Simultaneous transurethral resection of the prostate and cystolithotripsy: A urological dilemma examined.

INTRODUCTION: Controversy exists over whether transurethral resection of the prostate (TURP) in men with bladder stones prevents recurrence of stone formation and facilitates stone discharge. We sought to evaluate whether TURP in patients who underwent cystolithotripsy led to a lower recurrence of bladder stones for which a re-cystolithotripsy was necessary. METHODS: Patients (n=127) who underwent transurethral cystolithotripsy with (n=38) or without simultaneous TURP (n=89) between January 2009 and December 2013 were retrospectively included in five centers in the Netherlands. Median followup was 48 months. The primary endpoint was to compare the relative risk between both groups for re-cystolithotripsy due to recurrent bladder stones. Secondary outcomes were the relative risk of urinary retention, the need for a (re-)TURP and the average time until recurrence. RESULTS: Patients who underwent a cystolithotripsy with a simultaneous TURP had a lower need for re-cystolithotripsy, resulting in a risk reduction of 72%. (relative risk [RR] 0.28 [0.07-1.13], p=0.06, number needed to treat [NNT]=7). The length of in hospital stay (3.4 vs. 1.6 days, p=0.04) and operative time (58 vs. 33 minutes, p<0.01) was longer when a TURP was performed. There was no significant difference in complication rate, occurrence of urinary retention, re-TURP, and re-admission. Eighty-one percent of patients who did not undergo a TURP remained free of bladder stone recurrence. Due to the retrospective nature of the study, essential data concerning prostate volume and micturition analysis was lacking. CONCLUSIONS: A simultaneous TURP in patients who underwent a cystolithotripsy showed a trend towards a protective effect on the need for re-cystolithotripsy.

Discrepancy between Expectations and Experiences after Prostate Cancer Treatment: A Dutch Multicenter Study.

OBJECTIVES: To evaluate possible discrepancies between patients' expectations concerning sexual side effects related to prostate cancer treatment, based on the obtained information prior to treatment. Moreover, to determine if demographic or clinical factors may have an effect on the accuracy of patients' expectations concerning sexual side effects after treatment. METHODS: A multicenter, cross-sectional survey was performed among men treated with prostatectomy, brachytherapy, external-beam radiotherapy and/or hormonal therapy. RESULTS: In total, 412 questionnaires were analyzed. Of men with sexual side effects after treatment, 1 in 3 (32.5%, n = 109) reported their complaints as worse than expected; significantly more often reported by men treated surgically (P = .001), men with a local stage tumor (P = .005) and by men with a lower prostate-specific antigen level at diagnosis (P = .046). It was significantly less often reported by men treated with radiotherapy combined with hormonal therapy (P = .031). Men who used brochures as an information source reported their sexual side effects significantly less often as worse than expected (P < .001). CONCLUSION: One in three men with sexual side effects after prostate cancer treatment, experienced their complaints as worse than expected based on the obtained information prior to treatment. Men treated with radiotherapy combined with hormonal therapy indicated less discrepancy between expectations and developed sexual side effects, whereas prostatectomy, low stage tumor and low prostate-specific antigen level were associated with more discrepancy. Brochures should be administered additionally to verbal information to improve patients' understanding of possible sexual side effects and to enhance the accuracy of patients' expectations.

Investigating the effect of a symposium on sexual health care in prostate cancer among Dutch healthcare professionals.

AIMS AND OBJECTIVES: To investigate whether a symposium aimed at healthcare professionals in the uro-oncological field changes knowledge, competence and general practice regarding sexual dysfunction after prostate cancer treatment. BACKGROUND: Sexual dysfunction is not frequently discussed by healthcare professionals; lack of knowledge and training are two of the most often reported barriers. Provision of additional training could improve knowledge, competence and general practice of healthcare professionals. DESIGN: Two questionnaires were used in this pre-post study to determine knowledge, competence and general practice at the time of the symposium and six months afterwards. METHODS: In order to perform repeated measures to analyse alterations among participating healthcare professionals (n = 55), the McNemar's test was used. A STROBE checklist was completed. RESULTS: Seventy-three per cent (n = 40) stated that not enough attention was paid to prostate cancer-related sexual dysfunction during their education. Nurses felt significantly less competent in discussing sexual function, advising on sexual dysfunction and actively inquiring sexual complaints compared to other healthcare professionals. After the symposium, sexual dysfunction was significantly more often discussed. No significant effects were found on knowledge on sexual dysfunction, knowledge on treatment of sexual dysfunction, competence in discussing sexual function, advising on sexual dysfunction, actively inquiring sexual complaints and rate of referral. Tools needed to address sexual dysfunction concerned written information materials (75.5%) and a website containing adequate information (56.6%). CONCLUSIONS: The symposium had no significant influence on knowledge, competence and rate of referral in men with sexual dysfunction after prostate cancer treatment. However, sexual dysfunction was more frequently discussed after the symposium, so increase of awareness of consequences of prostate cancer treatment was achieved. RELEVANCE TO CLINICAL PRACTICE: Consequences of prostate cancer treatment to sexual function should be taken in consideration in daily practice; written information materials and a website containing adequate information were indicated as valuable resources to address sexual dysfunction in routine consultations.

Treatment-Related Sexual Side Effects From the Perspective of Partners of Men With Prostate Cancer.

A cross-sectional survey was performed among partners and men who received treatment for prostate cancer to investigate whether demographic and clinical characteristics are associated with the extent of how difficult partners found it dealing with sexual side effects and the degree of having experienced sexual problems after treatment. Moreover, an aim was to determine whether sexual side effects have an impact on the relationship. A total of 171 partners were included. In all, 104 men (70.7%) experienced an increase in erectile complaints after treatment. Almost half of partners of men with an increase in erectile complaints (63.6%, n = 63) found it difficult to deal with sexual side effects and 63.5% (n = 66) experienced sexual problems. Partners with lower education levels experienced fewer sexual problems than partners with higher education levels (p < .001). Furthermore, no significant associations were found on demographic characteristics, number of comorbidities, clinical characteristics (prostate-specific antigen level; tumor, node, and metastasis staging; Gleason grading), and type of treatment. The majority of men (58.4%, n = 59) and partners (62.5%, n = 65) indicated to not have experienced the impact of sexual side effects on their relationship.

[A man with a palpable node on the prostate]. / Een palpabele nodus in de prostaat.

A 64-year-old man was referred to our urology outpatient clinic with lower urinary tract symptoms (LUTS). During rectal examination a smooth nodule was identified. MRI-images showed a prostatic cyst, originating from the utriculus. An utriculus cyst is a relatively rare finding and originates from a persistent remnant of the Müllerian duct.

Suitable sexual health care according to men with prostate cancer and their partners.

PURPOSE: To determine which health care provider and what timing is considered most suitable to discuss sexual and relational changes after prostate cancer treatment according to the point of view of men and their partners. METHODS: A cross-sectional survey was conducted among men diagnosed with prostate cancer or treated after active surveillance, who received laparoscopic radical prostatectomy, brachytherapy, intensity-modulated radiotherapy, and/or hormonal therapy. If applicable, partners were included as well. RESULTS: In this survey, 253 men and 174 partners participated. Mean age of participating men was 69.3 years (SD 6.9, range 45-89). The majority (77.8%) was married and average length of relationship was 40.3 years (SD 14.1, range 2-64). Out of 250 men, 80.5% suffered from moderate to severe erectile dysfunction. Half of them (50.2%, n = 101) was treated for erectile dysfunction and great part was partially (30.7%, n = 31) up to not satisfied (25.7%, n = 26). Half of the partners (50.6%, n = 81) found it difficult to cope with sexual changes. A standard consultation with a urologist-sexologist to discuss altered sexuality is considered preferable by 74.7% (n = 183). Three months after treatment was the most suitable timing according to 47.6% (n = 49). CONCLUSIONS: During follow-up consultations, little attention is paid to the impact of treatment-induced sexual dysfunction on the relationship of men with prostate cancer and their partners. A standard consultation with a urologist-sexologist 3 months after treatment to discuss sexual and relational issues is considered as most preferable.

Degree of malnutrition and its relationship with major structural and eating factors in Honduran preschool population. Prevalence of breastfeeding / Grado de malnutrición y su relación con los principales factores estructurales y alimentarios de la población preescolar hondureña. Prevalencia de la lactancia materna en los mismos.

Introduction: Child malnutrition remains a serious public health problem in Honduras, with a national prevalence according to the World Health Organization (WHO) reference values of 29% in children under fi ve. In addition, the average chronic malnutrition in the region amounts to 80% in poor and indigenous communities, making Honduras the second country in Central America with the highest incidence of chronic malnutrition. Another problem of the region is the early cessation of exclusive breastfeeding: only 29.7% of children were exclusively breastfed until they were six months. Therefore, the study seeks to understand, identify and quantify the situation determinants and provide information for the design of public policies. Material and method:: The study consisted of a cross-sectional descriptive anthropometric assessment in which the nutritional status and the prevalence of undernourishment, malnutrition and malnutrition in 141 children aged between six months and fi ve years, belonging to urban and rural regions of the country, were analyzed, as well as assessing the prevalence of breastfeeding in fi ve Honduran departments (Intibucá, Lempira, Atlántida, Olancho and Francisco Morazán). Results and conclusion: When making the analysis by departments, differences regarding nutritional status and breastfeeding were observed between urban and rural areas, the latter being doubled in the case of chronic malnutrition and underweight, with percentages of 14.6% in urban areas versus28.8% in rural areas, and 4.6% in urban areas compared to 9% in rural areas, respectively. However, with respect to acute malnutrition and overweight in both regions, similar values were observed, above 1.1% for acute and 14% for overweight malnutrition. In relation to exclusive breastfeeding for six months, the departments of Olancho and Lempira maintained it for two years, with a percentage distribution of 80% and 48%, respectively. It must be noted that 36% of mothers did not provide breastfeeding, with the highest rate (15%) in the department of Francisco Morazán.

Introducción: la desnutrición infantil sigue siendo un grave problema de salud pública en Honduras, con una prevalencia nacional según valores de referencia de la Organización Mundial de la Salud (OMS) del 29% en niños menores de cinco años. Además, el promedio de desnutrición crónica en la región asciende hasta el 80% en comunidades pobres e indígenas, convirtiendo a Honduras en el segundo país en la región centroamericana con mayor incidencia de desnutrición crónica. Otro de los problemas que presenta la región resulta del abandono precoz de la lactancia materna exclusiva: solo el 29,7% de los menores fue alimentado exclusivamente con leche materna hasta los seis meses. Por ello, el estudio busca conocer, identificar y cuantificar la situación con factores determinantes y brindar información para el diseño de políticas públicas. Material y método: el estudio consistió en una evaluación antropométrica descriptiva transversal en la que se analizó el estado nutricional y la prevalencia de malnutrición en 141 niños con edades comprendidas entre los seis meses y los cinco años, pertenecientes a regiones urbanas y rurales del país, así como la valoración de la prevalencia de la lactancia materna en cinco departamentos hondureños (Intibucá, Lempira, Atlántida, Olancho y Francisco Morazán). Resultados y conclusión: al analizar por departamentos observamos diferencias en el estado nutricional y de lactancia según fuese un área urbana o rural, siendo esta última el doble en el caso de la desnutrición crónica y la desnutrición global, con porcentajes del 14,6% en áreas urbanas frente a 28,8% áreas rurales, y el 4,6% en áreas urbanas frente al 9% en áreas rurales, respectivamente. Sin embargo, en cuanto a la desnutrición aguda y el sobrepeso en ambas regiones se observaron valores afines, por encima del 1,1% para la desnutrición aguda y del 14% para el sobrepeso. En relación con la lactancia materna exclusiva durante seis meses, los departamentos de Lempira y Olancho mostraron una duración de la misma hasta los dos años, con una distribución porcentual del 80% y el 48%, respectivamente. Es importante destacar que un 36% de las madres no proporcionaron lactancia, destacando como la tasa más elevada un 15% en el departamento de Francisco Morazán.

Grado de malnutrición y su relación con los principales factores estructurales y alimentarios de la población preescolar hondureña. Prevalencia de la lactancia materna en los mismos / Degree of malnutrition and its relationship with major structural and eating factors in Honduran preschool population. Prevalence of breastfeeding

Introducción: la desnutrición infantil sigue siendo un grave problema de salud pública en Honduras, con una prevalencia nacional según valores de referencia de la Organización Mundial de la Salud (OMS) del 29% en niños menores de cinco años. Además, el promedio de desnutrición crónica en la región asciende hasta el 80% en comunidades pobres e indígenas, convirtiendo a Honduras en el segundo país en la región centroamericana con mayor incidencia de desnutrición crónica. Otro de los problemas que presenta la región resulta del abandono precoz de la lactancia materna exclusiva: solo el 29,7% de los menores fue alimentado exclusivamente con leche materna hasta los seis meses. Por ello, el estudio busca conocer, identificar y cuantificar la situación con factores determinantes y brindar información para el diseño de políticas públicas. Material y método: el estudio consistió en una evaluación antropométrica descriptiva transversal en la que se analizó el estado nutricional y la prevalencia de malnutrición en 141 niños con edades comprendidas entre los seis meses y los cinco años, pertenecientes a regiones urbanas y rurales del país, así como la valoración de la prevalencia de la lactancia materna en cinco departamentos hondureños (Intibucá, Lempira, Atlántida, Olancho y Francisco Morazán). Resultados y conclusión: al analizar por departamentos observamos diferencias en el estado nutricional y de lactancia según fuese un área urbana o rural, siendo esta última el doble en el caso de la desnutrición crónica y la desnutrición global, con porcentajes del 14,6% en áreas urbanas frente a 28,8% áreas rurales, y el 4,6% en áreas urbanas frente al 9% en áreas rurales, respectivamente. Sin embargo, en cuanto a la desnutrición aguda y el sobrepeso en ambas regiones se observaron valores afines, por encima del 1,1% para la desnutrición aguda y del 14% para el sobrepeso. En relación con la lactancia materna exclusiva durante seis meses, los departamentos de Lempira y Olancho mostraron una duración de la misma hasta los dos años, con una distribución porcentual del 80% y el 48%, respectivamente. Es importante destacar que un 36% de las madres no proporcionaron lactancia, destacando como la tasa más elevada un 15% en el departamento de Francisco Morazán (AU)

Introduction: Child malnutrition remains a serious public health problem in Honduras, with a national prevalence according to the World Health Organization (WHO) reference values of 29% in children under five. In addition, the average chronic malnutrition in the region amounts to 80% in poor and indigenous communities, making Honduras the second country in Central America with the highest incidence of chronic malnutrition. Another problem of the region is the early cessation of exclusive breastfeeding: only 29.7% of children were exclusively breastfed until they were six months. Therefore, the study seeks to understand, identify and quantify the situation determinants and provide information for the design of public policies. Material and method: The study consisted of a cross-sectional descriptive anthropometric assessment in which the nutritional status and the prevalence of undernourishment, malnutrition and malnutrition in 141 children aged between six months and five years, belonging to urban and rural regions of the country, were analyzed, as well as assessing the prevalence of breastfeeding in five Honduran departments (Intibucá, Lempira, Atlántida, Olancho and Francisco Morazán). Results and conclusion: When making the analysis by departments, differences regarding nutritional status and breastfeeding were observed between urban and rural areas, the latter being doubled in the case of chronic malnutrition and underweight, with percentages of 14.6% in urban areas versus 28.8% in rural areas, and 4.6% in urban areas compared to 9% in rural areas, respectively. However, with respect to acute malnutrition and overweight in both regions, similar values were observed, above 1.1% for acute and 14% for overweight malnutrition. In relation to exclusive breastfeeding for six months, the departments of Olancho and Lempira maintained it for two years, with a percentage distribution of 80% and 48%, respectively. It must be noted that 36% of mothers did not provide breastfeeding, with the highest rate (15%) in the department of Francisco Morazán (AU)

Contribution of bioavailable iron and zinc to the diet of Honduran children under 24 month / Aporte de hierro y zinc bioaccesible a la dieta de niños hondureños menores de 24 meses

Objective: In the present study we analyzed 18 baby food (10 made from traditional Honduran recipes, and 8 industrial baby food sold in that country) involving the staple food of Honduran excluded infants breast milk and infant formulas. Material and methods: The content and bioaccesibility (soluble and dialysable fractions) of Fe and Zn were determined. For thisin vitro gastrointestinal digestion in a first phase of gastric digestion (pepsin) followed by a second phase of intestinal digestion (with pancreatin and bile salts) was simulated. The atomic absorption spectrometry mineral content measured in soluble and dialyzable fractions. Results: Traditional porridges from Honduras (PTH) showed low density of micronutrients being the PTH prepared based on "rice with beans and greens", "rice with ground beans" and "beans with banana" which had a higher content values of 1.96, 1.56, and 1.46 mg Fe/100 g, respectively, although in vitroavailability values below 50% of its content. For Zn in these recipes, the values found were very low being below the detection limit. In relation to industrial porridges (PIH), those of "rice", "wheat with milk" and "5 cereals" they had a higher content of Fe (9.4, 8.53 and 7.56 mg Fe/100 g, respectively). Its availability in vitro was greater than 70% in all cases. PIH Zn showed values of 1.36, and 0.99 mg Zn/100 g samples of "wheat with milk" and "wheat with honey", respectively, and increased availability of 75%. Conclusions: It is shown that PTH have some limitations in its formulation that makes the selected micronutrients are in fewer and even less bioaccessible, compared with PIH, so review is recommended to avoid supplementation of these micronutrients and help improve the nutritional status of the child population as Honduran model country in Central America.

Objetivo: en el presente estudio se han analizado 18 alimentos infantiles (10 elaborados con recetas tradicionales hondureñas y 8 papillas industriales comercializadas en ese país), que suponen la base de la alimentación de los lactantes hondureños excluida la leche materna y las fórmulas infantiles. Material y métodos: se determinó el contenido y bioacesiblidad (fracciones solubes y dializables) de Fe y Zn. Para ello se simuló una digestión in vitro gastrointestinal con una primera fase de digestión gástrica (con pepsina), seguida de una segunda fase de digestión intestinal (con pancreatina y sales biliares). La espectrometría de absorción atómica midió el contenido mineral en las fracciones soluble y dializable. Resultados: las papillas tradicionales hondureñas (PTH) mostraron baja densidad de los micronutrientes estudiados, siendo las PTH elaboradas con base de "arroz con frijoles y hojas verdes", "arroz con frijol molido" y "frijoles con plátano" las que presentaron un contenido superior con valores de 1,96, 1,56, y 1,46 mg Fe/100 g, respectivamente, aunque con valores de disponibilidad in vitro inferiores al 50% de su contenido. Para el Zn en estas recetas, los valores encontrados fueron muy bajos y están por debajo del límite de detección. En relación a las papillas industriales (PIH), las de "arroz", "trigo con leche" y "5 cereales" presentaron un mayor contenido de Fe (9,4, 8,53 y 7,56 mg Fe/100 g, respectivamente). Su disponibilidad in vitro fue mayor del 70% en todos los casos. Las PIH mostraron valores de Zn de 1,36, y 0,99 mg Zn/100 g en las muestras de "trigo con leche" y "trigo con miel", respectivamente, y una disponibilidad mayor del 75%. Conclusión: queda demostrado que las PTH poseen algunas limitaciones en su formulación que hace que los micronutrientes seleccionados se encuentren en menor cantidad e incluso menos bioaccesibles, frente a los PIH, por lo que se recomienda su revisión para evitar la suplementación de estos micronutrientes y ayudar a mejorar el estado nutricional de la población infantil hondureña como país modelo de la región centroamericana.

Aporte de hierro y zinc bioaccesible a la dieta de niños hondureños menores de 24 meses / Contribution of bioavailable iron and zinc to the diet of Honduran children under 24 month

Objetivo: en el presente estudio se han analizado 18 alimentos infantiles (10 elaborados con recetas tradicionales hondureñas y 8 papillas industriales comercializadas en ese país), que suponen la base de la alimentación de los lactantes hondureños excluida la leche materna y las fórmulas infantiles. Material y métodos: se determinó el contenido y bioacesiblidad (fracciones solubes y dializables) de Fe y Zn. Para ello se simuló una digestión in vitro gastrointestinal con una primera fase de digestión gástrica (con pepsina), seguida de una segunda fase de digestión intestinal (con pancreatina y sales biliares). La espectrometría de absorción atómica midió el contenido mineral en las fracciones soluble y dializable. Resultados: las papillas tradicionales hondureñas (PTH) mostraron baja densidad de los micronutrientes estudiados, siendo las PTH elaboradas con base de «arroz con frijoles y hojas verdes», «arroz con frijol molido» y «frijoles con plátano» las que presentaron un contenido superior con valores de 1,96, 1,56, y 1,46 mg Fe/100 g, respectivamente, aunque con valores de disponibilidad in vitro inferiores al 50% de su contenido. Para el Zn en estas recetas, los valores encontrados fueron muy bajos y están por debajo del límite de detección. En relación a las papillas industriales (PIH), las de «arroz», «trigo con leche» y «5 cereales» presentaron un mayor contenido de Fe (9,4, 8,53 y 7,56 mg Fe/100 g, respectivamente). Su disponibilidad in vitro fue mayor del 70% en todos los casos. Las PIH mostraron valores de Zn de 1,36, y 0,99 mg Zn/100 g en las muestras de «trigo con leche» y «trigo con miel», respectivamente, y una disponibilidad mayor del 75%. Conclusión: queda demostrado que las PTH poseen algunas limitaciones en su formulación que hace que los micronutrientes seleccionados se encuentren en menor cantidad e incluso menos bioaccesibles, frente a los PIH, por lo que se recomienda su revisión para evitar la suplementación de estos micronutrientes y ayudar a mejorar el estado nutricional de la población infantil hondureña como país modelo de la región centroamericana (AU)

Objective: In the present study we analyzed 18 baby food (10 made from traditional Honduran recipes, and 8 industrial baby food sold in that country) involving the staple food of Honduran excluded infants breast milk and infant formulas. Material and methods: The content and bioaccesibility (soluble and dialysable fractions) of Fe and Zn were determined. For this in vitro gastrointestinal digestion in a first phase of gastric digestion (pepsin) followed by a second phase of intestinal digestion (with pancreatin and bile salts) was simulated. The atomic absorption spectrometry mineral content measured in soluble and dialyzable fractions. Results: Traditional porridges from Honduras (PTH) showed low density of micronutrients being the PTH prepared based on «rice with beans and greens», «rice with ground beans» and «beans with banana» which had a higher content values of 1.96, 1.56, and 1.46 mg Fe/100 g, respectively, although in vitro availability values below 50% of its content. For Zn in these recipes, the values found were very low being below the detection limit. In relation to industrial porridges (PIH), those of «rice», «wheat with milk» and «5 cereals» they had a higher content of Fe (9.4, 8.53 and 7.56 mg Fe/100 g, respectively). Its availability in vitro was greater than 70% in all cases. PIH Zn showed values of 1.36, and 0.99 mg Zn/100 g samples of «wheat with milk» and «wheat with honey», respectively, and increased availability of 75%. Conclusions: It is shown that PTH have some limitations in its formulation that makes the selected micronutrients are in fewer and even less bioaccessible, compared with PIH, so review is recommended to avoid supplementation of these micronutrients and help improve the nutritional status of the child population as Honduran model country in Central America (AU)

Elaboración de guías nutricionales para lactantes hondureños y madres con alto grado de analfabetismo / Development of nutritional guidelines for honduran infants and mothers with high illiteracy

Fundamentos: La alimentación durante la infancia en Honduras presenta muchos problemas debidos, no sólo a la escasa disponibilidad de alimentos a nivel familiar, sino también a la falta de conocimientos de las madres en cuanto a los alimentos que el niño pequeño necesita, su salubridad y la forma de prepararlos. El objetivo del estudio fue identificar las pautas erróneas de lactancia y alimentación complementaria en los infantes hondureños y diseñar un instrumento educativo destinada orientar a madres con un alto grado de analfabetismo contemplando aspectos de lactancia y alimentación complementaria. Métodos: El estudio descriptivo transversal. Realizado en 100 familias Hondureñas con hijos menores de 24 meses. Los análisis se realizaron en 5 departamentos (Olancho, Intibucá, Lempira, Atlántida y Francisco Morazán), mediante un muestreo aleatorio simple. Se utilizó un formulario precodificado con patrones alimentarios, demográficos, socioeconómicos, ambientales, clínicos, y aplicando el método frecuencia de consumo para niños menores de 24 meses. Resultados: Se observó cómo en las comunidades estudiadas un porcentaje alto de las familias (67%) no practicaban la lactancia materna exclusiva durante los 2 primeros meses, a pesar de que el 94% de las madre encuestadas si daban lactancia natural (p<0,005). El 31% de las madres presentaban un nivel educativo bajo y un 6,4% era analfabeta. La prevalencia de desnutrición global en esta población fue del 11% y de un 20% en desnutrición crónica. Conclusiones La educación alimentaria y nutricional es un elemento esencial en la prevalencia y control de problemas de salud relacionados con la dieta, los resultados plantean la necesidad de modificar conductas no deseadas, que están profundamente arraigadas en el contexto social y cultural de las familias Hondureñas (AU)

Background: Childhood feeding in Honduras presents many problems due not only to the scarce availability of food at the family level, but also to the lack of knowledge of the mothers about the food the child needs, the healthiness and the form to prepare them. The aim of this study was to identify the erroneous patterns of breastfeeding and complementary feeding in Honduran infants and to design an educational instrument aimed at orienting mothers with a high degree of illiteracy regarding aspects of breastfeeding and complementary feeding. Methods: The study was a descriptive cross-evaluation 100 Honduran families with children under 24 months. Analyses were performed in 5 departments (Olancho, Intibucá, Lempira, Atlantis and Francisco Morazán), by a simple random sampling. A pre-coded form was used with food, demographic, socioeconomic, environmental, clinical patterns and also the frequency of consumption method for children under 24 months form was applied. Results: A high percentage of families (67%) did not practice exclusive breastfeeding during the first two months, though, that 94% of stem surveyed if they gave breastfeeding, was noted how, in the communities studied (p <0.005). The 31% of mothers participating in the study had a low educational level and 6.4% were illiterate. The prevalence of underweight in this population was 11% and 20% in chronic malnutrition. Conclusions food and nutrition education is an essential element in the prevalence and control of health problems related to diet, the results suggest the need to modify unwanted behaviors that are deeply rooted in the social and cultural context of the Honduran families (AU)

Omissions in Urology Residency Training Regarding Sexual Dysfunction Subsequent to Prostate Cancer Treatment: Identifying a Need.

OBJECTIVE: To assess urology residents' current knowledge, practice, previous training, barriers, and training needs regarding prostate cancer treatment-related sexual dysfunction. MATERIALS AND METHODS: A cross-sectional questionnaire study inventoried the practice patterns and training need of urology residents attending a national training course in June 2015. RESULTS: Of 101 urology residents throughout the Netherlands, 87 attended the training (response rate 100%). Median age was 32 years (range 28-38); 55.2% were woman. Regardless of the residency level, most trainees had never received education about sexual dysfunction (58.6%), reported a limited level of knowledge (48.3%), and indicated an evident need for training (69.4%). The majority did not feel competent to advise prostate cancer patients regarding the treatment of sexual dysfunction (55.2%). Almost all participants inquired about preoperative erectile dysfunction (89.7%), and always informed about treatment-related sexual dysfunction (88.5%). At follow-up, 63.9% of the residents routinely addressed sexual complaints again. More than half of the participants indicated that urology residency training does not provide sufficient education on sexual dysfunction (54.8%).Time constraint (67.1%) and lack of training (35.3%) were the most frequently mentioned barriers. CONCLUSION: Current urology residency does not pay sufficient attention to sexual communication skills and sexual dysfunction. The residents require more knowledge about and more practical training in sexual counseling. Findings support efforts to enhance the education of urology residents regarding prostate cancer treatment-related sexual dysfunction.

Wide-Ranging Effects of the Yeast Ptc1 Protein Phosphatase Acting Through the MAPK Kinase Mkk1.

The Saccharomyces cerevisiae type 2C protein phosphatase Ptc1 is required for a wide variety of cellular functions, although only a few cellular targets have been identified. A genetic screen in search of mutations in protein kinase-encoding genes able to suppress multiple phenotypic traits caused by the ptc1 deletion yielded a single gene, MKK1, coding for a MAPK kinase (MAPKK) known to activate the cell-wall integrity (CWI) Slt2 MAPK. In contrast, mutation of the MKK1 paralog, MKK2, had a less significant effect. Deletion of MKK1 abolished the increased phosphorylation of Slt2 induced by the absence of Ptc1 both under basal and CWI pathway stimulatory conditions. We demonstrate that Ptc1 acts at the level of the MAPKKs of the CWI pathway, but only the Mkk1 kinase activity is essential for ptc1 mutants to display high Slt2 activation. We also show that Ptc1 is able to dephosphorylate Mkk1 in vitro. Our results reveal the preeminent role of Mkk1 in signaling through the CWI pathway and strongly suggest that hyperactivation of Slt2 caused by upregulation of Mkk1 is at the basis of most of the phenotypic defects associated with lack of Ptc1 function.

Prognostic value of admission glycated haemoglobin in unknown diabetic patients with acute myocardial infarction.

BACKGROUND: Acute glycometabolic derangement in non-diabetic patients with acute myocardial infarction (AMI) has been reported with discrepant prognostic results. The aim of the present study was to assess the prognostic impact of glycated haemoglobin (HbA1c) levels, reflecting long-term glycometabolic disturbance, in a population of patients without known diabetes mellitus. METHODS: We examined 601 consecutive prospective patients diagnosed with AMI and unknown diabetes mellitus. We analysed metabolic function as a stratified variable using three groups of patients according to HbA1c: Group 1 (< 5.5%): 222 patients (37%); Group 2 (5.5 to 6.4%): 337 patients (56%); Group 3 (>6.4%): 42 patients (7%). Association between HbA1c groups and classic cardiovascular risk factor and in-hospital outcomes were assessed through univariate and multivariate analysis. RESULTS: In-hospital mortality was 5% (32/601 patients). Higher HbA1c was associated with poor glycometabolic control, older patients, obesity, hypertension, Killip's class>1, increased heart rate, initial bundle branch block, atrial fibrillation and higher mortality during follow-up. In a multivariate adjusted risk, in-hospital mortality was associated with age (odds ratio (OR)= 1.056; 1-1.1; p=0.006), Killip's class>1 (OR=2.4; 1-6.1; p=0.05) and HbA1c (OR=1.5; 1.15-1.9; p=0.002). Hypertension (OR=0.39; 0.18-0.87; p=0.022) and angiotensin-converting enzyme inhibitors (OR=0.28; 0.12-0.69; p=0.005) were protective factors. CONCLUSIONS: HbA1c is an important risk marker in the absence of a history of diabetes mellitus in patients with AMI. The optimal management strategy in these patients may contribute to decreased in-hospital mortality.

Dynamics of serum-induced endothelial cell apoptosis in patients with myocardial infarction.

BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) reperfused with primary coronary intervention (PCI), the dynamics of endothelial cell (EC) viability, apoptosis and necrosis and its relationship with the structural consequences on the left ventricle have not been addressed so far. DESIGN: In 20 STEMI patients, we incubated human umbilical vein endothelial cells (HUVECs) with serum drawn before reperfusion and subsequently afterwards (24, 96 h, 30 days). Viability, apoptosis and necrosis percentages were evaluated by flow cytometry. Values were compared with 12 age- and sex-matched control subjects with normal coronary arteries. Cardiac magnetic resonance (CMR) was performed during the first week after infarction. RESULTS: Serum from STEMI patients induced a progressive loss of EC viability, with a nadir of 67.7 ± 10.2% at 96 h (baseline: 75 ± 6% and controls: 80.2 ± 3.9%, P < 0.001 in both cases). This is due to an increase in apoptosis that peaked at 96 h after reperfusion (15.2 ± 7.1% vs. 11 ± 6 at baseline and 5.8 ± 1.6% in controls, P < 0.001 in both cases). However, no significant dynamic changes in EC necrosis were detected. Extensive myocardial oedema (> 30%, median of left ventricular mass) was the only CMR variable significantly associated with a higher percentage of EC apoptosis at 96 h (extensive vs. nonextensive oedema: 18.3 ± 6.8% vs. 12.1 ± 6.3%, P < 0.05). CONCLUSIONS: Dynamic changes in EC viability occur in the setting of STEMI patients reperfused with PCI, these changes peak late after reperfusion, they are mainly the result of an increase of apoptosis and are associated with the presence of extensive myocardial oedema.

Valor pronóstico a largo plazo del análisis completo de los índices de resonancia magnética cardiaca tras un infarto de miocardio con elevación del segmento ST / Long-term prognostic value of a comprehensive assessment of cardiac magnetic resonance indexes after an ST-segment elevation myocardial infarction

Introducción y objetivos. Se ha demostrado el valor pronóstico de varios índices de resonancia magnética cardiaca a medio plazo tras un infarto agudo de miocardio con elevación del segmento ST. La extensión de la necrosis transmural permite una predicción simple y exacta de viabilidad miocárdica. Sin embargo, se desconoce su valor pronóstico a largo plazo más allá de una completa evaluación clínica y por resonancia. Nuestra hipótesis es que la evaluación semicuantitativa de la extensión de la necrosis transmural es el mejor índice de resonancia para predecir el pronóstico a largo plazo tras un infarto con elevación del segmento ST. Métodos. Se realizó un estudio cuantitativo con resonancia a 206 pacientes consecutivos tras un infarto con elevación del segmento ST. También se evaluó semicuantitativamente (número de segmentos alterados, modelo de 17 segmentos) edema, contractilidad basal y tras dobutamina, perfusión de primer paso, obstrucción microvascular y extensión de la necrosis transmural. Resultados. Durante el seguimiento (mediana, 51 meses), 29 pacientes sufrieron un primer evento cardiaco adverso (8 muertes cardiacas, 11 infartos y 10 reingresos por insuficiencia cardiaca). Estos eventos se asociaron con mayor alteración de los índices de resonancia. Tras un ajuste multivariable, la extensión de la necrosis transmural fue el único índice de resonancia con asociación independiente con los eventos cardiacos adversos (razón de riesgos = 1,34 [1,19-1,51] por cada segmento con necrosis transmural > 50%; p < 0,001). Conclusiones. Un sencillo análisis semicuantitativo de la extensión de la necrosis transmural es el índice de resonancia cardiaca más potente para predecir el pronóstico a largo plazo tras un infarto agudo de miocardio con elevación del segmento ST (AU)

Introduction and objectives: A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction. Methods: One week after a first ST-segment elevation myocardial infarction we carried out a comprehensive quantification of several resonance parameters in 206 consecutive patients. A semiquantitative assessment (altered number of segments in the 17-segment model) of edema, baseline and post-dobutamine wall motion abnormalities, first pass perfusion, microvascular obstruction, and the extent of transmural necrosis was also performed. Results: During follow-up (median 51 months), 29 patients suffered a major adverse cardiac event (8 cardiac deaths, 11 nonfatal myocardial infarctions, and 10 readmissions for heart failure). Major cardiac events were associated with more severely altered quantitative and semiquantitative resonance indexes. After a comprehensive multivariate adjustment, the extent of transmural necrosis was the only resonance index independently related to the major cardiac event rate (hazard ratio=1.34 [1.19-1.51] per each additional segment displaying >50% transmural necrosis, P<.001). Conclusions: A simple and non-time consuming semiquantitative analysis of the extent of transmural necrosis is the most powerful cardiac magnetic resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction (AU)

Long-term prognostic value of a comprehensive assessment of cardiac magnetic resonance indexes after an ST-segment elevation myocardial infarction.

INTRODUCTION AND OBJECTIVES: A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction. METHODS: One week after a first ST-segment elevation myocardial infarction we carried out a comprehensive quantification of several resonance parameters in 206 consecutive patients. A semiquantitative assessment (altered number of segments in the 17-segment model) of edema, baseline and post-dobutamine wall motion abnormalities, first pass perfusion, microvascular obstruction, and the extent of transmural necrosis was also performed. RESULTS: During follow-up (median 51 months), 29 patients suffered a major adverse cardiac event (8 cardiac deaths, 11 nonfatal myocardial infarctions, and 10 readmissions for heart failure). Major cardiac events were associated with more severely altered quantitative and semiquantitative resonance indexes. After a comprehensive multivariate adjustment, the extent of transmural necrosis was the only resonance index independently related to the major cardiac event rate (hazard ratio=1.34 [1.19-1.51] per each additional segment displaying>50% transmural necrosis, P<.001). CONCLUSIONS: A simple and non-time consuming semiquantitative analysis of the extent of transmural necrosis is the most powerful cardiac magnetic resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction.

Distinct docking mechanisms mediate interactions between the Msg5 phosphatase and mating or cell integrity mitogen-activated protein kinases (MAPKs) in Saccharomyces cerevisiae.

MAPK phosphatases (MKPs) are negative regulators of signaling pathways with distinct MAPK substrate specificities. For example, the yeast dual specificity phosphatase Msg5 dephosphorylates the Fus3 and Slt2 MAPKs operating in the mating and cell wall integrity pathways, respectively. Like other MAPK-interacting proteins, most MKPs bind MAPKs through specific docking domains. These include D-motifs, which contain basic residues that interact with acidic residues in the common docking (CD) domain of MAPKs. Here we show that Msg5 interacts not only with Fus3, Kss1, and Slt2 but also with the pseudokinase Slt2 paralog Mlp1. Using yeast two-hybrid and in vitro interaction assays, we have identified distinct regions within the N-terminal domain of Msg5 that differentially bind either the MAPKs Fus3 and Kss1 or Slt2 and Mlp1. Whereas a canonical D-site within Msg5 mediates interaction with the CD domains of Fus3 and Kss1, a novel motif ((102)IYT(104)) within Msg5 is involved in binding to Slt2 and Mlp1. Furthermore, mutation of this site prevents the phosphorylation of Msg5 by Slt2. This motif is conserved in Sdp1, another MKP that dephosphorylates Slt2, as well as in Msg5 orthologs from other yeast species. A region spanning amino acids 274-373 within Slt2 and Mlp1 mediates binding to this Msg5 motif in a CD domain-independent manner. In contrast, Slt2 uses its CD domain to bind to its upstream activator Mkk1. This binding flexibility may allow MAPK pathways to exploit additional regulatory controls in order to provide fine modulation of both pathway activity and specificity.