Case Report: Disseminated Paracoccidioidomycosis and Strongyloides Hyperinfection in a Patient with Human T-Lymphotropic Virus Type 1/2 Infection.

Co-occurrence of paracoccidioidomycosis and strongyloidiasis in immunosuppressed patients, particularly those infected with human T-lymphotropic virus type 1/2, is infrequent. We describe the case of a Peruvian farmer from the central jungle with human T-lymphotropic virus type 1/2 infection, with 2 months of illness characterized by respiratory and gastrointestinal symptoms associated with fever, weight loss, and enlarged lymph nodes. Strongyloides stercoralis and Paracoccidioides brasiliensis were isolated in sputum and bronchoalveolar lavage samples, respectively. The clinical evolution was favorable after the patient received ivermectin and amphotericin B. We hypothesize that autoinfestation by S. stercoralis in human T-lymphotropic virus type 1/2-infected patients may contribute to the disseminated presentation of Paracoccidioides spp. Understanding epidemiological context is crucial for suspecting opportunistic regional infections, particularly those that may coexist in immunosuppressed patients.

Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review.

Objective: This scoping review aimed to describe studies that evaluate the management of cryptococcal meningitis (CM) using cerebrospinal fluid (CSF) shunts, types of shunts used, and clinically relevant patient outcomes. Methods: We searched in the following databases: PubMed, Web of Science/Core collection, Embase, the Cochrane Library, and clinicaltrials.gov on 1 April 2022. We included two-arm and one-arm cohort studies that evaluated clinically relevant patient outcomes. Case reports were used to describe the type of CSF shunts used and the rationale behind its selection. The selection and extraction processes were independently performed by two authors. Results: This study included 20 cohort studies and 26 case reports. Only seven cohort studies compared two groups. Ventriculoperitoneal shunt was the most commonly used type of shunt (82.1%). The main indications for placing a shunt were persistently high opening pressure (57.1%) and persisting neurological symptoms or deterioration (54.3%). Cohort studies suggest that patients with shunt showed improvement in some outcomes such as neurological symptoms and hospital stay length. The most common shunt complications were post-operative fever (1-35.6%) and shunt obstruction (7-16%). Conclusion: CSF shunts may improve some clinically relevant outcomes in patients with CM, but the evidence is very uncertain.

Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report.

BACKGROUND: Actinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown. CASE PRESENTATION: A 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma. CONCLUSION: Esophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started.

Factors associated with frequent marijuana consumption in young people before admission to juvenile detention centers in Peru. / Factores asociados al consumo frecuente de marihuana en jóvenes antes de su ingreso a centros juveniles de diagnóstico y rehabilitación en Perú.

Marijuana is the most widely used illicit drug in the world, especially among young people. This study is relevant to policy makers because it expands the knowledge regarding drug use in vulnerable youth, allowing health authorities to reduce marijuana consumption via educational, family, and governmental strategies and policies. The objective of this study was to determine the prevalence of frequent marijuana consumption and its associated factors in young people before admission to juvenile detention centers in Peru. The data was taken from the 2016 National Population Census of the Youth Diagnostic and Rehabilitation Centers in Peru. The final sample was made up of 1,848 people with ages between 14 and 22 years old, with a median age of 17 (95.6% males). The variable frequent marijuana consumption was defined as the use of marijuana at least once a week, prior to entering the center. The main factors associated with frequent marijuana use were male sex, running away from home before the age of 15, physical abuse during childhood, having a family member who consumed alcohol or drugs frequently, and the presence of criminal gangs in the housing area. Additionally, it was found that living with parents up to a specific critical age decreases the probability of frequent use of marijuana in young people. These results could aid the development of strategies and public policies that help prevent the consumption of marijuana and other drugs from an early age.

La marihuana es la droga ilícita más consumida en el mundo, especialmente entre jóvenes. El presente estudio es relevante para la toma de decisiones en salud porque expande el conocimiento sobre el uso de drogas en la juventud vulnerable y permite a las autoridades sanitarias reducir el consumo de marihuana mediante estrategias educativas, familiares y gubernamentales. El objetivo de este estudio fue determinar la prevalencia del consumo frecuente de marihuana y sus factores asociados en jóvenes antes de su ingreso a centros juveniles de diagnóstico y rehabilitación en Perú. Los datos fueron tomados del Censo Nacional de Población en los Centros Juveniles de Diagnóstico y Rehabilitación del año 2016 en Perú. La muestra final estuvo compuesta por 1848 personas entre 14 y 22 años, con una mediana de edad de 17 años (95,6 % hombres). La variable consumo frecuente de marihuana fue definida como el consumo de marihuana de al menos una vez por semana por parte de los jóvenes, previo a su ingreso al centro. Los principales factores asociados al consumo frecuente de marihuana fueron el sexo masculino, huir de casa antes de los 15 años, haber sufrido abuso físico durante la infancia, tener un miembro de la familia que consuma alcohol o drogas frecuentemente y la presencia de pandillas criminales en la zona residencial. Asimismo, se halló que vivir con los padres hasta cierta edad crítica disminuye la probabilidad de consumo frecuente de marihuana en jóvenes. Estos resultados podrían ayudar a desarrollar estrategias y políticas públicas que ayuden a prevenir el consumo de marihuana y otras drogas desde edades tempranas.

Factores asociados al consumo frecuente de marihuana en jóvenes antes de su ingreso a centros juveniles de diagnóstico y rehabilitación en Perú / Factors associated with frequent marijuana consumption in young people before admission to juvenile detention centers in Peru

La marihuana es la droga ilícita más consumida en el mundo, especialmente entre jóvenes. El presente estudio es relevante para la toma de decisiones en salud porque expande el conocimiento sobre el uso de drogasen la juventud vulnerable y permite a las autoridades sanitarias reducir elconsumo de marihuana mediante estrategias educativas, familiares y gubernamentales. El objetivo de este estudio fue determinar la prevalenciadel consumo frecuente de marihuana y sus factores asociados en jóvenesantes de su ingreso a centros juveniles de diagnóstico y rehabilitación enPerú. Los datos fueron tomados del Censo Nacional de Población en losCentros Juveniles de Diagnóstico y Rehabilitación del año 2016 en Perú.La muestra final estuvo compuesta por 1848 personas entre 14 y 22 años,con una mediana de edad de 17 años (95,6 % hombres). La variable consumo frecuente de marihuana fue definida como el consumo de marihuanade al menos una vez por semana por parte de los jóvenes, previo a suingreso al centro. Los principales factores asociados al consumo frecuente de marihuana fueron el sexo masculino, huir de casa antes de los 15años, haber sufrido abuso físico durante la infancia, tener un miembro dela familia que consuma alcohol o drogas frecuentemente y la presenciade pandillas criminales en la zona residencial. Asimismo, se halló quevivir con los padres hasta cierta edad crítica disminuye la probabilidad deconsumo frecuente de marihuana en jóvenes. Estos resultados podríanayudar a desarrollar estrategias y políticas públicas que ayuden a prevenirel consumo de marihuana y otras drogas desde edades tempranas. (AU)

Marijuana is the most widely used illicit drug in the world, especiallyamong young people. This study is relevant to policy makers becauseit expands the knowledge regarding drug use in vulnerable youth, allowing health authorities to reduce marijuana consumption via educational, family, and governmental strategies and policies. The objectiveof this study was to determine the prevalence of frequent marijuanaconsumption and its associated factors in young people before admission to juvenile detention centers in Peru. The data was taken fromthe 2016 National Population Census of the Youth Diagnostic and Rehabilitation Centers in Peru. The final sample was made up of 1,848people with ages between 14 and 22 years old, with a median age of17 (95.6% males). The variable frequent marijuana consumption was defined as the use of marijuana at least once a week, prior to enteringthe center. The main factors associated with frequent marijuana usewere male sex, running away from home before the age of 15, physical abuse during childhood, having a family member who consumedalcohol or drugs frequently, and the presence of criminal gangs in thehousing area. Additionally, it was found that living with parents upto a specific critical age decreases the probability of frequent use ofmarijuana in young people. These results could aid the developmentof strategies and public policies that help prevent the consumption ofmarijuana and other drugs from an early age. (AU)

Epidemiología y características de las patologías neuroquirúrgicas en un hospital peruano nivel III-1 de alta complejidad. Periodo 2008-2020 / Epidemiology and characteristics of neurosurgical pathologies in a high complexity Peruvian hospital. Period 2008-2020

Introducción: existe una alta carga de enfermedad neuroquirúrgica en el mundo. La información sobre patología neuroquirúrgica en Perú es limitada. Objetivo. El objetivo del estudio es describir las características epidemiológicas y la distribución temporal de la patología neuroquirúrgica en un centro de alta complejidad. Material y Métodos: se realizó un estudio transversal analítico usando el registro de cirugías del servicio de neurocirugía del Hospital Nacional María Auxiliadora, en Lima-Perú entre 2008 y 2020. Se categorizó a los diagnósticos según la patología primaria en 10 categorías; y los diagnósticos específicos correspondientes a cada patología primaria. Se describieron frecuencias absolutas y relativas según patología. La distribución temporal se describió mediante un mapa de calor. Se usó la prueba de chi cuadrado para evaluar asociación entre los diagnósticos y el sexo. Resultados: se realizaron 2948 procedimientos quirúrgicos. La mediana de la edad fue de 38 años; y el 66,7% fue del sexo masculino. Los diagnósticos de traumatismo encefalocraneano, hidrocefalia y patología vascular representan el 60,0% de la carga de enfermedad neuroquirúrgica en el centro de estudio. El 20,2% de los TECs fueron hematomas subdurales crónicos y el 19,4% fueron hematomas epidurales. El 7,4% de todos los procedimientos fueron reintervenciones. Se encontró asociación entre el sexo y el diagnóstico primario (p < 0.001). Conclusiones: Los diagnósticos primarios más frecuentes fueron el traumatismo encefalocraneano, la hidrocefalia y los eventos vasculares. Es necesario comprender mejor el perfil de carga de enfermedad neuroquirúrgica en Perú.

Background: the neurosurgical burden of disease is high worldwide. Information regarding this in Peru is limited. We aim to describe epidemiological characteristics and temporal distribution of the neurosurgical burden of disease in a high complexity center in Peru. Material and Methods: we carried a cross-sectional analytical study using the surgery registry from the neurosurgical department of Hospital Nacional María Auxiliadora in Lima-Peru, which contains registers from 2008 to 2020. Diagnoses were classified into main diagnosis, a variable with 10 levels, each a broad category; and specific diagnosis, defining the etiology. Absolute and relative frequencies were described on a diagnosis basis. Temporal distribution was described using a heatmap. Chi-squared test was used to evaluate association between variables and sex. Results: there were 2948 surgeries in the studied period. The median age was 38, and 66,7% were male. Head trauma, hydrocephalus and vascular pathology represent 60,0% of neurosurgical burden of disease in our center. The most frequent specific diagnoses of head trauma were chronic subdural hematoma (20,2%) and epidural hematoma (19,4%). Reinterventions were 7,4% of all procedures. Sex and principal diagnosis were associated (p < 0.001). Conclusions: The most frequent diagnoses were head trauma, hydrocephalus and vascular pathology. We describe an association between principal diagnosis and sex. There is need for further understanding of the neurosurgical burden of disease in Peru.

Factores asociados a la fecundidad adicional no deseada: análisis de una encuesta nacional en Perú / Factors associated with unwanted additional fertility: secondary analysis of a national survey in Peru

Resumen Objetivos: Determinar la asociación entre los factores sociodemográficos y reproductivos con la fecundidad adicional no deseada (FAND) en el Perú. Materiales y métodos: Se realizó un estudio observacional, analítico transversal, a partir de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018 en el Perú. La FAND es una variable que se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada. La variable FAND, se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada y se agrupó en dos categorías donde la diferencia numérica positiva correspondió a la presencia de FAND. Se realizó una regresión de Poisson, tanto cruda como ajustada. Resultados: Se analizaron los datos de 6944 mujeres entre 40 y 49 años, con una edad promedio de 44,3 años. Se halló una prevalencia de FAND de 72,5% (IC95%: 70,4%-74,4%). En el modelo ajustado, se observó que pertenecer al quintil superior de riqueza (RPa 0,80; IC95%: 0,69-0,93) disminuía la probabilidad de FAND con respecto al quintil intermedio. Por otro lado, provenir del ámbito rural (RPa 1,07; IC95%: 1,01-1,14), aumenta la probabilidad de FAND con respecto al provenir del ámbito urbano. Conclusiones: La prevalencia de FAND en mujeres peruanas de 40 a 49 años que participaron de la ENDES 2018 es alta. Provenir del área rural aumenta la probabilidad de FAND; y pertenecer al quintil superior de riqueza, la disminuye.

Abstract Objectives: To determine the association between sociodemographic and reproductive factors with unwanted additional fertility (UAF) in Peru. Materials and methods: We carried out an observational, cross-sectional analytical study based on the 2018 Demographic and Family Health Survey (DHS) in Peru. The UAF variable was defined as the numerical difference between the general fertility rate and the total fertility rate. This variable was divided into 2 categories, UAF was considered when the numerical difference was positive. The Poisson regression was used, both crude and adjusted. Results: We analyzed data from 6,944 women with an average age of 44.3 years (range, 40 to 49). The prevalence of UAF was found to be 72.5% (95% CI: 70.4%-74.4%). In the adjusted model, patients in the top wealth quintile (aPR 0.80; 95% CI: 0.69-0.93) were found to have a lower probability of having unwanted pregnancies when compared to those in the middle quintile. On the other hand, patients from rural areas (aPR 1.07; 95% CI: 1.01-1.14) had a higher probability of having unwanted pregnancies when compared to those from urban áreas. Conclusions: The prevalence of UAF in Peruvian women between 40 and 49 years old who participated in the 2018 DHS is high. Patients from rural areas have a higher probability of having unwanted pregnancies, and those in the top wealth quintile have a lower probability.

Lateral amyotrophic sclerosis-like onset after combined antiretroviral treatment initiation.

Motor neuron disease (MND) have an incidence of 2 in 100 000 persons, resulting in the death of 1 in every 500 people affected. The most common disease in MND spectrum is amyotrophic lateral sclerosis (ALS). We describe the case of an ALS-like syndrome in a HIV patient. This case report presents a 38 years old male from Peru with HIV who after 2 months of combined antiretroviral treatment (cART) initiation was admitted to the hospital for spastic paraplegia. On his first admission, rapid plasma reagent (RPR) was positive and he was treated for neurosyphilis and discharged. Nevertheless, one month after, he was admitted for the second time because paraplegia persisted. Laboratory tests, electromyography and imaging were performed, and ALS was diagnosed. Normally, HIV treated patient with ALS tend to have a better prognosis, however this was not the case. In this case report, we discuss possible association between ALS and immune reconstitution inflammatory syndrome in HIV patients.

Lepra: sospecha diagnóstica en área no endémica. Serie de casos y revisión de la literatura / Leprosy: a suspected diagnosis in a non-endemic area. Case series and literature review

RESUMEN La lepra es una enfermedad crónica granulomatosa causada por el bacilo Mycobacterium Leprae que afecta piel y células de Schwann. En zonas no endémicas el diagnóstico de lepra suele ser dificultoso debido a la baja sospecha clínica. Durante el periodo de 2012 al 2019, se diagnosticaron y trataron tres casos de lepra en el servicio de infectología del Hospital Nacional Dos de Mayo. El tiempo de enfermedad promedio fue 4 años. Los pacientes iniciaron con pápulas pruriginosas en regiones corporales específicas, progresando a nódulos generalizados. Se constató parestesia e hipoestesia táctil, térmica, dolorosa y vibratoria; las cuales progresaron a anestesia. El diagnóstico se realizó mediante baciloscopía en secreción linfática y biopsia de nódulos cutáneos. Se describen las características clínicas de cada uno de los pacientes. Se remarca la importancia de la sospecha diagnóstica de esta entidad desatendida en áreas no endémicas.

ABSTRACT Leprosy (Hansen's disease) is a chronic granulomatous condition caused by Mycobacterium leprae, a microorganism that affects the skin and Schwann's cells. Making a diagnosis of this condition is difficult in non-endemic areas because of low clinical suspicion. During the 2012-2019 time period, three cases of Hansen's disease were diagnosed and treated in the ID service of Dos de Mayo Hospital. The average time history of the disease was 4 years. Patients started their condition with the appearance of pruriginous papular lesions affecting specific body regions, progressing to generalized nodular lesions. Paresthesia and tactile, thermal, pain, and vibratory hypoesthesia were found. These manifestations later progressed to anesthesia. Diagnosis was made through bacilloscopy in lymphatic fluid and skin node biopsy. Clinical features for each patient are also described. We emphasize the importance of clinical suspicion for diagnosing this unattended disease in non-endemic areas.

Factors associated with unwanted additional fertility: secondary analysis of a national survey in Peru. / Factores asociados a la fecundidad adicional no deseada: análisis de una encuesta nacional en Perú.

OBJECTIVES: To determine the association between sociodemographic and reproductive factors with unwanted additional fertility (UAF) in Peru. MATERIALS AND METHODS: We carried out an observational, cross-sectional analytical study based on the 2018 Demographic and Family Health Survey (DHS) in Peru. The UAF variable was defined as the numerical difference between the general fertility rate and the total fertility rate. This variable was divided into 2 categories, UAF was considered when the numerical difference was positive. The Poisson regression was used, both crude and adjusted. RESULTS: We analyzed data from 6,944 women with an average age of 44.3 years (range, 40 to 49). The prevalence of UAF was found to be 72.5% (95% CI: 70.4%-74.4%). In the adjusted model, patients in the top wealth quintile (aPR 0.80; 95% CI: 0.69-0.93) were found to have a lower probability of having unwanted pregnancies when compared to those in the middle quintile. On the other hand, patients from rural areas (aPR 1.07; 95% CI: 1.01-1.14) had a higher probability of having unwanted pregnancies when compared to those from urban áreas. CONCLUSIONS: The prevalence of UAF in Peruvian women between 40 and 49 years old who participated in the 2018 DHS is high. Patients from rural areas have a higher probability of having unwanted pregnancies, and those in the top wealth quintile have a lower probability.

OBJETIVOS: Determinar la asociación entre los factores sociodemográficos y reproductivos con la fecundidad adicional no deseada (FAND) en el Perú. MATERIALES Y MÉTODOS: Se realizó un estudio observacional, analítico transversal, a partir de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018 en el Perú. La FAND es una variable que se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada. La variable FAND, se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada y se agrupó en dos categorías donde la diferencia numérica positiva correspondió a la presencia de FAND. Se realizó una regresión de Poisson, tanto cruda como ajustada. RESULTADOS: Se analizaron los datos de 6944 mujeres entre 40 y 49 años, con una edad promedio de 44,3 años. Se halló una prevalencia de FAND de 72,5% (IC95%: 70,4%-74,4%). En el modelo ajustado, se observó que pertenecer al quintil superior de riqueza (RPa 0,80; IC95%: 0,69-0,93) disminuía la probabilidad de FAND con respecto al quintil intermedio. Por otro lado, provenir del ámbito rural (RPa 1,07; IC95%: 1,01-1,14), aumenta la probabilidad de FAND con respecto al provenir del ámbito urbano. CONCLUSIONES: La prevalencia de FAND en mujeres peruanas de 40 a 49 años que participaron de la ENDES 2018 es alta. Provenir del área rural aumenta la probabilidad de FAND; y pertenecer al quintil superior de riqueza, la disminuye.

Evaluation of validity and reliability of a methodology for measuring human postural attitude and its relation to temporomandibular joint disorders.

INTRODUCTION: Temporomandibular joint disorders (TMJDs) are caused by several factors such as anatomical, neuromuscular and psychological alterations. A relationship has been established between TMJDs and postural alterations, a type of anatomical alteration. An anterior position of the head requires hyperactivity of the posterior neck region and shoulder muscles to prevent the head from falling forward. This compensatory muscular function may cause fatigue, discomfort and trigger point activation. To our knowledge, a method for assessing human postural attitude in more than one plane has not been reported. Thus, the aim of this study was to design a methodology to measure the external human postural attitude in frontal and sagittal planes, with proper validity and reliability analyses. METHODS: The variable postures of 78 subjects (36 men, 42 women; age 18-24 years) were evaluated. The postural attitudes of the subjects were measured in the frontal and sagittal planes, using an acromiopelvimeter, grid panel and Fox plane. RESULTS: The method we designed for measuring postural attitudes had adequate reliability and validity, both qualitatively and quantitatively, based on Cohen's Kappa coefficient (> 0.87) and Pearson's correlation coefficient (r = 0.824, > 80%). CONCLUSION: This method exhibits adequate metrical properties and can therefore be used in further research on the association of human body posture with skeletal types and TMJDs.

Vaginoscopy compared to traditional hysteroscopy for hysteroscopic sterilization. A randomized trial.

OBJECTIVE: To compare vaginoscopic hysteroscopic sterilization with traditional hysteroscopic approach for differences in pain, bilateral microinsert placement rates, and procedure time. STUDY DESIGN: We performed a prospective, randomized, single-blinded study of hysteroscopic sterilization using the Essure System. The study setting was an inner city ObGyn clinic. Ninety patients were randomized to either vaginoscopy or traditional approach. The traditional approach was speculum insertion, paracervical analgesia, and tenaculum. All procedures were done with a 5 mm, 30 degree rigid hysteroscope. Main outcome measures were pain scores (10-point visual analog scale), bilateral placement rates, and procedure times. RESULTS: Vaginoscopy was successful in 42/45 patients (93%). There was no statistically significant difference in pain-scores for microinsert placement between the groups (p = 0.71). First attempt, bilateral microinsert placement rate was 95% (40/42) with vaginoscopy and 95% (43/45) with traditional (p = 0.89). Time for treatment completion was 16 minutes (mean) (range, 13-21) in the traditional group versus vaginoscopy time of 9 minutes (mean) (range, 7-11) (p = 0.03). CONCLUSION: Hysteroscopic sterilization via vaginoscopy is feasible with bilateral microinsert rates comparable to those of traditional hysteroscopy. Vaginoscopy is associated with less overall discomfort and is faster to perform.

Preprocedure patient preferences and attitudes toward permanent contraceptive options.

OBJECTIVE: To determine patient preference for laparoscopic tubal occlusion or hysteroscopic tubal occlusion, two common sterilization interventions, and the acceptability of a postprocedure confirmation test for a hysteroscopic approach. PARTICIPANTS AND METHODS: A total of 100 patients were offered two procedures. A description of each procedure was developed and read to each patient by a research nurse on site. Patients were then asked to respond to a questionnaire concerning options. Final informed consent, procedure review, and procedural date determination were provided by a physician upon completion of the questionnaire. Patients were not allowed to change their questionnaire responses after completion. No interviewer or physician input was allowed during the questionnaire. The study was completed in English or Spanish, as per patient request, by a bilingual/fluent speaker. Physicians completing informed consent were unaware of the questionnaire responses. Patients were not financially incentivized. RESULTS: Of 100 participants, 93 (93%) preferred hysteroscopic sterilization to laparoscopy. The reasons were as follows: fear of general anesthesia (24/93 [26%]), fear of incision (25/93 [27%]), cost (32/93 [34%]), and time (12/93 [13%]) to return to routine activity. All 93 viewed "office-based location" as the main advantage over laparoscopy; 88/93 (94.6%) considered a confirmation test to be a benefit of the procedure. After informed consent was obtained, one additional patient switched from a laparoscopic decision to hysteroscopy (total = 94/100); 89/94 (95%) hysteroscopic decisions underwent hysteroscopic sterilization; 4/6 (67%) laparoscopic decisions proceeded to that surgery. The remainder (N = 7) cancelled due to lack of financial resources. CONCLUSION: A nonincisional, office-based approach to sterilization has high patient acceptability. Patients viewed a confirmatory test for tubal occlusion as a benefit after sterilization.

Peritoneal adhesion prevention at cesarean section: an analysis of the effectiveness of an absorbable adhesion barrier.

OBJECTIVE: To evaluate the effectiveness of an absorbable adhesion barrier utilized at cesarean delivery. STUDY DESIGN: We performed a retrospective, two-arm cohort, chart review of primary and subsequent first repeat cesarean sections from January 1, 2006-December 31, 2009. Exclusion criteria were incomplete operative report, history of prior abdominal-pelvic surgery, pelvic inflammatory disease, chorioamnionitis, emergency cesarean delivery or use of corticosteroids within 2 weeks. Adhesion incidence/severity as well as skin incision to newborn delivery times were analyzed. Effects of peritoneal closure and suture types were examined. RESULTS: Of 262 primary cesareans performed, 43% (N= 112) had repeat cesarean section. With barrier, 74% had no adhesions at repeat surgery, versus 22% in the no barrier group (p = 0.011). Eleven percent had grade 2 adhesions with barrier, while 64% had grade 2-3 in the no barrier group (p = 0.012). The barrier group had no grade 3 adhesions. Those with parietal peritoneal closure had less incidence (p = 0.02) and mean adhesion severity (p = 0.03); no significant difference was found per suture type. No statistical difference in time from skin incision to newborn delivery was noted between primary and barrier group (p = 0.006); those without barrier had a statistically longer delivery interval (p = 0.35). CONCLUSION: Use of an absorbable adhesion baóóórrier reduces the incidence and severity of adhesions at cesarean.

Histological evaluation of bone regeneration means freeze dried bone allograft (FDBA) in post exodontia sockets / Evaluación histológica de la regeneración ósea en alvéolos post exodoncia mediante uso de freeze dried bone allograft (FDBA)

Within oral rehabilitation alveolar ridge preservation following extraction is important. This research study shows a histological, histochemical and histomorphometrical evaluation in two cases of post extraction ridge-socket preservation performed with FDBA. In two patients dental extraction procedures were performed and sockets were immediately filled with FDBA. Six months later a biopsy of grafted area was obtained and rehabilitated through dental implant. Grafted bone samples were treated for histological and histochemical analysis. Bone tissue area was measured. Laboratory analysis of three samples showed inactive bone surfaces, neither osteoblasts nor osteoclasts were found, only osteocyte and osteogenous cells were observed. These findings do not mean that tissue is metabolically inactive, rather bone genesis develop from a tissue matrix with the potential to generate undifferentiated osteocytes, and a micro environment with proteins such as bone morphogenetic proteins (BPM). Inactive biomaterial particles were not observed. Samples showed 0 percent and 30 percent bone tissue respectively. Considering histological differences between this and other research studies, it is necessary to develop further investigation to increase knowledge of processes involved in bone regeneration as well as bone quality, considering the variability that could be seen in each patient.

Dentro de la rehabilitación oral, es importante preservar el reborde alveolar post exodoncia. Se expone un análisis histológico, histoquímico e histomorfométrico de dos casos clínicos de terapias de regeneración ósea de alvéolos post extracción mediante FDBA. En dos pacientes se extrajeron piezas dentarias destruidas y se indujo regeneración ósea mediante FDBA. Seis meses después, se obtuvo una biopsia del injerto y mediante un implante de titanio fue rehabilitado. Para el análisis Histológico e Histomorfométrico, las muestras fueron tratadas con las técnicas Hematoxilina-Eosina, Azul de Alcián, Masson, Von Kossa y colorante Picrosirius de Junqueira.Se midió el área total de tejido, así como el área de tejido óseo. Las superficies de hueso de las muestras se observaron inactivas, no fueron encontrados osteoblastos ni osteoclastos, sólo osteocitos y células osteógenas, lo que no significa que el hueso esté en estado quiescente, sino mas bien a que su génesis ocurre a partir de la matriz de tejido donde se encuentran células con potencialidad de formar osteocitos indiferenciados y un microambiente con proteinas de la familia de factor de crecimiento transformante beta. No fueron encontradas partículas de biomaterial inactivo. En las muestras se cuantificó 0 por ciento y 30 por ciento de hueso mineralizado. Dadas las diferencias histológicas encontradas con otros estudios, es necesario profundizar el conocimiento en los procesos involucrados en la regeneración ósea dependiendo del biomaterial utilizado, y la calidad ósea resultante en cada procedimiento en particular sin perder de vista la variabilidad que puede presentarse dependiendo de cada caso clínico.

One patient, two uteri, two endometrial ablations: case report of thermal balloon ablation in uterine didelphys.

OBJECTIVE: To describe the clinical application and outcomes after endometrial ablation with ThermachoiceIII (Ethicon, Somerville, NJ) in a patient with uterine didelphys with heavy menstrual bleeding. DESIGN: Case report. SETTING: Inner-city community obstetrics and gynecology clinic. PATIENT(S): A 44-year-old Hispanic woman, gravida 3, para 0, with three spontaneous abortions. INTERVENTION(S): The patient underwent diagnostic hysteroscopy, gynecologic dilation and curettage, and endometrial ablation with ThermachoiceIII. MAIN OUTCOME MEASURE(S): Menstrual pattern at 3 months postoperatively, as either amenorrhea (complete lack of menstrual flow), hypomenorrhea (scant or minimal flow lasting <5 days, requiring only light pads), or failure (flow similar to pretreatment state or requiring any other therapy), as well as dysmenorrhea reduction from baseline. Hemoglobin value at 3 months was compared with baseline. RESULT(S): At 3 months, hypomenorrhea was maintained. Bleeding days were 10 per month at baseline and 2 per month after therapy. Visual analogue scale score for dysmenorrhea was 8 at baseline and 2 (mean) at study end. Hemoglobin was 8.9 g/dL at baseline (preoperatively) and 11.1 g/dL at 3 months postoperatively. CONCLUSION(S): Successful conservative therapy of menorrhagia seems possible with thermal balloon ablation in a uterine didelphic patient.

In-office thermachoice III ablation: a comparison of two anesthetic techniques.

BACKGROUND: Patient comfort and safety are prerequisites for office procedures. STUDY OBJECTIVE: comparison of the fentanyl transdermal patch with injection of local anesthesia for intraoperative/postoperative pain from in-office Thermachoice III ablations. METHODS: Single-center prospective randomized (1:1) cohort study. Primary Endpoint: intraoperative and postoperative VAS pain scores (0 as no pain, 10 as extreme pain). Secondary Endpoints: patient satisfaction between cohorts and adverse events. RESULTS: 41 patients were randomized [21 patch protocol (FP), 20 injection protocol (IP)]. For patch users, the median VAS scores were 2.60 (range 1-4) intraoperatively and 3.30 (range 2-5) postoperatively (p = 0.09, CI = -0.8 to 0.4), with the most common adverse events being nausea (62%) and vomiting (38%). Compared to injection, there was no significant difference in intraoperative VAS score (FP median VAS = 2.60, IP median VAS = 2.59; p = 0.15, CI = -0.05 to 0.48), but a significant difference postoperatively (FP median VAS = 3.30, IP median VAS = 6.0; p = 0.01, CI = -2.6 to -1.4). Less NSAIDs were used postoperatively with the FP. At 24 h, more FP patients were 'very satisfied' or 'satisfied' than IP patients. CONCLUSION: Patch intraoperative VAS pain scores are comparable to uterine block scores; postoperative VAS pain scores were statistically lower with the FP. FP resulted in more favorable 'satisfaction' rates compared to IP.

Conexión diente implante en rehabilitación bucal: evaluación clínica y elementos finítos no lineales / Connecting oral tooth implant rehabilitation: clinical evaluation and nonlinear finite element

La pérdida de piezas dentales es un problema para muchos países a nivel mundial. La rehabilitación bucal busca dar solución a los problemas que presentan los pacientes edéntulos por medio de prótesis. En este campo, la implantología ha sido un gran aporte en brindar mayores y mejores soluciones. Desde la década del 1980 se ha postulado la posibilidad de conectar protésicamente dientes e implantes dentales en zonas donde no es posible colocar más de un implante, diseño protésico que causa controversias en el área de rehabilitación bucal. La presente investigación muestra el estado del arte del análisis de Conexiones Diente Implante dental desde las perspectivas de análisis de elementos finitos no lineales y evaluaciones clínicas. Las prótesis fijas dento implanto soportadas deben ser evitadas, sin embargo, en casos donde no es posible poner más de un implante dental, podrían ser utilizadas, previa selección adecuada del caso clínico en base a un correcto diagnóstico. De ser indicadas, debe preferirse el sector posterior, por medio de conexiones rígidas, ferulizados a dientes con buen pronóstico endodóntico y periodontal. Con el advenimiento de biomateriales para regeneración ósea, es discutible la persistencia de casos en que realmente no es posible rehabilitar con más de un implante

Totally or partially toothless patients are a worldwide problem. Oral rehabilitation wants to give a solution by means of dental prosthesis. Implantology has given an important contribution offering a mayor variety and better solutions. From 1980 has been proposed that is possible to connect teeth to implant through fixed prosthesis in areas where does not exist conditions to indicate more than one implant. Tooth implant connections have been controversial, and actually are nowadays. The research wants to show state of art of investigations related to tooth implant connections under the view of non-linear finite elements and clinical analysis. Tooth implant connections must be avoided, however, in cases where is not possible use more than one implant, could be used if case is carefully selected based in a correct diagnosis. Tooth implant supported fixed prosthesis must be indicated in posterior zone of both maxillary bones, through rigid connection splinted to periodontal and endodontic healthy tooth. With advent of biomaterials to alveolar bone regeneration, is controversial to establish cases where really is not possible indicate a fixed prosthesis supported to more than one implant