Knowledge, attitudes, and behavior regarding antibiotics, antibiotic use, and antibiotic resistance in students and health care professionals of the district of Barranquilla (Colombia): A cross-sectional survey.

Objective: To evaluate the knowledge, attitudes and behavior regarding antibiotics, use of antibiotics, and antibiotic resistance in students and health care professionals of the district of Barranquilla, Colombia. Study design: Descriptive, cross-sectional. Methods: A sample of 399 respondents was selected, that included health professionals and medical students from 12 health institutions in the district of Barranquilla (Colombia), using an established stratified sampling method. Each of the respondent professionals completed a survey that included 43 items in the Likert scale. A descriptive analysis of the study variables was performed using the software SPSS version 25. Results: Most of the respondents were women (64.4%), aged between 26 and 35 years (47.6%); 28.8% were nurses and 26.1% general practitioners, with ≤10 years of professional experience (63.4%). Overall, the survey revealed that the participants had considerable knowledge about antibiotic use (89.5%-98% correct answers) and the spread of antibiotic resistance (67.4%-89% correct answers). Approximately 74% of the respondents agreed or fully agreed with the questions related to the management of infections and the provision of advice. Conclusions: The present study revealed that most of the health care professionals surveyed had a good knowledge about antibiotic use, although strategies must be developed to strengthen knowledge regarding the spread of antibiotic resistance. Likewise, it is important to identify opportunities for improvement related with access to the guidelines and/or materials necessary to treat infections and to provide advice on antibiotic use and antibiotic resistance.

Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction.

OBJECTIVE: To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. METHODS: We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. RESULTS: The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p<0.001]; extended operating time [OR 1.005 (1.003-1.006); p<0.001] and intra-operative red blood transfusion [OR 2.7 (1.4-5.3); p<0.001] were found to be independently associated with diverting ileostomy performance. Assuming a 7% AL rate cut-off, up to 51.8% of DI presented an AL risk below 7% and might have been spared. CONCLUSIONS: The risk factors that drive the gynecologic oncology surgeons to perform a diverting ileostomy, seem to differ from the actual risk factors that we have identified to be associated with postoperative anastomotic leak. Broader awareness of the risk factors that contribute to a higher perioperative risk profile, will facilitate a better risk stratification process and possibly avoid unnecessary stoma formation in ovarian cancer patients.

Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study.

OBJECTIVE: To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. BACKGROUND: In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. METHODS: Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. RESULTS: The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). CONCLUSIONS: Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided.

Clinical application of the sentinel lymph node technique in early ovarian cancer: a pilot study.

INTRODUCTION: There is limited evidence favoring the use of the sentinel lymph node technique in ovarian cancer, and no standardized approach has been studied. The objective of the present pilot study is to determine the feasibility of the sentinel lymph node technique by applying a clinical algorithm. METHODS: Patients with confirmed ovarian cancer were included. 99mTc and indocyanine green were injected into the ovarian and infundubulo-pelvic ligament stump. A gamma probe and near-infrared fluorescence imaging were used for sentinel lymph node detection. RESULTS: The sentinel lymph node technique was performed in nine patients with a detection rate in the pelvic and/or para-aortic region of 100%. The tracer distribution rates of sentinel lymph nodes in the pelvic and para-aortic regions were 87.5% and 70%, respectively. CONCLUSION: The detection of sentinel lymph nodes in early-stage ovarian cancer appears to be achievable. Based on these results, a clinical trial entitled SENTOV (SENtinel lymph node Technique in OVarian cancer) will be performed.

Evaluación de la capacidad antioxidante y metabolitos secundarios de extractos de dieciséis plantas medicinales / Evaluation of antioxidant capacity and secondary metabolites of sixteen medicinal plants extracts

El presente estudio evaluó la capacidad antioxidante de los extractos de dieciséis plantas medicinales: escoba amarga (Parthenium hysterophons), ajenjo (Artemisia absinthium), guarumo (t), chaya (Cnidoscolus chayamansa), borraja (Borago officinalis), balsa (Ochroma sp.), linaza (Linum usitatissimum), hierba Luisa (Cymbopogon citratus), toronjil (Melissa officinalis), buganvilla (Bougainvillea spectabilis), alcachofa (Cynara scolymus), guaviduca (Piper carpunya), altamisa (Ambrosia cumanensis), diente de león (Taxacum officinales), buscapina (Parietaria officinalis) y moringa (Moringa oleifera). Para ello, se usó el método DPPH (radical 1,1-difenil-2-picrilhidrazil); además, se realizaron ensayos de reconocimiento de metabolitos secundarios a fin de obtener los primeros indicios de compuestos de interés fitoquímico. La actividad captadora de radicales libres de los extractos se expresó como valor de IC50 (µg/mL) (cantidad necesaria para inhibir la formación de radicales DPPH en un 50%). El valor bajo de IC50 refleja mejor acción eliminadora de radicales libres. Aunque la mayoría de las muestras evaluadas mostraron buena capacidad antioxidante con este método (DPPH), los ensayos de los extractos hidro-alcohólicos demuestran que la alcachofa (IC50 9,89 µg/mL), moringa (IC50 11,4 µg/mL) y borraja (IC50 14,0 µg/mL) presentaron mayor capacidad antioxidante. Mediante las pruebas químicas de caracterización, se detectó la presencia de flavonoides, taninos, triterpenos, alcaloides y saponinas en la mayoría de las especies analizadas (aproximadamente 56-69%); tan sólo un 20% de las mismas mostró la presencia de polifenoles, glucósidos cianogénicos, lactonas, cumarinas, esteroles y antraquinonas. Según los resultados, se podría considerar a estas plantas como fuentes prometedoras de metabolitos secundarios con actividad antioxidante. ABSTRACTThis study evaluated the antioxidant capacity of sixteen medicinal plants: Escoba amarga (Parthenium hysterophons), ajenjo (Artemisia absinthium), guarumo (Cecropia obtusifolia), chaya (Cnidoscolus chayamansa), borraja (Borago officinalis), balsa (Ochroma sp.), linaza (Linum usitatissimum), hierba Luisa (Cymbopogon citratus), toronjil (Melissa officinalis), buganvilla (Bougainvillea spectabilis), alcachofa (Cynara scolymus), guaviduca (Piper carpunya), altamisa (Ambrosia cumanensis), diente de León (Taxacum officinales), buscapina (Parietaria officinalis)and moringa (Moringa oleifera). For this, the DPPH (radical 1, 1-difenil-2-picrilhidrazil) method was used; furthermore, recognition assays of secondary metabolites were performed, in order to obtain the first signs of phytochemical compounds of interest. The free radical scavenging activity of the extracts was expressed as IC50 value (g/mL) (necessary amount to inhibit the formation of 50% of DPPH radical). The low value of IC50 reflects better free radical scavenging action. Although most of the samples tested showed good antioxidant capacity with this method (DPPH), tests of hydroalcoholic extracts show that alcachofa (IC50 9.89 mg/mL), moringa (IC50 11.4 mg/mL) and borraja (IC50 14.0 mg/mL) were those with higher antioxidant capacity. Through chemical characterization tests, the presence of flavonoids, tannins, triterpenes, alkaloids and saponins were detected in most of the analyzed species (approximately 56-69%); only 20% of them showed the presence of polyphenols, cyanogenic glycosides, lactones, coumarins, anthraquinones and sterols. According to the results obtained, these plantsmight be considered as promising sources of secondary metabolites with antioxidant activity.

Subunidad beta de la gonadotropina corionica en el control de la enfermedad trofoblastica benigna. / Beta subunity of the corionic gonadotrophin in the control of benign throphoblastic disease

Se estudiaron 26 casos de enfermedad trofoblastica de curso benigno postevacuacion uterina de embarazo molar, analizando el comportamiento de la hormona gonadotropina corionica, mediante su determinacion en orina por metodo inmunologico asi como de la subunidad beta medida en suero por radioinmunoensayo. Con ambos metodos se observo descenso de los niveles hormonales hasta la negativizacion, la cual fue mas retardada y, por lo tanto, mas especifica en la subunidad beta, lo que es de gran importancia en la practica para demostrar ausencia de actividad trofoblastica

Clinical use of metoclopramide test in the diagnosis of women with hyperprolactinemia.

UNLABELLED: 14 women with elevated prolactin (PRL) serum levels (greater than 25 ng/ml) were given 2.5 mg of metoclopramide, by bolus intravenous injection, to evaluate its diagnosic potential as a stimulus for PRL release. Following metoclopramide injection there was a prompt increase in serum PRL in normal subjects and in patients with moderate PRL elevations associated with galactorrhea-oligomenorrhea. The women with amenorrhea-galactorrhea regardless of the presence of absence of a pituitary tumor, showed a blunted response. Metoclopramide failed to induce TSH secretion in all cases. IN CONCLUSION: the use of the metoclopramide test provides no additional clinical information to that furnished by the basal serum PRL concentration for the hyperprolactinemic patient.

Induction of ovulation with clomiphene and estradiol benzoate in anovulatory women refractory to clomiphene alone.

Twenty-two infertile and clomiphene-nonresponding patients received a course of clomiphene, 100 mg/day for 5 days, followed 7 days later by an intramuscular injection of 1 mg of estradiol benzoate. The diagnosis of idiopathic chronic anovulation had been established. None of these patients had galactorrhea, hirsutism, or ovarian enlargement. Thirteen of the twenty-two women had surges of both luteinizing hormone and follicle-stimulating hormone after the estradiol injection; the peak gonadotropin levels occurred within 72 hours of the injection. These 13 patients ovulated and pregnancy ensued in 10 of them. The estradiol benzoate injection also elicited a significant increase in serum prolactin levels- This enhanced prolactin release had no apparent effect on the gonadotropin surge. These results suggest that the association of clomiphene and estradiol benzoate potentiates the action of clomiphene and may prove useful in clomiphene nonresponders.