Evaluation of teleconsultation system in the urological patient during the COVID-19 pandemic. / Evaluación de la teleconsulta en el paciente urológico durante la pandemia COVID-19.

INTRODUCTION: The global pandemic of COVID-19 has led to rapid implementation of telemedicine, but there is little information on patient satisfaction of this system as an alternative to face-to-face care. OBJECTIVE: To evaluate urological patient satisfaction with teleconsultation during the COVID-19 pandemic. MATERIAL AND METHODS: Observational, prospective, cross-sectional, non-interventional study carried out by telephone survey during the period considered as the peak of the pandemic (March-April 2020). A quality survey composed of 11 questions on urological care provided by physicians during the COVID-19 pandemic was conducted, selecting a representative sample of patients attended by teleconsultation. RESULTS: Two hundred patients were contacted by telephone to answer a survey on the quality of teleconsultation. The distribution of patients surveyed among the specialized consultations was homogeneous with the number of consultations cited in the period; 18% of them required assistance from family members. Sixty percent of patients avoided going to a medical center during the pandemic. Of the surveyed patients, 42% had cancelled diagnostic tests, 59% had cancelled medical consultations, 3.5% had cancelled treatments and 1% had cancelled interventions. Ten percent reported a worsening of urological symptoms during confinement. According to physicians, consultations were effectively delivered in 72% of cases, with teleconsultation being carried out by their usual urologist in 81%. Teleconsultation overall satisfaction level was 9 (IQI8-10), and 61.5% of respondents consider teleconsultation as a «health care option¼ after the healthcare crisis. CONCLUSION: Teleconsultation has been evaluated with a high level of satisfaction during the COVID-19 pandemic, offering continuous care to urological patients during the healthcare crisis. The perceived quality offers a field of optional telematic assistance in selected patients, which should be re-evaluated in a period without confinement measures.

Análise bioeconômica do farelo de arroz na recria de bezerras de corte em azevém / Bioeconomics analyses of rice brain use for reaning of beef heifers on Italian ryegrass pasture

Objetivou-se avaliar a economicidade, o desempenho produtivo e o desenvolvimento das estruturas corporais relacionadas ao trato reprodutivo de bezerras de corte mantidas exclusivamente em pastagem de azevém (Lolium multiflorum Lam.) ou em pastagem de azevém recebendo 0,5 e 1,0% do peso corporal (PC) de farelo de arroz integral (FAI) como suplemento. O método de pastejo foi o rotativo, e o intervalo entre pastejos foi estabelecido considerando-se a soma térmica necessária para a emissão de 1,5 folha de azevém (187,5ºC). O delineamento experimental foi o inteiramente ao acaso, com medidas repetidas no tempo. O ganho médio diário das bezerras não diferiu entre os sistemas alimentares. A taxa de lotação e o ganho de peso por área foram maiores quando as bezerras receberam 1,0% do PC de farelo de arroz integral. A maior margem bruta foi observada quando as bezerras receberam 0,5% de FAI. O custo variável obtido para os diferentes sistemas alimentares apresentou comportamento crescente em função dos níveis de FAI, superando o uso exclusivo do azevém em 49,4% e 81,8%. O peso corporal final, o escore de condição corporal e o escore do trato reprodutivo não diferiram entre os sistemas alimentares. Considerando-se um animal adulto com peso corporal médio de 450kg, as bezerras ao início do experimento apresentaram 34% do peso corporal adulto e peso corporal final médio de 56% do peso adulto. A utilização de níveis de farelo de arroz integral (FAI) na recria de bezerras de corte sob pastejo rotativo em azevém não modifica o ganho médio diário e o escore do trato reprodutivo. O fornecimento de 1% de FAI mostrou efeito substitutivo, proporcionando um incremento de 31,2% na taxa de lotação e de 38,3% no ganho por área. O sistema alimentar AZ0,5 permitiu uma maior margem bruta; já o retorno financeiro direto foi positivo em todos os sistemas alimentares, com melhor retorno calculado para o uso exclusivo do azevém.(AU)

The experiment was carried out with the objective of evaluating the gross margin, the productive and reproductive performance of beef heifers kept exclusively on ryegrass pasture (Lolium multiflorum Lam.) or ryegrass receiving 0.5 and 1.0% of body weight (BW) of whole rice bran as supplement. The grazing method was the rotational and the interval between grazings was set by the thermal sum required for the appearing of 1.5 ryegrass leaf (187.5ºC). The experimental design was completely randomized with repeated measures. Heifers average daily gain did not differ between the feeding systems. The stocking rate and weight gain per area were higher when heifers received 1.0% BW of whole rice bran. The higher gross margin was observed when heifers received 0.5% BW. The variable cost obtained for the different feeding systems showed increasing behavior depending on the WRB levels, surpassing the exclusive use of ryegrass in 49.4% and 81.8%. The final body weight, body condition score and reproductive tract score did not differ between the feeding systems. Considering an adult animal with an average body weight of 450kg, the heifers at the beginning of the experiment showed 34% of mature body weight and final average body weight of 56% of adult weight. The use of rice bran levels (FAZ) in the rearing of beef heifers under rotational grazing on ryegrass does not change the average daily gain and the reproductive tract score. The supply of 1% FAI showed substitutive effect, providing an increase in capacity of 31,2% and 38.3% rate of the gain per area. The food system AZ0,5 allowed a higher gross margin, as the economic return was positive in all food systems, with better return calculated for the exclusive use of ryegrass.(AU)

A new approach to laparoscopic implantation of the artificial urinary sphincter: Vesicovaginal approach to the bladder neck. / Nueva aproximación al implante laparoscópico del esfínter urinario artificial: abordaje vesicovaginal al cuello vesical.

INTRODUCTION: The artificial urinary sphincter (AUS) is not used extensively in the treatment of female urinary stress incontinence (USI) due to the poor reproducibility of the techniques used. We describe a new approach to laparascopic implantation, of which dissection of the vesicovaginal space is an essential step. This enables an approach under direct vision to the posterior surface of the bladder neck. MATERIAL AND METHODS: We present two cases where this approach was used. A transperitoneal approach was made in the Trendelenburg position. The main steps were: creating the vesicovaginal space until identifying the bladder neck, creating two laterovesical spaces, communicating these with the vesicovaginal space, and dissecting the anterior surface of the bladder neck, attempting to preserve the pubovesical ligament. The cuff and reservoir were inserted through the 12mm infraumbilical trocar. The connections were externalised through a left suprapubic incision and a subcutaneous tunnel created up to the labia majora where the activation pump was placed. The procedure was completed with closure of the peritoneum. It is essential to use a vaginal valve to facilitate dissection. RESULTS: Surgery time: 140 and 135minutes, with no intraoperative complications. After removing the urinary catheter, one patient had elevated postvoid residual urine volume, which was managed conservatively. Hospital stay: 72h. At 3 and 9 months the patients were fully continent. CONCLUSIONS: We present the preliminary results of laparoscopic implantation of an AUS through a vesicovaginal approach to the posterior surface of the bladder neck, which might reduce potential complications that have been observed after the routine techniques.

Forage intake and performance of heifers fed rice bran on Alexandergrass pasture / Ingestão de forragem e performance de bezerros alimentados com farelo de arroz integral em pasto de papuã

he study was carried out to evaluate the forage intake and performance of beef heifers from 15 to 18 months of age, grazing on Alexandergrass (Urochloaplantaginea (Link) Hitch) fed rice bran (RB; 0, 0.5 and 1.0% body weight (BW)). The experiment consisted of a completely randomized design with repeated measurement arrangement. Rice bran increased the total dry matter (DM) intake, total crude protein intake and total digestible nutrients intake. Heifers that received 1.0% BW of RB reduced forage DM intake, increasing by 18% stocking rate (SR) and by 27% BW gain per area in comparison with the system exclusively on pasture. In the system in which the heifers were fed 0.5% BW of RB, SR and gain per area were similar to other systems. In this feeding system, we observed average daily gain 18% higher than when heifers were exclusively on pasture and gain similar to that observed when using 1.0% BW of RB. In Alexandergrass pasture it is recommended to supply 0.5% BW of RB for beef heifers from 15 to 18 months of age, to promote better productive responses compared to heifers exclusively on pasture and similar to those observed when supplying 1.0% BW of RB.(AU)

O presente trabalho foi desenvolvido com o objetivo de avaliar o consumo de forragem e o desempenho de novilhas de corte dos 15 aos 18 meses de idade, em pastejo em papuã (Urochloaplantaginea(Link) Hitch), recebendo farelo de arroz integral (FAI) como suplemento (0, 0,5 e 1,0% do peso corporal (PC)). O delineamento experimental foi o inteiramente ao acaso, com medidas repetidas no tempo. O uso de FAI aumentou o consumo total de matéria seca (MS), o consumo total de proteína bruta e de nutrientes digestíveis totais em relação às novilhas exclusivamente em pastejo. As novilhas que receberam 1,0% do PC de FAI reduziram o consumo de MS da forragem, aumentando em 18% a taxa de lotação (TxLot) e em 27% o ganho de PC por hectare (GPA) em comparação com o sistema exclusivamente a pasto. No sistema em que as novilhas receberam 0,5% do PC de FAI, a TxLot e o GPA foram similares aos demais sistemas. Nesse sistema alimentar, foi observado GDM 18% superior em relação às novilhas exclusivamente em pastejo e ganho similar ao uso de 1,0% do PC de FAI. Em pastagem de papuã, é recomendado o uso de 0,5% do PC de FAI para novilhas de corte dos 15 aos 18 meses de idade, por promover respostas produtivas superiores em relação às novilhas exclusivamente em pastejo e semelhantes às observadas quando fornecido 1,0% do PC de FAI.(AU)

Padrões de deslocamento de bezerras de corte recebendo suplemento em pastagem de azevém / Displacement patterns of beef heifers receiving supplement in Italian ryegrass pasture

O objetivo deste trabalho foi avaliar o tempo de permanência, o número de bocados nas estações e o deslocamento entre estações alimentares por bezerras de corte em pastagem de azevém (Lolium multiflorum Lam.) e recebendo farelo de arroz integral como suplemento em três níveis (0,0; 0,5 e 1,0% PC). O método de pastejo foi rotacionado, com número variável de animais. O período de descanso foi estabelecido pela soma térmica (ST) de 187,5ºC, equivalente à ST necessária para a emissão de 1,5 folhas de azevém. O delineamento experimental foi inteiramente ao acaso, com medidas repetidas no tempo, três níveis de suplemento e seis ciclos de pastejo. O tempo de permanência em cada estação alimentar (9,4s) foi semelhante para bezerras exclusivamente a pasto e as que receberam 1,0% PC de suplemento. As bezerras que receberam 0,5% PC de suplemento permanecem 1,1s a mais na estação alimentar quando comparadas com as bezerras nos demais níveis. O deslocamento entre estações alimentares (1,7 passos) e o número de bocados em cada estação alimentar (sete bocados) foram semelhantes independentemente do nível de farelo de arroz fornecido. As bezerras, ao receberem 0,5% PC de farelo de arroz, são mais dependentes da presença de lâminas foliares no estrato pastejável do dossel.(AU)

The aim of this study was to evaluate the length of stay and number of bites in the feeding stations and displacement between feeding stations for beef heifers on ryegrass pasture (Lolium multiflorum Lam.) and receiving rice bran as a supplement in three levels (0.0; 0.5 and 1.0% BW). The grazing method was rotational with variable number of animals. The interval between grazing was set by the thermal sum (TS) of 187.5ºC equivalent to TS necessary for externalization of 1.5 leaf lamina of ryegrass. The experimental design was completely randomized with repeated measures on time, three levels of supplement and six grazing periods. The stay time at each feeding station (9.4 sec.) was similar for heifers exclusively on pasture and receiving 1.0% supplement BW. Heifers that received 0.5% supplement BW remained 1.1 sec. longer at the feeding station than heifers on other supplement levels. Displacement between feeding stations (1.7 steps) and the number of bites in each feeding station (7 bites) were similar regardless of the supplied rice bran level. Heifers receiving 0.5% rice bran BW are more dependent on the presence of leaf blades in grazeable stratum of canopy.(AU)

Genetic parameters for growth characteristics of free-range chickens under univariate random regression models.

Repeated measures from the same individual have been analyzed by using repeatability and finite dimension models under univariate or multivariate analyses. However, in the last decade, the use of random regression models for genetic studies with longitudinal data have become more common. Thus, the aim of this research was to estimate genetic parameters for body weight of four experimental chicken lines by using univariate random regression models. Body weight data from hatching to 84 days of age (n = 34,730) from four experimental free-range chicken lines (7P, Caipirão da ESALQ, Caipirinha da ESALQ and Carijó Barbado) were used. The analysis model included the fixed effects of contemporary group (gender and rearing system), fixed regression coefficients for age at measurement, and random regression coefficients for permanent environmental effects and additive genetic effects. Heterogeneous variances for residual effects were considered, and one residual variance was assigned for each of six subclasses of age at measurement. Random regression curves were modeled by using Legendre polynomials of the second and third orders, with the best model chosen based on the Akaike Information Criterion, Bayesian Information Criterion, and restricted maximum likelihood. Multivariate analyses under the same animal mixed model were also performed for the validation of the random regression models. The Legendre polynomials of second order were better for describing the growth curves of the lines studied. Moderate to high heritabilities (h(2) = 0.15 to 0.98) were estimated for body weight between one and 84 days of age, suggesting that selection for body weight at all ages can be used as a selection criteria. Genetic correlations among body weight records obtained through multivariate analyses ranged from 0.18 to 0.96, 0.12 to 0.89, 0.06 to 0.96, and 0.28 to 0.96 in 7P, Caipirão da ESALQ, Caipirinha da ESALQ, and Carijó Barbado chicken lines, respectively. Results indicate that genetic gain for body weight can be achieved by selection. Also, selection for body weight at 42 days of age can be maintained as a selection criterion.

On the prediction of Hodgkin lymphoma treatment response.

PURPOSE: The cure rate in Hodgkin lymphoma is high, but the response along with treatment is still unpredictable and highly variable among patients. Detecting those patients who do not respond to treatment at early stages could bring improvements in their treatment. This research tries to identify the main biological prognostic variables currently gathered at diagnosis and design a simple machine learning methodology to help physicians improve the treatment response assessment. METHODS: We carried out a retrospective analysis of the response to treatment of a cohort of 263 Caucasians who were diagnosed with Hodgkin lymphoma in Asturias (Spain). For that purpose, we used a list of 35 clinical and biological variables that are currently measured at diagnosis before any treatment begins. To establish the list of most discriminatory prognostic variables for treatment response, we designed a machine learning approach based on two different feature selection methods (Fisher's ratio and maximum percentile distance) and backwards recursive feature elimination using a nearest-neighbor classifier (k-NN). The weights of the k-NN classifier were optimized using different terms of the confusion matrix (true- and false-positive rates) to minimize risk in the decisions. RESULTS AND CONCLUSIONS: We found that the optimum strategy to predict treatment response in Hodgkin lymphoma consists in solving two different binary classification problems, discriminating first if the patient is in progressive disease; if not, then discerning among complete and partial remission. Serum ferritin turned to be the most discriminatory variable in predicting treatment response, followed by alanine aminotransferase and alkaline phosphatase. The importance of these prognostic variables suggests a close relationship between inflammation, iron overload, liver damage and the extension of the disease.

Cost-effectiveness analysis of main diagnosis tools in women with overactive bladder. Clinical history, micturition diary and urodynamic study.

OBJECTIVES: The aim of the present clinical research is to analyze, in the light of the best scientific evidence, the performance and the cost of the main diagnostic tools for overactive bladder (OAB). METHODS: It is an exploratory transversal study in which 199 women diagnosed of OAB between 2006 and 2008 were selected and underwent to following prospective analyses: physical examination, urine analysis, micturition diary (MD) and urodynamic study (UDS). A percentage of 80% was assumed as highly sensitive and a diagnostic difference among tests of 10% would be considered clinically relevant. Tests' sensitivity for diagnosis of OAB was statistically established by two ways: isolated and combined. Besides, the direct and indirect costs of these tests performance were conducted. Cost-effectiveness study of clinical history (CH), MD and US for the diagnosis of OAB was performed. RESULTS: Overall sensitivity for OAB diagnosis is low for the 3 tests used in isolated way, whilst the combination of any two tests shows good overall sensitivity. The combination of CH and MD has appeared as the most cost-effective alternative to OAB diagnosis. CONCLUSIONS: For OAB diagnosis, CH-DM combination shows the same sensitivity than the association of either of them with the UDS, but unlike to these, it shows the lowest cost.

Giant adrenal carcinoma associated with renal vein and inferior vena cava thrombus. Case report and literature review.

OBJECTIVE: To present a case of giant adrenal carcinoma associated with renal vein and inferior vena cava (IVC) thrombus. Up to now, there is no similar case reported in the national literature. METHODS: 75 year old woman with signs of virilization. CT-scan showed an 18 cm adrenal mass with venous thrombus and possible pulmonary metastases. The working diagnosis was primary suprarenal carcinoma. RESULT: Due to elderly age and advanced stage, including metastasis, we decided to not perform surgery, and initiate chemotherapy. CONCLUSIONS: Adrenal Cancer is an infrequent and very aggressive tumor. Surgery is the only curative treatment. In advanced stages chemotherapy is recommended, but with poor results.

[A case of temporary nonthrombotic hemiplegia and aphasia due to neurotoxicity from angiographic contrast material?]. / Hemiplejia y afasia transitorias no tromboembólicas: ¿neurotoxicidad por contraste angiográfico?

We present the case of a 75-year-old woman who suddenly developed hemiplegia, aphasia, and reduced consciousness three hours after embolization of a cerebral aneurysm. No complications occurred during embolization and the findings at end-procedure angiography were normal. Cranial computed tomography (CT) after embolization showed hyperdensity of the cortex and sulci of the convexity; another CT examination performed four hours later showed these findings had disappeared. Cerebral arteriography 24h after embolization showed delayed blood flow to the parenchyma of the left hemisphere compared to the right but no vascular occlusion. The neurological deficit lasted 72 h and resolved spontaneously and completely as suddenly as it developed. This is one of the few cases of temporary neurological deficit related to iodinated contrast administration to be reported outside the posterior circulation (cortical blindness). When neurological symptoms occur after endovascular procedures in the brain, it is fundamental to distinguish this rare clinical syndrome of probable toxic origin from possible ischemic complications of the procedure.

[Shattered kidney in a patient with asymptomatic chronic hydronephrosis. Case report and literature review]. / Estallido renal en paciente con hidronefrosis crónica asintomática. A propósito de un caso y revisión de la literatura.

The incidence of renal anomalies in patients who suffer a renal trauma is around 4.4 and 19%. We introduce a case of a patient whose first sign of a chronic hydronefrosis was a renal burst secondary to an abdominal trauma.

Mujer de 23 años con crisis hipertensiva / A 23-year old woman with hypertensive episode

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Estallido renal en paciente con hidronefrosis crónica asintomática. A propósito de un caso y revisión de la literatura / Shattered kidney in a patient with asimptomatic chronic hydronephrosis. Case report and literature review

Se estima que la presencia de anomalías renales en pacientes que sufren un traumatismo renal oscila entre el 4,4 y el 19%. Presentamos un caso de un paciente cuya primera manifestación de una hidronefrosis crónica fue un estallido renal secundario a un traumatismo abdominal

The incidence of renal anomalies in patients who suffer a renal trauma is around 4.4 and 19%. We introduce a case of a patient whose first sign of a chronic hydronefrosis was a renal burst secondary to an abdominal trauma

[Low-dose 0.25% spinal levobupivacaine with epidural extension for cesarean section: comparison with 0.5% hyperbaric bupivacaine]. / Dosis bajas de 1-bupivacaína 0,25% espinal con extensión con salino epidural para cesárea: comparación con bupivacaína 0,5% hiperbárica.

INTRODUCTION: When low doses of local anesthetic are used in combined spinal-epidural anesthesia for cesarean section, an epidural catheter can be used to enhance a possibly incomplete block or insufficient dose. OBJECTIVE: To compare the efficacy of spinal 0.5% hyperbaric bupivacaine with fentanyl (20 microg) at a conventional high dose of 0.07 mg cm(-1) (group 1) vs 0.25% levobupivacaine at a low dose of 7.6 mg with fentanyl (20 microg) and epidural volume extension with 6 mL of saline through an epidural catheter (group 2). MATERIAL AND METHODS: A randomized clinical trial enrolling patients scheduled for elective cesarean section. RESULTS: Sixty-two patients were studied (31 in each group). Characteristics in the groups were comparable at baseline and the maximum level of sensory block achieved was sufficient for all but 1 patient in group 2 who required general anesthesia. The bupivacaine dose in group 1 ranged from 10.5 to 12 mg. The motor block and duration was less intense in group 2 (P<0.0001) and patients in that group could be transferred out of the postanesthetic care unit earlier. CONCLUSIONS: The use of low doses of levobupivacaine with an opiate in combination with volume extension through an epidural catheter in the context of combined spinal-epidural anesthesia is a safe, effective technique that may allow the doses and motor block to be reduced when hyperbaric levobupivacaine is administered, without adverse events for patients.

[Left inferior vena cava with renal cell carcinoma]. / Vena cava renal izquierda en un paciente con carcinoma de células renales.

We presented a case of inferior vena cava on the left side diagnosed by abdominal CT scan during the study of a renal cell carcinoma in the right side. This anomaly is very rare but it may suppose a more difficult approach to the nephrectomy.

Vena cava renal izquierda en un paciente con carcinoma de células renales / Left inferior vena cava with renal cell carcinoma

Presentamos un caso de vena cava renal izquierda diagnosticado mediante CT abdominal durante el estudio de extensión de un paciente por carcinoma de células renales. Esta anomalía es muy rara pero su conocimiento antes de la cirugía es importante para evitar complicaciones durante el procedimiento quirúrgico (AU)

We presented a case of inferior vena cava on the left side diagnosed by abdominal CT scan during the study of a renal cell carcinoma in the right side. This anomaly is very rare but it may suppose a more difficult approach to the nephrectomy (AU)

Successful induction of immune tolerance with FIX recombinant in a patient with haemophilia B with inhibitor.

We describe successful induction of immune tolerance in a 12-month-old patient with severe haemophilia B and low-titre and low response antifactor IX inhibitor at 5 Bethesda Unit (BU). Immune tolerance induction (ITI) was started with recombinant factor (rFIX) at 40-50 U kg(-1) day(-1) (1000 U three times per week) and 2 years after the beginning of therapy the inhibitor had been reduced to undetectable values. As complications, which appeared during the ITI, the patient presented minor haemorrhagic complications, which remitted following the administration of rFVIIa, and recurring infections of the catheter, requiring the withdrawal and subsequent placement of a new catheter.

[The natural history of sperm cleareance after vasectomy]. / La historia natural del aclaramiento de espermatozoides en el semen tras la vasectomía.

OBJECTIVE: To study the time required to obtain a negative sperm analysis after vasectomy. MATERIAL AND METHODS: We reviewed 239 consecutive vasectomies performed between september 1998 and september 1999. All of them were done in an ambulatory basis. Follow up interval was 41-853 days (mean 144, median 104). The first semen analysis was requested between 1 and 6 months after the surgical procedure. If the sample still showed spermatozoa, then a new one was requested every two months. Probability of becoming azoospermic was studied with Kaplan-Meier curves. RESULTS: Persistent spermatozoa could be found in 31 patients (13%) at the end of follow-up. Despite having a positive semen analysis, 10 patients (4.2%) discontinued medical visits. Time required to obtain a negative sperm count ranged from 58 to 362 days (mean 133, median 99). The probability of being azoospermic 200 and 260 days after vasectomy was 80-90% respectively. A total of 328 semen analysis were requested (range 1-4, mean 1.37, median 1) CONCLUSIONS: A minimum of 200 days (6.6 months) are needed to clear all the spermatozoa in semen after vasectomy in 80% of our patients. Requesting the first semen sample 7 months after vasectomy is cost-effective, reducing unnecesary medical visits and increasing the rentability of this test.