Pediatric kidney dimensions and risk of persistent albuminuria in Mexican adolescents.

In Mexico, chronic kidney disease of unknown origin is highly prevalent. Screening studies in adolescents have shown persistent microalbuminuria (pACR), adaptive podocytopathy and decreased kidney volume (KV). Here, we sought to develop normality tables of kidney dimensions by ultrasound in the Mexican state of Aguascalientes pediatric population (0 to 18y) and evaluate the relationship between the KV and pACR among the region's adolescents in a cross-sectional study. Kidney length (KL) and KV were determined by ultrasound. Our findings were compared with those in international literature of different populations where tables and graphs of normal kidney dimensions by ultrasound were reported. We compared organ dimensions in individuals above the age of 11 without albuminuria with those in patients with pACR recruited through screening studies in adolescents in Aguascalientes. This included 1068 individuals to construct percentile tables and graphs of the KL. Kidney dimensions were significantly lower when compared with all international comparisons. From a total 14,805 screen individuals, we compared 218 adolescents with pACR and 377 individuals without significant albuminuria. The Total KV adjusted to body surface (TKVBS) was significantly associated with pACR (odds ratio 1.03, 95% confidence interval 1.02-1.03). The upper quartile of TKVBS was highly associated with pACR (7.57, 4.13-13.87), hypertension (2.53, 1.66-3.86), and hyperfiltration (26 vs 11.5%). Thus, TKVBS is directly associated with pACR while greater KV, arterial hypertension, and hyperfiltration in patients with pACR suggest that the increase in volume is secondary to kidney hypertrophy. Additionally, the adaptative podocytopathy with low fibrosis seen on kidney biopsy which was performed in a subset of patients, and the smaller kidney dimensions in our population point to prenatal oligonephronia as the primary cause of the detected kidney disease.

Defining bladder outlet obstruction and detrusor underactivity in females with overactive bladder: Are we forgetting about the free uroflowmetry?

INTRODUCTION: Both detrusor underactivity (DU) and bladder outlet obstruction (BOO) can coexist in patients with overactive bladder. Definitions of both DU and BOO are based on pressure-flow study (PFS) data. However, invasive urodynamics study can differ from a natural micturition, in fact, discrepancies between free uroflowmetry (UFM) and PFS have been largely described. Our goal is to assess the correlation of free-flowmetry and PFS among patients with OAB and to evaluate how different definitions of DU/BOO are able to discriminate patients with different free UFMs. METHODS: A retrospective review of urodynamics performed at a single institution was conducted. Females with OAB who voided more than 150 mL in both UFM and PFS were included. Parameters from both voiding episodes were compared with nonparametric test. Two definitions of DU were applied; PIP1: Pdet@Qmax+Qmax < 30 and Gammie: Pdet@Qmax < 20 cmH2 O, Qmax < 15 mL/s, and BVE < 90% (Bladder voiding efficiency). Also, two definitions of obstruction were chosen; Defretias: Pdet@Qmax ≥25 cmH2 O and Qmax ≤ 12 mL/s and Solomon-Greenwell female BOO index ≥ 18. Patients who matched with each definition were compared to those who did not, to assess if any definitions were able to discriminate different noninvasive uroflowmetries. RESULTS: A total of 195 patients were included. Overall, mean age was 55 ± 12 years, 90.8% had mixed urinary incontinence, and 39% complained of at least one voiding symptom. Globally, Qmax and BVE correlated poorly between UFM and PFS, showing that most of the variation corresponded to a systematic error. Twenty-two individuals were found to have DU, they had a difference of 13 mL/s on both maximum flows. Fifty-four patients showed BOO, with a difference between their Qmax of 19 mL/s. Among the four definitions analyzed, only PIP1 and Defreitas were able to discriminate patients with actually a lower Qmax on the free UFM. CONCLUSIONS: Patients with overactive bladder seem to have a systematic discordance between the urine flow of the free and invasive studies. Current definitions of DU and BOO, which are based on the PFS parameters, are not consistently able to discriminate patients who actually void deficiently on the free UFM.

[Living-donor kidney graft ex vivo endoscopic nephrolithotomy with flexible instrument]. / Nefrolitotomía Endoscópica ex vivo del injerto renal de donante vivo con instrumento flexible.

INTRODUCTION: The finding of an asymptomatic stone in the study of a living kidney donor does not necessarily contraindicate donation, however, there is no consensus on the management of these cases. The use of a graft with lithiasis may represent a risk of recurrence in the remaining kidney in the donor and eventual obstructive complications in the transplanted kidney. The objective of this work is to present the usefulness of ureteroscopy (URS) to resolve lithiasis ex vivo before transplantation. MATERIAL AND METHODS: Donors with a small, asymptomatic kidney stone and with an analysis of lithogenic factors without relevant findings were considered to continue in the donation process. The kidney unit with stone was selected for nephrectomy. RESULTS: Four donor kidneys underwent flexible URS after nephrectomy under hypothermic preservation conditions during bench preparation. The average time of the procedure was 35 minutes and the stone was extracted in all cases without incident. The transplant was carried out in the usual way and the evolution of the recipients was without complications and with excellent renal function. During follow-up, no recurrence of lithiasis was observed in donors or recipients. CONCLUSIONS: In this experience, the URS of the donor kidney was a feasible procedure and was not associated with adverse consequences for the graft. The main advantage of this procedure is to avoid the potential risk to the recipient of an obstructive graft complication.

[Prognostic factors in patients with upper urinary tract urothelial carcinoma undergoing nephro-ureterectomy]. / Tabaquismo y tumores mayores de 2 centímetros son predictores de mortalidad en pacientes sometidos a nefro-ureterectomías por carcinoma de urotelio alto.

BACKGROUND: Upper urinary tract urothelial carcinoma (UTUC) represents 5-10% of urothelial carcinomas. It is managed with nephroureterectomy (NUR); however, kidney-sparing techniques are growingly used. AIM: To report the results of a 20-year series of NUR conducted in an academic center. PATIENTS AND METHODS: Review of clinical and pathological characteristics of patients undergoing NUR between 1999 and 2020. Patients were followed for 63 months. Global survival curves (OS) and mortality predictors were established through Cox regression. RESULTS: We included 90 patients with a median age of 68 years undergoing NUR, of whom 68 (75%) had a pelvic tumor and 22 (25%) had a proximal ureteral tumor. A laparoscopic NUR was performed in 60 patients (66%). Thirty-three patients (37%) had tumors confined to the urothelium (pTa), penetrating the lamina propria (pT1) or carcinoma in situ (CIS), 10 patients (11%) had a tumor spreading to the muscle layer (pT2) and 47 (52%) had a tumor spreading to nearby organs (pT3 / T4). Average tumor size was 3.69 cm, nodal disease (pN) was present 12 patients (13%). Twelve patients (13%) received adjuvant chemotherapy. A higher mortality was observed among smokers (Hazard ratio (HR) 8.79, 95% confidence intervals (CI) 1.5-49.0, p = 0.01), patients with tumors classfied as pT≥ 2 (HR 1.09, 95% CI 0.01-1.0, p = 0.04) and those with tumors larger than 2 cm (HR 14.79, CI 95% 1.5-272, p = 0.01). CONCLUSIONS: Smoking patients, those with invasive tumors (T2-T4) and greater than 2 cm have higher mortality. Therefore, they should not be candidates for conservative management.

Protective role of intravesical BCG in COVID-19 severity.

OBJECTIVES: To establish the role of BCG instillations in the incidence and mortality of COVID-19. PATIENTS AND METHODS: NMIBC patients in instillations with BCG (induction or maintenance) during 2019/2020 were included, establishing a COVID-19 group (with a diagnosis according to the national registry) and a control group (NO-COVID). The cumulative incidence (cases/total patients) and the case fatality rate (deaths/cases) were established, and compared with the national statistics for the same age group. T-test was used for continuous variables and Fisher's exact test for categorical variables. RESULTS: 175 patients were included. Eleven patients presented CIS (11/175, 6.3%), 84/175 (48.0%) Ta and 68/175 (38.9%) T1. Average number of instillations = 13.25 ± 7.4. One hundred sixty-seven patients (95.4%) had complete induction. Forty-three patients (cumulative incidence 24.6%) were diagnosed with COVID-19. There is no difference between COVID-19 and NO-COVID group in age, gender or proportion of maintenance completed. COVID-19 group fatality rate = 1/43 (2.3%). Accumulated Chilean incidence 70-79 years = 6.3%. Chilean fatality rate 70-79 years = 14%. CONCLUSIONS: According to our results, patients with NMIBC submitted to instillations with BCG have a lower case-fatality rate than the national registry of patients between 70 and 79 years (2.3% vs. 14%, respectively). Intravesical BCG could decrease the mortality due to COVID-19, so instillation schemes should not be suspended in a pandemic.

Intrarenal temperature measurement associated with holmium laser intracorporeal lithotripsy in an ex vivo model.

INTRODUCTION: The aim of this article was to quantify the effect of the use of holmium laser during intracorporeal lithotripsy in an ex vivo model. MATERIAL AND METHODS: A simulated model for laser nephro-lithotripsy was designed. Two ex vivo porcine kidneys were used. Electronic thermometer electrodes were inserted on the upper calyx. Intracorporeal lithotripsy was simulated with a holmium laser. Intrarenal temperature was recorded both at the beginning and after one minute of laser use with delta temperature (DT) defined as the difference between them. Measurements were made at different irrigation heights (30, 40, and 50 cm H2O), frequency (Hz), and laser energy (J) in addition to the presence or absence of the access sheath. Analysis of factors associated with temperature change was performed. RESULTS: Thirty-eight observations were recorded. The measurement without the use of access sheath showed an average DT of 4.9, 5.1, and 6.5°C for 5, 10, and 15 Hz, respectively; however, with a sheath, DTs were 0.2, 0.5, and 1.5°C. In terms of energy, mean DTs of 4.3, 6.1, 5.2, and 13.9°C for 0.5, 0.8, 1.0, and 1.5 J were recorded; in contrast, with a sheath, averages of 0.4, 0.5, 0.5, and 3.8°C, respectively were noted. In the adjusted model, energy, frequency, and use of sheath and water height were significant. CONCLUSIONS: The configuration of the laser significantly modifies the intrarenal temperature and height of the bladder irrigation. The use of an access sheath provides lower intrarenal temperatures regardless of laser configuration and water height.

Successful unilateral vasectomy reversal in a lion (Panthera leo).

Background: In 2016, the veterinarian team of Buin Zoo in Chile decided to try to increase the lion population. At that time, the zoo had three lions; two females and one male. The 9-year-old male had been vasectomized 5 years ago at the same institution for birth control. Considering the fact that in humans, vasectomy reversal has excellent reproductive outcomes, a team of human urologists, highly experienced in vasectomy reversal was contacted to perform the procedure. Case description: Surgery was performed on June 16, 2016 under general anesthesia, with the vasectomy site accessed through the previous scar localized in the lower groin. After opening the skin, dartos and tunica vaginalis, we were able to identify the previous vasectomy site. After liberating both vas ends and checking for permeability, a microsurgical anastomosis (magnification 25×) was performed. The surgery took 80 minutes with minimal bleeding, and no surgical complications were observed. After 2 weeks, the lion joined the lionesses and reproductive follow-up was started. Seven months after surgery, one lioness became pregnant, and 4 months later gave birth to two female lion cubs, with no incidents at the zoo. Both cubs were healthy and are still living at the zoo. Conclusion: Vasectomy reversal constitutes a valid perspective to reassume fertility in previous vasectomized lions.

Nefrolitotomía Endoscópica ex vivo del injerto renal de donante vivo con instrumento flexible

Introduction: The finding of an asymptomatic stone in the study of a living kidney donor does not necessarily contraindicate donation, however, there is no consensus on the management of these cases. The use of a graft with lithiasis may represent a risk of recurrence in the remaining kidney in the donor and eventual obstructive complications in the transplanted kidney. The objective of this work is to present the usefulness of ureteroscopy (URS) to resolve lithiasis ex vivo before transplantation. Material and Methods: Donors with a small, asymptomatic kidney stone and with an analysis of lithogenic factors without relevant findings were considered to continue in the donation process. The kidney unit with stone was selected for nephrectomy. Results: Four donor kidneys underwent flexible URS after nephrectomy under hypothermic preservation conditions during bench preparation. The average time of the procedure was 35 minutes and the stone was extracted in all cases without incident. The transplant was carried out in the usual way and the evolution of the recipients was without complications and with excellent renal function. During follow-up, no recurrence of lithiasis was observed in donors or recipients. Conclusions: In this experience, the URS of the donor kidney was a feasible procedure and was not associated with adverse consequences for the graft. The main advantage of this procedure is to avoid the potential risk to the recipient of an obstructive graft complication.

Tabaquismo y tumores mayores de 2 centímetros son predictores de mortalidad en pacientes sometidos a nefro-ureterectomías por carcinoma de urotelio alto / Prognostic factors in patients with upper urinary tract urothelial carcinoma undergoing nephro-ureterectomy

BACKGROUND: Upper urinary tract urothelial carcinoma (UTUC) represents 5-10% of urothelial carcinomas. It is managed with nephroureterectomy (NUR); however, kidney-sparing techniques are growingly used. AIM: To report the results of a 20-year series of NUR conducted in an academic center. Patients and Methods: Review of clinical and pathological characteristics of patients undergoing NUR between 1999 and 2020. Patients were followed for 63 months. Global survival curves (OS) and mortality predictors were established through Cox regression. RESULTS: We included 90 patients with a median age of 68 years undergoing NUR, of whom 68 (75%) had a pelvic tumor and 22 (25%) had a proximal ureteral tumor. A laparoscopic NUR was performed in 60 patients (66%). Thirty-three patients (37%) had tumors confined to the urothelium (pTa), penetrating the lamina propria (pT1) or carcinoma in situ (CIS), 10 patients (11%) had a tumor spreading to the muscle layer (pT2) and 47 (52%) had a tumor spreading to nearby organs (pT3 / T4). Average tumor size was 3.69 cm, nodal disease (pN) was present 12 patients (13%). Twelve patients (13%) received adjuvant chemotherapy. A higher mortality was observed among smokers (Hazard ratio (HR) 8.79, 95% confidence intervals (CI) 1.5-49.0, p = 0.01), patients with tumors classfied as pT≥ 2 (HR 1.09, 95% CI 0.01-1.0, p = 0.04) and those with tumors larger than 2 cm (HR 14.79, CI 95% 1.5-272, p = 0.01). CONCLUSIONS: Smoking patients, those with invasive tumors (T2-T4) and greater than 2 cm have higher mortality. Therefore, they should not be candidates for conservative management.

Subcapsular Renal-Infected Hematoma After Retrograde Intrarenal Surgery: A Rare but Serious Complication.

We report a case of a 53-year-old woman affected by a left kidney stone and persistent positive urinary culture treated by retrograde intrarenal surgery. During postoperative day 1, she developed a sudden back pain associated with a decrease in hemoglobin. CT scan showed a subcapsular hematoma giving the impression of partial compression of kidney and upper urinary tract. For that reason, in the first instance, a Double-J ureteral stent was installed. Unfortunately, an open surgical drainage was necessary because a secondary infection of the hematoma was evident during the following days.

[Shock wave lithotripsy, retrograde intrarenal surgery or percutaneous nephrolithotomy for lower pole renal stones?]. / ¿Litotricia extracorpórea, nefrolitotomía percutánea o cirugía intrarrenal retrógrada para la nefrolitiasis de polo inferior?

Among the therapeutic alternatives available for the treatment of lower pole renal calculi are extracorporeal lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. There is controversy about which of these techniques is more effective, especially for stones smaller than 20 mm. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified four systematic reviews including 11 pertinent randomized controlled trials overall. We combined the evidence and generated a summary of findings following the GRADE approach. We concluded percutaneous nephrolithotomy probably increases success rate, but it is not clear if it decreases the need of retreatment compared to extracorporeal shock wave lithotripsy. In comparison to retrograde intrarenal surgery, it may increase success rate, but it is not clear if it decreases the need of retreatment. Retrograde intrarenal surgery may increase success rate, and probably decreases need of retreatment compared to extracorporeal shock wave lithotripsy.

Dentro de las alternativas terapéuticas disponibles para el tratamiento de la litiasis renal de polo inferior se encuentran la litotricia extracorpórea, la nefrolitotomía percutánea y la cirugía intrarrenal retrógrada. Existe controversia sobre cuál de estas técnicas es más efectiva, sobre todo en cálculos menores de 20 milímetros. Utilizando la base de datos Epistemonikos, la cuál es mantenida mediante búsquedas en 30 bases de datos, identificamos cuatro revisiones sistemáticas que en conjunto incluyen 19 estudios. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. La nefrolitotomía percutánea probablemente aumenta la tasa libre de cálculos, pero no es claro si disminuye la necesidad de retratamiento comparada con la litotricia extracorpórea. En comparación con cirugía intrarrenal retrógrada podría aumentar la tasa libre de cálculos, pero no es claro si disminuye la necesidad de retratamiento. La cirugía intrarrenal retrógrada podría aumentar la tasa libre de cálculos, y probablemente disminuye la necesidad de retratamiento, comparada con la litotricia extracorpórea.

Sistema mHEALTH para el registro electrónico de la atención de personas en condición de postración en el hogar / mHEALTH system for electronic record of people bedridden at home care

La mSalud permite dar acceso y continuidad a la atención y cuidado de salud a personas que por su condición o lejanía de otra manera no podrían tener, acercando al equipo de salud al punto del cuidado donde la persona requiere la atención. Este estudio experimental randomizado, cuanti-cualitativo, longitudinal, tiene por propósito diseñar un registro electrónico móvil para el cuidado domiciliario del paciente postrado. En este artículo se da a conocer la primera de 6 fases que contempla el estudio, la de determinación de requerimientos de información, permitiendo reconocer la necesidad de sistematizar procesos clínicos y administrativos, así como representar el flujo de trabajo de los clínicos y representar el cuidado de las personas en el hogar(AU)

The mHealth can provide access and continuity of health care to people who's for condition or distance not might otherwise have. It allows approaching the health team to the point where the person requires health care. This randomized experimental study, quantitative qualitative longitudinal have the purpose to design a mobile electronic health record for home care patient bedridden. In this paper discloses the first of six phases that includes the study, the determination of information requirements, allowing recognize the need to systematize clinical and administrative processes, and represent the workflow of clinical care of people in the household(AU)

Ductilidad y daños sísmicos en edificios celulares de albañilería armada

La ductilidad disponible de los edificios celulares de muros portantes de albañilería armada de mediana altura-cuatro a seis niveles-sometidos, debe ser limitada con el propósito de reducir la magnitud de los daños que se producen en los mismos cuando ingresan en el rango inelástico. Con el propósito de cuantificar dicha limmitación se informa acerca del análisis de los resultados de diferentes investigaciones llevadas a cabo acerca del tema

El edificio celular : Un multifamiliar sismorresistente de bajo costo

En el hábitat urbano la vivienda incluye todos los aspectos relativos a: 1) la tierra; la 2) la infraestructura, el equipamiento y los servicios, y 3) las unidades habitacionales. Como consecuencia, la forma de atender la demanda habitacional condiciona la posibilidad económica de atender la demanda integral. Para evaluar dicho condicionamiento es esencial tener en cuenta que lo que interesa, y lo que debe buscarse, en última instancia, es la ciudad de costo mínimo y no cesesariamente la unidad habitacional de costo mínimo. Diferentes análisis de las situaciones y los problemas urbanos de los países en desarrollo asocian a la densidad urbana creciente con la solución urbana de costo mínimo. Es por ello, que si se ha de comenzar a mitigar el grave problema urbano de los países en desarrollo, las futuras unidades habitacionales y sus ciudades tendrán que ser provistas preferentemente en multifamiliares de mediana altura, normalmente de cuatro a seis niveles. El presente documento analiza: 1) la racionalidad que respalda la que tendrá que ser, en última instancia, una decisión política, y 2) las tecnologías ya existentes que la harán posible

El papel de los códigos de construcción en la ingeniería civil

Los códigos - normas o reglamentos - de construcción han tomado el control del ejercicio de la ingeniería civil sobre todo en el diseño, construcción y supervisión de estructuras. En las facultades de ingeniería cumplen con frecuencia la función de texto. Legalmente son el escudo protector del ingeniero: si él ha cumplido con lo que ellos señalan, no es el responsable del fracaso de la obra; tal responsabilidad recae en el código. Lamentablemente, los códigos no representan - ni pueden representar - las reglas del arte de la ingeniería; son, más bien, fruto de consenso o transacción. Estos papeles deben ser modificados si la ingeniería ha de cumplir su función social - por ejemplo, en la prevención de desastres - y el ingeniero - considerado hoy, con razón en muchos casos, un técnico - alcanzar su verdadera condición de profesional. El texto precisa, desde una perspectiva conceptual e histórica, las características de la ingeniería que la hacen el arte social por excelencia y le confieren un papel insustituible en el desarrollo. Con ese sustento se analizan los códigos de construcción - ubicándolos en el contexto del "contrato social" del cual deben formar parte - y se propone: 1) para los códigos, un nuevo papel; y, 2) para la ingeniería, tareas que debe perfeccionar o emprender para asegurar su correcto ejercicio (AU)

Los últimos adelantos en el diseño sísmico de la mampostería en latinoamérica

Se efectúa el análisis detallado del comportamiento sísmico de la mampostería con el propósito de establecer los criterios de diseño y construcción que asegure el comportamiento adecuado de los muros de mampostería y , luego, el del conjunto de muros que forman el edificio de albañilería. Se analiza el problema de los daños sísmicos en edificaciones de albañilería y la forma de mitigarlos. Finalmente se analiza la naturaleza y el comportamiento de los muros de mampostería armada y confinada (AU)