[Analysis of the demand for detection of SARSCoV-2 in a health area of Spain]. / Análisis de la demanda de detección de SARS-CoV-2 en un área de salud de España.

OBJECTIVE: Since the discovery of the SARS-CoV-2 virus, the polymerase chain reaction technique (RT-PCR) has become the fundamental method for diagnosing the disease in its acute phase. The objective is to describe the demand-based series of RT-PCR determinations received at a Microbiology Service at a third-level reference hospital for a health area for three months spanning from the onset of the epidemic by SARS-CoV-2. METHODS: A retrospective analysis of the total of the RT-PCR requested in the Microbiology Service analyzed from 02/25/2020 to 05/26/2020 (90 days) has been carried out. They have been grouped by epidemiological weeks and by the petitioner service. A descriptive analysis was carried out by age, gender and number of requests for each patient. In the tests carried out, a confidence level of 95% (p <0.05) was considered significant. RESULTS: A total of 27,106 requests was received corresponding to 22,037 patients. Median age 53.7 (RIC 40.9-71.7) years, women: 61.3%. Proportion of patients with any positive RT-PCR: 14%. Of the total requests for RT-PCR, positive 3,710. Week 13 had the highest diagnosis performance (39.0%). The primary care has been the service thar has made the most requests (15,953). Patients with 3 or more RT-PCR: 565, of them, 19 patients had a positive result after previously having a negative one. CONCLUSIONS: Requests have been increasing depending on the evolution of the epidemic. The RT-PCR has a high diagnostic performance in the phases of highest contagiousness and / or transmissibility of the virus.

Cirugía vascular e hipertensión arterial / Vascular surgery and arterial hypertension

La hipertensión arterial es una enfermedad muy prevalente en los pacientes tratados mediante cirugía vascular. Se encuentra, al igual que la vasculopatía, asociada con la edad. Por lo tanto, la hipertensión y la enfermedad vascular son más prevalentes cuanto mayores sean los pacientes. Dado que la cirugía vascular tiene alto riesgo de complicaciones y mortalidad intra y postoperatoria, en las últimas décadas han tenido un gran auge los procedimientos endovasculares. Aunque sus complicaciones son menores a corto plazo si las comparamos con la cirugía abierta, debido al riesgo inherente a los pacientes en los que se llevan a cabo, hacen que la probabilidad de eventos adversos sea hasta del 5%. Las escalas de riesgo postoperatorio en vasculopatía periférica no contemplan la hipertensión como un factor de riesgo de mortalidad. Sin embargo, estudios ulteriores en los que se asocian a las mismas la hipertensión han demostrado que esta variable mejora la fiabilidad de las mismas para predecir complicaciones. Así como la hipertensión aumenta el riesgo de problemas perioperatorios, también se conoce que su tratamiento disminuye la incidencia de eventos adversos. Habitualmente, se utilizan betabloqueantes, nitratos, alfabloqueantes, antagonistas de los canales del calcio e inhibidores de la enzima conversora de angiotensina para el control de la presión arterial en los pacientes vasculópatas

Arterial hypertension is a highly prevalent disease in vascular patients. As well as vasculopathy, it is related to elderly. Owing to high morbi-mortality in intra and postoperative period, endovascular procedures have been widely performed. Though short- term adverse events are lower, they are proceeded in high-risk patients. For that reason, the probabilitity of adverse events is as high as 5%. Postoperative-risk scales in peripheral vascular disease does not include arterial hypertension, but posterior studies have confirmed that arterial hypertension improves the reliability of such scales in order to predict complications. On the contrary, it is known that arterial hypertension treatment diminishes the incidence of perioperative adverse events. Beta blockers, nitrates, α blockers, calcium channel blockers and angiotensin-converting-enzyme inhibitors are currently used in the arterial hypertension treatment in patients suffering from vascular disease

Post-mortem microbiology in sudden death: sampling protocols proposed in different clinical settings.

BACKGROUND: Autopsies, including minimally invasive autopsies, are a powerful tool for determination of the cause of death. When a patient dies from an infection, microbiology is crucial to identify the causative organism. Post-mortem microbiology (PMM) aims to detect unexpected infections causing sudden deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical errors. Additionally, the analysis of the thanatomicrobiome may help to estimate the post-mortem interval. AIMS: The aim was to provide advice in the collection of PMM samples and to propose sampling guidelines for microbiologists advising autopsy pathologists facing different sudden death scenarios. SOURCES: A multidisciplinary team with experts in various fields of microbiology and autopsies on behalf of the ESGFOR (ESCMID - European Society of Clinical Microbiology and Infectious Diseases - study group of forensic and post-mortem microbiology and in collaboration with the European Society of Pathology) developed this narrative review based on a literature search using MedLine and Scopus electronic databases supplemented with their own expertise. CONTENT: These guidelines address measures to prevent sample contamination in autopsy microbiology; general PMM sampling technique; protocols for PMM sampling in different scenarios and using minimally invasive autopsy; and potential use of the evolving post-mortem microbiome to estimate the post-mortem interval. IMPLICATIONS: Adequate sampling is paramount to identify the causative organism. Meaningful interpretation of PMM results requires careful evaluation in the context of clinical history, macroscopic and histological findings. Networking and closer collaboration among microbiologists and autopsy pathologists is vital to maximize the yield of PMM.

Retraso en el diagnóstico de absceso espinal tras analgesia epidural en el parto. ¿Cuándo debemos sospecharlo? / Delay in the diagnosis of spinal abscess following epidural analgesia in childbirth. When we suspect it?

No disponible

Modelos de riesgo en pacientes con carcinoma de células renales localizado / Risk models for patients with localised renal cell carcinoma

Introducción: Realizamos un análisis retrospectivo de nuestra serie para evaluar los factores influyentes en la supervivencia libre de enfermedad (SLE) y en la supervivencia cáncer-específica (SCE) en pacientes con carcinoma de células renales (CCR) localizado y realizamos unos grupos de riesgo propios. Material y métodos: Entre enero de 1990 y diciembre de 2012 fueron operados 596 pacientes con CCR localizado (tanto de células claras como papilares o cromófobos). Se analizan las variables clinicopatológicas influyentes en la SLE y en la SCE mediante modelos de regresión de Cox y con ellas se diseñan grupos de riesgo de SLE y de SCE. Resultados: La mediana de seguimiento de la serie es de 5,96 años. Al final del estudio 112 pacientes (18,8%) evidenciaron recidiva de la enfermedad, siendo la SLE del 82%, 77% y 72% a 5, 10 y 15 años respectivamente. Los factores de influencia independiente en la SLE en el estudio multivariado fueron: grado de Furhman III-IV, hematuria, afectación vascular linfática, la presencia de necrosis tumoral y el estadio patológico pT3-pT4. Por otro lado, al final del estudio 57 pacientes (9,6%) fallecieron a causa del cáncer renal, siendo la SCE del 92%, 86% y 83% a 5, 10 y 15 años respectivamente. Los factores de influencia independiente en la SCE en el estudio multivariado fueron: Grado de Furhman III-IV, afectación de la grasa perirrenal y la presencia de necrosis tumoral. Conclusiones: Además del estadio patológico pT3-pT4 en pacientes con CCR localizado son importantes otros factores, como la presencia de hematuria y la afectación vascular linfática para la SLE; y especialmente relevantes el grado de Furhman III-IV y la presencia de necrosis tumoral tanto para la SLE como para la SCE

Introduction: We conducted a retrospective analysis of our series to assess the factors that influenced disease-free survival (DFS) and cancer-specific survival (CSS) for patients with localised renal cell carcinoma (RCC). We also created our own risk groups. Material and methods: Between January 1990 and December 2012, 596 patients underwent surgery for localised RCC (clear cell, papillary or chromophobe). Using Cox regression models, we analysed the clinical-pathological variables that influenced DFS and CSS and designed risk groups for DFS and CSS with the variables. Results: The median follow-up for the series was 5.96 years. By the end of the study, 112 patients (18.8%) had a recurrence of the disease, with DFS rates of 82%, 77% and 72% at 5, 10 and 15 years, respectively. The independent factors that influenced DFS in the multivariate study were the following: A Furhman grade of 3-4, haematuria, lymphocytic or vascular invasion, the presence of tumour necrosis and a disease stage pT3-pT4. Furthermore, by the end of the study, 57 patients (9.6%) died due to renal cancer, with CSS rates of 92%, 86% and 83% at 5, 10 and 15 years, respectively. The independent factors that influenced CSS in the multivariate study were the following: A Furhman grade of 3-4, perinephric fat invasion and the presence of tumour necrosis. Conclusions: Factors in addition to the disease stage pT3-pT4 in patients with localised RCC are important, such as the presence of haematuria and lymphocytic or vascular invasion for DFS. A Furhman grade of 3-4 and the presence of tumour necrosis are especially relevant for DFS and CSS

Predicción de efectividad de litotricia extracorpórea por ondas de choque en cálculos del tracto urinario. Grupos de riesgo para precisar retratamiento / Predicting the effectiveness of extracorporeal shock wave lithotripsy on urinary tract stones. Risk groups for accurate retreatment

Introducción: La litotricia extracorpórea por ondas de choque (LEOC) es un tratamiento no invasivo, seguro y efectivo para las litiasis del tracto urinario cuya efectividad varía según la localización y el tamaño del cálculo, entre otros factores; en ocasiones es necesario realizar varias sesiones. El objetivo es tratar de predecir el éxito o fracaso conociendo previamente las variables influyentes. Material y métodos: Analizamos a 211 pacientes con TAC previa entre aquellos tratados mediante LEOC entre los años 2010 y 2014. Se estudian las variables influyentes en la necesidad de retratamiento utilizando modelos de regresión logística binaria (estudio uni- y multivariado): densidad máxima, diámetro máximo, área, localización, desintegración y distancia del panículo adiposo. Con las variables influyentes se ha diseñado un modelo de riesgo valorando con regresión logística todas las posibles combinaciones (IBM SPSS versión 20.0). Resultados: Las variables de influencia independiente en la necesidad de retratamiento son: densidad máxima >864UH, diámetro máximo >7,5mm y localización pielocalicial. Utilizando estas variables, el mejor modelo incluye 3grupos de riesgo con probabilidades de necesitar retratamiento significativamente diferentes: grupo 1-bajo riesgo (0 variables) con 20,2%, grupo 2-riesgo intermedio (1-2 variables) con 49,2% y grupo 3-alto riesgo (3 variables) con 62,5%. Conclusiones: La densidad, el diámetro máximo y la localización pielocalicial del cálculo son factores determinantes en la efectividad del tratamiento con LEOC. Con estas variables, que se pueden obtener antes de la decisión terapéutica, el modelo de riesgo diseñado permite una aproximación precisa de cara a elegir el tratamiento más adecuado para cada caso en particular

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis. Its effectiveness varies depending on the location and size of the stones as well as other factors; several sessions are occasionally required. The objective is to attempt to predict its success or failure, when the influential variables are known beforehand. Material and methods: We analysed 211 patients who had had previous CT scans and were treated with ESWL between 2010 and 2014. The influential variables in requiring retreatment were studied using binary logistic regression models (univariate and multivariate analysis): maximum density, maximum diameter, area, location, disintegration and distance from the adipose panniculus. With the influential variables, a risk model was designed by assessing all possible combinations with logistic regression (version 20.0 IBM SPSS). Results: The independent influential variables on the need for retreatment are: maximum density > 864 HU, maximum diameter > 7.5 mm and pyelocaliceal location. Using these variables, the best model includes 3risk groups with a probability of requiring significantly different retreatment: group 1-low risk (0 variables) with 20.2%; group 2-intermediate risk (1-2 variables) with 49.2%; and group 3-high risk (3 variables) with 62.5%. Conclusions: The density, maximum diameter and pyelocaliceal location of the stones are determinant factors in terms of the effectiveness of treatment with ESWL. Using these variables, which can be obtained in advance of deciding on a treatment, the designed risk model provides a precise approach in choosing the most appropriate treatment for each particular case

Risk models for patients with localised renal cell carcinoma. / Modelos de riesgo en pacientes con carcinoma de células renales localizado.

INTRODUCTION: We conducted a retrospective analysis of our series to assess the factors that influenced disease-free survival (DFS) and cancer-specific survival (CSS) for patients with localised renal cell carcinoma (RCC). We also created our own risk groups. MATERIAL AND METHODS: Between January 1990 and December 2012, 596 patients underwent surgery for localised RCC (clear cell, papillary or chromophobe). Using Cox regression models, we analysed the clinical-pathological variables that influenced DFS and CSS and designed risk groups for DFS and CSS with the variables. RESULTS: The median follow-up for the series was 5.96 years. By the end of the study, 112 patients (18.8%) had a recurrence of the disease, with DFS rates of 82%, 77% and 72% at 5, 10 and 15 years, respectively. The independent factors that influenced DFS in the multivariate study were the following: A Furhman grade of 3-4, haematuria, lymphocytic or vascular invasion, the presence of tumour necrosis and a disease stage pT3-pT4. Furthermore, by the end of the study, 57 patients (9.6%) died due to renal cancer, with CSS rates of 92%, 86% and 83% at 5, 10 and 15 years, respectively. The independent factors that influenced CSS in the multivariate study were the following: A Furhman grade of 3-4, perinephric fat invasion and the presence of tumour necrosis. CONCLUSIONS: Factors in addition to the disease stage pT3-pT4 in patients with localised RCC are important, such as the presence of haematuria and lymphocytic or vascular invasion for DFS. A Furhman grade of 3-4 and the presence of tumour necrosis are especially relevant for DFS and CSS.

Predicting the effectiveness of extracorporeal shock wave lithotripsy on urinary tract stones. Risk groups for accurate retreatment. / Predicción de efectividad de litotricia extracorpórea por ondas de choque en cálculos del tracto urinario. Grupos de riesgo para precisar retratamiento.

INTRODUCTION: Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis. Its effectiveness varies depending on the location and size of the stones as well as other factors; several sessions are occasionally required. The objective is to attempt to predict its success or failure, when the influential variables are known beforehand. MATERIAL AND METHODS: We analysed 211 patients who had had previous CT scans and were treated with ESWL between 2010 and 2014. The influential variables in requiring retreatment were studied using binary logistic regression models (univariate and multivariate analysis): maximum density, maximum diameter, area, location, disintegration and distance from the adipose panniculus. With the influential variables, a risk model was designed by assessing all possible combinations with logistic regression (version 20.0 IBM SPSS). RESULTS: The independent influential variables on the need for retreatment are: maximum density >864HU, maximum diameter >7.5mm and pyelocaliceal location. Using these variables, the best model includes 3risk groups with a probability of requiring significantly different retreatment: group 1-low risk (0 variables) with 20.2%; group 2-intermediate risk (1-2 variables) with 49.2%; and group 3-high risk (3 variables) with 62.5%. CONCLUSIONS: The density, maximum diameter and pyelocaliceal location of the stones are determinant factors in terms of the effectiveness of treatment with ESWL. Using these variables, which can be obtained in advance of deciding on a treatment, the designed risk model provides a precise approach in choosing the most appropriate treatment for each particular case.

Spanish experience on the design of radon surveys based on the use of geogenic information.

One of the requirements of the recently approved EU-BSS (European Basic Safety Standards Directive, EURATOM, 2013) is the design and implementation of national radon action plans in the member states (Annex XVIII). Such plans require radon surveys. The analysis of indoor radon data is supported by the existing knowledge about geogenic radiation. With this aim, we used the terrestrial gamma dose rate data from the MARNA project. In addition, we considered other criterion regarding the surface of Spain, population, permeability of rocks, uranium and radium contain in soils because currently no data are available related to soil radon gas concentration and permeability in Spain. Given that, a Spanish radon map was produced which will be part of the European Indoor Radon Map and a component of the European Atlas of Natural Radiation. The map indicates geographical areas with high probability of finding high indoor radon concentrations. This information will support legislation regarding prevention of radon entry both in dwellings and workplaces. In addition, the map will serve as a tool for the development of strategies at all levels: individual dwellings, local, regional and national administration.

Valor pronóstico de la afectación de vesículas seminales en el espécimen de prostatectomía radical / Prognostic value of seminal vesicle involvement due to prostate cancer in radical prostatectomy specimens

Objetivo: Estudiar la influencia en términos de pronóstico del hallazgo de afectación de vesícula seminal en pacientes con adenocarcinoma de próstata tratados mediante prostatectomía radical. Material y método: Se revisa una serie de pacientes con afectación de vesícula seminal con adenocarcinoma de próstata clínicamente localizado sometidos a prostatectomía radical entre 1989-2009, con énfasis en sus características clinicopatológicas, la supervivencia libre de progresión bioquímica (SLPB) y la supervivencia específica (SE). Se evalúan las variables influyentes en la SLPB y se diseña un modelo de riesgo. Resultados: Un total de 127 pacientes sobre 1.132 intervenidos (11%) mostraron invasión de vesícula seminal; es decir, fueron pT3b. En el estudio multivariado de toda la serie (modelo de Cox) pT3b influye en la SLPB (HR: 2; IC 95%: 1,4-3,3; p = 0,001). Otros factores influyentes fueron márgenes afectos, PSA inicial, Gleason patológico y presencia de tumor palpable. Los tumores pT3b presentan peores variables clinicopatológicas cuando se comparan con pT2 y pT3a. El 65% ha evidenciado progresión bioquímica. La SLPB es significativamente peor en pT3b (40 ± 4% y 28 ± 4% a 5 y 10 años) que en pT2 y pT3a (p < 0,0001). La SE también es peor en pacientes pT3b (91 ± 2% y 76 ± 4% a 5 y 10 años) (p < 0,0001). Dentro del grupo de pacientes pT3b las variables predictivas son: PSA > 10 ng/ml (HR: 1,9; IC 95%: 1,04-3,6; p = 0,04) y Gleason patológico 8-10 (HR: 2,1; IC 95%: 1,2-3,5; p = 0,03). Se ha diseñado un modelo de riesgo que tiene en cuenta las variables implicadas, que conlleva 2 grupos con diferente SLPB (p = 0,004): a) grupo 1 (0-1 variables). SLPB: 46 ± 7% y 27 ± 8% a 5 y 10 años; y b) grupo 2 (2 variables). SLPB: 14 ± 7% y 5 ± 5% a 5 y 10 años. Conclusión: La afectación de vesícula seminal influye de manera severamente negativa en la SLPB y en la SE. Se diseña un modelo de riesgo con las variables de influencia independiente en la SLPB (Gleason patológico 8-10 y PSA > 10 ng/ml). Este modelo confirma que los tumores pT3b son un grupo heterogéneo, dentro del cual hay un grupo importante de mejor pronóstico cuando se lleva a cabo tratamiento quirúrgico

Objective: To study the influence, in terms of prognosis, of the finding of seminal vesicle involvement in patients with prostate adenocarcinoma treated with radical prostatectomy. Material and method: We reviewed a series of patients with seminal vesicle involvement with clinically localized prostate adenocarcinoma who underwent radical prostatectomy between 1989 and 2009, focusing on their clinical-pathological characteristics, biochemical progression-free survival (BPFS) and specific survival (SS). We assessed the variables that influenced BPFS and designed a risk model. Results: A total of 127 out of 1,132 patients who underwent surgery (11%) presented seminal vesicle invasion (i.e., pT3b). In the multivariate study of the entire series (Cox model), pT3b affects the BPFS (HR: 2; 95% CI: 1.4-3.3; P = .001). Other influential factors were the affected borders, initial prostate-specific antigen levels, pathological Gleason score and the presence of palpated tumor. The pT3b tumors have poorer clinical-pathological variables when compared with pT2 and pT3a tumors. Sixty-five percent of the patients evidenced biochemical progression. The BPFS was significantly poorer for pT3b (40 ± 4% and 28 ± 4% at 5 and 10 years, respectively) than for pT2 and pT3a (P < .0001). The SS was also poorer in patients with pT3b tumors (91 ± 2% and 76 ± 4% at 5 and 10 years, respectively) (P <. 0001). The predictors within the pT3b patient group were: PSA levels > 10 ng/mL (HR: 1.9; 95% CI: 1.04–3.6; P = .04) and pathological Gleason score 8-10 (HR: 2.1; 95% CI: 1.2-3.5; P = .03). We designed a risk model that accounts for the variables involved, which entails 2 groups with different BPFS (P = .004): Group 1 (0-1 variable), with a BPFS of 46 ± 7% and 27 ± 8% at 5 and 10 years, respectively; and Group 2 (2 variables), with a BPFS of 14 ± 7% and 5 ± 5% at 5 and 10 years, respectively. Conclusion: Seminal vesicle involvement severely and negatively affects the BPFS and SS. We designed a risk model with the independent influential variables in BPFS (pathological Gleason score 8-10 and PSA levels >10 ng/mL). This model confirms that pT3b tumors are a heterogeneous group, which includes an important group with better prognosis when surgical treatment is performed

Prognostic value of seminal vesicle involvement due to prostate cancer in radical prostatectomy specimens.

OBJECTIVE: To study the influence, in terms of prognosis, of the finding of seminal vesicle involvement in patients with prostate adenocarcinoma treated with radical prostatectomy. MATERIAL AND METHOD: We reviewed a series of patients with seminal vesicle involvement with clinically localized prostate adenocarcinoma who underwent radical prostatectomy between 1989 and 2009, focusing on their clinical-pathological characteristics, biochemical progression-free survival (BPFS) and specific survival (SS). We assessed the variables that influenced BPFS and designed a risk model. RESULTS: A total of 127 out of 1,132 patients who underwent surgery (11%) presented seminal vesicle invasion (i.e., pT3b). In the multivariate study of the entire series (Cox model), pT3b affects the BPFS (HR: 2; 95% CI: 1.4-3.3; P=.001). Other influential factors were the affected borders, initial prostate-specific antigen levels, pathological Gleason score and the presence of palpated tumor. The pT3b tumors have poorer clinical-pathological variables when compared with pT2 and pT3a tumors. Sixty-five percent of the patients evidenced biochemical progression. The BPFS was significantly poorer for pT3b (40 ± 4% and 28 ± 4% at 5 and 10 years, respectively) than for pT2 and pT3a (P<.0001). The SS was also poorer in patients with pT3b tumors (91 ± 2% and 76 ± 4% at 5 and 10 years, respectively) (P<.0001). The predictors within the pT3b patient group were: PSA levels >10 ng/mL (HR: 1.9; 95% CI: 1.04-3.6; P=.04) and pathological Gleason score 8-10 (HR: 2.1; 95% CI: 1.2-3.5; P=.03). We designed a risk model that accounts for the variables involved, which entails 2 groups with different BPFS (P=.004): Group 1 (0-1 variable), with a BPFS of 46 ± 7% and 27 ± 8% at 5 and 10 years, respectively; and Group 2 (2 variables), with a BPFS of 14 ± 7% and 5 ± 5% at 5 and 10 years, respectively. CONCLUSION: Seminal vesicle involvement severely and negatively affects the BPFS and SS. We designed a risk model with the independent influential variables in BPFS (pathological Gleason score 8-10 and PSA levels >10 ng/mL). This model confirms that pT3b tumors are a heterogeneous group, which includes an important group with better prognosis when surgical treatment is performed.

La simulación mejora la confianza de los estudiantes para adquirir competencias en urología / Simulators Help Improve Student Confidence to Acquire Skills in Urology

Objetivos: Conocer el grado de confianza de los alumnos de quinto de Grado en Medicina para realizar las maniobras de sondaje vesical y tacto rectal, antes y después del entrenamiento con simuladores. En segundo lugar, valorar la satisfacción de los estudiantes respecto a la utilización de la simulación como metodología de aprendizaje. Material y métodos: El estudio se llevó a cabo en el Centro de Simulación de la Facultad de Medicina, y participaron los 173 estudiantes que realizaron el taller práctico de la asignatura de Urología. Mediante cuestionarios anónimos, los estudiantes respondieron a preguntas sobre su grado de confianza en la realización del sondaje vesical y el tacto rectal, antes y después del taller, y sobre la satisfacción general respecto a la simulación como herramienta de entrenamiento. Los talleres se organizaron en grupos de 10 alumnos y estaban dirigidos por un profesor o residente de dicha especialidad que supervisaba de manera individual, resolvía dudas e instruía en la técnica correcta. Resultados: Todas las valoraciones respecto a las distintas competencias fueron significativamente más altas tras el entrenamiento (p < 0,001). Se encontraron diferencias significativas en la confianza antes del entrenamiento entre varones y mujeres en la maniobras de sondaje uretral masculino y reconocimiento de próstata normal o patológica, siendo menor la confianza en mujeres (p < 0,05). Estas diferencias desaparecieron tras el entrenamiento. El grado de satisfacción general con el taller fue alto, de 4,47 ± 0,9 sobre una puntuación máxima de 5. Conclusiones: La simulación es un método de entrenamiento

Objective: To know the level of confidence of fifth-year medical students in order to perform maneuvers in bladder catheterization and rectal examination before and after training with simulators. To be able to assess student satisfaction regarding the use of the simulation as a learning method. Materials and methods: The study was conducted in the Simulation Center of the Faculty of Medicine. A total of 173 students who completed a practical workshop on the subject of Urology participated. The students were asked to answer anonymous questionnaires on their level of confidence in performing a bladder catheterization and rectal examination before and after the workshop as well as their satisfaction in using the simulation as a training tool. The workshops were organized using groups of 10 students. A teacher or a resident in that area of expertise supervised each student individually, resolving their doubts and teaching them the proper technique. Results: All the evaluations made on the different abilities were significantly higher after training (p < 0.001). Significant differences were found in the confidence level between men and women before the training regarding male urethral catheterization maneuvers and recognition of normal or pathological prostate, The confidence level was lower in women (p < 0.05). These differences disappeared after training. The level of overall satisfaction with the workshop was high, going from 4.47 ± 0.9 to a maximum score of 5. Conclusions: Simulation is a training method that helps improve the confidence of the medical student in performing a bladder catheterization and digital rectal examination

The Spanish indoor radon mapping strategy.

Indoor radon mapping still represents a valuable tool for drawing the picture of the exposure of general public due to radon and radon progeny inhalation in a residential context. The information provided by means of a map is useful not only as awareness and strategic element for authorities and policy-makers, but also as a scientific start-up point in the design of epidemiological and other specific studies on exposure to natural radiation. The requirements for a good mapping are related to harmonisation criteria coming from European recommendations, as well as to national/local characteristics and necessities. Around 12,000 indoor radon measurements have been made since the Spanish national radon programme began at the end of the 1980s. A significant proportion of them resulted from the last campaign performed from 2009 to 12. This campaign completed the first version of a map based on a grid 10 × 10 km(2). In this paper, the authors present the main results of a new map together with the criteria adopted to improve the number of measurements and the statistical significance of them.

Simulators help improve student confidence to acquire skills in urology.

OBJECTIVE: To know the level of confidence of fifth year medical students in order to perform maneuvers in bladder catheterization and rectal examination before and after training with simulators. To be able to assess student satisfaction regarding the use of the simulation as a learning method. MATERIAL AND METHODS: The study was conducted in the Simulation Center of the Faculty of Medicine. A total of 173 students who completed a practical workshop on the subject of Urology participated. The students were asked to answer anonymous questionnaires on their level of confidence in performing a bladder catheterization and rectal examination before and after the workshop as well as their satisfaction in using the simulation as a training tool. The workshops were organized using groups of 10 students. A teacher or a resident in that area of expertise supervised each student individually, resolving their doubts and teaching them the proper technique. RESULTS: All the evaluations made on the different abilities were significantly higher after training (P<.001). Significant differences were found in the confidence level between men and women before the training regarding male urethral catheterization maneuvers and recognition of normal or pathological prostate, The confidence level was lower in women (P<.05). These differences disappeared after training. The level of overall satisfaction with the workshop was high, going from 4.47 ± 0.9 to a maximum score of 5. CONCLUSIONS: Simulation is a training method that helps improve the confidence of the medical student in performing a bladder catheterization and digital rectal examination.

[Malignant priapism: conservative management of a case]. / Priapismo maligno: un caso manejado de forma conservadora.

Priapism is an urological emergency which requires investigation, especially to differentiate between ischemic and non-ischemic priapism. Initial management is carried out through aspiration and gasometry of blood from the corpus cavernosum. We report the case of a 69-year-old patient with urothelium carcinoma of the bladder T2 G3 and metastasis in urethra/corpus cavernosum who requested an emergency consultation because of edema and a penile erection lasting several days. Due to the poor prognosis and the imaging test, a conservative management was carried out.

Priapismo maligno: un caso manejado de forma conservadora / Malignant priapism: conservative management of a case

El priapismo es una urgencia urológica que requiere especial valoración, especialmente en la diferenciación de priapismo isquémico y no isquémico. El manejo inicial es mediante aspiración y gasometría de la sangre de los cuerpos cavernosos. Presentamos un paciente de 69 años diagnosticado de carcinoma de urotelio vesical T2, con metástasis en uretra/cuerpo cavernoso que acude a urgencias por edema y tumefacción peneano de varios días de evolución. Ante el pronóstico malo y las pruebas de imagen realizadas se decide tratamiento de soporte y quimioterápico (AU)

Priapism is an urological emergency which requires investigation, especially to differentiate between ischemic and non-ischemic priapism. Initial management is carried out through aspiration and gasometry of blood from the corpus cavernosum. We report the case of a 69-year-old patient with urothelium carcinoma of the bladder T2 G3 and metastasis in urethra/corpus cavernosum who requested an emergency consultation because of edema and a penile erection lasting several days. Due to the poor prognosis and the imaging test, a conservative management was carried out (AU)

Intercomparison exercise on external gamma dose rate under field conditions at the laboratory of natural radiation (Saelices el Chico, Spain).

The last nuclear accident in Fukushima nuclear power plant has increased the necessity for measuring radiation in the environment. Therefore, radiation monitors providing results traceable throughout the country become essential and it is very important to test them under the same environmental conditions. The first intercomparison of natural radioactivity under field conditions was held in Saelices el Chico (Salamanca, Spain) in May 2011, including an exercise on environmental dose rate. This article presents the results achieved by 19 instruments belonging to 12 institutions from 7 different countries. The tested detectors are proportional counters, ionisation chambers, Geiger-Müller and scintillators measuring dose rate in three stations with reference values from 110 to 1800 nGy h(-1). All the results were given in terms of air kerma (nGy h(-1)) and the measurements show agreement within 25 % in all the sites. Evaluation criteria based on accuracy and statistical uncertainty were also carried out and 25 % of participants passed the test in all sites.

Function and expression of renal epithelial sodium transporters in rats with thyroid dysfunction.

Thyroid disorders are accompanied by major changes in renal sodium handling and blood pressure. Sodium transporters play a crucial role in regulating sodium excretion. We determined the function and expression of type 3 Na/H (NHE3) exchanger, type 2 Na+K+2Cl co-transporter (NKCC2) co-transporter, NaCl co-transporter (NCC) cotransporter, and epithelial sodium channel (ENaC) in hypoand hyperthyroid rats at 6 weeks after each thyroid disorder induction. We measured the renal response to functional blockade of the tubular sodium transporters, using acetazolamide to inhibit the activity of NHE3, furosemide for NKCC2, hydrochlorotiazide for NCC, and amiloride for ENaC. Expression of sodium transporters was analyzed by measuring the protein abundance by Western blot. The responsiveness to NHE3 inhibition and NHE3 protein was lower in hypothyroid rats and higher in hyperthyroid rats vs controls. Hypothyroid rats showed greater diuretic and natriuretic responses to NKCC2 and ENaC blockade and higher protein abundance of NKCC2 vs controls. Hyperthyroid rats showed greater protein expression of NKCC2 and NCC vs controls. Groups did not differ in responsiveness to NCC blockade. The expression and activity of ENaC were lower in hyperthyroid rats. In conclusion, reduced NHE3 activity may participate in the low blood pressure of hypothyroid rats and elevated NHE3 activity in the high blood pressure of hyperthyroid rats. These proximal alterations are counter-balanced by functional upregulation of NKCC2 and ENaC in downstream nephron segments of hypothyroid rats and by downregulation of αENaC activity and expression in hyperthyroid rats.

Resultados del vástago femoral no cementado Meridian. Estudio prospectivo de 109 casos / Uncemented Meridian femoral stem results: a prospective study of 109 cases

Objetivo. Evaluación del vástago no cementado Meridian en prótesis total de cadera primaria. Material y método. Estudio prospectivo de 109 casos con una edad media de 64 años (rango: 30-80) y un seguimiento de 6,5 años (rango: 5-12). Valoración clínica con escalas de Harris y Merle D’Aubigné, calidad de vida con SF-12 y Womac, resultados radiográficos y análisis de complicaciones. Resultados. La escala de Harris y Merle D’Aubigné se incrementó de 40,9 a 86,7 y de 8,4 a 10,5, con el 81% de resultados funcionales satisfactorios. El dolor en muslo (17%) se asociaba a insuficiente relleno femoral. Hubo 7 fracturas femorales intraoperatorias asociadas a una edad mayor de 65 años y un ajuste metafisario > 90%, debiendo revisarse tres. Hubo otros 5 vástagos con fijación fibrosa inestable asociados a un ajuste metafisario y/o diafisario insuficiente, y todos con indicación de revisión. La supervivencia del vástago a 7,5 años por causas asépticas fue del 94,7%. Discusión y conclusiones. El excesivo relleno tiene el riesgo de fractura metafisaria intraoperatoria pudiendo afectar a los resultados. El insuficiente relleno puede comprometer la fijación secundaria (AU)

To evaluate the results of the uncemented meridian femoral stem in primary total hip arthroplasty. Material and method. A prospective study was performed on 109 cases, with a mean age of 64 years (range: 30-80) and follow-up of 6.5 years (range: 5-12). The study included, a clinical assessment using the scales of Harris and Merle D’Aubigné, quality of life with SF-12 and WOMAC, radiographic results and analysis of complications. Results. The Harris and Merle D’Aubigné scales increased from 40.9 to 86.7 and from 8.4 to 10.5, respectively, with 81% satisfactory functional results. Thigh pain (17%) was associated with insufficient femoral filling. There 7 femoral fractures during surgery, associated with an age greater than 65 years and a metaphyseal adjustment >90%, 3 of which had to be revised. There were another 5 stems with unstable fibrous fixation, associated with insufficient metaphyseal and/or diaphyseal adjustment, and all with an indication for revision. The mean survival of the stem at 7.5 years due to aseptic causes was 94.7%. Discussion and conclusions. Excessive filling carries a risk of metaphyseal fractures during surgery, which could affect the results. Insufficient filling can compromise the secondary fixation (AU)