Genitourinary Tract Tumors in Children: An Update.

BACKGROUND: Genitourinary tract tumors in children are less common than in adults. Most of these tumors have different genetic backgrounds, clinical presentation, and oncologic behavior than their adult counterpart. As a result of low prevalence in children, some of the treatment approaches and recommendations are based on treatment experience in adult patients. However, thanks to scientific and technological development, survival rates have risen considerably. OBJECTIVE: This paper presents a review of the principal features of the tumors involving the genitourinary tract in children and an update in genetic background, diagnosis, and treatment. METHODS: A narrative review was performed on published literature about genitourinary tract tumors in pediatric patients. Papers presented in English and Spanish literature were reviewed. PubMed, Science Direct, and SciELO databases were used to collect information and present this article. RESULTS: Kidney tumors are the most common type of genitourinary tumors in children. Among those, Wilms tumor represents the majority of cases and shows the successful work of clinical trial groups studying this tumor type. Other tumors involving the genitourinary tract in children include Rhabdomyosarcoma, Transitional cell carcinoma, Testicular, and Adrenal tumors. CONCLUSION: Genitourinary tract tumors in children represent significant morbidity and economic burden, so awareness in early diagnosis represents improvement in treatment, clinical, and oncological outcomes.

Factors Related to Physical Activity in Early Childhood: A Systematic Review.

OBJECTIVE: To evaluate the relationship between biologico-demographical, sociocultural, and environmental factors and the performance of physical activity in early childhood. METHODOLOGY: A systematic search was carried out of the databases MEDLINE, EMBASE, CENTRAL, and LILACS, as well as Google Scholar, Open Grey, ClinicalTrials.gov, DARE, PROSPERO, Health Technology Assessment, and the World Health Organization International Clinical Trials Registry Platform, from their first records to June 2018. The selection criteria were previously defined with respect to population age and article theme. No meta-analyses were carried out due to the heterogeneity of the studies. RESULTS: The percentage of moderate to vigorous physical activity runs between 3% and 47%. Environmental and sociocultural factors were identified as exerting a greater influence on children's physical activity in early childhood, with the environmental factors being, according to almost all the study authors, the greater of the two. CONCLUSIONS: According to the studies included in this research project, the factors identified as associated with moderate to vigorous physical activity are environmental (play in open spaces) and sociocultural (the role of the family and the physical activity of the mother). The evidence is not strong enough to conclude that biologico-demographic factors are significantly influential in the physical activity at this age.

Cost-Effectiveness of Combination Therapy Versus Monotherapy in Benign Prostatic Hyperplasia: A Colombian Experience.

OBJECTIVES: To estimate the incremental cost-effectiveness ratio of pharmacological treatment for benign prostatic hyperplasia from the payer's perspective. METHODS: The cost-effectiveness of 5 mg finasteride, 0.5 mg dutasteride, 10 mg alfuzosin, 10 mg terazosin, 0.4 mg tamsulosin, 4 mg doxazosin, and the combination therapy of 5 mg finasteride and 8 mg doxazosin was evaluated using a Markov model over a 30-year period. The costs were estimated using national tariffs and were reported in US dollars. Cost and effectiveness outcomes were discounted at a rate of 5% per year. Men (aged ≥40 years) with moderate to severe lower urinary tract symptoms and uncomplicated benign prostatic hyperplasia were included in the analysis. Outcomes included costs and quality-adjusted life-years. A probabilistic sensitivity analysis was performed on important parameters with Monte-Carlo simulation. RESULTS: Finasteride alone or in combination with doxazosin dominated all α-blockers. After excluding dominated alternatives, the incremental cost-utility ratio for combination therapy was $377 per quality-adjusted life-year, being a cost-effective alternative using the threshold of $15 000. Model results were robust to changes in costs, utility weights, and probabilities. Acceptability curves consistently demonstrated that the combination therapy was most likely cost-effective. CONCLUSIONS: The combination of finasteride and doxazosin is cost-effective compared with dutasteride, tamsulosin, terazosin, and alfuzosin in patients with benign prostatic hyperplasia with moderate or severe symptoms who are older than 40 years.

Resumen guía de práctica clínica para la valoración urológica pretrasplante renal / Resumed Clinical Practice Guidelines, Urological Evaluation for Kidney Transplant

En Colombia actualmente, se ha visto un aumento significativo en el número de pacientes con enfermedad renal crónica terminal (ERC-T) llegando a 23.914 en 2014 según las estadísticas del instituto nacional de salud, lo que supone un aumento en el número de trasplantes, aumentando de un 12,5% en 2008 al 18% en 2014 del total de pacientes con ERC-T. Teniendo en cuenta que el trasplante renal se ha consolidado como la mejor opción terapéutica en esos pacientes, es de suma importancia unificar criterios y conceptos basados en la mejor evidencia científica disponible para reducir complicaciones y efectos nocivos derivados de esta terapia, razón por la cual se ha creado esta guía.

In Colombia, exist a significant increase in the number of patients with terminal chronic kidney disease (CKD), up to 23,914 patients in 2014 according to statics of the national health institute. This means an increase in the number of transplants, from 12.5% in 2008 to 18% in 2014 from the overall patients with terminal CKD. Considering that kidney transplant is the best option to those patients, it became of extreme importance to unify criteria and concepts based in the best available evidence to reduce complications and negative effects from the therapy. For these reasons we have created this guideline.

Intervenciones para el control de Aedes aegypti en América Latina y el Caribe: revisión sistemática y estudio cualitativo

Antecedentes. Al momento no se ha logrado sintetizar toda la información cualicuantitativa relacionada al control de Aedes aegypti (A. aegypti) en América Latina y el Caribe (ALC). Objetivo. Describir la existencia y el grado de ejecución de los programas específicos o actividades de control vectorial en ALC como parte de programas sanitarios, establecer los costos y/o costoefectividad de las estrategias de control vectorial e identificar barreras y facilitadores para la implementación de las estrategias. Métodos. El estudio se llevará a cabo en dos fases complementarias. La primera fase será cuantitativa en la forma de una revisión sistemática, cuyos detalles han sido publicados en la base PROSPERO (CRD42016038067). La segunda fase será cualitativa y consistirá en la realización de entrevistas en profundidad semiestructuradas a informants clave como investigadores, responsables programáticos,referentes nacionales, agentes del sistema sanitario y representantes de organizaciones no gubernamentales. Discusión. El abordaje cualicuantitativo permitirá describir las estrategias y el nivel de implementación para el control de vector y su efectividad, sus costos programáticos y costo-efectividad. Permitirá también analizar factores influyent es en la implementación de programas.

Intervenciones para el control de Aedes aegypti en América Latina y el Caribe: revisión sistemática y estudio cualitativo / Interventions for the control of Aedes aegypti in Latin America and the Caribbean: systematic review and qualitative study

RESUMEN Antecedentes Al momento no se ha logrado sintetizar toda la información cuali-cuantitativa relacionada al control de Aedes aegypti (A. aegypti) en América Latina y el Caribe (ALC). Objetivo Describir la existencia y el grado de ejecución de los programas específicos o actividades de control vectorial en ALC como parte de programas sanitarios, establecer los costos y/o costoefectividad de las estrategias de control vectorial e identificar barreras y facilitadores para la implementación de las estrategias. Métodos El estudio se llevará a cabo en dos fases complementarias. La primera fase será cuantitativa en la forma de una revisión sistemática, cuyos detalles han sido publicados en la base PROSPERO (CRD42016038067). La segunda fase será cualitativa y consistirá en la realización de entrevistas en profundidad semiestructuradas a informantes clave como investigadores, responsables programáticos,referentes nacionales, agentes del sistema sanitario y representantes de organizaciones no gubernamentales. Discusión El abordaje cualicuantitativo permitirá describir las estrategias y el nivel de implementación para el control de vector y su efectividad, sus costos programáticos y costo-efectividad. Permitirá también analizar factores influyentes en la implementación de programas.

Niveles de ingreso y prevalencia de tabaquismo en América Latina: revisión sistemática y metaanálisis / Income and smoking prevalence in Latin America: a systematic review and meta-analysis

Objetivo. Determinar la relación entre la prevalencia de consumo actual de tabaco y los niveles de ingresos monetarios de fumadores en América Latina y el Caribe (ALC). Métodos. Se realizó una búsqueda sistemática en bases de datos incluyendo MEDLINE, EMBASE, CENTRAL, SOCINDEX y LILACS. Se incluyeron estudios de ALC publicados desde enero 1989 hasta diciembre de 2015. Se realizaron análisis de subgrupos planeados por década calendario de los datos, país, riesgo de sesgo, sexo y grupos de edad. Resultados. De un total de 1 254 estudios evaluados por texto completo se incluyeron 29 artículos, de los cuales 25 fueron incorporados en metaanálisis. Todos los estudios incluidos fueron de corte transversal o de vigilancia, la mayoría provenientes de Brasil y de México. Un bajo nivel de ingresos se asoció con una mayor prevalencia de tabaquismo activo (odds ratio [OR] 1,62; intervalo de confianza de 95% [IC95%] 1,34–1,96) con respecto al nivel alto (referencia). Se observó una tendencia de efecto dosis-respuesta: nivel medio de ingresos (OR 1,23; IC95% 1,00-1,52) y nivel bajo de ingresos (OR 1,64; IC95% 1,17-2,30). Esta asociación fue mayor en hombres (OR 2,22; IC95% 1,77-2,78) que en mujeres (OR 1,6; IC95% 1,11-2,47). Conclusiones. Se observó una relación inversa entre el nivel de ingresos y la prevalencia de consumo de tabaco. Se requieren mayores esfuerzos para determinar esta relación en poblaciones especiales como adolescentes o embarazadas. Esta investigación puede ser útil para los decisores políticos al mejorar las estrategias de control del tabaco y para caracterizar cuestiones de equidad en la salud pública.

Objective. Determine the relationship between tobacco-use prevalence and smoker income level in Latin America and the Caribbean (LAC). Methods. A systematic search was carried out in MEDLINE, EMBASE, CENTRAL, SOCINDEX, and LILACS databases. Studies from LAC published from January 1989 to December 2015 were included and were analyzed by subgroups disaggregated by decade of data, country, bias risk, sex, and age group. Results. Of 1 254 studies evaluated by full text, 29 articles were included, of which 25 were chosen for meta-analysis. All included studies were cross-sectional or surveillance, primarily from Brazil and Mexico. Low income was associated with higher prevalence of active smoking (odds ratio [OR] 1.62; 95% confidence interval [95%CI] 1.34–1.96) than high income (reference). A dose-response effect trend was observed: middle income (OR 1.23; 95%CI 1.00-1.52) and low income (OR 1.64; 95%CI 1.17-2.30). This association was greater in men (OR 2.22; 95%CI 1.77-2.78) than in women (OR 1.6; 95%CI 1.11-2.47). Conclusions. An inverse relationship was observed between income and tobacco- use prevalence. Further efforts are required to determine this relationship in special populations, such as adolescents and pregnant women. This research can be useful for policymakers by improving tobacco control strategies and for characterizing public health equity issues.

[Network meta-analysis: mixed and indirect treatment comparisons. a new method to the service of clinical epidemiology and public health]. / Metanálisis en red: comparaciones indirectas y mixtas, un nuevo método al servicio de la epidemiología clínica y la salud pública.

This review describes essential concepts of network meta-analysis and indirect comparisons and their application to clinical science. There are an increasing number of systematic reviews and meta-analyses providing direct comparisons between different interventions, although this is often not feasible when there is a lack of evidence related to all possible comparisons. Thus, important statistical tools that help make indirect comparisons based on previously existing comparisons have been developed. Network meta-analyses are an innovative tool that could assist doctors, researchers, and governmental organizations when making clinical and public health decisions.

Metanálisis en red: comparaciones indirectas y mixtas, un nuevo método al servicio de la epidemiología clínica y la salud pública / Network meta-analysis: mixed and indirect treatment comparisons. A new method to the service of clinical epidemiology and public health

La presente revisión trata de describir algunos conceptos fundamentales de los metanálisis en red y las comparaciones indirectas y su aplicación en las ciencias clínicas. Actualmente existe un incremento de revisiones sistemáticas y metanálisis para lo que se requiere la existencia de comparaciones directas entre las diferentes intervenciones, sin embargo, en múltiples ocasiones, esto no es posible dada la carencia de evidencia relacionada con todas las comparaciones posibles. De tal manera que se han desarrollado herramientas estadísticas importantes que permiten hacer comparaciones múltiples e indirectas a partir de las ya existentes. Para concluir, los metanálisis en red son una herramienta novedosa que ayuda a los clínicos, investigadores y a los organismos gubernamentales en la toma de decisiones tanto clínicas como de salud pública...

This review describes essential concepts of network meta-analysis and indirect comparisons and their application to clinical science. There are an increasing number of systematic reviews and meta-analyses providing direct comparisons between different interventions, although this is often not feasible when there is a lack of evidence related to all possible comparisons. Thus, important statistical tools that help make indirect comparisons based on previously existing comparisons have been developed. Network meta-analyses are an innovative tool that could assist doctors, researchers, and governmental organizations when making clinical and public health decisions...

[Risk of bias assessment of clinical trials published in iberoamerican urological journals].

OBJECTIVES: To assess the risk of bias of clinical trials published in iberoamerican indexed journals from January 1, 2008 to December 31, 2012. METHODS: We performed a descriptive study based on the clinical trials published from January 1st 2008 to December 31st 2012 in the iberoamerican urological journals. We assessed the risk of bias by the Cochrane tool. We used descriptive statistics in Stata 13 and Revman 5.2 to create the risk of bias graphs within and across studies. RESULTS: We identified 41 clinical trials: 21 trials in the International Brazilian Journal of Urology, seven trials in Actas Urológicas Españolas, six trials in Archivos Españoles de Urología, two trials in the Boletin Mexicano de Urología, four trials in Revista Mexicana de Urología and one trial in Revista Urología Colombiana. Most of these trials had unclear risk for the generation of the randomization (selection bias), the allocation concealment (selection bias) and the blinding (performance and detection). There was low risk of bias for incomplete results data (Attrition bias) and selective notification (notification bias). High risk of bias was found in other possible sources of bias, mainly because of low sample size. CONCLUSIONS: Based on the Cochrane risk of bias tool assessment, most of the published trials do not accomplish an adequate description of the methods. We should also be aware that most of the trials lack an adequate sample size calculation that limits the power of these trials. We recommend better description of the methods for randomization, and increasing the sample size to improve the quality of the trials published in urologic iberoamerican journals.