Benign senile pyometra: case report

Pyometra is a pus accumulation in the endometrium cavity, with an incidence from 0.02% to 1.5%. The benign senile pyometra is a disease mainly reported in elder women, with an average age of 74 years. We present the case of a 59-year-old woman with the diagnosis of benign senile pyometra. The patient came to our service presenting purulent vaginal discharge, in bad condition with pelvic pain and altered hematic cytology. In the physical examination a pelvic mass was found, in the vaginal examination, the cervix was found estenotic, and the hysterometer could not be introduced. The image studies revealed an increased size of the uterus was liquid collection in its interior, compatible with blood or pus. We performed exploratory laparotomy, founding two abscecess in the uterin fundus which suffered rupture during the procedure. Abdominal hysterectomy with bilateral salpigooforectomy was performed, there were not other complications. Post surgical period was managed with antibiotics and close surveillance. The patient was discharged four days later with good response to the treatment. In the anatomophatological study no evidence of cervical or endometrial neoplasia was found.     

Ultrasonographic and doppler velocimetric evaluation of the levator ani muscle according to the hormonal status

Objective

We aimed to study the cross-sectional area of levator ani muscle and the doppler velocimetric parameters of vessels its in premenopausal and postmenopausal women.

Study design

Sixty-four patients, divided into 3 groups, were assessed: group I (20 women—average age 28 years) premenopausal and nulliparous (control); group II (24 women—average age 38 years, vaginal delivery 1–4) premenopausal with vaginal deliveries; group III (20 women—average age 55 years, parity 0–4) postmenopausal without hormonal therapy. Doppler velocimetry of levator ani muscle vessels through resistance and pulsatility indices was used and the means of the groups compared by adjusting the weighed variance model with multiple comparisons, according to Tukey's method. Similarly, we measured the cross-sectional area of the muscle using ultrasonography.

Results

There was a significant increase in resistance and pulsatility indices in postmenopausal patients as compared to the other two groups. We also observed a significant decrease in the cross-sectional area of the muscle of postmenopausal patients when compared to those in premenopausal.

Conclusion

The obtained results allow us to conclude that levator ani muscle vascularization significantly decreases after menopause (age and/or hipoestrogenism) and that it can be assumed that vaginal delivery does not promote long-term alterations in levator ani muscle vascularization. We also observed a significant decrease in the cross-sectional area of the muscle in postmenopausal women when compared to those in premenopausal.     

Heart rate variability,exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate cystic fibrosis

Background:Autonomic nervous system balance is altered in cystic fibrosis (CF), although its influence on physical fitness has been poorly explored.Objective:This study aimed to evaluate the association of heart rate variability (HRV) with exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate CF.Methods:A cross-sectional study including individuals with CF aged 6–18 years, not under CFTR modulator therapy, was performed. Sociodemographic (age, sex) and clinical information (airway colonization, pancreatic insufficiency, and genotyping) were collected. In addition, exercise capacity (modified shuttle test — MST), lung function (spirometry), body composition (bioimpedance), levels of daily physical activity (5-day accelerometer), and HRV (both at rest and during the MST) were evaluated.Results:30 individuals (20 females) aged 11.2±3.7 years, mean FEV162.8±27.6%, were included. A sympathovagal balance (LF/HF) increase (p<0.001) during the MST was shown, indicating a predominance of sympathetic modulation. The standard deviation of all RR intervals (SDNN) and the high frequency (HF) index during exercise correlated significantly with FEV₁ (r=0.45, p=0.01 and r=0.46, p=0.01; respectively). MST distance also correlated positively and significantly with SDNN (r=0.43, p=0.01), square root of the mean of the sums of squares of frequencies between RR intervals greater than 50 ms — RMSSD (r=0.53, p<0.01), low frequency — LF (r=0.48, p<0.01), HF (r=0.64, p<0.01), dispersion of points perpendicular to the short-term identity line — SD1 (r=0.40, p=0.02) and negatively with LF/HF (r=−0.57, p<0.01). Regarding daily physical activity, SDNN at rest (r=0.37, p=0.04) and exercise (r=0.41, p=0.02) showed positive correlations with time in moderate-to-vigorous activities. When normalizing the SDNN and classifying individuals as normal or altered, those presenting altered SDNN showed poorest FEV₁ (p=0.001) and lower exercise capacity (p=0.027).Conclusion:HRV correlates with lung function, exercise capacity and levels of daily physical activity in children and adolescents with CF. The study highlights the influence of CF on autonomic function and suggests HRV measurement as an easy tool to be used in clinical settings as an alternative marker to monitor CF individuals.     

Transdermal permeation of curcumin promoted by choline geranate ionic liquid: Potential for the treatment of skin diseases

The transdermal permeation of curcumin aided by choline and geranic acid ionic liquid (CAGE-IL) was addressed as a potential treatment for skin diseases. An in-depth analysis of the effect of CAGE-IL concentration in the enhancement of transdermal permeation of curcumin was performed, and the results were modelled via nonlinear regression analysis. The results obtained showed that a low percentage of CAGE-IL (viz. 2.0%, w/w) was effective in disrupting the skin structure in a transient fashion, facilitating the passage of curcumin dissolved in it.     

Hyperimmunized Chickens Produce Neutralizing Antibodies against SARS-CoV-2

The novel severe acute respiratory syndrome (SARS) coronavirus, SARS-CoV-2, is responsible for the global COVID-19 pandemic. Effective interventions are urgently needed to mitigate the effects of COVID-19 and likely require multiple strategies. Egg-extracted antibody therapies are a low-cost and scalable strategy to protect at-risk individuals from SARS-CoV-2 infection. Commercial laying hens were hyperimmunized against the SARS-CoV-2 S1 protein using three different S1 recombinant proteins and three different doses. Sera and egg yolk were collected at three and six weeks after the second immunization for enzyme-linked immunosorbent assay and plaque-reduction neutralization assay to determine antigen-specific antibody titers and neutralizing antibody titers, respectively. In this study we demonstrate that hens hyperimmunized against the SARS-CoV-2 recombinant S1 and receptor binding domain (RBD) proteins produced neutralizing antibodies against SARS-CoV-2. We further demonstrate that antibody production was dependent on the dose and type of antigen administered. Our data suggests that antibodies purified from the egg yolk of hyperimmunized hens can be used as immunoprophylaxis in humans at risk of exposure to SARS-CoV-2.     

Cribado e intervención breve en consumo de alcohol

La morbilidad asociada al consumo de alcohol incluye patología digestiva, psiquiátrica, neurológica, infecciosa, cáncer de diversos tipos, enfermedades cardiovasculares, lesiones intencionales, no intencionales, patología social y problemas familiares. Las evidencias más recientes no indican que el consumo «moderado» sea beneficioso para la salud. Por lo tanto, debe enfatizarse más bien la idea de evitar los consumos de riego y transmitir a los pacientes que lo más beneficioso para la salud sería no consumir alcohol o hacerlo en dosis de bajo riesgo. El instrumento más adecuado de cribado es el AUDIT-C. Las bases de la intervención breve consisten en estrategias cognitivo-conductuales y motivacionales. Hay que dar una información positiva sobre los beneficios de la moderación e informar sobre el peligro de la ingesta de alcohol. En fases precoces de la dependencia se contempla la oferta de tratamiento farmacológico de desintoxicación, deshabituación y seguimiento. Los casos más graves requieren coordinación con los servicios de adicciones. En España se ha podido comprobar que la intervención breve es efectiva y que disminuye el consumo 100 gramos de alcohol a la semana. Las estrategias comunitarias son el marco normativo adecuado para lograr los mejores resultados de la intervención breve. Estas deberán ir encaminadas a reducir la oferta y la disponibilidad para el consumo, mediante la adopción de medidas legislativas, de manera que se limite tanto la accesibilidad económica como la física. Por otra parte, habrá que implementar medidas para disminuir la demanda del alcohol mediante la educación para la salud a determinados grupos de riesgo.Palabras clave: Alcohol, Intervención breve, Prevención, Atención Primaria     

"Occult" renal insufficiency due to evaluating renal function using only serum creatinine

Timely referral to nephrologists depends on identification of renal failure. Most primary care physicians and specialists rely on serum creatinine as the standard test for determination of renal function. Creatinine clearance requires 24 hours urine collection with many pitfalls and wrong results. We compare serum creatinine and the Cockcroft-Gault (C-G) equation as measure of glomerular filtration rate (GFR). The study included 1,053 outpatients with serum creatinine lower than 2.5 mg/dl referred to our nephrological laboratory for serum creatinine and GFR determination using the C-G formula. Patients were grouped into two groups: normal renal function (serum creatinine < 1.3 mg/dl) and "incipient" abnormal renal function (serum creatinine 1.3-2.5 mg/dl). In the group of females with normal creatinine 22% (60-70 y), 35% (70-80 y) and 57% (> 80 y) had GFR values below 50 ml/min. In the group of males 11.3% (70-80 y) and 33.3% (> 80 y) also had GFR reduction in spite of normal serum creatinine. A severe renal insufficiency with creatinine clearance lower than 30 ml/min was observed in the group with "incipient" renal failure based on serum creatinine: 22.7%, 40% and 82.9% for females and 6%, 22.7% and 57% for male (60-70 y; 70-80 y; and > 80 y respectively). In order to improve management and prevention of renal failure appropriate measurements of renal function other than serum creatinine should be emphasize.