Clinical profiling of pediatric microtia patients: A cross-sectional analysis at a leading pediatric hospital in Ecuador (2015-2022).

BACKGROUND: Microtia is a frequent congenital deformity of the pinna, often with hearing loss. This study reviews the clinical profiles of microtia pediatric patients treated at a referral hospital in Quito, Ecuador, from 2015 to 2022. METHODS: A cross-sectional descriptive study was carried out based on the analysis of medical records of pediatric patients with microtia treated between January 2015 and December 2022 at the Hospital Pediátrico Baca Ortiz in Quito, Ecuador. Descriptive statistics were used, and the Chi-square test assessed associations between categorical variables. RESULTS: Of the 235 patients evaluated, 59.6% were male, 83.4% lived at high altitudes (2500-3500 m), and 19.1% had a family history of microtia. Grade III microtia was diagnosed in 63.8%, predominantly on the right side. Nearly all (99.1%) had hearing loss. Other anatomical alterations were observed in 27.7%, primarily the preauricular appendage. Bone vibrator implantation was a common treatment for 24.3%. Altitude did not show a significant correlation with microtia characteristics. CONCLUSIONS: Most patients had grade III microtia with associated hearing loss. Despite the high prevalence at elevated altitudes, no significant altitude-disease correlation was found. The study highlights the need for further research on microtia in regions like Ecuador.

A multivariable prediction model for intra-amniotic infection in patients with preterm labor and intact membranes including a point of care system that measures amniotic fluid MMP-8.

OBJECTIVES: Among patients with preterm labor and intact membranes (PTL), those with intra-amniotic infection (IAI) present the highest risk of adverse perinatal outcomes. Current identification of IAI, based on microbiological cultures and/or polymerase chain reaction amplification of the 16S ribosomal RNA gene, delay diagnosis and, consequently, antenatal management. The aim to of the study was to assess the performance of a multivariable prediction model for diagnosing IAI in patients with PTL below 34.0 weeks using clinical, sonographic and biochemical biomarkers. METHODS: From 2019 to 2022, we prospectively included pregnant patients admitted below 34.0 weeks with diagnosis of PTL and had undergone amniocentesis to rule in/out IAI. The main outcome was IAI, defined by a positive culture and/or 16S ribosomal RNA gene in amniotic fluid. Based on the date of admission, the sample (n=98) was divided into a derivation (2019-2020, n=49) and validation cohort (2021-2022, n=49). Logistic regression models were developed for the outcomes evaluated. As predictive variables we explored ultrasound cervical length measurement at admission, maternal C-reactive protein, gestational age, and amniotic fluid glucose and matrix metalloproteinase-8 (MMP-8) levels. The model was developed in the derivation cohort and applied to the validation cohort and diagnostic performance was evaluated. Clinical management was blinded to the model results. RESULTS: During the study period, we included 98 patients admitted with a diagnosis of PTL. Of these, 10 % had IAI. The final model included MMP-8 and amniotic fluid glucose levels and showed an area under the receiver operating characteristic curve to predict the risk of IAI of 0.961 (95 % confidence interval: 0.860-0.995) with a sensitivity of 75 %, specificity of 93.3 %, positive likelihood ratio (LR) of 11.3 and negative LR of 0.27 in the validation cohort. CONCLUSIONS: In patients with PTL, a multivariable prediction model including amniotic fluid MMP-8 and glucose levels might help in the clinical management of patients undergoing amniocentesis to rule in/out IAI, providing results within a few minutes.

Satisfaction of patients and primary care professionals with a teleophthalmology-based screening programme for diabetic retinopathy in a rural area in Castilla y León, Spain.

INTRODUCTION: Diabetic retinopathy (DR) is the leading cause of blindness in working-age adults in most developed countries. Early diagnosis and early treatment for retinopathy can reduce the incidence of severe loss of vision in a high percentage of sight-threatening DR. However, sight-threatening DR is asymptomatic in a high percentage of patients and no more than 50% of the diabetic patients are reviewed periodically in ophthalmology, mainly in rural areas. Telemedicine facilitates the exchange of information among professionals, reducing unnecessary journeys for patients who live in rural or remote areas. The survey of satisfaction is a highly useful quantitative instrument to obtain information directly from the users of a screening program. One aim of this study has been to determine the prevalence of DR in a sample of diabetic patients from a rural area of Spain and to classify DR patients according to the type and severity of this complication of the disease. The other main target was to evaluate the degree of satisfaction in both diabetic patients and professionals with a teleophthalmology-based screening program of DR. METHODS: A sample of 114 diabetic patients included in a new teleophthalmology program for the screening of DR in Castilla y León, Spain, were asked to take part in an in-person survey designed to evaluate the degree of satisfaction. This sample was obtained through a consecutive non-probability sampling technique, out of a total of 752 diabetic patients who underwent a retinography screening program in a distant rural healthcare center. The survey assessed aspects related to the information about the program the patients received, the organization of the center, the way the test was conducted and the reception of the results. All the included participants consented to participate in this study. Additionally, an anonymous survey was conducted via email. The sample was made up of 10 professionals responsible for taking the retinal images from the patients included in the study. This survey assessed their degree of satisfaction with their training, the way the test was carried out, the support from their managers and how this activity influenced their relationship with their patients. RESULTS: A high percentage of patients with DR in the study sample had a form of sight-threatening retinopathy (29.4%), which in this program is a criterion of referral to be assessed by an ophthalmologist. Of the surveyed patients, 93.8% scored eight points or higher for their degree of general satisfaction with the activity. All of them claimed they would prefer to continue their exploration at the healthcare center instead of going to the hospital. As regards the professionals, 70% scored eight points or more in terms of their degree of general satisfaction with the activity, whereas 20% scored between five and seven. One professional did not respond to the question. Finally, 90% stated that they would continue performing the activity, while the remaining 10% answered no. CONCLUSION: According to the high percentage of patients diagnosed with vision-threatening DR in this study, an early diagnosis of this complication of diabetes seems to be important. Teleophthalmology enhances patient accessibility to the healthcare system, making early diagnosis of DR easier, with a high degree of satisfaction among patients and healthcare professionals.

Degradación de ADN por micoplasmas en exudados faríngeos y vaginales, México / DNA Depletion byclinical isolated mycoplasmas, México

La limitada capacidad de biosíntesis de precursores esenciales en micoplasmas les ha permitido desarrollar mecanismos moleculares para su adquisición a partir de sus hospederos. Objetivo: Determinar la capacidad de degradación de ADN en micoplasmas aislados de exudados faríngeos y vaginales. Métodos: De las muestras clínicas de exudados faríngeos y vaginales se aislaron micoplasmas por método microbiológico y validaron por PCR. Las que resultaron positivas fueron evaluadas para determinar su capacidad de degradar ADN por método de formación de halo en agar. Resultados: La capacidad de degradar ADN a partir de los aislamientos clínicos de micoplasmas fue evidente y presentó diferencia significativa (P< 0,05) respecto a la cepa de referencia. Conclusiones: Los aislamientos clínicos de micoplasmas tienen actividad de ADNasas, implicando un papel importante para la adquisición de precursores de ácidos nucleicos, y condicionando alteración en las células hospederas.

The limited capacity of essential biosynthetic precursors mycoplasma enabled them to develop molecular mechanisms for acquisition from their hosts. Objective: To determine the ability of DNA degradation in mycoplasma isolated from clinical samples. Methods: From clinical samples of throat and vaginal swabs mycoplasmas were isolated by microbiological method and validated by PCR. The positive samples were evaluated for their ability to degrade DNA halo formation method on agar. Results: the ability to degrade DNA from clinical isolates of mycoplasma was evident and showed a significant difference (P <0.05) compared to the reference strain. Conclusions: Mycoplasma in clinical isolates have DNase activity, implying a role for the acquisition of nucleic acid precursors, and conditioning the host cells´ alteration.

Can jumping capacity of adult show jumping horses be predicted on the basis of submaximal free jumps at foal age? A longitudinal study.

The purpose of this study was to quantify performance characteristics of good jumping horses, and to determine whether these were already detectable at foal age. Kinematic data were collected of horses performing free jumps over a 0.60 m high fence at six months of age and of these same horses jumping with a rider over a 1.15 m high fence at five years of age. At five years of age the horses were divided into three groups on the basis of a puissance competition: a group of seven best jumpers that made no errors and in the end cleared a 1.50 m high fence, a group of nine worst jumpers that were unable to clear a 1.40 m high fence, and an intermediate group of 13 horses. Longitudinal kinematic data was available for all seven best jumpers and for six of the nine worst jumpers. Average values of variables for the best jumpers were compared with those of the worst jumpers for the jumps over 1.15 m. In the group of best jumpers, the forelimbs were shorter at forelimb clearance due to increased elbow flexion, and the hind limbs were further retroflexed at hind limb clearance. The same superior technique in clearing fences with the limbs was also found in this group at six months of age. Nevertheless, for individual horses it turned out to be too far-fetched to predict adult jumping capacity on the basis of kinematic variables collected during submaximal jumps at foal age.

Effect of early training on the jumping technique of horses.

OBJECTIVE: To investigate the effects of early training for jumping by comparing the jumping technique of horses that had received early training with that of horses raised conventionally. ANIMALS: 40 Dutch Warmblood horses. PROCEDURE: The horses were analyzed kinematically during free jumping at 6 months of age. Subsequently, they were allocated into a control group that was raised conventionally and an experimental group that received 30 months of early training starting at 6 months of age. At 4 years of age, after a period of rest in pasture and a short period of training with a rider, both groups were analyzed kinematically during free jumping. Subsequently, both groups started a 1-year intensive training for jumping, and at 5 years of age, they were again analyzed kinematically during free jumping. In addition, the horses competed in a puissance competition to test maximal performance. RESULTS: Whereas there were no differences in jumping technique between experimental and control horses at 6 months of age, at 4 years, the experimental horses jumped in a more effective manner than the control horses; they raised their center of gravity less yet cleared more fences successfully than the control horses. However, at 5 years of age, these differences were not detected. Furthermore, the experimental horses did not perform better than the control horses in the puissance competition. CONCLUSIONS AND CLINICAL RELEVANCE: Specific training for jumping of horses at an early age is unnecessary because the effects on jumping technique and jumping capacity are not permanent.

Contribution of the forelimbs and hindlimbs of the horse to mechanical energy changes in jumping.

The purpose of the present study was to gain more insight into the contribution of the forelimbs and hindlimbs of the horse to energy changes during the push-off for a jump. For this purpose, we collected kinematic data at 240 Hz from 23 5-year-old Warmbloods (average mass: 595 kg) performing free jumps over a 1.15 m high fence. From these data, we calculated the changes in mechanical energy and the changes in limb length and joint angles. The force carried by the forelimbs and the amount of energy stored was estimated from the distance between elbow and hoof, assuming that this part of the leg behaved as a linear spring. During the forelimb push, the total energy first decreased by 3.2 J kg(-1) and then increased again by 4.2 J kg(-1) to the end of the forelimb push. At the end of the forelimb push, the kinetic energy due to horizontal velocity of the centre of mass was 1.6 J kg(-1) less than at the start, while the effective energy (energy contributing to jump height) was 2.3 J kg(-1) greater. It was investigated to what extent these changes could involve passive spring-like behaviour of the forelimbs. The amount of energy stored and re-utilized in the distal tendons during the forelimb push was estimated to be on average 0.4 J kg(-1) in the trailing forelimb and 0.23 J kg(-1) in the leading forelimb. This means that a considerable amount of energy was first dissipated and subsequently regenerated by muscles, with triceps brachii probably being the most important contributor. During the hindlimb push, the muscles of the leg were primarily producing energy. The total increase in energy was 2.5 J kg(-1) and the peak power output amounted to 71 W kg(-1).

Variation in free jumping technique within and among horses with little experience in show jumping.

OBJECTIVE: To quantify variation in the jumping technique within and among young horses with little jumping experience, establish relationships between kinetic and kinematic variables, and identify a limited set of variables characteristic for detecting differences in jumping performance among horses. ANIMALS: Fifteen 4-year-old Dutch Warmblood horses. PROCEDURE: The horses were raised under standardized conditions and trained in accordance with a fixed protocol for a short period. Subsequently, horses were analyzed kinematically during free jumping over a fence with a height of 1.05 m. RESULTS: Within-horse variation in all variables that quantified jumping technique was smaller than variation among horses. However, some horses had less variation than others. Height of the center of gravity (CG) at the apex of the jump ranged from 1.80 to 2.01 m among horses; this variation could be explained by the variation in vertical velocity of the CG at takeoff (r, 0.78). Horses that had higher vertical velocity at takeoff left the ground and landed again farther from the fence, had shorter push-off phases for the forelimbs and hind limbs, and generated greater vertical acceleration of the CG primarily during the hind limb push-off. However, all horses cleared the fence successfully, independent of jumping technique. CONCLUSIONS AND CLINICAL RELEVANCE: Each horse had its own jumping technique. Differences among techniques were characterized by variations in the vertical velocity of the CG at takeoff. It must be determined whether jumping performance later in life can be predicted from observing free jumps of young horses.

Evaluation of consistency of jumping technique in horses between the ages of 6 months and 4 years.

OBJECTIVE: To determine whether differences in jumping technique among horses are consistent at various ages. ANIMALS: 12 Dutch Warmblood horses. PROCEDURE: Kinematics were recorded during free jumps of horses when they were 6 months old (ie, no jumping experience) and 4 years old (ie, the horses had started their training period to become show jumpers). Mean +/- SD height of the horses was 1.40 +/- 0.04 m at 6 months of age and 1.70 +/- 0.05 m at 4 years of age. RESULTS: Strong correlations were found between values from 6-month-old foals and 4-year-old horses for variables such as peak vertical acceleration generated by the hind limbs (r, 0.91), peak rate of change of effective energy generated by the hind limbs (r, 0.71), vertical velocity at takeoff (r, 0.65), vertical displacement of the center of gravity during the airborne phase (r, 0.81), and duration of the airborne phase (r, 0.70). CONCLUSIONS AND CLINICAL RELEVANCE: Although there are substantial anatomic and behavioral changes during the growing period, certain characteristics of jumping technique observed in naïve 4-year-olds are already detectable when those horses are foals.

Hipoacusia de niños / Hipoacusia in children

Se revisaron 1016 exámenes realizados a los niños que acudieron a la Consulta Externa de Otorrinolaringología (ORL) en el Hospital Baca Ortíz desde feb. 1993 a feb. 1995, durante este período se efectuaron 658 (64,8xciento) audiometrías, 230 (22,6xciento) timpanogramas y 2 (0,2xciento) potenciales evocados auditivos; encontrándose que el 60,4xciento fueron varones y el 39,6xciento mujeres. De las audiometrías efectuadas fueron normales el 35xciento, de las cuales correspondieron al sexo masculino 21,7xciento y al femenino 13,5xciento. Se diagnosticó Hipocausia Conductiva (40,5xciento) en mayor porcentaje bilateral en varones de 6-8 años de edad; además se demostró Hipocausia Neurosensorial (17xciento) con mayor afección bilateral en escolares de ambos sexos. Otras patologías menos frecuentes fueron Ototubaritis (4,3xciento) y Trauma Acústico (1xciento). Los timpanogramas más observados fueron los tipos B (36,1xciento), A (36,9xciento) y C (16,2xciento) en niños de 0-2 años, de 3-5 años y de 6-8 años de edad.

Síndrome de wolfram

Se presenta un caso de síndrome de Wolfram constituido por diabetes mellitus, atrofia óptica, diabetes insípida, sordera neurosensorial, vejiga neurógenal e hidronefrosis

Evaluación a la organización del Departamento de Enfermería de un Hospital Gíneco-Obstétrico de V nivel de atención Hospital Gíneco-Obstétrico Isidro Ayora / Evaluation to the organization of the Department of Infirmary of a Hospital Gi'neco-Obste'trico of V attention level Hospital Gi'neco-Obste'trico Isidro Ayora

Para realizar la presente investigación se ha basado en la auscultación directa de los problemas latentes en la Organización del departamento de Enfermería de una Unidad Operativa que corresponde al V Nivel de Atención de salud, ya que el Departamento de Enfermería es el núcleo vital de la Institución, lo que contribuye a brindar una atención de calidad al usuario que acude a esta Unidad Operativa. Esta investigación sobre "Evaluación de la Organización del Departamento de Enfermería del Hospital Gíneco-Obstétrico Isidro Ayora", realizado durante el transcurso del Internado Rotativo en esta Institución se establece la importancia de la Evaluación de la Organización del Departamento, utilizando el método científico y basándonos en entrevistas y encuestas al personal para obtener datos verídicos y la comprobación del Tipo de Organización que mantiene actualmente. Se analizó la situación de Salud de nuestro país, especialmente la de Hospitales Estatales y de la población Materno Infantil. En la situación de Salud se analizó desde la década del 60 hasta la actualidad en donde el país ha sufrido cambios económicos, políticos y culturales repercutiendo también en la salud; en cuanto a salud Materno Infantil que es la población olvidada durante muchos años, en la actualidad existen reformas en beneficio del binomio madre-niño, ampliando la cobertura de atención, disminuyendo a la vez las tasas de mortalidad de éste binomio para el cumplimiento de éste objetivo, dependiendo de presupuesto que el estado asigne a los profesionales del sector salud, especialmente de Enfermeras quienes están las 24 horas del día junto al paciente. Para el éxito del trabajo en equipo, es necesario que éste Departamento tenga una Organización efectiva que garantice la atención integral. La organización proporciona el marco formal dentro del cual se verifica el proceso administrativo, sistema de trabajo, de comunicaciones e identidad para los individuos es decir fomentar la satisfacción en el cumplimiento de sus labores. Se debe anotar además que el Departamento de Enfermería de toda Institución Hospitalaria, debe funcionar de acuerdo a un Manual Técnico Administrativo...