60 research outputs found
The Impact of Urinary Incontinence on Quality of Life: A Cross-Sectional Study in the Metropolitan City of Naples
Urinary incontinence is a hygienic and psychosocial problem that often brings people to restrict their social life and to experience depression. The main aim of this study was to evaluate the impact of urinary incontinence on quality of life among residents of the Metropolitan City of Naples, Italy, using a newly designed multidimensional questionnaire. The secondary objective was to find which variables affect the quality of life and symptom severity in these patients. To do so, a sample composed of twenty-eight patients was recruited in a multicentre cross-sectional study. Most of the participants had a mild impairment (60%) concerning social life and self-perception, especially those whose education was above the primary level (p = 0.036) and those who followed a pelvic floor rehabilitation program (p = 0.002). Overflow urinary incontinence was associated with a greater deterioration in the aspirational and occupational domain (p = 0.044). Symptom severity was worse in those who had comorbidities (p = 0.038), who had a high body mass index (p = 0.008) or who used diuretics (p = 0.007). In conclusion, our results suggest that there is a significant impairment of quality of life in patients who have only primary education and who follow a pelvic floor rehabilitation program
Correlative imaging of cystic lymphangiomas: ultrasound, CT and MRI comparison
Cystic lymphangioma is a rare benign lesion derived from the detachment of the lymph sacs from venous drainage systems; the treatment of choice is a surgical excision and the final diagnosis is of histological type
Emergency groin hernia repair: implications in elderly
BACKGROUND: Groin hernia is one of the most frequently encountered pathologies occurring in old age and it is often the cause of emergency procedures. In our study we evaluate the impact of emergency procedures in over 75 patients compared to younger patients. METHODS: We conducted a retrospective study about patients who underwent emergency hernioplasty between September 2007 and January 2013. Bilateral hernias and recurrences were excluded. We divided patients into two groups by age (under and over 75 years old) and then analyzed the early postoperative surgical complications. RESULTS: A total of 48 patients were enrolled, 18 were included in under 75 group and 30 in over 75. In the older group we found a higher rate of comorbidity and also a significant higher rate of postoperative complications. Two patients of over 75 group died. CONCLUSIONS: Our data suggests that a quick diagnosis and elective surgical procedures are desirable in order to avoid the complications that occur in emergency operations
Day-surgery inguinal hernia repair in the elderly: single centre experience
BACKGROUND: Inguinal hernioplasty is well established as a day-surgery procedure, our purpose is to assess the safeness of this approach in elderly patients. METHODS: A total of 292 inguinal hernioplasty were performed between June 2009 and February 2013. Patients were divided into 3 groups depending on the age and postoperative complications were compared in these groups. RESULTS: Despite of a large number of higher risk (ASA 3-4) patients and a higher rate of comorbidity in older patients, unplanned admission postoperative, symptoms and complications were comparable with those for the younger patients. CONCLUSIONS: Ambulatory surgery is feasible also in older patients. Age, comorbidity and higher ASA risk should not be a barrier to elective day surgery
Brain morphology and immunohistochemical localization of the gonadotropin-releasing hormone in the bluefin tuna, <i>Thunnus thynnus</i>
The present study was focused on the morphology of the
diencephalic nuclei (likely involved in reproductive functions)
as well as on the distribution of GnRH (gonadotropin-releasing
hormone) in the rhinencephalon, telencephalon and the
diencephalon of the brain of bluefin tuna (Thunnus thynnus)
by means of immunohistochemistry. Bluefin tuna has an
encephalization quotient (QE) similar to that of other large
pelagic fish. Its brain exhibits well-developed optic tecta and
corpus cerebelli. The diencephalic neuron cell bodies
involved in reproductive functions are grouped in two main
nuclei: the nucleus preopticus-periventricularis and the
nucleus lateralis tuberis. The nucleus preopticus-periventricularis
consists of the nucleus periventricularis and the nucleus
preopticus consisting of a few sparse multipolar neurons
in the rostral part and numerous cells closely packed and
arranged in several layers in its aboral part. The nucleus lateralis
tuberis is located in the ventral-lateral area of the
diencephalon and is made up of a number of large multipolar
neurones.
Four different polyclonal primary antibodies against salmon
(s)GnRH, chicken (c)GnRH-II (cGnRH-II 675, cGnRH-II 6)
and sea bream (sb)GnRH were employed in the immunohistochemical
experiments. No immunoreactive structures were
found with anti sbGnRH serum. sGnRH and cGnRH-II antisera
revealed immunoreactivity in the perikarya of the olfactory
bulbs, preopticus-periventricular nucleus, oculomotor
nucleus and midbrain tegmentum. The nucleus lateralis
tuberis showed immunostaining only with anti-sGnRH serum.
Nerve fibres immunoreactive to cGnRH and sGnRH sera were
found in the olfactory bulbs, olfactory nerve and neurohypophysis.
The significance of the distribution of the GnRHimmunoreactive
neuronal structures is discussed
Can Metformin Exert as an Active Drug on Endothelial Dysfunction in Diabetic Subjects?
Abstract: Cardiovascular mortality is a major cause of death among in type 2 diabetes (T2DM).
Endothelial dysfunction (ED) is a well-known important risk factor for the development of diabetes
cardiovascular complications. Therefore, the prevention of diabetic macroangiopathies by preserving
endothelial function represents a major therapeutic concern for all National Health Systems.
Several complex mechanisms support ED in diabetic patients, frequently cross-talking each other:
uncoupling of eNOS with impaired endothelium-dependent vascular response, increased ROS production,
mitochondrial dysfunction, activation of polyol pathway, generation of advanced glycation
end-products (AGEs), activation of protein kinase C (PKC), endothelial inflammation, endothelial
apoptosis and senescence, and dysregulation of microRNAs (miRNAs). Metformin is a milestone
in T2DM treatment. To date, according to most recent EASD/ADA guidelines, it still represents
the first-choice drug in these patients. Intriguingly, several extraglycemic effects of metformin have
been recently observed, among which large preclinical and clinical evidence support metformin’s
efficacy against ED in T2DM. Metformin seems effective thanks to its favorable action on all the
aforementioned pathophysiological ED mechanisms. AMPK pharmacological activation plays a key
role, with metformin inhibiting inflammation and improving ED. Therefore, aim of this review is
to assess metformin’s beneficial effects on endothelial dysfunction in T2DM, which could preempt
development of atherosclerosis
Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy
IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical
attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced
colorectal cancers at diagnosis.
OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced
oncologic stage and change in clinical presentation for patients with colorectal cancer.
DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all
17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December
31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period),
in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was
30 days from surgery.
EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery,
palliative procedures, and atypical or segmental resections.
MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer
at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as
cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding,
lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery,
and palliative surgery. The independent association between the pandemic period and the outcomes
was assessed using multivariate random-effects logistic regression, with hospital as the cluster
variable.
RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years)
underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142
(56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was
significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR],
1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic
lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03).
CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the
SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients
undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for
these patients
Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago
Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
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