Comparison of vaginal wall sling and modified vaginal wall sling for stress urinary incontinence

CONTEXT: There are several controversies about which is the best form of surgical treatment for stress urinary incontinence in women. The vaginal wall sling in its original and modified form were presented by Raz as new options for treatment of these conditions, but there is a lack of comparative clinical trials using both techniques. OBJECTIVE: To compare the effectiveness of the original and the modified vaginal wall sling. DESIGN: A comparative, prospective, non-randomized clinical trial. SETTING: Public and private health care units (Urology Division, Faculty of Medicine of the ABC Foundation, and Universidade Federal de São Paulo (UNIFESP) / Escola Paulista de Medicina). PARTICIPANTS: Twenty patients with anatomical and intrinsic sphincter deficiency stress urinary incontinence were surgically treated for evaluating the initial results of the vaginal wall sling, from February 5, 1994, to June 27, 1996. INTERVENTIONS: The patients were divided into two groups. Group A (n = 10) were treated with the original vaginal wall sling. Group B (n = 10) were treated with the modified vaginal wall sling. Both groups were statistically similar according to clinical and urodynamic parameters. MAIN MEASUREMENTS: Cure and complication rates. RESULTS: Follow-up ranged from 19 to 43 months (median = 28) for group A. The overall cure rate was 70%. Fifty per cent of the patients had urinary retention of 7 to 35 days. There were no major complications. Follow-up ranged from 14 to 26 months (median = 18) for Group B. The cure rate was 80%. Two patients had urinary retention of 7 and 55 days. There were no major complications. CONCLUSIONS: The vaginal wall sling is as effective as the modified vaginal wall sling but has a higher rate of urinary retention.CONTEXTO: Existem diversas controvérsias sobre qual é a melhor forma de tratamento cirúrgico da incontinência urinária de esforço em mulheres. O sling de parede vaginal, em suas formas original e modificada, foi apresentado como nova opção no tratamento dessa condição, mas um estudo comparativo com ambas as técnicas ainda não foi publicado. OBJETIVO: Avaliar a eficácia dos slings de parede vaginal e modificado. DESENHO: Ensaio clínico comparativo, prospectivo, não randomizado. LOCAL: Serviços das Disciplinas de Urologia da Faculdade de Medicina do ABC e da Universidade Federal de São Paulo (UNIFESP). PARTICIPANTES: Vinte pacientes com incontinência urinária de esforço tipos anatômica e por deficiência esfincterina intrínseca foram tratadas cirurgicamente para avaliação dos resultados iniciais do sling de parede vaginal, de 05 de fevereiro de 1994 a 27 de junho de 1996. INTERVENÇÃO: As pacientes foram divididas em dois grupos. Grupo A (n = 10) tratadas com o sling de parede vaginal original. Grupo B (n = 10) tratadas com o sling modificado. Ambos os grupos foram estatisticamente similares de acordo com parâmetros clínicos e urodinâmicos. VARIÁVEIS ESTUDADAS: Índices de cura e de complicações. RESULTADOS: O seguimento variou de 19 a 43 meses (mediana = 28) para o grupo A. O índice geral de sucesso foi 70%. 50% das pacientes tiveram retenção urinária que durou de 7 a 35 dias. Não houve complicações maiores. O seguimento variou de 14 a 26 meses (mediana = 18) para o grupo B. O índice de sucesso foi 80%. Duas pacientes tiveram retenção urinária durante 7 e 55 dias. Não houve complicações maiores. CONCLUSÕES: O sling de parede vaginal modificado tem eficácia similar ao original, que, por sua vez, tem maior índice de retenção urinária.Faculty of Medicine of the ABC Foundation, São Paulo Urology DivisionUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Urology DivisionUNIFESP, EPM, Urology DivisionSciEL

Enhancement of declarative memory associated with emotional content in a Brazilian sample

ABSTRACTSeveral studies have documented that emotional arousal may enhance long-term memory. This is an adaptation of a paradigm previously used in North American and European samples in investigations of the influence of emotion on long-term retention. A sample of 46 healthy adults of high and low educational levels watched a slide presentation of stories. A randomly assigned group watched a story with an arousing content and another group watched a neutral story. The stories were matched for structure and comprehensibility and the set and order of the 11 slides were the same in both conditions. Immediately after viewing the slide presentation, the participants were asked to rate the emotionality of the narrative. The arousing narrative was rated as being more emotional than the neutral narrative (t (44) = -3.6, P<0.001). Ten days later subjects were asked to remember the story and answer a multiple-choice questionnaire about it. The subjects who watched the arousing story had higher scores in the free recall measure (t (44) = -2.59, P<0.01). There were no differences between groups in the multiple-choice test of recognition memory (t (44) = 0.26). These findings confirm that an emotional arousing content enhances longterm declarative memory and indicate the possibility of applying this instrument to clinical samples of various cultural backgrounds

Effects of emotional reactivity on inhibitory avoidance in the elevated T-maze

ABSTRACTThe possibility of the presence of inter-individual emotional differences and the memory performance of rats was examined in the elevated T-maze. Two kinds of aversively motivated behaviors, inhibitory avoidance and escape learning, were measured. Based on the number of trials to achieve a learning criterion, rats were divided into two subgroups with either low or high avoidance reactivity (LAR or HAR, respectively). Retention test avoidance latencies showed that HAR animals had better avoidance memory (Mann-Whitney rank sum test, P = 0.0035). No such differences were found for the escape component of this test. These data suggest that individual emotional differences affect inhibitory avoidance performance, which may help to explain the dispersion of the data observed in other studies using this paradigm

Considerations about aging, memory and physical activity

A atividade física está relacionada a inúmeros benefícios físicos e mentais colaborando para a manutenção da saúde do cérebro, envolvendo mudanças na plasticidade sináptica e influenciando mecanismos de aprendizagem e memória. Após prática de atividade física tem sido observado um incremento na expressão do BDNF (fator neurotrófico derivado do cérebro), sendo este de fundamental importância para manter a sobrevivência e crescimento de muitos subtipos neuronais, surgindo como mediador-chave da eficiência sináptica. Apresentamos neste estudo, uma revisão sobre a influência do exercício físico sobre a memória dos idosos, enfatizando seus benefícios em contrapartida às perdas cognitivas decorrentes do envelhecimento. ________________________________________________________________________________ ABSTRACTPhysical activity is related to countless physical and mental benefits collaborating for the maintenance of the health of the brain, involving changes in the synaptic plasticity and influencing learning and memory mechanisms. After practicing physical activity an increment has been observed in the expression of BDNF (brain derived neurotrofic factor), this being of fundamental importance to maintain the survival and growth of many neurons subtypes, appearing as key-mediator of the synaptic efficiency. We present in this study, a revision of the influence of physical exercise on memory in old people, emphasizing their benefits in compensation to the current cognitive losses induced by aging

Cirurgia metabólica - cura para diabete tipo 2

ABSTRACTINTRODUCTION: Type 2 diabetes is a metabolic disease characterized by chronic hyperglycemia associated with several organs damage and failure. It is the most common cause of blindness, amputation and kidney failure in western adults, besides increase the risk of coronary disease and stroke with high mortality of patients. The association of type 2 diabetes with obesity is really significant. Obese diabetic patients had a better glucose control after bariatric surgery even prior to weight loss. METHODS: A systematic review in Pubmed, Bireme and Scielo research sites was made, using "Diabetes Mellitus", "Bariatric Surgery" and "Obesity" keywords. Were selected the studies related to surgical techniques in the treatment of obesity and type 2 diabetes. The papers presented at the 1st and 2nd World Congress of Interventional Therapies for Type 2 Diabetes was also included. CONCLUSION: Surgical treatment of patients with obesity and type 2 diabetes showed important initial results controling blood glucose. However, the procedures and techniques used must be more investigated in randomized controlled trials comparing the clinical and surgical treatments, in animals and in humans. ______________________________________________________________________________ RESUMOIntrodução - O diabete melito tipo 2 é doença metabólica caracterizada por hiperglicemia crônica que está associada com dano e insuficiência de vários órgãos. A evolução da doença é a causa mais comum de cegueira, amputações e insuficiência renal em adultos no ocidente, além de aumentar a incidência de infarto agudo do miocárdio e acidente vascular cerebral, com maior mortalidade dos pacientes. A associação dele com obesidade é relevante. Os pacientes obesos diabéticos quando submetidos ao tratamento cirúrgico da obesidade apresentam melhor controle da glicemia, mesmo antes de perderem peso. Método - Foi realizada revisão de literatura nos sites de pesquisa PubMed, Bireme e Scielo, com os descritores “Diabetes Mellitus”, “Cirurgia Bariátrica” e Obesidade”. Selecionaramse, principalmente, os estudos de aplicação de técnicas cirúrgicas nos tratamentos da obesidade e do diabete tipo 2. Adicionalmente foram Revisados os trabalhos apresentados no 1st e 2nd World Congress of Interventional Therapies for Type 2 Diabetes. Conclusão - O tratamento cirúrgico de pacientes obesos e diabéticos tipo 2 tem mostrado bom resultado inicial, com controle clínico precoce da glicemia. Porém, os procedimentos e técnicas empregados devem ser melhor investigados em estudos randomizados e controlados, comparando os tratamentos cirúrgico e clinico, em animais de experimentação e em seres humanos

Long-lasting mnemotropic effect of substance P and its N-terminal fragment (SP1-7) on avoidance learning

ABSTRACTWe investigated the long-lasting effect of peripheral injection of the neuropeptide substance P (SP) and of some N- or C-terminal SP fragments (SPN and SPC, respectively) on retention test performance of avoidance learning. Male Wistar rats (220 to 280 g) were trained in an inhibitory step-down avoidance task and tested 24 h or 21 days later. Immediately after the training trial rats received an intraperitoneal injection of SP (50 µg/kg), SPN 1-7 (167 µg/kg) or SPC 7-11 (134 µg/kg). Control groups were injected with vehicle or SP 5 h after the training trial. The immediate post-training administration of SP and SPN, but not SPC, facilitated avoidance behavior in rats tested 24 h or 21 days later, i.e., the retention test latencies of the SP and SPN groups were significantly longer (P<0.05, Mann-Whitney U-test) during both training-test intervals. These observations suggest that the memory-enhancing effect of SP is long-lasting and that the amino acid sequence responsible for this effect is encoded by its N-terminal part

Evaluation of water quality : proposal for a new index founded on the Fuzzy logic

Qualidade da água é um aspecto fundamental do ambiente para a saúde. Índices de Qualidade das Águas – IQA’s são operadores matemáticos que processam um conjunto de indicadores analíticos, produzindo um resultado numérico indexado, capaz de expressar a qualidade da água. O IQA mais difundido e aceito mundialmente é o proposto pela National Sanitation Foudantion - NSF, estando fundamentado na lógica clássica. No presente artigo, apresenta-se um novo IQA, alicerçado na lógica fuzzy, cujos conjuntos não têm fronteiras rigidamente definidas e incluem variáveis linguísticas em sua matriz de decisão, produzindo estimativas de um sistema não linear complexo, sem recorrer a modelos matemáticos. Para validá-lo, comparou-se os seus resultados com os obtidos pela aplicação do IQA da NSF durante 24 meses, fazendo uso das amostras de água do Rio Pimenta Bueno (Rondônia, Brasil). As comparações realizadas indicam que o IQA fuzzy é mais sensível do que o IQA da NSF às variações dos valores dos parâmetros que os compõem. O IQA fuzzy configurado por meio do software MATLAB, com as funções de agregação gaussianas, mostrou-se viável, seguro e mais flexível para avaliação da qualidade da água, podendo, portanto, ser considerado válido para classificação da qualidade da água de outros mananciais hídricos. _________________________________________________________________________________ ABSTRACTWater Quality Indexes (IQA) are mathematical operators that process a set of analytical indicators, producing a indexed numeric result, able to express the water quality. The IQA most world widely used and accepted is proposed by the National Sanitation Foundation - NSF and is based on classical logic. This work presents a new IQA based on fuzzy logic, whose boundaries are not rigidly defined and include linguistic variables in its decision matrix, producing estimates of a complex nonlinear system, without resorting to mathematical models. In order to validate it, the results were compared with those obtained using the IQA of NFS for 24 months, using water samples from the Pimenta Bueno River (Rondônia, Brazil). The comparisons realized indicates that the fuzzy IQA is more sensitive than the NSF IQA to variations of parameter values that compose them. The fuzzy IQA set by the MATLABÒ software, with Gaussians aggregations functions, revealed viable, safe and more flexible to evaluate water’s quality, therefore it can be considered valid valid to classify the water’s quality from other water’s sources

Avaliação da memória declarativa emocional em pacientes com epilepsia temporal mesial e pacientes submetidos à lobectomia temporal mesial

ABSTRACTEpileptic seizures generate cognitive and behavioral impacts in individuals who suffer from epilepsy. Declarative memory is one of the cognitive functions that can be affected by epileptic seizures. The main objective of this work was to investigate neurocognitive function, especially the emotional working memory of patients with unilateral mesial temporal lobe epilepsy, and that of patients submitted to unilateral mesial temporal lobectomy. A face recognition test that can simultaneously recruit the frontal lobe (working memory) and mesial temporal lobe (emotional memory) was used to investigate emotional working memory. Our findings showed that the epilepsy factor significantly compromised the performance in the emotional memory test. On the other hand, surgical removal of the epileptic focus promoted an improvement in the emotional working memory of these patients, in addition to the significantly decrease in the number of seizures. ________________________________________________________________________________ RESUMOCrises epilépticas geram impactos comportamentais e cognitivos em indivíduos que sofrem de epilepsia. Uma das funções cognitivas que pode ser afetada pelas crises epilépticas é a memória declarativa. O objetivo do nosso estudo foi investigar funções cognitivas, especialmente a memória operacional emocional de pacientes com epilepsia temporal mesial unilateral e pacientes submetidos a lobectomia temporal mesial unilateral. Para investigar a memória operacional emocional foi utilizado um teste de reconhecimento de faces que pode recrutar simultaneamente o lobo frontal (memória operacional) e o lobo temporal mesial (memória emocional). Nossos resultados demonstram que o fator epilepsia compromete de forma significativa o desempenho no teste de memória emocional. Por outro lado, a remoção cirúrgica do foco epiléptico promoveu uma melhora na memória emocional desses pacientes, além de diminuir o número de crises

Contaminación por mercurio y las malformaciones congénitas detectadas en el nacimiento en Porto Velho, Brasil, entre 1997 y 2007

The possible negative impacts of mercury contamination in the Madeira river, State of Rondonia, Brazil, on newborn babies health were evaluated. The incidence of congenital malformations was surveyed from the records of newborns in the main hospital of Porto Velho, Rondonia, from 1997 to 2007. The type of malformations between local population and cases transferred from other areas in Rondonia were compared. Neurological related malformations were found in 45% of the cases. The proportion of neurological defects in the local population was slightly higher than in transferred cases. Non-neurological malformations represented 43% of the sample and, 11.4% were unspecified. The incidence of general (including non-neurological) congenital malformations was similar to the region’s average. This is indicative of Hg contamination during pregnancy.Los posibles impactos negativos de la contaminación por mercurio en el río Madeira, Estado de Rondonia, Brasil, en la salud de los bebés recién nacidos fueron evaluados. La incidencia de malformaciones congénitas fue examinado en los registros de los recién nacidos en el principal hospital de Porto Velho, Rondonia, de 1997 a 2007. El tipo de malformaciones entre la población local y los casos transferidos de otras zonas de Rondonia fueron comparados. Malformaciones neurológicas relacionadas se encontraron en el 45% de los casos. La proporción de defectos neurológicos en la población local fue levemente superior en los casos transferidos. Malformaciones non neurológicas representó el 43% de la muestra y, el 11,4% sin especificar. La incidencia de la general (incluyendo non neurológicas) malformaciones congénitas fue similar al promedio de la región. Esto es indicativo de contaminación de mercurio durante el embarazo

Anosognosia cognitiva e alterações comportamentais em pacientes com provável doença de Alzheimer

Anosognosia, comprometimento do insight e ausência de reconhecimento de déficits são usados como termos equivalentes neste estudo. Objetivo: Investigar a relação entre a presença de sintomas de anosognosia e domínios cognitivos, habilidades funcionais, e sintomas neuropsiquiátricos em pacientes com provável doença de Alzheimer (pAD) e idosos controles. Métodos: vinte e um pDA (14 mulheres) e vinte e dois EC (16 mulheres) foram submetidos a uma bateria neuropsicológica de testes avaliando o estado cognitivo global, e funções cognitivas específicas: memória, funções executivas e atencionais, fluência verbal e habilidades visoconstrutivas. Adicionalmente, habilidades funcionais (FAQ) e sintomas neuropsiquiátricos (NPI) foram avaliados. Resultados: Teste estatístico de regressão linear indicou uma associação entre anosognosia e queixas subjetivas de memória, idade e aritmética-DRS no grupo controle. Por outro lado, aritmetica-DRS, IQCODE e FAQ (habilidades cognitivas e funcionais) foram melhores predictores nos pacientes com pDA, especificamente para consciência das alterações comportamentais. Conclusão: Os resultados indicaram que diferentes variáveis estão associadas com auto-percepção nos pacientes com pDA e controles, porém para ambos os grupos parece que o funcionamento executivo tem um papel importante contribuindo principalmente na percepção das alterações comportamentais.Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study. Objective: To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer's disease (pAD) and elderly controls (EC). Methods: Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured. Results: The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (Arithmetic- DRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness. Conclusion: These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes