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INTRODUCTION AND HYPOTHESIS: The mid-urethral sling (MUS) is considered the gold standard for stress urinary incontinence (SUI). Nevertheless, this procedure is not excluded from postsurgical complications, which can be challenging for most clinicians. Hence, one of the main concerns about this procedure is late postoperative voiding dysfunction (LDS), defined as obstructive symptoms 6 weeks after surgery. Primary medical management regularly includes expectant management and rehabilitation, including the mid-urethral cut sling (MUCS) as an alternative when it fails. This video provides an anatomical illustration and detailed description of the surgical steps of the J-cut of the lateral sling. MATERIALS AND METHODS: We set up a step-by-step surgical process and provided some advice for MUCS in a video; this material included how to position the sling, dissect, isolate the synthetic material, release adhesions and make a lateral cut of the MUS. Additionally, a case series of 30 patients from our institution is described to confirm the effectiveness of MUCS to manage delayed voiding dysfunction syndrome. RESULTS: MUCS in LDS was beneficial for our patients. Obstructive symptoms improved clinically from 75% to 100%, and urgency-related symptoms decreased from 57.9% to 26.3%, evidencing 20% SUI post-MUCS surgery. CONCLUSIONS: The lateral cut of the mid-urethral tape should be considered a surgical alternative for the resolution of post-sling late voiding dysfunction syndrome in patients who do not improve with expectant management.
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Slings Suburetrais , Incontinência Urinária por Estresse , Humanos , Masculino , Período Pós-Operatório , Slings Suburetrais/efeitos adversos , Síndrome , Uretra , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
Agricultural intensification is a key strategy to help meet increasing demand for food and bioenergy. It has the potential to reduce direct and indirect land use change (LUC) and associated environmental impacts while contributing to a favorable economic performance of the agriculture sector. We conduct an integral analysis of environmental and economic impacts of LUC from projected agricultural intensification and bioenergy production in the Orinoquia region in 2030. We compare three agricultural intensification scenarios (low, medium, high) and a reference scenario, which assumes a business-as-usual development of agricultural production. The results show that with current inefficient management or with only very little intensification between 26% and 93% of the existing natural vegetation areas will be converted to agricultural land to meet increasing food demand. This results in the loss of biodiversity by 53% and increased water consumption by 111%. In the medium and high scenarios, the intensification allows meeting increased food demand within current agricultural lands and even generating surplus land which can be used to produce bioenergy crops. This results in the reduction of biodiversity loss by 8-13% with medium and high levels of intensification compared to the situation in 2018. Also, a positive economic performance is observed, stemming primarily from intensification of cattle production and additional energy crop production. Despite increasing irrigation efficiency in more intensive production systems, the water demand for perennial crops and cattle production over the dry season increases significantly, thus sustainable management practices that target efficient water use are needed. Agricultural productivity improvements, particularly for cattle production, are crucial for reducing the pressure on natural areas from increasing demand for both food products and bioenergy. This implies targeted investments in the agricultural sector and integrated planning of land use. Our results showed that production intensification in the Orinoquia region is a mechanism that could reduce the pressure on natural land and its associated environmental and economic impacts.
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Conservação dos Recursos Naturais , Ecossistema , Agricultura , Animais , Biodiversidade , Bovinos , Colômbia , Produtos AgrícolasRESUMO
RESUMEN: La población femenina de adultos mayores suele presentar daños de los discos o meniscos articulares de la rodilla (DAR) generalmente derivados de procesos degenerativos de cartílago ocurridos en osteoartritis. Conocer patrones morfológicos estándares de los DAR en una población demográfica específica permite tener claridad de las características autóctonas de dicha población. Una forma de caracterizar estos patrones es a través del diseño de Modelos de Elementos Finitos (MEF) que permiten predecir anormalidades clínicas y radiológicas. Hasta el momento es escasa la evidencia sobre las características morfométricas de los DAR en la población colombiana. Por esta razón, el objetivo del presente estudio fue describir la morfometría de DAR en imágenes por resonancia magnética (IRM) de mujeres colombianas saludables. En este estudio se tomaron 25 IRM de la rodilla de mujeres colombianas con normo-peso, sin antecedentes de patología de la rodilla, ni historia de trauma o cirugía de esta, y con edades entre los 18 y 60 años. El análisis del ancho del cuerno posterior del DAR medial (12,73 ± 2,42) comparado con el lateral (8,04 ± 1,52) arrojó diferencia estadísticamente significativa (p<0,05). Por otra parte, el DAR medial presentó un diámetro antero-posterior aumentado (38,52 ± 2,71) en comparación con el del DAR lateral (29,18 ± 2,75) cercano a la significancia estadística (p=0.051). De igual manera, la altura del cuerno anterior se encontró aumentada en el DAR medial (4,42 ± 0,79) en comparación con el lateral (3,66 ± 0,76), con tendencia a la significancia estadística (p=0,063). Anatómicamente se reconoce que los DAR medial y lateral se adaptan a la forma y tamaño de los cóndilos femorales, lo que concuerda con las medidas resultantes de la población estudiada, donde se evidencia un DAR medial más largo (diámetro antero-posterior) y menos alto que el lateral.
SUMMARY: The elderly female population usually presents damage to the articular discs or menisci of the knee (ADK), generally derived from degenerative cartilage processes that occur in osteoarthritis. Knowing the standard morphological patterns of ADKs in a specific demographic population allows clarity of the indigenous characteristics of that population. One way to characterize these patterns is through the design of Finite Element Models (FEM) that would enable predicting clinical and radiological abnormalities. So far, there is little evidence on the morphometric characteristics of ADKs in the Colombian population. Thus, the objective of the present study was to describe the morphometry of ADK in magnetic resonance imaging (MRI) of healthy Colombian women. In this study, 25 MRIs of the knee of Colombian women with normal weight were taken, with no history of knee pathology, trauma, or surgery, and with ages between 18 and 60 years. The analysis of the width of the posterior horn of the medial ADK (12.73 ± 2.42) compared to the lateral (8.04 ± 1.52) showed a statistically significant difference (p <0.05). On the other hand, the medial ADK presented an increased anteroposterior diameter (38.52 ± 2.71) compared to that of the lateral ADK (29.18 ± 2.75) close to statistical significance (p = 0.051). Similarly, the height of the anterior horn was found to be increased in the medial ADK (4.42 ± 0.79) compared to the lateral (3.66 ± 0.76), with a trend towards statistical significance (p = 0.063). Anatomically, it is recognized that the medial and lateral ADK adapt to the shape and size of the femoral condyles, which is in agreement with the results of the studied population where measurements show that medial ADK has a longer (anterior to posterior diameter) and a shorter height than the lateral ADK.
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Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Imageamento por Ressonância Magnética , Menisco/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Estudos Transversais , Colômbia , Análise de Elementos Finitos , Menisco/anatomia & histologia , Articulação do Joelho/anatomia & histologiaRESUMO
Jaguars, Panthera onca (Linnaeus, 1758), and pumas, Puma concolor (Linnaeus, 1771) are the largest felids in the neotropics. Both can overlap in niche axes (time, space and prey), and are therefore potentially competing species. Segregation mechanisms presented by a low overlap in one of these axes of niche can facilitate the coexistence. Our aim was to analyze jaguar and puma temporal and spatial overlap for understanding their segregation mechanisms. Between 2015 and 2017, twenty-six camera trap stations were located in five habitat types of El Cielo Biosphere Reserve (ECBR) in northeastern Mexico. Temporal activity was analyzed using circular statistics and time overlap analysis. Spatial overlap was calculated with the Pianka index and a selectivity habitat analysis. Our results showed that jaguars and pumas were nocturnal and that the temporal overlap was high (∆4 = 0.77). We found an intermediate spatial overlap (Pianka index = 0.61). Jaguars were more selective and preferred the deciduous forest. In comparison, pumas preferred oak-pine forest, but also used oak and deciduous forest. Our results indicate that spatial segregation best explains the coexistence of jaguars and pumas in our study area, probably due to both habitat diversity in the reserve and the generalist habits of the puma.(AU)
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Animais , Felidae , Estudos de Séries Temporais , Análise Espacial , Panthera , Cadeia AlimentarRESUMO
Jaguars, Panthera onca (Linnaeus, 1758), and pumas, Puma concolor (Linnaeus, 1771) are the largest felids in the neotropics. Both can overlap in niche axes (time, space and prey), and are therefore potentially competing species. Segregation mechanisms presented by a low overlap in one of these axes of niche can facilitate the coexistence. Our aim was to analyze jaguar and puma temporal and spatial overlap for understanding their segregation mechanisms. Between 2015 and 2017, twenty-six camera trap stations were located in five habitat types of El Cielo Biosphere Reserve (ECBR) in northeastern Mexico. Temporal activity was analyzed using circular statistics and time overlap analysis. Spatial overlap was calculated with the Pianka index and a selectivity habitat analysis. Our results showed that jaguars and pumas were nocturnal and that the temporal overlap was high (∆4 = 0.77). We found an intermediate spatial overlap (Pianka index = 0.61). Jaguars were more selective and preferred the deciduous forest. In comparison, pumas preferred oak-pine forest, but also used oak and deciduous forest. Our results indicate that spatial segregation best explains the coexistence of jaguars and pumas in our study area, probably due to both habitat diversity in the reserve and the generalist habits of the puma.(AU)
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Animais , Cadeia Alimentar , Felidae , Análise Espaço-Temporal , MéxicoRESUMO
ABSTRACT Jaguars, Panthera onca (Linnaeus, 1758), and pumas, Puma concolor (Linnaeus, 1771) are the largest felids in the neotropics. Both can overlap in niche axes (time, space and prey), and are therefore potentially competing species. Segregation mechanisms presented by a low overlap in one of these axes of niche can facilitate the coexistence. Our aim was to analyze jaguar and puma temporal and spatial overlap for understanding their segregation mechanisms. Between 2015 and 2017, twenty-six camera trap stations were located in five habitat types of El Cielo Biosphere Reserve (ECBR) in northeastern Mexico. Temporal activity was analyzed using circular statistics and time overlap analysis. Spatial overlap was calculated with the Pianka index and a selectivity habitat analysis. Our results showed that jaguars and pumas were nocturnal and that the temporal overlap was high (4 = 0.77). We found an intermediate spatial overlap (Pianka index = 0.61). Jaguars were more selective and preferred the deciduous forest. In comparison, pumas preferred oak-pine forest, but also used oak and deciduous forest. Our results indicate that spatial segregation best explains the coexistence of jaguars and pumas in our study area, probably due to both habitat diversity in the reserve and the generalist habits of the puma.
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RESUMEN Objetivo: proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud. Materiales y métodos: se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en Medline y Cochrane Controlled Register of Trials durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de diagnóstico y tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 128-IETSI-ESSALUD-2019. Resultados: la presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: tamizaje, diagnóstico, tratamiento, soporte y rehabilitación. En base a estas preguntas se formularon 28 recomendaciones (8 fuertes y 20 condicionales), 38 puntos de buena práctica clínica, 1 nota de implementación y 2 flujogramas. Conclusión: el presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud.
ABSTRACT Objective: to provide evidence based clinical recommendations for the diagnosis and therapy of the acute stage of ischemic cerebrovascular accident in EsSalud. Materials and methods : a group for producing the guideline was conveyed, including specialized physicians and methodologists. The group prepared 8 clinical questions to be answered by the guideline. Systematic searches of previous reviews were performed, and - when it was deemed necessary - primary studies in Medline and the Cochrane Controlled Registry of Trials for 2018 were reviewed. Evidence was selected aiming to respond each one of the proposed clinical questions. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work sessions, the group used GRADE methodology for reviewing the evidence and generated recommendations, good clinical practice items, and designed flow charts for both diagnosis and therapy. Finally, the guide was approved with the decree N° 128-IETSI-ESSALUD-2019. Results : this clinical practice guideline focused in 8 clinical questions, which were divided into four topics: screening, diagnosis, therapy, support and rehabilitation. On the basis of these questions, 28 recommendations were formulated (8 strong and 20 conditional), 38 items for good clinical practice, 1 implementation note, and 2 flow charts. Conclusion : this paper summarizes both evidence based methodology and conclusions from a new clinical practice guide for diagnosis and therapy of the acute stage of a cerebrovascular accident in EsSalud.
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OBJECTIVE: The intervertebral disc supports axial and shear forces generated during tasks such as lifting and carrying weights. The objective of this study was to determine the forces in the lumbar spine of workers carrying a bag on the head, on the shoulder and on the anterior part of the trunk. METHODS: Kinematic measurements were recorded for 10 subjects carrying bags of 10, 20 and 25 kg on each of the three aforementioned positions. A simple dynamic model implemented in a custom program was then developed to determine the lumbar forces using the accelerations and positions obtained from the kinematic analysis. RESULTS: The analyses yielded a maximum compressive force of 2338.4 ± 422 N when a 25-kg bag was carried on the anterior part of the trunk. CONCLUSION: Carrying bags on the anterior part of the trunk generated higher lumbar forces compared to those developed by carrying the bag on the head or on the shoulder. Force levels suggest that this activity represents a moderate risk for the subjects. However, future biomechanical models should be developed to analyze the cumulative effect in the discs when longer periods of time are spent in this activity.
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Remoção , Vértebras Lombares/fisiologia , Caminhada/fisiologia , Adulto , Fenômenos Biomecânicos , Ergonomia , Marcha , Humanos , Masculino , Suporte de Carga/fisiologiaRESUMO
Autoimmune diseases share common immunopathogenic mechanisms (i.e., the autoimmune tautology), which explain the clinical similarities among them as well as their familial clustering. Guillain-Barré syndrome (GBS), an autoimmune peripheral neuropathy, has been recently associated with Zika virus (ZIKV) infection. Based on a series of cases, this review article provides a comparative analysis of GBS associated with ZIKV infection, contrasted with the general characteristics of GBS in light of the autoimmune tautology, including gender differences in prevalence, subphenotypes, polyautoimmunity, familial autoimmunity, age at onset, pathophysiology, ecology, genetics, ancestry, and treatment.
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Autoimunidade/genética , Síndrome de Guillain-Barré/epidemiologia , Infecção por Zika virus/complicações , Humanos , Estudos RetrospectivosRESUMO
We have focused on the epidemiology and immunobiology of Zika virus (ZIKV) infection and factors associated with the development of Guillain-Barré syndrome (GBS) and other neurological syndromes in Cúcuta, the capital of North Santander department, Colombia. Data of patients with ZIKV disease reported to the national population-based surveillance system were used to calculate the basic reproduction number (R0) and the attack rates (ARs) as well as to develop epidemiological maps. Patients with neurological syndromes were contacted and their diagnoses were confirmed. A case-control study in which 29 patients with GBS associated with ZIKV compared with 74-matched control patients with ZIKV infection alone was undertaken. Antibodies against arboviruses and other infections that may trigger GBS were evaluated. The estimated value of R0 ranged between 2.68 (95% CI 2.54-2.67) to 4.57 (95% CI 4.18-5.01). The sex-specific ARs were 1306 per 100,000 females, and 552 per 100,000 males. A non-linear interaction between age and gender on the ARs was observed. The incidence of GBS in Cúcuta increased 4.41 times secondary to ZIKV infection. The lag time between ZIKV infection and neurological symptoms was 7 days (interquartile range 2-14.5). Patients with GBS appeared to represent a lower socioeconomic status and were living near to environmentally contaminated areas. All GBS patients were positive for IgG antibodies against both ZIKV and Dengue virus, and 69% were positive for Chikungunya virus. Noteworthy, GBS was associated with a previous infection with M. pneumoniae (OR: 3.95; 95% CI 1.44-13.01; p = 0.006). No differences in antibody levels against C. jejuni, Epstein-Barr virus and cytomegalovirus were observed. High rates of cranial nerves involvement and dysautonomia were present in 82% and 75.9%, respectively. Intensive care unit (ICU) admission was necessary in 69% of the GBS patients. Most of the patients disclosed a high disability condition (Hughes grade 4). Dysautonomia was the main risk factor of poor GBS prognosis (i.e., ICU admission and disability). Thirteen patients were diagnosed with other neurological syndromes different to GBS (6 with transverse myelitis, 3 with encephalitis, 3 with peripheral facial palsy and one with thoraco-lumbosacral myelopathy). Our data confirm an increased transmission of ZIKV in Cúcuta, and provide support to the view that severe neurological syndromes are related to ZIKV disease. The complex ways by which previous infections and socioeconomic status interact to increase the risk of GBS in people infected by ZIKV should be further investigated.