The Relationship between Indoor and Outdoor Fine Particulate Matter in a High-Rise Building in Chicago Monitored by PurpleAir Sensors.

In urban areas like Chicago, daily life extends above ground level due to the prevalence of high-rise buildings where residents and commuters live and work. This study examines the variation in fine particulate matter (PM2.5) concentrations across building stories. PM2.5 levels were measured using PurpleAir sensors, installed between 8 April and 7 May 2023, on floors one, four, six, and nine of an office building in Chicago. Additionally, data were collected from a public outdoor PurpleAir sensor on the fourteenth floor of a condominium located 800 m away. The results show that outdoor PM2.5 concentrations peak at 14 m height, and then decline by 0.11 µg/m3 per meter elevation, especially noticeable from midnight to 8 a.m. under stable atmospheric conditions. Indoor PM2.5 concentrations increase steadily by 0.02 µg/m3 per meter elevation, particularly during peak work hours, likely caused by greater infiltration rates at higher floors. Both outdoor and indoor concentrations peak around noon. We find that indoor and outdoor PM2.5 are positively correlated, with indoor levels consistently remaining lower than outside levels. These findings align with previous research suggesting decreasing outdoor air pollution concentrations with increasing height. The study informs decision-making by community members and policymakers regarding air pollution exposure in urban settings.

Population dynamics of the long-snouted seahorse (Hippocampus guttulatus Cuvier, 1829) in the Mar Menor coastal lagoon.

A 10-year monitoring program was developed to quantify the population dynamics of the long-snouted seahorse population in the Mar Menor coastal lagoon. Based on 985 underwater visual censuses, we estimated the long-snouted seahorse (Hippocampus guttulatus Cuvier, 1829) population size in the Mar Menor lagoon and its reduction in size in the last decades, as well as the effect of eutrophication crises in 2016 and 2019 on the species. The annual recruitment for the 2013-2020 period was estimated by comparing the relative abundance of early seahorse life stages in the ichthyoplankton. The density ranged from 0.0458 specimens/m3 at the beginning of the sampling period to 0.0004 at the end, showing a statistically significant difference between the three analyzed periods (Hgl=2 = 14.0, p = 0.001). The long-snouted seahorse population from the Mar Menor lagoon exemplifies the impact of fishing activities and human pressure, especially euxinic episodes and habitat destruction. As a result of this, the Mar Menor population has decreased from several million specimens to a few thousand, in only three decades. This species showed considerable resilience, the seahorse population began to recover once fishing activity stopped. In contrast, the long-snouted seahorse showed high vulnerability to habitat loss and an episodic flooding event. Adult seahorses showed preferences for highly complex habitats, especially Caulerpa prolifera-Cymodocea nodosa mixed meadows and habitats of high complexity and anthropogenic origin, such as harbors, jetties, or breakwaters. In contrast, juvenile seahorses preferred monotonous seabeds with low complexity, such as the sandy beds that are characteristic of the Mar Menor lagoon littoral.

Concordancia entre hallazgos radiológicos y quirúrgicos en pacientes sometidos a mastoidectomía / Concordance between radiological and surgical findings in patients undergoing mastoidectomy

Introducción: Existe gran controversia acerca de los signos radiológicos de la patología de oído medio y su relación con la extensión real de la patología que nos sugiera decidir un comportamiento determinado. Objetivo: establecer la concordancia entre los hallazgos radiológicos y quirúrgicos encontrados en pacientes sometidos a mastoidectomía. Material y Método: Diseño observacional descriptivo de corte transversal de prueba diagnóstica. Se revisó fichas clínicas y se especificó el tipo de cirugía junto con los hallazgos intra-quirúrgicos. Resultados: se observó erosión de la cadena osicular intraoperatoria en 75 pacientes, 63 predichos correctamente por tomografía computada (TC), con sensibilidad del 84% y especificidad del 94% (k = 0,625). Se detectó erosión del tegmen tympani en nueve pacientes por TC de los 10, con un VPP = 90% y un VPN = 95% (k = 0,809). Hubo sospecha de erosión del canal semicircular lateral en cinco pacientes y se encontró dehiscencias intraoperatorias en 12, sin falsos positivos (k = 0,554). La TC detectó dehiscencia del canal del nervio facial con sensibilidad del 55% y especificidad del 98% (k = 0,636). Conclusión: Los resultados sugieren que la TC preoperatoria con evidencia radiológica de erosión osicular tiene una buena a muy buena concordancia con los hallazgos intraoperatorios.

Introduction: There is a great controversy about the radiological signs of middle ear pathology and its relation with the real extension of the pathology that suggests us to decide a certain medical choice. Aim: To establish concordance between radiological and surgical findings in patients submitted to mastoidectomy. Material and Method: An observational and descriptive design of retrospective cross-sectional diagnostic test. Clinical records were reviewed to specify the type of surgery and intraoperative findings. Results: Intraoperative ossicular chain erosion was observed in 75 patients, 63 were correctly predicted by computed tomography (CT), with a sensitivity of 84% and specificity of 94% (k = 0.625). Tegmen tympani erosion was detected by CT in 9 patients out of 10, with a PPV = 90% and NPV = 95% (k = 0.809). There was suspected lateral semicircular canal erosion in 5 patients and intraoperative dehiscence was found in 12, with no false positives (k = 0.554). CT detected facial nerve canal dehiscence with sensitivity of 55% and specificity of 98% (k = 0.636). Conclusion: The results suggest that preoperative CT with radiological evidence of ossicular erosion has good to very good agreement with intraoperative findings.

Prevalencia de infección por COVID-19 por serología positiva (IgG/IgM) en personal médico de la cátedra y servicio de otorrinolaringología del Hospital de Clínicas / Prevalence of COVID-19 infection by positive serology (IgG/IgM) in medical personnel of the chair and service of otorhinolaryngology of the Hospital de Clínicas

Resumen Introducción: El personal de otorrinolaringología presenta una elevada exposición al virus SARS-CoV-2, debido a los procedimientos que lleva a cabo. Es fundamental tomar las medidas de protección adecuadas. Determinar la seroprevalencia nos dará un mejor panorama sobre la exposición, contagios y efectividad de medidas de protección adoptadas. Objetivo: Determinar la prevalencia de resultados serológicos positivos en personal médico que presta servicio en la Cátedra de Otorrinolaringología de marzo del 2020 a marzo de 2021. Material y Método: Estudio observacional, descriptivo, corte transversal, retrospectivo con asociación cruzada. Muestreo no probabilístico de casos consecutivos. La población total fue de 38 médicos del Servicio de Otorrinolaringología del Hospital de Clínicas. Resultados: La media de edades fue 37,4 años, 63,5% refirió haber atendido a paciente conocido portador de COVID-19. Un 42% refirió no haber cumplido con todas las medidas de protección personal, mientras que un 23,7% de los sujetos de estudio dio positivo para IgG, interpretándose como infección previa por COVID-19. Conclusión: Más de las dos terceras partes de los médicos refirió dar consulta a paciente COVID-19 positivo. Casi la cuarta parte de los médicos resultó ser positivo para COVID-19 según la prueba de serología anti-N. No se halló asociación entre consulta ni cirugía a pacientes portadores de COVID-19 y el contagio al personal médico.

Abstract Introduction: Otolaryngology personnel have a high exposure to SARS-CoV-2 virus due to the procedures they perform. It is essential to take appropriate protective measures. Determining seroprevalence will give us a better picture of exposure, contagion and effectiveness of protective measures adopted. Aim: To determine the prevalence of positive serological results in medical staff serving in the otolaryngology department from March 2020 to March 2021. Material and Method: Observational, descriptive, cross-sectional, retrospective, retrospective study with cross-association. Non-probability sampling of consecutive cases. The total population was 38 physicians of the Otolaryngology Service of the Hospital de Clinicas. Results: The mean age was 37.4. 63.5% reported having seen a patient known to be a COVID-19 carrier, while 42% reported not having complied with all personal protection measures. A 23.68% of the study subjects tested positive for IgG, interpreting previous COVID-19 infection. Conclusion: More than two-thirds of the physicians referred to giving consultation to COVID-19 positive patients. Almost a quarter of the physicians were positive for COVID-19 according to the Anti-N serology test. No association was found between consultation or surgery of patients with COVID-19 and infection of medical personnel.

Quiste epidermoide en vallécula glosoepiglótica. Reporte de casos / Epidermoid cyst in the glossoepiglottic vallecula: case report

Resumen Los quistes laríngeos son muy infrecuentes y en su mayoría de etiología benigna. Se reportan dos casos de pacientes adultos que presentaron lesiones quísticas en vallécula glosoepiglótica con diagnóstico histológico de quiste epidermoide. Los quistes epidermoides en vallécula pocas veces han sido reportados en la literatura, pueden ser asintomáticos o por su localización producir síntomas como sensación de ocupación faríngea, tos o incluso dificultad respiratoria.

Abstract Laryngeal cysts are very infrequent and mostly benign. Two cases are presented of adult patients who presented cystic lesions in the glossoepiglottic vallecula with histological diagnosis of epidermoid cyst. Epidermoid cysts in vallecula have rarely been reported in the literature, they can be asymptomatic or due to their location produce symptoms such as pharyngeal occupation sensation, cough or even respiratory difficulty.

Teleconsulta en otorrinolaringología durante la pandemia por COVID-19, nuestra experiencia. Hospital de Clínicas. San Lorenzo, Paraguay 2020

Resumen Introducción: La teleconsulta puede ser de utilidad para evitar exposición de pacientes y optimizar recursos y dirigir a los que se consideran prioridad para atención presencial. Objetivo: Valorar el grado de satisfacción de la atención por teleconsulta en el Servicio de Otorrinolaringología del Hospital de Clínicas, San Lorenzo, durante julio de 2020. Material y Método: Diseño observacional, descriptivo, corte transversal, retrospectivo, muestreo probabilístico aleatorio simple. Se realizó encuestas sobre la calidad de atención por teleconsulta. Resultados: Se contactó 86 pacientes, 78 participaron. Edad promedio 32,2 años, 58,97% mujeres. 73% era de zona urbana, 27% rural. Los motivos de consulta más frecuentes fueron obstrucción nasal, hipoacusia y molestia en garganta. Un 66,67% no requirió ayuda para la consulta. 74,35% evitó asistir al médico durante la pandemia, el 51,72% por prevención o miedo. El 51,28% refirió empeoramiento de su dolencia durante la cuarentena. Se registró un alto nivel de satisfacción de la atención (9,41 ± 1,3). Un 82% refirió que esta modalidad puede ser implementada como opción, aunque el 70,5% requirió consulta presencial. Conclusión: La mayoría de los pacientes se encontraba en rango etario económicamente activo. La mayor parte de los pacientes no necesitó ayuda para acceder a la teleconsulta, reflejando la facilidad de acceso a esta. La teleconsulta disminuyó la necesidad de consulta presencial, el grado de aceptación del sistema de teleconsulta es elevada, traducidos en los altos índices de satisfacción y aceptación de la modalidad.

Abstract Introduction: Teleconsultation can be useful as a triage to prevent patient exposure to the COVID-19 virus, classifying infectious ones and perfecting hospital resources, to direct those considered priority for face-to-face care. Aim: To assess the degree of satisfaction of teleconsultation care. Material and Method: Observational design study, descriptive, cross-sectional, retrospective, simple random probabilistic sampling. Surveys were conducted on the quality of care of the teleconsultation service during July 2020. Results: 86 patients were contacted, 78 were surveyed. The average age was 32.2 years, 58.97% was female. 73% came from Asunción and metropolitan area, 27% of rural areas. Most common reasons for consultation were nasal obstruction, hearing loss and throat discomfort. 66.67% did not require help in carrying out the consultation. 74.35% avoided attending the doctor during the pandemic. 51.72% (30) for prevention or fear of infection. 51.28% reported worsening of their ailment during quarantine. There was an important level of attention satisfaction (9.41 ± 1.3). 82% reported that this mode of care can be implemented as an option in the service, although 70.5% require a face-to-face consultation. Conclusion: Most of the patients were in the economically active age range. Most of the patients did not required help for teleconsultation reflecting the ease of access to it. Teleconsultation reduced the need for face-to-face consultation, the degree of acceptance of the teleconsultation system is high, translated into the high rates of satisfaction and acceptance of the modality.

Developmental landmarks during floral ontogeny of jalapeño chili pepper (Capsicum annuum L.) and the effect of gibberellin on ovary growth.

Pepper (Capsicum annuum L.) is an important horticultural crop in many regions of the world. The final shape and size of the fruit are known to be determined at a very early step of flower development. During flower development hormonal treatments using gibberellins seem to promote growth resulting in higher yield and fruit quality. However, the morphological changes that occur in the pepper flowers after these treatments are largely unknown. In the present study, we provide a description of floral development landmarks of jalapeño chili pepper (cultivar Huichol), divided in nine representative stages from its initiation until the opening of the bud. We established a correlation among external flower development and the time and pattern of reproductive organogenesis. Male and female gametogenesis progression was used to define specific landmarks during flower maturation. The pattern of expression of key genes involved in gibberellin metabolism and response was also evaluated in the nine flower stages. The proposed development framework was used to analyze the effect of gibberellin treatments in the development of the flower. We observed both an effect of the treatment in the histology of the ovary tissue and an increase in the level of expression of CaGA2ox1 and CaGID1b genes. The developmental stages we defined for this species are very useful to analyze the molecular and morphological changes after hormonal treatments.

Conjuntivitis recurrente de causa no aclarada. ¿Hipertiroidismo? / Recurrent conjunctivitis of unknown origin. Hyperthyroidism?

El hipertiroidismo en la infancia es muy infrecuente; en la mayoría de los casos es de origen autoinmune (enfermedad de Graves). La tríada clásica se compone de bocio, oftalmopatía y dermatopatía. Su presentación clínica en la edad pediátrica es muy variable y de comienzo habitualmente insidioso, lo que en muchas ocasiones conlleva una demora en el diagnóstico y tratamiento. Presentamos el caso de una paciente de 12 años que consulta por una conjuntivitis crónica bilateral refractaria a tratamientos tópicos habituales, que finalmente fue derivada al Servicio de Endocrinología Pediátrica ante la sospecha de oftalmopatía de Graves (AU)

Hyperthyroidism in childhood is a very rare condition, and in most cases of autoimmune etiology (Graves’ disease). The classic triad consists of goiter, ophthalmopathy and dermopathy. Clinical presentation in children is highly variable and often with an insidious onset, which on many occasions may cause a delay on its diagnosis and treatment. A case is reported here where a 12-year-old patient, who showed a refractory bilateral chronic conjunctivitis refractary to topical usual treatments, was finally referred to the Pediatric Endocrinology Department due to the likelihood of her suffering from Graves' ophthalmopathy (AU)

Biometría etmoidal realizada por tomografía computarizada / Biometrics ethmoid by Computed Tomography

Introducción: El etmoides, en los últimos 20 años adquirió relevancia para anatomistas, clínicos, neurocirujanos y otorrinolaringólogos, por el desarrollo de técnicas quirúrgicas endoscópicas y múltiples variantes anatómicas que presenta. Objetivo: Este trabajo fue elaborado con el objetivo de establecer en nuestra muestra la profundidad del techo etmoidal predominante por sexo en población estudiada; frecuencia con la que se presenta simetría en el techo etmoidal; frecuencia con la que se encuentran celdas supraorbitarias en población estudiada; por último, se pretende establecer percentiles por sexo de dimensiones del etmoides en población adulta. Material y método: Estudio observacional descriptivo de corte transverso en el que se realizó revisión retrospectiva, consecutiva de tomografías de senos paranasales en cortes axiales, coronales y sagitales de pacientes mayores de 20 años, del Departamento de Radiología de los Hospitales, de Clínicas, del IPS, del Regional de Luque, Clínica Iribas y del Instituto Radiológico Calvo, Asunción, Paraguay. Resultados: Se encontró que la profundidad del techo etmoidal fue de Keros II en ambos sexos y ambas fosas nasales; se encontró simetría en el 60%; celdas supraorbitarias se encontraron en el 27,5% de casos. Conclusiones: Mediciones realizadas por tomografía computarizada en etmoides de pacientes que participaron del estudio, no difieren de las mediciones realizadas por otros autores. Estos resultados contribuyen a mejorar conocimientos de variantes anatómicas propias de nuestra población para difundirlos, ponerlos en práctica y mejorar la experiencia en el manejo integral de pacientes con patologías médico-quirúrgicas de senos paranasales.

Introduction: The ethmoid is a structure that has become relevant for anatomists, clinicians, neurosurgeons and otolaryngologists due the great development of endoscopic surgical techniques and multiple anatomic variants. Aim: This work was developed with the goal of establishing in our sample studied, depth of ethmoid roof, predominant by gender; frequency with which symmetry in ethmoid roof is presented, and frequency with which supraorbital cells is in sample studied. Finally, the study is aimed to establish percentages by gender, the dimensions of the ethmoid on adult population. Material and methods: The cross-sectional, descriptive observational study in which retrospective review was performed consecutively, tomographic studies of the paranasal sinuses in axial, coronal and sagittal on patients over 20 years old at the Radiology Department of the Hospitals, Clinics, IPS, Regional in Luque, Iribas Clinical Institute, and Calvo Radiological Institute. Results: The studies performed revealed that the depth of the ethmoid roof was Keros II in both genders and both nostrils, the symmetry was found in 60%, the supraorbital cells were found in 27.5% of both cases. Conclusions: Measurements by computed tomography in ethmoid bone of patients who participated in this study do not differ from the measurements performed by other authors.

[A case of breast necrosis]. / Un cas de nécrose mammaire.

We describe a case of a tumor-like lesion of the breast of a 45-year-old woman. The initial presentation is a persistent breast abscess after three courses of antibiotics. The association with multiple lung nodules suggests a presumed diagnosis of metastatic carcinoma. Fine needle biopsies of breast and pulmonary nodule reveal necrotic tissue without any evidence of malignancy. Systemic symptoms appear after three weeks of evolution : fever, spread cutaneous ulcers, livedo reticularis, arthralgias. The final diagnosis is made on both mastectomy sample analysis demonstrating necrotizing granulomatous vasculitis and presence of antineutrophil antibodies, thus defining Wegener granulomatosis, which initial involvement on the breast is very atypical.

Influence of the food to microorganisms (F/M) ratio and temperature on batch anaerobic digestion processes with and without zeolite addition.

The main objective of this work was to evaluate the influence of the food to microorganisms (F/M) ratio and temperature on batch anaerobic digestion processes carried out with and without zeolite addition as a microbial carrier. Three laboratory-scale experimental runs were conducted using a synthetic substrate with a COD:N:P ratio of 500:5:1. The first run (I) was conducted at a constant temperature of 27°C, increasing the F/M ratio from 0.21 to 0.40 (g COD/g VSS). During the second run (II) the temperature and the F/M ratio increased from 27°C to 37°C and from 0.21 to 0.40, respectively. Finally, in the third experimental run (III) the F/M ratio achieved high values (1.92 and 1.30) either by varying the substrate concentration at a constant biomass concentration or by increasing the biomass concentration at a constant substrate concentration. Higher biomass growth rate, COD removal and methane production were found in the reactors with zeolite, especially at the highest F/M assayed during the first run. The highest ammonium removals were also achieved at the highest F/M ratio (0.40) in the reactors with zeolite. Within the range studied (25°C-37°C) in the reactors with zeolite operating at 37°C, the second run demonstrated the low influence of temperature on substrate consumption and ammonia removal, with 93% and 70% of COD and ammonia removal efficiencies, respectively. The third run corroborated the results previously obtained and fit the experimental results to simple kinetic models, the Monod model being the most adequate for predicting the behavior of the systems studied. The maximum specific microorganism growth rate (µ(max)) values for the reactors with zeolite were almost twice as high as those obtained for the reactors without zeolite for similar F/M ratios.

The value of a formula including haematocrit, blood urea and gender (HUGE) as a screening test for chronic renal insufficiency.

INTRODUCTION: Despite increasing use in clinical practice, an estimated glomerular filtration rate value (eGFR) of <60 ml/min/1.73 m2 does not necessarily indicate the existence of chronic renal insufficiency (CRI) and this may lead to an over-estimate of CRI particularly in persons seventy years or older. AIM: To find a screening test able to differentiate CRI from the decrease in GFR normally associated with the renal ageing process. METHODS: Medical information of 487 individuals of both sexes aged 16-102 was obtained from nephrologists, internal medicine physicians, cardiologists, geriatricians, family and nuclear medicine doctors from Argentina, Portugal and Spain. Data were assessed and statistically analysed using logistic regression techniques. From the discriminative variables it was derived the HUGE formula. RESULTS: A formula including haematocrit , blood urea, and gender (HUGE), diagnoses CRI regardless of the variables of age, blood creatinine, creatinine clearance, or other eGFR. The HUGE formula is: L = 2.505458 - (0.264418 x Hematocrit) + (0.118100 x Urea) [+ 1.383960 if male]. If L is a negative number the individual does not have CRI; if L is a positive number, CRI is present. Our data demonstrate that the HUGE formula is more reliable than MDRD and CKD-EPI, particularly in persons aged over 70. CONCLUSIONS: Our HUGE screening formula offers a straightforward, easily available and inexpensive method for differentiating between CRI and eGFR < 60 ml/min/1.73 m2 that will prevent a considerable number of aged healthy persons, as much as 1.700.000 in Spain and 2.600.000 in U.K., to be excluded from clinical assays or treatments contraindicated in CRI.

Persistent microalbuminuria after treatment with renin-angiotensin axis blockers: causes and results of treatment intensification.

AIMS: The first phase of this study aimed to determine the causes of persistent microalbuminuria after treatment with renin-angiotensin axis (RAA) blocking drugs. In a second phase we tried to determine if strict control of blood pressure and intensive RAA blockade could induce remission or reduction of microalbuminuria in clinical (primary care) practice. PATIENTS AND METHODS: The study included both diabetic patients and non-diabetic hypertensive patients treated with RAA drugs in the presence of microalbuminuria. 211 patients were recruited (mean age 66.6±11.3 years, 111 men, 117 were diabetic). In the first phase treatment was optimized at standard doses. In the second phase treatment was increased during a three months period to reach a blood pressure (BP) < 130/80 mmHg by adding other antihypertensive treatment and to obtain maximal RAA blockade using long-acting drugs, increased dosage, or adding further medication at night. RESULTS: Initial mean BP was 141±16/81±11 mmHg. BP control was unsatisfactory (control of systolic blood pressure [SBP] 19.3%; diastolic blood pressure [DBP] 37.6%). Dosage of RAA blocking drugs was inadequate in 21% of patients. Only 27.4% of patients were taking antihypertensive drugs at night. 30.1% of patients took once daily short acting drugs. During the studymean SBP was reduced to 137±13 mmHg (p < .001) and DBP decreased to 79±10 mmHg (p < .001). Control of SBP improved to 24.5% and DBP control went to 44.4%. Mean microalbuminuria decreased from 64.4±47.0 mg/day to 50.1±53.0 mg/day (p < .001) and the prevalence of microalbuminuria was reduced to 59.1%. CONCLUSIONS: Persistent microalbuminuria was associated with poor blood pressure control and inadequate drug dosage. Low frequency of administration of drugs at night and inappropriate once-daily pills intake were frequent. Strict control of blood pressure and intensive RAA blockade significantly reduced the prevalence of microalbuminuria.

Cirugía en el papiloma invertido nasal / Surgery for the inverting nasal papilloma

Tumor benigno que afecta fosas nasales y senos paranasales; histológicamente se clasifica enoncocitico, invertido y fungiforme. Los signos y síntomasson obstrucción nasal unilateral, rinorrea, cefalea, epistaxis,anosmia. El diagnostico de certeza es por anatomíapatológica; se utilizan además métodos de diagnosticopor imagen para determinar la extensión tumoral. Existecierto porcentaje de asociación de esta patología al carcinomaescamoso. El tratamiento es quirúrgico. objetivos:Evaluar las características clínicas y quirúrgicas de papilomas invertidos operados en la Cátedra de ORL del Hospital de Clínicas de la Facultad de Ciencias Médica UNA. materiales y métodos: En este trabajo de carácter observacional y descriptivo se estudiaron los casos depapiloma invertido operados en el Hospital de Clínicasentre los años 1994 al 2008, mediante revisión de fichasde casos consecutivos, analizando las cirugías realizadas.resultados: 30 casos de los cuales la mayoría fue de estadio II y III de Krause, con una recidiva global del 30%con una malignización del 17%. discusión: En esta serie de pacientes se vio tumores con poca extensión pero con una transformación maligna presente, elevándolos al estadio IV de Krause. conclusión: Se sugiere intentar la mayor radicalidad posible siempre con el total consentimiento y conocimiento del paciente.

Cystatin C and blood pressure: results of 24 h ambulatory blood pressure monitoring.

BACKGROUND: The relationship between kidney function and blood pressure (BP) components has been studied in chronic kidney disease patients. Whether cystatin C, a marker of kidney function, is associated in the normal range with systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) obtained using ambulatory blood pressure monitoring has not been previously studied. METHODS: The sample subjects were 53 males and 34 females, mean age was 59.3+/-13.5 years. 76% were receiving antihypertensive drug treatment. Kidney function was evaluated by measuring serum cystatin C. Microalbuminuria was measured in a 24h urine collection. Glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease equations. The ambulatory BP was measured non-invasively for 24h by the Spacelab devices programmed to measure BP every 15 min during daytime and every 20 min during nighttime. RESULTS: The highest quartile of cystatin C distribution showed an older age and worsel parameters of renal function (cystatin C, serum creatinine and GFR) than the other groups. No differences for gender or diabetes were found. 24h SBP and PP were higher in the fourth quartile compared to the fist one (p<0.01). 24h DBP was lower for the patients in the fourth quartile of cystatin C compared which any one of the other groups (p<0.001). The relationship between cystatin C, as well as GFR, with SBP and PP was statistically significant as renal function comes down. Contrariwise, as cystatin C increases DBP declines; but the correlation with GFR measured through MDRD 4 is not significant. In the same way, no correlation was found for GFR and microalbuminuria, but there was a statistically significant positive relationship between cystatin C and microalbuminuria severity (p<0.01). Multivariate regression analysis confirms these findings. CONCLUSIONS: Both SBP and pulse pressure were significantly associated with kidney function. DBP was negatively correlated with cystatin C concentrations but not with GFR. Cystatin C shows a positive relationship with microalbuminura severity. Cystatin C might have cardiovascular effects beyond its use as a marker of the renal function.

Cirugía en el papiloma invertido nasal / Surgery in the inverted papillomas of the nose

Introducción: El papiloma invertido es un tumor benigno que afecta fosas nasales y senos paranasales; histológicamente se clasifica en oncocítico, invertido y fungiforme. Los signos y síntomas son obstrucción nasal unilateral, rinorrea, cefalea, epistaxis, anosmia. El diagnóstico de certeza es por anatomía patológica; se utilizan además métodos de diagnóstico por imagen para determinar la extensión tumoral. Existe cierto porcentaje de asociación de esta patología al carcinoma escamoso. El tratamiento es quirúrgico. Objetivo: Evaluar las características clínicas y quirúrgicas de papilomas invertidos operados en la Cátedra de ORL del Hospital de Clínicas de la Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Paraguay (UNA). Material y método: En este trabajo de carácter observacional y descriptivo se estudiaron los casos de papiloma invertido operados en el Hospital de Clínicas entre los años 1994 a 2008, mediante revisión de fichas de casos consecutivos, analizando las cirugías realizadas. Resultados: Treinta casos de los cuales la mayoría fue de estadio II y III de Krause, con una recidiva global del 30 por ciento con una malignización del 17 por ciento. Discusión: En esta serie de pacientes se vio tumores con poca extensión pero con una transformación maligna presente, elevándolos al estadio IV de Krause. Conclusión: Se sugiere intentar la mayor radicalidad posible siempre con el total consentimiento y conocimiento del paciente.

Introduction: Inverted papilloma is a benign tumor that affects nasal cavity and Para nasal sinuses; histologically classified as oncecitas, inverted papillomas and fundiform or exophytic. Signs and symptoms include unilateral nasal obstruction, rhino rhea, headache, epitasis, and anosmia. The certainty diagnosis is given by pathology and in diagnosis are used imaging methods to determine the extent of the tumor. There is a certain percentage of association of this pathology with squamous carcinoma. The treatment is surgical. Aim: To evaluate the clinical and surgical characteristics of inverted papillomas that were operated in the Department of ENTin the Hospital School of Medical Sciences, UNA. Material and method: In this observational and descriptive work were studied cases of inverted papilloma operated at the Hospital from 1994 to 2008, by reviewing records of consecutive cases and analyzing the surgeries performed. Results: 30 cases in which the majority were Stage II and III of Krause, with an overall of 30 percent, relapse with a malignancy of 17 percent. Discussion: In this series of patients we observed tumors with low extension but with malignant transformation which elevated them to stage IVKrause. Conclusión: We suggest trying the most radical possible surgery provided with the fuII consent and knowledge of the patient.

Symmetrical ambulatory arterial stiffness index: relationship with microalbuminuria and renal function.

OBJECTIVE: The aim of this study was to investigate the arterial stiffness parameters derived from the proposed linear relationship between SBP and DBP obtained by ABPM, regarding its relationships with two markers of renal disease, microalbuminuria and renal function. DESIGN AND METHODS: One hundred and sixty six patients were studied: 73 males and 93 females mean age 55.2+/-15.5 years. 36.2% were receiving antihypertensive drug treatment. Microalbuminuria was measured in 24-h urine collection as well as albumin to creatinine ratio (ACR) in first morning urine. The ambulatory BP was measured non-invasively for 24 h by the Spacelab devices. RESULTS: Correlation test showed a significant relationship of Sym-AASI with age (p<0.001), serum creatinine (p=0.038), creatinine clearance (-0.423, p<0.001) and GFR (-0.263, p<0.001). On the other hand AASI was also correlated with age (p<0.001) and creatinine clearance (p=0.012), but not with the other parameters studied. 24-h albumin excretion rate was not correlated with Sym-AASI or AASI. Contrariwise, the albumin to creatinine ratio was correlated with Sym-AASI (p=0.013). As expected, AASI and Sym-AASI increase as severity of renal diseases grows. The patients in the highest quartile of Sym-AASI distribution showed an older age (p<0.001) and worse parameters of renal function (GFR, p<0.001; and creatinine clearance, p<0.008). CONCLUSIONS: Sym-AASI, an improved method for detecting arterial stiffness, seems to get an independent relationship with these parameters of renal disease which could not be detected with AASI.