Pediatric cochlear implant explantation and reimplantation over a 32-year period.

OBJECTIVES: Cochlear implantation is indicated for pediatric patients with bilateral severe to profound sensorineural hearing loss. The literature reports large variability in cochlear implant (CI) device survival and rates of explantation and reimplantation. This retrospective chart review summarizes CI survival and rates of explantation and reimplantation in pediatric CI recipients at a Canadian tertiary pediatric hospital over 32 years. METHODS: A retrospective chart review of all pediatric patients who received a Cochlear Corporation® CI between April 1988 and June 2020 was undertaken. Rates of explantation/reimplantation were collected and categorized based on device type and reason for failure (medical, device, and inconclusive failure). Device survival analysis based on implant model was also completed utilizing Kaplan-Meier curves. RESULTS: 512 CIs were implanted over the 32-year period by four surgeons (77.1%, 18.16%, 4.49%, and 0.20%, respectively). Patient age ranged from seven months to 20.4 years. The overall explantation and reimplantation rate was 3.32% (17/512 implants), with seven as a result of device failure (1.37%), nine events of medical failure (1.76%), and one inconclusive failure (0.20%). Cumulative CI survival rates at 5, 10, 15, and 20 years were 98.15%, 96.33%, 95.53%, and 94.39%. CONCLUSION: The overall institutional CI failure, explantation, and reimplantation rates are lower than the average reported rates in the literature.

The effectiveness of mitomycin C in Otolaryngology procedures: A systematic review.

OBJECTIVE: Many studies have evaluated the effectiveness of topical intraoperative mitomycin (MCC) usage in a wide range of otolaryngologic procedures with variable conclusions on effectiveness. This systematic review aims to provide a qualitative estimation of mitomycin C's treatment effectiveness in maintaining or preventing stenosis after surgical interventions. DESIGN AND SETTING: Following the PRISMA guideline, a comprehensive systematic search of MEDLINE, EMBASE and CINAHL databases was performed including hand-searching and cross-reference checking. PARTICIPANTS: The search was limited to humans, sample size greater than two and study designs including a comparative arm. MAIN OUTCOME MEASURES: Outcome measures varied but included rates of restenosis, number of procedures, and post-surgical patency. RESULTS: A total of 571 unique abstracts and 109 full articles were reviewed. Seventy-seven studies were included in the final analysis. The available evidence ranged from case series to randomized control studies. Meta-analysis was deemed inappropriate due to heterogeneity of study design. Thirty-eight studies assessed the effective of MCC in dacryocystorhinostomy, which is reported in a separate meta-analysis. All other studies were categorized into otolaryngologic site and pathology including choanal atresia (n = 5), endoscopic sinus surgery (n = 12), airway procedures (n = 9), esophageal procedures (n = 8) and other (n = 2). CONCLUSIONS: The published literature on the effectiveness of MMC was mixed, but suggested topical MMC improved surgical outcomes in many otolaryngologic procedures compared to controls. This was the first review to assemble literature on MMC usage for different surgical procedures. Comprehensive interpretation of the data was limited due to heterogeneity in primary outcome, procedure type and study quality. High-quality prospective and randomized controlled studies are required to further confirm the positive effect of MMC use on surgical outcomes.

Características y prevalencia de las alteraciones del olfato y el gusto en pacientes con infección por COVID-19 / Characteristics of smell and taste alteration in patients with COVID-19

Introducción: La identificación de los síntomas o sus combinaciones con un alto valor predictivo para la enfermedad, es una estrategia crucial para el control de las enfermedades transmisibles. Las alteraciones en el olfato y el gusto han surgido como síntomas de alta prevalencia y un confiable predictor temprano de la enfermedad. El objetivo de este estudio fue caracterizar la prevalencia de las alteraciones del gusto y del olfato en pacientes con antecedente de infección por SARS-CoV-2 en la población colombiana. Materiales y métodos: estudio descriptivo de corte transversal. Se realizó una encuesta telefónica y electrónica a pacientes adultos con antecedente de infección por SARS-CoV-2 confirmado por PCR. Resultados: se incluyeron 182 pacientes en el estudio. El 59% manifestó alteraciones del olfato y 54% alteraciones del gusto. De estos, el 77% y 82%, respectivamente, presentaron mejoría de sus síntomas. El 14% de los participantes percibió las alteraciones del olfato antes del inicio de otros síntomas de COVID-19. El 9% reportó que la alteración del olfato fue el único síntoma de la infección. Para el gusto, 8% informó que fue el primer síntoma de COVID-19, mientras que el 6% reportó que fue el único síntoma. Conclusiones: las alteraciones del gusto y del olfato son síntomas de alta prevalencia en pacientes con infección por COVID-19 y en algunos casos pueden ser el síntoma de presentación de la infección o el único síntoma de la infección

Introduction: Identifying symptoms or symptom combinations with a high predictive value for diagnosing a disease is a crucial strategy for controlling transmissible diseases. Smell and taste alterations have been identified as highly prevalent symptoms of COVID-19 and have been used as a reliable early predictor of the disease. The objective in this study was characterizing the prevalence of smell and taste alterations in patients with COVID-19 in the Colombian population. Materials and methods: Cross-sectional, descriptive study. A telephonic and electronic survey was applied to adult patients with SARS-CoV-2 infection confirmed by PCR. Results: 182 patients were included. 59% presented with smell alterations and 54% with taste symptoms. Among these patients, 77% and 82% respectively perceived symptomatic improvement. 14% of patients presented smell alterations before the onset of other COVID-19 symptoms. 9% reported smell alterations to be the only symptom of the disease. 8% of patients perceived taste alterations as a first symptom and 6% reported it to be the only symptom of the disease. Conclusion: Taste and smell alterations are highly prevalent symptoms in Colombian patients with Covid-19 and in some cases they can be the either the first or the only perceived symptoms of the disease.

Dr. Francisco Valdés Lazo: un médico excepcional / Dr. Francisco Valdés Lazo: an exceptional physician

José Martí sentenció: "Saberse sacrificar es el precio del éxito durable en todo", y con grandes sacrificios y éxitos en su vida laboral se resume la obra del Dr. Francisco Valdés Lazo, un médico excepcional que supo vincular sus responsabilidades administrativas con la docencia y la investigación. Incansable luchador por los avances de la Medicina, gestor de la Escuela Cubana de Pediatría, representa un gran ejemplo para los médicos cubanos y de Latinoamérica. Durante su vida estudiantil colaboró de forma destacada en las actividades que se desarrollaron, siendo fundador de las milicias revolucionarias. Una vez graduado es ubicado en el hospital pediátrico de Santa Clara, además atendía a los milicianos que se encontraban movilizados en la lucha contra bandidos en El Escambray. Al cumplir el servicio social, ya había demostrado sus condiciones de liderazgo, siendo ubicado como subdirector del Hospital Pediátrico "Pedro Borrás"; sus cualidades como revolucionario, inteligencia y entrega total al trabajo, le permitieron ser promovido a diferentes cargos de dirección hasta ser ubicado en el nivel central. Brindó asesoría científica a diferentes países del mundo, entre ellos, Guinea Bissau, Nicaragua, Bolivia, México y Guatemala; impartió numerosos cursos de postgrado nacionales e internacionales y recibió diferentes condecoraciones como médico e investigador. Unido a su humanismo, sus métodos de dirección, su carácter afable y su sentido del humor aun en situaciones difíciles, hacen de este profesional de la Medicina cubana un ejemplo a seguir para todas las generaciones de médicos(AU)

José Martí declared: "Knowing how to sacrifice is the price of lasting success at everything." The work of Dr. Francisco Valdés Lazo can be summed up in great sacrifices and successes during all his working life. He was an exceptional physician who knew how to link his administrative responsibilities to teaching and research. He was a tireless fighter for the advances in Medicine, the founder of the Cuban School of Pediatrics and a great example for Cuban and Latin American doctors. During his student life, he collaborated prominently with different activities, being the founder of the revolutionary militias. As soon as he graduated, he started to work in the pediatric hospital of Santa Clara. He also cared for the militiamen who were mobilized in the fight against bandits in El Escambray. After he finished his social service, he had already demonstrated his leadership condition; therefore, he was designed as deputy director of the Pedro Borrás Pediatric Hospital. His qualities as revolutionary as well as his intelligence and total dedication to work allowed him to be promoted to different management positions until he was positioned at the central level. He provided scientific advice to different countries in the world such as Guinea Bissau, Nicaragua, Bolivia, Mexico, and Guatemala. He taught numerous national and international postgraduate courses and received different awards as physician and researcher. His humanism, management methods, affable character and his sense of humor, even in difficult situations, make this Cuban medical professional an example to be followed for all generations of doctors(AU)

Naegleria fowleri and Naegleria gruberi 20S proteasome: identification and characterization.

The Naegleria are ubiquitous free-living amoebae and are characterized by the presence of three phases in their biological cycle: trophozoite, cyst and flagellate. Of this genus, only Naegleria fowleri has been reported as pathogenic to humans. The proteasome is a multi-catalytic complex and is considered to be the most important structure responsible for the degradation of intracellular proteins. This structure is related to the maintenance of cellular homeostasis and, in pathogenic microorganisms, to the modulation of their virulence. Until now, the proteasome and its function have not been described for the Naegleria genus. In the current study, using bioinformatic analysis, protein sequences homologous to those reported for the subunits of the 20S proteasome in other organisms were found, and virtual modelling was used to determine their three-dimensional structure. The presence of structural and catalytic subunits of the 20S proteasome was detected by Western and dot blot assays. Its localization was observed by immunofluorescence microscopy to be mainly in the cytoplasm, and a leading role of the chymotrypsin-like catalytic activity was determined using fluorogenic peptidase assays and specific proteasome inhibitors. Finally, the role of the 20S proteasome in the proliferation and differentiation of Naegleria genus trophozoites was demonstrated.

Recomendaciones generales para la realización de procedimientos en otorrinolaringología pediátrica en tiempos de COVID-19 / General recommendations for the performance of pediatric otolaryngology procedures in the COVID-19 era

La pandemia causada por el SARS-CoV-2 (COVID-19) (1) ha desatado una crisis de salud pública global sin precedentes en nuestra historia reciente. Teniendo en cuenta que la población pediátrica, si bien no ha sido afectada con la severidad con que ha ocurrido con los adultos, es considerado un grupo de riesgo por su posibilidad de transmitir y propagar el SARS-CoV-2. En el siguiente documento sugerimos pautas tomadas de diferentes paneles de expertos para la realización de consulta externa, así como procedimientos quirúrgicos y no quirúrgicos durante esta pandemia. Es de recalcar que nos enfrentamos a una situación que cambia rápidamente, razón por la cual se harán actualizaciones periódicas de las recomendaciones acá pautadas en publicaciones subsecuentes, según la etapa en la que estemos entrando.

The pandemic caused by the SARS-CoV-2 (COVID-19) has developed a global public health crisis with no precedents in our recent history. The pediatric population has not been affected as much as the adult population although children are considered a risk group given the fact that they could spread the SARS-CoV-2. In the following document recommendations taken from various expert panels are given to otolaryngologist to take in consideration when organizing an outpatient clinic, performing surgical and non surgical procedures during this pandemic. It's important to highlight this is a rapidly evolving situation therefore updates will be done according to the pandemic stage we face.

Improving vaccination uptake in pediatric Cochlear implant recipients.

BACKGROUND: An Infectious Disease vaccine specialist joined our institution's Cochlear Implant Team in 2010 in order to address the high percentage of non-compliance to immunization prior to surgery identified previously from an internal review. The purpose of this study was to (1) review the immunization status of cochlear implant recipients in 2010-2014, (2) assess if introducing a vaccine specialist made a significant change in vaccination compliance and (3) elucidate any barriers to vaccination compliance. METHODS: Retrospective chart review and a telephone survey. Medical records of 116 cochlear implant recipients between 2010 and 2014 were reviewed. A telephone survey was conducted to obtain the current vaccination status in children who required post-operative vaccinations with incomplete records on chart review and, if applicable, the reason for non-compliance. RESULTS: Between 2010 and 2014, 98% of children were up-to-date at the time of surgery, compared to 67% up-to-date at the time of surgery between 2002 and 2007. 27 children were included in our post-operative immunization analysis. 29.6% (8/27) failed to receive necessary vaccinations post-surgery. Pneumovax-23, a vaccine for high-risk patients (such as cochlear implant candidates) was missed in all cases. CONCLUSION: Pre-operative vaccination for cochlear implant recipients improved dramatically with the addition of a vaccine specialist. However, a significant proportion of patients requiring vaccinations post-surgery did not receive them. The main reason for non-compliance was due to parents being unaware that their children required this vaccine postoperatively by being "high-risk". Although improvement was demonstrated, a communication gap continued to impede the adequacy of vaccination uptake in pediatric cochlear implant recipients following surgery at age 2 when the high-risk vaccine was due.

Flavonoids as a Natural Treatment Against Entamoeba histolytica.

Over the past 20 years, gastrointestinal infections in developing countries have been a serious health problem and are the second leading cause of morbidity among all age groups. Among pathogenic protozoans that cause diarrheal disease, the parasite Entamoeba histolytica produces amebic colitis as well as the most frequent extra-intestinal lesion, an amebic liver abscess (ALA). Usually, intestinal amebiasis and ALA are treated with synthetic chemical compounds (iodoquinol, paromomycin, diloxanide furoate, and nitroimidazoles). Metronidazole is the most common treatment for amebiasis. Although the efficacy of nitroimidazoles in killing amebas is known, the potential resistance of E. histolytica to this treatment is a concern. In addition, controversial studies have reported that metronidazole could induce mutagenic effects and cerebral toxicity. Therefore, natural and safe alternative drugs against this parasite are needed. Flavonoids are natural polyphenolic compounds. Flavonoids depend on malonyl-CoA and phenylalanine to be synthesized. Several flavonoids have anti-oxidant and anti-microbial properties. Since the 1990s, several works have focused on the identification and purification of different flavonoids with amebicidal effects, such as, -(-)epicatechin, kaempferol, and quercetin. In this review, we investigated the effects of flavonoids that have potential amebicidal activity and that can be used as complementary and/or specific therapeutic strategies against E. histolytica trophozoites. Interestingly, it was found that these natural compounds can induce morphological changes in the amebas, such as chromatin condensation and cytoskeletal protein re-organization, as well as the upregulation and downregulation of fructose-1,6-bisphosphate aldolase, glyceraldehyde-phosphate dehydrogenase, and pyruvate:ferredoxin oxidoreductase (enzymes of the glycolytic pathway). Although the specific molecular targets, bioavailability, route of administration, and doses of some of these natural compounds need to be determined, flavonoids represent a very promising and innocuous strategy that should be considered for use against E. histolytica in the era of microbial drug resistance.

Manejo de carcinoma glótico temprano: experiencia en el Hospital Universitario San Ignacio / Management of Early Glottic Cancer: Hospital Universitario San Ignacio Experience

Objetivos: Exponer la experiencia de la Unidad de Otorrinolaringología del Hospital Universitario San Ignacio en el manejo del cáncer glótico en estadios tempranos. Establecer la tasa de recurrencias y la calidad de la voz postratamiento. Diseño: Estudio descriptivo. Pacientes y métodos: Pacientes con cáncer glótico en estadios I y II, manejados con cirugía y/o radioterapia. Revisión de historias clínicas, 2004- 2012. Resultados: 63 pacientes con cáncer de laringe en estadios tempranos, 53 hombres y 10 mujeres, con edad promedio de 66,5 años; 48 recibieron manejo quirúrgico y 60 se trataron con radioterapia. 90% presentaron mejoría en el VHI y solo 10% sufrieron empeoramiento del mismo; la mejoría promedio fue de 19 puntos. En cuatro pacientes hubo recurrencia local y en dos a distancia. Conclusiones: Con el enfoque diagnóstico y terapéutico que realizamos en el Hospital San Ignacio, para el manejo del carcinoma glótico en estadios tempranos, hemos obtenido una adecuada tasa de curación de la enfermedad y mantenido una apropiada calidad de la voz postratamiento...

Objectives: To describe the experience of the ENT unit of the Hospital Universitario San Ignacio, in the management of glottic cancer in early stages with surgery and/ or radiotherapy. Establish the rate of recurrence and speech quality after treatment. Type of study: Descriptive study. Patients and Methods: Patients with glottic cancer at early stages managed with conservative surgery and/or radiotherapy. Medical charts of 2004 to 2012. Results: 63 patients with laryngeal cancer in the early stages (stages I and II), mean age 66.5 years. 48 patients underwent surgical treatment and 60 radiotherapy. Of the 31 patients, 28 showed improvement (90%) of de VHI and only 3 (10%) worsed, with an average improvement of 19 points. 4 patients developed local recurrence and 2 recurred in distance. Conclusions: The therapeutic approach in San Ignacio Hospital of glottic carcinoma stages I-II, obtained adequate cure rate with good voice quality after treatment...

Teniosis: serie clínica en 35 pacientes / Teniosis: a clinical serie of 35 human cases

Se presenta una serie clínica de 35 pacientes con teniosis. Los pacientes tenían un rango de edad que fluctuaba entre 4 a 71 años, 32 pacientes eran de zona urbana. En la serie se demostró la presencia de 6 casos con Taenia solium, 24 con Taenia saginata, 4 con Taenia spp, 1 caso con Diphyllobothrium latum. El motivo de consulta en 34 casos fue la eliminación de proglótidas. Entre los antecedentes de riesgo 27 pacientes tenían como antecedentes consumir carne cruda de vacuno y 5 de ellos consumían además carne cruda de cerdos. El tiempo de eliminación de proglótidas varió entre 4 días a 40 años. Los pacientes fueron tratados con niclosamida o praziquantel sin presentar reacciones adversas a los medicamentos

Un caso de anisakiosis en un adulto / An adult anisakiosis case

Un paciente de 38 años de edad con antecedentes de haber comido pescado crudo (mariscal) doce horas antes, presentó un severo dolor gástrico y eliminó por vía bucal una larva de nematodo de aproximadamente 20 mm de largo. La endoscopia mostró una leve gastritis, sin evidenciar la presencia de otras larvas o lesiones ulcerosas. El dolor desapareció totalmente a las dos semanas luego de un tratamiento con antihistamínicos y analgésicos