Evaluation of the effect of etamsylate on thromboelastographic traces of canine blood with and without the addition of heparin.

The objective of this study was to investigate the effect of etamsylate on canine blood and heparinised canine blood from healthy dogs using thromboelastography (TEG). Citrated blood was obtained from twenty healthy client-owned dogs, and 3 experiments were performed. Experiment 1 compared TEG in blood versus blood with etamsylate (250 mM). Experiment 2 evaluated TEG in heparinised blood (1 U/mL) with and without the addition of etamsylate (250 mM). Experiment 3 evaluated dose escalation of etamsylate (control, 250 µM, 500 µM and 1000 µM) in heparinised blood (1 U/mL). The addition of etamsylate to canine blood in experiment 1 increased the percentage of clot lysis at 30 min (z = -2.103, p = .035) and 60 min (z = -1.988, p = .047), suggesting that etamsylate could have a fibrinolytic effect. When etamsylate was added to heparinised canine blood (1 U/mL), etamsylate produced a dose-dependent inhibition of the effect of heparin when higher concentrations of etamsylate were used (500 µM and 1000 µM). The linear mixed effects model showed significant increases in α angle and maximal amplitude when high dose etamsylate was added compared to the control. In conclusion, etamsylate could be used at higher doses to inhibit the effect of heparin in dogs when protamine might not be available. However, etamsylate might have a fibrinolytic effect when used in healthy dogs.

Caracterización de la COVID-19 en el adulto mayor del municipio Ciego de Ávila

Fundamento: debido a cambios fisiológicos del envejecimiento, los adultos mayores presentan riesgo incrementado para enfermar por COVID-19. Objetivo: caracterizar la COVID-19 en el adulto mayor en el municipio de Ciego de Ávila. Métodos: se realizó una investigación descriptiva, transversal que abarcó la totalidad de pacientes mayores de 60 años confirmados de COVID-19 del municipio de Ciego de Ávila en el período comprendido entre el 1 de julio y el 31 de diciembre de 2021. La información se obtuvo a partir de las encuestas epidemiológicas realizadas a los casos confirmados, así como del informe y los registros estadísticos de la Unidad Municipal de Higiene y Epidemiología. Se analizaron las variables siguientes: grupo de edades, sexo, mes en que se realizó el diagnóstico, tasa de incidencia por área de salud y tasa de mortalidad (por meses y por edad). Resultados: se confirmaron 3 215 enfermos. Predominaron las edades entre 60 y 69 años (52,26 %), del sexo femenino (53,28%). Los meses de julio y agosto fueron los de mayor número de reportes. El área Norte fue la de mayor incidencia (2327,5 por 100 mil habitantes) y la mortalidad fue mayor en pacientes de 80 y más años (10,6 por 1000 habitantes). Conclusiones: la COVID 19 en el municipio Ciego de Ávila tuvo un predominio en el adulto mayor que se mantiene más incorporado a las actividades sociales, con mayor mortalidad en los mayores de 80 años, grupo de mayor vulnerabilidad para presentar complicaciones. La mayor transmisibilidad estuvo relacionada con la circulación de la variante delta en el país. Se aportó información útil para el seguimiento de los indicadores y en aras de contribuir a la disminución de la mortalidad en este grupo vulnerable.

Background: due to physiological changes of aging, older adults have an increased risk of getting sick from COVID-19. Objective: to characterize of COVID-19 on the elderly in the municipality of Ciego de Ávila. Methods: a cross-sectional descriptive investigation was carried out that included all confirmed COVID-19 patients over 60 years of age in the municipality of Ciego de Ávila in the period between July 1 and December 31, 2021. The information was obtained based on the epidemiological surveys carried out on confirmed cases, as well as the report and statistical records of the Municipal Hygiene and Epidemiology Unit. The data obtained were summarized in tables and graphs. The ethical principles of the research were complied with. Results: 3215 patients were confirmed. Ages between 60 and 69 years (52.26%), females (53.28%). The months of July and August were the ones with the highest number of reports. The North area had the highest incidence (2327.5 per 100 thousand inhabitants) and mortality was higher in patients aged 80 and over (10.6 per 1000 inhabitants). Conclusions: COVID 19 in the Ciego de Avila municipality had a predominance in the elderly who remain more incorporated into social activities, with higher mortality in those over 80 years of age, being the group with the highest vulnerability to present complications. Useful information was provided for monitoring the indicators and in order to contribute to the reduction of mortality in this vulnerable group.

Menopause and obstetric history as risk factors for fecal incontinence in women.

BACKGROUND: Fecal incontinence is a highly prevalent condition, especially in women. However, few data on prevalence in women attending primary care are available, particularly regarding the presence of risk factors. OBJECTIVE: The aim of this study was to determine characteristics of women with fecal incontinence and to analyze obstetric history and menopause as potential risk factors. DESIGN: Observational study with a cross-sectional design. SETTINGS: Patients in primary care at 10 health care centers in Barcelona, Spain. MAIN OUTCOME MEASURES: Fecal incontinence was defined as loss of flatus or liquid/solid stool occurring at least monthly. Data on the following variables were collected by face-to-face interviews and patient questionnaires: demographic and clinical characteristics, obstetric history, menopause data, fecal incontinence, and quality of life. Univariable and multivariable analyses were performed to study the association of potential risk factors with fecal incontinence. RESULTS: The study included 332 women with a mean age of 60.8 (SD, 17.8) years. The prevalence of fecal incontinence was 12.0% (40/332). Flatus incontinence was reported in 27 patients (67.5%), liquid stool incontinence in 25 (62.5%), and solid stool incontinence in (19) 47.5%. On multivariable analysis, the only independent risk factors for fecal incontinence were an obstetric history of complicated deliveries (instrumentation or podalic presentation; OR, 3.66; 95% CI, 1.54-8.68, P = .003) and menopause (OR, 5.67; 95% CI, 1.35-23.78; P = .018). LIMITATIONS: The cross-sectional design hampered identification of the time at which the impact of menopausal status occurred, and data obtained from patient interviews was subject to recall bias. CONCLUSIONS: Complicated deliveries are risk factors for fecal incontinence in women. Fecal incontinence appears to be more prevalent in menopausal women.

Empleo de bandas libres de tensión asociadas a la cirugía reconstructiva del suelo pelviano / The use of tension-free vaginal tape associated with pelvic floor reconstructive surgery

Objetivos: Presentar nuestros resultados a medio-largo plazo en la utilización de la cinta vaginal sin tensión (TVT) en la incontinencia urinaria (IUE) de esfuerzo femenina cuando se asocia a la corrección quirúrgica de los defectos del suelo pelviano para su resolución integral. Material y métodos: Entre enero de 2000 y mayo de 2008 se intervino quirúrgicamente a 171 pacientes con trastornos del suelo pelviano mediante TVT. En 117 se colocó una TVT de forma aislada como tratamiento de su IUE. A las restantes 54 pacientes, que presentaban diversos trastornos del suelo pelviano, la TVT se asoció a tratamiento para estos defectos (cistocele, rectocele, prolapso uterino) con el objetivo de corregirlos. Resultados: La media de seguimiento fue 36 (12-108) meses. La media de edad de las pacientes fue 55 (35-78) años en el grupo de TVT (grupo 1) y 57 (43-76) años en el grupo de TVT y cirugía vaginal (grupo 2). La paridad fue 2,23 (0-6) en el grupo 1 y 3,12 (1-6) en el grupo 2. Hay diferencias en cuanto al motivo de consulta para ambos grupos. La media de estancia fue de 24 h en el grupo 1 y de 4 días en el grupo 2. La complicación más grave fue la perforación vesical durante el acto quirúrgico, que sucedió en siete ocasiones y la más frecuente, la aparición de hiperactividad detrusora sintomática de novo que fue similar para los dos grupos. Conclusiones: La TVT es el estándar para la IUE femenina, con resultados demostrados en la literatura, su asociación a cirugía reconstructiva se presenta como una alternativa segura y satisfactoria para la resolución integral de los defectos del suelo pelviano, sin incrementarse por ello la morbilidad de la técnica (AU)

Objective: We present our medium- to long-term results for the use of TVT for female stress urinary incontinence (SUI) employed concomitantly with surgical correction of pelvic floor prolapse in order to provide an integral solution. Material and methods: Between January 2000 and May 2008, 171 women with pelvic floor disorders underwent a surgical procedure with TVT. 117 of those women received TVT as a sole treatment for SUI; in the 54 remaining patients who suffered from some type of pelvic organ prolapse, TVT was associated with a vaginal procedure to correct the prolapsed (cystocele, rectocele, prolapsed uterus).Results: Mean follow-up time was 36 months (range 12-108). The mean age was 55 years (35-78) in group 1 and 57 years (range 43-76) in the group for which TVT was associated with a pelvic floor correction. The parity was 2.23 (range 0-6) in group 1 and 3.12 (1-6) in group 2. There are some differences in the initial medical complaints among both groups. The mean hospitalisation time was 24 hours in group 1 and 4 days in group 2. The most serious complication was bladder perforation during surgery, which occurred in seven patients. The most frequent complication was the onset of de novo urge symptoms (overactive bladder), which was similar in both groups. Conclusions: TVT remains the gold standard treatment for female SUI with proven results in the literature, and may be safely and effectively associated with pelvic floor reconstructive surgery without increasing the technique’s morbidity rate (AU)

Aspectos prácticos en el manejo de las lesiones obstétricas perineales de tercer y cuarto grado para minimizar el riesgo de incontinencia fecal / Practical issues in the management of third and fourth degree tears to minimise the incidence of faecal incontinence

La incontinencia fecal es una condición subestimada en los estudios epidemiológicos debido a que muchas mujeres no acuden al médico a pesar de padecerla. La causa más frecuente de incontinencia fecal en las mujeres sanas es el traumatismo de etiología obstétrica. En este artículo se revisa la clasificación y la terminología, así como los factores de riesgo predisponentes a presentar una lesión obstétrica perineal de tercer y cuarto grado. También se repasan las diferentes técnicas de sutura y el seguimiento óptimo ulterior de las mujeres que sufren desgarros perineales, así como la conducta a seguir en las futuras gestaciones. Se recalca la importancia de la ecografía endoanal en el diagnóstico correcto de lesiones ocultas perineales de etiología obstétrica (AU)

Faecal incontinence is underestimated in most epidemiological studies, probably because women may feel unable to discuss the symptoms they experience and avoid seeking medical advice. The most common cause of faecal incontinence in healthy women is an injury during a vaginal delivery. In this article we review the classification and terminology, as well as the risk factors, for third and fourth degree perineal tears. We also comment on the different suture techniques, the follow-up of women who sustain third and fourth degree tears and the advice given to those women regarding future pregnancies and mode of delivery. We highlight the importance of the endoanal ultrasound on the diagnosis of occult anal sphincter injury (AU)

[Practical issues in the management of third and fourth degree tears to minimise the incidence of faecal incontinence]. / Aspectos prácticos en el manejo de las lesiones obstétricas perineales de tercer y cuarto grado para minimizar el riesgo de incontinencia fecal.

Faecal incontinence is underestimated in most epidemiological studies, probably because women may feel unable to discuss the symptoms they experience and avoid seeking medical advice. The most common cause of faecal incontinence in healthy women is an injury during a vaginal delivery. In this article we review the classification and terminology, as well as the risk factors, for third and fourth degree perineal tears. We also comment on the different suture techniques, the follow-up of women who sustain third and fourth degree tears and the advice given to those women regarding future pregnancies and mode of delivery. We highlight the importance of the endoanal ultrasound on the diagnosis of occult anal sphincter injury.

The use of tension-free vaginal tape associated with pelvic floor reconstructive surgery.

OBJECTIVE: To present our medium-to-long term results for the use of TVT in female stress urinary incontinence (SUI) employed concomitantly with surgical correction of pelvic floor prolapse for an integral solution. MATERIAL AND METHODS: Between January 2000 and May 2008, 171 women with pelvic floor disorders underwent a surgical procedure with TVT. 117 of those women received TVT as a sole treatment for SUI. In the remaining 54 patients, who suffered from some type of pelvic organ prolapse, TVT was combined with a vaginal procedure to correct the prolapse (cystocele, rectocele, prolapsed uterus). RESULTS: Mean follow-up time was 36 months (range 12-108). The mean age was 55 years (35-78) in the TVT group (group 1) and 57 years (range 43-76) in the TVT and pelvic floor correction group (group 2). The number of childbirths was 2.23 (range 0-6) in group 1 and 3.12 (1-6) in group 2. There were some differences in the initial medical complaints in both groups. Mean hospitalisation time was 24 hours in group 1 and 4 days in group 2. The most serious complication was bladder perforation during surgery, which occurred in seven patients. The most frequent complication was the onset of de novo detrusor overactivity (overactive bladder), which was similar in both groups. CONCLUSIONS: TVT is the reference standard treatment for female SUI with proven results in the literature. Its association with reconstructive surgery is presented as a safe and satisfactory alternative for comprehensive resolution of pelvic floor defects, without increasing the morbidity of the technique.