Fetal intervention for severe lower urinary tract obstruction: a multicenter case-control study comparing fetal cystoscopy with vesicoamniotic shunting.

OBJECTIVE: To evaluate the efficacy of fetal intervention using fetal cystoscopy or vesicoamniotic shunting in the treatment of severe lower urinary obstruction (LUTO). METHODS: A cohort of 111 fetuses with severe LUTO attending two centers between January 1990 and August 2013 were included retrospectively. Fetuses were categorized into three groups based on the method of intervention: (1) fetal cystoscopy, (2) vesicoamniotic shunting or (3) no intervention. Multivariate analyses were performed to determine the probability of survival and normal renal function until 6 months of age by comparing fetal cystoscopy and vesicoamniotic shunting to no fetal intervention. RESULTS: Of the 111 fetuses with severe LUTO that were included in the analysis, fetal cystoscopy was performed in 34, vesicoamniotic shunting was performed in 16 and there was no fetal intervention in 61. Gestational age at diagnosis, method of fetal intervention and cause of bladder obstruction were associated with prognosis. In multivariate analysis and after adjustment for potential confounders (considering all causes of LUTO) the overall probability of survival was significantly higher with fetal cystoscopy and vesicoamniotic shunting when compared to no intervention (adjusted relative risk (ARR), 1.86 (95% CI, 1.01-3.42; P = 0.048) and ARR, 1.73 (95% CI, 1.01-3.08; P = 0.04) respectively). A clear trend for normal renal function was present in the fetal cystoscopy group (ARR, 1.73 (95% CI, 0.97-3.08; P = 0.06)) but was not observed in the vesicoamniotic shunt group (ARR, 1.16 (95% CI, 0.86-1.55; P = 0.33)). In cases in which there was a postnatal diagnosis of posterior urethral valves, fetal cystoscopy was effective in improving both the 6-month survival rate and renal function (ARR, 4.10 (95% CI, 1.75-9.62; P < 0.01) and 2.66 (95% CI, 1.25-5.70; P = 0.01) respectively) while vesicoamniotic shunting was associated only with an improvement in the 6-month survival rate (ARR, 3.76 (95% CI, 1.42-9.97; P < 0.01)) with no effect on renal function (ARR, 1.03 (95% CI, 0.49-2.17, P = 0.93)). CONCLUSION: Fetal cystoscopy and vesicoamniotic shunting improve the 6-month survival rate in cases of severe LUTO. However, only fetal cystoscopy may prevent impairment of renal function in fetuses with posterior urethral valves. Our data support the idea of performing a subsequent randomized controlled trial to compare the effectiveness of fetal cystoscopy vs vesicoamniotic shunting for severe fetal LUTO.

A quick methodology for the evaluation of preliminary toxicity levels in soil samples associated to a potentially heavy-metal pollution in an abandoned ore mining site.

The risk assessment of pollution associated with metal extraction process is a social responsibility. The initial goal of this type of assessment should be the use of a methodology able to combine the use of easy application, low cost and high efficiency-techniques to provide the necessary information with the least amount of investment in time and money as possible. A suitable option maybe a combination of a simple, quick and reliable analytical technique such as PXRF with bioassays and chemometric tools like HCA, PCA or LDA as a viable approach to carrying out a preliminary estimation of phytotoxicity levels associated to the soil sampled in a metal-contaminated area. The method we propose has been shown to be a quick, economical and reliable tool for use in the first stages of environmental risk characterization in mining areas. Particularly, the use of root elongation (RE) as the classification criteria provides a viable approach for selecting the final samples (or zones) in which an "in-depth" investigation plan will be designed as part of a future remediation strategy.

Preclinical evaluation of the effects on the gastrointestinal tract of the antineoplastic drug vincristine repeatedly administered to rats.

BACKGROUND: Vincristine is a commonly used chemotherapeutic agent. It is associated with undesirable digestive side effects. However, the impact of vincristine on gastrointestinal structure and motility or its long-term effects have not been deeply studied in animal models. This could be useful in order to develop therapeutic or preventive strategies for cancer patients. The aim of this study was to analyze such effects. METHODS: Rats received saline or vincristine (0.1 mg kg-1 , ip) daily for 10 days. Evaluations were performed during treatment and 2-6 weeks after. Somatic mechano-sensitivity was assessed using von Frey hairs. Gastrointestinal motor function was studied by means of radiographic still images and colonic propulsion of fecal pellets using fluoroscopy videos. Histological assessment of the gut morphology and immunohistochemistry for HuC/D and nNOS were performed in whole-mount myenteric plexus preparations. KEY RESULTS: Peripheral sensitivity was increased in animals treated with vincristine and did not subside 2 weeks after treatment finalization. Vincristine treatment inhibited gastrointestinal motility although this was recovered to normal values with time. Damage in the digestive wall after vincristine treatment was greater in the ileum than in the colon. Villi shortening (in ileum) and large inflammatory nodules still remained 2 weeks after treatment finalization. Finally, the proportion of nNOS-immunoreactive neurons was increased with vincristine and continued to be increased 2 weeks after treatment finalization. CONCLUSIONS AND INFERENCES: Vincristine alters gastrointestinal motility, peripheral sensitivity and mucosal architecture. Vincristine-induced neuropathy (somatic and enteric), intestinal mucosa damage and inflammatory infiltrations are relatively long-lasting.

Multidrug-resistant tuberculosis outbreak among transvestite sex workers, Buenos Aires, Argentina.

We describe the first outbreak of multidrug-resistant tuberculosis (MDR-TB) that occurred in Argentina among transvestite sex workers, and actions undertaken for its control. In Buenos Aires city, transmission was documented between 2001 and 2004 by conventional and molecular methods in a hotel where transvestites used to reside and work. The source case was traced back to 1998. Six secondary cases were diagnosed and treated. Thirty-two contacts were investigated. The outbreak strain had formerly caused nosocomial transmission in Rosario, a city 300 km from Buenos Aires. Our findings highlight the difficulties controlling MDR-TB in Argentina.

[Comparison of quinfamide vs etofamide in the Mexican population with intestinal amebiasis]. / Comparación quinfamida vs etofamida en población mexicana con amibiasis intestinal.

An open comparative, prospective and randomized study was carried out to evaluate the efficacy and safety of quinfamide and etofamide in the treatment of intestinal amebiasis. This study evaluate two populations: children (1-16 years) and adults (17-80 years). The drugs used were quinfamide at doses of 4.3 mg/kg b.i.d. in children, and 100 mg t.i.d. adults both for one day; and etofamide at doses of 200 mg t.i.d. in children and 500 mg b.i.d. in adults both for three days. A total of 110 patients were included, 54 in the quinfamide group and 56 in the etofamide group. No significant difference between groups in baseline demographics characteristics were observed. Global healing rate for quinfamide group was 87% and for etofamife group was 76.8% (p = 0.0696). This difference was similar considering both group of populations. It is concluded that the therapeutical response was better for the quinfamide group than for the etofamide group. Both drugs have the same safety profile.

[Ultrastructure of the tracheal epithelium in preterm neonates treated with mechanical ventilation]. / Ultraestructura del epitelio traqueal en recién nacidos pretérmino sometidos a ventilación mecánica.

Tracheal epithelial damage, was evaluated in prematures that where intubated and with mechanical ventilation; biopsies were taken in seven preterm neonates; weight was 1100 to 2350; five were by cesarean section, y one via vaginal. Bronchial culture was negative in five, in one Lysteria monocitogena, and in another one Pseudomonas spiralis; biopsy was taken at different times o intubation. Five died because of pneumonia associated to other diseases. In optical and ultrastructural study it was found that with one day of intubation there was cilia loss; with three days of ventilation there was ciliary cells loss, and not ciliary cellular death and there were no cellular unions. In one case with three days of ventilation and 17 days of post-extubation with infection by Pseudomonas, ulcerated zones and edema were found. At 14 days there necrosis zones, increase in collagene. At 17 days there were ulcerated zones to the muscular layer with fibrosis and cellular rests at tracheal path. So, mechanical ventilation and the presence of a catheter, damage bronchial epithelium since the first 24 hours.

The use of a combined portable X ray fluorescence and multivariate statistical methods to assess a validated macroscopic rock samples classification in an ore exploration survey.

The combination of "ex situ" portable X ray fluorescence with unsupervised and supervised pattern recognition techniques such as hierarchical cluster analysis, principal components analysis, factor analysis and linear discriminant analysis have been applied to rock samples, in order to validate a "in situ" macroscopic rock samples classification of samples collected in the Boris Angelo mining area (Central Chile), during a drill-hole survey carried out to evaluate the economic potential of this Cu deposit. The analysed elements were Ca, Cu, Fe, K, Mn, Pb, Rb, Sr, Ti and Zn. The statistical treatment of the geological data has been arisen from the application of the Box-Cox transformation used to transform the data set in normal form to minimize the non-normal distribution of the data. From the statistical results obtained it can be concluded that the macroscopic classification applied to the transformed data permits at least, to distinguish quite well in relation to two of the rock classes defined (70.5% correctly classified (p<0.05)) as well as for four of the five alteration types defined "in situ" (75% of the total samples).

Comparacion quinfamida vs etofamida en poblacion mexicana con amibiasis intestinal / Comparation of quinfamide vs etofamide in Mexican polulation with intestinal amebiasis

Se llevó a cabo un estudio abierto, comparativo, prospectivo y al azar para evaluar la eficacia y seguridad de la quinfamida y de la etofamida en el tratamiento de pacientes con amibiasis intestinal. Se evaluaron dos poblaciones de niños (1-16 años) y adultos (17-80 años). Las dosis utilizadas fueron: Quinfamida en niños 4.3 mg/Kg 2 veces al día y en adultos 100 mg. cada 8 horas, en ambos por día; y Etofamida en niños 200 mg 3 veces al día y en adultos 500 mg. cada 12 horas, en ambos durante 3 días. Se incluyeron 110 pacientes, 54 en el grupo de la quinafamida y 56 en el de la etofamida. No se observaron diferencias significativas en las características demogr ficas basales. Al finalizar el tratamiento se observó una tasa de curación global para la quinfamida de 87 por ciento y de 76.8 por ciento para la etofamida (p = 0.0696). Separada por poblaciones se mantuvo la diferencia porcentual. Se concluye que la respuesta terapéutica fue mejor para la quinfamida y que el perfil de seguridad de ambos f rmacos es aceptable.