Performance of a vaginal self-collection device versus clinician collected cervical samples for the detection of high-risk human papillomavirus.

Objective: Screening for cervical cancer requires the participation of target women. Human papillomavirus (HPV) testing can be performed on vaginal self-samples and self-sampling can improve this participation. This study aims to validate the performance of the vaginal self-sampling device (Vitroveil®) to detect high risk human papillomavirus (hrHPV) in comparison to clinician collected samples and evaluate the degree of acceptability of the Vitroveil® device. Methods: A cross-sectional observational study was carried out in a cohort of 385 participating women (median age of 44 ± 10.47 years) attending primary care centers and cervical pathology services of Granada, Spain. Two paired samples (vaginal self-sample and clinician collected cervical sample) where collected from each participant to compare the detection of HPV with the Vitro HPV Screening assay (Vitro, Granada, Spain). A questionnaire was also provided to the participants to analyze the degree of satisfaction with the device and the preference for sampling method. Results: Overall concordance for hrHPV detection was substantial (ĸ 0.804). The prevalence of any hrHPV infection was higher in self-collected samples (30.6%) than in clinician-collected samples (24.3%). The participants found the self-sampling device easy to use and preferred self-collection as the collection method. Conclusion: The Vitroveil® self-sampling device enables safe and accruable hrHPV testing, obtaining equivalent results to those of the clinician collected samples. High acceptability of the device has been demonstrated among women in the study. Nevertheless, additional studies are necessary to verify the efficacy and reliability of the device's performance.

Características clínico-oftalmológicas y evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social, Paraguay / Clinical-ophthalmological characteristics and evolution of patients with moderately severe active thyroid ophthalmopathy treated with methylprednisolone boluses who attended the Central Hospital of the Instituto de Previsión Social, Paraguay

Introducción: La oftalmopatía tiroidea (OT) es un trastorno debilitante en pacientes con enfermedad tiroidea autoinmune, principalmente enfermedad de Graves, que se desarrolla entre el 30 a 50% de los casos. Objetivos: Describir las características clínico-oftalmológicas y la evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social en el tiempo comprendido entre enero de 2018 y setiembre de 2021. Materiales y métodos: Investigación de diseño observacional, con estudio descriptivo, retrospectivo. Resultados: Se revisaron fichas de 34 pacientes con OT activa moderada severa que recibieron bolos de metilprednisolona basado en las guías EUGOGO 2016, de los cuáles se excluyeron 3 pacientes por tener fichas incompletas y otros 3 pacientes ya que requirieron tratamiento de segunda línea previo al término del esquema de 12 sesiones. De los 28 pacientes estudiados, la edad promedio fue de 43,6 ±13,1 años, el 89% de sexo femenino y el 28,5%, fumadores. En cuanto a la función tiroidea de la población previo al tratamiento, se constató hipertiroidismo en el 82%, hipotiroidismo en el 11% y eutiroidismo en el 7%; y posterior al tratamiento, se constató hipertiroidismo en el 78,6% (subclínico), eutiroidismo en el 17,9% e hipotiroidismo en el 3,5%. La mayoría (92.6%) contaba con anticuerpos contra el receptor de TSH positivo, con un promedio de 18 ± 9,9 mIU/Ml. Respecto a la actividad de la oftalmopatía según la escala CAS, se constató un promedio de 4,1 ±1,0 previo al tratamiento y posterior 1,2 ±1,4; de ellos el 46,4% presentó un estado leve según escala de gravedad, 39% sin criterios de gravedad y 14 % persistió en moderada -severa. Se constató mejoría de la agudeza visual tras el tratamiento (57,1%), el promedio de exoftalmía previo al tratamiento fue 22,2 mm y posterior 21,1 mm; se presentó diplopía en el 7,1% previo al tratamiento y en el 3,6% posterior al tratamiento. Conclusión: El tratamiento con glucocorticoides endovenosos en la oftalmopatía de Graves moderada-severa (esquema EUGOGO 2016) fue muy efectivo, revirtiendo la actividad y consecuentemente ayudando a disminuir la gravedad, en la gran mayoría de nuestros pacientes. Esto podría explicarse porque la oftalmopatía era incipiente y por el alto grado de adherencia de los pacientes en el contexto de un manejo multidisciplinar bien protocolizado.

Introduction: Graves' orbitopathy (GO) is a debilitating disorder in patients with autoimmune thyroid disease, mainly Graves' disease, which develops in 30 to 50% of cases. Objectives: To describe the clinical-ophthalmological characteristics and evolution of patients with moderate-to- severe active GO treated with methylprednisolone boluses who attended the Central Hospital of the Institute of Social Security between January 2018 and September 2021. Materials and methods: Observational design research, descriptive, retrospective study. Results: Records of 34 patients with active moderate-to-severe GO who received boluses of methylprednisolone based on the EUGOGO 2016 guidelines, were reviewed, of which 3 patients were excluded due to having incomplete records and another 3 patients since they required second-line treatment prior to end the 12-session scheme. Of the 28 patients studied, the average age was 43.6 ±13.1 years, 89% were female and 28.5% were smokers. Regarding the thyroid function of the population prior to treatment, hyperthyroidism was found in 82%, hypothyroidism in 11% and euthyroidism in 7%; and after treatment, hyperthyroidism was found in 78.6% (subclinical), euthyroidism in 17.9% and hypothyroidism in 3.5%. The majority (92.6%) had positive thyrotropin receptor antibodies, with an average of 18 ± 9.9 mIU/Ml. Regarding the activity of orbitopathy according to the CAS scale, an average of 4.1 ±1.0 was found before treatment and 1.2 ±1.4 after; Of them, 46.4% presented a mild condition according to the severity scale, 39% without severity criteria and 14% persisted in moderate-severe. Improvement in visual acuity was noted after treatment (57.1%), the average exophthalmia before treatment was 22.2 mm and after 21.1 mm; Diplopia occurred in 7.1% before treatment and in 3.6% after treatment. Conclusion: Treatment with intravenous glucocorticoids in moderate-severe Graves' orbitopathy (EUGOGO 2016 scheme) was very effective, reversing the activity and consequently helping to reduce the severity, in the vast majority of our patients. This could be explained because the orbitopathy was incipient and by the high degree of patient adherence in the context of well-protocolized multidisciplinary management.

The application of blockchain algorithms to the management of education certificates.

Blockchain is a new application technology in many sectors and the same is true in the world of education. Therefore, there is an increasingly emerging need to research blockchain technology, as it is still taking its first steps in different sectors, such as education. This article presents a review of the state of the art of blockchain technology in the education sector, focusing on identifying the advantages, disadvantages, and challenges associated with the introduction of blockchain technology in the education sector. In addition, the implementation of a title certificate solution through blockchain technology through the BeCertify project is presented. In this solution, the development stages of the platform, the system architecture, and the operation of the API have been carried out, resulting in a platform that constitutes the first step towards a more transparent and technologically advanced way of managing the certifications of the students' qualifications.

Essentials in Minimally Invasive Gynecology Manual Skills Pilot Validation Trial.

STUDY OBJECTIVE: To evaluate the Essentials in Minimally Invasive Gynecology (EMIG)- Fundamentals of Laparoscopic Surgery Laparoscopic Simulation System and the EMIG Hysteroscopy Simulation System for face validity and functionality in a pilot testing environment. DESIGN: A prospective controlled pilot study. SETTING: Three teaching institutions in the US Southwest. SUBJECTS: Twenty-seven residents and gynecologists, with 22 fitting who fit 1 of 4 categories of exposure to hysteroscopic and laparoscopic surgery and surgical simulation. Eleven were postgraduate year 1 and 5 postgraduate year 3, 1 was American Board of Obstetrics & Gynecology certified, and 5 were either fellows in-training or had completed a fellowship in minimally invasive gynecologic surgery. INTERVENTIONS: After completing a screening survey, each subject was exposed to a structured orientation to the 2 simulation systems and then tested with proctor supervision on the 5 laparoscopic and 2 hysteroscopic exercises. A short 5-point Likert questionnaire designed to determine face validation and question clarity was administered to each subject at sites 2 and 3. MEASUREMENTS AND MAIN RESULTS: Face validity was high for each of the 7 exercises (means ranged from 4.8 to 4.9 of 5), and subjects considered instructions to be clear (means from 4.7 to 4.9). The recorded exercise times generally reduced with increasing levels of training, although the sample sizes were not designed to determine significance given the pilot design. Similarly, exercise errors were generally less frequent with increasing experience. The systems, including the devices and recording mechanisms, performed well, and proctor evaluation and training were satisfactory. CONCLUSION: The EMIG laparoscopic and hysteroscopic simulations systems were considered to have good face validity and appear to be suitable for a construct validation trial to confirm their utility in distinguishing among trainees and practitioners with a wide spectrum of endoscopic surgical experience. The recording and specimen storage mechanisms will allow for multiple proctors to rate a candidate's performance, thereby enhancing evaluation consistency and quality.

Association of first-trimester HbA1c levels with adverse pregnancy outcomes in different ethnic groups.

AIM: To determine, in a multi-ethnic cohort, the association of first-trimester HbA1c levels with the development of pregnancy complications. METHODS: A prospective study between April 2013-October 2016. Participants were stratified in five ethnic groups. Women had an HbA1c measurement added to their first antenatal bloods. Primary outcome was macrosomia and secondary outcomes included preeclampsia and large-for-gestational age (LGA). A multivariate logistic regression analysis was performed to adjust for potential confounders in determining the association between different HbA1c cut-off points and obstetric outcomes on each ethnic group. RESULTS: 1,882 pregnancies were included. Analysis was limited to the three main ethnic groups: Caucasian (54.3%), South-Central Asian (19%) and Latin-American (12.2%). There was no association between HbA1c levels and obstetric outcomes among Caucasians. In Latin-Americans, an HbA1c ≥ 5.8% (40 mmol/mol) was associated with higher risk of macrosomia, whereas an HbA1c ≥ 5.9% (41 mmol/mol) was associated with LGA. In South-Central Asian, an HbA1c ≥ 5.7% (39 mmol/mol) was associated with increased risk of macrosomia and a continuous graded relationship between HbA1c levels and preeclampsia and LGA was detected starting at HbA1c levels of 5.4% (36 mmol/mol). CONCLUSION: First-trimester HbA1c levels perform as a suitable predictor of pregnancy complications in South-Central Asian and Latin-American women whereas in Caucasian no significant associations were found.

Simultaneous Uterine and Bladder Rupture Following Successful Vaginal Birth After Cesarean Delivery: Laparoscopic Repair of Defect.

When gross hematuria occurs after a successful vaginal birth after cesarean section, bladder injury should be suspected. We report a postpartum patient who experienced progressively worsening abdominal pain a few hours after delivery and was found to have a simultaneous bladder and uterine rupture, which were successfully repaired via a laparoscopic approach. This case highlights a laparoscopic approach to repairing both defects in the immediate postpartum period.

Co-pyrolysis of sewage sludge and manure.

The management and valorization of residual organic matter, such as sewage sludge and manure, is gaining interest because of the increasing volume of these residues, their localized generation and the related problems. The anaerobic digestion of mixtures of sewage sludge and manure could be performed due to the similarities between both residues. The purpose of this study is to evaluate the feasibility of the co-pyrolysis of sewage sludge (SS) and digested manure (DM) as a potential management technology for these residues. Pyrolysis of a sewage sludge/manure blend (50:50%) was performed at 525°C in a stirred batch reactor under N2 atmosphere. The product yields and some characteristics of the product were analyzed and compared to the results obtained in the pyrolysis of pure residues. Potential synergetic and antagonist effects during the co-pyrolysis process were evaluated. Although sewage sludge and manure seem similar in nature, there are differences in their pyrolysis product properties and distribution due to their distinct ash and organic matter composition. For the co-pyrolysis of SS and DM, the product yields did not show noticeable synergistic effects with the exception of the yields of organic compounds, being slightly higher than the predicted average, and the H2 yield, being lower than expected. Co-pyrolysis of SS and DM could be a feasible management alternative for these residues in locations where both residues are generated, since the benefits and the drawbacks of the co-pyrolysis are similar to those of the pyrolysis of each residue.

Assessment of an Alternative to the Uterine Vein for Venous Drainage in Human Uterine Transplantation: A Case Series Following Laparoscopic Hysterectomy.

BACKGROUND/AIMS: To determine an alternative to the uterine vein, considering the utero-ovarian vein (UOV) for venous drainage in human uterine transplantation. METHODS: A case series of 10 total laparoscopic hysterectomies was conducted for benign indications and a vascular study was performed ex vivo on the surgical specimen, demonstrating ipsilateral and contralateral flow between the uterine artery (UA) and UOV visualizing anastomoses between these vessels. The flow pattern was documented using heparinized saline and illustrated through fluoroscopy using Isovue-300 dye. RESULTS: Successful cannulation of UA was accomplished in all 10 cases. Ipsilateral flow between the UA and UOV was demonstrated in all except one case, and contralateral flow was observed. Due to the long interval between the time of specimen retrieval and vascular study, the time to cannulation limited the ability to demonstrate ipsilateral and contralateral flow in 2 cases. CONCLUSION: Uterine transplantation has become a viable option for women with absolute uterine factor infertility. However, this surgery requires extensive surgical dissection, and the surgical retrieval of the uterine vein proposes a challenge. We present a potential option for venous drainage in uterine transplant surgery, considering the UOV for venous drainage as an alternative to the uterine vein and a possibility for minimally invasive approach.

Endometriosis of the bladder as a cause of obstructive uropathy.

A 47-year-old woman (gravida 1, para 1) with menorrhagia and pelvic pain was found to have an enlarged fibroid uterus and bladder mass on ultrasonographic imaging. The patient underwent an abdominal supracervical hysterectomy and transurethral bladder mass resection. Histopathologic findings revealed leiomyoma uteri, intramural adenomyosis, and bladder endometriosis. Most case series of bladder endometriosis include women that present with urinary symptoms. This is a rare case of obstructive uropathy secondary to bladder endometriosis in a patient without any urinary signs or symptoms.

Morbilidad y discapacidad de los pacientes adultos ingresados al Programa de Rehabilitación durante su hospitalización en el HNAL - 2011 / Morbidity and disability in adult patients admitted in the Rehabilitation Program during hospitalization in the HNAL - 2011

OBJETIVOS: Identificar los diagnósticos etiológicos y discapacidades más frecuentes de los pacientes adultos que ingresaron al programa de Rehabilitación, durante su hospitalización en el Hospital Nacional Arzobispo Loayza el año 2011, valorados mediante interconsulta por el Servicio de Medicina Física y Rehabilitación. METODOS: Estudio descriptivo, retrospectivo. Estudio realizado en el Hospital Nacional Arzobispo Loayza, con la revisión de los registros manuscritos del Servicio de Medicina Física y Rehabilitación, así como de las historias clínicas de los pacientes hospitalizados, comprendidos entre las edades de 20 y menores de 60 años, valorados mediante interconsulta por el SMFR, durante el 2011. Criterios de exclusión: pacientes no registrados en el cuaderno de interconsultas del SMFR, pacientes con doble registro, pacientes no admitidos al programa de Rehabilitación en fase aguda, historias clínicas sin formato de interconsulta o incompletas. RESULTADOS: El diagnóstico de rehabilitación más frecuente en la población adulta hospitalizada en el HNAL, valorada mediante interconsulta por el SMFR, el 2011, es G83 (Otros síndromes paralíticos). Las discapacidades más frecuentes registradas según CIF son: en el componente Función Corporal, b730 (funciones relacionadas con la fuerza muscular); en el componente Estructura Corporal, s110 (estructura del cerebro), en el componente Actividades y Participación, d415 (mantener la posición del cuerpo). Se obtuvo mayor número de datos de la población adulta intermedia (25 a 54 años). El número de interconsultas realizadas por el Servicio de Medicina Física y Rehabilitación durante el año 2011 (303 días laborales) ha sido de 1413 para atender en 26 ambientes de hospitalización. La media de interconsultas diaria a nuestro servicio ha sido de 4,66. 60 por ciento de los pacientes hospitalizados precisó de tratamiento rehabilitador. Los servicios de Medicina, Neurocirugía y Cirugía Plástica y Quemados fueron los que más...

Wiping behavior, skin resistance, and the metabolic response to dehydration in the arboreal frog Phyllomedusa hypochondrialis.

Several species of arboreal frogs secrete lipids from cutaneous glands and wipe these secretions over the body surfaces to reduce evaporative water losses. Following wiping, frogs become immobile in water-conserving postures, and some have suggested they are torpid. Here we report wiping behaviors and the physiological correlates of immobile postures in the arboreal monkey frog Phyllomedusa hypochondrialis. Skin resistance to water loss was comparatively high, and rates of evaporation were as low as 4% of that from a free water surface. Standard rates of metabolism (SMR) varied from 89 microL O2 h(-1) at 18 degrees C to 316 microL O2 h(-1) at 34 degrees C and were sensitive to both temperature (T) and body mass (W; mL O2 h(-1) = 0.016W0.642 x 10(0.030T)). The mean SMR did not change significantly during four consecutive days of dehydration when animals lost 19%-34% of body mass. Therefore, it appears these frogs do not routinely depress metabolic rates following wiping. However, some individuals that lost higher percentages of body water exhibited trends of decreasing oxygen consumption, suggesting that suppression of metabolic rates might occur at greater levels of body water deficit or perhaps during a slower course of dehydration than imposed by our experiments (e.g., individuals that are secluded during periods of drought).