BLAME-LESS STUDY: a two-arm randomized controlled trial evaluating the effects of an online psychoeducation programme for adolescents who have experienced physical/sexual violence or sexual abuse. Rationale, study design, and methods.

Background: Victims of physical/sexual violence or sexual abuse commonly experience defense responses that result in feelings of guilt and shame. Although trauma-focused interventions are effective in treating post-traumatic stress disorder symptoms, the presence of trauma-related shame and guilt can potentially hinder the process of disclosure during treatment, thus diminishing their overall effectiveness. It is hypothesized that providing psychoeducation about common defense responses will reduce feelings of shame and guilt, thereby increasing receptivity to trauma-focused treatment.Objective: This paper describes the rationale, study design, and methods of the BLAME-LESS study. The effects of a brief online psychoeducation program will be compared with a waiting-list control group. The intervention aims to reduce feelings of trauma-related shame and guilt that adolescents experience regarding their own defense responses during and after physical/sexual violence or sexual abuse.Methods: Adolescents (12 - 18 years old) with a history of physical/sexual violence or sexual abuse who suffer from trauma-related feelings of shame and guilt can participate in the study. The study follows a two-arm RCT that includes 34 participants. The primary outcomes includes trauma-related feelings of shame and guilt. The secondary outcomes includes PTSD symptoms, anxiety and depression symptoms, traumatic cognitions, readiness to disclose details of memories of the trauma, and motivation to engage in trauma-focused therapy. Assessments take place after screening, at baseline, two weeks after allocation to the intervention or waiting-list, and, only for the waiting-list participants, seven weeks after allocation to the intervention.Conclusions: There is a need for treatment approaches that target trauma-related feelings of shame and guilt. A recently developed brief online psychoeducation program on defense responses during and after trauma offers victims of physical/sexual violence or sexual abuse a free and accessible way to obtain reliable and valid information. The proposed RCT will evaluate the effectiveness of this online psychoeducation program.Trial Registration: Request is pending.

Some defense responses to physical/sexual violence or sexual abuse, such as tonic immobility and appeasement behaviour, are common but unknown and raise feelings of shame and guilt.BLAME-LESS (In Dutch: On(t)schuldig) is a newly developed online psychoeducation programme that aims to reduce feelings of trauma-related shame and guilt. This programme includes explanatory animations, in-depth interviews with experts and victims, and written information accompanied by case reports.The proposed study examines the effectiveness of the brief online psychoeducation programme BLAME-LESS in a well-controlled study.

Current opinion on laryngeal electromyography.

PURPOSE: This study evaluates expert opinion on laryngeal electromyography (LEMG). METHODS: A cross-sectional design was used to conduct an online survey of LEMG experts in 2021. They were questioned about the number LEMG performed annually, type of electrodes used, sector worked in, pain during the test, placement of the needle electrodes, interpretation of electrical muscle parameters, diagnosis of neuromuscular injury, prognostic sensitivity in vocal fold paralysis (VFP), laryngeal dystonia, tremor and synkinesis and quantifying LEMG. RESULTS: Thirty-seven professionals answered (23 Spanish and 14 from other countries), with a response rate of 21.56%. All physicians used LEMG. 91.9% had one- or two-years' experience and 56.8% performed 10-40 LEMG per year. 70.3% were otolaryngologists and 27%, neurologists. In 89.1% of cases, a team of electrodiagnostic physician and otolaryngologist performed LEMG. 91.3% of Spanish respondents worked in Public Health, 7.14% of other nationalities; 37.8% in a university department. Bipolar concentric needles electrodes were used by 45.9% and monopolar concentric by 40.5%. 57% professionals considered good patients' tolerance to the test. LEMG sensitivity was regarded as strong, median and interquartile range were 80.0 [60.0;90.0] to diagnose peripheral nerve injuries, less for other levels of lesions, and strong to evaluate prognosis, 70.0 [50.0;80.0]. Respondents believe locate the thyroarytenoid and the cricothyroid muscles with the needle, 80.0 [70.0;90.0], as opposed to 20.0 [0.00;60.0] the posterior cricoarytenoid. The interpretation of the electrical parts of the LEMG was strong, 80.0 [60.0;90.0]. LEMG identify movements disorders, 60.0 [20.0;80.0], and synkinesis, 70.0 [30.0;80.0]. The professionals prefer quantitative LEMG, 90.0 [60.0;90.0]. CONCLUSIONS: The experts surveyed consider LEMG that is well tolerated by patients. The insertional and spontaneous activity, recruitment and waveform morphology can be assessed easily. LEMG is mainly useful in the study of peripheral nerve injuries, and its value in VFP prognosis is considered strong.

Immobility and mobility practices in pandemic: Daily experiences of inhabitants of Temuco (Chile) / Prácticas de inmovilidad y movilidad en pandemia: experiencias cotidianas de habitantes de temuco (chile)

RESUMEN Durante el último tiempo, las ciudades de Chile han sido afectadas por las restricciones de movilidad impuestas por las autoridades con el objetivo de frenar el avance de la COVID-19. Considerando esta problemática, el artículo se enfoca en la percepción de habitantes de Temuco, como una de las primeras ciudades del país en afrontar la cuarentena total, respecto a las transformaciones experimentadas a partir de las medidas políticas de limitación de movilidad. Mediante un diseño metodológico cualitativo se analizó la percepción de algunos habitantes en relación con los cambios generados en sus rutinas cotidianas producto de la emergencia de inmovilidades, lo cual se relaciona directamente con la comprensión de la movilidad como una práctica central de las ciudades contemporáneas. Entre los hallazgos destaca la inmovilidad como una categoría que implica diversas encrucijadas cotidianas en las personas, el papel de la movilidad como categoría central para el desarrollo de la vida social, las transformaciones en los hábitos diarios de las personas y, por último, la necesidad de reflexionar el derecho a la movilidad de las personas desde los territorios.

ABSTRACT Innovation is one of the most important pillars for sustainable competitiveness, especially in micro and small companies that operate in a dynamic and complex context. In this context, the objective of the study was to determine the influence of human, organizational, and technical innovation capacities on the level of innovation. For this, an economic model of multiple linear regression was developed. The sampling procedure was a stratified probabilistic sample of 26 micro and small exporting textile crafts enterprises from the South area of Peru, which answered a questionnaire of 52 items. The results reflect that the capacity for human, organizational, and technical innovation influence with a coefficient of determination of 96.7%, positive and significant in the level of innovation. In conclusion, human innovation capacity has a greater influence on the variability of the level of innovation, due to the creativity, motivation, and knowledge of people.

Relevância da deambulação precoce no tempo de internação hospitalar de pacientes idosos: revisão integrativa / Relevance of early deambulation in the time of hospital admission of elderlypatients: integrative review / Relevancia de la caminata temprana en el tiempo de internamientohospitalariodel anciano: revisión integrativa

Introdução:No Brasil, a população considerada idosa representa a faixa etária que mais utiliza os serviçoshospitalares.Mesmo sendo um importante recurso, a admissão hospitalar frequente ou por um tempo prolongado, pode gerar comprometimentos funcionais a este público.A prática da reabilitação precoce contribui para minimizar e prevenir estesimpactos deletérios do imobilismo, favorecer a capacidade funcional, diminuindo o tempo de hospitalização, além de promover qualidade de vida. Objetivo:Observar a relevância da mobilização precoce em idosos, bem como os prejuízos acarretados pelo imobilismo durante internação hospitalar.Metodologia:Trata-se de uma revisão integrativa com busca online nas bases de dados PEDro, PUBMED, MEDLINE, LILACS e SciELO, os descritores foram: mobilização precoce, imobilismoeidosos, com seus respectivos em língua inglesa, foram selecionados artigos publicados entre os anos de 2016 a 2020, em língua portuguesa e estrangeira.Resultados:Foram selecionados cinco artigos para a discussão, sendo utilizado a deambulação precoce de precisão como limiar de segurança para reabilitação cardíaca; avaliou-se a influência da reabilitação precoce e terapia de reabilitação em pacientes com mais de 72 horas de ventilação mecânica prolongada; observou-se a intensificação da fisioterapia pós-operatória, com exercícios de respiração profunda e mobilização precoce; observou-se que a reabilitação domiciliar interdisciplinar geriátrica em idosos com fratura de quadril poderia melhorar a capacidade de locomoção e reduzir tempo de internação pós-operatória. Os achados discutidos entre os autores, apontam com unanimidade a aprovação da deambulação e mobilização precoce.Conclusões:A mobilização precoce mostrou-se eficaz tanto nos pacientes em atendimento hospitalar como no ambiente domiciliar, reduzindo significativamente os prejuízos ocasionados pelo imobilismo (AU).

Introduction:In Brazil, the population considered elderly represents the age group that most uses hospital services. Even though an important resource, frequent hospital admission orfor a prolonged period of time can generate functional impairments for this public. The practice of early rehabilitation helps to minimize and prevent the deleterious impacts of immobility, favoring functional capacity, decreasing the length of hospital stay and promoting quality of life. Objective:The study aims to observe the relevance of early mobilization in the elderly, as well as the damage caused by immobility during hospitalization. Methodology:This is an integrative review with an online search in the PEDro, PUBMED, MEDLINE, LILACS and SciELO databases. The descriptors were: early mobilization, immobility in the elderly and their respective in English. Articles published between the years 2016 to 2020, in Portuguese and foreign languages, were used. Results:Five articles were selected for discussion, using Precision Early Ambulation as a safety threshold for cardiac rehabilitation; the influence of early rehabilitation and rehabilitation therapyin patients with more than 72 hours of prolonged mechanical ventilation was evaluated; it was observed the intensification of postoperative physical therapy, with deep breathing exercises and early mobilization; geriatric interdisciplinary home rehabilitation in elderly patients with hip fractures was evaluated to improve mobility and reduce postoperative hospital stay. Discussions among the authors unanimously point to the approval of ambulation and early mobilization.Conclusions:Early mobilization proved to be effective both in patients in hospital care and in the home environment, significantly reducing the damage caused by immobility (AU).

Introducción:En Brasil, la población considerada anciana representa el grupo de edad que más utiliza los servicios hospitalarios. A pesar de que es un recurso importante, la hospitalización frecuente o por un período prolongado de tiempo puede generar deficiencias funcionales para este público. La práctica de la rehabilitación temprana ayuda a minimizar y prevenir los impactos deletéreos de la inmovilidad, favoreciendo la capacidad funcional, reduciendo el tiempo de hospitalización, además de promover la calidad de vida. Objetivo: El estudio tiene como objetivo observar la relevancia de la movilización temprana en ancianos, así como los daños causados por la inmovilización durante la hospitalización. Metodología: Esta es una revisión integradora con una búsqueda en línea de las bases de datos PEDro, PUBMED, MEDLINE, LILACS y SciELO, los descriptores fueron: movilización temprana, inmovilidad y ancianos en el idioma inglés, se seleccionaron artículos publicados entre los años de 2016 a 2020, en portugués y lenguas extranjeras. Resultados: Se seleccionaron cinco artículos para discusión, utilizando deambulación temprana de precisión como umbral de seguridad para la rehabilitación cardiaca; se evaluó la influencia de la rehabilitación temprana y la terapia de rehabilitaciónen pacientes con más de 72 horas de ventilación mecánica prolongada; hubo una intensificación de la fisioterapia posoperatoria, con ejercicios de respiración profunda y movilización precoz; Se evaluó la rehabilitación domiciliaria interdisciplinaria geriátrica en pacientes ancianos con fractura de caderapara mejorar la movilidad y reducir la estancia hospitalaria postoperatoria. Los hallazgos discutidos entre los autores apuntan unánimemente a la aprobación de la deambulación y la movilización precoz. Conclusiones: La movilización temprana demostró ser efectiva tanto en pacientes en atención hospitalaria como en el ámbito domiciliario, reduciendo significativamente el daño ocasionado por la inmovilización (AU).

Vocal fold immobility with normal LEMG: A range of possibilities.

OBJECTIVE: The objective of this paper is to study the etiology of vocal fold immobility with non-pathological LEMG. METHODS: A retrospective study was performed on patients who presented with vocal fold immobility and underwent LEMG from 2009 to 2017. Those patients with normal LEMG findings were selected. The different causes of vocal fold impairment were studied. RESULTS: Of the 120 patients included in this study, 15 had a normal LEMG recording. The different etiologies of vocal fold immobility were idiopathic, central nervous system damage, iatrogenic, and external compression. CONCLUSIONS: Vocal fold immobility and vocal fold paralysis are not equal terms. Vocal fold immobility with normal LEMG has a heterogeneous group of causes. It is not correct to assume that the major cause of immobility in patients with normal LEMG is always cricoarytenoid joint fixation.

Inmovilidad de cuerdas vocales con electromiografía laríngea normal: un abanico de posibilidades / Vocal fold immobility with normal LEMG: A range of possibilities

Objective: The objective of this paper is to study the etiology of vocal fold immobility with non-pathological LEMG. Methods: A retrospective study was performed on patients who presented with vocal fold immobility and underwent LEMG from 2009 to 2017. Those patients with normal LEMG findings were selected. The different causes of vocal fold impairment were studied. Results: Of the 120 patients included in this study, 15 had a normal LEMG recording. The different etiologies of vocal fold immobility were idiopathic, central nervous system damage, iatrogenic, and external compression. Conclusions: Vocal fold immobility and vocal fold paralysis are not equal terms. Vocal fold immobility with normal LEMG has a heterogeneous group of causes. It is not correct to assume that the major cause of immobility in patients with normal LEMG is always cricoarytenoid joint fixation. (AU)

Objetivo: El propósito de este artículo es estudiar la etiología de la inmovilidad de las cuerdas vocales con una EMG laríngea no patológica. Métodos: Se ha realizado un estudio retrospectivo de pacientes con inmovilidad de cuerdas vocales a los que se les hizo EMG laríngea desde 2009 a 2017. Se seleccionaron los pacientes con EMG laríngea normal. Se estudiaron las diferentes causas de inmovilidad de las cuerdas vocales. Resultados: De los 120 pacientes incluidos en el estudio, 15 tuvieron un resultado de EMG laríngea normal. Las diferentes etiologías de inmovilidad de las cuerdas vocales fueron idiopáticas, lesiones del sistema nervioso central, causas iatrogénicas y compresión externa. Conclusiones: La inmovilidad de cuerdas vocales y la parálisis de cuerdas vocales no son términos equivalentes. La inmovilidad de cuerdas vocales con EMG laríngea normal tiene un grupo de causas heterogéneo. No es correcto asumir que la principal causa de inmovilidad de cuerdas vocales en pacientes con EMG laríngea normal sea siempre la fijación cricoaritenoidea. (AU)

Vocal fold immobility with normal LEMG: A range of possibilities.

OBJECTIVE: The objective of this paper is to study the etiology of vocal fold immobility with non-pathological LEMG. METHODS: A retrospective study was performed on patients who presented with vocal fold immobility and underwent LEMG from 2009 to 2017. Those patients with normal LEMG findings were selected. The different causes of vocal fold impairment were studied. RESULTS: Of the 120 patients included in this study, 15 had a normal LEMG recording. The different etiologies of vocal fold immobility were idiopathic, central nervous system damage, iatrogenic, and external compression. CONCLUSIONS: Vocal fold immobility and vocal fold paralysis are not equal terms. Vocal fold immobility with normal LEMG has a heterogeneous group of causes. It is not correct to assume that the major cause of immobility in patients with normal LEMG is always cricoarytenoid joint fixation.

Invertendo o enfoque das "crises migratórias" para as "migrações de crise": uma revisão conceitual no campo das migrações / From "migration crisis" to "crisis migration": a conceptual review within the migration studies field / De "crisis migratoria" a "migraciones de crisis": una revisión conceptual en el campo de estudios de las migraciones

O presente artigo se propõe a debater um novo conceito no campo de estudos migratórios - as migrações de crise -, o qual traz à luz os processos, motivos e fatores vivenciados por populações afetadas por crises e que podem contribuir para processos migratórios de indivíduos, famílias e comunidades como um todo. Introduzindo diversas categorias correlatas - como a eventualidade, a imobilidade (ou enclausuramento) e a não escolha -, adota-se um direcionamento metodológico e conceitual que aponta para as crises como propulsoras das migrações. Dessa maneira, busca-se tensionar a ideia de que as migrações geram crises aos Estados-nação receptores de movimentos significativos de pessoas - a qual notavelmente se consolida pela disseminação do termo "crise migratória", em especial, nos discursos políticos e midiáticos correntes. A delimitação do novo conceito proposto e da sua metodologia de estudo pautou-se pela revisão bibliográfica da literatura especializada na área, com foco em pesquisas recentes sobre as migrações de crise e suas implicações tanto na esfera local como na internacional. Ao final do texto, levantamos os desafios e as contribuições de tal conceito, envolvendo debates centrais no campo das migrações, inobstante questões teórico-metodológicas

This article aims to debate a new concept within the migration studies field which is named "crisis migration", shedding light on the processes, motives and factors that influence the movement of populations affected by crisis. Introducing other interrelated categories - such as eventuality, immobility and non-choice - , the article is guided by a methodological and conceptual perspective that understands crisis as a driver to migration. Therefore it seeks to defy the idea that migrations generate crisis to nation-states receiving large contingents of people. This idea has been consolidated by the term "migration crisis" especially disseminated in the midia and political discourses. Our discussion of the new concept was based on bibliographic review, focusing on recent researchs in respect to crisis migration and its unfoldings not only in the local but also in the international scenario. Finally, we bring about the challenges as well as the contributions of this concept, which involve unsolved central debates within the migration field.

Este artículo tiene como objetivo discutir un nuevo concepto en el campo de los estudios migratorios, las migraciones de crisis, que saca a la luz los procesos, los motivos y los factores experimentados por las poblaciones afectadas por las crisis y que pueden contribuir a los procesos migratorios de las personas, las familias y comunidades en su conjunto. Al introducir varias categorías relacionadas, como eventualidad, inmovilidad (o confinamiento) y no elección, se adopta una dirección metodológica y conceptual que apunta a las crisis como motores de la migración. De esta manera, buscamos tensionar la idea de que la migración genera crisis en los Estados-nación que reciben movimientos significativos de personas, lo que se consolida notablemente por la difusión del término crisis migratoria, especialmente en los discursos políticos y mediáticos actuales. La delimitación del nuevo concepto propuesto y su metodología de estudio fue guiada por la revisión bibliográfica de la literatura especializada en el área, con un enfoque en investigaciones recientes sobre migraciones de crisis y sus implicaciones tanto a nivel local como internacional. Al final del texto, planteamos los desafíos y las contribuciones de dicho concepto, involucrando debates centrales en el campo de las migraciones, a pesar de los problemas teóricos y metodológicos que aún no se han superado suficientemente dentro de este.

Síndrome de inmovilidad en adultos mayores del Policlínico Bernardo Posse del municipio San Miguel del Padrón / Immobilization syndrome in elderly people in "Bernardo Posse" Policlinic in San Miguel del Padron

RESUMEN Fundamento: Dentro de los grandes síndromes geriátricos, la inmovilidad es una de las más graves consecuencias de las enfermedades que puede sufrir el anciano. Objetivo: Caracterizar el comportamiento del síndrome de inmovilidad en los adultos mayores del Grupo Básico de Trabajo n.o 1 del policlínico Bernardo Posse de San Miguel del Padrón. Metodología: Se realizó un estudio descriptivo, retrospectivo, en 145 pacientes con síndrome de inmovilidad, de una población de 160 ancianos desde enero de 2015 a diciembre del 2017. Se determinó el tipo de inmovilidad, y las causas principales, así como las complicaciones. Resultados: El síndrome predominó en pacientes femeninos en edades altas de la vida. El tipo de inmovilidad más frecuente fue la larvada y las causas más frecuentes fueron las enfermedades osteomioarticulares, las infecciones, el cáncer y el síndrome del cuidador. Las complicaciones que predominaron fueron a nivel de los sistemas digestivo, respiratorio, cardiovascular y la piel. Conclusiones: El riesgo de presentar algún tipo de inmovilidad aumenta con la edad y el sexo femenino es más susceptible a este. La inmovilidad es una entidad sindromática que deteriora de manera significativa la calidad de vida de los adultos mayores ya que el anciano inmovilizado es un paciente de alto riesgo para la aparición de complicaciones.

ABSTRACT Background: Within the great geriatric syndromes, immobility is one of the most serious consequences of the diseases that the elderly can suffer. Objective: To characterize the behavior of the immobility syndrome in the elderly from the Basic Working Group No. 1 at Bernardo Posse polyclinic in San Miguel del Padrón. Methodology: A retrospective descriptive study was carried out in 145 patients with immobility syndrome, from a population of 160 elderly people, from January 2015 to December 2017. The type of immobility was determined, as well as the main causes, as well as complications. Results: The syndrome predominated in female patients at high ages of life. The most frequent type of immobility was larvae and the most frequent causes were osteomyoarticular diseases, infections, and cancer also the caregiver syndrome. The predominated complications were at the level of the digestive, respiratory, cardiovascular and skin systems. Conclusions: The risk of presenting some type of immobility increases with age, and the female sex is more susceptible to it. Immobility is a syndromic disease that significantly deteriorates the quality of life of elderly, since the immobilized elderly person is a high-risk patient for complications.

Síndrome de inmovilidad en adultos mayores del Policlínico Bernardo Posse del municipio San Miguel del Padrón / Immobilization syndrome in elderly people in "Bernardo Posse" Policlinic in San Miguel del Padron

RESUMEN Fundamento: Dentro de los grandes síndromes geriátricos, la inmovilidad es una de las más graves consecuencias de las enfermedades que puede sufrir el anciano. Objetivo: Caracterizar el comportamiento del síndrome de inmovilidad en los adultos mayores del Grupo Básico de Trabajo n.o 1 del policlínico Bernardo Posse de San Miguel del Padrón. Metodología: Se realizó un estudio descriptivo, retrospectivo, en 145 pacientes con síndrome de inmovilidad, de una población de 160 ancianos desde enero de 2015 a diciembre del 2017. Se determinó el tipo de inmovilidad, y las causas principales, así como las complicaciones. Resultados: El síndrome predominó en pacientes femeninos en edades altas de la vida. El tipo de inmovilidad más frecuente fue la larvada y las causas más frecuentes fueron las enfermedades osteomioarticulares, las infecciones, el cáncer y el síndrome del cuidador. Las complicaciones que predominaron fueron a nivel de los sistemas digestivo, respiratorio, cardiovascular y la piel. Conclusiones: El riesgo de presentar algún tipo de inmovilidad aumenta con la edad y el sexo femenino es más susceptible a este. La inmovilidad es una entidad sindromática que deteriora de manera significativa la calidad de vida de los adultos mayores ya que el anciano inmovilizado es un paciente de alto riesgo para la aparición de complicaciones.

ABSTRACT Background: Within the great geriatric syndromes, immobility is one of the most serious consequences of the diseases that the elderly can suffer. Objective: To characterize the behavior of the immobility syndrome in the elderly from the Basic Working Group No. 1 at Bernardo Posse polyclinic in San Miguel del Padrón. Methodology: A retrospective descriptive study was carried out in 145 patients with immobility syndrome, from a population of 160 elderly people, from January 2015 to December 2017. The type of immobility was determined, as well as the main causes, as well as complications. Results: The syndrome predominated in female patients at high ages of life. The most frequent type of immobility was larvae and the most frequent causes were osteomyoarticular diseases, infections, and cancer also the caregiver syndrome. The predominated complications were at the level of the digestive, respiratory, cardiovascular and skin systems. Conclusions: The risk of presenting some type of immobility increases with age, and the female sex is more susceptible to it. Immobility is a syndromic disease that significantly deteriorates the quality of life of elderly, since the immobilized elderly person is a high-risk patient for complications.

Split cricoídeo posterior endoscópico con injerto de cartílago costal / Endoscopic posterior cricoid split with costal cartilage graft

RESUMEN A pesar de los avances en cirugía de vía aérea, tanto abierta como endoscópica, la inmovilidad bilateral de cuerdas vocales continúa representando un desafio significativo para los cirujanos de vía aérea. Entre las alternativas quirúrgicas existen tanto abordajes endoscópicos como transcervicales, no obstante, la mayoría de estas técnicas modifican estructuralmente regiones de la cuerda vocal y/o aritenoides de manera permanente. La traqueostomía ha sido el tratamiento de elección en niños con inmovilidad bilateral de cuerdas vocales severamente sintomática, sin embargo, el procedimiento ideal debiese establecer una vía aérea adecuada evitando la necesidad de realizar una traqueostomía, y a la vez no generar un deterioro de la función fonatoria. La capacidad de expandir el aspecto glótico posterior sin modificación estructural de aritenoides y/o ligamento vocal ha convertido a la sección cricoidea posterior endoscópica con injerto de cartílago costal en una alternativa quirúrgica atractiva para estos casos. En este trabajo se realiza una revisión de la literatura y presenta un caso tratado mediante esta técnica en el Hospital Guillermo Grant Benavente de Concepción, Chile.

ABSTRACT Despite advances in both open and endoscopic airway surgery, bilateral vocal cord immobility still poses a significant challenge for airway surgeons. Among the surgical alternatives there are both endoscopic and transcervical approaches. However, most of these techniques structurally modify certain regions of the vocal cord and/or arytenoids permanently. Tracheostomy has been the treatment of choice in severely symptomatic children with bilateral immobility of vocal cords. Nevertheless, the ideal procedure should establish an adequate airway, avoiding the need to perform a tracheostomy, and at the same time not causing a deterioration of the phonatory function. The ability to expand the posterior glottis without structural modification of the arytenoids and/or vocal ligament has converted the posterior endoscopic cricoid split with costal cartilage graft into an attractive surgical alternative for these cases. In this article we review the literature and present a case treated by this technique in the Guillermo Grant Benavente Hospital in Concepción, Chile.

The perpetual state of emergency that sacrifices protected areas in a changing climate.

A modern challenge for conservation biology is to assess the consequences of policies that adhere to assumptions of stationarity (e.g., historic norms) in an era of global environmental change. Such policies may result in unexpected and surprising levels of mitigation given future climate-change trajectories, especially as agriculture looks to protected areas to buffer against production losses during periods of environmental extremes. We assessed the potential impact of climate-change scenarios on the rates at which grasslands enrolled in the Conservation Reserve Program (CRP) are authorized for emergency harvesting (i.e., biomass removal) for agricultural use, which can occur when precipitation for the previous 4 months is below 40% of the normal or historical mean precipitation for that 4-month period. We developed and analyzed scenarios under the condition that policy will continue to operate under assumptions of stationarity, thereby authorizing emergency biomass harvesting solely as a function of precipitation departure from historic norms. Model projections showed the historical likelihood of authorizing emergency biomass harvesting in any given year in the northern Great Plains was 33.28% based on long-term weather records. Emergency biomass harvesting became the norm (>50% of years) in the scenario that reflected continued increases in emissions and a decrease in growing-season precipitation, and areas in the Great Plains with higher historical mean annual rainfall were disproportionately affected and were subject to a greater increase in emergency biomass removal. Emergency biomass harvesting decreased only in the scenario with rapid reductions in emissions. Our scenario-impact analysis indicated that biomass from lands enrolled in the CRP would be used primarily as a buffer for agriculture in an era of climatic change unless policy guidelines are adapted or climate-change projections significantly depart from the current consensus.

Tratamiento de la inmovilidad cordal bilateral / Bilateral vocal fold immobility treatment

La inmovilidad bilateral de las cuerdas vocales en aducción puede ser provocada por diversas etiologías y pone en riesgo la vida de los pacientes por la disnea grave que puede ocasionar. Existen diversas técnicas quirúrgicas para aumentar el espacio glótico, entre las que prevalecen las cirugías transorales que resecan tejido. El objetivo del presente trabajo es determinar la tasa de resolución de la disnea inspiratoria o decanulación, en pacientes con inmovilidad cordal bilateral en aducción, tratados mediante cordotomía posterior y aritenoidectomía parcial. Fueron tratados en este estudio 17 enfermos por inmovilidad bilateral de las cuerdas vocales en aducción, mediante cordotomía posterior y aritenoidectomía parcial medial por vía transoral con láser de CO2 , cauterio y radiofrecuencia. Ocho pacientes tuvieron traqueostomía. El 75% fueron decanulados. El 100% de los pacientes sin traqueostomía mejoraron la disnea inspiratoria y no tuvieron limitación para las actividades de su vida cotidiana. Como conclusión del trabajo, se determinó que la cordotomía posterior y la aritenoidectomía parcial por vía transoral fueron muy eficaces para mejorar el calibre de la vía aérea superior, con baja morbilidad y sin complicaciones. (AU)

Bilateral medial vocal fold immobility, can be caused by various etiologies and can lead to severe dyspnea that may risk patients life. There are several surgical techniques for increasing the glottic space, prevailing transoral surgeries that remove tissue. The objective of this study is to determine the rate of resolution of inspiratory dyspnea and decanulation in patients with bilateral vocal cord immobility in adduction. In this study 17 patients diagnosed with bilateral vocal fold immobility in adduction were treated with posterior cordotomy and partial medial arytenoidectomy with transoral approach, using CO2 laser, radiofrequency or electrocautery. Eight of our patients were tracheostomized. Six of the tracheostomized patients had their tracheostomies removed (6 out of 8, 75%). Nine without tracheostomy showed improvement of inspiratory dyspnea and had no limitation on their daily lives activities. (9 out of 9, 100%). As a conclussion, we can say that transoral cordotomy and partial arytenoidectomy were very effective in improving the caliber of the upper airway, with low morbidity and no complications. (AU)

[Review of functional impairment associated with acute illness in the elderly]. / Revisión sobre el deterioro funcional en el anciano asociado al ingreso por enfermedad aguda.

Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important.