Does Adjuvant Long-Acting Gestagen Therapy Improve the Outcome of Hysteroscopic Endometrial Resection in Women of Low-Resource Settings With Heavy Menstrual Bleeding?

ObjectiveTo test for the hypothesis of the beneficial effect of long-acting gestagens as an adjuvant postoperative therapy on the outcome of hysteroscopic transcervical endometrial resection (TCRE) in women of low-resource settings and suffering from ovulatory heavy menstrual bleeding (menorrhagia).DesignRandomized controlled trial (Canadian Task Force classification I).SettingLow-resource tertiary care university hospital.PatientsSeventy-one premenopausal women with established ovulatory menorrhagia.InterventionAfter randomization, 37 patients were treated with TCRE plus gestagen and 34 patients with TCRE alone.Measurements and Main ResultsVariations in menstrual patterns and bleeding scores, as well as amenorrhea and repeat surgery rates with treatment, were determined 1 year after resection. In those who continued to menstruate at 6 months, treatment with TCRE plus gestagen was associated with a significant reduction in the number of days bleeding from 7.2 to 3.4 (p ≤ .0001), increased cycle length from 24 to 30 (p = .02), a 60% reduction in dysmenorrhea score from 62 to 25 (p ≤ .0001), and a 60% reduction in premenstrual syndrome score from 55 to 22 (p = .04). Amenorrhea rates at 12 months in the TCRE plus gestagen and TCRE alone groups were 40% versus 26% (p = .02), with combined amenorrhea and hypomenorrhea rates of 75% versus 64% (p = .02), respectively. At 12 months, repeat surgery rates were higher in the TCRE alone group (21% vs 3%, p < .05).ConclusionIn a low-resource setting, the adjuvant postoperative long-acting gestagen therapy has proven to be superior in inducing amenorrhea after hysteroscopic TCRE.     

Conduction Mechanisms in Au/0.8 nm–GaN/n–GaAs Schottky Contacts in a Wide Temperature Range

Au/0.8 nm–GaN/n–GaAs Schottky diodes were manufactured and electrically characterized over a wide temperature range. As a result, the reverse current I_inv increments from 1 × 10⁻⁷ A at 80 K to about 1 × 10⁻⁵ A at 420 K. The ideality factor n shows low values, decreasing from 2 at 80 K to 1.01 at 420 K. The barrier height qϕ_b grows abnormally from 0.46 eV at 80 K to 0.83 eV at 420 K. The tunnel mechanism TFE effect is the responsible for the qϕ_b behavior. The series resistance R_s is very low, decreasing from 13.80 Ω at 80 K to 4.26 Ω at 420 K. These good results are due to the good quality of the interface treated by the nitridation process. However, the disadvantage of the nitridation treatment is the fact that the GaN thin layer causes an inhomogeneous barrier height.     

Cardiovascular benefits from SGLT2 inhibition in type 2 diabetes mellitus patients is not impaired with phosphate flux related to pharmacotherapy

The beneficial cardiorenal outcomes of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) have been substantiated by multiple clinical trials, resulting in increased interest in the multifarious pathways by which their mechanisms act. The principal effect of SGLT2i (-flozin drugs) can be appreciated in their ability to block the SGLT2 protein within the kidneys, inhibiting glucose reabsorption, and causing an associated osmotic diuresis. This ameliorates plasma glucose elevations and the negative cardiorenal sequelae associated with the latter. These include aberrant mitochondrial metabolism and oxidative stress burden, endothelial cell dysfunction, pernicious neurohormonal activation, and the development of inimical hemodynamics. Positive outcomes within these domains have been validated with SGLT2i administration. However, by modulating the sodium-glucose cotransporter in the proximal tubule (PT), SGLT2i consequently promotes sodium-phosphate cotransporter activity with phosphate retention. Phosphatemia, even at physiologic levels, poses a risk in cardiovascular disease burden, more so in patients with type 2 diabetes mellitus (T2DM). There also exists an association between phosphatemia and renal impairment, the latter hampering cardiovascular function through an array of physiologic roles, such as fluid regulation, hormonal tone, and neuromodulation. Moreover, increased phosphate flux is associated with an associated increase in fibroblast growth factor 23 levels, also detrimental to homeostatic cardiometabolic function. A contemporary commentary concerning this notion unifying cardiovascular outcome trial data with the translational biology of phosphate is scant within the literature. Given the apparent beneficial outcomes associated with SGLT2i administration notwithstanding negative effects of phosphatemia, we discuss in this review the effects of phosphate on the cardiometabolic status in patients with T2DM and cardiorenal disease, as well as the mechanisms by which SGLT2i counteract or overcome them to achieve their net effects. Content drawn to develop this conversation begins with proceedings in the basic sciences and works towards clinical trial data.     

Seasonal patterns of incidence,demographic factors and microbiological profiles of infectious keratitis: the Nottingham Infectious Keratitis Study

PurposeThe purpose of this study is to examine the seasonal patterns of incidence, demographic factors and microbiological profiles of infectious keratitis (IK) in Nottingham, UK.MethodsA retrospective study of all patients who were diagnosed with IK and underwent corneal scraping during 2008–2019 at a UK tertiary referral centre. Seasonal patterns of incidence (in per 100,000 population-year), demographic factors, culture positivity rate and microbiological profiles of IK were analysed.ResultsA total of 1272 IK cases were included. The overall incidence of IK was highest during summer (37.7, 95% confidence interval (CI): 31.3–44.1), followed by autumn (36.7, 95% CI: 31.0–42.4), winter (36.4, 95% CI: 32.1–40.8) and spring (30.6, 95% CI: 26.8–34.3), though not statistically significant (p = 0.14). The incidence of IK during summer increased significantly over the 12 years of study (r = 0.58, p = 0.049), but the incidence of IK in other seasons remained relatively stable throughout the study period. Significant seasonal variations were observed in patients’ age (younger age in summer) and causative organisms, including Pseudomonas aeruginosa (32.9% in summer vs. 14.8% in winter; p < 0.001) and gram-positive bacilli (16.1% in summer vs. 4.7% in winter; p = 0.014).ConclusionThe incidence of IK in Nottingham was similar among four seasons. No temporal trend in the annual incidence of IK was observed, as reported previously, but there was a significant yearly increase in the incidence of IK during summer in Nottingham over the past decade. The association of younger age, P. aeruginosa and gram-positive bacilli infection with summer was likely attributed to contact lens wear, increased outdoor/water activity and warmer temperature conducive for microbial growth.Subject terms: Epidemiology, Corneal diseases     

Recurrent symptomatic ischemic stroke in a 46-year-old African male revealing Angio-Behçet with severe cardiovascular involvement

Behçet’sdisease (BD) is a chronic, multisystem vasculitis. It is categorized under variable vessel vasculitis in the new Chapel Hill nomenclature as it involves blood vessels of any type and size. It is characterized by relapsing aphthous ulcers commonly occurring in the oral mucosa and genitalia with ocular involvement. Other organ systems may be involved any time throughout the course of the disease. The exact cause is unknown. However, combination of genetic and environmental factors is likely to play a role.Cardiac involvement may occur in the form of intracardiac thrombus, endocarditis, myocarditis, pericarditis, endomyocardial fibrosis, coronary arteritis, myocardial infarction, and valvular disease.We present a case of Angio-Behçet in a 46-year-old African male with severe cardiovascular involvement including pulmonary artery hypertension (PAH), right ventricular failure and left ventricular diastolic dysfunction diagnosed after 2 episodes of symptomatic ischemic stroke resulting from complete occlusion of the right internal carotid artery (ICA) up to its intracranial portion.Immunosuppressive and anticoagulant therapies have induced improvement in cardiac manifestations. Nevertheless, prompt recognition of the primarily vascular manifestation of BD without mucocutaneous manifestations was responsible for considerable delay that did not afford surgical therapy for the carotid occlusion.