Epidemiology of Pelvic Floor Dysfunction in the Tacna Region of Peru, 2023.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is highly prevalent in the general population, with numerous studies conducted in Europe and North America. However, there is a scarcity of data regarding its prevalence and sociodemographic factors in the southern region of Peru. There is an association between sociodemographic factors-such as age, educational level, body mass index, number of pregnancies, parity, mode of delivery, weight of the newborn-along with lifestyle factors such as physical effort, coffee and tobacco consumption with pelvic floor dysfunction (PFD). We anticipate that this association will negatively impact women's quality of life. METHODS: This was a quantitative study, with a non-experimental, descriptive, cross-sectional correlational design. A sample consisting of 468 women between 30 and 64 years old. A previously tested survey was applied to explore prevalence, symptoms, associated factors, and quality of life. RESULTS: The prevalence of PFD was 73.9%. UI was the most common. There is a significant association with overweight, obesity, parity, route of delivery, and physical effort. Even though a large percentage of participants presented with PFD, they reported that their quality of life was not affected (65.9% urinary discomfort, 96.5% colorectal-anal discomfort and 92.2% pelvic organ prolapse discomfort) and only in the case of urinary discomfort did they state that the impact was mild (28.6%) and moderate (5.5%). CONCLUSIONS: Pelvic floor dysfunction in women is very common and it is strongly associated with overweight, obesity, parity, route of delivery, and physical exertion. The impact on quality of life was mild and moderate for those who had urinary discomfort.

Breaking the taboo: qualitative analysis of the sexuality in people with acquired motor disability.

BACKGROUND: Globally 1 in 7 people experience some type of disability. In Latin America, as in other regions, there are programs focused on the protection of sexual and reproductive rights of this population group. However, to date, in Peru there are no programs, protocols or guidelines that include a specialist (sexologist or trained health professional) in the health system to improve the quality of life and well-being of this population. Therefore, the objective of this article is to qualitatively analyze the experience of sexuality in people with acquired motor disabilities. METHODS: We used the interpretative phenomenological approach and the semi-structured in-depth interview composed of 60 questions, which was applied to 7 people (4 women and 3 men) with acquired motor disabilities. RESULTS: Diversity in the experience of sexuality was observed. While some experience it without fear, others have annulled their sexual encounters, because in addition to physical limitations, they experience psychosocial limitations such as pain, functional alterations, depression, low self-esteem, discrimination, exclusion, stigmas and socio-environmental barriers, among others. Likewise, the study reflected the double discrimination suffered by women (for being a woman and having a disability), as well as the lack of education, counseling or sex therapy by specialized professionals, and the influence of religion, society and culture as factors that condition and limit their sexuality. This reflects the current situation in Peru and other countries in the region, where the sexuality of people with disabilities continues to be a complex and ambiguous issue. CONCLUSIONS: It is concluded that for some participants it is possible to experience sexuality without fear, while others hold back their experiences for reasons other than physical, self-esteem, social discrimination, among others. The review of the profile and level of specialization of the health services professionals involved in the integral medical care of people with disabilities and their couples is required because of their need for adequate and specialized attention for their better adaptation to the new condition.

Use of multiple indicators to assess the environmental quality of urbanized aquatic surroundings in San Luis, Argentina.

Urbanization can cause significant changes in the integrity of fluvial ecosystems, which makes it necessary to assess environmental conditions of areas where population growth rates are high. A study of the environmental quality of Chorrillos River (San Luis-Argentina) and its tributaries was carried out in order to evaluate the potential effect of an urbanization gradient. Six sites were sampled along the main course and tributaries of the river. Urbanization variables were measured and included to calculate an Urbanization Index. Physical­chemical analyses were performed in water samples to evaluate water quality through the use of a simplified index of water quality (SIWQ). Plants, macroinvertebrates, and amphibians metrics were used to assess the biological state of the studied sites. The Urbanization Index varied significantly between sites and was significantly correlated to the SIWQ. However, no significant correlations were found between SIWQ and macroinvertebrates and amphibians variables. Water quality of Chorrillos River and its tributaries is good, but it is affected by anthropic influences as reflected by the declining of SIWQ values. Although biological sampling constitutes an important tool in the assessment of water quality of rivers, in this report biological results were not conclusive.

Involvement of serum apolipoprotein AI and B100 and lecithin cholesterol acyl transferase in alcoholic cirrhotics.

Lipoproteins are synthesized by the liver and secreted to plasma. Chronic alcoholic intoxication produces frequently cirrhosis and concomitantly alterations in liver metabolism. Thirty patients with alcoholic cirrhosis and 83 healthy controls were selected for this study. Apolipoprotein A1, B100, lecithin cholesterol acyltransferase, responsible for cholesterol esterification and seudocholinesterase enzyme activity not related to lipid metabolism, as a referent of proteins synthesized by the liver were analyzed. In 7 patients serum tiobarbituric acids, catalase, glutathione peroxidase were measured, as exponent of the presence of oxidative stress. Our results showed a significant decrease in lipoproteins, lecithin cholesterol acyltransferase and seudocholinesterase activities. An increase in serum tiobarbituric acids and a decrease in both antioxidant enzymes were found as well. In conclusion, alcohol cirrhotic liver decreases the production of liver proteins including those related to lipid metabolism, allowing the formation of steatosis and/or necrosis. Moreover oxidative stress participate possible as a major mechanism in liver damage.

Validación prospectiva del índice pronóstico de Saldías en neumonía adquirida en la comunidad / Prospective validation of the Saldías predictive index in community-acquired pneumonia

Introducciòn: la identificación precoz y determinación de la severidad de la enfermedad son de vital importancia en el manejo del paciente con neumonía adquirida en la comunidad (NAC). Objetivo: no existen estudios prospectivos que evalúen la validez del índice de Saldías en el Perú, por lo que se intenta determinar la precisión de los índices complejo y simple de Saldías en la predicción de la mortalidad en NAC. Material y métodos: estudio prospectivo, desarrollado entre abril de 2001 a octubre de 2002, en el Hospital Alberto Sabogal de Bellavista, Callao. Se incluyeron 152 pacientes adultos con el diagnóstico de (NAC), confirmada con radiografía de tórax. Todo los pacientes fueron seguidos hasta el alta o el fallecimiento. Resultados: la edad promedio de los participantes fue de 72,8 años. El 36,8% de los pacientes fallecieron; las principales causas de muerte fueron el shock séptico (27,2%) y la falla multiorgánica (22,7%). No hubo diferencias significativas (p = 0,203) entre fallecidos y sobrevivientes al utilizar el Índice complejo de Saldías. El valor predictivo positivo (VPP) para la mortalidad en la categoría IV del índice fue sólo 46,2%. Según el índice simple de Saldías, los sobrevivientes tuvieron un puntaje promedio de 13,04 inferior al 16,59 hallado en los fallecidos. La diferencia fue significativa (p= 0,000). El 77,8% de los pacientes en la categoría III del índice simple fallecieron, a diferencia del 25,3 en la categoría I. El VPP para la mortalidad en pacientes en la categoría IV fue de 77,8 % con una relación de posibilidades (Odds Ratio) de 7,67 (IC al 95%: 2,48 - 22,45) y una especificidad de 95,8%, a diferencia de la categoría I con una relación de posibilidades inferior a 1 (OR = 0,287, IC 95%: 0,14 - 0,57), aunque con un bajo valor predictivo negativo. Conclusiones: el índice complejo de Saldías no fue útil para evaluar el riesgo de mortalidad por NAC. El índice simple de Saldías predice adecuadamente mortalidad pero no sobrevida, siendo menos preciso y más complejo que los índices CURB-65 y CRB-65.

Introducction: the early identification and determinacion of the severity of the disease are of vital importance in the management of patients with community- acquired pneumonia (CAP). Objetive: no prospective studies evaluating the validity of the Saldías Index exist in Perú; an attempt was made to determine the precision of the complex and simple Saldías Indices in the prediction of mortality in CAP. Materials and methods: This is a prospective study, developed from april 2001 to october 2002, in the Hospital Alberto Sabogal of Bellavista, Callao. 152 adult patients with CAP, confirmed by chest x-rays, were included. All the patients were followed to Hospital release or death. Results: The mean age of the participants was 72,8 years. 36,8% of the patients died; the main causes of death were septic shock (27,2%) and multiple organ failure (22,7%). There was no significant difference (p = 0,203) between deceased and surviving patients when using the complex Saldías index. The positive predictive value (PPV) for mortality in category IV of the index was only 46.2%. According to the simple Saldías index the survivors had a mean score of 13,04, lower than the 16,59 found in the non survivors. The difference was significant (p = 0,000). 77,8% of the patients in category III of the simple index died, as opposed to 25,3 % in category I. The PPV for mortality in patients in category IV was 77,8% with an Odds Ratio of 7,67 (95% CI: 2,48 - 22,45) and a specificity of 95,8%, as opposed to category I with an Odds Ratio ratio under 1 (OR = 0,287, 95% CI: 0,14 - 0,57), but with a low negative predictive value. Conclusions: The complex Saldías index was not useful to evaluate the mortality risk in CAP. The simple Saldías index predicts mortality adequately but not survival; it is less precise and more complex than the CURB-65 and CRB-65 indices.

Behaviour of the anti-oxidant defence system and heme oxygenase-1 protein expression in fructose-hypertensive rats.

1. Addition of fructose to a rat diet for various periods of time leads to hypertension, hyperinsulinaemia and dyslipidaemia and provides a model for testing oxidative stress parameters in the animals. 2. In the present study, oxidative stress generation, the soluble and enzymatic defence system and heme oxygenase-1 (HO-1) protein expression were investigated in the heart, liver and kidney of rats fed fructose for a period of 1 or 8 months. 3. Compared with the control group, fructose-hypertensive rats showed increased in lipid peroxidation only in the heart after both 1 and 8 months of fructose treatment. Changes in the behaviour of the soluble and enzymatic defence system and HO-1 protein expression were different depending on the organ. Increased or unaltered activities of anti-oxidant enzymes were found in the liver and kidney, respectively. Induction of HO-1 prevented the generation of oxidative stress in the liver, where the activity of anti-oxidant defence enzymes was not reduced. Increased expression of HO-1 protein was not able to prevent the generation of oxidative stress in the heart, where fructose treatment diminished the activity of anti-oxidant enzymes. 4. The results of the present study demonstrate that upregulation of HO-1 may prevent the generation of oxidative stress only when the anti-oxidant defence system is still operative.

Antioxidant role of heme oxygenase-1 in prehepatic portal hypertensive rats.

AIM: To study the effect of bilirubin on the oxidative liver status and the activity and expression of heme oxygenase-1 (HO-1) in rat liver injury induced by prehepatic portal hypertension. METHODS: Wistar male rats, weighing 200-250 g, were divided at random into two groups: one group with prehepatic portal hypertension (PH) induced by regulated prehepatic portal vein ligation (PPVL) and the other group corresponded to sham operated rats. Portal pressure, oxidative stress parameters, antioxidant enzymes, HO-1 activity and expression and hepatic sinusoidal vasodilatation were measured. RESULTS: In PPVL rats oxidative stress was evidenced by a marked increase in thiobarbituric acid reactive substances (TBARS) content and a decrease in reduced glutathione (GSH) levels. The activities of liver antioxidant enzymes, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) were also diminished while activity and expression of HO-1 were enhanced. Administration of bilirubin (5 mumol/kg body weight) 24 h before the end of the experiment entirely prevented all these effects. Pretreatment with Sn-protoporphyrin IX (Sn-PPIX) (100 mug/kg body weight, i.p.), a potent inhibitor of HO, completely abolished the oxidative stress and provoked a slight decrease in liver GSH levels as well as an increase in lipid peroxidation. Besides, carbon monoxide, another heme catabolic product, induced a significant increase in sinusoidal hepatic areas in PPVL group. Pretreatment of PPVL rats with Sn-PPIX totally prevented this effect. CONCLUSION: These results suggest a beneficial role of HO-1 overexpression in prehepatic portal hypertensive rats.

Glutamine is highly effective in preventing in vivo cobalt-induced oxidative stress in rat liver.

AIM: To evaluate the in vivo effect of glutamine on cobalt-generated oxidative stress and (HO-1) induction in rat liver. METHODS: Fasted female Wistar rats received a single injection of cobalt chloride (375 micromol/kg body weight) and then were killed at different times. Lipid peroxidation and soluble and enzymatic antioxidant defense system (reduced glutathione (GSH), catalase (CAT), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD)) were measured in liver homogenates. Ferritin and ferritin iron contents as well as heme oxygenase-1 (HO-1) activity and expression were also determined. The antioxidant properties of glutamine (Gln) were also evaluated. RESULTS: Cobalt chloride increased lipid peroxidation (50% over control values) 1 h after treatment. GSH reached a minimum at 3 h (40%) increasing thereafter. Twelve hours after CoCl2 injection, the antioxidant enzymes CAT, GSH-Px and SOD also diminished by about 30%. Heme oxygenase-1 induction was observed 6 h after treatment reaching a maximum value of 14-fold over the controls, 12 h after cobalt treatment. A 1.7-fold increase in ferritin and ferritin-bound iron 24 h after treatment were also obtained. Administration of glutamine (300 mg/kg body weight) by gavage 24 h before CoCl2 treatment entirely prevented the increase in thiobarbituric acid reactive substances (TBARS) content, the decrease in GSH levels, and partially reverted heme oxygenase-1 induction. CONCLUSION: These results suggested that a natural product such as glutamine prevents glutathione depletion and consequently heme oxygenase induction.

NPR-C receptors are involved in C-type natriuretic peptide response on bile secretion.

C-type natriuretic peptide (CNP) is a member of the natriuretic peptide family. Previous studies reported the presence of natriuretic peptide receptors and mRNA CNP in the liver. In the present work, we sought to establish the role of CNP in the regulation of bile secretion in the rat and the possible pathways involved.CNP diminished basal as well as bile salt-evoked bile flow and bile acid output in a dose-dependent manner. It also reduced the excretion of sodium, chloride, and potassium but did not modify bile pH or the excretion of phospholipids, total proteins, and glutathione. Neither parasympathetic nor sympathetic blockade abolished CNP inhibitory response on bile secretion. The selective NPR-C agonist, C-ANP-(4-23) amide, diminished bile flow and the co-administration of both peptides did not further decrease it. CNP did not alter mean arterial pressure or portal venous pressure at any given doses.CNP decreased bile acid-dependent flow without affecting bile acid-independent flow. The inhibitory effect of CNP did not involve the participation of the autonomic nervous system or hemodynamic changes. The participation of NPR-C receptors in CNP response is strongly supported by present findings. The present study shows that CNP modulates bile secretion in the rat, suggesting that CNP may be part of the large family of peptides involved in the regulation of gastrointestinal physiology.

Heme oxygenase-1 induction and dependent increase in ferritin. A protective antioxidant stratagem in hemin-treated rat brain.

The in vivo effect of hemin on both brain oxidative stress and heme oxygenase-1 (HO-1) induction was studied. A marked increase in lipid peroxidation was observed 1 h after hemin administration and antioxidant enzymes significantly decreased 3 h after hemin injection. HO-1 activity appeared 6 h after treatment, peaking 9 h after hemin administration. Such induction was preceded by a decrease in GSH pool and an increase in hydrogen peroxide concentration. Iron ferritin levels and ferritin content began to increase 6 h after HO-1 induction, and these increases remained high for at least 24 h after hemin injection. Administration of bilirubin entirely prevented HO-1 induction as well as the generation of oxidative stress parameters. These results indicate that the induction of heme oxygenase by hemin may be a general response to oxidant stress, by increasing bilirubin and ferritin levels and could therefore provide a major cellular defense mechanism against oxidative damage.

Paraquat-generated oxidative stress in rat liver induces heme oxygenase-1 and aminolevulinic acid synthase.

The in vivo effect of the known herbicide, paraquat, on both hepatic oxidative stress and heme metabolism was studied. A marked increase in lipid peroxidation and a decrease in reduced glutathione (GSH) content were observed 1 h after paraquat administration. The activity of liver antioxidant enzymes, superoxide dismutase, catalase and glutathione peroxidase was decreased 3 h after paraquat injection. Heme oxygenase-1 induction started 9 h after treatment, peaking at 15 h. delta-aminolevulinic acid synthase induction occurred once heme oxygenase had been enhanced, reaching its maximum (1.5-fold of control) at 16 h. delta-aminolevulinic acid dehydratase activity was 40% inhibited at 3 h showing a profile similar to that of GSH, while porphobilinogenase activity was not modified along the whole period of the assay. Administration of alpha-tocopherol (35 mmol/kg body weight) 2 h before paraquat treatment entirely prevented the increase in thiobarbituric acid reactive substances (TBARS) content, the decrease in GSH levels as well as heme oxygenase-1 and delta-aminolevulinic acid synthase induction. This study shows that oxidative stress produced by paraquat leads to an increase in delta-aminolevulinic acid synthase and heme oxygenase-1 activities, indicating that the herbicide affects both heme biosynthesis and degradation.

Angiotensin-(1-7) stimulates oxidative stress in rat kidney.

The effect of two different doses of angiotensin-(1-7) and angiotensin II on the oxidative stress generation was analyzed in rat kidney. Animals were injected intraperitoneally with a single dose of angiotensin-(1-7) or angiotensin II (20 or 50 nmol/kg body weight) and killed 3 h after injection. Production of thiobarbituric acid reactive substances (TBARS), measured as indicator of oxidative stress induction, was significantly increased in rat kidney after Ang-(1-7) administration up to 30% and 50% over controls, at 20 and 50 nmol/kg, respectively. Reduced glutathione (GSH), the most important soluble antioxidant defense in mammalian cells, showed a significant decrease of 13% and 20% at 20 and 50 nmol/kg of angiotensin-(1-7), respectively. When the antioxidant enzyme activities were determined, it was found that catalase activity was not altered by the assayed angiotensin-(1-7) doses while superoxide dismutase and glutathione peroxidase activities were significantly reduced by injection of 20 nmol/kg (34% and 13%, with respect to controls) and 50 nmol/kg of angiotensin-(1-7) (54% and 22%, respectively). In contrast, angiotensin II injections did not produce significant changes neither in TBARS levels nor in soluble and enzymatic defense parameters at the two doses used in this work. These results suggest that angiotensin-(1-7) is undoubtedly related to oxidative stress induction.

Positividad de cultivo de bilis y su influencia en el post-operatorio de colecistectomias según cirugía abierta y cirugía laparoscópica: estudio prospectivo de 140 pacientes en la clínica Angloamericana entre enero de 1994 a 31 de mayo de 1995

Se realizó un estudio prospectivo de 140 pacientes colecistectomizados, de los cuales 64 fueron del sexo masculino y 76 del sexo femenino que ingresaron al servicio de cirugía general de la clínica Angloamericana ya sea por el servicio de urgencias, como programadas. Presentando cuadros de colecistitis aguda, crónica, o reagudizada sea litiásica o alitiásica, en quienes se realizó análisis bacteriológico sistematizado intraoperatorio sea por punción en cirugía abierta, o por succión en cirugía laparoscópica, donde la edad de los pacientes fluctúan entre 1 y 90 años, encontrándose incidencia entre la tercera y quinta década de la vida. Se les realizó estudio anátomo-patológico no encontrándose una relación exacta entre el diagnóstico clínico pre operatorio y resultados anátomo-patológicos. Los bilicultivos positivos fueron más frecuentes en presencia de litiásis con relación de colecistisis crónica. Donde los gérmenes más frecuentemente encontrados: E.coli, Klebsiella, Pseudomona, candida, estreptococo B hemolitico y coagulasa (-); helicobactyer pilory pacientes portadores activamente de gastritis crónica por helicobacter, salmonella grupo D en pacientes con colecistitis crónica acalculosa. Los pacientes con flora bacteriológica mixta tuvieron como agente común a la salmonella D. Todos los pacientes con salmonella cursaron con fiebre tifoidea en algún momento de su vida. El uso de de antibióticoterapia profiláctica usaron en cirugía abierta los aminoglucósidos y cefalosporinas de primera y tercera generación, con asociación de otros antibióticos como cloranfenicol y clindamicina. En cirugía laparoscópica se usó como antibióticoterapia profiláctica a las cefalosporinas de segunda generación de segunda generación en el pre-operatorio como en el post-operatorio. Las complicaciones post-operatorias se encontró una mayor incidencia en cirugía abierta tanto en el grupo de cultivo de bilis positivo como negativo: fiebre de 38 grados, bilirragia, hemorragia, absceso residual, litiásis coledociana, pus, sindrome post-colecistectomizado, un caso de ictericia con sepsis falleciendo el paciente dentro de los 30 días. Usaron para todos los pacientes de cirugía abierta drenes. En cirugía laparoscópica no se presentó complicaciones excepto 3 casos con temperatura de 38º por dos días