[Cirrhotic cardiomyopathy ­ Clinically fact or academic curiosity? Review: Part 1: definition, epidemiology, pathology and clinical manifestations] / Cardiomiopatía cirrótica ­ ¿Realidad clínica o simple curiosidad académica? Revisión. Parte 1: definición, epidemiología, anatomía patológica y clínica

Severe cirrhosis affecting myocardial function provokes a syndrome called Cirrhotic Cardiomyopathy, defined as cardiac disfunction associated with hepatic cirrhosis in the absence of other known cardiac disease. The prevalence is variable according different groups of investigation owing to the latent or subclinical course until a stressful situation unmask it such as surgery, hemorrhage, infection, hepatic transplant or transjugular intrahepatic porto-systemic shunt. We aimed to review the definition, pathology, pathophysiology, clinical manifestations, diagnostic criteria, images, clinical relevance, pharmacological treatment and hepatic transplantation.

La cirrosis avanzada puede provocar alteraciones miocárdicas que constituyen el síndrome de Cardiomiopatía Cirrótica definido como la disfunción cardíaca asociada con cirrosis hepática en ausencia de enfermedad cardíaca preexistente. Su prevalencia es variable de acuerdo a lo reportado por diferentes grupos de investigación debido a que puede mantenerse subclínica o latente hasta que la pone de manifiesto una situación de estrés como una cirugía, hemorragia, infección, trasplante hepático o shunt porto-sistémico intrahepático transyugular. El objetivo de esta revisión es discutir la definición, los fundamentos anátomo-patológicos, fisiopatología, manifestaciones clínicas, criterios de diagnóstico, importancia de los estudios con imágenes, relevancia clínica, tratamiento farmacológico y trasplante hepático.

Blocking Hemopexin With Specific Antibodies: A New Strategy for Treating Diabetic Retinopathy.

Hemopexin (HPX) is overexpressed in the retina of patients with diabetes and induces the breakdown of the blood-retinal barrier in vitro. The aim of this study was to evaluate whether HPX blockade by specific antibodies (aHPX) could avoid vascular leakage in vivo and microvascular angiogenesis in vitro and ex vivo. For this purpose, the effect of intravitreal (IVT) injections of aHPX on vascular leakage was evaluated in db/db mice and rats with streptozotocin-induced diabetes using the Evans Blue method. Retinal neurodegeneration and inflammation were also evaluated. The antiangiogenic effect of aHPX on human retinal endothelial cells (HRECs) was tested by scratch wound healing and tube formation using standardized methods, as well as by choroidal sprouting assays from retinal explants obtained in rats. We found that IVT injection of aHPX significantly reduced vascular leakage, retinal neurodegeneration, and inflammation. In addition, treatment with aHPX significantly reduced HREC migration and tube formation induced by high glucose concentration and suppressed choroidal sprouting even after vascular endothelial growth factor stimulation, with this effect being higher than obtained with bevacizumab. The antipermeability and antiangiogenic effects of IVT injection of aHPX suggest the blockade or inhibition of HPX as a new strategy for the treatment of advanced stages of diabetic retinopathy. ARTICLE HIGHLIGHTS: Hemopexin (HPX) is the best-characterized permeability factor in steroid-sensitive nephrotic syndrome. We have previously reported that HPX is overexpressed in the retina of patients with diabetes and induces the breakdown of the blood-retinal barrier in vitro. Here, we report that intravitreal injection of anti-HPX antibodies significantly reduces vascular leakage, retinal neurodegeneration, and inflammation in diabetic murine models and that the immunoneutralization of HPX exerts a significant antiangiogenic effect in vitro and in retinal explants. The blockade of HPX can be considered as a new therapy for advanced stages of diabetic retinopathy.

Surgical Treatment Applied to Bilateral Vocal Fold Paralysis in Adults: Systematic Review.

INTRODUCTION: Bilateral vocal fold paralysis is a condition accounting for great mortality and significant worsening in patients' quality of life. Treatment applied to these patients seek balance among breathing, airway protection and voice quality. AIM: Critically and systematically reviewing the current literature on the topic in order to set the best technique to restore breathing comfort, without the need of tracheostomy, in patients with bilateral vocal fold paralysis. Furthermore, it seeks the surgical type technique accounting for the best breathing rate and for the smallest changes in voice parameters. MATERIALS AND METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses method methodology and population, interventions, comparatives, outcomes and study design criteria were used as systematic search in the biggest databases and in the grey literature. The following meshes were used for the search: surgical interventions, surgical treatment, bilateral vocal cord paralysis, bilateral vocal fold paralysis, tracheostomy, decannulation, voice, and dysphonia. The selected studies should have followed the randomized clinical-trial type or be longitudinal observational controlled prospective studies (cohort studies). RESULTS: In total, 3,548 articles were found. After duplicate studies were removed from the selection, the inclusion and exclusion criteria were applied and 06 articles were selected for qualitative analysis. CONCLUSIONS: The assessed surgical procedures showed good cost-benefit to treat bilateral vocal fold paralysis, either because they improved the breathing function in most patients and allowed decannulation in patients with tracheostomy, or because they accounted for small changes to both voice parameters or deglutition. However, none of the described techniques has shown respiratory and functional outcomes better than those recorded for the other ones. The decision on what surgery to perform still must be made based on the judgement of an experienced surgeon.

Enhancing the importance of value-based urology and uro-oncology / Realzar la importancia de la urología y la uro-oncología basadas en valores

With the ongoing advances and evolution in healthcare, we have witnessed new breakpoints in patient management. As a result, there have been tireless efforts to identify and eradicate barriers to care and minimize their impact on patients.

Con los continuos avances y la evolución de la asistencia sanitaria, hemos sido testigos de nuevos puntos de inflexión en la gestión de los pacientes. Como resultado, se han realizado incansables esfuerzos para identificar y erradicar las barreras a la atención y minimizar su impacto en los pacientes.

Systematic review: interventions in sickle cell disease-related priapism in reducing overall morbidity, recurrence, and side effects / Revisión sistemática: intervenciones en priapismo relacionado con enfermedad de células falciformes (ECF), en reducción de morbilidad, recurrencia y efectos secundarios

Pediatric priapism is a rare, underreported urological emergency. Sickle cell disease (SCD)-related priapism cases should be assessed considering specific pathophysiologic characteristics. Chronic control of the disease has an impact on a patient's quality of life. A systematic review in different databases was done, for defining if management in All-type priapism in SCD patients was equally effective in reducing overall morbidity, disability and comorbidities, recurrence, and therapy-related side effects. Qualitative analysis was performed. Nine studies were included in the study; the majority were case series, and 300 patients were included in the analysis. The interventions and outcomes were clinically heterogeneous but displayed perspectives for further studies. This is the first analysis approach for a consensus for SCD-related priapism treatment. Studies with internal validity and causality designs are needed, to evaluate further causality relationships and establish evidence-based approaches. Etilefrine, Pseudoephedrine/etilefrine-5 inhibitors, and finasteride are promising strategies. Quality of life scores should be applied to these patients, and molecular studies should be developed for pharmacological designs.

El priapismo pediátrico es una entidad poco común, sin embargo, es una urgencia urológica infranotificada. Los casos de priapismo relacionados con enfermedad de células falciformes (ECF) deben evaluarse teniendo en cuenta características fisiopatológicas específicas. El control crónico de la enfermedad tiene impacto en la calidad de vida del paciente. Se realizó una revisión sistemática en diferentes bases de datos, para definir si las intervenciones en pacientes con priapismo de todo tipo relacionado con ECF fueron igualmente efectivas en la reducción de morbilidad general, discapacidad, comorbilidades, recurrencia y efectos secundarios relacionados con la terapia. Se realizó un análisis cualitativo de nueve estudios; la mayoría series de casos, para un total de 300 pacientes. Las intervenciones y los resultados fueron clínicamente heterogéneos, pero mostraron perspectivas para futuros estudios. Este es el primer análisis de información para llegar a un consenso para el tratamiento del priapismo relacionado con la ECF. La perspectiva principal es la necesidad de estudios con validez interna y diseños elaborados para profundizar las relaciones de causalidad y el abordaje basado en la evidencia de esta condición. La etilefrina, los inhibidores de la PDE-5 y la finasterida son estrategias prometedoras. Se deben aplicar puntajes de calidad de vida a estos pacientes y se deben desarrollar estudios moleculares para diseños farmacológicos.

Association between dysphagia and tongue strength in patients with amyotrophic lateral sclerosis / Associação entre disfagia e força da língua em pacientes com esclerose lateral amiotrófica

Abstract Introduction Amyotrophic lateral sclerosis is the most common motor neuron disease in adults despite it being rare. It is a neurodegenerative disease in which dysphagia is a common and debilitating symptom. Dysphagia can be assessed by complementary exams, such as fiberoptic endoscopic evaluation of swallowing and the tongue strength test, as this is one of the main muscles involved in swallowing. Objective To compare the results of tongue strength and endurance measured by the Iowa oral performance instrument with the findings of the fiberoptic endoscopic evaluation of swallowing examination in patients affected by amyotrophic lateral sclerosis. Methods Cross-sectional study, carried out in a tertiary hospital specialized in treatment and rehabilitation. Twenty-five patients diagnosed with amyotrophic lateral sclerosis underwent dysphagia questionnaires, fiberoptic endoscopic evaluation of swallowing examination and tongue strength and resistance test with the Iowa oral performance instrument to assess the presence of dysphagia. Results Forty-eight percent of the sample had dysphagia at the fiberoptic endoscopic evaluation of swallowing and 76% had an altered tongue strength test. Ninety percent of patients with dysphagia had an average tongue pressure lower than 34.2 KPa. The tongue strength test showed sensitivity of 91.67% and specificity of 38.46% and accuracy of 64%. There was a statistically significant relationship between tongue strength and dysphagia and between tongue resistance and dysphagia. Conclusion Tongue strength tests, such as the Iowa oral performance instrument, proved to be effective in assessing dysphagia. This result should encourage further research to facilitate the early diagnosis of dysphagia.

Resumo Introdução A esclerose lateral amiotrófica é a doença do neurônio motor mais comum nos adultos, a despeito da baixa incidência e da raridade. É uma doença neurodegenerativa na qual a disfagia é um sintoma comum e debilitante. A disfagia pode ser avaliada por exames complementares como a videoendoscopia da deglutição e testes de força de língua, uma vez que se trata de um dos principais músculos envolvidos na deglutição. Objetivo Comparar os resultados da força e resistência da língua aferidos pelo Iowa Oral Performance Instrument com os achados do exame à videoendoscopia da deglutição, em pacientes acometidos por esclerose lateral amiotrófica. Método Estudo transversal, feito em um hospital terciário especializado em tratamento e reabilitação. Vinte e cinco pacientes com diagnóstico de esclerose lateral amiotrófica foram submetidos a questionários de disfagia, exame de videoendoscopia da deglutição e teste de força e resistência de língua com o Iowa Oral Performance Instrument para avaliar a presença de disfagia. Resultado Quarenta e oito por cento da amostra apresentavam disfagia à videoendoscopia da deglutição e 76% apresentavam teste de força de língua alterado. Noventa por cento dos pacientes com disfagia apresentaram pressão de língua média inferior a 34,2 KPa. O teste de força de língua apresentou sensibilidade de 91,67% e especificidade de 38,46% e acurácia de 64%. Houve relação estatisticamente significante entre força da língua e disfagia e entre resistência da língua e disfagia. Conclusão Testes de força de língua, como o Iowa Oral Performance Instrument, mostrou‐se eficaz para avaliar disfagia, mostrou sua associação com a força e resistência da língua. Esse resultado deve fomentar a feitura de novas pesquisas para facilitar o diagnóstico precoce da disfagia.

Supraglottic stenosis as a late complication of radiotherapy: a case report.

Nasopharyngeal carcinoma is rare and affect mainly men between the fourth and sixth decades of life. The clinic is characterized to be nonspecific and the main complaints or findings related to this disease are: cervical mass, aural dysfunction, and headache. The basis of treatment is radiotherapy that involves a wide field of irradiation of normal tissues, which usually generates sequelae with direct implications for quality of life. We report a case of a nasopharyngeal carcinoma treated with radiotherapy and chemotherapy that evolved, after 8 years, into supraglottic stenosis. We emphasize the relevance of clinical follow-up after radiotherapy, particularly due to the late sequelae and the relevance of using radiotherapy devices with a more focal cancer field, in order to minimize complications.

Is There a Difference between the Preoperative and Postoperative Serum Levels of Interleukin-6 and Tumor Necrosis Factor-α in Children Submitted to Adenotonsillectomy?

Abstract Introduction Palatine and pharyngeal tonsils are the first line of defense against pathogens. Clinically, two alterations may require surgical removal of the tonsils: hypertrophy and recurrent tonsillitis. The two conditions probably result from a dysfunction of the immune system. Objective To evaluate possible differences in the plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients submitted to adenotonsillectomy. Methods Prospective, longitudinal study with 25 children undergoing adenotonsillectomy separated into 3 different groups: recurrent tonsillitis (RT), composed of 7 patients; recurrent hypertrophy tonsillitis (RTTH), with 8 patients; and the tonsillar hypertrophy (TH) group, with 10 patients. Ten healthy control children (SD) were also included in the study. Peripheral blood was collected, and plasma was separated to measure the levels of TNF-α, IL-6, and IL-10. The Mann-Whitney test was used for statistical analysis. Results The plasma level of IL-6 was higher in the RT (p= 0.0394) and TH (p= 0.0009) groups, compared with the control group. The TH group also had higher levels of IL-6 than the RT group (p= 0.039). The IL-6/IL-10 ratio was higher in the RT (p= 0.029) and TH (p= 0.0005) groups compared with the control group. Between the RT and RTTH groups, the IL-6/IL-10 ratio was higher in the RT group, with a statistically significant difference (p= 0.0091). Conclusion Patients with a history of chronic tonsillitis had higher levels of IL-6, compared with the control group.

Is There a Difference between the Preoperative and Postoperative Serum Levels of Interleukin-6 and Tumor Necrosis Factor-α in Children Submitted to Adenotonsillectomy?

Introduction Palatine and pharyngeal tonsils are the first line of defense against pathogens. Clinically, two alterations may require surgical removal of the tonsils: hypertrophy and recurrent tonsillitis. The two conditions probably result from a dysfunction of the immune system. Objective To evaluate possible differences in the plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients submitted to adenotonsillectomy. Methods Prospective, longitudinal study with 25 children undergoing adenotonsillectomy separated into 3 different groups: recurrent tonsillitis (RT), composed of 7 patients; recurrent hypertrophy tonsillitis (RTTH), with 8 patients; and the tonsillar hypertrophy (TH) group, with 10 patients. Ten healthy control children (SD) were also included in the study. Peripheral blood was collected, and plasma was separated to measure the levels of TNF-α, IL-6, and IL-10. The Mann-Whitney test was used for statistical analysis. Results The plasma level of IL-6 was higher in the RT ( p = 0.0394) and TH ( p = 0.0009) groups, compared with the control group. The TH group also had higher levels of IL-6 than the RT group ( p = 0.039). The IL-6/IL-10 ratio was higher in the RT ( p = 0.029) and TH ( p = 0.0005) groups compared with the control group. Between the RT and RTTH groups, the IL-6/IL-10 ratio was higher in the RT group, with a statistically significant difference ( p = 0.0091). Conclusion Patients with a history of chronic tonsillitis had higher levels of IL-6, compared with the control group.

ERM Complex, A Therapeutic Target for Vascular Leakage Induced by Diabetes.

BACKGROUND: Ezrin, radixin, and moesin (the ERM complex) interact directly with membrane proteins regulating their attachment to actin filaments. ERM protein activation modifies cytoskeleton organization and alters the endothelial barrier function, thus favoring vascular leakage. However, little is known regarding the role of ERM proteins in diabetic retinopathy (DR). OBJECTIVE: This study aimed to examine whether overexpression of the ERM complex exists in db/db mice and its main regulating factors. METHODS: 9 male db/db mice and 9 male db/+ aged 14 weeks were analyzed. ERM proteins were assessed by western blot and by immunohistochemistry. Vascular leakage was determined by the Evans blue method. To assess ERM regulation, HRECs were cultured in a medium containing 5.5 mM D-glucose (mimicking physiological conditions) and 25 mM D-glucose (mimicking hyperglycemia that occurs in diabetic patients). Moreover, treatment with TNF-α, IL-1ß, or VEGF was added to a high glucose condition. The expression of ERM proteins was quantified by RT-PCR. Cell permeability was evaluated by measuring movements of FITC-dextran. RESULTS: A significant increase of ERM in diabetic mice in comparison with non-diabetic mice was observed. A high glucose condition alone did not have any effect on ERM expression. However, TNF-α and IL-1ß induced a significant increase in ERM proteins. CONCLUSION: The increase of ERM proteins induced by diabetes could be one of the mechanisms involved in vascular leakage and could be considered as a therapeutic target. Moreover, the upregulation of the ERM complex by diabetes is induced by inflammatory mediators rather than by high glucose itself.

Supraglottic stenosis as a late complication of radiotherapy: a case report

ABSTRACT Nasopharyngeal carcinoma is rare and affect mainly men between the fourth and sixth decades of life. The clinic is characterized to be nonspecific and the main complaints or findings related to this disease are: cervical mass, aural dysfunction, and headache. The basis of treatment is radiotherapy that involves a wide field of irradiation of normal tissues, which usually generates sequelae with direct implications for quality of life. We report a case of a nasopharyngeal carcinoma treated with radiotherapy and chemotherapy that evolved, after 8 years, into supraglottic stenosis. We emphasize the relevance of clinical follow-up after radiotherapy, particularly due to the late sequelae and the relevance of using radiotherapy devices with a more focal cancer field, in order to minimize complications.

Disfunción eréctil en personas con VIH ­ Revisión de alcance / Erectile Dysfunction in People with HIV ­ A Scoping Review

Objetivo Exponer los factores que han sido asociados al desarrollo de disfunción eréctil (DE) en las personas con virus de la inmunodeficiencia humana (VIH) y cuál es la prevalencia de la disfunción eréctil en esta población. Métodos Se realizó una revisión de alcance utilizando las siguientes bases de datos: MEDLINE, CENTRAL, Embase, Scopus, Lilacs, y Psycinfo. Los artículos incluidos debían tener cualquier información relacionada con la DE en personas con VIH, su prevalencia, y posibles factores asociados. Se filtraron un total de 2.726 artículos por título y resumen, y, de estos, se seleccionaron 22 referencias para revisión de texto completo y análisis. Resultados Se encontró que las personas con VIH tienen una mayor probabilidad de presentar DE en comparación con las personas sin VIH. Algunos estudios han establecido una asociación entre la DE y trastornos psicológicos o factores orgánicos, como la lipodistrofia, la hipertensión arterial, la hipercolesterolemia, la diabetes mellitus, la depresión, la ansiedad, y el hipogonadismo. La ingesta de terapia antirretroviral (TARV), más específicamente los inhibidores de la proteasa, sigue siendo cuestionada como causante de DE en pacientes con VIH. Conclusiones Ante un paciente con diagnóstico de VIH, se debe ahondar sobre DE con el fin de recomendar e iniciar conductas terapéuticas que aseguren un mejoramiento en su calidad de vida.

Aim To present factors that have been associated with the development of erectile dysfunction (ED) in people with human immunodeficiency virus (HIV) and the frequency of erectile dysfunction among this population. Methods We performed a scoping review on the following databases: MEDLINE, CENTRAL, Embase, Scopus, Lilacs, and Psycinfo. The articles included information related to ED in people with HIV, its frequency, and possible associated factors. A total of 2,726 articles were filtered by title and abstract, and, from these, 22 references were selected for full-text review and analysis. Results People with HIV were found to be more likely to have ED compared to people without HIV. Some studies have established an association between ED and psychological disorders or organic factors, such as lipodystrophy, high blood pressure, hypercholesterolemia, diabetes mellitus, depression, anxiety, and hypogonadism. The intake of antiretroviral therapy (ART), more specifically protease inhibitors, continues to be questioned as a cause of ED in patients with HIV. Conclusions In HIV-positive men, we recommend to actively seek ED in order to initiate therapeutic conducts that can ensure an improvement in their quality of life.

Comparación de la costo-efectividad de la nefrolitotomía percutánea y de la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 a 30 mm en Colombia / Comparison of the Cost-effectiveness of Percutaneous Nephrolithotomy and Flexible Retrograde Holmium Laser Nephrolithotomy in Patients with Kidney Stones of 20 to 30 mm in Colombia

Introducción y Objetivo Con el advenimiento de nuevas tecnologías, vienen controversias respecto al espectro de sus aplicaciones. El costo derivado de estas tecnologías juega un papel muy importante en el momento de la toma de decisiones terapéuticas. Es por esto que consideramos relevante estimar la costo-efectividad de la nefrolitotomía percutánea comparada con la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 mm a 30 mm en Colombia. Materiales y Métodos Por medio de la construcción de un modelo de árbol de decisión usando el programa Treeage (TreeAge Software, LLC, Williamstown, MA, EE.UU.), se realizó una comparación entre la nefrolitotomía percutánea y la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 mm a 30 mm. La perspectiva fue la del tercer pagador, y se incluyeron los costos directos. Las cifras fueron expresadas en pesos colombianos de 2018. La mejoría clínica, definida como el paciente libre de cálculos, fue la unidad de resultado. Se hizo una extracción de datos de efectividad y seguridad por medio de una revisión sistemática de la literatura. La razón de costo-efectividad incremental fue calculada. Resultados El modelo final indica que la nefrolitotomía percutánea puede ser considerada como la alternativa más costo-efectiva. Los hallazgos fueron sensibles a la probabilidad de mejoría clínica de la nefrolitotomía percutánea. Conclusión Teniendo en cuenta las variables económicas, los supuestos del modelo y desde la perspectiva del tercer pagador, la nefrolitotomía percutánea para el tratamiento de pacientes con cálculos renales de 20 mm a 30 mm es costo-efectiva en nuestro país. Estos hallazgos fueron sensibles a los costos y a la efectividad de los procedimientos quirúrgicos.

Introduction and Objective The advent of new technologies leads to controversies regarding the spectrum of their applications and their cost. The cost of these technologies plays a very important role when making therapeutic decisions. Therefore, we consider it relevant to estimate the cost-effectiveness of percutaneous nephrolithotomy compared with flexible retrograde holmium laser nephrolithotomy in patients with kidney stones of 20 mm to 30 mm in Colombia. Materials and Methods Through the development of a decision tree model using the Treeage (TreeAge Software, LLC, Williamstown, MA, US) software, we compared percutaneous nephrolithotomy with flexible holmium laser retrograde nephrolithotomy in patients with kidney stones of 20 mm to 30 mm. The perspective was that of the third payer, and all direct costs were included. The figures were expressed in terms of 2018 Colombian pesos. Clinical improvement, which was defined as a stone-free patient, was the outcome unit. We extracted data on effectiveness and safety through a systematic review of the literature. The incremental cost-effectiveness ratio was calculated. Results In terms of cost-effectiveness the final model indicates that percutaneous nephrolithotomy may be considered the best alternative. These findings were sensitive to the probability of clinical improvement of the percutaneous nephrolithotomy. Conclusion Taking into account the economic variables, the assumptions of the model, and through the perspective of the third payer, percutaneous nephrolithotomy for the treatment of patients with kidney stones of 20 mm to 30mm is cost-effective in our country. These findings were sensitive to the costs and effectiveness of the surgical procedures.

Vipoma asociado a dermatomiosistis, tiroiditis de Hashimoto y pancreatitis autoinmune (síndrome poliglandular tipo 3C)

Mujer de 72 años con diarrea crónica secretora, disfagia orofaringea, debilidad muscular proximal, compromiso dérmico y bocio multinodular; con imágenes y estudios auxiliares compatible con un VIPoma benigno asociado a una dermatomiositis y un síndrome poliglandular tipo IIIC (tiroiditis de Hashimoto y pancreatitis autoinmune). Fue tratado con corticoides, inmunosupresores y análogos de somatostatina con buena evolución clínica. Sería el primer caso reportado en nuestro país.

Turning Problems into Opportunities: How to Resume Urological Elective Surgery Using a Scoring System during COVID-19 Outbreak / Convirtiendo problemas en oportunidades: como reanudar la cirugía urológica electiva utilizando un sistema de puntaje durante la pandemia por COVID-19

Objective Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which is the largest pandemic in the last century and has created a health care crisis worldwide. Contingency plans have led to put on hold all urological elective surgeries. The aim of the present article is to report the adaptation of theMedically Necessary Time-Sensitive (MeNTS) scoring systemto triage patients who were awaiting urological elective surgery during the COVID-19 pandemic. Methods The present study was conducted as a part of a necessary transition of care delivery at a tertiary care institution in order to re-establish urological elective surgery. We triaged all urological elective surgeries with the MeNTS instrument and proposed a cutoff value of 45 points to avoid complications in the COVID-19 crisis while resuming elective procedures. Results A total of 91 patients awaiting elective urological surgery pending to be rescheduled were identified. Their median age was 60.5 years old (interquartile range [IQR]: 46­93). Twenty-five patients were American Society of Anesthesiologists (ASA) class I, 51 (56%) were class II, and 12 (13%) were class III. The median MeNTS score was 42 points (IQR: 36­59). Twenty-nine patients had aMeNTS score>45 and were advised to postpone their surgery. Sixty-two had a score 45 and were gradually rescheduled. Conclusions The present study may have practical implications regarding the selection of urological elective surgeries in the challenging health care situation caused by the COVID-19 pandemic. Our real-life data showed us that 32% of our procedures must be postponed, and 68% could be carefully considered and gradually rescheduled for surgery.

Introducción El coronavirus del síndrome de dificultad respiratoria aguda 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, en inglés) causa la llamada enfermedad por coronavirus 2019 (coronavirus disease 2019, COVID-19, en inglés) que ha generado la pandemia más grande en el último siglo, y ha llevado a una crisis en el sistema de salud a nivel mundial. El objetivo de este artículo es reportar la utilización del sistema médicamente necesario, sensible al tiempo (medically necessary, time-sensitive, MeNTS, en inglés) para gradualmente reanudar la cirugía urológica programada durante la pandemia. Metodos Este estudio se llevó a cabo como parte de una transición necesaria en la atención en salud para restablecer la cirugía urológica programada. Clasificamos a todos los pacientes utilizando el instrumento MeNTS, y arbitrariamente propusimos un punto de corte de 45 puntos, dinámico de acuerdo con el momento y la situación de la pandemia. Resultados Un total de 91 pacientes en espera de cirugía urológica programada fueron identificados. La mediana de edad fue de 60.5 años (rango intercuartil [RIC]: 46 a 93 años). En total, 25 (27.4%) pacientes eran clase I en la clasificación de la Sociedad Americana de Anestesiólogos (American Society of Anesthesiologists, ASA), 51 (56%) eran ASA II, y 12 (13%), ASA III. La mediana del puntaje del MeNTS fue de 42 puntos (RIC: 36 a 59). En total, 29 pacientes tuvieron un puntaje de MeNTS mayor a 45 puntos, y se les recomendó posponer su cirugía electiva; 62 (68%) tuvieron un puntaje ≤ 45 puntos, y se reprogramaron gradualmente a partir del 1ro de mayo de 2020. Conclusiones Este estudio puede tener varias implicaciones practicas a la hora de seleccionar pacientes para reprogramar su cirugía urológica electiva durante situaciones desafiantes para los sistemas de salud, como la pandemia por COVID-19. Nuestros datos de la práctica clínica real muestran que el 32% de los procedimientos se deben posponer, y el 68% pueden considerarse cuidadosamente para ser reprogramados gradualmente.

Surgical Technique of Supine Percutaneous Nephrolithotomy in Children / Técnica quirúrgica de la nefrolitotomía percutánea en supino en niños

Percutaneous nephrolithotomy (PCNL) in children has becomemore widely used due to its high efficacy and safety and to the development of miniaturized instruments. A supine approach is promising due to advantages such as better ventilation, reproducibility, and ergonomics. The purpose of the present study is to describe our surgical technique with special considerations in the pediatric population. We used an oblique supine position supported by one silicone gel positioning pad under the hip and another under the ipsilateral flank. The anatomical landmarks used to guide the puncture were the 11th and 12th ribs, the posterior axillary line, and the iliac crest. Initially, a ureteral catheter was introduced endoscopically. A retrograde pyelography was performed to guide the puncture, which was performed using a biplanar technique. A hydrophilic guide wire was then advanced through the needle. Dilation was performed with Alken telescopic dilators until 14 Ch. Fragmentation was performed either with a 13 Ch semirigid cystoscope or a flexible ureteroscope using a holmium: yttrium aluminum garnet (Ho:Yag) laser.We left a double J catheter. Supine PCNL in the pediatric population has comparable efficacy in terms of stone free rate to that of the prone approach as well as less complications. Certain considerations in children are careful padding and placement of the patient close to the edge of the table. Puncture should be guided by ultrasound to reduce radiation exposure. Miniaturized equipment is not widely available, so adaptation of adult equipment for the pediatric population is sometimes necessary.

La nefrolitotomía percutánea en niños se ha vuelto ampliamente utilizada por su alta efectividad, seguridad, y por la miniaturización de los instrumentos endoscópicos. El abordaje en supino es prometedor por sus ventajas, como mejor ventilación, reproducibilidad, y ergonomía. El propósito es describir nuestra técnica quirúrgica con las consideraciones especiales a tener en cuenta en la población pediátrica. Todos nuestros pacientes han sido intervenidos bajo la siguiente técnica quirúrgica: en una posición oblicua en supino, utilizando soportes de silicona ubicados debajo de la cadera y del flanco ipsilateral, se marcan los reparos anatómicos: las costillas once y doce, la línea axilar posterior y la cresta ilíaca. Inicialmente se introduce un cateter ureteral por vía endoscópica, con el cual se realiza una pielografía retrógrada para guiar la punción con una técnica biplanar. Se avanza una guía hidrofílica y, sobre esta, los dilatadores telescopados de Alken hasta un tracto de 14 Ch. Se realiza la fragmentación con un cistoscopio semirígido de 13 Ch o con un ureteroscopio flexible utilizando el láser Ho:Yag. Se deja un cateter JJ. La nefrolitotomía percutánea en la población pediátrica es comparable en términos de tasa libre de cálculos al abordaje en prono, con menos complicaciones. Una consideración importante en niños es una adecuada posición, cerca al eje de la mesa. La punción debe ser guiada por ultrasonido para disminuir la exposición a radiación. La disponibilidad de equipos miniaturizados es limitada, por lo cual usualmente es necesario adaptar los equipos de adultos.

Complete study for erectile dysfunction (CompED) improving diagnosis and treatment decision-making.

Erectile dysfunction is a condition associated with increasing age. Patient evaluation and management should follow a comprehensive, stepwise approach. The aim of this article was to report our experience with the complete study for erectile dysfunction, including intracavernous injection rigidity test, biothesiometry and colour duplex Doppler ultrasound. Data were collected and analysed prospectively. The primary end point was to determine whether treatment decision-making was eased by the CompED test. Secondary end points were to establish which clinical variables prior to the study could impact the results of the CompED test, to finally improve patient selection for the study. 187 patients were recruited, 31.2% of the patients had an axial rigidity below 50%, 28.5% had a peak systolic velocity <25 cm/s, 13.2% had an end-diastolic velocity >5cm/s and 27.5% had an abnormal biothesiometry. The factors that best predicted an abnormal result in any of the tests were age >70 years, IIEF domain A < 14 points, and previous radical prostatectomy or radiotherapy. The CompED test stands as a new alternative for the evaluation of patients with erectile dysfunction, being less time consuming, aiding in a more accurate determination of the aetiology and guiding treatment decision-making.