Correlation between the anti-Müllerian hormone and endovaginal ultrasound in the predictivity of polycystic ovary syndrome at Chracerh

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome posing diagnostic problems in current practice, because of the cumbersomeness associated with the application of the criteria that define it; giving rise to over or under diagnosis of it. Anti-Müllerian hormone (AMH) is an effective alternative in this case, being a stable, reproducible and non-operator dependent marker to diagnose PCOS due to the link that binds it to the multiple pre-antral follicles in the ovaries of PCOS patients. The aim of this study was to determine the threshold value of AMH required to define PCOS in our African population, by revealing the correlation with antral follicles count (AFC) on endovaginal ultrasound.Methods: We carried out a comparative cross-sectional study, with retrospective data collection in 23 infertile patients diagnosed with PCOS according to the Rotterdam 2003 criteria, and 23 non-PCOS infertile controls having performed the AMH test using the Immunotech technique at CHRACERH. Endovaginal ultrasound (U/S) was performed using a 7.5 mega Hertz (MHz) transvaginal transducer by different qualified operators (radiologists, gynecologists). The comparison of the two independent groups (PCOS and non-PCOS) was performed by the Student t-test; correlations between AMH, age, AFC and ovarian volume obtained by the Pearson test; and the diagnostic power of AMH test in PCOS was evaluated by receiver operating characteristic curves (ROC).Results: AMH was approximately twice as high in PCOS compared to controls (6.09 versus 3.80, P <0.001) and was inversely correlated with age (r = -0.301; P ˂0.05); significantly correlated antral follicle count (R = 0.85, P <0.0001) and ovarian volume (r = 0.625, P <0.0001). ROC analysis revealed that the AMH test was very informative for the diagnosis of PCOS with an area under the curve (AUC) at 0.90 (0.81-0.99; 95% CI); and the threshold value given by the farthest point of the diagonal representing the nil contribution test was 4.40 ng/L, and predicted PCOS with a sensitivity of 96% and a specificity of 70%.Conclusions: AMH is a predictive marker for PCOS. It is highly correlated with AFC and ovarian volume and appears to decrease with age. It offers good diagnostic performance in PCOS, with a threshold value of 4.40 ng/L for a sensitivity of 96% and specificity of 70%

El narcoperiodismo de García Márquez: uma análise dos aspectos da narcoliteratura no livro-reportagem Notícia de um sequestro

Desde os anos 1970, a cobertura da mídia tradicional sobre o narcotráfico caracterizou-se pela superficialidade de suas narrativas cujo processo impossibilita a profundidade de análise. Porém, alguns repórteres foram bem-sucedidos ao aproximar o narcotráfico e o jornalismo literário, rompendo com essa barreira limitante, principalmente, a partir da produção de livros-reportagem. O tema influenciou a literatura do continente (originando termos como narcoliteratura, narconarrativa e narcocultura), bem como o contexto do tráfico de drogas proporcionou a produção editorial de obras de não ficção, a partir dos final dos anos 80, atingindo o ápice nos anos 90 e 2000. Desta forma, este artigo discute o papel do livro-reportagem para a produção cultural da narcoliteratura, a partir de uma análise de seus aspectos dentro da obra jornalística Notícia de um sequestro (1996), de Gabriel García Márquez. O artigo está apoiado nos conceitos de livro-reportagem, de Edvaldo Pereira Lima e nas discussões sobre narcocultura, de Omar Rincón e de Diana Palaversich

Emergency surgery for colorectal cancer in patients over eighty

none8mixedVaccari, S.; Pirrera, B.; Brighi, M.; Belinga Atangana, A.G.; Picariello, E.; Monari, F.; Cervellera, M.; Tonini, V.Vaccari, S.; Pirrera, B.; Brighi, M.; Belinga Atangana, A.G.; Picariello, E.; Monari, F.; Cervellera, M.; Tonini, V

Emergency surgery for colorectal cancer (CRC) in patients over eighty

Aim: The aim of the study is to assess clinical features and postoperative outcomes in older patients treated for CRC. Method: 494 patients who underwent curative resection for CRC were enrolled in this study. 159 patients were over 80 years-old (GroupA), 335 patients were younger (GroupB). Patients\u2019 demographic, clinical and histo-pathological parameters, intra- and perioperative results were entered into a database and analysed. Statistical analysis was performed with SPSS v13.0; significance was defined as P < 0.05. Results: In GroupA 83 patients underwent emergency procedures (52%), in GroupB 104 patients (31%) (P < 0.001). We observed significant differences between the two groups in comorbidities, emergency presentation, intraoperative blood transfusions, laparoscopic approach and mortality (P < 0.001). There were no differences in the number of radical resection and number of lymph-nodes isolated. However, multivariate logistic regression analysis showed that age 6580 is an independent predictor of mortality (P = 0.004 OR 5.394) but not an independent predictor of morbidity (P = 0.6 OR 1.109). Conclusion: Old age 6580 does not represent a contraindication for CRC surgery though associated with higher morbidity and mortality, in particular in emergency setting. It is advisable to reduce emergency procedures with multidisciplinary approach (enlargement of screening in old patients and stenting as-bridge-to-surgery in obstructions)