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INTRODUCTION: Preserving the endocrine and reproductive function in young female cancer patients undergoing pelvic radiation is a significant challenge. While the photon beam radiation's adverse effects on the uterus and ovaries are well established, the impact of pelvic carbon ion radiotherapy on women's reproductive function is largely unexplored. Strategies such as oocyte cryopreservation and ovarian transposition are commonly recommended for safeguarding future fertility. METHODS: This study presents a pioneering case of successful pregnancy after carbon ion radiotherapy for locally advanced sacral chondrosarcoma. RESULTS: A multidisciplinary approach facilitated the displacement of ovaries and uterus before carbon ion radiotherapy, resulting in the preservation of endocrine and reproductive function. CONCLUSION: The patient achieved optimal oncological response and delivered a healthy infant following the completion of cancer treatment.

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Surgical mortality is the most significant measure of outcome in surgical healthcare. The objective was to assess surgical 30 days mortality and improve the identification of predictors for personalized risk stratification of patients undergoing elective and emergency surgery. The study was conducted as a single-center cohort retrospective observational study, based on the analysis of data collected from patients surgically treated from 2002 to 2014 in a multi-disciplinary research and care referral hospital with global case mix of 1.27. The overall in-hospital mortality rate was 1.89% (95% CI 1.82-1.95). In the univariable analysis, numerous predictors were significantly associated with in-hospital death following surgery. In the multivariable model, age, BMI (Body Mass Index), ASA score, department, planned surgical complexity, surgical priority, previous surgeries in the same hospitalization, cardiovascular, pulmonary, hepato-renal comorbidities, drug intolerance, cancer and AIDS were independently associated with mortality after surgery. At logistic regression, the computed SMATT score (graded 0-100), generated on the basis of multivariate analysis, demonstrated a good discrimination (10-fold cross-validated AUC-ROC 0.945, 95%CI 0.941-0.948) and correctly classified 98.5% of those admissions with a probability of death >50%. The novel SMATT score, based on individual preoperative and surgical factors, accurately predicts mortality and provides dynamic information of the risk in redo/reoperative surgery.

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Background: Neuraxial anesthesia is considered as the gold standard in the control labor of pain. Its variants are epidural analgesia and combined spinal-epidural analgesia. Few studies, as yet, have investigated the duration of labor as a primary outcome. Some authors have suggested that combined spinal-epidural analgesia may reduce labor duration but at the moment the benefit of shortening labor is uncertain. The main aim of this study was to compare combined spinal-epidural with epidural analgesia in terms of their effect on duration of stage I labor, maternal, and neonatal outcomes. Methods: A prospective cohort study was conducted. Parturients who requested analgesia at cervical dilatation <6 cm were included. Analgesia was either epidural with low concentration levobupivacaine or combined spinal epidural with subarachnoid sufentanil. The primary outcome was the length of stage I labor. Onset and quality of analgesia, mode of delivery, effects on uterine activity and use of oxytocin, fetal heart rate abnormalities and uterine hyperkinesia, maternal, and neonatal complications were also considered. Results: We enrolled 400 patients: 176 in the combined spinal-epidural group and 224 in the epidural group. Patients in the two treatment groups were similar with regard to demographic characteristics, parity, and incidence of obstetric comorbidities, labor induction, oxytocin infusion, Bishop score, and Visual Analogue Score (VAS) at analgesia request. Duration of stage I labor did not differ, at 195 (120-300) minutes for both the groups (p = .7). Combined spinal-epidural was associated with less reduction in uterine contractility after initial administration: 15.34 versus 39.73%, (p < .001) and with delayed need for oxytocin, at dilations of 7 ± 2.5 cm versus 6. ± 2.7, (p = .002). Onset of analgesia was quicker for combined spinal-epidural analgesia: 31 versus 20%, with VAS <4 after 5 minutes, (p < .001); and lower VAS scores after initial analgesia administration. No differences were found in the other outcomes. Conclusions: Combined spinal-epidural with subarachnoid sufentanil may not reduce the duration of stage I labor, but in our study it appeared to affect uterine contractility less. It also had a more rapid onset and was more effective, without any concomitant increase in maternal or neonatal complications.

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Candida se considera un patógeno oportunista que depende de factores propios de virulencia y factores favorecedores del hospedero para causar la infección. Los tractos digestivo y respiratorio, junto con la mucosa genital (vagina), son los reservorios más importantes en los seres humanos y origen de candidiasis endógena. Por lo antes expuesto se pretende determinar la prevalencia del género Candida en vagina de mujeres en edad reproductiva. Se analizaron 107 muestras de secreción vaginal en la unidad de Servicios Médicos Odontológico de la Universidad del Zulia, a dichas muestras se le realizo un examen directo con coloración de azul de metileno al 0,25% y cultivo en medio de Sabouraud, se incubaron a 28°C por 8 días. A las placas que presentaron crecimiento característico de Candida, se les realizaron las respectivas pruebas morfológicas y fisiológicas para su identificación y como confirmatorio el medio selectivo de ChromoAgar. Del total de muestras analizadas resultaron positivas 24, observándose prevalencia en mujeres en edades comprendidas entre 41-45 años (25%) seguidas de los grupos etarios comprendidos entre 21-25años (20.83%) y de 26 a 30 años (20.83%). Esta investigación determinó que la presencia de Candida es independiente del régimen alimentario, la sintomatología presente, la existencia de diabetes y la ingesta de medicamentos.

Candida is considered an opportunistic pathogen that depends on specific virulence factors and host predisposing factors to cause infection. Digestive and respiratory tracts, along with the genital mucosa (vagina), are the most important reservoirs in humans and origin of endogenous candidiasis. The aim of this study was, determine the prevalence of Candida in vagina of women of reproductive age. 107 vaginal samples were analyzed in the unit of Dental Medical Services at the University of Zulia, on those samples was performed direct examination with methylene blue stain 0.25% and grown in a Sabouraud culture medium, incubated at 28° C for 8 days. The Petri dishes that showed characteristic Candida growth were performed the respective morphological and physiological tests for identification and as a confirmatory test, Chromo Agar selective medium. Of the total number of samples tested, 24 were positive. The highest frequency was in women aged 41- 45 years (25%), followed by the age groups ranging from 21-25años (20.83%) and 26 to 30 years (20.83%). This research showed that the presence of Candida is independent of the diet, presence of symptoms, diabetes and medicament administration.

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PURPOSE: Induced labor is associated with a higher request for analgesia than spontaneous labor. This study compared duration of labor, mode of delivery, quantity of blood loss, type of perineal outcome and neonatal outcomes between women in induced labor and women in spontaneous labor, both on epidural analgesia (administered at cervical dilation ≤ 4 cm). METHODS: In a two-year longitudinal cohort study, data were gathered from nulliparous women with a single cephalic pregnancy of at least 37 weeks attending the labor and delivery ward in Policlinico San Matteo Fundation-Pavia. Data were compared for women with early labor analgesia in (1) spontaneous labor (Robson group 1) and (2) induced labor (dinoprostone - vaginal insert or gel, Robson group 2a). RESULTS: Of the 1104 women who underwent epidural analgesia in the study period, 531 were included: 326 in spontaneous labor and 205 in induced labor. The only significant difference found was duration of the first stage, which lasted 305 (200-390) min in spontaneous labor compared to 205 min (120-345) in induced labor (p <0.001). CONCLUSIONS: In women on early epidural analgesia, induction is associated with a shorter duration of the first stage of labor and does not affect other outcomes.

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PURPOSE: Few paediatric cases of clinically isolated syndrome (CIS) have been described in literature, even though it has been increasingly recognized also in this age group. Our study retrospectively enrolled seven Italian patients (four males and three females) who met the International Paediatric Multiple Sclerosis Study Group (IPMSSG) 2012 criteria for clinically isolated syndrome over the period 2010-2014; their clinical, laboratory and imaging findings were compared with current literature and with those seen in five patients (three males and two females) with acute disseminated encephalomyelitis, who were followed in our department over the same years (mean follow-up time 2.84 ± 1.8 years). RESULTS: In our CIS sample, male sex was prevalent, 42.8 % of patients had a multifocal presentation, MRI lesions mostly appeared confluent and with poorly defined margins, and CSF oligoclonal bands (OCBs) were identified in 28.6 %. All acute disseminated encephalomyelitis (ADEM) patients had polyfocal presentation and encephalopathy; large MRI subcortical lesions and polyclonal IgG distribution were identified. During the subsequent follow-up assessments, MRI scan revealed new lesions in three CIS patients, while in ADEM children it appeared normal. CONCLUSIONS: Paediatric CIS patients often show peculiar epidemiological, clinical and radiological features, which significantly differ from adult ones. The presence of encephalopathy and of extended MRI lesions leads to a diagnosis of ADEM, instead. In CIS patients the presence of multiple asymptomatic MRI lesions and of OCBs revealed to be the most predictive risk factors for progression to clinically definite multiple sclerosis (CDMS), so a regular long-term follow-up is recommended; in ADEM, no suitable risk factors for a relapse could be identified.

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Las levaduras del género Malassezia forman parte de la piel normal del hombre y otros vertebrados. La reciente descripción de nuevas especies para el género ha incentivado interés en el estudio de las mismas en diversos países, por lo tanto, es importante realizar investigaciones tendentes a obtener datos epidemiológicos de las especies en países tropicales como Venezuela. El estudio se realizó en piel sana de niños en edad preescolar (2 a 7 años) Las muestras fueron tomadas de diferentes áreas del cuerpo e inoculadas en el medio modificado de Dixon y Sabouraud Dextrosa Agar e incubadas a 32 °C. La identificación de las especies se realizó siguiendo las claves descritas por Guého y col. En la población estudiada se aislaron tres especies M. furfur, M. globosa y M. slooffiae. La especie predominante fue M. furfur con un 76,2% en todos los grupos etareos, seguida de M. globosa 16,7% y M. slooffiae 7,1% En relación a las localizaciones anatómicas M. furfur presentó un predominio en espalda (31,2%) seguida de pabellón auricular y pecho (21,9% respectivamente). M. globosa se aisló con mayor frecuencia de cuero cabelludo (71,4%) y M. slooffiae se observó en espalda (66,7%) y pabellón auricular (33,3%). Según las pruebas estadísticas aplicadas, no se encontraron diferencias significativas entre los grupos evaluados. Cabe destacar la importancia de continuar las investigaciones en otros grupos etarios, para establecer cuáles son las especies prevalentes en nuestra región y evaluar su potencial patógeno

Malassezia yeast forms part of the normal skin on man and other vertebrates. Recent descriptions of new species have stimulated interest in their study in diverse countries; it is important to conduct further research to collect epidemiological data about the species in tropical countries such as Venezuela. This study was made on healthy skins of preschool-age children (2 to 7 years). Samples were taken from different areas of the body, inoculated into a modified medium of Dixon and Sabouraud Agar and incubated at 32°C. Species identification was made following the code described by Guého and collaborators. In the population of children, three species were isolated: M furfur, M. globosa and M. slooffiae. The predominant species was M. furfur with 76.2% in all ages studied, followed by M globosa, 16.7%, and M. slooffiae, 7.1%. In relation to anatomical locations, M. furfur predominated on the back (31.2%), followed by the auricle (outer ear) and chest (21.9%), respectively. M globosa was most frequently isolated from the scalp (71.4%) and M. slooffiae was observed on the back (66.7%) and the auricle (33.3%). According to the statistical tests applied, there were no significant differences between the evaluated groups. It is important to continue this research with other age groups, to establish the prevalent species in this region and evaluate their pathogenic potential

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The yeasts of the Malassezia genus are part of the normal skin of man and other vertebrates. The description of new species for this genus has induced on their study in several countries. For this reason, is important to do research in order to get epidemiologic data about Malassezia species in tropical countries like Venezuela, where the new Malassezia species have not been reported. This study was made on healthy skin of a university student population. The samples were taken from different body areas and inoculated in Dixon modified medium and Sabouraud dextrose agar medium e incubated at 32 degrees C. The identification was achieved following the key of species described by Gueho et al. and the tween diffusion test proposed by Guillot et al. In this investigation the isolated specie was M. furfur, corresponding the major positive percentage to the age group from 16 to 20 years old (66.7%). The presence of Malassezia was predominant on shoulder and chest (33.3% and 26.6%). There were not found significant differences between the evaluated groups, as was demonstrated by the applied statistical tests, exact Fisher's test and Chi square test. It is important to continue the investigations on other age groups, in order to establish the prevalent species in our region and evaluate their pathogenic potential.

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Las levaduras del género Malassezia forman parte de la piel normal del hombre y otros vertebrados. La reciente descripción de nuevas especies para el género ha incentivado interés en el estudio de las mismas en diversos países, por lo tanto, es importante realizar investigaciones tendentes a obtener datos epidemiológicos de las especies de Malassezia en países tropicales como Venezuela, en el cual este tipo de trabajo no se ha reportado. El estudio se realizó en piel sana de población estudiantil universitaria. Las muestras fueron tomadas de diferentes áreas del cuerpo e inoculadas en el medio modificado de Dixon y Sabouraud Dextrosa Agar a 32°C. La identificación se realizó siguiendo las claves para la identificación de especies descrita por Gueho y colaboradores y el test de difusión en tween propuesto por Guillot y colaboradores. En esta investigación la especie aislada fue M. furfur, correspondiendo el mayor porcentaje de positividad al grupo etáreo de 16 a 20 años (66,7 por ciento). Las localizaciones anatómicas predominantes fueron espalda y pecho. (33,3 y 26,6 por ciento) Según las pruebas estadísticas aplicadas, Test exacto de Fisher's y Chi cuadrado, no se encontró diferencias significativas entre los grupos evaluados. Cabe destacar la importancia de continuar las investigaciones en otros grupos etarios, para establecer cuales son las especies prevalentes en nuestra región y evaluar su potencial patógeno

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