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1.
Infect Immun ; : e0020024, 2024 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-39133019

RESUMO

Group B Streptococcus (Streptococcus agalactiae; GBS) is a leading cause of neonatal sepsis worldwide. As a pathobiont of the intestinal tract, it is capable of translocating across barriers leading to invasive disease. Neonatal susceptibility to invasive disease stems from immature intestinal barriers. GBS intestinal colonization induces major transcriptomic changes in the intestinal epithelium related to barrier function. Butyrate, a microbial metabolite produced by fermentation of dietary fiber, bolsters intestinal barrier function against enteric pathogens, and these effects can be transferred in utero via the placenta to the developing fetus. Our aim was to determine if butyrate mitigates GBS disruption of intestinal barriers. We used human intestinal epithelial cell (IEC) lines to evaluate the impact of butyrate on GBS-induced cell death and GBS adhesion and invasion. IECs and human fetal tissue-derived enteroids were used to evaluate monolayer permeability. We evaluated the impact of maternal butyrate treatment (mButyrate) using our established mouse model of neonatal GBS intestinal colonization and late-onset sepsis. We found that butyrate reduces GBS-induced cell death, GBS invasion, monolayer permeability, and translocation in vitro. In mice, mButyrate decreases GBS intestinal burden in offspring. Our results demonstrate the importance of bacterial metabolites, such as butyrate, in their potential to bolster epithelial barrier function and mitigate neonatal sepsis risk.IMPORTANCEGroup B Streptococcus (GBS) is a leading cause of neonatal morbidity and mortality. It is a commensal of the intestines that can translocate across barriers leading to sepsis in vulnerable newborns. With the rise in antibiotic-resistant strains and no licensed vaccine, there is an urgent need for preventative strategies. Butyrate, a short-chain fatty acid metabolized in the gut, enhances barrier function against pathogens. Importantly, butyrate is transferred in utero, conferring these benefits to infants. Here, we demonstrate that butyrate reduces GBS colonization and epithelial invasion. These effects were not microbiome-driven, suggesting butyrate directly impacts epithelial barrier function. Our results highlight the potential impact of maternal dietary metabolites, like butyrate, as a strategy to mitigate neonatal sepsis risk.

2.
Aesthet Surg J ; 41(12): NP2034-NP2043, 2021 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33589930

RESUMO

As the leading global search engine with billions of daily queries, Google and its open-source Google Trends (Google, Mountain View, CA) represent an emerging and powerful tool for epidemiological and medical research. Within the field of plastic surgery, Google Trends has yielded insights into online interest for facial feminization surgery, gender-affirmation surgery, cosmetic body procedures, and breast reconstruction, among other common procedures. The existing literature of Google Trends in plastic surgery was systematically reviewed following established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Google Trends' 4 input variables-keyword, region, period, and category-were assessed. Seventeen plastic surgery studies employing Google Trends were reviewed. There was strong inter-rater reliability (Cohen's kappa = 0.68). Analyzing keyword syntax, only 3 of 17 studies (17.6%) used the "+" function to combine terms, which can significantly improve sensitivity. For the region variable, 12 of 16 studies (75%) conducted worldwide searches; yet, none of the studies used any non-English keywords, introducing significant bias. For the period, 88.2% of studies utilized a timespan of greater than 5 years, resulting in monthly intervals between data points in Google Trends. For the "category" variable, none of the studies appear to have employed the "surgery," "cosmetic surgery" or "health" categories to improve specificity. Google Trends is presented as an emerging methodology in plastic surgery research. The strengths and limitations of Google Trends as a resource for plastic surgeons and medical professionals are discussed, and a recommended step-by-step guide for conducting and interpreting Google Trends research is outlined.


Assuntos
Mamoplastia , Cirurgia Plástica , Face , Humanos , Internet , Reprodutibilidade dos Testes , Ferramenta de Busca
3.
Rev Clin Esp (Barc) ; 220(8): 472-479, 2020 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32620311

RESUMO

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

4.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32439229

RESUMO

BACKGROUND: Assess the reduction of packed red blood cells (PRBCs) transfusion in liver transplantation (LT) after the introduction of the thromboelastometry as intraoperative coagulation monitor. METHODS: We conducted a retrospective cohort study (n=92), randomized into two groups: groupA (control), in whom transfusion therapy was based on conventional laboratory tests (CLT), and groupB (ROTEM), whose blood transfusion was performed as protocolized algorithms, guided by thromboelastometry (ROTEM). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), platelets units, fibrinogen and tranexamic acid. We used the chi square test for the comparison of proportions and Student's t test to compare means when the distribution was normal. Otherwise, Mann-Whitney U test was performed. RESULTS: In groupA 84.8% of patients required transfusion of PRBCs, with a median (IQR) of 4 (1.5-6), compared with 67.4% in groupB with a median (IQR) of 2 (0-4) (P<.05). We also found differences in the following variables: FFP transfusion rate was 84.8% with a median (IQR) of 5 (2-12) IU in groupA and 56.5% (median (IQR) of 1 (0-4.5) in B (P<.001) and in the fibrinogen administration, that was 6.5% in groupA and 34.8% in groupB (P<.01). Backward stepwise logistic regression model showed associations between the clamping time, the preoperative hemoglobin, the portal hypertension (PHT) and being or not in the treatment group and the need for perioperative transfusion. We didn't find significant differences in the incidence of complication during the early postoperative period between the two groups. CONCLUSIONS: The introduction of thromboelastometry (ROTEM) measurements in hemostatic therapy algorithms reduces the transfusion rate of FFP and PRBCs during liver transplantation. The using of ROTEM derived thresholds leads to detecting higher requirements of fibrinogen compared to conventional laboratory tests.


Assuntos
Transfusão de Eritrócitos/métodos , Transplante de Fígado , Monitorização Intraoperatória/métodos , Plasma , Tromboelastografia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Estudos Retrospectivos
5.
J Investig Allergol Clin Immunol ; 30(4): 229-253, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31932268

RESUMO

BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.


Assuntos
Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Fígado/metabolismo , Pele/patologia , Algoritmos , Alopurinol/efeitos adversos , Antibacterianos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Comorbidade , Consenso , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/epidemiologia , Eosinofilia , Prova Pericial , Humanos , Leucocitose , Fígado/patologia , Fatores de Risco , Espanha/epidemiologia
6.
Rev Clin Esp ; 220(8): 472-479, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33994572

RESUMO

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11 a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

7.
Transplant Proc ; 46(9): 3087-91, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25420830

RESUMO

OBJECTIVE: To test the hypothesis that the restrictive volume therapy decreases blood transfusion requirement during liver orthotopic transplantation (OLT) without increasing acute renal complications and hospital length stay. MATERIAL AND METHODS: We conducted a retrospective cohort study (n = 89), randomized into 2 groups: A (liberal fluid strategy) and B (restrictive therapy). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), colloids, crystalloids, perioperative renal function, and hospital length stay. For comparison of proportions, we used the χ(2) test and Student t test to compare means (parametric). A logistic regression model was constructed to evaluate the association of all these variables with probability of PRBCs transfusion. RESULTS: In group A, 88.4% of patients required intraoperative transfusion of PRBCs, with a mean of 8.5 ± 7.02 IU, compared with 82.2% in group B with a mean of 5.02 ± 4.5 IU (P < .001). We also found differences in the following variables: FFP transfusion rate was 95.3% (mean, 15.02 ± 8.2 IU) in group A and 75.6% (mean, 8.7 ± 6.04 IU) in B (P < .001). The amount of colloid was 50% (mean, 692.8 ± 409.6 mL) in group A and 28.9% (mean, 607.6 ± 316.7 mL) in B (P = .032). Platelet concentrates transfusion was 79.1% (mean, 2.05 ± 1.1 IU) in group A and 51.1% (mean, 2.0 ± 1.08 IU) in B (P = .014). As an important effect of restrictive fluid therapy, renal function was assessed; no differences in mean creatinine or acute renal failure in the immediate postoperative period were observed. There was no difference in hospital length stay. Logistic regression modelling identified 3 variables as significant predictors of transfusion: Fluid administration policy, preoperative hemoglobin and FFP units transfused. Furthermore, an increase of preoperative hemoglobin is associated with a lesser probability of transfusion. CONCLUSIONS: These results show that fluid restriction management for OLT decreased blood products requirements, especially FFP. This could suggest that liberal fluid management may aggravate, rather than prevent, bleeding in these patients. We did observed any no difference in failure of renal function.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/estatística & dados numéricos , Hidratação/estatística & dados numéricos , Cuidados Intraoperatórios/métodos , Transplante de Fígado , Complicações Pós-Operatórias/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
8.
Colloids Surf B Biointerfaces ; 113: 176-81, 2014 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-24095987

RESUMO

Poly(vinylidene fluoride) (PVDF) and regenerated cellulose (RC) membranes were surface-modified by the adsorption of one adenosine receptor antagonist: the theophylline-oligo(ethylene glycol)-alkene derivative, Theo1. Surface modification was carried out by immersion of the membrane in a dichloromethane solution of Theo1 (PVDF+Theo1 and RC+Theo1 samples). Membrane surfaces with partial coverage by theophylline and/or its inclusion in the membrane structures were studied by X-ray photoelectron spectroscopy (XPS), solid-state nuclear magnetic resonance (SNMR), impedance spectroscopy (IS) and contact angle (CA) measurements. The Theo1 orientation was inferred from the data. Streptavidin (SA) was immobilized onto the membrane/Theo1 hybrid material. The protein-theophylline Theo1 interaction was visualized with bright field microscopy (BFM).


Assuntos
Membranas Artificiais , Estreptavidina/química , Teofilina/química , Microscopia , Ligação Proteica
9.
Farm Hosp ; 37(2): 128-34, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-23789756

RESUMO

INTRODUCTION: Fluid therapy is one of the most common daily practices although knowledge is necessary on electrolytes and fluids intake and on all the pathophysiologic states leading to fluid homeostasis impairment in order to properly handle the electrolytes for both fluid therapy and parenteral nutrition. OBJECTIVES: To know the content and electrolyte type in those drugs administered through the parenteral route commercialized and authorized in Spain until February of 2012. METHODS: Review of the technical sheets of all the drugs commercialized in Spain for usage through the parenteral route. Those drugs with content lower than 1 miliequivalent or 1 millimol per commercial presentation were excluded. RESULTS: Of the 1,800 active ingredients studied, only 211 had a commercial presentation for parenteral route. Of these, 52 active ingredients met the study inclusion criteria and most of them (51; 98.07%) had sodium content higher than 1 miliequivalent per commercial presentation, potassium was present in 3 and calcium in only 1. DISCUSSION: Most of the medications studied contained sodium as the main electrolyte; impairments in sodium concentration are one of the most common problems at the hospital setting and in some cases an indicator of quality of health care delivery. Therefore, it would be necessary to take into account the intake received through the medications prescribed to improve electrolyte reposition in both fluid therapy and parenteral nutrition.


Introducción: La fluidoterapia es una de las prácticas más habituales en la práctica clínica diaria pero para un correcto manejo de electrolitos tanto en la sueroterapia como en la Nutrición Parenteral se deben conocer todos los aportes de electrolitos y fluidos y todas aquellas situaciones fisiopatológicos que conllevan alteraciones en la homeostasis de fluidos. Objetivos: Conocer el contenido y tipo de electrolitos de los medicamentos administrados por vía parenteral comercializados y autorizados en España hasta Febrero 2012. Métodos: Revisión de todas las fichas técnicas de todos aquellos medicamentos que estuvieran comercializados en España y con presentación comercial disponible por vía parenteral. Aquellos medicamentos con un contenido menor de 1 miliequivalente o 1 milimol por presentación comercial fueron excluidos. Resultados: De los 1800 principios activos estudiados, sólo 221 formaban parte de alguna presentación comercial por vía parenteral. De estos 221, 52 principios activos cumplían los criterios de inclusión del estudio y la mayoría (51-98,07%) tenían sodio en contenido mayor de un miliequivalente por presentación comercial, luego el potasio estaba presente en 3 y el calcio únicamente en uno. Discusión: La mayoría de medicamentos objeto del estudio contenían como principal electrolito el sodio, siendo la alteración de las concentraciones de este electrolito una de las más frecuentes en el entorno hospitalario y, en algunos casos, indicador de calidad en la atención del paciente. Por ello, para un mejor manejo de la reposición de electrolitos tanto en la sueroterapia como por Nutrición Parenteral es necesario tener en cuenta el aporte recibido por la medicación prescrita en los casos en que sea necesario.


Assuntos
Eletrólitos/análise , Hidratação , Nutrição Parenteral , Preparações Farmacêuticas/química , Preparações Farmacêuticas/administração & dosagem , Espanha
11.
Med Lav ; 102(4): 350-61, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21834272

RESUMO

BACKGROUND: Since its foundation in 2002, the Italian Silica Network (NIS), a collaborative network of professionals and public authorities, has been engaged in several aspects of research, control, and prevention of silica exposure and effects, and also in support for compensation claims for silica-related occupational health effects in Italy. METHODS: We start with a report on the NIS point of view concerning the recent scientific results (from epidemiology and laboratory studies), including those carried out by NIS in cooperation with Italian universities and other public agencies. This is followed by a description of the data on silica exposure in different Italian workplaces and guidelines for the management of occupational exposure to silica, as developed by two model regional programmes for the ceramics industry, metal foundries and tunnel excavation. RESULTS: The NIS initiatives highlighted the persistence of workplace conditions posing a significant risk for silica-related health effects, particularly in small industries and workshops. Experimental work has also shown that a number of physical and chemical factors affect the bioreactivity of silica particles. CONCLUSION: Based on NIS experience, it appears clear that currently conditions exist in Italy so as to positively contribute to the WHO Programme for the eradication of silicosis and the other diseases related to silica exposure. In order to achieve this goal, a coordinated and wide-ranging effort is required to reduce the wide gap in specific prevention activities, particularly in small industries and workshops, where high levels of silica exposure sometimes occur.


Assuntos
Neoplasias Pulmonares/induzido quimicamente , Doenças Profissionais/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Dióxido de Silício/efeitos adversos , Carcinógenos , Humanos , Itália , Neoplasias Pulmonares/epidemiologia , Doenças Profissionais/epidemiologia , Saúde Ocupacional
12.
Med Lav ; 101(4): 243-51, 2010.
Artigo em Italiano | MEDLINE | ID: mdl-21090124

RESUMO

BACKGROUND: The quality of laboratory data is one of the main factors in guaranteeing efficacy of biological monitoring. OBJECTIVES: To analyze the quality of laboratory data used for biological monitoring of exposed workers. METHODS: A survey involving 18 companies employing 945 workers in the area of Modena, Italy, was carried out in 2008. RESULTS: Most of the 9 private laboratories receiving biological samples did not perform directly part or all of the laboratory assessments requested, but this was not indicated in the final report. Major problems were observed in the application of internal quality control, and only one laboratory participated in external quality assessment for blood lead measurements. CONCLUSIONS: Our results raise major concerns on the traceability and reliability of laboratory assessments performed for biomonitoring of exposed workers. Systematic evaluation of the quality of analytical data would be highly recommendable.


Assuntos
Monitoramento Ambiental/normas , Exposição Ocupacional/análise , Humanos , Itália
13.
Farm Hosp ; 34(4): 181-7, 2010.
Artigo em Espanhol | MEDLINE | ID: mdl-20359926

RESUMO

INTRODUCTION: Ongoing training by means of clinical sessions constitutes an essential activity for a pharmacy department, being joint analysis useful to adapt the clinical sessions' characteristics to the preferences of the professionals involved. By means of this study we hope to optimize clinical sessions for their better use and efficiency. METHODS: A least squares model was used to assess the usefulness of different clinical session profiles. Data was collected from 14 individual interviews (7 specialists and 7 residents); these interviews consisted in ordering the clinical session profiles by order of preference. RESULTS: The most valued attributes were duration of sessions (29.9%) and the structure of teaching content (27.8%) in both groups studied; although the duration of the sessions was assigned greater value by the group of residents (31.1% vs. 27.2%). The availability of bibliographical references was the third attribute most valued (17.9%), and the two last attributes by order of importance were availability of a copy in files for storage (13.8%) and multimedia content (10.5%). DISCUSSION: The adaptation of clinical sessions as an integral part of ongoing training leads us to see that we can modify the duration, content structure and availability of bibliographical references so as to adapt them to the preferences of the professionals involved. However, according to the population surveyed, other attributes are of little importance.


Assuntos
Educação Continuada em Farmácia/estatística & dados numéricos , Capacitação em Serviço/estatística & dados numéricos , Análise dos Mínimos Quadrados , Educação Continuada em Farmácia/métodos , Humanos , Modelos Teóricos , Recursos Humanos em Hospital/educação , Serviço de Farmácia Hospitalar , Reprodutibilidade dos Testes , Espanha
14.
J Appl Microbiol ; 105(3): 752-60, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18341553

RESUMO

AIM: To characterize 16 Vibrio harveyi strains isolated from different epizootic outbreaks affecting farmed Senegalese sole. MATERIALS AND RESULTS: The Vibrio harveyi strains tested have broad phenotypic diversity based on their biochemical and exoenzymatic patterns, outer membrane proteins (OMP), extracellular product (ECP) patterns and presence of prophages. Lethal dose 50 (LD(50)) of the strains and in vitro antagonism tests with two probiotic strains were also determined. The OMP analysis revealed three different patterns (A, M and V). The electrophoretic analysis of the ECP showed two different groups. All strains considered virulent based on their LD(50) exhibited the same protein pattern in their ECP (pattern I), while all nonvirulent strains showed a different profile (pattern II). About 32% of the tested strains were positive for prophages, although a clear relationship between virulence and the presence of prophages has not been established. CONCLUSIONS: The results obtained have shown differences between virulent and avirulent strains isolated from diseased farmed Senegalese sole based on the protein patterns of their ECP. However, a clear relationship between virulence and presence of prophages has not been established. SIGNIFICANCE AND IMPACT OF THE STUDY: The differences observed between virulent and nonvirulent strains could be used to design prophylactic strategies against diseases caused by V. harveyi in farmed Senegalese sole.


Assuntos
Doenças dos Peixes/microbiologia , Pesqueiros , Linguados/microbiologia , Vibrioses/microbiologia , Vibrio/isolamento & purificação , Animais , Proteínas da Membrana Bacteriana Externa/análise , Técnicas de Tipagem Bacteriana/métodos , Bacteriófagos/isolamento & purificação , Western Blotting , Eletroforese em Gel de Poliacrilamida , Fenótipo , Reação em Cadeia da Polimerase/métodos , Probióticos , Vibrio/genética , Vibrio/virologia , Virulência
16.
Rev Esp Enferm Dig ; 99(11): 636-42, 2007 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-18271661

RESUMO

We present our initial experience in the treatment of fecal incontinence (FI) with sacral root neuromodulation (SRN) by reporting the results of a prospective study with 26 patients where baseline Wexner-Cleveland scale scores and ability to delay defecation were compared to results after one year with SRN. The initial study of patients included history taking, general examination, anal ultrasonography, and manometry, and a three-week diary of continence and quality of life specific for FI was used. Before SRN the mean baseline Wexner-Cleveland score was 15.00 +/- 1.81, and 62.50% of patients could only delay defecation for less than a minute. After a year with NRS the mean Wexner-Cleveland score was 4.87 +/- 2.54 (p = 0.0031), and 75.01% of patients could delay defecation above fifteen minutes (p = 0.0018). We also describe the surgical technique and its indications, and finally review the various therapeutical options for FI and show our algorithm for this condition. SRN is an effective technique for the treatment of FI in properly selected patients with no response to medical therapies (including biofeedback) or anatomic correction (sphincteroplasty), with efficacy, little morbidity, and a short hospital stay.


Assuntos
Incontinência Fecal/terapia , Estimulação Elétrica Nervosa Transcutânea , Adulto , Idoso , Algoritmos , Estudos Transversais , Feminino , Humanos , Plexo Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
17.
Rev Clin Esp ; 206(3): 137-40, 2006 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-16597379

RESUMO

INTRODUCTION: Proctalgia fugax can be defined as transitory but recurrent anal pain. Although its etiology remains unknown, an internal anal sphincter spasm seems to be the most likely, so that the different treatments focus on reducing the pressure of the internal anal sphincter. This study is aimed at evaluating the effectiveness of botulinum A toxin in the treatment of proctalgia fugax. PATIENTS AND METHODS: Prospective clinical trial of patients with proctalgia fugax treated with botulinum A toxin at the Outpatient Clinic attached to the Coloproctogy Unit, University Hospital of Elche, from January 1999 to January 2002. The patients included in the study underwent rectal digital examination, anuscopy, rectoscopy, anal manometry and ultrasonography, barium enema and pelvic CT scan to rule out any organic cause for anal pain. The treatment consisted of 25 IU of botulinum A toxin, with a supplementary dose of 50 IU in those patients with persistence of anal pain episodes within the next two months. The patients were reviewed on the first week, second month, sixth month and first and second year. Anal pain was measured by the patients, using a linear analogue scale from 0 to 10, and continence was assessed at every visit using the Cleveland Continence Grading Scale. RESULTS: Five patients were recluted for the study, with a predominance of females (4 vs. 1). Mean age was 45 years. Length of symptoms prior to the treatment was 13 months (range: 6-18 months). Only one female patient required a second dose of botulinum A toxin to handle the anal pain. All the patients healed and remained free of pain up to finishing the follow-up. There were no local complications. Anal manometry showed an increased MRP (mean resting pressure) in comparison to a control group of patients (114 mmHg vs. 66 mmHg; p < 0.001) that restore to normal values after the treatment (75.65 mmHg). As for the MSP (mean squeeze pressure), it showed no difference with respect to the control group nor did it vary after the treatment. CONCLUSION: Botulinum A toxin offers a high rate of healing with no associate morbidity in the treatment of proctalgia fugax.


Assuntos
Doenças do Ânus/tratamento farmacológico , Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Dor/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Prospectivos
18.
J Fish Dis ; 28(9): 531-7, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16266326

RESUMO

Four bacterial isolates from farmed gilthead sea bream, Sparus aurata, included in a previous study as members of the Vibrionaceae and Pseudomonodaceae and the genus Micrococcus, have been evaluated for their adhesive ability to skin and intestinal mucus of farmed Senegalese sole, Solea senegalensis, and their antagonistic effect on Vibrio harveyi, a pathogen of sole. These isolates showed higher adhesion to sole mucus than the pathogenic strains of V. harveyi assayed. Only two of the isolates showed antagonistic activity to V. harveyi. Interactions of the four isolates with V. harveyi in respect of adhesion to skin and intestinal mucus under exclusion, competition and displacement conditions were studied. Three isolates were able to reduce the attachment to skin and intestinal sole mucus of a pathogenic strain of V. harveyi under displacement and exclusion conditions, but not under competition conditions. The in vivo probiotic potential of isolate Pdp11 was assessed by oral administration followed by challenge with the pathogenic V. harveyi strain Lg14/00. A group of 50 Senegalese sole received a commercial diet supplemented with 10(8) cfu g(-1) of lyophilized Lg14/00 for 15 days. A second group of fish received a non-supplemented commercial diet. After challenge the mortality of the fish receiving the diet supplemented with the potential probiotic isolate was significantly lower than that in the fish receiving the non-supplemented commercial diet. This study has shown that the ability to interfere with attachment of pathogens, as well as the adhesion to host surfaces, are suitable criteria for selection of candidate probiotics for use in the culture of Senegalese sole.


Assuntos
Fenômenos Fisiológicos Bacterianos , Doenças dos Peixes/microbiologia , Linguados/microbiologia , Probióticos/farmacologia , Dourada/microbiologia , Vibrioses/veterinária , Vibrio/patogenicidade , Ração Animal/microbiologia , Animais , Aquicultura/métodos , Aderência Bacteriana/efeitos dos fármacos , Aderência Bacteriana/fisiologia , Mucosa Intestinal/microbiologia , Probióticos/uso terapêutico , Pele/microbiologia , Especificidade da Espécie , Vibrio/efeitos dos fármacos , Vibrioses/tratamento farmacológico
19.
J Fish Dis ; 28(4): 229-37, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15813865

RESUMO

Abstract Most studies carried out to select microorganisms as candidate probiotics have focused on in vitro antagonism tests, such as the production of inhibitory compounds against pathogenic microorganisms. However, attachment to mucous surfaces could be another criterion to be considered when selecting potential probiotics for aquaculture. Nineteen isolates obtained from farmed Senegalese sole, Solea senegalensis Kaup, and gilthead sea bream, Sparus aurata L., have been evaluated for their capacity to adhere to skin and intestinal mucus of Senegalese sole, and their antagonistic effect against Photobacterium damselae subsp. piscicida, an important pathogen for farmed sole. The isolates from gilthead sea bream showed the highest percentage of adhesion to sole mucus, whilst the pathogenic microorganisms assayed and the isolates from sole showed, in general, a lower ability to adhere to sole mucus. The results suggest that the adhesion to fish mucus was more dependent on the isolate tested than on the host mucus. The isolates from gilthead sea bream also showed a higher antagonistic activity against P. damselae subsp. piscicida than those from Senegalese sole. Four isolates were selected, on the basis of their adhesive ability and antagonistic effect on P. damselae subsp. piscicida, to study their interactions with the pathogen in respect of adhesion to skin and intestinal mucus under exclusion, competition and displacement conditions. The results obtained show the ability of three isolates to reduce the adhesion of P. damselae subsp. piscicida to sole mucus under displacement and competition conditions. The adhesion of the pathogen to sole intestinal mucus was also significantly reduced when three isolates were assayed under exclusion conditions.


Assuntos
Aderência Bacteriana/fisiologia , Linguados/microbiologia , Muco/microbiologia , Photobacterium/fisiologia , Probióticos/isolamento & purificação , Dourada/microbiologia , Animais , Antibiose/fisiologia , Aquicultura , Linguados/fisiologia , Muco/fisiologia , Photobacterium/metabolismo , Probióticos/metabolismo , Senegal
20.
J Fish Dis ; 28(1): 33-8, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15660791

RESUMO

The protection of cultured sole, Solea senegalensis, against Vibrio harveyi and Photobacterium damselae subsp. piscicida was evaluated following the use of a divalent vaccine prepared with formalized whole cells and extracellular products of virulent strains of both pathogenic microorganisms and administered by the immersion route. Two prolonged immersions of 5-10 g fish in the divalent bacterin at a 1-month interval gave high levels of protection similar to those obtained when the respective monovalent vaccines were administered by the intraperitoneal route [relative percentage of survival (RPS) values >70%], which indicates that the former procedure can be a useful strategy with small fish. The high protection afforded by the divalent vaccine in sole lasted for 4 months after which the RPS values against both pathogens decreased significantly.


Assuntos
Vacinas Bacterianas/imunologia , Doenças dos Peixes/prevenção & controle , Linguados , Infecções por Bactérias Gram-Negativas/veterinária , Photobacterium/imunologia , Vibrio/imunologia , Animais , Doenças dos Peixes/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Imersão , Análise de Sobrevida
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