Irisin, in women and men: blood pressure, heart rate, obesity and insulin resistance.

Background: Irisin is a myokine that increases with leisure time physical activity (LTPA) and for which a cardiovascular protective role has been postulated. Our aim was to assess this role in the general population. Methods: A cross-sectional analysis was performed in a large randomly selected population sample (n=2298 women and 1529 men). Apart from age and sex, we record anthropometrics (blood pressure, heart rate, obesity), lifestyle (LTPA, smoking, alcohol), and biochemical measurements (irisin, lipid profile, insulin resistance). Correlations and regression multivariate models were used to analyze the association of irisin levels with the studied factors. Results: The variables more strongly and directly associated with irisin, adjusting the studied factors separately in women and men, were HOMA-2 (p=0.043 and p=0.001, respectively) and LTPA (p<0.001 and p=0.001, respectively). Also heart rate inversely (p=0.005 and p=0.002, respectively) and DBP directly (p<0.005 and p=0.045, respectively) were associated to irisin in both sexes. The waist/height ratio (p<0.001) was inversely associated to irisin only in women, and the alcohol drinking was directly associated (p=0.029) only in men. Conclusion: We provide new findings for irisin, such as its association with DBP and with heart rate; furthermore, in women irisin is associated to abdominal obesity, and in men is associated to the alcohol intake. We also corroborate the association of irisin with LTPA and insulin resistance. The associations detected point towards a protective role of irisin in the maintenance of cardiometabolic health.

Resistin as a risk factor for all-cause (and cardiovascular) death in the general population.

Serum resistin is a pro-inflammatory cytokine that has been described as a risk factor associated with mortality in several clinical sets including type 2 diabetes. Mortality studies in the general population are needed to find out the risk of death associated to this cytokine. In a follow-up study of a cohort of adult population (n = 6636) in Spain over a period of fifteen years (447 deaths/102,255 person-years), serum resistin measurements and death records were obtained. The risks of all-cause deaths, and deaths from cardiovascular and oncological diseases were estimated. Hazard ratios (HR) and its confidence intervals (CI) were calculated using multivariable Cox models, adjusting the effect of 11 traditional risk factors. The risk of all-cause mortality among participants exposed to the highest quintile of resistin was always higher than among those in the lowest quintile (HR varied between 1.55 when smoking was the adjusted factor [95% CI 1.17-2.05], and 1.68 when the adjusted factor was physical activity [95% CI 1.27-2.21]). The maximally adjusted model, accounting for the effect of all traditional factors, corroborated this higher risk of all-cause mortality among people in the highest resistin quintile (HR = 1.52; 95% CI 1.13-2.05). The effect of resistin was even higher for cardiovascular deaths (HR = 2.14; 95% CI 1.13-4.06), being exceeded only by suffering diabetes (HR = 3.04; 95% CI 1.98-4.69) or previous acute coronary syndrome (HR = 3.67; 95% CI 2.18-6.18). This findings corroborate the role of resistin as a risk factor for all-cause (and cardiovascular) death in the general population.

Mortality from chronic respiratory disease in Brazil: time trend and forecasts.

OBJECTIVE: To analyze the time trend of monthly mortality rates from chronic respiratory diseases in Brazil from 1996 to 2017, with forecasts for 2022, besides analyzing the possibility of achieving the goal of the Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil (Strategic Action Plan to Tackle Chronic Noncommunicable Diseases in Brazil) from 2011 to 2022. METHODS: This is an ecological study that uses data from Sistema de Informações sobre Mortalidade (SIM - Mortality Information System), Sistema de Informações Demográficas e Socioeconômicas (Demographic and Socioeconomic Information System) and Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD Contínua - Continuous National Household Sample Survey). We established the age range between 30 and 69 years old and the evolution of the rates over time was made by autoregressive integrated moving average models in R statistical tool. RESULTS: Premature mortality rates from chronic respiratory diseases are decreasing in Brazil as a whole, mostly in state capitals. There is also a trend to reach the Ministry of Health's goal in most of the country. For capitals that tend not to reach the goal, there is an association between mortality and social indicators, healthcare network and frequency of smoking. CONCLUSION: This study intends to improve planning of the public health system for the control of chronic respiratory diseases.

Incidence and mortality of cerebrovascular disease in Spain: 1,600,000 hospital admissions between 2001 and 2015.

BACKGROUND: To analyze the incidence and mortality of cerebrovascular diseases (CeVD) in Spain from 2001 to 2015. METHODS: Retrospective study of hospital incidence, hospital case fatality and population mortality, with records from the Spanish Government Statistics. Days of hospital stay and risk of death (RD) during admission were estimated adjusting for age, sex, first stroke (FS), atrial fibrillation (AF), diabetes, hypertension, and smoking. RESULTS: There were 1,662,487 stroke cases older than 15 years of age admitted to hospital (1,096,748 FS), with a national incidence = 291/105 in this period (Murcia maximum (367/105), Canary Islands minimum (238/105)). Population mortality (-50%) decreased while case fatality remained stable (-3%), despite the increase in the age of patients (+2.29 years) and the incidence (+25%). Canary Islands had the youngest patients (-3.5 years for men and -6 years for women) and the longest hospital stay (+5.1 days). Andalusia (odds ratio (OR) = 1.21 (1.19; 1.22)) and the Canaries (OR = 1.18 (1.15; 1.21)) had the highest RD. The factors associated to the highest increases in RD were FS (OR = 1.34 (95% confidence interval (CI) = 1.33-1.35)) and AF (OR = 1.30 (95% CI = 1.29-1.31)). CONCLUSION: Population mortality due to CeVD was reduced by half in Spain between 2001 and 2015, but hospital incidence increased. Andalusia and the Canary Islands had the highest RD in the country. These islands presented the lowest incidence, but their patients were younger, and their hospital stay longer. FS and AF were the factors associated with a higher RD.

Mortality from chronic respiratory disease in Brazil: time trend and forecasts / Mortalidade por doença respiratória crônica no Brasil: tendência temporal e projeções

ABSTRACT OBJECTIVE To analyze the time trend of monthly mortality rates from chronic respiratory diseases in Brazil from 1996 to 2017, with forecasts for 2022, besides analyzing the possibility of achieving the goal of the Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil (Strategic Action Plan to Tackle Chronic Noncommunicable Diseases in Brazil) from 2011 to 2022. METHODS This is an ecological study that uses data from Sistema de Informações sobre Mortalidade (SIM - Mortality Information System), Sistema de Informações Demográficas e Socioeconômicas (Demographic and Socioeconomic Information System) and Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD Contínua - Continuous National Household Sample Survey). We established the age range between 30 and 69 years old and the evolution of the rates over time was made by autoregressive integrated moving average models in R statistical tool. RESULTS Premature mortality rates from chronic respiratory diseases are decreasing in Brazil as a whole, mostly in state capitals. There is also a trend to reach the Ministry of Health's goal in most of the country. For capitals that tend not to reach the goal, there is an association between mortality and social indicators, healthcare network and frequency of smoking. CONCLUSION This study intends to improve planning of the public health system for the control of chronic respiratory diseases.

RESUMO OBJETIVO Analisar a tendência temporal das taxas mensais de mortalidade por doenças respiratórias crônicas no Brasil de 1996 até 2017, com projeções para 2022, além de analisar a possibilidade de cumprimento da meta do Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil de 2011 até 2022. MÉTODOS Trata-se de estudo ecológico que utiliza dados do Sistema de Informações sobre Mortalidade, do Sistema de Informações Demográficas e Socioeconômicas e da Pesquisa Nacional por Amostra de Domicílios Contínua. O recorte etário foi estabelecido entre 30 e 69 anos e a evolução das taxas no tempo foi feita por meio de modelos autorregressivos integrados de média móvel em plataforma estatística R. RESULTADOS As taxas de mortalidade precoce por doenças respiratórias crônicas apresentam-se decrescentes no Brasil como um todo e na maior parte das capitais, assim como, há tendência a atingir a meta do Ministério da Saúde na maior parte do país. Para capitais que tendem a não atingir a meta, verifica-se associação entre mortalidade e indicadores sociais, rede assistencial de saúde e frequência do tabagismo. CONCLUSÃO Pretende-se que o estudo possibilite um melhor planejamento do sistema público de saúde para o controle das doenças respiratórias crônicas.

Uncommon histopathological variant of prostate carcinoma: signet ring cells. / Variante histopatológica poco frecuente de carcinoma prostático: células en anillo de sello.

INTRODUCTION: Prostatic carcinoma withsignet ring cells is a very rare histopathological entity, withfew infected cases in the literature, for which there is nomanagement protocol.  DESCRIPTION OF CASES: Two patients are presented,one 46 years old and the other 76 years old, the firstdebuts with a decompensated picture of urinary and intestinalobstruction, and the second presents a torpid evolutionof his disease with progression from stage I to III in threemonths.  DISCUSSION: Mucosacretory prostate tumors have theirown morphohistological and immunohistochemical characteristics,which differentiate them from classic adenocarcinomas.  CONCLUSIONS: Prostatic carcinoma with signet ring cellsis an entity that must be borne in mind, especially in patientswith rapid progression of their disease.

INTRODUCCIÓN: El carcinoma prostáticocon células en anillo de sello es una entidad histopatológicamuy rara, con pocos casos descritos en la literatura, porlo cual no hay un protocolo de manejo. DESCRIPCIÓN DE CASOS: Se presentan dos pacientes,uno de 46 años y otro de 76 años, el primero debuta conun cuadro descompensado de obstrucción urinaria e intestinal,y el segundo presenta una evolución tórpida de suenfermedad con avance de un estadio I a III en tres meses. DISCUSIÓN: Los tumores de próstata mucosecretores tienencaracterísticas morfohistológicas e inmunohistoquímicaspropias, que los diferencian de los adenocarcinomasclásicos. CONCLUSIONES: El carcinoma prostático con células enanillo de sello es una entidad que hay que tener presente,sobre todo en pacientes con rápida progresión de su enfermedad.

Comparación del bloqueo periprostático con lidocaina y supositorio de diclofenac y placebo en la biopsia prostática / Comparison of periprostatic block with lidocaine and diclofenac suppository and placebo in prostate biopsy

El bloqueo del nervio peri prostático con lidocaína, proporciona un buen alivio del dolor en la realización de la biopsia prostática guiada por ultrasonido, pero el dolor post-procedimiento, puede llegar a ser significativo, la adición del supositorio de diclofenac, podría proporcionar alivio adicional. Se asignaron al azar pacientes en 2 grupos el grupo 1 bloqueo con lidocaína del plexo peri prostático + supositorio de diclofenac sódico y el grupo 2 bloqueo con lidocaína del plexo peri prostático + supositorio de placebo, realizando biopsia doble sextante, el dolor a varios intervalos después del procedimiento se registró en una escala visual análoga (EVA) de 0 a 10. Los 2 grupos fueron similares en cuanto a edad, volumen de próstata, antígeno prostático específico, diagnóstico histopatológico. Los pacientes que recibieron diclofenac tuvieron puntajes de dolor significativamente más bajos que los que recibieron placebo (2 frente a 3,35) p 0,02. La administración rectal de diclofenac antes de la realización de la biopsia de próstata es un procedimiento simple que alivia significativamente el dolor experimentado sin aumento en la morbilidad(AU)

The peri-prostatic nerve block with lidocaine, provides good pain relief in performing ultrasoundguided prostate biopsy, but the postprocedure pain can be significant, the addition of diclofenac suppository, could provide additional relief. Patients were randomly assigned in 2 groups to group 1 blockade with lidocaine of the prostatic peri plexus + suppository of diclofenac sodium and group 2 blockade with lidocaine of the prostatic peri plexus + placebo suppository, performing double sextant biopsy, pain at several intervals after the procedure was recorded on a visual analog scale (EVA) from 0 to 10. Thee 2 groups were similar in terms of age, prostate volume, prostate-specific antigen, histopathological diagnosis. Patients who received diclofenac had pain scores significantly lower than those who received placebo (2 vs. 3.35) p 0.02. Rectal administration of diclofenac before performing a prostate biopsy is a simple procedure that relieves significantly pain experienced without increased morbidity(AU)

Identification of a series of hair-cell MET channel blockers that protect against aminoglycoside-induced ototoxicity.

To identify small molecules that shield mammalian sensory hair cells from the ototoxic side effects of aminoglycoside antibiotics, 10,240 compounds were initially screened in zebrafish larvae, selecting for those that protected lateral-line hair cells against neomycin and gentamicin. When the 64 hits from this screen were retested in mouse cochlear cultures, 8 protected outer hair cells (OHCs) from gentamicin in vitro without causing hair-bundle damage. These 8 hits shared structural features and blocked, to varying degrees, the OHC's mechano-electrical transducer (MET) channel, a route of aminoglycoside entry into hair cells. Further characterization of one of the strongest MET channel blockers, UoS-7692, revealed it additionally protected against kanamycin and tobramycin and did not abrogate the bactericidal activity of gentamicin. UoS-7692 behaved, like the aminoglycosides, as a permeant blocker of the MET channel; significantly reduced gentamicin-Texas red loading into OHCs; and preserved lateral-line function in neomycin-treated zebrafish. Transtympanic injection of UoS-7692 protected mouse OHCs from furosemide/kanamycin exposure in vivo and partially preserved hearing. The results confirmed the hair-cell MET channel as a viable target for the identification of compounds that protect the cochlea from aminoglycosides and provide a series of hit compounds that will inform the design of future otoprotectants.

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences.

BACKGROUND: To analyze the trend of lower extremity major amputations (MA) among patients with type 2 diabetes mellitus (T2DM) in the Regions of Spain from year 2001 until 2015. METHODS: Descriptive study of 40,392 MA. Data were obtained from the national hospital discharge database in patients with T2DM. The incidence rate was calculated in each Region, in addition to the incidence ratios (IR) between annual incidence and incidence of the year 2001. The length of hospital stay and mortality risks were analyzed using regression models adjusted for sex, age and smoking. RESULTS: The major amputations incidence rate per 100,000 person-years was 0.48 in Spain; Canary Islands showed the highest incidence (0.81). The trend was a slight decrease or stability of the incidence in all Regions except in the Canary Islands (IR2015 = 2.0 [CI95% = 1.5, 2.6]) and in Madrid (IR2015 = 0.1 [CI95% = 0.1, 0.2]). Mortality after major amputations was 10% in Spain; Cantabria suffered the highest risk of death [1.7 (CI95% = 1.4; 2.1), p < 0.001] and La Rioja the lowest risk (0.5 [CI95% = 0.2; 0.9]; p = 0.026). The longest hospital stay was registered in the Canary Islands [(CI95% = 11.4;13.3], p < 0.001)], and the shortest in the Valencian Community [(CI95% = - 7.3; - 5.8), p < 0.001)]. CONCLUSION: MA in T2DM followed a growing trend in the Canary Islands, which diverged from the downward trend in Spain. The variability of mortality and hospital stay, suggest to review the clinical management in some Regions. Sudden incidence decrease in Madrid suggests checking the record procedures of hospital discharges.

[Evolution of Smoking According to Social Class in the Adult Population of the Canary Islands During 2000-2015: Follow-up of the CDC-Canary Cohort]. / Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias.

OBJECTIVE: To determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class. LOCATION: Canary Islands. PARTICIPANTS: General population cohort, with contacts in 2000 (n=6,729), 2008 (n=6,171) and 2015 (n=4,705). MAIN MEASUREMENTS: Smoking, gender, age, and social class. RESULTS: Consumption decreased by 6% (5-7%, P<.001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P<.001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P=.011) and intermediate ages (7% [6-8%], P<.001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P<.001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages. CONCLUSIONS: The evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes.

Frailty is associated with myosteatosis in obese patients with colorectal cancer.

BACKGROUND & AIMS: We aimed to explore the determinants of muscle fat infiltration and to investigate whether myosteatosis, assessed as muscle fat infiltration percentage (%MFI) and muscle attenuation from computed tomography (CT), is associated with frailty in a group of patients with colorectal cancer (CRC). METHODS: Cross sectional study including CRC patients. CT scan of the third lumbar vertebra was used to quantify body composition and the degree of %MFI (reported as percentage of fat within muscle area). Frailty was defined by Fried et al. (2001) as the presence of more than 3 criteria: unintentional weight loss, self-reported exhaustion, weakness (low handgrip strength), slow walking speed (gait speed) and low physical activity. Obesity was defined according to sex-and-age-specific body fat percentage (%BF) cutoff. RESULTS: A sample of 184 patients (age 60 ± 11 years; 58% men; 29% of patients with frailty) was studied. The sample was divided according to tertiles of MFI% (1st tertile 0 to 2.89%, n = 60; 2nd tertile ≥ 3.9-8.19%, n = 64; 3rd tertile ≥ 8.2-26%, n = 60). Age, females, body mass index, %BF, subcutaneous and visceral adipose tissue and the proportion of patients with frailty were significantly higher in the 3rd %MFI tertile. Phase angle and muscle attenuation were significantly lower in the 3rd %MFI tertile. The determinants of %MFI (r2 = 0.49), which was log transformed due to its normal distribution, were %BF (ß = 0.54; eß = 1.72; 95% CI: 0.032 to 0.051; P < 0.01), age (ß = 0.34; eß = 1.40; 95% CI: 0.016 to 0.032; P < 0.01) and gait speed (ß = -0.12; eß = 0.87; 95% CI: -0.84 to -0.001; P = 0.049). In addition, in obese patients (n = 74) presenting 4 or 5 frailty criteria increased the chance of having higher %MFI and lower muscle attenuation, after adjustment for sex, age and comorbidities when compared to none or 1 criteria. CONCLUSIONS: In a sample of CRC patients, %BF and gait speed were the determinants of %MFI. In addition, markers of myostetatosis were associated with frailty in the obese patients.

Seroprevalence of IgG and IgM anti-SARS-CoV-2 among voluntary blood donors in Rio de Janeiro, Brazil

Background: In Brazil, mathematical models for derivingestimates and projections of COVID-19 cases have been developed without data on asymptomatic SARS-CoV-2 infection. We estimated the seroprevalence of antibodies to SARS-CoV-2 among blood donors in the State of Rio de Janeiro. Methods: Data were collected on 2,857 blood donors from April 14 to 27, 2020. We report the crude prevalence of antibodies to SARS-CoV-2, the weighted prevalence by the total state population, and adjusted prevalence estimates for test sensitivity and specificity. To establish the correlates of SARS-CoV-2 prevalence, we used logistic regression models. The analysis included period and site of blood collection, sociodemographic characteristics, and place of residence. Results: The proportion of SARS-Cov-2 positive tests without any adjustment was 4.0% (95% CI 3.3-4.7%), and the weighted prevalence was 3.8% (95% CI 3.1-4.5%). Further adjustment by test sensitivity and specificity produced lower estimates, 3.6% (95% CI 2.7-4.4%) and 3.3% (95% CI 2.6-4.1%), respectively. The variable most significantly associated with the crude prevalence was the period of blood collection: the later the period, the higher the prevalence. Regarding socio-demographic characteristics, the younger the blood donors, the higher the prevalence, and the lower the educational level, the higher the odds of a positive SARS-Cov-2 antibody. Similar results were found for the weighted prevalence. Discussion: Although our findings resulted from a convenience sample, they match some basic premises: the increasing trend over time, since the epidemic curve in the state is still on the rise; the higher prevalence among the youngest who are more likely to circulate; and the higher prevalence among the less educated as they have more difficulties in following the social distancing recommendations. Despite the study limitations, it is possible to infer that protective levels of natural herd immunity to SARS-CoV-2 are far from being reached in Rio de Janeiro. (AU)

Seroprevalence of anti-SARS-CoV-2 among blood donors in Rio de Janeiro, Brazil

ABSTRACT OBJECTIVE To estimate the seroprevalence of antibodies to SARS-CoV-2 among blood donors in the state of Rio de Janeiro, Brazil. METHODS Data were collected on 2,857 blood donors from April 14 to 27, 2020. This study reports crude prevalence of antibodies to SARS-CoV-2, population weighted prevalence for the state, and prevalence adjusted for test sensitivity and specificity. Logistic regression models were used to establish the correlates of SARS-CoV-2 prevalence. For the analysis, we considered collection period and site, sociodemographic characteristics, and place of residence. RESULTS The proportion of positive tests for SARS-Cov-2, without any adjustment, was 4.0% (95%CI 3.3-4.7%), and the weighted prevalence was 3.8% (95%CI 3.1-4.5%). We found lower estimates after adjusting for test sensitivity and specificity: 3.6% (95%CI 2.7-4.4%) for the non-weighted prevalence, and 3.3% (95%CI 2.6-4.1%) for the weighted prevalence. Collection period was the variable most significantly associated with crude prevalence: the later the period, the higher the prevalence. Regarding sociodemographic characteristics, the younger the blood donor, the higher the prevalence, and the lower the education level, the higher the odds of testing positive for SARS-Cov-2 antibody. We found similar results for weighted prevalence. CONCLUSIONS Our findings comply with some basic premises: the increasing trend over time, as the epidemic curve in the state is still on the rise; and the higher prevalence among both the youngest, for moving around more than older age groups, and the less educated, for encountering more difficulties in following social distancing recommendations. Despite the study limitations, we may infer that Rio de Janeiro is far from reaching the required levels of herd immunity against SARS-CoV-2.

[Intravesical foreign body secondary to intraprostatic ethanol injection.] / Cuerpo extraño intravesical secundario a inyección intraprostática de etanol.

OBJECTIVE: This study aims to describe the presence of bladder foreign body as a rare complication following intraprostatic ethanol injection. CASE REPORTS:  A 71-year-old man and a 70-year-old male with bladder catheter probe due to obstructive benign prostatic enlargement underwent ethanol injection via transrectal echography. RESULTS: The first patient presented a urinary infection with acute urinary retention one year after the procedure. Ultrasonography revealed a 30 cc intravesical foreign body confirmed by urethrocystoscopy. Endoscopic treatment was unsuccessful, and the patient underwent cystotomy with retrieval of a soft, oval, brownish mass. Histological examination of the mass showed benign gland-stromal prostatic hyperplasia with extensive coagulative necrosis. The second patient had an acute urinary retention episode 3 months after surgery. The ultrasonography revealed an abnormal vesicoprostatic mass. Endoscopic treatment was successful, but required 2 sessions. Histological examination of the mass showed acute suppurative inflammation with marked autolysis of prostatic tissue. These foreign bodies in the bladder acted as a nest to promote infection, and generated a valve effect in the bladder neck, resembling a giant vesical lithiasis clinic, which was a diagnostic and therapeutic challenge since few centers worldwide manage this technique for prostatic hyperplasia. CONCLUSIONS: To our knowledge, this is the second report of a "calculus" or "foreign body" formed by prostatic tissue in the urinary tract after the injection of ethanol.

OBJETIVO: El presente trabajo tiene como propósito describir la presencia de cuerpo extraño vesical como complicación infrecuente posterior a inyección de etanol intraprostático.CASOS CLÍNICOS: Un hombre de 71 años de edad y otro de 70 años de edad portadores de sonda uretrovesical por crecimiento prostático benigno obstructivo se sometieron a inyección de etanol vía transrectal ecoguiado. RESULTADOS: El primer paciente al año después del procedimiento, presenta una infección urinaria con retención aguda de orina asociada. La ecosonografía reveló un cuerpo extraño intravesical de 30 cc confirmado por uretrocistoscopia. El tratamiento endoscópico no tuvo éxito, y el paciente se sometió a cistotomía con obtención de una masa blanda, ovalada, pardusca. El examen histológico de la masa mostró hiperplasia prostática glándulo-estromal benigna con necrosis coagulativa extensa. El do hombre a los 3 meses de la intervención, presenta un episodio de retención aguda de orina. La ecosonografía reveló una masa vesico-prostática anómala. El tratamiento endoscópico tuvo éxito, pero en 2 sesiones. El examen histológico de la masa mostró inflamación aguda supurativa con marcada autólisis de tejido prostático. Estos cuerpos extraños en vejiga actuaron como nido para propiciar infección, y generaron efecto de válvula en cuello vesical, semejando clínica de litiasis vesical gigante, lo cual fue un reto diagnóstico y terapéutico ya que pocos centros a nivel mundial manejan esta técnica para hiperplasia prostática. CONCLUSIONES: A nuestro conocimiento, este es el segundo reporte de un "cálculo" o "cuerpo extraño" formado por tejido prostático en vía urinaria después de la inyección de etanol.

Poluição do ar e impactos na saúde na Região Metropolitana de Belo Horizonte - Minas Gerais, Brasil / Air pollution and the impacts on health in the Metropolitan Region of Belo Horizonte in the State of Minas Gerais, Brazil

Resumo Examinamos o impacto da poluição atmosférica nas internações por doenças respiratórias totais (DRT), em crianças menores de cinco anos (DRC) e por doenças cardiovasculares em maiores de 39 anos (DCV) nos municípios de Belo Horizonte (BH), Betim e Contagem, da Região Metropolitana de Belo Horizonte. Modelos aditivos generalizados via regressão de Poisson foram utilizados para ajustar as séries de hospitalizações. Os poluentes, em defasagem simples e acumulada de até cinco dias, foram introduzidos como variáveis independentes e os modelos foram ajustados para temperatura, umidade, dias da semana e feriados. Em BH, o PM10 esteve relacionado às DRT (RR% 1,06 IC95%:0,41-1,72); DRC (RR% 1,25 IC95%:0,25-2,26) e DCV (RR% 2,29 IC95%:0,96-3,64). Em Betim, observou-se RR% 1,33 (IC95%:0,48-2,18) para DRT e RR% 2,38 (IC95%:1,20-3,56) para DRC. Em Contagem, observou-se RR% 1,23 (IC95%:0,32-2,15) e RR% 1,61 (IC95%:0,26-2,96) para DRT e DRC, respectivamente. SO2 e CO também apresentaram associação com as hospitalizações. As doenças respiratórias foram o desfecho mais relacionado aos poluentes investigados. Esses resultados podem ser úteis nas discussões das políticas de controle de emissões na região.

Abstract The impact of air pollution on hospitalizations for total respiratory diseases (DRT) among children under five (DRC), as well as for cardiovascular diseases (CVD) in patients over 39 years of age, was examined in the municipalities of Belo Horizonte, Betim and Contagem, of the Metropolitan Region of Belo Horizonte, Minas Gerais. Generalized additive models using Poisson regression were used to adjust the daily time series of hospitalizations. Single and accumulated lagged pollutants of up to five days were introduced as independent variables and models were adjusted for temperature, humidity, weekdays and holidays. In Belo Horizonte PM10 was related to DRT (RR% 1.06 CI 95%: 0.41-1.72); DRC (%RR 1.25 CI 95%: 0.25-2.26) and CVD (RR% 2.29, CI 95%: 0.96-3.64). In Betim an RR% of 1.33 (CI 95%: 0.48-2.18) for DRT and RR% 2.38 (CI 95%: 1.20-3.56) for DRC was observed. In Contagem RR% = 1.23 (CI 95%: 0.32-2.15) and RR% = 1.61 (CI 95%: 0.26-2.96) was observed for DRT and DRC, respectively. SO2 and CO were also associated with hospitalizations. Respiratory diseases were the outcome most frequently related to air pollutants investigated. These results can be useful in discussions on emission control policies in the region.

[Serum cellular inflammatory markers in the diagnosis of prostate cancer.] / Marcadores inflamatorios celulares séricos en el diagnóstico de cáncer de próstata.

Prostate cancer (PCa) is one of the most frequent neoplasms in the masculine sex, which has multiple etiological factors, inflammation is one of them. OBJECTIVE: To determine the role of different inflammatory markers in the diagnosis of PCa in first prostatic biopsies. METHODS: This is a prospective study evaluating neutrophil/ lymphocyte (NLR), neutrophil/monocyte (NMR) and platelet/lymphocyte (PLR) ratios of 78 patients with suspected PCa due to PSA alteration and/or abnormal digital rectal examination, and its correlation with twelve-cylinder biopsy result. RESULTS: The NLR, NMR and PLR were all higher in the group diagnosed with PCa compared to the group with benign prostatic hyperplasia (p > 0.05). CONCLUSIONS: Inflammatory markers can be predictive factors in the diagnosis of PCa, although more studies are needed for their routine use.

El cáncer de próstata (CaP) es una de las neoplasias más frecuentes en el sexo masculino, la cual tiene descrito múltiples factores etiológicos, entre ellos la inflamación. OBJETIVO: Describir el papel de diferentes marcadores inflamatorios en el diagnóstico de CaP en biopsias prostáticas por primera vez.MÉTODOS: Es un estudio prospectivo donde se evaluaron las relaciones neutrófilo/linfocito (RNL), neutrófilo/ monocito (RNM) y plaqueta/linfocito (RPL) séricas de 78 pacientes con sospecha de CaP por alteración de PSA y/o tacto rectal, y su correlación con el resultado de biopsia de 12 cilindros. RESULTADOS: Las RNL, RNM y RPL fueron todas más elevadas en el grupo con diagnóstico de CaP en comparación al grupo con hiperplasia prostática benigna (p > 0,05). CONCLUSIONES: Los marcadores inflamatorios pueden ser factores predictivos en el diagnóstico de CaP, que necesitan más estudios para su utilización rutinaria.

Exposure to the use of firewood for cooking in Brazil and its relation with the health problems of the population. / Exposição ao uso da lenha para cocção no Brasil e sua relação com os agravos à saúde da população.

Indoor air pollution is exacerbated by the burning of firewood in rustic stoves and poorly ventilated environments. Exposure to the pollutants emitted by this type of fuel results in increased morbidity and mortality. In Brazil, studies and estimates regarding these conditions are scarce. In order to understand this problem, the objective of this work was to investigate the use of firewood using the data series of government agencies to estimate the number of exposed people. The results indicated that firewood is the second most used fuel for cooking, being used by a significant portion of the population, more than 30 million Brazilians. A decisive factor in the increased use of this fuel is the socioeconomic level of the population associated with the price of liquefied petroleum gas (LPG). The studies carried out in the country recorded high concentrations of particles during firewood burning, exceeding the limits suggested by the World Health Organization (WHO). Associations were also observed between the exposure to the pollutants generated by the burning and the aggravation of health problems, among them respiratory diseases and cancer. Replacing fuelwood and other solid fuels with cleaner fuels should be the government's goal to minimize health costs.

A poluição do ar em ambientes fechados é agravada pela queima de lenha em fogões rústicos e ambientes pouco ventilados. A exposição aos poluentes emitidos por este tipo de combustível resulta no aumento da morbidade e da mortalidade. No Brasil, os estudos e as estimativas são escassos. Visando entender esta problemática, o objetivo deste trabalho foi investigar o uso de lenha utilizando as séries de dados das agências governamentais para estimar o número de pessoas expostas. Os resultados apontam que a lenha é o segundo combustível mais usado para cozinhar, sendo utilizada por uma parcela significativa da população, em torno de 30 milhões de brasileiros. Um fator decisivo no maior uso deste combustível é o nível socioeconômico da população associada ao preço do gás liquefeito de petróleo (GLP). Os estudos realizados no país registraram concentrações altas de partículas durante a queima da lenha, excedendo os limites sugeridos pela Organização Mundial da Saúde (OMS). Também foram observadas associações entre a exposição aos poluentes gerados pela queima e o agravamento dos mais diversos problemas de saúde, dentre eles doenças respiratórias e câncer. A substituição da lenha e outros combustíveis sólidos por combustíveis mais limpos deve ser a meta do governo para minimizar custos com a saúde.

Exposição ao uso da lenha para cocção no Brasil e sua relação com os agravos à saúde da população / Exposure to the use of firewood for cooking in Brazil and its relation with the health problems of the population

Resumo A poluição do ar em ambientes fechados é agravada pela queima de lenha em fogões rústicos e ambientes pouco ventilados. A exposição aos poluentes emitidos por este tipo de combustível resulta no aumento da morbidade e da mortalidade. No Brasil, os estudos e as estimativas são escassos. Visando entender esta problemática, o objetivo deste trabalho foi investigar o uso de lenha utilizando as séries de dados das agências governamentais para estimar o número de pessoas expostas. Os resultados apontam que a lenha é o segundo combustível mais usado para cozinhar, sendo utilizada por uma parcela significativa da população, em torno de 30 milhões de brasileiros. Um fator decisivo no maior uso deste combustível é o nível socioeconômico da população associada ao preço do gás liquefeito de petróleo (GLP). Os estudos realizados no país registraram concentrações altas de partículas durante a queima da lenha, excedendo os limites sugeridos pela Organização Mundial da Saúde (OMS). Também foram observadas associações entre a exposição aos poluentes gerados pela queima e o agravamento dos mais diversos problemas de saúde, dentre eles doenças respiratórias e câncer. A substituição da lenha e outros combustíveis sólidos por combustíveis mais limpos deve ser a meta do governo para minimizar custos com a saúde.

Abstract Indoor air pollution is exacerbated by the burning of firewood in rustic stoves and poorly ventilated environments. Exposure to the pollutants emitted by this type of fuel results in increased morbidity and mortality. In Brazil, studies and estimates regarding these conditions are scarce. In order to understand this problem, the objective of this work was to investigate the use of firewood using the data series of government agencies to estimate the number of exposed people. The results indicated that firewood is the second most used fuel for cooking, being used by a significant portion of the population, more than 30 million Brazilians. A decisive factor in the increased use of this fuel is the socioeconomic level of the population associated with the price of liquefied petroleum gas (LPG). The studies carried out in the country recorded high concentrations of particles during firewood burning, exceeding the limits suggested by the World Health Organization (WHO). Associations were also observed between the exposure to the pollutants generated by the burning and the aggravation of health problems, among them respiratory diseases and cancer. Replacing fuelwood and other solid fuels with cleaner fuels should be the government's goal to minimize health costs.

[Partial nephrectomy in Venezuela. Where are we? present considerations.] / Nefrectomía parcial en Venezuela ¿dónde estamos? consideraciones actuales.

OBJECTIVES: Partial nephrectomy was historically used in urology for the treatment of benign kidney processes. In the last 20 years, its greater use was focused on localized tumors being an alternative to radical nephrectomy. Initially, absolute indications included patients with a single kidney or bilateral tumors. Over time indications were expanded based on the risk of developing kidney disease, and became elective surgery in patients with tumors of less than 4 cm, and even tumors larger than 4 cm. We present a survey of the Venezuelan urological population, regarding partial nephrectomy, as part of treatment for renal masses. METHODS: Based on a 21-question survey, by Lopera Toro Adrián et al. Partial nephrectomy in Colombia: current situation, with their previous authorization and adding some questions, the survey was given to urologists and residents of the XXVII National Congress of Urology. RESULTS: 71 people answered, mostly from Caracas and the Metropolitan District (53.5%), 57 were urologists (80.2%) and 14 (19.71%) third year residents. The majority of urologists who answered the survey had a majority of 1 to 3 years of schooling (29.82%). 45.07% (n: 32/71) of the respondents practiced in most Level IV hospitals. 46.4% of these were university hospitals. 38.02% (n: 27/71) respondents did 4 or fewer radical nephrectomies per year. In the case of having a patient candidate for partial nephrectomy, 73.23% of the respondents performed it. Most of the respondents performed partial nephrectomies as part of the treatment of renal masses (84.5%). CONCLUSIONS: In the first place, it was very supportive to have a survey designed by Lopera Toro Adrian et al. It allowed us to carry out a survey in our urological population and to see the current state of partial nephrectomy in our environment, considering that a large part of the urological population performs this surgery in order to preserve nephrons even if laparoscopy is not the most used technique. Nevertheless, clear indications are kept.

OBJETIVO: La nefrectomía parcial históricamente se usaba en urología para el tratamiento de procesos benignos del riñón. En los últimos 20 años su mayor uso se centró en tumores localizados, siendo una alternativa a la nefrectomía radical. Inicialmente las indicaciones absolutas incluían pacientes de riñón único o tumores bilaterales. Con el tiempo las indicaciones se ampliaron en base al riesgo de desarrollo de enfermedad renal, y se convirtió en una cirugía electiva realizada en pacientes con tumores de menos de 4 cm y hasta de tumores mayores de 4 cm. Se presenta un sondeo en la población médica urológica venezolana, con respecto a la nefrectomía parcial, como parte de tratamiento de las masas renales. MÉTODOS: Basados en una encuesta de 27 preguntas, sobre consideraciones quirúrgicas de nefrectomía parcial y consideraciones sobre abordajes y conductas, se entregó la encuesta a urólogos y residentes en el XXVII Congreso Nacional Venezolano de Urología 2017. RESULTADOS: Se logró obtener respuesta de 71 personas, en su mayoría de Caracas y Distrito metropolitano (53,5%) 57 eran urólogos (80,2%) y 14 (19,71%) residentes de tercer año. La mayor parte de urólogos que contestaron la encuesta tenían en su mayoría, de 1 a 3 años de graduado (29,82%). El 45,07% ( n: 32 / 71) de los encuestados ejerce su práctica en centros hospitalarios la mayoría nivel IV. Dichos centros de trabajo son universitarios en el 46,4%. EL 38,02% ( n: 27 / 71) de los encuestados hace 4 o menos nefrectomías radicales al año. En el caso de tener un paciente candidato a nefrectomía parcial, el 73,23% de los encuestados la realiza. La gran mayoría de los encuestados realizan nefrectomías parciales como parte del tratamiento de las masas renales ( 84,5%), y de los que hacen nefrectomía parcial el 57,74% hacen entre 1 y 3 al año. El límite de las masas renales en tamaño para realizar una nefrectomía parcial es menor de 4 cm para el 40,84%. La gran mayoría utilizan la vía abierta (61,97%). El 38,02% de los encuestados no utiliza ningún score para determinar el grado de dificultad de la nefrectomía parcial y esto solo lo hacen rigurosamente el 36,61%, el RENAL score, es el más utilizado, seguido del PADUA. Con respecto al clampaje del pedículo vascular renal el 66,19% realiza isquemia. CONCLUSIONES: La nefrectomía parcial se viene realizando cada vez más no solo cuando las indicaciones absolutas, lo ameritan, si no que se ha ampliado su uso, con el fin de preservar la función renal, esta encuesta permitió conocer el manejo actual y las conductas de la población urológica venezolana con respecto a nefrectomía parcial, así mismo, nos permitió demostrar que gran parte de los urólogos realizan esta cirugía con la finalidad de preservar la función renal y garantizar la calidad de vida de los pacientes sin descuidar el control oncológico, en este sentido aun cuando se siguen realizando un gran número de nefrectomías radicales, se sigue avanzando en la realización de cirugías parciales en beneficio del paciente, en cuanto a la laparoscopia no es la técnica más utilizada, pero eso no impide mantener las indicaciones claras.

Hospital Mortality in 415 798 AMI Patients: 4 Years Earlier in the Canary Islands Than in the Rest of Spain.

INTRODUCTION AND OBJECTIVES: The Canary Islands has the highest mortality from diabetes in Spain. The aim of this study was to determine possible differences in mortality due to acute myocardial infarction (AMI) during hospital admission between this autonomous community and the rest of Spain, as well as the factors associated with this mortality and the population fraction attributable to diabetes. METHODS: Cross-sectional study of hospital admissions for AMI in Spain from 2007 to 2014, registered in the Minimum Basic Data Set. RESULTS: A total of 415 798 AMI were identified. Canary Island patients (16 317) were younger than those living in the rest of Spain (63.93 ± 13.56 vs 68.25 ± 13.94; P < .001) and death occurred 4 years earlier in the archipelago (74.03 ± 11.85 vs 78.38 ± 11.10; P < .001). This autonomous community had the highest prevalence of smoking (44% in men and 23% in women); throughout Spain, AMI occurred 13 years earlier in smokers than in nonsmokers. Patients in the Canary Islands had the highest mortality rates whether they had diabetes (8.7%) or not (7.6%), and they also showed the highest fraction of AMI mortality attributable to diabetes (9.4; 95%CI, 4.8-13.6). After adjustment for type of AMI, diabetes, dyslipidemia, hypertension, smoking, cocaine use, renal failure, sex and age, the Canary Islands showed the highest risk of mortality vs the rest of Spain (OR = 1.25; 95%CI, 1.17-1.33; P < .001) and it was one of the autonomous communities showing no significant improvement in the risk of mortality due to AMI during the study period. CONCLUSIONS: Mortality due to AMI during hospital admission is higher in the Canary Islands than in the rest of Spain.