Understanding Barriers to Timely Diagnosis and Intervention Among Immigrant Children With Hearing Loss.

OBJECTIVE: Identify the age at diagnosis and intervention of immigrant and/or non-English-speaking children with hearing loss (HL) and risk factors associated with delays. Identify barriers for non-English-speaking caregivers of deaf/hard-of-hearing children. STUDY DESIGN: Sequential mixed methods. SETTING: Tertiary care center in an urban city. METHODS: The analysis includes descriptive statistics, and 1-way and 2-way analysis of variance of the retrospective chart review. The quantitative study demonstrated foreign-born experienced disparities, so we conducted semistructured interviews on a subset of non-English-speaking families in the cohort that was then thematically analyzed using a human-centered design strategy. RESULTS: We divided 532 children into 3 groups: US-born with English as the preferred language (N = 294), US-born and non-English language preferred (N = 173), and foreign-born (N = 67). The laterality of HL and pure-tone averages were similar among the groups (p = .972 and .071, respectively). Age at diagnosis and time to the intervention were significantly different (39.7, 31.5, 75.8 months, p < .001 and 24.6, 29.2, 48.9 months, p = .001, respectively). Ages at diagnosis and intervention were associated with birthplace (p = .005, p = .0005, respectively) but not preferred language (p = .667, p = .343, respectively). Included in the qualitative interviews were Mandarin- (n = 5), Arabic- (n = 4), and Spanish-speaking families (n = 3). Insights revealed participants' quest for anticipatory guidance and social support, the consequences of cultural stigma, and the complexity of caring for a child with HL in an immigrant family. CONCLUSION: Foreign-born children with HL have significant delays in diagnosis and intervention compared to US-born children. For non-English-speaking parents, the diagnosis of HL presents challenges beyond that of the immigrant experience.

A non-randomized prospective study on the diagnostic performance of perineal prostatic biopsy, directed via diffusion nuclear resonance, in patients with suspected prostate cancer and previous negative transrectal prostate biopsy.

BACKGROUND: A definition of the best strategy is necessary to optimize the follow-up of patients with previous negative transrectal guided ultrasound biopsy (TRUS-GB) and the persistence of raised prostate-specific antigen (PSA).The purpose of this study was to evaluate the prostate cancer (PCa) diagnostic rate of targeted transperineal ultrasound guided biopsy (TPUS-GB) with cognitive multiparametric magnetic resonance imaging (mpMRI) registration with concurrent systematic biopsy in patients with previous negative systematic TRUS-GB and persistently elevated PSA levels. MATERIALS AND METHODS: In this prospective study conducted at the University Infanta Sofia Hospital from April 2016 to November 2017, patients with one previous negative systematic TRUS-GB and persistently high PSA levels were referred for mpMRI prostate scans. All patients underwent systematic TPUS-GB and those patients with suspicious findings on mpMRI scans, Pirads 3 and 4-5, underwent a subsequent cognitive guidance mpMRI-TPUS-GB. RESULTS: In total, 71 patients were included in this study. Suspicious findings on mpMRI scans prior to TPUS-GB were found in 50 patients (70.4%). 16 patients were diagnosed with prostate cancer (22.5%), of whom 14 (87.5%) had a mpMRI scan with Pirads 3 or Pirads 4-5. Patients with Pirads 3, 4 or 5 showed negative results in almost all cores taken by concurrent systematic TPUS-GB. CONCLUSIONS: Cognitive mpMRI-TPUS fusion biopsy is a useful tool to diagnose PCa in patients with previous negative prostate biopsy. The samples obtained from the suspicious areas in the mpMRI detect more cases of intermediate and high risk PCa compared to the samples obtained at random or from non-suspicious areas.

Late-Onset Facial Papular Elastorrhexis.

Papular elastorrhexis, a rare defect of dermal elastic fibers of unknown origin, usually involves the trunk and extremities of children or young adults. We report the case of a 62-year-old woman with multiple soft, skin-colored facial papules with histological findings characteristic of papular elastorrhexis. Awareness of this entity may allow for its proper identification outside the usual clinical setting.

Current evidence for cancer stem cells in gastrointestinal tumors and future research perspectives.

Cancer stem cells (CSCs) are a very heterogeneous subpopulation of "stem-like" cancer cells that have been identified in many cancers, including leukemias and solid tumors. It is believed that CSCs drive tumor growth, malignant behavior and are responsible for the initiation of metastatic spread. In addition, CSCs have been implicated in chemotherapy and radiotherapy resistance. Current evidence supports the theory that CSCs share at least two main features of normal stem cells: self-renewal and differentiation, properties that contribute to tumor survival even in the presence of aggressive chemotherapy; however, the mechanism(s) governing the unique biology of CSCs remain unclear. In the field of gastrointestinal cancer, where we face very low survival rates across different tumor types, unraveling the role of CSCs in gastrointestinal tumors should improve our knowledge of cancer biology and chemoresistance, ultimately benefiting patient survival. Towards this end, much effort is being invested in the characterization of CSCs as a means of overcoming drug resistance and controlling metastatic spread. In this review we will cover the concept of CSCs, the current evidence for CSCs in gastrointestinal tumors and future research directions.

Insulinoma-induced hypoglycemia in a patient with nesidiodysplasia after vagomotomy and pyloroplasty for duodenal ulcer.

A 45-year-old woman was referred to us for hypoglycemia. The patient had been operated on for a duodenal ulcer by bilateral troncular vagotomy and pyloroplasty 20 years ago and, since then, she showed a dumping syndrome. Two months before consultation she developed repetitive episodes of symptomatic hypoglycemia. An oral glucose tolerance test showed hypoglycemia with endogenous hyperinsulinism. The continuous glucose monitoring system sensor demonstrated fasting hypoglycemia. The endoscopic ultrasound of the pancreas showed a pancreatic tumor that was confirmed in the pathologic study after surgery. Moreover, nesidiodysplasia image was found surrounding pancreatic parenchyma. We report, for the first time, both histologic lesions associated in a patient with a history of vagotomy and pyloroplasty for a duodenal ulcer and we discuss the possible pathogenic mechanisms.

Functional neck dissection for the clinically negative neck: effectiveness and controversies.

This study was performed to evaluate the effectiveness of functional neck dissection in controlling metastasis to the clinically negative (cN0) neck, focusing on recurrences in the pathologically negative (pN0) neck and the role of extracapsular spread in the cN0 neck. A series of 172 patients (253 dissected fields) treated for cN0 laryngeal or hypopharyngeal cancer with a 5-year minimum follow-up is presented. Occult metastasis was observed in 30% of the patients. Extracapsular spread was present in 39% of the positive nodes. The neck recurrence rate was 5.2%. Surgical specimens from cases of neck recurrence in pN0 necks were reevaluated for micrometastasis by immunostaining with antibody for cytokeratins. The immunohistochemical findings were positive in 1 of 4 cases. Functional neck dissection provides good neck control and survival rates for the cN0 neck. The accurate prognostic significance of extracapsular spread in cN0 necks is still unknown. Micrometastasis alone may be insufficient to explain recurrences in pN0 necks.

Dermatofitosis atípica en un paciente con SIDA / Atypical dermatophytosis in a patient with AIDS

Presentamos el caso de un varón de 37 años VIH positivo, con nódulos subcutáneos faciales, sin historia previa de infección micótica superficial. El estudio histológico mostraba granulomas en dermis centrados por estructuras fúngicas. En cultivos repetidos se identificó Microsporum canis (AU)

Detección de ambliopía en preescolares de las Fuerzas Armadas / Ambliopi detection in preschools of the Army Strength

Se realizó un estudio en dos Instituciones Preescolares de las Fuerzas Armadas, con población de 354 niños de edades entre 3 y 6 años cumplidos, de los Preescolares "Fuerte Tiuna" ubicado en le Fuerte Tiuna, con 249 niños, y preescolar "Simón Bolívar" en las instalaciones de Hospital Militar "Dr Carlos Arvelo" con 105 niños, para determinar la población de preecolares con presencia de ambliopatía; clasificar según tipo y grado, y corregir cualquier defecto de refracción existente tratando de lograr la emetropía funcional

Genero y Desarrollo

Necesidades Practicas y estrategicas de genero. Autonomia, bondades y preocupaciones. Reglas y procedimientos

Endometritis post-cesárea: factores de riesgo / Post cesaream endometritis: risk factors

Objetivo: Dterminar los factores de riesgo de endometritis post-cesárea (EPC). Material y métodos: Se realizó un estudio retrospectivo caso-control en el Servicio de Obstetricia del Hospital Nacional Cayetano Heredia del 1 de Enero de 1992 al 31 de julio de 1996. Para el análisis estadístico se utilizó análisis bivariado y multivariado de regresión logística. Resultados: Durante este período se detectaron 82 pacientes con diagnóstico clínico de endometritis, seleccionándose aleatoriamente igual número de pacientes operadas de cesárea con puerperio normal. Los factores relacionados con un riesgo significativo de EPC fueron: edad materna menor de 21 años y valores de hematocrito post-operatorio menor o igual a 30 por ciento. En el grupo de pacientes con endometritis el 45.1 por ciento de las pacientes tuvieron infección concomitante, siendo la infección de herida operatoria (29.3 por ciento) y la del tracto urinario (11 por ciento) las más frecuentes.

Debilitamiento del oblícuo superior por técnica de elongación del tendón del oblícuo superior / Oblique superior debilitating by technical of elongation of superior oblique tendon

Este grupo de estudio está compuesto por diéz y siete (17) pacientes con anisotropía vertical con patrón en "A" mayor de 20 dioptrías prismáticas asociadas a hiperfunción de oblícuos superiores, con edades comprendidas entre 2 y 36 años, 41 por ciento masculino y 59 por ciento femenino, a quienes se les realizó debilitamiento del oblícuo superior hiperfuncionante, mediante la técnica de elongación de tendón de oblícuo superior y les fue realizado seguimiento postoperatorio por un período de 3 o más meses. En el postoperatorio el 82,4 por ciento de los pacientes presentaron excelentes resultados con eliminación del patrón en "A" y en el 17,6 por ciento se obtuvieron valores residuales en el patrón en "A" menores de 8 dioptrías prismáticas, 62 por ciento de los casos presentaron eliminación de la hiperfunción del oblícuo superior y en 37 por ciento restante disminuyó la hiperfunción; 11.76 por ciento de los pacientes presentaron hipertrofia en el postoperatorio causada por descompensación de una desviaciónn vertical disociada (DVD). Durante el período de estudio no se evidenció complicaciones atribuibles a los procedimientos de debilitamiento de oblicuo superior, como lo son hipofunción o parálisis del oblicuo superior, hiperfunción de oblícuo inferior, diplopias, ptosis, conversión de patrones en "A" en patrones en "V" ni síndromes de adherencia grasa

Camino a Beijing: algunas consideraciones y reflexiones a mitad del camino / Road to Beijing: some considerations and reflections to half of the road

Entre el 20 y 24 de septiembre de 1994 se realizó en Mar del Palta, Argentina, el Foro de ONGs de Mujeres de América Latina y el Caribe, instancia preparatoria a nivel regional para el Foro Alterntivo de ONGs que se llevará a cabo en septiembre de 1995 en Beijing, China en el marco de la IV Conferencia Mundial sobre la Mujer: Acción para la Igualdad, el Desarrollo y la Paz

Mitomicina en cirugía filtrante / Mitomicyn in filtering surgery

En el Servicio de Oftalmología del Hospital "F.A. Rísquez", se realizó un estudio prospectivo en pacientes de alto riesgo de fracaso de cirugía filtrante, con la aplicación tópica intraoperatoria de mitomicina-C, dosis de 0.5 por ciento por 5 minutos. Desde septiembre de 1991 a febrero de 1993, 44 pacientes se incluyeron en el estudio, un total de 50 ojos, con un período mínimo de seguimiento de 6 meses. El 56 por ciento eran pacientes con glaucoma primario de ángulo abierto; el 50 por ciento tenía antecedentes de una o más cirugías antiglaucomatosa; el 86 por ciento tenía excavación del disco óptico 0.9 a total. Se obtuvo éxito quirúrgico en el 88 por ciento de los casos, definiéndolo como presión intraocular postoperatoria menor de 20 mmHg, sin alteracición de la agudeza visual preoperatoria. El promedio de seguimiento de los pacientes fue de 12.4 meses. En el 78 por ciento de los casos se logró obtener presiones intraoculares menores de 12 mmHg, la media fue de 11.42 mmHg al sexto mes de postoperatorio. En 3 casos, se presentó disminución de la agudeza visual, 2 por hipotonia severa. Se analizan los resultados obtenidos, recomendando la aplicación de la mitomicina-C en cirugía filtrante, en pacientes con glaucoma refractario