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Systemic poisoning related to cobalt–chromium total hip arthroplasty can affect multiple organs. In the otolaryngologic area the most frequent symptoms are tinnitus and hearing loss. In this report, we describe 2 patients with cobalt-containing hip prostheses who presented with otologic symptoms. The first case describes a patient with an extremely high cobalt blood level, which we believe may be one of the highest reported to date, after replacing a broken ceramic-on-ceramic prosthesis with a metal-on-metal prosthesis. This patient suffered all known complications associated with cobalt poisoning and survived. The second case, a female patient with a left resurfacing metal-on-metal prothesis, presented with bilateral continuous high-pitched tinnitus that started 8 months after surgery. Orthopedic surgeons and otologists should be vigilant for cobalt-induced ototoxicity in patients with metal-on-metal total hip prostheses.

Fundamentos: Los géneros Salmonella y Campylobacter son los principales agentes bacterianos causantes de enteritis en el hombre en los países desarrollados. El objetivo del presente trabajo es estudiar las características descriptivas de los casos de infección por Salmonella y por Campylobacter y describir su tendencia y variación estacional en la provincia de Huesca para el período 1996-1999 Método: Las fuentes de información han sido los Laboratorios Microbiológicos Hospitalarios (LMH) que realizan analíticas de coprocultivo tanto de enfermos ambulatorios como hospitalarios. Se toma el municipio como unidad de referencia para representar la distribución espacial. Para el estudio de la tendencia se utiliza un modelo determinista multiplicativo, agrupando los datos en períodos cuatrisemanales Resultados: Se han recogido un total de 781 casos de infección por Salmonella y 654 casos de infección por Campylobacter, con unas tasas medias anuales de 95 y 79,5 × 10(5) habitantes respectivamente. La enteritis por Campylobacter se presenta mayoritariamente en menores de 5 años (73,4 %), contra el 35,5 % para la salmonelosis. La situación se invierte en el caso de porcentaje de ingreso hospitalario; así, el ingreso por salmonelosis es casi 5 veces superior. Ambos géneros presentan una clara estacionalidad, con un pico pronunciado en el mes de agosto. Conclusiones: Se observa una tendencia ascendente en el número de aislamientos positivos para ambos microorganismos y una clara estacionalidad en la época estival.

BackgroundNeonatologists and clinical neurophysiologists face challenges with the current electrodes used for long-duration amplitude-integrated electroencephalography (aEEG) in neonatal intensive care units (NICU), limiting the capacity to diagnose brain damage.ObjectivesThe objectives of this study were to develop methods for comparing the performance of different electrodes to be used in aEEG. The comparison was done between a newly designed neonate-specific electrode, aCUP-E, with commercial liquid gel electrodes used in amplitude-integrated electroencephalography (aEEG). The comparison included impedance stability, electrode survival, recording quality, usability, and satisfaction of NICU staff.MethodsaEEG recordings with bipolar montage was used, with one hemisphere fitted with commercial electrodes and the other with aCUP-E electrodes, alternated among subjects. Continuous impedance and raw EEG data were collected over a minimum of 24 h, and signal processing was performed using Python and MATLAB.Main resultsaCUP-E electrodes demonstrated superior performance, including: Increased impedance stability and electrode survival, enhanced recording quality with fewer artifacts, high correlation in signal capture between electrodes during optimal brain activity segments, higher signal-to-noise ratio (SNR) across varying impedance levels, greater staff satisfaction and ease of use. Moreover, Kaplan-Meier curves indicated a higher survival rate for aCUP-E electrodes over 24 h compared to commercial electrodes. Impedance variability analysis showed statistically significant stability improvements for aCUP-E.ConclusionaCUP-E electrodes outperform commercial liquid gel electrodes in impedance stability, electrode survival, and recording quality. These results suggest that aCUP-E electrodes could significantly enhance aEEG utilization in diagnosing and treating neonatal brain conditions in NICUs. Future improvements to the aCUP-E electrode may further reduce artifacts and increase electrode longevity, potentially leading to a significant improvement in neonatal brain monitoring by means of aEEG.

Abstract Background Facial nerve schwannomas (FNSs) are exceedingly rare benign tumors. This study aims to report on a series of excised FNSs, providing clinical information and details on their surgical management, including novel approaches. Methods We retrospectively reviewed patients who underwent surgical excision of FNSs in a private otology clinic and public tertiary referral center. The main outcome measures were facial nerve function, complete tumor removal, postoperative complications, tumor recurrence, and hearing. Results Seventeen patients (10 men and 7 women) with a mean age of 44.23 years (SD, 12.21) underwent surgery during the study period. The most common symptom was facial nerve dysfunction (58.8%). Facial and otoneurologic symptoms (hearing loss, tinnitus, and vertigo) were observed in 88.8% and 77.7% of patients, respectively. The middle cranial fossa (MCF) was the most common approach (six patients, 35.2%), followed by translabyrinthine (TL), transmastoid (TM), and combined TM‐MCF (three patients, 17.6% each). Exclusive endoscopic transcanal suprageniculate (ETS) and mastoid combined with cervical approaches were applied once in two patients, 5.8% each. Total tumor removal was achieved in all cases. No significant postoperative complications were observed. The mean follow‐up period was 193.2 months (SD, 119.5) and no tumor recurrence was observed. Conclusion This study provides further evidence for the safety and efficacy of various surgical approaches for FNS, and incorporates the endoscopic transcanal approach. Level of evidence 4.

BackgroundThe VDR gene is identified as a crucial host factor, influencing the gut microbiota. The current research focuses on an observational study that compares gut microbiota composition among individuals with different VDR gene TaqI polymorphisms in a Caucasian Spanish population. This study aims to elucidate the interplay between genetic variations in the VDR gene and the gut microbial composition.Methods87 healthy participants (57 men, 30 women), aged 18 to 48 years, were examined. Anthropometric measures, body composition, and dietary habits were assessed. VDR gene polymorphism TaqI rs731236 was determined using TaqMan assays. The V3 and V4 regions of the 16S rRNA gene were sequenced to study bacterial composition, which was analyzed using QIIME2, DADA2 plugin, and PICRUSt2. Statistical analyses included tests for normal distribution, alpha/beta diversity, ADONIS, LEfSe, and DESeq2, with established significance thresholds.ResultsNo significant differences in body composition or dietary habits were observed based on VDR genotypes. Dietary intake analysis revealed no variations in energy, macronutrients, or fiber among the different VDR genotypes. Fecal microbiota analysis indicated significant differences in alpha diversity as measured by Faith’s Phylogenetic Diversity index. Differential abundance analysis identified taxonomic disparities, notably in the genera Parabacteroides and Butyricimonas.ConclusionOverall, this study suggests potential associations between genetic variations in the VDR gene and the composition and function of gut microbiota.

A pandemia de COVID-19 gerou desafios para a saúde mental da comunidade acadêmica. Este artigo tem como objetivo descrever o perfil sociodemográfico e de saúde mental de estudantes universitárias de uma universidade do Sul do país no contexto do ensino remoto emergencial. Trata-se de um estudo descritivo realizado com 329 estudantes universitárias, entre 4 de agosto e 12 de setembro de 2020. Os dados foram coletados por meio de questionário autoaplicado online. Para o perfil sociodemográfico as questões incluíam etnia, idade, estado civil, renda familiar, curso de graduação e semestre. Para caracterizar a saúde mental das universitárias foram medidos os níveis de depressão através do PHQ-9 (Patient Health Questionnaire), o grau de ansiedade por meio do IDATE (Inventário de Ansiedade Traço e Estado) e a ideação suicida pela Escala de Ideação Suicida de Beck (BSI - Beck Scale for Suicide Ideation). Resultados e discussão: as estudantes eram em maioria brancas (77,5%), entre 18 e 24 anos (77,1%), sem companheiro 88,4%, das classes econômicas E (43,3%) e D (28,3%). Maioria da área da saúde (70,2%), entre o quarto e sexto semestre (40%). Foram rastreadas para depressão 85,4%, enquanto 24% apresentaram níveis altos de ansiedade traço (49,5% nível médio, 26,4% nível baixo). Os níveis de ansiedade estado foram classificados como alto para 21,3%, médio para 51,4% e baixo para 24%. No total 25,5% apresentaram ideação suicida. Conclusão: o estudo contribui na descrição da população estudada e na identificação da prevalência de depressão, ansiedade e ideação suicida entre as estudantes universitárias.

ABSTRACT Objectives: to evaluate the risk of postoperative complications in cardiac patients. Methods: an evaluative study using the Tuman Score on medical records of 70 adult patients who underwent cardiac surgery at a University Hospital. The R for Windows software was used for the analyses. Descriptive statistics and bivariate analysis were employed to verify the association between the risk score and complications. The relative risk between the Tuman Score and postoperative complications was obtained through Quasi-Poisson regression, with a 95% confidence interval. Results: the majority of the patients were male (58.57%), aged between 41-64 years (50%), who underwent myocardial revascularization (50%). These patients were associated with a lower risk of postoperative complications (p=0.003), (p=0.008), and (p=0.000), respectively. High-risk patients had pulmonary complications (RR=1.32, p=0.002) and neurological complications (RR=1.20, p=0.047). Conclusions: preoperative risk assessment promotes qualified care to reduce postoperative complications.

Jangada is a municipality in the Baixada Cuiabana region, State of Mato Grosso, Brazil. This study aimed to evaluate the collection of local cassava conserved by four traditional communities of Jangada in terms of ethnobotanical/socioeconomic and genetic aspects. Socioeconomic and ethnobotanical analyses were carried out with 40 farmers using qualitative techniques and descriptive statistics. Seven microsatellite markers were used for genetic analysis. A total of 182 cassava citations were verified, 31 of which were different. The Broto Branco variety was the most frequent (94.3%), followed by Vermelha Gaiadeira and Liberata (82.9 and 77.1%, respectively). The calculated median age for farmers was 56 years. Spearman’s coefficient indicated a positive correlation between the increase in farmer’s age and the number of cultivated local varieties. Few varieties are planted by many farmers, and most are planted by few farmers. High genetic diversity was observed, and most of the variability occurred within communities (88%). Two groups were formed in the cluster analysis, with two communities in each group. The propagule circulation network helped to understand the genetic similarity of communities with the closest geographic location. Cassava cultivation plays an important role in the studied communities, which maintain a high ethnobotanical and genetic diversity and relevant knowledge about the cultivated varieties.

Within patients with sepsis, there exists significant heterogeneity, and while all patients should receive conventional therapy, there are subgroups of patients who may benefit from specific therapies, often referred to as rescue therapies. Therefore, the identification of these specific patient subgroups is crucial and lays the groundwork for the application of precision medicine based on the development of targeted interventions. Over the years, efforts have been made to categorize sepsis into different subtypes based on clinical characteristics, biomarkers, or underlying mechanisms. For example, sepsis can be stratified into different phenotypes based on the predominant dysregulated host response. These phenotypes can range from hyperinflammatory states to immunosuppressive states and even mixed phenotypes. Each phenotype may require different therapeutic approaches to improve patient outcomes. Rescue strategies for septic shock may encompass various interventions, such as immunomodulatory therapies, extracorporeal support (e.g., ECMO), or therapies targeted at specific molecular or cellular pathways involved in the pathophysiology of sepsis. In recent years, there has been growing interest in precision medicine approaches to sepsis and phenotype identification. Precision medicine aims to tailor treatments to each individual patient based on their unique characteristics and disease mechanisms.

Abstract Background Cancer burden in India is rapidly growing, with oral, breast, and uterine cervix being the three most commonly affected sites. It has a catastrophic epidemiological and financial impact on rural communities, the vast majority of whom are socio‐economically disadvantaged. Strengthening the health system is necessary to address challenges in the access and provision of cancer services, thus improving outcomes among vulnerable populations. Objective To develop, test, and validate a health system capacity assessment (HSCA) tool that evaluates the capacity and readiness for cancer services provision in rural India. Methods A multi‐method process was pursued to develop a cancer‐specific HSCA tool. Firstly, item generation entailed both a nominal group technique (to identify the health system dimensions to capture) and a rapid review of published and gray literature (to generate items within each of the selected dimensions). Secondly, tool development included the pre‐testing of questionnaires through healthcare facility visits, and item reduction through a series of in‐depth interviews (IDIs) with key local stakeholders. Thirdly, tool validation was performed through expert consensus. Results A three‐step HSCA multi‐method tool was developed comprising: (a) desk review template, investigating policies and protocols at the state level, (b) facility assessment protocol and checklist, catering to the Indian public healthcare system, and (c) IDI topic guide, targeting policymakers, healthcare workforce, and other relevant stakeholders. Conclusions The resulting HSCA tool assesses health system capacity, thus contributing to the planning and implementation of context‐appropriate, sustainable, equity‐focused, and integrated early detection interventions for cancer control, especially toward vulnerable populations in rural India and other low‐resource settings.

Objectives The aim of this study was to map and compare stakeholders’ perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries.Design In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening.Setting The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania.Participants Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers.Methods Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis.Results 120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers’ lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women’s fear, shame and lack of priority to preventive healthcare were identified as psychological barriers.Conclusion The study provides an overview of stakeholders’ perceived barriers towards vulnerable women’s cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women’s psychological barriers had several similarities.