription rates occur among children from 1 to 4 years old. The rate of use in this age group is over 60%. AIM: To evaluate the effect of multi-faceted intervention on Primary Care paediatricians to reduce antibiotic use and to improve antibiotic prescribing for paediatric outpatients. METHODS: Outpatient antimicrobial prescribing was analysed before and after an intervention in paediatricians. The intervention included a clinical education session about diagnosis and treatment in the most prevalent paediatric infectious diseases, a clinical interview and communication skills, a workshop on rapid Streptococcus antigen detection test and patient information leaflets and useful internet websites for parents. The control group included paediatricians without this educational intervention on antibiotics. RESULTS: Antibiotic prescribing decreased from 19.17 defined daily doses per 1000 inhabitants/day (DID) to 14.36 DID among intervention paediatricians vs 19.84 DID to 16.02 DID in controls. The decreasing was higher in the intervention group, but the effect was not statistically significant. Macrolides and broad-spectrum penicillins prescribing decreased in both groups. CONCLUSION: Antibiotic prescribing decreased, but there were no statistically significant differences between the two groups. The high satisfaction of paediatricians in the intervention group makes it necessary to continue with these kinds of strategies to improve antibiotic use in outpatients.

Bacterial pathogens associated with bloody diarrhea in Uruguayan children.

Diarrheal disease continues to be a serious health problem, especially in developing countries. Bloody diarrhea represents approximately 20-30% of all cases and has higher morbidity and mortality. Treatment with antibiotics is beneficial in cases of Shigella, Campylobacter, Yersinia and Salmonella infection, principally in those children with a higher risk of invasive disease. The aims of this study were to detect the bacterial agents associated with bloody diarrhea in children and to determine their antimicrobial susceptibility patterns. Between June 2001 and January 2008, 249 children with bloody diarrhea were studied. Shigella and Shiga toxin-producing Escherichia coli (STEC) were recovered from 48 (19.3%) and 3 (1.2%) of the total of cases, respectively. In 49 out of 249 children, in whom other enteropathogens were investigated, we recovered Campylobacter jejuni from 7 children (14.3%), Salmonella spp. from 2 (4.1%) and Aeromonas spp. from 1 (2%) in addition to Shigella from 7 children (14.3%). Thirty-four (70%) Shigella isolates showed resistance to ampicillin and 13 (27%) to trimethoprim-sulfamethoxazole. All Shigella isolates were susceptible to nalidixic acid, ciprofloxacin and ceftriaxone. Salmonella and STEC isolates were susceptible to all antibiotics assayed. Thus, the use of trimethoprim-sulfamethoxazole or ampicillin would not be appropriate for the empirical treatment of Shigella - associated diarrhea.

Case report of a kidney transplant recipient converted to everolimus due to malignancy: resolution of bronchiolitis obliterans organizing pneumonia without everolimus discontinuation.

The use of proliferative signal inhibitors (PSIs) in immunosuppression-related malignancies opens new roads for increasing the survival and quality of life in patients with solid organ transplantation. A 56-year-old female recipient of a living donor renal allograft (1990), who was immunosuppressed with cyclosporine (CsA; Neoral), azathioprine, and steroids, did initially well with acceptable renal function. During the last 5 years she required local therapy due to posterior vaginal lip human papillomavirus (HPV) lesions. In 2000, she discontinued azathioprine and the CsA doses were reduced to 100 mg daily. The local lesion showed a good response to reduced immunosuppression. In February 2005, the lesion reappeared and a biopsy showed malignancy. Local surgery was performed and CsA was replaced by everolimus (EVL; Certican). Two months after treatment initiation, the patient developed cough, dyspnea, and low-grade fever. Chest X-ray showed a lesion at the base of the left lung compatible with pneumonitis. After fiberbronchoscopy a diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP) was obtained. She was treated with increased doses of oral steroids. EVL was never discontinued. The radiological lesion disappeared and the malignancy is currently in remission. In summary, a case of gynecological cancer in a renal transplant recipient was treated by surgical removal. After 1 year of immunosuppression with EVL, no recurrence has been observed. The adverse event (BOOP) was probably related to the PSI treatment and was controlled with an increased dose of steroids without discontinuing EVL.

Paradigma auditivo emocional en neuroimagen: una base para el estudio de la psicosis / Emotional auditory paradigm in neuroimaging: a base for the study of psychosis

Introducción. Desde la llegada de la neuroimagen numerosos estudios han tratado de analizar las diferencias en la respuesta emocional frente a la no emocional. La mayoría de estos estudios utilizan la modalidad visual (caras) y parten de los datos en sujetos normales. En el presente estudio se presenta un nuevo paradigma para el estudio de la respuesta emocional basado en la modalidad auditiva y diseñado específicamente para el estudio de la psicosis. Método. Se analizaron las palabras más frecuentes que oían los pacientes psicóticos con alucinaciones auditivas, se clasificaron según cinco categorías y a partir de las mismas se diseñó un tren de 13 palabras emocionales, comparándose con 13 palabras con la misma complejidad sintáctica y con una valencia emocional neutral. Se aplicó este paradigma para ver la activación cerebral mediante resonancia magnética funcional (RMf) en 10 varones sanos y diestros. Resultados. En los análisis preliminares se observa una clara diferenciación según el estímulo sea emocional o no emocional, tanto en la intensidad de la activación (corteza temporal derecha e izquierda) como en la activación de áreas específicas (precentral y supramarginal derecha). Conclusiones. El paradigma presentado permite observar una diferenciación en la activación cerebral de la respuesta a estímulos auditivos emocionales y podría ser de utilidad en pacientes psicóticos

Introduction. Since the arrival of neuroimaging numerous studies have tried to analyze the differences between emotional and non-emotional response. The majority of these studies use visual approach (faces) and begin with data in normal subjects. The present study introduces a new paradigm for the study of emotional response based on auditory approach and designed specifically for the study of psychoses. Method. The most frequent words heard by psychotic patients with auditory hallucinations were analyzed. They were classified according to five categories which were compared with 13 other words with the same structure but with a neutral emotional valency. This paradigm was applied to see the cerebral activation with functional magnetic resonance imaging (fMRI) in 10 right handed healthy males. Results. In the preliminary analysis a clear differentiation is observed depending on the type of stimulus applied (emotional or non-emotional), both in the intensity of activation (right and left temporal cortex) as in the activation of specific areas (right precentral and supramarginal gyrus) only with the emotional stimulus. Conclusions. The present paradigm allows the observation of a differentiation in the cerebral activation to emotional auditory stimulus and could be of utility in the study of psychotic patients

Emotional auditory paradigm in neuroimaging: a base for the study of psychosis.

INTRODUCTION: Since the arrival of neuroimaging numerous studies have tried to analyze the differences between emotional and non-emotional response. The majority of these studies use visual approach (faces) and begin with data in normal subjects. The present study introduces a new paradigm for the study of emotional response based on auditory approach and designed specifically for the study of psychoses. METHOD: The most frequent words heard by psychotic patients with auditory hallucinations were analyzed. They were classified according to five categories which were compared with 13 other words with the same structure but with a neutral emotional valency. This paradigm was applied to see the cerebral activation with functional magnetic resonance imaging (fMRI) in 10 right handed healthy males. RESULTS: In the preliminary analysis a clear differentiation is observed depending on the type of stimulus applied (emotional or non-emotional), both in the intensity of activation (right and left temporal cortex) as in the activation of specific areas (right precentral and supramarginal gyrus) only with the emotional stimulus. CONCLUSIONS: The present paradigm allows the observation of a differentiation in the cerebral activation to emotional auditory stimulus and could be of utility in the study of psychotic patients.

Serotipos, perfil plasmídico y antibiotipos de cepas de Shigella flexneri aisladas de niños menores de 5 años con diarrea sanguinolenta usuarios de los servicios de Salud Pública / Serotypes, serum profile and anti-biotypes of Shigella flexneri cultures isolated from infants under 5 years with diarrhea sanguinolenta users of Public Health Services

Introducción: en niños menores de 5 años con diarrea sanguinolenta, Shigella flexneri es el agente bacteriano más frecuentemente recuperado en nuestro medio. La shigellosis es una de las enfermedades infecciosas en las cuales el tratamiento con antimicrobianos es efectivo. La elección empírica del antimicrobiano adecuado es problemática debido a la resistencia de Shigella a diversos antibióticos. Esta situación estimuló el interés en el desarrollo de vacunas para el control de esta enfermedad. Debido a que algunas vacunas están orientadas a promover la respuesta inmune serotipo específica, es importante establecer la distribución de los serotipos prevalentes en la población que interesa inmunizar. El objetivo de este estudio fue caracterizar 50 cepas de Shigella flexneri aisladas a partir de niños con diarrea sanguinolenta, recuperadas en 4 encuestas etiológicas de gastroenteritis. Método: a cada una se le realizó: serotipificación, estudio del patrón de lipopolisacárido, perfil plasmídico y estudio de sensibilidad a diferentes antimicrobianos. Resultados: los seroptipos prevalentes fueron 2a, 3c, 4, 6, y 1. Se identificaron 10 antibotipos diferentes. En los cultivos del serotipo 2a se hallaron 3 patrones plasmídicos; el 5 fue el más frecuente, seguido por el 6 y el 7. El análisis de la evolución de los antibiotipos circulantes mostró una tendencia hacia la aparición de tipos con mayor espectro de resistencia. Conclusiones: vista esta evolución, y de acuerdo a los resultados obtenidos, resulta de interés ensayar un inmunógeno que incluya los determinantes "O" específicos de los serotipor 2a, 1, 3c, 4, 6 y el de Shigella sonnei.

Primer aislamiento en Uruguay de Escherichia Coli, productora de toxina Shiga del serotipo O157: H7 en una niña con síndrome urémico hemolítico / First Uruguayan isolation of Shiga toxin-producing Escherichia coli O157: H7 in female infant with hemolytic syndrome

En mayo de 2002 se aisló por primera vez en Uruguay Escherichia coli O157:H7, productora de toxina shiga a partir del coproductivo de una niña de 16 meses procedente de Melo, con diagnóstico de síndrome urémico hemolítico. La cepa, productora de toxinas shiga tipo 2 y tipo 2 variante humana a, era genéticamente distinta de las cepas circulantes en Argentina.

Salivary testosterone is related to both handedness and degree of linguistic lateralization in normal women.

The aim of this study was to test the hypothesis that individual differences in testosterone (T) are associated with different patterns of linguistic lateralization and hand preference. Twenty left-handed (LH) and 19 right-handed (RH) women filled in a handedness questionnaire and performed a consonant-vowel dichotic listening test (DL-CV). Salivary T was measured by radioimmunoassay (RIA). LH women showed significantly lower mean salivary T than RH women. T levels were negatively correlated with the absolute value of the DL laterality index. Subjects with right ear advantage (REA) were classified into strongly and weakly lateralized following Wexler et al. method (Brain Lang. 13 (1981) 13). When taking into account hand preference, a pattern emerged in that RH-strongly lateralized and LH-weakly lateralized women showed similar T levels. The lowest level appeared for LH-strongly lateralized women and the highest for RH-weakly lateralized women, being significantly different from each other. The results are discussed in terms of several theories that have proposed a link between testosterone and cerebral lateralization.

Test-retest performance for the consonant-vowel dichotic listening test with and without attentional manipulations.

The present work aimed to replicate Hugdahl and Hammar's (1997) study on the reliability of dichotic listening under divided or focused attention conditions. With the same consonant-vowel syllable dichotic listening procedure, 16 subjects were tested twice, 2 weeks apart. The design included a condition without attentional instructions (nonforced) and two conditions with the instruction to attend either to the right- or the left-ear input. The results showed a significant correlation coefficient of.82 for the standard nonforced condition, indicating temporal stability for the ear advantages. There were also high correlation coefficients for the focused attention conditions (.77 and.76), although the subjects performed the attentional instructions more accurately in session two.