Superior semicircular canal dehiscence in relation with the superior petrosal sinus: our experience, surgical management and systematic review of literature.

PURPOSE: Most of Superior Semicircular Canal Dehiscence (SSCD) are located in the apical region of the SSC. However, in a small number of cases, it may be situated in the medial wall, causing the SSC to contact with the superior petrosal sinus (SPS). The aim of this study is to describe four patients with SSCD involving the superior petrosal sinus (SSCD-SPS) and to perform a review of the literature. METHODS: Observational retrospective study of patients diagnosed of SSCD-SPS in a tertiary referral center. A systematic review was made, identifying 7 articles in the literature. Clinical presentation, complementary test (pure-tone audiometry, PTA; vestibular evoked myogenic potential, VEMP; computed tomography, CT), therapeutic management and outcomes were reported. RESULTS: Four new cases of SSCD-SPS are reported, in three of them a transmastoid plugging was performed. 54 patients with SSCD-SPS (57 dehiscences) were reported in the literature. The most frequent symptoms were aural pressure (57.41%) and vertigo provoked by pressure/Valsalva (55.55%). Conductive hearing loss was the most common finding in PTA (47.37%). Abnormally low thresholds were observed in 59.46% of reported VEMP. Transmastoid approach was used in ten cases, middle fossa approach in four, round window reinforcement in one, and occlusion of the SPS using coils in two. CONCLUSIONS: Within SSCD, we have encountered a rare subtype characterized by its medial wall location in close proximity to the SPS. This subgroup needs special consideration as it has shown its own distinct characteristics. Regarding therapeutic management, we advocate a transmastoid approach.

Epidemiology of influenza in Ethiopia: findings from influenza sentinel surveillance and respiratory infection outbreak investigations, 2009-2015.

BACKGROUND: Influenza is an acute viral disease of the respiratory tract which is characterized by fever, headache, myalgia, prostration, coryza, sore throat and cough. Globally, an estimated 3 to 5 million cases of severe influenza illness and 291 243-645 832 seasonal influenza-associated respiratory deaths occur annually. Although recent efforts from some African countries to describe burden of influenza disease and seasonality, these data are missing for the vast majority, including Ethiopia. Ethiopia established influenza sentinel surveillance in 2008 aiming to determine influenza strains circulating in the country and know characteristics, trend and burden of influenza viruses. METHODS: We used influenza data from sentinel surveillance sites and respiratory disease outbreak investigations from 2009 to 2015 for this analysis. We obtained the data by monitoring patients with influenza-like illness (ILI) at three health-centers, severe acute respiratory infection (SARI) at five hospitals and investigating patients during different respiratory infection outbreaks. Throat-swab specimens in viral transport media were transported to the national reference laboratory within 72 h of collection using a cold-chain system. We extracted viral RNA from throat-swabs and subjected to real-time PCR amplification. We further subtyped and characterized Influenza A-positive specimens using CDC real-time reverse transcription PCR protocol. RESULTS: A total of 4962 throat-swab samples were collected and 4799 (96.7%) of them were tested. Among them 988 (20.6%) were influenza-positive and of which 349 (35.3%) were seasonal influenza A(H3N2), 321 (32.5%) influenza A(H1N1)pdm2009 and 318 (32.0%) influenza B. Positivity rate was 29.5% in persons 5-14 years followed by 26.4% in 15-44 years, 21.2% in > 44 years and 6.4% in under five children. The highest positivity rate observed in November (37.5%) followed by March (27.6%), December (26.4%), October (24.4%) and January (24.3%) while the lowest positivity rate was in August (7.7%). CONCLUSION: In Ethiopia, seasonal Influenza A(H3N2), Influenza A(H1N1)pdm2009 and Influenza B viruses were circulating during 2009-2015. Positivity rate and number of cases peaked in November and December. Influenza is one of public health problems in Ethiopia and the need to introduce influenza vaccine and antivirus is important to prevent and treat the disease in future.

The national burden of influenza-associated severe acute respiratory illness hospitalization in Rwanda, 2012-2014.

BACKGROUND: Estimates of influenza-associated hospitalization are severely limited in low- and middle-income countries, especially in Africa. OBJECTIVES: To estimate the national number of influenza-associated severe acute respiratory illness (SARI) hospitalization in Rwanda. METHODS: We multiplied the influenza virus detection rate from influenza surveillance conducted at 6 sentinel hospitals by the national number of respiratory hospitalization obtained from passive surveillance after adjusting for underreporting and reclassification of any respiratory hospitalizations as SARI during 2012-2014. The population at risk was obtained from projections of the 2012 census. Bootstrapping was used for the calculation of confidence intervals (CI) to account for the uncertainty associated with all levels of adjustment. Rates were expressed per 100 000 population. A sensitivity analysis using a different estimation approach was also conducted. RESULTS: SARI cases accounted for 70.6% (9759/13 813) of respiratory admissions at selected hospitals: 77.2% (6783/8786) and 59.2% (2976/5028) among individuals aged <5 and ≥5 years, respectively. Overall, among SARI cases tested, the influenza virus detection rate was 6.3% (190/3022): 5.7% (127/2220) and 7.8% (63/802) among individuals aged <5 and ≥5 years, respectively. The estimated mean annual national number of influenza-associated SARI hospitalizations was 3663 (95% CI: 2930-4395-rate: 34.7; 95% CI: 25.4-47.7): 2637 (95% CI: 2110-3164-rate: 168.7; 95% CI: 135.0-202.4) among children aged <5 years and 1026 (95% CI: 821-1231-rate: 11.3; 95% CI: 9.0-13.6) among individuals aged ≥5 years. The estimates obtained from both approaches were not statistically different (overlapping CIs). CONCLUSIONS: The burden of influenza-associated SARI hospitalizations was substantial and was highest among children aged <5 years.

Nanotecnología: avances y expectativas en cirugía / Nanotechnology: advances and expectations in surgery

La nanotecnología es una ciencia enfocada al estudio y la manipulación de partículas sólidas coloidales de tamaños que oscilan entre 10 y 1.000 nanómetros, que, a su vez, pueden ser usadas ampliamente en el campo quirúrgico como elementos de diagnóstico temprano de lesiones tumorales, marcadores tumorales intraoperatorios o distribuidoras de medicamentos a blancos específicos, entre otros.

Nanotechnology is the science that focuses on the study and manipulation of solid colloidal particles ranging in size from10 nm to 1000 nm. The manipulation of these particles and elements can be widely applied in surgery, with elements such as those that allow the early diagnosis of tumor lesions, intra-operative tumor markers, or the delivery of drugs to specific targets, among others.

Análisis retrospectivo (2009-2010) de las alteraciones dermatológicas, óticas y oftalmológicas con diagnóstico clínico presuntivo de micosis en caninos y felinos / Análise retrospectiva (2009-2010) das alterações dermatológicas, óticas e oftalmológicas com diagnóstico clínico presuntivo de micose em cães e gatos / A retrospective analysis (2009-2010) of the dermatological, ear and ophtalmological alterations with presumptive clinical diagnosis of mycosis in canines and felines

Objetivo. Determinar la prevalencia de las alteraciones dermatológicas, óticas y oftalmológicas clínicamente presuntivas de ser causadas por hongos y analizar demográficamente su presentación. Materiales y métodos. Se realizó un estudio retrospectivo en una clínica para pequeños animales en Bogotá; se revisaron historias clínicas de pacientes que consultaron por alteraciones dermatológicas, óticas y oftalmológicas durante 2009 y 2010. Resultados. En el período evaluado la prevalencia de las alteraciones dermatológicas en caninos fue de 7,8%, las óticas de 4,2% y las oftalmológicas de 3,3%. Dentro de las alteraciones dermatológicas, la sospecha etiológica principal por diagnóstico clínico fueron los dermatofitos con 86,9%, en las alteraciones óticas fue Malassezia con 86,5% y para las oftalmológicas fue Candida con 83,3%. El análisis estadístico de variables no mostró asociación con los síntomas ni con los agentes etiológicos diagnosticados clínicamente; sin embargo, la evaluación categorizada evidenció asociaciones entre razas y edades con las etiologías por diagnóstico clínico. El diagnóstico de las etiologías micóticas se estableció en la mayoría de los casos por hallazgos clínicos y con menor frecuencia por raspado de piel y citología ótica; en ninguno de los casos se realizó cultivo micológico. La población felina no presentó alteraciones dermatológicas, óticas y oftalmológicas clínicamente compatibles con etiología fúngica. Conclusión. En caninos, la prevalencia de las alteraciones dermatológicas clínicamente compatibles con dermatofitos fue de 86,9%, los procesos óticos asociados con Malassezia de 86,5% y los oftalmológicos sospechosos de Candida con 83,3%. Los diagnósticos definitivos se establecieron por hallazgos clínicos sin la realización de metodologías diagnósticas estándar como el cultivo...

A retrospective analysis (2009-2010) of the dermatological, ear and ophtalmological alterations with presumptive clinical diagnosis of mycosis in canines and felines. Objective. To determine the prevalence of dermatological, ear and ophthalmological alterations clinically presumptive to be caused by fungi and to analyze their occurrence demographically. Materials and methods. We carried out a retrospective study in a clinic in Bogota for small animals. We reviewed the medical histories of patients who requested medical appointments due to dermatological, ear and ophtalmological alterations in 2009 and 2010. Results. In the assessed period, the prevalence of dermatological alterations in dogs was of 7.8%, 4.2% of ear alterations and of 3.3% of ophtalmological alterations. The main etiological suspects through clinical diagnosis were: dermatophytes with an incidence of 86.9% among dermatological alterations, Malassezia with an 86.5% of incidence in ear alterations, and Candida with 83.3% of incidence in ophtalmological alterations. Statistical analysis of variables showed no association with symptoms or clinically diagnosed etiological agents, but the categorized evaluation showed associations of races and ages with the etiologies through clinical diagnosis. The diagnosis of fungal etiologies was accomplished in most cases by clinical findings and less frequently by skin scrapings and ear cytology; in none of the cases a mycological culture was done. The feline population showed no dermatological, ear or ophtalmological alterations compatible with a fungal etiology. Conclusion. In canines, the prevalence of dermatological alterations clinically compatible with dermatophytes was of 86.9%; ear alterations associated with Malassezia were of 86.5%; and ophtalmological alterations Candida-suspected were 83.3%. Final diagnoses were accomplished with the help of clinical findings without following standard diagnostic methodologies such as cultivation...

Análise retrospectiva (2009-2010) das alterações dermatológicas, óticas e oftalmológicas com diagnóstico clínico presuntivo de micose em cães e gatos. Objetivo. Determinar a prevalência das alterações dérmicas, óticas e oftálmicas clinicamente presuntivo de serem causadas por fungos e analisar demograficamente sua apresentação. Materiais e métodos. Foi realizado um estudo retrospectivo numa clínica para pequenos animais em Bogotá; foram revisadas as histórias clínicas de pacientes com alterações dérmicas, óticas e oftalmicas em 2009 e 2010. Resultados. Durante o período de avaliação a prevalência das alterações dérmicas em cães foi de 7,8%, as óticas de 4,2% e as oftálmicas de 3,3%. Dentro das alterações dérmicas, a principal suspeita etiológica por diagnóstico clínico foram os dermatófitos com 86,9%, nas alterações óticas foi Malassezia com 86,5% e para as oftálmicas foi Candida com 83,3%. A análise estatística das variáveis não apresentou associação com os sintomas ou com os agentes etiológicos diagnosticados clínicamente; embora, a avaliação categorizada evidenciou associações entre raças e idades com as etiologias por diagnóstico clínico. O diagnóstico das etiologias micóticas foi estabelecido na maioria dos casos pelos achados clínicos e, menos freqüentemente por raspados de pele e citologia ótica, em nenhum dos casos foi realizada uma cultura micótica. A população felina não apresentou alterações dérmicas, óticas e oftálmicas clinicamente compatíveis com etiologia fúngica. Conclusão. Em cães, a prevalência das alterações dérmicas clinicamente compatíveis com dermatófitos foi de 86,9%, os processos óticos associados com Malassezia foi de 86,5% e os oftálmicos suspeitos de Candida foi de 83,3%. Os diagnósticos definitivos foram estabelecidos pelos achados clínicos sem a realização de métodos diagnósticos padroes, como o cultivo...

[Active search for leprosy and other skin diseases in school children from Agua de Dios, Colombia]. / Búsqueda Activa de Lepra y de Otras Enfermedades de la Piel en Escolares de Agua de Dios, Colombia.

OBJECTIVE: Actively searching for leprosy, other skin diseases and BCG vaccination scars amongst school children from Agua de Dios, the municipality having the highest prevalence of leprosy in Colombia. METHODS: A clinical examination of the children was carried out by nurses, interns, general practitioners and experts on leprosy. Skin smear tests and skin biopsies were performed when the clinical findings suggested leprosy. Anti-phenolic glycolipid antibodies in blood were determined in special cases. RESULTS: 86 % of the 2 844 school children were examined; 833 had skin diseases and 16 % of these required evaluation by specialists. Four new cases of paucibacillary leprosy, two indeterminate and two primary polyneuritic cases were found. Pediculosis capitis, pityriasis alba, tinea versicolor, hypopigmented nevus, insect bites and miliaria were frequently detected. BCG vaccination scars were absent in 387 children; following several logistical problems, they were vaccinated. Four children had signs of childhood abuse. An 11-year-old girl presented hypopigmented mycosis fungoides. All diseases and conditions found were treated. The community received information regarding the results, emphasising the importance of an early diagnosis of leprosy. CONCLUSIONS: The incidence of leprosy found (16/10,000) was 123 times higher than the rest of the country's incidence. It is advisable to continue clinical examinations in Agua de Dios and research into risk factors for acquiring leprosy.

Búsqueda Activa de Lepra y de Otras Enfermedades de la Piel en Escolares de Agua de Dios, Colombia / Active search for leprosy and other skin diseases in school children from Agua de Dios, Colombia

Objetivo: Buscar lepra, otras enfermedades de la piel y la cicatriz BCG, en escolares de Agua de Dios, municipio con la más alta prevalencia de lepra en Colombia: 23-39/10 000; educar y difundir los resultados en la comunidad. Métodos: Se hizo examen clínico de los niños por enfermeras, médicos internos y generales y por expertos en lepra. Cuando la clínica lo indicaba, se practicaron baciloscopias y biopsias de piel. En pocos casos se buscaron anticuerpos en sangre contra el glicolípido fenólico 1, del bacilo de Hansen. Resultados: Se examinaron 86 por ciento de los 2 844 escolares de las 17 instituciones del municipio; 833 tuvieron patologías cutáneas, de los cuales 16 por ciento requirieron el examen por expertos. Se demostraron cuatro casos nuevos de lepra paucibacilar, dos indeterminados y dos polineuríticos primarios. Las entidades más frecuentes fueron: pediculosis, pitiriasis alba, pitiriasis versicolor, nevus hipocrómicos, picaduras de insectos y miliaria. Cuatro niños tuvieron maltrato infantil y una niña de 11 años, micosis fungoides hipocromiante. La vacunación BCG se aplicó en 387 niños que no la habían recibido. Se trataron las condiciones encontradas. Se informó a la comunidad sobre las enfermedades detectadas, las funciones de la piel y sus cuidados generales, enfatizando la importancia del diagnóstico temprano de la lepra. Conclusiones: La incidencia de lepra encontrada (16/10 000), es la más alta en Colombia, 123 veces mayor que la global del país. Su búsqueda activa demostró enfermedad paucibacilar, sin discapacidades y otras enfermedades cutáneas importantes. Es recomendable persistir con este examen clínico y con la investigación de los factores predisponentes para adquirir la enfermedad.

Objetive: Actively searching for leprosy, other skin diseases and BCG vaccination scars amongst school children from Agua de Dios, the municipality having the highest prevalence of leprosy in Colombia. Methods: A clinical examination of the children was carried out by nurses, interns, general practitioners and experts on leprosy. Skin smear tests and skin biopsies were performed when the clinical findings suggested leprosy. Anti-phenolic glycolipid antibodies in blood were determined in special cases. Results: 86 percent of the 2 844 school children were examined; 833 had skin diseases and 16 percent of these required evaluation by specialists. Four new cases of paucibacillary leprosy, two indeterminate and two primary polyneuritic cases were found. Pediculosis capitis, pityriasis alba, tinea versicolor, hypopigmented nevus, insect bites and miliaria were frequently detected. BCG vaccination scars were absent in 387 children; following several logistical problems, they were vaccinated. Four children had signs of childhood abuse. An 11-year-old girl presented hypopigmented mycosis fungoides. All diseases and conditions found were treated. The community received information regarding the results, emphasising the importance of an early diagnosis of leprosy. Conclusions: The incidence of leprosy found (16/10 000) was 123 times higher than the rest of the country's incidence. It is advisable to continue clinical examinations in Agua de Dios and research into risk factors for acquiring leprosy.

Enhancing motor learning through dyad practice: contributions of observation and dialogue.

It has been shown that practice in dyads, as compared to individual practice, can enhance motor learning and increase the efficiency of practice (as two participants can be trained at the same time; Shea, Wulf, & Whitacre, 1999). The dyad practice protocol used by Shea et al. included both observation and dialogue between partners. Thus, it was not clear whether the learning benefits of dyad practice were due to observation, dialogue, or both. The present study examined the individual and interactive effects of observation and dialogue. The task used was speed cup stacking. Participants practiced under one of four conditions: observation/dialogue, observation/no dialogue, no observation/dialogue, and no observation/no dialogue. The two conditions that included observational practice were more effective (i.e., produced faster movement times) than the two conditions without it, both during practice and on a retention test performed under individual performance conditions. This suggests that the learning advantages of dyad practice are primarily due to the opportunity to observe another learner.

Tumor neuroendocrino de laringe: presentacion de un caso y revisión de la literatura / Larynx neuroendocrine neoplasm: a case report and literature review

Las neoplasias neuroendocrinas de laringe son estidades poco frecuentes. Estos tumores presentarn una amplia gama de características histiológicas que abarcan desde el típico carcinoma hasta los poco diferenciados carcinomas de células pequeñas. Su comportamiento se correlaciona con el subtipo histopatológico. El tratamiento central en los casos tempranos es la resección quirúrgica. La quimioterapia y la radioterapia no tienen un papel efectivó en el manejo de estas neoplasias. Exponemos el caso de un hombre de 64 años de edad que presentaba disfonía progresiva con cuatro meses de evolución. El examen físico y la laringoscopia evidenciaron un tumor supraglótico vegetante que afectaba el seno piriforme y se extiendía hasta la retrofaringe. Fue tratado con cirúgia radical; varias semanas después de ésta, se perdió de seguimiento sin actividad tumoral. Además del caso clínico, se comentan diversas consideraciones sobre los carcinomas neuroendocrinos.