A short anogenital distance on MRI is a marker of endometriosis.

STUDY QUESTION: Could the anogenital distance (AGD) as assessed by MRI (MRI-AGD) be a diagnostic tool for endometriosis? SUMMARY ANSWER: A short MRI-AGD is a strong diagnostic marker of endometriosis. WHAT IS KNOWN ALREADY: A short clinically assessed AGD (C-AGD) is associated with the presence of endometriosis. STUDY DESIGN SIZE DURATION: This study is a re-analysis of previously published data from a case-control study. PARTICIPANTS/MATERIALS SETTING METHODS: Women undergoing pelvic surgery from January 2018 to June 2019 and who had a preoperative pelvic MRI were included. C-AGD was measured at the beginning of the surgery by a different operator who was unaware of the endometriosis status. MRI-AGD was measured retrospectively by a senior radiologist who was blinded to the final diagnosis. Two measurements were made: from the posterior wall of the clitoris to the anterior edge of the anal canal (MRI-AGD-AC), and from the posterior wall of the vagina to the anterior edge of the anal canal (MRI-AGD-AF). MAIN RESULTS AND THE ROLE OF CHANCE: The study compared MRI-AGD of 67 women with endometriosis to 31 without endometriosis (controls). Average MRI-AGD-AF measurements were 13.3 mm (±3.9) and 21.2 mm (±5.4) in the endometriosis and non-endometriosis groups, respectively (P < 10-5). Average MRI-AGD-AC measurements were 40.4 mm (±7.3) and 51.1 mm (±8.6) for the endometriosis and non-endometriosis groups, respectively (P < 10-5). There was no difference of MRI-AGD in women with and without endometrioma (P = 0.21), or digestive involvement (P = 0.26). Moreover, MRI-AGD values were independent of the revised score of the American Society of Reproductive Medicine and the Enzian score. The diagnosis of endometriosis was negatively associated with both the MRI-AGD-AF (ß = -7.79, 95% CI (-9.88; -5.71), P < 0.001) and MRI-AGD-AC (ß = -9.51 mm, 95% CI (-12.7; 6.24), P < 0.001) in multivariable analysis. Age (ß = +0.31 mm, 95% CI (0.09; 0.53), P = 0.006) and BMI (ß = +0.44 mm, 95% CI (0.17; 0.72), P = 0.001) were positively associated with the MRI-AGD-AC measurements in multivariable analysis. MRI-AGD-AF had an AUC of 0.869 (95% CI (0.79; 0.95)) and outperformed C-AGD. Using an optimal cut-off of 20 mm for MRI-AGD-AF, a sensitivity of 97.01% and a specificity of 70.97% were noted. LIMITATIONS REASONS FOR CAUTION: This was a retrospective analysis and no adolescents had been included. WIDER IMPLICATIONS OF THE FINDINGS: This study is consistent with previous works associating a short C-AGD with endometriosis and the absence of correlation with the disease phenotype. MRI-AGD is more accurate than C-AGD in this setting and could be evaluated in the MRI examination of patients with suspected endometriosis. STUDY FUNDING/COMPETING INTERESTS: N/A. TRIAL REGISTRATION NUMBER: The protocol was approved by the 'Groupe Nantais d'Ethique dans le Domaine de la Santé' and registered under reference 02651077.

Anogenital distance in adult women is a strong marker of endometriosis: results of a prospective study with laparoscopic and histological findings.

STUDY QUESTION: Could anogenital distance (AGD) be a non-invasive marker of endometriosis and correlated to the American Society for Reproductive Medicine revised score (r-ASRM) and ENZIAN classifications? SUMMARY ANSWER: Surgically and histologically proven endometriosis is associated with a short AGD in women of reproductive age but not correlated either to the severity or to the location of the disease. WHAT IS KNOWN ALREADY: AGD is a marker of intrauterine androgen exposure and exposure to oestrogen-like chemicals such as phthalates. Moreover, exposure to endocrine disruptors, such as organochlorine chemicals, is associated with endometriosis. It has been suggested that a short AGD in women is associated with an increased risk of endometriosis based on clinical and ultrasound exams. STUDY DESIGN SIZE DURATION: A prospective cohort study was conducted from January 2018 to June 2019 in a tertiary-care centre including 168 adult women undergoing pelvic surgery. PARTICIPANTS/MATERIALS SETTING METHODS: Of the 168 women included, 98 patients had endometriosis (endometriosis group) and 70 did not (non-endometriosis group). An operator (not the surgeon) measured the distance from the clitoral surface to the anus (AGD-AC) and from the posterior fourchette to the anus (AGD-AF) before surgery using a millimetre accuracy ruler. Endometriosis was diagnosed on exploration of the abdominopelvic cavity, and the r-ASRM and ENZIAN scores were calculated. All removed tissues underwent pathological examination. MAIN RESULTS AND THE ROLE OF CHANCE: Mean (±SD) AGD-AF measurements were 21.5 mm (±6.4) and 32.3 mm (±8.1), and average AGD-AC measurements were 100.9 mm (±20.6) and 83.8 mm (±12.9) in the endometriosis and non-endometriosis groups (P < 0.001), respectively. Mean AGD-AF and AGD-AC measurements were not related to r-ASRM stage (P = 0.73 and 0.80, respectively) or ENZIAN score (P = 0.62 and 0.21, respectively). AGD-AF had a better predictive value than AGD-AC for discriminating the presence of endometriosis (AUC = 0.840 (95% CI 0.782-0.898) and 0.756 (95% CI 0.684-0.828)), respectively. For AGD-AF, an optimal cut-off of 20 mm had a specificity of 0.986 (95% CI 0.923-0.999), sensitivity of 0.306 (95% CI 26.1-31.6) and positive predictive value of 0.969 (95% CI 0.826-0.998). In multivariable analysis, the diagnosis of endometriosis was the only variable independently associated with the AGD-AF (ß = -9.66 mm 95% CI -12.20--7.12), P < 0.001). LIMITATIONS REASONS FOR CAUTION: The sample size was relatively small with a high proportion of patients with colorectal endometriosis reflecting the activity of an expert centre. Furthermore, we did not include adolescents and the AGD-AF measurement could be particularly relevant in this population. WIDER IMPLICATIONS OF THE FINDINGS: The measurement of AGD could be a useful non-invasive tool to predict endometriosis. This could be especially relevant for adolescents and virgin women to avoid diagnostic laparoscopy and empiric treatment. STUDY FUNDING/COMPETING INTERESTS: None.

Occurrence and seasonal variation of airborne gram negative bacteria in a sewage treatment plant.

A study was carried out to determine the microbial density and the seasonal variation of airborne Gram negative bacteria in a sewage treatment plant. Sampling was made at 16 sites and the settle plate technique was used. Of the 201 samples examined, 43.2% revealed fecal coliforms (mean value = 14 cfu/p/h), 53% Pseudomonas spp. (mean value = 11 cfu/p/h), 46.5% Shigella spp. (mean value = 13 cfu/p/h), 3% Legionella spp. (mean value = 2 cfu/p/h) and 2% Salmonella (mean value = < 1 cfu/p/h). 72% of the samples contained "other" Gram negative bacteria such as Aeromonas hydrophila, Serratia marcescens, Enterobacter cloacae and others. With the exception of Legionella spp. and Salmonella, all other bacteria were more frequent and numerous in the October-March period, when temperatures were lower and humidity higher. Although the oxidation tanks were covered overall contamination was nevertheless high, thus presenting a potential health risk for plant workers.

Reactivation enables memory updating, precision-keeping and strengthening: exploring the possible biological roles of reconsolidation.

Although much has been learned regarding the molecular and cellular mechanisms of memory reconsolidation, its actual biological function remains unclear. In this work we investigate the possibility that three different mnemonic processes - updating, precision-keeping and trace strengthening - are mediated by reconsolidation in contextual fear conditioning. Reconsolidation involves the activation of calcium channels for the destabilization during the reactivation. Our results show that when memory is reactivated in a situation that does not match the original information, content is modified, i.e., "updated". However, when the contextual condition matches the original one, memory reactivation contributes either to its strengthening or to the maintenance of its precision content over time. Since the L-type voltage-gated calcium channel antagonist nimodipine blocked these effects, we suggest that reconsolidation is the mechanism supporting these processes.

Phacotrabeculectomy with or without punch: preliminary results comparing the two techniques.

The authors report their experience in the combined surgery, for glaucoma and cataract, by using the Crozafon-De Laage punch. 24 patients affected by open-angle glaucoma and cataract have been enrolled in the study. 12 underwent a combined operation of phacoemulsification and trabeculectomy according to Cairns, and 12 underwent phacoemulsification and protective filtering surgery executed with the Crozafon-De Laage punch. Comparing the two methods we noted as advantage of the punch its easiness of use, through the sclerocorneal tunnel of the phacoemulsification, to create a filtering fistula; this shortened the duration of surgery. As a disadvantage of punch use we noted a lower filtering gradability as opposed to Cairns' trabeculectomy.

[Prevalence of Helicobacter pylori infection in primary health care]. / Prevalencia de la infección por Helicobacter pylori en atención primaria de salud.

OBJECTIVES: To find the prevalence of Helicobacter pylori (Hp) infection in the population as a whole. To assess its relationship with the associated factors described in other studies. DESIGN: Transversal study of an urban population of 20,000. PARTICIPANTS: Between 14 and 80 years old. Randomised sampling of the computerised records (640 clinical histories). Necessary sample n = 384 (alpha = 0.05, prior prevalence = 50%, precision 0.05). MEASUREMENTS: Breath test with urea marked (13C), age, sex, alcohol and tobacco consumption, social class and dyspepsia and/or gastro-duodenal pathology. RESULTS: 123 exclusions. 122 losses (23%). 397 people screened, 43.6% male. Average age: 42.6. 41.6% consumed alcohol. 30.5% smoked. Prevalence of dyspepsia, gastritis, gastric ulcer and duodenal ulcer, 14%, 2.8%, 2.8% and 2.0%, respectively. Hp prevalence: 56.1% (95% CI, 51.2-60.1). There were no significant differences between prevalence of Hp+ and sex, dyspepsia, peptic ulcer history, gastritis, alcohol consumption and tobacco consumption. Greatest prevalence of Hp+ in over-70s (73%). Significant linear tendency between presence of Hp+ and age (p < 0.05) and low social class (p < 0.05). The logistic regression analysis found a statistically significant relationship only between the presence of H. pylori and age and social class. CONCLUSIONS: Prevalence was similar to that in other studies. The relationship between low social class and age and greater Hp prevalence was confirmed. Dyspepsia is not a justification for empirical treatment of Hp. Patients with and without the infection must be followed to evaluate morbidity longitudinally.

[Overattendance at primary care: a study of psychosocial factors]. / Hiperfrecuentación en atención primaria: estudio de los factores psicosociales.

OBJECTIVE: To determine the effect of various psychological and social factors--family function, social support, psychological malaise and social class--on frequency of attendance. DESIGN: Study with cases and controls. SETTING: Health Districts Girona-3 and La Bisbal. PARTICIPANTS: Criteria for inclusion: being older than 14, being on a list as a user, and having been seen at least once during the study period. The person over-attending is defined as someone attending 7 or more times in a year. The normal attender attends less than 7 times. The sample was 441 patients (209 cases and 232 controls). MEASUREMENTS AND MAIN RESULTS: The Smilkestein family Apgar and the DUKE-UNC social support questionnaires, and the Goldberg anxiety and depression scale, were administered. Social class was defined according to the job of the head of the family. Statistical analysis was undertaken in two steps: firstly, bivariate analysis; and second, multivariate. The social support and age variables were related to frequency of attendance: they explained 8.1% of it (through multiple regression). Depression increased by between 1.21 and 2.58 the risk of over-attending and explained 10.53% of the variability of over-attendance, in line with the logistical regression analysis. CONCLUSIONS: The psychological and social variables studied fail to explain most of the variability. We should demystify the importance of psychological and social factors in the use of health resources.

Gestión de la demanda de urgencias: Quiero que el médico me vea ahora. ¿Cómo lo hacemos? / Demand management of emergencies, I want the doctor to see me now. What do we do?

Objectivo. Descripción de la experiencia organizativa de gestión de la demanda en nuestro centro de salud. Valoración de la utilidad, grado de satisfacción y percepción de mejora por parte de los profesionales del centro mediante una encuesta de valoración. Material y métodos. DISEÑO: Estudio descriptivo de la experiencia y de una encuesta de valoración. EMPLAZAMIENTO: Área urbana con 29.674 pacientes asignados. PARTICIPANTES: Todo el equipo de profesionales sanitarios y no sanitarios del centro de salud. INTERVENCIONES: Disminución de la cita previa en las agendas de los facultativos con aumento de las visitas del día y creación de un circuito nuevo de atención a los pacientes con una enfermera de triaje y un médico de guardia. Aplicación de una encuesta de valoración a todos los «profesionales del centro». MEDICIONES PRINCIPALES: Análisis de las visitas de la enfermera de triaje así como del porcentaje de resolución y análisis de los resultados de la encuesta por estamentos. Resultados. La media de visitas por parte de la enfermera de triaje es de 30 con un 41% de resolución por parte de la misma. Encuesta cumplimentada por el 93,8% de los profesionales del centro. Conclusiones. Valoración elevada por parte de todo el personal de la consulta de triaje. Las mejoras y la disminución de carga de trabajo lo refieren principalmente administrativos y médicos (AU)

Objectives. Description of the experience of organizational management of demand in our health centre. Assessment of the usefulness, level of satisfaction and perception of improvement on the part of the professionals of the centre using an evaluation survey. Material and methods. DESIGN: Descriptive Study of the experience and an evaluation survey. SETTING: Urban Area with 29,674 patients assigned. PARTICIPANTS: The team of health and non-health professionals of the health centre. INTERVENTIONS: Decrease in previous appointments in the lists of the physicians, with an increase in the visits on the day and creation of a new circuit of patient care using a triage nurse and an emergency physician. Implementation of an evaluation survey of all “professionals of the centre”. MAIN MEASUREMENTS: Analysis of triage nurse visits, as well as the percentage of resolution and analysis of the results of the survey by profession. Results. The average of visits to the nurse triage was 30, with 41% of them being resolved there. The survey was completed by 93.8% of professionals of the centre. Conclusions. There were high appraisals for the triage clinic by all the staff. The improvements and the decrease in workload were mainly administrative and medical (AU)

Prevalencia de la infección por Helicobacter pylori en atención primaria de salud / Prevalence of helicobacter pylori infection in primary health care

Objetivos. Conocer la prevalencia de infección por Helicobacter pylori (Hp) en población general. Valorar la relación con los factores asociados descritos en otros ámbitos. Diseño y ámbito. Estudio transversal. Población urbana: 20.000 personas. Sujetos. Edad de 14-80 años. Muestreo aleatorio del registro informatizado (640 historias clínicas). Muestra necesaria, 384 (alfa, 0,05; prevalencia previa, 50 por ciento; precisión, 0,05). Mediciones. Prueba del aliento con urea marcada (13C), edad, sexo, consumo de alcohol y tabaco, clase social y dispepsia y/o patología gastroduodenal. Resultados. Exclusiones, 123; pérdidas, 122 (23 por ciento); cribados, 397; varones, 43,6 por ciento; edad media, 42,6 años; consumía alcohol, 41,6 por ciento; fumaba, 30,5 por ciento. Prevalencia de dispepsia, gastritis, ulcus gástrico y duodenal, respectivamente, 14, 2,8, 2,8 y 2,0 por ciento. Prevalencia Hp, 56,1 por ciento (IC del 95 por ciento, 51,2-60,1). No hay diferencias significativas entre prevalencia de Hp+ y sexo, dispepsia, antecedentes de ulcus péptico, gastritis, consumo de alcohol y consumo de tabaco. Máxima prevalencia de Hp+ en mayores de 70 años (73 por ciento). Tendencia lineal significativa entre presencia de Hp+ y edad (p < 0,05) y clase social baja (p < 0,05). El análisis de regresión logística sólo encuentra relación estadísticamente significativa entre presencia de Hp y edad y clase social. Conclusiones. La prevalencia es similar a la de otros estudios. Se confirma la relación entre clase social baja y edad y mayor prevalencia de Hp. La dispepsia no justificaría el tratamiento empírico de Hp. Es necesario el seguimiento de los pacientes con y sin infección para evaluar la morbilidad longitudinalmente (AU)