Monocytes are classified according to their CD14 and CD16 expression into classical (reparative), intermediate (inflammatory), and non-classical. This study assessed the frequency of monocyte and the relationship between monocyte subset percentages and the levels of blood cytokines in Colombian chagasic patients with different clinical forms. This study included chagasic patients in different clinical stages: indeterminate (IND) n = 14, chronic chagasic cardiomyopathy (CCC) n = 14, and heart transplant chagasic (HTCC) n = 9; controls with non-chagasic cardiopathy (NCC) n = 15, and healthy individuals (HI) n = 15. Peripheral blood mononuclear cells (PBMCs) were isolated, labeled for CD14, CD16, and HLA-DR, and analyzed by flow cytometry. Cytokines were measured with a bead-based immunoassay. Percentages of total CD14+ CD16+ and CD14+ HLA-DR+ monocytes were higher in patients with heart involvement (CCC, HTCC, and NCC) than controls. Percentages of intermediate monocytes increased in symptomatic chagasic patients (CCC and HTCC) compared to asymptomatic chagasic patients (IND) and controls (HI). Asymptomatic chagasic patients (IND) had higher percentages of classical monocytes, an increased production of CCL17 chemokine compared to chagasic symptomatic patients (CCC), and their levels of CCL17 was positively correlated with the percentage of classical monocyte subset. In CCC, the percentages of intermediate and classical monocytes were positively correlated with IL-6 levels, which were higher in this group compared to HI, and negatively with IL-12p40 concentration, respectively. Remarkably, there also was an important increased of classical monocytes frequency in three chronic chagasic patients who underwent cardiac transplant, of which one received anti-parasitic treatment. Our findings suggest that cardiac chagasic patients have an increased percentage of inflammatory monocytes and produce more IL-6, a biomarker of heart failure and left ventricular dysfunction, whereas asymptomatic chagasic individuals present a higher percentage of reparative monocytes and CCL17.

Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. Materials and Methods: A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. Results: A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m 2) and nonobese (<30 kg/m 2). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. Conclusions: This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.

Body stalk anomaly is a rare and severe malformation syndrome in which the exact pathophysiology and trigger factors are still unknown. This is a case of a 30-year-old patient who underwent ultrasound at 9 weeks of gestation. It revealed an abnormal location of the inferior body of the embryo in the coelomic space. The findings suggested a short umbilical cord syndrome. In order to confirm the diagnosis, the patient was scheduled for a second ultrasonography at 11 weeks of gestation. The obtained images, confirmed the location of the inferior body in the coelomic space with no visible bladder, absence of the right leg, severe abdominal wall defect, consistent with an omphalocele, and a short 5 mm umbilical cord. These last ultrasonographic findings were consistent with body stalk anomaly. Because of severe malformation incompatible with life, the patient was offered termination of pregnancy. Pathologic examination confirmed the suspected pathology of body stalk anomaly.

Purpose The artificial urinary sphincter (AUS) is one of the most effective surgical treatments for male urinary incontinence regardless of its severity. Current knowledge comes from high‐volume centers, but little is known about the performance of this surgery from community practices. This study aims to report contemporary AUS performance in a nationwide observational study in Colombia. Methods Male patients who underwent AUS surgery with AMS 800™ between 2000 and 2020 in more than 17 centers and four cities were identified. Pre, intra, and postoperative characteristics were evaluated, mainly addressing patient reported outcomes measurements in the postoperative period. Retrospective and prospective data collection and descriptive analysis were completed. Kaplan‐Meier analysis was used to determine AUS survival rate. Results Out of an initial 667 cases, a total of 215 patients met inclusion and exclusion criteria and were included. Mean age was 67 ± 9.4 years, and mean follow‐up was 6.0 ± 4.4 years with maximum range of 14 years. The etiology of urinary incontinence was prostate cancer surgery in 141 (81%) of the cases. The rest of the cases were related to benign prostatic disease or spinal cord injury. It is noteworthy that out of 115 patients, only 59 (51.3%) reported previous formal pelvic floor rehabilitation. Subjective severity of urinary incontinence determined by a visual analog scale showed a decrease in 4.5 points after sphincter implantation. Sphincter removal was required in 50 (23.2%) cases. The main reasons for implant removal were urethral erosion and infection. The sphincter survival rate at 2, 5, 8, 10, and 14 years was 76%, 70%, 60%, 57%, and 17%, respectively. Of the subjects at the last follow‐up with the device still in place, 80.7% defined their urinary condition as “does not cause or causes minor discomfort,” and 99% would recommend the device to a friend or relative in the same condition. Conclusions This series from a community‐based practice shows the lack of adherence to clinical practice guidelines and the lack of standardized data collection. In contrast, this study provides real‐world data on explantation and revision rates, allows physicians to inform patients and to have clear metrics for a shared decision‐making process before the procedure.

Purpose Bladder and bowel dysfunction (BBD) is defined as the presence of functional alterations in both organs. The correct diagnosis and treatment prevent the exposure of patients to multiple antibiotic treatments, invasive procedures and radiological studies. The aim of the present study was to estimate the prevalence of BBD in the outpatient clinic of pediatric urology and nephrology. Methods A prospective cohort composed of 334 patients aged between 5 and 18 years was evaluated. The Pediatric Lower Urinary Tract Symptom Score (PLUTSS) was applied. A score higher than 8 was considered as significant urinary symptomatology. Moreover, the Bristol Stool Scale and the Rome IV Criteria for functional constipation and fecal incontinence were used. Patients with organic pathologies were excluded. The risk factors were evaluated using logistic regression models. Results The median age was 9 years old (interquartile range [IQR]: 6–13). The PLUTSS questionnaire was significant in 16.5% of the kids, constipation was found in 31.9%, and fecal incontinence, in 4%. The prevalence of BBD was of 27.8%. The female gender (odds ratio [OR]: 2.47; p = 0.002) and psychological disorders (OR: 4.637; p = 0.024) were considered risk factors. The evaluation of the PLUTSS questionnaire showed relevance regarding incontinence (OR: 3.059; p = 0.038), enuresis (OR: 8.532; p < 0.001); intermittent flow (OR: 9.211; p = 0.004), frequency (OR: 6.73; p = 0.005), and constipation (OR: 34.46; p < 0.001). Conclusions The prevalence of BBD is of 27.8% in the outpatient clinic. It is important to prevent associated complications and the exposure to multiple antibiotic treatments, as well as invasive and imaging procedures, which also generate high costs to the health system.

Monocytes are classified according to CD14 and CD16 expression into classical, intermediate and non classical. Variations in monocytes subsets are involved in the pathogenesis of protozoan and helminthic infections. This study assessed the relationship of monocyte subsets percentages and the level of cytokines in blood from Colombian chagasic patients. Donors included asymptomatic or indeterminate (IND), symptomatic or chronic cardiac chagasic (CCC) and heart transplant (HTCC) patients; also, non-chagasic cardiopathy patients (NCC) and healthy individuals (HI) as controls. Peripheral blood mononuclear cells (PBMCs) were isolated. Fc receptors were blocked using anti-CD16/CD32 and human AB serum. Cells were labeled with antibodies for CD14, CD16 and HLA-DR, and acquired in a flow cytometer. Cytokines were measured in plasma with a Human M1/M2 Macrophage kit. Comparisons were done with Kruskal-Wallis followed by Dunn’s post hoc test and correlations were evaluated by Spearman’s coefficient. Percentages of CD14+ CD16+ and CD14+ HLA-DR+ monocytes were higher in patients with heart involvement (CCC, HTCCC, and NCC). Percentage of intermediate monocytes (inflammatory) increased in CCC patients and was positively correlated with IL-6 concentration and negatively correlated with IL-12p40 levels. IND donors had higher percentages of classical monocytes and an increased production of CCL17, and they positively correlate. The results suggest that variations in the monocyte subsets and cytokines levels might be associated with protection (classical monocytes and CCL17) or the development (intermediate monocytes and IL-6) of chagasic myocardiopathy