Efectividad de la realidad virtual y los videojuegos sobre el control postural y equilibrio en población infantil con parálisis cerebral en el ámbito de la Atención Temprana. Revisión sistemática / Effectiveness of virtual reality and video games on postural control and balance in children with cerebral palsy in Early Intervention. Systematic review

Antecedentes y objetivo: Las alteraciones motoras de la parálisis cerebral generan alteraciones del control postural y equilibrio. Los videojuegos y la realidad virtual trabajan sobre esos aspectos lúdicamente. El objetivo fue evaluar su efectividad en el control postural y equilibrio en población infantil con parálisis cerebral en Atención Temprana. Material y métodos: Entre enero y febrero del 2021 se realizó la búsqueda de ensayos clínicos aleatorizados y sin grupo control en Epistemonikos, Pubmed, Cochrane Library, Web of Science, Scopus, Science Direct, PEDro y Dialnet. Se revisó la bibliografía de guías clínicas, revisiones sistemáticas y metaanálisis. Se complementó con las revistas Fisioterapia, Cuestiones de Fisioterapia y Pediatric Physical Therapy. Tras la elección de artículos utilizándose la Declaración PRISMA, se analizó su calidad con las escalas CONSORT, TREND y SIGN. Resultados: Se incluyeron 16 estudios que evaluaban el control postural, equilibrio y función motora gruesa en población infantil entre 3 y 13 años con parálisis cerebral. La realidad virtual utilizada fue: Wii, XBOX, PlayStation2, TYROMOTION y ordenador. Los estudios obtuvieron mejoras significativas en variables que median el control postural, equilibrio y función motora gruesa al finalizar y se mantuvieron 4-8 semanas. No indicaron efectos adversos reseñables. La calidad fue variable incluyéndose estudios 1+ y 1− de la escala SIGN. Conclusiones: Los estudios reportan cierto grado de efectividad en la mejora del control postural y equilibrio en población infantil con parálisis cerebral en diferentes rangos de edad. Son necesarios estudios con mayor muestra, calidad y población centrada en Atención Temprana para generalizar estos resultados. (AU)

Background and objective: Motor disorders in cerebral palsy cause alterations in postural control and balance. Video games and virtual reality work on these aspects in a playful way. The objective was to evaluate their effectiveness on postural control and balance in children with cerebral palsy in Early Intervention.Material and methods: Between January and February 2021 we searched in Epistemonikos, Pubmed, Cochrane Library, Web of Science, Scopus, Science Direct, PEDro and Dialnet for randomised clinical trials and trials without a control group. Bibliographies of clinical guidelines, systematic reviews and meta-analyses were reviewed. It was complemented with the journals Fisioterapia, Cuestiones de Fisioterapia and Pediatric Physical Therapy. We use PRISMA Statement. After selecting articles, their quality was analysed using CONSORT, TREND and SIGN scales.Results: Sixteen studies were included that assessed postural control, balance and gross motor function in children aged 3–13 years with cerebral palsy. The virtual reality used was Wii, XBOX, PlayStation2, TYROMOTION and computer. The studies showed significant improvements in variables that evaluate postural control, balance and gross motor function at the end and maintained for 4–8 weeks. Motivation and participation levels increased. No notable adverse effects were reported. Quality was variable, including 1+ and 1− on the SIGN scale.Conclusions: Studies report a certain degree of effectiveness in improving postural control and balance in children with cerebral palsy in different age ranges. Studies with a larger sample, quality and a study population focused on Early Intervention are needed to generalise these results. (AU)

Osteonecrosis of the jaw induced by arsenic trioxide therapy in a leukemia patient: A rare case report and literature review.

A patient suffering from acute promyelocytic leukemia (APL) was referred to the dental department before introduction of chemotherapy by all-trans retinoic acid and arsenic trioxide (ATO). A panoramic radiography showed his third upper maxillary left tooth included into the maxillary bone. The patient presented with a febrile episode. Consequently, the infectious gateway was researched. A left maxillary sinus migration of his third upper left tooth together with a bony sequestrum has been observed on a CT-scan. A surgery was then performed to remove the bony sequestrum and the tooth. The first hypothesis of tooth migration could be that the patient had an infection prior to introduction of chemotherapy. However, neither clinical or radiographic signs were observed during the initial check-up. The second hypothesis is that ATO caused osteonecrosis of the jaw (ONJ) induced the formation of a bony sequestrum associated to the tooth migration into the sinus. ONJ could be a potential adverse of ATO chemotherapy.

Cheiloplasty associated to a palatal obturator in a preterm infant with a cleft lip and palate.

INTRODUCTION: Preterm infants are commonly treated by non-invasive ventilation (NIV) and nasal continuous positive airway pressure (CPAP), which are associated with fewer complications than nasotracheal intubation. In preterm infants with a cleft lip and palate, this method of respiratory management is difficult or impossible to perform because of air leakage through the cleft defect. CASE: We report a male infant who was born at 29 weeks of gestation with a left complete unilateral cleft lip and palate. Birth weight was 900 grammes. Because of the cleft, we have any problems to ventile this infant. We decide to close the cleft prematurely on day 17 after multidisciplinary discussion. DISCUSSION: NIV cannot be performed with the usual equipment in very premature infants with a cleft lip and palate because of air leakage through the cleft defect. Very few studies report pre term infant with cleft lip and palate and his difficulties of ventilation. This is the first case reported to perform cheiloplasty on a 900g preterm infant.

Implementation and assessment of a training course for residents in neonatology and pediatric emergency medicine.

BACKGROUND AND AIMS: Residents must balance patient care and the ongoing acquisition of medical knowledge. With increasing clinical responsibilities and patient overload, medical training is often left aside. In 2010, we designed and implemented a training course in neonatology and pediatric emergency medicine for residents in pediatrics, in order to improve their medical education. The course was made of didactic sessions and several simulation-based seminars for each year of residency. We conducted this study to assess the impact of our program on residents' satisfaction and self-assessed clinical skills. METHODS: A survey was conducted at the end of each seminar. The students were asked to complete a form on a five-point rating scale to evaluate the courses and their impact on their satisfaction and self-assessed clinical skills, following the French National Health Institute's adapted Kirkpatrick model. RESULTS: Sixty-four (84%) of the 76 residents who attended the courses completed the form. The mean satisfaction score for the entire course was 4.78±0.42. Over 80% of the students felt that their clinical skills had improved. CONCLUSION: Medical education is an important part of residency training. Our training course responded to the perceived needs of the students with consistently satisfactory evaluations. Before the evaluation of the impact of the course on patient care, further studies are needed to assess the acquisition of knowledge and skills through objective evaluations.

[Cocooning strategy: Effectiveness of a pertussis vaccination program for parents in the maternity unit of a university hospital]. / Stratégie du cocooning : efficacité d'une politique de promotion de la vaccination anticoquelucheuse des parents à la maternité d'un CHU.

The aim of this study was to evaluate the impact on vaccination coverage of a protocol in which promotion and administration of pertussis vaccine in the maternity ward were proposed upon discharge from a French university hospital. Pertussis is a potentially fatal bacterial respiratory infection, especially in young infants. Since 2004 the High Council of Public Health has recommended vaccinating adults who may become parents. This recommendation is not widely applied in France. The study, organized as a professional practice evaluation (EPP) was conducted by a multidisciplinary team at Caen University Hospital. Thirty couples were included for each period. The primary endpoint was the rate of vaccination coverage for both parents at hospital discharge. Before the information campaign (first period, January 2012), immunization coverage of mothers and fathers was 20% and 13%, respectively. No couple had received a prescription for vaccines. During the second period (June 2013), vaccination coverage was 77% at hospital discharge for mothers and 57% for fathers. Parental immunization coverage against pertussis was multiplied by four to five during the study, which is very encouraging, and it is important to continue this campaign at the region and national levels.

[Alveolar capillary dysplasia with misalignment of pulmonary veins: a fatal cause of refractory neonatal cyanosis]. / Dysplasie alvéolo-capillaire avec mésalignement des veines pulmonaires : une cause de cyanose néonatale réfractaire létale.

Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare neonatal pathology that combines refractory hypoxemia with severe pulmonary arterial hypertension, and leads to death every time. Histologic examination of lung tissue confirms the diagnosis and is characterized by a decreased number of pulmonary capillaries, immature lobular development, and abnormal proximity between pulmonary arteries and veins. This abnormal proximity is responsible for an arteriovenous shunt. We report five cases confirmed by postmortem histology, which occurred over 14 years in Lower Normandy (France). The cumulative incidence is therefore of 1.8 for 100,000 births. In these five cases, the first symptoms appeared during the first hour of life and death occurred before 24h in four of five cases. The patient with the longest survival had mild histological lesions and delayed emergence of the first symptoms. Genitourinary and gastrointestinal anomalies were associated with ACD/MPV in two cases, and bilateral pulmonary hypoplasia in three cases. Optimized invasive ventilation, pulmonary vasodilators, vasoactive drugs, and pulmonary surfactant did not improve survival. Extracorporeal membrane oxygenation (ECMO) was not used. We present a review of the literature on ACD/MPV, a clinical and histological entity little known to both clinicians and pathologists, whereas a premortem diagnosis is possible and genetic counseling in affected families can be suggested.

NIDCAP in preterm infants and the neurodevelopmental effect in the first 2 years.

This paper has been retracted because it contained errors in the data extraction and analyses that affect the results, figures and tables. Data from a study that had been published in two different journal articles were included twice in the analyses. There was an error in the description of the measures used for neurodevelopmental testing in the reporting of the results.

[Two uncommon extrapulmonary forms of Mycoplasma pneumoniae infection]. / Infections extrapulmonaires àMycoplasma pneumoniae : atteintes neurologique et rénale.

Mycoplasma pneumonia is the second most frequent bacterium in pneumonia and the leading intracellular type. M. pneumoniae pulmonary infection is characterized by a slower onset profile and a lower biological inflammatory picture than pneumococcal infection. Both upper and lower respiratory tracts are often affected and sometimes a Kawasaki-like syndrome can be associated, with conjunctivitis or cheilitis. Extrapulmonary forms of the disease can occur, whether or not it is associated with pulmonary infection. We report two cases: in the first case, a renal form of M. pneumoniae disease developed in a 6-year-old girl, with membranous proliferative glomerulonephritis expressed as a picture of impure nephritic syndrome with decreased serum complement concentration, following an upper respiratory infection. Diagnosis was obtained by means of a kidney biopsy. The second case occurred in an 8-year-old girl who expressed, after a respiratory tract infection, neurological symptoms such as ocular flutter, perception disorder, and ataxia. This onset is typical of post-infectious rhombencephalitis. Biological investigations and imaging were normal. In both cases, M. pneumoniae infection was diagnosed on the basis of immunoglobulin M-positive serology. Direct exploration of the bacterium was negative, due to its fragility and delayed diagnostic hypothesis. Several forms of M. pneumoniae infection are either the direct effect of the bacterium or are secondary to a cross-immunological reaction. As its frequency is increasing, M. pneumoniae infection should be raised as a cause of atypical, less well-known extrapulmonary forms of the disease.

Alcalosis metabólica en los límites de la hipocloremia / Metabolic alkalosis in the limits of hypochloremia

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