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Sickle cell retinopathy (SCR) is a progressive, sight-threatening ophthalmic complication of sickle cell disease (SCD). Current SCR screening focuses on the detection of pathologic sea fan neovascularization, the first sign of proliferative sickle cell retinopathy (PSR). If untreated, PSR can lead to severe visual impairment and blindness through progression to vitreous hemorrhage and/or retinal detachment. SCR screening with dilated fundus examination (DFE) is recommended every 1-2 years starting at age 10, but data underlying this recommendation are of poor quality and based upon expert consensus. We performed a systematic review to characterize imaging techniques, laboratory-based tests, and clinical practices for SCR screening. This PROSPERO-registered systematic review included relevant texts identified through predetermined searches in online databases. Collected test accuracy data facilitated the calculation of likelihood ratios. Forty-four studies evaluating 4928 patients were included. DFE demonstrated moderate test accuracy (LR+ of 8.0, LR- of 0.3). Ultra-widefield-fundus photography demonstrated superior accuracy (LR+ 32.5, LR- 0.03). Optical coherence tomography angiography applications were highly accurate for PSR identification (machine learning LR+ 32.5, LR- 0.03; human grader LR+ 2.8-213.1, LR- 0.1-0.2). Most techniques and tests were more accurate at detecting PSR than staging SCR or detecting lower-grade SCR. Our findings support the integration of advanced image-based approaches, such as computer-based image analysis and ultra-wide-field fundus imaging, for SCR screening in SCD patients given the superior accuracy in PSR detection compared with the current standard of care. Rigorous SCR screening implementation studies are needed to support evidence-based SCR screening recommendations.
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PURPOSE OF THE ARTICLE: As editorial boards (EBs) of medical education journals (MEJs) hold substantial control over framing current medical education scholarship, we aimed to evaluate representation of women as well as geographic and socioeconomic diversity on EBs of these journals. MATERIALS AND METHODS: In our cross-sectional study, Composite Editorial Board Diversity Score (CEBDS) was used to evaluate diversity at gender, geographic region, and country income level. Websites of MEJs were screened for relevant information. Job titles were categorized into 3 editorial roles and data were analyzed using SPSS version 26. RESULTS: Out of 42 MEJs, 19 journals (45.2%) were published from the Global South. Among 1219 editors, 57.5% were men. Out of 46 editors in chief (EICs), 34.7% were women, and 60.9% were based in high income countries. No EIC belonged to low-income country. The proportion of female advisory board members was found to be positively correlated with the presence of a female EIC. Moreover, 2 journals achieved the maximum CEBDS. All editors belonged to the same World Bank income group and geographic region for 12 and 8 journals respectively. CONCLUSIONS: In order to allow a truly global perspective in medical education to prevail, diversity and inclusivity on these journals become important parameters to address. Thus, promoting policies centered on improving diversity in all aspects should become a top priority.
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Diversidade, Equidade, Inclusão , Publicações Periódicas como Assunto , Masculino , Humanos , Feminino , Estudos TransversaisRESUMO
Pediculosis is an integumentary disease caused by the ecto-parasite Pediculus humanus capitis, which infests human hair. It is a common public health problem that is most prominent worldwide in elementary school children. The current study aimed to investigate the prevalence, risk factors, and genetic diversity of P. humanus capitis among primary school children in the Erbil province. For this purpose, this study was conducted from October 2019 to December 2019 among 1100 randomly selected elementary school children aged 6-12. Data collection was performed via a regular questionnaire and physical hair examination. For the genetic diversity part, after collecting one louse randomly from each individual, DNA was extracted. The mitochondrial Cox1 gene was then amplified by universal primer and PCR. Gene sequencing was performed by ABI (BioNEER, South Korea). Data analysis was done by Chi-Square and T-test using the SPSS ver. 23. The overall infestation rate was 21.27%, and the rate was significantly higher among females (34.93%) compared to males (7.91%). Some variables had found the prevalence rate to be strongly affected. This included age; the rate was not significant (26.87%) in the age group 8-9 years compared to other age groups. According to hair length, the rate was significantly increased (36.52%) among children with tall hair. In terms of hair type, the incidence of curly-haired children was significantly higher (31.54%); in terms of hair color, there were not significant differences among blonde children (25.90%) and others. According to the results of Cox1 gene sequencing, of 234 infested children to lice, 86 (36.75%) of them were exposed to clade A, 38 (16.24%) were exposed to clade B, clade C has not been seen among any children (0%), 105 students (44.87%) were exposed to clade D, and 5 of them exposed to clade E (2.14%). Eventually, a significantly higher incidence (33.78%) was reported in rural primary school children. The infection rate of human head lice in Erbil province is still high, which is one of the health problems of children in public schools.
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Pediculus , Adulto , Animais , Criança , Feminino , Variação Genética , Humanos , Masculino , Pediculus/genética , Prevalência , Fatores de Risco , Instituições AcadêmicasRESUMO
PURPOSE: Endometriomas are a common cause of infertility necessitating assisted reproductive technology (ART). It had been previously thought that surgical removal of the endometriomas prior to ART would improve reproductive outcomes, but recent data suggests that surgical cystectomy might affect the ovarian reserve, decreasing the chances of ART success. The aim of this article is to review the literature on the effects of endometrioma surgery on ART outcomes providing an overview of the current evidence and assessing the need for further studies. METHODS: A literature search was performed using PubMed and MEDLINE databases to identify studies that discuss endometriomas and assisted reproductive technology before versus after surgery. RESULTS: In women with an endometrioma requiring ART, growing evidence suggests that surgery might result in damage to the ovarian reserve and further decrease chances of fertility. However, pregnancy rates, implantation rates, fertilization rates, and live birth rates seemed to be consistently similar across both groups. CONCLUSION: The current evidence is inconclusive on whether endometriomas should be surgically removed prior to ART. Further large randomized controlled trials are needed for a definite answer, and until then, management should be individualized.
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Endometriose , Infertilidade Feminina , Reserva Ovariana , Coeficiente de Natalidade , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Infertilidade Feminina/etiologia , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida/efeitos adversosRESUMO
PURPOSE: Adenomyosis is a poorly understood entity with no unified treatment protocol. It has been thought to only affect the quality of life of older women, but growing evidence is highlighting the increased frequency of adenomyosis in younger patients and its possible effects on fertility outcomes. This can have a great impact on how clinicians screen, diagnose, and treat this condition. The aim of this review is to explore the relationship between adenomyosis and infertility. METHODS: A literature search of the keywords "adenomyosis", "infertility", "pregnancy" and "fertility" was conducted using the PubMed and Medline search engines. The articles selected were observational, systematic reviews, meta-analyses, and randomized controlled trials. The search was limited to English, abstracts were screened, and articles were selected. RESULTS: The literature reports lower clinical pregnancy rates, lower live birth rates, higher miscarriage rates, and higher odds of adverse obstetric outcomes in patients with adenomyosis. Treatment seems to be associated with higher pregnancy rates and live births rates. CONCLUSION: An association between adenomyosis and infertility seems to exist, and treatment could lead to improved fertility outcomes.
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Aborto Espontâneo , Adenomiose , Infertilidade Feminina , Aborto Espontâneo/epidemiologia , Adenomiose/complicações , Adenomiose/epidemiologia , Feminino , Humanos , Infertilidade Feminina/terapia , Nascido Vivo , Gravidez , Taxa de Gravidez , Qualidade de VidaRESUMO
PURPOSE: Platelet-rich plasma (PRP) has become a novel treatment in various aspects of medicine including orthopedics, cardiothoracic surgery, plastic surgery, dermatology, dentistry, and diabetic wound healing. PRP is now starting to become an area of interest in reproductive medicine more specifically focusing on infertility. Poor ovarian reserve, menopause, premature ovarian failure, and thin endometrium have been the main areas of research. The aim of this article is to review the existing literature on the effects of autologous PRP in reproductive medicine providing a summation of the current studies and assessing the need for additional research. METHODS: A literature search is performed using PubMed, MEDLINE, and CINAHL Plus to identify studies focusing on the use of PRP therapy in reproductive medicine. Articles were divided into 3 categories: PRP in thin lining, PRP in poor ovarian reserve, and PRP in recurrent implantation failure. RESULTS: In women with thin endometrium, the literature shows an increase in endometrial thickness and increase in chemical and clinical pregnancy rates following autologous PRP therapy. In women with poor ovarian reserve, autologous intraovarian PRP therapy increased anti-Mullerian hormone (AMH) levels and decreased follicle-stimulating hormone (FSH), with a trend toward increasing clinical and live birth rates. This trend was also noted in women with recurrent implantation failure. CONCLUSIONS: Limited literature shows promise in increasing endometrial thickness, increasing AMH, and decreasing FSH levels, as well as increasing chemical and clinical pregnancy rates. The lack of standardization of PRP preparation along with the lack of large randomized controlled trials needs to be addressed in future studies. Until definitive large RCTs are available, PRP use should be considered experimental.
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Fertilização in vitro , Indução da Ovulação , Plasma Rico em Plaquetas/metabolismo , Medicina Reprodutiva , Hormônio Antimülleriano/metabolismo , Feminino , Humanos , Infertilidade Feminina/tratamento farmacológico , Infertilidade Feminina/genética , Reserva Ovariana/genética , Plasma Rico em Plaquetas/fisiologia , GravidezRESUMO
BACKGROUND: The Swenson model was developed as a linear regression model to estimate postoperative day 1 hematocrit levels after benign hysterectomy. Predictive variables included preoperative hematocrit level, patient weight, estimated blood loss, intraoperative crystalloid volume, preoperative platelet count, and hysterectomy route that predicted postoperative day 1 hematocrit level at ±5% for 100% of patients who used an internal validation set. OBJECTIVE: We aimed to validate externally the Swenson model using our hysterectomy population and to further validate the model in a cohort that included robotic-assisted cases. STUDY DESIGN: In a retrospective cohort, data were collected from benign hysterectomies from April 2014 through May 2016. Predicted postoperative day 1 hematocrit level was calculated with the use of the Swenson equation and compared with measured hematocrit values. We compared our results to the Swenson model results using chi-square or Fisher's exact test. We then restricted our analysis to those with actual postoperative day 1 hematocrit level of ≤30%, to determine whether the model performed accurately in this subgroup that may need intervention. We generated a receiver-operating characteristic curve with Louden Index to determine the best cut-point from the Swenson hematocrit level projections for the prediction of an actual hematocrit level of ≤30%. Furthermore, we stratified the Swenson model predicted hematocrit level into 4 ranges: <32%, 32-35%, 35-38%, and >38%. This stratification allowed us to assess the differential accuracy of the Swenson model across hematocrit level ranges. RESULTS: Of 602 hysterectomies, 478 patients had all the variables that were needed for the Swenson model and postoperative day 1 hematocrit level for comparison. The Swenson model was significantly less accurate in our data compared with their validation set with fewer patients whose predicted hematocrit level was accurate at different thresholds from ±1% through ±5% of actual hematocrit level (all P<.001). Only 76.8% of the predicted hematocrits were accurate within ±5%. Analysis of variance showed accuracy that was similar among different surgical routes (P=.193). A quadratic best-fit curve showed accuracy was maximized when hematocrit level of 36.2%. Projected hematocrit level was ±2.5% of actual but deteriorated at higher and lower hematocrit level values. When the analysis was restricted to those patients with postoperative day 1 hematocrit levels of ≤30%, accuracy was worse, with only 55.3% of predicted hematocrit level values within ±5%. In this subset, the Swenson equation was more likely to overestimate hematocrit level and give false reassurance. A receiver-operating characteristic curve analysis showed that the best Swenson cut-point for the prediction of an actual hematocrit level of ≤30% was 31.9% (sensitivity, 75.5%; specificity, 64.0%). Finally, predicted hematocrit level was divided into 4 groups: <32%, 32-35%, 35-38%, and >38%. When predicted hematocrit level was <32% (n=164), the model was more likely to under-predict hematocrit level and was least accurate in the subset of patients who were most likely to need intervention. When predicted hematocrit level was 32-35% (n=192), 17.2% of the patients (approximately 1 in 6) had an actual postoperative day 1 hematocrit level of ≤30%. When a predicted hematocrit level of ≥35% was used as a cut-off point, the percentage of patients who had an actual postoperative day 1 hematocrit level of ≤30% dropped to 8.2%. No patients had an actual hematocrit level of <24%, which makes this a reasonable choice for screening for anemia. CONCLUSION: Although the Swenson model was reliable for the prediction of postoperative day 1 hematocrit level in their internal validation set, it did not perform as well in our hysterectomy population. It may have utility as a screening tool if the projected hematocrit level was ≥35%. Further research is needed to create a model for the prediction of postoperative day 1 hematocrit level that can be incorporated into standard practice.
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Hematócrito , Histerectomia , Período Pós-Operatório , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Peso Corporal , Estudos de Coortes , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
OBJECTIVE: To investigate the prevalence of kidney stones in a population of children with Cushing disease (CD) and to compare it with the prevalence of kidney stones in healthy children. STUDY DESIGN: Clinical and biochemical data from 139 pediatric patients with CD (68 females, 71 males) were analyzed retrospectively. Computed tomography scans were reviewed for kidney stones. RESULTS: Among 139 patients, 27 with CD (19.4%) had either radiographic evidence and/or a history of kidney stones. Those with kidney stones had higher urine free cortisol (P = .008) and transsphenoidal surgery at an older age (P = .007). The average urinary calcium/creatinine ratio was elevated in patients with CD (0.22 ± 0.11). The prevalence of kidney stones was higher in children with CD than in normal children (19.42% vs 1.0%; P < .001). CONCLUSION: Our results illustrate that kidney stones are an underestimated complication of pediatric CD, especially when compared with the prevalence of nephrolithiasis in the general pediatric population. Long-term consequences for kidney function are not known and need to be studied.
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Cálculos Renais/etiologia , Hipersecreção Hipofisária de ACTH/diagnóstico , Adolescente , Criança , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/epidemiologia , Masculino , Hipersecreção Hipofisária de ACTH/complicações , Prevalência , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Hepatitis C and hepatitis B are public health problems in the United States and remain largely undiagnosed. In response to the availability of rapid, point of care hepatitis tests, we assessed hepatitis knowledge and acceptability of hepatitis testing during an emergency department (ED) or pharmacy visit. METHODS: From June 2010 to May 2011, an anonymous prospective survey was administered to a convenience sample of New York City ED patients and pharmacy clients. RESULTS: The study population (N=2078) was 54% female, 36% Hispanic and 41% black. Mean age was 39, SD ± 15 years. The majority (72%;1480/2,2060) of the participants responded that they would get tested if free testing were offered, and 67% (1272/1912) of those responded that they would test for hepatitis B/C in conjunction with HIV. Participants who had previously tested for hepatitis had higher mean knowledge scores than those who had never tested. Pharmacy clients, those of black race, and those with higher mean knowledge scores would be more willing to accept hepatitis B/C testing if offered. CONCLUSIONS: Urban ED patients and pharmacy clients were receptive to hepatitis testing. Most individuals would elect to be tested for hepatitis with HIV, which raises the possibility of integrated testing.
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Serviço Hospitalar de Emergência/estatística & dados numéricos , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Feminino , Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Fumar/epidemiologia , Fatores Socioeconômicos , Cuidados de Saúde não Remunerados/estatística & dados numéricos , População Urbana/estatística & dados numéricosRESUMO
IMPORTANCE: Endometrial cancer and precancer are common gynecologic problems for many women. A majority of these patients require surgery as the mainstay of treatment. Many of these patients often have concurrent pelvic floor disorders. Despite the prevalence and shared risk, fewer than 3% of women undergo concomitant surgery for PFDs at the time of surgery for endometrial cancer or endometrial intraepithelial neoplasia/hyperplasia. OBJECTIVE: This study aimed to evaluate postoperative morbidity of concomitant pelvic organ prolapse (POP) and/or urinary incontinence (UI) procedures at the time of hysterectomy for endometrial cancer (EC) or endometrial intraepithelial neoplasia/endometrial hyperplasia (EIN/EH). METHODS: This retrospective analysis of women undergoing hysterectomy for EC or EIN/EH between 2017 and 2022 used the American College of Surgeons National Surgical Quality Improvement Program database. The primary outcome was any major complication within 30 days of surgery. Comparisons were made between 2 cohorts: hysterectomy with concomitant pelvic organ prolapse/urinary incontinence procedures (POPUI) versus hysterectomy without concomitant POP or UI procedures (HYSTAlone). A subgroup analysis was performed in patients with EC. A propensity score matching cohort was also created. RESULTS: A total of 23,144 patients underwent hysterectomy for EC or EIN/EH: 1.9% (n = 432) had POP and/or UI procedures. Patients with POPUI were older, were predominantly White, had higher parity, and had lower body mass index with lower American Society of Anesthesiologists class. Patients with POPUI were less likely to have EC (65.7% vs 78.3%, P < 0.0001) and more likely to have their hysterectomy performed by a general obstetrician- gynecologists or urogynecologists. Major complications were low and not significantly different between POPUI and HYSTAlone (3.7% vs 3.6%, P = 0.094). A subgroup analysis of EC alone found that the HYSTAlone subset did not have more advanced cancers, yet the surgeon was more likely a gynecologic oncologist (87.1% vs 68.0%, P < 0.0001). There were no statistically significant differences between the 2 cohorts for the primary and secondary outcomes using propensity score matching analysis. CONCLUSIONS: Concomitant prolapse and/or incontinence procedures were uncommon and did not increase the rate of 30-day major complications for women undergoing hysterectomy for EC/EH.
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Neoplasias do Endométrio , Distúrbios do Assoalho Pélvico , Prolapso de Órgão Pélvico , Incontinência Urinária , Feminino , Humanos , Distúrbios do Assoalho Pélvico/complicações , Estudos Retrospectivos , Histerectomia/efeitos adversos , Incontinência Urinária/epidemiologia , Neoplasias do Endométrio/complicações , Prolapso de Órgão Pélvico/complicaçõesRESUMO
Journals have been described as "duty bearers" of upholding fundamental ethical principles that are essential for maintaining the ethical integrity of newly generated and disseminated knowledge. To play our part, we evaluated diversity and inclusion in the leadership and management of global and international health journals. We developed Journal Diversity Index (JDI) to measure three parameters of diversity and representation (gender, geographic, socioeconomic status). Relevant information regarding editorial board members of systematically screened journals was sequentially extracted and job titles were categorized into five editorial roles. Chi-squared test was utilized to study associations between gender and geographic distribution of editors along with the Medline indexing of the journal and its impact factor. Out of 43 journals included, 62.7% were published from two high-income countries. Women comprised 44% of the total editors. Among all the editorial board members, we did not find any information suggesting the representation of non-binary and transgender individuals. Furthermore, 68.2% of editors were based in high-income countries with 67.3% of the editors belonging to the Global North. This disparity in geographic region and socioeconomic level was observed across all five editorial roles. Among all women editors, more than 70% worked in non-Medline and non-impact factor journals. Only two journals scored "excellent" on JDI. Despite the continuous evolution of the definition of global health ethics, marginalized individuals, and their perspectives remain underrepresented in this field. Thus, we call for swift action regarding the decentralization and redistribution of global and international health journal editorial boards. Supplementary Information: The online version contains supplementary material available at 10.1007/s41649-023-00243-8.
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Child abuse is a preventable phenomenon of considerable concern resulting in significant child mortality and morbidity. We analyze various abuse lesions such as radiological (visceral and skeletal lesions and those associated with head trauma) and cutaneous (burns, bruises, bites, etc.) to enhance streamlined identification of injuries in cases of physical child abuse. For effective results, it is essential to remain mindful of all background factors, such as the caregiver setting and the prevalence of child maltreatment in the concerned community while acknowledging the possibility of natural causes (genetic diseases such as osteogenesis imperfecta and hemophilia, or acquired abnormalities) that can mimic NAT and cause confusion in diagnosis and treatment. The margin of error in cases of abuse is negligible, therefore, making its diagnosis a momentous as well as challenging clinical task. An ineffective diagnosis can have detrimental emotional consequences for the family and may even expose the child to future potentially fatal episodes of abuse. Hence, there is a need to direct special focus on the importance of accurate history taking and immediate, responsible reporting to authorities, as well as to child protective services. Therefore, considering the multifactorial approach this subject requires, this review aims to delve into prevalence statistics, various risk factors, and their effect on psychological health to offer a near-complete regulation to ensure an effective understanding of NAT on part of doctors, social workers, and other relevant authorities.
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BACKGROUND: Induction of labor is a common obstetrical intervention; much research focuses on medical indications, clinical outcomes, and induction agents. Little research has been conducted evaluating the patients' understanding of and satisfaction with induction of labor. Video-based educational tools have been validated as a practical and efficient counseling method by previous studies. OBJECTIVE: This study aimed to evaluate whether an educational video enhances the patients' knowledge about induction of labor and improves satisfaction with the induction of labor process. STUDY DESIGN: This was a single-center study in which women undergoing a scheduled induction of labor were randomized to either the control or intervention group. The control group was given a knowledge questionnaire about induction of labor before meeting their provider (midwife or obstetrician) on the day of scheduled induction of labor. The intervention group was shown a 3-minute educational video about induction of labor before administration of the knowledge questionnaire. Both groups, 24 to 48 hours after delivery, were asked to fill out a second questionnaire about satisfaction with the induction of labor process. Moreover, the video intervention group was asked to evaluate the video in the second questionnaire. Both knowledge and satisfaction questionnaires were compared between the control and intervention groups. RESULTS: From October 2019 to February 2020, 145 women scheduled for induction of labor were eligible and approached for the study. Of the 145 participants, 129 consented and 119 completed the entire study. Moreover, 64 participants were randomized into the control group and 55 into the intervention group. Compared with patients in the control group, the patients who watched the educational video in the intervention group had significantly improved baseline knowledge about induction of labor (P<.001). Knowledge scores remained significantly higher in the intervention group when considering participants who had a previous induction of labor (parity, P<.001; nulliparity, P<.001; multiparity, P<.001). In addition, satisfaction with the induction of labor process among participants in the intervention group was significantly higher than those in the control group (P<.001). Moreover, this held true in those who had a cesarean delivery or had a history of a previous induction of labor (P<.003 and P<.001, respectively). CONCLUSION: A brief educational video about induction of labor improved the patients' knowledge about the induction of labor process and their overall satisfaction with their delivery experience. Video-based education can play an innovative and important role in patient knowledge and satisfaction with the induction of labor process.
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Trabalho de Parto , Cesárea , Feminino , Humanos , Trabalho de Parto Induzido , Paridade , Gravidez , Inquéritos e QuestionáriosRESUMO
5-fluorouracil (5-FU) is a widely used chemotherapeutic agent but cardiotoxicity challenges its clinical usefulness. Thus, searching for more cardioprotective drugs is highly required to prevent the accompanied cardiac hazards. Up to date, the different mechanisms involved in 5-FU cardiotoxicity are still unclear and there is no evaluation of bosentan's role in controlling these cardiac complications. This forced us to deeply study and evaluate the possible cardiopreserving properties of bosentan and different mechanisms involved in mediating it. 32 Wistar albino rats were included in our experiment and induction of cardiotoxicity was performed via administration of 5-FU (150 mg/kg) on 5th day of the experiment by intraperitoneal (i.p.) injection with or without co-administration of bosentan (50 mg/kg/day) orally for 7days. Our data revealed that 5-FU could induce cardiotoxicity which was detected as significant increases of troponin I, lactate dehydrogenase (LDH), creatine kinase- MB (CK-MB), endothelin receptors, malondialdehyde (MDA), toll like receptor4 (TLR4), myeloid differentiation primary response 88 (MyD88), nuclear factor kappa B (NFκB), and caspase 3 levels. However, there is marked decrease in endothelial nitric oxide synthase (eNOS), reduced glutathione (GSH) and total antioxidant capacity (TAC). In addition, the histopathological examination showed severe toxic features of cardiac injury. Interestingly, co-administration of bosentan could ameliorate 5-FU-induced cardiotoxicity via improving the detected biochemical and histopathological changes besides modulation of TLR4/MyD88/NFκB signaling pathway, eNOS, and endothelin receptors. Bosentan had a significant cardioprotective effect against 5-FU induced cardiac damage. This effect may be attributed to its ability to inhibit endothelin receptors, stimulates eNOS, anti-oxidant, anti-inflammatory, anti-apoptotic properties with modulation of TLR4/MyD88/NFκB signaling pathway.
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Antimetabólitos Antineoplásicos/toxicidade , Bosentana/farmacologia , Antagonistas dos Receptores de Endotelina/farmacologia , Fluoruracila/toxicidade , Cardiopatias/prevenção & controle , Miócitos Cardíacos/efeitos dos fármacos , Receptores de Endotelina/efeitos dos fármacos , Animais , Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Apoptose/efeitos dos fármacos , Cardiotoxicidade , Cardiopatias/induzido quimicamente , Cardiopatias/metabolismo , Cardiopatias/patologia , Fator 88 de Diferenciação Mieloide/metabolismo , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , NF-kappa B/metabolismo , Óxido Nítrico Sintase Tipo III/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos Wistar , Receptores de Endotelina/metabolismo , Transdução de Sinais , Receptor 4 Toll-Like/metabolismoRESUMO
Endometriosis of the diaphragm has been gaining more attention in the practice of gynecologists and thoracic surgeons in recent years. Understanding related symptoms and developing imaging methods have improved their approach. A review of the literature was performed with the aim to report on incidence, diagnosis, treatment and prognosis of diaphragmatic endometriosis. We also cover the issue of the Thoracic Endometriosis Syndrome (TES). Complaints of cyclic chest pain in patients of childbearing age should have as differential diagnosis the presence of thoracic endometriosis. Catamenial pneumothorax is the main manifestation of diaphragmatic endometriosis and Thoracic Endometriosis Syndrome. Other possible manifestations are hemothorax, pulmonary nodules, and diaphragmatic hernia. Despite the possibility of drug treatment, many patients will be submitted to surgical treatment. The minimally invasive approach should be the one of choice. The robotic pathway allows for an easier approach due to its ability to articulate robotic arms, allowing the treatment of lesions in hard-to-reach locations, such as the posterior part of the diaphragm. Multidisciplinary treatment should be used in most cases, as only abdominal approach is not sufficient for the diagnosis and treatment of lesions in the thoracic cavity. The approach of endometriosis of the diaphragm and Thoracic Endometriosis Syndrome should be multidisciplinary, allowing the improvement of quality of life in most patients.
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Endometriosis negatively impacts the lives of countless women around the world. When medical management fails to improve the quality of life for women with either previously confirmed or suspected endometriosis often a decision must be made whether or not to proceed with surgery. When deeply infiltrating disease is diagnosed either clinically or by imaging studies often medical management alone will not suffice without excisional surgery. Surgery for endometriosis, especially deeply infiltrating disease, is not without risks. Aside from common risks of surgery endometriosis may also involve pelvic nerves, which can be hard to recognize to the untrained eye. Identification of pelvic nerves commonly encountered during endometriosis surgery is paramount to avoid inadvertent injury to optimize function outcomes. Injury to pelvic nerves can lead to urinary retention, constipation, sexual dysfunction, and refractory pain. However, nerve-sparing surgery for endometriosis has been proven to mitigate these complications and enhance recovery following surgery. Here we review the benefits of nerve-sparing surgery for deeply infiltrating disease.
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Endometriosis negatively impacts the lives of countless women around the world. When medical management fails to improve quality of life often women are left making a decision whether or not to proceed with surgery. With endometriomas, patient's surgical options include complete surgical removal or drainage via laparoscopy. Here, we review the literature to discuss both techniques, excision and drainage of endometriomas, and what the research supports for endometrioma management.
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(1) Background: Adenomyosis is a poorly understood entity which makes it difficult to standardize treatment. In this paper we review and compare the currently approved medical and surgical treatments of adenomyosis and present the evidence behind them. (2) Methods: A PubMed search was conducted to identify papers related to the different treatments of adenomyosis. The search was limited to the English language. Articles were divided into medical and surgical treatments. (3) Results: Several treatment options have been studied and were found to be effective in the treatment of adenomyosis. (4) Conclusions: Further randomized controlled trials are needed to compare treatment modalities and establish a uniform treatment algorithm for adenomyosis.
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Immunocompromised individuals especially children with cancer are at risk for acquiring cryptosporidiosis, which can result in severe morbidity and mortality. This work was conducted to evaluate the prevalence of Cryptosporidium parasite and its genotypes in children with cancer. Stool specimens were collected from 145 children in the Oncology unit of Pediatric Department, Zagazig University Hospital, Sharqiyah province, Egypt. Cryptosporidium infection was evaluated using modified Ziehl-Neelsen (MZN) staining and nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. The prevalence of Cryptosporidium infection in oncological children was 29.7% using microscopy and 25.5% using nested PCR. Genotypic characterization showed that 23 (62.2%) had C. hominis, 11 (29.7%) C. parvum, and 3 specimens (8.1%) were mixed infection of both genotypes. Cryptosporidiosis was significantly associated with diarrhea. However, no statistically significant difference was detected between the age, gender, residency, animal contact and malignancy type concerning to Cryptosporidium infection. This study concluded that Cryptosporidium is a prevailing opportunistic parasite among children with cancer. It should be considered in oncological patients especially those suffering from diarrhea which requires proper management to reduce its complications.