Independent sets and non-augmentable paths in generalizations of tournaments

AbstractWe study different classes of digraphs, which are generalizations of tournaments, to have the property of possessing a maximal independent set intersecting every non-augmentable path (in particular, every longest path). The classes are the arc-local tournament, quasi-transitive, locally in-semicomplete (out-semicomplete), and semicomplete k-partite digraphs. We present results on strongly internally and finally non-augmentable paths as well as a result that relates the degree of vertices and the length of longest paths. A short survey is included in the introduction

Análisis del programa de detección precoz de hipoacusia en recién nacidos en la provincia de Salamanca (años 2005-2014)

[ES] La hipoacusia es un problema de Salud Pública y sus consecuencias en los niños se ponen de manifiesto cuando ésta se desarrolla en el periodo neonatal. Se trata de una enfermedad que cumple con todos los requisitos para ser sometida a un cribado universal. Su diagnóstico precoz e intervención temprana permiten evitar dichas consecuencias y, por tanto, conseguir un desarrollo social, educativo, emocional y comunicativo apropiado. Hasta el año 2004 en los hospitales de Castilla y León se realizaba el cribado sólo a los niños que presentaban factores de riesgo de la misma y es a partir de ese año cuando se inicia en los 14 hospitales públicos de nuestra Comunidad Autónoma el “Programa de Detección Precoz y Atención Integral de la Hipoacusia Infantil en Castilla y León”. En este trabajo se realiza el estudio de cómo se ha producido el desarrollo del Programa de Detección Precoz de la Hipoacusia Neonatal en los niños nacidos en la provincia de Salamanca durante los diez primeros años desde su implantación (años 2005 al 2014, ambos incluidos). Se realiza la comparación con la situación previa cuando sólo se realizaba cribado auditivo a los niños que presentaban factores de riesgo de hipoacusia (años 2000 a 2003, ambos incluidos), en términos de edad de diagnóstico y edad de instauración del tratamiento. El Programa aplicado en nuestra población cumple con los criterios de calidad establecidos por la Comisión para la detección precoz de la hipoacusia infantil (CODEPEH). Los factores de riesgo más frecuentes detectados en nuestra población entre los años 2005 y 2014 (ambos incluidos) son la historia familiar de hipoacusia permanente desde la infancia, cualquier enfermedad que requiera un ingreso en Unidad de cuidados intensivos neonatales mayor de 48 horas y un peso menor de 1500 gramos

Symptoms and signs of unilateral and bilateral vestibular hypofunction

[ES] Introducción y objetivo: La disfunción vestibular periférica implica a los órganos vestibulares o a los nervios vestibulares, produciendo una gran variedad de síntomas y signos clínicos. Método: Revisión narrativa. Discusión: El otoneurólogo es el encargado de realizar una evaluación exhaustiva para llegar a identificar el trastorno que presenta el paciente que acude con vértigo o desequilibrio. La clave diagnóstica es la anamnesis profunda completada con un cuidadoso examen otoneurológico. Además, las nuevas tecnologías de estudio que han surgido en este campo permiten un cambio en la definición, caracterización y tratamiento de estas patologías. Conclusiones: En la presente revisión narrativa se describirán los dos grandes grupos de deficiencia vestibular periférica: la vestibulopatía unilateral y bilateral

Vestibular compensation

[ES] Introducción y objetivo: La compensación vestibular es el conjunto de procesos que se ponen en marcha cuando tiene lugar una lesión a nivel vestibular sea cual sea el origen y la magnitud de la misma. a vez establecida la lesión los mecanismos de compensación del daño son variados y se establecen diferentes líneas de actuación. Para conocer cómo mejorar el estado de nuestros pacientes es importante saber cómo funciona la compensación vestibular y a qué niveles podemos actuar para acelerar el proceso de recuperación. Conclusiones: Es importante conocer los mecanismos de compensación vestibular para adecuar la terapia a cada paciente y así mejorar su calidad de vida

Usefulness of circulating microRNAs miR-146a and miR-16-5p as prognostic biomarkers in community-acquired pneumonia

Introduction Patients with community-acquired pneumonia (CAP) undergo a dysregulated host response that is related to mortality. MicroRNAs (miRNAs) participate in this response, but their expression pattern and their role as biomarkers in CAP have not been fully characterized. Methods A prospective observational study was performed in a cohort of 153 consecutive patients admitted to hospital with CAP. Clinical and analytical variables were collected, and the main outcome variable was 30-day mortality. Small RNA was purified from plasma of these patients obtained on the first day of admission, and miRNA expression was analyzed by RTPCR. Univariate and multivariate analyses were carried out through the construction of a logistic regression model. The proposed model was compared with established prognostic clinical scales using ROC curve analysis. Results The mean age of the patients included was 74.7 years [SD 15.9]. Their mean PSI was 100.9 [SD 34.6] and the mean modified Charlson index was 2.9 [SD 3.0]. Both miR-146a and miR- 16-5p showed statistically significant association with 30-day mortality after admission due to CAP (1.10 vs. 0.23 and 51.74 vs. 35.23, respectively), and this association remained for miR-16-5p in the multivariate analysis adjusted for age, gender and history of bronchoaspiration (OR 0.95, p = 0.021). The area-under-the-curve (AUC) of our adjusted multivariate model (AUC = 0.954 95%CI [0.91–0.99]), was better than those of prognostic scales such as PSI (AUC = 0.799 [0.69–0.91]) and CURB-65 (AUC = 0.722 [0.58–0.86]). Conclusions High levels of miR-146a-5p and miR-16-5p upon admission due to CAP are associated with lower mortality at 30 days of follow-up. Both miRNAs could be used as biomarkers of good prognosis in subjects hospitalized with CAPThis work has been funded by the Carlos III Health Institute (ERDF, European Regional Development Fund), by the Spanish Society of Pneumology and Thoracic Surgery and by the Ministry of Science, Innovation and Universities of Spain

Cochlear implantation in bilateral Ménière’s disease. A case report

Introducción: La enfermedad de Ménière se caracteriza por síntomas cocleares y vestibulares. Puede ser unilateral o bilateral. Cuando la pérdida de audición asociada es severa-profunda de forma bilateral o unilateral pero con problemas de audición en el otro oído, dicha audición puede beneficiarse de un implante coclear. Si además, presenta crisis de vértigo y Tumarkin refractarias al tratamiento médico, se puede plantear la realización simultánea de una laberintectomía quirúrgica y colocación de un implante coclear. Descripción: Se describe el caso de un paciente con enfermedad de Ménière bilateral con hipoacusia neurosensorial profunda de oído derecho con fluctuaciones auditivas izquierdas que asocia crisis vertiginosas y de Tumarkin sin respuesta a corticoides orales e intratimpánicos ni a gentamicina intratimpánica. Se le realizó una laberintectomía quirúrgica con implante coclear en el mismo acto quirúrgico anticipándonos al probable deterioro auditivo contralateral. Posteriormente presenta buen rendimiento del implante y desaparición de las crisis del oído intervenido. Discusión: El objetivo del tratamiento es controlar las crisis preservando la función, pero en pacientes en los que las medidas conservadoras fallan, se han de considerar otras más destructivas como es la laberintectomía química, que consigue altas tasas de control de las crisis, y el implante coclear, indicado para restaurar la audición en el oído afectado por enfermedad de Ménière. Si ambas se realizan en un mismo tiempo quirúrgico, se consigue reducir riesgos asociados con otros procedimientos quirúrgicos y anestésicos y evitar las modificaciones histológicas tras una laberintectomía química que dificultarían la posterior colocación del implante colear.Introduction and objective: Ménière’s disease (MD) is an episodic vestibular syndrome associated with sensorineural hearing loss and tinnitus. It may be unilateral or bilateral. Cochlear implantation (CI) could be considered in MD patients if a profound hearing loss is showed in both ears. As alternative, it should be valued if profound hearing loss affects only one ear but the contralateral is affected too. When a MD patient suffers from vertigo spells or otolitic crisis of Tumarkin appart from the profound hearing loss, a simultaneous surgical labyrinthectomy and CI procedure could be considered. Description: Bilateral MD patient with right profound hearing loss and left fluctuating moderate hearing loss. No response was observed after oral and intratympanic steroids and intratympatic gentamicin in the treatment of right ear. A cochlear implantation and classic labyrinthectomy were performed at the same time in the right ear. No new vertigo spells or otolitic crisis of Tumarkin appeared after three months of follow up. Discussion: The objective in the treatment of MD is to get the control of vertigo spells and a hearing preservation. When conservative treatment is not useful, the gold standard is the labyrinthectomy (gentamicin or classic labyrinthectomy). The surgical labyrinthectomy could be accompanied by cochlear implantation to restore hearing in this ear. To perform both surgical labyrinthectomy and cochlear implantation simultaneously should be considered in order to reduce anesthesic ricks and cochlear histological changes after labyrinthectomy

Hearing loss after intratympanic gentamicin in Ménière's disease. Retrospective study

Introduction and objective: Ménière's disease (MS) is characterized by recurrent vertigo attacks with tinnitus, hearing loss and aural fullness. Among the therapeutic options, intratympanic injection of gentamicin (ITG) will be discussed, among others. The objective is to evaluate hearing loss after ITG in patients with MS. Method: 33 patients of the Otorhinolaryngology and Head and Neck Surgery Service of the Hospital Clínico Universitario de Salamanca will be studied, all of them with definitive MS to whom ITG was administered. Hearing loss will be assessed one month after the ITG, at 6, 12 and 24 months. Results: Of the 33 patients analyzed, 78.8% had unilateral MS; 21.2%, bilateral. 48.5% were women; 51.5%, men. 39.4% had already been treated with betahistine and corticosteroids. 9 patients presented Tumarkin crisis before ITG. The PTA (Pure Tone Average) prior to ITG administration was compared with that obtained at 2 years and hearing decreased from 57.50 dB to 62.58 dB. 9 patients required a second round of ITG, with a hearing loss ranging from 66.72 dB to 68.96 dB. And after this, 3 patients needed a third wave, hearing from 63.75dB to 72.50 dB. Conclusions: The use of ITG in MS causes a fall in PTA of around 5 dB at the expense of an improvement in the frequency and intensity of vertigo attacks./nIntroducción y objetivo: La enfermedad de Ménière (EM) se caracteriza por crisis de vértigo recurrentes acompañadas de acúfenos, pérdida de audición y sensacio?n de plenitud o?tica. Dentro de las opciones terapéuticas se hablará, entre otras, de inyección de gentamicina intratimpánica (ITG). El objetivo es evaluar la pérdida de audición tras la ITG en pacientes con EM. Método: Se estudiaron 33 pacientes con EM definitiva a los cuales se les administró ITG. Se valoró la pérdida de audición al mes de la ITG, a los 6, 12 y 24 meses. Resultados: De los 33 pacientes analizados, el 78,8% presentaban EM unilateral; el 21,2%, bilateral. El 48,5% fueron mujeres; el 51,5%, hombres. El 39,4% ya habían sido tratados con betahistina y corticoides. 9 pacientes presentaron crisis de Tumarkin antes de la ITG. Se comparó el PTA (Pure Tone Average) previo a la administración de ITG con el obtenido a los 2 años y la audición disminuyó de 57,50 dB a 62,58 dB. 9 pacientes precisaron una segunda tanda de ITG, con una pérdida de audición desde 66,72 dB a 68,96 dB. Y tras esto, 3 pacientes necesitaron una tercera tanda, pasando la audición de 63,75dB a 72,50 dB. Conclusiones: La utilización de ITG en la EM y provoca una caída del PTA de alrededor de 5 dB a expensas de una mejoría en la frecuencia e intensidad de las crisis de vértigo./

Clinical and Cytokine Profile in Patients with Early and Late Onset Meniere Disease

Background: Meniere disease (MD) is an inner ear disorder associated with comorbidities such as autoimmune diseases or migraine. This study describes clinical and cytokine profiles in MD according to the age of onset of the condition. Methods: A cross-sectional study including 83 MD patients: 44 with early-onset MD (EOMD, <35 years old), and 39 with late-onset MD (LOMD, >50 years old), 64 patients with migraine and 55 controls was carried out. Clinical variables and cytokines levels of CCL3, CCL4, CCL18, CCL22, CXCL,1 and IL-1β were compared among the different groups. Results: CCL18 levels were higher in patients with migraine or MD than in controls. Elevated levels of IL-1β were observed in 11.4% EOMD and in 10.3% LOMD patients and these levels were not dependent on the age of individuals. EOMD had a longer duration of the disease (p = 0.004) and a higher prevalence of migraine than LOMD (p = 0.045). Conclusions: Patients with EOMD have a higher prevalence of migraine than LOMD, but migraine is not associated with any cytokine profile in patients with MD. The levels of CCL18, CCL3, and CXCL4 were different between patients with MD or migraine and controls.ISCIII and European Regional Funds (Grants PI17/01644 and PI20/01126)Andalusian Health Government (Grant PE-0356-2018).Andalusian Health Government (Grant PI-0027-2020)

Deregulated cellular circuits driving immunoglobulins and complement consumption associate with the severity of COVID-19 patients

SARS-CoV-2 infection causes an abrupt response by the host immune system, which is largely responsible for the outcome of COVID-19. We investigated whether the specific immune responses in the peripheral blood of 276 patients were associated with the severity and progression of COVID-19. At admission, dramatic lymphopenia of T, B, and NK cells is associated with severity. Conversely, the proportion of B cells, plasmablasts, circulating follicular helper T cells (cTfh) and CD56–CD16+ NK-cells increased. Regarding humoral immunity, levels of IgM, IgA, and IgG were unaffected, but when degrees of severity were considered, IgG was lower in severe patients. Compared to healthy donors, complement C3 and C4 protein levels were higher in mild and moderate, but not in severe patients, while the activation peptide of C5 (C5a) increased from the admission in every patient, regardless of their severity. Moreover, total IgG, the IgG1 and IgG3 isotypes, and C4 decreased from day 0 to day 10 in patients who were hospitalized for more than two weeks, but not in patients who were discharged earlier. Our study provides important clues to understand the immune response observed in COVID-19 patients, associating severity with an imbalanced humoral response, and identifying new targets for therapeutic interventionThe study was funded by grants SAF2017- 82886-R to FS-M from the Ministerio de Economía y Competitividad, and from “La Caixa Banking Foundation” (HR17-00016) to FS-M. Grant PI018/01163 to CMC and grant PI19/00549 to AA were funded by Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo, Spain. SAF2017-82886-R, PI018/01163 and PI19/00549 grants were also co-funded by European Regional Development Fund, ERDF/FEDER. This work has been funded by grants Fondo Supera COVID (CRUE-Banco de Santander) to FSM, and “Ayuda Covid 2019” from Comunidad de Madri

Oral health service utilization by elderly beneficiaries of the Mexican Institute of Social Security in México city

<p>Abstract</p> <p>Background</p> <p>The aging population poses a challenge to Mexican health services. The aim of this study is to describe recent oral health services utilization and its association with socio-demographic characteristics and co-morbidity in Mexican Social Security beneficiaries 60 years and older.</p> <p>Methods</p> <p>A sample of 700 individuals aged 60+ years was randomly chosen from the databases of the Mexican Institute of Social Security (IMSS). These participants resided in the southwest of Mexico City and made up the final sample of a cohort study for identifying risk factors for root caries in elderly patients. Sociodemographic variables, presence of cognitive decline, depression, morbidity, medication consumption, and utilization of as well as reasons for seeking oral health services within the past 12 months were collected through a questionnaire. Clinical oral assessments were carried out to determine coronal and root caries experience.</p> <p>Results</p> <p>The sample consisted of 698 individuals aged 71.6 years on average, of whom 68.3% were women. 374 participants (53.6%) had made use of oral health services within the past 12 months. 81% of those who used oral health services sought private medical care, 12.8% sought social security services, and 6.2% public health services. 99.7% had experienced coronal caries and 44.0% root caries. Female sex (OR = 2.0), 6 years' schooling or less (OR = 1.4), and caries experience in more than 22 teeth (OR = 0.6) are factors associated with the utilization of these services.</p> <p>Conclusion</p> <p>About half the elderly beneficiaries of social security have made use of oral health services within the past 12 months, and many of them have to use private services. Being a woman, having little schooling, and low caries experience are factors associated with the use of these services.</p