Contribución de la tomografía computada con densitometría ósea en el diagnóstico de la otoesclerosis

Planteo del problema: la otoesclerosis es una patología que en sus formas clínicas de hipoacusia mixta neurosensorial presenta un desafío diagnóstico no resuelto. El aporte de las imágenes no ha significado una ayuda, debido a técnicas complejas y de difícil interpretación. Se propone una técnica de medición densitométrica en tomografía computada con 10 puntos sobre la cápsula laberíntica para determinar focos de reabsorción o fijación ósea. Objetivos: determinar sensibilidad y especificidad de una nueva técnica de medición densitométrica en tomografía computada de pacientes con otoesclerosis. Material y métodos: se comparan 2 grupos. Un grupo control de 20 oídos sanos, y un grupo problema de 30 pacientes. A todos se les realiza medición de densitometría en Unidades Hounsfield (U.H.) de acuerdo a técnicas sencillas (7 a 10 puntos de medición). Resultados: en el grupo control se hallaron los siguientes valores de referencia: promedio y desviación estándar 2038+-64 U.H. en el grupo problema se hallaron valores por fuera del rango, determinándose un valor de 203 U.H. en más o menos del promedio, como valor altamente sugestivo de enfermedad (sensibilidad 80.8% y especificidad 85%).Fil: Zernotti, Mario Emilio. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin

Hearing preservation and cochlear implants according to inner ear approach: multicentric evaluation

AbstractIntroductionElectroacoustic stimulation is an excellent option for people with residual hearing in the low frequencies, who obtain insufficient benefit with hearing aids. To be effective, the subject's residual hearing should be preserved during cochlear implant surgery.ObjectivesTo evaluate the hearing preservation in patients that underwent implant placement and to compare the results in accordance with the approach to the inner ear.Methods19 subjects underwent a soft surgical technique, and the electrode MED-EL FLEX™ EAS, designed to be atraumatic, was used. We evaluated pre- and postoperative tonal audiometric tests with an average of 18.4 months after implantation, to measure the rate of hearing preservation.Results17 patients had total or partial preservation of residual hearing; 5 had total hearing preservation and two individuals had no preservation of hearing. The insertion of the electrode occurred through a cochleostomy in 3 patients, and in 2 of these there was no hearing preservation; the other 16 patients experienced electrode insertion through a round window approach. All patients benefited from the cochlear implant, even those who are only using electrical stimulation.ConclusionThe hearing preservation occurred in 89.4% of cases. There was no significant difference between the forms of inner ear approach

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Prótese implantável do ouvido médio: ganho funcional em perda auditiva mista

Atresia óssea e otite média crônica são os principais grupos de beneficiários com implantes do ouvido médio. Cirurgia de atresia é tecnicamente complexo, tem muitas complicações e resultados funcionais pobres. Os aparelhos auditivos osseointegrados são uma alternativa. Eles fornecem um ganho funcional muito bom, mas tem muitos problemas de pele e osseointegração. Na otite média crônica, ossiculoplastias resolveram parcialmente o problema de audição. Infelizmente, em alguns casos de otites média e cavidades abertas, equipamentos com aparelhos auditivos convencionais são difíceis e muitas vezes insatisfatórios. Objetivo: Determinar a utilidade de um implante do ouvido médio. Desenho de estudo longitudinal. Métodos: Vibrant-Soundbrigde foi implantado em oito pacientes com perda auditiva mista grave. Quatro apresentavam otite média crônica e quatro apresentavam atresia unilateral. A colocação do estimulador (FMT ou Floating Mass Transducer) foi em cinco pacientes na janela redonda, dois no estribo e um na janela oval. Resultados: Ganho funcional foi de 35 dB, 40 dB, 48,7 dB e 50 dB para as frequências de 500, 1000, 2000 e 4000 Hz, respectivamente. Conclusão: Vibrant-Soundbrigde é uma excelente opção no restabelecimento da audição em perda auditiva mista grave e profunda. Ele fornece um excelente ganho funcional em doenças de difícil tratamento com equipamentos convencionais.Fil: Zernotti, Mario Emilio. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Di Gregorio, María Fernanda. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Bravo Sarasty, Andrea C. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin

Active smoking effect in allergic rhinitis

Background: Tobacco smoke has been described as causing increased prevalence of rhinitis symptoms and decreased atopy. Furthermore, these nasal symptoms and quality of life in smokers with Allergic Rhinitis (AR) were not significantly different to non-smokers. As a result of this duality, a comparison study between the quality of life and inflammatory markers of atopy among active smokers and non-smokers having AR was put forward. Material and methods: Cross-sectional study in adult smokers and non-smokers, with a clinical diagnosis of AR and positive Skin Prick Test (SPT). Smoking status was confirmed by salivary cotinine measurements. Functional respiratory evaluation was performed, and quality of life between groups was compared using Mini-RQLQ questionnaire. Immunological markers in serum and nasal washes (IgE, IL-4, IL 5, IL 13, IL 17, IL 33) were evaluated, while samples from a third group of passive smokers was incorporated for serological comparison exclusively. The statistical analysis included Student T test, x2, Mann Whitney U (Anova 2-way), and Kruskal Wallis for 3 groups analysis. Values of P < 0.05 were considered significant. Results: Twenty-two patients per group with similar demographics and allergen sensitivity were studied. Regarding inflammatory markers, a reduction of IL 33 in the serum of smokers (P < 0.001) was the only statistically significant different parameter revealed, showing a remarkable trend in nasal lavage. Salivary cotinine levels were absolutely different (P < 0.0001), but pulmonary function evaluations were not statistically significant after multiple adjusting. There were no significant differences in quality of life parameters. Conclusions: In our study of AR, active smokers do not demonstrate impaired nasal related quality of life or impact on atopic inflammatory parameters, compared to non-smokers. Reduced levels of IL33 could explain a lack of symptoms alerting smokers of the harmful consequences of smoking.Fil: Gómez, René Maximiliano. Instituto Médico Alas. Fundación Ayre; ArgentinaFil: Croce, Víctor Hugo. Instituto Modelo Cardiología. Pediatric Allergy Dept.; ArgentinaFil: Zernotti, Mario Emilio. Universidad Católica de Córdoba. Faculty of Medicine; ArgentinaFil: Muiño, Juan Carlos. Dept. on Allergy & Immunology Association of Córdoba; Argentin

New perspectives in the treatment of allergic rhinitis and asthma in children

PURPOSE OF REVIEW: Allergic rhinitis and asthma are some of the most prevalent chronic diseases in children. Meticulous evaluations of the therapeutic options and interventions are needed to control this burden. The central pathogenic mechanism is an immediate hypersensitivity reaction, followed by interventions in the allergic cascade. Once inflammation is established, potent anti-inflammatory agents or mediator antagonists could help control the phenomenon and reduce the characteristic symptoms related to severity. RECENT FINDINGS: Monoclonal antibody against IgE has demonstrated its efficacy in reducing the symptoms of asthma and rhinitis. In difficult-to-treat asthma patients it allows a reduction in the dose of inhaled steroids, the number of exacerbations, emergency visits and hospitalizations. Its broad implementation is limited by its high cost because adverse events are not a concern. Specific sublingual immunotherapy gave promising results in clinical trials, while modifying immunoglobulins and cytokine profiles, also inducing T-cell tolerance. Safety issues of subcutaneous immunotherapy have been surpassed by the sublingual route, with equivalent efficacy. The new inhaled steroid ciclesonide is effective in established inflammation, is activated only in the respiratory system, and has negligible systemic effects. SUMMARY: Robust evidence on the efficacy and safety of several novel therapies in rhinitis and asthma is available.Fil: Baena Cagnani, Carlos E. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; ArgentinaFil: Passalacqua, Giovanni. Allergy and Respiratory Disease, DIMI, University of Genoa, Genoa, ItalyFil: Gómez, Maximiliano. Alas Medical Centre, Salta, ArgentinaFil: Zernotti, Mario Emilio. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; ArgentinaFil: Canonica, Giorgio Walter. Allergy and Respiratory Disease, DIMI, University of Genoa, Genoa, Ital

Bacterial biofilm evidence in nasal polyposis

The pathogeny of chronic rhinosinusitis with nasal polyposis (CRS/NP) has not been elucidated. Bacterial exotoxins have beenimplicated in many infl ammatory chronic diseases, such as chronic otitis, chronic tonsillitis, cholesteatomas, and more recently CRS/NP. Wepropose that the bacteria in CRS/NP are not only present in a planktonic state, but also occur in microbial communities as biofi lms.Objective: To determine and characterize the presence of biofi lms in CRS/NP.Methods: We performed a prospective study in 12 patients undergoing endoscopic sinus surgery for nasal polyposis. Ten patients withoutCRS/NP who underwent septoplasty were included as a control group. Tissue samples were obtained from the inferior turbinate mucosae.The bacteria were isolated and typifi ed and the material was examined in vitro using a spectrophotometer, and in vivo using opticalmicroscopy and confocal scanning laser microscopy.Results: Moderate to high in vitro biofi lm-forming capacity was detected in 9 out of 12 patients with CRS/NP (mean [SD] optical densityvalues of between 0.284 [0.017] and 3.337 [0.029]). The microorganisms isolated were Staphylococcus (5 patients), Streptococcus viridans,Pseudomonas aeruginosa, Enterococcus faecalis and Streptococcus viridans/Corynebacterium. Biofi lms were demonstrated in vivo in 2 patientsand no biofi lm structures were evident in any of the controls.Conclusion: This study demonstrates the presence of bacterial biofi lms in patients with CRS/NP. This chronic infl ammatory factor mightcontribute to nasal mucosa damage, increased infl ammatory cells in tissue, and the subsequent hyperplasic processFil: Zernotti, Mario Emilio. Sanatorio Allende. Servicio de Otorrinolaringología; ArgentinaFil: Angel Villegas, Natalia. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Farmacia; ArgentinaFil: Roques Revol, M.. Sanatorio Allende. Servicio de Otorrinolaringología; ArgentinaFil: Baena Cagnani, C. E.. Universidad Católica de Córdoba; ArgentinaFil: Arce Miranda, Julio Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Farmacia; ArgentinaFil: Paredes, M. E.. Sanatorio Allende. Departamento de Bacteriología; ArgentinaFil: Albesa, Inés. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Farmacia; ArgentinaFil: Paraje, María Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Farmacia; Argentin

Hearing preservation and cochlear implants based on inner ear approach: Multicentric evaluation

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