Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain).

BACKGROUND: Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain. METHODS: This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR). RESULTS: Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3-89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57-0.79). CONCLUSIONS: Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out.

[Frailty impact on COVID-19 disease in an older cohort from the city of Barcelona]. / Impacto de la fragilidad y COVID-19 en una cohorte de gente mayor de la ciudad de Barcelona.

Objetive To describe the incidence and mortality of the first wave of COVID-19 in the elderly population of Barcelona, according to their previous levels of frailty. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Population aged 65 or over assigned to the Barcelona Primary Care centres of the Institut Català de la Salut, followed between March and June 2020. MAIN MEASUREMENTS: Frailty was calculated at baseline from the computerised medical records. Results during follow-up: diagnosis of COVID-19, possible or confirmed with PCR and all-cause mortality. RESULTS: 251788 patients over 64 years of age were analysed, 61.3% had some level of frailty, 27.8% moderate or severe. The incidence of COVID-19 was 3.13 cases per 100 inhabitants (N=7883) and the mortality from COVID-19 was 21.5% (N=1691). Both the incidence and mortality from COVID-19 were higher at older age, in men, at greater deprivation and at a higher level of frailty. Individuals with mild, moderate, and severe frailty had an adjusted Hazard Ratio (HR) for COVID-19 disease of 1.47, 2.08, and 3.50, respectively. Among subjects with COVID-19, those with mild, moderate, and severe frailty had an adjusted HR for COVID-19 mortality of 1.44, 1.69, and 2.47, respectively. CONCLUSIONS: We consider it necessary to address frailty also in a pandemic situation, since it is a treatable condition and in turn a more serious risk factor for COVID-19, where the role of primary care is essential, due to its accessibility and longitudinal character.

[Perceptions and attitudes of Chilean primary care physicians toward clinical practice guidelines]. / Percepciones y actitudes de médicos de atención primaria respecto de las Guías de Práctica Clínicas en el Régimen de Garantías en Salud.

BACKGROUND: Clinical practice guidelines (CPGs) promote better quality and equity in health care and potentially they could improve patients' outcomes. However, their implementation is hindered by a number of factors including some related to health care professionals. AIM: To assess the perceptions and attitudes of primary care physicians regarding CPGs developed by the Chilean Ministry of Health in the context of the Health Sector Reform. MATERIAL AND METHODS: An adaptation of the survey "Knowledge, perceptions and attitudes towards Clinical Practice Guidelines" was sent to 1,264 primary care physicians in Chile and answered completely by 354. The analysis assessed the attitudes towards CPG, their use in primary care and their relationship with socio demographic features of respondents. RESULTS: Eighty two percent of respondents reviewed the flowcharts of the guidelines, 85% consulted their online version. The classification of evidence levels and the strength of recommendations generated a high level of confidence with the guidelines in 70 and 64% of respondents. Eighty five percent considered that CPG could help to standardize clinical practice. The most relevant barrier hindering CPG use was the lack of a brief, simple and easy to access format in 63% of respondents. The three dimensions of the theory of planned behavior (attitude toward behavior, subjective norms, and perceived behavioral control) were associated with a greater frequency of guideline use. A higher age and not being Chilean were associated with a lower frequency of use. CONCLUSIONS: The identified factors associated with CPG use should be considered in future guideline design.

Efficient synthesis of novel 3-aryl-5-(4-chloro-2-morpholinothiazol-5-yl)-4,5-dihydro-1H-pyrazoles and their antifungal activity alone and in combination with commercial antifungal agents.

The α,ß-unsaturated carbonyl compounds 5a-f were prepared by reaction between 2-chloro-4-morpholinothiazol-5-carbaldehyde 3 and substituted acetophenones 4a-f. Treatment of compounds 5a-f with hydrazine hydrate employing mild reaction conditions led to the formation of 4,5-dihydro-1H-pyrazoles 6a-f. Then the treatment with acetic anhydride or formic acid afforded the expected 4,5-dihydro-1H-pyrazoles 7a-f and 8a-f. The antifungal activity of each series of synthesized compounds was determined against the clinically important fungi Candida albicans and Cryptococcus neoformans. In addition, the most active compounds 7e and 7f were tested in combination with the commercial antifungal agents: fluconazole, itraconazole, and amphotericin B. Compound 7e showed a synergistic effect with fluconazole against C. albicans while 7f showed synergistic activities with all tested antifungal drugs against the same yeast.

Insights from a Qualitative Exploration of Adolescents' Opinions on Sex Education.

BACKGROUND: Adolescence is a crucial time in the development of young people's identity, and sexuality is a key issue. Comprehensive sex education provides the knowledge and skills to help adolescents protect their sexual and reproductive health and rights. Policies on sex education in secondary schools are highly influential in the development of quality programmes that support comprehensive sex education. The aim of this study was to explore, describe and understand adolescents' experiences of sex education. METHODS: A qualitative study based on Gadamer's phenomenology was used. Two focus groups and four in-depth interviews were conducted with 12 private school students, followed by inductive data analysis using ATLAS.ti software 9.0. RESULTS: Two main themes were identified in the analysis: (1) sex education is a challenge for secondary schools and (2) student expectations of sex education. CONCLUSION: It is essential for adolescents to have access to comprehensive sex education that is adapted to the different stages of their development, is provided by specialised teachers, and involves their families in the process.

Isolation of major components from the roots of Godmania aesculifolia and determination of their antifungal activities.

From the methanol root extract of Godmania aesculifolia, a species selected in a multinational OAS program aimed at discovering antifungal compounds from Latin American plants, a new chavicol diglycoside (1), the known 3,4-dihydroxy-2-(3-methylbut-2-en-1-yl)-3,4-dihydronaphthalen-1(2H)-one (2), and lapachol (3) were isolated and characterized by 1D and 2D NMR and MS techniques. Only 3 exhibited fairly good activity against a panel of clinical isolates of Cryptococcus neoformans (MIC50 between 7.8 and 31.2 µg/mL) and moderate activities against Candida spp. and non-albicans Candida spp.

Synthesis, antifungal and antitumor activity of novel (Z)-5-hetarylmethylidene-1,3-thiazol-4-ones and (z)-5-ethylidene-1,3-thiazol-4-ones.

New hetaryl- and alkylidenerhodanine derivatives 3a-d, 3e, and 4a-d were prepared from heterocyclic aldehydes 1a-d or acetaldehyde 1e. The treatment of several rhodanine derivatives 3a-d and 3e with piperidine or morpholine in THF under reflux, afforded (Z)-5-(hetarylmethylidene)-2-(piperidin-1-yl)thiazol-4(5H)-ones and 2-morpholinothiazol-4(5H)-ones 5a-d, 6a-d, and (Z)-5-ethylidene-2-morpholinothiazol-4(5H)-one (5e), respectively, in good yields. Structures of all compounds were determined by IR, 1D and 2D NMR and mass spectrometry. Several of these compounds were screened by the U.S. National Cancer Institute (NCI) to assess their antitumor activity against 60 different human tumor cell lines. Compound 3c showed high activity against HOP-92 (Non-Small Cell Lung Cancer), which was the most sensitive cell line, with GI50 = 0.62 µM and LC50 > 100 µM from the in vitro assays. In vitro antifungal activity of these compounds was also determined against 10 fungal strains. Compound 3e showed activity against all fungal strains tested, but showed high activity against Saccharomyces cerevisiae (MIC 3.9 µg/mL).

Integrating Noncancer Chronic Pain to Multimorbidity: A Real Practice Challenge in Chile.

Chronic noncancer pain (CNCP) is, and continues to be, a global problem that affects people with multimorbidity. The objective is to comment on the gap in Chile in integrating multimorbidity and CNCP in the real practice context despite the advances in public policies and local evidence revealed. Therefore, a pilot is responding to this problem by implementing an approach to incorporate into a multimorbidity comprehensive approach the assessment of CNCP and adding nonmedical services. It is expected to evaluate its impact on the performance of the health system, as well as on people.

Prognostic Factors Associated with Acute Heart Failure in Patients Admitted for COVID-19: Analysis of the SEMI-COVID-19 Registry.

INTRODUCTION: Since the beginning of the COVID-19 pandemic in March 2020, an intimate relationship between this disease and cardiovascular diseases has been seen. However, few studies assess the development of heart failure during this infection. This study aims to determine the predisposing factors for the development of heart failure (HF) during hospital admission of COVID-19 patients. METHODOLOGY: A retrospective and multicenter study of patients with HF admitted for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). A bivariate analysis was performed to relate the different variables evaluated in patients developing heart failure during hospital admission. A multivariate analysis including the most relevant clinical variables obtained in bivariate analyses to predict the outcome of heart failure was performed. RESULTS: A total of 16.474 patients hospitalized for COVID-19 were included (57.5% men, mean age 67 years), 958 of them (5.8%) developed HF during hospitalization. The risk factors for HF development were: age (odds ratio [OR]): 1.042; confidence interval 95% (CI 95%): 1.035-1.050; p < 0.001), atrial fibrillation (OR: 2.022; CI 95%: 1.697-2.410; p < 0.001), BMI > 30 kg/m2 (OR: 1.460 CI 95%: 1.230-1.733; p < 0001), and peripheral vascular disease (OR: 1.564; CI 95%: 1.217-2.201; p < 0.001). Patients who developed HF had a higher rate of mortality (54.1% vs. 19.1%, p < 0.001), intubation rate (OR: 2,36; p < 0.001), and ICU admissions (OR: 2.38; p < 0001). CONCLUSIONS: Patients who presented a higher risk of developing HF were older with cardiovascular risk factors. The risk factors for HF development were age, atrial fibrillation, obesity, and peripheral vascular disease. In addition, patients who developed HF more frequently required to be intubated or admitted to the ICU.

Does Influenza Vaccination Reduce the Risk of Contracting COVID-19?

The concurrent timing of the COVID-19 pandemic and the seasonal occurrence of influenza, makes it especially important to analyze the possible effect of the influenza vaccine on the risk of contracting COVID-19, or in reducing the complications caused by both diseases, especially in vulnerable populations. There is very little scientific information on the possible protective role of the influenza vaccine against the risk of contracting COVID-19, particularly in groups at high-risk of influenza complications. Reducing the risk of contracting COVID-19 in high-risk patients (those with a higher risk of infection, complications, and death) is essential to improve public well-being and to reduce hospital pressure and the collapse of primary health centers. Apart from overlapping in time, COVID-19 and flu share common aspects of transmission, so that measures to protect against flu might be effective in reducing the risk of contracting COVID-19. In this study, we conclude that the risk of contracting COVID-19 is reduced if patients are vaccinated against flu, but the reduction is small (0.22%) and therefore not clinically important. When this reduction is analysed based on the risk factor suffered by the patient, statistically significant differences have been obtained for patients with cardiovascular problems, diabetics, chronic lung and chronic kidney disease; in all four cases the reduction in the risk of contagion does not reach 1%. It is worth highlighting the behaviour that is completely different from the rest of the data for institutionalized patients. The data for these patients does not suggest a reduction in the risk of contagion for patients vaccinated against the flu, but rather the opposite, a significant increase of 6%. Socioeconomic conditions, as measured by the MEDEA deprivation index, explain increases in the risk of contracting COVID-19, and awareness campaigns should be increased to boost vaccination programs.

Baby teething in early modern England: theory and therapeutic practice.

Oral and dental healthcare was a major medical concern in 16th- and 17th-century England. The analysis of a representative corpus from Early English Books Online (EEBO) reveals that the general principles and therapeutic management of baby teething were found most often in pediatric and midwifery treatises. The chapters devoted to this babyhood process usually gave information on factors determining teething onset, eruption schedule, order of appearance, associated disorders and short-term prognosis. Among the remedies available to alleviate children's pain, the authors mention anti-inflammatory herbal ointments, soothing fomentations, periodic mouthwashes, and minor surgery. Although the selected chapters on baby teething do not include detailed accounts of teething-related symptoms, one can find consistent data in the different descriptions and recipes provided. This scholarly agreement indicates systematic medical and midwifery practices to deal with a predictable, but frequently troublesome, stage of children's development.

Light modulates important physiological features of Ralstonia pseudosolanacearum during the colonization of tomato plants.

Ralstonia pseudosolanacearum GMI1000 (Rpso GMI1000) is a soil-borne vascular phytopathogen that infects host plants through the root system causing wilting disease in a wide range of agro-economic interest crops, producing economical losses. Several features contribute to the full bacterial virulence. In this work we study the participation of light, an important environmental factor, in the regulation of the physiological attributes and infectivity of Rpso GMI1000. In silico analysis of the Rpso genome revealed the presence of a Rsp0254 gene, which encodes a putative blue light LOV-type photoreceptor. We constructed a mutant strain of Rpso lacking the LOV protein and found that the loss of this protein and light, influenced characteristics involved in the pathogenicity process such as motility, adhesion and the biofilms development, which allows the successful host plant colonization, rendering bacterial wilt. This protein could be involved in the adaptive responses to environmental changes. We demonstrated that light sensing and the LOV protein, would be used as a location signal in the host plant, to regulate the expression of several virulence factors, in a time and tissue dependent way. Consequently, bacteria could use an external signal and Rpsolov gene to know their location within plant tissue during the colonization process.

Discovery and quantification of anaerobic nitrogen metabolisms among oxygenated tropical Cuban stony corals.

Coral reef health depends on an intricate relationship among the coral animal, photosynthetic algae, and a complex microbial community. The holobiont can impact the nutrient balance of their hosts amid an otherwise oligotrophic environment, including by cycling physiologically important nitrogen compounds. Here we use 15N-tracer experiments to produce the first simultaneous measurements of ammonium oxidation, nitrate reduction, and nitrous oxide (N2O) production among five iconic species of reef-building corals (Acropora palmata, Diploria labyrinthiformis, Orbicella faveolata, Porites astreoides, and Porites porites) in the highly protected Jardines de la Reina reefs of Cuba. Nitrate reduction is present in most species, but ammonium oxidation is low potentially due to photoinhibition and assimilatory competition. Coral-associated rates of N2O production indicate a widespread potential for denitrification, especially among D. labyrinthiformis, at rates of ~1 nmol cm-2 d-1. In contrast, A. palmata displays minimal active nitrogen metabolism. Enhanced rates of nitrate reduction and N2O production are observed coincident with dark net respiration periods. Genomes of bacterial cultures isolated from multiple coral species confirm that microorganisms with the ability to respire nitrate anaerobically to either dinitrogen gas or ammonium exist within the holobiont. This confirmation of anaerobic nitrogen metabolisms by coral-associated microorganisms sheds new light on coral and reef productivity.

Synthesis, characterization and antimicrobial properties of a Co(II)-phthalylsulfathiazolate complex.

The reaction between phthalylsulfathiazole (H(2)PST), in alkaline aqueous solution, and cobalt(II) nitrate led to a pink solid, [Co(PST)(H(2)O)(4)] (1), which was characterized by elemental and thermogravimetric analysis; FT-IR, Raman and diffuse reflectance spectra. Spectroscopic data reveal that the ligand would be doubly deprotonated and that the Co(II) ion environment is a distorted octahedral one. (1) showed antibacterial activity similar to the ligand.

Antifungal activity of extracts and prenylated coumarins isolated from Baccharis darwinii Hook & Arn. (Asteraceae).

The petroleum ether extract of Baccharis darwinii showed activity against Cryptococcus neoformans and dermatophytes. Bioactivity-guided fractionation of Baccharis darwinii has resulted in the isolation of three coumarins: 5'-hydroxy aurapten (anisocoumarin H, 1), aurapten (7-geranyloxycoumarin, 2) and 5'-oxoaurapten (diversinin, 3). The structures of these compounds were characterized by spectroscopic methods. These compounds were evaluated for their antimicrobialactivity against a panel of each, bacteria and fungi. Compound 3 showed the best activities against Microsporum gypseum, Trichophyton rubrum and Trichophyton mentagrophytes with MICs = 15.6 microg/mL, followed by compound 1 whose MICs against the same fungi were 62.5 microg/mL. In addition they showed fungicidal rather than fungistatic activity. Both compounds showed moderate activity (MICs = 125 microg/mL) against Cryptococcus neoformans. This is the first report of the presence of compound 1 in B. darwinii.

Brief interventions to promote behavioral change in primary care settings, a review of their effectiveness for smoking, alcohol and physical inactivity. / Intervenciones breves para promover cambios conductuales en el ámbito de la atención primaria: revisión de su efectividad en consumo de tabaco, alcohol y sedentarismo.

The brief intervention is a therapeutic strategy suggested to address behavioral changes associated with risk factors for chronic non-communicable diseases and there is ample evidence of its effectiveness. However, this evidence is sustained by various definitions of “brief intervention”, a fact that makes the clinical application of this strategy difficult. This literature review article aimed to conduct a search for systematic reviews in the Epistemonikos database in order to identify common factors in the definition of “brief intervention” and summarize some brief intervention strategies frequently used in primary health care. It also seeks to describe their effectiveness, for three risk factors: tobacco, alcohol and physical activity, within this clinical context.

La intervención breve en salud es una estrategia terapéutica, sugerida para abordar cambios conductuales asociados a factores de riesgo de enfermedades crónicas no transmisibles. Existe amplia evidencia sobre su efectividad. Sin embargo, esta evidencia se sustenta en distintas definiciones de intervención breve, lo que dificulta su aplicación clínica. Este artículo de revisión de literatura, se propuso realizar una búsqueda de revisiones sistemáticas en la base de datos Epistemonikos con el fin de identificar factores comunes en su definición y resumir algunas estrategias de intervención breve usadas con frecuencia en la atención primaria de salud. Asimismo, se busca describir su efectividad en este contexto clínico, para tres factores de riesgo: tabaco, alcohol y actividad física.

Intervenciones en competencias parentales: evaluación de eficacia del modelo PPF y triple P / Parenting skills interventions: evaluating the effectiveness of the FPP and triple P models

Las capacidades prácticas de los padres para cuidar, proteger y educar a sus hijos, asegurándoles un desarrollo sano, son los aspectos centrales de las competencias parentales. La intervención del Programa de Prevención Focalizada en Chile (PPF) y de Triple P en su 4to nivel (grupal) -de origen Australiano- tiene entre sus propósitos, fortalecer las competencias parentales en personas que tengan a cargo un niño/a. La presente investigación de diseño cuasi experimental, de tipo pre-post con grupo control equivalente, comparó la eficacia de ambos programas en la intervención de competencias parentales, en una muestra de 15 padres y cuidadores de niños/as entre 2 y 12 años. Los resultados muestran que no hay diferencias significativas en las variables estilos de crianza, autoeficacia parental y dificultades de ajuste en la infancia entre las intervenciones realizadas a través del modelo Triple P versus PPF, así como tampoco en la evaluación de estas variables pre y post intervención en ninguna de las dos estrategias. Aunque los resultados resultan interesantes en términos de discusión sobre la efectividad de estas estrategias de intervención en las variables descritas, las dificultades asociadas a la adherencia de las familias a las citaciones y el bajo número de sujetos con el que contó la investigación deben tomarse en cuenta al analizar nuestros resultados. Se recomienda incluir análisis cualitativos e investigaciones con un N mayor que permitan comparar los resultados y mejorar la evidencia sobre la efectividad de estos programas de intervención.

The practical abilities of parents to care for, protect and educate their children, ensuring their healthy development, are the central aspects of parental competencies. The intervention of the Chilean Focused Prevention Programme (PPF) and Triple P in its 4th level (group) - of Australian origin - has, among its purposes, to strengthen parental competencies in people who are in charge of a child. The present research of quasi-experimental design, of pre-post type with an equivalent control group, compared the effectiveness of both programmes in parenting skills in a sample of 15 parents and caregivers of children between 2 and 12 years old. The results show no significant differences in the variables of parenting styles, parental self-efficacy, and adjustment difficulties in childhood between the interventions carried out through the Triple P model versus PPF, nor in assessing these variables pre and post intervention in either of the two strategies. Although the results are interesting as a discussion of the effectiveness of these intervention strategies on the variables described, the difficulties associated with families' adherence to the citations and the low number of subjects in the research should be considered when analysing our results. It is recommended to include qualitative analyses and research with a higher N to compare the results and improve the evidence on the effectiveness of these intervention programmes.

MALDI-TOF to compare polysaccharide profiles from commercial health supplements of different mushroom species.

In this work MALDI-TOF mass spectroscopy was investigated to characterise the ß-glucan profiles of several commercial health supplements, without any derivatisation or purification pre-treatment. The effect of two solvents (water and dimethyl sulfoxide) and two MALDI matrices (2,5-dihydroxybenzoic acid and 2',4',6'-trihydroxyacetophenone) was first evaluated on dextran standards. MALDI-TOF was found as a useful and quick technique to obtain structural information of diverse food supplements based on mushroom extracts. The MALDI polysaccharide profiles of 5 supplements from different mushroom species were qualitatively similar showing [Glucan+Na](+) cations with a peak-to-peak mass difference of 16 Da consistent with the repeating unit of the ß-(1→3)-glucan. The profiles strongly depended on the sample solvent used, with m/z values around 5000-8000 for water and 2000 for dimethyl sulfoxide; differences between samples were revealed in the molecular weight of the aqueous preparation, with the highest values for Maitake and Cordyceps species.

Complicaciones de la nefrolitotomía percutánea como tratamiento de la litiasis renal coraliforme

RESUMEN Introducción: La nefrolitotomía percutánea es la primera opción terapéutica para la litiasis renal coraliforme. Objetivo: Caracterizar a los pacientes con complicaciones de la nefrolitotomía percutánea para el tratamiento de la litiasis renal coraliforme. Método: Se estudió una serie de 191 pacientes, operados mediante nefrolitotomía percutánea. Variables estudiadas: tipo de litiasis coraliforme, posición para la técnica, condición de libre de litiasis después de la operación, presencia de complicaciones, momento, tipo y grado según clasificación de Clavien-Dindo. Se hallaron frecuencias absolutas, relativas y se utilizó el test de ji cuadrado para determinar asociación entre variables. Resultados: El 86,9 % tenía menos de 60 años, 67,0 % eran masculinos, 61,7 % presentaba comorbilidades. La litiasis coraliforme era parcial o total (30,3 % y 46,5 %, respectivamente). En 60,2 % afectaba el riñón izquierdo; 58,1 % se operaron en supino y 70,2 % quedaron libre de litiasis con la nefrolitotomía percutánea monoterapéutica. Ocurrieron complicaciones en 19,9 %; 16,2 % fueron postoperatorias, 14,1 % infecciosas, 7,8 % Clavien-Dindo I y 5,2 % IIIb. El tipo de litiasis y la posición de la nefrolitotomía percutánea no se asociaron con las complicaciones (p> 0,05). El grado de la complicación no se relacionó con el tipo de litiasis (p> 0,05). Conclusiones: Las complicaciones postoperatorias más frecuentes son las relacionadas con la infección y el sangrado; predominan ligeramente en los pacientes con litiasis coraliformes parcial, total y en los operados en supino; el grado Clavien-Dindo de las complicaciones, es mayor en las litiasis coraliformes más complejas.

ABSTRACT Introduction: Percutaneous nephrolithotomy is the first therapeutic option for staghorn kidney stones. Objective: To characterize patients with complications of percutaneous nephrolithotomy for the treatment of staghorn renal lithiasis. Method: A series of 191 patients, operated by percutaneous nephrolithotomy, was studied. Variables studied: type of staghorn lithiasis, position for the technique, stone-free condition after the operation, presence of complications, time, type and grade according to the Clavien-Dindo classification. Absolute and relative frequencies were found and the chi-square test was used to determine the association between variables. Results: 86.9 % were less than 60 years old, 67,0 % were male, 61,7 % had comorbidities. The staghorn lithiasis was partial or total (30,3 % and 46,5 %, respectively). In 60,2 % it affected the left kidney; 58.1 % underwent supine surgery and 70,2 % were stone free with monotherapeutic percutaneous nephrolithotomy. Complications occurred in 19,9 %; 16,2 % were postoperative, 14,1 % infectious, 7,8 % Clavien-Dindo I, and 5,2 % IIIb. The type of lithiasis and the position of the percutaneous nephrolithotomy were not associated with complications (p> 0,05). The degree of complication was not related to the type of lithiasis (p> 0,05). Conclusions: The most frequent postoperative complications are those related to infection and bleeding; they slightly predominate in patients with partial and total staghorn stones and in those operated on in the supine position; the Clavien-Dindo grade of complications is higher in the more complex staghorn stones.

Class Anxiety in Secondary Education: Exploring Structural Relations with Perceived Control, Engagement, Disaffection, and Performance.

The aim of this study was to assess the relationships between class-related anxiety with perceived control, teacher-reported behavioral engagement, behavioral disaffection, and academic performance. Participants were 355 compulsory secondary students (9th and 10th grades; Mean age = 15.2 years; SD = 1.8 years). Structural equation models revealed performance was predicted by perceived control, anxiety, disaffection, and engagement. Perceived control predicted anxiety, disaffection, and engagement. Anxiety predicted disaffection and engagement, and partially mediated the effects from control on disaffection (ß = -.277, p < .005; CI = -.378, -.197) and engagement (ß = .170, p < .002; CI = .103 .258). The negative association between anxiety and performance was mediated by engagement and disaffection (ß = -.295, p < .002; CI = -.439, -.182). Anxiety, engagement, and disaffection mediated the effects of control on performance (ß = .352, p < .003; CI = .279, .440). The implications of these results are discussed in the light of current theory and educational interventions.