Management of CRSwNP in Latin America: A multidisciplinary consensus from an expert working group.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition of the nasal and paranasal tissues, characterized by the presence of bilateral nasal polyps. While etiology and pathogenetic mechanisms are heterogeneous and complex, in most patients, disease is mediated predominantly through type 2 inflammatory processes. Clinical management is challenging, and a multidisciplinary approach is preferred. Principal treatment approaches are the use of local/systemic corticosteroids and sinonasal surgery, although outcomes can be unsatisfactory. Recent availability of biological therapies targeting underlying inflammatory processes can offer effective treatment options in uncontrolled disease. Specialist guidelines greatly assist clinical decision-making, although as these are chiefly written from a global/international perspective, they may not wholly accommodate disease patterns and clinical practice at a regional level. An expert panel of specialists from Latin America was convened to develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the chief observations and recommendations which can provide guidance for clinicians in the Latin American region.

Facile hyperpolarization chemistry for molecular imaging and metabolic tracking of [1-13C]pyruvate in vivo.

Hyperpolarization chemistry based on reversible exchange of parahydrogen, also known as Signal Amplification By Reversible Exchange (SABRE), is a particularly simple approach to attain high levels of nuclear spin hyperpolarization, which can enhance NMR and MRI signals by many orders of magnitude. SABRE has received significant attention in the scientific community since its inception because of its relative experimental simplicity and its broad applicability to a wide range of molecules, however in vivo detection of molecular probes hyperpolarized by SABRE has remained elusive. Here we describe a first demonstration of SABRE-hyperpolarized contrast detected in vivo, specifically using hyperpolarized [1-13C]pyruvate. Biocompatible formulations of hyperpolarized [1-13C]pyruvate in, both, methanol-water mixtures, and ethanol-water mixtures followed by dilution with saline and catalyst filtration were prepared and injected into healthy Sprague Dawley and Wistar rats. Effective hyperpolarization-catalyst removal was performed with silica filters without major losses in hyperpolarization. Metabolic conversion of pyruvate to lactate, alanine, and bicarbonate was detected in vivo. Pyruvate-hydrate was also observed as minor byproduct. Measurements were performed on the liver and kidney at 4.7 T via time-resolved spectroscopy and chemical-shift-resolved MRI. In addition, whole-body metabolic measurements were obtained using a cryogen-free 1.5 T MRI system, illustrating the utility of combining lower-cost MRI systems with simple, low-cost hyperpolarization chemistry to develop safe, and scalable molecular imaging.

Endoscopic maxillectomy: anatomo-radiological description of the "double" maxillary sinus window.

OBJECTIVES/HYPOTHESIS: To present a modified endoscopic medial maxillectomy (MEMM) approach to control maxillary sinus pathologies. METHODS: MEMM was completed in 13 fresh-frozen specimens. An MEMM includes cutting the nasolacrimal duct, inferior meatus flap, and repositioning the inferior turbinate (IT). The following measurements were obtained: length of IT, height from the nasal floor to valve of Hasner, height of the IT at the level of valve of Hasner, height of the IT at the insertion of the middle turbinate, and distance from the piriform aperture to the posterior wall of maxillary sinus and to the posterior border of palatine bone. Similar measurements were also performed on craniofacial computed tomography (CT) scans (n = 50). The surgical technique was performed in a case series (n = 8). RESULTS: The mean of the specimens was 82 (range 70-95) years old. The average area of the harvested inferior meatus flap area was 9.6 ± 1.0 cm2. In the radiologic study, the mean maximum antrostomy area was 8.8 ± 1.7 cm2 and the IT area overlapping the antral window was 5.8 ± 1.1 cm2, the area allowing a double window control was 3.1 ± 1.9 cm2, the posterior IT insertion length was 0.7 ± 0.4 cm, and the inferior meatus flap covering the inferior meatotomy had an area measuring 6.7 ± 1.7 cm2. Eight patients underwent MEMM for various benign conditions showing no recurrence after 26 month follow-up. CONCLUSION: The proposed modifications of MEMM provide a "double" window maxillary sinus control with access to all maxillary walls and preservation of the IT.

Prodromal Parkinson disease in patients with idiopathic hyposmia.

BACKGROUND: Idiopathic hyposmia (IH) is a prodromal marker of Parkinson disease (PD). However, IH is common in the general population and only a minority will develop PD. Identification of individuals with IH at prodromal stage of PD would serve to select them to implement neuroprotective agents, when available. OBJECTIVE: To identify prodromal PD in IH patients using the Movement Disorders Society (MDS) research criteria for prodromal PD. METHODS: We applied the MDS research criteria for prodromal PD to 25 consecutive patients older than 50 years who were self-referred for smell loss and had IH, and to 18 controls. A number of risk and prodromal PD markers were assessed in all participants including REM sleep behavior disorder (RBD) by video-polysomnography and nigrostriatal dopaminergic dysfunction by DAT-SPECT. After follow-up of 4.7 ± 2.2 years, participants were re-assessed to look for incident PD. RESULTS: Prodromal PD probability was higher in patients than in controls (19.45 ± 34.9% versus 1.74 ± 4.48%; p = 0.019). Four (16%) patients met the criteria of prodromal PD surpassing 80% probability (99.8%, 99.5%, 88.3%, 86.4%). Three (12%) patients had RBD and four (16%) abnormal DAT-SPECT. At the end of follow-up, one (4%) IH patient who had RBD and baseline prodromal PD probability of 86.4% developed PD, while all controls remained disease free. CONCLUSIONS: Prodromal PD is infrequent among IH patients. MDS research criteria for prodromal PD are useful to identify a subgroup of IH patients at high risk of PD when RBD is assessed by video-polysomnography and nigrostriatal dopamine deficiency with DAT-SPECT.

Prediction of biological integrity based on environmental similarity--revealing the scale-dependent link between study area and top environmental predictors.

Indices of Biological integrity (IBI) are considered valid indicators of the overall health of a water body because the biological community is an endpoint within natural systems. However, prediction of biological integrity using information from multi-parameter environmental observations is a challenging problem due to the hierarchical organization of the natural environment, the existence of nonlinear inter-dependencies among variables as well as natural stochasticity and measurement noise. We present a method for predicting the Fish Index of Biological Integrity (IBI) using multiple environmental observations at the state-scale in Ohio. Instream (chemical and physical quality) and offstream parameters (regional and local upstream land uses, stream fragmentation, and point source density and intensity) are used for this purpose. The IBI predictions are obtained using the environmental site-similarity concept and following a simple to implement leave-one-out cross validation approach. An IBI prediction for a sampling site is calculated by averaging the observed IBI scores of observations clustered in the most similar branch of a dendrogram--a hierarchical clustering tree of environmental observations--built using the rest of the observations. The standardized Euclidean distance is used to assess dissimilarity between observations. The constructed predictive model was able to explain 61% of the IBI variability statewide. Stream fragmentation and regional land use explained 60% of the variability; the remaining 1% was explained by instream habitat quality. Metrics related to local land use, water quality, and point source density and intensity did not improve the predictive model at the state-scale. The impact of local environmental conditions was evaluated by comparing local characteristics between well- and mispredicted sites. Significant differences in local land use patterns and upstream fragmentation density explained some of the model's over-predictions. Local land use conditions explained some of the model's IBI under-predictions at the state-scale since none of the variables within this group were included in the best final predictive model. Under-predicted sites also had higher levels of downstream fragmentation. The proposed variables ranking and predictive modeling methodology is very well suited for the analysis of hierarchical environments, such as natural fresh water systems, with many cross-correlated environmental variables. It is computationally efficient, can be fully automated, does not make any pre-conceived assumptions on the variables interdependency structure (such as linearity), and it is able to rank variables in a database and generate IBI predictions using only non-parametric easy to implement hierarchical clustering.

Linking indices of biotic integrity to environmental and land use variables: multimetric clustering and predictive models.

Advanced computerized methods and models of retrieving knowledge from large multiparameter data bases were used to analyze data on fish and macroinvertebrate composition (metrics), habitat, land use and water quality. The research focused on the north central and northeastern United States and involved thousands of sites monitored by the state agencies. The techniques and methodologies included supervised and unsupervised Artificial Neural Networks (ANN) modeling, Principal Component Analysis, Canonical Component Analysis (both linear and nonlinear), Multiple Regression Analyses, and analyses of variance by ANOVA. The research resulted in defining a concept of clusters of sites based on their biotic (fish) community composition, identified cluster dominating factors, and developed meaningful models for predicting fish composition based on environmental and in-stream habitat stresses.

Conocimientos, actitudes y prácticas respecto a la bartonelosis aguda (fiebre de la Oroya) en los pobladores del distrito de Ollantaytambo, provincia de Urubamba, en el Valle Sagrado de los Incas, Cusco, Perú / Knowledge, Attitudes and Practices regarding acute Bartonellosis (Oroya fever`s) in Persons Living in Ollantaytambo District, Urubamba Province in the Sacred Valley of the Incas, Cusco, Peru

Introducción: la bartonelosis humana por Bartonella bacilliformis (BHxBb) o enfermedad de Carrión (EC) es una enfermedad prevalente de los valles interandinos del Perú, tradicionalmente en zonas endémicas reconocidas como Ancash, Cajamarca, Junín y Amazonas. Sin embargo, en los últimos años se han identificado nuevas zonas endémicas como el Valle Sagrado de los Incas, en el Cusco. Objetivo: describir los conocimientos, actitudes y prácticas sobre la bartonelosis aguda (BA) o fiebre de la Oroya (FO), en pobladores del distrito de Ollantaytambo, provincia de Urubamba, Valle Sagrado de los Incas, en el departamento del Cusco en julio del año 2004. Material y método: se realizó un estudio descriptivo de conocimientos, actitudes y prácticas (CAP), utilizando como instrumento una encuesta. Ésta se aplicó a 280 pobladores de diez comunidades en riesgo para bartonelosis aguda o fiebre de la Oroya. Se elaboró una clave de respuestas para determinar el nivel de conocimientos que se clasificó en tres niveles. Resultados: encontramos que, 151/280 (53,94%) pobladores pertenecían al nivel III (avanzado); en caso de presentar sintomatología, 228/242 (94,21%) acudirían a la posta médica; y que 32,02% (92/242) no realiza ninguna medida preventiva. Conclusiones: más de la mitad reconoce de manera óptima aspectos elementales sobre la bartonelosis y el vector que la transmite. La población en su mayoría desconoce qué medidas preventivas son efectivas para evitar la enfermedad, por lo tanto no las practica. Paralelamente la población tiene actitudes favorables para prevenir la enfermedad.

Introduction: Bartonellosis is a prevalent disease in Andean valleys of Peru, typically in endemic areas such as Ancash, Cajamarca, Junín, and Amazonas. However, in the past few years, new endemic areas have been identified, such as the Sacred Valley of the Incas in Cusco. Objective: To describe knowledge, attitude and practices regarding Bartonellosis in persons living in Ollantaytambo District, Urubamba Province in the Sacred Valley of the Incas, Cusco-Peru, July 2004. Materials and Methods: A knowledge, attitude and practices (KAP) survey was conducted in 280 persons from ten communities identified as being at risk for Bartonellosis in Ollantaytambo. A score was used to identify knowledge levels in three categories. Results: We found that 151/280 persons (53.94%) had advanced (level III) knowledge, that in case of feeling sick, 228/242 (94.21%) residents would go to the health care center, and that 32.02% (92/242) do not practice any activity to prevent Bartonellosis. Conclusions: More than half of people living in the surveyed areas adequately recognize basic aspects regarding Bartonellosis and the vector involved in its transmission. Most people do not know preventive measures against; therefore, they do not practice such activities. However, they have a favorable attitude for preventing the disease.

Presencia de Strongyloides stercoralis en un estudio sobre enteroparasitosis en escolares del asentamiento humano "La Candelaria", distrito de Chancay, provincia de Huaral, departamento de Lima / Presence of Strongyloides stercoralis in a enteroparasites study in school students of "La Candelaria", district of Chancay, province of Huaral, department of Lima

Introducción: la parasitosis intestinal es un problema de salud pública en el Perú siendo la Strongyloidosis la infección producida por el nemátode Strongyloides stercoralis, la cual es endémica en nuestro medio. Se han realizado en el Perú estudios que demuestran su alta prevalencia en comunidades de la selva y en menor grado en la sierra y ha sido poco estudiada en comunidades costeras. Objetivo: determinar la prevalencia de Strongyloides stercoralis entre los enteroparásitos en una comunidad de la costa peruana. Materiales y Métodos: se recolectó una muestra de heces de todos los asistentes a una campaña de salud que se realizó en el colegio público "Virgen de la Candelaria" en el asentamiento humano "La Candelaria", distrito de Chancay provincia de Huaral, las cuales fueron procesadas mediante 5 exámenes coprológicos: examen directo, técnica sedimentación espontánea en tubo, método de Baermann modificado en copa por Lumbreras, técnica de Kato, técnica de sedimentación rápida de Lumbreras, para la búsqueda de Strongyloides stercoralis y otros enteroparásitos. Resultados: fueron recolectadas un total de 173 muestras. La prevalencia de cualquier parásito fue de 98% y 76% tuvo algún parásito patógeno. La prevalencia de Strongyloides stercoralis fue de 1,1% (2 alumnos). Conclusiones: este estudio revela que existe alta enteroparasitosis en general y específicamente Strongyloides stercoralis en una comunidad costera en el Perú.

Introducction: the intestinal parasitoses are public health problems in Perú. Strongyloidiasis is the intestinal infection produced by the nematode Strongyloides stercoralis; it is endemic in Perú, with proven high prevalences in jungle and andean communities; its presence has been barely studied in coastal communities. Objetives: to determine the prevalence of Strongyloides stercoralis among the human enteroparasites in a coastal community in Perú. Materials and methods: a fecal sample was obtained from all willing participants in a health campaign that took place at the public school "Virgen de la Candelaria" at the community of "La Candelaria", Chancay district, Huaral province. The samples were processed using 5 coprologic methods: direct examination, spontaneous tube sedimentation, rapid sedimentation technique modified by Lumbreras, Kato test, and Baermann technique modified by Lumbreras, to evaluate the presence of Strongyloides stercoralis and other enteroparasites. Results: 173 samples where collected. The prevalence of enteroparasitosis (any parasite or commensal) was 98%; that of pathogenic enteroparasites was 76%. S. stercoralis was found in 2 schoolchildren (1.1%). Conclusion: this study shows the high frequency of enteroparasites in general and indicates the presence of S. stercoralis in a coastal community of Perú.