Kaplan-Meier Type Survival Curves for COVID-19: A Health Data Based Decision-Making Tool.

Countries are recording health information on the global spread of COVID-19 using different methods, sometimes changing the rules after a few days. All of them are publishing the number of new individuals infected, recovered and dead individuals, along with some supplementary material. These data are often recorded in a non-uniform manner and do not conform the standard definitions of these variables. In this paper we show that, using data from the first wave of the epidemic (February-June), Kaplan-Meier curves calculated with them could provide useful information on the dynamics of the disease in different countries. We developed our scheme based on the cumulative total number of infected, recovered and dead individuals provided by the countries. We present a robust and simple model to show certain characteristics of the evolution of the dynamic process, showing that the differences in evolution between countries are reflected in the corresponding Kaplan-Meier-type curves. We compare the curves obtained for the most affected countries at that time, with the corresponding interpretation of the properties that distinguish them. The model is revealed as a practical tool for countries in the management of the Healthcare System.

Update on Dietary Compliance, Nutritional Status, and Neuropsychological Functioning in the Chilean Phenylketonuria cohort

Abstract Since 1992, Chile has had a Newborn Screening Program for Phenylketonuria (PKU), which currently has an incidence of 1:18,916 newborns. The objective of the current study was to describe the 2020 follow up of the Chilean PKU cohort. The variables analyzed were: nutritional status, dietary compliance and neuropsychological functioning. We conducted a descriptive cross-sectional statistical analysis. The 271 subjects with PKU had an average age of diagnosis of 17±8 days and a phenylalanine (Phe) level of 1122±546 umol/L. Approximately 80% of protein requirement came from a protein substitute. For those <18 years of age, 80% had good dietary compliance with Phe level between 120-360 umol/L and those >18 years had a median of 522 umol/L (95%CI 468 - 636). Forty-four percent of the active PKU cohort had overweight/obesity. Eighty-five percent of the cohort >4 years of age had a normal intelligence quotient (IQ) (score 80-120). We observed a negative correlation (p <0.001; 95% CI: - 0.5, -0.2) between IQ score and Phe level. The Chilean protocol and protein substitute subsidy for life, together with the follow-up and continuous education carried out by the clinical team has encouraged compliance.

Leche, moco y asma. ¿Mito o realidad? / Milk, mucus and asthma: Myth or reality?

Existe la creencia de que la leche aumenta la producción de moco, incluso que las personas con asma deben evitar los productos lácteos. Sin embargo no existe evidencia que recomiende no ingerirlos de forma general, ni durante los catarros, ni en los sujetos con asma. En sujetos sanos o con catarro, la ingesta de leche o productos lácteos no se asocia con un aumento en la producción de moco, aunque algunos pacientes manifiestan síntomas como mayor espesor del moco y la saliva. En asmáticos la mayoría de los trabajos no encuentran un empeoramiento con su consumo, incluso aparece como un factor protector. La evidencia científica no apoya la asociación entre el consumo de leche o derivados y la producción de moco, ni tampoco con la aparición o exacerbación de asma. Por esta razón no se aconsejan las dietas restrictivas debido al posible déficit de nutrientes que estas pueden ocasionar

There is a belief that milk increases mucus production, it is even thought that people with asthma should dairy products. However, there is no evidence in the recommendation to avoid these products in general, during colds, or in subjects with asthma. Intake of milk or dairy products is not associated with an increase in mucus production in healthy subjects or upper respiratory infection, although some subjects show symptoms such as increased thickness of mucus and saliva. Most studies do not find a worsening with milk consumption in asthmatic subjects. Even a protective factor is found in milk. The scientific evidence does not support the association between consumption of milk or dairy products and mucus production, nor with the onset or exacerbation of asthma. This is why restrictive diets are not advised because of the potential nutrient deficiency that can cause

Eosinophilic esophagitis: an underdiagnosed cause of dysphagia and food impaction to be recognized by otolaryngologists.

Eosinophilic esophagitis (EoE) is a recently recognised pathologic entity whose prevalence has risen significantly since first being described in 1993. Defined as a chronic, local immune-mediated disease with predominant eosinophil infiltration, it is nowadays the leading cause of dysphagia and food bolus impaction in children and young adults. Genetic and environmental risk factors, and especially food antigens, trigger the disease and are in the focus of investigation as avoidance can cure three quarters of patients. The most common antigen involved is milk, followed by egg and gluten. These patients frequently come undiagnosed to the otolaryngologist with complaints of dysphagia and recurrent non-sharp food impactions, although pharyngolaryngeal reflux symptoms and other airway complaints could also be a first sign. Delayed diagnosis and treatment can produce fibrostenosis of the esophagus that greatly impairs patients' quality of life.In-office transnasal esophagoscopy with esophageal biopsy offers a unique opportunity to promptly diagnose and follow-up these patients, without causing the morbidity of repeated sedations and reducing exploration overload in gastroenterology departments. The search for food-antigen triggers, response evaluation to swallowed steroids, or proton pump inhibitors (PPIs) make multiple endoscopies and biopsies necessary every 6 to 8 weeks.There are three first-line interchangeable treatments with the same recommendation: PPIs, dietary allergen elimination and topical swallowed steroids. The choice should be discussed with the patient on an individual basis.The objective of this article is to raise awareness of this condition, update otolaryngologists with the new EoE consensus, and highlight the need for biopsy in patients with dysphagia to rule out EoE.

Diagnóstico automatizado de las psicosis mediante imagen cerebral / No disponible

No disponible

Barcodes of marine invertebrates from north Iberian ports: Native diversity and resistance to biological invasions.

Ports are gateways for many marine organisms transported by ships worldwide, especially non-indigenous species (NIS). In this study carried out in North Iberian ports (Cantabrian Sea, Bay of Biscay) we have observed 38% of exotic macroinvertebrates. Four species, namely the barnacle Austrominius modestus, the tubeworm Ficopomatus enigmaticus, the Pacific oyster Crassostrea gigas and the pygmy mussel Xenostrobus securis, exhibited clear signs of invasiveness. A total of 671 barcode (cytochrome oxidase subunit I or 18S rRNA) genes were obtained and confirmed the species status of some cryptic NIS. Negative and significant correlation between diversity estimators of native biota and proportion of NIS suggests biotic resistance in ports. This could be applied to management of port biota for contributing to prevent the settlement of biopollutants in these areas which are very sensitive to biological invasions.

In vitro and in vivo effects of lutein against cisplatin-induced ototoxicity.

INTRODUCTION: Cisplatin is a commonly prescribed drug that produces ototoxicity as a side effect. Lutein is a carotenoid with antioxidant and anti-inflammatory properties previously tested for eye, heart and skin diseases but not evaluated to date in ear diseases. AIM: To evaluate the protective effects of lutein on HEI-OC1 auditory cell line and in a Wistar rat model of cisplatin ototoxicity. MATERIALS AND METHODS: In vitro study: Culture HEI-OC1 cells were exposed to lutein (2.5-100 µM) and to 25 µM cisplatin for 24h. In vivo study: Twenty eight female Wistar rats were randomized into three groups. Group A (n=8) received intratympanic lutein (0.03 mL) (1mg/mL) in the right ear and saline solution in the left one to determine the toxicity of lutein. Group B (n=8) received also intraperitoneal cisplatin (10mg/kg) to test the efficacy of lutein against cisplatin ototoxicity. Group C (n=12) received intratympanic lutein (0.03 mL) (1mg/mL) to quantify lutein in cochlear fluids (30 min, 1h and 5 days after treatment). Hearing function was evaluated by means of Auditory Steady-State Responses before the procedure and 5 days after (groups A and B). Morphological changes were studied by confocal laser scanning microscopy. RESULTS: In vitro study: Lutein significantly reduced the cisplatin-induced cytotoxicity in the HEI-OC1 cells when they were pre-treated with lutein concentrations of 60 and 80 µM. In vivo study: Intratympanic lutein (1mg/mL) application showed no ototoxic effects. However it did not achieve protective effect against cisplatin-induced ototoxicity in Wistar rats. CONCLUSIONS: Although lutein has shown beneficial effects in other pathologies, the present study only obtained protection against cisplatin ototoxicity in culture cells, but not in the in vivo model. The large molecule size, the low dose administered, and restriction to diffusion in the inner ear could account for this negative result.

Impact of borderline minimum inhibitory concentration on the outcome of invasive infections caused by Enterobacteriaceae treated with ß-lactams: a systematic review and meta-analysis.

Minimum inhibitory concentrations (MICs) have been used to denote susceptibility in vitro and to guide clinical practice. Our objective was to investigate whether the clinical outcomes of patients with invasive infections caused by Enterobacteriaceae treated with ß-lactams were worse among those with a borderline susceptible MIC according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints than those with a lower MIC. Studies reporting MICs of ß-lactams used for infection and clinical outcome were identified through a systematic literature search. Isolates were classified as "highly susceptible" (HS, those with MIC ≤1 dilution below the susceptibility breakpoint for the antibiotic used) and "borderline susceptible" (BS, isolates with MIC at the susceptibility breakpoint) using EUCAST criteria. Clinical outcomes were clinical cure and 30-day mortality. A meta-analysis was performed. Twenty-four studies were included. Taking all antimicrobials into consideration, the meta-analysis revealed no significant difference in mortality between HS and BS [odds ratio (OR) = 0.58; 95 % confidence interval (CI): 0.28-1.21; p = 0.148). However, HS was associated with higher cure rates than BS (OR = 3.73; 95 % CI: 1.76-7.92; p < 0.001). For specific antibiotics, no differences were found except for piperacillin-tazobactam, where higher clinical cure and lower mortality rates were seen with HS compared with BS isolates (OR = 3.17; 95 % CI: 1.09-9.20; p = 0.034 and OR = 0.12; 95 % CI: 0.02-0.92; p = 0.042; respectively). Our data suggest that HS isolates are associated with higher clinical cure rates than BS isolates according to EUCAST susceptibility breakpoints; this effect was evident only for piperacillin-tazobactam, probably because of limited numbers.

Hearing threshold levels for an otologically screened population in Spain.

OBJECTIVE: The aim of the present study was to provide thresholds data as a function of age for an otologically normal population in Spain, compared to the current ISO 7029 (2000) standard. DESIGN: A prospective study in an otologically screened population. STUDY SAMPLE: Data was collected from 1175 otologically-normal persons aged between 5 and 90 years. Inclusion criteria involved those listed in ISO 389-1 (1998) and the 8253-1 (2010). Suitability for inclusion was evaluated through interview, based on a questionnaire, and physical examination. RESULTS: The hearing thresholds decreased slightly from 125 to 2000 Hz. From 2000 Hz onwards the thresholds increased; this increase being more pronounced with increasing frequency and age. No statistically significant sex differences were found. The hearing threshold levels in the present study were higher (poorer) than the ones provided by ISO 7029 (2000). CONCLUSIONS: Results from this study suggest that the thresholds listed in ISO 7029 (2000) may be too restrictive, and could be useful in formulating the ISO 7029 update.

Earphones in extended high-frequency audiometry and ISO 389-5.

OBJECTIVE: To determine common reference equivalent threshold sound pressure levels (RETSPL) for the earphones used in the extended high-frequency (EHF) range, as different earphones are commercially available, but there are not RETSPLs for each model. DESIGN: Hearing threshold sound pressure levels were measured up to 20 kHz for the Sennheiser HDA 200 audiometric earphone, and were compared to the ISO 389-5 (2006) norm and other investigations using that earphone and different ones. STUDY SAMPLE: A total of 223 otologically-normal subjects (aged 5-25 years old) participated in the hearing determination. RESULTS: The results are in good agreement with previous studies of hearing thresholds using the same and other earphones. CONCLUSIONS: The results of the present investigation are relevant for the international standard for the calibration of audiometric equipment in the 8 to 16 kHz frequency range, ISO 389-5. The data may be used for a future update of the RETSPL for circumaural and insert audiometric earphones.

Extended high-frequency (9-20 kHz) audiometry reference thresholds in 645 healthy subjects.

OBJECTIVE: The aim of the present study was to study patterns in the extended spectrum of the human hearing (0.125 to 20 kHz) in order to obtain reference thresholds. Then, we compare our values with existing results at extended high-frequencies (8 to 20 kHz) in an attempt to establish new standards for potential international adoption. DESIGN: A prospective study in a group of otologically healthy subjects. STUDY SAMPLE: A total of 645 subjects aged between 5 and 90 years were recruited. Pure-tone thresholds were determined for conventional and extended high-frequencies. RESULTS: There was an increase in the hearing thresholds as a function of frequency and age. For the 20 to 69 years old group, thresholds were lower in females than in males, especially at 12.5 and 16 kHz. Our threshold values are comparable to those presented in previous studies that used different instrumentation and populations. CONCLUSIONS: When comparing different studies the hearing thresholds were found to be similar. Therefore, it would be possible to establish international standard thresholds.

Effect of intratympanic dimethyl sulphoxide (DMSO) in an in vivo model of cisplatin-related ototoxicity.

Although dimethyl sulfoxide (DMSO) is one of the most common solvents employed in otoprotection studies, its effect on the inner ear remains unknown. Only a few in vitro studies have addressed the effect of DMSO in cochlear cells. Up to the date, no in vivo functional studies have been reported. To determine the effect of intratympanic DMSO application in the inner ear, and to evaluate its effect in combination with cisplatin in Wistar rats, twelve Wistar rats were randomly assigned into two groups. Group A received intratympanic 1 % DMSO in both ears. Group B received intraperitoneal cisplatin (10 mg/kg) and intratympanic 0.5 % DMSO in the right ear and saline solution in the left ear. Functional changes were evaluated with Auditory Steady-State Responses before and 5 days after the procedure. Morphological changes were studied by means of confocal laser scanning microscopy following the removal of the temporal bones and cochlear dissection. Hearing threshold levels in group A did not show any statistically significant changes after the treatment. In group B, significant differences between pre- and post-treatment were found, with no statistically significant variations between right (DMSO) and left ear (saline solution). We suggest that DMSO could be safely used to dissolve hydrophobic compounds in otoprotection studies without interfering with the cochlear damage produced by cisplatin.

Revisión y crítica de la valoración del daño estético: propuesta de un nuevo baremo / Review and critique of aesthetic damage assessment. Proposal for a new scale

Introducción: el perjuicio estético sigue siendo hoy en día un problema a la hora de la valoración del daño corporal, ya que no se establecen cuáles son los elementos a considerar ni su cuantificación, asumiendo así un componente subjetivo tanto por parte del individuo que lo sufre como del perito encargado de la valoración. Material y métodos: se lleva a cabo una revisión bibliográfica. Se realiza un análisis de los textos y baremos más importantes empleados en la valoración del perjuicio estético, para posteriormente proponer una nueva sistemática de valoración del daño estético, que intente disminuir al máximo la subjetividad y valorar las diferentes partes del perjuicio estético. Resultados: se propone un nuevo baremo para la valoración del daño estético, en el cual se tienen en cuenta tres aspectos principales: alteraciones en la piel (cicatrices y quemaduras), amputaciones y pérdidas de sustancia, y alteraciones dinámicas (marcha, postura, expresión y habla), tomando como referencia el baremo del Real Decreto Legislativo 8/2004. Discusión: la elaboración del presente protocolo se ha basado en el baremo de la Tabla VI recogida en el Real Decreto Legislativo 8/2004, en el que se establece que edad, sexo y profesión no deben tenerse en cuenta, y en el que la valoración del daño estético se hace en un apartado independiente del daño funcional. Un baremo válido debe incluir todos los aspectos que atañen al perjuicio estético, tanto estático como dinámico (AU)

Introduction: Even today the aesthetic impairment remains a problem when assessing corporal damage, as it has not been established which are the elements to be considered and their quantification, thus assuming a subjective component by both the individual as the expert in charge of the assessment. Materials and methods: A literature review and analysis of the texts and major scales found is carried out. An analysis of methods and scales used in the assessment of aesthetic impairment is carried out in order to propose a new systematic assessment of aesthetic damage, minimizing subjectivity and assessing the different parts of the aesthetic damage. Results: A new scale for assessing the aesthetic damage is proposed; taking into account 3 main areas: changes in the skin (scars and burns), amputations and loss of substance, and disturbances of the dynamic (motion, posture, expression, and speech), with reference to the Real Decreto Legislativo 8/2004. Discussion: The preparation of this protocol has been relied on the scale of Table VI contained in the Real Decreto Legislativo 8/2004, which states that age, sex and profession should not be taken into account,and that the assessment of aesthetic impairment is done in a separate section of functional impairment. A valid scale should include all aspects pertaining to the aesthetic impairment, both static and dynamic (AU)

Bleeding control in endoscopic sinus surgery: a systematic review of the literature.

In the literature various methods are described to reduce bleeding in endoscopic sinus surgery. Scientific evidence and results were gathered and analysed to determine the effectiveness of the various methods used. A total of 20 articles fulfilled the inclusion criteria. Two retrospective articles studied the differences between local and general anaesthesia. Three articles analysed the use of local methods to control bleeding. The majority of the articles analysed the use of different systemic drugs to control intraoperative bleeding. Certain procedures, such as the reverse Trendelenburg position, the use of high doses of epinephrine, the infiltration of phenylephrine and lidocaine into the pterygopalatine fossa, the preoperative use of prednisone, and the control of the heart rate (with dexmedetomidine or remifentanil), appear to reduce the intraoperative blood loss and/or improve the visualisation of the surgical field. However, the evidence supporting these conclusions is poor. The benefits of other procedures, such as the preoperative use of ß-blockers, antihypertensive agents, and surgical pledgets with oxymetazoline, phenylephrine, or cocaine, for bleeding control are not evidenced in the literature. In addition, the literature does not present any evidence on the benefits of local anaesthesia compared with general anaesthesia or the use of propofol compared to inhaled analgesics in terms of intraoperative bleeding or complication rates.

A DNA pooling based system to detect Escherichia coli virulence factors in fecal and wastewater samples

The availability of a useful tool for simple and timely detection of the most important virulent varieties of Escherichia coli is indispensable. To this end, bacterial DNA pools which had previously been categorized were obtained from isolated colonies as well as selected in terms of utilized phenotype; the pools were assessed by two PCR Multiplex for the detection of virulent E. coli eaeA, bfpA, stx1, stx2, ipaH, ST, LT, and aatA genes, with the 16S gene used as DNA control. The system was validated with 66 fecal samples and 44 wastewater samples. At least one positive isolate was detected by a virulent gene among the 20 that were screened. The analysis of fecal samples from children younger than 6 years of age detected frequencies of 25% LT positive strains, 8.3% eae, 8.3% bfpA, 16.7% ipaH, as well as 12.5 % aatA and ST. On the other hand, wastewater samples revealed frequencies of 25.7% eaeA positive, 30.3% stx1, 15.1% LT and 19.7% aatA. This study is an initial step toward carrying out epidemiological field research that will reveal the presence of these bacterial varieties.

Agenesia de arterias cerebelosas postero-inferiores en adulto asintomático con malformación de Dandy Walker / Agenesis of posterior inferior cerebellar arteries in an asymptomatic adult with Dandy-Walker malformation

No disponible

A DNA pooling based system to detect Escherichia coli virulence factors in fecal and wastewater samples.

The availability of a useful tool for simple and timely detection of the most important virulent varieties of Escherichia coli is indispensable. To this end, bacterial DNA pools which had previously been categorized were obtained from isolated colonies as well as selected in terms of utilized phenotype; the pools were assessed by two PCR Multiplex for the detection of virulent E. coli eaeA, bfpA, stx1, stx2, ipaH, ST, LT, and aatA genes, with the 16S gene used as DNA control. The system was validated with 66 fecal samples and 44 wastewater samples. At least one positive isolate was detected by a virulent gene among the 20 that were screened. The analysis of fecal samples from children younger than 6 years of age detected frequencies of 25% LT positive strains, 8.3% eae, 8.3% bfpA, 16.7% ipaH, as well as 12.5 % aatA and ST. On the other hand, wastewater samples revealed frequencies of 25.7% eaeA positive, 30.3% stx1, 15.1% LT and 19.7% aatA. This study is an initial step toward carrying out epidemiological field research that will reveal the presence of these bacterial varieties.

Efecto del preparado FZ sobre algunos parámetros de la coagulaicón en perros beagles / Effect of FZ on the coagulation in dogs

INTRODUCCIÓN. Los estudios fundamentales, toxicológicos y preclínicos conducidos empleando FZ, han demostrado que este posee propiedades adsortivas selectivas a la glucosa en el tracto gastrointestinal, permitiendo controlar los niveles de glucosa en sangre en animales de laboratorio alimentados con glucosa, sacarosa y almidón. OBJETIVOS. Conocer un posible efecto secundario del FZ sobre la coagulación. MATERIAL Y MÉTODOS. Se estudiaron 2 grupos de 5 perros Beagles; un grupo control y el otro tratado con FZ. Todos los animales recibieron di¬ariamente durante 18 días, 400 gramos de pienso para perros, el grupo tratamiento recibió el FZ al 2% adicionado al pienso. Las extracciones de sangre se realizaron antes de comenzar la administración del FZ y al final de los 18 días que duró el estudio. Se realizaron determinaciones de tiempo de protrombina y tiempo de tromboplastina parcial activada con caolín. Y se midieron los niveles de glucemia en ayunas. Los resultadosobtenidos al inicio y al concluir el período de estudio se compararon en ambos grupos mediante la prueba no paramétrica de Wilcoxon, mientras que la comparación entre el grupo control y el grupo tratamiento se realizó mediante la prueba U de Manm Witney. RESULTADOS. No se encontraron alteraciones significativas en los tiempos de protrombina y el tiempo de tromboplastina parcial activada con caolin. CONCLUSIONES. FZ a la dosis efectiva para lograr el efecto antihiperglucemiante, no produce una alteración estadísticamente significativa sobre los tiempos de coagulación estudiados (AU)

INTRODUCTION. IT has been obtained a product which has been named FZ. Toxicological and pre-clinical studies have demonstrated that it possesses selective adsorptive properties on glucose in the gastrointestinal tract, allowing controlling glucose levels in blood, in animals fed with glucose, sucrose and starch. MATERIAL AND METHODS. There were studied 2 groups of 5 dogs Beagles; a group control and another treated with FZ, both received daily 400 grams of food for dogs during 18 days, the treatment group received the FZ to 2 % added to the food. Extractions of blood were realized before beginning and at the end of the study to determine Prothrombin Time and Partial Thromboplastin Time. Also was measured fasting blood sugar. Statistical analysis. The results obtained were compared in both groups before and when the period of research concluded with non parametric Wilcoxon and Manm Witney test. RESULTS. Non significative alterations were fond in prothrombin times and in time of tromboplastina partial activated with kaolin. CONCLUSIONS. FZ in antihyperglucemiant effective dose, do not produce a statistically significant alteration on the times of coagulation (AU)

Past, present and future of newborn screening in Chile.

The history of the Newborn Screening Program in Chile begins in 1984, when a pilot plan was developed that demonstrated the feasibility of its implementation. In 1992, the Ministry of Health started a national newborn screening program for phenylketonuria (PKU) and congenital hypothyroidism (CH), and in 1998, this was extended to the entire country. Throughout this period, a total of 2,478,123 newborns (NB) have been analyzed, obtaining initial coverage of 48.8%, which was later increased to 87.7%, and at present it is at 98.7% of all NB of our country. During this period, 131 cases with PKU have been diagnosed, resulting in an incidence of 1:18,916 NB, an average age of diagnosis of 18 ± 10.2 days and average phenylalanine level of 19,9 ± 8.8 mg/dl. In relation to CH, 783 cases have been confirmed, arriving at an incidence of 1:3,163 NB, with average age of diagnosis of 12.5 ± 6.9 days. Due to the good results of the program, the government is evaluating the initiation of an extended pilot program, to introduce other pathologies.