Allotriophagy And Allotriodipsia In Endocrinology.

Allotriophagy is defined as food cravings that are different from the expected or the norm. It gives clinical pointers to an underlying diagnosis. We propose a new term, allotriodipsia which suggests a preference for beverages that are different from the norm. Taken together, these two entities may point towards certain endocrinological abnormalities and iatrogenic sequelae. In this communication we highlight the clinical relevance of allotriophagy and allotriodipsia.

Geochemical composition and potential health risks of geophagic materials: an example from a rural area in the Limpopo Province of South Africa.

Geophagy is a common practice among rural population of the Fetakgomo Tubatse Local Municipality area in the Limpopo Province of South Africa. Although, the practice might be beneficial to the health of the consumers, its negative effects could overshadow the positive effects and might lead to detrimental health issues. The present work sought to investigate the geochemical composition as well as pH and organic matter (OM) content of geophagic materials commonly consumed in the study area. Furthermore, assessment of the potential health risk of the materials on geophagic individuals was also considered. Twelve samples were collected in the study area and analysed by X-ray Fluorescence (XRF) and Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) for major and trace elements composition. The results showed higher concentrations of non-essential elements (e.g., As, Cr, Pb) than the proposed recommended daily standards intake, suggesting a potential health risk. The alkaline nature (pH 6.80 to 9.22) of the studied samples might affect the bioacessibility of some essential elements. Furthermore, the OM content (> 0.7%) observed in some of the studied samples may retain pathogenic micro-organisms detrimental to health. Although As and Cr presented a low bioaccessible fraction (< 16.0%), health risk assessment revealed that their concentrations represented a hazard (HQ > 1) and might induce non-carcinogenic health threats to geophagic individuals. Based on the geochemical analysis, pH and OM content as well as health risk assessment findings, the studied geophagic materials are not considered suitable for human consumption. The practice should therefore be discouraged amongst the population in the study area to avoid possible detrimental health issues.

Oxaliplatin-Induced Damage to the Gastric Innervation: Role in Nausea and Vomiting.

Nausea and vomiting are common gastrointestinal side effects of oxaliplatin chemotherapy used for the treatment of colorectal cancer. However, the mechanism underlying oxaliplatin-induced nausea and vomiting is unknown. The stomach is involved in the emetic reflex but no study investigated the effects of oxaliplatin treatment on the stomach. In this study, the in vivo effects of oxaliplatin treatment on eating behaviour, stomach content, intrinsic gastric neuronal population, extrinsic innervation to the stomach, levels of mucosal serotonin (5-hydroxytryptamine, 5-HT), and parasympathetic vagal efferent nerve activity were analysed. Chronic systemic oxaliplatin treatment in mice resulted in pica, indicated by increased kaolin consumption and a reduction in body weight. Oxaliplatin treatment significantly increased the stomach weight and content. The total number of myenteric and nitric oxide synthase-immunoreactive neurons as well as the density of sympathetic, parasympathetic, and sensory fibres in the stomach were decreased significantly with oxaliplatin treatment. Oxaliplatin treatment significantly increased the levels in mucosal 5-HT and the number of enterochromaffin-like cells. Chronic oxaliplatin treatment also caused a significant increase in the vagal efferent nerve activity. The findings of this study indicate that oxaliplatin exposure has adverse effects on multiple components of gastric innervation, which could be responsible for pica and gastric dysmotility.

In vitro release of aluminum from the geophagic clay "Chacco" in the Peruvian highlands: Chemical characterization and health risk assessment.

In the altiplano zone of Latin America, "Chacco" is one of the clays widely consumed as part of geophagy. The objectives of the study were to chemically characterize "Chacco", determine the zero charge point, evaluate the release of aluminum in vitro, perform the kinetic study and evaluate the health risk. The results by ICP-OES showed that the elements with the highest concentration were Al, Ba, Ca, Fe, K, Mg, Mn, Na, Si, Sr, Ti and Zn. ATR-FTIR analysis showed the presence of Si-O (693 and 990 cm-1), Al-O (790 cm-1), Al-Al-OH bending vibration (912 cm-1), Si-H bond stretching (2100 to 2500 cm-1) and free -OH groups (3629 cm-1). SEM-EDX results indicate that Al is one of the main constituents of "Chacco" (7.35 wt%). The pHzpc of "Chacco" was 6.83. In the dissolution profiles, the highest Al release occurred at pH 6.8 and in intestinal juice simulated with pseudo-second order dissolution kinetics. The EDIAl and EWIAl were 20.24 and 142.66 respectively, comparing EWIAl with the PTWI established by JECFA (2 mg/kg bw), it is concluded that the weekly intake of "Chacco" represents an appreciable health risk. There are no reports of the carcinogenic factor of Al, so TRAl was not calculated.

Pica caused by emetic drugs in laboratory rats with kaolin, gypsum, and lime as test substances.

Pica refers to eating nonfood substances. The pica behavior has been the focus of attention in physiological and pharmacological studies, because its consumption is a good marker of nausea in laboratory rats, which cannot vomit due to neuroanatomical reasons. Almost all pica studies with rats have used kaolin clay pellets as nonfood substances. The present study primarily aimed to explore an alternative (or more suitable) substance to kaolin for detection of nausea induced by emetic drugs. Two calcium compounds, gypsum and lime, were evaluated in this study. An injection of lithium chloride (LiCl) increased pica behavior not only in the rats given kaolin but also in the rats given gypsum, suggesting that gypsum consumption could be used as an indicator of nausea. However, its sensitivity was no greater than that of kaolin consumption. In addition, lime is not a useful marker for nausea because the size of pica was small in the LiCl-injected rats, and did not differ from the control in the cisplatin-injected rats. In short, the superiority of kaolin as a test substance for nausea could not be overturned. However, the fact that nauseous rats displayed pica behavior with gypsum and lime refutes the claim that aluminosilicate, the main component of kaolin, is the critical determinant of emetic-caused pica in laboratory rats.

Liujunanwei decoction attenuates cisplatin-induced nausea and vomiting in a Rat-Pica model partially mediated by modulating the gut micsrobiome.

Studies show that traditional Chinese medicine (TCM), such as Liujunanwei (LJAW) decoction, can play important roles in alleviating side effects of chemotherapy. The purpose of this study was to understand how LJAW can counter chemotherapy-induced emesis via alteration of gut microbiota. We evaluated the effect of LJAW on cisplatin (DDP)-induced nausea and vomiting using a rat-pica model. Rats react to emetic-producing stimuli with increased kaolin consumption, a phenomenon called pica. The rats were injected with cisplatin and then randomly assigned to the control (DDP), Ondansetron or LJAW. The intake of kaolin and chow diet as well as body weights were recorded every 24 hours. Fecal samples were collected prior to, after three and seven days of treatment. The expression of proteins was measured by western blot. The concentration of cytokines and serotonin was evaluated using ELISA assay kits. Kaolin consumption in rats induced by cisplatin was reduced by 16.5%, 22.5%, and 30.1% in the LJAW group compared to the DDP group at 24 hours, 48 hours and 72 hours, respectively (p>0.05). LJAW significantly increased the food intake of the rats (13.94 ± 4.73 g) during the first 24 hours as opposed to the DDP (9.23 ± 3.77 g) (p<0.05). 16S rRNA gene sequencing showed the abundance of Bacteroidetes increased in cisplatin treated rats. In addition, cisplatin injection caused an enrichment of Escherichia-Shigella and Enterococcus at the genus level. While, enrichment of Blautia and Lactobacillus was presented in LJAW treated rats. Serotonin decreased in LJAW treated intestine and medulla oblongata tissues. Further, the protein expression of tryptophan hydroxylase 1 (TPH1) a rate limiting enzyme of serotonin was inhibited in LJAW treated rat's jejunum compared with cisplatin only treated rats. In addition, LJAW downregulated chemotherapy induced elevated inflammation. The results of this study indicated that LJAW is capable of decreasing cisplatin-induced kaolin intake in rat-nausea model (pica), which might be mediated through gut microbiome-induced anti-inflammation and anti-serotonin synthesis functions.

Exploration of anatomical landmarks for performing an endoscopic transoral nasopharyngectomy.

BACKGROUND: Performing a nasopharyngectomy via a transoral approach has been reported; however, defining landmarks to facilitate this approach has not been addressed. This study aims to explore anatomical landmarks to aid in performing a nasopharyngectomy via the transoral corridor. METHODS: An endoscopic transoral nasopharyngectomy was performed on six cadaveric specimens (12 sides). Related anatomical landmarks were defined, and the strategy to preserve the parapharyngeal internal carotid artery (pICA) was explored. RESULTS: An endoscopic transoral nasopharyngectomy was successfully achieved in all 12 sides. Utilizing the pterygoid hamulus as a landmark, the cartilaginous ET and attachments could be adequately exposed. Identification of the pICA is a prerequisite prior to Eustachian tube (ET) transection. The sphenoidal spine and the petrotympanic fissure could be sufficiently revealed in all 12 sides, which aided in transection of the cartilaginous ET without pICA injury. The ET and the prevertebral contents could be adequately removed via the transoral corridor. CONCLUSION: The pterygoid hamulus, sphenoidal spine and petrotympanic fissure serve as reliable landmarks for performing a transoral nasopharyngectomy. Identification of the pICA is a prerequisite prior to transection of the ET to avoid pICA injury.

Localisation of the petrous internal carotid artery relative to the vidian canal on computed tomography: a case-control study evaluating the impact of petroclival chondrosarcoma.

BACKGROUND: The vidian canal (VC) is normally a reliable anatomical landmark for locating the petrous internal carotid artery (pICA). This study determined the influence of petroclival chondrosarcoma on the relationship between the VC and pICA. METHODS: Nine patients (3 males, 6 females; median age 49) with petroclival chondrosarcoma, and depiction of the pICA on contrast-enhanced CT, were retrospectively studied. CT-based measurements were performed by two observers, both in the presence of the petroclival chondrosarcoma (case) and on the contralateral control side. The antero-posterior (AP) and craniocaudal (CC) measurements from the posterior VC to the pICA, whether the pICA was in the trajectory of the VC, and the coronal relationship of the pICA anterior genu with the VC were recorded. RESULTS: Chondrosarcoma usually displaced the pICA anteriorly (8/9 cases) and superiorly (6/9 cases) relative to the normal side with mean AP and CC measurements of 3.9 mm v 7.2 mm (p = 0.054) and 4.4 mm v 1.4 mm (p = 0.061). The VC trajectory less frequently intersected the pICA cross-section in the presence of chondrosarcoma however it was in the line of the eroded dorsal VC in one case. The anterior genu of the pICA was displaced more laterally by chondrosarcoma but usually remained superior to the VC. CONCLUSION: Petroclival chondrosarcoma variably influences the anatomical relationship between the VC and the pICA, hence requiring an individualised approach. The pICA is usually anterosuperiorly displaced, and the anterior genu remains superior to the VC, however it may be located in the line of the canal.

Desiderosmia: a manifestation of iron deficiency in pregnancy.

A pregnant woman in her 20s presented with an excessive desire to smell a specific household cleaning product. She was found to have severe iron deficiency anaemia and her symptoms resolved following intravenous iron supplementation. She described symptoms of fatigue, shortness of breath and olfactory cravings. The specific scent could not be replicated with other smells and the woman had to significantly modify her lifestyle to accommodate the excessive desire. She had a similar experience during her prior pregnancy which resolved after the correction of severe iron deficiency anaemia. This unique symptom has been described as desiderosmia: iron deficiency manifesting as olfactory cravings. This underappreciated but useful symptom is defined as a separate entity to pica, as there is an absence of desire to ingest the product. Desiderosmia can harm mother and baby through inhalation of potentially harmful fumes; hence, women who describe this symptom should be assessed for iron deficiency anaemia.

Pica y traumatismo craneoencefálico en un paciente adolescente: recuperación <> con paliperidona / Pica and traumatic brain injury in an adolescent: complete improvement with paliperidone

Presentamos el caso clínico de un adolescente varón de 15 años derivado a Psiquiatría Infanto-Juvenil por realizar ingestas repetitivas de sustancias no nutritivas como gomas de borrar, escamas psoriásicas o incluso pintura de la pared. Entre sus antecedentes somáticos de interés, conviene destacar la Enfermedad de Kawasaki y psoriasis, además de haber sufrido un traumatismo craneoencefálico (TCE) tras lo cual presentó una exacerbación del cuadro. Tras el fracaso en el manejo conductual realizado por parte de su madre y teniendo en cuenta sus rasgos de personalidad caracterizados por una elevada suspicacia y desconfianza hacia los demás, se decide iniciar tratamiento con paliperidona oral produciéndose una rotunda mejoría clínica. Durante todo el seguimiento posterior hasta su mayoría de edad, se ha mantenido la desaparición de la pica. Presentamos el primer caso clínico publicado en la bibliografía actual de un adolescente con el diagnóstico de pica y un TCE previo y una adecuada respuesta a paliperidon

We present a case report of a 15-year-old male adolescent who was referred to our consultation of Children and Adolescent Psychiatry due to persistent eating of non-nutritive substances like rubber, psoriatic scale or wall paint. The patient had the previous diagnostic of Kawasaki Disease and psoriasis. In addition, he had suffered a traumatic brain injury, after which he presented an exacerbation of the clinic. After behaviour therapy failure realized by his mother and taking into account his personality features with high suspicion and distrust of others, he was prescribed paliperidone oral treatment and pica disappeared. During all subsequent follow-up until the age of majority, the disappearance of pica has been maintained. We describe the first case report in the current bibliography of an adolescent with the diagnosis of pica, a previous traumatic brain injury and a good response to oral paliperidone.

Drug repositioning of antipsychotic drugs for cisplatin-induced pica behavior in mice.

We aimed to clarify whether various antipsychotics ameliorate cisplatin-induced pica behavior in mice using a drug repositioning approach. Mice were administered cisplatin (12.5 mg/kg, i.p.) with or without olanzapine (1 mg/kg, i.p.), asenapine (4 mg/kg, i.p.), mirtazapine (5 mg/kg, i.p.) or standard three-drug antiemetics (granisetron [0.5 mg/kg, i.p.], fosaprepitant [25 mg/kg, i.p.], and dexamethasone [3 mg/kg, i.p.]). Kaolin, food, and water intake, and spontaneous motor activity on the day before and seven consecutive days after the cisplatin administration were measured using a telemetry system. At the primary endpoint, kaolin intake was significantly higher at day three in the cisplatin group than in the pre-treatment and saline groups ( p < 0.05). Additionally, kaolin intake was not significantly higher in cisplatin with olanzapine, asenapine, and mirtazapine groups for seven days than in the pre-treatment group. At the secondary endpoint, cisplatin decreased the food and water intake, and spontaneous motor activity in a time-dependent manner. Three antipsychotics failed to improve the cisplatin-induced decrease in food and water intake, and spontaneous motor activity. The findings suggest that prophylactic administration of antipsychotics besides olanzapine may improve cisplatin-induced nausea and vomiting in a delayed phase and de-escalate standard 3-drug antiemetics.

Administration of a Probiotic Mixture Ameliorates Cisplatin-Induced Mucositis and Pica by Regulating 5-HT in Rats.

Probiotic-based therapies have been shown to be beneficial for chemotherapy-induced mucositis. Previous research has demonstrated that a probiotic mixture (Bifidobacterium brevis, Lactobacillus acidophilus, Lactobacillus casei, and Streptococcus thermophilus) can ameliorate chemotherapy-induced mucositis and dysbiosis in rats, but the underlying mechanism has not been completely elucidated. We aimed to determine the inhibitory effects of the probiotic mixture on cisplatin-induced mucositis and pica and the underlying mechanism, focusing on the levels of 5-hydroxytryptamine (5-HT, serotonin) regulated by the gut microbiota. A rat model of mucositis and pica was established by daily intraperitoneal injection of cisplatin (6 mg/kg) for 3 days. In the probiotic+cisplatin group, predaily intragastric injection of the probiotic mixture (1 × 109 CFU/kg BW) was administrated for 1 week before cisplatin injection. This was then followed by further daily probiotic injections for 6 days. Histopathology, pro-/anti-inflammatory cytokines, oxidative status, and 5-HT levels were assessed on days 3 and 6. The structure of the gut microbiota was analyzed by 16S rRNA gene sequencing and quantitative PCR. Additionally, 5-HT levels in enterochromaffin (EC) cells (RIN-14B cell line) treated with cisplatin and/or various probiotic bacteria were also determined. The probiotic mixture significantly attenuated kaolin consumption, inflammation, oxidative stress, and the increase in 5-HT concentrations in rats with cisplatin-induced intestinal mucositis and pica. Cisplatin markedly increased the relative abundances of Enterobacteriaceae_other, Blautia, Clostridiaceae_other, and members of Clostridium clusters IV and XIVa. These levels were significantly restored by the probiotic mixture. Importantly, most of the genera increased by cisplatin were significantly positively correlated with colonic 5-HT. Furthermore, in vitro, the probiotic mixture had direct inhibitory effects on the 5-HT secretion by EC cells. The probiotic mixture protects against cisplatin-induced intestine injury, exhibiting both anti-inflammatory and antiemetic properties. These results were closely related to the reestablishment of intestinal microbiota ecology and normalization of the dysbiosis-driven 5-HT overproduction.

Administration of cyclophosphamide to rats induces pica and potentiates 5-hydroxytryptamine synthesis in the intestine without causing severe intestinal injury.

The effects of cyclophosphamide on 5-hydroxytryptamine (5-HT) synthesis in the intestinal tissue of rats were investigated. Rats received 120 mg/kg cyclophosphamide intraperitoneally as a single administration, and kaolin and food intake was measured by an automatic monitoring apparatus. Ileal tissues were collected at either 24 or 72 h after administration. Cyclophosphamide caused a significant increase in kaolin intake at the acute and the delayed phases and was associated with a decrease in food intake, and body weight. Cyclophosphamide had no significant effect on intestinal mucosal morphology, or inducible nitric oxide synthase and cyclooxygenase-2 expression in the intestine. Cyclophosphamide significantly increased tryptophan hydroxylase 1 (TPH1) mRNA expression, number of anti-TPH antibody-positive cells, and 5-HT content in the intestine. Cyclophosphamide also significantly increased the expression of Tac1 mRNA, encoding preprotachykinin-1, which is a preprotein of substance P, and the number of anti-substance P antibody-positive cells in the intestine. Cyclophosphamide significantly increased Lgr5, Bmi1, and Atoh1 mRNA levels, which are markers for the proliferation and differentiation of stem cells. This study demonstrated that cyclophosphamide induced pica in rats, and potentiated 5-HT synthesis associated with hyperplasia of substance P-containing enterochromaffin cells without causing severe intestinal injury.

Forsythiae Fructus aqueous extract attenuates cisplatin-induced kaolin consumption (pica) by inhibiting NLRP3 inflammasome activation in rats.

The present study was conducted to evaluate the effect of Forsythiae Fructus aqueous extract (FAE) against cisplatin-induced emesis and to explore the antiemetic mechanism of FAE by focusing on NLRP3 inflammasome activation in a rat pica model. Our results showed that FAE significantly ameliorated cisplatin-induced acute and delayed pica in rats. Moreover, FAE improved the gastrointestinal histopathological injury and reduced the levels of serum ROS, IL-1ß, and IL-18 in cisplatin-treated rats. In addition, the expressions of NLRP3, ASC, caspase-1, and IL-1ß and the colocalization of the NLRP3 with ASC or caspase-1 in rat gastric antrum and ileum were also suppressed by FAE. Taken together, our findings indicate that FAE has a therapeutic effect against CINV, which may be related to its inhibition of the activation of NLRP3 inflammasome.

Geochemical and mineralogical composition of geophagic materials from Baringo town, Kenyan Rift Valley and their possible health effects on the consumers.

Consumption of geophagic materials can be detrimental to human health. These materials, which are harvested from the natural environment, can contain high concentrations of potentially harmful elements and minerals. In this study, mineralogical and geochemical investigation of geophagic rock materials consumed by the local population in Baringo town, in Kenya, was conducted to assess its possible health effects. Twelve representative samples were purchased from an open market in Baringo town for this investigation. Optical and scanning electron microscope as well as X-ray diffractometer was used to determine the mineralogy as well as the morphology of the minerals present in the studied samples. The material is composed of about 10 to 20% coarse to very coarse (0.38-3.00 mm) and semi-rounded to angular crystals of quartz, feldspars, and amphiboles, together with lithic fragments occurring in a fine-grained matrix. X-ray fluorescence and inductively coupled plasma mass spectrometry were used to determine the major and trace elements composition, respectively. The analyses show that elements such as Si, Fe, Mn, Al, Hg, Cr, Cd, and Pb are particularly above their recommended daily allowances. This study assumes 100% bioavailability of elements in the geophagic materials, in the absence of a bioaccessibility test. Therefore, the consumption of some of the revealed elements, based on this assumption, can be detrimental due to possible short- and/or long-term health effects. From a mineralogical point of view, the presence of feldspar and quartz with Moh's hardness of 6 and 7, respectively, and their coarse and angular morphology may cause damage to the dental enamel and the gastrointestinal tract. From a geochemical point of view, the high concentrations of the revealed chemical elements can have various health effects including, but not limited to neurotoxic effects, which are critical in prenatal exposure, neurodegenerative diseases, and cancer amongst other serious diseases.

Experiencia de la plastia laparoscópica de uréter retrocavo en el Hospital General de México Dr. Eduardo Liceaga.

INTRODUCCIÓN: El uréter retrocavo es una anomalía congénita rara que requiere manejo quirúrgico. OBJETIVO: Reportar los resultados en el manejo laparoscópico para uréter retrocavo y hacer una revisión bibliográfica. MÉTODO: Estudio retrospectivo, descriptivo, transversal, en pacientes con diagnóstico de uréter retrocavo que fueron sometidos a plastia laparoscópica de uréter retrocavo. RESULTADOS: Cuatro pacientes sometidos a plastia laparoscópica por diagnóstico de uréter retrocavo, 1 hombre y 3 mujeres, con una media de edad de 40.7 años. La media del tiempo operatorio fue de 138.2 minutos. La pérdida de sangre cuantificada transoperatoria media fue de 23.7 ml. Ningún paciente presentó complicaciones transoperatorias ni posoperatorias. Los pacientes permanecieron hospitalizados hasta su egreso una media de 2.5 días. Todos los pacientes presentaron mejoría de su sintomatología. CONCLUSIONES: El uréter retrocavo es una condición rara y aún no existe un consenso sobre su diagnóstico, tratamiento y seguimiento. El manejo quirúrgico laparoscópico es una opción para el tratamiento de estos pacientes. INTRODUCTION: The retrocave ureter is a rare congenital anomaly that requires surgical management. OBJECTIVE: Report the results in laparoscopic management for retrocave ureter and literature review. METHOD: Retrospective, descriptive, cross-sectional study in patients with a diagnosis of retrocave ureter who were sometimes a laparoscopic retrocave ureter. RESULTS: Four patients sometimes underwent laparoscopic plasty for diagnosis of retrocave ureter, 1 man and 3 women, with a mean age of 40.7 years. The mean operative time was 138.2 minutes. The mean intraoperative quantified blood loss was 23.7 ml. No patient presented transoperative or postoperative complications. The patients remained hospitalized until their progress with an average of 2.5 days. All patients visualize improvement in their symptoms. CONCLUSION: The retrocave ureter is a rare condition and there is still no consensus on its diagnosis, treatment and follow-up. Laparoscopic surgical management is an option for the treatment of these patients.

Complicaciones de la histerectomía total laparoscópica en pacientes de un hospital de alta especialidad.

OBJETIVO: Describir las complicaciones transoperatorias y posoperatorias en pacientes operadas de histerectomía total laparoscópica. MÉTODO: Serie de casos del servicio de ginecología de la Unidad Médica de Alta Especialidad Hospital de Gineco-Obstetricia No. 3 del Centro Médico Nacional La Raza, del Instituto Mexicano del Seguro Social, de las pacientes sometidas a histerectomía total laparoscópica de diciembre de 2015 a diciembre de 2018. Se documentaron el peso uterino, el índice de masa corporal, la edad, la comorbilidad, el uso de dióxido de carbono y las complicaciones. Se usaron frecuencias, proporciones, medidas de tendencia central y dispersión. RESULTADOS: Se reportan 79 pacientes de 44.2 ± 7.5 años, tiempo de cirugía de 104.3 ± 32.7 minutos y promedio de sangrado 102.8 ± 62.3 ml. Presentaron complicaciones transoperatorias seis (7.6%): dos (2.5%) lesión vesical, una (1.3%) lesión intestinal, una (1.3%) hemorragia de muñón y dos (2.5%) más conversión a laparotomía exploradora (una por tamaño uterino > 14 cm y otra por hallazgo de tumor ovárico de aspecto maligno). Siete pacientes (8.8%) tuvieron complicaciones posoperatorias: cuatro (5.1%) fueron reintervenidas (tres por hemorragia y una por dehiscencia de cúpula vaginal) y tres (3.7%) tuvieron colección vaginal. CONCLUSIONES: La tasa de complicaciones perioperatorias en esta serie coincide con la reportada en otros estudios. El tiempo quirúrgico y el sangrado fueron ligeramente menores, pese al poco tiempo de madurez del programa. OBJECTIVE: Describe the intraoperative and postoperative complications in patients undergoing total laparoscopic hysterectomy (TLH). METHOD: Cases series carried out in the gynecology service of Hospital de Gineco-Obstetricia No. 3, Centro Medico Nacional La Raza, Instituto Mexicano del Seguro Social, of all patients undergoing total laparoscopic hysterectomy from December 2015 to December 2018. Uterine weight, body mass index, age, comorbidities, CO2 use, and complications were documented. Frequencies, proportions, central tendency and dispersion measures were used. RESULTS: 79 patients are reported. Mean age was 44.2 ± 7.5 years. Surgery time was 104.3 ± 32.7 minutes, and bleeding 102.8 ± 62.3 mL. Six (7.6%) had intraoperative complications: two (2.5%) bladder injury, one (1.3%) bowel injury, one (1.3%) stump hemorrhage, and two (2.6%) where converted to exploratory laparotomy: one for uterine size > 14 cm, and one because malignant ovarian tumor was suspected. Seven patients (8.8%) had postoperative complications: four (5.1%) were re operated: 3 due to hemorrhage and 1 due to vaginal dome dehiscence; three (3.7%) had vaginal collection. CONCLUSIONS: The rate of perioperative complications reported in this series coincides with that reported in other studies. Surgery time and bleeding were slightly minors regardless of program's youth.

Geophagia and risk of squamous cell esophageal cancer in the African esophageal cancer corridor: Findings from the ESCCAPE multicountry case-control studies.

Geophagia, the intentional practice of consuming soil, occurs across the African esophageal cancer corridor, particularly during pregnancy. We investigated whether this practice is linked to endemic esophageal squamous cell carcinoma (ESCC) in this region. We conducted ESCC case-control studies in Tanzania, Malawi and Kenya. Cases were patients with incident histologically/clinically confirmed ESCC and controls were hospital patients/visitors without digestive diseases. Participants were asked if they had ever eaten soil (never/regularly/pregnancy-only). Odds ratios (OR) are adjusted for sex, age, tobacco, alcohol, country, religion and marital status. Overall, 934 cases (Malawi 535, Tanzania 304 and Kenya females 95) and 995 controls provided geophagia information. Among controls, ever-geophagia was common in women (Malawi 49%, Kenya 43% and Tanzania 29%) but not in men (10% Malawi, <1% Tanzania). In women, ESCC ORs were 1.25 (95% CI: 0.70, 2.22) for regular versus never geophagia and 0.88 (95% CI: 0.64, 1.22) for pregnancy-only versus never. Findings were stronger based on comparisons of cases with hospital visitor controls and were null using hospital patients as controls. In conclusion, geophagia is too rare to contribute to the male ESCC burden in Africa. In women, the practice is common but we did not find consistent evidence of a link to ESCC. The study cannot rule out selection bias masking modest effects. Physical effects of geophagia do not appear to have a large impact on overall ESCC risk. Research with improved constituent-based geophagia exposure assessment is needed.