[Vowel articulation and intelligibility of speech in Spanish speakers with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus]. / Articulación de las vocales e inteligibilidad del habla en hispanohablantes con enfermedad de Parkinson tratados con estimulación cerebral profunda del núcleo subtalámico.

INTRODUCTION: Parkinson's disease (PD) can affect the intelligibility of speech. Although studies of vowel production are useful for measuring this impairment, they do not exist in Spanish speakers with the disease who have been treated with subthalamic nucleus deep brain stimulation (STN-DBS). STN-DBS is an effective treatment for the classic signs of PD, but with varied effects on speech. PATIENTS AND METHODS: Data from two individuals with PD treated with STN-DBS were studied: one (P1) had impairment and the other (P2) had stable speech intelligibility after STN-DBS implantation. The triangular vowel space area (tVSA) and the vowel articulation index (VAI) were measured and compared before the implantation surgery, and at three, six and nine months after surgery. These measurements were compared with measurements of speech intelligibility (percentage of words correctly identified and degree of intelligibility). RESULTS: Both participants presented variations in measurements of vowel articulation after surgery. In P1, the reduction in the tVSA, but not the post-surgical change in the VAI, was consistent with reduced speech intelligibility. However, in P2, both measurements (tVSA and VAI) reflected stable speech intelligibility after surgery. CONCLUSIONS: Reduced speech intelligibility in Spanish speakers with PD after STN-DBS implantation may be reflected in a reduced tVSA.

TITLE: Articulación de las vocales e inteligibilidad del habla en hispanohablantes con enfermedad de Parkinson tratados con estimulación cerebral profunda del núcleo subtalámico.Introducción. La enfermedad de Parkinson (EP) puede alterar la inteligibilidad del habla. Aunque los estudios de la producción de las vocales son útiles para medir esta afectación, no existen en hispanohablantes con la enfermedad que hayan sido tratados con estimulación cerebral profunda del núcleo subtalámico (STN-DBS). La STN-DBS es un tratamiento efectivo para los signos clásicos de la EP, pero con variados efectos en el habla. Pacientes y métodos. Se estudiaron los datos de dos personas con EP tratadas con STN-DBS: uno (P1) con deterioro y el otro (P2) con estabilidad de la inteligibilidad del habla después de la implantación de la STN-DBS. Se calcularon y compararon medidas de espacio vocálico acústico triangular (tVSA) e índice de articulación de las vocales (VAI) antes de la cirugía de implantación y a los tres, seis y nueve meses de la intervención. Estas medidas se contrastaron con medidas de inteligibilidad del habla (porcentaje de palabras correctamente identificadas y grado de inteligibilidad). Resultados. Ambos participantes mostraron variación de las medidas de articulación de las vocales después de la cirugía. En P1, la reducción del tVSA, pero no el cambio posquirúrgico del VAI, correspondió con disminución de la inteligibilidad del habla. Por el contrario, en P2, el comportamiento de ambas medidas (tVSA y VAI) reflejó la estabilidad de la inteligibilidad del habla después de la cirugía. Conclusiones. La reducción de la inteligibilidad del habla en hispanohablantes con EP después de la implantación de la STN-DBS puede reflejarse en la reducción del tVSA.

Protocolo anestésico para periquito australiano (Melopsittacus undulatus) / Anesthetic protocol for budgerigar (Melopsittacus undulatus)

RESUMEN La anestesia aviar constituye un área de estudio controvertida debido a la morfofisiología diferente entre aves y mamíferos. Lo anterior hace necesario desarrollar protocolos confiables que contribuyan al bienestar de las aves en cautiverio. La anestesiología en aves representa una actividad clínica que demanda especial cuidado de los pacientes que requieren procedimientos quirúrgicos. Este estudio describe los parámetros de SpO2, frecuencias cardiaca y respiratoria durante la anestesia con isoflurano de Melopsittacus undulatus. Se monitorearon 12 machos y 7 hembras durante las etapas anestésicas. La inducción anestésica duró 1:30 ± 0:31 min en machos y 2:19 ± 0:16 min en hembras, con promedio de mantenimiento de 7:00 ± 1:39 min. No se encontraron diferencias significativas en los tiempos anestésicos entre hembras y machos (p>0,05). Se presentó una variación estadísticamente significativa (p<0,05) de la SpO2 en el periodo de recuperación, las hembras presentaron mayor saturación de oxígeno (71±4 %) en comparación con los machos (89±2 %). En la valoración de la función cardiaca durante la anestesia, no se detectaron diferencias significativas entre machos y hembras (p>0,05). Se concluye como un protocolo anestésico seguro para procedimientos clínicos de corta duración para aves pequeñas como M. undulatus.

ABSTRACT Avian anesthesia is a controversial area of study due to the differences between birds and mammals morpho physiology. This makes necessary to develop reliable protocols for birds in captivity, which contributes to their welfare under human care. Bird anesthesiology today represents a veterinary clinical activity that demands special care for patients requiring surgical procedures. This study describes the parameters of SpO2, cardiac activity, heart and respiratory rate during anesthesia with isoflurane for Melopsittacus undulatus. 12 males and 7 females were monitored during the anesthetic stages. Anesthetic induction lasted 1:30 ± 0:31 min in males and 2:19 ± 0:16 min in females, with an average maintenance time of 7:00 ± 1:39 min. No significant differences were found in anesthetic times between females and males (p>0.05). There was a statistically significant variation (p<0.05) of SpO2 in the recovery period, females had higher oxygen saturation (71±4%) compared to males (89±2%). In the assessment of cardiac function during anesthesia, no significant differences were detected between males and females (p>0.05). It is concluded as a safe anesthetic protocol for clinical procedures of short duration for small birds such as M. undulates.

Knowledge about genetics and trust in genetic testing in a mid-size city in Argentina / Conocimiento sobre genética y confianza en pruebas genéticas en una ciudad de tamaño medio en Argentina

ABSTRACT Public attitudes about genetics appear to depend on the local context. We analyzed survey responses obtained in 2015 from 293 residents of Luján, a city in the province of Buenos Aires, Argentina, who self-assessed their knowledge about genetics and their trust in genetic tests. The survey integrated a larger research project for which consenting adult participants shared demographic and genealogical information and provided saliva samples for genetic ancestry analyses. Participants reported little knowledge but high trust in genetic testing when questioned about knowledge and trust. Well-known media stories of DNA-based forensic genetic investigations to identify the victims of state repression during the military dictatorship may have contributed to the high self-assessment of their genetic knowledge expressed by some participants, regardless of educational attainment. Our analysis provides information that could be used as a baseline to begin unraveling the current level of public trust in genetics in a region of the Global South where genetic testing has become widespread, but people's knowledge of and trust in genetics remain poorly studied.

RESUMEN Las actitudes del público sobre la genética parecen depender del contexto local. Analizamos las respuestas de una encuesta suministrada en 2015 a 293 residentes de Luján, una ciudad de la provincia de Buenos Aires, Argentina, quienes autoevaluaron su conocimiento sobre genética y su confianza en las pruebas genéticas. La encuesta integraba un proyecto de investigación más amplio en el que los adultos participantes que dieron su consentimiento compartieron información demográfica y genealógica y proporcionaron muestras de saliva para un estudio de ancestría genética. Cuando se les preguntó sobre su conocimiento y confianza, los participantes informaron tener poco conocimiento sobre genética, pero mucha confianza en las pruebas genéticas. Historias muy conocidas de los medios de comunicación sobre investigaciones genéticas forenses basadas en el ADN para identificar a las víctimas de la represión estatal durante la dictadura militar pueden haber contribuido a la alta autoevaluación del propio conocimiento genético manifestado por algunos participantes, independientemente de su nivel educativo. Nuestro análisis proporciona información que podría utilizarse como base para comenzar a desentrañar los niveles actuales de confianza pública en la genética en una región del Sur Global donde las pruebas genéticas se han generalizado, pero el conocimiento y confianza de las personas sobre genética están poco estudiados.

A cross-sectional study of gender differences in quality of life domains in patients with neurofibromatosis type 1.

BACKGROUND: There is limited data regarding gender differences in quality of life between women and men with Neurofibromatosis type 1. We aimed to study differences in quality of life domains between women and men with Neurofibromatosis type 1 living in Canada. METHODS: This is a cross sectional study of adults with Neurofibromatosis type 1 attending a tertiary NF centre at Toronto General Hospital between January 2016 to December 2017. Demographic and clinical data were collected. We compared scores of generic measures (SF-36, EQ-5D-5L, pain interference) and a disease-specific measure (PedsQL-NF1 module) between women and men. We also assessed the relationship between disease visibility scored by an examiner (Ablon's visibility index) and self-reported perceived physical appearance, stratified by gender. RESULTS: One hundred and sixty-two participants were enrolled, 92 females and 70 males. Ablon's index score 1 was in 43% and score 2 in 44%, while only 13% of patients had a score 3. Women had worse scores on the total PedsQL-NF1 scales, and also in the perceived physical appearance, anxiety and emotional health domains. In women, there was a low but significant correlation between Ablon's index and perceived physical appearance (r = - 0.27, p = 0.01, ANOVA p < 0.001). In men, there was no difference in self-reported physical appearance by Ablon's index. There were no differences between men and women in the SF-36 or EQ-5D-5L scores. CONCLUSION: Women with NF1 reported worse NF1-related quality of life than men, with worse perceived physical appearance, anxiety, and mental health. Perceived physical appearance does not always correlate to disease visibility; therefore, healthcare providers should inquire about body image, physical appearance concerns, and mental health, especially among women with NF1.

The role of the genetic testing industry in patient education of hereditary cancer: An observational study assessing the quality of patient education videos.

OBJECTIVES: Genetic testing (GT) companies have developed patient education videos to supplement or replace pre-test genetic counseling (GC) by certified genetic counselors (CGC). The aim of this study was to assess the quality of these videos compared to the standard of care (SOC). METHODS: Videos from four major GT companies were selected from an internet search identifying pre-test patient education videos. A scoring rubric with 22 questions and 36 total points was devised to assess quality metrics, as described by the National Cancer Institute and National Society of Genetic Counselors. Twenty-two individuals with varying genetics expertise (3 gynecologic oncologists, 3 academic generalists, 4 CGC, a genetics community health worker, 3 cancer care navigators, and 8 medical students) scored each video. Scorers were blinded to others' assessments. RESULTS: Invitae had the highest median score (26/36), followed by Myriad (22/36), Ambry (17.5/36), and Color (15/36). All videos scored highly in explaining DNA basics, cancer development, and hereditary cancer predisposition. All addressed benefits of GT but failed to address potential disadvantages. All scored poorly in explaining medical terms and different GT options. There was variability in addressing patient concerns including cost, privacy, and procedure. CONCLUSIONS: There is significant variation in the content of pre-test patient education videos between GT companies. None of the videos met the SOC for pre-test GC, and none addressed disadvantages of GT, possibly due to a conflict of interest. With improvement in content, accessibility, and use of interactive platforms, these videos may serve as an adjunct to in-person pre-test GC.

Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study.

OBJECTIVES: To investigate the incidence of clinical, ultrasonographic and biochemical findings related to pre-eclampsia (PE) in pregnancies with COVID-19, and to assess their accuracy to differentiate between PE and the PE-like features associated with COVID-19. DESIGN: A prospective, observational study. SETTING: Tertiary referral hospital. PARTICIPANTS: Singleton pregnancies with COVID-19 at >20+0  weeks. METHODS: Forty-two consecutive pregnancies were recruited and classified into two groups: severe and non-severe COVID-19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms-like tyrosine kinase-1/placental growth factor [sFlt-1/PlGF]) were assessed in women with suspected PE. MAIN OUTCOME MEASURES: Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt-1/PlGF. RESULTS: Thirty-four cases were classified as non-severe and 8 as severe COVID-19. Five (11.9%) women presented signs and symptoms of PE, all five being among the severe COVID-19 cases (62.5%). However, abnormal sFlt-1/PlGF and UtAPI could only be demonstrated in one case. One case remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE-like syndrome. CONCLUSIONS: Pregnant women with severe COVID-19 can develop a PE-like syndrome that might be distinguished from actual PE by sFlt-1/PlGF, LDH and UtAPI assessment. Healthcare providers should be aware of its existence and monitor pregnancies with suspected pre-eclampsia with caution. TWEETABLE ABSTRACT: This study shows that a pre-eclampsia-like syndrome could be present in some pregnancies with severe COVID-19.

Arsenic exposure: A public health problem leading to several cancers.

Arsenic, a metalloid and naturally occurring element, is one of the most abundant elements in the earth's crust. Water is contaminated by arsenic through natural sources (underground water, minerals and geothermal processes) and anthropogenic sources such as mining, industrial processes, and the production and use of pesticides. Humans are exposed to arsenic mainly by drinking contaminated water, and secondarily through inhalation and skin contact. Arsenic exposure is associated with the development of vascular disease, including stroke, ischemic heart disease and peripheral vascular disease. Also, arsenic increases the risk of tumors of bladder, lungs, kidneys and liver, according to the International Agency for Research on Cancer and the Food and Drug Administration. Once ingested, an estimated 70-90% of inorganic arsenic is absorbed by the gastrointestinal tract and widely distributed through the blood to different organs, primarily to the liver, kidneys, lungs and bladder and secondarily to muscle and nerve tissue. Arsenic accumulates in the organs, especially in the liver. Its excretion mostly takes place through urination. The toxicokinetics of arsenic depends on the duration of exposure, pathway of ingestion, physicochemical characteristics of the compound, and affected biological species. The present review outlines of arsenic toxic effects focusing on different cancer types whit highest prevalence's by exposure to this metalloid and signaling pathways of carcinogenesis.

Performance of a household tuberculosis exposure survey among children in a Latin American setting.

OBJECTIVE: To evaluate the performance of a survey that quantifies the intensity of household tuberculosis (TB) exposure among children.METHODS: Children aged 0-14 years in Lima, Peru, with ≥1 signs and/or symptoms of TB and a history of contact with an adult TB patient were included. The 10-question survey was administered to caregivers and addressed sleep proximity, frequency of exposure, and infectiousness of the contact. Infection status was determined using tuberculin skin tests (TSTs). The exposure scale was evaluated for association with TST positivity using mixed-effects regression analyses.RESULTS: The exposure score was significantly associated with TST positivity (age-adjusted odds ratio [aOR] 1.14, 95%CI 1.02-1.28). We observed a stronger association with TST positivity in children aged ≤5 years; (aOR 1.23, 95%CI 1.07-1.41) and no association in children 6-14 years of age (aOR 0.99, 95%CI 0.82-1.20).CONCLUSION: This survey was easy to use and modestly successful in predicting TST positivity in children aged ≤5 years. It may be a useful resource for clinicians for diagnosing TB in children, and for national TB programs aiming to scale up preventive therapy initiatives.

[Colopericardial fistula after esophageal replacement surgery: case report and literature review]. / Fístula colopericárdica tras cirugía de reemplazo esofágico: reporte de caso y revisión bibliográfica.

INTRODUCTION: Colopericardial fistula is a rare complication of colonic replacement surgery whose incidence is unknown. Therefore, we present the following case and perform a literature review. CLINICAL CASE: 17-year-old female patient of age consults for respiratory distress and precordial pain of 5 days of evolution. Background: Long gap esophageal atresia (esophagostoma and feeding gastrostomy, subsequent colonic graft). Bilateral pneumonia is initially diagnosed. It rapidly evolves to a state of sepsis. On chest x-ray, pneumopericardium is observed. Water-soluble contrasted study confirms diagnosis of colopericardial fistula. Surgical treatment is established, despite this the patient dies due to respiratory distress. COMMENT: Colopericardial fistula is a very serious entity with a high mortality rate. The clinical presentation and the complementary methods of diagnostic confirmation must be known in order to carry out the appropriate treatment.

INTRODUCCION: La fístula colopericárdica (FCP) constituye una complicación rara de la cirugía de reemplazo esofágico cuya incidencia se desconoce. Por este motivo presentamos el siguiente caso y realizamos una revisión bibliográfica. CASO CLINICO: Paciente de sexo femenino de 17 años de edad que consulta por dificultad respiratoria y dolor precordial de 5 días de evolución. Antecedentes: atresia esofágica de tipo long gap (esofagostoma y gastrostomía, posterior ascenso colónico). Se diagnostica inicialmente neumonía bilateral. Evoluciona rápidamente a estado de sepsis. En la radiografía de tórax se constata neumopericardio. Estudio contrastado hidrosoluble confirma diagnóstico de fístula colopericárdica. Se instaura tratamiento quirúrgico, a pesar de ello la paciente fallece por distrés respiratorio. COMENTARIO: La FCP es una entidad muy grave, que presenta un alto índice de mortalidad. Se deben conocer las formas de presentación clínica y los métodos complementarios de confirmación diagnóstica para realizar el tratamiento adecuado.

Efecto de bloques con propionato de calcio sobre respuestas productivas en corderos y GEI in vitro / Effect of blocks with calcium propionate on lamb productive performance and in vitro GHG

RESUMEN Objetivo. Evaluar bloques multinutricionales con y sin propionato de calcio (Pr-Ca) en la digestibilidad y cambios de peso de corderos y en la emisión de gases in vitro. Materiales y métodos. Se utilizaron doce borregos (20.17 ± 2.35 Katahdin x criollo) en tres tratamientos: Dieta basal (DB 70% paja de avena; 30% concentrado), DB+ Bloque sin Pr-Ca y DB + Bloque con 1.5% de Pr-Ca, por 50 días. Se midió producción de gas (PG) in vitro y parâmetros de cinética (Vmax, S, Lag). Se estimó la digestibilidad, CH4 y CO2 in vitro e in vivo. Resultados. El consumo de materia seca fue menor (p<0.0001) en borregos sin bloque (753 g/d) en comparación con bloque sin (839 g) o con Pr-Ca (828 g) al incluir bloques aumentó metano (16.16 y 16.18 g/d; 0 y 1.5% Pr-Ca respectivamente) que con DB (13.93 g/d). La PG in vitro fue mayor (p=0.0001) con la DB (380.76 ml) sin diferencias entre bloques (335.76 y 341.13 ml, 0 y 1.5% Pr-Ca respectivamente), y la DB tuvo mayor (p=0.0001) producción de CH4 (47.16 mol) y CO2 (200.04 mol) que con bloques (42.25 y 41.58 mol CH4; 179.21 y 176.39 moles CO2; 0 y 1.5% Ca-Pr respectivamente). Conclusiones. La suplementación con bloques mejora el consumo de materia seca. Los bloques disminuyeron la producción de gas in vitro e incrementaron la digestibilidad reduciendo CH4 y CO2.

ABSTRACT Objective. Evaluate multinutritional blocks with and without calcium propionate (Ca-Pr) on digestibility and live weight changes of lambs and in the green house emission in vitro. Materials and methods. Twelve lambs were used (20.17±2.35 Katahdin x criollo) in three treatments: Basal diet (BD 70% oat straw, 30% concentrate), BD+ Block without Ca-Pr and BD+ Block with 1.5% Ca-Pr in 50 days assay. In vitro gas production (GP) and kinetic parameters were estimated (Vmax, S, Lag). In vitro and in vivo, CH4, CO2 and digestibility were estimated. Results. The dry matter intake was the lowest (p<0.0001) in lambs without block (753 g/d) compared lambs supplemented with block without (839 g) or with Ca-Pr (828 g); including blocks increased methane (16.16 and 16.18 g/d; 0 and 1.5% Ca-Pr respectively) than BD (13.93 g/d). The GP in vitro was higher (p=0.0001) with BD (380.76, ml) than with blocks without differences among blocks (335.76 and 341.13 ml, 0 and 1.5% Ca-Pr respectively), and the BD had higher (p=0.0001) production of CH4 (47.16 mol) and CO2 (200.04 mol) than with blocks (42.25 and 41.58 mol CH4; 179.21 and 176.39 mol CO2; 0 and 1.5% Ca-Pr respectively). Conclusions. Block supplementation improved dry matter intake. Blocks reduced in vitro gas production and increased digestibility by reducing CH4 and CO2.

Evaluation of risk factors in the development of type 2 diabetes in a Mexican population.

Type 2 diabetes (T2D), which causes many adverse effects such as endothelial dysfunction and cardiovascular disease, affects approximately 425 million people worldwide. However, about half have not yet been diagnosed. For what is recommended the use of screening tools to identify individuals at risk for T2D or in the early stages of the disease in order to impement preventive strategies or early treatment. According to a widely used survey, the FINDRISC scale, a hereditary family history of T2D (FH-T2D) is as important a risk factor as having had high glucose levels. The aim of the present study was to carry out non-probabilistic sampling in a Mexican population to evaluate key factors in the development of diabetes. The participants were divided into three groups: with and without FH-T2D and diagnosed with T2D. A comparison of the groups with and without FH-T2D revealed higher values in the former for body mass index (BMI: 24.5 vs 21.9 kg/m2), glycosylated hemoglobin [Hb1Ac: 5.775% (39 mmol/mol) vs 4.825% (29 mmol/mol)] and triglycerides (164.18 vs 68.12 mg/dL), and a lower value for the BH4/BH2 index (0.7846 vs 1.6117). These results indicate significant metabolic alterations and endothelial dysfunction for the FH-T2D group. This strongly suggests the need to screen individuals with a family history of inherited T2D based on their level of HbA1c, triglycerides and BH4.

[Result of 12 years of non-surgical treatment of pectus carinatum]. / Resultado de 12 años de tratamiento no quirúrgico del pectus carinatum.

OBJECTIVE: To report our experience in the treatment of pectus carinatum by using the dynamic compression system. MATERIAL AND METHODS: Retrospective study during the period from January 2005 to September 2017. Patients with typical condrogladiolar pectus carinatum and correction pressure (PC) ≤ 14 PSI (pound square inch) were included. Exclusion criteria: patients with previous thoracic surgery, mixed malformations and chondromanubrial pectus carinatum. For the treatment, the Dynamic Thoracic Compressor System (FMF) with pressure meter in PSI was used. The PC, the treatment pressure (PT), the correction time (TC) and the maintenance time (TM), recurrences and complications were analyzed. A qualitative scale was measured in three grades: where A is excellent or very good, B is regular and C is bad. RESULTS: We treated 104 patients under 18 years of age. The PT was 2.26. The average of the TC was 8.8 months. The TM was on average 8 months. 36.5% of the patients finished the treatment, 36.5% still continue in treatment and 26.9% of the patients lost the follow-up due to desertion. The qualitative assessment was positive in 95.5% of our patients, and unfavourable in 4.5%. CONCLUSION: The non-surgical treatment of pectus carinatum is efficient, non-invasive and of low morbidity. Regarding the high dropout rate, we must analyze the variables to be modified to reduce it. This treatment should be considered as the first option to correct pectus carinatum in patients with flexible thorax.

OBJETIVO: Describir nuestra experiencia en el tratamiento del pectus carinatum mediante el uso del sistema de compresión dinámico. MATERIALES Y METODOS: Estudio retrospectivo durante el período de enero de 2005 a septiembre de 2017. Se incluyeron pacientes con pectus carinatum condrogladiolar típico y presión de corrección (PC) ≤ 14 PSI (pound per square inch). Criterios de exclusión: pacientes con cirugía torácica previa, malformaciones mixtas y condromanubriales. Para el tratamiento se utilizó el sistema compresor torácico dinámico (FMF) con medidor de presión en PSI. Se analizaron la PC, la presión de tratamiento (PT), el tiempo de corrección (TC) y el tiempo de mantenimiento (TM), recidivas y complicaciones. Se realizó una escala cualitativa medida en tres grados: donde A es excelente o muy bueno, B regular y C malo. RESULTADOS: Tratamos 104 pacientes menores de 18 años. La PT fue de 2,26. El promedio del TC fue de 8,8 meses. El TM fue en promedio de 8 meses. El 36,5% de los pacientes finalizaron el tratamiento, 36,5% aún continúan en tratamiento y 26,9% de los pacientes se perdió el seguimiento por deserción del mismo. La valoración cualitativa fue positiva en el 95,5% de nuestros pacientes, y desfavorable en el 4,5%. CONCLUSION: El tratamiento no quirúrgico del pectus carinatum es eficiente, no invasivo y de baja morbilidad. Respecto a la alta tasa de deserción, debemos analizar las variables a modificar para disminuirla. Este tratamiento debe ser considerado una opción de primera elección, para corregir el pectus carinatum en pacientes con tórax flexible.

Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis.

Videolaryngoscopy (VL) may improve the success of orotracheal intubation compared with direct laryngoscopy (DL). We performed a systematic search of PubMed, Embase, and CENTRAL databases for studies comparing VL and DL for emergency orotracheal intubations outside the operating room. The primary outcome was rate of first-pass intubation, with subgroup analyses by location, device used, clinician experience, and clinical scenario. The secondary outcome was complication rates. Data are presented as [odds ratio (95% confidence intervals); P-values]. We identified 32 studies with 15 064 emergency intubations. There was no difference in first-pass intubation with VL compared with DL [OR=1.28, (0.99-1.65); P=0.06]. First-pass intubations were increased with VL compared with DL in the intensive care unit (ICU) [2.02 (1.43-2.85); P<0.001], and similar in the emergency department or pre-hospital setting. First-pass intubations were similar with GlideScope®, but improved with the CMAC® [1.32 (1.08-1.62); P=0.007] compared with DL. There was greater first-pass intubation with VL compared with DL amongst novice/trainee clinicians [OR=1.95 (1.45-2.64); P<0.001], but not amongst experienced clinicians or paramedics/nurses. There was no difference in first-pass intubation with VL compared with DL during cardiopulmonary resuscitation or trauma. VL compared with DL was associated with fewer oesophageal intubations [OR=0.32 (0.14-0.70); P=0.003], but more arterial hypotension [OR=1.49 (1.00-2.23); P=0.05]. In summary, VL compared with DL is associated with greater first-pass emergency intubation in the ICU and amongst less experienced clinicians, and reduces oesophageal intubations. However, VL is associated with greater incidence of arterial hypotension. Further trials investigating the utility of VL over DL in specific situations are required.

Variante de las venas hemiácigos: ¿vena ácigos izquierda? reporte de un caso / Variant of the hemiazygos veins: left azygos vein? a case report

INTRODUCCIÓN: El sistema venoso ácigos-hemiácigos es imprescindible en el drenaje del tórax. Estos vasos se originan en la etapa embrionaria a partir de las venas supracardinales, con una serie de afluentes que parten de la pared torácica y mediastino principalmente, encontrando variedades, como nuestro hallazgo, mismos que deben ser considerados en la práctica médica. PRESENTACIÓN DEL CASO: Se presenta un caso encontrado en una disección de pieza cadavérica, de sexo masculino, en el cual se halló un tronco venoso paralelo al lado izquierdo de la columna, que resultaría de la unión de las venas hemiácigos; originándose por la confluencia de la vena subcostal y lumbar ascendente, drenando en la vena braquiocefálica del mismo lado, muy parecido a la vena ácigos, sin conexión entre ambas. DISCUSIÓN: Son muchas las variedades reportadas en diversos estudios, encontrando una clasificación de dichas anomalías en tres tipos, correspondiendo nuestro caso a la variedad tipo I, con una incidencia del 1%; dichas alteraciones pueden originarse en etapa embrionaria por la falta de diferenciación de las venas supracardinales. De esta manera, resaltamos la importancia de estas variantes en el ámbito clínico, quirúrgico e imagenológico. CONCLUSIÓN: El presente hallazgo resulta ser un caso muy particular, a diferencia de otros estudios revisados, por lo que sería pertinente ampliar el trabajo para obtener la incidencia del mismo

INTRODUCTION: The azygos-hemiazygos venous system is necessary in the drainage of the thorax. These vessels originate in the embryological phase from the supracardinal veins, with a series of tributaries that begin in the thoracic Wall and mediastinum mainly, finding varieties, such as our finding, which must be considered in medical practice. CASE PRESENTATION: In a male corpse dissection we found a venous trunk parallel to the left side of the vertebral column which would result in the joining of the hemiazygos veins; beginning in the confluence of the subcostal vein and ascending lumbar, draining in the brachiocephalic vein on the same side, similar to the azygos vein, without any connection between them. DISCUSSION: There are many varieties reported in diverse studies, which can be categorized in three types. Ours corresponds to type I, with an incidence of 1%. Such varieties can originate in embryological phase due to the lack of differentiation of supracardinal veins. We can highlight the importance of such varieties in the clinical and surgical fields. CONCLUSION: Our finding is a very particular case, unlike other revised studies, which is why it would be pertinent to further research this topic

Effect of oocyte maturation time, sperm selection method and oxygen tension on in vitro embryo development in alpacas.

We evaluated the effect of in vitro maturation time, sperm selection and oxygen tension on alpaca embryo development. In Experiment I, Cumulus Oocyte- Complexes (COCs) were obtained from abattoir ovaries and in vitro matured in TCM-199 for 24 (n = 217), 28 (215), or 32 h (223) at 38.5 °C, high humidity and 5% CO2 in air. Oocytes from 24 (n = 392), 28 (n = 456) or 32 (n = 368) h groups were in vitro fertilized with epididymal sperm and cultured in SOFaa at 38.5 °C, high humidity and 5% CO2, 5% O2 and 90% N2 for 7 days. Embryo development was evaluated on Day 2, 5 and Day 7 of in vitro culture (Day 0 = in vitro fertilization). In Experiment II, a 2 by 2-factorial design was used to determine the effect of sperm selection (Swim-up vs Percoll) and oxygen tension (20% vs 5%) during embryo culture and their interaction on embryo development. COCs were in vitro matured for 32 h at 38.5 °C and 5% CO2 in air and then in vitro inseminated with epididymal sperm processed by swim-up or Percoll. Zygotes were cultured in SOFaa + cumulus cells at 38.5 °C under 20 or 5% of O2 tension and high humidity for 7 days. A total of 235, 235, 253 and 240 oocytes were assigned to: swim-up+20 O2, swim-up+5 O2 or Percoll+20 O2, Percoll+5 O2, groups respectively. The proportion of oocytes reaching MII stage was highest after 32 h of in vitro maturation (P < 0.05). Blastocyst rate (29.1 ± 2.7%) was also highest for COCs matured for 32 h (Exp I). In Experiment II, Blastocysts rate (26.03 ± 4.7; 27.7 ± 4.3; 29.7 ± 3.8 and 27.6 ± 4.2% for swim-up+20 O2, swim-up+5 O2 or Percoll+20 O2, Percoll+5 O2, respectively) was not affected by sperm selection method (P = 0.8), oxygen tension (P = 0.9) or their interaction (P = 0.5).

Carbofuran degraded by iron-doped anatase: Weakening the cholinesterase inhibitory activity in the photoproducts mixture.

Carbofuran is a toxic carbamate pesticide, and its use has increased in recent years. While marketing information indicates stability in different chemical media, carbofuran exhibits relative photolability. The aim of this research was to decompose carbofuran and to identify the photoproducts achieved when two different doped titania photocatalysts were employed under UV irradiation. The iron-doped TiO2 materials were obtained (a) via a hydrothermal method and (b) by an ultrasound-assisted sol-gel method. The precursors were TiOSO4⋅xH2O and Fe3(NO3)·9H2O. X-ray studies confirmed that the anatase phase of the iron-doped TiO2 resulted from the two preparation methods. The photocatalytic performance of the prepared materials was monitored by LC/ESI-QTOF-MS, enabling the identification of photoproducts: oxo-carbamates, hydroxylated benzofuranes, a carboxamide, and one amine. By using the iron-doped TiO2 materials, 2,2-dimethyl-2,3-dihydrobenzofuran-3,7-diol was the most abundant photoproduct, and N,2,2-trimethyl-2,3-dihydrobenzofuran-7-amine was the only compound that had not been previously reported in the photolysis and photocatalysis of carbofuran. The product 3-hydroxy carbofuran, a cholinesterase inhibitor, was quantified and was found to be transformed into compounds that lack this inhibitive property.

Randomized controlled trial of the Valencia model of waking hypnosis plus CBT for pain, fatigue, and sleep management in patients with cancer and cancer survivors.

BACKGROUND: This study evaluated the efficacy of an intervention combining the Valencia model of waking hypnosis with cognitive-behavioral therapy (VMWH-CBT) in managing cancer-related pain, fatigue, and sleep problems in individuals with active cancer or who were post-treatment survivors. We hypothesized that four sessions of VMWH-CBT would result in greater improvement in participants' symptoms than four sessions of an education control intervention. Additionally, we examined the effects on several secondary outcome domains that are associated with increases in these symptoms (depression, pain interference, pain catastrophizing, and cancer treatment distress). METHODS: The study design was a randomized controlled crossover clinical trial comparing the VMWH-CBT intervention with education control. Participants (N = 44) received four sessions of both treatments, in a counterbalanced order (n = 22 per order condition). RESULTS: Participants were 89% female (N = 39) with mean age of 61 years (SD = 12.2). They reported significantly greater improvement after receiving the active treatment relative to the control condition in all the outcome measures. Treatment gains were maintained at 3-month follow-up. CONCLUSIONS: This study supports the beneficial effects of the VMWH-CBT intervention relative to a control condition and that treatment gains remain stable. VMWH-CBT-trained clinicians should be accessible for managing symptoms both during and after cancer treatment, though the findings need to be replicated in larger samples of cancer survivors.

Electrocardiographic waveforms fitness check device technique for sudden cardiac death risk screening.

A novel cardiac health device technique development for reliable, non-invasive and cost-effective heart screening in preventive cardiovascular healthcare is presented. In particular, identification of apparently healthy individuals involved in sports activities (particularly in the young, age <; 35 years) who may be at-risk of sudden-cardiac-death (SCD) is mainly focused here. Nevertheless, the same device technique may be prospectively extended for detecting cardiovascular abnormalities in children and adolescents with type1-diabetes, and also in detecting patients with Brugada syndrome. The device system has been aimed to provide a single figure diagnostic output, thus, not requiring highly-skilled medical personnel. The principles of the required ECG-waveform analysis algorithm have been reported in previous clinical studies. A prototype system platform design that will enable low-cost, portability and key user-friendly characteristics was implemented and in-vitro tested. Real-time firmware integrity and cardiac fitness detection algorithm performed reliably with an in-vitro positive SCD ECG-waveform modelling technique.