Surgical Treatment for Advanced Thoracic Spinal Tuberculosis in Infants: Case Series and Literature Review.

BACKGROUND: Spinal tuberculosis (TB), or Pott's disease, is the most common form of osteoarticular TB. Early diagnosis and anti-TB drug therapy are the mainstays of treatment. However, in advanced stages, surgery is essential to correct spinal deformities and avoid neurological damage. Very few cases in young children requiring surgical treatment have been described. We present 2 cases of surgically treated thoracic spinal TB in patients under 2 years of age and review the literature on this entity in young children. CASE DESCRIPTION: Two male toddlers, aged 21 (patient 1) and 23 (patient 2) months, were admitted due to insidious systemic deterioration associated with neck stiffness and nonspecific abdominal pain in patient 1 and limping in patient 2. The findings of laboratory tests were unremarkable despite an increase in acute-phase reactants. After an extensive workup, results of a magnetic resonance imaging were consistent with spinal TB in both patients. Patient 1 underwent costotransversectomy of the left third and fourth ribs, debridement, T3-T4 corpectomy, and T2-T6 posterior fusion, to which an anterior rib autograft was added. Patient 2 had a right-sided thoracotomy performed at the apex in addition to debridement and T8 corpectomy; the resected rib was used as anterior structural autograft. Several samples of purulent, caseous material were sent for study. On follow-up, progression of proximal junctional kyphosis was evidenced in patient 1, requiring revision surgery to restore sagittal alignment; the patient was asymptomatic at 2-year follow-up. Patient 2 evolved satisfactorily without neurological sequelae and was asymptomatic at 4-year follow-up. CONCLUSIONS: Spinal TB in young children requires appropriate surgical treatment when presenting at advanced stages or having severe deformity or neurological compromise. Despite the challenges associated with young age and ongoing growth, surgery can be performed safely provided proper surgical expertise. After extensive debridement and decompression, priority should be given to restoring sagittal alignment and balance with stable and durable spinal reconstructions.

Eficacia de un entrenamiento cognitivo computarizado sobre la atención de adultos mayores con envejecimiento normal / Efficacy of a computerized cognitive training program on elderly with normal ageing

Resumen La atención es un proceso implícito en el funcionamiento cognitivo que disminuye con la edad; no obstante, programas de entrenamiento computarizado han demostrado ser eficaces en la mejora y mantenimiento de esta función en el adulto mayor. El objetivo de la presente investigación es determinar la eficacia del módulo de atención del programa computarizado CogniPlus sobre la atención de adultos mayores con envejecimiento normal. Se realizó un estudio con un diseño preexperimental de un solo grupo con pre y posprueba, de entrenamiento individual con una intensidad de 2 sesiones de 45 minutos, 1 vez por semana, durante 5 semanas a 23 participantes mayores de 60 años en la ciudad de Bogotá. Se tomaron medidas pre y postentrenamiento con las pruebas cubos de Corsi en Progresión, Dígitos en Progresión, Symbol Digit Modalities Test, Digit Vigilance Test y el Visual Search and Attention Test. Los resultados comparativos pre y post mostraron diferencias significativas en las medidas de vigilancia, en la ejecución medida en segundos con un efecto pequeño, así como en la reducción de omisiones con un efecto mediano y en la prueba de la atención sostenida visual con un efecto grande. Se concluye que el módulo de atención CogniPlus es eficaz y puede ayudar a mejorar las habilidades de vigilancia y atención sostenida visual de adultos mayores con envejecimiento normal.

Abstract Attention is an implicit process in the cognitive function that is decreases when ageing. However, the computerized training programs have demonstrated effectiveness in the improvement and maintenance of this function. The aim of this study is determining the efficiency of the attention module of the CogniPlus in older adults with normal ageing. This study used a pre and post experimental design with just one group with pre and post individual testing training with an intensity of two sessions of 45 minutes each two times per week during 5 weeks; there were 23 participants older than 60 years from Bogota city. It was measured using pre and post training test with digit span forward and Corsi forward, Symbol Digit Modalities Test (SDMT), Digit Vigilance Test (DVT) and Visual Search and Attention Test (VSAT). The comparative results pre and posts showed significant differences in the vigilant measure which was tested through seconds of DVT with a minimum effect size, as well as a reduction of the omissions with an average effect size, and the VSAT test with a large effect size. It can be concluded that the module of attention called CogniPlus could help to improve the abilities of vigilance and sustained attention of elderly people who aged normal.

Curso clínico y perfil neuropsicológico de un caso de trastorno neurocognitivo frontotemporal mayor variante lingüística / Clinical course and neuropsychological profile of Frontotemporal Neurocognitive Disorder Linguistic Language Variant

Resumen El trastorno neurocognitivo frontotemporal es una enfermedad neurodegenerativa que incluye manifestaciones clínicas de subtipo comportamental y lingüística. La afasia progresiva primaria (APP) es un síndrome en el que aparecen alteraciones del lenguaje que comprende tres tipos de variantes: no fluente, semántica y logopénica. Este estudio describe la evolución clínica y las características neuropsicológicas de una mujer de 63 años que presenta un deterioro progresivo del lenguaje. Se evalúan las funciones de atención, memoria, lenguaje y funciones ejecutivas. La paciente obtuvo un bajo rendimiento en memoria, velocidad de procesamiento y funciones ejecutivas. Su lenguaje se caracteriza por presentar baja fluidez, agramatismo, parafasias verbales y dificultades en denominación. Se concluye que la paciente presenta características de la APP no fluente, que varía a través del tiempo y afecta su funcionamiento; características de un curso clínico de un trastorno neurocognitivo mayor posible debido a una degeneración del lóbulo frontotemporal.

Abstract Mild cognitive impairment, frontotemporal dementia (FTD) is a neurodegenerative disease characterized by clinical manifestations of behavior and linguistic subtypes. Primary Progressive Aphasia (APP) is a syndrome in which language alterations appear that include three types of variations: Non - fluent, Semantic and Logopenic. This study describes the clinical evolution and the neurophysiological characteristics of a 63 years old woman that started with a progressive language impairment. The functions which are evaluated are attention, memory, language and executive functions. The patient obtained a low performance in memory, processing speed and executive functions. The language is characterized by low fluency, agramatism, paraphasias and denomination difficulties. It is concluded, that the patient has characteristics of APP non-fluent which varies throughout the time and it affects her performance; characteristics of a clinical course of a greater neurocognitive disorder might be due to a lobe frontotemporal degeneration.

Descripción y evaluación de la rotación de estudiantes de Medicina por Pediatría de Atención Primaria / Description and assessment of medical student rotation in Primary Care Paediatrics

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[Ethical and legal questions of anonymity and confidentiality in gamete donation]. / Cuestiones éticas y legales del anonimato y la confidencialidad en la donación de gametos.

Spain is the European country where more assisted reproduction techniques (ART) are performed, reaching 9% of newborns. The objective of this article is to introduce the legal framework and to analyze some ethical questions, not without controversy, in relation to the anonymity of gamete donors and the concealment of origin by ART from their children. Spanish legislation establishes the relative anonymity of donors: both gamete recipients and born children have the right to obtain general information about them as long as their identity is not included, but in situations of risk to the life and health of the children allows your bankruptcy. Likewise, an unequivocal right to privacy and confidentiality of submission to the ART is established. The movement aimed at introducing in our country a legislative amendment that ends the anonymity of gamete donors is based on the right of those children to know their biological origin. Along with legal changes, the attitude of parents and professionals must gradually change towards more transparent and responsible communication, based on the experiences of adults conceived by these techniques, and those adopted. Building values such as trust and truth in the family relationships from responsibility requires placing the children, largely forgotten and the most vulnerable part, at the center of the debate.

Hernia de Spiegel, una causa poco conocida de dolor abdominal / Spigelian hernia, a little-known cause of abdominal pain

La hernia de Spiegel es una causa poco frecuente de dolor abdominal en la infancia. Se produce a lo largo de la línea semilunar, en la zona de transición de la aponeurosis y el músculo transverso del abdomen. Presenta una clínica atípica, y su baja incidencia en Pediatría puede llevar a errores o retrasos diagnósticos con el consecuente riesgo de complicaciones. En este artículo presentamos el caso de un niño de tres años con dolor abdominal de larga evolución producido por una hernia de Spiegel

Spiegelian hernia is a rare cause of abdominal pain in the childhood. It occurs along the semilunar line, in the transitional zone of the aponeurosis and the transverse muscle of the abdomen. It presents an atypical clinic and its low incidence in pediatrics can lead to errors or diagnostic delays with the consequent risk of complications. In this article we present the case of a 5-year-old boy with abdominal pain of long evolution caused by a Spiegelian hernia

Subluxación atloaxoidea no traumática: síndrome de Grisel / Nontraumatic atlantoaxial subluxation: Grisel síndrome

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Scoliosis Associated with Proteus Syndrome: Report of 2 Cases and Review of the Literature.

BACKGROUND: Proteus syndrome (PS) is a complex genetic disorder, characterized by the sporadic appearance of hamartomatous lesions that follow a mosaic pattern and have a progressive evolution. It affects most of the mesodermal origin tissues, including the bones. Scoliosis is a common manifestation, with great variability and specific peculiarities, but little about it has been published. CASE DESCRIPTION: Presentation of 2 clinical cases of patients with PS that underwent scoliosis surgery and literature review. Two patients aged 17 years, a girl (patient 1) and a boy (patient 2), both diagnosed with PS, were being followed-up for scoliosis. Patient 1 had a right thoracic curve with a Cobb angle of 69.1°, whereas patient 2 also had a right thoracic curve of 106.8°. In both patients a posterior fusion was performed, associating rib and ponte osteotomies at the level of the apex in patient 2. A minimum 2-year follow-up was done. Both patients had a satisfactory evolution without neurologic or other complications, with a high degree of correction of their curves (Cobb angle 29.2° and 55.6°, respectively). Their total SRS-22 (Scoliosis Research Society Outcomes Questionnaire) score at the last visit was 4.77 and 4.64, respectively. CONCLUSIONS: Both PS and scoliosis are conditions associated with deformities and physical limitations that decrease the health-related quality of life of these patients. Because of the severity of the spinal deformities and their risk of progression, early diagnosis and prompt treatment is recommended. Despite being highly complex, scoliosis surgery allows a satisfactory deformity correction and consequently improves the health-related quality of life of patients with PS.

Jugar es un asunto serio / No disponible

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Recomendaciones para "no hacer" en Pediatría / "Do not do" recommendations in Pediatrics

En los últimos años, varias sociedades e instituciones científicas, nacionales e internacionales, han emitido recomendaciones sobre "no hacer" (do not do) determinadas intervenciones médicas por no estar suficientemente basadas en pruebas científicas, con el objetivo principal de mejorar la calidad y sostenibilidad de la atención sanitaria y la seguridad en el paciente. Presentamos una recopilación y síntesis de las recomendaciones elaboradas por diferentes organizaciones sanitarias dirigidas a los pediatras de Atención Primaria y orientadas a disminuir pruebas y consultas innecesarias

In recent years, several national and international scientific societies and healthcare organizations have created "do not do" recommendations. They are trying to reduce healthcare interventions that are not based on scientific evidence, to improve the quality and sustainability of the health system and to promote patient safety. We present a compilation and synthesis of the recommendations published by different health organizations aiming to reduce unnecessary tests and consultations to Pediatric Primary Health Care practitioners

Adecuación del esfuerzo terapéutico a propósito de Charlie Gard / Appropriateness of the therapeutic effort in the case of Charlie Gard

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Reflexiones del Comité de Bioética de la AEP sobre el rechazo de tratamientos vitales y no vitales en el menor / Views of the Spanish Paediatric Association Bioethics Committee on the refusal of essential and non-essential treatment in minors

Los conflictos que se plantean al negarse el menor de edad o sus representantes a recibir un tratamiento considerado necesario por el pediatra suponen un importante problema ético y conllevan fuerte impacto emocional. Para afrontar el rechazo al tratamiento es necesario explorar y comprender las razones que aducen los implicados, considerar los factores contextuales de cada caso y conocer la conducta a seguir teniendo en cuenta consideraciones bioéticas y el fundamento legal (AU)

The conflicts that arise when minors or their legal representatives refuse to receive medical treatment considered necessary by the paediatrician pose a serious ethical dilemma and also have a considerable emotional impact. In order to adequately tackle this rejection of medical treatment, there is to identify and attempt to understand the arguments of the people involved, to consider the context in each individual case and be conversant with the procedure to follow in life-threatening scenarios, taking into account bioethical considerations and the legal framework (AU)

Encondromatosis múltiple, enfermedad de Ollier / Multiple enchondromatosis, Ollier disease

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Pediatras sólidos en tiempos líquidos. Reanimando la profesionalidad / Solid paediatricians in fluid times: Reviving professionalism

La profesionalidad apenas se enseña formalmente. Se aprende por ósmosis a través del currículum oculto: conjunto de actitudes que cada uno de nosotros transmite de forma inconsciente a estudiantes, residentes y compañeros. Todos somos modelo o contramodelo de profesionalidad a través de una serie de valores que han constituido los pilares de nuestra profesión desde Hipócrates. Valores que parecen soportar mal el paso del tiempo. Existen factores propios del siglo XXI como la crisis económica, el excesivo tecnicismo, la burocratización o la banalización del acto médico que pueden explicar, pero nunca justificar, el declive de los valores de nuestra profesión: la empatía, la integridad, la solidaridad, el altruismo o la confidencialidad. Por eso, desde el Comité de Bioética de la Asociación Española de Pediatría planteamos la necesidad de reanimar la profesionalidad. Construir y mantener los valores de nuestra profesión formando pediatras científicamente competentes, pero también excelentes desde el punto de vista ético, es parte de nuestra responsabilidad (AU)

Professionalism is rarely taught formally. It is learned by osmosis through the hidden curriculum: a set of attitudes that each one of us transmits unconsciously to students, medical residents, and colleagues. All of us are a model or counter-model of professionalism through a series of values that have been the pillars of our profession since Hippocrates. Values that do not seem to be strong enough to pass our time. There are specific factors of the 21st century such as the financial crisis, the highly technical nature of medicine, bureaucratisation or trivialisation of the medical process that could explain, but not justify, the decline in the values of our profession: Empathy, integrity, solidarity, the altruism, or confidentiality. That is why, from the Bioethics Committee of the Spanish Paediatrics Association we establish the need to revive professionalism. Building and maintaining the values of our profession by training scientifically competent paediatricians, as well as being excellent from an ethical point of view, is part of our responsibility (AU)

[Views of the Spanish Paediatric Association Bioethics Committee on the refusal of essential and non-essential treatment in minors]. / Reflexiones del Comité de Bioética de la AEP sobre el rechazo de tratamientos vitales y no vitales en el menor.

The conflicts that arise when minors or their legal representatives refuse to receive medical treatment considered necessary by the paediatrician pose a serious ethical dilemma and also have a considerable emotional impact. In order to adequately tackle this rejection of medical treatment, there is to identify and attempt to understand the arguments of the people involved, to consider the context in each individual case and be conversant with the procedure to follow in life-threatening scenarios, taking into account bioethical considerations and the legal framework.