Effects of varying the intensity of the primary tones on the amplitudes of Distortion Product Otoacoustic Emissions (OAEdp) in patients with normal hearing

Indexación: Web of Science; ScieloIntroducción: Las emisiones otoacústicas (EOA) son sonidos generados por las células ciliadas externas (CCE). Se ha visto que la generación y registro de las EOA evocadas depende de factores técnicos de evaluación como el nivel de intensidad de los tonos primarios, relación frecuencial entre los tonos, etc. Objetivos: Estudiar el efecto de la variación de la intensidad de los tonos primarios en la amplitud de la respuesta de las EOA producto de distorsión (pd) en individuos con audición normal. Material y método: Se evaluaron 35 individuos a los cuales se les midieron EOApd utilizando diferentes intensidades de tonos primarios: Intensidad baja (I1=50dBSPL e I2=50dBSPL), intensidad media (I1=55dBSPL e I2=65dBSPL) e intensidad alta (I1=70dBSPL e I2=70dBSPL). Resultados: Se observó que para tonos primarios a bajas intensidades (I1=50dBSPL e I2=50dBSPL) existe una disminución tanto en amplitud y presencia de las EOApd, mientras que para tonos primarios a intensidades mayores (I1=55dBSPL e I2=65dBSPL - I1=70dBSPL e I2=70dBSPL) se evidenció un aumento en amplitud y presencia de EOApd en los sujetos estudiados. Conclusión: Se evidencian diferencias estadísticamente significativas en la amplitud de las EOApd al variar la intensidad de los tonos primarios. Por lo cual se puede establecer que las intensidades medias-altas son las más adecuadas para la evaluación de EOApd en sujetos con audición normal.Introduction: Otoacoustic emissions (OAE) are sounds produced by outer hair cells. The generation and recording of evoked OAE depends on technical factors such as level of intensity of primary tones, frequency relationship between the tones, etc. Aim: To study the effect of varying the intensity of primary tones in the amplitude of the response of Distortion Product OAE (DP) in individuals with normal hearing. Material and method: 35 individuals were measured using different intensities OAEdp primary tones: Low Intensity (I1= I2 =50dBSPL 50dBSPL e), Medium Intensity (11= I2 =65dBSPL 55dBSPL e) and High Intensity (I1 =70dBSPL and I2 =70dBSPL). Results: Using Low primary tones (I1 =I2 =50dBSPL 50dBSPL) there is a decrease in amplitude and presence of DPOAE, while for primary tones at higher intensities (I1 and I2 = = 55dBSPL 65dBSPL -11 =70dBSPL and I2 =70dBSPL) an increase in amplitude and presence of OAEdp in subjects with normal hearing was observed . Conclusion: There are statistically significant differences in OAEdp amplitude by varying the intensity of the primary tones. Therefore medium-high intensities are best suited for the evaluation of OAEdp in subjects with normal hearing.http://ref.scielo.org/36dbs

Análisis del espesor coroideo en pacientes con queratocono

Objective. To determine and compare choroidal thickness (CT) in keratoconus (KC) patients using Enhanced Depth Imaging (EDI) OCT. Methods. A comparative cross-sectional study including 26 patients with KC and 26 healthy controls assessed with Pentacam and EDI-OCT. CT was measured manually with the Caliper function at thirteen locations at 500 µm regular intervals. Results. The average CT in T6 was 253.96 ± 88.95 μm in the KC group, and of 309.39 ± 94.11 μm in the control group (p <0.041). No significant differences in mean CT were observed in the rest of the points, including the subfoveal CT (M), 351.48 ± 106.3 vs 365.35 ± 114.6 μm, (p = 0.66). No correlation was observed between the mean subfoveal CT (M), the mean CT in the KC group, and the values of K1 (p = 0.977 and p = 0.498 respectively), K2 (p = 0.450 and p = 0.656), corneal asphericity (Q ) (p = 0.986 and p = 0.902), minimal pachymetry (Pachy) (p = 0.408 and p = 0.688), keratoconus index (KI) (p = 0.601 and p = 0.217), vertical asymmetry index (VAT) (p = 0.296 and p = 0.523), staging of KC (TKC) (p = 0.549 and p = 0.08) and corneal apex morphology. Conclusion. Significant lower CT was found in the KC group in T6 (3000 μm temporal to the fovea). No significant difference of CT values in KC patients and healthy subjects was found in the other twelve measurement locations.We found no association between the refractive and keratometric indexes obtained by corneal topography and subfoveal CT.Objetivo. Determinar y comparar el grosor de la coroides (CT) en pacientes con queratocono (KC) usando OCT con Enhanced Depth Imaging (EDI). Métodos. Estudio comparativo transversal que incluye 26 pacientes con KC y 26 controles sanos evaluados con Pentacam y EDI-OCT. El KC fue medido manualmente con la función Caliper en trece puntos a intervalos regulares de 500 µm. Resultados. El promedio de CT en T6 fue de 253,96 ± 88,95 μm en el grupo KC, y de 309,39 ± 94,11 μm en el grupo de control (p <0,041). No se observaron diferencias significativas en la media de CT en el resto de los puntos, incluyendo el CT subfoveal (M), 351.48 ± 106.3 vs 365.35 ± 114.6 μm, (p = 0.66). No se observó ninguna correlación entre la media de CT (M) subfoveal, la media de CT en el grupo KC, y los valores de K1 (p = 0,977 y p = 0,498 respectivamente), K2 (p = 0,450 y p = 0,656), la asfericidad corneal (Q) (p = 0,986 y p = 0. 902), paquimetría mínima (Pachy) (p = 0,408 y p = 0,688), índice de queratocono (KI) (p = 0,601 y p = 0,217), índice de asimetría vertical (VIA) (p = 0,296 y p = 0,523), estadificación del KC (TKC) (p = 0,549 y p = 0,08) y morfología del ápice corneal. Conclusión. Se observó un CT significativamente menor en el grupo KC en T6 (3000 μm temporal a la fóvea). No se encontraron diferencias significativas entre los valores del CT en los pacientes con KC y en los sujetos sanos en los 12 puntos de medida restantes. No se encontró ninguna asociación entre los índices refractivos y queratométricos obtenidos por la topografía corneal y el CT subfoveal

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Evolution of the use of corticosteroids for the treatment of hospitalised COVID-19 patients in Spain between March and November 2020: SEMI-COVID national registry

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID- 19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236- 996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%

IPCC, 2023: Climate Change 2023: Synthesis Report, Summary for Policymakers. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, H. Lee and J. Romero (eds.)]. IPCC, Geneva, Switzerland.

This Synthesis Report (SYR) of the IPCC Sixth Assessment Report (AR6) summarises the state of knowledge of climate change, its widespread impacts and risks, and climate change mitigation and adaptation. It integrates the main findings of the Sixth Assessment Report (AR6) based on contributions from the three Working Groups1 , and the three Special Reports. The summary for Policymakers (SPM) is structured in three parts: SPM.A Current Status and Trends, SPM.B Future Climate Change, Risks, and Long-Term Responses, and SPM.C Responses in the Near Term.This report recognizes the interdependence of climate, ecosystems and biodiversity, and human societies; the value of diverse forms of knowledge; and the close linkages between climate change adaptation, mitigation, ecosystem health, human well-being and sustainable development, and reflects the increasing diversity of actors involved in climate action. Based on scientific understanding, key findings can be formulated as statements of fact or associated with an assessed level of confidence using the IPCC calibrated language

Resonancia magnética cardíaca: aplicaciones clínicas

https://digitalrepository.unm.edu/sc_advocate_news/3662/thumbnail.jp

The European contribution to "Sugarbaker's protocol" for the treatment of colorectal peritoneal carcinomatosis Aportación europea al "protocolo de Sugarbaker" en el tratamiento de la carcinomatosis peritoneal colorrectal

Introduction: in 1981, Dr. PH Sugarbaker, challenging oncological orthodoxy, considered carcinomatosis to be a locoregional stage of the disease that was still susceptible to treatment with curative intent. To this end he developed a new therapeutic alternative based on the combined treatment. The macroscopic disease treated by maximum radical oncological cytoreductive surgery (through the peritonectomies described by him), followed by treatment of the residual microscopic disease with the direct intra-abdominal application of intraoperative chemotherapy with locoregional intensification, modulated by hyperthermia and early normothermic postoperative intra-abdominal chemotherapy. Using this new therapeutic regimen, known as "Sugarbaker's Protocol", his group has reported 45% survival rates in carcinomatosis of colorectal origin at 5 years, and, in selected groups of patients, 50% survival rates at 5 years. The scientific community, however, has criticized these results considering that: it is a personal experience, with a not homogenous treatment protocol with developmental modifications over time, that it is a retrospective non-randomized study, and finally that the cytostatics used in his protocol are obsolete. Various European groups have replied to these main criticisms confirming the good results that this new therapeutic alternative offers for patients with carcinomatosis of colorectal origin. The purpose of this article is to present these contributions. Material and methods: all the articles published in the English language by European groups in the world's medical literature have been reviewed using the Pubmed-MEDLINE database to identify the relevant articles related to the treatment of carcinomatosis of colorectal origin using cytoreduction and intraperitoneal chemotherapy from January 1980 to January 2008. Results: the European contribution during these 25 years in favour of the "Sugarbaker's Protocol" has consisted fundamentally in: a) one multicenter retrospective study; b) two randomized prospective phase III studies; and c) the use of oxaliplatin and irinotecan as new cytostatic agents in the protocols for intraperitoneal chemotherapy. At the same time, two new transcendental European contributions have been made in which the possibility has been considered of combined simultaneous treatment for patients with hepatic metastases and carcinomatosis, and the introduction, as a selection factor, of patients responsive to intravenous induction chemotherapy within the regimen of sandwich treatment (with systemic neoadjuvant and adjuvant chemotherapy) complementary to intraperitoneal chemotherapy. Conclusions: the results obtained by European groups using "Sugarbaker's protocol" and "Elias' protocol" with oxaliplatin compel us to request that these treatments be considered by all professionals involved in the treatment of patients with colorectal carcinomatosis as the best treatment currently available for this condition. Furthermore a randomized, prospective, multicenter study should be carried out to clarify its value and the degree of scientific evidence. A validation of this treatment will change, in the future, the dogmatic consideration of carcinomatosis as an incurable disease stage.Introducción: el Dr. P. H. Sugarbaker en 1981, desafiando la ortodoxia oncológica, consideró la carcinomatosis como un estadio locorregional de la enfermedad susceptible todavía de tratamiento con intención curativa. Para ello desarrolló una nueva alternativa terapéutica basada en el tratamiento combinado. La enfermedad macroscópica mediante la máxima cirugía citorreductora radical oncológica (merced a las peritonectomías por él descritas), seguido del tratamiento de la enfermedad microscópica residual con la aplicación directa intraabdominal, de quimioterapia de intensificación locorregional, intraoperatoria modulada por hipertermia y de quimioterapia intraabdominal normotérmica postoperatoria precoz. Con este nuevo esquema terapéutico, conocido como "Protocolo de Sugarbaker", su grupo ha publicado supervivencias en carcinomatosis de origen colorrectal de 45% a 5 años y en grupos selectos de pacientes supervivencia de 50% a 5 años. La comunidad científica, sin embargo, ha criticado estos resultados al considerar que: se trata de una experiencia personal, con un protocolo de tratamiento no homogéneo con modificaciones evolutivas en el tiempo, tratarse de un estudio retrospectivo no randomizado, y finalmente considerar que los citostáticos empleados en su protocolo son obsoletos. Diversos grupos europeos han dado respuesta a las principales objeciones, confirmando los buenos resultados que esta nueva alternativa terapéutica ofrece en pacientes con carcinomatosis de origen colorrectal. El objetivo de este trabajo es presentar estas aportaciones. Material y métodos: se han revisado todos los artículos publicados en lengua inglesa por grupos europeos en la literatura médica mundial usando la base de datos Pubmed-MEDLINE para identificar los artículos relevantes relacionados con el tratamiento de la carcinomatosis de origen colorrectal mediante citorreducción y quimioterapia intraperitoneal desde enero de 1980 a enero de 2008. Resultados: durante estos 25 años, la aportación europea como respuesta a las objeciones al "Protocolo de Sugarbaker" ha consistido fundamentalmente en: a) un estudio multicéntrico retrospectivo; b) dos estudios randomizados prospectivos fase III; y c) en la utilización del oxaliplatino e irinotecán como nuevos agentes citostáticos en los protocolos de quimioterapia intraperitoneal. Paralelamente se han producido dos nuevas aportaciones euro-peas trascendentales al considerar la posibilidad del tratamiento conjunto simultáneo en pacientes con metástasis hepáticas y carcinomatosis, y al introducir como factor de selección a los pacientes respondedores a quimioterapia intravenosa de inducción, dentro del esquema del tratamiento sándwich (con quimioterapia sistémica neoadyuvante y adyuvante) complementaria a la quimioterapia intraperitoneal. Conclusiones: la resultados obtenidos por los grupos euro-peos utilizando el "protocolo de Sugarbaker" y el "protocolo de Elias" con oxaliplatino, nos obligan a solicitar que estos tratamientos sean considerados por todos los profesionales, involucrados en el tratamiento de pacientes con carcinomatosis colorrectal, como el mejor tratamiento disponible en la actualidad para esta patología, y permita la realización de un estudio randomizado prospectivo multicéntrico que esclarezca su valía y grado de evidencia científica. La validación de este tratamiento, permitirá en el futuro cambiar el dogma de considerar a la carcinomatosis como un estadio incurable de la enfermedad

Invasive infections with Purpureocillium lilacinum: clinical characteristics and outcome of 101 cases from FungiScope® and the literature

ObjectivesTo provide a basis for clinical management decisions in Purpureocillium lilacinum infection.MethodsUnpublished cases of invasive P. lilacinum infection from the FungiScope® registry and all cases reported in the literature were analysed.ResultsWe identified 101 cases with invasive P. lilacinum infection. Main predisposing factors were haematological and oncological diseases in 31 cases (30.7%), steroid treatment in 27 cases (26.7%), solid organ transplant in 26 cases (25.7%), and diabetes mellitus in 19 cases (18.8%). The most prevalent infection sites were skin (n = 37/101, 36.6%) and lungs (n = 26/101, 25.7%). Dissemination occurred in 22 cases (21.8%). Pain and fever were the most frequent symptoms (n = 40/101, 39.6% and n = 34/101, 33.7%, respectively). Diagnosis was established by culture in 98 cases (97.0%). P. lilacinum caused breakthrough infection in 10 patients (9.9%). Clinical isolates were frequently resistant to amphotericin B, whereas posaconazole and voriconazole showed good in vitro activity. Susceptibility to echinocandins varied considerably. Systemic antifungal treatment was administered in 90 patients (89.1%). Frequently employed antifungals were voriconazole in 51 (56.7%) and itraconazole in 26 patients (28.9%). Amphotericin B treatment was significantly associated with high mortality rates (n = 13/33, 39.4%, P = &lt;0.001). Overall mortality was 21.8% (n = 22/101) and death was attributed to P. lilacinum infection in 45.5% (n = 10/22).ConclusionsP. lilacinum mainly presents as soft-tissue, pulmonary or disseminated infection in immunocompromised patients. Owing to intrinsic resistance, accurate species identification and susceptibility testing are vital. Outcome is better in patients treated with triazoles compared with amphotericin B formulations

Tercer Congreso de Investigación Científica - UNAH

Tercer Congreso de Investigación Científica - UNAH. Síntesis del 3er Congreso de Investigación Científica realizada del 28 de septiembre al 1 de octubre del 2009 en la UNAH. Evento realizado por la Dirección de Investigación Científica de la UNAH