Evaluation and Management of the Undescended Testis in Puerto Rico: A Single Surgeon's 10 Years of Experience.

OBJECTIVE: Cryptorchidism is an abnormality of the male genitourinary tract in which one or both testes fail to descend into the scrotum. The American Urological Association (AUA) clinical guidelines for the evaluation and treatment of cryptorchidism were recently published. We reviewed our experience with the evaluation and management of our patients and examined our findings with respect to the AUA and European Association of Urology (EAU) guidelines. METHODS: Data were obtained from pediatric patients who underwent a surgical intervention for an undescended testis from 2007 through 2017 at HIMA Hospital and the University Pediatric Hospital (both in Puerto Rico); all the surgeries were performed by the same surgeon. A total of 754 patients were identified; 142 patients were excluded due to lack of follow-up data (N = 612). The data obtained included age, testes locations, radiologic and surgical findings, and postoperative results. RESULTS: At their initial evaluations, a large proportion of the patients (46.4%) came accompanied with radiographic imaging. These findings were consistent with those of the physical examination in 58.5% of the patients and with the surgical findings in 63.1% (sensitivity 77.9%, specificity 45.8%). Our data showed that the median referral age was 24 months, which suggests that there was a significant delay in diagnosis. At the time of surgery, the average age of the patients who required an orchiectomy was 3.93 years, while those who underwent an orchiopexy had an average age of 3.28 years. CONCLUSION: Our data reveal that, despite its lack of usefulness, radiologic imaging continues to be included in the diagnostic workups of children newly identified with cryptorchidism in Puerto Rico. In addition, and contrary to the guidelines, there tends to be a significant delay in treatment with surgical intervention. It is important to continue to educate our referring physicians on the AUA and EUA guidelines in order to create awareness and encourage the proper diagnostic and treatment approach for cryptorchidism.

Aplicaciones clínicas del análisis acústico de la voz / Clinical applications of acoustic voice analysis

El análisis acústico de la voz es un método de evaluación vocal objetivo y no invasivo, utilizado con fines diagnósticos, terapéuticos e investigativos. Utiliza registros acústicos obtenidos directamente de la voz del paciente mediante el uso de un micrófono profesional. Existe una gran variedad de programas y métodos de graficación disponibles, que favorecen la versatilidad y especificidad del proceso. Esta revisión muestra los métodos de graficación de la voz más utilizados.

The acoustic voice analysis is an objective and non invasive vocal assessment method, used for voice diagnosis, therapy and research. It uses acoustic records obtained from the patient's voice using professional microphones. There is a variety of softwares and graphing programs available that allows process versatility and specificity. This review presents the most utilized methods of voice graphing.

Incorporación del estudio de ADN fetal en sangre materna al cribado de cromosomopatías / Incorporation of the study of fetal DNA in maternal blood to the screening of chromosomal diseases

OBJETIVO: Evaluar la efectividad del cribado combinado de primer trimestre para la detección prenatal de aneuploidías tras 6 años de implantación en nuestro servicio y su repercusión en la disminución de pruebas diagnósticas invasivas. Se propone establecer un protocolo para incorporar el estudio de ADN fetal en sangre materna a partir de las revisiones bibliográficas publicadas. MÉTODO: Se evaluó el riesgo de anomalía cromosómica fetal en 3177 gestaciones mediante cribado combinado de primer trimestre entre enero de 2011 y diciembre de 2014. Se revisaron las amniocentesis realizadas desde que se instauró el cribado combinado en 2008 comparándolas con las de los 5 años anteriores. RESULTADOS: La tasa de detección del cribado para trisomía 21 fue del 94,4% y la tasa de falsos positivos de 6,4%. En el año 2005 estábamos realizando 194 amniocentesis, tras 6 años de implantación del cribado, en el año 2013 se realizaron 35 amniocentesis lo que implica una disminución del 70%. CONCLUSIONES: El cribado combinado de primer trimestre ha demostrado una mayor tasa de detección para trisomía 21 que el cribado de segundo trimestre y/o la edad materna, además de que ha llevado a una importante reducción en el número de pruebas invasivas. En los próximos años la incorporación del estudio de ADN fetal mejorará la detección de aneuploidías, con una drástica disminución de las pruebas invasivas por lo que se hace necesario la implantación de nuevos protocolos.

AIMS: To evaluate the effectiveness of first trimester combined screening in the prenatal detection of aneuploidy after 6 years of implantation in our service and its impact in reducing invasive diagnostic tests. It is proposed to establish a protocol to incorporate the study of fetal DNA in maternal blood from published literature reviews. METHODS: The risk of fetal chromosomal anomalies was assessed in 3177 pregnancies with first trimester combined screening between January 2009 and December 2014. The amniocenteses performed were checked against those of the previous 5 years. RESULTS: The detection rate of screening for trisomy 21 was 94.4% and the false-positive rate was 6.4%. In 2005 there were 194 amniocenteses. In 2013, 5 years after the introduction of screening, 68 amniocenteses were performed, representing a 70% reduction in invasive procedures. CONCLUSIONS: First trimester combined screening has shown a higher detection rate for trisomy 21 that the second trimester screening and/or maternal age, and has substantially reduced the use of invasive prenatal diagnostics procedures. In the coming years, the incorporation of the study of fetal DNA improve the detection of aneuploidys with a drastic reduction of invasive tests so that, the implementation of new protocols is necessary.

Vocal patterns of adult females and juveniles Caiman yacare (Crocodilia: Alligatoridae) in Brazilian Pantanal wetland / Patrones de vocalización de jóvenes y hembras adultas de Caiman yacare (Crocodilia: Alligatoridae) en el Pantanal de Brasil

The Paraguayan caiman (Caiman yacare) is the main Caimaninae species occurring in the Brazilian Pantanal Wetland. Despite the relative availability of works focused on biology and conservation of the Paraguayan caiman, almost nothing is known about its vocal structure and behavior. We recorded aggressive calls of adult caiman females guarding nests and, afterwards, the distress calls of the new born juvenile caimans in seasonally flooded areas of the Nhecolândia (Southern Pantanal). The results of both observations and sonographic analyses diverged from studies with other crocodilian species. Aggressive vocalization of adult females of the Paraguayan caiman was longer and more complex than the same vocalization of larger Alligatoridae species. Vocalizations of the young caimans presented interspecific differences with other crocodilian offsprings. Moreover, we found statistically significant intraspecific variation in the distress call structure among different pods, even separated by few kilometers. Differences in distress call structure were tested by Canonical Discriminant Analysis (CDA). We obtained the squared Mahalanobis distances between the acoustic multivariate spaces of each pod provided by the CDA and compared with the geographic distance between the bays of origin of each pod through Mantel Test. The geographic distance by itself did not explain the differences found in the structure of the vocalization of young caimans from different pods. The adult females of Paraguayan caiman positively responded to playbacks of calls from juvenile caimans from pods of other regions, as well as to rough imitations of distress call. Since the adult caimans showed protective responses to quite heterogeneous vocalizations of distress by juveniles, we hypothesized that the variation in the distress call pattern may be associated to a low specificity in sound recognition by adult caimans.

Poco se conoce sobre la estructura vocal del Caiman yacare del Pantanal brasileño. Llamadas agresivas de hembras adultas que cuidaban de los nidos fueron registradas durante enero y febrero y llamadas de socorro de caimanes jóvenes, en abril de 1992. Hembras adultas de C. yacare presentaron una vocalización agresiva más larga y compleja que en otras especies más grandes de Alligatoridae. Las vocalizaciones de los jóvenes caimanes también presentaron diferencias interespecíficas con otros cocodrilos y variaciones intraespecíficas entre grupos separados por pocos kilómetros. Se utilizó la Prueba de Mantel para comparar las distancias de Mahalanobis entre la estructura de las vocalizaciones de los jóvenes de acuerdo con sus grupos y las distancias geográficas donde ellos estaban. La distancia geográfica en sí no explica las diferencias en las vocalizaciones de jóvenes de diferentes grupos. Hembras adultas de C. yacare han respondido a grabaciones de llamadas de caimanes de grupos de otras regiones, así como a imitaciones de llamada de socorro. Se postula que las variaciones en las llamadas de socorro pueden estar asociadas con una baja especificidad en el reconocimiento de sonido por caimanes adultos que han respondido de la misma forma protectora a las más heterogéneas expresiones de peligro de los jóvenes.

Stridulatory file and calling song of two populations of the tropical bush cricket Eneoptera surinamensis (Orthoptera, Gryllidae, Eneopterinae)

This study characterizes the calling song and ultramorphology of the stridulatory file of two geographically isolated populations of the tropical bush cricket Eneoptera surinamensis (De Geer, 1773) from city of Foz do Iguaçu, state of Paraná, and town of Rio Claro, state of São Paulo, Brazil, distant 1,000 Km from each other. The teeth are shell-shaped, the larger ones are distributed in the medium region of the file, decreasing gradually in size towards the edges. Specimens from Foz do Iguaçu have a file with 82 ± 9.8 teeth, length=1.89 mm ± 0.15 with 43.76 ± 5.94 teeth per mm (n=15). Specimens from Rio Claro present a file with 87 ± 9.81, length=1.96 ± 0.19 mm with 44.52 ± 4.61 teeth per mm (n=15). Statistical differences found between the two populations are not significant. The calling song is an uninterrupted trill that alternates two sets of notes distinct for its temporal features.

Este estudo caracteriza a ultramorfologia da nervura estridulatória e o som de chamado de duas populações de Eneoptera surinamensis (De Geer, 1773) de Foz do Iguaçu, Paraná e Rio Claro, São Paulo, distantes cerca de mil quilômetros. Os dentes que compõem a nervura estridulatória têm forma de concha, os maiores presentes na região mediana da fileira, reduzindo gradualmente de tamanho em direção às extremidades. Os espécimes de Foz do Iguaçu têm a nervura estridulatória com 1,89 mm ± 0,15 de comprimento, 82 ±9,8 dentes, sendo 43,76 ± 5,94 (n=15) por milímetro, enquanto os de Rio Claro 1,96 ± 0,19 mm de comprimento, 87 ± 9,81 dentes e 44,52 ± 4,61 dentes por mm (n=15). As diferenças observadas entre as populações não são estatisticamente significantes. O som de chamado é composto por um trill contínuo que alterna dois conjuntos de notas, com padrões temporais distintos.

Stridulatory file and calling song of two populations of the tropical bush cricket Eneoptera surinamensis (Orthoptera, Gryllidae, Eneopterinae)

This study characterizes the calling song and ultramorphology of the stridulatory file of two geographically isolated populations of the tropical bush cricket Eneoptera surinamensis (De Geer, 1773) from city of Foz do Iguaçu, state of Paraná, and town of Rio Claro, state of São Paulo, Brazil, distant 1,000 Km from each other. The teeth are shell-shaped, the larger ones are distributed in the medium region of the file, decreasing gradually in size towards the edges. Specimens from Foz do Iguaçu have a file with 82 ± 9.8 teeth, length=1.89 mm ± 0.15 with 43.76 ± 5.94 teeth per mm (n=15). Specimens from Rio Claro present a file with 87 ± 9.81, length=1.96 ± 0.19 mm with 44.52 ± 4.61 teeth per mm (n=15). Statistical differences found between the two populations are not significant. The calling song is an uninterrupted trill that alternates two sets of notes distinct for its temporal features.

Este estudo caracteriza a ultramorfologia da nervura estridulatória e o som de chamado de duas populações de Eneoptera surinamensis (De Geer, 1773) de Foz do Iguaçu, Paraná e Rio Claro, São Paulo, distantes cerca de mil quilômetros. Os dentes que compõem a nervura estridulatória têm forma de concha, os maiores presentes na região mediana da fileira, reduzindo gradualmente de tamanho em direção às extremidades. Os espécimes de Foz do Iguaçu têm a nervura estridulatória com 1,89 mm ± 0,15 de comprimento, 82 ±9,8 dentes, sendo 43,76 ± 5,94 (n=15) por milímetro, enquanto os de Rio Claro 1,96 ± 0,19 mm de comprimento, 87 ± 9,81 dentes e 44,52 ± 4,61 dentes por mm (n=15). As diferenças observadas entre as populações não são estatisticamente significantes. O som de chamado é composto por um trill contínuo que alterna dois conjuntos de notas, com padrões temporais distintos.