Experiencia de cuatro años con la cinta reajustable para incontinencia urinaria de esfuerzo / 4-year experience with the use of readjustable tape for stress urinary incontinence

Resumen OBJETIVO: Describir la experiencia con el cabestrillo reajustable Remeex® en pacientes con incontinencia urinaria de esfuerzo recurrente, como una alternativa de tratamiento. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional, de serie de casos llevado a cabo en un solo centro de la ciudad de Medellín, Colombia, en pacientes atendidas en la Unidad de Uroginecología de la Clínica Universitaria Bolivariana. Criterios de inclusión: mujeres mayores de 18 años, con diagnóstico de incontinencia urinaria recidivante después de una o más cirugías fallidas para corregir la incontinencia urinaria o con diagnóstico de deficiencia intrínseca del esfínter a las que se les practicó el procedimiento de cabestrillo reajustable (Remeex Female Neomedic) entre el 2016 y el 2019. RESULTADOS: Se evaluaron 19 pacientes con media de edad de 62 años (DE ± 9). La mediana de seguimiento fue de 19.4 meses (RIQ 10-26.5). Todas las pacientes tenían urodinamia prequirúrgica que confirmó el diagnóstico de incontinencia urinaria de esfuerzo. Las 19 pacientes tuvieron diagnóstico de incontinencia urinaria moderada-severa-recurrente, 4 con hipoactividad del detrusor y 1 con deficiencia intrínseca del esfínter. De las 19 pacientes, a 10 se les intervino para corrección de prolapso de órganos pélvicos concomitante, que se distribuyeron en: 6 pacientes con colporrafia anterior o posterior, 3 colpocleisis y 1 sacrocolpopexia por laparotomía. CONCLUSIONES: El cabestrillo reajustable es una buena opción para mujeres con intervenciones previas antiincontinencia con recidiva en quienes se demostró la mejoría en el grado de incontinencia en relación con el inicial, beneficio que se reflejó en mejor calidad de vida.

Abstract OBJECTIVE: To describe the experience with the readjustable sling Remeex® in patients with recurrent stress urinary incontinence as a treatment alternative. MATERIALS AND METHODS: Retrospective, observational, case series study carried out in a single center in the city of Medellin, Colombia, in patients attended at the Urogynaecology Unit of the Bolivarian University Clinic. Inclusion criteria: women over 18 years of age, with a diagnosis of recurrent urinary incontinence after one or more failed surgeries to correct urinary incontinence or with a diagnosis of intrinsic sphincter deficiency who underwent the readjustable sling procedure (Remeex Female Neomedic) between 2016 and 2019. RESULTS: Nineteen patients were evaluated with mean age 62 years (SD ± 9). The median follow-up was 19.4 months (RIQ 10-26.5). All patients had preoperative urodynamics that confirmed the diagnosis of stress urinary incontinence. All 19 patients had a diagnosis of moderate-severe-recurrent urinary incontinence, 4 with detrusor hypoactivity and 1 with intrinsic sphincter deficiency. Of the 19 patients, 10 underwent surgery for correction of concomitant pelvic organ prolapse, which were distributed as follows: 6 patients with anterior or posterior colporrhaphy, 3 colpocleisis and 1 sacrocolpopexy by laparotomy. CONCLUSIONS: The readjustable sling is a good option for women with previous anti-incontinence interventions with recurrence in whom improvement in the degree of incontinence in relation to the initial one was demonstrated, a benefit that was reflected in better quality of life.

Factores asociados a la falta de oportunidad en la terapia de reperfusión miocárdica en pacientes con síndrome coronario agudo en una institución de salud / Factors associated with the lack of opportunity in myocardial reperfusion therapy in patients with acute coronary syndrome in a health institution

Resumen Introducción La oportunidad en la terapia de reperfusión en pacientes con infarto agudo de miocardio se asocia con factores sociodemográficos, clínicos y de atención. Independientemente de la terapia de reperfusión utilizada, lo importante es minimizar el tiempo de isquemia total. Objetivo Determinar los factores asociados a la falta de oportunidad en la terapia de reperfusión miocárdica. Método: Estudio con enfoque empírico analítico, cuantitativo, observacional de corte transversal, en el que se analizaron los factores asociados a la falta de oportunidad en la terapia de reperfusión miocárdica, mediante la prueba de ji al cuadrado y el cálculo de la razón de disparidad para estudiar la asociación con un nivel de confianza del 95%. Resultados Se analizaron 256 pacientes que ingresaron a urgencias por síndrome coronario agudo. El 63% de los eventos ocurrieron en horario nocturno, fin de semana o festivo. El 22% de los pacientes tenía elevación del segmento ST; de estos, solo el 47% llegaron en menos de 12 horas del inicio de los síntomas y al 52% se les realizó Intervención Coronaria Percutánea Primaria (ICPP) en un tiempo mayor de 90 minutos. La falta de oportunidad se relacionó con el horario del evento (p = 0.001), el tiempo hasta la realización del electrocardiograma (ECG) (p = 0.01), el tiempo hasta la atención por el médico general y urgentólogo (p = 0.003) y el tiempo hasta la atención del cardiólogo hemodinamista (p = 0.015). Conclusiones Más de la mitad de los pacientes que llegaron a urgencias con el ST elevado recibieron una terapia de reperfusión inoportuna, y ello estuvo relacionado con el horario del evento, el tiempo ECG, y el tiempo de atención médica en urgencias y por el hemodinamista.

Abstract Introduction The opportunity in reperfusion therapy in patients with acute myocardial infarction is associated with sociodemographic, clinical and attention factors. Regardless of the reperfusion therapy used, the important thing is to minimize the time of total ischemia. Objective To determine the factors associated with the lack of opportunity in myocardial reperfusion therapy. Method The study was conducted with empirical analytical, quantitative, cross-sectional observational approach, factors associated with the lack of opportunity in myocardial reperfusion therapy were analyzed, using the ji squared test and calculating odds ratios to study the association with a level 95% confidence. Results 256 patients who were admitted for emergencies with ACS were analyzed, 63% of the events occurred at night, weekend or holiday, 22% of the patients admitted with ST segment elevation, of these only 47% arrived in less than 12 hours after the onset of symptoms and 52%, the inappropriate ICPP was performed in a time greater than 90 minutes, related to the time of the event (p = 0.001); ECG time (p = 0.01), general doctor and urgentologist care time (p = 0.003) and hemodynamic cardiologist care time (p = 0.015). Conclusions More than half of the patients who arrived at the emergency department with elevated ST receive an inappropriate reperfusion therapy and it is related to the time of the event, ECG time, time of emergency medical attention and hemodynamics.

Breaching the Bacterial Envelope: The Pivotal Role of Perforin-2 (MPEG1) Within Phagocytes.

The membrane attack complex (MAC) of the complement system and Perforin-1 are well characterized innate immune effectors. MAC is composed of C9 and other complement proteins that target the envelope of gram-negative bacteria. Perforin-1 is deployed when killer lymphocytes degranulate to destroy virally infected or cancerous cells. These molecules polymerize with MAC-perforin/cholesterol-dependent cytolysin (MACPF/CDC) domains of each monomer deploying amphipathic ß-strands to form pores through target lipid bilayers. In this review we discuss one of the most recently discovered members of this family; Perforin-2, the product of the Mpeg1 gene. Since their initial description more than 100 years ago, innumerable studies have made macrophages and other phagocytes some of the best understood cells of the immune system. Yet remarkably it was only recently revealed that Perforin-2 underpins a pivotal function of phagocytes; the destruction of phagocytosed microbes. Several studies have established that phagocytosed bacteria persist and in some cases flourish within phagocytes that lack Perforin-2. When challenged with either gram-negative or gram-positive pathogens Mpeg1 knockout mice succumb to infectious doses that the majority of wild-type mice survive. As expected by their immunocompromised phenotype, bacterial pathogens replicate and disseminate to deeper tissues of Mpeg1 knockout mice. Thus, this evolutionarily ancient gene endows phagocytes with potent bactericidal capability across taxa spanning sponges to humans. The recently elucidated structures of mammalian Perforin-2 reveal it to be a homopolymer that depends upon low pH, such as within phagosomes, to transition to its membrane-spanning pore conformation. Clinical manifestations of Mpeg1 missense mutations further highlight the pivotal role of Perforin-2 within phagocytes. Controversies and gaps within the field of Perforin-2 research are also discussed as well as animal models that may be used to resolve the outstanding issues. Our review concludes with a discussion of bacterial counter measures against Perforin-2.

MPEG1/Perforin-2 Haploinsufficiency Associated Polymicrobial Skin Infections and Considerations for Interferon-γ Therapy.

Introduction: Macrophage expressed gene 1 (MPEG1) is highly expressed in macrophages and other phagocytes. The gene encodes a bactericidal pore-forming protein, dubbed Perforin-2. Structural-, animal-, and cell-based studies have established that perforin-2 facilitates the destruction of phagocytosed microbes upon its activation within acidic phagosomes. Relative to wild-type controls, Mpeg1 knockout mice suffer significantly higher mortality rates when challenged with gram-negative or -positive pathogens. Only four variants of MPEG1 have been functionally characterized, each in association with pulmonary infections. Here we report a new MPEG1 non-sense variant in a patient with the a newly described association with persistent polymicrobial infections of the skin and soft tissue. Case Description: A young adult female patient was evaluated for recurrent abscesses and cellulitis of the breast and demonstrated a heterozygous, rare variant in MPEG1 p.Tyr430*. Multiple courses of broad-spectrum antimicrobials and surgical incision and drainage failed to resolve the infection. Functional studies revealed that the truncation variant resulted in significantly reduced capacity of the patient's phagocytes to kill intracellular bacteria. Patient-derived macrophages responded to interferon gamma (IFN-γ) by significantly increasing the expression of MPEG1. IFN-γ treatment supported perforin-2 dependent bactericidal activity and wound healing. Conclusions: This case expands the phenotype of MPEG1 deficiency to include severe skin and soft tissue infection. We showed that haploinsufficiency of perforin-2 reduced the bactericidal capacity of human phagocytes. Interferon-gamma therapy increases expression of perforin-2, which may compensate for such variants. Thus, treatment with IFN-γ could help prevent infections.

CexE Is a Coat Protein and Virulence Factor of Diarrheagenic Pathogens.

CexE is a 12 kDa protein that was originally reported to be present in just three strains of enterotoxigenic Escherichia coli (ETEC); a frequent cause of diarrheal illnesses worldwide. However, an examination of sequenced genomes has revealed that CexE is actually present in a majority of ETEC strains. In addition, homologs of CexE are present in enteroaggregative E. coli (EAEC), Yersinia enterocolitica, Providencia alcalifaciens, and Citrobacter rodentium. Although it has been hypothesized that CexE and its homologs are virulence factors, this has yet to be tested. Thus the primary aim of this study was to determine if these proteins contribute to pathogenicity. Our secondary aim was determine if they are secreted coat proteins. Here we report that all neonatal mice infected with a wild-type strain of C. rodentium perished. In contrast a cexE mutant was significantly attenuated with 45% neonate survival. In adult mice the wild-type strain reached significantly higher loads in the large intestines and were shed in greater numbers than cexE mutants. Secretion of the CexE homolog in EAEC is dependent upon an atypical Type I secretion system that accepts its client from the periplasm rather than the cytoplasm. Insertion mutants of cexC, the putative ATPase of the CexE secretion system, were attenuated in our murine model. In vitro we found that CexC is required for the secretion of CexE to the outer membranes of both ETEC and C. rodentium. Secretion is not constitutive because CexE accumulates in the periplasm when the two pathogens are cultured under noninducing conditions. Although secretion conditions differ between ETEC and C. rodentium, secreted CexE remains predominantly associated with the outer membranes of both species. In aggregate these findings demonstrate that CexE is a secreted coat protein and virulence factor that promotes colonization of host intestinal tissues by enteric pathogens.

Prevalencia de dislipidemias en la región capital: resultados preliminares del estudio EVESCAM / Prevalence of dyslipidemias in the capital region: preliminary results of the EVESCAM study

Las dislipidemias son un factor de riesgo para enfermedades cardiovasculares. Se desconoce la prevalencia actual de dislipidemias en la región Capital de Venezuela. Objetivo: Determinar la prevalencia de dislipidemias en adultos de la región capital evaluados en el estudio EVESCAM. Métodos: Estudio poblacional, observacional, transversal de muestreo aleatorio poliestratificado por conglomerados. Se evaluaron 7 comunidades de la Región Capital desde julio de 2015 hasta enero de 2016: El Retiro; Miranda Casco Central y Bello Campo; Los Teques: La Cima; Guatire: Centro y Castillejo y rural: Guatire: La Candelaria. Participaron 416 sujetos desde los 20 años de edad. Los puntos de corte para definir las dislipidemias fueron hipoalfalipoproteinemia: colesterol HDL < 40 mg/dL; hipertrigliceridemia: triglicéridos (TG) ≥ 150 mg/dL; hipercolesterolemia: colesterol total ≥ 200 mg/dL; colesterol LDL elevado: colesterol LDL ≥ de 130 mg/dL; dislipidemia aterogénica: TG ≥ 150 mg/dL más colesterol HDL bajo (mujeres: < 40 mg/dl y hombres: < 50 mg/dl). Las frecuencias se expresaron en porcentajes y se aplicó el estadístico Chi cuadrado, un valor de p < 0,05 fue considerado como estadísticamente significativo. Resultados: La dislipidemia con mayor prevalencia fue la hipoalfalipoproteinemia (67.1%) seguida de la LDLc elevada (20%), hipercolesterolemia (17,1%), hipertrigliceridemia (12,0%) y por último dislipidemia aterogenica (9,4%). La hipoalfalipoproteinemia, fue mayor en hombres que en mujeres (81,6% y 60,8%; respectivamente, p < 0,001) presentándose con mayor prevalencia en el grupo etario de 20 a 40 años al contrario del resto de las dislipidemias. Conclusión: La hipoalfalipoproteinemia persiste como la dislipidemia más prevalente de la región(AU)

Dyslipidemias are a risk factor for cardiovascular diseases. The current prevalence of dyslipidemias in the Capital Region of Venezuela is unknown. Objective: To determine the prevalence of dyslipidemias in adults from the capital region of Venezuela evaluated in the EVESCAM study. Methods: apopulation based, observational, cross-sectional, and cluster sampling study was desing. Seven communities from the Capital Region were evaluated from July 2015 to January 2016: El Retiro; Miranda- Chacao: Casco Central y Bello Campo; Los Teques: La Cima; Guatire: Centro y Castillejo y Rural: Guatire: Candelaria. 416 subjects were included. Dyslipidemias was define as hypoalphalipoproteinemia: HDL cholesterol <40 mg/ dL; hypertriglyceridemia: triglycerides ≥ 150 mg/dL; hypercholesterolemia: total cholesterol ≥ 200 mg/dL; High LDL cholesterol: ≥ 130 mg/dL; therogenic dyslipidemia: triglycerides ≥ 150 mg / dL and low HDL cholesterol (women: <40 mg / dl and men: <50 mg / dl). The frequencies were expressed as percentages and Chi-square test was applied to assess differences. The level of statistical significance accepted was a p-value < 0.05. Results: The most prevalent dyslipidemia was hypoalphalipoproteinemia (67.1%) followed by elevated LDLc (20%), hypercholesterolemia (17.1%), hypertriglyceridemia (12.0%), and atherogenic dyslipidemia (9.4%). Hypoalphalipoproteinemia was higher in men than women (81.6% and 60.8%, respectively, p <0.001), with a higher prevalence at the age group of 20 to 40 years, unlike the rest of dyslipidemias. Conclusion: The hypoalphalipoproteinemia persists as the most prevalent dyslipidemia in the region(AU)

Manifestación inusual de carcinoma neuroendocrino de células no pequeñas / Unusual presentation of a neuroendocrine lung non small cells carcinoma

El dolor lumbar ocupa la primera causa de consulta por afección músculo-esquelética en el primer nivel de atención, siendo de suma importancia la enfermedad actual y los hallazgos al examen físico. Se presenta un caso clínico de un hombre de 60 años de edad con manifestaciones lumbares de alarma, al cual se le diagnosticó un carcinoma neuroendocrino de células no pequeñas de pulmón en etapa avanzada. Se discuten las características generales e histogénesis del tumor, así como las estrategias de tratamiento, teniendo en cuenta que esta enfermedad es infrecuente y representa un difícil diagnóstico(AU)

Lumbar pain is the first cause of consultation for musculoskeletal affections in the primary level of attention. The history and findings on physical examination are very important. We present a case of a sixty years-old man with lumbar alarming manifestations. He was diagnosed with a neuroendocrine carcinoma of non-small lung cells at an advanced stage. The assessment and histogenesis of the tumor are discussed, as well as the treatment strategies(AU)

Validez discriminante, convergente/divergente, fiabilidad y consistencia interna, del WHOQOL-BREF y el MOSSF-36 en adultos sanos de un municipio colombiano / Discriminant, convergent/divergent validity, reliability and internal consistency of WHOQOL-BREF and MOSSF-36 in healthy adults from colombian municipality

La evaluación de la calidad de vida es de gran utilidad para trascender las mediciones clásicas de morbilidad, mortalidad y discapacidad. En Colombia su medición se focaliza en el dominio económico y no se han valorado algunos instrumentos que proporcionan una evaluación más holística. OBJETIVO:evaluar las propiedades psicométricas de los cuestionarios WHOQOL-BREF y MOSSF-36 en adultos de un municipio colombiano. METODOLOGIA:estudio de evaluación psicométrica y transversal en 565 adultos de Rionegro, Antioquia, seleccionados por muestreo probabilístico. Se empleó fuente de información primaria y el análisis se realizó en SPSS 21.0® y Epidat 3.0 por medio de frecuencias y medidas de resumen para describir las dimensiones de los instrumentos, y con base en a de Cronbach y coeficientes de correlación de Pearson para evaluar sus propiedades psicométricas. RESULTADOS:la edad promedio fue cincuenta y un años con rango entre veinte y noventa y cuatro. La fiabilidad fue superior a 0,8 y el porcentaje de éxito en la consistencia interna y la validez discriminante fue del 100% en todas las dimensiones Las dimensiones de ambos instrumentos presentaron correlaciones estadísticamente significativas y superiores a 0,4 evidenciando la validez convergente de las dos escalas. CONCLUSION:el WHOQOL-BREF y el moss-f36 tuvieron un buen desempeño psicométrico, por lo que su aplicación brinda medidas fiables para la valoración de la calidad de vida en poblaciones de Colombia.

Assessing quality of life is useful strategy to transcend the classical measurements of morbidity, mortality and disability. In Colombia its measurement focuses on the economical factors and some tools that provide a more holistic assessment have been evaluated. OBJECTIVE:to evaluate the psychometric properties of the whoqol-bref and mossf-36 questionnaires with adults from a Colombian municipality. METHODOLOGY: a psychometric assessment and a cross sectional study conducted on 565 adults from the Rionegro municipality selected through probability sampling. The primary source of information was used and the analysis was performed with the SPSS21.0® and Epidat 3.0 software packages using frequencies and summary measures to describe the dimensions of the instruments. Similarly, Cronbach's a and Pearson correlation coefficients ewere usde to evaluate the psychometric properties. RESULTS :the mean age was 51 years with a range between 20 and 94. Reliability was greater than 0.8 and the percentage of success in internal consistency and discriminant validity was 100% for all dimensions. The dimensions of both instruments showed statistically significant correlations above 0.4, demonstrating the convergent validity of the two scales. CONCLUSIONS: The WHOQOL-BREF and MOSSF-36 questionnaire had good psychometric performance, thus their application provides reliable and valid measures for assessing the quality of life of Colombian populations.

Ser niño en situación de calle: un riesgo permanente / Homeless children: a permanent risk

Este trabajo se realizó con niños en situación de calle en la ciudad de Medellín, Colombia. OBJETIVO: comprender las experiencias y significados que tienen las situaciones de riesgo que viven en su cotidianeidad. METODOLOGIA: estudio cualitativo, enfoque etnográfico, se realizaron entrevistas, observaciones y diario de campo. Se garantizó la confidencialidad en la divulgación de los datos. RESULTADOS : para los niños la calle significa un riesgo representado por circunstancias que favorecen la ocurrencia de una situación generadora de daño físico y emocional, está condicionado por los lugares en los que se encuentren, las instituciones a las que tienen acceso, las personas con quienes interactúan, las ocupaciones que realizan y el consumo de drogas. CONCLUCUSION:los niños consideran que el medio en el cual se mueven representa un riesgo, lo que los convierte en personas vulnerables que deben protegerse a sí mismos.

This study was conducted with homeless children in Medellin, Colombia. OBJECTIVE: to understand the experiences and meanings of the risky situations that homeless children experience every day. METHODOLOGY: a qualitative study with an ethnographic approach. Interviews, observations and field journals were used for data collection. RESULTS :the streets are a risk for children because their circumstances favor the occurrence of physical and emotional damage. This damage depends on the places the children are in, the institutions to which they have access, the people with whom they interact, their occupations and the drugs they use. CONCLUSSION:children believe that the environment in which they live is risk-filled, and this makes them vulnerable people who must protect themselves.

Absence of fluid-ordered/fluid-disordered phase coexistence in ceramide/POPC mixtures containing cholesterol.

The effect of temperature on the lateral structure of lipid bilayers composed of porcine brain ceramide and 1-palmitoyl 2-oleoyl-phosphatidylcholine (POPC), with and without addition of cholesterol, were studied using differential scanning calorimetry, Fourier transformed infrared spectroscopy, atomic force microscopy, and confocal/two-photon excitation fluorescence microscopy (which included LAURDAN generalized polarization function images). A broad gel/fluid phase coexistence temperature regime, characterized by the presence of micrometer-sized gel-phase domains with stripe and flowerlike shapes, was observed for different POPC/ceramide mixtures (up to approximately 25 mol % ceramide). This observed phase coexistence scenario is in contrast to that reported previously for this mixture, where absence of gel/fluid phase coexistence was claimed using bulk LAURDAN generalized polarization (GP) measurements. We demonstrate that this apparent discrepancy (based on the direct comparison between the LAURDAN GP data obtained in the microscope and the fluorometer) disappears when the additive property of the LAURDAN GP function is taken into account to examine the data obtained using bulk fluorescence measurements. Addition of cholesterol to the POPC/ceramide mixtures shows a gradual transition from a gel/fluid to gel/liquid-ordered phase coexistence scenario as indicated by the different experimental techniques used in our experiments. This last result suggests the absence of fluid-ordered/fluid-disordered phase coexistence in the ternary mixtures studied in contrast to that observed at similar molar concentrations with other ceramide-base-containing lipid mixtures (such as POPC/sphingomyelin/cholesterol, which is used as a canonical raft model membrane). Additionally, we observe a critical cholesterol concentration in the ternary mixtures that generates a peculiar lateral pattern characterized by the observation of three distinct regions in the membrane.

Lateral organization and domain formation in a two-component lipid membrane system.

The thermodynamic phase behavior and lateral lipid membrane organization of unilamellar vesicles made from mixtures of 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) and 1,2 distearoyl-sn-glycero-3-phosphocholine (DSPC) were investigated by fluorescence resonance energy transfer (FRET) as a function of temperature and composition. This was done by incorporating a headgroup-labeled lipid donor (NBD-DPPE) and acceptor (N-Rh-DPPE) in low concentrations into the binary mixtures. Two instances of increased energy transfer efficiency were observed close to the phase lines in the DMPC/DSPC phase diagram. The increase in energy transfer efficiency was attributed to a differential preference of the probes for dynamic and fluctuating gel/fluid coexisting phases. This differential preference causes the probes to segregate (S. Pedersen, K. Jørgensen, T. R. Baekmark, and O. G. Mouritsen, 1996, Biophys. J. 71:554-560). The observed increases in energy transfer match with the boundaries of the DMPC/DSPC phase diagram, as measured by Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). We propose that the two instances of probe segregation are due to the presence of DMPC-rich and DSPC-rich domains, which form a dynamic structure of gel/fluid coexisting phases at two different temperatures. Monitoring the melting profile of each lipid component independently by FTIR shows that the domain structure is formed by DMPC-rich and DSPC-rich domains rather than by pure DMPC and DSPC domains.