Twelve-year long-term postoperative outcomes in patients with chronic rhinosinusitis with nasal polyps.

BACKGROUND: Evidence regarding long-term postoperative follow-up of chronic rhinosinusitis with nasal polyps (CRSwNP) patients is scarce in the literature. The objective of the present study was to report long-term 12-year postoperative outcomes for CRSwNP patients. METHODS: CRSwNP patients were prospectively followed after endoscopic sinus surgery. Sinonasal symptoms, nasal polyp score (NPS), Barcelona Smell Test 24 (BAST-24), Lund-Mackay Score (LMS), and Medical Outcome Study Short Form-36 (SF-36) questionnaire were assessed before and 12 years after surgery. RESULTS: At long-term follow-up (median, 12 years), a strong improvement was noted for all patients (N=76) in nasal symptoms score, NPS, BAST-24, and LMS scores compared with baseline. No long-term improvement in SF-36 was found. CONCLUSION: Patients with CRSwNP have a long-term 12-year postoperative improvement in nasal symptoms, polyp size, computed tomography, and olfaction.

[Recurring genital bleeding in an extreme premature infant]. / Sangrado genital recurrente en una lactante prematura extrema.

Mini-puberty refers to the transient activation of the hypothalamic-pituitary-gonadal axis during the first months of life. This activation in preterm infants could be more exaggerated and prolonged. Ob jective: To present a case of exaggerated mini-puberty in an extremely preterm infant, with recurrent genital bleeding. Clinical Case: A 25-week preterm newborn presented at 5 months old with breast buds, areolar pigmentation, and estrogenic effects on the vaginal mucosa, with recurrent genital blee ding in three consecutive months. Her laboratory evaluation showed elevated values of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2). An exaggerated mini-puber ty due to extreme prematurity was suspected, therefore a conservative approach was taken. During follow-up, the patient showed partial regression of breast buds and cessation of genital bleeding, and decreasing levels of gonadotropin and estradiol. Conclusion: Mini-puberty in preterm newborns can present exaggeratedly, simulating precocious puberty and even presenting, exceptionally, recurrent genital bleeding. Considering the increasing survival of extremely premature infants, it is important to know the spectrum of clinical and laboratory manifestations of this phenomenon, in order to carry out adequate management.

Twelve-year long-term postoperative outcomes in patients with chronic rhinosinusitis with nasal polyps.

BACKGROUND: Evidence regarding long-term postoperative follow-up of chronic rhinosinusitis with nasal polyps (CRSwNP) patients is scarce in the literature. The objective of the present study was to report long-term 12-year postoperative outcomes for CRSwNP patients. METHODS: CRSwNP patients were prospectively followed after endoscopic sinus surgery. Sinonasal symptoms, nasal polyp score (NPS), Barcelona Smell Test 24 (BAST-24), Lund-Mackay Score (LMS), and Medical Outcome Study Short Form-36 (SF-36) questionnaire were assessed before and 12 years after surgery. RESULTS: At long-term follow-up (median, 12 years), a strong improvement was noted for all patients (N=76) in nasal symptoms score, NPS, BAST-24, and LMS scores compared with baseline. No long-term improvement in SF-36 was found. CONCLUSION: Patients with CRSwNP have a long-term 12-year postoperative improvement in nasal symptoms, polyp size, computed tomography, and olfaction.

Viscosity decay of hydrocolloids under oral conditions.

The aim of this study was to understand the contribution of hydrocolloids to oral structure breakdown of starch-based systems in relation to mouthfeel sensations. For this, carrot purees were prepared using corn starch and a different second thickener (λ-carrageenan, carboxymethylcellulose (CMC), xanthan gum, or an extra amount of starch). The viscosity decay of purees under in vitro oral conditions was measured (starch pasting cell adapted to a rheometer) when shearing at a constant shear rate in the presence of artificial saliva. Sensory properties of purees were described using the Flash Profile technique by a group of 13 panellists. Oral viscosity decay of systems was modelled using a second order structural kinetic equation that included three parameters: initial viscosity, rate of breakdown, and viscosity at equilibrium. Although they had the same initial viscosity, the structural breakdown of the purees in oral conditions varied, depending on the second thickener used. The structure of purees containing xanthan and λ-carrageenan were more resistant under oral conditions exhibiting a slow and smaller breakdown. In contrast, purees containing only starch showed a rapid and large decay because of the complete structure breakdown by amylase. For puree containing CMC, there was also a rapid decrease, but smaller than starch, indicating that part of the structure remained after digestion. Texture sensations freely described by assessors varied according to two main sensory dimensions, that were clearly related to the structural breakdown parameters. As expected, the dimension of thickness (from watery and liquid to thick and viscous) separated base purees from thickened purees and was related to the initial viscosity. The smoothness dimension (from rough and lumpy to the smooth and creamy) was related to the viscosity at equilibrium indicating that after the oral digestion, the characteristics of the remaining structure can explain differences in complex attributes of semisolid systems such as smoothness and creaminess.

Influence of the particle size and hydrocolloid type on lipid digestion of thickened emulsions.

Hydrocolloids are used as stabilizing agents in order to enhance the physical stability of emulsions during their storage. However, they can also play an important role in nutrient release and bioavailability. In this context, the aim of this research was to study the effect of the emulsion type and thickener type on the physical-structural changes and free fatty acid release during in vitro digestion. Oil-in-water emulsions were prepared with different particle sizes (CE: conventional emulsions and NE: nanoemulsions) and thickening agents (starch and xanthan gum). The experimental conditions of homogenization used allowed food emulsions to be obtained at the microscale and nanoscale, with particle sizes ranging among 3.2-3.4 µm and 78-107 nm for CE and NE, respectively. The addition of thickening agents (XG and ST) modified the physical properties of emulsions (particle size, zeta potential and stability) slightly, and thickened samples with similar viscosity were obtained. The kinetics of FFAs released during the in vitro intestinal digestion showed no significant differences (p > 0.05) in the digestion rate among samples; however, emulsion and thickener types decreased the final extent of free fatty acids, being more evident for those samples with starch. Xanthan gum kept the particle size of nanoemulsions stable during the oral and gastric phases, which promoted the release of FFAs during the intestinal phase. Therefore, xanthan gum could be used as a thickening agent of nanoemulsions exerting a minor impact on their lipid bioaccessibility.

Windowed Green function method for the Helmholtz equation in the presence of multiply layered media.

This paper presents a new methodology for the solution of problems of two- and three-dimensional acoustic scattering (and, in particular, two-dimensional electromagnetic scattering) by obstacles and defects in the presence of an arbitrary number of penetrable layers. Relying on the use of certain slow-rise windowing functions, the proposed windowed Green function approach efficiently evaluates oscillatory integrals over unbounded domains, with high accuracy, without recourse to the highly expensive Sommerfeld integrals that have typically been used to account for the effect of underlying planar multilayer structures. The proposed methodology, whose theoretical basis was presented in the recent contribution (Bruno et al. 2016 SIAM J. Appl. Math.76, 1871-1898. (doi:10.1137/15M1033782)), is fast, accurate, flexible and easy to implement. Our numerical experiments demonstrate that the numerical errors resulting from the proposed approach decrease faster than any negative power of the window size. In a number of examples considered in this paper, the proposed method is up to thousands of times faster, for a given accuracy, than corresponding methods based on the use of Sommerfeld integrals.

Development and assessment of the disposition index based on the oral glucose tolerance test in subjects with different glycaemic status

Insulin secretion and insulin sensitivity indexes are related by hyperbolic functions, allowing the calculation of the disposition index (DI) as the product of the acute insulin response (AIR) and the insulin sensitivity index (Si) from intravenous glucose tolerance test (IVGTT). Our objective was to develop an oral-DI based on the oral glucose tolerance test (OGTT) and to assess its association with glucose tolerance status. This research is structured in three studies. Study 1: OGTT were performed in 833 non-diabetic Chilean women (18-60 years) without family history of diabetes mellitus. Study 2: an independent group of n = 57 non-diabetic (18-46 years) without family history of diabetes mellitus carried out an OGTT and an abbreviated IVGTT. Study 3: a sample of 1674 Chilean adults (18-60 years) with different glycaemic status performed an OGTT. An adequate statistical fit for a rectangular hyperbola was found between the area under the curve of insulin-to-glucose ratio (AUCI/G-R) and the Matsuda ISI-COMP index (study 1). The oral-DI derived as AUCI/G-R × ISI-COMP was previously termed insulin-secretion-sensitivity index-2 (ISSI-2). ISSI-2 significantly correlated with DI from IVGTT (rho = 0.34; p = 0.009) (study 2). ISSI-2 shows important differences across groups of subjects with different glycaemic status (study 3). We have confirmed that ISSI-2 replicates the mathematical properties of DI, showing significant correlations with DI from the abbreviated MM-IVGTT. These results indicate that ISSI-2 constitutes a surrogate measure of insulin secretion relative to insulin sensitivity and emphasizes the pivotal role of impaired insulin secretion in the development of glucose homeostasis dysregulation (AU)

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Development and assessment of the disposition index based on the oral glucose tolerance test in subjects with different glycaemic status.

Insulin secretion and insulin sensitivity indexes are related by hyperbolic functions, allowing the calculation of the disposition index (DI) as the product of the acute insulin response (AIR) and the insulin sensitivity index (Si) from intravenous glucose tolerance test (IVGTT). Our objective was to develop an oral-DI based on the oral glucose tolerance test (OGTT) and to assess its association with glucose tolerance status. This research is structured in three studies. Study 1: OGTT were performed in 833 non-diabetic Chilean women (18-60 years) without family history of diabetes mellitus. Study 2: an independent group of n = 57 non-diabetic (18-46 years) without family history of diabetes mellitus carried out an OGTT and an abbreviated IVGTT. Study 3: a sample of 1674 Chilean adults (18-60 years) with different glycaemic status performed an OGTT. An adequate statistical fit for a rectangular hyperbola was found between the area under the curve of insulin-to-glucose ratio (AUCI/G-R) and the Matsuda ISI-COMP index (study 1). The oral-DI derived as AUCI/G-R × ISI-COMP was previously termed insulin-secretion-sensitivity index-2 (ISSI-2). ISSI-2 significantly correlated with DI from IVGTT (rho = 0.34; p = 0.009) (study 2). ISSI-2 shows important differences across groups of subjects with different glycaemic status (study 3). We have confirmed that ISSI-2 replicates the mathematical properties of DI, showing significant correlations with DI from the abbreviated MM-IVGTT. These results indicate that ISSI-2 constitutes a surrogate measure of insulin secretion relative to insulin sensitivity and emphasizes the pivotal role of impaired insulin secretion in the development of glucose homeostasis dysregulation.

Adherencia a la suplementación con vitamina D y factores determinantes de ella, durante el primer año de vida / Adherence to vitamin D supplementation and determinant factors during the first year of life

Introduction: Breastfed infants under one year of age may not get enough vitamin D; therefore a vitamin supplement is needed. The adherence to this policy has not yet been evaluated in Chile. Objective: To evaluate the adherence to vitamin D supplementation in children less than one year old and the determinant factors involved. Patients and Method: A cross-sectional study was carried out in three Catholic University Health Network centers. Breastfed infants under one year of age were included in the study. Their parents/guardians filled out a questionnaire about adherence to supplementation and its determinant factors. Results: 170 infants were recruited. 164 of them received supplementation, with a good adherence of 68.9%. The main reason for non-adherence was due to maternal forgetfulness. The identified risk factor for poor adherence was the number of maternal children. Conclusions: Vitamin D supplementation in Chile reaches high levels, but its adherence is poor. More education to parents on ways to avoid forgetting the supplement is needed as well as on identifying risk factors during medical consultations.

Introducción: Los lactantes menores de un año alimentados con leche materna poseen múltiples factores que impiden una adecuada adquisición de vitamina D, haciendo la suplementación necesaria. La adherencia a esta política de salud no ha sido evaluada en Chile. Objetivo: Evaluar la adherencia a la suplementación con vitamina D en niños menores de un año y conocer los factores determinantes que intervienen en ella. Pacientes y Método: Estudio transversal en tres Centros de Salud pertenecientes a Red de Salud Universidad Católica. Se reclutaron lactantes menores de 1 año que recibían lactancia materna y se realizó una encuesta a sus tutores indagando sobre adherencia a la suplementación y factores determinantes de ésta. Resultados: Se reclutaron 170 lactantes. Recibían suplementación 164 de ellos, reportando buena adherencia en un 68,9%. La principal causa para no adherir fue el olvido materno. El factor de riesgo identificado para mala adherencia fue el número de hijos maternos. Conclusiones: La suplementación con vitamina D en Chile alcanza niveles altos, pero la adherencia a ésta es deficiente. Se necesita de mayor educación a los padres al respecto, reforzando maneras de evitar el olvido e identificando los factores de riesgo en todas las consultas médicas.

[Adherence to vitamin D supplementation and determinant factors during the first year of life]. / Adherencia a la suplementación con vitamina D y factores determinantes de ella, durante el primer año de vida.

INTRODUCTION: Breastfed infants under one year of age may not get enough vitamin D; therefore a vitamin supplement is needed. The adherence to this policy has not yet been evaluated in Chile. OBJECTIVE: To evaluate the adherence to vitamin D supplementation in children less than one year old and the determinant factors involved. PATIENTS AND METHOD: A cross-sectional study was carried out in three Catholic University Health Network centers. Breastfed infants under one year of age were included in the study. Their parents/guardians filled out a questionnaire about adherence to supplementation and its determinant factors. RESULTS: 170 infants were recruited. 164 of them received supplementation, with a good adherence of 68.9%. The main reason for non-adherence was due to maternal forgetfulness. The identified risk factor for poor adherence was the number of maternal children. CONCLUSIONS: Vitamin D supplementation in Chile reaches high levels, but its adherence is poor. More education to parents on ways to avoid forgetting the supplement is needed as well as on identifying risk factors during medical consultations.

Fat replacers in low-fat carboxymethyl cellulose dairy beverages: Color, rheology, and consumer perception.

Low-fat foods are an interesting option for consumers interested in health-related issues or in maintaining adequate body weight; however, fat reduction may influence consumer acceptance of the end product. This study aims to obtain information about the effectiveness of λ-carrageenan and a blend (50:50) of short- and long-chain inulin as fat replacers in dairy beverages prepared with carboxymethyl cellulose (CMC) and to determine to what extent consumers perceive instrumental color and rheological differences among samples. Results showed that both λ-carrageenan and the inulin blend could be used as fat replacers in CMC-based dairy beverages and that consumers could distinguish among samples that differed in color and rheological behavior.

Treatment of Trypanosoma cruzi-infected children with nifurtimox: a 3 year follow-up by PCR.

Patients suffering from Chagas' disease, as determined by positive serological results, were tested for further evidence of Trypanosoma cruzi infection by xenodiagnosis and PCR. The patients included 67 children aged from 0 to 10 years and 75 adults. All children were positive by PCR on their pre-therapy sample, while only 69% of the seropositive adults and none of the 78 seronegative control adults were PCR positive. Xenodiagnosis was positive in 79% of the children, but only in 21% of the adults. A group of 66 children was treated with nifurtimox, and followed up every 3 months during the first year and every 6 months during the second and third year post-therapy, by PCR, xenodiagnosis and serology. We concluded that PCR was the most effective test to monitor children for 3 years post-chemotherapy, when all the cases converted from positive to negative. Conventional serology, however, remained positive after that period in most cases. In contrast, conversion to negative xenodiagnosis occurred very early after treatment.

[Yield of xenodiagnosis and PCR in the evaluation of specific chemotherapy of Chagas' disease in children]. / Rendimiento del xenodiagnóstico y el PCR para evaluar el tratamiento quimioterápico específico de la enfermedad de Chagas en niños.

Amplification by the polymerase chain reaction (PCR) of Trypanosoma cruzi kinetoplastic DNA was used to enhance sensitivity in the detection of the parasite in blood, with the ultimate goal of improving the parasitological diagnosis of Chagas' disease in 0-10 year-old infected children. Twenty eight children were evaluated by using xenodiagnosis (XD) and PCR. Whereas XD detected 75.0% of the cases PCR was positive in 96.8%. The usefulness of the PCR was further investigated in the 28 children who have received specific treatment with nifurtimox. Negativation of XD after three and six months post treatment was observed in all the cases, but only 21.4% and 35.8% negativation of the PCR after three and six months post treatment respectively. These observations suggest that PCR is the most sensitive and quick technique available for direct detection of T. cruzi in chagasic children and that it can be a very useful tool for the follow-up of infected subjects after specific chemotherapeutical treatment.

[Rotational atherectomy (Rotablator) for percutaneous transluminal coronary angioplasty]. / Aterectomía rotacional (Rotablator) en la angioplastía coronaria percutánea transluminal.

BACKGROUND: The use of Rotablator in percutaneous transluminal coronary angioplasty attempts to reduce the atheromatous plaque abrading it and fragmenting the parietal calcium of the artery. AIM: To report our experience with the use of Rotablator. PATIENTS AND METHODS: Rotational atherectomy was performed in 189 patients aged 60.8 +/- 11 years (154 men). The clinical indication for the procedure was chronic angina in 22%, unstable angina in 44%, myocardial infarction in 21%, silent angina in 7% and re-stenosis in 6%. One hundred seventy seven patients were followed for a mean of 15.9 +/- 6.3 months. RESULTS: Two hundred thirty six stenoses in 215 coronary arteries were treated with a 98.7% angiographic success rate. One patient had a Q infarction and no patient died or required emergency surgery. Fourteen patients had rises in CK MB enzymes (non Q infarction). Three patients had a pseudoaneurism and three had bleedings that required transfusion. Of the followed patients, 33 had a clinically suspected re-stenosis, that was angiographically confirmed in 23. Cardiac mortality was 2.3%. Seventy nine percent of patients had an evolution without angina or coronary events. CONCLUSIONS: Percutaneous transluminal coronary angioplasty with the use of Rotablator had a high immediate success rate and a low incidence of complications. The clinical evolution of patients has been favorable with a low incidence of mortality and ischemic events.

[Radiofrequency fulguration of accessory pathways]. / Fulguración por radiofrecuencia de haces paraespecíficos.

Between August 1991 and August 1993, 75 patients (42 male) with Wolff Parkinson White syndrome (43 concealed) were subjected to radiofrequency ablation of accessory pathways at our institution. 55 had left, 8 postero septal, 2 anteroseptal and 10 right accessory pathways. A retrograde aortic technique with placement of the ablation catheter in close proximity to the mitral annulus was used for most of the patients with left accessory pathways and for some with posteroseptal pathways. The right, anteroseptal and some posteroseptal pathways were ablated using a right heart approach placing the ablation catheter in the tricuspid annulus. Ablation was successful in 61 patients (81%). One subject developed a fatal cardiac tamponade after a transeptal catheterization and was unrelated to the ablation per se. It is concluded that radiofrequency ablation of accessory pathways is a curative procedure for a great majority of patients with Wolf Parkinson White syndrome.

The effect of apnea on brain compliance and intracranial pressure.

The effect of 2 minutes of apnea during endotracheal intubation on intracranial pressure (ICP), compliance, and cerebral blood volume (CBV) was studied in 19 adult dogs during normo-, hypo-, and hypercapnia. The compliance was measured from the cisterna magna in response to an intrathecal bolus injection (pressure-volume index). CBV was monitored by radiolabeled red blood cell activity. These measurements were made before and after 2 minutes of apnea. At normocapnia (pCO2 of 35-40 mm Hg), a period of apnea resulted in an increase in ICP from 9.6 to 26.3 mm Hg, a decrease in compliance from 0.051 to 0.020 ml/mm Hg (60%), and an increase in CBV of 0.26 ml (9.6%). When the animals were hypocapnic (pCO2 of 24-28 mm Hg), ICP increased from 12.8 to 19.6 mm Hg, compliance fell from 0.041 to 0.029 ml/mm Hg(29%), and CBV increased 0.07 ml (3.1%). Hypercapnia (pCO2 of 50-58 mm Hg) before apnea resulted in an increase in ICP from 21.5 to 47.1 mm Hg, a decrease in compliance from 0.032 to 0.015 ml/mm Hg (52%), and an increase in CBV of 0.41 ml (13.4%). These results suggest that hyperventilation (hypocapnia) before intubation limits the adverse decrease in brain compliance and increase in ICP by reducing changes in cerebral blood volume.

Acetaminophen does not induce oxidative stress in isolated rat hepatocytes: its probable antioxidant effect is potentiated by the flavonoid silybin.

Acetaminophen hepatotoxicity is characterized by glutathione depletion and the formation of the reactive electrophilic metabolite N-acetyl-p-benzoquinone imine. The induction of oxidative stress, expressed as lipid peroxidation, is controversial in acute acetaminophen intoxication. Isolated rat hepatocytes develop spontaneously or when incubated with buthionine sulfoximide, a progressive lipid peroxidation which may be inhibited by the antioxidant flavonoid silybin. When cells are incubated with acetaminophen, lipid peroxidation is not observed, this antilipoperoxidative effect being potentiated by silybin. It is proposed that when hepatocytes are incubated with a high concentration of acetaminophen, the drug may accumulate in the cells due to saturation and/or inhibition of detoxification pathways (as in the case of silybin). Under these conditions the development of hepatocyte oxidative stress may be inhibited due to the antioxidant behaviour of acetaminophen.