Comparative evaluation of continence and potency after radical prostatectomy: Robotic vs. laparoscopic approaches, validating LAP-01 trial.

BACKGROUND: Minimally invasive techniques have demonstrated several advantages over the open approach. In the field of prostate cancer, the LAP-01 trial demonstrated the superiority of robotic-assisted radical prostatectomy (RARP) over laparoscopic radical prostatectomy (LRP) when comparing continence at 3-month after surgery, with no statistically significant differences at 6 and 12 months of follow-up. OBJECTIVES: Externally validate the LAP-01 study and compare functional outcomes between the two minimally invasive approaches. MATERIAL AND METHODS: This retrospective study, conducted by a single surgeon (MRB), utilized data from a prospectively collected database, which included patients who underwent both RARP or LRP. Data regarding baseline characteristics, continence (assessed through the 24-h Pad test and ICIQ questionnaire) and potency were collected at multiple time points: 1 and 6 weeks after catheter removal, 3-, 6-, and 12-months post-surgery. RESULTS: The study encompasses 601 patients, 455 who underwent LRP and 146 RARP. The median age at diagnosis was 64 for LRP and 62 for RARP, while the median PSA levels at diagnosis were 6.7 ng/mL for LRP and 6.5 ng/mL for RARP. Bilateral nerve-sparing procedures were performed in 34.07 % of LRP cases and 51.37 % of RARP cases. RARP exhibited a significant advantage over LRP both in continence and potency. Continence rates at 3-, 6- and 9-month after radical prostatectomy (RP) were 36.43 %, 61.86 % and 79.87 % for LRP, compared to 50.98 %, 69.87 % and 91.69 % for RARP. Potency rates at the same intervals were 0.90 %, 3.16 % and 6.39 % for LRP, and 6.19 %, 9.16 % and 18.96 % for RARP. These rates were more pronounced in patients with bilateral nerve-sparing. CONCLUSION: Our study demonstrates that RARP results in significantly better continence recovery and superior potency outcomes throughout the entire follow-up period compared to LRP, even at the beginning of the robotic approach learning curve.

Incidence and clinical impact of inappropriate periprocedural and perioperative management of antiplatelet therapy.

BACKGROUND AND AIMS: There is little evidence on the impact of current recommendations on the use of antiplatelet therapy during the perioperative and periprocedural period in our setting. The aim of this study was to analyze the incidence and clinical impact of inappropriate use of antiplatelet therapy in a population of patients undergoing surgery or a diagnostic or therapeutic procedure in "real life" in Spain. METHODS: A prospective multicenter observational study of patients treated with antiplatelet agents requiring intervention was conducted. The incidence of thrombotic and hemorrhagic events at 30 days was analyzed according to peri-intervention management of antiplatelet therapy. RESULTS: We included 643 patients (31.9% women, 39.0% over 75 years of age), most of them (87.7%) receiving aspirin as antiplatelet therapy at a dose of 100mg/day. Indications for antiplatelet therapy were ischemic heart disease (44.9%), cerebrovascular disease (21.7%), and peripheral vascular disease (23.0%). Ischemic risk was low in 74.3%, while 51.6% had a low bleeding risk of the intervention. Periprocedural management was considered appropriate in 61.7% of cases. 30-day incidence of the combined primary endpoint of thrombotic events and major bleeding (12.1% versus 5.0%; p=0.002) and 30-day mortality (5.2% versus 1.5%; p=0.008) were significantly higher in patients with inappropriate periprocedural management of antiplatelet agents. CONCLUSIONS: Despite current recommendations for the use of antiplatelet drugs in the perioperative/periprocedural period, their implementation in the "real world" remains low. Inappropriate use is associated with an increased incidence of adverse events, both thrombotic and hemorrhagic.

Prostate cancer patients with lymphatic node involvement detected by immunohistochemistry. Is the effort worthwhile?

INTRODUCTION: Lymph node (LN) status is one of the main prognostic factors in localized prostate cancer (CaP) patients after surgery. Examining palpable lymph nodes with hematoxylin and eosin (HE) is the most common approach in clinical practice; however, immunohistochemistry (IHC) has been reported to increase the LN detection rate. We reviewed the oncological results of patients with LN metastasis detected by IHC. METHODS: Retrospective study of CaP patients who underwent lymphadenectomy at the time of the prostatectomy. Extended lymphadenectomy was performed with complementary indocyanine green (ICG) guidance. Three groups were considered according to LN status. Definition of the pN+ group was made if LNs were detected by HE, occulted lymph node-positive (OLN+) was considered when ≥ 1 LN was identified with IHC and occulted lymph node-negative (OLN-) if no metastatic nodes were found. Oncological outcomes were reported regarding PSA kinetics, biochemical recurrence (BCR), need for secondary treatments and metastasis-free survival (MFS). RESULTS: A total of 283 patients with a median follow-up of 69 months were included in the study. Immunohistochemical assessment revealed metastatic LNs in 8.9% of patients. The rate of locally advanced disease and positive surgical margins was higher in the OLN + and pN + groups vs the OLN - group (P < 0.05). At the end of follow-up, 19%, 44% and 52% of patients from the OLN -, OLN + and pN + groups experienced BCR (P < 0.001), respectively. Additionally, 2.6%, 17% and 22% of patients developed metastatic progression from the OLN -, OLN + and pN+ group (P < 0.001), respectively. In the multivariate analysis, the OLN + group had a higher risk HR: 12 (95% CI, 2.4-56; P = 0.002) of metastatic progression in comparison with OLN - patients. This difference was not observed in the risk of biochemical recurrence HR 1.8 (95% CI, 0.9-3.8; P = 0.09). CONCLUSION: Conventional HE histological analysis underdiagnosed nearly 10% of patients. IHC-detected patients were at higher risk of metastasis development than OLN - patients. This report highlights the importance of optimizing the anatomopathological analysis properly.

Disfunción eréctil y YouTube: calidad de los vídeos en español / Erectile dysfunction and YouTube: Quality of videos in Spanish

Introducción: La disfunción eréctil (DE) es una de las enfermedades urológicas más prevalentes, pero los datos de la calidad de su información en redes sociales son escasos. El objetivo de nuestro estudio fue evaluar la calidad de la información sobre DE contenida en los vídeos de YouTube. Material y métodos: Estudio descriptivo transversal de los 50 primeros vídeos en castellano publicados en YouTube, evaluados por tres urólogos mediante dos cuestionarios validados: Patient Education Materials Assessment Tool (PEMAT) y DISCERN, clasificándolos según puntuación DISCERN en calidad pobre y moderada-buena. Resultados: La mediana de duración fue de 2,42 minutos, y la de visualizaciones, de 94.197 (2.313-3.027.890), con 682,5 (0-54.020) «me gusta» y 39 (0-2.843) «no me gusta». La mediana de PEMAT fue del 29% en inteligibilidad y del 29% en factibilidad. Con DISCERN, 27 vídeos (57,4%) fueron de calidad pobre y 20 (42,6%), de calidad moderada-buena. No observamos diferencias significativas entre ambos grupos en duración, visualizaciones, número de «me gusta» o de «no me gusta». Sí existieron diferencias en PEMAT de inteligibilidad y de factibilidad. El 86,7% de los protagonizados por personal médico fueron de calidad moderada-buena (p=0,001). El 85,7% de los que describían el tratamiento fueron de calidad moderada-buena y el 84% de los vídeos no médicos fueron de calidad pobre (p=0,001). Conclusiones: La mayoría de los vídeos sobre DE en YouTube son de calidad pobre. Los vídeos de mayor calidad son aquellos realizados por profesionales, aunque no son los más vistos. Sería importante el desarrollo de medidas para evitar la difusión de desinformación entre los usuarios de redes sociales. (AU)

Introduction: Erectile dysfunction (ED) is one of the most prevalent urological diseases, but there is limited data about the quality of its information in social networks. The aim of our study was to assess the quality of ED information contained in YouTube videos. Material and methods: Descriptive study of the first 50 Spanish-language videos, published on YouTube, evaluated by three urologists. We used two validated questionnaires: PEMAT (Patient Education Materials Assessment Tool) and DISCERN. Videos were classified according to DISCERN score into poor or moderate-good quality. Results: The median time duration was 2.42minutes (0.15-3.58), 94,197 views (2,313-3,027,890), 682.5 «likes» (0-54,020) and 39 «dislikes» (0-2843). The median of PEMAT score was 29% (9%-95.5%) in understandability and 29% (0-95.5%) in actionability. According to DISCERN score 27 videos (57.4%) had poor quality and 20 (42.6%) moderate-good quality. There were no significant differences between the two groups in time duration, views, «likes» or «dislikes». There were differences in PEMAT score in understandability and actionability. The 86.7% of the moderate-good quality videos were starred by health care provider (P=.001). Also, the 85.7% of videos that describes treatment had moderate-good quality (P=.001). The 84% of the non-medical videos had a poor quality (P=.001). Conclusion: Most ED videos on YouTube have poor quality. The highest quality videos are those made by professionals, although they are not the most viewed. It would be important to develop measures to prevent the spread of misinformation among social network users. (AU)

[Erectile dysfunction and YouTube: Quality of videos in Spanish]. / Disfunción eréctil y YouTube: calidad de los vídeos en español.

INTRODUCTION: Erectile dysfunction (ED) is one of the most prevalent urological diseases, but there is limited data about the quality of its information in social networks. The aim of our study was to assess the quality of ED information contained in YouTube videos. MATERIAL AND METHODS: Descriptive study of the first 50 Spanish-language videos, published on YouTube, evaluated by three urologists. We used two validated questionnaires: PEMAT (Patient Education Materials Assessment Tool) and DISCERN. Videos were classified according to DISCERN score into poor or moderate-good quality. RESULTS: The median time duration was 2.42minutes (0.15-3.58), 94,197 views (2,313-3,027,890), 682.5 «likes¼ (0-54,020) and 39 «dislikes¼ (0-2843). The median of PEMAT score was 29% (9%-95.5%) in understandability and 29% (0-95.5%) in actionability. According to DISCERN score 27 videos (57.4%) had poor quality and 20 (42.6%) moderate-good quality. There were no significant differences between the two groups in time duration, views, «likes¼ or «dislikes¼. There were differences in PEMAT score in understandability and actionability. The 86.7% of the moderate-good quality videos were starred by health care provider (P=.001). Also, the 85.7% of videos that describes treatment had moderate-good quality (P=.001). The 84% of the non-medical videos had a poor quality (P=.001). CONCLUSION: Most ED videos on YouTube have poor quality. The highest quality videos are those made by professionals, although they are not the most viewed. It would be important to develop measures to prevent the spread of misinformation among social network users.

Tailor-Made Bio-Based Non-Isocyanate Polyurethanes (NIPUs).

Non-isocyanate polyurethanes (NIPUs) based on biobased polyamines and polycarbonates are a sustainable alternative to conventional polyurethanes (PU). This article discloses a novel method to control the crosslinking density of fully biobased isocyanate-free polyurethanes, synthesized from triglycerides carbonated previously in scCO2 and different diamines, such as ethylenediamine (EDA), hexamethylenediamine (HMDA) and PriamineTM-1075 (derived from a dimerized fatty acid). As capping substances, water or bioalcohols are used in such a way that the crosslinking density can be adjusted to suit the requirements of the intended application. An optimization of the NIPU synthesis procedure is firstly carried out, establishing the polymerization kinetics and proposing optimal conditions set for the synthesis of the NIPUs. Then, the influence of the partial blocking of the active polymerization sites of the carbonated soybean oil (CSBO), using monofunctional amines, on the physical properties of the NIPUS is explored. Finally, the synthesis of fully biobased NIPUs with a targeted crosslinking density is achieved using hybrid NIPUs, employing partially carbonated oil and H2O or ethanol as blockers to achieve the desired physical properties in a very precise manner.

Prospective observational registry of perioperative and periprocedural management of antithrombotic therapy in "real world": the REQXAA study.

INTRODUCTION AND OBJECTIVES: There is scarce real-world evidence on the management of perioperative antithrombotic treatment according to current recommendations. The aim of this study was to analyze the management of antithrombotic treatment in patients undergoing surgery or another invasive intervention and to assess the consequences of this management on the occurrence thrombotic or bleeding events. METHODS: This prospective, observational, multicenter and multispecialty study analyzed patients receiving antithrombotic therapy who underwent surgery or another invasive intervention. The primary endpoint was defined as the incidence of adverse (thrombotic and/or hemorrhagic) events after 30 days of follow-up with respect to management of perioperative antithrombotic drugs. RESULTS: We included 1266 patients (male: 63.5%; mean age 72.6 years). Nearly half of the patients (48.6%) were under chronic anticoagulation therapy (mainly for atrial fibrillation; CHA2DS2-VASC: 3.7), while 53.3% of the patients were under chronic antiplatelet therapy (mainly for coronary artery disease). Low ischemic and hemorrhagic risk was found in 66.7% and 51.9%, respectively. Antithrombotic therapy management was in line with current recommendations in only 57.3% of the patients. Inappropriate management of antithrombotic therapy was an independent risk factor for both thrombotic and hemorrhagic events. CONCLUSIONS: The implementation of recommendations on the perioperative/periprocedural management of antithrombotic therapy in real-world patients is poor. Inappropriate management of antithrombotic treatment is associated with an increase in both thrombotic and hemorrhagic events.

Quality of bladder cancer information on YouTube.

Introduction: YouTube is one of the social networks most widely used as a source of information. However, there are doubts about the scientific quality of the information available. This study aims to characterise this by analysing videos about bladder cancer posted on YouTube. Material and methods: This was a cross-sectional descriptive study of the first 50 Spanish-language videos published on YouTube, leaving 38 for analysis. The videos were evaluated by three urologists using two validated questionnaires: Patient Education Materials Assessment Tool (PEMAT) and DISCERN (quality criteria for consumer health information), classifying them according to the score of the latter, in poor quality (1-2 points) and moderate/good quality (3-5 points). Results: The median PEMAT score was 71.6% (16-5-100%) for understanding and 35.5% (0-100%) for action. According to DISCERN, 26 videos (66.7%) were of poor quality and 12 (30.8%) of moderate/good quality. We found significant differences in terms of PEMAT of understanding (p = 0.004) and action (p = 0.000). In total, 90.9% of those involving medical staff were of low quality, which is paradoxical, but statistically significant (p = 0.01). Furthermore, 52.4% of those describing relevant information were of moderate/good quality, and 94.1% of those not describing relevant information were of poor quality (p = 0.02). Conclusions: More than 60% of the videos published on YouTube about bladder cancer in Spanish are of low quality. This represents an important risk of misinformation for the general public to whom most of them are addressed.

Fibre Intake in Chronic Kidney Disease: What Fibre Should We Recommend?

Chronic kidney disease (CKD) is a major global health problem that challenges all patients' healthcare needs. Fibre consumption benefits kidney patients by acting preventively on associated risk factors, improving intestinal microbiota composition or reducing metabolic acidosis and inflammation. In this review, we focus on increasing fibre consumption and the quality of fibre to recommend, in addition to increasing the consumption of foods that naturally have it in their design, that can resort to fortified foods or fibre supplements. The Western nutritional practice, which is low in fibre and rich in animal proteins, saturated fats, sodium, and sugar, increases the risk of mortality in these patients. On the contrary, patterns with higher consumption of fibre and vegetable proteins, such as the Mediterranean, vegetarian, or Plant dominant low protein diet (PLADO), seem to have a preventive effect on the associated risk factors and influence CKD progression. Until now, the use of fibre supplements has not achieved an evident impact on clinical results. Fibre-rich foods contain other nutrients that reduce cardiovascular risk. Promoting diets richer in vegetables and guaranteeing adequate energy and protein intake is a challenge for the multidisciplinary teams involved in the standard of care for CKD.

COVID-19 psychological impact in 3109 healthcare workers in Spain: The PSIMCOV group.

BACKGROUND: The current coronavirus disease (COVID-19) has a great impact worldwide. Healthcare workers play an essential role and are one of the most exposed groups. Information about the psychosocial impact on healthcare workers is limited. METHODS: 3109 healthcare workers completed a national, internet-based, cross-sectional 45-item survey between 9 and 19 April 2020. The objective is to assess the psychological impact of the COVID-19 pandemic in Spanish healthcare workers. A Psychological Stress and Adaptation at work Score (PSAS) was defined combining four modified versions of validated psychological assessment tests (A) Healthcare Stressful Test, (B) Coping Strategies Inventory, (C) Font-Roja Questionnaire and (D) Trait Meta-Mood Scale. RESULTS: The highest psychosocial impact was perceived in Respiratory Medicine, the mean (S.D.) PSAS was 48.3 (13.6) and Geriatrics 47.6 (16.4). Higher distress levels were found in the geographical areas with the highest incidence of COVID-19 (>245.5 cases per 100 000 people), PSAS 46.8 (15.2); p < 0.001. The least stress respondents were asymptomatic workers PSAS, 41.3 (15.4); p < 0.001, as well as those above 60 years old, PSAS, 37.6 (16); p < 0.001. Workers who needed psychological therapy and did not receive it, were more stressed PSAS 52.5 (13.6) than those who did not need it PSAS 39.7 (13.9); p < 0.001. CONCLUSIONS: The psychological impact in healthcare workers in Spain during COVID-19 emergency has been studied. The stress perceived is parallel to the number of cases per 100 000 people. Psychotherapy could have a major role to mitigate the experimented stress level.

Rapid and sustainable self-questionnaire for large-scale psychological screening in pandemic conditions for healthcare workers.

Background: The pandemic caused by a coronavirus (COVID-19) has shocked healthcare systems worldwide. However, the psychological stressors remain unclear. The objective of this study was to assess the impact of a major pandemic on healthcare workers. We hypothesized that exposure to the virus would be the primary cause of psychological stress perceived by healthcare workers. Methods: A national cross-sectional study conducted via an online questionnaire was distributed between April 9 and April 19, 2020 with a non-probabilistic sample technique. A structural equation model (SEM) was built with the variable "exposure to the virus" and the Psychological Stress and Adaptation at work Score (PSAS). "Exposure to the virus" was defined as the combined factors of 'personal-sphere', "work-related stress" and "hospital characteristics." A generalized linear model (GLM) was also tested. Results: A total of 2,197 participants filled in the questionnaire and were analyzed. The exploratory factor analysis showed statistically significant variables related to the personal-sphere, work-related stress and the hospital's characteristics, although the confirmatory factor analysis showed only the work-related stress factors to be significant. The GLM showed that personal-sphere-related variables (P < .001), stress at work (P < 0.001) and age (P < 0.001) were statistically significant. Conclusion: Physical exposure to the virus is an essential factor that contributes to the psychological impact perceived during the pandemic by healthcare professionals. A combination of personal-sphere variables, work-related stress and hospital characteristics is a significant factor correlating with the degree of stress measured by PSAS, a new and fast instrument to assess stress in healthcare workers.

Clinical characteristics of COVID-19 hospitalized patients associated with mortality: A cohort study in Spain.

Background: The heterogeneity of patients with COVID-19 may explain the wide variation of mortality rate due to the population characteristics, presence of comorbidities and clinical manifestations. Methods: In this study, we analyzed 5342 patients' recordings and selected a cohort of 177 hospitalized patients with a poor prognosis at an early stage. We assessed during 6 months their symptomatology, coexisting health conditions, clinical measures and health assistance related to mortality. Multiple Cox proportional hazards models were built to identify the associated factors with mortality risk. Results: We observed that cough and kidney failure triplicate the mortality risk and both bilirubin levels and oncologic condition are shown as the most associated with the demise, increasing in four and ten times the risk, respectively. Other clinical characteristics such as fever, diabetes mellitus, breathing frequency, neutrophil-lymphocyte ratio, oxygen saturation, and troponin levels, were also related to mortality risk of in-hospital death. Conclusions: The present study shows that some symptomatology, comorbidities and clinical measures could be the target of prevention tools to improve survival rates.

Impact of COVID-19 Pandemic on Anesthesia and Critical Care Residents in Spain.

BACKGROUND: The pandemic caused by coronavirus disease 2019 (COVID-19) has substantially changed the activity in Spanish healthcare centers. Residents who face pandemics are vulnerable physicians with different knowledge and experience. OBJECTIVES: This study aimed to determine the impact of COVID-19 pandemic on the Anesthesia and Critical Care residents and to establish its formative and personal consequences. METHODS: A 35-question digital survey was developed, and was distributed among Anesthesia and Critical Care residents in Spain. The quantitative variable "Objective Formative Impact Score" (PIOF) was defined, being proportional to the impact on formative routines. RESULTS: Several parameters were associated to a higher formative impact, such as the exposition to patients with COVID-19 (P = 0,020), an increase in the autonomy (P = 0,001), fear to contagion due to lack of protective equipment (P = 0,003), working in higher incidence areas (P < 0,001), being assigned to COVID-19 critical care units (P < 0,001), or to other departments different from Anesthesia and Critical Care. Residents experienced feelings of loneliness from the social distancing or ethical conflicts when working in suboptimal conditions. CONCLUSIONS: COVID-19 pandemic has had a major impact on Anesthesia and Critical Care residents both personally and formatively. The designed parameter PIOF brings an objective value about residents' formation.

[Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection]. / Consenso multidisciplinar sobre la valoración y el tratamiento nutricional y dietético en pacientes con enfermedad renal crónica e infección por SARS-CoV-2. Consenso de nutrición en enfermedad renal crónica e infección por SARS-CoV-2.

The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection.The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST.It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values.In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass.Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea.Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.

Efectividad y seguridad del ácido hialurónico intravesical para el control de los síntomas en cistopatías crónicas / Effectiveness and safety of intravesical hyaluronic acid for symptom control in chronic cystopathies

Introducción: Las cistopatías crónicas son una patología frecuente. El ácido hialurónicoendovesical es una de las opciones terapéuticas paraestos pacientes. Se pretende verificar la efectividad yseguridad del tratamiento con instilaciones intravesicales de ácido hialurónico en pacientes con síntomas vesicalesMaterial y métodos: Se presenta una serie de 32pacientes que recibieron instilaciones intravesicales deácido hialurónico. Se analizaron las características demográficas, tolerancia y complicaciones, y se compararon los síntomas antes y después del tratamiento. El alivio sintomático conseguido con el tratamiento se evaluómediante la escala de impresión de mejoría global delpaciente (PGI-I). Resultados: La mediana de edad fue de 74 años (IQR60-78), siendo el 65,6% mujeres. La mediana de seguimiento fue 10 meses (IQR 7-14). Once pacientes fuerondiagnosticados de cistitis rádica, 17 de síndrome dedolor vesical/cistitis intersticial (SDV/CI) y 4 de cistitisde repetición. Tras el tratamiento mejoraron los síntomasel 81,8% de los pacientes con cistitis rádica, el 82,3%de los pacientes con SDV/CI y el 75% de los pacientescon cistitis recurrentes. La incidencia de hematuria seredujo del 46,9% al 9,4% (p<0,001), los síntomas dellenado del 62,5% al 12,5% (p<0001), y el dolor de un40,6% al 12,5% (p=0,004). El 100% de los pacientestoleró bien el tratamiento y sólo se registraron 2 efectosadversos (infección del tracto urinario y retención agudade orina). Durante el seguimiento un 65,6% mostró uncontrol total de los síntomas y un 15,6% un control parcial, consiguiendo una respuesta mayor en el grupo depacientes con hematuria (73,3%). El 61,3% de los pacientes percibió alivio de los síntomas tras el tratamientosegún la escala PGI-I. El 88,9% mantiene la mejoría delos síntomas al finalizar el seguimiento.Conclusión: El ácido hialurónico intravesical es untratamiento seguro y efectivo para los síntomas de llenado, hematuria y...(AU)

Introduction: Chronic bladder disorders are a common condition. Endovesical hyaluronicacid is one of the therapeutic options for these patients.It is intended to verify the effectiveness and safety oftreatment with intravesical instillations of hyaluronic acidin patients with bladder symptoms. Material and methods: We present a series of 32patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance,and complications were analyzed, and symptoms before and after treatment were compared. Symptomaticrelief achieved with treatment was assessed using thePatient Global Improvement Impression Scale (PGI-I).Results: The median age was 74 years (IQR 60-78)and 65.6% were women. Median follow-up was 10months (IQR 7-14). Eleven patients were diagnosed withradiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrentcystitis. After treatment, symptoms improved in 81.8%of patients with radical cystitis, 82.3% of patients withBPS/IC, and 75% of the patients with recurrent cystitis.The incidence of hematuria was reduced from 46.9% to9.4% (p<0.001), filling symptoms from 62.5% to 12.5%(p<0.001), and pain from 40.6% to 12.5% (p=0.004).100% of the patients tolerated the treatment well andonly 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6%showed total control of symptoms and 15.6% partialcontrol, achieving a greater response in the group ofpatients with hematuria (73.3%). 61.3% of the patientsperceived relief of symptoms after treatment accordingto the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up.Conclusion: Intravesical hyaluronic acid is a safeand effective treatment for filling symptoms, hematuria,and pain in patients with chronic cystopathies. Patientswith radiotherapy-induced cystitis seem to especiallybenefit from treatment.

[Effectiveness and safety of intravesical hyaluronic acid for symptom control in chronic bladder diseases.] / Efectividad y seguridad del ácido hialurónico intravesical para el control de los síntomas en cistopatías crónicas.

INTRODUCTION: Chronic bladder disorders are a common condition. Endovesical hyaluronic acid is one of the therapeutic options for these patients. It is intended to verify the effectiveness and safety of treatment with intravesical instillations of hyaluronic acidin patients with bladder symptoms. MATERIAL AND METHODS: We present a series of 32 patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance, and complications were analyzed, and symptoms before and after treatment were compared. Symptomatic relief achieved with treatment was assessed using the Patient Global Improvement Impression Scale (PGI-I). RESULTS: The median age was 74 years (IQR 60-78) and 65.6% were women. Median follow-up was 10 months (IQR 7-14). Eleven patients were diagnosed with radiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrent cystitis. After treatment, symptoms improved in 81.8% of patients with radical cystitis, 82.3% of patients with BPS/IC, and 75% of the patients with recurrent cystitis. The incidence of hematuria was reduced from 46.9% to 9.4% (p<0.001), filing symptoms from 62.5% to 12.5% (p<0.001) and pain from 40.6% to 12.5% (p= 0.004). 100% of the patients tolerated the treatment well and only 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6% showed total control of symptoms and 15.6% partial control, achieving a greater response in the group of patients with hematuria (73.3%). 61.3% of the patients perceived relief of symptoms after treatment according to the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up. CONCLUSION: Intravesical hyaluronic acid is a safe and effective treatment for filling symptoms, hematuria, and pain in patients with chronic cystopathies. Patients with radiotherapy-induced cystitis seem to especially benefit from treatment.

INTRODUCCIÓN: Las cistopatías crónicas son una patología frecuente. El ácido hialurónico endovesical es una de las opciones terapéuticas para estos pacientes. Se pretende verificar la efectividad y seguridad del tratamiento con instilaciones intravesicales de ácido hialurónico en pacientes con síntomas vesicales.MATERIAL Y MÉTODOS: Se presenta una serie de 32 pacientes que recibieron instilaciones intravesicales de ácido hialurónico. Se analizaron las características demográficas, tolerancia y complicaciones, y se compararon los síntomas antes y después del tratamiento. El alivio sintomático conseguido con el tratamiento se evaluó mediante la escala de impresión de mejoría global del paciente (PGI-I).RESULTADOS: La mediana de edad fue de 74 años (IQR60-78), siendo el 65,6% mujeres. La mediana de seguimiento fue 10 meses (IQR 7-14). Once pacientes fueron diagnosticados de cistitis rádica, 17 de síndrome de dolor vesical/cistitis intersticial (SDV/CI) y 4 de cistitis de repetición. Tras el tratamiento mejoraron los síntomas el 81,8% de los pacientes con cistitis rádica, el 82,3% de los pacientes con SDV/CI y el 75% de los pacientes con cistitis recurrentes. La incidencia de hematuria se redujo del 46,9% al 9,4% (p<0,001), los síntomas de llenado del 62,5% al 12,5% (p<0,001) y el dolor de un 40,6% al 12,5% (p=0,004). El 100% de los pacientes toleró bien el tratamiento y sólo se registraron 2 efectos adversos (infección del tracto urinario y retención agudade orina). Durante el seguimiento un 65,6% mostró un control total de los síntomas y un 15,6% un control parcial, consiguiendo una respuesta mayor en el grupo de pacientes con hematuria (73,3%). El 61,3% de los pacientes percibió alivio de los síntomas tras el tratamiento según la escala PGI-I. El 88,9% mantiene la mejoría de los síntomas al finalizar el seguimiento.CONCLUSIÓN: El ácido hialurónico intravesical es un tratamiento seguro y efectivo para los síntomas de llenado, hematuria y dolor en pacientes con cistopatías crónicas. Los pacientes con cistitis rádica parecen beneficiarse especialmente del tratamiento.

Consenso multidisciplinar sobre la valoración y el tratamiento nutricional y dietético en pacientes con enfermedad renal crónica e infección por SARS-CoV-2. Consenso de nutrición en enfermedad renal crónica e infección por SARS-CoV-2 / Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection

La presencia de malnutrición en pacientes con enfermedad renal crónica (ERC) es elevada, puede agravarse por la infección por SARS-CoV-2. La valoración nutricional se debe adaptar para minimizar contagios, recomendando monitorizar: porcentaje de pérdida de peso, índice de masa corporal (IMC), pérdida de apetito, parámetros analíticos y capacidad funcional mediante dinamometría. Así como valorar la sarcopenia mediante la escala SCARF, y la posibilidad de utilizar los criterios GLIM en aquellos pacientes que el cribado MUST ha dado positivo. Es importante adaptar las recomendaciones nutricionales en ingesta calórica y proteica, al estadio de la ERC y a la fase de infección por SARS-CoV-2. En pacientes hipercatabólicos priorizar preservar estado nutricional (35kcal/kg peso/día, proteínas hasta 1,5g/kg/día). El resto de nutrientes se adaptarán a estadio de ERC y valores analíticos. En la etapa postinfección, se recomienda realizar valoración nutricional completa, incluyendo sarcopenia. Los requerimientos energéticos y proteicos en esta fase se adaptarán a la afectación del estado nutricional, con especial atención a la pérdida de masa muscular. Es necesario adaptar las recomendaciones dietéticas a efectos secundarios de la infección por SARS-CoV-2: anorexia, disfagia, disgeusiay diarrea. La anorexia y el hipercatabolismo dificulta el cumplimiento de los requerimientos a través de la alimentación, por lo que se recomienda la utilización de soporte nutricional oral y en las fases severas la nutrición enteral o la parenteral. (AU)

The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection. The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST. It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35kcal/kg weight/day, proteins up to 1.5g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values. In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass. Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea. Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases. (AU)

Effect of Foaming Formulation and Operating Pressure on Thermoregulating Polyurethane Foams.

The synthesis of rigid polyurethane (RPU) foams containing thermoregulatory microcapsules has been carried out under reduced pressure conditions with a new foaming formulation to reduce the final composite densities. These optimized RPU foams were able to overpass the drawbacks exhibited by the previous composites over the studied temperature range, working as insulating and thermal energy storage materials. The change in the formulation allowed to decrease the final foam density and enhance their mechanical strength. The effect of the operating pressure (atmospheric, 800 mbar, and 700 mbar) and microcapsules content (up to 30 wt%) on the physical, mechanical, and thermal PU foam properties was studied. The reduction of the pressure from atmospheric to 800 mbar did not have any effect on the cell size, strut thickness, and compression strength 10% of deformation, the Young modulus being even higher at 800 mbar. Nevertheless, a strong impact on the microstructure and mechanical properties was observed for the foam composites obtained at 700 mbar. A deleterious impact on the RPU foams thermal conductivity was observed when using low-pressure conditions. Thermal analyses showed that a composite able to work as heat accumulator and thermal insulation both at transient and at steady state was achieved.

Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection.

The presence of malnutrition in patients with Chronic Kidney Disease (CKD) is high, it can be made worse by SARS-CoV2 infection. The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST. It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values. In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass. Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea. Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.