Tinnitus: una revisión narrativa / Tinnitus: A narrative review / Tinnitus: uma revisão narrativa

El tinnitus o acúfeno es la percepción de sonido en ausencia de un estímulo acústico externo; es uno de los motivos de consulta más comunes en el área de otorrinolaringolo­gía. Se ha asociado a diversas etiologías tales como ototoxicidad, tumores, traumatismo craneoencefálico y trastornos psiquiátricos, siendo también las causas de carácter idio­pático ampliamente conocidas. Las características clínicas de los tinnitus son variables de paciente a paciente, por lo que su diagnóstico, tratamiento y seguimiento son un desafío clínico Si bien recientes estudios han propuesto distintos manejos clínicos y terapéuticos, estos continúan hoy en día en estudio. Esta revisión narrativa pretende realizar una actualización sobre el abordaje diagnóstico, clínico y terapéutico de los tinnitus en la última década.

Tinnitus, the perception of sound in the absence of an external acoustic stimulus, is one of the most common reasons for consultation in the area of otorhinolaryngology. It has been associated with various etiologies such as ototoxicity, tumors, head trauma, and psychiatric disorders; idiopathic causes are also widely known. The clinical characteristics of tinnitus are variable from patient to patient; therefore, its diagnosis, treatment, and follow-up are a clinical challenge. Although recent studies have proposed different clinical and therapeutic approaches, these are still under analysis today. This narrative review aims to update the diagnostic, clinical and therapeutic approach to tinnitus in the last decade.

Tinnitus ou zumbido é a percepção do som na ausência de um estímulo acústico externo; é um dos motivos mais comuns de consulta na área de otorrinolaringologia. Tem sido associada a várias etiologias, como ototoxicidade, tumores, traumatismo craniano e distúrbios psiquiátricos, sendo também amplamente conhecidas causas idiopáticas. As características clínicas do zumbido são variáveis de paciente para paciente, por isso seu diagnóstico, tratamento e acompanhamento são um desafio clínico, embora estudos recentes tenham proposto diferentes abordagens clínicas e terapêuticas, ainda hoje estão em estudo. Esta revisão narrativa visa atualizar a abordagem diagnóstica, clínica e terapêutica do zumbido na última década.

ZnO-mesoporous glass scaffolds loaded with osteostatin and mesenchymal cells improve bone healing in a rabbit bone defect.

The use of 3D scaffolds based on mesoporous bioactive glasses (MBG) enhanced with therapeutic ions, biomolecules and cells is emerging as a strategy to improve bone healing. In this paper, the osteogenic capability of ZnO-enriched MBG scaffolds loaded or not with osteostatin (OST) and human mesenchymal stem cells (MSC) was evaluated after implantation in New Zealand rabbits. Cylindrical meso-macroporous scaffolds with composition (mol %) 82.2SiO2-10.3CaO-3.3P2O5-4.2ZnO (4ZN) were obtained by rapid prototyping and then, coated with gelatin for easy handling and potentiating the release of inorganic ions and OST. Bone defects (7.5 mm diameter, 12 mm depth) were drilled in the distal femoral epiphysis and filled with 4ZN, 4ZN + MSC, 4ZN + OST or 4ZN + MSC + OST materials to evaluate and compare their osteogenic features. Rabbits were sacrificed at 3 months extracting the distal third of bone specimens for necropsy, histological, and microtomography (µCT) evaluations. Systems investigated exhibited bone regeneration capability. Thus, trabecular bone volume density (BV/TV) values obtained from µCT showed that the good bone healing capability of 4ZN was significantly improved by the scaffolds coated with OST and MSC. Our findings in vivo suggest the interest of these MBG complete systems to improve bone repair in the clinical practice.

[Psychoprophylaxis in elective paediatric general surgery: does audiovisual tools improve the perioperative anxiety in children and their families?] / Psicoprofilaxis quirurgica audiovisual en cirugía general pediátrica: ¿podemos disminuir la ansiedad del niño y de su familia?

AIM OF THE STUDY: Surgery is considered a stressful experience for children and their families who undergo elective procedures. Different tools have been developed to improve perioperative anxiety. Our objective is to demonstrate if the audiovisual psychoprophylaxis reduces anxiety linked to paediatric surgery. METHODS: A randomized prospective case-control study was carried out in children aged 4-15 who underwent surgery in a Paediatric Surgery Department. We excluded patients with surgical backgrounds, sever illness or non-elective procedures. Simple randomization was performed and cases watched a video before being admitted, under medical supervision. Trait and state anxiety levels were measured using the STAI-Y2, STAI-Y2, STAI-C tests and VAS in children under 6-years-old, at admission and discharge. RESULTS: 100 patients (50 cases/50 controls) were included, mean age at diagnosis was 7.98 and 7.32 respectively. Orchiopexy was the most frequent surgery performed in both groups. Anxiety state levels from parents were lower in the Cases Group (36.06 vs 39.93 p= 0.09 in fathers, 38.78 vs 40.34 p= 0.43 in mothers). At discharge, anxiety levels in children aged > 6 were statistically significant among cases (26.84 vs 32.96, p< 0.05). CONCLUSIONS: The use of audiovisual psychoprophylaxis tools shows a clinically relevant improvement in perioperative anxiety, both in children and their parents. Our results are similar to those reported by other authors supporting these tools as beneficial strategy for the family.

OBJETIVOS: La cirugía supone una experiencia traumática tanto para el niño como para su familia. Recientemente se han diseñado estrategias audiovisuales en nuestro Servicio para tratar de disminuir la ansiedad vinculada a la intervención quirúrgica. Nuestro objetivo es analizar si la psicoprofilaxis audiovisual reduce los niveles de ansiedad derivados del evento quirúrgico. MATERIAL Y METODOS: Estudio prospectivo aleatorizado en niños intervenidos en el Servicio de Cirugía Pediátrica (4-15 años). Se excluyeron pacientes con antecedentes quirúrgicos, patología grave o procedimientos de Urgencia. La aleatorización en casos-controles fue realizada mediante sistema par-impar. Los casos visualizaron el vídeo antes del ingreso bajo supervisión médica. Se realizó la evaluación de los niveles de ansiedad estado y ansiedad rasgo mediante test autocompletables (STAI-Y1,STAI-Y2,STAI-C, test EVA en < 6 años) al ingreso y al alta en ambos grupos. RESULTADOS: 100 pacientes fueron incluidos (50 casos/50 controles) edad media de 7,98 y 7,32 años, respectivamente. La intervención practicada con mayor frecuencia fue la orquidopexia en ambos grupos. Se observaron niveles de ansiedad estado menores en los progenitores de los casos frente a los controles (36,06 vs 39.93 en padres p= 0,09, 38,78 vs 40,34 en madres p= 0,43). Al alta, los niveles de ansiedad fueron menores en niños > 6 años (26,84 vs 32,96), siendo esta diferencia estadísticamente significativa (p< 0,05). CONCLUSIONES: El uso de la psicoprofilaxis prequirúrgica mediante herramientas audiovisuales disminuye la ansiedad de forma clínicamente relevante tanto en los niños como en sus familias de manera sencilla y fácilmente reproducible. Nuestros resultados coinciden con los reportados en la literatura y consideramos esta herramienta beneficiosa para el núcleo familiar.

Management of sternoclavicular dislocation in young children: considerations about diagnosis and treatment of four cases.

The records of 4 children of under 14 years of age treated at our institution for traumatic sternoclavicular dislocation (SCJ) were reviewed. Closed reduction in posterior SCJ after computed tomography (CT) was successful as immediate procedure. For anterior SCJ instability, open reduction and SCJ reconstruction obtained satisfactory results. Conservative treatment of SCJ subluxation for asymptomatic children was sufficient. Radiographs in "serendipity view" were useful for confirming reduction and stability in children. No postoperative CT was needed for this purpose. Closed reduction in posterior SCJ dislocation and surgical treatment in anterior SCJ dislocation in young children can provide stability and a satisfactory return to a normal function, but with some limitation when intense or competitive shoulder motion is required during sport. Young children and parents should be aware about this possibility. Conservative treatment of SCJ subluxation for asymptomatic children is useful. Reflection is required regarding the correct imaging examination after treatment to check stable reduction in a SCJ injury.

Gestión integral de residuos sólidos peligrosos y cumplimiento de normas de bioseguridad en laboratorios de tanatopraxia, Medellín, 2001 / Integral management of solid dangerous residues and fulfillment of the bio-safety standards in laboratories of mortuary practice, Medellín, 2001

Las funerarias son generadoras de residuos peligrosos similares a los hospitalarios, denominados tanatopráxicos en este trabajo. En el presente estudio se analizó la gestión integral de los residuos sólidos peligrosos infecciosos y químicos, el cumplimiento de las normas de bioseguridad, la cobertura de vacunación y el nivel de inmunización para hepatitis B en el personal expuesto en laboratorios de tanatopraxia de nueve funerarias de Medellín, durante el segundo semestre de 2001, con lo cual se evidenció que dichos factores son un riesgo potencial para la salud de estos trabajadores. Durante el período de estudio se atendieron en promedio 34,68 fallecidos/día, lo que producía un total de 30.820 g/día y 888,7 g/fallecido de residuos sólidos peligrosos, cuyo adecuado manejo era desconocido en casi la totalidad de las funerarias. El estudio en 46 tanatólogos evidenció que el 98 por ciento conocían los factores de riesgo ocupacionales a los que se exponen; sin embargo, el 60 por ciento de ellos no se protegían adecuadamente. Los esquemas de vacunación en la mayoría de las funerarias se encontraban incompletos y ninguna había realizado pruebas de seroconversión al personal expuesto; al realizar la prueba, se encontró que el 43,4 por ciento no tenían un nivel adecuado de seroconversión para su oficio.

Boric acid susceptibility testing of non-C. albicans Candida and Saccharomyces cerevisiae: comparison of three methods.

To establish the best method for boric acid susceptibility testing, we compared two agar dilution methods (high and low inoculum) and a standard broth microdilution method (from the National Commitee for Clinical Laboratory Standards document NCCLS M-27A). Saccharomyces cerevisiae (37) and non-C. albicans Candida (39) isolates, as well as one isolate of Trichosporon sp., were included. All were isolated from female workers with vulvovaginitis. Good agreement within a fourfold dilution range was found between the three methods, and only the broth microdilution method versus the agar dilution method with high inoculum showed significant discrepancies. Reading results was easier with the broth microdilution method than with the agar dilution methods because of partial growth inhibition in the latter. In conclusion, broth microdilution is a suitable method for testing yeast susceptibility to boric acid.

Tinea cruris in female prostitutes.

Tinea cruris is a dermatophytosis that mainly affects males. Infections in females are rare, and there are no known data on the frequency of tinea cruris in female prostitutes. We describe seven female prostitutes with tinea cruris with on age range of between 19-34 years (mean 25.3). Each prostitute had a mean of 50 sexual partners per month. Four Trichophyton mentagrophytes (57.1%), 2 T rubrum (28.6%), and 1 Epidermophyton floccosum (14.3%) isolates were cultered. Tinea cruris transmission is mainly indirect, but direct contact may serve to transmit the disease in some cases, and the spread of active lesions in prostitutes through multiple contacts among with their clients is possible.

Prevalence of anti-human papillomavirus type 16, 18, 31, and 58 virus-like particles in women in the general population and in prostitutes.

Genital human papillomavirus (HPV) infection is sexually transmitted. The aim of the study was to characterize serological responses to HPV types 16, 18, 31, and 58 by exploring type-specific virus-like particles (VLPs) in two groups of women with very distinct sexual behaviors. Anti-VLP antibodies for types 16, 18, 31, and 58 and HPV DNA in cervical cells were investigated with 177 prostitutes and 283 age-matched controls from the female general population in Spain. Anti-VLP positivity increased with number of lifetime sexual partners in women from the general population, and no seroresponse was found in virgins. However, in prostitutes HPV infection was characterized by higher multireactivity to three or four VLPs (25%) than the general population (3%) and by a more frequent antibody response to HPV-58 than in the general population. About 75% of the women seropositive for type 58 had been born in a Latin American country. Seroprevalence of HPV and cervical HPV DNA in prostitutes were 14 and 10 times higher than observed in women in the general population (prevalence odds ratio [POR] of HPV seropositivity, 14.04 [95%; CI = 8.4 to 23.6] and POR for HPV DNA, 10.4 [95% CI = 3.9 to 27.6). Our results indicate that prostitutes are at an increased risk of oncogenic HPV infections, and they confirm the validity of anti-VLPs as markers of present or past HPV infection, that the number of sexual partners is the major determinant in acquisition of oncogenic HPV, and that anti-VLPs could be used as a marker of repeated infection in prostitutes.

Susceptibility of Candida species isolated from female prostitutes with vulvovaginitis to antifungal agents and boric acid.

The aim of this study was to determine the antifungal susceptibility of 108 Candida albicans and 23 Candida glabrata isolates obtained from female prostitutes with vulvovaginitis, a population for which available data is limited. Amphotericin B, flucytosine, and fluconazole were tested by broth microdilution, and boric acid was tested by the agar dilution method. The susceptibility patterns found in this population were the same as those in the general population. Candida glabrata required greater concentrations of boric acid for inhibition in vitro than did Candida albicans.

Vulvovaginal candidiasis in female sex workers.

Vulvovaginal candidiasis is a frequent inflammatory process in women but it has not been widely studied in female sex workers (FSWs). To estimate the frequency of Candida species infection in FSWs and to identify related risk factors and clinical findings, we carried out a retrospective study of 1923 FSWs over 11 years. We also performed a prospective study of 163 consecutive FSWs with a history of candidiasis during a 4-year period. Candida species were isolated in 1967 samples (18.5% of the total). Candida albicans (89.3%) was the most frequent species, followed by Candida glabrata (2.7%), Candida parapsilosis (1.2%) and Saccharomyces cerevisiae (0.4%). In the prospective study of 163 patients, we found vaginal discharge in 76.1% of cases, soreness in 52.1% and vulval pruritus in 32.5%. We identified 12 patients (7.4%) with recurrent vulvovaginal candidiasis. No statistical difference was found between recurrent vulvovaginitis and the use of oral contraceptives, oral sex, tight-fitting clothing and synthetic underwear. FSWs have the same prevalence of candidiasis as other groups of women described in published literature. The proportion of albicans and non-albicans species does not differ between women with recurrent and non-recurrent vulvovaginal candidiasis (VVC).

Angioplastia percutánea transluminal. Experiencia en el Hospital Español / Transluminal percutaneous angioplasty. Experience of the ®Hospital Español¼

El propósito del presente trabajo, es el de revisar la experiencia obtenida en un Servicio de Cirugía Vascular en un grupo de enfermos con lesiones vasculares oclusivas, que fueron tratadas con técnicas de dilatación vascular, describir los protocolos empleados para ello, y analizar los resultados. De 1988 a 1996 se trataron con angioplastia 20 lesiones en 19 enfermos. Se les dividió en dos Grupos. Grupo A, 15 con lesiones de miembros inferiores. Y Grupo b, cinco con fístulas A/V para Hemodiálisis disfuncionales, colocadas en los miembros torácicos. Tres enfermos fueron del sexo femenino y seis masculino. Las indicaciones para efectuar la angioplastia. Para el grupo A: Claudicación intermitente en cuatro e isquemia crítica en 10. En el Grupo B había disyunción de fístula A/V en todos los casos. Los territorios anatómicos involucrados fueron Aorto-iliaco en ocho, femoro-poplíteo-tibial en seis y miembros torácicos. En cinco de los enfermos del grupo A hubo éxito inicial en el 87 por ciento de los casos y salvamento de extremidad en el 83 por ciento de los casos, en un caso se efectuó redilatación de la arteria iliaca y colocación de endoprótesis seis meses después de efectuada la angioplastia inicial. En el grupo B había disyunción de fístula en tres casos durante un tiempo promedio de 3.5 años. Conclusión. Los procedimientos vasculares pueden realizarse con éxito en enfermos con lesioens vasculares cortas localizadas preferentemente en el territorio aorto-iliaco. En la actualidad, se recomienda a los grupos que practican cirugía vascular capacitarse en los procedimientos endovasculares y realizarlos de manera independiente o con otros especialistas

[Scrotal granuloma caused by oil migrating from the hip in 2 transsexual males (scrotal sclerosing lipogranuloma)]. / Granuloma escrotal por aceite migrado desde la cadera en dos varones transexuales (lipogranuloma esclerosante escrotal)

OBJECTIVE: To describe two patients with scrotal granuloma due to silicone oil migrated from the hip. METHODS/RESULTS: Two male transsexuals without genitoplasty developed scrotal inflammatory masses after subcutaneous injection of silicone oil to remodel the hip contour. Imaging studies and pathologic examination disclosed lesions similar to those encountered in ruptured silicone breast implants. CONCLUSIONS: Silicone migration to the scrotum through subdermal fascial planes can cause a granulomatous lesion similar to that of ruptured breast implants. The migratory pathway is similar to that of scrotal emphysema and, inversely, the dissemination of necrotizing fasciitis of the genitalia.

[Isolation of Haemophilus influenzae and Haemophilus parainfluenzae in genitourinary infections: a 4-year review]. / Aislamiento de Haemophilus influenzae y Haemophilus parainfluenzae en infecciones genitourinarias: una revisión de 4 años.

BACKGROUND: Haemophilus spp. had been previously suggested as a potential pathogen in genitourinary infections that could be sexually transmitted. In order to check that suggestions we have determined the incidence, pathogenic role, possible sexual transmission and susceptibility to antibiotics in isolates of Haemophilus parainfluenzae and Haemophilus influenzae from genital tract infections. The microbiological samples were taken during a period of four years from patients attended in a Service of Sexual Transmission Diseases and the data were further reviewed. METHODS: The study included 5,572 genital specimens from 2,182 women prostitutes with different genitourinary infections and from 825 men with urethritis. Microbiological samples were cultured in a non-specific media for genital pathogens and species of Haemophilus spp. and clinical circumstances of isolation were evaluated. Susceptibility tests were performed by using a standard microdilution test. RESULTS: Haemophilus spp. was isolated in 155 samples (2.8%) using a non-selective culture method. H. parainfluenzae was isolated in 100 cases (64.5%), Haemophilus influenzae in 45 cases (29%) and Haemophilus spp. in 10 strains (6.4%). Haemophilus spp. was isolated as a sole pathogen in men with urethritis (8 cases), epididymo-orchitis (2 cases), cervicitis and/or vaginitis (9 cases) and Bartholin's Abscess (2 cases). The most frequent biotypes were H. parainfluenzae biotype II (43%) and III (19%), and H. influenzae biotype IV (35.5%). Beta lactamase activity and ampicillin resistance were present in 29% of the H. parainfluenzae strains and in the 26.7% of clinical isolates of H. influenzae. CONCLUSIONS: 1) Haemophilus spp. was isolated from genitourinary infections at a low frequency in the studied group. 2) The pathogenic role of Haemophilus spp. was suggested when was isolated as a sole pathogen present from some infections of the genitourinary tract such as urethritis in men and Bartholin's abscess in women. 3) The susceptibility to antibiotics in the clinical isolates of Haemophilus spp. from genitourinary infections was similar previously reported studies performed in Spain.

[Comparison of 3 culture methods for genital mycoplasmas]. / Comparación de tres métodos de cultivo para micoplasmas genitales.

BACKGROUND: To compare and evaluate two commercial methods for Mycoplasma hominis and Ureaplasma urealyticum with the isolation in agar A7 medium. METHOD: One hundred and twenty three vaginal and cervical swabs in women prostitutes, and urethral swabs in men, were studied for Mycoplasma hominis and Ureaplasma urealyticum isolation in agar A7 medium (BioMérieux; France), Mycoplasma IST (BioMérieux, France) and MycoFast ALL-IN (Unipath, U.K.). RESULTS: Of all 123 samples studied, it was isolated 24 Mycoplasma hominis (19.5%) and 56 Ureaplasma urealyticum (45.5%) in agar A7. The sensitivity was 100% for Mycoplasma hominis and Ureaplasma urealyticum in Mycoplasma IST versus 29.2% and 50% in MycoFast ALL-IN, both respectively. Specificity was lower for Ureaplasma urealyticum (59.7%) in Mycoplasma IST than in MycoFast ALL-IN (100%). It was found a tetracycline resistance of 15% and 12.5% for Ureaplasma urealyticum and Mycoplasma hominis, both respectively. CONCLUSIONS: The use of commercial methods permits to count the genital mycoplasmas, being Mycoplasma IST better than MycoFast ALL-IN for Mycoplasma hominis isolation. Both methods have limitations for Ureaplasma urealyticum and they require the use of agar A7. Mycoplasma IST could be a good method to survey tetracycline resistance.

Comparison of seven phenotyping methods for Candida albicans.

Seven different phenotyping methods for strain differentiation of Candida albicans (auxonotyping, enzymotyping, resistotyping, Phongpaichit's morphotyping, Hunter's morphotyping and Odds and Abbott's biotyping method-1980 and 1983 versions) were compared on a single population of 94 strains. 77.6% of the strains belonged to auxonotyping 1, 59.6% to enzymotyping A, 34% to resistotyping B and 30.8% to BC, 40.4% to Phongpaichit's morphotyping 000,000 and 40.4% to Hunter's morphotyping 'No fringe/Smooth surface'. Using biotyping systems (1980 and 1983 versions), the most frequent biotypes were 145 (29.8%) and 147 (31.9%) respectively. The Discriminatory Index of Hunter and Gaston was employed to carry out comparisons among the different systems. The best discriminatory results, although far from ideal, were found using Phongpaichit's morphotyping (DI = 0.827) and Odds and Abbott's method (DI = 0.815 and 0.831--1980 and 1983 versions). A good discriminatory result was also found using Hunter's morphotyping method together with the biotyping of Odds and Abbott (1983 version). These approximated the ideal (DI = 0.950) and showed minimal difficulty in interpretation. The proposed combined method revealed high discrimination among the vulvovaginal strains, and suggested the absence of transmissible pathogenic strains.

Prostitution, HIV, and cervical neoplasia: a survey in Spain and Colombia.

The prevalence of cervical intraepithelial neoplasia (CIN) and the association of CIN with prostitution was examined in Oviedo, a region in Spain with low incidence of cervical cancer, and in Cali, Colombia, where the incidence of cervical cancer is 6-10 times higher. In Oviedo, the study included 758 prostitutes attending a sexually transmitted diseases clinic and 1203 nonprostitutes attending a family-planning clinic. In Cali, 775 prostitutes and 1795 nonprostitutes attending health centers were included. Seropositivity to common sexually transmitted agents was investigated in Spanish prostitutes. No significant difference was found in the prevalence of CIN between Oviedo and Cali in both prostitutes (2.5 versus 1.8%) and nonprostitutes (1.2 versus 1.1%). Prostitutes had a 2-fold increased risk of CIN as compared to nonprostitutes; in Spain, the prevalence odds ratio (POR) was 2.3 and the 95% confidence interval (CI) was 1.1-4.5, and, in Colombia, POR was 1.8 and the 95% CI was 0.9-3.5. Among prostitutes in Oviedo, human immunodeficiency virus (HIV) prevalence was 4.9% and HIV-positive prostitutes showed a high risk of CIN as compared to HIV-negative prostitutes (POR, 12.7; 95% CI, 3.9-40.9); 76% of HIV-positive prostitutes were i.v. drug users and showed an increased seroprevalence of other sexually transmitted diseases. HIV-negative prostitutes did not show any increased risk of CIN (POR, 1.2; 95% CI, 0.5-2.8). These results show that among nonprostitutes the prevalence of CIN was not statistically different between the two cities in Spain and Colombia; prostitutes were at moderate increased risk compared to nonprostitutes in both cities.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic accuracy of the cytologic diagnosis of anal human papillomavirus infection compared with DNA hybridization studies.

During the years 1990 to 1991, smears taken from the anal canal of 45 randomly selected homosexual males were studied. Several cytological criteria were used to study infection by human papillomavirus (HPV). The cytological study and an anoscopy was performed and a swab was taken for HPV-DNA hybridization, using labelled RNA probes for HPV-DNA: 6,11,16,18,31,33, and 35. In our study we observed the existence of a high proportion (9.5%) of inadequate smears that did not contain glandular cells and/or metaplasia. A sensitivity of 78% and a specificity of 72% was obtained. Sensitivity and specificity were 68% and 91%, respectively, when these criteria were restricted to the presence of koilocytes and/or dyskeratocytes. The high rate of occult infections obtained in our study lead us to suggest the simultaneous use of cytology, molecular hybridization, and anoscopy for suitable care of those patients with a high risk of contracting HPV infections of the anal canal.