The impact of the COVID-19 pandemic on people living with HIV: a cross-sectional study in Caracas, Venezuela.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted multiple health services, including human immunodeficiency virus (HIV) testing, care, and treatment services, jeopardizing the achievement of the Joint United Nations Programme on HIV/AIDS 90-90-90 global target. While there are limited studies assessing the impact of the COVID-19 pandemic on people living with HIV (PLHIV) in Latin America, there are none, to our knowledge, in Venezuela. This study aims to assess the impact of the COVID-19 pandemic among PLHIV seen at the outpatient clinic of a reference hospital in Venezuela. METHODS: We conducted a cross-sectional study among PLHIV aged 18 years and over seen at the Infectious Diseases Department of the University Hospital of Caracas, Venezuela between March 2021 and February 2022. RESULTS: A total of 238 PLHIV were included in the study. The median age was 43 (IQR 31-55) years, and the majority were male (68.9%). Most patients (88.2%, n = 210) came for routine check-ups, while 28 (11.3%) were newly diagnosed. The majority of patients (96.1%) were on antiretroviral therapy (ART), but only 67.8% had a viral load test, with almost all (95.6%) being undetectable. Among those who attended regular appointments, 11.9% reported missing at least one medical consultation, and 3.3% reported an interruption in their ART refill. More than half of the patients (55.5%) had received at least one dose of the COVID-19 vaccine, while the rest expressed hesitancy to get vaccinated. Most patients with COVID-19 vaccine hesitancy were male (65.1%), younger than 44 years (57.5%), employed (47.2%), and had been diagnosed with HIV for less than one year (33%). However, no statistically significant differences were found between vaccinated patients and those with COVID-19 vaccine hesitancy. Older age was a risk factor for missing consultations, while not having an alcoholic habit was identified as a protective factor against missing consultations. CONCLUSION: This study found that the COVID-19 pandemic had a limited impact on adherence to medical consultations and interruptions in ART among PLHIV seen at the University Hospital of Caracas, Venezuela.

First wave of COVID-19 in Venezuela: Epidemiological, clinical, and paraclinical characteristics of first cases.

The coronavirus disease 2019 (COVID-19) pandemic has particularly affected countries with weakened health services in Latin America, where proper patient management could be a critical step to address the epidemic. In this study, we aimed to characterize and identify which epidemiological, clinical, and paraclinical risk factors defined COVID-19 infection from the first confirmed cases through the first epidemic wave in Venezuela. A retrospective analysis of consecutive suspected cases of COVID-19 admitted to a sentinel hospital was carried out, including 576 patient cases subsequently confirmed for severe acute respiratory syndrome coronavirus 2 infection. Of these, 162 (28.1%) patients met the definition criteria for severe/critical disease, and 414 (71.2%) were classified as mild/moderate disease. The mean age was 47 (SD 16) years, the majority of which were men (59.5%), and the most frequent comorbidity was arterial hypertension (23.3%). The most common symptoms included fever (88.7%), headache (65.6%), and dry cough (63.9%). Severe/critical disease affected mostly older males with low schooling (p < 0.001). Similarly, higher levels of glycemia, urea, aminotransferases, total bilirubin, lactate dehydrogenase, and erythrocyte sedimentation rate were observed in severe/critical disease patients compared to those with mild/moderate disease. Overall mortality was 7.6% (44/576), with 41.7% (28/68) dying in hospital. We identified risk factors related to COVID-19 infection, which could help healthcare providers take appropriate measures and prevent severe clinical outcomes. Our results suggest that the mortality registered by this disease in Venezuela during the first epidemic wave was underestimated. An increase in fatalities is expected to occur in the coming months unless measures that are more effective are implemented to mitigate the epidemic while the vaccination process is ongoing.

Knowledge, attitudes, and practices related to COVID-19 among patients at Hospital Universitario de Caracas triage tent: A cross-sectional study. / Conocimientos, actitudes y prácticas relacionadas con COVID-19 en pacientes de la carpa de triaje del Hospital Universitario de Caracas: un estudio transversal

INTRODUCTION: The studies on knowledge, attitudes, and practices (KAP) regarding COVID-19 help to identify erroneous concepts and inadequate practices related to the disease. This baseline information is essential to design effective strategies and improve adherence to prevention measures. OBJECTIVE: To identify the COVID-19-related KAP in Venezuelan patients screened at the Hospital Universitario de Caracas triage tent. MATERIALS AND METHODS: We conducted a cross-sectional study among 215 patients between April 25th and May 25th, 2020, with in-person interviews using a KAP survey. RESULTS: Most surveyed patients (53.5%) were asymptomatic. Most of them, both from the symptomatic and the asymptomatic groups, had adequate knowledge about the symptoms and transmission of the disease and the majority said they were practicing quarantine, frequent handwashing, and the use of face masks in public areas. However, the daily replacement of cloth face masks was more frequent in the asymptomatic group whereas replacement every three days was more frequent in the symptomatic group. Finally, more than half of the participants admitted having been in crowded places, a common practice among the symptomatic compared to the asymptomatic patients. CONCLUSIONS: This is the first KAP study in Venezuela about COVID-19. Knowledge and practices among Venezuelans could be improved by strengthening education and training programs. This information from the early phase of the pandemic in Venezuela may contribute to the design of COVID-19 promotion and prevention strategies.

Introducción: Los estudios sobre conocimientos, actitudes y prácticas (CAP) sobre COVID-19 ayudan a identificar conceptos erróneos y prácticas inadecuadas relacionadas con la enfermedad. Esta información de referencia es fundamental para diseñar estrategias efectivas y mejorar la adherencia a las medidas de prevención. Objetivo: Identificar la CAP relacionada con COVID-19 en pacientes venezolanos cribados en la carpa de triaje del Hospital Universitario de Caracas. Materiales y métodos: Realizamos un estudio transversal entre 215 pacientes entre el 25 de abril y el 25 de mayo de 2020, con entrevistas en persona utilizando una encuesta KAP. Resultados: La mayoría de los pacientes encuestados (53,5%) se encontraban asintomáticos. La mayoría de ellos, tanto del grupo sintomático como asintomático, tenían un conocimiento adecuado sobre los síntomas y la transmisión de la enfermedad y la mayoría dijo que practicaban la cuarentena, el lavado frecuente de manos y el uso de mascarillas en las áreas públicas. Sin embargo, el reemplazo diario de mascarillas de tela fue más frecuente en el grupo asintomático, mientras que el reemplazo cada tres días fue más frecuente en el grupo sintomático. Finalmente, más de la mitad de los participantes admitieron haber estado en lugares concurridos, una práctica común entre los sintomáticos en comparación con los asintomáticos. Conclusiones: Este es el primer estudio CAP en Venezuela sobre COVID-19. El conocimiento y las prácticas entre los venezolanos podrían mejorarse fortaleciendo los programas de educación y capacitación. Esta información de la fase inicial de la pandemia en Venezuela puede contribuir al diseño de estrategias de promoción y prevención del COVID-19.

Knowledge, attitudes, and practices related to COVID-19 among patients at Hospital Universitario de Caracas triage tent: A cross-sectional study / Conocimientos, actitudes y prácticas relacionadas con la Covid-19 en pacientes atendidos en la carpa de triaje del Hospital Universitario de Caracas: un estudio transversal

Abstract | Introduction: The studies on knowledge, attitudes, and practices (KAP) regarding COVID-19 help to identify erroneous concepts and inadequate practices related to the disease. This baseline information is essential to design effective strategies and improve adherence to prevention measures. Objective: To identify the COVID-19-related KAP in Venezuelan patients screened at the Hospital Universitario de Caracas triage tent. Materials and methods: We conducted a cross-sectional study among 215 patients between April 25th and May 25th, 2020, with in-person interviews using a KAP survey. Results: Most surveyed patients (53.5%) were asymptomatic. Most of them, both from the symptomatic and the asymptomatic groups, had adequate knowledge about the symptoms and transmission of the disease and the majority said they were practicing quarantine, frequent handwashing, and the use of face masks in public areas. However, the daily replacement of cloth face masks was more frequent in the asymptomatic group whereas replacement every three days was more frequent in the symptomatic group. Finally, more than half of the participants admitted having been in crowded places, a common practice among the symptomatic compared to the asymptomatic patients. Conclusions: This is the first KAP study in Venezuela about COVID-19. Knowledge and practices among Venezuelans could be improved by strengthening education and training programs. This information from the early phase of the pandemic in Venezuela may contribute to the design of COVID-19 promotion and prevention strategies.

Resumen | Introducción. Los estudios de conocimientos, actitudes y prácticas (CAP) relacionados con la Covid-19 permiten establecer los conceptos erróneos y las prácticas inadecuadas en torno a esta enfermedad, información fundamental para diseñar estrategias eficaces y mejorar el cumplimiento de las medidas de prevención. Objetivo. Establecer los conocimientos, actitudes y prácticas relacionadas con la Covid-19 en pacientes venezolanos cribados en la carpa de triaje del Hospital Universitario de Caracas. Materiales y métodos. Se hizo un estudio transversal en 215 pacientes entre el 25 de abril y el 25 de mayo de 2020, mediante entrevistas personales y utilizando una encuesta sobre conocimientos, actitudes y prácticas. Resultados. La mayoría (53,5 %) de los pacientes encuestados se encontraba asintomática; los encuestados tenían un conocimiento adecuado sobre los síntomas y la transmisión de la enfermedad, sin distinción entre sintomáticos y asintomáticos. La mayoría de ellos indicó estar respetando las prácticas de cuarentena, lavado de manos frecuente y uso de tapabocas en público; sin embargo, el reemplazo diario de los tapabocas de tela fue más frecuente en el grupo de los asintomáticos, en tanto que el reemplazo cada tres días fue más común entre los sintomáticos. Por último, más de la mitad de los participantes admitió haber estado en lugares concurridos, siendo esta práctica más frecuente entre los sintomáticos que entre los asintomáticos. Conclusiones. Este es el primer estudio de conocimientos, actitudes y prácticas sobre la Covid-19 en Venezuela. El conocimiento y las prácticas de los venezolanos podrían mejorar mediante el fortalecimiento de los programas de educación y capacitación. Esta información, obtenida durante la fase inicial de la pandemia en Venezuela, podría contribuir al diseño de estrategias de promoción y prevención de la Covid-19.

Striking alkenol versus allenol reactivity: metal-catalyzed chemodifferentiating oxycyclization of enallenols.

An efficient chemodivergent metal-controlled methodology for the generation of different highly functionalized oxygen heterocycles from common enallenol substrates has been developed. Chemoselectivity control in the O-C functionalization of an enallenol can be achieved through the choice of catalyst: AuCl(3), PdCl(2), and [PtCl(2)(CH(2)=CH(2))](2) exclusively afford dihydrofurans through selective activation of the allenol moiety, whereas FeCl(3) solely gives tetrahydrofurans or tetrahydropyrans through selective activation of the alkenol moiety. We have also shown that a combination of metal-mediated hydroalkoxylation and allenic aminocyclization reactions can lead to a useful preparation of the tetrahydrofuro[3,2-b]piperidine core of the antimalarial alkaloid isofebrifugine. These divergent heterocyclization reactions have been developed experimentally and additionally, their mechanisms have been investigated by a theoretical study.

El infectológo y su labor en el hospital: 10 años de gestión, 2000-2009 / The infectious disease and its work in the hospital: 10 years of management, 2000-2009

El infectológo es de gran importancia en los hospitales; realiza funciones en atención ambulatoria, hospitalización, control de infecciones hospitalarias, docencia, investigación, asesoria en epidemias y pandemias entre otras. Precisar el cumplimiento de las funciones del infectológo, investigando la carga laboral y académica en HUC durante la última década. Se analizaron los registros de atención al paciente y programas académicos cumplidos desde el 1 de enero 2000 al 31 de diciembre 2009, calculando el número de pacientes evaluados en cada una de las actividades asistenciales y horas académicas. Se evaluaron 110 691 pacientes atendidos a través de los años. La distribución de las actividades correspondió a 72 521 (65 %) de atención en consultas ambulatorias (35 % pacientes viviendo con VIH y 30 % no VIH); 18 682 interconsultas de pacientes hospitalizados para control de antimicrobianos (17 %); 12 792 (12 %) cursos de tratamiento administrados en la sala de tratamiento ambulatorio (STA); 3 764 (3 %) egresos del SEIA y 2 932 personas atendidas por exposición de riesgo biológico. La actividad académica fue regular durante la década, cumpliendose los programas correspondientes. El número de horas empleadas en las revistas a los pacientes hospitalizados en el SEIA fue > 300/año. Seis miembros del servicio participaron en el programa del control de infecciones del HUC. Residentes y especialistas del SEIA cumplieron las funciones del infectológo en la última década;El mayor número de pacientes fue atendido de forma ambulatoria (consultas y la STA).

Hospital role of infectious diseases (ID) specialists is important. They participate in outpatient and inpatient care, hospital infection control, academic and research activities, and also pandemic and epidemic issues. This study's aim was to assess the number of activities, booth academic and im patients care, and fulfillment of ID physicians'roles at HUC during the last decade. Analysis of records for patient care and academic programs during January 1, 2000 to December 31, 2009. The number of patients clinically assessed and academic hours spent was calculated. During the decade, 110 691 patients were evaluated. There was a progessive increase of patients cared fir throughout they years. The activities distribution was as follows: 72 521 (65 %) outpatients (35 % HIV infected patients y % non HIV); 18 682 inpatients assessed following HUC policy on antibiotic control (17 %); 12 792 (12 %) courses of treatment administered at the outpatient treatment clinic (OTC); 3 764 (3 %) discharged patients fron SEIA y 2 932 people evaluated because of biologic risk exposition. Academic activities were fulfilled according to the fellowship program. Physicians dedicated more than 300 hour/year for inpatient rounds at SEIA. Six specialist form the ID Service also Were Members of HUC Infection Control Committee. Physicians at SEIA have accomplished the role of ID doctors during the last decade; most patients were evaluated outpatients and at OTC.

Synthesis of benzo- and naphthoquinonyl boronic acids: exploring the Diels-Alder reactivity.

Substituted 2-quinonyl boronic acids have been synthesised from 1,4-dimethoxy aromatic derivatives in two steps: regiocontrolled boronation and oxidative demethylation. The study of their dienophilic behaviour evidenced that the boron substituent significantly increases the reactivity and triggers an efficient domino process in which the Diels-Alder reaction was followed by a protodeboronation or dehydroboronation, depending on the substitution on both the quinone and diene partners. The boronic acid acts as a temporary controller, opening a direct access to trans-fused meta-regiosomeric adducts when 3-methyl-substituted 2-quinonyl boronic acids react with dienes with a substituent at C-1. A particularly valuable synthetic result was obtained in the reaction between 3,6-dimethyl-2-quinonyl boronic acid and piperylene under an oxygen atmosphere; trans-fused 8a-hydroxy-2,4a,8-trimethyl tetrahydronaphthoquinone was formed directly, in excellent yield and in a highly diastereoselective manner.

Exploring Morita-Baylis-Hillman reactions of p-quinols.

The Morita-Baylis-Hillman reaction of p-methylquinols with activated aromatic aldehydes has been studied. Depending on the reaction conditions (solvent and additives), three different products were formed. A mono or double Morita-Baylis-Hillman adduct and a fused 1,3-dioxolane could be obtained in good chemical yields. The use of non-nucleophilic bases to promote the reaction suggested an autocatalytic mechanism.

Utilidad del cefadroxilo en leishmaniosis tegumentaria americana con infecciones piógenas sobreagregadas / Use of cefadroxil for american tegumentary leishmaniosis with intercurrent pyogenic infections

La leishmaniosis tegumentaria americana es un problema de salud en el medio rural venezolano. Las úlceras leishmánicas tienden a infectarse secundariamente por bacterias piógenas. Se evaluaron 41 pacientes con la enfermedad que recibieron cefadroxilo oral previo a la toma de segmentos de piel del borde de las úlceras para la demostración microscópica de Leishmania spp. La mayoría de los pacientes eran adultos masculinos y provenían del medio rural del estado Miranda, con una úlcera única localizada en los miembros inferiores. El diagnóstico inmunoserológico se efectuó por leishmanina y anticuerpos fluorescentes y el de certeza por visualización de amastigotes en frotis coloreados. Los resultados inmunoserológicos fueron positivos en todos los pacientes, mientras que el parásito se observó en 51 por ciento de los frotis coloreados con Giemsa. Una semana postratamiento antimicrobiano, los pacientes presentaban mejoría de las infecciones sobreagregadas y también progreso en la visualización del parásito por disminución de la carga bacteriana. Los pacientes fueron tratados con antimoniato de meglumina intramuscular en series de 10 días, con reposo intermedio. Respondieron adecuadamente, las lesiones cicatrizaron y los nódulos satelitales acompañantes desaparecieron. Se concluye que el cefadroxilo es útil para tratar las infecciones piógenas secundarias asociadas en LTA y aumentar la sensibilidad para observar los parásitos en piel. La leishmaniosis considerada como enfermedad emergente, motiva la búsqueda de alternativas terapéuticas adecuadas

Cutaneous leishmaniosis of the New World (CLNW) is a health problem in rural areas of Venezuela. Patients with muco-cutaneous ulcers tend to present intercurrent infections of the lesions by pyogenic bacteria. After removing skin specimens from the ulcer borders for microscopic demonstration of Leishmania spp amastigotes, forty-one patients with the disease, being treated with cefadroxil per os were studied. Most of the patients came from rural Miranda state, were male adults and had one ulcer on a lower limb. Confirmatory diagnosis was made using the Montenegro test, or Leishmanin immunoserology (IFAT) and demonstration of the presence of parasites in the skin samples. All the patients were positive for the Leishmanin test, while parasites were observed in 51 percent of the skin smears colored by the Giemsa procedure. After a week of treatment with cefadroxil, bacterial infections were reduced and a decrease in bacterial load was also noted when visualizing the parasite from the skin smears. Patients were treated with intramuscular antimony meglumine for 10-day periods with an intervening rest period. All patients responded adequately to the meglumine antileishmania treatment; the lesions healed and accompanying tributary lymph nodes disappeared. Conclusion: Cefadroxil is a suitable antibiotic for treating intercurrent pyogenic infections in cases of tegumentary leishmaniosis. Since leishmaniosis is considered an emerging disease, a search for appropriate, alternative therapies is required

New regiocontrolled synthesis of functionalized pyrroles from 2-azetidinone-tethered allenols.

A new one-pot approach to synthesize densely substituted racemic and enantiopure pyrroles from beta-lactams has been developed. The approach relies on the regiocontrolled cyclization of beta-allenamine intermediates derived from the ring opening of 2-azetidinone-tethered allenols. In this approach four points of diversity are introduced, one of which is the position of the allene moiety on the beta-lactam ring.

Carbonyl allenylation/free radical cyclization sequence as a new regio- and stereocontrolled access to bi- and tricyclic beta-lactams.

A novel approach to racemic and enantiopure nonconventional fused bi- and tricyclic beta-lactams has been developed by using regio- and stereocontrolled intramolecular free radical reactions in monocyclic 2-azetidinone-tethered allenynes and haloallenes. The access to allene cyclization precursors was achieved by metal-mediated carbonyl allenylation of appropriately substituted 4-oxoazetidine-2-carbaldehydes in an aqueous environment. The tin-promoted radical cyclizations of allene-beta-lactams are totally regioselective for the central allenic carbon, providing bi- and tricyclic beta-lactams containing a seven-membered ring.

Domino metal-free allene-beta-lactam-based access to functionalized pyrroles.

A novel transition metal-free domino reaction sequence in allene-beta-lactams, leading to the biologically relevant pyrrole frame has been developed using a sodium methoxide-methanol system.

Synthesis of strained tricyclic beta-lactams by intramolecular [2+2] cycloaddition reactions of 2-azetidinone-tethered enallenols: control of regioselectivity by selective alkene substitution.

A convenient metal-free methodology for the preparation of structurally novel, strained tricyclic beta-lactams containing a cyclobutane ring has been developed. The first examples accounting for the intramolecular [2+2] cycloaddition reactions in beta-lactams have been achieved by the thermolysis of 2-azetidinone-tethered enallenols, which have been prepared in aqueous media by regio- and diastereoselective indium-mediated carbonyl allenylation of 4-oxoazetidine-2-carbaldehydes. Notably, the regioselectivity of the cycloaddition can be tuned in the allene component just by a subtle variation in the substitution pattern of the alkene component.

Diastereoselectivity enhancement in the 1,3-cycloaddition of beta-lactam aldehydes. Application to the synthesis of enantiopure indolizidinone amino esters.

[reaction: see text] Enantiopure alpha-alkoxy beta-lactam acetaldehydes were prepared via the thiazole-based one-carbon homologation. The 1,3-dipolar cycloaddition reaction involving alpha-alkoxy beta-lactam acetaldehyde-derived azomethine ylides gave with excellent diastereoselectivity highly functionalized 2-azetidinone-tethered prolines, which were directly used for the first preparation of azabicyclo[4.3.0]nonane (indolizidinone) amino esters from beta-lactams.

Novel N1-C4 beta-lactam bond breakage. Synthesis of enantiopure alpha-alkoxy-gamma-keto acid derivatives.

Addition reaction of 2-(trimethylsilyl)thiazole (TMST) to cis- or trans-4-formyl-beta-lactams gave enantiopure alpha-alkoxy-gamma-keto acid derivatives via a novel N1-C4 bond breakage of the beta-lactam nucleus. This is the first time that the cleavage of the N1-C4 bond on the beta-lactam nucleus has been shown to occur in 2-azetidinones lacking an aryl moiety at C4. [reaction--see text]

Asymmetric synthesis of unusual fused tricyclic beta-lactam structures via aza-cycloadditions/ring closing metathesis.

Conveniently substituted bis-beta-lactams, pyrrolidinyl-beta-lactams, and piperidinyl-beta-lactams undergo ring-closing methatesis using Grubbs' carbene, Cl(2)(Cy(3)P)(2)Ru=CHPh, to give medium-sized rings fused to bis-2-azetidinone, pyrrolidinyl-2-azetidinone, or piperidinyl-2-azetidinone systems. The diolefinic cyclization precursors can be obtained from optically pure 4-oxoazetidine-2-carbaldehydes bearing an extra alkene tether at position 1 or 3 of the beta-lactam ring via [2 + 2] cycloaddition of imino 2-azetidinones, N-metalated azometine ylide [3 + 2] cycloaddition, and subsequent N-acylation of the pyrrolidinyl nitrogen atom, or through aza-Diels-Alder cycloaddition of 2-azetidinone-tethered imines. Under standard reaction conditions, the combination of cycloaddition reactions of 2-azetidinone-tethered imines with ring-closing methatesis offers an asymmetric entry to a variety of unusual fused tricyclic 2-azetidinones bearing two bridgehead nitrogen atoms.

New domino transposition/intramolecular Diels-Alder reaction in monocyclic allenols: a general strategy for tricyclic compounds.

A novel and direct synthetic strategy to prepare fused tricycles has been developed from monocyclic allenols, masked functionalized dienes, which underwent a domino allenol transposition/intramolecular Diels-Alder reaction.

Neuropatia auditiva: aspectos relevantes na investigaçäo clínica / Auditory neuropathy: relevant aspects to clinical investigation

Introdução: O termo neuropatia auditiva define grupode alterações auditivas a partir do resultado de examescomplementares na avaliação da audição. Objetivo:Observar a ocorrência de sinais e sintomas auditivos emportadores de neuropatia auditiva. Forma de estudo:Retrospectivo clínico. Material e método: Análise de 30casos de neuropatia auditiva diagnosticados entre junhode 1995 e junho de 1997, em que o desenvolvimento dossintomas ocorreu após a aquisição da fala, enfatizando osachados na anamnese, exame físico, exames subsidiáriose avaliação audiológica. Resultados: Ocorreu nessa sériea prevalência de vários sintomas e sinais associados deforma peculiar. Conclusão: Existem vários sinais esintomas que, associados ou nao, podem sugerir apresença da neuropatia auditiva

Alterações dos limiares auditivos causados pelo colabamento de meato acústico externo / Misdiagnosis of Hearing Loss Due to Ear Canal Collapse

O colabamento do meato acústico externo pode resultar em uma piora dos limiares auditivos, principalmente nas freqüências mais agudas, em decorrência de um fechamento total ou parcial do meato acústico externo, devido à pressão dos fones exercida sobre o pavilhão auricular durante a avaliação audiológica. Para evitar erros deste tipo, algum método deve ser utilizado para que meatos acústicos externos estreitos e/ou pavilhões auriculares flácidos permaneçam livres permitindo que a onda sonora seja capaz de atingir a membrana timpânica durante a obtenção dos limiares tonais. Material e métodos: Neste trabalho estão demonstrados os resultados com 47 pacientes que apresentaram melhora de seus limiares auditivos de até 50 dBNA quando um tubo de polietileno foi inserido no meato acústico externo para evitar o colabamento.

Collapse of the external auditory meatus during audiometry can lead to spuriously increased hearing thresholds being obtained, particularly at high frequencies, by pressure exerted on the pinna during audiometryc testing. The pressure of the earphone against the pinna may result in the partial closure or complete collapse of the external auditory meatus during audiometry. To avoid such errors, na effective method has to be used to eliminate outer ear closure to allow sound to reach" the tympanic membrane during tonal audiometry. Material and methods: In a sample of 47 patients, we demonstraded best. results after using a small piece of polyethylene tubbing inserted in the canal to avoid the collapse of the ear canal.