Blefaroplastia biplanar de párpado inferior. Técnica Lima / Double-plane lower eyelid blepharoplasty. Lima technique

Introducción y objetivo: Cuando la cirugía de rejuvenecimiento de párpado inferior implica resección significativa de piel, el riesgo de ocasionar exposición escleral (scleral show) como secuela es alto, razón por la que la mayoría de autores recomiendan ser muy prudentes en las escisiones de piel.En nuestra opinión, no hay una técnica mayoritariamente aceptada para los casos en los que es necesaria una resección cutánea amplia, motivo por el que proponemos la Técnica Lima.Material y métodos.La Técnica Lima, tras revisar la fisiopatología de la exposición escleral, propone como punto principal del nuevo diseño preservar el paralelismo de los fascículos musculares del parpado inferior al resecar el colgajo miocutáneo.Resultados.En nuestra revisión de 285 pacientes, la técnica propuesta permitió resección de piel de párpado inferior de entre 8 a 12 mm, sin riesgo de exposición escleral.Conclusiones.El diseño de la Técnica Lima permite mayor seguridad en la resección amplia de piel de párpado inferior en la cirugía de rejuvenecimiento palpebral. (AU)

Bacground and objective: When performing lower eyelid rejuvenation surgery that involves significant skin resection, the risk of causing scleral show as a consequence is high; so, most authors recommend being overly cautious in skin excision.In our opinion, there is no widely accepted technique for wide skin resections, and for this reason, we propose the Lima Technique to solve this problem.Methods.The Lima Technique, after having reviewed the pathophysiology of the scleral show, proposes as the main condition of the new design, the preservation of the parallelism of the muscular fascicles of the lower eyelid when resecting the myocutaneous flap.Results.In our revision of 285 patients, the proposed technique allowed lower eyelid skin resection between 8 to 12 mm, without the risk of causing a scleral show.Conclusions.The new design of the Lima Technique gave us total safety when performing wide resections of lower eyelid skin in eyelid rejuvenation. (AU)

Usage of EpiFinder clinical decision support in the assessment of epilepsy.

BACKGROUND: The diagnosis of epilepsy is at times elusive for both neurologists and nonneurologists, resulting in delays in diagnosis and therapy. The development of screening methods has been identified as a priority in response to this diagnostic and therapeutic gap. EpiFinder is a novel clinical decision support tool designed to enhance the process of information gathering and integration of patient/proxy respondent data. It is designed specifically to take key terms from a patient's history and incorporate them into a heuristic algorithm that dynamically produces differential diagnoses of epilepsy syndromes. OBJECTIVE: The objective of this study was to test the usability and diagnostic accuracy of the clinical decision support application EpiFinder in an adult population. METHODS: Fifty-seven patients were prospectively identified upon admission to the Epilepsy Monitoring Unit (EMU) for episode classification from January through June of 2017. Based on semiologic input, the application generates a list of epilepsy syndromes. The EpiFinder-generated diagnosis for each subject was compared to the final diagnosis obtained via continuous video electroencephalogram (cVEEG) monitoring. RESULTS: Fifty-three patients had habitual events recorded during their EMU stay. A diagnosis of epilepsy was confirmed (with cVEEG monitoring) in 26 patients while 27 patients were found to have a diagnosis other than epilepsy. The algorithm appropriately predicted differentiation between the presence of an epilepsy syndrome and an alternative diagnosis with 86.8% (46/53 participants) accuracy. EpiFinder correctly identified the presence of epilepsy with a sensitivity of 86.4% (95% confidence interval [CI]: 65.0-97.1) and specificity of 85.1% (95% CI: 70.2-96.4). CONCLUSION: The initial testing of the EpiFinder algorithm suggests possible utility in differentiating between an epilepsy syndrome and an alternative diagnosis in adult patients.

Estimating national landfill methane emissions: an application of the 2006 Intergovernmental Panel on Climate Change Waste Model in Panama.

This paper estimates national methane emissions from solid waste disposal sites in Panama over the time period 1990-2020 using both the 2006 Intergovernmental Panel on Climate Change (IPCC) Waste Model spreadsheet and the default emissions estimate approach presented in the 1996 IPCC Good Practice Guidelines. The IPCC Waste Model has the ability to calculate emissions from a variety of solid waste disposal site types, taking into account country- or region-specific waste composition and climate information, and can be used with a limited amount of data. Countries with detailed data can also run the model with country-specific values. The paper discusses methane emissions from solid waste disposal; explains the differences between the two methodologies in terms of data needs, assumptions, and results; describes solid waste disposal circumstances in Panama; and presents the results of this analysis. It also demonstrates the Waste Model's ability to incorporate landfill gas recovery data and to make projections. The former default method methane emissions estimates are 25 Gg in 1994, and range from 23.1 Gg in 1990 to a projected 37.5 Gg in 2020. The Waste Model estimates are 26.7 Gg in 1994, ranging from 24.6 Gg in 1990 to 41.6 Gg in 2020. Emissions estimates for Panama produced by the new model were, on average, 8% higher than estimates produced by the former default methodology. The increased estimate can be attributed to the inclusion of all solid waste disposal in Panama (as opposed to only disposal in managed landfills), but the increase was offset somewhat by the different default factors and regional waste values between the 1996 and 2006 IPCC guidelines, and the use of the first-order decay model with a time delay for waste degradation in the IPCC Waste Model.