Data analytics in a clinical setting: Applications to understanding breathing patterns and their relevance to neonatal disease.

In this review, we focus on the use of contemporary linear and non-linear data analytics as well as machine learning/artificial intelligence algorithms to inform treatment of pediatric patients. We specifically focus on methods used to quantify changes in breathing that can lead to increased risk for apnea of prematurity, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and provide a list of potentially useful algorithms that comprise a suite of software tools to enhance prediction of outcome. Next, we provide a brief overview of machine learning/artificial intelligence methods and applications within the sphere of perinatal care. Finally, we provide an overview of the infrastructure needed to use these tools in a clinical setting for real-time data acquisition, data synchrony, data storage and access, and bedside data visualization to assist in clinical decision making and support the medical informatics mission. Our goal is to provide an overview and inspire other investigators to adopt these tools for their own research and optimization of perinatal patient care.

Quiste epidermoide en conducto auditivo externo: reporte de caso / Epidermoid cysts of the external auditory canal: case report

Resumen El quiste epidérmico es una lesión benigna y común de la piel. Se desarrolla por un bloqueo de la unidad pilosebácea, con la consecuente proliferación de células epiteliales y secuestro de queratina. El 7% se desarrollan en cabeza y cuello, sin embargo, son infrecuentes en canal auditivo externo. Su patrón de crecimiento es lento y progresivo durante años, siendo asintomáticos. Al aumentar de tamaño causan sintomatología variable, acorde a su localización; en el canal auditivo tienen un comportamiento obstructivo que genera síntomas como otalgia e hipoacusia. Se presenta caso de una paciente de 69 años, con acúfeno e hipoacusia progresiva derecha. Durante la otoscopia se observó una neoformación obstructiva del 100% de la luz del conducto. Se realizaron estudios de imagen que reportaron tumoración de características quísticas de conducto auditivo derecho, bien circunscrita, sin erosión ósea. Para el diagnóstico definitivo, se realizó resección quirúrgica y biopsia reportando quiste epidérmico. Durante el seguimiento posoperatorio sin hallazgos de recidiva.

Abstract The epidermal cyst is a common and benign lesion of the skin. It develops due to a blockage of the pilosebaceous unit, with the consequent proliferation of epithelial cells and keratin sequestration. Seven percent develop in the head and neck; however, they are infrequent in the external auditory canal. Its growth pattern is slow and progressive over the years, being asymptomatic. As they increase in size, they cause variable symptoms, according to their location. In the ear canal they have an obstructive behavior that generates symptoms such as earache and hearing loss. A case of a 69-year-old female with tinnitus and progressive right hearing loss is presented. At otoscopy, a 100% obstructive neoformation of the canal lumen was observed. Imaging studies showed a well circumscribed, cystic tumor of the right ear canal, without bone erosion. For the definitive diagnosis, a resection and biopsy were performed, reporting an epidermal cyst. During follow up there was no recurrence of tumor.

Creación de un comité de vía aérea quirúrgica para la decisión de traqueostomía electiva en pacientes críticos COVID-19

Resumen La traqueostomía es un procedimiento ampliamente utilizado en pacientes críticos en la unidad de cuidados intensivos, con sus indicaciones, contraindicaciones, beneficios y complicaciones. El virus de SARS-CoV-2 afecta el tracto respiratorio y puede provocar complicaciones pulmonares graves que requieren, en ocasiones, intubación endotraqueal y ventilación mecánica prolongada como parte de su tratamiento. La infección por este virus tiene alto riesgo de contagio por medio de aerosoles con alta letalidad. Además, la traqueostomía es un procedimiento altamente productor de aerosoles, por lo que nos exige tomar las consideraciones para su indicación. Es imperioso tener las recomendaciones y/o guías para su realización. La formación de un comité especializado en la valoración quirúrgica de la vía aérea es necesario en todos los hospitales que atiendan pacientes con SARS-CoV-2.

Abstract Tracheostomy is a procedure widely used in critically ill patients in the intensive care unit, with its indications, contraindications, benefits and complications. SARS-CoV-2 virus affects the respiratory tract and can cause severe pulmonary complications that could require endotracheal intubation and long-term assisted mechanical ventilation as part of its treatment. Infection caused by this virus has a high contagious risk through aerosols with high lethality. Furthermore, tracheostomy is a highly aerosol-producing procedure, this requires us to consider the indications of this procedure. It is imperative to have the recommendations and/or guidelines for its implementation. It is essential to develop a surgical airway evaluation specialized committee in every hospital that attends SARS-CoV-2 patients.

Reducción de proteínas y glucosa por reacción de Maillard en leche con lactosa hidrolisada / Protein and glucose reduction by Maillard reaction in milk with hydrolyzed lactose

Se evaluó el efecto de la temperatura sobre la desnaturalización de proteínas y la reacción de Maillard en leche entera y descremada con lactosa hidrolizada. Las leches hidrolizadas se trataron térmicamente a 100, 110, 120 y 130 °C durante un período de 1 hora y se midió la concentración de glucosa, el grado de pardeamiento y la desnaturalización de proteínas. El grado de dorado en la leche entera varió de 14.4 (100 °C) a 42.6 (130 °C). Para la leche descremada fue de 20.2 (100 °C) a 38.0 (130 °C). La concentración de glucosa en leche entera (47% p/v) y en leche descremada (41% p/v) después del tratamiento térmico (130 °C) mostró una reducción significativa en relación con el control (25 °C). El efecto de la temperatura en la desnaturalización de proteínas en leche entera y descremada en relación con el control (25 °C) fue del 100%. La leche tratada térmicamente con lactosa hidrolizada promovió la desnaturalización de proteínas con un aumento del pardeamiento característico de la reacción de Maillard, lo que afectó la calidad nutricional.

The effect of temperature in protein denaturation and Maillard reaction in whole and skim milk with hydrolyzed lactose was evaluated. Hydrolyzed milk was thermally treated at 100, 110, 120 and 130 °C over a period of 1 hour and glucose concentration, browning degree and protein denaturation were measured. The browning degree in whole milk varied from 14.42 (100 °C) to 42.63 (130 °C) and 20.21 (100 °C) to 38.03 (130 °C) in skim milk. Glucose concentration in whole milk (47% - w/v) and skim milk (41% - w/v) after heat treatment (130 °C) showed a significant reduction in relation to the control (25 °C). The temperature effect in protein denaturation in whole and skim milk in relation to the control (25 °C) was 100%. Thermally treated milk with hydrolyzed lactose promoted protein denaturation with increasing browning characteristic of the Maillard reaction, thus affecting the nutritional quality.

Estudio clínico y micológico de otomicosis en diabéticos: una serie de 17 casos / Clinical and mycological study of otomycosis in diabetics: series of 17 cases

RESUMEN Introducción: La otomicosis en pacientes inmunosuprimidos esta caracterizada por ser bilateral y ser causada por candida. Pocos estudios comparan las características micológicas encontradas en la microscopía directa y el cultivo. Objetivo: Identificar las características clínicas y micológicas de la otomicosis en pacientes diabéticos. Material y método: Estudio transversal en centro hospitalario de segundo nivel. Criterios de inclusión: pacientes diabéticos con diagnóstico clínico de otomicosis. Intervención: la muestra se examinó directamente bajo el microscopio y se cultivó. Resultados: Se incluyeron 17 pacientes, 10 mujeres y 7 hombres con una edad media de 47,5 años. Los síntomas predominantes fueron hipoacusia en 91,4% (n =16), prurito en 82,4% (n =14), otorrea en 76,5% (n=13)y otalgia en 70,6% (n =12). Afección bilateral se encontró en 47,1% (n =8). Estudio directo al microscopio mostró levaduras en 94,1% (n =16) y 5,9% mostró aspergillus (n =1). Cándida fue el género más comúnmente encontrado en los cultivos y en el examen directo microscópico con 94,1% (n =16) y Candida albicans la especie más común con 88,2% (n =15). Conclusión: Candida albicans es el agente etiológico más común en pacientes diabéticos con otomicosis. Su presentación clínica más frecuente es hipoacusia, prurito y otorrea. El examen directo identificó adecuadamente a los géneros fúngicos.

ABSTRACT Introduction: Otomycosis in immunocompromised patients is characterize by its bilateral course and the predominant etiologic agent is Candida. Few studies compare the mycological features between microscopic direct exam and culture. Aim: To identify the clinical and mycological characteristics of otomycosis in diabetic patients. Material and method: Transversal study. Secondary care center. Inclusion criteria: diabetic patients with clinical diagnosis of otomycosis. Intervention: Direct examination under a microscope of the ear sample and culture. Results: We included 17 patients, 10 women, 7 men with a mean age of 47.5 years. Symptoms were hearing loss 94.1% (n = 16), pruritus 82.4% (n =14) otorrhoea 76.5% (n =13) and otalgia 70.6% (n =12). Bilateral involvement was found in 47.1% (n =8). Direct microscopic study found 94.1% of yeast (n =16) and 5.9% of Aspergillus (n =1). Candida was the most common fungal genus in culture and microscopic exam with 94.1% (n =16) of cases and Candida albicans was the most common species in 88.2% (n =15) cases. Conclusion: Candida albicans is the most common etiologic agent in diabetic patients with otomycosis. Main symptoms were hearing loss, itching and otorrhea. Direct exam correctly identified the fungal genus.

Conductas de control de peso en mujeres adolescentes dietantes y su relación con insatisfacción corporal y obsesión por la delgadez / Weight control behaviors in dieting adolescent girls and their relation to body dissatisfaction and obsession with thinness

Introducción: La obsesión por la delgadez y la insatisfacción corporal pueden llevar a las adolescentes a seguir dietas sin supervisión, lo que podría asociarse además a conductas riesgosas de control de peso, tales como ayuno, vómitos, uso de diuréticos y laxantes. El objetivo fue explorar conductas de control de peso en adolescentes dietantes y relacionarlas con insatisfacción corporal (IC) y obsesión por la delgadez (DT). Pacientes y Método: Estudio transversal en 439 adolescentes de colegios públicos de Valparaíso diseñado para indagar conductas de control de peso riesgosas a través de escalas de IC y DT del Cuestionario de Trastornos Alimentarios (EDI-2), comparando dietantes y no dietantes. Resultados: El 43% había realizado dieta sin supervisión médica. Las dietantes presentan valores superiores en DT e IC. El 29,6% de ellas presenta restricción alimentaria de riesgo moderado a alto, tomando como base el criterio de expertos, y se encuentran diferencias en la presencia y severidad de las conductas purgativas de control de peso entre los dos grupos estudiados. Conclusiones: Un tercio de las adolescentes estudiadas hacen dietas sin supervisión profesional, presentan mayor IC y DT y conductas riesgosas de control de peso. Aquellas con sobrepeso y obesidad realizan dietas más restrictivas y conductas de control de peso más riesgosas.

Introduction: Obsession with thinness and body dissatisfaction can lead adolescents to follow unsupervised diets, which could result in risky weight control behaviors such as fasting, vomiting, use of diuretics and laxatives. The aim of the current study is to examine weight control behaviors in dieting adolescents and relate them to body dissatisfaction (BD) and obsession with thinness (OT). Methods: A cross-sectional study was conducted on 439 adolescents from Valparaiso public schools to investigate risky weight control behaviors due to BD and OT scales from the Eating Disorders Inventory-2 (EDI-2), comparing restrained eaters and non-restrained eaters. Results: A total of 43% adolescents had followed a weight loss diet without medical supervision. The dieters had higher BD and OT values. Moderate to severe food restriction, based on expert judgment, was observed in 29.6%, and differences in the presence and severity of purging behaviors were found between the 2 groups. Conclusions: One third of the adolescents studied followed diets without professional supervision and had higher BD and OT values, as well as risky weight control behaviors. Overweight and obese adolescents followed more restrictive diets and developed riskier weight control behaviors.

Safety of allergen immunotherapy: a review of premedication and dose adjustment.

From the first allergen immunotherapy proposed in the early 1900s to the present day, numerous studies have proven the efficacy of allergen immunotherapy for the treatment of allergic rhinitis, allergic conjunctivitis, allergic asthma and stinging insect hypersensitivity. The major risk, however small, with allergen immunotherapy is anaphylaxis. There has been considerable interest and debate regarding risk factors for immunotherapy reactions (local and systemic) and interventions to reduce the occurrence of these reactions. One of these interventions that is especially debated regards dose adjustment for various reasons, but in particular for local reactions. In this review, we discuss the safety of immunotherapy and provide a comprehensive review of the literature regarding immunotherapy schedules and doses.

FLAVONOIDES AISLADOS DE LAS INFLORESCENCIAS DE Piper hispidum Kunth (PIPERACEAE) Y DERIVADOS ACETILADOS ISOLATED / FLAVONOIDS FROM INFLORESCENCES OF Piper hispidum Kunth (PIPERACEAE) AND ACETYLATED DERIVATIVES / DERIVATIVES FLAVONOIDES ISOLADOS DAS INFLORESCÊNCIAS DE Piper hispidum Kunth (PIPERACEAE) E DERIVADOS ACETILADOS

A partir del extracto etanílico de las inflorescencias de la especie Piper hispidum Kunth (Piperaceae) fueron aislados tres flavonoides: 5-hidroxi-7-metoxiflavanona, 5-hidroxi-4,7-dimetoxiflavanona y 2,4,6-trimetoxidihidrochalcona. De las flavanonas aisladas fueron obtenidos los derivados acetilados: 5-acetoxi- 7-metoxiflavanona y 5-acetoxi-4,7- dimetoxiflavanona. Las estructuras fueron elucidadas empleando técnicas espectrocópicas y por comparacióncon datos de literatura. Los compuestos naturales y sus derivados fueron sometidos al bioensayo de letalidad frente a Artemia salina. El flavonoide 5-hidroxi-7-metoxiflavanona presenta la mayor actividad tóxica frente a los microcrustáceos CL50 1.8 [1]g/ml.

From the ethanolic extract of the inflorescences of Piper hispidum Kunth (Piperaceae) were isolated three flavonoids 5-hydroxy-7-methoxyflavanone, 5-hydroxy-4,7-dimethoxyflavanone and 2,4,6-trimethoxydihydrochalcone. The acetylated derivatives 5-acetoxy- 7-methoxyflavanone and 5-acetoxy- 4,7- dimethoxyflavanone were synthesized from the isolated pure flavanones. Characterization was mainly achieved by spectroscopic techniques and compared with literature data. Natural compounds and derivatives were subjected to brine shrimp lethality bioassay. The most toxic compound was the flavonoid 5-hydroxy- 7-methoxyflavanone with a LC50 1,8 [1]g/ml.

A partir do extracto etanílico das inflorescancias da especie Piper hispidum Kunth (Piperaceae) foram isolados tras flavonoides: 5-hidroxi-7-metoxiflavanona, 5-hidroxi-4,7-dimetoxiflavanona y 2,4,6-trimetoxidihidrochalcona. Das flavanonas isoladas foram sintetizados os derivados acetilados 5-acetoxi-7-metoxiflavanona y 5-acetoxi-4,7-dimetoxiflavanona. As estruturas foram elucidadas empregando técnicas espectrocópicas e por comparasau com dados da literatura. Os compostos naturais e seus derivados foram submetidos a bioensaáos de letalidade frente a Artemia salina. O flavonoide 5-hidroxi-7-metoxiflavanona presenta uma major atividad toxica frente aos microcrustaceos CL50 1,8 [1]g/ml.

[Cryoablation of pulmonary veins as complementary treatment of atria I fibrillation in valvular surgery]. / Criocoagulación de venas pulmonares como tratamiento complementario de la fibrilación auricular en cirugía valvular.

BACKGROUND: The Cox MAZE III operation for the treatment of atrial fibrillation (AF) is complex and consumes significant operative time. Cryoablation of the pulmonary veins (CPV) is a simpler alternative for patients that require concomitant valvular surgery. AIM: To evaluate CPV in patients with AF submitted to valvular surgery. PATIENTS AND METHODS: Twenty one patients had simultaneous valvular surgery and CPV, 81 % of them had permanent AF for an average of 5 years. Twenty patients had mitral valve disease. The etiology was rheumatic in 14. Average left atrial diameter was 60 mm. In 7 patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. A combined transeptal and superior approach was used for all patients. The CPV was performed after the valvular procedure with cryothermy at -60 degrees C for 2 minutes with two 15 mm cryoprobes applied simultaneously. RESULTS: CPV increased surgical time by 10 to 20 minutes. Operative mortality was 4.8% (1 patient). One patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. All patients improved their functional class. At the end of an average 10.5 months of follow-up, 50% of patients were in normal sinus rhythm and 25% persisted in AF. The remaining patients were in some type of regular rhythm. CONCLUSIONS: CPV as a complementary procedure in patients with AF undergoing valvular surgery had good results to abate AF. It restored normal sinus rhythm in 50% of the cases, with low morbidity and mortality and little increment in surgical time.

Criocoagulación de venas pulmonares como tratamiento complementario de la fibrilación auricular en cirugía valvular / Cryoablation of pulmonary veins as complementary treatment of atria I fibrillation in valvular surgery

Background: The Cox MAZE III operation for the treatment of atrial fibrillation (AF) is complex and consumes significant operative time. Cryoablation of the pulmonary veins (CPV) is a simpler alternative for patients that require concomitant valvular surgery. Aim: To evaluate CPV in patients with AF submitted to valvular surgery. Patients and Methods: Twenty one patients had simultaneous valvular surgery and CPV, 81 percent of them had permanent AFfor an average of 5 years. Twenty patients had mitral valve disease. The etiology was rheumatic in 14. Average left atrial diameter was 60 mm. In 7patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. A combined transeptal and superior approach was used for all patients. The CPV was performed after the valvular procedure with cryothermy at -60°C for 2 minutes with two 15 mm cryoprobes applied simultaneously. Results: CPV increased surgical time by 10 to 20 minutes. Operative mortality was 4.8 percent (1 patient). One patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. All patients improved their functional class. At the end of an average 10.5 months of follow-up, 50 percent of patients were in normal sinus rhythm and 25 percent persisted in AF. The remaining patients were in some type of regular rhythm. Conclusions: CPV as a complementary procedure in patients with AF undergoing valvular surgery had good results to abate AF. It restored normal sinus rhythm in 50 percent of the cases, with low morbidity and mortality and little increment in surgical time.