Techno-functional aspects of kombucha analogs formulated from mulberry coproducts.

This study investigated the techno-functional conditions for producing fermented beverages using the kombucha artisanal consortium (kAC) while implementing sustainable strategies. According to the circular economy principles, the study focused on mulberry coproducts (MC) generated as agro-industrial waste during mulberry fruit production. The presence of target microorganisms in the beverage and biofilm was recorded to determine the MC content necessary for establishing kAC. Additionally, the physicochemical characteristics, carbohydrate and polyphenol profiles were analyzed to understand their impact on antioxidant activity and sensory responses in the soft drink. Notably, a concentration of 0.25% MC was found to yield fermented soft drinks rich in probiotic populations and displaying nutraceutical qualities that enhance antioxidant activity and sensory acceptability. This study offers valuable technical guidance for repurposing mulberry pruning coproducts in the creation of novel products.

Enhancing Robotic Perception through Synchronized Simulation and Physical Common-Sense Reasoning.

We introduce both conceptual and empirical findings arising from the amalgamation of a robotics cognitive architecture with an embedded physics simulator, aligning with the principles outlined in the intuitive physics literature. The employed robotic cognitive architecture, named CORTEX, leverages a highly efficient distributed working memory known as deep state representation. This working memory inherently encompasses a fundamental ontology, state persistency, geometric and logical relationships among elements, and tools for reading, updating, and reasoning about its contents. Our primary objective is to investigate the hypothesis that the integration of a physics simulator into the architecture streamlines the implementation of various functionalities that would otherwise necessitate extensive coding and debugging efforts. Furthermore, we categorize these enhanced functionalities into broad types based on the nature of the problems they address. These include addressing challenges related to occlusion, model-based perception, self-calibration, scene structural stability, and human activity interpretation. To demonstrate the outcomes of our experiments, we employ CoppeliaSim as the embedded simulator and both a Kinova Gen3 robotic arm and the Open-Manipulator-P as the real-world scenarios. Synchronization is maintained between the simulator and the stream of real events. Depending on the ongoing task, numerous queries are computed, and the results are projected into the working memory. Participating agents can then leverage this information to enhance overall performance.

Microwave-Assisted Synthesis of Zeolite A from Metakaolinite for CO2 Adsorption.

The global demand for energy and industrial growth has generated an exponential use of fossil fuels in recent years. It is well known that carbon dioxide (CO2) is mainly produced, but not only from fuels, which has a negative impact on the environment, such as the increasing emission of greenhouse gases. Thus, thinking about reducing this problem, this study analyzes microwave irradiation as an alternative to conventional heating to optimize zeolite A synthesis conditions for CO2 capture. Synthesis reaction parameters such as different temperatures (60-150 °C) and different time durations (1-6 h) were evaluated. The CO2 adsorption capacity was evaluated by CO2 adsorption-desorption isotherms at 25 °C and atmospheric pressure. The results showed that the synthesis of zeolite A by microwave irradiation was successfully obtained from natural kaolinite (via metakaolinization), reducing both temperature and time. Adsorption isotherms show that the most promising adsorbent for CO2 capture is a zeolite synthesized at 100 °C for 4 h, which reached an adsorption capacity of 2.2 mmol/g.

Incorporation of feeding behaviour traits to increase the genetic gain of feed efficiency in Pietrain pigs.

Improved feed efficiency is an essential goal for the sustainability of pig production in economic and environmental terms. Traits such as feed conversion rate (FCR), residual feed intake (RFI), residual body weight gain (RG) and feeding behaviour, such as duration (TPV) and feeding rate per visit (FR) can now be measured by automatic feeding systems. The aim of this study was to evaluate the benefits of incorporating feeding behaviour traits into a selection index to improve feed efficiency in a nucleus of purebred Pietrain pigs. Data on body weight, feed intake and duration were recorded at each visit in 1608 animals. The information contained in 843,605 visits was grouped by animal ID to obtain a set of feed efficiency and feeding behaviour traits. These traits were obtained in three periods (first, second and total period). Bayesian models were built to estimate the posterior marginal distribution of the variance components. The heritabilities were between 0.44 and 0.59 for feeding behaviour traits and between 0.31 and 0.49 for feed efficiency traits. The FCR and RFI showed a considerable genetic correlation with daily feed intake (~0.65). FCR showed a genetic correlation with feeding behaviour traits, such as feed intake per visit (FPV) (0.44) and FR (0.33). Furthermore, the fast-eating pigs were less efficient. This was due to the positive genetic correlation found between the FR and the FCR (0.33) and the RFI (0.23), and the negative correlation found with the RG (-0.28). On the other hand, the inclusion of the feeding behaviour traits into a selection index slightly increased the selection response for FCR (4%) and RFI (1.8%). However, there was an increase of up to 19% in the selection response for RG and an improvement in accuracy from 0.59 to 0.70. Therefore, we concluded that it would be interesting to include feeding behaviour traits in a selection index to improve the selection response and accuracy of feed efficiency traits.

Manejo del estado epiléptico en niños: encuesta en hospitales pediátricos de la Ciudad Autónoma de Buenos Aires / Management of status epilepticus in childhood: a survey conducted at pediatric hospitals in the City of Buenos Aires

Introducción. El estado epiléptico constituye la emergencia neurológica más frecuente. Si bien la mortalidad en niños es baja, su morbilidad puede superar el 20 %. Objetivo. Conocer las pautas de manejo del estado epiléptico referidas por médicos pediatras que atienden esta patología en forma habitual. Población y métodos. Estudio descriptivo, transversal, basado en una encuesta a médicos de tres hospitales pediátricos monovalentes de gestión pública de la Ciudad Autónoma de Buenos Aires. Resultados. Se administraron 292 encuestas (la tasa de respuesta completa alcanzó el 86 %); el 77 % se administró a pediatras y el 16 %, a especialistas en cuidados intensivos. Un 47 % de los participantes refiere indicar la primera benzodiacepina en el tiempo correcto; el 56 % utilizar diazepam intrarrectal en ausencia de un acceso intravenoso; el 95 % elige lorazepam como benzodiacepina inicial en caso de contar con acceso intravenoso; el 58 % refiere iniciar la etapa de fármacos de segunda línea en tiempo adecuado; el 84 % opta por fenitoína como fármaco inicial de segunda línea, un 33 % no cronometra el tiempo durante el tratamiento. La adherencia global a las recomendaciones internacionales fue del 17 %. Conclusiones. Nuestro estudio advierte una baja adherencia referida de los pediatras a las guías internacionales, en particular en las decisiones tiempo-dependientes. También se observó mayor heterogeneidad en las conductas terapéuticas a medida que se avanza en el algoritmo de tratamiento.

Introduction. Status epilepticus is the most common neurological emergency. Although mortality in children is low, morbidity may exceed 20%. Objective. To evaluate the management of status epilepticus by pediatricians who usually treat this condition. Population and methods. Descriptive, cross-sectional study based on a survey administered to physicians from 3 pediatric hospitals in the City of Buenos Aires. Results. A total of 292 surveys were administered (complete response rate as high as 86%); 77% were administered to pediatricians and 16% to intensive care specialists. Forty-seven percent of the participants reported that they administer the first dose of a benzodiazepine within the correct timeframe; 56% use intrarectal diazepam when intravenous access is not available; 95% choose lorazepam as the initial benzodiazepine if an intravenous access is available; 58% initiate the administration of a second-line drug within the correct timeframe; 84% administer phenytoin as the first-choice, second-line drug; and 33% do not measure treatment time. Overall adherence to international recommendations was 17%. Conclusions. Our study highlights poor adherence of pediatricians to international guidelines, particularly in time-dependent decisions. Greater heterogeneity was observed in treatment approaches as the treatment algorithm progressed.

Understanding the Characteristics of At-Risk Youths in Guatemala: Evidence from a Sports for Human Development Program.

Guatemala is a multiethnic and multicultural country that has suffered from poverty and violence. Sports can serve as tool to foster development across the country; however, there is limited research on the use of sports as a tool for promoting broader social benefits in Guatemala. The purpose of this study was to compare sports and the health and physiological characteristics of at-risk youths in Guatemala. The research objectives were achieved through a quantitative approach and the participation of 90 youths involved in an educational organization through sports and 91 youths who have not been influenced by any organization. The results showed that urban at-risk youths involved in a sports for education organization develop more self-esteem; they have higher levels of physical activity than their peers who are not involved in an educational organization; the socioemotional competencies of self-regulation and motivation are higher in urban areas; empathy is higher in men than in women; the level of the self-perception of health is lower and health literacy higher. However, the at-risk youths who are not involved in an educational organization showed that their self-regulation was higher, and the level of health literacy was higher for all factors. This was through a set of attitudes and skills as a result of their historical development and sociocultural strategies transmitted from generation to generation to foster health and physical activity.

Point-of-Care Noninvasive Technology for Pediatric Dehydration Assessment.

OBJECTIVE: Dehydration is a commonly encountered problem worldwide. Current clinical assessment is limited by subjectivity and limited provider training with children. The objective of this study is to investigate a new noninvasive, point-of-care technology that measures capillary refill combined with patient factors to accurately diagnose dehydration. METHODS: This is a prospective observational study at a tertiary care children's hospital in Buenos Aires, Argentina. Patients were eligible if younger than 10 years who presented to the emergency department with vomiting and/or diarrhea whom the triage nurse deems to be potentially dehydrated. Patients had the digital capillary refill device done on presentation in addition to standard of care vital signs and weight. Patients had serial weights measured on hospital scales throughout their stay. The primary outcome was dehydration, which was calculated as a percent change in weight from admission to discharge. RESULTS: Seventy-six children were enrolled in the study with 56 included in the final analysis. A stepwise forward method selection chose malnutrition, temperature, and systolic blood pressure for the multivariable model. The area under the curve for the final model was fair (0.7431). To further look into the utility of such a device in the home setting where blood pressure is not available often, we reran the model without systolic blood pressure. The area under the curve for the final model was 0.7269. CONCLUSIONS: The digital capillary refill point-of-care device combined with readily available patient-specific factors may improve the ability to detect pediatric dehydration and facilitate earlier treatment or transfer to higher levels of care.

Management of status epilepticus in childhood: a survey conducted at pediatric hospitals in the City of Buenos Aires. / Manejo del estado epiléptico en niños: encuesta en hospitales pediátricos de la Ciudad Autónoma de Buenos Aires.

Introduction. Status epilepticus is the most common neurological emergency. Although mortality in children is low, morbidity may exceed 20%. Objective. To evaluate the management of status epilepticus by pediatricians who usually treat this condition. Population and methods. Descriptive, cross-sectional study based on a survey administered to physicians from 3 pediatric hospitals in the City of Buenos Aires. Results. A total of 292 surveys were administered (complete response rate as high as 86%); 77% were administered to pediatricians and 16% to intensive care specialists. Forty-seven percent of the participants reported that they administer the first dose of a benzodiazepine within the correct timeframe; 56% use intrarectal diazepam when intravenous access is not available; 95% choose lorazepam as the initial benzodiazepine if an intravenous line is available; 58% initiate the administration of a second-line drug within the correct timeframe; 84% administer phenytoin as the first-choice, second-line drug; and 33% do not measure treatment time. Overall adherence to international recommendations was 17%. Conclusions. Our study highlights poor adherence of pediatricians to international guidelines, particularly in time-dependent decisions. Greater heterogeneity was observed in treatment approaches as the treatment algorithm progressed.

Introducción. El estado epiléptico constituye la emergencia neurológica más frecuente. Si bien la mortalidad en niños es baja, su morbilidad puede superar el 20 %. Objetivo. Conocer las pautas de manejo del estado epiléptico referidas por médicos pediatras que atienden esta patología en forma habitual. Población y métodos. Estudio descriptivo, transversal, basado en una encuesta a médicos de tres hospitales pediátricos monovalentes de gestión pública de la Ciudad Autónoma de Buenos Aires. Resultados. Se administraron 292 encuestas (la tasa de respuesta completa alcanzó el 86 %); el 77 % se administró a pediatras y el 16 %, a especialistas en cuidados intensivos. Un 47 % de los participantes refiere indicar la primera benzodiacepina en el tiempo correcto; el 56 % utilizar diazepam intrarrectal en ausencia de un acceso intravenoso; el 95 % elige lorazepam como benzodiacepina inicial en caso de contar con acceso intravenoso; el 58 % refiere iniciar la etapa de fármacos de segunda línea en tiempo adecuado; el 84 % opta por fenitoína como fármaco inicial de segunda línea, un 33 % no cronometra el tiempo durante el tratamiento. La adherencia global a las recomendaciones internacionales fue del 17 %. Conclusiones. Nuestro estudio advierte una baja adherencia referida de los pediatras a las guías internacionales, en particular en las decisiones tiempo-dependientes. También se observó mayor heterogeneidad en las conductas terapéuticas a medida que se avanza en el algoritmo de tratamiento.

Hyperbaric oxygen therapy for hypoxic-ischemic encephalopathy in non-fatal drowning.

Paroxysmal autonomic instability syndrome with dystonia (PAISD) is a possible complication that worsens the prognosis of hypoxic-ischemic encephalopathy related to non-fatal drowning. There are case reports of hyperbaric oxygen (HBO2) therapy enhancing recovery in such cases. We report a case of a 5-year-old boy admitted to the Pediatric Intensive Care Unit after a non-fatal drowning. He was transferred under mechanical ventilation and sedation, with hemodynamic instability and hypothermia. On admission he had a Glasgow Coma Score of 6. On the fifth day of admission he presented episodes of dystonia with decerebration posture, diaphoresis, tachycardia and hypertension, sometimes with identified triggers, suggesting PAISD. The episodes were difficult to control; multiple drugs were needed. Electroencephalography showed diffuse slow wave activity, and cranioencephalic magnetic resonance imaging showed hypoxia-related lesions, suggesting hypoxic-ischemic encephalopathy. Early after admission the patient started physiotherapy combined with normobaric oxygen therapy. Subsequently he started HBO2 therapy at 2 atmospheres, with a total of 66 sessions. Dystonia progressively subsided, with gradual discontinuation of therapy. He also showed improvement in spasticity, non-verbal communication and cephalic control. This case highlights the diagnostic and therapeutic challenges of PAISD and the potential benefit of HBO2 therapy, even in the subacute phase, in recovery of hypoxic-ischemic encephalopathy.

Designing a Cyber-Physical System for Ambient Assisted Living: A Use-Case Analysis for Social Robot Navigation in Caregiving Centers.

The advances of the Internet of Things, robotics, and Artificial Intelligence, to give just a few examples, allow us to imagine promising results in the development of smart buildings in the near future. In the particular case of elderly care, there are new solutions that integrate systems that monitor variables associated with the health of each user or systems that facilitate physical or cognitive rehabilitation. In all these solutions, it is clear that these new environments, usually called Ambient Assisted Living (AAL), configure a Cyber-Physical System (CPS) that connects information from the physical world to the cyber-world with the primary objective of adding more intelligence to these environments. This article presents a CPS-AAL for caregiving centers, with the main novelty that includes a Socially Assistive Robot (SAR). The CPS-AAL presented in this work uses a digital twin world with the information acquired by all devices. The basis of this digital twin world is the CORTEX cognitive architecture, a set of software agents interacting through a Deep State Representation (DSR) that stored the shared information between them. The proposal is evaluated in a simulated environment with two use cases requiring interaction between the sensors and the SAR in a simulated caregiving center.

Características clínicas y mortalidad de pacientes con Neumonía Adquirida en la Comunidad en el Hospital Nacional de Itauguá / Clinical characteristics and mortality of patients with Community-acquired pneumonia at the Itauguá National Hospital

Introducción. La neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente, que se asocia con una significativa morbilidad y mortalidad. Objetivo: Determinar las características clínicas y la mortalidad de pacientes con NAC internados en el Departamento de Medicina Interna del Hospital Nacional de Itaugua entre enero 2009 a diciembre 2017. Pacientes y métodos: Se realizó un estudio observacional, descriptivo, retrospectivo, de corte trasverso de pacientes adultos con NAC, internados en el Hospital Nacional de Itaugua. Se realizó una revisión retrospectiva de las historias clínicas y se analizaron los datos demográficos, antecedentes de vacuna antigripal, presencia de comorbilidad, hallazgos laboratoriales de cultivos y la mortalidad. Los datos fueron analizados con Epi Info 2007, utilizándose estadística descriptiva; y para establecer asociación, la prueba de Chi cuadrado a un nivel de significancia de 0,05. Resultados: Se incluyeron 168 pacientes entre 18 a 101 años (edad media ± DE: 57± 23 años), hubo leve predominio (55%) del sexo femenino. El 92,2% tenía comorbilidad, siendo las más frecuentes: la hipertensión arterial (41,1%), el tabaquismo (19%) y etilismo (11,9%). Tenían vacuna antigripal 11 (6,5%). Ingresaron a la unidad de cuidados intensivos 31 (18,4%) pacientes. Staphylococcus aureus, Staphylococcus coagulasa negativo y Streptococcus pneumoniae fueron los gérmenes más frecuentemente aislados. La mortalidad fue de 29,7%, que se asoció con edad mayor a 65 años y tener como comorbilidad, enfermedad renal crónica y neoplasia. Conclusión: La mayoría de los pacientes tenía alguna comorbilidad. La mortalidad estuvo dentro del rango esperado y asociada con una edad de mayor a 65 años.

Background: Community-acquired pneumonia (CAP) is a frequent disease that is associated with significant mortality and morbidity. Objective: To determine the clinical characteristics and mortality of patients with community acquired pneumonia admitted to the Department of Internal Medicine of Itaugua National Hospital in the period 2009-2017 Patients and methods: Observational, descriptive, retrospective, cross-sectional study of adult patients with a diagnosis of community pneumonia was performed, admitted to the Itaugua National Hospital in the period of January 2009 - December 2017. Medical charts of patients with CAP were retrospectively reviewed and demographic data, history of influenza vaccine, presence of comorbidity, laboratory findings of cultures and mortality were analyzed. Data were analyzed with Epi Info 2007, using descriptive statistics and to establish association, Chi-square test at a significant level 0f 0.05. Results: 168 patients between 18 to 101 years (mean 57 ± 23 years) were studied, slight predominance of women (55%); 92.2% had co-morbidity, the most frequent was high blood pressure, smoking, and ethylism; 11 (6.5%) had history of flu vaccination; 31 (18.4%) admitted to the intensity care unit. Staphylococcus aureus Coagulase negative Staphylococcus and Streptococcus pneumoniae were the most frequently isolated microorganism, mortality rate was 29.7%, which was associated with age >65 years and the presence of chronic renal failure and neoplasia. Conclusion: Most of the patients had some comorbidity. Mortality was within the expected range and associated with an age older than 65 years.

Mechanical and Geometric Performance of PLA-Based Polymer Composites Processed by the Fused Filament Fabrication Additive Manufacturing Technique.

In this work, the effect of short carbon fibre (CF) on the mechanical and geometric properties of 3D printed polylactic acid (PLA) composite parts processed using the Fused Filament Fabrication (FFF) technique have been analysed. Tensile, flexural and interlaminar shear strength (ILSS) tests were performed to obtain the mechanical performance of the different samples. The surface quality and geometric accuracy of the printed specimens were also evaluated. Finally, Scanning Electron Microscope (SEM) images of the printed samples are analysed. The results revealed that the addition of carbon fibres effectively improved all assessed mechanical properties of PLA-CF composites as compared to the neat PLA. In particular, Flat PLA-CF samples showed an average increase in tensile performance of 47.1% for the tensile strength and 179.9% for the tensile stiffness in comparison to the neat PLA. From the flexural behaviour point of view, Flat PLA-CF samples revealed an increase in average flexural strength and stiffness of 89.75% and 230.95%, respectively in comparison to the neat PLA. Furthermore, PLA-CF samples depicted the best ILSS performance. In general, the use of short carbon fibre as reinforcement did not affect the dimensional accuracy of the PLA-CF samples, and even improved the surface roughness in certain cases, particularly in Flat and On-edge orientations.

Additive Manufacturing of PLA-Based Composites Using Fused Filament Fabrication: Effect of Graphene Nanoplatelet Reinforcement on Mechanical Properties, Dimensional Accuracy and Texture.

Fused filament fabrication (FFF) is a promising additive manufacturing (AM) technology due to its ability to build thermoplastics parts with advantages in the design and optimization of models with complex geometries, great design flexibility, recyclability and low material waste. This technique has been extensively used for the manufacturing of conceptual prototypes rather than functional components due to the limited mechanical properties of pure thermoplastics parts. In order to improve the mechanical performance of 3D printed parts based on polymeric materials, reinforcements including nanoparticles, short or continuous fibers and other additives have been adopted. The addition of graphene nanoplatelets (GNPs) to plastic and polymers is currently under investigation as a promising method to improve their working conditions due to the good mechanical, electrical and thermal performance exhibited by graphene. Although research shows particularly promising improvement in thermal and electrical conductivities of graphene-based nanocomposites, the aim of this study is to evaluate the effect of graphene nanoplatelet reinforcement on the mechanical properties, dimensional accuracy and surface texture of 3D printed polylactic acid (PLA) structures manufactured by a desktop 3D printer. The effect of build orientation was also analyzed. Scanning Electron Microscope (SEM) images of failure samples were evaluated to determine the effects of process parameters on failure modes. It was observed that PLA-Graphene composite samples showed, in general terms, the best performance in terms of tensile and flexural stress, particularly in the case of upright orientation (about 1.5 and 1.7 times higher than PLA and PLA 3D850 samples, respectively). In addition, PLA-Graphene composite samples showed the highest interlaminar shear strength (about 1.2 times higher than PLA and PLA 3D850 samples). However, the addition of GNPs tended to reduce the impact strength of the PLA-Graphene composite samples (PLA and PLA 3D850 samples exhibited an impact strength about 1.2-1.3 times higher than PLA-Graphene composites). Furthermore, the addition of graphene nanoplatelets did not affect, in general terms, the dimensional accuracy of the PLA-Graphene composite specimens. In addition, PLA-Graphene composite samples showed, in overall terms, the best performance in terms of surface texture, particularly when parts were printed in flat and on-edge orientations. The promising results in the present study prove the feasibility of 3D printed PLA-graphene composites for potential use in different applications such as biomedical engineering.

Laparoscopic Distal Pancreatectomy: Our Experience in a Tertiary Referral Center.

BACKGROUND: Despite an increase in the number of laparoscopic distal pancreatectomy (LDP) procedures being performed, the long-term oncology and operative results are still unclear. The aim of this study was to present the surgical and long-term results of patients undergoing LDP for the treatment of distal pancreatic tumors. MATERIALS AND METHODS: A retrospective review was made of patients who underwent LDP in our clinic, between 2006 and 2018, and who were diagnosed with pancreas tail, neck, and corpus tumors. For the purposes of this study, the data related to the preoperative, operative, and postoperative characteristics of the patients were determined. RESULTS: A total of 46 patients were identified as suitable for inclusion in the study. Of these, 52.1% were female individuals, and the average age of the whole group was 63 years. Previous surgery for malignant diseases was recorded for 54.3% of the patients, due to premalignant diseases in 13% and benign diseases in 32.7%. On average, 10 lymph nodes were removed from patients diagnosed with malignant tumors. The conversion rate was found to be 2.1%. The postoperative pancreatic fistula rate was 26%, and there was 1 complication each of grades III and IV according to the Clavien-Dindo classification. The mortality rate was 0%. CONCLUSIONS: It was concluded that LDP of distal pancreas tumors seems to be both safe and effective in respect of the long-term results in addition to the early results of the operation.

Análisis de los factores que influyen en el resultado final del traumatismo craneal moderado / Analysis of the factors influencing the final outcome of moderate head injury

Introducción: El traumatismo craneoencefálico (TCE) es un fenómeno muy frecuente, asociado a elevadas tasas de morbilidad. Objetivo: Describir una serie amplia de pacientes adultos, mayores de 14 años, que sufren TCE moderado atendidos en el Hospital Universitario de Getafe, entre los años 2005 y 2015, estudiar el perfil epidemiológico y analizar el diagnóstico y el tratamiento efectuados, así como establecer los principales factores pronósticos que influyen en el resultado final. Método: Se ha realizado un estudio retrospectivo, de revisión de historias clínicas y entrevistas telefónicas. Resultados: Se ha estudiado un total de 66 pacientes que sufren TCE moderado. El TCE moderado es más frecuente en varones, y el mecanismo causante más común es el accidente de tráfico. Conclusiones: El presente estudio establece la necesidad de ingreso hospitalario, ya sea en planta de Neurocirugía o en la Unidad de Cuidados Intensivos (UCI), en función de la situación clínica del paciente y de los hallazgos radiológicos encontrados en la Tomografía Computarizada (TC). Las variables que han resultado determinantes de la evolución adversa en el paciente que sufre trauma craneal moderado son los hallazgos patológicos en la TC, la existencia de focalidad neurológica, la presencia de deterioro clínico, la edad avanzada, los hallazgos en la TC de control, y los atropellos, caídas e impactos directos como mecanismos causantes. Existe diferencia de pronóstico entre pacientes con puntuación de 11 y 12, con una evolución más parecida al del paciente que sufre trauma leve, y los que obtienen 9 y 10 puntos, con un pronóstico más similar al del trauma grave.

Introduction: Head injuries are very frequent and associated with high morbidity rates. This paper describes a large series of patients, all ≥14 years old, who suffered moderate head injuries and were treated at the University Hospital of Getafe, between 2005 and 2015 (n = 66). Our aims were (1) to examine patients' epidemiological profile; (2) to describe the best diagnostic and therapeutic measures performed; and (3) to identify the main determinants of final outcome. Methods: This was a combined retrospective and prospective study, consisting first of a review of medical records, followed by telephone interviews of eligible patients to determine final outcomes. Results: Sixty-six patients with moderate head injuries were studied. In this series, most patients were males, and the most common causative mechanism was a traffic accident. The needs for hospital admission, admission into the Neurosurgery service, and admission to Intensive Care Unit (ICU) were determined by patients' clinical presentation and radiological findings. Risk factors for a poor final neurological outcome were the presence of neurological defects during the initial clinical examination, findings on brain computerized tomography (CT), and patient age. The Glasgow Coma Scale was poor at predicting the final outcome in these patients with moderate head injuries, incapable of distinguishing between patients with a score of 11 or 12, more similar to mild trauma, and those with scores of 9 or 10 points, more similar to severe head trauma. Conclusions: In this series of adolescent and adult patients with moderate head injuries, the best predictors of final outcome were the initial presence/absence of neurological defects and CT findings, and patient age. The Glasgow Coma Scale was less useful.

Factores pronósticos del traumatismo craneoencefálico grave / Prognostic factors for severe head injury

Introducción: El traumatismo craneoencefálico (TCE) es un fenómeno frecuente, asociado a elevadas tasas de morbilidad. Clásicamente se ha prestado más atención al traumatismo craneal grave o severo, dada la trascendencia del problema sanitario. Objetivo: Describir una serie de pacientes mayores de 14 años, que sufrieron TCE grave atendidos en el Hospital Universitario de Getafe entre los años 1993 y 2015 (n = 86), estudiar el perfil epidemiológico de presentación, y analizar el diagnóstico y tratamiento efectuados, así como establecer los principales factores pronósticos que influyen en el resultado final. Método: Se ha realizado un estudio retrospectivo, de revisión de historias clínicas y entrevistas en Consultas Externas. Resultados: El TCE grave es más frecuente en varones, y el mecanismo causante más común en nuestro medio es el accidente de tráfico. En este estudio, las variables que han resultado más determinantes de la evolución adversa en el paciente que sufre trauma craneal grave son la edad, el tamaño y la reactividad pupilar, la peor puntuación obtenida por el paciente en la escala de Glasgow para el Coma y las lesiones encontradas en la Tomografía Computarizada (TC) de cráneo. Conclusiones: Las lesiones en el trauma craneal grave se pueden categorizar en nueve patrones patológicos de acuerdo con la información aportada por la TC. Estos patrones presentan un perfil anatómico, clínico y una significación pronóstica bien definidos, asociándose a su vez a un patrón de comportamiento de la PIC característico. Los hematomas extra-axiales puros son las lesiones que presentan mejor pronóstico, siendo la lesión axonal difusa asociada a hinchazón cerebral y las contusiones múltiples bilaterales las que conllevan peor evolución. La Escala de Rimel se ajusta correctamente a la severidad del traumatismo craneal. La Escala de Glasgow para el Coma se relaciona bien con el pronóstico final del paciente con trauma craneal grave.

Introduction: Head injury is a very frequent event, associated with high morbidity rates. Classically, more attention has been paid to severe trauma. This paper describes a large series of patients, all ≥14 years old, who suffered severe head injuries and were treated at the University Hospital of Getafe, between 2005 and 2015 (n = 66). Our aims were (1) to examine patients' epidemiological profile; (2) to describe the best diagnostic and therapeutic measures performed; and (3) to identify the main determinants of final outcome. Methods: This was a combined retrospective and prospective study, consisting first of a review of medical records, followed by in-house neurosurgical consultations to determine final outcomes. Results: In this study, the variables that were most determinant of poor outcomes in patients with severe head injuries were patient age, the initial size and reactivity of their pupils, their worst Glasgow Coma Scale score, and lesions found on brain computed tomography (CT). Conclusions: Severe head injuries can be categorized into nine pathological patterns, based upon brain CT findings. Each pattern has a distinct anatomical and clinical profile and well-defined prognostic significance, in turn associated with behavior patterns characteristic of intracranial pressure (ICP). Pure extra-axial hematomas are associated with the best prognosis, with diffuse axonal lesions associated with brain swelling and multiple bilateral contusions the worst. The Rimel Scale accurately adjusts to the severity of head trauma. The Glasgow Coma Scale is a good predictor of ultimate outcomes in patients with severe head injuries.

Tumor glioneuronal formador de rosetas del IV ventrículo. Presentación de 2casos y revisión de la literatura / Rosette-forming glioneuronal tumor of the fourth ventricle. Two cases report and literature review

El tumor glioneuronal formador de rosetas del IV ventrículo es un tumor primario del sistema nervioso central introducido en el grupo de tumores glioneuronales en la clasificación de la OMS de 2007. Inicialmente se describió alrededor del IV ventrículo, pero recientemente se han publicados casos en distintas localizaciones. Presentamos 2casos de este raro tumor, ambos tratados quirúrgicamente. El primero en un varón de 41 años de edad, con síntomas típicos de lesión de fosa posterior; el segundo, en una mujer de 18 años de edad, con hallazgo incidental de lesión en fosa posterior que también fue tratada quirúrgicamente. Presentamos imágenes de resonancia magnética pre- y posquirúrgicas, aportamos imágenes histológicas de este tumor y realizamos una revisión de la literatura

Rosette-forming glioneuronal tumor of the fourth ventricle is a primary central nervous system tumor introduced in the group of glioneuronal tumors in the WHO classification of 2007. Initially it was described around the fourth ventricle, but recently have been published cases in different locations. We present 2cases of this rare tumor, both surgically treated. The first in a 41 year old man with typical symptoms of posterior fossa injury. The second in an 18 year old woman, with incidental finding of posterior fossa injury that was also surgically treated. We present pre- and post-surgical magnetic resonance images, histological pictures of this tumor and we make a review of the literature