Prospective study of sound localisation in patients with single sided deafness and asymmetric hearing loss treated with cochlear implant.

BACKGROUND AND OBJECTIVE: Sound localization plays a crucial role in our daily lives, enabling us to recognize voices, respond to alarming situations, avoid dangers, and navigate towards specific signals. However, this ability is compromised in patients with Single-Sided Deafness (SSD) and Asymmetric Hearing Loss (AHL), negatively impacting their daily functioning. The main objective of the study was to quantify the degree of sound source localization in patients with single-sided deafness or asymmetric hearing loss using a Cochlear Implant (CI) and to compare between the two subgroups. MATERIALS AND METHODS: This was a prospective, longitudinal, observational, single-center study involving adult patients diagnosed with profound unilateral or asymmetric sensorineural hearing loss who underwent cochlear implantation. Sound localization was assessed in a chamber equipped with seven speakers evenly distributed from -90º to 90º. Stimuli were presented at 1000 Hz and intensities of 65 dB, 70 dB, and 75 dB. Each stimulus was presented only once per speaker, totaling 21 presentations. The number of correct responses at different intensities was recorded, and angular error in degrees was calculated to determine the mean angular distance between the patient-indicated speaker and the speaker presenting the stimulus. Both assessments were conducted preoperatively without a cochlear implant and two years post-implantation. RESULTS: The total sample comprised 20 patients, with 9 assigned to the SSD group and 11 to the AHL group. The Preoperative Pure Tone Average (PTA) in free field was 31.7 dB in the SSD group and 41.8 dB in the AHL group. There was a statistically significant improvement in sound localization ability and angular error with the use of the cochlear implant at all intensities in both SSD and AHL subgroups. CONCLUSIONS: Cochlear implantation in patients with SSD and AHL enhances sound localization, reducing mean angular error and increasing the number of correct sound localization responses.

Haemorrhoidal artery distribution in patients with grade III and IV haemorrhoids treated with artery ligation and rectoanal repair. Assessment of Doppler guidance / Distribución de las arterias hemorroidales en pacientes con hemorroides de grado III y IV tratados mediante ligadura arterial y reparación rectoanal. Evaluación del guiado Doppler

Introduction: While haemorrhoidal dearterialization and mucopexy are accepted as a valid alternative to haemorrhoidectomy, differences exist regarding the fixed or variable location of the arteries to be ligated. Our aim was to shed light on this issue of arterial distribution in candidates for surgery. Methods: The study included consecutive patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR) at 2 medical centres in Spain. The main objective was to evaluate the number and 12-h clock locations of arterial ligatures necessary to achieve Doppler silence. Results: In total, 146 patients were included: 111 (76%) men, and 35 (24%) women. Average age was 54 years (21–84). Grade III and grade IV haemorrhoids were diagnosed in 106 (72.6%) and 40 (27.4%) patients, respectively. The average number of ligatures per patient was 7 (range 2–12). Ligature percentages greater than 60% occurred at clock positions 7, 11, 10, 12, 9, and 1. The average number of mucopexies per patient was 3 (range 1–4). The most frequent mucopexy locations were the left posterior, right posterior, and right anterior octants. Conclusions: While the greatest frequency of arterial ligatures occurred in odd-numbered clock positions, non-negligible percentages occurred in even-numbered clock positions, which, in our opinion, makes the use of Doppler necessary, given that arterial distribution is not the same in all patients. We also noted that more ligatures and mucopexies were needed on the right half of the rectal circumference than on the left side, suggesting greater right-side vascularization.(AU)

Introducción: Aunque la desarterialización hemorroidal y mucopexia es técnica aceptada como alternativa válida a la hemorroidectomía, existen divergencias en lo que se refiere a una localización fija o variable de las arterias a ligar. Nuestro objetivo ha sido arrojar luz sobre esta cuestionada distribución arterial en pacientes quirúrgicos. Métodos: Se han incluido consecutivamente pacientes con diagnóstico de hemorroides de III y IV grado operados mediante desarterialización hemorroidal guiada por Doppler (D-HAL) y reparación rectoanal (RAR) en dos centros hospitalarios españoles. El principal objetivo fue evaluar el número necesario de ligaduras arteriales y su localización horaria para conseguir un silencio Doppler. Resultados: Se han incluido consecutivamente 146 pacientes, 111 (76%) varones y 35 (24%) mujeres, con una media de edad de 54 años (21–84), 106 (73%) fueron diagnosticados como grado III y 40 (27%) como grado IV. La media de ligaduras por paciente fue de 7 (2–12). Se encontraron porcentajes de ligaduras superiores al 60% en las posiciones horarias 7, 11, 10, 12, 9 y 1. La media de mucopexias por paciente fue 3 (1–4), siendo las localizaciones más frecuentes los octantes posterior izquierdo, posterior derecho y anterior derecho. Conclusiones: Aunque los puntos horarios impares son los de mayor frecuencia de localización arterial, porcentajes no despreciables de localización ocurren en las posiciones pares lo que, en nuestra opinión, hace que el uso del Doppler sea necesario dado que la distribución arterial no es constante en todos los pacientes. Hemos podido constatar también que en la semicircunferencia derecha han sido necesarias más ligaduras y pexias que en el lado izquierdo, lo que sugiere una mayor vascularización derecha.(AU)

Haemorrhoidal artery distribution in patients with grade III and IV haemorrhoids treated with artery ligation and rectoanal repair. Assessment of Doppler guidance.

INTRODUCTION: While haemorrhoidal dearterialization and mucopexy are accepted as a valid alternative to haemorrhoidectomy, differences exist regarding the fixed or variable location of the arteries to be ligated. Our aim was to shed light on this issue of arterial distribution in candidates for surgery. METHODS: The study included consecutive patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR) at 2 medical centres in Spain. The main objective was to evaluate the number and 12-h clock locations of arterial ligatures necessary to achieve Doppler silence. RESULTS: In total, 146 patients were included: 111 (76%) men, and 35 (24%) women. Average age was 54 years (21-84). Grade III and grade IV haemorrhoids were diagnosed in 106 (72.6%) and 40 (27.4%) patients, respectively. The average number of ligatures per patient was 7 (range 2-12). Ligature percentages greater than 60% occurred at clock positions 7, 11, 10, 12, 9, and 1. The average number of mucopexies per patient was 3 (range 1-4). The most frequent mucopexy locations were the left posterior, right posterior, and right anterior octants. CONCLUSIONS: While the greatest frequency of arterial ligatures occurred in odd-numbered clock positions, non-negligible percentages occurred in even-numbered clock positions, which, in our opinion, makes the use of Doppler necessary, given that arterial distribution is not the same in all patients. We also noted that more ligatures and mucopexies were needed on the right half of the rectal circumference than on the left side, suggesting greater right-side vascularization.

Embarazo Ectópico Cornual: Reporte De Una Localización Inusual / Interstitial ectopic pregnancy: report of an unusual location

Resumen Se define a un embarazo ectópico cuando el blas tocisto en desarrollo se implanta fuera de la cavidad uterina. La localización más frecuente es en la trom pa, pero también puede ocurrir en el ovario, cérvix, cicatriz de cesárea, cuerno uterino (también mencio nado como intersticial en la literatura) o abdominal. Se estima que la incidencia de embarazo ectópico es aproximadamente el 2% de todos los embarazos, sien do la localización cornual solo el 2-4% de esos casos. El objetivo de este reporte es describir el caso de una paciente con sospecha de embarazo ectópico de loca lización incierta a quien se le realizó una laparoscopia exploradora por inicio de síntomas, evidenciando un embarazo ectópico cornual en el lecho de una salpin gectomía, producto de un embarazo ectópico tubario previo. Se realizó la cornuotomía con resección del mismo por laparoscopia y su evolución fue favorable con negativización de la subunidad beta. Este tipo de localización es rara y se asocia con grandes tasas de morbimortalidad materna. Representa un desafío diagnóstico y terapéutico para el ginecólogo que lo enfrenta.

Abstract Ectopic pregnancy occurs when a developing blastocyst implants at any site other than the uterine cavity. Ectopic pregnancy is most commonly found in the fallopian tube but may also occur in the cornua of the uterus (also found as interstitial in the literature), cervix, ovary, or abdominal cavity or in a cesarean scar. An estimated 2% of pregnan cies are ectopic, of which an interstitial pregnancy repre sents an extremely rare variant of ectopic pregnancy (EP), accounting for 2% to 4 % of all cases. The aim of this report is to describe the case of a patient with suspected ectopic pregnancy of uncertain location in which an exploratory laparoscopy was performed due to the onset of symptoms, discovering a cornual ectopic pregnancy in site of a past salpingectomy because of a tubal ectopic pregnancy. A cornuotomy by laparoscopy was performed to resect the cornual ectopic pregnancy. The patient had an unevent ful postoperative course, with negativization of human chorionic gonadotropin levels. This type of location is rare and is associated with high rates of maternal morbidity and mortality. It represents a diagnostic and therapeutic challenge for the gynecologist who faces it.

Ventaja de jugar en casa y el efecto de anotar primero en el fútbol profesional costarricense. Análisis de los campeonatos 2012/13 - 2018/19 / Home Advantage and Effects of Scoring First in the Costa Rican Professional Soccer. Analysis of Championships 2012/13 - 2018/19 / Vantagem de jogar em casa e o efeito de marcar primeiro no futebol profissional costa-riquenho. Análise dos campeonatos de 2012/13 - 2018/19

Resumen: Objetivo: analizar la ventaja de jugar en casa y la influencia de anotar primero sobre el resultado de los partidos en 14 campeonatos, desde el 2012/13 hasta el 2018/19, en el fútbol profesional costarricense. Metodología: se examinó un total de 1848 partidos, considerando el resultado del partido (ganador, empate o perdedor), la localización (local y visitante) y el orden de anotación (primero y segundo). Se aplicó estadística descriptiva y pruebas no paramétricas. Resultados: se evidenció que los equipos que jugaban de locales lograron mayor número de victorias (Z = -4,51; p < 0,01) y anotaron más goles (Z = -4,51; p < 0,01) que los visitantes. La ventaja de jugar en casa fue de 62,46 % y esta no difirió significativamente entre los campeonatos (H = 10,86; p = 0,62). La ventaja de anotar de primero fue de 78,86 % para equipos locales y de 72,26 % para los visitantes. Cuando el equipo local anotaba el primer gol, ganaba el 73,73 % de sus partidos, mientras que, los equipos visitantes terminaban ganando el 58,12 % de las veces (χ. = 53,674; p < 0,001; phi = 0,17, V = 0,17). Los 4 mejores equipos de la tabla de clasificación anotaron más goles y ganaron más partidos tanto en casa como de visita y presentaron una ventaja de anotar de primeros superior cuando jugaban de visita, en comparación con los que ocuparon las otras posiciones. Conclusión: jugar en casa y anotar el primer gol representaron una ventaja para que los equipos obtuvieran resultados positivos en los campeonatos de fútbol costarricense analizados. Implicaciones: estos resultados pueden orientar a los cuerpos técnicos a plantear estrategias para afrontar partidos que disputen tanto en casa como de visita.

Abstract: Objective: to analyze home advantage and the influence of scoring first on match outcomes in 14 Costa Rican professional soccer championships from 2012/13 to 2018/19. Methodology: a total of 1848 games were examined considering the match outcome (winner, draw or loser), the localization (home and away) and the order of scoring (first and second). Descriptive statistics and non-parametric tests were applied. Results: it was shown that local teams achieved a greater number of victories (Z = -4,51; p < 0,01) and scored more goals (Z = -4,51; p< 0,01) than the away ones. Home advantage was 62.46 % and this did not differ significantly among the championships (H = 10,86; p = 0,62). The advantage of scoring first was 78.86 % for home teams and 72.26 % for away ones. When the home team scored the first goal, they won 73.73 % of their matches, while the away ones ended up winning 58.12 % of their matches (χ. = 53,674; p < 0,001; phi = 0,17, V = 0,17). The top 4 teams in the ranking scored more goals and won more games both at home and away and had a superior scoring first advantage when played away compared to the teams than occupying the other positions. Conclusion: playing at home and scoring the first goal represented an advantage for teams to achieve positive results in the Costa Rican soccer championships analyzed. Implications: these results can guide the staff coach to propose strategies to front facing matches both at home and away.

Resumo: Objetivo: analisar a vantagem de jogar em casa e a influência do primeiro gol no resultado dos jogos em 14 campeonatos, de 2012/13 a 2018/19, no futebol profissional costarriquenho. Metodologia: um total de 1848 jogos foi analisado considerando seus resultados (vencedor, empate ou perdedor), localização (em casa e fora) e ordem de pontuação (primeiro e segundo). Foram aplicadas estatísticas descritivas e testes não paramétricos. Resultados: ficou evidente que as equipes da casa conseguiram um número maior de vitórias (Z= -4,51; p< 0,01), e marcaram mais gols (Z= -4,51; p< 0,01) que as equipes visitantes. A vantagem doméstica foi de 62,46% e não diferiu significativamente entre os campeonatos (H= 10,86; p= 0,62). A vantagem de marcar primeiro foi 78,86% para as equipes da casa e 72,26% para as equipes visitantes. Quando a equipe da casa marcou o primeiro gol, ele ganhou 73,73% de seus jogos; enquanto as equipes visitants, eles acabaram ganhando 58,12% do tempo (χ2= 53,674; p< 0,001; phi= 0,17, V= 0,17). As quatro melhores equipes da tabela do campeonato marcaram mais gols e ganharam mais jogos tanto em casa quanto fora e tiveram uma maior vantagem no primeiro gol quando jogaram fora em comparação com as equipes nas outras posições. Conclusão: Jogar em casa e marcar o primeiro gol representou uma vantagem para as equipes obterem resultados positivos nos campeonatos de futebol costarriquenhos analisados. Implicações: estes resultados podem orientar o pessoal de coaching no planejamento de estratégias para enfrentar jogos em casa e fora.

Programa de Reducción de la Infección Quirúrgica del Observatorio de Infección en Cirugía (PRIQ-O). Documento de priorización y consenso Delphi de recomendaciones para la prevención de la infección de localización quirúrgica / Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection

La infección de localización quirúrgica es la complicación más frecuente y más evitable de la cirugía, pero las guías clínicas para su prevención tienen un seguimiento insuficiente. Presentamos los resultados de un consenso Delphi realizado por un panel de expertos de 17 sociedades científicas con revisión crítica de la evidencia científica y guías internacionales, para seleccionar las medidas con mayor grado de evidencia y facilitar su implementación. Se revisaron 40 medidas y se emitieron 53 recomendaciones. Se priorizan 10 medidas principales para su inclusión en bundles de prevención: ducha preoperatoria; correcta higiene quirúrgica de manos; no eliminación del vello del campo quirúrgico o eliminación con maquinilla eléctrica; profilaxis antibiótica sistémica adecuada; uso de abordajes mínimamente invasivos; descontaminación de la piel con soluciones alcohólicas; mantenimiento de la normotermia; protectores-retractores plásticos de herida; cambio de guantes intraoperatorio, y cambio de material quirúrgico y auxiliar antes del cierre de las heridas. (AU)

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure. (AU)

Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection.

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure.

Quality of Life and Body Region Affected by Psoriasis: A Systematic Review.

PURPOSE: Psoriasis is a chronic skin condition that affects approximately 1-3% of the world's population and is known to decrease patients' quality of life. However, it is yet to be ascertained whether the specific location of psoriatic lesions on the body influences one's quality of life. METHODS: A systematic review was conducted with a search of MEDLINE, EMBASE, and Web of Science databases. Only non-case report and non-review studies with explicitly stated body regions affected by psoriasis were included in the review. FINDINGS: Psoriatic patches and plaques in different areas of the body were not found to influence patients' quality of life to differing extents. CONCLUSIONS: While the body of evidence is limited and presents unstandardized results, the results of this review point to the fact that all psoriatic patches and plaques decrease patients' quality of life, with neither one region doing so to a significantly greater extent than another.

Quality of Life and Body Region Affected by Psoriasis: A Systematic Review. / [Artículo traducido] Calidad de vida y región corporal afectada por la psoriasis: una revisión sistemática.

PURPOSE: Psoriasis is a chronic skin condition that affects approximately 1-3% of the world's population and is known to decrease patients' quality of life. However, it is yet to be ascertained whether the specific location of psoriatic lesions on the body influences one's quality of life. METHODS: A systematic review was conducted with a search of MEDLINE, EMBASE, and Web of Science databases. Only non-case report and non-review studies with explicitly stated body regions affected by psoriasis were included in the review. FINDINGS: Psoriatic patches and plaques in different areas of the body were not found to influence patients' quality of life to differing extents. CONCLUSIONS: While the body of evidence is limited and presents unstandardized results, the results of this review point to the fact that all psoriatic patches and plaques decrease patients' quality of life, with neither one region doing so to a significantly greater extent than another.

Análisis de las lesiones más frecuentes en miembros inferiores en el fútbol / Análise das lesões mais freqüentes nos membros inferiores do futebol / Analysis of the most frequent injuries in lower limbs in football

RESUMEN Introducción: La presente investigación se originó a partir del notable incremento de lesiones en futbolistas de Honduras. Objetivo: El objetivo fue conocer las lesiones más frecuentes e identificar su localización, clasificación y factores de riesgo. Materiales y métodos: El estudio utilizó el método empírico cualitativo indirecto o no interactivo: consulta a documentos oficiales a través de la búsqueda en la base de datos, PMC US National Library of Medicine se utilizó las palabras claves: futbol, lesiones más frecuentes y factores de riesgos quedando 28 documentos relacionados directamente con la temática. Resultados: Los principales resultados se centran en la revisión realizada donde se verificó que las lesiones más frecuentes de miembros inferiores en el futbol se localizan en: muslo-tobillo, ingle-cadera, cuádriceps-isquiotibiales, ligamento interno, cruzado y externo. Referente a la clasificación se encontró la del grupo de prevención en el deporte de la Sociedad Española de Medicina del Deporte y la asumida por la Unión de Federaciones Europeas de Futbol (UEFA) Champions League. Entre los factores de riesgos identificados se evidencian: la biomecánica alterada del movimiento, composición corporal, lesiones previas, déficit de flexibilidad, insuficiente desarrollo de la resistencia a la fuerza isométrica de los músculos estabilizadores, desbalance músculo-tendón entre cuádriceps e isquitibiales y los altos volúmenes de cargas y horas de entrenamiento. Conclusiones: El presente estudio permitió valorar las lesiones más frecuentes de miembros inferiores, su localización y factores de riesgo en el fútbol.

SÍNTESE Introdução: A presente pesquisa teve origem no notável aumento do número de lesões em jogadores de futebol em Honduras. Objetivo: O objetivo era descobrir as lesões mais freqüentes e identificar sua localização, classificação e fatores de risco. Materiais e métodos: O estudo utilizou o método empírico qualitativo indireto ou não interativo: consulta de documentos oficiais através de uma pesquisa no banco de dados da PMC US National Library of Medicine, utilizando as palavras-chave: futebol, lesões mais freqüentes e fatores de risco, deixando 28 documentos diretamente relacionados com o assunto. Resultados: Os principais resultados estão centrados na revisão realizada onde foi verificado que as lesões mais freqüentes nos membros inferiores do futebol se localizam em: coxa, virilha, quadríceps-ischiotibial, ligamento interno, cruciforme e externo. Com relação à classificação, encontramos a do grupo de prevenção no esporte da Sociedade Espanhola de Medicina Esportiva e a assumida pela Liga dos Campeões da União das Federações Européias de Futebol (UEFA). Entre os fatores de risco identificados, são evidentes os seguintes: biomecânica alterada do movimento, composição corporal, lesões anteriores, déficit de flexibilidade, desenvolvimento insuficiente da resistência isométrica de força de músculos estabilizadores, desequilíbrio músculo-tendão entre quadríceps e tendões e altos volumes de cargas e horas de treinamento. Conclusões: O presente estudo nos permitiu avaliar as lesões mais freqüentes nos membros inferiores, sua localização e fatores de risco no futebol.

ABSTRACT Introduction: The present research originated from the notable increase in injuries in football players in Honduras. Objective: The objective was to know the most frequent injuries and identify their location, classification and risk factors. Material and methods: The study used the indirect or non-interactive qualitative empirical method: consultation of official documents through the search in the database, PMC US National Library of Medicine, the keywords were used: football, most frequent injuries and risk factors, remaining 28 documents directly related to the theme. Results: The main results focus on the review carried out where it was verified that the most frequent lower limb injuries in football are located in: thigh-ankle, groin-hip, quadriceps-hamstrings, internal, cruciate and external ligaments. Regarding the classification, it was found that of the sports prevention group of the Spanish Society of Sports Medicine and that assumed by the Union of European Football Federations (UEFA) Champions League. Among the risk factors identified are: altered biomechanics of movement, body composition, previous injuries, flexibility deficit, insufficient development of endurance to isometric strength of the stabilizing muscles, muscle-tendon imbalance between quadriceps and hamstrings and the upper load volumes and training hours. Conclusion: The present study allowed assessing the most frequent injuries of the in lower limbs in football.

Historical geographic overlap of human rickettsiosis with animal reservoirs in Juiz de Fora, Minas Gerais, Brazil / Sobreposição geográfica histórica da riquetsiose humana com reservatórios animais em Juiz de Fora, Minas Gerais, Brasil

Background and objectives: we investigated the existence of a historical geographic overlap between the location of spotted fever group rickettsiosis human cases, a disease caused by the gram-negative bacterium Rickettsia sp., and that of mammalian reservoirs, specifically domestic horses and capybaras, in the urban perimeter of the city of Juiz de Fora, Minas Gerais, Brazil. Methods: cases of human rickettsiosis that occurred during a period of 17 years (2003-2020) were geolocated and the distribution of cases in time and geographic space was assessed using 1st and 2nd order geospatial association indicators. We also analyzed the overlap between the locations of human rickettsiosis cases and the area of occurrence of domestic horses and capybaras. Results: men were diagnosed more often than women, but a large proportion of affected women died. The results indicate an aggregation of human rickettsiosis cases in time (cases tend to occur close to each other at each epidemic event) and in geographic space (cases are concentrated in a specific geographic region of the urban perimeter). Human cases seem to be more associated with city regions with: i) higher local frequency of domestic horses and not capybaras; ii) lower rates of family development. Conclusion: it is suggested that, in the local epidemiological scenario, domestic horses appear to be the main sources of the rickettsia infecting humans, not capybaras.(AU)

Justificativa e objetivos: foi investigada a existência de uma sobreposição geográfica histórica entre a localização dos casos de riquetsiose humana do grupo da febre maculosa, um grupo de doenças causadas pela bactéria Gram-negativa Rickettsia sp., e dos reservatórios mamíferos, especificamente cavalos domésticos e capivaras, no perímetro urbano do município de Juiz de Fora, Minas Gerais, Brasil. Métodos: foram geolocalizados os casos de riquetsiose humana ocorridos durante um período de 17 anos (2003-2020), sendo avaliada a distribuição dos casos no tempo e espaço geográfico através de indicadores de associação geoespacial de 1a e 2a ordem. Também analisamos a superposição dos locais dos casos de riquetsiose humana com a área de ocorrência de cavalos domésticos e capivaras. Resultados: homens foram diagnosticados mais frequentemente que as mulheres, mas grande proporção das mulheres acometidas faleceu. Os resultados indicam uma agregação dos casos de riquetsiose humana no tempo (os casos tendem a ocorrer próximos entre si a cada evento epidêmico) e no espaço geográfico (os casos se concentram em uma região geográfica específica do perímetro urbano). Os casos humanos aparentam ser mais associados às regiões da cidade com: i) maior frequência local de cavalos domésticos e não das capivaras; ii) menores índices de desenvolvimento familiar. Conclusão: sugere-se que, no cenário epidemiológico local, são os cavalos domésticos que aparentam ser as principais fontes da riquétsia infectando os humanos, não as capivaras.(AU)

Justificación y objetivos: investigamos la existencia de una superposición geográfica histórica entre la localización de casos de rickettsiosis exantemáticas humana, enfermedad causada por la bacteria gramnegativa Rickettsia sp., y la de mamíferos reservorios, específicamente caballos domésticos y capibaras, en el perímetro urbano de la ciudad de Juiz de Fora, Minas Gerais, Brasil. Métodos: se geolocalizaron los casos de rickettsiosis humana ocurridos durante un período de 17 años (2003-2020), y se evaluó la distribución de casos en el tiempo y espacio geográfico utilizando indicadores de asociación geoespacial de 1er y 2do orden. También analizamos la superposición entre las ubicaciones de los casos de rickettsiosis humana y el área de ocurrencia de los caballos domésticos y capibaras. Resultados: los hombres fueron diagnosticados con más frecuencia que las mujeres, pero una gran proporción de mujeres afectadas fallecieron. Los resultados indican una agregación de casos de rickettsiosis humana en el tiempo (los casos tienden a ocurrir cerca uno del otro en cada evento epidémico) y en el espacio geográfico (los casos se concentran en una región geográfica específica del perímetro urbano). Los casos humanos parecen estar más asociados con regiones urbanas con: i) mayor frecuencia local de caballos domésticos y no de capibaras; ii) menores tasas de desarrollo familiar. Conclusión: se sugiere que, en el escenario epidemiológico local, los caballos domésticos parecen ser las principales fuentes de la rickettsia que infecta a los humanos, no los capibaras.(AU)

Tofo gotoso en dorso nasal: reporte de caso / Nasal gouty tophus: case report

La gota es el trastorno del metabolismo de las purinas que se caracteriza por acumulación de ácido úrico por aumento de su producción o por disminución de su excreción. Con el paso del tiempo, el exceso de urato monosódico permite que se deposite en diferentes tejidos del organismo; siendo particularmente infrecuente la presentación de tofos a nivel facial. Paciente masculino adulto de 56 años, con antecedente de gota hace 38 años y presencia de tofos gotosos a nivel de miembros superiores e inferiores que acude por cuadro de 4 años de evolución de lesión indurada, levemente dolorosa a nivel de tercio medio de dorso nasal que ha ido aumentando de tamaño, que causa deformidad de pirámide nasal y leve sensación de obstrucción nasal bilateral por lo que se planifica resolución quirúrgica. El análisis histopatológico de las muestras enviadas bajo exéresis quirúrgica confirma que tejido enviado corresponde a tofo gotoso. Los tofos gotosos pueden aparecer en diferentes tejidos, como cartílagos, membranas y líquido sinovial, superficies articulares, siendo excepcionalmente raro, en el miocardio, válvulas mitral y aórtica, ojos, nariz y médula espinal. El lugar de presentación puede ser muy variable, al igual que su tamaño

Gout is a purine metabolism disorder characterized by accumulation of uric acid due to increased production or decreased excretion. Over time, excess monosodium urate allows it to be accumulated in different body tissues, although the occurrence in the facial area is particularly infrequent. A 56- year-old male patient with a gout antecedent from 38 years ago that presented gouty tophi at the level of the upper and lower limbs seek medical advice due to an indurated slightly painful lesion at the level of the middle third of the nasal dorsum that started 4 years before and has been increasing in size. The lesion was causing nasal pyramid deformity and a slight sensation of bilateral nasal obstruction, for which surgical resolution is planned. The histopathological analysis of the samples sent under surgical exeresis confirms that the tissue sample corresponds to gouty tophi. Gouty tophi can appear in different tissues, such as cartilage, membranes and synovial fluid, joint surfaces, being exceptionally rare in the myocardium, mitral and aortic valves, eyes, nose and spinal cord. The place of presentation can be very variable, as well as its size

Influencia de las variables contextuales en los indicadores de efectividad ofensiva en el waterpolo de Español / Influencia de variáveis contextuais em indicadores de eficácia ofensiva no polo aquático Espanhol / Influence of contextual variables on indicators of offensive effectiveness in Spanish water polo

El presente estudio tiene por objetivo evaluar los posibles efectos de las variables contextuales sobre los indicadores de efectividad ofensiva en División de Honor Masculina de Waterpolo en España. Las variables contextuales fueron: localización de partido, calidad del oponente y marcador al comienzo del cuarto. Se llevo a cabo un análisis post partido de ochenta y ocho partidos correspondientes a las temporadas 2011-2014 mediante un sistema de análisis notacional. Las variables independientes fueron las variables contextuales, mientras que los indicadores de efectividad fueron las variables dependientes. Los análisis univariados (ANOVA, t de Student, Kruskal-Wallis, U de Mann-Whitney y modelo lineal generalizado) indicaron que los porcentajes de éxito de: ataques en igualdad, superioridad, contrataque, lanzamientos en igualdad, lanzamientos en superioridad, lanzamientos en contrataque, lanzamientos desde zona 1, zona 2, zona 3, zona 4 y zona 5, lanzamientos directos, lanzamientos después de 1 finta, de 2 fintas y más de 2 fintas, fueron influenciados por alguna de las tres variables contextuales. Los entrenamientos deberían centrarse particularmente en preparar para los posibles efectos sobre los indicadores de efectividad ofensivos de la localización de partido, calidad del oponente, y comienzo del marcador en cada cuarto, creando tareas específicas. Futuras investigaciones deberían confirmar si estas tendencias identificadas en España son también confirmadas en ligas de waterpolo de otros países. (AU)

The current study aims to appraise the possible effects of contextual variables on offensive effectiveness indicators in the Spanish Professional First Water Polo League. A post-event match of eighty-eight matches from the 2011-2014 domestic league seasons was carried out. The contextual variables were: match location, quality of opposition and starting quarter score. Univariate analyses (ANOVA test; Student ́s t-test, Kruskal-Wallis test, Mann-Whitney U test and Generalized Linear Model Test) indicated that even, power-play and counterattack attack and shots, shots from zone 1, 2, 3, 4 and 5, drive, after 1 fake, after 2 fakes, and shots more than 2 fakes, were influenced by a least one of the three contextual variables. Training aspects should focus particularly on preparing potential effects of match location, quality of opposition, and quarter initial score, on the indicators ofoffensive effectiveness of water polo performance, creating specific practice tasks. (AU)

O objetivo deste estudo e avaliar os possíveis efeitos de variáveis contextuais sobre os indicadores de eficácia ofensiva na Divisão de Honra do Polo Aquático Masculino na Espanha. Uma análise pós-jogo de oitenta e oito partidas correspondentes as temporadas de 2011-2014 foi realizada. As variáveis contextuais foram: local da partida, qualidades do adversário e pontuação no início do quarto. Análises univariadas (ANOVA, t de Student, Kruskal-Wallis, Mann Whitney U e modelo linear generalizado) indicaram que: ataques y tiros em igualdades, superioridades y contra-ataque, tiros da zona 1, 2, 3, 4 e 5, tiros diretos, após 1 finta, 2 fintas e mais de 2 fintas, foram influenciados por qualquer uma das três variáveis contextuais. Os treinamentos devem focar na preparação para os possíveis efeitos nos indicadores de eficácia ofensiva de localização da partida, qualidade do oponente e início da pontuação, criando tarefas específicas. (AU)

¿Qué hemos aprendido de las encuestas de la AEC, AECP y del Observatorio de Infección en Cirugía? Cumplimiento de las medidas de prevención de infección postoperatoria y comparación con las recomendaciones de la AEC / What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations

Antes de planificar estrategias de mejora, es crucial conocer el grado de implementación de las medidas preventivas de infección postoperatoria. Se presentan los resultados agregados de 3encuestas realizadas por el Observatorio de Infección en Cirugía a miembros de 11 asociaciones de cirugía y de enfermería quirúrgica. Las preguntas fueron dirigidas a determinar el conocimiento de la evidencia científica, las creencias personales y el uso real de las principales medidas. De 2.295 encuestados, el 45,1% no recibe información de la tasa de infección de su unidad. Se observó un conocimiento insuficiente de algunas de las principales recomendaciones de prevención y unas tasas de utilización, en ocasiones, inquietante. Se indagó sobre las estrategias preferidas para mejorar el cumplimiento de las pautas preventivas y su grado de implementación. Se confirmó la brecha existente entre la evidencia científica y la práctica clínica en la prevención de infecciones en diferentes especialidades quirúrgicas (AU)

Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed (AU)

Estudio epidemiológico y anatomopatológico del melanoma uveal / Epidemiologic and anatomopathologic study of uveal melanoma

Objetivo: Determinar el comportamiento epidemiológico y anatomopatológico del melanoma uveal. Método: Estudio descriptivo, longitudinal y retrospectivo en pacientes enucleados por diagnóstico de melanoma uveal en el Centro Oftalmológico de Villa Clara entre enero de 2010 a mayo de 2021. Resultados: La edad media de presentación del melanoma uveal fue de 61,3 años. Las mujeres fueron ligeramente más afectadas que los hombres-56,3 por ciento. El 81,3 por ciento de los melanomas uveales se originó en la coroide. Los tumores de células epitelioides y fusiformes fueron los más representativos; ambos con un 37,5 por ciento. El grosor y diámetro basal medio en los tumores estudiados fue de 11,2 mm y 15,8 mm respectivamente; prevalecieron los tumores medianos con un 56,3 por ciento. Se encontró infiltración tumoral en 37,5 por ciento de los ojos, la infiltración escleral fue la más frecuente. Conclusiones: El melanoma uveal se presenta con mayor frecuencia en personas con edad avanzada y en la coroide. El estudio histológico confirma el diagnóstico en la totalidad de los casos. Aproximadamente 2/3 de los tumores con algún grado de infiltración son grandes y la mitad de células epitelioides(AU)

Objective: To determine the epidemiologic and anatomopathologic behavior of uveal melanoma. Methods: Descriptive, longitudinal and retrospective study in patients enucleated for diagnosis of uveal melanoma in the Ophthalmologic Center of Villa Clara from January 2010 to May 2021. Results: The average age of presentation of uveal melanoma was 61.3 years. Women were slightly more affected than men-56.3 percent. 81.3 percent of uveal melanomas originated in the choroid. Epithelioid and spindle cell tumors were the most representative; both with 37.5 percent. The average thickness and basal diameter of the tumors studied were 11.2mm and 15.8mm respectively; medium-sized tumors prevailed with 56.3 percent. Tumor infiltration was found in 37.5 percent of the eyes, scleral infiltration was the most frequent. Conclusions: Uveal melanoma occurs more frequently in people with advanced age and in the choroid. Histological study confirms the diagnosis in all cases. Approximately 2/3 of the tumors with some degree of infiltration are large and half are epithelioid cells(AU)

What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations.

Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.

Ischemic colitis. Does right colon location mean worst prognosis?

INTRODUCTION: Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC). METHODS: Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of ICD9 codes. They were divided into 2 groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P < 0.05. RESULTS: A total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P < 0.001). Differences in post-surgical mortality (32% vs 55%) and overall mortality (20% vs 15%) were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61% vs 25%, P < 0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD. CONCLUSIONS: CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes.

Colitis isquémica. ¿La localización en el colon derecho tiene peor pronóstico? / Ischemic colitis. Does right colon location mean worst prognosis?

Introducción: La mayoría de los pacientes con colitis isquémica tienen una evolución favorable; sin embargo, se ha relacionado la localización en el colon derecho con un peor pronóstico. El propósito de este estudio es comparar la presentación clínica y los resultados de la colitis isquémica del colon derecho (CICD) con la colitis isquémica de otros segmentos del colon (no CICD). Métodos: Estudio retrospectivo, observacional de los pacientes ingresados en nuestro hospital con colitis isquémica entre 1993 y 2014, identificados mediante búsqueda computarizada de los códigos de ICD-9. Se dividieron en 2grupos: CICD y no CICD. Se compararon las comorbilidades, presentación clínica, necesidad de cirugía y mortalidad. El análisis multivariado se realizó mediante regresión logística ajustando por edad y sexo. La significación estadística se estableció en un valor de p<0,05. Resultados: Fueron identificados 204 pacientes, 61 (30%) con CICD. El 61% de los pacientes con CICD necesitaron cirugía en comparación con el 22% de los pacientes no CICD (p<0,001). La mortalidad posquirúrgica (32 vs. 55%) y la global (20 vs. 15%) no fueron estadísticamente significativas entre los 2grupos. Los pacientes con CICD tuvieron resultados desfavorables más comúnmente que los no?CICD (61 vs. 25%; p <0,001). La odds ratio (OR) para cirugía fue de 5,28 y de 4,47 para resultados desfavorables para pacientes con CICD. Conclusiones: Los pacientes con CICD tienen peor pronóstico que los pacientes con no CICD, 5 veces más probabilidades de necesitar cirugía y 4 veces más de presentar resultados desfavorables (AU)ies

Introduction: Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC). Methods: Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of the ICD9 codes. They were divided into 2groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P <0.05.ResultsA total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P <0.001). Post-surgical mortality (32 vs. 55%) and overall mortality (20 vs. 15%) differences were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61 vs. 25%, P <0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD. Conclusions: CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes(AU)

Resultados quirúrgicos y localización de las glándulas patológicas en el tratamiento del hiperparatiroidismo primario esporádico con gammagrafía 99mTc-sestamibi negativa / Surgical results and the location of pathological glands in the treatment of primary sporadic hyperparathyroidism with negative preoperative 99mTc-sestamibi scintigraphy

Introducción: El hiperparatiroidismo primario es una enfermedad endocrina frecuente siendo la cirugía el único tratamiento curativo. La técnica quirúrgica puede estar condicionada por las pruebas de localización preoperatorias. Nuestro objetivo ha sido analizar los resultados quirúrgicos en cuanto a la tasa de curación, etiología y localización de las glándulas responsables del hiperparatiroidismo primario en pacientes con gammagrafía con 99mTc-sestamibi preoperatoria negativa. MétodosEstudio observacional en pacientes con diagnóstico de hiperparatiroidismo primario esporádico con gammagrafía 99mTc-sestamibi negativa operados de forma consecutiva en una Unidad de Cirugía Endocrina durante 18 años. Se analizaron las tasas de curación, la hormona paratiroidea intraoperatoria (PTHio), etiología y la localización de las glándulas patológicas. Resultados En el estudio se incluyeron 120 pacientes. Tras la cirugía el 95% (n = 114) presentaron criterios de curación de hiperparatiroidismo. El 14,1% presentaba una enfermedad multiglandular. Respecto a la localización de los adenomas el 69% presentaban una localización peritiroidea habitual, objetivando un 23,9% de ectopias que se localizan a nivel cervical y un 7,1% de localización mediastínica. Conclusiones La ausencia de captación en gammagrafía con 99mTc-sestamibi no debe condicionar la indicación quirúrgica, ya que en manos expertas el porcentaje de éxito es similar a los pacientes con la prueba positiva. La indicación debe ser establecida por criterios clínicos y bioquímicos(AU)

Introduction: The primary hyperparathyroidism is a frequent disease whom the surgery is the only curative treatment. The preoperative location imaging techniques could help in the surgical management. Our objective was to analyze surgical results regarding the cure rate, etiology and location of the glands responsible for the primary hyperparathyroidism in patients with negative preoperative 99mTc-sestamibi scintigraphy. Methods Observational study in patients with the diagnosis of primary sporadic hyperparathyroidism with negative 99mTc-sestamibi scintigraphy, operated consecutively in an Endocrine Surgery Unit for 18 years. The cure rate, the intraoperatory parathyroid hormone (PTH), the etiology and the pathological glands location were analyzed. Results In the study were included 120 patients. After surgery 95% of patients (n = 114) presented cure criteria of hyperparathyroidism. The 14.1% presented a multigland disease; 69% of the adenomas presented a typical perithyroid location, founding a percentage of 23.9% of ectopic adenomas in cervical location and a 7.1% in mediastinum. Conclusions The absence of uptake in the 99mTc-sestamibi scintigraphy should not condition the surgical indication. The success with experienced surgeons is similar to patients with positive results. The surgical indication must be established by clinical and biochemistry criteria (A)

Diagnostic value of transrectal combined scrotal ultrasonography in acquired obstructive azoospermia / Valor diagnóstico de la ecografía transrectal y escrotal en la azoospermia obstructiva adquirida

Objective: To investigate the transrectal and scrotal ultrasonographic features of acquired obstructive azoospermia and evaluate the role of ultrasonography in the location diagnosis of acquired obstructive azoospermia patients.Methods: Retrospectively analysis of 92 cases of acquired obstructive azoospermia in recent years. All the patients underwent transrectal and scrotal ultrasonography. The ultrasonographic features were observed of testis, epididymis, scrotal segment of vas deferens, seminal vesicle, ejaculatory duct and prostate. Eighty cases with normal semen were taken as control group.Results: Among the 92 cases of acquired obstructive azoospermia, 28 cases were prostate midline cyst, 32 cases were stone or calcification of the ejaculation duct and 21 cases were chronic seminal vesicle inflammation, which were found through transrectal ultrasonography; 27 cases were vas deferens dilation, 30 cases had abnormal mass of epididymis tail, 31 cases were epididymis thickness with reticular change, 8 cases were cystic dilatation of rete testis, which were found through scrotal ultrasonography. Compared with the control group, ultrasound examination increased the detection rate of distal seminal duct lesions and epididymal lesions in acquired obstructive azoospermia patients (p<.01). Comparison of testicular volume between case group and control group did not reveal significant difference (p>.05). The thickness of the head, body and tail of epididymis in case group was significantly bigger than that in control group (p<.01). (AU)

Objetivo: Investigar las características ecográficas transrectales y escrotales de la azoospermia obstructiva adquirida y evaluar el rol de la ecografía en el diagnóstico de localización de los pacientes con azoospermia obstructiva adquirida.Métodos: Análisis retrospectivo de 92 casos de azoospermia obstructiva adquirida en los últimos años. Todos los pacientes fueron sometidos a ecografía transrectal y escrotal, observándose las características ecográficas en los testículos, epidídimo, segmento escrotal de los conductos deferentes, vesícula seminal, conducto eyaculatorio y próstata. Se tomaron ocho casos con semen normal, como grupo control.Resultados: Entre los 92 casos de azoospermia obstructiva adquirida, se detectaron mediante ecografía transrectal 28 casos de quiste prostático de línea media, 32 casos de cálculo o calcificación del conducto eyaculatorio y 21 casos de inflamación crónica de la vesícula seminal; también se detectaron mediante ecografía escrotal 27 casos de dilatación de los conductos deferentes, 30 casos de masa anormal en el tallo del epidídimo, 31 casos de grosor del epidídimo con cambio reticular y ocho casos de dilatación quística de la rete testis. En comparación con el grupo control, el examen ecográfico incrementó la tasa de detección de las lesiones del conducto seminal distal y las lesiones epididímicas en los pacientes con azoospermia obstructiva adquirida (p < 0,01). La comparación entre el volumen testicular entre el grupo de casos y el grupo control, no reveló ninguna diferencia significativa (p > 0,05). El espesor de la cabeza, cuerpo y cola del epidídimo en el grupo de casos fue significativamente mayor que en el grupo control (p < 0,01). (AU)