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Resumen: Introducción: La parálisis braquial obstétrica (PBO) suele tener un pronóstico favorable; sin embargo, casi un tercio de los casos graves presentan secuelas permanentes que generan gran discapacidad. Valoramos la eficacia del tratamiento con infiltraciones ecoguiadas de toxina botulínica A (TB-A) y describimos el procedimiento. Pacientes y métodos: Estudio prospectivo, descriptivo, de los casos de PBO moderada-grave tratados entre enero del 2010 y diciembre del 2014. Recogimos datos demográficos, tipo de PBO y evolución. Valoramos eficacia con la escala de movimiento activo (EMA), Mallet Classification System y videofilmación. Resultados: Valoramos a 14.133 recién nacidos vivos, con 15 casos de PBO (1,06 por cada 1.000). El 40% casos graves (0,4/1000), nacidos de parto distócico, con APGAR < 5 y peso medio de 4.038 g. Edad media de inicio de infiltraciones 11,5 meses. El pronator teres, subescapularis, teres major, latissimus dorsi y/o pectoralis major fueron los más frecuentemente infiltrados. Mejoría progresiva hasta 3 niveles en EMA y una media de 19,5 puntos sobre 25 en la escala de Mallet a los 2 años en todos los casos de PBO que completaron el seguimiento (83%). Todos mejoraron funcionalidad y posturas anormales. Evitamos la cirugía en 3 pacientes y se retrasó en uno. Los efectos adversos del tratamiento fueron leves y autolimitados. Conclusiones: Por su seguridad y eficacia, parece razonable la utilización «off label» de TB-A como tratamiento adyuvante a las terapias físicas y/o tratamiento quirúrgico en las PBO moderadas-graves. La ecografía podría aumentar la eficacia y disminuir efectos adversos. Abstract: Introduction: Obstetric brachial plexus palsy (OBPP) usually has a favourable prognosis. However, nearly one third of all severe cases have permanent sequelae causing a high level of disability. In this study, we explore the effectiveness of ultrasound-guided injection of botulinum toxin A (BoNT-A) and describe the procedure. Patients and methods: We designed a prospective, descriptive study including patients with moderate to severe OBPP who were treated between January 2010 and December 2014. We gathered demographic data, type of OBPP, and progression. Treatment effectiveness was assessed with the Active Movement Scale (AMS), the Mallet classification, and video recordings. Results: We gathered a total of 14 133 newborns, 15 of whom had OBPP (1.6 per 1000 live births). Forty percent of the cases had severe OBPP (0.4/1000), a dystocic delivery, and APGAR scores

Resumen: Introducción: El trastorno por déficit de atención e hiperactividad (TDAH) es el trastorno del neurodesarrollo más frecuente y debe ser considerado un problema de primer orden de salud pública por sus repercusiones funcionales a nivel escolar, familiar y social. Empoderar en salud es un modelo innovador en el cuidado de pacientes con enfermedades crónicas, basado en la educación de automanejo. Nuestro objetivo es valorar la eficacia de empoderar mediante coaching, dentro de un plan de tratamiento multimodal en pacientes pediátricos con TDAH. Material y métodos: estudio descriptivo, abierto y prospectivo. Incluimos a niños de entre 6 y 12 años pertenecientes a una asociación de pacientes de un área suburbana de la Comunidad de Madrid. Valoramos la situación previa y posterior a 5 sesiones gratuitas de coaching mediante el Cuestionario de conducta de Conners de dificultades a lo largo del día (D-DTODS) y escalas de satisfacción. Resultados: Incluimos a 49 pacientes, el 73,5% varones, con una edad media de 8,5 años. El 63,3% tenía TDAH subtipo hiperactivo/impulsivo y el 77,6% algún tipo de comorbilidad. Todos tratados con metilfenidato y mala evolución clínica. El 79,6% mejoró clínicamente, con una reducción media ± DT de los síntomas del 34,6 ± 11,1% y mantenida en el 79,6% tras 6 meses de seguimiento post coaching. Alcanzamos un nivel de satisfacción de 7,8 ± 1,7 sobre 10 y el 95,9% recomendó el tratamiento a otras familias. Conclusiones: Nuestros resultados aportan información sobre los posibles beneficios del coaching como tratamiento asociado en el TDAH. Abstract: Introduction: Attention deficit hyperactivity disorder (ADHD) is the most frequent neurodevelopmental disorder and must be considered a public health priority because of its functional repercussions in school, family, and social settings. Health empowerment is an innovative model of care for patients with chronic diseases based on self-management education. Our goal is to evaluate the effectiveness of empowerment using coaching within a multimodal treatment plan in paediatric patients with ADHD. Material and methods: Descriptive open prospective study. We included children between 6 and 12 years old belonging to patient association in a suburban area of the Region of Madrid. We evaluated the situation before and after 5 cost-free coaching sessions using the Conners Questionnaire, Dundee difficult times of day scale, and satisfaction scales. Results: We included 49 patients (73.5% males) with an average age of 8.5 years. The ADHD hyperactive-impulsive subtype was present in 63.3% and 77.6% had some type of comorbidity. All were treated with methylphenidate and their clinical course was poor. Clinical improvements were observed in 79.6% with a 34.6% mean reduction in symptoms (SD 11.1), and improvements remained stable at 6 months follow-up after coaching. We reached a satisfaction level of 7.8 out of 10 (SD 1.7), and 95.9% of the participants recommended this treatment to other families. Conclusions: Our results provide information on the potential benefits of coaching as complementary treatment for ADHD. Palabras clave: Empoderar, Coaching, Trastorno por déficit de atención e hiperactividad, Hiperactividad, Déficit de atención, Psicoestimulantes, Keywords: Empowerment, Coaching, Attention deficit hyperactivity disorder, Hyperactivity, Attention deficit, Psychostimulants

Fish from the river Chenab were analyzed for DNA damage by the Comet and Micronucleus assays. The fatty acid profile was determined by gas chromatography using a Flame Ionization Detector. Atomic absorption spectrophotometry showed significant (p < 0.05) levels of contamination due to Cd, Hg, Cu, Mn, Zn, Pb, Cr, Sn and phenols in the fish habitat. The Comet assay revealed significant (p < 0.05) DNA damage in Cirrhinus mrigala of 37.29±2.51%, 34.96±2.53% and 38.80±2.42% in the comet tail, in the tail moment of 23.48±3.90, 19.78±4.26 and 14.30±1.82, in the olive moment of 16.22±2.04, 13.83±1.96 10.99±0.90, respectively, from three experimental sites. The micronucleus assay showed a high frequency of single micronucleus induction of 44.80±3.73, double induction of 06.20±0.97 and nuclear abnormalities of 09.60±1.72, as calculated in a thousand cells. C8:0, C12:0, C20:0, C16:1(n-7), C16:1(n-9), C20:1(n-9), C18:2(n-6), C18:4(n-3), C20:5(n-3), C22:4(n-6) fatty acids were found missing in the fish with a higher intensity of DNA damage but were found in optimal amounts both in farmed and wild fish from non polluted habitats. A highly significant (p < 0.01) correlation was also found in saturated, unsaturated fatty acids and DNA damage and habitat. The present study revealed that the habitat of even lower intensity pollutions not only induce DNA damage but also confiscate essential fatty acids of the omega series and reduce the amount of unsaturated fatty acids for which fish is preferred over other animals.

Introduction: gastric cancer is the most frequent gastrointestinal malignancy in Mexico and the proportion of patients younger than 40 years is one of the highest reported in the world literature. Recently several families with familial diffuse gastric cancer have been identified at the National Institute of Medical Sciences and Nutrition. Germline mutations in the E-cadherin gene (CHD1) have been described that result in the development of diffuse hereditary gastric cancer in young patients. Methods: the complete coding sequence at exons 1 to 16 and the promoter region of CDH1 was amplified by polymerase chain reaction in peripheral blood samples of two patients with early onset familial diffuse gastric cancer. Results: no germline inactivating mutations of CHD1 were found on either patient. Single nucleotide polymorphisms -160 C→A were detected in the promoter region of CDH1 in both patients. Conclusions: the polymorphism -160 C→A theoretically confers an increased risk of developing diffuse gastric cancer. The relatives of these patients may an increased risk of gastric cancer among other tumors. There is presently not enough evidence to consider the -160 C→A polymorphism an etiologic factor of diffuse gastric cancer in these patients since the frequency and type of genetic alterations of CDH1 are largely unknown in the Mexican population. It will be necessary to conduct epidemiologic studies in the Mexican population to determine the influence that genetic alterations have on the genesis of diffuse gastric carcinoma.Introducción: el cáncer gástrico es la neoplasia más frecuente del tracto gastrointestinal en México y la proporción de pacientes menores de 40 años es una de las más altas reportadas en la literatura mundial. Recientemente se han identificado en el Instituto Nacional de Ciencias Médicas y Nutrición varias familias con cáncer gástrico difuso familiar. Múltiples mutaciones germinales del gene de E-cadherina (CHD1) han sido descritas en relación al desarrollo de cáncer gástrico difuso hereditario en pacientes jóvenes. Métodos: la secuencia codificadora completa exones 1 al 16 y la región promotora de CDH1 fueron amplificadas mediante reacción en cadena de la polimerasa en muestras de sangre periférica de dos pacientes con diagnósticos de cáncer gástrico de aparición temprana familiar. Resultados: en ninguno de los 2 pacientes se detectaron mutaciones germinales inactivadoras de CDH1. Se encontraron polimorfismos de nucleotido único C→A en la región promotora de CDH1 en la posición -160 en ambos pacientes. Conclusiones: el polimorfismo -160 C→A confiere teóricamente un aumento en el riesgo de desarrollar cáncer gástrico difuso. Los miembros de las familias presentan un riesgo mayor para cáncer gástrico difuso al igual que otras neoplasias. No existe actualmente evidencia suficiente para considerar al polimorfismo -160 C→A como un factor etiológico determinante de cáncer gástrico difuso debido a que la frecuencia y tipo de alteraciones en el gen CDH1 en población mexicana se desconocen. Será necesario llevar a cabo estudios epidemiológicos en población mexicana que determinen la influencia de diversas alteraciones genéticas en la génesis de esta neoplasia.

Este nuevo Centro Parroquial, además de la nave —con capacidad para 600 personas—, comprende: las salas, en las que se desarrollan actividades docentes, reuniones, programas para la juventud; vivienda del párroco y el sacristán; etc. En su composición arquitectónica, el arquitecto ha sabido establecer una estrecha vinculación entre la construcción y el arte, y combinar acertadamente los elementos paralelepipédicos, buscando nuevas formas plásticas, enriquecidas por elementos arquitectónicos tales como: escaleras, cornisas, voladizos, etc. Como integración de las Artes Plásticas, destacan las obras de dos escultores: Moillet y Walter Gürtler.

As a unique woody oil tree, Camellia oleifera Abel originates from southern China and is now being cultivated in central China, such as the southern Henan province. The aim of this work is to determine some physiochemical parameters, fatty acid profile and tocopherol composition of the Camellia oleifera seed oils harvested in southern Henan in the 2016 season. The lipid contents of the kernel are in the range of 28.39- 56.94% on dry matter. The acid value (AV), saponification value (SV), iodine value (IV), and refractive index of the oils are in the ranges: 0.22-5.17 mg KOH/g, 178.90-196.91 mg KOH/g, 82.0-87.1 g I2/100g, and 1.4667-1.4720 (nD25) , respectively. The main fatty acids are: palmitic 7.07-9.52%, palmitoleic 0.09-0.22%, stearic 1.45-2.94%, oleic 77.02-84.33%, linoleic 5.19-11.23%, linolenic 0.53-0.70% and arachidic 0.22-0.70%. The sn-2 fatty acid composition is: 84.36-91.33% oleic, 7.14-14.22% linoleic, and 0.89-1.96% others. The tocopherol content is in the range of 39.55-75.94 mg/100g oil, including mainly α-tocopherol (33.98-67.82 mg/100g) and γ-tocopherol (5.57- 8.27 mg/100g) when the oils are extracted with hexane; and 14.91-44.36 mg/100g, including mainly α-tocopherol (9.42-37.08 mg/100g) and γ-tocopherol (5.50-7.33 mg/100g) when the oils are extracted by ethyl ether. The physiochemical properties C. oleifera seed oils from southern Henan are similar to those from other districts of China.

Background: Biliary papillomatosis is a rare type of papillomatosis. Depending on the location of the disease, radical surgical resection or liver transplants are the treatment of choice. These radical surgical options may be unrealistic in patients who are not surgical candidates or who are unwilling to consider surgery., Aims: To evaluate the effectiveness of endoscopic electrocoagulation for the biliary papillomatosis., Methods: In this case series, we report six patients with unresectable biliary papillomatosis who underwent cholangioscopic electrocoagulation using needle knife and their clinic follow up information., Results: After patients received cholangioscopy with electrocoagulation of the residual biliary papilloma, the daily T-tube drainage volume increased to 200-400ml with improvement in the drainage content and significant relief of clinical symptoms, such as jaundice and abdominal pain., Conclusion: This method of using electrocoagulation to directly target and destroy tumor tissue is a safe and effective alternative for those with unresectable disease, and this method has shown to enhance T-tube drainage volume and improve patients' overall clinical symptoms., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)