RESUMEN

INTRODUCTION AND HYPOTHESIS: The objective was to present endoscopic images of a meshoma and describe the complete excision of a complicated mesh after sacrocolpopexy (SCP) using a combined vaginal-endoscopic technique. METHODS: We present a video documentation of an innovative technique. A 58-year-old woman was referred with painless, foul-smelling vaginal discharge and recurrent vaginal mesh erosions. She had undergone a laparoscopic SCP 12 years ago and her symptoms had begun 5 years ago. A pre-operative MRI scan revealed a cuff meshoma and an inflammatory sinus around the mesh extending from the cuff to the sacral promontory. Under general anesthesia, a 30° hysteroscope was inserted transvaginally into the sinus, where the retained mesh was seen in the form of a shrunken meshoma, and then the mesh arms were recognized extending cephalad into a sinus tract. Under direct endoscopic visualization, the mesh was carefully mobilized at its highest point with the use of laparoscopic grasping forceps. Then, the mesh was dissected with hysteroscopic scissors in close proximity to the bone. No peri-operative complications were recognized. RESULTS: A combined vaginal-endoscopic approach was successfully used to remove an eroded mesh and cuff meshoma after SCP. CONCLUSION: This procedure offers a minimally invasive, low-morbidity, and rapid-recovery approach.

RESUMEN

Introduction During menopause, healthy women experience a diverse aggregate of clinical manifestations and symptoms that relate to hormonal and aging changes. These alterations are strictly associated with psychological disorders, mainly depression. Estrogen treatment may be effective for these mood variations caused by menopause. Aim To demonstrate the impact of phytoestrogen treatment in menopausal women with depressive symptoms. Methods The study is a consecutive case series study, with a six-month follow-up. It was conducted in a private consultant endocrinologist clinic in Trikala, Greece. A total of 108 eligible participants aged from 45 and above experiencing depressive symptoms were included. The Beck Depression Inventory-II (BDI-II) questionnaire for depressive symptoms was measured at three time points (t=0, t=3 months, t=6 months) and the means were analyzed and compared to each other. Results The overall mean BDI-II scores reveal that depressive symptoms constantly and gradually decreased over time, with the numbers of postmenopausal women experiencing minimal or mild depression and moderate depression, as tested at baseline and study completion (before and after phytoestrogen use), being inversely proportional. Conclusion Phytoestrogen administration to menopausal women is indicated to reduce depression symptoms. More research in the area is needed to reach definite conclusions.

RESUMEN

OBJECTIVES: Synthetic materials have been used for the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). During the last 25 years, these materials were composed mostly of polypropylene (PP), whereas recently the use of polyvinylidene difluoride (PVDF) is of increasing interest due to its characteristics. This study aimed to compare the results after SUI/POP surgery using PVDF versus PP materials by synthesizing the data of relevant existing literature. STUDY DESIGN: This systematic review and meta-analysis included clinical trials, case-control studies, or cohort studies written in the English language. The search strategy included the electronic databases MEDLINE, EMBASE, and Cochrane, and grey literature (congresses IUGA, EUGA, AUGS, FIGO). All studies have to provide numeric data or odds ratios (OR) of developing a specific outcome in surgeries with PVDF compared with outcomes of other used materials. No restrictions of race or ethnicity were applied, nor chronological restrictions. Exclusion criteria were studies that included patients with cognitive impairment, dementia, stroke, or central nervous system trauma. All studies were screened by two reviewers, initially by title and abstract, and afterward by full text. Disagreements were resolved through mutual consent. All studies were assessed for their quality and bias risk. Data were extracted using a data extraction form formulated in a Microsoft Excel spreadsheet. Our results were divided into studies dealing only with SUI patients, studies dealing only with POP patients, and cumulative analysis of variables expressed in both SUI and POP surgery. The primary outcomes were the rates of post-operative recurrence, mesh erosion, and postoperative pain after surgery with PVDF compared to PP. The secondary outcomes were post-operative sexual dissatisfaction, overall satisfaction rates, hematoma, urinary tract infection, de novo urge incontinence, and reoperation rate. RESULTS: No differences in the post-operative rates of SUI/POP recurrence, mesh erosion, and pain were found after surgery with PVDF vs surgery with PP. Patients after SUI surgery with PVDF tapes had statistically significant lower rates of de-novo urgency compared to the PP group [OR = 0.38 (0.18, 0.88), p = 0.01]; patients after POP surgery with PVDF materials had statistically significant lower rates of de-novo sexual dysfunction compared to the PP group [OR = 0.12 (0.03, 0.46), p = 0.002]. CONCLUSIONS: This study provided evidence that the use of PVDF in SUI/POP surgeries could be a valid alternative to PP. However our results are limited by uncertainty due to the overall low quality of the existent data. Further research and validation would contribute to better surgical techniques.

Asunto(s)

RESUMEN

Introduction Peripheral neuropathy is one of the possible complications of diabetes. Alpha-lipoic acid (a-lipoic acid or ALA) is a powerful antioxidant cofactor synthesized in mitochondria that could help stimulate nerves and regenerate nerve fibers, thus preventing disease progression. Moreover, the possible feeling of oppression from the lifestyle changes needed to avoid the complications of diabetes may contribute to the development of depressive symptoms. ALA increases insulin sensitivity, which could increase serotonin synthesis and thus reduce the manifestations of depressive disorder. Aim The aim of this study is to investigate the therapeutic effect after oral administration of a-lipoic acid in patients with type II diabetes mellitus, regarding the possibility of developing peripheral neuropathy and the possibility of developing depressive disorder due to the existence of diabetes type II. Methods The study sample consisted of 148 Greek patients, type II diabetics, 68 men and 80 women, aged 50-75 years. All of them were non-smokers and did not consume alcohol. Their treatment was a combination of gliclazide, sodium-glucose-linked transporter 2 (SGLT-2) inhibitors, metformin, and glucagon-like peptide 1 (GLP-1) analogs. None of them were under insulin administration. Any other treatment received chronically from the patients for other comorbidities was not altered or paused. All patients were in regular monitoring of renal, hepatic, and ocular function, which was normal. Patients were monitored with a balanced diet, based on equivalents, in order to maintain an almost constant body mass index (BMI). All were given one tablet of 600 mg a-lipoic acid, two hours before a meal, for eight months, and the incidence of developing peripheral neuropathy and depressive disorder was assessed, using the Subjective Peripheral Neuropathy Screen Questionnaire (SPNSQ) and Beck Depression Inventory (BDI) questionnaire. Results ALA administration after both four and eight months resulted in statistically significant results and, specifically, the peripheral neuropathy development mean score was reduced by 4.79 at four months and 6.22 after eight months. Concerning the incidence of depressive disorder, an average decrease of 4.43 in the related depression score was observed at the four-month milestone and 7.56 at eight months, both statistically significant. Conclusion A-lipoic acid is a powerful antioxidant and, when used with conventional treatment, has shown to significantly decrease the incidence of depression and peripheral neuropathy in patients with type 2 diabetes mellitus.

RESUMEN

INTRODUCTION: L-Carnitine is a very important component of the human body which is involved in cardiac function and generally in the proper functioning of the muscular system. Also, it contributes to the proper use of glucose by the cell, thereby improving the regulation of glucose metabolism of the diabetic patient and preventing complications such as fatigue, insomnia, and mental activity. In this paper we would like to show the therapeutic effect of L-carnitine on type II diabetic patients after 2 g/day oral administration of L-carnitine. METHODS: In this study 181 Greek patients, 84 men and 97 women, aged 50-65 years, Type II diabetics, were administered L-carnitine for six months. All of them were euglycemic, under the proposed treatment, with no diabetic complications or cardiovascular problems. They were under the Mediterranean diet trying to keep their body mass index (BMI) constant. They were neither smokers nor alcohol drinkers. They were administered 2 g/day L-carnitine, orally, once daily for six months, on an empty stomach. The blood tests included fasting glucose, glycated hemoglobin (HBA1c), total cholesterol, and triglycerides and they were performed before, three months after, and six months after the treatment initiation. We also evaluated their tiredness, insomnia, and mental activity at these time points; the participants were given forms to fill out (regarding the distance they are able to brisk walk thrice/week, the duration of their calm uninterrupted sleep and their performance in a cognitive screening test, respectively) and based on the results of their answers, they were allocated to graded groups and scale analysis was performed in each one of them. RESULTS: Fasting glucose mean decrease was 17.51 after three months of medication (p<0.05); the decrease though noted after six months was not statistically significant. HbA1c showed a statistically significant mean decrease in both three- and six-month milestones (0.335, p<0.05 and 0.623, p<0.05 respectively). Changes noted in cholesterol levels were not statistically significant. Triglyceride measurements showed a significant decrease; -15.38 after three months (p<0.05) and -31.39 after six months of treatment (p<0.05). Finally, significant changes were found in both time periods for tiredness (three months: -0.49, p<0.05, six months: -0.88, p<0.05), insomnia (three months: -0.49, p<0.05, six months: -0.88, p<0.05), and mental activity (three months: +0.25, p<0.05, six months: +0.89, p<0.05). CONCLUSION: L-Carnitine could be a valuable dietary supplement in patients with type II diabetes who follow a Mediterranean diet and are under recommended treatment. Research in this field though is at an early stage and more studies should be performed.

RESUMEN

It is a common ground that humans have always modified the genome of both plants and animals. This intrusive process that has existed for thousands of years, many times through mistakes and failures, was initially carried out through the crossing of organisms with desirable features. This was done with the aim of creating and producing new plants and animals that would benefit humans, that is , they would offer better quality food, more opportunities for people to move and transport products, greater returns to work, resistance to diseases, etc. However, creating genetically modified organisms does not proceed without conflicts. One part of the equation concerns objections made by disputants of genetically modified organisms to the manipulation of life, as opposed to defenders who argue that it is essentially an extension of traditional plant cultivation and animal breeding techniques. There are also conflicts regarding the risks to the environment and human health from using genetically modified organisms. Concerns about the risks to the environment and human health from genetically modified products have been the subject of much debate, which has led to the development of regulatory frameworks for the evaluation of genetically modified crops. However, the absence of a globally accepted framework has the effect of slowing down technological development with negative consequences for areas of the world that could benefit from new technologies. So, while genetically modified crops can provide maximum benefits in food safety and in adapting crops to existing climate change, the absence of reforms, as well as the lack of harmonization of the frameworks and regulations about the genetic modifications results in all those expected benefits of using genetically modified crops being suspended. However, it is obvious that the evolution of genetically modified products is not going to stop. For that reason, research on the impact of genetic modification on medical technologies, agricultural production, commodity prices, land use and on the environment in general, should therefore continue.