Trends in pelvic organ prolapse management in Latin America.

AIMS: To describe practice patterns and perspectives regarding pelvic organ prolapse (POP) management among urologists, gynecologists, and urogynecologists in Latin America (LATAM). METHODS: A cross-sectional study was conducted from April to September 2016 using a 37-item internet-based survey applied to members of urologic and gynecologic associations from 18 countries. Participants were asked about their background and practice patterns. Descriptive statistics were employed. RESULTS: A total of 673 responses were obtained. Most came from Colombia (33.6%) and Brazil (24.7%). The number of practitioners who perform at least one POP procedure per month and were eligible to finish the survey was 529 (78.6%), out of which 323 (61.0%) were urologists, 156 (29.5%) gynecologists, and 50 (9.5%) urogynecologists. Mesh-based POP repairs were used by 57.1% of participants. Out of non-mesh users, the most frequent vaginal procedures were sacrospinous fixation (30%), colporrhaphy (25%), and uterosacral fixation (12%). Regarding the impact of FDA warnings, 75.2% participants indicated that the use of mesh has declined, and 41.9% considered this has had a negative effect in the use of incontinence tapes as well. Only two physicians reported legal disputes related to mesh procedures, and 75.8% said they would still indicate mesh repairs in certain cases. CONCLUSIONS: This is the first report on POP practice patterns in LATAM. Preferences regarding surgical management of POP are not very different from international trends. Despite intense scrutiny and media exposure, mesh-based procedures are still largely used in LATAM.

Porphyrins as Catalysts in Scalable Organic Reactions.

Catalysis is a topic of continuous interest since it was discovered in chemistry centuries ago. Aiming at the advance of reactions for efficient processes, a number of approaches have been developed over the last 180 years, and more recently, porphyrins occupy an important role in this field. Porphyrins and metalloporphyrins are fascinating compounds which are involved in a number of synthetic transformations of great interest for industry and academy. The aim of this review is to cover the most recent progress in reactions catalysed by porphyrins in scalable procedures, thus presenting the state of the art in reactions of epoxidation, sulfoxidation, oxidation of alcohols to carbonyl compounds and C-H functionalization. In addition, the use of porphyrins as photocatalysts in continuous flow processes is covered.

Overexpression of catalase in myeloid cells causes impaired postischemic neovascularization.

OBJECTIVE: Myeloid lineage cells (MLCs) such as macrophages are known to play a key role in postischemic neovascularization. However, the role of MLC-derived reactive oxygen species in this process and their specific chemical identity remain unknown. METHODS AND RESULTS: Transgenic mice with MLC-specific overexpression of catalase (Tg(Cat-MLC) mice) were created on a C57BL/6 background. Macrophage catalase activity was increased 3.4-fold compared with wild-type mice. After femoral artery ligation, laser Doppler perfusion imaging revealed impaired perfusion recovery in Tg(Cat-MLC) mice. This was associated with fewer collateral vessels, as assessed by microcomputed tomography angiography, and decreased capillary density. Impaired functional recovery of the ischemic limb was also evidenced by a 50% reduction in spontaneous running activity. The deficient neovascularization was associated with a blunted inflammatory response, characterized by decreased macrophage infiltration of ischemic tissues, and lower mRNA levels of inflammatory markers, such as tumor necrosis factor-α, osteopontin, and matrix mettaloproteinase-9. In vitro macrophage migration was impaired in Tg(Cat-MLC) mice, suggesting a role for H(2)O(2) in regulating the ability of macrophages to infiltrate ischemic tissues. CONCLUSIONS: MLC-derived H(2)O(2) plays a key role in promoting neovascularization in response to ischemia and is a necessary factor for the development of ischemia-induced inflammation.

Angiopoietin-2 stimulates blood flow recovery after femoral artery occlusion by inducing inflammation and arteriogenesis.

OBJECTIVE: Recently, we have shown that shear stress regulates the angiogenic potential of endothelial cells in vitro by an Angiopoietin-2 (Ang2)-dependent mechanism; however its pathophysiological significance in vivo was not clear. We hypothesized that Ang2 plays an important role in blood flow recovery after arterial occlusion in vivo by regulating angiogenesis and arteriogenesis. METHODS AND RESULTS: C57Bl/6J mice underwent femoral artery ligation and were injected with a specific Ang2 inhibitor, L1-10, or vehicle for 10 days. Ang2 mRNA was upregulated at day 2, and Ang2 protein was upregulated at day 2, 5, and 7 in the ligated hindlimb. L1-10 treatment significantly blunted blood flow recovery. L1-10 decreased smooth muscle cell coverage of neovessels without affecting capillary density, suggesting a specific role for Ang2 in arteriogenesis. Mechanistically, L1-10 decreased expression of intercellular and vascular cell adhesion molecules as well as infiltrating monocytes/macrophages in the ischemic tissue. Although L1-10 had no effect on the number of CD11b+ cells (monocytes/macrophages) mobilized in the bone marrow, it maintained elevated numbers of circulating CD11b+ cells in the peripheral blood. CONCLUSIONS: These results suggest that Ang2 induced in ischemic tissue plays a critical role in blood flow recovery by stimulating inflammation and arteriogenesis.

In vivo imaging of hydrogen peroxide with chemiluminescent nanoparticles.

The overproduction of hydrogen peroxide is implicated in the development of numerous diseases and there is currently great interest in developing contrast agents that can image hydrogen peroxide in vivo. In this report, we demonstrate that nanoparticles formulated from peroxalate esters and fluorescent dyes can image hydrogen peroxide in vivo with high specificity and sensitivity. The peroxalate nanoparticles image hydrogen peroxide by undergoing a three-component chemiluminescent reaction between hydrogen peroxide, peroxalate esters and fluorescent dyes. The peroxalate nanoparticles have several attractive properties for in vivo imaging, such as tunable wavelength emission (460-630 nm), nanomolar sensitivity for hydrogen peroxide and excellent specificity for hydrogen peroxide over other reactive oxygen species. The peroxalate nanoparticles were capable of imaging hydrogen peroxide in the peritoneal cavity of mice during a lipopolysaccharide-induced inflammatory response. We anticipate numerous applications of peroxalate nanoparticles for in vivo imaging of hydrogen peroxide, given their high specificity and sensitivity and deep-tissue-imaging capability.

VIH/SIDA: la enseñanza y el aprendizaje de una pandemia / HIV/AIDS: Teaching and learning of a pandemia

La pandemia del VIH/SIDA sigue aumentando en el mundo y el problema no es menor en Colombia; por lo tanto, es urgente que el médico general y los profesionales de todas las disciplinas cuyos esfuerzos terapéuticos se enfocan sobre esta población reciban una adecuada formación para diagnosticar y tratar esta fatal enfermedad antes de que el paciente alcance sus estadios más avanzados en los que ya es irreversible. A lo largo de la historia ha ido cambiando el rol del maestro, pasando del que era autoritario hasta llegar al que es más cercano a sus alumnos, con el cual ellos se identifican y del cual adquieren un conocimiento técnico, pero sobre todo de quien adquieren pasión y deseo por el saber mediante una serie de competencias sociales, éticas, políticas y culturales, que lo capacitan integralmente. Si bien la enseñanza en grupos pequeños y el aprendizaje basado en problemas son herramientas muy útiles en diferentes escenarios pedagógicos, no existen antecedentes que orienten sobre cómo implementarlos en los diferentes aspectos relacionados con el VIH/SIDA. Por tal motivo, en el ámbito clínico hemos adoptado en la Facultad de Medicina de la Universidad de Antioquia el “aprendizaje basado en la ronda clínica”, metodología que motiva al alumno a pensar con una posición reflexiva, formándolo para un medio laboral donde debe primar el trabajo en equipo, pero siempre acompañado por su maestro quien mantiene una posición definitiva en las decisiones que se toman, logrando posteriormente que el alumno adopte una independencia tal que le permita tomar decisiones dirigidas hacia la búsqueda del conocimiento y del bienestar de sus pacientes.

The HIV/AIDS pandemic is still growing around the world, and the problem is equally serious in Colombia. This situation implies that general physicians, as well as all other professionals working with this specific population, should receive an adequate training to be able to diagnose and treat this potentially fatal disease before patients reach the advanced, irreversible stages. Throughout history, the role of teachers has evolved from an authoritarian model to being closer to their alumni; in the latter model students may find an easier identification with their teachers, acquire technical skills, and develop passion for knowledge; this goal is reached through several social, ethical, political and cultural competences that prepare alumni in an integral way. The small group didactics and the problem-based learning are useful tools in different pedagogic scenarios, but there is no precedent of their implementation in HIV/AIDS teaching. For that reason, at the Medical Faculty, University of Antioquia, in Medellín, Colombia, we have adopted the ward round-based teaching methodology, that motivates alumni to think from a reflective position, preparing them for practicing in a milieu in which team work is the most important goal to reach. However, teachers keep their active role in decision-making. Students must achieve independence to take decisions focused on the search for knowledge and for the wellbeing of patients.

Nefrectomia laparoscopica en Medellin / Laparoscopic nephrectomy in Medellin

Objetivos: La Nefrectomía Laparoscópica (NL) es un procedimiento que tiene menor morbilidad que la cirugía abierta, pero se requiere de gran experiencia para realizarla. Nosotros presentaremos nuestra revisión de las primeras 30 NL. Materiales y Métodos: Revisamos 30 pacientes a los que se les realizó NL por enfermedad benigna o maligna, entre agosto del 2001 y agosto del 2003, por un mismo cirujano. Tuvimos en cuenta el tipo de cirugía, la indicación y el acceso que se realizó. Además de las complicaciones y los resultados patológicos. Resultados: De los treinta pacientes 15 eran hombres y 15 mujeres. A dieciséis se les realizó NL izquierda, a los catorce restantes NL derecha. El acceso transperitoneal, retroperitoneal y mano asistida se realizó en el 80, 10 y 10 por ciento respectivamente. El 73.3 por ciento de los pacientes fueron llevados a cirugía por enfermedad benigna con una edad promedio de 38 años. El 26.7 por ciento restante tenían enfermedad maligna, con un promedio de edad de 59 años. De los que tenían enfermedad benigna, en el 53.3 por ciento la indicación de la cirugía fue atrofia renal. Se realizaron 21 NL simples, 7 NL radicales y 2 NL parciales. En nuestro estudio no hubo diferencias en el tiempo quirúrgico entre enfermedad benigna y maligna, 194/193 minutos respectivamente; pero si en la estancia hospitalaria. Se presentaron dos complicaciones mayores (6.6 por ciento) que fueron pacientes llevados a NL radical, una conversión (3 por ciento) por sangrado del hilio renal y un paciente que falleció al siguiente día de la cirugía por coagulopatía de consumo. Tres complicaciones fueron menores (10 por ciento), dos infecciones de herida quirúrgica. La otra complicación fue un urinoma en un caso al que se le realizó NL parcial. Dos de los 30 pacientes requirieron transfusión. El informe patológico fue pielonefritis crónica-pionefrosis 46 por ciento, hidronefrosis-Estrechez Píelo Ureteral 25 por ciento y CCR 21.4 por ciento. El tiempo de incapacidad postoperatoria fue de 7 días en enfermedad benigna y 12 en enfermedad maligna. Conclusiones: La NL es un procedimiento que se puede realizar con seguridad y eficiencia en enfermedad benigna o maligna pero se requiere de una curva de aprendizaje prolongada. Tiene una menor morbilidad que la cirugía abierta con una tasa de éxito similar

Ureterostomia cutanea transperitoneal por laparoscopia / Trasperitoneal cutaneous ureterostomy for laparoscopy

Paciente de 72 años, femenino, monorrena desde hace 12 años por Tumor renal, con historia de múltiples resecciones transuretrales secundarias a tumor vesical, con vejiga esclerosada, pequeña y de poca capacidad, uréter refluyente y compromiso de la función de su única unidad renal con hidroureteronefrosis