RESUMEN
Molecular profiling of normal tissues is a regular and necessary step when developing systems for expression analyses in biological samples, including diagnostic panels for various diseases and conditions. Yet there are still no rigorous criteria to allow precise typing of normal tissues. A main problem is that the methods employed in diagnostic expression testing are difficult to standardize. While various technologies, instruments, and reagents are available, universal protocols of handling biological material are lacking, thus impairing the reproducibility of data from independent studies. The review describes a new approach to standardizing circulating microRNA studies in forensic biology, which has relatively recently (7-8 years ago) come to employ RNA markers in molecular typing of tissues and biological fluids. Forensic biology is now one of the few disciplines where several panels of tissue mRNA markers have been developed within a short period of time and a number of specific microRNA markers have been established and validated for several biological fluids. To allow their successful use, new protocols have been combined with the available, rigidly standardized system of genetic personal identification. Although a ready diagnostic product has still not been obtained with this well-working approach, the apparent efficiency of the standardization methods clearly demonstrates that the problem is possible to solve in other biomedical fields, including those where RNA-based diagnostic protocols are still under development.
Asunto(s)
MicroARN Circulante/sangre , Ciencias Forenses/métodos , Reacción en Cadena de la Polimerasa/normas , ARN Mensajero/sangre , Biomarcadores/metabolismo , MicroARN Circulante/genética , Femenino , Ciencias Forenses/instrumentación , Humanos , Masculino , Secreción del Pezón/química , Secreción del Pezón/metabolismo , Reacción en Cadena de la Polimerasa/instrumentación , Reacción en Cadena de la Polimerasa/métodos , ARN Mensajero/genética , Reproducibilidad de los Resultados , Saliva/química , Saliva/metabolismo , Semen/química , Semen/metabolismo , Sensibilidad y Especificidad , Excreción Vaginal/diagnóstico , Excreción Vaginal/genética , Excreción Vaginal/metabolismoRESUMEN
OBJETIVOS: El reflujo vaginal (RV) o micción intravaginal es una causa de incontinencia urinaria diurna, con goteo postmiccional. El llenado retrógrado de la vagina durante la micción obedece a causas anatómicas predisponentes o funcionales. MÉTODOS: Exposición de casos clínicos. RESULTADO: Caso clínico 1.- Niña de 10 años, con infecciones de orina acompañadas de incontinencia postmicional a diario. En CUMS se aprecia, en las placas miccionales, la aparición progresiva de urocolpos, que desaparece parcialmente al finalizar la micción. Se inicia tratamiento con re-educación miccional con resolución de síntomas. Caso clínico 2.- Niña de 9 años, con antecedentes de Reflujo Vesicoureteral (RVU) corregido en la infancia que desde hace un año presenta incontinencia de escasa cuantía, postmiccional, con sensación de vaciado incompleto. Aporta ecografia pre y postmiccional normal, pero en la CUMS se aprecia RV, por lo que se inicia tratamiento específico con mejoría de los síntomas. Caso clínico 3.- Niña de 10 años con sobrepeso que consulta por incontinencia diurna, sin síntomas nocturnos. En CUMS se aprecia RV por lo que se establecen medidas conductuales. A los seis meses, las fugas han recurrido, al incumplir la paciente dichas medidas. Concluisones: Hasta un 12-15% de las niñas prepúberes que consultan por escapes de orina pueden presentar RV. El tratamiento consiste en la re-educación del hábito miccional, insistiendo en micciones frecuentes y programadas con un hábito postural correcto consistente en apertura de piernas e inclinación hacia delante, o bien, a horcajadas sobre el inodoro en posición contraria a la habitual
OBJECTIVE: Vesico-vaginal reflux (VVR) is defined as the reflux of urine into the vaginal vault during voiding, occasionally seen in pre- adolescent girls. The typical history consists in post voiding leaks in the daytime, that correspond to the progressive urine discharge from the vagina, after it has been filled up during micturition. We intend to show two cases presenting with significant urocolpos. METHODS: Description of two clinical cases observed in the pediatric urology office. RESULTS: Clinical case 1.- A 10-year-old girl presented with the complaint of diurnal incontinence (in the immediate post-voiding minutes). The early voiding phase in the cystourethrogram (VCUG) demonstrated progressive gross distension of the vagina (urocolpos) due to retrograde filling as the bladder emptied. The girl was managed with behavioural modifications, and was dry afterwards. Clinical case 2.- A 9-year-old girl presented with history of incomplete voiding. In infancy, she had right-sided vesicoureteral reflux (VUR) and was endoscopically treated at the age of 2. VCUG showed VVR, and no VUR. She was then successfully treated with behavioural modifications. Clinical case 3.- A 10-year-old girl complained of diurnal urinary incontinence, described as post voiding leaks. Again, a VCUG showed VVR and a small urocolpos. After re-education of voiding habits, leaks disappeared, but recurred 6 months afterwards, when she acknowledged no adherence to the therapy. DISCUSSION: Between 12 to 15% of girls referred to Urological clinics because of urine incontinence present VVR. In the absence of a clear anatomical obstruction, reflux happens as the urine flow encounters a natural obstacle in the labia majora usually in girls that close their legs as they void. Instructions on proper voiding form a key element in the management of VVR, and if not enough, the behavioural modification consists on a reverse position during voiding