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STUDY OBJECTIVE: To determine the surgical time, suture time, presence of postoperative dyspareunia, and complications that occur after closing the vaginal cuff with a barbed suture compared with conventional suture. DESIGN: A randomized, controlled clinical trial (Canadian Task Force classification I). SETTING: Private gynecologic clinic in Medellin, Colombia. PATIENTS: One hundred fifty women who underwent total laparoscopic hysterectomy for benign pathology. INTERVENTIONS: The patients underwent total laparoscopic hysterectomy with intracorporeal closure of the vaginal cuff and were randomized to 2 groups, 1 using a barbed suture (V-Loc 90; Medtronic/Covidien, New Haven, CT) and 1 using polyglactin 910 (coated Vicryl suture; Ethicon/Johnson & Johnson, New Brunswick, NJ). MEASUREMENTS AND MAIN RESULTS: The total operative time, closing time of the vaginal vault, presence of complications in the cuff, and incidence of postoperative dyspareunia were recorded. The patients were evaluated at a postoperative office visit 2 weeks after the procedure and by telephone interview at 24 weeks. Seventy-five patients were included in the barbed suture group and 75 patients in the polyglactin 910 group. The average time to complete the suture of the vaginal cuff was 12.01 minutes (± 5.37 standard deviation) for the barbed suture group versus 13.49 minutes (± 6.48) in the polyglactin 910 group (95% confidence interval, -.44 to 3.4; pâ¯=â¯.130). Blood loss was 31.56 ± 22.93 mL in the barbed suture group versus 30.82 ± 21.75 mL in the polyglactin 910 group (95% confidence interval, -7.95 to 6.47; pâ¯=â¯.840). The frequency of postoperative events such as hematoma, cellulitis, cuff dehiscence, fever, emergency consultation, and hospitalization was not statistically significant between groups. No statistically significant difference was found regarding deep dyspareunia at 24 postoperative weeks. CONCLUSION: No differences were found in surgical time or frequency of adverse events when comparing patients after vaginal cuff closure with barbed suture versus polyglactin 910.
Assuntos
Histerectomia/métodos , Técnicas de Sutura , Doenças Uterinas/cirurgia , Vagina/cirurgia , Técnicas de Fechamento de Ferimentos , Adulto , Colômbia/epidemiologia , Dispareunia/epidemiologia , Dispareunia/etiologia , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/estatística & dados numéricos , Incidência , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estruturas Criadas Cirurgicamente/patologia , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/estatística & dados numéricos , Suturas/efeitos adversos , Resultado do Tratamento , Doenças Uterinas/epidemiologia , Vagina/patologia , Técnicas de Fechamento de Ferimentos/efeitos adversos , Técnicas de Fechamento de Ferimentos/estatística & dados numéricosRESUMO
Abstract Background: Genetic association studies have been increasingly used in cattle breeding programs. However, inconsistent results -such as positive, negative, or absence of association- across studies restrain reproducibility and proper implementation, propitiating the occurrence of bias. Objective: To identify and classify potential sources of bias and determine possible strategies to avoid it in genetic association studies in cattle. Source of bias in genetic association studies: Genetic and genomic sources of bias include effects associated with the gene loci governing expression. Sampling-related and statistical biases are related with factors such as stratification and database size. Strategies to correct bias in genetic association studies: Correction strategies differ in nature. Genetic and genomic strategies are based on determining the appropriate approach to obtain and report the genetic information. Sampling-related and statistical strategies are based on grouping individuals with certain traits that lead to a reduction in heterogeneity. Conclusion: It is necessary to consider the methodology used in previous studies to establish a hierarchy of sources of bias and facilitate decisions on the use of tools to reduce inconsistencies in the results of future studies.
Resumen Antecedentes: Los estudios de asociación genética son cada vez más usados en los programas de mejoramiento genético. Sin embargo, resultados inconsistentes de los estudios -como positivos, negativos o ausencia de asociación- restringen la reproducibilidad y su aplicación adecuada, propiciando la aparición de sesgos. Objetivo: Identificar y clasificar las fuentes potenciales de sesgo y determinar posibles estrategias para evitarlo en estudios de asociación genética en ganado. Fuentes de sesgo en estudios de asociación genética: Las fuentes genéticas y genómicas de sesgo incluyen los efectos asociados con la expresión que gobierna los loci. Los sesgos estadísticos y de muestreo están relacionados con factores como la estratificación y el tamaño de la base de datos. Estrategias para corregir sesgos en estudios de asociación genética: Las estrategias de corrección difieren en naturaleza. Las estrategias genéticas y genómicas se basan en determinar el enfoque apropiado para obtener la información genética. Las estrategias estadísticas y relacionadas con el muestreo se basan en la agrupación de individuos con ciertos rasgos que conducen a una reducción de la heterogeneidad. Conclusión. Se deben considerar las metodologías utilizadas en estudios previos para jerarquizar las fuentes de sesgo y facilitar las decisiones sobre el uso de herramientas para reducir inconsistencias en resultados futuros.
Resumo Antecedentes: Nos programas de criação de bovinos, os estudos de associação genética têm sido cada vez mais utilizados. No entanto, resultados inconsistentes, como positivos, negativos ou ausência de associação entre os estudos, restringem a reprodutibilidade e sua adequada implementação, propiciando o aparecimento de viés. Objetivo: Identificar e classificar potenciais fontes de viés e determinar estratégias possíveis para evitá-lo nos estudos de associação genética em bovinos. Fonte de viés em estudos de associação genética: Fontes genéticas e genômicas do viés incluem os efeitos associados aos genes que relacionam a expressão. Os vícios estatísticos e de amostragem estão relacionados a fatores como a estratificação e o tamanho do banco de dados. Estratégias para corrigir os viéses nos estudos de associação genética: As estratégias de correção diferem na natureza. As estratégias genéticas e genômicas são baseadas na determinação da abordagem apropriada para obter e relatar a informação genética. As estratégias estatísticas e de amostragem baseiam-se no agrupamento de indivíduos com certos traços que levam a uma redução na heterogeneidade. Conclusão: É necessário considerar a metodologia utilizada em estudos anteriores para estabelecer uma hierarquia de fontes de viés e facilitar decisões sobre o uso de ferramentas para reduzir inconsistências nos resultados de estudos futuros.
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The high incidence of Diabetes Mellitus in low-income regions has promoted the development of low-cost alternatives to replace blood-based procedures. In this work, we present a bienzymatic paper-based sensor suitable for the naked-eye detection of glucose in saliva samples. The sensor was obtained by a stamping procedure and modified with chitosan to improve the colorimetric readout. The bienzymatic reaction of GOx-HRP coupled with 2,4,6-tribromo-3-hydroxy benzoic acid was applied for the detection of glucose within a range from 0 to 180 mgdL-1 in buffer and artificial saliva solutions. The visual readout was perceived by the naked eye and registered with an office scanner to evaluate the analytical performance. The results showed a limit of detection of 0.37 mgdL-1 (S/N = 3) with an R.S.D. of 1.69% and a linear range from 1 to 22.5 mgdL-1 with an R² of 0.99235. The analysis of human saliva samples was performed without pre-processing, achieving recoveries from 92 to 114%. The naked-eye detection was evaluated under two different light settings, showing average recoveries of 108.58 and 90.65% for standard and low illumination. The proposed device showed potential for easy-to-use, sensitive, low-cost, fast, and device-free detection of salivary glucose suitable for untrained personnel operation and limited facilities.
Assuntos
Saliva , Colorimetria , Olho , Glucose , Humanos , Papel , Visão OcularRESUMO
The subclavian artery pseudoaneurysm is a rare entity with only few cases re- ported in the literature. Most injuries were related to iatrogenic manipulation with catheters for canalization of central lines in the hospital setting. In rare cases, this injury has been described secondary to a blunt trauma and motor vehicle accidents with traumatic injury to the subclavian artery caused by seatbelt use. We report an unusual case presentation of subclavian artery pseudoaneurysm.
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Falso Aneurisma/diagnóstico , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Rouquidão/etiologia , Adulto , Falso Aneurisma/complicações , Humanos , Masculino , Artéria Subclávia/lesõesRESUMO
Prolymphocytic leukemias (PLLs) are rare mature lymphoid disorders of B- and T-cell subtypes with distinct features and an aggressive clinical course. PLL represents only 2% of all mature lymphocytic leukemias in adults. T-PLL represents 20% of all PLLs cases. T-cell prolymphocytic leukemia (T-PLL) is more rare and more rapidly progressive and aggressive than B-PLL; it is generally resistant to conventional chemotherapy, and historically the median survival has been about 7 months. Clinicians will often only see a case of T-PLL once every 5 to 10 years, which makes recognition of the disorder difficult. The prognosis is poor and there is no curative therapy. We report a 77-year-old male patient with de novo T-PLL presenting with WBC count of 1,115,000. We will discuss the clinical, morphologic, immunophenotypic and cytogenetic features of this rare entity. A distinctive hematologic aspect of T-PLL is a rapidly rising white blood cell count with a doubling time of weeks to months. The key morphologic feature in the diagnosis of T-PLL is a population of more than 55% prolymphocytes in the peripheral blood. The diagnosis can be made on peripheral blood by flow cytometry where a monoclonal lymphocyte population will show positivity for T-cell markers. T-PLL is characterized by complex chromosomal abnormalities, which suggests that chromosomal aberrations might occur progressively during the course of the disease, thus explaining the aggressive nature of this condition. The main challenge as a clinician treating T-PLL is to deliver long-term disease-free survival. The most important predictor of outcome is response to alemtuzumab therapy (Campath). Knowledge of the disrupted pathways and mechanisms underlying activation and proliferation in T-PLL has raised the possibility of developing future and promising treatment approach that targets these pathways and signals by the use of future molecule inhibitors. T-PLL is a rare disease and careful attention should be given to correctly diagnose this T-cell leukemia. Physicians should be aware of this unusual entity. With the advent of alemtuzumab, although much progress has been made in the treatment of this disease, autologous or allogeneic hematologic stem cell transplant (HSCT) still remains the only hope for cure.
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Splenic artery aneurysms (SAA) are a rare life threatening clinical diagnosis. We present a case of a young Hispanic woman with an aneurysm of the middle branch of the splenic artery and active leakage. The defect was embolized with complete resolution of the retroperitoneal bleeding. Physicians should be aware of this rare entity especially when female patients presents complainiing of severe epigastric pain with associated hypovolemic shock.
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Aneurisma Roto/complicações , Aneurisma/complicações , Hemorragia/etiologia , Artéria Esplênica/patologia , Feminino , Hispânico ou Latino , Humanos , Espaço Retroperitoneal/patologia , Adulto JovemRESUMO
Paroxysmal nocturnal hemoglobinuria (PNH) is a non-malignant, acquired clonal hematopoietic stem cell disease that can present with bone marrow failure, hemolytic anemia, smooth muscle dystonias, and thrombosis. We present a case of a 32 year-old-female, G2P2A0 with no past medical history of any systemic illnesses who refers approximately 2 months of progressively worsening constant heartburn with associated abdominal discomfort. CBC showed leukopenia (WBC 2.9 x 103 /µL) with neutropenia (segmented neutrophils 48%), macrocytic anemia (Hgb 6.1 g/dL, hematocrit 20%, MCV,113 fL) and thrombocytopenia (platelet count 59 x 109/L). Abdomino-pelvic CT scan revealed a superior mesenterc vein thrombosis, which was treated initially with low-molecular-weight heparih for full anticoagulation. Peripheral blood flow cytometry assays revealed diminished expression of CD55 and CD59 on the erythrocytes, granulocytes and monocytes.' Paroxysmal nocturnal hemoglobinuria is a rare, clonal, hematopoietic stem-cell disorder whose manifestations are almost entirely explained by complement-mediated intravascular hemolysis. The natural history of PNH is highly variable, ranging from indolent to life-threatening. The median survival is 10 to 15 years, but with a wide range. Thrombosis is the leading cause of death, but others may die of complications of bone marrow failure, renal failure, myelodysplastic syndrome, and leukemia. Anticoagulation is only partially effective in preventing thrombosis in PNH; thus, thrombosis is an absolute indication for initiating treatment with Eculizumab. Nevertheless, bone marrow transplantation (BMT) is still the only curative therapy for PNH but is associated with significant morbidity and mortality.
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Azia/etiologia , Hemoglobinúria Paroxística/diagnóstico , Dor Abdominal/etiologia , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticoagulantes/uso terapêutico , Medula Óssea/patologia , Fadiga/etiologia , Feminino , Glicosilfosfatidilinositóis/deficiência , Hemoglobinúria/etiologia , Hemoglobinúria Paroxística/complicações , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/tratamento farmacológico , Isquemia Mesentérica/etiologia , Pancitopenia/etiologia , Tomografia Computadorizada por Raios X , Varfarina/uso terapêuticoRESUMO
Madelung's disease is an extremely rare disorder of unknown etiology characterized by multiple, non-encapsulated, infiltrative lipomas located symmetrically on the trunk, neck, and proximal parts of the limbs. Approximately 200 patients have been reported in the medical literature. In this case report we present an extremely unusual case of multiple symmetric lipomatosis compatible with Madelung's disease.
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Lipomatose Simétrica Múltipla/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Kaposi's sarcoma is a rare malignancy requiring infection with human Herpes virus for development. We report a case of a 76-year-old immunocompetent male with recurrent leg cellulitis. The cellulitis eventually developed into a non-healing ulcer and a palpable nodule consistent with nodular Kaposi's sarcoma.
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Sarcoma de Kaposi , Idoso , Humanos , Imunocompetência , Masculino , Sarcoma de Kaposi/patologia , Sarcoma de Kaposi/terapiaRESUMO
The objective of this study was to determine the magnitude of genotype by climate interaction (GCI) in the national genetic evaluation for weaning (WW) and yearling (YW) weights of Mexican Braunvieh cattle. The numbers of performance records and animals in the pedigree were 12,364 and 25,173 for WW, and 7,991 and 18,072 for YW, respectively. Performance records were clustered based on climatological variables into: dry tropic (DT), wet tropic (WT), and temperate (TE) climates. Animal models were used to estimate genetic parameters and predict breeding values in each of the climates. Bivariate analyses were carried out for pairwise combinations of climates on each trait, considering the same trait in different climates as a different trait. Criteria to evaluate GCI were genetic correlations (r g), correlations between predicted breeding values (r BV), and frequencies of coincidence (FC) in the ranking of the top 25 sires. Results of comparisons between pairs of climates were variable, depending on specific cases. For WW, the r g, r BV, and FC ranged from -0.36 to 0.84, -0.60 to 0.97, and 0.16 to 0.92, respectively; whereas for YW, they fluctuated between 0.23 and 0.99, 0.33 and 1.00, and 0.60 and 1.00, respectively. For both traits, the results suggest absence of GCI between DT and TE; however, GCI was detected in the other pairs of climates, where WT was involved. To maximize genetic progress, the joint genetic evaluation should be performed only for animals with performance data in DT and TE, whereas a separated evaluation is suggested for animals with performance records generated under WT conditions.