Severe intestinal ischemia as a presenting feature of metastatic ileal carcinoid tumor: role of MDCT with coronal reformation in the early diagnosis.

Intestinal ischemia is a rare but potentially fatal complication of mesenteric metastasis of intestinal carcinoid tumor and its mechanism isn't entirely clear. We present a case of intestinal ischemia secondary to metastatic ileal carcinoid tumor diagnosed by CT that showed a small mesenteric mass with an extensive desmoplastic reaction causing an intense involvement of the small bowel. Improvements in CT technology with the use of MDCT scanners and advanced reformatting capabilities play an important role in the early diagnosis and accurate recognition of this entity and its need for immediate treatment.

Interpretation of a serial Mantoux test taking into account the annual risk of tuberculous infection.

BACKGROUND: Interpretation of tuberculin tests (TSTs) can be difficult. However, it is even more difficult to classify an individual as infected or non-infected if he or she has undergone a prior TST, as the difference between the booster effect and true conversion is not always clear. OBJECTIVE: To determine the size of the induration that is indicative of true infection after a second Mantoux test, based on the fact that the annual risk of tuberculous infection (ARTI) is equivalent, regardless of whether it is calculated directly or indirectly. METHOD: We performed two TSTs in the same population (aged 6 years at the first examination) with a 1-year interval. We calculated the prevalence of infection the first year (1.16%, 95%CI 0.67-1.65) and the ARTI using the indirect method (0.18%, 95%CI 0.00-0.37). For the second year, we considered different induration sizes and finally accepted a diameter of >10 mm as the criterion according to which the ARTI, calculated directly, corresponded to the value of the previous year (0.18%). CONCLUSION: Although they served as an aid in the interpretation of the TST, calculations of this type will probably be unnecessary in the future, when in vitro diagnostic tests for tuberculosis are made available in every health centre, thus enabling the classification of those individuals with indurations of intermediate size in the TST.

Modeling the adsorption of Cr(III) from aqueous solution onto Agave lechuguilla biomass: study of the advective and dispersive transport.

The biosorption of Cr(III) onto packed columns of Agave lechuguilla was analyzed using an advective-dispersive (AD) model and its analytical solution. Characteristic parameters such as axial dispersion coefficients, retardation factors, and distribution coefficients were predicted as functions of inlet ion metal concentration, time, flow rate, bed density, cross-sectional column area, and bed length. The root-mean-square-error (RMSE) values 0.122, 0.232, and 0.285 corresponding to the flow rates of 1, 2, and 3 (10(-3))dm3min(-1), respectively, indicated that the AD model provides an excellent approximation of the simulation of lumped breakthrough curves for the adsorption of Cr(III) by lechuguilla biomass. Therefore, the model can be used for design purposes to predict the effect of varying operational conditions.

Effects of single sessions of low-intensity continuous and moderate-intensity intermittent exercise on blood lipids in the same endurance runners.

The factors responsible for the acute effects of exercise on blood lipids are not well known, and there have been few studies comparing different kinds of exercise in the same population. The concentration of blood lipids was evaluated in this study at the end and at post-24h of two 14km/90min single exercise sessions: continuous exercise (CE) at 44.5+/-5.6% VO(2max) and intermittent exercise (IE) at 39-72% VO(2max), in subjects with high levels of aerobic training. Fourteen male athletes (endurance runners) took part in this study and each completed a 24h dietary record. The O(2) uptake and CO(2) production were recorded, and blood lactate and blood lipids were measured. The results showed that triacylglycerols were not modified by any kind of exercise. Total cholesterol was increased at the end of both exercises: 7.04% for CE (p<0.001) and 4.23% for IE (p=0.001). High-density lipoprotein cholesterol was increased at the end of IE: 11.38% (p=0.03) and low-density lipoprotein cholesterol was increased only at the end of CE: 7.45% (p=0.006). The increase of lipids for CE was negatively correlated with aerobic fitness indicators (heart rate and %HRmax at lactate threshold), and was positively associated with energy expenditure. For IE, %HRmax and lactate were negatively correlated, and the respiratory exchange ratio was positively correlated, with the lipid increase. We conclude that in trained male athletes, a 14km run in 90min induced different changes of lipid profile if the exercise was done continuously or intermittently, and that in CE the extent of these increases was influenced by aerobic fitness.

[Spanish adaptation and diagnostic validity of the Yale Global Tics Severity Scale]. / Adaptación al español y validez diagnósticade la Yale Global Tics Severity Scale.

AIM: The aim of the study is to analyse the psychometric properties of the Spanish version of the Yale Global Tics Severity Scale (YGTSS). In addition, we analysed the sensitivity of this Scale for measuring change, as an instrument for quantifying the clinical evolution of patients with Tourette syndrome. PATIENTS AND METHODS: Analysis of the properties of the adapted version of the YGTSS questionnaire is focused on the validity of the concept (principal component factor analysis), internal consistency (Cronbach's alpha), intra-observer reliability (intraclass correlation coefficient) and sensitivity to change (Wilcoxon rank sum test). RESULTS: The factor analysis confirmed the existence of two dimensions on the scale, which account for 76.3% of the variability. The internal consistency, measured by Cronbach's alpha, was 0.997 for the motor tic dimension and 0.996 for the phonic tic dimension. The intra-observer reliability, assessed by intraclass correlation coefficient, was equal to or greater than 0.95, both for the 10 items related to tics (motor and phonic) and for the item related to disability. In the global scores for motor tics, phonic tics and disability, there were statistically significant differences between the mean score for the first interview (incorporation into the study group) and the second one (after 15 days' treatment). CONCLUSIONS: The Spanish version of the YGTSS adequately reflects the three psychometric properties examined in our study population. Its validity and reliability is greater in the motor and phonic tic dimensions than in that of disability.

Adaptación al español y validez diagnóstica de la Yale Global Tics Severity Scale / Spanish adaptation and diagnostic validity of the yale global tics severity scale

El instrumento de medida habitualmente utilizado para valorar la gravedad clínica del síndrome deTourette es la Yale Global Tics Severity Scale (YGTSS), originariamente escrita en inglés, y no existe una versión validada enespañol que permita su aplicación directa a los pacientes hispanohablantes. Objetivo. Analizar las propiedades psicométricasde la versión de la YGTSS, traducida al español, y su sensibilidad para medir cambios, como instrumento para cuantificar laevolución en pacientes con síndrome de Tourette. Pacientes y métodos. El análisis versa sobre la validez del concepto (análisisfactorial de componentes principales), consistencia interna (alfa de Cronbach), fiabilidad intraobservadores (coeficientede correlación intraclase) y sensibilidad al cambio (test de rangos de Wilcoxon). Resultados. El análisis factorial confirmó laexistencia de dos dimensiones en la escala, que explican el 76,3% de la variabilidad. La consistencia interna fue de 0,997 parala dimensión tics motores, y de 0,996 para la dimensión tics fónicos. La fiabilidad intraobservadores fue igual o superior a0,95, tanto en los 10 ítems referidos a los tics (motores y fónicos) como en el ítem de discapacidad. En las puntuaciones globalesde tics motores, tics fónicos y discapacidad, hubo diferencias estadísticamente significativas entre la media de puntuaciónentre la primera entrevista (entrada en el estudio) y la segunda entrevista (a los 15 días de tratamiento). Conclusiones.La adaptación efectuada al español de la YGTSS cumple adecuadamente las tres propiedades psicométricas en nuestra poblaciónde estudio. La validez y fiabilidad es mayor en las dimensiones de tics motores y fónicos que en la discapacidad

The aim of the study is to analyse the psychometric properties of the Spanish version of the Yale Global TicsSeverity Scale (YGTSS). In addition, we analysed the sensitivity of this Scale for measuring change, as an instrument forquantifying the clinical evolution of patients with Tourette syndrome. Patients and methods. Analysis of the properties of theadapted version of the YGTSS questionnaire is focused on the validity of the concept (principal component factor analysis),internal consistency (Cronbach’s alpha), intra-observer reliability (intraclass correlation coefficient) and sensitivity to change(Wilcoxon rank sum test). Results. The factor analysis confirmed the existence of two dimensions on the scale, which account for76.3% of the variability. The internal consistency, measured by Cronbach’s alpha, was 0.997 for the motor tic dimension and0.996 for the phonic tic dimension. The intra-observer reliability, assessed by intraclass correlation coefficient, was equal to orgreater than 0.95, both for the 10 items related to tics (motor and phonic) and for the item related to disability. In the globalscores for motor tics, phonic tics and disability, there were statistically significant differences between the mean score for thefirst interview (incorporation into the study group) and the second one (after 15 days’ treatment). Conclusions. The Spanishversion of the YGTSS adequately reflects the three psychometric properties examined in our study population. Its validity andreliability is greater in the motor and phonic tic dimensions than in that of disability

[Family impact of rotavirus gastroenteritis in children under two years]. / Impacto familiar de la gastroenteritis por rotavirus en menores de dos años.

INTRODUCTION: Acute gastroenteritis (AGE) in infants has a significant impact on the quality of life of their parents. MATERIAL AND METHODS: Cross-sectional study on the sociological family impact related to rotavirus AGE in children under 2 years. The study was carried out in 25 hospitals and 5 primary care centres in Spain. Sociodemographic, epidemiological and clinical data were recorded, as well as the symptomatology of AGE and its severity measured by the Clark scale. Stool samples were tested to determine rotavirus positive (RV+) or negative (RV-). The parents were asked to complete a a family impact questionnaire. RESULTS: Stool specimens were tested in 1087 AGE cases (584 RV+ vs 503 RV-). The 99.5 % of parents whose children were RV+ reported more worries vs. the 97.7 % of RV-, and RV+ had a higher importance score (p < 0.05). A higher percentage of RV+ parents and those with a high importance score reported more time dedicated to dehydration treatment (p < 0.05). The 82.5 % vs. 73.9 % had disruption of their household tasks, with more importance scores (p < 0.05). RV+ had a higher percentage and importance score than RV- ones in all aspects of their child's AGE symptoms, except loss of appetite. CONCLUSION: AGE produces important dysfunctional experiences in daily family life. According to parental perceptions, RV+ produces greater worries and dysfunctions in child behaviour.

X-ray absorption near edge structure and extended X-ray absorption fine structure analysis of standards and biological samples containing mixed oxidation states of chromium(III) and chromium(VI).

For the first time a method has been developed for the extended X-ray absorption fine structure (EXAFS) data analyses of biological samples containing multiple oxidation states of chromium. In this study, the first shell coordination and interatomic distances based on the data analysis of known standards of potassium chromate (Cr(VI)) and chromium nitrate hexahydrate (Cr(III)) were investigated. The standards examined were mixtures of the following molar ratios of Cr(VI):Cr(III), 0:1, 0.25:0.75, 0.5:0.5, 0.75:0.25, and 1:0. It was determined from the calibration data that the fitting error associated with linear combination X-ray absorption near edge structure (LC-XANES) fittings was approximately +/-10% of the total fitting. The peak height of the Cr(VI) pre-edge feature after normalization of the X-ray absorption (XAS) spectra was used to prepare a calibration curve. The EXAFS fittings of the standards were also investigated and fittings to lechuguilla biomass samples laden with different ratios of Cr(III) and Cr(VI) were performed as well. An excellent agreement between the XANES data and the data presented in the EXAFS spectra was observed. The EXFAS data also presented mean coordination numbers directly related to the ratios of the different chromium oxidation states in the sample. The chromium oxygen interactions had two different bond lengths at approximately 1.68 and 1.98 A for the Cr(VI) and Cr(III) in the sample, respectively.

Potential of Agave lechuguilla biomass for Cr(III) removal from aqueous solutions: thermodynamic studies.

Thermodynamic studies on the bioadsorption of Cr(III) onto Agave lechuguilla biomass were conduced. The experimental results at different temperatures were modeled using the Langmuir and Freundlich isotherms to obtain the characteristic parameters of each model. Both the Freundlich and Langmuir models were found to represent the bioadsorption process. The average adsorption capacities calculated from Freundlich (4.7 mg/g) and Langmuir (14.2 mg/g) isotherms showed A. lechuguilla to be an effective biomass in the removal of Cr(III) from an aqueous solution. Thermodynamic parameters (deltaG0, deltaH0 and deltaS0) determined in the temperature range from 10 to 40 degrees C along with the parameters of the Dubinin-Radushkevick equation support the idea that the binding of Cr(III) may be caused by interactions with functional groups such as carboxyl groups located on the outer surface of the cell tissue of the bioadsorbent.

Estudio del mobiliario escolar en una población infantil / Study of the school furniture in a children population

El estudio describe las dimensiones de mobiliario (sillas y mesas) utilizado por una población infantil, así como su distribución en el espacio de la clase. Se elige a una población escolar randomizada, perteneciente a un colegio de educación primaria, y se miden las dimensiones del mobiliario (sillas y mesas) utilizado y consideradas en la norma ISO 5970: altura, profundidad, anchura mínima y ángulo del asiento, altura y anchura del respaldo, ángulo asiento-respaldo, altura, anchura, profundidad e inclinación de la mesa, altura libre y profundidad para muslos, rodillas y piernas y distancia asiento-mesa). Se toman fotos desde distintos ángulos para estudiar la distribución del mobiliario en el entorno de la clase. La población estudiada es n = 68, perteneciente a los cursos de 3º, 4º, 5º y 6º de primaria, con edad media de 10,38 ñ 1,244 años y de los que el 51,5 por ciento son niñas y el resto niños. Se han encontrado 5 modelos diferentes de sillas (A, B, C, D y E) y dos de mesas (A y B); en ambos casos se ordenaron en función del tamaño. La distribución del mobiliario en las clases es similar en los cursos de 3º y 4º (distribución en forma de U) y en los de 5º y 6º (distribución en filas y columnas).En el mobiliario utilizado por los niños en la escuela aparecen distintos tipos de mesas y sillas que se distribuyen en cada clase según su tamaño, sin embargo, las dimensiones de éste no se corresponden con las recomendaciones de la norma ISO (AU)

Fracaso renal agudo: ¿evitable? / Is postischemic acute tubular necrosis avoildable?

Se presenta el caso de una adolescente sana que, como consecuencia de una deshidratación secundaria a un episodio de gastroenteritis aguda, manifiesta un cuadro compatible con necrosis tubular aguda (NTA), con buena evolución posterior. En la población infantil, esta entidad es, mayoritariamente, postisquémica, debido a hipoperfusión y fallo prerrenal prolongado que, al no ser corregido con prontitud, evoluciona de forma insidiosa a fracaso renal intrínseco. A pesar de estar descrito en la bibliografia, lo infrecuente del caso en la actualidad, debido a las pautas establecidas de rehidratación oral, obliga a reflexionar sobre la necesidad de una mayor atención en los pacientes de riesgo (diarrea o vómitos cuantiosos), para diagnosticar de forma precoz las lesiones prerrenales y corregirlas adecuadamente, evitando así un daño mayor. Se resumen las causas de fracaso renal agudo (FRA) en la población infantil; realizándose un diagnóstico diferencial entre las más frecuentes. Asimismo, se describe brevemente la fisiopatología de la NTA. (AU)

Eritroblastopenia secundaria a infección por parvovirus B19 / Erythroblastopenia secondary to parvovirus B19 infection

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[Streptococcus bovis meningitis. An infrequent cause of bacterial meningitis in the adult patient]. / Meningitis por Streptococcus bovis: una causa poco frecuente de meningitis bacteriana en el paciente adulto.

INTRODUCTION: Bacterial meningitis in adult patients, produced by streptococci other than Streptococcus pneumoniae, is not common. CASE REPORT: We report the case of a 74 year old male patient with meningitis and endocarditis due to Streptococcus bovis (group D, not enterococcus), sensitive to penicillin (CMI< 0.1 mg/L), with no characteristic clinical or analytical discoveries. A gastrointestinal exploration revealed only diverticles in the colon and two lesions compatible with splenic infarction, observed by using computerised axial tomography of the abdomen. The patient responded favourably to a four week course of antibiotics; he remained asymptomatic, afebrile and culture negative after the therapy was stopped. CONCLUSIONS: In many previously reported cases, there is an association with gastrointestinal illness, endocarditis or oral lesions. Gram staining of the cerebrospinal fluid is usually negative and the neurological signs are often subtle. In the case of bacteraemia, endocarditis or S. bovis meningitis, the presence of an underlying pathology of the colon due to the frequent association between these processes must be ruled out. Treatment with penicillin G is usually sufficient.

[Drug-induced hepatotoxicity in children. Where we are and where we are going]. / Toxicidad hepática por fármacos. Dónde estamos y hacia dónde caminamos.

Childhood is characterized by continuous growth and development during which the organs and systems gradually mature. Because drug pharmacokinetics and pharmacodynamics in children differ from those in adults, pediatric patients are highly susceptible to adverse drug reactions. Surprisingly, very few studies have been designed to study the efficacy and safety of drugs in this population and consequently dosage regimens are based on the assumption that children are small adults. We present a detailed review of these controversial aspects and propose the establishment of a multicenter, multidisciplinary network to monitor drug-induced liver disease in children. This project represents the integration of an epidemiological approach into routine clinical care. A protocol agreed by consensus for the collection of data on cases of hepatotoxicity with uniform and internationally accepted criteria for causality assessment and the classification of drug-induced liver injuries is proposed.

Toxicidad hepática por fármacos. Dónde estamos y hacia dónde caminamos / Drug-induced hepatotoxicity in children. Where we are and where were are going

La infancia abarca un período caracterizado por el crecimiento y el desarrollo con un paulatino proceso de maduración de órganos y sistemas y la consiguiente variabilidad en la cinética y en la respuesta a los fármacos, que convierten al niño en un sujeto especialmente vulnerable a los efectos adversos de los medicamentos. Sorprendentemente, apenas se han diseñado estudios para investigar la eficacia y seguridad de los medicamentos en esta población, por lo que las prescripciones se realizan sobre la base de considerar al niño "un adulto en miniatura". Una revisión detallada de estos controvertidos aspectos se sigue de la propuesta de establecer una red multicéntrica y multidisciplinaria de vigilancia enfocada en el diagnóstico de las hepatopatías asociadas a medicamentos en pediatría, donde se incorpore una actitud epidemiológica a las condiciones habituales de la práctica clínica. Se propone un protocolo consensuado de recogida de datos de incidencias de hepatotoxicidad con criterios uniformes e internacionalmente aceptados de establecimiento de causalidad y de clasificación de la lesión hepatotóxica (AU)

Meningitis por Streptococcus bovis: una causa poco frecuente de meningitis bacteriana en el paciente adulto / Streptococcus bovis meningitis. An infrequent cause of bacterial meningitis in the adult patient

Introducción. La meningitis producida por estreptococos diferentes del S. pneumoniae es infrecuente en los pacientes adultos. Caso clínico. Paciente varón, de 74 años, que presentó meningitis y endocarditis debidas a Streptococcus bovis (grupo D, no enterococo), sensible a la penicilina (CMI< 0,1 mg/L), sin hallazgos clínicos ni analíticos característicos. En el estudio gastrointestinal sólo se observaron divertículos en el colon; mediante tomografía computarizada abdominal se observaron dos lesiones esplénicas compatibles con infarto. El paciente evolucionó favorablemente con el tratamiento antibiótico que recibió durante cuatro semanas, tras el cual permaneció asintomático, afebril y con hemocultivos negativos. Conclusiones. En muchos de los casos similares que se han comunicado coexiste una enfermedad gastrointestinal, endocarditis o lesiones orales. La tinción de Gram del líquido cefalorraquídeo suele ser negativa y los signos neurológicos son a menudo sutiles. En caso de bacteriemia, endocarditis o meningitis por S. bovis, es necesario descartar la presencia de patología colónica debido a la frecuente asociación entre estos procesos. El tratamiento con penicilina G es usualmente adecuado (AU)

[Persistent hyperglycemia and hyperinsulinemia in a newborn infant]. / Recién nacido con hiperglucemia persistente e hiperinsulinemia.

Management of neonatal hyperglycemia is complex, especially in immature newborns. Etiology is diverse, the most frequent cause being iatrogeny. Neonatal diabetes mellitus is a rare cause of hyperglycemia during the first days of life. Insulin treatment is sometimes required to control the condition. When insulin requirements exceed 2I U/kg/day insulin resistance syndrome should be suspected. We present the case of a newborn infant with Donohue syndrome, or leprechaunism, which is a rare, genetically determined dysmorphic syndrome leading to significant insulin resistance.

Recién nacido con hiperglucemia persistente e hiperinsulinemia / Persistent hyperglycemia and hyperinsulinemia in a newborn infant

La hiperglucemia neonatal es un cuadro de complejo tratamiento sobre todo en recién nacidos inmaduros. La etiología es muy variada, aunque la causa más frecuente suele ser la yatrogénica. La diabetes mellitus neonatal es una causa rara de hiperglucemia en los primeros días de vida, que en ocasiones necesita tratamiento insulínico para su control. Cuando los requerimientos de insulina sobrepasan las 2 U/kg/día hay que sospechar un síndrome de resistencia a la insulina. Se presenta el caso de un recién nacido con un síndrome de Donohue o leprechaunismo que es un raro síndrome dismórfico de causa genética y que determina una importante resistencia a la insulina (AU)

[Use of intrapleural urokinase in children]. / Utilización de urocinasa intrapleural en niños.

OBJECTIVE: To present the use of intrapleural urokinase as an alternative to surgical management of complicated pleural effusions in children. To add new cases to the literature and set bases for the development of a standardized protocol. METHOD: Presentation of three cases in children under three years of age treated with intrapleural urokinase. RESULTS: Resolution of the effusions with lack of adverse effects. CONCLUSION: Treatment of pleural effusions when loculations develop. This invasive approach might be avoided in some cases by instillation of a fibrinolytic agent such as urokinase into the pleural space, this being an efficient and safe procedure.