Felipe Cardemil

Absolute eosinophils count as a marker of mortality in patients with severe sepsis and septic shock in an intensive care unit

INTRODUCTION Eosinophils in the circulating blood undergo apoptosis during sepsis syndromes induced by the action of certain cytokines. OBJECTIVE The aim of the study was to evaluate the absolute eosinophils count (EC) as a marker of mortality in severe sepsis and septic shock. PATIENTS AND METHOD A prospective cohort study of patients with a diagnosis of sepsis or septic shock admitted to the intensive care unit (ICU) of the Dr Gustavo Fricke Hospital between January 2008 and December 2009 was conducted. Daily EC in all patients was analyzed. Receiver operating characteristic curve analysis was used to assess the performance of the diagnostic test. RESULTS We studied a total of 240 patients. The median age was 62 years (interquartile range [IQR], 48-72 years), and 67 (27.9%) died. The median EC in patients who died was 43 (IQR, 14-121), whereas in surviving patients, it was 168 (IQR, 98-292) (P < .001). When the EC on the fifth day of hospital stay was assessed, an area under the curve (AUC) of 0.64 (95% confidence interval, 0.55-0.73) was observed. Eosinophils count at intensive care unit discharge showed an area under the curve of 0.81 (95% confidence interval, 0.76-0.87). DISCUSSION Eosinophils counts were lower in patients who died of sepsis than in those who survived, but its clinical usefulness seems limited. Their role as an indicator of clinical stability seems to be important.

Xylene-induced auditory dysfunction in humans

Objectives: Animal data indicate that xylene induces cochlear dysfunction, characterized by the loss of outer hair cells. There is little evidence regarding xylene-induced ototoxicity in humans. The aim of the study was to investigate the possible adverse effects of xylene on the peripheral and central auditory system in humans. Design: A total of 30 medical laboratory workers who had been exposed to a mixture of xylene isomers, together with 30 nonexposed control participants matched for gender, age, and educational level were selected. Participants of both groups were not exposed to noise levels above 85 dBA time-weighted average. All participants were evaluated with a comprehensive audiological test battery, which included measures of peripheral and central auditory function. Peripheral auditory measures included pure-tone audiometry and distortion product otoacoustic emissions. Behavioral measures of central auditory function included a pitch pattern sequence test, an adaptive test of temporal resolution, a dichotic digit test, and a masking level difference test. The auditory brainstem response was used to objectively evaluate the function of the auditory pathways at the brainstem level. Speech perception in quiet and in noise was evaluated using the Hearing In Noise Test (HINT). The xylene-exposed participants were extensively evaluated with regard to their exposure to both noise and xylene. Noise dosimetry was conducted over an 8-hr work shift to obtain noise-exposure levels for each xylene-exposed worker. Airborne xylene concentrations were obtained at 11 different workstations throughout the medical laboratories, and methyl hippuric acid levels per gram of creatinine in urine were obtained for each xylene-exposed subject. Finally, a detailed interview exploring current and past solvent and noise exposure was conducted. Results: The xylene-exposed participants showed significantly worse pure-tone thresholds in comparison with the nonexposed participants. The xylene-exposed participants demonstrated significantly worse results than the control group participants for the pitch pattern sequence test, dichotic digit test, HINT, and the auditory brainstem response (absolute and interpeak latencies). No significant differences between the xylene-exposed and nonexposed participants were observed for distortion product otoacoustic emissions, adaptive test of temporal resolution, or the masking level difference test. A significant correlation between the concentrations of methyl hippuric acid in urine and pure-tone thresholds (2 to 8 kHz) was found in xylene-exposed workers. Also, participants with high cumulative dose of xylene exposure presented with poorer test results than participants with low cumulative dose of xylene exposure. Conclusions: The results of the present research suggest that xylene is associated with adverse central auditory effects and poorer sound detection abilities in humans. A major limitation of the study is that the results found among xylene-exposed participants cannot be proved to be permanent, and thus further research should be conducted to clarify this limitation. Workers exposed to this chemical should be routinely evaluated with a comprehensive audiological test battery, to detect early signs of auditory dysfunction.

Evaluación del programa "Active Communication Education" para rehabilitación auditiva en adultos mayores con hipoacusia usuarios de audífonos

Introduccion: La hipoacusia es una condicion prevalente en adultos mayores. Sin embargo, la baja adherencia al uso del audifono representa una realidad. Objetivo: Evaluar la utilidad de un programa de intervencion para mejorar adherencia en pacientes con hipoacusia mayores de 65 anos usuarios de audifono. Material y metodo: Ensayo clinico aprobado por Comite de Etica. Se incluyeron pacientes beneficiarios del GES de hipoacusia. Se evaluo adherencia al audifono en un corte a 6 meses. Resultados: Fueron evaluados 180 pacientes, correspondiendo a 90 pacientes control y 90 intervenidos. La adherencia global al uso del audifono fue de 78%. No hubo diferencia en los grupos por sexo, edad, ni grado de hipoacusia. El promedio de horas diarias de uso en el grupo control fue de 6,9 horas, comparado con el del grupo intervenido que fue 9,6 horas (p <0,0001). Hubo una asociacion significativa entre la intervencion y la regularidad del uso del audifono, con 80% de pacientes que lo usaban regularmente en el grupo intervenido contra el 8,9% en el grupo control (p <0,001). Discusion: La intervencion implementada ha demostrado excelentes resultados preliminares en terminos de tiempo de uso del audifono, por lo que seria de utilidad implementaria como parte de la politica GES y difundir su uso.

Programa de tamizaje universal e intervención precoz (PTUIP) en hipoacusia sensorioneural bilateral congénita: Tarea pendiente desde la perspectiva de políticas públicas de salud en Chile

Congenital hearing loss is the total or partial inability to hear sounds through the ears. It is the most common disability in newborns in Chile and worldwide, and is a permanent condition. The direct impact on children who are not adequately diagnosed is the alteration in acquisition of language and cognitive skills and a decline in their social and school insertion, jeopardizing their professional and potentially productive life. Universal screening programs for hearing loss are essential for the diagnosis, since 50% of infants with hearing loss have no known risk factor. Screening before one month of age, confirmation before 3 months, and effective intervention before 6 months, allows the development of these children as if they had normal hearing. In Chile there is a selective program of screening for infants aged less than 32 weeks or 1,500 grams, as part of Explicit Health Guarantees, but it covers only 0.9% of newborns per year. Therefore, a large majority of children remain without diagnosis. The aim of this review is to compare the situation in Chile with other countries, raising the need to move towards a universal neonatal hearing loss screening program, and propose necessary conditions in terms of justification and implementation of a universal screening public policy.Congenital hearing loss is the total or partial inability to hear sounds through the ears. It is the most common disability in newborns in Chile and worldwide, and is a permanent condition. The direct impact on children who are not adequately diagnosed is the alteration in acquisition of language and cognitive skills and a decline in their social and school insertion, jeopardizing their professional and potentially productive life. Universal screening programs for hearing loss are essential for the diagnosis, since 50% of infants with hearing loss have no known risk factor. Screening before one month of age, confirmation before 3 months, and effective intervention before 6 months, allows the development of these children as if they had normal hearing. In Chile there is a selective program of screening for infants aged less than 32 weeks or 1,500 grams, as part of Explicit Health Guarantees, but it covers only 0.9% of newborns per year. Therefore, a large majority of children remain without diagnosis. The aim of this review is to compare the situation in Chile with other countries, raising the need to move towards a universal neonatal hearing loss screening program, and propose necessary conditions in terms of justification and implementation of a universal screening public policy.

Prevalence and associated factors of hearing aid use among older adults in Chile

Abstract Objective: The aim of this study was to determine the prevalence of use of hearing aids by older adults in Chile and the influence of some variables such as education level, income level and geographic area of residence on the prevalence of hearing aids. Design: A national cross-sectional survey which was carried out in 2009. Study sample: A representative sample of 4766 Chilean older adults aged 60 years and above. Results: The percentage of older adults in Chile who self-reported hearing problems and used hearing aids was 8.9%. Such prevalence increased for adults living in urban areas and for those who knew about the new Chilean programme of universal access to health services (AUGE). For older adults who did not know about this programme, significant associations between the use of hearing aids and the variables of age, geographic area of residence, and income level were found. Conclusions: People’s knowledge about AUGE programme may positively influence the use of hearing aids, although a direct effect cannot be attributed.

Hemitransdomal versus Dome-Binding Suture

Abstract The dome‐binding suture (DBS) and hemitransdomal suture (HTS) are suture techniques used to narrow and define the nasal tip. The DBS can create a pinched, unnatural appearance, while the HTS puts the lateral crus in a more favorable orientation. This allows a natural contour between the nasal tip and alar lobule while maintaining alar margin support. Objective measurement of the rotational axis of the lateral crus between the DBS and the HTS has not been reported in the literature. To determine whether the DBS or HTS technique results in a more favorable rotational axis of the lateral crus as measured by the alar surface septal angle (ASSA). Open rhinoplasty with cephalic trim and placement of a DBS or HTS was performed in 6 cadaveric heads, for a total of 12 lower lateral cartilages at the VirtuOHSU Simulation and Surgical Training Center at Oregon Health and Science University (OHSU). ASSA measurements were taken at baseline and after placement of either a DBS or HTS. A total of 36 ASSA measurements were obtained. The median baseline ASSA prior to suture placement was 142 degrees (interquartile range [IQR]: 131.5‐145 degrees), following DBS placement was 141 degrees (IQR: 33‐150.5 degrees), and following HTS placement was 112 degrees (IQR: 108‐117 degrees). There was no statistically significant difference of ASSA measurements between baseline and DBS placement (p = 0.24), but there was a statistically significant difference between baseline and HTS (p < 0.0001) and between DBS and HTS (p < 0.0001). The HTS technique creates a more favorable rotational axis of the lateral crus as compared with the DBS, as measured by the ASSA. This study provides objective data to support the use of the HTS for nasal tip contouring.

Avoiding irregularities on the nasal dorsum in rhinoplasty

Palpable irregularities along the nasal dorsum are a frequent complication of dorsal handling in rhinoplasty because resection techniques are used. This is often a result of improper management of the dorsum after resection. The surgical technique for handling of dorsal irregularities following dorsal resection is described. The key steps to avoid irregularities are diamond rasps, autospreader and morselized cartilage as camouflage. Following resection of the hump, the anatomy of the nasal dorsum should be adequately restructured; thereby we achieve an adequate aesthetic result and ideally preventing irregularities on palpation.

Randomized Controlled Trial to Assess the ACE Program for Rehabilitation in Patients with Hearing Loss

Objectives: Implement a standardized counselling program in elderly patients with hearing loss users of hearing aids and evaluate its utility in terms of adherence to hearing aids. Methods: A randomized clinical trial was carried out during the period from October 2011 to August 2012, with a follow-up of 6 months, approved by the hospital ethics committee. Patients 65 years and older with hearing loss diagnosed by pure tone audiometry who were patients from the National Public Health Service were included. The intervention used was a rehabilitation program called Active Communication Education (ACE), designed in Australia in 2007, which aims to improve rehabilitation of hearing aids users. To assess adherence, the International Outcome Inventory for Hearing Aids scale was used. Results: One hundred and eighty patients were evaluated, corresponding to 90 control and 90 rehabilitated patients. The overall adherence of hearing aids use was 78%. There was no difference in sex, age, and audiometric variable groups. The average daily hours of use in the control group were 6.9 hours, compared with 9.6 hours in the intervention group (P < 0.0001). There was a significant association between the intervention and the use of the hearing aid, with a greater proportion of patients who used more than 8 hours per week in the intervention group (66.6% vs 33.3%, P < 0.001). Conclusions: The intervention implemented has shown excellent preliminary results in terms of time of use of the hearing aid. It would be useful to include this intervention in the hearing loss national public policy.

Merlina y nuevos tratamientos de schwannomas vestibulares en pacientes con neurofibromatosis tipo 2

Los schwannomas vestibulares son tumores benignos que habitualmente se presentan en forma esporadica y unilateral, pero pueden aparecer de manera bilateral en el contexto de una neurofibromatosis tipo 2 (NF2). En aquellos asociados a NF2 se han identificado mutaciones del gen NF2 que codifica para merlina, una proteina citoplasmatica que se localiza primariamente en protrusiones celulares ricas en actina, y en sitios de contacto entre celulas y matriz extracelular. La evidencia sugiere que merlina ejerce un rol como proteina supresora de tumores ya que regula la cascada de activacion de diversos tipos de receptores de factores de crecimiento celular De esta manera, el deficit de merlina provoca un patron de proliferacion celular aumentado, alteraciones del citoesqueleto, apoptosis disminuida, y un incremento de la adhesion a la matriz extracelular. Se han desarrollado terapias clinicas para la NF2 con anticuerpos monoclonales e inhibidores dirigidos contra distintas moleculas involucradas en las cascadas de senalizacion celular moduladas por merlina. En este articulo se revisan y discuten los mecanismos celulares dependientes de merlina y los diversos estudios clinicos y experimentales que se han probado en pacientes con NF2.