Severity of COVID-19 cases in the months of predominance of the Alpha and Delta variants.

New SARS-CoV-2 may pose problems in controlling the COVID-19 pandemic for public health. We aimed to assess and compare the symptoms and severity of cases due to the Alpha and Delta variant dominance periods, taking into account the effect of COVID-19 vaccination. A prospective epidemiological study of SARS-CoV-2 in Lleida was made to determine differences between Alpha and Delta variants periods. We assessed symptoms, specific comorbidities, sociodemographic information and vaccination status. Bivariate and logistic regression analyses were used to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) to investigate the relationship between symptoms and severity and the variants. Alpha variant period compared to the Delta showed an increased risk of ICU admission (aOR 2.0; 95% CI 1.2-2.3) and death (aOR 2.6; 95% CI 1.8-3.9) and cases were associated with people aged > 85 years (aOR 2.1; 95% CI 1.7-2.6) and partially vaccinated (aOR 5.6; 95% CI 3.2-9.9) and unvaccinated people (aOR 27.8; 95% CI 19.7-40.5). Fever, cough and vomiting were significantly associated with the Alpha variant compared to the Delta (aOR 1.6 (95% CI 1.5-1.7), 2.0 (95% CI 1.9-2.2) and 2.5 (95% CI 2.2-2.9, respectively). Our results show that the severity and profile of clinical symptoms varied according to the variant. The risk of ICU admission and death was higher in the Alpha period compared to the Delta as it affected the elderly and cases were less vaccinated.

Fighting for inclusion across borders: Latin American Trans women's health in Canada.

Background: Worldwide, Trans women from Latin America experience some of the highest rates of violence, which has led many to emigrate. There is limited research exploring the experiences of Trans migrants, and most LGBTQI2S + migrant research focuses on immigrant gay men. This study uses the frameworks of Intersectionality and the Social Determinants of Health (SDoH) to examine the impact of migration on the health and wellbeing of Latin American Trans women living in Toronto, Canada. Methodology: This qualitative arts-based study included nine participants and used hand mapping, a sociodemographic questionnaire, and focus groups to generate data. Data analysis encompassed inductive and deductive approaches and rigor was maintained through reflexivity and several verification strategies. Results: While migration was used as a safety strategy, participants' multiple identities as immigrants, Trans women, and Latinas, produced compounded experiences of oppression post-migration. Facing transphobia and xenophobia simultaneously, participants were forced to navigate precarious housing and employment, minimal social capital, and low social position. This limited their ability to exercise power and ultimately caused poor health and wellbeing post-migration; however, participants used sophisticated strategies to resist asymmetrical power relations, actively searching for safety and community participation, and caring for themselves and each other. Conclusion: The participants fought for inclusion across borders of economic exclusion and gender identity, borders of power and social position, as well as geopolitical borders. Their intersectional experiences across these "borders" should be understood in the context of migration without liberation, consumption without income, compounding oppressions, as well as positive intersectionality. While the women's resistance and strength are positive by-products of fighting oppression, they cannot be the solution. Access to health and wellbeing should not be a privilege for some; it must be a right for all.

Disección endoscópica submucosa para el tratamiento del cáncer esofágico / Endoscopic submucosal dissection for the treatment of esophageal cancer

Resumen Introducción: El cáncer de esófago (CE) constituye la sexta causa de muerte por cáncer en el mundo. La disección endoscópica submucosa (DES) es una técnica que permite la resección en bloque de lesiones del tubo digestivo. Tiene rol curativo en pacientes seleccionados y potenciales ventajas sobre la esofagectomía. Objetivo: Describir los resultados perioperatorios y oncológicos de la DES como tratamiento del CE en nuestro centro. Materiales y Método: Estudio retrospectivo de pacientes sometidos a DES por CE entre los años 2010-2020. Resultados: Diez pacientes fueron tratados con DES por CE entre los años 2010 y 2020. El 80% eran hombres y la edad promedio fue de 72 años (63-84). La resección en bloque fue lograda en todos los casos y no se presentó morbimortalidad perioperatoria. Todas las disecciones fueron R0 y el 90% cumplió con estándares de curación. El seguimiento promedio fue de 38 meses (3,5-123). La sobrevida global fue de 90%. La sobrevida específica por cáncer y libre de recurrencia fue de 100%. Discusión: La morbimortalidad asociada a la esofagectomía es alta. La DES sería una alternativa más segura, que permite lograr un R0 y eventualmente la curación en pacientes seleccionados con CE limitado a la mucosa o submucosa. Conclusión: La presente constituye la primera serie reportada de pacientes con cáncer esofágico sometidos a DES en nuestro país. Muestra excelentes resultados oncológicos y seguridad del procedimiento, comparables a las grandes series descritas en la literatura internacional.

Introduction: Esophageal cancer is the sixth leading cause of death by cancer worldwide. Endoscopic submucosal dissection (ESD) is a technique that allows en bloc resection of early lesions of the digestive tract. It has curative potential in selected patients and potential benefits over esophagectomy for the treatment of esophageal cancer (EC). Aim: To report the results of ESD for EC in a high-volume center in Chile. Materials and Method: Retrospective descriptive study of patients who underwent ESD for EC at our center. Results: A total of 10 patients were treated with ESD for EC between 2010 and 2020. Eighty percent were male patients, the average age was 72 years (63-84). En bloc resection was achieved in all cases and there were no complications or mortality. All of the dissections were classified as R0 and 90% met curative standards. The mean follow-up was 38 months (3.5-123). Overall survival was 90%. Cancer-specific survival was 100% and recurrence-free survival was 100%. Discussion: The rate of morbidity and mortality of esophagectomy is high. ESD would be a safer technique, which allows R0 resections and eventually curation in selected patients with EC limited to the mucosa or submucosa. Conclusion: This is the first report of ESD for the treatment of EC in our country, it shows excellent oncologic results and safety of the procedure, comparable to those reported in the larger series published to date.

Complicaciones postoperatorias en esofagectomía por cáncer: evaluación de 215 casos según definiciones del grupo de consenso internacional / Postoperative complications in esophagectomy for cancer: evaluation of 215 cases according to definitions of the international consensus group

Resumen Introducción: La esofagectomía presenta una alta morbilidad postoperatoria. Sin embargo, las definiciones de las complicaciones son variables. Un grupo multinacional (esophagectomy complications consensus group; ECCG) propuso definiciones estandarizadas. Objetivo: Evaluar las complicaciones postoperatorias en esofagectomía según las definiciones propuestas por el ECCG. Materiales y Método: Realizamos un estudio de cohorte retrospectivo, a partir de una base de datos prospectiva. Se incluyeron pacientes sometidos a una esofagectomía por cáncer entre 1996 y 2018 en un centro. Se aplicaron las definiciones de las complicaciones postoperatorias según el ECCG. Resultados: Se incluyeron 215 pacientes (Hombres 64%; edad 67 [31-82] años). Un 64% presentaban alguna comorbilidad. Existió un predominio de carcinoma escamoso con un 68%. La ubicación tumoral más frecuente fue el tercio inferior del esófago (48%). Se utilizó un abordaje abierto en 74% y mínimamente invasivo en 26%. La morbilidad postoperatoria total fue de 67%. Las complicaciones más frecuentes fueron las respiratorias alcanzando un 27%. En total, un 25% de los pacientes presentó una filtración de la anastomosis esofagogástrica, de las cuales un 24% fueron tipo II (no requirieron una reintervención quirúrgica). Se produjo una paresia de cuerda vocal en 7%, todas tipo I (no requirieron terapia específica). Se presentó una fístula quilosa en 2%, en 1% se trataron con nutrición parenteral (tipo II) y en 1% se realizó una reintervención (tipo III). Conclusión: La esofagectomía se asocia a una alta morbilidad. Las principales complicaciones son las respiratorias y las gastrointestinales. La utilización de las definiciones de consenso permite una estandarización y graduación de las complicaciones.

Introduction: Esophagectomy presents a high postoperative morbidity. However, the definitions used are variable. A multinational group (esophagectomy complications consensus group; ECCG) proposed standardized definitions. Aim: To evaluate postoperative complications in esophagectomy according to the definitions proposed by the ECCG. Materials and Method: We conducted a retrospective cohort study, based on a prospective database. Patients undergoing esophagectomy for cancer between 1996 and 2018 at one center were included. The definitions of postoperative complications according to the ECCG were applied. Results: We included 215 patients (64% men, age 67 [31-82] years). Sixty-four percent had some comorbidity. There was a predominance of squamous carcinoma with 68%. The most frequent tumor location was the lower third of the esophagus (48%). An open approach was used in 74% and minimally invasive in 26%. Total postoperative morbidity was 67%. The most frequent complications were respiratory complications, which reached 27%. The leakage of the esophagogastric anastomosis reached 25%, 24% were type II (did not require surgical reoperation). There was a vocal cord paresis in 7%, all were classified as type I (did not require specific therapy). A chylous fistula was presented in 2%, in 1% they were treated with parenteral nutrition (type II) and in 1% a reoperation was performed (type III). Conclusion: Esophagectomy is associated with a high morbidity. The main complications are respiratory and gastrointestinal. The use of consensus definitions allows standardization and grading of complications.

Efecto del uso intraoperatorio de corticoides en dosis bajas en pacientes sometidos a resección hepática mayor con maniobra de Pringle / Effects of low dose corticosteroids in patients undergoing major hepatic resection with Pringle maneuver

Introducción: Las resecciones hepáticas mayores pueden presentar una alta morbimortalidad en relación al sangrado intraoperatorio. La utilización de la maniobra de Pringle permite disminuir esta complicación a costa de un daño por isquemia-reperfusión. Una estrategia para minimizarla es el uso de corticoides perioperatorios. Objetivo: Evaluar el uso de metilprednisolona en dosis bajas (< 500 mg) en pacientes sometidos a resección hepática mayor con maniobra de Pringle en la incidencia de daño por isquemiareperfusión, morbilidad y mortalidad perioperatoria. Material y Métodos: Estudio retrospectivo utilizando la base de datos de hepatectomías entre los años 2000 y 2015. De un total de 171 resecciones hepáticas mayores, 62 utilizaron clampeo vascular. Se establecieron dos grupos: (A) aquellos que recibieron metilprednisolona inmediatamente previo al clampeo (n = 27) y (B) pacientes sin metilprednisolona (n = 35). Se evaluó el daño por isquemia-reperfusión por alteración de las pruebas hepáticas en los días 1, 3 y 5. Resultados: Los pacientes del grupo A tuvieron mayor tiempo de isquemia (43 + 3,3 vs 27 + 2,1 min, p < 0,05) que el grupo B, con una significativamente menor elevación de las fosfatasas alcalinas y bilirrubina en los días 1 y 5 poshepatectomía. No se observó diferencias en la magnitud del sangrado y no hubo diferencias en morbimortalidad. Conclusiones: La utilización de dosis bajas de metilprednisolona parece disminuir el impacto del DIR relacionado a la resección hepática bajo clampeo vascular, evitando los efectos adversos de la administración de esteroides en dosis altas.

Introduction: Liver resections may be associated with high morbidity and mortality due to intraoperative bleeding. Pringle maneuver reduces this complication at the expense of ischemia-reperfusion injury. Current strategies to minimize reperfusion injury include the use of perioperative corticosteroids. Objective: To assess the use of methylprednisolone in low doses (< 500 mg) in patients submitted to major hepatic resection under Pringle maneuver in the incidence of ischemia-reperfusion injury, peri-operative morbidity, and mortality. Material and Methods: Retrospective study from the liver resections database undertaken between the years 2000-2015 in our center. One hundred and seventy-one major liver resections were done, in 62 under Pringle maneuver. Two groups were established: (A) Patients administered methylprednisolone immediately before Pringle maneuver (n = 27) and (B) those without steroid (n = 35). We assessed ischemia-reperfusion injury by measuring liver tests on days 1, 3 and 5. Results: Patients in group A had longer ischemia time (43 ± 3.3 vs. 27 ± 2.1 min, p < 0.05) than those of group B, and significantly lower elevation of serum phosphatase alkaline and bilirubin on days 1 and five post-hepatectomy. We did not observe any difference in bleeding magnitude, and there were no differences in morbidity or mortality. Conclusions: The use of low doses of methylprednisolone seems to diminish the impact of ischemia-reperfusion injury related to major hepatic resection under Pringle maneuver avoiding the adverse side effects of high dose steroid.

Infecção de sítio cirúrgico em revascularizações do miocárdio: estudo retrospectivo / Surgical site infection in myocardial revascularization: a retrospective study

Objetivo: analisar a incidência de infecção do sítio cirúrgico em revascularizações do miocárdio. Métodos: estudo quantitativo com 314 prontuários de pacientes submetidos às revascularizações no período de 2014 a 2016, do serviço de cirurgia cardíaca. Foram avaliadas as relações de variáveis operatórias com o aparecimento de infecção de sítio cirúrgico para determinar os fatores significativos. Para a coleta dos dados utilizou-se as fichas de circulação extracorpórea e para a análise as definições estabelecidas pela Agência Nacional de Vigilância Sanitária. Resultados: 66,2% eram do sexo masculino; 62,1%, brancos; 47,3%, hipertensos; 22,8%, diabéticos e 91,7%, cirurgias eletivas. Evidenciou-se que febre, edema local em 24 horas, dor, necrose em lesão operatória e (re)abordagem cirúrgica são os principais fatores para incidência de infecções relacionada ao tempo médio de circulação extracorpórea e de cirurgia. Conclusão: a infecção de sítio cirúrgico em revascularizações está relacionada com o tempo de cirurgia e de circulação extracorpórea.

Objective: to analyze the incidence of surgical site infection in myocardial revascularizations.Methods: a quantitative study with 314 medical records of patients submitted to revascularizationin the period from 2014 to 2016, of the cardiac surgery service. The relationships of operativevariables with the appearance of surgical site infection were evaluated to determine the significantfactors. Data collection was done using the cardiopulmonary bypass records and for the analysis thedefinitions established by the National Sanitary Surveillance Agency. Results: 66,2% were male;62,1% white; 47,3% hypertensive and 22,8% diabetic; 91.7% were elective surgeries. It was evidencedthat fever, local edema in 24 hours, pain, necrosis in operative lesion and surgical intervention are the main factors for the incidence of infections related to the mean time of extracorporealcirculation and surgery. Conclusion: the surgical site infection in revascularizations is related to thetime of surgery and extracorporeal circulation.

A straight choice: avoiding septal re-deviation using titanium plates. A 16 year retrospective patient follow-up evaluation.

BACKGROUND: To propose a new surgical technique for fixing the nasal septum to the midline, for long term prevention of nasal obstruction, in secondary and select cases of primary septoplasty. METHODOLOGY: Retrospective study, within hospital medical center. PATIENTS: Two hundred and twenty two patients who underwent septoplasty. Data collection occurred consecutively between March 1st of 2000 and May 1st 2016. Twenty six percent females and seventy four percent males. MAIN OUTCOME MEASURES: Patterns of septal deformity, materials used for titanium plates, surgical results, symptom improvement, and surgical complications were investigated. RESULTS: A total of 222 patients were included in this study. 163 patients (73%) had no previous nasal surgery. Fifty nine patients (27%) presented with a previous nasal surgery. Sixteen year follow up included more than 90% of patients and resulted in an overall 2.7% revision rate. CONCLUSIONS: The use of titanium plate for septoplasty has shown to be simple, safe, and easy to learn technique in both secondary and select cases of primary septoplasty. Most importantly the results indicate a long term prevention of the.

Carryover of aflatoxins from feed to lambari fish (Astyanax altiparanae) tissues.

The aim of this study was to verify the carryover of aflatoxin B1 from feed to lambari fish. Aflatoxins (AF) were incorporated into feed, checking the levels by HPLC. Treatments were: Control, feed without toxin; A, feed + 10 µg AFB1 kg-1; B, feed + 20 µg AFB1 kg-1; and C, feed + 50 µg AFB1 kg-1. Juveniles of lambari fish were placed in 12 aquariums at a density of 50 fish/m2. Fish were fed twice a day with extruded feed, at 5% of animal biomass. The unit sample was constituted by a pool of 10 fish. AFs B1, B2, G1, G2 and M1 were quantified by HPLC in fish muscle and liver after 30, 60, 90 and 120 days of experiment. There was accumulation of AFs is fish liver and muscle, mainly after 90 days. Fish from treatment C had higher levels of AFB1 in muscle when compared with the others, and AFB1 in muscle at 120 days was similar to the levels in feed. Therefore, when lambari fish is exposed on a daily and long-term basis to AFs in feed, the regulation limits for AFs in animal feed do not guarantee safety for consumers.

First detection and molecular characterization of Nebovirus in Brazil.

Nebovirus is a new genus of viruses belonging to the Caliciviridae family recently characterized in cattle, and is associated with gastrointestinal disorders, such as diarrhoea, anorexia and intestinal lesions particularly in calves. The aim of this study was to investigate the prevalence of neboviruses in Brazilian cattle and analyse phylogenetically the virus strains detected. A prevalence of 4·8% of neboviruses in faecal samples from 62 head of cattle from different Brazilian states was detected. All positive animals were aged 96·0% nt (100% aa) sequence identity between the virus sequences in this study and >88·8% nt (>94·4% aa) identity with Newbury1/UK. Our results indicate, for the first time, the occurrence of neboviruses in Brazil as well as in South America, and the first Newbury1-like nebovirus found outside the UK.

Niveles de hormonas tiroideas en niños obesos / Thyroid function in obese children

Introducción: El rendimiento del estudio de función tiroidea en niños obesos es desconocido. Nuestro objetivo fue describir en esta población los niveles de hormona tiro-estimulante (TSH) y tiroxina plasmática libre (T4L), los factores asociados y la frecuencia de hipotiroidismo. Pacientes y Método: Estudio retrospectivo de 260 fichas clínicas de niños obesos que consultaron a una nutrióloga infantil por primera vez entre enero de 2007 y junio de 2012. Se consignó la edad, sexo, pubertad, peso, talla y perímetro de cintura (PC). Calculamos el índice de masa corporal (IMC, z-score), peso/talla (IPT) y talla/edad (NCHS 2000). Se determinaron los niveles de TSH y T4L. Resultados: Se incluyeron 210 pacientes entre 2 y 18 años, 59 por ciento mujeres, 51,4 por ciento pre-púberes. 23,9 por ciento sobrepeso y 76,1 por ciento obesidad. 70,8 por ciento presentó obesidad central. TSH y T4L fueron 2,31 uUI/mL (0,69 a 8,07) y 1,289 +/- 0,17 ng/dL, respectivamente. Se encontró hipotiroidismo en 21 pacientes (10 por ciento), subclínico en 20 de éstos. Hubo una correlación inversa de LogTSH con edad y directa de LogTSH con zIMC. Con regresión múltiple solamente zIMC fue significativo (p < 0,001, R2 ajustado 8,2 por ciento, beta 0,19). No hubo diferencias en edad, sexo, pubertad ni estado nutricional entre eutiroideos e hipotiroideos. Conclusión: Encontramos 9,5 por ciento de hipotiroidismo subclínico, lo cual justifica el tamizaje con TSH en niños obesos.

Introduction: Study results regarding thyroid function in obese children are unknown. The objective of this study was to describe the levels of thyroid stimulating hormone (TSH), free plasma thyroxine (FT4), associated factors and frequency of hypothyroidism in these children. Patients and Method: A retrospective study of medical records of 260 obese children who consulted a physician for the first time between January 2007 and June 2012. Age, gender, puberty, weight, height and waist circumference (WC) were considered; body mass index (BMI z -score), weight/height (IPT) and height/age (NCHS 2000) were calculated, and TSH and FT4 were measured. Results: 210 patients aged 2 to 18 years were included, 59 percent female, 51.4 percent prepubescent children, 23.9 percent were overweight and 76.1 percent obese. 70.8 percent of the children surveyed had central obesity. TSH and FT4 values were 2.31 uUI/mL (0.69 to 8.07) and 1.289 +/- 0.17 ng/dL, respectively. Hypothyroidism was found in 21 patients (10 percent), 20 of these presented it as subclinical condition. An inverse correlation was present between age and log TSH and a direct correlation was described between log TSH and zBMI. Qnly zBMI was significant (p < 0.001, adjusted R2 8.2 percent beta 0.19) after using multiple regression. No differences in age, gender, nutritional status and puberty between euthyroid and hypothyroid patients were found. Conclusion: 9.5 percent of patients presented subclinical hypothyroidism, which supports TSH screening in obese children.

[Thyroid function in obese children]. / Niveles de hormonas tiroideas en niños obesos.

INTRODUCTION: Study results regarding thyroid function in obese children are unknown. The objective of this study was to describe the levels of thyroid stimulating hormone (TSH), free plasma thyroxine (FT4), associated factors and frequency of hypothyroidism in these children. PATIENTS AND METHOD: A retrospective study of medical records of 260 obese children who consulted a physician for the first time between January 2007 and June 2012. Age, gender, puberty, weight, height and waist circumference (WC) were considered; body mass index (BMI z -score), weight/height (IPT) and height/age (NCHS 2000) were calculated, and TSH and FT4 were measured. RESULTS: 210 patients aged 2 to 18 years were included, 59% female, 51.4% prepubescent children, 23.9% were overweight and 76.1% obese. 70.8% of the children surveyed had central obesity. TSH and FT4 values were 2.31 µUI/mL (0.69 to 8.07) and 1.289 ± 0.17 ng/dL, respectively. Hypothyroidism was found in 21 patients (10%), 20 of these presented it as subclinical condition. An inverse correlation was present between age and log TSH and a direct correlation was described between log TSH and zBMI. Qnly zBMI was significant (p < 0.001, adjusted R2 8.2%, ß 0.19) after using multiple regression. No differences in age, gender, nutritional status and puberty between euthyroid and hypothyroid patients were found. CONCLUSION: 9.5% of patients presented subclinical hypothyroidism, which supports TSH screening in obese children.

Healthcare context and nursing workforce in a main city of Angola.

BACKGROUND: Angola is one of the largest African countries with continuing levels of insecurity, considerable weakness in terms of respect for human rights, destroyed infrastructure and low transparency and social accountability levels. The health system displays gaps and nursing represents the main contingent among human resources in health. AIM: This research aims to understand the healthcare context in Angola from the perspective of Brazilian nurses who were involved in helping their Angolan colleagues. This general view of health services is followed by a description of nursing workforce particularities at a tertiary health service in the province of Luanda. METHODS: Data were extracted from the database of the Global Network of World Health Organization Collaborating Centres for Nursing and Midwifery Development, constructed based on technical visits to Angola in 2009. Information related to health service characteristics was used, focusing on nursing human resource activities at two tertiary, one secondary and one primary health institutions located in the province of Luanda. The study data were analysed through descriptive statistics. FINDINGS: Among the problems the nursing workforce faces, the lack of human, material and financial resources stands out, as well as insufficient professional qualification, excessive work journeys, low remunerations, non-valuation of professionals, leading to unsatisfactory work environments and discouraged human resources. CONCLUSIONS: Nursing in Angola is conquering its professional space. Therefore, regulatory policies are fundamental, defining the rights and obligations of all categories involved, with a view to determining nurses' function in the health team, including respect for and acknowledgement of their role in the community.

Bacillus cereus infection outbreak in captive psittacines.

This study reports an uncommon epizootic outbreak of Bacillus cereus that caused the sudden death of 12 psittacines belonging to the species Anodorhynchus hyacinthinus (1 individual), Diopsittaca nobilis (1 individual), Ara severa (1 individual) and Ara ararauna (9 individuals) in a Brazilian zoo. Post-mortem examination of the animals reveled extensive areas of lung hemorrhage, hepatic congestion, hemorrhagic enteritis and cardiac congestion. Histopathological examination of the organs showed the presence of multiple foci of vegetative cells of Gram-positive bacilli associated with discrete and moderate mononuclear inflammatory cell infiltrate. Seventeen B. cereus strains isolated from blood and sterile organs of nine A. ararauna were analyzed in order to investigate the genetic diversity (assessed by Rep-PCR) and toxigenic profiles (presence of hblA, hblC and hblD; nheA, nheB and nheC as well as cytK, ces and entFM genes) of such strains. Amplification of genomic DNA by Rep-PCR of B. cereus strains generated two closely related profiles (Rep-PCR types A and B) with three bands of difference. All strains were classified as belonging to the toxigenic profile I which contained HBL and NHE gene complexes, entFM and cytK genes. Altogether, microbiological and histopathological findings and the evidence provided by the success of the antibiotic prophylaxis, corroborate that B. cereus was the causative agent of the infection that killed the birds.

Trayectoria de vida de profesionales universitarios con déficit auditivo: estudio exploratorio de aspectos significativos para inclusión laboral / Life trajectories of university graduates with hearing impairments: exploratory study of meaningful aspects to labor inclusion

El presente estudio ha tenido como propósito conocer los aspectos significativos en el proceso de inclusión laboral de dos profesionales universitarios con hipoacusia severa de la Región Metropolitana, por medio de la realización de entrevistas focalizadas en el desempeño laboral, de manera de avanzar en el conocimiento de estrategias que permitan mejorar las oportunidades de empleo para esta población. Es un estudio de tipo exploratorio, retrospectivo y transversal. Para la recolección de datos se diseñó una entrevista semiestructurada, solicitando previamente el consentimiento informado. La entrevista abarca sus trayectorias de vida focalizándola en el desempeño laboral. Se identifican como aspectos significativos las siguientes categorías: familia nuclear, familia de origen, déficit auditivo, desempeño educativo, desempeño laboral y redes de apoyo. En base a éstas se observa la importancia del capital cultural y económico, las estrategias personales para acceder a la información oral, el origen del déficit, el grado de interacción requerido en sus puestos de trabajo actuales, entre otros aspectos.

This study aims to know the meaningful aspects to the process of labor inclusion to two college graduates with several hypoacusis in the Metropolitan Region, through interviews focused on job performance to advance the understanding of strategies to improve employment opportunities for this population. It is an exploratory, retrospective and transversal study. It has designed a semistructured interview, previously requesting informed consent, for to collect the data. The interview covers their life trajectories focuses on job performance. They are identified as respects the following categories: nuclear family, family of origin, hearing loss, educational performance, work performance and their social support network. As a result of the former to emerge the importance of cultural and economic capital, personal strategies to access oral information, the source of the deficit, the degree of interaction required in their current jobs, among others.

Cierre de fístula oroantral con injerto óseo y con rotación y avance de colgajo palatino / Surgical repair oroantral fistula with a rotation and advancement palatal flap and autologous bone graft

La fístula oroantral se presenta entre otras causas como resultado de la extracción de un molar en relación al maxilar Como consecuencia el paciente presenta episodios de sinusitis de evolución tórpida y refractaria a tratamiento médico, siendo la reparación quirúrgica su mejor solución, existiendo distintas técnicas. El objetivo de este caso es mostrar la experiencia de un paciente operado mediante la utilización de un colgajo de rotación y avance palatino e injerto de hueso autólogo. Se trata de una mujer de 32 años que dos semanas después de extracción de molar superior izquierdo presenta reiterados episodios de sinusitis unilateral izquierda. Al examen físico y estudio con tomografía computarizada se diagnostica sinusitis maxilar izquierda, secundaria a fístula oroantral por extracción de pieza dentaria del maxilar. Se realiza reparación quirúrgica con utilización de un colgajo de rotación y avance palatino e injerto de hueso autólogo. Se realizó seguimiento por 6 meses con resultados óptimos, sin complicaciones ni recidivas. Las fístulas oroantrales son un problema que tiene múltiples opciones de tratamiento quirúrgico. La utilización de injertos óseos autólogos y la utilización de un colgajo de rotación y avance palatino, pretende ser una buena opción quirúrgica, permitiendo un cierre definitivo del defecto.

Oroantral fistula occurs between other causes as a result of the extraction of a molar in relation to the maxillary bone. As a result the patient experiences episodes of sinusitis refractory to medical treatment. Surgical repair remains the best solution, there are different techniques. The aim is to show our experience of one case operated using a rotation and advancement palatal flap and autologous bone graft. The clinical case is a 32 year old woman that two weeks after removal of upper left molar suffers repeated episodes of unilateral sinusitis. Physical examination and computed tomography shown left maxillary chronic sinusitis secondary to an oroantral fistula, due to tooth extraction from maxillary bone. Surgical repair is performed using a rotation and advancement palatal flap and autologous bone graft. Six months following there was no complication neither recurrent sinusitis, with optimal results. Oroantral fistula is a problem that has multiple options for surgery. The use of autologous bone graft and rotation and advancement palatal flap intended to be a good surgical option, allowing closure of the defect.

Causa poco común de obstrucción nasosinusal recurrente: enfermedad de Rosai-Dorfman / Uncommon cause of recurrent sinus obstruction: Rosai-Dorfman disease

La enfermedad de Rosai-Dorfman corresponde a una enfermedad rara con menos de 1.000 casos reportados. Sus características clínicas corresponden a un aumento de volumen en ganglios cervicales, sin embargo, presenta compromiso extranodal como única manifestación entre el 25 por ciento y 50 por ciento de los casos. La ubicación nasosinusal ha sido reportada previamente, pese a ello, es más frecuente encontrarla en otras ubicaciones. El diagnóstico se basa en el estudio histopatológico encontrándose el fenómeno de emperipolesis, con células positivas a la proteína S-100. Esta enfermedad es frecuentemente confundida con neoplasias malignas, por lo que debe ser reconocida y sospechada. Se presenta el caso de un paciente de 15 años con historia obstrucción nasal de larga data, con múltiples recurrencias de la enfermedad de Rosai-Dorfman, demostrada mediante histopatología.

The Rosai-Dorfman disease corresponds to a rare disease with less than 1,000 reported cases. Their clinical characteristics correspond to a volume increase in cervical nodes, There is an extranodal involvement as the only manifestation of between 25 percent percent and 50 percent percent of cases. The sinonasal location has been previously reported. Diagnosis is based on histopathology with the phenomenon of emperipolesis with cells positive for S-100 protein. This disease is often confused with malignancy, so it must be recognized and suspected. A case of a patient 15 years with a history of longstanding nasal obstruction, with multiple recurrences of Rosai-Dorfman disease, demonstrated by histopathology.

Manejo del paciente con fisura labio-palatina en Arica: experiencia de 15 años / Management of cleft lip palate in Arica: 15 years experience

Introducción: Frente al alto número de pacientes con fisura labial y/o palatina ya existente en la ciudad de Arica y al incremento constante de nuevos casos, en 1987 decidimos abordar el problema desde un punto de vista multidisciplinario e interdisciplinario, integrando además la valiosa ayuda de los padres de los niños fisurados. Objetivo: Mostrar nuestra experiencia y sus resultados parciales en el manejo multidisciplinario del paciente fisurado en la ciudad de Arica entre los años 1987y 2002. Material y método: Mediante la creación y puesta en práctica del "Programa de Atención del Paciente Fisurado", en el Hospital Juan Noé de Arica entre los años 1987y 2002, se atienden 59 pacientes que siguen el programa. Resultados: A modo de resultado preliminar se entrega la experiencia de 59 casos que siguieron el protocolo del programa. Conclusión: El trabajo con el paciente fisurado, es un trabajo de largo aliento. Como factores de importancia se destacan el largo tiempo de seguimiento, el factor crecimiento y la observación atenta de la evolución en cada caso en particular. Resulta imprescindible el trabajo en equipo multidisciplinario, evaluando en conjunto cada caso, elaborando un claro y estructurado plan de acción con cada paciente, así como evaluar en forma periódica y en conjunto los resultados parciales.

Introduction: Due to the high prevalence of patients with cleft lip with or without cleft palate in the city of Arica Chile and the constant increase of new cases, in 1987 we decided to face the problem from a multidisciplinary and interdisciplinary point of view, incorporating the valuable help from the parents of the affected children. Aim: To show our experience in the multidisciplinary manage of cleft lip-palate in the city of Arica during the years 1987 to 2002 Material and method: By the creation and set up of the "Cleft Lip-Palate patient attention program", in the Juan Noé Hospital of Arica during the years 1987 to 2002, we follow 59 patients attending the program. Results: Some preliminary results are displayed, according to the experience of 59 cases of patients attending the program. Conclusion: Complete management of the cleflip patient is a longjob. As important factors outstand age, growth and careful observation ofevolution in every single case. Multidisciplinary team work is a must, evaluating each case together, developing a clear structured plan of action for each patient, as well as periodically evaluating partial results.

Evaluación auditiva neonatal universal: revisión de 10.000 pacientes estudiados / Universal newborn hearing screening: review of 10. 000 evaluations

Introducción: La hipoacusia es la discapacidad congénita más frecuente entre los recién nacidos vivos y su diagnóstico precoz e intervención temprana permiten un desarrollo social y educacional normal en el niño. Objetivo: Revisar la experiencia del programa de evaluación auditiva universal de nuestra institución. Material y método: Estudio retrospectivo de todos los recién nacidos evaluados entre mayo de 2001 y diciembre de 2007. El tamizaje auditivo se realizó mediante emisiones otoacústicas y potenciales evocados auditivos automatizados. Resultados: En el período de estudio fueron evaluados 10.095 recién nacidos, pesquisándose 30 casos de hipoacusia congénita. La mayoría de éstas (80 por ciento) correspondieron a hipoacusias leves a moderadas. El diagnóstico de hipoacusia estaba confirmado antes de los 3 meses de vida en el 88,5 por ciento de los casos. Se calculó una tasa de hipoacusia congénita de 2,8 por cada 1.000 recién nacidos en sala cuna y de 21 por cada 1.000 recién nacidos de alto riesgo (UTI neonatal). Discusión: En nuestros resultados destacan la amplia cobertura lograda y la precocidad del diagnóstico, lo que ha permitido realizar una oportuna intervención y rehabilitación.

Introduction: Hearing loss is the most common congenital disability, and its early recognition and treatment is important for the normal social and educational development of the child. Aim: To review the results of the universal newborn hearing screening program at our institution. Material and method: Retrospective study of all newborns examined between May 2001 and December 2007. Hearing screening was carried out by otoacoustic emissions and automated auditory brainstem potentials. Results: 30 cases of congenital hearing loss were detected among the 10.095 newborns that were examined during the study period. Most hearing impairments (80 percent) were mild to moderate. Diagnosis of hearing loss was confirmed by the age of 3 months in88.5 percent> of the patients. We estimated a congenital hearing loss rate of 2.8 cases in 1000 newborns at the nursery, and of 21 cases In 1000 high-risk newborns (neonatal ICU). Discussion: From our results, it is noteworthy the high coverage and the early diagnosis achieved, which enabled us to make timely interventions and rehabilitation.

Técnicas quirúrgicas actuales en adenoamigdalectomía / Adenotonosillectomy current surgical techniques

Las indicaciones de la amigdalectomía y la adenoidectomía no han variado significativamente en las últimas décadas. En la actualidad, una gran variedad de métodos quirúrgicos están disponibles para realizar estos procedimientos, todos los cuales son esencialmente seguros y efectivos. La posibilidad de visualizar el campo operatorio rinofaríngeo a través de una cámara adosada a un endoscopio ha permitido reducir las recurrencias sintomáticas y las complicaciones post-operatorias. Respecto a la amigdalectomía, cobran cada día más importancia nuevas técnicas como son la ablación por radiofrecuencia o las resecciones intracapsulares que permiten disminuir las tasas de hemorragia y el dolor post-operatorio. La decisión de optar por una técnica en particular dependerá de una serie de factores: indicación de la cirugía (infección vs. obstrucción), disponibilidad de equipamiento en pabellón, posibilidad de asumir costos adicionales y preferencias del cirujano.

The indications for adenotonsillectomy have not been changed significlantly in the last decades. Currently, a great variety of surgical procedures are available and are all essentially safe and effective. Regarding tonsillectomy, everyday new techniques are becoming more popular, such as coblation, radiofrecuency, or intracapsular resection that allows a decrease in the incidente of post operative hemorrhage and pain. The use of an endoscope and camera to visualize the rhino pharynx has reduced the recurrence of adenoids and decreased post operative complications. The decision for one particular surgical technique will vary depending of several factors, such as infection versus obstruction, availability of equipment, the possibility of assuming extra cost, and the preference of each surgeon.