Climate teleconnections modulate global burned area.

Climate teleconnections (CT) remotely influence weather conditions in many regions on Earth, entailing changes in primary drivers of fire activity such as vegetation biomass accumulation and moisture. We reveal significant relationships between the main global CTs and burned area that vary across and within continents and biomes according to both synchronous and lagged signals, and marked regional patterns. Overall, CTs modulate 52.9% of global burned area, the Tropical North Atlantic mode being the most relevant CT. Here, we summarized the CT-fire relationships into a set of six global CT domains that are discussed by continent, considering the underlying mechanisms relating weather patterns and vegetation types with burned area across the different world's biomes. Our findings highlight the regional CT-fire relationships worldwide, aiming to further support fire management and policy-making.

Surgeon-performed ultrasound changes surgical management in patients with thyroid cancer.

BACKGROUND: A comprehensive neck ultrasound (US) is essential in the operative planning of patients with thyroid disease. Recent literature has shown surgeon-performed US (SUS) can be more accurate than radiology-performed US for the purpose of surgical planning. Missed findings on radiology-performed ultrasound may lead to inadequate surgical management. METHODS: A retrospective cohort study of patients undergoing total thyroidectomy with lateral neck dissection for thyroid cancer, with both radiology-performed US and SUS performed by a Head and Neck surgeon. Ultrasound findings and adherence to American Thyroid Association (ATA) guidelines were compared, and changes in management based on SUS findings were identified. RESULTS: A total of 26 patients who underwent total thyroidectomy with lateral neck dissection met the inclusion criteria. Preconsultation US investigations fulfilled criteria as recommended by the American Thyroid Association (ATA) guidelines in 57.7%% of cases. The central and lateral neck compartments were assessed in 57.7% and 84.6% of preconsultation US investigations respectively. Central and lateral metastatic neck metastases were incorrectly reported or not reported in 78.6% and 42.3% of cases. The SUS findings prompted a change in surgical management in 65.4% of cases. CONCLUSION: SUS changed surgical management in two thirds (65.4%) of patients. Reliance on radiology-performed ultrasound alone may result in incorrect staging. Awareness of the additional benefits of SUS is important for surgeons treating patients with thyroid disease to prevent inadequate surgery being performed.

The negative predictive value of FDG PET/CT staging in early oropharyngeal squamous cell carcinoma and implications to transoral robotic surgery patient selection.

OBJECTIVES: Our objective was to determine the negative predictive value (NPV) of preoperative FDG PET/CTfor detecting locoregional nodal disease. The aim was to help inform the decision-making process when identifying patients with early-stage OPSCC that would be suitable for transoral robotic surgery (TORS) as a single-modality treatment. MATERIALS AND METHODS: A retrospective cohort study was conducted of adults with primary stage cT1-2 OPSCC with up to one metastatic neck lymph node (cN0-1) planned for TORS. Patients with a preoperative PET/CT and who had undergone staging neck dissection (ND) were included. Clinical and pathological nodal staging was established based on PET/CT and ND, respectively. The primary outcome was the frequency of occult (not seen on PET/CT) nodal disease on ND. RESULTS: Eighty-eight patients were included (N = 88). The rate of occult nodal disease was 28.4 % (n = 25). The NPV of PET/CT in the clinically negative neck was 79 % and 66 % in cases with a single clinical node. Following staging ND, thetreatment plan changed in 27 % of cases overall, 7 % in cN0 and 36.7 % in cN1. Among these, 18 % met criteria for radiotherapy and 9 % for CRT. This represented a decrease in the number of ideal candidates for TORS as single-modality treatment from 88 to 64 (73 %). CONCLUSIONS: PET/CT is a useful tool in the workup of patients for primary TORS. However, about one third of patients with early-stage OPSCC might benefit from adjuvant therapy not predicted by preoperative PET/CT. A staging ND helps confirm candidates for single-modality treatment with TORS.

Prevalence of middle ear disease in Chilean natives and the impact of development over 14 years.

INTRODUCTION: The prevalence of middle ear disease and its risk factors have been the subject of multiple studies. High prevalence of middle ear disease has been described among North American natives, especially chronic otitis media. Such studies have not been carried out in South America. OBJECTIVE: To describe the prevalence of middle ear pathology and risk factors in native schoolchildren from southern Chile who belong to the Mapuche ethnic group, as well as the impact of socio-economic and demographic changes after 14 years of development. MATERIAL AND METHODS: Two otologic evaluations with an interval of 14 years were performed in schoolchildren with a percentage of indigenous population above 85%. Socioeconomic and demographic data were collected from national official statistical data. RESULTS: A total of 1067 schoolchildren were examined. Many described risk factors for ear pathology were found. An overall prevalence of 0.19% for tympanic membrane perforation, 5.6% for pars tensa retraction pockets, 1.5% for pars flaccida retraction pockets and 11.1% of otitis media with effusion was found. There were several socioeconomic improvements after 14 years. The difference between the prevalence of symptoms and the presence of otitis media with effusion was statistically significant (p<0.001). CONCLUSIONS: Despite the presence of several risk factors for middle ear disease, this study population showed a low prevalence of middle ear disease. The ethnic-racial factor seems to be a protective factor.

Supraglottoplasty for laryngomalacia: The experience from Concepcion, Chile.

OBJECTIVE: To review the clinical manifestations and outcomes of supraglottoplasty in patients with moderate to severe laryngomalacia at Guillermo Grant Benavente Hospital between January 2015 and January 2017. METHODS: Retrospective study of patients with laryngomalacia who underwent CO2 laser supraglottoplasty at a tertiary referral center. A review of medical records of these patients was performed. Epidemiological data along with symptoms, comorbidities, morphological type of laryngomalacia, synchronous airway lesions, surgery outcomes and satisfaction of parents after the procedure were recorded. Surgical success was defined as the resolution of the criteria of severity of laryngomalacia. RESULTS: Twenty-four patients were operated, 1 was excluded due to prior tracheostomy. Twenty-three patients were included, the median age at the time of surgery was 5.5 months. All the patients had stridor, 87% presented feeding difficulties, 34.8 % had cyanosis and 21.7% had failure to thrive. Six cases had congenital anomalies and four cases had nongenetic comorbidities. Fifteen patients (65.2%) had synchronous airway lesions. 17.4% had type I laryngomalacia and 82.6% were type 2. The postoperative average hospital stay was 1.3 days. The average follow-up was 14 months and no complications were reported. The overall success rate of surgery was 95%. CONCLUSIONS: Patients with laryngomalacia and any symptom of severity should undergo a full airway evaluation, to rule out synchronous airway lesions, and supraglottoplasty if needed, as it has been shown to be a safe and effective technique for the management of these patients.

Endoscopic management of bilateral vocal fold paralysis in newborns and infants.

INTRODUCTION: Bilateral vocal cord paralysis in adducted position (BVCPAd) is a severe cause of airway obstruction and usually debuts with stridor and airway distress necessitating immediate intervention. Tracheostomy has long been the gold standard for treating this condition, but has significant associated morbidity and mortality in pediatric patients. New conservative procedures have emerged to treat this condition thus avoiding tracheostomy, like endoscopic anterior and posterior cricoid split (EAPCS). The objective of this paper was to review our experience with EAPCS in newborns and infants. METHODS: Prospective study involving patients undergoing endoscopic EAPCS for symptomatic BVCPAd. The primary outcomes were tracheostomy avoidance and resolution of airway symptoms. RESULTS: Three patients underwent EAPCS between January 2016 and December 2016. All patients stayed at least 7 days in the Intensive Care Unit (ICU) intubated. All patients presented complete resolution of their symptoms due to airway obstruction, without the need for tracheostomy. CONCLUSION: EAPCS is a novel and effective alternative to treat BVCPAd in patients under 1 year old. Our study is an initial experience; more cases are required to identify the real impact and benefits of this technique and to determine the proper selection of patients.

Prevalence of middle ear disease in Chilean natives and the impact of development over 14 years / Prevalência de doenças da orelha média em nativos chilenos e o impacto do desenvolvimento ao longo de 14 anos

Abstract Introduction The prevalence of middle ear disease and its risk factors have been the subject of multiple studies. High prevalence of middle ear disease has been described among North American natives, especially chronic otitis media. Such studies have not been carried out in South America. Objective To describe the prevalence of middle ear pathology and risk factors in native schoolchildren from southern Chile who belong to the Mapuche ethnic group, as well as the impact of socio-economic and demographic changes after 14 years of development. Material and methods Two otologic evaluations with an interval of 14 years were performed in schoolchildren with a percentage of indigenous population above 85%. Socioeconomic and demographic data were collected from national official statistical data. Results A total of 1067 schoolchildren were examined. Many described risk factors for ear pathology were found. An overall prevalence of 0.19% for tympanic membrane perforation, 5.6% for pars tensa retraction pockets, 1.5% for pars flaccida retraction pockets and 11.1% of otitis media with effusion was found. There were several socioeconomic improvements after 14 years. The difference between the prevalence of symptoms and the presence of otitis media with effusion was statistically significant (p < 0.001). Conclusions Despite the presence of several risk factors for middle ear disease, this study population showed a low prevalence of middle ear disease. The ethnic-racial factor seems to be a protective factor.

Resumo Introdução A prevalência de doenças da orelha média e seus fatores de risco já foram objeto de múltiplos estudos. A alta prevalência dessas doenças foi descrita entre os nativos da América do Norte, principalmente a otite média crônica. Tais estudos não foram feitos na América do Sul. Objetivo Descrever a prevalência de doenças da orelha média e fatores de risco em crianças de idade escolar, nativos do sul do Chile pertencentes à etnia Mapuche, bem como o impacto de mudanças socioeconômicas e demográficas após 14 anos de desenvolvimento. Método Foram feitas duas avaliações otológicas com intervalo de 14 anos em escolares com percentual da população indígena acima de 85%. Dados socioeconômicos e demográficos foram coletados a partir de dados estatísticos oficiais nacionais. Resultados Foram examinados 1.067 escolares. Foram encontrados diversos fatores de risco descritos para doença otológica. Foi encontrada uma prevalência geral de 0,19% para perfuração da membrana timpânica, 5,6% para retrações da pars tensa, 1,5% para retração da pars flácida e 11,1% de otite média com efusão. Houve várias melhorias socioeconômicas após 14 anos. A diferença entre a prevalência de sintomas e a presença de otite média com efusão foi estatisticamente significante (p < 0,001). Conclusões Apesar da presença de vários fatores de risco para doença da orelha média, a população estudada apresentou baixa prevalência da doença. O fator étnico parece ser protetor.

Ameloblastoma maxilar: a propósito de un caso / Maxillary ameloblastoma. Aclinical case

El Ameloblastoma es un tumor odontogenico benigno, poco frecuente, pero con alta tasa de recurrencia debido a su carácter localmente invasivo. Se produce en la región mandibular en la mayoría de los casos, siendo solo en un 20% de localización maxilar. Se presenta el caso clínico de un paciente, hombre, de 60 años con un Ameloblastoma Uniquístico de localización maxilar en región posterior, tratado con una maxilectomía parcial con incisión de Weber Ferguson y reconstrucción de maxilar con malla de titanio y obturador removible. A partir de este se presenta una breve revisión de la literatura con respecto al Ameloblastoma.

Ameloblastoma is an infrequent benign odontogenic tumor with a high recurrence rate due to its locally invasive nature. Most originate in the upper jaw with only 20% found in the lower jaw. We present the clinical case of a sixty year old male with monocystic ameloblastoma located in the posterior maxillary region. We performed a partial maxillectomy using a Weber Ferguson incision and carried out reconstruction using a titanium mesh and removable plug. We present a brief review of the literature concerning ameloblastoma.

Cryptococcus neoformans en heces de palomas (Columba livia) en Lima Metropolitana / Cryptococcus neoformans in the stools of dove (Columba livia) in metropolitan Lima

Objetivos: Investigar la presencia del hongo levaduriforme Cryptococcus neoformans en heces de palomas domésticas (Columba livia). Material y métodos: Estudio descriptivo transversal realizado en la ciudad de Lima- Perú. Se recolectaron 300 muestras de heces encontradas en los suelos de parques y hospitales. Además se tomó 30 muestras de las cloacas de algunas palomas capturadas. Resultados: Se aisló el hongo en 47 muestras de las que 7 correspondieron al Cryptococcus neoformans var. neoformans pero no se aisló el hongo en cloaca. Las 7 cepas aisladas tuvieron 100% de sensibilidad frente a Anfotericin B, Nistatina y Clotrimazol; además presentaron 100% de resistencia a Fluconazol e Itraconazol y 57% de resistencia a Ketoconazol. Conclusiones: Cryptococcus neoformans se encuentra presente en heces de palomas en Lima Metropolitana. (AU)

Objectives: To evaluate the presence of Cryptococcus neoformans in the stools of domestic dove (Columba livia). Methods: Cross-sectional study carried-out in the city of Lima-Peru. 300 stool samples found in the soil of parks and hospital were collected. In addition, 30 sewage samples were also processed. Results: the fungus was isolated in 47 samples, Cryptococcus neoformans var neoformans was isolated in 7 of these samples, none was isolated from sewage samples. The seven strains showed 100% susceptibility to amphotericin B, nystatin and clotrimazol, but showed 100% resistance to fluconazole and itraconazole and 57% resistance to ketoconazole. Conclusions: Cryptococcus neoformansis found in the stools of domestic dove in metropolitan Lima. (AU)

Identificación de especies de Malassezia aisladas de piel sana en pobladores de Lima, Perú / Identification of Malassezia species isolated from healthy skin in residents of Lima, Peru

Objetivo: Identificar las especies de Malassezia en zonas seborreicas de piel sana en población limeña. Diseño: Estudio descriptivo transversal. Lugar: Instituto de Medicina Tropical æDaniel Alcides CarriónÆ, Universidad Nacional Mayor de San Marcos, Lima, Perú. Participantes: Pobladores asintomáticos. Intervenciones: Empleando la técnica de Mariat y Adan-Campos, se recolectó muestras de piel de 129 pobladores asintomáticos de diversos distritos de la ciudad de Lima. El aislamiento de Malassezia se realizó en medio Dixon modificado e incubado a 32 grados centígrados por 7 días, la identificación de las colonias por sus características macro y micromorfológicas, y la tipificación mediante el estudio de las propiedades bioquímicas y fisiológicas según la técnica de Guillot y col. Principales medidas de resultados: Especie de Malassezia, sexo, edad y región anatómica. Resultados: Se aisló Malassezia spp en 43,4 por ciento de los pobladores, obteniéndose 49,2 por ciento en varones y 37,5 por ciento en mujeres. De las diferentes regiones corporales, 68 cultivos fueron positivos: cuero cabelludo 31 (45,6 por ciento), espalda 36 (52,9 por ciento) y región frontal 1 (1,5 por ciento). El grupo etario con mayor frecuencia de aislamientos (47,2 por ciento) fue el de 14 a 25 años (adolescentes jóvenes). M. slooffiae fue encontrado en 83,8 por ciento y M. obtusa en 16,2 por ciento de los casos. Conclusiones: Se encontró Malassezia spp. en la piel humana sana. M. slooffiae fue la especie predominante de los casos positivos (83,8 por ciento) seguido de M. obtusa (16,2 por ciento)...

Objective: To identify Malassezia species in healthy skin seborrhea areas in Lima inhabitants. Design: Cross-sectional study. Setting: Daniel Alcides Carrion Tropical Medicine Institute, Universidad Nacional Mayor de San Marcos, Lima, Peru. Participants: Asymptomatic persons. Interventions: Skin samples were collected from 129 asymptomatic residents of several districts of Lima city using Mariat and Adan-CamposÆ technique. Malassezia isolation was performed in modified Dixon medium and incubated at 32 grades centigrades for 7 days. Colonies were identified by macro and micro morphological characteristics and typing was determined by biochemical and physiological properties using GuillotÆs technique. Main outcome measures: Malassezia species, participantsÆ gender, age and anatomical region. Results: Malassezia spp was isolated in 43.4 per cent of the residents, 49.2 per cent in men and 37.5 per cent in women. From various body regions 68 cultures were positive: scalp 31 (45.6 per cent), back 36 (52.9 per cent) and frontal region 1 (1.5 per cent). Isolates most common age group (47.2 per cent) was that of adolescents-young (14-25 year-old). M. slooffiae was found in 83.8 per cent and M. obtusa in 16.2 per cent of cases. Conclusions: Malassezia spp. was present in healthy human skin. M. slooffiae was the predominant species in positive cases (83.8 per cent) followed by M. obtusa (16.2 per cent)...