Prognostic value of surgical resection over biopsy in elderly patients with glioblastoma: a meta-analysis.

PURPOSE: Maximal-safe resection has been shown to improve overall survival in elderly patients with glioblastoma in observational studies, however, the only clinical trial comparing resection versus biopsy in elderly patients with surgically-accessible glioblastoma showed no improvements in overall survival. A meta-analysis is needed to assess whether surgical resection of glioblastoma in older patients improves surgical outcomes when compared to biopsy alone. METHODS: A search was conducted until October 9th, 2023, to identify published studies reporting the clinical outcomes of glioblastoma patients > 65 years undergoing resection or biopsy (PubMed, MEDLINE, EMBASE, and COCHRANE). Primary outcomes were overall survival (OS), progression-free survival (PFS), and complications. We analyzed mean difference (MD) and hazard ratio (HR) for survival outcomes. Postoperative complications were analyzed as a dichotomic categorical variable with risk ratio (RR). RESULTS: From 784 articles, 20 cohort studies and 1 randomized controlled trial met our inclusion criteria, considering 20,523 patients for analysis. Patients undergoing surgical resection had an overall survival MD of 6.13 months (CI 95%=2.43-9.82, p = < 0.001) with a HR of 0.43 (95% CI = 0.35-0.52, p = < 0.00001). The progression-free survival MD was 2.34 months (95%CI = 0.79-3.89, p = 0.003) with a 0.50 h favoring resection (95%CI = 0.37-0.68, p = < 0.00001). The complication RR was higher in the resection group favoring biopsy (1.49, 95%CI = 1.06-2.10). CONCLUSIONS: Our meta-analysis suggests that upfront resection is associated with improved overall survival and progression-free survival in elderly patients with newly diagnosed glioblastoma over biopsy. However, postoperative complications are more common with resection. Future clinical trials are essential to provide more robust evaluation in this challenging patient population.

Simultaneous Parkinsonism and Dementia as Initial Presentation of Intracranial Dural Arteriovenous Fistulas: A Systematic Review.

BACKGROUND: Intracranial dural arteriovenous fistulas (IDAVFs) are abnormal vascular connections between dural arteries and various venous structures within the brain. IDAVFs, rarely present with parkinsonism and dementia concurrently, making this a unique and underexplored clinical scenario. To the best of our knowledge, this is the first systematic review to comprehensively analyze cases of IDAVFs manifesting as both parkinsonism and dementia. METHODS: We assessed databases from inception to September 18, 2023. We identified studies describing patients with IDAVFs initially presenting with dementia or parkinsonism. Inclusion criteria encompassed case reports and case series, while excluding review articles, guidelines, technical notes, comments, conference abstracts, and editorials. RESULTS: The systematic search resulted in the initial screening of 383 studies, with 33 articles meeting the inclusion criteria. Among these, 29 were case reports, often describing 3 or fewer patients. From the remaining 4 case series, data pertinent to patients presenting both parkinsonism and dementia were selectively extracted, yielding a total study population of 43 patients. The anatomical distribution of IDAVFs within this cohort was diverse, with the transverse and sigmoid sinuses being the most common locations. Although most of these patients received endovascular therapy, a few underwent microsurgical occlusion or combined surgical and endovascular treatment. CONCLUSIONS: IDAVFs presenting with both parkinsonism and dementia represent a rare clinical entity. This systematic review provides valuable insights into the clinical characteristics, treatment options, and outcomes for such cases. However, additional research involving larger cohorts is essential to better comprehend the underlying mechanisms and establish standardized therapeutic guidelines.

A 29-year-old woman presenting for urgent cesarean hysterectomy: a multidisciplinary care challenge.

This case describes a patient who needed an urgent cesarean hysterectomy for new-onset fetal heart rate abnormalities and preexisting placenta accreta spectrum. Rapid assembly of a multidisciplinary team consisting of obstetrics, anesthesiology, neonatology, and nursing contributed to a favorable clinical outcome.

Satisfacción laboral y calidad de vida de los médicos residentes españoles en los meses posteriores a la terminación del estado de alarma por la COVID-19 y al año de la misma / Job satisfaction and quality of life of Spanish medical residents in the months after the end of the state of alarm due to COVID-19 and one year later

Introducción: Describir y analizar la percepción existente acerca de la satisfacción laboral (SL) y la calidad de vida (CV) de los/las médicos/as residentes españoles/as en los meses posteriores a la terminación del estado de alarma por la COVID-19 y al año de la misma. Método: Estudio descriptivo-correlacional, siendo la población diana los/las residentes españoles/as a quienes se preguntó, mediante formulario online, en dos cortes (1º de 01/11 al 31/12 de 2020 y 2º entre 01/11 y 31/12 de 2021). Para la SL se utilizó el cuestionario Font-Roja y para la CV el WHOQOL-BREF (ambos mediante escala Likert de 5 valores). Resultados: Respondieron 404 residentes (1er corte) y 411 (2º corte). Los resultados para a SL global mostraron Rho = 0,09; p = 0,081, sin diferencias entre sus medias (-0,07; p = 0,090). La CV global, medida a través del cuestionario, indicó baja correlación entre ambos cortes (Rho = 0,10; p = 0,041), con diferencias entre sus medias (-0,14; p < 0,001). Conclusiones: En relación a la SL no se constató asociación entre los dos periodos estudiados. Respecto a la CV se evidenciaron mejores datos, en el 2º corte, tanto en la CV autopercibida como en el resultado global del cuestionario (AU)

Introduction: To describe and analyze the existing perception about job satisfaction (SL) and quality of life (QoL) of Spanish resident doctors in the months which follow the end of the state of alarm due to COVID-19 and one year after that.Method: A Descriptive-correlational study, being the Spanish residents the target population who was asked, using an online form, in two periods (1st from 11/01 to 12/31, 2020 and 2nd between 11/01 and 12/31, 2021). For SL, the Font-Roja questionnaire was used and for QoL, the WHOQOL-BREF (both using a 5-point Likert scale).Results: 404 residents responded (1st cut) and 411 (2nd cut). The results for the global SL showed Rho = 0.09; p = 0.081, without differences between their means (-0.07; p = 0.090). The global QoL, measured through the question-naire, evinced a low correlation between both cut-offs (Rho = 0.10; p = 0.041), with variations between their means (-0.14; p < 0.001).Conclusions: In relation to SL, no association was revealed between the two periods studied. Regarding QoL, more positive data were found in the 2nd period, both in self-perceived QoL and in the global result of the questionnaire (AU)

Satisfacción laboral y calidad de vida de los médicos residentes españoles durante la pandemia por la COVID-19 / Job satisfaction and quality of life of Spanish resident doctors during the COVID-19 pandemic

Introducción: Describir y analizar la percepción existente acerca de los factores vinculados a la satisfacción laboral (SL) y la calidad de vida (CV) de los médicos residentes españoles durante la pandemia por la COVID-19. Método: Estudio descriptivo-correlacional, siendo la población diana los residentes españoles a los que se preguntó, mediante formulario online, entre el 01/11/2020 y el 31/12/2020. Para la SL se utilizó el cuestionario Font-Roja y para la CV el WHOQOL-BREF (ambos mediante escala Likert de 5 valores). Resultados Respondieron 404 residentes, sin diferencias por sexo (p 0 0,269). La SL presentó media de 2,97 ± 0,04 y la CV de 3,27 ± 0,03. Se observó asociación en la SL de los residentes de primer año y el resto (p < 0,001). La SL no se afectó por los turnos de urgencia, pero sí la CV para las relaciones sociales (p = 0,042). La relación entre SL y CV fue buena (Rho = 0,53, p < 0,001). Conclusiones: El tutor fue referente para el residente, no así la dirección del hospital. No se encontraron diferencias en relación al sexo ni a los turnos de guardia con la SL. Los residentes de primer año presentaron mayor SL y CV, pudiendo deberse a su menor responsabilidad y cansancio acumulado durante la pandemia. Los turnos de guardia sí afectaron la CV, específicamente en las relaciones sociales. La escasa formación en investigación se vio asimismo agravada por la pandemia. (AU)

Introduction: To describe and analyze the existing perception about the factors related to job satisfaction (LS) and quality of life (QOL) of Spanish resident doctors during the COVID-19 pandemic. Method: Descriptive-correlational study, the target population being the Spanish residents who were asked, using the online form, between 11/01/2020 and 12/31/2020. The Font-Roja questionnaire was used for LS and the WHOQOL-BREF for QOL (both using a 5-value Likert scale). Results: 404 residents responded, without differences by sex (p = 0.269). The LS presented a mean of 2.97 ± 0.04 and the CV of 3.27 ± 0.03. An association was observed in the LS of the first-year residents and the rest (p < 0.001). The LS was not affected by the emergency shifts, but the (QOL) for social relationships (p = 0.042). The relationship between SL and (QOL) was good (Rho = 0.53, p < 0.001). Conclusions: The tutor was a reference for the resident, not the hospital management. No differences were found in relation to sex or duty shifts with the LS. First-year residents presented higher LS and (QOL), which could be due to less responsibility and less accumulated fatigue during the pandemic. The shifts on duty did affect QOL, specifically in social relationships. Poor research training was also compounded by the pandemic (AU)

[Malignant Skin Neoplasms in Workers in the Fishing Industry: Systematic Review]. / Lesiones malignas de la piel en trabajadores del sector pesquero: Revisión sistemática.

OBJECTIVE: To review the scientific literature related to the effects of occupational exposure to risk factors for skin neoplasms in fishery workers. METHOD: Critical analysis of the papers recovered through systematic review from en MEDLINE (PubMed), EMBASE, The Cochrane Library, Scopus, Web of Science y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). STOROBE guidelines were followed to evaluate their quality. RESULTS: After attributing inclusion and exclusion criteria to the search, 11 articles were accepted for review and critical analysis. In 7 of them, a statistically significant association was obtained between skin neoplasia and occupational exposure in fishermen. CONCLUSIONS: Despite having found studies that were significant in terms of the relationship of malignant lesions and exposure to ultraviolet radiation in the workplace, some of them did not control possible biases, therefore the results should be taken with caution.

OBJETIVO: Revisar la literatura científica relacionada con los efectos de la exposición ocupacional a factores de riesgo para neoplasias cutáneas en trabajadores del sector pesquero. MÉTODO: Análisis crítico de los trabajos recuperados mediante revisión sistemática en MEDLINE (PubMed), EMBASE, The Cochrane Library, Scopus, Web of Science y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). Se evaluó la calidad de los artículos seleccionados mediante el cuestionario STROBE. RESULTADOS: Al atribuir los criterios de inclusión y exclusión a la búsqueda, se aceptaron 11 estudios para su revisión. En 7 de ellos, se obtuvo una asociación estadísticamente significativa entre neoplasia cutánea y exposición ocupacional.  CONCLUSIONES: Se observa una relación entre lesiones malignas y exposición a radiación ultravioleta en el ámbito laboral, no obstante, la existencia de posibles sesgos hace que los resultados deban de tomarse con precaución.

Lesiones malignas de la piel en trabajadores del sector pesquero: Revisión sistemática / Malignant Skin Neoplasms in Workers in the Fishing Industry: Systematic Review

OBJETIVO: Revisar la literatura científica relacionada con los efectos de la exposición ocupacional a factores de riesgo para neoplasias cutáneas en trabajadores del sector pesquero. MÉTODO: Análisis crítico de los trabajos recuperados mediante revisión sistemática en MEDLINE (PubMed), EMBASE, The Cochrane Library, Scopus, Web of Science y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). Se evaluó la calidad de los artículos seleccionados mediante el cuestionario STROBE. RESULTADOS: Al atribuir los criterios de inclusión y exclusión a la búsqueda, se aceptaron 11 estudios para su revisión. En 7 de ellos, se obtuvo una asociación estadísticamente significativa entre neoplasia cutánea y exposición ocupacional. CONCLUSIONES: Se observa una relación entre lesiones malignas y exposición a radiación ultravioleta en el ámbito laboral, no obstante, la existencia de posibles sesgos hace que los resultados deban de tomarse con precaución

OBJECTIVE: To review the scientific literature related to the effects of occupational exposure to risk factors for skin neoplasms in fishery workers. METHOD: Critical analysis of the papers recovered through systematic review from en MEDLINE (PubMed), EMBASE, The Cochrane Library, Scopus, Web of Science y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). STOROBE guidelines were followed to evaluate their quality. RESULTS: After attributing inclusion and exclusion criteria to the search, 11 articles were accepted for review and critical analysis. In 7 of them, a statistically significant association was obtained between skin neoplasia and occupational exposure in fishermen. CONCLUSIONS: Despite having found studies that were significant in terms of the relationship of malignant lesions and exposure to ultraviolet radiation in the workplace, some of them did not control possible biases, therefore the results should be taken with caution

Mitochondria and calcium defects correlate with axonal dysfunction in GDAP1-related Charcot-Marie-Tooth mouse model.

Ganglioside-induced differentiation associated protein 1 (GDAP1) gene encodes a protein of the mitochondrial outer membrane and of the mitochondrial membrane contacts with the endoplasmic reticulum (MAMs) and lysosomes. Since mutations in GDAP1 cause Charcot-Marie-Tooth, an inherited motor and sensory neuropathy, its function is essential for peripheral nerve physiology. Our previous studies showed structural and functional defects in mitochondria and their contacts when GDAP1 is depleted. Nevertheless, the underlying axonal pathophysiological events remain unclear. Here, we have used embryonic motor neurons (eMNs) cultures from Gdap1 knockout (Gdap1-/-) mice to investigate in vivo mitochondria and calcium homeostasis in the axons. We imaged mitochondrial axonal transport and we found a defective pattern in the Gdap1-/- eMNs. We also detected pathological and functional mitochondria membrane abnormalities with a drop in ATP production and a deteriorated bioenergetic status. Another consequence of the loss of GDAP1 in the soma and axons of eMNs was the in vivo increase calcium levels in both basal conditions and during recovery after neuronal stimulation with glutamate. Further, we found that glutamate-stimulation of respiration was lower in Gdap1-/- eMNs showing that the basal bioenergetics failure jeopardizes a full respiratory response and prevents a rapid return of calcium to basal levels. Together, our results demonstrate that the loss of GDAP1 critically compromises the morphology and function of mitochondria and its relationship with calcium homeostasis in the soma and axons, offering important insight into the cellular mechanisms associated with axonal degeneration of GDAP1-related CMT neuropathies and the relevance that axon length may have.

Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016.

We conducted an observational study from January 2016 through January 2017 of patients admitted to a reference pediatric hospital in Madrid, Spain, for neurologic symptoms and enterovirus infection. Among the 30 patients, the most common signs and symptoms were fever, lethargy, myoclonic jerks, and ataxia. Real-time PCR detected enterovirus in the cerebrospinal fluid of 8 patients, nasopharyngeal aspirate in 17, and anal swab samples of 5. The enterovirus was genotyped for 25 of 30 patients; enterovirus A71 was the most common serotype (21/25) and the only serotype detected in patients with brainstem encephalitis or encephalomyelitis. Treatment was intravenous immunoglobulins for 21 patients and corticosteroids for 17. Admission to the pediatric intensive care unit was required for 14 patients. All patients survived. At admission, among patients with the most severe disease, leukocytes were elevated. For children with brainstem encephalitis or encephalomyelitis, clinicians should look for enterovirus and not limit testing to cerebrospinal fluid.

The Children's International Mucositis Evaluation Scale Is Valid and Reliable for the Assessment of Mucositis Among Brazilian Children With Cancer.

BACKGROUND: The Children's International Mucositis Evaluation Scale (ChIMES) is considered a valid and reliable instrument for the assessment of mucositis in pediatric patients aged 0-18 years. OBJECTIVE: To perform the translation and cultural adaptation of ChIMES to Brazilian Portuguese and assess its psychometric properties. METHODS: Methods for translation and cultural adaptation were used. Other measurements obtained concomitantly for the assessment of psychometric properties included the Oral Mucositis Daily Questionnaire, a visual analog scale, the World Health Organization grading scale for mucositis, and the National Cancer Institute Common Terminology Criteria for Adverse Events toxicity scale. For test-retest analysis, patients and guardians responded to the self-report and proxy versions of ChIMES within intervals of one to seven days. RESULTS: Regarding internal consistency, Cronbach's alpha (α) values were 0.769 (95% CI = 0.631-0.868) and 0.879 (95% CI = 0.872-0.920) for the self-reported and proxy versions, respectively. The convergent validity criteria were met for the self-reported and proxy versions (Spearman's rho = 0.466-0.751; P < 0.001 and Spearman's rho = 0.410-0.551; P < 0.001, respectively). Test-retest reliability assessment for the total score and Items 1, 2, 3, and 4 in both versions showed an intraclass correlation coefficient of ≥0.7. CONCLUSIONS: The Portuguese self-reported and proxy versions of ChIMES were considered to be culturally adapted, valid, and reliable for Brazilian pediatric patients ranging from an age of one month to 18 years and were named ChIMES-BR.

Autopsia molecular en muerte súbita cardíaca neonatal mediante secuenciación de siguiente generación (NGS): presentación de un caso / Molecular autopsy in neonatal sudden cardiac death by next generation sequencing (NGS): presentation of a case

Presentamos un caso de muerte súbita de una lactante de tres meses de edad. La autopsia reveló una miocardiopatía hipertrófica y la muestra de sangre del cordón umbilical almacenada fue utilizada para análisis molecular. Mediante la secuenciación de siguiente generación (NGS) de 4813 genes (exoma clínico), se identificó una variante patogénica en el gen ELAC2, (c.210_222 del p.Gly71ThrfsTer26) en estado heterocigoto y otra variante probablemente patogénica en el mismo gen (c.1177C>T p.His393Tyr) en estado heterocigoto, asociadas con miocardiopatía hipertrófica. Adicionalmente, se identificó una variante patogénica en el exón 358 del gen TTN, (c.104515C>T, het p.Arg34839X) y una VUS (variante de significado incierto) en el gen MYPN (c.2428C>T, p.Arg810Cys), la cual podría tener un efecto aditivo en el fenotipo de la paciente. Así mismo se observa un polimorfismo de riesgo en el exón 16 en el gen LRP8, asociado con enfermedad coronaria (CAD) e infarto de miocardio prematuros (MI) (NM_017522: c.2066G>A, het, p.R689Q). La cardiopatía hereditaria es una causa probable de muerte súbita cardiaca, el análisis molecular por NGS puede ayudar a realizar un diagnóstico precoz para predecir a edad temprana pacientes con riesgo potencial de muerte súbita cardiaca así como un asesoramiento genético dirigido.

We present the case of sudden death in a three month old female infant. The girl died of sudden death, and the autopsy revealed a hypertrophic cardiomyopathy as the underlying alteration. The stored umbilical cord blood sample was used for molecular analysis. A pathogenic heterocigous variant in ELAC2 (c.210_222del, p.Gly71ThrfsTer26), and another probably pathogenic variant in the same gene ( c.1177C> T p.His393Tyr,het) associated with hypertrophic cardiomyopathy was identified. In addition, a pathogenic variant is identified in exon 358 of the TTN gene (c.104515C> T, het p.Arg34839X,het) and a VUS (variant of uncertain significance) in the MYPN gene (c.2428C> T, p.Arg810Cys,het), which may have an additive effect on the patient's phenotype. A risk polymorphism at exon 16 in the LRP8 gene, associated with premature coronary artery disease (CAD) and premature myocardial infarction (MI) (NM_017522: c.2066G> A, het, p.R689Q) was also found. Hereditary heart disease is a probable cause of sudden cardiac death, molecular analysis by NGS can help an early diagnosis and to predict at an early age, the risk of sudden cardiac death as well as directed genetic counseling.

Translation and cultural adaptation of the Shame and Stigma Scale (SSS) into Portuguese (Brazil) to evaluate patients with head and neck cancer / Tradução e adaptação cultural da Shame and Stigma Scale (SSS) para a língua portuguesa (Brasil) para avaliação de pacientes com câncer de cabeça e pescoço

Abstract Introduction: Head and neck cancer is the sixth leading cause of death from cancer worldwide and its treatment may involve surgery, chemotherapy and/or radiation therapy. The surgical procedure may cause mutilating sequelae, that can alter patient self-image. Thus, head and neck cancer is often connected to the negative stigma with decreased quality of life. Few studies assess the social stigma and shame perceived by patients with head and neck cancer. Objective: To perform the translation and cultural adaptation of the Shame and Stigma Scale (SSS) into Portuguese (Brazil). Methods: Two independent translations (English into Portuguese) were carried out by two professionals fluent in the English language. After the synthesis of the translations, two independent back-translations (from Portuguese into English) were performed by two translators whose native language is English. All translations were critically assessed by a committee of experts consisting of five members. A sample of 15 patients answered the Brazilian Portuguese version of the SSS to carry out the pretest. At this step, the patients were able to suggest modifications and evaluate the understanding of the items. Results: There was no need to change the scale after this step. Based on the previous steps, we obtained the Portuguese (Brazil) version of the SSS, which was called "Escala de Vergonha e Estigma". Conclusion: The Portuguese (Brazil) version of the SSP was shown to be adequate to be applied to the population with HNC and, therefore, the psychometric properties of the tool will be evaluated during following steps.

Resumo Introdução: O câncer de cabeça e pescoço corresponde à sexta causa de morte por câncer no mundo; seu tratamento pode envolver cirurgia, quimio e/ou radioterapia, a cirurgia pode acarretar sequelas mutiladoras, pode alterar a autoimagem do paciente. Assim, o câncer de cabeça e pescoço é muitas vezes ligado ao estigma negativo, com diminuição da qualidade de vida. Poucos instrumentos avaliam o estigma social e a vergonha percebidos por pacientes com câncer de cabeça e pescoço. Objetivo: Traduzir e adaptar culturalmente a Shame and Stigma Scale (SSS) para o português/Brasil. Método: Fizeram-se duas traduções independentes (do inglês para o português) por dois profissionais fluentes na língua inglesa. Após a síntese das traduções, duas retrotraduções independentes (do português para o inglês) foram feitas por dois tradutores cuja língua materna é o inglês. Todas as traduções foram analisadas criticamente por um comitê de especialistas composto por cinco membros. Uma amostra de 15 pacientes respondeu à versão em português/Brasil da SSS para o pré-teste. Nessa etapa, os pacientes puderam sugerir modificações e avaliar o entendimento dos itens. Resultados: Não houve necessidade de alteração da escala após essa fase. A partir das etapas anteriores, obteve-se a versão em português/Brasil da SSS, denominada de Escala de Vergonha e Estigma. Conclusão: A versão em português/Brasil da SSS se mostrou apta para ser aplicada na população com câncer de cabeça e pescoço; portanto, as propriedades psicométricas do instrumento serão avaliadas na etapa seguinte.

Translation and cultural adaptation of the Shame and Stigma Scale (SSS) into Portuguese (Brazil) to evaluate patients with head and neck cancer.

INTRODUCTION: Head and neck cancer is the sixth leading cause of death from cancer worldwide and its treatment may involve surgery, chemotherapy and/or radiation therapy. The surgical procedure may cause mutilating sequelae, that can alter patient self-image. Thus, head and neck cancer is often connected to the negative stigma with decreased quality of life. Few studies assess the social stigma and shame perceived by patients with head and neck cancer. OBJECTIVE: To perform the translation and cultural adaptation of the Shame and Stigma Scale (SSS) into Portuguese (Brazil). METHODS: Two independent translations (English into Portuguese) were carried out by two professionals fluent in the English language. After the synthesis of the translations, two independent back-translations (from Portuguese into English) were performed by two translators whose native language is English. All translations were critically assessed by a committee of experts consisting of five members. A sample of 15 patients answered the Brazilian Portuguese version of the SSS to carry out the pretest. At this step, the patients were able to suggest modifications and evaluate the understanding of the items. RESULTS: There was no need to change the scale after this step. Based on the previous steps, we obtained the Portuguese (Brazil) version of the SSS, which was called "Escala de Vergonha e Estigma". CONCLUSION: The Portuguese (Brazil) version of the SSP was shown to be adequate to be applied to the population with HNC and, therefore, the psychometric properties of the tool will be evaluated during following steps.

Índice de éxito en cirugía del estribo en el tratamiento de otoesclerosis / Index of success in stapes surgery in the treatment of otosclerosis

Introducción: La otoesclerosis es un padecimiento que ocasiona hipoacusia y es de relativa frecuencia en nuestra región con tratamiento quirúrgico bien establecido e índice de éxito relativamente alto. Objetivo: Determinar el índice de éxito del tratamiento quirúrgico de la otoesclerosis en un tercer nivel de atención. Diseño: Estudio observacional descriptivo de corte transversal. Materiales y Métodos. Se revisaron los expedientes clínicos de los pacientes con diagnóstico de otoesclerosis y manejo quirúrgico con estapedectomía y estapedotomía en el servicio de otorrinolaringología de esta institución de julio 2009 a enero 2011. Resultados: De un total de 56 expedientes revisados en el período de estudio, se encontraron 36 expedientes completos, 61.9% mujeres y 27.1% hombres, con una edad media de 36.7 años; la afección bilateral fue del 80% y unilateral del 20%. Con respecto al síntoma predominante, 62% de los pacientes presentaron sólo hipoacusia y 38% tinitus e hipoacusia, con una duración media de 8.4 años. Los hallazgos audiológicos demostraron una prevalencia de hipoacusia conductiva moderada bilateral en 13 pacientes, severa bilateral en 4 casos, hipoacusia conductiva superficial unilateral en 2, hipoacusia conductiva severa y moderada unilateral con uno en ambos casos e hipoacusia conductiva unilateral superficial en 1. En 21 pacientes, se realizaron 29 cirugías, bilaterales en 10 pacientes, 7 en oído izquierdo y 2 en oído derecho y 2 decidieron no operar. Discusión: Se encontró un índice de éxito quirúrgico mayor del 90%. Conclusión: Los resultados presentados, fueron semejantes a los reportados en la literatura.

Introduction: Otosclerosis is a relatively frequent condition that causes hearing loss in our region. The surgical treatment is well established with stapedectomy and stapedotomy, and its success rate is high. Objective: To determine the success rate of surgical treatment of otosclerosis in a third level of care. Design: Observational, Cross sectional study. Material and methods: We reviewed the clinical records of patients with diagnosis and surgical management with stapedectomy and stapedotomy in the otorhinolaryngology department of this institution from July 2009 to January 2011. Results: Of a total of 56 files reviewed during the study period, 36 complete files were found, 61.9% were female and 27.1% were male, with a mean age of 36.7 years, bilateral affection was found in 80% of the patients and unilateral in 20%. Regarding to the predominant symptom, 62% of the patients had only hearing loss and 38% reported tinnitus and hearing loss, with an average duration of 8.4 years. The audiological findings showed a prevalence of moderate bilateral conductive hearing loss in 13 cases, bilateral severe in 4 cases, unilateral conductive hearing loss in 2, unilateral moderate and severe conductive hearing loss in one case, and unilateral conductive hearing loss in 1. In 21 patients, 29 surgeries were carried out, bilateral in 10 patients, 7 in the left ear and 2 in the right ear and 2 decided not to operate. Discussion: A surgical success rate of more than 90% was found. Conclusion: The results presented were similar to those reported in the literature.

[Structural dynamics of Legionella pneumophila and Legionella bozemanii colony/biofilm]. / Dinámica estructural de colonias/biofilm de Legionella pneumophila y Legionella bozemanii.

OBJECTIVES: The genus Legionella includes very pleomorphic species responsible for disease outbreaks in humans. The appearance of such has great importance to develop artificial biofilms in aquatic ecosystems. The aim of this work was to study the dynamics of growth and evolution of the internal structure of colonies of representative species of the genus as static biofilm model. METHODS: Isolated colonies of Legionella pneumophila and Legionella bozemanii grown in specific media for three and fifteen days were processed for histological methods and embedded in paraffin and epoxy resin for analysis by light microscopy, electron microscopy and image analysis. RESULTS. In colonies of both species were observed and defined specific architectural patterns, based on stratification and evolve over time. The strata differ in the amount of extracellular matrix, the morphology and population density and the proportion of dead cells. The internal structure of three days colonies showed large differences between L. pneumophila (two layers) and L. bozemanii (four layers). However, in the fifteen days colonies of both species evolved towards a common unique pattern formed by three layers. In both species the growth was also found within the culture medium, although this phenomenon was more intense in L. bozemanii with unique, central and larger invasions. CONCLUSIONS: Our results demonstrate that Legionella colonies on solid culture media are a good model of static biofilm with a complex structural dynamics characterized by the presence of morphological and functional subpopulations. We bring here an histological approach model, allowing, in further research, detailed studies in evolutionary adaptations in multicellular communities to adverse media and to antimicrobials in Legionella species of clinical interest.

Dinámica estructural de colonias/biofilm de Legionella pneumophila y Legionella bozemanii / Structural dynamics of Legionella pneumophila and Legionella bozemanii colony/biofilm

Objetivos. El género Legionella engloba especies muy pleomórficas responsables de brotes infecciosos en humanos. En la aparición de los mismos tiene gran importancia el desarrollo de biofilms en ecosistemas acuáticos artificiales. El objetivo de este trabajo fue estudiar la dinámica de crecimiento y la evolución de la estructura interna de colonias de especies representativas del género como modelo de biofilm estático. Material y métodos. Colonias aisladas de Legionella pneumophila y Legionella bozemanii crecidas en medios específicos durante tres y quince días fueron procesadas por métodos histológicos de inclusión en parafina y resina epoxi para su análisis mediante microscopía óptica, microscopía electrónica y análisis de imagen. Resultados. En las colonias de ambas especies se observaron patrones arquitecturales definidos y específicos, basados en la estratificación y que evolucionan en el tiempo. Los estratos se diferencian por la cantidad de matriz extracelular, la morfología y densidad poblacional y la proporción de células muertas. La estructura interna de las colonias de tres días presentaba grandes diferencias entre L. pneumophila (dos estratos) y L. bozemanii (cuatro estratos). Sin embargo, en las colonias de quince días ambas especies evolucionaron hacia un patrón único común formado por tres estratos. En ambas especies se comprobó también el crecimiento en el interior del medio de cultivo, aunque este fenómeno fue mucho más intenso en L. bozemanii, con invasiones únicas, centrales y de gran tamaño. Conclusiones. Nuestros resultados demuestran que las colonias de Legionella sobre medio de cultivo sólido son un buen modelo de biofilm estático, con una dinámica estructural compleja caracterizada por la presencia de subpoblaciones morfológicas y funcionales. La aproximación histológica empleada en este modelo permitirá estudiar adaptaciones evolutivas de comunidades multicelulares a medios hostiles, así como la respuesta a los antimicrobianos de las especies de Legionella de interés clínico (AU)

Objectives. The genus Legionella includes very pleomorphic species responsible for disease outbreaks in humans. The appearance of such has great importance to develop artificial biofilms in aquatic ecosystems. The aim of this work was to study the dynamics of growth and evolution of the internal structure of colonies of representative species of the genus as static biofilm model. Methods. Isolated colonies of Legionella pneumophila and Legionella bozemanii grown in specific media for three and fifteen days were processed for histological methods and embedded in paraffin and epoxy resin for analysis by light microscopy, electron microscopy and image analysis. Results. In colonies of both species were observed and defined specific architectural patterns, based on stratification and evolve over time. The strata differ in the amount of extracellular matrix, the morphology and population density and the proportion of dead cells. The internal structure of three days colonies showed large differences between L. pneumophila (two layers) and L. bozemanii (four layers). However, in the fifteen days colonies of both species evolved towards a common unique pattern formed by three layers. In both species the growth was also found within the culture medium, although this phenomenon was more intense in L. bozemanii with unique, central and larger invasions. Conclusions. Our results demonstrate that Legionella colonies on solid culture media are a good model of static biofilm with a complex structural dynamics characterized by the presence of morphological and functional subpopulations. We bring here an histological approach model, allowing, in further research, detailed studies in evolutionary adaptations in multicellular communities to adverse media and to antimicrobials in Legionella species of clinical interest (AU)

Aspectos socioculturales relacionados con la donación voluntaria de sangre descritos por promotores de la donación de un Banco de sangre de la Ciudad de Bogotá, Colombia / Sociocultural aspects related to voluntary blood donation promoters described by donating a blood bank of the city of Bogotá, Colombia

Introducción: La promoción de la donación voluntaria y altruista de sangre se convierte en una estrategia de reclutamiento y seguridad de componentes sanguíneos. Objetivo: Conocer los principales aspectos socioculturales relacionados con la donación voluntaria de sangre descritos por promotores de la donación de un Banco de sangre categoría A de la ciudad de Bogotá, Colombia. Materiales y Métodos: Se realizó un estudio de tipo trasversal, por medio de la aplicación de una encuesta a 52 promotores de la donación de la Fundación Hematológica Colombia, se les solicito que según su experiencia clasificaran según género de la población los aspectos socioculturales evaluados. El análisis de los datos se hizo bajo supuestos de normalidad en todos los casos. Resultados: La edad promedio de los promotores fue de 26±5,25 (IC95% 24,52-27,46), en la distribución de los imaginarios sociales descritos por los promotores fue; "miedo a las agujas" fue predominante para el género masculino en un 55,77% (n=29), mientras que para el género femenino fue "Aumento o pérdida de peso" en un 45,28% (n=24), los aspectos que motivan a las personas a la donación "colaboración" en un 33% (n=17) seguido del "altruismo" en un 29% (n=15). Discusión: Dentro de los motivos para la donación se encontró que los promotores describen que el sexo femenino realiza la donación principalmente por "Compromiso Social", mientras que el sexo masculino lo hacen por "Beneficio propio", de igual manera se encuentra que el principal imaginario social es el "Aumento de peso" en las mujeres y "Miedo a las agujas" en hombres.

Introduction: The promotion of voluntary, unpaid donation of blood becomes a recruitment strategy and safety of blood components. Objective: To identify cultural aspects related to voluntary blood donation promoters described by donating a category Blood Bank city of Bogotá, Colombia. Methods: This was a transversal study, through the implementation of a survey to 52 promoters of Hematology Foundation grant Colombia, were asked to rank according to their experience of the population by gender sociocultural evaluated. The data analysis was made under assumptions of normality in all cases. Results: The average age of the promoters was 26±5.25 (95%CI 24.52 to 27.46), in the distribution of social images was described by the promoters, "afraid of needles" was predominant male gender in 55.77% (n=29), while for the female gender was "weight gain or loss" in 45.28% (n=24), the aspects that motivate people to donation "collaboration" by 33% (n=17) followed by "altruism" by 29% (n=15). Conclusions: Among the reasons for the donation was found that developers described that females performed mainly by donation "Social Commitment", while males do so for "personal gain", just as it is the main social imaginary is the "weight gain" in women and "Fear of needles" in men.

Pertinencia del tamizaje genético en donantes de gametos / The pertinence of genetic screening in gamete donors

Introducción: una preocupación importante para las parejas sometidas a tratamientos de reproducción asistida con gametos donados es la posibilidad de adquirir enfermedades infecciosas o la transmisión de enfermedades genéticas a la descendencia. Existen reportes, basados en la legislación de cada país y en la experiencia de cada centro, que hacen referencia al tipo de evaluación genética, infecciosa y psicológica que deben tener los donantes de gametos. En Colombia no existe una ley específica sobre las técnicas de reproducción asistida y la donación de gametos. Tampoco existe claridad acerca de si los donantes deberían ser evaluados genéticamente y con qué tipo de pruebas. Objetivo: el objetivo de este documento es hacer una reflexión sobre la pertinencia de evaluar genéticamente a los donantes de gametos a partir de la caracterización de las principales condiciones genéticas prevalentes en nuestra población, la alteración genética de base y el método actual de diagnóstico genético. Conclusión: se concluye que es necesario desarrollar un protocolo claro a nivel nacional y en los centros de reproducción asistida a cerca de la evaluación genética en los pacientes donantes de gametos.

Introduction: A major concern for pairs undergoing assisted reproduction treatment with donated gametes is the possibility of acquiring infectious diseases or transmitting genetic diseases to their offspring. Some reports have been based on the legislation of each country and each centre’s experience referring to the type of genetic infectious and/or psychological evaluation which gamete donors must undergo. There is no specific law in Colombia about assisted reproduction and/ or gamete donor techniques; also, there is no clarity about whether donors should be genetically evaluated and which type of test should be used for this. Objective: This document was aimed at making a reflection about the pertinence of genetically evaluating gamete donors by characterising the main genetic conditions prevailing in the Colombian population, base genetic alteration and the method currently being used for genetic diagnosis. Conclusion: It was concluded that a clear national protocol must be developed about genetic evaluation in gamete-donating patients; this should also be done in assisted reproduction centres.