[Metformin-associated lactic acidosis. Report of one case]. / Acidosis láctica asociada a metformina. Caso clínico.

Metformin-associated lactic acidosis is a severe and infrequent adverse event. Early diagnosis is essential to start an early treatment, which often has favorable results. We report a 56 years old non-insulin-requiring type 2 diabetic female who developed a severe metabolic acidosis associated with metformin in relation to an acute renal failure secondary to infectious diarrhea. Early treatment with bicarbonate and continuous hemofiltration allowed a quick improvement of the patient. Metformin-associated lactic acidosis has an elevated mortality (50-80%) and has a specific and effective treatment. Therefore, the condition must be born in mind.

Effectiveness of a physiologic voice therapy program based on different semioccluded vocal tract exercises in subjects with behavioral dysphonia: A randomized controlled trial.

PURPOSE: The present study aimed to assess the effectiveness of a physiologic voice therapy program based on different semioccluded vocal tract exercises in subjects with behavioral dysphonia. METHODS: Thirty-four participants with behavioral dysphonia were randomly assigned to one of two treatment groups: 1) voice treatment with physiologic voice therapy plus vocal hygiene program (n=20), and 2) vocal hygiene program only (n=14). Laryngoscopic assessment was performed in all subjects. Before and after voice therapy, participants underwent aerodynamic, electroglottographic, and acoustic assessment. The Voice Handicap Index (VHI), Voice symptom scale (VoiSs), Vocal tract discomfort scale (VTDS), and self-assessment of resonant voice quality were also performed. The treatment included eight voice therapy sessions. For the experimental group, the exercises consisted of a sequence of seven phonatory tasks performed with four different semioccluded vocal tract exercises (SOVTE). Comparison for all variables were performed between experimental group and control group. RESULTS: Wilcoxon test showed significant improvements for experimental group for VHI, VoiSs, VTDS (decrease), and self-perception of resonant voice quality (increase). Significant decrease for experimental groups was observed on subglottic pressure, phonation threshold pressure, and glottal airflow across the implemented tasks. CONCLUSION: Physiologic voice therapy based on semioccluded vocal tract exercises seems to be an effective tool to improve voice in subjects diagnosed with behavioral dysphonia. Apparently, most changes should be expected in variables related to physical and functional aspects compared to objective variables. Subglottic pressure and phonation threshold pressure seem to be the most change-sensitive parameters and they may reflect a reduction in phonatory effort reported by patients after voice therapy.

Scanning electron microscopy of dermatofibroma.

Dermatofibroma is a proliferation of spindle cells located in the dermis. We used scanning electron microscopy to examine two histologically confirmed lesions and observed preserved collagen bundles in the perilesional area. In the lesional area, the collagen was denser, without formation of bundles. Higher magnification showed collagen with mesh-like appearance similar to stretched tufts of cotton. Very high magnification evidenced the tufts of cotton and spindle cells measuring 2 to 12 microns.

Melaleuca quinquenervia (Cav.) S.T. Blake (Myrtales: Myrtaceae): Natural alternative for mosquito control.

OBJECTIVE: To evaluate an essential oil with larvicide, adulticide and growth inhibitory activity against Aedes aegypti, Aedes albopictus and Culex quinquefasciatus mosquitoes, of medical importance. METHODS: Standardized methodology by WHO was used to determine the levels of susceptibility of mosquito larvae exposed to the essential oil. To evaluate the adulticide activity with the essential oil at different doses, bottles were impregnated according to the methodology CDC. To determine the development inhibitory activity of Melaleuca quinquenervia (M. quinquenervia) oil in three mosquito species, third instar larvae were exposed to the LC50 and LC90 dose (calculated for each population) of M. quinquenervia oil in glass containers with a capacity of 500 mL. After 24 h exposure, the dead larvae were discarded. The mortality of larvae and pupae were recorded on a daily basis. RESULTS: The calculated LC50 indicates an order of effectiveness of preferential oil for Culex quinquefasciatus (LC50 = 0.0021%), Aedes aegypti (LC50 = 0.0047%) and Aedes albopictus (LC50 = 0.0049%). CONCLUSIONS: The adulticide activity was achieved with impregnated bottles at 40 and 50 mg/mL with the three mosquitoes species. In larvae, a growth inhibition was detected when exposed to sublethal doses. The results indicate that M. quinquenervia is a plant with promising environmentally sustainable source for vector control.

Comparison of Supraglottic Activity and Spectral Slope Between Theater Actors and Vocally Untrained Subjects.

PURPOSE: The present study aimed to assess supraglottic activity in theater actors and to observe whether they present differences compared with subjects with no voice training. Acoustic and perceptual analyses were also performed. METHODS: A total of 20 participants were divided into two groups: an experimental group of trained theater actors, and a comparative group of subjects with no voice training. Absence of laryngeal pathology was confirmed by rigid videostroboscopy. Flexible laryngoscopy was performed to assess supraglottic activity during speaking phonatory tasks. Voice recording was also carried out. Four blinded judges were asked to assess laryngoscopic and perceptual variables using a visual analog scale. A comparison between groups, phonatory tasks, and loudness levels was performed. RESULTS: Multivariate linear regression showed that trained participants had a higher degree of both laryngeal and pharyngeal activities compared with untrained participants. Moreover, phonatory tasks at high intensity showed higher activity than those at medium and low intensities for most phonatory tasks and laryngoscopic parameters. Vocally trained participants evidenced higher values for all spectral variables compared with untrained participants. CONCLUSION: Actors have a greater degree of both laryngeal and pharyngeal activities than vocally untrained subjects. Apparently, this higher activity is associated to speaking voice training and not to a hyperfunctional vocal behavior. Anterior-posterior laryngeal compression is greater than medial compression. Intensity and phonatory tasks have an effect on all laryngoscopic variables. Supraglottic activity during professional speaking voice may be not necessarily a hyperfunctional behavior, but a strategy to avoid vocal fold damage while producing the desired voice quality.

Scanning electron microscopy of dermatofibroma

Abstract: Dermatofibroma is a proliferation of spindle cells located in the dermis. We used scanning electron microscopy to examine two histologically confirmed lesions and observed preserved collagen bundles in the perilesional area. In the lesional area, the collagen was denser, without formation of bundles. Higher magnification showed collagen with mesh-like appearance similar to stretched tufts of cotton. Very high magnification evidenced the tufts of cotton and spindle cells measuring 2 to 12 microns.

Longitud cervical en la predicción de parto prematuro espontáneo y resultados perinatales en población de gemelos (dobles) en Hospital Provincial, Chile / Cervix measurement in spontaneous labor prediction and perinatal results in twins from a provincial hospital, Chile

RESUMEN Diversas publicaciones han demostrado que el acortamiento cervical es un elemento predictor de parto prematuro en embarazo gemelar. Los objetivos del presente trabajo fueron comparar los resultados perinatales de gestantes con longitud cervical (LC), entre las 20-24 semanas, ≤ 25mm y aquellas con LC > 25mm; y evaluar la capacidad predictiva para parto prematuro ≤ 32 semanas. Estudio analítico observacional, retrospectivo de cohorte, se recogieron los datos de las gestantes con embarazo gemelar doble, atendidas en el servicio de Obstetricia y Ginecología Hospital Las Higueras Talcahuano, durante los años 2010 al 2018; quienes se les había realizado al menos una evaluación cervical entre las 20 y 24 semanas; recolectando desde base de datos y ficha clínica sus datos perinatales. Se obtuvo los datos de 186 pacientes, la edad promedio de las pacientes fue 29 años, longitud cervical promedio fue 40,8 mm, parto promedio fue a las 35,6 semanas. El 71% de las gestantes fue gemelar Bicorial-Biamniótico y 29% Monocorial-Biamniótico. El 3,2% de los casos (n=6) tuvo longitud cervical ≤ 25mm en el segundo trimestre. En el grupo con longitud cervical ≤ 25 mm la EG al parto fue 30,7 semanas, con peso promedio de 1.555 gramos y una talla de 41,1 cm; mientras que estos mismos valores en el grupo con cérvix > 25 mm fueron 35,8 semanas, 2,527 gramos y 45,8 cm. La longitud cervical en relación a parto ≤ 32 semanas tuvo una sensibilidad de un 27,8%; especificidad de un 99,4%; VPP de 83,3% y un VPN de 92,8%. CONCLUSIÓN: Nuestros resultados muestran que la longitud cervical logra tener una gran especificidad, VPP y VPN en relación del parto prematuro ≤ 32 semanas, pero con una sensibilidad limitada. Pudiendo ser un buen método para identificar al embarazo gemelar en riesgo de parto prematuro ≤ 32 semanas.

ABSTRACT Several publications have shown that cervical shortening is a predictive element of premature delivery in twin pregnancy. The objectives of the present study were to compare the perinatal results of pregnant women with cervical length, between 20-24 weeks, ≤ 25mm and those with> 25mm; and evaluate the predictive capacity for premature delivery ≤ 32 weeks. An observational, cohort, retrospective, analytical study collected the data of pregnant women with double twin pregnancy treated at the Obstetrics and Gynecology Service Hospital Las Higueras Talcahuano during the years 2010 to 2018; who had at least one cervical measurement between 20 and 24 weeks of pregnancy; collecting perinatal data from database and clinical record. Data were obtained from 186 patients, the average age of the patients was 29 years, average cervical measurement was 40.8 mm, average delivery was 35.6 weeks. The 71% of pregnant women were twin BcBa and 29% McBa. The 3.2% (n = 6) had cervical measurement ≤ 25mm in the second trimester. In the group with cervical length ≤ 25 mm, the GA at delivery was 30.7 weeks, with an average weight of 1555 grams and a height of 41.1 cm; while these same values in the group with cervix > 25 mm were 35.8 weeks, 2527 grams and 45.8 cm. Cervical measurement in relation to childbirth ≤ 32 weeks had a sensitivity of 27.8%; specificity of 99.4%; PPV of 83.3% and a NPV of 92.8%. CONCLUSION: Our results show that cervical length has great specificity, PPV and NPV in relation to premature labor ≤ 32 weeks, but with limited sensitivity. It can be a good method to identify the twin pregnancy at risk of preterm birth ≤ 32 weeks.

Acidosis láctica asociada a metformina: caso clínico / Metformin-associated lactic acidosis: report of one case

Metformin-associated lactic acidosis is a severe and infrequent adverse event. Early diagnosis is essential to start an early treatment, which often has favorable results. We report a 56 years old non-insulin-requiring type 2 diabetic female who developed a severe metabolic acidosis associated with metformin in relation to an acute renal failure secondary to infectious diarrhea. Early treatment with bicarbonate and continuous hemofiltration allowed a quick improvement of the patient. Metformin-associated lactic acidosis has an elevated mortality (50-80%) and has a specific and effective treatment. Therefore, the condition must be born in mind.

Enfisema subcutâneo, pneumotórax e pneumomediastino após tonsilectomia / Emphysema subcutaneous, pneumothorax and pneumomediastinum after tonsillectomy

Várias complicações podem estar relacionadas a procedimentos cirúrgicos na área de cabeça e pescoço. O pneumomediastino, pneumotórax e enfisema subcutâneo estão descritos em menor número de casos, em relação às demais complicações. Nesses procedimentos, constata-se importante o cuidado com a técnica cirúrgica, evitando manobras cirúrgicas agressivas, além de parcimônia no uso de máscaras de oxigênio sob pressão positiva e intubação. Este estudo relata um caso de enfisema subcutâneo, pneumotórax e pneumomediastino, com aparecimento 48 horas após tonsilectomia palatina, e discute possíveis mecanismos, morbidade, formas de prevenção e tratamento

Several complications can be related to surgical approaches of the head and neckareas. Subcutaneous emphysema, pneumothorax and pneumomediastinum are described in a small number of cases, among others. In these surgeries, a careful surgical technique approach is of utmost importance, and aggressive surgical maneuvers should be avoided.Caution should be taken with the use of oxygen masks for positive pressure ventilation during anesthesia recovery and intubation. This study reports a case of pneumomediastinum, pneumothorax and subcutaneous emphysema that appeared 48 hours after palate tonsillectomy and discusses possible mechanisms, morbidity, ways of prevention and treatment