Are weight or age limits for pediatric laparoscopic pyeloplasty? Results of a multicentric study.

INTRODUCTION: Anderson-Hynes pyeloplasty is the technique of choice for the treatment of pyeloureteral junction obstruction (PUJO) with an excellent success rate. Minimally invasive surgery has become the standard of care for the management of PUJO in children. Although it has been comparable to the open approach at all levels, its diffusion or employment in younger children has not been widely adopted. Our aim is to evaluate laparoscopic pyeloplasty outcomes from international academic centers in children under 1 year of age, focusing on feasibility and outcomes including possible complications. MATERIALS AND METHODS: This is review of consecutive infants under 1 year of age who underwent laparoscopic pyeloplasty between 2009 and 2018 with more than 12 months of follow-up. Seven different training centers with different backgrounds participated in this study. Evaluation was carried out with ultrasound and renogram before and after surgery. Demographic data, perioperative characteristics, complications, and results are described and analyzed. RESULTS: Over 9 years, 124 transperitoneal laparoscopic Anderson-Hynes pyeloplasties were performed on 123 children under 1 year of age; 88 males and 35 females, with 1 case of bilateral PUJO. Of the 124 renal units, 86 were left-sided. Mean age at surgery was 6.6 months (1 week-12 months), with 56% (n = 70) done before 6 months of age. Mean weight at surgery was 6.8 kg (3-12 kg), with 59% (n = 73) weighing less than 8 kg. Mean operative time (skin-to-skin) was 150 min (75-330 min). After a mean follow-up of 46 months (12-84 months), 12 (9%) patients developed complications, with only 1 needing a redo pyeloplasty also done laparoscopically. One child, with deterioration in renal function, underwent nephrectomy. CONCLUSION: Laparoscopic pyeloplasty under 1 year of age and/or less than 12 kilos is feasible with lower complication rate. Furthermore, age younger than 6 months and weight less than 8 kg are no longer limiting factors for a successful pyeloplasty as shown by this multicentre study.

Latitudes and attitudes: A multinational study of laparoscopic pyeloplasty in children.

PURPOSE: The Anderson-Hynes technique has been the treatment of choice for primary ureteropelvic junction obstruction in children. Laparoscopic approach has shown similar outcomes to open, with advantages of shorter hospital stay and less pain. We reviewed the experience of 11 geographically diverse, tertiary pediatric urology institutions focusing on the outcomes and complications of laparoscopic pyeloplasty. MATERIALS AND METHODS: A descriptive, retrospective study was conducted evaluating patients undergoing Anderson-Hynes dismembered laparoscopic pyeloplasty. Centers from four different continents participated. Demographic data, perioperative management, results, and complications are described. RESULTS: Over a 9-year period, 744 laparoscopic pyeloplasties were performed in 743 patients. Mean follow-up was 31 months (6-120m). Mean age at surgery was 82 months (1 w-19 y). Median operative time was 177 min. An internal stent was placed in 648 patients (87%). A catheter was placed for bladder drainage in 702 patients (94%). Conversion to open pyeloplasty was necessary in seven patients. Average length of hospital stay was 2.8 days. Mean time of analgesic requirement was 3.2 days. Complications, according to Clavien-Dindo classification, were observed in 56 patients (7.5%); 10 (1%) were Clavien-Dindo IIIb. Treatment failure occurred in 35 cases with 30 requiring redo pyeloplasty (4%) and 5 cases requiring nephrectomy (0.6%). CONCLUSION: We have described the laparoscopic pyeloplasty experience of institutions with diverse cultural and economic backgrounds. They had very similar outcomes, in agreement with previously published data. Based on these findings, we conclude that laparoscopic pyeloplasty is safe and successful in diverse geographics areas of the world.

Imagen corporal, variables antropométricas y ansiedad en escolares de primaria / Body image, anthropometric variables and anxiety in primary school students

La imposición de un modelo estético en las sociedades actuales genera insatisfacción con el propio cuerpo. Esta situación puede agravarse durante la pandemia y en edades tempranas. Objetivo: determinar la relación existente entre el grado de satisfacción con la imagen corporal, variables antropométricas e índice de ansiedad en escolares de primaria durante el estado de alarma decretado a causa de la COVID-19. Material y métodos: estudio descriptivo transversal realizado el 23 de marzo de 2020 el cual está compuesto con una mues¬tra de 116 escolares españoles de Educación Primaria con un rango de edad comprendido entre los 8 y 12 años. El índice de ansiedad se valoró mediante el cuestionario Spence Children Anxiety Scale (SCAS). El grado de satisfacción con la imagen corporal se valoró mediante un ítem del cuestionario Health Behavior in School-aged Children (2009). Resultados: el análisis descriptivo mostró que las mujeres presentan un mayor porcentaje de satisfacción con la imagen corporal menor (p < 0.005), una mayor ansiedad (p < 0.005) y un menor peso (p < 0.005) respecto a los varones. La prueba de regresión lineal mostró una asociación entre el grado de satisfacción con la imagen corporal con la edad, el peso, el IMC y el índice de ansiedad con un valor de R2 = 0,293. Conclusión: el grado de satisfacción con la imagen corporal se asocia con variables antropométricas y ansiedad en las mujeres pero no en varones escolares de Primaria(AU)

The imposition of an aesthetic model in current societies generates dissatisfaction with the body itself. This situation can be aggravated during the pandemic and at an early age. Objective: to determine the relationship between the degrees of satisfaction with body image, anthropometric variables and anxiety index in primary school children during the state of alarm decreed due to COVID-19. Material and methods: This cross-sectional descriptive study was carried out on 23 March 2020 and consisted of a sample of 116 Spanish primary schoolchildren aged between 8 and 12 years. The anxiety index was assessed using the Spence Children Anxiety Scale (SCAS) questionnaire. The degree of satisfaction with body image was assessed using an item from the Health Behavior in School-aged Children questionnaire (2009). Results: the descriptive analysis showed that women have a lower percentage of satisfaction with body image (p <0.005), higher anxiety (p <0.005) and lower weight (p <0.005) compared to men. Likewise, the linear regression test showed an association between the degree of satisfaction with body image with age, weight, BMI and the anxiety index with a value of R2 = 0.293. Conclusion: the degree of satisfaction with body image is associated with anthropometric variables and anxiety in women but not in primary school boys(AU)

Nivel de ansiedad según el tipo de desayuno en escolares durante el estado de alarma por la COVID-19 en España / Anxiety level and breakfast type in schoolchildren during the COVID-19 state of alarm in Spain

Introducción: El desayuno suscita un considerable interés científico como posible parámetro relacionado con el estilo de vida. Objetivo: Analizar los niveles de ansiedad según el tipo de desayuno en escolares de Educación Primaria durante el estado de alarma decretado en España a causa de la COVID-19. Métodos: Estudio transversal compuesto por 116 escolares de la Isla de Fuerteventura. Se valoró la ansiedad a través del cuestionario Spence Children Anxiety Scale (SCAS). Los ítems referidos al desayuno fueron extraídos del test de Adhesión a la Dieta Mediterránea KIDMED. Las pruebas estadísticas utilizadas fueron el análisis de varianza simple (one way ANOVA) y la prueba de regresión logística multivariante. Resultados: La ingesta de un cereal se asocia con una menor probabilidad de desarrollar ataques de pánico y agorafobia (OR = 1,14, p < 0,01), fobia social (OR = 0,71, p < 0,05), trastorno obsesivo-compulsivo (OR = 1,22, p < 0,05) e índice ansiedad global (OR = 1,05, p < 0,05). Asimismo, no desayunar bollería habitualmente se asoció con una menor probabilidad de desarrollar un trastorno obsesivo-compulsivo (OR = 1,13; p < 0,05). Conclusiones: Una calidad del desayuno óptima, como consumir cereales saludables y no consumir bollería industrial, se asocia con menores niveles de ansiedad en escolares de Educación Primaria durante el estado de alarma decretado en España a causa de la COVID-19(AU)

Introduction: Breakfast arouses considerable scientific interest as a potential lifestyle parameter. Objective: Analyze the relationship between anxiety levels and breakfast type in schoolchildren. Methods: A cross-sectional study was conducted of 116 schoolchildren from the Isle of Fuerteventura. Anxiety was evaluated with the Spence Children Anxiety Scale (SCAS) questionnaire. Items about breakfast were taken from the KIDMED Test of Adherence to the Mediterranean Diet. Statistical processing was based on one way ANOVA and the multivariate logistic regression test. Results: Intake of a cereal is associated to a lesser probability of developing agoraphobia and panic attacks (OR = 1.14, p < 0.01), social phobia (OR = 0.71, p < 0.05), obsessive-compulsive disorder (OR = 1.22, p < 0.05) and overall anxiety index (OR = 1.05, p < 0.05). On the other hand, not having pastry for breakfast habitually was associated to a lesser probability of developing obsessive-compulsive disorder (OR = 1.13; p < 0.05). Conclusions: Optimum breakfast quality, such as eating healthy cereals and not eating industrial pastries, is associated to lower levels of anxiety in schoolchildren during the state of alarm decreed in Spain due to the COVID-19 pandemic(AU)

Analysis of physical fitness according to sex, age, body mass index and level of physical activity in Spanish elementary school students / Análisis de la condición física según sexo, edad, índice de masa corporal y nivel de actividad física en estudiantes de primaria en España

Abstract Introduction: Scientific evidence suggests that schoolchildren's quality of life is directly related to their physical fitness (PF). Objective: To analyze the physical fitness of elementary school students according to age, sex, body mass index (BMI) and level of physical activity (PA). Materials and methods: Cross-sectional and descriptive study conducted in 103 schoolchildren (aged 8-12 years) from Spain. PF and PA were measured using the ALPHA-fitness test battery and the Physician-based Assessment and Counseling for Exercise instrument, respectively. Participants were classified according to their level of PA (physically inactive vs. physically active) and their BMI (normal weight vs. overweight-obese). Parametric statistics were used for data analysis. Results: Male participants had a better level of PF. In addition, it was found that PF slightly increases as age increases, regardless of the sex. Normal weight or physically active schoolchildren had better aerobic capacity and a healthier body composition. Conclusion: Keeping optimal PF levels at any stage of life requires adopting a healthy lifestyle since childhood; therefore, it is necessary to encourage schoolchildren to do physical activity on their own.

Resumen Introducción. La evidencia científica sugiere que la calidad de vida de los escolares se relaciona de forma directa con el estado de su condición física (CF). Objetivo. Analizar la CF según edad, sexo, índice de masa corporal (IMC) y nivel de actividad física en estudiantes de primaria. Materiales y métodos. Se realizó un estudio descriptivo transversal con 103 escolares entre 8 y 12 años de España. La CF se midió mediante la batería ALPHA-Fitness y la actividad física, con el cuestionario Physician-based Assessment and Counseling for Exercise. Los participantes se categorizaron según su nivel de actividad física (no activos versus activos) y su IMC (normo-peso versus sobrepeso-obesidad). Para el análisis se aplicó estadística paramétrica. Resultados. Los varones tuvieron un mejor nivel de CF, pero en ambos sexos se observó un leve incremento de esta a medida que aumentaba la edad. Los escolares con normopeso o activos físicamente tuvieron una mejor capacidad aeróbica y una composición corporal más saludable. Conclusión. Mantener niveles óptimos de CF a lo largo de la vida requiere de la adopción de un estilo de vida saludable desde la infancia, por tanto, es necesario promover la práctica autónoma de actividad física en los escolares.

Incidencia del sexo, el índice de masa corporal y el número de hermanos en la competencia motriz autopercibida / Influence of sex, body mass index and number of siblings on self-perceived motor competence

Introducción: La infancia se caracteriza por ser un periodo trascendental en el ciclo vital de la persona, es donde se inicia la formación de la personalidad y la adquisición de hábitos de vida saludables. Objetivo: Analizar la autopercepción de competencia motriz en relación al género, el estado de peso y el número de hermanos. Métodos: Participaron en el estudio 310 escolares de sexto curso (M ± DE; 10,87 ± 0,54) ubicados en la comunidad Autónoma de Castilla La Mancha. El instrumento utilizado para medir este constructo es la percepción de la competencia motriz en Educación Física. Resultados: La percepción de competencia motriz es un factor más a desarrollar en la adquisición de estilos de vida saludables, especialmente en las chicas. El contexto educativo en colaboración con los padres debe favorecer la formación de una personalidad completa y equilibrada del escolar junto con la adquisición de hábitos de vida saludables. Conclusiones: El análisis estadístico efectuado pone de manifiesto una mayor percepción de competencia motriz a favor de los varones, los escolares normopeso y los escolares sin hermanos en los factores de experiencia personal y compañeros (p < 0,05)(AU)

Introduction: Childhood is a crucial period in a person's life cycle. It is the time when the personality begins to take definitive shape and healthy daily habits are acquired. Objective: Analyze the self-perception of motor competence in relation to gender, body weight and number of siblings. Methods: The study population was 310 sixth-grade students (M ± SD; 10.87 ± 0.54) from the Autonomous Community of Castile-La Mancha. The tool used to measure this construct was motor competence perception in physical education. Results: Motor competence perception is yet another factor to be developed as part of the acquisition of a healthy lifestyle, particularly by girls. The educational setting in joint coordination with the parents should contribute to the formation of the students' full, well-balanced personality alongside the acquisition of healthy daily habits. Conclusions: The statistical analysis performed revealed greater motor competence perception among male, normal weight, only child students in terms of their own experience and that of their schoolmates (p < 0.05)(AU)

Relación entre la actividad física y el índice de masa corporal en escolares de Murcia / Relationship between physical activity and body mass index in schoolchildren in Murcia

La obesidad infantil es una epidemia mundial, en donde, la Organización mundial para la salud prevé que casi dos de cada tres europeos adultos tendrá sobrepeso en 2030. El objetivo de este estudio fue analizar la relación entre la actividad física y el índice de masa corporal (IMC) según la etapa educativa y el sexo. Diseño descriptivo de corte transversal con una muestra de 635 participantes (266 varones (41,9%) y 369 mujeres (58,1%); 13,1 ± 2,8 años) procedentes de un área urbana de Murcia. La prueba T de student reflejó que los varones de Secundaria realizan más AF que las chicas (p < 0,004). Por su parte, la prueba Ji cuadrado mostró diferencias significativas en el estado de peso en normopeso a favor de las mujeres (72,4% vs. 63,2%; p < 0,001) y en sobrepeso a favor de los varones (31,2% vs. 20,1%; p < 0,003). Al analizar la relación entre el IMC y la actividad física mediante la correlación de Pearson, se obtuvo una correlación inversa en las mujeres de bachillerato (p = 0,002; r = - 0,223), en los varones de bachillerato (p = 0,001; r = - 0,212 y en el total de los escolares de bachillerato (p = 0,002; r = - 0,218). La relación entre el IMC y la actividad física en escolares de Primaria, Secundaria y Bachillerato es nula o débil. En futuros estudios se sugiere tener en cuenta valoraciones más objetivas del nivel de actividad física y variables antropométricas que puedan aportar luz a la relación entre estas variables(AU)

Childhood obesity is a global epidemic, with the World Health Organization predicting that almost two out of every three adult Europeans will be overweight by 2030. The objective of this study was to analyze the relationship between physical activity and body mass index (BMI) according to educational stage and sex. Descriptive cross-sectional design with a sample of 635 participants (266 men (41.9%) and 369 women (58.1%); 13.1 ± 2.8 years) from an urban area of Murcia. Student's T-test showed that Secondary males perform more physical activity than girls (p <0.004). In turn, the Chi-square test showed significant differences in weight status in normal weight in favor of women (72.4% vs. 63.2%, p <0.001) and overweight in favor of men (31.2% vs. 20.1% p <0.003). When analyzing the relationship between BMI and physical activity through the Pearson correlation, an inverse correlation was obtained in high school girls (p = 0.002, r = - 0.223), in high school boys (p = 0.001, r = - 0.212 and in the total number of baccalaureate students (p = 0.002, r = - 0.218). The relationship between BMI and physical activity in primary, secondary and high school students is null or weak. In future studies, it is suggested to take into account more objective assessments of the level of physical activity and nutritional status that may shed light on the relationship between these variables(AU)

Urology mythbusters: do we need to surgically correct vesicoureteral reflux in older girls to prevent problems in future pregnancy? (revision 1).

In this edition of Mythbusters we critically examine the premise that, because women with history of vesicoureteric reflux (VUR) are at higher risk of urinary tract infection (UTI) and other morbidity during pregnancy, persistent VUR in older girls should be considered an indication for surgical correction. The literature is very limited in that there are essentially no methodologically robust comparisons of pregnancy outcomes among women whose childhood VUR was or was not surgically repaired. Most of the case series and cohorts find relatively high incidence of UTI and pyelonephritis among pregnant women with a history of VUR, but there is very little to suggest that persistent VUR is itself a risk factor for infection during pregnancy. Indeed, some studies suggest that UTI risk is actually higher among women who previously underwent anti-reflux surgery compared to those who did not, although these data are compromised by significant selection bias. In contrast, there is relatively strong evidence that maternal and fetal morbidity is higher when the mother is known to have renal scarring; such women probably merit close surveillance during pregnancy for infection, hypertension and pre-eclampsia, and other problems. Overall, current evidence is insufficient to support routine anti-reflux surgery in girls with the sole purpose of decreasing complications during future pregnancy, particularly for girls with lower-grades of VUR and no renal scarring. The verdict for this urolegend: it contains a a "teeny, tiny nugget of truth."

Análisis de la dieta mediterránea en escolares de Primaria, Secundaria y Bachillerato / Analysis of the Mediterranean diet in Primary, Secondary and high school students

RESUMEN La dieta Mediterránea es considerada uno de los modelos dietéticos más saludables. El objetivo es analizar el grado de adherencia a la dieta mediterránea (DM) en escolares atendiendo al sexo y etapa educativa. Se realizó un estudio descriptivo transversal (n= 634; 280 varones y 354 mujeres). La adherencia a la DM se halló a través del cuestionario KIDMED. La adherencia a la calidad de la DM no difiere significativamente entre varones y mujeres. Sin embargo, atendiendo por ítems, los varones ingieren más verduras (p< 0.036) y desayunan lácteos (p< 0.043) mientras que las mujeres hacen un mayor uso del aceite de oliva (p< 0.028). Aunque a nivel global los escolares obtienen valores más elevados de adherencia a una DM alta (p< 0.013), solo el 38.8% escolares presentan una elevada adherencia a la DM, siendo Primaria con mayor adherencia a la DM alta (p< 0.001). Conclusiones: el sexo no es un elemento diferenciador en la calidad de la DM. Se observa un descenso progresivo en los niveles óptimos de DM a partir de Primaria. Estos resultados sugieren la necesidad de implementación de actividades tendientes a la promoción de habilidades y actitudes que supongan la adherencia hacia hábitos alimenticios saludables.

ABSTRACT The Mediterranean diet is considered one of the healthiest dietary models. The objective of this study was to analyse the degree of adherence to the Mediterranean diet (MD) in schoolchildren according to sex and educational stage. A cross-sectional descriptive study was carried out (n= 634, 280 men and 354 women). Adherence to MD was measured using the KIDMED questionnaire. Adherence to the quality of MD did not differ significantly between men and women. However, according to the items, men ingested more fresh vegetables (p< 0.036) and consumed a dairy breakfast (p< 0.043) while women used olive oil more often (p< 0.028). Although, on a global level, the students obtained high values of adherence to a MD (p< 0.013), only 38.8% of the students had high adherence to MD, with Primary Education being the stage with the highest adherence to MD (p< 0.001). Conclusions: Sex was not a differentiating factor to the quality of MD. There is a progressive decrease in the optimal levels of MD from primary education. These results suggest the need to implement activities aimed at the promotion of skills and attitudes that improve adherence to healthy eating habits.

Pediatric Robotic Surgery in South America: Advantages and Difficulties in Program Implementation.

Robotic assisted laparoscopic surgery is gaining popularity around the world due to its vast benefits. Although it has been established mainly in developed countries, in South America the robotic programs have become more popular, but its growth is clearly slower. Information about robotic pediatric surgery program in Brazil, Chile, Uruguay, and Argentina was collected through e-mail surveys. Results were analyzed and compared to worldwide information about robotic surgery. Due to the wide social, economical, and technological gap between hospitals in South America, it is hard to develop a proper pediatric robotic surgery program. The main obstacles in those four countries appear to be a combination of high purchase costs and equipment maintenance, lack of financial coverage of the procedure by insurance companies and the absence of significant benefits proved in pediatrics in relation to laparoscopic surgery. The pediatric specialties are in the process of making and implementing robotic programs supported by the evident development in adult specialties. However, pediatric robotic surgery in Brazil, Chile, Uruguay and Argentina do not seems to share that growth.

Percepción de competencia física en escolares de España e Irán. Un estudio cultural / Perception of physical competence in schoolchildren in Spain and Iran. A cultural study

La percepción de competencia física (PCF) es un constructo psicológico que puede estar influenciado por factores culturales. Objetivo: analizar la PCF en una muestra de escolares españoles e iraníes. Método: en el estudio participaron 910 escolares, con edades entre 10 y 12 años, pertenecientes a Castilla la Mancha (España) y Golestan (Irán). El instrumento utilizado para medir este constructo fue la Percepción de la competencia en Educación Física, y se aplicó la prueba U-Mann Whitney. Resultados: los varones y las mujeres de España obtuvieron valores superiores en los factores de experiencia personal (p< .05) y compañeros (p<.05). A nivel global, solo los varones españoles presentaron una mayor PCF que sus homólogos iraníes (p<.05). Estos resultados muestran diferencias interculturales en la PCF a favor de los escolares españoles. Conclusión: conocer la PCF permite adecuar el desarrollo de las clases de Educación Física con el fin de influir en la intención de ser físicamente activo y un mayor ajuste psicológico del escolar.

The perception of physical competence (PPC) is a psychological construct that may be influenced by cultural factors. The objective was to analyze the PPC in a sample of Spanish and Iranian schoolchildren. 910 schoolchildren (ages 10-12 years) belonging to Castilla la Mancha (Spain) and Golestan (Iran) participated in the study. The instrument used to measure this construct is the perception of the competence in Physical Education. The U-Mann Whitney test has shown that men and women in Spain obtain higher values in personal experience factors (p <.05) and partners (p <.05). At a global level, Spanish schoolchildren present a higher perception of physical competence than their Iranian counterparts (p <.05). These results show intercultural differences in the PPC in favor of Spanish schoolchildren. Knowing the perception of physical competence allows adapting the development of Physical Education classes in order to influence the intention to be physically active and a greater psychological adjustment of the school.

A percepção de concorrência física (PCF) é um conceito psicológico que pode estar influenciado por fatores culturais. Objetivo: analisar a PCF em uma mostra de escolares espanhóis e iranianos. Método: no estudo participaram no estudo 910 escolares, com (idades entre 10 e- 12 anos,) pertencentes a Castilla a Mancha (Espanha) e Golestan (Irão). Instrumento utilizado para medir este conceito foi é a percepção da concorrência em Educação Física, e aplicou-se a prova Ou-Mann Whitney. Resultados: os varões e as mulheres de Espanha obtiveram valores superiores nos fatores de experiência pessoal (p< .05) e colegas (p<.05) A nível global, só os varões espanhóis apresentaram uma maior percepção de concorrência física que seus homólogos iranianos (p<.05) Estes resultados mostram diferenças interculturais na PCF a favor de os escolares espanhóis. Conclusão: conhecer a percepção de concorrência física permite adequar o desenvolvimento das classes de Educação Física com o fim de influir na intenção de ser fisicamente ativo e um maior ajuste psicológico do escoar.

Estado nutricional y adherencia a la dieta mediterránea en escolares de la Región de Murcia / Nutrition Status and Adherence to the Mediterran Diet in School Children from the Region of Murcia

Resumen Antecedentes: el sobrepeso y la obesidad infantil son un problema de salud pública a nivel mundial. Objetivo: analizar la relación entre el estado nutricional y la adherencia a la dieta mediterránea en escolares. Materiales y métodos: estudio transversal con 634 escolares de Murcia (280 niños y 354 niñas). El estado nutricional se evaluó mediante el Índice de Masa Corporal (kg/m2) y la adherencia a la dieta mediterránea mediante el cuestionario KIDMED. Resultados: no se encontraron diferencias significativas entre varones y mujeres en el Índice de Masa Corporal (p<0,101) ni en adherencia a la dieta mediterránea (p<0,954). Según la prueba ji al cuadrado de Pearson, en primaria había más escolares normopeso (p<0,002) y con mayor adherencia a la dieta mediterránea (p <0,036) y alta (p <0,001). En el grupo total los obesos usaban menos aceite de oliva (p<0,006), los normopeso tenían mayor consumo de frutos secos (p<0,001) y golosinas (p<0,032), y quienes tenían sobrepeso fueron los que menor hábito de desayunar presentaron (p<0,010). No se encontraron diferencias entre el estado nutricional y el grado de adherencia a la dieta mediterránea (p<0,904). Conclusión: aunque en educación primaria en los escolares de Murcia estudiados hay mayor proporción de normopeso y adherencia a la dieta mediterránea media y alta, el estado nutricional no se asocia con el grado de adherencia a la dieta mediterránea en ninguna etapa educativa.

Abstract Background: Childhood overweight and obesity are a public health problem worldwide. Objective: To analyze the relationship between nutrition status and adherence to the Mediterranean diet in school children. Material and Methods: Cross-sectional study with 634 school children (280 boys and 354 girls). Nutrition status was evaluated using the body mass index (weight (kg) / height (cm) 2). Adherence to the Mediterranean diet (MD) was measured through the KIDMED questionnaire. Results: The Wann-whitney U-test showed that there are no significant differences between boys and girls in BMI (p <0.101) or in adherence to MD (p <0.954). Distinguishing by school year, the Pearson's χ2 test showed that in Primary there are most schoolchildren with normal weight (p <0.002) and with greater adherence to medium (p <0.036) and high (p <0.001) MD. Among all students, obese students use less olive oil (p <0.006), students of normal weight have a higher consumption of nuts (p <0.001) and sweets (p <0.032), and overweight students were the least likely to regularly eat breakfast (p <0.010). No significant differences were observed between nutritional status and the degree of adherence to MD (p <0.904). Conclusion: Although in Primary school most school children are normal weight with medium to high adherence to MD nutritional status is not shown to be correlated to the degree of adherence to MD in any school year.

Relación entre el índice de masa corporal, sexo y número de hermanos en escolares / Relationship between body mass index, sex and number of siblings in schoolchildren

La sobrecarga ponderal infantil ha alcanzado niveles mundiales que suponen una preocupación social. Objetivo: El objetivo de este estudio fue analizar la relación entre el índice de masa corporal, el sexo y el número de hermanos en adolescentes. Métodos: Estudio descriptivo con una muestra de 310 escolares de Castilla la Mancha (164 varones (52,9 %) y 146 mujeres (47,1 %) (M±DE; 10,87 ± 0,54 años). El estado de peso se calculó mediante el IMC (peso (kg)/talla (cm) 2) y el número de hermanos a través de un cuestionario. Resultados: Se encontraron diferencias significativas a favor de los varones en un mayor peso (p< 0,041) y sobrepeso (p< 0,001). Sin embargo, las mujeres obtienen un mayor promedio en normopeso (p< 0,001). A su vez, existen diferencias a favor de los escolares en normopeso que poseen un solo hermano; tanto en mujeres como en el total de la muestra (p<0,005). Sin embargo, se encontraron diferencias significativas a favor del estado de peso en sobrecarga ponderal en aquellos que poseen dos o más hermanos; tanto en varones como para el total de la muestra (p<0,001). Como análisis complementario, la prueba ANOVA reflejó que los escolares con un solo hermano poseen un estado de peso más saludable (normopeso vs. sobrecarga ponderal) respecto a los escolares que poseen dos o más hermanos (p< 0,039). Conclusiones: el número de hermanos puede ser un elemento diferenciador en el estado de peso en adolescentes(AU)

Childhood weight overload has reached global levels that represent a social concern. Objective: The objective of this study was to analyze the relationship between body mass index, sex and the number of siblings in adolescents. Methods: Descriptive study with a sample of 310 schoolchildren from Castilla la Mancha (164 males (52.9%) and 146 females (47.1%) (M ± DE, 10.87 ± 0.54 years) The weight status was calculated by means of the BMI (weight (kg)/height (cm)2) and the number of siblings was found through a questionnaire. Results: Significant differences have been found in favor of males in greater weight (p <0.041) and overweight (p <0.001). However, women obtain a greater average in normal weight (p <0.001). In turn, there are differences in favor of schoolchildren in normal weight who have only one sibling, both in women and in the total sample (p <0.005). However, significant differences have been found in favor of weight status in weight overload in those who have two or more siblings, both in men and for the total sample (p <0.001). As a complementary analysis, the ANOVA test showed that schoolchildren with only one sibling have a healthier weight status (normal weight vs. overweight) compared to schoolchildren who have two or more siblings (p <0.039). Conclusions: the number of siblings can be a differentiating factor in the state of weight in adolescents(AU)

Optimizar los tiempos de pabellón; un nuevo enfoque a una idea antigua / Optimize pavilion times; a new approach to and old idea

INTRODUCCION: El tiempo de pabellón es un recurso escaso y costoso. Por eso optimizar el tiempo de un paciente en pabellón se presenta como el gran desafío. Se han intentado múltiples intervenciones para aumentar la eficiencia de los pabellones, desde técnicas para afianzar los equipos, hasta cambios en la planta física, pero el objetivo final sigue siendo hacer del proceso quirúrgico una sinfonía armónica. Nuestro objetivo es dar los primeros pasos que permitan, en un estudio de largo plazo, encontrar la fórmula teórica que permita optimizar el tiempo en pabellón. (AU)

INTRODUCTION: The time in the operating room (OR) is a scarce and expensive resource. So optimize the time of a patient in the OR presents as a great challenge. Multiple interventions have been attempted to increase the efficiency of the ORs, from techniques to strengthen teams, to changes in the physical plant, but the ultimate goal remains to make the surgical process an harmonic symphony. Our aim is to take the first steps to allow, on a long-term study, find the theoretical formula for optimizing the time in the ORs. (AU)

Optimizar los tiempos de pabellón; un nuevo enfoque a una idea antigua / Optimize or times; a new approach to an old idea

Introducción. El tiempo de pabellón es un recurso escaso y costoso. Por eso optimizar el tiempo de un paciente en pabellón se presenta como el gran desafío. Se han intentado múltiples intervenciones para aumentar la eficiencia de los pabellones, desde técnicas para afianzar los equipos, hasta cambios en la planta física, pero el objetivo final sigue siendo hacer del proceso quirúrgico una sinfonía armónica. Nuestro objetivo es dar los primeros pasos que permitan, en un estudio de largo plazo, encontrar la fórmula teórica que permita optimizar el tiempo en pabellón. Métodos. Estudio prospectivo con registro de los procesos en un pabellón de especialidad durante 4 semanas. Se registraron los tiempos de diferentes procesos de cada paciente y se descompuso en subprocesos (traslado, preoperatorio, técnicoanestesia, inducción-anestésica, arsenalera, lavado-paciente, prequirúrgico, quirúrgico, despertar, salida, aseo). Luego del análisis se plantearon 4 escenarios teóricos: (I)"tiempo observado"; (II)"tiempo mejorado", donde se realizó el traslape máximo de los subprocesos observados; (III)"tiempo mejorado+preanestesia", considerando sala de preanestesia y paciente se prepara antes de entrar a pabellón; (IV)"tiempo mejorado+preanestesia+arsenalera", además del paciente preparado se cuenta con arsenalera lista al momento del ingreso a pabellón. Se analizó la disminución del tiempo quirúrgico entre el observado y los tres escenarios a través de comparación de medianas (Wilcoxon). Además se estratificó según complejidad de la cirugía. Resultados. Se analizaron 22 cirugías urológicas de distinta complejidad: baja 32 por ciento; media 45 por ciento y alta 23 por ciento. La mediana del tiempo observado (I) fue de 123 minutos, el (II) fue 103 min, el (III) fue 74 min y (IV) fue 69 min. Disminución que es estadísticamente significativa al comparar el tiempo observado (I) con los tres grupos (p<0,001). Al hacer la comparación del observado con los otros tres escenarios según grado de complejidad de la cirugía, también se evidencia disminución estadísticamente significativa en los 3 grupos (baja, mediana y alta complejidad) con p 0.018; p 0.07; p 0.043 respectivamente. Conclusión. El análisis realizado se basa en tiempos reales y su comparación es con escenarios teóricos; sin embargo permite visualizar que sólo con un buen ordenamiento de los procesos en pabellón (tiempo mejorado (II)), traslapando aquellos procesos independientes, disminuiría el tiempo del pabellón en 20 min por cirugía. La cual sería mayor si se implementara el paciente ingresando preparado (III) y la arsenalera lista al ingreso del pabellón (IV). Sin embargo, estamos conscientes que estos escenarios son inalcanzables en nuestro medio. Además surgiría la interrogante de si serán lo suficientemente seguros para el paciente. En resumen solo cambiando la forma de gestionar los procesos del pabellón, se podría obtener un mejor aprovechamiento del tiempo y con esto aumentar la eficiencia de los pabellones. (AU)

Introduction. EThe time in the operating room (OR) is a scarce and expensive resource. So optimize the time of a patient in the OR presents as a great challenge. Multiple interventions have been attempted to increase the efficiency of the ORs, from techniques to strengthen teams, to changes in the physical plant, but the ultimate goal remains to make the surgical process an harmonic symphony. Our aim is to take the first steps to allow, on a long-term study, find the theoretical formula for optimizing the time in the ORs. Method. Prospective study that consisted in the registration of processes in a subspecialty OR for 4 weeks. Times of different processes were recorded for each patient and were decomposed into subprocesses (transfer, preoperative, anesthesiatechnician, anestheticinduction, instrumentalist, skin-preparation, surgeonpreoperative, surgery, awakening, exit, ORs-cleaning). After analyzing, four theoretical scenarios were proposed: (I) "observed time" (II) "Improved time", which consisted in the maximum overlap of the observed sub processes; (III) "improved time + preanesthesia " considering pre-anesthesia room and patient prepared before entering the operating room; (IV) " improved time + preanesthesia + instrumentist", where beside patient ready it counts with instrumentist also ready when entering de operating room. We analyzed the reduction of surgical time between the observed and the three scenarios through medians comparison (Wilcoxon). Furthermore stratified by surgery's complexity. Results. 22 urological surgeries of varied complexity were analyzed: low 32 pertcent, mean 45 pertcent, high 23pertcent. The observed median time (I) was 123 minutes, the (II) was 103 min, the (III) was 74 min and (IV) was 69 min. Decreased time is statistically significant by comparing the observed time (I) with the three groups (p <0.001). Comparing the observed time with the other three scenarios stratified by surgery complexity, also evidenced statistically significant decrease in the 3 groups (low, medium and high complexity) with p 0.018, p 0.07, p 0.043 respectively. Conclusión. The analysis is based on comparing real times with the oretical scenarios, however allows to see that with only a good order of the processes in the operating room (improved time (II)), overlapping those independent processes, decreases the time in the OR in 20 min. Which would be higher if the patient is prepared (III) and instrumentist ready (IV) when the patient enters to the Operating Room. However, we are aware that these scenarios are unattainable in our reality. Besides, the question that would arise is whether they would be safe enough for the patient. Therefore just by changing the way you manage processes in the OR, you might get a better use of time and thereby increase the efficiency of them.(AU)

Circuncisión neonatal con anestesia local: Resultados de un protocolo estandarizado / Neonatal circumcision with local anesthesia: Results of a standardized protocol

Introducción La circuncisión neonatal es un procedimiento frecuente en EE. UU. y en otros países, y presenta baja tasa de complicación en manos entrenadas. Sin embargo, en Chile recién está siendo incorporado clínicamente a nuestro medio. Nuestro objetivo fue establecer un protocolo local estandarizado de circuncisión neonatal con anestesia local y evaluar sus resultados y las posibles complicaciones. Pacientes y método Protocolo prospectivo estandarizado a pacientes que soliciten circuncisión neonatal cuyos criterios de inclusión fueron: niños < 60 días y < 5 kg. La técnica quirúrgica consiste en anestesia local tópica y bloqueo peneano, atrición del prepucio y mucosa redundante con clamp de Mogen® y sección con bisturí. Se evalúa protocolo utilizado desde noviembre de 2005 a octubre de 2014 por un urólogo pediatra y/o cirujano pediatra entrenados en la técnica. Se registran y analizan complicaciones y condiciones hasta el alta definitiva. Resultados En 9 años se aplicó el protocolo a 108 pacientes. La edad promedio al procedimiento fue de 9 días (1-52). Un paciente (0,9%) presentó sangrado inmediato, requiriendo cirugía posterior. Todos los pacientes fueron dados de alta definitiva de controles al mes, sin otras complicaciones. La razón para realizar el procedimiento fue por solicitud de los padres en el 100% de los casos por razones sociales o religiosas. Conclusión La circuncisión neonatal con anestesia local es un procedimiento sencillo y que en casos seleccionados tiene excelentes resultados, sin mayores complicaciones. Con el debido entrenamiento y adecuando el protocolo inicial, se puede realizar de manera ambulatoria, sin necesidad de someter al niño a los riesgos de la anestesia general en recién nacidos.

Introduction Neonatal circumcision is a common procedure in the US and other countries, with low rates of complications in trained hands. However, it has recently been incorporated into the clinical environment in Chile. Our goal was to establish a local standardised protocol for neonatal circumcision under local anaesthesia, and evaluate the results and possible complications. Patients and method A standardised prospective protocol was used on patients who underwent neonatal circumcision. The inclusion criteria were: children < 60 days and < 5 kg. The surgical technique used was topical local anaesthesia and penile block, attrition of redundant prepuce and mucosa with Mogen® clamp, and section with scalpel. The protocol was used and evaluated from November 2005 to October 2014 by a paediatric surgeon and/or paediatric urologist trained in the technique. Complications and conditions until final discharge were analysed. Results The protocol was applied to 108 patients over a 9 year period. The mean age at procedure was 9 days (1-52). One patient (0.9%) had immediate bleeding, requiring further surgery. All patients were discharged from further medical checks at 1 month, without any other complications. The reason for the procedure was by parental request in 100% of the cases, and always for sociocultural reasons. Conclusion Neonatal circumcision under local anaesthesia is a simple procedure, and has excellent results in selected patients, and with no major complications. With proper training, and adapting the initial protocol, it can be performed on an outpatient basis, without putting the neonates through the risks of general anaesthesia.

[Neonatal circumcision with local anesthesia. Results of a standardized protocol]. / Circuncisión neonatal con anestesia local. Resultados de un protocolo estandarizado.

INTRODUCTION: Neonatal circumcision is a common procedure in the US and other countries, with low rates of complications in trained hands. However, it has recently been incorporated into the clinical environment in Chile. Our goal was to establish a local standardised protocol for neonatal circumcision under local anaesthesia, and evaluate the results and possible complications. PATIENTS AND METHOD: A standardised prospective protocol was used on patients who underwent neonatal circumcision. The inclusion criteria were: children <60days and <5kg. The surgical technique used was topical local anaesthesia and penile block, attrition of redundant prepuce and mucosa with Mogen® clamp, and section with scalpel. The protocol was used and evaluated from November 2005 to October 2014 by a paediatric surgeon and/or paediatric urologist trained in the technique. Complications and conditions until final discharge were analysed. RESULTS: The protocol was applied to 108 patients over a 9year period. The mean age at procedure was 9days (1-52). One patient (0.9%) had immediate bleeding, requiring further surgery. All patients were discharged from further medical checks at 1 month, without any other complications. The reason for the procedure was by parental request in 100% of the cases, and always for sociocultural reasons. CONCLUSION: Neonatal circumcision under local anaesthesia is a simple procedure, and has excellent results in selected patients, and with no major complications. With proper training, and adapting the initial protocol, it can be performed on an outpatient basis, without putting the neonates through the risks of general anaesthesia.

Outcome of tunnelled central venous catheters used for haemodialysis in children weighing less than 15 kg.

PURPOSE: Central venous catheters (CVC) are frequently used for haemodialysis (HD) in children. However, there is paucity of information on the outcomes of CVCs when used for HD in very young patients. Our objective is to report the success, safety and complication rates of CVCs used for HD in children weighing less than 15 kg. MATERIALS AND METHODS: This is a single-center retrospective study of all patients with end-stage renal disease (ESRD) weighing <15kg, who underwent a tunneled CVC placement for HD, between July 2006 and June 2012 at our institution. Analysed data included clinical background, age and weight at initiation of HD, outcome of HD, CVC vein insertion site, reason for removal, and catheter survival (in days). RESULTS: Thirty-one CVC were placed in 11 patients weighing <15 kg, 8 males and 3 females. The main causes of ESRD were renal dysplasia and congenital nephrotic syndrome. At the beginning of HD, mean age was 27.5 (range 5-60) months and mean weight was 10.4 kg (4.5-13 kg). The preferred insertion site was the right internal jugular vein (90%). Mean duration of HD was 312 days. Mechanical factors were the main reason for catheter removal (39%). Mean catheter survival was 110 days/catheter. CONCLUSIONS: We believe our study provides relevant information and encouraging data to support the use of CVC for HD in this cohort of infants; however, further improvement in prevention of catheter thrombosis and management of infections needs to be achieved.

Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series.

OBJECTIVE: Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease that is considered as male genital variant lichen sclerosis. The incidence varies greatly in different series; diagnosis is mostly clinical but histopathological confirmation is mandatory. Various treatments are described, but there is no consensus that one is the best. MATERIALS AND METHODS: A literature review was made of BXO and lichen sclerosis in boys under 18 years of age, between 1995 and 2013, analyzing demographic dates, treatments and outcomes. In addition to that, we reviewed BXO cases treated in our centers in the last 10 years. RESULTS: After literature review, only 13 articles matched the inclusion criteria. Analyzing those selected, the global incidence of BXO is nearly 35% among circumcised children. Described symptoms are diverse and the low index of clinical suspicion is highlighted. The main treatment is circumcision, with use of topical and intralesional steroids and immunosuppressive agents. CONCLUSION: BXO is a condition more common than we believe and we must be vigilant to find greater number of diagnoses to avoid future complications. The main treatment for BXO is circumcision, but as topical or intralesional treatments are now available with potentially good outcomes, they may be considered as coadjuvants.