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ABSTRACT Objectives: To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. Patients and Methods: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. Results: Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. Conclusion: Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection.
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OBJECTIVES: To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. PATIENTS AND METHODS: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. RESULTS: Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. CONCLUSION: Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection.
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Vasectomia , Masculino , Humanos , Vasectomia/efeitos adversos , Vasectomia/métodos , Cauterização/métodos , Ligadura , Instrumentos Cirúrgicos , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate the occlusive failure risk of ligation and excision with fascial interposition vasectomy technique. There are doubts about the effectiveness of this technique largely used in Asia and Latin America. STUDY DESIGN: We conducted a prospective longitudinal observational descriptive study among men who underwent a vasectomy performed under local anesthesia in a clinic specializing in sexual and reproductive health services in Bogotá, Colombia. Three urologists used the Percutaneous No-Scalpel Vasectomy technique to isolate the vas deferens. They then ligated the vas, excised a 1 cm segment between ligations, and ligated the fascia on the prostatic end to cover the testicular end. We requested all patients to submit a semen sample three months after the vasectomy. We defined probable and confirmed vasectomy failure as 1-4.9 million sperm/ml and 5 million sperm/ml or more or any number of motile sperm observed on the last semen sample available, respectively. RESULTS: Among 1149 participants, 581 (51%) had at least one post-vasectomy semen analysis. The overall failure risk was 5.2% (30/581; 95% confidence interval [CI] 3.6%-7.3%) with probable and confirmed failure risk of 1.9% (11/581; 95% CI 1.1%-3.4%) and 3.3% (19/581; 95% CI 2.1%-5.1%), respectively. Older men and one urologist had statistically significant higher risk of overall failure. CONCLUSION: Our study confirmed that the ligation and excision with fascial interposition vasectomy technique is associated with an unacceptable risk of failure. IMPLICATIONS: Surgeons who use the ligation and excision with fascial interposition vasectomy technique and countries with large vasectomy programs in Asia and Latin America that still recommend this technique should consider adopting alternatives to reduce the failure risk to below 1% as recommended by the American Urological Association.
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Risco , Falha de Tratamento , Vasectomia/métodos , Adulto , Fatores Etários , Colômbia , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Contagem de Espermatozoides , Instrumentos Cirúrgicos , Ducto Deferente/cirurgiaRESUMO
Cartagena Bay (CB) is an industrialized site in the Caribbean. The aim of this study was to evaluate contamination patterns by trace elements in sediments from CB. Sediment samples from twelve sites in CB, and three at the Grand Marsh of Santa Marta (GMSM), a reference site, were collected during dry and rainy seasons. Forty-four trace elements were evaluated employing ICP-MS, and mercury (Hg) was measured using a Hg analyzer. Most contaminated sites corresponded to stations related to repair and maintenance of ships, with high concentrations of Cr, Cu, As and Cd; as well as in areas where cargo transshipment centers and cruise ship terminals operate, which showed elevated levels of Ba. Stations receiving inputs from petrochemical and fertilizer plants displayed high content of Pb. At the station where an extinct chlor-alkali plant was located, a high total Hg level was found, highlighting its persistence. At least 70% of the samples presented Cr, Cu, and As concentrations that were ≥ Threshold Effect Level, < Probable Effect Level, ≥ Effects Range Low and < Effects Range Medium, suggesting adverse biological effects could occur occasionally. Potential Ecological risk values revealed that only Hg and Cd may generate deleterious effects to the aquatic life. However, with few exceptions, sediment samples from CB can be considered as moderately to heavily contaminated, as shown by the Igeo. In short, the principles of ecosystem-based management should be implemented along Cartagena Bay to guarantee safe levels of trace elements in sediments and a better quality of this estuary.
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Baías/química , Sedimentos Geológicos/química , Medição de Risco , Oligoelementos/análise , Poluentes Químicos da Água/análise , Região do Caribe , Ecossistema , Monitoramento Ambiental , Desenvolvimento Industrial , Mercúrio/análise , Metais Pesados/análise , Estações do AnoRESUMO
How did the forced migration of nearly 11 million enslaved Africans to the Americas influence their knowledge of plants? Vernacular plant names give insight into the process of species recognition, acquisition of new knowledge, and replacement of African species with American ones. This study traces the origin of 2,350 Afro-Surinamese (Sranantongo and Maroon) plant names to those plant names used by local Amerindians, Europeans, and related groups in West and Central Africa. We compared vernacular names from herbarium collections, literature, and recent ethnobotanical fieldwork in Suriname, Ghana, Benin, and Gabon. A strong correspondence in sound, structure, and meaning among Afro-Surinamese vernaculars and their equivalents in other languages for botanically related taxa was considered as evidence for a shared origin. Although 65% of the Afro-Surinamese plant names contained European lexical items, enslaved Africans have recognized a substantial part of the neotropical flora. Twenty percent of the Sranantongo and 43% of the Maroon plant names strongly resemble names currently used in diverse African languages for related taxa, represent translations of African ones, or directly refer to an Old World origin. The acquisition of new ethnobotanical knowledge is captured in vernaculars derived from Amerindian languages and the invention of new names for neotropical plants from African lexical terms. Plant names that combine African, Amerindian, and European words reflect a creolization process that merged ethnobotanical skills from diverse geographical and cultural sources into new Afro-American knowledge systems. Our study confirms the role of Africans as significant agents of environmental knowledge in the New World.
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Pessoas Escravizadas , Plantas/classificação , Terminologia como Assunto , África/etnologia , Humanos , América do Sul , Especificidade da EspécieRESUMO
Folk perceptions of health and illness include cultural bound syndromes (CBS), ailments generally confined to certain cultural groups or geographic regions and often treated with medicinal plants. Our aim was to compare definitions and plant use for CBS regarding child health in the context of the largest migration in recent human history: the trans-Atlantic slave trade. We compared definitions of four CBS (walk early, evil eye, atita and fontanels) and associated plant use among three Afro-Surinamese populations and their African ancestor groups in Ghana, Bénin and Gabon. We expected plant use to be similar on species level, and assumed the majority to be weedy or domesticated species, as these occur on both continents and were probably recognized by enslaved Africans. Data were obtained by identifying plants mentioned during interviews with local women from the six different populations. To analyse differences and similarities in plant use we used Detrended Component Analysis (DCA) and a Wald Chi-square test. Definitions of the four cultural bound syndromes were roughly the same on both continents. In total, 324 plant species were used. There was little overlap between Suriname and Africa: 15 species were used on two continents, of which seven species were used for the same CBS. Correspondence on family level was much higher. Surinamese populations used significantly more weedy species than Africans, but equal percentages of domesticated plants. Our data indicate that Afro-Surinamers have searched for similar plants to treat their CBS as they remembered from Africa. In some cases, they have found the same species, but they had to reinvent the largest part of their herbal pharmacopeia to treat their CBS using known plant families or trying out new species. Ideas on health and illness appear to be more resilient than the use of plants to treat them.
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Etnofarmacologia , Transtornos Mentais/tratamento farmacológico , Plantas Medicinais , Adolescente , África Ocidental , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Suriname , SíndromeRESUMO
Los hemangiomas capilares son lesiones tumorales benignas comunes en diferentes localizaciones. Sin embargo la afección del sistema central es extremadamente inusual. En la literatura tan solo han sido reportados 7 casos de hemangiomas capilares de localización exclusiva intramedular y poco más de 20 casos con compromiso extramedular adicional. Reportamos un paciente adolescente alteración motora y sensitiva progresivo del miembro superior izquierdo asociado a cervicalgia y espasmos musculares cervicales. La resonancia magnética reveló la presencia de una lesión medular cervical sugestiva de neoplasia con un importante componente vascular. Durante la resección no se observó compromiso extra-medular. Los exámenes histopatológico e inmunohistoquímico confirmaron el diagnostico de hemangioma capilar. Si bien, se han publicado muy pocos casos de hemangiomas capilares intramedulares, se cree que puede existir un importante subregistro. En general constituyen una patología benigna de buen pronóstico y que no requiere de manejos adyuvantes como quimio o radioterapia, pero si de un seguimiento neurológico.
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Humanos , Hemangioma , Neurologia , ParesiaRESUMO
Objetivo: determinar la concordancia entre observadores para medir la función de sensibilidad al contraste empleando el test CSV 1000E en un grupo de infantes entre los siete a diez años. Metodología: fueron evaluados cincuenta niños (cien ojos) visualmente sanos empleando el CSV 1000E. Cada infante fue evaluado por dos evaluadores el mismo día con una diferencia de 30 minutos entre evaluaciones. Resultados: la curva de sensibilidad al contraste promedio fue normal, aunque superior hacia las frecuencias espaciales altas, al ser comparada con un estudio similar (López, 2003). La concordancia obtenida fue muy pobre coeficiente de correlación concordancia de Lin (pc<0.90) para todas las frecuencias espaciales, debido a la falta de precisión del test; los límites de acuerdo fueron más amplios a los publicados en otra investigación (Pomerance & Evans, 1994). Conclusiones: los resultados encontrados muestran que el test tiene una baja concordancia, lo que indicaría una pobre validez para medir la función de sensibilidad al contraste en niños.
The purpose of this trial was determinate the test retest reliability between evaluators to measurement contrast sensitivity function using the CSV 1000E test in children between 7-10 years. Methods: fifty visually-healthy children were tested using the CSV1000E. Each children was seen by 2 evaluators the same day, thirty minutes apart from each evaluations. Results: the contrast sensitivity curve function was normal, although it was higher for high spatial frequencies when compared to that was it found in another trial (López, 2003). test retest reliability was poor (pc<0.90) for all spatial frequencies because the CSV 1000 precision was low, 95 por ciento limits of agreement were wider than found in another research project (Pomerance y Evans, 1994). Conclusions: the results have shown that CSV 1000 had low agreement, means this test has poor reliability to assess contrast sensitivity function in children.