Improvement in Smell Using Monoclonal Antibodies Among Patients With Chronic Rhinosinusitis With Nasal Polyps: A Systematic Review.

BACKGROUND: Impairment of smell is more commonly related to chronic rhinosinusitis with nasal polyps (CRSwNP) than without, especially when asthma and/or NSAID-exacerbated respiratory disease and type 2 inflammation are also present. Therapeutic options include intranasal and systemic corticosteroids, surgery, and, more recently, biological therapy. We summarize current knowledge on the effect of biologics on olfaction in patients with CRSwNP. METHODS: We performed a systematic search of the PubMed and Cochrane databases from January 2001 to June 2022. The inclusion criteria were as follows: adult patients with CRS treated with dupilumab, omalizumab, mepolizumab, benralizumab, or reslizumab; and studies published in English reporting outcomes for sense of smell based on psychophysical and/or subjective tools. We excluded reports that did not assess CRSwNP, loss of smell evaluated with a method other than those accepted in the inclusion criteria, review articles, and expert opinions. No funding was received. RESULTS: Dupilumab has demonstrated rapid and sustained long-term improvement in smell in clinical trials and in real life. Omalizumab improves smell at 24 weeks. This improvement is maintained in the long-term, although it is not clinically relevant. Mepolizumab and benralizumab improved smell in the long term based on a subjective scale. No studies examining the improvement in smell in patients with CRSwNP treated with reslizumab were found. Indirect comparisons by meta-analysis consistently conclude that dupilumab is the most effective biologic for improving impaired sense of smell. CONCLUSION: Dupilumab seems to be more efficacious for improving the sense of smell than omalizumab, mepolizumab, and benralizumab.

Improvement in Smell Using Monoclonal Antibodies Among Patients With Chronic Rhinosinusitis With Nasal Polyps: A Systematic Review

Background: Impairment of smell is more commonly related to chronic rhinosinusitis with nasal polyps (CRSwNP) than without, especially when asthma and/or NSAID-exacerbated respiratory disease and type 2 inflammation are also present. Therapeutic options include intranasal and systemic corticosteroids, surgery, and, more recently, biological therapy. We summarize current knowledge on the effect of biologics on olfaction in patients with CRSwNP.Methods: We performed a systematic search of the PubMed and Cochrane databases from January 2001 to June 2022. The inclusion criteria were as follows: adult patients with CRS treated with dupilumab, omalizumab, mepolizumab, benralizumab, or reslizumab; and studies published in English reporting outcomes for sense of smell based on psychophysical and/or subjective tools. We excluded reports that did not assess CRSwNP, loss of smell evaluated with a method other than those accepted in the inclusion criteria, review articles, and expert opinions. No funding was received.Results: Dupilumab has demonstrated rapid and sustained long-term improvement in smell in clinical trials and in real life. Omalizumab improves smell at 24 weeks. This improvement is maintained in the long-term, although it is not clinically relevant. Mepolizumab and benralizumab improved smell in the long term based on a subjective scale. No studies examining the improvement in smell in patients with CRSwNP treated with reslizumab were found. Indirect comparisons by meta-analysis consistently conclude that dupilumab is the most effective biologic for improving impaired sense of smell.Conclusion: Dupilumab seems to be more efficacious for improving the sense of smell than omalizumab, mepolizumab, and benralizumab. (AU)

Antecedentes: La pérdida de olfato de la rinosinusitis crónica se relaciona principalmente con el fenotipo que presenta poliposis nasal (RSCcPN), especialmente si asocia asma y/o EREA, e inflamación tipo 2. Los corticoides intranasales y sistémicos, la cirugía y, de forma más reciente, los fármacos biológicos, constituyen las principales estrategias terapéuticas. Este documento contiene una revisión sistemática del efecto de los fármacos biológicos en el olfato de pacientes con RSCcPN. Métodos: Se realizó una búsqueda sistemática en las bases de datos PubMed y Cochrane desde enero de 2001 hasta junio de 2022. Los criterios de inclusión fueron: pacientes adultos con RSC tratados con dupilumab, omalizumab, mepolizumab, benralizumab o reslizumab; estudios publicados en inglés, con datos sobre la mejoría del olfato utilizando test psicofísicos y/o subjetivos. Los criterios de exclusión fueron: publicaciones que no incluían pacientes con poliposis nasal, la pérdida del olfato evaluada con un método diferente de los criterios de inclusión mencionados, los artículos de revisión y la opinión de expertos. No se empleó ningún recurso de financiación. Resultados: Dupilumab ha demostrado una mejora del olfato rápida y mantenida a largo plazo en ensayos clínicos y en la práctica clínica habitual. Omalizumab mejora el olfato en la 24ª semana y lo mantiene a largo plazo, pero no alcanza una mejoría clínicamente relevante. Mepolizumab y benralizumab mejoran el olfato a largo plazo, evaluado mediante un test subjetivo. No se encontraron estudios respecto a la mejoría del olfato en pacientes con RSCcPN tratados con reslizumab. Las comparaciones indirectas mediante metaanálisis concluyen de forma consistente que dupilumab es el biológico más eficaz para mejorar el sentido del olfato. Conclusión: Dupilumab es el biológico más eficaz en la mejoría del olfato en RSCcPN, en comparación con omalizumab, mepolizumab y benralizumab. (AU)

BepiColombo mission confirms stagnation region of Venus and reveals its large extent.

The second Venus flyby of the BepiColombo mission offer a unique opportunity to make a complete tour of one of the few gas-dynamics dominated interaction regions between the supersonic solar wind and a Solar System object. The spacecraft pass through the full Venusian magnetosheath following the plasma streamlines, and cross the subsolar stagnation region during very stable solar wind conditions as observed upstream by the neighboring Solar Orbiter mission. These rare multipoint synergistic observations and stable conditions experimentally confirm what was previously predicted for the barely-explored stagnation region close to solar minimum. Here, we show that this region has a large extend, up to an altitude of 1900 km, and the estimated low energy transfer near the subsolar point confirm that the atmosphere of Venus, despite being non-magnetized and less conductive due to lower ultraviolet flux at solar minimum, is capable of withstanding the solar wind under low dynamic pressure.

Manejo y factores de riesgo de mortalidad del estatus epiléptico: estudio retrospectivo / Status epilepticus management and mortality risk factors: A retrospective study

Introducción: El estatus epiléptico (SE, por sus siglas en inglés) es una urgencia neurológica con altas tasas de mortalidad. En este estudio analizamos el manejo del SE e identificamos factores de riesgo de mortalidad en los que realizar intervenciones de mejora o modificaciones en los protocolos de actuación hospitalarios. Métodos: Retrospectivamente se analizaron los datos demográficos de tratamiento y pronóstico de 65 pacientes (59 [44,5-77] años, 53,8% mujeres) que ingresaron en un hospital terciario cumpliendo los criterios de SE de la ILAE 2015, durante un periodo de 18 meses. Resultados: Treinta (46,2%) pacientes tenían antecedentes de epilepsia. Las causas más frecuentes de SE fueron enfermedad cerebrovascular (27,7%) e infección sistémica (16,9%). Se registraron desviaciones respecto al tratamiento habitual: la administración de las benzodiazepinas como primer fármaco solo en 33 (50,8%) pacientes, la combinación de 2 benzodiazepinas en 7 (10,8%) pacientes y el uso off-label de lacosamida en 5 (7,7%) pacientes. El electroencefalograma (EEG) fue realizado únicamente en 26 (40%) pacientes y solo 5 EEG (7,7% de pacientes) en las primeras 12 h. La tasa de mortalidad fue del 21,5%. Ictus agudo y complicaciones cerebrovasculares se asociaron con mortalidad, mientras que epilepsia previa e ingreso en la unidad de cuidados intensivos (UCI) fueron factores de buen pronóstico (p < 0,05). Conclusiones: Para mejorar el manejo del SE y reducir la tasa de mortalidad, sería recomendable implementar actividades formativas dirigidas a los profesionales del departamento de urgencias, así como el ingreso electivo en la UCI para pacientes con factores de riesgo (primera crisis epiléptica, con ictus agudo o complicaciones cardiovasculares). (AU)

Introduction: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. Methods: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. Results: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <.05). Conclusions: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications). (AU)

The Drivers of the Martian Bow Shock Location: A Statistical Analysis of Mars Atmosphere and Volatile EvolutioN and Mars Express Observations.

The Martian interaction with the solar wind leads to the formation of a bow shock upstream of the planet. The shock dynamics appear complex, due to the combined influence of external and internal drivers. The extreme ultraviolet fluxes and magnetosonic Mach number are known major drivers of the shock location, while the influence of other possible drivers is less constrained or unknown such as crustal magnetic fields, solar wind dynamic pressure, or the Interplanetary Magnetic Field (IMF) intensity, and orientation. In this study, we compare the influence of the main drivers of the Martian shock location, based on several methods and published datasets from Mars Express (MEX) and Mars Atmosphere Volatile EvolutioN (MAVEN) missions. We include here the influence of the crustal fields, extreme ultraviolet fluxes, solar wind dynamic pressure, as well as (for MAVEN, thanks to magnetic field measurements) magnetosonic Mach number and Interplanetary Magnetic Field parameters (intensity and orientation angles). The bias due to the cross-correlations among the possible drivers is investigated with a partial correlations analysis. Several model selection methods (Akaike Information Criterion and Least Absolute Shrinkage Selection Operator regression) are also used to rank the relative importance of the physical parameters. We conclude that the major drivers of the shock location are extreme ultraviolet fluxes and magnetosonic Mach number, while crustal fields and solar wind dynamic pressure are secondary drivers at a similar level. The IMF orientation also plays a significant role, with larger distances for perpendicular shocks rather than parallel shocks.

Sistematización de experiencias de un equipo de encuestadoras durante una prueba piloto en parto humanizado / Systematization of experiences of a team of interviewers during a test pilot in humanized childbirth

Resumen Introducción: Esta sistematización recoge las riquezas de notas de campo escritas por siete encuestadoras de siete ciudades de Colombia (Bogotá, Medellín, Cali, Barranquilla, Bucaramanga, Manizales y Pasto), realizadas durante una prueba piloto, en donde se reconocieron sus dinámicas y aprendizajes. Objetivo: Sistematizar las experiencias de los traslados hacia los terrenos de campo y de las experiencias del parto de mujeres entrevistadas, a través de las voces de las encuestadoras. Método: Se plantearon tres fases para seguir la metodología de la sistematización de experiencias: fase de reconstrucción, fase de la interpretación y fase de la potenciación de la experiencia. Resultados: Se evidenciaron tres categorías de análisis: el trayecto y el entorno, las convergencias en la maternidad y la experiencia del parto. Conclusiones: Las notas de campo de las encuestadoras se convirtieron en fuente primordial de informaciones no homogéneas y muy diversas. Se hizo imprescindible analizar sus experiencias durante sus traslados a los terrenos de campo y, de esta forma, aplicar un enfoque intersectorial para entender e interpretar lo que ellas escucharon de parte de las madres encuestadas, por ejemplo: circunstancias cálidas y respetuosas a la hora de recibir la atención clínica del parto, así como situaciones de maltrato en la asistencia obstétrica, donde han sido culturalmente jerarquizadas por la medicalización del parto, lo que constituye una posición de subordinación hacia la paciente.

Abstract Introduction: This systematization gathers the richness of the field notes written by seven interviewers from seven cities in Colombia (Bogotá, Medellin, Cali, Barranquilla, Bucaramanga, Manizales and Pasto), carried out during a test pilot, where their dynamics and learning were recognized. Objective: To systematize experiences of itineraries to the territories, as well as childbirth from the voices of the interviewers. Method: The methodological process presented three phases designed to follow the methodology of systematization of experiences. Reconstruction phase; interpretation phase and experience empowerment phase. Results: Three categories of analysis were evidenced: the journey and the environment, the convergences in motherhood and the experience of childbirth. Conclusions: The field notes of the pollsters became a primary source of inhomogeneous and highly diverse information. It became essential to analyze their experiences during their transfers to the fields and thus apply an intersectoral approach to understand and interpret what they heard from the surveyed mothers: warm and respectful circumstances when receiving clinical care of childbirth, as well as situations of abuse in obstetric care that are and have been culturally hierarchical by the medicalization of childbirth, constituting a subordinate position towards the patient.

Observations of a Solar Energetic Particle Event From Inside and Outside the Coma of Comet 67P.

We analyze observations of a solar energetic particle (SEP) event at Rosetta's target comet 67P/Churyumov-Gerasimenko during 6-10 March 2015. The comet was 2.15 AU from the Sun, with the Rosetta spacecraft approximately 70 km from the nucleus placing it deep inside the comet's coma and allowing us to study its response. The Eastern flank of an interplanetary coronal mass ejection (ICME) also encountered Rosetta on 6 and 7 March. Rosetta Plasma Consortium data indicate increases in ionization rates, and cometary water group pickup ions exceeding 1 keV. Increased charge exchange reactions between solar wind ions and cometary neutrals also indicate increased upstream neutral populations consistent with enhanced SEP induced surface activity. In addition, the most intense parts of the event coincide with observations interpreted as an infant cometary bow shock, indicating that the SEPs may have enhanced the formation and/or intensified the observations. These solar transient events may also have pushed the cometopause closer to the nucleus. We track and discuss characteristics of the SEP event using remote observations by SOHO, WIND, and GOES at the Sun, in situ measurements at Solar Terrestrial Relations Observatory Ahead, Mars and Rosetta, and ENLIL modeling. Based on its relatively prolonged duration, gradual and anisotropic nature, and broad angular spread in the heliosphere, we determine the main particle acceleration source to be a distant ICME which emerged from the Sun on 6 March 2015 and was detected locally in the Martian ionosphere but was never encountered by 67P directly. The ICME's shock produced SEPs for several days which traveled to the in situ observation sites via magnetic field line connections.

Status epilepticus management and mortality risk factors: a retrospective study.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. METHODS: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. RESULTS: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <  .05). CONCLUSIONS: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications).

Ecografía diafragmática perioperatoria en el punto de atención como herramienta de predicción de fallo respiratorio postoperatorio en pacientes de alto riesgo: estudio de viabilidad y serie de casos / Perioperative diaphragm point-of-care ultrasound as a prediction tool of postoperative respiratory failure in high-risk patients: A feasibility study and case series

Introducción: La función muscular respiratoria en el período postoperatorio es clave para determinar si un paciente desarrollará insuficiencia respiratoria postoperatoria (IRP) o no. La IRP ocurre cuando el intercambio de gases no satisface las necesidades metabólicas. La parálisis ipsilateral del hemidiafragma después del bloqueo del plexo braquial interescalénico (BPBI) provoca una reducción aguda de la función muscular respiratoria. Esta reducción no causa IRP cuando el hemidiafragma contralateral genera suficiente intercambio de gases para satisfacer las demandas metabólicas. Objetivos: Estudiar la evolución de la función muscular hemidiafragmática durante el perioperatorio mediante ecografía diafragmática (D-POCUS) y usarlo como una herramienta innovadora de predicción de IRP valorando el hemidiafragma contralateral en caso de que ocurra una parálisis hemidiafragmática aguda. Métodos: Se estudian pacientes considerados de alto riesgo programados para cirugía de hombro con BPBI. Se evalúan ecográficamente ambos hemidiafragmas, antes y después del procedimiento, mediante fracción de acortamiento (FA) y excursión diafragmática (ED). Se registró en URPA los pacientes con IRP. Resultados: En los 6 pacientes estudiados se produjo una reducción significativa de la FA y la ED del hemidiafragma ipsilateral. Solo 1/6 mostró signos de IRP. La evaluación del hemidiafragma contralateral durante el postoperatorio mostró que en los 5 pacientes sin signos de IRP no existieron cambios significativos en la función del hemidiafragma contralateral. El único paciente que mostró una caída de la función hemidiafragmática contralateral fue el único paciente que padeció IRP. Conclusiones: En esta serie de casos D-POCUS permite conocer la función perioperatoria del diafragma en pacientes de alto riesgo. Todos los pacientes sufrieron una reducción de la FA y la excursión hemidiafragmática aguda tras BPBI; sin embargo, estos pacientes no desarrollaron...(AU)

Introduction: Respiratory muscle function in the postoperative period is a key to whether a patient develops Postoperative Respiratory Failure (PRF) or not. PRF occurs when the gas exchange does not meet metabolic needs. Ipsilateral paralysis of the hemidiaphragm after interscalenic brachial plexus block (ISB) causes an acute reduction of respiratory muscle function. This reduction does not cause PRF when the contralateral hemidiaphragm generates enough gas exchange to meet metabolic demands. Objectives: To study the evolution of hemidiaphragmatic muscle function during the perioperative period with diaphragmatic ultrasound (D-POCUS), and use it as an innovative tool to predict PRF, assessing the contralateral hemidiaphragm in the event of acute hemidiaphragm paralysis. Methods: Patients considered high risk, scheduled for shoulder surgery with ISB are studied. Both hemidiaphragms were evaluated by ultrasound, before and after the procedure, measuring Thickening Fraction (TF) and Diaphragmatic Excursion (DE). PACU patients with PRF were registered. Results: There was a significant reduction in the TF and DE of the ipsilateral hemidiaphragm in the six patients studied. Only 1/6 patients showed signs of PRF. The evaluation of the contralateral hemidiaphragm during the postoperative period showed that in the five patients without signs of PRF, there were no significant changes in the function of the contralateral hemidiaphragm. The patient, who showed a reduction in contralateral hemidiaphragm function, was the only one who suffered PRF. Conclusions: In this case series, D-POCUS allows to know the perioperative function of the diaphragm in high-risk patients. All patients suffered an acute reduction of hemidiaphragm function after ISB; however, these patients did not develop PRF when the contralateral hemidiaphragm function was preserved.(AU)

Perioperative diaphragm point-of-care ultrasound as a prediction tool of postoperative respiratory failure in high-risk patients: A feasibility study and case series. / Ecografía diafragmática perioperatoria en el punto de atención como herramienta de predicción de fallo respiratorio postoperatorio en pacientes de alto riesgo: estudio de viabilidad y serie de casos.

INTRODUCTION: Respiratory muscle function in the postoperative period is a key to whether a patient develops Postoperative Respiratory Failure (PRF) or not. PRF occurs when the gas exchange does not meet metabolic needs. Ipsilateral paralysis of the hemidiaphragm after interscalenic brachial plexus block (ISB) causes an acute reduction of respiratory muscle function. This reduction does not cause PRF when the contralateral hemidiaphragm generates enough gas exchange to meet metabolic demands. OBJECTIVES: To study the evolution of hemidiaphragmatic muscle function during the perioperative period with diaphragmatic ultrasound (D-POCUS), and use it as an innovative tool to predict PRF, assessing the contralateral hemidiaphragm in the event of acute hemidiaphragm paralysis. METHODS: Patients considered high risk, scheduled for shoulder surgery with ISB are studied. Both hemidiaphragms were evaluated by ultrasound, before and after the procedure, measuring Thickening Fraction (TF) and Diaphragmatic Excursion (DE). PACU patients with PRF were registered. RESULTS: There was a significant reduction in the TF and DE of the ipsilateral hemidiaphragm in the six patients studied. Only 1/6 patients showed signs of PRF. The evaluation of the contralateral hemidiaphragm during the postoperative period showed that in the five patients without signs of PRF, there were no significant changes in the function of the contralateral hemidiaphragm. The patient, who showed a reduction in contralateral hemidiaphragm function, was the only one who suffered PRF. CONCLUSIONS: In this case series, D-POCUS allows to know the perioperative function of the diaphragm in high-risk patients. All patients suffered an acute reduction of hemidiaphragm function after ISB; however, these patients did not develop PRF when the contralateral hemidiaphragm function was preserved.

Prevalence, characteristics, and outcome of asthmatic patients with type 2 diseases in hospitalized patients with COVID-19 in Madrid, Spain

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Status epilepticus management and mortality risk factors: A retrospective study. / Manejo y factores de riesgo de mortalidad del estatus epiléptico: estudio retrospectivo.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. METHODS: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. RESULTS: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <.05). CONCLUSIONS: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications).

Uso de la timpanometría en Atención Primaria / Use of tympanometry in Primary Care

Dada la elevada prevalencia de la otitis media en la población infantil y las dificultades que a esta edad presenta la otoscopia para establecer el diagnóstico, la timpanometría aporta información cuantitativa valiosa respecto a la presencia de líquido en el oído medio. Es una exploración habitual en todos los Servicios de Otorrinolaringología (ORL) y pensamos que podría ser de gran utilidad en Atención Primaria. En este trabajo pretendemos aportar el conocimiento teórico necesario para comprender e interpretar las curvas que obtendremos con un timpanómetro portátil, discutiendo las características y beneficios de esta prueba. Con la intención de mejorar la capacidad de seguimiento de la otitis media serosa (OMS) en Atención Primaria, constituimos un equipo de pediatras y ORL de la misma área de salud para ir introduciendo y adaptando un conjunto de procedimientos, entre los que se encuentra la timpanometría. El aparato elegido ha sido el timpanómetro MicroTymp®3 de Welch-Allyn y la exploración es realizada por una enfermera experimentada en esta prueba. Al pediatra le corresponde la interpretación de los hallazgos timpanométricos, que, junto a la historia clínica y la otoscopia neumática, le facilitarán el diagnóstico. Se describen los fundamentos de la timpanometría y la manera de realizar y analizar los timpanogramas. Discutimos las ventajas y limitaciones de esta exploración en el contexto de la otitis media serosa infantil en Atención Primaria. En niños mayores de seis meses, la timpanometría con MicroTymp®3 es una herramienta práctica y eficaz en el diagnóstico de la OMS en Atención Primaria (AU)

Due to the high prevalence of otitis media in children and to the difficulties of otoscopy to establish the diagnosis at this age, tympanometry brings valuable quantitative information about the presence of fluid in the middle ear. It is a usual scan on all services of ENT and we think that it could be very useful in primary care. In this paper we aim to provide the theoretical knowledge necessary to understand and interpret the curves you get with a portable instrument, discussing the features and benefits of this test. We are a team of pediatricians and ENT of the same Area of health who pretend to improve the follow up of otitis media with effusion (OME) in primary care; we are introducing and adapting a set of procedures, which include tympanometry. The selected device has been MicroTymp®3 Welch-Allyn and the scan is performed by a nurse experienced in this test. The pediatrician interpretate the tympanometric findings, that along with the clinical history and pneumatic otoscopy, will facilitate the diagnosis. We describe the fundamentals of tympanometry and how to perform and interpret the tympanograms. We discuss the advantages and limitations of this exploration in the context of OME in primary care. The Welch Allyn MicroTymp®3 is a practical and effective tool in the diagnosis of OME in children older than 6 months in primary care (AU)

Valoración de la presión pulmonar y su repercusión sobre cavidades derechas por ecocardiografía / No disponible

El presente capítulo tiene como objetivo acercar al neumólogo el conocimiento de la ecocardiografía como herramienta fundamental para la estimación de parámetros hemodinámicos de indudable importancia para el agnóstico, la estratificación del riesgo y el manejo terapéutico de la hipertensión pulmonar (HTP) y el tromboembolismo pulmonar (TEP). En general, estas mediciones ecocardiográficas muestran una excelente correlación con la hemodinámica y los métodos empleados no son excesivamente complejos, estando al alcance de cualquier profesional con un tiempo de adiestramiento muy razonable. Este texto trata de explicar, de forma gráfica y sencilla, los distintos métodos empleados en ecocardiografía para cuantificar la presión pulmonar y las resistencias vasculares pulmonares. La ecocardiografía valora, además, las repercusiones que la HTP y el TEP ejercen sobre las cavidades derechas en su intento de adaptación, permitiéndonos analizar los principales parámetros de morfología y función ventricular derecha, que han demostrado tener un valor pronóstico en estas patologías

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Plasma observations during the Mars atmospheric "plume" event of March-April 2012.

We present initial analysis and conclusions from plasma observations made during the reported "Mars plume event" of March - April 2012. During this period, multiple independent amateur observers detected a localized, high-altitude "plume" over the Martian dawn terminator [Sanchez-Lavega et al., Nature, 2015, doi:10.1038/nature14162], the cause of which remains to be explained. The estimated brightness of the plume exceeds that expected for auroral emissions, and its projected altitude greatly exceeds that at which clouds are expected to form. We report on in-situ measurements of ionospheric plasma density and solar wind parameters throughout this interval made by Mars Express, obtained over the same surface region, but at the opposing terminator. Measurements in the ionosphere at the corresponding location frequently show a disturbed structure, though this is not atypical for such regions with intense crustal magnetic fields. We tentatively conclude that the formation and/or transport of this plume to the altitudes where it was observed could be due in part to the result of a large interplanetary coronal mass ejection (ICME) encountering the Martian system. Interestingly, we note that the only similar plume detection in May 1997 may also have been associated with a large ICME impact at Mars.

Otoscopia neumática / Pneumatic otoscopy

Tras explicar en un artículo previo la mejor forma de limpiar la cera del oído, pretendemos con este segundo trabajo mostrar las ventajas que tiene la otoscopia neumática (ON) en el diagnóstico de la otitis media (OM), exponiendo el procedimiento y los hallazgos exploratorios. Las conclusiones aportadas conjugan, nuevamente, las recomendaciones ofrecidas por la revisión bibliográfica efectuada en relación a la otoscopia neumática, con la experiencia de un equipo de pediatras y de otorrinolaringólogos de la misma área de salud. Las guías americanas y la mayoría de pediatras consideran que la ON es el método preferido para examinar en los niños la presencia de exudado de oído medio, sin embargo, muy pocos lo usan. Es un procedimiento sencillo, económico, fehaciente y fácilmente accesible en Atención Primaria; pero siendo la valoración subjetiva, es necesario un entrenamiento previo dirigido. Consideramos fundamental el aprendizaje y la aplicación de la otoscopia neumática en Atención Primaria, como procedimiento diagnóstico del derrame de oído medio (AU)

After explaining the best way to clean ear wax in a previous article, in the second one we aim to show the advantages of pneumatic otoscopy (PO) when diagnosing otitis media (OM), exposing the procedure and exploratory findings. Our conclusions sum up again the recommendations offered by the literature review carried out about pneumatic otoscopy, and the experience of a team of pediatricians and otolaryngologists from the same Healthcare Area. American guidelines and most pediatricians consider PO is the best method to examine the middle ear in children when effusion is present; however, very few pediatricians use it. It is a simple, economical, reliable and easily accessible procedure in Primary care; but, as it is a subjective technique, a prior targeted training is necessary. We consider that learning and application of the pneumatic otoscopy is essential in Primary care, as a diagnostic procedure of middle ear effusion (AU)

Extracción de la cera de los oídos / Extraction of wax from the ear

A través de cuatro artículos sucesivos pretendemos mostrar los procedimientos que consideramos de mayor utilidad para el diagnóstico y el seguimiento de la otitis media serosa (OMS) por parte de Pediatría de Atención Primaria. En este primero, expondremos la que, a nuestro juicio, es la manera más eficaz de limpiar la cera del oído de un niño. Las conclusiones aportadas conjugan las recomendaciones ofrecidas por las principales guías sobre extracción de cera del oído y las de la revisión bibliográfica efectuada, con la experiencia de un equipo de pediatras y de otorrinolaringólogos de la misma área de salud. Alrededor de un 50% de niños requieren limpiar de cera sus oídos a fin de realizar una correcta otoscopia. Para ello podemos utilizar la instilación de cerumenolíticos, la irrigación, la extracción manual o cualquier combinación. No existe evidencia en la bibliografía de que un procedimiento sea mejor que otro. Conclusiones: tras aplicar las diferentes técnicas de limpieza, consideramos que, si la cera es externa y el conducto auditivo permeable, la mejor manera de eliminarla es mediante el uso de curetas o porta-algodones, pero si la cera es más profunda o está impactada, el método elegido será el lavado con irrigación de agua templada, para lo que un cerumenolítico aplicado previamente es de gran ayuda. Aconsejamos realizar dicha irrigación con una jeringa de 20 cc y un catéter intravenoso Abocat® del 14-16, a fin de evitar riesgos (AU)

Through four successive articles we aim to show the procedures we consider to be most useful for the diagnosis and follow-up of otitis media with effusion (OME) by Primary care Pediatrics. In the first one, we expose what we believe is the best way to clean wax from the ear of a child. The conclusions provided combine the recommendations offered by the main guides on extraction of wax from the ear and the literature review carried out, with the experience of a team of pediatricians and otolaryngologists from the same Healthcare Area. Around 50% of children require clean wax from their ears in order to perform a correct otoscopy. To do this we can use the instillation of cerumenolytics, irrigation, manual removal, or any combination. There is no evidence in the literature that a procedure is better than another one. Conclusions: after applying different cleaning techniques, we believe that if the wax is external and the ear canal permeable, the best way to remove it is by the use of blunt ear curettes or applicator with triangular tip, but if the wax is deeper or is impacted, the better choice will be washing with warm water irrigation, in this case, the previous application of a cerumenolytic will be of great help. We advise to perform such irrigation with a syringe of 20 cc and an intravenous catheter Abocat® 14-16, in order to avoid risks (AU)