RESUMO
INTRODUCTION AND AIMS: An anastomotic leak is one of the most dreaded complications in colorectal surgery because it increases postoperative morbidity and mortality. The aim of the present study was to identify whether indocyanine green fluorescence angiography (ICGFA) reduced the anastomotic dehiscence rate in colorectal surgery. MATERIAL AND METHODS: A retrospective study on patients that underwent colorectal surgery with colonic resection or low anterior resection and primary anastomosis, within the time frame of January 2019 and September 2021, was conducted. The patients were divided into the case group, in which ICGFA was performed for the intraoperative evaluation of blood perfusion at the anastomosis site, and the control group, in which ICGFA was not utilized. RESULTS: A total of 168 medical records were reviewed, resulting in 83 cases and 85 controls. Inadequate perfusion that required changing the surgical site of the anastomosis was identified in 4.8% of the case group (nâ¯=â¯4). A trend toward reducing the leak rate with ICGFA was identified (6% [nâ¯=â¯5] in the cases vs 7.1% in the controls [nâ¯=â¯6] [pâ¯=â¯0.999]). The patients that underwent anastomosis site change due to inadequate perfusion had a 0% leak rate. CONCLUSIONS: ICGFA as a method to evaluate intraoperative blood perfusion showed a trend toward reducing the incidence of anastomotic leak in colorectal surgery.
RESUMO
INTRODUCTION AND AIM: Anastomosis leak occurs in 1-19% of colorrectal surgeries. Our objective was to present the first Mexican case series on colorrectal surgery using indocyanine green fluorescence angiography to evaluate perfusion prior to carrying out the anastomosis. MATERIALS AND METHODS: A retrospective, analytic, descriptive study was conducted. We studied the case records of consecutive patients that underwent colorrectal surgery with indocyanine green angiography performed by the same group of colorrectal surgeons. RESULTS: Twenty-one case records were reviewed. Eleven (52.3%) of the patients were women, mean patient age was 57 years (38-82), and mean body mass index was 25 kg/m2 (17-34). Fifteen (71.4%) patients were diagnosed with malignant disease. Indocyanine green angiography changed our therapeutic decision in three (14.2%) patients. Two colorrectal anastomoses (14.2%) were performed at fewer than 5 cm from the anal verge and 13 (61.9%) were performed at more than 5 cm from the anal verge. Three of the anastomoses were ileocolic (14.2%), two were coloanal (9.5%), and one was ileoanal (4.7%). There were six (28.5%) complications, no cases of anastomotic leak, and no complications associated with the use of indocyanine green. The mortality rate was 0%. CONCLUSION: The present case series is the first on colorrectal surgery conducted in Mexico using indocyanine green fluorescence angiography, with excellent results.
Assuntos
Cirurgia Colorretal , Verde de Indocianina , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Angiofluoresceinografia , Humanos , México , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
INTRODUCTION AND AIM: Anastomotic leak occurs in 1-19% of colorrectal surgeries. Our objective was to present the first Mexican case series on colorrectal surgery using indocyanine green fluorescence angiography to evaluate perfusion prior to carrying out the anastomosis. MATERIALS AND METHODS: A retrospective, analytic, descriptive study was conducted. We studied the case records of consecutive patients that underwent colorrectal surgery with indocyanine green angiography performed by the same group of colorrectal surgeons. RESULTS: Twenty-one case records were reviewed. Eleven (52.3%) of the patients were women, mean patient age was 57 years (38-82), and mean body mass index was 25 kg/m2 (17-34). Fifteen (71.4%) patients were diagnosed with malignant disease. Indocyanine green angiography changed our therapeutic decision in three (14.2%) patients. Two colorrectal anastomoses (14.2%) were performed at fewer than 5 cm from the anal verge and 13 (61.9%) were performed at more than 5 cm from the anal verge. Three of the anastomoses were ileocolic (14.2%), two were coloanal (9.5%), and one was ileoanal (4.7%). There were six (28.5%) complications, no cases of anastomotic leak, and no complications associated with the use of indocyanine green. The mortality rate was 0%. CONCLUSION: The present case series is the first on colorrectal surgery conducted in Mexico using indocyanine green fluorescence angiography, with excellent results.
RESUMO
Surfaces were prepared with polyelectrolyte derivatives of poly(styrene- alt-maleic anhydride) (PSMA) functionalized with amino acids of different hydropathy indices, with the aim of evaluating the effect of the chemical functionality of polyelectrolytes on SH-SY5Y neuroblastoma cell adhesion. Functionalizing PSMA derivatives with l-glutamine, l-methionine, and l-tyrosine yielded PSMA-Gln, PSMA-Met, and PSMA-Tyr polyelectrolytes, respectively. We first studied the adsorption behavior of PSMA functionalized with amino acids on silicon wafer surfaces modified with 3-aminopropyltriethoxysilane at pH 4.0 and 7.0 and at low and high ionic strengths. The highest rate of polyelectrolyte adsorption was at pH 4.0 and high ionic strength and was higher with the glutamine and tyrosine films. The advance contact angles (θA) of the polyelectrolyte surfaces showed a moderate effect of ionic strength and pH on polyelectrolyte film wettability, with PSMA-Tyr being slightly more hydrophobic. Atomic force microscopy images of the polyelectrolyte surfaces showed two types of morphology: the well-defined globular nanostructure of PSMA-Met and PSMA-Tyr and densely packed nanofibrous-like structure of PSMA-Gln. The highest level of ionic strength caused a slight decrease in the size of the nanostructure that formed the surface domains, which was reflected in the degree of surface roughness. Cell adhesion assays with the polyelectrolyte film showed that SH-SY5Y neuroblastoma cells cultured on PSMA-Met present a well-extended morphology characterized by a stellate shape, with five or more actin-rich thin processes, whereas SH-SY5Y cells that were seeded on PSMA-Gln and PSMA-Tyr have a round morphology, with fewer and shorter processes. These results indicate that it is possible to modulate the surface characteristics of polyelectrolyte films based on their chemical functionality and environmental parameters such as pH and ionic strength in order to evaluate their effect on cell adhesion. Thus, surfaces prepared from polyelectrolytes functionalized with amino acids are an attractive and simple platform for cell adhesion, which can be used in developing biomaterials with modulated surface properties.
Assuntos
Aminoácidos/química , Nanoestruturas/química , Polieletrólitos/química , Polímeros/química , Adesão Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Humanos , Concentração de Íons de Hidrogênio , Maleatos/química , Microscopia Eletrônica de Varredura , Nanoestruturas/ultraestrutura , Polímeros/farmacologia , Poliestirenos/química , Espectroscopia de Infravermelho com Transformada de Fourier , Propriedades de Superfície , MolhabilidadeRESUMO
This study aimed to evaluate the effects of dietary supplementation of ferulic acid (FA) on reproductive tract weight (RTW), ovarian activity and serum concentrations of some metabolites and thyroid hormones of pre-pubertal hairbreed ewe lambs during the natural anestrous season. Twenty Dorper x Pelibuey crossbred ewe lambs (initial body weightâ¯=â¯28.5⯱â¯0.5â¯kg and ageâ¯=â¯5.0â¯mo) were fed a basal diet and assigned to two treatments (nâ¯=â¯10) under randomized complete block design: FA supplementation to dosages of 0 (control) or 300â¯mg of FA/d animal-1. Females were treated with FA during 34â¯d and then slaughtered to evaluate RTW and ovary. Blood samples were collected at days 1 and 34 to determine serum concentrations of metabolites (i.e. glucose, cholesterol, triglycerides, urea and total protein) and thyroid hormones. Final weight, dry matter intake, and serum concentrations of metabolites (except glucose) and thyroid hormones were unaltered by FA. Compared to control, FA-fed ewe lambs had lower (Pâ¯=â¯0.05) serum glucose level but higher (Pâ¯≤â¯0.05) RTW, ovarian mass, number of larger follicles and corpus luteum (CL). While percentage of ewe lambs with small follicles and number of small follicles per female did not vary, percentage of ewe lambs with large follicles and CL increased (Pâ¯=â¯0.02) with FA. In conclusion, FA supplementation improves the reproductive tract development and ovarian activity of pre-pubertal hairbreed ewe lambs during the natural anestrous season. An improvement in functionality of the glucose-insulin system could be related with this benefic effect of FA.
Assuntos
Ácidos Cumáricos/farmacologia , Dieta/veterinária , Maturidade Sexual/efeitos dos fármacos , Ovinos/crescimento & desenvolvimento , Animais , Glicemia/efeitos dos fármacos , Feminino , Folículo Ovariano/efeitos dos fármacos , Distribuição Aleatória , Estações do AnoRESUMO
OBJECTIVES: Puerto Rico (PR), is the fifth highest jurisdiction of the United States of America (US) with respect to HIV prevalence and the leading in cervical cancer incidence. This cross-sectional study describes the prevalence and correlates of cervical HPV infection among a clinic-based sample of 302 women living with HIV/AIDS in PR. METHODS: Data collection included questionnaires, blood and cervical samples. Multivariable logistic regression models were used to estimate the magnitude of association (adjusted Prevalence odds ratio [aPOR]) between HPV cervical infection and other covariates. RESULTS: Mean age of participants was 40.3 years (± 10.3SD). The prevalence of HPV infection was 50.3%; 41.1% for low-risk types and 29.5% for high-risk types. Having ≥ 10 lifetime sexual partners (aPOR = 2.10, 95% CI:1.02-4.29), an abnormal Pap (aPOR = 3.58, 95% CI:1.93-6.62), active genital warts (aPOR = 3.45, 95% CI:1.60-7.42), and CD4 counts ≤ 200 (aPOR = 4.24, 95% CI: 1.67-10.78) were positively associated with any cervical HPV infection. Similar results were observed for HR HPV infection. CONCLUSIONS: A high burden of HPV co-infection exists among women living with HIV/AIDS in this population. Given the high incidence of HIV in PR and the higher risk of cervical cancer among women living with HIV/AIDS, HPV vaccination should be promoted in this population.
Assuntos
Colo do Útero/virologia , Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Hispânico ou Latino , Infecções por Papillomavirus/etnologia , Infecções por Papillomavirus/epidemiologia , Adulto , Coinfecção/virologia , Condiloma Acuminado/epidemiologia , Condiloma Acuminado/etiologia , Condiloma Acuminado/virologia , Efeitos Psicossociais da Doença , Estudos Transversais , DNA Viral , Feminino , Infecções por HIV/complicações , Infecções por HIV/virologia , Humanos , Modelos Logísticos , Razão de Chances , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Parceiros Sexuais , Inquéritos e Questionários , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/virologiaRESUMO
ANTECEDENTES: en salud la objeción de conciencia del profesional es posible reconocerla globalmente como la negativa individual y privada para el cumplimiento de un deber jurídico considerado injusto que afecta la conciencia moral de quien objeta. En Chile ha cobrado especial relevancia en la actual discusión sobre la despenalización del aborto en tres causales, emergiendo como uno de los temas centrales. OBJETIVO: el presente artículo describe las principales características observadas en el debate público desde los primeros intentos para restablecer el aborto terapéutico hasta el actual proyecto en tramitación que intenta regular la despenalización del aborto en tres causales. La información fue obtenida a partir de la búsqueda en los principales medios de comunicación, identificando los principales actores, las instituciones y el discurso predominante. RESULTADOS: se identificaron 251 piezas de prensa y 215 actores provenientes en mayor proporción de la Cámara de Diputados, de las Universidades y del Ejecutivo. En el discurso prevalece la referencia a la objeción de conciencia individual e institucional, surgiendo la polémica en torno a su legitimidad y posibles consecuencias. DISCUSIÓN: debe evaluarse con mayor profundidad el fundamento basado en el derecho constitucional a la libertad de conciencia considerando los límites establecidos en un Estado de Derecho democrático y las directrices éticas presentes en la relación clínica. Se plantea la necesidad de regular su ejercicio previendo que no se vulneren derechos fundamentales, en especial de quienes detentan un mayor grado de vulnerabilidad.
BACKGROUND: objection on grounds of conscience by health care professionals is generally recognized as a personal, private refusal to perform a legal duty deemed unjust and deleterious to the objector's moral conscience. Conscientious objection has become a central aspect of the debate on the proposed decriminalization of abortion on three grounds currently underway in Chile. METHODS: this article describes the main constituent elements of the associated public debate, covering from the early efforts to restore therapeutic pregnancy termination through to the draft decriminalization legislation now being discussed in Congress. All data comes from a review of leading media outlets; key participants, institutions and prevailing discourses are identified. RESULTS: the said review encompassed 251 media items and 215 key players affiliated mostly with the Chamber of Deputies, universities, and government. Themes prevailing in associated discourses reference conscientious objection by personal and institutional players, as well as the attendant controversy over its legitimacy and possible consequences. DISCUSSION: this article posits that the constitutional right to freedom of conscience should be scrutinized further with due regard to the limits existing in rule-of-law democracies and to the ethical standards governing doctor-patient relationships. The exercise of conscientious objection privilege needs to be regulated in order to prevent infringement of fundamental rights, especially those of particularly vulnerable segments of the population.
Assuntos
Humanos , Feminino , Gravidez , Pessoal de Saúde/psicologia , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/ética , Consciência , Meios de Comunicação de Massa/estatística & dados numéricos , Chile , Aborto Induzido/psicologiaRESUMO
Introducción: El síndrome de Cogan es una entidad poco frecuente, de origen autoinmune.Se caracteriza por queratitis intersticial no sifilítica asociada a síntomasaudiovestibulares similares al síndrome de Ménière. Los primeros síntomas ocularesincluyen enrojecimiento y fotofobia, a los que se puede agregar conjuntivitis o uveítis.Objetivo: Presentar un caso de síndrome de Cogan típico y describir las principalescaracterísticas de la entidad.Caso clínico: Varón, 32 años, sin antecedentes mórbidos. Consulta por cuadro de cuatrodías de evolución caracterizado por dolor ocular e inyección conjuntival. Diagnosticadoen un comienzo con sinusitis y conjuntivitis aguda y se maneja como tal. Alpersistir sintomatología se hospitaliza a la semana evidenciándose fiebre, inyecciónconjuntival bilateral y a los pocos días hipoacusia. Los exámenes de laboratorio destacanleucocitosis, trombocitosis, PCR, VHS e IgA elevadas. Autoanticuerpos y estudiopara VIH y VHC negativos, TAC de cerebro y cavidades paranasales normales. Evaluadopor oftalmología y otorrinolaringología, describiéndose hiperemia conjuntival yquemosis, e hipoacusia neurosensorial de probable origen autoinmune, respectivamente.Evaluado por reumatología, se plantea síndrome de Cogan típico. Se indicaprednisona 1 mg/kg/día, metilprednisolona por dos días y metotrexato semanal, conbuena respuesta. Evoluciona con disminución de cefalea, de compromiso ocular ehipoacusia, afebril, dándose de alta con prednisona y metotrexato. Control al mesdel alta, paciente asintomático, se mantiene tratamiento. Control en oftalmología20 días después, objetivándose leve edema corneal, por lo que se indica tratamientotópico...
Background: Cogans syndrome is a rare entity of autoimmune origin. It is characterizedby non-syphilitic interstitial keratitis associated with audiovestibular symptomssimilar to Menieres syndrome. Early symptoms include eye redness and photophobia,which can be added conjunctivitis or uveitis.Objective: To report a case of typical Cogans syndrome and describe the main featuresof the entity.Case report: Male, 32, no morbid history. Consults for story of 4 days of evolutioncharacterized by eye pain and conjunctival injection. Initially diagnosed with sinusitisand acute conjunctivitis and handled as such. By persisting symptoms is hospitalizeda week later demonstrating fever, bilateral conjunctival injection and in a few dayshearing loss. Laboratory tests include leukocytosis, thrombocytosis, and elevatedPCR, VHS and IgA. Autoantibodies, HIV and HCV study were negative, brain and sinusesCT normal. Reviewed by ophthalmology and otolaryngology, describing conjunctivalhyperemia and chemosis, and sensorineural hearing loss of probable autoimmuneorigin, respectively. Evaluated by rheumatology, typical Cogans syndrome arises. It isindicated prednisone 1 mg/kg/day, methylprednisolone for 2 days and weekly methotrexate,with good response. Evolves with decreased in headache, eye commitmentand hearing loss, afebrile, was discharged with prednisone and methotrexate. Controla month after discharge, asymptomatic, treatment is maintained. Control 20 days laterin ophthalmology, objectifying mild corneal edema, so topical treatment indicated...
Assuntos
Humanos , Masculino , Adulto , Síndrome de Cogan/diagnóstico , Síndrome de Cogan/tratamento farmacológico , Glucocorticoides/uso terapêutico , Metotrexato/uso terapêutico , Perda Auditiva/etiologia , Prednisona/uso terapêutico , Ceratite/etiologia , Síndrome de Cogan/complicaçõesRESUMO
A trial was conducted to evaluate the effects of adding an exogenous -amylase--glucanase complex produced from Bacillus amyloliquefaciens on the growth performance, carcass yield, and relative AME bioequivalence in broilers fed corn-soy diets from 1 to 40 d of age. One thousand seven hundred and fifty one-day-old Cobb x Cobb 500 slow-feathering male broilers were randomly allotted to seven treatments with 10 replicates of 25 birds each as follows: control diet (C); C diet with reduction of 60 (C-60), 90 (C-90), or 120 (C-120) kcal AME/kg; C diet with reduction of 120 kcal AME/kg and supplemented with 200 (C-120-200), 300 (C-120-300), or 400 (C-120-400) mg of the enzyme complex/kg. Each g of the enzyme complex corresponded to 200 kilo-Novo -amylase and 350 fungal -glucanase units. On d 40, eight birds were randomly taken from each pen and processed to evaluate carcass and commercial cuts yields. Percent mortality was not affected by the treatments (p > 0.05). Live performance, as indicated by BW gain (BWG) linearly decreased (p 0.05) and FCR linearly increased with the reduction in AME. Birds fed diets supplemented with the enzyme complex showed weekly improvements in BWG and FCR. There were no effects of the treatments on the yield of the carcass or of commercial cuts; however, abdominal fat was significantly lower (p 0.0343) in birds fed the C-120-400 compared to the C-120 feeding program (1.67% vs. 1.90%); all other treatments were intermediate. Average AME equivalence of the enzyme complex varied weekly. Estimations for the entire period were 40, 46, and 56 kcal for BWG and 58, 76, and 99 kcal AME/kg for FCR (p 0.001) for the diets containing 200, 300, and 400 mg enzyme complex/kg, respectively.