Chemoradiotherapy in a patient with locally advanced small cell neuroendocrine carcinoma of the cervix complicated by pelvic organ prolapse: A case report.

BACKGROUND: The coexistence of cervical cancer and pelvic organ prolapse represents a rare clinical scenario. Small cell neuroendocrine histology likewise represents only 0.9-1.5% of all invasive cervical cancers. There is no consensus regarding the optimal management of patients with concomitant locally advanced cervical cancer and pelvic organ prolapse. CASE SUMMARY: The patient was a 32-year old woman with an 8-cm fungating cervical mass extruding from the introitus. Biopsy was consistent with small cell neuroendocrine carcinoma. Examination showed stage IIIC1r cervical cancer with stage IV pelvic organ prolapse. After manual reduction, a pessary was used to optimize target volume reproducibility during definitive chemoradiation. The patient was treated using cisplatin and etoposide chemotherapy with intensity modulated radiation therapy followed by intracavitary brachytherapy. The patient had no clinical evidence of disease and recurrence of symptomatic prolapse one year after treatment completion. CONCLUSION: This is the first reported case of a cervical neuroendocrine carcinoma in a prolapsed uterus, and the youngest patient in literature to have concomitant cervical cancer and pelvic organ prolapse. The use of a pessary for optimizing target volume reproducibility during definitive chemoradiation is a viable option in managing this rare case scenario.

Measuring geospatial healthcare access to primary level facilities in Mexico: a GIS-based diagnosis analysis.

To describe a general overview of health services delivery in Mexico and geospatially analyze the current distribution and accessibility of Primary Health Care (PHC) facilities to contribute to new approaches to improve healthcare planning in Mexico. We performed a spatial analysis of official data to analyze current distances from health facilities to population, to determine the underserved areas of health services delivery in three selected states using a ranking of indicators. We estimated service area coverage of PHC facilities with road networks of three Mexican states (Chiapas, Guerrero, and Oaxaca). Our estimations provide an overview of spatial access to healthcare of the Mexican population in Mexico's three most impoverished states. We did not consider social security nor private providers. Geospatial access to health facilities is critical to achieving PHC and adequate coverage. Countries like Mexico must measure this to identify underserved areas with a lack of geospatial access to healthcare to solve it. This type of analysis provides critical information to help decision-makers decide where to build new health facilities to increase effective geospatial access to care and to achieve Universal Health Coverage.

Measuring geospatial healthcare access to primary level facilities in Mexico: a GIS-based diagnosis analysis / Medindo o acesso geoespacial da assistência médica a instalações de nível primário no México: uma análise de diagnóstico baseada em sistemas de informação geográfica

Abstract To describe a general overview of health services delivery in Mexico and geospatially analyze the current distribution and accessibility of Primary Health Care (PHC) facilities to contribute to new approaches to improve healthcare planning in Mexico. We performed a spatial analysis of official data to analyze current distances from health facilities to population, to determine the underserved areas of health services delivery in three selected states using a ranking of indicators. We estimated service area coverage of PHC facilities with road networks of three Mexican states (Chiapas, Guerrero, and Oaxaca). Our estimations provide an overview of spatial access to healthcare of the Mexican population in Mexico's three most impoverished states. We did not consider social security nor private providers. Geospatial access to health facilities is critical to achieving PHC and adequate coverage. Countries like Mexico must measure this to identify underserved areas with a lack of geospatial access to healthcare to solve it. This type of analysis provides critical information to help decision-makers decide where to build new health facilities to increase effective geospatial access to care and to achieve Universal Health Coverage.

Resumo Descrever uma visão geral da prestação de serviços de saúde no México e analisar geoespacialmente a atual distribuição e acessibilidade das unidades de APS para contribuir com novas abordagens para melhorar o planejamento da saúde no México. Realizamos uma análise espacial de dados oficiais para analisar as distâncias atuais das unidades de saúde à população, para determinar as áreas descobertas de prestação de serviços de saúde em 3 estados selecionados usando uma classificação de indicadores. Estimamos a cobertura da área de serviço das unidades de APS com redes viárias de 3 estados do México (Chiapas, Guerrero e Oaxaca). Nossas estimativas fornecem uma visão geral do acesso espacial à saúde da população mexicana nos três estados mais pobres do México. Não consideramos seguridade social nem prestadores privados. O acesso geoespacial às unidades de saúde é fundamental para alcançar a cobertura universal de saúde e uma cobertura eficaz. Países, como o México, devem medir isso para identificar áreas não merecidas com falta de acesso geoespacial à saúde para resolvê-lo. Os governos devem gerar políticas e mecanismos para distribuir efetivamente novas instalações de saúde para aumentar o acesso geoespacial efetivo à saúde, bem como para evitar instalações de saúde não planejadas.

STAR particles for enhanced topical drug and vaccine delivery.

Drug delivery to the skin is highly constrained by the stratum corneum barrier layer1. Here, we developed star-shaped particles, termed STAR particles, to dramatically increase skin permeability. STAR particles are millimeter-scale particles made of aluminum oxide or stainless steel with micron-scale projections designed to create microscopic pores across the stratum corneum. After gentle topical application for 10 s to porcine skin ex vivo, delivery of dermatological drugs and macromolecules, including those that cannot be given topically, was increased by 1 to 2 orders of magnitude. In mice treated with topical 5-fluorouracil, use of STAR particles increased the efficacy of the drug in suppressing the growth of subcutaneous melanoma tumors and prolonging survival. Moreover, topical delivery of tetanus toxoid vaccine to mice using STAR particles generated immune responses that were at least as strong as delivery of the vaccine by intramuscular injection, albeit at a higher dose for topical than intramuscular vaccine administration. STAR particles were well tolerated and effective at creating micropores when applied to the skin of human participants. Use of STAR particles provides a simple, low-cost and well-tolerated method for increasing drug and vaccine delivery to the skin and could widen the range of compounds that can be topically administered.

Central nervous system evaluation of an ethanol extract of Bidens odorata Cav (Asteraceae) leaves, and its antinociceptive interaction with paracetamol and naproxen.

INTRODUCTION: Bidens odorata Cav (Asteraceae) is a medicinal plant employed for the treatment of pain, anxiety, and depression. This study aimed to evaluate some neuropharmacological effects of an ethanol extract of B. odorata (BOE) and assess its antinociceptive interaction with naproxen and paracetamol. MATERIALS AND METHODS: The following neuropharmacological effects were evaluated with the ethanolic extract of B. odorata leaves (BOE) (10-200 mg/kg p.o.): the strychnine-induced-convulsion assay (anticonvulsant effect), rotarod test (locomotor activity), tail suspension test (anti-depressant-like activity), cylinder exploratory test (anxiolytic-like actions), and pentobarbital-induced sleep test (sedative effect). The interaction of the BOE-paracetamol and BOE-naproxen combinations were evaluated with the acetic acid-induced writhing test. The ED50 value of each drug was estimated and the combinations of paracetamol and naproxen with BOE were calculated. RESULTS: BOE (100-200 mg/kg) showed anti-convulsant activity by increasing the latency to occurrence of strychnine-induced convulsions, antidepressant-like effects by 28% and 33%, respectively, exerted anxiolytic actions (ED50 = 125 mg/kg), but did not affect motor locomotion. The pre-treatment with 2 mg/kg flumazenil or 20 mg/kg pentylenetetrazol partially reverted the anxiolytic activity shown by BOE alone. BOE (200 mg/kg) prolonged the duration of sleep with similar effect in comparison to clonazepam (1.5 mg/kg). The combinations of BOE-paracetamol (1:1) and BOE-naproxen (1:1) showed antinociceptive synergism. CONCLUSION: BOE induces sedative and anticonvulsant effects. The anxiolytic actions shown by BOE are probably induced by the participation of the GABAergic system. BOE exerts antinociceptive synergistic interaction with paracetamol and naproxen probably by the participation of nitric oxide and ATP-sensitive K+ channels, respectively.

Factores de riesgo para la infección del sitio quirúrgico posapendicectomía. Estudio de casos y controles / Risk factors for surgical-site infection in the atlantic state, colombia. A case-control study

Resumen Objetivo: Evaluar la influencia de los determinantes sociodemográficos, clínicos y del servicio de salud sobre el riesgo de infección del sitio quirúrgico en pacientes apendicectomizados, en los hospitales del Atlántico, Colombia. Materiales y métodos: Estudio de casos y controles retrospectivo. Se revisaron los registros quirúrgicos de pacientes apendicectomizados entre 2009 y 2013. Muestra: 80 casos y 272 controles. Factores estudiados: sociodemográficos (edad, género, régimen de afiliación al sistema de salud); clínicos (antecedentes patológicos, hospitalizaciones previas, grado del apéndice); servicios (tiempos de espera, técnica quirúrgica, duración del procedimiento, profilaxis antibiótica, tiempo de estancia hospitalaria). Análisis: bivariable y multivariable. Se calcularon las razones de momios (OR), intervalos de confianza al 95 %, y pruebas de significancia estadística. Resultados: Luego del análisis multivariado, los factores de riesgo independientes fueron: edad mayor de 54 años (OR = 5,37); afiliación al régimen subsidiado del sistema general de seguridad social en salud (OR = 3,49) y el grado histopatológico del apéndice II, que incluye inflamación focal, ulceraciones del epitelio y microabscesos aislados en folículos linfáticos, (OR = 1,98). Conclusión: Este estudio aporta nueva evidencia de la multicausalidad de la infección nosocomial en pacientes sometidos a apendicectomía. Se destaca el rol de la desigualdad en salud como factor de riesgo importante, lo cual merece especial atención.

Abstract Objective: To evaluate sociodemographic, clinical and health-service-related determinants associated to surgical site infections in patients undergoing appendectomy in third level Hospitals, located in the Colombian Northern Region, from 2009 to 2013. Methods: Retrospective data was collected of hospital records from participating hospitals; 80 cases and 272 controls were compared regarding socio-demographic (age, gender, regime of affiliation to the social-security health system), clinical (comorbidity, prior hospitalization, degree of appendix), and healthcare-related variables (diagnostic time, preoperative time, operation duration, prophylaxis with antibiotics and hospital-stay length). Both bivariate and multivariate analysis were conducted. Odds Ratios, 95% confidence intervals were estimated; Besides, both X2-Test and T Student Tests were used to evaluate statistical significance. Results: Socio-demographic (age, affiliation to the subsidized-health-system), clinical (metabolic disease) and health-care related factors such as preoperative waiting time showed to be associated to surgical site infections, in the bivariate analysis. In the final regression model only age above 54 (OR= 5,37); subsidized affiliation to the social security system (3,49) and histopathological grade of appendix, which included focal inflammation, epithelial ulcers, and isolated micro-abscesses in lymphatic's follicles showed to be independent risk factors (OR= 1,98). Conclusion: This study adds new evidence on the multifactorial origin of post-surgery nosocomial infections and spotlights health inequality as a major risk factor that needs to be addressed.

Decreased Urethral Volume Is Comparable to Funneling as a Predictor of Intrinsic Sphincter Deficiency.

OBJECTIVES: The aims of this study were to determine the association between x-ray funneling and ultrasound urethral sphincter complex measurements and to compare the reliability of funneling versus urethral volume measurement in the detection of intrinsic sphincter deficiency (ISD). METHODS: This was a retrospective analysis, which included 54 stress incontinent women dichotomized into those with (1) ISD and (2) no ISD. The presence of bladder neck funneling was diagnosed by fluoroscopic images obtained at the time of video-urodynamics testing. Measurements of the urethral sphincter complex were obtained from ultrasound volumes. Reliability measures were obtained for both funneling and urethral volume measurements. RESULTS: Rhabdomyosphincter length and area were found to be smaller in patients with funneling compared with those with no funneling (P = 0.0161, P = 0.0359). The urethral volume was significantly smaller in the ISD versus no-ISD group (P = 0.0002). For those who had funneling, the ISD group had smaller urethral volume compared with the no-ISD group (P = 0.0019). For those who did not have funneling, the ISD group still had a smaller urethral volume compared with the no-ISD group (P = 0.0054). An ultrasound urethral volume of less than 3.5 cm had a sensitivity of 81% and a specificity of 64% for the presence of ISD, whereas x-ray funneling had a sensitivity of 76% and a specificity of 73%. CONCLUSIONS: Smaller rhabdomyosphincter length and area on ultrasound are associated with x-ray funneling. Ultrasound urethral volume of 3.5 cm as a cutoff provides the same reliability as x-ray funneling for the diagnosis of ISD.

Increasing compliance with stretch breaks in computer users through reminder software.

In order for a repetitive strain injury (RSI) prevention program to be effective, it is important to implement strategies to maintain a client's compliance with the program. This quantitative study explored the effectiveness of computer reminder software in increasing compliance with a stretching program designed to prevent RSI associated with prolonged computer use. Data were collected from a convenience sample of 26 participants who were instructed in a preventative stretching program and assigned to either a treatment group with the computer reminder software, or a control group without the software. To measure compliance, all participants recorded the number of times per day they stretched. Although a statistically significant difference was not found in the mean number of stretch breaks taken by the two groups (p = 0.09), further analysis suggested a type II error may have occurred. The effect size, d, revealed a large effect suggesting that the computer software had an impact on the frequency of stretch breaks, with the mean number of breaks per hour of work greater for the treatment group. Results strongly suggest that further research is warranted in this area.