Dietary Curcumin Intake and Its Effects on the Transcriptome and Metabolome of Drosophila melanogaster.

Curcumin, a polyphenol derived from Curcuma longa, used as a dietary spice, has garnered attention for its therapeutic potential, including antioxidant, anti-inflammatory, and antimicrobial properties. Despite its known benefits, the precise mechanisms underlying curcumin's effects on consumers remain unclear. To address this gap, we employed the genetic model Drosophila melanogaster and leveraged two omics tools-transcriptomics and metabolomics. Our investigation revealed alterations in 1043 genes and 73 metabolites upon supplementing curcumin into the diet. Notably, we observed genetic modulation in pathways related to antioxidants, carbohydrates, and lipids, as well as genes associated with gustatory perception and reproductive processes. Metabolites implicated in carbohydrate metabolism, amino acid biosynthesis, and biomarkers linked to the prevention of neurodegenerative diseases such as schizophrenia, Alzheimer's, and aging were also identified. The study highlighted a strong correlation between the curcumin diet, antioxidant mechanisms, and amino acid metabolism. Conversely, a lower correlation was observed between carbohydrate metabolism and cholesterol biosynthesis. This research highlights the impact of curcumin on the diet, influencing perception, fertility, and molecular wellness. Furthermore, it directs future studies toward a more focused exploration of the specific effects of curcumin consumption.

Biliary Leaks: Multidisciplinary Approach to Diagnosis and Treatment.

Bile leaks arise from various causes such as trauma, complications after hepatobiliary surgery, and intrahepatic malignancies or their associated liver-directed treatments. Bile leaks can result in significant morbidity and mortality. Delayed diagnosis is not uncommon due to nonspecific manifestations; therefore, a high clinical suspicion is needed. A multidisciplinary approach for treatment of biliary leaks with prompt referral to tertiary care centers with experienced hepatobiliary surgeons, advanced endoscopists, and interventional radiologists is needed to address these challenging complications. Management of biliary leaks can range from conservative management to open surgical repair. Minimally invasive procedures play a crucial role in biliary leak treatment, and the interventional radiologist can help guide appropriate management on the basis of a clear understanding of the pathophysiology of biliary leaks and a current knowledge of the armamentarium of treatment options. In most cases, a simple diversion of bile to decompress the biliary system may prove effective. However, persistent and high-output biliary leaks require delineation of the source with tailored treatment options to control the leak. This may be done by additional diversions, occluding the source, reestablishing connections, or using a combination of therapies to bridge to more definitive surgical interventions. The authors describe the different treatment options and emphasize the role of interventional radiology. ©RSNA, 2024.

Woolly mutation with the Get02 locus overcomes the polygenic nature of trichome-based pest resistance in tomato.

Type-IV glandular trichomes, which only occur in the juvenile developmental phase of the cultivated tomato (Solanum lycopersicum), produce acylsugars that broadly protect against arthropod herbivory. Previously, we introgressed the capacity to retain type-IV trichomes in the adult phase from the wild tomato, Solanum galapagense, into the cultivated species cv. Micro-Tom (MT). The resulting MT-Galapagos enhanced trichome (MT-Get) introgression line contained 5 loci associated with enhancing the density of type-IV trichomes in adult plants. We genetically dissected MT-Get and obtained a subline containing only the locus on Chromosome 2 (MT-Get02). This genotype displayed about half the density of type-IV trichomes compared to the wild progenitor. However, when we stacked the gain-of-function allele of WOOLLY, which encodes a homeodomain leucine zipper IV transcription factor, Get02/Wo exhibited double the number of type-IV trichomes compared to S. galapagense. This discovery corroborates previous reports positioning WOOLLY as a master regulator of trichome development. Acylsugar levels in Get02/Wo were comparable to the wild progenitor, although the composition of acylsugar types differed, especially regarding fewer types with medium-length acyl chains. Agronomical parameters of Get02/Wo, including yield, were comparable to MT. Pest resistance assays showed enhanced protection against silverleaf whitefly (Bemisia tabaci), tobacco hornworm (Manduca sexta), and the fungus Septoria lycopersici. However, resistance levels did not reach those of the wild progenitor, suggesting the specificity of acylsugar types in the pest resistance mechanism. Our findings in trichome-mediated resistance advance the development of robust, naturally resistant tomato varieties, harnessing the potential of natural genetic variation. Moreover, by manipulating only 2 loci, we achieved exceptional results for a highly complex, polygenic trait, such as herbivory resistance in tomato.

Inhibiting tau-induced elevated nSMase2 activity and ceramides is therapeutic in an Alzheimer's disease mouse model.

BACKGROUND: Cognitive decline in Alzheimer's disease (AD) is associated with hyperphosphorylated tau (pTau) propagation between neurons along synaptically connected networks, in part via extracellular vesicles (EVs). EV biogenesis is triggered by ceramide enrichment at the plasma membrane from neutral sphingomyelinase2 (nSMase2)-mediated cleavage of sphingomyelin. We report, for the first time, that human tau expression elevates brain ceramides and nSMase2 activity. METHODS: To determine the therapeutic benefit of inhibiting this elevation, we evaluated PDDC, the first potent, selective, orally bioavailable, and brain-penetrable nSMase2 inhibitor in the transgenic PS19 AD mouse model. Additionally, we directly evaluated the effect of PDDC on tau propagation in a mouse model where an adeno-associated virus (AAV) encoding P301L/S320F double mutant human tau was stereotaxically-injected unilaterally into the hippocampus. The contralateral transfer of the double mutant human tau to the dentate gyrus was monitored. We examined ceramide levels, histopathological changes, and pTau content within EVs isolated from the mouse plasma. RESULTS: Similar to human AD, the PS19 mice exhibited increased brain ceramide levels and nSMase2 activity; both were completely normalized by PDDC treatment. The PS19 mice also exhibited elevated tau immunostaining, thinning of hippocampal neuronal cell layers, increased mossy fiber synaptophysin immunostaining, and glial activation, all of which were pathologic features of human AD. PDDC treatment reduced these changes. The plasma of PDDC-treated PS19 mice had reduced levels of neuronal- and microglial-derived EVs, the former carrying lower pTau levels, compared to untreated mice. In the tau propagation model, PDDC normalized the tau-induced increase in brain ceramides and significantly reduced the amount of tau propagation to the contralateral side. CONCLUSIONS: PDDC is a first-in-class therapeutic candidate that normalizes elevated brain ceramides and nSMase2 activity, leading to the slowing of tau spread in AD mice.

Drosophila melanogaster as a Translational Model System to Explore the Impact of Phytochemicals on Human Health.

Fruits, vegetables, and spices are natural sources of bioactive phytochemicals, such as polyphenols, carotenoids, flavonoids, curcuminoids, terpenoids, and capsaicinoids, possessing multiple health benefits and relatively low toxicity. These compounds found in the diet play a central role in organism development and fitness. Given the complexity of the whole-body response to dietary changes, invertebrate model organisms can be valuable tools to examine the interplay between genes, signaling pathways, and metabolism. Drosophila melanogaster, an invertebrate model with its extensively studied genome, has more than 70% gene homology to humans and has been used as a model system in biological studies for a long time. The notable advantages of Drosophila as a model system, such as their low maintenance cost, high reproductive rate, short generation time and lifespan, and the high similarity of metabolic pathways between Drosophila and mammals, have encouraged the use of Drosophila in the context of screening and evaluating the impact of phytochemicals present in the diet. Here, we review the benefits of Drosophila as a model system for use in the study of phytochemical ingestion and describe the previously reported effects of phytochemical consumption in Drosophila.

Inhibiting tau-induced elevated nSMase2 activity and ceramides is therapeutic in murine Alzheimer's disease.

Background: Cognitive decline in Alzheimer's disease (AD) is associated with prion-like tau propagation between neurons along synaptically connected networks, in part via extracellular vesicles (EV). EV biogenesis is triggered by ceramide enrichment at the plasma membrane from neutral sphingomyelinase2(nSMase2)-mediated cleavage of sphingomyelin. We report, for the first time, that tau expression triggers an elevation in brain ceramides and nSMase2 activity. Methods: To determine the therapeutic benefit of inhibiting this elevation, we evaluated the efficacy of PDDC, the first potent, selective, orally bioavailable, and brain-penetrable nSMase2 inhibitor, in the PS19 tau transgenic AD murine model. Changes in brain ceramide and sphingomyelin levels, Tau content, histopathology, and nSMase2 target engagement were monitored, as well as changes in the number of brain-derived EVs in plasma and their Tau content. Additionally, we evaluated the ability of PDDC to impede tau propagation in a murine model where an adeno-associated virus(AAV) encoding for P301L/S320F double mutant human tau was stereotaxically-injected unilaterally into the hippocampus and the contralateral transfer to the dentate gyrus was monitored. Results: Similar to human AD, PS19 mice exhibited increased brain ceramides and nSMase2 activity; both were completely normalized by PDDC treatment. PS19 mice exhibited elevated tau immunostaining, thinning of hippocampal neuronal cell layers, increased mossy fiber synaptophysin immunostaining, and glial activation, all pathologic features of human AD. PDDC treatment significantly attenuated these aberrant changes. Mouse plasma isolated from PDDC-treated PS19 mice exhibited reduced levels of neuron- and microglia-derived EVs, the former carrying lower phosphorylated Tau(pTau) levels, compared to untreated mice. In the AAV tau propagation model, PDDC normalized the tau-induced increase in brain ceramides and significantly decreased tau spreading to the contralateral side. Conclusions: PDDC is a first-in-class therapeutic candidate that normalizes elevated brain ceramides and nSMase2 activity leading to the slowing of tau spread in AD mice.

Flow Cytometry of Synaptoneurosomes (FCS) Reveals Increased Ribosomal S6 and Calcineurin Proteins in Activated Medial Prefrontal Cortex to Nucleus Accumbens Synapses.

Learning and behavior activate cue-specific patterns of sparsely distributed cells and synapses called ensembles that undergo memory-encoding engram alterations. While Fos is often used to label selectively activated cell bodies and identify neuronal ensembles, there is no comparable endogenous marker to label activated synapses and identify synaptic ensembles. For the purpose of identifying candidate synaptic activity markers, we optimized a flow cytometry of synaptoneurosome (FCS) procedure for assessing protein alterations in activated synapses from male and female rats. After injecting yellow fluorescent protein (YFP)-expressing adeno-associated virus into medial prefrontal cortex (mPFC) to label terminals in nucleus accumbens (NAc) of rats, we injected 20 mg/kg cocaine in a novel context (cocaine+novelty) to activate synapses, and prepared NAc synaptoneurosomes 0-60 min following injections. For FCS, we used commercially available antibodies to label presynaptic and postsynaptic markers synaptophysin and PSD-95 as well as candidate markers of synaptic activity [activity-regulated cytoskeleton protein (Arc), CaMKII and phospho-CaMKII, ribosomal protein S6 (S6) and phospho-S6, and calcineurin and phospho-calcineurin] in YFP-labeled synaptoneurosomes. Cocaine+novelty increased the percentage of S6-positive synaptoneurosomes at 5-60 min and calcineurin-positive synaptoneurosomes at 5-10 min. Electron microscopy verified that S6 and calcineurin levels in synaptoneurosomes were increased 10 min after cocaine+novelty. Pretreatment with the anesthetic chloral hydrate blocked cocaine+novelty-induced S6 and calcineurin increases in synaptoneurosomes, and novel context exposure alone (without cocaine) increased S6, both of which indicate that these increases were due to neural activity per se. Overall, FCS can be used to study protein alterations in activated synapses coming from specifically labeled mPFC projections to NAc.SIGNIFICANCE STATEMENT Memories are formed during learning and are stored in the brain by long-lasting molecular and cellular alterations called engrams formed within specific patterns of cue-activated neurons called neuronal ensembles. While Fos has been used to identify activated ensemble neurons and the engrams within them, we have not had a similar marker for activated synapses that can be used to identify synaptic engrams. Here we developed a procedure for high-throughput in-line analysis of flow cytometry of synaptoneurosome (FCS) and found that ribosomal S6 protein and calcineurin were increased in activated mPFC-NAc synapses. FCS can be used to study protein alterations in activated synapses within specifically labeled circuits.

Application of Comprehensive Genomic Profiling-Based Next-Generation Sequencing Assay to Improve Cancer Care in a Developing Country.

PURPOSE: Identifying actionable oncogenic mutations have changed the therapeutic landscape in different types of tumors. This study investigated the utility of comprehensive genomic profiling (CGP), a hybrid capture-based next-generation sequencing (NGS) assay, in clinical practice in a developing country. METHODS: In this retrospective cohort study, CGP was performed on clinical samples from patients with different solid tumors recruited between December 2016 and November 2020, using hybrid capture-based genomic profiling, at the individual treating physicians' request in the clinical care for therapy decisions. Kaplan-Meier survival curves were estimated to characterize the time-to-event variables. RESULTS: Patients median age was 61 years (range: 14-87 years), and 64.7% were female. The most common histological diagnosis was lung primary tumors, with 90 patients corresponding to 52.9% of the samples (95% CI 45.4-60.4%). Actionable mutations with FDA-approved medications for specific alterations correspondent to tumoral histology were identified in 58 cases (46.4%), whereas other alterations were detected in 47 different samples (37.6%). The median overall survival was 15.5 months (95% CI 11.7 months-NR). Patients who were subjected to genomic evaluation at diagnosis reached a median overall survival of 18.3 months (95% CI 14.9 months-NR) compared to 14.1 months (95% CI 11.1 months-NR) in patients who obtained genomic evaluation after tumor progression and during standard treatment (P = .7). CONCLUSION: CGP of different types of tumors identifies clinically relevant genomic alterations that have benefited from targeted therapy and improve cancer care in a developing country to guide personalized treatment to beneficial outcomes of cancer patients.

Simultaneous hernia repair following robotic-assisted radical prostatectomy is safe with low rates of mesh-related complications.

Robotic-assisted radical prostatectomy (RARP) is the gold-standard treatment for localized prostate cancer in the USA. However, performing RARP along with a concomitant hernia repair with mesh is debatable because of the lack of well-designed studies on this subject. Some argue that this procedure may result in mesh infections and increased complications due to possible contact of mesh and urine. This study reports our experience with simultaneous hernia repair with mesh placement in patients who underwent radical prostatectomy. We compared 244 patients (from August 2008 to August 2021) who underwent RARP with concomitant hernia repair (inguinal, umbilical, and ventral) and mesh placement with 244 patients from 6275 RARPs operated on the same period without hernia repair. We performed a propensity score matching analysis using preoperative covariates and compared the perioperative outcomes, and complications in 90 days after surgery. Median follow-up was 36.6 months for the control and hernia groups respectively (p = 0.81). Eighty-three patients had unilateral inguinal hernia repair, 22 had a bilateral inguinal hernia repair, 95 had a ventral hernia repair, and 44 had an umbilical hernia repair. The median operative time was 112 min for the control group and 160 min for hernia groups (p < 0.001). We did not find statistically significant differences in minor complications (Clavien ≤ 2). Although the postoperative readmissions in 90-days were higher in the hernia group (18 vs. 7, p = 0.038), none was associated with mesh complications. Limitation includes the retrospective design of the study. Robotic-assisted radical prostatectomy with simultaneous hernia repair and mesh placement is safe and does not increase complications related to the mesh. In our experience, hernia repair increases the operative time, usually due to initial peritoneal flap dissection and final suturing. Therefore, we believe that hernia repair with mesh during RARP is safe and spares patients the additional impacts of an additional surgical procedure.

Síndrome de Anton-Babinsky / Anton-Babinski Syndrome

Introducción: El síndrome de Anton-Babinsky es un trastorno neuropsiquiátrico poco frecuente, que se manifiesta por anosognosia y ceguera cortical, debido a lesiones en las áreas visuales asociativas de la corteza occipital sin presentar afectación en la vía visual. En adultos mayores sus manifestaciones clínicas suelen ser atípicas y la valoración geriátrica integral permite orientar el diagnóstico, que se puede asociar con síndromes geriátricos. Objetivo: Describir las manifestaciones clínicas, síndromes geriátricos, paraclínicos y tratamiento de un paciente con Síndrome de Anton-Babinsky. Caso clínico: Paciente de 85 años, quien durante un postoperatorio inmediato de cirugía ocular (pterigión) presentó alteración fluctuante del estado de conciencia, alucinaciones visuales, disminución de la agudeza visual bilateral y anosognosia. La analítica sanguínea no reportó alteraciones y la tomografía computarizada de cráneo documentó isquemia occipital bilateral, se le diagnosticó síndrome de Anton-Babinsky. Conclusiones: El síndrome de Anton-Babinsky puede tener presentación atípica a través de síndromes geriátricos. La valoración geriátrica integral permite realizar un diagnóstico y manejo multicomponente oportuno con el objetivo de influir en el pronóstico tanto a corto como a largo plazo(AU)

Introduction: Anton-Babinski syndrome is a rare neuropsychiatric disorder, with a manifestation of anosognosia and cortical blindness, due to lesions in the associative visual areas of the occipital cortex without presenting visual pathway impairment. In elderly adults, its clinical manifestations are usually atypical and a comprehensive geriatric assessment allows to guide the diagnosis, which can be associated with geriatric syndromes. Objective: To describe the clinical manifestations, geriatric syndromes, paraclinical findings and treatment of a patient with Anton-Babinski syndrome. Clinical case: This is the case of an 85-year-old patient who, during the immediate postoperative period after ocular surgery (pterygium), presented a fluctuating alteration of consciousness, visual hallucinations, decreased bilateral visual acuity and anosognosia. Blood analysis reported no alterations and cranial computed tomography documented bilateral occipital ischemia; the patient was diagnosed with Anton-Babinski syndrome. Conclusions: Anton-Babinski syndrome may have an atypical presentation through geriatric syndromes. Comprehensive geriatric assessment allows for timely multicomponent diagnosis and management with the aim of influencing both short- and long-term prognosis(AU)

Creation of an Ex Vivo Renal Perfusion Model to Investigate Microwave Ablation.

This study hypothesized that an ex vivo renal perfusion model can create smaller microwave ablation (MWA) measurements during perfused states compared with nonperfused states across multiple device settings. Nine bovine kidneys, a fluoroscopic compatible perfusion model, and a commercially-available clinical MWA system were used to perform 72 ablations (36 perfused and 36 nonperfused) at 9 different device settings. Comparing perfused and nonperfused ablations at each device setting, significant differences in volume existed for 6 of 9 settings (P < .05). Collapsed across time settings, the ablation volumes by power were the following (perfused and nonperfused, P value): 60 W, 2.3 cm3 ± 1.0 and 7.2 cm3 ± 2.7, P < .001; 100 W, 5.4 cm3 ± 2.1 and 11.5 cm3 ± 5.6, P < .01; and 140 W, 11.2 cm3 ± 3.7 and 18.7 cm3 ± 6.3, P < .01. Applied power correlated with ablation volume: perfused, 0.021 cm3/W and R = 0.462, P = .004, and nonperfused, 0.029 cm3/W and R = 0.565, P < .001. These results support that an ex vivo perfused organ system can evaluate MWA systems and demonstrate heat sink perfusion effects of decreased ablation size.

Trombosis de seno venoso en paciente en puerperio mediato. Reporte de caso / Venous sinus thrombosis in a patient during the immediate puerperium. Case report

Resumen ANTECEDENTES: La trombosis del seno venoso representa el 1% de los eventos vasculares cerebrales; su incidencia es de 5 casos por cada millón de habitantes y su mortalidad es del 10%. Los senos sagital superior y venoso transversal son los más afectados. El embarazo es un factor de riesgo especial pues la trombosis se registra en el 0.01% de las gestaciones. CASO CLÍNICO: Paciente de 40 años, primigesta, con embarazo gemelar bicorial biamniótico de 33.6 semanas. Se ingresó al servicio de Urgencias debido al diagnóstico de preeclampsia con criterios de severidad, con presión arterial de 160-100 mmHg y transaminasemia. Se le indicó tratamiento antihipertensivo y sulfato de magnesio intravenoso. Se decidió la finalización del embarazo por cesárea. Al cuarto día poscesárea tuvo disminución de la fuerza en ambos brazos, pérdida del tono muscular en los miembros pélvicos, cefalea holocraneana y alteración del estado de alerta (Glasgow de 14). Mediante resonancia magnética se evidenció la oclusión del seno longitudinal superior e isquemia en la región parieto occipital izquierda. Se le administraron anticoagulantes y analgésicos con los que evolucionó adecuadamente; se dio de alta sin complicaciones. CONCLUSIONES: La trombosis del seno venoso implica un reto cuando no se tiene una alta sospecha diagnóstica en pacientes con signos y síntomas neurológicos y, más aún, cuando se agregan factores de riesgo protrombóticos, como el embarazo y el puerperio. El diagnóstico oportuno brinda la oportunidad de iniciar el tratamiento adecuado y disminuir los síntomas y comorbilidades.

Abstract BACKGROUND: Venous sinus thrombosis accounts for 1% of cerebral vascular events; its incidence is 5 cases per million population and its mortality is 10%. The superior sagittal and transverse venous sinuses are the most affected. Pregnancy is a special risk factor since thrombosis is registered in 0.01% of pregnancies. CLINICAL CASE: A 40-year-old primigravida patient with a 33.6 week biamniotic twin pregnancy. She was admitted to the Emergency Department due to the diagnosis of preeclampsia with severity criteria, with blood pressure of 160-100 mmHg and transaminasemia. She was prescribed antihypertensive treatment and intravenous magnesium sulfate. It was decided to terminate the pregnancy by cesarean section. On the fourth post-cesarean day she had decreased strength in both arms, loss of muscle tone in the pelvic limbs, holocranial headache and altered alertness (Glasgow of 14). Magnetic resonance imaging showed occlusion of the superior longitudinal sinus and ischemia in the left parietooccipital region. He was administered anticoagulants and analgesics with which he evolved adequately; he was discharged without complications. CONCLUSIONS: Venous sinus thrombosis implies a challenge when there is no high diagnostic suspicion in patients with neurological signs and symptoms and, even more so, when prothrombotic risk factors are added, such as pregnancy and puerperium. Timely diagnosis provides the opportunity to initiate appropriate treatment and reduce symptoms and comorbidities.

Cerebral amyloid angiopathy in an octogenarian

Cerebral amyloid angiopathy presents with lobar intracerebral hemorrhage, dementia or tran sient neurological events. It occurs due to P-amyloid deposits in the media and adventitia of small arteries, leptomeningeal capillaries and the cerebral cortex. Its prevalence increases with age, and its association with cognitive impairment is well established. We present the case of an 80-year-old previously independent woman with no disabilities or cognitive impairment, and a history of well-controlled systemic arterial hypertension who consulted due to a de novo seizure and focal neurological deficits. On imaging follow up, two bilateral parietal-occipital macrohemorrhages were found, which occurred at two different times during the development of the clinical condition. These findings were attributed to cerebral amyloid angiopathy, and the patient ultimately died during this hospitalization. In this case presentation, we discuss the diagnostic criteria for considering the presence of cerebral amyloid angiopathy, its prognosis, and the reason it led to death. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2567).

La angiopatía amiloide cerebral se presenta con hemorragia intracerebral lobular, demencia o eventos neurológicos transitorios. Ocurre como resultado del depósito de (3-amiloide en la media y la adventicia de las arterias pequeñas, los capilares de las leptomeninges y la corteza cerebral. Su prevalencia aumenta con la edad y su asociación con deterioro cognitivo está bien establecido. Se presenta el caso de una mujer de 80 años, previamente independiente, sin discapacidad ni deterioro cognitivo, con antecedente de hipertensión arterial sistémica bien controlada, quien consultó por episodio convulsivo de novo y focalización neurológica. Durante el seguimiento imagenológico se documentó presencia de dos macrohemorragias parietooccipitales bilaterales, acontecidas en dos momentos diferentes durante la evolución del cuadro clínico, hallazgos que fueron atribuidos a la presencia de angiopatía amiloide cerebral, finalmente la paciente falleció durante dicha hospitaliza ción. En esta presentación de caso se discuten los criterios diagnósticos para considerar la presencia de angiopatía amiloide cerebral, el pronóstico y la razón que llevó a la muerte. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2567).

Resultados de la cirugía bariátrica en pacientes obesos internados en el Hospital Nacional de Itauguá / Results of bariaric surgery in obese patients admitted to Itauguá National Hospital

Introducción: La obesidad es la segunda causa de muerte susceptible de prevención. El tratamiento quirúrgico es el único tratamiento eficaz y demostrado para pacientes con obesidad grave (índice de masa corporal > 40 kg/m²). Las operaciones bariátricas prolongan la supervivencia y corrigen las enfermedades asociadas con la obesidad grave. Objetivos: Caracterizar los resultados de la cirugía bariátrica en pacientes obesos internados en el Hospital Nacional de Itauguá de marzo a diciembre del año 2019. Materiales y métodos: Estudio observacional, descriptivo de corte transversal, retrospectivo con muestreo no probabilístico a conveniencia. Se incluyeron pacientes de ambos sexos, mayores a 16 años con obesidad sometidos a cirugía bariátrica en el Servicio de Cirugía General del Hospital Nacional de Itauguá. Resultados: Se incluyeron a 24 pacientes, cuyo promedio de peso fue de 117,5 kg y un promedio del IMC de 43,5. El 67% presentó obesidad grado III y el 70% un ASA III. La técnica quirúrgica empleada con mayor frecuencia fue gastrectomía vertical en manga laparoscópica. El promedio de pérdida de exceso de peso post quirúrgico a los 12 meses fue de 56,4 kg. La estancia hospitalaria post quirúrgico en promedio fue de 48 horas. En el 96% de los casos no se presentaron complicaciones. Conclusión: El resultado de nuestro estudio sugiere que la cirugía bariátrica ha demostrado ser una alternativa con excelentes resultados para el tratamiento de la obesidad, mejorando así no solo patologías clínicas crónicas sino también la calidad de vida del paciente.

Introduction: Obesity is the second cause of death susceptible to prevention. Surgical treatment is the only effective and proven treatment for severely obese patients (body mass index > 40 kg/m²). Bariatric operations prolong survival and correct diseases associated with severe obesity. Objectives: To determine the short-term and long-term results of bariatric surgery in obese patients admitted to the National Hospital of Itauguá from March to December 2019. Materials and methods: Observational, descriptive cross-sectional, retrospective study with non-probabilistic sampling at convenience. We included patients of both sexes, over 16 years of age with obesity who underwent bariatric surgery and were admitted to the General Surgery Service of the Hospital Nacional de Itauguá in 2019. Results: Twenty-four patients were followed up in the study, with an average weight of 117.5 kg and a mean BMI of 43.5. 67% presented with grade III obesity and 70% with ASA III. The most frequently used surgical technique was vertical gastrectomy in the laparoscopic sleeve. The average postoperative weight loss at 12 months was 56.4 kg. The average postoperative hospital stay was 48 hours. There were no complications in 96% of cases. Conclusion: The result of our study suggests that bariatric surgery has proven to be an alternative with excellent results for the treatment of morbid obesity, , thus improving not only chronic clinical pathologies but also the quality of life of the patient with increased life expectancy.

Esplenectomía laparoscópica en pacientes adultos con enfermedades hematológicas en el servicio de cirugía general del Hospital Nacional de Itauguá

Introducción: La esplenectomía es una opción terapéutica para una variedad de patologías hematológicas. La cirugía laparoscópica ha tomado ventaja y, actualmente, se ha convertido en el abordaje estándar en pacientes sometidos a esplenectomía de forma electiva para patologías hematológicas. Objetivo: Evaluar las indicaciones, condiciones generales y complicaciones intraoperatorias más frecuentes en pacientes adultos con enfermedades hematológicas, sometidos a esplenectomía laparoscópica. Materiales y métodos: Estudio descriptivo, retrospectivo de corte longitudinal con muestreo no probabilístico de casos consecutivos. Se realizó revisión de expedientes clínicos de todos los pacientes con patología esplénica que fueron sometidos a esplenectomía laparoscópica con intención curative. Resultados: El estudio comprendió a 10 pacientes con una media de edad de 47 años. El tiempo de operación fue de 215 ±60 minutos; el ASA score de 3; los días de internación fueron de 14 días en promedio y la pérdida de sangre estimada en mililitros fue de 213 ±366. Siete pacientes requirieron cirugía laparoscópica, cuatro de ellos finalizaron sin complicaciones, mientras que tres requirieron conversión a cirugía convencional. Se identificó bazo accesorio en 1 paciente. Las indicaciones para la esplenectomía han sido púrpura trombocitopénica idiopática; síndromes linfoproliferativos; síndrome de Felty; anemia hemolítica autoimmune y anemia hemolítica no autoimmune. Discusión: La esplenectomía continúa siendo un procedimiento útil para numerosas patologías hematológicas. Se debe tener en cuenta la necesidad de realizar las vacunaciones y profilaxis antibiótica correspondientes, además de contar con el equipo quirúrgico entrenado en técnicas convencionales como en laparoscópicas.

Introduction: muscle strength may decrease in patients with chronic kidney failure due to various causes. Objective: to determine the anthropometric and clinical variables and muscle strength in adult patients with chronic kidney failure. Methodology: an observational, descriptive, cross-sectional design was applied. Men and women, older than 17 years, with chronic kidney failure who attended the National Hospital (Itauguá) and Military Hospital (Asunción), Paraguay, between April and November 2021 were included. Anthropometric, clinical and laboratory variables were determined. Muscle strength was measured with a hand dynamometer. A group of healthy young subjects was used for the comparison of muscle strength. Descriptive statistics were applied with the statistical program Epi Info 7 ™. The research was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: 119 subjects entered the study, being 62 (52%) males with a mean age 56 ± 15 years and 57 (48%) females, with a mean age 51 ± 16 years. The mean creatinine clearance was 16.4 ± 17.9 mL / min. The most common etiology was the association of arterial hypertension and diabetes mellitus (45%). The healthy group included 99 women with a mean age 25 ± 5 years and 51 men with a mean age 26 ± 5 years. When comparing strength between patients and healthy subjects, 66.4% decreased muscle strength was found among patients with chronic renal failure. Conclusion: muscle strength is decreased in 66.4% of chronic kidney failure patients. Early detection and early treatment of muscle strength deficit is recommended in this group of patients.

Women's perspectives on the acceptability and feasibility of an HPV screen-and-treat approach to cervical cancer prevention in Iquitos, Peru: a qualitative study.

BACKGROUND: The objective of this study was to explore women's experiences of a screen-and-treat approach with ablative therapy (referred to by the Spanish acronym TVT-TA) as a method of treatment following a positive HPV test in Iquitos, Peru. METHODS: A total of 111 in-depth interviews were conducted with 47 HPV positive women who attended the TVT-TA procedure at a primary-level healthcare facility. Interviews were conducted immediately before, immediately after, and six-weeks after TVT-TA. RESULTS: Most interviewed women reported experiencing moderate pain during ablative therapy and minimal pain immediately after and six weeks after ablative therapy. Women also stated that the pain was less intense than they had expected. The most common physical after-effects of treatment were bleeding and vaginal odor. Women experienced oscillating emotions with fear upon receiving a positive HPV result, calming after hearing about ablative therapy treatment, worry about pain from the treatment itself, relaxation with counseling about the procedure, and relief following treatment. CONCLUSIONS: Nearly all participants emphasized that they were pleased with the TVT-TA process even if they had experienced pain during TVT-TA, recommended that TVT-TA be expanded and available to more women, and stated that TVT-TA was faster and easier than expected. This study found that TVT-TA is a feasible and acceptable means of treating HPV according to the women receiving the treatment.

Flexible Ureteroscopy as a Major Ambulatory Surgery Procedure. Single Center Experience and Analysis of Variables Related to Hospital Readmission.

OBJECTIVE: To assess our experience in flexible ureteroscopy (fURS) in major ambulatory surgery (MAS) and to detect variables related to unplanned medical assistance after surgery. MATERIAL & METHODS: We conducted a retrospective study among patients with renal stones undergoing a fURS from 2014 to 2019 in MAS at our hospital. VARIABLES: Age, gender, ASA physical status, type of anesthetic technique performed, stone characteristics, influence of double J stent before or after surgery, and postoperative complications according to the Clavien-Dindo modified classification. We evaluated variables related to hospital readmission or visit to the emergency room after surgery. RESULTS: A total of 222 consecutive fURS for stone disease were performed in MAS. Patients' average age was 52.9 ± 13.91 years old. The mean operating time was 57.86 ± 21.11 minutes. The mean stone size was 1.92 ± 1.43 with a diameter of 10.01 ± 4.24 mm. 47.3% of patients had a double J stent before fURS, and in 35.14% of cases, a stent was placed after surgery. 7.65% of patients required unplanned hospitalization. 14.86% of patients presented to the emergency room in the following month after surgery. Among them, one-third consulted for symptoms related to the double J. Patients who carried a double J stent before the fURS had 64% less risk of visiting the emergency department in the following month after surgery [OR = 0,363; IC95% (0.153-0.798)]. All other variables (age, gender, operating time...) did not modify the risk of unplanned medical assistance. CONCLUSION: The low complication rate following flexible ureteroscopy allows its performance as an ambulatory surgery. Patients who carry double J stent before the procedure have less risk of requiring unplanned medical assistance after the surgery.

Comparison of Longitudinal Skeletal Thigh Muscle Findings With Magnetic Resonance Imaging in Patients With Peripheral Artery Disease With-Versus-Without Diabetes Mellitus.

The aim of this secondary analysis of ELIMIT (The Effect of Lipid Modification on Peripheral Artery Disease after Endovascular Intervention Trial) was to determine longitudinal changes over 24 months in skeletal thigh muscle volumes and individual muscle compartments in patients with peripheral artery disease (PAD) with and without diabetes. A total of 48 patients with available magnetic resonance imaging of the distal superficial femoral artery at baseline and 2 years were included in this analysis. Muscle volumes and superficial femoral artery wall, lumen, and total vessel volumes were quantified. Intrareader reproducibility of muscle tracings was assessed with the intraclass correlation coefficient using a 2-way model. Baseline characteristics were similar between patients with PAD with and without diabetes, except for smoking history (p = 0.049), cholesterol levels (p <0.050), and calf walking pain (p = 0.049). Interobserver reproducibility of the muscle volume tracings was excellent for all muscle groups (all intraclass correlation coefficients >0.86, confidence interval 0.69 to 0.94). Total muscle and total leg volumes increased significantly between baseline and 24 months among patients with PAD without diabetes (31 ± 6.4 cm3 vs 32 ± 7.0 cm3, p <0.001; 18 ± 4.4 cm3 vs 19 ± 4.8 cm3, p = 0.045), whereas there was no change in patients with PAD and diabetes. Total muscle volume was inversely associated with age and body mass index in patients with PAD both with and without diabetes (p <0.05). In conclusion, magnetic resonance imaging-quantified thigh muscle volumes are highly reproducible and may be of interest in assessing PAD patients with and without diabetes.

Abordaje de hipertensión secundaria en adultos mayores: reporte de caso / Secondary hypertension approach in older adults: a case report

Resumen La hipertensión arterial secundaria es poco frecuente y está asociada con una causa que puede ser tratable, por lo cual su diagnóstico y tratamiento oportuno son importantes. La orientación diagnóstica se hace con base en los datos obtenidos en la anamnesis y examen físico del paciente buscando posibles etiologías. Se presenta el caso de un hombre de 63 años, con hipertensión arterial resistente, sin otra sintomatología ni antecedentes personales o familiares. Se realizaron estudios iniciales que documentaron hipopotasemia, lo que hizo sospechar hiperaldosteronismo primario, se solicitaron pruebas complementarias con aldosterona plasmática elevada, actividad de la renina plasmática baja, además con imagen diagnóstica por resonancia nuclear magnética que mostró nódulo suprarrenal derecho. Se considero llevar a adrenalectomía derecha, con reporte de patología compatible con adenoma cortical adrenal. Durante el seguimiento en atención primaria presento adecuado control en cifras de presión arterial con disminución del número de medicamentos antihipertensivos requeridos.

Abstract Secondary arterial hypertension is rare, it is associated with a cause that can be treatable, for which its diagnosis and treatment are not important.The diagnostic orientation is made based on the data obtained in the anamnesis and physical examination of the patient, looking for possible etiologies.We present the case of a 63-year-old man with resistant hypertension, without other symptoms or personal or family history. Initial studies were performed that documented hypokalemia, which led to the suspicion of primary hyperaldosteronism. Complementary tests were requested with high plasma aldosterone, low plasma renin activity, in addition to a diagnostic magnetic resonance imaging that showed an adrenal nodule. A right adrenalectomy was considered, with a report of pathology compatible with adrenal cortical adenoma.During the follow-up in primary care, patient presented adequate control in blood pressure figures with a decrease in the number of antihypertensive drugs required.