Long-term outcomes following the Ross procedure in neonates and infants: A multi-institutional analysis.

OBJECTIVES: For neonates and infants with aortic valve pathology, the Ross procedure historically has been associated with high rates of morbidity and mortality. Data regarding long-term durability are lacking. METHODS: The international, multi-institutional Ross Collaborative included 6 tertiary care centers. Infants who underwent a Ross operation between 1996 and 2016 (allowing a minimum 5 years of follow-up) were retrospectively identified. Serial echocardiograms were examined to study evolution in neoaortic size and function. RESULTS: Primary diagnoses for the 133 patients (n = 30 neonates) included isolated aortic stenosis (14%, n = 19), Shone complex (14%, n = 19), and aortic stenosis plus other (excluding Shone complex; n = 95, 71%), including arch obstruction (n = 55), left ventricular hypoplasia (n = 9), and mitral disease (moderate or greater stenosis or regurgitation, n = 31). At the time of the Ross procedure, median age was 96 days (interquartile range, 36-186), and median weight was 4.4 kg (3.6-6.5). In-hospital mortality occurred in 13 of 133 patients (10%) (4/30 [13%] neonates). Postdischarge mortality occurred in 10 of 120 patients (8%) at a median of 298 days post-Ross. Post-Ross neoaortic dilatation occurred, peaking at 4 to 5 SDs above normal at 2 to 3 years before returning to near-baseline z-score at a median follow-up of 11.5 [6.4-17.4] years. Autograft/left ventricular outflow tract reintervention was required in 5 of 120 patients (4%) at a median of 10.3 [4.1-12.8] years. Freedom from moderate or greater neoaortic regurgitation was 86% at 15 years. CONCLUSIONS: Neonates and infants experience excellent postdischarge survival and long-term freedom from autograft reintervention and aortic regurgitation after the Ross. Neoaortic dilatation normalizes in this population in the long-term. Increased consideration should be given to Ross in neonates and infants with aortic valve disease.

MUC1 Expressions and Its Prognostic Values in US Gastric Cancer Patients.

This study aims to evaluate the prognostic value of MUC expression in US GC patients. A total of 70 tumor specimens were collected from GC patients who underwent surgery or endoscopic resection between 2013 and 2019 at a tertiary referral center in the US. MUC expression status including MUC1, MUC2, MUC5AC, and MUC6 was evaluated by immunohistochemical staining. The positive rates of MUC1, MUC2, MUC5AC, and MUC6 were 71.4%, 78.6%, 74.3%, and 33.3%, respectively. Patients with positive MUC1 expression had a significantly higher rate of aggressive pathologic features including diffuse-type cancer (42.0% vs. 0%; p < 0.001), advanced GC (80.0% vs. 30.0%, p < 0.001), lymph node metastasis (62.0% vs. 20.0%; p = 0.001), and distant metastasis (32.0% vs. 5.0%; p = 0.017) compared with those with negative MUC1 expression. However, the differences in the pathologic features were not observed according to MUC2, MUC5AC, and MUC6 expression status. In early gastric cancer (EGC), patients with a high level of MUC1 expression showed a higher rate of lymphovascular invasion (71.4% vs. 21.4%; p = 0.026) and EGC meeting non-curative resection (85.7% vs. 42.9%; p = 0.061) than those with negative MUC1. In US GC patients, MUC1 expression is associated with aggressive pathological features, and might be a useful prognostic marker.

Retrospective analysis of the prognostic implications of tumor spread through air spaces in lung adenocarcinoma patients treated with surgery.

BACKGROUND: Tumor spread through air spaces (STAS) in lung adenocarcinoma is a novel mechanism of invasion. STAS has been proposed as an independent predictor of poor prognosis. The aim of this study was to evaluate the correlations between STAS status and other clinicopathologic variables and to assess the prognostic implications of STAS and the distance from the edge of the tumor to the farthest STAS in patients with resected lung adenocarcinoma. MATERIAL AND METHODS: This is a single-institution retrospective observational study. We included all patients with resected lung adenocarcinoma from January 2017 to December 2018 at La Paz University Hospital. The cut-off for the distance from the edge of the tumor to the farthest STAS was 1.5 mm and was assessed by the area under the receiver operating characteristic curve. RESULTS: A total of 73 patients were included. STAS was found in 52 patients (71.2%). Histological grade 3 (P = 0.035) and absence of lepidic pattern (P = 0.022) were independently associated with the presence of STAS. The median recurrence-free survival (RFS) was 48.06 months [95% confidence interval (CI) 33.58 months to not reached]. STAS-positive patients had shorter median RFS [39.23 months (95% CI 29.34-49.12 months)] than STAS-negative patients (not reached) (P = 0.04). STAS-positive patients with a distance from the edge of the tumor to the farthest STAS ≥1.5 mm had an even shorter median RFS [37.63 months (95% CI 28.14-47.11 months)]. For every 1 mm increase in distance, the risk of mortality increased by 1.26 times (P = 0.04). CONCLUSIONS: Histological grade 3 and absence of lepidic pattern were independently associated with the presence of STAS. STAS was associated with a higher risk of recurrence. The distance from the edge of the tumor to the farthest STAS also had an impact on overall survival.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil / Esgoto de hospital terciário como reservatório de bactérias expressando o fenótipo MDR no Brasil

High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil

Abstract High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Resumo Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil / Esgoto de hospital terciário como reservatório de bactérias expressando o fenótipo MDR no Brasil

High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.

Comparación de sutura mecánica con sutura manual de la faringe en laringectomía total / Comparison of mechanical suture with manual suture of the pharynx in total laryngectomy

Introducción: La sutura mecánica es una opción para el cierre de la faringorrafia en laringectomía total por cáncer de laringe. Objetivo: Comparar el uso de sutura mecánica lineal con sutura manual de la faringe durante la laringectomía total por cáncer de laringe. Material y Método: Se realizó un estudio de tipo experimental prospectivo. Se compararon dos grupos pacientes: Los pacientes con sutura mecánica desde 2018 a marzo de 2020 y los pacientes con sutura manual previa a enero de 2018 en el Servicio de Otorrinolaringología del Hospital Barros Luco. Se analizaron fístula faringo-cutánea posoperatoria (FFC), tiempo operatorio, estadía hospitalaria y costo. Resultados: El estudio incluyó a 14 pacientes, cada grupo con n = 7. El grupo con sutura mecánica presento 0% de FFC y el grupo sutura manual 28%. El grupo con sutura mecánica reinicio alimentación a los 7 días y el grupo con sutura manual en promedio a los 11,5 (7-23) días. (p = 0,0023). El tiempo promedio de cirugía para el grupo experimental es de 288 ± 37,4 minutos y con sutura manual 311 ± 32,4 minutos. (p = 0,0176). El promedio de hospitalización para el grupo experimental fue de 11 ± 2,6 días (9 a 16), y para el grupo control fue de 21 ± 14 días (10 a 49) (p < 0,0001). Conclusión: La sutura mecánica es un procedimiento fácil de usar y seguro. Existiría un beneficio en el uso de sutura mecánica para el cierre faríngeo al compararlo con la sutura manual al disminuir el número de FFC, el tiempo operatorio y los días de hospitalización.

Introduction: Mechanical suture is an option for the closure of the pharyngorrhaphy in total laryngectomy due to laryngeal cancer. Aim: To compare the use of linear mechanical suture with manual pharyngeal suture during total laryngectomy for laryngeal cancer. Material and Method: A prospective experimental study was carried out. Two patient groups were compared: patients with mechanical suture from 2018 to March 2020 and patients with manual suture prior to January 2018 at the otorhinolaryngology service of the Barros Luco Hospital. Postoperative pharyngocutaneous fistula (FFC), operative time, hospital stay and cost were analyzed. Results: The study included 14 patients, each group with n = 7. The group with mechanical suture presented 0% of FFC and the group with manual suture 28%. The group with mechanical suture restarted feeding at 7 days and the group with manual suture on average at 11.5 (7-23) days (p = 0.0023). The average surgery time for the experimental group was 288 ± 37.4 minutes, while for the group with manual suture was 311 ± 32.4 minutes (p = 0.0176). The mean hospitalization for the experimental group was 11 ± 2.6 days (9 to 16), and for the control group it was 21 ± 14 days (10 to 49) (p < 0.0001). Conclusion: The mechanical suture is an easy to use and safe procedure. There would be a benefit in the use of mechanical suture for pharyngeal closure when buying it with manual suture by reducing the number of FFCs, operative time and days of hospitalization.

Rol protector de N-acetilcisteína en la ototoxicidad inducida por cisplatino en pacientes con cáncer de cabeza y cuello. Ensayo clínico controlado aleatorizado

Resumen Introducción: La ototoxicidad por cisplatino es un evento muy frecuente y sus consecuencias producen mucho deterioro en los pacientes. El diagnóstico precoz es esencial, pues permitiría implementar apropiadamente estrategias para aminorar su efecto. Entre estas tenemos la N-acetilcisteína, un agente antioxidante que ha demostrado efecto otoprotector. Objetivo: Evaluar el rol otoprotector de N-acetilcisteína comparado con placebo, en pacientes con cáncer de cabeza y cuello tratados con cisplatino. Material y Método: Ensayo clínico aleatorizado, paralelo y controlado con placebo. Se incluyen pacientes con cáncer de cabeza y cuello que requieren tratamiento con cisplatino, dos ramas: un grupo control que recibe placebo y otro que recibe el fármaco. Se realizan audiometrías de altas frecuencias (6-16 kHz) antes, durante y una vez finalizado el tratamiento. Resultados: Se aleatorizaron 45 pacientes, 23 al grupo intervencional y 22 al grupo control. Se encontró una incidencia general de la ototoxicidad del 73%, un empeoramiento en relación con tiempo de medición, una detención y estabilización del efecto ototóxico en el grupo que recibió N-acetilcisteína, todas estas diferencias fueron significativas. Conclusión: La N-acetilcisteína no previene la ototoxicidad inducida por cisplatino, pero modifica su curso de instalación y progresión. No se registraron efectos adversos al uso del fármaco. El monitoreo audiológico precoz es esencial para identificar la ototoxicidad y ejercer acciones para modificar su curso y mejorar la calidad de vida.

Abstract Introduction: Cisplatin-induced ototoxicity is a very frequent event and its consequences can cause a lot of deterioration in patients. There are some strategies to reduce its effect, among these, N-acetylcysteine, an antioxidant agent, has shown otoprotective effect. Aim: To evaluate the effect of N-acetylcysteine on ototoxicity by chemotherapy-radiotherapy in patients with head and neck cancer, compared with placebo. Material and Method: Randomized, parallel design and placebo controlled clinical trial. Patients with head and neck cancer who require treatment with cisplatin were enrolled: a control group that receives a placebo and experimental group that receives the drug. High-frequency audiometries were performed before, during and after the treatment finalization. Results: Forty-five patients were randomized, 23 for the experimental group and 22 for control group. The investigators found an incidence of ototoxicity of 73%, a worsening in relation to the time of measurement and a stopping and stabilization of the ototoxic effect in the group that received N-acetylcysteine, all these differences were statistically significant. Conclusion: N-acetylcysteine does not prevent cisplatin-induced ototoxicity, but does modify its course of installation and progression. No adverse effects were registered in this trial. Early audiological monitoring is essential to identify ototoxicity and eventually modify its course and improve the quality of life.

Evidencias de validez, fiabilidad e invarianza factorial de una escala breve de empatía para niños peruanos / Evidence of validity, reliability and factor invariance of a brief scale of empathy for Peruvian children

Resumen La empatía es conceptualizada como la conciencia de las emociones y cogniciones de los demás y resulta importante en el contexto escolar para el favorecimiento de la convivencia y prevención de conductas agresivas. En ese sentido, el presente estudio tiene como objetivo examinar las evidencias de validez, fiabilidad e invarianza factorial de una escala breve de empatía básica (BES) en niños peruanos. Por ende, participaron 838 niños y niñas entre 8 y 12 años de edad (M = 9.95; DE = 1.13) de seis instituciones educativas, algunos colegios fueron utilizados para el análisis exploratorio y otros para confirmar. Se administró la BES que fue adaptada para niños (BES-I). Respecto al análisis de datos, se efectuó un análisis factorial exploratorio (AFE) y confirmatorio (AFC), además del análisis de invarianza factorial, para finalmente examinar la fiabilidad mediante el coeficiente omega (ω). Los resultados del AFE sugieren una medida bidimensional oblicua (cognitivo y afectivo). Del mismo modo, el AFC reafirmó estos resultados por presentar buenas bondades de ajuste (CFI ≥ .97, RMSEA ≤ .04); estos hallazgos son coherentes con los postulados teóricos que sugieren que la empatía es un constructo compuesto por factores específicos y no por un solo factor. La invarianza factorial de acuerdo con el sexo demostró que la BES-I mide lo mismo en niños y niñas y la fiabilidad obtenida mediante el coeficiente ω fue superior a .65, lo cual indica que es aceptable. Se concluye que la BES-I es un instrumento breve que puede resultar valioso en la comprensión de la empatía infantil en futuras investigaciones.

Abstract Childhood is a period where prevention and promotion actions can be carried out; therefore, the study of positive variables such as mindfulness, well-being, resilience and empathy has increased for some years. In this sense, empathy is conceptualized as the awareness of the emotions and cognitions of others in socio-emotional theoretical models; additionally, its study is important in the school context for the promotion of coexistence and prevention of aggressive behavior. Likewise, women are known to present higher empathy prevalence than men. Within the perspectives of this construct related to the cognitive and affective states, it became the most relevant in various studies and measurement instruments; despite this, there is a lack of brief instruments to measure empathy in the Latin American context. In this sense, this study aims to examine the evidence of validity, reliability and factor invariance of a short Basic Empathy Scale (BES) in Peruvian children. For these purposes, 838 children between 8-12 years old (M = 9.95; SD = 1.13) from six schools participated, some of them were used for exploratory analysis and others for confirmation. Likewise, eleven professionals from the clinical field and with experience in children's issues participated and applied the two criteria-based BES: relevance and representativeness. Prior to this, ten children were interviewed to verify the clarity of the items. After this procedure, trained research assistants created a version of the BES for children (BES-I) for children in their respective classrooms; who also requested parental authorization by signing an informed consent. The data was analyzed by R statistical software of free access using packages such as 'psych', 'lavaan', 'MBESS', 'semTools'; two factor analyses were performed; one, exploratory (AFE) and two, confirmatory (AFC), in a third moment a multigroup analysis was performed to evaluate to what extent the factor structure is invariant in the subgroups of males and females; finally, reliability was calculated using the omega coefficient (ω). The results show that the items have the representativeness and relevance in their content according to eleven experts in clinical psychology, whose responses were quantified by V of Aiken reaching values higher than .70. The internal structure in the AFE indicated the presence of two related factors (cognitive and affective) that explain 35 % of the model variance. Similarly, the AFC verified these results by showing optimal goodness of fit (IFC ≥ .97, RMSEA ≤ .04) in the two-factor model; these empirical findings are consistent with theoretical assumptions suggesting that empathy is a construct comprising specific factors rather than a single factor. As for the multi-group analysis according to sex, the invariance of the BES-I was evidenced, when observing that the differences between the base or configuration model and those with restricted thresholds, loads, variance and covariance are minimally recommended; in that way, the BES-I is established to measure the same in boys and girls; finally, regarding the reliability in the two-factor model, the coefficient ω is observed to exceed .65 for both the cognitive factor (ω = .66) and the affective factor (ω = .66). It is concluded that the BES-I is a brief instrument to be interpreted in a two-dimensional oblique way, taking as reference the theoretical cognitive-affective perspective; thus, the validity evidence of the BES-I is valuable for the understanding of child empathy in future Latin American researches.

Adherencia al uso de audífonos en adultos mayores con hipoacusia: Un ensayo clínico aleatorizado para evaluar un programa de rehabilitación auditiva

Resumen Introducción: La presbiacusia es una condición muy prevalente. Habitualmente se implementan audífonos como tratamiento, pero un problema es la baja adherencia exhibida que puede rondar un 50%. Objetivo: Evaluar si el programa de rehabilitación auditiva Active Communication Education (ACE) mejora la adherencia al uso del audífono. Material y Método: Se realizó un ensayo clínico aleatorizado controlado para evaluar la efectividad del programa ACE sumado a un refuerzo teleeducativo para mejorar la adherencia al uso del audífono. El proyecto fue aprobado por comité de ética y cada participante firmó consentimiento informado. La adherencia se evaluó por medio de la escala CIRUA y Dr. Yueh. Cada participante fue seguido en su domicilio en controles cada 3 meses hasta 1 año posterior a la intervención por encuestadores entrenados. Resultados: Se incluyeron 202 participantes, 101 en cada rama. La mediana de edad fue de 78 años y el 59,9% de la muestra fue de sexo femenino. El PTP promedio óseo fue de 48,59 dB y el aéreo fue de 55 dB. El grupo control tuvo adherencia de 65,91% y 62,30%. El grupo intervencional tuvo una adherencia de 78,41% y 72,28%. Hubo diferencias significativas en el porcentaje de adherencia entre grupo control y experimental según CIRUA (p = 0,027) y Yueh (p = 0,011). Conclusión: El programa de rehabilitación auditiva ACE es eficaz para mejorar la adherencia al uso del audífono en pacientes adultos mayores con hipoacusia. Este estudio representa uno de los mayores esfuerzos publicados para evaluar la efectividad de los programas de rehabilitación auditiva en adultos mayores con hipoacusia.

Abstract Introduction: Hearing loss associated with older adults is a very prevalent condition. Hearing aids are usually implemented as treatment, but there is low adherence exhibited, which can be around 50%. Aim: To assess whether the Active Communication Education (ACE) hearing rehabilitation program improves adherence to hearing aid use. Material and Method: A randomized controlled clinical trial was carried out to evaluate the effectiveness of the ACE program added to a tele-educational reinforcement to improve adherence to hearing aid use. The project was approved by the ethics committee of the institution and each participant signed an informed consent. Adherence was evaluated using the CIRUA scale and Dr. Yueh scale. Each participant was followed at home in controls every 3 months up to 1 year after the intervention by trained interviewers. Results: 202 participants were included, 101 in each branch. The median age was 78 years and 59.9% of the sample was female. The average bone PTA was 48.59 dB and air PTA was 55 dB. Adherence in the control group was 65.91% and 62.30%. In the interventional group, adherence was 78.41% and 72.28%. There were significant differences in the percentage of adherence between the control and experimental groups according to CIRUA (p = 0.027) and Yueh (p = 0.011). Conclusion: The ACE auditory rehabilitation program improves adherence to hearing aid use in older adults with hearing loss. This study represents one of the largest published efforts to evaluate the effectiveness of auditory rehabilitation programs in older adults with hearing loss.

Adherencia al uso de audífonos en adultos mayores chilenos con hipoacusia

Resumen Introducción: Se estima que hasta un 30% de la población mayor de 65 años presenta hipoacusia. Una intervención validada para la hipoacusia en adultos mayores es el uso de audífonos, pero el problema es que hasta un 50% de los adultos mayores no los utiliza. Objetivo: Estimar la adherencia al uso de audífonos en adultos mayores beneficiarios del programa GES de "Hipoacusia bilateral en mayores de 65 años que requieran audífonos" en un hospital en Santiago, Chile. Material y Método: Se utilizó la rama control de un ensayo clínico aleatorizado para estimar la adherencia al uso de audífono con cuestionarios validados y estructurados, por encuestadores entrenados que acudieron a los tres, seis, nueve y doce meses desde la intervención al domicilio de los beneficiarios del programa. Resultados: Se incluyeron 101 adultos mayores. El promedio de edad fue 76,3 años. Al analizar la adherencia considerando un criterio de uso del audífono mayor a 8 h al día, cada día, durante las últimas dos semanas, la adherencia a 3 meses fue un 56,8%, a 6 meses un 62,6%, a 9 meses un 63,2% y a 12 meses un 54,5%. Al analizar considerando uso entre 4-8 h/diarias, la adherencia del período fue entre 73,8% y 87,3%. Según el cuestionario del Dr. Yueh, la adherencia a 3 meses fue un 64,7%, a 6 meses un 63,9%, a 9 meses un 73,7% y a 12 meses un 67,8%. Conclusión: Los resultados del presente análisis muestran una excelente adherencia al uso del audífono en Chile, lo que representa una cifra positiva respecto a la efectividad de la política pública.

Abstract Introduction: It is estimated that up to 30% of the population over 65 years of age present hearing loss. A validated intervention for hearing loss in older adults is the use of hearing aids, but the problem is that up to 50% of older adults do not use them. Aim: To estimate the hearing aid adherence in elderly population with hearing loss who are beneficiaries of the GES program "Bilateral hearing loss in people over 65 who require hearing aids" in a hospital in Santiago, Chile. Material and Method: The control arm of a randomized clinical trial was used to estimate adherence to hearing aid with validated and structured questionnaires, by trained interviewers who visited the beneficiaries of the program at three, six, nine and twelve months posterior to the intervention. Results: 101 older adults were included. The average age was 76.3 years. When analyzing adherence as "use for more than 8 hours a day during the last two weeks", adherence at 3 months was 56.8%, at 6 months 62.6%, at 9 months 63.2%, and at 12 months 54.5%. When analyzing considering use between 4-8 h/day, the adherence during the follow-up was between 73.8% and 87.3%. According to Dr. Yueh's questionnaire, adherence at 3 months was 64.7%, at 6 months 63.9%, at 9 months 73.7%, and at 12 months 67.8%. Conclusion: The results of the present analysis show an excellent adherence to hearing aids in a group of Chilean population, which represents a positive outcome regarding the effectiveness of this particular public policy.

Embarazo y nuevo coronavirus: experiencia global reportada / Pregnancy and novel coronavirus: worldwide reported experience

INTRODUCCIÓN: La Organización Mundial de La Salud ha reportado recientemente que el nuevo foco de la pandemia global de la enfermedad Covid-19 es el continente americano. OBJETIVO: Realizar una revisión de la literatura sobre la experiencia internacional de la pandemia Covid 19 y embarazo. MÉTODO: Se realiza una búsqueda de la base de datos PubMed para las palabras clave Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, desde el 1 de noviembre 2019 hasta el 21 de mayo 2020. RESULTADOS: Un total de 365 artículos fueron inicialmente seleccionados de acuerdo con la estrategia de búsqueda diseñada. El total de artículos revisados de acuerdo con los criterios fueron 42. Las series clínicas seleccionadas acumularon un total de 1098 embarazadas y enfermedad de Covid-19. Las co-morbilidades mas frecuentes fueron hipertensión arterial, diabetes mellitus, obesidad y asma. La mortalidad en relación con el total de pacientes fue de un 1,2 % y la transmisión al recién nacido de 1,7% (15 de 875). CONCLUSIÓN: La información obtenida permite inferir que la presentación clínica de la enfermedad es a lo menos equivalente a la de mujeres de la misma edad no embarazadas. Dada la severidad de la enfermedad por SARS-CoV-2 reportada, las lecciones aprendidas deben ser rápidamente asimiladas y utilizadas en el contexto de la situación nacional epidémica.

INTRODUCTION: The World Health Organization has recently reported that the new focus of the global pandemic of Covid-19 disease is the American continent. OBJECTIVE: To conduct a literature review on the international experience of the Covid 19 pandemic and pregnancy. METHOD: A PubMed database search is performed for the keywords Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, from November 1, 2019 to May 21, 2020. RESULTS: A total of 365 articles were initially selected according to the designed search strategy. The total of articles reviewed according to the criteria was 42. The selected clinical series accumulated a total of 1098 pregnant women and Covid-19 disease. The most frequent comorbidities were hypertension, diabetes mellitus, obesity, and asthma. Mortality in relation to the total number of patients was 1.2% and transmission to the newborn was 1.7% (15 of 875). CONCLUSION: The information obtained allows us to infer that the clinical presentation of the disease is at least equivalent to that of non-pregnant women of the same age. Given the severity of the reported SARS-CoV-2 disease, the lessons learned must be quickly assimilated and used in the context of the national epidemic situation.

Portación nasal de staphylococcus aureus en población pediátrica con epistaxis anterior recurrente / Nasal carriage of staphylococcus aureus in pediatric population with recurrent anterior epistaxis

RESUMEN Introduction La epistaxis es un motivo frecuente de consulta en otorrinolaringología pediátrica. Diversos factores se han asociado, existiendo tanto causas locales como sistémicas. Ciertos estudios en adultos, han sugerido la asociación de colonización nasal por Staphylococcus aureus con la recurrencia de la epistaxis. Este hallazgo en población pediátrica tendría un potencial rol dentro del tratamiento y sería un posible blanco para profilaxis. Objetivo Comparar la prevalencia de colonización nasal por S. aureus en pacientes pediátricos con epistaxis recurrente, en el Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau, respecto a pacientes sin este antecedente. Material y método Estudio caso-control, definiendo caso como pacientes entre 2 y 15 años que consultaron por cuadros de epistaxis anterior recurrente. Se tomaron cultivos nasales a ambos grupos. Resultados Se incluyeron 46 pacientes con epistaxis y 45 controles. La prevalencia de S. aureus fue de 39% en los casos y 37% en los controles, sin diferencias estadísticamente significativas. Al examen físico de la mucosa nasal, ninguna de las características estudiadas mostró una relación significativa con la presencia de S. aureus. Conclusión La colonización nasal de S. aureus de niños con y sin epistaxis recurrente no varía considerablemente. En este estudio, la presencia de S. aureus no se asoció estadísticamente a epistaxis recurrente.

ABSTRACT Introduction: Epistaxis is a frequent reason for consultation in pediatric otolaryngology. Several factors have been associated, both local and systemic. Some studies in adult population, have suggested the association of nasal colonization by Staphylococcus aureus with the recurrence of epistaxis. Finding this association in pediatric population could have a potential role in treatment and also as a possible target for prophylaxis. Aim: To compare the prevalence of nasal colonization by S. aureus between pediatric patients with recurrent epistaxis and controls with no previous recurrent epistaxis, in the Service of Otorhinolaryngology in Barros Luco Trudeau Hospital. Material and method: Case-control study, defining case as patients between 2 and 15 years who consulted for recurrent anterior epistaxis. Nasal cultures were taken from both groups. Results: 46 patients with epistaxis and 45 controls were included. The prevalence of S. aureus was 39% in the case group and 37% in the controls, without statistically significant differences. At the physical examination of the nasal mucosa, none of the characteristics studied showed a significant relationship with the presence of S. aureus. Conclusion: Nasal colonization of S. aureus in children with and without recurrent epistaxis does not vary considerably. In this study, the presence of S. aureus was not statistically associated with recurrent epistaxis.

Enfermedad por IgG4 multisistémica: a propósito de un caso: revisión de la literatura / Multisystemic IgG4 disease: a case report: literature review

We report a 63-year-old male patient who consulted for a 4-month history of xerophthalmia, xerostomia and cervicalgia, associated with jaundice, choluria, low weight and night sweats. Exams show an obstructive pattern and abdominal ultrasound describes a possible mass in the pancreatic head with secondary dilation of the bile duct. Colangio-MRI (magnetic resonance imaging) confirms a focal pancreatic head lesion that determines intrapancreatic bile duct stenosis, proximal dilation of the bile duct and stenosis of the main pancreatic duct. Pancreatic neoplasia versus autoimmune pancreatitis (PAI) is proposed, complementing a study with a count of IgG subclasses where IgG4 stands out at 1050 mg/dl (normal range: 3.9-86) and computed tomography (CT) of the thorax, abdomen and pelvis, that in addition to the biliary-pancreatic alterations, shows thickening of the vesicular wall, multiple bilateral lesions in the renal parenchyma and peri-aortic soft tissue. Salivary gland biopsy reports lymphoplasmacytic infiltrate characteristic of IgG4 disease. A disease related to IgG4 (ER-IgG4) is diagnosed with pancreatic, renal, biliary, vascular, lymphatic, salivary and lacrimal glands involvement. It is treated with corticoidal therapy, evolving favorably with resolution of the symptomatology and regression of imaging alterations.

Se reporta caso de paciente de sexo masculino de 63 años que consulta por cuadro de 4 meses de xeroftalmia, xerostomía y cervicalgia, asociado a ictericia, coluria, baja de peso y sudoración nocturna. En exámenes destaca pruebas hepáticas con un patrón obstructivo y ecografía abdominal que muestra una posible masa en la cabeza pancreática con dilatación secundaria de la vía biliar. Colangio-resonancia (resonancia magnética-RM) confirma una lesión focal en la cabeza pancreática que determina estenosis del colédoco intrapancreático, dilatación proximal de la vía biliar y estenosis del conducto pancreático principal. Se plantea neoplasia de páncreas versus pancreatitis autoinmune (PAI), complementando estudio con recuento de subclases de IgG donde destaca IgG4 de 1.050 mg/dl (rango normal: 3,9-86) y tomografía computada (TC) de tórax, abdomen y pelvis, que además de las alteraciones bilio-pancreáticas, demuestra engrosamiento de la pared vesicular, lesiones múltiples bilaterales en el parénquima renal y tejido de partes blandas peri-aórtico. Biopsia de las glándulas salivales informa sialoadenitis crónica e inespecífica. Se diagnostica una enfermedad relacionada a IgG4 (ER-IgG4) con compromiso pancreático, renal, biliar, vascular, linfático, de glándulas salivales y lagrimales. Se trata con terapia corticoidal, evolucionando favorablemente con resolución de la sintomatología y regresión de las alteraciones imagenológicas.

Influencia del exceso de peso en el éxito de la adenoamigdalectomía en pacientes con hiperplasia adenoamigdalina sintomática / The influence of overweight in the success of adenotonsillectomy in patients with adenotonsillar symptomatic hyperplasia

Resumen Introducción: En población pediátrica con malnutrición por exceso, existe controversia respecto al rol de la hiperplasia adenoamigdalina en la etiología de los trastornos del sueño y de la efectividad de la adenoamigdalectomía sobre dicha sintomatología. Objetivo: Comparar la efectividad de la adenoamigdalectomía entre pacientes pediátricos eutróficos y con malnutrición por exceso sometidos a adenoamigdalectomía por hiperplasia adenoamigdalina, en relación a la disminución de la sintomatología. Materiales y método: Estudio retrospectivo mediante revisión de fichas clínicas entre junio de 2016 y enero de 2017 de pacientes operados de adenoamigdalectomía por hiperplasia adenoamigdalina sintomática. Se clasificaron los pacientes de acuerdo a edad y estado nutricional en 4 grupos y se evaluó la resolución de la sintomatologia mediante interrogación a padres/tutores. Resultados: Se incluyeron 98 pacientes, con una edad media de 6,3 años. 44,9% de los pacientes fueron eutróficos y 55,1% con malnutrición por exceso. El análisis estadístico entre pacientes eutróficos y aquellos con malnutrición no demostró diferencias significativas en relación a la resolución de la sintomatología. Conclusión: La adenoamigdalectomía por hiperplasia adenoamigdalina sintomática se asocia a una reducción de la frecuencia de roncopatía con pausas en pacientes pediátricos, independientemente del estado nutricional.

Abstract Introduction: In pediatric population with malnutrition by excess, the role of the adenotonsillar hyperplasia in the etiology of breathing-related sleep disorders, and the effectivity of the adenotonsillectomy for reducing symptoms remains controversial. Aim: To compare and evaluate the effectiveness of the adenotonsillectomy between eutrophic and malnutrition by excess pediatric patients submitted to adenotonsillectomy by adenotonsillar hyperplasia, regarding to symptoms resolution. Material and method: A retrospective study was performed collecting data from clinical records between June 2016 and January 2017 of patients submitted to adenotonsillectomy by symptomatic adenotonsillar hyperplasia. Patients were assigned to 4 groups according to age and nutrional status and the rate of symptoms resolution was evaluated through interrogation to parents/guardians. Results: We included 98 patients, with an average age of 6.3 years. A 44.9% of patients were eutrophic and 55.1% had malnutrition by excess. Comparing eutrophic and malnutrition by excess patients, no significant differences were observed regarding to symptoms resolution. Conclusion: The adenotonsillectomy by symptomatic adenotonsillar hyperplasia was associated to an amelioration of the rate of snoring and respiratory pauses during sleeping in pediatric patients, independently of the nutritional status.

Momento de inicio de radioterapia posoperatoria como factor pronóstico en pacientes con cáncer de laringe avanzado / Time to initiation of postoperative radiotherapy as a prognostic factor in patients with advanced laryngeal cancer

RESUMEN Introducción: Dentro de los factores que juegan un rol en la supervivencia y recidiva de enfermedad de los pacientes con cáncer laríngeo escamoso operados se encuentra el tiempo de inicio de la radioterapia (RT) posoperatoria. Objetivo: Determinar el impacto del retraso de inicio de RT posoperatoria en la supervivencia y recidiva de enfermedad en pacientes con cáncer de laringe escamoso avanzado operado. Material y método: Estudio tipo cohorte retrospectiva. Recolección de datos mediante revisión de fichas clínicas. Análisis de supervivencia y recidiva de enfermedad mediante el método de Kaplan-Meier, comparación de curvas con prueba de Log-Rank y modelo de regresión de Cox para análisis de factores pronósticos. Resultados: El tiempo de espera entre la cirugía y el inicio de la RT en nuestras realidades hospitalarias fueron 11 semanas. La supervivencia específica a 5 años en los pacientes que comienzan la RT ≤6 semanas desde la cirugía es de 33,3% y disminuye a 20% en aquellos que la comienzan >6 semanas (p =0,20). Conclusión: Los pacientes que inician la RT en más de 6 semanas desde la cirugía no presentan una diferencia estadísticamente significativa en el pronóstico.

ABSTRACT Introduction: Among the factors that play a role in the survival and recurrence of disease of patients with operated squamous laryngeal cancer is the time to initiation of postoperative radiotherapy (RT). Aim: To determine the impact of delayed onset of postoperative RT on survival and disease recurrence in patients with advanced operated squamous laryngeal cancer. Material and Method: Retrospective cohort study. Collection of data through review of clinical records. Analysis of survival and disease recurrence using the Kaplan-Meier method, comparison of curves with Log-Rank test and Cox regression model for analysis of prognostic factors. Results: The waiting time between surgery and the initiation of RT in our hospital realities was 11 weeks. The 5-year specific survival in patients who start RT ≤ 6 weeks after surgery is 33.3% and decreases to 20% in those who start > 6 weeks (p = 0.20). Conclusion: Patients who start RT in more than 6 weeks after surgery do not present a statistically significant difference in prognosis.

Do we publish what we preach? Analysis of Spanish Shoulder and Elbow Surgery Society publication rates. / ¿Publicamos lo que predicamos? Tasa de publicación de los congresos de la Sociedad Española de Cirugía de Hombro y Codo.

INTRODUCTION: The purpose of this study is to analyse the publication rate of studies presented as podium presentations in the Spanish Society of Shoulder and Elbow Surgery (SECHC) congresses. METHODS: One hundred and twenty-two abstracts presented at the SECHC congresses held in 2007, 2009 and 2011 were included for the purpose of the study. The oral communications were categorized by study type, sample included and follow-up. In June 2017, possible publications of these studies were searched in PubMed. Type of study, delay in publication, journal and impact factor obtained were recorded. The concordance between the information presented at the congress and their subsequent full-text publications was analysed. RESULTS: The publication rate was 17.21% (21 of the 122 abstracts studied) after 6 years, with a mean time spent for publications of 36.71 months, and a mean impact factor of 1.51. There were no differences between results initially presented at the congresses and those subsequently published (P>0.05). DISCUSSION: The majority of papers presented at SECHC congresses do not end up with a publication. The papers that are published do not usually contain significant differences compared to the content delivered at the congress.