Transcriptional regulation of esophageal, intestinal, and branchial solute transporters by salinity, growth hormone, and cortisol in Atlantic salmon.

In marine habitats, Atlantic salmon (Salmo salar) imbibe seawater (SW) to replace body water that is passively lost to the ambient environment. By desalinating consumed SW, the esophagus enables solute-linked water absorption across the intestinal epithelium. The processes underlying esophageal desalination in salmon and their hormonal regulation during smoltification and following SW exposure are unresolved. To address this, we considered whether two Na+ /H+ exchangers (Nhe2 and -3) expressed in the esophagus contribute to the uptake of Na+ from lumenal SW. There were no seasonal changes in esophageal nhe2 or -3 expression during smoltification; however, nhe3 increased following 48 h of SW exposure in May. Esophageal nhe2, -3, and growth hormone receptor b1 were elevated in smolts acclimated to SW for 2.5 weeks. Treatment with cortisol stimulated branchial Na+ /K+ -ATPase (Nka) activity, and Na+ /K+ /2Cl- cotransporter 1 (nkcc1), cystic fibrosis transmembrane regulator 1 (cftr1), and nka-α1b expression. Esophageal nhe2, but not nhe3 expression, was stimulated by cortisol. In anterior intestine, cortisol stimulated nkcc2, cftr2, and nka-α1b. Our findings indicate that salinity stimulates esophageal nhe2 and -3, and that cortisol coordinates the expression of esophageal, intestinal, and branchial solute transporters to support the SW adaptability of Atlantic salmon.

Wild Zebrafish Sentinels: Biological Monitoring of Site Differences Using Behavior and Morphology.

Environmental change poses a devastating risk to human and environmental health. Rapid assessment of water conditions is necessary for monitoring, evaluating, and addressing this global health danger. Sentinels or biological monitors can be deployed in the field using minimal resources to detect water quality changes in real time, quickly and cheaply. Zebrafish (Danio rerio) are ideal sentinels for detecting environmental changes due to their biomedical tool kit, widespread geographic distribution, and well-characterized phenotypic responses to environmental disturbances. Here, we demonstrate the utility of zebrafish sentinels by characterizing phenotypic differences in wild zebrafish between two field sites in India. Site 1 was a rural environment with flowing water, low-hypoxic conditions, minimal human-made debris, and high iron and lead concentrations. Site 2 was an urban environment with still water, hypoxic conditions, plastic pollution, and high arsenic, iron, and chromium concentrations. We found that zebrafish from Site 2 were smaller, more cohesive, and less active than Site 1 fish. We also found sexually dimorphic body shapes within the Site 2, but not the Site 1, population. Advancing zebrafish sentinel research and development will enable rapid detection, evaluation, and response to emerging global health threats.

Nanocochleates containing N-Octylglicoside extracted Vibrio cholerae antigens elicited high vibriocidal antibodies titers after intragastric immunization in a mice model.

Biological detergents are used in research laboratories, to extract or solubilize proteins from cell membranes. In order to evaluate the ability to extract antigens from the bacterial cell surface of the wild Vibrio cholerae strain C7258 and study their immunogenic potential by forming proteoliposomes and cochleate and preserving their immunogenicity, the non-ionic detergent, n-Octylglucoside (n-OG), and the Zwitterionic detergent (3-cholamidopropyl dimethylammonio 1-propanesulfonate; CHAPS) were tested in concentrations between 5 and 15%. The anionic detergent sodium deoxycholate (DOC) was used as a reference. Electrophoretic, immunochemical and electron microscopy techniques have characterized the extracts and their chromatographic fractions. With CHAPS and n-OG detergents in concentrations between 5 and 15%, a higher yield was obtained in the extraction of proteins and lipopolysaccharides (LPS) and other components from the bacterial surface compared to 10% DOC. When using 10% DOC, 15% CHAPS and n-OG between 5 and 15%, stable proteoliposomes were formed, of average size between 82 and 93 nm in diameter, with known proportions of proteins, LPS and other components. In some of the concentrations, liposomes were formed with almost pure proteins. Some cholera outer membrane proteins like the 17 kDa protein, which corresponds to the mannose-sensitive hemagglutinin (MSHA), which mediates the adhesion to the brush border of the small intestine and the outer membrane protein U (OMPU) were identified with monoclonal antibodies (mAbs) and purified. The fundamental components of liposomes, proteins and LPS, retained their molecular weights, when compared with known standards and by processing programs of electrophoretic profiles and their antigenicity, without alterations due to the extraction procedure, as could be verified by immune identification techniques with monoclonal antibodies in the case of LPS, significant antigens in this pathogen. The main purpose of the present work was to show that a new anticholera vaccine formulation based on cochleates, containing selected protein and LPS fraction extracted by detergents, is able to elicit protective high titers of bactericidal antibodies after intragastric immunization in the mice model. The objective was achieved.

An Evidence-Based Review of Overuse Wrist Injuries in Athletes.

Overuse wrist injuries are a common problem in athletes and can be related to tendinopathies or osteoarticular pathology. Fortunately, athletes rarely miss time from their sport due to these conditions because many can be treated nonoperatively. For refractory cases, there often is a curative surgical procedure that can be done during the off-season.

Scaphoid Fractures in Athletes.

Scaphoid fractures are common injuries in athletes. Most can be treated with cast immobilization, with an expected rate of union of 90% to 95%. Cast treatment, however, has the disadvantages of longer immobilization time, joint stiffness, reduced grip strength, and longer time to return to manual work or athletics. Closed reduction and percutaneous screw fixation generally are preferred in athletes to allow a quicker return to sport; if closed reduction cannot be obtained, open reduction and internal fixation may be required.

Collective Behavior in Wild Zebrafish.

Anthropogenic change is expected to alter environments at alarming rates. To predict the impact of modified environments on social behavior, we must study the relationship between environmental features and collective behavior in a genetically tractable model, zebrafish (Danio rerio). Here, we conducted a field study to examine the relationship between salient environmental features and collective behavior in four populations of zebrafish. We found zebrafish in flowing water formed volatile groups, whereas those in still water had more consistent membership and leadership. Groups in fast-flowing water were large (up to 2000 fish) and tightly knit with short nearest neighbor distances, whereas group sizes were smaller (11 fish/group) with more space between individual fish in still and slow-flowing water. These observations point to a possible profound role of water flow in influencing collective behavior in wild zebrafish.

Interaction with Cartilage Increases the Viscosity of Hyaluronic Acid Solutions.

Injection of hyaluronic acid (HA) viscosupplements is a prevalent treatment for patients suffering from mild to moderate osteoarthritis. The efficacy of these supplements is attributed to increased synovial fluid viscosity, which leads to improved lubrication and reduced pain. Therefore, viscosity is a key parameter to consider in the development of HA supplements. HA localizes near the cartilage surface, resulting in a viscosity gradient with heightened viscosity near the surface. Traditional rheological measurements confine HA between metal fixtures and therefore do not capture the effect of HA localization that occurs on cartilage. In these experiments, we investigate the effect of modifying rheometer fixtures with cartilage surface coatings on the effective viscosity of HA solutions. Our results demonstrate up to a 20-fold increase in effective viscosity when HA was confined between cartilage surfaces compared to steel surfaces. For low-molecular-weight HA, the effective viscosity was dependent on the gap height between the rheometer plates, which is consistent with the formation of a viscous boundary film. Together, these results indicate that this method for assessing HA viscosity may be more relevant to lubrication than traditional methods and may provide a more accurate method for predicting the viscosity of HA viscosupplements in vivo where HA is able to interact with the cartilage surface.

Integrable Floquet Hamiltonian for a Periodically Tilted 1D Gas.

An integrable model subjected to a periodic driving gives rise generally to a nonintegrable Floquet Hamiltonian. Here we show that the Floquet Hamiltonian of the integrable Lieb-Liniger model in the presence of a linear potential with a periodic time-dependent strength is instead integrable and its quasienergies can be determined using the Bethe ansatz approach. We discuss various aspects of the dynamics of the system at stroboscopic times and we also propose a possible experimental realization of the periodically driven tilting in terms of a shaken rotated ring potential.

Dynamics of Synovial Fluid Aggregation under Shear.

The synovial fluid (SF) that lubricates articular joints exhibits complex rheological and tribological properties due to the interactions and behaviors of its various molecular components. Under shear, SF films abruptly thicken by more than 300% and large, dense aggregates form within the fluid. In this study, we used the Surface Force Apparatus to elucidate which SF components are involved in this shear-induced transformation by (i) determining which (if any) of all major SF components replicate the behavior of SF under shear and (ii) observing the effect of removing implicated components from SF by enzymatic digestion. While most previous studies of SF have focused on the tribological roles of lubricin or hyaluronic acid, our results indicate that albumin is a key contributor to the formation of aggregates in SF under shear. Our results also suggest that SF aggregation is associated with efficient surface protection against wear. As our findings are based on experiments involving rigid, nonporous surfaces, they may be used to investigate shear-mediated aggregation mechanisms occurring during the lubrication of artificial joints, ultimately advancing our current vision of implant design.

Extraskeletal Myxoid Chondrosarcoma of the Midfoot Presenting as Charcot Arthropathy: A Case Report.

CASE: Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue malignancy that very seldomly presents in the foot or ankle and as a result is not commonly in the differential of patients presenting with foot pain. We cite a case of EMC presenting in the atypical location of the midfoot. Because of its location and similarities, this tumor was initially misdiagnosed and mistreated by multiple medical providers as midfoot Charcot arthropathy. CONCLUSIONS: Neoplastic etiologies, including EMC, should remain in the differential for atypical, refractory foot pain that presents in a manner similar to Charcot foot.

Boundary mode lubrication of articular cartilage with a biomimetic diblock copolymer.

We report the design of a diblock copolymer with architecture and function inspired by the lubricating glycoprotein lubricin. This diblock copolymer, synthesized by sequential reversible addition-fragmentation chain-transfer polymerization, consists of a cationic cartilage-binding domain and a brush-lubricating domain. It reduces the coefficient of friction of articular cartilage under boundary mode conditions (0.088 ± 0.039) to a level equivalent to that provided by lubricin (0.093 ± 0.011). Additionally, both the EC50 (0.404 mg/mL) and cartilage-binding time constant (7.19 min) of the polymer are comparable to purified human and recombinant lubricin. Like lubricin, the tribological properties of this polymer are dependent on molecular architecture. When the same monomer composition was evaluated either as an AB diblock copolymer or as a random copolymer, the diblock effectively lubricated cartilage under boundary mode conditions whereas the random copolymer did not. Additionally, the individual polymer blocks did not lubricate independently, and lubrication could be competitively inhibited with an excess of binding domain. This diblock copolymer is an example of a synthetic polymer with lubrication properties equal to lubricin under boundary mode conditions, suggesting its potential utility as a therapy for joint pathologies like osteoarthritis.

Desarrollo de lenguaje en niños con implante coclear en centro terciario de salud: serie clínica / Language development in children with cochlear implant at a tertiary health care center: clinical series

Resumen Introducción: Desde la década de los 90, los implantes cocleares han progresado desde aplicaciones experimentales a un uso clínico estandarizado en niños con pérdida auditiva severa y profunda. Las investigaciones han producido cambios en la tecnología de los implantes y ha dado lugar a la expansión de los candidatos a implante para incluir a los niños menores de 2 años de edad. El objetivo principal de la implantación coclear pediátrica es facilitar el desarrollo del lenguaje hablado. A pesar de los avances en la tecnología de implantes y los cambios en el manejo de la pérdida auditiva, los resultados de lenguaje en niños son todavía muy variables, participando de este proceso tanto el tratamiento oportuno, la red familiar y nivel socioeconómico entre algunos de ellos. Objetivo: Describir resultados de niños menores 6 años sometidos a cirugía de implante coclear en un centro terciario de salud. Material y método: Estudio longitudinal de cohorte retrospectivo, análisis a 99 pacientes implantados en centro terciario de salud desde inicio programa en 1994 a 2015. Resultados: 99 pacientes, 57% hombres 43% mujeres, edad promedio implantación 16,3 meses. 54,8% casos origen congénito no especificado o prematurez. En 74,4% se objetivó presencia de lenguaje auditivo verbal. El nivel socioeconómico (NSE) mostró asociación con no desarrollo de lenguaje (p =0,009) evidenciando que pacientes de bajo NSE 20% no desarrolla lenguaje. La variable discapacidad asociada (p <0,001) y la variable NSE (p =0,036) se asociaron de manera independiente a lenguaje de señas o no desarrollo de lenguaje oral. Conclusión: Los implantes cocleares ofrecen una opción en la rehabilitación auditiva en hipoacusia sensorio neural profunda, para candidatos de todo el espectro de edad, sin embargo los resultados dependen en gran medida del entorno en el que se utilizan los implantes cocleares.

ABSTRACT Introduction: Since the 90s, cochlear implantation has progressed from experimental to standard clinical practice for children with severe and profound hearing loss. Research has produced changes in implant technology and has led to the expansion of implant candidacy to include children younger than 2 years of age. The primary goal of pediatric cochlear implantation is to facilitate spoken language development. Despite the advances in implant technology and the changes to the management of hearing loss, language outcomes for children are still highly variable, participating in this process both timely treatment, the family network and socio economic level among others. Aim: describe outcomes of patients younger than 6 years undergoing cochlear implant surgery in a tertiary care center. Material and method: retrospective longitudinal cohort study, 99 patients implanted in a tertiary health center since the program's inception in 1994 to 2015 was analyzed. Results: 99 patients, 57 % men 43 % women, average age of implantation 16.3 months. 54.8 % of cases were congenital or prematurity. In 74.4 % they had auditory verbal language. Socioeconomic status (SES) showed association with the lack of language development (p =0.009) demonstrating that low SES patients (20%) do not develop language. The disability associated variable (p <0.001) and the SES variable (p =0.036) were independently associated with sign language or no oral language development. Conclusions: Cochlear implants offer an option for hearing rehabilitation in profound hearing loss, for candidates of all ages, however the results depend largely on the environment in which cochlear implants are used.

Metabolic syndrome and hip fracture: Epidemiology and perioperative outcomes.

INTRODUCTION: Hip fractures and metabolic syndrome (MetS) are becoming major global healthcare burdens as populations age. This study sought to determine the impact of MetS in hip fracture patients on perioperative outcomes following operative fixation or arthroplasty. METHODS: Data from the 2004-2014 Nationwide Inpatient Sample was used to select 3,348,207 discharges with hip fracture. MetS patients were identified by having at least 3 of 4 component comorbidities: hypertension, dyslipidemia, obesity, and diabetes. Logistic regression was used to estimate odds ratios for the association between MetS and perioperative outcomes adjusted for age, gender, race, payer status, and comorbidities. RESULTS: Overall, 32% of hip fracture patients were treated with open reduction internal fixation (ORIF), 28% hemiarthroplasty (HA), 18% closed reduction with internal fixation (CRPP), and 3% primary total hip arthroplasty (THA). The remaining 19% of cases were either treated via unspecified procedure of hip repair (9%), managed non-operatively (2%), underwent multiple procedures during the hospital stay (6%), or the surgical procedure data was missing (2%) and were excluded from procedural analyses. The prevalence of MetS was 7.9% and increased among minorities, patients treated at urban hospitals, with comorbidities (heart failure, kidney disease, peripheral vascular disease), and with Medicare coverage. MetS was associated with increased odds of any adverse event (p < 0.0001), specifically: acute renal failure, myocardial infarction, acute posthemorrhagic anemia. MetS was also associated with increased LOS (p < 0.0001) and increased total charges (p < 0.0001). However, MetS was associated with reduced odds of postoperative pneumonia, deep vein thrombosis and pulmonary embolism, surgical site infection, septicemia, and in-hospital mortality (p < 0.0001). The above associations were maintained for MetS patients stratified according to their treatment groups: HA, CRPP, and ORIF. CONCLUSIONS: MetS is associated with increased odds of complications in hip fracture patients but decreased odds of in-hospital mortality. This may be related to patients' nutritional status and catabolic states in the perioperative period.

Resultados del programa de implantes cocleares de Clínica Las Condes a 20 años de su inicio: serie clínica 1994-2015 / Cochlear implant program results in Clinica Las Condes 20 years since the beginning: clinical series 1994-2015

RESUMEN Introducción: La hipoacusia sensorioneural es la tercera causa de discapacidad en Chile, con incidencia en recién nacidos de 1 a 3 casos cada 1.000 recién nacidos vivos, y prevalencia en adultos de hasta 70%, siendo muchos casos susceptibles de ser tratados mediante implante coclear. Objetivo: Describir resultados de los pacientes sometidos a cirugía de implante coclear en Clínica Las Condes (CLC). Material y método: Estudio longitudinal de cohorte retrospectiva, se analizaron a 237 pacientes implantados en Clínica Las Condes desde 1994 al año 2015. Resultados: Se analizan 237 pacientes, 106 mujeres (44,7%) y 131 hombres (55,3%). El 65,5% de los pacientes se implantaron entre los 2-6 años de vida. Las etiologías más frecuentes fueron hipoacusia congénita no sindrómica (45,9%), genética tardía (11,8%) y posmeningitis (11,4%). Se encontró asociación significativa entre promedio tonal de la palabra (PTP) y presencia de malformación coclear (p =0,008). Sólo 9,9% de los pacientes presentaron otra discapacidad asociada a la hipoacusia. La tasa de reimplante fue 16,3% y sólo la variable malformación coclear se asoció a ella (p =0,016). Conclusión: El implante coclear es una herramienta beneficiosa en pacientes hipoacúsicos que no se benefician de otros dispositivos auditivos ofreciendo la posibilidad de reinsertarlos social y laboralmente con bajo riesgo quirúrgico y alta tasa de éxito.

ABSTRACT Introduction: Sensorineural hearing loss is the third leading cause of disability in Chile, with incidence in infants 1 to 3 cases per 1,000 newborn and prevalence in adult up to 70%, with many cases that can be treated with cochlear implant. Aim: to describe outcomes of our series of patients undergoing cochlear implant surgery at Clinica Las Condes (CLC). Material and method: Retrospective longitudinal cohort study, 237 patients implanted in our center since 1994 to 2015 were analyzed. Results: 237 patients, 106 women (44.7%) and 131 men (55.3%) received a cochlear implant during this period. 65.5% of patients were implanted between 2-6 years of age. The most common etiologies were; non-syndromic congenital deafness (45.9%), late genetic onset (11.8%) and meningitis (11.4%). A significant association between the average pure tone average and presence of cochlear malformation (p =0.008) was demonstrated. Only 9.9% of patients had other disabilities associated with hearing loss. Re-implantation rate was 16.3% and only the variable cochlear malformation was associated to it (p =0.016) Conclusions: The cochlear implant provides clear benefits to patients with hearing impairment who do not benefit from other hearing devices offering the possibility of social and labor reintegrating, with low surgical risk and high success rate.

Synergistic Interactions of a Synthetic Lubricin-Mimetic with Fibronectin for Enhanced Wear Protection.

Lubricin (LUB), a major mucinous glycoprotein of mammalian synovial fluids, is believed to provide excellent lubrication to cartilage surfaces. Consequently, when joint disease or replacement leads to increased friction and surface damage in the joint, robust synthetic LUB alternatives that could be used therapeutically to improve lubrication and surface protection are needed. Here, we report the characterization of a lubricating multiblock bottlebrush polymer whose architecture was inspired by LUB, and we investigate the role of fibronectin (FN), a glycoprotein found in the superficial zone of cartilage, in mediating the tribological properties of the polymer upon shear between mica surfaces. Our surface forces apparatus (SFA) normal force measurements indicate that the lubricin-mimetic (mimLUB) could be kept anchored between mica surfaces, even under high contact pressures, when an intermediate layer of FN was present. Additional SFA friction measurements show that FN would also extend the wearless friction regime of the polymer up to pressures of 3.4 MPa while ensuring stable friction coefficients (µ ≈ 0.28). These results demonstrate synergistic interactions between mimLUB and FN in assisting the lubrication and wear protection of ideal (mica) substrates upon shear. Collectively, these findings suggest that our proposed mimLUB might be a promising alternative to LUB, as similar mechanisms could potentially facilitate the interaction between the polymer and cartilage surfaces in articular joints and prosthetic implants in vivo.

The Second Victim Experience and Support Tool: Validation of an Organizational Resource for Assessing Second Victim Effects and the Quality of Support Resources.

OBJECTIVES: Medical errors and unanticipated negative patient outcomes can damage the well-being of health care providers. These affected individuals, referred to as "second victims," can experience various psychological and physical symptoms. Support resources provided by health care organizations to prevent and reduce second victim-related harm are often inadequate. In this study, we present the development and psychometric evaluation of the Second Victim Experience and Support Tool (SVEST), a survey instrument that can assist health care organizations to implement and track the performance of second victim support resources. METHODS: The SVEST (29 items representing 7 dimensions and 2 outcome variables) was completed by 303 health care providers involved in direct patient care. The survey collected responses on second victim-related psychological and physical symptoms and the quality of support resources. Desirability of possible support resources was also measured. The SVEST was assessed for content validity, internal consistency, and construct validity with confirmatory factor analysis. RESULTS: Confirmatory factor analysis results suggested good model fit for the survey. Cronbach α reliability scores for the survey dimensions ranged from 0.61 to 0.89. The most desired second victim support option was "A respected peer to discuss the details of what happened." CONCLUSIONS: The SVEST can be used by health care organizations to evaluate second victim experiences of their staff and the quality of existing support resources. It can also provide health care organization leaders with information on second victim-related support resources most preferred by their staff. The SVEST can be administered before and after implementing new second victim resources to measure perceptions of effectiveness.

Fibronectin mediates enhanced wear protection of lubricin during shear.

Fibronectin (FN) is a glycoprotein found in the superficial zone of cartilage; however, its role in the lubrication and the wear protection of articular joints is unknown. In this work, we have investigated the molecular interactions between FN and various components of the synovial fluid such as lubricin (LUB), hyaluronan (HA), and serum albumin (SA), which are all believed to contribute to joint lubrication. Using a Surface Forces Apparatus, we have measured the normal (adhesion/repulsion) and lateral (friction) forces across layers of individual synovial fluid components physisorbed onto FN-coated mica substrates. Our chief findings are (i) FN strongly tethers LUB and HA to mica, as indicated by high and reversible long-range repulsive normal interactions between surfaces, and (ii) FN and LUB synergistically enhance wear protection of surfaces during shear, as suggested by the structural robustness of FN+LUB layers under pressures up to about 4 MPa. These findings provide new insights into the role of FN in the lubricating properties of synovial fluid components sheared between ideal substrates and represent a significant step forward in our understanding of cartilage damage involved in diseases such as osteoarthritis.

Programa de screening auditivo neonatal universal: experiencia de más de 10 años / Universal newborn hearing screening program: experience over 10 years

Introducción: La implementación de Programas de Evaluación Auditiva Neonatal (PEAN) eficientes permite mejorar la pesquisa de recién nacidos (RN) con hipoacusia congénita (HC), facilitando una intervención temprana. Objetivo: Describir los resultados del PEAN universal llevado a cabo por el Departamento de Otorrinolaringología de Clínica Las Condes. Material y método: Estudio descriptivo, retrospectivo. Se estudiaron los resultados del programa y las variables: género, edad de diagnóstico, edad gestational al parto y factores de riesgo asociados al desarrollo de HC en RN evaluados entre mayo 2001 y junio 2012. Resultados: Fueron evaluados 18.224 RN. Reprobaron esta evaluación 809 RN (4,43%). Se diagnostican 70 HC (56% varones, 44% mujeres), con una incidencia general estimada de 3-4 cada 1.000 RN en este establecimiento. 54,3% correspondió a HC unilaterales y 45,7% a bilaterales, siendo éstas en 90% leves a moderadas. El factor de riesgo mayormente asociado fue presencia de anomalías craneofaciales en 38,5% seguido de un peso nacimiento <1.500 gr. en 10%. Discusión y conclusiones: Es imperativo la realización de PEAN universales para diagnosticar a la población general susceptible a desarrollar HC y más aún en aquellas poblaciones donde se concentran los factores de riesgo.

Introduction: Efficient universal newborn hearing screening program (UNHSP) Implementation allows the inquest improvement of newborns with congenital hearing loss (CHL), facilitating an early intervention. Aim: To describe the results of the UNHSP carried out by the Department of Otorhinolaryngology of Clinica Las Condes. Material and method: Descriptive, retrospective study. We studied the program results and variables: sex, diagnosis age, birth age in weeks and risk factors associated with development CHL in newborns evaluated between May, 2001 and June, 2012. Results: 18.224 newborns were evaluated. 809 reproved this evaluation (4.43%). We diagnosed 70 CHL (56% males, 44% women), with an incidence estimated of 3-4 cases every 1.000 newborns. 54.3% corresponded to unilateral CHL and 45.7% bilateral, 90% of this CHL were slight to moderate. The presence of craniofacial anomalies was the main associate risk factor in 38,5% followed by a weight birth <1.500 gr. in a 10%. Discussion and conclusions: Is imperative the accomplishment of UNHSP to diagnose the population at risk of developing CHL and even more in those populations where the risk factors are concentrated.

Estrategias para mejorar el seguimiento del Programa de Evaluación Auditiva Neonatal Universal / Strategies to improve follow-up of the Universal Newborn Hearing Screening Program

Introducción: El Programa de Evaluación Auditiva Neonatal (PEAN) en Clínica Las Condes se inició el 2001 y ha evaluado más de 18.000 niños. Nuestro desafío actual es lograr que aquellos cuyo examen se encuentre alterado reciban precozmente evaluación y derivación oportuna. Objetivo: Analizar el impacto de estrategias para mejorar el seguimiento del programa por medio de la reducción del porcentaje de pérdida de seguimiento. Material y método: Durante 2010 se implementaron nueve estrategias para mejorar el seguimiento del PEAN. Mediante una cohorte retrospectiva se evaluaron los resultados de PEAN 12 meses previos y posteriores a la implementación de éstas. Resultados: El 2009 se evaluaron 1.797 niños, completaron el protocolo 71,1%, perdiéndose en el seguimiento 28,9%. El 2011, posterior a la implementación de las medidas, se evaluaron 1.823 niños, completaron el protocolo 85,1%, perdiéndose en el seguimiento sólo 14,9%. La diferencia del porcentaje de pérdidas de seguimiento entre el2009y 2011 fue de 13.87% (p: 0.042). Discusión y conclusiones: Es necesario descubrir las causas de pérdida de seguimiento para establecer estrategias que ayuden a mejorar estas cifras y permitir que todo niño pesquisado sea diagnosticado a tiempo. La implementación de estrategias como las planteadas en este trabajo son una forma práctica y efectiva para mejorar el seguimiento del PEAN.

Introduction: The Newborn Hearing Screening Program (NHSP) at Clinica Las Condes began in 2001 and up to date, has evaluated over 18.000 children. Our current challenge is to achieve that children with referred screening, receive early evaluation and intervention. Aim: To analyze the Impact of strategies to Improve program's follow-up reducing the percentage of follow-up losses. Material and method: During 2010 nine NHSP strategies were implemented to improve the follow-up. By a retrospective cohort NHSP's results were evaluated 12 months previous and after the implementation of these strategies. Results: In 20091.797 children were evaluated, 71,1% completed the protocol, with 28,9% lost in the follow-up. In 2011, after strategies' implementation, 1.823 children were evaluated, 85,1 %, completed the protocol and only 14,9 % were lost in the follow-up. The difference in the percentage lost between 2009 and 2011 was 13.87 % (p: 0.042). Discussion and conclusions: It is necessary to discover the reasons of loss to follow-up, in order to establish strategies that may allow every referred child to be diagnosed in time. Implementation of strategies like the raised in this investigation is a practical and effective way to improve the follow-up of NHSP.