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Introduction Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue. Objective To compare low-pressure and high-pressure irrigation delivery systems for wound cleansing in DNI. Methods we designed a retrospective cohort study and reviewed the medical records of patients operated on due to DNI from June 2016 to December 2017 at our institution. One cohort included patients treated with an intraoperative irrigation method that exerts low pressure over the irrigated tissue, and the other cohort, to a system capable of generating higher pressure. The Pearson Chi-squared test was used to analyze the data. Results A total of 42 patients whose ages ranged from 16 months to 72 years were included. The low-pressure irrigation system was used in 18 patients, and the high-pressure system was used in 24 patients. No statistical differences were observed regarding the irrigation methods, the complexity of the DNI, and the overall outcomes. Conclusions The present is the first study in which low- and high-pressure systems for wound lavage were evaluated in the treatment of DNI. When comparing these methods, we did not find one to be superior to the other; however, the additional cost associated with the high-pressure devices may not justify their in head and neck procedures.
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Objective: Quality of life (QOL) is an important consideration in head and neck cancer (HNC) due to lasting disease and treatment-related toxicities. We performed a comprehensive review of predictors of QOL in this population, including distance to care. Study Design: Retrospective cohort study from 2017 to 2022. Setting: Academic medical center. Methods: QOL was quantified in patients treated for HNC utilizing the University of Washington Quality of Life and 20-Item Short Form surveys completed at subsequent clinic visits. Distance to treatment center and other demographic, socioeconomic, disease-specific, and behavioral data were analyzed. Results: There were 176 patients in the cohort (69% male; mean age, 64 ± 10.8 years). There was no association between miles traveled and any of the QOL subscales. Marital status was the strongest predictor of QOL, significantly associated with 7/8 QOL domains and favoring those who were married. Other significant predictors of decreased QOL included emotional/physical abuse, current tobacco use, documented religious affiliation, and treatment involving surgery plus adjuvant therapy. A significant positive trend over time existed for multiple QOL subscales. Conclusion: QOL is unchanged in patients who travel greater distances for care. QOL is more closely linked to factors such as marital status, physical/emotional abuse, tobacco use, religious affiliation, treatment intensity, and time following surgery. This highlights the importance of a strong support structure and the influence of certain socioeconomic and lifestyle factors on patients, with opportunities for screening and intervention throughout their cancer care.
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Importance: Despite access to routine laboratory evaluation, primary hyperparathyroidism (PHP) remains underdiagnosed and undertreated. Objective: To determine the consequences associated with missed diagnoses and prolonged time to diagnosis and treatment of PHP. Design, Setting, and Participants: This is a retrospective cohort study of patients older than 40 years with 2 instances of hypercalcemia during 2010 to 2020 and 3 years of follow-up. Patients were recruited from 63 health care organizations in the TriNetX Research Network. Data analysis was performed from January 2010 to September 2020. Exposures: Elevated serum calcium. Main Outcomes and Measures: Existing symptoms and diagnoses associated with PHP (osteoporosis, fractures, urolithiasis, major depressive disorder, anxiety, hypertension, gastroesophageal reflux disease, malaise or fatigue, joint pain or myalgias, constipation, insomnia, polyuria, weakness, abdominal pain, headache, nausea, amnesia, and gallstones) compared in patients deemed high-risk and without a diagnosis and matched controls, and those who experienced times from documented hypercalcemia to diagnosis and diagnosis to treatment within or beyond 1 year. Results: There were 135â¯034 patients analyzed (96â¯554 women [72%]; 28â¯892 Black patients [21%] and 88â¯010 White patients [65%]; 3608 Hispanic patients [3%] and 98â¯279 non-Hispanic patients [73%]; mean [SD] age, 63 [10] years). Two groups without a documented diagnosis of PHP were identified as high risk: 20â¯176 patients (14.9%) with parathyroid hormone greater than or equal to 50 pg/mL and 24â¯905 patients (18.4%) with no parathyroid hormone level obtained or recorded explanation for hypercalcemia. High-risk patients experienced significantly increased rates of all associated symptoms and diagnoses compared with matched controls. Just 9.7% of those with hypercalcemia (13â¯136 patients) had a diagnosis of PHP. Compared with individuals who received a diagnosis within 1 year of hypercalcemia, those whose workup exceeded 1 year had significantly increased rates of major depressive disorder, anxiety, hypertension, gastroesophageal reflux disease, malaise or fatigue, joint pain or myalgias, polyuria, weakness, abdominal pain, and headache at 3 years. The rate of osteoporosis increased from 17.1% (628 patients) to 25.4% (935 patients) over the study period in the group with delayed diagnosis. Among those with a diagnosis, 5280 patients (40.2%) underwent parathyroidectomy. Surgery beyond 1 year of diagnosis was associated with significantly increased rates of osteoporosis and hypertension at 3 years after diagnosis compared with those treated within 1 year. Conclusions and Relevance: Many patients were at high risk for PHP without a documented diagnosis. Complications in these patients, as well as those who received a diagnosis after prolonged workup or time to treatment, resulted in patient harm. System-level interventions are necessary to ensure proper diagnosis and prompt treatment of PHP.
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Transtorno Depressivo Maior , Hipercalcemia , Hiperparatireoidismo Primário , Osteoporose , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Cálcio , Transtorno Depressivo Maior/complicações , Hipercalcemia/diagnóstico , Hipercalcemia/epidemiologia , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/epidemiologia , Osteoporose/complicações , Hormônio Paratireóideo , Poliúria/complicações , Estudos Retrospectivos , Idoso , MasculinoRESUMO
A thorough microwave response study of high temperature superconductors, considered as an alternative beam screen coating, has become integral in the design decisions for CERN's future research infrastructure. Here, we present the surface resistance [Formula: see text] of various [Formula: see text] (RE = rare earth) coated conductors available in large scale as a function of magnetic field in a broad temperature range measured by a Hakki-Coleman type resonator with resonant frequency [Formula: see text]. Analysis of the high frequency dissipation supported by DC transport characterization reveals the vortex dynamics in thick [Formula: see text] films. Determined microscopic vortex parameters span over a wide range of magnitudes and reflect the relevance of the superconducting layer's microstructure. We demonstrate that the depinning frequencies [Formula: see text] surpass [Formula: see text], which confirms the operation in high performing, low dissipation pinning regime at measurement conditions. Surface impedance extrapolation to FCC-hh conditions points towards a significant outperformance of copper by coated conductors in terms of surface resistance. The surface resistance margins would open up potential ways for a more efficient frontier circular collider.
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Abstract Introduction Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue. Objective To compare low-pressure and high-pressure irrigation delivery systems for wound cleansing in DNI. Methods we designed a retrospective cohort study and reviewed the medical records of patients operated on due to DNI from June 2016 to December 2017 at our institution. One cohort included patients treated with an intraoperative irrigation method that exerts low pressure over the irrigated tissue, and the other cohort, to a system capable of generating higher pressure. The Pearson Chi-squared test was used to analyze the data. Results A total of 42 patients whose ages ranged from 16 months to 72 years were included. The low-pressure irrigation system was used in 18 patients, and the high-pressure system was used in 24 patients. No statistical differences were observed regarding the irrigation methods, the complexity of the DNI, and the overall outcomes. Conclusions The present is the first study in which low- and high-pressure systems for wound lavage were evaluated in the treatment of DNI. When comparing these methods, we did not find one to be superior to the other; however, the additional cost associated with the high-pressure devices may not justify their in head and neck procedures.
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Laryngotracheoesophageal cleft is a rare congenital malformation where a communication exists between the aero-digestive tracts that is associated with high morbidity and mortality. In this case series, we describe our experience with two neonates evaluated in our institution with two diverse initial presentations and symptomatology of type IV laryngotracheoesophageal clefts. One patient presented with acute distress and respiratory failure due to bowel contents obstructing the trachea and the other presented with mild subcostal retractions and inspiratory stridor without overt respiratory failure. Most importantly, not every patient with type IV laryngotracheoesophageal clefts will present with fulminant respiratory difficulty. This prompted a literature review.
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Anormalidades Congênitas/diagnóstico , Laringe/anormalidades , Insuficiência Respiratória/etiologia , Broncoscopia/métodos , Anormalidades Congênitas/terapia , Esôfago/anormalidades , Evolução Fatal , Feminino , Humanos , Recém-Nascido , Masculino , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios X , Traqueia/anormalidadesRESUMO
Introducción: la falta de estudios en Venezuela que demostraran la importancia de moscas de interés médico como vectores mecánicos de enteroparásitos, motivó la realización de este trabajo descriptivo transversal, con muestra intencional, donde con trampas plásticas y ecológicas se capturaron adultos de moscas. Materiales y método: los ejemplares eran inactivados, para luego ser clasificadas por género, lavados con solución salina 0,85%, separados de la solución, y luego esta era centrifugada 10 minutos a 3.000 rpm, para posteriormente utilizar el pelet, el cual se montaba entre lámina y laminilla para observar el sedimento al microscopio. Resultados: se lograron capturar 1.061 adultos de moscas, los cuales correspondían taxonómicamente a los géneros: Phaenicia sp (29,2%), Blepharicnema splendens (6,4%), Cochliomyia hominivorax (3,8%), Musca domestica (3,4%), Sarcophaga sp; (3%), Cochliomyia macellaria (2,5%) y la sumatoria de otras especies (51,7%), tal que, de más de siete especies de moscas, se logró identificar los enteroparásitos Blastocystis sp, Endolimax nana, Entamoeba hartmanni, Entamoeba histolytica/dispar, Entamoeba coli, Iodamoeba butschlii, Pentatrichomonas sp (Trichomonas sp), mientras que los únicos helmintos conseguidos fueron las uncinarias (Anquilostomideos). Conclusiones: la contaminación enteroparasitaria de más de siete especies de moscas, con siete especies de enteroparásitos diagnosticados, resalta el papel transmisor de estos dípteros en el ciclo de los parásitos entéricos. (AU)
Introduction: the lack of studies in Venezuela that demonstrate the importance of flies of medical interest as mechanical vectors of enteroparasites, motivated the realization of this crosssectional descriptive work, with intentional sample, where with plastic and ecological traps, adults of flies were captured. Materials and methods: the specimens were inactivated, to be classified by gender, washed with 0.85% saline, separated from the solution and then centrifuged 10 min at 3000 rpm, to later use the pellet, which was mounted between lamina and lamella to observe the sediment under a microscope. Results: 1.061 adults of flies were captured, which corresponded taxonomically to the genera: Phaenicia sp (29,2%), Blepharicnema splendens (6,4%), Cochliomyia hominivorax (3,8%), Musca domestica (3,4), Sarcophaga sp; (3%), Cochliomyia macellaria (2,5%) and the sum of other species (51,7%), such that from more than seven species of flies were able to identify the enteroparasites: Blastocystis sp, Endolimax nana, Entamoeba hartmanni , Entamoeba histolytica/dispar, Entamoeba coli, Iodamoeba butschlii, Pentatrichomonas sp (Trichomonas sp), while the only helminths obtained were Uncinarias (Anquilostomideos). Conclusions: the enteroparasitic contamination of more than seven species of flies with seven species of enteroparasites diagnosed highlights the role of these dipterous transmitters in the cycle of enteric parasites.
Introdução: a falta de estudos demonstrando Venezuela voa a importância de interesse médico como vetores mecânicos enteroparasitas, conduziu à realização do presente trabalho descritiva em corte transversal, onde amostra intencional com plástico e armadilhas ecológicas, moscas adultas foram capturados. Materiais e métodos: as amostras foram inactivadas, e, em seguida, são classificados por género, lavada com 0,85% de solução salina, separado da solução e, em seguida, esta foi centrifugado 10 min a 3000 rpm, e, em seguida, usando o sedimento, que foi montado entre a lâmina e a lamela para observar o sedimento ao microscópio. Resultados: conseguiram capturar 1.061 moscas adultas, que taxonomicamente correspondiam aos géneros: Phaenicia sp (29,2%), Blepharicnemasplendens (6,4%), Cochliomyia hominivorax (3,8%), Musca domestica (3,4), Sarcophaga sp; (3%), Cochliomyia macellaria (2,5%) e a soma de outras espécies (51,7%), de modo que mais do que sete espécies de moscas podem ser identificados parasitas intestinais: Blastocystis sp, Endolimax nana, Entamoeba hartmanni histolytica / dispar Entamoeba, Entamoeba coli, Iodamoeba butschlii, Pentatrichomonas sp (Trichomonas sp), ao passo que apenas foram obtidos helmintos Uncinarias (Ancilóstomo). Conclusões: contaminação enteroparasitaria de mais de sete espécies de moscas com sete espécies de parasitas intestinais sublinha o papel destes transmissor Diptera no ciclo de parasitas entéricos diagnosticados.
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Venezuela , Poluição Ambiental , Dípteros/parasitologiaRESUMO
Se presentan dos casos de pacientes jóvenes VIH negativos, clínicamente inmunocompetentes, sin antecedentes de exposición actínica prolongada ni riesgo ocupacional, con diagnóstico de carcinoma escamoso de conjuntiva. Presentación inusual en este tipo de lesión que se caracteriza por ser más frecuente a partir de la sexta década de vida, en personas expuestas a las radiaciones ultravioletas o con inmunocompromiso. Su incidencia varía entre 0,13 y 1,9 casos por 100 000 habitantes y ocupa el segundo lugar en frecuencia de los tumores malignos oculares. Se realizó biopsia excisional amplia con margen de 5 mm, crioterapia en las márgenes de la lesión e injerto de membrana amniótica en ambos casos, sin recidiva tumoral en dos años de evolución.
Two cases of young HIV-negative clinically immunocompromised patients, with no history of prolonged actinic exposure or occupational risk, and diagnosed with squamous cell carcinoma of the conjunctiva were presented. This is an unusual presentation in this type of injury that is more frequent after 60 years of age in people exposed to ultraviolet radiation or immunocompromised. Its incidence ranges 0,13 to 1,9 cases per 100,000 pop and ranks second infrequency of ocular malignancies. Excisional biopsy was performed with a 5 mm wide margin, cryotherapy in the borders of the lesion and amniotic membrane grafting were also performed in both cases, without tumor recurrence after two years of evolution.
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Humanos , Adolescente , Biópsia/métodos , Carcinoma de Células Escamosas/diagnóstico , HIV , Neoplasias Oculares/epidemiologia , Âmnio/lesõesRESUMO
OBJETIVO: describir el comportamiento de las cavidades anoftàlmicas atípicas. MÉTODOS: se realizó un estudio descriptivo prospectivo en pacientes con cavidades anoftálmicas atípicas atendidos en la consulta de Cirugía Plástica Ocular, en el período de enero de 2009 a julio de 2010. Se analizaron diferentes variables como sexo, edad, alteraciones de la cavidad y tratamiento quirúrgico. RESULTADOS: del total de los pacientes vistos en la consulta, 57 % pertenecían al sexo masculino. El 43 % se encontraba entre los 30 y 49 años. El 90,2 % presentó alteraciones conjuntivales, y la de mayor representatividad fue la retracción del fornix inferior, con el 33,8 %. Dentro de las técnicas quirúrgicas, la reinserción conjuntival del fondo de saco fue la más utilizada y se realizó en el 38 % de los pacientes. CONCLUSIONES: el mayor número de pacientes vistos pertenecen al sexo masculino y al grupo de edades entre 30 y 49 años. Predominaron las alteraciones conjuntivales y dentro de ellas la retracción del fornix inferior. La técnica más utilizada fue la reinserción de la conjuntiva.
OBJECTIVE: to describe the behavior of atypical anophthalmic cavities. METHODS: aprospective and descriptive study was conducted in patients with atypical anophthalmic cavities seen in the ocular plastic surgery service from January 2009 to July 2010. The analyzed variables were sex, age, cavity abnormalities, and surgical treatment. RESULTS: of all patients seen, 57 % were males and 43 % were 30 to 49 years-old. In this group, 90,2 % had conjunctival anomalies, being the inferior fornix retraction the most significant with 33.8 %. Among the surgical techniques used, the conjunctival reinsertion of the fornix was the most performed in 38% of cases. CONCLUSIONS: the highest number of patients was males and the predominant age group was 30-49 years; conjunctival alterations were predominant, mainly the inferior fornix retraction. The most used technique was the reintegration of the conjunctiva.
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Humanos , Masculino , Idoso , Blefaroptose/terapia , Enoftalmia/diagnóstico , Anoftalmia/terapia , Próteses Visuais/efeitos adversos , Epidemiologia Descritiva , Estudos ProspectivosRESUMO
Los traumatismos de los anejos oculares son frecuentes, debido a la ubicación anatómica de estas estructuras y cumplir con una de sus principales funciones de protección del globo ocular. Se pueden clasificar en afecciones traumáticas de párpados, conjuntiva, órbita y traumas del aparato lagrimal. Según los datos aportados por el United States Eye Injury Registry, las lesiones de los anejos oculares constituyen el 5 porciento de todos los traumas oculares y las más frecuentes con 81 porciento son las laceraciones canaliculares....
The ocular adnexal traumas are common due to the anatomical location of these structures, and the fulfilling of one of its main duties, that is, the protection of the eyeball. They are classified into traumatic conditions of the eyelids, the conjunctiva, the orbit, and lachrymal system traumas. According to data provided by the United States Eye Injury Registry, the ocular adnexal injuries account for 5 percent of all ocular traumas, and the most common are canalicular lacerations with 81 percent...
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Humanos , Masculino , Pessoa de Meia-Idade , Túnica Conjuntiva/lesões , Traumatismos Oculares/cirurgia , Traumatismos Oculares , Órbita , Relatos de CasosRESUMO
Objetivo: evaluar la efectividad de la iridoplastia periférica con Nd YAG láser doblado mediante imágenes de Scheimpflug y gonioscopia.Métodos: estudio longitudinal descriptivo prospectivo en 40 ojos (23 pacientes) con cierre angular residual (grado 0-2 según Shaffer) por bloqueo pupilar (n=30) o por síndrome de iris plateau (n=10). La presión intraocular, gonioscopia e imágenes de Scheimpflug (Oculus Pentacam) fueron obtenidas antes de la cirugía y 1 semana después, y luego comparadas.Resultados: 70 porciento de los ojos con bloqueo pupilar (p=0,00) y 100 porciento con iris plateau mostraron gonioscópicamente ángulos grado 2-3 (según Shaffer) en el posoperatorio. Las imágenes de Scheimpflug no evidenciaron modificación de la abertura angular posquirúrgica (p=0,696, p=0,572, bloqueo pupilar; p=0,053, p=0,113, iris plateau). El volumen medio de la cámara anterior (p=0,001 y p=0,008) y el diámetro pupilar (p=0,002, bloqueo pupilar) se incrementaron significativamente. Se obtuvo una reducción posoperatoria de la presión intraocular de 2,4 mmHg (p=0,004, bloqueo pupilar) y 3,6 mmHg (p=0,011, iris plateau). Las complicaciones fueron mínimas y fueron resueltas con tratamiento tópico.Conclusiones: la iridoplastia con Nd YAG láser es efectiva y segura. Las imágenes de Scheimpflug no son útiles para adquirir mensuraciones precisas de la amplitud del ángulo camerular
Objective: to assess the effectiveness of double-frequency Nd YAG laser peripheral iridoplasty using Scheimpflug images and gonioscopy.Methods: longitudinal prospective and descriptive study of 40 eyes (23 patients) with residual angle-closure (Shaffer´s grade 0-2) due to pupillary block (n=30) or plateau iris syndrome (n=10). The gonioscopy, Scheimpflug images (Oculus Pentacam) and intraocular pressure were obtained preoperatively and one week postoperatively and then compared.Results: of the surgical eyes, 70 per cent with pupillary block (p=0,000) and the 100 per cent with plateau iris were Shaffer´s grade 2-3 postoperatively. The Scheimpflug images did not show changes on angle openness after surgery (p=0,696, p=0,572, pupillary block; p=0,053, p=0,113, plateau iris). The mean volume of anterior chamber (p=0,001 and p=0,008) and the pupil diameter (p=0,002 in pupillary block) significantly increased The intraocular pressure reduction of 2,4 mmHg (p=0,004, pupillary block) and 3,6 mmHg (p=0,011, plateau iris) was obtained. Complications were minimal and responded well to topical treatment.Conclusion: the Nd YAG laser peripheral iridoplasty is effective and safe. Scheimpflug images are not useful for precise measurements of angle openness
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La infección micobacteriana diseminada después de la vacunación por bacilo Calmette-Guerin (BCG) es un trastorno muy raro que ocurre principalmente en pacientes con inmunodeficiencia. Se describe un caso donde se observó una reacción adversa inducida por la vacunación con BCG expresada por una linfadenitis regional supurada y abscedada, la cual se manifestó en una paciente al mes de nacida. A los 5 meses de nacida presentó fiebre, vómitos y diarreas, y exantema súbito a los 11 meses. El curso clínico y la evaluación inmunológica sugiere una inmunodeficiencia congénita