Satisfaction and experience with colorectal cancer screening: a systematic review of validated patient reported outcome measures.

BACKGROUND: Patient satisfaction or experience with colorectal cancer screening can determine adherence to screening programs. An evaluation of validated patient reported outcome measures (PROMs) for measuring experience or satisfaction with colorectal cancer screening does not exist. Our objective was to identify and critically appraise validated questionnaires for measuring patient satisfaction or experience with colorectal cancer screening. METHODS: We conducted a systematic review following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. We conducted searches on MEDLINE, EMBASE, PsychINFO, CINAHL and BiblioPRO and assessed the methodological quality of studies and measurement properties of questionnaires according to the COSMIN guidelines for systematic reviews of PROMs. PROSPERO registration number: CRD42019118527. RESULTS: We included 80 studies that used 75 questionnaires, of which only 5 were validated. Four questionnaires measured satisfaction with endoscopy: two in the context of colorectal cancer screening (for colonoscopy and sigmoidoscopy) and two for non-screening endoscopy. One questionnaire measured satisfaction with bowel preparation. The methodological quality of studies was variable. The questionnaires with evidence for sufficient content validity and internal consistency were: the CSSQP questionnaire, which measures safety and satisfaction with screening colonoscopy, and the Post-Procedure questionnaire which measures satisfaction with non-screening endoscopic procedures. CONCLUSIONS: This systematic review shows that a minority of existing PROMs for measuring patient satisfaction with colorectal cancer screening are validated. We identified two questionnaires with high potential for further use (CSSQP and the Post-Procedure questionnaire).

Improvement in clinical outcomes and replacement factor VIII use in patients with haemophilia A after factor VIII pharmacokinetic-guided prophylaxis based on Bayesian models with myPKFiT®.

OBJECTIVES: Patients with severe haemophilia A (HA) receive factor VIII (FVIII) replacement therapy as prophylaxis. myPKFiT® is an online medical application that allows authorized users to simulate dosing regimens with patient pharmacokinetic (PK) profiles based on only 2 blood samples. Our aim was to assess the impact of using this medical device in routine practice in terms of FVIII consumption and clinical outcomes. METHODS: Thirty-six patients with severe HA on prophylaxis with Advate® were recruited in 3 centres in Spain. Annual bleeding rate (ABR), annual joint bleeding rate (AJBR) and annual FVIII consumption before and after adjustment were obtained using the patient's clinical history (12 months before) and prospectively recorded data (12 months after), respectively. Adjustment was based on PK parameters provided by myPKFiT® , joint status and relative risk associated with physical activity and bleeding phenotype. RESULTS: ABR and AJBR were significantly reduced after adjustment in the overall sample (-2.2 ± 1.3, P = .018 and -1.9 ± 1.2, P = .012, respectively) and in patients aged >15 years (-2.6 ± 1.4, P = .011 and -2.0 ± 1.2, P = .005, respectively). Adjustment had an effect on the individual FVIII consumption of most patients: annual amount was reduced in 18 cases and increased in 14. There was no significant effect on the mean amount (198 784 ± 110 387) compared to that used the year prior to myPKFiT® -adjusted prophylaxis (199 466 ± 103 670; P = .737). DISCUSSION: Our results suggest that PK-guided prophylaxis using myPKFiT® improved clinical outcomes and optimized FVIII consumption in the study population. This personalized approach may reduce bleeding rates without significantly increasing the overall cost of FVIII therapy.

Icosahedral boron clusters: a perfect tool for the enhancement of polymer features.

Boron clusters and organic molecules display manifestly different electronic, physical, chemical and geometrical characteristics. These differences highlight the complementarity of organic synthons and boron clusters, and therefore the feasibility of producing hybrid polymers incorporating both types of fragments. This review focuses on the development of hybrid organic-inorganic π conjugated, silane, siloxane and coordination polymers containing icosahedral boron clusters in the last few decades, which have received considerable academic and technological interest due to the combination of the electronic, optical and thermal properties of traditional inorganic materials with many of the desirable properties of organic plastics, including mechanical flexibility and low production costs.

Pharmacologic interventions to treat renal colic pain in acute stone episodes: Systematic review and meta-analysis.

OBJECTIVE: To assess effectiveness of pharmacologic interventions to relieve pain in patients suffering an acute stone episode. METHODS: Relevant trials that included patients with acute renal colic and radiological findings of urinary stones were identified in four databases. The main outcome was pain relief evaluated by Visual Analogue Scale score (VAS). RESULTS: In overall, diclofenac was superior to other NSAIDs for pain relief (MD of -12.57 [95% CI: -19.26, -5.88]). Paracetamol was superior to morphine for pain reduction at 30minutes (MD of -3.92 [95% CI: -6.41, -1.43]) and also to placebo at 15minutes (MD of -24.77 [95% CI: -33.19, -16.35]) and at 30minutes (MD of -16 [95% CI:-29, -2.96]) after drug administration. Finally, diclofenac was superior to paracetamol for pain reduction at 60 (MD of 6.60 [95% CI: 4.37, 8.83]) and 90minutes (MD of 3.4 [95% CI: 2.01, 4.79]). CONCLUSIONS: Diclofenac was superior to other NSAIDs and paracetamol for diminishing pain in patients suffering an acute stone episode. Paracetamol was superior to morphine and placebo for short pain relief. Future trials should address the role of paracetamol in the management of pain in patients suffering an acute stone episode.

Losses of leaf area owing to herbivory and early senescence in three tree species along a winter temperature gradient.

In temperate climates, evergreen leaves have to survive throughout low temperature winter periods. Freezing and chilling injuries can lead to accelerated senescence of part of the leaf surface, which contributes to a reduction of the lifespan of the photosynthetic machinery and of leaf lifetime carbon gain. Low temperatures are also associated with changes in foliar chemistry and morphology that affect consumption by herbivores. Therefore, the severity of foliar area losses caused by accelerated senescence and herbivory can change along winter temperature gradients. The aim of this study is to analyse such responses in the leaves of three evergreen species (Quercus ilex, Q. suber and Pinus pinaster) along a climatic gradient. The leaves of all three species presented increased leaf mass per area (LMA) and higher concentrations of structural carbohydrates in cooler areas. Only the two oak species showed visible symptoms of damage caused by herbivory, this being less intense at the coldest sites. The leaves of all three species presented chlorotic and necrotic spots that increased in size with leaf age. The foliar surface affected by chlorosis and necrosis was larger at the sites with the coldest winters. Therefore, the effects of the winter cold on the lifespan of the photosynthetic machinery were contradictory: losses of leaf area due to accelerated senescence increased, but there was a decrease in losses caused by herbivory. The final consequences for carbon assimilation strongly depend on the exact timing of the appearance of the damage resulting from low temperature and grazing by herbivores.

Sperm functionality is differentially regulated by porcine oviductal extracellular vesicles from the distinct phases of the estrous cycle.

Context Extracellular vesicles (EVs) derived from the oviductal fluid (oEVs) play a critical role in various reproductive processes, including sperm capacitation, fertilisation, and early embryo development. Aims To characterise porcine oEVs (poEVs) from different stages of the estrous cycle (late follicular, LF; early luteal, EL; mid luteal, ML; late luteal, LL) and investigate their impact on sperm functionality. Methods poEVs were isolated, characterised, and labelled to assess their binding to boar spermatozoa. The effects of poEVs on sperm motility, viability, acrosomal status, protein kinase A phosphorylation (pPKAs), tyrosine phosphorylation (Tyr-P), and in in vitro fertility were analysed. Key results poEVs were observed as round or cup-shaped membrane-surrounded vesicles. Statistical analysis showed that poEVs did not significantly differ in size, quantity, or protein concentration among phases of the estrous cycle. However, LF poEVs demonstrated a higher affinity for binding to sperm. Treatment with EL, ML, and LL poEVs resulted in a decrease in sperm progressive motility and total motility. Moreover, pPKA levels were reduced in presence of LF, EL, and ML poEVs, while Tyr-P levels did not differ between groups. LF poEVs also reduced sperm penetration rate and the number of spermatozoa per penetrated oocyte (P Conclusions poEVs from different stages of the estrous cycle play a modulatory role in sperm functionality by interacting with spermatozoa, affecting motility and capacitation, and participating in sperm-oocyte interaction. Implications The differential effects of LF and LL poEVs suggest the potential use of poEVs as additives in IVF systems to regulate sperm-oocyte interaction.

Cost-effectiveness of recombinant activated factor VII vs. plasma-derived activated prothrombin complex concentrate in the treatment of mild-to-moderate bleeding episodes in patients with severe haemophilia A and inhibitors in Spain.

Several analyses have shown that recombinant activated factor VII (rFVIIa) is a cost-effective intervention compared with plasma-derived activated prothrombin complex concentrate (pd-aPCC) for the on-demand treatment of mild-to-moderate bleeds in haemophilia patients with inhibitors. The aim of the study was to assess the cost-effectiveness of rFVIIa vs. pd-aPCC in the treatment of bleeding episodes in severe haemophilia A patients with inhibitors in Spain. A decision analytic model was designed to evaluate the costs and clinical outcomes of using rFVIIa or pd-aPCC to treat mild-to-moderate joint bleeds in children (≤14 years old) and adults with inhibitors. Data were obtained from a published meta-analysis and a panel of haemophilia experts. The analysis was conducted from the perspective of the Spanish National Healthcare System. One-way sensitivity analyses were performed to assess the impact of model assumptions on study results. In the Treur meta-analysis, rFVIIa resulted in cumulative joint bleed resolution of 88% and 95% after 24 and 36 h, respectively, compared with 62% and 76%, respectively, with pd-aPCC (Treur et al. Haemophilia 2009; 15: 420-36). Here, the mean cost per bleed was estimated at €8473 and €15 579 in children and adults treated with rFVIIa, vs. €8627 and €15 677 in children and adults treated with pd-aPCC. rFVIIa treatment was found to be the dominating option (cheaper and more effective). The one-way sensitivity analysis also confirmed that rFVIIa was less costly than pd-aPCC. The model suggests that rFVIIa is a cost-effective option compared with pd-aPCC for the treatment of mild-to-moderate bleeding episodes in a Spanish setting.

Serum tryptase concentrations in beekeepers with and without Hymenoptera venom allergy.

BACKGROUND: Increased tryptase concentrations are a risk marker for the severity of reactions to Hymenoptera stings or venom immunotherapy OBJECTIVE: To investigate serum tryptase concentrations in beekeepers with and without Hymenoptera venom allergy (HVA). METHODS: Serum tryptase concentrations were measured in adult patients with HVA (n = 91, 37 of whom were beekeepers), beekeepers without HVA (n = 152), and control individuals from the general adult population (n = 246). RESULTS: Multivariate analyses revealed that serum tryptase levels were positively associated with beekeeping activities (P < .001) and HVA (P < .001). Tryptase levels were also positively associated with age (P < .001) and male'sex (P = .02), and negatively associated with alcoho consumption (P = .002). CONCLUSIONS: Beekeeping and HVA are independently associated with increased concentrations of serum tryptase.

Evaluation of a Vibrotactile Biofeedback System Targeting Stance Time Symmetry Ratio of Individuals With Lower-Limb Amputation: A Pilot Study.

Individuals with lower-limb amputation (LLA) often exhibit atypical gait patterns and asymmetries. These patterns can be corrected using biofeedback (BFB). Real-time BFB strategies have demonstrated to be effective to various degrees in BFB systems. However, no studies have evaluated the use of corrective vibrotactile BFB strategies to improve temporal gait symmetry of LLA. The aim of this study was to evaluate a wearable vibrotactile BFB system to improve stance time symmetry ratio (STSR) of LLA, and compare two corrective BFB strategies that activate either one or two vibrating motors at two different frequency and amplitude levels, based on a pre-set STSR target. Gait patterns of five unilateral LLA were assessed with and without BFB. Spatiotemporal and kinematic gait parameters were measured and assessed using a wearable motion capture system. Usability and workload were assessed using the System Usability Scale and NASA Task Load Index questionnaires, respectively. Results showed that participants significantly ( [Formula: see text]) improved STSR with BFB; however, this coincided with a reduction in gait speed and cadence compared to walking without feedback. Knee and hip flexion angles improved and changes in other parameters were variable. Immediate post-test retention effects were observed, suggesting that gait changes due to BFB were preserved for at least a short-time after feedback was withdrawn. System usability was found to be acceptable while using BFB. The outcomes of this study provide new insights into the development and implementation of clinically practical and viable BFB system. Future work should focus on assessing the long-term use and retention effects of BFB outside controlled-laboratory conditions.

Characterization of the 1-(5-(4,5-Dimethyl-1,3,2-dioxoborolan-2-yl)thiophen-2-yl)ethanone Using NMR 13C, 1H and 11B through the Density Functional Theory.

The use of computational methods that allow us to perform characterization on new compounds is not a novelty; nevertheless, the degree of complexity of the structures makes their study more challenging since new techniques and methods are required to adjust to the new structural model. The case of nuclear magnetic resonance characterization of boronate esters is fascinating because of its widespread use in materials science. In this paper, we use density functional theory to characterize the structure of the compound 1-[5-(4,5-Dimethyl-1,3,2-dioxaborolan-2-yl)thiophen-2-yl]ethanonea by means of nuclear magnetic resonance. We studied the compound in its solid form with the PBE-GGA and PBEsol-GGA functionals, with a set of plane wave functions and an augmented wave projector, which included gauge in CASTEP and its molecular structure with the B3LYP functional using the package Gaussian 09. In addition, we performed the optimization and calculation of the chemical shifts and isotropic nuclear magnetic resonance shielding of 1H, 13C, and 11B. Finally, we analyzed and compared the theoretical results with experimental diffractometric data observing a good approximation.

Profilin as an aeroallergen by means of conjunctival allergen challenge with purified date palm profilin.

BACKGROUND: The role of profilin as a food allergen is well established, but little research has been done about its ability to elicit respiratory disease. Profilin is considered more of a confounding allergen on skin testing with whole pollen extracts than other airborne allergens. Our aim was to find out whether or not profilin can cause symptoms in sensitized individuals, which would be compatible with its role as an airborne allergen. METHODS: We performed conjunctival allergen challenges with date palm profilin in a series of consecutive pollen-allergic patients with rhino-conjunctivitis, divided in two groups: profilin sensitized (n = 17) and not sensitized (n = 14), who served as controls. We investigated the possible association between profilin sensitization and profilin allergy in these groups of patients. RESULTS: None of the patients from the not profilin-sensitized group had a positive result in conjunctival allergen challenges. In contrast, 65% of profilin sensitized patients had a positive conjunctival allergen challenge and were considered allergic to profilin. We found a significant statistical association between being profilin allergic and being profilin sensitized (χ(2) = 10.39, p < 0.005). CONCLUSIONS: Profilin seems to work as an aeroallergen in a significant proportion of profilin-sensitized patients. This might explain the uselessness of conjunctival challenges with whole pollen extracts to disclose genuine sensitization. In the future, the possibility of quantifying this allergen in pollen immunotherapy vaccines should be considered.

F8 gene dosage defects in atypical patients with severe haemophilia A.

We performed molecular analysis of the factor 8 gene (F8) in 272 unrelated Spanish patients with haemophilia A (HA) and detected a mutation by routine analysis in 267 of them (98.1%). No mutation was detected in the remaining five patients despite clinical and laboratory confirmation of HA. The aim is to describe the molecular alterations in F8 discovered by gene dosage methodologies in three of these patients. For methodology, F8 sequencing, intragenic marker analysis, multiplex ligation-dependent probe amplification and quantitative real time-PCR were followed. One patient had Klinefelter syndrome (47,XXY) and a large deletion spanning exons 1-12 masked by the other F8 allele; the second patient showed a large duplication spanning exons 2-10 and the third patient revealed a non-contiguous double duplication of exons 14 and 23-25. The remaining two patients had mild HA and dosage results were normal. The application of gene dosage methods is useful to define haemophilic patients in whom mutations are not detected using other routine methods. Nevertheless, in a small percentage of patients (<1%), no molecular pathology can be identified after testing several genetic methodologies.

[Increase of newborns with anorectal malformation in 2011. Is it just by chance?]. / Acumulación de neonatos con malformación anorrectal en 2011. Solo azar?

OBJECTIVE: In 2011 we have diagnosed 9 anorectal malformations (MAR). This means 13.3 cases/10.000 NB versusu the estimated incidence of 2 cases/10.000 NB. This accumulation of defects can not be due to chance, so we have decided to focus on its research. MATERIAL AND METHODS: The study included all the patients with anorrectal malformations born in 2011. In all of them we analyzed: geographic area, age and health status of parents, pregnancy, exposure to teratogens, especially lorazepam intake, sex, gestational age, weight at birth, exploration of the abdomen and perineum, birth defects associated, imaging studies performed, treatment and current situation. RESULTS: All patients came from our province, and maternal age is under 20 years in 2 patientes and older than 30 in 7; male-dominated (8/1); low forms in 4 of 9 patients. 100% of newborns have some type of associated malformation, in genitals, urinary system or costovertebral. Clinical assessment and imaging study provided the right diagnosis in all the cases. It must be noted the absence of difficulties in the surgery treatment and a favorable outcome in all children. CONCLUSIONS: To this accumulation of cases with anorrectal malformation cases it is added a male predominanced, and a high incidence of associatedmalformations and high defects. We have not found an epidemiological explanation for this concentration of patients with anorrectal malformations. This forces us to continue our investigation if detected for some reason, currently not known.

Exploration of Vibrotactile Biofeedback Strategies to Induce Stance Time Asymmetries.

BACKGROUND: Gait symmetry is the degree of equality of biomechanical parameters between limbs within a gait cycle. Human gait is highly symmetrical; however, in the presence of pathology, gait often lacks symmetry. Biofeedback (BFB) systems have demonstrated the potential to reduce gait asymmetry, improve gait function, and benefit overall long-term musculoskeletal health. OBJECTIVES: The aim of this study was to develop a BFB system and evaluate three unique BFB strategies, including bidirectional control - constant vibration (BC), bidirectional control - variable vibration (BV), and unidirectional control - variable vibration (UV) relevant to gait symmetry. The assessed feedback strategies were a combination of vibration frequency/amplitude levels, vibration thresholds, and vibrotactile stimuli from one and two vibrating motors (tactors). Learning effect and short-term retention were also assessed. METHODOLOGY: Testing was performed using a custom BFB system that induces stance time asymmetries to modulate temporal gait symmetry. The BFB system continuously monitors specific gait events (heel-strike and toe-off) and calculates the symmetry ratio, based on the stance time of both limbs to provide real-time biomechanical information via the vibrating motors. Overall walking performance of ten (n=10) able-bodied individuals (age 24.8 ± 4.4 years) was assessed via metrics of symmetry ratio, symmetry ratio error, walking speed, and motor's vibration percentages. FINDINGS: All participants utilized BFB somatosensory information to modulate their symmetry ratio. UV feedback produced a greater change in symmetry ratio, and it came closer to the targeted symmetry ratio. Learning or short-term retention effects were minimal. Walking speeds were reduced with feedback compared to no feedback; however, UV walking speeds were significantly faster compared to BV and BC. CONCLUSION: The outcomes of this study provide new insights into the development and implementation of feedback strategies for gait retraining BFB systems that may ultimately benefit individuals with pathological gait. Future work should assess longer-term use and long-term learning and retention effects of BFB systems in the populations of interest.

Trocar shortening for pediatric vitreoretinal surgery with a 3D printed trocar spacer: Report of two cases.

PURPOSE: To show the results of a trocar spacer for pediatric vitreoretinal surgery with a 3D printed trocar spacer in 2 cases. METHODS: We used standard 27 gauge (ga) and 25 ga trocars and cannulae, and prototyped 1.5 mm × 3 mm spacers with a Prusa MK3 3D printer (0.4 mm nozzle) with Fuse deposition melting (FDM) technology. Parts were printed with a 50 µm layer height in polylactic acid or polylactide (PLA). The spacer was placed in two places: between the blade's base and the trocar, and between the trocar and the sclera depending on the desired amount of shortening. This prototype was used in 2 vitrectomy cases in pediatric patients. RESULTS: We used this trocar spacer in 2 cases with positive results. CONCLUSIONS: This 3D printed spacer has proved to effectively shorten the introduced trocar into two different small eyes. More studies are needed to validate the efficacy and safety of this spacer in clinical practice.

Inhibition of growth hormone receptor activation by pegvisomant may increase bone density in acromegaly.

Treatment of acromegaly with pegvisomant lowers serum IGF-1 and raises serum growth hormone. As both IGF-1 and GH are important for bone growth and remodeling, we were concerned that lowering of IGF-1 could cause loss of bone. To evaluate the effects of treatment of acromegaly with pegvisomant on bone mineral density (BMD) we developed an observational, prospective study. 7 acromegaly patients participated in the study. Male and female subjects aged 18 years or more were eligible to participate. Patients were eugonadal or on adequate gonadal replacement therapy for at least 3 years before participating in the study. These patients were treated with a mean dosage of 20 mg of pegvisomant daily for up to 7 years. Bone mineral density (BMD) was evaluated by dual X-ray absorbtiometry (DXA) at baseline, 8, and 18 months as a part of a prospective trial and periodically thereafter. Baseline mean serum insulin-like growth factor-1 (IGF-1) concentration±SD was elevated in all patients (679.86±138.21 ng/ml). The IGF-1 concentrations at 18 months decreased significantly from baseline (p=0.016). Wilcoxon signed-rank tests showed significant increases in the spine BMD from baseline to 18 months (p=0.016) and significant increases in the right hip BMD from baseline to 18 months (p=0.032). The range of the increases was 4.3-17.8% at 7 years. It is concluded that successful treatment of acromegaly with pegvisomant increases BMD.

Dynamics of sperm DNA damage in fresh versus frozen-thawed and gradient processed ejaculates in human donors.

The rate of increase of sperm DNA fragmentation (rsDF) in fresh and frozen-thawed and processed sperm samples after a density gradient for sperm selection was analysed after 0, 0.5, 1.5, 4.5, 6, 24, 48 and 72 h of incubation at 37 °C, in five donors with proven fertility. The results showed that: (i) sperm DNA fragmentation (sDF) at baseline in fresh samples (14.3 ± 3.3) was lower than that obtained after freeze-thawing and selection (19.4 ± 4.1), significant differences; (ii) After 6 h of incubation the mean sDF in fresh samples (24.2 ± 10.2) was significantly lower than that in frozen-thawed samples (45.3 ± 7.1); (iii) Subsequently, the rsDF in fresh semen samples was 1.6% per h after 6 h of incubation, while after thawing and selection the rsDF was 4.3% per h; The tendency to increase in sDF showed high R(2) values (R(2) = 0.90) for exponential functions in case of fresh samples, whereas R(2) values for linear functions were higher after sperm selection (R(2) = 0.97). These results indicate that differences in sperm DNA fragmentation dynamics before and after storage are an important issue that must be considered for storage of sperm to be used for artificial reproduction techniques.

Determination of the anal position in newborns and in children with chronic constipation: comparative study in two European healthcare centres.

INTRODUCTION: The objective of this study was to determine the normal anal position index (API) in neonates and in a group of older children with chronic constipation, and to identify the incidence of anterior ectopic anus (AEA) in the two groups. MATERIALS AND METHODS: A prospective random study was carried out in two European hospitals determining the API in 1,012 neonates (529 in Group A, and 483 in Group B) and in 64 children suffering chronic constipation of ages between 3 months and 12 years (Group C). The API is defined as the ratio between the fourchette-anal and fourchette-coccygeal distances in girls and the scroto-anal and scroto-coccygeal distances in boys. The gestational age, weight, meconium evacuation and anal calibre were recorded in Groups A and B, and age, sex, and API in Group C. Statistical comparisons were made using Student's t test and Welch's t test for independent sample groups. RESULTS: The mean API in Group A was 0.53 ± 0.06 in males and 0.40 ± 0.05 in females, and in Group B 0.51 ± 0.06 in males and 0.39 ± 0.08 in females, with significant differences between the sexes (p < 0.0001) in both groups; 1.7% of the neonates in Group A and 2.4% of Group B presented AEA. 4/13 newborns females with AEA presented with severe constipation during their first months of life. For the 64 patients in Group C: 59.3% were female; the mean API was 0.47 ± 0.1 in males and 0.36 ± 0.1 in females (p < 0.0001). The incidence of AEA was 47% in females and 35% in males. CONCLUSIONS: In the neonates (Groups A and B), the position of the anus in the perineum was more anterior in females than in males (p < 0.0001); 31% of the newborns females with AEA presented with constipation in their first months of life. In the Group C patients, there was a high incidence of AEA, especially in the females, and we consider it to be the probable cause of this defecation disorder.

[Evaluation of the anal position in newborns and children with chronic constipation. Incidence of anterior ectopic anus]. / Valoración de la posición del ano en recién nacidos y en niños con estreñimiento crónico. Incidencia del ano anterior ectópico.

INTRODUCTION: Anterior ectopic anus (AEA), continues to be a controversial issue. The objective is to determine the normal position of the anus or anal ano-genital index (AGI) in newborns (NB) and in a group of infants with chronic constipation, know the incidence of AEA in both groups, and its relationship with constipation. METHODS: A prospective aleatory study is performed in where the AGI is determined in 529 NB and 64 older patients with chronic constipation. The AGI is obtained by dividing the distances (cm): vulvar fornix-anus/fornix-coccyx in females and scrotum-anus/scrotum-coccyx in males. The NB group is further studied for gestational age, weight, number of meconium discharges and anal calibration. The newborns with AEA are then controlled to exclude constipation. In patients with chronic constipation, their age, sex and AGI are evaluated. The statistical comparisons are made by a Student's t test and Welch's t test for independent samples. RESULTS: 49.5% of NB are male. The average gestational age is 38.95 +/- 2.08/w in NB females and 38.54 +/- 2.26/w in NB males. The average weight is 3101.91 +/- 511.41/g in newborn females and 3145.14 +/- 573.36/g in newborn males. The average AGI of NB females is 0.40 +/- 0.05 and NB males 0.53 +/- 0.06. AEA is considered with AGI < 0.30 in females and < 0.41 in males. 2.2% of NB females (6/267) and 1.1% of NB males (3/262) have AEA. There is a significant difference between the AGI of NB females and NB males (p < 0.0001). 98% of NB discharge meconium in the first 24 hours. 2 NB females with AGI 0,21 and 0,26 had severe constipation in the first months of life. In group with chronic constipation (64 pacients), 59.4% are female. The AGI is 0.36 +/- 0.1 in females and 0.47 +/- 0.1 in males (p < 0.0001). Concerning of AEA in the NB group (AGI < 0.30 in females and 0.41 in males) incidence of AEA in group with chronic constipation is 35% in males and 47% in females. CONCLUSIONS: The position of the anus in the perineal floor is anterior in females, with significant differences (p < 0.0001) to the AGI in males. AEA has more incidence in females (2.2%). In the constipated group 47% of females had AEA and it is considered the probable reason for this disorder in these patients. To conclude, each NB evaluation protocol should include determination of the AGI in the neonatal period to exclude AEA and to prevent clinical consequences.