1,721,090 research outputs found
Analisi della microflora neovaginale in pazienti che si sottopongono ad intervento di conversione dei genitali in senso androginoide
No full textIntroduzione
Sebbene esistano molti studi sul microbiota genitale maschile e femminile i sono molto scarsi i dati relativi alla composizione della microflora della vagina in donne transessuali sottoposte ad intervento di conversione dei genitali con tecnica penoscrotale.
Materiali e metodi
Sono state arruolate nello studio le donne trans sottoposte ad intervento di conversione androginoide presso la Clinica Urologica di Trieste con tecnica penoscrotale. Queste pazienti hanno eseguito 2 tamponi uno a livello della mucosa uretrale in prossimità del meato uretrale, l’altro a livello del fondo della neovagina.
Sono stati inoltre raccolti tamponi di una paziente operata da circa 4 mesi e di altre 2 pazienti operate da circa 24 mesi.
Ogni tampone l’analisi della microflora è stata eseguita mediante la metodica V3-16S rRNA Next Generation Sequencing (NGS) e multiplex PCR.
Per tutte le pazienti sono stati prospetticamente raccolti dati anagrafici e relativi alle proprie abitudini sessuali inoltre è stata indagata la storia di infezioni genitourinarie.
Il follow-up ha previsto come da protocollo interno visite di controllo a 3, 6, 12, 24, 36 mesi.
Risultati
Dal Luglio 2016 all’ottobre 2017, 14 pazienti sottoposti ad intervento di conversione dei genitali in senso androginoide MtoF. L’età media era 35,2 anni (range 24-50). Tutte le pazienti stavano assumendo una terapia ormonale a base di antiandrogeni ed estrogeni da almeno 1 anno al momento della chirurgia. Una paziente era HIV sieropositiva. Tutte le altre pazienti erano HIV, HBV ed HCV sieronegativi. Quindici pazienti (93,75%) presentavano un orientamento eterosessuale mentre una paziente (6,25%) era omosessuale. I tamponi sono stati eseguiti durante la degenza post-operatoria per 13 pazienti mentre una paziente è stata arruolata a 3 mesi dall’intervento e 2 pazienti 24 mesi dopo la chirurgia. Il follow-up medio dell’intera corte di pazienti è di 21,1 mesi (DS: 8,03 mesi). La flora neovaginale è risultata esser composta prevalentemente da Provetella, Escherichia e Provetella. In nessun campione è stata identificata la presenza di lattobacilli. Solo 2 pazienti hanno riferito storia di infezioni urinarie ricorrenti. Non è stato quindi possibile identificare correlazioni tra le caratteristiche del microbiota e l'insorgenza di infezioni urinarie.
Conclusioni
La nostra analisi ha permesso la caratterizzazione della microflora vaginale nell’immediato post-operatorio delle pazienti che si sottopongono ad intervento di conversione ginoandroide. Nonostante la terapia ormonale, la neovagina è risultata esser massivamente colonizzata da batteri comunemente presenti nei genitali maschili e spesso responsabili di infezioni del tratto genitourinario nelle donne biologiche. E’ stata esclusa la presenza di lactobacilli. Questo studio è il primo che fornisce un modello di microbiota vaginale nelle pazienti sottoposte ad intervento di conversione androginoide
Profilassi antibiotica nelle procedure urologiche
No full textAntibiotic prophylaxis in urological procedures Thousands of patients receive every day an antibiotic prophylaxis before diagnostic or therapeutic urological procedures. Aim of antibiotic prophylaxis is to reduce the risk of infective complications, unfortunately good quality evidences for the best choice of prophylaxis strategy are often lacking. Nowadays antimicrobial resistance is a major health problem caused primarily by overuse of antibiotics. It is the responsibility of all physicians to practice antibiotic stewardship avoiding the unnecessary use of this precious drugs. Given the previous consideration prophylaxis should be chosen on the base of the best evidences, if evidences are lacking prophylaxis should be tailored on the base of each patient individual features and risk factor for infection complications. This narrative review of antibiotic prophylaxis in urological procedure resumes the principle to follow for the correct management of antibiotic prophylaxis in urological procedure
Antimicrobial Prophylaxis for Postoperative Urinary Tract Infections in Transurethral Resection of Bladder Tumors: A Systematic Review and Meta-analysis. Letter
No full textThe correct use of antimicrobial drugs represents a major strategy to slow down or avoid the development of antimicrobial resistance.1 Given the high incidence of bladder cancer, transurethral resection of the bladder (TURB) is one of the most common urological procedures.2 Nowadays, many urologists give 1 or more doses of antimicrobial drugs as antimicrobial prophylaxis (AMP) to patients who undergo TURB. This practice is probably based on common habits but remarkably, as stated by Bausch et al in their recent review,3 there is an absence of evidence in the literature demonstrating that using AMP before routine TURB reduces the risks of infection complications.4 So far, in the age of evidence-based medicine, the study of Bausch et al importantly underlines the need for better quality evidence in sustaining or not the very common practice of the use of AMP for patients who undergo TURB. Interestingly enough, the answer to the question, “Does AMP reduce the rate of postoperative symptomatic urinary tract infection in patients undergoing TURB?” could be negative. It is a matter of fact that low quality evidence sustaining safety of TURB without using AMP exists. In our department, according to a nearly 11-year internal protocol, almost all patients with negative urine culture who undergo routine TURB do not receive any AMP regardless of the dimension of the tumor or the burden of patient comorbidity. With the purpose to assess results of this practice, we retrospectively reviewed all clinical files connected to hospitalization and the following first month after discharge of all patients who underwent TURB at our institution be- tween January 2011 and December 2013. We identified 223 patients who underwent TURB without AMP. In this population, only 6 (2.7%) patients developed postoperative infection compli- cations and no cases of sepsis were reported. According to these results we concluded that AMP should not be routinely used prior to TURB.5 We are well aware that many local factors could influence the risks of postoperative infectious complications and could limit the generalizations of our results. Furthermore, a randomized controlled trial would produce better evidence. However, despite limitations, we recommend consideration of our experience because avoiding the use of AMP prior to routine TURB even in a part of patients would spare thousands of doses of antibiotics every day. In the era of antimicrobial resistance, good use of antimicrobial drugs counts; and even small acts, like avoiding antimicrobial prophylaxis if not necessary, matter
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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