Hearing results with combination steroid therapy for sudden sensorineural hearing loss.

BACKGROUND: Sudden Sensorineural Hearing Loss was described by Mc. Cabe in 1979 and, since then, many authors have tried to define, explain and correctly treat this disease. The National Institute on Deafness and Other Communication Disorders defines it as sudden sensorineural hearing loss of at least 30 dB in three contiguous audiometric frequencies in a period of 72 hours. Among the therapeutic strategies, corticosteroids have been shown to have the greatest benefit due to their anti-inflammatory and anti-cellular stress effects. OBJECTIVE: To determine the hearing results with combined steroid therapy in patients with sudden sensorineural hearing loss (SSHL), according to the Siegel recovery criteria scale. METHOD: Study carried out in the otorhinolaryngology and head and neck surgery service of the Centro Médico Naval, Ciudad de México, where 150 patients diagnosed with SSHL and who received combined therapy with intratympanic dexamethasone and systemic prednisone were included. RESULTS: Therapeutic effectiveness was demonstrated by correlating therapeutic success in 82% of cases and therapeutic failure in 18% of cases, by correlating it with the Siegel recovery criteria scale. When evaluating the general average of the pure tone average levels at the beginning and 6 weeks after treatment, a statistically significant difference was obtained (p = 0.001). The average of the speech audiometry at the beginning and 6 weeks later had a statistically significant difference (p = 0.001). CONCLUSIONS: Initial combined steroid treatment for SSHL has been shown to have beneficial results according to Siegel recovery criteria scale.

ANTECENDENTES: La Hipoacusia Neurosensorial Súbita Idiopática fue descrita por Mc. Cabe en 1979 y, desde entonces, muchos autores han tratado de definir, explicar y tratar correctamente esta enfermedad. El Nacional Institute on Deafness and Other Communication Disorders la define como pérdida auditiva neurosensorial brusca de al menos 30 dB en tres frecuencias audiométricas contiguas en un periodo de 72 horas. Entre las estrategias terapéuticas, los corticosteroides han demostrado tener mayor beneficio por sus efectos antiinflamatorios y antiestrés celular. OBJETIVO: Determinar los resultados auditivos con la terapia de esteroides combinados en pacientes con hipoacusia neurosensorial súbita idiopática (HNSI), de acuerdo a la escala de criterios de recuperación de Siegel. MÉTODO: Estudio realizado en el servicio de otorrinolaringología y cirugía de cabeza y cuello del Centro Médico Naval, en Ciudad de México, en el que se incluyeron 150 pacientes con diagnóstico de HNSI y que recibieron terapia combinada con dexametasona intratimpánica y prednisona sistémica. RESULTADOS: Se demostró una efectividad terapéutica al correlacionar el éxito terapéutico en el 82% de los casos y un fracaso terapéutico en el 18% de los casos según la escala de criterios de recuperación de Siegel. Al evaluar el promedio general de los niveles de promedio de tonos puros al inicio y 6 semanas posterior al tratamiento se obtuvo una diferencia estadísticamente significativa (p = 0.001). El promedio de las logoaudiometrías al inicio y 6 semanas posterior al tratamiento tuvo una diferencia estadísticamente significativa (p = 0.001). CONCLUSIONES: El tratamiento combinado con esteroides de manera inicial para la HNSI ha demostrado tener resultados benéficos de acuerdo con la escala de criterios de recuperación de Siegel.

Effectiveness of endoscopy in cochlear implantation.

OBJECTIVE: Determine the effectiveness of endoscopy in cochlear implantation as compared to microscopy. METHOD: Study comparing microscopy and endoscopy in cochlear implant placement in 34 patients (23 endoscopic implants and 20 implants via microscopy), between 2014 and 2019, at the Centro Medico Naval, Mexico City. The study was performed under informed consent and according to the Council for International Organizations of Medical Sciences (CIOMS). RESULTS: Of the 34 patients, 12 were children or adolescents and 22 were adults. The visualization of the round window classified via microscopy per St. Thomas Hospital's classification showed that type IIB prevailed in 30.2% of patients, and type III in 41.9%, and when using the endoscope, the round window was observed in full in 82.6% of patients (type I), and type IIA was only observed in 17.4% (four patients). The number of attempts made to place the cochlear implant was greater with the microscope. The time to insertion of the electrode was 1.6 minutes. No differences were observed (p > 0.05) in the number of inpatient days. Cochleostomy was more frequent when using the microscope. CONCLUSIONS: Endoscopy is an effective resource in cochlear implantation for posterior tympanotomy, with no complications observed, offering greater safety in inserting the electrode through the round window.

OBJETIVO: Determinar la efectividad de la endoscopía en la implantación coclear en comparación con la técnica microscópica. MÉTODO: Se comparó la microscopía frente a la endoscopía en la colocación de implante coclear en 34 pacientes (23 endoscópicos y 20 microscópicos), del año 2014 al año 2019, en el Centro Médico Naval de la Ciudad de México. El estudio se realizó bajo consentimiento informado y apegado a las normas del Council for International Organizations of Medical Sciences. RESULTADOS: De los 34 pacientes, 12 eran niños o adolescentes y 22 eran adultos. La visualización de la ventana redonda fue clasificada con microscopio según la clasificación del St. Thomas Hospital, predominando la tipo IIB (30.2%) y la III (41.9%), y al utilizar el endoscopio se observó completa en el 82.6% (tipo I) y tipo IIA en tan solo el 17.4% (cuatro pacientes). El número de intentos en la colocación del implante coclear fue mayor con el microscopio. El tiempo en el que se insertó el electrodo fue de 1.6 minutos. No hubo diferencias (p > 0.05) en la estancia hospitalaria. Fue más frecuente la cocleostomía cuando se uso el microscopio. CONCLUSIONES: La endoscopía es un instrumento efectivo en la implantación coclear por timpanotomía posterior, sin presentarse complicaciones y dando mayor seguridad para insertar el electrodo por la ventana redonda.

Mecanismos en la atención del personal de salud en pandemia: experiencias de Bolivia y Perú / Mechanisms in the care of health personnel in pandemics: experiences of Bolivia and Peru

Webinar N° 139 realizado el 15 de septiembre de 2022. El Organismo Andino de Salud Convenio Hipólito Unanue visibiliza la respuesta de los ministerios de salud ante una tarea de carácter urgente en la presente crisis de recursos humanos en salud, como principal nudo crítico para avanzar hacia la Salud Universal. Las acciones de los países responden al abordaje de las persistentes amenazas a la salud y la seguridad de los trabajadores sanitarios, incluido el tema de mejorar la salud mental y el bienestar psicológico de los recursos humanos en salud. Bolivia y Perú desde sus direcciones de Gestión del personal comparten experiencias, accione sy desafíos para avanzar.

A rabies virus vampire bat variant shows increased neuroinvasiveness in mice when compared to a carnivore variant

Rabies is one of the most important zoonotic diseases and is caused by several rabies virus (RABV) variants. These variants can exhibit differences in neurovirulence, and few studies have attempted to evaluate the neuroinvasiveness of variants derived from vampire bats and wild carnivores. The aim of this study was to evaluate the neuropathogenesis of infection with two Brazilian RABV street variants (variant 3 and crab-eating fox) in mice. BALB/c mice were inoculated with RABV through the footpad, with the 50% mouse lethal dose (LD50) determined by intracranial inoculation. The morbidity of rabies in mice infected with variant 3 and the crab-eating fox strain was 100% and 50%, respectively, with an incubation period of 7 and 6 days post-inoculation (dpi), respectively. The clinical disease in mice was similar with both strains, and it was characterized initially by weight loss, ruffled fur, hunched posture, and hind limb paralysis progressing to quadriplegia and recumbency at 9 to 12 dpi. Histological lesions within the central nervous system (CNS) characterized by nonsuppurative encephalomyelitis with neuronal degeneration and necrosis were observed in mice infected with variant 3 and those infected with the crab-eating fox variant. However, lesions and the presence of RABV antigen, were more widespread within the CNS of variant-3-infected mice, whereas in crab-eating fox-variant-infected mice, RABV antigens were more restricted to caudal areas of the CNS, such as the spinal cord and brainstem. In conclusion, the results shown here demonstrate that the RABV vampire bat strain (variant 3) has a higher potential for neuroinvasiveness than the carnivore variant. (AU) i

A rabies virus vampire bat variant shows increased neuroinvasiveness in mice when compared to a carnivore variant.

Rabies is one of the most important zoonotic diseases and is caused by several rabies virus (RABV) variants. These variants can exhibit differences in neurovirulence, and few studies have attempted to evaluate the neuroinvasiveness of variants derived from vampire bats and wild carnivores. The aim of this study was to evaluate the neuropathogenesis of infection with two Brazilian RABV street variants (variant 3 and crab-eating fox) in mice. BALB/c mice were inoculated with RABV through the footpad, with the 50% mouse lethal dose (LD50) determined by intracranial inoculation. The morbidity of rabies in mice infected with variant 3 and the crab-eating fox strain was 100% and 50%, respectively, with an incubation period of 7 and 6 days post-inoculation (dpi), respectively. The clinical disease in mice was similar with both strains, and it was characterized initially by weight loss, ruffled fur, hunched posture, and hind limb paralysis progressing to quadriplegia and recumbency at 9 to 12 dpi. Histological lesions within the central nervous system (CNS) characterized by nonsuppurative encephalomyelitis with neuronal degeneration and necrosis were observed in mice infected with variant 3 and those infected with the crab-eating fox variant. However, lesions and the presence of RABV antigen, were more widespread within the CNS of variant-3-infected mice, whereas in crab-eating fox-variant-infected mice, RABV antigens were more restricted to caudal areas of the CNS, such as the spinal cord and brainstem. In conclusion, the results shown here demonstrate that the RABV vampire bat strain (variant 3) has a higher potential for neuroinvasiveness than the carnivore variant.

Exhumation of Wistar rats experimentally exposed to the carbamate pesticides aldicarb and carbofuran: A pathological and toxicological study.

Exhumation is required for the investigation of suspicions deaths when a body is buried and is usually performed under court order. Exhumation of animals is not a routine practice in forensic pathology. In this study, 30 male 70-day-old Wistar rats were experimentally exposed to the carbamate pesticides aldicarb and carbofuran. Toxicological, macroscopic and microscopic examinations were performed. Groups of 3 animals (2 exposed and 1 control) were evaluated at 24h, 3days, 5days, 7days and 10days post-mortem. In histopathological examination, the brain, liver, lungs and kidneys were assessed, and for toxicological analysis, the gastric contents, liver, vitreous humor, skeletal muscle and larvae (when available) were collected. The pesticides were detected by HPLC and quantified in the analyzed matrices, and a possible delay in tissue putrefaction due to the pesticides was observed. This study has revealed that it is possible to exhume animals for investigations of possible poisoning by carbamates and has demonstrated that the exhumation of an animal in a suspected case of poisoning should not be ruled out. The increasing demand for investigations of suspicious animal deaths, e.g., in cases of poisoning, will likely lead to an increase in the use of this type of procedure in veterinary pathology.

[Functional parameters and their association with gait speed in Chilean community-dwelling older adults]. / Parámetros funcionales y su relación con la velocidad de marcha en adultos mayores chilenos residentes en la comunidad.

INTRODUCTION: Gait speed is a test to measure functional capacity in older adults. Nevertheless, the factors influencing this variable are not well described in South American populations. OBJECTIVE: To determine the relationship between usual and maximal walking speed and functional parameters among Chilean community-dwelling older adults. MATERIALS AND METHODS: An observational, descriptive and cross-sectional study including 69 older adults was conducted. The usual and maximal gait speeds were associated with body composition (body mass index), upper limbs muscle strength (arm curl-ups), lower limbs muscle strength (30 seconds sit-to-stand test), global function (Barthel index), ankle flexibility (range of motion), dynamic balance (timed Up & Go test) and aerobic capacity (2 minutes walking test). RESULTS: The ankle flexibility, lower limbs strength and aerobic capacity influenced the maximal speed (R2 =0.65; p <0.001), while the usual speed was influenced by upper limbs and lower limbs strength and by the aerobic capacity (R2 = 0.51; p <0.001). CONCLUSION: The usual and maximal gait speeds are mostly influenced by the lower limbs muscle strength plus aerobic capacity.

Parámetros funcionales y su relación con la velocidad de marcha en adultos mayores chilenos residentes en la comunidad / Functional parameters and their association with gait speed in Chilean community-dwelling older adults

Introducción. La velocidad de marcha es una prueba para medir la capacidad funcional en adultos mayores. Sin embargo, los factores que influyen en esta variable han sido poco descritos en la población sudamericana. Objetivo. Determinar la relación existente entre la velocidad de marcha usual y máxima, y los parámetros de funcionalidad en chilenos adultos mayores de la comunidad. Material y métodos. Este estudio cuantitativo, observacional y descriptivo, de corte transversal, incluyó 69 adultos mayores. La velocidad de marcha normal y la máxima se asociaron con la composición corporal (índice de masa corporal), la fuerza de las extremidades superiores (pruebas de flexiones de brazos) e inferiores (pararse y sentarse en 30 segundos), la funcionalidad general (índice de Barthel), la flexibilidad de los tobillos (rango de movimiento), el equilibrio estático y dinámico (timed Up & Go test) y la capacidad aeróbica (test de marcha en dos minutos). Resultados. La flexibilidad de los tobillos, la fuerza de las extremidades inferiores y la capacidad aeróbica, influyeron sobre la velocidad de marcha máxima (R2 =0,65; p<0,001). La marcha normal se vio influida por la fuerza de las extremidades superiores e inferiores, y la capacidad aeróbica (R2 =0,51; p<0,001). Conclusión. La velocidad de marcha, tanto normal como máxima, está influenciada principalmente por la fuerza de las extremidades inferiores y la capacidad aeróbica.

Introduction: Gait speed is a test to measure functional capacity in older adults. Nevertheless, the factors influencing this variable are not well described in South American populations. Objective: To determine the relationship between usual and maximal walking speed and functional parameters among Chilean community-dwelling older adults. Materials and methods: An observational, descriptive and cross-sectional study including 69 older adults was conducted. The usual and maximal gait speeds were associated with body composition (body mass index), upper limbs muscle strength (arm curl-ups), lower limbs muscle strength (30 seconds sit-to-stand test), global function (Barthel index), ankle flexibility (range of motion), dynamic balance (timed Up & Go test) and aerobic capacity (2 minutes walking test). Results: The ankle flexibility, lower limbs strength and aerobic capacity influenced the maximal speed (R2 =0.65; p <0.001), while the usual speed was influenced by upper limbs and lower limbs strength and by the aerobic capacity (R2 = 0.51; p <0.001). Conclusion: The usual and maximal gait speeds are mostly influenced by the lower limbs muscle strength plus aerobic capacity.