Endoscopic stapes surgery outcomes and complication rates: a systematic review.

OBJECTIVE: These days, the gold standard procedure for otosclerosis treatment is stapes surgery. The endoscopic approach of the procedure is gaining popularity as endoscopic ear surgery develops across the globe. The main objective of this study is to gather and compile well-documented and reliable data regarding surgical outcomes for the endoscopic approach to stapes surgery up to this date. MATERIALS AND METHODS: Publications in English were searched in the PUBMED/MEDLINE database and were systematically reviewed. A total of 16 articles were reviewed according to the inclusion criteria, obtaining a total of 573 patients managed surgically for otosclerosis, using an endoscopic approach. Data were systematically extracted and compared across variables. RESULTS: Data were obtained as follows: mean age of 43 years; female proportion of 60%; 3 mm endoscope diameter of 51%, 4 mm of 39%; titanium piston-type prostheses of 52% and Teflon of 48%; length of the prosthesis (mode) was 4.5 mm; 0.6 mm diameter of the piston of 81% and 0.4 mm of 19%; mean surgical time was 55 min. Hearing results, mean preoperative air-bone gap (ABG) 31 dB; mean postoperative ABG 9 dB; ABG improvement of 22 dB; an ABG closure rate to 20 dB or less of 92% and an ABG closure rate to 10 dB or less of 77%. Complication rates: intraoperative tympanic membrane perforation of 5%; postoperative vertigo of 11%; postoperative dysgeusia of 10%; reported a postoperative neurosensorial hearing loss of 0.2%; reported gusher phenomenon of one case (0.2%). CONCLUSION: Endoscopic stapes surgery is completely achievable using 0º angle and 4-mm-diameter sinus surgery endoscope. Instrument availability should not be an obstacle to the development of this type of surgery in any otolaryngology department. Audiological outcomes are comparable to microscopic approaches.

Productivity and nutritive value of elephant grass pastures under organic and conventional production systems.

Elephant grass (EG) (Pennisetum purpureum Schum.) have great importance in tropical and subtropical climates, especially on dairy farms. Normally, EG is established alone under high fertilization levels. EG in organic production system can improve low production costs and environmental issues, are still little known. The aim of this research was to evaluate the performance of herbage yield, nutritive value, extraction/ export nutrient and forage yield and animal responses. Three production systems of EG were analyzed: (i) EG mixed spontaneous-growing species (SGE) in warm-season and ryegrass (R) in cool-season under organic production; (ii) EG mixed SGE + R under conventional system (positive control); and (iii) EG based under conventional production (control). Holstein cows were used in a rotational stocking. Forage samples were collected to evaluate the pasture and animal responses. Seven grazing cycles were performed during the experimental period (312 days). Herbage yield, forage intake, and stocking rate were 12548; 10270; 19168 kg ha-1 and 2.5; 2.6; 2.7% and 3.3; 2.1; 4.5 AU ha-1 day-1, respectively. Crude protein of EG was 17.9; 15.4; 16.4%, respectively. Mixed pastures, in conventional and organic production, had a better forage distribution throughout the seasons. Highest forage yield and extraction/ export nutrient was reported in pure EG within the conventional system.

Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study.

BACKGROUND: Optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV) is not established. METHODS: Multicenter prospective cohort including all COVID-19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7-10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. RESULTS: Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00-1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60-1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23-1.33]). CONCLUSIONS: ET had a similar or lower post-tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID-19 patients.

Produtividade de pastagens de Coastcross-1 em consórcio com diferentes leguminosas de ciclo hibernal / Productivity of Coastcross-1 pastures mixed with cool-season legumes

Objetivou-se com esta pesquisa avaliar três sistemas forrageiros constituídos por Coastcross-1 (CC) + 100kg de N ha-1 ano-1 + ervilhaca comum; CC + 100kg de N ha-1 ano-1 + trevo vesiculoso; e CC + 200kg de N ha-1 ano-1. Durante o período experimental (345 dias), foram realizados treze pastejos. Para avaliação, foram utilizadas vacas em lactação da raça Holandesa. Foram avaliadas a massa de forragem, composição botânica, relação folha/colmo; taxa de acúmulo diário, produção e consumo de forragem; eficiência de pastejo e taxa de lotação. Os valores médios de produção de forragem e lotação foram de 21,0; 20,3 e 24,3t ha-1; 7,0; 6,5 e 7,7 unidades animais ha-1 dia-1, para os respectivos sistemas forrageiros. Melhores resultados foram obtidos no consórcio de CC com ervilhaca e no cultivo singular de CC.

The objective of this research was to evaluate three grazing systems with Coastcross-1 (CC) + 100kg N ha-1 year-1 + common vetch; CC + 100kg N ha-1 year-1 + arrowleaf clover; and CC + 200kg N ha-1 year-1. Thirteen grazing cycles were performed during the experimental period (345 days). Lactating Holstein cows were used in the evaluation. The forage mass, botanical composition, leaf/stem ratio; daily accumulation rate, production and forage intake; grazing efficiency and stocking rate were evaluated. The average of forage production and stocking rate were 21.0, 20.3, 24.3t ha-1 and 7.0, 6.5, 7.7 animal units ha-1 day-1 for the respective forage systems. Better results were found on Coastcross-1 mixed with common vetch and Coastcross-1 alone.

Algunos aspectos etiopatogénicos de la enfermedad de Alzheimer / Etiopathogenic aspects of Alzheimer disease

Este trabajo tiene por objetivo realizar un análisis de la enfermedad de Alzheimer desde un punto de vista etiopatogénico. Se ha seleccionado dicha patología dado que a pesar de su alta prevalencia a nivel mundial, aún hoy no existe una terapéutica eficaz que permita revertir totalmente esta afección. Se plantean los conceptos de "demencia filogenética" y "heterogeneidad intra e interhemisférica" y se destacan aspectos de su biología molecular y la deficiencia existente de diferentes neurotrasmisores, poniendo particular énfasis en un déficit colinérgico cortical. Esperamos en un futuro trabajo poder abordar aspectos terapéuticos de esta afección que permitan mejorar sensiblemente el pronóstico de la misma

A propósito de un caso de encefalopatía de Wernicke tratado en sala de internación psiquiatrica de la Unidad de Salud Mental del Hospital Maciel / Apropos of a case of Wernicke' encephalopathy admitted in Hospital Maciel Mental Health Department

El presente trabajo tiene por objeto la presentación de un paciente portador de una encefalopatía de Wernicke internado en la sala de Salud Mental del Hospital Maciel. Se destaca la importancia de dicha internación en un servicio psiquiátrico que funciona en un hospital general, ya que esto posibilita un abordaje multidisciplinario más eficiente, y permite efectuar un diagnóstico precoz a la vez que evita consecuencias invalidantes severas a las cuales puede llevar esta afección

Realidad de una necesidad: sala de internación psiquiatrica en un Hospital General / Reality of a need: Mental Health Room in a General Hospital

El objetivo de este trabajo consiste en el estudio de la incidencia de la violencia, la depresión y otros trastornos vinculados, como el consumo de alcohol y drogas, en la población que accede a la Sala de Salud Mental del Hospital Maciel. Con tal fin se analizan 328 historias clínicas correspondientes a pacientes internados durante los años 1992 a 1995, efectuándose una evaluación estadística de los datos obtenidos comparándolos con los valores correspondientes a los años previos a su inauguración en 1989. Detectamos un aumento porcentual significativo de población adolescente, siendo los motivos predominantes de ingreso a Sala: intentos de autoeliminación y trastornos por abuso de sustancias psicoactivas. Concluimos que es fundamental contar con salas de internación psiquiátrica en hospitales generales, dado los recursos existentes en esos centros y la diferente resonancia a nivel familiar, social, escolar y laboral que implica este tipo de internación en un hospital psiquiátrico