Stochastic Chaos in a Turbulent Swirling Flow.

We report the experimental evidence of the existence of a random attractor in a fully developed turbulent swirling flow. By defining a global observable which tracks the asymmetry in the flux of angular momentum imparted to the flow, we can first reconstruct the associated turbulent attractor and then follow its route towards chaos. We further show that the experimental attractor can be modeled by stochastic Duffing equations, that match the quantitative properties of the experimental flow, namely, the number of quasistationary states and transition rates among them, the effective dimensions, and the continuity of the first Lyapunov exponents. Such properties can be recovered neither using deterministic models nor using stochastic differential equations based on effective potentials obtained by inverting the probability distributions of the experimental global observables. Our findings open the way to low-dimensional modeling of systems featuring a large number of degrees of freedom and multiple quasistationary states.

Experimental characterization of extreme events of inertial dissipation in a turbulent swirling flow.

The three-dimensional incompressible Navier-Stokes equations, which describe the motion of many fluids, are the cornerstones of many physical and engineering sciences. However, it is still unclear whether they are mathematically well posed, that is, whether their solutions remain regular over time or develop singularities. Even though it was shown that singularities, if exist, could only be rare events, they may induce additional energy dissipation by inertial means. Here, using measurements at the dissipative scale of an axisymmetric turbulent flow, we report estimates of such inertial energy dissipation and identify local events of extreme values. We characterize the topology of these extreme events and identify several main types. Most of them appear as fronts separating regions of distinct velocities, whereas events corresponding to focusing spirals, jets and cusps are also found. Our results highlight the non-triviality of turbulent flows at sub-Kolmogorov scales as possible footprints of singularities of the Navier-Stokes equation.

[Extra-abdominal umbilical vein varix. A case report]. / Variz venosa umbilical intramniótica. Reporte de un caso.

UNLABELLED: The intra-abdominal umbilical vein varix is very uncommon, characterized by a dilation of the vein, usually located between its entry into the abdomen and completion in the portal system. However, the location of this anomaly to extra-abdominal level is very unusual and more difficult to diagnose by ultrasound. CLINICAL CASE: We present a case undiagnosed during pregnancy, demonstrating cord abnormality in its extra-abdominal portion and confirmed later by the pathology study. It was a gestation of 36 + 6 weeks, ending by performing emergency caesarean section for abnormal fetal heart rate, with good perinatal outcome. The diagnosis was made after placental delivery, by the existence of fibrotic cystic structure in the middle third of the umbilical cord.

Effect of lithium on the properties of a liquid crystal formed by sodium dodecylsulphate and decanol in aqueous solution.

Understanding the molecular interactions that rule the physicochemical properties of molecular assemblies is of particular interest when trying to explain the behavior of much more complicated systems, such as the cell membranes. This work was devoted to study a discotic nematic lyotropic liquid crystal, formed by sodium dodecylsulphate (3% SDS-d25) and decanol (20% DeOH-α-d2), dissolved in aqueous solutions (0.1% D2O) of Na2SO4 or Li2SO4. The average size of the aggregates was estimated using fluorescence quenching experiments, and their dynamics were studied by measuring the (2)H-NMR quadrupole splitting (ΔνQ) and the longitudinal relaxation times (T1) of the deuterated species. To provide an atomic insight into these assemblies, molecular dynamics simulations of the systems were carried out with atomic detail. As a previous step in this study, a reparameterization of the standard GROMOS 87 force field was required to perform the equilibrated simulations and to prevent instabilities emerging during the simulations. Finally, an excellent agreement between simulation and experimental data was obtained. In addition, variations in the long range electrostatic interactions at the aggregate/solution interface, the orientation and the reorientational relaxation time of the water dipole, the translational diffusion coefficient of sodium ions, and the amphiphile-counterion coordination associated with the presence of Li(+) in the solution were other key aspects investigated to explain the variation in the quadrupole splittings (ΔνQ) in the presence of lithium in solution.

Factores pronósticos en el ictus. De la fase aguda a los tres años / Prognostic factors in stroke. From the acute phase to three years

Introducción. El ictus constituye la primera causa de invalidez permanente en adultos. La mayor atención se centra en la fase aguda. Los estudios centrados en la fase subaguda o crónica son más escasos. Objetivo. Analizar la situación funcional de pacientes que han sufrido un ictus y qué factores influyen en el cambio funcional. Pacientes y método. Estudio prospectivo longitudinal observacional. Se evaluó a los pacientes que ingresaron en nuestro hospital con el diagnóstico de ictus desde mayo hasta julio de 2004, en la fase aguda, a los 6 meses y a los 3 años. Se analizó la evolución funcional comparando el cambio del valor en las escalas de Rankin modificada e índice de Barthel mediante la prueba de Wilcoxon. El análisis de los factores que influyen en el cambio funcional se realizó con las tablas de contingencia para variables cualitativas, la prueba de la t para variables cuantitativas con distribución normal y pruebas no paramétricas (U de Mann-Whitney) para variables cuantitativas con distribución no normal. Significación estadística, p<0,05. Resultados. Se incluyó a 61 pacientes. El 64%, varones. Media de edad, 72,4±10,1 años. Los factores que influyen de forma significativa con la mejora funcional son: el Rankin previo, la puntuación del NIHSS en el momento agudo, la presencia de déficit y realizar tratamiento de rehabiltación. Conclusiones. Tras un ictus, se produce una pérdida funcional que tiende a la mejoría durante los primeros 6 meses y se estabiliza posteriormente. La funcionalidad previa, puntuación NIHSS inicial y realizar tratamiento de rehabilitación se relacionan con mejor evolución funcional(AU)

Introduction. Stroke is the first cause of permanent disability in adults. The greatest attention is given to the acute phase. There are very few studies focused on the subacute or chronic stages. Objective. To evaluate functional status and the factors that determine improvement in stroke survivors. Patients and methods. Longitudinal, observational and prospective study. All stroke patients admitted to our hospital from May to July 2004 were evaluated during the first week, at 6 months and three years. Functional improvement was evaluated by change in Barthel index and modified Rankin scale using Wilcoxon signed-rank test. The analysis of those factors related to functional change was done with contingence tables for categorical variables, t-test for quantitative variables with normal distribution and non-parametrical tests (Mann Whitney U Test) for non normal distribution. Statistical significance P<.05. Results. A total of 61 patients, 64% males, were included. Average age was 72.4 years (SD 10.1). The factors that significantly affected functional improvement were: Previous Rankin, NIHSS score in acute phase, presence of impairment and undergoing a rehabilitation program. Conclusions. Stroke produces a functional loss that tends to improve during the first six months and stabilizes afterwards. Previous functionality, initial NIHSS punctuation, and rehabilitation treatment are associated with better functional progress(AU)

Ictus maligno: funcionalidad posterior a la hemicraniectomía descompresiva / Malignant stroke: functionality following decompressive hemicraniectomy

Introducción. La hemicraniectomía descompresiva es un método terapéutico utilizado en el ictus maligno (IM) con aceptables resultados funcionales según las publicaciones disponibles. El objetivo de nuestro estudio fue valorar la capacidad funcional a los 6 meses de evolución en los pacientes diagnosticados de IM intervenidos mediante hemicraniectomía descompresiva en nuestro hospital. Material y métodos. Se trata de un estudio descriptivo de una serie de casos realizado mediante una encuesta telefónica. Se incluyó a 6 pacientes diagnosticados de IM desde mayo a septiembre de 2008. Como variables descriptivas de la muestra recogimos la localización del ictus, la comorbilidad, la edad, el sexo, la lateralidad encefálica, la escala modificada de Ictus del Instituto Nacional de Salud, el índice de Barthel (IB) y la escala de Rankin iniciales, y el tiempo desde el ictus hasta la cirugía descomprensiva. Para la evaluación de la situación funcional utilizamos el IB, la escala de Rankin, la Glasgow Outcome Scale y la Escala Observacional de Síntomas Depresivos aplicable a enfermos afásicos o con demencia en los que no es posible la anamnesis. Resultados. Los pacientes tenían una edad media de 47,2 años y la mayoría eran varones. Previo al ictus, todos los pacientes eran funcionalmente independientes con escasa comorbilidad. Se realizó un seguimiento de 7 meses de media. En ese momento, la supervivencia era del 100% y el IB medio era de 56; todos puntuaron 4 en la escala de Rankin y 3 en la Glasgow Outcome Scale, y la puntuación media en la Escala Observacional de Síntomas Depresivos era de 5,4, es decir, el 60% presentaba una puntuación que sugería depresión. Conclusión. En nuestra serie, la hemicraniectomía descompresiva tuvo una supervivencia elevada. Sin embargo, a los 6 meses de evolución, existía una grave alteración de la capacidad funcional(AU)

Introduction. Decompressive hemicraniectomy is a therapeutic method used in malignant. Stroke with acceptable functional outcome results in recent publications. The aim of our study is to evaluate functional outcome at six months, in patients that had a decompressive hemicraniectomy in our hospital. Materials and methods. It is a descriptive prospective. We included all patients diagnosed of malignant stroke from September to May 2008. As descriptive variables we analyzed: localization of the stroke, vascular territory and side, comorbidities, age, gender, NIHSS, Barthel Index, Modified Rankin Scale, time from onset of symptoms to surgery. To evaluate six months functional outcome we used Barthel Index, Glasgow Outcome Scale, modified. Rankin scale and an observer-rated screening scale for depression applicable to aphasic patients. Results. Average age was 47.2 years. Previous to stroke, all patients were functionally independent and with few comorbidities. Average follow up was 7 months. 100% surveillance at follow up. Average Barthel Index was 56, all patients scored 4 at modified Rankin Scale and 3 at GOS and 60% of patients had depression symptoms. Conclusion. The results of this study show that surgical decompression in malignant stroke has a high surveillance rate although survivors have poor functional outcome at six months follow up(AU)

First Report of Grapevine leafroll-associated virus 5 in Spain.

Grapevine leafroll-associated viruses (GLRaVs) cause significant reductions in yield and quality in the wine industry worldwide. At least nine different GLRaVs have been found in different regions of the world. In the process of virus indexing of candidate grapevine clones for certification, which includes grafting of scions onto rootstocks, we observed strong leafroll symptoms 1 year after grafting with one vine of cv. Estaladina in Castilla y León, Spain and one vine of cv. Tempranillo in La Rioja, Spain, collected in 2008 and 2007, respectively. Both vines tested positive by real-time reverse transcription (RT)-PCR with TaqMan probes specific for Grapevine leafroll-associated virus 5 and double-antibody sandwich (DAS)-ELISA with a mix of monoclonal antibodies that recognizes GLRaV-4, 5, 6, 7, and 9 (Bioreba, Reinach, Switzerland). RNA extracts of both GLRaV-5 positive vines were analyzed by conventional RT-PCR with a pair of consensus degenerated primers derived from GLRaV-5 hsp70 sequences available in GenBank: LR5HYF (5'-TGGGATGAAYAARTTCAATGC-3') and LR5HYR (5'-TGAAATTCCTCATRTARGAGC-3') that amplified a 250-bp fragment. Amplicons were cloned and the comparison of the amino acid sequences (Estaladina isolate, Est110: Accession No. HM208622; Tempranillo isolate, Tem020: Accession No. HM208618) showed in the case of the Est110 isolate, 100 and 82.6% identity, respectively, with the homologous genes of one GLRaV-5 isolate from the United States (AF233934 [3]) and Argentina (EU815935 [2]). For isolate Tem020, the hsp70 gene showed 97.1 and 81.2% amino acid identity with the homologous hsp70 genes of the United States and Argentina isolates. The coat protein (cp) genes of both isolates were also amplified and cloned using the specific GLRaV-5 primers, LR53413 (5'-CGTGATACAAGGTAGGACAACCGT-3') and LR53843 (5'-CTTGCACTATCGCTGCCGTGAAT-3'), designed according to the sequence of AF233934. Fragments were of the expected size (430 bp) and the nucleotide sequences were obtained (Est110: Accession No. HM363522; Tem020: Accession No. HM363523) and used for pairwise nucleotide comparisons. The Est110 isolate showed 96.7 and 97.5% amino acid identity with the isolates from the United States and Argentina, respectively, while the Tem020 isolate showed 94.8 and 95.6% identity, respectively. Amino acid identity of Est110 and Tem020 cp genes was 100% when compared with the homologous genes of isolates AF233934 and EU815935. To our knowledge this is the first report of GRLaV-5 in Spain. Since 2008, we have detected eight additional vines positive for this virus in 200 clones analyzed for certification, suggesting that the incidence of GLRaV-5 in Spain could be widespread. This research indicates that virus indexing for GLRaV should be included in certification schemes for grapevine candidate clones (1) in Spain. References: (1) Anonymous. OEPP/EPPO Bull. 38:422, 2008. (2) S. Gomez Talquenca et al. Virus Genes 38:184, 2009. (3) F. Osman et al. J. Virol. Methods 141:22, 2007.

First Report of Arabis mosaic virus on Grapevine in Spain.

Arabis mosaic virus (ArMV; genus Nepovirus, family Comoviridae) is one of several nepoviruses responsible for infectious degeneration disease of grapevines in Europe (3). The first occurrence in Spain, in the summer of 2007, was found in Val de Salnés, Rias Baixas appellation, Galice on 25-year-old vines of the Albariño variety grafted onto an unidentified rootstock and showing leaf yellowing. The second finding was in the spring of 2008 in Barriobusto, Rioja appellation, Basque Country on 30-year-old vines of Tempranillo variety grafted onto 41B rootstock. In this case, no obvious foliar symptoms were observed but fruit set was very poor. Positive ELISA results were obtained at two different laboratories using antibodies to ArMV obtained from two companies (BIOREBA, Reinach, Switzerland and Sediag, Longvic, France). At a third lab, the presence of ArMV was further confirmed by reverse transcription (RT)-nested PCR using the primers described by Bertolini et al. (1). External primers ArMV 1 and ArMV 2 amplified a fragment of 340 bp from the coat protein region of the virus and internal primers ArMV i1 and ArMV i2 amplified a fragment of 203 bp. The specificity of the amplicons was subsequently confirmed by sequencing and comparison with other ArMV isolates available in the GenBank, EMBL, and DDBJ databases. Alignment performed using Blastn showed 85% nucleotide sequence identity with ArMV isolate NW (Accession No. AY017339). ELISA revealed co-infection with GLRaV-1 in Galice, GLRaV-3 in Rioja, and GFkV at both sites; these other viruses being common in their respective appellations. ArMV could be mechanically transmitted from rooted cuttings onto Chenopodium amaranticolor with an average of a 46% success rate (1:10 tissue/buffer ratio; [2]), but the range was very wide (0 to 100%) and dependent on the individual source vine. No statistical differences were found between nicotine or phosphate buffer for extraction or when using shoot tips or root tips as a source of virus (Fisher's exact test). Infection in C. amaranticolor was symptomless, but detectable by ELISA, and systemic. The Galician grapevine was an isolated plant, replanted on the spot of a dead one. Xiphinema diversicaudatum, the nematode vector of ArMV, was found in the vineyard soil. Only two ArMV-positive vines were found among 1,993 plants analyzed in Galice from 2005 to 2007 (no field data available for the second finding). In Rioja, one positive vine was found in a random sample of 74 vines from two different vineyards. Further testing of the neighboring vines indicated that one of the adjacent plants was also infected. This minimal spread since the vineyard was planted is suggestive of a lack of vectored transmission. In Spain as a whole, the virus seems to be rare and associated with the Atlantic biogeographic region. Both vineyards were planted before certified material became widely available. Currently, statutory testing of grapevine propagation material should prevent further spread. References: (1) E. Bertolini et al. Phytopathology 93:286, 2003. (2) G. P. Martelli, ed. Graft-Transmissible Diseases of Grapevines. Handbook for Detection and Diagnosis, FAO, Rome, 1993. (3) G. P. Martelli and E. Boudon-Padieu. Directory of Infectious Diseases of Grapevines and Viruses and Virus-like Diseases of the Grapevine. Bibliographic Report 1998-2004, CIHEAM, Paris, 2006.

Estudio de tuberculosis entre niños inmigrantes ingresados en un hospital general de Barcelona durante el período de 1 de enero de 2000 a diciembre de 2005 / Tuberculosis in immigrant children hospitalized in a general hospital in Barcelona, Spain, between January 2000 and December 2005

Introducción: Este estudio se realizó con el objetivo de conocer la situación de los hijos de inmigrantes llegados en los últimos 5 años en relación con la tuberculosis. Métodos: Se practicó una prueba de la tuberculina (PT) a los ingresados en una unidad de pediatría por sospecha de tuberculosis, a los contactos y a los pacientes con una estancia menor de 5 años que, aunque nacidos aquí, viajaran a su país o recibieran a familiares adultos procedentes de él durante los últimos 5 años. Con una PT positiva, se practicaba un estudio de imagen y un aspirado del jugo gástrico o esputo. En los vacunados con BCG y con resultado negativo de la PT, se buscaba el efecto recuerdo a los 10-15 días. Resultados: Se estudiaron 389 niños( entre 1 mes y 18 años de edad), 286 de ellos menores de 10 años. Latinoamérica (42,93%)y el sudestea siático (28,8%) eran las zonas geográficas dominantes. Se constataron 13 casos de enfermedad y 22 de infección latente, y la PT fue negativa en el 83,8% de los casos. Hubo diferencias significativas entre los no vacunados con BCG (13,5%) y los vacunados (5,1%; p=0,004). No hubo diferencias en cuanto al lugar de procedencia y el tiempo de llegada. Se halló un mayor número de PT positivas en el grupo de mayor edad, con diferencias significativas (p <0,001). También hubo diferencias estadísticamente significativas en los pacientes que tuvieron contacto con casos activos (66,7%;p <0,001). El estudio de regresión logística para la relación de factores sólo de muestra que la edad mantiene la significación estadística en el estudio multivariado (p= 0,011). En 192 vacunados con BCG se constató la presencia de enfermedad en 7 casos e infección latente en 18, y el efecto de recuerdo fue válido sólo en el 26,22% de los casos. Conclusiones: Hay más posibilidades de positividada la PT cuanto mayor es la edad de los pacientes, así como en los vacunados con BCG

Introduction: The purpose of the present study was to assess the incidence of tuberculosis (TB) infections in children of immigrants who had arrived in Spain within the last five years. Methods: The tuberculin skin test (TST) was performed in: a) all the immigrant children admitted to the Pediatric Unit for suspected TB; b) all those who had been in contact with an adultwith TB; and c) all those who, having been in Spain for less than five years, including those born here, had traveled to their country of origin or had receivedt he visit of adults from said country within the last five years. When the TST was positive, imaging studies were performed and specimens (gastrica spirate or sputum) were collected for smear or culture. In children with negative TST who had been vaccinated with bacillus Calmette-Guerin (BCG), the booster effect was assessed 10 to 15 days later. Results: The authors studied 389 children aged between 1 month and 18 years. 286 of whom were under the age of 10 years. The predominant countries were located in latin America (42.93%) or in Southeast Asia (28.8%). TB was diagnosed in 13 cases and latent TB infection in 22, while the TST was negativein 83.8%. There were statistically significant differences between children who had been vaccinated with BCG (5.1% ) and those who had not (13.5%;p = 0.004). No differences were observed in terms of the country of origin or time elapsed since their arrival in Spain. The number of positive TST was significantly higher among older children (p< 0.001). There was also a statistically significant predominance of children who had been in contact with active TB (66.7%; p <0.001). The multivariate analysis using logistic regression to determine the relationship between factors revealed statistical significance only for age (p=0.001). Of the 192 children who had been vaccinated with BCG, TB was detected in 7 and latent TB infection in 18. while the booster effect was present only in 26.22% cases. Conclusions: The probability of a positive TST is higher in older children and those who have been vaccinated with BCG

¿Está infradiagnosticada la “tinea pedis”en pediatría? Estudio en una población escolar de Barcelona / Is tinea pedis underdiagnosed in children? Study in Barcelona school children

La tiña de los pies es menos frecuente en el niño que en el adulto y raramente aparece antes de los 4 años. Para identificar la prevalencia de este tipo de tiñas entre escolares se planificó un estudio en 39 escuelas del distrito que es área de referencia del Hospital del Mar de Barcelona. Se examinaron 2.613 escolares de edades comprendidas entre los 3 y 15 años. Se detectaron 72 casos con cultivo positivo a dermatófitos, 3 padecían conjuntamente afectación ungueal. La prevalencia era del 2,75% y aumentaba con la edad: un 0,86% entre los 3 y 5 años, un 2,08% entre los 10 y 12 años, y un 7,04% entre los 13 y 15 años. Los agentes fueron Trichophyton mentagrophytes (48,6%), J: rubrum (40,27%), Epidermophyton mophyton floccosum(6,94%y) J:t onsurans( 4,16%). De los 72 casos de dermatofitosis, sólo 49 tenían lesiones clínicas evidentes. Sólo 19 de los 49 con manifestacionesc línicas tenían conocimiento de sus lesiones, y 8 habían realizado tratamiento antifúngico de forma irregular unos meses antes. Posibles razones del bajo nivel diagnóstico podrían estar en: a) el bajo interés familiar por las lesiones, al no haber sido verbalizadas, y ser valoradas como triviales; b) la consideración de situación propia de la edad y asociada a la actividad deportiva; c) reducida sintomatología subjetiva; d) falta de práctica exploratoria sistemática de zonas interdigitales de los pies; e) la falta de un correcto diagnóstico diferencial; f) bajo interés de los adolescentes en acudir a visitas pediátricas; y g) autodiagnóstico y automedicación

Tinea pedís is less common in children than in adults and rarely appears before the age of tour years. A cross-sectional study was performed to determine the prevalence of this type of tinea in schoolc hildren in BarcelonaS, pain. A total of 2,613s choocl hildrenw ith the agesf rom 3 to 15, from 39 schools located in the municipal district in the vicinity of the hospital, were examinedto identity the presence of dermatophytogis of the feet. Seventy-two had positive cultures for tínea pedis and dermatophytes, while in three, the nail was involved as well. The overall prevalence was 2.75%, and increased with age, being 0.86% in 3 to 5-year-olds, 2.08% in 10 to 12-year-old and 7.04% in 13 to 15-year-old. The fungi found were Tríchophyton mentagrophytes (48.6%),T rubrum( 40.27%)Epidermophyton floccosum (6.94%) and T. tonsurans(4.16%).Of these 72 children, 49 had interdigital lesions, only 19 of them were aware of their presence and 8 had received antifungal therapy previously, although not consistently. Although the incidence of tinea pedís is low in children, we think that it is underdiagnose. Possible reasons for this could be the limited interest in the lesions on the part of parents, who consider them trivial and do not mention them during physical examinations; the consideration that the condition is characteristic of the age group and is associated with sports and the generalized use of athletic foot wear, the lack of proper foot hygiene after doing sports; the fact that there are few subjective symptoms; the failure on the part of the pediatrician to systematically and carefully examine the interdigital skin of the feet of healthy children; the lack of an accurate differential diagnosis; the reluctance of adolescents to visit the pediatrician; self-diagnosis and self-medication

Cuatro casos de eritema fijo medicamentoso en la infancia. Un diagnóstico no siempre fácil / Four cases of fixed drug eruption in children: not always easily diagnosed

El exantema fijo medicamentoso es una de las posibles manifestaciones de las toxicodermias; sin embargo, la presentación pediátrica no es de las más frecuentes. Su característica de localizarse siempre en los mismos sitios puede ayudar a establecer el diagnóstico, pero este dato no favorece el que se establezca de forma precoz. Son múltiples los medicamentos que pueden ocasionarlo. Se presentan 4 casos con sus características clínicas, producidos por 3 fármacos distintos (cotrimoxazol, fenobarbital y paracetamol), así como el diagnóstico diferencial que debe realizarse

Fixed drug eruption is one of the possible clinical presentations of cutaneous reactions to drugs; however, it is not very common in children. Characteristically, it is always localized at the same sites, a fact that can help to establish the diagnosis. but this circumstance is of no help for the early diagnosis. It can be caused by a number of drugs. We describe the clinical features of four cases produced by three different drugs (co-trimoxazole. phenobarbital, paracetamol) and the actions involved in the differential diagnosis

Meningitis por Listeria monocytogenes en una niña inmunocompetente / Listeria monocytogenes meningitis in an immunocompetent girl

No disponible

[Spontaneous passage of a submandibular salivary stone]. / Expulsión espontánea de un cálculo salival submandibular.

Sialolithiasis rarely occurs in children and usually affects the submandibular salivary gland. Because of its rarity, its clinical expression is frequently missed and diagnosis is delayed. We describe the case of a 9-year-old boy with submandibular sialolithiasis who presented spontaneous passage of a large salivary stone. We review the clinical findings and etiopathogenesis of sialolithiasis in children, as well as diagnostic imaging techniques and several therapeutic approaches to stone extraction.

Expulsión espontánea de un cálculo salival submandibular / Spontaneous passage of a submandibular salivary stone

La sialolitiasis es un trastorno poco frecuente en pacientes pediátricos que suele afectar a las glándulas salivales submandibulares. Su rareza hace que a menudo su expresión clínica pase desapercibida y se retrase el diagnóstico. Se presenta el caso de un niño de 9 años con una sialolitiasis submandibular que consigue la salida espontánea de un cálculo de grandes dimensiones mediante manipulación externa. Se revisan los hallazgos clínicos, la etiopatogenia, las técnicas de diagnóstico por la imagen y las diversas técnicas terapéuticas de extracción de cálculos en la sialolitiasis (AU)

[Measurement of cytokines in patients with exercise-induced asthma treated with anti-leukotrienes]. / Determinación de citocinas en pacientes con asma inducida por el ejercicio y tratada con un antileucotrieno.

BACKGROUND: Exercise-induced asthma is defined as the transient broncho-spasm, that occurs after 3 to 8 minutes of continuous exercise; one of two mechanisms are implicated: the first is given by a hyper-osmolar environment interchange with the warm respiratory air and the water loss, the second due to reactive hyperemia or bronchial blood vessels edema. OBJECTIVES: To determine the effectiveness and safety of Zafirlukast treatment in exercise induce asthma, and in mild and moderated persistent bronchial asthma. Evaluate the security with laboratory test IL-2, IL-4, INFg, and CD69, to determinate TH1 and Th2 cells, laboratory and thorax x-ray determinations before and after zafirlukast treatment in exercise induce asthma, plus the functional respiratory test, and assert the clinical and adverse reaction with Zafirlukast. MATERIAL AND METHODS: A open, prospective, longitudinal study. Challenge test on a treadmill for 8 minutes. Twenty patients from the Allergy Service at Lic. Adolfo López Mateos Hospital, ISSSTE, in México City, fifteen female and five males. Aged 15 to 35 years. There was a control group of ten healthy subjects with similar age and sex. The drug Zafirlukast was administered 20 mg twice a day for eight weeks, with patient's informed and signed consent. Laboratory test: Blood Cell count, transaminases, bilirubins A, G, M and E immunoglobulins thorax X-ray, electrocardiogram, functional respiratory test before and after treatment. RESULTS: Zafirlukast blocked exercise induced asthma in the early and late phases. There was a statistically significant improvement of a VEF-1 after exercise with a p > 0.001; furthermore, there was significant improvement in the mid-spiratory speed before the exercise with a p > 0.05. The mid-spiratory speed after the exercise, improved (p > 0.01). There were no collateral reactions, such as Churg-Strauss, only transitory headache in six and nauseas in two. There were no statistically significant changes in the cytokines assessment. CONCLUSIONS: There were no statistically significant changes in the cytokines assessments, in four cases the IL-4 decreased after the treatment. The anti-leukotriene improved the bronchospastic answer during the early and late phases, reducing the FEV-1, decreasing the recovering phase.

Raquitismo en inmigrantes asiáticos en período puberal / Rickets in asian immigrants during puberty

La primera infancia y la pubertad son períodos críticos para la aparición de manifestaciones clínicas de hipovitaminosis D, ya que existen unas demandas de calcio aumentadas, secundarias a una mayor aposición ósea. En los países subdesarrollados el raquitismo continúa siendo una de las enfermedades más prevalentes en la infancia. Por el contrario, en la actualidad, en los países occidentales se trata de una enfermedad prácticamente erradicada y su incidencia depende del fenómeno migratorio. De hecho, existen numerosas publicaciones sobre raquitismo y osteomalacia nutricional descritos en lactantes, adolescentes y mujeres gestantes de India, Paquistán, Bangladesh que han inmigrado a países desarrollados de clima frío. Se presentan los casos de 3 adolescentes de origen paquistaní, que consultaron por dolor de extremidades, dificultad en la deambulación, genu valgo o crisis convulsiva. Todos ellos presentaban hipocalcemia, niveles de parathormona y fosfatasa alcalina elevado, con valores disminuidos de 25(OH)D. La administración de vitamina D y modificaciones en su dieta normalizaron los parámetros analíticos y produjeron mejoría de su sintomatología. Dado el incremento de la migración que se está produciendo en España en los últimos años, probablemente volverá a verse una enfermedad ya olvidada (AU)