Search

Introduction: In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. Material and methods: A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients >16 years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with >40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. Results: A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P = .014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. Conclusions: In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved. Resumen: Introducción: En 2014 se publicó el Documento de Consenso desarrollado por SEIP-SERPE-SEOP para el diagnóstico y el tratamiento de las infecciones osteoarticulares (IOA). En 2015 se constituyó RIOPed como red nacional multidisciplinar para la investigación en IOA. El objetivo del estudio ha sido valorar el grado de adecuación a las recomendaciones establecidas en el consenso durante un año de seguimiento. Material y métodos: Estudio prospectivo multicéntrico nacional realizado entre septiembre de 2015 y septiembre de 2016 en 37 hospitales con inclusión de pacientes menores de 16 años diagnosticados de IOA, confirmada mediante aislamiento microbiológico, o probable: artritis séptica (AS) con >40.000 leucocitos en líquido sinovial u osteomielitis (OM)/osteoartritis (OA)/espondilodiscitis (ED) con prueba de imagen compatible. Los resultados se compararon con los obtenidos en el estudio retrospectivo realizado entre 2008 y 2012. Resultados: Se incluyeron 255 casos: 131 OM, 79 AS, 30 OA y 15 ED. Respecto a las pruebas complementarias que el consenso consideró de obligada realización, la radiografía se llevó a cabo en el 87,8% de los casos, el hemocultivo en el 91,6% y el cultivo de líquido sinovial en el 99% de AS. Se realizó RM en el 71% de las OM. La elección del tratamiento antibiótico intravenoso empírico se adecuó a las recomendaciones en el 65,1% de los casos, y en el 62,3% para el tratamiento oral. Se llevó a cabo cirugía en el 36,8% de las AS (85,7% artrotomía), con un descenso significativo respecto al estudio retrospectivo (P = ,014). Solo el 58,5% de casos se ajustaron a las recomendaciones de duración del tratamiento; sin embargo, se comprobó una menor duración del tratamiento intravenoso. Conclusiones: En general, el grado de adecuación a las recomendaciones que marcaron el grupo de expertos es bueno para las pruebas complementarias y aceptable respecto a la elección del tratamiento antibiótico, aun detectándose casi un 40% de inadecuación. Se ha conseguido un descenso de la estancia hospitalaria.

Objectives: To evaluate electrocardiogram markers to predict coronary involvement in patients with Kawasaki disease by assessing measures of ventricular repolarization parameters on the 12-lead electrocardiogram. Study design: This cross-sectional study included 180 Spanish and Japanese patients ≤14 years of age with Kawasaki disease, with or without coronary involvement, from 2011 to 2016. We manually measured the Tp-Te/QT ratio and QTc interval (with Bazett's formula) in 12-lead electrocardiogram in the acute and recovery period and explored their potential association with coronary involvement. Results: No association was found between Tp-Te/QT ratio obtained manually in V5 and V6 leads and coronary involvement in the acute (V5:0.25 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .80; V6:0.24 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .86) or the recovery (V5: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.19-0.25], P = .68; V6: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.17-0.25], P = .50) period. By contrast, QTc in V5 and V6 was significantly lower in patients with Kawasaki disease and coronary involvement in the acute period (V5: 378 ms [IQR, 364-395 ms] vs 390 ms [IQR, 371-411 ms], P = .04; V6: 377 ms [IQR, 364-392 ms] vs 390 ms [IQR, 371-410 ms], P = .01). A QTc interval of

[ES] La diversidad cultural, enriquecedora de valores y capacidades para la humanidad, como destaca el Convenio sobre la Diversidad Cultural de la UNESCO (2005), precisa de una necesaria gestión intercultural para garantizar la interacción equitativa de culturas y la posibilidad de generar expresiones culturales compartidas, adquiridas por medio del diálogo y de una actitud de respeto mutuo.Esta obra colectiva e interdisciplinar, a la que han contribuido investigadores procedentes de diversos países e instituciones, aborda la interculturalidad desde la perspectiva del respeto y la promoción de los Derechos Humanos. De este modo, se tratan las políticas públicas y la tutela judicial de la interculturalidad, afrontando la discriminación y odio vinculados a la cultura, el uso del Derecho Penal como elemento represor de la diferencia, los conflictos territoriales y la protección frente a la discriminación en el ámbito laboral. Así mismo, se presta especial atención a los colectivos vulnerables, la integración de segundas y posteriores generaciones y a los modelos de intervención para la convivencia intercultural, destacando la diversidad cultural en el contexto educativo y las diferentes estrategias comunicativas. Todo ello, sin olvidar el análisis desde una perspectiva cuantitativa de la interculturalidad y los Derechos Humanos y su abordaje crítico desde el enfoque interseccional.

KAWA-RACE study group., [Background] Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children., [Objective] This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain., [Methods] Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals)., [Results] A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p 900,000 cells/mm3, maximum temperature < 39.5°C, total duration of fever > 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms., [Conclusions] In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary., CC received a grant from Spanish Society of Paediatric Rheumatology (SERPE), 2015.

Multiplex molecular techniques can detect a diversity of respiratory viruses and bacteria that cause childhood acute respiratory infection rapidly and conveniently. However, currently available techniques show high variation in performance. We sought to compare the diagnostic accuracy of the novel multiplex NxTAG respiratory pathogen panel (RPP) RUO test versus a routine multiplex Anyplex II RV16 assay in respiratory specimens collected from children kappa coefficients were assessed. Bidirectional sequencing was performed for the resolution of discordant results. A total of 319 samples were analyzed by both techniques. A total of 268 (84.0%) of them yielded concordant results. Positive percent agreement values ranged from 83.3 to 100%, while the negative percent agreement was more than 99% for all targets except for enterovirus/rhinovirus (EV/RV; 94.4%). Kappa coefficients ranged from 0.83 to 1.00. Discrepancy analysis confirmed 66.0% of NxTAG RPP RUO results. A total of 260 viruses were detected, with EV/RV ( n = 105, 40.4%) being the most prevalent target. Viral coinfections were found in 44 (14.2%) samples. In addition, NxTAG RPP RUO detected single bacterial and mixed viral-bacterial infections in seven samples. NxTAG RPP RUO showed high positive and negative agreement with Anyplex II RV16 for main viruses that cause acute respiratory infections in children, coupled with an additional capability to detect some respiratory bacteria.

URL del artículo en la web de la Revista: https://www.upo.es/revistas/index.php/romula/article/view/3962, En este artículo se explica la metodología en los trabajos arqueológicos y antropológicos aplicados en la investigación de los supuestos casos de sustracción ilegal de niños y niñas recién nacidos en el cementerio de San José, Cádiz. Durante los años sesenta y hasta los noventa, en España, se sustrajeron recién nacidos a los padres biológicos, para proceder a adopciones ilegales. En Cádiz son un total de 46 familias las que han solicitado la excavación arqueológica para buscar indicios sobre este supuesto delito o localizar los restos óseos de su bebé., This article explains, the methodology in the archaeological and anthropological works applied in the investigation of the alleged cases of illegal subtraction of newborn children in the Cemetery of San Jose, Cadiz. During the sixties until the nineties, in Spain, newborn children were kidnapped to the biological parents, to proceed to illegal adoptions. In Cadiz there are a total of 46 families those that have requested the archaeological excavation to look for indications on this supposed crime or to locate the osseous remains of his baby., Universidad Pablo de Olavide

In 2010 and 2011, the European Union signed a series of Protocols with Tunisia, Lebanon, Egypt and Jordan, and an Agreement with Morocco, concerning the settlement of trade disputes that might arise in application of the Euro-Mediterranean Association Agreements signed with these countries. These Protocols provide for a specific, staged mechanism for the resolution of disputes. This paper analyses that mechanism for the resolution of trade disputes and his role in the framework of the Euro-Mediterranean area. En los años 2010 y 2011 la Unión Europea firmó una serie de Protocolos con Túnez, Líbano, Egipto y Jordania, y un Acuerdo con Marruecos, relativos a la solución de diferencias comerciales que puedan surgir en aplicación de los Acuerdos Euromediterráneos de Asociación suscritos con tales países. Tales Protocolos contemplan un mecanismo específico de solución de controversias estructurado en varias etapas. En este artículo se analiza con detalle dicho mecanismo de solución de diferencias y su papel en el marco del espacio euromediterráneo. Entre les années 2010 et 2011, l’Union Européenne a signé une série de protocoles avec la Tunisie, le Liban, l’Égypte et la Jordanie, et un accord avec le Maroc, en ce qui concerne le règlement des différends commerciaux qui résultent de l’application des accords euro-méditerranéens d’association établis avec lesdits pays. Les protocoles évoqués comprennent un mécanisme spécifique de règlement des controverses structuré en différentes étapes. Cet article analyse avec détails lesdits mécanismes et leur rôle dans l’espace euro-méditerranéen.

Resumen: Objetivo: Analizar las características de presentación, complicaciones y secuelas, de las fracturas de temporal ingresadas en UCIP. Material y métodos: Análisis descriptivo retrospectivo de las historias clínicas y TC craneal. Resultados: Veintisiete pacientes ingresados en UCIP presentaron fractura del temporal: 13 (48%) sin afectación de peñasco (grupo 1) y 14 (52%) con afectación de peñasco (grupo 2). El grupo 2 presentó mayor estancia en la UCIP: 4,5 días (RI: 2,75-22,25) vs. 2 (RI: 1-3) (p = 0,018), mayor frecuencia de secuelas (p = 0,04) y presencia de fístula del LCR (p

Resumen: La cefalea es una patología frecuente en las consultas pediátricas de Atención Primaria, correspondiendo la mayoría de ellas a cefaleas primarias que no requieren exámenes complementarios. Cuando la cefalea es sugestiva de patología intracraneal hay que realizar pruebas de imagen, siendo los tumores una causa frecuente de cefalea secundaria. No obstante, otras patologías benignas pueden dar clínica de hipertensión intracraneal (HTIC) como es el caso de la hemicerebelitis. Presentamos un caso de una niña de 10 años de edad, con cefalea y evolución a HTIC de inicio agudo. La resonancia magnética reveló una inflamación unilateral del cerebelo, diagnosticándose de hemicerebelitis. Nuestra paciente mantuvo síntomas hasta la realización de la punción lumbar que la dejó asintomática. El pronóstico de esta patología es excelente y la remisión clínica completa. En la mayoría de los casos, queda una atrofia cerebelosa del hemisferio afecto residual, generalmente sin repercusión clínica. La evolución clínica y hallazgos de la resonancia magnética ayudan a descartar malignidad y adoptar un enfoque conservador tanto diagnóstico como terapéutico. Abstract: Headache is a frequent pathology in pediatric Primary Care, most of which correspond to primary headaches that do not require additional examination. When headache is suggestive of intracranial pathology, imaging tests are needed, since tumors are a frequent cause of secondary headache. However, intracranial hypertension (IH) may be a symptom of other benign pathologies, such as hemicerebellitis. We present the case of a 10-year-old girl, with headache that progresses into IH of acute onset. Magnetic resonance imaging revealed unilateral inflammation of the cerebellum, diagnosed as hemicerebellitis. Symptoms continued until a lumbar puncture was performed, after which the patient became asymptomatic. This pathology has an excellent prognosis, and clinical remission is complete. In most cases, a residual cerebellar atrophy of the affected hemisphere remains, generally without clinical impact. The clinical course and the findings of magnetic resonance imaging help to discard malignancy and to take a diagnostic and therapeutic conservative approach.

The control of maritime traffic in the Strait of Gibraltar is conditioned by the regulation established in the United Nations Convention on the Law of the Sea, of 1982, in relation to straits used for international navigation where transit passage is applied. In this respect, it is necessary a cooperation between Spain and Morocco in order to designate sea lanes and establish a traffic separation scheme in that space. An analysis of this cooperation and of the last modifications of the Traffic Separation Scheme of the Strait of Gibraltar after the new Tangier-Med port being brought into service will be carried out in this paper.

El hombro doloroso es un motivo de consulta frecuente en centros de Atención Primaria y urgencias hospitalarias pediátricas. Establecer un correcto diagnóstico diferencial evitará la iatrogenia sobre el paciente. Presentamos un caso de Síndrome de Parsonage-Turner (también conocido como neuritis braquial aguda) que, aunque es causa infrecuente de hombro doloroso, presenta una clínica muy sugestiva caracterizada por dolor agudo seguido de síntomas neurológicos de instauración tórpida. Como pruebas complementarias (se trata de un diagnóstico de exclusión) son de utilidad el electromiograma y la resonancia magnética. Presenta una evolución favorable con resolución espontánea, aunque está demostrado el beneficio del tratamiento antiinflamatorio y rehabilitador.

In the last years some authors have questioned the autonomy of the European Community when implementing its commercial policy, due to the amount of trade agreements signed by it and especially because of the commitments acquired in the WTO. There is no doubt that the compulsory fulfilment of these commitments is a conditioning factor with regard to the implementation of the Common Commercial Policy, but that doesn’t make the autonomy of the EU disappear in order to put its model of commercial policy into practice. In this respect, it’s necessary to underline the ample discretionary margin in the management of the commercial policy that the Court of Justice of the European Communities recognizes in favour of the EU institutions within the framework of its case-law related to the denial of the direct effect of the WTO agreements, as we analyze in this paper.

Multiplex molecular techniques can detect a diversity of respiratory viruses and bacteria that cause childhood acute respiratory infection rapidly and conveniently. However, currently available techniques show high variation in performance. We sought to compare the diagnostic accuracy of the novel multiplex NxTAG respiratory pathogen panel (RPP) RUO test versus a routine multiplex Anyplex II RV16 assay in respiratory specimens collected from children

En este artículo se aborda el estudio del estado actual en el que se encuentra la zona de libre cambio prevista en el Acuerdo Euromediterráneo firmado el 26 de febrero de 1996 por las Comunidades Europeas y sus Estados miembros con el Reino de Marruecos, así como el potencial de dicha zona de libre cambio como pilar fundamental en el que basar las negociaciones entre la Unión Europea y Marruecos en orden a la conclusión de un acuerdo de libre comercio profundo y completo, This paper analyses the current state of the free trade area under the Euro-Mediterranean Agreement, signed on 26 February 1996 by the European Communities and its Member States with the Kingdom of Morocco, and the potentiality of this free trade area to become a cornerstone on which to base negotiations between the EU and Morocco in order to conclude a deep and comprehensive free trade agreement

To evaluate the clinical presentation, complications and sequelae in patients with temporal bone fracture in the last 11 years.A total of 27 patient medical records were retrospectively analysed.Of the 27 patients who were admitted for temporal bone fracture from 2001 to 2012, 13 (48%) had no petrous involvement (Group 1), and 14 (52%) with petrous involvement (Group 2). Patients in Group 2 had a longer P-ICU stay: median 4.5 days (RI: 2.75-22.25 d) vs 2 (RI: 1-3 d) (P=.018); more days on mechanical ventilation support: median 3 days (RI: 1.50-17 d) vs 1 (RI: 1-1.25 d). This group also had a higher frequency in sequelae (P=.04 OR=1.4 (95% CI: 1.05-1.95)) and a higher incidence in cerebrospinal fluid (CSF) fistula (P.02; OR 2.33; 95% CI (1.27-4.27)). Severity scores (PRIMS III and PTI) showed no significant differences. Some degree of hearing loss was observed in 31% of the patients. Traffic accident was the main cause of trauma (33%), followed by falls (27%). There were 2 deaths and 4 (15%) had permanent sequelae.Isolated temporal bone fractures usually have a good outcome in children, but in some cases they can be fatal or have permanent sequelae. Long term follow up is recommended by authors.

X-chromosome-linked ichthyosis is caused by mutation or deletion of the STS gene associated with a deficiency of the enzyme steroid sulphatase, located in the distal part of the short arm of the X chromosome (Xp22.3-pter), close to the pseudo-autosomal region. Depending on its size, it can present as an isolated entity or combined with a syndrome caused by neighbouring genes, thus associating itself with other monogenic diseases as well as other mental disorders. The most relevant findings from the literature review are the importance of the Xp22.3-pter region and the higher incidence of neurological disorders among males (attention deficit hyperactivity disorder, autism and X-linked mental retardation). The role and implication of these genes in the disease are discussed and the authors suggest a possible contribution of the gene PNPLA4, which was originally described as GS2 and codes for calcium-independent phospholipase A2 beta, involved in lipoprotein metabolism, as one of the causes of autism. Improvements have been observed following treatment with citicoline, thanks to the role this nootropic plays in the biosynthesis of structural phospholipids involved in the formation and repair of the neuronal membrane.

We show a summary about Bronze Age in the island of San Fernando. Archaeological basis are analyzed to study the societies of the midle of the second millennium B.C. They are peripheric communities who live in the island, where they use natural resources, fundamentally molluscs, which generate an important agriculture, so there is a clear relation of dependence with regard to a nuclear center in the interior contrysides.