Nosocomial SARS-CoV-2 infection in urology departments: Results of a prospective multicentric study.

OBJECTIVE: To evaluate the coronavirus disease 2019 perioperative infection rate and mortality rate of patients undergoing urological surgeries during the early pandemic period in Spain. METHODS: This was a non-interventional multicenter prospective study carried out from 9 March to 3 May 2020 in two urology departments in Madrid, Spain. Clinical, microbiological and radiological data of patients who underwent surgery were collected from computerized medical records. RESULTS: A total of 148 patients were included in the study, and 141 were analyzed for nosocomial infection risk, after excluding previous and concomitant severe acute respiratory syndrome coronavirus type 2 infections. Elective surgeries represented 76.6% of the procedures, whereas emergent surgeries represented 23.4%. Preoperative screening was carried out with polymerase chain reaction test in 34 patients, all were negative. A total of 14 patients also had chest X-ray (not suspicious in all cases). Three patients (2.1%) developed severe acute respiratory syndrome coronavirus type 2 nosocomial infection (symptoms developed between the third day after surgery to the 14th day after hospital discharge). Time from admission to a compatible clinical case was 5.5 days (4-12 days). Two patients underwent surgery with concomitant diagnosis of coronavirus disease. The mortality rate due to severe acute respiratory syndrome coronavirus type 2 infection is 0.7%, and the specific mortality rate in patients undergoing surgery with community-acquired coronavirus disease 2019 infection was 50% (1/2). CONCLUSIONS: The nosocomial severe acute respiratory syndrome coronavirus type 2 infection rate was low in patients undergoing urological surgical procedures during the peak of the pandemic in Madrid. With appropriate perioperative screening, urological surgical activity can be carried out in safety conditions.

[Results of active surveillance in low and intermediate risk prostate cancer]. / Resultados de la vigilancia active en cancer de prostata de riesgo bajo e intermedio.

In this article we review the most significant published papers on active surveillance in prostate cancer and present the results of our case series. We used as main response variables the percentage of patients remaining in surveillance and the oncological results presented as global, cancer specific and metastasis free survivals. Globally, in published series 71.2% of patients included in active surveillance programs, 10-year overall survival is 68% in the series with longer follow up, and cancer-specific survival varies from 97% to 100%. In our series of 144 patients with median follow up of 3.2 years, 76.3% of the patients continue on surveillance. 24 patients (15.9%) stopped surveillance due to histological progression. 5 patients (21.3%) out of the 23 undergoing surgery presented unfavorable pathological criteria on prostatectomy specimen. No patient has died or developed metastases.

Leisure Time Habits and Levels of Physical Activity in Children and Adolescents.

BACKGROUND/OBJECTIVES: Childhood and adolescence are important stages of life for acquiring healthy habits. There is a high prevalence of sedentary lifestyles worldwide during these ages, which negatively impacts health. This is attributed, in part, to excessive time spent engaging in sedentary behaviors. The aim of this study was to assess the time spent on sedentary behaviors and their relationship with physical activity levels in children and adolescents in the Community of Madrid. METHODS: A total of 26,729 participants aged 10-17 from various schools and institutes took part in this study. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was used, and they were asked about the time they spent on different leisure time habits (specific sedentary behaviors and organized physical activity). A generalized linear model was used to analyze the association between the time spent in sedentary activities and the time spent in physical activity. RESULTS: The results revealed that children and adolescents engage in low levels of physical activity and most of them spend considerable time in sedentary behaviors such as studying, watching television, or using social media. Completing school homework (Coef: 1.23, 95% CI: -0.51 to 2.97, p = 0.167) or using social media for more than 2 h (Coef: 1.29, 95% CI: -2.98 to 0.40, p = 0.133) compared to not dedicating time to them did not show a significant association with daily physical activity time. Watching television for more than 2 h was associated with a decrease of 2.60 min (95% CI: -4.41 to -0.78, p = 0.005). Thus, no or only irrelevant associations were found between time spent in sedentary activities and physical activity time. CONCLUSIONS: Despite the drawbacks of spending time engaging in sedentary behaviors, they seem to be compatible with physical activity levels. Therefore, it is important to continue research on physical activity adherence strategies to promote overall health and well-being.

The role of ischemia in the deterioration of renal function after partial nephrectomy.

OBJECTIVES: Nephron-sparing surgery (NSS ) has been considered throughout history for patients with solitary kidney, bilateral renal tumors, impaired renal function (RF), and hereditary renal cancer. However, recently the indications for Partial Nephrectomy (PN ) have extended and include patients with a healthy contralateral kidney. NSS has evolved in a great way during the last decade, specifically in terms of oncological indications, and in the renal ischemia time used with the goal to maintain as much renal function as possible. This change is secondary to a better understanding of renal cancer histology, the equivalence in oncological outcomes between radical and PN, and finally the impact of chronic kidney disease (CKD ) as a cause of cardiovascular complications and mortality.The main purpose of our study is to review the role of ischemia in NSS. METHODS: A literature review was performed focusing on NSS, risk factors of renal damage, types of ischemia, as well as its effect on RF, and ischemia time. CONCLUSIONS: Renal ischemia has been considered for a long time as the main factor related with postoperative Renal Function (RF) in patients with NSS. Furthermore it is one of the few modifiable factors that directly depend on the surgeon. The ischemia time limit, both in warm and cold, is not well established and is a controversial issue that is still on debate till now. At this moment, there is evidence that considers the impact of ischemia only in acute or early stages. Also other factors have emerged and seem to have greater effect on RF, mainly in the long-term, leaving ischemia in second place. These factors are the quantity and quality of the remaining renal parenchyma. More studies are needed to support this rising concept and to clarify the real part that ischemia plays.

Barriers to Physical Activity in Spanish Children and Adolescents: Sex and Educational Stage Differences.

According to worrisome childhood obesity and inadequate physical activity (PA) levels worldwide, especially exacerbated in adolescents girls, this work aimed to identify sex and educational stage differences in barriers to meet PA requirements and international guidelines in Spanish children and adolescents considering the entire educational pathway (primary, secondary, and college). The Short Form of the International PA Questionnaire and the Scale of Perceived Barriers were administered to primary, secondary, and college education students (13,491 boys and 13,238 girls, 9-19 yrs). Two-way ANOVA was performed to analyze barriers to PA according to sex and educational stage with physical status as covariate. Higher disliking and time barriers were reported by females (1.5 ± 1.2 and 3.2 ± 1.5 points) in comparison to males (1.2 ± 1.0 and 2.8 ± 1.4), while primary students showed lower disliking and time (1.2 ± 1.0 and 2.8 ± 1.5) and higher safety (3.1 ± 1.8) constraints in comparison to secondary (1.4 ± 1.1, 3.1 ± 1.4, and 2.8 ± 1.7) and college (1.5 ± 1.2, 3.2 ± 1.5, and 2.8 ± 1.6; p < 0.05 for all comparisons). College females showed higher disliking (1.7 ± 1.2) and time (3.5 ± 1.4) barriers than secondary females (1.5 ± 1.2 and 3.3 ± 1.4; p < 0.05). Sex and educational stage were determinant for time and dislike of PA barriers, which were rated higher by female students in comparison to their male counterparts and from primary education onwards. Altogether this, suggests promotion strategies should carefully consider girls and the step into secondary school.

Relation of Physical Activity Level to Postural Balance in Obese and Overweight Spanish Adult Males: A Cross-Sectional Study.

The aim of this study was to analyze the influence of physical activity level on postural control in obese and overweight Spanish adult males. Forty-three males aged between 25 and 60 years old were included. Anthropometric, body composition, and physical activity variables were assessed, and postural control was evaluated using the Sensory Organization Test. No correlation was found between the level of physical activity and postural control, assessed by the Sensory Organization Test within the whole sample. However, within the group with a higher total fat mass percentage, non-sedentary individuals presented improved scores on the somatosensory organization test when compared to sedentary individuals (96.9 ± 1.8 vs. 95.4 ± 1.2; p < 0.05) and poorer scores on the composite equilibrium score (73.4 ± 7.2 vs. 79.2 ± 6.9; p < 0.05). The altered integration of somatosensory inputs most likely affects the tuning, sequencing, and execution of balance strategies in sedentary men with a high total fat mass percentage.

Long-Term Experience with Hyperthermic Chemotherapy (HIVEC) Using Mitomycin-C in Patients with Non-Muscle Invasive Bladder Cancer in Spain.

(1) Background: Intravesical mitomycin-C (MMC) combined with hyperthermia is increasingly used in non-muscle invasive bladder cancer (NMIBC), especially in the context of a relative BCG shortage. We aim to determine real-world data on the long-term treatment outcomes of adjunct hyperthermic intravesical chemotherapy (HIVEC) with MMC and a COMBAT® bladder recirculation system (BRS); (2) Methods: A prospective observational trial was performed on patients with NMIBC treated with HIVEC using BRS in nine academic institutions in Spain between 2012-2020 (HIVEC-E). Treatment effectiveness (recurrence, progression and overall mortality) was evaluated in patients treated with HIVEC MMC 40mg in the adjuvant setting, with baseline data and a clinical follow-up, that comprise the Full Analysis Set (FAS). Safety, according to the number and severity of adverse effects (AEs), was evaluated in the safety (SAF) population, composed by patients with at least one adjunct HIVEC MMC instillation; (3) Results: The FAS population (n = 502) received a median number of 8.78 ± 3.28 (range 1-20) HIVEC MMC instillations. The median follow-up duration was 24.5 ± 16.5 (range 1-81) months. Its distribution, based on EAU risk stratification, was 297 (59.2%) for intermediate and 205 (40.8%) for high-risk. The figures for five-year recurrence-free and progression-free survival were 50.37% (53.3% for intermediate and 47.14% for high-risk) and 89.83% (94.02% for intermediate and 84.23% for high-risk), respectively. A multivariate analysis identified recurrent tumors (HR 1.83), the duration of adjuvant HIVEC therapy <4 months (HR 1.72) and that high-risk group (HR 1.47) were at an increased risk of recurrence. Independent factors of progression were high-risk (HR 3.89), recurrent tumors (HR 3.32) and the induction of HIVEC therapy without maintenance (HR 2.37). The overall survival was determined by patient age at diagnosis (HR 3.36) and the treatment duration (HR 1.82). The SAF population (n = 592) revealed 406 (68.58%) patients without AEs and 186 (31.42%) with at least one AE: 170 (28.72%) of grade 1-2 and 16 (2.7%) of grade 3-4. The most frequent AEs were dysuria (10%), pain (7.1%), urgency (5.7%), skin rash (4.9%), spasms (3.7%) and hematuria (3.6%); (4) Conclusions: HIVEC using BRS is efficacious and well tolerated. A longer treatment duration, its use in naïve patients and the intermediate-risk disease are independent determinants of success. Furthermore, a monthly maintenance of adjunct MMC HIVEC diminishes the progression rate of NMIBC.

[Antibiotic prophylaxis in prostatic surgery: Adherence to the hospital protocol. Prospective cohort study.] / Profilaxis antibiótica en cirugía de próstata: adecuación al protocolo hospitalario. Estudio de cohortes prospectivo.

OBJECTIVES: To assess the adherence to the antibiotic prophylaxis protocol in patients undergoing prostate surgery and evaluate the effect of antibiotic prophylaxis on surgical site infections (SSI). MATERIAL AND METHODS: A prospective cohort study was carried out between January 2009 and September 2016. The global compliance with the antibiotic prophylaxis protocol was evaluated studying the items: time of onset, route of administration, antibiotic prescribed, duration and dose. Percentages of adequacy are described. The incidence of infection was calculated after 30 days of follow-up. Relationship between the adequacy to the protocol and the surgical site infection are described with the relative risk. RESULTS: A total of 595 patients were studied. The global adequacy was 93.8%. The leading cause of inadequacy was the time of onset 3%. The incidence of surgical site infection was 1%. No relationship between the inadequacy of antibiotic prophylaxis and surgical site infection (RR=1.1%; 95%CI: 1.0-1.2) was found. No relationship between the procedure (laparoscopic or open surgery) and surgical site infection (RR=0.4%; 95%CI: 0.1-1.9) was found. CONCLUSIONS: The adequacy of antibiotic prophylaxis was high. The incidence of surgical site infection was low and compliance of antibiotic prophylaxis contributes to diminish surgical site infection incidence.

OBJETIVO: El objetivo de este trabajo ha sido evaluar la adecuación de la profilaxis antibiótica y su relación con la incidencia de infección de sitio quirúrgico (ISQ) en pacientes sometidos a cirugía de próstata.MATERIAL Y MÉTODOS: Estudio de cohortes prospectivo, realizado de enero de 2009 a septiembre de 2016. Se evaluó la adecuación global al protocolo de profilaxis antibiótica y de cada apartado de la profilaxis (inicio, vía de administración, antibiótico de elección, duración y dosis). Se describieron los porcentajes de adecuación. Se calculó la incidencia de infección tras un periodo máximo de 30 días de incubación. Se evaluó la adecuación entre adecuación de la profilaxis e ISQ mediante el riesgo relativo (RR). RESULTADOS: Se incluyeron 595 pacientes en el estudio. La adecuación global fue del 93,8%. La mayor causa de incumplimiento fue el inicio de la profilaxis con un 3,0%. La incidencia de infección de sitio quirúrgico fue del 1,0%. No se encontró relación entre la inadecuación de la profilaxis antibiótica y la infección de sitio quirúrgico (RR=1,01; IC95%: 1,00-1,02). No se encontró relación en el riesgo de infección entre la cirugía laparoscópica y la cirugía abierta (RR=0,37; IC95%: 0,08-1,98). CONCLUSIONES: La adecuación de la profilaxis antibiótica fue alta. La incidencia de infección de sitio quirúrgico fue baja y la adecuada cumplimentación de la profilaxis antibiótica en la cirugía de próstata permite reducir la incidencia de infección de sitio quirúrgico.

[Complicated renal cyst by fistula from acute appendicitis on an appendicular mucocele. First literature report.] / Quiste renal complicado por fistulización de apendicitis aguda sobre un mucocele apendicular. Primera descripción en la literatura.

We describe the first clinical case in the reviewed literature of a patient with a complicated renal cyst by fistula of an appendicular neoplasm with acute appendicitis, as well as the management performed and the therapeutic options in similar cases.

Se describe el primer caso clínico en la literatura revisada de un paciente con un quiste renal complicado por sobreinfección tras fistulización de una neoplasia apendicular con apendicitis aguda, así como el manejo realizado y las opciones terapéuticas en un caso similar.

Recognition of Barriers to Physical Activity Promotion in Immigrant Children in Spain: A Qualitative Case Study.

Physical activity facilitates the acquisition of healthy habits from childhood to adulthood. Differences exist regarding the performance of physical activity among immigrant children compared to native Spanish children. The purpose of the study was to describe the barriers that exist for the promotion of physical activity. A qualitative case-study approach was implemented. Parents of immigrant children, teachers, a school principal, and priests were included, using purposeful sampling. Data were collected from 25 participants, via unstructured and semi-structured interviews, focus groups, and researchers' field notes. A thematic analysis was performed and ecological levels were identified. Our findings revealed the following barriers to performing physical activity: (a) the meaning of physical activity, (b) gender inequalities, (c) academic burden, (d) lack of social contact, (e) expenses and family economy, (f) lack of infrastructure and natural surroundings, (g) time constraints, (h) fear and insecurity, and (i) the reason for immigrating. These results may be used to revise the school curriculum, promoting equal opportunities for physical activity and encouraging family participation. Additionally, urban design policies should be encouraged to facilitate access to open spaces for recreation within cities.

[Relationship of physical activity level and body composition on postural control in male adults]. / Relación del nivel de actividad física y de la composición corporal en el control postural en adultos varones.

INTRODUCTION: balance is very important in order to perform daily physical activities as standing or walking. Both physical activity and body composition are some of the most important adjustable intrinsic factors influencing balance. OBJECTIVE: to analyze the influence of physical activity level and different body variables on the postural control of male adults. METHODS: observational, cross-sectional study with 63 men between 25 and 60 years of age, with body mass index (BMI) between 18 and 35 kg/ m2. Anthropometric variables (e.g., weight, BMI, waist circumference), body composition and its distribution (e.g., percentage of total fat mass: TFM%, of the legs: LFM%, and android: AFM%), physical activity (PAL) and postural control (e.g., SOM ratio) were measured. Multiple linear regression was used to evaluate the relationship of all variables with the SOM ratio. RESULTS: the results of this study show a correlation between TFM% (r = -0.384, p = 0.002), AFM% (r = -0.421, p = 0.001) and PAL (r = 0.291, p = 0.021) with the SOM ratio. In addition, individuals classified as obese (TFM% ≥ 28) scored worse on SOM ratio than non-obese individuals (97.33 ± 2.52 vs 96.37 ± 1.54, p = 0.013), and individuals classified as active (PAL ≥ 1.4) scored higher on SOM ratio than sedentary individuals (97.13 ± 2.33 vs 96.18 ± 1.38; p = 0.035). CONCLUSIONS: the fat mass and PAL seem to influence proprioceptively on postural control, being the waist circumference the variable that predicts SOM ratio the most.

INTRODUCCIÓN: el equilibrio es crucial para el desempeño de actividades de la vida diaria como la bipedestación o la marcha. La actividad física y la composición corporal son algunos de los factores intrínsecos modificables más importantes que influyen en el equilibrio. OBJETIVO: analizar la influencia del nivel de actividad física (PAL) y de diferentes variables corporales sobre el control postural de adultos varones. MÉTODOS: estudio observacional, transversal, con 63 varones de entre 25 y 60 años, con índice de masa corporal (IMC) entre 18 y 35 kg/m2. Se midieron variables antropométricas (i.e., peso, IMC, perímetro de cintura), de composición corporal y de su distribución (i.e., porcentaje de masa grasa de piernas: %MGP, androide: %MGA y total: %MGT), de actividad física (PAL) y de control postural (i.e., ratio somatosensorial: SOT-SOM). Se utilizó una regresión lineal múltiple para evaluar la relación de todas las variables con la SOT-SOM. RESULTADOS: los resultados de este estudio muestran una correlación entre %MGT (r = -0,384, p = 0,002), %MGA (r = -0,421, p = 0,001) y PAL (r = 0,291, p = 0,021) con la SOT-SOM. Además, los individuos clasificados como obesos (%MGT ≥ 28) obtuvieron peores puntuaciones en la SOT-SOM que los individuos no obesos (97,33 ± 2,52 vs. 96,37 ± 1,54; p = 0,013) y los individuos clasificados como activos (PAL ≥ 1,4) obtuvieron mejores puntuaciones en la SOT-SOM que los individuos sedentarios (97,13 ± 2,33 vs. 96,18 ± 1,38; p = 0,035). CONCLUSIONES: la masa grasa y el PAL parecen influir a nivel propioceptivo en el control postural, siendo el perímetro de cintura la variable que más predice la SOT-SOM.

[PSA doubling time as a new diagnostic and prognostic method for prostate cancer]. / El tiempo de doblaje de PSA como nuevo método diagnóstico y pronóstico del cáncer de próstata.

OBJECTIVES: To review the value of PSA kinetics in the diagnosis and prognosis of prostate cancer. METHODS: Review of the literature through a Medline search. CONCLUSIONS: A pre-tretament PSAV value >2ng/ ml/yr is a risk factor for increased mortality from prostate cancer after surgery or radiation therapy. A PSADT<3ms is indicative of reduced survival after treatment. For patients with PSA recurrence after surgery a PSADT> 10 is more likely associated with local recurrence.