Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital.

Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital

Abstract Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Hematoma retropúbico masivo posterior a TVT: enfrentamientos diferentes para una complicación infrecuente / Massive retropubic hematoma after TVT: different approaches for an uncommon complication

INTRODUCCIÓN: La TVT (tension-free vaginal tape) es una cirugía efectiva, pero no exenta de riesgos. Las complicaciones vasculares ocurren en un 0,9-1,7%; solo el 0,33% se presentan como hematoma masivo, en general asociado a la lesión de variante anatómica corona mortis (CM). OBJETIVO: Reportar tres tipos de manejo en pacientes con hematomas masivos después de cirugía para la incontinencia. MÉTODO: Revisión de casos de hematomas masivos tras TVT. Análisis de tres casos con diferente manejo. RESULTADOS: 1086 pacientes operadas en 10 años, 1% hematomas sintomáticos, 0,36% hematomas masivos. Se presentan tres casos. Caso 1: presenta inestabilidad hemodinámica sin respuesta a volumen ni vasoactivos, requirió laparotomía exploradora y se encontró un vaso sangrante retropúbico, compatible con CM, y un hematoma de 1000 cc. Caso 2: hipotensión que responde a volumen, asintomática al día siguiente de alta, reingresó 12 días después con caída de 6 puntos en la hemoglobina y la tomografía computarizada (TC) mostró un hematoma de 550 cc; recibió drenaje percutáneo. Caso 3: asintomática, alta el primer día posoperatorio, reingresa al quinto día con descenso de 4 puntos en la hemoglobina y la TC informa hematoma de 420 cc, que drena espontáneamente por vía vaginal. Todas las pacientes recibieron 14 días de antibióticos, y permanecieron continentes. CONCLUSIONES: Los hematomas retropúbicos masivos son una complicación poco frecuente. Su manejo considera la estabilización hemodinámica, el control del sangrado y el drenaje.

INTRODUCTION: TVT (tension-free vaginal tape) is an effective surgery, not without risks. Vascular complications occur in 0.9 to 1.7%, of which 0.33% present as massive hematoma, generally associated with injury of an anatomical variant, Corona Mortis (CM). OBJECTIVE: To report three types of management in patients with massive hematomas after anti-incontinence surgery. METHOD: Review of cases of massive hematomas after TVT surgery. Analysis of three cases with different management. RESULTS: 1086 patients operated in 10 years, 1% symptomatic hematomas, 0.36% massive. Three cases are presented. Case 1: hemodynamic instability without response to volume or vasoactive agents, required reoperation with exploratory laparotomy, a retropubic bleeding vessel, compatible with CM, and hematoma 1000 cc was found. Case 2: hypotension responds to volume, asymptomatic at next day in discharge conditions, she was readmitted 12 days later with falled 6-point in Hb, and CT showed hematoma 550 cc; she received percutaneous drainage. Case 3: asymptomatic, discharge on the first day after TVT, readmitted on the 5th day with falled 4-point in Hb, CT informed hematoma 420 cc, spontaneously drains vaginally. Patients received 14 days of antibiotics, remained continent. CONCLUSIONS: Massive retropubic hematomas are an infrequent complication, and management considers hemodynamic stabilization, bleeding control and drainage.

Concordance Analysis of ALK Gene Fusion Detection Methods in Patients with Non-Small-Cell Lung Cancer from Chile, Brazil, and Peru.

About 4% to 7% of the non-small-cell lung cancer patients have anaplastic lymphoma kinase (ALK) rearrangements, and specific targeted therapies improve patients' outcomes significantly. ALK gene fusions are detected by immunohistochemistry or fluorescent in situ hybridization as gold standards in South America. Next-generation sequencing-based assays are a reliable alternative, able to perform simultaneous detection of multiple events from a single sample. We analyzed 4240 non-small-cell lung cancer samples collected in 37 hospitals from Chile, Brazil, and Peru, where ALK rearrangements were determined as part of their standard of care (SofC) using either immunohistochemistry or fluorescent in situ hybridization. A subset of 1450 samples was sequenced with the Oncomine Focus Assay (OFA), and the concordance with the SofC tests was measured. An orthogonal analysis was performed using a real-time quantitative PCR echinoderm microtubule-associated protein-like 4-ALK fusion detection kit. ALK fusion prevalence is similar for Chile (3.67%; N = 2142), Brazil (4.05%; N = 1013), and Peru (4.59%; N = 675). Although a comparison between OFA and SofC assays showed similar sensitivity, OFA had significantly higher specificity and higher positive predictive value, which opens new opportunities for a more specific determination of ALK gene rearrangements.

First Results: Innovative Solar Disinfection Technology for Treated Wastewater that Integrates Materiality, Geometry, and Reflective Panels.

Climate change is having drastic consequences in Chile. The lack of water in various regions is causing environmental impacts on ecosystems, including the decrease in the productive activities of rural economies and the deterioration in the quality of life of the inhabitants that occupy the affected physical spaces. In this paper, we propose a sustainable, low-cost treatment of wastewater and its reuse as an adaptation and mitigation policy, patented in 2019, that consists of a wastewater disinfection system based on solar energy. This system can work in both continuous and discontinuous modes. The water passes through a canal of reflective material in the continuous regime, and in the batch regime, the water remains in the canal. The panels are located parallel to the lateral faces of the canal. These panels concentrate the radiation in the canal through reflection. The trapezoidal geometry of the disinfectant canal deflects the radiation and reflects in the direction of the front walls of the canal, radiating what is returned and vice versa. The fraction of the radiation reflected outside the canal reaches the reflective side panels that return the radiation to the canal. The synergy of these three considerations increases the radiation in the canal area, augmenting the elimination of the bacterial load. In the trapezoidal reflective canal without panels, only 5% of the measured radiation exceeded the atmospheric radiation, eliminating 83% of the coliforms. The incorporation of panels surpassed the atmospheric radiation over 36% of the measured radiations, and the removal of coliforms exceeded 99.7%.

Gastrosquisis: ¿una pandemia con tasas en aumento? Experiencia del estudio colaborativo latino americano de malformaciones congénitas (ECLAMC) en Chile. Período 1982-2014 / Gastroschisis: A pandemic with increasing rates? ECLAMC experience in Chile 1982-2015

Introducción: Numerosas publicaciones han alertado sobre el aumento sostenido de las tasas de prevalencia al nacimiento de gastrosquisis en todo el mundo, catalogado este hecho como una «pandemia¼ fuertemente asociada a edad materna baja. Objetivos: Comprobar si en Chile se ha producido también un aumento significativo de la tasa de prevalencia al nacimiento de gastrosquisis y si se relaciona con edad materna baja. Pacientes y método: Se usó la base de datos ECLAMC de 26 hospitales chilenos participantes. Las tasas de prevalencia entre hospitales y las categorías de edad materna se compararon con prueba de Chi cuadrado o prueba exacta de Fisher. Se estudió la serie temporal mediante comparación de tendencias lineales, usando comparaciones de medias vía t-test y Wilcoxon-test. Resultados: En el período 1982-2014 nacieron 721.901 niños, entre los que se encontró 107 casos de gastrosquisis (1,49/10.000), el 75,7% de ellos eran hijos de mujeres menores de 25 años. El promedio de edad materna de los casos fue de 21,6 años, y el promedio nacional es cercano a 28 años, según el Ministerio de Salud. A partir de 1995 esta tasa mostró una tendencia ascendente significativamente distinta de cero (p = 0,00714), con un aumento de 0,1591 cada año. Este incremento fue alrededor del 300% entre 1995 y 2014, respecto del período anterior (p < 0,00001). Conclusión: En Chile se ha producido un aumento significativo de las tasas de gastrosquisis después del año 1995, y esta anomalía se asocia fuertemente con baja edad materna.

Introduction: Several communications have reported a significant increase in the prevalence of gastroschisis at birth in the last three decades. In many Countries it is referred to as "a pandemic strongly associated to low maternal age". Objective: To verify if there has been a significant increase in the prevalence of gastroschisis at birth in Chile, and if this rate is associated with a low maternal age. Patients and methods: The study was performed using the ECLAMC data base from 26 Chilean Hospitals. Comparison between prevalence rates and maternal age categories were made using the X² test or Fisher exact Test. The time series was studied comparing average tendencies using the Student t test and Wilcoxon-test. Results: There were 721,901 newborns in the period 1982-2014, among which 107 were diagnosed with gastroschisis (1.48/10,000). Around three-quarters (75.7%) of them were born from mothers younger than 25. The mean maternal age was 21.6 years in mothers of children with gastroschisis, while the mean maternal age of all mothers from Chile was almost 28 years old. The gastroschisis prevalence at birth rate was constant at around 1/10,000 until 1994. From 1995 this rate has a significant increasing tendency of 0.1591 by year (P = .00714). This increase is about a 300% on average for the 1995-2014 period, compared with the previous one (P < .00001). Conclusion: There has been a significant increase in the gastroschisis prevalence at birth in Chile from 1995, and this anomaly is associated with a low maternal age.

[Gastroschisis: A pandemic with increasing rates? ECLAMC experience in Chile 1982-2015]. / Gastrosquisis: ¿una pandemia con tasas en aumento? Experiencia del estudio colaborativo latino americano de malformaciones congénitas (ECLAMC) en Chile. Período 1982-2014.

INTRODUCTION: Several communications have reported a significant increase in the prevalence of gastroschisis at birth in the last three decades. In many Countries it is referred to as "a pandemic strongly associated to low maternal age". OBJECTIVE: To verify if there has been a significant increase in the prevalence of gastroschisis at birth in Chile, and if this rate is associated with a low maternal age. PATIENTS AND METHODS: The study was performed using the ECLAMC data base from 26 Chilean Hospitals. Comparison between prevalence rates and maternal age categories were made using the X2 test or Fisher exact Test. The time series was studied comparing average tendencies using the Student t test and Wilcoxon-test. RESULTS: There were 721,901 newborns in the period 1982-2014, among which 107 were diagnosed with gastroschisis (1.48/10,000). Around three-quarters (75.7%) of them were born from mothers younger than 25. The mean maternal age was 21.6 years in mothers of children with gastroschisis, while the mean maternal age of all mothers from Chile was almost 28 years old. The gastroschisis prevalence at birth rate was constant at around 1/10,000 until 1994. From 1995 this rate has a significant increasing tendency of 0.1591 by year (P=.00714). This increase is about a 300% on average for the 1995-2014 period, compared with the previous one (P<.00001). CONCLUSION: There has been a significant increase in the gastroschisis prevalence at birth in Chile from 1995, and this anomaly is associated with a low maternal age.

Association between pelvic floor disorder symptoms and QoL scores with depressive symptoms among pelvic organ prolapse patients.

BACKGROUND: There is no consensus on the relationship between depressive symptoms (DS) and pelvic organ prolapse (POP) symptoms and quality of life (QoL). Our hypothesis was that women with DS and POP have worse symptoms and QoL than those without DS and POP. AIM: Our aim was to compare two groups of POP patients, those with depressive symptoms and those without, and evaluate the association of symptoms and QoL. MATERIALS AND METHODS: This planned report is part of a prospective study evaluating the impact of pessary use among symptomatic POP patients. Patients were evaluated by POP quantification (POP-Q), pelvic ultrasound (US), voiding diaries, stress test, pad test, Pelvic Floor Distress Inventory (PFDI-20), Prolapse QoL (P-QoL) and the Goldberg Health Questionnaire (GHQ-12) (psychological health screening for DS when score ≥5). A sample size of 78 patients was required to demonstrate a 50-point difference in the global PFDI-20 score with 80% power and 95% probability. RESULTS: Ninety-one women with POP were included. GHQ-12 was positive in 47 (51.6%) patients. No differences were found in POP-Q, pad and stress test between those with a positive GHQ-12 and those without. However, GHQ-12 was associated with higher PFDI-20 scores and higher scores in seven of nine P-QoL domains. GHQ-12 persisted as an independent risk factor for worse P-QoL scores after multivariable analysis. CONCLUSION: A 'positive' screening for DS was associated with worse PFDI-20 and P-QoL scores despite no difference in objective measurements. It may be that depressed patients interpret their symptoms differently.

Eficacia de la cuantificación de interleucina- 6 en el líquido cefalorraquídeo para el diagnóstico de meningitis bacteriana neonatal / Effectiveness of the measurement of interleukin- 6 in cerebrospinal fluid for detection of neonatal bacterial meningitis

Introducción. Una gran variedad de citocinas se producen en el sistema nervioso central como respuesta a infección microbiana, elevándose de manera consistente para ser consideradas indicadores de infección, por lo que bien podría servir para el diagnóstico de meningitis neonatal. Objetivo: conocer las concentraciones de interleucina- 6 (IL- 6) en líquido cefalorraquídeo (LCR) del recién nacido (RN) con meningitis bacteriana y determinar la eficacia de la prueba en el diagnóstico de meningitis. Material y métodos. Este estudio se realizó de manera prospectiva de diciembre de 2002 a julio de 2003, en el que se midieron las concentraciones de IL- 6 en el LCR de 58 RN con sospecha de sepsis a los que se les realizó punción lumbar para la obtención y análisis del LCR. Resultados. Catorce de los 58 RN cursaron con meningitis bacteriana. La media de la concentración de IL- 6 en el grupo de no expuestos fue de 15.4 pg/mL, mientras que en el grupo expuesto fue de 9 994 pg/mL (P <0.05). Los resultados de sensibilidad (92%), especificidad (100%), valor predictivo positivo y área bajo la curva ROC, muestran una concentración de IL- 6 igual o mayor de 50 pg/mL en el LCR como positivo para diagnóstico de meningitis neonatal. Conclusiones. La determinación de la concentración de IL- 6 en LCR puede ser herramienta útil en el diagnóstico de meningitis, aunque el análisis citoquímico y el cultivo del LCR continúan siendo el estándar de oro.

Introduction. A great variety of cytokines are produced locally in the central nervous system in response to microbial infection, and their levels have been used as a diagnostic parameter of infection. Objectives: to determine the concentrations of interleukin- 6 (IL- 6) in cerebrospinal fluid (CSF) of newborns with bacterial meningitis and the effectiveness of the determination as a diagnostic tool. Material and methods. This was a prospective study from December 2002 to July 2003, in the Instituto Nacional de Perinatologia (INPer), in which the concentrations of IL- 6 in the CSF were measurered in newborns with a clinical diagnosis of sepsis. Results. Fourteen out of 58 newborns attended during the study period had bacterial meningitis.The mean IL- 6 concentration in the meningitis group was 9 994 pg/mL vs 15.4 pg/mL in the control group (P <0.05). Sensitivity was (92%),the specificity (100%);the positive predictive value and area under the ROC curve support that IL- 6 concentration of >50 pg/mL in CSF are the cut- off level of neonatal bacterial meningitis. The concentrations of IL- 6 in the CSF were greater, demonstrating itself that concentrations of IL- 6 equal or greater to 50 pg/mL have a sensitivity of 92% and a specificity of 100%, for the diagnosis of bacterial meningitis. Conclusions. The determination of the concentration of IL- 6 in CSF could be a useful tool in the meningitis diagnosis; however CSF conventional analysis and culture are still the gold standard.