Acesso a serviço de saúde e reabilitação auditiva de adultos e idosos durante o período inicial da pandemia COVID-19 no Brasil / Access to health service and hearing rehabilitation for adult and older adults during the initial period of the COVID-19 pandemic in Brazil / Acceso a servicios de salud yrehabilitación auditiva para adultos y ancianos durante el período inicial de la pandemia COVID-19 en Brasil

Introdução: A perda auditiva é uma deficiência comum na população mundial e contribui para dificuldade na comunicação verbal e redução da qualidade de vida, evidenciando a importância da identificação precoce, reabilitação e acompanhamento audiológico dessa deficiência para mitigar suas consequências. Durante a pandemia da COVID-19, as medidas restritivas diminuíram a capacidade de atendimento dos serviços de saúde auditiva e dificultaram a busca de auxílio para resolver problemas relacionados à adaptação aos dispositivos eletrônicos de amplificação sonora (DAES), sendo uma barreira no processo de reabilitação da perda auditiva. Objetivo: Caracterizar os usuários de DEAS e o processo inicial de reabilitação auditiva de adultos e idosos e verificar fatores associados ao retorno para a consulta de monitoramento auditivo durante o período inicial da pandemia da COVID-19.Métodos: Estudo observacional transversal com usuários adultos e idosos de um serviço ambulatorial de saúde auditiva com retorno para consulta de monitoramento auditivo agendada no período inicial da implementação das medidas restritivas da pandemia da COVID-19 no Brasil. Resultados: A maioria dos participantes conseguiu retornou para a consulta de monitoramento auditivo, sendo eles em sua maioria idosos, do sexo feminino e vacinados contra a COVID-19. Houve maior prevalência de adaptação adequada aos DAES. Não houve associação estatística entre as variáveis relacionadas à adaptação aos DAES, COVID-19 e saúde mental e o retorno à consulta de monitoramento auditivo. Conclusão: Os fatores relacionados à adaptação aos DAES, à COVID-19 ou à saúde mental não influenciaram o retorno à consulta de monitoramento auditivo na presente pesquisa. (AU)

Introduction: Hearing loss is a common disability in the world population and contributes to difficulty in verbal communication and reduced quality of life, highlighting the importance of early identification, rehabilitation and audiological monitoring of this disability to mitigate its consequences. During the COVID-19 pandemic, restrictive measures reduced the service capacity of hearing health services and made it difficult to seek help to solve problems related to adaptation to personal sound amplification products (PSAPs), being a barrier in the rehabilitation process of hearing loss. Aim: To characterize PSAPs users and the initial hearing rehabilitation process for adults and elderly people and verify the factors associated with the return to hearing monitoring consultations in the initial period of the COVID-19 pandemic. Methods: Cross-sectional observational study with adults and elderly people: elderly users of an outpatient hearing health service who return for a scheduled hearing monitoring consultation in the initial period of the implementation of restrictive measures of the COVID-19 pandemic in Brazil. Results: Most participants were able to return to the hearing monitoring clinic, the majority of whom were elderly, female and vaccinated against COVID-19. There was a higher prevalence of adequate adaptation to the PSAPs. There was no statistical association between variables related to adaptation to PSAPs, COVID-19 and mental health and return to hearing monitoring consultation. Conclusion: Factors related to adaptation to PSAPs, COVID-19 or mental health did not influence the return to hearing monitoring consultation in the present investigation. (AU)

Introducción: La pérdida auditiva es una discapacidad común en la población mundial y contribuye a la dificultad en la comunicación verbal y a la reducción de la calidad de vida, destacando la importancia de la identificación temprana, rehabilitación y seguimiento audiológico de esta discapacidad para mitigar sus consecuencias. Durante la pandemia de COVID-19, las medidas restrictivas redujeron la capacidad de atención de los servicios de salud auditiva y dificultaron la búsqueda de ayuda para resolver problemas relacionados con la adaptación a dispositivos electrónicos de amplificación del sonido (DEAS), siendo una barrera en el proceso de rehabilitación de la pérdida auditiva. Objetivo: Caracterizar a los usuarios de DEAS y el proceso inicial de rehabilitación auditiva de adultos y ancianos y verificar los factores asociados al retorno a las consultas de monitorización auditiva en el período inicial de la pandemia COVID-19. Métodos: Estudio observacional transversal con adultos y ancianos: ancianos usuarios de un servicio ambulatorio de salud auditiva que regresan para consulta de monitorización auditiva programada en el período inicial de la implementación de medidas restrictivas de la pandemia de COVID-19 en Brasil. Resultados: La mayoría de los participantes pudieron regresar a la clínica de monitorización auditiva, la mayoría de los cuales eran ancianos, mujeres y estaban vacunados contra COVID-19. Hubo mayor prevalencia de adaptación adecuada a la DEAS. No hubo asociación estadística entre variables relacionadas con adaptación a DEAS, COVID-19 y salud mental y retorno a consulta de monitorización auditiva. Conclusión: Los factores relacionados con la adaptación a DEAS, el COVID-19 o la salud mental no influyeron en el retorno a la consulta de monitorización auditiva en la presente investigación. (AU)

Maximum serum K+ concentration within 1 hour with enteral replacement in severe hypokalemia / Concentración sérica máxima de K+ en 1 hora por vía enteral en hipopotasemia severa

Introduction: we report two cases with severe hypokalemia. Patients and methods: a 68-year-old woman was admitted with lower limb swelling and urinary symptoms; on the fourth day serum K+ concentration (s[K+]) was 2.3 mmol/L. A 64-year-old woman was admitted with pain in the lumbosacral spine, she was diagnosed with multiple myeloma. After receiving specific therapy she showed s[K+] at 2.4 mmol/L. A KCl solution containing 26.8 mEq of K+ was administered enterally, which increased s[K+] by 0.7 mmol/L within 1 h. Results and conclusion: these cases reveal that peak s[K+] may be achieved within 1 hour after KCl intake in severe hypokalemia, which is probably faster than IV administration.(AU)

Introducción: se presentan dos casos clínicos con hipopotasemia severa. Pacientes y métodos: mujer de 68 años que ingresó por edema en miembros inferiores y síntomas urinarios; al cuarto día, el nivel sérico de K+ ([K+]s) era de 2,3 mmol/L. Una mujer de 64 años ingresó por dolor en la columna lumbosacra y fue diagnosticada de mieloma múltiple; luego de recibir terapia específi ca, presentó una [K +]s de 2.4 mmol/L. Se administró por vía enteral una solución de KCl que contenía 26,8 mEq de K +, aumentando la [K +]s en 0,7 mmol/L en 1 h. Resultados y conclusión: estos casos revelan que la [K + ]s máxima se alcanzaría 1 hora después de la ingestión de KCl en la hipopotasemia grave, probablemente en menos tiempo que por vía intravenosa.(AU)

Maximum serum K+ concentration within 1 hour with enteral replacement in severe hypokalemia.

Introduction: Introduction: we report two cases with severe hypokalemia. Patients and methods: a 68-year-old woman was admitted with lower limb swelling and urinary symptoms; on the fourth day serum K+ concentration (s[K+]) was 2.3 mmol/L. A 64-year-old woman was admitted with pain in the lumbosacral spine, she was diagnosed with multiple myeloma. After receiving specific therapy she showed s[K+] at 2.4 mmol/L. A KCl solution containing 26.8 mEq of K+ was administered enterally, which increased s[K+] by 0.7 mmol/L within 1 h. Results and conclusion: these cases reveal that peak s[K+] may be achieved within 1 hour after KCl intake in severe hypokalemia, which is probably faster than IV administration.

Introducción: Introducción: se presentan dos casos clínicos con hipopotasemia severa. Pacientes y métodos: mujer de 68 años que ingresó por edema en miembros inferiores y síntomas urinarios; al cuarto día, el nivel sérico de K+ ([K+]s) era de 2,3 mmol/L. Una mujer de 64 años ingresó por dolor en la columna lumbosacra y fue diagnosticada de mieloma múltiple; luego de recibir terapia específica, presentó una [K+]s de 2.4 mmol/L. Se administró por vía enteral una solución de KCl que contenía 26,8 mEq de K+, aumentando la [K+]s en 0,7 mmol/L en 1 h. Resultados y conclusión: estos casos revelan que la [K+]s máxima se alcanzaría 1 hora después de la ingestión de KCl en la hipopotasemia grave, probablemente en menos tiempo que por vía intravenosa.

Tendencias actuales en el manejo clínico quirúrgico de la presbicia / Current Trends in the Clinical and Surgical Management of Presbyopia

La presbicia es la pérdida gradual y progresiva de la amplitud de acomodación del cristalino que comienza entre los 38 y 40 años de edad y culmina a los 55 años al perderse por completo. Es provocada por el aumento de rigidez del cristalino y, en particular, un mayor cambio en la rigidez del núcleo de su corteza. La presbicia no corregida o hipocorregida tiene un impacto negativo en la calidad de vida en relación con la visión, las personas afectadas experimentan un cambio positivo significativo de productividad en sus actividades diarias al utilizar una corrección óptica adecuada. Las diferentes alternativas de tratamiento deben aplicarse de forma personalizadas para optimizar el rango de enfoque para las tareas diarias, minimizar los efectos visuales adversos y cumplir con las expectativas del paciente según necesidades y alcance económico. Los tratamientos más efectivos y con menos efectos indeseables hasta el momento son los dispositivos ópticos como las gafas y las lentes de contacto. Los métodos quirúrgicos pueden dejar síntomas visuales. El objetivo de este estudio fue realizar una búsqueda bibliográfica sobre las actuales tendencias en el manejo clínico-quirúrgico de la presbicia(AU)

Presbyopia is the gradual and progressive loss of the accommodative range of the crystalline lens that begins between 38 and 40 years of age and culminates at 55 years of age when it is completely lost. It is caused by increased stiffness of the lens and, in particular, a greater change in the stiffness of the nucleus of its cortex. Uncorrected or undercorrected presbyopia has a negative impact on quality of life in relation to vision, affected individuals experience a significant positive change in productivity in their daily activities when using an appropriate optical correction. The different treatment alternatives should be applied in a personalized way to optimize the range of focus for daily tasks, minimize adverse visual effects and meet the patient's expectations according to needs and economic scope. The most effective treatments with the least undesirable effects so far are optical devices such as glasses and contact lenses. Surgical methods may leave visual symptoms. The aim of this study was to perform a literature search on current trends in the clinical-surgical management of presbyopia(AU)

How common is extra-articular knee deformity? How to achieve a «safe zone¼ alignment total knee arthroplasty in patients with extra-articular deformity / ¿Qué tan común es la deformidad extraarticular de rodilla? ¿Cómo lograr una artroplastia total de rodilla con alineación de «zona segura¼ en pacientes con deformidad extraarticular?

Abstract: The need for total knee arthroplasty is increasing considerably and one of the goals is to achieve post-surgical coronal alignment. Robotic surgical assistance achieves a functional alignment, which is a hip-knee-ankle angle of 0o. However, it is not possible to provide robotic assisted surgery to all our patients so we must include the full-length hip-to-ankle AP weight-bearing radiograph in preoperative planning to obtain a «safe zone¼ alignment, which is a post-surgical hip-knee-ankle Angle of 0 ± 3o. How can we achieve a «safe zone¼ alignment total knee arthroplasty in patients with extra-articular deformity?

Resumen: La necesidad de artroplastia total de rodilla está aumentando considerablemente y uno de los objetivos es lograr la alineación coronal postquirúrgica. La asistencia quirúrgica robótica consigue una alineación funcional, que es un ángulo cadera-rodilla-tobillo de 0o. Sin embargo, no es posible ofrecer cirugía asistida por robot a todos nuestros pacientes, por lo que debemos incluir la radiografía AP de soporte de peso de cadera a tobillo de cuerpo entero en la planificación preoperatoria para obtener una alineación de «zona segura¼, que es un ángulo postquirúrgico cadera-rodilla-tobillo de 0 ± 3o. ¿Cómo podemos conseguir una artroplastia total de rodilla con alineación de «zona segura¼ en pacientes con deformidad extraarticular?

Nueva técnica de fijación de dartos en la reparación de hipospadias / A novel triple dartos fixation in hypospadias repair

Objetivo Este estudio investiga el impacto del uso de la cobertura de dartos para aumentar la neouretra en los resultados funcionales y cosméticos. Evaluar una técnica novedosa que demuestra cómo fijar la cobertura de dartos como cobertura de barrera de la neouretra en la corrección de hipospadias. Pacientes y métodos Este estudio se realizó en 204 pacientes varones, todos con diferentes grados de hipospadias (HPD: 132, hipospadias coronal: 46 y HPM: 26). Sus edades oscilaban entre 1-23 años (edad media: 2 años). Había incurvación ventral (chorda) en (HPD: 45, hipospadias coronal: 33 y HPM: 26). Todos los pacientes tenían un chorro urinario anormal dirigido hacia abajo. La corrección del hipospadias se realizó mediante la técnica TIP clásica, además de nuestra novedosa modificación con cobertura de dartos. El seguimiento se realizó durante 5 años mediante evaluaciones clínicas de los parámetros funcionales y cosméticos. Resultados Se registraron tasas de éxito en 200 pacientes, 3 pacientes tuvieron complicaciones con una fístula uretrocutánea subcoronal y un paciente presentó la pérdida completa de la reparación. Conclusión La fijación triple de dartos es una técnica sencilla con la que todos los hipospadiólogos pueden reducir la fístula uretrocutánea como complicación común de la corrección de hipospadias con unos buenos resultados funcionales y cosméticos (AU)

Objective This study investigates the impact of the use of dartos covering to augment the neourethra on functional and cosmetic results. To evaluate a novel technique demonstrating how to fix dartos flap to cover the neourethra as a barrier in hypospadias repair. Patients and methods This study comprised 204 male patients with different degree of hypospadias (DPH: 132, coronal hypospadias: 46, MPH: 26). Their ages ranged from 1-23 ys (mean age: 2ys). Penile chordee was in (DPH: 45, coronal hypospadias: 33, MPH: 26). All patients had abnormal downward directed urinary stream. Hypospadias repair was performed by the classic TIP technique in addition to our novel modification of dartos covering. Patients were submitted to 5 years of follow-up including clinical examination of the functional and cosmetic parameters. Results Success rates were reported in 200 patients, 3 patients had complications with subcoronal urethrocutaneous fistula and one patient with complete repair disruption. Conclusion Triple dartos fixation is a simple technique for all hypospadiologists to minimize urethrocutaneous fistula as common complication of hypospadias repair with good functional and cosmetic results (AU)

A novel triple dartous fixation in hypospadias repair.

OBJECTIVE: This study investigates the impact of the use of dartos covering to augment the neourethra on functional and cosmetic results. To evaluate a novel technique demonstrating how to fix dartos flap to cover the neourethra as a barrier in hypospadias repair. PATIENTS AND METHODS: This study comprised 204 male patients with different degree of hypospadias (DPH = 132, coronal hypospadias = 46, MPH = 26). Their ages ranged from 1 to 23 ys (mean age = 2 ys). Penile chordee was in (DPH = 45, coronal hypospadias = 33, MPH = 26). All patients had abnormal downward directed urinary stream. Hypospadias repair was performed by the classic TIP technique in addition to our novel modification of dartos covering. Patients were submitted to 5 years of follow-up including clinical examination of the functional and cosmetic parameters. RESULTS: Success rates were reported in 200 patients, 3 patients had complications with subcoronal urethrocutaneous fistula and one patient with complete repair disruption. CONCLUSION: Triple dartos fixation is a simple technique for all hypospadiologists to minimize urethrocutaneous fistula as common complication of hypospadias repair with good functional and cosmetic results.

Factors affecting prognosis of the patients with severe hyponatremia.

INTRODUCTION: Hyponatremia is one of the most common electrolyte abnormalities in clinical practice. Data regarding factors that have impact on mortality of severe hyponatremia and outcomes of its therapeutic management is insufficient. The present study aimed to examine the factors associated with mortality and the outcomes of treatment in patients with severe hyponatremia. MATERIALS AND METHODS: Patients with serum Na≤115mequiv./L who were admitted to Ordu State Hospital and Ordu University Training and Research Hospital between 2014 and 2018 were included in the study. Demographic and laboratory features, severity of the symptoms, comorbid diseases, medications, and clinical outcome measures of the patients were obtained retrospectively from their medical records. Factors associated with in-hospital mortality, overcorrection and undercorrection were assessed. RESULTS: A total of 145 patients (median age 69 years and 58.6% female) met inclusion criteria. Diuretic use was the most common etiologic factor for severe hyponatremia that present in 50 (34.5%) patients. Sixty-seven (46.2%) patients had moderately severe while 8 patients (5.5%) had severe symptoms. The median increase in serum Na 24h after admission in the study population was 8.9mequiv./L (-6 to 19). Nonoptimal correction was seen in 92 (63.4%) patients. Hypertonic saline use was associated with overcorrection (OR, 3.07; 95% CI: 1.47-6.39; p=0.002). Avoidance of hypertonic saline (aOR, 2.52; 95% CI: 1.12-5.66; p=0.029) and having neuropsychiatric disorder (aOR, 2.60; 95% CI: 1.10-6.11; p=0.025) were associated with undercorrection. In-hospital mortality rate was 12.4% and having CKD and cancer, undercorrection of sodium and presence of severe symptoms were significantly associated with in-hospital mortality. CONCLUSION: Severe hyponatremia in hospitalized patients is associated with substantial mortality. The incidence of non-optimal correction of serum Na is high; under-correction, presence of severe symptoms, chronic kidney disease and cancer were the factors that increase mortality rate.

Corrección del efecto de desplazamiento angular horizontal de la cabeza en pruebas de estimulación visual en MATLAB / Correction of horizontal and angular head displacement effects by MATLAB visual stimulation tests / Correção do efeito do deslocamento angular horizontal da cabeça em testes de estimulação visual no MATLAB

RESUMEN Introducción: Las irregularidades en los movimientos oculares constituyen un indicador importante para diagnosticar determinadas enfermedades neurodegenerativas. La electrooculografía es la técnica más difundida para medir dichos movimientos oculares. Durante la realización de una prueba visual, el paciente puede realizar movimientos de cabeza indeseados que añaden perturbaciones a la señal electrooculográfica, modificando su morfología y, por tanto, alterando determinados parámetros diagnósticos. Objetivo: Desarrollar un método para corregir el efecto del desplazamiento angular horizontal de la cabeza en la señal electrooculográfica. Método: Se detalla un modelo matemático utilizado en la Universidad de Oriente desde marzo de 2021 a diciembre de 2021, para la implementación de la corrección en dos tipos de señales electrooculográficas artificiales con diferentes movimientos de cabeza horizontales. Resultados: Se evalúo cualitativamente el comportamiento del método utilizado a través de su implementación en señales generadas artificialmente en MATLAB. Finalmente se caracterizaron los efectos de la corrección en los parámetros diagnósticos de la señal electrooculográfica. Conclusiones: El método implementado demostró su validez para casos específicos, en el que se logra para dos tipos de señales eliminar los errores introducidos por el desplazamiento de la cabeza. La corrección mejora el error introducido en la amplitud de la señal electrooculográfica sin corregir y mantiene inalterables, a falta de un análisis más profundo, los demás parámetros diagnósticos.

ABSTRACT Introduction: Eye movement disorders are an important indicator for the diagnosis of certain neurodegenerative diseases. Electrooculography is the most widespread technique for measuring such eye movements. During the performance of the eye test, patients may forge unwanted head movements that add disturbances to the electrooculographic signal, modifying its morphological characteristic and, therefore, changing certain diagnostic parameters. Objective: To develop a method for the correction of the effect of the horizontal and angular head displacement by the electrooculographic signal. Method: It is detailed the use of a mathematical model for the correction of two types of artificial electrooculographic signals with different horizontal head movements at the Universidad de Oriente, from March 2021 to December 2021. Results: The behavior of the method used was evaluated qualitatively through its implementation in the signals generated artificially in MATLAB. Finally, the correction effects on the diagnostic parameters of the electrooculographic signal were characterized. Conclusions: The implemented method proved its validity for specific cases, in which it is possible to eliminate the errors caused by head displacement in two types of signals. The correction minimizes the error introduced in the uncorrected electrooculographic signal amplitude and keeps unchanged the other diagnostic parameters in absence of further analyses.

RESUMO Introdução: As irregularidades nos movimentos oculares são um importante indicador para diagnosticar certas doenças neurodegenerativas. A eletrooculografia é a técnica mais difundida para medir esses movimentos oculares. Durante um teste visual, o paciente pode realizar movimentos involuntários da cabeça que adicionam distúrbios ao sinal eletrooculográfico, modificando sua morfologia e, portanto, alterando alguns parâmetros diagnósticos. Objetivo: Desenvolver um método para corrigir o efeito do deslocamento angular horizontal da cabeça no sinal eletrooculográfico. Método: Um modelo matemático usado na Universidade de Oriente de março de 2021 a dezembro de 2021 é detalhado para a implementação da correção em dois tipos de sinais eletrooculográficos artificiais com diferentes movimentos horizontais da cabeça. Resultados: O comportamento do método utilizado foi avaliado qualitativamente através de sua implementação em sinais gerados artificialmente no MATLAB. Por fim, foram caracterizados os efeitos da correção sobre os parâmetros diagnósticos do sinal eletrooculográfico. Conclusões: O método implementado demonstrou sua validade para casos específicos, nos quais é possível eliminar os erros introduzidos pelo deslocamento da cabeça para dois tipos de sinais. A correção melhora o erro introduzido na amplitude do sinal eletrooculográfico não corrigido e mantém os demais parâmetros diagnósticos inalterados, na ausência de uma análise mais profunda.

Factors affecting prognosis of the patients with severe hyponatremia / Factores que afectan el pronóstico de los pacientes con graves hyponatremia

Introduction: Hyponatremia is one of the most common electrolyte abnormalities in clinical practice. Data regarding factors that have impact on mortality of severe hyponatremia and outcomes of its therapeutic management is insufficient. The present study aimed to examine the factors associated with mortality and the outcomes of treatment in patients with severe hyponatremia.Materials and methods: Patients with serum Na≤115mequiv./L who were admitted to Ordu State Hospital and Ordu University Training and Research Hospital between 2014 and 2018 were included in the study. Demographic and laboratory features, severity of the symptoms, comorbid diseases, medications, and clinical outcome measures of the patients were obtained retrospectively from their medical records. Factors associated with in-hospital mortality, overcorrection and undercorrection were assessed.Results: A total of 145 patients (median age 69 years and 58.6% female) met inclusion criteria. Diuretic use was the most common etiologic factor for severe hyponatremia that present in 50 (34.5%) patients. Sixty-seven (46.2%) patients had moderately severe while 8 patients (5.5%) had severe symptoms. The median increase in serum Na 24h after admission in the study population was 8.9mequiv./L (−6 to 19). Nonoptimal correction was seen in 92 (63.4%) patients. Hypertonic saline use was associated with overcorrection (OR, 3.07; 95% CI: 1.47–6.39; p=0.002). Avoidance of hypertonic saline (aOR, 2.52; 95% CI: 1.12–5.66; p=0.029) and having neuropsychiatric disorder (aOR, 2.60; 95% CI: 1.10–6.11; p=0.025) were associated with undercorrection. In-hospital mortality rate was 12.4% and having CKD and cancer, undercorrection of sodium and presence of severe symptoms were significantly associated with in-hospital mortality.Conclusion: Severe hyponatremia in hospitalized patients is associated with substantial mortality. ... (AU)

Introducción: La hiponatremia es una de las alteraciones electrolíticas más frecuentes en la práctica clínica. Los datos sobre los factores que tienen impacto en la mortalidad de la hiponatremia grave y los resultados de su manejo terapéutico son insuficientes. El presente estudio tuvo como objetivo examinar los factores asociados con la mortalidad y los resultados del tratamiento en pacientes con hiponatremia grave.Materiales y métodos: Se incluyeron en el estudio pacientes con Na sérico ≤ 115 mequiv./L que ingresaron en el Hospital Estatal de Ordu y en el Hospital de Investigación y Capacitación de la Universidad de Ordu entre 2014 y 2018. Las características demográficas y de laboratorio, la gravedad de los síntomas, las enfermedades comórbidas, los medicamentos y las medidas de resultado clínico de los pacientes se obtuvieron retrospectivamente de sus registros médicos. Se evaluaron los factores asociados con la mortalidad hospitalaria, la hipercorrección y la hipocorrección.Resultados: Un total de 145 pacientes (mediana de edad de 69 años y 58,6% mujeres) cumplieron los criterios de inclusión. El uso de diuréticos fue el factor etiológico más común para la hiponatremia grave que se presenta en 50 (34,5%) pacientes. Sesenta y siete (46,2%) pacientes tenían síntomas moderadamente graves, mientras que 8 pacientes (5,5%) tenían síntomas graves. El aumento medio del Na sérico 24 h después de la admisión en la población de estudio fue de 8,9 mequiv./L (-6 a 19). Se observó una corrección no óptima en 92 (63,4%) pacientes. El uso de solución salina hipertónica se asoció con sobrecorrección (OR, 3.07; 95% CI:1.47–6.39; p = 0.002). Evitar la solución salina hipertónica (aOR, 2.52; 95% CI: 1.12–5.66; p = 0.029) y tener un trastorno neuropsiquiátrico (aOR, 2.60; 95% CI: 1.10–6.11; p = 0.025) se asociaron con hipocorrección. ... (AU)

Osteotomía lateral de calcáneo en el tratamiento de la enfermedad de Müller-Weiss / Lateral osteotomy of the calcaneus in the treatment of Müller-Weiss disease

Resumen: Introducción: La afección deformante del hueso navicular conocida como enfermedad de Müller-Weiss (EMW) es una enfermedad rara. Los pacientes presentan dolor crónico en la articulación talonavicular y un pie plano paradójico con retropié varo. Objetivo: Analizar los resultados clínicos de la osteotomía valguizante de calcáneo aplicada a pacientes con EMW. Material y métodos: Estudio observacional, retrospectivo, realizado en dos centros hospitalarios. La serie consta de nueve casos en ocho pacientes, todos ellos con enfermedad de Müller-Weiss sintomática, fueron tratados mediante osteotomía valguizante de calcáneo entre 2012 y 2017, con un seguimiento medio de cuatro años (dos a seis). La edad media fue de 62 años (50-75). En todos los pacientes se midieron los ángulos de Costa-Bartani (CB), el ángulo de Kite y la inclinación calcánea (IC). Además, se utilizó la escala Manchester Oxford (MO) para medir la satisfacción postquirúrgica de los pacientes. Resultados: Todos los pacientes refieren haber mejorado en su dolor, obteniendo una puntuación postoperatoria media de 32.54 puntos (15.62-53.75) en la escala Manchester Oxford. En 66% de los pacientes el ángulo CB mejoró, al igual que en el ángulo de Kite en 89% y la IC en 33%. Conclusión: La mejoría en el dolor de los pacientes de nuestra serie no está acompañada por cambios radiológicos en la misma proporción, es una técnica sencilla y sin complicaciones en nuestro seguimiento.

Abstract: Introduction: The deforming condition of the navicular bone known as Müller-Weiss disease (MWD) is a rare disease. Patients present with chronic pain in the talonavicular joint and a paradoxical flat foot with a varo hindfoot. Objective: To analyze the clinical results of a lateral osteotomy of calcaneus applied to patients with MWD. Material and methods: Retrospective observational study carried out in two hospitals. The series consists of nine cases in eight patients, all of them with symptomatic Müller-Weiss disease, treated by lateral osteotomy of the calcaneus between 2012 and 2017, obtaining an average follow-up of 4 years (2-6). The mean age was 62 years (50-75). In all patients, Costa-Bartani angles (CB), Kite angle and Calcaneal Inclination (CI) were measured. In addition, the Manchester Oxford Scale (MO) to measure the post-surgical satisfaction of patients. Results: All patients report having improved their pain by obtaining a postoperative score on the mean Manchester Oxford scale of 32.54 points (15.62-53.75). In 66% of patients the CB angle improves, the Kite angle in 89% and the CI in 33%. Conclusion: The improvement in the pain of the patients in our series is not accompanied by radiological changes in the same proportion, it is a simple and uncomplicated technique in our follow-up.

Ventana aortopulmonar. Reporte de caso familiar / Aortopulmonary window. Family case report

Resumen Antecedentes: La ventana aortopulmonar (VAP) es un defecto del septo aortopulmonar, una cardiopatía congénita rara. Es una comunicación entre la aorta ascendente y el tronco pulmonar y/o rama pulmonar derecha, en presencia de ambos planos valvulares sigmoideos separados, lo cual la diferencia del tronco arterioso. Se clasifica en cuatro tipos. Objetivo: Reportar un caso familiar de VAP. Paciente de sexo femenino de 1 mes de vida extrauterina que reingresa por insuficiencia cardiaca congestivo-venosa. Discusión: Se discute la alta letalidad y la recurrencia de esta rara malformación cardiaca. Conclusión: El asesoramiento genético es muy importante.

Abstract Background: The Aorto pulmonary window in one of the rarest congenital heart diseases. That results from a defect between the main pulmonary artery and the proximal aorta is named aortopulmonary window (APW) and differences between the Truncus arteriosus. Classification of the APW have been described 4 types. Objective: To report a Family case with APW. 1 month-old female who was refered to our center by congestive heart failure. Discussion: The high incidence of dead and the recurrence of this rarest congenital heart diseases. Conclusion: The Genetic assessment is very important in this Patology.

Factors affecting prognosis of the patients with severe hyponatremia.

INTRODUCTION: Hyponatremia is one of the most common electrolyte abnormalities in clinical practice. Data regarding factors that have impact on mortality of severe hyponatremia and outcomes of its therapeutic management is insufficient. The present study aimed to examine the factors associated with mortality and the outcomes of treatment in patients with severe hyponatremia. MATERIALS AND METHODS: Patients with serum Na≤115mequiv./L who were admitted to Ordu State Hospital and Ordu University Training and Research Hospital between 2014 and 2018 were included in the study. Demographic and laboratory features, severity of the symptoms, comorbid diseases, medications, and clinical outcome measures of the patients were obtained retrospectively from their medical records. Factors associated with in-hospital mortality, overcorrection and undercorrection were assessed. RESULTS: A total of 145 patients (median age 69 years and 58.6% female) met inclusion criteria. Diuretic use was the most common etiologic factor for severe hyponatremia that present in 50 (34.5%) patients. Sixty-seven (46.2%) patients had moderately severe while 8 patients (5.5%) had severe symptoms. The median increase in serum Na 24h after admission in the study population was 8.9mequiv./L (-6 to 19). Nonoptimal correction was seen in 92 (63.4%) patients. Hypertonic saline use was associated with overcorrection (OR, 3.07; 95% CI: 1.47-6.39; p=0.002). Avoidance of hypertonic saline (aOR, 2.52; 95% CI: 1.12-5.66; p=0.029) and having neuropsychiatric disorder (aOR, 2.60; 95% CI: 1.10-6.11; p=0.025) were associated with undercorrection. In-hospital mortality rate was 12.4% and having CKD and cancer, undercorrection of sodium and presence of severe symptoms were significantly associated with in-hospital mortality. CONCLUSION: Severe hyponatremia in hospitalized patients is associated with substantial mortality. The incidence of non-optimal correction of serum Na is high; under-correction, presence of severe symptoms, chronic kidney disease and cancer were the factors that increase mortality rate.

Estimation of peach supply response in Colombia using a Vector Error Correction Model / Estimación de la respuesta de la oferta de durazno en Colombia mediante el modelo de vector de corrección de errores / Estimativa da resposta de fornecimento de pêssego na Colômbia usando um Modelo de Correcção de Erros Vectoriais

ABSTRACT An empirical study of peach supply response to own-price and yield in Colombia using time series data from 2000 to 2018 was undertaken. A quantitative, correlational and non-experimental research design was selected and the Johansen's co-integration as well as the vector error correction framework were employed. The Augmented Dickey-Fuller test showed that the time series were integrated of order one and the Johansen's co-integration confirmed the existence of a long-term relationship between the variables. Moreover; the short and long run coefficients for own-price and yield were statistically significant and presented the expected signs, however estimated own-price elasticity was below unit suggesting it is not an important factor in peach supply response. Furthermore, the vector error correction coefficient (-0.32) was negative and in line with theory which showed that in the long-run, the model converges towards equilibrium, however at a relatively slow pace. Therefore, it can be concluded that, overall, the proposed model contributes to the understanding of the dynamics in peach output supply

RESUMEN Se realizó un estudio empírico sobre la respuesta a la oferta de durazno con relación a su precio y rendimiento agr'cola en Colombia, utilizando datos de series de tiempo para el per'odo comprendido entre 2000 y 2018. Se seleccionó un diseño de investigación cuantitativo, correlacional y no experimental y se empleó la cointegración de Johansen y el modelo de vector de corrección de errores. Los resultados de la a prueba de Aumentada de Dickey-Fuller demostraron que las series temporales estaban integradas en el orden uno y la cointegración de Johansen confirmó la existencia de una relación a largo plazo entre las variables. Además, los coeficientes del precio y rendimiento a largo y corto plazo fueron estadísticamente significativos y presentaron los signos esperados. Sin embargo, la elasticidad precio estimada fue inferior a la unidad, lo cual sugiere que no es un factor importante en la respuesta de la oferta de durazno. Asimismo, el coeficiente de corrección de error del vector (-0.32) fue negativo y en línea con la teoría, denostando que, a largo plazo, el modelo converge hacia al equilibrio, pero a una velocidad relativamente lenta. Por lo tanto, se puede concluir que, en general, el modelo propuesto, contribuye a la comprensión de la dinámica de la respuesta de la oferta de durazno.

RESUMO Realizou-se um estudo empírico da resposta da oferta de pêssego em função do seu preço e rendimento agrícola na Colômbia, usando dados de séries temporais para o período entre 2000 a 2018. O estudo usou um desenho de pesquisa quantitativa, correlacional e não experimental assim como a cointegração de Johansen e o modelo Vetorial de Correção de Erro. Os resultados do teste Aumentado de Dickey-Fuller demonstraram que as séries são integradas de ordem um e a cointegração de Johansen confirmou a existência de uma relação de longo prazo entre as variáveis. Além disso, os coeficientes do curto e longo prazo para preço e rendimento foram estatisticamente significantes e apresentaram os sinais esperados; no entanto, a elasticidade estimada do preço foi menor que a unidade, sugerindo que não é um fator importante na resposta da oferta de pêssego. Além disso, o coeficiente de correção de erros vetoriais (-0,32) foi negativo e alinhado à teoria, que mostrou que, a longo prazo, o modelo converge para o equilíbrio, porém a um ritmo relativamente lento. Portanto, pode-se concluir que, de maneira geral, o modelo proposto contribui para entender a dinâmica da oferta de produção de pêssego.

Seguimiento por cuatro años de pacientes con pie equinovaro aducto congénito manejados con método Ponseti / Four years follow up in congenital talipes equino varus patients managed with Ponseti method

Resumen: Introducción: El pie equinovaro aducto congénito (PEVAC) es una deformidad congénita frecuente del pie. El método Ponseti es el estándar de oro para el tratamiento. Consiste en la manipulación del pie con yesos seriados semanales, una cirugía mínimamente invasiva y barra Dennis-Brown hasta los cinco años. Objetivo: Describir el seguimiento de los pacientes con PEVAC tratados mediante método Ponseti. Material y métodos: Estudio descriptivo, longitudinal, durante 2013-2019, en pacientes con PEVAC manejados con método Ponseti. Se incluyeron pacientes con PEVAC uni- o bilateral, menores de dos años, sin cirugía previa, cuyos padres firmaron consentimiento informado. Se excluyeron pacientes con otras malformaciones. Se colocó yeso semanal seriado por cuatro a ocho semanas, se realizó tenotomía del tendón de Aquiles y yeso por tres semanas más; luego calzado de horma inversa con barra Dennis-Brown. Se registraron las revisiones al día cero, a las ocho semanas y cada tres meses hasta los cinco años de edad. Se valoró la corrección de la deformidad y el dolor a la marcha. Resultados: Fueron 22 pacientes; 17 (77.3%) corrigieron más de 90% de la deformidad, con adecuada funcionalidad y 86.3% sin dolor a la marcha, seguimiento medio de 3.9 años (uno a siete años); seis pacientes tuvieron recidiva (27.27%) por mal apego, uno retratado con yesos y cinco con transferencia de tibial anterior, todos con éxito. Conclusiones: El PEVAC manejado con método Ponseti corrige más de 90% de la deformidad y sin o mínimo dolor con buen apego al tratamiento. Tuvimos una recidiva de 27.27% en nuestra serie.

Abstract: Introduction: Congenital talipes equino varus (club foot) is a frequent congenital deformity of the foot. The Ponseti method is the gold standard for treatment. It consists of foot manipulation with weekly serial cast, minimally invasive surgery and Dennis-Brown bar up to five years. Objective: To describe the follow-up of patients with PEVAC treated using the Ponseti method. Material and methods: Descriptive, longitudinal study, during 2013-2019, in patients with PEVAC managed with Ponseti method. We included patients with uni- or bilateral club foot, under two years of age, without prior surgery, whose parents signed informed consent. Patients with other malformations were excluded. Serial weekly cast was placed for 4-8 weeks, a tenotomy of the Achilles tendon was performed, and cast for three more weeks; then reverse footwear with Dennis-Brown bar. The revisions were recorded at day zero, at eight weeks and every three months up to five years of age. Correction of deformity and pain on walking was assessed. Results: There were 22 patients; 17 (77.3%) corrected more than 90% of the deformity, with adequate functionality and 86.3% without pain on gait, mean follow-up 3.9 years (1-7 years); six patients relapsed (27.27%) due to poor attachment, one re-treated with cast, and five with anterior tibial transfer, all successfully. Conclusions: The club foot managed with Ponseti method corrects more than 90% of the deformity and without or minimal pain with good adherence to treatment. We had a 27.27% recurrence in our series.

Desenvolvimento de um módulo adaptativo para o Sistema de Treinamento das Habilidades Auditivas / Adaptive module development for Sistema de Treinamento das Habilidades Auditivas - SisTHA / Desarrollo de un módulo adaptativo para el Sistema de Entrenamiento de Habilidades Auditivas

Objetivo: O objetivo deste estudo foi desenvolver um modelo conceitual e implementar um módulo adaptativo de treinamento auditivo para o Sistema de Treinamento das Habilidades Auditivas (SisTHA) para adultos e idosos usuários de aparelho auditivo. Métodos: Foi implementado um modelo de treinamento auditivo baseado no perfil do usuário, nas suas restrições socioemocionais e queixas auditivas iniciais, e em seu desempenho ao longo do treinamento. Os questionários Hearing Handicap Inventory for the Adult (HHIA), Hearing Handicap Inventory for the Eldery (HHIE) e de queixas auditivas foram aplicados antes e depois do treinamento. Resultados: Foram implementadas melhorias de responsividade da interface e navegabilidade no SisTHA. O modelo adaptativo foi utilizado para definir o protocolo de treinamento resultando em quatro algoritmos para detecção de perfil, definição do treinamento, treinamento e medição de desempenho. Conclusão: Em futuros ensaios clínicos usando os grupos adaptativo e padrão espera-se avaliar se o treinamento adaptativo possui maior efetividade sobre o padronizado.

Objective: To develop a conceptual model and implement an adaptive hearing training module for the Hearing Skills Training System (SisTHA) for adults and elderly hearing aid users. Methods: A hearing training model based on the user's profile, psychosocial restrictions and initial hearing complaints, and their performance throughout the training was implemented. The Hearing Handicap Inventory for the Adult (HHIA), Hearing Handicap Inventory for the Elderly (HHIE) and Hearing Complaints questionnaires were applied before and after training. Results: Improvements in SisTHA interface responsiveness and navigability was implemented. The adaptive model was used to define the training protocol resulting in four algorithms for profile detection, training definition, training and performance measurement. Conclusion: Future clinical trials will be performed using the adaptive and standard groups to evaluate the possibility of adaptive training is more effective than the standardized ones.

Objetivo: El objetivo de esta investigación fue desarrollar y evaluar un módulo de entrenamiento auditivo adaptativo para el Sistema de Entrenamiento de las Capacidades Auditivas (SisTHA) para adultos y ancianos usuarios de audífonos. Métodos: un modelo de entrenamiento auditiva basado en el perfil del usuario, sus restricciones psicosociales y quejas iniciales de audición y su desempeño a lo largo del entrenamiento fue puesto en ejecución. Los cuestionarios Hearing Handicap Inventory for the Adult (HHIA), Hearing Handicap Inventory for the Eldery (HHIE) y quejas auditivas había sido aplicado antes y después del entrenamiento. Resultados: se han implementado mejoras en la capacidad de respuesta y navegabilidad de la interfaz SisTHA. El modelo adaptativo fue utilizado para definir el protocolo de entrenamiento que resultó en cuatro algoritmos para la detección de perfil, definición de entrenamiento, entrenamiento y medición de rendimiento. Conclusión: en futuros ensayos clínicos que usen los grupos adaptativos y estándar, se espera evaluar si el entrenamiento adaptativo es más efectivo que los estandarizados.

Importance of attenuation correction in PET/MR image quantification: Methods and applications. / Importancia de la corrección de atenuación en la cuantificación de imagen PET/RM: métodos y aplicaciones.

The generation of accurate attenuation correction (AC) maps is a basic step to allow for quantitative PET/MR imaging. However, generating MR-based AC maps is a challenge because there is no direct relationship between the PET attenuation coefficients (µ) and the intensity of the MR signal, contrary to what happens with the intensity of CT images. In fact, ignoring the bone causes a distorted and biased distribution of the calculated SUV values. To solve this problem, several MR-based AC methods have been proposed in the literature. In this paper we describe how these methods work, and the challenge they faced to translate into full body applications. Currently, in research environments, the accuracy of AC methods is no longer a limiting factor to solve in order to carry out quantitative in vivo molecular imaging studies. However, many of these methods present a series of limitations for their real implementation in the clinical practice due to insufficient clinical validation and the difficulty of their implementation in a real environment (as described in the examples of clinical applications). Thus, we need the PET/MR community to work on the standardization of the use and assessment of different AC methods. In this scenario, the opening and access by vendors to the implementation of new AC methods in their PET/MR scanners plays a crucial role.

Impacto do enquadre terapêutico em grupo nas necessidades de famílias de crianças com deficiência auditiva / Impact of the therapeutic group setting on the needs of families of children with hearing loss / Impacto del encuadre terapéutico en grupo en las necesidades de familias de niños con deficiencia auditiva

Introdução: Evidências na área da (re)habilitação auditiva infantil têm indicado a potencial ação transformadora da família como um fator robusto no prognóstico do tratamento. Fundamenta-se ainda que as intervenções devam basear-se na avaliação das necessidades das famílias. Objetivo: avaliar o impacto do enquadre terapêutico de grupo na diminuição das necessidades de familiares de crianças com deficiência auditiva. Método: estudo de intervenção realizado em um serviço de saúde auditiva do SUS, durante o período de seis meses, em que um grupo de 10 famílias de crianças com deficiência auditiva na faixa etária de 1 ano e 4 meses a 5 anos e 3 meses, usuárias de AASI ou IC, responderam ao Inventário das Necessidades Familiares nos momentos pré e pós intervenção, tendo o delineamento da intervenção sido realizado a partir das necessidades evidenciadas pelo instrumento aplicado. As sessões contaram com situações de dinâmicas de grupo, simulações, treino de habilidades e rodas de conversa. Realizada a análise estatística descritiva e indutiva, além da avaliação qualitativa, que contou com um grupo focal. Resultados: destacaram-se como tópicos de maior necessidade das famílias a comunicação com a criança com deficiência auditiva, assuntos sobre a perda auditiva e dispositivos auxiliares à audição, em especial, quanto ao implante coclear. A idade dos responsáveis e a escolaridade, bem como a idade cronológica e auditiva das crianças foram consideradas na análise de diminuição das necessidades de informações pelas famílias. Conclusão: houve impacto positivo do enquadre terapêutico em grupo nas necessidades dos familiares de crianças com deficiência auditiva.

Introduction: Evidences from pediatric auditory (re)habilitation has indicated the potential transformative action of the family as a robust factor in the prognosis of treatment. It is also argued that interventions should be based on the assessment of the family needs. Objective: to evaluate the impact of the therapeutic group setting on reducing the needs of the families of hearing impaired children. Method: an intervention study performed at a government hearing service during a six-month period, in which a group of 10 families of children with hearing loss aged from 1 year and 4 months to 5 years and 3 months, hearing aids or cochlear implant users, responded to the Family Needs Inventory in the pre- and post-intervention moments, and the design of the intervention was made based on the needs evidenced by the instrument applied. The sessions included situations of group dynamics, simulations, skills training and conversation group. Descriptive and inductive statistical analysis was performed, in addition to the qualitative evaluation, which included a focus group. Results: the most important topics for families were communication with the hearing impaired child, hearing loss and electronic devices issues, especially regarding cochlear implantation. The age and the educational status of parents, as well as the chronological and auditory age of the children were considered in the analysis of the reduction of the information needs by the families. Conclusion: there was a positive impact of the therapeutic group setting on the needs of the families of children with hearing impairment.

Introducción: Evidencias en el área de la (re) habilitación auditiva infantil han indicado la potencial acción transformadora de la familia en el pronóstico del tratamiento. Se fundamenta también que las intervenciones deben basarse en la evaluación de las necesidades de las familias. Objetivo: evaluar el impacto del encuadre terapéutico de grupo en la disminución de las necesidades de familiares de niños con pérdida auditiva. Método: estudio de intervención realizado en un servicio de salud auditiva del gobierno, durante el período de seis meses, en que un grupo de familias de niños con deficiencia auditiva en el grupo de edad especifico, usuarias de audífonos o implante coclear, respondieron al Inventario de las Necesidades Familiares en los momentos pre y post intervención, siendo la intervención realizado a partir de las necesidades evidenciadas por el instrumento aplicado. Las sesiones contaron con situaciones de dinámica de grupo, simulaciones, entrenamiento de habilidades y ruedas de conversación. Se realizó el análisis estadístico descriptivo e inductivo, además de la evaluación cualitativa, que contó con un grupo focal. Resultados: se destacaron como temas de mayor necesidad de las familias la comunicación, asuntos sobre la pérdida auditiva y dispositivos auxiliares a la audición. La edad y la escolaridad de los responsables, así como la edad cronológica y auditiva de los niños fueron considerados en el análisis de disminución de las necesidades de información por las familias. Conclusión: hubo un impacto positivo del encuadre terapéutico en grupo en las necesidades de los familiares de niños con deficiencia auditiva.

Mecanismo de acción de la terapia celular en enfermedades hereditarias / Mechanism of action of cell therapy in hereditary diseases

Los trastornos heredados del metabolismo son enfermedades graves de la infancia que cursan con un gran deterioro cognitivo y del desarrollo psicomotor. La fisiopatología del progresivo deterioro del sistema nervioso suele estar asociada a una severa neuroinflamación y desmielinización, y como consecuencia, neurodegeneración. Por el momento no tienen cura y precisan de actitudes terapéuticas precoces y agresivas, que conllevan altas tasas de mortalidad y, muy frecuentemente, escasos grados de mejoría funcional y supervivencia. El trasplante de médula ósea y de células mesenquimales de médula ósea son terapias de elección y experimentales que consiguen mejorar el curso de estas enfermedades mediante diferentes mecanismos de acción: remplazo de enzima deficiente, intercambio de membranas y regulación del proceso inflamatorio.

Inherited metabolism disorders are serious childhood diseases that lead to significant cognitive impairment and regression of psychomotor development. The pathophysiology of the neural progressive deterioration is usually associated with severe neuroinflammation and demyelination, and as a consequence, neurodegeneration. At the moment they have no adequate treatment and require early and aggressive therapeutic approaches, which entail high mortality rates and, very frequently, low degrees of functional improvement and survival. Bone marrow transplantation and bone marrow mesenchymal cells grafts are therapeutic and experimental therapies that improve the course of these diseases through different mechanisms of action: enzyme replacement, membrane exchange and regulation of the inflammatory process.

Presbyopic correction use and its impact on quality of vision symptoms.

AIM: To assess real-world adoption of presbyopic correction and its impact on quality of vision. METHOD: The use of visual corrections by 529 sequential patients (aged 36 years to 85 years, 50.4% female) attending 4 optometric practices in diverse areas across London were surveyed by interview and completed the quality of vision (QoV) questionnaire to evaluate visual symptoms. RESULTS: Over half of the population (54.7%) managed without glasses at least some of the time, while between 30 and 40% wore distance, reading and progressive spectacles with those using Progressive Addition Lenses wearing them over 80% of the time, while those wearing reading spectacles only approximately 25% of the time. Age, sex and driving frequency had no effect of QoV (p>0.05), whereas the distance of the task significantly impacted QoV (p<0.01). In all QoV metrics, regardless of the far, intermediate or near blur assessment, QoV was rated higher by patients whose main tasks were far focused (n=231, 43.9%), than those who principally conduct intermediate tasks (n=165, 31.4%) and worse still for those whose main tasks were near (n=130, 24.7%), regardless of the form of correction. CONCLUSION: Majority of tasks are in the distance and these had a higher QoV than intermediate tasks with near focused tasks being even worse. It is important to discuss with patients the principal distance of the tasks they generally perform and the forms of presbyopic correction used from the outset.