Ganancia auditiva en pacientes intervenidos de cirugía del estribo por otosclerosis / Hearing gain in patients undergoing stapes surgery for otosclerosis

Introducción y objetivo: La otosclerosis es una causa de hipoacusia en jóvenes, con mayor frecuencia en mujeres. La cirugía del estribo es un procedimiento correctivo ampliamente aceptado, con el advenimiento de la tecnología y cambios en la técnica, surge la interrogante de si existen diferencias entre ellas. Objetivo: Evaluar si existen diferencias en la ganancia auditiva entre técnicas y abordajes de las cirugías del estribo en pacientes con otosclerosis Método: Se recabaron variables demográficas, clínicas y quirúrgicas. Se aplicó estadística descriptiva. Se empleó prueba U de Mann-Whitney para variables numéricas, así como Kruskal Wallis para comparación diferencias en tres o más grupos. Se consideró significativo un valor de p ≤ a 0.05. Resultados: Entre los años 2020 y 2023 se realizaron 55 cirugías de estribo por otosclerosis, de las cuales 20 se tuvieron que excluir. De 35 cirugías en 31 pacientes, la media de edad de 41.16 ± 8.64 años, 77.4% fueron mujeres, el 51.4 % fueron en el oído derecho; se presentaron comorbilidades en el 25.7%, las complicaciones 5 presentaron hipoacusia, el 88.6 % de los procedimientos se encontró un cierre satisfactorio de la brecha aérea y ósea. No se presentaron diferencia entre las técnicas de la cirugía de estribo y resultados audiológicos postquirúrgicos p=0.872, ni con el tipo de abordaje de visualización p=0.636. Discusión: Nuestros resultados son similares a lo que encontraron algunos autores, no obstante, aún sigue existiendo incertidumbre sobre la mejor técnica. Conclusiones: No se encontraron diferencias estadísticamente significativas en cuanto a la ganancia auditiva con el abordaje de visualización y el tipo de procedimiento en el estribo para la colocación de la prótesis. (AU)

Introduction and objective: Otosclerosis is a cause of hearing loss in young people, more frequently in women. Stapes surgery is a widely accepted corrective procedure, with the advent of technology and changes in technique, the question arises as to whether there are differences between them. Objective: To evaluate whether there are differences in hearing gain between techniques and approaches of stapes surgeries in patients with otosclerosis. Method: Demographic, clinical and surgical variables were collected. Descriptive statistics were applied. The Mann-Whitney U test was used for numerical variables, as well as the Kruskal Wallis test to compare differences in three or more groups. A p value ≤ 0.05 was considered significant. Results: Between 2020 and 2023, 55 stapes surgeries were performed for otosclerosis, of which 20 had to be excluded. Of 35 surgeries in 31 patients, mean age 41.16 ± 8.64 years, 77.4% were women, 51.4% were in the right ear; Comorbidities were present in 25.7%, 5 complications presented hearing loss, in 88.6% of the procedures a satisfactory closure of the air-bone gap was found. There was no difference between stapes surgery techniques and postsurgical audiological results p=0.872, nor with the type of visualization approach p=0.636. Discussion: Our results are similar to what some authors found, however, there is still uncertainty about the best technique. Conclusions: No statistically significant differences were found in terms of hearing gain with the visualization approach and the type of procedure in the stapes for placement of the prosthesis. (AU)

Cambios ventilatorios después de una traqueotomía en neumonía por COVID-19 / Ventilatory changes after a tracheostomy in COVID-19 pneumonia

Introducción: existe aún una controversia sobre los efectos en los parámetros ventilatorios en pacientes sometidos a una traqueotomía, y los estudios en casos de pacientes con SARS-CoV-2 son escasos. Objetivo: describir los cambios en los parámetros ventilatorios en pacientes operados de traqueotomía por SARS-CoV-2 en la unidad de cuidados intensivos (UCI). Métodos: se realizó un estudio retrospectivo, descriptivo y longitudinal en el que se incluyeron las variables como edad, sexo, comorbilidades, tiempo de intubación, parámetros ventilatorios, gasométricos y el índice de Kirby. Se utilizó estadística descriptiva con medidas de tendencia central y medidas de dispersión. Resultados: se recibieron 493 casos con COVID-19, 133 (26,35 %) ingresaron, 21 fueron operados en la UCI; el género masculino fue 76 % y edad de 56 años; la obesidad y la hipertensión fueron las comorbilidades más comunes, todos con PCR positivo; los parámetros ventilatorios preoperatorios fueron presión positiva al final de la espiración (PEEP) de 7,61 y fracción inspirada de oxígeno (FiO2) de 41,42, la gasometría fue pH de 7,42, presión parcial de oxígeno (pO2) de 95,04, presión parcial de dióxido de carbono (pCO2) de 41,47, bicarbonato (HCO3) de 29,14, saturación de oxígeno (SatO2) de 94,7 %, el índice de Kirby x = 235; y los posoperatorios (PEEP de 7,19 y FiO2 de 40,6), la gasometría fue de pH de 7.44, pO2 de 43,7, pCO2 de 87,7, HCO3 de 27,4, SatO2 de 95,23 %. Fallecieron tres pacientes, dos pacientes complicados con sangrado y un caso con decanulación accidental. El tiempo promedio de ventilación mecánica de fue de 5,7 días. Conclusiones: la traqueotomía generó cambios muy sutiles en los parámetros ventilatorios y gasométricos; sin embargo, la liberación de la ventilación mecánica fue en promedio menor a una semana, desocupando espacio en la UCI.

Introduction: Controversy continues to exist regarding the effects on ventilatory parameters in patients undergoing tracheostomy, and studies in cases with SARS-CoV-2 are scarce. Objective: To describe changes in ventilatory parameters in patients undergoing tracheostomy for SARS-CoV-2 in the intensive care unit. Methods: A retrospective, descriptive, longitudinal study was carried out. Variables such as age, sex, comorbidities, time of IOT, ventilatory parameters, blood gases and the Kirby index were included. Descriptive statistics with measures of central tendency and measures of dispersion were used. Results: n = 493 COVID-19 cases were received, n = 133 (26.35%) were admitted, 21 were operated on in the ICU, male gender was 76%, age 56 years, obesity and hypertension were the most common comorbidities, all With CRP +, the preoperative ventilatory parameters x (PEEP 7.61) and (FiO2 41.42), the blood gas was (pH 7.42), (pO2 95.04), (pCO2 41.47), ( HCO3 29.14), (Saturation O2 94.7%) and the Kirby index x = 235 and postoperative x (PEEP 7.19) and (FiO2 40.6), the blood gas was (pH 7.44), (pO2 43.7), (pCO2 87.7), (HCO3 27.4), (Saturation O2 95.23%). n = 3 died, two patients with bleeding complications and one case with accidental decannulation. The mean time of mechanical ventilation was n = 5.7 days. Conclusions: The tracheostomy generated very subtle changes in the ventilatory and gasometric parameters, however, the release of mechanical ventilation was on average less than one week, emptying space in the ICU.

Hipertrofia de amígdalas linguales: presentación de casos revisión narrativa / Lingual tonsil hypertrophy: presentation of cases narrative review

Actualmente no es sólito tener pacientes con síntomas causados por la implicación de las amígdalas linguales y que pasemos por alto su sospecha. Los signos y síntomas que pueden presentar los pacientes son variados, desde el síndrome de apnea obstructiva del sueño (síntoma más común) y disfagia hasta tos crónica mal abordada y, por lo mismo, tratada inadecuadamente. Presentamos los casos clínicos de dos pacientes con hipertrofia de amígdalas linguales y una revisión narrativa del tema.

Currently, it is not unusual to have patients with symptoms due to the involvement of lingual tonsils and let us go unnoticed their suspicion. The signs and symptoms that patients may present are varied, from giving obstructive sleep apnea syndrome (the most common symptom) dysphagia to poorly treated and poorly treated chronic cough. We present the clinical cases of two patients with hypertrophy of the lingual tonsils and a narrative review of the subject.

Relationship between glucose control, glycemic variability, and oxidative stress in children with type 1 diabetes / Relación entre control metabólico, variabilidad glucémica y estrés oxidativo en niños con diabetes tipo 1

Introduction: Few studies assessing the relationship between oxidative stress and glycemic variability in children with type 1 diabetes mellitus (T1DM) are available, and most of them reported no significant results. Objective: To assess the relationship between glucose control, glycemic variability, and oxidative stress as measured by urinary excretion of 8-iso-prostanglandin F2-alpha (8-iso-PGF2alfa) in children with T1DM. Materials and methods: A cross-sectional study including 25 children with T1DM. Participants were evaluated during five days in two different situations: 1st phase during a summer camp, and 2nd phase in their everyday life at home. The following data were collected in each study phase:. Six capillary blood glucose measurements per day. Mean blood glucose (MBG) levels and glucose variability parameters, including standard deviation, coefficient of variation, and mean amplitude of glycemic excursions (MAGE), were calculated. - Capillary HbA1c level. - 24-h urine sample to measure 8-iso-PGF2alfa. Results: There were no statistically significant differences in urinary 8-iso-PGF2alfa levels (142 ± 37 vs. 172 ± 61 pg/mg creatinine) and glucose control and glycemic variability parameters between both phases. In the 2nd phase, statistically significant correlations were found between urinary 8-iso-PGF2alfa and HbA1c levels (r = 0.53), MBG (r = 0.72), standard deviation (r = 0.49), and MAGE (r = 0.42). No significant correlations between glucose control, glycemic variability and urinary 8-iso-PGF2alfa excretion were found in the 1st phase. Conclusions: A significant correlation was found between glycemic variability and HbA1c level and urinary 8-iso-PGF2α excretion in a group of children with T1DM during their daily lives. Additional studies are needed to confirm this finding and to explore its long-term impact on health

Introducción: En niños con diabetes tipo 1 (DM1) hay pocos estudios que evalúen la relación entre estrés oxidativo y variabilidad glucémica, y la mayoría de ellos no encuentran resultados significativos. Objetivo: Evaluar la relación entre control metabólico, variabilidad glucémica y estrés oxidativo medido por la excreción urinaria de 8-iso-prostaglandina F2 alfa (8-iso-PGF2alfa) en niños con DM1. Material y método: Estudio transversal que incluyó 25 niños con DM1. Los participantes fueron evaluados durante 5 días en 2 situaciones diferentes: 1.a fase durante un campamento de verano y 2.a fase durante su actividad habitual en domicilio. En cada fase se recogieron:- Seis determinaciones de glucemia capilar diarias. Se calcularon glucemia media y parámetros de variabilidad glucémica: desviación estándar, coeficiente de variación y «mean amplitude of glycemic excursions» (MAGE). - HbA1c capilar. - Muestra de orina de 24h para la determinación de 8-iso-PGF2alfa. Resultados: No se encontraron diferencias estadísticamente significativas en excreción urinaria de 8-iso-PGF2alfa (142 ± 37 vs. 172 ± 61 pg/mg creatinina) y parámetros de control y variabilidad glucémicos entre las fases. En la 2.a fase se observaron correlaciones estadísticamente significativas entre 8-iso-PGF2alfa urinario con HbA1c (r = 0,53), glucemia media (r = 0,72), desviación estándar (r = 0,49) y MAGE (r = 0,42). En la 1.a fase del estudio no se han detectado correlaciones significativas. Conclusiones: Se ha encontrado una correlación significativa entre parámetros de variabilidad glucémica y HbA1c con la excreción urinaria de 8-iso-PGF2alfa en un grupo de niños con DM1 evaluados durante su vida diaria. Son necesarios más estudios para confirmar estos resultados y evaluar el impacto a largo plazo sobre la salud

Relationship between glucose control, glycemic variability, and oxidative stress in children with type 1 diabetes.

INTRODUCTION: Few studies assessing the relationship between oxidative stress and glycemic variability in children with type 1 diabetes mellitus (T1DM) are available, and most of them reported no significant results. OBJECTIVE: To assess the relationship between glucose control, glycemic variability, and oxidative stress as measured by urinary excretion of 8-iso-prostanglandin F2-alpha (8-iso-PGF2α) in children with T1DM. MATERIALS AND METHODS: A cross-sectional study including 25 children with T1DM. Participants were evaluated during five days in two different situations: 1st phase during a summer camp, and 2nd phase in their everyday life at home. The following data were collected in each study phase:. - Six capillary blood glucose measurements per day. Mean blood glucose (MBG) levels and glucose variability parameters, including standard deviation, coefficient of variation, and mean amplitude of glycemic excursions (MAGE), were calculated. - Capillary HbA1c level. - 24-h urine sample to measure 8-iso-PGF2α. RESULTS: There were no statistically significant differences in urinary 8-iso-PGF2α levels (142±37 vs. 172±61pg/mg creatinine) and glucose control and glycemic variability parameters between both phases. In the 2nd phase, statistically significant correlations were found between urinary 8-iso-PGF2α and HbA1c levels (r=0.53), MBG (r=0.72), standard deviation (r=0.49), and MAGE (r=0.42). No significant correlations between glucose control, glycemic variability and urinary 8-iso-PGF2α excretion were found in the 1st phase. CONCLUSIONS: A significant correlation was found between glycemic variability and HbA1c level and urinary 8-iso-PGF2α excretion in a group of children with T1DM during their daily lives. Additional studies are needed to confirm this finding and to explore its long-term impact on health.

Late survival of Neanderthals at the southernmost extreme of Europe.

The late survival of archaic hominin populations and their long contemporaneity with modern humans is now clear for southeast Asia. In Europe the extinction of the Neanderthals, firmly associated with Mousterian technology, has received much attention, and evidence of their survival after 35 kyr bp has recently been put in doubt. Here we present data, based on a high-resolution record of human occupation from Gorham's Cave, Gibraltar, that establish the survival of a population of Neanderthals to 28 kyr bp. These Neanderthals survived in the southernmost point of Europe, within a particular physiographic context, and are the last currently recorded anywhere. Our results show that the Neanderthals survived in isolated refuges well after the arrival of modern humans in Europe.