[Ipsilateral ureteroureterostomy. A safe alternative in complete duplicated collecting system with associated pathology]. / Uretero-ureteroanastomosis distal ipsilateral. Una alternativa segura en doble sistema renal completo con patología asociada.

In patients with complete double renal system with the involvement of only one system, there are several surgical alternatives for its resolution. Uretero-ureteral anastomosis has been presented as a good alternative, even in cases with atrophy of the affected system. OBJECTIVE: To report our experience in patients with complete double renal system with only one system affected, with the surgical technique of uretero-ureteral anastomosis. PATIENTS AND METHOD: Retrospective study of patients with double renal system with involvement of one of the systems, treated with uretero-ureteral anastomosis technique between January 2015 and May 2022. The variables of age, specific pathology of the affected system, preoperative study, days of hospitalization, postoperative complications (leakage, obstruction, infection), and follow-up time were evaluated. RESULTS: We analyzed 26 procedures in 25 patients, mean age 36.8 months (range: 8-80); 53.8% had ectopic ureter, 23% ureterocele, 11.5% sphincteric ureterocele, and 11.5% VUR of the lower system. All were studied preoperatively with urethrocystography and 65% with scintigraphy. 50% of the operated systems showed signs of renal atrophy. The average hospital stay was 2.2 days (range: 1-7). In an average follow-up of 26.5 months (range: 3-77), one patient presented leakage, no patient presented signs suggestive of obstruction, and one patient presented febrile urinary tract infection with persistent lower-grade reflux. CONCLUSION: In our experience, the uretero-ureteral anastomosis technique proved to be an easy and safe alternative to reproduce, with a success rate of 96%, 11% of grade I complications, and 4% of grade II complications according to the Clavien-Dindo classification.

Colesteatoma del conducto auditivo externo: Experiencia de 5 años Hospital del Salvador / External ear canal cholesteatoma: 5-year experience Hospital del Salvador

Introducción: El colesteatoma del conducto auditivo externo (CCAE) es una estructura quística revestida por epitelio escamoso estratificado queratinizado que tiene la capacidad de invadir y erosionar localmente al hueso temporal. Su incidencia es de 0,19 a 0,3/100.000 habitantes siendo 60 veces menos frecuente que el de oído medio. Objetivo: Describir las características epidemiológicas, clínicas, imagenológicas y tratamiento de los pacientes diagnosticados con CCAE en el Servicio de Otorrinolaringología Hospital del Salvador. Material y Método: Se presenta una serie de ocho casos clínicos recopilados durante el período 2017 y 2021. Se realizó revisión de fichas clínicas, biopsias y tomografías computadas de oídos (TC oídos). Se describen los hallazgos y tratamiento efectuado. Resultados: El promedio de edad fue de 65,6 años, correspondiente a 5 mujeres y 3 hombres con presencia de tabaquismo y diabetes en la mitad de los casos. Los síntomas y signos más frecuentes fueron otalgia e hipoacusia seguido de otorrea. 7 pacientes se presentaron con tímpano íntegro y el compromiso de la pared inferior del conducto se evidenció en 6 de 8 pacientes. La TC oídos mostró erosión ósea del conducto, con o sin compromiso de estructuras adyacentes, en todos los casos y el diagnóstico histológico fue efectuado en el 100% de los pacientes. Se privilegió el tratamiento conservador mediante curaciones óticas periódicas asociado a ácido salicílico al 3% y/o antibióticos tópicos en 6/8 pacientes. Conclusiones: El CCAE es una entidad poco frecuente sin signos ni síntomas patognomónicos por lo que el diagnóstico histológico junto con el estudio imagenológico es perentorio. El tratamiento conservador es una alternativa terapéutica válida que ofrece buenos resultados en pacientes con adecuada adherencia al tratamiento y posibilidad de seguimiento estricto.

Introduction: External ear canal cholesteatoma (EECC) is a cystic structure lined by keratinized stratified squamous epithelium that has the ability to locally invade and erode the temporal bone. Its incidence is 0.19 to 0.3 / 100,000 habitants, being 60 times less frequent than that of the middle ear. Aim: To describe the epidemiological, clinical, imaging and treatment characteristics of patients diagnosed with EECC in the Hospital del Salvador ENT department. Material and Methods: A series of eight clinical cases collected during the period 2017 and 2021 is presented. A review of clinical records, biopsies and computed tomography of the ear (ear CT) was carried out. The findings and treatment carried out are described. Results: The average age was 65.6 years corresponding to 5 women and 3 men with the presence of smoking and diabetes in half of the cases. The most frequent symptoms and signs were earache and hearing loss followed by otorrhea. 7 patients presented with an intact eardrum and compromise of the inferior wall of the canal was evidenced in 6 of 8 patients. Ears CT showed bone erosion of the canal with or without compromise of adjacent structures in all cases and the histological diagnosis was made in 100% of the patients. Conservative treatment with periodic ear dressings associated with 3% salicylic acid and / or topical antibiotics was favored in 6/8 patients. Conclusion: EECC is a rare entity without pathognomonic signs or symptoms, therefore the histological diagnosis together with the imaging study is peremptory. Conservative treatment is a valid therapeutic alternative that offers good results in patients with adequate adherence to treatment and the possibility of strict follow-up.

Type II hiatal hernias: do they exist or are they actually parahiatal hernias?

BACKGROUND: Type II hiatal hernias (HH) are characterized by a portion of the gastric fundus located above the esophageal hiatus adjacent to the esophagus while the gastroesophageal junction (GEJ) remains fixed below the esophageal hiatus. This type of HH has been called the "true" paraesophageal hernia (PEH) because the fundus appears to the side of the esophagus. In our experience, Type II HHs are occasionally identified on radiographic testing, however they are rarely, if ever, confirmed intraoperatively. This led to our question: Does Type II HH exist? METHODS: We searched for evidence of type II HH in three locations: 1. Retrospective review of all first-time PEH repairs (excluding Type I HHs and re-operative cases) performed at the University of Washington Medical Center from 1994 to 2021; 2. Operative videos available on YouTube and WebSurg websites; and 3. Abstracts from the SAGES annual meetings from 2005 to 2021. RESULTS: We found no evidence of Type II HH in any of our three searches. We performed 846 PEH repairs: 760 Type III, 75 Type IV, and 11 parahiatal. Upon website video review, we found only one possible type II hernia, though it too was likely a para-hiatal hernia. No video or case presentations of a type II HH were identified within SAGES annual meeting abstracts. CONCLUSION: Type II HHs do not exist as they are currently defined. Although uncommon, parahiatal hernia can easily be misinterpreted as Type II HH. We should consider changing the hiatal hernia classification system to prevent ongoing clinical confusion.

Oclusión de la arteria central de la retina como complicación oftalmológica luego de un accidente ofídico / Central retinal artery occlusion as an ophthalmic complication after snakebite

La mordedura de serpiente causa entre 421.000-1.200.000 envenenamientos anuales con múltiples trastornos sistémicos secundarios a hematotoxicidad, neurotoxicidad y vasculotoxicidad siendo raras las manifestaciones oftalmológicas secundarias a mordedura de serpiente. La familia de serpientes Viperidae, causa más frecuentemente manifestaciones oftalmológicas como el infarto macular, el glaucoma crónico de ángulo abierto y la hemorragia retiniana o vítrea. La oclusión de la arteria central de la retina es una complicación ocular extremadamente rara. Reportamos el caso de una paciente de 30 años de edad, que consultó por mala visión del ojo izquierdo semanas después de sufrir una mordedura de serpiente (Bothrops atrox) en el miembro inferior izquierdo. Se diagnosticó de una oclusión de la arteria central de la retina con hallazgos anormales en el examen físico oftalmológico y en pruebas complementarias retinianas y neurooftalmológicas (AU)

Snakebite causes 421,000 - 1,200,000 poisonings per year due to hematotoxicity, neurotoxicity and vasculotoxicity. Ophthalmological manifestations secondary to snake bites are rare. If the snake belongs to the Viperidae family, the most frequent ophthalmologic manifestations are macular infarction, chronic open-angle glaucoma, and retinal or vitreous hemorrhage. Central retinal artery occlusion is an extremely rare ocular complication. We report the case of a 30-year-old patient, who consulted due to poor vision in her left eye weeks after suffering a snake bite (Bothrops atrox) in her left lower limb. The diagnosis was a central retinal artery occlusion in the left eye with abnormal findings in the ophthalmological physical examination and in complementary retinal and neuro-ophthalmological tests (AU)

Central retinal artery occlusion as an ophthalmic complication after snakebite.

Snakebite causes 421.000-1.200.000 poisonings per year due to and hematotoxicity, neurotoxicity y vasculotoxicity. Ophthalmological manifestations secondary to snake bites are rare. If the snake belongs to the Viperidae family, the most frequent ophthalmologic manifestations are macular infarction, chronic open-angle glaucoma, and retinal or vitreous hemorrhage. Central retinal artery occlusion is an extremely rare ocular complication. We report the case of a 30-year-old patient, who consulted due to poor vision in her left eye weeks after suffering a snake bite (Bothrops atrox) in her left lower limb. The diagnosis was a central retinal artery occlusion in the left eye with abnormal findings in the ophthalmological physical examination and in complementary retinal and neuro-ophthalmological tests.

Neurocognitive function in adult residents of a mining district in Mexico after reducing manganese exposure: Follow-up after 11 years.

BACKGROUND: Little is known about the neurotoxic effects of chronic exposure to airborne Mn once exposure has been reduced. The environmentally exposed and the reference adult populations evaluated in 2002 were followed, after an environmental management program (EMP) was implemented to reduce the exposure in a mining district in Mexico. OBJECTIVE: The aim of this study was to compare the association between exposure to Mn and neurocognitive performance in environmentally exposed and reference groups of adults before and after EMP implementation. METHODS: In 2013, the same battery of neurocognitive tests used in the initial study (2002) was applied to 58 adults exposed to airborne Mn and 30 adults from the reference community. A cumulative exposure index (CEI) was estimated for the study population before and after the EMP. Categorical outcomes were analyzed using logistic regression, and the resulting ORs were compared between studies. Continuous outcomes were analyzed using linear regression. All models were adjusted for age, years of education, socioeconomic status and blood lead levels. RESULTS: Exposed adults from the post-EMP study showed an improvement in fine motor and verbal regulation of motor skills (OR < 1) compared to the exposed adults from the pre-EMP study (OR > 1). In both pre- and post-studies, the exposed adults showed a deterioration in their dynamic organization of motor activity compared to the reference group (p < 0.05); however, they showed no significant change in attention and working-memory performance. DISCUSSION: After four years of a significant reduction in airborne Mn levels resulting from EMP implementation, chronically exposed adults showed an improvement in fine motor and verbal regulation of motor skills; however, the remaining areas of their motor and cognitive functions remained impaired.

Determination of caffeine in dietary supplements by miniaturized portable liquid chromatography.

In this study three miniaturized liquid chromatography (LC) instruments have been evaluated and compared for the analysis of caffeine in dietary supplements, namely a benchtop capillary LC (capLC) system, a benchtop nano LC (nanoLC)system and a portable LC system. Commercial products derived from different sources of caffeine have been analyzed. Under optimized conditions, the methods based on benchtop systems were superior in terms of sensitivity. The limits of detection (LODs) found with the capLC and nanoLC systems were 0.01 and 0.003 µg mL-1, respectively, whereas the LOD obtained with the portable LC instrument was of 1 µg mL-1. The portable LC-based method was superior in terms of simplicity and throughput (total analysis time < 15 min). On the basis of the results obtained, a new method for the rapid measurement of caffeine in dietary supplements by portable miniaturized LC is presented. This method provided good linearity within the 1-20 µg mL-1 interval, and it allowed the quantification of caffeine even in products derived from decaffeinated green coffee extracts. The contents of caffeine found with the proposed portable LC method in the real samples analyzed ranged from 1.38 to 7 mg per gram of product, which were values statistically equivalent to those found with the benchtop capLC and nanoLC methods, being the precision, expressed as relative standard deviation (RDS), of 2 -14% (n = 3). The proposed portable LC based method can be used as a simple and rapid alternative to estimate the quality, effectiveness and safety of dietary supplements, regarding their caffeine content.

Nerve gaps repaired with acellular nerve allografts recellularized with Schwann-like cells: Preclinical trial.

BACKGROUND: Acellular nerve allografts (ANA) recellularized with mesenchymal stem cells (MSC) or Schwann cells (SC) are, at present, a therapeutic option for peripheral nerve injuries (PNI). This study aimed to evaluate the regenerative and functional capacity of a recellularized allograft (RA) compared with autograft nerve reconstruction in PNI. METHODS: Fourteen ovines were randomly included in two groups (n=7). A peroneal nerve gap 30 mm in length was excised, and nerve repair was performed by the transplantation of either an autograft or a recellularized allograft with SC-like cells. Evaluations included a histomorphological analysis of the ANA, MSC pre differentiated into SC-like cells, at one year follow-up functional limb recovery (support and gait), and nerve regeneration using neurophysiological tests and histomorphometric analysis. All evaluations were compared with the contralateral hindlimb as the control. RESULTS: The nerve allograft was successfully decellularized and more than 70% of MSC were pre differentiated into SC-like cells. Functional assessment in both treated groups improved similarly over time (p <0.05). Neurophysiological results (latency, amplitude, and conduction velocity) also improved in both treated groups at twelve months. Histological results demonstrated a less organized arrangement of nerve fibers (p <0.05) with an active remyelination process (p <0.05) in both treated groups compared with controls at twelve months. CONCLUSIONS: ANA recellularized with SC-like cells proved to be a successful treatment for nerve gaps. Motor recovery and nerve regeneration were satisfactorily achieved in both graft groups compared with their contralateral nontreated nerves. This approach could be useful for the clinical therapy of PNI.

Lessons Learned: the 20th Gatherings in Biosemiotics.

We review the organization and contents of the 20th Gatherings in Biosemiotics. As the organizers, we share our insights from organizing a community research project in the year where the Covid-19 pandemic halted international travel. We try to describe the challenges of putting together the yearly conference on Biosemiotics and the main content that was presented by the research community.

[Tropical pyomyositis of the iliacus, obturator internus, piriformis and psoas major muscles in an immunocompetent patient with claudication]. / Piomiositis tropical del músculo ilíaco, obturador interno, piriforme y psoas mayor en un paciente inmunocompetente con claudicación.

INTRODUCTION: Pyomyositis is a term that denotes pyogenic infection usually primary skeletal muscle, associated with hematogenous dispersion due to transient bacteremia, or penetrating trauma, usually forming abscesses. Classically described frequently in tropical areas and predominantly affecting the lower limb musculature, however, in recent decades it has increasingly been associated with areas of temperate climates and relatively more frequently in immunosuppressed patients, being the patients under 30 years the most affected. CLINICAL CASE: Male of 15 years without relevant medical history. The patient had no history of trauma, falls, surgical interventions, infections or any other systemic condition. He came because of a clinical picture of 7 days of evolution characterized by pain referred to the groin and left iliac crest area associated with claudication and hyperthermia not quantified, which yielded partially to NSAIDs and paracetamol, but without achieving improvement so it is taken emergency by relatives. CONCLUSIONS: It is necessary to bear in mind this pathology when performing the differential diagnostic approach of a patient presenting with pain and functional limitation of some joint associated with data suggestive of an infectious or inflammatory process.

INTRODUCCIÓN: La piomiositis es un término que denota infección piógena por lo general primaria de músculo esquelético. Clásicamente descrita de manera frecuente en zonas tropicales y en pacientes inmunocomprometidos; sin embargo, en las últimas décadas se observa cada vez más en zonas de climas templados y con relativa mayor frecuencia en pacientes inmunocompetentes, siendo el grupo etario más afectado el de menores de 30 años. CASO CLÍNICO: Masculino de 15 años sin antecedentes médicos de relevancia. Acude por presentar cuadro clínico de siete días de evolución caracterizado por dolor referido en ingle y zona de la cresta ilíaca izquierda asociado a claudicación e hipertermia no cuantificada, que cedían parcialmente a AINES y paracetamol, pero sin lograr mejoría, por lo que es llevado a urgencias por familiares. CONCLUSIONES: Es necesario tener en mente esta patología al momento de realizar el abordaje diagnóstico diferencial de un paciente que se presenta con dolor y limitación funcional de alguna articulación asociada a datos sugestivos de un proceso infeccioso o inflamatorio.

Hallazgos oftalmológicos en pacientes con leucemia en una población colombiana / Ophthalmological findings in patients with leukaemia in a Colombian population

Objetivo Publicar las manifestaciones oculares en paciente con leucemia. Métodos Estudio observacional analítico de corte transversal, en pacientes con manifestaciones oculares por leucemia. Resultados Se evaluaron 14 ojos de 8 pacientes (5 mujeres y 3 varones) con leucemia. La edad promedio al diagnóstico de leucemia fue de 43 años (31-76 años). Seis ojos correspondían a pacientes con leucemia mieloide aguda (LMA), 4 ojos a pacientes con leucemia linfoide aguda (LLA), 2 ojos a pacientes con leucemia mieloide crónica (LMC) y 2 ojos a pacientes con leucemia de células peludas (LCP). Los hallazgos oculares primarios fueron: invasión coroidea en 12 ojos (85,7%), infiltración retiniana en 4 ojos (28,6%) y desórdenes neuroftalmológicos en 4 ojos (28,6%). La agudeza visual promedio mejoró de 0,689 a 0,449 logMAR (p 0,012) luego del tratamiento con quimioterapia sistémica e intratecal. De los 8 pacientes, 4 murieron debido a complicaciones de su enfermedad. Conclusiones Este es el primer artículo de múltiples manifestaciones oculares secundaria a leucemia en una población colombiana. Es importante tener en cuenta que este tipo de manifestaciones hacen parte de los síndromes de enmascaramiento por lo tanto es primordial hacer un diagnóstico y manejo precoz ya que en ocasiones está en riesgo la vida del paciente (AU)

Objective To report the ocular manifestations in patients with leukaemia. Methods This is a retrospective, descriptive and observational study in patients with ocular manifestations of leukaemia. Results A total of 14 eyes were evaluated corresponding to 8 patients (5 women and 3 men) with ocular manifestations of leukaemia. The mean age at diagnosis was 43 years (31-76 years). Six eyes corresponded to patients with acute myeloid leukaemia (AML), four eyes to acute lymphoid leukaemia (ALL), two eyes to chronic myeloid leukaemia (CML), and the remaining two belonged to patients with hairy cell leukaemia (HCL). The primary ocular findings were choroidal invasion in 12 eyes (85.7%), retinal infiltration in 4 eyes (28.6%), and neuro-ophthalmic disorders in 4 eyes (28.6%). The mean visual acuity improved from 0.689 to 0.449 (logMAR) (P=.012) after the systemic and intrathecal chemotherapy. Of the eight patients, four died from systemic complications of the underlying disease. Conclusions This is the first report of multiple ocular manifestations secondary to leukaemia in a Colombian population. It is important to keep in mind that this disease is included within the masquerade syndromes and that the ophthalmological findings that, while subtle, can also be devastating and be signs of a life-threatening disease (AU)

Ophthalmological findings in patients with leukaemia in a Colombian population. / Hallazgos oftalmológicos en pacientes con leucemia en una población colombiana.

OBJECTIVE: To report the ocular manifestations in patients with leukaemia. METHODS: This is a retrospective, descriptive and observational study in patients with ocular manifestations of leukaemia. RESULTS: A total of 14 eyes were evaluated corresponding to 8 patients (5 women and 3 men) with ocular manifestations of leukaemia. The mean age at diagnosis was 43 years (31-76 years). Six eyes corresponded to patients with acute myeloid leukaemia (AML), four eyes to acute lymphoid leukaemia (ALL), two eyes to chronic myeloid leukaemia (CML), and the remaining two belonged to patients with hairy cell leukaemia (HCL). The primary ocular findings were choroidal invasion in 12 eyes (85.7%), retinal infiltration in 4 eyes (28.6%), and neuro-ophthalmic disorders in 4 eyes (28.6%). The mean visual acuity improved from 0.689 to 0.449 (logMAR) (P=.012) after the systemic and intrathecal chemotherapy. Of the eight patients, four died from systemic complications of the underlying disease. CONCLUSIONS: This is the first report of multiple ocular manifestations secondary to leukaemia in a Colombian population. It is important to keep in mind that this disease is included within the masquerade syndromes and that the ophthalmological findings that, while subtle, can also be devastating and be signs of a life-threatening disease.

[Bearing surfaces in primary hip arthroplasty. Is there any difference?] / Pares articulares en prótesis primaria de cadera. ¿Existe alguna diferencia?

INTRODUCTION: In primary hip replacement, different materials are used for bearing surfaces. In our medium metal or ceramic heads with highly crossed-linked polyethylene (PA) are the most used. These combinations have good results, but it is not clear which is clinically superior. The objective of this study is to determine whether there is any clinically significant difference based on a systematic review of the literature and national registries of arthroplasty. MATERIAL AND METHODS: We conduct a systematic review of the literature and national registries of arthroplasty and we were looking for studies comparing bearing surfaces: ceramic-highly cross-linked polyethylene (CP) and metal-highly cross-linked polyethylene (MP); describing the revision rate according to the surface type with a minimum 10-year follow-up. The outcome evaluated was: review rate for any cause depending on surface type. RESULTS: Two out of fifteen national registries were included. The Australian registry shows a difference in the 15-year revision rate: CP: 6.3 (IC 5.8, 6.7) vs MP: 5.1 (IC 4.6, 5.7). The New Zealand registry shows no differences in revision rate/100 components/year: CP 0.54 (0.48-0.61) vs MP 0.61 (0.57-0.66). We do not find clinical studies with inclusion criteria that answer the research question. CONCLUSION: The results of this review show a high survival rate with the use of highly cross-linked polyethylene, the results are similar when using ceramic or metal heads.

INTRODUCCIÓN: En un reemplazo total de cadera primario (RTC), diferentes materiales son los que se usan para las superficies de apoyo. En nuestro medio, las cabezas de metal o cerámica con polietileno altamente entrecruzado (PA) son los más utilizados. Estas combinaciones tienen buenos resultados, pero no es claro cuál es superior clínicamente. Basados en una revisión sistemática de la literatura y de los registros nacionales de artroplastía, el objetivo de este estudio es determinar si existe alguna diferencia significativa desde el punto de vista clínico. MATERIAL Y MÉTODOS: Realizamos una revisión sistemática de la literatura y de los registros nacionales de artroplastía. Buscamos estudios en los que se compararan los tipos de superficie de contacto: cerámica-polietileno altamente entrecruzado (CP) y metal-polietileno altamente entrecruzado (MP), además de los registros nacionales de artroplastía que describieran, con un seguimiento mínimo de 10 años, la tasa de revisión según el tipo de superficie. El desenlace evaluado fue: tasa de revisión por cualquier causa según el tipo de superficie. RESULTADOS: Dos de quince registros nacionales fueron incluidos: el registro australiano muestra una diferencia en la tasa de revisión a 15 años, comparando CP: 6.3 (IC 5.8, 6.7) contra MP: 5.1 (IC 4.6, 5.7). El registro de Nueva Zelanda no muestra diferencias en la tasa de revisión/100 componentes/año: CP de 0.54 (0.48-0.61) en comparación con MP de 0.61 (0.57-0.66). No encontramos estudios clínicos con los criterios de inclusión que respondan la pregunta de investigación. CONCLUSIÓN: Los resultados de esta revisión muestran una alta supervivencia cuando se usa polietileno altamente entrecruzado; asimismo, los resultados son similares cuando se utilizan cabezas de cerámica o metálicas.

Exploring hand-portable nano-liquid chromatography for in place water analysis: Determination of trimethylxanthines as a use case.

Analytical performance and optimization of figures of merit of a portable nano liquid chromatograph (NanoLC) with UV detection at 255 nm have been established for in place analysis. Methylxanthines: caffeine, theophylline and theobromine were selected as target analytes. A fast lab method based on IT-SPME coupled on line with capillary liquid chromatograph (CapLC) with diode array detection (DAD) was employed for comparative studies. IT-SPME and solid phase extraction were coupled off-line to NanoLC for improving instrumental parameters, mainly detection capacity and selectivity. IT-SPME or SPE/portable NanoLC based methods were superior in terms of chromatographic resolution and organic solvent consumption per sample, around 200 µL vs 10 mL for IT-SPME-CapLC-DAD. Limits of detection (LODs) obtained with the SPE/portable NanoLC were 2-10 ng/mL, which can be suitable for testing the presence of the analytes in several environmental waters in the field. As predictable, the lab method provided better LODs, between 0.1 and 0.5 ng/mL. Good linearity was achieved for both methods and precision was similar for them (≤7%). Both systems were tested for the analysis of real water samples with suitable results.

Impact of an intervention for reducing waste through educational strategy: A Mexican case study, what works, and why?

Generation and inadequate management of solid waste constitute a global challenge. Projections for 2050 portend an annual increase of 3.40 billion tons of waste. This study assessed the impact of an environmental education intervention (EEI) aimed at reducing waste generation and fomenting pro-environmental behaviors in an academic public-health institution in Mexico. The EEI was implemented over 20 months using a model of behavior change. Using a mixed-method design (QUAN + qual), baseline and follow-up measurements were performed through electronic questionnaires (n = 754), focus groups (n = 20), and waste quantification. A double-difference model was performed to measure pro-environmental behaviors impact: overall and by sex, age, educational level and function within the institution. Waste quantification was performed using a quartering method and weekly monitoring. The qualitative data were studied through thematic analysis. As a result of the EEI, women reduced their use of multilayer packaging (-15.6 pp, p < 0.05) and frequent use of non-ecological materials (-17.6 pp, p < 0.05). Graduate-level participants reduced their regular and frequent use of these materials (-33.3 pp, p < 0.05, 27.6 pp, p < 0.01), while those with lower educational levels increased their ecological behavior at home (12.1 pp, p < 0.05). Waste generation dropped by 60.1% vis-a-vis the baseline measurement. Our qualitative findings showed a relationship between holding a position of power in the institution and recycling. They also revealed that available infrastructure for separating waste contributed substantially to the observed impact. With actions centered on physical structure, community practice and institutional policy components, the EEI improved the pro-environmental behaviors and perceptions of participants.

Candidate Electromagnetic Counterpart to the Binary Black Hole Merger Gravitational-Wave Event S190521g.

We report the first plausible optical electromagnetic counterpart to a (candidate) binary black hole merger. Detected by the Zwicky Transient Facility, the electromagnetic flare is consistent with expectations for a kicked binary black hole merger in the accretion disk of an active galactic nucleus [B. McKernan, K. E. S. Ford, I. Bartos et al., Astrophys. J. Lett. 884, L50 (2019)AJLEEY2041-821310.3847/2041-8213/ab4886] and is unlikely [

Experiencia en estapedostomías en Hospital del Salvador entre 2012 y 2018 / Stapedotomy experience at Hospital del Salvador between 2012 and 2018

INTRODUCCIÓN: La otoesclerosis es una enfermedad de presumible origen metabólico que determina la fijación de la cadena osicular. La estapedostomía con instalación de prótesis es la cirugía de elección en la actualidad para esta patología. OBJETIVO: Describir experiencia y resultados del tratamiento quirúrgico de pacientes con otoesclerosis en el Hospital del Salvador entre los años 2012 y 2018. Material y método: Estudio descriptivo retrospectivo mediante revisión de fichas clínicas de pacientes intervenidos quirúrgicamente en nuestro servicio desde enero de 2012 hasta septiembre de 2018 con sospecha de otoesclerosis. RESULTADOS: Se realizaron en total 52 cirugías a 45 pacientes, 40 vía microscópica, 10 vía endoscópica y 2 mixtas, se utilizaron dos modelos de prótesis, Schuknecht - type piston and wire y Stapes-Prothesen. El promedio tonal puro (PTP) por vía aérea prequirúrgico fue de 65 dB, con una diferencia ósea-aérea (gap) promedio de 36 dB. El PTP promedio posquirúrgico fue de 35 dB con gap promedio de 9 dB, logrando en promedio una mejoría de 31 dB en la vía aérea y 27 dB de cierre de gap. El 92% de los pacientes intervenidos lograron mejoría con respecto al gap posoperatorio. CONCLUSIÓN: La estapedostomía es una intervención que si bien no está exenta de complicaciones, ha demostrado ser segura y tener buenos resultados auditivos en la mayoría de los pacientes.

INTRODUCTION: Otosclerosis is a presumable metabolic disease that determines ossicular chain fixation. Stapedotomy with prosthesis installation is the surgery of choice for this pathology at present. AIM: To describe the experience and results of the surgical treatment of patients with otosclerosis in the Hospital del Salvador between 2012 and 2018. MATERIAL AND METHODS: Clinical records were reviewed of patients treated surgically in our department from January 2012 to September 2018 with suspicion of otosclerosis. RESULTS: A total of 52 surgeries were performed in 45 patients, 42 via microscopy and 10 via endoscopy, two models of prostheses were used Schuknecht - type piston and wire y Stapes-Prothesen. The pure tonal average (PTP) by pre-surgical air was 65 dB, with an average air gap (gap) of 36 dB. The average post-surgical PTP was 35 dB with an average gap of 9 db, achieving on average an improvement of 31 dB in the airway and 27 dB of gap closure. 92% of the patients who underwent surgery improved with respect to the postoperative gap. CONCLUSION: The stapedotomy is an intervention that although not free of complications, has been shown to be safe and have good hearing results in most patients.

Historia del manejo de rinitis atrófica / The history of the treatment of atrophic rhinitis

La rinitis atrófica es una enfermedad crónica progresiva caracterizada por dilatación anormal de las cavidades nasales con atrofia de la mucosa, submucosa y cornetes nasales subyacentes. Los factores etiopatogénicos aún son desconocidos. Su presentación clínica consiste en congestión nasal paradójica asociado a secreciones viscosas, con presencia de costras secas de mal olor. La higiene nasal con irrigación de alto volumen y baja presión es el estándar de tratamiento médico. El tratamiento quirúrgico busca reducir el tamaño de las cavidades nasales y promover la regeneración de la mucosa nasal así como también su vascularización y lubricación. A lo largo de la historia se han descrito múltiples procedimientos quirúrgicos que han buscado estrechar la cavidad nasal para permitir el paso de aire de forma más fisiológica. Por otra parte, se han propuesto intervenciones radicales como el cierre de las fosas nasales para disminuir los síntomas y mejorar la calidad de vida. En este artículo se resumen los principales manejos y procedimientos propuestos junto con sus resultados y conclusiones. Si bien la mayoría de las técnicas descritas ya no se utilizan en la actualidad, es importante conocerlas ya que aún existen pacientes que fueron sometidos a ellas pudiendo presentar complicaciones y/o efectos adversos.

Atrophic rhinitis is a chronic progressive disease characterized by abnormal dilatation of the nasal cavities with atrophy of the mucosa, nasal submucosa and underlying nasal turbinates. The etiopathogenic factors are still unknown. Its clinical presentation consists of paradoxical nasal congestion associated with viscous secretions, usually with the presence of dry, bad-smelling crusts. Nasal hygiene with high pressure irrigation remains the standard of medical treatment. Surgical treatment seeks to reduce the size of nasal cavities and promote regeneration of nasal mucosa as well as its vascularization and lubrication. Throughout history, multiple surgical procedures have been described that have sought the narrowing of the nasal cavity to allow the passage of air more physiologically. On the other hand, radical interventions have been proposed such as the closure of the nostrils to reduce symptoms and improve quality. This article summarizes the main proposed procedures along with their results and conclusions. Although most of the techniques described are no longer used today, it is important to know them since there are still patients who were subjected to them and may present complications and / or adverse effects.