Association between obesity, gender and preoperative inflammatory markers with postsurgical pain in live kidney donors.

BACKGROUND: Pain perception has unresolved controversies. The live kidney donor is a model of a healthy subject without a previous painful disease. Our aim is to investigate the association among preoperative obesity, gender, and inflammatory marker levels with postsurgical pain intensity and analgesic consumption. METHODS: We included 70 kidney donors classified as normal weight, overweight, or obese. We measured percentage of adiposity, leptin, adiponectin, IL-6, IL1ß, TNFα, malondialdehyde, erythrocyte sedimentation rate, white blood cells, serum glucose, creatinine, creatinine clearance, and lipid profile 1 week prior to surgery. Visual analogue scale (VAS) scores at 0, 12, 24, and 48 h postsurgery were evaluated. Data were analyzed by means, ANOVA and/or Kruskal-Wallis test. Association among VAS score, ropivacaine consumption, and preoperative cytokine levels was carried out using the Pearson correlation test; p value ≤ 0.05 was considered significant. RESULTS: Normal weight and overweight patients showed a positive correlation of VAS with analgesic requirements. In obese donors there was no correlation. Leptin levels were positively correlated with body mass index (BMI) and adiposity (rP 0.574, and rP 0.764). IL-6 serum concentration was higher in males than in females in all BMI groups. Adiposity percentage and BMI exhibited an inverse correlation with VAS scores at 48 h (rP -0.442 and rP -0.397, respectively), and IL-1ß was correlated with the VAS score at 8 h (r = 0.417). CONCLUSIONS: We observed no statistical differences in the proinflammatory cytokine preoperative serum levels and other inflammatory markers among groups. In our study, obese patients used higher doses of ropivacaine than overweight or normal weight patients.

Resultados de una encuesta epidemiológica de hábitos de higiene íntima en mujeres latinoamericanas / Resultof of an epidemiological survery about hygiene habits in latin american women

Describir los hábitos higiénicos íntimos femeninos de algunas mujeres de Latinoamérica durante 2008. Se aplicó una encuesta piloto, previamente diseñada, a un total de mil mujeres que acudieron a la consulta de un grupo de ginecólogos de Latinoamérica durante 2008 y aceptaron contestar voluntariamente la encuesta. Los países participantes fueron: Colombia, Costa Rica, Ecuador, Guatemala, Honduras, México, Panamá, Perú, República Dominicana y Venezuela. El 95,4 por ciento de las mujeres refirió realizar aseo corporal una o más veces al día y 2,8 por ciento, una o dos veces por semana. El 71 por ciento realiza aseo del área genital de adelante hacia atrás (de vulva a ano). El tipo de jabón más comúnmente usado es el jabón en barra, seguido de la presentación líquida. Se evidenció un porcentaje de 66,9 por ciento de mujeres que depilan su área genital. El área circunscrita al bikini es la más depilada con 32,8 por ciento y la depilación del área genital en su totalidad es de 28,8 por ciento. El material de la ropa interior en la región vulvar más utilizado por las mujeres latinoamericanas encuestadas es el algodón (65,5 por ciento), que sumado a 20,2 por ciento de las mujeres que utilizan ropa interior de cualquier material con algodón fue cercano al 86 por ciento. En relación con el uso de elementos de aseo genital durante las relaciones sexuales, 29,7 por ciento de las mujeres encuestadas refiere utilizar duchas vaginales; de las cuales 42 por ciento refirió su uso siempre que tiene relaciones sexuales y 43 por ciento, ocasionalmente. A la costumbre de orinar antes y después de tener relaciones sexuales se encontró que 37,9 por ciento de las mujeres orina después del coito; 17 por ciento, antes y 11,8 por ciento orina antes y después. Las mujeres realizan en un gran porcentaje lavado de manos después de orinar o defecar, pero el hábito de lavarse las manos antes, sigue siendo bajo. En cuanto a la técnica de aseo genital, el porcentaje de técnica inadecuada...

To describe the intimate hygienic feminine habits of some women of Latin-America during 2008. A previously designed pilot survey was applied to a total of one thousand women who assisted to the office of a group of gynecologists of Latin America during 2008 and agreed to voluntarily answer the survey. The participant countries were: Colombia, Costa Rica, Ecuador, Guatemala, Honduras, Mexico, Panama, Peru, Dominican Republic and Venezuela.95.4 percent of these women practiced corporal hygiene at least once daily and 2.8 percent, once or twice a week. 71 percent cleaned their genital area backwards (from vulva to anus). The type of soap most commonly used is the bar soap followed by liquid body wash. Evidence showed that 66.9 percent of women depilate their genital area. The bikini surrounding area is the most depilated one, with a 32.8 percent and the total depilation of the genital area is 28.8 percent. Cotton is the most commonly used material for underwear on the vulvar area by surveyed Latin American women (65.5 percent), which added to a 20.2 percent of women who use underwear of any material with cotton was nearly 86 percent. When the use of genital hygiene devices during sexual intercourse is questioned, 29.7 percent of the surveyed women opted to use vaginal showers; of which 42 percent used it every time they had sexual intercourse and 43 percent just occasionally. In relation to the habit of urinating before and after having sexual intercourse it was established that 37.9 percent of women urinate after the coitus; 17 percent before it, and 11.8 percent urinates before and after. Women, in a great percentage, wash their hands after urinating or defecating, but the habit of washing their hands before is still not as frequent. Regarding the genital (feminine) hygiene technique, the percentage of "inadequate" hygiene technique is surprisingly as low as about 28 percent. With this in mind, it is fundamental to reinforce training, improve information...

Higiene íntima femenina y vaginosis bacteriana: Encuesta Epidemiológica Latinoamericana 2008 / Intimate hygiene and bacterial vaginosis: Epidemiological Latinoamerican Survey 2008

Objetivos: hacer una aproximación a la prevalencia de vaginosis bacteriana (VB) en mujeres en Latinoamérica y explorar la asociación entre el tipo de hábitos higiénicos y prácticas sexuales con la presencia de este diagnóstico. Metodología: estudio de corte transversal en mujeres de 10 países de Latinoamérica entre los 16 y 49 años, vida sexual activa y ciclos menstruales. Se excluyeron las mujeres que presentaban otro tipo de infección vaginal, en gestación o en puerperio, con incapacidad para responder la encuesta o con cambio de pareja sexual en el último trimestre. Igualmente, se realizó muestreo por conveniencia de 1.000 mujeres. Se presenta la prevalencia de punto de VB. Se aplicó una encuesta que contenía información sociodemográfica, información sobre actividad sexual e higiene íntima y se hizo el diagnóstico presuntivo de vaginosis bacteriana basado en criterios clínicos y de laboratorio. Se evalúa la asociación entre VB, los hábitos higiénicos y prácticas sexuales por medio del OR y su intervalos de confianza del 95%. Resultados: la prevalencia de VB fue del 40% en las pacientes encuestadas. Se encontró asociación con el uso de alcohol y tabaco. Como actores protectores se identificaron el lavarse las manos después de orinar o defecar (OR=0,32; IC95%, 0,16-0,63); utilizar una técnica “adecuada” de aseo genital (OR=0,55; IC95%, 0,41-0,74) el uso de jabón en forma líquida (OR=0,62; IC95%, 0,46-0,84) y el uso de un jabón exclusivo para el área genital (OR=0,56; IC95%, 0,42-0,75). Como factores de riesgo se encontraron el uso de tampón (OR=3,00; IC95%,1,88-4,80), tener relaciones sexuales durante el período menstrual (OR=1,46; IC95%, 1,03-2,07) y usar lubricantes durante el coito (OR=1,68; IC 95%, 1,07-2,64). Conclusión: la prevalencia de VB es similar a la previamente informada en Latinoamérica. Su frecuencia esta asociada a los hábitos higiénicos y prácticas sexuales.

Objectives: presenting an approximation to bacterial vaginosis (BV) prevalence in Latin America and exploring the association between types of hygienic habits and sexual practices presented along with such diagnosis. Methodology: this was an epidemiological survey of women aged 16 to 49 from ten Latin-American countries who had active sexual lives and menstrual cycles. Females having another type of vaginal infection, pregnant females or those in puerperium, those unable to fill in the survey or who had changed their sexual partner during the last three-month period were excluded. 1,000 females were included by convenience sampling. The survey revealed BV prevalence; it had and provided data about presumptive diagnosis of BV, sociodemographic data, information about sexual activity, physical grooming, genital hygiene, underwear, intimate and menstrual hygiene and protection related to sexual activity. A presumptive diagnosis of BV was based on clinical and laboratory criteria. The association between BV and the females’ hygienic habits and sexual practices was evaluated by means of OR and 95% confidence intervals. Results: 40% of the surveyed patients had BV. An association was found between BV and alcohol and tobacco use. Washing hands before and after urinating or defecating (OR=0.32; 0.16-0.63 95%CI), using a “suitable” genital washing technique (vulva to anus) (OR=0.55; 0.41-0.74 95%CI), using liquid soap (OR=0.62; 0.46-0.84 95%CI) and soap just for the genital area (OR=0.56; 0.42-0.75 95%CI) were found to be protection-inducing factors. Hygienic habits explored as being risk factors for BV included tampon use (OR=3.00; 1.88-4.80 95%CI), having sexual relations during the menstrual period (OR=1.46; 1.03-2.07 95%CI) and using lubricants during coitus (OR=1.68; 1.07-2.64 95%CI). Conclusion: BV prevalence was found to be similar to that previously reported for Latin-America. Such frequency was found to be associated with hygienic habits and sexual practices.

Risk screening, emergency care, and lay concepts of complications during pregnancy in Chiapas, Mexico.

Maternal morbidity and mortality are widespread in Chiapas, Mexico's southernmost state, as in many developing regions. Globally, the utility of three approaches to addressing such problems has been debated: (a) obstetric risk screening (i.e. screening women for risk during pregnancy and channeling those at risk to preventive care); (b) emergency obstetric care (i.e. identifying complications during pregnancy or birth and providing prompt effective treatment); and (c) combined risk screening and emergency care. Unaddressed to date in peer-reviewed journals are the lay perceptions of complications and risk that precede and incite the quest for obstetric care in Mexico. High incidence of maternal mortality in Chiapas, exacerbated by the predominantly rural, highly indigenous, geographically dispersed, and economically marginalized nature of the state's southern Border Region, prompted us to conduct 45 open-ended interviews with a convenience sample of women and their close relative/s, including indigenous and non-indigenous informants in urban and rural areas of four municipalities in this region. Interviews suggest that none of the three approaches is effective in this context, and we detail reasons why each approach has fallen short. Specific obstacles identified include that (1) many women do not access adequate prenatal screening care on a regular basis; (2) emergency obstetric care in this region is severely circumscribed; and (3) lay notions of pregnancy-related risk and complications contrast with official clinical criteria, such that neither clinical nor extra-clinical prenatal monitoring encompasses the entire range of physical and social risk factors and danger signs. Findings reported here center on a rich description of the latter: lay versus clinical criteria for risk of antepartum complication.

[Clinical effects of metformin in patients with polcystic ovarian syndrome]. / Efectos clínicos de la metformina en pacientes con síndrome de ovario poliquistico.

OBJECTIVE: To verify the medical effects of metformin in polycystic ovary syndrome patients. METHOD: 10 women with polycystic ovary syndrome were including in this prospective clinical study. After a baseline workup, body mass index (BMI) and waist hip index (WHI) were measured; the diagnosis of polycystic ovary syndrome was achieved with the following basal clinical studies: vaginal ultrasound, prolactin, thyroid profile, glucose, insulin, testosterone, androstenedione, 17-hidroxiprogesterone, dehydroepiandrosterone sulfate and cortisol. The diagnosis of insulin resistance was achieved by model homeostasis assessment and the relationship glucose/insulin. Patients were given 500 mg of metformin twice a day for 3 months and reevaluated. RESULTS: 8 of 10 patients who completed treatment, showed significant improvement in insulin resistance (only by homeostasis model); there were decrease in hirsutism (mean of 35.07%), without improve menstrual cyclicity, although we achieved at least one menstruation in 42.85% in cases with amenorrhea after 2 or 3 months of treatment. There were no changes in weight, BMI neither in ovarian volume and number of follicles. CONCLUSION: A 3 month course of metformin therapy in women with polycystic ovary syndrome did not improve menstrual cyclicity, albeit significant decrease in insulin, insulin resistance and hirsutism was obtained.

[Frequency and etiology of seminal infections in the study of infertile couples]. / Frecuencia y etiología de las infecciones seminales en el estudio de la pareja infértil.

UNLABELLED: Male genital infections are a relevant cause in the etiology of infertility, due to abnormalities in sperm quality, affecting spermatozoal count and motility. OBJECTIVE: Identify the most common bacteria isolated from seminal cultures and their impact on seminal quality. MATERIAL AND METHODS: A retrospective, longitudinal and observational study was performed by reviewing 295 files of infertile males seen in our clinic of Reproductive Biology at the Hospital Juárez de México, in whom seminogram and seminal cultures were practiced for detection of seminal infection and quality assessment. RESULTS: 47% of cases presented infection by one or two bacteria, Staphylococcus epidermidis, Streptococcus (alpha and beta hemolitic) and Escherichia coli prevailed. The main alterations in quality were motility, pH, morphology and viscosity in association with S. epidermidis and E. coli. CONCLUSIONS: Nearly half of our group of study disclosed seminal infections and it resembled the percentages reported in the literature; most of them were asymptomatic. In disparity with other reports the most common bacterial agent found in association with changes in seminal quality was a skin saprophyte.

Vaginoplasty with amniotic membrane graft

Introducción. Las opciones para reconstrucción de agenesia vaginal están limitadas por la disponibilidad de tejido local, las malformaciones asociadas, la necesidad de usar conformadores y las dificultades técnicas. Las complicaciones a largo plazo como serían las estenosis de vaginas injertadas, el defecto de sitios donadores y la durabilidad de la reconstrucción afectan la elección del tipo de cirugía. Se presenta una paciente con agenesia total de vagina, reconstruida con una técnica simple, efectiva y relativamente poco invasiva utilizando injertos de membrana amniótica colocados en un túnel disecado en el espacio vésico-rectal. Esta técnica permite reepitelización vigorosa de la neovagina que tendrá resultados permanentes funcionales y estéticos. Caso clínico. Paciente fenotípicamente femenina de 17 años de edad con ausencia de útero y vagina. El plan incluía reconstrucción vaginal con injerto de membranas amnióticas. El seguimiento a largo plazo de la paciente expresó satisfacción con la reconstrucción. Ella reportó relaciones sexuales normales, negó problemas en el área quirúrgica o estenosis, y se describe la reconstrucción como estéticamente equivalente a una vagina normal.Conclusión. Esta técnica ofrece numerosas ventajas sobre técnicas convencionales; un factor que limita su utilidad es la posibilidad de transmisión de enfermedades infecciosas. Para medios en los que los recursos son limitados, representa un beneficio significativo cuando se compara con otros métodos reconstructivos. Malformaciones congénitas; vaginoplastia; injerto de amnios.