Active engagement in a web-based tutorial to prevent obesity grounded in Fuzzy-Trace Theory predicts higher knowledge and gist comprehension.

We used Sharable Knowledge Objects (SKOs) to create an Intelligent Tutoring System (ITS) grounded in Fuzzy-Trace Theory to teach women about obesity prevention: GistFit, getting the gist of healthy eating and exercise. The theory predicts that reliance on gist mental representations (as opposed to verbatim) is more effective in reducing health risks and improving decision making. Technical information was translated into decision-relevant gist representations and gist principles (i.e., healthy values). The SKO was hypothesized to facilitate extracting these gist representations and principles by engaging women in dialogue, "understanding" their responses, and replying appropriately to prompt additional engagement. Participants were randomly assigned to either the obesity prevention tutorial (GistFit) or a control tutorial containing different content using the same technology. Participants were administered assessments of knowledge about nutrition and exercise, gist comprehension, gist principles, behavioral intentions and self-reported behavior. An analysis of engagement in tutorial dialogues and responses to multiple-choice questions to check understanding throughout the tutorial revealed significant correlations between these conversations and scores on subsequent knowledge tests and gist comprehension. Knowledge and comprehension measures correlated with healthier behavior and greater intentions to perform healthy behavior. Differences between GistFit and control tutorials were greater for participants who engaged more fully. Thus, results are consistent with the hypothesis that active engagement with a new gist-based ITS, rather than a passive memorization of verbatim details, was associated with an array of known psychosocial mediators of preventive health decisions, such as knowledge acquisition, and gist comprehension.

Evidence that small molecule enhancement of ß-hexosaminidase activity corrects the behavioral phenotype in Dutch APP(E693Q) mice through reduction of ganglioside-bound Aß.

Certain mutant Alzheimer's amyloid-ß (Aß) peptides (that is, Dutch mutant APP(E693Q)) form complexes with gangliosides (GAß). These mutant Aß peptides may also undergo accelerated aggregation and accumulation upon exposure to GM2 and GM3. We hypothesized that increasing ß-hexosaminidase (ß-hex) activity would lead to a reduction in GM2 levels, which in turn, would cause a reduction in Aß aggregation and accumulation. The small molecule OT1001 is a ß-hex-targeted pharmacological chaperone with good bioavailability, blood-brain barrier penetration, high selectivity for ß-hex and low cytotoxicity. Dutch APP(E693Q) transgenic mice accumulate oligomeric Aß as they age, as well as Aß oligomer-dose-dependent anxiety and impaired novel object recognition (NOR). Treatment of Dutch APP(E693Q) mice with OT1001 caused a dose-dependent increase in brain ß-hex levels up to threefold over those observed at baseline. OT1001 treatment was associated with reduced anxiety, improved learning behavior in the NOR task and dramatically reduced GAß accumulation in the subiculum and perirhinal cortex, both of which are brain regions required for normal NOR. Pharmacological chaperones that increase ß-hex activity may be useful in reducing accumulation of certain mutant species of Aß and in preventing the associated behavioral pathology.

La exposición al tabaco como factor de riesgo de enfermedad invasora en niños / Exposure to tobacco smoke as a risk factor for invasive disease in children

La gran mayoría de niños expuestos al tabaco no eligen esta exposición. Se estima que alrededor de la mitad de los niños se encuentran en un ambiente contaminado por el humo del tabaco, particularmente en su domicilio. Los resultados obtenidos en los estudios sobre tabaco y enfermedad invasora por Haemophilus influenzae tipo B y Streptococcus pneumoniae no son consistentes; se precisan nuevas investigaciones que aporten mayor evidencia con respecto a esta posible asociación, ya que determinados hallazgos biológicos apuntan hacia ella. La exposición al tabaco en los niños aumenta el riesgo de padecer enfermedad invasora por meningococo; así lo confirman varios estudios en los que existe una importante fuerza de asociación después de haber ajustado por posibles variables de confusión. Estos hallazgos aumentan la evidencia del efecto perjudicial del tabaco en la salud infantil. Toda estrategia encaminada a la reducción de esta exposición contribuirá a mejorar la salud infantil; en este sentido, hay que hacer hincapié en la conveniencia de no fumar en presencia del niño y, fundamentalmente, en el domicilio

The great majority of children who are exposed to tobacco smoke do not choose this exposure. It is estimated that about half of all children are subjected to environments contaminated by tobacco smoke, mainly at home. The results of studies of the association between exposure to tobacco smoke and risk for invasive Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are not consistent and further studies providing greater evidence of a relationship will be necessary since there are certain biological findings that suggest that it exists. Exposure to tobacco smoke increases the risk of invasive meningococcal disease in children, as has been shown in a number of studies that have demonstrated a strong association after adjustment for different confounding variables. These findings increase the body of evidence of the harmful effect of tobacco smoke on children's health. Any strategy aimed at reducing the exposure of children to tobacco smoke will improve their health. It is important to educate parents and the importance of avoiding smoking in the household should be stressed

[The pharmacological approach to the autistic spectrum]. / Abordaje farmacológico en el espectro autista.

OBJECTIVE: To describe our experience of the drug treatment of children within the autistic spectrum. DEVELOPMENT: We analyze some neuroleptic drugs, the serotonin uptake inhibitors and antiepileptic drugs, emphasizing the most suitable drugs for each symptom we wish to treat and how to do so. CONCLUSIONS: The treatment of children within the autistic spectrum should be specific, meticulous and well controlled by the neuropaediatrician. It should be changed according to the symptoms and never expected to be the same during the patient s entire life. More studies are needed in this field.

Una etiología infrecuente de síndrome de resistencia de las vías aéreas superiores / An unusual etiology of upper airway resistance syndrome

Presentamos el caso de un hombre de 38 años que consultó por presentar frecuentes crisis de despertar asfícticas con sensación de ahogo siempre que dormía. Asociaba además somnolencia excesiva diurna y un ronquido intenso antes de cada despertar, pero no durante el resto del sueño. El estudio polisomnográfico evidenció valores normales en el índice de desaturaciones de O2, en la mínima saturación de O2, una desestructuración de la arquitectura del sueño, con mínimos porcentajes de los estadios IIIIV, un índice elevado de arousals y un RDI <5. Los diámetros faríngeos medidos mediante TC resultaron normales, pero el grado de hipersomnia detectado en la escala de Epworth fue muy elevado. El estudio nasofibroscópico objetivó una epiglotis basculante que en inspiración forzada ocluía totalmente la vía aérea. La ausencia de episodios de desaturación con numerosos despertares durante el sueño y somnolencia diurna excesiva condujeron al diagnóstico de síndrome de resistencia de las vías aéreas superiores (SRVAS). El tratamiento con C-PAP condicionó empeoramiento de los síntomas, pero la epiglotectomía parcial con láser CO2 fue resolutiva de los mismos. Se comentan los aspectos fisiopatólogicos del SRVAS, así como su monitorización y alternativas terapéuticas (AU)

We present the case of a thirty-eight years-old man bearing of frequent crisis of asphyxiating wakefulness and breathnessless whenever he was asleep. There also were excessive daytime sleepiness and a strong snore before every wakefulness, but not for the rest of sleep. A polysomnographic study revealed normal values in the oxygen desaturation index, minimum oxygen saturation, an sleep structure alteration with a decrease of III-IV stages, high arousals index and RDI < 5. Pharyngeal diameters measured by mean of TC were normal, but sleepiness degree detected in the Epworth scale was high. Nasal fiberoptic endoscopy study allowed to see a swinging epiglottis that closed totally the upper airway during forced inspiration. The lack of desaturation episodes with numerous wakefulness along the sleep and excessive daytime sleepiness drove to the diagnosis of upper airway resistance syndrome (UARS). Treatment whit C-PAP just provoked an impairment in symptoms, but a CO2-laser partial epiglottectomy improved them. Patophysiological aspects of UARS, as well as its follow-up and therapeutic alternatives are commented (AU)

[The effects of psychostimulants on the cognitive results and behaviour of children with the combined subtype of attention deficit with hyperactivity]. / Efectos de los psicoestimulantes en el desempeño cognitivo y conductual de los niños con un déficit de atención con hiperactividad subtipo combinado.

INTRODUCTION: Many studies have shown the efficacy of methylphenidate in treating children with attention deficit and hyperactivity to reduce the main symptoms of the disorder and problems of behaviour: behaviour which is disruptive, antisocial, negative and aggressive. OBJECTIVES: 1. Analyze the therapeutic effects of methylphenidate on the cognitive function of children with TDAH, combined subtype, evaluated by means of neuropsychological tests of attention and inhibitory control. 2. Determine the efficacy of methylphenidate in improving the basic symptoms of TDAH C according to the DSM 1V for parents and teachers, and their behaviour, evaluated by their teachers, in the combined subtype. PATIENTS AND METHODS: The sample was made up of 48 children with TDAH C. 24 of these had been referred by paediatricians and received drug treatment with methylphenidate, 0.5 mg/kg once in the morning and once after lunch (TDAH C/CTF). The other group of 24 children with TDAH C were referred from their teachers to a school psychologist so that they followed the usual guidelines for orientation but not a systematically developed treatment (TDAH C/C or control group). RESULTS. In relation to the first objective the results were good for the TDAH C/CTF compared with the TDAH C/C group regarding the proportion of children who improved their results on neuropsychological testing of planning inhibitory control and attention. The differences between the two groups were statistically significant in the latent period of the reflexive impulsive test (MFF), arithmetic, cancellation of rhomboids and cancellation of numbers. Regarding the second objective, the improvement in the TDAH C/CTF group according to the teachers opinions were statistically significant with respect to attention, hyperactivity and impulsiveness, as compared with the control group. However, according to the parents assessment, although improvement was greater in both dimensions, the differences between the two groups did not reach statistical significance. Finally, the teachers observed greater improvement in the medicated group as compared to the control group regarding three variables: learning problems, antisocial conduct and failure to adapt to school. CONCLUSIONS: Overall, our results coincide with those of other excellent reviews, which have shown the effectiveness of methylphenidate in the treatment of cognitive and behaviour disorders in this group.

Epidemiology of invasive streptococcus pneumoniae infections in children in Spain, 1996-1998.

BACKGROUND: Streptococcus pneumoniae is a significant cause of meningitis and septicemia in early infancy, being associated to a high case-fatality rates and serious sequelae. OBJECTIVE: To investigate the burden of invasive disease caused by S. pneumoniae in Valencia, Spain, during a three-year period (1996-1998). METHODS: Hospital-based prospective active surveillance program for invasive bacterial diseases in children < or = 15 years of age in Valencia, from December 1, 1995 to January 1999. RESULTS: A total of 94 cases of invasive pneumococcal disease were detected in patients < or = 15 years of age. The overall annual incidence of invasive pneumococcal disease was 4.6/100,000 persons, < or = 15 years of age. The incidence of invasive disease and meningitis was higher among children younger than 2 years of age (16.8 and 3.8, respectively). Serotypes 19, 14 and 6 accounted for 83% of the isolates. CONCLUSIONS: The age distribution of invasive pneumococcal disease and meningitis shows a peak in the first two years of life and a decline thereafter. Serotypes 19, 14 and 6 are those primarily responsible for invasive pneumococcal disease in children of this region of Spain.

Indicaciones de la prescripción de los audífonos por el otorrinolaringólogo / Indications for the prescription of hearing-aids by the Otolaryngologist

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Efectos de los psicoestimulantes en el desempeño cognitivo y conductual de los niños con déficit de atención e hiperactividadsubtipo combinado / The effects of psychostimulants on the cognitive results and behaviour of children with the combined subtype of attention deficit with hyperactivity

Introducción. Numerosos estudios han comprobado la eficacia del metilfenidato en la intervención de los niños con déficit de atención con hiperactividad, para disminuir los síntomas centrales del trastorno y los problemas de comportamiento: conductas disruptivas, antisociales, negativismo, agresividad. Objetivos. 1. Analizar los efectos terapéuticos del metilfenidato sobre el funcionamiento cognitivo de niños con TDAH, subtipo combinado, valorado mediante pruebas neuropsicológicas de atención y control inhibitorio; 2. Determinar la eficacia del metilfenidato para mejorar los síntomas esenciales del TDAH-C según el DSM-IV para padres y profesores, así como el funcionamiento conductual, valorado a partir de la estimación de profesores, en el subtipo combinado. Pacientes y métodos. La muestra la formaban un total de 48 niños con TDAH-C; 24 pertenecían al grupo de niños remitidos clínicamente por pediatras, que recibieron tratamiento farmacológico con metilfenidato con dosis de 0,5 mg/kg, una por la mañana y otra después de comer (TDAH-C/CTF), y el otro grupo de 24 niños con TDAH-C procedían de remisiones del profesor al psicólogo escolar, de tal manera que seguían las pautas habituales de orientación, pero no un tratamiento sistemáticamente desarrollado (TDAH-C/C o grupo control). Resultados. En relación con el primer objetivo, los resultados fueron ventajosos para el grupo TDAH-C/CTF respecto al grupo TDAH-C/C, en cuanto al porcentaje de niños que obtuvieron progresos en su rendimiento en las pruebas neuropsicológicas de planificación-control inhibitorio y de atención. Las diferencias entre los dos grupos fueron estadísticamente significativas en el tiempo de latencia de la prueba de reflexividad-impulsividad (MFF), aritmética, cancelación de rombos y cancelación de números. En relación al segundo objetivo, las mejoras del grupo TDAH-C/CTF, de acuerdo con la estimación de los profesores, fueron estadísticamente significativas en la dimensión de atención y en la de hiperactividad e impulsividad, respecto al otro grupo de comparación; sin embargo, según la valoración de los padres, aunque también fueron las mejoras superiores en ambas dimensiones, las diferencias entre los grupos no llegaron a ser significativas. Por último, los profesores observan mejoras superiores en el grupo con medicación respecto al control en tres variables: problemas de aprendizaje, conducta antisocial e inadaptación escolar. Conclusiones. Globalmente, nuestros resultados coinciden con los aportados por otras excelentes revisiones, que han puesto de manifiesto la efectividad del metilfenidato para el tratamiento de las alteraciones cognitivas y conductuales de este trastorno (AU)

[Infrequent etiology of upper airway resistance syndrome]. / Una etiología infrecuente de síndrome de resistencia de las vías aéreas superiores.

We present the case of a thirty-eight years-old man bearing of frequent crisis of asphyxiating wakefulness and breathnessless whenever he was asleep. There also were excessive daytime sleepiness and a strong snore before every wakefulness, but not for the rest of sleep. A polysomnographic study revealed normal values in the oxygen desaturation index, minimum oxygen saturation, an sleep structure alteration with a decrease of III-IV stages, high arousals index and RDI < 5. Pharyngeal diameters measured by mean of TC were normal, but sleepiness degree detected in the Epworth scale was high. Nasal fiberoptic endoscopy study allowed to see a swinging epiglottis that closed totally the upper airway during forced inspiration. The lack of desaturation episodes with numerous wakefulness along the sleep and excessive daytime sleepiness drove to the diagnosis of upper airway resistance syndrome (UARS). Treatment whit C-PAP just provoked an impairment in symptoms, but a CO2-laser partial epiglottectomy improved them. Patophysiological aspects of UARS, as well as its follow-up and therapeutic alternatives are commented.

[Pharmacological treatment with risperidone in children with behavior disorders]. / Tratamiento farmacológico con risperidona en niños con trastornos en el comportamiento.

INTRODUCTION: Behavior disorders are frequently seen in children attending a neuropaediatric clinic. The classical neuroleptic drugs are usually used for treatment. However response tends to be irregular with adverse effects at a cognitive level and extrapyramidal symptoms. PATIENTS AND METHODS: We started to use risperidone in children with serious behavior problems who had not responded to other drugs, and evaluated the clinical course and side effects. RESULTS: A total of 16 patients aged between 7 and 14 years were treated for diagnoses of: hyperactivity attention deficit disorder, mental retardation with non specific behavior disorder, Gilles de la Tourette disorder with hyperactivity attention deficit disorder and generalized disorder of development. The doses of risperidone varied between 0.01 and 0.05 mg/kg/day. In two cases the evolution could not be assessed, was good in 10 and no change was seen in 4. The group of patients with most improvement were those with mental retardation. The commonest adverse effect was weight gain. No patient had extrapyramidal symptoms. CONCLUSION: We consider risperidone to be a safe drug for the pharmacological treatment of children with behavior problems.

Tumores tectales en pediatría. Revisión de ocho pacientes / Tectal tumours in paediatrics. a review of eight patients

Introducción. Los tumores de la región tectal constituyen, dentro del apartado de los gliomas del tronco del encéfalo, un subgrupo de mejor pronóstico que requiere una estrategia terapéutica distinta. Objetivos. Revisión retrospectiva de los tumores tectales en niños perfilando la actitud terapéutica más idónea y el pronóstico esperable. Pacientes y métodos. Se revisan ocho pacientes pediátricos que en los últimos 11 años han desarrollado un tumor tectal diagnosticado mediante técnicas de neuroimagen. Se evalúan sus características clínicas y, especialmente, su evolución clinicorradiológica. Resultados. La media de edad al diagnóstico fue de 10 años. Todos los casos mostraron una presentación clínica de hipertensión intracraneal secundaria a la obstrucción del acueducto de Silvio. La RM resultó clave para objetivar la lesión tectal en todos los casos excepto en uno visualizada previamente en la TC. La actitud terapéutica inicial y exclusiva fue la derivación ventricular. El seguimiento clinicorradiológico medio en nuestra serie ha sido de 4 años, con buena evolución en todos los casos sin precisar otras medidas terapéuticas. Los controles de RM dieron evidencia de estabilidad tumoral en todos los casos excepto en uno con mínima expansión lesional sin repercusión clínica. Conclusiones. Los tumores tectales en los niños muestran, en la mayoría de los casos, un curso benigno. La derivación ventricular es habitualmente el único tratamiento requerido. No obstante, se debe realizar un seguimiento clínico y radiológico estrecho para descartar progresión tumoral que aconseje otras medidas terapéuticas. La RM es electiva en la valoración inicial y en el seguimiento de estos tumores (AU)

Impact of non-routine vaccination on the incidence of invasive Haemophilus influenzae type b (Hib) disease: experience in the autonomous region of Valencia, Spain.

OBJECTIVE: This study assessed the impact of non-routine vaccination against invasive Haemophilus influenzae (Hib)disease before the introduction of universal childhood Hib vaccination. METHODS: Data were obtained from a prospective surveillance program for invasive bacterial diseases in children <15 years of age that was begun in the Autonomous Region of Valencia on 1 December 1995. RESULTS: An incidence of 15.5 cases of invasive Hib disease per 100,000 children <5 years of age was reported in the first year of the surveillance program (from 1 December 1995 to 30 November 1996), when Hib vaccination coverage was estimated to be 32.5%. An increase in vaccination coverage to 44% in the second year (1 December 1996 to 30 November 1997) was associated with a reduction in disease incidence to 3.3 cases per 100,000. After the initiation of universal vaccination in December 1998, only two cases were reported. The effectiveness of non-routine vaccination was 71% in 1997. CONCLUSIONS: These results show that before the introduction of routine childhood Hib vaccination, widespread use of the vaccine can dramatically reduce the occurrence of invasive Hib disease.

Epidemiological pattern of meningococcal disease in Valencia, Spain. Impact of a mass immunization campaign with meningococcal C polysaccharide vaccine.

The objective of this study was to define the epidemiological pattern of meningococcal disease in the autonomous region of Valencia, Spain, and the impact of a mass immunization campaign against serogroup C meningococcus. Data were obtained from a prospective surveillance program for invasive bacterial diseases in children < 15 y of age that began in the Valencia region on 1 December, 1995. During the period 1996-98, 213 cases of meningococcal disease were detected, representing an annual incidence of 11.3/100,000 children < 15 y. Serogroup C accounted for 31% and 38.5% of cases in 1996 and 1997, respectively (annual incidences of 2.9 and 5.4 cases/100,000 children < 15 y). An immunization campaign with the meningococcal C polysaccharide vaccine, which included all persons between 18 months and 19 y of age, began in late 1997 (vaccination coverage of 86%). In 1998, the annual incidence of meningococcal C disease fell to 1.4 cases per 100,000 children < 15 y of age. These results mirror the increase in the reported incidence of serogroup C meningococcal disease in Spain in the 1990s, a trend that was reversed after the introduction of the mass vaccination campaign. Meningococcal polysaccharide vaccine seems to be an effective public health tool for the management of this serious communicable disease.

Tratamiento farmacológico con risperidonaen niños con trastornos en el comportamiento / Pharmacological treatment with risperidone in children with behavior disorders

Introducción. Los trastornos del comportamiento en los niños constituyen una patología frecuente en la consulta de neuropediatría. El tratamiento farmacológico se realiza generalmente con los neurolépticos clásicos, que provocan una respuesta irregular y efectos adversos relevantes en cuanto al nivel cognitivo y a síntomas extrapiramidales. Pacientes y métodos. Iniciamos el empleo de la risperidona en niños con problemas graves de comportamiento que no habían respondido a otros fármacos, y valoramos la evolución clínica y los efectos secundarios. Resultados. Se trataron un total de 16 pacientes entre los 7 y 14 años de edad con los diagnósticos de: trastorno de déficit de atención con hiperactividad (TDAH), retraso mental (RM) con trastorno del comportamiento perturbador no especificado, trastorno de Gilles de la Tourette con TDAH y trastorno generalizado del desarrollo. Las dosis de risperidona osciló entre 0,01 y 0,05 mg/kg/día. La evolución no se pudo valorar en dos casos, fue positiva en 10 y sin cambios en 4. El grupo de pacientes que más se benefició fue el afecto de RM. El efecto adverso más frecuente fue el incremento de peso. Ningún caso presentó sintomatología extrapiramidal. Conclusión. Consideramos a la risperidona un fármaco seguro para el tratamiento farmacológico de los niños con problemas en su comportamiento (AU)

[Tectal tumours in paediatrics. A review of eight patients]. / Tumores tectales en pediatría. Revisión de ocho pacientes.

INTRODUCTION: Tumours of the tectal region form, within the group of gliomas of the brain stem, a sub group with better prognosis which require a different therapeutic strategy. OBJECTIVES: A retrospective review of tectal tumours in children to find the most suitable therapeutic approach and the prognosis to be expected. PATIENTS AND METHODS: We reviewed 8 paediatric patients who, during the past 11 years, had developed tectal tumours diagnosed by means of neuro imaging techniques. We evaluated their clinical features and especially their clinico radiological progress. RESULTS: The average age at the time of diagnosis was 10 years. All cases presented with the clinical features of raised intracranial pressure secondary to obstruction of the aqueduct of Sylvius. MR was the key to visualization of the tectal lesion in all cases but one, which had already been shown on CT. The initial and only treatment given was a ventricular shunt. The average clinico radiological follow up in our series was 4 years, with good progress in all cases so that no other therapeutic measures were required. MR follow up showed that the tumours were stable in all cases but one, which had increased slightly in size but without parallel clinical signs. CONCLUSION: In most cases tectal tumours in children follow a benign course. A ventricular shunt is usually the only treatment necessary. However, close clinical and radiological follow up should be carried out to rule out growth of the tumour which make other treatment also necessary. MR is the method of choice for initial evaluation and follow up of these tumours.

Epidemiologic aspects of pediatric multiple trauma in a Spanish urban population.

BACKGROUND/PURPOSE: Trauma is still the most frequent cause of mortality and disability in childhood and adolescence. An epidemiologic prospective study on children under 16 years of age with multiple trauma (MT) was conducted in a large Spanish urban university hospital over a 6-year period. METHODS: Of 1,937 children admitted at the pediatric trauma unit for musculoskeletal injuries from March 1988 until March 1994, 56 patients including 37 boys and 19 girls had MT. MT was considered when at least 2 long bones were fractured or there was a fracture of 1 long bone combined with an injury of 4 other major anatomic regions (face and neck, thorax, abdomen, or neural system). The severity of injuries was evaluated according to the modified injury severity score (MISS). RESULTS: Injury to pedestrians was the most frequent cause of MT (54%). The overall mortality rate of the series, including those children dying during transport to the hospital was 11.5%. The average MISS for the whole group was 15 (range, 5 to 59). Head trauma was the most frequent associated injury (52%), two thirds of which were considered minor injuries (Glasgow Coma Scale >15). Seventy-seven fractures were registered, 10% of which were open fractures. External fixation was the most common surgical technique among operated fractures. The average hospitalization period was 16 (median, 13; range, 1 to 150) days. Children with a MISS above 18 points showed a significant longer hospitalization period (mean, 31 +/- 45 days) as compared with those with MISS below 18 points (mean, 10 +/- 7 days; P < .05). There was a strong correlation between the MISS and both the period of hospitalization at the pediatric intensive care unit and the total length of hospital stay. CONCLUSIONS: Pedestrian accidents caused by motor vehicles in children playing at the street contributed most significantly to MT in the urban pediatric population. Special care for prevention must be taken in the age group of 6 to 10 years. Head injury was the main cause of death in children with multiple trauma. MISS was found to be a good predictor of survival and duration of hospital stay in pediatric MT.

Indicadores de actividad amilasa en la enfermedad parotídea. Parotiditis crónica recurrente infantil / Amylase activity markers for parotid disease: infant recurrent chronic parotiditis

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