Minimalist revision of Mesochorus Gravenhorst, 1829 (Hymenoptera: Ichneumonidae: Mesochorinae) from Área de Conservación Guanacaste, Costa Rica, with 158 new species and host records for 129 species / Revisión minimalista de Mesochorus Gravenhorst, 1829 (Hymenoptera: Ichneumonidae: Mesochorinae) del Área de Conservación Guanacaste, Costa Rica, con 158 especies nuevas y registros de hospedantes para 129 especies

Introduction: Species of Mesochorus are found worldwide and members of this genus are primarily hyperparasitoids of Ichneumonoidea and Tachinidae. Objectives: To describe species of Costa Rican Mesochorus reared from caterpillars and to a lesser extent Malaise-trapped. Methods: The species are diagnosed by COI mtDNA barcodes, morphological inspection, and host data. A suite of images and host data (plant, caterpillar, and primary parasitoid) are provided for each species. Results: A total of 158 new species of Mesochorus. Sharkey is the taxonomic authority for all. Conclusions: This demonstrates a practical application of DNA barcoding that can be applied to the masses of undescribed neotropical insect species in hyperdiverse groups.

Introducción: Las especies de Mesochorus se encuentran en todo el mundo y los miembros de este género son principalmente hiperparasitoides de las familias Ichneumonoidea y Tachinidae. Objetivos: Describir las especies de Mesochorus costarricenses obtenidas de orugas y en menor medida por trampas Malaise. Métodos: Las especies se diagnosticaron mediante el uso de código de barra molecular por COI del ADNmt, inspección morfológica y datos del huésped. Se proporciona un conjunto de imágenes y datos de los huéspedes (planta, oruga y parasitoide primario) para cada especie. Resultados: Se encontró un total de 158 nuevas especies de Mesochorus. Sharkey es la autoridad taxonómica para todas las especies. Conclusiones: Se demuestra una aplicación práctica del código de barras de ADN que se puede aplicar a grandes cantidades de especies de insectos neotropicales no descritas para grupos hiperdiversos.

Lipofuscinosis neuronal ceroidea tipo 2 (CLN2): primer caso diagnosticado en Panamá, causado por una variante patogénica del gen TPP1 producida por una mutación sin sentido

Se presenta el caso clínico de un paciente con Lipofuscinosis Neuronal Ceroidea tipo 2 (CLN2), condición genética producida por mutaciones en el gen TPP1. La CLN2 es una Enfermedad de Depósito Lisosomal (LSD), grupo de trastornos genéticos que forman parte de los Errores Innatos del Metabolismo, en los que se acumula un sustrato que no puede ser degradado a nivel de los lisosomas por la deficiencia en una enzima. En el caso de la CLN2, este déficit enzimático ocasiona un cuadro de deterioro neurológico acelerado con epilepsia refractaria, tratándose del primer caso descrito en la República de Panamá a la fecha. Esta condición es una enfermedad rara, y este reporte muestra la importancia de la necesidad de considerar la realización de paneles de diagnóstico genético cuando se presenta una epilepsia de difícil manejo en infantes. (provisto por Infomedic International)

The clinical case of a patient with Ceroid Neuronal Lipofuscinosis type 2 (CLN2), a genetic condition produced by mutations in the TPP1 gene, is presented. CLN2 is a Lysosomal Deposition Disease (LSD), a group of genetic disorders that are part of the Inborn Errors of Metabolism, in which a substrate accumulates that cannot be degraded at the level of the lysosomes due to a deficiency in an enzyme. In the case of CLN2, this enzymatic deficit causes an accelerated neurological deterioration with refractory epilepsy, being the first case described in the Republic of Panama to date. This condition is a rare disease, and this report shows the importance of the need to consider genetic diagnostic panels when a difficult-to-manage epilepsy occurs in infants. (provided by Infomedic International)

Validity and Reliability of the Reflux Symptoms Index Translated into Indonesian: The Role of Upper Endoscopy in Assessing Extra-Esophageal Gastroesophageal Reflux Disease Symptoms / 대한소화기학회지

Background/Aims@#The Reflux Symptom Index (RSI) is a questionnaire that evaluates the severity of extra-esophageal symptoms and is one of the most widely used measures to evaluate LPR. This study assessed the validity and reliability of the RSI questionnaire in Bahasa Indonesia and investigated the association between each extra-esophageal symptom reported in the questionnaire and the severity of erosive esophagitis as determined by endoscopic findings. @*Methods@#85 adult patients with GERD symptoms had an upper endoscopy examination and were asked to complete the translated RSI. The validity and reliability of the questionnaire were assessed. @*Results@#The construct validity of the RSI translated into Bahasa Indonesia was verified with the r value of each question being higher than the crucial table value (r>0.213, p<0.05). Our questionnaire had a Cronbach alpha value of 0.81, which indicates an acceptable level of internal consistency. At least one extra-esophageal symptom was seen in 91.7% of patients with Los Angeles (LA) grade B or higher-grade esophagitis. In addition, the presence of extra-esophageal symptoms was associated with significant mucosal erosion (p=0.20). The symptoms of cough after eating or lying down and chronic cough were associated with the severity of esophageal mucosal erosion (p<0.05). @*Conclusions@#The version of RSI translated into Bahasa Indonesia is a valid and reliable tool for assessing extra-esophageal GERD symptoms. The occurrence of extra-esophageal symptoms in patients with typical GERD symptoms is associated with endoscopic findings of LA grade B or erosive esophagitis of higher severity.

Comparison of RDQ and GERDQ for Predicting Erosive Esophagitis in Patients with Typical GERD Symptoms / 대한소화기학회지

Background/Aims@#The management decisions regarding gastroesophageal reflux disease (GERD) may differ according to the presence of erosive esophagitis. On the other hand, the availability of upper endoscopy in Indonesia is relatively limited. This study compared the Reflux Disease Questionnaire (RDQ) and the GERD questionnaire (GERDQ) performance in predicting the presence of clinically significant erosive esophagitis and determined the validity and reliability of the Indonesian-translated version of RDQ. @*Methods@#Ninety-two adults with GERD suspicion were recruited. All patients completed RDQ and GERDQ. Receiver operating curve analysis was conducted on RDQ and GERDQ to evaluate their performance in discriminating LA GERD B or higher esophagitis from others. The translated RDQ preserved its main structure and was culturally adapted. @*Results@#The patients were 66.3% female and 73.9% Javanese. Only 22 (23.9%) patients presented with LA grade B or higher erosive esophagitis. The RDQ showed a higher AUC than the GERDQ (0.602 vs. 0.589). A cutoff point of 20 was selected for the RDQ with sensitivity and specificity of 73% and 50%, respectively, whereas the optimal cutoff point of GERDQ was 8, with a sensitivity and specificity of 77% and 43%, respectively. The r-value greater than the critical value table (r>0.205, p<0.01) confirmed the construct validity of our translated RDQ. The questionnaire also demonstrated excellent reliability (α=0.900) and moderate similarity with the Indonesian version of GERDQ (κ=0.459, p<0.01). @*Conclusions@#The RDQ is slightly superior to GERDQ in predicting the presence of clinically significant erosive esophagitis (LA grade B or higher). The Indonesian-translated RDQ is valid and reliable.

Enfermedad de Huntington en población panameña, 2007-2021

Introducción: La enfermedad de Huntington (EH) es un desorden neurodegenerativo autosómico dominante caracterizado por disfunción progresiva motora, cognitiva y psiquiátrica1. No se conoce la prevalencia de EH en Centro América (2-11). En Panamá no se han reportado estudios sobre esta Enfermedad. El objetivo es estimar la prevalencia de EH en población panameña. Metodología: Se realizó un estudio descriptivo de casos con EH entre 2007 y 2021 en un hospital de tercer nivel. Se incluyeron individuos panameños, mayores de 15 años, un caso por familia, con cuadro clínico sugestivo, con o sin antecedentes familiares, resonancia magnética cerebral y prueba genética HTT positiva. Estos casos fueron incluidos en el Registro Nacional de Enfermedad de Huntington. Resultados: Presentamos 11 casos índice, 6 femeninos.  Se estima una prevalencia de 0.25 x 100000 habitantes, edad promedio 40 años (rango 23-63), media 43±12.4, la edad de inicio 29 años (rango 14-43), media 27±11.13, presentación juvenil 3 casos. Se detectaron 91 sintomáticos de 185 familiares, transmisión predominante paterna, todos heterocigóticos. Alelo normal entre 13-23 repeticiones de CAG, mientras que alelo mutante oscila entre 41 y 59 repeticiones de CAG. Conclusión: Este es el primer reporte de la EH en población panameña, la prevalencia estimada es baja de 0.25 x 100000 habitantes. Estudios futuros deberán realizarse para conocer la prevalencia en Panamá y Centro América además de determinar el origen ancestral de esta población. (provisto por Infomedic International)

Introduction: Huntington´s disease (HD) is an autosomal dominant neurodegenerative disorder characterized by progressive motor, cognitive and psychiatric dysfunction. HD prevalence in Panama or in Central America is unknown. This will be the first report in Panamá about HD. Metodology: The objective is to estimate HD prevalence in Panamanian population. A retrospective, descriptive study of patients with HD between 2007 and 2021 was conducted. Panamanians > 15 years, 1 case per family, with typical clinical symptoms, with or without family history, brain magnetic resonance and positive genetic test and then included in the National registry of Huntington Disease. Results: Eleven index cases were presented, 6 women. The mean age was 40 years (range 23-63), median 43±12.4, sex ratio was 5:6, the onset age was 29 years (range 14-43), median 27±11.13. 3 cases in young patients. 91 symptomatic cases out of 185 relatives, with a dominant paternal transmission, all heterozygous. Normal allele between 13-23 CAG repetitions, while the mutant allele ranges between 41 and 59 CAG repetitions. Conclusions: This is the first HD report in Panamanian population, with a low estimated prevalence of 0.25 x 100,000. The aim of this study is to promote HD research in Panama and Central America and determine the ancestral origin of this population. (provided by Infomedic International)

Assessment of substance use among injured persons seeking emergency care in Nairobi, Kenya

ntroduction: Trauma is a leading cause of morbidity and mortality in Kenya. In many countries, substance use is common among patients presenting with injuries to an emergency center (EC). Objective: To describe the epidemiology of self-reported substance use among adult injured patients seeking ED care in Nairobi, Kenya. Methods: This prospective cross-sectional study, assessed patients presenting with injuries to the Kenyatta Na-tional Hospital ED in Nairobi, Kenya from March through June of 2021. Data on substance use, injury character-istics and ED disposition were collected. Substances of interest were alcohol, stimulants, marijuana, and opiates.The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) tool was used to characterize hazardous alcoholuse. Results: A total of 1,282 patients were screened for participation, of which 646 were enrolled. Among participants,322 (49.8%) reported substance use in the past month (AUDIT-C positive, stimulants, opiates, and/or marijuana). Hazardous alcohol use was reported by 271 (42.0%) patients who screened positive with AUDIT-C. Polysubstance use, (≥2 substances) was reported by 87 participants in the past month. Median time from injury to ED arrival was 13.1 h for all enrolees, and this number was significantly higher among substance users (median 15.4 h, IQR 5.5 - 25.5; p = 0.029). Conclusions: In the population studied, reported substance use was common with a substantial proportion of injured persons screening positive for hazardous alcohol use. Those with substance use had later presentations for injury care. These data suggest that ED programming for substance use disorder screening and care linkagecould be impactful in the study setting.

Calcifilaxis / Calciphylaxis

La calcifilaxis o arteriolopatía urémica calcificante es una enfermedad rara que conlleva elevada morbilidad y una mortalidad de 40-80%. Se produce por la calcificación de los vasos de pequeño calibre y afecta sobre todo a los pacientes con insuficiencia renal crónica. Suele iniciarse con cambios en la coloración de la piel. Luego se produce ulceración, dolor y necrosis cutánea. Se presenta el caso de un varón de 70 años con insuficiencia renal crónica que desarrolló lesiones cutáneas dolorosas en los miembros inferiores.

Calciphylaxis or calcifying uremic arteriolopathy is a rare disease that carries high morbidity and mortality between 40% and 80%. It is produced by calcification of small caliber vessels and mainly affects patients with chronic renal failure. It usually begins with a change in skin color and then ulceration, pain and skin necrosis occur. We present a 70-year-old man with chronic renal failure who developed painful skin lesions on his lower limbs.

Nanofiber Scaffolds by Electrospinning for Rotator Cuff Tissue Engineering / 전남의대학술지

Rotator cuff tears continue to be at risk of retear or failure to heal after surgical repair, despite the use of various surgical techniques, which stimulate development of novel scaffolding strategies. They should be able to address the known causes of failure after the conventional rotator cuff repair: (1) failure to reproduce the normal tendon healing process, (2) resultant failure to reproduce four zones of the enthesis, and (3) failure to attain sufficient mechanical strength after repair. Nanofiber scaffolds are suited for this application because they can be engineered to mimic the ultrastructure and properties of the native rotator cuff tendon. Among various methods for tissue-engineered nanofibers, electrospinning has recently been highlighted in the rotator cuff field.Electrospinning can create fibrous and porous structures that resemble natural tendon’s extracellular matrix. Other advantages include the ability to create relatively large surface-to-volume ratios, the ability to control fiber size from the micro to the nano scale, and the flexibility of material choices. In this review, we will discuss the anatomical and mechanical features of the rotator cuff tendon, their potential impacts on improper healing after repair, and the current knowledge of the use of electrospinning for rotator cuff tissue engineering.

A Prospective Comparative Study of Mobile Acoustic Uroflowmetry and Conventional Uroflowmetry / 대한배뇨장애요실금학회지

Purpose@#The aim of this study was to assess the performance of a mobile acoustic Uroflowmetry (UFM) application compared with standard UFM in the pediatric population. @*Methods@#A mobile acoustic UFM application represents a noninvasive method to estimate the urine flow rate by recording voiding sounds with a smartphone. Male pediatric patients who were undergoing UFM testing were prospectively recruited, and the voiding sounds were recorded and analyzed. The intraclass correlation coefficient (ICC) was used to compare the maximum flow rate (Qmax), average flow rate (Qavg), voiding time (VT), and voiding volume (VV) as estimated by acoustic UFM with those calculated by standard UFM. Differences in Qmax, Qavg, VT, and VV between the 2 UFM tests were determined using 95% Bland-Altman limits of agreement. @*Results@#A total of 16 male patients were evaluated. Their median age was 9 years. With standard UFM, the median Qmax, Qavg, VT, and VV were 18.7 mL/sec, 11.1 mL/sec, 15.2 seconds, and 157.8 mL, respectively. Strong correlations were observed between the 2 methods for Qmax (ICC=0.755, P=0.005), VT (ICC=0.974, P<0.001), and VV (ICC=0.930, P<0.001), but not for Qavg (ICC=0.442, P=0.135). The Bland-Altman plot showed good agreement between the 2 UFM tests. Flow patterns recorded by acoustic UFM and conventional UFM showed good visual correlations. @*Conclusions@#Acoustic UFM was comparable to standard UFM for male pediatric patients. Further validation of its performance in different toilet settings is necessary for broader use.

Cross-cultural adaptation and measurement of psychometric properties of the Filipino version of Victorian Institute of Sports Assessment Ankle Instability (VISA-A) questionnaire for achilles tendinopathy

BACKGROUND@#Achilles Tendinopathy (AT) is common in elite and recreational athletes involved in sports such as running and jumping. The severity of this condition can be assessed using the VISA-A questionnaire. However, this is originally developed in English. This has been translated to several languages, but there is no translation and cross-cultural adaptation yet to Filipino. This study aims to translate, cross-culturally adapt the VISA-A questionnaire to Filipino, and examine its psychometric properties.@*METHOD@#The translation and validation process were in accordance with the guidelines set by Beaton et al., and Sousa et al. The psychometric properties were assessed on n= 8 healthy and n= 8 symptomatic athletes.@*RESULTS@#The VISA-A questionnaire exhibited excellent face validity (100% agreement), content validity (Item-Content Validity Index and Scale-Content Validity Index= 1.00), construct validity (U= 2.50, p= 0.001), and concurrent validity (r= 0.90, p= 0.001). The items have good internal consistency (α= 0.80) and showed excellent reliability (ICC= 0.94; 95% CI: 0.73–0.99).@*CONCLUSIONS@#The cross-cultural adaptation of the Filipino version of VISAA (VISA-A-Fil) was successful. Preliminary psychometric testing showed that the VISA-A-Fil questionnaire is a valid and reliable tool that measures the severity of AT. However, there is still a need to explore its full psychometric properties.

Intestinal Parasites and Salmonella typhi Infection among Food-handlers in Port Harcourt Metropolis, Nigeria

Background: Intestinal parasites andSalmonellainfections are of main public health concerns in Nigeria and the world, especially in developing countries where access to safe water and hygienic food handling practices by food handlers is a challenge. Consequently, food-handlers play a major role in the transmission of these types of foodborne diseases.Objective: This study was to determine the preponderance of intestinal parasites and Salmonella typhiamong food-handlers in selected areas in Port Harcourt.Materials and Methods: A total of 480 food-handlers (195 males and 285 females) of various educational levels were sampled. Stool samples were collected and analyses were carried out using direct smear examination and formol-ether concentration technique -adopted for nvestigation of intestinal parasites and deoxycholate citrate agar and Salmonella-Shigella agar for the cultivation of Salmonella typhi.Results:Of 480 food-handlers examined, comprisesof 195(40.6%) males and 285(59.4%) females,-majority (85.4%) were young adults aged 20-40 years. 47.9% of them -had education above secondary educational level. The preponderance of intestinal parasites was 48(10.0%) and implicated were Ascaris lumbricoides(41.7%), hookworm (33.3%) and Trichuris trichiura(25.0%). No intestinal protozoa were identified. Prevalence of 30(6.3%) was recorded for Salmonella typhi.Conclusion:Prevalence of Intestinal Parasites and S.typhi infection is relatively low among food handlers in Port Harcourt, but indicates the important role food handlers play in the transmission of the infection. Therefore, awareness should be step-up forthe food handlers to avoid escalation of these infections

A study to evaluate the safety and cost effectiveness of preformed catgut endoloops and polyglactin 910 extracorporeal ligation in the management of appendicular stump closure in laparoscopic appendicectomy

Background: The most essential component of laparoscopic appendectomy is the closure of appendicular stump. Failure of which can result in catastrophic complications including intra-abdominal and surgical site infections and rarely faecal fistula. The aim of this study was to verify the effectiveness of preformed catgut endoloop and extracorporeal polyglactin 910 for appendicular stump closure.Methods: This prospective study was carried out in 64 patients. We compared patient demographics, duration of surgery, intra and post-operative complications, hospital stay and cost of surgery between the two groups.Results: A total of sixty-four patients were finally included in the analysis, catgut group (n=34), polyglactin 910 group (n=30). The demographics between the two groups were similar. The mean age in catgut group was 23.94 years and polyglactin 910 groups was 23.33 years. Mean duration of surgery was 41.6 and 41.8 minutes in catgut and endoloop group respectively. Mean hospital stay was 3 days. There was no mortality but complications were seen in 6 patients. However, there was no statistical significance in between the two groups with any of the parameters studied.Conclusions: Multiple studies have demonstrated safety and effectiveness of various techniques of appendicular stump. The use of extracorporeal single polyglactin 910 extracorporeal suture knot is safe and cost-effective technique for closure of appendicular stump in rural and resource poor regions.

The six geometries revisited / 대한치과교정학회지

Forces and moments delivered by a straight wire connecting two orthodontic brackets are statically indeterminate and cannot be estimated using the classical equations of static equilibrium. To identify the mechanics of such two-bracket systems, Burstone and Koenig used the principles of linear beam theory to estimate the resulting force systems. In the original publication, however, it remains unclear how the force systems were calculated because no reference or computational details on the underlying principles have been provided. Using the moment carry-over principle and the relative angulation of the brackets, a formula was derived to calculate the relative moments of the two brackets.Because of the moment equilibrium, the vertical forces that exist as a forcecouple on the two brackets can also be calculated. The accuracy of the proposed approach can be validated using previously published empirical data.

Pioglitazone Alters the Proteomes of Normal Bladder Epithelial Cells but Shows No Tumorigenic Effects / 대한배뇨장애요실금학회지

Purpose@#Pioglitazone, an antihyperglycemic drug, is widely used in diabetes mellitus patients with insulin resistance. Although pioglitazone is known to have a potential link to bladder cancer (BC), there have been contradictory results. This present study is designed to understand the regulatory mechanisms that drive the effects of pioglitazone on the bladder epithelial cells. @*Methods@#Labeled liquid chromatography-tandem mass spectrometry-based proteomics profiling characterized the global proteomes of normal human bladder epithelial cells treated with or without pioglitazone. @*Results@#This approach detected approximately 5,769 proteins in total. Of those 5,769 proteins, 124 were identified as being differentially expressed due to pioglitazone treatment. Further analysis identified 95 upregulated and 29 downregulated proteins (absolute log2 fold change >0.58 and P-value<0.05). The following functional gene enrichment analysis suggested that pioglitazone may be altering a few select biological processes, such as gene/chromatin silencing, by downregulating BMI1 (B lymphoma Mo-MLV insertion region 1 homolog), a polycomb complex protein. Further cell-based assays showed that cell adhesion molecules, epithelial-mesenchymal transition markers, and major signaling pathways were significantly downregulated by pioglitazone treatment. @*Conclusions@#These experimental results revealed the proteomic and biological alterations that occur in normal bladder cells in response to pioglitazone. These findings provided a landscape how bladder proteome is influenced by pioglitazone, which suggests the potential adverse effects of diabetes drugs and their links to bladder dysfunctions.

Injury patterns of patients presenting to a non-governmental hospital in Western Uganda

Introduction: Injury is a leading cause of morbidity and mortality globally and disproportionately affects low-income countries. While most injury data comes from tertiary care centers in urban settings, the purpose of this study was to describe the characteristics and severity of injury in rural Uganda and the associated treatment patterns and delays in care. Methods: This is a retrospective cohort study of a trauma registry that was implemented at Masindi-Kitara Medical Center (MKMC), a rural hospital in Western Uganda. Demographic information, injury characteristics, modified Kampala Trauma Scores (M-KTS), and treatment modalities over a 12 month period were retrospectively collected from paper-based registry forms completed for all injury patients presenting to MKMC. Results: A total of 350 patients were entered into the trauma registry. Most patients were male (71.2%) with a median age of 26.5 years. Motorcycle crashes were the most prevalent mechanism of injury (42.3%) with the majority being unhelmeted (83.3%). Soft tissue injury was the most common diagnosis (44.9%). Patients were frequently treated in the outpatient department and then discharged (54.8%). Patients requiring admission or transfer (M-KTS = 11.57 or 11.67) tended to have a lower M-KTS than discharged patients (M-KTS = 12.75). Analgesics (74.6%) and antibiotics (52.9%) were the most common treatments administered. For those patients requiring admission (29.4%), only one in-hospital death was documented. Thirty-nine percent of patients reported a delay in seeking care, most frequently due to lack of transportation (31.5%) with a median time of delay of 11 h. Conclusion: Road traffic injuries were the leading cause of injury in Masindi, with a high proportion of injuries associated with unhelmeted motorcycle crashes. Future opportunities to prevent injury and improve care may be seen through improved prehospital care, enforcement of helmet laws, increased access to neurosurgical services, and enactment of hospital quality improvement measures

Moderate or severe LUTS is associated with increased recurrence of non - muscle - invasive urothelial carcinoma of the bladder

ABSTRACT Purpose: Non - muscle - invasive bladder cancer (NMIBC) can recur despite transurethral resection (TURBT) and adjuvant intravesical therapy. Tobacco products excreted in the urine are hypothesized to cause tumor - promoting effects on urothelial cells through direct contact. We determined if moderate or severe lower urinary tract symptoms (LUTS) (defined as International Prostate Symptom Score [IPSS] ≥ 8) was associated with increased tumor recurrence. Materials and Methods: We retrospectively identified 70 consecutive men initially diagnosed with NMIBC at our institution from 2010 - 2016. Means were compared with independent T - test and proportions with chi - square analysis. Multivariate logistic regression was performed to determine independent predictors of recurrence. Results: The majority of patients had Ta disease (58.6%) followed by T1 (28.6%) and Tis (12.9%). Forty - one (58.6%) patients had moderate or severe LUTS upon presentation within 30 days of initial TURBT with mean IPSS of 13.2 vs. 5.2 in the control group (p < 0.01). Biopsy - proven tumor recurrence occurred in 24 (34.3%) patients at mean follow-up of 31.7 months. Mean time to recurrence was 14.6 months. Moderate or severe LUTS was an independent predictor of tumor recurrence (odds ratio [OR]: 19.1, 95% confidence interval [CI]: 2.86 - 127; p = 0.002). Voiding or storage symptoms based on the IPSS did not independently correlate with tumor recurrence (p = 0.08 and p = 0.31, respectively) although total mean IPSS score did (OR: 1.26, 95% CI: 1.07 - 1.47, p = 0.005). Conclusions: The presence of moderate or severe LUTS may be an important prognostic factor in NMIBC. Patients with significant urinary symptoms could be monitored more aggressively due to higher recurrence risk.

ANCA associated vasculitis: experience of a tertiary care referral center / Vasculite associada a ANCA: experiência de um centro de referência de atendimento terciário

ABSTRACT Background and objectives: Anti-neutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis is a small vessel vasculitis with insufficient epidemiologic estimates in the United States. We aimed to determine demographic and clinical features of ANCA associated vasculitis patients presenting to a large tertiary care referral center in Upstate New York. Design, setting, participants, and measurements: A retrospective analysis of cases with pauci-immune GN on renal biopsy and clinical diagnosis of ANCA vasculitis presenting over 11 years was conducted. Outcomes of interest were: demographics, ANCA antibody positivity, patient and renal survival, and regional trends. Results: 986 biopsies were reviewed, 41 cases met the criteria for inclusion: 18 GPA, 19 MPA, and 4 double positive (anti-GBM disease plus ANCA vasculitis). Mean age at presentation was 52.4 years (SD 23.7), 23 (56%) were male and median creatinine was 2.6 mg/dL. The median patient follow up was 77 weeks (IQR 10 - 263 weeks), with a 3-month mortality rate of 5.7% and a 1-year estimated mortality rate of 12%. Thirteen patients required hemodialysis at the time of diagnosis; 7 patients came off dialysis, with median time to renal recovery of 4.86 weeks (IQR 1.57 - 23.85 weeks). C-ANCA positivity (p < 0.001) and C-ANCA plus PR3 antibody pairing (p = 0.005) was statistically significant in GPA versus MPA. P-ANCA positivity was observed in MPA versus GPA (p = 0.02) and double positive versus GPA (p = 0.002), with P-ANCA and MPO antibody pairing in MPA versus GPA (p = 0.044). Thirty-seven of the 41 cases were referred locally, 16 cases were from within a 15-mile radius of Albany, Schenectady, and Saratoga counties. Conclusions: ANCA vasculitis is associated with end stage renal disease and increased mortality. Our study suggests the possibility of higher regional incidence of pauci-immune GN in Upstate New York. Further studies should investigate the causes of clustering of cases to specific regions.

RESUMO Introdução e objetivos: A vasculite associada a anticorpos anticitoplasma de neutrófilo (ANCA) é uma vasculite de pequenos vasos com estimativas epidemiológicas insuficientes nos Estados Unidos. Nosso objetivo foi determinar características demográficas e clínicas de pacientes com vasculite associada à ANCA, apresentando-se a um grande centro de referência de atendimento terciário em Upstate New York. Formato, cenário, participantes e medidas: Foi realizada uma análise retrospectiva dos casos de GN pauci-imune em biópsias renais e diagnóstico clínico de vasculite ANCA por mais de 11 anos. Os resultados de interesse foram: dados demográficos, positividade de anticorpos ANCA, sobrevidas renal e de pacientes e tendências regionais. Resultados: 986 biópsias foram revisadas, 41 casos preencheram os critérios de inclusão: 18 GPA, 19 PAM, e 4 duplo-positivos (doença anti-MBG com vasculite ANCA). A média de idade na apresentação foi de 52,4 anos (DP 23,7), 23 (56%) eram do sexo masculino e mediana de creatinina de 2,6 mg/dL. O acompanhamento mediano dos pacientes foi de 77 semanas (IQR 10 - 263 semanas), com uma taxa de mortalidade de 3 meses de 5,7% e uma taxa de mortalidade estimada em 1 ano de 12%. Treze pacientes necessitaram de hemodiálise no momento do diagnóstico; 7 pacientes saíram da diálise, com tempo médio para recuperação renal de 4,86 semanas (IQR 1,57 - 23,85 semanas). A positividade para C-ANCA (p < 0,001) e o pareamento de anticorpos C-ANCA mais PR3 (p = 0,005) foram estatisticamente significantes em GPA versus PAM. A positividade de P-ANCA foi observada em PAM versus GPA (p = 0,02) e duplo positivo versus GPA (p = 0,002), com pareamento de anticorpos P-ANCA e MPO em PAM versus GPA (p = 0,044). Trinta e sete dos 41 casos foram encaminhados localmente, 16 casos foram de dentro de um raio de 15 milhas dos condados de Albany, Schenectady e Saratoga. Conclusões: A vasculite por ANCA está associada à doença renal terminal e aumento da mortalidade. Nosso estudo sugere a possibilidade de maior incidência regional de GN pauci-imune no norte do estado de Nova York. Novos estudos devem investigar as causas do acúmulo de casos em regiões específicas.

Two unique studies highlighting the positive effects of enhanced recovery after surgery (ERAS) pathways on patient care and satisfaction / Dos estudios únicos en los que se destacan los efectos positivos de los protocolos ERAS (Recuperación rápida después de cirugía) para la atención y la satisfacción de los pacientes

Enhanced recovery after surgery (ERAS) programs are clinical pathways designed to "fast-track" patients back to baseline health as quickly as possible after surgery. These perioperative plans were initially conceived by Kehlet1,a surgeon in Europe. Kehlet and Mogensen2 designed surgical interventions to improve patient outcomes in colorectal surgery. The central tenets of ERAS pathways include: minimal fasting time/early satiety, early ambulation, and multimodal analgesia.3 By employing these concepts, they were able to significantly decrease their surgical patient's length of stay without increasing complications.2 Since that time, ERAS programs have expanded to many countries and across other surgical subspecialties with similar results. Other interventions such as pre-operative surgical and anesthetic education, pre-habilitation, optimization of chronic medical conditions, minimizing bowel preparation/fasting times, carbohydrate loading, multimodal analgesia, nausea and vomiting prophylaxis, thromboembolism prophylaxis, standard antibiotics, standardized operative ventilation strategies, goal-directed fluid therapy, early postoperative ingestion of clear fluids, and early ambulation have been incorporated into various ERAS pathways.4 Typical goals of these programs include decreased length of stay, decreased morbidity and mortality, and improved patient secondary outcomes.5 By reducing hospital stay and complications, hospital systems, and patients experience decreased overall costs. 6 In this editorial, I will comment on 2 articles using ERAS pathways to show positive effects on patient care and satisfaction.

Los programas de recuperación mejorada después de la cirugía (ERAS) son vías clínicas diseñadas para "acelerar" a los pacientes para que vuelvan a su estado de salud inicial lo más rápido posible después de la cirugía. Estos planes perioperatorios fueron concebidos inicialmente por Kehlet1, un cirujano en Europa. Kehlet y Mogensen2 diseñaron intervenciones quirúrgicas para mejorar los resultados de los pacientes en cirugía colorrectal. Los principios centrales de las vías ERAS incluyen: tiempo mínimo de ayuno / saciedad temprana, deambulación temprana y analgesia multimodal.3 Al emplear estos conceptos, pudieron disminuir significativamente la duración de la estadía del paciente quirúrgico sin aumentar las complicaciones.2 Desde entonces, ERAS Los programas se han expandido a muchos países y a otras subespecialidades quirúrgicas con resultados similares. Otras intervenciones tales como educación preoperatoria quirúrgica y anestésica, pre-habilitación, optimización de condiciones médicas crónicas, minimización de los tiempos de preparación / ayuno intestinal, carga de carbohidratos, analgesia multimodal, profilaxis de náuseas y vómitos, profilaxis de tromboembolismo, antibióticos estándar, estrategias de ventilación operativa estandarizadas , la fluidoterapia dirigida por objetivos, la ingestión posoperatoria temprana de líquidos claros y la deambulación temprana se han incorporado en varias vías del ERAS.4 Los objetivos típicos de estos programas incluyen la disminución de la duración de la estadía, la disminución de la morbilidad y la mortalidad y la mejora de los resultados secundarios del paciente.5 reducir la estancia hospitalaria y las complicaciones, los sistemas hospitalarios y los pacientes experimentan una reducción de los costos generales. 6 En este editorial, comentaré 2 artículos que utilizan las vías ERAS para mostrar efectos positivos en la atención y satisfacción del paciente.

Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database

BACKGROUND: Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. METHODS: Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. RESULTS: There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF's purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.