Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. ¿Es útil la consulta telefónica en ORL?

ObjectiveTo describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty.Material and methodsFrom March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23.ResultsDuring the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone.DiscussionThe state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone.ConclusionThe telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients.     

Anterior pelvic ring fractures: a proposal of a variant of osteosynthesis of the pubic symphysis

Different internal fixation techniques (ORIF) have been proposed for the reduction and stabilization of traumatic diastase of the pubic symphysis: two-hole plates, multi-hole plates and double plates. Classically the synthesis of the symphysis is executed with 2 plates of 3.5 or 4.5 mm (anterior and sovrapubic), where screws are inserted from anterior to posterior. Since 2005 to January 2008, the first author has treated 16 patients modifying the anterior screws positioning for the stabilization of the pubic symphysis. In the 16 considered cases we have positioned just 2 anterior screws, one for each pubic branch, in the conviction of a better respect of the physiological forces lines. All the screws have a length from 55 to 65 mm. Functional results were excellent in 90%, good in 10%; reductions resulted excellent in 90% and good in 10%. The modified screws fixation method could be proposed in the management of treatment of anterior unstable pelvic ring.     

Presenting manifestations of eosinophilic cystitis in two Filipino children

Eosinophilic cystitis is a very rare clinical disease entity in the pediatric population. We report two cases of Filipino children with eosinophilic cystitis who presented with irritative voiding symptoms, gross hematuria, peripheral eosinophilia, and hydroureteronephrosis and urinary bladder wall thickening visualized on ultrasonography and CT urography. Cystoscopy and transurethral biopsy confirmed the diagnosis. Both patients were started with corticosteroid with or without an antihistamine. Resolution from the signs and symptoms were observed in both patients as documented by disappearance of peripheral eosinophilia, normal urinalysis results, and resolution of the hydroureteronephrosis and urinary bladder wall thickening on ultrasonography on follow-up.     

CD45RA expression on HCMV-specific effector memory CD8+ T cells is associated with the duration and intensity of HCMV replication after transplantation

In this cross-sectional study on 42 solid organ transplant recipients, the association of kinetics of human cytomegalovirus (HCMV) replication and EMRA HCMV-specific CD8+ T cells was investigated. Correlation was observed between the duration of HCMV replication after transplantation and CD45RA+CD27− (r = 0.609; p = 0.004), CD45RA+ CD28− (r = 0.579; p = 0.008) or CD45RA+CCR7− (r = 0.488; p = 0.029) HCMV-specific CD8+ T cells percentages. In the multivariate regression analyses, CD45RA+CD27−, CD45RA+CD28− or CD45RA+CCR7− HCMV-specific CD8+ T cells percentages increased 5.58% (p = 0.001), 5.35% (p = 0.001) or 4.49% (p = 0.012), respectively, with every 10-day increase in the duration of HCMV replication. Moreover, CD45RA+CD27− or CD45RA+CD28− frequencies increased 4.16% (p = 0.024) or 3.58% (p = 0.049), respectively, with every unity increase in log₁₀ genomes/mL. These observations support the major association between the frequency of EMRA HCMV-specific CD8+ T cells and the duration of post-transplant HCMV replication episodes in solid organ transplantation recipients.     

Exertional Headache as Unusual Presentation of the Syndrome of an Elongated Styloid Process

We present the case of a 34-year-old man with a 2-year history of pain related to efforts in heavy lifting, beginning in the right ear and radiating to the neck and to the vertex. He underwent multiple negative neuroimaging examinations, until a 3-dimensional computerized tomography scan of the pharyngeal region evidenced an elongated styloid process. A diagnosis of Eagle's syndrome was made. The excision of the elongated styloid process was performed, resulting in complete and lasting pain relief. We focus on Eagle's syndrome and in particular on this atypical presentation.