Management of CRSwNP in Latin America: A multidisciplinary consensus from an expert working group.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition of the nasal and paranasal tissues, characterized by the presence of bilateral nasal polyps. While etiology and pathogenetic mechanisms are heterogeneous and complex, in most patients, disease is mediated predominantly through type 2 inflammatory processes. Clinical management is challenging, and a multidisciplinary approach is preferred. Principal treatment approaches are the use of local/systemic corticosteroids and sinonasal surgery, although outcomes can be unsatisfactory. Recent availability of biological therapies targeting underlying inflammatory processes can offer effective treatment options in uncontrolled disease. Specialist guidelines greatly assist clinical decision-making, although as these are chiefly written from a global/international perspective, they may not wholly accommodate disease patterns and clinical practice at a regional level. An expert panel of specialists from Latin America was convened to develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the chief observations and recommendations which can provide guidance for clinicians in the Latin American region.

[Severe post-COVID-19 dialysis dependence and inpatient acute kidney injury]. / Dependencia a diálisis posterior a COVID-19 grave y lesión renal aguda intrahospitalaria.

Background: COVID-19 challenged our health system, within the broad clinical spectrum acute kidney injury was presented as a catastrophic event, acute kidney injury and the risk of dependency after dialysis constitute a clinical problem with high repercussions in the funcionality. Objective: To identify risk factors for dialysis dependence after acute kidney injury from COVID-19. Material and methods: A retrospective observational cohort study was carried out at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI, of the Mexican Institute of Social Security, from March 2020 to March 2021. 317 patients were included, we performed descriptive statistics, we compared differences between the stages of acute kidney injury, finding a difference in obesity with a frequency of 2.2% in stage 1, 20.82% stage 2 and 14.51% stage 3, with p value = 0.018. Results: We found dialysis dependence one year after hospital-acquired acute kidney injury induced by COVID-19 in 58 patients (18.9%), we analyzed by KDIGO stage, in those patients who had AKI KDIGO 1 (2.83%) it depended on dialysis at one year, in the KDIGO stage 2 (3.78%), in the KDIGO stage 3 (11.67%). Conclusions: Our study allowed us to identify that the risk factors associated with dialysis dependence are: male gender, type 2 diabetes mellitus, obesity, cardiovascular disease.

Introducción: la COVID-19, retó a nuestro sistema de salud, dentro del amplio espectro clínico la lesión renal aguda se presentó como un evento catastrófico, la lesión renal aguda y el riesgo de dependencia posterior a diálisis constituye un problema clínico con alta repercusión en la funcionalidad. Objetivo: identificar los factores de riesgo para la dependencia a diálisis posterior a lesión renal aguda por COVID-19. Material y métodos: se realizó un estudio de cohorte observacional retrospectivo en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI, del Instituto Mexicano del Seguro Social, del periodo de marzo del 2020 a marzo del 2021. Se incluyeron 317 pacientes, realizamos estadística descriptiva, comparamos diferencias entre los estadios de lesión renal aguda encontrando diferencia en obesidad con frecuencia de 2.2% en estadio 1, de 20.82% estadio 2 y de 14.51% estadio 3, con valor p = 0.018. Resultados: encontramos la dependencia a diálisis a un año posterior a lesión renal aguda intrahospitalaria inducida por COVID-19 en 58 pacientes (18.9%), analizamos por estadio de KDIGO, en aquellos pacientes que cursaron con LRA KDIGO 1 (2.83%) dependió de diálisis a un año, en el estadio KDIGO 2 (3.78%), en el estadio KDIGO 3 (11.67%). Conclusiones: nuestro estudio permitió identificar que los factores de riesgo que se asocian con dependencia a diálisis son: sexo masculino, diabetes mellitus tipo 2, obesidad, enfermedad cardiovascular.

Guía de práctica clínica para el tratamiento de la rinosinusitis crónica: versión completa / Clinical practice guideline for the treatment of chronic rhinosinusitis: full version

La rinosinusitis (RS) se define como la inflamación de la nariz y los senos paranasales con dos o más síntomas como bloqueo/obstrucción/congestión o secreción nasal (goteo nasal anterior/posterior) más dolor/presión facial y/o reducción o pérdida del sentido del olfato. Adicional, se tienen en cuenta los hallazgos objetivos como la presencia de pólipos nasales y/o descarga mucopurulenta en meato medio y/o edema u obstrucción de la mucosa en el meato medio en la endoscopia nasal. Se pueden considerar o no, los cambios tomográficos como cambios mucosos en el complejo osteomeatal y la mucosa de los senos paranasales. Se reconoce que los síntomas tienen alta sensibilidad, pero baja especificidad, de ahí la necesidad de hallazgos objetivos.

Rhinosinusitis (RS) is defined as inflammation of the nose and sinuses with two or more symptoms such as blockage/obstruction/congestion or nasal discharge. with two or more symptoms such as nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior runny nose) plus facial pain/pressure and/or reduction or loss of the sense of smell. sense of smell. In addition, objective findings such as the presence of nasal polyps and/or nasal presence of nasal polyps and/or mucopurulent discharge from the middle meatus and/or edema or mucosal obstruction or mucosal obstruction in the middle meatus on nasal endoscopy. Tomographic changes may or may not tomographic changes may or may not be considered as mucosal changes in the osteomeatal complex and mucosal osteomeatal complex and the mucosa of the paranasal sinuses. It is recognized that the symptoms symptoms have high sensitivity but low specificity, hence the need for objective findings. findings.

Guía de práctica clínica para el tratamiento de la rinosinusitis crónica: versión corta para profesionales de la salud. Colombia-2023 / Clinical practice guideline for the management of chronic rhinosinusitis: short version for health care professionals. Colombia-2023

La rinosinusitis (RS) se define como la inflamación de la nariz y los senos paranasales con dos o más síntomas como bloqueo/obstrucción/congestión o secreción nasal (goteo nasal anterior/posterior) más dolor/presión facial y/o reducción o pérdida del sentido del olfato. Adicional, se tienen en cuenta los hallazgos objetivos como la presencia de pólipos nasales y/o descarga mucopurulenta en meato medio y/o edema u obstrucción de la mucosa en el meato medio en la endoscopia nasal.

Rhinosinusitis (RS) is defined as inflammation of the nose and sinuses with two or more symptoms such as blockage/obstruction/congestion or nasal discharge with two or more symptoms such as nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior runny nose) plus facial pain/pressure and/or reduced or lost sense of smell sense of smell. Additionally, objective findings such as the presence of nasal polyps and/or nasal presence of nasal polyps and/or mucopurulent discharge in the middle meatus and/or edema or mucous or mucosal obstruction in the middle meatus on nasal endoscopy.

Diagnóstico y tratamiento de la rinosinusitis crónica en adultos. Consenso de expertos: Asociación Colombiana de Otorrinolaringología-2021. / Diagnosis and treatment of chronic rhinosinusitis in adults. Expert consensus: Asociación Colombiana de Otorrinolaringología -2021.

Introducción: la Rinosinusitis Crónica se define como la inflamación crónica de la nariz y los senos paranasales por más de 12 semanas. La prevalencia varía entre el 5% - 30% de acuerdo con la zona geográfica según un estudio de carga de enfermedad (2012-2014), la prevalencia de las enfermedades respiratorias crónicas (rinitis y sinusitis crónica) varió entre el 10% y el 25%. Objetivo: establecer un conjunto de consideraciones basadas en consenso de expertos, para el diagnóstico y el tratamiento de la rinosinusitis crónica en pacientes adultos, en el contexto colombiano. Métodos: se llevó a cabo un consenso formal (Delphi y nominal). Se conformó un grupo de expertos, se definieron el alcance y las preguntas. Se realizaron dos rondas de calificación anónimas, y una discusión para las preguntas sin consenso. En las preguntas con opciones de uno a nueve, se consideró consenso con una mediana de uno a tres o de siete a nueve. En las preguntas tipo Likert, se consideró consenso un porcentaje igual o superior al 80% en acuerdos o desacuerdos. Resultados: se definieron y calificaron 18 preguntas, con la participación de 17 otorrinolaringólogos, de 8 ciudades colombianas, todos miembros de la Asociación Colombiana de Otorrinolaringología y con un promedio de experticia de 19.2 años (Desviación estándar [DE]: 10,2). Se obtuvieron 18 recomendaciones para el diagnóstico y el tratamiento de esta patología. Conclusiones: las recomendaciones emitidas por los expertos permiten orientar y estandarizar el diagnóstico y el tratamiento de la rinosinusitis crónica en adultos, en el contexto de los servicios de salud en Colombia.

Introduction: Chronic Rhinosinusitis is defined as chronic inflammation of the nose and paranasal sinuses for more than 12 weeks. The prevalence varies between 5% - 30% depending on the geographical area according to a disease burden study (2012-2014), the prevalence of chronic respiratory diseases (rhinitis and chronic sinusitis) varied between 10% - 25%. Objective: To establish a set of considerations based on expert consensus, for the diagnosis and treatment of chronic rhinosinusitis in adult patients, in the Colombian context. Methods: A formal consensus (Delphi and nominal) was carried out. A group of experts was formed, the scope and questions were defined. Two anonymous grading rounds were conducted, and a discussion for questions without consensus. In the Questions with options from one to nine were considered consensus with a median of one to three or seven to nine. In the Likert-type questions, a percentage equal to or greater than 80% in agreements or disagreements was considered consensus. Results: 18 questions were defined and scored, with the participation of 17 otorhinolaryngologists, from eight Colombian cities, all members of the Colombian Association of Otorhinolaryngology and with an average experience of 19.2 years (Standard desviation [SD]: 10.2). 18 recommendations were obtained for the diagnosis and treatment of this pathology. Conclusions: The recommendations issued by the experts allow to guide and standardize the diagnosis and treatment of chronic rhinosinusitis in adults, in the context of health services in Colombia.

Factors That Influence the Attitude of the Population to Be a Donor in Mexico.

BACKGROUND: Transplantation depends on a donation from a living or deceased donor, with the latter ideally involving a multiorgan transplant. The objective of this study was to determine the factors that influence the attitudes of the population in Mexico toward being a donor. METHODS: We conducted an observational, cross-sectional study with a survey on the attitudes toward donation in the population of Mexico. The survey had 33 items on it regarding sociodemographic aspects and people's positions on the issues of organ and tissue donation. We used central tendency and dispersion averages and calculated the difference between groups using chi squares or the Student t test. We also used the statistical program SPSS version 25. RESULTS: The perception of respondents regarding organ and tissue donation (with 1064 people or 65.1% in favor) points to a lack of knowledge in Mexico. People do not talk about organ donation with their relatives and especially do not discuss their wishes in case of death (only 660 people indicated they had or 40.4%). There is a better attitude toward donation among younger respondents, women, single people, health personnel, people with higher incomes, Catholics, and those who do not have a hospitalized family member. CONCLUSIONS: It is necessary to provide more information about organ donation to people in Mexico. The opinion toward donation is generally favorable; however, there are multiple factors that influence opinions. Family members of patients in intensive care are the least willing to donate themselves or donate a relative's organs.

Uncommon Complications in the First Year After Renal Transplantation.

INTRODUCTION: Classic post-transplant complications are highly studied and monitored; however, other unusual complications may occur due to immunosuppression. The objective of this study is to show these rare complications in a kidney transplant center. MATERIAL AND METHODS: Retrospective, observational, longitudinal study of renal transplants carried out from 2013 to 2017 in the Renal Transplant Unit of the National Medical Center Siglo XXI. A total of 790 transplants were performed, with surveillance for 1 year and rare events described. An analysis of frequencies and percentages of the events was performed using the statistical package SPSS version 25. RESULTS: Of the 790 patients, 110 (13.92%) experienced rare events, classified into 9 types of complications. DISCUSSION AND CONCLUSIONS: Complications exist in renal transplantation that are often ignored or minimized. A considerable number have been observed in this study, 110 events (13.92%); this result allows us to consider multiple possibilities in a kidney transplant program, especially infectious complications (34 patients) and surgical complications (29 cases). With the increase in diabetic receptor transplantation, metabolic complications will surely increase in the coming years.

Lista de chequeo preoperatorio para la cirugía endoscópica de hipófisis / Preoperative checklist for endoscopic pituitary surgery

Introducción: las listas de chequeo son herramientas que buscan evitar errores y complicaciones al momento de realizar un procedimiento. El adenoma hipofisiario es la primera causa de cirugía endoscópica transnasal de la región selar, y se estima que ocurren hasta un 20 % de complicaciones derivadas de esta cirugía. Objetivo: desarrollar una lista de chequeo preoperatoria que sirva como una guía para la evaluación prequirúrgica de los pacientes a quienes se les realicen cirugías de la región selar. Metodología: se realizó una revisión de la literatura para desarrollar una lista de chequeo preliminar y una serie de declaraciones que resumían los puntos importantes de la lista. Se construyó un comité de expertos en cirugía endoscópica de la base de cráneo conformado por neurocirujanos y otorrinolaringólogos de hospitales de Bogotá. Utilizando la metodología Delphi modificada, se llegó a un consenso para la realización de la lista de chequeo final. Resultados: se describieron 15 declaraciones; de estas, hubo una discrepancia en 6 declaraciones. Por esta razón, se realizaron modificaciones en 5 declaraciones, y se llegó a un consenso entre los expertos participantes. La lista de chequeo final aprobada está compuesta por 4 ítems. Discusión/conclusiones: la cirugía para el manejo de la patología de la región selar es compleja y requiere de un equipo quirúrgico entrenado y disciplinado para lograr los mejores desenlaces posibles. Consideramos que nuestra lista de chequeo es una herramienta que permitirá a los equipos que realizan estas cirugías en Colombia tener una visión más completa del paciente y, eventualmente, ayudar a evitar errores y posibles complicaciones.

Introduction: checklists that seek to avoid errors are very useful tools for any surgical practice. Pituitary adenomas are the leading indication to perform a transnasal endoscopic surgery in the sellar region and up to 20 % complications have been reported related to this procedure. Objetive: develop a preoperative checklist, based on an expert consensus, to serve as a guide for the skull base teams to consistently evaluate preoperatively all patients with pathologies in the sellar region. Methods: a literature review was conducted to develop a preliminary checklist and a series of statements summarizing the most important items on the list. A committee of experts in endoscopic skull base surgery was summoned, made up of neurosurgeons and otolaryngologists from hospitals in Bogotá. Using the modified Delphi methodology, a consensus was reached for the completion of the final checklist. Results: fifteen statements were developed. A discrepancy was seen in six statements. Modifications were made for five statements, thus reaching a consensus among the participating experts. The final approved checklist is made up of 4 items. Conclusion: surgery for treating different pathologies in the sellar region is complex and requires a welltrained and disciplined surgical team to achieve the best possible outcomes. We consider that our preoperative checklist is a valuable resource for skull base surgical teams performing transnasal endoscopic surgery of the sellar region. This tool will allow skull base surgical teams in Colombia to have a more comprehensive view of the patient and eventually help to avoid errors and possible complications.

Recomendaciones en rinología, cirugía endoscópica nasal y cirugía de base de cráneo en tiempos de COVID-19 / Recommendations in rhinology, nasal endoscopic and skull base surgery during the era of COVID-19

En el mundo de la pandemia por SARS-CoV-2 (COVID-19), definir pautas durante la fase a la que nos enfrentamos es un gran reto, ya que los criterios pueden cambiar, así como las medias de protección y aislamiento. Esta publicación pretende orientar los procedimientos, patologías y procesos relacionados con el área de rinología, senos paranasales y cirugía de base de cráneo en el contexto de consulta externa, procedimientos ambulatorios, cirugía relacionada y controles postquirúrgicos.

In the world of the SARS-CoV-2 pandemic (COVID-19), defining guidelines during the current phase is a real challenge since those criteria can change as well as the protection and isolation measures. This publication is intended to guide the procedures, pathologies and processes related to the area of Rhinology, Paranasal Sinuses and Skull Base Surgery, in the context of Outpatient Consultation, Outpatient Procedures, Related Surgery and Post-surgical controls.

Anatomical Variants in Renal Transplantation, Surgical Management, and Impact on Graft Functionality.

INTRODUCTION: Chronic kidney disease (CKD) is a priority problem due to its high prevalence. According to the modalities of renal replacement therapy, kidney transplantation (TR) offers to be the best alternative. TR presents multiple factors of dependence of success; among them is the management of the anatomical variants of the graft and the surgical decision on the basis of these. Therefore, the objective of this study is to determine the frequency of variants in the graft, its surgical management, and the impact on the functionality of the transplanted kidney. MATERIAL AND METHODS: This was an observational, retrospective study of patients in the renal transplant unit of the Siglo XXI National Medical Center from 2002-2016. The analysis begins in the description of the population doing bivariate analysis to establish relative risks. For variables with a central tendency, the parametric tests analysis of variance, Student t paired, and unpaired will be used. In the case of nominal variables, the proportion's difference will be estimated using the chi-square test, establishing significance when P is ≤ .05. SPSS 21 software was used. RESULTS: There were a total of 773 patients, with 576 transplants from living donors and 197 from deceased donors. In the case of the artery, a greater number of variants is observed-27.8% being alive versus 17.3% of the variants found in deceased donors. For the renal vein, 12.7% of the kidneys were taken from living donor vs 6.1% from deceased donors. This required one more day of hospitalization (6 vs 7 days of single vs multiple vessels); likewise, increases in immediate post-transplant infections were 5% for single vessels vs 8% in the case of multiple variants. CONCLUSIONS: The importance of knowing the anatomical variants prior to the TR allows them to plan the potential surgical maneuvers, decreasing the times aimed at improving the immediate functionality of the renal graft, while also considering the increase in hospital expenses due to the greater number of days of hospitalization.

Estandarización y evaluación de un modelo de entrenamiento quirúrgico de cirugía endoscópica nasosinusal en cabezas de cordero desarrollado en el Hospital Militar Central / Standardization and evaluation of a surgical training model of functional endoscopic sinus surgery in lamb heads developed in the Central Military Hospital

Objetivo: Estandarización y evaluación del modelo de entrenamiento quirúrgico en cirugía endoscópica rinosinusal en residentes de otorrinolaringología del Hospital Militar Central. Diseño: Estudio experimental no aleatorio (antesdespués) Metodología: Se evaluó a los sujetos en estudio con la escala validada para habilidades quirúrgicas "GOALS" antes y después de realizar nuestro modelo de entrenamiento quirúrgico propuesto en cabezas de cordero, se midió el cambio en las habilidades quirúrgicas de los sujetos en estudio y se realizó el análisis estadístico con pruebas no paramétricas para muestras relacionadas (prueba de wilcoxon) en el programa SPSS(v.15) Resultados: Se reclutaron 12 residentes de Otorrinolaringología, se realizó una medición de las competencias quirúrgicas previa y posterior al entrenamiento comparando el desempeño quirúrgico antes y después evidenciando una mejoría en la percepción de profundidad y destreza bimanual estadísticamente significativa (p<0,05Wilcoxon), sin embargo, posterior al entrenamiento completo no encontramos una mejoría estadísticamente significativa en habilidades como manipulación de los tejidos y autonomía (p>0,05 Wilcoxon). Conclusiones: El modelo de entrenamiento quirúrgico propuesto mejora el desempeño de habilidades mínimas necesarias para una cirugía endoscópica nasal adecuada y segura, sin embargo, la simulación presenta limitaciones con respecto al desarrollo de habilidades como el manejo de los tejidos, sangrado y autonomía del procedimiento.

Aim: Standardization and assessment of the surgical training model in functional endoscopic sinus surgery in otolaryngology residents of the Central Military Hospital. Design: Non-randomized experimental study (before-after) Methods: we perform an assesment of the subjects enrolled in our study with the validated scale for surgical skills "GOALS" before and after the training with our proposed surgical training model in lambs heads, the change in the surgical skills of the subjects under study was measured and the statistical analysis was performed with nonparametric tests for related samples (wilcoxon test) in SPSS(v.15) estatistical software. Results: Twelve otorhinolaryngology residents were enrolled in the study, the surgical performance before and after the training model was compared showing an improvement in depth perception and bimanual dexterity, we found statistically significant differences (p<0.05 Wilcoxon). However, after the complete training, we did not find a statistically significant improvement in skills such as tissue manipulation and autonomy (p>0.05 Wilcoxon). Conclusions: Our surgery training model in lamb's head improves the performance of minimum skills necessary for an adequate and safe functional endoscopic sinus surgery , however, the simulation presents limitations regarding the development of some skills such as tissue management, bleeding and autonomy of the procedure.

Saludo del presidente / Presidential Greetings

Las exigencias actuales en educación medica continuada, el compromiso de que la atención en salud por parte de los otorrinolaringólogos de Colombia tenga un direccionamiento estratégico, con asociados reentrenados en competencias clínicas y quirúrgicas y para que una organización como la Asociación Colombiana de Otorrinolaringología, Cirugía de Cabeza y Cuello, maxilofacial y Estética facial, recertifique a sus miembros y ofrezca un proyecto académico y gremial acorde con las necesidades de hoy, me motivaron para ser elegido s de hoy, me motivaron para ser elegido como Presidente de la asociación para el periodo 2018 -2020.

The current requirements in continuing medical education, the commitment that health care by Colombian otolaryngologists has a strategic direction, with partners re-trained in competencies clinical and surgical and for an organization such as the Colombian Association of Otolaryngology, Head and Neck Surgery, maxillofacial and facial aesthetics, recertify to its members and offer an academic and guild project according to the needs of today, motivated me to be elected today, motivated me to be elected as President of the association for the period 2018 -2020.

Tamizaje auditivo neonatal en pacientes de alto riesgo con otoemisiones acústicas evaluación de resultados / Neonatal hearing screening in high risk patients with otoacoustic emissions: evaluation of results

Objetivo: Evaluar la efectividad del programa de tamizaje auditivo del Hospital Militar Central en pacientes de alto riesgo de hipoacusia neurosensorial, el cual está basado en la realización de otoemisiones acústicas. Diseño: Estudio de Cohorte Histórica. Métodos: Se incluyeron pacientes mayores de 12 meses de edad nacidos en el Hospital Militar central entre enero de 2009 y diciembre de 2012; a quienes por condiciones de alto riesgo de hipoacusia neurosensorial se les realizó antes de los 6 meses de edad otoemisiones acústicas como prueba de tamizaje auditivo. Se analizaron 125 pacientes evaluando cada oído por separado para un total de 250 mediciones, a esta población, se le realizó diagnóstico auditivo con el "Gold standard" cross-check. Resultados: Se estudiaron los factores de riesgo para hipoacusia neurosensorial encontrando que el peso al nacer ≤1500 gr se relacionó con hipoacusia en un 16%. El 5.6% tiene antecedente familiar de hipoacusia neurosensorial en primer y segundo grado de consanguinidad. La infección congénita (STORCH: sífilis, toxoplasmosis, rubéola, citomegalovirus, herpes); como factor de riesgo se presentó en el 2.4% únicamente con la presencia de Toxoplasmosis, de los cuales 2 oídos presentaron cofosis. Conclusiones: Las otoemisiones acústicas son efectivas como prueba de tamizaje auditivo en el HOMIC en pacientes de alto riesgo de hipoacusia Neurosensorial. La sensibilidad de las Otoemisiones acusticas para sospechar hipoacusia neurosensorial de moderada a profunda fue del 93.7 % La especificidad estimada en nuestro estudio fue de 90.9%

Objective: To evaluate the effectiveness of the auditory screening program at the "Hospital Militar Central" in patients who were at high risk of sensorineural hearing loss, which is based on the realization of otoacoustic emissions. Design: Retrospective cohort study Methods: We included patients older than 12 months of age who were at "Hospital Militar Central" (HOMIC) between January 2009 and December; who ought to their high risk conditions of sensorineural hearing loss were underwent otoacoustic emissions and hearing screening test before 6 months of age. Total population was 125 patients. We evaluated each ear separately for a total of 250 measurements, an auditory diagnosis was performed through crosscheck method. Results: Risk factors for sensorineural hearing loss were studied. We found that birth weight ≤1500gr was associated with hearing loss by 16%. 5.6% have a family history of sensorineural hearing loss in first and second degree of consanguinity. Congenital infection (TORCHS: toxoplasmosis, syphilis, rubella, cytomegalovirus, or herpes) as a risk factor occurred in 2.4% only in the presence of Toxoplasmosis, of which 2 ears presented deafness. Conclusions: The otoacoustic emissions are effective as a hearing screening test in the "Hospital Militar Central" in patients at high risk of Sensorineural hearing loss. The sensitivity of otoacoustic emissions to suspect sensorineural hearing loss was 93.7%. The estimated specificity in our study was 90.9%

Specific Antigens by Federal Entity in Patients at the Transplant Unit of Specialities Hospital, National Medical Center Twenty-First Century, Mexico.

BACKGROUND: The study of the kidney transplant involves understanding the immunologic basis, such as histocompatibility and the genetic basis of a population. In Mexico, the study of the genetic basis has led to a genetic map by federal entities. METHODS: We performed an HLA study with 1,276 kidney transplant patients (recipients and donors) in the Hospital of the National Medical Center Twenty-First Century, determining HLA class I (A, B, and Cw) and class II (DRß1 and DQß1) antigens with the use of SSOP-PCR. A descriptive analysis was conducted with measures of central tendency (mean, SD). RESULTS: Of 1,276 HLA patients studied, we obtained 2,552 results for each class by the composition of the 2 haplotypes, and for HLA-Cw we processed 796 patients, for a total of 1,592 antigens for this class. We found antigens specific to each federal entity, and it was found that the Federal District had the highest number of specific antigens (10) followed by Morelos (7), Querétaro and Mexico State (3 each), and Tamaulipas, Aguascalientes, Michoacán, Guerrero, Puebla, and Oaxaca (1 each). CONCLUSIONS: The genetic map allows us to know proportions of antigens in every state in the center and south of Mexico owing to the diversity and area of influence of the National Medical Center XXIst Century, as well as the wide number of patients. Furthermore, there are still preserved proportionally distinct genetic roots in every entity.

Análisis reflexivo sobre un currículo basado en competencias en otorrinolaringología / Reflective analysis about competency-based curriculum in otolaryngology

Se presenta una reflexión argumentativa acerca de las razones para diseñar un currículo basado en competencias para la especialización en Otorrinolaringología en la Universidad Militar Nueva Granada, además se proponen algunos elementos que pueden orientar dicho currículo. Debido a la universalización de la cultura humana debemos responder a los desafíos de la globalización, conservando nuestra identidad cultural. Hay dos situaciones específicas que como docentes universitarios debemos enfrentar. La necesidad de los estudiantes de tener acceso a la movilidad interinstitucional, y la necesidad de los profesionales de poder homologar sus títulos. Un currículo basado en competencias puede responder a estas demandas de forma apropiada, ya que es uno de los modelos más difundidos en el mundo actualmente, y favorece en el estudiante la adquisición de saberes, actitudes y habilidades; que le permitirán competir en condiciones de igualdad en el mundo laboral. Se requiere el diseño de mecanismos evaluativos específicos para este modelo, que sin embargo puede continuar conservando algunas herramientas tradicionales como la presentación de casos clínicos o exámenes sobre temas específicos como anatomía. Pruebas como el Mini-CEX pueden permitir evaluar el desempeño (saber hacer) del estudiante ante una situación clínica específica.

We present an argumentative reflection about the reasons for designing a competencybased curriculum for the specialization in Otolaryngology at the Universidad Militar Nueva Granada, also we propose some elements that can guide the curriculum. Due to the universalisation of the human culture we must respond to the challenges of globalization, preserving our cultural identity. There are two specific situations we face as university professors. The need of students to have access to the interinstitutional mobility, and the need of professionals to have homologate their titles. A competency-based curriculum can meet these demands properly, since it is one of the most popular models in the world today, and helps the student in the acquisition of knowledge, attitudes and skills, which allow them to compete on equal terms in the working world. It requires the design of specific evaluative mechanisms for this model, which nevertheless can continue preserving some traditional tools such as the presentation of case reports or tests on specific topics such as anatomy. Tests such as the Mini-CEX may allow assessment of the performance (know- how) of the student to a specific clinical situation.

Comparación del manejo temprano versus tardio en pacientes con trauma nasal / Comparison of early treatment versus late treatment in patients with nasal trauma

Objetivo: Determinar si en pacientes con trauma facial que requieren tratamiento quirúrgico, el manejo tardío de la fractura nasal ofrece porcentajes de éxito diferentes a los ofrecidos por el manejo temprano. Diseño: Estudio tipo cohorte histórica (cohorte retrospectiva). Metodología: Se incluyeron todos los pacientes sometidos a intervención quirúrgica por fractura nasal debido a trauma de guerra. Los pacientes se asignaron a dos grupos de investigación. Grupo I, aquellos que recibieron cirugía temprana y Grupo II aquellos pacientes que recibieron tratamiento luego de tres semanas del trauma. Se calculó un tamaño de muestra de 55 pacientes por grupo. Los pacientes fueron evaluados clínicamente de forma ciega por dos especialistas para determinarl éxito o fracaso quirúrgico. Resultados: Se revisó los registros de historias clínicas de 175 pacientes asistentes al Hospital Militar Central que cumplieron criterios de inclusión, de estos, 32 fueron excluidos y 21 fueron asignados a una prueba piloto inicial. Se analizaron 122 pacientes en total divididos en dos grupos, Grupo I (n=67) y Grupo II (n=55). Evaluación ciega con una alta concordancia interevaluador (kappa =0.98). Se comparó la proporción de éxito quirúrgico entre los dos grupos sin encontrar diferencias estadísticamente significativas (chi 2 Pearson p=0.97). Conclusión: En el contexto del trauma de guerra, la decisión de llevar a un paciente de trauma nasal a un manejo de forma temprana o tardía dependerá de muchos factores inherentes al conflicto armado. La oportunidad en el manejo quirúrgico según los hallazgos del presente estudio, no interviene en la probabilidad de éxito quirúrgico.

Objective: To determine whether patients with facial trauma requiring surgical treatment, late nasal fracture management provides success rates different to those offered by earlier operation. Study design: Historical cohort study (retrospective cohort). Methodology: All patients undergoing surgery for nasal fracture due to war trauma were included. Patients were assigned to one of two groups. Group I, those who received early surgery and Group II those patients who received treatment after three weeks of trauma. A sample size of 55 patients per group was calculated. The evaluation was blind by two service specialists to determine failure or success of the surgery. Results: 175 medical records of patients attending the Central Military Hospital who met inclusion criteria were reviewed. Of these, 32 were excluded and 21 were assigned to an initial pilot study. A total of 122 patients divided in two groups; Group I (n=67) and Group II (n=55) were analyzed. Two raters evaluated the subjects blindly with a high concordance inter-rater (kappa = 0.98). The proportion of surgical success between the two groups was compared; we found no statistically significant difference between the two groups (Pearson chi 2 p = 0.97). Conclusion: In the context of the trauma of war, the decision to refer a patient to a nasal trauma management how early or late will depend on many factors inherent in armed conflict. The opportunity in the surgical management according to the findings of this study, is not involved in the probability of surgical success.

Timpanoplastia en perforación timpánica secundaria a trauma por onda explosiva / Tympanoplasty in tympanic membrane perforation caused by blast injury / Timpanoplastia em perfuração timpânica secundaria ao trauma por onda explosiva

Objetivo: Determinar si pacientes con perforación timpánica causada por trauma por onda explosiva tienen un resultado quirúrgico peor que el encontrado en pacientes con perforación timpánica causada por otitis media crónica. Metodología: Estudio observacional analítico tipo cohorte prospectiva. Se comparó los resultados en timpanoplastia tipo I entre pacientes expuestos a trauma por onda explosiva (cohorte expuesta) y pacientes con perforación causada por otitis media crónica (cohorte no expuesta). Se incluyeron pacientes mayores de 18 años en quienes se utilizó técnica “over-under” de colocación de injerto de cartílago. Se excluyeron pacientes en quienes se utilizó otras técnicas quirúrgicas, a quienes se les practicó mastoidectomia u osciculoplastia, aquellos con perforaciones secundarias a otra etiología y quienes tenían colesteatoma. El tamaño de la muestra se calculó para la variable resultado anatómico y fue de 43 pacientes por cohorte. El estudio se terminó una vez se consiguió el tamaño de muestra propuesto. El análisis principal fue la comparación del resultado anatómico (estado del neo tímpano) y funcional (brecha aíre-hueso <10dB) entre las cohortes expuesta y no expuesta. Resultados: El estudio inició en agosto1 de 2011 y finalizó en julio 25 de 2013. No se encontró asociación entre la exposición bajo estudio y el fracaso anatómico, RR=4.0 [IC 95% RR = 0.47- 34.35]. Tampoco hubo asociación entre el fracaso anatómico y perforación timpánica ≥50%, localización anterior de la perforación timpánica e inflamación /infección al momento de la cirugía [IC 95% RR incluyó el valor 1]. Los pacientes de la cohorte expuesta tuvieron un RR=1.76 de fracaso funcional [IC 95% RR=1.19-2.59]. Conclusiones: El resultado anatómico de la timpanoplastia tipo I es equiparable entre los pacientes con perforación timpánica secundaria a trauma por onda explosiva respecto a aquellos con perforaciones timpánicas por otitis crónica. Sin embargo se observó un peor resultado funcional entre los pacientes víctimas de trauma por onda explosiva.

Objective: To determine whether patients with perforated eardrum caused by blast injury have a worse surgical outcome than that found in patients with perforated eardrum caused by chronic otitis media Methods: This is a prospective cohort study. We compared the results in type I tympanoplasty in patients exposed to blast injury (exposed cohort), and patients with perforation caused by chronic otitis media (unexposed cohort). We included patients older than 18 years in whom the over-under tympanoplasty technique was used, using cartilage graft. We excluded patients who underwent other surgical techniques, who underwent mastoidectomy and/or osciculoplastia, those with perforations secondary to other etiologies and those with cholesteatoma. The sample size was calculated for the variable anatomical outcome, and it was 43 patients per cohort. The study was finished once we reached the proposed sample size. The main outcome was the comparison of the anatomical outcome (status of the eardrum) and the functional outcome (air-bone gap <10 dB), between the exposed and unexposed cohorts. Results: The study began in August 1, 2011 and ended on July 25, 2013. There was no association between the exposure under study and the anatomical failure, RR=4.0 [IC 95% RR = 0.47-34.35]. There was also no association between the anatomical outcome and size of the perforated eardrum ≥ 50%, anterior tympanic membrane perforation and inflammation/infection at the time of surgery [IC 95%RR included the value 1]. The patients of the exposed cohort had a RR = 1.76 for functional failure, [IC 95% RR=1.19-2.59]. Conclusions: The anatomical outcome of type I tympanoplasty is comparable between patients with tympanic membrane perforation secondary to blast injury compared to those with chronic otitis media. However, we found a worse functional outcome among patients suffering from blast injury.

Objetivo: Avaliar se os pacientes com perfuração timpânica causada pelo trauma por onda explosiva tem um resultado cirúrgico pior do que os pacientes com perfuração timpânica causada pela otites media crônica. Metodologia: Estudo observacional analítico prospectivo. Foram comparados os resultados em timpanoplastia tipo I entre pacientes expostos ao trauma por onda explosiva (grupo exposto) e pacientes com perfuração por otites media crônica (grupo não exposto). Foram incluídos pacientes maiores de 18 anos utilizando a técnica “over-under” de colocação de implante de cartilagem. Foram excluídos os pacientes que utilizaram outras técnicas cirúrgicas, mastoidectomia ou ossiculoplastia, aqueles com perfurações secundarias a outra etiologia e os que tinham colesteatoma. O tamanho dà amostra foi calculada para a variável resultado anatômico e foi de 43 pacientes por grupo. O Estudo finalizou no momento que a amostra foi atingida. O análise principal foi a comparação do resultado anatômico (estado do neo-timpano) e funcional (lacuna aire-osso<10dB) entre os grupos exposto e não exposto. Resultados: O estudo inicio o primeiro de agosto de 2011 e finalizou o 25 de junho de 2013. Não se apresentou associação entre a explosão no estudo e o fracasso anatômico, RR=4.0 [IC 95% RR = 0.47-34.35]. Além disso, não houve associação entre o fracasso anatômico e perfuração timpânica ≥50%, localização anterior da perfuração timpânica e inflamação/infecção ao momento do procedimento cirúrgico [IC 95% RR incluiu o valor 1]. Os pacientes do grupo exposto tiveram um RR=1.76 de fracasso funcional [IC 95% RR=1.19-2.59]. Conclusões: O resultado anatômico da timpanoplastia tipo I é equiparável entre os pacientes com perfuração timpânica secundaria ao trauma por onda explosiva quanto a aqueles com perfurações timpânicas por otites crônica. Embora, foi observado um pior resultado funcional entre os pacientes vítimas de trauma por onda explosiva.

Timpanoplastia en perforación timpánica secundaria a trauma por onda explosiva: comparación entre fascia temporal y cartílago auricular / Tympanoplasty in tympanic membrane perforation caused by blast injury: fascia temporalis vs. auricular cartilage

Objetivo: Comparar los resultados de timpanoplastia entre fascia temporal (GI) y cartílago auricular (GII) en perforación timpánica secundaria a trauma por onda explosiva. Diseño: Estudio de cohorte histórica. Métodos: Se incluyeron pacientes llevados a timpanoplastia tipo I, intervenidos entre febrero 1.º del 2007 y diciembre 31 del 2009. Los sujetos son miembros de las Fuerzas Armadas de Colombia, heridos en combate. Fueron excluidos aquellos sometidos a mastoidectomía u osciculoplastia. El resultado anatómico se evaluó mediante prueba exacta de Fisher, y el funcional, mediante Anova. Resultados: Se incluyeron 36 sujetos, GI = 16 y GII = 20. No hubo diferencias en el éxito anatómico entre GII = 95% (19/20) y GI = 87,5% (14/16), a los 12 meses (p = 0,57). En pacientes con cadena íntegra-móvil, la brecha aire-hueso a los seis meses (n = 30) fue de 5,8 dB (DE = 8 dB), y a los doce meses (n = 26) fue de 5,4 dB (DE = 8 dB). No hubo asociación entre el resultado funcional y el tipo de injerto utilizado (p > 0,05). Conclusiones: la timpanoplastia en perforación secundaria a trauma por onda explosiva ofrece resultados satisfactorios y estables a los doce meses, tanto con fascia como con cartílago...

Objective: to compare tympanoplasty outcomes between fascia temporalis (GI) and auricular cartilage (GII) in tympanic membrane perforation caused by blast injury. Design: historical cohort study. Methods: patients underwent tympanoplasty type I, between February 1-2007 and December 31-2009, were included. The study subjects are members of the armed forces of Colombia that were wounded in combat. Patients who underwent mastoidectomy or ossiculoplasty were excluded. The Fisher’s exact test was performed to assess the anatomical outcome, and the ANOVA test to assess the functional outcome. Results: 36 subjects were included, GI = 16 and GII = 20. Regarding the anatomical success, there was no differences between GI = 95% (19/20) and GII = 87.5% (4/16), at 12 months of follow-up (p = 0.57). In patients with an intact ossicular chain, the airbone gap at 6 months (n = 29) was = 5.8 dB (SD = 8 dB); while at 12 months (n = 26) it was = 5.4 dB (SD = 8 dB). There was no relationship between the functional outcome and the kind of graft used (p > 0.05). Conclusions: the surgical outcomes of the tympanoplasty in tympanic membrane perforation caused by blast injury are satisfactory and stable at 12 months, with fascia and cartilage...

Factores pronósticos para cirugía endoscópica funcional en rinusinusitis crónica: una revisión de la literatura actual / Prognostic factors for functional endoscopic surgery in chronic rhinosinusitis: a review of current literature / Fatores prognósticos para cirurgia endoscópica funcional en rinossinusite crônica: uma revisão da literatura atual

La rinusinusitis crónica es una patología bastante frecuente en la consulta diaria tanto de medicina general como a nivel de otorrinolaringología. Su entendimiento, adecuado diagnóstico y manejo preciso son de gran relevancia pues se encuentra dentro de una de las enfermedades que mas causa limitación en los pacientes y por lo tanto ocupa los primeros lugares dentro de las causas de ausentismo laboral. Dentro de sus opciones de manejo se encuentra la cirugía endoscópica funcional hasta el momento con altas tasas de éxito. A pesar de esto los pacientes con rinusinusitis recurrente sometidos a múltiples procedimientos quirúrgicos constituyen un dilema diario en la práctica clínica. Por todo lo anterior es de vital importancia conocer los factores prequirúgicos que puedan predecir de alguna manera el pronóstico postoperatorio del paciente. El objetivo de este artículo fue realizar una revisión de la literatura actual de los factores pronóstico para cirugía endoscópica en pacientes con rinusinusitis crónica (RSC)...

Chronic rhinosinusitis is a very frequent pathology in the daily consultation both at the general medicine and otorrhinolaryngology level. Its understanding, appropriate diagnosis and accurate management are of critical relevance since it is one of the most disabling diseases for the patients thus holding one of the first places as a cause of absenteeism form work. Among its management options there is the functional endoscopic surgery with high success rates up to now. In spite of this, patients with recurrent rhinosinusitis undergoing multiple surgical procedures are a daily dilemma in the clinical practice. For the aforementioned reasons, it is of vital importance to know the pre-surgical factors which can predict in some way the post-operatory prognosis for the patient. The objective of this paper was to perform a review of the current literature about the prognostic factors for the endoscopic surgery in patients with chronic rhinosinusitis (CRS)...

A rinossinusite crônica é uma patologia bastante frequente na consulta diária tanto de medicina geral como de otorrinolaringologia. Seu entendimento, adequado, diagnóstico e tratamento adequado são de grande relevância pois encontra-se dentro de una das doenças que mas causa limitação nos pacientes e portanto ocupa os primeiros lugares dentro de las causas de faltas ao trabalho. Dentro de suas opções de tratamento encontra-se cirurgia endoscópica funcional até o momento com altas taxas de sucesso. Apesar disso os pacientes com rinossinusite recorrente submetidos a múltiplos procedimentos cirúrgicos constituem um dilema diário na prática clínica. Por tudo isso é de vital importância conhecer os fatores pré-cirúrgicos que possam predizer de alguma maneira o prognóstico pós-operatório do paciente. O objetivo deste artigo foi realizar uma revisão da literatura atual dos fatores prognóstico para cirurgia endoscópica em pacientes com rinossinusite crônica (RSC)...