Analysis of risk factors and targeted surveillance for postnatal hearing loss during 25 years of hearing screening.

Introduction: Since 1972, the Joint Committee on Infant Hearing (JCIH) in the USA has proposed the early audiological evaluation of every children born with certain "risk factors" (RF), because of these RF have been associated frequently with hearing loss. After universal hearing screening became a reality, it was also indicated that newborns with permanent postnatal or delayed-onset hearing loss (DH) RF should be followed./nMethods: The results obtained after 25 years of application of a neonatal auditory screening program at the HCU in Valladolid (Spain) are analyzed, looking for the performance obtained with the follow-up of children with RF of DH./nResults: We evaluated 27,649 newborns, and detected 0.25 per thousand with DH. This represents 8% of congenital hearing loss and 0.65% of newborns with RF. The family history of hearing loss and the presence of malformations or syndromes that associate hearing loss are in our environment the RF with higher prevalence of DH. DH usually is bilateral and neurosensorial, with a high percentage (23%) of mild degree./nDiscussion/Conclusions: The monitoring of risk factors proposed by the JCIH as DH indicators is neither effective nor economically profitable. Given the importance of DH, we consider that the follow-up of children with high prevalence of RF should be maintained, in addition to this, we realized that half of them have not associate RF, for this reason, we think that a neonatal study of genetic tests for hearing loss should be carried out together with citomegalovirus screening.:Introducción: En 1972 el Joint Committee on Infant Hearing (JCIH) de EEUU, propone la evaluación audiológica precoz de los niños que nacen con determinados "factores de riesgo" (FR), al comprobarse que asocian hipoacusia con mayor frecuencia. Tras hacerse realidad el cribado auditivo universal, se sigue indicando la conveniencia de un seguimiento de los recién nacidos (RN) con FR de hipoacusia permanente posnatal o de inicio tardío (HPP)./nMaterial y métodos: Tras aplicar durante 25 años un programa de cribado auditivo neonatal, en el Hospital Clínico Universitario (HCU) de Valladolid (España), hemos analizado la incidencia de los FR y el rendimiento obtenido con el seguimiento de los niños que presentaban FR de hipoacusia tardía al nacimiento./nResultados: De los 27.649 RN evaluados, detectamos un 0,25 por mil de HPP, que representa el 8% de las hipoacusias congénitas y el 0,65% de los RN con FR. En nuestro medio, los FR con mayor prevalencia de HPP son, los antecedentes familiares de hipoacusia y la presencia de malformaciones o síndromes que asocian hipoacusia. La HPP es fundamentalmente bilateral, de tipo neurosensorial y en un elevado porcentaje (23%) de grado leve./nDiscusión y Conclusiones: El seguimiento de los factores de riesgo propuestos por el JCIH como indicadores de HPP, no resulta ni eficaz ni económicamente rentable; sin embargo, dada la importancia de la HPP, consideramos que en el momento actual debería mantenerse el de aquellos FR que tengan una prevalencia elevada de hipoacusia y dado que, la mitad de las hipoacusias posnatales no asocian FR, añadir a este seguimiento, la realización de un estudio neonatal de pruebas genéticas de hipoacusia junto al análisis de la presencia de citomegalovirus

Zenker diverticulum. Report of two atypical cases and review of surgical alternatives

[ES]Introducción y objetivo: El divertículo de Zenker es una protrusión o hernia de la mucosa faríngea posterior en la unión faringoesofágica. El mecanismo etiopatogénico parece ser la relajación insuficiente del músculo cricofaríngeo. Es el divertículo esofágico más común y los síntomas predominantes son disfagia y aspiración. El tratamiento quirúrgico está indicado en pacientes sintomáticos. Existen diversas alternativas. Descripción del caso: Presentamos dos casos clínicos atípicos de divertículo de Zenker. El primero es un paciente de 56 años de edad que presenta un divertículo de Zenker asociado a un carcinoma de tiroides en el cual se lleva a cabo una tiroidectomía total y la exéresis del divertículo. El segundo caso es un paciente de 64 años pluripatológico intervenido en otro centro de un divertículo de Zenker mediante abordaje endoscópico, remitido a nuestro servicio por disnea, enfisema, neumomediastino y absceso cervicomediastínico a los 3 días de dicha intervención. Se realiza traqueotomía temporal y cervicotomía y evoluciona favorablemente. Discusión: El divertículo de Zenker es una patología rara con una prevalencia menor al 0,1%. Se disponen de varias alternativas quirúrgicas, tanto por cirugía abierta como por procedimientos endoscópicos. No hay casos descritos asociados a neoplasias tiroideas. Aunque las complicaciones postoperatorias son raras pueden ser muy graves. Conclusiones: El divertículo de Zenker es una patología infrecuente cuyo tratamiento quirúrgico no está exento de complicaciones. Hay varias alternativas terapéuticas, desde la cirugía abierta hasta la endoscopia rígida o flexible. Todos los abordajes han sido bien demostrados en manos experimentadas y ninguno en es claramente superior a los demás. [EN] Introduction and objective: Zenker`s diverticulum is a protusion or hernation of the posterior pharyngeal mucosa in the pharyngoesophageal junction. The etiopathogenic mechanism appears to be insufficient relaxation of the cricopharyngeal muscle. It`s the most common esophageal diverticulum and the predominant symptoms are dysphagia and aspiration. Surgical treatment is indicated in symptomatic patients. There are several alternatives. Case description: We present two atypical clinical cases of Zenker diverticulum. The first is a 56 yo patient diagnosed of Zenker´s diverticulum associated with thyroid carcinoma wich is performed a total thyroidectomy and excision of the diverticulum. The second case is a 64 yo pluripathological patient intervened in another center of Zenker`s diverticulum by endoscopic approach, wich is referred to our department with dyspnea, emphysema, pneumomediastinum and cervical abscess at 3 days of this intervention. Temporary tracheotomy and cervicotomy is performed and progressing favorably. Discussion: Zenker`s diverticulum is a rare pathology with a prevalence less than 0,1%. There are various surgical options both open surgery and the endoscopic procedures. There are no reported cases associated with thyroid neoplasms. Postoperative complications are rare and severe. Conclusions: Zenker`s diverticulum is a uncommon pathology and the surgical treatment is not without complications. There are various treatment options wich include open surgery and the rigid and flexible endoscopy. All approaches have been well proven in experienced hands and none is clearly superior to others

Etiology of hearing loss in children.

Introduction and objective: The neonatal hearing loss is one of the most common disabilities, with lifelong implications for the child and his family. The implementation of the universal newborn hearing screening and the development in molecular medicine, genetic and integrative neuroscience has perfected the early diagnosis of the hearing loss children and consequently its intervention. With this work, we want to clarify the audiological aspects and causes of the permanent hearing loss diagnosed during the past 20 years. Method: We reviewed retrospectively the records of the children diagnosed with less than 3 years of age of permanent hearing loss, during the period 1994-2015, in a tertiary center. Evaluate the time of home, laterality, type and degree of hearing loss. Depending on the background, genetic testing and other complementary explorations, we present the results of our diagnostic study. Results: In the study-population (n = 183), 71% of the permanent hearing loss > 30 dB HL was diagnosed at birth (congenital). Its main features are the bilaterality (81%), the predominance sensorineural (85%) and the grade profound (42%) or moderate (30%), more prevalent in the unilateral forms. About the etiologic diagnosis, a 47% of the cases are of origin genetic (29% of which are syndromic), a 25% of cause environmental and a 28% unknown. Discussion: Our results are consistent for the generally accepted distribution of causes, but there are discrepancies in the literature. Despite the different tests used, we had to infer the etiology in 62% of children with hearing loss, finally unknown by 28%. Conclusions: We consider fundamental the monitoring for a consensus standardized etiological protocol that orient in the diagnostic process of hearing loss in children.Introducción y objetivo: La hipoacusia neonatal es una de las discapacidades más frecuentes, con importantes consecuencias para el niño y su familia durante toda la vida. El desarrollo del cribado auditivo universal y el avance de la medicina molecular, de la genética y de la neurociencia han perfeccionado el diagnóstico precoz de la hipoacusia infantil y consecuentemente su intervención. Con este trabajo queremos mostrar los aspectos audiológicos y las causas de las hipoacusias permanentes diagnosticadas durante estos últimos 20 años. Método: Revisamos retrospectivamente los registros de los niños diagnosticados con menos de 3 años de edad de hipoacusia permanente, durante el periodo 1994-2015, en un centro de tercer nivel. Evaluamos el momento de inicio, lateralidad, tipo y grado de hipoacusia. En función de los antecedentes, pruebas genéticas y otras exploraciones complementarias, presentamos los resultados de nuestro estudio diagnóstico. Resultados: En la población estudiada (n = 183) un 71% de las hipoacusias permanentes >30 dB HL se diagnosticaron al nacimiento (congénitas). Sus principales características son la bilateralidad (81%), el predominio neurosensorial (85%) y el grado profundo (42%) o moderado (30%), más prevalente en las formas unilaterales. En cuanto al diagnóstico etiológico, un 47% son de origen genético (29% de los cuales son sindrómicas), un 25% de causa adquirida y un 28% desconocida. Discusión: Nuestros resultados concuerdan con la distribución de causas generalmente aceptada, pero en la literatura existen discrepancias. A pesar de las diferentes pruebas utilizadas, tuvimos que deducir la etiología en un 62% de niños con hipoacusia, siendo finalmente desconocida en un 28%. Conclusiones: Consideramos fundamental el seguimiento de un protocolo de consenso estandarizado que oriente en el proceso diagnóstico de la hipoacusia infantil

Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms

Alimentación y salud. Una experiencia de aprendizaje e innovación para la comunidad universitaria UCM a través de la Agenda 2030

Los desequilibrios políticos, económicos y sociales que presenta Colombia y la Región de Antioquia han derivado en altas tasas de inseguridad alimentaria. Este hecho, junto al elevado consumo de alimentos ultraprocesados en detrimento de la alimentación tradicional, está afectando gravemente la salud de la población. A todo ello hay que añadir el impacto del cambio climático y los eventos derivados extremos que comprometen la producción y distribución de alimentos. A través de cinco webinars, el público asistente conocerá de primera mano la importancia de la Cooperación Internacional al Desarrollo y la Agenda 20-30 como pretexto para afrontar la problemática de la inseguridad alimentaria en Antioquia, fenómeno que, pese a haberse hecho más evidente en los últimos años, permanece casi invisible por la mayoría de la población española. Asimismo, se hará especial hincapié en las políticas llevadas a cabo por Colombia para mejorar la alimentación, sin olvidar las consecuencias que están teniendo el cambio climático, los conflictos armados, los estragos generados por la pandemia por COVID-19 o la geopolítica mundial sobre la situación nutricional en la región colombiana

Formando educadores en el sur de Colombia : Investigación educativa en licenciatura en educación infantil.

Este libro ofrece al lector reflexión continua de los retos de la universidad en la formación de licenciados para la transformación y emancipación de Colombia hacia la construcción de paz, revela las realidades socio críticas del XXI en los programas académicos de licenciados y visualiza las niñeces como sujetos políticos y sociales, logrando un despliegue significativo de metodologías pertinentes para la formación de maestros en Colombia y Latinoamérica

Formando educadores en el sur de Colombia : Investigación educativa en licenciatura en educación infantil.

Este libro ofrece al lector reflexión continua de los retos de la universidad en la formación de licenciados para la transformación y emancipación de Colombia hacia la construcción de paz, revela las realidades socio críticas del XXI en los programas académicos de licenciados y visualiza las niñeces como sujetos políticos y sociales, logrando un despliegue significativo de metodologías pertinentes para la formación de maestros en Colombia y Latinoamérica

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections