Comparison of quality of life after radical treatment in prostate cancer: radical prostatectomy versus external radiotherapy.

OBJECTIVE: To assess and compare the functional and quality of life results in patients treated with curative intent for localized prostate cancer during 2015 in our hospital. METHOD: 77 patients treated by radical prostatectomy or external radiotherapy with androgen deprivation were prospective enrolled. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire at 3-year follow-up and Spanish Questionnaire on Quality of Life in Patients with Prostate Cancer (CAVIPRES-30) at diagnosis and at 3-year follow-up were registered. RESULTS: 68 patients were included, 39 patients treated by radical prostatectomy and 29 received external radiotherapy with androgen deprivation. Among the operated patients, 61.5% were dry and 17.9% use three or more daily pads, compared to 72.4% and 6.8%, respectively, in the radiotherapy group. 48.7% of prostatectomized patients reported very poor or no capacity to have a sufficiently rigid erection, compared to 69% of the radiated group. After surgery, 43.6% considered bad or very bad quality-of-life, compared to 68.9% in the radiotherapy group. In the comparison of the data of the pre- and post-treatment questionnaire can be seen that the patients had a superior perception before the procedure. CONCLUSIONS: Patients treated by surgery have a better perception of quality-of-life compared to those treated by radiotherapy.

OBJETIVO: Determinar y comparar los resultados funcionales y de calidad de vida de pacientes con cáncer de próstata tratados con intención curativa durante el año 2015 en nuestro centro. MÉTODO: Se incluyeron 77 pacientes sometidos a prostatectomía radical (PR) o radioterapia externa con terapia de deprivación androgénica (TDA). Se realizaron el Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) tras 3 años de seguimiento y el Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata (CAVIPRES-30) al diagnóstico y a los 3 años. RESULTADOS: Se incluyeron 68 pacientes, 39 con PR y 29 con radioterapia más TDA. De los pacientes intervenidos, el 61.5% están secos y el 17.9% usan tres o más compresas, diarias frente al 72.4% y el 6.8%, respectivamente, en el grupo de radioterapia. El 48.7% de los prostatectomizados refieren erecciones muy malas o ninguna, frente al 69% de los radiados. Tras la cirugía, el 43.6% refieren mala o muy mala calidad de vida, frente al 68.9% de los radiados. En la comparación de los datos del cuestionario pre- y postratamiento, los pacientes tenían una percepción superior antes del procedimiento. CONCLUSIONES: Los pacientes tratados mediante cirugía tienen una mejor percepción de su calidad de vida relacionada con la salud que los radiados.

Prioritisation of pesticides and target organ systems for dietary cumulative risk assessment based on the 2019-2021 monitoring cycle.

Aiming at accelerating the implementation of cumulative risk assessment to pesticide residues, this report describes a two-step prioritisation analysis, on individual pesticides and on target organ systems, that allows to identify (i) low-priority substances expected to have a marginal contribution to cumulative risk, and (ii) high priority organ systems to be addressed in future cumulative risk assessments. The analysis encompassed 350 substances and 36 raw primary commodities of plant origin surveyed in the monitoring cycle 2019-2021, carried out in 30 population groups, covering 3 age classes, and 17 EU countries. Probabilistic exposure calculations, for chronic and acute effects, were executed on the occurrence and consumption data by a two-dimensional procedure, modelling variability and uncertainty. In the first step, the prioritisation method adopted allowed to reduce the number of substances by about 80%. These substances were in turn grouped based on their capacity to cause toxicological effects on common organ systems and, as second step, probabilistic combined exposure calculations were carried out for 16 target organ systems. This step allowed to identify the organ systems that need further assessment, reducing their initial number by about 70%. The organ systems would need to be prioritised as follows: reproductive and developmental toxicity, liver, kidney, male reproductive system, and haematopoietic system and haematology. The sources of uncertainty stemming from the modelling procedure and from methodological assumptions were discussed and their impact qualitatively assessed. Overall, it was concluded that the risk estimates for the different organ systems were more likely to be overestimated than underestimated.

Focussed assessment of certain existing MRLs of concern for acetamiprid and modification of the existing MRLs for table olives, olives for oil production, barley and oats.

In compliance with Article 43 of Regulation (EC) No 396/2005, EFSA received from the European Commission a mandate to provide its reasoned opinion on the existing maximum residue levels (MRLs) for acetamiprid which might lead to consumers intake concerns on the basis of the new toxicological reference values agreed upon by Member States (MSs) in October 2017. In order to identify the MRLs of potential concern that require a more detailed assessment, EFSA performed a preliminary risk assessment, identifying a risk for consumers for 12 commodities. Measures for reduction of the consumer exposure were assessed by EFSA and should be considered by risk managers. Furthermore, in accordance with Article 6 of Regulation (EC) No 396/2005, ADAMA Makhteshim Ltd submitted two requests to modify the existing MRL for acetamiprid in table olives, olives for oil production, barley and oats. The data submitted in support of the requests were found to be sufficient to derive MRL proposals for all crops under assessment. Based on the risk assessment results, EFSA concluded that the short-term and long-term intake of residues resulting from the use of acetamiprid according to the intended agricultural practices on table olives, olives for oil production, barley and oats is unlikely to present a risk to consumer health.

[Overall survival and renal function after partial and radical nephrectomy in malignant localized renal tumors.] / Supervivencia y función renal tras nefrectomía parcial y radical en tumores renales malignos localizados.

OBJECTIVE: To evaluate the overall survival rate and renal function in our series after radical nephrectomy (RN) and partial nephrectomy (PN) in renal tumors in an early stage. METHODS: We retrospectively reviewed the medical records of 229 patients who underwent RN or PN for renal cancer T1-T2N0M0 in our center between 1995 and 2015. We described demographic factors, first symptom, TNM, histology, post-surgery data, recurrence rate and renal function. We utilized Fisher test, Chi square test and T-Student and we considered statistical significance when p<0.05. RESULTS: 203 patients underwent RN and 26 PN. 39.4% of the tumors who received RN were T1bN0M0 and 76.92% of PN were T1aN0M0. We report nine complications grade II of modified Clavien System for RN and only one grade I for PN. We detected an 11.3% recurrence in RN and none in PN. 66%of patients from RN are alive today, 12.81% died as result of renal cancer and 22.7% suffered a non-cancer-specific death. No deaths were observed in PN group. We observed similar mean preoperative serum creatinine (Cr) in both groups. Creatinine after the first post-operative month was 1.81mg/dL and 1.06mg/dL for RN and PN, respectively; At one year post-operative we registered Cr 1.82mg/dL and Cr 0.97mg/dL, respectively. CONCLUSIONS: Both methods provide excellent oncologic results for renal carcinoma in an early stage. PN is safe and reduces the incidence of renal dysfunction with a lower rate of non-cancer-specific death.

Los problemas de la analgesia obstétrica / Problems in obstetric analgesia

A pesar de las múltiples declaraciones de los organismos internacionales, el manejo del dolor en el trabajo de parto y el parto es insuficiente debido a las barreras que impone el sistema de salud, pero también por las concepciones equivocadas sobre la analgesia epidural de las pacientes y, peor aún, también de enfermeras, obstetras y anestesiólogos. El presente artículo menciona el punto de vista de reconocidas instituciones internacionales sobre el tema, los problemas atribuibles al sistema de salud y discute las limitaciones que imponen los especialistas médicos, enfatizando, de manera particular, en las prevalecientes concepciones de obstetras y anestesiólogos, por las cuales una gran proporción de las maternas sufren, innecesariamente, de dolor durante el trabajo de parto y el parto.

Despite countless statements from international agencies, pain management during labor and delivery is insufficient due to the hurdles imposed by the health system, and also to the misconceptions regarding epidural analgesia among patients, but worse still, among nurses, obstetricians and anesthesiologists. This article mentions the point of view of outstanding international institutions on the subject, the problems that may be attributed to the health system, and the limitations imposed by specialists, emphasizing in particular the views prevailing among obstetricians and gynecologists that explain why a large proportion of women in child birth experience pain unnecessarily.

Is there any influence of breastfeeding on the cerebral blood flow? A review of 256 healthy newborns

OBJECTIVE: To investigate whether breastfeeding influence the cerebral blood-flow velocity. MATERIALS AND METHODS: The present study included 256 healthy term neonates, all of them with appropriate weight for gestational age, 50.8% being female. Pulsatility index, resistance index and mean velocity were measured during breastfeeding or resting in the anterior cerebral artery, in the left middle cerebral artery, and in the right middle cerebral artery of the neonates between their first 10 and 48 hours of life. The data were analyzed by means of a paired t-test, Brieger's f-test for analysis of variance and linear regression, with p < 0.01 being accepted as statistically significant. RESULTS: Mean resistance index decreased as the mean velocity increased significantly during breastfeeding. Pulsatility index values decreased as much as the resistance index, but in the right middle cerebral artery it was not statistically significant. CONCLUSION: Breastfeeding influences the cerebral blood flow velocities.

Guía de práctica clínica basada en la evidencia para el diagnóstico de disfagia en niños / Evidence-based practice guidelines for the diagnosis of dysphagia in children

Se presenta una guía basada en la evidencia para el diagnóstico de disfagia en niños. Se llevó a cabo una búsqueda de artículos indexados entre enero de 1996 y diciembre de 2007 en las bases de datos Medline, Lilacs y el registro Cochrane. Se hizo restricción por idioma a publicaciones en inglés y español y, por edad, solo se incluyó a la población pediátrica. Se complementó la exploración con artículos incluidos en la bibliografía de artículos primarios y citados en revisiones no sistemáticas. La estrategia de búsqueda produjo 605 artículos de los cuales se seleccionaron 58. El análisis de la validez de los artículos y el grado de recomendación se hicieron por consenso entre los investigadores. El desarrollo de la guía se basó en el instrumento AGREE (Appraisal of Guidelines Research and Evaluation) y en el modelo GRADE del Colegio Americano de Médicos del Tórax (Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines). El enfoque diagnóstico del niño con disfagia debe partir de la sospecha clínica. La anamnesis y el examen físico deben preceder a cualquier actividad diagnóstica. Se encontró que en niños con alta sospecha clínica de disfagia debe complementarse la evaluación clínica con la videofluoroscopia (Recomendación 1C), que es el estándar de oro para confirmar la presencia de aspiración o penetración de la vía aérea (Recomendación 1A). El ultrasonido es el método de elección en niños con disfagia asociada a anormalidades de la lengua. (Recomendación 1C). La electromiografía se puede utilizar como una prueba de tamizaje para niños mayores de cinco años con alteración de la musculatura facial (Recomendación 2B). La resonancia magnética nuclear es útil en pacientes con sospecha de lesiones cervicales que alteran la dinámica de la deglución (Recomendación 1C). Se concluye que los estudios diagnósticos disponibles tienen deficiencias metodológicas que no permiten hacer recomendaciones de mayor grado de validez.

We present an evidence-based guideline for the diagnosis of dysphagia in children. The articles included were retrieved by electronic search in Medline, Lilacs, and Cochrane databases. The search was restricted to those published between January 1996 and December 2007, in English or Spanish, and only to those including children (0-18 years). Manual search of papers cited by primary articles and non-systematic reviews was also done. The search strategy identified 605 articles and 58 were chosen for further analysis. Evaluation of the papers was carried out by all the authors and recommendations were done by consensus. The guideline was developed by using the AGREE instrument (Appraisal of Guidelines Research and Evaluation) and the GRADE model (Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines) from the American College of Chest Physicians. The diagnostic approach to children with dysphagia begins with clinical suspicion, and thorough clinical history and physical examination should precede any diagnostic test. We found that in children with clinical features that suggest dysphagia, videofluoroscopy is the recommended imaging technique to confirm this condition (Recommendation 1C). This test is considered to be the gold standard to demonstrate aspiration and/or penetration of contrast material into the airway (Recommendation 1A). Ultrasound is considered as the best diagnostic imaging technique in children with dysphagia associated with tongue abnormalities (Recommendation 1C). On the other hand, electromyography might be used as a screening test in children aged 5 years or more with disorders of the facial muscles (Recommendation 2B). Finally, magnetic resonance imaging seems to provide the best diagnostic yield in those children with cervical lesions responsible for disrupting deglutition dynamics (Recommendation 1C). In conclusion, available articles on diagnostic tests for dysphagia have serious methodological deficiencies and do not allow recommendations with better levels of evidence.