The geriatric nutritional risk index predicts complications after nephrectomy for renal cancer

ABSTRACT Purpose: We examined if malnutrition, as defined by the Geriatric Nutritional Risk Index (GNRI), is independently associated with 30-day postoperative complications in patients undergoing nephrectomy for the treatment of renal cancer. Materials and methods: Using the American College of Surgeons National Surgical Quality Improvement Program database from 2006-2019, we identified patients ≥65 years old who underwent nephrectomy for renal cancer. The following formula for GNRI was used to define preoperative nutritional status: 1.489 x serum albumin (g/L) + 41.7 x (current body weight [kg]/ ideal body weight [kg]). Based on the GNRI, patients were classified as having no (> 98), moderate (92-98), or severe malnutrition (< 92). After adjusting for potential confounders, multivariable logistic regression analyses were performed to assess the association between GNRI and 30-day postoperative complications. Odds ratios (OR) with 95% confidence intervals (CI) were reported. Results: A total of 7,683 patients were identified, of which 1,241 (16.2%) and 872 (11.3%) had moderate and severe malnutrition, respectively. Compared to normal nutrition, moderate and severe malnutrition were significantly associated with a greater odds of superficial surgical site infection, progressive renal insufficiency, readmission, extended length of stay, and non-home discharge. Severe malnutrition was also associated with urinary tract infection (OR 2.10, 95% CI 1.31-3.35) and septic shock (OR 2.93, 95% CI 1.21-7.07). Conclusion: Malnutrition, as defined by a GNRI ≤ 98, is an independent predictor of 30-day complications following nephrectomy. The GNRI could be used to counsel elderly patients with renal cancer prior to nephrectomy.

The geriatric nutritional risk index predicts complications after nephrectomy for renal cancer.

PURPOSE: We examined if malnutrition, as defined by the Geriatric Nutritional Risk Index (GNRI), is independently associated with 30-day postoperative complications in patients undergoing nephrectomy for the treatment of renal cancer. MATERIALS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database from 2006-2019, we identified patients ≥65 years old who underwent nephrectomy for renal cancer. The following formula for GNRI was used to define preoperative nutritional status: 1.489 x serum albumin (g/L) + 41.7 x (current body weight [kg]/ ideal body weight [kg]). Based on the GNRI, patients were classified as having no (> 98), moderate (92-98), or severe malnutrition (< 92). After adjusting for potential confounders, multivariable logistic regression analyses were performed to assess the association between GNRI and 30-day postoperative complications. Odds ratios (OR) with 95% confidence intervals (CI) were reported. RESULTS: A total of 7,683 patients were identified, of which 1,241 (16.2%) and 872 (11.3%) had moderate and severe malnutrition, respectively. Compared to normal nutrition, moderate and severe malnutrition were significantly associated with a greater odds of superficial surgical site infection, progressive renal insufficiency, readmission, extended length of stay, and non-home discharge. Severe malnutrition was also associated with urinary tract infection (OR 2.10, 95% CI 1.31-3.35) and septic shock (OR 2.93, 95% CI 1.21-7.07). CONCLUSION: Malnutrition, as defined by a GNRI ≤ 98, is an independent predictor of 30-day complications following nephrectomy. The GNRI could be used to counsel elderly patients with renal cancer prior to nephrectomy.

Seroprevalence and Risk Factors Possibly Associated with Emerging Zoonotic Vaccinia Virus in a Farming Community, Colombia.

In 2014, vaccinia virus (VACV) infections were identified among farmworkers in Caquetá Department, Colombia; additional cases were identified in Cundinamarca Department in 2015. VACV, an orthopoxvirus (OPXV) used in the smallpox vaccine, has caused sporadic bovine and human outbreaks in countries such as Brazil and India. In response to the emergence of this disease in Colombia, we surveyed and collected blood from 134 farmworkers and household members from 56 farms in Cundinamarca Department. We tested serum samples for OPXV antibodies and correlated risk factors with seropositivity by using multivariate analyses. Fifty-two percent of farmworkers had OPXV antibodies; this percentage decreased to 31% when we excluded persons who would have been eligible for smallpox vaccination. The major risk factors for seropositivity were municipality, age, smallpox vaccination scar, duration of time working on a farm, and animals having vaccinia-like lesions. This investigation provides evidence for possible emergence of VACV as a zoonosis in South America.

Diagnostic precision of sentinel lymph node biopsy in penile cancer.

INTRODUCTION: Sentinel lymph node biopsy (SLNB) was designed as a minimally invasive method for evaluation of nodal involvement in patients with penile cancer and nonpalpable lymph nodes. Nevertheless, SLNB is not used in a regular basis due to the lack of studies that adequately characterize the performance of this procedure. The purpose of this study was to evaluate the diagnostic performance of SLNB in patients with infiltrative penile carcinoma without palpable inguinal lymph nodes in a Colombian population. MATERIALS AND METHODS: This is a retrospective observational study of 89 patients diagnosed with infiltrative penile squamous cell carcinoma with nonpalpable inguinal lymph nodes. These patients underwent partial or complete penectomy, along with SLNB, between 2008 and 2017. Those individuals with a positive SLNB underwent inguinal lymphadenectomy, while those with a negative SLNB were followed on a quarterly basis with a physical examination and imaging to assess relapse. Statistical analysis was done using the STATA 14 software. A contingency table was made to calculate sensitivity, specificity, positive predictive value, negative predictive value, and exactitude, each one with its own confidence interval (CI) of 95%. RESULTS: There was an average follow-up of 31.4 months, and all 89 patients were evaluated; most primary tumors were T2 (55%), followed by T1 (37%), all of which were subclassified as T1b and T3 (8%). Tumours were most frequently located in the glans (43%). All patients were classified as cN0 and underwent SLNB. Sixty-one patients (69%) tested negative in the SLNB, four of whom (6%) presented with lymph node relapse. On the other hand, 28 patients (31%) tested positive in the SLNB and consequently underwent inguinal lymphadenectomy, seven of whom had negative lymph nodeinvolvement (25% false positives). According to the results, the sensitivity was 84% (95% CI, 65.3-93.6) and the specificity was 89% (95% CI, 79.4-94.7), with a false-negative rate of 6.5%. CONCLUSIONS: The SLNB using radiotracer can be a useful method for lymph node staging in patients with penile cancer and nonpalpable lymph nodes when performed in experienced centers.

Clinical Correlation Between Computerized Tomography Findings and Pathologic Diagnosis in Patients Surgically Treated for Complex Renal Cysts in a Colombian Tertiary Center.

Introduction Recent data have reexamined the historical rates of malignancy observed in Bosniak IIF and III cystic lesions, and this has led to an endorsement of the use of active surveillance as the standard of care for Bosniak III renal cysts by affirming that overtreatment rates for this subgroup are close to 50%. In light of this, the present study describes the correlation between imaging studies and pathologic diagnosis in patients surgically treated for complex renal cysts in Colombia. Materials and methods This is a retrospective, descriptive, and observational study. We analyzed the medical histories of patients who had been surgically treated for complex renal cysts between 2010 and 2018 in the urology department of a tertiary center in Bogota, Colombia. The exclusion criteria were incomplete clinical histories and absent diagnostic images or their official interpretation. Results Out of the 235 urological procedures performed, nine were excluded. And 6.19% (n = 14) were cases of surgically treated complex renal cysts; 38.46% were compatible with Bosniak IIF, 46.15% were Bosniak III, and 15.38% were Bosniak IV. The percentage of renal cancer as revealed by the histopathological study was 60, 66.7 and 100 for renal cysts Bosniak IIF, III, and IV, respectively; 77.7% of these confirmed oncological cases had received a diagnosis of clear cell renal carcinoma. Conclusions In our study, the percentage of malignancy in patients with renal cysts Bosniak IIF and III was found to be greater compared to the findings in the recent medical literature. We believe that the management offered to the population with complex renal cysts in Colombia should be tailored to the individual risk characteristics of each patient.

La práctica reflexiva como posibilidad de construcción de saberes. Aportes a la formación docente en Educación Física / A prática reflexiva como possibilidade de construção de saberes: contribuições para a formação docente na Educação Física / Reflective practice as a possibility for knowledge construction: contributions to teacher training in Physical Education

La investigación se ocupó de identificar los tópicos que los profesores asumen como objeto de análisis, mediante la experiencia de una práctica reflexiva basada en la escritura de diarios epistémicos, como la posibilidad de distanciamiento, objetivación de la propia práctica y producción de saber. La técnica de investigación fue el diario epistémico, a partir de una referencia teórica basada en las posibilidades reflexivas de la escritura y en las propias prácticas. Se profundizó en cuatro casos, con profesores de la asignatura "Práctica Pedagógica Profesional", que forma parte del currículo del curso de Licenciatura en Educación Física de una universidad de Colombia. Finalmente, los diarios fueron abordados según el enfoque del análisis cualitativo. El estudio pretende contribuir con el debate sobre la formación docente desde enfoques orientados a la configuración de estrategias formativas basadas en la reflexión. así como a la producción de saber a partir de la práctica(AU)

A pesquisa consistiu em identificar os tópicos que os professores assumem como objeto de análise, mediante a experiência de uma prática reflexiva baseada na escrita de diários epistêmicos, como a possibilidade de distanciamento, objetivação da própria prática e produção de saber. A técnica de pesquisa foi o diário epistêmico, a partir de um referencial teórico com base nas possibilidades reflexivas da escrita e nas próprias práticas. Quatro casos foram aprofundados com professores da disciplina "Prática Pedagógica Profissional", pertencente ao currículo do curso de Licenciatura em Educação Física de uma Universidade Estadual da Colômbia. Finalmente, os diários foram abordados pela análise qualitativa. Espera-se contribuir para o debate sobre a formação docente com abordagens que visam à configuração de estratégias formativas baseadas na reflexão, assim como a produção de saber a partir da prática, em uma área em que isso não está consolidado(AU)

The study focused on identifying the topics that teachers choose as their objects of analysis through the experience of a reflexive practice based on the writing of epistemic diaries as a possibility for distancing oneself, objectifying one's own practice and producing knowledge. The research technique chosen was an epistemic diary under a theoretical reference based on the reflective and epistemic possibilities of writing and reflection about practice. Four cases were observed with professors of "Professional Pedagogical Practice" corresponding to the curriculum of a Physical Education Teacher Training Degree in Colombia. Finally, the diaries were addressed according to the qualitative data analysis approach. The study aims to contribute to the debate on teacher training under approaches oriented to knowledge production based on practice in an area where that is not consolidated(AU)

Métodos semiempíricos para la evaluación rápida de orbitales frontera en la clasificación de agonistas y antagonistas de la subunidad NR1 de los receptores iGluR-NMDA / Semiempirical methods for the rapid evaluation of frontier orbitals in the classification of agonists and antagonists of the NR1 subunit of the iGluR-NMDA receptors / Métodos semi-empíricos de avaliação rápida de orbitais fronteira na classificação dos agonistas e antagonistas da subunidade NR1 dos receptores iGluRNMDA

Los receptores iGluR-NMDA poseen gran interés farmacológico debido a que están implicados en desórdenes neurodegenerativos y neurosiquiátricos incluso participan en procesos como plasticidad sináptica, esencial para la formación de la memoria. La subunidad NR1 de los iGluR-NMDA es fundamental para que este tipo de receptores se activen apropiadamente, de hecho muchos de los fármacos estudiados para los desórdenes anteriormente mencionados, están dirigidos específicamente a la subunidad NR1. Estudios previos han determinado que el orbital molecular de más baja energía (LUMO), puede ser usado como parámetro para estimar la actividad agonista o antagonista en la subunidad NR1. Objetivo. Evaluar el método semiempírico CNDO para el cálculo rápido de la energía LUMO, con la finalidad de crear un modelo sencillo para el diseño in silico de nuevos fármacos. Materiales y métodos. Fueron seleccionadas 168 moléculas entre agonistas y antagonistas de la subunidad NR1. La energía de cada estructura fue optimizada y posteriormente fueron calculadas las energías de los orbitales frontera, el LogP, la energía total, la capacidad de formar puentes de hidrógeno, la energía de unión y el momento dipolar. Resultados. Se demuestra que la energía LUMO es suficiente para discriminar entre moléculas agonistas y antagonistas de esta subunidad y que el método CNDO evalúa estas propiedades de manera rápida y eficiente. Conclusión. El método CNDO permite el cálculo rápido, generando a futuro procedimientos eficaces para la caracterización de fármacos potenciales que actúen sobre este sitio en particular.

The ionotropic glutamate receptors activated by N-Methyl-D-Aspartate (iGluR-NMDA) are of great importance in pharmacology since they are involved in neurodegenerative and neuropsychiatric disorders; they even participate in processes such as synaptic plasticity that are essential for memory formation. Subunit NR1 iGluRs-NMDA is of paramount importance for the appropriate activation of this type of receptors; in fact, many of the pharmaceutical products studied for the abovementioned disorders are targeted specifically to the NR1 subunit. Previous studies have shown that the lowest energy unoccupied molecular orbital (LUMO) can be used as a parameter to estimate the agonist and antagonist activity of the NR1subunit. Objective. Evaluate the semiemprical method CNDO for the rapid calculation of the LUMO energy with the aim of preparing a simple model for the in silico design of new pharmacological substances. Materials and methods. 168 molecules with agonist and antagonist activity in the NR1 subunit were selected. Energy of each structure was optimized and then we calculated the energy of the frontier orbital, the LogP, total energy, capacity of forming hydrogen bonds, binding energy, and dipolar moment. Results. We demonstrate that LUMO energy is enough for discriminating agonist and antagonist molecules of the NR1 subunit and that the CNDO method evaluates these properties in a rapid and efficient way. Conclusions. The CNDO method facilitates a rapid calculation, enabling a future development of effective procedures for the characterization of potential pharmacological substances acting on this particular site.

Os receptores IGluR-NMDA têm grande interesse farmacológico porque estão envolvidos em desordens neurodegenerativas e neuropsiquiátricas inclusive participam em processos de plasticidade sináptica, essenciais para a formação da memória. A subunidade NR1 dos iGluR-NMDA é fundamental para que este tipo de receptores se ativem de forma adequada, de fato, muitos dos fármacos estudados para os transtornos mencionados acima, são orientados especificamente pela subunidade NR1. Estudos prévios determinaram que o orbital molecular de mais baixa energia (LUMO), pode ser usado como um parâmetro para estimar a atividade agonista ou antagonista na subunidade NR1. Objetivo. Avaliar o método semi-empírico CNDO para o cálculo rápido da energia LUMO, a fim de criar um modelo simples para o desenho in silicio de novas drogas. Materiais e métodos. Foram selecionadas 168 moléculas entre agonistas e antagonistas da subunidade NR1. A energia de cada estrutura foi otimizada e, em seguida, foram calculadas as energias de orbitais fronteira, o LogP, a energia total, a capacidade de formar pontes de hidrogênio, a energia de ligação e o momento dipolar. Resultados. Foi demonstrado que a energia LUMO é suficiente para discriminar entre moléculas agonistas e antagonistas desta subunidade e que o método CNDO avalia essas propriedades de forma rápida e eficiente. Conclusão. O método CNDO permite o cálculo rápido, gerando a futuro procedimentos eficazes para a caracterização de potenciais medicamentos que agem neste sitio em particular.