Histopathological and statistical study of corneal repair in rabbits. A new way to understand corneal recovery.

The study aims to evaluate corneal healing post amniotic membrane transplantation in controlled corneal defects, justifying its application in routine ophthalmology practice. The objective is to establish a reliable method for assessing the repair process. In three groups of six adult New Zealand rabbits, keratectomy and a monolayer transplant of dehydrated human amniotic membrane (AM) were conducted in the left eye (OS) with the right eye (OD) serving as the control eye. Clinical signs were assessed, and both eyes were enucleated at 1, 2, and 4 weeks for optical coherence tomography (OCT) measurements and histological analysis, collecting data from different epithelium, stroma, and limbus regions. This study was conducted using a formula that combines histologic data categorizing their presence and/or type as beneficial for corneal repair. No statistically significant differences were found between the experimental and control eyes regarding all clinical signs and OCT measurements. However, a linear model using histopathological results showed a period-implant mode interaction with statistical significance (p=0.010). The use of the single-layer amniotic membrane resulted in improved corneal recovery with the stromal side showing better performance in the first week and the epithelial side proving to be more effective than the stromal side in the long term. For the first time, a statistical formula employing histopathological data is introduced to determine corneal recovery, potentially offering a more accurate and reliable method compared with the observation of clinical signs and corneal measurements with OCT.

Clinical considerations and pathophysiological associations among obesity, weight loss, heart failure, and hypertension.

PURPOSE OF REVIEW: To describe the relationship between three pandemics: hypertension, obesity, and heart failure. From pathophysiology to treatment, understanding how these disease entities are linked can lead to breakthroughs in their prevention and treatment. The relevance of this review lies in its discussion of novel pharmacological and surgical treatment strategies for obesity and hypertension, and their role in the prevention and treatment of heart failure. RECENT FINDINGS: Novel medications such as GLP-1 agonists have demonstrated sustained weight loss in patients with obesity, and concurrent improvements in their cardiometabolic profile, and possibly also reductions in hypertension-related comorbidities including heart failure. Surgical therapies including laparoscopic bariatric surgery represent an important treatment strategy in obese patients, and recent studies describe their use even in patients with advanced heart failure, including those with ventricular assist devices. SUMMARY: These developments have deep implications on our efforts to understand, mitigate, and ultimately prevent the three pandemics, and offer promising improvements to quality of life, survival, and the cost burden of these diseases.

Effect of Conventional Cataract Surgery and Femtosecond Laser-Assisted Cataract Surgery on Bruch's Membrane Opening-Minimum Rim Width, Retinal Nerve Fiber Layer, and Macular Thickness.

Purpose: To evaluate the effect of conventional cataract surgery (CCS) and femtosecond laser-assisted cataract surgery (FLACS) on Bruch's membrane opening-minimum rim width (BMO-MRW), peripapillary retinal nerve fiber layer thickness (RNFL), and macular thickness (MT) using spectral-domain optical coherence tomography (SD-OCT). Methods: BMO-MRW, RNFL, and MT were measured using SD-OCT preoperatively, 1 month and 6 months after surgery in both CCS and FLACS groups. Differences between preoperative and postoperative values were evaluated in both groups. The postoperative changes were evaluated in each group and compared between groups. Results: A total of 146 eyes of 146 patients were included in this study, 65 underwent CCS, and 81 underwent FLACS. One month after surgery, there was an increase (in microns) of 20.93 in BMO-MRW, 4.26 in RNFL, and 7.85 in MT in CCS group (P < 0.001), and 17.7, 3.73, and 5.65, respectively, in FLACS group (P < 0.001). Six months after surgery, there was an increase of 12.53 in BMO-MRW, 1.42 in RNFL, and 4.72 in MT in CCS group (P < 0.001), and 13.7, 1.88, and 4.14, respectively, in FLACS group (P < 0.001). The postoperative changes in CCS group were similar to those in FLACS group. Conclusion: CCS as well as FLACS result in a slight increase in BMO-MRW, RNFL, and MT values one month and six months after surgery. Neither CCS nor FLACS lead to a deterioration in the parameters that define the structure of the optic nerve head and the macula. These results suggest that FLACS is as safe as CCS regarding the optic nerve head and the macula in normal eyes.

Thyroid Fine Needle Aspiration, the Bethesda System, and the BRAFV600E Mutation in Papillary Thyroid Carcinoma: Association and Prediction for Biopsy.

INTRODUCTION: BRAFV600E mutations have been associated with papillary thyroid carcinoma (PTC) histological types including tall-cell and classical, peritumoral infiltration, and nuclear signs, whereas cytological features such as plump cells and sickle nuclei have also been associated with favorable thyroid fine needle aspiration (FNA) results for this tumor. BRAF and RAS are considered early driver mutations that contribute to the development of BRAF-like PTCs and RAS-like PTCs. Our aim was to assess the possible association between all Bethesda System cytological features and thyroid FNAs for PTC and their potential predictive value for future BRAFV600E-related biopsies. METHODS: Our study analyzed 63 cases of PTCs operated on at our hospital over a 5-year period between 2005 and 2017 that had previously undergone FNA and had been classified by the Bethesda System. BRAFV600E was identified by pyrosequencing paraffin-embedded tissues and comparing the cytological signs with the Bethesda System. In addition, a statistical and predictive study of the diagnostic factors "non-follicular," "non-round nuclei," and "non-clear chromatin" was performed to discriminate BRAF-like signs from other hypothetical RAS-like follicular signs. RESULTS: BRAFV600E was detected in 43/63 cases (68.2%). Histological types were significant (p < 0.001), with the classical variant being the most prevalent 31/63 (49.2%) and independent by multivariate analysis odds ratio of 10.58 [2.67; 41.97]. Follicular cytological signs are negatively associated with BRAFV600E: follicular structure (p < 0.001), round nuclei (p = 0.015), and clear chromatin (p = 0.049), while the diagnostic factors: "non-follicular" (positive predictive value [PPV] 82.9, sensitivity 79.1, negative predictive value [NPV] 59.1, specificity 65.0), "non-round nuclei" (PPV 76.6, sensitivity 83.7, NPV 56.3, specificity 45.0), and "non-clear chromatin" (PPV 75.6, sensitivity 79.1, NPV 50.0, specificity 45.0) have predictive value for the mutation. There was no individual significance for the remaining cytological features. CONCLUSIONS: Our study found no association between cytomorphological signs of thyroid FNA and BRAFV600E mutation. Considering the Bethesda System, there is an association (p = 0.045) with numerous cases of mutated PTC in categories V and VI. Our results indicate, however, that the presence of signs referred to as "non-follicular," "non-round nuclei," and "non-clear chromatin" in biopsy of papillary thyroid carcinoma is predictive of BRAF type mutation, whereas follicular signs indicate a RAS type PTC, according to published literature. These results need to be confirmed or modified by further research.

Fascial Innervation: A Systematic Review of the Literature.

Currently, myofascial pain has become one of the main problems in healthcare systems. Research into its causes and the structures related to it may help to improve its management. Until some years ago, all the studies were focused on muscle alterations, as trigger points, but recently, fasciae are starting to be considered a new, possible source of pain. This systematic review has been conducted for the purpose of analyze the current evidence of the muscular/deep fasciae innervation from a histological and/or immunohistochemical point of view. A literature search published between 2000 and 2021 was made in PubMed and Google Scholar. Search terms included a combination of fascia, innervation, immunohistochemical, and different immunohistochemical markers. Of the 23 total studies included in the review, five studies were performed in rats, four in mice, two in horses, ten in humans, and two in both humans and rats. There were a great variety of immunohistochemical markers used to detect the innervation of the fasciae; the most used were Protein Gene Marker 9.5 (used in twelve studies), Calcitonin Gene-Related Peptide (ten studies), S100 (ten studies), substance P (seven studies), and tyrosine hydroxylase (six studies). Various areas have been studied, with the thoracolumbar fascia being the most observed. Besides, the papers highlighted diversity in the density and type of innervation in the various fasciae, going from free nerve endings to Pacini and Ruffini corpuscles. Finally, it has been observed that the innervation is increased in the pathological fasciae. From this review, it is evident that fasciae are well innerved, their innervation have a particular distribution and precise localization and is composed especially by proprioceptors and nociceptors, the latter being more numerous in pathological situations. This could contribute to a better comprehension and management of pain.

Changes in the Mechanical Properties of the Horizontal Force-Velocity Profile during a Repeated Sprint Test in Professional Soccer Players.

The objective was to analyze the changes in the horizontal force-velocity profile (HFVP) during the execution of repeated sprinting. Methods: Seventeen first-division Chilean soccer players completed a repeated sprint protocol consisting of eight sprints of 30 m with 25-s pauses between repetitions. The behavior of HFVP variables in each attempt was recorded from video recordings and analysis in the MySprint® application. Results: Differences (p < 0.05) were found between sprints in the following: time (T), starting from sprint 5 (F = 35.6; η2p = 0.69); theoretical maximum speed (V0), starting from sprint 4 (F = 29.3; η2p = 0.51); maximum power (PM), starting from sprint 5 (F = 17; η2p = 0.52); rate of decrease in force index produced at each step (DRF), starting from sprint 1 (F = 3.20; η2p = 0.17); and RF10, starting from sprint 1 (F = 15.5; η2p = 0.49). In comparison, F0 and RFpeak did not present any differences (p > 0.05). Conclusion: The HFVP variables more sensitive to the effects of fatigue induced by an RSA protocol are those associated with the production of force at high speeds, being V0, DRF, and Pmax, while those that contribute to the generation of force at the beginning of the sprint, F0 and RFpeak, do not present essential variations.

Evaluation of the effectiveness of transcutaneous nerve stimulation during labor in breech presentation: a case series.

Objective: To analyze the effectiveness of pain relief with transcutaneous electrical nerve stimulation (TENS) dispositive during labor in breech vaginal delivery and also to describe its tolerance and satisfaction.Design: A randomized, double-blind, and placebo-controlled trial was conducted.Setting: Labor room of Complejo Hospitalario Universitario Insular-Materno Infantil (Spain).Participants: Ten women who met the inclusion criteria of the clinical trial and also had a fetus breech presentation were randomly assigned to three groups.Interventions: A portable TENS, Cefar Rehab 2pro®, unit was used to apply the experimental intervention, with different doses in the three groups in women during labor. The device intensity (amplitude) was individually adjusted to each participant's maximum sensory level. The pain was evaluated with visual analog scale (VAS). COMFORTS scale was used to measure women's satisfaction.Results: A significant association of VAS was detected depending on the type of TENS over time. Active TENS2 was the only group that obtained an improvement with clinically significant results. In connection with women satisfaction, active TENS2 group was also the group that presented higher values.Conclusions: We can recommend the use of TENS dispositive to relieve pain during labor, also in those women with breech presentation.

Laparoscopic Sleeve Gastrectomy in Patients with Obesity and Ventricular Assist Devices: a Comprehensive Outcome Analysis.

We analyzed in detail the outcomes of eight patients with ventricular assist devices (VADs) and obesity who underwent laparoscopic sleeve gastrectomy (LSG) at a single heart transplant (HT) center. This comprehensive analysis included body mass index (BMI) trends from VAD implantation to the time of LSG; BMI and percentage of excess BMI lost during follow-up; adverse outcomes; and changes in echocardiographic parameters, fasting lipids, unplanned hospitalizations, and functional status. We also identified the patients who achieved the following outcomes: listing for HT, HT, 50% excess BMI loss, and BMI < 35 kg/m2. Laparoscopic sleeve gastrectomy seems to be a reasonable and effective intervention to help patients with VADs and obesity to decrease excess BMI and become candidates for HT.

Bariatric Surgery in Patients with Obesity and Ventricular Assist Devices Considered for Heart Transplantation: Systematic Review and Individual Participant Data Meta-analysis.

BACKGROUND: Class II obesity (body mass index BMI ≥35 kg/m2) is a contraindication to heart transplantation (HT). Although few single-center studies (case reports/series and small cohorts) have reported promising outcomes of bariatric surgery (BS) in patients with obesity and ventricular assist devices, low sample sizes have made their analysis and interpretation challenging. METHODS AND RESULTS: We conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase, PubMed, Google Scholar, and most relevant bariatric and heart failure journals. We extracted baseline and outcome individual participant data for every ventricular assist device patient undergoing BS with reported postoperative BMI and their respective timepoints when BMI data were measured. Fourteen references with 29 patients were included. The mean age was 41.9 ± 12.2 years, 82.8% underwent laparoscopic sleeve gastrectomy, and 39.3% had reported perioperative adverse events. The mean pre-BS BMI was 45.5 ± 6.6 kg/m2 and decreased significantly during follow-up (rho -0.671; P< .00001). Among 23 patients with documented listing status, 78.3% were listed for HT. Thirteen of 28 patients (46.4%) underwent HT at 14.4 ± 7.0 months. There were no reported deaths for the HT-free 1-year period. Median follow-up was 24 months (interquartile range, 12-30 months). Twenty-two of 28 patients (78.6%) achieved the composite outcome (BMI of<35 kg/m2/HT/listing for HT/myocardial recovery) at 11 months (interquartile range, 3-17 months). Patients with a BMI<45 kg/m2 had a higher chance of achieving the composite outcome (P< .003). CONCLUSIONS: BS may help patients with obesity and ventricular assist devices to lose a significant amount of weight and improve their candidacy for HT or even achieve myocardial recovery.

Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices: a data note.

OBJECTIVES: Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight after implantation, which is associated with higher complication rates and is a contraindication for heart transplantation (HT). The objective was to analyze the outcomes of obese patients with ESHF and VADs who underwent laparoscopic sleeve gastrectomy (LSG) at Ochsner Medical Center in New Orleans, which is the only program performing VADs and HT in the State of Louisiana, and also one of the largest VAD centers in the USA. DATA DESCRIPTION: This dataset contains detailed baseline, perioperative, and long-term data of patients with VADs undergoing LSG. These variables were collected retrospectively from electronic medical records. Patients who achieved ≥ 50% excess BMI loss, BMI ≤ 35 kg/m2, listing for HT, HT, or myocardial recovery were identified and the timing to each of these milestones was documented. These data can be used alone or in combination with other datasets to achieve a larger sample size with more power for further analysis of these variables, which include the most important, standard, and objective bariatric and ESHF outcomes of patients with VADs undergoing LSG. Elaboration of composite outcomes is feasible.

Bariatric surgery in obese patients with ventricular assist devices.

OBJECTIVES: Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight, which may prevent them from receiving heart transplantation (HT) if their body mass index (BMI) reaches ≥ 35 kg/m2. The objective was to synthesize all cases available in the literature and describe the most important outcomes of bariatric surgery (BS) in VAD patients, including BMI trends, reaching a BMI < 35 kg/m2, listing for HT, achieving HT, myocardial recovery, and mortality. These data were obtained for an individual participant data (IPD) meta-analysis and include available IPD for every case in the scientific literature describing VAD patients undergoing BS during VAD support with documented postoperative BMI (and time of measurement) during follow-up. DATA DESCRIPTION: These data include baseline, periprocedural, and long-term outcomes for the 29 patients meeting selection criteria. The composite outcome includes reaching a BMI < 35 kg/m2, listing for HT, receiving HT, and myocardial recovery, indicating significant BMI loss associated with major ESHF outcomes. As multiple centers are becoming more experienced in this field, the present data can be merged with their databases to form larger samples that will allow to perform further statistical analysis to identify outcome predictors and improve clinical protocols and outcomes.

Implant-based immediate breast reconstruction: failure rate when radiating the tissue expander or the permanent implant-a meta-analysis.

BACKGROUND: Implant-based immediate approach remains to be a first line option for reconstruction of mastectomy defects. When combined with post-mastectomy radiation therapy (PMRT) two different schemas are possible: radiating the temporary tissue expander (TTE) or the permanent implant (PI). The present article intends to be the biggest cohort meta-analysis to the date comparing reconstructive failure (RF) rate in these two scenarios: PMRT to TE compared with PMRT to PI. METHODS: A systematic search of the literature was performed on PUBMED/MEDLINE. The following key words were chosen: Breast Reconstruction AND Implant based AND Immediate. The time limit applied was from January 2008 to January 2019. We selected ten articles (n=1,130) to perform a meta-analysis due to the similarity of their approaches. Secondly, we did a simple literature review in order to identify some variables possibly working as predicting factors for RF. RESULTS: Previous meta-analysis are analysed. Some variables possibly working as risk factors for RF are summarized. We performed a meta-analysis in two scenarios: a fixed-effect model and a random effect model. For the random effect model an OR of 1.85 was obtained (0.96, 3.57; P=0.067). A funnel plot is performed showing no publication bias exists. CONCLUSIONS: There is a tendency towards a higher RF rate when the TTE is irradiated compared with the irradiation of the PI. Further studies trying to elucidate the influence of the suggested risk factors for RF have to be performed to stablish a consensus about the indications and contraindications of this reconstructive modality.

Primary and post-chemoradiotherapy MRI detection of extramural venous invasion in rectal cancer: the role of diffusion-weighted imaging.

OBJECTIVE: To assess the added value of diffusion-weighted imaging (DWI) to high-resolution T2-weighted sequences (HRT2w) in MRI detection of extramural venous infiltration (EMVI), according to the previous experience of radiologists. METHODS: A cross-sectional study of a retrospective database including 1.5 T MRI records from 100 patients with biopsy-proven rectal cancer (2011-2016; 75 male/25 female, average 63 y/o), which included primary staging (54) and post-chemoradiotherapy follow-up MRIs (46). The reference standard was histology of surgical specimens. All cases were individually blindly reviewed by ten radiologists: three specialists in abdominal radiology, three specialized in different areas and four residents. In each case, the presence of EMVI was assessed twice: first, using just HRT2w; second, with DWI added to HRT2w. The results were pooled by experience, analyzing sensitivity, specificity, accuracy (area under ROC curve), likelihood ratios, predictive values and overstaging/understaging. RESULTS: Addition of DWI improved diagnostic performance by specialists radiologists, particularly post-chemoradiotherapy (accuracy 0.74-0.84; positive likelihood ratio 3.9-9.1; overstaging 16-8%), less so at primary staging (specificity 76-87.2%; overstaging 21-11%). Non-specialist radiologists also improved, but only at primary staging (accuracy 0.59-0.63). Residents showed small changes, except for notably increased sensitivity in both primary staging (35.7-43%) and post-chemoradiotherapy (41.7-58.3%) staging, at the expense of increased overstaging. CONCLUSIONS: The addition of DWI improved the diagnostic performance of EMVI by experienced radiologists, downgrading overstaging, especially in post-chemoradiotherapy follow-up. It resulted in fewer changes for inexperienced radiologists (enhanced primary staging) and residents (increased sensitivity).

Primary and post-chemoradiotherapy staging using MRI in rectal cancer: the role of diffusion imaging in the assessment of perirectal infiltration.

PURPOSE: To analyze changes in MRI diagnostic accuracy in main rectal tumor (T) evaluation resulting from the use of diffusion-weighted imaging (DWI), according to the degree of experience of the radiologist. METHODS: This is a cross-sectional study of a database including one hundred 1.5 T MRI records (2011-2016) from patients with biopsy-proven rectal cancer, including primary staging and post-chemoradiotherapy follow-up. All cases were individually blindedly reviewed by ten radiologists: three experienced in rectal cancer, three specialized in other areas, and four residents. Each case was assessed twice to detect perirectal infiltration: first, evaluating just high-resolution T2-weighted sequences (HRT2w); second, evaluation of DWI plus HRT2w sequences. Results were pooled by experience, calculating accuracy (area under ROC curve), sensitivity and specificity, predictive values, likelihood ratios, and overstaging/understaging. Histology of surgical specimens provided the reference standard. RESULTS: DWI significantly improved specificity by experienced radiologists in primary staging (63.2% to 75.9%) and, to a lesser extent, positive likelihood ratio (2.06 to 2.87); minimal changes were observed post-chemoradiotherapy, with a slight decrease of accuracy (0.657 to 0.626). Inexperienced radiologists showed a similar pattern, but with slight enhancement post-chemoradiotherapy (accuracy 0.604 to 0.621). Residents experienced small changes, with increased sensitivity/decreased specificity in both primary (69% to 72%/67.2% to 64.7%) and post-chemoradiotherapy (68.1% to 73.6%/47.3% to 44.6%) staging. CONCLUSIONS: Adding DWI to HRT2w significantly improved specificity for the detection of perirectal infiltration at primary staging by experienced radiologists and also by inexperienced ones, although to a lesser extent. In the post-neoadjuvant treatment subgroup, only minimal changes were observed.

Effect of femtosecond laser-assisted lens surgery on the optic nerve head and the macula.

AIM: To evaluate the effect of femtosecond laser-assisted lens surgery (FLALS; cataract surgery or refractive lens exchange) on the structure of the optic nerve head and the macula. METHODS: This prospective longitudinal study included healthy eyes undergoing FLALS. Eyes with glaucoma or any other ocular disease that could alter optical coherence tomography results were excluded. Retinal nerve fiber layer (RNFL), Bruch's membrane opening-minimum rim width (BMO-MRW) and macular thickness (MT) were measured preoperatively, 1 and 6mo after surgery using spectral-domain optical coherence tomography (SD-OCT). Changes between preoperative and postoperative values were evaluated. RESULTS: A total of 87 eyes of 46 patients were included in this study. Preoperative RNFL, BMO-MRW and MT in microns (µm) were 100.77±10.39, 330.31±49.99 and 276.30±33.39, respectively. Postoperative RNFL, BMO-MRW and MT were 104.74±11.55, 348.32±54.05 and 279.83±22.65 1mo after surgery and 102.93±11.17, 343.11±53.4 and 278.90±22.19 6mo after surgery, respectively; which equals an increase of 3.93%, 5.45% and 1.27%, respectively, 1mo after surgery, and 2.14%, 3.87% and 0.94% 6mo after surgery. The differences between the preoperative and the postoperative RNFL and BMO-MRW values were statistically significant (P<0.001). Regarding MT values, there were not statistically significant differences (P=0.26). CONCLUSION: Our study suggests that FLALS does not have a negative impact on the structural status of the optic nerve head in healthy eyes, assessed by SD-OCT. There is a slight increase in the values of RNFL, BMO-MRW and MT 1mo and 6mo after surgery.

Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial.

BACKGROUND: Pain during labour is one of the most intense pain that women may experience in their lifetime. There are several non-pharmacological analgesic methods to relieve pain during labour, among them transcutaneous electrical nerve stimulation (TENS). TENS is a low-frequency electrotherapy technique, analgesic type, generally used in musculoskeletal pathology, but it has also come to be used as an alternative treatment during labour. The purpose of this study is to investigate the pain-relieving effect of a TENS application during labour and to find out the most effective dose. METHODS: This study is a randomized, double-blind, placebo-controlled trial. TENS therapy was initiated at the beginning of the active phase of labour. Participants were randomly assigned to three groups (21 per group: two active TENS and one placebo). Active TENS 1 intervention consisted in a constant frequency of 100-Hz, 100-µs, active TENS 2 intervention consisted in a varying high-frequency (80-100 Hz), 350 µs, and in a placebo group, participants were connected to the TENS unit without electrical stimulation. TENS was applied with two self-adhesive electrodes placed parallel to the spinal cord (T10-L1 and S2-S4 levels). The primary outcome was pain intensity (0-10 cm) measured on a visual analogue scale (VAS) at several stages (at baseline and at 10 and 30 min later). Secondary outcomes included women's satisfaction (via the Care in Obstetrics: Measure for Testing Satisfaction scale). RESULTS: Sixty-three women participated. Regarding baseline characteristics, no differences were found among the three groups. The active TENS 2 group obtained an improvement with clinically significant VAS results (- 2.9, 95% confidence interval - 4.1 to - 1.6, p <  0.001). Regarding satisfaction, the results also revealed better results in the active TENS than in the placebo group. CONCLUSIONS: TENS with high frequencies modified in time as well as high pulse width are effective for relieving labour pain, and they are well considered by pregnant participants. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03137251 . Registered on 2 May 2017.

Cólico nefrítico en el servicio de urgencias: estudio epidemiológico, diagnóstico y etiopatogénico / Renal colic at emergency departments: epidemiologic, diagnostic andetiopathogenic study

Objetivo: Estudiar los factores epidemiológicos, etiopatogénicos y clínicos del cólico nefrítico (CN). Método/resultados: Se realizó un estudio prospectivo, multicéntrico, transversal con 146 pacientes (n=146) tratados en el Servicio de Urgencias por CN y 146 casos control sin CN (n=146). Se valoraron: edad, sexo, antecedentes patológicos, factores etiopatogénicos de la litiasis renal, cuadro clínico, urianálisis, composición química de la litiasis y radiología. Se hizo un análisis comparativo estadístico (hallazgo p) entre ambos grupos de pacientes. El CN fue más frecuente en varones, el pico máximo de incidencia fue de 31-50 años, con 36,30 por ciento en hombres y 21,23 por ciento de mujeres, el 60,27 por ciento catalogaron el dolor como intensidad severa, 140 pacientes con CN (95,89 por ciento) presentaron antecedentes urológicos vs. 15 (10,27 por ciento) en los sin CN (p=0,001), fue más frecuente la presentación con dolor intenso, brusco, lumboabdominal o lumbar (93,83 por ciento), tenían historia familiar de enfermedad litiásica 23,28 por ciento de pacientes con CN vs. 6,16 por ciento en los sin CN (p<0,001), el mayor número de CN se vio en los meses de verano (36,58 por ciento), 80,82 porciento de pacientes con CN ingerían < de 2L agua/día vs. 18,49% en los sin CN (p<0,001). Hubo hematuria en un 90,41por ciento de CN vs. 11,64 por ciento de los sin CN (p<0,001). Se visualizó litiasis (Rx) en un 42,10 por ciento vs. 57,89 por ciento donde no se visualizó. La litiasis más frecuente fue la de oxalato cálcico mono o dihidratado (61,2 por ciento). Conclusiones: La incidencia de CN en nuestra área de salud es mayor en el sexo masculino. El dolor característico del CN es agudo, severo, de aparición súbita, localizado en la región lumbar, por debajo de las costillas, irradiado hacia el flanco abdominal, región inguinal y genitales externos (testículo o labios mayores) del lado afecto...(AU)

Objectives: To investigate epidemiologic, etiopathogenic and clinical factors associated with emergency renal colic (RC). Methods ands results: We performed a prospective cross-sectional multicenter case-control study of 146 patients treated for RC at emergency departments. Data collected included age, sex, localization/severity of pain, symptoms, personal/family medical history, urine analysis, etiopathogenic factors, chemical composition of the lithiasis, and x-ray studies. Comparative statistical analysis was performed using SPSS 12.2 software. RC was more frequent in men; maximum incidence was between 31-50 years for both sex, with 36.3 percent in men and 21.23 percent in women; 60.27 percent of patients rated pain as severe; 140 RC patients (95.89 percent) had urologic antecedents vs. 15 (10.27 percent) controls without RC (p<0.001). The most frequent presentation (93.83 percent) was sudden intense lumbar-abdominal or lumbar pain; 23.28 percent of RC patients had family history for urinary lithiasis vs. 6.16 percent controls (p<0,001). Most RC patients were seen during summer (36.58 percent), 82 percent of RC patients drank <2L of water daily vs. 18.49 percent in non-RC patients (p<0.001). Hematuria was found in 132 (90.41 percent) patients with RC vs. 17 (11.64 percent) in those without (p<0.001). Lithiasis was observed by KUB x-ray in 42.10 percent of RC patients vs. 57.89 percent controls, most frequent calculi composition was calcium oxalate monohydrate and dehydrate (61,2 percent). Conclusions: The incidence of urinary lithiasis and RC in our health care area shows a male predominance. The characteristic pain of RC is severe and appears suddenly. It starts in the back (lumbar region), below the ribs, radiating towards the groin and external genitals (testicles in man or major lips in woman) on the same side. Nausea and vomiting are frequent. Family history of urinary lithiasis and low water intake are risk factors that need to be investigate...(AU)

Cólico nefrítico en el servicio de urgencias. Estudio epidemiológico. Diagnóstico etipiopatiogénico / Renal colic (nc) at emergency departments. Epidemiologic, diagnostic and ethiopathogenic study

OBJETIVO: Estudiar los factores epidemiológicos, etiopatogénicos y clínicos del cólico nefrítico (CN).MÉTODO/RESULTADOS: Se realizó un estudio prospectivo, multicéntrico, transversal con 146 pacientes (n=146) tratados en el Servicio de Urgencias por CN y 146 casos control sin CN (n=146). Se valoraron: edad, sexo, antecedentes patológicos, factores etiopatogénicos de la litiasis renal, cuadro clínico, urianálisis, composición química de la litiasis y radiología. Se hizo un análisis comparativo estadístico (hallazgo p) entre ambos grupos de pacientes. El CN fue más frecuente en varones, el pico máximo de incidencia fue de 31-50 años, con 36,30% en hombres y 21,23% de mujeres, el 60,27% catalogaron el dolor como intensidad severa, 140 pacientes con CN (95,89%) presentaron antecedentes urológicos vs. 15 (10,27%) en los sin CN (p=0,001), fue más frecuente la presentación con dolor intenso, brusco, lumboabdominal o lumbar (93,83%), tenían historia familiar de enfermedad litiásica 23,28% de pacientes con CN vs. 6,16% en los sin CN (p<0,001), el mayor número de CN se vio en los meses de verano (36,58%), 80,82% de pacientes con CN ingerían < de 2L agua/día vs. 18,49% en los sin CN (p<0,001). Hubo hematuria en un 90,41% de CN vs. 11,64% de los sin CN (p<0,001). Se visualizó litiasis (Rx) en un 42,10% vs. 57,89% donde no se visualizó. La litiasis más frecuente fue la de oxalato cálcico mono o dihidratado (61,2%)(AU)

CONCLUSIONES: La incidencia de CN en nuestra área de salud es mayor en el sexo masculino. El dolor característico del CN es agudo, severo, de aparición súbita, localizado en la región lumbar, por debajo de las costillas, irradiado hacia el flanco abdominal, región inguinal y genitales externos (testículo o labios mayores) del lado afecto. La historia familiar de CN y la baja ingestión de agua son factores etiopatogénicos que deben ser investigados, además las ocupaciones y estilos de vida sedentarios, los ambientes y meses de verano calurosos, sobre todo en Julio y Agosto, aumentan la posibilidad de formación de litiasis urinaria y aparición de CN. La litiasis más frecuente en nuestro medio fue la de oxalato cálcico mono y dihidratado(AU)

OBJECTIVES: To investigate epidemiologic, etiopathogenic and clinical factors associated with emergency renal colic (RC).METHODS ANDS RESULTS: We performed a prospective cross-sectional multicenter case-control study of 146 patients treated for RC at emergency departments. Data collected included age, sex, localization/severity of pain, symptoms, personal/family medical history, urine analysis, etiopathogenic factors, chemical composition of the lithiasis, and x-ray studies. Comparative statistical analysis was performed using SPSS 12.2 software. RC was more frequent in men; maximum incidence was between 31-50 years for both sex, with 36.3% in men and 21.23% in women; 60.27% of patients rated pain as severe; 140 RC patients (95.89%) had urologic antecedents vs. 15 (10.27%) controls without RC (p<0.001). The most frequent presentation (93.83%) was sudden intense lumbar-abdominal or lumbar pain; 23.28% of RC patients had family history for urinary lithiasis vs. 6.16% controls (p<0,001). Most RC patients were seen during summer (36.58%), 82% of RC patients drank <2L of water daily vs. 18.49% in non-RC patients (p<0.001). Hematuria was found in 132 (90.41%) patients with RC vs. 17 (11.64%) in those without (p<0.001). Lithiasis was observed by KUB x-ray in 42.10% of RC patients vs. 57.89% controls, most frequent calculi composition was calcium oxalate monohydrate and dehydrate (61,2%)(AU)

CONCLUSIONS: The incidence of urinary lithiasis and RC in our health care area shows a male predominance. The characteristic pain of RC is severe and appears suddenly. It starts in the back (lumbar region), below the ribs, radiating towards the groin and external genitals (testicles in man or major lips in woman) on the same side. Nausea and vomiting are frequent. Family history of urinary lithiasis and low water intake are risk factors that need to be investigated. Occupations associated with a sedentary life style or with a hot, dry workplace show a higher incidence of lithiasis. A hot, dry climate favours the formation of urinary lithiasis and the highest incidence of lithiasis is in the summer, during the months of July and August. The most frequent component of urolithiasis in our study, as well as in other studies, was calcium oxalate monohydrate and dihydrate(AU)