Intro to Translation

“Translation is that which transforms everything so that nothing changes.” –Gunter Grass

I recently completed an 8-month long translation course focusing on English to Spanish translation. My initial intent was to focus solely on medical translation: consent forms, patient information pamphlets and the like. However, this course offered a variety of material: legal, business, economic, and fictional narratives to be translated from the English source material to Spanish. It definitely was a demanding class, requiring much reading, researching, writing and editing, but it helped me improve my written Spanish communication immensely. Reading and writing a language is also a superb way to increase vocabulary and grammar knowledge. It’s easy to graze over grammatical errors when we speak, but writing hides nothing. There it is, in black and white, for the reader to see: spelling mistakes, run-on sentences, incorrect punctuation, missing accent marks and all.

I plan on shifting my blog focus for several future entries on written Spanish. This is because working as a physician demands not only the ability to dialogue with patients, but to also provide them with various forms of reading material in Spanish. You cannot orally describe a surgical procedure to a patient in Spanish, only to hand them the consent form written in English. Because Spanish is the second most popular language spoken in U.S. homes, there is a wealth of reading material available in the various areas of medical specialty that physicians can obtain for their patients.

However, there are always office-specific procedural forms, consents and materials, research study descriptions and consents, that need to be translated. Take, for example, a study design on cytomegalovirus-induced uveitis in immune-compromised patients below. This was one of my class assignments for translation.

While comparing the translation to the original, take note that there are several factors to consider when translating a document. A few to consider are: Who will the reading public be? Should certain names and/or abbreviations be left in the original English? Are numbers and measuring units written the same way in the target language as in the source? Do you keep the same formatting? Answering these questions first helps to create a successful and cohesive translation.

Methods

Patients
Patients with AIDS and newly diagnosed, active cytomegalovirus retinitis were enrolled at 18 clinical sites in the United States. Eligible patients had to be at least 18 years old, and their best corrected visual acuity had to be 20/200 or better in at least one affected eye. Exclusion criteria included opacities that would prevent visualization of the fundus, contraindications to intraocular surgery or to therapy with intravenous ganciclovir, the presence of overt signs or symptoms of extraocular cytomegalovirus infection, an absolute neutrophil count below 500 cells per cubic millimeter, a platelet count below 25,000 cells per cubic millimeter, a serum creatinine concentration above 1.5 mg per deciliter (133 µmol per liter), and a Karnofsky score below 60. Informed consent was obtained from all patients.

Base-Line Evaluation and Randomization
Before randomization, patients underwent a complete base-line examination, which included nine-field fundus photography. The randomization was stratified so as to distribute patients with unilateral and bilateral cytomegalovirus retinitis equally among the three treatment groups, and blocking was used to assign patients equally to the treatment groups over time.

Treatment and Follow-Up
Eligible patients were assigned with equal probability to receive one of three treatments: an intraocular implant (Vitrasert, Chiron Vision, Irvine, Calif.) with a release rate of 1 µg of ganciclovir (Cytovene, Roche Laboratories, Nutley, N.J.) per hour, an intraocular implant with a release rate of 2 µg of ganciclovir per hour, or intravenous ganciclovir. A 2-µg-per-hour implant was included to determine whether a release rate higher than that used in a previous study³⁷ (1 µg per hour) would have greater efficacy. Investigators and patients were unaware of the release rate of the ganciclovir implant. The surgical procedure to insert the implant has been described elsewhere.^35,36 Patients assigned to receive intravenous ganciclovir received an induction dose of 5 mg per kilogram of body weight twice daily (total daily dose, 10 mg per kilogram) for at least 14 days, followed by maintenance therapy at a dose of 5 mg per kilogram once daily.
For patients in the implant groups, ophthalmic examinations were performed on postoperative days 1, 3, 4, 5, and 7. Patients in all three groups were examined at weeks 2, 4, 6, and 8 and then monthly until there had been eight months of progression-free follow-up or until progression of cytomegalovirus retinitis, death, or another event specified as leading to the termination of follow-up occurred. At follow-up visits from week 2 on, a complete ophthalmic examination was conducted, including measurement of visual acuity with modified Bailey–Lovie charts,⁴⁴ slit-lamp examination, indirect ophthalmoscopy with the eyes dilated, and bilateral, nine-field photography of the fundus.

[ Source http://content.nejm.org/cgi/content/full/337/2/83, New England Journal of Medicine]

Métodos

Pacientes

Los pacientes con el síndrome de inmunodeficiencia adquirida (SIDA) y la retinitis activa por citomegalovirus (CMV) de diagnóstico reciente se inscribieron en dieciocho sitios clínicos en los Estados Unidos. Los pacientes elegibles tenían que tener por lo menos dieciocho años, y la agudeza visual mejor corregida tenía que ser 20/200  o mejor en al menos un ojo afectado. Los criterios de exclusión  incluyeron: opacidades que impedirían la visualización del fondo del ojo, contraindicaciones de la cirugía intraocular o la terapia con el ganciclovir intravenoso, la presencia de signos o síntomas evidentes de la infección por citomegalovirus extraocular, un recuento absoluto de los neutrófilos debajo de 500 células por milímetro cúbico, un recuento de plaqueta debajo de 25.000 células  por milímetro cúbico,  una concentración de creatinina sérica arriba de 1,5mg por decilitro (133 µmol por litro) y índice de Karnofsky debajo de 60. El consentimiento informado se obtuvo de todos los pacientes.

Evaluación inicial y  randomización

Antes de la randomización, los pacientes tuvieron una evaluación inicial  que incluyó la fotografía de nueve campos del fondo del ojo. La randomización se estratificó para distribuir de manera equilibrada los pacientes con la retinitis por citomegalovirus unilateral o bilateral entre los tres grupos de tratamiento, y el bloqueo de los datos se utilizó para asignar a los pacientes por igual a los grupos de tratamiento a través del tiempo.

Tratamiento y  seguimiento

Los pacientes elegibles se asignaron con probabilidad igual para recibir uno de tres tratamientos: un implante intraocular (Vitrasert, Chiron Vision, Irvine, Calif.) con una tasa de liberación de 1 µg de ganciclovir (Cytovene, Roche Laboratories, Nutley, NJ) por hora, un implante intraocular con una tasa de liberación de 2 µg de ganciclovir por hora, o ganciclovir intravenoso.  Un implante de 2µg por hora se incluyó para determinar si una tasa de liberación superior a la utilizada en un estudio previo³⁷ (1µg por hora) tendría mayor eficacia. Los investigadores y los pacientes no estaban al tanto de la velocidad de liberación del implante de ganciclovir. El procedimiento quirúrgico para insertar el implante se ha descrito en otra parte^35,36. Los pacientes asignados a recibir el ganciclovir intravenoso recibieron la dosis de inducción de 5mg por kilogramo de peso corporal dos veces al día. (la dosis diaria total, 10mg por kilogramo) por a menos 14 días, seguido por el tratamiento de mantenimiento con las dosis de 5mg por kilogramo cada día.

Para los pacientes de los grupos con implantes, se realizaron exámenes oftalmológicos en los días postoperatorios 1, 3, 4, 5, y 7.  Los pacientes en los tres grupos se examinaron en semanas 2, 4, 6, y 8 y luego mensualmente hasta que había pasado ocho meses del seguimiento sin progresión o hasta que la progresión de la retinitis por citomegalovirus, la muerte, o cualquier otro evento especificado como la causa de la terminación del seguimiento. En las visitas de seguimiento de la semana 2 y demás, un examen oftalmológico completo se realizó y se incluyó la medida de la agudeza visual con los gráficos  modificados de Bailey-Lovie⁴⁴,  el examen por la lámpara de hendidura, la oftalmoscopia indirecta con ojos dilatados, y  la fotografía de nueve campos del fondo de nueve campos del fondo del ojo bilateral.

Joan of Arc, Jules Bastien-LePage