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Made available in DSpace on 2022-04-29T08:38:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Introduction: To investigate the influence of a training of mobility, gait speed and postural balance of pelvic floor muscles (PFM). Methods: A single-arm clinical trial study was approved and registered at the Brazilian Clinical Trials Registry (RBR-4rxhd4). Eighteen women over the age of 60 with pelvic floor dysfunction complaints were subjected to 10 sessions of functional electrical stimulation and digital palpation of PFM. Mobility and gait speed were evaluated by the Timed up and Go and the 10-m walk tests respectively. Standing balance was evaluated using a force plate. Results: No significant differences were found in mobility, gait speed, and standing balance. PFM contraction worsened mobility, gait speed, and standing balance performance. Conclusions: The training protocol enhanced PFM strength and endurance, but the improved ability to recruit PFM did not positively affect balance, mobility, and gait speed. Human Development and Technologies Program Institute of Biosciences São Paulo State University (UNESP) Department of Tocogynecology Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy Faculty of Philosophy and Sciences São Paulo State University (UNESP) Human Development and Technologies Program Institute of Biosciences São Paulo State University (UNESP) Department of Tocogynecology Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy Faculty of Philosophy and Sciences São Paulo State University (UNESP)

BackgroundIn patients with stroke, current guidelines recommend non-invasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols.MethodsFrom April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT, CTA and CTP and were treated accordingly. Hypoperfusion areas defined by time-to-maximum of the tissue residue function (Tmax) >6 s, congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated non-contrast CT and CTA to identify intracranial VO (CTA-VO).ResultsOf the 338 patients included in the analysis, 157 (46.5%) presented with CTP-VO (median Tmax >6s: 73 (29–127) mL). CTA-VO was identified in 83 (24.5%) of the cases. Overall CTA-VO sensitivity for the detection of CTP-VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with increased CTA-VO detection (OR 1.03; 95% CI 1.02 to 1.04). EVT was performed in 103 patients (30.5%; Tmax >6s: 102 (63–160) mL), representing 65.6% of all CTP-VO. Overall CTA-VO sensitivity for the detection of EVT-VO was 69.9% and specificity was 95.3%. Among patients who received EVT, the rate of false negative CTA-VO was 30.1% (Tmax >6s: 69 (46–99.5) mL).ConclusionSystematically including CTP in acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.

Introduction Accumulation of polyglutamine (polyQ) ataxin-3 (ATXN3) contributes to the pathobiology of spinocerebellar ataxia type 3 (SCA3). Recently, we showed that polyQ ATXN3 is elevated in the plasma and cerebrospinal fluid (CSF) of SCA3 patients, and has the potential to serve as a biological marker for this disease [1]. Based on these findings, we investigated whether polyQ ATXN3 can also be detected in urine samples from SCA3 patients. Methods We analyzed urine samples from 30 SCA3 subjects (including one pre-symptomatic subject), 35 subjects with other forms of ataxia, and 37 healthy controls. To quantify polyQ ATXN3 protein levels, we used our previously developed immunoassay. Results PolyQ ATXN3 can be detected in the urine of SCA3 patients, but not in urine samples from healthy controls or other forms of ataxia. There was a significant statistical association between polyQ ATXN3 levels in urine samples and those in plasma. Further, the levels of polyQ ATXN3 urine associated with an earlier age of SCA3 disease onset. Conclusion As clinical trials for SCA3 advance, urine polyQ ATXN3 protein has potential to be a useful, non-invasive and inexpensive biomarker for SCA3.

Introduction: In black Africa, connectivites have been for a long time a source of diagnostic erraticity because of their clinical polymorphism. This study aims to determine the therapeutic itinerary of patients followed for connectivitis in the Internal Medicine Department of the CNHU HKM of Cotonou. Methodology: This is a cross-sectional study that included patients followed for connectivitis in the HKM-Cotonou Internal Medicine Department from January 2010 to October 2018. Results: Out of 3600 patients hospitalized in the study period, 21 had connectivitis, i.e. a hospital frequency of 0.58%. Of the 21 patients collected, 18 met the inclusion criteria. The mean age was 40 (±11) years old and the youngest was of 21 and the oldest 58. The sex ratio was 17.9. The “Fon” ethnic group was the most represented (33.3%) and 15 (83.3%) subjects were Christians. Systemic lupus erythematosus was the most frequent connectivitis (55.6%). The average time of consultation was 38 months. Witchcraft was the most incriminating cause (78%). Ten (55.5%) patients had resorted to self-medication as their first choice of treatment, 5 (27.8%) to traditional medicine treatment and 3 (16.7%) to prayer for healing. The reasons for the first choice of treatment were satisfaction (44.4%), financial problems (27.8%), trivialization of the disease (16.7%), and advice from family and friends (11.1%). The consultation at the CNHU followed a referral from a first contact health structure (61%) or an initiative of the patient (27.8%). Conclusion: Connectivitis is a source of diagnostic error in our context. Awareness must be raised among patients for an early consultation at the first symptoms.

The purpose of this article is to understand the actions and processes of change made in the logistics policy of a funeral home operating in Northeast Brazil to cope with the period of the COVID-19 pandemic. The paper addresses an exploratory case study with a qualitative analytical approach, which used a semi-structured interview script to collect data from the operations manager of the company in question, videoconferenced in July 2020. The survey was designed in four stages: (1) construction of theoretical subsidies; (2) interview with the operations manager; (3) return to the interviewee to consolidate the collected data; (4) analysis of the main changes occurring in the organisation’s logistics process during the pandemic. The results of the analysis helped conclude that the context of the public health crisis generated actions in and a need to re-adapt the firm’s logistics policy for transport, procurement and inventory, in order to ensure continuity of the funeral services rendered, without detriment to the consumers of the funeral plans and new clients.

Con el objetivo de conocer las características clínicas y epidemiológicas de niños con COVID-19, se evaluaron las historias clínicas de pacientes atendidos de manera ambulatoria y en hospitalización del Instituto Nacional de Salud del Niño San Borja de marzo a mayo de 2020. Se registraron 33 pacientes, 57,6% fueron varones con mediana de edad de 4,8 años (rango: 2 meses - 17 años). El 81,8% tuvo contacto epidemiológico y la mediana del periodo de incubación fue siete días. El 60,6% tuvieron enfermedades concomitantes; el 93,9% presentó síntomas, los más comunes fueron fiebre y tos. El hemograma y los reactantes de fase aguda fueron normales en la mayoría de los casos. La radiografía de tórax fue anormal en 11/16 pacientes. El manejo fue de soporte, dos pacientes requirieron oxígeno suplementario. Un paciente falleció por complicaciones asociadas a una tumoración cerebral en fase terminal. Se reporta las caracteristicas clinicas y epidemiologicas en niños con COVID-19 durante los primeros meses de la pandemia en Perú.

No treatment for frontotemporal dementia (FTD), the second most common type of early-onset dementia, is available, but therapeutics are being investigated to target the 2 main proteins associated with FTD pathological subtypes: TDP-43 (FTLD-TDP) and tau (FTLD-tau). Testing potential therapies in clinical trials is hampered by our inability to distinguish between patients with FTLD-TDP and FTLD-tau. Therefore, we evaluated truncated stathmin-2 (STMN2) as a proxy of TDP-43 pathology, given the reports that TDP-43 dysfunction causes truncated STMN2 accumulation. Truncated STMN2 accumulated in human induced pluripotent stem cell-derived neurons depleted of TDP-43, but not in those with pathogenic TARDBP mutations in the absence of TDP-43 aggregation or loss of nuclear protein. In RNA-Seq analyses of human brain samples from the NYGC ALS cohort, truncated STMN2 RNA was confined to tissues and disease subtypes marked by TDP-43 inclusions. Last, we validated that truncated STMN2 RNA was elevated in the frontal cortex of a cohort of patients with FTLD-TDP but not in controls or patients with progressive supranuclear palsy, a type of FTLD-tau. Further, in patients with FTLD-TDP, we observed significant associations of truncated STMN2 RNA with phosphorylated TDP-43 levels and an earlier age of disease onset. Overall, our data uncovered truncated STMN2 as a marker for TDP-43 dysfunction in FTD.

Aim The purpose of this study was to review genitourinary (GU) and gastrointestinal (GI) toxicity associated with high-dose radiotherapy (RT) delivered with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) or volumetric arc therapy (VMAT) following radical prostatectomy (RP). Background RP is a therapeutic option for the management of prostate cancer (PrCa). When assessing postoperative RT techniques for PrCa, the published literature focuses on patients treated with 2-dimensional conventional methods without reflecting the implementation of 3D-CRT, IMRT, or VMAT. Materials and methods A total of 83 patients were included in this analysis; 30 patients received 3D-CRT, and 53 patients received IMRT/VMAT. Acute and late symptoms of the GU and lower GI tract were retrospectively graded according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer radiation toxicity grading systems. The relapse failure-free rate and overall survival were also evaluated. Results The rate of acute GU toxicity was 9.4% vs. 13.3% for the IMRT/VMAT and 3D-CRT groups (p = 0.583). The 5-year actuarial rates of late GI toxicity for IMRT/VMAT and 3D-CRT treatments were 1.9% and 6.7%, respectively. The rate of late GU toxicity for the IMRT/VMAT and 3D-CRT treatment groups was 7.5% and 16.6%, respectively (p = 0.199). We found no association between acute or late toxicity and the RT technique in univariate and multivariate analyses. Conclusion Postprostatectomy IMRT/VMAT and 3D-CRT achieved similar morbidity and cancer control outcomes. The clinical benefit of highly conformal techniques in this setting is unclear although formal analysis is needed.

AIM: Describe characteristics and outcomes of three patients treated with pelvic radiation therapy after kidney transplant. BACKGROUND: The incidence of pelvic cancers in kidney transplant (KT) recipients is rising. Currently it is the leading cause of death. Moreover, treatment is challenging because anatomical variants, comorbidities, and associated treatments, which raises the concern of using radiotherapy (RT). RT has been discouraged due to the increased risk of urethral/ureteral stricture and KT dysfunction. MATERIALS AND METHODS: We reviewed the electronic health records and digital planning system of patients treated with pelvic RT between December 2013 and December 2018 to identify patients with previous KT. CASES DESCRIPTION: We describe three successful cases of KT patients in which modern techniques allowed full standard RT for pelvic malignances (2 prostate and 1 vaginal cancer) with or without elective pelvic nodal RT, without allograft toxicity at short and long follow-up (up to 60 months). CONCLUSION: When needed, RT modern techniques remain a valid option with excellent oncologic results and acceptable toxicity. Physicians should give special considerations to accomplish all OAR dose constraints in the patient’s specific setting. Recent publications recommend KT mean dose

Aim The aim of this study was to assess treatment modalities, treatment response, toxicity profile, disease progression and outcomes in 14 patients with a confirmed diagnosis of primary cutaneous T-cell lymphoma (PCTCL) treated with total skin electron beam therapy (TSEBT). Background Primary cutaneous lymphomas (PCLs) are extranodal non-Hodgkin lymphomas originating in the skin without evidence of extracutaneous disease at diagnosis. Despite advances in systemic and local therapy options, the management of advanced stages remains mostly palliative. Materials and Methods This is a retrospective study of patients with PCTCL, diagnosed and treated in a reference center in Mexico City, analyzing treatment modalities, response to treatment, long-term outcome, and mortality. Results Eight males (57%) and 6 (43%) females were identified. Most patients were stage IVA (n = 5, 36%) followed by stage IB and IIB (28.5% and 21.4%, respectively). Eleven patients received the low-dose RT scheme (12 Gy), 1 patient, the intermediate-dose RT scheme (24 Gy), and 2 patients, the conventional-dose RT scheme (36 Gy). Mean follow-up time was 4.6 years. At first follow-up examination, 6–8 weeks after radiotherapy, the overall response rate (ORR) for the cohort was 85%. The median PFS for the whole cohort was 6 months. Conclusion This study reinforces the role of TSEBT when compared with other treatment modalities and novel agents. Low-dose TSEBT is now widely used because of the opportunity for retreatment.

La Asociación española de psiquiatría del niño y del adolescente (AEPNyA) se fundó en Barcelona en el año 1950 como una sociedad médica que tenía como objetivo el estudio de los trastornos psiquiátricos de niños y adolescentes. Su desarrollo corre en paralelo con la de la psiquiatría infantil europea. Los fundadores fueron hombres y mujeres ilustrados, comprometidos con su tiempo y con la salud mental, la educación y los derechos de la infancia. Este artículo aborda los hitos principales de la historia de AEPNyA y distingue tres periodos: los comienzos, la fase de afianzamiento y el tiempo de la madurez. Los autores desean rendir un homenaje a los miembros fundadores y a todos aquellos que han contribuido al desarrollo de la Asociación.

The American Diabetes Association recommends that patients with type II diabetes and atherosclerotic cardiovascular disease be prescribed an SGLT-2 inhibitor or GLP-1 agonist for cardioprotective benefit. This project assessed the use of these medications in this patient population in a rural clinic by measuring prescribing rates of SGLT-2/GLP-1 therapy before and after pharmacist interventions. Of the 60 patients identified at baseline, 39.39% (13/33) managed by a pharmacist were prescribed SGLT-2/GLP-1 therapy compared to the 14.81% (4/27) who had not seen a pharmacist (p = 0.025). Of the 43 patients that were not on SGLT-2/GLP-1 therapy at baseline, 13 were lost to follow-up and 13 had contraindications. For the 17 remaining patients, pharmacists recommended initiating SGLT-2/GLP-1 therapy and were able to successfully initiate therapy for 9 patients (52.94%). Pharmacist interventions improved the prescription rates from a baseline of 36.17% (17/47) to 55.3% (26/47) (p = 0.002), with SGLT-2/GLP-1 therapy contraindicated in 27.66% (13/47) of patients. This suggests that patients managed by a pharmacist have medication regimens that were optimized at a greater rate and pharmacists can have a positive impact on the appropriate medication usage in this population.

Made available in DSpace on 2022-04-29T08:32:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-10-01 Introduction and hypothesis: The quantification of urinary incontinence (UI) is widely used in clinical practice to guide the prognosis and treatment, and the pad test is an inexpensive, quick, and easy tool to assess UI that has been used in studies in the literature. Another way to evaluate UI is the subjective urine leakage amount, but no studies have tried to correlate it with the 20-min pad test. Therefore, this study aimed to assess the correlation of the 20-min pad test with the subjective urine leakage amount and compare it with the pelvic floor function. Methods: This is a cross-sectional study with a sample size of 72 participants. It evaluated pelvic floor muscle strength as well as the duration of symptoms and pad weight. It used mean, standard deviation, median, and 95% confidence interval. In addition, ANOVA, Kruskal-Wallis, and Spearman’s correlation coefficient were used. The significance level was fixed at 5% (significant if P < 0.05). Results: Only age was different between leakage volumes; participants who report greater UI volume were older than the participants who leaked less urine. There were no differences related to the duration of symptoms between different UI volumes and pad weights according to the subjective volume reported. Spearman’s coefficient between pad weight and subjective volume of urine leakage was rs = 0.558 (P ≤ 0.0001), demonstrating a moderate positive correlation. Conclusions: There was a moderate correlation between the UI volume reported and the 20-min pad test. Additionally, no differences related to pelvic floor function were detected. Department of Tocogynecology Botucatu Medical School São Paulo State University (UNESP) Department of Gynecology Federal University of São Paulo (UNIFESP) Department of Physical Education Institute of Biosciences of Rio Claro São Paulo State University (UNESP), Rio Claro Department of Tocogynecology Botucatu Medical School São Paulo State University (UNESP) Department of Physical Education Institute of Biosciences of Rio Claro São Paulo State University (UNESP), Rio Claro

AIM: To compare the dose to organs at risk with free breathing (FB) or voluntary breath-hold (VBH) during radiotherapy of patients with left sided breast cancer. BACKGROUND: Radiotherapy reduces the risk of breast-cancer-specific mortality but the effects on other organs increase non-cancer-specific mortality. Radiation exposure to the heart, in particular in patients with left sided breast cancer, can be reduced by breath hold methods that increase the distance between the heart and the radiation field. MATERIALS AND METHODS: Three-dimensional conformal radiotherapy (3D-CRT) dose plans for the left breast and organs at risk including the heart, left anterior descending coronary artery (LAD) and ipsilateral lung were compared with FB and VBH in ten patients with left sided breast cancer. RESULTS: The mean doses to the heart and LAD were reduced by 50.4 % (p

Introduction: Tuberculosis remains a major public health problem. The damage to the central nervous system is severe. We reported here two cases. Clinical Case 1: A 37-year-old female patient, naively Human Immunodeficiency Virus1 (HIV1)-positive with antiretroviral (ARV) treatment, hospitalized in the Internal Medicine department for altered consciousness in a febrile context. The clinical examination at admission noted a meningeal syndrome. Cytological analysis of the cerebrospinal fluid (CSF) revealed lymphocytic meningitis with 98% lymphocytes for 3634 leukocytes. CSF polymerase chain reaction (PCR) detected Mycobacterium tuberculosis DNA. She was put on anti-tuberculosis treatment. The immediate course was favourable, but a secondary worsening of the clinical picture was the cause of his death. Clinical Case 2: A 34-year-old male patient, naively HIV1-positive with ARV treatment. He is hospitalized in the Multi-Purpose Anaesthesia and Resuscitation Department of the CNHU HKM for altered consciousness in a feverish context. The clinical examination noted a meningeal syndrome. The cytological analysis of the CSF noted 184 leukocytes for 99% lymphocytes. The CSF PCR identified the DNA of Mycobacterium tuberculosis. He was put on anti-tuberculosis treatment. The evolution was marked by his death. Conclusion: The neuromeningeal localization of tuberculosis is a poor prognosis. Co-infection with HIV remains a potential deadly combination.

Cytomegalovirus (CMV) infection is an infection that most often affects immunocompromised individuals with a seroprevalence of more than 80%. CMV co-infection is associated with increased mortality in HIV-infected individuals despite antiretroviral treatment. It has the potential for hematogenous dissemination to all the organs, but only becomes symptomatic when the viral load is high. This is especially possible when the human immune system is well controlled so that the individual infected with CMV generally remains asymptomatic, and possibly for a long period. Once the immune system fails, CMV infection becomes symptomatic. Diagnosis is not easy and is often done postmortem in developing countries with limited technical facilities. We report here two cases diagnosed at the Internal Medicine Service of the CNHU-HKM in Cotonou. The patients were infected with HIV and had a long term fever. The diagnoses were made on the basis of CMV serology. The first diagnosis was post-mortem, and the second patient died 48 hours after the start of the treatment.

Background Patients with diffuse parenchymal lung disease (DPLD) have the poorest survival rates both before and after lung transplantation (LT). Early mortality among LT patients as a result of DLPD is estimated at 10% to 20%. The aim of the study was to assess intrahospital mortality after LT procedures for DLPD and to identify factors in the recipient, donor, intra- and postoperative periods that might improve early outcomes. Methods A retrospective, observational, cohort, single-hospital study was conducted. Data from 67 patients with LT patients owing to DPLD were recorded between October 2008 to June 2017 in Madrid, Spain. Results Out of 67 LT recipients with DPLD, 51 had idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP), 6 nonspecific interstitial pneumonia (NSIP), and 10 other DPLD. Intrahospital mortality took place in 13.4% of patients, with a median survival time of 34 days (interquartile range [IQR], 27.50–66). In the preoperative period, there were no differences in the recipients' demographic and hemodynamic characteristics, respiratory function, or time spent in the waiting list, except higher doses of systemic steroids in nonsurvivors (prednisone 15 vs 10 mg, P = .046). No differences were reported in the donors' characteristics (age, mechanical ventilation hours, PaO2/FiO2). In the intraoperative and postoperative periods, we found differences statistically significant in longer cold ischemia time and development of primary graft dysfunction (PGD) grade 3 in the nonsurvivor group. Conclusions The mortality rate in our series was 13.4%, and the main risk factors for intrahospital mortality were longer cold ischemia time and greater incidence of PGD grade 3.

Hospitalized patients with COVID-19 show increased serum concentrations of neurofilament light chain that correlate with worse clinical outcomes., Brain damage marker in COVID-19 SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), causes neurological manifestations in a substantial proportion of patients. Determining the extent of neuronal injury is essential to better understand disease pathophysiology and to evaluate potential therapies. Prudencio et al. analyzed serum from 142 patients hospitalized with COVID-19 and showed that the expression of the neurofilament light protein (NFL), a marker of neuroaxonal injury, was elevated compared to healthy controls. In addition, serum NFL expression correlated with disease severity and tended to be reduced in subjects treated with remdesivir. The results suggest that serum NFL analysis should be incorporated when evaluating therapeutic trials for COVID-19., Brain imaging studies of patients with COVID-19 show evidence of macro- and microhemorrhagic lesions, multifocal white matter hyperintensities, and lesions consistent with posterior reversible leukoencephalopathy. Imaging studies, however, are subject to selection bias, and prospective studies are challenging to scale. Here, we evaluated whether serum neurofilament light chain (NFL), a neuroaxonal injury marker, could predict the extent of neuronal damage in a cohort of 142 hospitalized patients with COVID-19. NFL was elevated in the serum of patients with COVID-19 compared to healthy controls, including those without overt neurological manifestations. Higher NFL serum concentrations were associated with worse clinical outcomes. In 100 hospitalized patients with COVID-19 treated with remdesivir, a trend toward lower NFL serum concentrations was observed. These data suggest that patients with COVID-19 may experience neuroaxonal injury and may be at risk for long-term neurological sequelae. Neuroaxonal injury should be considered as an outcome in acute pharmacotherapeutic trials for COVID-19.

Introduction: Sexually transmitted infections (STI) have consequences that negatively affect the population's quality of life and health. Young adults are susceptible to low access to preventive measures and a greater behavior risk. The objective was to evaluate and compare STI' Knowledge in university students from health courses, a public institution, and a private institution of higher education in Brazil. Methods: a cross-sectional study conducted in 2019 in Brazil at the FEMA School of Medicine in Assis-SP and the University of the State of São Paulo (UNESP) in Marília in the courses of Physiotherapy, Speech Therapy, and Occupational Therapy, in undergraduate students, over 18 years of age, through a self-applied questionnaire translated and adapted to the Brazilian Portuguese from the STD-KQ – Transmitted Disease Knowledge Questionnaire.Results: 462/700 students participated (66.66%) 18-46 years of age (mean 21.46 years, +/- 3.61), 99 men and 363 women. In the private institution, 262/340 (77.06%), and in the public institution, 200/360 (55.55%). The mean age was 22.21 (+/- 4.21) years among men and 21.25 (+/- 3.41) years among women. The mean percentage of the 28 test questions' correct answers was 52.07%. The average number of correct responses per student was 17.49 out of 28 possible, 62% (+/-4.97). The distribution between the groups was normal. In the multiple linear regression model for the percentage of correct answers, adjusted for the confounding variables, the intercept was 55.2. The students of the private institution answered 19,655 questions more than the public one (P

INTRODUCTION Internal hernias caused by broad ligament defects are an infrequent cause of bowel obstruction. These defects may be congenital or acquired mainly by gynecological antecedents. Small bowel is the most common affected and the diagnosis is difficult due to nonspecific symptoms and absences of characteristic radiological signs. MATERIAL AND METHODS We report the cases of three women aged from 43 to 56 years old, who came to the emergency with abdominal pain, vomiting and bloating of hours duration. One patient has a history of laparoscopic appendectomy, the rest of them with no surgical history. In all of the cases, x-rays showed dilatation of small bowel loops and air-fluid levels and the abdominal TC revealed a generalized distention of bowel loops with transition point in the terminal ileum with no identifiable cause compatible with small bowel obstruction. RESULTS We decided to perform an urgent surgery with an exploratory laparotomy in one case and the rest by laparoscopic approach, finding an internal hernia occasioned by incarceration of small bowel through a broad ligament defect. In all cases, the hernia content was liberated without evidence of ischemia with no need for intestinal resection, and the defect was closed. All patients had a favourable postoperative course without complications. DISCUSSION Broad ligament defects are a rare cause of internal hernias. These are difficult to diagnose clinically as well as radiologically for an absence of characteristic signs. A high level of clinical suspicion allows early diagnosis and the treatment should be performed as soon as possible to reduce the chances of intestinal necrosis.

INTRODUCTION Perforated gastroduodenal ulcer represents a common surgical emergency and is associated with a morbimortality close to 40-50%. HP infection, tobacco and alcohol and some socioeconomic aspects represent the most commonly described risk factors. MATERIAL AND METHODS A descriptive and retrospective study was performed between 2018-2020. A total of 40 patients with a history of gastroduodenal perforation were selected. Data corresponding to: sex, age, ulcer location, treatment, tobacco and alcohol consumption, HP infection (presence or not of eradicating treatment) and other potential risk factors were collected and analysed. The aim of the study is to assess how new lifestyle changes, the evolution and improvement in the management of PH infection and the general decrease in smoking have modified the classic profile of patients with gastroduodenal perforations. RESULTS Gastroduodenal perforations predominated in the fifth/sixth decade of life (mean age 59 years). Although a predominance in men is described in the literature, in our sample no significant sex differences were found (1:1 ratio). The most frequent location was duodenal and the reference surgical treatment was primary suture + epipoplasty. Only one third of the patients had a known history of peptic ulcer. CONCLUSIONS Gastroduodenal perforations are a major problem for the on-call surgeon. It is essential to know the current risk factors and their potential relationship with morbimortality and postoperative evolution in order to guarantee the optimal management of these patients.

INTRODUCTION The results obtained from the establishment of a multimodal rehabilitation program in elective colorectal surgery by a multidisciplinary team at our center are presented. Protocols are carried out to achieve optimization of perioperative care and the analysis of the rates of complications and morbidity and mortality. MATERIAL AND METHODS Through a retrospective study, a control group of patients who underwent elective colorectal surgery prior to the implantation of the rehabilitation program, included during a period from May and October 2018, with a total of 68 patients, were compared with the group of optimized patients, who were operated between December 2018 and June 2019, with a total of 80 patients. RESULTS The readmission rate 30 days after discharge between the two groups is analyzed, showing a decrease in the multimodal rehabilitation group, with a readmission rate of 5.9%, compared to the control group, which was 8.8%. A decrease was observed in both surgical complications (35.3%) and medical complications (22.1%) in the multimodal rehabilitation group compared to the control group. A decrease in the mortality rate is observed in the multimodal rehabilitation group, being 1.5% with respect to the control group, which was 2.9%. CONCLUSIONS The multimodal rehabilitation system is a feasible and safe method that requires the implementation of protocols that must be carried out by a multidisciplinary team, and that presents satisfactory results with improved morbidity and mortality.

INTRODUCTION Anastomosis dehiscence is one of the most serious complications in colorectal surgery, influenced by many factors, especially the anastomotic ischemia. Intraoperative Indocyanine Green (ICG) Fluorescence Angiography allows to assess the vascular perfusion of the ends anastomotic and anastomosis thus seeking to decrease the number of sutures failure. MATERIAL AND METHODS A retrospective and descriptive study of patients undergoing colorectal surgery in our centre using intraoperative indocyanine green fluorescence angiography. We analysed a total of 45 patients, including 40 cases of colorectal cancer and 5 cases with a benign pathology (4 diverticular disease and 1 Crohńs disease). RESULTS After administration of ICG, the site of resection was changed in 6 cases due to bad perfusion findings. 5 patients presented anastomotic leakage during the postoperative period. The medium hospital stay length was 10 days, increasing to 29,2 days medium stay in patients with postoperative dehiscence respect to 7’72 days in patients without postoperative complications. No deaths or adverse reactions associated with the ICG were detected. CONCLUSIONS The technique with ICG seems to be a promising tool for the colorectal surgery as a predictor of suture failure. It allows a reduction of hospital stay length and postoperative morbidity and mortality from this cause and it can serve as a good help for making decisions in the course of a surgery.

OBJECTIVE: We assessed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients with coronavirus disease 2019 (COVID-19) compared with that in a matched cohort with similar cardiovascular risk factors and the effects of DVT and PE on the hospital course. METHODS: We performed a retrospective review of prospectively collected data from COVID-19 patients who had been hospitalized from March 11, 2020 to September 4, 2020. The patients were randomly matched in a 1:1 ratio by age, sex, hospital of admission, smoking history, diabetes mellitus, and coronary artery disease with a cohort of patients without COVID-19. The primary endpoint was the incidence of DVT/PE and the odds of developing DVT/PE using a conditional logistic regression model. The secondary endpoint was the hospitalization outcomes for COVID-19 patients with and without DVT/PE, including mortality, intensive care unit (ICU) admission, ICU stay, and length of hospitalization (LOH). Multivariable regression analysis was performed to identify the variables associated with mortality, ICU admission, discharge disposition, ICU duration, and LOH. RESULTS: A total of 13,310 patients had tested positive for COVID-19, 915 of whom (6.9%) had been hospitalized across our multisite health care system. The mean age of the hospitalized patients was 60.8 ± 17.0 years, and 396 (43.3%) were women. Of the 915 patients, 82 (9.0%) had had a diagnosis of DVT/PE confirmed by ultrasound examination of the extremities and/or computed tomography angiography of the chest. The odds of presenting with DVT/PE in the setting of COVID-19 infection was greater than that without COVID-19 infection (0.6% [5 of 915] vs 9.0% [82 of 915]; odds ratio [OR], 18; 95% confidence interval [CI], 8.0-51.2; P < .001). The vascular risk factors were not different between the COVID-19 patients with and without DVT/PE. Mortality (P = .02), the need for ICU stay (P < .001), duration of ICU stay (P < .001), and LOH (P < .001) were greater in the DVT/PE cohort than in the cohort without DVT/PE. On multivariable logistic regression analysis, the hemoglobin (OR, 0.71; 95% CI, 0.46-0.95; P = .04) and D-dimer (OR, 1.0; 95% CI, 0.33-1.56; P = .03) levels were associated with higher mortality. Higher activated partial thromboplastin times (OR, 1.1; 95% CI, 1.00-1.12; P = .03) and higher interleukin-6 (IL-6) levels (OR, 1.0; 95% CI, 1.01-1.07; P = .05) were associated with a greater risk of ICU admission. IL-6 (OR, 1.0; 95% CI, 1.00-1.02; P = .05) was associated with a greater risk of rehabilitation placement after discharge. On multivariable gamma regression analysis, hemoglobin (coefficient, -3.0; 95% CI, 0.03-0.08; P = .005) was associated with a prolonged ICU stay, and the activated partial thromboplastin time (coefficient, 2.0; 95% CI, 0.003-0.006; P = .05), international normalized ratio (coefficient, -3.2; 95% CI, 0.06-0.19; P = .002) and IL-6 (coefficient, 2.4; 95% CI, 0.0011-0.0027; P = .02) were associated with a prolonged LOH. CONCLUSIONS: A significantly greater incidence of DVT/PE occurred in hospitalized COVID-19-positive patients compared with a non-COVID-19 cohort matched for cardiovascular risk factors. Patients affected by DVT/PE were more likely to experience greater mortality, to require ICU admission, and experience prolonged ICU stays and LOH compared with COVID-19-positive patients without DVT/PE. Advancements in DVT/PE prevention are needed for patients hospitalized for COVID-19 infection.

Background Obesity is a metabolic chronic disease with important associated morbidities and mortality. Bariatric surgery is the most effective treatment for maintaining long-term weight loss in severe obesity and, consequently, for decreasing obesity-related complications, including chronic inflammation. Aim To explore changes in components of the inflammasome machinery after bariatric surgery and their relation with clinical/biochemical parameters at baseline and 6 months after bariatric surgery. Patients and methods Twenty-two patients with morbid-obesity that underwent bariatric surgery (sleeve gastrectomy and Roux-en-Y gastric bypass) were included. Epidemiological/clinical/anthropometric/biochemical evaluation was performed at baseline and 6 months after bariatric surgery. Inflammasome components and inflammatory-associated factors [nucleotide-binding oligomerization domain-like receptors (NLRs), inflammasome activation components, cytokines and inflammation/apoptosis-related components, and cell-cycle and DNA-damage regulators) were evaluated in peripheral blood mononuclear cells (PBMCs) at baseline and 6 months after bariatric surgery. Clinical molecular correlations/associations were analyzed. Functional parameters (lipid accumulation/viability/apoptosis) were analyzed in response to specific inflammasome components silencing in liver HepG2 cells). Results A profound dysregulation of inflammasome components after bariatric surgery was found, especially in NLRs and cell-cycle and DNA damage regulators. Several components were associated with baseline metabolic comorbidities including type 2 diabetes (C-C motif chemokine ligand 2/C-X-C motif chemokine receptor 1/sirtuin 1), hypertension (absent in melanoma 2/ASC/purinergic receptor P2X 7), and dyslipidemia [C-X-C motif chemokine ligand 3 (CXCL3)/NLR family pyrin domain containing (NLRP) 7) and displayed changes in their molecular profile 6 months after bariatric surgery. The gene expression fingerprint of certain factors NLR family CARD domain containing 4 (NLRC4)/NLRP12/CXCL3)/C-C motif chemokine ligand 8/toll-like receptor 4) accurately differentiated pre- and postoperative PBMCs. Most changes were independent of the performed surgical technique. Silencing of NLRC4/NLRP12 resulted in altered lipid accumulation, apoptosis rate, and cell viability in HepG2 cells. Conclusion Bariatric surgery induces a profound alteration in the gene expression pattern of components of the inflammasome machinery in PBMCs. Expression and changes of certain inflammasome components are associated to baseline metabolic comorbidities, including type 2 diabetes, and may be related to the improvement and reversion of some obesity-related comorbidities after bariatric surgery.

IntroductionSexually transmitted infections (STI) have consequences that negatively affect the population’s quality of life and health. Young adults are susceptible to low access to preventive measures and a greater risk behavior risk. The objective was to evaluate and compare STI’ Knowledge in university students from health courses, a public institution, and a private institution of higher education in Brazil.Methodsa cross-sectional study conducted in 2019 in Brazil at the FEMA School of Medicine in Assis-SP and the University of the State of São Paulo (UNESP) in Marília in the courses of Physiotherapy, Speech Therapy, and Occupational Therapy, in undergraduate students, over 18 years of age, through a self-applied questionnaire translated and adapted to the Brazilian Portuguese from the STD-KQ – Transmitted Disease Knowledge Questionnaire.Results462/700 students participated (66.66%) 18-46 years of age (mean 21.46 years, +/− 3.61), 99 men and 363 women. In the private institution, 262/340 (77.06%), and in the public institution, 200/360 (55.55%). The mean age was 22.21 (+/− 4.21) years among men and 21.25 (+/− 3.41) years among women. The mean percentage of the 28 test questions’ correct answers was 52.07%. The average number of correct responses per student was 17.49 out of 28 possible, 62% (+/− 4.97). The distribution between the groups was normal. In the multiple linear regression model for the percentage of correct answers, adjusted for the confounding variables, the intercept was 55.2. The students of the private institution answered 19,655 questions more than the public one (PConclusionthere are gaps in STI knowledge among university students in the health area. The students of the first semesters of the courses, and, in particular, students from a public educational institution, had a significantly lower performance of the right in the questionnaire applied. Thus, actions to promote STI knowledge and preventive attitudes are necessary among university students.

Context Prostate cancer (PCa) is one of the leading causes of cancer-related death among the male population worldwide. Unfortunately, current medical treatments fail to prevent PCa progression in a high percentage of cases; therefore, new therapeutic tools to tackle PCa are urgently needed. Biguanides and statins have emerged as antitumor agents for several endocrine-related cancers. Objective To evaluate: (1) the putative in vivo association between metformin and/or statins treatment and key tumor and clinical parameters and (2) the direct effects of different biguanides (metformin/buformin/phenformin), statins (atorvastatin/simvastatin/lovastatin), and their combination, on key functional endpoints and associated signalling mechanisms. Methods An exploratory/observational retrospective cohort of patients with PCa (n = 75) was analyzed. Moreover, normal and tumor prostate cells (normal [RWPE-cells/primary prostate cell cultures]; tumor [LNCaP/22RV1/PC3/DU145 cell lines]) were used to measure proliferation/migration/tumorsphere-formation/signalling pathways. Results The combination of metformin+statins in vivo was associated to lower Gleason score and longer biochemical recurrence-free survival. Moreover, biguanides and statins exerted strong antitumor actions (ie, inhibition of proliferation/migration/tumorsphere formation) on PCa cells, and that their combination further decreased; in addition, these functional parameters compared with the individual treatments. These actions were mediated through modulation of key oncogenic and metabolic signalling pathways (ie, AR/mTOR/AMPK/AKT/ERK) and molecular mediators (MKI67/cMYC/androgen receptor/cell-cycle inhibitors). Conclusions Biguanides and statins significantly reduced tumor aggressiveness in PCa, with this effect being more potent (in vitro and in vivo) when both compounds are combined. Therefore, given the demonstrated clinical safety of biguanides and statins, our results suggest a potential therapeutic role of these compounds, especially their combination, for the treatment of PCa.

The red blood cell (RBC) storage lesion is a series of morphological, functional and metabolic changes that RBCs undergo following collection, processing and refrigerated storage for clinical use. Since the biochemical attributes of the RBC unit shifts with time, transfusion of older blood products may contribute to cardiac complications, including hyperkalemia and cardiac arrest. We measured the direct effect of storage age on cardiac electrophysiology and compared with hyperkalemia, a prominent biomarker of storage lesion severity. Donor RBCs were processed using standard blood banking techniques. The supernatant was collected from RBC units (sRBC), 7-50 days post-donor collection, for evaluation using Langendorff-heart preparations (rat) or human stem-cell derived cardiomyocytes. Cardiac parameters remained stable following exposure to ‘fresh’ sRBC (day 7: 5.9+0.2 mM K+), but older blood products (day 40: 9.7+0.4 mM K+) caused bradycardia (baseline: 279±5 vs day 40: 216±18 BPM), delayed sinus node recovery (baseline: 243±8 vs day 40: 354±23 msec), and increased the effective refractory period of the atrioventricular node (baseline: 77+2 vs day 40: 93+7 msec) and ventricle (baseline: 50+3 vs day 40: 98+10 msec) in perfused hearts. Beating rate was also slowed in human cardiomyocytes after exposure to older sRBC (−75+9%, day 40 vs control). Similar effects on automaticity and electrical conduction were observed with hyperkalemia (10-12 mM K+). This is the first study to demonstrate that ‘older’ blood products directly impact cardiac electrophysiology, using experimental models. These effects are likely due to biochemical alterations in the sRBC that occur over time, including, but not limited to hyperkalemia. Patients receiving large volume and/or rapid transfusions may be sensitive to these effects.New & noteworthyWe demonstrate that red blood cell storage duration time can have downstream effects on cardiac electrophysiology, likely due to biochemical alterations in the blood product. Hyperkalemia and cardiac arrest have been reported following blood transfusions, but this is the first experimental study to show a direct correlation between storage duration and cardiac function. Infant and pediatric patients, and those receiving large volume and/or rapid transfusions may be sensitive to these effects.

Background Cardiopulmonary exercise test (CPET) provides information about the pathophysiology of the exercise limitation. CPET parameters in pulmonary arterial hypertension (PAH) exhibit distinctive features, such as low peak oxygen uptake (pVO2), low end tidal carbon dioxide tension (PetCO2) and high ventilation-carbon dioxide slope (VE/VCO2).Pulmonary veno-oclussive disease (PVOD) is a PAH subgroup with particular underlying physiology, difficult diagnosis and poor prognosis. Purpose We hypothesized that different CPET patterns could be identified in PAH subgroups, and this may contribute to their diagnosis workup. Methods CPETs performed on the following PAH subgroups between September 2019 and January 2020 were prospectively included: Idiopathic PAH (IPAH), Heritable PAH (HPAH), and PAH responders to calcium channel blockers (CCB-R). Due to its low prevalence and its clinical relevance, CPET data on PVOD patients was retrospectively included. Results 57 CPET were included: 20 IPAH (35%); 13 HPAH (22.8%); 9 CCB-R (15.8%),15 PVOD (26.3%). All patients presented impaired functional capacity with reduced peakVO2 and increased VE/VCO2). Remarkably, PVOD patients,in spite of a younger age, exhibit the worst functional capacity and ventilatory efficiency even showing downward PetCO2 kinetics. CCB-R group achieved the highest peakVO2 and had better ventilatory parameters.(Table 1) Conclusion CPET is a useful tool to classify patients by PAH subgroups. Very low PetCO2 at rest and a downward PetCO2 kinetic strongly suggest PVOD, which has significant implications on treatment. Funding Acknowledgement Type of funding source: None

Background and aims Pregnancy is as a major risk scenario for pulmonary hypertension (PH) females. Disease targeted therapy (DTT) has dramatically changed prognosis in certain PH groups, namely: pulmonary arterial hypertension (PAH), chronic thromboembolic PH (CTEPH) or segmental-PH; also facilitating pregnancy management. In spite a more benign course in the responders to calcium channel blockers subgroup (R-CCB), maternal mortality is thought to remain high and current recommendations still consider all PH-patients as very high risk (mWHO IV). We aimed to analyse pregnancy outcomes in PAH, CTEPH and segmental-PH in a contemporary cohort and to specifically assess pregnancy risks in the R-CCB subgroup. Methods and results All pregnant PAH, CTEPH and segmental PH patients and patients transferred within 8 weeks post-delivery between January 2000 and January 2020 to our centre were studied. 28 pregnancies were included. Mean age 28±6 years. Underlying aetiology: 10 (36%) Idiopathic-PAH, 4 (14%) Heritable-PAH (1 of them veno-occlussive disease-POVD-), 2 (7.1%)PAH-connective tissue disease, 9 (32,1%) PAH-congenital heart disease (1 Eisenmenger), 1 (3.6%) CPETH, 2 (7.1%) segmental-HP. 21% were R-CCB. From the overall 28 pregnancies, 32% underwent early termination of pregnancy (ETP). When pregnancy was continued in non-responders, 5 (23%) were admitted from cardiac causes and up to 13% required inotropes. 66.7% of non-responders patients needed uptitration of PH-DTT along pregnancy (19% being discharged on prostacyclins). Considering the whole cohort, two patients (7.1%) died along the pregnancy period, both non-responders PAH (1 IPAH and 1 POVD). One died at ETP and the other one 48 hours after C-section at week 22. No R-CCB presented with maternal complications, and all continued on CCB without needing any change on treatment. Regarding the new-born, average gestational age was 28 weeks and 53% suffered from some neonatal morbidity (only 1 R-CCB), including 1 neonatal death. From a haemodynamic perspective, baseline mean pulmonary artery pressure (mPAP) was 41.9±15 mmHg, pulmonary vascular resistances (PVR) were at 7.1±4 WU. If haemodynamics were also available after pregnancy (53%), no significant increase in PVR was noted, although the required DTT was remarkably higher. Survival-free of death or lung transplantation (Figure 1) was calculated at 78.57% over a median long-term follow-up of 6 years. Conclusions DTT has improved outcomes in pregnant PH females. Although mortality related to pregnancy appears high but not prohibited, maternal and neonatal morbidity is still very high. Moreover, ETP in this population is not without complications. In addition, DTT often requires uptitration suggesting disease progression. Nevertheless, R-CCB females appear to be able to complete pregnancy without events supporting our suggestion to reconsider their estimated pregnancy-associated risks. Figure 1. 5-year survival Funding Acknowledgement Type of funding source: None

Spinocerebellar ataxia type 3 (SCA3), caused by a CAG repeat expansion in the ataxin-3 gene (ATXN3), is characterized by neuronal polyglutamine (polyQ) ATXN3 protein aggregates. Although there is no cure for SCA3, gene-silencing approaches to reduce toxic polyQ ATXN3 showed promise in preclinical models. However, a major limitation in translating putative treatments for this rare disease to the clinic is the lack of pharmacodynamic markers for use in clinical trials. Here, we developed an immunoassay that readily detects polyQ ATXN3 proteins in human biological fluids and discriminates patients with SCA3 from healthy controls and individuals with other ataxias. We show that polyQ ATXN3 serves as a marker of target engagement in human fibroblasts, which may bode well for its use in clinical trials. Last, we identified a single-nucleotide polymorphism that strongly associates with the expanded allele, thus providing an exciting drug target to abrogate detrimental events initiated by mutant ATXN3. Gene-silencing strategies for several repeat diseases are well under way, and our results are expected to improve clinical trial preparedness for SCA3 therapies.

Aim: To assess the relationship between air pollution and the mortality of IPF. Methods: The probability of death was analyzed from 32 IPF patients diagnosed in our ILD Unit from 2011 to 2019 and it was related to the values of (CO, NO2, PM2.5, PM10, O3 and SO2) in Madrid during that period. Results: Thirty-two patients were reviewed with a mean age of 66±10 years at the time of diagnosis, 7 (21.9%) of them were women. The average of the pollutants from the three months prior to the date of death of the 11 patients was (34.4%) patients who died was SO2=9.518±4.397μg/m2, NO2=58.910±8.819μg/m2, CO=0.390±0.104mg/m2, O3=38.778±15.309 μg/m2, PM2,5=12.371±2.138 μg/m2 PM10= 23.583±5.196 μg/m2 and the average air in the previous three months to the last clinic visit in 21 (65,6%) patients who are still alive was SO2 =8.736±1.719 μg/m2, NO2=56.216±9.586μg/m2, CO=0.237±0.106 mg/m2 O3=48.294±14,059 μg/m2 PM2,5=11.029±2,280 μg/m2 PM10=22.376±4,533 μg/m2 . Firstly, we observed that those 28 (87.5%) patients who were treated had no association with the probability of death [OR=7,500 (0.676-83.264)] (p=0.101) and after that we saw that pollution levels in all patients were not associated with the likelihood of dying: OR SO2= 1.154 (0.521-2.557) (p=0.723), OR CO=1.247 (0.970-1.602) (p=0.085), OR NO2 = 0.829 (0.468-1.468) (p=0.520), OR O3 = 0.944 (0.578-1.544) (p=0.820), OR PM2,5 = 0.646 (0.152-2.744) (p=0.554), OR PM10 = 1.302 (0.668-2.537) (p=0.439). Conclusion: There is no evidence to affirm that air pollution in Madrid is associated with the probability of death in IPF patients.

Purpose To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil. Methods This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI. Results Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups. Conclusion Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.

ContextObesity is a major health problem associated with severe comorbidities, including type 2 diabetes and cancer, wherein microRNAs (miRNAs) might be useful as diagnostic/prognostic tools or therapeutic targets.ObjectiveTo explore the differential expression pattern of miRNAs in obesity and their putative role in obesity-related comorbidities such as insulin resistance.MethodsAn Affymetrix-miRNA array was performed in plasma samples from normoweight (n = 4/body mass index < 25) and obese subjects (n = 4/body mass index > 30). The main changes were validated in 2 independent cohorts (n = 221/n = 18). Additionally, in silico approaches were performed and in vitro assays applied in tissue samples and prostate (RWPE-1) and liver (HepG2) cell-lines.ResultsA total of 26 microRNAs were altered (P < 0.01) in plasma of obese subjects compared to controls using the Affymetrix-miRNA array. Validation in ampler cohorts revealed that miR-4454 levels were consistently higher in obesity, associated with insulin-resistance (Homeostatic Model Assessment of Insulin Resistance/insulin) and modulated by medical (metformin/statins) and surgical (bariatric surgery) strategies. miR-4454 was highly expressed in prostate and liver tissues and its expression was increased in prostate and liver cells by insulin. In vitro, overexpression of miR-4454 in prostate cells resulted in decreased expression levels of INSR, GLUT4, and phosphorylation of AMPK/AKT/ERK, as well as in altered expression of key spliceosome components (ESRP1/ESRP2/RBM45/RNU2) and insulin-receptor splicing variants.ConclusionsObesity was associated to an alteration of the plasmatic miRNA landscape, wherein miR-4454 levels were higher, associated with insulin-resistance and modulated by obesity-controlling interventions. Insulin regulated miR-4454, which, in turn may impair the cellular response to insulin, in a cell type-dependent manner (i.e., prostate gland), by modulating the splicing process.

Made available in DSpace on 2020-12-12T02:20:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-08-01 Background: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide, and this condition may be compromising female sexual function. However, there are controversial findings regarding the impact of GDM diagnosis and proposed treatments on sexual function during pregnancy. Therefore, this study seeks to elucidate the impact of GDM on sexual function in pregnant women by making a comparison between GDM and non-GDM groups using pregnancy sexual response inventory (PSRI). Materials and Methods: A case-control study involved 303 [168 women without GDM (control group) and 108 women diagnosed with GDM (case group)] Brazilian pregnant women at the Perinatal Diabetes Research Centre-Universidade Estadual Paulista, Brazil. PSRI was used to collect the data. The sexual function was scored in 10 domains as composite and specific scores by domains, categorized into quartiles (0 50). There were no significant differences in the sexual functions between the two groups before pregnancy (p > 0.0001). After GDM diagnosis and proposed treatment, the differences were significant (p

Two clinical pharmacy faculty members from a college of pharmacy provide comprehensive medication management in a rural family medicine clinic. The data was assessed for patients with diabetes managed by the pharmacists from 1 January 2017 through to 31 December 2019 to determine the service&rsquo, s impact on patient outcomes. The primary outcome of this study is the change in the goal attainment rates of the three clinical goals of hemoglobin A1c, blood pressure, and appropriate statin therapy after pharmacist intervention. A total of 207 patients were included. At baseline, the patients had an average of 1.13 of the three goals met, improving to an average of 2.02 goals met after pharmacist intervention (p &lt, 0.001). At baseline, 4.8% of the patients had met all three clinical goals, improving to 30.9% after pharmacist intervention (p &lt, 0.001). There were significant improvements for the individual goal attainment rates of hemoglobin A1c (24.15% vs. 51.21%, p &lt, 0.001), blood pressure (42.51% vs. 85.51%, p &lt, 0.001), and appropriate statin therapy (45.89% vs. 65.70%, p &lt, 0.001). This data adds to the evidence supporting the integration of clinical pharmacists into primary care clinics to improve patient outcomes related to diabetes.

Made available in DSpace on 2021-06-25T10:46:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 BACKGROUND: There is ample evidence that gestational diabetes mellitus has a direct influence on urinary incontinence and pelvic floor muscles. There are no standardized pelvic floor muscle exercise programs in the literature for the physiotherapy and differ in the type of exercise, intensity, type and duration of application, and the frequency and duration of treatment sessions. The aim of this systematic review will be to investigate that Pelvic Floor Muscle Training can prevent and/or decrease the pregnancy specific urinary incontinence in women with gestational diabetes mellitus or gestational hyperglycemia. METHODS: We will perform a systematic review according to the Cochrane methodology of Randomized Controlled Trials. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases, with the date of consultation until June 2020. The MeSH terms used will be Pregnancy, Hyperglycemia, Diabetes Mellitus, Type 2, Diabetes Mellitus, Type 1, Pregnancy in Diabetics, Diabetes, Gestational, Urinary Incontinence, Pelvic Floor Muscle Strength. Primary outcomes: improvement or cure of pregnancy specific urinary incontinence (which can be assessed by questionnaires, and tools such as tampon test, voiding diary, urodynamic study). Secondary outcomes: improvement of pelvic floor muscle strength (pelvic floor functional assessment, perineometer, electromyography, functional ultrasonography), improved quality of life (questionnaires), presence or absence of postpartum Urinary Incontinence and adverse effects. Quality assessment by Cochrane instrument. Metanalysis if plausible, will be performed by the software Review Manager 5.3. DISCUSSION: The present study will be the first to analyze the effectiveness of pelvic floor exercises in pregnant women with Gestational Diabetes Mellitus or Hyperglycemia, who suffer from pregnancy specific urinary incontinence. Randomized Controlled Trials design will be chosen because they present the highest level of evidence. It is expected to obtain robust and conclusive evidence to support clinical practice, in addition to promoting studies on the theme and contributing to new studies. TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42017065281. Department of Physiotherapy and Occupational Therapy School of Philosophy and Sciences São Paulo State University (UNESP) Department of Gynecology and Obstetrics Botucatu Medical School (FMB) São Paulo State University (UNESP) Stricto Sensu Graduate Program in Nursing at UNIVERITAS Guarulhos University (UNG) Discipline of Evidence-Based Medicine Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP) Department of Physiotherapy Universidade do Oeste Paulista (UNOESTE) Pelvic Care Center Maastricht Maastricht University Medical Center Department of Nursing Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy School of Philosophy and Sciences São Paulo State University (UNESP) Department of Gynecology and Obstetrics Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Nursing Botucatu Medical School (FMB) São Paulo State University (UNESP)

Made available in DSpace on 2020-12-12T02:20:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Aim: To evaluate the pelvic floor (PF) biometry using three-dimensional ultrasound (US) at two-time points of gestational in pregnant women with gestational diabetes mellitus (GDM). Methods: A prospective cohort study conducted at the Perinatal Diabetes Research Center including 44 pregnant women with GDM and 66 pregnant women without GDM at 24 to 28 weeks of gestation. Three-dimensional transperineal US was performed at 24 to 28 and 34 to 38 weeks of gestation in the lithotomy position at rest. The axial plane of the minimal Levator hiatal dimensions was used to determine Levator ani muscle and Hiatal area (HA) biometry at 24 to 28 and 34 to 38 weeks of gestation. Results: Of the 110 pregnant women, 100 (90.9%) completed the follow-up at 34 to 38 weeks of gestation. The evaluation by US showed a negative biometric change between the two-time points, during pregnancy in women with GDM; in the HA (β coefficient: estimative of effect in biometric progression according to GDM diagnosis, using the non-GDM group as reference = −6.76; P =.020), anteroposterior diameter (β = −5.07; P =.019), and Levator ani thickness (β = −12.34; P =.005). Conclusions: Pregnant women with GDM had a significantly lower than expected percentage of changes in biometry of Levator ani thickness and HA from 24 to 28 to 34 to 38 weeks of gestation when compared with the group of pregnant women without GDM. GDM alters the morphology of PF structures assessed by three-dimension US. This reported complication may be implicated in adverse birth outcomes and may play a role in the development of PF dysfunction. Department of Gynecology and Obstetrics Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Medicine Assis Municipality Educational Foundation (FEMA) Medical School Fundação Educacional do Município de Assis (FEMA) Department of Gynecology Pelvic Floor Center Charité Charité University Hospital Department of Physiotherapy and Occupational Therapy School of Philosophy and Sciences São Paulo State University (UNESP) Department of Gynecology and Obstetrics Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy School of Philosophy and Sciences São Paulo State University (UNESP)

A completely healthy middle-aged female High School teacher developed stomach cancer 1 month after she spent several hours talking face to face with one person with serious stomach problem. Two months later she had surgical removal of stomach cancer. Our research confirmed that in the presence of coexisting strong virus infection of HPV-16 & HHV-6 and strong Electromagnetic field, early stage of cancer can develop very rapidly within 24 hours and these rapidly developed cancers are infectious & difficult to treat. Just before Thanksgiving Day (late November) the 1st author drank one full cup of Eggnog, at the same time he also ate part of Blueberry Pie. About 6 hours later the 1st author developed severe left low abdominal pain and diarrhea. Since he realized eggnog had extremely strong infection of HPV-16 and HHV-8 surrounded by strong electromagnetic field this might have caused early stage cancer and found the presence of early stages of 5 new cancers: 1) Hepatoma of liver 2) Hodgkin's lymphoma 3) Transitional Cell Carcinoma of Urinary Bladder 4) Adenocarcinoma of Pancreas 5) Adenocarcinoma of the Breast. All of these cancers did not exist before this unplanned accidental human experiment. In 2017 Pancreatic cancer and Breast cancer were found in the 1st author within 24 hours after 4 hours of medical examination of middle aged Japanese male patient with chief complaints of Breast Cancer & Pancreatic Cancer in close distance. The patient also had strong infection of these viruses. The author was able to eliminate these 2 cancers completely a few months before drinking the eggnog. The other cancers were also developed under similar circumstances all of them were eventually eliminated, but all these 5 cancers did not exist before drinking eggnog. The eggnog had a very high concentration of about 10000ng of HPV-16 and HHV-8 and most of cancer tissue has over maximum infection of both viruses, 7000-11000ng. The reason we have been using optimal dose of Vitamin D3 every 8 hours for every cancer patient is we can continuously excrete cancer contributing viruses to much less than 6000ng since when viruses of HPV-16 & HHV-8 are less than 6000ng, the cancer was less active. We could not eliminate the 5 infectious cancers in the first author in spite of our improved treatment with combine use of optimal doses of vitamins D3 & white fleshed Dragon fruits (since we found it to contain near optimal doses of DHEA, Zinc, Magnesium, Lithium, and a small amount of Vitamin D3, etc.) Fortunately, on Dec. 8, 2018, for the first time in cancer treatment we succeeded in completely eliminating active cancer semi-permanently under specific conditions. In this study the second time author was able to semi-permanently inhibit all 3 cancers' activity. Through this process, we were able to detect the presence or absence of active cancer very accurately from 2-10 cc of urine or rapidly changing QRS complex of ECGs. In the subsequent 10 days no cancers were detected once Thymosin α1 and 3 Thymosin β4 reach very high value of 800ng measured using reference control substances.

Our study indicated that cancer can develop in very short time if there is a strong coexisting infection of HPV-16 and HHV-8 in the presence of strong repeated electromagnetic field. Recently the first author himself developed cancer by drinking eggnog, which happened to contain strongest infection of both these 2 viruses, in the presence of Electro-magnetic field. Sometimes these cancers can also appear as a small metastatic mass in the back of the finger or hand. These metastatic tumors that are appearing in the hand are often misdiagnosed as benign lipoma since they do not seem to create any pain or other symptoms. In this article we described 2 examples of such an unusual metastatic tumor appearing as if it is a benign lipoma. If left untreated, or biopsy or surgical removal of these metastatic tumors can be new sources of metastases or unrecognized existence of an advanced tumor of original organ without significant symptoms. These rapidly developed cancers are infectious & difficult to treat. Fortunately, we succeeded in discovering an essential parameter required to completely inhibit these cancers by implementing the combination of the following 3 different methods given sequentially 1) Simultaneous Intake of Optimal Doses of Vitamin D3 (with 10 unique beneficial effects) every 8 hours & white fleshed Dragon fruit (since we found it containing close to optimal dose of DHEA, Zinc, Magnesium, Lithium, and a small amount of Vitamin D3 etc.) every 24 hours; 2) Selective Drug Uptake Enhancement Method; 3) Manual Stimulation of the Thymus Gland Representation Area of the Back of Each Hand. When these 3 different methods are used consequently there is a possibility of safe effective treatment for hopelessly advanced cancer patients, if Thymosin α1 & Thymosin β4 are both very significantly increased to 800ng or higher.

Amebiasis is the third-largest parasitic cause of death in the world. Endemic in the hot and humid regions of the globe, it remains a cosmopolitan affection. Pleuropulmonary involvement is the second most extraintestinal localization of amoebiasis after hepatic localization. We report a clinical case of amoebiasis with hepatic and pleuropulmonary involvement. The diagnosis was made by amoebic imaging and serology. The patient was found to have HBsAg on this occasion. The clinical course was favorable under treatment with metronidazole and needle puncture-aspiration of pus. The association of extra-intestinal amoebiasis and hepatitis B is not common. It was therefore a question of seeing if there could be a link between these two affections

AIM To compare the cannulation success, biochemical profile, and complications of the papillary fistulotomy technique vs catheter and guidewire standard access. METHODS From July 2010 to May 2017, patients were prospectively randomized into two groups: Cannulation with a catheter and guidewire (Group I) and papillary fistulotomy (Group II). Amylase, lipase and C-reactive protein at T0, as well as 12 h and 24 h after endoscopic retrograde cholangiopancreatography, and complications (pancreatitis, bleeding, perforation) were recorded. RESULTS We included 102 patients (66 females and 36 males, mean age 59.11 ± 18.7 years). Group I and Group II had 51 patients each. The successful cannulation rates were 76.5% and 100%, respectively (P = 0.0002). Twelve patients (23.5%) in Group I had a difficult cannulation and underwent fistulotomy, which led to successful secondary biliary access (Failure Group). The complication rate was 13.7% (2 perforations and 5 mild pancreatitis) vs 2.0% (1 patient with perforation and pancreatitis) in Groups I and II, respectively (P = 0.0597). CONCLUSION Papillary fistulotomy was more effective than guidewire cannulation, and it was associated with a lower profile of amylase and lipase. Complications were similar in both groups.