Zephyr 375 urinary sphincter implant by unical perineal incision. Initial experience.

The treatment of male severe stress incontinence (MUI) after surgery is the implantation of an artificial urinary sphincter (AUS). Traditionally you need two incisions: perineal and inguinal. Our objetive is present a series of patients treated with the Zephyr 375 EUA implant through a single perineal incision. We present six men operated on for MUI after Transuretral resection of the prostate (TURP) (1) and radical prostatectomy (5). Preoperatively we perform Pad-Test and cystoscopy. Under epidural anesthesia, a vertical perineal incision was made and dissection up to the bulbospongiosus muscle was divided and we dissected the bulbar urethra. After removing the probe, we place the cuff, checking that it reaches the appropriate pressure, leaving it deactivated. To place the pump-reservoir, we digitally develop a scrotal dartos pocket from the perineum that we close with Vicryl 3/0. After closing the muscle with 3/0 Vicryl, we left a suction drain and a bladder catheter. The mean age was 63 years (55-72). Mean surgical time was 68 minutes (60-85). All were discharged the next day without catheter and drain. All patients comfortably palpated the scrotal reservoir-pump. After activation, all patients were continent without needing additional adjustment, using 3 a safety pad. The degree of satisfaction was very high, all of them affirmed that they would undergo the same intervention again. The Zephyr 375 urinary sphincter allows placement through a single perineal incision, reducing surgical time, simplifying the technique, and reducing morbidity without compromising the functional outcome.

New analytical method for the determination of endocrine disruptors in human faeces using gas chromatography coupled to tandem mass spectrometry.

Endocrine-disrupting chemicals are environmental pollutants that can enter our bodies and cause diverse pathologies. Some bisphenols and parabens have been shown to be capable of modifying proper functioning of the endocrine system. Among other dysfunctions, endocrine-disrupting chemicals can cause changes in intestinal microbiota. Faeces are a convenient matrix that can be useful for identifying the quantity of endocrine disruptors that reach the intestine and the extent to which the organism is exposed to these pollutants. The present work developed a new analytical method to determine 17 compounds belonging to the paraben and bisphenol families found in human faeces. The extraction method was optimized using an ultrasound-assisted extraction technique followed by a clean-up step based on the QuEChERS (Quick, Easy, Cheap, Effective, Rugged and Safe) technique. Optimization was performed using the design of experiments technique. In validation analysis, the method was proven to be linear over a wide range. R-squared outcomes were between 95 and 99%. Selectiveness and sensitivity outcomes were acceptable, with detection limits being between 1 and 10 ng g-1 in all cases, whilst quantification limits were between 3 and 25 ng g-1 in all instances, with the exception of bisphenol AF. The method was deemed accurate, with recovery values being close to 100% and relative standard deviations being lower than 15% in all cases. Applicability was examined by analysing 13 samples collected from volunteers (male and female). All samples were contaminated with at least one of the analytes studied. The most commonly found compounds were methylparaben and bisphenol A, which were detected in almost all samples and quantitatively determined in 11 and 12 samples, respectively. Of the 17 compounds analysed, 11 were found in at least one sample. Outcomes demonstrate that faeces can be a good matrix for the determination of exposure to contaminants of interest here.

Reducing preoperative anxiety in parents of surgical patients.

Aims and objectives: To investigate preoperative anxiety in parents of paediatric surgical patients, testing whether the provision of information (using video and story books) regarding the surgical process can impact on reducing anxiety. Analyse if any personal factors influence the reduction of anxiety. Background: Attending a surgical theatre generates anxiety, especially in the case of children. The effect of different preoperative intervention procedures in children that attempt to reduce their anxiety level have been studied a great deal. However, although their parents also suffer high levels of anxiety, potential intervention to reduce their levels has not received the same attention. Study design: Randomised Clinical trial. Methods: One hundred and twenty-five parents of children (8-12 y.o.) undergoing surgery in a public hospital were randomly assigned to the control group CG (34 individuals) or one of the 3 experimental groups EG (91). In this Randomised Controlled Study, children and parents of the experimental groups were provided with a story book, a video with additional information of nursing, or both. Prior to the surgical intervention, the State Anxiety, S-A, and Trait Anxiety, T-A, of the parents and children were measured using the STAI and STAIC questionnaires respectively. Data collection was carried out for 12 months starting in October 2016. Results: Parents' S-A in the control group was higher than in the experimental groups. A linear model explains the parents' S-A using as regressors: children S-A, age and T-A of the parents, and children age. Conclusions: Providing information about the surgical process (through stories or videos) to which a child is going to be subjected can reduce the anxiety of the parents. Relevance to clinical practice: Given their close connection to the patient and the potential effects on the children of their psychological situation, healthcare professionals should consider paying greater attention to communicating with the parents.

Results of a Phase II Trial Testing the Resensitization With Trabectedin in Platinum-resistant Ovarian Cancer.

BACKGROUND/AIM: In patients with advanced platinum-resistant ovarian cancer we prospectively evaluated whether trabectedin could resensitize the tumor cells to platinum rechallenge. PATIENTS AND METHODS: Upon progression to platinum-based chemotherapy, trabectedin was administered as a 3-hour infusion every three weeks and subsequently crossed over to carboplatin/carboplatin-based combinations. The primary endpoints comprised objective response rate (ORR) and time to progression after trabectedin (TTP Trab). Secondary endpoints included ORR following platinum post-trabectedin, the growth modulation index (GMI) assessed as the ratio of successive TTP to platinum, given after (TTP2) and before (TTP1) trabectedin, quality of life (QoL), and ancillary translational studies. RESULTS: Ten patients with platinum-resistant ovarian cancer from a single institution were treated with trabectedin, one of whom achieved a partial response (PR) reaching the ORR of 10% and six had stable disease (SD) for a disease control rate (DCR) of 70%. After the treatment with platinum post-trabectedin, one patient achieved a PR and two had SD, attaining a rate of resensitization to platinum of 37.5%. The median TTP with trabectedin treatment was 15.0 weeks, while eight patients who received platinum post-trabectedin had the median TTP2 of 19.9 weeks. One patient reached the threshold of GMI >1 (12.5%) as indicator of clinical benefit. QoL of patients was not deteriorated with trabectedin. Predictive biomarkers of response to trabectedin and/or re-exposure to platinum could not be identified. CONCLUSION: Although trabectedin did not achieve a wide resensitization to platinum in this heavily pretreated platinum-resistant population, a significant number of patients attained disease control.

Chronic gemcitabine-induced thrombotic microangiopathy in the kidneys / Microangiopatía trombótica crónica localizada en riñones asociada al uso de gemcitabina

Abstract Thrombotic microangiopathies (TMAs) are characterized by microvascular occlusion secondary to diffuse endothelial damage which produces inflammation, platelet aggregation and red blood cell destruction, causing ischemic injury to the affected organ. They are clinically characterized by Coombs-negative microangiopathic hemolytic anemia, and multiple organ damage (mainly of the kidneys, central nervous system, cardiovascular apparatus and gastrointestinal tract). They may occur systemically or locally, and they have multiple etiologies. In patients with cancer, determining the cause of thrombotic microangiopathy is a great diagnostic challenge, with the most frequent etiologies being active malignant neoplasms, disseminated intravascular coagulation, infections and antineoplastic drugs. We present the clinical case of a patient with unresectable pancreatic adenocarcinoma on chronic gemcitabine treatment, and highlight the importance of suspecting and distinguishing chemotherapy-induced TMAs from neoplasm-induced TMAs, as their prognosis and treatment are very different. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2249).

Resumen Las microangiopatías trombóticas (MAT) se caracterizan por la oclusión microvascular como consecuencia de una lesión endotelial difusa que produce inflamación, agregación plaquetaria y destrucción de glóbulos rojos, causando daño isquémico del órgano afectado. Se caracterizan clínicamente por anemia hemolítica microangiopática, Coombs negativo, daño multiorgánico (principalmente de riñones, sistema nervioso central, aparato cardiovascular y tracto gastrointestinal). Su presentación puede ser sistémica o localizada y sus etiologías son múltiples. En los pacientes con cáncer es un gran reto diagnóstico establecer la causa de la microangiopatía trombótica, siendo las etiologías más frecuentes la neoplasia maligna activa, la coagulación intravascular diseminada, infecciones y medicamentos antineoplásicos. Se presenta el caso clínico de una paciente con adenocarcinoma cáncer de páncreas irresecable, en manejo crónico con gemcitabina y se resalta la importancia de sospechar y distinguir la MAT inducida por quimioterapia, de la causada por la neoplasia ya que el pronóstico y tratamiento son muy diferentes. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2249).

[Characterization of congenital cataract and postoperative visual outcome in a Pediatric Ophthalmology Unit in a middle-income country]. / Caracterización de catarata congénita y resultado visual postoperatorio en una Unidad de Oftalmología Pediátrica en un país de ingresos medios.

The functional visual outcome after cataract surgery is influenced by several factors such as the age at diagnosis and surgical treatment, as well as visual rehabilitation. OBJECTIVE: to characterize con genital cataract patients and assess the postoperative visual outcome in an ophthalmological care center in Guatemala. PATIENTS AND METHOD: A cross-sectional retrospective study. Clinical records of all congenital cataract patients who underwent congenital cataract surgery from 2014 and 2015 were reviewed. The following was recorded: postoperative visual acuity, age at diagnosis and surgery, sex, unilateral or bilateral involvement, etiology and morphology of the cataract, preoperative poor visual prognosis factors, and postoperative follow-up. RESULTS: Fifty-nine patients underwent pediatric ca taract surgery in this period, ages ranging from 1 month to 13 years (median 48 months), and 23 were congenital (38.98%). Fourteen were male, 16 bilateral, and the mean age at diagnosis and surgery was 7 and 12 months, respectively. Only 13 patients completed 3 years of follow-up visits. Visual acuity was recorded at 3 years after surgery, observing in 11 patients and 8 patients visual impairment or worse, respectively. Delayed consultations occurred in 82.6% of the patients (older than 3 months of age). CONCLUSION: In this series, the diagnosis of congenital cataract and its surgical treatment were delayed, observing a high rate of patients unable to complete follow-up visits. The visual outcome at 3 years after congenital cataract surgery was mostly visual impairment or worse.

"Malignant" origin of the left coronary artery, case report / Origen «maligno¼ de arteria coronaria izquierda, reporte de caso

Anomalous origin of the coronary arteries are very infrequent, however their diagnosis has been increasing due to the increase in the use of coronary computer tomography angiography (CCTA) within the algorithm of patients with suspected coronary disease; We present a case of a patient with acute on chronic chest pain in whom an anomalous origin was diagnosed with an interarterial "malignant" course of the left coronary artery, who was taken to surgery with complete improvement of symptoms and quality of life.

El origen anómalo de las arterias coronarias (OAAC) es muy infrecuente, sin embargo, su diagnóstico ha ido en aumento por el incremento en el uso de la angiotomografía coronaria por tomografía dentro del algoritmo del paciente con sospecha de enfermedad coronaria. Presentamos el caso de un paciente con dolor torácico crónico agudizado en quien se diagnosticó un OAAC de la coronaria izquierda con curso interarterial «maligno¼, que fue llevado a cirugía, con mejoría completa de síntomas y en calidad de vida.

Evaluation of the Effect of Hydroxyzine on Preoperative Anxiety and Anesthetic Adequacy in Children: Double Blind Randomized Clinical Trial.

Surgical procedures can generate significant preoperative anxiety (POA) in as much as 70% of the paediatric population. The role of hydroxyzine and distractive techniques such as clowns in the management of anxiety is controversial. Our main objective was to evaluate the effect of hydroxyzine on the control of POA. The secondary objective was to assess the potential additive effect of hydroxyzine and distracting techniques. We performed a randomized double-blind, controlled clinical trial in children aged 2-16 years undergoing outpatient surgery (n = 165). Subjects were randomized to hydroxyzine (group 1) or placebo (group 2). For the secondary objective, two further groups were made by allocation by chance to hydroxyzine plus accompaniment with clowns (group 3) and placebo plus clowns (group 4). All patients were accompanied by their parents as the standard procedure. POA was determined by a modified Yale scale of POA (m-YPAS). Compliance of children during induction of anesthesia (Induction Compliance Checklist (ICC)) was also assessed. No differences (p = 0.788) were found in POA control at the time of induction measured by m-YPAS (group 1: 39.2 ± 27.9; group 2: 37.0 ± 26.1; group 3: 34.7 ± 25.5; group 4: 32.4 ± 20.5). No differences were found in the level of ICC between the different treatment arms (group 1: 1.8 ± 3.4; group 2: 1.5 ± 3.0; group 3: 1.2 ± 2.4; group 4: 1.5 ± 2.7). The combination of all treatments (group 3) was the only effective strategy to contain the progression of anxiety. In conclusion, hydroxyzine was not effective to control POA in children. The combination of hydroxyzine and clowns avoided the progression of POA in our patients. This trial is registered with ClinicalTrials.gov identifier: NCT03324828 (registered 21 September 2017, subject recruitment started on 12th January 2018).

Latin American ophthalmology practitioner's perception on current COVID-19 pandemic / Percepção do profissional latino-americano de oftalmologia sobre a atual pandemia de COVID-19

ABSTRACT Purpose: To assess the perception of Latin American ophthalmology practitioners regarding coronavirus disease 2019 (COVID-19) exposure risk, knowledge about personal protection measures, and prioritization of patients. Methods: Self-administered voluntary anonymous survey (Google Drive forms) was distributed via text message to ophthalmology practitioners from May 01 to May 05, 2020. Results: Three hundred seventy-one practitioners (45% response rate) comprising 118 (27.6%) residents, 111 (40.5%) ophthalmologists, and 142 (32.8%) sub-specialists completed the survey. Among them, 106 (32.6%) thought that they were at a high risk of acquiring COVID-19 during the course of work. Furthermore, 273 (69.1%) believed that the current guidelines were insufficient to identify COVID-19 patients. The survey also revealed that 265 (59.5%) were not trained to use personal protective equipment (PPE), and even with its correct use, 341 (91.5%) still felt that they were at risk of acquiring COVID-19. Moreover, 80% of the respondents were of the view that staff members were not knowledgeable about national protocols for attending COVID-19 patients. However, only 9 (2%) considered changing their profession to ameliorate COVID-19 contagion risk. Conclusion: This survey has revealed the issues faced by ophthalmology practitioners in Latin America during their routine practice. These concerns and anxiety about COVID- 19 pandemic seem to be the same worldwide. It is important to reinforce the confidence of ophthalmology practitioners on current guidelines for attending COVID-19 patients. It is also necessary to conduct training programs on PPE usage and ensure that PPE items are available at all times to enhance the quality of care and minimize the spread of the disease.

RESUMO Objetivos: Avaliar a percepção do risco de exposição da Doença de Coronavírus 2019 (COVID-19), conhecimento sobre medidas de proteção pessoal entre os profissionais de oftalmologia latino-americanos e priorização de pacientes com Covid-19. Métodos: Pesquisa anônima voluntária autoadministrada (formulários do Google Drive) distribuída por mensagem de texto para profissionais de oftalmologia em 1º a 5 de maio de 2020. Resultados: Trezentos e setenta e um profissionais completaram a pesquisa (taxa de resposta de 45%), composta por 118 residentes (27,6%), 111 oftalmologistas (40,5%) e 142 subespecialistas (32,8%). 106 profissionais (32,6%) sentiram-se em alto risco de adquirir o COVID-19 no trabalho. 273 (69,1%) acreditavam que as diretrizes atuais não são suficientes para identificar os pacientes com COVID-19. 265 (59,5%) não tinham treinamento para usar os equipamentos de proteção individual (EPI) e, mesmo com seu uso correto, 341 (91,5%) ainda se sentiram em risco de adquirir COVID-19. 80% consideraram que a equipe de trabalho não tem conhecimento de protocolos nacionais para o atendimento aos pacientes com COVID-19. Apenas 9 dos profissionais (2%) consideraram mudar a profissão para minimizar o risco de contágio por COVID-19. Conclusão: Esta pesquisa mostra a escassez de pessoal e treinamento específico que os praticantes de oftalmologia na América Latina enfrentam em sua prática diária. Essas preocupações e ansiedade parecem ser as mesmas em todo o mundo com a pandemia de COVID- 19. É importante reforçar a confiança dos profissionais de oftalmologia nas diretrizes atuais de atendimento ao paciente com COVID-19 e também disponibilizar programas de treinamento sobre o uso de EPI e também itens de EPI disponíveis em todos os momentos para garantir a qualidade do atendimento e a disseminação mínima da doença.

Latin American ophthalmology practitioner's perception on current COVID-19 pandemic.

PURPOSE: To assess the perception of Latin American ophthalmology practitioners regarding coronavirus disease 2019 (COVID-19) exposure risk, knowledge about personal protection measures, and prioritization of patients. METHODS: Self-administered voluntary anonymous survey (Google Drive forms) was distributed via text message to ophthalmology practitioners from May 01 to May 05, 2020. RESULTS: Three hundred seventy-one practitioners (45% response rate) comprising 118 (27.6%) residents, 111 (40.5%) ophthalmologists, and 142 (32.8%) sub-specialists completed the survey. Among them, 106 (32.6%) thought that they were at a high risk of acquiring COVID-19 during the course of work. Furthermore, 273 (69.1%) believed that the current guidelines were insufficient to identify COVID-19 patients. The survey also revealed that 265 (59.5%) were not trained to use personal protective equipment (PPE), and even with its correct use, 341 (91.5%) still felt that they were at risk of acquiring COVID-19. Moreover, 80% of the respondents were of the view that staff members were not knowledgeable about national protocols for attending COVID-19 patients. However, only 9 (2%) considered changing their profession to ameliorate COVID-19 contagion risk. CONCLUSION: This survey has revealed the issues faced by ophthalmology practitioners in Latin America during their routine practice. These concerns and anxiety about COVID- 19 pandemic seem to be the same worldwide. It is important to reinforce the confidence of ophthalmology practitioners on current guidelines for attending COVID-19 patients. It is also necessary to conduct training programs on PPE usage and ensure that PPE items are available at all times to enhance the quality of care and minimize the spread of the disease.

Metodología de canales endémicos del dengue en Ecuador 2015-2020: Necesidad para planificar y administrar la salud pública / Methodology of endemic channels of dengue, Ecuador 2015-2020: Need to plan and manage public health

El Dengue es la enfermedad de más rápida propagación en el mundo y una permanente amenaza para la salud pública, puesto que la mitad de la población global corre el riesgo de contraer la enfermedad. Ante la gravedad del cuadro de la enfermedad a nivel nacional y mundial, es necesario generar nuevas metodologías de predicción útiles para la adopción de decisiones en salud pública. Por ello, se caracterizó los casos notificados de dengue entre el 2015 y el 2020 en Ecuador. Se hizo un estudio descriptivo retrospectivo, utilizando la base de datos de las gacetas oficiales, caracterizando los casos de dengue. Se elaboraró un canal endémico describiendo la metodología empleada. Se evidenció que la tendencia del dengue en provincias es positiva, lo que indica que en los últimos cinco años se ha incrementado el número de casos, junto a la afectación de un ciclo epidemiológico común en el primer periodo de cada año del último quinquenio. El estudio de los datos actuales de la enfermedad del dengue en Ecuador, su tendencia epidémica y el contexto en que se desarrolla, permiten concluir en la importante necesidad de planificar y administrar la salud pública, aplicando la metodología planteada de elaboración de canales endémicos en la vigilancia de situaciones de interés en salud pública que conlleven a acciones de control de alcance tanto nacional como territorial que se sostengan el tiempo(AU)

Dengue is the fastest spreading disease in the world and a permanent threat to public health, since half of the global population is at risk of contracting the disease. Given the seriousness of the disease at the national and global level, it is necessary to generate new useful prediction methodologies for decision-making in public health. Therefore, the reported cases of dengue between 2015 and 2020 in Ecuador were characterized. A retrospective descriptive study was carried out, using the official gazette database, characterizing dengue cases. An endemic channel was developed describing the methodology used. It was evidenced that the dengue trend in the provinces is positive, which indicates that in the last five years the number of cases has increased, together with the involvement of a common epidemiological cycle in the first period of each year of the last five years. The study of current data on dengue disease in Ecuador, its epidemic trend and the context in which it develops, allow us to conclude on the important need to plan and administer public health, applying the methodology proposed for the elaboration of endemic channels in the surveillance of situations of interest in public health that lead to control actions of both national and territorial scope that are sustained over time(AU)

Specific inhibition of IL-6 receptor attenuates inflammatory bone loss in experimental periodontitis.

BACKGROUND: Periodontal pathogenesis takes into consideration that disease results from a complex inflammatory immune response. Among the major cytokines related to periodontal damage, interleukin (IL)-6 enhances a cascade of tissue destruction. Tocilizumab (TCZ) is a humanized monoclonal anti-human IL-6 receptor that inhibits IL-6-mediated proinflammatory activity. This study aimed to elucidate whether TCZ inhibits the deleterious effect of ligature-induced periodontitis. METHODS: Experimental ligature-induced periodontitis was treated with systemic administration of TCZ intraperitoneally in three different concentration dosages (2 mg/kg, 4 mg/kg, and 8 mg/kg. Euthanasia occurred at 7 and 14 days after the initiation of the study. Local changes in the alveolar bone were measured by bone volume, the ratio of bone volume, and trabecular thickness using microcomputed tomography. Attachment loss and inflammatory infiltrate were evaluated by histology. Immune response was analyzed focusing on the Th17 pattern. RESULTS: TCZ inhibited alveolar bone resorption and attachment loss in 7 and 14 days for all dosage groups in comparison to controls (P  < 0.05). Besides, TCZ induced lower expression of inflammatory infiltrate (P <0.05) and less production of Th17-related cytokines (P <0.05) and RANKL (P <0.05). CONCLUSIONS: The inhibition of IL-6-mediated proinflammatory activity by IL-6R blocking reduced alveolar bone resorption and attachment loss supported by the modulation of the Th17 periodontal response. Considering the inflammatory status, modulatory therapy may be a promising approach to periodontal disease.

Trigeminal nerve injuries. Four years' experience at a single Argentine referral center and a literature review.

The aim of this retrospective study was to describe the etiology and characteristics of trigeminal nerve injuries referred to a specialized center in Buenos Aires, Argentina. A retrospective analysis was performed of patients referred from February 2016 to January 2020. Age, sex, intervention performed, nerve affected, time elapsed from injury, diagnosis, location, and whether patient had signed informed consent were recorded. A descriptive analysis of the data was made, and 95% confidence intervals were calculated for prevalence. The study sample consisted of 30 subjects (31 nerve injuries), 19 female and 11 male, average age (±SD) 40 ± 17 years. The inferior alveolar nerve was the most frequently injured nerve (74%,) while the lingual nerve accounted for 26%. The most common etiologies were inferior molar extractions (47%), dental implants (20%), and local anesthesia (13%). Other etiologies were autologous mandibular bone grafts for dental implants, removal of cysts associated with the inferior third molar, and endodontic treatment. Dental Institutions at which treatment was provided were found to be significantly associated with patients being warned and asked to sign informed consent (p<0.05), while dentists working at private offices requested fewer consents. The most frequent symptom was paresthesia, and 5 patients suffered spontaneous or evoked pain. Only 2 patients intended to file legal claims. Dentists should be aware of the debilitating effects resulting from trigeminal injuries, the complexity of their resolution and the importance of carefully planning dental procedures to prevent them.

El objetivo de este estudio fue describir la etiología y características de las lesiones del nervio trigémino remitidas a un servicio de referencia especializado en Buenos Aires, Argentina. Se realizó un análisis retrospectivo de los pacientes remitidos desde febrero de 2016 a enero de 2020. Se registraron edad, género, intervención recibida, nervio afectado, tiempo transcurrido desde la lesión, diagnóstico, ubicación y firma del consentimiento informado previo a la intervención Se realizó un análisis descriptivo de los datos y se calcularon intervalos de confianza del 95%. La muestra del estudio consistió en 30 sujetos (31 lesiones nerviosas), 19 mujeres y 11 hombres, con una edad promedio (± DE) de 40 ± 17 años. Aproximadamente 3 de cada 4 lesiones correspondieron al nervio alveolar inferior, representando el resto al nervio lingual. Las etiologías más frecuentes fueron la extracción dentaria (47%), los implantes dentales (20%) y la aplicación anestesia local (13%). Otras etiologías fueron la regeneración ósea para la colocación de implantes mandibulares, la extirpación de quistes asociados al tercer molar inferior y el tratamiento endodóntico. Se encontró que el tipo de establecimiento donde se realizó el procedimiento odontológico que generó la lesión, se asoció significativamente con los pacientes a los que se les advirtió y se les pidió que firmen el consentimiento informado (p<0.05); los odontólogos que trabajan en consultorios privados obtienen una menor proporción de consentimientos que los de las instituciones. El síntoma más frecuente fue la parestesia y 5 pacientes sufrieron dolor espontáneo o evocado. Solo 2 pacientes tenían intención de iniciar acciones legales. Teniendo en cuenta que son lesiones potencialmente permanentes, y de resolución compleja, la comunidad odontológica debe realizar especiales esfuerzos para disminuir esta complicación.

Trigeminal nerve injuries. Four years' experience at a single Argentine referral center and a literature review / Lesiones del nervio trigémino. Cuatro años de experiencia de un servicio quirúrgico odontológico en Argentina y revisión bibliográfica

ABSTRACT The aim of this retrospective study was to describe the etiology and characteristics of trigeminal nerve injuries referred to a specialized center in Buenos Aires, Argentina. A retrospective analysis was performed of patients referred from February 2016 to January 2020. Age, sex, intervention performed, nerve affected, time elapsed from injury, diagnosis, location, and whether patient had signed informed consent were recorded. A descriptive analysis of the data was made, and 95% confidence intervals were calculated for prevalence. The study sample consisted of 30 subjects (31 nerve injuries), 19 female and 11 male, average age (±SD) 40 ± 17 years. The inferior alveolar nerve was the most frequently injured nerve (74%,) while the lingual nerve accounted for 26%. The most common etiologies were inferior molar extractions (47%), dental implants (20%), and local anesthesia (13%). Other etiologies were autologous mandibular bone grafts for dental implants, removal of cysts associated with the inferior third molar, and endodontic treatment. Dental Institutions at which treatment was provided were found to be significantly associated with patients being warned and asked to sign informed consent (p<0.05), while dentists working at private offices requested fewer consents. The most frequent symptom was paresthesia, and 5 patients suffered spontaneous or evoked pain. Only 2 patients intended to file legal claims. Dentists should be aware of the debilitating effects resulting from trigeminal injuries, the complexity of their resolution and the importance of carefully planning dental procedures to prevent them.

RESUMEN El objetivo de este estudio fue describir la etiología y características de las lesiones del nervio trigémino remitidas a un servicio de referencia especializado en Buenos Aires, Argentina. Se realizó un análisis retrospectivo de los pacientes remitidos desde febrero de 2016 a enero de 2020. Se registraron edad, género, intervención recibida, nervio afectado, tiempo transcurrido desde la lesión, diagnóstico, ubicación y firma del consentimiento informado previo a la intervención Se realizó un análisis descriptivo de los datos y se calcularon intervalos de confianza del 95%. La muestra del estudio consistió en 30 sujetos (31 lesiones nerviosas), 19 mujeres y 11 hombres, con una edad promedio (± DE) de 40 ± 17 años. Aproximadamente 3 de cada 4 lesiones correspondieron al nervio alveolar inferior, representando el resto al nervio lingual. Las etiologías más frecuentes fueron la extracción dentaria (47%), los implantes dentales (20%) y la aplicación anestesia local (13%). Otras etiologías fueron la regeneración ósea para la colocación de implantes mandibulares, la extirpación de quistes asociados al tercer molar inferior y el tratamiento endodóntico. Se encontró que el tipo de establecimiento donde se realizó el procedimiento odontológico que generó la lesión, se asoció significativamente con los pacientes a los que se les advirtió y se les pidió que firmen el consentimiento informado (p<0.05); los odontólogos que trabajan en consultorios privados obtienen una menor proporción de consentimientos que los de las instituciones. El síntoma más frecuente fue la parestesia y 5 pacientes sufrieron dolor espontáneo o evocado. Solo 2 pacientes tenían intención de iniciar acciones legales. Teniendo en cuenta que son lesiones potencialmente permanentes, y de resolución compleja, la comunidad odontológica debe realizar especiales esfuerzos para disminuir esta complicación.

Effect of chemoradiation on the size of the thyroid gland.

We aimed to evaluate changes in thyroid gland size during the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation. We performed a retrospective review of records of adult patients treated at our institution with external beam radiation to the chest and/or chemotherapy with taxanes, alkylating agents, and/or a topoisomerase II inhibitor. Neck and chest computed tomography (CT) images were used to calculate thyroid gland volume before and after therapy, using Vitrea® software or the volumetric ellipsoid method. Thirty-seven patients were included. After treatment, there was a significant reduction in thyroid gland volume of 14.0% (P < 0.01) using Vitrea and 17.1% (P < 0.05) using the volumetric ellipsoid method. Exposure to radiation or chemotherapy was not found to be associated with the degree of thyroid gland reduction, nor was the number of days between CT scans or the stage of the malignancy being treated. Finally, the degree of thyroid gland size reduction did not predict mortality. Our results showed that the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation results in a reduction in thyroid gland size. The impact on thyroid gland function remains unknown.

Pre-operative anxiolysis in children through a combined pharmacological therapy with hydroxyzine and a non-pharmacological distraction technique with a clown (SONRISA): study protocol for randomised double-blind clinical trial.

BACKGROUND: Surgery can generate significant stress and anxiety in up to 70% of the paediatric population. There are several pharmacological and non-pharmacological strategies to reduce pre-operative anxiety in children, however, they have several side effects and the available information about them is contradictory. The role of clowns and hydroxyzine in the management of anxiety is controversial, with some studies supporting and others contraindicating both strategies. METHODS: We propose a randomised double-blind, controlled clinical trial that will evaluate the effectiveness of both interventions (hydroxyzine and clowns), alone or in combination, to reduce pre-operative anxiety (using the modified Yale scale of preoperative anxiety) in children aged 2-16 years undergoing outpatient surgery (n = 188). Subjects will be randomised into two groups - (1) standard procedure (parental accompaniment) combined with placebo or (2) standard procedure combined with preoperative hydroxyzine. After randomisation, they will be divided by chance into two further groups, depending on the presence of clowns on the patient's surgery day. Control of pre-operative anxiety will be determined in the four groups by a modified Yale scale of preoperative anxiety and cortisol levels. Compliance of children during induction of anaesthesia, time until anaesthesia recovery, presence of postoperative delirium and use of analgesia until discharge will be also assessed. For additional information, the children, parents and healthcare professionals involved in the study will complete a satisfaction survey. CONCLUSIONS: This study aims to gather evidence on which of these four therapeutic options achieves the highest reduction of pre-operative anxiety with the best safety profile to allow paediatricians and anaesthesiologists to use the most effective and safe option for their patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03324828. Registered 21 September 2017.

Patient Discomfort in Relation to Thyroid Nodule Fine-Needle Aspiration (FNA) Performed with or without Parenteral and/or Topical Anesthetic.

OBJECTIVE: There is much reported variation in the impact of local anesthesia on thyroid fine-needle aspiration (FNA) related discomfort. We compare patients undergoing thyroid FNA with subcutaneous injection or topical anesthetic to no anesthetic. METHODS: We conducted a retrospective review of 585 sequential ultrasound guided thyroid FNA procedures in Mayo Clinic. Group 1 (n = 200), no anesthetic; Group 2 (n = 185), subcutaneous injection anesthetic; and Group 3 (n = 200), topical anesthetic. Patient demographics, number of FNA passes, needle gauge, and cytopathology were recorded plus a discomfort score (0 to 10) before and immediately post procedure in all 3 groups and peak discomfort during the FNA in Groups 1 and 2. RESULTS: There were no differences among the 3 groups in age, sex, FNA sufficiency rate, cytopathology, and FNA passes number. There was no significant difference between Groups 1 and 2 in peak discomfort score during the FNA: 0 (45%, 42.2%), 1 to 2 (19%, 24.9%), 3 to 5 (23.5%, 20.5%), 6 to 8 (9.5%, 10.8%), 9 to 10 (3%, 1.6%), respectively. Discomfort score post procedure: 0 (78.5%, 77.8%, 53.5%), 1 to 2 (13%, 13%, 36.5%), 3 to 5 (7%, 7%, 9%), 6 to 8 (1.5%, 2.2%, 1%), 9 to 10 (0%, 0%, 0%) for groups 1, 2, and 3, respectively. There were no significant differences among the 3 groups for a discomfort score ≥3. CONCLUSION: FNA associated patient discomfort was comparable during and after the procedure regardless of the use of anesthetic or the type utilized. Approximately 90% of patients experienced mild to moderate discomfort during the procedure. And 90% reported no more than a level 2 discomfort post procedure. ABBREVIATIONS: End = endocrinology; FNA = fine-needle aspiration; MCF = Mayo Clinic Florida; MCR = Mayo Clinic Rochester.

Caracterización clínica y microbiológica de pacientes con pie diabético que requieren hospitalización en alta complejidad. Serie de casos / Clinical and microbiological profile of patients with diabetic foot requiring admission to a high complexity hospital. Case Series

Introducción El pie diabético infectado es una complicación frecuente de la diabetes y un marcador de deterioro del paciente. Existe escasa información en Colombia sobre características de los pacientes que ingresan a los servicios de urgencias de alta complejidad con esta patología y desenlaces como amputación y perfil microbiológico. Materiales y Métodos Serie de casos de pacientes que ingresaron al servicio de urgencias del Hospital Pablo Tobón Uribe con motivo de consulta principal pie diabético infectado. Se analizaron las historias clínicas de manera retrospectiva y se utilizaron herramientas de estadística descriptiva para la caracterización de la población y de variables relacionadas con diagnóstico, tratamiento y resultados tempranos intrahospitalarios. Resultados Entre enero de 2009 y diciembre de 2013 ingresaron 118 pacientes con 145 úlceras infectadas por pie diabético, el 90% con HbAc>6.5, el 52% con disfunción renal, el 51% con enfermedad arterial periférica. El 57% tenía úlceras grado 3 o mayor en la clasificación de Wagner, la infección fue polimicrobiana en el 63%. El 58% requirió amputación, el 62% de las amputaciones fueron amputaciones menores. La mortalidad fue del 10%, la mortalidad atribuible a infección del pie diabético o complicaciones derivadas de la amputación fue del 1,7%. Discusión Los pacientes con pie diabético que ingresaron a urgencias de un hospital de alta complejidad en Colombia tienen una enfermedad sistémica avanzada, relacionada con disfunción renal y vascular periférica, lesiones locales graves con compromiso óseo y articular avanzado; dada la gravedad de estas condiciones, la prevalencia de amputaciones mayores puede ser superior a la reportada en la literatura. Nivel de Evidencia: IV

Background Infected diabetic foot is a frequent complication of diabetes and a marker of patient deterioration. There is little information in Colombia on the characteristics of patients that enter the highly complex emergency services with this condition and their outcomes, such as amputation and microbiological profile. Materials Case series of patients admitted to the emergency department of Pablo Tobón Uribe Hospital whose main consultation was infected diabetic foot. The medical records were retrospectively analysed and descriptive statistical tools were used to characterise the population, as well as the variables related to diagnosis, treatment, and early in-hospital outcomes. Results Between January 2009 and December 2013, 118 patients with 145 ulcers due to an infected diabetic foot were admitted. The HbA1c was> 6.5 in 90%, and 52% had renal dysfunction, 51% with peripheral arterial disease, and 57% had ulcers grade 3 or higher in the Wagner classification. The infection was polymicrobial in 63%, and 58% required amputation, with 62% of amputations being classed as minor. Mortality was 10%, and mortality attributable to diabetic foot infection or complications derived from amputation was 1.7%. Discussion Patients with diabetic foot admitted to the emergency room of a high complexity hospital in Colombia have an advanced systemic disease, related to renal and peripheral vascular dysfunction, and serious local injuries with advanced bone and joint involvement. Given the severity of these conditions, the prevalence of major amputations may be higher than that reported in the literature. Evidence Level: IV