Publications by authors named "Mariela Torrente"

14 Publications

  • Page 1 of 1

How the COVID-19 pandemic affects specialty training: An analysis of a nationwide survey among otolaryngology residents in Chile.

Medwave 2021 Jan 8;21(1):e8098. Epub 2021 Jan 8.

Departamento Otorrinolaringología, Facultad de Medicina, Universidad de Católica del Norte, Coquimbo, Chile. ORCID: 000-0002-1775-0057.

Introduction: Coronavirus disease 2019, or COVID-19, has become a global pandemic. Given that the highest viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found in the airway, otolaryngologists are at high risk of infection. As a result, multiple recommendations have emerged regarding protective measures for surgical teams, including suspending non-urgent procedures and surgeries.

Objectives: To evaluate the impact of the COVID-19 pandemic on otolaryngology residency training programs nationwide.

Methods: A cross-sectional survey-based study was completed in April 2020. The participants were recruited through an online survey, sent by email to all Chilean otolaryngology residents. Demographics, clinical activities, on-call shifts, COVID-19 infection status, exposure to COVID-19 patients, deployment to other specialties, diagnostic/therapeutic procedures, and surgeries performed were analyzed. Self-reported surgical data logs from previous years were used to compare results.

Results: Forty-seven residents completed the survey (84% response rate); 64% of residents refer seeing patients ten days or less during April 2020. Commonly performed procedures such as flexible nasolaryngoscopy, rigid nasal endoscopy, and peritonsillar abscess drainage were not performed by over 40% of the residents in that month. Only 38% participated in surgeries, with an average of 0.6 surgeries as a first surgeon, a dramatic decrease in surgical exposure when comparing the data logs from previous years. Most residents refer the following measures taken by their residency program to improve residency training: bibliographic videoconferences (87%), online clinical case seminars (60%), weekly journal clubs (38%), among others.

Conclusions: Clinical and surgical opportunities decreased dramatically during April 2020. Adjustments to the regular academic curricula should be considered to decrease the negative impact of this pandemic on residency training.
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http://dx.doi.org/10.5867/medwave.2021.01.8097DOI Listing
January 2021

[Hearing loss as a risk factor for dementia].

Rev Med Chil 2020 Aug;148(8):1128-1138

Departamento de Neurociencia, Universidad de Chile, Santiago, Chile.

In the last decades, there has been an increase in life expectancy in the world, with the consequent modification in the proportion of adults over 60 years. This is accompanied by an increase in pathologies for which aging is the main risk factor, such as dementia and hearing loss, which profoundly affect the quality of life of individuals and their family and impact health system costs. Given the lack of disease-modifying treatments for dementia, the study of mechanisms to prevent its occurrence has become a world priority. In the year 2017, the Lancet "Commission for dementia prevention, intervention, and care" proposed a model, in which hearing loss emerged as a new modifiable risk factor for the development of dementia. This result undoubtedly has important consequences for the understanding the multifactorial nature of dementia, our daily clinical practice and public policies aimed at its prevention and treatment. In this article, we review the current evidence supporting the association between dementia and hearing loss, discussing the available strategies for prevention, detection and treatment of hearing loss and its possible impact on the natural course of dementia. A flow chart for the clinical management of different subgroups of patients is proposed.
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http://dx.doi.org/10.4067/S0034-98872020000801128DOI Listing
August 2020

The Spanish 12-item version of the Speech, Spatial and Qualities of Hearing scale (Sp-SSQ12): adaptation, reliability, and discriminant validity for people with and without hearing loss.

Disabil Rehabil 2020 Jul 28:1-8. Epub 2020 Jul 28.

Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand.

Purpose: Because of the limited number of Spanish validated questionnaires available to assess auditory functionality in daily life situations in adults, the purpose of this study was to investigate the validity and the reliability of the Spanish version of the Speech, Spatial and Qualities of Hearing 12 items scale (sp-SSQ12), adapted from the published Spanish SSQ49, and to provide reference data for normal and hearing-impaired populations.

Methods: The SSQ12 is a self-report questionnaire, consisting of 12 items assessing a range of daily life listening situations. One hundred fifty adults (101 female) with a mean age of 53.9 years (SD 20.3; range 20-88 years) took part in the study. Internal consistency, test-retest reliability, validity, and floor and ceiling effects were investigated.

Results: The sp-SSQ12 questionnaire had high internal consistency (Cronbach's alpha = 0.95) and test-retest scores were highly correlated (ICC = 0.79). There was minimal evidence of floor and ceiling effects in our sample. Significant differences were observed overall and for the three subscales between normal and hearing-impaired groups. Although some significant differences in SSQ12 scores between groups of participants from different countries, these differences were minimal.

Conclusions: The sp-SSQ12 questionnaire is a valid and reliable tool that is easy to administer and requires a short time to answer. We recommend the use of this tool for the assessment of functional hearing in the Spanish-speaking population.Implication for rehabilitationHearing loss impacts people's lives in a number of ways that are captured in the SSQ.The sp-SSQ12 is a valid and reliable tool for assessing everyday listening abilities and limitations experienced by Spanish-speaking adults with hearing loss.The sp-SSQ12 can be incorporated in the hearing rehabilitation process as a tool for evaluating and improving hearing assessment and rehabilitation programs.The sp-SSQ12 can help to identify adults who require a comprehensive hearing assessment.
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http://dx.doi.org/10.1080/09638288.2020.1795279DOI Listing
July 2020

Reduced suprathreshold auditory nerve responses are associated with slower processing speed and thinner temporal and parietal cortex in presbycusis.

PLoS One 2020 19;15(5):e0233224. Epub 2020 May 19.

Neuroscience Department, Faculty of Medicine, University of Chile, Santiago, Chile.

Epidemiological evidence shows an association between hearing loss and dementia in elderly people. However, the mechanisms that connect hearing impairments and cognitive decline are still unknown. Here we propose that a suprathreshold auditory-nerve impairment is associated with cognitive decline and brain atrophy.

Methods: audiological, neuropsychological, and brain structural 3-Tesla MRI data were obtained from elders with different levels of hearing loss recruited in the ANDES cohort. The amplitude of waves I (auditory nerve) and V (midbrain) from auditory brainstem responses were measured at 80 dB nHL. We also calculated the ratio between wave V and I as a proxy of suprathreshold brainstem function.

Results: we included a total of 101 subjects (age: 73.5 ± 5.2 years (mean ± SD), mean education: 9.5 ± 4.2 years, and mean audiogram thresholds (0.5-4 kHz): 25.5 ± 12.0 dB HL). We obtained reliable suprathreshold waves V in all subjects (n = 101), while replicable waves I were obtained in 92 subjects (91.1%). Partial Spearman correlations (corrected by age, gender, education and hearing thresholds) showed that reduced suprathreshold wave I responses were associated with thinner temporal and parietal cortices, and with slower processing speed as evidenced by the Trail-Making Test-A and digit symbol performance. Non-significant correlations were obtained between wave I amplitudes and other cognitive domains.

Conclusions: These results evidence that reduced suprathreshold auditory nerve responses in presbycusis are associated with slower processing speed and brain structural changes in temporal and parietal regions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233224PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237004PMC
August 2020

Computer-aided diagnosis of external and middle ear conditions: A machine learning approach.

PLoS One 2020 12;15(3):e0229226. Epub 2020 Mar 12.

Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile.

In medicine, a misdiagnosis or the absence of specialists can affect the patient's health, leading to unnecessary tests and increasing the costs of healthcare. In particular, the lack of specialists in otolaryngology in third world countries forces patients to seek medical attention from general practitioners, whom might not have enough training and experience for making correct diagnosis in this field. To tackle this problem, we propose and test a computer-aided system based on machine learning models and image processing techniques for otoscopic examination, as a support for a more accurate diagnosis of ear conditions at primary care before specialist referral; in particular, for myringosclerosis, earwax plug, and chronic otitis media. To characterize the tympanic membrane and ear canal for each condition, we implemented three different feature extraction methods: color coherence vector, discrete cosine transform, and filter bank. We also considered three machine learning algorithms: support vector machine (SVM), k-nearest neighbor (k-NN) and decision trees to develop the ear condition predictor model. To conduct the research, our database included 160 images as testing set and 720 images as training and validation sets of 180 patients. We repeatedly trained the learning models using the training dataset and evaluated them using the validation dataset to thus obtain the best feature extraction method and learning model that produce the highest validation accuracy. The results showed that the SVM and k-NN presented the best performance followed by decision trees model. Finally, we performed a classification stage -i.e., diagnosis- using testing data, where the SVM model achieved an average classification accuracy of 93.9%, average sensitivity of 87.8%, average specificity of 95.9%, and average positive predictive value of 87.7%. The results show that this system might be used for general practitioners as a reference to make better decisions in the ear pathologies diagnosis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229226PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067442PMC
June 2020

Decellularized equine carotid artery layers as matrix for regenerated neurites of spiral ganglion neurons.

Int J Artif Organs 2020 May 22;43(5):332-342. Epub 2019 Aug 22.

Department of Otolaryngology, Hannover Medical School, Hannover, Germany.

Today's best solution in compensating for sensorineural hearing loss is the cochlear implant, which electrically stimulates the spiral ganglion neurons in the inner ear. An optimum hearing impression is not ensured due to, among other reasons, a remaining anatomical gap between the spiral ganglion neurons and the implant electrodes. The gap could be bridged via pharmacologically triggered neurite growth toward the electrodes if biomaterials for neurite guidance could be provided. For this, we investigated the suitability of decellularized tissue. We compared three different layers (tunica adventitia, tunica media, and tunica intima) of decellularized equine carotid arteries in a preliminary approach. Rat spiral ganglia explants were cultured on decellularized equine carotid artery layers and neurite sprouting was assessed quantitatively. Generally, neurite outgrowth was possible and it was most prominent on the intima (in average 83 neurites per spiral ganglia explants, followed by the adventitia (62 neurites) and the lowest growth on the media (20 neurites). Thus, decellularized equine carotid arteries showed promising effects on neurite regeneration and can be developed further as efficient biomaterials for neural implants in hearing research.
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http://dx.doi.org/10.1177/0391398819868481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221869PMC
May 2020

Comprehensive analysis of HPV expression in laryngeal squamous cell carcinoma.

J Med Virol 2014 Apr 30;86(4):642-6. Epub 2013 Dec 30.

International Agency for Research on Cancer, Lyon, France.

Role of human papillomavirus (HPV) in laryngeal carcinoma remains controversial. The aim of this study is to evaluate the role of HPV in laryngeal squamous cell carcinoma by determining presence of markers of viral infection. HPV DNA and E6*I mRNA status was determined by type-specific E7 PCR bead-based multiplex genotyping and RT-PCR assays in laryngeal squamous cell carcinoma biopsy samples. p16(INK4a) and COX-2 expression was determined by immunohistochemistry. Four cases out of 32 (13%) were HPV DNA+: HPV 11 (n = 1), HPV 31 (n = 3), HPV 59 (n = 1). One double infection: HPV 11 and HPV 31. p16(INK4a) was overexpressed in three cases (9%) and COX-2 in 17 cases (53%). Two of four HPV DNA+ samples had E6*I mRNA for HPV 31 and overexpressed p16(INK4a) and COX-2. HPV appears to play an active role in a small subset of laryngeal squamous cell carcinoma. p16(INK4a) can be used as a surrogate marker of transcriptionally active HPV infection; COX-2 expression had no correlation with HPV DNA and/or RNA positivity.
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http://dx.doi.org/10.1002/jmv.23866DOI Listing
April 2014

Prevalence of the 35delG mutation in the GJB2 gene in two samples of non-syndromic deaf subjects from Chile.

Biol Res 2013 ;46(3):239-42

Laboratorio de Epidemiología Genética, Programa de Genética Humana, ICBM, Facultad de Medicina, Universidad de Chile, Chile,

Hearing loss is the most common inherited sensorial deficiency in humans; about 1 in 1000 children suffer from severe or profound hearing loss at birth. Mutations in the GJB2 gene are the most common cause of prelingual, non-syndromic autosomal recessive deafness in many populations; the c.35delG mutation is the most common in Caucasian populations. The frequency of the c.35delG mutation was estimated in two samples of deaf patients from Santiago, Chile. Unrelated non-syndromic sensorioneural deaf patients were examined: Group 1 consisted of 47 unrelated individuals with neurosensory deafness referred to the Chilean Cochlear Implant Program; Group 2 included 66 school children with prelingual deafness attending special education institutions for deaf people. Individuals with profound to moderate isolated neurosensory hearing loss with unknown etiology were included. The presence of the c.35delG mutation was evaluated by the allele-specific polymerase chain reaction method (PCR), and in some cases it was confirmed by direct DNA sequencing of the coding region of the GJB2 gene. Deaf relatives were present in 20.3% of the cases. We found 19.5% (22/113) patients with the c.35delG mutation, 6 of them homozygous; these rates are similar to frequencies found in other Latin American countries.
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http://dx.doi.org/10.4067/S0716-97602013000300003DOI Listing
February 2016

Inactivation of the putative suppressor gene DOK1 by promoter hypermethylation in primary human cancers.

Int J Cancer 2012 Jun 22;130(11):2484-94. Epub 2011 Sep 22.

International Agency for Research on Cancer (IARC), Lyon, France.

The DOK1 gene is a putative tumour suppressor gene located on the human chromosome 2p13 which is frequently rearranged in leukaemia and other human tumours. We previously reported that the DOK1 gene can be mutated and its expression down-regulated in human malignancies. However, the mechanism underlying DOK1 silencing remains largely unknown. We show here that unscheduled silencing of DOK1 expression through aberrant hypermethylation is a frequent event in a variety of human malignancies. DOK1 was found to be silenced in nine head and neck cancer (HNC) cell lines studied and DOK1 CpG hypermethylation correlated with loss of gene expression in these cells. DOK1 expression could be restored via demethylating treatment using 5-aza-2'deoxycytidine. In addition, transduction of cancer cell lines with DOK1 impaired their proliferation, consistent with the critical role of epigenetic silencing of DOK1 in the development and maintenance of malignant cells. We further observed that DOK1 hypermethylation occurs frequently in a variety of primary human neoplasm including solid tumours (93% in HNC, 81% in lung cancer) and haematopoietic malignancy (64% in Burkitt's lymphoma). Control blood samples and exfoliated mouth epithelial cells from healthy individuals showed a low level of DOK1 methylation, suggesting that DOK1 hypermethylation is a tumour specific event. Finally, an inverse correlation was observed between the level of DOK1 gene methylation and its expression in tumour and adjacent non tumour tissues. Thus, hypermethylation of DOK1 is a potentially critical event in human carcinogenesis, and may be a potential cancer biomarker and an attractive target for epigenetic-based therapy.
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http://dx.doi.org/10.1002/ijc.26299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3422753PMC
June 2012

DNA extraction from formalin-fixed laryngeal biopsies: Comparison of techniques.

Acta Otolaryngol 2011 Mar 10;131(3):330-3. Epub 2010 Dec 10.

Departamento de Otorrinolaringología, Hospital San Juan de Dios, Facultad de Medicina, Universidad de Chile, Santiago, Chile.

Conclusion: PCR-quality DNA could be extracted from formalin-fixed paraffin-embedded (FFPE) samples with amplicons of at least 390 bp. Paraffin removal was not a necessary step. Proteinase K digestion was as efficient as the commercial kit for DNA extraction with a lower cost.

Objectives: To compare different DNA extraction protocols for FFPE samples and to describe the suitability of the extracted DNA for PCR reactions.

Methods: For deparaffinization the following techniques were compared: alkaline heat, xylene, and no removal. For DNA extraction, proteinase K digestion and organic extraction were compared. A commercial extraction kit was included as standard. DNA quality was assessed by PCR amplification of the HFE gene, for amplicons of 208 and 390 bp.

Results: Extraction with the commercial kit and proteinase K digestion were more efficient than other techniques, with no statistical difference between them for both amplicons. The proteinase K digestion buffer had a cost of U$ 0.2 per sample and the commercial kit of U$7 per sample.
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http://dx.doi.org/10.3109/00016489.2010.528794DOI Listing
March 2011

Human papillomavirus infections in laryngeal cancer.

Head Neck 2011 Apr;33(4):581-6

Departamento de Otorrinolaringologia, Universidad de Chile, Santiago de Chile, Chile.

Although the association and clinical significance of human papillomavirus (HPV) infections with a subset of head and neck cancers, particularly for oropharyngeal carcinoma, has recently been well documented, the involvement of HPV in laryngeal cancer has been inadequately evaluated. Herein we review the currently known associations of HPV infections in diseases of the larynx and their potential for oncogenicity. Using several methods of detection, HPV DNA has been detected in benign (papillomatosis), indolent (verrucous carcinoma), and malignant (squamous cell carcinoma) lesions of the larynx. Consistent with the known oncogenic risk of HPV infections, common HPV types associated with laryngeal papillomatosis include low-risk HPV types 6 and 11, with high-risk HPV types 16 and 18 more commonly present in neoplastic lesions (verrucous carcinoma and squamous cell carcinoma). Although a broad range of prevalence has been noted in individual studies, approximately 25% of laryngeal squamous cell carcinomas harbor HPV infections on meta-analysis, with common involvement of high-risk HPV types 16 (highest frequency) and 18. Preliminary results suggest that these high-risk HPV infections seem to be biologically relevant in laryngeal carcinogenesis, manifested as having viral DNA integration in the cancer cell genome and increased expression of the p16 protein. Despite this knowledge, the clinical significance of these infections and the implications on disease prevention and treatment are unclear and require further investigation.
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http://dx.doi.org/10.1002/hed.21421DOI Listing
April 2011

Exploring the relation between human papilloma virus and larynx cancer.

Acta Otolaryngol 2007 Sep;127(9):900-6

Servicio de Otorrinolaringología Hospital San Juan de Dios, Santiago, Chile.

Human papilloma virus (HPV) has a role in benign and malignant pathology of the larynx. In this review we present the biological and epidemiological aspects related to these issues.
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http://dx.doi.org/10.1080/00016480601110238DOI Listing
September 2007

Molecular detection and typing of human papillomavirus in laryngeal carcinoma specimens.

Acta Otolaryngol 2005 Aug;125(8):888-93

Departamento de Otorrinolaringología, Hospital San Juan de Dios, Facultad de Medicina, Universidad de Chile, Santiago, Chile.

Conclusions: Human papillomavirus (HPV) DNA was detected in 32% of laryngeal carcinoma biopsy samples studied. The genotypes identified were high-risk types, the most frequent being HPV 16. Viral DNA was integrated into the host genome (genotype HPV 16), providing supporting evidence for a role of HPV in the carcinogenic pathway of laryngeal squamous cell carcinoma.

Objective: HPV has been detected in laryngeal lesions, both benign and neoplastic, with a variable frequency (8-60%). These viral agents have been proposed as an adjuvant or cofactor in head and neck carcinogenesis because of their oncogenic properties. The aims of this study were to identify HPV in laryngeal carcinoma samples and to describe the physical state of the viral genome, i.e. its integration to the host DNA.

Material And Methods: Formalin-fixed, paraffin wax-embedded tumor samples from patients with newly diagnosed laryngeal carcinomas were collected. The HPV genome was identified using polymerase chain reaction (PCR) with primers complementary to the conserved region L1 (MY09-11). Genotyping was accomplished by restriction fragment length polymorphism. Samples positive for HPV 16 were assayed by PCR with primers complementary to region E2, interrupted during viral genome integration.

Results: Ten of the 31 samples (32%) were positive for HPV DNA and all of the samples were positive for human beta-globin. The genotypes identified were HPV 16 (n=3), HPV 58 (n=2) and HPV 39, 45, 51, 59, 66 and 69 (n=1 for each). The three samples positive for HPV 16 had lost region E2, meaning that the viral DNA had been integrated into the host genome.
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http://dx.doi.org/10.1080/00016480510038220DOI Listing
August 2005

[Authorship in the Chilean journal Revista de Otorrinolaringología y Cirurgía de Babeza y Cuello: analysis of three decades].

Rev Med Chil 2002 Jul;130(7):773-8

Facultad de Medicina, Universidad de Chile, Campus Occidente, Servicio de Otorrinolaringología del Hospital San Juan de Dios, Santiago de Chile.

Background: The number of authors of scientific papers has increased significantly in the last decade. The increasing complexity of medical research but also vicious practices are possible causes of this trend.

Aim: To analyze the number of authors and type of papers published in the Chilean Journal of Otorhinolaryngology and Head and Neck Surgery in the last three decades.

Material And Methods: A review of all manuscripts published between 1970 and 1999. The number of authors and the type of paper was registered.

Results: Five hundred nineteen papers were reviewed. The mean number of authors per paper increased from 1.9 to 3 (p < 0.001). Research reports decreased from 79% to 61% and the number of review articles and case reports increased. No multicentric work was published in the period.

Conclusions: A significant increase in the number of authors per manuscript was observed in this review.
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July 2002