Mirabegron role in urolithiasis management: what you should know

El propósito de este trabajo fue desarrollar una revisión narrativa de la literatura describiendo la evidencia disponible sobre la eficacia del mirabegrón en tres escenarios: como terapia médica expulsiva, como tratamiento médico antes de la ureteroscopia para incrementar el acceso exitoso al cálculo, y en el manejo de los síntomas asociados con el uso de catéter doble J. Solo dos estudios originales han evaluado su uso como terapia médica expulsiva, con resultados contradictorios en términos de tasa de expulsión del cálculo; sin embargo, ambos demostraron mejor control del dolor en el grupo de mirabegrón. Un estudio aleatorizado multicéntrico encontró un aumento en el acceso exitoso al cálculo durante la ureteroscopia cuando el mirabegrón era administrado una semana antes del procedimiento. Adicionalmente, dos estudios aleatorizados controlados demostraron eficacia del medicamento para disminuir los síntomas relacionados con el catéter doble J. El uso del mirabegrón como parte del arsenal del tratamiento para urolitiasis tiene un rol prometedor, tanto en la terapia médica expulsiva como antes de la ureteroscopia, para aumentar la posibilidad de acceder exitosamente al cálculo, y en pacientes con catéter doble J, para disminuir los síntomas asociados. Sin embargo, se requiere estudios más grandes, prospectivos, doble ciegos y aleatorizados antes de que podamos utilizarlo con estos fines en un escenario clínico.The purpose of the present study was to develop a narrative review of the available evidence of mirabegron efficacy in three scenarios: as a medical expulsive therapy; as a medical treatment to increase a successful access to stones before ureteroscopy, and management of double-J stent-related symptoms. Only two original studies have evaluated its use as a medical expulsive therapy, with contradictory results in terms of stone expulsion rate; however, both demonstrated a better pain control in the mirabegron group. One randomized controlled trial (RCT) found a higher successful access to ureteral stones when mirabegron was administered 1 week before the ureteroscopy. And two RCTs demonstrated its efficacy in diminishing discomfort related with double-J stent. There is a promising role for the use of mirabegron in the arsenal of urolithiasis treatment, even as a medical expulsive therapy, before ureteroscopy surgery, to increase the successful access to the stones and after the placement of ureteral catheter to reduce the related symptoms. However, larger-scaled prospective double-blinded RCTs are needed before it can be used with these purposes in the clinical scenario

Sustentación de caso: propuesta de un plan estratégico del ingreso al mercado peruano de una empresa del sector fast fashion

El presente trabajo está enfocado en la sustentación del caso para realizar una propuesta de plan estratégico del ingreso al mercado peruano de la empresa “Fast Retailing”, compañía japonesa de la industria Fast Fashion que con su marca principal “Uniqlo” ha llegado a expandirse a nivel internacional siguiendo el modelo de minorista de tienda especializada con marca propia. Este trabajo, buscará ser parte de un aporte académico al evaluar y esclarecer el modelo de negocio, la cadena de valor, la ventaja competitiva de la empresa, la estrategia genérica, las estrategias corporativas, funcionales y a nivel global que Fast Retailing viene implementando, asi como determinar el análisis Externo e Interno a través de diversas herramientas como la matriz FODA(Fortalezas, Oportunidades, Debilidades y Amenazas), el análisis PEST a nivel internacional y nacional, entre otras. De esta manera, se ha compuesto este documento a través de cuatro módulos principales: el Diagnóstico estratégico, la Formulación de la estrategia, la Implementación estratégica y el Control estratégico. Con el paso de los años el grupo Fast Retailing, con su CEO Tadashi Yanai al mando, ha atravesado 4 etapas que le han brindado una vasta experiencia en materia de expansión e ingreso a nuevos mercados, convirtiéndola en la empresa exitosa que es hoy en día; sin embargo, en el presente documento se presentarán diversas propuestas y recomendaciones que tienen como finalidad aportar a la toma de decisiones en el futuro ingreso de Fast Retailing al mercado peruano para el año 2019 y de esta manera, continuar con un crecimiento exitoso en la región Sudamericana.This work is focused on supporting the case to make a proposal for a strategic plan for the entry into the Peruvian market of the company "Fast Retailing", a Japanese company in the Fast Fashion industry that with its main brand "Uniqlo" has expanded to international level following the model of a specialized store retailer with its own brand. This work will seek to be part of an academic contribution by evaluating and clarifying the business model, the value chain, the company's competitive advantage, the generic strategy, the corporate, functional and global strategies that Fast Retailing has been implementing, thus How to determine the External and Internal analysis through various tools such as the SWOT matrix (Strengths, Weaknesses, Opportunities and Threats), the PEST analysis at the international and national level, among others. In this way, this document has been composed through four main modules: Strategic Diagnosis, Strategy Formulation, Strategic Implementation and Strategic Control. Over the years the Fast Retailing group, with its CEO Tadashi Yanai at the helm, has gone through 4 stages that have given it vast experience in terms of expansion and entry into new markets, making it the successful company it is today ; However, this document will present various proposals and recommendations that are intended to contribute to decision-making in the future entry of Fast Retailing to the Peruvian market for the year 2019 and in this way, continue with a successful growth in the region. South American

Exploring the views of young women and their healthcare professionals on dietary habits and supplementation practices in adolescent pregnancy: a qualitative study

Background: Nutrition is a modifiable factor affecting foetal growth and pregnancy outcomes. Inadequate nutrition is of particular concern in adolescent pregnancies with poor quality diet and competing demands for nutrients. The aim of this study was to explore knowledge and understanding of nutrition advice during adolescent pregnancy,and identify barriers and facilitators to dietary change and supplementation use in this vulnerable population. Methods: Semi-structured interviews were conducted with young women and key antenatal healthcare providers: midwives, family nurses and obstetricians. Doncaster, Manchester and London were chosen as sites offering different models of midwifery care alongside referral to the Family Nurse Partnership programme. Results: A total of 34 young women (adolescents aged 16–19 years) and 20 health professionals were interviewed. Young women made small changes to their dietary intake despite limited knowledge and social constraints. Supplementation use varied; the tablet format was identified by few participants as a barrier but forgetting to take them was the main reason for poor adherence. Health professionals provided nutrition information but often lack the time and resources to tailor this appropriately. Young women’s prime motivator was a desire to have a healthy baby; they wanted to understand the benefits of supplementation and dietary change in those terms. Conclusion: Pregnancy is a window of opportunity for improving nutrition but often constrained by social circumstances. Health professionals should be supported in their role to access education, training and resources which build their self-efficacy to facilitate change in this vulnerable population group beyond the routine care they provide

Early participation in a prenatal food supplementation program ameliorates the negative association of food insecurity with quality of maternal-infant interaction.

Food insecurity is detrimental to child development, yet little is known about the combined influence of food insecurity and nutritional interventions on child development in low-income countries. We proposed that women assigned to an early invitation time to start a prenatal food supplementation program could reduce the negative influence of food insecurity on maternal-infant interaction. A cohort of 180 mother-infant dyads were studied (born between May and October 2003) from among 3267 in the randomized controlled trial Maternal Infant Nutritional Interventions Matlab, which was conducted in Matlab, Bangladesh. At 8 wk gestation, women were randomly assigned an invitation time to start receiving food supplements (2.5 MJ/d; 6 d/wk) either early (~9 wk gestation; early-invitation group) or at the usual start time (~20 wk gestation; usual-invitation group) for the government program. Maternal-infant interaction was observed in homes with the use of the Nursing Child Assessment Satellite Training Feeding Scale, and food-insecurity status was obtained from questionnaires completed when infants were 3.4-4.0 mo old. By using a general linear model for maternal-infant interaction, we found a significant interaction (P = 0.012) between invitation time to start a prenatal food supplementation program and food insecurity. Those in the usual-invitation group with higher food insecurity scores (i.e., more food insecure) had a lower quality of maternal-infant interaction, but this relationship was ameliorated among those in the early-invitation group. Food insecurity limits the ability of mothers and infants to interact well, but an early invitation time to start a prenatal food supplementation program can support mother-infant interaction among those who are food insecure

Evaluation of a nutrition supplementation programme in the Northern Cape Province of South Africa

AIM: This study aimed at assessing the effectiveness regarding implementation and impact of a take-home nutrition supplementation programme, the Protein Energy Malnutrition (PEM) Scheme, that targets malnourished pre-school children and pregnant and lactating women in the Northern Cape Province of South Africa. METHODOLOGY: In assessing implementation of the PEM Scheme, a cross-sectional descriptive study was undertaken over a 6-month period in the six regions of the Northern Cape Province. Interviews were conducted with programme managers and health personnel at clinics who were responsible for implementing the PEM Scheme. In assessing the impact of the PEM Scheme on growth, a retrospective review was done of the clinic records (including anthropometric data) of children enrolled in the PEM Scheme over a 1-year period. RESULTS: About 76% of the budget allocated to the PEM Scheme had been utilised over the 1-year period. The budget for the following financial year was based solely on food supplements purchased in the previous year. Coverage of malnourished pre-school children and eligible pregnant and lactating women for enrolment was estimated to be 50% and 60%, respectively. Eighty-five per cent of health facilities in the province participated in the PEM Scheme. Some of the main problems identified included: lack of training, inappropriate targeting of certain groups, incorrect application especially of discharge criteria for pregnant and lactating women, inadequate assessment for nutrition-related disease, inadequate nutrition counselling and no standardised monitoring. Of the 319 children enrolled over a year, the mean age was 16.2 (standard deviation 16.2) months, 41% had been low-birth-weight and 18% had been diagnosed with tuberculosis. Ten per cent of the children with a weight-for-age Z-score of <-2 moved into the normal Z-score range after being on the PEM Scheme for a mean duration of 8 months. There was an overall improvement in the weight-for-age Z-scores of 25% of the sample, with a significant difference between the mean weight-for-age Z-scores at enrolment and follow-up This was mainly related to significant improvement in the mean weight-for-age Z-scores of children <2 years. CONCLUSIONS: Numerous problems with the PEM Scheme have been identified which could have limited its impact. Recommendations are proposed for improving the effectiveness and impact of the PEM Scheme in the province

Minimally invasive management of osteoma cutis miliaris

Osteoma cutis miliaris is a rare condition of bone formation in the dermis, often misdiagnosed. We present a 52-year-old woman with asymptomatic, hard papules on the forehead, initially treated as acne. Biopsy confirmed osteoma cutis, and surgical removal via microincisions successfully extracted the lesions with no recurrence. This case emphasizes the importance of accurate diagnosis and highlights a minimally invasive approach as an effective, low-risk treatment option

The effect of gentamycin in the irrigating solution to prevent joint infection after anterior cruciate ligament (ACL) reconstruction

Background: Arthroscopic reconstruction of ACL is an effective method to restore knee stability after ACL rupture. Postoperative septic arthritis (SA) is very uncommon while the incidence of serious complications range between 0.14 and 1.8. Some of the devastating consequences of septic arthritis can encompass hyaline cartilage damage, arthrofibrosis, and in rare cases amputation. The purpose of this study was to evaluate the effect of gentamicin irrigation solutions as a process to restrain septic arthritis following arthroscopic ACL reconstruction. Methods: In this retrospective cohort study, 1464 patients who underwent ACL reconstruction with hamstring tendon autograft in our institution over 7 years (February 2008 to January 2015) were included. The patients were divided into two groups based on the type of intra-articular irrigation solution used during the surgery. Patients in Group 1 (Saline) received intra-articular irrigation with normal saline (0.9 sodium chloride) solution, while those in Group 2 (Gentamycin) received intra-articular irrigation with gentamicin (80 mg/L) added to the normal saline solution. Data about postoperative infection, its course, management, and outcome were obtained from patients' records. Results: Seven patients developed SA, four of whom were from SALINE group (2.2) and three from Gentamycin group (0.23). The incidence rate of SA after arthroscopic ACL reconstruction was significantly lower (P <0.05) when irrigated with gentamicin solution than merely with saline solution. Conclusion: Gentamicin irrigation solution has a preservative and protective effect against SA development following arthroscopic ACL reconstruction. We recommend evaluating this technique as a way in order to depreciate the prevalence of SA after ACL reconstruction. © 2019 BY THE ARCHIVES OF BONE AND JOINT SURGERY

Avaliação do impacto da suplementação alimentar a gestantes no cotrole do baixo peso ao nascer no município de São Paulo, SP (Brasil)

A partir de estudo realizado em oito grandes maternidades do Município de São Paulo, SP (Brasil) que atendem clientela predominantemente de baixo nível sócio-econômico, objetivou-se analisar o impacto da suplementação alimentar durante a assistência pré-natal sobre a incidência de recém-nascidos de baixo peso ao nascer (peso < 2.500 g). Foram envolvidos no estudo 1.060 recém-nascidos de mães que receberam suplementação e 664 recém-nascidos de mães que não a receberam. Ã incidência de baixo peso ao nascer foi de cerca de 11%, considerada elevada e semelhante em ambos os grupos de recém-nascidos. A análise multivariada, realizada para controlar eventuais diferenças entre os grupos, que não a condição de suplementação, descartou qualquer associação significativa entre suplementação e peso ao nascer e revelou, por outro lado, que tabagismo e morbidade na gestação e determinadas características antropométricas e reprodutivas da mãe, prévias à gestação, são importantes fatores de risco para o baixo peso ao nascer. A aparente explicação para a ausência de impacto da suplementação alimentar na população estudada parece residir não na quantidade insuficiente da suplementação alimentar oferecida (370 Kcal/dia), mas no predomínio de fatores não alimentares na determinação do baixo peso ao nascer. São formuladas recomendações quanto ao controle do baixo peso ao nascer no contexto estudado