Comparative Efficacy of a High-Dose vs Standard-Dose Hepatitis B Revaccination Schedule Among Patients With HIV: A Randomized Clinical Trial.

Importance: Active immunization for hepatitis B virus (HBV) infection is recommended in patients living with HIV. Limited evidence is available about the most appropriate regimen of HBV vaccination among those who have not responded to an initial schedule. Objective: To determine the efficacy of a high-dose schedule compared with a standard dose of HBV vaccination. Design, Setting, and Participants: This double-masked, parallel-group, randomized controlled trial included patients living with HIV at a single outpatient HIV and hepatology clinic in Chile for whom previous HBV vaccination had failed. Patients with hepatitis B surface antibody (anti-HBs) titers less than 10 IU/L after an initial HBV vaccination regimen were included. Consecutive patients were recruited between December 2013 and March 2018. Data were analyzed in June 2018 using intention-to-treat analysis. Intervention: The high-dose HBV vaccination group consisted of 3 doses of 40 µg recombinant hepatitis B vaccine at 0, 1, and 2 months. The standard-dose group received 3 doses 20 µg each at 0, 1, and 2 months. Main Outcomes and Measures: Primary outcome was the serologic response to HBV vaccination (anti-HBs greater than 10 IU/L) 4 to 8 weeks after completion of the schedule. Secondary outcomes were anti-HBs greater than 100 IU/L and seroprotective anti-HBs at 1 year follow up. Results: A total of 107 patients underwent randomization (55 to the standard-dose group, 52 to the high-dose group); 81 (75.7%) were men, and the mean (SD) patient age was 47.0 (13.3) years. Nearly all patients were receiving antiretroviral therapy (105 patients [98%]) and 92 patients (86%) had an undetectable HIV viral load. Mean (SD) CD4 count was 418 (205) cells/mm3. There were no differences in baseline characteristics between groups. Serological response in the high-dose group was found in 36 of 50 patients (72%; 95% CI, 56.9%-82.9%) compared with 28 of 55 patients in the standard-dose group (51%; 95% CI, 37.1%-64.6%) (odds ratio, 2.48; 95% CI, 1.02-6.10; P = .03). Mean (SD) anti-HB levels were 398.0 (433.4) IU/L in the high-dose group and 158.5 (301.4) IU/L in the standard-dose group (P < .001). Of patients with a serological response in the high-dose group, 29 of 36 (80.6%) had anti-HBs titers greater than 100 IU/L compared with 14 of 28 responders (50.0%) in the standard-dose group (P = .02). At 1-year follow-up, 20 of 25 patients (80.0%) with a serological response in the high-dose group had protective anti-HBs vs 9 of 23 patients (39.1%) in the standard-dose group (P = .01). Conclusions and Relevance: The results of this randomized clinical trial suggest that use of a high-dose regimen for HBV revaccination for patients with HIV achieves a higher and longer-lasting serological response as compared with a standard-dose regimen. Trial Registration: ClinicalTrials.gov Identifier: NCT02003703.

Intoxicación por monóxido de carbono: una causa rara de hipoacusia neurosensorial reversible / Reversible sensorineural hearing loss following carbon monoxide poisoning

No disponible

Impact of adenotonsillectomy on the evolution of inflammatory markers.

BACKGROUND: Tonsils are first-line host defence organs against pathogenic agents and participate in local and systemic immunity. Persistent increases in systemic inflammatory responses may contribute to associated morbidity. The aim of this study was to verify the short- and long-term impact of adenotonsillectomy on the evolution of inflammatory markers in 3- to 9-year-old children. METHODS: A prospective and longitudinal study was conducted over 1 year in 29 children who underwent tonsillectomy due to either chronic tonsillitis or adenotonsillar hypertrophy. Measurements of high-sensitivity C-reactive protein (hs-CRP) levels were taken. Levels of Th1-type cytokines [interleukin-1, interferon-γ, and tumor necrosis factor-α (TNF-α)] and anti-inflammatory Th2-type cytokines [interleukin-4, -5, -6, -10 and -13] were measured. Levels of transforming growth factor-beta (TGF-ß) and intercellular adhesion molecule-1 (ICAM-1) were also determined. The results were compared to those of 29 control children. RESULTS: At baseline, children with surgery indications presented with higher levels of hs-CRP, interleukin-1 and -10, interferon-γ, TNF-α and ICAM-1, whereas values of interleukin-4 were significantly lower than in control children. Children with severe tonsillar obstruction had higher values of interleukin-1, -4, and -5 and lower values of interleukin-10 compared with children with recurrent tonsillitis. One year after surgery, the levels except IL-4 did not show a significant difference from those obtained in the control group. The levels of hs-CRP and TNF-α decreased significantly in the first month. CONCLUSION: Children with chronic tonsillitis and/or adenotonsillar hypertrophy have significantly elevated levels of proinflammatory cytokines. Adenotonsillectomy restores the normal values of these parameters 1 year after surgery.

39. Complicaciones en 500 procedimientos consecutivos de estudio electrofisiológico y/o ablación por radiofrecuencia en un solo centro

Antecedentes: el estudio electrofisiológico (EEF) y la ablación por radiofrecuencia (ABL) son técnicas pautadas y aceptadas en todo el mundo desde hace más de 25 años. En Uruguay aún no integran la canasta de prestaciones básicas obligatorias de los efectores ni son cubiertas por el Fondo Nacional de Recursos. Debido a ello, no están incorporados a las indicaciones habituales del cardiólogo general y se realizan menos procedimientos de los que estarían indicados. Hay falta de difusión y se plantea frecuentemente la incertidumbre respecto a la ocurrencia de complicaciones. Objetivo: evaluar la ocurrencia de complicaciones mayores y menores en una serie extensa de procedimientos de EEF y ABL. Material y método: se realizó un estudio descriptivo, retrospectivo. Se incluyeron 500 procedimientos consecutivos de EEF y ABL realizados en nuestro servicio. Se tomaron las variables demográficas, tipo de procedimiento realizado, indicaciones, resultados y ocurrencia de complicaciones. Todos los pacientes fueron registrados y controlados al mes de realizado el procedimiento. Resultados: quedaron incluidos 410 (82%) ablaciones y 90 (18%) estudios electrofisiológicos. La edad media fue de 34,1 ± 23,5 años, variando entre 7 meses y 91 años. Se realizaron 211(42%) en menores de 18 años y 389 (78%) en adultos. El 54% se hizo en varones. Las indicaciones de la ablación fueron por vía accesoria abierta 33,2%, oculta 18,3%, reentrada nodal 24,6%, flutter auricular 13,4%, taquicardia auricular 3,4%, fibrilación auricular 1,2%, taquicardia ventricular 2,7% y ablación del nodo AV 3,2%. La ablación global fue efectiva en 365 (89%) y hubo 25 (6,1%) de recurrencias. Complicaciones mayores en cuatro pacientes (1%). No hubo decesos, un paciente (0,2%) presentó bloqueo AV permanente que requirió marcapaso, dos pacientes (0,5%) bloqueo AV transitorio y un paciente (0,2%) pericarditis. Complicaciones menores en cinco pacientes (1,2%): tres con hematoma (0,7%) y dos (0,5%) con bloqueo de rama derecha permanente. Se analizaron los datos en relación con otros procedimientos invasivos indicados habitualmente por los cardiólogos. Conclusiones: en una serie extensa de EEF y ABL tuvimos una tasa de 1% de complicaciones mayores, sin decesos y solo un caso con secuela permanente (marcapaso) y 1,2% de complicaciones menores.

Surgical results of different palate techniques to treat oropharyngeal collapse.

The aim of this study was to assess the surgical success rate of patients undergoing oropharyngeal surgery, selected through drug-induced sleep endoscopy. Secondly, to compare outcomes of the different oropharyngeal surgery techniques applied. The study design was retrospective case series of surgically treated patients from 2006 to 2013. All patients were diagnosed with either moderate or severe obstructive sleep apnea and did not tolerate conventional positive airway pressure. We performed five different surgical techniques to treat oropharyngeal collapse: partial palate resection, uvulopalatopharyngoplasty, Z-palatoplasty, lateral pharyngoplasty and expansion pharyngoplasty. Patients in whom multilevel surgery was performed were excluded. 53 patients were included in our study, 52.8 % were severe obstructive sleep apnea patients, mean age was 43.9 years, mean body mass index 27.5. The surgical success rate according to Sher's criteria was 71.7 %. 47.2 % had a postoperative apnea hypopnea index lower than 10. The highest success rate was measured in patients who underwent expansion pharyngoplasty (90 % according to Sher's criteria, 80 % with a postoperative apnea hypopnea index lower than 10) although it did not reach statistical significance. Our conclusion is that drug-induced sleep endoscopy is a good tool to select surgical candidates in patients with moderate-to-severe obstructive sleep apnea who are not compliant with the optimal therapy. Expansion pharyngoplasty was the surgical technique with the highest success rates.

Precisión diagnóstica de la citología por punción aspiración con aguja fina en tumores de la glándula parótida / Diagnostic accuracy of fine needle aspiration cytology in parotid tumours

Introducción y objetivos: La citología por punción aspiración con aguja fina (PAAF) es un método globalmente aceptado en la evaluación preoperatoria de los tumores de cabeza y cuello, sin embargo, su efectividad en la interpretación de lesiones neoplásicas de las glándulas salivales es controvertida. El objetivo del presente estudio es evaluar la eficacia de la PAAF en el diagnóstico preoperatorio en los tumores de glándula parótida. Métodos: Se realizó un estudio retrospectivo de una muestra de 93 pacientes con enfermedad tumoral de la glándula parótida tratados en el Servicio de Otorrinolaringología de nuestra institución durante el período 2007-2011, que fueron sometidos a PAAF diagnóstica preoperatoria y posteriormente a exéresis quirúrgica y estudio anatomopatológico. Los resultados de la citología fueron clasificados como negativo o positivo para enfermedad maligna, o muestra insuficiente. Posteriormente, los resultados fueron comparados con el diagnóstico anatomopatológico definitivo. Resultados: La edad media de la muestra fue de 52,9 años, con un rango comprendido entre los 11 y los 88 años; el 55,9% eran hombres. La PAAF presentó una sensibilidad para detectar malignidad en tumores de la glándula parótida del 57,1% y una especificidad de 95,1%, con valores predictivo positivo y predictivo negativo para malignidad de 50 y 96,3%, respectivamente. Conclusiones: La PAAF es una prueba sencilla pero de utilidad limitada para la orientación diagnóstica en la enfermedad tumoral de la glándula parótida en nuestro medio, debido principalmente a su baja sensibilidad; sin embargo, su alta especificidad y elevado valor predictivo negativo hacen de la misma una prueba con mayor precisión frente a un resultado benigno o negativo de la misma (AU)

Introduction and objectives: Fine needle aspiration cytology (FNAC) is a globally accepted technique in the preoperative evaluations of head and neck tumours; however, the effectiveness in the interpretation of salivary glands neoplastic lesions is still controversial. The objective of this study consisted of assessing the efficacy of FNAC in preoperative diagnosis of parotid tumours. Methods: This retrospective study was conducted using 93 patient samples with parotid gland tumoral pathology, treated at the Otorhinolaryngology Department in our institution during the 2007-2011 period. Preoperative FNAC was employed and the patients subsequently submitted to surgical excision with histopathological diagnosis of the specimen. Cytology results were classified as negative for malignancy, positive for malignancy or insufficient sample, and later compared with the definitive histological diagnosis. Results: The mean age of the studied sample was 52.9 years (range: 11 to 88 years); 55.9% were men. The FNAC showed significant sensitivity of 57.1%, with a specificity of 95.1%, for detecting malignancy in parotid gland tumours. The positive and negative predictive values for malignancy were 50 and 96.3%, respectively. Conclusions: FNAC is considered a simple test but of limited use for diagnostic guidance in tumour pathology of the parotid gland in our environment, mainly because of its low sensitivity. However, the high specificity and high negative predictive value of FNAC makes it a more accurate test in benign or negative result cases (AU)

Exploración videoendoscópica con sueño inducido, utilidad clínica y revisión de la literatura / Drug-induced sleep videoendoscopy: Clinical usefulness and literature review

La exploración fibroscópica de la faringe mediante sueño inducido es una prueba que ayuda a conocer las zonas de vibración y colapso de los pacientes con trastornos respiratorios del sueño. En este artículo se realiza una revisión de la literatura disponible sobre el tema para ayudar al otorrinolaringólogo a conocer la prueba y resolver algunas controversias existentes sobre la misma (AU)

Fiberoptic examination of the pharynx under drug-induced sleep is a test that helps to detect the areas of vibration and collapse in patients with sleep-disordered breathing. This article is a review of the available literature on the subject, aimed at helping otolaryngologists to understand the procedure and to resolve some controversies surrounding it (AU)

[Diagnostic accuracy of fine needle aspiration cytology in parotid tumours]. / Precisión diagnóstica de la citología por punción aspiración con aguja fina en tumores de la glándula parótida.

INTRODUCTION AND OBJECTIVES: Fine needle aspiration cytology (FNAC) is a globally accepted technique in the preoperative evaluations of head and neck tumours; however, the effectiveness in the interpretation of salivary glands neoplastic lesions is still controversial. The objective of this study consisted of assessing the efficacy of FNAC in preoperative diagnosis of parotid tumours. METHODS: This retrospective study was conducted using 93 patient samples with parotid gland tumoral pathology, treated at the Otorhinolaryngology Department in our institution during the 2007-2011 period. Preoperative FNAC was employed and the patients subsequently submitted to surgical excision with histopathological diagnosis of the specimen. Cytology results were classified as negative for malignancy, positive for malignancy or insufficient sample, and later compared with the definitive histological diagnosis. RESULTS: The mean age of the studied sample was 52.9 years (range: 11 to 88 years); 55.9% were men. The FNAC showed significant sensitivity of 57.1%, with a specificity of 95.1%, for detecting malignancy in parotid gland tumours. The positive and negative predictive values for malignancy were 50 and 96.3%, respectively. CONCLUSIONS: FNAC is considered a simple test but of limited use for diagnostic guidance in tumour pathology of the parotid gland in our environment, mainly because of its low sensitivity. However, the high specificity and high negative predictive value of FNAC makes it a more accurate test in benign or negative result cases.

[Drug-induced sleep videoendoscopy: clinical usefulness and literature review]. / Exploración videoendoscópica con sueño inducido, utilidad clínica y revisión de la literatura.

Fiberoptic examination of the pharynx under drug-induced sleep is a test that helps to detect the areas of vibration and collapse in patients with sleep-disordered breathing. This article is a review of the available literature on the subject, aimed at helping otolaryngologists to understand the procedure and to resolve some controversies surrounding it.

Autofonía de etiología infrecuente: síndrome de la trompa patulosa / Uncommon aetiology for autophony: patulous eustachian tube

Presentamos el caso de un paciente con autofonía, diagnosticado de síndrome de la trompa patulosa y tratado mediante cierre de la trompa con catéter según la técnica modificada de Bluestone y Cantekin en el que se obtuvieron buenos resultados tras un año de seguimiento (AU)

We report the case of a patient with autophony diagnosed with a patulous Eustachian tube. The patient was treated according to the technique described by Bluestone and Cantekin, inserting an indwelling catheter into the tube. Good results were obtained after one year of monitoring (AU)

Uncommon aetiology for autophony: patulous eustachian tube.

We report the case of a patient with autophony diagnosed with a patulous Eustachian tube. The patient was treated according to the technique described by Bluestone and Cantekin, inserting an indwelling catheter into the tube. Good results were obtained after one year of monitoring.

Digesto de leyes nacionales y provinciales de la República Argentina sobre VIH/sida: actualización a diciembre de 1999

[Extraída de la presentación] El Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA y la OPS/OMS, identificaron en 1997 la necesidad de recopilar y hacer accesible las leyes que en forma directa o indirecta estaban relacionadas al SIDA en Argentina. Apenas transcurridos dos años se planteó la necesidad de actualizar este Digesto sobre VIH/SIDA, debido a la numerosa legislación que en este tiempo se produjo en el país

Digesto de leyes nacionales y provinciales de la República Argentina sobre VIH/sida

[Extraído de la presentación] La sistematización de leyes de la República Argentina concernientes a la temática VIH/sida, tanto a nivel nacional como provincial, tuvo como objetivo reflejar la tendencia legislativa en la relación salud pública - derechos humanos. La metodología utilizada ha sido, en una primera fase, la de rastrear, en las distintas jurisdicciones la legislación vigente que estuviera vinculada de modo directo o indirecto con la materia señalada; luego se procedió a la recolección de dichos instrumentos legales; y, por último, a seleccionar y sistematizar los mismos