First birth after uterine transposition in low-volume lymph node metastasis of cervical cancer: A long journey for success.

Locally advanced cervical cancer poses a significant challenge to fertility-sparing treatments. Pelvic radiotherapy impairs reproductive potential owing to ovarian, uterine, and endometrial side effects. This study presents a literature review of the main fertility-sparing therapeutic alternatives for locally advanced cervical cancer and a case report of the first childbirth following uterine transposition for gynecological malignancies.

Very high-power and short-duration radiofrequency ablation for atrial fibrillation in a Latin American low-volume private center.

BACKGROUND: Center volume and operator experience/training are important factors impacting outcomes in AFib CA. Setting for RF delivery (power, duration, and contact force) associated with better outcomes remains to be determined. METHODS: This is an observational, longitudinal, and retrospective study. All consecutive procedures performed between December 12, 2013, and March 9, 2023, in a low-volume private center in Latin America were analyzed. Procedure characteristics and outcomes were compared between STD and vHPSD. RESULTS: Two hundred ten procedures were performed on 194 patients. Median annual number of procedures was 19 (7-29). Median age was 62 (52-68), and majority were male (71%). Median procedure duration was 155 (125-195) min, mean fluoroscopy time 32.8 ± 15 min and mean fluoroscopy dose 373.5 ± 208.9 mGray. Median follow-up was 27 months, significantly longer in STD compared with vHPSD group (43 [31-68] vs. 13 [8-19], respectively; P ≤ 0.001). The recurrence rate was 33.2% and major complications 8.6%. Compared with STD, vHPSD resulted in a significantly shorter procedure duration (125 vs. 180 min, P ≤ 0.001), shorter fluoroscopy time (22.7 ± 9.5 vs. 39.2 ± 14.3 min, P ≤ 0.001), and lower fluoroscopy dose (283.8 ± 161.1 vs. 438.3 ± 216.1 mGray, P ≤ 0.001). No long-term recurrence difference was observed when the follow-up periods were comparable. No difference in complication rate was observed (8.5% vs. 8.6%, P = 0.988). CONCLUSIONS: Outcomes in AFib CA in a Latin American low-volume private center can be considered acceptable, with efficacy and safety similar to those reported in the literature. Compared with STD ablation, vHPSD showed higher efficiency with similar efficacy and safety.

Malathion insecticide resistance in Aedes aegypti: laboratory conditions and in situ experimental approach through adult entomological surveillance.

OBJECTIVE: In Brazil, the most common method of controlling outbreaks of arbovirus is by the use of chemical sprays, which kill the insect vector, Aedes aegypti. The main objective of this study was to evaluate the resistance of Ae. aegypti to the insecticide, malathion, in situ. The location of this study was the municipality of Foz do Iguaçu, in the state of Paraná, Brazil. METHODS: Ultra-low-volume (ULV) fogging equipment was used, by vehicle, to apply the insecticide in situ, and mosquito populations after treatment were compared with those of control areas. The resistance of strains collected from the municipality was compared to the Rockefeller strain under laboratory conditions. RESULTS: We found 220 adult female specimens and 7423 eggs of Ae. aegypti in the areas subjected to UBV treatment, whereas 245 adult females and 10 557 eggs were found in the control areas. The UBV treatment area showed no significant difference compared to the control area, for all the indices. Mortality of the Rockefeller colony varied more quickly when there were slight variations in malathion concentration than the Foz do Iguaçu population.

OBJECTIF: Au Brésil, la méthode la plus courante de lutte contre les épidémies d'arbovirus consiste à utiliser des pulvérisations chimiques qui tuent l'insecte vecteur, Aedes aegypti. L'objectif principal de cette étude était d'évaluer la résistance de Ae. aegypti à l'insecticide, le malathion, in situ. Le lieu de cette étude était la municipalité de Foz do Iguaçu, dans l'état du Paraná, au Brésil. MÉTHODES: Un équipement de brumisation à très faible volume (ULV) a été utilisé, par véhicule, pour appliquer l'insecticide in situ et les populations de moustiques après le traitement ont été comparées à celles des zones témoins. La résistance des souches collectées dans la municipalité a été comparée à la souche Rockefeller dans des conditions de laboratoire. RÉSULTATS: Nous avons trouvé 220 spécimens femelles adultes et 7.423 œufs d'Ae. aegypti dans les zones soumises au traitement ULV, alors que 245 femelles adultes et 10.557 œufs ont été trouvés dans les zones témoins. La zone de traitement ULV n'a montré aucune différence significative par rapport à la zone témoin, pour tous les indices. La mortalité de la colonie de Rockefeller variait plus rapidement lorsqu'il y avait de légères variations dans la concentration de malathion que la population de Foz do Iguaçu.

Field Efficacy Trials of Aerial Ultra-Low-Volume Application of Insecticides Against Caged Aedes aegypti in Mexico.

We evaluated the efficacy of aerial ultra-low-volume (ULV) insecticide spraying in field bioassays with caged Aedes aegypti in May 2017 in Puerto Vallarta, Jalisco, Mexico. The insecticides tested included an organophosphate (Mosquitocida UNO ULV) and a neonicotinoid-pyrethroid combination (Cielo). Two Ae. aegypti populations were evaluated: a field pyrethroid-resistant local strain (Puerto Vallarta) and an insecticide-susceptible laboratory strain (New Orleans). Knockdown after 1 h by both products was ≥97.0%, and mortality after 24 h was ≥98% for the susceptible laboratory strain. Knockdown of the local Puerto Vallarta field strain by both products after 1 h was ≥96.5%; and mosquito mortality after 24 h was also very high (≥98%). Meteorological conditions during this evaluation were favorable for aerial mosquito control and represented conditions that typically occur during adulticide space spray applications. Temperature oscillated between 24°C and 26°C with winds between 6 and 10 km/h. The majority of droplets met the droplet distribution criteria required for the insecticides. The evaluation demonstrated an acceptable performance of both products for Ae. aegypti control when applied undiluted at a rate of 199.4 ml/ha and 73.07 ml/ha for Mosquitocida UNO ULV and Cielo, respectively. The volume median diameter (VMD) droplet size was characterized at 31.3 µm and 37.3 µm, respectively.

Eficacia y seguridad de tres esquemas para la preparación del colon para colonoscopia (polietilenglicol (PEG) 4 litros (4 L) (dosis única) vs. PEG 4 L dividido (2 L + 2 L) vs. PEG 2 L dividido de volumen bajo (1 L + 1 L): ensayo clínico controlado aleatorizado / A randomized controlled clinical trial of the efficacy and safety of colonoscopy preparation using a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG

Resumen Introducción: la colonoscopia es el examen estándar de oro para evaluar la mucosa del colon. De la limpieza del colon en la preparación intestinal para colonoscopia depende el hallazgo de pólipos, que pueden ser adenomatosos con potencial maligno y con la posibilidad de degenerarse en cáncer de colon. Objetivo: comparar la eficacia y la seguridad de tres tipos de preparaciones para la limpieza del colon: dosis única de polietilenglicol (PEG) 4 litros (4 L) y dosis divididas: PEG 4 L dividido (2 L + 2 L) y PEG 2 L dividido (1 L + 1 L) de volumen bajo. Métodos: en pacientes con una colonoscopia electiva de una clínica universitaria, se realizó un ensayo clínico controlado aleatorizado y ciego (para el médico que evaluó la limpieza del colon). Se asignaron 74 pacientes para cada grupo. El parámetro principal de eficacia fue la preparación integral de calidad adecuada medida con la escala de Boston, y los parámetros secundarios fueron el porcentaje de eventos adversos, la tolerabilidad y la tasa de detección de pólipos. Resultados: la preparación completa de todo el colon fue significativamente de mayor la calidad en la alternativa de 4 L divididos (2 L + 2 L), seguida de la otra alternativa dividida (1 L + 1 L) y menor en la dosis única (79,7 %, 75,7 % y 63,5 %, respectivamente, p = 0,019); también se encontraron diferencias en la detección de pólipos (13,5 %, 24,3 % y 9,5 %, p = 0,037) y sin diferencias en la presentación de al menos un evento adverso (p = 0,254) ni en la tolerabilidad (p = 0,640). Conclusiones: las dos preparaciones de dosis dividida tienen una mayor eficacia en la limpieza del colon en comparación con la dosis única de 4 L y en la detección de pólipos, mientras que no se evidencian diferencias en las preparaciones para la ocurrencia de eventos adversos y la tolerabilidad. La dosis de PEG 2 L dividido puede ser una muy buena opción para las preparaciones de colonoscopia electiva.

Abstract Introduction: Colonoscopy is the gold standard for evaluation of the colonic mucosa. Colon cleansing in preparation for colonoscopy depends on finding of polyps which can be adenomatous with malignant potential and the possibility of degenerating into colon cancer. Objective: This study's objective was to compare the efficacy and safety of three types of preparations for colon cleansing: a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG. Methods: This is a randomized controlled clinical trial of patients who underwent elective colonoscopy at a University clinic. It was blinded for the doctor who evaluated colon cleansing. Seventy four patients 74 patients were randomized into each group. The main parameter of effectiveness was integral preparation of adequate quality measured on the Boston scale. Secondary parameters were the percentage of adverse events, tolerability and detection rate of polyps. Results: Complete preparation of the entire colon was achieved significantly more often with 4 liters divided into two 2 liter doses followed by the other divided alternative (1 L + 1 L). It was achieved least frequently with in the single dose: 79.7%, 75.7% and 63.5%, respectively, p = 0.019. Differences were also found in the detection of polyps (13.5%, 24.3% and 9.5%, respectively, p = 0.037). ) There were no differences in presentation of at least one adverse event (p = 0.254) or in tolerability (p = 0.640). Conclusions: The two divided dose preparations had higher colon cleansing and polyp detection efficacies than did the single 4L dose while there were no differences in occurrence of adverse events and tolerability. The divided PEG 2L dose could be a very good option for elective colonoscopy preparation.

Entomological Efficacy of Aerial Ultra-Low Volume Insecticide Applications Against Aedes aegypti (Diptera: Culicidae) in Mexico.

A cluster-randomized controlled trial quantified the entomological efficacy of aerial ultra-low volume (AULV) applications of the insecticide chlorpyrifos against Aedes aegypti in Puerto Vallarta, México, during November-October 2017. The trial involved 16 large (1 × 1 km) clusters distributed between treatment-control arms. Primary endpoint was the abundance of Ae. aegypti indoors (total adults, females, and blood-fed females) collected using Prokopack aspirators. After four consecutive weekly cycles of AULV, all adult Ae. aegypti infestation indices were significantly lower in the treatment arm (OR and IRR ≤ 0.28). Efficacy in reducing indoor Ae. aegypti increased with each weekly application cycle from 30 to 73% (total adults), 33 to 76% (females), and 45.5 to 89% (blood-fed females). Entomological indices remained significantly lower in the treatment arm up to 2 wk after the fourth spraying round. Performing AULV spraying can have significant and lasting entomological impact on Ae. aegypti as long as multiple (ideally four) spray cycles are implemented using an effective insecticide.

Liver transplantation center in México with low-volume and excellent results / Centro de trasplante hepático en México con bajo volumen y excelentes resultados

Background: Orthotopic liver transplantation (OLT) is the treatment of choice for end stage liver disease. Many studies show an inverse relationship between the number of procedures and operative mortality. Objective: The objective of the study is to show the results of our center and determine if it can have comparable results to high volumen centers. Method: This is a retrospective study which analyzed the information of patients with OLT at our institution from 1985 to December 31, 2012. Depending on date of transplantation, the study was divided into three stages. Stage 1: from 1985 to 1999. Stage 2: from 2000 to 2007. Stage 3: from 2008 to 2012. In the 1, 2 and 3 stage 22, 37 and 56 OLT were performed respectively. Results: Perioperative mortality was significantly lower between Stage 3 vs. Stage 1 and 2 (3.5% vs. 50% and 21.7%, p = 0.001). Patient survival was also better at 1 and 5 years at Stage 3 (94.4%, 87.8%) vs. era 2 (77.6%, 66.17%) and Stage 1 (47% and 29%) (p = 0.001). Conclusion: In conclusion, the present results of OLT at our program are excellent despite being a low-volume center.

Antecedentes: El trasplante hepático ortotópico (THO) es el tratamiento de elección para la insuficiencia hepática terminal. Numerosos estudios muestran una relación inversa entre el número de procedimientos y la mortalidad operatoria. Objetivo: El objetivo de este estudio es mostrar los resultados de nuestro centro y determinar si puede tener resultados equiparables a los obtenidos en centros de alto volumen. Método: Es un estudio retrospectivo en el que se analizó la información de pacientes con THO en nuestra institución, de 1985 al 31 de diciembre de 2012. Dependiendo de la fecha del THO, el estudio se dividió en tres etapas: etapa 1, de 1985 a 1999; etapa 2, de 2000 a 2007; y etapa 3, de 2008 a 2012. En las etapas 1, 2 y 3 se realizaron 22, 37 y 56 THO, respectivamente. Resultados: La mortalidad perioperatoria fue menor de manera significativa en la etapa 3 en comparación con las etapas 1 y 2 (3.5 vs. 50 y 21.7%; p = 0.001). La supervivencia de los pacientes a 1 y 5 años fue mejor en la etapa 3 (94.4 y 87.8%) que en la etapa 2 (77.6 y 66.17%) y en la etapa 1 (47 y 29%) (p = 0.001). Conclusión: En conclusión, los resultados actuales en THO en nuestro programa son excelentes, a pesar de ser un centro de bajo volumen.

Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil.

BACKGROUND: Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. METHODS: The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. RESULTS: The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. CONCLUSIONS: There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access to emergency and surgical care. However more investments in are necessary to improve small hospitals capabilities to fill this gap.

¿Existen diferencias en el impacto de la atención de salud en hospitales de alto y bajo volumen?: síntesis rápida de evidencia / Are there differences in the impact of health care in high- and low-volume hospitals?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO Se desea conocer si el número de pacientes atendidos en un establecimiento de salud tendría un impacto sobre la calidad de la atención recibida por parte de los pacientes. En esa línea, se comparan hospitales de alto y bajo volumen para ver sus resultados en cuanto a mortalidad y sobrevida en pacientes con cáncer e infarto al miocardio. Esta síntesis fue solicitada por la División de Prevención y Control de Enfermedades. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en las bases de datos PDQ-Evidence, Health Systems Evidence, Health Evidence, Cochrane y PubMed con el objetivo de identificar revisiones sistemáticas del tema. Para realizar la búsqueda, se excluyeron estudios que analizaban volumen en cuanto al número de cirugías. Consultando al solicitante, se decidió considerar pacientes con cáncer o infarto al miocardio, excluyendo poblaciones con VIH/SIDA, diabetes, trasplantes o población en general. RESULTADO Se utilizan 3 revisiones sistemáticas, de las cuales se obtuvieron los siguientes resultados: -Los pacientes con cáncer que se atienden en hospitales de alto volumen tendrían una sobrevida mayor que pacientes que son atendidos en hospitales de bajo volumen. -Los pacientes con cáncer de cuello o cabeza que se atienden en hospitales de alto volumen no tendrían diferencia en la mortalidad con los pacientes que son atendidos en hospitales de bajo volumen. -Los pacientes pediátricos con tumores cerebrales que se atienden en hospitales de alto volumen tendrían una menor mortalidad que pacientes que son atendidos en hospitales de bajo volumen. -Los pacientes con infarto al miocardio que se atienden en hospitales de alto volumen no tendrían diferencia en la mortalidad con los pacientes que son atendidos en hospitales de bajo volumen. -Los pacientes con cáncer (sarcoma de Erwing) que se atienden en hospitales de alto volumen tendrían una sobrevida mayor que pacientes que son atendidos en hospitales de bajo volumen. -No está clara la certeza de la evidencia, puesto que esta no fue evaluada en este resumen.

Achieving good perioperative outcomes after pancreaticoduodenectomy in a low-volume setting: a 25-year experience.

Perioperative mortality following pancreaticoduodenectomy has improved over time and is lower than 5% in selected high-volume centers. Based on several large literature series on pancreaticoduodenectomy from high-volume centers, some defend that high annual volumes are necessary for good outcomes after pancreaticoduodenectomy. We report here the outcomes of a low annual volume pancreaticoduodenectomy series after incorporating technical expertise from a high-volume center. We included all patients who underwent pancreaticoduodenectomy performed by a single surgeon (ADC.) as treatment for periampullary malignancies from 1981 to 2005. Outcomes of this series were compared to those of 3 high-volume literature series. Additionally, outcomes for first 10 cases in the present series were compared to those of all 37 remaining cases in this series. A total of 47 pancreaticoduodenectomies were performed over a 25-year period. Overall in-hospital mortality was 2 cases (4.3%), and morbidity occurred in 23 patients (48.9%). Both mortality and morbidity were similar to those of each of the three high-volume center comparison series. Comparison of the outcomes for the first 10 to the remaining 37 cases in this series revealed that the latter 37 cases had inferior mortality (20% versus 0%; P = 0.042), less tumor-positive margins (50 versus 13.5%; P = 0.024), less use of intraoperative blood transfusions (90% versus 32.4%; P = 0.003), and tendency to a shorter length of in-hospital stay (20 versus 15.8 days; P = 0.053). Accumulation of surgical experience and incorporation of expertise from high-volume centers may enable achieving satisfactory outcomes after pancreaticoduodenectomy in low-volume settings whenever referral to a high-volume center is limited.

Application methods and insecticides for controlling stink bugs in soybean / Métodos de aplicação e inseticidas no controle de percevejos na cultura da soja

Insecticides application is the most widely used form to control stink bugs in soybean, being the application technology and the insecticide used the major factors for an efficient control. The experiment was conducted in a soybean field during the 2008/09 growing season, in São Sepé, RS, in order to evaluate efficiency of three methods of application and two insecticides for controlling stink bugs in soybeans. The experimental design used was completely randomized, in a factorial scheme 3x2 +1 control, with five replicates. The experimental units had dimensions of 40.0 x 40.0 m. The factor A was represented by the methods of application, as follows: A1- Tractorized spray with hydraulic nozzle; A2- Aerial, with rotary disc atomizers and A3- Aerial, with hydraulic nozzles. The factor B was represented by the insecticides, as follows: B1- thiamethoxam + lambda-cyhalothrin and B2-acephate. Ground and aerial applications with low volume oily had greater efficiency for controlling stink bugs in soybean, where led to an increase in soybean grain yield. Insecticides thiamethoxam + lambda-cyhalothrin and acephate were similar in controlling stink bugs and in residual effect.

A aplicação de inseticidas é a forma mais utilizada no controle de percevejos na cultura da soja, sendo a escolha da tecnologia de aplicação e do inseticida fundamental para obtenção de um controle eficiente. O experimento foi desenvolvido em lavoura comercial de soja, na safra agrícola 2008/09, em São Sepé, RS, com o objetivo de avaliar a eficiência de três métodos de aplicação e dois inseticidas no controle de percevejos na soja. O delineamento experimental utilizado foi inteiramente casualizado, em esquema fatorial 3x2+1 testemunha, com cinco repetições. As unidades experimentais tiveram dimensões de 40,0 x 40,0 m. O fator A foi representado pelos métodos de aplicação, sendo: A1- Terrestre com pontas hidráulicas, A2- Aérea, com atomizadores rotativos de discos e A3- Aérea, com pontas hidráulicas. O fator B foi representado pelos inseticidas sendo: B1- tiametoxam + lambda-cialotrina e B2- acefato. As aplicações terrestres e aéreas com baixo volume oleoso apresentam maior eficiência no controle de percevejos na cultura da soja, refletindo-se este controle em maior rendimento de grãos. Os inseticidas tiametoxam + lambda-cialotrina e acefato apresentam controle de percevejos e efeito residual semelhante.

Application methods and insecticides for controlling stink bugs in soybean / Métodos de aplicação e inseticidas no controle de percevejos na cultura da soja

Insecticides application is the most widely used form to control stink bugs in soybean, being the application technology and the insecticide used the major factors for an efficient control. The experiment was conducted in a soybean field during the 2008/09 growing season, in São Sepé, RS, in order to evaluate efficiency of three methods of application and two insecticides for controlling stink bugs in soybeans. The experimental design used was completely randomized, in a factorial scheme 3x2 +1 control, with five replicates. The experimental units had dimensions of 40.0 x 40.0 m. The factor A was represented by the methods of application, as follows: A1- Tractorized spray with hydraulic nozzle; A2- Aerial, with rotary disc atomizers and A3- Aerial, with hydraulic nozzles. The factor B was represented by the insecticides, as follows: B1- thiamethoxam + lambda-cyhalothrin and B2-acephate. Ground and aerial applications with low volume oily had greater efficiency for controlling stink bugs in soybean, where led to an increase in soybean grain yield. Insecticides thiamethoxam + lambda-cyhalothrin and acephate were similar in controlling stink bugs and in residual effect.

A aplicação de inseticidas é a forma mais utilizada no controle de percevejos na cultura da soja, sendo a escolha da tecnologia de aplicação e do inseticida fundamental para obtenção de um controle eficiente. O experimento foi desenvolvido em lavoura comercial de soja, na safra agrícola 2008/09, em São Sepé, RS, com o objetivo de avaliar a eficiência de três métodos de aplicação e dois inseticidas no controle de percevejos na soja. O delineamento experimental utilizado foi inteiramente casualizado, em esquema fatorial 3x2+1 testemunha, com cinco repetições. As unidades experimentais tiveram dimensões de 40,0 x 40,0 m. O fator A foi representado pelos métodos de aplicação, sendo: A1- Terrestre com pontas hidráulicas, A2- Aérea, com atomizadores rotativos de discos e A3- Aérea, com pontas hidráulicas. O fator B foi representado pelos inseticidas sendo: B1- tiametoxam + lambda-cialotrina e B2- acefato. As aplicações terrestres e aéreas com baixo volume oleoso apresentam maior eficiência no controle de percevejos na cultura da soja, refletindo-se este controle em maior rendimento de grãos. Os inseticidas tiametoxam + lambda-cialotrina e acefato apresentam controle de percevejos e efeito residual semelhante.