Real-world prostate-specific antigen reduction and survival outcomes of metastatic hormone-sensitive prostate cancer patients treated with apalutamide: An observational, retrospective, and multicentre study.

Background: Metastatic hormone-sensitive prostate cancer (mHSPC) treatment has changed drastically during the last years with the emergence of androgen receptor-targeted agents (ARTAs). ARTA combined with androgen deprivation therapy has demonstrated better oncological and survival outcomes in these patients. However, the optimal choice among different ARTAs remains uncertain due to their analogous efficacy. Objectives: The objective of this study was to describe prostate-specific antigen (PSA) response and oncological outcomes of patients with mHSPC treated with apalutamide. Material and methods: Medical records from three different hospitals in Spain were used to conduct this study. Patients diagnosed with mHSPC and under apalutamide treatment were included between March 2021 and January 2023. Data regarding PSA response, overall survival (OS), and radiographic progression-free survival (rPFS) were collected and stratified by metastasis volume, timing, and stating. Results: 193 patients were included; 34.2% of patients were de novo mHSPC, and the majority was classified as m1b. The 18-month OS and rPFS were 92.5% and 88.9%, respectively. Patients with PSA levels ≤0.2 ng/ml showcased an 18-month OS rate of 98.7%, contrasting with 65.3% for those with PSA >0.2 ng/ml. Similar trends emerged for rPFS (97.4% and 53.7%, respectively). When differentiating between low-volume and high-volume metastasis, the OS rate stood at 98.4% and 80.7%, respectively, while the rPFS rates were 93% and 81.6%, respectively. No significant differences were found between groups stratified by metastasis timing. Conclusion: This real-world study on patients with mHSPC treated with apalutamide plus androgen deprivation therapy revealed robust oncological outcomes, aligning with the emerging evidence. The study's hallmark finding highlights the significance of rapid and deep PSA response as a predictor of improved oncological and survival outcomes.

Upgraded main ion charge exchange recombination spectroscopy on the C-2W field reversed configuration (FRC) plasma.

A prototype main-ion CHarge Exchange Recombination Spectroscopy (mCHERS) diagnostic is providing measurements of the main-ion (hydrogen or deuterium) temperature and velocity in the C-2W field reversed configuration plasma using charge exchange Balmer-alpha emission at five different radial locations with 500 Hz frequency and a per-pixel velocity resolution of 15 km/s. Measurement along the entire plasma radius of C-2W is enabled by a diagnostic neutral beam (DNB) that passes through the center of plasma, unlike the larger diameter heating neutral beams that have impact parameters of 20 cm. DNB provides high time resolution via beam modulation and spatial resolution via its small cross section. The goals of the current mCHERS upgrade are to double the number of spatial channels, improve the per-pixel velocity resolution by three times, and increase the measurement frequency to match the maximum modulation frequency of the diagnostic neutral beam (∼10 kHz). To accomplish these goals, a new astigmatism-free Isoplane spectrometer has been commissioned. Progress and results from the newly upgraded mCHERS system are detailed.

Factores de riesgo asociados a hipoglucemia en recién nacidos / Risk factors associated with hypoglycemia in newborns

RESUMEN Se realizó un artículo de revisión narrativo para evaluar los factores de riesgo relacionados con la hipoglucemia en los recién nacidos. Los objetivos buscaron determinar la evidencia clínica de los factores de riesgo relacionados con la hipoglucemia neonatal y determinar el soporte fisiopatológico sobre los factores de riesgo implicados en el desarrollo de hipoglucemia en los recién nacidos. Se han realizado búsquedas literarias en Medline-Pubmed, SCOPUS e HINARI sobre artículos publicados hasta noviembre de 2021; Esto arrojó un total de 108 artículos. Se concluye que, aunque el cribado universal de hipoglucemia en recién nacidos asintomáticos y de bajo riesgo puede ser innecesario, existe evidencia de que la hipoglucemia puede causar anomalías en el desarrollo neurológico; siendo factores de riesgo maternos de hipoglucemia en neonatos tales como: diabetes gestacional, preeclampsia y obesidad gestacional; Los factores de riesgo del recién nacido para hipoglucemia neonatal son: sepsis, bajo peso al nacer y prematuridad.

ABSTRACT A review paper was written aiming to determine risk factors related with hypoglycemia in newborns. Objectives were to determine clinical evidence for neonatal hypoglycemia-related risk factors and to determine the pathophysiological support upon risk factors implicated in the occurrence of hypoglycemia in newborns. Searches were performed in Medline-Pubmed, SCOPU, and HINARI, looking for papers published up to November 2021. We obtained 108 papers. It was concluded that although universal screening for hypoglycemia in asymptomatic low-risk newborns could be unnecessary, there is evidence that hypoglycemia may cause abnormalities in neurological development. Maternal risk factors for neonatal hypoglycemia include gestational diabetes, preeclampsia, and gestational obesity. Risk factors in newborns include sepsis, low birth weight and prematurity.

Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study.

BACKGROUND: Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality. METHODS: Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality. RESULTS: 868 patients were included (median age, 64 years [interquartile range [IQR], 56-71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50-63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56-62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1.051, 95% CI 1.033-1.068)), SAPS3 (OR per 1-point increase 1.027, 95% CI 1.011-1.044), diabetes (OR 1.546, 95% CI 1.085-2.204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI 1.001-1.016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1.878 (95% CI 1.124-3.140), use of selective digestive decontamination strategy during ICU stay (OR 0.590 (95% CI 0.358-0.972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2.042 (95% CI 1.205-3.460). CONCLUSION: The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered).

Main ion charge exchange recombination spectroscopy on C-2W FRC plasmas.

A main ion charge exchange recombination spectroscopy (mChERS) diagnostic has been developed to measure the velocity and temperature of the main deuterium ions in the C-2W (also called Norman) field-reversed configuration (FRC) device. A modulated diagnostic neutral beam (DNB) of hydrogen with 40 keV full energy and a nominal current of 8.5 A provides the charge exchange signal. The DNB can achieve a fast modulation frequency of up to 10 kHz, a rare attribute to find on other fusion devices, which defines the time resolution of mChERS. Currently, the mChERS diagnostic provides simultaneous measurements at five spatial locations in the FRC plasma using a high-speed camera. The design and capabilities of the mChERS system are presented along with first experimental data.

Recomendaciones para el primer nivel de atención de salud frente a la emergencia por Covid-19 / Recommendations for the first level of health care in the face of the Covid-19 emergency

El 80% de los casos de SARS-Cov-2 recibe tratamiento en el primer nivel de atención, las políti- cas sanitarias deben reforzar este eslabón en sus sistemas. Los autores realizaron una revisión de la bibliográfica con el propósito de incrementar la capacidad resolutiva de sus unidades, dismi- nuir los contagios y las posibles complicaciones en el estado de salud de los pacientes. Sin que esas recomendaciones tengan un carácter absoluto, sino que se precisa una actualización perma- nente según las nuevas evidencias científicas y las tendencias epidemiológicas de la enferme- dad

The First Level of Medical Care is the first step into the Health Care System, in which 80% of cases are treated, leaving the remaining cases to the higher ranks of the system. The Covid-19 pandemic has put our Primary Health Care to the test, which is a strategy that is used by the Ministry of Health to improve the accessibility of usage of the care services. In response, we present a bibliographic revision which gathers theoretical and epidemiological information regarding some recommendations to strengthen the First Level of Medical Care against Covid-19.

Enteritis eosinofílica, una causa extraña de abdomen agudo. reporte de caso clínico / Eosinophilic enteritis, a strange cause of acute abdomen Clinical case report

La enteritis eosinofílica, es una patología rara, caracterizada por infiltración de eosinófilos en una o más capas histológicas en diferentes niveles del tracto gastrointestinal, siendo el estómago e intestino delgado los más afectados; su cuadro clínico, inespecífico, caracterizado por dolor abdominal, náusea, vómito, diarrea o estreñimiento, pérdida de peso y ascitis, con presencia o ausencia de eosinofilia en la biometría. Reporte de caso Paciente masculino de 51 años de edad, acudió a emergencia por distensión abdominal y náusea, al examen físico en la palpación intenso dolor y distención abdominal, percusión timpánico y abolición de ruidos hidroaéreos. La analítica reportó leucocitosis con neutrofilia, radiografía de abdomen íleo adinámico, en la ecografía abdominal presencia de imágenes tubulares con aspecto de diana, asociado a líquido libre purulento en fosa ilíaca derecha y fondo de saco vésico rectal. Un cuadro clínico compatible con abdomen agudo de resolución quirúrgica, se realizó laparotomía exploratoria (AU);

The eosinophilic enteritis is a rare pathology, characterized by infiltration of eosinophils in one or more histological layers at different levels of the gastrointestinal tract, the stomach and small intestine being the most affected; its nonspecific clinical picture, characterized by abdominal pain, nausea, vomiting, diarrhea or constipation, weight loss and ascites, with the presence or absence of eosinophilia in the biometry. Enteritis eosinofílica, una causa extraña de abdomen agudo. reporte de caso clínico Eosinophilic enteritis, a strange cause of acute abdomen year-old male patient came to the emergency room due to abdominal distention and nausea, to physical examination on palpation, intense abdominal pain and distention, tympanic percussion and abolition of air-fluid sounds. Laboratory analysis reported leukocytosis with neutrophilia, abdominal ileus adynamic radiography, abdominal ultrasound presence of tubular images with a target appearance, associated with free purulent fluid in the right iliac fossa and rectal vesicum fundus. A clinical picture compatible with an acute abdomen with surgical resolution, an exploratory laparotomy was performed (AU);

Fast-ion D-alpha diagnostic development for the C-2W field-reversed configuration plasma.

TAE Technologies's advanced beam-driven field-reversed configuration device has a large fast-ion population, allowing for fast-ion D-alpha (FIDA) studies. Development of a FIDA spectrometer for the new C-2W device is underway. Previous measurements were combined with C-2W geometry to inform the design [N. Bolte, Rev. Sci. Instrum. 87, 11E520 (2016)]. Measured signal levels led to the purchase of a Phantom Miro 110 high-speed camera that will be paired with a Holospec f/1.8 spectrograph from Kaiser Optical Systems, Inc. The spectrograph utilizes a custom transmission grating centered at 656.0 nm. Simulations were used to choose available ports with large predicted signals. Eight neutral beams and 354 ports were considered. Experimentally obtained 1D plasma profiles from C-2U were mapped onto Q2D [M. Onofri, Phys. Plasmas 24, 092518 (2017)] simulation flux surfaces. For each point on the vessel wall, many lines-of-sight (LOSs) are created to view the entirety of each neutral beam path. FIDA spectra are simulated for each LOS using the FIDA simulation code FIDASIM [http://d3denergetic.github.io/FIDASIM/; W. Heidbrink, Commun. Comput. Phys. 10, 716 (2011); and B. Geiger, "Fast-ion transport studies using FIDA spectroscopy at the ASDEX Upgrade tokamak," Ph.D. thesis, Ludwig Maximilian University of Munich, 2012]. Integrating over wavelength and beam-space allows individual ports to be chosen for their large prospective signals.

Less Data Same Information for Event-Based Sensors: A Bioinspired Filtering and Data Reduction Algorithm.

Sensors provide data which need to be processed after acquisition to remove noise and extract relevant information. When the sensor is a network node and acquired data are to be transmitted to other nodes (e.g., through Ethernet), the amount of generated data from multiple nodes can overload the communication channel. The reduction of generated data implies the possibility of lower hardware requirements and less power consumption for the hardware devices. This work proposes a filtering algorithm (LDSI-Less Data Same Information) which reduces the generated data from event-based sensors without loss of relevant information. It is a bioinspired filter, i.e., event data are processed using a structure resembling biological neuronal information processing. The filter is fully configurable, from a "transparent mode" to a very restrictive mode. Based on an analysis of configuration parameters, three main configurations are given: weak, medium and restrictive. Using data from a DVS event camera, results for a similarity detection algorithm show that event data can be reduced up to 30% while maintaining the same similarity index when compared to unfiltered data. Data reduction can reach 85% with a penalty of 15% in similarity index compared to the original data. An object tracking algorithm was also used to compare results of the proposed filter with other existing filter. The LDSI filter provides less error ( 4 . 86 ± 1 . 87 ) when compared to the background activity filter ( 5 . 01 ± 1 . 93 ). The algorithm was tested under a PC using pre-recorded datasets, and its FPGA implementation was also carried out. A Xilinx Virtex6 FPGA received data from a 128 × 128 DVS camera, applied the LDSI algorithm, created a AER dataflow and sent the data to the PC for data analysis and visualization. The FPGA could run at 177 MHz clock speed with a low resource usage (671 LUT and 40 Block RAM for the whole system), showing real time operation capabilities and very low resource usage. The results show that, using an adequate filter parameter tuning, the relevant information from the scene is kept while fewer events are generated (i.e., fewer generated data).

Tumor Carcinoide del Pulmón. Resección en Man-Guito. Primer Caso Realizado en el Hospital Vicente Corral Moscoso. Cuenca / Carcinoid Tumor of the Lung. Man-Guito Resection. First case performed at the Vicente Corral Moscoso Hospital. Basin

El cáncer de pulmón es un tumor frecuente y con alta mortalidad en países desarrolla-dos; en el tratamiento existen nuevas técnicas como la lobectomía más resección en manguito con anastomosis bronquial, que ha disminuido la mortalidad hasta en un 95% de los casos, este es un procedimiento oncológi-camente válido y a la vez comparable a una neumonectomía pero con un menor impacto funcional a nivel pulmonar; vale recalcar que es uno de los procedimientos de elección en el caso de neoplasias de los bronquios o en ocasiones de traumatismos que obstruyen los bronquios con pocos casos reportados sobre el uso de esta técnica a nivel mundial. De he-cho es la primera resección en manguito rea-lizada en el Hospital Vicente Corral Moscoso. Se presenta el caso de una paciente con presencia de una masa tumoral que causa obstrucción de la luz bronquial del pulmón derecho, diagnosticada hace dos años me-diante fibrobroncoscopía flexible por lo cual procede a ser intervenida quirúrgicamente para desobstruir la vía aérea; se realizó una lobectomía más resección en manguito, apo-yados en la literatura acerca de la validez del procedimiento realizado como cirugía oncológica, los riesgos quirúrgicos existentes y los efectos en la fisiología pulmonar.

Lung cancer is the most common tumor that causes increased mortality in developed countries, in the treatment there are new techniques such as the Lobectomy and sleeve resection with bronchial anastomosis, this technique has reduced the mortality by 95% of cases. This is an oncologically valid procedure and it is also comparable to a pneumonectomy but with a lower functional impact in the lungs; it ́s necessary to emphasize that this is one of the election procedures in the case of tumors of the bronchi or trauma sometimes obstructing the bronchi with few cases reported about using of this technique worldwide. In fact it is the first sleeve resection performed at the Vicente Corral Moscoso Hospital.The case of a patient with presence of a tumor mass obstructing the bronchial lumen of right lung is presented, it was diagnosed two years ago with flexible fibro-bronchoscopy so it proceed with surgery to unblock the airway, A lobectomy more sleeve resection was performed; supported in the literature about the validity of the procedure performed as cancer surgery, the surgical risks, and physiological effects on lung function.

Genetic variants in PARP1 (rs3219090) and IRF4 (rs12203592) genes associated with melanoma susceptibility in a Spanish population.

BACKGROUND: Few high penetrance genes are known in Malignant Melanoma (MM), however, the involvement of low-penetrance genes such as MC1R, OCA2, ASIP, SLC45A2 and TYR has been observed. Lately, genome-wide association studies (GWAS) have been the ideal strategy to identify new common, low-penetrance susceptibility loci. In this case-control study, we try to validate in our population nine melanoma associated markers selected from published GWAS in melanoma predisposition. METHODS: We genotyped the 9 markers corresponding to 8 genes (PARP1, MX2, ATM, CCND1, NADSYN1, CASP8, IRF4 and CYP2R1) in 566 cases and 347 controls from a Spanish population using KASPar probes. Genotypes were analyzed by logistic regression and adjusted by phenotypic characteristics. RESULTS: We confirm the protective role in MM of the rs3219090 located on the PARP1 gene (p-value 0.027). Additionally, this SNP was also associated with eye color (p-value 0.002). A second polymorphism, rs12203592, located on the IRF4 gene was associated with protection to develop MM for the dominant model (p-value 0.037). We have also observed an association of this SNP with both lentigines (p-value 0.014) and light eye color (p-value 3.76 × 10(-4)). Furthermore, we detected a novel association with rs1485993, located on the CCND1 gene, and dark eye color (p-value 4.96 × 10(-4)). Finally, rs1801516, located on the ATM gene, showed a trend towards a protective role in MM similar to the one firstly described in a GWAS study. CONCLUSIONS: To our knowledge, this is the first time that these SNPs have been associated with MM in a Spanish population. We confirmed the proposed role of rs3219090, located on the PARP1 gene, and rs12203592, located on the IRF4 gene, as protective to MM along the same lines as have previous genome-wide associated works. Finally, we have seen associations between IRF4, PARP1, and CCND1 and phenotypic characteristics, confirming previous results for the IRF4 gene and presenting novel data for the last two, suggesting that pigmentation characteristics correlated with eye color are potential mediators between PARP1 and MM protection.

Treatment of resistant pruritus from cholestasis with albumin dialysis: combined analysis of patients from three centers.

BACKGROUND & AIMS: Albumin dialysis using molecular adsorbent recirculating system (MARS) is a new procedure for treating resistant pruritus from cholestasis, but it is usually published as a case report or a short series. Therefore, we analyzed patients with resistant pruritus treated with MARS from three centers, to assess the changes on pruritus and the indices of cholestasis. METHODS: Twenty patients (12 female, mean age: 51+/-3.4 years) with chronic cholestatic liver disease or chronic liver-graft rejection were evaluated. The severity of pruritus was assessed using a visual analogue scale (VAS) before and after treatment, and 30 days thereafter. Liver tests, including total bilirubin, alkaline phosphatase, gamma-glutamyl-transferase, cholesterol, triglycerides, and total bile acid were also determined, as well as the number of sessions and the coupled procedure (dialysis or perfusion). RESULTS: Albumin dialysis resulted in a decrease of pruritus (VAS: from 70.2+/-4.8 to 20.1+/-4.2, p<0.001), which partially resumed after 30 days (38.7+/-6.6). VAS decreased by 72% immediately after treatment and by 51% after 1 month. Pruritus decreased in all but one patient. MARS resulted in a significant bile acid decrease of 41% after treatment and by 37% after 1 month. The effect of MARS on pruritus and markers of cholestasis was similar in patients with different diseases and was independent of the coupled procedure. The improvement of pruritus in individuals was positive in 75% of patients. No major adverse effects were observed. CONCLUSIONS: Albumin dialysis using MARS is an effective procedure for managing resistant pruritus in most patients with chronic cholestasis and graft rejection.

Seguimiento a largo plazo de pacientes con ectasia vascular del antro gástrico tratados mediante coagulación con argón plasma / Long-term follow-up of patients with gastric antral vascular ectasia treated with argon plasma coagulation

Fundamento y objetivo: La APC (argon plasma coagulation coagulación con argón plasma ) es actualmente el método más utilizado para tratamiento endoscópico de la GAVE (gastric antral vascular ectasia ectasia vascular antral gástrica ) por su fácil uso y sus bajas tasas de complicaciones. El objetivo de este trabajo fue analizar la efectividad y la seguridad de la APC en el tratamiento de la GAVE. Material y método: Se revisaron retrospectivamente los pacientes con GAVE tratados con APC y con seguimiento superior a 24 meses. Resultados: Se incluyó a 18 pacientes (edad media de 67,16 DE: 13,53 años), 11 de éstos eran mujeres. Cinco pacientes se presentaron como hemorragias agudas y 13 como anemia crónica. La eliminación de la GAVE se consiguió en una media de 3,38 de 1 a 4 sesiones por paciente. No hubo complicaciones mayores. Hubo 5 hemorragias leves y 11 epigastralgias autolimitadas durante el tratamiento. En 2 pacientes con hipergastrinemia basal se desarrollaron pólipos hiperplásicos. Siete pacientes (39%) recidivaron: 3 hemorragias antes de 12 meses y 4 anemias después de 12 meses. No se encontraron diferencias entre los pacientes que presentaron recidivas y los que no presentaron recidivas. Conclusión: La APC es una técnica efectiva y segura en el tratamiento de la GAVE. Las recidivas clínicas y endoscópicas aumentan con el paso del tiempo, por lo que es necesaria la monitorización clínica y analítica de estos pacientes (AU)

Background and objective. Due to its easy use and low complication rates, argon plasma coagulation (APC) it is most common method of endoscopic treatment for gastric antral vascular ectasia (GAVE). We analyze both the long term effectiveness of APC for the treatment of GAVE and its side effects. Material and methods: A retrospective review of GAVE patients treated with APC and followed up for a minimum of 24 months was done. Results: Eighteen patients (mean age 67,16±13,53; 11 women) were included. Five initially presented with acute bleeding and 13 with anemia. GAVE eradication was achieved over 3.38±1,4 sessions per patient. There were no major complications. Five patients had mild bleeding and 11 complained of abdominal pain, that was self-limited during treatment. Seven patients relapsed (39%); 3 of them with melenae and 4 with anemia. Two patients with hypergastrinemia developed hyperplastic polyps. No differences were found between relapsers and non-relapsers. Conclusions: APC is a safe and effective technique for the treatment of GAVE. The recurrence rates increase gradually over time. Early action on recurrence would require improved clinical follow-up and blood test monitoring (AU)

[Long-term follow-up of patients with gastric antral vascular ectasia treated with argon plasma coagulation]. / Seguimiento a largo plazo de pacientes con ectasia vascular del antro gástrico tratados mediante coagulación con argón plasma.

BACKGROUND AND OBJECTIVE: Due to its easy use and low complication rates, argon plasma coagulation (APC) it is most common method of endoscopic treatment for gastric antral vascular ectasia (GAVE). We analyze both the long term effectiveness of APC for the treatment of GAVE and its side effects. MATERIAL AND METHODS: A retrospective review of GAVE patients treated with APC and followed up for a minimum of 24 months was done. RESULTS: Eighteen patients (mean age 67,16+/-13,53; 11 women) were included. Five initially presented with acute bleeding and 13 with anemia. GAVE eradication was achieved over 3.38+/-1,4 sessions per patient. There were no major complications. Five patients had mild bleeding and 11 complained of abdominal pain, that was self-limited during treatment. Seven patients relapsed (39%); 3 of them with melenae and 4 with anemia. Two patients with hypergastrinemia developed hyperplastic polyps. No differences were found between relapsers and non-relapsers. CONCLUSIONS: APC is a safe and effective technique for the treatment of GAVE. The recurrence rates increase gradually over time. Early action on recurrence would require improved clinical follow-up and blood test monitoring.

Use of sedation in gastrointestinal endoscopy: a nationwide survey in Spain.

INTRODUCTION: Gastrointestinal endoscopy causes discomfort and pain in patients. Sedation reduces anxiety and pain. Its use, however, continues to be a controversial issue and it varies greatly from one country to another. The use of sedation in Spanish gastrointestinal endoscopy (GIE) units is unknown. AIM: To determine the use of sedation in Spanish GIE units. MATERIALS AND METHODS: A 24-question survey on the use of sedation was distributed among 300 Spanish GIE units. RESULTS: Surveys were answered by 197 GIE units (65%), which had performed 588,326 endoscopies over the past 12 months. Sedation was used in more than 20% of gastroscopies performed at 55% of the GIE units, and more than 20% of colonoscopies were sedated at 71% of the units; endoscopic retrograde cholangiopancreatography (ERCP) is almost always performed under sedation. The most common drugs were midazolam for gastroscopy and midazolam and pethidine for colonoscopy and ERCP; propofol is used by anesthetists; pulse oximetry is used at 77% of GIE units; 42% of the GIE units fill in a nursing record; 52% of GIE units have recovery rooms and 91% have a cardiac arrest trolley. CONCLUSION: The use of sedation in endoscopy varies greatly in Spain. It is seldom used in gastroscopy; it is more frequent in colonoscopy, and in ERCP it is the norm. In most GIE units sedation is controlled by the endoscopist with pulse oximetry. The most commonly used drugs are benzodiazepines, on their own for gastroscopy and combined with opioids for colonoscopy and ERCP.

Minor adverse events of colonoscopy on ambulatory patients: the impact of moderate sedation.

BACKGROUND: Minor complications in colonoscopy, such as pain, distension, headache, dizziness, etc. are an important cause for the rejection of colonoscopy procedure. Their incidence, however, has not been established. OBJECTIVE: To determine minor complication rates in outpatient colonoscopy procedures and the effect of sedation on these complications. PATIENTS: A prospective randomized cohort study was performed on 1250 adults selected randomly among patients referred to our endoscopy unit. Complications and undesirable affects related to the colonoscopy were reordered during the patients' stay in the endoscopy unit (early complications) and 30 days postprocedure (late complications). RESULTS: One thousand one hundred and twenty-six patients were enrolled (mean age 50.43+/-13.7 years; 54.5% female), of which 875 (78%) were sedated and 251 (22%) were not. No difference between groups was observed. Thirty-one percent of the patients had early minor complications (25% among sedated patients; 52% of nonsedated patients; P<0.001 chi2); 23% had late minor complications (16% of sedated patients vs. 51% nonsedated patients; P<0.001 chi2). The most common undesirable effects were pain and abdominal distension. The risk of experiencing complications - odds ratio - was 1.013 times higher per year of age [confidence interval (CI) 95%: 1.004-1.022]; 1.953 times higher per increase in American Society of Anesthesiologists classification (95% CI: 1.524-2.504); and 0.116 times lower when sedation was used (95% CI: 0.079-0.170). CONCLUSION: Minor complications of colonoscopy are common. Their incidence increases with age and American Society of Anesthesiologists class and decreases with the use of sedation.

Leiomioma vesical / Leiomyoma of the bladder

OBJETIVOS: El leiomioma localizado en la vejiga urinaria tiene una rara incidencia y la mayoría de las veces su diagnóstico es casual. Aportamos un nuevo caso con revisión de la literatura nacional donde han sido publicados muy pocos casos, y se hace la valoración de la clínica, de las exploraciones complementarias y del tratamiento. MATERIAL Y MÉTODOS: Se trata de una paciente que ingresa de parto, por embarazo a término y que en la exploración rutinaria de su ingreso se palpa una tumoración en la cara anterior de vagina. Se le practican estudios ecográficos, radiológicos y endoscópicos. RESULTADOS: Confirmada la presencia de una tumoración vesical y valorada la repercusión sobre estructuras vecinas se practica una RTU-Biopsia, siendo el diagnóstico anatomopatológico el de leiomioma vesical. CONCLUSIONES: Las imágenes ecográficas y radiológicas del leiomioma localizado en vejiga son lo suficientemente demostrativas como para sospechar su naturaleza pero sólo la anatomía patológica podrá hacer el diagnóstico definitivo. El tipo de tratamiento quirúrgico, cirugía abierta o cirugía endoscópica, estará en función de la localización y del tamaño tumoral. el síntoma predominante es el cólico renal y/o la hematuria. Generalmente no hay daño renal u obstrucción severa incluso con tumores de gran tamaño. Sin embargo, como en el caso que presentamos, puede estar presente una ureterohidronefrosis ó un riñón no funcionante. Una citología urinaria falsamente positiva puede ocurrir en los pólipos fibroepiteliales del uréter, como algunos autores han descrito (7). El diagnóstico es difícil de establecer pues la iconografía va a poner de manifiesto un defecto de replección a nivel ureteral inespecifico. Hoy en día con la exploración endoscópica del uréter se puede hacer una aproximación diagnósticabastante fiable. En cualquier caso es el estudio histológico de la pieza quirúrgica el que finalmente demuestra la naturaleza de la lesión (10). Al tratarse de una tumoración benigna, la mayor parte de los autores están de acuerdo en realizar una cirugía conservadora. No ha sido descrita la recurrencia después de realizar polipectomia o resección segmentaria, siendo el pronóstico excelente (5). La nefroureterectomía puede ser requerida cuando el riñón está severamente dañado, cuando la lesión es muy grande o cuando el diagnóstico de benignidad es dudoso (3) (AU)

Meningoencefalitis: a propósito de una epidemia / Meningoencephalitis: epidemys report

Se realizó un estudio longitudinal y descriptivo que incluyó 485 casos con diagnóstico de Meningoencefalitis, atendidos en el servicio de Urgencias del Hospital Pediátrico Docente "Eduardo Agramonte Piña" de Camagüey en el período comprendido entre enero/95 y febrero/96. Se pudo constatar diferencias en la interpretación clínica y humoral de esta entidad, lo que provoca errores en el diagnóstico etiológico de la misma, y por ende en su adecuada conducta y terapéutica posterior. Se propone un esquema que pudiera orientar al respecto basado en los nuevos elementos fisiopatológicos sobre el tema(AU)