Clinical profile, otologic, and auditory outcomes in patients with Down syndrome.

INTRODUCTION AND OBJECTIVES: Even though the incidence has decreased in recent years, Down syndrome (DS) remains the most common chromosomal disorder today. Despite being a condition with multisystemic involvement, it often tends to affect the head and neck area, making it a frequent reason for consultation with pediatric otolaryngologists or otologists. The purpose of this work is to be one of the first in Spain to characterize and describe the pathology and therapeutic approach typically provided to these patients, analyzing the evolution from a clinical and auditory perspective. MATERIAL AND METHODS: We aim to analyze a sample of 16 pediatric patients recruited over the past 24 years, diagnosed with Down syndrome, and experiencing a wide range of diseases affecting the ear and its auditory function. RESULTS: 62.50% of the patients were women, whose main reason for seeking specialist care was acute and serous otitis media, accounting for 31.25%. These patients have an indication for treatment for various entities within the otological sphere that usually do not differ from those of a healthy child. However, the evolution and response to treatments can take on a torpid character due to the anatomical characteristics of the ears of these patients. CONCLUSIONS: Although the frequency of children with DS in the pediatric otolaryngologist's clinic is decreasing, these patients have a predisposition to ear diseases with auditory repercussions, with variable evolution depending on the disease and the child's intrinsic characteristics.

Uncovering Forensic Evidence: A Path to Age Estimation through DNA Methylation.

Age estimation is a critical aspect of reconstructing a biological profile in forensic sciences. Diverse biochemical processes have been studied in their correlation with age, and the results have driven DNA methylation to the forefront as a promising biomarker. DNA methylation, an epigenetic modification, has been extensively studied in recent years for developing age estimation models in criminalistics and forensic anthropology. Epigenetic clocks, which analyze DNA sites undergoing hypermethylation or hypomethylation as individuals age, have paved the way for improved prediction models. A wide range of biomarkers and methods for DNA methylation analysis have been proposed, achieving different accuracies across samples and cell types. This review extensively explores literature from the past 5 years, showing scientific efforts toward the ultimate goal: applying age prediction models to assist in human identification.

Plasma Concentrations of High Mobility Group Box 1 Proteins and Soluble Receptors for Advanced Glycation End-Products Are Relevant Biomarkers of Cognitive Impairment in Alcohol Use Disorder: A Pilot Study.

Alcohol use disorder (AUD) is a major component in the etiology of cognitive decline and dementia. Underlying mechanisms by which long-term alcohol abuse causes cognitive dysfunction include excessive oxidative stress and inflammation in the brain, activated by increased reactive oxygen/nitrogen species (ROS/RNS), advanced glycation end-products (AGEs) and high-mobility group box 1 protein (HMGB1). In a pilot study, we examine the potential clinical value of circulating biomarkers of oxidative stress including ROS/RNS, HMGB1, the soluble receptor for AGE (sRAGE), the brain biomarker of aging apolipoprotein D (ApoD), and the antioxidant regulator nuclear factor erythroid 2-related factor 2 (NRF2) as predictive indices for cognitive impairment (CI) in abstinent patients with AUD (n = 25) compared to patients with established Alzheimer's disease (AD, n = 26) and control subjects (n = 25). Plasma concentrations of sRAGE were evaluated with immunoblotting; ROS/RNS with a fluorometric kit; and HMGB1, ApoD, and NRF2 by ELISA. Abstinent AUD patients had higher sRAGE, ROS/RNS (p < 0.05), and ApoD (p < 0.01) concentrations, similar to those of AD patients, and lower NRF2 (p < 0.01) concentrations, compared to controls. These changes were remarkable in AUD patients with CI. HMGB1, and sRAGE correlated positively with duration of alcohol use (rho = 0.398, p = 0.022; rho = 0.404, p = 0.018), whereas sRAGE correlated negatively with periods of alcohol abstinence (rho = -0.340, p = 0.045). A predictive model including ROS/RNS, HMGB1, sRAGE, alcohol use duration, and alcohol abstinence periods was able to differentiate AUD patients with CI (92.3% of correct predictions, ROC-AUC= 0.90) from those without CI. In conclusion, we propose ROS/RNS, HMGB1, and sRAGE as stress biomarkers capable of predicting cognitive impairment in AUD patients.

Assessment of Blood and Semen Detection and DNA Collection from Swabs up to Three Months after Deposition on Five Different Cloth Materials.

Body fluid identification plays a crucial role in criminal investigations. Because of their presence in many cases, blood and semen are the most relevant body fluids in forensic sciences. Based on antigen-antibody reactions binding unique proteins for each body fluid, serological assays represent one of the most rapid and highly specific tests for blood and semen. Currently, few studies have assessed the factors affecting body fluid identification by applying these assays. This work aimed to study the effect of different fabrics from clothes and time since deposition on identification through immunochromatographic tests for blood and semen, DNA isolation, and STR profiling from these samples. Body fluids were deposited on black- and white-dyed denim and cotton fabrics, and on leather. Afterward, blood and semen were sampled at 1 day, 30 days, and 90 days after deposition and identified by using the SERATEC® HemDirect Hemoglobin Test and the PSA Semiquant and SERATEC® BLOOD CS and SEMEN CS tests, respectively. Laboratory and crime scene tests presented similar performances for the detection of blood and semen stains on every tested fabric. No differences were found on band intensities between timepoints for all fabrics. It was possible to recover and identify blood and semen samples up to three months after deposition and to obtain full STR profiles from all the tested fabrics. Both body fluid STR profiles showed differences in their quality between 1 and 90 days after deposition for all fabrics except for black cotton for semen samples. Future research will expand the results, assessing body fluid identification on other substrates and under different environmental conditions.

An atlas of cells in the human tonsil.

Palatine tonsils are secondary lymphoid organs (SLOs) representing the first line of immunological defense against inhaled or ingested pathogens. We generated an atlas of the human tonsil composed of >556,000 cells profiled across five different data modalities, including single-cell transcriptome, epigenome, proteome, and immune repertoire sequencing, as well as spatial transcriptomics. This census identified 121 cell types and states, defined developmental trajectories, and enabled an understanding of the functional units of the tonsil. Exemplarily, we stratified myeloid slan-like subtypes, established a BCL6 enhancer as locally active in follicle-associated T and B cells, and identified SIX5 as putative transcriptional regulator of plasma cell maturation. Analyses of a validation cohort confirmed the presence, annotation, and markers of tonsillar cell types and provided evidence of age-related compositional shifts. We demonstrate the value of this resource by annotating cells from B cell-derived mantle cell lymphomas, linking transcriptional heterogeneity to normal B cell differentiation states of the human tonsil.

All Set before Flowering: A 16S Gene Amplicon-Based Analysis of the Root Microbiome Recruited by Common Bean (Phaseolus vulgaris) in Its Centre of Domestication.

Plant roots recruit most prokaryotic members of their root microbiota from the locally available inoculum, but knowledge on the contribution of native microorganisms to the root microbiota of crops in native versus non-native areas remains scarce. We grew common bean (Phaseolus vulgaris) at a field site in its centre of domestication to characterise rhizosphere and endosphere bacterial communities at the vegetative, flowering, and pod filling stage. 16S r RNA gene amplicon sequencing of ten samples yielded 9,401,757 reads, of which 8,344,070 were assigned to 17,352 operational taxonomic units (OTUs). Rhizosphere communities were four times more diverse than in the endosphere and dominated by Actinobacteria, Bacteroidetes, Crenarchaeota, and Proteobacteria (endosphere: 99% Proteobacteria). We also detected high abundances of Gemmatimonadetes (6%), Chloroflexi (4%), and the archaeal phylum Thaumarchaeota (Candidatus Nitrososphaera: 11.5%): taxa less frequently reported from common bean rhizosphere. Among 154 OTUs with different abundances between vegetative and flowering stage, we detected increased read numbers of Chryseobacterium in the endosphere and a 40-fold increase in the abundances of OTUs classified as Rhizobium and Aeromonas (equivalent to 1.5% and over 6% of all reads in the rhizosphere). Our results indicate that bean recruits specific taxa into its microbiome when growing 'at home'.

Prognostic factors and outcomes in COVID-19 patients requiring prolonged mechanical ventilation: a retrospective cohort study.

BACKGROUND: Mechanical ventilation (MV) in coronavirus disease 2019 (COVID-19) patients is associated with high mortality and extensive resource utilization. The aim of this study was to investigate prognostic factors and outcomes associated with prolonged mechanical ventilation (PMV) in COVID-19 patients. METHODS: This was a retrospective cohort study of COVID-19 patients requiring invasive MV who were hospitalized between 1 March 2020 and 30 June 2021 in the intensive care units (ICUs) of three referral hospitals belonging to a single health system. Data were extracted from electronic health records. PMV was defined as > 17 days of MV. RESULTS: Of 355 patients studied, 86 (24%) required PMV. PMV patients had lower PaO2/FiO2 ratio, higher PCO2, and higher plateau and driving pressures during the first 2 weeks of MV than their short MV (SMV; ⩽ 17 days) counterparts. PMV patients received more proning, neuromuscular blockade, and tracheostomy, had longer ICU and hospital length of stay (LOS), and required discharge to an inpatient rehabilitation facility more frequently (all p < 0.001). Overall 30-day mortality was 43.9%, with no statistically significant difference between PMV and SMV groups. In PMV patients, smoking, Charlson comorbidity index > 6, and week 2 PaO2/FiO2 ratio < 150 and plateau pressure ⩾ 30 were positively associated with 30-day mortality. In a multivariate model, results were directionally consistent with the univariate analysis but did not reach statistical significance. CONCLUSION: PMV is commonly required in COVID-19 patients with respiratory failure. Despite the higher need for critical care interventions and LOS, more than half of the PMV cohort survived to hospital discharge. Higher PaO2/FiO2 ratio, lower plateau pressure, and fewer comorbidities appear to be associated with survival in this group.

Videogravação e videofeedback no ensino-aprendizagem de habilidades de exame físico / Video recording and videofeedback in teaching-learning of physical examination skills

Resumo: Introdução: O ensino de habilidades de exame físico, parte integrante e obrigatória dos currículos de escolas médicas, ocorre, tradicionalmente, com uma abordagem baseada na "demonstração e prática", e, embora existam outros modelos, não há, até o momento, nenhuma evidência de que um seja superior ao outro. Inovações nessa área são apontadas como caminho para suprir as deficiências de ensino-aprendizagem. Objetivo: Este estudo teve como objetivos descrever a incorporação da videogravação e do videofeedback no ensino-aprendizagem de habilidades de exame físico e avaliar a eficácia desses recursos. Método: Foi realizado um estudo historicamente controlado antes e depois da intervenção com alunos do primeiro ano de um curso de Medicina. O grupo de intervenção, em que se aplicaram a videogravação e o videofeedback, foi constituído de 91 alunos do semestre 2019.2, e o grupo controle contou com 72 alunos do semestre 2018.1. Ambas as turmas realizaram duas avaliações teóricas somativas (T1 e T2) e duas práticas, no formato de um exame clínico objetivo estruturado (OSCE). Na análise estatística comparativa das notas de ambas as turmas, utilizaram-se os testes não paramétricos da soma de postos de Wilcoxon-Mann-Whitney. Resultado: A mediana das notas das avaliações práticas (primeiro e segundo OSCEs) de 2019 foram maiores do que as de 2018. Constatou-se ainda que a turma de 2019 teve uma evolução positiva das suas notas práticas passando de uma mediana de 11,6 no primeiro OSCE para 13,85 no segundo OSCE, o que também ocorreu com as provas teóricas (p < 0,05). Já na turma de 2018, houve queda da mediana das notas da T1 para T2 e do primeiro OSCE para o segundo OSCE, mas sem significância estatística. Conclusão: A incorporação da videogravação e videofeedback no ensino-aprendizagem de habilidades de exame físico entre graduandos do primeiro ano do curso de Medicina, em ambientes simulados, mostrou-se efetiva na melhora do desempenho dos discentes em avaliações teóricas e práticas. Essa abordagem se mostra ainda como meio de desenvolvimento e aplicação de uma aprendizagem motora observacional, reflexiva, experiencial e da metacognição no ensino-aprendizagem de habilidades de exame físico entre estudantes de Medicina.

Abstract: Introduction: Physical examination skills, an integral and mandatory part of medical school curricula, are traditionally taught through an approach based on "demonstration and practice", and although other models exist, there is, to date, no evidence that one is superior to the other. Innovations in this area are pointed out as a way to supply deficiencies in teaching and learning. Objectives: To describe the incorporation of video recording and video feedback in the teaching-learning of physical examination skills and to evaluate the effectiveness of such approach. Method: A historically controlled study was carried out before and after the intervention with students in the first year of a medical course. The intervention group, in which video recording and video feedback was applied, consisted of 91 students from semester 2019.2 and the control group had 72 students from semester 2018.1. Both classes underwent two summative theoretical (T1 and T2) and two practical assessments, in the format of an objective structured clinical examination (OSCE). In the comparative statistical analysis of the grades of both classes, the non-parametric Wilcoxon and Mann Whitney rank test was used. Results: The median of the marks of the practical evaluations (1st and 2nd OSCE) of the 2019 class were higher than those of 2018. It was also found that the class of 2019 showed a positive evolution in its practical marks, with the median score increasing from 11.6 in the 1st OSCE to 13.85 in the 2nd OSCE, which also happened with the theoretical tests (p <0.05). In the class of 2018, there was a drop in the median mark from T1 to T2 and from the 1st OSCE to the 2nd OSCE, but without statistical significance. Conclusion: The incorporation of video recording and video feedback in teaching-learning physical examination skills among first-year medical students, in simulated environments, proved to be effective in improving student performance in both theoretical and practical assessments. This approach is also shown as a means of developing and applying observational, reflective, experiential and metacognition motor learning in the teaching-learning of physical examination skills among medical students.

Planificação da atenção à saúde e planejamento: experiência do Rio Grande do Sul / Planification of health care and planning: experience of Rio Grande do Sul

O objetivo do presente relato é apresentar a experiência do processo de Planificação da Atenção à Saúde da Secretaria de Estado da Saúde do Rio Grande do Sul (RS). A Planificação da Atenção à Saúde no RS, estruturada com o apoio do Conselho Nacional de Secretários de Saúde, trata-se de um conjunto de oficinas, além de processos de tutoria em unidades-laboratórios, para as equipes de saúde e gestores municipais. Visa à organização dos macro e microprocessos da Atenção Primária à Saúde (APS) e sua organização estruturada com a Atenção Ambulatorial Especializada. Em fevereiro de 2018, as oficinas já haviam sido concluídas em duas Regiões de Saúde - com aproximadamente 120 facilitadores e 1.000 trabalhadores da APS, e estava em fase de finalização em outras duas Regiões de Saúde - com cerca 1.300 trabalhadores da APS. O desafio para o planejamento e para a gestão estadual é ampliar a Planificação da Atenção à Saúde para as demais 26 Regiões de Saúde do RS, bem como o monitoramento e a avaliação do processo. Em última análise, a Planificação, como método de planejamento, visa ao fortalecimento da Atenção Primária à Saúde como base para a implementação das Redes de Atenção à Saúde no território gaúcho.

The objective of the present report is to present the experience of the Health Care Planification process of the State Health Department of Rio Grande do Sul (RS). The Planification of Health Care in RS, structured with the support of the National Council of Health Secretaries, is a set of workshops, as well as tutoring processes in laboratory units for health workers and municipal managers. It aims to organize macro and micro-processes of Primary Health Care (PHC) and its organization structured with Specialized Ambulatory Care. In February 2018, the workshops were completed in two Health Regions - with approximately 120 facilitators and 1,000 PHC workers- and were finalized in two other Health Regions - with approximately 1,300 PHC workers. The challenge for planning and state management is to expand the Health Care Planification for the other 26 Health Regions of RS, as well as the monitoring and evaluation of the process. As a planning method, Health Care Planification aims to strengthen Primary Health Care as the basis for the implementation of Health Care Networks in the state of Rio Grande do Sul.

Treatment of Severe Hypercapnic Respiratory Failure Caused by SARS-CoV-2 Lung Injury with ECCO2R Using the Hemolung Respiratory Assist System.

Acute respiratory distress syndrome (ARDS) due to COVID-19 leads to a high rate of mortality in the intensive care unit (ICU). A lung-protective mechanical ventilation strategy using low tidal volumes is a cornerstone to management, but uncontrolled hypercapnia is a life-threatening consequence among severe cases. A mechanism to prevent progressive hypercapnia may offset hemodynamic instability among patients who develop hypercapnia. We present the case of a woman in her mid-60's with severe acute hypercapnic respiratory failure secondary to COVID-19 pneumonia who was successfully treated with early implementation of lung-protective ventilation facilitated by extracorporeal carbon dioxide removal (ECCO2R). This patient's multiple comorbid conditions included obesity, hypertension, type 2 diabetes mellitus, and hypercholesterolemia. On her fifth day of admission at the referring hospital, her worsening hypoxemia prompted endotracheal intubation during which she developed pneumothorax. She was transferred to our institution for advanced care where upon arrival, she had profound hypercapnia and respiratory acidosis. She met the criteria for treatment with an investigational ECCO2R device (Hemolung Respiratory Assist System) available through FDA Emergency Use Authorization. ECCO2R is similar to extracorporeal membrane oxygenation (ECMO) but operates at much lower blood flows (350-550 mL/min) through a smaller 15.5 French central venous catheter. Standard heparinization was provided intravenously to achieve appropriate levels of anticoagulation during ECCO2R therapy. Unlike ECMO, ECCO2R does not provide clinically meaningful oxygenation but is simpler to implement and manage. The use of ECCO2R successfully corrected and controlled the patient's hypercapnia and acidosis and enabled meaningful reductions in ventilator tidal volumes, respiratory rates, and mean airway pressures. The patient was weaned from ECCO2R after 17 days and from mechanical ventilation 10 days later. With low tidal volume ventilation facilitated by expeditious implementation of ECCO2R, the patient survived to discharge despite her many risk factors for a poor outcome and an extended duration of invasive mechanical ventilation.

Evolución clínica y funcional de los pacientes que ingresan en residencias tras una fractura de cadera. Implementación de un programa de intervención multinivel / Functional and clinical outcomes in patients admitted to nursing homes after hip fractures. Implementation of a multi-level intervention program

ANTECEDENTES Y OBJETIVO: Conocer la situación de los pacientes que ingresan en residencias de ancianos para recuperación tras una fractura de cadera y valorar su perfil de recuperación clínica y funcional. MATERIAL Y MÉTODOS: Se incluyó a los pacientes ingresados tras una fractura de cadera en los centros de un grupo residencial durante 2016. Se estandarizó un sistema de valoración y tratamiento y se les siguió durante 90 días. Se evaluó el estado nutricional (mediante el Mini-Nutritional Assessment y el índice de masa corporal), la presencia de dolor (mediante una escala analógica visual y la escala PAINAD) y la existencia de úlceras por presión, estudio analítico (vitamina D, hemoglobina y proteínas) y la situación funcional (mediante el índice de Barthel y la escala Functional Assessment Categories). RESULTADOS: En total 116 pacientes cumplieron los criterios de inclusión. La edad media fue 84,9 años (+/-6,7 DE) y 91 fueron mujeres (78,4%). Al ingreso, en las personas en las que pudo determinarse (56%), el 73,8% presentaron anemia, el 76,7% hipovitaminosis D, el 88% malnutrición o riesgo y el 15,3% úlceras por presión. Entre el ingreso y los 90 días, el estado funcional moderado-severo (IB < 60) se redujo del 90,4 al 39,6%, la dependencia para la deambulación del 97,3 al 36,1% y el dolor moderado-severo del 88,9 al 14,4% de los casos. Se resolvieron el 94,4% de las úlceras por presión. CONCLUSIONES: Los pacientes derivados a residencias tras una fractura de cadera se trasladan en mala situación clínica y funcional. A los 90 días, se obtienen buenos resultados en la recuperación funcional y de la marcha, en el control del dolor y en la cura de las úlceras por presión

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the clinical and functional outcomes of patients discharged to nursing homes after a hip fracture. METHODS: The study included all patients admitted to a group of nursing homes after a hip fracture in 2016. A geriatric assessment protocol was applied, and patients were treated with a specific protocol for 90 days. They were assessed for nutritional status (Mini-Nutritional Assessment and Body Mass Index), pain (Visual Analogue Scale, and the PAINAD Scale), the presence of pressure ulcers, blood test (D vitamin, haemoglobin, proteins), and functional status (Barthel index and Functional Assessment Categories). RESULTS: Out of a total of 175 patients, 116 (75%) met the inclusion criteria. The mean age was 84.9 years old (+/-6.7 SD), and 91 (78.4%) were women. At admission, 73.8% of 65 residents had anaemia, 76.7% hypovitaminosis D, 88% malnutrition or «at risk of malnutrition», and 15.3% had pressure ulcers. After 90 days, the moderate-severe functional status (Barthel index < 60) was reduced from 90.4 to 39.6%, dependence due to gait from 97.3 to 36.1%, and moderate-severe pain from 88.9 to 14.4%. Most of the pressure ulcers healed (94.4%). CONCLUSIONS: Patients admitted to nursing homes after a hip fracture had poor clinical and functional status. This study shows that after 90 days from admission these patients had positive outcomes in terms of functionality, gait, pain control, and pressure ulcers healing

[Functional and clinical outcomes in patients admitted to nursing homes after hip fractures. Implementation of a multi-level intervention program]. / Evolución clínica y funcional de los pacientes que ingresan en residencias tras una fractura de cadera. Implementación de un programa de intervención multinivel.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the clinical and functional outcomes of patients discharged to nursing homes after a hip fracture. METHODS: The study included all patients admitted to a group of nursing homes after a hip fracture in 2016. A geriatric assessment protocol was applied, and patients were treated with a specific protocol for 90 days. They were assessed for nutritional status (Mini-Nutritional Assessment and Body Mass Index), pain (Visual Analogue Scale, and the PAINAD Scale), the presence of pressure ulcers, blood test (D vitamin, haemoglobin, proteins), and functional status (Barthel index and Functional Assessment Categories). RESULTS: Out of a total of 175 patients, 116 (75%) met the inclusion criteria. The mean age was 84.9 years old (±6.7 SD), and 91 (78.4%) were women. At admission, 73.8% of 65 residents had anaemia, 76.7% hypovitaminosis D, 88% malnutrition or «at risk of malnutrition¼, and 15.3% had pressure ulcers. After 90 days, the moderate-severe functional status (Barthel index < 60) was reduced from 90.4 to 39.6%, dependence due to gait from 97.3 to 36.1%, and moderate-severe pain from 88.9 to 14.4%. Most of the pressure ulcers healed (94.4%). CONCLUSIONS: Patients admitted to nursing homes after a hip fracture had poor clinical and functional status. This study shows that after 90 days from admission these patients had positive outcomes in terms of functionality, gait, pain control, and pressure ulcers healing.

Otopalatodigital syndrome type I: New temporal bone CT-scan sign in a case with a de novo novel mutation / Síndrome otopalatodigital de tipo I: Nuevo signo de TC en una paciente con mutación de novo no descrita

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Caracterización de la enfermedad por reflujo faringolaríngeo en pacientes de edad avanzada y ancianos / Characterisation of laryngo-pharyngeal reflux disease in old and ageing patients

Objetivos: Caracterizar la enfermedad por reflujo faringolaríngeo en pacientes de edad avanzada y ancianos. Métodos: Estudio retrospectivo de pacientes mayores de 60 años, con sintomatología sugestiva de enfermedad por reflujo faringolaríngeo, vistos entre 2005 y 2014 en el Departamento de Otorrinolaringología de un hospital universitario. Se seleccionaron 85 pacientes (54 mujeres y 31 hombres) sometidos a una pH-metría de 24 h con doble sensor ("gold standard" en el diagnóstico del reflujo). Se calculó el índice de masa corporal. Se revisó la información clínica y evaluaron las pH-metrías según los criterios de DeMeester y Johnson. Se revisó el cuestionario «Reflux Symptoms Index» (RSI), considerado patológico cuando fue ≥13. Se evaluaron los hallazgos endoscópicos faringolaríngeos del "Reflux Finding Score" (RFS), considerado patológico cuando fue ≥7. Resultados: La edad media fue 67 años. En 70 pacientes (82%) la pH-metría fue patológica. El índice de masa corporal fue patológico en 50 pacientes (59%), de los que casi el 90% tenían pH-metría patológica. El RSI medio fue 9,8, con resultados anormales en 24 pacientes (28%). En 20 pacientes (23%) con RSI anormal tenían una pH-metría positiva. El hallazgo endoscópico más común (90%) fue la hipertrofia de comisura posterior. El RFS medio fue 9,07, con resultados anormales en 69 pacientes (70%). En 61 pacientes (70%) con RFS anormal tenían una pH-metría patológica. Solo 18 pacientes con RSI y RFS patológicos tenían una pH-metría patológica. Conclusiones: En pacientes mayores, los valores patológicos de índice de masa corporal se asocian altamente con pH-metrías patológicas. El RSI es un indicador de poco valor, mientras que el RFS es de valor moderado

Objectives: To characterize laryngo-pharyngeal reflux (LPR) in patients over 60 years of age. Methods: Retrospective review of patients over 60 years of age with symptoms suspicious of LPR, seen from 2005 to 2014 at an ENT Department of an academic hospital. Eighty-five consecutive patients (54 females, 31 males) who had completed a dual-sensor 24-hour pH-metry were included (considered "gold-standard" in LPR diagnosis). Body mass index, and reflux information and interventions were revised. pH-metries were evaluated according to DeMeester & Johnson's criteria. Symptoms were assessed according to the Reflux Symptom Index (RSI) and classified as abnormal if score was ≥ 13. A naso-fibro-laryngoscopy enabled findings to be documented according to the Reflux Finding Score (RFS), and they were classified as abnormal if the score was ≥ 7. Results: The patients’ mean age was 67 years. A positive pH-metry was present in 70 patients (82.5%). Fifty patients (59%) had abnormal body mass index, and almost 90% of them had an abnormal pH-metry. Mean RSI score was 9.8, with abnormal results in 24 patients (28%). Only 20 patients (23%) with abnormal RSI had a positive pH-metry. Posterior commissure hypertrophy was the most common finding (90% of patients). Mean RFS score was 9.07, with abnormal results in 69 patients (81%). Sixty-one patients (70%) with abnormal RFS had a positive pH-metry. Only 18 patients (20%) had coincidental abnormal pH-metry, RSI, and RFS. Conclusions: In ageing patients, abnormal body mass index is strongly associated with abnormal pH-metry. RSI is a weak indicator of LPR, whereas RFS has a moderate value

Characterisation of laryngo-pharyngeal reflux disease in old and ageing patients. / Caracterización de la enfermedad por reflujo faringolaríngeo en pacientes de edad avanzada y ancianos.

OBJECTIVES: To characterize laryngo-pharyngeal reflux (LPR) in patients over 60 years of age. METHODS: Retrospective review of patients over 60 years of age with symptoms suspicious of LPR, seen from 2005 to 2014 at an ENT Department of an academic hospital. Eighty-five consecutive patients (54 females, 31 males) who had completed a dual-sensor 24-hour pH-metry were included (considered "gold-standard" in LPR diagnosis). Body mass index, and reflux information and interventions were revised. pH-metries were evaluated according to DeMeester & Johnson's criteria. Symptoms were assessed according to the Reflux Symptom Index (RSI) and classified as abnormal if score was ≥13. A naso-fibro-laryngoscopy enabled findings to be documented according to the Reflux Finding Score (RFS), and they were classified as abnormal if the score was ≥7. RESULTS: The patients' mean age was 67 years. A positive pH-metry was present in 70 patients (82.5%). Fifty patients (59%) had abnormal body mass index, and almost 90% of them had an abnormal pH-metry. Mean RSI score was 9.8, with abnormal results in 24 patients (28%). Only 20 patients (23%) with abnormal RSI had a positive pH-metry. Posterior commissure hypertrophy was the most common finding (90% of patients). Mean RFS score was 9.07, with abnormal results in 69 patients (81%). Sixty-one patients (70%) with abnormal RFS had a positive pH-metry. Only 18 patients (20%) had coincidental abnormal pH-metry, RSI, and RFS. CONCLUSIONS: In ageing patients, abnormal body mass index is strongly associated with abnormal pH-metry. RSI is a weak indicator of LPR, whereas RFS has a moderate value.

Multiparameter Flow Cytometry Identification of Neoplastic Subclones: A New Biomarker in Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma.

Multiparameter flow cytometry (MFC)-based clonality assessment is a powerful method of diagnosis and follow-up in monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). However, the relevance of intraclonal heterogeneity in immunophenotypic studies remains poorly understood. The main objective of this work was to characterize the different immunophenotypic subclones in MGUS and MM patients and to investigate their correlation with disease stages. An 8-color MFC protocol with 17 markers was used to identify the subclones within the neoplastic compartment of 56 MGUS subjects, 151 newly diagnosed MM patients, 30 MM subjects in complete remission with detectable minimal residual disease, and 36 relapsed/refractory MM patients. Two or more clusters were observed in > 85% of MGUS subjects, 75% of stage I MM patients, and < 15% in stage III. Likewise, a significant correlation between the dominant subclone size, secondary cytogenetic features, and changes in the expression of CD27, CD44, and CD81 was detected. The loss of intraclonal equilibrium may be an important factor related with kinetics and risk of progression not well considered to date in MFC studies. The MFC strategy used in this work can provide useful biomarkers in MGUS and MM.

A Rare Case of Pure Erythroid Sarcoma in a Pediatric Patient: Case Report and Literature Review.

We describe an exceptional case of erythroid sarcoma in a pediatric patient as a growing orbital mass with no evidence of morphologic bone marrow involvement, who was finally diagnosed of pure erythroid sarcoma based on histopathology and flow cytometry criteria. We discuss the contribution of standardized eight-color flow cytometry as a rapid and reliable diagnostic method. The use of normal bone marrow databases allowed us to identify small aberrant populations in bone marrow and later confirm the diagnosis in the neoplastic tissue.

Lesiones faciales y hepatitis aguda en paciente infectada por el virus de la inmunodeficiencia humana procedente de Paraguay / Facial lesions and acute hepatitis in an Human Immunodeficiency Virus infected patient from Paraguay

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