Conventional vs. diode laser stapedotomy: audiological outcomes and clinical safety.

PURPOSE: To compare the hearing results and clinical safety of patients undergoing stapes surgery with conventional technique and diode laser. METHODS: Retrospective observational study, which included patients treated with primary stapes surgery performed between January 2009 and January 2020. Three audiometric measurements (PTA, GAP and SDS) were evaluated as main results, evaluated by analysis of covariance (controlling the preoperative value). Intraoperative and postoperative complications were also analyzed. Outcomes were measured 6 months (± 1 month) after surgery. RESULTS: 153 cases were included, 97 operated with conventional technique and 56 with laser technique. Postoperative GAP ≤ 10 dB was obtained in 85.6% of the total sample, 82.5% in the conventional technique and 91.1% in the laser technique. Analysis of covariance showed no significant differences in the three surgery outcomes between the two groups (PTA, p = 0.277; GAP, p = 0.509 and SDS, p = 0.530). Regarding surgical complications, sensorineural damage was higher in the conventional technique group (p = 0.05). On the other hand, there were four cases of facial paresis, all in the laser group, three of them with the 980 nm laser. CONCLUSIONS: Stapedotomy offered a high percentage of hearing success in the two groups studied. There were no significant differences in audiometric result, but there was a differential presentation of complications, being more frequent sensorineural hearing loss in the conventional technique group and facial paresis in the laser group.

An anti-infodemic virtual center for the Americas.

The Pan American Health Organization/World Health Organization (PAHO/WHO) Anti-Infodemic Virtual Center for the Americas (AIVCA) is a project led by the Department of Evidence and Intelligence for Action in Health, PAHO and the Center for Health Informatics, PAHO/WHO Collaborating Center on Information Systems for Health, at the University of Illinois, with the participation of PAHO staff and consultants across the region. Its goal is to develop a set of tools-pairing AI with human judgment-to help ministries of health and related health institutions respond to infodemics. Public health officials will learn about emerging threats detected by the center and get recommendations on how to respond. The virtual center is structured with three parallel teams: detection, evidence, and response. The detection team will employ a mixture of advanced search queries, machine learning, and other AI techniques to sift through more than 800 million new public social media posts per day to identify emerging infodemic threats in both English and Spanish. The evidence team will use the EasySearch federated search engine backed by AI, PAHO's knowledge management team, and the Librarian Reserve Corps to identify the most relevant authoritative sources. The response team will use a design approach to communicate recommended response strategies based on behavioural science, storytelling, and information design approaches.

El centro virtual contra la infodemia para la Región de las Américas de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) es un proyecto liderado por el Departamento de Evidencia e Inteligencia para la Acción en la Salud de la OPS y el Center for Health Informatics de la Universidad de Illinois, centro colaborador de la OPS/OMS en sistemas de información para la salud, con la participación de personal y consultores de la OPS en toda la Región. Su objetivo es crear un conjunto de herramientas que combinen inteligencia artificial (IA) y los criterios humanos para apoyar a los ministerios de salud y las instituciones relacionadas con la salud en la respuesta a la infodemia. Los funcionarios de salud pública recibirán formación sobre las amenazas emergentes detectadas por el centro y recomendaciones sobre cómo abordarlas. El centro virtual está estructurado en tres equipos paralelos: detección, evidencia y respuesta. El equipo de detección empleará una combinación de consultas mediante búsqueda avanzada, aprendizaje automático y otras técnicas de IA para evaluar más de 800 millones de publicaciones nuevas en las redes sociales al día con el fin de detectar amenazas emergentes en el ámbito de la infodemia tanto en inglés como en español. El equipo de evidencia hará uso del motor de búsqueda federado EasySearch y, con el apoyo de la IA, el equipo de gestión del conocimiento de la OPS y la red Librarian Reserve Corps, determinará cuáles son las fuentes autorizadas más pertinentes. El equipo de respuesta utilizará un enfoque vinculado al diseño para difundir las estrategias recomendadas sobre la base de las ciencias del comportamiento, la narración de historias y el diseño de la información.

O Centro Virtual Anti-Infodemia para as Américas (AIVCA, na sigla em inglês) da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) é um projeto liderado pelo Departamento de Evidência e Inteligência para a Ação em Saúde da OPAS e pelo Centro de Informática em Saúde da Universidade de Illinois, EUA (Centro Colaborador da OPAS/OMS para Sistemas de Informação para a Saúde), com a participação de funcionários e consultores da OPAS de toda a região. Seu objetivo é desenvolver um conjunto de ferramentas ­ combinando a inteligência artificial (IA) com o discernimento humano ­ para ajudar os ministérios e instituições de saúde a responder às infodemias. As autoridades de saúde pública aprenderão sobre as ameaças emergentes detectadas pelo centro e obterão recomendações sobre como responder. O centro virtual está estruturado com três equipes paralelas: detecção, evidência e resposta. A equipe de detecção utilizará consultas de pesquisa avançada, machine learning (aprendizagem de máquina) e outras técnicas de IA para filtrar mais de 800 milhões de novas postagens públicas nas redes sociais por dia, a fim de identificar ameaças infodêmicas emergentes em inglês e espanhol. A equipe de evidência usará o mecanismo de busca federada EasySearch, com apoio de IA, da equipe de gestão de conhecimento da OPAS e do Librarian Reserve Corps (LRC), para identificar as fontes abalizadas mais relevantes. A equipe de resposta usará uma abordagem de design para comunicar estratégias de resposta recomendadas com base em abordagens de ciência comportamental, narração de histórias e design da informação.

[Public health and digital interdependence: technological evolution, technological sustainability, and the user revolutionSaúde pública e a interdependência digital: evolução tecnológica, sustentabilidade tecnológica e a revolução do usuário]. / Salud pública y la interdependencia digital: evolución tecnológica, sostenibilidad tecnológica y la revolución del usuario.

The "technological revolution in the health sector" resulting from the boom in the use of information and communications technologies (ICT) during the COVID-19 pandemic may, in fact, be due to a revolution among users whose close relationship with ICT has mobilized health systems, with the pandemic as a turning point. This article proposes a conceptual model of technological evolution and revolution among users, with transitions from acceptance of digital health to an understanding of its potential, and from the sustainability of digital health to trust in its various applications and governance. This requires clear approaches and agreements between the different sectors of the health system in terms of management, infrastructure, policies, and training, among other areas, focused on the user revolution and ensuring that no one is left behind.This article aims to conceptualize the process of evolution and revolution in ICT, as it applies to health in the context of the COVID-19 pandemic.

Argumenta-se que a chamada "revolução tecnológica no setor da saúde", devido ao boom no uso das tecnologias da informação e comunicação (TIC) ocorrido durante a pandemia de COVID-19, na verdade se deve a uma revolução do usuário que, devido à sua estreita relação com as TIC e no ponto de inflexão da pandemia, mobilizou os sistemas de saúde. Nesse sentido, propõe-se um modelo conceitual de evolução e revolução tecnológica dos usuários, com transições da aceitação da saúde digital para a compreensão do seu potencial, bem como da sustentabilidade da saúde digital para a confiança em suas diversas aplicações e governanças. Isso requer enfoques e acordos claros entre os diferentes setores do sistema de saúde em termos de gestão, infraestrutura, políticas e capacitação, entre outros, com foco na revolução do usuário e assegurando que ninguém fique para trás. Este artigo tem como objetivo conceitualizar o processo de evolução e revolução das TIC aplicadas à saúde no contexto da pandemia de COVID-19.

Toward a holistic definition for Information Systems for Health in the age of digital interdependence.

The article's main objective is to propose a new definition for Information Systems for Health, which is characterized by the identification and involvement of all the parts of a complex and interconnected process for data collection and decision-making in public health in the information society. The development of the concept was through a seven-step process including document analysis, on-site and virtual sessions for experts, and an online survey of broader health professionals. This new definition seeks to provide a holistic view, process, and approach for managing interoperable applications and databases that ethically considers open and free access to structured and unstructured data from different sectors, strategic information, and information and communication technology (ICT) tools for decision-making for the benefit of public health. It also supports the monitoring of the Sustainable Development Goals and the implementation of universal access to health and universal health coverage as well as Health in All Policies as an approach to promote health-related policies across sectors. Information Systems for Health evolves from preconceptions of health information systems to an integrated and multistakeholder effort that ensures better care and better policy-making and decision-making.

El objetivo principal de este artículo es proponer una nueva definición de los sistemas de información para la salud, que se caracterizan por la identificación y la participación de todas las partes involucradas en un complejo proceso interconectado de recopilación de datos y toma de decisiones en el ámbito de la salud pública en la sociedad de la información. El concepto se desarrolló en un proceso de siete pasos que incluyó el análisis de documentos, sesiones presenciales y virtuales con expertos y una encuesta en línea a profesionales de la salud en general. Esta nueva definición procura ofrecer un criterio holístico, un proceso y un enfoque para la gestión de bases de datos y aplicaciones interoperables que considere desde un punto de vista ético el acceso abierto y gratuito a datos estructurados y no estructurados de diferentes sectores, información estratégica y herramientas de tecnologías de la información y de la comunicación (TIC) para la toma de decisiones en beneficio de la salud pública. También brinda apoyo al seguimiento de los Objetivos de Desarrollo Sostenible y la ejecución del acceso universal a la salud y la cobertura universal de salud, así como la salud en todas las políticas como iniciativa para promover políticas relacionadas con la salud en todos los sectores. El concepto de sistemas de información para la salud implica una evolución desde lo que se consideraba anteriormente sistemas de información de salud hacia un esfuerzo integrado por parte de varios interesados directos que garantiza una mejora en la atención, la formulación de políticas y la toma de decisiones.

O principal objetivo deste artigo é propor uma nova definição para Sistemas de Informação em Saúde, que são caracterizados pela identificação e participação de todas as partes de um processo complexo e interconectado para a coleta de dados e tomada de decisão em saúde pública na sociedade da informação. O conceito foi desenvolvido por um processo de sete passos incluindo análise de documentos, sessões presenciais e virtuais com especialistas e uma pesquisa on-line com profissionais de saúde generalistas. A nova definição busca oferecer uma visão, um processo e uma abordagem holística para gerenciar aplicativos e bases de dados interoperáveis que consideram eticamente o acesso aberto e gratuito a dados estruturados e não estruturados de diferentes setores, informações estratégicas e ferramentas de tecnologia da informação e comunicação (TIC) para tomadas de decisão em prol da saúde pública. Também sustenta o monitoramento dos Objetivos de Desenvolvimento Sustentável e a implementação do acesso universal à saúde e da cobertura universal de saúde, assim como a Saúde em Todas as Políticas como uma abordagem para promover políticas relacionadas à saúde em vários setores. Os Sistemas de Informação em Saúde evoluíram de pré-conceitos dos sistemas de informação de saúde para um esforço integrado e com muitas partes interessadas, assegurando melhor cuidado, formulação de políticas e tomada de decisão.

3D-Printed Quasi-Cylindrical Bragg Reflector to Boost the Gain and Directivity of cm- and mm-Wave Antennas.

We demonstrate a concept for a large enhancement of the directivity and gain of readily available cm- and mm-wave antennas, i.e., without altering any property of the antenna design. Our concept exploits the high reflectivity of a Bragg reflector composed of three bilayers made of transparent materials. The cavity has a triangular aperture in order to resemble the idea of a horn-like, highly directive antenna. Importantly, we report gain enhancements of more than 400% in relation to the gain of the antenna without the Bragg structure, accompanied by a highly directive radiation pattern. The proposed structure is cost-effective and easy to fabricate with 3D-printing. Our results are presented for frequencies within the conventional WiFi frequencies, based on IEEE 802.11 standards, thus, enabling easily implementation by non-experts and needing only to be placed around the antenna to improve the directivity and gain of the signal.

Repeatability of material parameter extraction of liquids from transmission terahertz time-domain measurements.

Recently, many research groups worldwide have reported on the THz properties of liquids. Often these parameters, i.e., refractive index and absorption coefficient, are determined using liquids in cuvettes and terahertz time-domain spectroscopy. Here, we discuss the measurement process and determine how repeatable such measurements and the data extraction are using rapeseed oil as a sample. We address system stability, cuvette positioning, cuvette cleaning and cuvette assembly as sources affecting the repeatability. The results show that system stability and cuvette assembly are the most prominent factors limiting the repeatability of the THz measurements. These findings suggest that a single cuvette with precise positioning and thorough cleaning of the cuvette delivers the best discrimination among different liquid samples. Furthermore, when using a single cuvette and measurement systems of similar stability, the repeatability calculated based on several consecutive measurements is a good estimate to tell whether samples can be discriminated.

Ultralow chirp photonic crystal fiber Mach-Zehnder interferometer.

A photonic crystal fiber Mach-Zehnder interferometer design was optimized to obtain high performance and ultralow chirp. Two long-period gratings were used to excite the cladding modes, and the rich structure of the cladding was tailored to obtain a slightly chirped free spectral range, as required by the Telecommunication Standardization Sector of the International Telecommunication Union (ITU-T) Norm G.694.1. Finally, a fabrication tolerance analysis was performed. The advantages of the proposed device are an ultralow chirp, high bandwidth, and fabrication robustness tolerance.

[Infoxication in health. Health information overload on the Internet and the risk of important information becoming invisible]. / Infoxicación en salud. La sobrecarga de información sobre salud en la web y el riesgo de que lo importante se haga invisible.

OBJECTIVE: The objectives of this study were to: 1) raise awareness of the volume of quality health information on the Internet; 2) explore perceptions of information professionals with regard to the use of qualified sources for health decision-making; and 3) make recommendations that facilitate strengthening health worker capacities and institutional competencies related to digital literacy. METHODS: A non-experimental, descriptive cross-sectional study was conducted with a non-probability sample of 32 information professionals from nine countries. Internet information was compiled on the volume of content in Internet tools, social networks, and health information sources. Searches in English and Spanish were carried out using the keywords Ebola, Zika, dengue, chikungunya, safe food, health equity, safe sex, and obesity. Finally, information was obtained on opportunities for formal education on the subjects of digital literacy, information management, and other related topics. RESULTS: Selecting only four diseases with a high impact on public health in May 2016 and averaging minimum review time for each information product, it would take more than 50 years without sleeping to consult everything that is published online about dengue, Zika, Ebola, and chikungunya. CONCLUSION: We conclude that public health would benefit from: health institutions implementing formal knowledge management strategies; academic health sciences institutions incorporating formal digital literacy programs; and having health workers who are professionally responsible and functional in the information society.

[Strategy for governance of open health data: a paradigm shift in information systemsEstratégia para a governança de dados abertos de saúde: uma mudança de paradigma nos sistemas de informação]. / Estrategia para la gobernanza de datos abiertos de salud: un cambio de paradigma en los sistemas de información.

Policy development and review, planning, innovation, research, and the measurement of progress, barriers, and opportunities require open access to reliable data, information, and expert knowledge. This is part of the principles of the Pan American Sanitary Code and the Constitution of the Pan American Health Organization. Between 1950 and 1978, the subject of health data collection, in particular vital statistics, was expressly addressed in each of the first seven editions of Health in the Americas. However, despite considerable improvement in data quality, since the early 1980s it has been recognized that countries' health information systems require constant modernization in order to provide health data with better quality, coverage, and timeliness for informed decision-making. With the rise of the Internet, growing access to information and communications technologies--and today, with social networks, the increase in available content--has become massive and is growing in an exponential, unstructured, unclassified, and often uncontrolled manner. This situation forces health institutions to adopt strategies and standards for the management of open data that make it possible to strengthen their quality, confidentiality, and security. We propose a strategy for the governance of health data using tools, concepts, and recommendations that will enable countries to generate open, higher-quality, reliable, and secure data.

A formulação ou revisão de políticas, o planejamento, a inovação, a pesquisa e a medição do progresso, barreiras ou oportunidades requerem o acesso aberto a dados confiáveis, informações e conhecimentos qualificados. Isto faz parte dos princípios do Código Sanitário PanAmericano e da Constituição da Organização PanAmericana da Saúde. Entre 1950 e 1978, a questão da compilação de dados de saúde, em particular sobre estatísticas vitais, manifestou-se expressamente em cada uma das sete primeiras edições da publicação conhecida como "Saúde nas Américas". No entanto, embora tenha sido observada uma melhoria considerável na qualidade dos dados, existe o reconhecimento, desde o início da década de 1980, de que os sistemas de informação em saúde dos países precisam ser modernizados constantemente para proporcionar dados de saúde com melhor qualidade, cobertura e oportunidades para a tomada de decisões bem embasadas. Desde o despontar da Internet, com o crescente acesso a tecnologias da informação e comunicação, e hoje em dia com as redes sociais, o volume de conteúdos disponíveis tem se massificado e cresce exponencialmente de forma não estruturada, não classificada e, muitas vezes, descontrolada. Esta situação obriga as instituições de saúde a adotar estratégias e normas para a gestão de dados abertos que permitam fortalecer a qualidade, a confidencialidade e a segurança dos dados. Propomos aqui uma estratégia de governança dos dados de saúde por meio de ferramentas, conceitos e recomendações que permitirão aos países gerar dados abertos e de maior qualidade, além de confiáveis e seguros.

Fear on the networks: analyzing the 2014 Ebola outbreak.

During the 2014 Ebola outbreak, information spread via multiple platforms, including social networks and Internet search engines. This report analyzes Twitter tweets, Facebook posts, and Google trends, as well as several other Internet resources, from March - November 2014. Understanding the types of discussions, social behaviors, feelings expressed, and information shared during the Ebola outbreak can help health organizations improve communication interventions and avert misinformation and panic during health emergencies. In all, 6 422 170 tweets, 83 Facebook posts, and Google search trends were integrated with 63 chronological Ebola-related events. Events that prompted a surge in tweets using #ebola were related to new cases of infection or the entry of the disease into a new goegraphic area. Most tweets were re-tweets of information provided by news agencies and official health organizations. Events related to new infections and deaths seemed to correlate with an increase of words that express fear. Google results concurred with Twitter and Facebook. Data from social media activity can be used to form hypotheses about how the public responds to and behaves during public health events, prompting health organizations to adopt new strategies for communications interventions. Furthermore, a spike in activity around a topic can be used as a surveillance technique to signal to health authorities that an outbreak may be underway. It is also recommended that news agencies, which engage with the public most often, consider content review by health experts as part of their health communications process.

Durante el brote de ébola del 2014, se difundió información por medio de varias plataformas, entre ellas las redes sociales y los motores de búsqueda de Internet. En este informe se analizan los tuits en Twitter, los mensajes publicados en Facebook y las tendencias de búsqueda en Google, así como varios recursos más en Internet, en el período comprendido entre marzo y noviembre del 2014. La comprensión de los tipos de conversaciones, el comportamiento social, los sentimientos expresados y la información transmitida durante el brote de ébola puede ayudar a las organizaciones de salud a mejorar sus intervenciones en materia de comunicación y evitar la información incorrecta y el pánico que se pueden propagar durante las emergencias de salud.En total, se integraron 6 422 170 tuits, 83 mensajes de Facebook y las tendencias de búsqueda en Google con 63 eventos cronológicos relacionados con ébola. Los eventos que dieron lugar a un incremento de los tuits con la etiqueta #ebola estaban relacionados con nuevos casos de infección o la entrada de la enfermedad en una nueva zona geográfica. La mayor parte de los tuits eran reenvíos de información suministrada por las agencias de noticias y las organizaciones de salud oficiales. Los eventos relacionados con nuevas infecciones y defunciones parecían guardar correlación con un aumento del uso de palabras que expresaban temor. Los resultados de Google coincidían con Twitter y Facebook.Se pueden emplear datos provenientes de la actividad de las redes sociales para formar hipótesis sobre el modo en que el público responde a los eventos de salud pública y en que se comporta durante ellos, e incitar a las organizaciones de salud a que adopten nuevas estrategias para las intervenciones en materia de comunicación. Además, se pueden usar los aumentos de la actividad en torno a un tema como técnica de vigilancia para señalar a las autoridades de salud que es posible que haya un brote. Se recomienda también que las agencias de noticias, que interactúan con el público con más frecuencia, consideren la posibilidad de contar con expertos en salud para examinar los contenidos en el marco de su proceso de comunicación para la salud.

No transcurso do surto de Ebola de 2014, a informação se espalhou por diversas plataformas como as redes sociais e os mecanismos de busca da internet. Este artigo examina as mensagens no Twitter, postagens no Facebook e tendências no Google e outras mídias digitais no período de março a novembro de 2014. Entender as formas de discussões, comportamentos sociais, sentimentos expressos e informações partilhadas no decorrer do surto de Ebola pode contribuir para melhorar as intervenções em comunicação por parte das organizações de saúde e evitar a desinformação e o pânico em situações de emergência em saúde.Ao todo, 6.422.170 mensagens no Twitter, 83 postagens no Facebook e tendências de busca no Google foram correlacionadas a 63 eventos cronológicos relativos ao surto de Ebola. Os eventos que suscitaram um aumento no número de mensagens no Twitter com o hashtag #ebola foram a ocorrência de novos casos de infecção ou o surgimento da doença em outras áreas geográficas. Grande parte da atividade no Twitter consistiu no reenvio de mensagens com informações fornecidas pelas agências de notícias e organizações oficiais de saúde. Os eventos relacionados a novas infecções e mortes aparentemente se correlacionaram ao uso de um maior número de palavras que expressam temor. Os resultados do Google coincidiram com os do Twitter e Facebook. A análise da atividade nas mídias sociais permite formular hipóteses sobre a reação e o comportamento do público em situações de risco em saúde pública, motivando o uso de novas estratégias de comunicação por parte das organizações de saúde. Um pico de atividade em torno de um assunto pode ser um recurso de vigilância usado pelas autoridades sanitárias para sinalizar a possível ocorrência de um surto. Também se recomenda às agências de notícias, por estarem em contato constante com o público, integrar a análise do conteúdo por especialistas em saúde ao processo de comunicação de assuntos em saúde.

Three-dimensional quasi-conformal transformation optics through numerical optimization.

In this paper we demonstrate the possibility to achieve 3-dimensional quasi-conformal transformation optics through parametrization and numerical optimization without using sliding boundary conditions. The proposed technique, which uses a quasi-Newton method, is validated in two cylindrical waveguide bends as design examples. Our results indicate an arbitrarily small average anisotropy can be achieved in 3D transformation optics as the number of degrees of freedom provided by the parametrization was increased. The waveguide simulations confirm modal preservation when the residual anisotropy is neglected.

Tapered GRIN fiber microsensor.

The sensitivity of an optical fiber microsensor based on inter-modal interference can be considerably improved by tapering a short extension of the multimode fiber. In the case of Graded Index fibers with a parabolic refractive index profile, a meridional ray exhibits a sinusoidal path. When these fibers are tapered, the period of the propagated beam decrease down-taper and increase up-taper. We take advantage of this modulation -along with the enhanced overlap between the evanescent field and the external medium- to substantially increase the sensitivity of these devices by tuning the sensor's maximum sensitivity wavelength. Moreover, the extension of this device is reduced by one order of magnitude, making it more propitious for reduced space applications. Numerical and experimental results demonstrate the success and feasibility of this approach.

Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus.

Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.

Chronic pain is one of the most frequent reasons for medical consultation in Latin America. In the tenth revision of the International Classification of Diseases and Related Health Problems (ICD-10), chronic pain was not adequately defined and individual pain diagnoses were poorly defined. For the first time in Latin America, a meeting of pain experts analyzed and reviewed the 11th version of the International Classification of Diseases (ICD-11), when the Latin America Federation of Associations for the Study of Pain organized a meeting of experts from 14 Latin American countries. In ICD-11, chronic pain is recognized as a biopsychosocial phenomenon and defined as pain that continues or returns for more than 3 months. It is split into seven types: chronic primary pain and six types of chronic secondary pain. In ICD-11, chronic primary pain is now considered a disease in itself, not a mere manifestation of other disease. Our article is the first to address the problems, challenges and benefits of using ICD-11 from a Latin American perspective. It will help to facilitate and disseminate the use of this new classification of chronic pain. This will improve chronic pain treatment, statistics, research and development of better health strategies for pain management in Latin America.

Relationship between hypovitaminosis D and sarcopenia in patients with stage 3 and 4 chronic kidney disease in Colombian patients.

BACKGROUND: Sarcopenia is a condition associated with aging and multiple medical conditions such as CKD and hypovitaminosis D. METHODS: An observational cross-sectional study was carried out, based on patients registered in a database of specialized nephrology consultation in the city of Manizales, Colombia. 101 patients over 18 years of age who had stage 3 or 4 CKD were included. RESULTS: The frequency of sarcopenia was 10.9%. No relationship was found between sarcopenia alone and serum vitamin D levels. However, when sarcopenia was categorized as severe there was a direct relationship with hypovitaminosis D. There was also a direct relationship between dynapenia and hypovitaminosis D. In addition, patients who had serum vitamin D levels above 40 ng/ml had better muscle performance, and, consequently, probably a lower risk of frailty. CONCLUSION: When patients, within their treatment, received vitamin D supplementation, no effect on muscle performance was observed.

[Ultrasound-accelerated thrombolysis. Initial experience in patients with contraindications to systemic thrombolysis]. / Trombólisis acelerada por ultrasonido. Experiencia inicial en pacientes con contraindicación para trombólisis sistémica.

Background: acute pulmonary embolism (APE) is a complex and potentially deadly entity, with a variable clinical course, considered the third cardiovascular cause of death. Its management varies according to the stratified risk from anticoagulation to reperfusion therapy, suggesting systemic thrombolysis as a first-choice strategy; however, in a large group of patients their use will be contraindicated, discouraged or will have failed, thus recommending as options in such cases endovascular therapies or surgical embolectomy. With the presentation of 3 clinical cases and a review of the literature, we seek to communicate our initial experience in the use of ultrasound-accelerated thrombolysis with the EKOS system and to investigate key elements for its understanding and application. Clinical cases: the cases of 3 patients with APE of high and intermediate risk with contraindications for systemic thrombolysis taken to accelerated thrombolysis therapy by ultrasound are discussed. They presented adequate clinical and hemodynamic evolution in the short term, achieving a rapid decrease in thrombolysis, systolic and mean pulmonary arterial pressure, improvement of right ventricular function and reduction of thrombotic burden. Conclusion: Ultrasound-accelerated thrombolysis is a novel pharmaco-mechanical therapy that combines the emission of ultrasonic waves with the infusion of a local thrombolytic agent, a strategy that, according to different trials and clinical registries, has a high success rate and a good safety profile.

Introducción: la tromboembolia pulmonar (TEP) aguda es una entidad compleja y potencialmente mortal, de curso clínico variable, considerada como la tercera causa cardiovascular de muerte. Su manejo varía de acuerdo con el riesgo estratificado desde anticoagulación hasta terapia de reperfusión, por lo que se sugiere como estrategia de primera elección la trombólisis sistémica; sin embargo, en un grupo amplio de pacientes su empleo estará contraindicado, desaconsejado o habrá fallado y se recomendarán como opciones en tales casos terapias endovasculares o embolectomía quirúrgica. A partir de la presentación de 3 casos clínicos y una revisión de la literatura, buscamos comunicar nuestra experiencia inicial en el uso de trombólisis acelerada por ultrasonido con sistema EKOS e indagar elementos claves para su entendimiento y aplicación. Caso clínico: se discuten los casos de 3 pacientes con TEP aguda de riesgo alto e intermedio con contraindicaciones para la trombólisis sistémica, llevados a terapia de trombólisis acelerada por ultrasonido, los cuales presentaron adecuada evolución clínica y hemodinámica a corto plazo, y lograron una rápida disminución de la presión arterial pulmonar sistólica y media, mejoría de función ventricular derecha y reducción de la carga trombótica. Conclusión: la trombólisis acelerada por ultrasonido es una terapia fármaco-mecánica novedosa que combina la emisión de ondas ultrasónicas con la infusión de un agente trombolítico local, estrategia que según diferentes ensayos y registros clínicos presenta una alta tasa de éxito y un buen perfil de seguridad.

Broadband dispersion compensation using inner cladding modes in photonic crystal fibers.

A photonic crystal fiber is optimized for chromatic dispersion compensation by using inner cladding modes. To this end, a photonic-oriented version of the downhill-simplex algorithm is employed. The numerical results show a dispersion profile that accurately compensates the targeted dispersion curve, as well as its dispersion slope. The presented fiber has a simple structure, while radiation losses can be reduced simply by adding a few more air-hole rings. Fabrication tolerances are also considered showing how fabrication inaccuracies effects can be overridden by just adjusting the compensation length.

Ultrahigh-birefringent squeezed lattice photonic crystal fiber with rotated elliptical air holes.

We report an experimental realization of a highly birefringent photonic crystal fiber as a result of compressing a regular hexagonal structure. The experimental measurements estimate a group birefringence of approximately 5.5x10(-3) at 1550 nm in good agreement with the numerical results. We study the influence of compressing the regular structure at different directions and magnifications, obtaining a method to realistically enhance the phase birefringence while moderating the group birefringence.

Bioelectrical impedance analysis and dual x-ray absorptiometry agreement for skeletal muscle mass index evaluation in sarcopenia diagnosis.

BACKGROUND: All definitions for diagnosing sarcopenia include the estimation of muscle mass. This can be made using bioelectrical impedance analysis (BIA) or dual x-ray absorptiometry (DXA). BIA is a portable and inexpensive method suitable for clinical settings, while DXA is cumbersome, more expensive and less available. OBJECTIVES: To evaluate the interchangeability of both techniques for skeletal muscle mass index (SMI) estimation, and assess whether the two methods are comparable for the diagnosis of sarcopenia. APPROACH: Prospective, cross-sectional study. SETTING: Faculty for Health Sciences, Universidad de Caldas, Colombia. PARTICIPANTS: Seventy-two subjects aged 65-80 years were recruited. MEASUREMENTS: BIA and DXA for SMI estimation and sarcopenia diagnoses using the definition of the European Working Group on Sarcopenia in Older People (EWGSOP). Of the 72 patients, 28 were diagnosed with sarcopenia by BIA and corroborated by DXA were included in the study. To establish the agreement between techniques, the intraclass correlation coefficient and the concordance correlation coefficient were calculated. A Bland-Altman plot evaluated the agreement. To evaluate agreement on the diagnosis of sarcopenia, a Cohen's kappa test was performed. MAIN RESULTS: Agreement between SMI by BIA and DXA was good according to the intraclass correlation coefficient (ICC 0.7 95% CI 0.5 to 0.8) but poor when the concordance correlation coefficient was used (CCC 0.4 was calculated 95% CI 0.3 to 0.5). The Bland-Altman analysis showed a clinically unacceptable discrepancy between the methods; the confidence intervals were too wide; the difference between methods tends to get larger as the average increases and the scatter around the bias line get larger as the average gets higher. Cohen's kappa test was 0.2 (SEE: 0.1). SIGNIFICANCE: The agreement between BIA and DXA was weak. We concluded that, in this studied population, the methods were not interchangeable. Results may improve if a specific formula in a greater sample size is used.

Provisional cut-off points for the diagnosis of sarcopenia in elderly people from Caldas (Colombia) / Puntos de corte provisionales para el diagnóstico de sarcopenia en ancianos de Caldas, Colombia

Introduction: Sarcopenia is defined as a decrease in muscle mass associated with the reduction of performance and physical function. It is an indicator of adverse outcomes in elderly people. Its diagnosis requires body composition data of healthy young population to establish reference values of low muscle mass. Objective: To establish a provisional cut-off point for sarcopenia in the elderly population from Caldas based on the skeletal muscle composition data of young people using electric bioimpedance. Materials and methods: Body composition data from healthy young people (18 to 35 years old) were used to calculate the skeletal muscle mass index. The Kolmogorov-Smirnov test was applied to evaluate the normality of the data and then the average and standard deviation of muscle mass index were established for both men and women. Results: Based on these data, we established as low muscle mass a skeletal muscle mass index of two standard deviations below the mean of the muscular mass index in young people. The cut-off points were 6.42 kg/m2 and 8.39 kg/m2 for women and men, respectively. Conclusion: This is the first study that offers a description of skeletal muscle body composition in young Colombians and provides cut-off points for the diagnosis of sarcopenia in the elderly population from the Central-Andean region. The data gathered are similar to those proposed by some Asian authors, which shows that the population of this Colombian region has body composition characteristics similar to those from Asia.

Introducción. La sarcopenia es la disminución de masa muscular y la consecuente reducción del rendimiento y de la función física. Su aparición puede ser indicativa de riesgo de otras condiciones en los ancianos, y su diagnóstico requiere la comparación con los datos sobre la composición corporal de la población joven sana para establecer valores de referencia de la disminución de la masa muscular.Objetivo. Establecer puntos provisionales de corte recolectados mediante bioimpedancia eléctrica para el diagnóstico de sarcopenia en ancianos caldenses a partir de los datos de la composición muscular esquelética de jóvenes.Materiales y métodos. Se utilizaron las mediciones de la composición corporal de jóvenes sanos entre los 18 y los 35 años de edad tomadas mediante bioimpedancia eléctrica con base en las cuales se estableció el índice de masa muscular esquelética. Se aplicó la prueba de Kolmogorov-Smirnov para evaluar la normalidad de los datos y se estableció el promedio de dicho índice con sus desviaciones estándar tanto para hombres como para mujeres.Resultados. A partir de estos datos, se estableció como bajo un índice de masa muscular esquelética con un valor de dos desviaciones estándar por debajo de la media del índice en jóvenes. En las mujeres el valor fue de 6,42 kg/m2 y, en hombres, de 8,39 kg/m2.Conclusión. Estos valores son similares a los determinados por algunos autores en población asiática, lo que evidencia que esta tiene características de composición corporal similares a la población de estudio. Hasta donde se sabe, este es el primer estudio que ofrece una descripción de la composición corporal muscular esquelética en jóvenes colombianos y establece puntos de corte para el diagnóstico de sarcopenia en ancianos de esta región centro-andina del país.