Risk Factors for Postoperative Sore Throat in Patients with a Double-lumen Endotracheal Tube / 中山大学学报(医学科学版)

ObjectiveTo investigate risk factors for postoperative sore throat in patients with double-lumen endotracheal intubation. MethodsThe data used in this post-hoc analysis were prospectively collected from a randomized， controlled trial. Age from 18 to 65 years old， ASAI-Ⅲ patients undergoing general anesthesia with a double-lumen endotracheal tube were enrolled. The perioperative data collected retrospectively were as follows： gender， age， smoking history， endotracheal tube diameter， duration of endotracheal tube， dose of Sufentanil， use of Flurbiprofen Axetil， cough after extubation， etc..Dynamometer was applied to assess extubation force. According to occurrence of postoperative sore throat， patients were divided into two groups： those who experienced sore throats and those who did not. Comparative analysis and multivariate logistic regression analysis were performed to screen the risk factors. ROC curve was used for predicting the predictive value of risk factors. ResultsAmong the 163 patients ， 74 （45.4%） had postoperative sore throat vs 89 （54.6%） not had. Multivariate logistic regression showed female ［OR95%CI=3.83（1.73， 8.50）， P=0.000 1］ and extubation force ［OR95%CI=1.78（1.45， 2.17）， P＜0.001］ were independent risk factors for postoperative sore throat. AUC value showed the extubation force was 0.773［95%CI（0.701， 0.846）， P＜0.001］. Youden index was 0.447， and the cut-off valve of extubation force was 13N. ConclusionFemale and extubation force were risk factors for sore throat in patients with double lumen endotracheal intubation.

Algoritmo diagnóstico y terapéutico de las lesiones esplácnicas provocadas durante la inserción de sondas pleurales / Diagnostic and Therapeutic Algorithm for Splanchnic Injuries Caused during Chest Tube Insertions

Introducción: La colocación de sondas pleurales es un procedimiento quirúrgico frecuente que puede tener graves complicaciones, las cuales dependen en la mayoría de los casos de la experiencia del operador, el tamaño del tubo y el uso de imágenes para guiar la inserción. Objetivo: Describir las principales lesiones esplácnicas provocadas durante la inserción de sondas pleurales y presentar algoritmos para el diagnóstico precoz y el tratamiento oportuno de estas iatrogenias. Métodos: Se realizó una revisión descriptiva narrativa durante el primer trimestre del año 2023. Se utilizaron las bases de datos electrónicas PubMed, LILACS, EBSCO y Cochrane. Se revisaron artículos publicados desde 1984 hasta el 2022. Se procuró que la mayoría de la información se enmarcara en un período no mayor de 10 años de antigüedad. Desarrollo: De las lesiones esplácnicas de la cavidad torácica, la de pulmón es la más frecuente y puede conducir a sangrado o fuga aérea persistente. Las lesiones vasculares son graves y pueden provocar la muerte si no se toman las medidas pertinentes. Se han descrito lesiones de órganos huecos de la cavidad abdominal que suelen ser parte de una hernia diafragmática. Dentro de las lesiones esplácnicas en el abdomen más frecuentes están la hepática y la esplénica. Conclusiones: Estas lesiones son prevenibles y se debe tener en cuenta su mecanismo de producción para evitarlas. Para este fin recomendamos una selección cuidadosa del sitio de inserción, realizar una confirmación adecuada de la posición de la sonda, manipularla cuidadosamente y monitorear constantemente al paciente(AU)

Introduction: Chest tube insertion is a frequent surgical procedure that can have serious complications, which depend mostly on the practitioner's experience, the tube's size and the use of imaging to guide the insertion. Objective: To describe the main splanchnic injuries caused during chest tube insertion, as well as to present algorithms for early diagnosis and timely treatment of these types of iatrogeny. Methods: A descriptive narrative review was performed during the first quarter of the year 2023. The electronic databases PubMed, LILACS, EBSCO and Cochrane were used. Articles published from 1984 to 2022 were reviewed. Most of the information was secured to be framed within a period of no more than 10 years. Development: Among the splanchnic injuries within the thoracic cavity, lung injury is the most frequent and may lead to bleeding or persistent air leak. Vascular injuries are severe and can lead to death if appropriate measures are not taken. Injuries to hollow organs of the abdominal cavity have been described to be usually part of a diaphragmatic hernia. Among the most frequent splanchnic lesions within the abdomen are the hepatic and splenic injuries. Conclusions: These lesions are preventable and their mechanism of production should be taken into account in order to avoid them. To achieve this, we recommend that the insertion site be carefully selected and that the tube's position be adequately confirmed, as well as the careful handling of the tube and the constant monitoring of the patient(AU)

Terapia de fotobiomodulação em lesões por pressão relacionada a dispositivos médicos: relato de caso em lábio de um paciente adulto / Photobiomodulation therapy for medical device-related pressure injuries: a case report of an adult with lip involvement

Lesão por pressão relacionada a dispositivos médicos é uma complicação bastante comum e geralmente oriunda da fixação do dispositivo utilizado na intubação endotraqueal para ventilação mecânica. Desta forma, o presente estudo reportou o caso de um paciente do sexo masculino, 65 anos, leucoderma, internado em uma unidade de terapia intensiva, e que desenvolveu lesão ulcerada na região de fixação do dispositivo utilizado para intubação orotraqueal. Após alívio da pressão local exercida, terapia de fotobiomodulação foi proposta como única estratégia para cicatrização da lesão e diminuição do edema. Após 3 sessões diárias foi possível observar excelente curso de reparação tecidual e remissão dos sinais flogísticos. De acordo com o presente caso, a terapia de fotobiomodulação parece ser bastante eficiente para o tratamento de lesões por pressão relacionada a dispositivos médicos(AU)

Medical device-related pressure injuries are very common complications and usually arise from the fixation of the device used in endotracheal intubation for mechanical ventilation. Thus, the present study reports a case of a Caucasian male patient, 65 years old, who was admitted to an intensive care unit and developed later an ulcerated lesion on the region of fixation of the device used for orotracheal intubation. After relieving the local pressure exerted, photobiomodulation therapy was proposed as the only strategy for wound healing and edema reduction. After 3 daily sessions, it was possible to note an excellent tissue repair course and remission of phlogistic signs. According to the present case, photobiomodulation therapy appears to be a quite efficient treatment strategy for medical device-related pressure injuries(AU)

Manejo conservador del neumotórax oculto en trauma

Introducción: El neumotórax oculto (NTXO) se encuentra hasta en el 15% de los traumatismos torácicos. Existen antecedentes del manejo conservador de esta patología (sólo observación), aunque su práctica continúa siendo discutida, especialmente, en traumatismos penetrantes. El objetivo de este trabajo es describir nuestra experiencia en el manejo conservador del NTXO. Materiales y Método: Estudio de cohorte retrospectivo realizado durante un período de 3 años en un Hospital de Trauma nivel I. Se incluyeron pacientes con traumatismo torácico (cerrado o penetrante) con NTXO. Se dividieron en dos grupos (conservados o drenados), realizándose una comparación de su evolución. Resultados: En 3 años fueron admitidos con traumatismo torácico 679 pacientes. De 93 pacientes con NTXO, 74 (80%) fueron conservados inicialmente y 19 (20%) tratados con drenaje pleural. Dos (3%) presentaron progresión del neumotórax en el seguimiento radiológico (conservación fallida). No se registraron complicaciones relacionadas con la ausencia de drenaje pleural. Las complicaciones y estancia hospitalaria fueron menores en el grupo de manejo conservador. Conclusión: Pacientes con NTXO por traumatismo de tórax (cerrado o penetrante), sin requerimiento de ventilación asistida y hemodinámicamente estables, pueden manejarse de manera conservadora con un monitoreo cercano durante 24 horas en forma segura, con menor tasa de complicaciones y de estancia hospitalaria.

Background: Occult pneumothorax (OPTX) is found in up to 15% of chest injuries. There is a history of conservative management of this pathology (only observation), although its practice continues to be discussed, especially in penetrating trauma. The objective of this paper is to describe our experience in the conservative management of OPTX. Materials and Method: Retrospective cohort study conducted over a 3-year period at a level I Trauma Center. Patients with thoracic trauma (blunt or penetrating) with OPTX were included. They were divided into two groups (preserved or drained) comparing their evolution. Results: Over a 3-year period 679 patients were admitted with chest trauma. From 93 patients with OPTX, 74 (80%) were initially preserved and 19 (20%) drained. Two patients (3%) presented pneumothorax progression in the follow-up imaging. There were no complications related to the absence of pleural drainage. Complications and hospital stay were lower in the conservative management group. Conclusion: Patients with OPTX due to chest trauma (blunt or penetrating), without requiring assisted ventilation and hemodynamically stable, can be safely conservative managed with close monitoring for 24 hours, with a lower rate of complications and hospital stay.

Prevalencia de defectos congénitos folato-sensibles en la provincia de Villa Clara / Prevalence of folate-sensitive birth defects in Villa Clara province

Introducción: Los defectos congénitos son un problema global que anualmente afecta a 7,9 millones de recién nacidos, los cuales constituyen la primera causa de muerte en los países desarrollados, y la segunda en países en vías de desarrollo, como es el caso de Cuba. Objetivos: Determinar la prevalencia de defectos congénitos folato-sensibles entre nacidos vivos, nacidos muertos e interrupciones electivas del embarazo. Métodos: Se realizó un estudio descriptivo y transversal en la provincia de Villa Clara donde se incluyeron todos los casos con defectos congénitos folato-sensibles diagnosticados entre 2013 y 2018. Resultados: Las cardiopatías congénitas conotruncales, el síndrome Down y los defectos del tubo neural fueron los fenotipos clínicos más prevalentes. La tasa de prevalencia ajustada fue de 5,79 por 1 000 nacimientos. Se constató una mayor tasa de prevalencia entre nacidos muertos y se interrumpió el 43,26 % de los embarazos con defectos diagnosticados prenatalmente. Las mayores tasas de prevalencia ajustada de cardiopatías y hendiduras labiopalatinas se identificaron en los municipios de Corralillo y Quemado de Güines, mientras que Placetas tuvo las mayores tasas de defectos del tubo neural y síndrome Down, y Manicaragua las de gastrosquisis. Conclusiones: La mayor frecuencia de defectos congénitos entre nacidos muertos puede estar en relación con la gran expresividad variable de los defectos estudiados, donde se incluyen fenotipos clínicos de gravedad. En los diferentes municipios con elevadas tasas de prevalencia de estos defectos están involucrados diferentes factores de riesgo ambientales que actúan sobre un genotipo que predispone a estos defectos congénitos.

Introduction: congenital defects are a global problem, annually affecting 7.9 million newborns. They constitute the leading cause of death in developed countries and the second one in developing countries like Cuba. Objective: to determine the prevalence of folate-sensitive birth defects among live births, stillbirths and elective pregnancy terminations. Methods: a descriptive and cross-sectional study was carried out in Villa Clara province, where all cases with folate-sensitive birth defects diagnosed between 2013 and 2018 were included. Results: conotruncal congenital heart diseases, Down syndrome and neural tube defects were the most prevalent clinical phenotypes. The adjusted prevalence rate was 5.79 per 1,000 births. A higher prevalence rate was found among stillbirths and 43.26% of pregnancies with prenatally diagnosed defects were terminated. The highest rates of adjusted prevalence of cleft lip and palate and heart diseases were identified in Corralillo and Quemado de Güines municipalities, while Placetas had the highest rates of neural tube defects and Down syndrome, as well as Manicaragua those of gastroschisis. Conclusions: the higher frequency of congenital defects among stillbirths may be related to a highly variable expressivity of the studied defects, where serious clinical phenotypes are included. Different environmental risk factors acting on a genotype that predisposes these congenital defects are involved in the different municipalities with high prevalence rates of these defects.

Síndrome de Currarino incompleto. Presentación de un caso

El síndrome de Currarino es una enfermedad hereditaria y de baja incidencia, compuesta por una tríada: estenosis anal, malformación sacro coccígea y masa presacra. Puede cursar desapercibido hasta la adultez y generar subdiagnósticos. Se describe un paciente de 75 años, masculino, piel negra, de procedencia urbana y con antecedentes de hipertensión arterial, quien acudió al hospital por presentar hematuria, dolor en fosa lumbar izquierda y estreñimiento. Se realizaron estudios imagenológicos, como ultrasonido, tomografía de abdomen y resonancia magnética lumbosacra, los cuales condujeron al diagnóstico de tumor renal, síndrome de Currarino incompleto (dado por dos elementos de la triada: malformación sacro coccígea y masa presacra) asociado a otra enfermedad malformativa raquimedular, médula anclada. Son pocos los casos reportados en el mundo (casi 300), por lo que se considera una entidad rara, pero de fácil diagnóstico debido al advenimiento de las nuevas tecnologías en el campo de la imagenología.

Currarino syndrome is a hereditary disease with a low incidence, composed of a triad: anal stenosis, sacrococcygeal malformation and presacral mass. It can go unnoticed until adulthood and generate subdiagnoses. A 75-years-old male, black-skinned, urban origin patient with a history of arterial hypertension is described, who attended the hospital presenting hematuria, pain in the left lumbar fossa, and constipation. Radiological studies such as ultrasound, abdominal tomography and lumbosacral magnetic resonance were performed, which led to the diagnosis of a renal tumor, incomplete Currarino syndrome (given by two elements of the triad: sacrococcygeal malformation and presacral mass) associated with another spinal cord malformation disease, tethered cord. There are few cases reported in the world (almost 300), so it is considered a rare entity, but easy to diagnose due to new imaging technologies.

Remissão total do zumbido pediátrico: relato dos resultados de uma abordagem não medicamentosa da disfunção tubária / Total remission of pediatric tinnitus: reporting the results of a non-drug approach to tubal dysfunction / Remisión total del acufeno pediátrico: informe de los resultados de un enfoque no farmacológico a la disfunción tubárica

Introdução: Zumbido é um sintoma crescente na população pediátrica e sua multifatoriedade etiológica demanda amplas investigações para utilizar-se adequadas intervenções. Objetivos: relatar os efeitos de uma abordagem não medicamentosa em um caso de remissão total do zumbido pediátrico oriundo da disfunção tubária. Método: Este artigo apresenta um indivíduo com sete anos, do sexo feminino e com queixa de zumbido crônico associado a disfunção tubária, considerado escasso na literatura. Além disso, este estudo descreve as avaliações médicas (neurológica e otorrinolaringológica), a avaliação audiológica e psicoacústica do zumbido, o processo diagnóstico e a intervenção fonoaudiológica realizada. Utilizou-se uma abordagem não medicamentosa que contemplou exercícios miofuncionais orofaciais, Manobra de Valsalva e limpeza nasal. Resultados: Após um mês de intervenção, com a prática diária dos exercícios, o indivíduo estudado referiu ausência da percepção do sintoma e das demais queixas auditivas. Este resultado também foi constatado nas avaliações audiológicas. Conclusão: A abordagem não medicamentosa da disfunção tubária demonstrou bons resultados frente ao manejo do zumbido crônico, para o presente caso. (AU)

Introduction: Tinnitus is a growing symptom in the pediatric population and its etiological multifactorial demands extensive investigations to use appropriate interventions. Objective: report the effects of a non-medicated approach of a case of total remission of pediatric tinnitus from tube dysfunction. Methods: This article presents a seven-year-old female patient with a complaint of chronic tinnitus associated with tubal dysfunction, considered rare in the literature. Besides that, this study describes the medical evaluations (neurological and otorhinolaryngological), the audiological and psychoacoustic evaluations of the tinnitus, the diagnostic process and the speech-language intervention performed. It was used a non-medication approach that included orofacial myofunctional exercises, Valsalva maneuver and nasal cleaning. Results: After a month of intervention, with the daily practice of exercises, the studied subject reported the absence of perception of the symptom and other auditory complaints. This result was also verified in the audiological evaluations. Conclusion: The non-medication approach to tubal dysfunction has shown good results in relation to the management of chronic tinnitus for the present case. (AU)

Introducción: Acufeno es un síntoma creciente en la población pediátrica y su multifatoriedad etiológica demanda amplias investigaciones para utilizar adecuadas intervenciones. Objetivos: Informar los efectos de un enfoque no farmacológico de un caso de remisión total del acufeno pediátrico oriundo de la disfunción tubárica. Metodos: Este artículo presenta un sujeto con siete años, del sexo femenino y con queja de acufeno crónico asociado a disfunción tubárica, considerado escaso en la literatura. Además, este estudio describe las evaluaciones médicas (neurológica y otorrinolaringológica), la evaluación audiológica y psicoacústica del zumbido, el proceso diagnóstico y la intervención fonoaudiológica realizada. Se utilizó un abordaje no medicamentoso que contempló ejercicios miofuncionales orofaciales, Maniobra de Valsalva y limpieza nasal. Resultados: Después de un mes de intervención, con la práctica diaria de los ejercicios, el sujeto estudiado refirió ausencia de la percepción del síntoma y de las demás quejas auditivas. Este resultado también se constató en las evaluaciones audiológicas. Conclusión: El abordaje no medicamentoso de la disfunción tubárica demostró buenos resultados frente al manejo del acufeno crónico, para el presente caso. (AU)

Spontaneous bilateral pneumothorax in a previously healthy COVID-19 patient: A case report

Coronavirus disease 2019 (COVID-19) is commonly linked with mild cough, fever, and shortness of breath symptoms. However, there have been reports of pneumothorax, which particularly occurred at least 1 week following symptom onset in elderly COVID-19 patients. Spontaneous pneumothorax (SP) is an uncommon but possibly fatal complication of COVID-19 pneumonia and is rarely reported in non-intubated patients. We report a case of a healthy, non-smoker 35-year-old young woman who presented with a 7-day cough, fever, and sudden shortness of breath. She was diagnosed with severe COVID-19 pneumonia, experienced a right SP, and developed a second pneumothorax on the contralateral side. She improved gradually following chest tube insertion in the right lung and conservative management for the left pneumothorax.

ULTRASOUND ASSESSMENT OF SUBGLOTTIC LARYNGEAL DIAMETER FOR ESTIMATION OF APPROPRIATE ENDOTRACHEAL TUBE SIZE IN PAEDIATIRIC PATIENTS – A PROSPECTIVE RANDOMIZED STUDY

Background and Aim: The appropriate size of endotracheal tube for children are traditionally selected based on their age, height and or weight by using formulas. The ultrasound guided measurement of subglottic laryngeal diameter can be used to appropriate selection of endotracheal tube. The endotracheal tube is selected based on the nearest external diameter corresponding to the measured subglottic region. The aim of the study is to compare the appropriateness of uncuffed endotracheal tube selection based on age based formula with that of ultrasound assessment of subglottic diameter in children. A prospective randomised parallel group study involving 60 children Materials and Methods: of age 2-6years undergoing elective surgeries under general anaesthesia were selected for study. They are divided into two groups as Group A – Endotracheal tube selection based on ultrasound assessment of diameter of subglottic region and Group B – Endotracheal tube selection based on age based formula which is (Age /3)+ 3.5mm ID. The noted parameters were internal diameter (ID) and external diameter (OD) of the predicted ETT by the two methods, ID and OD of the appropriate size ETT used and the ultrasound assessed subglottic diameter. The incidence of ETT size predicted by ultrasound assessment of Results: subglottic diameter was 83.33% while with age based formula it is 53.34%. The linear regression equation model in Group A showed R²= 0.694, P = 0.001 which was statistically signicant. While in Group B it was R²=0.258., p=0.001. There Conclusion: was a strong correlation between the outer diameter of clinically used uncuffed ETT and the subglottic diameter assessed with ultrasound examination in paediatric patients. Hence USG assessment of the subglottic diameter is a better tool in predicting the appropriate uncuffed ETT in paediatric patients undergoing elective surgeries under general anaesthesia than the age- based formula

Choosing the Correct?Sized Adult Double?Lumen Tube: Quest for the Holy Grail

Appropriate size selection of double?lumen tubes (DLTs) for one?lung ventilation (OLV) in adults is still a humongous task. Several important factors are to be considered like patient height, gender, tracheal diameter, left main bronchial diameter, and cricoid cartilage transverse diameter. In addition to radiological assessment of the airway diameters, the manufacturing details of the particular DLT being used also play a significant role in size selection. Optimal positioning of the appropriately sized DLT is indispensable to avoid complications like airway trauma, cuff rupture, hypoxemia, and tube displacement. It is imperative to know whether the one?size?fits?all dictum holds for DLT size selection as claimed by certain studies. Further randomized studies are required for crystallizing standard protocols ascertaining the correct DLT size. This systematic review article highlights the various parameters employed for DLT size selection and explores the newer DLTs used for adult OLV.

Parálisis facial alternobárica: a propósito de un caso y revisión de la literatura / Alternobaric facial palsy: case report and literature review

La parálisis o paresia facial alternobárica es una neuropraxia del séptimo nervio cra-neal debido a cambios de presión. Se produce en el contexto de una disfunción de la trompa de Eustaquio, una dehiscencia canal del nervio facial y cambios en la presión atmosférica. Se considera una rara complicación de barotrauma. Su prevalencia es difícil de estimar y, probablemente, se encuentre subreportada. La forma de presentación más habitual incluye paresia facial, plenitud aural, hipoacusia, otalgia, parestesias faciales y linguales. La mayoría de los episodios son transitorios, con una duración entre minutos y algunas horas, con recuperación posterior completa. Entre los diagnósticos diferenciales se encuentran causas periféricas y centrales de paresia facial, las cuales hay que sospechar ante la persistencia de los síntomas en el tiempo o ante la presencia de otros signos o síntomas neurológicos. La evaluación inicial debe incluir un examen otoneurológico completo. La tomografía computarizada de hueso temporal favorece la visualización de posibles dehiscencias del canal del facial. La prevención de nuevos episodios incluye la práctica de ecualización efectiva, la resolución de la disfunción de la trompa de Eustaquio y en algunos casos específicos, métodos alternativos de ventilación del oído medio como la colocación de tubos de ventilación. Una vez instalada la parálisis facial, si no se produce recuperación espontánea, el uso de corticoides es una opción. Se presenta un caso de paresia facial alternobárica recurrente y una revisión de literatura.

Alternobaric facial palsy or paralysis is a neuropraxia of the seventh cranial nerve due to pressure changes. It occurs in the context of Eustachian tube dysfunction, facial nerve canal dehiscence, and changes in atmospheric pressure. It is considered a rare complication of barotrauma. Its prevalence is difficult to estimated, and this condition is probably underreported. The most common form of presentation includes facial weakness, ear fullness or pressure, hearing loss, otalgia, facial and lingual paresthesias. Most episodes are transient, lasting from minutes to a few hours, with a subsequent complete recovery. Among the possible differential diagnoses are peripheral and central causes of facial paralysis, which must be suspected due to the persistence of symptoms over time or the presence of other neurological signs or symptoms. The initial evaluation should include a complete otoneurological examination. Computed tomography of the temporal bone is useful for the visualization of facial canal dehiscence. Prevention of further episodes includes practicing effective equalization, Eustachian tube dysfunction treatment, and in certain specific cases, alternative middle ear ventilation methods such as tympanostomy tubes. Once facial paralysis is established, if spontaneous recovery does not occur, the use of corticosteroids is considered an option. A case of recurrent alternobaric facial paresis and a review of the literature are presented.

Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil

Abstract Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001). Conclusions The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of

Conocimientos sobre el ácido fólico periconcepcional en mujeres puérperas del hospital de la mujer, La Paz-Bolivia / Awareness of periconceptional folic acid in postpartum women at the hospital de la mujer, La Paz-Bolivia

INTRODUCCIÓN Y/O ANTECEDENTES: Los defectos del tubo neural se encuentran entre las anomalías congénitas más comunes en todo el mundo, el ácido fólico (0.4-0.8 ug/día) reduce el riesgo de ocurrencia y recurrencia, por lo que se recomienda su uso concepcional y periconcepcional. El conocimiento de sus efectos protectores varía mucho en la población. OBJETIVOS: Describir el conocimiento de las puérperas sobre el uso correcto del ácido fólico y sus alcances como factor protector. MATERIAL Y MÉTODO: Se condujeron encuestas entre un grupo de mujeres puérperas del Hospital de la Mujer mediante cuestionarios estructurados para obtener información el conocimiento del uso del ácido fólico periconcepcional. RESULTADOS: Entrevistamos 87 puérperas. El conocimiento y el uso del ácido fólico entre las entrevistadas fue bajo, 51% y 48.3% respectivamente. La escolaridad en este grupo poblacional es un factor predictivo del conocimiento y uso correcto del ácido fólico. DISCUSIÓN, CONCLUSIONES Y RECOMENDACIONES: El conocimiento del ácido fólico es relativamente bajo entre las mujeres puérperas entrevistadas, su uso durante el embarazo es insuficiente y la suplementación con antes de la concepción es nula. Aún nos queda un largo camino por recorrer. Se recomienda promover el conocimiento y el uso del ácido fólico en etapa periconcepcional, así como mayor información sobre los alimentos fortificados.

INTRODUCTION AND BACKGROUND: Neural tube defects are among the most common congenital anomalies worldwide; folic acid reduces their risk of occurrence and is strongly recommended for conceptional and periconceptional use. Awareness of its protective effects varies widely among populations. OBJECTIVES: To measure the awareness of postpartum women about the correct use of folic acid and its protectants. MATERIALS AND METHODS: A survey was conducted in one group of postpartum women using structured questionnaires to obtain information on awareness and use of folic acid. RESULTS: We interviewed 87 postpartum women. Awareness and use of folic among the interviewees were low, 51% and 48.3% respectively. Schooling is a predictor of folic acid correct use and awareness. DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS: Awareness of folic acid is relatively low among pregnant Bolivian women, its use during pregnancy is insufficient and supplementation before conception is zero. We still have a long way to go. We recommend the promotion of awareness and the use of folic acid in pregnant women.

An unusual case of nasal foreign body presenting as recurrent otitis media

Otitis media (OM) is a common problem involving children. In the majority, the cause is related to dysfunction of the Eustachian tube due to bacterial or viral rhinitis and less commonly due to nasopharyngeal tumors. We present a case of recurrent OM which was evaluated and incidentally found a nasal foreign body for which the patient was asymptomatic. This nasal body was the cause of recurrent OM which is very unusual.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado ​​para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados ​​para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Application of syringe needle guided transabdominal double-J tube placement in total laparoscopic ileal neobladder surgery / 现代泌尿外科杂志

【Objective】 To explore the application of 1.2 mm×35 mm thin walled, long oblique angle syringe needle guided double-J tube insertion through abdominal wall in total laparoscopic ileal neobladder surgery. 【Methods】 Clinical data of 5 patients undergoing total laparoscopic ileal neobladder surgery in our hospital during Dec.2020 and Jan.2022 were retrospectively analyzed. Under laparoscopy and direct vision, 3 cm above pubic symphysis was taken as the puncture point, and an syringe needle was inserted to establish a channel. After that, a double-J tube was inserted under the guidance of the guide wire through the needle. 【Results】 The double-J tube was successfully implanted in all 5 patients. The time needed was 2-4 min, with an average of 3 min. 【Conclusion】 Under the guidance of a 1.2 mm×35 mm syringe needle, the placement of a double-J tube through the abdominal wall in total laparoscopic ileal neobladder surgery is safe, effective, simple and accurate. It can not only preserve the original operation channel without destroying the pneumoperitoneum, but also shorten the operation time. It is a new auxiliary means in total laparoscopic ileal neobladder surgery.

Clinical analysis of hypospadias repair with free tube graft urethroplasty / 现代泌尿外科杂志

As an optional method for the treatment of hypospadias, free tube graft urethroplasty has been applied in some centers in recent years. It has the advantages of convenient urethra materials, high freedom of surgery, and satisfactory urine flow and appearance, but there are fewer reported cases and many complications. Therefore, it is recommended to be used cautiously. This paper summarizes the experience of 497 cases of free surgical surgery based on Buck fascia reconstruction, including key points such as full correction of penile lower curvature, no tension-free urethra, long-inclined plane anastomosis, and reliable coverage enhancement.

Identification of B(A) subtype and analysis of bood transfusion strategiaes / 中国输血杂志

【Objective】 To investigate the serology and genotype identification method of B (A) subtype patients. 【Methods】 Test tube method (serology) was used to confirm the clinically difficult ABO blood group samples of 3 patients with ABO blood group; ABO blood group was genotyped by real-time PCR, and the ABO gene exon 1-7 was sequenced to determine the genotype. 【Results】 The forward and reverse blood typing result of three patients was B (A) subtype all with ABO genotype B/O2 and c.640A> G mutation on B allele of exon 7, which meets the characteristics of ABO * BA.04 genotype. 【Conclusion】 The combination of serological and genetic testing could identify difficult blood types such as ABO subtypes accurately and ensure the safety of clinical blood use.