Comparison of coronary angiography findings in diabetic and non-diabetic women with non-ST-segment-elevation acute coronary syndrome

OBJECTIVE: Compare hemodynamic and angiographic patterns, as well as atherosclerotic lesion morphology, in diabetic and non-diabetic females with unstable angina or non-ST-segment-elevation myocardial infarction (UA/NSTEMI). METHODS: Two interventional cardiologists determined the presence of severe atherosclerotic lesion, defined as those > 70%; plaque morphology, according to the American Heart Association classification; collateral circulation; plus ventricular and aortic pressures. Ejection fraction was calculated by angiography or echocardiography. RESULTS: During eight and a half years, 645 coronary angiographies were performed in women with UA/NSTEMI. In the present study, 593 female patients were assessed (215 diabetic - 36%). This group differed from the non-diabetic in the following aspects: older age (61 ± 10.6 x 58.1 ± 11.4), higher prevalence of postmenopausal women and lower prevalence of the smoking habit. Severe three-vessel disease was significantly more frequent in diabetic patients (28% x 10%), as well as totally occluded vessels: 51 (23%) x 54 (14.3%), p 70%, a morfologia da placa, de acordo com a classificação da American Heart Association, a presença de circulação colateral e as pressões ventriculares e aórticas. A fração de ejeção foi calculada pela angiografia ou pelo ecocardiograma. RESULTADOS: Em oito anos e meio, foram realizados 645 coronariografias em mulheres com AI/IAMSS. Foram analisadas 593 pacientes (215 diabéticas - 36%). Este grupo diferiu das não-diabéticas nos seguintes aspectos: idade mais alta (61 ± 10,6 x 58,1 ± 11,4), prevalência maior de mulheres pós-menopausa e menor prevalência de tabagismo. Lesão grave em três vasos foi significativamente mais freqüente nas pacientes diabéticas (28% x 10%), assim como vasos totalmente ocluídos: 51 (23%) x 54 (14.3%), p < 0.005.Fração de ejeção < 50% foi mais comum nas diabéticas. CONCLUSÃO: Estes achados confirmam o acometimento difuso da doença aterosclerótica em pacientes diabéticas, assim como maior deterioração da função ventricular, que pode estar relacionada ao pior prognóstico dessa população em curto e em longo prazo.Universidade Federal de São Paulo (UNIFESP)Hospital Santa MarcelinaUNIFESPSciEL

An unusual presentation of urethral duplication presenting with chronic bladder retention, left scrotal transposition and left renal agenesis

Introduction and objective: Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally (2). Usually the ventral urethra is the more functional of both. Duplications occurring in the coronal plane are quite rare and they are usually associated with bladder duplication (3). The purpose of this paper was to present a video of a boy with an unusual urethral duplication form. Materials and Methods: Patient was born premature due to oligohydramnios at 7 months-gestational age and he has initial diagnosis of hypospadia. Since then, he presented at least 7 febrile UTI and mother complained of difficult micturition and a presence of a mass at lower abdomen. Patient was referred to our institution and we identified urethral duplication with a glandar and scrotal meatus, palpable bladder and left penile-hemiscrotum transposition. US and CT-scan showed left kidney agenesis and overdistended bladder. VCUG and retrograde urethrography showed duplication, presence of contrast in the seminal vesicles and complete catheterizing of both urethras was not possible. Results: The topic urethra was dysplastic and not patent to a 4Fr plastic tube so we were unable to access it endoscopically. We performed initially a Mitrofanoff procedure to allow CIC and treat chronic retention. Six months later, we assessed both urethras surgically and concluded that dorsal urethra was dysplastic after 3cm still in the penile area and scrotal urethra was not possible to be catheterized. We excised the ventral urethra because of dribbling complaints up to bulbar area and reconstructed the scrotal transposition, keeping the topic urethra for cosmetic issues. Patient had excellent outcome, performs CIC every 4 hours and has not presented further UTI episodes. Discussion and conclusion: The urethral duplication is an anomaly that has multiple anatomical presentations. There are several theories about the etiology, but none can explain all types of presentations. There is also more than one rating available, and the Effmann classification is the most detailed. The case exemplifies this varied spectrum of anatomic urethral duplication. It resembles the urethral duplication type IIa-Y, however, ventral urethra meatus was located in penoscrotal area and both urethras were at least partially hypoplastic/dysplastic associated with obstruction and bladder retention. In determining how to best manage a patient with Y-type urethral duplication, the caliber and quality of the orthotopic urethra must first be assessed. Published reports suggest that best outcomes are those using the ventral duplicated urethra for the reconstruction (4). In this case, none of urethras were functional and a supravesical outlet channel had to be provided. The treatment of this condition requires an individualized planning and a vast technical knowledge of reconstructive surgery.Univ Fed Sao Paulo, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilWeb of Scienc

Nuevas cargas procesales para las entidades públicas en el proceso contencioso administrativo a la luz de la ley 1437 de 2011

La Ley 1437 de 2011 que implantó la oralidad en el procedimiento contencioso administrativo, surge como una necesidad de adaptarse a la constitucionalización del derecho que permite a la Justicia Contencioso administrativa responder a la realidad histórica que para el momento le competía. El Código de Procedimiento Administrativo y de lo Contencioso Administrativo contempló novedosas figuras jurídicas como lo es Extensión de la jurisprudencia del Consejo de Estado a terceros por parte de las autoridades, fortaleció figuras existentes como el Derecho de petición, e impuso en sede judicial cargas procesales a las entidades pública con sanciones por su incumplimiento, que permiten efectivizar los derechos de los ciudadanos que acuden a las entidades públicas o se ven afectados por éstas

A new formulation of oxalic acid for Varroa destructor control applied in Apis mellifera colonies in the presence of brood

International audienceAbstractAn organic product based on oxalic acid was evaluated for use in Varroa control under spring/summer climatic conditions in Argentina. The formulation consists of four strips made of cellulose impregnated with a solution based on oxalid acid. Forty-eight beehives were used to assess the product efficacy. Residues of the product were also tested in honey, bees, and wax. Each trial had respective control groups without oxalic treatment. At the beginning of the experiment, four strips of the formulation were applied to the colonies belonging to the treated group. Falling mites were counted after 7, 14, 21, 28, 35, and 42 days. After the last count, the strips were removed and colonies received two flumethrin strips for 45 days. Falling mites were counted throughout this period. Average efficacy of the organic product was 93.1 % with low variability. This product is an organic treatment designed for Varroa control during brood presence and represents a good alternative to the synthetic treatments

The role of grade of injury in non-operative management of blunt hepatic and splenic trauma. Case series from a multicenter experience

This retrospective study shows the results of a 2 years application of a clinical pathway concerning the indications to NOM based on the patient's hemodynamic answer instead of on the injury grade of the lesions.We conducted a retrospective study applied on a patient's cohort, admitted in "Azienda Ospedaliero-Universitaria Ospedali Riuniti of Ancona" and in the Digestive and Emergency Surgery Department of the Santa Maria of Terni hospital between September 2015 and December 2017, all affected by blunt abdominal trauma, involving liver, spleen or both of them managed conservatively. Patients were divided into 3 main groups according to their hemodynamic response to a fluid administration: stable (group A), transient responder (group B) and unstable (group C). Management of patients was performed according to specific institutional pathway, and only patients from category A and B were treated conservatively regardless of the injury grade of lesions.From October 2015 to December 2017, a total amount of 111 trauma patients were treated with NOM. Each patient underwent CT scan at his admission. No contrast pooling was found in 50 pts. (45.04%). Contrast pooling was found in 61 patients (54.95%). The NOM overall outcome resulted in success in 107 patients (96.4%). NOM was successful in 100% of cases of liver trauma patients and was successful in 94.7% of splenic trauma patients (72/76). NOM failure occurred in 4 patients (5.3%) treated for spleen injuries. All these patients received splenectomy: in 1 case to treat pseudoaneurysm, (AAST, American Association for the Surgery of Trauma, grade of injury II), in 2 cases because of re-bleeding (AAST grade of injury IV) and in the remaining case was necessary to stop monitoring spleen because the patient should undergo to orthopedic procedure to treat pelvis fracture (AAST grade of injury II).Non-operative management for blunt hepatic and splenic lesions in stable or stabilizable patients seems to be the choice of treatment regardless of the grade of lesions according to the AAST Organ Injury Scale

Noite de terror na cidade luz: os atos terroristas em Paris e a avaliação da imagem de destino por turistas brasileiros

Contemporary terrorism may be considered one of the ills of the 21st century and its actions have reached an increasing number of non-combatant targets. The extremist groups are looking for places with large circulation of people as sights to carry out their attacks. The attacks aim to reach a greater number of kafirs, term to define the unbelievers or infidels of the Islamic doctrine, or to obtain a greater attention of the media. Thus, the present study aimed to understand how Brazilian tourists, who were in Paris, perceive the interference of the night of the attacks in November 2015 in the tourist image of the city. The research was qualitative with the triangulation of data: documentary research, open questionnaires and testimonials in videos, with the use of content analysis. The results show a medium impact on tourism activity, but little importance in the image of the city of Paris in the months following the attacks, with the flow of visitors reestablished in the short term. The primary relevance of this article was to understand the impact on tourist demand after terrorist attacks from the perception of tourists under the image of the destination.El terrorismo contemporáneo puede ser considerado uno de los males del siglo XXI y sus acciones han alcanzado un número cada vez mayor de blancos no combatientes. Los grupos extremistas están buscando lugares con gran circulación de personas como puntos turísticos para realizar sus ataques. Los atentados anhelan alcanzar un mayor número de kafirs, término para definir a los incrédulos o infieles de la doctrina islámica, o obtener una mayor atención de los medios. Así, el presente estudio tuvo como objetivo entender cómo los turistas brasileños, que se encontraban en París, perciben la interferencia de la noche de los atentados en noviembre de 2015 en la imagen turística de la ciudad. La investigación fue cualitativa con la triangulación de los datos: investigación documental, cuestionarios abiertos y testimonios en videos, con el uso del análisis de contenido. Los resultados muestran un impacto mediano en la actividad turística, pero poco importante en la imagen de la ciudad de París en los meses posteriores a los atentados, siendo el flujo de visitantes restablecido a corto plazo. La relevancia primordial de este artículo fue comprender el impacto en la demanda turística post-atentados terroristas a partir de la percepción de los turistas bajo la imagen del destino.O terrorismo contemporâneo pode ser considerado um dos males do século XXI e suas ações têm atingido um número cada vez maior de alvos não combatentes. Os grupos extremistas estão à procura de lugares com grande circulação de pessoas como pontos turísticos para realizar os seus ataques. Os atentados almejam alcançar um maior número de kafirs, termo para definir os incrédulos ou infiéis da doutrina islâmica, ou obter uma maior atenção da mídia. Assim, o presente estudo objetivou entender como turistas brasileiros, que estavam em Paris, percebem a interferência da noite dos atentados em 13 e 14 de novembro de 2015 na imagem turística da cidade. A investigação foi qualitativa exploratória com a triangulação dos dados: pesquisa documental, questionários abertos e depoimentos em vídeos, com o uso da análise de conteúdo. Os resultados mostram um impacto mediano na atividade turística, porém pouco importante na imagem da cidade de Paris nos meses subsequentes aos atentados, sendo o fluxo de visitantes reestabelecido em curto prazo. A relevância primordial deste artigo foi compreender o impacto na demanda turística pós-atentados terroristas a partir da percepção dos turistas sob a imagem do destino