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Introduction and objective Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. Material and methods The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The location, size and number of ACs, neurological development, age at diagnosis, follow-up time, the performance of surgery on the cyst, evolution, anatomical relationship between brain electrical activity and location of AC, and type of epilepsy are analyzed. Results After analyzing the database, we found 1881 patients diagnosed with epilepsy, of which 25 had at least one intracranial AC. In 9 of the patients, cerebral or genetic pathologies were the cause of epilepsy. Of the other 16, only 2 patients showed that the type of epilepsy and the epileptogenic focus coincided with the location of the AC; one of them was surgically treated without success, and the other one remained asymptomatic without receiving medical or surgical treatment. Conclusions Although it is necessary to design a prospective study to establish causality, the results of our research and the available literature suggest that there is no causal relationship between the presence of ACs and epilepsy. The study and treatment of these patients should be carried out in a multidisciplinary epilepsy surgery unit, without initially assuming that the AC is the cause of epilepsy.

Resumen Introduccion y objetivos La hipoglucemia neonatal ofrece multiples controversias. El objetivo del estudio es valorar los principales factores y circunstancias ambientales implicadas en el desarrollo de la hipoglucemia neonatal precoz. Metodos Estudio analitico prospectivo de una cohorte de recien nacidos entre 34 + 1 y 40 + 6 semanas de edad gestacional. Se realizo una determinacion de glucemia capilar a las dos, cuatro y ocho horas de vida. Tamano muestral: 207; 59 neonatos desarrollaron hipoglucemia. Resultados Prenatalmente, los factores con mayor influencia fueron la diabetes gestacional con mal control glucemico, gemelaridad y edad gestacional. La presencia de liquido amniotico meconial y el nacimiento por cesarea programada se asociaron a mayor probabilidad de hipoglucemia. Postnatalmente, el contacto precoz piel con piel, la succion al pecho, la iluminacion tenue y la normotermia fueron factores protectores. El modelo predictivo que combino tipo de iluminacion, temperatura corporal y cifra de exceso de bases clasifico correctamente al 98% de los casos de hipoglucemia grave, con un R2 de Nagelkerke de 0,645 y especificidad del 99,5%. Conclusiones Los factores postnatales ambientales parecen estar relacionados de forma directa en el desarrollo de la hipoglucemia precoz, por lo que el apoyo a la union maternofilial y a la lactancia materna es fundamental. Nuestros resultados permiten una mejor identificacion de los neonatos que no son subsidiarios de realizar controles de glucemia por tener poco riesgo de desarrollarla.

Little attention has been paid to how medication management technologies, designed for older adults, modify the participation of family caregivers. We developed a tablet-based ambient display that provides external cues to remind and motivate older adults to take their medications. This study aimed to understand the effect of ambient displays on the involvement of family members in the elderly's medication management. We conducted a 10-week study consisting of interviews administered weekly to nine elderly-caregivers. We identify that new involvement patterns of the family caregivers were provoked through external cues, which made them aware of older adults' medication adherence and encouraged younger relatives to help older adults.

Hombre de 61 años de edad referido al servicio de neurocirugía de un segundo nivel de atención, por presentar alteraciones en la sensibilidad de la región abdominal y de miembros pélvicos, junto con una disminución en la fuerza de los mismos aunado a fallas ocasionales para el control de esfínter vesical, se realizaron estudios de diagnóstico, en las imágenes de resonancia magnética (RMN) se observa una lesión ocupante de espacio en la región torácica relacionada a un probable meningioma espinal en T6. Se efectuó laminoplastía y se resecó la lesión tumoral quitando la compresión medular, el resultado de patología confirmo un meningioma transicional, la sintomatología remitió, ha ido recuperando el déficit neurológico y la fuerza muscular.

Introduction: Although primary immune thrombocytopenia (ITP) is rare in childhood, it is the most frequent cause of thrombocytopenia. There have been attempts to establish risk factors to predict the progression of the disease in order to optimise its management, which has changed in recent years due to, among other reasons, specialised care. Material and methods: A retrospective, observational and analytical study was conducted on patients diagnosed with ITP over a 3-year period in a Paediatric Haematology specialist clinic. Results: From the epidemiological, clinical and analytical point of view, the characteristics of this group are similar to others. Most of the patients (23/31, 74.2 %) had ITP for less than 12 months, with there being no serious complications related to the disease or the treatment received. It was established that risk factors were related to being slowly evolving (lower event-free survival (EFS)) with no statistical significance, female gender, age over 10 years, leukopenia absence of initial severe thrombocytopenia, and non-specialised care. The absence of a history of infection was significantly related to a lower EFS. Conclusions: The epidemiological and analytical risk factors for a slowly evolving ITP are the same that described in the literature. Patients treated before the beginning of specialised care also had a lower EFS. These data seem to support the current recommendation that rare diseases should be managed in specialised units. Resumen: Introducción: La trombopenia inmune primaria (PTI) es poco frecuente en la infancia, pero es la causa más habitual de trombopenia. Se han intentado establecer factores de riesgo para predecir su evolución, con el objetivo de poder optimizar su manejo, que se ha modificado en los últimos años, debido entre otros factores, a una atención más especializada. Material y métodos: Estudio retrospectivo, observacional y analítico de los pacientes con PTI, en un periodo de 3 años, en una consulta especializada en Hematología Pediátrica. Resultados: Desde el punto de vista epidemiológico, clínico y analítico, las características de esta serie son similares a las de otros grupos. La mayoría de los pacientes (23/31; 74.2 %) presentaron una PTI de duración menor de 12 meses, sin complicaciones graves relacionadas con la enfermedad ni con el tratamiento. Se establecieron como factores de riesgo relacionados con una evolución tórpida (supervivencia libre de eventos (SLE) menor), sin alcanzar la significación estadística, el sexo femenino, la edad mayor de 10 años, la leucopenia, la ausencia de trombopenia grave inicial y la atención no especializada. La ausencia de antecedente de infección se relacionó significativamente con una SLE menor. Conclusiones: Los factores de riesgo de evolución tórpida de PTI epidemiológicos y analíticos de este estudio coinciden con los descritos en la literatura. Presentaron una SLE menor los pacientes tratados antes del inicio de la atención especializada. Estos datos parecen apoyar la recomendación actual de que las enfermedades poco frecuentes, como ésta, se controlen en unidades especializadas.

The coronavirus disease 2019 (COVID-19) produced by SARS-CoV-2 has taken on great importance in recent months, and is under constant investigation by different areas of medicine, including rheumatology, in search of the best evidence scientific. In the case of the paediatric population, it is particularly important as it was first thought that the impact of the pandemic in this population would be less due to the low presence of severe cases. Evidence is now being reported of clinical pictures in children with a diagnosis of COVID-19 who are characterised by an altered inflammatory state consisting of a storm of pro-inflammatory cytokines that produces manifestations similar to those presented in autoimmune diseases, such as Kawasaki disease. It has been called Multisystemic Inflammatory Syndrome in children, temporarily associated with SARS-CoV-2 which, in many cases requires hospitalisation in paediatric intensive care units and multidisciplinary management by various specialties. Resumen La enfermedad por coronavirus 2019 (COVID-19) producida por el SARS-CoV-2 ha tomado una gran importancia en los ultimos meses y se encuentra bajo constante investigacion por distintas areas de la medicina, incluida la reumatologia, en la busqueda de la mejor evidencia cientifica. En el caso de la poblacion pediatrica cobra especial importancia puesto que en un principio se pensaba que el impacto de la pandemia en esta poblacion seria menor, debido a la baja presencia de casos severos, pero la evidencia actual reporta la existencia de cuadros clinicos en ninos con diagnostico de COVID-19 que se caracterizan por un estado inflamatorio alterado consistente en una tormenta de citocinas proinflamatorias que produce manifestaciones similares a las presentadas en enfermedades autoinmunes como la enfermedad de Kawasaki. Se le ha denominado sindrome inflamatorio multisistemico en ninos asociado temporalmente con SARS-CoV-2, el cual en muchos casos precisa internacion en unidades de cuidados intensivos pediatricos y el manejo multidisciplinario por diversas especialidades.

Resumen Introduccion El sindrome antifosfolipido es una trombofilia autoinmune adquirida que se caracteriza por una serie de fenomenos consistentes en trombosis (venosa y/o arterial o microvascular) y/o la perdida del embarazo o complicaciones en asociacion con anticuerpos antifosfolipido positivos persistentes. Esta patologia comprende otras manifestaciones sistemicas, y existen multiples causas que conllevan complicaciones hemorragicas en tal contexto. En este articulo se revisan las principales caracteristicas del compromiso hemorragico de sindrome antifosfolipido y se ofrece asesoramiento en relacion con el manejo de estas manifestaciones. Materiales y metodos Se realizo una revision narrativa de la literatura mediante la busqueda en las bases de datos PubMed, el motor de busqueda de Medline, y Embase hasta noviembre del 2020. En dicha revision se caracterizaron las complicaciones hemorragicas en el contexto de sindrome antifosfolipido. Resultados Se encontraron 290 articulos. Al excluir los que no cumplian con el objetivo del estudio, duplicados y cartas al editor, quedaron un total de 55, que fueron incluidos para el desarrollo del presente articulo. Conclusion El sindrome antifosfolipido clasicamente se ha descrito como un trastorno protrombotico y asociado a comorbilidad obstetrica. Sin embargo, por su fisiopatologia se presumen muchas otras manifestaciones, entre ellas las hemorragicas. Debido a la escasa evidencia cientifica sobre este tipo de manifestaciones, es necesario continuar con estudios mas profundos y reportes de casos que aporten informacion acerca de las manifestaciones hemorragicas como complicaciones del sindrome antifosfolipido.

Objetivo: Evaluar el nivel de independencia funcional de los pacientes sometidos a cirugía cardiaca durante su proceso de recuperación. Materiales y Método: Investigación con enfoque cuantitativo y estudio de tipo analítico longitudinal prospectivo. La población de estudio estuvo conformada por personas mayores de 18 años, sometidas a cirugía cardiaca programada, en una institución de salud de la ciudad de Medellín, Colombia. Se aplicó un cuestionario para las variables sociodemográficas y el procedimiento quirúrgico, además se utilizó el instrumento de independencia funcional de Granger y Hamilton traducido al español por Paolinelli. Se realizó un análisis univariado, bivariado y se usó la regresión de la mediana como prueba multivariada no paramétrica. Resultados: El total de participantes fue de 33. El 50% tenía 64 años. El 66.7% fueron hombres. Se encontró que el 57.6% eran hipertensos y el 12.1% diabéticos. El 54.5% se sometió a bypass coronario. Se evidencia una diferencia estadísticamente significativa entre cada una de las mediciones de la independencia funcional (p

espanolIntroduccion: El pie diabetico una de las complicaciones mas frecuentes de la Diabetes mellitus con impacto funcional, economico y elevada morbimortalidad, pudiendo ser evitado hasta en 75% de casos con modificacion sus factores de riesgo; en la literatura mundial la frecuencia de los factores de riesgo cardiovascular en el Pie Diabetico son referidos en pocas veces de manera individual, por lo que su correcta identificacion daria una base mas sistematica para su abordaje. Objetivo: Identificar los Factores cardiovasculares en pacientes con Diabetes mellitus que estan asociados a pie diabetico. Material y metodos: El estudio es observacional, analitico con diseno trasversal, en pacientes adultos en area de urgencias con diagnostico de Diabetes mellitus. Se estudiaron las variables: presencia o ausencia de pie diabetico, edad, genero, hipertension, sobrepeso, tabaquismo, Dislipidemia. Mediante R Studio 1.0.153, se determino normalidad, se realizaron correlaciones y comparaciones entre variables. Analisis estadistico: Se obtuvieron 201 pacientes, media de edad: 59.4±15.3 anos, 48.76% de genero masculino y 51.24% femenino; prevalencia de pie Diabetico de 31.34% (63 pacientes). Se analizo cada variable, siendo no estadisticamente significativas: edad (p=0.2172), Sexo (p= 0.8796), sobrepeso u Obesidad (p= 0.1423), Tabaquismo (p= 0.4993) y dislipidemia (p=0.8699). Existio una asociacion estadisticamente significativa para hipertension mediante Prueba Exacta de Fisher (p: 0.001156), con intervalo de confianza de 95% (1.556-9.603) y Odds Ratio de 3.6456. Conclusiones: De las variables senaladas como factores de riesgo cardiovascular solo la hipertension arterial sistemica presento correlacion estadisticamente significativa con el pie diabetico. EnglishIntroduction: Diabetic foot is one of the most frequent complications of Diabetes mellitus with functional impact and high morbidity and mortality, being able to be avoided in up to 75% of cases with modification of risk factors; In the world literature, the frequency of cardiovascular risk factors in the Diabetic Foot are referred in a few times individually, so that their correct identification would give a more systematic basis for their approach. Objective: To identify the cardiovascular factors in patients with diabetes mellitus that are associated with diabetic foot. Material and methods: The study is observational, analytical with transversal design, in adult patients in emergency area diagnosed with Diabetes mellitus. The variables were studied: presence or absence of diabetic foot, age, gender, hypertension, overweight, smoking, dyslipidemia. Using R Studio 1.0.153, normality was determined, correlations and comparisons between variables were made. Statistical analysis: 201 patients were obtained, mean age: 59.4 ± 15.3 years, 48.76% male and 51.24% female; Diabetic foot prevalence of 31.34% (63 patients). Each variable was analyzed, being not statistically significant: age (p = 0.2172), Sex (p = 0.8796), overweight or Obesity (p = 0.1423), Smoking (p = 0.4993) and dyslipidemia (p = 0.8699). There was a statistically significant association for hypertension by Fisher's Exact Test (p: 0.001156), with 95% confidence interval (1556-9.603) and Odds Ratio of 3.6456. Conclusions: Of the variables indicated as cardiovascular risk factors, only systemic arterial hypertension showed a statistically significant correlation with diabetic foot.

Montelukast is widely used in recurrent wheezing and/or asthma treatment. Several adverse drug reactions (ADRs) have been described in children related to montelukast. Neuropsychiatric reactions are one of the most important. We designed an observational, retrospective, descriptive study on ADRs related to montelukast in the Pediatric Pulmonology Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain. Between January 2012 and December 2017, in the Pediatric Pulmonology Unit, 348 patients were treated with Montelukast; of them, 20 presented RAM. The main symptoms described Reacciones adversas a montelukast: de la teoria a la practica. Serie de casos Adverse drug reactions of montelukast: from theory to practice. Case report were insomnia (n = 7), hyperactivity (n = 4), nightmares (n = 3), abdominal pain (n = 2) and paraesthesia in extremities (n = 2). They appeared from the first days to months after the start of treatment and disappeared after stopping it. Two patients presented limb paresthesia, not described previously in children. The 5.7 % of our patients treated with montelukast had ADRs that required treatment discontinuation. Sleep disorders were the most frequent.

Resumen La enfermedad por coronavirus (COVID-19) producida por el SARS-CoV-2 ha sido un reto para los servicios de salud en todo el mundo. La pandemia se ha extendido ampliamente con mas de 80 millones de casos confirmados y mas de un millon de muertes a nivel mundial, por lo que ha estado bajo constante investigacion para entender todos los aspectos de la enfermedad. Recientemente se han reportado varios casos de pacientes con sindrome de Guillain-Barre asociado a COVID-19 como manifestacion principal, convirtiendola en la primera enfermedad neurologica autoinmune desencadenada por SARS-CoV-2; sin embargo, es necesario obtener mas informacion para entender completamente los mecanismos inmunopatogenicos implicados en esta asociacion.

Convolutional neural networks (CNNs) have proven their efficiency in various applications in agriculture. In crops such as date, they have been mainly used in the identification and sorting of ripe fruits. The aim of this study was the performance evaluation of eight different CNNs, considering transfer learning for their training, as well as five hyperparameters. The CNN architectures evaluated were VGG-16, VGG-19, ResNet-50, ResNet-101, ResNet-152, AlexNet, Inception V3, and CNN from scratch. Likewise, the hyperparameters analyzed were the number of layers, the number of epochs, the batch size, optimizer, and learning rate. The accuracy and processing time were considered to determine the performance of CNN architectures, in the classification of mature dates’ cultivar Medjool. The model obtained from VGG-19 architecture with a batch of 128 and Adam optimizer with a learning rate of 0.01 presented the best performance with an accuracy of 99.32%. We concluded that the VGG-19 model can be used to build computer vision systems that help producers improve their sorting process to detect the Tamar stage of a Medjool date.

Background Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior component separation through the same previous incision as a safe and reproducible technique for these complex cases. Methods We present a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. Results A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 patients (15%) requiring procedural intervention. During a mean follow-up of 18 (range, 6–62), 1 (2%) case of clinical recurrence was registered. In addition, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative compared with the preoperative scores. Conclusion Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients’ reported outcomes. pre-print 371 KB

The coronavirus disease 2019 (COVID-19) produced by SARS-CoV-2 has taken on great importance in recent months, and is under constant investigation by different areas of medicine, including rheumatology, in search of the best scientific evidence. In the case of the pediatric population, it is particularly important as it was first thought that the impact of the pan-demic in this population would be less due to the low presence of severe cases. Evidence is now being reported of clinical pictures in children with a diagnosis of COVID-19 who are characterized by an altered inflammatory state consisting of a storm of pro-inflammatory cytokines that produces manifestations similar to those presented in autoimmune diseases, such as Kawasaki disease. It has been called Multisystemic Inflammatory Syndrome in children, temporarily associated with SARS-CoV-2 which, in many cases requires hospitalization in pediatric intensive care units and multidisciplinary management by various specialties. RESUMEN La enfermedad por coronavirus 2019 (COVID-19), producida por el SARS-CoV-2, ha tomado una gran importancia en los últimos meses y se encuentra bajo constante investigación por distintas áreas de la medicina, incluida la reumatología, en la búsqueda de la mejor evidencia científica. En el caso de la población pediátrica cobra especial importancia puesto que en un principio se pensaba que el impacto de la pandemia en esta población sería menor, debido a la baja presencia de casos severos, pero la evidencia actual reporta la existencia de cuadros clínicos en niños con diagnóstico de COVID-19 que se caracterizan por un estado inflamatorio alterado consistente en una tormenta de citocinas proinflamatorias que produce manifestaciones similares a las presentadas en enfermedades autoinmunes como la enfermedad de Kawasaki. Se le ha denominado síndrome inflamatorio multisistémico en ninos asociado temporalmente con SARS-CoV-2, el cual en muchos casos precisa internación en unidades de cuidados intensivos pediátricos y el manejo multidisciplinario por diversas especialidades.

Background Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users’ attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence. Objective This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults. Methods A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique. Results The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (P=.02) and between the intervention and postintervention phases (P=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD’s external cues not only improved older adults’ medication adherence but also mediated family caregivers’ involvement. Conclusions The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior. Trial Registration ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97

Item does not contain fulltext OBJECTIVES: Duplicative institutional review board/research ethics committee review for multicenter studies may impose administrative burdens and inefficiencies affecting study implementation and quality. Understanding variability in site-specific institutional review board/research ethics committee assessment and barriers to using a single review committee (an increasingly proposed solution) can inform a more efficient process. We provide needed data about the regulatory oversight process for the Sepsis PRevalence, OUtcomes, and Therapies multicenter point prevalence study. DESIGN: Survey. SETTING: Sites invited to participate in Sepsis PRevalence, OUtcomes, and Therapies. SUBJECTS: Investigators at sites that expressed interest and/or participated in Sepsis PRevalence, OUtcomes, and Therapies. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using an electronic survey, we collected data about 1) logistics of protocol submission, 2) institutional review board/research ethics committee requested modifications, and 3) use of a single institutional review board (for U.S. sites). We collected surveys from 104 of 167 sites (62%). Of the 97 sites that submitted the protocol for institutional review board/research ethics committee review, 34% conducted full board review, 54% expedited review, and 4% considered the study exempt. Time to institutional review board/research ethics committee approval required a median of 34 (range 3-186) days, which took longer at sites that required protocol modifications (median [interquartile range] 50 d [35-131 d] vs 32 d [14-54 d)]; p = 0.02). Enrollment was delayed at eight sites due to prolonged (> 50 d) time to approval. Of 49 U.S. sites, 43% considered using a single institutional review board, but only 18% utilized this option. Time to final approval for U.S. sites using the single institutional review board was 62 days (interquartile range, 34-70 d) compared with 34 days (interquartile range, 15-54 d) for nonsingle institutional review board sites (p = 0.16). CONCLUSIONS: Variability in regulatory oversight was evident for this minimal-risk observational research study, most notably in the category of type of review conducted. Duplicative review prolonged time to protocol approval at some sites. Use of a single institutional review board for U.S. sites was rare and did not improve efficiency of protocol approval. Suggestions for minimizing these challenges are provided.

Introduction: We present our experience on idiopathic intracranial hypertension (IIH), before and after the introduction of a specific diagnosis and management protocol. Method: A descriptive retrospective study was conducted on patients with IIH over a 25 year period (1990–2015), comparing the last 7 years (after introduction of the protocol) with the previous 18 years. Results: Among the 18,865 patients evaluated, there were 54 cases of IIH (29 infants and 25 children). A comparison was made between the two time periods: 32 cases in 1990–2008—published in An Pediatr (Barc). 2009;71:400-6—, and 23 cases in 2008–2015. In post-protocol period, there were 13 patients aged between 3–10 months (62% males) with transient bulging fontanelle, and 10 aged between 2 and 14 years (50% males), with papilloedema. A total of 54% of infants had recently finished corticosteroid treatment for bronchitis. In the older children, there was one case associated with venous thrombosis caused by otomastoiditis, one case on corticosteroid treatment for angioma, and another case treated with growth hormone. Transfontanelle ultrasound was performed on all infants, and CT, MRI and angio-MRI was performed on every child. Lumbar puncture was performed on 2 infants in whom meningitis was suspected, and in all children. All patients progressed favourably, with treatment being started in 3 of them. One patient relapsed. Discussion: Characteristics and outcomes of patients overlap every year. IIH usually has a favourable outcome, although it may be longer in children than in infants. It can cause serious visual disturbances, so close ophthalmological control is necessary. The protocol is useful to ease diagnostic decisions, monitoring, and treatment. Resumen: Introducción y objetivos: Se presenta nuestra experiencia en hipertensión intracraneal idiopática (HII) preimplantación y postimplantación de un protocolo específico de actuación. Material y métodos: Estudio descriptivo retrospectivo de los pacientes con diagnóstico de HII en 25 años (1990-2015), comparando los últimos 7 años (tras implantar protocolo) con los 18 previos. Resultados: De 18.865 pacientes valorados en 25 años, hay 54 casos de HII (29 lactantes y 25 niños mayores). Se comparan ambos periodos: 32 casos de 1990-2008 —publicados en An Pediatr (Barc). 2009;71:400-6— y 23 de 2008-2015. En el periodo posprotocolo, hubo 13 pacientes entre 3 y 10 meses (62% varones) con abombamiento transitorio de fontanela y 10 entre 2 y 14 años (50% varones) con papiledema. El 54% de los lactantes habían finalizado recientemente tratamiento corticoideo por bronquitis. En los mayores, un caso asoció trombosis de senos venosos por otomastoiditis, otro tratamiento corticoideo por angioma y otro tratamiento con hormona de crecimiento. Se hizo ecografía transfontanelar a todos los lactantes; TAC, RM y angioRM a todos los mayores, y punción lumbar a 2 lactantes (por sospecha de meningitis) y a todos los mayores. Todos los pacientes evolucionaron favorablemente; solo en 3 se instauró tratamiento. Una paciente recidivó. Discusión: Las características y la evolución de los pacientes son superponibles en todos los años. La HII suele tener un curso favorable, aunque puede tardar en resolverse en niños mayores y presentar graves repercusiones visuales, por lo que precisa estrecho control oftalmológico. Destacamos la utilidad del protocolo para facilitar la toma de decisiones diagnósticas, de seguimiento y tratamiento.

The international scope of critical neurologic insults in children is unknown. Our objective was to assess the prevalence and outcomes of children admitted to PICUs with acute neurologic insults. Prospective study. Multicenter (n = 107 PICUs) and multinational (23 countries, 79% in North America and Europe). Children 7 days to 17 years old admitted to the ICU with new traumatic brain injury, stroke, cardiac arrest, CNS infection or inflammation, status epilepticus, spinal cord injury, hydrocephalus, or brain mass. None. We evaluated the prevalence and outcomes of children with predetermined acute neurologic insults. Child and center characteristics were recorded. Unfavorable outcome was defined as change in pre-post insult Pediatric Cerebral Performance Category score greater than or equal to 2 or death at hospital discharge or 3 months, whichever came first. Screening data yielded overall prevalence of 16.2%. Of 924 children with acute neurologic insults, cardiac arrest (23%) and traumatic brain injury (19%) were the most common. All-cause mortality at hospital discharge was 12%. Cardiac arrest subjects had highest mortality (24%), and traumatic brain injury subjects had the most unfavorable outcomes (49%). The most common neurologic insult was infection/inflammation in South America, Asia, and the single African site but cardiac arrest in the remaining regions. Neurologic insults are a significant pediatric international health issue. They are frequent and contribute substantial morbidity and mortality. These data suggest a need for an increased focus on acute critical neurologic diseases in infants and children including additional research, enhanced availability of clinical resources, and the development of new therapies.

This article presents the design process of innovative prototypes for cervical cancer prevention in primary care centers located in low-income settings in Cali, Colombia, using the Human-Centered Design (HCD). The project was developed in collaboration with a public healthcare network comprised of 38 urban and rural centers with women between the ages of 25 and 65 years, healthcare providers of the cancer program, healthcare administrators and the general manager of said network. Our HCD process involved five stages: research, need synthesis, ideation and co-design process, prototyping and in-context usability testing. In practice, some of the stages are overlapped and iterated throughout the design process. We conducted observations, open-ended interviews and conversations, multi-stakeholder workshops, focus groups, systematic text condensation analyses and tests in real contexts. As a result, we designed four prototypes: (1) 'Encanto': An educational manicure service, (2) 'No le des la espalda a la citologia': A media-based strategy, (3) An educational wireless queuing device in the waiting room, and (4) Citobot: A cervical cancer early detection device, system, and method. The tests carried out with each prototype showed their value, limitations and possibilities in terms of subsequent development and validation through public health research or clinical research. We recognize that a longer-term evaluation is required in order to determine whether the prototypes will be used regularly, integrated into cervical cancer screening services and effectively improve access to cytology as a screening test. We conclude that HCD is a useful for design-based prevention in the field of cervical cancer. The integration of this approach with public health research would allow the generation of evidence during to the formulation of policies and programs as well as optimize existing interventions and, ultimately, facilitate the scalability and financing of what actually works.

Resumen Antecedentes y objetivo La metahemoglobinemia es un cuadro de intoxicacion aguda tipico de ninos menores de un ano. Se produce por un exceso de nitratos que producen la oxidacion del hierro de la hemoglobina impidiendo su adecuada union al oxigeno. Es mas frecuente en lactantes debido a su inferior actividad enzimatica. Pacientes Dos casos de lactantes de 15 meses con cuadros de metahemoglobinemia tras ingesta de verduras, atipicos por la edad de los pacientes y por la severidad inicial en el primer caso, que llego a simular un cuadro septico. En ambos casos se logro la resolucion del cuadro con adecuada oxigenoterapia. Conclusiones Aunque la clinica mas frecuente es cianosis asociada a dificultad respiratoria, la metahemoglobinemia puede presentarse con cuadros mas severos y confusos y en mayores de un ano. El tratamiento de eleccion es oxigenoterapia a altas concentraciones y azul de metileno como antidoto por via intravenosa unicamente en casos seleccionados. La ingesta de vegetales es el principal causante de este cuadro, por lo que es importante dar la informacion adecuada a los padres sobre el consumo y la conservacion de estos alimentos.

Wireless fidelity (WiFi) networks are deployed in several varied environments all around the World. Usually, the wireless fidelity access points are always on in houses and other small companies. In buildings of large companies and public organizations and in university campuses the number of access points is elevated, they are powered using power over the ethernet and are always on. Consequently, they consume a considerable amount of electric energy. The last versions of the International Electric and Electronic Engineers 802.11 standardized procedures to save energy in a wireless fidelity terminal but not in the access point. We designed a formal method to show when energy can be saved in wireless fidelity access points considering different power supplies for the access point: an electric energy battery and a standard voltage supply. We use an external battery that stores electric energy during an interval of time from a standard voltage supply (Charge period). After that interval (Discharge period), the energy supply for the access point is the external battery. Those intervals of time are repeated sequentially (Charge and Discharge cycles). We verified our formal model implementing a hardware circuit that controls the power supply for the access point. The amount of energy saving for a large number of of access points during a long period of time is considerably high.

Nowadays, harvesting, sorting, and packaging fruit and vegetables are still done manually, despite the hard work this represents. The features that experts commonly use to sorting the date palm fruit are size, color, shape, and texture. Recently, it has started to design and develop artificial vision systems that consider the criteria of size, color, shape, and texture to automate these processes. However, the development of these systems is complex due to the lack of labeled datasets that facilitate the creation of models to locate, recognize and classify palm date fruit. This dataset is entitled Medjool, an image dataset of different sizes and maturity levels of Medjool dates. Researchers may use this data to develop a model for automatic location, recognition, classification, and visual counting of the Medjool dates on trays taking into account their visual features such as shape, color, size, and texture. This dataset was collected from the first-round harvest at Palmeras RQ Ranch in Mexicali, Mexico. Images acquisition was performed in natural light. The dataset comprises 2,576 annotated images in two formats, YOLO and PascalVOC format.

Post-partum haemorrhage (PPH) is a major cause of maternal mortality, according to the WHO. Early PPH occurs in 5% to 15% of births. In 80% of cases, uterine atonia is the cause. We describe a case of uterine necrosis following uterine artery embolization (UAE). due to PPH. The patient was a 37-year-old woman who had a normal delivery after her second pregnancy, but experienced haemorrhage due to uterine atonia that failed to respond to drugs. She underwent UAE with Spongostan® with no complications. The peri-partum period was normal. At 16 days, she consulted due to recurrence of fever. Magnetic resonance imaging confirm the diagnosis of uterine necrosis. Abdominal hysterectomy was performed.

In this paper, we present the development of an infrastructure-less indoor location system (ILS), which relies on the use of a microphone, a magnetometer and a light sensor of a smartphone, all three of which are essentially passive sensors, relying on signals available practically in any building in the world, no matter how developed the region is. In our work, we merge the information from those sensors to estimate the user’s location in an indoor environment. A multivariate model is applied to find the user’s location, and we evaluate the quality of the resulting model in terms of sensitivity and specificity. Our experiments were carried out in an office environment during summer and winter, to take into account changes in light patterns, as well as changes in the Earth’s magnetic field irregularities. The experimental results clearly show the benefits of using the information fusion of multiple sensors when contrasted with the use of a single source of information.

Sertoli-Leydig cell tumors are uncommon ovarian neoplasms, accounting for only about 0.5% of all ovarian tumors. Although these tumors secrete androgen-producing signs of virilization, not all are functionally active. Treatment and prognosis depend on age and the stage and degree of tumor differentiation. We present 2 cases in a 13-year-old girl and a 47-year-old woman, both with findings of androgenism, hirsutism and images of solid lesion in the right ovary. Both patients underwent surgery with a histopathological diagnosis of moderately differentiated Sertoli-Leydig cell tumor.

Background and objectives Methaemoglobinaemia is a typical acute intoxication disorder in children under one-year old. It is produced by excess nitrates which induce the haemoglobin's iron oxidation, preventing its adequate binding to oxygen. It is more frequent in infants due to its lower enzymatic activity. Patients Two cases of 15-month-old infants with methaemoglobinaemia after the intake of vegetables, atypical by the age of the patients and the initial severity in the first case that simulated a septic syndrome. Both cases evolved well with adequate oxygen therapy. Conclusions Although the most frequent clinical manifestation is cyanosis associated with respiratory distress, methaemoglobinaemia can present with more severe and confusing symptoms. The main treatment is oxygen therapy at high concentrations and methylene blue as an intravenous antidote only in selected cases. The intake of vegetables is the main cause of this in infants, so it is important to give adequate information to parents about the consumption and preservation of these foods during the first year of life.

User indoor positioning has been under constant improvement especially with the availability of new sensors integrated into the modern mobile devices, which allows us to exploit not only infrastructures made for everyday use, such as WiFi, but also natural infrastructure, as is the case of natural magnetic field. In this paper we present an extension and improvement of our current indoor localization model based on the feature extraction of 46 magnetic field signal features. The extension adds a feature selection phase to our methodology, which is performed through Genetic Algorithm (GA) with the aim of optimizing the fitness of our current model. In addition, we present an evaluation of the final model in two different scenarios: home and office building. The results indicate that performing a feature selection process allows us to reduce the number of signal features of the model from 46 to 5 regardless the scenario and room location distribution. Further, we verified that reducing the number of features increases the probability of our estimator correctly detecting the user’s location (sensitivity) and its capacity to detect false positives (specificity) in both scenarios.

Indoor positioning systems (IPS) use sensors and communication technologies to locate objects in indoor environments. IPS are attracting scientific and enterprise interest because there is a big market opportunity for applying these technologies. There are many previous surveys on indoor positioning systems; however, most of them lack a solid classification scheme that would structurally map a wide field such as IPS, or omit several key technologies or have a limited perspective; finally, surveys rapidly become obsolete in an area as dynamic as IPS. The goal of this paper is to provide a technological perspective of indoor positioning systems, comprising a wide range of technologies and approaches. Further, we classify the existing approaches in a structure in order to guide the review and discussion of the different approaches. Finally, we present a comparison of indoor positioning approaches and present the evolution and trends that we foresee. © 2017 Ramon F. Brena et al.

In this paper, we present Ambient Information Systems (AIS) that support strategies relevant to enable elders to effectively manage their medication, such as: remind (Remind-Me AIS), guide (GUIDE-Me AIS), and motivate (CARE-Me AIS) them to medicate. We have informed the AIS design through a case study we carried out to understand elders' deficiencies for adhering to their medication routine. As a result of the case study and the AIS design process; we identified the design issues that should be addressed when developing AIS that cope with the elders needs for living independently. Identifying these design issues is a step toward proposing design guidelines for the development of AIS for elderly. Through a heuristic evaluation, we identified several usability problems that enabled us to improve AIS characteristics, such as the intuitive mapping of the information representations and the visibility of the different AIS states.

La infección por Helicobacter pylori afecta aproximadamente la mitad de la población mundial, se adquiere en la infancia y se ha asociado con desarrollo de gastritis crónica, úlcera péptica y cáncer de estómago en la edad adulta. El tratamiento que incluye dos o tres antibióticos ha generado problemas de resistencia bacteriana, efectividad, costo y seguridad; evidenciando la necesidad del desarrollo de nuevas terapias alternativas. El grupo de investigación Salud Pública de la Universidad de Nariño (Pasto, Colombia), determinó que los aceites esenciales puros de Rosmarinus officinalis L. y Ruta graveolens L. presentan actividad anti-H. pylori in vitro; pero no analizaron su inocuidad para consumo humano. Este estudio evalúa la citotoxicidad de ambos aceites en linfocitos humanos mantenidos en cultivo y su mutagenicidad mediante el prueba de Ames con la cepa TA-100 de Salmonella typhimurium. El aceite esencial de R. officinalis no presentó efecto citotóxico ni mutagénico en ninguna concentración evaluada en comparación con los controles. El aceite esencial puro de R. graveolens fue citotóxico (viabilidad de linfocitos inferior al 40%); sin embargo, en diluciones 10-1 hasta 10-5, este aceite se considera seguro en los dos sistemas de ensayo. Estos resultados demuestran que ambos extractos son promisorios para el consumo humano y a futuro, podrían considerarse como una alternativa para tratamiento complementario de H. pylori.

Older adults relatives, playing the role of primary caregivers, face an emotional burden as elderly dependence increments. Interventions to help older adults to maintain activities of daily living, such as managing their medications, may alleviate family caregivers’ burden. Medication adherence supported by ambient computing technologies has been previously explored for improving older adults’ medication compliance. However, their impact has not been evaluated on family caregivers. In this study we assessed the utilization feasibility and acceptance of a Medication Ambient Display for supporting elderly to autonomously medicate. The system was placed in the homes of two seniors-caregivers dyads during 4 weeks. The attitudes and preferences of these volunteers were assessed through survey instruments. Overall experiences were consistently positive even though some usability issues were also reported. Responses from our participants indicated that they appreciated the potential of this technology to make older adults more responsible for taking their medications, which provided caregivers with peace of mind.

Modern society demands cheap, more efficient, and safer public transport. These enhancements, especially an increase in efficiency and safety, are accompanied by huge amounts of data traffic that need to be handled by wireless communication systems. Hence, wireless communications inside and outside trains are key technologies to achieve these efficiency and safety goals for railway operators in a cost-efficient manner. This paper briefly describes nowadays used wireless technologies in the railway domain and points out possible directions for future wireless systems. Channel measurements and models for wireless propagation are surveyed and their suitability in railway environments is investigated. Identified gaps are pointed out and solutions to fill those gaps for wireless communication links in railway environments are proposed.

Malignant mixed Mullerian tumours are extremely rare, highly aggressive, biphasic neoplasms composed of carcinomatous and sarcomatous tumour components (Cantrell et al. 2012). In extragenital areas...

La alta morbimortalidad en aneurismas intracraneales exige la identificación rápida de los síntomas de alarma y el tratamiento oportuno en caso de ruptura. De ahí la importancia de las imágenes diagnósticas para identificar a los pacientes en riesgo y definir el manejo endovascular o quirúrgico. Revisamos los criterios para el uso del stent redireccionador de flujo en aneurismas intracraneales, método endovascular que reduce las comorbilidades, el tiempo quirúrgico y la estancia hospitalaria. Estudio descriptivo retrospectivo de 2010 a 2012 de siete casos. Se presentan las complicaciones siendo la cefalea y la trombosis posterior al procedimiento las más frecuentes. El tratamiento endovascular es seguro, eficaz e innovador y por tanto puede implementarse y difundirse. Abreviaturas: AI, aneurisma (s) intracraneal (es).

In this paper, we propose to use the Activity Theory and causal diagrams for modelling human activities with the aim of facilitating the specification of an agent-based assistance system through the Prometheus methodology. As a case study, we consider the elder medication activity, a recurring, complex and context-rich activity that involves several individual and collective activities which may require assistance. From the data collected in a contextual study of the elder medication, we modeled the medical consultation and refill medicine activities. Our results demonstrate that causal diagrams allow to capture the dynamics of the modelled activity, introduce the assistance of intelligent agents, extract the multiple scenarios synthesized in the activity structure and translate them into Prometheus artifacts.

Medication adherence has been identified as a problem that contributes to increasing the use of health-care services. In this paper, we present the design of a Wearable Notification Display for supporting Medication Adherence which was designed in the context of a project that will study the impact of using “help buttons” to provide permanent socio-medical assistance to the elderly. From a case study that we conducted with six (6) participants we gained an initial understanding of how the elderly manage their medications to avoid the inherent risks associated with medicating that are identified in the literature. From this understanding, we identified how the characteristics for Notification Systems should be implemented in a system with the goal of supporting an activity carried out by older adults. Thus, we present the design characteristics incorporated into the Wearable Notification Display for Medication Adherence, which we consider will enable the elderly to easily read and interpret the information presented on the display.

peer-reviewed Providing mobility to participants of business processes is an increasing trend in the banking sector. Independence of a physical place to interact with clients, while been able to use the information managed in the banking applications is one of the benefits of mobile business processes. Challenges arising from this approach include to deal with a scenario of occasionally connected communication; security issues regarding the exposition of internal information on devices -that could be lost-; and restrictions on the capacity of mobile devices. This paper presents our experience in implement- ing a service-based architecture solution to extend centralised resources from a finanancial institution to a mobile platform.

As they age, older adult's present losses in their functional capabilities which cause them can't continue performing their activities of daily living (ADL) independently at home. We propose Ambient Information Systems (AIS) as appropriate pervasive devices to promote their independent living. Therefore our aim is to determine the utility and usability of AIS to support the independent life of older adults by helping them to perform their activities. In this paper we present preliminary results of a case study that we carried out for understanding the problems and needs that older adults face in doing some of their activities of daily living. In particular, we present results regarding the elderly problems to adhere to their medication prescription. Based on these results we propose AIS to support older adults to medicate. Finally, we present the design attributes incorporated into this AIS, which were identified from the design taxonomies of AIS reported in the literature.

In this work, an environmental audio classification scheme is proposed using a Chi squared filter as a feature selection strategy. Using feature selection (FS), the original 62 features characteristic vector can be optimized, and it can be used for environmental sound classification. These features are obtained using statistical analysis and frequency domain analysis. As a result, we obtain a reduced feature vector composed of 15 features: 11 statistical and 4 of the frequency domain. Using this reduced vector, a 10 class classification was done, using Support Vector machines (SVM) as classification method, the accuracy is higher than 90%.