Pediatric Surgery and University. / Cirugía Pediátrica y Universidad.

INTRODUCTION: Pediatric Surgery studies in Spanish universities are not regulated, and their situation varies significantly from one region to another. MATERIALS AND METHODS: A descriptive study by means of a survey directly addressed to the heads of the 47 Spanish healthcare units was carried out. RESULTS: Only 33 pediatric surgeons currently teach at the university level. Most of them are employed (associate professors) and assigned to non-surgical departments. The degree of teaching accreditation of these professionals is meager. CONCLUSION: It is necessary to reflect deeply on the absence of our specialty in universities and, conversely, on the scarce presence of university studies and research in healthcare units.

INTRODUCCION: Los estudios de Cirugía Pediátrica en las universidades del Estado Español no están reglados y su situación es muy variable de unas regiones a otras. MATERIAL Y METODOS: Estudio descriptivo a través de una encuesta dirigida directamente a los responsables de las 47 unidades asistenciales españolas. RESULTADOS: Tan solo 33 cirujanos pediátricos ejercen actualmente docencia universitaria, en su inmensa mayoría con vinculación laboral (profesores asociados) y adscritos en su mayoría a departamentos no quirúrgicos. El grado de acreditación docente de estos profesionales es muy bajo. CONCLUSIONES: Se hace necesaria una profunda reflexión sobre la ausencia de nuestra especialidad en las universidades y, viceversa, sobre la escasa presencia de los estudios universitarios y de la investigación en las unidades asistenciales.

Cirugía Pediátrica y Universidad / Pediatric Surgery and University

Introducción: Los estudios de Cirugía Pediátrica en las universidades del Estado Español no están reglados y su situación es muy variablede unas regiones a otras. Material y métodos: Estudio descriptivo a través de una encuestadirigida directamente a los responsables de las 47 unidades asistencialesespañolas. Resultados: Tan solo 33 cirujanos pediátricos ejercen actualmentedocencia universitaria, en su inmensa mayoría con vinculación laboral(profesores asociados) y adscritos en su mayoría a departamentos noquirúrgicos. El grado de acreditación docente de estos profesionaleses muy bajo. Conclusiones: Se hace necesaria una profunda reflexión sobre laausencia de nuestra especialidad en las universidades y, viceversa, sobrela escasa presencia de los estudios universitarios y de la investigaciónen las unidades asistenciales.(AU)

Introduction: Pediatric Surgery studies in Spanish universitiesare not regulated, and their situation varies significantly from oneregion to another. Materials and methods: A descriptive study by means of asurvey directly addressed to the heads of the 47 Spanish healthcareunits was carried out. Results: Only 33 pediatric surgeons currently teach at the university level. Most of them are employed (associate professors)and assigned to non-surgical departments. The degree of teachingaccreditation of these professionals is meager. Conclusion: It is necessary to reflect deeply on the absence ofour specialty in universities and, conversely, on the scarce presenceof university studies and research in healthcare units.(AU)

Analysis of a clinical guideline for treatment and early discharge in complicated acute appendicitis. / Análisis de una guía clínica para el tratamiento y alta precoz en apendicitis aguda complicada.

OBJECTIVE: The objective of this study was to assess the results of a clinical guideline for the treatment and early discharge of patients with complicated acute appendicitis in terms of infectious complications and hospital stay. MATERIALS AND METHODS: A guideline for appendicitis treatment according to severity was created. Complicated appendicitis cases were treated with ceftriaxone-metronidazole for 48h, with discharge being approved if certain clinical and blood test criteria were met. A retrospective analytical study comparing the incidence of postoperative intra-abdominal abscess (IAA) and surgical site infection (SSI) in patients under 14 years of age to whom the new guideline was applied (Group A) vs. the historical cohort (Group B, treated with gentamicin-metronidazole for 5 days) was carried out. A prospective cohort study to assess which antibiotic therapy (amoxicillin-clavulanic acid or cefuroxime-metronidazole) proved more effective in patients meeting early discharge criteria was also conducted. RESULTS: 205 patients under 14 years of age were included in Group A, whereas 109 patients were included in Group B. IAA was present in 14.3% of patients from Group A vs. 13.8% from Group B (p= 0.83), while SSI was present in 1.9% of patients from Group A vs. 8.25% from Group B (p= 0.008). Early discharge criteria were met by 62.7% of patients from Group A. Median hospital stay decreased from 6 to 3 days. At discharge, 57% of patients received amoxicillin-clavulanic acid, whereas 43% received cefuroxime-metronidazole, with no differences being found in terms of SSI (p= 0.24) or IAA (p= 0.12). CONCLUSIONS: Early discharge reduces hospital stay without increasing the risk of postoperative infectious complications. Amoxicillin-clavulanic acid is a safe option for at-home oral antibiotic therapy.

OBJETIVO: El objetivo de este estudio es evaluar los resultados en términos de complicaciones infecciosas y estancia hospitalaria de la instauración de una guía clínica para el tratamiento y alta precoz en pacientes con apendicitis aguda complicada. MATERIAL Y METODOS: Se elaboró una guía para el tratamiento de las apendicitis en función de su grado de severidad. Las complicadas se trataron con ceftriaxona-metronidazol durante 48 h, siendo alta si cumplen ciertos criterios clínicos y analíticos. Se realizó un estudio analítico retrospectivo comparando la incidencia de abscesos intraabdominales postquirúrgicos (AIA) e infección del sitio quirúrgico (ISQ) en pacientes menores de 14 años sometidos a la nueva guía (Grupo A), respecto a una cohorte histórica (Grupo B), en la que la pauta de tratamiento era gentamicina-metronidazol 5 días. Además, se realizó un estudio de cohortes prospectivas para evaluar qué antibioterapia (amocilina-clavulánico o cefuroxima-metronidazol) es más eficaz en los pacientes que cumplen criterios de alta precoz. RESULTADOS: Se incluyeron 205 pacientes menores de 14 años en el Grupo A y 109 en el Grupo B. Presentaron AIA un 14,3% en el grupo A, frente al 13,8% en el B (p=  0,83); e ISQ un 1,9% y un 8,25% respectivamente (p=  0,008). Cumplieron criterios de alta precoz el 62,7% de los pacientes del Grupo A. La mediana de estancia disminuyó a de 6 a 3 días. Al alta, el 57% recibieron amoxicilina-clavulánico y el 43% cefuroxima-metronidazol, sin hallarse diferencias en términos de ISQ (p=  0,24) ni de AIA (p=  0,12). CONCLUSIONES: El alta precoz disminuye la estancia hospitalaria sin aumentar el riesgo de complicaciones infecciosas postquirúrgicas. La amoxicilina-clavulánico es una opción segura para la antibioterapia oral domiciliaria.

Análisis de una guía clínica para el tratamiento y alta precoz en apendicitis aguda complicada / Analysis of a clinical guideline for treatment and early discharge in complicated acute appendicitis

Objetivo: El objetivo de este estudio es evaluar los resultados entérminos de complicaciones infecciosas y estancia hospitalaria de lainstauración de una guía clínica para el tratamiento y alta precoz enpacientes con apendicitis aguda complicada.Material y métodos: Se elaboró una guía para el tratamiento delas apendicitis en función de su grado de severidad. Las complicadas setrataron con ceftriaxona-metronidazol durante 48h, siendo alta si cumplen ciertos criterios clínicos y analíticos. Se realizó un estudio analíticoretrospectivo comparando la incidencia de abscesos intraabdominalespostquirúrgicos (AIA) e infección del sitio quirúrgico (ISQ) en pacientesmenores de 14 años sometidos a la nueva guía (Grupo A), respecto a unacohorte histórica (Grupo B), en la que la pauta de tratamiento era gentamicina-metronidazol 5 días. Además, se realizó un estudio de cohortesprospectivas para evaluar qué antibioterapia (amocilina-clavulánico ocefuroxima-metronidazol) es más eficaz en los pacientes que cumplencriterios de alta precoz. Resultados: Se incluyeron 205 pacientes menores de 14 años en elGrupo A y 109 en el Grupo B. Presentaron AIA un 14,3% en el grupoA, frente al 13,8% en el B (p= 0,83); e ISQ un 1,9% y un 8,25% respectivamente (p= 0,008). Cumplieron criterios de alta precoz el 62,7%de los pacientes del Grupo A. La mediana de estancia disminuyó a de6 a 3 días. Al alta, el 57% recibieron amoxicilina-clavulánico y el 43%cefuroxima-metronidazol, sin hallarse diferencias en términos de ISQ(p= 0,24) ni de AIA (p= 0,12).Conclusiones: El alta precoz disminuye la estancia hospitalariasin aumentar el riesgo de complicaciones infecciosas postquirúrgicas.La amoxicilina-clavulánico es una opción segura para la antibioterapiaoral domiciliaria.(AU)

Objective: The objective of this study was to assess the results of aclinical guideline for the treatment and early discharge of patients withcomplicated acute appendicitis in terms of infectious complicationsand hospital stay. Materials and methods: A guideline for appendicitis treatmentaccording to severity was created. Complicated appendicitis caseswere treated with ceftriaxone-metronidazole for 48h, with dischargebeing approved if certain clinical and blood test criteria were met. Aretrospective analytical study comparing the incidence of postoperative intra-abdominal abscess (IAA) and surgical site infection (SSI) inpatients under 14 years of age to whom the new guideline was applied(Group A) vs. the historical cohort (Group B, treated with gentamicinmetronidazole for 5 days) was carried out. A prospective cohort study toassess which antibiotic therapy (amoxicillin-clavulanic acid or cefuroxime-metronidazole) proved more effective in patients meeting earlydischarge criteria was also conducted.Results: 205 patients under 14 years of age were included in GroupA, whereas 109 patients were included in Group B. IAA was presentin 14.3% of patients from Group A vs. 13.8% from Group B (p=0.83),while SSI was present in 1.9% of patients from Group A vs. 8.25%from Group B (p=0.008). Early discharge criteria were met by 62.7%of patients from Group A. Median hospital stay decreased from 6 to 3days. At discharge, 57% of patients received amoxicillin-clavulanic acid,whereas 43% received cefuroxime-metronidazole, with no differencesbeing found in terms of SSI (p=0.24) or IAA (p=0.12). Conclusions: Early discharge reduces hospital stay without increas-ing the risk of postoperative infectious complications. Amoxicillin-clavulanic acid is a safe option for at-home oral antibiotic therapy.(AU)

Conservative treatment of suprahepatic pseudoaneurysm in a pediatric patient. / Manejo conservador de un pseudoaneurisma suprahepático en un paciente pediátrico.

INTRODUCTION: Suprahepatic and inferior vena cava (IVC) pseudoaneurysms are rare in children. Most cases in adults are treated surgically due to the high risk of rupture. CASE REPORT: Seven-year-old girl referred for a thoracic-abdominal trauma of unknown origin. Hemodynamically stable, with a hemoglobin level of 9.1 g/dl. An emergency CT scan was performed, showing a pseudoaneurysm at the confluence of the IVC with the middle and left suprahepatic veins, with active bleeding contained by the hepatic capsule. Given the hemodynamic stability and surgical risk, conservative treatment was decided upon. CT-scan at 24 hours showed cessation of bleeding. A control CT-scan was performed one month, three months, one year, and one and a half years later, showing the lesion had disappeared. DISCUSSION: Conservative treatment of suprahepatic vein pseudoaneurysm/ICV is feasible in the case of hemodynamic stability provided that strict clinical and radiological surveillance is maintained.

INTRODUCCION: Los pseudoaneurismas suprahepáticos y de la vena cava inferior (VCI) son excepcionales en niños. La mayoría de casos en adultos se manejan quirúrgicamente debido al alto riesgo de rotura. CASO CLINICO: Niña de siete años remitida por traumatismo tóraco-abdominal no presenciado. Hemodinámicamente estable, con hemoglobina de 9,1 g/dL. Se realiza un TC urgente, objetivándose un pseudoaneurisma en la confluencia de la VCI con las suprahepáticas media e izquierda, con sangrado activo contenido por la cápsula hepática. Dada la estabilidad hemodinámica y el riesgo quirúrgico, se optó por un manejo conservador. En el TC a las veinticuatro horas se observó cese del sangrado. Se realizó un TC de control al mes, tres meses, un año y año y medio, con desaparición de la lesión. COMENTARIOS: El manejo conservador del pseudoaneurisma de las venas suprahepáticas/VCI es factible en caso de estabilidad hemodinámica siempre que se mantenga una vigilancia clínica y radiológica estrechas.

Manejo conservador de un pseudoaneurisma suprahepático en un paciente pediátrico / Conservative treatment of suprahepatic pseudoaneurysm in a pediatric patient

Introducción: Los pseudoaneurismas suprahepáticos y de la venacava inferior (VCI) son excepcionales en niños. La mayoría de casosen adultos se manejan quirúrgicamente debido al alto riesgo de rotura. Caso clínico: Niña de siete años remitida por traumatismo tóraco-abdominal no presenciado. Hemodinámicamente estable, con hemoglobina de 9,1 g/dL. Se realiza un TC urgente, objetivándose unpseudoaneurisma en la confluencia de la VCI con las suprahepáticasmedia e izquierda, con sangrado activo contenido por la cápsula hepática.Dada la estabilidad hemodinámica y el riesgo quirúrgico, se optó por unmanejo conservador. En el TC a las veinticuatro horas se observó cesedel sangrado. Se realizó un TC de control al mes, tres meses, un año yaño y medio, con desaparición de la lesión. Comentarios: El manejo conservador del pseudoaneurisma de lasvenas suprahepáticas/VCI es factible en caso de estabilidad hemodinámica siempre que se mantenga una vigilancia clínica y radiológicaestrechas.(AU)

Introduction: Suprahepatic and inferior vena cava (IVC) pseudoaneurysms are rare in children. Most cases in adults are treated surgicallydue to the high risk of rupture. Clinical case: Seven-year-old girl referred for a thoracic-abdominaltrauma of unknown origin. Hemodynamically stable, with a hemoglo-bin level of 9.1g/dl. An emergency CT scan was performed, showinga pseudoaneurysm at the confluence of the IVC with the middle andleft suprahepatic veins, with active bleeding contained by the hepatic capsule. Given the hemodynamic stability and surgical risk, conservativetreatment was decided upon. CT-scan at 24 hours showed cessation ofbleeding. A control CT-scan was performed one month, three months,one year, and one and a half years later, showing the lesion had disappeared. Discussion: Conservative treatment of suprahepatic vein pseudoaneurysm/ICV is feasible in the case of hemodynamic stability providedthat strict clinical and radiological surveillance is maintained.(AU)

[Duodenal bleeding due to metastasis from lung adenocarcinoma controlled by radiotherapy: A case report and literature review]. / Saignement duodénal dû à une métastase d'un cancer pulmonaire contrôlé par radiothérapie : cas clinique et revue de la littérature.

INTRODUCTION: Gastrointestinal (GI) metastases in lung cancer rarely occur. CASE REPORT: We report here the case of a 43-year-old male active smoker who was admitted to our hospital for cough, abdominal pain and melena. Initial investigations revealed poorly differentiated adenocarcinoma of the superior-right lobe of the lung: positive for thyroid transcription factor-1 and negative for protein p40 and for antigen CD56, with peritoneal, adrenal and cerebral metastasis, as well as anemia requiring major transfusion support. Over 50% of cells were positive for PDL-1, and ALK gene rearrangement was detected. GI endoscopy showed a large ulcerated nodular lesion of the genu superius with active intermittent bleeding, as well as an undifferentiated carcinoma with positivity for CK AE1/AE3 and TTF-1, and negativity for CD117, corresponding to metastatic invasion originating from lung carcinoma. Palliative immunotherapy with pembrolizumab was proposed, followed by targeted therapy with brigatinib. Gastrointestinal bleeding was controlled with a single 8Gy dose of haemostatic radiotherapy. CONCLUSION: GI metastases are rare in lung cancer and present nonspecific symptoms and signs but no characteristic endoscopic features. GI bleeding is a common revelatory complication. Pathological and immunohistological findings are critical to diagnosis. Local treatment is usually guided by the occurrence of complications. In addition to surgery and systemic therapies, palliative radiotherapy may contribute to bleeding control. However, it must be used cautiously, given a present-day lack of evidence and the pronounced radiosensitivity of certain gastrointestinal tract segments.

Short-term physical exercise controls age-related hyperinsulinemia and improves hepatic metabolism in aged rodents.

PURPOSE: Aging is associated with changes in glucose homeostasis related to both decreased insulin secretion and/or impaired insulin action, contributing to the high prevalence of type 2 diabetes (T2D) in the elderly population. Additionally, studies are showing that chronically high levels of circulating insulin can also lead to insulin resistance. In contrast, physical exercise has been a strategy used to improve insulin sensitivity and metabolic health. However, the molecular alterations resulting from the effects of physical exercise in the liver on age-related hyperinsulinemia conditions are not yet fully established. This study aimed to investigate the effects of 7 days of aerobic exercise on hepatic metabolism in aged hyperinsulinemic rats (i.e., Wistar and F344) and in Slc2a4+/- mice (hyperglycemic and hyperinsulinemic mice). RESULTS: Both aged models showed alterations in insulin and glucose tolerance, which were associated with essential changes in hepatic fat metabolism (lipogenesis, gluconeogenesis, and inflammation). In contrast, 7 days of physical exercise was efficient in improving whole-body glucose and insulin sensitivity, and hepatic metabolism. The Slc2a4+/- mice presented significant metabolic impairments (insulin resistance and hepatic fat accumulation) that were improved by short-term exercise training. In this scenario, high circulating insulin may be an important contributor to age-related insulin resistance and hepatic disarrangements in some specific conditions. CONCLUSION: In conclusion, our data demonstrated that short-term aerobic exercise was able to control mechanisms related to hepatic fat accumulation and insulin sensitivity in aged rodents. These effects could contribute to late-life metabolic health and prevent the development/progression of age-related T2D.

Estimulantes de tipo anfetamínico en estudiantes de medicina latinoamericanos: una revisión / Amphetamine-type stimulants in Latin American medicine students: a review

Introducción: el consumo de estimulantes de tipo anfetamínico (ETA) y sus derivados está cada vez más presente en los estudiantes universitarios y, en particular, en los programas de medicina. El objetivo principal de este estudio fue revisar la literatura sobre el uso de ETA y sus derivados en estudiantes de medicina latinoamericanos. Materiales y método: se realizó una revisión de la literatura disponible, utilizando las bases de datos PubMed, SciELO y LILACS. Se encontraron un total de 1.054 artículos, de los cuales 17 fueron seleccionados para esta revisión. Resultados: la revisión muestra, en general, una mayor frecuencia de uso de ETA en estudiantes de medicina de América Latina en comparación con la población general y estudiantes de otras carreras universitarias. También existe una tendencia a un mayor uso en hombres, de mayor nivel socioeconómico y en cursos posteriores del programa. La razón más informada para usar ETA fue aumentar el rendimiento académico. Como factor protector se destacaron los deportes, el tiempo en familia y la profesión de alguna creencia religiosa. De los artículos seleccionados, no se encontraron estudios sobre las consecuencias a largo plazo del uso de ETA en estudiantes de medicina. Discusión: en resumen, los estudiantes de medicina latinoamericanos tienen un alto consumo de ETA, por lo que es evidente la necesidad de nuevos estudios para mejorar la precisión estadística, determinar factores de riesgo específicos, estudiar las consecuencias a largo plazo y establecer políticas de prevención y tratamiento.

Introduction: the consumption of amphetamine-type stimulants (ATS) and their derivatives are increasingly present in university students and in particular in medical programs. The main objective of this study was to review the literature on the use of ATS and their derivatives in Latin American medical students. Materials and method: a review of the literature available was performed, using PubMed, SciELO, and LILACS databases. A total of 1054 articles were found, of which 17 were selected for this review. Results: the review generally shows a higher frequency of use of ATS in medical students of Latin America compared to the general population and students from other university degrees. There is also a tendency of a higher use in men, from higher socioeconomic status, and in later courses of the program. The most reported reason for using ATS was to increase the academic performance. As a protective factor, sports, family time and professing some religious belief stood out. Of the selected articles, no studies were found on the long-term consequences of the use of ATS in medical students. Discussion: in summary, Latin American medical students have a high consumption of ATS, and therefore there is an evident need for new studies to improve statistical precision, to determine specific risk factors, to study long-term consequences, and to stablish prevention policies and treatment.

Descripción y aplicación clínica de las escalas de valoración geriátrica integral: una revisión sistemática rápida de revisiones / Description and clinical application of comprehensive geriatric assessment scales: a rapid systematic review of reviews

Objetivo Realizar una descripción de las principales escalas utilizadas en la valoración geriátrica integral mediante un análisis narrativo detallando su aplicación clínica en relación con sus ventajas y desventajas en función de sus propiedades psicométricas (valoración mental) y los sesgos en su aplicación. Las escalas seleccionadas fueron: índice de Barthel, índice de Katz, escala de Lawton y Brody, mini-examen del estado mental, test del reloj, escala de depresión geriátrica y la escala de recursos sociales. Métodos Se realizó una revisión sistemática rápida de revisiones en MEDLINE (PubMed) hasta enero de 2021, informando de los hallazgos mediante PRISMA, 2020. Para construir la estrategia de búsqueda reproducible se empleó el lenguaje MeSH, palabras clave y los operadores booleanos AND y OR. Resultados Se seleccionaron 31 que cumplieron los criterios de elegibilidad; 18 revisiones sistemáticas, 12 revisiones de la literatura y una revisión de alcance. Se encontraron múltiples versiones para algunas de las escalas y se constataron sesgos en su interpretación. Se recomienda la administración de cuestionarios cortos y fáciles de aplicar y se aconseja que los puntos de corte se definan según la educación formal. Conclusión Las escalas de valoración geriátrica integral son instrumentos baratos, eficaces y útiles para detectar problemas y potencialidad en las personas mayores. Deben ser de fácil aplicación, no extensas, válidas para múltiples culturas y distintos niveles de educación formal y aplicables a diferentes grados de discapacidad. Es recomendable que los profesionales sanitarios se entrenen en su uso para evitar sesgos en la interpretación de los resultados (AU)

Objective This work aims to describe the main scales used in comprehensive geriatric assessment through a narrative analysis detailing their clinical application in relation to their advantages and disadvantages in terms of their psychometric properties (mental assessment) and biases in their application. The scales selected were: Barthel Index, Katz Index, Lawton and Brody Scale, Mini-Mental State Examination, Clock Test, Geriatric Depression Scale, and the Social Resources Scale. Methods We conducted a rapid systematic review of reviews in MEDLINE (PubMed) up to January 2021, reporting findings using PRISMA, 2020. MeSH language, keywords, and the Boolean operators AND and OR were used to construct the reproducible search strategy. Results Thirty-one works were selected that met the eligibility criteria: 18 systematic reviews, 12 literature reviews, and one scoping review. Multiple versions were found for some of the scales and biases in their interpretation were observed. Short, easy-to-administer questionnaires are recommended and cut-off points should be defined by formal education. Conclusion Comprehensive geriatric assessment scales are inexpensive, effective, and useful instruments for identifying problems and potential problems in the elderly. They should be easy to apply, not extensive, valid for multiple cultures and different levels of formal education, and applicable to individuals with different degrees of disability. It is recommended that health professionals be instructed in their use to avoid biases in the interpretation of the results (AU)

Determination of Time in Range Associated With HbA1c ≤7% in a Prospective Cohort of Patients With Type 1 Diabetes Using CGM for Three Months.

INTRODUCTION: Finding a goal of time in range (%TIR) that defines good glycemic control is necessary. Previous retrospective studies suggest good concordance between HbA1c ≤7% with a TIR >70%; however, the studies that included the largest number of patients used blood glucose measurement data with a follow-up time of less than 90 days. This study defined the TIR value that best discriminates HbA1c ≤7%. METHODS: We performed a prospective study of diagnostic tests based on a cohort of patients with type 1 diabetes (T1D) treated with a hybrid closed loop (HCL) followed for three months. The ability of %TIR to distinguish patients with HbA1c ≤7% was evaluated through receiver operating characteristic curve analysis. We determined the %TIR cutoff point with the best operating characteristics. RESULTS: A total of 118 patients were included (58.1% women, 47% overweight or obese, and 33% with high glycemic variability). A moderate negative correlation (R = -.54, P < .001) was found between %TIR and HBA1c. The discrimination ability was moderate, with an area under the curve of 0.7485 (95% confidence interval = 0.6608-0.8363). The cutoff point that best predicted HbA1c ≤7% was %TIR ≥75.5 (sensitivity 70%, specificity 67%). The findings were similar among those with a coefficient of variation (CV%) ≥36%. CONCLUSIONS: Our data suggest that the %TIR adequately identifies patients with HbA1c ≤7%. A target of TIR ≥75%, rather than the currently recommended TIR ≥70%, may be a more suitable value for optimal glycemic control.

Usefulness of intraoperative voiding cystourethrogram as an indicator of success in the endoscopic treatment of vesicoureteral reflux. / Utilidad de la cistouretrografía miccional intraoperatoria como indicador de éxito del tratamiento endoscópico del reflujo vesicoureteral.

OBJECTIVE: Up until now, serial voiding cystourethrogram (SVCU) has been regarded as the gold standard technique in the diagnosis of vesicoureteral reflux (VUR). The aim of intraoperative SVCU during endoscopic treatment is to detect those patients eligible to receive more biosynthetic material as a result of persistent VUR. The objective of this study was to assess the usefulness of SVCU as a predictor of treatment success. MATERIALS AND METHODS: An analytical, retrospective study of patient medical records was carried out. Patients included had undergone endoscopic VUR surgery from 2000 to 2019, and they were measured in ureteral units. VUR persistence at intraoperative SVCU following treatment was compared with SVCU results after 3 months. RESULTS: Of a total of 167 ureteral units undergoing surgery, persistent reflux immediately after surgery was observed in 17 cases (10% of the sample). Only 3 cases had other urological malformations. In the SVCU carried out after 3 months, reflux was found in 38% of the sample (64 cases). When comparing the results, intraoperative SVCU demonstrated a specificity of 92.6%, and a sensitivity of 15.6%. CONCLUSIONS: Given the low sensitivity (15.6%) of intraoperative SVCU to detect cases of persistent reflux in the mid-term, and considering the risks associated with radiation in the pediatric population - which is extremely sensitive to it -, intraoperative SVCU should be ruled out as a useful indicator of endoscopic treatment success.

OBJETIVO: La cistouretrografía miccional seriada (CUMS) ha sido hasta ahora el gold standard en el diagnóstico del reflujo vesicoureteral (RVU). La finalidad de la CUMS intraoperatoria durante el tratamiento endoscópico es detectar aquellos pacientes subsidiarios de inyectar más material biosintético por persistencia del RVU. En este estudio hemos querido evaluar la utilidad de esta prueba como predictor de éxito del tratamiento. MATERIAL Y METODOS: Estudio analítico retrospectivo mediante la revisión de historias clínicas de pacientes, medidos en unidades ureterales, intervenidos de RVU de forma endoscópica entre los años 2000 y 2019. Se comparó la persistencia de RVU en la CUMS intraoperatoria tras el tratamiento con el resultado de la CUMS a los 3 meses. RESULTADOS: De un total de 167 unidades ureterales intervenidas, se observó persistencia del reflujo inmediatamente tras la intervención en 17 casos (10% de la muestra). Solo 3 asociaban otras malformaciones urológicas. En la CUMS a los 3 meses se observó reflujo en el 38% de la muestra (64 casos). Al comparar los resultados, obtenemos para la CUMS intraoperatoria una especificidad del 92,6% y una sensibilidad del 15,6%. CONCLUSIONES: Dada la baja sensibilidad (15,6%) de la CUMS intraoperatoria para detectar los casos en los que persiste el reflujo a medio plazo y, teniendo en cuenta los riesgos asociados a la radiación que supone en una población especialmente sensible como es la pediátrica, se desestima su utilidad como indicador de éxito del tratamiento endoscópico.

Utilidad de la cistouretrografía miccional intraoperatoria como indicador de éxito del tratamiento endoscópico del reflujo vesicoureteral / Usefulness of intraoperative voiding cystourethrogram as an indicator of success in the endoscopic treatment of vesicoureteral reflux

Objetivo: La cistouretrografía miccional seriada (CUMS) ha sido hasta ahora el gold standard en el diagnóstico del reflujo vesicoureteral (RVU). La finalidad de la CUMS intraoperatoria durante el tratamientoendoscópico es detectar aquellos pacientes subsidiarios de inyectar más material biosintético por persistencia del RVU. En este estudio hemos querido evaluar la utilidad de esta prueba como predictor de éxito deltratamiento. Material y métodos: Estudio analítico retrospectivo mediante la revisión de historias clínicas de pacientes, medidos en unidades ureterales, intervenidos de RVU de forma endoscópica entre los años 2000 y2019. Se comparó la persistencia de RVU en la CUMS intraoperatoria tras el tratamiento con el resultado de la CUMS a los 3 meses. Resultados: De un total de 167 unidades ureterales intervenidas, se observó persistencia del reflujo inmediatamente tras la intervención en 17 casos (10% de la muestra). Solo 3 asociaban otras malformacionesurológicas. En la CUMS a los 3 meses se observó reflujo en el 38% de la muestra (64 casos). Al comparar los resultados, obtenemos para la CUMS intraoperatoria una especificidad del 92,6% y una sensibilidad del 15,6%. Conclusiones: Dada la baja sensibilidad (15,6%) de la CUMS intraoperatoria para detectar los casos en los que persiste el reflujo a medio plazo y, teniendo en cuenta los riesgos asociados a la radiación que supone en una población especialmente sensible como es la pediátrica, se desestima su utilidad como indicador de éxito del tratamientoendoscópico.(AU)

Objective: Up until now, serial voiding cystourethrogram (SVCU) has been regarded as the gold standard technique in the diagnosis ofvesicoureteral reflux (VUR). The aim of intraoperative SVCU during endoscopic treatment is to detect those patients eligible to receive morebiosynthetic material as a result of persistent VUR. The objective of this study was to assess the usefulness of SVCU as a predictor of treatment success. Materials and methods: An analytical, retrospective study of patient medical records was carried out. Patients included had undergoneendoscopic VUR surgery from 2000 to 2019, and they were measured in ureteral units. VUR persistence at intraoperative SVCU followingtreatment was compared with SVCU results after 3 months. Results: Of a total of 167 ureteral units undergoing surgery, persistent reflux immediately after surgery was observed in 17 cases (10%of the sample). Only 3 cases had other urological malformations. In the SVCU carried out after 3 months, reflux was found in 38% of thesample (64 cases). When comparing the results, intraoperative SVCU demonstrated a specificity of 92.6%, and a sensitivity of 15.6%. Conclusions: Given the low sensitivity (15.6%) of intraoperative SVCU to detect cases of persistent reflux in the midterm, and considering the risks associated with radiation in the pediatric population which is extremely sensitive to it, intraoperative SVCU should be ruled outas a useful indicator of endoscopic treatment success.(AU)

Description and clinical application of comprehensive geriatric assessment scales: A rapid systematic review of reviews.

OBJECTIVE: This work aims to describe the main scales used in comprehensive geriatric assessment through a narrative analysis detailing their clinical application in relation to their advantages and disadvantages in terms of their psychometric properties (mental assessment) and biases in their application. The scales selected were: Barthel Index, Katz Index, Lawton and Brody Scale, Mini-Mental State Examination, Clock Test, Geriatric Depression Scale, and the Social Resources Scale. METHODS: We conducted a rapid systematic review of reviews in MEDLINE (PubMed) up to January 2021, reporting findings using PRISMA, 2020. MeSH language, keywords, and the Boolean operators AND and OR were used to construct the reproducible search strategy. RESULTS: Thirty-one works were selected that met the eligibility criteria: 18 systematic reviews, 12 literature reviews, and one scoping review. Multiple versions were found for some of the scales and biases in their interpretation were observed. Short, easy-to-administer questionnaires are recommended and cut-off points should be defined by formal education. CONCLUSION: Comprehensive geriatric assessment scales are inexpensive, effective, and useful instruments for identifying problems and potential problems in the elderly. They should be easy to apply, not extensive, valid for multiple cultures and different levels of formal education, and applicable to individuals with different degrees of disability. It is recommended that health professionals be instructed in their use to avoid biases in the interpretation of the results.

Design and validation of games and emotions scale for children (GES-C) / Diseño y validación de la escala de juegos y emociones para niños (GES-C) / Concepção e validação da escala de jogos e emoções para crianças (GES-C)

Several instruments exist to measure emotional experiences during physical activity. However, these instruments are designed on a clinically basis and use mood concepts rather than emotions. Moreover, these instruments are designed and validated only with adult samples. An instrument is needed to study the emotional experiences of schoolchildren when participating in games or sports. Therefore, the aim of this study was to design and validate the Games and Emotions Scale for Children to assess the intensity of emotions (positive or negative) of schoolchildren in physical education classes, when players participated in games of different motor action domains, with or without competition (winner or loser). A total of 293 students from four Spanish primary schools participated. Ten experts evaluated the content. The results of confirmatory factor analysis, reliability and validity (convergent and discriminant) yielded two factors and satisfactory fit indices. Acceptable reliability and validity values were obtained. The present study suggests that the GES-C is a structurally valid and reliable instrument for measuring emotional intensity in motor games, both in an educational and sport context. Thus, the results could benefit both teachers and coaches, allowing them to know the type of emotional experiences generated by their motor practices. (AU)

Existen varios instrumentos que permiten medir las experiencias emocionales durante la actividad física. Sin embargo, estos instrumentos están diseñados desde una base clínica y utilizan conceptos de estado de ánimo en lugar de emociones. Además, estos instrumentos están diseñados y validados sólo con muestras de adultos. Se necesita un instrumento para estudiar las vivencias emocionales de los escolares al intervenir en juegos o deportes. Por ello, el objetivo de este estudio fue diseñar y validar la Escala de Juegos y Emociones para Niños para evaluar la intensidad de las emociones (positivas o negativas) de los escolares en las clases de educación física, cuando los jugadores participan en juegos de diferentes dominio de acción motriz, con o sin competición (ganador o perdedor). Participaron 293 alumnos de cuatro centros de enseñanza primaria españoles. Diez expertos evaluaron el contenido. Los resultados del análisis factorial confirmatorio, de fiabilidad y validez (convergente y discriminante) arrojaron dos factores e índices de ajuste satisfactorios. Se obtuvieron valores aceptables de fiabilidad y validez. El presente estudio sugiere que el GES-C es un instrumento estructuralmente válido y fiable para medir la intensidad emocional en los juegos motores, tanto en un contexto educativo como deportivo. Así, los resultados podrían beneficiar tanto a los maestros como a los entrenadores, permitiéndoles conocer el tipo de experiencias emocionales que generan sus prácticas motrices. (AU)

Existem vários instrumentos para medir as experiências emocionais durante a actividade física. No entanto, estes instrumentos são concebidos a partir de uma base clínica e utilizam conceitos de humor em vez de emoções. Além disso, estes instrumentos são concebidos e validados apenas com amostras adultas. Existe a necessidade de um instrumento para estudar as experiências emocionais das crianças em idade escolar quando participam em jogos ou desportos. Portanto, o objectivo deste estudo era conceber e validar a Escala de Jogos e Emoções para Crianças para avaliar a intensidade das emoções (positivas ou negativas) das crianças em idade escolar nas aulas de educação física, quando os jogadores participam em jogos de diferentes domínios de acção motora, com ou sem competição (vencedor ou perdedor). Participaram um total de 293 estudantes de quatro escolas primárias espanholas. Dez peritos avaliaram o conteúdo. Os resultados da análise dos factores de confirmação, fiabilidade e validade (convergente e discriminante) mostraram dois factores e índices de ajuste satisfatórios. Foram obtidos valores aceitáveis de fiabilidade e validade. O presente estudo sugere que o GES-C é um instrumento estruturalmente válido e fiável para medir a intensidade emocional em jogos motorizados, tanto num contexto educativo como desportivo. Assim, os resultados poderiam beneficiar tanto professores como treinadores, permitindo-lhes conhecer o tipo de experiências emocionais geradas pelas suas práticas motoras. (AU)

Malformaciones ano-rectales: cambios en el manejo neonatal en los últimos 22 años / Anorectal malformations: changes in neonatal management in the last 22 years

Introducción y objetivos. Una inspección perineal alterada o el retraso en la expulsión meconial debe hacernos sospechar una malformación anorrectal. El objetivo de este estudio es conocer la incidencia de estas malformaciones, así como el estudio de las características obstétricas y neonatales, diagnósticas y terapéuticas de estos pacientes, y sus complicaciones en los últimos 22 años. Material y método. Estudio descriptivo y retrospectivo incluyendo pacientes con diagnóstico en periodo neonatal de malformaciones anorrectales, excluyendo enfermedad de Hirschsprung, entre 2000-2021. Se establecieron dos periodos temporales para ver posibles cambios (2000-2010 versus 2011-2021). Resultados. 27 pacientes, 92,6% varones. Incidencia de 1 caso por cada 5.895 recién nacidos en nuestra región. El 88,9% fueron intervenidos con una mediana de edad de 2 días, precisando ingreso todos ellos durante una mediana de 15 días. El 95,8% recibió antibioterapia (mediana de 6 días), siendo la pauta más utilizada la asociación ampicilina, gentamicina y clindamicina; el 25% precisó ventilación mecánica invasiva (mediana de 1 día) y el 25% sedoanalgesia, tras la intervención; y 17 pacientes precisaron nutrición parenteral (media de 7,6 días). El 16,7% presentó complicaciones a corto plazo (75% infecciosas). A mediolargo plazo, el 37,5% precisó reintervención. No hemos encontrado diferencias significativas en las características clínicas ni diagnósticas entre los dos periodos temporales analizados. Conclusiones. Las malformaciones anorrectales son una causa relativamente frecuente de obstrucción intestinal en periodo neonatal que requiere un tratamiento multidisciplinar. En los últimos 22 años no hemos encontrado diferencias en cuanto a su incidencia ni en su manejo y resultado (AU)

Introduction and objectives. An altered perineal inspection or the delay in meconium expulsion should lead us to suspect an anorectal malformation. This study has aimed to know the incidence of these malformations and to study the obstetric and neonatal, diagnostic and therapeutic characteristics of these patients, and their complications in the last 22 years. Material and methods. A descriptive and retrospective study including patients having a diagnosis in the neonatal period of anorectal malformations, excluding Hirschsprung’s disease, between 2000-2021. Two time periods were established to see possible changes (2000-2010 versus 2011-2021). Results. 27 patients, 92.6% males, there being an incidence of one case per 5,895 newborns in our region. 88.9% underwent surgery with a median age of 2 days, admission being required for a median of 15 days. 95.8% received antibiotic therapy (median of 6 days), the regimen used most being the association of ampicillin, gentamicin and clindamycin; 25% required invasive mechanical ventilation (median of 1 day) and 25% sedated analgesia after the intervention. 17 patients required parenteral nutrition (mean 7.6 days). 16.7% had short-term complications (75% infectious). In the medium to long term, 37.5% required reoperation. We did not find any significant differences in the clinical or diagnostic characteristics between the two time periods analyzed. Conclusions. Anorectal malformations are a relatively frequent cause of intestinal obstruction in the neonatal period that requires multidisciplinary treatment. We have not found differences in terms of its incidence or in its management and outcome regarding the last 22 years (AU)

Prognostic factors at admission on patients with cancer and COVID-19: Analysis of HOPE registry data.

BACKGROUND: Previous works seem to agree in the higher mortality of cancer patients with COVID-19. Identifying potential prognostic factors upon admission could help identify patients with a poor prognosis. METHODS: We aimed to explore the characteristics and evolution of COVID-19 cancer patients admitted to hospital in a multicenter international registry (HOPE COVID-19).Our primary objective is to define those characteristics that allow us to identify cancer patients with a worse prognosis (mortality within 30 days after the diagnosis of COVID-19). RESULTS: 5838 patients have been collected in this registry, of whom 770 had cancer among their antecedents. In hospital mortality reached 258 patients (33.51%). The median was 75 years (65-82). Regarding the distribution by sex, 34.55% of the patients (266/770) were women.The distribution by type of cancer: genitourinary 238/745 (31.95%), digestive 124/745 (16.54%), hematologic 95/745 (12.75%).In multivariate regression analysis, factors that are independently associated with mortality at admission are: renal impairment (OR 3.45, CI 97.5% 1.85-6.58), heart disease (2.32, 1.47-3.66), liver disease (4.69, 1.94-11.62), partial dependence (2.41, 1.34-4.33), total dependence (7.21, 2.60-21.82), fatigue (1.84, 1.16-2.93), arthromialgias (0.45, 0.26-0.78), SatO2 < 92% (4.58, 2.97-7.17), elevated LDH (2.61, 1.51-4.69) and abnormal decreased Blood Pressure (3.57, 1.81-7.15). Analitical parameters are also significant altered. CONCLUSION: In patients with cancer from the HOPE registry, 30-day mortality from any cause is high and is associated with easily identifiable clinical factors upon arrival at the hospital. Identifying these patients can help initiate more intensive treatments from the start and evaluate the prognosis of these patients.

ANTECEDENTES: Trabajos previos parecen coincidir en la mayor mortalidad de los pacientes con cáncer y COVID-19. La identificación de posibles factores pronósticos en el momento del ingreso podría ayudar a identificar a los pacientes con mal pronóstico. MÉTODOS: Nos propusimos explorar las características y la evolución de los pacientes con cáncer y COVID-19 ingresados en un registro internacional multicéntrico (HOPE COVID-19).Nuestro objetivo principal es definir aquellas características que nos permitan identificar a los pacientes con cáncer de peor pronóstico (mortalidad en los 30 días siguientes al diagnóstico de COVID-19). RESULTADOS: En este registro se ha recogido a 5.838 pacientes, de los cuales 770 tenían cáncer entre sus antecedentes. La mortalidad hospitalaria alcanzó a 258 pacientes (33,51%). La mediana fue de 75 años (65-82). En cuanto a la distribución por sexo, el 34,55% de los pacientes eran mujeres (266/770).La distribución por tipo de cáncer: genitourinario 238/745 (31,95%), digestivo 124/745 (16,54%) y hematológico 95/745 (12,75%).En el análisis de regresión multivariante, los factores que se asocian de forma independiente con la mortalidad al ingreso son: insuficiencia renal (OR 3,45; IC 97,5%: 1,85-6,58), cardiopatía (2,32; 1,47-3,66), hepatopatía (4,69; 1,94-11,62), dependencia parcial (2,41; 1,34-4,33), dependencia total (7,21; 2,60-21,82), fatiga (1,84, 1;16-2,93), artromialgias (0,45; 0,26-0,78), SatO2 < 92% (4,58; 2,97-7,17), LDH elevada (2,61; 1,51-4,69) y disminución anormal de la presión arterial (3,57; 1,81-7,15). Los parámetros analíticos también están significativamente alterados. CONCLUSIÓN: En los pacientes con cáncer del registro HOPE, la mortalidad a los 30 días por cualquier causa es elevada y se asocia a factores clínicos fácilmente identificables a su llegada al hospital. La identificación de estos pacientes puede ayudar a iniciar tratamientos más intensivos desde el principio y evaluar el pronóstico de estos pacientes.

Role of ethylene in effective establishment of the peanut-bradyrhizobia symbiotic interaction.

Ethylene has been implicated in nitrogen fixing symbioses in legumes, where rhizobial invasion occurs via infection threads (IT). In the symbiosis between peanut (Arachis hypogaea L.) and bradyrhizobia, the bacteria penetrate the root cortex intercellularly and IT are not formed. Little attention has been paid to the function of ethylene in the establishment of this symbiosis. The aim of this article is to evaluate whether ethylene plays a role in the development of this symbiotic interaction and the participation of Nod Factors (NF) in the regulation of ethylene signalling. Manipulation of ethylene in peanut was accomplished by application of 1-aminocyclopropane-1-carboxylic acid (ACC), which mimics applied ethylene, or AgNO3, which blocks ethylene responses. To elucidate the participation of NF in the regulation of ethylene signalling, we inoculated plants with a mutant isogenic rhizobial strain unable to produce NF and evaluated the effect of AgNO3 on gene expression of NF and ethylene responsive signalling pathways. Data revealed that ethylene perception is required for the formation of nitrogen-fixing nodules, while addition of ACC does not affect peanut symbiotic performance. This phenotypic evidence is in agreement with transcriptomic data from genes involved in symbiotic and ethylene signalling pathways. NF seem to modulate the expression of ethylene signalling genes. Unlike legumes infected through IT formation, ACC addition to peanut does not adversely affect nodulation, but ethylene perception is required for establishment of this symbiosis. Evidence for the contribution of NF to the modulation of ethylene-inducible defence gene expression is provided.