Proboscis Lateralis With Choanal Atresia.

The case of a female patient who was born with proboscis lateralis, choanal atresia, and telecanthus is submitted. A report is made on the initial management of this patient, the clinical follow-up that has been carried out so far, and a review of the literature is conducted, taking into account the limited information found in this specific pathology, in order to contribute to its diagnostic orientation and treatment from a plastic and craniofacial surgery point of view.

Lefort I Osteotomy With and Without Osteogenic Distraction in Cleft Lip and Palate Patients: Experience at Hospital Universitario Infantil De San José.

INTRODUCTION: Cleft lip and cleft palate (CLP) are congenital diseases that lead to several secondary craniofacial anomalies, such as hypoplasia of the middle third of the face, which can be treated with different surgical techniques to help improve functional and esthetic alterations associated with the maxilla. This article reports the results of patients managed with LeFort I osteotomy in the same craniofacial surgery center for 10 years. OBJECTIVE: To determine the postoperative results regarding recurrence rates, malocclusion, and speech status after surgical treatment, in patients with retrusion of the midface with CLP, who underwent LeFort I osteotomy with or without osteogenic distraction (OD). METHODS: A descriptive cohort study was performed at the Hospital Infantil Universitario de San José in Bogotá, Colombia, between 2010 and 2020, evaluating 38 patients with CLP who met the inclusion criteria, all managed by LeFort I osteotomy with and without OD. The authors reported the sociodemographic information, as well as data related to speech before and after surgery, recurrence, complications, and cephalometric characteristics. The recurrence of the patients was described at 6 and 12 months after the surgical procedure. RESULTS: A total of 43 patients met the inclusion criteria, of which 20 patients were managed with conventional LeFort I osteotomy, and 23 with LeFort I osteotomy with OD; 5 patients were excluded due to lack of data in the medical records, with a final sample of 38 patients. The distribution based on sex was: 57.8% men and 42.1% women. Regarding laterality, we have 7 patients with right CLP (18.42%), 11 patients with left CLP (28.9%), and 20 patients with bilateral CLP (52.63%), 100% of patients with a class III bite in Angle's classification. In group 1 (OD), 55% of the patients did not present changes in speech before surgery, 30% presented improvement in speech, and 15% worsened it. In group 2 (conventional advancement), 66% of the patients did not present changes in speech, 5.5% presented improvement, and 27.7% presented worsening of speech based on the preoperative condition, with a clinical recurrence at 6 months of 15% for group 1 and of 33% for group 2, and at 1 year of 20% for group 1 and 16% for group 2. CONCLUSIONS: Osteogenic distraction is a safe method that can be applied in patients with CLP depending on the clinical characteristics. According to what is described in the literature, those patients who require advancement of up to 6 mm treated without OD have obtained good results, showing esthetic improvement by increasing the projection of the middle third of the face, without worsening of velopharyngeal insufficiency and achieving an adequate occlusal class (Angle I) in the immediate postoperative period or after the postoperative orthodontic management. However, in patients who require advances ≥7 mm, it is clear that OD is the best option, given its association with a lower recurrence rate, minimal changes in the speech, achieving occlusion edge-to-edge at the end of the distraction or Angle's class I, which is corroborated by the results obtained in this study.

Detection of filovirus-reactive antibodies in Australian bat species.

Bats have been implicated as the reservoir hosts of filoviruses in Africa, with serological evidence of filoviruses in various bat species identified in other countries. Here, serum samples from 190 bats, comprising 12 different species, collected in Australia were evaluated for filovirus antibodies. An in-house indirect microsphere assay to detect antibodies that cross-react with Ebola virus (Zaire ebolavirus; EBOV) nucleoprotein (NP) followed by an immunofluorescence assay (IFA) were used to confirm immunoreactivity to EBOV and Reston virus (Reston ebolavirus; RESTV). We found 27 of 102 Yinpterochiroptera and 19 of 88 Yangochiroptera samples were positive to EBOV NP in the microsphere assay. Further testing of these NP positive samples by IFA revealed nine bat sera that showed binding to ebolavirus-infected cells. This is the first report of filovirus-reactive antibodies detected in Australian bat species and suggests that novel filoviruses may be circulating in Australian bats.

Complication After Mandibular Reconstruction With Fibula Free Flap in a Patient With Hemifacial Microsomia.

ABSTRACT: Hemifacial microsomia is the second most frequent pathology in craniofacial malformations. Clinical findings are broad, mainly affecting the mandible. Several classifications of mandibular compromise exist that guide the best treatment option in each patient. The authors present a case of an unusual complication following fibular free flap mandibular reconstruction in a patient with hemifacial microsomia prada type IV, who presented with ankylosis at the skull base and simultaneous fibula pseudoarthrosis at the union with the residual mandible. These dual findings allowed the patient to have a functional mouth aperture, which give us time to let him grow and wait for final management. Treatment options and follow up are discussed, knowing that there is no literature to support any protocol with this patient, so we present his evolution.

Availability of personal protective equipment and diagnostic and treatment facilities for healthcare workers involved in COVID-19 care: A cross-sectional study in Brazil, Colombia, and Ecuador.

Many affected counties have had experienced a shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. We aimed to investigate the needs of healthcare professionals and the technical difficulties faced by them during the initial outbreak. A cross-sectional web-based survey was conducted among the healthcare workforce in the most populous cities from three Latin American countries in April 2020. In total, 1,082 participants were included. Of these, 534 (49.4%), 263 (24.3%), and 114 (10.5%) were physicians, nurses, and other professionals, respectively. At least 70% of participants reported a lack of PPE. The most common shortages were shortages in gown coverall suits (643, 59.4%), N95 masks (600, 55.5%), and face shields (569, 52.6%). Professionals who performed procedures that generated aerosols reported shortages more frequently (p<0.05). Professionals working in the emergency department and primary care units reported more shortages than those working in intensive care units and hospital-based wards (p<0.001). Up to 556 (51.4%) participants reported the lack of sufficient knowledge about using PPE. Professionals working in public institutions felt less prepared, received less training, and had no protocols compared with their peers in working private institutions (p<0.001). Although the study sample corresponded to different hospital centers in different cities from the participating countries, sampling was non-random. Healthcare professionals in Latin America may face more difficulties than those from other countries, with 7 out of 10 professionals reporting that they did not have the necessary resources to care for patients with COVID-19. Technical and logistical difficulties should be addressed in the event of a future outbreak, as they have a negative impact on healthcare workers. Clinical trial registration: NCT04486404.

First report of Trypanosoma dionisii (Trypanosomatidae) identified in Australia.

Trypanosomes are blood-borne parasites that can infect a variety of different vertebrates, including animals and humans. This study aims to broaden scientific knowledge about the presence and biodiversity of trypanosomes in Australian bats. Molecular and morphological analysis was performed on 86 blood samples collected from seven different species of microbats in Western Australia. Phylogenetic analysis on 18S rDNA and glycosomal glyceraldehyde phosphate dehydrogenase (gGAPDH) sequences identified Trypanosoma dionisii in five different Australian native species of microbats; Chalinolobus gouldii, Chalinolobus morio, Nyctophilus geoffroyi, Nyctophilus major and Scotorepens balstoni. In addition, two novels, genetically distinct T. dionisii genotypes were detected and named T. dionisii genotype Aus 1 and T. dionisii genotype Aus 2. Genotype Aus 2 was the most prevalent and infected 20.9% (18/86) of bats in the present study, while genotype Aus 1 was less prevalent and was identified in 5.8% (5/86) of Australian bats. Morphological analysis was conducted on trypomastigotes identified in blood films, with morphological parameters consistent with trypanosome species in the subgenus Schizotrypanum. This is the first report of T. dionisii in Australia and in Australian native bats, which further contributes to the global distribution of this cosmopolitan bat trypanosome.

Viral Diversity of Microbats within the South West Botanical Province of Western Australia.

Bats are known reservoirs of a wide variety of viruses that rarely result in overt clinical disease in the bat host. However, anthropogenic influences on the landscape and climate can change species assemblages and interactions, as well as undermine host-resilience. The cumulative result is a disturbance of bat-pathogen dynamics, which facilitate spillover events to sympatric species, and may threaten bat communities already facing synergistic stressors through ecological change. Therefore, characterisation of viral pathogens in bat communities provides important basal information to monitor and predict the emergence of diseases relevant to conservation and public health. This study used targeted molecular techniques, serological assays and next generation sequencing to characterise adenoviruses, coronaviruses and paramyxoviruses from 11 species of insectivorous bats within the South West Botanical Province of Western Australia. Phylogenetic analysis indicated complex ecological interactions including virus-host associations, cross-species infections, and multiple viral strains circulating concurrently within selected bat populations. Additionally, we describe the entire coding sequences for five alphacoronaviruses (representing four putative new species), and one novel adenovirus. Results indicate that viral burden (both prevalence and richness) is not homogeneous among species, with Chalinolobus gouldii identified as a key epidemiological element within the studied communities.

Insights into Australian Bat Lyssavirus in Insectivorous Bats of Western Australia.

Australian bat lyssavirus (ABLV) is a known causative agent of neurological disease in bats, humans and horses. It has been isolated from four species of pteropid bats and a single microbat species (Saccolaimus flaviventris). To date, ABLV surveillance has primarily been passive, with active surveillance concentrating on eastern and northern Australian bat populations. As a result, there is scant regional ABLV information for large areas of the country. To better inform the local public health risks associated with human-bat interactions, this study describes the lyssavirus prevalence in microbat communities in the South West Botanical Province of Western Australia. We used targeted real-time PCR assays to detect viral RNA shedding in 839 oral swabs representing 12 species of microbats, which were sampled over two consecutive summers spanning 2016⁻2018. Additionally, we tested 649 serum samples via Luminex® assay for reactivity to lyssavirus antigens. Active lyssavirus infection was not detected in any of the samples. Lyssavirus antibodies were detected in 19 individuals across six species, with a crude prevalence of 2.9% (95% CI: 1.8⁻4.5%) over the two years. In addition, we present the first records of lyssavirus exposure in two Nyctophilus species, and Falsistrellus mackenziei.

Vaccinia virus as a vaccine delivery system for marsupial wildlife.

Vaccines based on recombinant poxviruses have proved successful in controlling diseases such as rabies and plague in wild eutherian mammals. They have also been trialled experimentally as delivery agents for fertility-control vaccines in rodents and foxes. In some countries, marsupial mammals represent a wildlife disease reservoir or a threat to conservation values but, as yet there has been no bespoke study of efficacy or immunogenicity of a poxvirus-based vaccine delivery system in a marsupial. Here, we report a study of the potential for vaccination using vaccinia virus in the Australian brushtail possum Trichosurus vulpecula, an introduced pest species in New Zealand. Parent-strain vaccinia virus (Lister) infected 8/8 possums following delivery of virus to the oral cavity and outer nares surfaces (oronasal immunisation), and persisted in the mucosal epithelium around the palatine tonsils for up to 2 weeks post-exposure. A recombinant vaccinia virus construct (VV399, which expresses the Eg95 antigen of the hydatid disease parasite Echinococcus granulosus) was shown to infect 10/15 possums after a single-dose oronasal delivery and to also persist. Both parent vaccinia virus and the VV399 construct virus induced peripheral blood lymphocyte reactivity against viral antigens in possums, first apparent at 4 weeks post-exposure and still detectable at 4 months post-exposure. Serum antibody reactivity to Eg95 was recorded in 7/8 possums which received a single dose of the VV399 construct and 7/7 animals which received triple-dose delivery, with titre end-points in the latter case exceeding 1/4000 dilution. This study demonstrates that vaccinia virus will readily infect possums via a delivery means used to deploy wildlife vaccines, and in doing is capable of generating immune reactivity against viral and heterologous antigens. This highlights the future potential of recombinant vaccinia virus as a vaccine delivery system in marsupial wildlife.

Phylogenetic analysis of New Zealand earthworms (Oligochaeta: Megascolecidae) reveals ancient clades and cryptic taxonomic diversity.

We have constructed the first ever phylogeny for the New Zealand earthworm fauna (Megascolecinae and Acanthodrilinae) including representatives from other major continental regions. Bayesian and maximum likelihood phylogenetic trees were constructed from 427 base pairs from the mitochondrial large subunit (16S) rRNA gene and 661 base pairs from the nuclear large subunit (28S) rRNA gene. Within the Acanthodrilinae we were able to identify a number of well-supported clades that were restricted to continental landmasses. Estimates of nodal support for these major clades were generally high, but relationships among clades were poorly resolved. The phylogenetic analyses revealed several independent lineages in New Zealand, some of which had a comparable phylogenetic depth to monophyletic groups sampled from Madagascar, Africa, North America and Australia. These results are consistent with at least some of these clades having inhabited New Zealand since rifting from Gondwana in the Late Cretaceous. Within the New Zealand Acanthodrilinae, major clades tended to be restricted to specific regions of New Zealand, with the central North Island and Cook Strait representing major biogeographic boundaries. Our field surveys of New Zealand and subsequent identification has also revealed extensive cryptic taxonomic diversity with approximately 48 new species sampled in addition to the 199 species recognized by previous authors. Our results indicate that further survey and taxonomic work is required to establish a foundation for future biogeographic and ecological research on this vitally important component of the New Zealand biota.

La importancia de evaluar síntomas y alteraciones funcionales en enfermedades neurológicas crónicas: experiencia en cuidado paliativo y rehabilitación en una institución colombiana / The Importance of Evaluating Symptoms and Functional Alterations in Chronic Neurological Diseases: Experiences in Palliative Care and Rehabilitation at a Colombian Institution / A importância da avaliação de sintomas e limitações funcionais nas doenças neurológicas crônicas: experiência em cuidados paliativos e de reabilitação em uma instituição na Colombia

Existe un incremento en la prevalencia de enfermedades neurológicas y su carga de enfermedad. Debido a ello, identificar la frecuencia de síntomas y las alteraciones funcionales es de vital importancia para definir un adecuado plan de tratamiento. Se llevó a cabo un estudio de corte transversal para identificar los síntomas principales y las alteraciones funcionales en pacientes neurológicos de un centro de referencia colombiano para manejo de rehabilitación. Se encontraron como síntomas y alteraciones funcionales más frecuentes: alteraciones de la marcha (65,5 %), desórdenes de comunicación (36,98 %), alteraciones emocionales y de memoria (38 %), dolor (29,45 %) y alteraciones en las actividades básicas cotidianas (24,3 %). El 50 % de los pacientes que reportaron dolor, el 30 % de los que manifestaron insomnio y el 80 % de los que refirieron estreñimiento no recibieron tratamiento en la primera consulta. Algunos de los síntomas identificados no son características que definen la enfermedad, y no siempre son objeto de intervención. Los resultados de este estudio pueden contribuir a reconocer la carga de los síntomas de las enfermedades neurológicas, sensibilizando a los profesionales de la salud acerca de la importancia del cuidado paliativo en pacientes con enfermedades progresivas no oncológicas.

There is an increase in the prevalence of neurological diseases and the burden they impose. Therefore, identifying the frequency of symptoms and the functional alterations is of paramount importance to develop an adequate treatment plan. A cross-sectional study was carried out to pinpoint the main symptoms and functional alterations in neurological patients at a rehabilitation center in Colombia. The five most frequent symptoms and functional alterations identified were: walking disorders (65.5%), communication disorders (36.98%), memory and emotional alterations (38%), pain (29.45%), and alterations in activities of daily living (24.3%). Fifty percent of the patients who reported pain, 30% of those who complained of insomnia, and 80% of those who mentioned constipation did not receive treatment during the first consultation. Some of the identified symptoms are not characteristics that define the disease, and are not always the subject of intervention. The results of this study can contribute to recognition of the burden of the symptoms of neurological diseases, by making health professionals more aware of the importance of palliative care for patients with non-oncological progressive diseases.

A prevalência de doenças neurológicas e sua carga de doença têm aumentado. Portanto, é de importância vital identificar a freqüência dos sintomas e o comprometimento funcional para definir um plano de tratamento adequado. Para identificar os principais sintomas e a limitação funcional em pacientes neurológicos de um centro de referência para manejo da reabilitação na Colômbia se realizou um estudo transversal. Os sintomas e as limitações funcionais mais freqüentes foram: distúrbio da marcha (65,5%), distúrbios da comunicação (36,98%), distúrbios emocionais e da memória (38%), dor (29,45%) e alterações em atividades básicas diárias (24,3%). O 50% dos pacientes que relataram dor, 30% das pessoas que manifestaram insônia e 80% daqueles que relataram constipação não foram tratados na primeira consulta. Alguns dos sintomas identificados não são características que definem a doença, nem sempre eles são objeto de intervenção. Os resultados deste estudo podem ajudar a reconhecer o peso dos sintomas da doença neurológica através da sensibilização de profissionais da saúde sobre a importância dos cuidados paliativos em pacientes com doenças progressivas não cancerosas.

Encefalitis herpética: un caso en la unidad de ciudado intensivo UCI pediátrica del Hospital Occidente de Kennedy, Bogotá / Herpetic encephalitis: a case in the pediatric unit of intensive care of the Hospital of Kennedy, Bogotá

Presentamos el caso de una lactante con diagnóstico confirmado de encefalitis herpética mediante la reacción en cadena de la polimerasa (PCR), hallazgos típicos por imágenes y pronóstico favorable a corto plazo

Enfermedad cerebrovascular en niños: enfoque diagnóstico y guías de manejo / Cerebrovascular diseases in children: focus diagnostic and handling guides

La enfermedad cerebrovascular (ECV) de los niños presenta características clínicas y epidemiológicas que la diferencian de su homónima en los adultos, de tal manera que las aproximaciones diagnósticas y terapéuticas merecen consideraciones especiales. Las alteraciones pre y perinatales continúan siendo causa frecuente de enfermedad cerebrovascular en los recién nacidos. En la infancia las enfermedades infecciosas y las alteraciones metabólicas ocasionan un número importante de casos. El diagnóstico descansa en una oportuna sospecha clínica y en el adecuado reconocimiento de las particularidades etiológicas de este grupo, especialmente de las condiciones geneticohereditarias que favorecen su presentación o generan clínica que puede simularla. El tratamiento de la enfermedad cerebrovascular en la infancia se ha afrontado con menor frecuencia y rigor que en los adultos. Los autores presentan la mejor evidencia disponible en cada uno de estos tópicos

Uso de amantadina en el síndrome neuroléptico maligno en el Hospital Occidente de Kennedy, Bogotá / Amantadine usefulness in neuroleptic malignant syndrome

El síndrome neuroléptico maligno, es la complicación mas temida con el uso de medicamentos tales como: las butiferofenonas (haloperidol), las fonotiazinas y las sales de litio en especial, aunque se ha descrito con otros fármacos. Su frecuencia es baja, 1/100 aproximadamente. El síndrome es una reacción idiosincrática caracterizada por la triada clínica de fiebre, rigidez y cambios mentales. Su curso puede ser fatal si no se reconoce y maneja prontamente. Se presentan tres casos de sindrome neuroléptico maligno atendidos en el Hospital Occicente de Kennedy (Bogotá), diagnosticados en fase inicial y tratados con infusión de amantadina con respuesta clínica favorable.

Canalopatías de calcio y enfermedades neurológicas / Calcium channalopathies and nervous system disease

Se presentan las alteraciones genéticas y de los canales de calcio en algunas afecciones hereditarias como la migraña hemipléjica, la ataxia episódica tipo 2 y la ceguera nocturna, entre otras. Se discute la disfunción y clasificación de las alteraciones estructurales de los canales de calcio y se propone una nomenclatura que facilite la comprensión de la muy frecuente literatura sobre este tópico