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Sexually Transmitted Infections (STIs) are a critical global health concern, with low- and middle-income countries carrying the highest burden. The development of rapid point-of-care STI tests has enabled screening in settings without laboratory access. Yet, high-need settings face unique challenges that may influence the implementation and uptake of STI screening. This piece discusses lessons learned from the implementation of STI screening in a rural, low-resource setting in Chiapas, Mexico. Despite minimal privacy and a low staff-to-patient ratio, a streamlined approach was developed to destigmatize and maximize STI screening. The clinic team developed strategies through practice, including incorporating screening into triage procedures and offering screening to family members. This protocol led to an average screening rate of 37% within three months and acceptance of screening by family units. It was observed that access to treatment was necessary to alleviate patient hesitation to screening due to fears of a positive result. As STI screening increases globally, healthcare systems must develop robust access to treatment to effectively prevent and treat STIs worldwide.
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INTRODUCTION: Open spina bifida (OSB) is the most common congenital anomaly of the central nervous system. It is associated with severe neurodevelopmental delay, motor impairment, hydrocephalus, and bowel and bladder dysfunction. In selected cases, intrauterine spina bifida repair has been shown to improve neonatal outcomes. Rarely, the spine can have a double defect compromising two different segments and there is a lack of evidence on the feasibility and benefits of intrauterine repair in these cases. CASE PRESENTATION: We present a case with both cervicothoracic and lumbosacral myelomeningocele, Arnold-Chiari malformation type II and bilateral ventriculomegaly, that was treated successfully at 25 weeks with open micro-neurosurgery. Double myelomeningocele was successfully treated through a single 2-cm micro-hysterotomy, by performing external versions to sequentially expose and repair both defects. Weekly postoperative follow-up showed no progression of ventriculomegaly or complications attributable to the procedure. Preterm rupture of membranes prompted a conventional cesarean delivery at 32 weeks of gestation. Neurodevelopmental outcome at 20 months was within normal ranges, having achieved ambulation without orthopedic support and with no need for ventriculoperitoneal shunting. CONCLUSION: This report demonstrates for the first time the feasibility of double OSB repair through a single 2-cm micro-hysterotomy, suggesting that selected isolated cases of double myelomeningocele could be candidates for fetal intervention. Further prospective studies should be carried out to assess the potential benefit of double OSB intrauterine open repair.
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Histerotomia , Meningomielocele , Humanos , Meningomielocele/cirurgia , Meningomielocele/diagnóstico por imagem , Feminino , Histerotomia/métodos , Gravidez , Recém-Nascido , Malformação de Arnold-Chiari/cirurgia , Malformação de Arnold-Chiari/diagnóstico por imagem , Adulto , Terapias Fetais/métodosRESUMO
INTRODUCTION: A proportion of monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) can present after 26 weeks of gestation. The aim of this study was to compare perinatal outcomes of late TTTS treated by fetoscopic laser coagulation versus traditional management with amniodrainage and/or emergency preterm cesarean delivery (CD). METHODS: Retrospective cohort from January 2012 to January 2023 of consecutive MCDA twin pregnancies complicated by TTTS after 26 weeks and evaluated in our referring centers. We analyzed perinatal outcomes of cases treated with fetoscopic laser surgery at our national referral fetal surgery center in Queretaro, Mexico, and compared them with those managed with traditional management (amniodrainage and/or emergency preterm CD). The primary outcome was survival at discharge and the secondary outcome was gestational age (GA) at birth. RESULTS: Among the study population, 46 TTTS cases were treated by fetoscopy at 27+6 (26+0-31+0) weeks+days and were compared with a group of 39 cases who underwent emergency preterm CD. In comparison to the group who underwent traditional management, the group treated by laser fetoscopy showed a significantly higher GA at birth (32+3 vs. 29+1 weeks+days, p < 0.001), lower frequency of preterm delivery below 37 weeks (91.3% vs. 100%, p = 0.06), 34 weeks (63.0% vs. 100%, p < 0.001), 32 weeks (50% vs. 74.4%, p = 0.02), or 30 weeks (28.3% vs. 53.8%, p = 0.01), and significantly higher perinatal survival (89.1% vs. 71.8%, p < 0.05 of at least one twin; and 65.2% vs. 38.5%, p = 0.01 of both twins, respectively). CONCLUSION: MCDA twins complicated with TTTS can be treated with fetoscopic laser surgery between 26 and 31 weeks of gestation, which is a feasible and safe option, and such cases are associated with a higher GA at birth and better perinatal survival than those managed with amniodrainage and/or emergency preterm CD.
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Transfusão Feto-Fetal , Terapia a Laser , Gravidez , Recém-Nascido , Feminino , Humanos , Fetoscopia , Resultado da Gravidez , Estudos Retrospectivos , Terapia a Laser/efeitos adversos , Gravidez de Gêmeos , Fotocoagulação a Laser , Idade GestacionalRESUMO
INTRODUCTION: Given the high rate of complete nodal response, the role of axillary lymph node dissection on staging the axilla has been questioned. This survey, addressed to breast cancer surgeons in Spain, has the objective of assessing current clinical trends on axillary staging of cN + patients treated with NAC. METHODS: An online survey was conducted among breast surgeons from the Spanish Society of Surgery (AEC), Spanish Surgical Oncology Society (SEOQ), Spanish Breast Cancer Surgeons Society (AECIMA) and Spanish Gynecology and Obstetrics Society (SEGO). It was structured in 5 sections: general information and clinical practice, knowledge of clinical trials, diagnosis work-up and nodal marking, axillary staging, and axillary treatment. RESULTS: 150 breast cancer surgeons completed the full survey (96.7%). 81.8% of respondents performed SLNB or targeted axillary dissection in cN1 patients treated with NAC. Radiological axillary response was the preferred parameter guiding the surgical strategy. The excision of the clipped node (92.0%), use of dual tracer (73.2%), and axillary US (65.9%) after treatment were the most important variables considered by respondents, to increase the accuracy of SLNB in cN + patients. CONCLUSION: This survey confirms a trend toward a less invasive approach for axillary staging in cN + patients treated with NAC among breast cancer surgeons in Spain. While there is widespread agreement in less invasive approaches to axillary staging, there is, however, a lack of consensus around treatment strategy. Further, it shows a wide heterogeneity in their clinical practice. This study highlights the need for clear evidence concerning less invasive staging procedures and their oncological safety, to ensure consistent recommendations in surgical practice.
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Neoplasias da Mama , Cirurgiões , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela/métodos , Terapia Neoadjuvante/métodos , Espanha , Axila , Estadiamento de Neoplasias , Excisão de Linfonodo/métodos , Inquéritos e Questionários , Linfonodos/cirurgia , Linfonodos/patologiaRESUMO
Background: Occipital encephalocele is a congenital defect of the neural tube at the level of the cranial midline, which results in herniation of meninges and brain tissue. The results of the management of myelomeningocele study determine the maternal and fetal risks for an open fetal surgery and have motivated the constant review of the concepts and strategies which the pediatric neurosurgeon can employ for the treatment of neural tube defects in the prenatal period. Case Description: We present a case of a female patient in utero of 26 gestational weeks with the diagnosis of an occipital encephalocele treated by open fetal surgery. During week 20 of gestation, the diagnosis of occipital encephalocele was made by ultrasound, which was corroborated by fetal magnetic resonance that showed cranial protrusion of neural and meningeal content in the occipital region, measuring 1.6 × 2.8 × 3.3 cm with an approximate volume of 7.7 cc through a bone defect of 6 mm. The closure of the defect was performed by the postnatal surgical technique adapted to the open fetal surgery. Later, the patient was born transabdominal with a 2.8 cm occipital wound, with suture points and approximated borders, normocephalic, without clinical signs of sepsis, hydrocephalus, or overt neurologic compromise. Conclusion: Open fetal surgery is a therapeutic option in the face of an isolated occipital encephalocele. This case report demonstrates the viability of the surgical procedure by the adaptation of a postnatal surgical technique to a prenatal surgery. Further studies are needed to evaluate the long-term functional results, comparing them with those seen in patients who undergo a postnatal procedure.
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Background: Obturator hernia is a rare type of hernia. Because symptoms and signs are non-specific, diagnosis and treatment are often delayed, increasing the rate of strangulation and mortality. Material and Methods: A retrospective study was performed in 17 cases of obturator hernia at Ramón y Cajal Hospital between January 1986 and December of 2007. Results: All patients were women with a mean age of 77 years (range 19-88 years). Mean time from onset of symptoms to surgery was 3 days (range 0-10 days). Howship-Romberg sign was positive in five cases (29,4 percent). Emergency surgery was performed in 16 cases (94 percent) and elective surgery in one (6 percent). CT has increased the rate of preoperative diagnosis from 16,6 percent to 41,2 percent, however, the rate of strangulation of bowel was 47 percent, requiring intestinal resection ten patients (59 percent). Hernia repair was performed using polypropylene mesh in 8 cases (47 percent) and by means of simple suture and apposition of the peritoneum in the rest 9 cases. Mean hospital postoperative stay was 11,65 days (range 4-26 days) and mortality was 23,5 percent. Conclusion: Although CT sean has facilitated us the correct diagnosis of obturator hernia, decreasing the mean time from onset of symptoms to surgery to 3 days, we could not reduce the rate of intestinal resection and mortality.
La hernia obturatriz es una entidad rara, con frecuente ausencia de signos y síntomas específicos, lo que retrasa su diagnóstico y tratamiento, y por ello puede presentar una elevada tasa de estrangulación y mortalidad. Material y Métodos: Efectuamos un estudio retrospectivo sobre 17 casos de hernia obturatriz en el Hospital Ramón y Cajal entre enero de 1986 y diciembre de 2007. Resultados: Todos los pacientes eran mujeres con una edad media de 77 años (rango 19-88 años). El tiempo medio desde el inicio de los síntomas hasta la cirugía fue de 3 días (rango 1-10 días). El signo de Howship- Romberg fue positivo en 5 casos (29,4 por ciento). Se efectuaron 16 intervenciones con carácter de urgente (94 por ciento) y una de forma electiva (6 por ciento). La realización de un TAC va a incrementar la tasa de diagnóstico preoperatorio de un 16,6 por ciento a un 41,2 por ciento. La tasa de estrangulación fue de 47 por ciento, requiriendo resección intestinal 10 pacientes (59 por ciento). En 8 ocasiones se reparó el defecto hemiario con una malla de polipropileno (47 por ciento), siendo con cierre simple y aposición del peritoneo en los 9 restantes. La estancia media postoperatoria fue de 11,65 días (rango 4-26 días) y la tasa de mortalidad de 23,5 por ciento. Conclusión: Aunque la realización del TAC ha incrementado la tasa de diagnóstico preoperatorio, disminuyendo el tiempo desde la aparición de los síntomas hasta la cirugía a 3 días, no hemos podido reducir la tasa de resección intestinal y mortalidad.
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Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Hérnia do Obturador/cirurgia , Hérnia do Obturador/diagnóstico , Hérnia do Obturador/complicações , Tempo de Internação , Obstrução Intestinal/etiologia , Complicações Pós-Operatórias , Polipropilenos/uso terapêutico , Estudos Retrospectivos , Telas Cirúrgicas , Técnicas de SuturaRESUMO
El presente estudio muestra que hay en la actualidad cierta tendencia a asignar mayor valor a la observación del crecimiento folicular por ultrasonido que a los niveles hormonales "per se". Sin embargo, la apreciación del crecimiento es sólo parte del fenómeno de desarrollo y madurez ovárica, por lo cual la vigilancia con monitor hormonal de la respuesta ovárica sigue teniendo un papel preponderante en las Clínicas de Reproducción Asistida. Los niveles basales principalmente de FSH y en menor grado los de LH, correlacionan inversamente con la cantidad de ovocitos recuperados. Los valores de estradiol deben interpretarse con un punto de referencia fijo, como el día de la administración de HCG y se aprecia una relación directa entre niveles de estradiol y ovocitos capturados; sin embargo, es de mayor utilidad valorar el comportamiento de la curva de estradiol, con el conocimiento de que el pronóstico para buenas tasas de captura mejora al presentarse valores ascendentes y por arriba de los 700 pg en el día de la administración de HCG.
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Humanos , Feminino , Estradiol , Fertilização , Hormônio Foliculoestimulante , Subunidade alfa de Hormônios Glicoproteicos , Hormônio Luteinizante/efeitos dos fármacos , Hormônio Luteinizante/uso terapêutico , Menotropinas/uso terapêutico , Ultrassonografia , ZigotoRESUMO
Se determinaron las fluctuaciones de la progesterona sérica durante el día en tres mujeres con ciclos menstruales regulares y con fase lúteas de duración normal en base a la curva de temperatura basal. Se observaron variaciones significativas a través de las 24 horas cuando las muestras se tomaron a intervalos de 20 minutos y dicha variabilidad no se relacionó con algún período en especial del día o de la noche. Este hecho confirma la forma de producción pulsátil de la hormona por el cuerpo lúteo humano. En 62 mujeres se investigó la importancia clínica del fenómeno en relación al empleo de la determinación de la progesterona sérica como prueba indirecta de ovulación y como parámetro para valorar la calidad de la fase lútea en pacientes con esterilidad. En 64.5% de 31 pacientes con fase lútea normal de acuerdo a la biopsia de endometrio, se encontraron diferencias significativas entre dos o más de cuatro mediciones de progesterona tomadas con 30 minutos de intervalo. En 26% de las pacientes con fase lútea normal los niveles de la hormona fueron inferiores a 3 ng/ml. En 95% de las 19 pacientes con endometrio proliferativo estas cífras fueron menores de 1.0 ng/ml. Se analiza la importancia de estos hechos con base a los resultados del presente estudio y a lo reportado por otros autores
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Humanos , Feminino , História do Século XX , Fase Luteal , Progesterona , Infertilidade , MéxicoRESUMO
En Santiago de los Caballeros, República Dominicana, se llevó a cabo una investigación sobre el estado de la atención estomatológica con la intención a largo plazo de producir reformas en el sistema y de fortalecer la integración servicio-docencia. La investigación se centró en la situación real de la integración llevada a cabo por la Secretaría de Estado de Salud Pública y Asistencia Social y la Universidad Católica Madre y Maestra, que son las dos entidades de servicio y docencia, respectivamente. La investigación se lleva a cabo en dos etapas. En la primera, cumplida en 1983 y que se expone en el artículo, se trazó como objetivo principal el reunir información sobre el sistema en estudio. Desde el punto de vista metodológico, escogió una muestra de 61 pacientes atendidos en tres centros de atención básica estomatológica, ubicados en el área. Se utilizaron las técnicas de la observación directa, la entrevista, la medición del tiempo por actividad y la formación de archivos. Se estudiaron todas las variables que podían influir en una apreciación de la situación en ese momento y de las proyecciones para el futuro. Cabe citar, entre otras, las siguientes variables: grupo prioritario, grupo de edad, condición de salud, evolución del tratamiento y motivo de la elección del centro de atención y motivos de la consulta. Se encontró que el 81,97% de los pacientes era menor de 14 años y que el 78,69% pertenecían al grupo de 5 a 14 años. La mayor parte de los pacientes declaró de buena salud pero, simultáneamente, hubo un alto porcentaje que manifestó haber padecido de ciertas dolencias. Del total de pacientes estudiados, el 73,77% fue dado de alta, cifra satisfactoria. El estímulo principal para haber acudido a la consulta fue la cercanía del domicilio del paciente. Sobre la base del estudio, el grupo de investigación recomendó una revisión de las normas para los servicios odontológicos a nivel nacional; la adecuácion de las actividades a los espacios físicos; la planificación de la integración servicio-docencia; el estímulo de las actitudes innovadoras de los profesionales de servicio y de docencia y, por último, la ampliación del programa de formación de recursos humanos dentro de la integración servicio-docencia hacia las comunidades y no su limitación a actividades intramurales