Comparative global analysis of stroke rehabilitation recommendations across income levels.

OBJECTIVE: Successful implementation of stroke rehabilitation guidelines demands high-quality practice standards tailored to targeted sociodemographic contexts. The primary objective is to determine the quality differences in post-stroke rehabilitation practice guidelines (PGs), when comparing high-income countries (HIC) and low or middle-income countries (LMIC). STUDY DESIGN AND SETTING: We conducted a scoping review of PGs in English or Spanish, published between 2012 and 2021, and providing recommendations on post-stroke rehabilitation. We used Search engines, databases, guideline libraries, gray literature, and references from previous reviews on post-stroke rehabilitation as sources of evidence. Quality assessment of PGs was performed using 6P's, ELSE, IOM, and AGREE II instruments. We evaluated each item using a scale between 0 to 3, based on the confidence of adherence to the standard. For AGREE II, we followed the instruction manual for scoring. At least two reviewers were independently involved in every step of the process. A cloud-based spreadsheet was used to chart data. We compared the results of PGs originating from HIC with those from LMIC. RESULTS: The inclusion criteria were met by 35 documents, which were subjected to evaluation. The study included 21 documents from HIC and 14 from middle-income countries (MIC). No manuscripts from low-income countries were available for inclusion in the study. The quality of PGs from MIC was found to be lower, in terms of methodological rigor and adherence to international recommendations for guidelines development. PGs from both groups of countries failed to include all target audiences and stakeholders (according to the 6P's criteria) and integration of ethical, legal, social, and economic considerations. CONCLUSION: There are gaps in the quality and availability of stroke rehabilitation guidelines worldwide, especially in LMIC. Designing and providing financial support for the implementation of high-quality guidelines will contribute to more effective implementation strategies in stroke rehabilitation programs and lead to improved patient outcomes.

Factors associated with anxiety during the first two years of the COVID-19 pandemic in the United States: An analysis of the COVID-19 Citizen Science study.

COVID-19 increased the prevalence of clinically significant anxiety in the United States. To investigate contributing factors we analyzed anxiety, reported online via monthly Generalized Anxiety Disorders-7 (GAD-7) surveys between April 2020 and May 2022, in association with self-reported worry about the health effects of COVID-19, economic difficulty, personal COVID-19 experience, and subjective social status. 333,292 anxiety surveys from 50,172 participants (82% non-Hispanic white; 73% female; median age 55, IQR 42-66) showed high levels of anxiety, especially early in the pandemic. Anxiety scores showed strong independent associations with worry about the health effects of COVID-19 for oneself or family members (GAD-7 score +3.28 for highest vs. lowest category; 95% confidence interval: 3.24, 3.33; p<0.0001 for trend) and with difficulty paying for basic living expenses (+2.06; 1.97, 2.15, p<0.0001) in multivariable regression models after adjusting for demographic characteristics, COVID-19 case rates and death rates, and personal COVID-19 experience. High levels of COVID-19 health worry and economic stress were each more common among participants reporting lower subjective social status, and median anxiety scores for those experiencing both were in the range considered indicative of moderate to severe clinical anxiety disorders. In summary, health worry and economic difficulty both contributed to high rates of anxiety during the first two years of the COVID-19 pandemic in the US, especially in disadvantaged socioeconomic groups. Programs to address both health concerns and economic insecurity in vulnerable populations could help mitigate pandemic impacts on anxiety and mental health.

Nuevas formas de motivación en la enseñanza de la anatomía humana / New forms of motivation in the teaching of human anatomy

Introducción: Las nuevas generaciones de alumnos (generación Z o nativa digital) en la actualidad han provocado la necesidad de implantar nuevas metodologías docentes en las que el alumnado sea un sujeto activo y participativo en su propio proceso de aprendizaje. Entre estas metodologías, el uso del aprendizaje basado en juegos puede considerarse una alternativa que refuerce a la clásica ‘clase magistral’ y las clases prácticas en la docencia universitaria. Sujetos y métodos: Utilización del aprendizaje basado en juegos (juegos serios) en los alumnos matriculados de la asignatura de Anatomía Humana I (Aparato Locomotor), de primer curso del grado de Medicina en la Universidad de Zaragoza. Resultados: El uso de esta metodología ha sido valorado, mediante encuesta de evaluación de respuesta voluntaria, de manera muy positiva, haciendo hincapié en el efecto que tiene sobre la motivación, la participación y la integración de contenidos teóricos y prácticos. Conclusión: El aprendizaje basado en juegos debe considerarse como una potente alternativa que mejora la motivación, la participación y la integración de contenido en el aula de educación superior.(AU)

Introduction: The new generations of students, such as the current generation Z or digital natives, have provoked the need to implement new teaching methodologies where students are active and participative subjects in their own learning process. Among these methodologies, the use of game-based learning can be considered an alternative to reinforce the classic ‘master class’ in university teaching. Subjects and methods: Use of game-based learning (serious games), in students enrolled in the subject of Human Anatomy I (Locomotor System), first year of the Degree of Medicine at the Universidad de Zaragoza. Results: The use of this methodology has been evaluated, by means of a voluntary evaluation survey, in a very positive way, emphasizing the effect on motivation, participation and integration of theoretical and practical contents. Conclusion: Game-based learning should be considered as a powerful alternative that improves motivation, participation and content integration in the higher education classroom.(AU)

Evolución de la producción científica generada sobre la dehiscencia del canal semicircular posterior / Evolution of the scientific production generated on posterior semicircular canal dehiscence

Introducción: La dehiscencia del canal semicircular posterior es una vestibulopatía rara, de baja prevalencia y cuya sintomatología se explica por el fenómeno de la tercera ventana. No fue hasta 2003 cuando Krombach describe los primeros casos. Objetivo: Evaluar mediante análisis bibliométrico y temático la producción científica sobre trabajos de dehiscencia del canal semicircular posterior (DCSP) y su incidencia a nivel de la comunidad científica mediante una revisión bibliográfica. Método: Se realiza búsqueda, revisión, selección y estudio a partir de ítems relacionados con DCSP indexados en la base de datos Pubmed, Web of Science, Alcorze y Scopus, desde el año 2003 hasta 2019, seleccionando 90 artículos. Resultados: Los 90 artículos han sido publicados en un total de 48 revistas, siendo 52% originales, 38% casos clínicos, 9% revisiones y 1% conferencias. La temática predominante fue la clínica (32%) y la etiología (27%). Los artículos estaban escritos en ocho idiomas diferentes, predominando el inglés (85%), y siendo Estados Unidos el país con más publicaciones (42%). Los índices de actividad institucional y autoría son bajos. La calidad de las revistas es alta, ya que el 70% de las publicaciones se encontraban en los cuartiles Q1-Q2. El área principal es Otorrinolaringología, con 66 trabajos, seguida por Radiología con 14. El número de descargas fue 6958, con una media de 77,31 por artículo, y las citaciones fueron 1193, equivalente a una media de 13,25. Conclusión: Los datos bibliométricos revelan cómo los trabajos sobre dehiscencia del canal semicircular posterior representan una pequeña producción científica, el tema está en fase de crecimiento sostenido, los índices de autoría, institucionalidad y colaboración son bajos y las publicaciones se concentran en pocas revistas, con una orientación claramente anglófona, pero de alta calidad e importante visualización. (AU)

Introduction: The dehiscence of the posterior semicircular canal is a rare vestibulopathy, of low prevalence and whose symptomatology is explained by the phenomenon of the third window. It was not until 2003 that Krombach described the first cases. Objective: Evaluate the scientific production about the dehiscence of the posterior semicircular canal (DCSP) by a bibliometric and thematic analysis and observes its incidence at the scientific community level. Method: A search with subsequent review, selection and study was carried out using items related to DCSP indexed in the Pubmed, Web of Science, Alcorze and Scopus databases, from 2003 to 2019, selecting a total of 90 articles. Results: The 90 articles have been published in a total of 48 magazines. 52% were originals, 38% clinical cases, 9% reviews and 1% conferences. Clinical (32%) and etiology (27%) were the main themes. The articles were written in eight different languages, predominantly English (85%), and the United States has been the country with the highest number of publications (42%). Institutional activity and authorship rates are low. The quality of the journals is high: 70% of the publications were in the Q1-Q2 quartiles. The main area corresponds to otorhinolaryngology, with a total of 66 works, followed by radiology (14). The total number of downloads was 6958, with an average of 77.31 per article and the total citations were 1193, 13.25 per article. Conclusions: The bibliometric results reveal how the works on dehiscence of the posterior semicircular canal present a small scientific production, the subject is in a phase of sustained growth, the authorship, institutional and collaboration index are low, the publications are concentrated in a few journals of high quality and important visualization, with a clearly anglophone orientation. (AU)

Anatomical study about the variations in renal vasculature.

Renal vascularization is classically described as a renal artery and vein. However, this vascular pattern presents numerous anatomical variations in terms of their number, origin and course due to ontogenetic alterations. The aim was to carry out a descriptive study of the renal vascular pattern observed during the dissection of cadavers intended for teaching purposes. A descriptive and observational study of renal vascular anatomy was carried out by dissecting 16 renal blocks from 8 cadavers donated to science and used for teaching at the Faculty of Medicine of the University of Zaragoza. The prevalence of arterial variations was 75% (56.3% for polar renal arteries, 12.5% for pre-hilar branching and 6.25% for double communicating arterial arch) and venous was 62.5% (12.5% for polar renal veins, 25% for late venous confluence, 6.25% for triple renal vein and 18.75% for double circumaortic renal vein). We conclude that the renal vascular anomalies occur with high frequency; for this reason, knowledge of these anomalies is extremely important for the correct planning of numerous medical-surgical activities.

Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas / Controversias en neuroinmunología: esclerosis múltiple, vacunación, SARS-CoV-2 y otros dilemas

Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.

La neuroinmunología es una disciplina que cada vez amplía más sus horizontes en la comprensión de las enfermedades neurológicas. Contemporáneamente, y a la luz de los nexos fisiopatológicos de las enfermedades neurológicas y la inmunología, se han planteado enfoques diagnósticos y terapéuticos específicos. A pesar de los importantes avances de esta disciplina, existen múltiples dilemas que le conciernen y se filtran en la práctica clínica. En esta revisión, se presentan y discuten 15 controversias, las cuales se construyen con la información clínica disponible más actualizada. Los temas incluidos son: disminución de esteroides en recaídas de esclerosis múltiple; recomendaciones terapéuticas en esclerosis múltiple a la luz de la pandemia por el SARS-CoV-2; evidencia de vacunación en esclerosis múltiple y en otras enfermedades desmielinizantes; panorama actual del síndrome clínico y radiológico aislado; y fallas terapéuticas en esclerosis múltiple; además, criterios para suspender las terapias modificadoras de la enfermedad; evidencia del manejo en recaídas leves; recomendaciones para la profilaxis contra Strongyloides stercolaris; utilidad de un segundo ciclo de inmunoglobulina en el síndrome de Guillain-Barré; criterios para diferenciar una polineuropatía crónica desmielinizante inflamatoria de inicio agudo de un síndrome de Guillain-Barré y, utilidad de la enzima convertidora de angiotensina en neurosarcoidosis. En cada una de las controversias, se presenta la problemática general y se ofrecen recomendaciones específicas que pueden adoptarse en la práctica clínica diaria.

Controversias en neuroinmunología: esclerosis múltiple, vacunación, SARS-CoV-2 y otros dilemas / Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas

La neuroinmunología es una disciplina que cada vez amplía más sus horizontes en la comprensión de las enfermedades neurológicas. Contemporáneamente, y a la luz de los nexos fisiopatológicos de las enfermedades neurológicas y la inmunología, se han planteado enfoques diagnósticos y terapéuticos específicos. A pesar de los importantes avances de esta disciplina, existen múltiples dilemas que le conciernen y se filtran en la práctica clínica. En esta revisión, se presentan y discuten 15 controversias, las cuales se construyen con la información clínica disponible más actualizada. Los temas incluidos son: disminución de esteroides en recaídas de esclerosis múltiple; recomendaciones terapéuticas en esclerosis múltiple a la luz de la pandemia por el SARS-CoV-2; evidencia de vacunación en esclerosis múltiple y en otras enfermedades desmielinizantes; panorama actual del síndrome clínico y radiológico aislado; y fallas terapéuticas en esclerosis múltiple; además, criterios para suspender las terapias modificadoras de la enfermedad; evidencia del manejo en recaídas leves; recomendaciones para la profilaxis contra Strongyloides stercolaris; utilidad de un segundo ciclo de inmunoglobulina en el síndrome de Guillain-Barré; criterios para diferenciar una polineuropatía crónica desmielinizante inflamatoria de inicio agudo de un síndrome de Guillain-Barré y, utilidad de la enzima convertidora de angiotensina en neurosarcoidosis. En cada una de las controversias, se presenta la problemática general y se ofrecen recomendaciones específicas que pueden adoptarse en la práctica clínica diaria.

Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.

Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application: A Randomized Clinical Trial.

Importance: Self-measured blood pressure (SMBP) with commercially available connected smartphone applications may help patients effectively use SMBP measurements. Objective: To determine if enhanced SMBP paired with a connected smartphone application was superior to standard SMBP for blood pressure (BP) reduction or patient satisfaction. Design, Setting, and Participants: This randomized clinical trial was conducted among 23 health systems participating in PCORnet, the National Patient-Centered Clinical Research Network, and included patients who reported having uncontrolled BP at their last clinic visit, a desire to lower their BP, and a smartphone. Enrollment and randomization occurred from August 3, 2019, to December 31, 2020, which was followed by 6 months of follow-up for each patient. Analysis commenced shortly thereafter. Interventions: Eligible participants were randomly assigned to enhanced SMBP using a device that paired with a connected smartphone application (enhanced) or a standard device (standard). Participants received their device in the mail, along with web-based educational materials and phone-based support as needed. No clinician engagement was undertaken, and the study provided no special mechanisms for delivering measurements to clinicians for use in BP management. Main Outcomes and Measures: Reduction in systolic BP, defined as the difference between clinic BP at baseline and the most recent clinic BP extracted from electronic health records at 6 months. Results: Enrolled participants (1051 enhanced [50.0%] vs 1050 standard [50.0%]; 1191 women [56.7%]) were mostly middle-aged or older (mean [SD] age, 58 [13] years), nearly a third were Black or Hispanic (645 [31%]), and most were relatively comfortable using technology (mean [SD], 4.1 [1.1] of 5). The mean (SD) change in systolic BP from baseline to 6 months was -10.8 (18) mm Hg vs -10.6 (18) mm Hg (enhanced vs standard: adjusted difference, -0.19 mm Hg; 95% CI, -1.83 to 1.44; P = .81). Secondary outcomes were mostly null, except for documented attainment of BP control to lower than 140/<90 mm Hg, which occurred in 32% enhanced vs 29% standard groups (odds ratio, 1.15; 95% CI, 1.01-1.34). Most participants were very likely to recommend their SMBP device to a friend (70% vs 69%). Conclusions and Relevance: This randomized clinical trial found that enhanced SMBP paired with a smartphone application is not superior to standard SMBP for BP reduction or patient satisfaction. Trial Registration: ClinicalTrials.gov Identifier: NCT03796689.

Impacto del SARS-CoV-2 (COVID-19) en la docencia teórico-práctica de la neuroanatomía humana / Impact of SARS-CoV-2 (COVID-19) on the theoretical-practical teaching of human neuroanatomy

Introducción: Durante el curso 2019-2020, debido a la situación provocada por la COVID-19, Neuroanatomía humana (cuarto semestre, grado de Medicina, Universidad de Zaragoza), que en condiciones normales combina teoría y práctica presenciales, se planteó de manera telemática, mediante la aportación al alumnado de material didáctico a través de la intranet Anillo Digital Docente-Moodle© e Instagram©, así como por tutorías vía Google Meet©. Material y métodos: Con objeto de poder comprobar el grado de satisfacción de la docencia teórico-práctica presencial frente a la telemática, se realizaron con el alumnado dos cuestionarios (pre-COVID-19 y durante la COVID-19) de cuatro y seis preguntas cerradas, respectivamente, con cinco opciones de respuesta según una escala de Likert. Además, se plantearon dos preguntas abiertas en cada cuestionario. Por parte del profesorado, la valoración fue en una reunión de coordinación de la asignatura tras finalizar el período lectivo. Resultados: Las encuestas de satisfacción las respondió el 71% de los alumnos (68/95). La falta de asistencia no sufre variación significativa en ambas situaciones con respecto a la asistencia a las clases teóricas y prácticas, pero sí los motivos causantes de ausencia: los primeros fueron principalmente profesionales, y los segundos, de conectividad. El alumnado valora la docencia teórica presencial frente a la telemática de forma muy parecida, mientras que, a nivel práctico, sigue prefiriendo la presencialidad, lo que coincide con el profesorado. Conclusión: Esta evaluación permite constatar que la docencia teórica de la asignatura por vía telemática es viable, siempre y cuando el alumnado disponga de una buena conectividad, pero no así la parte práctica, donde la presencialidad es imprescindible actualmente.(AU)

Introduction: During the 2019-2020 academic year, and due to the situation caused by COVID-19, Human Neuroanatomy (4th semester- Degree of Medicine- University of Zaragoza) which under conditions of normality combines in-person theory and practice, had to consider itself in a telematic way by providing students with teaching materials through intranet ADD (Digital Teaching Ring)- Moodle©, Instagram©, as well as tutoring via Google Meet©. Material and methods: In order to be able to check the degree of satisfaction of the theoretical teaching- face-to-face versus telematic teaching, 2 questionnaires were carried out by the students (pre-COVID-19 and during COVID-19), of 4 and 6 closed questions respectively, with 5 answer options, according to Likert scale. In addition, 2 open questions were raised in each questionnaire. On the part of the teachers, was valued in a coordination meeting of the subject, after the end of the teaching period: Results: Satisfaction surveys were answered by 71% of students (68/95). The lack of attendance does not suffer a significant variation in both situations, but the reasons that have led to the absence, being the first being mainly professional, and the second reasons for connectivity. Students value in-person theoretical teaching versus telematics in a very similar way, while on a practical level, they continue to prefer face-to-face, coinciding with the teachers. Conclusion: This evaluation confirms that the theoretical teaching of the subject via telematics is viable, as long as the students have good connectivity, but not the practical part, where attendance is essential today.(AU)

El juego como factor motivador en la enseñanza de la anatomía humana / Game as a motivating factor in the teaching of human anatomy

INTRODUCCIÓN: Con la llegada a la universidad de una nueva generación de alumnos, la 'generación Z', considerada como la primera generación nativa digital, se hace necesario implantar nuevas metodologías docentes en el ámbito universitario para mejorar el proceso de enseñanza-aprendizaje y conseguir una mayor motivación en el alumno. Para ello, el uso de nuevas tecnologías de la información y de la comunicación ha permitido dinamizar estos procesos y aumentar la motivación del alumnado en todos los niveles educativos, incluyendo la docencia universitaria. SUJETOS Y MÉTODOS: Utilización de la aplicación educativa Kahoot a través de dispositivos móviles, con los alumnos matriculados de la asignatura de 'Anatomía Humana II (Esplacnología)', de segundo curso del Grado de Medicina en la Universidad de Zaragoza. RESULTADOS: El impacto que la experiencia ha causado en los estudiantes se ha medido a través de encuestas de valoración cualitativas, analizando sus resultados de aprendizaje. Estos resultados han sido valorados de manera muy positiva por el alumnado, tanto en lo referente a utilidad en la enseñanza-aprendizaje como a motivación. CONCLUSIÓN: Kahoot es una herramienta digital interactiva, gratuita y de manejo sencillo tanto para el docente como para los alumnos, que permite que éstos mejoren en su aprendizaje haciendo uso de nuevas tecnologías y se sientan así más motivados

INTRODUCTION: The need to face a new generation of students, the 'Z generation', considered as the first digital native generation, makes it necessary to implement new teaching methodologies in the university field to improve the teaching-learning process and above all achieve greater motivation in the student. To this end, the use of new information and communication technologies has enabled the dynamics of these processes and increasing student motivation at all educational levels, including university teaching. SUBJECTS AND METHODS: Use of the Kahoot educational app was raised through mobile devices as an innovative tool that enhances motivation and learning process, participating students enrolled in the subject of 'Human Anatomy II (Esplacnology)', second course of the Degree of Medicine in the University of Zaragoza. RESULTS: The impact that the experience has caused students has been studied through qualitative assessment surveys, analyzing the learning outcomes obtained by students. The results achieved in terms of implementation of these new teaching-learning methodologies have been valued by students, in a very positive way both at the level of usefulness in learning teaching and at the level of motivation. CONCLUSION: Kahoot is an interactive digital tool, free and easy to use for both teachers and students, and which allows the latter to improve their learning using new technologies, feeling more motivated

An innovative quick solidifying technique for the forensic investigation of brain circulation using addition silicones.

Post-mortem study of the brain is extremely relevant to medico-legal autopsies. However, it can be difficult to handle due to its fragility. This article presents a study on the development of an arterial solidifying technique that can be applied to analyze arterial circulation, consequently easing the handling and later diagnosis of diseases in this anatomical site. Vinylpolysiloxane silicone is introduced into the internal carotid arteries until it completely fills the arterial tree, creating a detailed model of the arterial's internal anatomy. This technique is fast, easy to apply and requires no previous tissue fixation. In addition, it allows for further toxicological and pathological tests. In conclusion, this technique represents a simple, sensitive and efficient method to employ in conventional autopsies, which can help in the diagnosis of death.

Radiologic correlation between the thickness of the roof of the glenoid fossa and that of the bony covering of the superior semicircular canal.

OBJECTIVES: Dehiscence of the superior semicircular canal (SSC) has been associated with alteration of the temporomandibular joint, although data explaining this association are lacking. The present study examined the correlations between the presence of dehiscences and thickness of the bone covering the SSC and the roof of the glenoid fossa (RGF). STUDY DESIGN: Computed tomography was used in a cross-sectional analysis of the presence of dehiscences and thickness of the bone overlying the SCC and RGF in 156 temporal bones of 78 patients. The correlations of the presence of dehiscences in the SSC and ipsilateral RGF and the thickness of bone covering the SSC and RGF were analyzed by using the χ2 or Fisher's exact test. The relationship between the thickness of the bone overlying the SCC and RGF was analyzed by using the Spearman correlation coefficient and the Kruskal-Wallis test. The relationship between the thickness of the RGF and the covering of the SCC and patient age and gender was analyzed with the general linear model. RESULTS: Significant correlations were found between the presence of dehiscences and thickness of the bone overlying the SSC and RGF (P < .001). CONCLUSIONS: There is a morphologic relationship between the structure of the SSC and RGF.

Tonsillectomy in adults: Analysis of indications and complications.

OBJECTIVE: Tonsillectomy is one of the surgical techniques most practiced by otolaryngologists, and despite being a relatively simple technique; it presents a considerable percentage of complications, such as postoperative bleeding. The aim of this study is to describe the surgical indications and most frequent complications, analyze whether surgical suture of the tonsillar pillars has an influence on bleeding, and study the data of hospital stay and its importance for the control of complications. METHODS: A retrospective study of 326 patients who underwent a tonsillectomy in our Department of Otolaryngology from 2006 to 2014 was conducted. The obtained data were statistically analyzed using the Excel and SPSS 21.0 programs. RESULTS: The most frequent indication was recurrent tonsillitis, with a 74.85% (244) occurrence, and the most recurrent complication was bleeding, in 5.21% (17) of the tonsillectomies, requiring surgical revision 13 of the 17 patients. No statistically significant differences in the risk of bleeding were observed in patients in whom tonsil pillars were sutured comparing to those that were not. No statistically significant differences were detected associating surgical indication and oropharyngeal post-tonsillectomy hemorrhage. All operated patients were admitted, with a postoperative average hospital stay of 2.17 days, gaining a quick and effective control of the immediate complications. CONCLUSION: Bleeding is the most common and important complication. No statistically significant association between bleeding and tonsil pillar suture or surgical indication was found. Tonsillectomy was not set as outpatient surgery at the time.

Are congenital malformations more frequent in fetuses with intrahepatic persistent right umbilical vein? A comparative study.

OBJECTIVE: Persistent right umbilical vein (PRUV) is a vascular anomaly where the right umbilical vein remains as the only conduit that returns oxygenated blood to the fetus. It has classically been described as associated with numerous defects. We distinguish the intrahepatic variant (better prognosis) and the extrahepatic variant (associated with worse prognosis). The objective of this study was to compare rates of congenital malformations in fetuses with intrahepatic PRUV (I-PRUV) versus singleton pregnancies without risk factors. MATERIALS AND METHODS: A multicenter, crossover design, comparative study was performed between 2003 and 2013 on fetuses diagnosed with I-PRUV (n=56), and singleton pregnancies without congenital malformation risk factors (n=4050). RESULTS: Fifty-six cases of I-PRUV were diagnosed (incidence 1:770). A statistically significant association between I-PRUV and the presence of congenital malformations (odds ratio 4.321; 95% confidence interval 2.15-8.69) was found. This positive association was only observed with genitourinary malformations (odds ratio 3.038; 95% confidence interval 1.08-8.56). CONCLUSION: Our rate of malformations associated with I-PRUV (17.9%) is similar to previously published rates. I-PRUV has shown a significant increase in the rate of associated malformations, although this association has only been found to be statistically significant in the genitourinary system. Noteworthy is the fact that this comparative study has not pointed to a significant increase in the congenital heart malformation rate. Diagnosis of isolated I-PRUV does not carry a worse prognosis.

Nueva causa de vértigo estructural: la dehiscencia del canal semicircular superior / A new cause of structural vertigo: superior semicircular canal dehiscence

Resumen. La anamnesis del vértigo debe adaptarse a los conocimientos actuales. En 1998 se describió una nueva causa devértigo asociado a una anomalía estructural, que es la dehiscencia del canal semicircular superior. Ésta causa alteraciones vestibulares y auditivas, frecuentemente asociadas, y una anamnesis bien dirigida permite sospechar el diagnóstico: el sujeto afectado puede sufrir vértigo desencadenado por sonidos intensos (fenómeno de Tullio) y por cambios de presión en el oído o en el espacio intracraneal, con ocasión de maniobras de Valsalva o al presionar sobre el trago del oído (signo de Hennebert). No es infrecuente que el sujeto padezca un desequilibrio crónico empeorado con dichos desencadenantes. Un síntoma auditivo frecuente de la dehiscencia de canal semicircular superior es la autofonía en el oído dehiscente, asociado a una hipoacusia de su transmisión. En este artículo se exponen las preguntas que deben incluirse en la anamnesis del vértigo a fin de evaluar la presencia de estas dehiscencias. También se abordan los procedimientos diagnósticos adecuados para confirmarla. La dehiscencia del canal semicircular superior tiene una solución quirúrgica satisfactoria (AU)

Summary. The medical history of vertigo must be updated to accommodate current knowledge. In 1998 a new cause of vertigo associated with a structural anomaly was reported: superior semicircular canal dehiscence. This condition causes vestibular and auditory disorders, which are frequently associated, and a well-directed medical history allows a suspected diagnosis to be reached: the subject may suffer from vertigo triggered by loud sounds (Tullio’s phenomenon) and by changes in pressure within the ear or in the intracranial space, when Valsalva’s manoeuvres are performed or on pressing on the tragus (Hennebert’s sign). It is not uncommon for subjects to suffer from a chronic imbalance that is exacerbated by the aforementioned precipitating factors. One frequent auditory symptom of superior semicircular canal dehiscence is autophony in the dehiscent ear, associated with hypoacusis of its transmission. This article outlines the questions that must be included in the medical history of vertigo in order to determine whether these dehiscences are present or not. The diagnostic procedures that are best suited to confirming it are also addressed. Superior semicircular canal dehiscence can be resolved satisfactorily by surgery (AU)

Defecto de cobertura del canal semicircular superior y su implicación clínica / Defect of the bony roof in the superior semicircular canal and its clinical implications

Introducción y objetivo: En la actualidad se desconoce la etiología del síndrome de dehiscencia del canal semicircular superior. Nuestro objetivo es analizar y discutir las distintas hipótesis sobre el origen de dicha patología. Métodos: En un estudio sobre 295 temporales se describe desde el punto de vista anatómico y radiológico un caso de una alteración parcial de la cobertura ósea del canal semicircular superior derecho y se compara con el temporal del otro lado. Resultados: Macroscópicamente el canal semicircular superior exhibe un deterioro de su cubierta ósea, constituida exclusivamente por su capa más interna o endostal que separa el canal del conducto semicircular superior. La reconstrucción en el plano Pöschl demuestra que aunque la cubierta está íntegra, su grosor disminuye a lo largo de la curvatura del canal hasta el defecto (0,6 a 0,3 mm).Conclusión: La presencia de defectos parciales en la cobertura ósea del canal semicircular superior con ausencia de sus capas externa y media, sumado a su menor grosor, hacen susceptible al canal para sufrir un segundo evento que podría causar su rotura pudiéndose convertir en una dehiscencia (AU)

Introduction and objective: The aetiology of the superior semicircular canal dehiscence is currently unknown. Our objective was to analyse and discuss different hypotheses about the origin of this pathology. Methods: In this study performed on 295 temporal bones, one case of partial alteration of the bony roof in the right superior semicircular canal was described from the anatomical and radiological points of view, and compared with the temporal bone on the other side. Results: Macroscopically, the superior semicircular canal shows deterioration in the bony roof, which consists exclusively of the inner or endosteal layer that separates the canal from the superior semicircular conduct. The Pöschl plane reconstruction showed a whole bony roof, but its thickness decreased from the canal curvature to the defect (from 0.6 to 0.3 mm). Conclusion: The presence of partial defects in the bony roof of the superior semicircular canal with absence of the external and middle layers, besides its lesser thickness, makes the canal susceptible to suffering a second event. This could produce its fracture and a dehiscence (AU)

[A new cause of structural vertigo: superior semicircular canal dehiscence]. / Nueva causa de vértigo estructural: la dehiscencia del canal semicircular superior.

The medical history of vertigo must be updated to accommodate current knowledge. In 1998 a new cause of vertigo associated with a structural anomaly was reported: superior semicircular canal dehiscence. This condition causes vestibular and auditory disorders, which are frequently associated, and a well-directed medical history allows a suspected diagnosis to be reached: the subject may suffer from vertigo triggered by loud sounds (Tullio's phenomenon) and by changes in pressure within the ear or in the intracranial space, when Valsalva's manoeuvres are performed or on pressing on the tragus (Hennebert's sign). It is not uncommon for subjects to suffer from a chronic imbalance that is exacerbated by the aforementioned precipitating factors. One frequent auditory symptom of superior semicircular canal dehiscence is autophony in the dehiscent ear, associated with hypoacusis of its transmission. This article outlines the questions that must be included in the medical history of vertigo in order to determine whether these dehiscences are present or not. The diagnostic procedures that are best suited to confirming it are also addressed. Superior semicircular canal dehiscence can be resolved satisfactorily by surgery.

[Defect of the bony roof in the superior semicircular canal and its clinical implications]. / Defecto de cobertura del canal semicircular superior y su implicación clínica.

INTRODUCTION AND OBJECTIVE: The aetiology of the superior semicircular canal dehiscence is currently unknown. Our objective was to analyse and discuss different hypotheses about the origin of this pathology. METHODS: In this study performed on 295 temporal bones, one case of partial alteration of the bony roof in the right superior semicircular canal was described from the anatomical and radiological points of view, and compared with the temporal bone on the other side. RESULTS: Macroscopically, the superior semicircular canal shows deterioration in the bony roof, which consists exclusively of the inner or endosteal layer that separates the canal from the superior semicircular conduct. The Pöschl plane reconstruction showed a whole bony roof, but its thickness decreased from the canal curvature to the defect (from 0.6 to 0.3mm). CONCLUSION: The presence of partial defects in the bony roof of the superior semicircular canal with absence of the external and middle layers, besides its lesser thickness, makes the canal susceptible to suffering a second event. This could produce its fracture and a dehiscence.

Development of the stapedius muscle canal and its possible clinical consequences.

OBJECTIVE: To study the development of the stapedius muscle canal in human embryos and foetuses. MATERIALS AND METHODS: 46 temporal bones with ages between 9mm and new-borns were studied. The preparations were dyed using Martins' trichrome technique. RESULTS: Two areas of different embryological origin form the stapedius muscle canal, which contains this muscle and the facial nerve. On the otic capsule, at 11 weeks an extension starts to grow from its caudal part, which moves outwards and near to Reichert's cartilage, forming the footplate and internal wall. The pyramidal eminence comes from the mesenchyme that surrounds the muscle, forming a partition to separate it from the laterohyale portion of Reichert's cartilage. Extensive connections are observed in its development between bone marrow and mesenchyme. At 35 weeks the muscle and nerve start to separate by means of a bony partition. If this partition does not form, there is going to be a dehiscence that could cause peripheral nerve pathology due to the repeated contraction of the muscle, or the dissemination of infections from middle ear. CONCLUSION: During the development of the stapedius muscle canal the presence of dehiscences between the facial nerve and the muscle may have clinical repercussions.

Contribution to morphological knowledge of the development of the human incudo-mallear joint.

CONCLUSION: At the time of birth, the incudo-mallear joint is completely developed. OBJECTIVE. To study the development of the incudo-mallear joint in human embryos and fetuses. MATERIALS AND METHODS. In all, 46 temporal bones with ages between 9 mm and newborns were studied. The preparations were cut in a series and dyed using Martins' trichrome technique. RESULTS. The incudo-mallear joint acquires the characteristics of a saddle joint at 10 weeks of development. The cartilage that covers the articular surfaces is formed by different strata that develop successively: the superficial stratum at 14 weeks, the transitional between 15 and 19 weeks, and the radial from 20 weeks. The subchondral bone develops between weeks 25 and 28 by the mechanisms of apposition and extension of the periosteal and endosteal bones, but it is not until week 30 that it completely covers the articular surfaces, consisting of bone fascicles whereby the lines of force will be transmitted. The articular capsule is formed as from the inter-zone. The surface zone develops the capsular ligament, and the internal surface develops the synovial membrane. Even though it is not consistent, the primordium of the meniscus is seen at 18 weeks.