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Background: during recent years consistent studies have characterized the relationship between moderate and severe protein-calorie malnutrition and the appearance of non-communicable diseases in adulthood like metabolic syndrome (MS)., Aim: to analyze the relationship between moderate and severe protein-calorie malnutrition during the first 1 000 days of life and the MS in a cohort of adults from Curicó, Chile., Material and Methods: we studied 49 young adults who had suffered moderate to severe protein-calorie malnutrition during their first two years of life. Anthropometry, blood pressure measurement and laboratory tests were performed, and the burden of MS attributes was determined., Results: the prevalence of MS was 14.3% with no significant differences by gender, showing a direct and significant association between burden of MS and body mass index, waist / height index, blood pressure, plasma levels of glucose and triglyceride, and an inverse association with HDL., Conclusion: systolic blood pressure and plasma level of triglyceride represented the most important risk factors for SM in this cohort. We found no association between the presence of protein-calorie malnutrition and MS., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

The criteria for modifying the immunization schedule depends on the disease (load, frequency, morbidity and mortality, killing potential) of the vaccine (immunogenicity, efficacy, effectiveness, efficiency, compatibility, safety and assurance of supply) and society (impact on the population and the health system, perception of disease in the population). In Spain there are 19 different vaccine schedules that are not justified from a health, epidemiological, social or economic perspective. The Spanish Association of Paediatrics recommends: vaccinating against rotavirus from the sixth week, against papillomavirus in preadolescent girls, achieving universal pneumococcal protection, administering a second dose of varicella at 3-4 years, changing the indications of the pertussis vaccine and flu vaccine and hepatitis A risk. We will review further the vaccines that have recently been introduced: rotavirus, pneumococcus and papillomavirus and mention the major changes in existing ones., (Copyright © 2011 Elsevier España, S.L. y SEMERGEN. All rights reserved.)

Vaccines are biological products used to achieve active artificial immunization. Nowadays, vaccines are increasingly powerful, effective and safe. The list of vaccine-preventable diseases is expanding, which together with the increasing population likely to be vaccinated, it is expected that vaccine products will increase this century. This article is a brief but practical overview of the concept and types of vaccines, advances that have taken place recent decades on the fundamentals of the immune response and vaccine components (including the role of adjuvants). These concepts give rise to the criteria for when and how to vaccinate, to whom and why not to do it. With the hope that this text is useful, it ends with a brief overview as to why there are people who refuse vaccinations.

Introduction: Guillain-Barré syndrome (GBS) is an acute inflammatory ascending polyradiculoneuropathy. Autoimmune mechanisms play a role in the demyelinating process. Clinically, progressive symmetric loss of motor strength, areflexia, sensitive and autonomic manifestations are observed. Albuminocytological dissociation and electrophysiological signs of demyelination are frequently found. It is the most common cause of acute flaccid paralysis in children., Patients and Methods: Retrospective review of all children with GBS admitted to Garcia de Orta Hospital in a 10 year period (1994-2003)., Results: 17 children (18 months to 14 years) were admitted during this period. Respiratory or gastrointestinal prodrome was identified in 15 children, with positive serologic studies in six. The main clinical manifestations were disturbances of gait, progressive muscular weakness, sensitive manifestations (pain, paresthesias) and osteotendinous areflexia. 13 children had albuminocytological dissociation and acute demyelinating neuropathy was identified in 12.64% of children were treated with immunoglobulins (2 g/kg). Clinical evolution was favourable in 16 cases, with a death secondary to autonomic dysfunction., Conclusions: Clinical presentation may be unspecific, particularly in young patients, with pain as a primary complaint, preceding muscular weakness and areflexia. Increased cerebrospinal protein and abnormal electrodiagnostic studies may be absent in the early course of GBS. Immunoglobulin therapy was efficacious and well-tolerated.

Background: Corpus callosum agenesis (CCA) is an uncommon entity, which can be diagnosed in utero. Uncertain prognosis makes prenatal counseling difficult. AIM. We have tried to establish a positive correlation between clinical history and imaging findings in patients with CCA., Patients and Methods: We retrospectively reviewed clinical data and imaging findings of patients with callosal agenesis diagnosed at our institution between December 1995 and September 2002., Results: Eight patients with CCA were found, five males and three females. Mean age at last clinical follow up was six years and six months, ranging from three months to 20 years. All diagnoses except for one were post natal. All patients underwent, at least, one magnetic resonance (MR) of the brain. Abnormal pregnancy was reported in three patients. Family history was unremarkable in all patients. Three patients were diagnosed with isolated CCA. One of these patients was asymptomatic at three months. Another had a slight language delay at seventeen months. The other patient had a mild developmental delay at five years. All other five patients had non isolated CCA and all were symptomatic, with variable clinical pictures: psicomotor developmental delay (4), epilepsy (4), hemiparesis (1), ocular apraxia (1), macrocephaly (2)., Conclusion: Non isolated CCA is likely to have a worse prognosis. This may be of significant value in prenatal counseling.

Introduction: Perinasal sinus infections is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the gravity of this condition, because late recognition and delay in treatment can increase mortality and morbidity. The authors made a retrospective study of pediatric patients admitted to Garcia de Orta Hospital between 1996 and 2001 with the diagnosis of subdural empyema and sinusitis., Case Reports: Four patients were identified, with ages between 9 and 13 years. Prodromal manifestations of sinusitis were present in all, followed several days later by headaches, fever, vomiting and neurological abnormalities. Two patients presented in the emergency department with an acute confusional state and a non convulsive status epilepticus. The other two patients had a longer duration of disease, severe deterioration of consciousness and focal neurologic signs. Medical treatment was started in all cases at admission, but none improved significantly before being submitted to surgical intervention, which was repeated several times in two patients. Streptococcus milleri and anaerobic organisms were isolated. There was no mortality and global evolution was favorable, with a median follow up of 32 months., Conclusions: Clinical presentation of subdural empyema can be relatively inespecific, requiring a high degree of suspicion. Facing a young adolescent with fever of unknown origin associated with any neurological abnormality and previous history of sinusitis, neuroradiological investigation shoul be asked. Early diagnosis and treatment are the mainstays of successful outcome.

Introduction: Herpes simplex encephalitis is a serious infection of the nervous system, causing death or considerable neurological morbidity in infants and children. Rapid diagnosis and prompt institution of antiviral therapy is essential. Prodromal manifestations (fever, headache, and behavioural disturbances) can be quite unspecific. Focal neurological signs, seizures (focal or generalised) and coma appear subsequently. Electrophysiologic studies and neuroimaging can be normal or show non specific changes, particularly in this age group. After the 1990 s polymerase chain reaction (PCR) examination of the LCR has become the gold standard for diagnosing herpes simplex encephalitis, virtually replacing cerebral biopsy with high sensitivity and specificity. The authors present the acute presentation and follow up of four children aged 3 months 12 years, admitted between 1997 and 2000 with the diagnosis of herpes simplex encephalitis. Clinical presentation, electroencephalogram and neuroimaging studies are discussed. Diagnostic confirmation was obtained with serologic methods in one child and with PCR in the remaining three. Evolution was severe, with a movement disorder that responded dramatically to tetrabenazine in one child, severe neurological sequel with refractory epilepsy in two children and one death with cerebral hemorrhage during the acute stage of disease.