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CT perfusion is a new technique that is rapid, available and minimally invasive which provides functional vascular information and can be made after conventional CT and CT angiography at the same imaging session. CT perfusion applications have focused on ischemic stroke with only a short series of applications to brain death diagnosis Instead, Cf angiography is frequently performed as a confirmatory test of brain death, but it has not been completely validated yet. Hence Cr perfusion may help in supporting the diagnosis of brain death. We present the case of a 12-year-old child with clinical criteria for brain death who required a confirmatory test. Cl' angiography and Cl' perfusion were performed. Both revealed the absence of any intracranial blood flow which supported the clinical diagnosis of brain death. [ABSTRACT FROM AUTHOR]

The Water Framework Directive (WFD, 2000/60/EC) mandates member states to consider trace element background values when establishing environmental quality standards (EQS) for sediments. This study proposes defining the "background" value as the trace element concentration that is consistently present in the unaltered natural environment, and the "reference" value as an upper limit of variation of naturally occurring concentrations, suggestive of anthropogenic enrichment if exceeded. We argue that background and reference values can be computed as the upper limits of the one-sided 95 % confidence interval for the median and for the 90th percentile, respectively. This proposition has been tested in two European river basins with different historical anthropogenic impacts: the Nalón (impacted by mining activities) and the Esva (mostly unpolluted) basins. For 110 bottom sediment samples collected from both pristine (background) and potentially impacted (non-background) locations, 19 elements were analyzed by ICP-MS/ICP-AES. The proposed background and reference values, calculated using the Bootstrap method, demonstrated consistency despite geological differences between the basins. The methodology proved particularly effective in datasets with a limited sample size and highly skewed data distributions. In the Nalón basin, with higher anthropogenic activity, the percentage of samples exceeding reference values was higher than in the Esva basin (e.g., 29 % vs 7 % for As and 11 % vs 0 % for Pb), suggesting the utility of these values in discerning potential impacts of historic mining activities. In the Esva basin, background and reference values were either near or below generic thresholds for good ecological status (LEL, TEL) unlike the Nalón basin, in which reference values for all elements, except three, exceeded these thresholds., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Almudena Ordonez reports financial support was provided by Spanish Ministry of Science and Innovation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Since the onset of the SARS-CoV-2 pandemic, the pediatric population has been less affected by the disease both in frequency and severity. However, since April cases of variable presentation and severity characterized by inflammatory phenomena that affect multiple organs have been reported, a condition called Multisystem Inflammatory Syndrome in Children (MIS-C). The literature has reported frequent cardiac involvement, up to 80%. This is characterized by myocardial injury with a significant increase of biomarkers such as serum troponins I and T, BNP, or NT-ProBNP coupled with varying degrees of ventricular dysfunction, pericarditis, valvulitis, and arrhythmias. Coronary compromise has also been described, which can occur in up to 23% of cases, and ranges from dila tations to aneurysms. Inpatient and outpatient cardiology follow-up has been systematized based on the clinical phenotypes such as myocardial injury (myocarditis, valvulitis, pericarditis), shock (usua lly vasoplegic), Kawasaki disease-type manifestations, and those MIS-C that do not comply with the clinic of the previous three. This last group represents the main challenge in the short-, medium- and long-term follow-up, therefore, it is necessary a multidisciplinary team for managing these patients. Considering the high frequency of cardiac compromise in MIS-C, and the importance of reaching a consensus regarding its management and follow-up, we present these recommendations according to the current state of knowledge regarding this recently described pathology.

Introduction: Cigarette consumption among teenagers is one of the most critical health-related risk behaviors., Method: Prospective study carried out in seven sites of five Latin American countries (Argentina [Cordoba, N=958, Corrientes, N=1013], Brazil [Curitiba, N=650; Uruguaiana, N=997], Cuba [Havana, N=1004], Mexico [Veracruz, N=991] and Paraguay [Ciudad del Este, N=868]) with public-school adolescents (aged 12-19 years). Respondents were asked to answer the California Student Tobacco Survey., Results: 6550 adolescents took part in the survey (average age: 14 years). 38.5% (N=2517) "tried smoking" and 37.5% started smoking before the age of 12. Sixty-one percent of adolescents think that cigarettes are easily accessible; 41.7% considered that smokers have more friends; 88% indicated knowledge of the harms of smoking one to five cigarettes per day; 58.9% would smoke new cigarette types with less harmful substances; 27.8% have already used e-cigarettes; 28% have smoked hookah. Fifty-seven point five percent have been, in the past seven days, in the same room with someone who was smoking a cigarette; and 30.5% indicated that there were not any no-smoking rules inside their homes. Identifiable risk factors were (logistic regression analysis): smoking cigarettes offered by friends, smoking cigarettes with less harmful substances, knowing what a hookah is, being in the same room with a smoker in the past week. Identifiable protective factors against tobacco use were: knowing the health risks caused by smoking hookah and to have their own room., Conclusion: Youth tobacco use in Latin America is a major public health concern, and tobacco control measures are highly needed., (Copyright © 2018. Published by Elsevier España, S.L.U.)

Introduction: Kawasaki disease (KD) is a serious disease in children due to its potential complications and sequelae if not promptly and adequately managed., Objectives: To describe clinical and epidemiological characteristics of children hospitalized due to KD at a tertiary care center and identify risk factors for poor outcome., Patients and Methods: Retrospective and descriptive study of 32 medical records of patients hospitalized with diagnosis of KD at a tertiary care center of Santiago, Chile between February 1999 and May 2007., Results: The annual frequency was of 5 cases, mainly boys and during spring. The median age at diagnosis was 1.5 years and 87.5% of the children were younger than 5 years. Typical presentation prevailed in all ages (68,7%). Coronary artery affection, including dilatation or aneurisms, occurred in 21.9% of the cases, with aneurysms in 3 cases. All patients were treated with aspirin and intravenous immunoglobulin (IVIG); 4 patients required a second dose. No deaths were reported. The identified risk factors for poor outcome were age older than 5 years and hypoalbuminemia., Conclusions: KD is an infrequent disease that mainly occurs in children younger than 5 years and with a typical presentation. There are risk factors associated with poor outcome.

Objective/method: We present 2 cases of miliary tuberculosis with choroidal tubercles., Results/conclusions: Miliary tuberculosis is a severe disease that may cause death in case of misdiagnosis, but might be resolved with an adequate mycobacterial therapy. The diagnosis was based on a combínation of findings and the presence of choroidal tubercles may play an important role in the final diagnosis and correct treatment.

In recent years, eating disorders (Anorexia and Bulimia Nervosa) have increased and are appearing at increasingly younger ages. They affect predominantly adolescent females 12 to 25 years of age. The objective of this study of adolescents is to detect and discuss unhealthy eating behaviour, defined by either of two factors: (1) following a slimming diet not advised or supervised by any person trained in health care; or (2) eating very large quantities at irregular times, not related to anxiety or stress. A transversal study has been undertaken of 630 school children of 14-18 years of age (average: 15.9 years) in Cádiz (Andalucia, Spain), using an anonymous self-reporting questionnaire to collect data on personal and educational situation, on eating habits, on nutritive intake and knowledge of nutrition, and on dieting and physical exercise. The study has considered averages, ratios, statistical significance (chi2) and, as a measure of risk, the Disequality Ratio of Prevalence (DRP). Anomalous eating behaviour was detected in 46.3% (292), with females predominant by a ratio of 2:1. Comparing groups with anomalous and with normal eating habits, significant differences were detected in respect of: perception of body image (p < 0.001), frequency of weighing oneself (p < 0.05), periods of abstinence from eating (DRP 1.66; 95% confidence interval (CI): 1.66-2.37), provocation of vomiting (DRP 2.02; 95% CI: 1.13-3.65), use of laxatives (DRP 4.25: 95% CI: 1.08-9.63), and the exclusion of certain meals and types of food, mainly bread and cereals, fats and sugars. Conclusions are drawn on the substantial scale of unhealthy eating behaviour among adolescents in Cadiz. More adequate education on personal health and related social issues should be provided.