Urologist validation of an artificial intelligence-based tool for automated estimation of penile curvature.

INTRODUCTION: Severity of penile curvature (PC) is commonly used to select the optimal surgical intervention for hypospadias, either alone or in conjunction with other phenotypic characteristics. Despite this, current literature on the accuracy and precision of different PC measurement techniques in hypospadias patients remains limited. PURPOSE: Assess the feasibility and validity of an artificial intelligence (AI)-based model for automatic measurement of PC. MATERIAL AND METHODS: Seven 3D-printed penile models with variable degrees of ventral PC were used to evaluate and compare interobserver agreement in estimation of penile curvatures using various measurement techniques (including visual inspection, goniometer, manual estimation via a mobile application, and an AI-based angle estimation app. In addition, each participant was required to complete a questionnaire about their background and experience. RESULTS: Thirty-five clinical practitioners participated in the study, including pediatric urologists, pediatric surgeons, and urologists. For each PC assessment method, time required, mean absolute error (MAE), and inter-rater agreement were assessed. For goniometer-based measurement, the lowest MAE achieved was derived from a model featuring 86° PC. When using either UVI (unaid visual inspection), mobile apps, or AI-based measurement, MAE was lowest when assessing a model with 88° PC, indicating that high-grade cases can be quantified more reliably. Indeed, MAE was highest when PC angle ranged between 40° and 58° for all the investigated measurement tools. In fact, among these methodologies, AI-based assessment achieved the lowest MAE and highest level of inter-class correlation, with an average measurement time of only 22 s. CONCLUSION: AI-based PC measurement models are more practical and consistent than the alternative curvature assessment tools already available. The AI method described in this study could help surgeons and hypospadiology researchers to measure PC more accurately.

Correction of hidden penis during Gomco clamp circumcision in the office.

Hidden penis is considered to be a contraindication for clamp circumcision due to high likelihood of healing with concealment. A new technique was created for penoscrotal skin tacking during Gomco circumcision, where the sutures are placed externally instead of internally. Of 716 boys who did not have penoscrotal skin tacking performed, 11 (1.5%) developed concealment. None of the 57 boys who had penoscrotal skin tacking developed concealment. Adding just a couple of minutes to the procedure and with no documented side effects, external penoscrotal skin tacking during Gomco circumcision appears to be a promising addition to the pediatric urology armamentarium.

Himen imperforat en el diagnòstic diferencial de la massa vaginal / Himen imperforado en el diagnóstico diferencial de la masa vaginal / Imperforate hymen in the differential diagnosis of a vaginal mass

Introducció. L’himen és una membrana que envolta i cobreix parcialment l’introit vaginal. La presència d’un himen imperforat pot passar desapercebuda, donar símptomes obstructius de l’aparell genital i del tracte urinari en el període neonatal o presentar-se com a dolor abdominal amb amenorrea en l’adolescència, com a clínica més freqüent. Cas clínic. Presentem el cas d’una pacient de dos mesos amb diagnòstic d’himen imperforat, amb una fístula preauricular esquerra i una hèrnia umbilical concomitant. Davant de la manca de simptomatologia, s’adopta una conducta expectant fins als quatre anys; amb la persistència de l’hèrnia umbilical, s’indica la cirurgia correctora dels tres defectes, que es duu a terme sense incidències. Posteriorment, la pacient presenta una evolució correcta sense recidives. Comentari. L’obstrucció vaginal congènita sol detectar-se clínicament en la pubertat i és diagnosticada de forma poc freqüent durant el període de lactant. L’himen imperforat és la malformació congènita vaginal i l’anomalia obstructiva de l’aparell reproductor femení més freqüent, però no és l’única; per aquest motiu, és important fer un correcte diagnòstic diferencial de les masses vaginals, per donar el millor tractament dirigit i evitar una morbimortalitat més alta dels pacients. (AU)

Introducción. El himen es una membrana que rodea y cubre parcialmente el introito vaginal. La presencia de un himen imperforado puede pasar desapercibida, dar síntomas obstructivos del aparato genital y del tracto urinario en el período neonatal o presentarse como dolor abdominal con amenorrea en la adolescencia, como clínica más frecuente. Caso clínico. Presentamos el caso de una paciente de dos meses con diagnóstico de himen imperforado, con una fístula preauricular izquierda y una hernia umbilical concomitante. Ante la ausencia de sintomatología, se adopta una conducta expectante hasta los cuatro años; con la persistencia de la hernia umbilical se indica la cirugía correctora de los tres defectos, que se lleva a cabo sin incidencias. Posteriormente, la paciente presenta una correcta evolución sin recidivas. Comentario. La obstrucción vaginal congénita suele detectarse clínicamente en la pubertad y es diagnosticada de forma poco frecuente durante el período de lactante. El himen imperforado es la malformación congénita vaginal y la anomalía obstructiva del aparato reproductor femenino más frecuente, pero no es la única; por este motivo, es importante la realización de un correcto diagnóstico diferencial de las masas vaginales para dar el mejor tratamiento dirigido y evitar una mayor morbimortalidad en los pacientes. (AU)

Introduction. The hymen is a membrane that surrounds and partially covers the vaginal entrance. The presence of an imperforate hymen may go unnoticed, give obstructive symptoms of the genital tract and urinary tract in the neonatal period, or most commonly present as abdominal pain with amenorrhea in adolescence. Case report. We present a two-month-old girl diagnosed with imperforate hymen, with a left preauricular fistula and a concomitant umbilical hernia. In the absence of symptoms, conservative management was followed until four years of age, when with the persistence of the umbilical hernia corrective surgery of the three defects was performed without complications. Comments. Congenital vaginal obstruction usually occurs clinically during puberty and is rarely diagnosed during infancy. Imperforate hymen is the most common congenital vaginal malformation and obstructive anomaly of the female reproductive tract, although not the only one; for this reason, it is important to make a correct differential diagnosis of a vaginal mass in children to optimize management. (AU)

Coexistència de la malaltia de Wilkie i la síndrome del trencanous / Coexistencia de enfermedad de Wilkie y síndrome del cascanueces / Simultaneous occurrence of Wilkie and nutcracker syndromes

Introducció. La síndrome de l’artèria mesentèrica superior,o malaltia de Wilkie, i la síndrome de compressió de lavena renal esquerra, o síndrome del trencanous, són pocfreqüents. Normalment estan provocades per una compressió extrínseca del duodè o de la vena renal esquerra, respectivament, a causa d’una disminució de l’angle entrel’artèria mesentèrica superior i l’aorta.Cas clínic. Adolescent de 15 anys que va consultar a urgències per dolor abdominal de cinc mesos d’evolució localitzata l’epigastri, acompanyat de vòmits, proteïnúria i pèrdua depes. La pacient havia consultat prèviament en altres centresi s’havien descartat patologies urgents quirúrgiques. Es vacompletar l’estudi amb una tomografia computada abdominal amb diagnòstic de síndrome de l’artèria mesentèricasuperior i síndrome del trencanous. La pacient va ingressara la planta d’hospitalització i es va tractar de forma conservadora amb una dieta hipercalòrica; el trànsit intestinal i laproteïnúria van millorar, i va poder ser remesa a domicili icontrolada ambulatòriament de forma multidisciplinària.Comentari. Els problemes secundaris a la compressió aortomesentèrica poden donar quadres compatibles amb la síndrome de l’artèria mesentèrica superior i la síndrome deltrencanous. El diagnòstic d’aquests quadres pot resultarcomplex per la incidència baixa i per la simptomatologiainespecífica que els caracteritza. El tractament conservador representa la primera línia de tractament, però en alguns casos pot no ser suficient. Per tot això és necessarifer un maneig multidisciplinari d’aquests pacients. (AU)

Introducción. El síndrome de la arteria mesentérica superior o deWilkie y el síndrome del cascanueces son poco frecuentes. Normalmente están producidos por una compresión extrínseca delduodeno o de la vena renal izquierda, respectivamente, debido a una disminución del ángulo entre la arteria mesentérica superior yla aorta.Caso clínico. Adolescente de 15 años que consultó a urgencias pordolor abdominal de cinco meses de evolución localizado en epigastrio, acompañado de vómitos, proteinuria y pérdida de peso. Lapaciente había consultado previamente en otros centros descartando patologías urgentes quirúrgicas. Se completó el estudio conuna tomografía computarizada abdominal con diagnóstico de síndrome de la arteria mesentérica superior o de Wilkie y síndrome delcascanueces. La paciente ingresó en planta de hospitalización y setrató de forma conservadora con una dieta hipercalórica con mejoría del tránsito intestinal y de la proteinuria, y pudo ser remitida adomicilio y controlada ambulatoriamente de forma multidisciplinar.Comentario. Los problemas secundarios a la compresión aortomesentérica pueden dar cuadros compatibles con el síndrome de laarteria mesentérica superior o de Wilkie y el síndrome del cascanueces. El diagnóstico de estos cuadros puede resultar complejo por subaja incidencia y por la sintomatología inespecífica que los caracteriza. El tratamiento conservador representa la primera línea de tratamiento, pero en algunos casos puede no ser suficiente. Por estosmotivos es necesario un manejo multidisciplinar de estos pacientes. (AU)

Introduction. The superior mesenteric artery syndrome or Wilkiesyndrome and the nutcracker syndrome are rare. They are normallycaused by extrinsic compression of the duodenum or the left renalvein respectively, due to a narrowing of the angle between the superior mesenteric artery and the aorta.Case report. A 15-year-old girl presented to the emergency roomwith a five-month history of abdominal pain located in the epigastrium, accompanied by vomiting, proteinuria, and weight loss. Thepatient had previously consulted in other centers, and urgent surgical conditions were ruled out. The study was completed with anabdominal computed tomography scan, which led to the diagnosisof superior mesenteric artery or Wilkie syndrome, and nutcrackersyndrome. The patient was admitted to the hospital and treatedconservatively with a hypercaloric diet with improvement in intestinal transit and proteinuria. She was discharged to continue thefollow-up with a multidisciplinary team. Comment. Problems secondary to aortomesenteric compression cangive symptoms like superior mesenteric artery or Wilkie syndromeand nutcracker syndrome. The diagnosis of these conditions canbe complex due to their low incidence and the non-specific symptomatology that characterizes them. Conservative treatment represents the first line of treatment, but in some cases it may not beenough. For these reasons, multidisciplinary management of thesepatients is necessary. (AU)

Gomco circumcision in the office in patients heavier than 5.5 Kg and/or older than 3 months.

INTRODUCTION: Although most pediatric urologists do not perform clamp circumcisions in boys older than 3 months or heavier than 5.5 kg, there are no universally accepted guidelines on the optimal patient age or weight. OBJECTIVE: To compare outcomes of office circumcision within and outside these traditional patient parameters. METHODS: This is a retrospective review of circumcisions performed by a single surgeon from 2019 to 2022. Demographics reviewed include age and weight at time of circumcision, gestational weeks at birth, as well as post-procedure: bleeding, planned and unplanned visits, adhesions/concealment, and interventions related to the circumcision. "Active Bleeding" was defined as bleeding occurring after discharge requiring intervention with pressure, sutures, or cautery. "All Bleeding" included Active Bleeding, and cases where bleeding was controlled at home with pressure, stopped by the time of arrival at clinic or emergency department, and immediate bleeding after circumcision controlled before discharge. RESULTS: During the study period, 773 Gomco circumcisions were performed. A total of 603 patients (78%) had post-procedure evaluation 2 weeks after circumcision. 574 patients (74%) were less than 5.5 kg and 199 (26%) over. Only age corrected for gestation was used in the study: 658 (85%) were younger than 3 months and 115 (15%) older. There was no significant difference in Active Bleeding based on weight (p = 0.3819) or age (p = 0.2798), and no difference in All Bleeding based on weight (p = 0.2072). There was a significant difference (p = 0.0258) in All Bleeding based on age. There was also a significant difference in unexpected visits based on weight (p = 0.0258) and age (p = 0.0131). With regards to adhesions, there was no statistical significant differences when comparing weight or age. However, older and heavier boys had significantly more concealment (5% vs <1%). DISCUSSION: Our study showed Active Bleeding rates 0.5-0.9% higher in the older and heavier group, although the difference did not reach statistical significance. We found a significantly increased rate of unexpected post-procedure visits of around 3.5-4.7% in those patients older than 3 months and heavier than 5.5 kg. Also, post -procedure concealment was significantly increased in the older and heavier boys. Modifications of the dressing for high risk groups could reduce the risk of bleeding, and efforts on pre-circumcision education of the families might ameliorate unexpected visits. Exlcuding patients with hidden penis or performing penoscrotal skin tacking at the time of the gomco circumcision could decrease concealment rates in the higher risk patients. CONCLUSIONS: Gomco clamp circumcision is safe in patients over 5.5 kg and older than 3 months, with a less than 1% higher risk of bleeding, which in the current study was controlled without the need for general anesthesia or transfusions. Broadening the inclusion criteria for office clamp circumcisions could reduce costs and make the procedure available to patients who cannot afford to have the surgery under general anesthesia.

Astrocytic engagement of the corticostriatal synaptic cleft is disrupted in a mouse model of Huntington's disease.

Astroglial dysfunction contributes to the pathogenesis of Huntington's disease (HD), and glial replacement can ameliorate the disease course. To establish the topographic relationship of diseased astrocytes to medium spiny neuron (MSN) synapses in HD, we used 2-photon imaging to map the relationship of turboRFP-tagged striatal astrocytes and rabies-traced, EGFP-tagged coupled neuronal pairs in R6/2 HD and wild-type (WT) mice. The tagged, prospectively identified corticostriatal synapses were then studied by correlated light electron microscopy followed by serial block-face scanning EM, allowing nanometer-scale assessment of synaptic structure in 3D. By this means, we compared the astrocytic engagement of single striatal synapses in HD and WT brains. R6/2 HD astrocytes exhibited constricted domains, with significantly less coverage of mature dendritic spines than WT astrocytes, despite enhanced engagement of immature, thin spines. These data suggest that disease-dependent changes in the astroglial engagement and sequestration of MSN synapses enable the high synaptic and extrasynaptic levels of glutamate and K+ that underlie striatal hyperexcitability in HD. As such, these data suggest that astrocytic structural pathology may causally contribute to the synaptic dysfunction and disease phenotype of those neurodegenerative disorders characterized by network overexcitation.

Do patients with Peyronie's disease perceive penile curvature in adults and children differently than the general population?

BACKGROUND: As perception of penile curvature varies widely, we sought to understand how adults perceive curvature and how these opinions compare with those of patients with curvature, specifically Peyronie's disease (PD). AIM: To investigate the perspectives of curvature correction from adults with and without PD, as well as differences within demographics. METHODS: A cross-sectional survey was administered to adult patients and nonpatient companions in general urology clinics at 3 institutions across the United States. Men, women, and nonbinary participants were recruited. Patients were grouped as having PD vs andrology conditions without PD vs general urology conditions plus companions. The survey consisted of unlabeled 2-dimensional images of penis models with varying degrees of curvature. Participants selected images that they would want surgically corrected for themselves and their children. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to correct. OUTCOMES: Our main outcome was to detect differences in threshold to correct curvature between those with and without PD. RESULTS: Participants were grouped as follows: PD (n = 141), andrology (n = 132), and general (n = 302) . Respectively, 12.8%, 18.9%, and 19.9% chose not to surgically correct any degree of curvature (P = .17). For those who chose surgical correction, the mean threshold for correction was 49.7°, 51.0°, and 51.0° (P = .48); for their children, the decision not to correct any degree of curvature was 21.3%, 25.4%, and 29.3% (P = .34), which was significantly higher than correction for themselves (P < .001). The mean threshold for their children's correction was 47.7°, 53.3°, and 49.4° for the PD, andrology, and general groups (P = .53), with thresholds no different vs themselves (P = .93). On multivariable analysis, no differences were seen in demographics within the PD and andrology groups. In the general group, participants aged 45 to 54 years and those who identified as LGBTQ (lesbian, gay, bisexual, transgender, queer) had a higher threshold for correction as compared with their counterparts when factoring other demographic variables (63.2° vs 48.8°, P = .001; 62.1° vs 50.4°, P = .05). CLINICAL IMPLICATIONS: With changing times and viewpoints, this study stresses the importance of shared decision making and balancing risks and benefits to correction of penile curvature. STRENGTHS AND LIMITATIONS: Strengths include the broad population surveyed. Limitations include the use of artificial models. CONCLUSION: No significant differences were seen in the decision to surgically correct curvature between participants with and without PD, with participants being less likely to choose surgical correction for their children.

Pediatric urologists' confidence and accuracy in estimating penile curvature.

BACKGROUND: Assessment and management of congenital penile curvature (PC) can be variable. Methods for correction of PC usually are dependent on degree of PC which is reliant on how degree is assessed. We sought to assess the confidence and accuracy of measuring PC and hence management using case-based examples. METHODS: A survey was emailed to members of the Societies for Pediatric Urology. Demographic information, management strategies for PC, and self-reported confidence in measuring PC were assessed. A Likert scale measured self-confidence. Case scenarios were used to assess ability to measure PC and methods of correction. The cases consisted of three computer-generated penis model images with arc-type ventral curvature and one image of lateral curvature in an infant. RESULTS: The response rate was 30% (108/355). The mean confidence score was 3.6 ± 0.8 (3-fairly confident; 4-very confident). In clinic, 89% of urologists used eyeball estimates to assess PC; 5% used both eyeball and goniometer. In the operating room, 71% used eyeball estimates, 8% used goniometer, and 16% used both. If sole decision-maker, urologists recommend surgical correction of PC over observation at median 30° (IQR 21-30°). At a median of 45°, there was a shift in corrective surgical preference from dorsal plication (DP) (IQR 30-54°) to ventral lengthening (IQR 34-60°). Urologists underestimated PC degree for all cases (summary table). For all cases, there was no association between years in practice or confidence level on estimated PC degree. In case 1, only 24% of urologists would correct a mean estimate of 23° PC; those who would correct had a higher mean PC estimate vs those who would not (28° vs 21°, p < 0.001). Case 2 and 4 had similar estimations and correction methods. In case 2, those who chose VL had a higher mean PC estimate vs those who did not (43° vs 37°, p < 0.01), but no estimate difference was seen for DP (p = 0.52). In case 4 with lateral PC, those who chose DP had a higher mean PC estimate vs those who did not (41° vs 33°, p = 0.049). Yet in case 3, there was no difference in PC estimate in urologists who chose VL vs not (57° vs 53°, p = 0.16). CONCLUSIONS: A uniform underestimation of PC existed despite self-reported confidence in the ability to measure PC. An increasing willingness to perform surgical correction was demonstrated with a shift towards VL for ventral curvature and less so for lateral curvature as PC worsens.

Pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?

OBJECTIVES: Ureteral stents are commonly used during pyeloplasty to ensure drainage and anastomotic healing. Antibiotic prophylaxis is often used due to concerns for urinary tract infection (UTI). Although many surgeons prescribe prophylactic antibiotics following pyeloplasty, practices vary widely due to lack of clear evidence-based guidelines. We hypothesize that the rate of stent UTI does not significantly vary between children who receive antibiotics and those who do not. METHODS: We reviewed the medical records of 741 patients undergoing pyeloplasty between January 2010 and July 2018 across seven institutions. Exclusion criteria were: age older than 22 years, no stent placed, externalized stents used, and incomplete records. Surgical approach, age, antibiotic use, stent duration, Foley duration, and urine culture results were recorded. Patients were categorized into two groups, those younger than four years of age and those four years and older as proxy for likely diaper use. Univariate logistic regression was conducted to identify variables associated with UTI. Multivariable backward stepwise logistic regression was used to identify the best model with Akaike information criterion as model selection criteria. The selected model was used to calculate odds ratios and 95% confidence intervals summarizing the association between prophylactic antibiotics and stent UTI while controlling for age, gender, and intra-operative urine cultures. RESULTS: 672 patients were included; 338 received antibiotic prophylaxis and 334 did not. These groups differed in mean age (3.91 vs. 6.91 years, P < .001), mean stent duration (38.5 vs. 35.32 days, P < .001), and surgical approach (53.25% vs. 32.04% open vs. laparoscopic, P < .001). The incidence of stent UTI was low overall (7.59%) and similar in both groups: 31/338 (9.17%) in the prophylaxis group and 20/334 (5.99%) in the non-prophylaxis group (P = .119). Although female gender, likely diaper use, and positive intra-operative urine culture were each associated with significantly higher odds of stent UTI, prophylactic antibiotic use was not associated with significant reduction in stent UTI in any of these groups. Surgical approach, stent duration, and Foley duration were not associated with stent UTI. CONCLUSION: Incidence of stent UTI is low overall following pyeloplasty. Prophylactic antibiotics are not associated with lower rates of stent UTI following pyeloplasty even after controlling for risk factors of female gender, likely diaper use, and positive intra-operative urine culture. Routine administration of prophylactic antibiotics after pyeloplasty does not appear to be beneficial, and may be best reserved for those with multiple risk factors for UTI.

Factores de riesgo biomecánico lumbar por manejo manual de cargas en el reparto de productos cárnicos / Lumbar biomechanical risk factors due to manual handling of loads in the distribution of meat products

Introducción: Identificar los factores de riesgo de trastornos musculoesqueléticos (TME) lumbares asociados al manejo manual (MMC) de productos cárnicos en las actividades de carga y descarga de camiones. Método: Estudio observacional descriptivo transversal con enfoque mixto, basado en el análisis ergonómico de la actividad de trabajo. Participaron los 4 trabajadores de los puestos de cargador y cargador-conductor. Se realizaron análisis cinemáticos y dinamométricos para determinar las fuerzas de compresión y cizallamiento y el riesgo biomecánico musculoesquelético en la zona lumbar. Se realizaron entrevistas y observaciones para analizar tareas y determinar los tiempos involucrados en cada operación, tipo de exposición y los determinantes de la actividad de trabajo. Resultados: El contexto de trabajo es sumamente variable durante la carga y descarga del camión, considerando la variabilidad en cada punto de entrega las características de los estacionamientos, las condiciones climáticas, la presencia de animales y otros obstáculos durante el transporte manual de la carga. El MMC produce fuerzas sobre los 4000 N de compresión discal en los niveles L4-L5 y L5-S1, las fuerzas iniciales de empuje y arrastre fueron de 51.2 kg*f y 27.3 kg*f respectivamente, lo que evidencia el riesgo de TME. La actividad de trabajo está determinada por el tipo de jornada, la organización del reparto y la falta de medios mecánicos de apoyo para la carga y descarga de los camiones. Conclusiones: Las tareas de MMC en esta industria son físicamente muy exigentes y mejorar estas condiciones de trabajo representa un desafío importante para la prevención (AU)

Introduction: Identify risk factors for lumbar musculoskeletal disorders (MSD) associated with manual handling (MHL) of meat products in truck loading and unloading activities. Method: Cross-sectional descriptive observational study with a mixed approach, based on ergonomic analysis of work activity. The 4 workers from the loader and loader-driver positions participated. Kinematic and dynamometric analyzes were performed to determine compression and shear forces and musculoskeletal risk in the lumbar area. Interviews and observations were conducted to analyze tasks and determine the times involved in each operation, type of exposure and the determinants of work activity. Results: The work context is highly variable during the loading and unloading of the truck, considering the variability at each delivery point the characteristics of the parking lots, weather conditions, the presence of animals and other obstacles during manual transport of the load. The MHL produces forces over 4000 N of disc compression at levels L4-L5 and L5-S1, the initial push and pull forces were 51.2 kg*f and 27.3 kg*f respectively, which shows the risk of MSD. The work activity is determined by the type of working day, the organization of the distribution and the lack of mechanical means to support the loading and unloading of trucks. Conclusions: The manual handling tasks in this industry are physically very demanding and improving these working conditions represents a significant challenge for prevention (AU)

[Lumbar biomechanical risk factors due to manual handling of loads in the distribution of meat products]. / Factores de riesgo biomecánico lumbar por manejo manual de cargas en el reparto de productos cárnicos.

INTRODUCTION: Identify risk factors for lumbar musculoskeletal disorders (MSD) associated with manual handling (MHL) of meat products in truck loading and unloading activities. METHOD: Cross-sectional descriptive observational study with a mixed approach, based on ergonomic analysis of work activity. The 4 workers from the loader and loader-driver positions participated. Kinematic and dynamometric analyzes were performed to determine compression and shear forces and musculoskeletal risk in the lumbar area. Interviews and observations were conducted to analyze tasks and determine the times involved in each operation, type of exposure and the determinants of work activity. RESULTS: The work context is highly variable during the loading and unloading of the truck, considering the variability at each delivery point the characteristics of the parking lots, weather conditions, the presence of animals and other obstacles during manual transport of the load. The MHL produces forces over 4000 N of disc compression at levels L4-L5 and L5-S1, the initial push and pull forces were 51.2 kg*f and 27.3 kg*f respectively, which shows the risk of MSD. The work activity is determined by the type of working day, the organization of the distribution and the lack of mechanical means to support the loading and unloading of trucks. CONCLUSIONS: The manual handling tasks in this industry are physically very demanding and improving these working conditions represents a significant challenge for prevention.

Introducción: Identificar los factores de riesgo de trastornos musculoesqueléticos (TME) lumbares asociados al manejo manual (MMC) de productos cárnicos en las actividades de carga y descarga de camiones. Método: Estudio observacional descriptivo transversal con enfoque mixto, basado en el análisis ergonómico de la actividad de trabajo. Participaron los 4 trabajadores de los puestos de cargador y cargador-conductor. Se realizaron análisis cinemáticos y dinamométricos para determinar las fuerzas de compresión y cizallamiento y el riesgo biomecánico musculoesquelético en la zona lumbar. Se realizaron entrevistas y observaciones para analizar tareas y determinar los tiempos involucrados en cada operación, tipo de exposición y los determinantes de la actividad de trabajo. Resultados: El contexto de trabajo es sumamente variable durante la carga y descarga del camión, considerando la variabilidad en cada punto de entrega las características de los estacionamientos, las condiciones climáticas, la presencia de animales y otros obstáculos durante el transporte manual de la carga. El MMC produce fuerzas sobre los 4000 N de compresión discal en los niveles L4-L5 y L5-S1, las fuerzas iniciales de empuje y arrastre fueron de 51.2 kg*f y 27.3 kg*f respectivamente, lo que evidencia el riesgo de TME. La actividad de trabajo está determinada por el tipo de jornada, la organización del reparto y la falta de medios mecánicos de apoyo para la carga y descarga de los camiones. Conclusiones: Las tareas de MMC en esta industria son físicamente muy exigentes y mejorar estas condiciones de trabajo representa un desafío importante para la prevención.

La risa: niveles y factores demográficos, en el contexto de la COVID-19 / Laughter: demographic levels and factors, in the context of COVID-19

Introducción: La pandemia no se detiene, los estudios sobre la misma tampoco; esta pandemia produce dolor, tristeza, desesperación y muertes, cuyos números son incalculables. Ante esta situación difícil y dolorosa, la risa levanta su bandera de esperanza. Objetivo: El estudio tiene el objetivo de describir los niveles y los factores demográficos de la risa, en el contexto la COVID-19. Métodos: El estudio corresponde a un enfoque cuantitativo, de tipo descriptivo, de corte transversal. Los datos sobre los niveles de la risa se obtuvieron mediante una encuesta virtual, cuyos participantes fueron 101, de edades entre 20 y 60 años, quienes participaron voluntariamente, procedentes de las tres regiones del Perú: costa, sierra y selva. Los datos sobre la experiencia de la risa, con misma encuesta, con el tipo Likert: nunca, a veces y siempre. Resultados: De los 101 participantes, 87 (entre 20 y 60 años) presentan una risa en el nivel alto y 14 en el nivel medio. 14 participantes (entre solteros, casados, divorciados y convivientes) revelan una risa en el nivel medio y 87 en el nivel alto. De las tres regiones (costa, sierra y selva), 14 participantes se ubican en el nivel medio y 87 en el nivel alto. Por otro lado, 6 hombres y 8 mujeres practican una risa ubicada en el nivel medio, en el alto 28 y 59, respectivamente. En el factor: religión, 14 (entre católicos, adventistas, evangélicos y otros) revelan una sonrisa en el nivel medio, 87 en el alto. Según el factor: nivel de estudios (primario, secundario y superior), 14 y 87 ubican su risa en el nivel bajo y alto, respectivamente. En el círculo familiar y de los amigos, se experimenta siempre la risa: 58.4% y 66.3%, respectivamente; para los encuestados es más fácil reír, siempre, 54.5% y 66.3%, en el entorno familiar y de los amigos, respectivamente. Declararon que la risa previene las enfermedades, fortalece la salud, evita el covid-19, fortalece el sistema inmunológico y limita la producción de la hormona cortisol (responsable del estrés), siempre 70.3%, 31.7%, 81.2; 31.7%, 71.3% y 83.2%, respectivamente. Conclusión: En el contexto de la COVID-19, los niveles más significativos de la risa encontrados en el estudio son dos: medio y alto; los factores demográficos más ponderados son: edad, sexo, religión y estado laboral.

Introduction: The pandemic does not stop, neither does the studies on it; This pandemic produces pain, sadness, despair and deaths, the numbers of which are incalculable. Faced with this difficult and painful situation, laughter raises its flag of hope. Objective: The study aims to describe the levels and demographic factors of laughter, in the context of COVID-19. Methods: The study corresponds to a quantitative, descriptive, cross-sectional approach. The data were obtained through a virtual survey, whose participants were 101, from the three regions. Results: Of the 101 participants, 87 (between 20 and 60 years old) are located in the high level and 14 in the medium level. Similarly, 14 (among single, married, divorced and cohabitants) in the medium level and 87 in the high level. Of the three regions (coast, mountains and jungle), 14 in the medium level and 87 in the high level. On the other hand, 6 men and 8 women are in the medium level, in the high 28 and 59, respectively. In the factor: religion, 14 (among Catholics, Adventists, Evangelicals and others) in the medium level, 87 in the high. According to the factor: educational level (primary, secondary and higher), 14 and 87 are located in the low and high level, respectively. In the family and friends circle, laughter is always experienced: 58.4% and 66.3%, respectively; for respondents it is easier to laugh, always, 54.5% and 66.3%, in the family environment and with friends, respectively. They declared that laughter prevents diseases, strengthens health, prevents covid-19, strengthens the immune system and limits the production of the hormone cortisol (responsible for stress), always 70.3%, 31.7%, 81.2; 31.7%, 71.3% and 83.2%, respectively. Conclusion: In the context of COVID-19, the most significant levels of laughter found in the study are two: medium and high; the most weighted demographic factors are: age, sex, religion, and employment status.

Cell-intrinsic glial pathology is conserved across human and murine models of Huntington's disease.

Glial pathology is a causal contributor to the striatal neuronal dysfunction of Huntington's disease (HD). We investigate mutant HTT-associated changes in gene expression by mouse and human striatal astrocytes, as well as in mouse microglia, to identify commonalities in glial pathobiology across species and models. Mouse striatal astrocytes are fluorescence-activated cell sorted (FACS) from R6/2 and zQ175 mice, which respectively express exon1-only or full-length mHTT, and human astrocytes are generated either from human embryonic stem cells (hESCs) expressing full-length mHTT or from fetal striatal astrocytes transduced with exon1-only mHTT. Comparison of differential gene expression across these conditions, all with respect to normal HTT controls, reveals cell-type-specific changes in transcription common to both species, yet with differences that distinguish glia expressing truncated mHTT versus full-length mHTT. These data indicate that the differential gene expression of glia expressing truncated mHTT may differ from that of cells expressing full-length mHTT, while identifying a conserved set of dysregulated pathways in HD glia.

Síndrome neuroléptico maligno en la urgencia pediátrica / Neuroleptic malignant syndrome in pediatrics. A case report

El síndrome neuroléptico maligno es una urgencia pediátrica con una elevada morbimortalidad, relacionada con alteración de sistema de neurotransmisión dopaminérgico. Se caracteriza por hipertermia junto con hipertonía muscular, alteración autonómica y de los niveles de conciencia. Un diagnóstico precoz es imprescindible para prevenir complicaciones comunes como la broncoaspiración, desgaste, escaras, procesos infecciosos y cambios neuropsiquiátricos. El tratamiento debe incluir en medidas generales de soporte y terapéutica farmacológica sintomática. Pese a que la mayoría de los casos descritos corresponden a población adulta, también se ha descrito en niños y adolescentes. Presentamos un caso de síndrome neuroléptico maligno en un adolescente de 12 años con encefalopatía y tetraparesia espática secundario al cese de la administración de baclofeno

Neuroleptic malignant syndrome is a pediatric emergency with high morbidity and mortality, related to an alteration of the dopaminergic neurotransmission system. It is characterized by hyperthermia along with muscular hypertonia, dysautonomia, and altered level of consciousness. An early diagnosis is essential to prevent common complications such as bronchoaspiration, wear, bedsores, infectious processes, and neuropsychiatric changes. Treatment should include general support measures and symptomatic pharmacological therapy. Although most of the cases described correspond to the adulthood, it has also been described in children and adolescents. We present a case of neuroleptic malignant syndrome in a 12-year-old adolescent with encephalopathy and spastic tetraparesis secondary to the cessation of baclofen administration

Standardization of penile angle estimation with a semi-automated algorithm.

INTRODUCTION: Penile curvature (PC) refers to an abnormal bending of the main longitudinal axis of the penis. It is frequently associated to hypospadias. To date, accurate and objective evaluation of PC is not easily reproducible amongst surgeons and there are no stablished protocols on how to measure PC in a standard way and in real-time to guide intraoperative decision making. For this reason, we want to present the results of creating a semi-automated algorithm to establish a reproducible and objective assessment of PC and propose it as a standard protocol for clinical applicability using inanimate 3-D penile models. METHODS: This project consisted in two different phases. 1. Creation of an automated algorithm to estimate penile angle based on digital images. 2 Use of the algorithm to estimate penile angle on 3-D models and estimate interrater agreement using the algorithm. The algorithm was created to initially identify the geometrical centerline of the penile model to establish an automated output for angle estimation. 3-D printed penile models with known curvature angles ranging from 10 to 90° were used to test the algorithm (total of 9 penile models. These models were curved at one hinge as opposed to an arc type model. For each inanimate model, a set of 5 pictures were obtained from a lateral view at different camera angles (00, 150, 300, 450 and 600) at a standard distance of 75 cm. Angle estimation using our designed PC algorithm was performed by a total of 10 different evaluators. Inter-rater reliability analysis in using the semiautomated algorithm was performed using the inter-class correlation coefficient (ICC) with two-way mixed effect model. RESULTS: If the camera angle was greater than 30°, the absolute angle mean difference was greater than 10°. Camera angle with the smallest mean difference was at 00 with a mean difference of 7.83°. Agreement between raters showed greater variability towards the higher camera angles. Nonetheless, a high degree of between evaluator reliability was found between the measurements at different camera angles. Single measures ICC ranges from .873 to .946, p-values were all <.0001. CONCLUSION: Our results help standardize PC assessment using digital images and reduce subjectivity using an algorithm for PC estimation. Optimal camera position between 00 to 300 vertical from the penis gives the least variable and most accurate angle estimation. Future studies using algorithms will help define predictive PC cutoff values and evaluate postoperative outcomes.

Acute Acalculous Cholecystitis Due to a Primary Epstein Barr Virus Infection in a Pediatric Patient.

Epstein-Barr virus (EBV) is estimated to infect more than 98% of adults worldwide and is one of the most common human viruses. Acute acalculous cholecystitis (AAC) of the gallbladder is an atypical complication of infectious mononucleosis caused by EBV. Conservative management has been described in the context of AAC caused by EBV. A surgical approach must be considered in the case of acute complications such as perforation or gallbladder gangrene. We present the case of a 10-year-old female patient with AAC due to infectious mononucleosis syndrome caused by primary EBV infection.