Neuropatía auditiva y cribados neonatales

In the 2010 CODEPEH Recommendations, the discovery of all hearing loss is advised regardless of its etiology and severity. Auditory neuropathy can go unnoticed in programs based on the use of otoemissions as the first level of screening. However, there are very specific cases that can present this pathology and this allows its discovery provided that adequate criteria are followed in the programs based on otoemissions, as has been done in all of them. This work, in addition to describing this pathology in its etiological, pathophysiological, clinical, diagnostic and therapeutic aspects, specifies those antecedents that make us suspect, not only auditory neuropathy, but also retrocochlear lesions that, due to their own location, would not be detected by otoemissions. It is children who spend more than 5 days in PICU, those with toxoplasmosis, those who have had hyperbilirubinemia with exchange transfusion, and those with a family history of neurological processes, especially those with a history of Otof Gene disorders, who need to complete screening with auditory evoked potentials.En las Recomendaciones de la CODEPEH 2010, se aconseja el descubrimiento de todas las hipoacusias independientemente de su etiología y severidad. La neuropatía auditiva puede pasar desapercibida en los programas basados en el uso de otoemisiones como primer nivel del cribado. Sin embargo son casos muy concretos los que pueden presentar esta patología y ello permite su descubrimiento siempre que se sigan unos criterios adecuados en los programas basados en las otoemisiones, como se viene haciendo en todos ellos. Este trabajo, además de describir esta patología en sus aspectos etiológico, fisiopatológico, clínico, diagnóstico y terapéutico, concreta aquellos antecedentes que hacen sospechar, no solo la neuropatía auditiva, también las lesiones retrococleares que por su propia localización no serían detectadas por las otoemisiones. Son los niños que pasan más de 5 días en UCIP, los que tienen toxoplasmosis, los que han tenido hiperbilirrubinemia con exanguinotransfusión y los que tienen antecedentes familiares de procesos neurológicos, especialmente aquellos con antecedentes de trastornos del Gen Otof, los que necesitan completar el cribado con potenciales evocados auditivos

Laboratorio de temporal: mejorando el conocimiento aplicado del oído

Memoria ID-026. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2019-2020.[ES]El objetivo principal del presente proyecto fue el desarrollo de conocimiento y habilidades sobre el hueso temporal, donde está alojado el sentido de la audición y el equilibrio, a través de la disección de hueso temporal de cadáver

Entendiendo el vértigo: de la tablet a la realidad

Memoria ID-014 Ayudas de la Universidad de Salamanca para la innovación docente, curso 2020-2021

Atlas de otoscopia para estudiantes de medicina

Memoria ID-024. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2021-2022

Regulation of Fn14 Receptor and NF-κB Underlies Inflammation in Meniere’s Disease

Meniere’s disease (MD) is a rare disorder characterized by episodic vertigo, sensorineural hearing loss, tinnitus, and aural fullness. It is associated with a fluid imbalance between the secretion of endolymph in the cochlear duct and its reabsorption into the subarachnoid space, leading to an accumulation of endolymph in the inner ear. Epidemiological evidence, including familial aggregation, indicates a genetic contribution and a consistent association with autoimmune diseases (AD). We conducted a case–control study in two phases using an immune genotyping array in a total of 420 patients with bilateral MD and 1,630 controls. We have identified the first locus, at 6p21.33, suggesting an association with bilateral MD [meta-analysis leading signal rs4947296, OR = 2.089 (1.661–2.627); p = 1.39 × 10−09]. Gene expression profiles of homozygous genotype-selected peripheral blood mononuclear cells (PBMCs) demonstrated that this region is a trans-expression quantitative trait locus (eQTL) in PBMCs. Signaling analysis predicted several tumor necrosis factor-related pathways, the TWEAK/Fn14 pathway being the top candidate (p = 2.42 × 10−11). This pathway is involved in the modulation of inflammation in several human AD, including multiple sclerosis, systemic lupus erythematosus, or rheumatoid arthritis. In vitro studies with genotype-selected lymphoblastoid cells from patients with MD suggest that this trans-eQTL may regulate cellular proliferation in lymphoid cells through the TWEAK/Fn14 pathway by increasing the translation of NF-κB. Taken together; these findings suggest that the carriers of the risk genotype may develop an NF-κB-mediated inflammatory response in MD

Diseño para el desarrollo sustentable y la habitabilidad segura e incluyente

Este libro se divide en dos partes que permiten permear en el campo de la enseñanza del diseño; la primera se enfoca en temáticas que se desprenden del diseño en la educación para la sustentabilidad; en la segunda, se identifican las tendencias del diseño como un modo de verlo y sentirlo: va desde el diseño emocional hacia uno de conservación, reúso y reparación de objetos para reducir el consumo de recursos materiales

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Predicción del comportamiento biológico de los niveles de calcio tras tiroidectomía mediante modelos matemáticos

La hipocalcemia postoperatoria es un evento frecuente y potencialmente grave que supone una de las principales complicaciones de la cirugía tiroidea. Su origen es el daño de la vascularización o la extirpación de las glándulas paratiroides y, dada la particular fisiología del metabolismo del calcio, puede manifestarse incluso más allá de las 48 horas siguientes a la intervención, por lo que su predicción durante la estancia hospitalaria del paciente sería de gran utilidad. Se han propuesto distintos modelos para realizar esta estimación, basados en el número de paratiroides controladas durante la cirugía, la pendiente del nivel de calcio en las primeras horas, o, más recientemente, el cambio en los niveles de paratohormona (PTH) tras la intervención. En este estudio incluimos 192 pacientes sometidos a tiroidectomía total entre los años 2003 y 2012 en el servicio de Otorrinolaringología del Complejo Hospitalario Universitario de Badajoz. A lo largo de distintas fases conformamos un modelo matemático basado en ecuaciones diferenciales, cuyo objeto es predecir el nivel mínimo de calcio que se podrá encontrar a lo largo de cada postoperatorio, y trazar una curva de estimación que represente el comportamiento biológico de estos niveles en los primeros cuatro días tras la intervención. Los resultados de este modelo en sus dos objetivos son evaluados en el texto y comparados con los obtenidos aplicando los modelos existentes en la bibliografía.Postoperative hypocalcaemia is a frequent and potentially severe complication of thyroid surgery. Its origin is the extirpation of parathyroid glands or the damage of their vascularization and, due to the particular physiology of calcium metabolism, can appear even beyond 48h after surgery, so its prediction within the patient’s hospital stay would be of great utility. Several models have been proposed for this estimation, based on the number of seen parathyroid glands during surgery, the decrease of calcium level after the first hours or, more recently, the change of PTH levels after the procedure. In this study we evaluate 192 patients undergoing total thyroidectomy between 2003 and 2012 in the ENT Department of the University Hospital of Badajoz. Along several stages a mathematical model, based on differential equations, is built with the aim of predicting the minimum level of calcium and tracing an estimation curve that represents the biologic behaviour of these levels during the first four days after the procedure. The results obtained with the model described are compared with those of the existing models in literature

Tell me where you live and I'll tell you who you are: Spatial segregation of southern species of Eligmodontia Cuvier in Patagonia, Argentina

Eligmodontia morgani and E. typus are two small (<25 g) sigmodontine rodents that live in dry areas of southern Argentina. The species are very difficult to distinguish in the field, so their geographical delimitation has always been the subject of controversy. In this work we used sampling sites where each species has been previously identified by its karyotypes and mtDNA, and modeled their potential distribution using a maximum entropy analysis. Our results show a clear niche segregation between the two species, mainly driven by temperature. Ecological niche models show E. morgani is a more likely inhabitant of western Patagonia (the Steppe ecoregion), while E. typus is a more likely inhabitant of the eastern region (the Monte ecoregion). In ecotonal areas our models predict E. morgani occupies the highest and coldest areas at the top of plateaus, while E. typus occupies the Monte ecoregion. Our mathematical models show a habitat selection of average minimum temperatures of 1 °C and 5 °C for E. morgani and E. typus, respectively, and of average maximum temperatures of 22 °C and 27 °C for each species.Eligmodontia morgani y E. typus son dos pequeños (<25 g) roedores sigmodontinos que habitan los ambientes áridos del sur de Argentina. Debido a que las especies son difíciles de distinguir en el campo, su delimitiación geográfica siempre ha sido controvertida. En este trabajo usamos registros donde las especies fueron identificadas por su cariotipo y ADN mitocondrial, y modelamos su distribución potencial usando análisis de máxima entropía. Nuestros resultados muestran una segregación en el nicho entre las especies, mayormente impulsado por la temperatura. Los modelos ecológicos de nicho muestran que E. morgani es un habitante del oeste y centro patagónico correspondientes con la ecorregión de la Estepa Patagónica, mientras E. typus es un habitante de las regiones centrales y el este patagónico, correspondientes con la ecorregión del Monte. En áreas de ecotono, nuestros modelos predicen que E. morgani ocupa las zonas altas y frías de las mesetas, mientras que E. typus ocupa zonas bajas con una matriz de vegetación de la Ecorregión del Monte. Nuestros modelos matemáticos muestran una selección de hábitat de temperaturas medias mínimas de 1 °C y 5 °C para E. morgani y E. typus, respectivamente, y de temperaturas máximas medias de 22 °C y de 27 °C para cada especie.Fil: Ruiz Barlett, Trinidad. Fundación Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Martin, Gabriel Mario. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Centro de Investigación Esquel de Montaña y Estepa Patagóica. Universidad Nacional de la Patagonia "San Juan Bosco". Facultad de Ciencias Naturales - Sede Esquel. Centro de Investigación Esquel de Montaña y Estepa Patagónica; ArgentinaFil: Laguna, Maria Fabiana. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Abramson, Guillermo. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Energía Nuclear. Instituto Balseiro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Monjeau, Jorge Adrian. Fundación Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentin