Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates / Inserção de dispositivo intrauterino de cobre no pós-parto imediato em hospital universitário brasileiro: Taxas de expulsão e continuação

Abstract Objective To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. Materials and Methods In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. Results There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. Conclusion Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.

Resumo Objetivo Avaliar as taxas de expulsão e continuação do dispositivo intrauterino (DIU) de cobre inserido no pós-parto imediato em um hospital universitário brasileiro. Materiais e Métodos Neste estudo de corte transversal, foram incluídas parturientes submetidas à inserção de DIU de cobre no pós-parto imediato entre março de 2018 e dezembro de 2019. Foram coletados dados clínicos e da ultrassonografia (US) transvaginal realizada após seis semanas. As taxas de expulsão e de continuação foram avaliadas após seis meses por meio de dados do prontuário ou por contato telefônico. O resultado principal foi a proporção de DIUs expelidos em seis meses. Para análise estatística, utilizaram-se o teste t de Student, a distribuição de Poisson, e o teste do Qui quadrado. Resultados Houve 3,728 nascimentos no período, e foram inseridos 352 DIUs, em uma taxa de 9,4%. Com 6 semanas, o DIU estava bem posicionado em 65,1% dos casos, em 10,8%, houve expulsão parcial, e, em 8,5%, fora totalmente expelido. Aos 6 meses de pós-parto, foram obtidas informações de 234 mulheres, 74,4% das quais usavam DIU, com uma taxa de expulsão geral de 25,6%. A taxa de expulsão foi maior após o parto vaginal do que após cesariana (68,4% versus 31,6%, respectivamente; p = 0,031). Não houve diferenças quanto à idade, paridade, idade gestacional, índice de massa corpórea final, e peso do recém-nascido. Conclusão Apesar da baixa taxa de inserção e alta taxa de expulsão, a taxa de continuação em longo prazo da contracepção intrauterina com DIU de cobre foi elevada, o que indica que se trata de intervenção útil para prevenir gestações indesejadas em curto intervalo de tempo.

Categorias de Aptidão Física Baseadas no VO2max em População Brasileira com Suposto Alto Nível Socioeconômico e sem Cardiopatia Estrutural / VO2max-Based Physical Fitness Categories in a Brazilian Population with Supposed High Socioeconomic Status and without Structural Heart Disease

Resumo Fundamento Os dados mais utilizados como referência de aptidão cardiorrespiratória (ACR) são os de Cooper, que utiliza valores calculados de captação máxima de oxigênio (VO2máx). Objetivo Desenvolver valores de ACR a partir do teste cardiopulmonar de exercício (TCPE) em uma população brasileira com alto nível socioeconômico e livre de cardiopatia estrutural. Os resultados dos testes de VO2max foram comparados aos dados de Cooper e do FRIEND Registry. Métodos Foram utilizados neste estudo dados de TCPE de indivíduos consecutivos entre 1º de janeiro de 2000 e 31 de maio de 2016. Os critérios de inclusão foram: VO2máx pré-definido. Foi construído um gráfico de ACR de acordo com os percentuais do VO2máx: muito ruim (≤20%), ruim (20-40%), regular (40-60%), boa (60-80%), excelente (80-90%), e superior (≥90%). A correlação Kappa foi usada para analisar nossos dados em comparação aos dados dos outros dois bancos de dados. Os testes estatísticos com p<0,005 foram considerados significativos. Resultados A coorte final incluiu 18.186 testes: 12.552 homens, 5.634 mulheres (7 a 84 anos). A resposta mais recorrente foi "boa" (20,2%). Houve diferença média de peso, altura, índice de massa corporal (IMC) e idade no gráfico da ACR. Houve correlação inversa entre VO2máx e idade, peso e IMC. Usando uma regressão linear e essas variáveis, uma equação preditiva foi desenvolvida para o VO2máx. Nossas descobertas diferiram das dos outros bancos de dados. Conclusão Desenvolvemos uma classificação para a ACR e encontramos valores mais altos em todas as faixas de classificação de capacidade funcional, em contraste com os dados de Cooper e do FRIEND Registry. Nossos achados oferecem uma interpretação mais precisa da ACR nessa grande amostra populacional brasileira, quando comparados aos padrões anteriores, com base no VO2máx estimado. (Arq Bras Cardiol. 2020; 115(3):468-477)

Abstract Background The most widely used data for cardiorespiratory fitness (CRF) referrals are from the Cooper Clinic, which uses calculated maximal oxygen uptake (VO2max) values. Objective To develop CRF values from cardiopulmonary exercise testing (CPX) in a Brazilian population with high socioeconomic level and free of structural heart disease. VO2max testing results were compared with the Cooper Clinic and FRIEND Registry data. Methods CPX data from consecutive individuals between January 1,2000, and May 31,2016 were used in this study. Inclusion criteria were: VO2max by a pre-specified definition. We built a CRF chart according to VO2max percentiles: very poor (≤20%), poor (20-40%), fair (40-60%), good (60-80%), excellent (80-90%), and superior (≥90%). Kappa correlation was used to analyze our data in comparison with that of the other two databases. Statistical tests with p<0.005 were considered significant. Results Final cohort included 18,186 tests: 12,552 men, 5,634 women (7-84 years). The most recurrent response was "good" (20.2%). There was a mean difference in weight, height, body mass index (BMI), and age in the CRF chart. An inverse correlation existed between VO2max and age, weight, and BMI. Using a linear regression and these variables, a predictive equation was developed for VO2max. Our findings differed from that of the other databases. Conclusion We developed a classification for CRF and found higher values in all classification ranges of functional capacity in contrast to the Cooper Clinic and FRIEND Registry. Our findings offer a more accurate interpretation of ACR in this large Brazilian population sample when compared to previous standards based on the estimated VO2max. (Arq Bras Cardiol. 2020; 115(3):468-477)

Effect Of Dynamic Neuromuscular Stabilization Therapy Vs Parachute Resistance Training On Performance Level In Race Walkers: Comparative Study

Background: Race walking significantly places stress on the lower extremity joints affecting ADLs. The gait pattern of race walking is different than normal walking that causes biomechanical alterations leading to musculoskeletal disabilities. DNS (Dynamic Neuromuscular Stabilization) therapy is based on developmental kinesiology and the integration of neurophysiology and biomechanical principles in which each purposeful movement pattern is reinforced by the coordination between every segmented required for postural stability. Parachute Resistance training works on the principle of air resistance and terminal velocity, which helps in improving lower extremity muscle strength and power, decreasing the stress put on joints during physical activity. Methods: The study was completed by using a stratified sampling technique among the race walkers between the age group of 18-29 years, a total of 40 race walkers (20 males and 20 females) were selected based on the inclusion and exclusion criteria by approaching various sports academies. Participants were divided into two groups, Group A and Group B. The groups consisted of 20 participants each. They were verbally interviewed regarding their demographics. Pre-treatment assessment of vo2max and speed was done using the Cooper test and sprint test, respectively. Participants in group A underwent Dynamic Neuromuscular Stabilization Technique, and group B underwent a Parachute resistance training program, and post-treatment assessment of all the parameters was done. Results: DNS Therapy shows significant improvement in the performance level of race walkers in group A as compared to Group B with p-value 0.003 and 0.001. Conclusion: The study concluded that DNS therapy and Parachute resistance training exercises are equally effective in improving the performance level in race walkers.

Disulfiram combined with cooper inhibits proliferation and induces apoptosis of osteosarcoma / 中国组织工程研究

BACKGROUND: Studies have shown that disulfiram has anti-tumor activity, which can be combined with copper (Cu) ions to exert an anti-tumor effect on multiple tumors in vivo and in vitro, but the effect of disulfiram on osteosarcoma proliferation and apoptosis has not been clarified. OBJECTIVE: To investigate the effect of disulfiram combined with Cu on osteosarcoma proliferation and apoptosis and the possible mechanism in vivo and in vitro. METHODS: The study protocol was approved by the Animal Ethics Committee of Shanxi Medical University (approval No. 2017LL077). (1) In vitro study: Diethyldithiocarbamate (DDTC)-Cu (0.5, 1, 2, 3, and 5 μmol/L) was configured with Cu and DDTC which is the transformation of disulfiram after absorbed by bodies. DDTC single drug (5 μmol/L), Cu single drug (5 μmol/L) and blank control groups were set. Osteosarcoma cell lines Saos-2 and MG-63 were treated with drugs, and cell counting kit-8 assay was used to detect the inhibitory effect of DDTC-Cu at different concentrations on the proliferation of Saos-2 and MG-63 cells. Changes in Saos-2 apoptosis were measured by AnnexinV-FITC/PI staining. (2) In vivo study: A total of 10 BALB/c-nu/nu female nude mice of 4 weeks old were randomly divided into DDTC-Cu group and control group. The mixture of Saos-2 cells and Matrigel (1:1 mixed, 400 μL per mouse) was injected subcutaneously into the right back of nude mice. Two weeks after inoculation, model mice were intraperitoneally injected dexamethasone (0.5 mg/kg once every other day) in the control group, and dexamethasone (0.5 mg/kg once every other day) and DDTC-Cu complex (10 nmol/g once every other day) in the DDTC-Cu group. Xenograft tumors in each group were measured at regular intervals and tumor growth curves were drawn. Five weeks after inoculation, the animals were sacrificed under anesthesia, and tumors were completely removed. Immunohistochemistry was used to detect the expression level of ki67 protein in tumor paraffin sections. The expressions of proteins related to cell proliferation and apoptosis and JNK pathway proteins were determined by western blot analysis. RESULTS AND CONCLUSIONS: (1) In vitro study: The proliferation inhibition in the DDTC-Cu group was significantly stronger than that in the DDTC single drug, Cu single drug and blank control groups. Cell counting kit-8 results showed that DDTC-Cu inhibited osteosarcoma proliferation in a dose-dependent manner, with 50% inhibiting concentration of 0.337 μmol/L (Saos-2) and 0. 487 μmol/L (MG-63) for 24 hours, respectively. The results of flow cytometry showed that DDTC-Cu promoted Saos-2 apoptosis in a dose-dependent manner. (2) In vivo study: The tumor volume and mass of the DDTC-Cu group were smaller than those of the control group. Immunohistochemical results showed that the expression level of ki-67 protein in the DDTC-Cu group was lower than that in the control group. Western blot results showed that the expression levels of p-JNK and c-jun in the DDTC-Cu group were up-regulated. To conclude, disulfiram combined with Cu inhibits proliferation and induces apoptosis of osteosarcoma in vitro and in vivo, and its mechanism may be related with activation of JNK signaling pathway.

Síndrome de Wilson: relato de caso / Wilson´s Disease: a case repor

Objetivos: Este relato descreve um distúrbio genético raro, denominado de Síndrome de Wilson, herdado em caráter autossômico recessivo, com sintomas muito facilmente confundidos com outras doenças. A causa básica responsável pelas manifestações clínicas é o acúmulo de cobre em diversos compartimentos do organismo humano, especialmente em locais como fígado, cérebro, rins e córneas, devido a mutações no gene ATP7B que codifica a Cu+2 ATPase, uma proteína transportadora de cobre que está localizada no complexo de Golgi dos hepatócitos. As alterações hepáticas podem se apresentar como hepatite crônica, cirrose e, mais raramente, hepatite fulminante. As alterações neurológicas são variáveis, predominando os sintomas extrapiramidais, tremores, distonia, disartria, alterações de humor, sintomas psiquiátricos e, se não tratada, diminuição progressiva da capacidade intelectual. Uma das características mais extraordinárias dessa síndrome é a grande variabilidade de manifestações fenotípicas em pacientes que possuem a mesma mutação. No diagnóstico da doença de Wilson são analisados diversos parâmetros bioquímicos, sendo eles: ceruloplasmina sérica, cobre sérico, excreção urinária de cobre e concentração hepática de cobre. Além disso, realiza-se exame oftalmológico com a observação de anéis de Kayser ­ Fleischer. A fim de complementar e facilitar o diagnóstico podem ser realizados estudos genéticos, visto que muitas vezes os sintomas e alterações laboratoriais podem estar associados a outras doenças. O tratamento baseia-se no uso de drogas quelantes do cobre. A Dpenicilamina é a droga de escolha, apesar do risco de piora neurológica em até 50% dos pacientes e dos diversos efeitos colaterais associados ao seu uso. Trientina e tetratiomolibdato são drogas alternativas, sendo a última escolhida para indivíduos com sintomas neurológicos. O zinco tem indicação em assintomáticos ou em terapia de manutenção. O tratamento precoce evita graves complicações. Relato de caso: Paciente de 14 anos de idade, natural de Poço Fundo-MG, procurou atendimento médico por apresentar episódios frequentes de paralisia facial, principalmente na região mandibular, que levava à disfagia e disfonia, além de irritabilidade e anormalidades na marcha. Foi submetida ao exame de ressonância magnética que mostrou "alteração de sinal simétrica nos corpos estriados bilateralmente, com sinais de edema dos putâmens e núcleos caudados, e atrofia dos globos pálidos. Diante do histórico familiar para a síndrome de Wilson, foi realizado o diagnóstico diferencial, por meio da concentração de sérica de ceruloplasmina e cobre sérico e urinário, que mostraram alterações típicas da síndrome de Wilson e a biomicroscopia ocular que constatou a presença do anel de Kayser-Fleischer. Conclusões: Ainda há um longo caminho a ser seguido no que se diz respeito ao diagnóstico precoce da Síndrome de Wilson. Nesse caso, a paciente não apresentou hepatopatia pregressa. Isso mostra que a doença nem sempre se apresenta da forma esperada, e reflete a dificuldade de estabelecer um diagnóstico precoce que possa impedir o surgimento dos primeiros sintomas. Todos os portadores da síndrome de Wilson necessitam de atendimento multidisciplinar, (AU)

Objectives: This report describes a rare genetic disorder, called Wilson's Disease, inherited in an autosomal recessive form, with symptoms very easily confused with other diseases. The underlying cause of the clinical manifestations is the accumulation of copper in various compartments of the human body, especially in places such as liver, brain, kidneys and corneas, due to mutations in the ATP7B gene encoding Cu + 2 ATPase, a copper carrier protein which is located in the Golgi complex of hepatocytes. Liver changes may present as chronic hepatitis, cirrhosis and, more rarely, fulminant hepatitis. Neurological changes are variable, predominantly extrapyramidal symptoms, tremors, dystonia, dysarthria, mood changes, and psychiatric symptoms, if not treated, progressive decrease in intellectual capacity. One of the most extraordinary characteristics of this syndrome is the great variability of phenotypic manifestations in patients who have the same mutation. In the diagnosis of Wilson's disease, several biochemical parameters are analyzed: serum ceruloplasmin, serum copper, urinary excretion of copper and hepatic copper concentration. In addition, an ophthalmologic examination is performed with Kayser-Fleischer rings observation. In order to complement and facilitate the diagnosis, genetic studies can be performed, since the symptoms and laboratory abnormalities can often be associated with other diseases. Treatment is based on the use of copper chelating drugs. D-penicillamine is the drug of choice, despite the risk of neurological worsening in up to 50% of patients and the various side effects associated with its use. Trientin and tetrathiomolybdate are alternative drugs, the latter being chosen for individuals with neurological symptoms. Zinc is indicated for asymptomatic or maintenance therapy. Early treatment prevents serious complications. Case report: A 14-year-old patient from Poço Fundo-MG sought medical attention because of frequent episodes of facial paralysis, especially in the mandibular region, leading to dysphagia and dysphonia, as well as irritability and gait abnormalities. She underwent magnetic resonance imaging (MRI), which showed "symmetrical signal changes in the bilaterally striatum, with signs of edema of the caudate nuclei and caudate nuclei, and atrophy of the pale globes." In view of the family history of Wilson's syndrome, a differential diagnosis was performed, by serum concentration of ceruloplasmin and serum and urinary copper, which showed typical changes in Wilson's syndrome and ocular biomicroscopy, which verified the presence of the Kayser-Fleischer ring. The patient did not present previous liver disease, showing that the disease does not always present as expected, and reflects the difficulty in establishing an early diagnosis that may prevent the emergence of the first symptoms. All patients with Wilson's syndrome require multidisciplinary care since it is a disease that can significantly affect various organs and systems (AU)

Influence of iron and copper on the activity of laccases in Fusarium oxysporum f. sp. lycopersici

ABSTRACT Fusarium oxysporum f. sp. lycopersici is a phytopathogenic fungus that causes vascular wilt in tomato plants. In this work we analyze the influence of metal salts such as iron and copper sulphate, as well as that of bathophenanthrolinedisulfonic acid (iron chelator) and bathocuproinedisulfonic acid (copper chelator) on the activity of laccases in the intra (IF) and extracellular fractions (EF) of the wild-type and the non-pathogenic mutant strain (rho1::hyg) of F. oxysporum. The results show that laccase activity in the IF fraction of the wild and mutant strain increased with the addition of iron chelator (53.4 and 114.32%; respectively). With copper, it is observed that there is an inhibition of the activity with the addition of CuSO4 for the EF of the wild and mutant strain (reduction of 82 and 62.6%; respectively) and for the IF of the mutant strain (54.8%). With the copper chelator a less laccase activity in the IF of the mutant strain was observed (reduction of 53.9%). The results obtained suggest a different regulation of intracellular laccases in the mutant strain compared with the wild type in presence of CuSO4 and copper chelator which may be due to the mutation in the rho gene.

Influence of iron and copper on the activity of laccases in Fusarium oxysporum f. sp. lycopersici

ABSTRACT Fusarium oxysporum f. sp. lycopersici is a phytopathogenic fungus that causes vascular wilt in tomato plants. In this work we analyze the influence of metal salts such as iron and copper sulphate, as well as that of bathophenanthrolinedisulfonic acid (iron chelator) and bathocuproinedisulfonic acid (copper chelator) on the activity of laccases in the intra (IF) and extracellular fractions (EF) of the wild-type and the non-pathogenic mutant strain (rho1::hyg) of F. oxysporum. The results show that laccase activity in the IF fraction of the wild and mutant strain increased with the addition of iron chelator (53.4 and 114.32%; respectively). With copper, it is observed that there is an inhibition of the activity with the addition of CuSO4 for the EF of the wild and mutant strain (reduction of 82 and 62.6%; respectively) and for the IF of the mutant strain (54.8%). With the copper chelator a less laccase activity in the IF of the mutant strain was observed (reduction of 53.9%). The results obtained suggest a different regulation of intracellular laccases in the mutant strain compared with the wild type in presence of CuSO4 and copper chelator which may be due to the mutation in the rho gene.

Índice de massa corporal e desempenho cardiorrespiratório em militares / Índice de masa corporal y desempeño cardiorrespiratorio en militares / Index body mass and cardiorespiratory performance in militaries

Introdução: É necessário que os militares mantenham um condicionamento físico que os capacite ao desempenho de suas funções. Por questões de testes rotineiros e ou por detecção de estado de saúde, investigar parâmetros de condicionamento físico se faz necessário. Objetivo: Identificar se existe correlação entre o Índice de massa corporal e o desempenho de militares no teste de Cooper. Métodos: Pesquisa original do tipo descritiva por correlação entre dados, com corte transversal. A amostra foi composta por 32 policiais do serviço administrativo do Batalhão de Ações com Cães da Policia Militar do estado do Rio de Janeiro, voluntários, com 39,84±3,08 anos de idade, todos do sexo masculino. Foi feita a medição de massa corporal e estatura dos policiais, a fim de obter o Índice de Massa Corporal (IMC), além disso, foi aplicado testes de Cooper (12 minutos). Resultados: Os valores de IMC foram 27,02 ± 3,14 e Cooper 2479,06 ± 270,73m. Com a realização desses testes foi verificado correlação moderada entre ambos. A correlação foi feita através do coeficiente de Pearson que resultou r=-0,52 e um nível de significância de 0,002. Conclusão: Os policiais apresentaram maior frequência de sobrepeso, porém tal fator parece não influenciar no nível de aptidão física destes indivíduos, uma vez que a maior parte da amostra teve bom desempenho no teste de Cooper(AU)

Introducción: Es necesario que los militares mantengan un condicionamiento físico que los capacite para el desempeño de sus trabajos. Por motivos de pruebas rutinarias y / o por detección de estado de salud, investigar parámetros de acondicionamiento físico se hace necesario. Objetivo: identificar si existe una correlación entre el índice de masa corporal y el rendimiento militar en la prueba de Cooper. Métodos: estudio original de tipo descriptivo por correlación entre datos, con corte transversal. Se incluyeron 32 agentes hombres del Departamento Administrativo del batallón de acciones con los perros de la policía militar del estado de Río de Janeiro, con 39,84 ± 3,08 años de edad. Se encontró la altura y el peso de los sujetos para obtener el Índice de Masa Corporal (IMC), además, se aplicó la prueba de Cooper (12 minutos). Resultados: los valores de IMC fueron 27,02 ± 3,14 y Cooper 2479,06 ± 270,73m. Con la realización de estas pruebas se encontró correlación moderada entre ambos. La correlación se realizó mediante el coeficiente de Pearson r = -0,52 dado y un nivel de significación de 0,002. Conclusiones: la mayoría de los agentes de policía mostraron sobrepeso, pero este factor no influyó en el nivel de forma física de estas personas, ya que la mayoría de la muestra tuvo un buen rendimiento en la prueba de Cooper(AU)

Introduction: It is necessary for the military to maintain a physical condition that enables them to perform their jobs. For reasons of routine testing and / or detection of health status, investigating physical fitness parameters is necessary. Objective: This study aimed to Identify if there is a correlation between the index body mass and the cooper test and the performance of militaries in the cooper test. Methods: Original research of the descriptive type by correlation between data, with cross-section. The sample was composed for 32 policies of the administrative service of the Action's Battallion with dogs of the military police of the Rio de Janeiro state, with voluntaries with 39,84 ±3,08 years old, all of male. It was made the measurement of the corporal mass and the height of the policies to obtain the index body mass, and it was applied the cooper test (12 minutes). Results: The BMI values were 27.02 ± 3.14 and Cooper 2479.06 ± 270.73m. With the tests a moderate influence of BMI was observed in the outcome of the Cooper test. The correlation was made with the Pearson's coefficient that result r=-0,52 and a significance level of 0,002. Conclusions: The police had higher frequency of overweight, however this factor apparently not influence the physical aptitude of this men, once the bigger part of the sample had a good performance in the cooper test(AU)

Copper-Zinc ratio and nutritional status in colorectal cancer patients during the perioperative period

PURPOSE : This study aimed to determine Cu/Zn ratio, nutritional and inflammatory status in patients during the perioperative period for colorectal cancer. METHODS: The study included patients with histological diagnosis of colorectal adenocarcinoma (Cancer Group, n=46) and healthy volunteers (Control Group, n=28). We determined habitual food intake, body composition, laboratory data of nutritional status, serum calprotectin and plasma Cu and Zn concentrations. Mann-Whitney U-test was performed between-group comparisons and Spearman correlation test for correlations between the variables. RESULTS: Individuals in the Cancer Group presented significantly lower BMI, fat mass, plasma hemoglobin, total protein and albumin as compared with the Control Group. Serum calprotectin[70.1 ng/mL (CI95% 55.8-84.5) vs.53.3 ng/mL (40.3-66.4), p=0.05], plasma Cu concentrations [120 µg/dL(CI95% 114-126) vs. 106 µg/dL(CI95% 98-114), p<0.01] and the Cu/Zn ratio [1.59 (CI95% 1.48-1.71)vs. 1.35 (CI95% 1.23-1.46), p=0.01]were higher in patients with colorectal cancer than in controls. Additionally, the Cancer Group showed negative correlations between the Cu/Zn ratio and Zn intake, hemoglobin, serum albumin, and positive correlation between the Cu/Zn ratio and serum calprotectin. CONCLUSION: These results indicate that an increased plasma Cu/Zn ratio and serum calprotectin, and decreased protein values may be a result of the systemic inflammatory response to the tumor process.

Translocación de dispositivo intrauterino. Reporte de un caso / Translocation of intrauterine device. Report of a case

La translocación de dispositivo intrauterino (DIU) es poco frecuente, con afección a órganos vecinos como el recto-sigmoide, la vejiga y el ovario; luego de la perforación uterina por migración de DIU se justifica su inmediata extracción de la cavidad abdominal. Presentamos el caso clínico de una mujer de 38 años de edad, que cursó con una perforación parcial de dispositivo intrauterino que causó dolor pélvico en la mujer.

Translocation of an intrauterine device (IUD), is slightly frequent, affecting neighboring organs like the rectal sigmoid, bladder and ovaries. After uterine perforation, because of IUD migration, immediate removal of the abdominal cavity is justified. We present a case of a 38 year-old woman who had a partial perforation by an intrauterine device causing pelvic pain.

Protocolo de manejo de hernia inguinal en el servicio de cirugía general del hospital Dr. Teodoro Maldonado Carbo, Guayaquil / Protocol of handling of inguinal hernia in the service of general surgery of the Hospital Dr. Teodoro Maldonado Carbo, Guayaquil

Se propone un protocolo de manejo para la patología herniaria en el Servicio de Cirugía General del Hospital Dr. Teodoro Maldonado Carbo de Guayaquil, cuyo propósito es unificar criterios para el manejo de esta patología tan frecuente en nuestro medio; siendo el objetivo principal disminuir las recurrencias, que fluctúan entre 4 y 6% según las estadísticas mundiales; independientemente de las variables atribuibles al equipo quirúrgico y evaluación exacta de cada caso.Como conclusiones podemos mencionar que la causa principal de recidiva es la tensión en la línea de sutura y que la técnica de Shouldice es la apropiada cuando existe defecto de la pared posterior. Este artículo resume una propuesta para el manejo de esta patología muy frecuente como resultado de la experiencia en este servicio.

We intend to propose a protocol for handling a hernial pathology in the Service of General Surgery of the Hospital of the I.E.S.S of Guayaquil. Our purpose is to unify criteria for the handling of this pathology that is very frequent in our society. Our main objective is to lower recurrences that are between 4 and 6% according to world statistics independent from variables such as surgery equipment and the evaluation of each case.As a conclusion the main cause of recurrence is the suture line tension. We also want to conclude that the Shouldice technique should be used when there is a defect on the posterior wall. This article summarizes a proposal of the handling of this pathology that is very frequent at our service.

Clinical Outcome Between Fixations of the Rectus Fascia to the Cooper's Ligament and Abdominal Wall in Pubovaginal Sling Operation

PURPOSE: Pubovaginal fascial sling for stress urinary incontinence has never achieved widespread application because of a perception that the complication rate (prolonged urinary retention and secondary detrusor instability) is relatively high. We performed modified pubovaginal fascial sling operation and compared the safety and efficacy of the Cooper's ligament fixation with those of abdominal wall fixation of rectus fascia in pubovaginal sling. MATERIALS AND METHODS: We retrospectively compared 30 women treated with pubovaginal fascial sling procedure as Blaivas described in 1995(Group I) with 30 women treated with a modified technique included fixation of sling to the Cooper's ligament(Group II). Patients were evaluated preoperatively with detailed history, physical examination, urodynamic study and incontinence staging. Postoperative outcome measures and complications were checked. RESULTS: Preoperative parameters, such as clinical and urodynamic data were comparable for both groups. With a mean follow-up of 5.4 months(range 1-14) for group I, 27(90%) were cured. In group II, with a mean follow-up of 6.7 months(range 1-11), 28(93%) were cured. Postoperative de novo urge incontinence was present in 6(20%) patients in group I. The hospital stays, periods of residual urine below 50ml and postoperative lower abdominal pain of group II were significantly lower than those of group I. Each group(97%) was either very satisfied or somewhat satisfied with their outcome. CONCLUSION: Modified pubovaginal fascial sling operation including the use of small piece of rectus fascia and fixation of sling to the Cooper's ligament is an effective treatment for stress incontinence with high cure and low complication rate. However, larger followup is needed to confirm our results.

Enfermedad de Wilson. Su diagnóstico en el adulto

Se estudiaron 19 pacientes adultos con edad entre 19 y 41 años en quienes sospechamos esta enfermedad por el cuadro clínico y los antecedentes personales y familiares. A todos se les realizaron las siguientes determinaciones: ceruloplasmina, cobre en sangre, cobre en orina, antes y después de la administración de D'penicilamina, prueba de función hepática, laparoscopia y biopsia hepática con determinación de cobre en tejido. Se realizó además examen oftalmológico con lámpara de hendidura en busca de anillo de Kaysser Fleisher. Sólo 9 reunieron los criterios para el diagnóstico de la entidad. Los exámenes de más valor para diagnosticar la enfermedad de Wilson en el adulto son cobre en tejido y cobre en orina, antes y después del tratamiento con D'penicilamina. Consideramos que en el adulto joven con antecedentes de íctero a repetición, transaminasas elevadas o hepatopatía crónica debe investigarse la enfermedad de Wilson.

A group of 19 adult patients aged 19-41 years who were supposed to present with Wilson's disease because of the clinical picture and personal and familial history, were studied. All patients underwent the following determinations: ceruloplasmin, blood copper, urine copper before and after the administration of D'penicillamine, a test for the hepatic function, laparoscopy and liver biopsy with tissue copper determination. Besides, and ophthalmologic examination with the use of a slitlamp to determine the presence or not of a kayser-Fleisher ring. Only 9 patients met criteria for the diagnosis of this entity. The most useful examinations to diagnose Wilson's disease in the adult is the determination of copper in tissue and copper in urine, before and after treatment with D'penicillamine. It is considered that in the young adult patients with history of repeated icterus, high transaminase values and chronic hepatopathy Wilson's disease should be investigated.

Hair Heavy Metal Contents in Mentally Retarded Children IV: In Association with Copper / 예방의학회지

The relationship between copper content in scalp hair and mental retardation was investigated. Samples of scalp hair were collected from 297 mentally retarded children who were students in one of two schools providing special educational services, one, consisted of children living in an orphan home, the other, children living with parents. For comparison, 117 scalp hair samples were collected from the children who had got average or above average academic achievement in a regular elementary school. Hair samples were taken from the nape of the neck and the copper content was determined by an atomic absorption spectrophotometer (IL 551). There was no statistically significant difference in scalp copper levels across different age groups except female orphan group, but no trend or correlation between copper contents and age was found. The hair copper contents of the group accompanied by Down's syndrome and unknown group were significantly lower than that of control group in both sex, and in the case of accompanied by epilepsy or autism, lower than control group in male. Although the results of this study show no evidence that mental retardation has owed to copper deficiency, the possibility of copper deficiency in their fetal or infant age could not be ruled out. Thus further study is needed to determine whether mental retardation could be attributed to copper deficiency. through the examinations about their living environments, dietary pattern, eating habit and the impact of copper deficiency on brain development.