ABSTRACT
BACKGROUND: Recurrent vulvovaginal candidosis (RVVC) has been associated with increased antifungal resistance. Recently, we reported that Candida isolates from Colombian patients with RVVC did not show an increase in antifungal resistance. OBJECTIVE: The aim of this study was to evaluate the virulence of Candida isolates from patients with RVVC. METHODS: A total of 40 Candida isolates were evaluated (37 C. albicans and 3 C. lusitaniae ). C. albicans isolates were divided into two groups based on the number of VVC episodes in patients per year: Group 1 (four to seven episodes; n = 26) and Group 2 (≥ eight episodes; n = 11). The XTT assay was used to assess biofilm formation. Galleria mellonella larvae were used for survival analysis and fungal load assessment, and the qPCR technique to determine the expression of the PRA1 gene. RESULTS: It was observed that C. lusitaniae and C. albicans isolates from patients with ≥ eight VVC episodes per year exhibited a greater capacity to form biofilms compared to those from patients with four to seven VVC episodes. Moreover, in the G. mellonella model, larvae inoculated with isolates from RVVC patients exhibited approximately 80% mortality. Similarly, larvae infected with C. albicans from patients who experienced ≥ eight VVC episodes showed a significantly higher fungal load compared to the other evaluated groups; likewise, the expression of the PRA1 gene was significantly higher in isolates from patients with ≥ eight VVC episodes. CONCLUSION: These results indicate that Candida isolates from patients with RVVC exhibit a high degree of virulence and suggest that virulence may be one of the mechanisms explaining recurrence rather than antifungal resistance itself.
Subject(s)
Biofilms , Candida , Candidiasis, Vulvovaginal , Candidiasis, Vulvovaginal/microbiology , Humans , Female , Virulence , Biofilms/growth & development , Animals , Candida/pathogenicity , Candida/genetics , Candida/isolation & purification , Candida/classification , Candida/drug effects , Candida/physiology , Recurrence , Larva/microbiology , Candida albicans/pathogenicity , Candida albicans/genetics , Candida albicans/isolation & purification , Candida albicans/physiology , Drug Resistance, Fungal , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Moths/microbiologyABSTRACT
BACKGROUND: In patients with persistent atrial fibrillation (AF), addition of posterior wall isolation (PWI) to pulmonary vein isolation (PVI) is controversial. OBJECTIVE: Compare PVI plus PWI versus PVI alone in patients with persistent AF. METHODS: We searched PubMed (by MEDLINE), Embase, LILACS, CENTRAL (by Cochrane Library), and Clinicaltrials.gov databases for randomized trials comparing PVI + PWI and PVI alone in persistent AF. The outcomes were: (i) AF recurrence; (ii) composite of recurrent atrial arrhythmias (i.e., AF, atrial tachycardia, or atrial flutter); (iii) major clinical complications (i.e., pericardial effusion or tamponade, sinus node dysfunction, or atrioesophageal fistula); (iv) mean ablation time. Risk of bias and quality of evidence were evaluated using the Cochrane Risk of Bias 2.0 tool and GRADE, respectively. Statistical significance was set at 5%, and subgroup and sensitivity analyses were performed. RESULTS: We included eight studies and 1119 patients, of which 561 underwent PVI + PWI. During follow-up (12 - 24 months), recurrence of AF was significantly reduced with adjunctive PWI (RR 0.66, 95% CI 0.44-0.98). Composite of recurrent atrial arrhythmias did not differ significantly (RR 0.83, 95% CI 0.65-1.06). Major clinical complications (RR 0.81, 95% CI 0.42-1.58) were similar, with PVI alone having a shorter mean procedure time (mean difference -23.37 minutes, 95% CI -30.23, -16.50). CONCLUSION: Adjunctive PWI appears to be effective in improving recurrent AF, but not recurrence of all atrial arrhythmias. Procedure time was longer with PVI + PWI without significant change in overall safety. Further studies should focus on long-term benefit.
FUNDAMENTO: Em pacientes com fibrilação atrial (FA) persistente, a realização do isolamento da parede posterior (IPP) além do isolamento das veias pulmonares (IVP) é controversa. OBJETIVO: Comparar IVP mais IPP versus IVP exclusivo em pacientes com FA persistente. MÉTODOS: Trata-se de uma revisão sistemática conduzida nas bases de dados PubMed (MEDLINE), Embase, LILACS, CENTRAL (Cochrane Library), e Clinicaltrials.gov por ensaios clínicos randomizados comparando IVP + IPP e IVP exclusivo e FA persistente. Os desfechos foram (i) recorrência de FA; (ii) recorrência de arritmias atriais, isto é, FA, taquicardia atrial, ou flutter atrial); (iii) complicações clínicas importantes (isto é, derrame ou tamponamento pericárdico; disfunção do nó sinusal ou fístula atrioesofágica); (iv) tempo médio de ablação. O risco de viés e a qualidade da evidência foram avaliados usando a ferramenta Cochrane de avaliação de risco de viés (RoB 2.0) e o GRADE, respectivamente. A significância estatística foi estabelecida em 5%, e análises por subgrupos e de sensibilidade foram realizadas. RESULTADOS: Foram incluídos oito estudos e 1119 pacientes, dos quais 561 se submeteram a IVP+IPP. Durante o seguimento (12-24 meses), a recorrência de FA foi significativamente diminuída com IPP adjuvante (RR 0,66; IC 95%; 0,44-0,98). O composto de arritmias atriais recorrentes não difere significativamente (RR 0,83, IC 95% 0,65- 1,06). As complicações clínicas maiores (RR 0,81, IC95% 0,42-1,58) foram similares, e o IVP exclusivo foi associado a um tempo médio mais curto de procedimento (diferença média -23,37 minutos, IC 95% -30,23, -16,50). CONCLUSÃO: O IPP adjuvante parece efetivo em melhorar FA recorrente, mas não a recorrência de todas as arritmias atriais. O tempo de procedimento foi mais longo com IVP + IPP sem mudança significativa na segurança global. Mais estudos são necessários para investigar os benefícios em longo prazo.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Pulmonary Veins , Recurrence , Humans , Atrial Fibrillation/surgery , Catheter Ablation/methods , Treatment Outcome , Pulmonary Veins/surgery , Randomized Controlled Trials as Topic , Time FactorsABSTRACT
La neuralgia del trigémino es un trastorno neuropático craneofacial que sigue una o más de las ramas del nervio craneal V y ocasiona ataques paroxísticos de alta intensidad, produce discapacidad y es más prevalente en el sexo femenino. El tratamiento de primera línea es el farmacológico, con el objetivo de aliviar los síntomas, evitar recidivas y complicaciones. Sin embargo, presenta un alto índice de refractariedad, por lo que se han desarrollado otros procedimientos no invasivos como la radiocirugía estereotáctica. Este tratamiento ofrece un alivio de los síntomas durante un periodo más prolongado que permite al paciente puntuar entre el rango I-III en la escala del Instituto Neurológico Barrow; sin embargo, también puede reaparecer. Con el objetivo de determinar la recurrencia de neuralgia del trigémino refractaria en pacientes tratados con radiocirugía estereotáctica, se realizó una revisión narrativa de artículos originales de revistas científicas en inglés y español, publicados de 2019 a 2024. La recurrencia posterior a la radiocirugía puede estar determinada por características propias de la enfermedad, así como por el plan de tratamiento. A pesar de ello, debido a la seguridad y eficacia que ofrece, es posible realizar múltiples intervenciones sin presentar complicaciones graves y obteniendo baja incidencia de casos de hipoestesia y una escasa prevalencia de aneurismas.
Trigeminal neuralgia is a neuropathic disease with a craniofacial trajectory following one or all the branches of the V cranial nerve. It is characterized by paroxysmal pain of high intensity that may cause disability, with higher prevalence in females. The first line of treatment is pharmacological seeking to alleviate the symptoms, diminishing the odds of recurrence and complications. Nonetheless, this therapy has a high rate of refractoriness. As a result, other non-invasive procedures have been developed such as stereotactic surgery. This treatment offers symptom relief for a longer period allowing the patient to score between I-III range in the Barrow Neurological Institute scale; however, it can also present refractoriness. This paper was written with the objective of determining the recurrence of trigeminal neuralgia in patients that have been treated with stereotactic surgery. The current review was done using original articles from journals in English and Spanish from 2019 to 2024. Post-radiosurgery recurrence may be determined by characteristics of the disease as well as the treatment plan. Despite this, due to the safety and effectiveness, multiple interventions can be performed, with low cases of hypoesthesia and aneurysms
Subject(s)
Patients , Recurrence , Trigeminal Neuralgia , Radiosurgery , El SalvadorABSTRACT
Introducción. La herniorrafia inguinal es una cirugía ampliamente realizada a nivel mundial, con casi 20 millones de procedimientos anuales. En la literatura no se describen diferencias significativas en las tasas de recurrencia entre las técnicas laparoscópicas, pero estos resultados difieren en cuanto a la fijación de la malla. Métodos. Estudio retrospectivo observacional en el que se incluyeron los pacientes sometidos a herniorrafia inguinal por laparoscopia en una institución de cuarto nivel en Medellín, Colombia, entre enero de 2019 y junio de 2023. Se registraron los datos demográficos, como edad, género y comorbilidades, y los datos del procedimiento, como técnica utilizada, tipo de hernia, tipo de malla y fijación o no de la malla. Los desenlaces posoperatorios evaluados fueron dolor agudo y crónico, recurrencia y otras complicaciones. Resultados. De un grupo de 1106 pacientes sometidos a herniorrafia inguinal por vía laparoscópica, 69,0 % fueron sometidos a la técnica transabdominal preperitoneal, 23,1 % a la técnica totalmente extraperitoneal y 7,9 % a totalmente extraperitoneal extendida. La malla macroporosa de baja densidad fue la más utilizada (56,3 %). A 784 (70,9 %) se les fijó la malla y a 322 (29,1 %) no. La tasa de complicaciones fue menor al 8 %. Al final, 77 (7,0 %) pacientes experimentaron dolor agudo y 26 crónico (2,3 %). Hubo recurrencia de la hernia en 20 pacientes (1,8 %). Conclusión. El uso de prótesis sin fijación en la herniorrafia inguinal por laparoscopia pareciera ser un procedimiento seguro, con una tasa de recidivas equiparables a los procedimientos con fijación y con una leve tendencia a un menor dolor posquirúrgico agudo y crónico.
Introduction. Inguinal herniorrhaphy is a widely performed surgery worldwide, with almost 20 million procedures annually. The literature does not describe significant differences in recurrence rates between laparoscopic techniques, but these outcomes differ in terms of mesh fixation. Methods. Retrospective observational study that included patients undergoing laparoscopic inguinal herniorrhaphy at a fourth-level institution in Medellin, Colombia, between January 2019 and June 2023. Demographic data, including age, gender, and comorbidities were recorded, along with data related to the procedure details, such as technique used, type of hernia, type of mesh, and mesh fixation or not. Postoperative outcomes evaluated were acute and chronic pain, recurrences, and other complications. Results. Of a group of 1106 patients undergoing laparoscopic inguinal herniorrhaphy, 69.0% underwent the preperitoneal transabdominal technique, 23.1% underwent the totally extraperitoneal tecnhique, and 7.9% underwent the extended totally extraperitoneal tecnique. Low-density macroporous mesh was the most used (56.3%); 784 (70.9%) had the mesh fixed and 322 (29.1%) did not. The complication rate was less than 8%. In the end, 77 (7.0%) patients experienced acute pain and 26 (2.3%) developed chronic pain. There was hernia recurrence in 20 patients (1.8%). Conclusion. The use of prostheses without fixation in laparoscopic inguinal herniorrhaphy seems to be a safe procedure, with a recurrence rate comparable to procedures with fixation and with slight tendency towards less acute and chronic postsurgical pain.
Subject(s)
Humans , Prostheses and Implants , Herniorrhaphy , Postoperative Complications , Recurrence , Laparoscopy , Hernia, InguinalABSTRACT
BACKGROUND: Anterior component separation (ACS), or Ramirez component separation technique, is an established technique still used by surgeons to repair a ventral hernia. Compared with other ventral hernia repair techniques, recent studies about ACS show more postoperative complications like wound breakdown, wound infection, hematoma, skin necrosis, seroma, and recurrence. Our study aims to compare the ACS technique with the preservation perforator technique and verify if the perforator preservation technique can decrease postoperative complications. MATERIALS AND METHODS: Cochrane Central, Embase, and PubMed were systematically searched for studies comparing the perforator-sparing ACS ventral hernia repair and the standard technique. Outcomes assessed were wound breakdown, skin necrosis, wound infection, seroma, hematoma, reoperation, and recurrence at least 3 months postoperatively. Statistical analysis was performed with R Studio. RESULTS: 94 studies were screened, and 11 studies were selected for full-text reading. Seven studies were selected, comprising 761 patients, of which 309 (40.6%) underwent the perforator-sparing ACS technique. We found lower wound breakdown rates for the preservation technique (RR 0.45; 95% CI 0.32; 0.63; p < 0.01). Also, the perforator-sparing technique presented lower reoperation rates (RR 0.59; 95% CI 0.35; 0.72; p < 0.01). No differences were found in skin necrosis (RR 0.22; 95% CI 0.03; 1.63; p = 0.14), wound infection (RR 0.69; 95% CI 0.25; 1.90; p = 0.47), seroma (RR 0.29; 95% CI 0.07; 1.26; p = 0.1), hematoma (RR 0.73; 95% CI 0.11; 5.06; p = 0.75), or recurrence (RR 0.81; 95% CI 0.37; 1.74; p = 0.59) rates. CONCLUSION: Our comprehensive systematic review with meta-analysis compared the perforator-sparing ACS with the standard technique and found lower wound breakdown and reoperation rates for the perforator-sparing technique. No differences were found in the other outcomes analyzed.
Subject(s)
Hernia, Ventral , Herniorrhaphy , Postoperative Complications , Humans , Herniorrhaphy/methods , Herniorrhaphy/adverse effects , Postoperative Complications/prevention & control , Hernia, Ventral/surgery , Reoperation/statistics & numerical data , Perforator Flap/blood supply , Seroma/etiology , Seroma/prevention & control , RecurrenceABSTRACT
OBJECTIVE: Surgical resection remains the gold standard treatment for bronchiectasis in patients who present with hemoptysis or suppuration, as well as in those who do not respond to clinical treatment. We sought to investigate the efficacy of sublobar resection (segmentectomy) and compare it with that of lobar resection (lobectomy) in patients with non-cystic fibrosis bronchiectasis. METHODS: Patients undergoing lobectomy or segmentectomy between 2019 and 2023 were included in the study. We analyzed intraoperative complications and postoperative outcomes, including length of hospital stay, length of ICU stay, and disease recurrence. RESULTS: There was no significant difference between the lobectomy and segmentectomy groups regarding the occurrence of intraoperative complications such as bleeding > 1000 ml, cardiogenic shock, and ventilatory instability (p > 0.999). However, the frequency of complications was significantly lower in the segmentectomy group than in the lobectomy group (p = 0.016). Hospital stays were longer in the lobectomy group than in the segmentectomy group (16 days vs. 5 days; p = 0.027), as were ICU stays (7 days vs. 1 day; p = 0.006). There was no significant difference between the lobectomy and segmentectomy groups regarding the recurrence rate (p = 0.541). CONCLUSIONS: Early identification of bronchiectasis patients who are candidates for surgical resection is essential because those who are identified as such early on are candidates for parenchyma-sparing resections, which are similar to lobar resections in terms of disease control and lead to shorter hospital stays and better postoperative outcomes.
Subject(s)
Bronchiectasis , Length of Stay , Pneumonectomy , Postoperative Complications , Humans , Bronchiectasis/surgery , Pneumonectomy/methods , Pneumonectomy/adverse effects , Male , Female , Middle Aged , Treatment Outcome , Adult , Aged , Retrospective Studies , Intraoperative Complications , RecurrenceABSTRACT
PURPOSE: RVVC is defined as four or more episodes of candidiasis in a 12-month period. Conventional treatment is complex and often involves long-term medication use or multiple treatments. ABL therapy is a promising treatment option as it is acceptable to women and has only rare side effects. We conducted a prospective study with the objective of assessing the effects of antimicrobial blue light (ABL) therapy for recurrent vulvovaginal candidiasis (RVVC) in drug-resistant women. METHODS: Our study enrolled RVVC drug-resistant women (defined based on clinical non-response to standard azole therapies confirmed through culture or persistence of VVC symptoms (oedema, erythema, pruritus, burning, dysuria and leucorrhea)), who received ABL through 10 sessions for 20 min once a week from January 2023 to January 2024. The symptoms of Recurent VVC were assessed after 10 treatment sections and after 6 months. RESULTS: We included 62 patients. The overall symptoms improvement were 79% immediately after treatment and 58% after 6 months, respectively. There was an improvement in the symptoms of pruritus, burning, oedema, erythema and leucorrhoea. CONCLUSION: ABL was an effective therapy to be employed in drug-resistant women suffering from RVVC.
Subject(s)
Candidiasis, Vulvovaginal , Recurrence , Humans , Female , Candidiasis, Vulvovaginal/therapy , Candidiasis, Vulvovaginal/drug therapy , Candidiasis, Vulvovaginal/radiotherapy , Adult , Prospective Studies , Brazil , Young Adult , Treatment Outcome , Phototherapy/methods , Middle Aged , Lasers, Semiconductor/therapeutic use , Blue LightABSTRACT
Lagochilascariasis is a neglected zoonosis that affects domestic and wild mammals, including humans, and can form nodules, especially on the neck. Although emerging, it is considered a rare disease in the Americas and, therefore, the objective was to report an atypical case of recurrent otitis with the formation of polyps in the ear canal in a domestic feline associated with lagochilascariasis in Brazil. A cat had a purulent exudate in one of her ears and responded poorly to treatments. During an otoendoscopy procedure, a polyp and nematodes were removed and sent for histopathological and parasitological diagnosis. Nematodes were subjected to DNA extraction, whose amplification of the 18S, cox1 and 12S genes in the Polymerase Chain Reaction (PCR) and genetic sequencing confirmed the presence of Lagochilascaris minor. To our knowledge, this is the first description of recurrent otitis with the formation of polyps in the ear canal associated with lagochilascariasis in domestic cats and the description of this atypical case may contribute to the elucidation of new clinical cases. Additionally, new molecular sequences are provided, contributing to the knowledge of the parasite.
Subject(s)
Cat Diseases , Ear Canal , Animals , Cats , Cat Diseases/parasitology , Cat Diseases/diagnosis , Cat Diseases/pathology , Brazil , Ear Canal/parasitology , Ear Canal/pathology , Female , Otitis/veterinary , Otitis/parasitology , Recurrence , Polyps/veterinary , Polyps/parasitology , Polyps/pathology , Ascaridida Infections/veterinary , Ascaridida Infections/parasitology , Ascaridida Infections/diagnosisABSTRACT
BACKGROUND: Treatment of atrial fibrillation (AF) with catheter ablation (CA) has evolved significantly. However, real-world data on long-term outcomes are limited, particularly in low- and middle-income countries. OBJECTIVE: This multicenter prospective cohort of consecutive patients aimed to evaluate the safety and efficacy of first-time CA for AF in Southern Brazil from 2009 to 2024. METHODS: The primary outcome was any atrial tachyarrhythmia (ATA) recurrence. Multivariable Cox proportional hazards model assessed independent predictors of recurrence. RESULTS: Among 1,043 patients (mean age 67.3 ± 11.3 years, 27.9% female), 75.5% had paroxysmal AF. At a median follow-up of 1.4 (1.0 - 3.4) years, 21.4% had ATA recurrence. Recurrence rates were 18.6% for paroxysmal and 29.8% for persistent AF, and 67.3% of events occurred within the first year after CA. Predictors of recurrence were persistent AF at baseline (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.15-2.13; p = 0.004), enlargement of left atrial diameter (HR 1.03, 95% CI 1.00-1.05; p = 0.033), and higher EHRA score of AF symptoms (HR 1.60, 95% CI 1.18-2.18; p = 0.003). Recurrence rates decreased over time according to the procedure's calendar year, with a 9% relative reduction per consecutive year (HR 0.91; p < 0.001). There was a 2.1% rate of procedure-related adverse events. CONCLUSIONS: In the largest cohort study of consecutive AF ablations in Latin America, predictors of ATA recurrence were related to later stages of AF. Complication and recurrence rates were comparable to those in high-income countries, underscoring the global applicability of CA for AF management.
FUNDAMENTO: O tratamento da fibrilação atrial (FA) com ablação por cateter evoluiu significativamente. No entanto, dados do cenário clínico real em desfechos de longo prazo são limitados, particularmente em países de baixa e média renda. OBJETIVO: Este estudo prospectivo, multicêntrico, do tipo coorte de pacientes consecutivos tem como objetivo avaliar a segurança da primeira ablação por cateter da FA na região sudeste do Brazil entre 2009 e 2024. MÉTODOS: O desfecho primário foi a recorrência de qualquer taquiarritmia atrial (TAA). O modelo de riscos proporcionais de Cox avaliou preditores independentes de recorrência. RESULTADOS: Entre 1043 pacientes (idade média 67,3 ± 11,3 anos, 27,9% mulheres), 75,5% apresentaram FA paroxística. Após um tempo mediano de acompanhamento de 1,4 (1,0 3,4) anos, 21,4% apresentaram recorrência de TAA. As taxas de recorrência foram de 18,6% para FA paroxística e de 29,8% para FA persistente; 67,3% dos eventos ocorreram no primeiro ano após a ablação por cateter. Preditores de recorrência foram FA persistente no basal [hazard ratio (HR) 1,57, Intervalo de Confiança (IC) 95% 1,15-2,13; p = 0,004), aumento do diâmetro atrial esquerdo (HR 1,03, IC95% 1,00-1,05; p = 0,033), e escore EHRA de sintomas de FA mais alto (HR 1,60, IC95% 1,18-2,18; p = 0,003). As taxas de recorrência diminuíram ao longo do tempo de acordo com o ano calendário do procedimento, com uma redução de 9% por ano consecutivo (HR 0,91; p < 0,001). Houve uma taxa de 2,1% de ocorrência de eventos adversos relacionados ao procedimento. CONCLUSÃO: No maior estudo coorte de ablações consecutivas da FA da América Latina, preditores de recorrência de TAA se associaram com estágios mais avançados da FA. As taxas de complicação e de recorrência foram comparáveis às de países de alta renda, destacando a aplicabilidade global da ablação por cateter para o manejo da FA.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Recurrence , Registries , Humans , Atrial Fibrillation/surgery , Female , Male , Aged , Catheter Ablation/adverse effects , Catheter Ablation/methods , Prospective Studies , Brazil/epidemiology , Middle Aged , Treatment Outcome , Risk Factors , Time Factors , Proportional Hazards ModelsABSTRACT
BACKGROUND: Pancreas divisum is an anatomical abnormality where the junction of the main and accessory pancreatic duct fails to occur and the smaller-caliber duct acts as dominant, resulting in overload during the drainage of the organ's secretion through the minor duodenal papilla. AIMS: To report a case of recurrent acute pancreatitis due to symptomatic pancreas divisum who underwent pancreatoduodenectomy. CASE REPORT: A 21-year-old male patient presented with intermittent painful crises, located in the upper abdomen, with radiation to the back, associated with nausea and vomiting, for the past three years. Magnetic resonance imaging and endoscopic retrograde cholangiopancreatography revealed pancreas divisum, subsequently confirmed by endoscopic ultrasound. An attempt was made through endoscopic intervention but failed to catheterize the minor papilla; therefore, a pancreaticoduodenectomy was indicated. The organ was identified as hard and atrophied, with moderate peripancreatic inflammation. The histopathological findings also identified a focal well-differentiated G1-type neuroendocrine tumor measuring 0.4 cm. CONCLUSIONS: In patients with pancreas divisum, rare cases may progress to recurrent acute pancreatitis. Pancreaticoduodenectomy is an option in symptomatic patients who had no success with endoscopic treatment.
Subject(s)
Pancreas , Pancreaticoduodenectomy , Pancreatitis , Recurrence , Humans , Male , Pancreatitis/surgery , Pancreatitis/etiology , Young Adult , Acute Disease , Pancreas/abnormalities , Pancreas/surgery , Pancreas DivisumABSTRACT
OBJECTIVE: Pelvic organ prolapse affects women's quality of life through symptoms such as vaginal laxity, urinary incontinence, defecation and sexual dysfunction, and pelvic pain. Given the challenges in managing recurrent cases, understanding risk factors and the effect of surgical choices on recurrence is vital for guiding clinical decisions. This study explores how uterine preservation influences postoperative recurrence and develops predictive models to aid in assessing recurrence risk. METHODS: A total of 87 patients diagnosed with pelvic organ prolapse who underwent laparoscopic sacral fixation were included. Patients were classified into two groups based on the occurrence of pelvic organ prolapse recurrence within 3 years post-surgery (recurrence: n=22; no recurrence: n=65). Follow-up over 3 years was recorded. Factors including age, body mass index, birth order, occupation, and uterus preservation during surgery were evaluated. The relationship between pelvic floor muscle strength and pelvic organ prolapse recurrence was also examined. Logistic regression analysis assessed the correlation between pelvic organ prolapse recurrence and levels of serum elastase inhibitor and osteopontin. RESULTS: In a follow-up of 87 patients with pelvic organ prolapse, 22 experienced recurrences within 3 years, marking a 25.29% recurrence rate. Multivariate analysis identified older age, higher parity, and sustained contraction of type II muscle fibers as independent risk factors for recurrence (all p<0.05). Lower systolic blood pressure in type I and II muscle fibers was associated with decreased serum elastase inhibitor and osteopontin levels, increasing pelvic organ prolapse recurrence risk. Logistic regression identified age, multiple deliveries, and low systolic pressure in type II muscle fibers as independent recurrence factors. The constructed nomogram risk prediction model, incorporating these factors, showed good discrimination ability with an area under the receiver operating characteristic curve of 0.891 (95%CI 0.871, 0.921), indicating accurate predictions and high net benefit. CONCLUSION: Factors such as age, birth order, uterine preservation, and pelvic floor muscle strength impact postoperative pelvic organ prolapse recurrence. Older age, a higher number of deliveries, and reduced systolic pressure of class II muscle fibers are independent risk factors for pelvic organ prolapse recurrence after surgery.
Subject(s)
Nomograms , Pelvic Organ Prolapse , Recurrence , Humans , Female , Pelvic Organ Prolapse/surgery , Middle Aged , Risk Factors , Aged , Risk Assessment , Adult , Age Factors , Pelvic Floor/physiopathology , Laparoscopy , Treatment Outcome , Follow-Up Studies , Logistic ModelsABSTRACT
OBJECTIVE: This study aimed to evaluate the prognostic significance of the cardiac electrophysiological balance index in predicting the recurrence of atrial fibrillation following radiofrequency ablation. METHODS: Patients with paroxysmal atrial fibrillation undergoing radiofrequency ablation were enrolled from July 2021 to March 2023 and categorized into recurrence and non-recurrence groups based on postoperative atrial fibrillation recurrence during a 6- to 12-month follow-up. Clinical and electrocardiogram data at admission were collected, and cardiac electrophysiological balance index was calculated. Multivariate logistic regression analysis identified independent factors contributing to atrial fibrillation recurrence. Receiver operating characteristic curves assessed predictive values. RESULTS: Among 127 subjects, 36 experienced postoperative recurrence (22 paroxysmal atrial fibrillation, 10 atrial flutter, and 4 atrial tachycardia). Significant differences in hypersensitive C-reactive protein levels, QT, QRS, and cardiac electrophysiological balance index were observed between recurrent and non-recurrent groups. Multivariate analysis revealed cardiac electrophysiological balance index as an independent risk factor for recurrence (OR 1.766, 95%CI 1.415-2.204, p<0.001). Receiver operating characteristic curve analysis showed cardiac electrophysiological balance index's predictive value with an area under the curve of 0.865 (95%CI 0.807-0.923, p<0.001), and a cutoff value of 4.3 demonstrated a sensitivity of 87.67% and a specificity of 71.23%. CONCLUSIONS: The cardiac electrophysiological balance index emerges as a non-invasive tool with substantial predictive value for estimating the likelihood of paroxysmal AF recurrence post-ablation.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Electrocardiography , Predictive Value of Tests , ROC Curve , Recurrence , Humans , Atrial Fibrillation/physiopathology , Atrial Fibrillation/surgery , Male , Female , Middle Aged , Risk Factors , Aged , Prognosis , Treatment OutcomeABSTRACT
Mosquito-borne infectious diseases represent a significant public health issue. Age has been identified as a key risk factor for these diseases, and another phenomenon reported is relapse, which involves the reappearance of symptoms after a symptom-free period. Recent research indicates that susceptibility to and relapse of mosquito-borne diseases are frequently age-dependent. This paper proposes a new model to better capture the dynamics of mosquito-borne diseases by integrating two age-dependent factors: chronological age and asymptomatic-infection age. Chronological age refers to the time elapsed from the date of birth of the host to the present time. On the other hand, asymptomatic infection age denotes the time elapsed since the host became asymptomatic after the primary infection. The system of integro-differential equations uses flexible, unspecified functions to represent these dependencies, assuming they are integrable. We analyzed the global stability of both the disease-free and endemic equilibrium states using the direct Lyapunov method with Volterra-type Lyapunov functionals. Additionally, the paper explores several special cases involving well-known host-vector models.
Subject(s)
Culicidae , Mosquito Vectors , Vector Borne Diseases , Humans , Animals , Vector Borne Diseases/transmission , Vector Borne Diseases/epidemiology , Recurrence , Disease Susceptibility , Computer Simulation , Risk Factors , Algorithms , Models, Biological , Age Factors , Mosquito-Borne DiseasesABSTRACT
BACKGROUND: Point-by-point ablation with a high-power short-duration (HPSD) technique in atrial fibrillation (AF) ablation is used worldwide. Little data is available with the HPSD and dragging technique (DT). OBJECTIVE: To perform a multivariate analysis of clinical and procedural predictors of success and recurrence in HPSD with DT. METHODS: 214 patients in the first AF ablation in sinus rhythm were prospectively enrolled. DT with radiofrequency power of 50 W and contact force (CF) of 10-20 g and 5-10 g at a flow rate of 40 mL/min were applied on the anterior and posterior walls, respectively. Statistical significance was defined as p < 0.05. RESULTS: 143 (66.8%) males, paroxysmal AF (PAF) in 124 (57.9%), with 61.1±12.3 years and followed for 32.8±13.2 months. After 90 days, AF occurred in 43 (20.1%) patients, 19 (15.3%) from PAF, and 24 (26.7%) in persistent AF (PersAF). Multivariate analysis indicated as clinical predictors of recurrence: age ≥ 65 years (p=0.006); obesity [body mass index > 30 (p=0.009)]; CHA2DS2VASC score ≥ 3 (p=0.003); and PersAF (p=0.045). The procedural predictor of recurrence was a heart rate increase < 10% (p=0.006). Predictors of success were an increase in heart rate ≥ 30% (p=0.04) and < 60 min in left atrium time (LAT) (p=0.007). CONCLUSION: AF ablation with DT and HPSD clinical and procedural predictors of recurrence were ≥ 65 years, obesity, a CHA2DS2VASC ≥ 3, PersAF, and a heart rate increase of < 10% after ablation. Success predictors were an increase of ≥ 30% in heart rate and low LAT (< 60 min).
FUNDAMENTO: A ablação ponto a ponto com uma técnica de curta duração e alta potência (HPSD) é utilizada em todo o mundo para fibrilação atrial (FA). Poucos dados estão disponíveis com HPSD e técnica de arrasto (DT). OBJETIVO: Realizar uma análise multivariada dos preditores clínicos e procedimentais de sucesso e reincidência em HPSD com DT. MÉTODOS: Foram incluídos prospectivamente 214 pacientes em primeira ablação de FA em ritmo sinusal. DT com potência de radiofrequência de 50 W e força de contato (FC) de 1020 g e 510 g a uma vazão de 40 mL/min foram aplicados nas paredes anterior e posterior, respectivamente. A significância estatística foi definida como p < 0,05. RESULTADOS: 143 (66,8%) homens, FA paroxística (FAP) em 124 (57,9%), com 61,1±12,3 anos e acompanhados por 32,8±13,2 meses. Após 90 dias, FA ocorreu em 43 (20,1%) pacientes, 19 (15,3%) na FAP e 24 (26,7%) na FA persistente (FAPers). A análise multivariada indicou como preditores clínicos de reincidência: idade ≥ 65 anos (p=0,006); obesidade [índice de massa corporal > 30 (p=0,009)]; pontuação CHA2DS2VASC ≥ 3 (p=0,003); e FAPers (p=0,045). O preditor procedimental de reincidência foi um aumento da frequência cardíaca < 10% (p=0,006). Os preditores de sucesso foram aumento da frequência cardíaca ≥ 30% (p=0,04) e < 60 min no tempo de átrio esquerdo (TAE) (p=0,007). CONCLUSÃO: A ablação de FA com preditores clínicos e procedimentais DT e HPSD de reincidência foram ≥ 65 anos, obesidade, CHA2DS2VASC ≥ 3, FAPers e aumento da frequência cardíaca < 10% após a ablação. Os preditores de sucesso foram um aumento ≥ 30% na frequência cardíaca e TAE baixo (< 60 min).
Subject(s)
Atrial Fibrillation , Catheter Ablation , Recurrence , Humans , Atrial Fibrillation/surgery , Atrial Fibrillation/physiopathology , Male , Female , Catheter Ablation/methods , Middle Aged , Aged , Time Factors , Treatment Outcome , Multivariate Analysis , Prospective Studies , Risk FactorsABSTRACT
INTRODUCTION: The benefits of long-acting injectable antipsychotics have been documented in several observational studies, but data remain scarce in Latin America. This study aimed at evaluating the effectiveness of paliperidone palmitate once monthly (PP1M) on treatment adherence and relapse in the schizophrenia population followed in a government-funded mental health care facility in Colombia. METHODS: A mirror-image study was conducted. Adult schizophrenia patients treated with oral antipsychotics who subsequently received ≥2 PP1M injections between Jan. 1st, 2015 and Oct. 31st, 2018 were included. The study consisted of two retrospective phases: 12 months before and after the first PP1M injection. Outcomes were treatment adherence (proportion of days covered ≥80%), hospitalized relapse, hospital length of stay, and non-hospitalised relapse. Effect of PP1M on outcomes was assessed through multivariable conditional Poisson regression. RESULTS: 123 patients were eligible (mean age, 30.3 years; 79.7% males). Adherence was 23.6% in the pre-phase and 89.4% in the post-phase (RR=3.77; 95%CI, 2.75-5.17). The proportion of patients with hospitalised relapse decreased from 46.3% to 35.0% (RR=0.76; 95%CI, 0.59-0.99). In the 75 (61.0%) patients who continued PP1M throughout post-phase, beneficial effect on hospitalised relapse was stronger (RR=0.64; 95%CI, 0.42-0.98). The proportion of patients with non-hospitalised relapse symptoms increased from 6.5% to 18.7% (RR=2.27; 95%CI, 1.11-4.64). CONCLUSIONS: PP1M initiation led to a dramatic improvement in treatment adherence and a decrease in hospitalised relapse. Observed increase in non-hospitalised relapse may be explained by a decrease in severity. Limitations are absence of a parallel comparison group and a generalisability limited to the population treated at this facility. Study provides data for the Latin America region and strength is the assessment of non-hospitalised relapse symptoms.
Subject(s)
Antipsychotic Agents , Paliperidone Palmitate , Recurrence , Schizophrenia , Humans , Paliperidone Palmitate/administration & dosage , Male , Female , Adult , Colombia , Antipsychotic Agents/administration & dosage , Schizophrenia/drug therapy , Retrospective Studies , Hospitalization/statistics & numerical data , Young Adult , Delayed-Action Preparations , Treatment Outcome , Length of Stay/statistics & numerical data , Middle AgedABSTRACT
OBJECTIVE: The objective of this study was to describe the single-surgeon experience on transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension in patients with severe prolapse who had concomitant vaginal hysterectomy. METHODS: A total of 53 patients with severe uterine prolapse who underwent vaginal hysterectomy and transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension between January 2021 and March 2023 were included in the study. Operation time, intraoperative and postoperative complications, de novo urinary continence, and duration of hospitalization were obtained from the patient records. Initial postoperative follow-up visits were scheduled for the first week of the month. Patients were followed up yearly, and they had the opportunity to reach the surgical team at any time. Symptomatic prolapse beyond the hymen is defined as recurrence. RESULTS: Patients had a mean age of 61.7 years ±7.7 SD. All patients received bilateral opportunistic salpingectomy and salpingo-oophorectomy. The total operation time was 162±31 min, with transvaginal natural orifice transluminal endoscopic surgery taking 32.3±5.37 min. There were no intraoperative complications. 12 patients had recurrence; 8 anterior, 3 apical, and 1 posterior prolapse. The mean recurrence time was 11.5 months (range 5-23 months). The reoperation rate was 13.2% (n:7). Three of the patients had obliterative vaginal surgery, three of the patients had anterior, and one patient had posterior repair. Overall failure of apical surgical procedure was 5.6%. Two patients had de novo incontinence postoperatively. CONCLUSIONS: Transvaginal natural orifice transluminal endoscopic surgery uterosacral ligament suspension is a feasible technique to treat severe pelvic organ prolapse with promising results for short-term efficacy and safety in patients who had concomitant vaginal hysterectomy. Longer follow-up periods are needed to evaluate the long-term efficacy profile of transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension.
Subject(s)
Hysterectomy, Vaginal , Ligaments , Natural Orifice Endoscopic Surgery , Operative Time , Pelvic Organ Prolapse , Humans , Female , Middle Aged , Hysterectomy, Vaginal/methods , Natural Orifice Endoscopic Surgery/methods , Aged , Treatment Outcome , Ligaments/surgery , Pelvic Organ Prolapse/surgery , Postoperative Complications , Retrospective Studies , RecurrenceABSTRACT
OBJECTIVE: We aim to perform a systematic review and meta-analysis to analyze the efficacy and safety of low-cost meshes compared to polypropylene meshes for IHR. METHODS: We searched Pubmed, Embase, Cochrane, and Web of Science for randomized controlled trials (RCTs) comparing low-cost and standard meshes for IHR. Low-cost mesh was defined as a material non-designed for medical use. The primary outcomes analyzed were postoperative pain, recurrence, surgical site infection (SSI), seroma, and hematoma rates. Statistical analysis was done using R software. RESULTS: 8 RCTs were ultimately included in our study with 788 patients, of which 394 (50%) underwent IHR repair with low-cost mesh. Surgical techniques employed were Lichtenstein repair in 7 studies, and laparoscopic totally extraperitoneal (TEP) repair in 1 RCT. No statistically significant differences for both superficial (2.8% vs. 2.8%; RR 0.98; 95%CI 0.4-2.43; P = 0.97; I2 = 0%), deep SSI (0% vs. 0.31%; RR 0.33; 95%CI 0.01-7.91; P = 0.5; I2 = 0%) and overall SSI (3.6% vs. 4.3%; RR 0.83; 95%CI 0.42-1.66; P = 0.6; I2 = 0%) were evidenced. Recurrence rate at 1 year was similar between the groups analyzed (0.66% vs. 0%; RR 2.95; 95%CI 0.31-27.95; P = 0.35; I2 = 0%). No differences were found for hematoma (12.6% vs. 12.6%; RR 0.99; 95%CI 0.67-1.47; P = 0.98; I2 = 0%) and seroma (1.97% vs. 2.33%; RR 0.83; 95%CI 0.29-2.4; P = 0.73; I2 = 0%) rates. CONCLUSION: This meta-analysis found similar postoperative complication rates for both low-cost and standard polypropylene meshes following IHR. PROSPERO REGISTRATION: ID CRD42024555273.
Subject(s)
Hernia, Inguinal , Herniorrhaphy , Randomized Controlled Trials as Topic , Surgical Mesh , Humans , Surgical Mesh/economics , Herniorrhaphy/adverse effects , Herniorrhaphy/economics , Herniorrhaphy/methods , Hernia, Inguinal/surgery , Postoperative Complications , Polypropylenes , Surgical Wound Infection , RecurrenceABSTRACT
Multiple sclerosis (MS) is a chronic, multifactorial, inflammatory and demyelinating disease of the central nervous system (CNS), which involves an autoimmune response against components of the myelin sheaths. Anti-B cell therapies have been proven to be successful in reducing relapses. Therefore, the study of B cells in both phases of the disease (relapse and remission) is of great importance. Here, we analyzed peripheral blood-cell BCR repertoire from 11 MS patients during a relapse phase and during remission, 6 patients with other inflammatory neurological diseases (OIND) and 10 healthy subjects (HCs), using next generation sequencing. In addition, immunoglobulins G, M, A and D were quantified in the serum of patients and controls, using ELISA. BCR repertoire of relapsing MS patients showed lower diversity, as well as a higher rate of somatic hypermutation compared to the other study groups. Within this group, the highest percentage of shared clonotypes was observed. IGHV4-32 gene was identified as a potential differential biomarker between MS and OIND, as well as IGL3-21 gene as a potential MS biomarker. On the other hand, an elevation of IgG and IgD was found in the serum of MS patients during remission, and the serum IgG was also elevated in MS patients during relapse. In conclusion, these results show the important role of B cells in the pathogenesis of the MS relapses and a new panorama on the analysis of the peripheral blood BCR repertoire to obtain diagnostic tools for MS. Furthermore, this work highlights the need of studies in diverse populations, since results reported in Caucasian populations may not coincide with the immunological course of MS patients in other latitudes, due to differences in genetic background and environmental exposures.
Subject(s)
B-Lymphocytes , Multiple Sclerosis , Receptors, Antigen, B-Cell , Humans , Female , Adult , Male , Receptors, Antigen, B-Cell/genetics , Receptors, Antigen, B-Cell/immunology , Middle Aged , Multiple Sclerosis/immunology , Multiple Sclerosis/blood , Multiple Sclerosis/genetics , B-Lymphocytes/immunology , Recurrence , Multiple Sclerosis, Relapsing-Remitting/immunology , Multiple Sclerosis, Relapsing-Remitting/blood , Multiple Sclerosis, Relapsing-Remitting/genetics , Biomarkers/blood , Young Adult , Immunoglobulin G/blood , Immunoglobulin G/immunologyABSTRACT
Up to one-third of patients with classical Hodgkin lymphoma (cHL) are not responsive to first-line therapy or eventually relapse. Immune checkpoint inhibitors (ICIs) have been successfully employed to treat relapsed/refractory cHL (r/r cHL) but place patients at risk of financial toxicity. Early-phase trials and observational data suggest that low doses of ICIs may achieve similar results to those obtained with high doses. In this study, we report a single-center experience using low-dose nivolumab (LD-Nivo) in different combinations for r/r cHL, including monotherapy, LD-Nivo plus brentuximab vedotin (BV), and LD-Nivo plus chemotherapy. The primary outcome was to assess the efficacy of LD-nivo in patients with r/r cHL. We included 23 consecutive patients (median age 27 years; 57% female). LD-Nivo was prescribed in 40, 100, and 140 mg fixed doses Q2W. Survival analysis was performed employing the Kaplan-Meier method. 73% of patients achieved an overall response, 43% complete response, and 30% partial response. One-year overall survival was 94.4% (95% CI, 0.84-1), and the 1-year progression-free survival was 89.4% (95% CI, 0.77-1). OS and PFS were similar accross combinations. The median dose of nivolumab was 0.78 mg/kg (range, 0.62-1.11), and the median number of cycles until a response was documented was 6 (range, 2-9). During follow-up, 18 patients received transplantation (11 autologous, 6 allogeneic). No statistically significant differences in survival or response were detected between nivolumab combinations or doses. Adverse events were observed in 61% of the patients, with none grade 3-4. LD-Nivo demonstrated promising results in relapsed/refractory HL, highlighting its potential as a cost-effective treatment option. Further research is needed to validate these findings and guide clinical practice.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Brentuximab Vedotin , Hodgkin Disease , Nivolumab , Humans , Nivolumab/administration & dosage , Nivolumab/therapeutic use , Hodgkin Disease/drug therapy , Hodgkin Disease/mortality , Female , Male , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Middle Aged , Young Adult , Brentuximab Vedotin/administration & dosage , Brentuximab Vedotin/therapeutic use , Adolescent , Immune Checkpoint Inhibitors/administration & dosage , Immune Checkpoint Inhibitors/therapeutic use , Immune Checkpoint Inhibitors/adverse effects , Retrospective Studies , Aged , RecurrenceABSTRACT
BACKGROUND: Given the 4-times higher prevalence of femoral hernias among females compared to males, this diagnosis may be missed during inguinal hernia repair (IHR), causing risk of reoperation for pseudo recurrence of femoral hernias (FH). Minimally invasive approaches are suggested as potential reducers of missed FH since they provide a posterior view of all defect areas, despite studies suggesting that women receive less MIS than men. We aim to assess the missed FH during IHR and after reoperation for recurrence following IHR in women. METHODS: PubMED, Cochrane, and EMBASE databases were searched for studies assessing patients undergoing recurrent IHR, analyzing the incidence of reoperation for FH and occult femoral hernias during IHR. Statistical analysis was performed using R software. RESULTS: From 6,226 records, 10 retrospective observational studies were included, totaling 15,863 patients (20% females). We found that 19.56 per 100 women (95% CI 8.34, 39.37) who are reoperated for an inguinal hernia are found as having a FH during the new repair. Compared to men, women were at a significantly higher risk to be reoperated for FH after IHR (RR 8.97; 95% CI 7.35, 10.93; P < 0.001). Our analysis also showed that 20.7% of females received MIS approaches for groin hernia repair, while 79.3% received open procedures. Furthermore, our study found a pooled incidence of occult FH during the initial IHR of 6.85 per 100 patients for both genders (95% CI 2.78, 15.90), which increased to 21.42 per 100 patients when assessing females only (95% CI 15.46, 28.89). CONCLUSIONS: Females have a higher incidence of FH following reoperation for recurrence of inguinal hernia repair. Added to the high rate of occult FH encountered during inguinal procedures, this suggests a missed diagnosis of FH during IHR. The adoption of MIS IHR for women is fundamental to reduce the underdiagnosis of FH.