The efficiency in the management of patients with suspected malignant lesions represents the main objective of the oncology of head and neck. Flexible nasopahyngolaryngoscopy with working channel ...allows to quickly and safely assess and obtain histological samples of this type of lesion. Our objective is to describe the usefulness of this technique in lesions suggestive of malignancy in terms of efficiency, sensitivity and specificity. A retrospective study was carried out over a period of time from December 2014 to December 2019, including patients biopsied with flexible fibroscopy of lesions of debut suspected of malignancy. Here we assess the location of the lesion, the histological results, the diagnostic time and the epidemiological variables. 104 patients were included in the study. More than half of the lesions, 55.2% (57), were located in the larynx; 57.7% (60) resulted positive for malignancy in the flexible fiberscope biopsy; 19.2% (20) were taken to the operating room to get biopsied under general anesthesia resulting in 7.4% (14) positive for malignancy, which shows a sensitivity of the test of 81%. In our sample, a diagnostic time of 15 days was obtained. Considering our results, the few complications and the revised literature, flexible fiberscope biopsy with working channel is an efficient procedure for the management of oncological patients of head and neck.
The so-called El Trébol is a critical road interchange in Quito connecting the north and south regions of the city. In addition, it connects Quito with the highly populated Los Chillos Valley, one of ...the most traveled zones in the Ecuadorian capital. El Trébol was constructed in the late 1960s in order to resolve the traffic jams of the capital city and for that purpose the Machángara River was rerouted through an underground concrete box tunnel. In March 2008, the tunnel contained a high amount of discarded furniture that had been impacting the top portion of the tunnel, compromising the structural integrity. On 31 March 2008 after a heavy rainfall a sinkhole of great proportions formed in the Trébol traffic hub. In the first few minutes, the sinkhole reached an initial diameter of 30 m. The collapse continued to grow in the following days until the final dimensions of 120 m in diameter and some 40 m of depth, revealing the Machángara River at the base of the sinkhole.A state of emergency was declared. The cause of the sinkhole was a result of the lack of monitoring of the older subterranean infrastructure where trash had accumulated and damaged the concrete tunnel that channelized the Machángara River until it was worn away for a length of some 20 m, leaving behind the sinkhole and the fear of recurrence in populated areas.With the intent to understand the causes and consequences of this sinkhole event, rainfall data are shown together with hydrogeological characteristics and a view back to the recent history of sinkhole lineation or arrangement of the city of Quito. The economic impact is also emphasized, where the direct costs of the damage and the reconstruction are presented and compared to indirect costs associated with this socio-natural disaster. These analyses suggest that the costs of indirect financial damage, like time loss or delay, and subsequent higher expenses for different types of vehicles, are equivalent to many times the costs of the reconstruction of El Trébol.
We report the findings from the Spanish Society of Neurology's NeuroCOVID-19 Registry.
We performed a multicentre study of patients with neurological manifestations of COVID-19. Participating ...physicians reported demographic, clinical, and paraclinical data and judged the involvement of COVID-19 in causing neurological symptoms.
A total of 233 cases were submitted, including 74 different combinations of manifestations. The most frequently reported were stroke (27%), neuromuscular symptoms (23.6%), altered mental status (23.6%), anosmia (17.6%), headache (12.9%), and seizures (11.6%). The mean age of patients was 61.1 years, with 42.1% being women; a higher proportion of women was recorded among patients with altered mental status, anosmia, and headache. The onset of symptoms differed within categories. Onset of anosmia occurred a mean (standard deviation) of 2.9 (2.5) days after the first general symptom, whereas neuromuscular symptoms appeared after 13.9 (10.1) days. Neurological symptoms were persistent in 33% of patients. General symptoms were present in 97.7% of patients, and results from general laboratory studies were abnormal in 99.4% of patients. Cerebrospinal fluid analysis findings were abnormal in 62.7% of the cases in which this test was performed (n = 51), but positive results for SARS-CoV-2 were only found in one case.
The neurological manifestations of COVID-19 are diverse. Anosmia, myalgia, and headache occur earlier in the course of the disease. Altered mental status, neuromuscular symptoms, and stroke are associated with greater severity. COVID-19 must be incorporated into most clinical and radiological differential diagnoses. COVID-19 may cause persistent and disabling neurological symptoms.
•NeuroCovid-19 is polymorph: Authors reported >70 different combinations of neurological syndromic presentations.•The symptom's timing varies from early (anosmia, headache, myalgia) to later stages (altered mental status, seizures, stroke, neuromuscular).•Some neurological symptoms might persist, as headache or anosmia; while other may cause persistent disability, as stroke or polyneuropathies.•Cerebrospinal fluid was frequently abnormal but direct isolation of SARS-CoV-2 occurred only in 1/233 cases.•Neurologists must be prepared to face the various neurological syndromes that may be associated with Covid-19 infection.
Objective
This study investigated early, real‐world outcomes with cenobamate (CNB) in a large series of patients with highly drug‐resistant epilepsy within a Spanish Expanded Access Program (EAP).
...Method
This was a multicenter, retrospective, observational study in 14 hospitals. Inclusion criteria were age ≥18 years, focal seizures, and EAP authorization. Data were sourced from patient clinical records. Primary effectiveness endpoints included reductions (100%, ≥90%, ≥75%, and ≥50%) or worsening in seizure frequency at 3‐, 6‐, and 12‐month visits and at the last visit. Safety endpoints included rates of adverse events (AEs) and AEs leading to discontinuation.
Results
The study included 170 patients. At baseline, median epilepsy duration was 26 years and median number of seizures/month was 11.3. The median number of prior antiseizure medications (ASMs) and concomitant ASMs were 12 and 3, respectively. Mean CNB dosages/day were 176 mg, 200 mg, and 250 mg at 3, 6, and 12 months. Retention rates were 98.2%, 94.5%, and 87% at 3, 6, and 12 months. At last available visit, the rate of seizure freedom was 13.3%; ≥90%, ≥75%, and ≥50% responder rates were 27.9%, 45.5%, and 63%, respectively. There was a significant reduction in the number of seizures per month (mean: 44.6%; median: 66.7%) between baseline and the last visit (P < 0.001). Responses were maintained regardless of the number of prior or concomitant ASMs. The number of concomitant ASMs was reduced in 44.7% of patients. The cumulative percentage of patients with AEs and AEs leading to discontinuation were 68.2% and 3.5% at 3 months, 74.1% and 4.1% at 6 months, and 74.1% and 4.1% at 12 months. The most frequent AEs were somnolence and dizziness.
Significance
In this highly refractory population, CNB showed a high response regardless of prior and concomitant ASMs. AEs were frequent but mostly mild‐to‐moderate, and few led to discontinuation.
Virtual Communities of Practices (vCoP) offer patients the possibility to interact and share tools and knowledge necessary for their empowerment. This paper describes the co-design process of a vCoP ...for the empowerment of people with ischemic heart disease (IHD).
We used a modified experience-based design approach to co-design the vCoP in collaboration with people with IHD and health professionals consisting of two phases: exploratory and development phase. Data collection techniques included listening labs, workshops, and online participation.
Twenty-five people with IHD and ten health professionals participated. Experiences and needs for empowerment in IHD were identified in the exploratory phase allowing for the development of a Patient Journey Map. In the development phase, people with IHD prioritized needs to be addressed by the vCoP content framework in addition to content proposals.
The Patient Journey Map helped to easily visualize the empowerment needs of people with IHD and it might be transferable for the development of other people-centred interventions. The co-design process also allowed the development of training materials adapted to the priorities of people with IHD.
A people-centred co-design process of a vCoP may facilitate the empowerment of people with IHD.
RESUMEN Objetivo: La relevancia de los premios literarios ha sido ampliamente estudiada, aunque no se han encontrado trabajos que reflejan su importancia en el caso de la Literatura Infantil y ...Juvenil (LIJ) de Brasil, por lo que este trabajo tiene como objetivo ser un primer acercamiento al tema. Método: Para ello se han estudiado los premios de LIJ nacionales en Brasil, así como 474 títulos galardonados vigentes entre 2000 y 2020 y se ha realizado una caracterización de los mismos estudiando su evolución cronológica, las instituciones de las que dependen, sus modalidades, categorías y géneros más premiados. Asimismo, se analizan los autores y autoras más galardonados, los géneros literarios y las materias más habituales de los títulos premiados. Resultado: Se concluye que en Brasil hay pocos premios nacionales de LIJ en comparación con su gran extensión territorial. También se observa que son premios consolidados en el tiempo, aunque su aparición sea tardía en comparación con la primera aparición del libro infantil/juvenil en Brasil. Conclusiones: El estudio de los autores permite conocer que no todos los premiados poseen reconocimiento y son considerados grandes nombres de la LIJ en Brasil. Finalmente, el género más premiado es la narrativa seguido de los álbumes ilustrados, sobre todo en los últimos estudiados.
La relevancia de los premios literarios ha sido ampliamente estudiada, aunque no se han encontrado trabajos que reflejen su importancia en el caso de la Literatura Infantil y Juvenil (LIJ) de Brasil, ...por lo que este trabajo tiene como objetivo ser un primer acercamiento al tema. Para ello se han estudiado los premios de LIJ nacionales en Brasil así como 474 títulos galardonados vigentes entre 2000 y 2020 y se ha realizado una caracterización de los mismos estudiando su evolución cronológica, las instituciones de las que dependen, sus modalidades, categorías y géneros más premiados. Asimismo, se analizan los autores y autoras más galardonados, los géneros literarios y las materias más habituales de los títulos premiados. Se concluye que en Brasil hay pocos premios nacionales de LIJ en comparación con su gran extensión territorial. También se observa que son premios consolidados en el tiempo, aunque su aparición sea tardía en comparación con la primera aparición del libro infantil/juvenil en Brasil. El estudio de los autores permite conocer que no todos los premiados poseen reconocimiento y son considerados grandes nombres de la LIJ en Brasil. Finalmente, el género más premiado es la narrativa seguido de los álbumes ilustrados, sobre todo en los últimos estudiados.
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