Renal Cell Carcinoma With Tumor Thrombus: A Case Series in Puerto Rico.

INTRODUCTION:  Renal cell carcinoma (RCC) is one of the most common types of kidney cancer. While RCC tends to present as a localized tumor, a notable proportion may present with distant metastasis. In some instances, RCC may also present with intravascular tumor extension, often called tumor thrombus (TT). Its presence confers a worse prognosis and has important implications for the tumor's staging and treatment. Despite extensive documentation of RCC TT in the US, limited data exists regarding its presentation, management, and outcomes in Puerto Rico (PR). This study aims to broaden the available information on RCC TT, emphasizing surgical management and outcomes. We also provide descriptive data on patient demographics and clinical presentation to improve decision-making among clinicians caring for Puerto Rican men and women. METHODS:  In this single-center, retrospective study, we evaluated patients who underwent partial or total nephrectomy at Saint Luke's Episcopal Medical Center between 2018 and 2022. Data was abstracted from electronic health records (EHR). Patients without documented evidence of TT during the peri-operative period were excluded from the study. A total of 220 patient records were evaluated, of which 12 met the inclusion criteria for the study. Cases were categorized using the latest RCC TT guidelines. Central tendency measurements were used to describe the sample distribution. The mean was considered to make assumptions regarding the prevalent observations, and the median was considered to rule out possible outliers. Categorical data were evaluated using proportion analyses, including TT extension level and BMI variables. Fisher's exact test evaluated the association between the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade and TT extension level. RESULTS:  Most patients lacked TT-related symptoms. The most severe presenting symptom was a pulmonary embolism (8.3%). Hypertension (83.3%), BMI greater than 25 at the time of diagnosis (75%), and type 2 diabetes mellitus (66.7%) were the most common comorbid conditions within our cohort. Nearly 75% of patients underwent laparoscopic radical nephrectomy with TT resection. One left-sided level III case was managed by laparoscopic-assisted open radical nephrectomy with a right subcostal incision. There were zero intraoperative complications and two postoperative complications. The histopathological reports of all cases were consistent with clear cell carcinoma, and half of the cases (n=6) were WHO/ISUP G4. All patients are alive and free of disease. CONCLUSION:  RCC is a common renal neoplasm in PR that can present with intravascular tumor extension. Our findings do not establish a definitive association between BMI, tumor size, WHO/ISUP grading, and TT extension level. Our study shows that laparoscopic removal of RCC TT is a safe and effective approach. However, the generalizability of our findings is limited by the study's design and sample size. Future research should focus on identifying predictive markers, establishing effective screening protocols, and determining if our hybrid approach has comparable outcomes to the standard open approach.

Autonomous Sensor System for Low-Capacity Wind Turbine Blade Vibration Measurement.

This paper presents the design, implementation, and validation of an on-blade sensor system for remote vibration measurement for low-capacity wind turbines. The autonomous sensor system was deployed on three wind turbines, with one of them operating in harsh weather conditions in the far south of Chile. The system recorded the acceleration response of the blades in the flapwise and edgewise directions, data that could be used for extracting the dynamic characteristics of the blades, information useful for damage diagnosis and prognosis. The proposed sensor system demonstrated reliable data acquisition and transmission from wind turbines in remote locations, proving the ability to create a fully autonomous system capable of recording data for monitoring and evaluating the state of health of wind turbine blades for extended periods without human intervention. The data collected by the sensor system presented in this study can serve as a foundation for developing vibration-based strategies for real-time structural health monitoring.

Circumcision and Sexual Medicine.

INTRODUCTION: Male circumcision is one of the most frequently performed and debated urological procedures due to its possible implications for sexual health. OBJECTIVES: The objective of this article is to review the literature on male circumcision and reconcile the scientific evidence to improve the quality of care, patient education, and clinician decision-making regarding the effects on sexual function of this procedure. METHODS: A review of the published literature regarding male circumcision was performed on PubMed. The criteria for selecting resources prioritized systematic reviews and cohort studies pertinent to sexual dysfunction, with a preference for recent publications. RESULTS: Despite the conflicting data reported in articles, the weight of the scientific evidence suggests there is not sufficient data to establish a direct association between male circumcision and sexual dysfunction. CONCLUSION: This review provides clinicians with an updated summary of the best available evidence on male circumcision and sexual dysfunction for evidenced-based quality of care and patient education.

HIV/AIDS infection in critical care: epidemiological profile and risk factors for mortality in a Colombian cohort.

INTRODUCTION: Outcomes of human immunodeficiency virus (HIV) infected patients admitted to intensive care units (ICU) have improved with antiretroviral therapy (ART). However, whether the outcomes have improved in low- and middle-income countries, paralleling those of high-income countries is unknown. The objective of this study was to describe a cohort of HIV-infected patients admitted to ICU in a middle-income country and identify the risk factors associated with mortality. METHODOLOGY: A cohort study of HIV-infected patients admitted to five ICUs in Medellín, Colombia, between 2009 and 2014 was done. The association of demographic, clinical and laboratory variables with mortality was analyzed using a Poisson regression model with random effects. RESULTS: During this time period, 472 admissions of 453 HIV-infected patients were included. Indications for ICU admission were: respiratory failure (57%), sepsis/septic shock (30%) and central nervous system (CNS) compromise (27%). Opportunistic infections (OI) explained 80% of ICU admissions. Mortality rate was 49%. Factors associated with mortality included hematological malignancies, CNS compromise, respiratory failure, and APACHE II score ≥ 20. CONCLUSIONS: Despite advances in HIV care in the ART era, half of HIV-infected patients admitted to the ICU died. This elevated mortality was associated to underlying disease severity (respiratory failure and APACHE II score ≥ 20), and host conditions (hematological malignancies, admission for CNS compromise). Despite the high prevalence of OIs in this cohort, mortality was not directly associated to OIs.

An NmrA-like enzyme-catalysed redox-mediated Diels-Alder cycloaddition with anti-selectivity.

The Diels-Alder cycloaddition is one of the most powerful approaches in organic synthesis and is often used in the synthesis of important pharmaceuticals. Yet, strictly controlling the stereoselectivity of the Diels-Alder reactions is challenging, and great efforts are needed to construct complex molecules with desired chirality via organocatalysis or transition-metal strategies. Nature has evolved different types of enzymes to exquisitely control cyclization stereochemistry; however, most of the reported Diels-Alderases have been shown to only facilitate the energetically favourable diastereoselective cycloadditions. Here we report the discovery and characterization of CtdP, a member of a new class of bifunctional oxidoreductase/Diels-Alderase, which was previously annotated as an NmrA-like transcriptional regulator. We demonstrate that CtdP catalyses the inherently disfavoured cycloaddition to form the bicyclo[2.2.2]diazaoctane scaffold with a strict α-anti-selectivity. Guided by computational studies, we reveal a NADP+/NADPH-dependent redox mechanism for the CtdP-catalysed inverse electron demand Diels-Alder cycloaddition, which serves as the first example of a bifunctional Diels-Alderase that utilizes this mechanism.

Prevalencia del síndrome metabólico en estudiantes del Campus San Lorenzo de la Universidad Nacional de Asunción / Prevalence of metabolic syndrome in students of the Campus San Lorenzo of the National University of Asunción

Introducción. El síndrome metabólico (SM) constituye una serie de desórdenes metabólicos que en conjunto son considerados factor de riesgo para desarrollar diabetes y enfermedad cardiovascular. Objetivo. Determinar la prevalencia del SM y sus componentes en estudiantes del campus San Lorenzo dela Universidad Nacional de Asunción en el periodo 2015-2016. Materiales y métodos. Estudio observacional descriptivo de corte transverso con un muestreo por conglomerados. Se incluyeron a 163 estudiantes de facultades o institutos seleccionados. Se aplicó un cuestionario para datos sociodemográficos y actividad física, y se realizaron mediciones de circunferencia de cintura(CC), peso y altura, además de niveles séricos en ayunas de glucosa, colesterol-HDLc y triglicéridos, conjuntamente con medición de presión arterial para determinar la presencia de SM según los criterios del Panel III (NCEP-ATP-III). Los datos fueron resguardados con estricta confidencialidad. Resultados.El50,92% de los participantes era del sexo masculino, con edad promedio de 21,6± 2,4 años. El 49,7% fueron considerados sedentarios,25,16% presentó sobrepeso, 8,59% obesidad,6,75% CCelevaday16,56% hipertensión. El 2,45% y 4,9% presenta ronglicemia basal y triglicérido elevados, respectivamente, y 37,42%HDL-c bajo. La prevalencia del SM fue del 4,91%,el 52,15 % presentó al menos un factor del NCEP-ATP-III para SM Conclusión. Alrededor de la mitad de los participantes presentó al menos un factor de riesgo de SM, y los componentes más frecuentes fueron la baja concentración de HDLc, y la hipertensión arterial. Se recomienda acciones preventivas en la población juvenil basadas en actividad física y alimentación saludable. Palabras Clave: síndrome metabólico; hipertensión; sobrepeso; adulto joven

Introduction: The metabolic syndrome (MS) constitutes of a series of metabolic disorders that together are considered a risk factor to develop diabetes and cardiovascular disease.Objective.To determine the prevalence of MS and its components in students of the National University of Asunción ­San Lorenzo Campusin the 2015-2016 period. Materials and Methods.Observational descriptive cross-sectional study with a cluster sampling. A total of 163 students from selected faculties or instituteswas included. A questionnaire was applied for sociodemographic data and physical activityandwaist circumference(WC), weight and height were measured, as well as fasting serum levels of Glucose, HDLc cholesterol and triglycerides, together with blood pressure to determine the presence of MS according to the Panel III criteria (NCEP-ATP-III). All data were kept strictly confidential. Results. 50,92% of participants were male, with a mean age of 21,6± 2,4 years.49.7% were considered sedentary,25,16% presented overweight, and 8,59% obesity, 16,56%hypertension. 6,75% presentedan elevated abdominal circumference,2,45% elevated basal glycemia, 4,9% elevated Triglycerides, 37,42% low HDLc.The prevalence of MS was 4,91%and52,15% presented at least one NCEP-ATP-III factor for MS. Conclusion. Aroundhalf of the participantspresented at least one risk factor for MS, the most frequent components were low HDLc concentration and arterial hypertension.It is recommendedpreventive actions in the youth population based on physical activity and healthy eating. Key words: metabolic syndrome; hypertension; overweight; young adult

Association Between Early-Onset Osteoporosis With Hearing Loss and Benign Paroxysmal Positional Vertigo (BPPV): A Systematic Review and Meta-Analysis.

OBJECTIVE: Osteoporosis is a chronic systemic disease characterized by low bone mass, progressive microarchitectural deterioration and increased bone fragility. Hearing loss and benign paroxysmal positional vertigo (BPPV) have been found in patients diagnosed with osteoporosis over 65 years, however, there is lack of information about these conditions in young patients. Herein, we conducted a systematic review and meta-analysis to provide evidence of the association between osteoporosis and audio-vestibular findings in young subjects. METHODS: Systematic review and meta-analysis were performed according to PRISMA guidelines. Searches were conducted in PubMed, Embase, and Web of Science Core Collection. Mean age, proportion of patients with low mineral density, hearing loss, and BPPV were calculated for the systematic review and meta-analysis. Odds Ratio (OR) with their corresponding 95% confidence intervals (CI) were calculated. RESULTS: A total of 26 articles were reviewed. Only 10 studies met inclusion criteria for the meta-analysis. Six were assessed pursuing the association between osteoporosis and hearing loss. Pooled evidence suggested in patients with osteoporosis, an increased risk for developing hearing loss (OR = 1.52, 95% CI 1.06-2.19; P = .02) compared to controls. Another 6 studies reported the association between osteoporosis and BPPV. A significant increased risk for BPPV was found in individuals with osteoporosis (OR = 1.58, 95% CI 1.02-2.4; P = .04). There was no publication bias. CONCLUSION: Subjects younger than 65 years with osteoporosis have an increase odds for hearing loss and BPPV compared to controls. These conditions could be associated with early inner or middle ear bone morphologic changes.

Constrictive Pericarditis and Cardiac Tamponade Due to Tuberculosis as Presentation of Human Immunodeficiency Virus/Syndrome of Acquired Immunodeficiency: Case Report / Pericarditis constrictiva y taponamiento cardíaco por tuberculosis como presentación de virus de inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida: presentación de caso / Pericardite constritiva e tamponamento cardíaco devido à tuberculose com uma apre-sentação do vírus da imunodeficiência adquirida: relato de cas

We report a case of constrictive pericarditis due to extrapulmonary tuberculosis associated with Human Immuno-deficiency Virus, complicated by cardiac tamponade that required surgical intervention in a drug user patient. The importance of early diagnosis and management is widely highlighted

El artículo presenta un caso de pericarditis constrictiva secundaria a tuberculosis extrapulmonar en un paciente con prueba positiva para virus de inmunodeficiencia humana (VIH) consumidor de sustancias psicoactivas, quien durante la hospitalización desarrolló un taponamiento cardíaco con requerimiento de intervención quirúrgica. Se plantea la discusión de la importancia de cada una de las pruebas solicitadas y el manejo adecuado en pacientes con dichas patologías

O artigo apresenta um caso de pericardite constritiva secundária à tuberculose extrapulmonar em paciente com teste positiva para vírus da imunodeficiência humana (HIV) e usuário de substâncias psicoativas que, durante a internação, desenvolveu tamponamento cardíaco com necessidade de intervenção cirúrgica. Discute-se a importância de cada um dos exames solicitados e o manejo ade-quado de pacientes com essas patologias

Nutritional and Educational Intervention to Recover a Healthy Eating Pattern Reducing Clinical Ileostomy-Related Complications.

The aim of this study was to evaluate a diet intervention implemented by our hospital in order to determinate its capacity to improve the eating pattern of patients with an ileostomy, facilitating the implementation new eating-related behaviors, reducing doubt and dissatisfaction and other complications. The study was conducted with a quasi-experimental design in a tertiary level hospital. The elaboration and implementation of a nutritional intervention consisting of a Mediterranean-diet-based set of menus duly modified that was reinforced by specific counseling at the reintroduction of oral diet, hospital discharge and first follow-up appointment. Descriptive, bivariate and multivariate analyses were performed. The protocol was approved by the competent Ethics Committee. The patients of the intervention group considered that the diet facilitated eating five or more meals a day and diminished doubt and concerns related to eating pattern. Most patients (86%) had a favorable experience regarding weight recovery and a significant reduction of all-cause readmissions and readmission with dehydration (p = 0.015 and p < 0.001, respectively). The intervention helped an effective self-management of eating pattern by patients who had a physical improvement related to hydration status, which, together with an improvement in weight regain, decreased the probability of readmissions.

Multiplexing the Quantitation of MAP Kinase Activities Using Differential Sensing.

Protein kinases are therapeutic targets for many human diseases, but the lack of user-friendly quantitative assays limits the ability to follow the activities of numerous kinases at once (multiplexing). To develop such an assay, we report an array of sulfonamido-oxine (SOX)-labeled peptides showing cross-reactivity to different mitogen-activated protein kinases (MAPKs) for use in a differential sensing scheme. We first verified using linear discriminant analysis that the array could differentiate MAPK isoforms. Then, using principal component analysis, the array was optimized based on the discrimination imparted by each SOX-peptide. Next, the activity of individual MAPK families in ternary mixtures was quantified by support vector machine regression. Finally, we multiplexed the quantification of three MAPK families using partial least squares regression in A549 cell lysates, which has possible interference from other kinase classes. Thus, our method simultaneously quantifies the activity of multiple kinases. The technique could be applied to other protein kinase families and the monitoring of diseases.

Studies of Surface Preparation for the Fluorosequencing of Peptides.

Silica passivating agents have shown great success in minimizing nonspecific protein binding to glass surfaces for imaging and microscopy applications. Amine-derivatized surfaces are commonly used in conjugation with amide coupling agents to immobilize peptides/proteins through C-terminal or side-chain carboxylic acids. In the case of the single-molecule fluorosequencing of peptides, attachment occurs via the C-terminus and nonspecific surface binding has previously been a source of error in peptide identification. Here, we employ fluorosequencing as a high-throughput, single-molecule sensitivity assay to identify and quantify the extent of nonspecific binding of peptides to amine-derivatized surfaces. We show that there is little improvement when using common passivating agents in combination with the surface derivatizing agent 3-aminopropyl-triethoxysilane (APTES) to couple the peptides to the modified surface. Furthermore, many xanthene fluorophores have carboxylic acids in the appended phenyl ring at positions ortho and meta or ortho and para, and the literature shows that conjugation through the ortho position is not favored. Because xanthene-derived fluorophores are commonly used for single-molecule applications, we devised a novel assay to probe the conjugation of peptides via their fluorophores relative to their C-termini on silane-derivatized surfaces. We find significant attachment to the ortho position, which is a warning to those attempting to immobilize fluorophore-labeled peptides to silica surfaces via amide coupling agents. However, eliminating all amines on the surface by switching to 3-azidopropyl-triethoxysilane (AzTES) for coupling via copper-catalyzed azide-alkyne cycloaddition (CuAAC) and omitting additional passivation agents allowed us to achieve a high level of C-terminally bound peptides relative to nonspecifically or ortho-phenyl-bound, fluorophore-labeled peptides. This strategy substantially improves the specificity of peptide immobilization for single-molecule fluorosequencing experiments.

Data of texture profile analysis performed by different input settings on stored 'Nui' and 'Rahi' blueberries.

Texture Profile Analysis is a well-established method for assessing mechanical properties of horticultural food products and consists of two compression cycles on a repeated motion to a given strain using a flat surface probe (i.e., compression plate). Input settings of target deformation (strain%) and duration (s) between compression cycles utilized for Texture Profile Analysis could influence output mechanical properties. The article provides data related to the ability of different Texture Profile Analysis operational settings to enable the separation of blueberries with variable mechanical properties. To create variable mechanical parameters of 'Nui' and 'Rahi' blueberries, fruit was stored in four relative humidity for 21 d at 4°C. For each storage humidity, mechanical properties of hardness (BH, N), hardness slope (BHS, kN m-1), apparent modulus of elasticity (E, MPa), and resilience (BR, -) were determined by utilizing two strain (15% or 30% of berry equatorial height). Meanwhile, mechanical parameters of cohesiveness (BCo, -), and springiness (BSp, -) were obtained by utilizing the combination of two strain (15% or 30%) and two duration between cycles (2 s and 10 s) as TPA operational settings. The statistical evaluation was conducted by one-way ANOVA, and the means of each storage humidity were separated according to the Tukey-HSD test (P = 0.05). The data presented in this article was used to select the Texture Profile Analysis operational settings utilized in the article entitled "Influence of water loss on mechanical properties of stored blueberries" Rivera et al. [1].

Septic Arthritis of the Shoulder After SARS-CoV-2 Pfizer Vaccination: A Case Report.

CASE: We report a case of a 68-year-old woman who developed left shoulder glenohumeral joint septic arthritis within 1 week of receiving the COVID-19 Pfizer-BioNTech vaccine. CONCLUSION: Common vaccine complications include injection site pain, fever, chills, arthralgia, and hypersensitivity reactions. A less common and more serious complication of septic arthritis has been reported and requires invasive treatment of surgical irrigation and debridement, and culture-specific parenteral antibiotic therapy. The current report highlights the clinical presentation and significant potential for serious complication with the improper technique. We urge vaccine administrators to practice caution and aseptic technique when vaccinating patients to reduce the risk of complication and morbidity.

Combination of two analytical techniques improves wine classification by Vineyard, Region, and vintage.

Three important wine parameters: vineyard, region, and vintage year, were evaluated using fifteen Vitis vinifera L. 'Pinot noir' wines derived from the same scion clone (Pinot noir 667). These wines were produced from two vintage years (2015 and 2016) and eight different regions along the Pacific Coast of the United States. We successfully improved the classification of the selected Pinot noir wines by combining an untargeted 1D 1H NMR analysis with a targeted peptide based differential sensing array. NMR spectroscopy was used to evaluate the chemical fingerprint of the wines, whereas the peptide-based sensing array is known to mimic the senses of taste, smell, and palate texture by characterizing the phenolic profile. Multivariate and univariate statistical analyses of the combined NMR and differential sensing array dataset classified the genetically identical Pinot noir wines on the basis of distinctive metabolic signatures associated with the region of growth, vineyard, and vintage year.

Safe and effective performance of pediatric spinal deformity surgery in patients unwilling to accept blood transfusion: a clinical study and review of literature.

BACKGROUND: Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah's witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion. METHODS: After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018. We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up). RESULTS: Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (14), juvenile idiopathic (1), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.4° to 11.2° (80% correction, p <  0.001) at the latest follow-up. A mean of 11.4 levels were fused and 5.6 levels of Pontes osteotomies were performed. One patient underwent L1 hemivertebra resection and three patients had fusion to pelvis. Estimated blood loss, percent estimated blood volume loss, and cell saver returned averaged 307.9 mL, 8.5%, and 80 mL, respectively. Average operative time was 214 min. The average drop in hemoglobin after surgery was 2.9 g/dL. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative complications were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis. CONCLUSIONS: Blood conservation techniques allow for safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications, when performed by an experienced multidisciplinary team. LEVEL OF EVIDENCE: Level IV.

Availability and Variability of Consumer Prices for Lumbar Discectomy Across US Hospitals in 2018.

OBJECTIVE: To determine the availability and variability of consumer pricing data for an elective lumbar discectomy in the USA. METHODS: Hospital representatives were contacted via telephone, hospital websites, and state price-transparency websites. A total of 153 hospitals were contacted via telephone calls under the guise of a patient requesting a self-pay price for elective lumbar discectomy. The same hospitals were then researched for price comparison between those requested by phone and those listed on hospital websites after installment of the price transparency law by the Centers of Medicare and Medicaid Services (CMS) on 1 January 2019. Complete and partial prices were recorded for both datasets when available. Hospitals were grouped based on profit status, teaching status, and geographical region. Statistical analysis compared rates of price availability and mean prices between hospital groups and between datasets. RESULTS: Thirty-four (23.0%) of 148 hospitals included in the final analysis were able to provide complete price information via telephone. An additional 70 (47.3%) were able to provide a partial price. A total of four (2.7%) institutions provided a complete price and an additional 65 (43.9%) provided a partial price via website. The mean complete price for microdiscectomy when provided was $27,342.36 (n = 34). When compared to government and non-profit hospitals combined, private hospitals had significantly lower partial-prices. CONCLUSION: A patient seeking to undergo a common surgical procedure in the USA will likely be met with difficulty and few options if motivated by price. A high degree of variability exists among US hospitals in 2018 with regards to availability and comprehensiveness of pricing information.

Recomendaciones para la atención fonoaudiológica en las áreas de audiología y otoneurología en contexto COVID-19: una revisión narrativa / Recommendations for audiologist assistance in the areas of audiology and otoneurology in context COVID-19: a narrative review

La pandemia por el virus SARS-CoV-2 causante de la enfermedad COVID-19 se ha expandido rápidamente a nivel mundial. Las autoridades de salud pública han recomendado limitar las prestaciones de salud no esenciales, buscando el equilibrio entre el riesgo del retraso en el tratamiento y la potencial exposición al virus. En la mayoría de las prestaciones en las áreas de audiología y otoneurología no es posible cumplir con el distanciamiento físico recomendado y la duración de la atención puede superar los 45 minutos, factores que aumentan el riesgo de contagio para el profesional. El objetivo de la presente revisión es describir la evidencia actual sobre las recomendaciones de atención para las áreas de audiología y otoneurología en contexto COVID-19. Además de la búsqueda de artículos científicos en diversas bases de datos, se revisaron las recomendaciones emitidas por las principales asociaciones en el área. La información obtenida se organizó considerando cuatro aspectos clínicos relevantes: prestaciones, procedimientos, elementos de protección personal y limpieza de equipamiento e insumos. La evidencia científica y las sugerencias de las asociaciones están en constante actualización y algunos temas se han desarrollado escasamente. Sin embargo, las recomendaciones coinciden en priorizar la atención a distancia, extremar el uso de elementos de protección personal, implementar protocolos de higiene de manos y limpieza de equipos e insumos. También, se sugiere incorporar estrategias de comunicación alternativas al lenguaje oral con las personas con hipoacusia para facilitar la discriminación de la palabra.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has rapidly spread worldwide. Public health authorities have recommended limiting non-essential healthcare, in search of a balance between the risk of delaying treatment and the potential exposure to the virus. Most services in the audiology and otoneurologyareas can easily exceed 45 minutes and it is not possible to keep the recommended physical distancing. Both factors increase the risk of professionals being infected. Therefore, the purpose of this review is to describe the current evidence about recommendations in audiology and otoneurology care in the context of COVID-19. In addition to the search of scientific articles in various databases, recommendations issued by the mainassociations in the area were consulted. The information was gathered considering four relevant clinical aspects: health careservices, procedures, personal protective equipment and the cleaning of equipment and supplies. Scientific evidence and suggestions made by associations are being constantly updated, and therefore there is limited content on some topics. However, the recommendations agree on prioritizing remote health care, increasing the use of personal protective equipment, implementing protocols for hand hygiene and for the cleaning of equipment and supplies. The incorporation communication strategies other than oral language to interact with people with hearing lossto facilitate speech discrimination is also recommended.

Adaptation of the "active communication education" programme into Spanish for older adults with hearing loss.

Objective: To adapt the Active Communication Education (ACE) programme into Spanish. In addition, this study aimed at determining the effects of the adapted ACE programme on the social/emotional impacts of hearing loss and hearing functioning in a group of older adults with hearing loss who do not wear hearing aids.Design: This was an exploratory cohort study. Study group participants received the newly adapted ACE programme and control group participants received a cognitive stimulation programme. The Shortened Hearing Handicap Inventory for the Elderly in Spanish (HHIE-S) and the Spanish version of the Amsterdam Inventory for Auditory Disability and Handicap (S-AIADH) were carried out before and after each programme.Study sample: Sixty-six older adults with hearing loss and who did not wear hearing aids were randomly assigned to either an ACE group (n = 30) or a cognitive stimulation group (n = 36).Results: Participants who received the ACE programme showed a significantly larger improvement for the S-AIADH than did the cognitive stimulation group participants.Conclusions: The ACE programme has been adapted into Spanish for use with Chilean older adults with hearing loss. The results show that older adults report better functioning in listening situations after attending the sessions of the adapted ACE programme.

Intra-articular Calcaneus Fractures: Current Concepts Review.

Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level of Evidence: Level V, expert opinion.