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1.
J Stroke Cerebrovasc Dis ; 30(4): 105656, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33571877

RESUMO

OBJECTIVES: Post-stroke complications affect stroke survivors across the world, although data on them are limited. We conducted a questionnaire survey to examine the real-world state and issues regarding post-stroke complications in Japan, which represents a super-aged society. MATERIALS AND METHODS: In 2018, a nationwide multi-center questionnaire survey was conducted in the top 500 Japanese hospitals regarding the number of stroke patients treated. Three questionnaires regarding post-stroke complications were mailed to the doctors responsible for stroke management. RESULTS: Responses were obtained from 251 hospitals (50.2%). The chief doctors responsible for stroke management answered the questionnaires. The number of stroke patients in the departments of neurology and neurosurgery was 338.3 ± 195.3 and 295.8 ± 121.8. Hospitals were classified using the categories secondary (n =142) and tertiary hospitals (n = 106); most hospitals were acute hospitals. Dementia was the most common complication (30.9%), followed by dysphagia (29.3%), and apathy (16.3%). Dementia was thought to be more common by neurologists than neurosurgeons, while apathy and bladder-rectal disorder were thought to be more common by neurosurgeons than neurologists (p = 0.001). The most difficult complication to treat was dysphagia (40.4%), followed by dementia (33.9%), epilepsy (4.1%), and fall (4.1%). Dementia was considered to lack clinical evidence regarding treatment (32.8%), followed by dysphagia (25.3%), and epilepsy (14.1%). Epilepsy was considered to lack clinical evidence among hospitals with a larger number of stroke cases (p = 0.044). CONCLUSION: This study revealed the current state and issues regarding post-stroke complications in Japan. Clinicians should be aware of the importance of post-stroke complications, although data on them remain unsatisfactory.


Assuntos
Afasia/epidemiologia , Demência/epidemiologia , Epilepsia/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidentes por Quedas , Apatia , Afasia/fisiopatologia , Afasia/terapia , Demência/psicologia , Demência/terapia , Epilepsia/fisiopatologia , Epilepsia/terapia , Pesquisas sobre Serviços de Saúde , Humanos , Japão/epidemiologia , Saúde Mental , Neurologistas , Neurocirurgiões , Doenças Retais/epidemiologia , Especialização , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Doenças da Bexiga Urinária/epidemiologia
2.
Am J Gastroenterol ; 115(10): 1609-1616, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32796176

RESUMO

INTRODUCTION: Although current literature has addressed gastrointestinal presentations including nausea, vomiting, diarrhea, abnormal liver chemistries, and hyperlipasemia as possible coronavirus disease 2019 (COVID-19) manifestations, the risk and type of gastrointestinal bleeding (GIB) in this population is not well characterized. METHODS: This is a matched case-control (1:2) study with 41 cases of GIB (31 upper and 10 lower) in patients with COVID-19 and 82 matched controls of patients with COVID-19 without GIB. The primary objective was to characterize bleeding etiologies, and our secondary aim was to discuss outcomes and therapeutic approaches. RESULTS: There was no difference in the presenting symptoms of the cases and controls, and no difference in severity of COVID-19 manifestations (P > 0.05) was observed. Ten (32%) patients with upper GIB underwent esophagogastroduodenoscopy and 5 (50%) patients with lower GIBs underwent flexible sigmoidoscopy or colonoscopy. The most common upper and lower GIB etiologies were gastric or duodenal ulcers (80%) and rectal ulcers related to rectal tubes (60%), respectively. Four of the esophagogastroduodenoscopies resulted in therapeutic interventions, and the 3 patients with rectal ulcers were referred to colorectal surgery for rectal packing. Successful hemostasis was achieved in all 7 cases that required interventions. Transfusion requirements between patients who underwent endoscopic therapy and those who were conservatively managed were not significantly different. Anticoagulation and rectal tube usage trended toward being a risk factor for GIB, although it did not reach statistical significance. DISCUSSION: In COVID-19 patients with GIB, compared with matched controls of COVID-19 patients without GIB, there seemed to be no difference in initial presenting symptoms. Of those with upper and lower GIB, the most common etiology was peptic ulcer disease and rectal ulcers from rectal tubes, respectively. Conservative management seems to be a reasonable initial approach in managing these complex cases, but larger studies are needed to guide management.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Hemorragia Gastrointestinal/epidemiologia , Úlcera Péptica/epidemiologia , Pneumonia Viral/complicações , Doenças Retais/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Endoscopia/estatística & dados numéricos , Enema/efeitos adversos , Enema/instrumentação , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Úlcera Péptica/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Doenças Retais/etiologia , Doenças Retais/terapia , Fatores de Risco
3.
Int J Surg ; 80: 157-161, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32679205

RESUMO

BACKGROUND: during the COVID-19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID-19 pandemic and during a control period. MATERIAL AND METHODS: a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared. RESULTS: two hundred and eighty-five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased (26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups. CONCLUSION: during the COVID-19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.


Assuntos
Abscesso/cirurgia , Apendicite/cirurgia , Colecistite Aguda/cirurgia , Infecções por Coronavirus/epidemiologia , Obstrução Intestinal/cirurgia , Mortalidade , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Doenças Retais/cirurgia , Parede Abdominal , Abscesso/epidemiologia , Doença Aguda , Apendicectomia/estatística & dados numéricos , Apendicite/epidemiologia , Betacoronavirus , Colecistite Aguda/epidemiologia , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Emergências , Feminino , Hérnia Abdominal/epidemiologia , Hérnia Abdominal/cirurgia , Herniorrafia/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Obstrução Intestinal/epidemiologia , Laparoscopia/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Pandemias , Doenças Retais/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Espanha/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos
4.
Lancet ; 395(10240): 1865-1877, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32534649

RESUMO

Neisseria meningitidis is an obligate human commensal bacterium that frequently colonises the upper respiratory tract. Person-to-person transmission occurs via direct contact or through dispersion of respiratory droplets from a carrier of the bacteria, and can lead to invasive meningococcal disease. Rare sporadic cases of meningococcal urogenital and anorectal infections, including urethritis, proctitis, and cervicitis, have been reported, typically following orogenital contact with an oropharyngeal meningococcal carrier. The resulting infections were clinically indistinguishable from infections caused by Neisseria gonorrhoeae. Over the past two decades, there have also been multiple outbreaks across North America and Europe of invasive meningococcal disease among men who have sex with men (MSM). The responsible meningococci belong to a highly virulent and predominantly serogroup C lineage, including strains that are able to express nitrite reductase and grow in anaerobic environments, such as the urogenital and anorectal tracts. More recently, a distinct clade within this lineage has expanded to cause urethritis predominantly among men who have sex with women. Evolutionary events giving rise to this clade included the loss of the ability to express a capsule, and acquisition of several gonococcal alleles, including one allele encoding a highly efficient gonococcal nitrite reductase. Members of the clade continue to acquire gonococcal alleles, including one allele associated with decreased antibiotic susceptibility. This evolution has implications for the clinical and public health management of those who are infected and their close contacts, in terms of both antibiotic treatment, and prevention through vaccination.


Assuntos
Doenças Urogenitais Femininas/epidemiologia , Doenças Urogenitais Masculinas/epidemiologia , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/transmissão , Neisseria meningitidis , Doenças Retais/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Feminino , Doenças Urogenitais Femininas/microbiologia , Doenças Urogenitais Femininas/prevenção & controle , Heterossexualidade , Homossexualidade Masculina , Humanos , Transmissão Vertical de Doença Infecciosa , Masculino , Doenças Urogenitais Masculinas/microbiologia , Doenças Urogenitais Masculinas/prevenção & controle , Infecções Meningocócicas/prevenção & controle , Doenças Retais/microbiologia , Doenças Retais/prevenção & controle , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controle
5.
Hautarzt ; 71(4): 275-283, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32025745

RESUMO

BACKGROUND: Sexually transmitted infections (STIs) in the anorectal region are disproportionally detected in risk populations such as men who have sex with men (MSM). However, due to changes in sexual behaviour they are increasingly diagnosed in heterosexual individuals. Due to the recent implementation of oral HIV pre-exposure prophylaxis together with lack of condom use, a further rise in STIs is expected. OBJECTIVES: This review addresses epidemiology, clinical picture, diagnostic pitfalls and current therapy guidelines of "classical" bacterial STIs involving the anorectum. CONCLUSIONS: STI manifestations in the anal region are frequently nonspecific or asymptomatic so that the diagnosis may be missed. In an endoscopic examination of the rectum, they can even mimic inflammatory bowel disease or malignancy. Therefore, knowledge of possible symptoms of bacterial STIs in this area is helpful for early diagnosis. Coinfections with other STIs are common and should prompt a search of other pathogens including HIV and hepatitis B/C.


Assuntos
Doenças do Ânus/diagnóstico , Coinfecção/diagnóstico , Doenças Retais/diagnóstico , Comportamento Sexual , Doenças Sexualmente Transmissíveis , Sexo sem Proteção , Doenças do Ânus/epidemiologia , Doenças do Ânus/terapia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/terapia , Coinfecção/epidemiologia , Feminino , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Gonorreia/terapia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Heterossexualidade , Homossexualidade Masculina , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/epidemiologia , Linfogranuloma Venéreo/terapia , Masculino , Doenças Retais/epidemiologia , Doenças Retais/terapia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/terapia , Sífilis/diagnóstico , Sífilis/epidemiologia , Sífilis/terapia
6.
Infection ; 48(2): 259-265, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31993971

RESUMO

BACKGROUND: Rectal sexually transmitted infections (STI) are common in men having sex with men (MSM). Mycoplasma genitalium is increasingly being reported in this localization, but due to frequent lack of symptoms at this site, clinical significance is still unclear. Rectal prevalence of Mycoplasma hominis and Ureaplasma species is not well studied so far. We aimed to investigate the prevalence and antibiotic sensitivity of rectal Mollicutes in our HIV-cohort. METHODS: In 227 MSM presenting for annual STI-screening, 317 anorectal swabs were collected from January 2017 to December 2018. PCR was performed for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, M. genitalium and also culture for M. hominis and Ureaplasma spec. RESULTS: Prevalence for M. genitalium, M. hominis, Ureaplasma spec., C. trachomatis and N. gonorrhoeae was 8.2%, 7.3%, 12.0%, 5.1% and 1.9%, respectively. Patients were asymptomatic with few exceptions. Seroprevalence of syphilis in 227 MSM was 41.9%. In 20 strains of M. genitalium, resistance-associated mutations to macrolides and quinolones were found in 60% and 30%, respectively; in five strains (25%) to both. M. hominis and Ureaplasma spec. frequently occurred combined, mostly in significant quantity consistent with infection. M. hominis and Ureaplasma spec. regularly showed sensitivity to tetracycline. CONCLUSION: At screening, rectal colonization with Mollicutes was common in our patients, but rarely caused symptoms. Due to rising antibiotic resistance of M. genitalium against quinolones, therapeutic options are increasingly limited. Treatment should be guided by antibiotic resistance testing including quinolones. In persisting anorectal symptoms, M. hominis and Ureaplasma spec. should also be taken into account.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Negativas , Infecções por HIV/complicações , Doenças Retais/microbiologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Tenericutes/efeitos dos fármacos , Adulto , Alemanha/epidemiologia , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por HIV/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prevalência , Doenças Retais/complicações , Doenças Retais/epidemiologia , Tenericutes/isolamento & purificação , Tenericutes/fisiologia
7.
Eur J Endocrinol ; 182(3): 313-318, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31940279

RESUMO

Objective: Patients with acromegaly are at increased risk of colorectal polyps. However, their risk of colorectal cancer remains unclear. This study aimed to identify the histopathological features of colorectal polyps in patients with acromegaly and compare their risk of colorectal cancer with that in healthy controls. Methods: The study participants were 178 patients who underwent Hardy's operation and perioperative colonoscopy at our hospital between April 2008 and September 2016. For the control group, we randomly selected 356 age- and sex-matched patients who underwent colonoscopy at our hospital during the same period. The incidence, size, location, and histology of the colorectal polyps detected were compared between the groups. Results: Colorectal polyps were detected in 66.8% of the acromegaly group and 24.2% of the control group (P < 0.001). The average number and size of the polyps were 2.44 and 4.74 mm, respectively, in the acromegaly group and 1.77 and 3.89 mm in the control group (P = 0.001). Polyps in the acromegaly group were more likely to be in the rectosigmoid region (P = 0.006). In the acromegaly group, the frequency of polyps ≥5 mm was 34.3% and that for polyps ≥10 mm was 15.2%; the respective values were 7.6% and 2.2% in the control group (P < 0.001). We found no evidence of between-group histopathological differences in the polyp specimens resected by endoscopy. Conclusions: Patients with acromegaly are at an increased risk of colorectal polyps, especially in the rectosigmoid region. However, there is no pathological evidence that they are at greater risk of colorectal cancer than the general population.


Assuntos
Acromegalia/epidemiologia , Adenocarcinoma/epidemiologia , Pólipos Adenomatosos/epidemiologia , Pólipos do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adenoma/epidemiologia , Adenoma/patologia , Adenoma/cirurgia , Pólipos Adenomatosos/patologia , Pólipos Adenomatosos/cirurgia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa , Feminino , Humanos , Pólipos Intestinais/epidemiologia , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Retais/epidemiologia , Doenças Retais/patologia , Doenças Retais/cirurgia , Fatores de Risco , Carga Tumoral , Adulto Jovem
8.
J Minim Invasive Gynecol ; 27(2): 441-451.e2, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31785416

RESUMO

OBJECTIVE: The recurrence rate after colorectal surgery for endometriosis is up to 50% at 5 years. The aim of the current review and meta-analysis was to assess recurrence associated with shaving, disc excision, and segmental resection for endometriosis with colorectal involvement. DATA SOURCES: A systematic review was performed by searching the PubMed, ClinicalTrials.gov, EMBASE, Cochrane Library, and Web of Science databases for publications before February 28, 2019, using the terms "colorectal endometriosis" and "recurrence" in English. The outcome measure was histologically proven recurrence 1 year after the index surgery. METHODS OF STUDY SELECTION: Studies rated as good or fair by a study quality assessment tool were included. Two reviewers independently assessed the quality of the studies; discrepancies were discussed, and if a consensus was not reached, a third reviewer was consulted. TABULATION, INTEGRATION, AND RESULTS: Of 156 relevant published trials, 41 were systematically reviewed and 4 were included in the meta-analysis. The risk of recurrence was higher after rectal shaving than after both segmental resection (odds ratio [OR], 5.53; 95% confidence interval [CI], 2.33-13.12; I2 = 0%; p = .001) and disc excision for histologically proven recurrence (OR, 3.83; 95% CI, 1.33-11.05; I2 = 0%; p = .01). This difference was not significant when comparing disc excision with segmental resection (OR, 2.63; 95% CI, 0.8-8.65; I2 = 0%; p = .11). CONCLUSION: The current analysis shows that the risk of recurrence is lower when segmental resection or disc excision is performed than when rectal shaving is performed. This finding is important when deciding the most appropriate surgical management.


Assuntos
Doenças do Colo/cirurgia , Endometriose/cirurgia , Complicações Pós-Operatórias , Doenças Retais/cirurgia , Ensaios Clínicos como Assunto/estatística & dados numéricos , Doenças do Colo/epidemiologia , Doenças do Colo/patologia , Bases de Dados Factuais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Endometriose/epidemiologia , Endometriose/patologia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Doenças Retais/epidemiologia , Doenças Retais/patologia , Recidiva , Resultado do Tratamento
9.
J Infect Dis ; 221(2): 214-217, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-30715417

RESUMO

Using published data, we found a direct correlation between the incidence of rectal gonorrhea and human immunodeficiency virus (HIV) infection in men who have sex with men who were not using oral preexposure prophylaxis. HIV incidence was predicted using rectal gonorrhea incidence as the determinant in regression analysis. The observed correlation suggest that rectal gonorrhea incidence can potentially serve as a predictor of HIV incidence. If confirmed with additional data, a quantitative correlation for incidence of the 2 infections could be useful in active-controlled HIV prevention trials where low HIV incidence is expected. Widespread improvements in treatment as prevention and gonorrhea control can negatively impact the correlation and its utility.


Assuntos
Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Doenças Retais/epidemiologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Ensaios Clínicos como Assunto , Infecções por HIV/prevenção & controle , Humanos , Masculino , Profilaxia Pré-Exposição , Medição de Risco
10.
Sex Transm Infect ; 96(1): 10-18, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31217322

RESUMO

OBJECTIVES: There are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia (Chlamydia trachomatis (CT)) and rectal gonorrhoea (Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated amplification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice. METHODS: This was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal samples (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). Samples were linked to demographic data and symptom status. RESULTS: Rectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) samples, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 samples (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079). CONCLUSION: These data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.


Assuntos
Homossexualidade Masculina/estatística & dados numéricos , Infecções por Mycoplasma/epidemiologia , Doenças Retais/epidemiologia , Reto/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/classificação , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Coinfecção/epidemiologia , Coinfecção/microbiologia , Estudos Transversais , Gonorreia/epidemiologia , Gonorreia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycoplasma/microbiologia , Mycoplasma genitalium/classificação , Mycoplasma genitalium/genética , Mycoplasma genitalium/isolamento & purificação , Neisseria gonorrhoeae/classificação , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Faringe/microbiologia , Doenças Retais/microbiologia , Comportamento Sexual , Adulto Jovem
11.
J Minim Invasive Gynecol ; 27(1): 212-219, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31326634

RESUMO

Laparoscopic discoid colorectal resection is a surgical option for bowel endometriosis, 1 of the most severe forms of endometriosis. However, no study has clearly analyzed the feasibility or the complication and recurrence rates of the procedure in a homogeneous population with specific criteria for discoid resection. The aims of this study were to evaluate the rate of conversion to segmental resection, the need for double discoid resection, and the complication and recurrence rates. We conducted a prospective study of 93 consecutive patients who underwent discoid resection in Tenon University Hospital, Paris, France. The median follow-up was 20 months. We included patients with colorectal endometriosis (≤3 cm long and <90° of bowel circumference) experiencing failure of medical treatment or associated infertility. All the patients underwent a discoid colorectal resection using a transanal circular stapler. The primary end point was the rate of conversion to segmental resection (3.2%). The secondary end point was the rate of double discoid resection (6.5%). The overall complication rate was 24%, and the severe complication rate (i.e., Clavien-Dindo IIIB) was 3% (n = 4). Postoperative voiding dysfunction requiring bladder self-catheterization was observed in 16% (n = 15). The mean duration of bladder self-catherization was 30 days (range, 15-90) including 11 cases (74%) lasting less than 30 days and 4 cases lasting more than 30 days. No patients required bladder self-catheterization over 3 months. No difference in the complication rate or in voiding dysfunction was observed between double and single discoid resection. The low rate of conversion to radical resection confirms the satisfactory preoperative evaluation of bowel endometriosis. Few publications report the rate of conversion to radical surgery. This raises the crucial issue of the right indications for discoid resection. The present study confirms that discoid resection is probably the best option for small lesions because of its high feasibility and low complication rate. Further studies are required to evaluate the technique for larger colorectal endometriotic lesions.


Assuntos
Doenças do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Endometriose/cirurgia , Complicações Pós-Operatórias , Doenças Retais/cirurgia , Adulto , Doenças do Colo/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Endometriose/epidemiologia , Estudos de Viabilidade , Feminino , Seguimentos , França/epidemiologia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Doenças Retais/epidemiologia , Recidiva , Resultado do Tratamento , Bexiga Inativa/epidemiologia , Bexiga Inativa/etiologia , Cateterismo Urinário/estatística & dados numéricos , Adulto Jovem
12.
Hong Kong Med J ; 25(6): 460-467, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31796645

RESUMO

INTRODUCTION: This study assessed the incidence of late rectal toxicities and evaluated potential predictive factors for late proctitis in patients treated with prostate-specific intensity-modulated radiotherapy in Hong Kong. METHODS: This retrospective longitudinal observational study included patients with localised prostate cancer who were treated with intensity-modulated radiation therapy in an oncology unit in Hong Kong between January 2007 and December 2011, and who had >1 year of follow-up. Clinical, pharmacological, and radiation parameters were recorded. Toxicities were measured by Common Terminology Criteria for Adverse Events version 4. RESULTS: In total, 232 patients were included in this analysis. The mean follow-up time was 7.3 ± 2.1 years and 46.5% of the patients had late rectal toxicities. Late proctitis occurred in 30.5% of patients; 25% of the patients with late proctitis exhibited grade ≥2 toxicity. Median onset times for late proctitis and rectal bleeding were 15 and 18.4 months, respectively. Multivariable regression showed increased odds for the occurrence of late proctitis in patients with older age (odds ratio [OR]=1.11, 95% confidence interval [CI]=1.04-1.19, P=0.003), higher V70 (OR=1.08, 95% CI=1.01-1.15, P=0.027), and presence of acute rectal toxicities (OR=4.47, 95% CI=2.37-8.43, P<0.001). Antiplatelet use was not significantly associated with the occurrence of late proctitis (OR=1.98, 95% CI=0.95-4.14, P=0.07). CONCLUSIONS: The incidence of late rectal toxicities was considerable among patients in this study. Clinicians should consider the possibility of late proctitis for patients with older age, acute rectal toxicities, and higher V70. High doses to rectal volumes should be limited because of the significant association with V70.


Assuntos
Anormalidades Induzidas por Radiação/epidemiologia , Neoplasias da Próstata/radioterapia , Doenças Retais/epidemiologia , Reto/efeitos da radiação , Anormalidades Induzidas por Radiação/etiologia , Idoso , Hong Kong/epidemiologia , Humanos , Incidência , Estudos Longitudinais , Masculino , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada , Doenças Retais/etiologia , Estudos Retrospectivos
13.
Hum Reprod ; 34(12): 2362-2371, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31820806

RESUMO

STUDY QUESTION: Is there a difference in functional outcomes and recurrence rate between conservative versus radical rectal surgery in patients with large deep endometriosis infiltrating the rectum 5 years postoperatively? SUMMARY ANSWER: No evidence was found that long-term outcomes differed when nodule excision was compared to rectal resection for deeply invasive endometriosis involving the bowel. WHAT IS KNOWN ALREADY: Functional outcomes of nodule excision and rectal resection for deeply invasive endometriosis involving the bowel are comparable 2 years after surgery. Despite numerous previously reported case series enrolling patients managed for colorectal endometriosis, long-term data remain scarce in the literature. STUDY DESIGN, SIZE, DURATION: From March 2011 to August 2013, we performed a two-arm randomized trial, enrolling 60 patients with deep endometriosis infiltrating the rectum up to 15 cm from the anus, measuring >20 mm in length, involving at least the muscular layer in depth, and up to 50% of rectal circumference. Among them, 55 women were enrolled at one tertial referral centre in endometriosis, using a randomization list drawn up separately for this centre. Institute review board approval was obtained to continue follow-up to 10 years postoperatively. One patient requested to stop the follow-up 2 years after surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients underwent either nodule excision by shaving or disc excision, or segmental resection. Randomization was performed preoperatively using sequentially numbered, opaque, sealed envelopes, and patients were informed of randomization results. The primary endpoint was the proportion of patients experiencing one of the following symptoms: constipation (1 stool/>5 consecutive days), frequent bowel movements (≥3 stools/day), anal incontinence, dysuria or bladder atony requiring self-catheterization 24 months postoperatively. Secondary endpoints were values taken from the Knowles-Eccersley-Scott-symptom questionnaire (KESS), the gastrointestinal quality of life index (GIQLI), the Wexner scale, the urinary symptom profile (USP) and the Short Form 36 Health Survey (SF36). MAIN RESULTS AND THE ROLE OF CHANCE: Fifty-five patients were enrolled. Among the 27 patients in the excision arm, two were converted to segmental resection (7.4%). One patient managed by segmental resection withdrew from the study 2 years postoperatively, presuming that associated pain of other aetiologies may have jeopardized the outcomes. The 5 year-recurrence rate for excision and resection was 3.7% versus 0% (P = 1), respectively. For excision and resection, the primary endpoint was present in 44.4% versus 60.7% of patients (P = 0.29), respectively, while 55.6% versus 53.6% of patients subjectively reported normal bowel movements (P = 1). An intention-to-treat comparison of overall KESS, GIQLI, Wexner, USP and SF36 scores did not reveal significant differences between the two arms 5 years postoperatively. Statistically significant improvement was observed shortly after surgery with no further improvement or impairment recorded 1-5 years postoperatively. During the 5-year follow-up, additional surgical procedures were performed in 25.9% versus 28.6% of patients who had undergone excision or resection (P = 0.80), respectively. LIMITATIONS, REASONS FOR CAUTION: The presumption of a 40% difference concerning postoperative functional outcomes in favour of nodule excision resulted in a lack of power for demonstration of the primary endpoint difference. WIDER IMPLICATIONS OF THE FINDINGS: Five-year follow-up data do not show statistically significant differences between conservative and radical rectal surgery for long-term functional digestive and urinary outcomes in this specific population of women with large involvement of the rectum. STUDY FUNDING/COMPETING INTEREST(S): No specific funding was received. Patient enrolment and follow-up until 2 years postoperatively was supported by a grant from the clinical research programme for hospitals in France. The authors declare no competing interests related to this study. TRIAL REGISTRATION NUMBER: This randomized study is registered with ClinicalTrials.gov, number NCT01291576. TRIAL REGISTRATION DATE: 31 January 2011. DATE OF FIRST PATIENT'S ENROLMENT: 7 March 2011.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Endometriose/cirurgia , Complicações Pós-Operatórias/epidemiologia , Doenças Retais/cirurgia , Adulto , Cirurgia Colorretal/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endometriose/epidemiologia , Feminino , Seguimentos , França/epidemiologia , Humanos , Dor Pélvica/cirurgia , Doenças Retais/epidemiologia , Recidiva , Resultado do Tratamento
14.
LGBT Health ; 6(7): 370-376, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31618167

RESUMO

Purpose: The purpose of this study was to explore risk factors for HIV and sexually transmitted infections (STIs) among transgender women (TW) in Lima, Peru. Methods: HIV-negative or serostatus unknown TW reporting recent condomless receptive anal intercourse underwent testing for STIs and HIV and completed a sociobehavioral survey. Results: Among 120 TW, 29.6% had rectal Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) and 12.6% had HIV. Age and migrant status were associated with rectal GC/CT, and rectal GC/CT predicted HIV infection. Conclusions: Further study is needed to understand individual and social factors that contribute to HIV/STI vulnerability among TW.


Assuntos
Chlamydia trachomatis/crescimento & desenvolvimento , HIV/crescimento & desenvolvimento , Neisseria gonorrhoeae/crescimento & desenvolvimento , Doenças Retais/etiologia , Comportamento Sexual , Doenças Sexualmente Transmissíveis/epidemiologia , Pessoas Transgênero , Adolescente , Adulto , Fatores Etários , Canal Anal , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/etiologia , Infecções por Chlamydia/microbiologia , Preservativos , Feminino , Gonorreia/epidemiologia , Gonorreia/etiologia , Gonorreia/microbiologia , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Infecções por HIV/virologia , Humanos , Pessoa de Meia-Idade , Peru/epidemiologia , Doenças Retais/epidemiologia , Doenças Retais/microbiologia , Doenças Retais/virologia , Reto/microbiologia , Reto/virologia , Fatores de Risco , Doenças Sexualmente Transmissíveis/etiologia , Doenças Sexualmente Transmissíveis/microbiologia , Doenças Sexualmente Transmissíveis/virologia , Migrantes , Sexo sem Proteção , Adulto Jovem
15.
J Epidemiol Glob Health ; 9(3): 153-157, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31529931

RESUMO

The Centers for Disease Control and Prevention (CDC) recommends syphilis screening at least annually for sexually active men who have sex with men (MSM). The objective of this study is to assess the frequency of MSM testing for syphilis and how syphilis test results compared with results of rectal gonorrhea and chlamydia tests. In collaboration with a large US commercial laboratory, we identified men aged 15-60 years who had rectal chlamydia or gonorrhea tests during 09/01/2013-09/30/2015 as presumed MSM. We classified MSM as having current or past syphilis if during the study period they had (1) either a reactive qualitative non-treponemal test or at least a 1:1 quantitative non-treponemal test, and (2) they had a reactive treponemal test. Of 52,771 MSM, 14.3% had no syphilis testing, 4.8% had only treponemal testing (37.8% were reactive), 63.2% had only non-treponemal testing (2.0% were reactive), and 17.7% had both non-treponemal and treponemal testing (86.6% had current or past syphilis). Of those MSM who had reactive qualitative non-treponemal tests, at least 90% had no quantitative non-treponemal tests. Current or past syphilis was more common among MSM with positive rectal gonorrhea or chlamydia tests (24.1%) than MSM with negative rectal gonorrhea and chlamydia tests (13.0%, p < 0.005). Of MSM with any syphilis testing during 09/01/2013-09/30/2014, 64.8% also had annual repeat testing. Syphilis testing in general and repeat syphilis testing were frequent but suboptimal among MSM. It is important to continually monitor syphilis for MSM, especially for those MSM who had rectal chlamydia or gonorrhea infection.


Assuntos
Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Infecções por HIV/diagnóstico , Homossexualidade Masculina/estatística & dados numéricos , Programas de Rastreamento/normas , Doenças Retais/diagnóstico , Sífilis/diagnóstico , Adolescente , Adulto , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Doenças Retais/epidemiologia , Sífilis/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
16.
Tech Coloproctol ; 23(9): 899-902, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31482393

RESUMO

BACKGROUND: Natural orifice specimen extraction (NOSE)surgery is gaining popularity among colorectal surgeons. The technical aspects of this new procedure are still debated and many variations have been presented in the last decade. METHODS: We propose a new variation of transanal NOSE after robotic and laparoscopic LAR consisting of rectal eversion by using a special rod after laparoscopic TME. Eversion makes it possible to perform resection and placement of the anvil extracorporeally. We included a video demonstration of the technique. Clinical Patient Grading Assessment Scale was calculated 1 month after stoma closure and the Low Anterior Resection Syndrome (LARS )score was calculated preoperatively and 1 month after stoma closure. RESULTS: Seven female patients with rectal cancer, all with normal BMI, underwent laparoscopic (n = 5) or robotic (n = 2) TME with rectal eversion. No intraoperative and postoperative complications were reported. One month after stoma closure, the median Clinical Patient Grading Assessment Scale was 5 (range 3-7), which means "a good deal better". The median LARS score was 14 (IQR 14-19,5) preoperatively and 19 (IQR 19-21,5) 1 month after stoma closure. CONCLUSIONS: This variation of NOSE surgery was safe and effective in our patient population.


Assuntos
Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Abdome/cirurgia , Adulto , Feminino , Humanos , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Doenças Retais/epidemiologia , Doenças Retais/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Estomas Cirúrgicos/estatística & dados numéricos , Síndrome , Resultado do Tratamento
17.
Prog Urol ; 29(17): 1011-1020, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31521507

RESUMO

OBJECTIVE: Neurogenic bowel disorders (NBD) are frequently observed in patients with multiple sclerosis (MS); the prevalence of constipation is estimated to be 35-54 % and fecal incontinence between 29 and 51 % (LE 4). They contribute to the deterioration of patients' quality of life (LE 4). The aim of this article is to review the literature on the physiopathology, prevalence, impact, and management of bowel disorders in patients with MS in order to educate caregivers about their existence and thus help them to optimize therapeutic choices. MATERIALS AND METHODS: A bibliographic search was conducted between 2000 and 2019 and 31 relevant scientific articles were selected. Relevant references were subsequently added, bringing the total to 50 articles. A level of scientific evidence (LE) was assigned to each article, except for literature reviews. RESULTS: The origin of NBD is multifactorial and includes impairment of neurological pathways, polypharmacy, behavioural disorders, and loss of autonomy (LE 4). Patients with MS should be questioned about their bowel habits and, in cases of proven NBD, specific management options should be offered. The first step concerns the dietary and lifestyle rules associated with the use of laxatives, suppositories, and/or enemas (LE 4). In the event of failure, therapies such as abdominal massages (LE 1 and 2), biofeedback and transanal irrigation can be proposed (LE 4). Anterograde colonic irrigation may also be an option (LE 4). The efficacy of stimulating the posterior tibial nerve needs to be proven (LE 4). The implantation of a sacral neuromodulation device is, for the moment, difficult due to the impossibility of performing a spinal magnetic resonance imaging during follow-up. A stoma improves the quality of life of patients and should not be proposed too late. CONCLUSION: Effective treatment of NBD improves the quality of life of patients and reduces the incidence of bladder disorders (LE 4).


Assuntos
Esclerose Múltipla/complicações , Doenças Retais/etiologia , Humanos , Prevalência , Doenças Retais/epidemiologia , Doenças Retais/fisiopatologia , Doenças Retais/terapia
18.
Rev Gastroenterol Peru ; 39(2): 136-140, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31333230

RESUMO

OBJECTIVE: To describe the anorectal manometry results in the pediatric population with chronic constipation and acquired anorectal disease. MATERIALS AND METHODS: We reviewed the records of children who were referred to the Motility and Pelvic Floor Laboratory of the Hospital San Jose Tecnologico de Monterrey between 2004-2016 for further evaluation with anorectal manometry and who presented acquired anorectal disease. RESULTS: We reviewed 170 records. The mean age was 7.18 ± 4.51 years old. The prevalence of anorectal disease was 73%. The symptoms more frequently presented were difficult evacuation (78%), painful defecation (67%), large and hard stool (50%) and fecal soiling (49%). 44% of patients with hypotonic external anal sphincter (EAS) presented with soiling and 74% of those had diminished critical volume. Significant manometric values (p<0.05) were EAS resting pressure, maximal squeeze pressure, and critical volume. 97.7% of those who underwent abdomino pelvic coordination evaluation had pelvic floor dyssynergia (anismus). CONCLUSIONS: Contrary to adult population, the manometric values in children with acquire anorectal pathology were within normal values except for the EAS resting pressure and critical volume that were diminished. This could suggest a different mechanism in the pediatric population. Pelvic floor dyssynergia could explain chronic constipation in these patients.


Assuntos
Canal Anal/fisiopatologia , Constipação Intestinal/fisiopatologia , Doenças Retais/fisiopatologia , Reto/fisiopatologia , Criança , Pré-Escolar , Doença Crônica , Constipação Intestinal/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Manometria , Doenças Retais/complicações , Doenças Retais/diagnóstico , Doenças Retais/epidemiologia
19.
Cancer ; 125(21): 3873-3881, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322729

RESUMO

BACKGROUND: The prevalence and associated psychosocial morbidity of late-onset anorectal disease after surgery and radiotherapy for the treatment of childhood cancer are not known. METHODS: A total of 25,530 survivors diagnosed between 1970 and 1999 (median age at cancer diagnosis, 6.1 years; age at survey, 30.2 years) and 5036 siblings were evaluated for late-onset anorectal disease, which was defined as a self-reported fistula-in-ano, self-reported anorectal stricture, or pathology- or medical record-confirmed anorectal subsequent malignant neoplasm (SMN) 5 or more years after the primary cancer diagnosis. Piecewise exponential models compared the survivors and siblings and examined associations between cancer treatments and late-onset anorectal disease. Multiple logistic regression with generalized estimating equations was used to evaluate associations between late-onset anorectal disease and emotional distress, as defined by the Brief Symptom Inventory 18 (BSI-18), and health-related quality of life, as defined by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: By 45 years after the diagnosis, 394 survivors (fistula, n = 291; stricture, n = 116; anorectal SMN, n = 26) and 84 siblings (fistula, n = 73; stricture, n = 23; anorectal neoplasm, n = 1) had developed late-onset anorectal disease (adjusted rate ratio [RR] for survivors vs siblings, 1.2; 95% confidence interval [CI], 1.0-1.5). Among survivors, pelvic radiotherapy with ≥30 Gy within 5 years of the cancer diagnosis was associated with late-onset anorectal disease (adjusted RR for 30-49.9 Gy vs none, 1.6; 95% CI, 1.1-2.3; adjusted RR for ≥50 Gy vs none, 5.4; 95% CI, 3.1-9.2). Late-onset anorectal disease was associated with psychosocial impairment in all BSI-18 and SF-36 domains. CONCLUSIONS: Late-onset anorectal disease was more common among childhood cancer survivors who received higher doses of pelvic radiotherapy and was associated with substantial psychosocial morbidity.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Segunda Neoplasia Primária/diagnóstico , Doenças Retais/diagnóstico , Autorrelato , Estresse Psicológico/diagnóstico , Adolescente , Adulto , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/terapia , Prevalência , Qualidade de Vida , Doenças Retais/epidemiologia , Doenças Retais/terapia , Irmãos , Estresse Psicológico/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
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