Combinational Diuretics in Heart Failure.

PURPOSE OF REVIEW: Diuretics are the cornerstone therapy for acute heart failure (HF) and congestion. Patients chronically exposed to loop diuretics may develop diuretic resistance as a consequence of nephron remodelling, and the combination of diuretics will be necessary to improve diuretic response and achieve decongestion. This review integrates data from recent research and offers a practical approach to current pharmacologic therapies to manage congestion in HF with a focus on combinational therapy. RECENT FINDINGS: Until recently, combined diuretic treatment was based on observational studies and expert opinion. Recent evidence from clinical trials has shown that combined diuretic treatment can be started earlier without escalating the doses of loop diuretics with an adequate safety profile. Diuretic combination is a promising strategy for overcoming diuretic resistance in HF. Further studies aiming to get more insights into the pathophysiology of diuretic resistance and large clinical trials confirming the safety and efficacy over standard diuretics regimens are warranted.

Consensus on the approach to hydrosaline overload in acute heart failure. SEMI/SEC/S.E.N. recommendations.

Most of the signs and symptoms of heart failure can be explained by fluid overload, which is also related to disease progression. Fluid overload is a complex phenomenon that extends beyond increased intravascular pressures and poses challenges for accurate diagnosis and effective treatment. Current recommendations advise a multiparametric approach, including clinical data (symptoms/signs), imaging tests, and biomarkers. This article proposes a practical therapeutic approach to managing hydrosaline overload in heart failure in both inpatient and outpatient settings. This document is an initiative of the Spanish Society of Internal Medicine (SEMI) in collaboration with the Spanish Society of Cardiology (SEC) and the Spanish Society of Nephrology (S.E.N.).

Practical Approaches to the Management of Cardiorenal Disease beyond Congestion.

BACKGROUND: The coexistence of heart and kidney diseases, also called cardiorenal syndrome, is very common, leads to increased morbidity and mortality, and poses diagnostic and therapeutic difficulties. There is a risk-treatment paradox, such that patients with the highest risk are treated with lesser disease-modifying medical therapies. SUMMARY: In this document, different scientific societies propose a practical approach to address and optimize cardiorenal therapies and related comorbidities systematically in chronic cardiorenal disease beyond congestion. Cardiorenal programs have emerged as novel models that may assist in delivering coordinated and holistic management for these patients. KEY MESSAGES: (1) Cardiorenal disease is a ubiquitous entity in clinical practice and is associated with numerous barriers that limit medical treatment. (2) The present article focuses on the practical approaches to managing chronic cardiorenal disease beyond congestion to overcome some of these barriers and improve the treatment of this high-risk population.

Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy.

We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.

Combining loop and thiazide diuretics for acute heart failure across the estimated glomerular filtration rate spectrum: A post-hoc analysis of the CLOROTIC trial.

AIMS: In patients with acute heart failure (AHF), the addition of hydrochlorothiazide (HCTZ) to furosemide improved diuretic response in the CLOROTIC trial. This work aimed to evaluate if these effects differ across the estimated glomerular filtration rate (eGFR) spectrum. METHODS AND RESULTS: This post-hoc analysis of the CLOROTIC trial analysed 230 patients with AHF and explored the influence of eGFR on primary and secondary endpoints. The median eGFR was 43 ml/min/1.73 m2 (range 14-109) and 23% had eGFR ≥60 ml/min/1.73 m2 (group 1), 24% from 45 to 59 ml/min/1.73 m2 (group 2), and 53% <45 ml/min/1.73 m2 (group 3). Patients treated with HCTZ had greatest weight loss at 72 h in all three groups, but patients in group 1 had a significantly greater response (-2.1 kg [-3.0 to 0.5]), compared to patients in groups 2 (-1.3 kg [-2.3 to 0.2]) and 3 (-0.1 kg [-1.3 to 0.4]) (p-value for interaction = 0.246). At 96 h, the differences in weight were -1.8 kg (-3.0 to -0.3), -1.4 kg (-2.6 to 0.3), and -0.5 kg (-1.3 to -0.1) in groups 1, 2, and 3, respectively (p-value for interaction = 0.256). There were no significant differences observed with the addition of HCTZ in terms of diuretic response, mortality or rehospitalizations, or safety endpoints (impaired renal function, hyponatraemia, and hypokalaemia) among the three eGFR groups (all p-values for interaction were no significant). CONCLUSION: The addition of eGFR-adjusted doses of oral HCTZ to loop diuretics in patients with AHF improved diuretic response across the eGFR spectrum. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT01647932; EudraCT number: 2013-001852-36.

The influence of comorbidities on the prognosis after an acute heart failure decompensation and differences according to ejection fraction: Results from the EAHFE and RICA registries.

OBJECTIVE: The role of comorbidities in heart failure (HF) outcome has been previously investigated, although mostly individually. We investigated the individual effect of 13 comorbidities on HF prognosis and looked for differences according to left-ventricular ejection fraction (LVEF), classified as reduced (HFrEF), mildly-reduced (HFmrEF) and preserved (HFpEF). METHODS: We included patients from the EAHFE and RICA registries and analysed the following comorbidities: hypertension, dyslipidaemia, diabetes mellitus (DM), atrial fibrillation (AF), coronary artery disease (CAD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), heart valve disease (HVD), cerebrovascular disease (CVD), neoplasia, peripheral artery disease (PAD), dementia and liver cirrhosis (LC). Association of each comorbidity with all-cause mortality was assessed by an adjusted Cox regression analysis that included the 13 comorbidities, age, sex, Barthel index, New York Heart Association functional class and LVEF and expressed as adjusted Hazard Ratios (HR) with 95% confidence intervals (95%CI). RESULTS: We analysed 8,336 patients (82 years-old; 53% women; 66% with HFpEF). Mean follow-up was 1.0 years. Respect to HFrEF, mortality was lower in HFmrEF (HR:0.74;0.64-0.86) and HFpEF (HR:0.75;0.68-0.84). Considering patients all together, eight comorbidities were associated with mortality: LC (HR:1.85;1.42-2.42), HVD (HR:1.63;1.48-1.80), CKD (HR:1.39;1.28-1.52), PAD (HR:1.37;1.21-1.54), neoplasia (HR:1.29;1.15-1.44), DM (HR:1.26;1.15-1.37), dementia (HR:1.17;1.01-1.36) and COPD (HR:1.17;1.06-1.29). Associations were similar in the three LVEF subgroups, with LC, HVD, CKD and DM remaining significant in the three subgroups. CONCLUSION: HF comorbidities are associated differently with mortality, LC being the most associated with mortality. For some comorbidities, this association can be significantly different according to the LVEF.

Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial.

AIMS: To evaluate whether the addition of hydrochlorothiazide (HCTZ) to intravenous furosemide is a safe and effective strategy for improving diuretic response in acute heart failure (AHF). METHODS AND RESULTS: A prospective, double-blind, placebo-controlled trial, including patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The coprimary endpoints were changes in body weight and patient-reported dyspnoea 72 h after randomization. Secondary outcomes included metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. Safety outcomes (changes in renal function and/or electrolytes) were also assessed. Two hundred and thirty patients (48 women, 83 years) were randomized. Patients assigned to HCTZ were more likely to lose weight at 72 h than those assigned to placebo [2.3 vs. 1.5 kg; adjusted estimated difference (notionally 95 confidence interval) 1.14 (1.84 to 0.42); P 0.002], but there were no significant differences in patient-reported dyspnoea (area under the curve for visual analogue scale: 960 vs. 720; P 0.497). These results were similar 96 h after randomization. Patients allocated to HCTZ showed greater 24 h diuresis (1775 vs. 1400 mL; P 0.05) and weight loss for each 40 mg of furosemide (at 72 and at 96 h) (P 0.001). Patients assigned to HCTZ more frequently presented impaired renal function (increase in creatinine 26.5 moL/L or decrease in eGFR 50; 46.5 vs. 17.2; P 0.001), but hypokalaemia and hypokalaemia were similar between groups. There were no differences in mortality or rehospitalizations. CONCLUSION: The addition of HCTZ to loop diuretic therapy improved diuretic response in patients with AHF.

[The impact of COVID-19 on urology restructuring and organization.] / Impacto de la COVID-19 sobre la reestructuración y organización en urología.

Desde que el 31 de diciembre de 2019, se informó el primer caso de neumonía de etiología desconocida en la ciudad de Wuhan (China), la humanidad desconocía cómo iba a cambiar la vida tal cual la conocíamos y los profundos cambios que se iban a suscitar. La Organización Mundial de la Salud (OMS) el 12 de enero de 2020 reporta una nueva cepa de coronavirus que causaba el Síndrome Respiratorio Agudo Severo CoronaVirus 2 (SARS-CoV-2) (1) caracterizado por un cuadro clínico que variaba desde el portador asintomático hasta casos mortales de neumonía, insuficiencia respiratoria y fallo multiorgánico...

Desde que el 31 de diciembre de 2019, se informó el primer caso de neumonía de etiología desconocida en la ciudad de Wuhan (China), la humanidad desconocía cómo iba a cambiar la vida tal cual la conocíamos y los profundos cambios que se iban a suscitar. La Organización Mundial de la Salud (OMS) el 12 de enero de 2020 reporta una nueva cepa de coronavirus que causaba el Síndrome Respiratorio Agudo Severo CoronaVirus 2 (SARS-CoV-2) (1)caracterizado por un cuadro clínico que variaba desde el portador asintomático hasta casos mortales de neumonía, insuficiencia respiratoria y fallo multiorgánico...

[Urodynamic AUR in Guillain-Barré syndrome post-infection by coronavirus Sars-CoV-2. A bibliographic review.] / Urodinámica de la RAO en el síndrome De Guillain-Barré post-infección por coronavirus Sars-Cov-2. Revisión bibliográfica.

INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 coronavirus infection has beenassociated with the development of the novo genitourinarysymptoms and neurological symptomssecondary to peripheral nervous system damage.One of the neurological pathologies described associatedwith the infection has been Guillain-Barrésyndrome (GBS). We conducted a review of the literatureon SARS-CoV-2 infection and its relationshipwith lower urinary tract symptoms (LUTS), such asurinary retention (AUR). Bladder alterations derivedfrom neurological involvement by SARS-CoV-2,such as GBS, were also analyzed. An own case ispresented. MATERIAL AND METHODS: A literature searchwas performed using a combination of keywords(MeSH terms): "COVID", "COVID-19", "SARS-CoV-2","Urinary retention" and "Guillain-Barre Syndromeand Urodynamics". We searched for articles publishedup to March 2021. All articles identified fromthe bibliographic search were analyzed, using thePICOS criteria (participants, intervention, comparisons,results, type of study) to assess the eligibilityof the articles. Both prospective and retrospectivestudies, clinical cases and published systematicreviews were included. RESULTS: Findings in the academic literatureabout the associations between COVID-19 and RAO,LUTS and Guillain-Barré Syndrome are discussed,as well as their possible pathogenic mechanisms,A summary of relevant studies on urodynamic findingsin GBS patients is also provided. The resultsare summarized in attached tables. A case of AURassociated with COVID-19 and Guillain-Barré Syndromeis provided, with its urodynamic findings. CONCLUSION: Although the association betweenurinary symptoms and SARS-CoV-2 is not well described,there seems to be evidence of a possibleassociation, at least temporary, between the presentationof SARS-Cov-2 infection and the developmentof GBS with secondary LUT neurophysiologyalterations.

INTRODUCCIÓN Y OBJETIVO: La infecciónpor coronavirus SARS-CoV-2 se ha asociadoa la aparición de síntomas genitourinarios de novo,además de síntomas neurológicos secundarios al dañodel sistema nervioso periférico. Una de las patologíasneurológicas descritas asociadas a la infección ha sidoel síndrome de Guillain-Barré (SGB). Realizamos unarevisión de la literatura sobre la infección por SARSCoV-2 y su relación con los síntomas del tracto urinarioinferior (STUI), como la retención urinaria (RAO).Se analizaron también las alteraciones vesicales derivadasde la afectación neurológica por SARS-CoV-2,como el SGB. Se presenta un caso propio. MATERIAL Y MÉTODOS: Se realizó una búsquedade la literatura utilizando una combinación de palabrasclave (términos MeSH): "COVID", "COVID-19","SARS-CoV-2", "Urinary retention" y "Guillain-BarreSyndrome and Urodynamics". Se realizaron búsquedasde artículos publicados hasta marzo de 2021. Todos los artículos identificados a partir de la búsquedabibliográfica fueron analizados, utilizando los criteriosPICOS (participantes, intervención, comparaciones,resultados, tipo de estudio) para evaluar la elegibilidadde los artículos. Se incluyeron tanto estudios prospectivos,retrospectivos, casos clínicos y revisiones sistemáticaspublicadas. RESULTADOS: Se discuten los hallazgos en la literaturade las asociaciones entre COVID-19 y RAO, STUIy Síndrome de Guillain-Barré, así como sus posiblesmecanismos patogénicos. También se aporta un resumende trabajos relevantes sobre hallazgos urodinámicosen pacientes con SGB. Los resultados seresumen en tablas anexas. Se aporta un caso de RAOasociado a COVID-19 y Síndrome de Guillain-Barrécon sus hallazgos urodinámicos. CONCLUSIÓN: A pesar de la asociación entre síntomasurinarios y SARS-CoV-2 no está bien descrita, pareceque hay indicios de una posible asociación, al menostemporal entre la presentación de infección porcoronavirus SARS-Cov-2 y el desarrollo de un SGB conalteraciones de la neurofisiología del TUI secundaria.

[Prevalence and risk factors for lower urinary tract symptoms after robotic sacrocolpopexy.] / Prevalencia y factores de riesgo de síntomas del tracto urinario inferior post sacrocolpopexia robótica.

OBJECTIVES: To analyse the outcomes of Robotic Sacrocolpopexy (RSC) on resolution of Lower urinary tract Symptoms (LUTS) associated to pelvic organ prolapses (POP) and to determine the risk factors for preoperative LUTS presence. MATERIAL AND METHODS: A longitudinal study was carried out on 51 females mean aged (± standard deviation) 66 ± 9 years, who underwent RSC. A preoperative evaluation was made on the degree and type of POP, and the presence of the LUTS stress urinary incontinence (SUI), urgency and voiding difficulty. An urodynamic study was also performed. The presence of LUTS was evaluated again six months after being operated on. The statistical test used were the Mcnermar test for dependent variables, the Fisher's exact test and the t Student's mean comparison test. The signification level was set at p < 0.05 bilaterally. RESULTS: A significate decrease of postoperative SUI and voiding difficult was observed. However, urgency did not significantly diminish. Transobturatice free-tension mesh ( TOT) implementation in patients with evident or occult (with POP reduction) urodynamic SUI significantly decreased the prevalence of symptomatic SUI. The only significate risk factor was the preoperative presence of urgency regarding its postoperative prevalence. CONCLUSIONS: Robotic sacrocolpopexy significantly improves postoperative voiding difficult. TOT implement in patients with positive POP reduction test is useful to prevent postoperative symptomatic SUI.

OBJETIVOS: Analizar los resultados de la sacrocolpopexia laparoscópica (LSC) robótica en la resolución de los síntomas funcionales del tracto urinario inferior (LUTS) asociados a los prolapsos pélvicos (POP) y determinar los posibles factores de riesgo para la presencia de LUTS postoperatorios.MATERIAL Y MÉTODOS: Se realizó un estudio longitudinal de 51 mujeres de edad media (± desviación típica) 66 ± 9 años intervenidas de LSC robótica por POP. Preoperatoriamente se evaluó el grado y tipo de POP, la presencia de los LUTS incontinencia urinaria de esfuerzo (SUI), y urgencia y dificultad miccionales, y se realizó un estudio urodinámico. A los 6 meses de la cirugía se volvió a evaluar la presencia de LUTS. Los test estadísticos utilizados fueron el test de Mcnemar para variables dependientes y el test exacto de Fisher y la prueba de comparación de medias de la t de Student para variables independientes. El nivel de significación se fijó en p < 0,05 bilateral. RESULTADOS: Se comprobó una disminución postoperatoria significativa de la SUI y la dificultad miccional, pero no de la urgencia miccional. La implantación de una malla transobturatiriz (TOT) en pacientes con incontinencia de esfuerzo urodinámica evidente o Post reducción del POP (incontinencia de esfuerzo oculta) disminuyo significativamente la prevalencia de SUI sintomática postoperatoria. El único factor de riesgo significativo fue la presencia preoperatoria de urgencia miccional respecto a la prevalencia postoperatoria de ese LUTS. CONCLUSIONES: La LSC robótica mejora significativamente la dificultad miccional preoperatoria. La implantación de un TOT en pacientes con test de reducción del POP positivo es útil para prevenir la SUI sintomática postoperatoria.

Large study (283 women) on the effectiveness of Manosar®: 2 g of d-mannose + 140 mg of proanthocyanidins (PAC), of prolonged release. / Amplio estudio (283 mujeres) sobre la eficacia de Manosar®: 2 g de d-manosa + 140 mg de proantocianidinas (PAC), de liberación prolongada frente a 240 mg de PAC de liberación prolongada en la prevención a 6 meses por vía oral de las infecciones urinarias recurrentes.

OBJECTIVE: To compare the efficacy and safety in the prophylasis of urinary tract infections (UTIs) with a food supplement that contains D-mannose like active ingredient (Manosar®), in comparison to another preparation in which the active ingredient are the proanthocyanidins (PAC), both of them, in prolonged released, after, they was administered for 24 weeks. METHODS: A multicenter, randomized and double blind experimental study was carried out. 283 women with a history of recurrent UTIs without evidence of complication were included. They were randomized 1: 1 in two groups. In one group, 1 oral sachet of Manosar® a day was administered, and in the other group 1 oral sachet of a compound of 240 mg of continuous-release PAC. Prior to inclusion in the study, the episode of UTI was confirmed at least by the clinical symptoms and positivity of the Combur test. RESULTS: Valid data were obtained from 184 patients with an average age of 49.5 years: 90 received Manosar® and 94 isolated PAC. A total of 72 patients suffered an UTI due to E.coli: 25 patients in the arm with Manosar® versus 47 patients in the isolated PAC group, this difference being statistically significant (p=0.002). The free time of new UTI recurrences was 98.6 days in the group treated with Manosar® and 84.6 days in the group with isolated PAC. CONCLUSION: The oral taking of a daily sachet of Manosar® is effective and safe in preventing recurrent UTIs in women, being superior to the oral taking of isolated PAC.

OBJETIVO: Comparar la eficacia y seguridad de la profilaxis de las infecciones del tracto urinario (ITUs) con un complemento alimenticio que contiene D-manosa como principio activo principal (Manosar®), en comparación con otro preparado cuyo principio activo único son las proantocianidinas (PAC), ambos de liberación continuada, tras su administración durante24 semanas.MÉTODOS: Estudio experimental multicéntrico, aleatorizado y doble ciego. Se incluyeron 283 mujeres con historia de ITUs recurrentes sin evidencias de complicación. Se randomizaron 1:1 en dos grupos. En un grupo se administró 1 sobre diario oral de Manosar®, y en el otro 1 sobre diario oral de un compuesto de 240 mg de PAC de liberación continuada. Previo a la inclusión en el estudio se confirmó el episodio de ITU al menos por la sintomatología clínica y positividad del test de Combur. RESULTADOS: Se obtuvieron datos válidos de 184 pacientes con edad media de 49,5 años: 90 recibieron Manosar® y 94 PAC aislado. Un total de 72 pacientes padecieron una ITU por E.coli: 25 pacientes en el brazo con Manosar® frente a 47 pacientes en el grupo de PAC aislado, siendo esta diferencia estadísticamente significativa (p=0,002). El tiempo libre de nuevas recurrencias de ITU fue de 98,6 días en el grupo tratado con Manosar® y de 84,6 días en el grupo con PAC aislado.CONCLUSIÓN: La toma oral de un sobre al día de Manosar® es eficaz y segura en la prevención de las ITUs recurrentes en la mujer, siendo superior a la toma oral de PAC aislado.

Physical exam in the evaluation of bladder pain syndrome (BPS): A key component for differential diagnosis. / La exploración física en la evaluación del síndrome de dolor vesical (SDV): un importante elemento para la orientación terapéutica.

OBJECTIVES: To describe in more detail the usual clinical practice regarding physical examination (PE) in Bladder Pain Syndrome (BPS) and to evaluate if the performance of PE relates to changes in severity of symptoms and in Health Related Quality of Life (HRQoL). MATERIAL AND METHODS: Epidemiological, observational, national and multicentric study that included 319 patients with BPS (79 of new diagnosis and 240 in follow-up). Demographic and clinical data were collected. The diagnostic study was performed according to the usual clinical practice, including as the case: PE and biopsy. The patients completed the "Bladder Pain/Interstitial Cystitis Symptom Score" (BPIC-SS) and "EuroQoL-5D-5L" (EQ-5D-5L) questionnaires. To describe the continuous variables, the mean, standard deviation (SD) and quartiles analyzed were used, and for categorical variables, number and percentage of patients by response category. The questionnaires' results were described according to the visual analog scale (VAS). Health status was evaluated in patients with myofascial pain. RESULTS: PE was performed in 296 cases. 28.4% of the patients presented pelvic myofascial pain. The variation of the BPIC-SS score in the explored patients was 7.77 points, compared to 1.73 in the unexplored ones. The variations in EQ-5D-5L were 0.13 and 0.04 points, respectively. CONCLUSIONS: Myofascial involvement was observed in 28.4% of the 296 cases of BPS who receiveda PE. It is important to implement a systematic, comprehensive method of PE at the national level in order to achieve a more precise characterization of BPS and a better evolution of the patient's symptoms and HRQoL.

OBJETIVOS: Conocer en mayor detalle la práctica clínica habitual de la exploración física (EF) del Síndrome de Dolor Vesical (SDV) y evaluar los cambios en síntomas y Calidad de Vida Relacionada con la Salud (CVRS) según los resultados de la EF.MATERIAL Y MÉTODOS: Estudio epidemiológico, observacional, nacional y multicéntrico que incluyó 319 pacientes con SDV (79 de nuevo diagnóstico y 240 en seguimiento). Se recogieron datos demográficos y clínicos. El estudio diagnóstico se realizó según práctica  clínica habitual, incluyendo según el caso: EF y biopsia. Las pacientes cumplimentaron los cuestionarios "BladderPain/Interstitial Cystitis-Symptom Score" (BPIC-SS) y "EuroQoL-5D-5L" (EQ-5D-5L). Para describir las variables continuas se utilizaron la media, desviación estándar (DE) y cuartiles analizados y para las cualitativas, el número y porcentaje de pacientes por categoría de respuesta. Los resultados de los cuestionarios se describieron según la escala visual analógica (EVA). Se evaluó el estado de salud en pacientes con dolor miofascial. RESULTADOS: Se realizó EF en 296 casos. El 28,4% de los pacientes presentaban dolor miofascial. La variación de la puntuación BPIC-SS en los pacientes explorados fue de 7,77 puntos, en comparación con los 1,73 en los no explorados. Las variaciones en EQ-5D-5L fueron 0,13 y 0,04 puntos, respectivamente. CONCLUSIONES: La implicación miofascial se observó en el 28,4% de los 296 casos de SDV sometidos a EF. Es importante implementar un método sistemático e integral de EF a nivel nacional para lograr una caracterización más precisa del SDV y una mejor evolución de los síntomas y CVRS del paciente.

Transcultural Adaptation and Psychometric Validation of a European Spanish Language Version of the Falls Behavioral Scale.

BACKGROUND AND PURPOSE: The Falls Behavioral Scale (FaB) is considered a valid and reliable tool for measuring fall risk factors related to behavior among older people. It was originally developed and validated in Australia by Clemson et al. The purpose of this study was to perform a transcultural adaptation and validation of the FaB to European Spanish. METHODS: The transcultural adaptation of the questionnaire followed the methodology structured and validated by Beaton et al. The prefinal version in European Spanish was tested in a pilot study utilizing 15 participants. A total of 167 participants older than 60 years and capable of walking independently, with or without gait assistive devices, were recruited for the study. Internal consistency and reliability were analyzed using Cronbach α and the intraclass correlation coefficient (ICC) with a 95% confidence interval. Convergent validity was assessed using Spearman's coefficient, and correlations were evaluated with the European Spanish versions of the EuroQoL-5D (EQ-5D) and the Activities-Specific Balance Confidence Scale (ABC-16). RESULTS: Good internal consistency was obtained (α = .714) as was test-retest reliability of the overall questionnaire (ICC = 0.97). For each item, good test-retest reliability was achieved, obtaining values for ICC ranging between 0.63 and 0.91 (P < 0.001). Floor and ceiling effects in the European Spanish FaB were not found. Moderate convergent validity was shown, demonstrated by statistically significant associations between the European Spanish version of the FaB and both the ABC-16 (rS = -0.512, P < .001) and the health status subjective value of the EuroQoL-5D scale, also in its European Spanish version (rS = -300, P < .001). Minimum detectable change (MDC) was calculated to provide confidence that any changes are not the result of a random variation or a measuring error (6.49 points; 9.28% MDC). CONCLUSION: The European Spanish FaB was shown to be a valid and reliable tool for use with Spanish-speaking seniors.

[Clinical and urodynamic risk factors of recurrent urinary tract infections in patients with multiple sclerosis.] / Factores de riesgo clínicos y urodinámicos de infecciones urinarias recurrentes en pacientes con esclerosis múltiple.

OBJECTIVES: To determine the risk factors of recurrent urinary infections (rUTIs) in patients with Multiple Sclerosis (MS). METHODS: A retrospective cohort study was conducted including 114 patients with MS, 84 women (74%) and 30 men (26%), with a mean age of 49. They underwent videourodynamic study and selective sphincter electromyography due to urinary symptoms (LUTS). Clinical data (both neurological and urological) and videourodynamic data (including free flowmetry, cystomanometry and pressure flow study) were collected. In 37 patients (32%), the presence of rTUIs was demonstrated. RESULTS: Statistically significant differences were demonstrated between the patients with and without rUTIs with respect to the following clinical variables: the time of evolution of the symptoms (greater in the case of rUTIs), time from the diagnosis of MS (higher in the case of rUTIs), EDSS score (Expanded Disability Staus Scale) (higher in the case of rUTIs) and the EM type [higher frequency of rUTIs in the progressive types (primary and secondary)]. Urodynamic variables with significant differences were: maximum flow in free flowmetry (lower in patients with rUTIs), voiding volume in free flowmetry (lower in patients with rUTIs), micturition efficiency (higher percentage of residual urine in patients with rUTIs), stress urinary incontinence (SUI) (higher frequency of rUTIs in patients with SUI), detrusor pressure at maximum flow (lower in patients with rUTIs) and bladder contractility index (lower in patients with rUTI). No significant difference was demonstrated in relation to the presence and type of neurogenic lower urinary tract dysfunction (NLUTD). CONCLUSIONS: The severity and duration of MS is a risk factor for rUTIs. Urodynamic risk factors are compatible with a lower contractile capacity in patients with rUTIs, while the existence of NLUTD would not imply any specific risk factor.

OBJETIVO: Determinar los factores de riesgo de infecciones urinarias recurrentes (rUTIs) en pacientes con Esclerosis Múltiple (EM).MÉTODOS: Se realizó un estudio de cohortes retrospectivo en 114 pacientes, 84 mujeres (74%) y 30 varones (26%), de edad media 49 años con EM sometidos a estudio videourodinámico y electromiografía selectiva esfinteriana por presentar síntomas urinarios (LUTS). Se recogieron los datos clínicos (tanto neurológicos como urológicos) y videourodinámicos (incluyendo flujometría libre, cistomanometría y estudio presión flujo). En 37 pacientes (32%) se demostró la presencia de rTUIs. RESULTADOS: Se demostraron diferencias estadísticamente significativas entre los pacientes con y sin rUTIs respecto de las siguientes variables clínicas: el tiempo de evolución de los síntomas (mayor en el caso de rUTIs), antigüedad de la EM (mayor en el caso de rUTIs), la puntuación EDSS (Expanded Disability Staus Scale) (mayor en el caso de rUTIs) y el tipo EM [mayor frecuencia de rUTIs en los tipos progresivos (primario y secundario)]. Las variables urodinámicas con diferencias significativas fueron: el flujo máximo en la flujometría libre (menor en pacientes con rUTIs), el volumen miccional en la flujometría libre (menor en pacientes con rUTIs), la eficiencia miccional (mayor porcentaje de residuo en pacientes con rUTIs), la incontinencia urinaria de esfuerzo (SUI) (mayor frecuencia de rUTIs en pacientes con SUI), la presión del detrusor a flujo máximo (menor en pacientes con rUTIs) y el índice de contractilidad vesical (menor en pacientes con rUTI). No se demostró ninguna diferencia significativa en relación con la presencia y tipo de disfunción neurógena del tracto urinario inferior (NLUTD). CONCLUSIONES: La gravedad y duración de la EM constituye un factor de riesgo para las rUTIs. Los factores de riesgo urodinámicos son compatibles con una menor capacidad contráctil en los pacientes con rUTIs, mientras que la existencia NLUTD no supondría ningún factor de riesgo específico.

[Functional changes during the voiding phase in males with non-neurogenic detrusor underactivity undergoing bladder catheterization.] / Cambios funcionales en la fase miccional de varones diagnosticados de detrusor hipoactivo no neurogénico sometidos a cateterización vesical.

OBJECTIVES: To investigate urodynamic changes during the voiding phase in males with detrusor underactivity (DU) undergoing bladder catheterization for urinary retention. METHODS: From a total of 64 patients with urinary retention, a follow-up study was performed in 17 males with a mean age of 77 years. Patients received a urodynamic diagnosis of DU based on a Bladder Contractility Index (BCI) score of < 100 and underwent permanent bladder catheterization (16 cases) or clean intermittent catheterization (1 case) for acute urinary retention (14 cases), or post void residual urine (3 cases). Patients underwent a second urodynamic study after a mean 13 months of follow-up. Fisher's exact test was used with categorical variables and Student's t test with parametric variables. The level of significance was set at p < 0.05 for a two-sided test. RESULTS: The second urodynamic study showed a significant increase in maximal detrusor pressure, pressure at maximum flow rate, BCI score, Bladder Outlet Obstruction Index (BOOI) score, and number of patients who urinated during the pressure-flow study. CONCLUSIONS: Bladder catheterization in men with DU significantly improves bladder contractility and revealed obstructions of the lower urinary tract that were masked by insufficient detrusor pressure in relation to the DU of these patients. These findings could have diagnostic as well as prognostic and therapeutic applications.

OBJETIVOS: Determinar los cambios urodinámicos de la fase miccional en varones con hipocontractilidad del detrusor (DU) sometidos a cateterismo vesical por retención urinaria. MÉTODOS: De un total de 64 pacientes con retención urinaria, se realizó un estudio de seguimiento en 17 varones de edad media 77 años, diagnosticados urodinámicamente de DU por presentar un Índice de Contractilidad Vesical (BCI) menor de 100, sometidos a sonda vesical a permanencia (16 casos) o cateterismo vesical limpio intermitente (1 caso) por retención aguda de orina (14 casos), o residuo postmiccional patológico (3 casos). Los pacientes fueron sometidos a un segundo estudio urodinámico a los 13 meses de seguimiento de media. Las pruebas estadísticas utilizadas fueron el test exacto de Fisher para variables cualitativas y el test de comparación de media de la t de Student para variables paramétricas. El nivel de significación se fijó en p < 0,05 bilateral. RESULTADOS: En el segundo estudio urodinámico, se observó un aumento significativo de la presión máxima del detrusor, la presión a flujo máximo, el BCI y el Índice de Obstrucción de Salida Vesical (BOOI) y del número de pacientes que orinaron durante el estudio presión/ flujo. CONCLUSIONES: El cateterismo vesical en varones con DU mejora significativamente la contractilidad vesical y permiten desenmascarar obstrucciones del tracto urinario inferior que estaban ocultas por una insuficiente presión del detrusor en relación a la DU de estos pacientes. Esto podría tener no sólo aplicaciones diagnósticas, sino pronósticas y terapéuticas.

Cohort profile: the Hortega Study for the evaluation of non-traditional risk factors of cardiometabolic and other chronic diseases in a general population from Spain.

PURPOSE: The Hortega Study is a prospective study, which investigates novel determinants of selected chronic conditions with an emphasis on cardiovascular health in a representative sample of a general population from Spain. PARTICIPANTS: In 1997, a mailed survey was sent to a random selection of public health system beneficiaries assigned to the University Hospital Rio Hortega's catchment area in Valladolid (Spain) (n=11 423, phase I), followed by a pilot examination in 1999-2000 of 495 phase I participants (phase II). In 2001-2003, the examination of 1502 individuals constituted the Hortega Study baseline examination visit (phase III, mean age 48.7 years, 49% men, 17% with obesity, 27% current smokers). Follow-up of phase III participants (also termed Hortega Follow-up Study) was obtained as of 30 November 2015 through review of health records (9.5% of participants without follow-up information). FINDINGS TO DATE: The Hortega Study integrates baseline information of traditional and non-traditional factors (metabolomic including lipidomic and oxidative stress metabolites, genetic variants and environmental factors, such as metals), with 14 years of follow-up for the assessment of mortality and incidence of chronic diseases. Preliminary analysis of time to event data shows that well-known cardiovascular risk factors are associated with cardiovascular incidence rates, which add robustness to our cohort. FUTURE PLANS: In 2020, we will review updated health and mortality records of this ongoing cohort for a 5-year follow-up extension. We will also re-examine elder survivors to evaluate specific aspects of ageing and conduct geolocation to study additional environmental exposures. Stored biological specimens are available for analysis of new biomarkers. The Hortega Study will, thus, enable the identification of novel factors based on time to event data, potentially contributing to the prevention and control of chronic diseases in ageing populations.