Gender differences in workplace violence against physicians and nurses in Latin America: a survey from the Interamerican Society of Cardiology.

OBJECTIVES: To evaluate gender differences in workplace violence (WPV) against physicians and nurses in Latin America. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional electronic survey was conducted between January 11 and February 28, 2022. A prespecified gender analysis was performed. RESULTS: Among the 3056 responses to the electronic survey, 57% were women, 81.6% were physicians, and 18.4% were nurses. At least one act of violence was experienced by 59.2% of respondents, with verbal violence being the most common (97.5%). Women experienced more WPV than men (65.8% vs 50.4%; P < 0.001; odds ratio [OR]: 1.89; 95% confidence interval [CI]: 1.63-2.19). Women were more likely to report at least one episode of WPV per week (19.2% vs 11.9%, P < 0.001), to request for psychological help (14.5% vs 9%, P = 0.001) and to experience more psychosomatic symptoms. In addition, women were more likely to report having considered changing their job after an aggression (57.6% vs 51.3%, P = 0.011) and even leaving their job (33% vs 25.7%, P = 0.001). In a multivariate analysis, being a woman (OR: 1.76), working in emergency departments (OR: 1.99), and with COVID-19 patients (OR: 3.3) were independently associated with more aggressive interactions, while older age (OR: 0.95) and working in a private setting (OR: 0.62) implied lower risk. CONCLUSIONS: Women are more likely to experience WPV and to report more psychosomatic symptoms after the event. Preventive measures are urgently needed, with a special focus on high-risk groups such as women.

Lack of association between angiotensin-converting enzyme genotype and muscle strength in Peruvian older people.

Aging can be associated with decreasing muscle strength, and related factors are comorbidities, sex, physical activity, and possibly genetic factors. Among genetic factors the renin-angiotensin system is of interest, but data on the Peruvian population is lacking. The objective of our study was to evaluate the association of grip strength and angiotensin convertase enzyme (ACE) polymorphism in Peruvian older people. A cross-sectional study in a convenience sample of 104 participants over 60 years in Lima, Perú, with analysis of the ACE polymorphism, was performed. We studied 104 participants, 46 men (44,2%) and 58 women (55,8%), with a mean age and standard deviation (SD) of 73,7 (7,4) years, range between 60-90 years. The frequency of D/D, I/D and I/I genotypes was 12,7; 43,7 and 43,7% respectively. The genotype distribution of ACE polymorphism agreed with the Hardy-Weinberg equilibrium (p=0,746). The mean (SD) of grip strength in the D/D, I/D and I/I polymorphisms were 24,8 (7,2); 22,8 (7,2) and 23,4 (7,6) kg respectively; no significant difference was observed (p=0,41) between genetic groups. In this small convenience sample of older Peruvians, no association was found between grip strength and ACE genotype.

Effects of storage time on the motility, mortality and calcium levels of Atlantic salmon Salmo salar spermatozoa.

This study estimates spermatozoa mortality, morphology, motility and intracellular calcium levels in Atlantic salmon Salmo salar milt after prolonged storage. Milt samples were preserved at 4° C for 25 days and then evaluated for mortality. Motility remained high for the first 3 days and the mortality was low during the first 5 days of storage. A decrease of >50% in calcium content was observed after 5 days of storage. When spermatozoa were activated, calcium levels increased >200% in relative fluorescence units (RFU); this rate of increase was lost when the samples were stored for extended periods of time and was only partially manifested in a zero calcium solution. The results suggest that in vitro storage of S. salar spermatozoa at 4° C for a period of 3 days preserves motility and limits mortality to levels similar to those of fresh spermatozoa. This method also maintains intracellular calcium storage critical for spermatozoa performance.

Effect of aracnotoxin from Latrodectus mactans on bovine sperm function: modulatory action of bovine oviduct cells and their secretions.

Latrodectus mactans' aracnotoxin (Atx) induces changes in sperm function that could be used as a co-adjuvant in male contraceptive barrier methods. This effect includes the suppression of intracellular reactive oxygen species (ROS), an event necessary for capacitation, chemotaxis and acrosome reaction (AR). The sperm that are not trapped by the barrier method can reach the oviduct before fertilisation and be exposed to the secretions of the oviducts. This study evaluated the effect of bovine tubal explants (TU) and conditioned media (CM) from the ampullar and isthmal regions on spermatozoa exposed to Atx. Thawed bovine sperm were incubated with Atx, TU and CM from the ampullar and isthmal regions for 4 h and then DNA integrity, intracellular ROS and lysophosphatidylcholine-induced AR were determined. Spermatozoa exposed to Atx and co-incubated with TU and CM for 4 h produced an increase in sperm DNA damage, a decrease in ROS production and a decrease in %AR, compared with the control. A similar result was obtained from the co-incubation of spermatozoa with Atx. In conclusion, the effect of Atx is not modified by tubal cells or their secretions and this opens the door to future studies to evaluate the application of synthetic peptides obtained from Atx as a co-adjuvant of contraceptive barrier methods.

SARC-F and SARC-CalF Scores as Mortality Risk Factors in Older Men with Cancer: A Longitudinal Study from Peru.

OBJECTIVES: We aimed to evaluate the role of SARC-F and SARC-CalF scores as risk factors for mortality in adults over 60 years of age with cancer of the Centro Médico Naval (CEMENA) in Callao, Peru during 2012-2015. METHODS: We performed a secondary analysis of data from a prospective cohort carried out from September 2012 to February 2013 in the Geriatrics Department of CEMENA. The outcome variable was mortality at two years of follow-up, while the exposure variable was the risk of sarcopenia assessed using the SARC-F and SARC-CalF scales. We carried out Cox proportional-hazards models to assess the role of SARC-F and SARC-CalF scores as risk factors for mortality. We estimated crude (cHR) and adjusted (aHR) hazard ratios (HR) with their respective 95% confidence intervals (95%CI). Likewise, we calculated the area under the curve (AUC) of both exposure variables in relation to mortality. RESULTS: We analyzed data from 922 elderly men with cancer; 43.1% (n=397) were between 60 and 70 years old. 21.5% (n=198) and 45.7% (n=421) were at risk of sarcopenia according to SARC-F and SARC-CalF, respectively, while the incidence of mortality was 22.9% (n=211). In the adjusted Cox regression model, we found that the risk of sarcopenia measured by SARC-F (aHR=2.51; 95%CI: 1.40-2.77) and SARC-CalF (aHR=2.04; 95%CI: 1.55-4.02) was associated with a higher risk of death in older men with cancer. In the diagnostic performance analysis, we found that the AUC for mortality prediction was 0.71 (95%CI: 0.68-0.75) for SARC-F and 0.80 (95%CI: 0.78-0.82) for SARC-CalF. CONCLUSIONS: The risk of sarcopenia evaluated by SARC-F and SARC-CalF scores was associated with an increased risk of mortality in older men with cancer. Both scales proved to be useful and accessible instruments for the identification of groups at risk of mortality.

Open or laparoscopic nephrectomy and extracoroporeal repair of complicated renal artery aneurysms: techniques for renal salvage.

Renal artery aneurysm is an infrequently seen disease. The most feared symptom is rupture, which is often rapidly fatal. Indications for intervention include size, intractable symptoms and pregnancy. Many cases are managed by endovascular techniques; however, very complex cases often are referred to the urologist. We report our experience with the rarely used technique of renal artery aneurysms repair comprised of nephrectomy, extracorporeal vascular reconstruction with aneurysmectomy, and autotransplant.

Frailty and Vulnerability as Predictors of Chemotherapy Toxicity in Older Adults: A Longitudinal Study in Peru.

BACKGROUND: Multiple markers are used to assess frailty and vulnerability, conditions associated with the development of chemotherapy toxicity (CTT). However, there is still no consensus on which condition has stronger association with this adverse effect of chemotherapy in the elderly. OBJECTIVES: To evaluate the association between frailty and vulnerability with the development of CTT in oncogeriatric patients. DESIGN, SETTING, AND PARTICIPANTS: Through a retrospective cohort, a secondary database of 496 male oncogeriatric military patients treated at the Geriatrics Service of the Naval Medical Centre of Peru during 2013-2015 was analyzed. MEASUREMENTS: With prior informed consent, the presence of frailty, assessed by Fried Phenotype; and vulnerability, assessed by the Vulnerable Elders Survey-13 (VES-13) and G-8, was determined. The follow-up of patients in chemotherapy was performed every 8 weeks, to determine the development of CTT (according to the Common Terminology Criteria for Adverse Events v4.0). In addition, we included sociodemographic characteristics, medical background information and functional assessment variables. The data collected was encoded and imported into STATA v14.0 statistical package for analysis. Multivariate analysis was performed using crude and adjusted Cox regression models. The reported measure was the hazard ratio (HR) with their respective 95% confidence intervals (95%CI). RESULTS: The average age was 79.2 ± 4.3 years. 129 (26.01%) developed CTT during follow-up. Similarly, 129 older adults (26.01%) were positive for frailty according to Fried phenotype; 101 (20.36%) were positive for vulnerability with VES-13, and 112 (22.58%) with G-8. In the adjusted Cox model, by type of cancer and adverse effects, a statistically significant association was found between the 3 scales evaluated and the development of CTT, with the Fried Phenotype as the scale with the strongest association (HR=2.01; 95%CI: 1.04-4.90). CONCLUSIONS: The frailty and vulnerability in the elderly are conditions associated with the development of CTT. The Fried phenotype was the scale with the most significant association with the outcome studied.

Deforestation and increased flooding of the upper Amazon.

The height of the annual flood crest of the Amazon at Iquitos has increased markedly in the last decade. During this same period, there has been greatly increased deforestation in the upper parts of the Amazon watershed in Peru and Ecuador, but no significant changes in regional patterns of precipitation. The change in Amazonian water balance during the last decade appears to be the result of increased runoff due to deforestation. If so, the long-predicted regional climatic and hydrological changes that would be the expected result of Amazonian deforestation may already be beginning.

Description of the outbreak of bluetongue in Corsica in 2003, and lessons for surveillance.

Since 1999, several serotypes of bluetongue virus (btv) have been isolated in the western part of the Mediterranean basin, and since 2000, Corsica has been exposed to three different serotypes: BTV serotype 2 in 2000, BTV serotype 4 (BTV-4) in 2003 and BTV serotype 16 in 2004. In 2000 there were no surveillance systems for bluetongue, but in 2003, active surveillance of the circulation of BTV and its vector Culicoides species, aided by a raised level of awareness in farmers and veterinarians, made it possible to study the introduction of BTV-4. The monitoring and analysis of the seroconversions of sentinel herds of goats, clinical signs and meteorological variables showed that the serotype had been present in the island since May that year, but clinical signs were first observed only in October. Moreover, the weather conditions and wind patterns were suitable for the transport of Culicoides species from Sardinia in May. These observations suggest that btv had been transported on air currents from a southern infected area, and that it could have spread without causing clinical signs of disease for a few months.

Stent-graft treatment of trauma to the supra-aortic arteries. A review.

Trauma to the carotid, subclavian, vertebral, or innominate arteries may be blunt or penetrating. Some injuries, such as those caused by central venous catheterization, are iatrogenic. Trauma-induced fistulas and pseudoaneurysms of the supra-aortic arteries are relatively rare, but may result in disabling neurologic symptoms or death. Traditional surgical approaches to supra-aortic artery trauma have high morbidity and mortality rates, especially in patients with multiple injuries and patients with a serious concomitant illness. The minimally invasive endovascular approach may offer an alternative that avoids the tissue damage, bleeding, infectious complications, pain and disability, long recovery time, and high financial cost associated with surgery. In the past 15 years, stent-grafts have evolved from bare-metal stents to which the operator attached autologous vein or a prosthetic material to manufactured balloon-expandable or self-expanding endoprosthetic systems. No devices designed specifically for use in the supra-aortic arteries are yet available. Nevertheless, the reported experience with stent-graft treatment of supra-aortic artery trauma is growing rapidly, although it remains limited to case reports and small series with relatively short follow-up times. Results have been very promising: complete lesion exclusion from the circulation and resolution of symptoms has been achieved in almost all cases, and few procedural complications and stent-graft stenoses and thromboses have been reported. The stent-graft approach warrants additional research on its long-term outcomes, as well as continued development of enhancements for the devices used.

Initial 200 cases of carotid artery stenting using a reversal-of-flow cerebral protection device.

AIM: Because embolic complications can occur during carotid angioplasty and stenting (CAS), a new device, the Parodi Anti-Emboli System (PAES) was developed to protect the brain from embolization. We describe our initial experience with this device. METHODS: Between September 1999 and December 2003, CAS was performed in 200 consecutive patients (146 men; mean age, 70.4 years) with symptomatic (52%) or asymptomatic (48%) severe carotid artery stenosis (>70%). De novo lesions were present in 169 patients, restenosis in 18, and radiation-induced stenosis in 13. Wallstents were inserted in all cases, with selective predilatation, and the PAES was employed during all CAS procedures. Patients were evaluated by a neurologist before and after CAS. Minor strokes, major or fatal strokes, and myocardial infarctions that occurred within 30 days of the procedure were recorded. RESULTS: The overall technical success rate for CAS using the PAES (with the PAES placed in position percutaneously) was 99%. The overall perioperative stroke and death rate was 1.5%. There were four transient neurologic events after CAS, three of which were related to hemodynamic instability and one to postoperative embolization. CONCLUSIONS: Our experience indicates that CAS using the PAES is safe and effective. The protection device may prevent the debris released by angioplasty from entering the cerebral circulation. Additional studies of this device are warranted.

Is there evidence that cerebral protection is beneficial? Clinical data.

Advances in angioplasty techniques and the development of low-profile, flexible, tapered nitinol stents designed specifically for carotid applications have made carotid artery stenting a viable alternative to carotid endarterectomy for treatment of occlusive disease of the carotid arteries. During the stenting process, however, debris may be released and cause distal embolization that can lead to stroke or death. Thus, several embolic protection devices have been developed for use in carotid stenting, two of which are available in the United States. In the past 5 years, data from several large trials, series, and registries of carotid artery stenting-reflecting the experience in thousands of patients-have become available. These investigations include the CAVATAS study, the Global Carotid Artery Stent Registry, the SAPPHIRE study, the ARCHeR trials, the CABERNET registry, the BEACH registry, the SECuRITY registry, the German Registry, and the EVA-3S trial. The studies have provided considerable evidence that use of an embolic protection device decreases the incidence of cerebral embolic events during carotid stenting in both symptomatic and asymptomatic patients. They have also shown that increased experience with angioplasty in the carotid artery decreases complication rates associated with the procedure, even when a protection device is not employed. Although the benefits of routine use of cerebral protection have not been confirmed by level 1 evidence, a consensus supports such use.

Techniques for carotid artery stenting under cerebral protection.

Carotid angioplasty and stenting is an alternative to carotid endarterectomy in the treatment of carotid artery stenosis. During the stenting process, however, distal embolization usually occurs, and the particles released may cause neurologic problems or death. Thus, the safety of carotid stenting depends partly on use of a cerebral protection device during the procedure. Three principal types of protection mechanisms have been developed: distal balloon occlusion, distal filtration, and proximal occlusion with or without reversal of flow. Products using these mechanisms have been manufactured by a variety of companies, and many are used routinely outside the United States (US). One distal filter, the RX Accunet, has been approved by the US Food and Drug Administration for clinical use. Large clinical trials of most of the newest carotid stents and cerebral protection devices are under way, and some initial results have been reported. Several clinical series in which cerebral protection was employed have also been described. Each type of protection device has advantages and disadvantages, which are discussed in this review.

Bromatological characteristics of fillet fish of Leporinus agassizi and Leporinus fasciatus (Pisces: Characidae) in its natural habitat / Características bromatológicas de filetes de Leporinus agassizy Leporinus fasciatus (Pisces: Characidae) en su hábitat natural

ABSTRACT Bromatological parameters in 39 Warakú verdadero (Leporinus agassizi) and 21 Warakú pinima (Leporinus fasciatus) fillets were analyzed at three different sites of the Vaupés River, Colombia sampled during a hydrobiological cycle. The bromatological parameters did not shown significant differences in relation to the sites and season of capture. At point 3 and during the descending water season Leporinus agassizi had the highest values for dry matter (25.24%), protein (19.82%) and ash (2.16%). The highest lipid value for this species was found in low waters at point 1 (2.93%). Leporinus fasciatus showed the highest levels of dry matter (25.19%) and ash (2.16%) at point 3 during ascendant and high waters, respectively. The bromatological parameters tends to vary regarding the time of year. It was possible to determined that these fish species have great potential for continental aquaculture thus constituting a healthy food model.

RESUMEN Se analizaron los parámetros bromatológicos de 39 filetes de Warakú verdadero (Leporinus agassizi) y 21 filetes de Warakú pinima (Leporinus fasciatus) muestreados durante un ciclo hidrológico en tres puntos diferentes del Rio Vaupés, Colombia. Los parámetros evaluados no presentaron diferencias significativas en relación al sitio y época de captura. En el punto 3 y durante la temporada de aguas descendentes Leporinus agassizi tuvo los valores más altos para materia seca (25,24%), proteína (19,82%) y cenizas (2,16%). Los mayores niveles de lípidos para esta especie fueron encontrados en aguas bajas del punto 1 (2,93%). Leporinus fasciatus presentó los niveles más altos de materia seca (25,19%) y cenizas (2,16%) en el punto 3 durante la temporada de aguas ascendentes y altas, respectivamente. Las variables bromatológicas tendieron a variar de acuerdo con la época del año. Fue posible determinar que estas especies de peces poseen un gran potencial para la acuicultura de aguas continentales constituyendo así un modelo de alimentación saludable.

Nitric oxide producing neurons in the monkey and human digestive system.

Nitric oxide has been proposed as an inhibitory transmitter molecule that plays a role in muscle relaxation and vasodilation in the gastrointestinal tract. The present study analyzes the distribution of nitric-oxide-producing neurons in the monkey and human digestive system by means of nicotinamide-adenine-dinucleotide-phosphate-diaphorase histochemistry. This histochemical method is reliable and convenient for the visualization of neuronal nitric-oxide synthase, the enzyme responsible for nitric-oxide generation. In the gastrointestinal tract, nitric-oxide-synthase-related diaphorase activity was present in nerve fibers running throughout the muscular layer (circular > longitudinal) and in numerous ganglion cells and processes in the myenteric plexus of monkeys and humans. Labelled ganglion cells and fibers also were observed in the submucous plexus, although they were much less numerous than those seen in the myenteric plexus. In the submucosa, a few positive fibers were seen around blood vessels. In the mucosa, stained fibers were sparse at the base of the villi and crypts, whereas they were quite abundant in the muscularis mucosae, especially in the small intestine and colon. In the gallbladder (human), labelling was found in ganglion cells and processes of the innermost and outermost ganglionated plexuses. Stained fibers also were distributed to the muscular layer and, less abundantly, to the mucosa and vasculature. Labelled fibers were more abundant in the sphincter of Oddi (human) than in the gallbladder. In the monkey and human pancreas, nicotinamide-adenine-dinucleotide-diaphorase staining was seen mainly in ganglion cells and fibers of intrapancreatic ganglia, and in processes running among acini, around ducts and in the stroma. A moderate density of stained fibers also was distributed to the vasculature, whereas the islets showed few positive processes. Finally, double label experiments performed in the pancreas showed that the vast majority of neurons producing nitric oxide are immunoreactive for vasoactive intestinal peptide.(ABSTRACT TRUNCATED AT 250 WORDS)

Graded effect of protein on regional myoelectric activity of the opossum sphincter of Oddi.

Although it is known that the sphincter of Oddi exhibits a myoelectric response to intraluminal nutrients, the effect of specific dietary components has not been well characterized. The aim of this study was to determine the effect of intragastric instillation of a protein meal on regional myoelectric activity of the opossum sphincter of Oddi. Seven adult opossums were chronically prepared with self-retaining bipolar electrodes secured to the proximal and distal parts of the sphincter. After a 2-week recovery period, and with the animals fasted and conscious, myoelectric activity was recorded for two cycles of the migrating myoelectric complex. The animals then received graded calories of protein through an orogastric tube and recordings were continued until return of the fasted cyclic activity. Doses of 60, 120, and 240 kcal of protein elicited increases in myoelectric spike activity of the proximal sphincter of 18.7%, 41.9%, and 66.6%, respectively. Similarly, the length of the fed state was prolonged by increasing caloric loads, with mean (plus or minus standard error of the mean) times of 266 +/- 25, 292 +/- 15, and 375 +/- 42 minutes for each dose. A similar relationship was noted in the distal part of the sphincter. Regression analysis between the proximal and distal parts of the sphincter during the fasted and fed states showed a strong and persistent correlation of gradient of spikeburst frequency. We conclude that myoelectric spike frequency of the opossum sphincter of Oddi exhibits a dose-related response to intragastric protein calories. Furthermore, the proximal and distal parts of the sphincter remain electrically coupled, with the proximal region pacing the distal region during the fasted state and after protein administration.

Late functional adaptation after colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis.

Ileal pouch-anal anastomosis (IPAA) is currently an alternative to proctocolectomy and ileostomy for patients with ulcerative colitis or familial polyposis. Some studies have suggested significant anal sphincter damage after mucosal proctectomy. Our aim was to assess prospectively late sphincter function after IPAA. In 250 patients, anorectal pressures were assessed with a pneumohydraulic perfused catheter manometry system. Each patient underwent colectomy, mucosal proctectomy, ileoanal anastomosis of a 15 cm ileal J-pouch, and loop ileostomy. Eight weeks after IPAA, anal manometry was repeated, and the ileostomy was closed. Manometry was repeated at yearly intervals. A decline in resting tone of the anal sphincter occurred early after IPAA with a gradual recovery toward control. External sphincter squeeze after pressures were not affected by IPAA and steadily increased to 8 years after operation. During this time, a progressive increase in J-pouch capacity was noted, and 24-hour stool frequency declined from 7.9 +/- 0.3 stools to 6.5 +/- 0.3 stools (p less than 0.05). We conclude that mucosal proctectomy results in internal anal sphincter trauma but is associated with long-term sphincter recovery, coupled with a significant improvement in external sphincter capacity, ileal pouch volume, and stool frequency.

Transfemoral, endovascular stented graft repair of an abdominal aortic aneurysm.

Endovascular aortic graft implantation is a new procedure for the repair of arterial aneurysms. We report on the first such case successfully performed in the United States. A 76-year-old man with severe oxygen-dependent pulmonary insufficiency, coronary artery disease, and recurrent ventricular tachyrhythmia was also diagnosed as having a 7.5-cm infrarenal abdominal aortic aneurysm. Because of the high risks associated with conventional surgical repair, consent was obtained for compassionate use of an experimental device. Using local anesthesia, a 22-mm Dacron prosthesis was inserted under fluoroscopic guidance through an open, left transfemoral route. Completion arteriography demonstrated aneurysm exclusion. No blood transfusion was required and there were no perioperative complications. Further technical refinements and clinical trials will be required prior to the broad implementation of this technique.

Transfemoral endovascular stented graft treatment of aorto-iliac and femoropopliteal occlusive disease for limb salvage.

BACKGROUND: Endovascular stented grafts employ a new technique that blends intravascular stent and prosthetic graft technologies. These devices may be used to treat arterial aneurysms, occlusive disease, and vascular injuries. This report describes the application of stented grafts to the treatment of limb-threatening ischemia secondary to occlusive disease of the aorta, iliac, and femoral arteries. METHODS: Three patients with limb-threatening ischemia and severe comorbid medical illnesses were treated with transvascular stented grafts that were composed of 6-mm thin-walled polytetrafluoroethylene grafts and Palmaz balloon expandable stents. The grafts were inserted through a cutdown in an artery remote from the site of occlusion and introduced into the vascular system within 14-Fr introducer sheaths. RESULTS: Technical success was documented in all three patients with restoration of arterial continuity following stent graft deployment. Patency and limb salvage has been achieved to 1 year. One patient required further dilatation of the proximal stent at 6 weeks. Complications were limited to an iliofemoral deep vein thrombosis in one patient. CONCLUSIONS: Endovascular stented grafts can be inserted to treat limb-threatening ischemia. Although these initial results are encouraging, greater experience in more patients observed for longer periods of time is necessary before this technique can be advocated for widespread use.