Secundino Fernandez | Universidad de Navarra (original) (raw)
Papers by Secundino Fernandez
Journal of Voice, Oct 1, 2022
Journal of Voice, May 1, 2023
PubMed, Jul 1, 1993
We present a review of the current literature and our experience with distortion product otoacous... more We present a review of the current literature and our experience with distortion product otoacoustic emissions. They represent a new tool for the clinical study of deafness as shown and of the basic functional status of the cochlea.
Frontiers in Aging Neuroscience, Nov 16, 2021
The aim of this article is to present the research protocol for a prospective cohort study that w... more The aim of this article is to present the research protocol for a prospective cohort study that will assess the olfactory function and the effect of an intervention based on olfactory training in healthy very old adults (≥75 years old). A convenience sample of 180 older people (50% female) will be recruited in three different environments: hospitalized control group (CH) with stable acute illness (n = 60); ambulatory control group (CA) of community-based living (n = 60); and an experimental odor training group (EOT) from nursing homes (n = 60). The odor training (OT) intervention will last 12 weeks. All the volunteers will be assessed at baseline; CA and EOT groups will also be assessed after 12 weeks. The primary end point will be change in olfactory capacity from baseline to 12 weeks period of intervention or control. The intervention effects will be assessed with the overall score achieved in Sniffin Sticks Test (SST)-Threshold, Discrimination, and Identification (TDI) extended version. Secondary end points will be changes in cognitive tasks, quality of life, mood, immune status, and functional capacity. All these measurements will be complemented with an immune fitness characterization and a deep proteome profiling of the olfactory epithelium (OE) cultured ex vivo. The current study will provide additional evidence to support the implementation of olfactory precision medicine and the development of immunomodulatory nasal therapies based on non-invasive procedures. The proposed intervention will also intend to increase the knowledge about the olfactory function in very elderly people, improve function and quality of life, and promote the recovery of the health.
Otolaryngology-Head and Neck Surgery, Jul 21, 2020
Objective. To validate a simulator for upper airway examination, fitted with sensors, for use as ... more Objective. To validate a simulator for upper airway examination, fitted with sensors, for use as an academic tool for learning how to conduct examination of the upper airway and for evaluation of that learning. Study Design. Validation study. Setting. Undergraduate medical education. Subjects and Methods. A group of 18 fifth-year medical students and another of 6 otorhinolaryngology specialists conducted 6 examinations each with the simulator. To investigate concurrent validity, we calculated the correlation between damage scores provided by the simulator and damage assessment by a specialist. To evaluate construct validity, we compared both groups with regard to damage scores, technical procedure, and time spent. To examine content and face validity, we used questionnaires based on a 5-point Likert scale. Results. For concurrent validity, the correlation between the simulator's damage scores and the specialist's damage assessment was high: Spearman's r was 0.828 (P \ .001). For construct validity, the group of students differed from the group of specialists in damage scores (P = .027) and in technical procedures (P \.001) but not in time spent. For content validity, all questionnaire statements were scored highly, and both groups had similar average scores. For face validity, the group of specialists considered the simulator to be realistic, and all statements on the questionnaire were rated with at least 4/5. Conclusion. Concurrent, construct, content, and face validity have been demonstrated for a sensor-fitted simulator for upper airway examination, which is therefore accurate enough to be used as an academic tool for learning and evaluation of learning.
Journal of Voice, 2016
The purpose of this study was to detect specific vocal aerodynamic patterns in attention deficit ... more The purpose of this study was to detect specific vocal aerodynamic patterns in attention deficit hyperactivity disorder (ADHD) patients and to define a possible new phenotypic feature of this disorder that must be diagnosed and treated. This is a prospective study. Seventy-nine children aged 5-13 years were recruited: 44 children with ADHD diagnosis and 35 children, as a control group, matched according to age and gender. All children were evaluated in the voice laboratory. Each subject repeated sustained vowels, syllables, words, and sentences several times. Intraoral pressure, transglottal airflow, microphone, and electroglottograph results were recorded and analyzed. Children affected by ADHD, with adequate tolerance, were evaluated endoscopically and by the speech therapist. The aerodynamic analysis shows that the subglottal pressure is higher and transglottal airflow is lower in ADHD children compared with the children of the control group. Those differences are statistically significant. The endoscopic physical examination showed vocal nodules in 25 children (78.125%) and hyperfunctional vocal behavior in all ADHD children studied. We proposed that every child with ADHD disorder must be evaluated from a laryngeal point of view (otolaryngologist and speech therapist) as an important part of the diagnosis and global treatment. It could be considered as a new phenotypic characteristic of this disorder.
Clinical Case Reports, Mar 1, 2022
We report the case of a 48‐year‐old woman, a teacher, with recurrent severe dysphonia and multipl... more We report the case of a 48‐year‐old woman, a teacher, with recurrent severe dysphonia and multiple and different lesions at the same time in her vocal folds. The evolution of the lesions and the possible mechanism by which they have been associated in the same patient are commented.
Authorea (Authorea), Oct 26, 2021
We report the case of a 48-year-old woman, a teacher, with recurrent severe dysphonia and multipl... more We report the case of a 48-year-old woman, a teacher, with recurrent severe dysphonia and multiple and different lesions at the same time in her vocal folds.
Otolaryngology Case Reports, Mar 1, 2023
Actas urológicas españolas, May 1, 2023
Otolaryngology Case Reports, Nov 1, 2020
Innate immune defense against microbial pathogens occurs by physical barriers, by recruitment of ... more Innate immune defense against microbial pathogens occurs by physical barriers, by recruitment of cells such as neutrophils, NK cells, and macrophages, and by secretion of molecules with antimicrobial activity. Such molecules are produced by various epithelia including skin. The importance of antimicrobial peptides has been shown in cathelicidin-deficient mice, which have increased susceptibility to skin infection by Streptococcus. Although keratinocytes increase cathelicidin expression upon injury, their role relative to neutrophil cathelicidin and their sites of peptide storage and activation have not been elucidated. Herein, it is reported that cathelicidin predominantly resides in granules of the superficial epidermis and partially localizes in lamellar bodies as determined by immunogold electron microscopy and immunoblot of lamellar bodies isolated from mice. In cultured keratinocytes, cathelicidin displays a granular distribution and partially localizes within the Golgi apparatus. Cathelicidin processing can be observed by western blot analysis in keratinocyte extracts but not in conditioned media. Further, fluorescent bacteria colocalize with cathelicidin in granules both intracellularly and at the cell surface. These observations illustrate the immune defense potential of keratinocytes acting directly through storage and processing of antimicrobial peptides.
Journal of The European Academy of Dermatology and Venereology, Sep 14, 2016
Autoimmune blistering diseases (AIBD) comprise several entities characterized by the presence of ... more Autoimmune blistering diseases (AIBD) comprise several entities characterized by the presence of autoantibodies targeted against structural proteins either in desmosomes or in the dermoepidermal junction of polystratified squamous epithelium. Patients develop blisters, erosions in cutaneous surfaces or mucosas. Diagnosis is based on the characteristic mucocutaneous lesions, the typical findings on histological studies and direct immunofluorescence assays, and the presence of specific autoantibodies against the epidermal antigens. It may not be possible for dermatologists to appropriately explore the nose and throat (NT). Thus, a clinical exploration by endoscopic procedures of NT may be a useful tool during the conventional dermatological exam. The aims of this review are to draw attention to the most frequent NT manifestations in AIBD patients, and underline the utility of endoscopic procedures to achieve a more successful and rationale management of patients. Additionally, we will provide brief information related to the anatomical structures and type of epithelium in NT areas which may explain the extent and type of NT involvement in AIBD. Endoscopic exploration in AIBD patients is important for several reasons. Firstly, it will allow the real NT mucosal involvement in each patient to be determined, thus making a differential diagnosis during the endoscopic exam possible, based on the localization of mucosal lesions. Secondary mucosal morbidity can also be ruled out. Secondly, the clinical response to treatment may be established, especially in NT mucosa, as these are anatomical areas subjected to important local traumas, and physiological functions such as breathing, swallowing, speech production and phonation may be damaged. Therefore, a multidisciplinary management in AIBD is mandatory by both dermatologists and otorhinolaryngologists, adding the clinical exploration by endoscopic procedures of NT to the conventional dermatological exam in all AIBD patients, irrespective of whether they exhibit associated symptoms.
Simulation in healthcare : journal of the Society for Simulation in Healthcare, Nov 2, 2020
Introduction The AirSim Multi (TruCorp) airway simulator is used to practice exploration of the u... more Introduction The AirSim Multi (TruCorp) airway simulator is used to practice exploration of the upper respiratory tract with a flexible endoscope to assess the nasal cavities, their structures and spaces (inferior, middle, and superior turbinates and meati), and the nasopharynx. The passage of the flexible endoscope through the nose is usually the most annoying and painful maneuver to continue the exploration of the airway to the pharynx and larynx. For this reason, it is important to develop self-assessment training systems in safe environments that allow trainees to develop the necessary skills to carry out this type of assessment with the least inconvenience and the greatest security. Despite this simulator's accurate anatomical reproduction of the tract, its suitability as a tool for endoscope exploration learning is limited without a feedback system. Effective endoscopic exploration should not cause pain or lesions, not only for comfort and safety reasons, but also because only when discomfort is minimized is a complete and detailed exploration of the anatomical structures possible. The objective of the project was to provide a feedback system from the simulator to the trainee that would facilitate improvements in self-trained skills needed to perform an endoscopic exploration of the airways. Methods A device based on the Hall-effect sensor was designed and placed outside the airway in the upper nasal turbinate. This device detects changes in the magnetic flux, indicating a displacement on the nasal turbinate due to endoscopic maneuvers that deform the inside of the simulator and would be expected to be harmful or painful in real life. Results The improved AirSim provides audible and visual feedback during exploration to indicate a change on the nasal turbinate due to endoscopic contact with the turbinate surface that would be expected to be harmful or painful in real life. We expect this feature to facilitate self-learning with minimal professional supervision and reduce the overall training time required to successfully perform a complete exploration of the airway. Conclusions The inclusion of sensors on a passive simulator is a cost-effective measure that may allow for better training experiences using AirSim Multi simulator from the TruCorp company. Our improved simulator turns endoscopic exploration into a self-assessed exercise suitable for all disciplines and level of learners.
European Archives of Oto-rhino-laryngology, Aug 1, 1997
Otoacoustic emissions are a relatively new tool for assessment of inner ear function. We studied ... more Otoacoustic emissions are a relatively new tool for assessment of inner ear function. We studied 65 patients diagnosed as having Menibre's disease. In order to obtain and characterize responses at different frequencies we used distortion-product otoacoustic emissions (DPOAE). In unilateral cases, the difference in response between ears on the diseased and healthy sides was evident at all frequencies. In the former the result was lower than expected for a group of normally hearing subjects, while in the latter it was better than expected according to pure tone averages. Reduction in amplitude and increment in threshold of the DPOAE in the diseased ear was a significant finding and could be correlated to the stage of the disease. In those subjects treated with Betahistine after 1 year's follow-up, DPOAE testing showed the recovery of response at low frequencies and a reduction of its threshold at all frequencies studied.
Simulation in healthcare : journal of the Society for Simulation in Healthcare, Aug 1, 2013
Introduction: Current European Resuscitation Guidelines 2010 recommend the use of prompt/feedback... more Introduction: Current European Resuscitation Guidelines 2010 recommend the use of prompt/feedback devices when training for cardiopulmonary resuscitation (CPR). We aimed to assess the quality of CPR training among second-year medical students with a voice advisory mannequin (VAM) compared to guidance provided by an instructor. Methods: Forty-three students received a theoretical reminder about CPR followed by a 2-minute pretest on CPR (compressions/ventilations cycle) with Resusci Anne SkillReporter (Laerdal Medical). They were then randomized into a control group (n = 22), trained by an instructor for 4 minutes per student, and an intervention group (n = 21) trained individually with VAM CPR mannequin for 4 minutes. After training, the students performed a 2-minute posttest, with the same method as the pretest. Results: Participants in the intervention group (VAM) performed more correct hand position (73% vs. 37%; P = 0.014) and tended to display better compression rate (124 min j1 vs. 135 min j1 ; P = 0.089). In a stratified analyses by sex we found that only among women trained with VAM was there a significant improvement in compression depth before and after training (36 mm vs. 46 mm, P = 0.018) and in the percentage of insufficient compressions before and after training (56% vs. 15%; P = 0.021). Conclusions: In comparison to the traditional training method involving an instructor, training medical students in CPR with VAM improves the quality of chest compressions in hand position and in compression rate applied to mannequins. Only among women was VAM shown to be superior in compression depth training. This technology reduces costs in 14% in our setup and might potentially release instructors' time for other activities.
Cirugia Espanola, Jul 1, 2023
Otolaryngology-Head and Neck Surgery, Aug 1, 2012
ObjectivePatients with chronic rhinosinusitis resistant to systemic treatment have as an alternat... more ObjectivePatients with chronic rhinosinusitis resistant to systemic treatment have as an alternative endoscopic nasal surgery. The Relieva Stratus system has allowed local treatment in paranasal cavities, avoiding an aggressive surgery and high corticoesteroids systemic treatment. We describe our experience with the system in the first six patients.MethodFour patients suffering ethmoid and 2 with frontal chronic rhinosinusitis have been included. The Stratus catheter was implanted endoscopically under general anesthesia in combination with balloon sinuplasty technique for either the maxillary or the frontal sinus. Triamcinolone was used for local delivery. Stratus was removed in office 4 week later.ResultsStratus Relieva was implanted in patients with chronic inflammation of the ethmoid or frontal sinus. No major complications were observed. Four catheters were implanted in the ethmoid bulla and 2 in the frontal sinus. They were removed in office under local anesthesia. Intraoperaory bleeding was minimal. Patients described no foreign object sensation after surgery. We observed good evolution in all patients but one, in which Stratus Relieva was performed. This patient persisted with chronic inflammation of the maxillary and ethmoid sinus and functional endoscopy surgery was performed as alternative for definitive treatment.ConclusionResults with this device are promising although longer observation period is needed. It is possible that the patient that did not show an improvement of disease may have not been an adequate candidate for this surgery. Therefore, we consider that appropriate selection of patients is necessary for a good outcome.
Cirugía Española (English Edition)
Journal of Voice, Oct 1, 2022
Journal of Voice, May 1, 2023
PubMed, Jul 1, 1993
We present a review of the current literature and our experience with distortion product otoacous... more We present a review of the current literature and our experience with distortion product otoacoustic emissions. They represent a new tool for the clinical study of deafness as shown and of the basic functional status of the cochlea.
Frontiers in Aging Neuroscience, Nov 16, 2021
The aim of this article is to present the research protocol for a prospective cohort study that w... more The aim of this article is to present the research protocol for a prospective cohort study that will assess the olfactory function and the effect of an intervention based on olfactory training in healthy very old adults (≥75 years old). A convenience sample of 180 older people (50% female) will be recruited in three different environments: hospitalized control group (CH) with stable acute illness (n = 60); ambulatory control group (CA) of community-based living (n = 60); and an experimental odor training group (EOT) from nursing homes (n = 60). The odor training (OT) intervention will last 12 weeks. All the volunteers will be assessed at baseline; CA and EOT groups will also be assessed after 12 weeks. The primary end point will be change in olfactory capacity from baseline to 12 weeks period of intervention or control. The intervention effects will be assessed with the overall score achieved in Sniffin Sticks Test (SST)-Threshold, Discrimination, and Identification (TDI) extended version. Secondary end points will be changes in cognitive tasks, quality of life, mood, immune status, and functional capacity. All these measurements will be complemented with an immune fitness characterization and a deep proteome profiling of the olfactory epithelium (OE) cultured ex vivo. The current study will provide additional evidence to support the implementation of olfactory precision medicine and the development of immunomodulatory nasal therapies based on non-invasive procedures. The proposed intervention will also intend to increase the knowledge about the olfactory function in very elderly people, improve function and quality of life, and promote the recovery of the health.
Otolaryngology-Head and Neck Surgery, Jul 21, 2020
Objective. To validate a simulator for upper airway examination, fitted with sensors, for use as ... more Objective. To validate a simulator for upper airway examination, fitted with sensors, for use as an academic tool for learning how to conduct examination of the upper airway and for evaluation of that learning. Study Design. Validation study. Setting. Undergraduate medical education. Subjects and Methods. A group of 18 fifth-year medical students and another of 6 otorhinolaryngology specialists conducted 6 examinations each with the simulator. To investigate concurrent validity, we calculated the correlation between damage scores provided by the simulator and damage assessment by a specialist. To evaluate construct validity, we compared both groups with regard to damage scores, technical procedure, and time spent. To examine content and face validity, we used questionnaires based on a 5-point Likert scale. Results. For concurrent validity, the correlation between the simulator's damage scores and the specialist's damage assessment was high: Spearman's r was 0.828 (P \ .001). For construct validity, the group of students differed from the group of specialists in damage scores (P = .027) and in technical procedures (P \.001) but not in time spent. For content validity, all questionnaire statements were scored highly, and both groups had similar average scores. For face validity, the group of specialists considered the simulator to be realistic, and all statements on the questionnaire were rated with at least 4/5. Conclusion. Concurrent, construct, content, and face validity have been demonstrated for a sensor-fitted simulator for upper airway examination, which is therefore accurate enough to be used as an academic tool for learning and evaluation of learning.
Journal of Voice, 2016
The purpose of this study was to detect specific vocal aerodynamic patterns in attention deficit ... more The purpose of this study was to detect specific vocal aerodynamic patterns in attention deficit hyperactivity disorder (ADHD) patients and to define a possible new phenotypic feature of this disorder that must be diagnosed and treated. This is a prospective study. Seventy-nine children aged 5-13 years were recruited: 44 children with ADHD diagnosis and 35 children, as a control group, matched according to age and gender. All children were evaluated in the voice laboratory. Each subject repeated sustained vowels, syllables, words, and sentences several times. Intraoral pressure, transglottal airflow, microphone, and electroglottograph results were recorded and analyzed. Children affected by ADHD, with adequate tolerance, were evaluated endoscopically and by the speech therapist. The aerodynamic analysis shows that the subglottal pressure is higher and transglottal airflow is lower in ADHD children compared with the children of the control group. Those differences are statistically significant. The endoscopic physical examination showed vocal nodules in 25 children (78.125%) and hyperfunctional vocal behavior in all ADHD children studied. We proposed that every child with ADHD disorder must be evaluated from a laryngeal point of view (otolaryngologist and speech therapist) as an important part of the diagnosis and global treatment. It could be considered as a new phenotypic characteristic of this disorder.
Clinical Case Reports, Mar 1, 2022
We report the case of a 48‐year‐old woman, a teacher, with recurrent severe dysphonia and multipl... more We report the case of a 48‐year‐old woman, a teacher, with recurrent severe dysphonia and multiple and different lesions at the same time in her vocal folds. The evolution of the lesions and the possible mechanism by which they have been associated in the same patient are commented.
Authorea (Authorea), Oct 26, 2021
We report the case of a 48-year-old woman, a teacher, with recurrent severe dysphonia and multipl... more We report the case of a 48-year-old woman, a teacher, with recurrent severe dysphonia and multiple and different lesions at the same time in her vocal folds.
Otolaryngology Case Reports, Mar 1, 2023
Actas urológicas españolas, May 1, 2023
Otolaryngology Case Reports, Nov 1, 2020
Innate immune defense against microbial pathogens occurs by physical barriers, by recruitment of ... more Innate immune defense against microbial pathogens occurs by physical barriers, by recruitment of cells such as neutrophils, NK cells, and macrophages, and by secretion of molecules with antimicrobial activity. Such molecules are produced by various epithelia including skin. The importance of antimicrobial peptides has been shown in cathelicidin-deficient mice, which have increased susceptibility to skin infection by Streptococcus. Although keratinocytes increase cathelicidin expression upon injury, their role relative to neutrophil cathelicidin and their sites of peptide storage and activation have not been elucidated. Herein, it is reported that cathelicidin predominantly resides in granules of the superficial epidermis and partially localizes in lamellar bodies as determined by immunogold electron microscopy and immunoblot of lamellar bodies isolated from mice. In cultured keratinocytes, cathelicidin displays a granular distribution and partially localizes within the Golgi apparatus. Cathelicidin processing can be observed by western blot analysis in keratinocyte extracts but not in conditioned media. Further, fluorescent bacteria colocalize with cathelicidin in granules both intracellularly and at the cell surface. These observations illustrate the immune defense potential of keratinocytes acting directly through storage and processing of antimicrobial peptides.
Journal of The European Academy of Dermatology and Venereology, Sep 14, 2016
Autoimmune blistering diseases (AIBD) comprise several entities characterized by the presence of ... more Autoimmune blistering diseases (AIBD) comprise several entities characterized by the presence of autoantibodies targeted against structural proteins either in desmosomes or in the dermoepidermal junction of polystratified squamous epithelium. Patients develop blisters, erosions in cutaneous surfaces or mucosas. Diagnosis is based on the characteristic mucocutaneous lesions, the typical findings on histological studies and direct immunofluorescence assays, and the presence of specific autoantibodies against the epidermal antigens. It may not be possible for dermatologists to appropriately explore the nose and throat (NT). Thus, a clinical exploration by endoscopic procedures of NT may be a useful tool during the conventional dermatological exam. The aims of this review are to draw attention to the most frequent NT manifestations in AIBD patients, and underline the utility of endoscopic procedures to achieve a more successful and rationale management of patients. Additionally, we will provide brief information related to the anatomical structures and type of epithelium in NT areas which may explain the extent and type of NT involvement in AIBD. Endoscopic exploration in AIBD patients is important for several reasons. Firstly, it will allow the real NT mucosal involvement in each patient to be determined, thus making a differential diagnosis during the endoscopic exam possible, based on the localization of mucosal lesions. Secondary mucosal morbidity can also be ruled out. Secondly, the clinical response to treatment may be established, especially in NT mucosa, as these are anatomical areas subjected to important local traumas, and physiological functions such as breathing, swallowing, speech production and phonation may be damaged. Therefore, a multidisciplinary management in AIBD is mandatory by both dermatologists and otorhinolaryngologists, adding the clinical exploration by endoscopic procedures of NT to the conventional dermatological exam in all AIBD patients, irrespective of whether they exhibit associated symptoms.
Simulation in healthcare : journal of the Society for Simulation in Healthcare, Nov 2, 2020
Introduction The AirSim Multi (TruCorp) airway simulator is used to practice exploration of the u... more Introduction The AirSim Multi (TruCorp) airway simulator is used to practice exploration of the upper respiratory tract with a flexible endoscope to assess the nasal cavities, their structures and spaces (inferior, middle, and superior turbinates and meati), and the nasopharynx. The passage of the flexible endoscope through the nose is usually the most annoying and painful maneuver to continue the exploration of the airway to the pharynx and larynx. For this reason, it is important to develop self-assessment training systems in safe environments that allow trainees to develop the necessary skills to carry out this type of assessment with the least inconvenience and the greatest security. Despite this simulator's accurate anatomical reproduction of the tract, its suitability as a tool for endoscope exploration learning is limited without a feedback system. Effective endoscopic exploration should not cause pain or lesions, not only for comfort and safety reasons, but also because only when discomfort is minimized is a complete and detailed exploration of the anatomical structures possible. The objective of the project was to provide a feedback system from the simulator to the trainee that would facilitate improvements in self-trained skills needed to perform an endoscopic exploration of the airways. Methods A device based on the Hall-effect sensor was designed and placed outside the airway in the upper nasal turbinate. This device detects changes in the magnetic flux, indicating a displacement on the nasal turbinate due to endoscopic maneuvers that deform the inside of the simulator and would be expected to be harmful or painful in real life. Results The improved AirSim provides audible and visual feedback during exploration to indicate a change on the nasal turbinate due to endoscopic contact with the turbinate surface that would be expected to be harmful or painful in real life. We expect this feature to facilitate self-learning with minimal professional supervision and reduce the overall training time required to successfully perform a complete exploration of the airway. Conclusions The inclusion of sensors on a passive simulator is a cost-effective measure that may allow for better training experiences using AirSim Multi simulator from the TruCorp company. Our improved simulator turns endoscopic exploration into a self-assessed exercise suitable for all disciplines and level of learners.
European Archives of Oto-rhino-laryngology, Aug 1, 1997
Otoacoustic emissions are a relatively new tool for assessment of inner ear function. We studied ... more Otoacoustic emissions are a relatively new tool for assessment of inner ear function. We studied 65 patients diagnosed as having Menibre's disease. In order to obtain and characterize responses at different frequencies we used distortion-product otoacoustic emissions (DPOAE). In unilateral cases, the difference in response between ears on the diseased and healthy sides was evident at all frequencies. In the former the result was lower than expected for a group of normally hearing subjects, while in the latter it was better than expected according to pure tone averages. Reduction in amplitude and increment in threshold of the DPOAE in the diseased ear was a significant finding and could be correlated to the stage of the disease. In those subjects treated with Betahistine after 1 year's follow-up, DPOAE testing showed the recovery of response at low frequencies and a reduction of its threshold at all frequencies studied.
Simulation in healthcare : journal of the Society for Simulation in Healthcare, Aug 1, 2013
Introduction: Current European Resuscitation Guidelines 2010 recommend the use of prompt/feedback... more Introduction: Current European Resuscitation Guidelines 2010 recommend the use of prompt/feedback devices when training for cardiopulmonary resuscitation (CPR). We aimed to assess the quality of CPR training among second-year medical students with a voice advisory mannequin (VAM) compared to guidance provided by an instructor. Methods: Forty-three students received a theoretical reminder about CPR followed by a 2-minute pretest on CPR (compressions/ventilations cycle) with Resusci Anne SkillReporter (Laerdal Medical). They were then randomized into a control group (n = 22), trained by an instructor for 4 minutes per student, and an intervention group (n = 21) trained individually with VAM CPR mannequin for 4 minutes. After training, the students performed a 2-minute posttest, with the same method as the pretest. Results: Participants in the intervention group (VAM) performed more correct hand position (73% vs. 37%; P = 0.014) and tended to display better compression rate (124 min j1 vs. 135 min j1 ; P = 0.089). In a stratified analyses by sex we found that only among women trained with VAM was there a significant improvement in compression depth before and after training (36 mm vs. 46 mm, P = 0.018) and in the percentage of insufficient compressions before and after training (56% vs. 15%; P = 0.021). Conclusions: In comparison to the traditional training method involving an instructor, training medical students in CPR with VAM improves the quality of chest compressions in hand position and in compression rate applied to mannequins. Only among women was VAM shown to be superior in compression depth training. This technology reduces costs in 14% in our setup and might potentially release instructors' time for other activities.
Cirugia Espanola, Jul 1, 2023
Otolaryngology-Head and Neck Surgery, Aug 1, 2012
ObjectivePatients with chronic rhinosinusitis resistant to systemic treatment have as an alternat... more ObjectivePatients with chronic rhinosinusitis resistant to systemic treatment have as an alternative endoscopic nasal surgery. The Relieva Stratus system has allowed local treatment in paranasal cavities, avoiding an aggressive surgery and high corticoesteroids systemic treatment. We describe our experience with the system in the first six patients.MethodFour patients suffering ethmoid and 2 with frontal chronic rhinosinusitis have been included. The Stratus catheter was implanted endoscopically under general anesthesia in combination with balloon sinuplasty technique for either the maxillary or the frontal sinus. Triamcinolone was used for local delivery. Stratus was removed in office 4 week later.ResultsStratus Relieva was implanted in patients with chronic inflammation of the ethmoid or frontal sinus. No major complications were observed. Four catheters were implanted in the ethmoid bulla and 2 in the frontal sinus. They were removed in office under local anesthesia. Intraoperaory bleeding was minimal. Patients described no foreign object sensation after surgery. We observed good evolution in all patients but one, in which Stratus Relieva was performed. This patient persisted with chronic inflammation of the maxillary and ethmoid sinus and functional endoscopy surgery was performed as alternative for definitive treatment.ConclusionResults with this device are promising although longer observation period is needed. It is possible that the patient that did not show an improvement of disease may have not been an adequate candidate for this surgery. Therefore, we consider that appropriate selection of patients is necessary for a good outcome.
Cirugía Española (English Edition)