Design and Methods of the Early Age-Related Hearing Loss Investigation Randomized Controlled Trial.

OBJECTIVE: Hearing loss has been identified as a major modifiable risk factor for cognitive decline. The Early Age-Related Hearing Loss Investigation (EARHLI) study will assess the mechanisms linking early age-related hearing loss (ARHL) and cognitive impairment. STUDY DESIGN: Randomized, controlled, single-site, early phase II, superiority trial. SETTING: Tertiary academic medical center. PARTICIPANTS: One hundred fifty participants aged 55 to 75 years with early ARHL (severity defined as borderline to moderate) and amnestic mild cognitive impairment will be included. INTERVENTIONS: Participants will be randomized 1:1 to a best practice hearing intervention or a health education control. MAIN OUTCOME MEASURES: The primary study outcome is cognition measured by the Alzheimer Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite. Secondary outcomes include additional measures of cognition, social engagement, and brain organization/connectivity. RESULTS: Trial enrollment will begin in early 2024. CONCLUSIONS: After its completion in 2028, the EARHLI trial should offer evidence on the effect of hearing treatment versus a health education control on cognitive performance, social engagement, and brain organization/connectivity in 55- to 75-year-old community-dwelling adults with early ARHL and amnestic mild cognitive impairment.

Bladder duplication in a patient with a persistent urogenital sinus: Case report and systematic review of the literature.

Bladder duplication (BD) is a rare malformation that is often associated to other anomalies. We report a newborn diagnosed with BD in the sagittal plane, associated to persistent urogenital sinus (UGS), given the opening of the vagina immediately below the bladder neck. It is the fourth time this association is reported. Surgical repair was made: both bladders were joined, the common channel was left as urethra and the vagina was descended with a vaginoplasty with an intestinal segment. She also presented an anterior anus, that required posterior mobilization. The patient is currently 3 years old with good sphincter control.

Utility of Extended High-Frequency Audiograms in Clinical Practice.

OBJECTIVES: Extended high-frequency (EHF) audiometry elicits pure-tone thresholds at frequencies above 8 kHz, which are not included in routine clinical testing. This study explores the utility of EHF audiometry in patients with various audiologic symptoms despite normal-hearing thresholds at ≤8 kHz. METHODS: A retrospective review was performed of all patients receiving conventional (250-8 kHz) and EHF (9-20 kHz) audiometry at a tertiary otological referral center between April 2021 and August 2022. Only patients with audiologic symptoms and pure-tone thresholds ≤25 dB HL at ≤8 kHz bilaterally on routine testing were included in subsequent analysis. EHF-PTA was defined for each ear as an average of the air conduction thresholds at 9.0, 10.0, 11.2, 12.5, 14.0, 16.0, 18.0, and 20.0 kHz. RESULTS: Of the 50 patients who received EHF testing, 40 had audiologic symptoms and normal conventional audiograms at ≤8 kHz. Twenty-five of the 40 (62.5%) were found to have hearing loss in the highest frequencies. Patients with EHF hearing loss (EHF-HL) were more likely to report subjective hearing loss. Age was significantly greater in those with EHF-HL compared with those without EHF-HL, and age was positively correlated with the degree of EHF-HL. CONCLUSION: EHF testing correlates with audiologic symptoms in patients with normal testing at ≤8 kHz and may be considered when standard audiometry is normal. Additional data are warranted to create an evidenced-based, clinical algorithm for EHF audiometry that can guide treatment, direct mitigation strategies, and potentially identify those at higher risk of hearing loss over time. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:907-910, 2024.

Sarcopenia as a Prognostic Factor in Patients with Hepatoblastoma: Does It Influence Surgical Outcomes and Survival? Preliminary Retrospective Study.

AIM: Sarcopenia is associated with poor prognosis in adult oncologic patients, with little evidence of this association in pediatric population, including hepatoblastoma. METHODS: Retrospective study in patients with hepatoblastoma, divided into those with or without sarcopenia. Sarcopenia was assessed by measuring psoas muscle area (PMA) at L4-L5 level on the CT/MR and defined as z-score values ≤ 2. Relapse and mortality were analyzed. RESULTS: Twenty-one patients (57.1% male) were included, with median age 35.7 months (IQR: 23.5-58.5). Seven (33.3%) had sarcopenia on initial studies compared to 14 (66.7%) who did not. No differences were found between groups in age, weight, PRETEXT, surgical treatment or. α-fetoprotein levels. Sarcopenia was associated with a higher rate of metastases at diagnosis (49.2% vs 0.0%; p = 0.026) and surgical complications (57.1% vs 21.4%, p = 0.047). After a median follow-up of 65.1 months (1.7-144.8), 2 patients (28.6%) had tumor relapse in sarcopenic group compared to 1 (7.1%) in non-sarcopenic group. Two patients died in sarcopenic group and 1 in non-sarcopenic group. Median event-free survival (EFS) was lower in sarcopenic group (100.38 ± 25.63 vs 118.91 ± 11.52 months) as well as overall survival (OS) (101.72 ± 24.86 vs 121.78 ± 8.75 months) with no statistical significance. Five-year EFS was also lower in sarcopenic group (71% vs 93%) as well as 5-year OS (71% vs 87%). CONCLUSIONS: Sarcopenia at diagnosis was associated with a higher rate of metastases and surgical complications in hepatoblastoma. Our data shows the first evidence of its role as a possible poor prognostic factor, influencing survival and risk of relapse. LEVEL OF EVIDENCE: II. TYPE OF STUDY: Original article. Retrospective study.

Factores de riesgo para mortalidad por COVID-19 en adultos ingresados en un hospital de Honduras / Risk factors to COVID-19 mortality in adults admitted to a hospital in Honduras

Según estudios a nivel internacional, los casos fatales de la COVID-19 están relacionados con edad avanzada, sexo masculino y presencia de enfermedades crónicas. Objetivo: Determinar factores de riesgo asociados a mortalidad por COVID-19 en pacientes adultos ingresados en un hospital público de Honduras. Métodos: Estudio tipo casos y controles en pacientes ingresados con diagnóstico de COVID-19; Casos: pacientes con diagnóstico de COVID-19 con condición de egreso fallecido, Controles: pacientes con diagnóstico de COVID-19 con condición de egreso alta médica. Se analizó una muestra de 100 casos y 200 controles. Se realizó análisis de características demográficas, clínicas y laboratoriales, posteriormente se estimaron OR y se construyó un modelo de regresión logística múltiple. Resultados: Se encontró que 57.5% (171/300) tenía 60 años o más y 60.3% (181/300) era del sexo masculino. Los síntomas más frecuentes fueron dificultad respiratoria 94%, fiebre 90.3% y tos 86%. Los factores de riesgo asociados a mortalidad por COVID-19 fueron edad (OR 10.40 IC95% 3.96-27.30), sexo masculino (OR 3.25 IC95% 1.75-6.06), comorbilidades (OR 2.14 IC95% 1.03-4.45), niveles elevados de dímero D (OR 2.28 IC95% 1.20-4.32) y LDH (OR 5.65 IC95% 2.62-12.18). Discusión: Los factores de riesgo asociados a mortalidad por COVID-19 encontrados en este estudio coinciden con los presentados en estudios internacionales. Es necesario identificar los pacientes con estos factores para ofrecer manejos oportunos según su condición clínica...(AU)

Uso de anticuerpos monoclonales en adultos con COVID-19 en un hospital público de Honduras / Use of monoclonal antibodies in adults with COVID-19 in a public hospital of Honduras

Antecedentes: La pandemia de COVID-19 ha provocado una crisis de salud pública mundial, creando incertidumbre sobre su tratamiento. El Tocilizumab (TCZ), un anticuerpo monoclonal humanizado que actúa como antagonista del receptor de Interleucina 6 (IL-6), ha sido utilizado en enfermedades inmunológicas y en pacientes críticos por COVID-19. Objetivo: Describir el uso de TCZ en pacientes adultos hospitalizados por COVID-19 en Hospital María Especialidades Pediátricas (HMEP), agosto 2020-marzo 2021. Métodos: Estudio descriptivo, retrospectivo. Fuente de datos: expedientes clínicos. Criterios de inclusión: Adulto mayor de 18 años, manejo hospitalario por COVID-19, con TCZ y expediente clínico completo. Criterios de exclusión: Haber recibido TCZ en otro hospital. Se utilizó estadística descriptiva y se realizó análisis de sobrevida de Kaplan & Meier para comparar las probabilidades de sobrevida según edad, con un nivel se significancia p<0.05. Resultados: Se analizaron 104 expedientes clínicos. La mediana de edad de los pacientes fue 57 años (RI=44-67), la edad fue mayor en los pacientes fallecidos; 60% (62/104) del sexo masculino. Los pacientes mostraron mejoría en parámetros clínicos y laboratoriales, como descensos en frecuencia respiratoria y frecuencia cardíaca, aumento de linfocitos y descenso de Proteína C Reactiva (PCR). El análisis de sobrevida de Kaplan & Meier mostró que la probabilidad de vivir en estos pacientes disminuye conforme aumenta la edad. Discusión: Los resultados de este estudio coinciden con los encontrados a nivel internacional, avalando el uso de TCZ en pacientes críticos por COVID-19...(AU)

Alzheimer's Disease: A Silent Pandemic - A Systematic Review on the Situation and Patent Landscape of the Diagnosis.

BACKGROUND: Alzheimer's disease (AD) is characterized by cognitive impairment, tau protein deposits, and amyloid beta plaques. AD impacted 44 million people in 2016, and it is estimated to affect 100 million people by 2050. AD is disregarded as a pandemic compared with other diseases. To date, there is no effective treatment or diagnosis. OBJECTIVE: We aimed to discuss the current tools used to diagnose COVID-19, point out their potential to be adapted for AD diagnosis, and review the landscape of existing patents in the AD field and future perspectives for AD diagnosis. METHODS: We carried out a scientific screening following a research strategy in PubMed; Web of Science; the Derwent Innovation Index; the KCI-Korean Journal Database; Sci- ELO; the Russian Science Citation index; and the CDerwent, EDerwent, and MDerwent index databases. RESULTS: A total of 326 from 6,446 articles about AD and 376 from 4,595 articles about COVID-19 were analyzed. Of these, AD patents were focused on biomarkers and neuroimaging with no accurate, validated diagnostic methods, and only 7% of kit development patents were found. In comparison, COVID-19 patents were 60% about kit development for diagnosis; they are highly accurate and are now commercialized. CONCLUSION: AD is still neglected and not recognized as a pandemic that affects the people and economies of all nations. There is a gap in the development of AD diagnostic tools that could be filled if the interest and effort that has been invested in tackling the COVID-19 emergency could also be applied for innovation.

Postoperative Pneumoperitoneum in Pediatric Patients: Residual Air or Surgical Complication? A Prospective Study.

Background: Residual postoperative pneumoperitoneum (RPP) can be confused with postoperative complications. Our aim was to study RPP characteristics in pediatric patients. Materials and Methods: Prospective study in children with noncomplicated appendicitis, from July to December 2019, divided into open appendectomy (OA) or laparoscopic appendectomy (LA). Abdominal ultrasounds were performed daily to assess RPP. Demographic, surgical data, and RPP characteristics were analyzed. Results: Forty-one patients (63% male) aged 9.8 ± 2.9 years were included: 19 had OA and 22 LA. RPP was present in 90.9% of LA patients versus 21.1% of OA (P < .001). RPP disappeared by the postoperative day (POD) 2, in all OA patients. RPP was present in 90.9% of LA patients in POD 1, 53.8% on POD 2, 25% on POD 3, and in no patient from POD 4. RPP prevalence was not associated with surgical duration, age, gender, or type of appendicitis. RPP was associated with pain radiating to the shoulders (PRS) (P = .018), with a sensitivity of 50.0% and specificity of 88.23% for diagnosis. Conclusions: Surgical approach was the main factor associated with RPP persistence. PRS in the physical examination may be helpful for diagnosis when RPP is suspected. The persistence of RPP beyond POD 4 is uncommon, and should be considered when making decisions.

First multivisceral transplantation in Mitchell-Riley/Martinez-Frias syndrome.

BACKGROUND: MRS/MFS is a rare multisystem disorder with a poor prognosis. The high mortality rate of this syndrome is related to the severity of the associated gastrointestinal, pancreatic, and hepatobiliary conditions, as most of them are not amenable to conventional medical and surgical treatments. METHODS: We report the case of a Romani girl with all the key clinical features of MRS/MFS, and a review of cases reported in the literature. Our patient is a newborn from consanguineous parents who presented duodenal atresia, hypoplastic pancreas, gallbladder agenesis, and neonatal diabetes. Given the clinical suspicion of MRS/MFS, a genetic analysis was performed which revealed the presence of a homozygous variant in the RFX6 gene. During the course of the disease, the patient presented intractable secretory diarrhea and severe intestinal failure. RESULTS: At 2 years of age, she underwent MVT of the stomach, duodenum, small intestine, colon, liver, and pancreas. There were no surgical complications. Histologic evaluation of the small bowel showed extensive patches of gastric heterotopia. After more than 10 years of follow-up, she had presented with normal gastrointestinal, hepatic, and pancreatic function. She has one of the longest survival periods in the literature. CONCLUSIONS: Our experience suggests that multivisceral transplantation may be a promising option in select cases of MRS/MFS.

Evaluación de cribado de la calidad de vida en cuidadores primarios informales de pacientes oncológicos / Screening assessment of quality of life in informal primary caregivers of cancer patients

Objetivo: determinar las propiedades psicométricas de un instrumento de CV (CQoLC) y evaluar la calidad de vida (CV) de los cuidadores primarios (CPI) de pacientes con cáncer. Material y método:estudio tres fases: (1) evaluación de CV en CPI con un instrumento validado para población general y de pacientes que requieren atención médica (InCaViSa); (2) adaptación y piloteo del CQoLC y; (3) evaluación de confiabilidad, validez y normas del CQoLC. Se incluyeron 317 CPI de pacientes con diferentes diagnósticos oncológicos. Se realizaron análisis descriptivos de la CV reportada por los CPI. Para piloteo del instrumento se estimó el porcentaje de CPI que tuvieron dificultades para comprender algún reactivo. En la fase de validación se realizó un análisis factorial por ejes principales y la estructura propuesta se sometió a un análisis factorial confirmatorio (AFC). La confiabilidad se obtuvo a través del Alfa de Cronbach y el coeficiente Omega de McDonald’s. Finalmente, se estimaron los parámetros para calificación del CQoLC. Resultados: los CPI obtuvieron puntajes de “baja” a “muy baja” CV en la mayoría de las subescalas del InCaViSa. El CQoLC no mostró dificultades para su comprensión y se obtuvo una versión de nueve reactivos, distribuidos en cuatro indicadores, que explican el 45,62% de la varianza con adecuado ajuste en el AFC y adecuados índices de confiabilidad (Alfas de Cronbach de 0,496 a 0,866 y coeficiente Omega de McDonald’s = 0,868).Conclusiones:la CV de los CPI de pacientes con cáncer se encuentra afectada importantemente. El CQoLC es un instrumento especializado, que demostró ser adecuado como herramienta de cribado en las mediciones de auto-reporte (AU)

Objective: To determine the psychometric properties of a QoL instrument (CQoLC) and to assess the quality of life (QoL) of primary caregivers (PC) of cancer patients. Methods:Three-phase study: (1) assessment of QoL in PC with an instrument validated for general population and patients requiring medical care (InCaViSa); (2) adaptation and piloting of the CQoLC and (3) assessment of reliability, validity, and norms of the CQoLC. A total of 317 PCs of patients with different oncologic diagnoses were included. Descriptive analyses of the QOL reported by the PCs were performed. For piloting the instrument, the percentage of PCs who had difficulties in understanding any item was estimated. Factor analysis by main axes was performed in the validation phase, and the proposed structure was subjected to confirmatory factor analysis (CFA). Reliability was obtained through Cronbach’s Alpha and McDonald’s Omega coefficient. Finally, the parameters for CQoLC scoring were estimated. Results: The PCs obtained “low” to “deficient” QoL scores in most InCaViSa subscales. The CQoLC showed no difficulties in its comprehension, and a version of nine items was obtained, distributed in four indicators, which explain 45,62% of the variance with adequate adjustment in the AFC and adequate reliability indexes (Cronbach’s alphas from 0,496 to 0,866 and McDonald’s Omega coefficient = 0,868). Conclusions: The QoL of the CQoLC of cancer patients is significantly affected. The CQoLC is a specialized instrument, which proved to be adequate as a screening tool in self-report measurements (AU)

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery.

INTRODUCTION: In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. MATERIALS AND METHODS: Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with "patient-controlled analgesia" (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55-127), with no differences between the groups. RESULTS: PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). CONCLUSION: PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

Vascular smooth muscle cell dysfunction contribute to neuroinflammation and Tau hyperphosphorylation in Alzheimer disease.

Despite the emerging evidence implying early vascular contributions to neurodegenerative syndromes, the role of vascular smooth muscle cells (VSMCs) in the pathogenesis of Alzheimer disease (AD) is still not well understood. Herein, we show that VSMCs in brains of patients with AD and animal models of the disease are deficient in multiple VSMC contractile markers which correlated with Tau accumulation in brain arterioles. Ex vivo and in vitro experiments demonstrated that VSMCs undergo dramatic phenotypic transitions under AD-like conditions, adopting pro-inflammatory phenotypes. Notably, these changes coincided with Tau hyperphosphorylation at residues Y18, T205, and S262. We also observed that VSMC dysfunction occurred in an age-dependent manner and that expression of Sm22α protein was inversely correlated with CD68 and Tau expression in brain arterioles of the 3xTg-AD and 5xFAD mice. Together, these findings further support the contribution of dysfunctional VSMCs in AD pathogenesis and nominate VSMCs as a potential therapeutic target in AD.

Influencia de la pandemia por coronavirus 2(sars-cov-2) en la apendicitis aguda. Sars-cov-2 en la apendicitis aguda / Influence of the coronavirus 2 (sars-cov-2) pandemic on acute apendicitis

INTRODUCCIÓN: La apendicitis aguda (AA) es la urgencia quirúrgica abdominal más frecuente. No encontramos estudios específicos que evalúen el impacto de la pandemia causada por el coronavirus 2 (SARS-Cov-2) sobre la AA y su tratamiento quirúrgico. Analizamos la influencia de esta nueva patología sobre la AA. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo en pacientes intervenidos por AA desde enero hasta abril de 2020. Fueron clasificados según el momento de la apendicectomía, antes de la declaración del estado de alarma (Pre-COVID19) y después de la declaración del estado de alarma (Post-COVID19) en España. Se evaluaron variables demográficas, duración de la sintomatología, tipo de apendicitis, tiempo quirúrgico, estancia hospitalaria y complicaciones postoperatorias. RESULTADOS: Se incluyeron 66 pacientes (41 Pre-COVID19; 25 Post-COVID19 con edad media de 10.7 ± 3 y 9.3 ± 3.1; p = 0.073; respectivamente). La fiebre se encontró en un mayor número de pacientes post-COVID19 (52 vs 19.5%; p = 0.013), así como una PCR más elevada (72.7 ± 96.2 vs 31.3 ± 36.2 mg/dl; p = 0.042). Este grupo presentó una mayor proporción de apendicitis complicada al compararle con el Pre-COVID19 (32 vs 7.3%; p = 0.015). La estancia media hospitalaria fue mayor en el grupo Post-COVID19 (5.6 ± 5.9 vs 3.3 ± 4.3 días; p = 0.041). No se encontraron diferencias en el tiempo de evolución de los síntomas ni en el tiempo quirúrgico. CONCLUSIONES: La pandemia por SARS-Cov-2 influye en el momento de diagnóstico de la apendicitis, así como en su grado de evolución y estancia hospitalaria. La peritonitis fue lo más frecuentemente observado. Una sospecha y orientación clínica más temprana, es necesaria para evitar un manejo inadecuado de este trastorno quirúrgico común

INTRODUCTION: Acute appendicitis (AA) is the most common abdominal surgical emergency. No specific studies have been found that evaluate the impact of the coronavirus 2 (SARS-Cov-2) pandemic on AA and its surgical management. An analysis was made on the influence of this new pathology on the clinical course of AA. MATERIAL AND METHODS: Retrospective observational study was conducted on patients operated on for AA from January to April 2020. They were classified according to the time of the appendectomy, before the declaration of the state of alarm (Pre-COVID-19), and after its declaration (Post-COVID-19) in Spain, one the most affected countries in the world. An evaluation was made of demographic variables, duration of symptoms, type of appendicitis, surgical time, hospital stay, and postoperative complications. RESULTS: The study included 66 patients (41 Pre-COVID-19; 25 Post-COVID-19) with mean age of 10.7 ± 3 and 9.3 ± 3.1; P = .073, respectively. Fever was found in a higher number of post-COVID-19 patients (52 vs 19.5%; P = .013), as well as a higher CRP (72.7 ± 96.2 vs 31.3±36.2 mg/dL; P = .042). This group presented with a higher proportion of complicated appendicitis when compared to Pre-COVID-19 (32 vs 7.3%; P = .015). The mean hospital stay was longer in the Post- COVID-19 group (5.6 ± 5.9 vs 3.2 ± 4.3 days; P = .041). No differences were found in the time of onset of symptoms or surgical time. Conclusions. The SARS-Cov-2 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Peritonitis was more frequently seen. As a result of the significant circumstances, delaying diagnosis and treatment of AA during SARS-Cov-2 pandemic, inappropriate management of this common surgical disorder has been noticed

[Influence of the coronavirus 2 (SARS-Cov-2) pandemic on acute appendicitis]. / Influencia de la pandemia por coronavirus 2 (SARS-Cov-2) en la apendicitis aguda.

INTRODUCTION: Acute appendicitis (AA) is the most common abdominal surgical emergency. No specific studies have been found that evaluate the impact of the coronavirus 2 (SARS-Cov-2) pandemic on AA and its surgical management. An analysis was made on the influence of this new pathology on the clinical course of AA. MATERIAL AND METHODS: Retrospective observational study was conducted on patients operated on for AA from January to April 2020. They were classified according to the time of the appendectomy, before the declaration of the state of alarm (pre-COVID-19), and after its declaration (post-COVID-19) in Spain, one the most affected countries in the world. An evaluation was made of demographic variables, duration of symptoms, type of appendicitis, surgical time, hospital stay, and postoperative complications. RESULTS: The study included 66 patients (41 pre-COVID-19; 25 post-COVID-19) with mean age of 10.7 ± 3 and 9.3 ± 3.1; P = .073, respectively. Fever was found in a higher number of post-COVID-19 patients (52 vs. 19.5%; P = 0.013), as well as a higher CRP (72.7 ± 96.2 vs. 31.3 ± 36.2 mg/dL; P = 0.042). This group presented with a higher proportion of complicated appendicitis when compared to pre-COVID-19 (32 vs. 7.3%; P = 0.015). The mean hospital stay was longer in the post-COVID-19 group (5.6 ± 5.9 vs. 3.2 ± 4.3 days; P = 0.041). No differences were found in the time of onset of symptoms or surgical time. CONCLUSIONS: The SARS-Cov-2 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Peritonitis was more frequently seen. As a result of the significant circumstances, delaying diagnosis and treatment of AA during SARS-Cov-2 pandemic, inappropriate management of this common surgical disorder has been noticed.

Effectiveness of short-term physical agents treatment on macroscopic morphology in patients with plaque psoriasis / Efectividad del tratamiento a corto plazo de los agentes físicos en la morfología macroscópica de las placas de psoriasis

Psoriasis is a chronic inflammatory disease that presents skin rashes which can arise through plaques. The aim of this work was to compare the effectiveness of short-term physical agents treatment on macroscopic morphology (area and erythema) in patients with plaque psoriasis. This prospective randomized experimental study included fourteen subjects, medically diagnosed with psoriasis, with more than one plaque in the skin and voluntarily without topical treatment. All subjects completed the study that consisted of 12 treatment sessions divided in control (C), artificial balneotherapy (AB), phototherapy (PT) or balneophototherapy (BPT) groups. After session 12, there was a significant reduction of the plaque area by all treatments when compared to C group and BPT was the most effective one. However, only AB and PT presented a reduction of erythema. Regarding severity, 9 patients changed to a lower category on the PASI test, and 5 of them maintained a mild psoriasis, but lowered their score. Finally, 13 of 14 subjects improved their quality of life. The physical agents used reduced the severity of psoriasis and improved quality of life of patients after 12 sessions of treatment during a onemonth period. The BPT was the more effective in controlling psoriasis by diminishing its area and PT by attenuating the erythema.

La Psoriasis es una enfermedad inflamatoria crónica que presenta irritación cutánea que puede derivar a placas. El objetivo de este trabajo fue comparar la efectividad del tratamiento a corto plazo con agentes físicos en la morfología macroscópica (área y eritema) en pacientes con placas de psoriasis. Estudio experimental, prospectivo, randomizado. Catorce sujetos participaron con diagnóstico médico de psoriasis, con más de una placa en la piel y sin tener tratamiento tópico de forma voluntaria. Todos los sujetos completaron el estudio, el cual consistió de 12 sesiones de tratamiento dividido en grupo control (C), BA, FT y BFA. Posterior a la sesión 12, se observó una reducción significativa en toda el área de las placas que recibieron tratamiento al compararlas al grupo C y el grupo BFA fue el más efectivo. Sin embargo, solo los grupos BA y FT presentaron una reducción del eritema. Respecto a la severidad, 9 pacientes cambiaron de la baja categoría en el test de PASI y 5 de ellos se mantuvieron en el nivel medio, pero disminuyeron su puntaje. Finalmente, 13 de 14 sujetos mejoraron su calidad de vida. Los agentes físicos usados redujeron la severidad de la psoriasis y mejoraron la calidad de vida de los pacientes después de 12 sesiones de tratamiento durante el período de un mes. La BFA fue la más efectiva en controlar la psoriasis por la disminución en el área y la FT por la atenuación del eritema.

Prevalence of food allergens sensitization and food allergies in a group of allergic Honduran children.

BACKGROUND: Food allergy is a public health problem that has increased in the last decade. Despite the increasing rates in children, quality data on the burden of these diseases is lacking particularly in developing countries. Honduras has no studies in pediatric patients. OBJECTIVES: The objective of this research was to identify the most common sensitization patterns to food through epicutaneous skin testing and food allergy rates in children and their correlation with common allergic diseases in a group of patients from Hospital of Pediatrics Maria. METHODS: Cross-sectional retrospective, descriptive study in which records and database of all allergic patients in the immunology outpatient clinic from Hospital of Pediatrics Maria were reviewed between the periods of January 2015 through June 2016. RESULTS: A total of 365 children were analyzed, the age of participants were in the range from 1 to 18 years, with an average of 9.8 years. Sensitization to food allergens were found in 23, and 58.3% were poly-sensitized. The most common food allergens that patients were sensitized to: milk 9.0%, eggs 6.9%, peanut 4.9% and pork meat 4.4%. Food allergy was confirmed via oral food challenged in 9.3% of the patients. The most frequent food allergies found were: cow's milk allergy 6%, hen's egg allergy 5.2% and wheat allergy 1.9%. CONCLUSIONS: Milk and egg were the most common a food allergens found in the population studied. Most of the patients were found to be poly-sensitized. The frequent food allergies confirmed via oral food challenge were cow's milk allergy, hen's egg allergy and wheat allergy.

Localización y clínica asociada al cáncer de colon: Hospital Nacional Arzobispo Loayza: 2009 - 2013 / Location and associated clinical characteristics of colon cancer: Hospital Nacional Arzobispo Loayza: 2009 - 2013

OBJETIVO: Determinar la clínica asociada a la localización del cáncer de colon en pacientes del Hospital Nacional Arzobispo Loayza durante el periodo mayo 2009 - setiembre 2013. MATERIAL Y MÉTODOS: estudio transversal que analizó información de 114 pacientes con neoplasia maligna primaria de colon, de los cuales 42 cumplieron los criterios de inclusión; internados en el Servicio 6-II del Departamento de Cirugía General del Hospital Nacional Arzobispo Loayza entre mayo 2009 y setiembre 2013. RESULTADOS: La media de edad fue de 60.5 años, y predominó el género femenino con 66.7%. El 100% de los tipos histológicos fue adenocarcinoma. El colon derecho resultó afectado en 61.9%, el izquierdo en 33,3% y un 4,8% presentó localización mixta. En la topografía, se halló 33,3% en colon ascendente y 21,4% en colon sigmoides. Los síntomas más frecuentes fueron dolor abdominal (76,2%), pérdida de peso (69%) y anemia (64%). Para el colon derecho, hubo 13 veces más riesgo de presentar astenia, y 4.44 veces más riesgo de presentar anemia (p<0,05). CONCLUSIÓN: La localización de cáncer de colon más frecuente fue en el colon derecho, el cual se asoció significativamente a la presencia de astenia y anemia en el cuadro clínico. Los síntomas más presentados fueron el dolor abdominal y la pérdida de peso, en cualquiera de sus localizaciones. Todos los casos fueron de adenocarcinoma. (Horiz Med 2015; 15(2): 49-55)

OBJECTIVE: To determine the association between the clinical characteristics and the location of colon cancer in patients hospitalized at "Hospital Nacional Arzobispo Loayza", during May 2009 - September 2013. MATERIAL AND METHODS: transversal study of 144 patients with primary colon cancer, of which 42 patients met the inclusion criteria; hospitalized in the 6-II Wing of the Department of General Surgery at "Hospital Nacional Arzobispo Loayza", between May 2009 and September 2013. RESULTS: the mean age was 60.5 years, and 66.7% of the cases were women. 100% of histologic types were adenocarcinoma. The right colon was affected in 61.9% of the cases; the left colon in 33.3%, and a mixed location in 4,8%. Regarding the topography, 33,3% of the cases were found in the ascending colon and 21,4% in the sigmoid colon. The most frequent symptoms were abdominal pain (76.2%), weight loss (69%) and anemia (64%). For right colon cancer, fatigue was 13 times more likely to appear, and anemia was 4.44 times more likely (p< 0.05). CONCLUSION: the most common location for cancer was in the right colon, and it was associated significantly with the presence of fatigue and anemia among the clinical characteristics. The most frequent symptoms were abdominal pain and weight loss, in any location. All cases were adenocarcinoma. (Horiz Med 2015; 15(2): 49-55)