Uncovered p1 and p2 waves preceding the N3 vestibular evoked neurogenic potential in profound sensorineural hearing loss.

BACKGROUND: The N3 wave is a vestibular evoked neurogenic potential detected in some patients with profound sensorineural hearing loss (PSNHL) during brainstem auditory evoked potential (BAEP) analysis. In 1998, Kato et al. mentioned two electropositive waves preceding N3, which we named p1-p2, but no further description was given. OBJECTIVE: We sought to demonstrate the reproducibility of these waves and hypothesize on their anatomic origin. METHODS: We used two cohorts of patients with PSNHL. The first cohort comprised 10 patients with N3, allowing us to establish a new test with adequate electrophysiological conditions headed to detect p1-p2 waves (PN3EP). The second cohort consisted of two groups: group A comprised 10 patients in whom N3 was not detected; and group B comprised 20 patients presenting N3. PN3EP was performed in both groups, of which 50% had cervical myogenic vestibular evoked potentials (cVEMPs). RESULTS: Only group B presented p1-p2. The PN3EP facilitated the identification of p1-p2 over BAEP analysis, and their presence correlated well with cVEMPs. CONCLUSIONS: P1-p2 may be covered due to inadequate BAEP setting conditions, and could be generated in the distal neural path that generates the N3 wave.

[Epidemiology of invasive pneumococcal disease in Tarragona, Spain, 2012-2015: incidence, lethality and serotype-coverage for distinct antipneumococcal vaccine formulations]. / Epidemiología de la enfermedad neumocócica invasiva en la región de Tarragona, 2012-2015: Incidencia, letalidad y cobertura de serotipos para las distintas formulaciones vacunales antineumocócicas.

OBJECTIVE: Nowadays, after licensure of the second generation new pneumococcal conjugate vaccines (PCV10/PCV13). The epidemiology of the pneumococcal disease must be re-evaluated. The present study described incidence, lethality and serotype distribution of invasive pneumococcal disease (IPD) in the general population of Tarragona's region (Spain) after licensure of these vaccines. METHODS: Retrospective study that included all cases of IPD (pneumococcus isolated in sterile sites) diagnosed among all-age individuals in the Spanish region of Tarragona (Tarragonés, Alt Camp and Baix Penedés counties) from 01/01/2012 to 31/12/2015. Incidence and lethality rates were estimated by age strata and globally. Similarly, it was determined the prevalence of IPD cases caused by serotypes included in the distinct formulations of multivalent conjugate vaccines (pcv7), PCV10 and PCV13) or 23-valent polysaccharide vaccine (PPV23). RESULTS: A total of 171 IPD cases were observed, which means a global incidence (per 100,000 persons-year) of 10.82 (7.86 in ≤14 years, 5.94 in 15-64 years and 36.46 in ≥65 years; p<0.001). Overall lethality rate was 6.8% (none in children, 9,3% in people 15-64 years and 6.9% in people ≥65 years). A serotype was identified in 132 (77.2%) of the 171 studied samples. Serotype-vaccine coverages (cases due to vaccine-type serotypes) were 14.4%, 26.5%, 42.4% and 78.8% for the PCV7, PCV10, PCV13 and PPV23, respectively (p<0.001). CONCLUSIONS: Incidence and lethality of IPD were intermediate-low in the region of Tarragona throughout 2012-2015. During this period, Serotype- vaccine coverage was almost double for the 23-valent than for the 13-valent vaccine.

OBJETIVO: En la actualidad, tras la comercialización de las nuevas vacunas neumocócicas conjugadas de segunda generación (VNC10/VNC13), la epidemiología de la enfermedad neumocócica debe ser reevaluada. El presente estudio tuvo como objetivo describir la incidencia, letalidad y distribución serotípica de la enfermedad neumocócica invasiva (ENI) en la población general del área de Tarragona durante el cuatrienio posterior a la introducción de estas vacunas. METODOS: Estudio observacional retrospectivo que incluyó todos los casos de ENI (Streptococcus pneumoniae aislado en sangre, líquido cefalorraquídeo, líquido pleural/articular/peritoneal o muestras de tejidos profundos obtenidas de forma estéril mediante punción-aspiración o biopsia) diagnosticados en el área de Tarragona (comarcas del Tarragonés, Alt Camp y Baix Penedés) entre 01/01/2012 y 31/12/2015. Se estimaron tasas de incidencia y letalidad (globalmente y por estratos etarios) y se determinó la prevalencia de casos causados por serotipos incluidos en las distintas formulaciones de vacunas antineumocócicas conjugadas heptavalente (VNC7), decavalente (VNC10), tridecavalente (VNC13) y polisacárida tricosavalente (VNP23). RESULTADOS: Se observaron 171 casos de ENI, lo que representó una incidencia (por 100.000 personas-año) de 10,82 (7,86 en ≤14 años, 5,94 en 15-64 años y 36,46 en ≥65 años; p<0,001). La letalidad fue del 6,8% (ninguna en niños, 9,3% en 15-64 años y 6,9% en personas ≥65 años; p<0,001). El serotipo responsable fue identificado en 132 (77,2%) de las 171 muestras estudiadas. La cobertura serotípica (casos causados por serotipos vacunales) fue del 14,4%, 26,5%, 42,4% y 78,8% para la VNC7, VNC10, VNC13 y VNP23, respectivamente (p<0,001). CONCLUSIONES: Durante el periodo 2012-2015 la incidencia y letalidad por ENI fue intermedia-baja en el área de Tarragona, destacando que la cobertura serotípica fue casi doble para la vacuna 23-valente que para la 13-valente.

Evaluating clinical effectiveness of 13-valent pneumococcal conjugate vaccination against pneumonia among middle-aged and older adults in Catalonia: results from the EPIVAC cohort study.

BACKGROUND: Benefits using the 13-valent pneumococcal conjugate vaccine (PCV13) in adults are controversial. This study investigated clinical effectiveness of PCV13 vaccination in preventing hospitalisation from pneumonia among middle-aged and older adults. METHODS: Population-based cohort study involving 2,025,730 individuals ≥50 years in Catalonia, Spain, who were prospectively followed from 01/01/2015 to 31/12/2015. Primary outcomes were hospitalisation for pneumococcal or all-cause pneumonia and death from any cause. Cox regression models were used to evaluate the association between PCV13 vaccination and the risk of each outcome, adjusting for age, sex and major comorbidities/underlying risk conditions. RESULTS: Cohort members were observed for a total of 1,990,701 person-years, of which 6912 person-years were PCV13 vaccinated. Overall, crude incidence rates (per 100,000 person-years) were 82.8 (95% confidence interval [CI]: 77.7-88.1) for pneumococcal pneumonia, 637.9 (95% CI: 599.0-678.7) for all-cause pneumonia and 2367.2 (95% CI: 2222.8-2518.7) for all-cause death. After multivariable adjustments we found that the PCV13 vaccination did not alter significantly the risk of pneumococcal pneumonia (multivariable-adjusted hazard ratio [mHR]: 1.17; 95% CI: 0.75-1.83; p = 0.493) and all-cause death (mHR: 1.07; 95% CI: 0.97-1.18; p = 0.190), although it remained significantly associated with an increased risk of all-cause pneumonia (mHR: 1.69; 95% CI: 1.48-1.94; p < 0.001). In stratified analyses focused on middle-aged or elderly persons and immunocompromised or immunocompetent subjects, PCV13 vaccination did not appear effective either. CONCLUSION: Our data does not support clinical benefits of PCV13 vaccination against pneumonia among adults in Catalonia. It must be closely monitored in future studies involving more vaccinated person-time at-observation.

Epidemiología de la enfermedad neumocócica invasiva en la región de Tarragona, 2012-2015: incidencia, letalidad y cobertura de serotipos para las distintas formulaciones vacunales antineumocócicas / Epidemiology of invasive pneumococcal disease in Tarragona, Spain, 2012-2015: incidence, lethality and serotype-coverage for distinct antipneumococcal vaccine formulations

Fundamentos: En la actualidad, tras la comercialización de las nuevas vacunas neumocócicas conjugadas de segunda generación (VNC10/VNC13), la epidemiología de la enfermedad neumocócica debe ser reevaluada. El presente estudio tuvo como objetivo describir la incidencia, letalidad y distribución serotípica de la enfermedad neumocócica invasiva (ENI) en la población general del área de Tarragona durante el cuatrienio posterior a la introducción de estas vacunas. Métodos: Estudio observacional retrospectivo que incluyó todos los casos de ENI (Streptococcus pneumoniae aislado en sangre, líquido cefalorraquídeo, líquido pleural/articular/peritoneal o muestras de tejidos profundos obtenidas de forma estéril mediante punción-aspiración o biopsia) diagnosticados en el área de Tarragona (comarcas del Tarragonés, Alt Camp y Baix Penedés) entre 01/01/2012 y 31/12/2015. Se estimaron tasas de incidencia y letalidad (globalmente y por estratos etarios) y se determinó la prevalencia de casos causados por serotipos incluidos en las distintas formulaciones de vacunas antineumocócicas conjugadas heptavalente (VNC7), decavalente (VNC10), tridecavalente (VNC13) y polisacárida tricosavalente (VNP23). Resultados: Se observaron 171 casos de ENI, lo que representó una incidencia (por 100.000 personas-año) de 10,82 (7,86 en ≤14 años, 5,94 en 15-64 años y 36,46 en ≥65 años; p<0,001). La letalidad fue del 6,8% (ninguna en niños, 9,3% en 15-64 años y 6,9% en personas ≥65 años; p<0,001). El serotipo responsable fue identificado en 132 (77,2%) de las 171 muestras estudiadas. La cobertura serotípica (casos causados por serotipos vacunales) fue del 14,4%, 26,5%, 42,4% y 78,8% para la VNC7, VNC10, VNC13 y VNP23, respectivamente (p<0,001). Conclusiones: Durante el periodo 2012-2015 la incidencia y letalidad por ENI fue intermedia-baja en el área de Tarragona, destacando que la cobertura serotípica fue casi doble para la vacuna 23-valente que para la 13-valente

Background: Nowadays, after licensure of the second generation new pneumococcal conjugate vaccines (PCV10/PCV13). The epidemiology of the pneumococcal disease must be re-evaluated. The present study described incidence, lethality and serotype distribution of invasive pneumococcal disease (IPD) in the general population of Tarragona's region (Spain) after licensure of these vaccines. Methods: Retrospective study that included all cases of IPD (pneumococcus isolated in sterile sites) diagnosed among all-age individuals in the Spanish region of Tarragona (Tarragonés, Alt Camp and Baix Penedés counties) from 01/01/2012 to 31/12/2015. Incidence and lethality rates were estimated by age strata and globally. Similarly, it was determined the prevalence of IPD cases caused by serotypes included in the distinct formulations of multivalent conjugate vaccines (pcv7), PCV10 and PCV13) or 23-valent polysaccharide vaccine (PPV23). Results: A total of 171 IPD cases were observed, which means a global incidence (per 100,000 persons-year) of 10.82 (7.86 in ≤14 years, 5.94 in 15-64 years and 36.46 in ≥65 years; p<0.001). Overall lethality rate was 6.8% (none in children, 9,3% in people 15-64 years and 6.9% in people ≥65 years). A serotype was identified in 132 (77.2%) of the 171 studied samples. Serotype-vaccine coverages (cases due to vaccine-type serotypes) were 14.4%, 26.5%, 42.4% and 78.8% for the PCV7, PCV10, PCV13 and PPV23, respectively (p<0.001). Conclusion: Incidence and lethality of IPD were intermediate-low in the region of Tarragona throughout 2012-2015. During this period, Serotype-vaccine coverage was almost double for the 23-valent than for the 13-valent vaccine

Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against community-acquired pneumonia in the general population aged ≥ 60 years: 3 years of follow-up in the CAPAMIS study.

BACKGROUND: The benefits of using the 23-valent pneumococcal polysaccharide vaccine (PPV23) are controversial. This study assessed clinical effectiveness of PPV23 in preventing community-acquired pneumonia (CAP) among the general population aged ≥ 60 years. METHODS: This was a population-based cohort study involving 27 204 individuals aged ≥ 60 years in Tarragona, Spain, who were prospectively followed from 1 December 2008 until 30 November 2011. Primary outcomes were hospitalization for pneumococcal CAP (bacteremic and nonbacteremic cases) and all-cause CAP. All CAP cases were radiographically confirmed and validated by checking clinical records. Cox regression was used to evaluate the association between pneumococcal vaccination and the risk of each outcome. RESULTS: Cohort members were followed for a total of 76 033 person-years (29 065 person-years for vaccinated subjects). Incidence rates (per 1000 person-years) were 0.21 for bacteremic pneumococcal CAP (0.14 vs 0.26 among vaccinated and unvaccinated subjects, respectively), 1.45 for nonbacteremic pneumococcal CAP (1.46 vs 1.44), and 7.51 for all-cause CAP (7.19 vs 7.71). In primary analyses including all cohort members, PPV23 did not appear to be effective against any analyzed outcome. However, a beneficial effect emerged in sensitive and stratified analyses. After multivariable adjustments, as compared with those never vaccinated, recent vaccination with PPV23 (<5 years ago) was associated with reduced risks of bacteremic pneumococcal CAP (hazard ratio [HR], 0.38; 95% confidence interval [CI], .09-1.68), nonbacteremic pneumococcal CAP (HR, 0.52; 95% CI, .29-.92), overall pneumococcal CAP (HR, 0.49; 95% CI, .29-.84), and all-cause CAP (HR, 0.75; 95% CI, .58-.98). CONCLUSIONS: Our data support a protective effect of recent PPV23 vaccination (within previous 5 years) against both pneumococcal and all-cause CAP.

Middle ear effusion in mechanically ventilated patients: effects of the nasogastric tube.

BACKGROUND: Middle ear effusion (MEE) is rare among adults, but has a higher incidence among ICU patients. The aim of this study was to analyze the effect of nasogastric tube (NGT) on MEE and to assess other predisposing factors. METHODS: Prospective observational study, carrying out an otoscopic examination and tympanometry in 100 mechanically ventilated patients. Immittance testing was carried out within 24 hours of ICU admission and every 72 hours until ICU discharge. In a case of persisting pathologic curve at the moment of discharge from ICU, there was a follow-up examination every 3 days until middle ear function was restored. In addition to descriptive variables, we recorded placement (left or right nostril) and diameter (12, 16, or 18 French) of the NGT. A Cox regression analysis was performed, adjusted for the days since ICU admission. RESULTS: A total of 535 tympanometry studies were carried out, of which 352 were normal and 183 observations presented MEE. We observed that 12 and 16 French NGTs were not significantly associated with abnormal middle ear function, whereas 18 French NGT was significantly associated with MEE (odds ratio 2.54, 95% CI 1.42-4.55; P = .01). Other variables independently associated with pathological tympanogram curves were Ramsay Sedation Scale score ≥ 4 (odds ratio 2.42, 95% CI 1.65-3.55; P = .01) and orotracheal intubation (odds ratio 5.72, 95% CI 3.40-9.60; P = .01). No intracranial infection or long-term disabilities were identified. CONCLUSIONS: MEEs and tympanometric alterations are frequent in intubated patients (32% in our study). To prevent these complications, they should receive NGTs with a diameter lower than 18 French, when feasible.

Hemorragia intralaberíntica / Intralabyrinthine haemorrhage

No disponible

No disponible

Angioedema por inhibidores de la enzima convertidora de angiotensina / Angioedema caused by ACE inhibitor

No disponible

No disponible

[Myringoplasty: auditory follow-up and study of prognostic factors]. / Miringoplastia: seguimiento auditivo y estudio de factores pronósticos.

OBJECTIVE: To perform a five-year study of hearing evolution in patients undergoing myringoplasty to determine whether eardrum repair correlates with improved hearing. We also studied factors that might predispose to failure and their usefulness as prognostic factors. MATERIAL AND METHOD: In a serial case study, we reviewed all myringoplasties performed at our centre during 2000, 2001, and 2002. We reviewed 83 case histories and studied the closure of the perforation, auditory function pre-operatively, postoperatively and after 5 years, as well as different associated factors. RESULTS: The perforation was closed in 75.9 % of cases. The mean gain of auditory function was 1.5 dB at five years, without statistical significance. The hearing evolution presented a post-surgical improvement and a subsequent deterioration, both statistically significant. We found a statistically significant relationship between the size of the perforation and the condition of the contralateral ear. CONCLUSIONS: Perforation closure in our series (75.9 %) is similar to that reported in the literature. We found contralateral ear pathology and the perforation extension to be associated with poor prognosis after myringoplasty.

Miringoplastia: seguimiento auditivo y estudio de factores pronósticos / Myringoplasty: auditory follow-up and study of prognostic factors

Objetivo: Realizar un estudio a 5 años de la audición de los pacientes sometidos a miringoplastia a fin de probar si la restitución timpánica tiene correlación con la mejora auditiva. Se investigan también posibles factores predisponentes al fracaso y averiguar si podemos describirlos como factores pronósticos. Material y método: Se realiza estudio tipo serie de casos y una revisión de las miringoplastias realizadas en nuestro centro en los años 2000, 2001 y 2002. Se revisaron 83 historias y se estudió el cierre de la perforación, la función auditiva prequirúrgica, posquirúrgica y a 5 años, así como diferentes factores relacionados. Resultados: Se obtiene un cierre de la perforación en el 75,9 % de los casos. En cuanto a la función auditiva, obtenemos una ganancia sin significación estadística de 1,5 dB a los 5 años. La evolución auditiva presenta una mejora posquirúrgica y un empeoramiento posterior, ambos estadísticamente significativos. Se ha obtenido una relación estadística en el tamaño de la perforación y el estado del oído contralateral. Conclusiones: Se presenta un resultado de cierre de la perforación acorde con la mayoría de las series. El estado patológico del oído contralateral y la extensión de la perforación son factores de mal pronóstico de la miringoplastia (AU)

Objective: To perform a five-year study of hearing evolution in patients undergoing myringoplasty to determine whether eardrum repair correlates with improved hearing. We also studied factors that might predispose to failure and their usefulness as prognostic factors. Material and method: In a serial case study, we reviewed all myringoplasties performed at our centre during 2000, 2001, and 2002. We reviewed 83 case histories and studied the closure of the perforation, auditory function pre-operatively, postoperatively and after 5 years, as well as different associated factors. Results: The perforation was closed in 75.9 % of cases. The mean gain of auditory function was 1.5 dB at five years, without statistical significance. The hearing evolution presented a post-surgical improvement and a subsequent deterioration, both statistically significant. We found a statistically significant relationship between the size of the perforation and the condition of the contralateral ear. Conclusions: Perforation closure in our series (75.9 %) is similar to that reported in the literature. We found contralateral ear pathology and the perforation extension to be associated with poor prognosis after myringoplasty (AU)

[Stapedotomy outcomes in the treatment of otosclerosis: our experience]. / Resultados de la estapedotomía en el tratamiento de la otosclerosis: nuestra experiencia.

OBJECTIVE: The main objective of our study is to identify whether there is measurable audiometric deterioration in patients undergoing stapedotomy with a follow-up of more than eight years. MATERIAL AND METHOD: We conducted a retrospective clinical study in which we reviewed a total of 150 case histories of patients with stapedotomy at our department between 1993 and 1997, with a successful initial audiological assessment using tone audiometry in the first three months after surgery and later audiometrical follow-up. RESULTS: We obtained a significant mean post-operative hearing impairment of 1.02 dB per year, with a pre-operative mean PTA of 51.45 dB, going on to early post-operative mean PTA of 26.71 dB, and later post-operative mean PTA of 35.42 dB, with all these changes turning out to be statistically significant. CONCLUSIONS: The auditory level obtained after surgery worsens as the years go by, but always without exceeding the hearing loss prior to surgery.

[Abnormal internal carotid artery in the middle ear and severe otorrhagia after myringotomy]. / Arteria carótida aberrante. A propósito de un caso.

We present a clinical-surgical case of a 72-year-old woman referred from another Hospital due to presentation of otorrhagia following myringotomy. We later determined by means of imaging studies that it was a case of an aberrant internal carotid artery. All masses in the middle ear, especially pulsing masses, must be studied by imaging methods such as computerized tomography and, preferably, magnetic resonance angiography.

Arteria carótida aberrante. A propósito de un caso / Abnormal internal carotid artery in the middle ear and severe otorrhagia after myringotomy

Los autores presentan un caso clínico-quirúrgico de una mujer de 72 años de edad, remitida desde otro centro hospitalario por una otorragia grave tras una miringotomía. Mediante estudios de imagen se determinó que se trataba de un caso de arteria carótida aberrante de oído derecho. Toda masa en oído medio, especialmente las que son pulsátiles, deben ser estudiadas mediante pruebas de imagen como tomografía computarizada y, preferentemente, angiografía por resonancia magnética

We present a clinical-surgical case of a 72-year-old woman referred from another Hospital due to presentation of otorrhagia following myringotomy. We later determined by means of imaging studies that it was a case of an aberrant internal carotid artery. All masses in the middle ear, especially pulsing masses, must be studied by imaging methods such as computerized tomography and, preferably, magnetic resonance angiography