Diagnosis in Bytes: Comparing the Diagnostic Accuracy of Google and ChatGPT 3.5 as an Educational Support Tool.

BACKGROUND: Adopting advanced digital technologies as diagnostic support tools in healthcare is an unquestionable trend accelerated by the COVID-19 pandemic. However, their accuracy in suggesting diagnoses remains controversial and needs to be explored. We aimed to evaluate and compare the diagnostic accuracy of two free accessible internet search tools: Google and ChatGPT 3.5. METHODS: To assess the effectiveness of both medical platforms, we conducted evaluations using a sample of 60 clinical cases related to urological pathologies. We organized the urological cases into two distinct categories for our analysis: (i) prevalent conditions, which were compiled using the most common symptoms, as outlined by EAU and UpToDate guidelines, and (ii) unusual disorders, identified through case reports published in the 'Urology Case Reports' journal from 2022 to 2023. The outcomes were meticulously classified into three categories to determine the accuracy of each platform: "correct diagnosis", "likely differential diagnosis", and "incorrect diagnosis". A group of experts evaluated the responses blindly and randomly. RESULTS: For commonly encountered urological conditions, Google's accuracy was 53.3%, with an additional 23.3% of its results falling within a plausible range of differential diagnoses, and the remaining outcomes were incorrect. ChatGPT 3.5 outperformed Google with an accuracy of 86.6%, provided a likely differential diagnosis in 13.3% of cases, and made no unsuitable diagnosis. In evaluating unusual disorders, Google failed to deliver any correct diagnoses but proposed a likely differential diagnosis in 20% of cases. ChatGPT 3.5 identified the proper diagnosis in 16.6% of rare cases and offered a reasonable differential diagnosis in half of the cases. CONCLUSION: ChatGPT 3.5 demonstrated higher diagnostic accuracy than Google in both contexts. The platform showed satisfactory accuracy when diagnosing common cases, yet its performance in identifying rare conditions remains limited.

Seguimiento de dilatación del tracto urinario neonatal diagnosticada en la evaluación de infección del tracto urinario / Follow-up of Neonatal Urinary Tract Dilatation Diagnosed in the Evaluation of Urinary Tract Infection

Objetivo: Mostrar las características y seguimiento de la dilatación del tracto urinario en recién nacidos con infección del tracto urinario. Métodos: Estudio observacional, descriptivo, realizado desde 1992 hasta 2019, en neonatos ingresados con infección del tracto urinario. A todos se les realizó ultrasonido renal y uretrocistografía miccional. Se analizaron las características clínicas y de radioimagen de presentación en el seguimiento de la dilatación del tracto urinario. Resultados: Se estudiaron 403 pacientes. La mediana de seguimiento fue de 13 meses. El ultrasonido renal resultó positivo para dilatación del tracto urinario en 148 (36,7 por ciento). Predominaron los grados de dilatación ligera (5-10 mm.) sobre grados moderados y severos. En 38 casos (9,4 por ciento) la dilatación del tracto urinario se asoció a reflujo vésico-ureteral. La condición más común fue la dilatación transitoria con una mediana de desaparición de la dilatación 5 meses. Hubo asociación estadística significativa de la desaparición de la dilatación del tracto urinario con el grado de esta y entre aquellos casos calificados de transitoria con los otros portadores de alguna anomalía del tracto urinario que también tuvieron desaparición de la dilatación en algún momento de su evolución. Conclusiones: Cerca de una tercera parte de los neonatos con infección del tracto urinario tuvieron dilatación del tracto urinario en ultrasonido renal, con predominio de grado ligero, como probable expresión de una anomalía del tracto urinario subyacente. Con frecuencia ocurre resolución de la dilatación del tracto urinario en aquellos casos no asociados con anomalía del tracto urinario, habitualmente dentro del primer año de vida(AU)

OBjective: To show the characteristics and follow-up of urinary tract dilatation in neonates with urinary tract infection. Methods: Observational, descriptive study performed from 1992 to 2019, in neonates admitted with urinary tract infection. All underwent renal ultrasound and voiding urethrocystography. The clinical and radioimaging features of presentation were analyzed in the follow-up of urinary tract dilatation, Results: 403 patients were studied. The median follow-up was 13 months. Renal ultrasound was positive for urinary tract dilatation in 148 (36.7 percent). Mild degrees of dilatation (5-10 mm) predominated over moderate and severe degrees. In 38 cases (9.4 percent) urinary tract dilatation was associated with vesico-ureteral reflux. The most common condition was transient dilatation with a median disappearance of dilatation 5 months. There was significant statistical association of the disappearance of urinary tract dilatation with the degree of dilatation and between those cases qualified as transient with the other carriers of some urinary tract anomaly who also had disappearance of dilatation at some point in their evolution. Conclusions: About one third of neonates with urinary tract infection had dilatation of the urinary tract on renal ultrasound, predominantly of mild degree, probably expression of an underlying anomaly. Resolution of dilatation frequently occurs in those cases not associated with urinary tract anomaly, usually within the first year of life(AU)

Diagnóstico prenatal de anomalías nefrourológicas en el Centro de Referencia Perinatal Oriente, Santiago, Chile / Prenatal diagnosis of nefrourological anomalies at the Eastern Perinatal Referral Center, Santiago, Chile

INTRODUCCIÓN: Las anomalías congénitas de los riñones y las vías urinarias (CAKUT, Congenital Anomalies of the Kidney and Urinary Tract) representan un 20-30% de las anomalías detectadas en el periodo prenatal. Si bien la mayoría son de buen pronóstico, un 25% se asocian a enfermedad renal crónica en la infancia y en los casos graves a mortalidad perinatal. OBJETIVO: Describir los casos ingresados al Centro de Referencia Perinatal Oriente (CERPO) y determinar los resultados perinatales y la sobrevida al año. MÉTODO: Estudio descriptivo y retrospectivo. Se incluyeron pacientes ingresadas en la base de datos CERPO, entre los años 2003 y 2019, con diagnóstico de anomalía nefrourológica. Se incluyeron antecedentes prenatales, perinatales y de seguimiento posnatal al año. RESULTADOS: Se evaluaron 273 pacientes. La edad gestacional promedio de derivación fue de 29 semanas + 2 días. El diagnóstico más frecuente fueron las anomalías del tracto de salida (69%). Un 40% de los casos se asociaron a otras anomalías congénitas, siendo las cardiopatías las más frecuentes (19%). Aceptaron la realización de estudio genético invasivo 38 pacientes, de las cuales un 34% presentaron aneuploidías, siendo las trisomías 18 y 13 las más frecuentes (17% y 6%, respectivamente). Se instalaron cinco shunts derivativos vesicoamnióticos en fetos diagnosticados con megavejiga. La sobrevida global para la patología nefrourológica fue del 63% al año, y la mortalidad fetal y neonatal fue del 7% y el 16%, respectivamente. La sobrevida al año según el grupo de clasificación CAKUT fue del 22% para las anomalías de número de riñones, del 46% para las anomalías de tamaño y de morfología renal, del 60% para las anomalías de la posición renal y del 72% para las anomalías del tracto de salida. En este último grupo, la sobrevida alcanza el 81% al excluir los pacientes con diagnóstico prenatal de megavejiga, que presentaron una sobrevida al año del 28%. Los casos de patología nefrourológica asociada a oligohidramnios (índice de líquido amniótico < 5 cm) sin evidencias de uropatía obstructiva asociada presentaron una sobrevida al año del 3%. CONCLUSIONES: Las anomalías del sistema nefrourológico son un diagnóstico prenatal frecuente. La sobrevida al año fue del 63%, pero es necesario prolongar el seguimiento a largo plazo para determinar la evolución de la función renal en cada diagnóstico. La asociación de patología nefrourológica y oligohidramnios conlleva una sobrevida menor.

INTRODUCTION: Congenital anomalies of the kidneys and urinary tract (CAKUT) represent 20 to 30% of the anomalies detected prenatally. Although most are of good prognosis, 25% are associated with chronic kidney disease in childhood and severe cases with perinatal mortality. OBJECTIVE: To describe the cases studied in the Eastern Perinatal Referral Center (CERPO) and to determine the perinatal outcome and survival at one year. METHOD: Descriptive and retrospective study. Patients registered on the CERPO database, between 2003 to 2019, with diagnosis of nephrourological anomaly were included. Antenatal, perinatal and postnatal follow-up information was collected. RESULTS: 273 patients were evaluated. The average gestational age at referral was 29 + 2 weeks. The main diagnosis was urinary tract outlet disorders (69%). Thirty nine percent of the cases were associated with other congenital anomalies, with heart disease being the most frequent (19%). Thirty-eight patients accepted an invasive procedure for genetic study, 34% presented aneuploidy, trisomy 18 and 13 were the most frequent (17% and 6% respectively). Five vesico-amniotic derivative shunts were installed in fetuses diagnosed with megabladder. Overall survival at one year was 63% and fetal and neonatal mortality were 7% and 16% respectively. One-year survival per group according to CAKUT classification was 22% in kidney number abnormalities, 46% in kidney size and morphology abnormalities, 60% in renal position abnormalities and 72% in outflow tract abnormalities. In the latter, survival reaches 81% excluding the patients with prenatal diagnosis of megabladder who had a one-year survival of 28%. The cases of nephrourological pathology associated with oligohydramnios (amniotic fluid index < 5 cm) without evidence of associated obstructive uropathy presented a survival of 3% at one year. CONCLUSIONS: The anomalies of the nephrourological system correspond to a frequent prenatal diagnosis. Overall, the one-year survival was 63%; however, follow-up must continue to determine the evolution of renal function in relation to each diagnosis.

Special strategies and management of urological diseases during the COVID-19 pandemic: initial experiences from a Medical Center of China

ABSTRACT Although urological diseases are not directly related to coronavirus disease 2019 (COVID-19), urologists need to make comprehensive plans for this disease. Urological conditions such as benign prostatic hyperplasia and tumors are very common in elderly patients. This group of patients is often accompanied by underlying comorbidities or immune dysfunction. They are at higher risk of COVID-19 infection and they tend to have severe manifestations. Although fever can occur along with urological infections, it is actually one of the commonest symptoms of COVID-19; urologists must always maintain a high index of suspicion in their clinical practices. As a urological surgeon, how we can protect medical staff during surgery is a major concern. Our hospital had early adoption of a series of strict protective and control measures, and was able to avoid cross-infection and outbreak of COVID-19. This paper discusses the effective measures that can be useful when dealing with urological patients with COVID-19.

Special strategies and management of urological diseases during the COVID-19 pandemic: initial experiences from a Medical Center of China.

Although urological diseases are not directly related to coronavirus disease 2019 (COVID-19), urologists need to make comprehensive plans for this disease. Urological conditions such as benign prostatic hyperplasia and tumors are very common in elderly patients. This group of patients is often accompanied by underlying comorbidities or immune dysfunction. They are at higher risk of COVID-19 infection and they tend to have severe manifestations. Although fever can occur along with urological infections, it is actually one of the commonest symptoms of COVID-19; urologists must always maintain a high index of suspicion in their clinical practices. As a urological surgeon, how we can protect medical staff during surgery is a major concern. Our hospital had early adoption of a series of strict protective and control measures, and was able to avoid cross-infection and outbreak of COVID-19. This paper discusses the effective measures that can be useful when dealing with urological patients with COVID-19.

Aspectos clínicos e hematológicos da doença do trato urinário inferior em felinos / Clinical and haematological aspects of feline lower urinary tract disease

A obstrução uretral é uma condição urológica considerada comum e potencialmente fatal na doença do trato urinário inferior (DTUIF). Os principais sinais clínicos da obstrução uretral são: polaquiúria, disúria, hematúria, periúria, insucesso na micção, angústia, anorexia, hipotermia, ausência de libido ou ereção e durante o exame clínico observa-se a vesícula urinária repleta e firme, condições que conduzem à necessidade de intervenção imediata. Diante disso, o objetivo do trabalho foi descrever e comparar alterações clínicas e hematológicas de gatos com doença do trato urinário inferior obstrutiva e gatos saudáveis. No estudo, foram admitidos 30 gatos e distribuídos em dois grupos: o grupo controle composto por animais sem afecções clínicas notáveis e o grupo obstruído com animais diagnosticados clinicamente com quadro de obstrução urinária. Foi realizada anamnese detalhada dos animais, histórico, realização de exame físico geral com ênfase no trato urinário, ultrassonografia e exame hematológico completo. As principais alterações clínicas dos animais obstruídos foram desidratação, mucosas hipocoradas e hipotermia. O hemograma dos animais obstruídos revelou diferença significativa (p<0,05) para as médias encontradas quando comparados com o grupo controle para contagem de eritrócitos, concentração de hemoglobina e volume globular, tendo o grupo obstruído apresentado valores inferiores ao controle. Pode-se concluir que os exames hematológicos podem identificar alterações importantes do quadro inflamatório geral em animais obstruídos, apresentando neutrofilia, linfopenia e monocitose. Além disso, observou-se que o monitoramento longitudinal possibilita acompanhar a progressão da enfermidade e o risco de anemia bem como a melhora do quadro clínico.(AU)

Urethral obstruction is a urological condition considered to be common and potentially fatal in lower urinary tract disease (DTUIF). The main clinical signs of urethral obstruction are: pollakiuria, dysuria, hematuria, periuria, urination failure, anguish, anorexia, hypothermia, absence of libido or erection and during the clinical examination a full and firm urinary vesicle is observed, conditions that lead to the need for immediate intervention. Therefore, the objective of the study was to describe and compare clinical and hematological changes in cats with obstructive lower urinary tract disease and healthy cats. In the study, 30 cats were admitted and distributed in two groups: the control group composed of animals without clinical diseases and the obstructed group with animals clinically diagnosed with urinary obstruction. Detailed anamnesis of the animals, history, general physical examination with emphasis on urinary examination, ultrasound and complete hematological examination were performed. The main clinical changes in the obstructed animals were dehydration, bleached mucous membranes and hypothermia. The blood count of the obstructed animals showed a significant difference (p <0.05) to the average found when compared to the control group for erythrocyte count, hemoglobin concentration and globular volume, and the obstructed group presented values lower than the control. It can be concluded that hematological tests can identify important changes in the general inflammatory condition in obstructed animals, presenting neutrophilia, lymphopenia and monocytosis. In addition, longitudinal monitoring allows the progress of the disease and the risk of anemia to be monitored, as well as improvements in the clinical condition.(AU)

Aspectos clínicos e hematológicos da doença do trato urinário inferior em felinos / Clinical and haematological aspects of feline lower urinary tract disease

A obstrução uretral é uma condição urológica considerada comum e potencialmente fatal na doença do trato urinário inferior (DTUIF). Os principais sinais clínicos da obstrução uretral são: polaquiúria, disúria, hematúria, periúria, insucesso na micção, angústia, anorexia, hipotermia, ausência de libido ou ereção e durante o exame clínico observa-se a vesícula urinária repleta e firme, condições que conduzem à necessidade de intervenção imediata. Diante disso, o objetivo do trabalho foi descrever e comparar alterações clínicas e hematológicas de gatos com doença do trato urinário inferior obstrutiva e gatos saudáveis. No estudo, foram admitidos 30 gatos e distribuídos em dois grupos: o grupo controle composto por animais sem afecções clínicas notáveis e o grupo obstruído com animais diagnosticados clinicamente com quadro de obstrução urinária. Foi realizada anamnese detalhada dos animais, histórico, realização de exame físico geral com ênfase no trato urinário, ultrassonografia e exame hematológico completo. As principais alterações clínicas dos animais obstruídos foram desidratação, mucosas hipocoradas e hipotermia. O hemograma dos animais obstruídos revelou diferença significativa (p<0,05) para as médias encontradas quando comparados com o grupo controle para contagem de eritrócitos, concentração de hemoglobina e volume globular, tendo o grupo obstruído apresentado valores inferiores ao controle. Pode-se concluir que os exames hematológicos podem identificar alterações importantes do quadro inflamatório geral em animais obstruídos, apresentando neutrofilia, linfopenia e monocitose. Além disso, observou-se que o monitoramento longitudinal possibilita acompanhar a progressão da enfermidade e o risco de anemia bem como a melhora do quadro clínico.

Urethral obstruction is a urological condition considered to be common and potentially fatal in lower urinary tract disease (DTUIF). The main clinical signs of urethral obstruction are: pollakiuria, dysuria, hematuria, periuria, urination failure, anguish, anorexia, hypothermia, absence of libido or erection and during the clinical examination a full and firm urinary vesicle is observed, conditions that lead to the need for immediate intervention. Therefore, the objective of the study was to describe and compare clinical and hematological changes in cats with obstructive lower urinary tract disease and healthy cats. In the study, 30 cats were admitted and distributed in two groups: the control group composed of animals without clinical diseases and the obstructed group with animals clinically diagnosed with urinary obstruction. Detailed anamnesis of the animals, history, general physical examination with emphasis on urinary examination, ultrasound and complete hematological examination were performed. The main clinical changes in the obstructed animals were dehydration, bleached mucous membranes and hypothermia. The blood count of the obstructed animals showed a significant difference (p <0.05) to the average found when compared to the control group for erythrocyte count, hemoglobin concentration and globular volume, and the obstructed group presented values lower than the control. It can be concluded that hematological tests can identify important changes in the general inflammatory condition in obstructed animals, presenting neutrophilia, lymphopenia and monocytosis. In addition, longitudinal monitoring allows the progress of the disease and the risk of anemia to be monitored, as well as improvements in the clinical condition.

Urological manifestations of the disease related to immunoglobulin G4.

Immunoglobulin G4 related disease (IgG4-RD) is a fibro-inflammatory disease of unknown etiology, characterized by lesions in the form of tumors, elevated serum IgG4 levels, plasma cells with significant IgG4 infiltration, accompanied by phlebitis obliterans and fibrosis. This disease usually has multiorgan disease, including pancreas, biliary tract, salivary glands, peri orbital tissues, kidneys, lungs, lymph nodes and retro peritoneum. IgG4-RD mainly affects men with a predominance of age by young adults until old age. The clinical manifestations of IgG4-RD, depend mainly on the organs affected and the response to steroids. His forecast is not yet clear. Within the affected urogenital organs can be observed kidney, retroperitoneum, ureter, bladder, urachus, testis/epididymis, paratesticular region, prostate and urethra.

La enfermedad relacionada con la inmunoglobulina G4 (ER-IgG4) es una enfermedad fibroinflamatoria de etiología desconocida, la cual se caracteriza por presentar lesiones en forma de tumoraciones, concentraciones séricas aumentadas de IgG4 y células plasmáticas con una infiltración importante de IgG4, junto con flebitis obliterante y fibrosis. Esta enfermedad suele tener afección multiorgánica, incluyendo el páncreas, el tracto biliar, las glándulas salivares, los tejidos periorbitarios, los riñones, los pulmones, los ganglios linfáticos y el retroperitoneo. La ER-IgG4 afecta principalmente a hombres, con un predominio de edad por los adultos jóvenes y hasta la vejez. Las manifestaciones clínicas de la ER-IgG4 dependen principalmente de los órganos afectados y de la respuesta a los esteroides. Su pronóstico aún no es del todo claro. Dentro de los órganos urogenitales afectados pueden incluirse el riñón, el retroperitoneo, el uréter, la vejiga, el uraco, el testículo/epidídimo, la región paratesticular, la próstata y la uretra.

Referral gynecological ambulatory clinic: principal diagnosis and distribution in health services.

BACKGROUND: The association between gynecological diagnoses and their distribution in the health sectors provides benefits in the field of women's health promotion and in medical and interdisciplinary education, along with rationalization according to level of care complexity. Thus, the objective is analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory care, and their distribution in health services. METHOD: This is a research project of retrospective audit study design with a chart review of data from 428 women treated at University Ambulatory Clinic of Women's Health, the facility in gynecology and training for Family and Community Medical Residents, São Paulo, Brazil, from 2012 to 2014. Clinical and demographic information, gynecological diagnoses (International Classification of Diseases), and distribution of health services (primary, secondary, and tertiary) were described. RESULTS: The female patients present non-inflammatory disorders of the female genital tract (81.07%, n = 347) and diseases of the urinary system (22.66%, n = 97) among the gynecological diagnoses. The chances of having benign breast disease and non-inflammatory disorders of the female genital tract during the reproductive period corresponds to being 3.61 (CI 1.00-16.29) and 2.56 times (CI 1.58-4.16) higher, respectively, than during the non-reproductive period. The non-inflammatory disorders of the female genital tract (93.33%, n = 28) are most related to the tertiary sector. The distribution in health services was the following: 71.30% (n = 305) in the primary sector, 21.70% (n = 93) in the secondary sector and 7% (n = 30) in the tertiary sector. CONCLUSION: The studied women presented non-inflammatory disorders of the female genital tract and diseases of the urinary system as determined by gynecological diagnoses. Low-assistance complexity followed in most cases.

Urinary manifestations in Isaacs's syndrome. Our experience in 8 cases.

INTRODUCTION: Isaacs's syndrome (IS), is a rare neurological disorder, characterized by sustained muscular activity, fasciculations, cramps, myokymia, excessive sweating, and occasional elevation of creatine phosphokinase (CPK) enzyme. AIM: To report our experience in patients with IS and urinary manifestations, describing clinical findings, test's results, and response to treatment. Methods An observational, retrospective analysis of patients with IS and urinary manifestations treated at German Hospital of Buenos Aires between 2001 and 2011 was done. Diagnosis was performed with clinical examination and electromyography (EMG) of external sphincter of the anus and/or urethra. Demographic, clinical, and treatment variables were analyzed. International Prognostic Scoring System (IPSS) at diagnosis and follow up was made. RESULTS: Eleven IS patients were recruited, of whom 8 (72.72%) were females with a mean age 47.87 years (DS ± 13.95) and presented associated lower tract urinary symptoms (LUTS). Six of them (75%) had voiding and 2 (25%) filling symptoms. Urodynamic and electromyographic findings reproduced symptomatology in all patients. Patients with voiding symptomatology were treated with combination of alpha-blockers with benzodiazepines; membrane stabilizings agents; antiepileptics; neurotropic; corticoids; posterior tibial nerve stimulation and botulinum toxin, achieving improvement in 4/6. The two patients with storage symptoms were treated in first instance with anticholinergic drugs, one of which did not respond completely was added oral pentosansulfate and electrical stimulation, reversing the symptomatology. Four patients had associated pathologies: Hashimoto's thyroiditis; Sjögren's syndrome; dysautonomia, and myasthenia gravis. CONCLUSIONS: In our experience, IS urinary manifestations are common and usually has a good evolution with adequate treatment for each patient.

Feline Pandoras Syndrome: A Bibliographic Review / Síndrome De Pandora Em Felinos: Revisão De Literatura / Síndrome De Pandora En Felinos: Revisión De Literatura

Pandora"s syndrome is a multifactorial disorder in which other systemic aetiologies may influence clinical signs in a target organ. In cats with chronic and idiopathic lower urinary tract disease, diagnosis requires a criteria of exclusion and must fulfil at least four other criteria as a confirmation of the diagnostic. Fundamental treatment of the syndrome is based on the elimination of stress factors as well as environmental enrichment.

A síndrome de Pandora é uma doença de caráter multifatorial onde outras etiologias sistêmicas podem influenciar sinais clínicos em um órgão alvo. Em gatos com doença do trato urinário inferior crônicas e idiopáticas, o diagnóstico além de ser por exclusão, deve preencher no mínimo três outros critérios para que a síndrome seja ocorrente. Seu tratamento fundamental baseia-se na eliminação de fatores estressantes bem como o enriquecimento ambiental.

El síndrome de Pandora es un disturbio multifatorial, en el cual otras etiologías pueden influenciar en signos clínicos en un órgano diana. En los gatos con enfermedad del tracto urinario inferior crónica e idiopática, el diagnostico requiere criterios de exclusión y debe completar al menos otros cuatro criterios para su confirmación. El tratamiento fundamental de esta síndrome es basado en la eliminación de los factores de estrés, además de enriquecimiento ambiental.

Feline Pandoras Syndrome: A Bibliographic Review / Síndrome De Pandora Em Felinos: Revisão De Literatura / Síndrome De Pandora En Felinos: Revisión De Literatura

Pandora"s syndrome is a multifactorial disorder in which other systemic aetiologies may influence clinical signs in a target organ. In cats with chronic and idiopathic lower urinary tract disease, diagnosis requires a criteria of exclusion and must fulfil at least four other criteria as a confirmation of the diagnostic. Fundamental treatment of the syndrome is based on the elimination of stress factors as well as environmental enrichment.(AU)

A síndrome de Pandora é uma doença de caráter multifatorial onde outras etiologias sistêmicas podem influenciar sinais clínicos em um órgão alvo. Em gatos com doença do trato urinário inferior crônicas e idiopáticas, o diagnóstico além de ser por exclusão, deve preencher no mínimo três outros critérios para que a síndrome seja ocorrente. Seu tratamento fundamental baseia-se na eliminação de fatores estressantes bem como o enriquecimento ambiental.(AU)

El síndrome de Pandora es un disturbio multifatorial, en el cual otras etiologías pueden influenciar en signos clínicos en un órgano diana. En los gatos con enfermedad del tracto urinario inferior crónica e idiopática, el diagnostico requiere criterios de exclusión y debe completar al menos otros cuatro criterios para su confirmación. El tratamiento fundamental de esta síndrome es basado en la eliminación de los factores de estrés, además de enriquecimiento ambiental.(AU)

International Consultation on Urological Diseases: Congenital Anomalies of the Genitalia in Adolescence.

OBJECTIVE: To provide a comprehensive overview of genital anomalies encountered among adolescents, including late effects of problems addressed earlier in childhood. MATERIALS AND METHODS: The major congenital genital anomalies encountered in pediatric urology were identified. They include hypospadias, exstrophy-epispadias, cloacal malformations, disorders of sexual development, undescended testes, and some acquired penile anomalies seen in adolescence (priapism, adolescent varicocele). Recommendations of the International Consultation on Urological Diseases are provided on various aspects of these conditions, such as postpubertal cosmesis and function, fertility implications, and long-term nephrological considerations (when relevant). RESULTS: Specific recommendations for care, including strength of clinical recommendation, are provided in this paper. Whereas the basis of this paper is to discuss specific management recommendations as they relate to several heterogeneous conditions, general recommendations include patient-centered discussions regarding operative treatment be deferred until the patient is able to articulate goals and participate in shared decision-making and utilization of multidisciplinary teams for conditions where multiple organ systems may be involved. CONCLUSION: Congenital abnormalities of the genitalia are common and widely heterogeneous. Late effects and concerns often emerge after puberty, and patients should be followed throughout their adult lives to address such concerns.

Use of the FLOTAC technique to diagnosing parasites of the urinary tract of dogs.

Among the nematodes that infect the urinary tract of dogs, the Dioctophyma renale and Capillaria plica are those more frequently reported. For a long time, sedimentation was the only method used to detect eggs of these parasites in urine. The aim of this study was to analyze urine samples (n = 54) of dogs, obtained by bladder catheterization or cystocentesis, by using a modified FLOTAC technique. Animals were divided into two groups, i.e., with (n = 20) and without (n = 34) suspicion of urinary disease. The overall positivity herein observed was 3.8 % (2/54), being all animals (10 %; 2/20) from the group with suspicion of urinary disease. In the first positive sample, a single egg of D. renale was detected, whereas in the second sample two trematode-like eggs were observed. This is the first short survey employed to detect eggs of parasites that inhabit the urinary tract of dogs using a modified FLOTAC technique; in addition, for the first time, eggs of D. renale have been detected using this tool.

[Prevalence of urinary tract symptoms in women with diabetes mellitus]. / Prevalencia de síntomas urinarios en mujeres con diabetes mellitus.

BACKGROUND: The objective was to evaluate the prevalence of urinary tract symptoms and the impact in the quality of life in women with diabetes, the association with DM and neuropathy evolution time and glycemic control. METHODS: A cohort of women from the DiabetIMSS program was evaluated from January 2011 to 2013. The personal history, time of DM diagnosis, neuropathy, urinary symptoms, glycemic control and quality of life impact were noted. RESULTS: A total of 169 women were evaluated. The median age was 58 years (29-85) and DM main evolution time was 9 years (0.5-31). Urinary tract symptoms were present in 128 (75.7 %) patients. Stress and urge incontinence were predominantly present (45.3 and 40.6 % respectively), followed by obstructive and irritative symptoms (25 and 10.1 % respectively). The impact in the quality of life was mild-moderate in 91.1 % of the patients. At least one criteria for neuropathy was noted in 154 (91.1 %) patients. Neuropathy evolution time was longer in the symptomatic group (12 vs 4.8 months). Symptoms were mainly present in patients with more than one year of neuropathy; p < 0.05. CONCLUSION: There is a high prevalence of urinary tract symptoms in diabetic women. The only associated risk factor was neuropathy. No significative association was found between the rest of the factors.

Introducción: la diabetes mellitus (DM) conlleva un aumento de la ingesta de líquidos y del gasto urinario por el estado hiperosmolar al que induce a los que la padecen. El objetivo fue evaluar la prevalencia de síntomas urinarios en mujeres con DM, su impacto en la calidad de vida y su asociación con el tiempo de diagnóstico de DM, neuropatía y control glucémico. Métodos: en una cohorte de mujeres del programa DiabetIMSS evaluamos, de enero de 2011 a enero de 2013, sus antecedentes, neuropatía y síntomas urinarios, control glucémico e impacto en la calidad de vida mediante entrevista, medición de peso, exámenes paraclínicos y cuestionarios (ICIQ-SF, IPSS y QoL). Resultados: entrevistamos 169 mujeres con mediana de edad de 58 años (29-85) y mediana al diagnóstico de DM de 9 años (0.5-31). Presentaron síntomas urinarios 128 (75.7 %), principalmente incontinencia urinaria de esfuerzo y urgencia (45.3 y 40.6 %), síntomas obstructivos (25 %) e irritativos (10.1 %). Su impacto en la calidad de vida fue de leve a moderado (91.1 %). Presentaron neuropatía 154 (91.1 %), con un tiempo mayor de evolución en las pacientes sintomáticas (12 frente a 4.8 meses), igualmente prevalecieron los síntomas urinarios en aquellas con neuropatía de más de un año de evolución, p < 0.05. Conclusión: la prevalencia de síntomas urinarios en mujeres diabéticas es elevada, con el tiempo de evolución de neuropatía como único factor asociado. El tiempo de evolución de DM y una determinación de HbA1c no evidenciaron asociación significativa.

Prevalência e perfil de susceptibilidade a antimicrobianos dos uropatógenos em pacientes atendidos no Instituto Lauro de Souza Lima/Bauru/SP / Prevalence and antimicrobial susceptibility profile of uropathogens in patients treated at the Instituto Lauro de Souza Lima / Bauru / SP

As infecções de trato urinário (ITU) estão entre as doenças infecciosas mais comuns na prática clínica. O objetivo do presente estudo foi investigar a prevalência de microrganismos patogênicos, analisando a faixa etária e gênero mais acometidos bem como o perfil de resistência aos antimicrobianos. O estudo caracterizou-se por uma pesquisa histórica documental, na qual se analisou registros de 605 uroculturas realizadas pelo Laboratório de microbiologia do Instituto Lauro de Souza Lima, na cidade de Bauru/SP, no período de Outubro de 2010 a Outubro de 2015. Foram incluídos pacientes de ambos os gêneros e de todas as idades. Os dados foram coletados a partir do livro de registro de exames do laboratório e do sistema de informatização SIGH e transcritos para uma planilha eletrônica utilizando o programa Microsoft Office Excel. Das 605 uroculturas analisadas, 24,2% apresentaram resultados positivos para ITU. Dentre as positivas, 75,3% foram de pacientes do gênerofeminino. Analisando a incidência dos microrganismos, a bactéria Escherichia coli foi a mais isolada, apresentando maior resistência à Penicilina G, quinolonas e trimetoprim-sulfamatoxazol. Pode-se concluir que o correto diagnóstico é imprescindívelna escolha e na instituição da antibioticoterapia mais adequada, evitando o uso indiscriminado de antimicrobianos...

Ecotomografía renal como estudio inicial de malformaciones urológicas en niños hospitalizados por infección del tracto urinario / Renal ecotomography as initial study in hospitalized children for presenting urinary tract infection

La Infección del Tracto Urinario (ITU) es una de las patologías infecciosas más frecuentes en pediatría. Como factores de riesgo más relevantes se encuentran el reflujo vesicoureteral y las malformaciones urogenitales. El estudio con imágenes es imprescindible para detectar posibles anomalías del tracto urinario, demostrando la ecografía la mejor correlación costo-beneficio. Objetivo: Describir las características y resultados de las ecografías renales y vesicales de pacientes hospitalizados por ITU en el Hospital San Martín de Quillota (HSMQ) en el año 2014. Material y métodos: Estudio descriptivo; estudio de casos, se incluyó a niños hospitalizados en el servicio de pediatría del HSMQ durante el año 2014, ingresados con diagnóstico de ITU. Resultados: Ingresos por ITU: 99 pacientes, excluyéndose 27 casos con un número total de 72 pacientes; de estos, 71 % fueron de sexo femenino, 76% lactantes. Del total de ecografías, 55% resultaron normales, 3 1% compatibles con Pielonefritis Aguda (PNA) y 14% con alteración anatómica, siendo lo más frecuente el doble sistema pielocalicial. Discusión: Hubo similitud entre la información entregada por la literatura de un 12 a 15% de ecografías alteradas y un 14% en este estudio.

The Urinary Tract Infection (UTI) is one of the most common infectious diseases in children. Vesicouretral reflux and urogenital malformations are amongst the most significant risk factors. The imagenological studies are essential to detect possible anatomical or functional urological abnormalities. Within them, renal ultrasound (US) has the best cost-benefit relation. Objective: Describe the characteristics and results of renal and vesical ultrasound done on patients hospitalized in Hospital San Miguel de Quillota (HSMQ) during 2014, diagnosed with UTI. Material and methods: Descriptive study, cases study includes hospitalized children under the diagnose of UTI in the Pediatric Service of HSMQ during 2014. Results: 99 patients entered with the diagnose of UTI, 27 cases were excluded,with 72 patient which met the inclusion criteria:71% of them were female and 76% were infants. From the total of US, 55% were normal, 3 1% showed acute pyelonephritis (APN) and 14% anatomical abnormalities, where duplicated collecting system was the highest frequency condition. Discussion: There were similar results in literature that showed 12-15% of altered ultrasound compared to 14% obtained in this study.