Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.
Abdominal Cavity ; Abdominal Injuries ; Aged ; Aged, 80 and over ; Anal Canal ; Causality ; Female ; Humans ; Intestinal Perforation ; Intestine, Small ; Lacerations* ; Pathology ; Pelvis ; Rectal Prolapse ; Rectum

The aim of this study was to analyze the use of 12 single-nucleotide polymorphisms in genes ELAC2, RNASEL and MSR1 as biomarkers for prostate cancer (PCa) detection and progression, as well as perform a genetic classification of high-risk patients. A cohort of 451 men (235 patients and 216 controls) was studied. We calculated means of regression analysis using clinical values (stage, prostate-specific antigen, Gleason score and progression) in patients and controls at the basal stage and after a follow-up of 72 months. Significantly different allele frequencies between patients and controls were observed for rs1904577 and rs918 (MSR1 gene) and for rs17552022 and rs5030739 (ELAC2). We found evidence of increased risk for PCa in rs486907 and rs2127565 in variants AA and CC, respectively. In addition, rs627928 (TT-GT), rs486907 (AG) and rs3747531 (CG-CC) were associated with low tumor aggressiveness. Some had a weak linkage, such as rs1904577 and rs2127565, rs4792311 and rs17552022, and rs1904577 and rs918. Our study provides the proof-of-principle that some of the genetic variants (such as rs486907, rs627928 and rs2127565) in genes RNASEL, MSR1 and ELAC2 can be used as predictors of aggressiveness and progression of PCa. In the future, clinical use of these biomarkers, in combination with current ones, could potentially reduce the rate of unnecessary biopsies and specific treatments.
Aged ; Aged, 80 and over ; Cohort Studies ; Disease Progression ; Endoribonucleases/*genetics ; Gene Frequency ; Genetic Markers/genetics ; Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; Neoplasm Proteins/*genetics ; *Polymorphism, Single Nucleotide ; Prognosis ; Prostate/metabolism/*pathology ; Prostatic Neoplasms/*diagnosis/*genetics ; Scavenger Receptors, Class A/*genetics

OBJECTIVE: Glaucomatous optic neuropathy (GON), defined as definitive damage to the optic-nerve head (ONH) and retinal-nerve-fiber layer (RNFL), involves structural changes in the ONH and RNFL and functional losses in the central visual field. Due to the unique anatomic distribution of the nerve fibers as they enter the ONH, there are specific changes in the ONH correlated with specific findings in the visual-field characteristic of GON. The evaluation of these changes is discussed. METHODS: There are qualitative and quantitative methods in the structural examination of the ONH and RNFL, and quantitative techniques in the functional assessment of the central visual field. They are correlated to one another their strengths and limitations are discussed. RESULTS: Clinical evaluation of the ONH and RNFL consists of five basic rules: (1) identify the limits of the optic disc and determine its size, (2) identify the s of the neuroretinal rim, (3) examine the RNFL, (4) examine the region for parapapillary atrophy, and (5) look for retinal and optic-disc hemorrhages. These steps are simple to use and comprise a portion of the comprehensive eye evaluation. Without proper documentation of the changes in glaucoma progression may be missed. Computer-based digital-imaging technology exemplified by the HRT II, GDx, OCT, provides fast, reproducible, objective measurements of the ONH and RNFL, allowing for more precise diagnosis and monitoring of glaucoma. These changes have good correlation to functional assessments exemplified by the standard automated perimetry (SAP) and the selective perimetry (FDT, SWAP). Typical glaucomatous visu field defects include nasal step, paracentral scotoma, and arcuate defects which follow the RNFL pattern. Progression of these defects is monitored over time and needs to be differentiated from long-term fluctuation. CONCLUSION: The clinician should perform both structural and functional assessments to diagnose and monitor glaucoma. Both examinations provide complimentary information and each has its own place in the clinical care of glaucoma patients. The newer imaging devices and selective perimetry augment the diagnostic armamentarium of the clinician and should, therefore, be used appropriately.
GLAUCOMA ; OPTIC NERVE ; VISUAL FIELDS ; VISUAL FIELD TESTS ; OPTIC DISK

Objective: To assess the benefit of protective ostomies on anastomotic leak rate, urgent re-operations, and mortality due to anastomotic leak complications in ovarian cancer surgery. Methods: A systematic literature search was performed in MEDLINE, Web of Science, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for all studies on anastomotic leak and ostomy formation related to ovarian cancer surgery. Non-controlled studies, case series, abstracts, case reports, study protocols, and letters to the editor were excluded. Meta-analysis was performed on the primary endpoint of anastomotic leak rate. Subgroup analysis was carried out based on type of bowel resection and bevacizumab use. Secondary endpoints were urgent re-operations and mortality associated with anastomotic leak, length of hospital stay, postoperative complications, 30-day readmission rate, adjuvant chemotherapy, survival, and reversal surgery in ostomy and non-ostomy patients. Results: A total of 17 studies (2,719 patients) were included: 16 retrospective cohort studies, and 1 case-control study. Meta-analysis of 17 studies did not show a decrease in anastomotic leak rate in ostomy patients (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.60–1.70; p=0.980). Meta-analysis of ten studies (1,452 women) did not find a decrease in urgent re-operations in the ostomy group (OR=0.72; 95% CI=0.35–1.46; p=0.360). Other outcomes were not considered for meta-analysis due to the lack of data in included studies. Conclusion Protective ostomies did not decrease anastomotic leak rates, and urgent re-operations in ovarian cancer surgery. This evidence supports the use of ostomies in very select cases.

No abstract available.
Blood Platelets* ; Stroke*

Previous evidence supports the important role that oxidative stress (OxS) plays in metabolic syndrome (MetS)-related manifestations. We determined the relationship between the number of MetS components and the degree of OxS in MetS patients. In this comparative cross-sectional study from the LIPGENE cohort, a total of 91 MetS patients (43 men and 48 women; aged between 45 and 68 years) were divided into four groups based on the number of MetS components: subjects with 2, 3, 4 and 5 MetS components (n=20, 31, 28 and 12, respectively). We measured ischemic reactive hyperemia (IRH), plasma levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), total nitrite, lipid peroxidation products (LPO), hydrogen peroxide (H2O2), superoxide dismutase (SOD) and glutathione peroxidase (GPx) plasma activities. sVCAM-1, H2O2 and LPO levels were lower in subjects with 2 or 3 MetS components than subjects with 4 or 5 MetS components. IRH and total nitrite levels were higher in subjects with 2 or 3 MetS components than subjects with 4 or 5 MetS components. SOD and GPx activities were lower in subjects with 2 MetS components than subjects with 4 or 5 MetS components. Waist circumference, weight, age, homeostatic model assessment-beta, triglycerides (TGs), high-density lipoprotein and sVCAM-1 levels were significantly correlated with SOD activity. MetS subjects with more MetS components may have a higher OxS level. Furthermore, association between SOD activity and MetS components may indicate that this variable could be the most relevant OxS biomarker in patients suffering from MetS and could be used as a predictive tool to determine the degree of the underlying OxS in MetS.
Aged ; Anthropometry ; Antioxidants/metabolism ; Biological Markers/metabolism ; Blood Pressure ; Endothelium, Vascular/pathology/physiopathology ; Female ; Glutathione Peroxidase/blood ; Humans ; Hydrogen Peroxide/metabolism ; Hyperemia/blood/physiopathology ; Male ; Metabolic Syndrome X/blood/enzymology/*pathology/physiopathology ; Middle Aged ; Nitrites/blood ; *Oxidative Stress ; Regression Analysis ; Superoxide Dismutase/blood ; Vascular Cell Adhesion Molecule-1/metabolism

Objective: This study compared the economic viability of initial medical therapy with topical prostaglandin analogues (PGAs) versus selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG). Method: This was an economic analysis using actual, current treatment costs of PGA therapy versus SLT applied to theoretical, literature-derived clinical efficacy data projected for a period of 19 years. A socioeconomic and demographic survey conducted among POAG patients at the Department of Health Eye Center of the East Avenue Medical Center from March-April 2022 provided the economic context and setting for the analysis. The treatment regimens were compared in terms of total cost, clinical efficacy, cost-effectiveness and cost-utility in the setting of a tertiary government hospital. Results: Thirty-one (31) patients were included in the study. The total annual cost of topical PGAs was Philippine Pesos (Php) 13,532 versus Php 6,195 for SLT. Cost-effectiveness was Php 1,933 for PGAs/mmHg reduction in intraocular pressure (IOP) versus Php 983 for SLT. Cost-utility was Php 59,793/Quality Adjusted Life Years (QALY) gained for PGAs versus Php 27,373/QALY gained for SLT projected for 19 years. With government insurance coverage, cost-utility ratio was Php 47,831/QALY gained for topical PGAs versus 16,327/QALY gained for SLT. Conclusion In POAG patients, SLT was more cost-effective versus PGAs with a lower cost per mmHg IOP reduction, and lower cost-utility ratio for every QALY gained. SLT can be recommended as initial therapy for POAG especially for patients being treated at tertiary government hospitals.
Economic analysis ; cost-utility ; glaucoma ; prostaglandin analogues ; quality adjusted life years ; Philippines

Objective: To determine the validity of serum H. pylori IgG in the detection of H. pylori-associated gastroduodenitis in patients with gastrointestinal symptoms. Methods: Cross-sectional study which included consecutive patients 1-18 years old with upper gastrointestinal symptoms who underwent esophagogastroduodenoscopy. H. pylori infection was diagnosed by positive tests for both rapid urease test (RUT) and Giemsa stain of gastric biopsies. H. pylori IgG (ELISA) serology was also performed. Results: Twenty-five patients [Mean (SD) age: 12 (4.5) years, 68% females] were included. Majority presented with epigastric pain (64%) and had endoscopic gastritis (84%). Four patients had ulcers (1 antral, 3 duodenal). Giemsa stain was positive in 16 (64%) patients and RUT in one. Prevalence of H. pylori infection was 4%. Serum H. pylori IgG test was positive in two; borderline in three with a 100% sensitivity, 80% specificity, and a positive and negative likelihood ratio of 10.9 and 0.6. Conclusion The present study showed a low prevalence of H. pylori infection, thus, the validity of the H. pylori serology could not be adequately evaluated. We presently could not recommend the serum IgG in the detection of H. pylori gastroduodenitis in our setting.

OBJECTIVE: To describe the demographic and clinical characteristics of patients with glaucoma managed at private and government institutions in the Philippines between 2009 and 2014.

METHODS: A research team from two private and two government institutions in the Philippines reviewed the case records of 1246 patients seen who met the following criteria: intraocular pressure of >21 mmHg, optic nerve and nerve fiber layer abnormalities, and visual field defects. For bilateral cases, we selected the eye with worse glaucoma parameters.

RESULTS: There were 600 and 646 patients in the private and government groups (mean age at presentation, 60.51 and 55.88 years), respectively, with the majority being Filipino (91%). Patients with visual acuity (VA) of 20/20 to 20/40 were more frequently observed in private centers (58.7% vs. 41.3%), while a VA worse than counting fingers was more frequently observed in government centers (66.1% vs. 33.9%). Within-group analysis showed that primary angle-closure glaucoma was the most frequent glaucoma subtype in both private (27.3%) and government institutions (37.8%). In between-group analysis showed the following to be more common in private than government centers: primary open-angle glaucoma (61.3% vs. 38.7%), normal-tension glaucoma (63.9% vs. 36.1%), ocular hypertension (92.3% vs. 7.7%), and glaucoma suspects (80.4% vs. 19.6%) while government institutions registered a larger number of primary angle-closure glaucoma (59.8% vs. 40.2%) and secondary glaucoma (70.3% vs. 29.7%) cases. Medical treatment using a single drug and multiple drugs was employed for 245 (23%) and 825 (77%) patients, respectively. Within-group analysis showed that laser iridotomy and trabeculectomy were the most commonly performed laser and surgical procedures in both institution types.

CONCLUSION: There is a contrasting profile of glaucoma between clinical institutions in the Philippines with openangle glaucoma being more predominant in private centers while closed-angle glaucoma and secondary glaucoma being more frequent in government centers. Our findings may provide important preliminary information that can aid future health studies or training programs.

Background: and Purpose Visual hallucinations (VH) and subjective cognitive complaints (SCC) are associated with cognitive impairment (CI) in Parkinson’s disease. Our aims were to determine the association between VH and SCC and the risk of CI development in a cohort of patients with Parkinson’s disease and normal cognition (PD-NC). Methods: Patients with PD-NC (total score of >80 on the Parkinson’s Disease Cognitive Rating Scale [PD-CRS]) recruited from the Spanish COPPADIS cohort from January 2016 to November 2017 were followed up after 2 years. Subjects with a score of ≥1 on domain 5 and item 13 of the Non-Motor Symptoms Scale at baseline (V0) were considered as “with SCC” and “with VH,” respectively. CI at the 2-year follow-up (plus or minus 1 month) (V2) was defined as a PD-CRS total score of <81. Results: At V0 (n=376, 58.2% males, age 61.14±8.73 years [mean±SD]), the frequencies of VH and SCC were 13.6% and 62.2%, respectively. VH were more frequent in patients with SCC than in those without: 18.8% (44/234) vs 4.9% (7/142), p<0.0001. At V2, 15.2% (57/376) of the patients had developed CI. VH presenting at V0 was associated with a higher risk of CI at V2 (odds ratio [OR]=2.68, 95% confidence interval=1.05–6.83, p=0.039) after controlling for the effects of age, disease duration, education, medication, motor and nonmotor status, mood, and PD-CRS total score at V0. Although SCC were not associated with CI at V2, presenting both VH and SCC at V0 increased the probability of having CI at V2 (OR=3.71, 95% confidence interval=1.36–10.17, p=0.011). Conclusions VH were associated with the development of SCC and CI at the 2-year follow-up in patients with PD-NC.