A Comparative Study of a Small Series of Patients (50 Patients) with Pelvic Varicose Veins Treated with Plugs Alone or Plugs and Polidocanol.

LEVEL OF EVIDENCE: Level 2. PURPOSE: To compare the safety and efficacy of vascular plug (VP) and vascular plug and polidocanol foam (VPPF) treatments for embolization in pelvic congestion syndrome (PCS). MATERIALS AND METHODS: A comparative, prospective, two-center study enrolled 50 women with PCS from January 2019 to January 2020. The patients were divided into two groups, and embolization was performed with VP (n = 25) and VPPF (n = 25) treatments. The mean age of the patients was 45.6 years ± 6.9. Three clinical parameters were assessed: abdominal pain, dyspareunia, and lower limb pain. The primary outcome (clinical success at 1 yr using a VAS), number of devices, procedure and fluoroscopy times, radiation doses, costs, and complications were compared. The participants were followed-up at 1, 3, 6, and 12 months. RESULTS: At the 1-year follow-up, clinical success did not significantly differ between the two groups (VP vs. VPPF) regarding the improvement of the symptoms analyzed (pelvic pain, dyspareunia, lower extremity pain, and other symptoms (p < 0.05)). The mean number of devices per case was 4 ± 1.1 for the VP group and 2 ± 0.31 for the VPPF group (p < 0.001). No major complications were recorded in either group. The VPPF group had a significantly longer fluoroscopy time (42.8 min ± 14.2 vs. 25.4 min ± 7) and longer radiation dose (VPPF air kerma 839.4 ± 513 vs. VP air kerma 658.4 mGy ± 355 (all p < 0.001)). CONCLUSIONS: Embolization for PCS resulted in pain relief in 90% of patients; the use of polidocanol did not demonstrate changes in the clinical outcome. The use of a VP alone was associated with decreased fluoroscopy time and radiation dose.

Nematicidal Activity of the Endophyte Serratia ureilytica against Nacobbus aberrans in Chili Plants (Capsicum annuum L.) and Identification of Genes Related to Biological Control.

The genus Serratia is widely distributed in soil, water, plants, animals, invertebrates, and humans. Some species of this genus have antifungal, antibacterial, and nematicidal activity. In this work, the nematicidal activity of the endophytic strain of Serratia sp. in chili, Capsicum annuum L., is reported, where at a bacterial concentration of 4 × 109 cel/mL, the penetration of nematodes into the roots significantly decreased by 91 and 55% at 7 and 21 days after inoculation. This bacterial concentration also significantly decreased the number of galls, eggs, egg masses and reproduction factor produced by Nacobbus aberrans in Chili plants, with respect to the control where this bacterial strain was not applied. In the analysis of the genome of the strain, based on average nucleotide identity (ANI), the isolate could be affiliated to the species Serratia ureilytica. The size of the genome is 5.4 Mb, with a 59.3% content of GC. Genes related to the synthesis of chitinases, siderophores, proteases C, serralisins, hemolysin, and serrawettin W2 that have been reported for biocontrol of nematodes were identified in the genome. It is the first report of Serratia ureilytica with nematicidal activity. Based on these results of nematicidal activity, this strain can be evaluated in the field as an alternative in the biocontrol of Nacobbus aberrans in chili cultivation.

Ibero-American Society of Interventionism (SIDI) and the Spanish Society of Vascular and Interventional Radiology (SERVEI) Standard of Practice (SOP) for the Management of Inferior Vena Cava Filters in the Treatment of Acute Venous Thromboembolism.

OBJECTIVES: to present an interventional radiology standard of practice on the use of inferior vena cava filters (IVCFs) in patients with or at risk to develop venous thromboembolism (VTE) from the Iberoamerican Interventional Society (SIDI) and Spanish Vascular and Interventional Radiology Society (SERVEI). METHODS: a group of twenty-two interventional radiologist experts, from the SIDI and SERVEI societies, attended online meetings to develop a current clinical practice guideline on the proper indication for the placement and retrieval of IVCFs. A broad review was undertaken to determine the participation of interventional radiologists in the current guidelines and a consensus on inferior vena cava filters. Twenty-two experts from both societies worked on a common draft and received a questionnaire where they had to assess, for IVCF placement, the absolute, relative, and prophylactic indications. The experts voted on the different indications and reasoned their decision. RESULTS: a total of two-hundred-thirty-three articles were reviewed. Interventional radiologists participated in the development of just two of the eight guidelines. The threshold for inclusion was 100% agreement. Three absolute and four relative indications for the IVCF placement were identified. No indications for the prophylactic filter placement reached the threshold. CONCLUSION: interventional radiologists are highly involved in the management of IVCFs but have limited participation in the development of multidisciplinary clinical practice guidelines.

Future scenarios and opportunities for interventional radiology in the post COVID-19 era.

Pandemic outbreak has led health systems worldwide into a rapid reorganization in response to coronavirus infections, forcing interventional radiology units to adapt. Interventional procedures have evolved in number, type and setting and have arguably been optimized as a direct consequence of this pandemic; a result that will undoubtedly lead to radical change within the specialty. This paper explores the future of interventional radiology from various perspectives, and forecasts the new opportunities that will be presented, from the adaptation of the interventional radiology staff and angiography suite, to the immunological environment, and through to digital medical education. We analyze the economic impact and the future relationship we can expect with the rest of the medical industry.

Serratia sp., an endophyte of Mimosa pudica nodules with nematicidal, antifungal activity and growth-promoting characteristics.

In the present study, the nematicidal activity of an isolated strain of Mimosa pudica nodules was evaluated against the Nacobbus aberrans (J2) phytonymatodes with a mortality of 88.8%, while against the gastrointestinal nematode Haemonchus contortus (L3) and free-living Panagrellus redivivus was 100%. The ability to inhibit the growth of phytopathogenic fungi Fusarium sp., and Alternaria solani, as well as the oomycete Phytophthora capsici, this antifungal activity may be related to the ability to produce cellulases, siderophores and chitinases by this bacterial strain. Another important finding was the detection of plant growth promoter characteristics, such as auxin production and phosphate solubilization. The strain identified by sequences of the 16S and rpoB genes as Serratia sp. is genetically related to Serratia marcescens and Serratia nematodiphila. The promoter activity of plant growth, antifungal and nematicide of the Serratia sp. strain makes it an alternative for the biocontrol of fungi and nematodes that affect both the livestock and agricultural sectors, likewise, candidate as a growth-promoting bacterium.

Venous Doppler ultrasound in critically Ill COVID-19 patients: game changer in anticoagulation therapy.

BACKGROUND: COVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE). METHODS: The purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n = 23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU). RESULTS: DVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. Computed Tomography Pulmonary Angiography (CTPA) was performed in six patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy. CONCLUSION: In critically COVID-19 ill ICU patients with severe respiratory failure and elevated D-dimer, the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulate these patients.

COVID-19 Outbreak: Infection Control and Management Protocol for Vascular and Interventional Radiology Departments-Consensus Document.

COVID-19 (SARS-CoV-2 virus) pandemic was recently declared by the WHO as a global health emergency. A group of interventional radiology senior experts developed a consensus document for infection control and management of patients with COVID-19 in interventional radiology (IR) departments. This consensus statement has been brought together at short notice with the help of different protocols developed by governmental entities and scientific societies to be adapted to the current reality and needs of IR Departments. Recommendations are the specific strategies to follow in IR departments, preventive measures and regulations, step by step for donning and doffing personal protective equipment, specific IR procedures which can not be delayed, and aerosol-generating procedures in IR with COVID-19 patients. It is advisable with this document to be adapted to local workplace policies.

Hyperlocomotion and anxiety- like behavior induced by binge ethanol exposure in rat neonates. Possible ameliorative effects of Omega 3.

Maternal alcohol consumption during pregnancy may cause neurocognitive and behavioral disorders that can persist until adulthood. Epidemiological data has revealed an alarming increase in the frequency of alcohol intake in pregnant women. Nutritional variables may also have an impact on the behavioral alterations occasioned by alcohol during development. Moreover, omega-3, a polyunsaturated fatty acid necessary for normal brain development, is deficient in ethanol-treated animals. Although studies have shown that omega-3 supplementation after prenatal ethanol (EtOH) treatment improves some disorders, there are no reports about acute treatment with omega-3 in binge alcohol neurotoxic models during postnatal development. The goal of this study was to determine whether an administration of omega-3, after an acute ethanol dose in neonates, would be able to attenuate alcohol effects in offspring. Male/ female rats were administered ethanol (2.5 g/kg s.c. at 0 and 2 h) or saline on postnatal day (PND) 7, with a single dose of omega-3 (720 mg/kg) 15 min after the last alcohol injection. It was have found that EtOH-treated animals showed hyperlocomotion on PND 14 (pre-juvenile), and anxiety-like behavior was observed at all the three ages studied. Administration of omega-3 after EtOH treatment reduced hyperlocomotion and the anxiety-like behaviors on PND 14, but did not diminish the anxiety on either PND 20 or 30 (juvenile). In conclusion, acute ethanol exposure produced neurobehavioral alterations that persisted in the offspring, with omega-3 able to ameliorate these effects on PND 14. These data are relevant considering that omega-3 administration may have therapeutic effects through mitigating some of ethanol´s damaging consequences.

Noncirrhotic portal hypertension: An under-reported late adverse event of SIRT in metastatic colorectal cancer patients.

INTRODUCTION: Selective internal radiation therapy (SIRT) is increasingly used in different scenarios. Although portal hypertension (PHT) has been described as a nonclinically relevant finding after SIRT, its real incidence could have been neglected due to the nature of the diseases for which SIRT is indicated. CASE REPORTS: Here we report three cases with clinically relevant late PHT after treatments including SIRT and oxaliplatin among others. DISCUSSION: The sequential use of oxaliplatin and SIRT in patients with colorectal cancer metastases could have additive effects on the liver.

Isolation and characterization of endophytes from nodules of Mimosa pudica with biotechnological potential.

Legumes establish symbiotic relationships with different microorganisms, which could function as plant growth promotion microorganisms (PGPM). The finding of new PGPM strains is important to increase plant production avoiding or diminishing the use of industrial fertilizers. Thus, in this work we evaluated the plant growth promotion traits of ten strains isolated from Mimosa pudica root nodules. According to the 16S rDNA sequence, the microorganisms were identified as Enterobacter sp. and Serratia sp. To the best of our knowledge this is the first report describing and endophytic interaction between Mimosa pudica and Enterobacter sp. These strains have some plant growth promoting traits such as phosphate solubilization, auxin production and cellulase and chitinase activity. Strains identified as Serratia sp. inhibited the growth of the phytopathogenic fungi Fusarium sp., and Alternaria solani and the oomycete Phytophthora capsici. According to their biochemical characteristics, three strains were selected to test their plant growth promoting activity in a medium with an insoluble phosphate source. These bacteria show low specificity for their hosts as endophytes, since they were able to colonize two very different legumes: Phaseolus vulgaris and M. pudica. Seedlings of P. vulgaris were inoculated and grown for fifteen days. Enterobacter sp. NOD1 and NOD10, promoted growth as reflected by an increase in shoot height as well as an increase in the size and emergence of the first two trifolia. We could localize NOD5 as an endophyte in roots in P. vulgaris by transforming the strain with a Green Fluorescent Protein carrying plasmid. Experiments of co-inoculation with different Rhizobium etli strains allowed us to discard that NOD5 can fix nitrogen in the nodules formed by a R. etli Fix- strain. The isolates described in this work show biotechnological potential for plant growth promoting activity and production of indoleacetic acid and siderophores.

Strong genetic structure revealed by multilocus patterns of variation in Giardia duodenalis isolates of patients from Galicia (NW-Iberian Peninsula).

We report a survey of genetic variation at three coding loci in Giardia duodenalis of assemblages A and B obtained from stool samples of patients from Santiago de Compostela (Galicia, NW-Iberian Peninsula). The mean pooled synonymous diversity for assemblage A was nearly five times lower than for assemblage B (0.77%±0.30% and 4.14%±1.65%, respectively). Synonymous variation in both assemblages was in mutation-drift equilibrium and an excess of low-frequency nonsynonymous variants suggested the action of purifying selection at the three loci. Differences between isolates contributed to 40% and 60% of total genetic variance in assemblages A and B, respectively, which revealed a significant genetic structure. These results, together with the lack of evidence for recombination, support that (i) Giardia assemblages A and B are in demographic equilibrium and behave as two genetically isolated populations, (ii) infections are initiated by a reduced number of individuals, which may be genetically diverse and even belong to different assemblages, and (iii) parasites reproduce clonally within the host. However, the observation of invariant loci in some isolates means that mechanisms for the homogenization of the genetic content of the two diploid nuclei in each individual must exist.

Influencia de la integración docente asistencial en la calidad de los servicios de salud del primer nivel de atención y en la formación médica en la Universidad Nacional San Antonio Abad del Cusco / Influence of teaching-health care integration on the quality of first level health services and medical education at San Antonio Abad del Cusco National University

Introducción. La Organización Panamericana de la Salud (OPS) promueve la formación médica con énfasis en el componente social, a través de la integración docente asistencial (IDA) definida como el proceso de articulación entre instituciones de servicios de salud e instituciones de educación, para contribuir a mejorar las condiciones de vida de la colectividad, mediante la prestación de servicios adecuados a las necesidades reales de la población. Objetivo. Determinar si la integración docente asistencial influye en la mejora de la calidad de los servicios de salud de la comunidad y en la formación integral de los médicos. Diseño. Estudio observacional, descriptivo. Lugar. Facultad de Medicina de la Universidad Nacional de San Antonio Abad del Cusco y establecimientos de salud del primer nivel de atención en comunidades de extrema pobreza del Cusco, Perú. Participantes. Usuarios de los establecimientos de salud, familias de las comunidades, trabajadores de los establecimientos de salud, autoridades locales, y estudiantes internos de medicina. Intervenciones. Aplicación de encuesta de satisfacción a pacientes en relación a la atención recibida en los establecimientos y comunidades donde se implementó la IDA; así mismo, encuestas de conocimientos, actitudes y prácticas. Resultados. Las comunidades donde se implementó la IDA mostraron mayor satisfacción por los servicios recibidos, en 48% de los usuarios. Las familias (64%), los trabajadores de los establecimientos de salud (95%), así como las autoridades locales (86%) valoraron como bueno el trabajo realizado por los estudiantes de medicina a través del internado rural. Los estudiantes valoraron el internado rural como contribución a su formación, en 81%. Conclusiones. La IDA contribuyó a mejorar la situación de salud de las comunidades intervenidas, la calidad de los servicios en los establecimientos de salud, e influyó en la formación y desempeño del futuro médico.

Introduction: The Pan American Health Organization (PAHO) promotes medical education with emphasis on the social component, through teaching care integration (TCI) defined as the process of articulation between health service and education institutions to contribute to improving the living conditions of the community by provision of adequate services to the real needs of the population. Objective: To determine whether if the teaching care integration influences in improving the quality of health services in the community and in the integral training of physicians. Design: Observational, descriptive study. Setting: Faculty of Medicine of San Antonio Abad del Cusco National University and first level of health attention establishments in extreme poverty communities of Cusco, Peru. Participants: Users of health facilities, community families, health facility workers, local authorities, and internal medicine students. Interventions: Application of patients' satisfaction survey to the care received in the establishments and communities where the teaching care integration was implemented; also surveys on knowledge, attitudes, and practices were applied. Results: The communities where the TCI was implemented showed greater satisfaction with the services received, in 48% of the users. Families (64%), health care workers (95%), and local authorities (86%) valued the work performed by the medical students through the rural intership as good. The students valued the rural boarding school as a contribution to their training in 81%. Conclusions: The teaching care integration contributed to improving health and quality of health services in the communities, and influenced the training and performance of the future physicians.

[Urinary tract dysfunction in older patients]. / La disfunción del tracto urinario inferior en el paciente mayor.

Urinary tract dysfunction in older patients has a multifactorial aetiology and is not a uniform clinical condition. Changes due to physiological ageing as well as comorbidity and polypharmacy, can produce several dynamic conditions such as urinary incontinence and urinary retention. Lower urinary tract symptoms increase with age in both sexes and are a major problem in older patients due to their medical and psychosocial consequences. For these reasons, in assessing urinary dysfunction in older patients, we should consider external circumstances such as polypharmacy, poor mobility, affective and cognitive disorders and also accessibility to housing.

Abdominal strength in voiding cystometry: a risk factor for recurrent urinary tract infections in women.

INTRODUCTION AND HYPOTHESIS: Recurrent urinary tract infections are a common condition in women. The aim of this study is the evaluation of lower urinary tract dysfunctions that are risk factors for recurrent urinary tract infections in women. METHODS: We conducted a case-control study in 49 women with recurrent urinary tract infections (rUTIs) and 49 control women without rUTIs, comparing the urinary symptoms and urodynamic data of both groups. RESULTS: The main significant differences between these groups were age (the women were older in the control group) and the value of abdominal pressure during voiding cystometry (this was higher in the group with rUTIs). After controlling age as a confounding factor, it was confirmed that the value of maximum abdominal pressure during voiding was the only factor to facilitate the rUTIs and the ideal cut-off was 28 cm H(2)O. CONCLUSIONS: Abdominal strength in the voiding phase constitutes a risk factor for recurrent urinary tract infections in women.

Contrast-enhanced ultrasound of liver lesions related to arterial thrombosis in adult liver transplantation.

PURPOSE: To describe the contrast-enhanced ultrasound (CEUS) features of liver and biliary lesions related to hepatic artery thrombosis in adult patients with orthotopic liver transplantation. METHODS: Gray-scale ultrasound (US), Doppler US, and CEUS using a hexafluoride-based US contrast media were performed on a series of eight patients with liver transplantation and hepatic artery thrombosis. RESULTS: Six of the cases presented infarctions, seen as parenchymal geographic areas of lack of enhancement. Biliary necrosis, seen as nonenhancing periportal cuff, was seen in one case. Infected biloma, seen as a nonenhancing hilar collection, was present in two cases. Infarction and biloma coexisted in one patient. Two abscesses were seen as a late complication in one case. One of them was seen as a typical necrotic abscess with a central nonenhancing area and peripheral rim enhancement higher than the surrounding liver. The other one was seen as a partially liquefied abscess. CONCLUSION: CEUS was useful to diagnose lesions related to hepatic artery thrombosis in liver transplantation. It enabled distinguishing between them and to define their size and extension better than conventional gray-scale US.

[Tuberculosis in Mexico: contributions of the Museum of Anatomopathology, 1895-1899]. / La tuberculosis en México: aportaciones del Museo Anatomopatológico, 1895-1899.

In 1895, Rafael Lavista founded the Museum of Anatomopathology at the Hospital de San Andrds in Mexico City, for the purpose of preparing and preserving anatomical pieces useful for the study of different diseases. Porfirio Diaz officially inaugurated the Museum in March 1896, but in June 1899 it was renamed as the Instituto Patológico Nacional. During its four years of activity, a variety of illnesses were studied, including tuberculosis, which spurred great interest among Museum personnel because of its high incidence. This text examines the labors developed at the Museum of Anatomopathology in relation to tuberculosis, discusses the researchers involved, and reviews the articles published in the Museum's journal: Revista quincenal de anatomía patológica.

Reliability of ambulatory urodynamics in patients with spinal cord injuries.

OBJECTIVE: To determine the test-retest repeatability of the urodynamic parameters commonly utilized in ambulatory urodynamics (AM) for patients with neurogenic lower urinary tract dysfunction (NLUTD). METHODS: A test-retest repeatability study was performed on 64 consecutive patients with stable spinal cord injuries who underwent two AM studies 24 hr apart. RESULTS: The mean age was 43.2 years, with 47 males and 17 females. A significant intraclass correlation coefficient (ICC) was found between the two studies with respect to the functional bladder capacity (FBC; 0.74), the maximum detrusor pressure during the involuntary detrusor contraction (P(detmaxIDC); 0.84), and the post-void residual (PVR; 0.76). Of note, the ICC of the end filling detrusor pressure (P(detfill)) was not significant (0.25). The correlation with respect to the presence of involuntary detrusor contraction (IDC) was significant but low (κ = 0.40). Based on the logistic regression analysis, the variables that influenced the concordance with respect to the presence of the IDC were P(detmaxIDC) (directly) and P(detmax) (inversely). The variable that that influenced the concordance with respect to P(detmaxIDC) was PVR (directly). The variable that influenced the concordance with respect to PVR was the FBC (directly). CONCLUSIONS: AM is reliable for the reproduction of the main urodynamic parameters investigated in patients with NLUTD, except for the end filling detrusor pressure, which was a non-reliable parameter. The concordance of AM can be improved primarily by taking into account the values of the maximum detrusor pressure during involuntary detrusor contraction (P(detmaxIDC)).

Influencia de la integración docente asistencial en la calidad de los servicios del primer nivel del Perú y en la formación médica / Influence of Teaching Care Integration in the quality of services of health of first level in Peru and in the medical education

El objetivo de la presente investigación realizada en la Facultad de Medicina de la Universidad Nacional de San Antonio Abad del Cusco, fue determinar la influencia de la Integración Docente Asistencial (IDA) en la mejora de la salud de la comunidad, en la calidad de los servicios de salud y en la formación de los médicos más aptos a resolver los problemas prioritarios de salud de la comunidad. Se realizaron encuestas a poblaciones de comunidades participantes y no participantes de la IDA, para evaluar su grado de conocimientos, actitudes y prácticas (CAP) sobre los problemas de salud más comunes de sus comunidades. También se hicieron encuestas a pacientes que acababan de recibir atención en servicios de salud con IDA y sin IDA. De otra parte para evaluar el desempeño y las actitudes de los estudiantes se hizo encuestas a los campesinos intervenidos, a los trabajadores de los establecimientos de salud y a las autoridades locales. Así mismo se encuestaron a estos estudiantes para conocer su apreciación del IR Y sus perspectivas profesionales. Los resultados nos muestran que las poblaciones con IDA tienen un mejor grado de CAP que las poblaciones sin IDA, que el grado de satisfacción por los servicios recibidos en los establecimientos de salud con IDA es mayor que en los si IDA. Los comuneros, los trabajadores y autoridades locales valoran el trabajo realizado por los estudiantes tanto en el establecimiento y en la comunidad. Los estudiantes valoran las diversas actividades realizadas en el IR, y manifiestan su deseo de trabajar en entidades públicas de la región. Conclusión: La IDA contribuye a mejorar la situación de salud de las comunidades intervenidas, a mejorar la calidad de los servicios en los establecimientos de salud en comparación con los que no tienen IDA y contribuye a mejorar la formación y el desempeño del médico general.

The objective of this research done at the Faculty of Medicine of the National University of San Antonio Abad del Cusco, was to determine the influence of the Integración Docente Asistencial (IDA) in improving rural community health, quality health services and the training of doctors more able to solve priority health problems of the rural community. We surveyed participant populations and non-participant population of the IDA in rural communities, to assess their knowledge, attitudes and practices (CAP) on common health issues of their rural communities and we did also survey patients who had just received care services at the health facilities with and without IDA. To evaluate the performance and attitudes of students we surveyed participant population, workers from health facilities and local authorities. Also these students were interviewed to know their assessment of IR and career prospects. The results show that populations with IDA have a better degree of CAP than the populations without it. The degree of satisfaction of the services received at health facilities with IDA is higher than in those without IDA. The community members, workers and local authorities value the work done by students in health facilities and in the community. The students appreciate the various activities done in the IR, and expressed their desire to work in public institutions of the region. Conclusion: The IDA contributes: to improve the health status of the target communities, to improve the quality of services in health facilities compared to those without IDA and helps to improve training and performance of general practitioners.