Metronidazole for Prevention of Pelvic Cellulitis and Abscess after Laparoscopic Hysterectomy: A Triple-blinded, Randomized, Placebo-controlled Clinical Trial.

STUDY OBJECTIVE: To determine whether a postoperative 5-day treatment schedule with vaginal metronidazole added to conventional antibiotic prophylaxis with 2 g cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). DESIGN: A randomized, controlled, triple-blind, multicenter clinical trial. SETTING: Two centers dedicated to minimally invasive gynecologic surgery in Colombia. PATIENTS: A total of 574 patients were taken to TLH because of benign diseases. INTERVENTION: Patients taken to TLH were divided into 2 groups (treatment group, cefazolin 2 g intravenous single dose before surgery + metronidazole vaginal ovules for 5 days postoperatively, control group: cefazolin 2 g intravenous single dose + placebo vaginal ovules for 5 days postoperatively). MEASUREMENTS AND MAIN RESULTS: The absolute frequency (AF) of PC and PA and their relationship with the presence of bacterial vaginosis (BV) were measured. There was no difference in AF of PC (AF, 2/285 [0.7%] vs 5/284 [1.7%] in the treatment and placebo groups, respectively; risk ratio, 1.75; 95% confidence interval, 0.54-5.65; p = .261), nor for PA (AF, 0/285 [0%] vs 2/289 [0.7%]; p = .159, in the treatment and placebo groups, respectively). The incidence of BV was higher in the metronidazole group than the placebo group (42.5% vs 33.4%, p = .026). CONCLUSION: The use of vaginal metronidazole ovules during the first 5 days in postoperative TLH added to conventional cefazolin prophylaxis does not prevent the development of PC or PA, regardless of the patient's diagnosis of BV.

Leptolegnia chapmanii como alternativa biológica para el control de Aedes aegypti

Leptolegnia chapmanii is a facultative pathogen of many species of mosquitoes, among which species of the genus Aedes, Culex and Anopheles stand out for their medical and sanitary importance. The potential of L. chapmanii as an alternative to control lies in its virulence, pathogenicity and specificity against the larval stages of mosquitoes, and because of its harmlessness to non-target species such as fish and amphibians, among others. The natural presence of L. chapmanii had been reported in Argentina, Brazil and the United States. Its presence is possible in other countries throughout the American continent. The development of protocols to produce, formulate, store and apply products based on this microorganism is one of the objectives proposed for the group of Entomopathogenic Fungi at the Centro de Estudios Parasitológicos y de Vectores, Universidad Nacional de La Plata. The efficacy of L. chapmanii as controller is affected by external factors such as temperature, pH, salinity and radiation among others. The process of transfer from the research centers to industry implies many phases. In this way, our project with L. chapmanii is in an initial phase, where we are working on a laboratory scale in proof of concept. We hope to begin soon with the efficacy, efficiency, stability and ecotoxicological safety tests, at the laboratory, semi-field and field scale.

Leptolegnia chapmanii es un microorganismo patógeno facultativo de diversas especies de mosquito, entre las que se destacan, por su importancia médica y sanitaria, especies de los géneros Aedes, Culex y Anopheles. El potencial de L. chapmanii como alternativa de control radica en la virulencia, capacidad patógena y grado de especificidad que presenta hacia los estadios larvales de las diferentes especies de mosquito, y por su inocuidad frente a organismos acuáticos no blanco como, por ejemplo, peces y anfibios. Su presencia natural ha sido reportada en Argentina, Brasil, y Estados Unidos, pensándose como posible en otros países dentro del continente americano. La eficacia de L. chapmanii como controlador se ve influenciada por factores externos, como la temperatura, la radiación y el pH, entre otros. Uno de los objetivos de trabajo del Grupo de Hongos Entomopatógenos del Centro de Estudios Parasitológicos y de Vectores de la Universidad Nacional de La Plata, corresponde al desarrollo de protocolos para la producción, formulación, almacenamiento y aplicación de productos basados en este microorganismo. Con este referente, estamos desarrollando un proyecto con L. chapmanii que se encuentra en la fase inicial, en la que se está trabajando la prueba de concepto a escala de laboratorio. Se espera continuar en el futuro con estudios de eficacia, eficiencia, estabilidad y seguridad ecotoxicológica, a diferentes escalas.

Leptolegnia chapmanii como alternativa biológica para el control de Aedes aegypti / Leptolegnia chapmanii as a biological alternative to control Aedes aegypti

Leptolegnia chapmanii es un microorganismo patógeno facultativo de diversas especies de mosquito, entre las que se destacan, por su importancia médica y sanitaria, especies de los géneros Aedes, Culex y Anopheles. El potencial de L. chapmanii como alternativa de control radica en la virulencia, capacidad patógena y grado de especificidad que presenta hacia los estadios larvales de las diferentes especies de mosquito, y por su inocuidad frente a organismos acuáticos no blanco como, por ejemplo, peces y anfibios. Su presencia natural ha sido reportada en Argentina, Brasil, y Estados Unidos, pensándose como posible en otros países dentro del continente americano. La eficacia de L. chapmanii como controlador se ve influenciada por factores externos, como la temperatura, la radiación y el pH, entre otros. Uno de los objetivos de trabajo del Grupo de Hongos Entomopatógenos del Centro de Estudios Parasitológicos y de Vectores de la Universidad Nacional de La Plata, corresponde al desarrollo de protocolos para la producción, formulación, almacenamiento y aplicación de productos basados en este microorganismo. Con este referente, estamos desarrollando un proyecto con L. chapmanii que se encuentra en la fase inicial, en la que se está trabajando la prueba de concepto a escala de laboratorio. Se espera continuar en el futuro con estudios de eficacia, eficiencia, estabilidad y seguridad ecotoxicológica, a diferentes escalas.

Leptolegnia chapmanii is a facultative pathogen of many species of mosquitoes, among which species of the genus Aedes, Culex and Anopheles stand out for their medical and sanitary importance. The potential of L. chapmanii as an alternative to control lies in its virulence, pathogenicity and specificity against the larval stages of mosquitoes, and because of its harmlessness to non-target species such as fish and amphibians, among others. The natural presence of L. chapmanii had been reported in Argentina, Brazil and the United States. Its presence is possible in other countries throughout the American continent. The development of protocols to produce, formulate, store and apply products based on this microorganism is one of the objectives proposed for the group of Entomopathogenic Fungi at the Centro de Estudios Parasitológicos y de Vectores, Universidad Nacional de La Plata. The efficacy of L. chapmanii as controller is affected by external factors such as temperature, pH, salinity and radiation among others. The process of transfer from the research centers to industry implies many phases. In this way, our project with L. chapmanii is in an initial phase, where we are working on a laboratory scale in proof of concept. We hope to begin soon with the efficacy, efficiency, stability and ecotoxicological safety tests, at the laboratory, semi-field and field scale.

Barbed Suture versus Conventional Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy: Randomized Controlled Clinical Trial.

STUDY OBJECTIVE: To determine the surgical time, suture time, presence of postoperative dyspareunia, and complications that occur after closing the vaginal cuff with a barbed suture compared with conventional suture. DESIGN: A randomized, controlled clinical trial (Canadian Task Force classification I). SETTING: Private gynecologic clinic in Medellin, Colombia. PATIENTS: One hundred fifty women who underwent total laparoscopic hysterectomy for benign pathology. INTERVENTIONS: The patients underwent total laparoscopic hysterectomy with intracorporeal closure of the vaginal cuff and were randomized to 2 groups, 1 using a barbed suture (V-Loc 90; Medtronic/Covidien, New Haven, CT) and 1 using polyglactin 910 (coated Vicryl suture; Ethicon/Johnson & Johnson, New Brunswick, NJ). MEASUREMENTS AND MAIN RESULTS: The total operative time, closing time of the vaginal vault, presence of complications in the cuff, and incidence of postoperative dyspareunia were recorded. The patients were evaluated at a postoperative office visit 2 weeks after the procedure and by telephone interview at 24 weeks. Seventy-five patients were included in the barbed suture group and 75 patients in the polyglactin 910 group. The average time to complete the suture of the vaginal cuff was 12.01 minutes (± 5.37 standard deviation) for the barbed suture group versus 13.49 minutes (± 6.48) in the polyglactin 910 group (95% confidence interval, -.44 to 3.4; p = .130). Blood loss was 31.56 ± 22.93 mL in the barbed suture group versus 30.82 ± 21.75 mL in the polyglactin 910 group (95% confidence interval, -7.95 to 6.47; p = .840). The frequency of postoperative events such as hematoma, cellulitis, cuff dehiscence, fever, emergency consultation, and hospitalization was not statistically significant between groups. No statistically significant difference was found regarding deep dyspareunia at 24 postoperative weeks. CONCLUSION: No differences were found in surgical time or frequency of adverse events when comparing patients after vaginal cuff closure with barbed suture versus polyglactin 910.

In vitro antifungal activity of silver nanoparticles against fluconazole-resistant Candida species.

Nowadays, current advances in nanotechnology constitute a promising alternative in the development of new antimicrobial agents. Silver nanoparticles (AgNPs) are some very interesting products currently provided by available nanotechnology for control of microbial infection. In the present study, AgNPs were synthesized by eco-friendly method, using cysteine as a reducing agent. Also, antifungal activity against Candida species with resistance to fluconazole was evaluated through determination of Minimum Inhibitory Concentration (MIC50) according to protocol M27-A3 of Clinical and Laboratory Standards Institute (CLSI) and Minimum Fungicide Concentration (MFC). This study was carried out with strains Candida krusei and Candida glabrata. As a result, the formation of spherical nanoparticles was obtained with mean sizes of 19 nm and positive surface charge. Values of MIC50 were 0.1 µg ml(-1) AgNPs for the studied species, and MFC were 0.25 and 0.5 µg ml(-1) for C. glabrata and C. krusei, respectively. The AgNPs synthesized showed cytotoxic effect in 50% of Murine Fibroblast Cells (CC50) at a mean concentrations of 10 µg ml(-1) (100 times higher than MIC50). Consequently, AgNPs could be considered as an alternative potential in the development of new antifungal agents with minimum cytotoxicity in fibroblasts and lethal action on Candida species with resistance to conventional antifungal compounds.

Transversus abdominis plane block after ambulatory total laparoscopic hysterectomy: randomized controlled trial.

OBJECTIVE: To determine if transversus abdominis plane anesthetic blockage (TAP block) diminishes early postoperative pain scores and facilitates ambulatory management following total laparoscopic hysterectomy. DESIGN: Randomized triple blind trial. SETTING: Gynecological endoscopy unit at a referral center for laparoscopic surgery. POPULATION: A total of 197 patients. METHODS: Comparison of a treatment group receiving TAP block with bupivacaine 0.25% and placebo group with comparably placed bilateral injection of sterile saline solution. MAIN OUTCOME MEASURES: Pain scores at discharge 24, 48 and 72 h after surgery, opioid requirement after procedure. RESULTS: Patients who had TAP block had a significant reduction in their pain score at discharge compared with the placebo group (p = 0.017). There were no significant differences in the pain scores between groups at 24 h (95% CI 1.36-0.133, p = 0.237), 48 h (95% CI 0.689-0.465, p = 0.702) and 72 h (95% CI -0.631 to 0.223, p = 0.347). No differences were found between the groups regarding opioid requirements following the procedure (χ(2)  = 3.62, p = 0.46). CONCLUSION: Although TAP block after a total laparoscopic hysterectomy reduced the pain score at discharge compared with placebo, its role in this setting is debatable due to the possible lack of clinical significance of the small difference found.

[Sciatic hernia as a cause of chronic pelvic pain]. / Hernia ciática como causa de dolor pélvico crónico.

Sciatic hernia constitutes the scarcest group of hernias of pelvic floor; however, they should be considered in the origin of chronic pelvic pain. The proper diagnosis of sciatic hernias has allowed to surgeons treating successfully patients with acute or chronic pelvic pain, with intestinal or ureteral obstruction and with urinary or gluteus sepsis. It has to be considered as differential diagnosis before the finding of a congenital or acquired gluteus mass. Laparoscopist gynecologist should know the existence of this defect, to be familiar with its aspect in laparoscopic view and to know the laparoscopic treatment of this disease.