Perspectiva bioética de la detención temprana de hipoacusias y el implante coclear en edad pediátrica en la Argentina

La hipoacusia se define como la disminución de la percepción auditiva, la cual constituye la vía habitual para la adquisición el lenguaje. Se trata de un problema relevante en la infancia temprana, dado que el logro de capacidades y habilidades intelectuales y sociales están ligados a un desarrollo adecuado de la audición como principal vía de aprendizaje. La audición, junto con el resto de los sentidos permite el establecer relaciones sociales y del individuo con su entorno. Es uno de los principales procesos fisiológicos que posibilita a los niños el aprendizaje, siendo de suma importancia para el desarrollo del pensamiento. Por ello es importante analizar las diferentes aristas que intervienen en la prevención, promoción y atención primaria y secundaria de dicha afección. A continuación analizaremos el Programa Nacional de Detección Temprana de Hipoacusias (su legislación, gestión y funcionalización), la importancia de una adecuada información a los padres o responsables del niño hipoacúsico, la perspectiva de la cultura sorda y la perspectiva de la oralización de pacientes sordos mediante el implante coclear en la infancia.Hearing loss is defined as the decrease in auditory perception, wich is the usual way to acquire language. This is a relevant problem in early childhood, as the achievement of skills and intellectual and social skills are linked to proper development of hearing as the main means of learning. The hearing, along with the rest of the senses allows social relationships and the individual with his environment. It is one of the key physiological processes that enables children learning to be of utmost importance for the development of thought. We considered important to analyze the different aspects involved in prevention, promotion and primary and secondary care of these condition. We will discuss the National Early Hearing Loss Screening (legislation, management and functionalization), the importance of adequate information to parents or guardians of children with hearing loss, the deaf culture perspective and the perspective of oralist deaf patients, through the cochlear implant in children.Fil: Saenz, A. Hospital Universitario (Mendoza, Argentina)Fil: Fazio, S.. Hospital Universitario (Mendoza, Argentina)Fil: Arreghini, M.. Hospital Pediátiro Humberto J. Notti (Mendoza, Argentina

Influence of rainfall on the discharge, nutrient concentrations and loads of a stream of the "Pampa Ondulada" (Buenos Aires, Argentina)

The basin area of the Durazno Stream covers approx. 360 km2 of a plain with a gentle slope, mainly devoted to cattle farming and agriculture. This study examines the variability of chemical composition of surface water of the stream in relation to stream discharge, estimated from a hydrological deterministic model from rainfall data. Fifteen samplings were carried out, four in high flow condition and the rest in baseline flow. In each sampling, the main physico-chemical variables were determined. Since discharge data from this stream were not available, it was estimated in situ through an instantaneous unitary hydrograph model. Both estimations of stream discharge were similar. The main forms of dissolved inorganic nitrogen were ammonium and nitrate. The four significant components of PCA that explained 84.4 % of total variance were: mineral component, particulate matter content, ammonium and dissolved phosphorus levels, and nitrates' level. The decreased concentrations of major ions and conductivity during high flow condition suggest solutes' dilution by the massive inflow of water originated by rainfalls. The highest concentrations and loads of suspended solids (SS) (86 mg/l and 22638 kg/day) and particulate organic carbon (POC) (3.1 mg/l and 832 kg/day) were observed in the sample obtained during the rising limb of the hydrograph following a drought period, suggesting that basin erosive processes are more important during the first hours of the storm. Three of the samplings that were carried out in high flow conditions showed low mineral and nutrient content that revealed better water quality. In contrast, the sampling with the greatest total runoff (14.1 mm) showed high concentrations of ammonium (1205 μg/l) and dissolved phosphorus (561 μg/l), suggesting that a long stagnant period on soils with low permeability, could favor reduction processes of nitrate to ammonium and mobilization of dissolved phosphorus to overlying water. The nutrients' loads increased in high flow conditions most likely due to runoff from the riverbank soils. The rise of nutrients, SS, POC and total organic carbon (TOC), loads in the same or in higher proportion than the stream discharge, alerts on the risk of contamination of surface water in an agricultural basin.La cuenca del Arroyo Durazno abarca aproximadamente 360 km2 de una llanura con suave pendiente, dedicada principalmente a ganadería y agricultura. Este estudio examina la variabilidad en la composición química del agua superficial del arroyo en relación con el caudal estimado a través de un modelo hidrológico determinístico a partir de los datos de lluvia. Se realizaron quince muestreos: cuatro en condiciones de alto caudal, los restantes en caudal base. En cada muestreo se determinaron las principales variables fisico-químicas. Dado que no existen datos publicados de caudal de este arroyo, se lo estimó in situ, y a partir del modelo de hidrograma unitario. Ambas estimaciones resultaron similares. Las principales formas de nitrógeno inorgánico disuelto fueron amonio y nitrato. Los primeros 4 factores extraídos del PCA que explicaron 84.4 % de la varianza total fueron: componente mineral, contenido de material particulado, niveles de amonio y fósforo disuelto y nivel de nitratos. El decrecimiento de iones mayoritarios y conductividad durante las condiciones de alto caudal sugiere su dilución por la entrada masiva de agua por lluvias. Las mayores concentraciones y cargas de sólidos suspendidos (SS) (86 mg/l y 22638 kg/día) y carbono orgánico particulado (COP) (3.1 mg/l y 832 kg/día) se hallaron en el muestreo realizado durante la rama ascendente del hidrograma posterior a un período de sequía, sugiriendo que los procesos erosivos de la cuenca son más importantes en las primeras horas de la tormenta. Tres de los muestreos realizados en condiciones de alto caudal presentaron bajo contenido mineral y de nutrientes, indicando mejor calidad de agua. En cambio en el muestreo de mayor lámina de escorrentía acumulada (14.1 mm) las concentraciones de amonio (1205μg/l) y fósforo disuelto (561μg/l) fueron elevadas, sugiriendo que un prolongado periodo de estancamiento en un suelo de baja permeabilidad favorecería los procesos de reducción de nitratos a amonio y la movilización de fósforo disuelto al agua de inundación. Las cargas de nutrientes aumentaron en condiciones de alto caudal probablemente debido al aporte por escorrentía de suelos ribereños. El ascenso en las cargas de nutrientes, SS, COP y carbono orgánico total en igual o mayor magnitud que el caudal alerta sobre el riesgo de contaminación de las aguas superficiales en una cuenca agrícola

Nutritional status in post SARS-Cov2 rehabilitation patients

After prolonged hospitalization, the assessment of nutritional status and the identification of adequate nutritional support is of paramount importance. In this observational study, we aimed at assessing the presence of a malnutrition condition in SARS-Cov2 patients after the acute phase and the effects of a multidisciplinary rehabilitation program on nutritional and functional status

Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

Background: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams.Objectives: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases.Methods: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions.Results: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive\u2014Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post\u2014Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache.Conclusions: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian Consensus Conference on Pain in Neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

FOCUS SULLA MALATTIA METAFOCALE ASPETTI ETIOPATOGENETICI E CLINICI. DESCRIZIONE DI CASI DI INTERESSE MEDICO-SPECIALISTICO

Le infezioni misconosciute a partenza dal cavo orale e da foci otorinolaringoiatrici (ORL) rappresentano un importante fattore di rischio per lo sviluppo di patologie a carattere sistemico. Scopo della presente rassegna è stato da un lato, quello di analizzare le malattie metafocali che originano da foci odontoiatrici ed ORL e definire il ruolo delle diverse figure mediche specialistiche impegnate nella gestione clinica delle problematiche ad esse associate ed in particolare quello centrale dell’infettivologo; dall’altro, quello di effettuare una revisione dei casi più recenti riportati in letteratura internazionale, descrivendone alcuni di rilevante interesse clinico osservati presso l’Università di Ferrara

Tolerability, safety and efficacy of Iloprost infusion without peristaltic pump in systemic sclerosis

Objective. To evaluate safety, tolerability and efficacy on Raynaud’s phenomenon (Rp) of iloprost infusion without peristaltic pump in patients with systemic sclerosis (SSc). Patients and methods. The inclusion criteria were diagnosis of SSc, age between 18 and 65 years, presence of Rp, and absence of any controindication to the use of iloprost. The treatment was carried out in a day hospital setting and consisted first of 5 consecutive days of iloprost infusion (from an initial dose of 1.0 ng/Kg/min up to 2 ng/kg/min), and then of 2 days of infusions at the maximum possible dose every 45 days for one year. All of the adverse events were carefully recorded and the changes in the Rp were measured by a 5 grade scale (worsened, unmodified, slightly improved, very improved, disappeared). Results. Thirty-eight SSc patients (all females), mean age 49 years (range 18.5-65), disease duration 1.5 years (range 0.5-10.8) were enrolled in the study. During the first cycle of therapy, 14 avderse events occurred in 11 (28.9%) patients and during the next cycles, 3 adverse events were seen in 3 (7.9%) patients. In all of the cases they were mild and transient. Rp was considered very improved in 15 (39.5%) patients, slightly improved in 13 (34.2%), unmodified in 8 (21%) and worse in 2 (5.2%). Discussion. In this study intravenous iloprost without peristaltic pump proved to be safe, well tolerated, and as effective as traditional infusion through peristaltic pump in improving Rp in patients with SSc

Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients

The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients

Programme and retention characteristics of SONOS memory arrays with layered tunnel barrier

Layered tunnel barriers (T-ONO) might help circumvent retention limitations of nitride charge trapping devices (SONOS) programmed/erased by direct tunnelling without invoking high-K dielectrics in the gate stack. In order to establish to what extent the properties of a T-ONO tunnel layer influence the performance of SONOS memories, NOR memory arrays containing a silicon oxide/silicon nitride/silicon oxide T-ONO layer, a silicon nitride charge trapping layer and a silicon oxide blocking layer were fabricated and investigated. The T-ONO layer was formed using wet reoxidation of the silicon nitride, as this process is known to generate a lot of traps at the interface between silicon nitride and silicon oxide, as well as in the reoxidized portion of the silicon nitride itself. Besides standard memory measurements like programme/erase behaviour, endurance and retention, charge centroid extraction measurements were carried out in order to explain the retention behaviour and associate it with the position of the charge. It has been demonstrated that the performance of SONOS memories with a T-ONO layer strongly depends on the technological properties/quality of the T-ONO barrier which, therefore, may not be a universal solution to retention problems in SONOS devices

Water pollution in an urban Argentine river

Discharges derived from industries, crude sewage, municipal wastes and petroleum have been the most common and important source of pollution to the main rivers of the Province of Buenos Aires, Argentina. During the last decade, several investigations have been carried out to determine the effects of pollution upon the biotic communities of the rivers located in this region. The present paper describes the density variations of the main groups of phyto- and zooplankton in relation to several environmental variables, including heavy metals, throughout the main channel of the river. The effects of complex chemical mixtures present in the water were assessed through genotoxic activity and algal assays. Phytoplankton (mean: 25,000 ind. mL-1) and zooplankton (mean: 534 ind. L-1) densities were high, exceeding by approximately an order of magnitude the mean records from Reconquista River. Cyanophyceae (38%), Chlorophyceae (33%), Bacillariophyceae (23%) and Euglenophyceae (10%) were the dominant algal classes. Rotifers were widely dominant among zooplankton groups (99%). Algal bioassays showed that the inhibition of growth was correlated with nickel. This river has been and still undergoes recovery plans that focus the treatment mainly on the cleaning of its river bed. The results obtained suggest that a definitive recovery of the river should not only rely on river bed cleaning and a decrease in the input of crude effluents, but also on the care and recovery of the river banks and surrounding lands.Fil: Magdaleno, Anahí. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Puig, Alba. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: de Cabo, Laura Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Salinas, Cristian. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Arreghini, Silvana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Korol, Sonia. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Bevilacqua, S.. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: López, Laura. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Moretton, Juan. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentin