Complicaciones agudas hospitalarias en adultos mayores con Enfermedad Cerebrovascular asociadas a características neuro-geriátricas / Acute hospital complications in older adults with Cerebrovascular Disease associated with neurogeriatric characteristics

INTRODUCCIÓN: La enfermedad cerebrovascular en los adultos mayores tiene implicaciones clínicas, sociales y económicas que pueden comprometer la funcionalidad y la calidad de vida. Es importante determinar las complicaciones que puede presentar el paciente geriátrico con enfermedad cerebrovascular durante los días de estancia hospitalaria. OBJETIVO: Determinar las características neuro-geriátricas asociadas a las complicaciones agudas no neurológicas y los días de hospitalización de los pacientes adultos mayores con enfermedad cerebrovascular. MATERIALES Y MÉTODOS: Estudio descriptivo prospectivo. Población de 120 y muestra de 73 pacientes mayores de 65 años con enfermedad cerebro vascular de la Unidad de Neurología del Hospital Carlos Andrade Marín que inició en agosto de 2020 y culminó en enero 2021. Se excluyó a pacientes que no cumplieron el criterio mencionado, con dependencia funcional total previa, patologías psiquiátricas previas, o personas que no aceptaron ser parte del estudio. Se efectuó el seguimiento de los pacientes desde el ingreso hasta el alta hospitalaria, para identificar complicaciones agudas no neurológicas y días de hospitalización. Se determinó las características neuro-geriátricas mediante las escalas de Barthel, Gijón, Charlson, Norton, Glasgow y NIHSS. Se obtuvo riesgo relativo e intervalos de confianza, considerando significativo un valor p<0,05. RESULTADOS: La edad media fue de 77 (±8,5) años. Las complicaciones fueron infección de tracto urinario (22,0%), neumonía (20,0%), desequilibrio hidroelectrolítico (19,0%), disfagia (13,0%) y úlceras por presión (9,0%). Las complicaciones que se presentaron significativamente ante una estancia hospitalaria prolongada comparada con quienes no las presentaron fueron la Neumonía (Media 5,81 (1,47 a 10,16) con IC 95%) y la infección del tracto urinario (Media 4,95 (1,52 a 8,38) con IC 95%). Según las características neuro-geriátricas y las complicaciones, encontramos diferencia estadísticamente significativa solo con en el grupo de riesgo bajo, según la escala de Norton RR 0,744 con IC 95% (0,584 - 0,949). CONCLUSIONES: Es importante realizar la valoración geriátrica integral al paciente neurológico tanto al ingreso como al egreso hospitalario, ya que permite detectar complicaciones que pueden pasar desapercibidas y prolongar la estancia hospitalaria.

INTRODUCTION: Cerebrovascular disease in older adults has clinical, social, and economic implications that can compromise functionality and quality of life. It is important to determine the complications that the geriatric patient with cerebrovascular disease may present during hospital days. OBJECTIVE: To determine the neuro-geriatric characteristics associated with acute non-neurological complications and hospital days in older adult patients with cerebrovascular disease. MATERIALS AND METHODS: Prospective descriptive study. Population of 120 and sample of 73 patients older than 65 years with cerebrovascular disease from the Neurology Unit of the Carlos Andrade Marín Hospital that began in August 2020 and culminated in January 2021. Patients who did not meet the aforementioned criteria, with previous total functional dependence, previous psychiatric pathologies, or people who did not agree to be part of the study were excluded. Patients were followed up from admission to hospital discharge to identify acute non-neurological complications and days of hospitalization. Neuro-geriatric characteristics were determined using the Barthel, Gijon, Charlson, Norton, Glasgow and NIHSS scales. Relative risk and confidence intervals were obtained, considering a p-value <0.05 as significant. RESULTS: Mean age was 77 (±8.5) years. Complications were urinary tract infection (22.0%), pneumonia (20.0%), water and electrolyte imbalance (19.0%), dysphagia (13.0%) and pressure ulcers (9.0%). Complications that occurred significantly in the face of a prolonged hospital stay compared to those who did not present were Pneumonia (Mean 5.81 (1.47 to 10.16) with 95% CI) and urinary tract infection (Mean 4.95 (1.52 to 8.38) with 95% CI). According to neuro-geriatric characteristics and complications, we found statistically significant difference only with in the low risk group, according to the Norton scale RR 0.744 with 95% CI (0.584 - 0.949). CONCLUSIONS: It is important to perform comprehensive geriatric assessment of the neurological patient both on admission and hospital discharge, as it allows the detection of complications that may go unnoticed and prolong hospital stay.

Enfoque médico social de la enfermedad renal crónica en Pediatría / Medical and social approach to chronic kidney disease in Paediatrics

RESUMEN Introducción: las malformaciones congénitas renales y de las vías urinarias constituyen un grupo heterogéneo de anomalías secundarias a un proceso anormal en el desarrollo embrionario del sistema renal. Objetivo: profundizar en los aspectos relacionados con el diagnóstico precoz de las malformaciones congénitas renales y de vías urinarias, como causa frecuente de la enfermedad renal crónica oculta en la edad pediátrica, desde una perspectiva integral y personalizada, sobre la base de un enfoque médico social. Métodos: se realizó una revisión sistemática sobre el tema en las bases de datos: EBSCO, SciELO, Scopus, PubMed, y en revistas de Nefrología pediátrica, de Pediatría, de Genética y de Teratología. Los artículos fueron publicados en idioma español o inglés. Se realizó un análisis de contenido directo para lograr la actualización teórica del tema con un enfoque médico social. Conclusiones: el desarrollo de la Nefrología pediátrica constituye una línea de trabajo del MINSAP. Sus principios son: la intersectorialidad, la prevención y la participación de especialidades afines (de manera que se alcancen resultados asistenciales, docentes e investigativos que determinen mayor calidad en el diagnóstico precoz de las malformaciones congénitas renales y de vías urinarias). Dicha afección es causa frecuente de la enfermedad renal crónica oculta en la edad pediátrica, desde una perspectiva integral y personalizada, sobre la base de un enfoque médico social.

ABSTRACT Introduction: congenital renal and urinary tract malformations constitute a heterogeneous group of anomalies secondary to an abnormal embryonic development of the renal system. Objective: to study in depth the aspects related to the early diagnosis of congenital renal and urinary tract malformations, as a frequent cause of occult chronic kidney disease in the paediatric age group, from an integral and personalized perspective, based on a medical and social approach. Methods: a systematic review on the subject was carried out in the following databases: EBSCO, SciELO, Scopus, PubMed, and in journals of Paediatric Nephrology, Paediatrics, Genetics and Teratology. The articles were published in Spanish or English languages. A direct content analysis was performed to achieve the theoretical update of the topic with a medical and social approach. Conclusions: the development of Paediatric Nephrology constitutes a line of work of MINSAP. Its principles are intersectoriality, prevention and participation of related specialities (in order to achieve care, teaching and research results that determine greater quality in the early diagnosis of congenital renal and urinary tract malformations). This condition is a frequent cause of occult chronic kidney disease in the paediatric age group, from an integral and personalized perspective, based on a medical and social approach.

Factores asociados a malformaciones congénitas renales y de vías urinarias / Factors associated to renal and urinary tract ´s congenital malformations

Introducción: Las malformaciones congénitas del riñón y del tracto urinario representan entre 20 y 30 por ciento de todas las malformaciones reconocidas en humanos. Objetivo: Identificar los antecedentes patológicos familiares y las enfermedades durante el embarazo asociados a la aparición de defectos congénitos renales. Métodos: Estudio descriptivo prospectivo transversal realizado en 672 niños nacidos entre julio de 2014 y junio de 2015 en Santa Clara, con ultrasonido prenatal normal. A todos los niños durante la consulta médica se les hizo examen físico detallado y previo consentimiento informado del familiar acompañante, se aplicó a estos una encuesta y se registraron variables epidemiológicas, antecedentes familiares de enfermedades renales, morbilidad de la madre durante el embarazo y se realizó un ultrasonido renal para identificar las alteraciones sonográficas sugerentes de algún tipo de anomalías del desarrollo renal. Resultados: En 40 (5,95 por ciento) pacientes se detectó alteración sonográfica. El 27,50 por ciento eran hijos de madres que presentaron alguna enfermedad durante el embarazo. La glucemia elevada afectó 10 por ciento de las madres de los niños con anomalías del desarrollo renal, seguida del bajo peso materno (7,5 por ciento). El hecho de presentar antecedente patológico familiar de enfermedad renal aportó un riesgo de 1,88 y en las de tipo obstructivo el riesgo fue de 5,08. Conclusiones: Las alteraciones sonográficas sugestivas de malformación congénita renal son más frecuentes en los lactantes cuyas madres presentaron concentraciones elevadas de glucosa y bajo peso durante el embarazo. Los niños con antecedentes familiares de malformación renal tienen mayor riesgo de presentar una anomalía del desarrollo renal(AU)

Introduction: Kidney and urinary tract´s malformations represent among 20 and 30 percent of all malformations known in humans. Objective: To identify during pregnancy family pathological history and diseases associated to the onset of renal congenital malformations. Methods: Prospective, descriptive, cross-sectional study carried out to 672 children with normal prenatal ultrasound whom were born from July, 2014 to June 2015 in Santa Clara province. All children during the medical consultation had a detailed physical examination and previous informed concent; it was applied also a survey and the epidemiologic variables, family history of renal diseases, morbility of the mother during pregnancy were recorded, and it was made a renal ultrasound to identify sonographic alterations suggesting any kind of anomaly in the renal development. Results: In 40 patients (5,95 percent), it was detected any sonographic alteration. 27,50 percent were children of mothers that presented any disease during pregnancy. High glycemia affected the 10 percent of mothers of children with anomalies in the renal development, followed by low maternal weight (7,5 percent). The fact of presenting a family pathological history of renal disease implied a risk of 1,88 percent and the risk was of 5,08 percent in the obstructive kind of diseases. Conlusions: Sonographic alterations suggesting renal congenital malformations are more frequent in newborns whose mothers had high concentrations of glycemia and low weight during pregnancy. Children with family history of renal malformations have higher risk of presenting an anomaly of the renal development(AU)

Infección del tracto urinario en la enfermedad renal crónica / Urinary tract infection in chronic kidney disease patients

Resumen Las infecciones en personas con enfermedad renal crónica son una causa importante de morbimortalidad. Los pacientes renales presentan factores de riesgo específicos para la adquisición de infecciones, que además suelen ser más graves, de progresión más rápida y de resolución más lenta que en sujetos sanos. La infección del tracto urinario en esta población es a menudo complicada debido a la presencia de diabetes, microorganismos multirresistentes, anomalías anatómicas o funcionales del tracto urinario, alteraciones metabólicas y el uso frecuente de sonda vesical. Las infecciones urinarias ocasionan una de las tasas más altas de hospitalización en diálisis y son muy prevalentes en el trasplante renal. Este trabajo tiene como objetivo revisar la literatura publicada sobre la etiología, el diagnóstico microbiológico y el tratamiento de las infecciones del tracto urinario en pacientes con enfermedad renal crónica.

Abstract Infections in chronic kidney disease patients are a major cause of morbidity and mortality. Renal patients have specific risk factors for acquiring infections, which also tend to be more severe and have a more rapid progression and slower resolution than in the healthy individuals. Urinary tract infection in renal patients is often complicated due to the presence of diabetes, multiresistant microorganisms, anatomic or functional abnormalities of the urinary tract, metabolic disturbances and the frequent use of urinary catheters. It causes one of the highest rates of hospitalization among dialysis patients and is highly prevalent in kidney transplantation. The aim of this work is to review the etiology, microbiological diagnosis and treatment of urinary tract infections in chronic kidney disease patients.

Urinary tract infection in pediatrics: an overview / Infecção do trato urinário em pediatria: uma visão geral

Abstract Objective This review aimed to provide a critical overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, chemoprophylaxis, and complications of urinary tract infection in pediatric patients. Source of data Data were obtained independently by two authors, who carried out a comprehensive and non-systematic search in public databases. Summary of findings Urinary tract infection is the most common bacterial infection in children. Urinary tract infection in pediatric patients can be the early clinical manifestation of congenital anomalies of the kidney and urinary tract (CAKUT) or be related to bladder dysfunctions. E. coli is responsible for 80-90% of community-acquired acute pyelonephritis episodes, especially in children. Bacterial virulence factors and the innate host immune systems may contribute to the occurrence and severity of urinary tract infection. The clinical presentation of urinary tract infections in children is highly heterogeneous, with symptoms that can be quite obscure. Urine culture is still the gold standard for diagnosing urinary tract infection and methods of urine collection in individual centers should be determined based on the accuracy of voided specimens. The debate on the ideal imaging protocol is still ongoing and there is tendency of less use of prophylaxis. Alternative measures and management of risk factors for recurrent urinary tract infection should be emphasized. However, in selected patients, prophylaxis can protect from recurrent urinary tract infection and long-term consequences. According to population-based studies, hypertension and chronic kidney disease are rarely associated with urinary tract infection. Conclusion Many aspects regarding urinary tract infection in children are still matters of debate, especially imaging investigation and indication of antibiotic prophylaxis. Further longitudinal studies are needed to establish tailored approach of urinary tract infection in childhood.

Resumo Objetivo Esta revisão teve como objetivo fornecer uma visão crítica da patogênese, achados clínicos, diagnóstico, investigação por imagem, tratamento, quimioprofilaxia e complicações da infecção do trato urinário em pacientes pediátricos. Fonte de dados Os dados foram obtidos de forma independente por dois autores que fizeram uma pesquisa abrangente e não sistemática em bancos de dados públicos. Síntese dos achados A infecção do trato urinário é a infecção bacteriana mais comum em crianças. Em pacientes pediátricos, pode ser a manifestação clínica precoce de anomalias congênitas do rim e trato urinário (CAKUT) ou estar relacionada a disfunções da bexiga. A E. coli é responsável por 80-90% dos episódios agudos de pielonefrite adquirida na comunidade, principalmente em crianças. Os fatores de virulência bacteriana e o sistema imunológico inato do hospedeiro podem contribuir para a ocorrência e gravidade da infecção do trato urinário. A apresentação clínica de infecções do trato urinário em crianças é altamente heterogênea, com sintomas que podem ser bastante obscuros. A cultura de urina ainda é o padrão-ouro para o diagnóstico de infecção do trato urinário e os métodos de coleta de urina em centros individuais devem ser determinados com base na precisão das amostras coletadas. O debate sobre o protocolo de imagem ideal ainda está em andamento e há uma tendência a um menor uso da profilaxia. Medidas opcionais e o manejo dos fatores de risco para infecção do trato urinário recorrente devem ser enfatizados. Entretanto, em pacientes selecionados, a profilaxia pode proteger contra infecção do trato urinário recorrente e consequências em longo prazo. Segundo estudos populacionais, hipertensão e doença renal crônica raramente são associadas à infecção do trato urinário. Conclusão Muitos aspectos relacionados à infecção do trato urinário em crianças ainda são motivo de debate, principalmente a investigação por imagem e a indicação de profilaxia com antibióticos. Estudos longitudinais adicionais são necessários para estabelecer uma abordagem personalizada da infecção do trato urinário na população pediátrica.

Analysis of Correlation and Agreement between the Uroflowmetry and the International Prostate Symptom Score in Patients after retropubic Radical Prostatectomy: A Multicenter Prospective Study[*] / Análisis de correlación y concordancia entre la uroflujometría y la escala internacional de síntomas prostáticos posterior a prostatectomía radical retropúbica: estudio multicéntrico prospectivo

Objectives Patients undergoing retropubic radical prostatectomy (RRP) may suffer from lower urinary tract symptoms (LUTS). We aim to characterize LUTS and to evaluate the correlation and agreement between uroflowmetry and the International Prostate Symptom Score (IPSS) in patients after RRP in two reference centers. Methods An observational multicenter prospective study was conducted between December 2015 and September 2016. Patients with at least 12-months of follow-up after RRP were included; these were evaluated with uroflowmetry and the IPSS. Results A total of 90 patients were included. The mean follow-up was of 54.6 months (standard deviation [SD] = 27.52), and the mean age was 65 (SD = 6.85) years old. The mean IPSS was 7.41 (SD = 6.29), with 33.3% (n = 54) of the patients with moderate symptoms and 6.7% (n = 6) with severe symptoms. A total of 50% (n = 45) of the patients had normal uroflowmetry. Patients with an abnormal/equivocal result in the uroflowmetry had a mean of 9.31 (SD = 7.03) points in the IPSS versus 5.51 (SD = 4.82) in patients with a normal uroflowmetry result (p < 0.01). The level of agreement between mild versus moderate-to-severe LUTS and normal uroflowmetry versus abnormal/equivocal was 61.1% (k = 0.22, p = 0.04). We found that a score ≥ 10 in the IPSS had a level of agreement of 65.6% (k = 0.31, p = 0.0004). Conclusions We consider that although the IPSS cannot replace uroflowmetry and vice versa, these tests are complementary and may be useful tools in the evaluation of patients with LUTS after RRP.

Objetivos Los pacientes en quienes se realiza prostatectomía radical retropúbica (PRR) pueden sufrir de síntomas del tracto urinario inferior (STUIs). El propósito es poder caracterizar STUI y correlacionarlos con la uroflujometría y la Escala Internacional de Síntomas Prostáticos (IPSS por sus siglas en inglés). Métodos Se realizó un estudio multicéntrico prospectivo entre Diciembre de 2015 y Septiembre de 2016. Se incluyeron todos los pacientes con un seguimiento mínimo de 12 meses después de la PRR. Estos fueron evaluados con uroflujometría e IPSS. Resultados Se incluyeron un total de 90 pacientes. El seguimiento promedio fue de 54,6 meses (desviación estándar [DE] = 27,52), la edad promedio fue de 65 años (DE 6,85). El promedio de la puntuación en la IPSS fue de 7,41 (DE = 6,29) con 33,3% de los pacientes con síntomas moderados y 6,7% con síntomas severos. El 50% de los pacientes tuvieron una uroflujometría normal. Los pacientes con resultado anormal o equívoco en la uroflujometría presentaron un promedio de 9,31 (DE = 7,03) en la puntuación de la IPSS, versus 5,51 (DE = 4,82) en pacientes con una uroflujometría normal (p < 0,01). El nivel de concordancia entre los STUIs leves y moderados/severos y uroflujometría normal versus anormal/equívoca fue de 61,1% (k = 0,22, p = 0,04). Se encontró que un puntaje ≥ 10 en la IPSS tiene un nivel de concordancia del 65,6% (k = 0.31, p = 0.0004). Conclusiones Se considera que aunque la IPSS no puede reemplazar la uroflujometría y viceversam, estas pruebas son complementarias, y son herramientas útiles en la evaluación de pacientes con STUIs después de la PRR.

Intravesical Glycosaminoglycans Experience for Chronic Lower Urinary Tract Pathology Treatment / Experiencia con glucosaminoglicanos intravesicales para el tratamiento de patologías crónicas del tracto urinario inferior

Objective Intravesical glycosaminoglycans (GAG) treatment is one of the therapeutic options for chronic bladder pathologies and is approved for Bladder Pain Syndrome (BPS), radiation cystitis, and recurrent urinary tract infections (UTIs). The purpose of this study is to describe the demographic characteristics of patients with such pathologies in our population and to evaluate treatment response. Methods It is a retrospective study of patients with the aforementioned pathologies, who received treatment with GAG. Demographic characteristics and subjective improvement with treatment were evaluated. A bivariate analysis was performed to study possible improvement predictors. Results 53 patients were evaluated. Of them, 33 (62.3%) with BPS, 12 (22.6%) with recurrent UTIs, and 8 (15.1%) with radiation cystitis. The dose range received was between 4 - 20 instillations, with a median of 6 doses. 67.9% of patients showed improvement of symptoms with treatment, this percentage being even higher for the group of patients with recurrent UTIs (91%). No treatment response predictors were found. Conclusions Intravesical GAG treatment is a therapeutic alternative for patients with chronic bladder pathologies, with satisfactory results in the medium term. Prospective studies are needed to support the findings of this study.

Objetivo El tratamiento con glucosaminoglicanos intravesicales hace parte de las opciones terapéuticas de las patologías crónicas de la vejiga y se encuentra aprobado para el tratamiento de síndrome de vejiga dolorosa (SVD), cistitis por radiación e infección urinaria recurrente. El objetivo de este estudio es describir las características demográficas de los pacientes con dichas patologías en nuestra población y evaluar la respuesta al tratamiento. Métodos Estudio retrospectivo de pacientes con las patologías mencionadas, quienes recibieron tratamiento con glucosaminoglicanos. Se evaluaron las características demográficas y la respuesta al tratamiento. Se realizó un análisis bivariado para estudiar posibles variables predictoras de mejoría. Resultados Se evaluaron 53 pacientes. De estos, 33 (62.3%) con síndrome de vejiga dolorosa, 12 (22.6%) con infección urinaria recurrente y 8 (15.1%) con cistitis por radiación. El rango de dosis recibida estuvo entre 4-20 instilaciones, con una mediana de 6 dosis. El 67.9% de los pacientes tuvo una respuesta adecuada al tratamiento, siendo este porcentaje aún mayor para el grupo de pacientes con IVU recurrente (91%). No se encontraron factores predictores de respuesta al tratamiento. Conclusiones El tratamiento con GAG intravesicales es una alternativa terapéutica para pacientes con patologías crónicas de la vejiga, con resultados satisfactorios a mediano plazo. Se necesitan estudios prospectivos que soporten los hallazgos de este trabajo.

Pielonefritis xantogranulomatosa secundaria a litiasis obstructiva en un paciente pediátrico / Pyelonephritis Xanthogranulomatous Secundary to Obstructive Lithiasis in Pediatric Patient

Introducción La pielonefritis xantogranulomatosa (XGPN), es una enfermedad inflamatoria crónica del parénquima renal, de rara presentación en pediatría. Su etiología es multifactorial comenzando con un proceso obstructivo del tracto urinario por litiasis e infección hasta el daño renal crónico. Su diagnóstico se logra por sospecha clínica, estudio imagenológico e histopatológico, lo que require tratamiento definitivo en la mayoría con nefrectomía simple. Materiales y métodos Paciente masculino de 4 años de edad con infección de la vía urinaria y dilatación de pelvis y uréter causada por cálculos que genera un proceso inflamatorio crónico y destrucción del parénquima renal. Sin respuesta clínica a tratamiento antibiótico quien requirió manejo en unidad de cuidados intensivos y nefrectomía. Discusión Se presenta entre la cuarta a sexta década de vida, con reportes de caso en edad pediátrica. Cursa con fiebre, dolor abdominal y masa palpable. Puede presentar en cambio de cursar con leucocitosis, anemia y piuria. Estudio radiológico de XGPN se puede apreciar de forma focal o difusa. A la histopatología se evidencia necrosis tisular crónica con macrófagos espumosos en su interior entremezclados con células inflamatorias. El tratamiento definitivo requiere nefrectomía de unidad renal disfuncional. Conclusiones Se presenta el caso de paciente pediátrico con XGPN por obstrucción urinaria litiásica; entidad de baja frecuencia en ese grupo poblacional, requiere una adecuada correlación clínico-imagenológica e histológica para lograr el diagnóstico final y puede ser tratado con manejo médico y quirúrgico.

Introduction Xanthogranulomatous pyelonephritis (XGPN) is a chronic inflammatory disease of the renal parenchyma, rare in pediatrics. Etiology is multifactorial ranging from an obstructive urinary tract process through lithiasis and infection generating chronic kidney amage. Its diagnosis is achieved by clinical suspicion, imaging and histopathology, which requires definitive treatment in the majority with simple nephrectomy Materials and Methods A 4-year-old male patient with urinary tract infection and dilation of the pelvis and ureter caused by calculus that generate a chronic inflammatory process and destruction of the renal parenchyma. No clinical response to antibiotic treatment that required management and intensive care unit and nephrectomy. Discussion It occurs between the fourth and sixth decade of life, with case reports in pediatric age. Patients have fever, abdominal pain and palpable mass. They can occur with leukocytosis, anemia and pyuria. Radiological study of XGPN can be seen in focal or diffuse form. Histopathology looks a chronic tissue necrosis with foamy macrophages and inflammatory cells. Definitive treatment requires nephrectomy of damaged renal unit. Conclusions We report the case of pediatric patients with XGPN due to urinary obstruction of the lithiasis; Low frequency entity in this population group, requires an adequate clinical-imaging and histological correlation to achieve final diagnosis and can be treated with medical and surgical management.

Factores Pronósticos de Recurrencia y Mortalidad en los Pacientes con Tumor de Urotelio Superior Tratados con Cirugía / Prognostic Factors for Recurrence and Mortality in Upper Urinary Tract Tumor

Objetivo Identificar factores pronósticos de recurrencia y mortalidad cáncer-específica en pacientes con tumor de urotelio superior tratados con cirugía. Material y Métodos Análisis retrospectivo de pacientes con tumor de urotelio superior operados entre 1999 y 2011 (139 pacientes). Se recogieron variables demográficas, clínicas, diagnósticas y patológicas así como el tratamiento, las complicaciones y la evolución. Análisis descriptivo mediante la prueba de la Chi cuadrado para variables categóricas y el test ANOVA para variables continuas. Análisis univariante y multivariante mediante modelo de riesgos proporcionales de Cox. Significación estadística si p < 0,05. Cálculos realizados con SPSS statistics v-21. Resultados En el análisis multivariante se identificaron como factores predictores independientes de recurrencia: crecimiento sólido tumoral (HR = 4,02; p < 0,001) y alto grado citológico (G3) (HR = 3,42; p = 0,01). La presencia de tumor vesical previo o concomitante (HR = 1,84; p = 0,07) presentó una tendencia a la significación. Se identificaron como factores predictores independientes de mortalidad cáncer-específica: presencia de tumor vesical previo o concomitante (HR = 2,23; p = 0,02), crecimiento sólido tumoral (HR = 2,73; p = 0,008), presencia de hidronefrosis (HR = 2,46; p = 0,02) y estadio patológico avanzado pT3-pT4 (HR = 2,74; p = 0,01). Conclusión En nuestra serie, la existencia de tumor vesical previo o sincrónico, el crecimiento tumoral sólido y el alto grado citológico se comportaron como factores pronósticos de recurrencia. La hidronefrosis, el tumor vesical previo o sincrónico, el estadio pT3­4 y el crecimiento tumoral sólido, se comportaron como factores pronósticos de mortalidad cáncer-específica.

Objective To identify predictors of recurrence and cancer-specific mortality in patients with upper urinary tract carcinoma treated with surgery. Material and Methods Retrospective analysis of patients with upper urinary tract urothelial carcinoma getting surgery between 1999 and 2011 in our institution (139 patients). We collected demographic, clinical, pathological and diagnostic variables as well as the treatment performed, the occurred complications and the evolution. A descriptive analysis was performed using the Chi square test for categorical variables and the ANOVA test for continuous variables. We performed an univariate and multivariate analysis using a proportional Cox risks model. Statistical significance was considered when p < 0.05. All calculcations were performed with SPSS statistics v-21. Results In the multivariate analysis, the solid tumor growth (HR = 4.02; p < 0.001) and a high cytological grade (G3) (HR = 3.42; p = 0.01) were identified as independent predictors; the presence of previous or concomitant bladder tumor (HR = 1.84; p = 0.07) showed a trend to statistical significance. In the multivariate analysis, the presence of previous or concomitant bladder tumor (HR = 2.23; p = 0.02), the solid tumor growth (HR = 2.73; p = 0.008), the presence of hydronephrosis (HR = 2.46; p = 0.02) and the advanced pathological stage pT3-pT4 (HR = 2.74; p = 0.01) were identified as independent predictors of cancer-specific mortality. Conclusion The existence of previous or concomitant bladder cancer at the diagnosis of upper urinary tract carcinoma, solid growth pattern and high cytological grade (G3) were identified as independent predictors of recurrence in our series. The existence of hydronephrosis at diagnosis, prior or concomitant bladder tumor, pathologic stage pT3­4 and the solid growth pattern were identified as independent predictors of cancerspecific mortality.

Qualidade de vida de mulheres com infecções recorrentes do trato urinário em atendimento ambulatorial / Quality of life in women with recurrent urinary tract infections in an outpatient care

Objetivo: Avaliar a qualidade de vida de mulheres com infecções recorrentes do trato urinário em atendimento ambulatorial, utilizando dois instrumentos, e verificar concordância entre eles. Métodos: Estudo transversal com mulheres com infecções recorrentes do trato urinário, confirmados pela cultura de urina, utilizando WHOQOL-bref e King´s Health Questionaire (KHQ). Resultados: Participaram 30 mulheres com idade entre 20 e 87 anos. De acordo com o WHOQOL-bref, seis (20,0%) mulheres referiam qualidade de vida ruim ou muito ruim e 17 (56,7%) estavam insatisfeitas ou muito insatisfeitas com a saúde. Houve boa consistência do instrumento WHOQOL-bref para qualidade de vida geral, satisfação com a saúde e domínio físico; o KHQ apresentou consistência satisfatória para todos os domínios, exceto Medidas de Gravidade. O KHQ mostrou maior comprometimento da qualidade de vida nos domínios: Impacto da Incontinência, Relações Pessoais e Emoções. Houve correlação significativa entre WHOQOL-bref e KHQ, em todos os domínios. Conclusão: As mulheres apresentaram maior comprometimento da qualidade de vida nos domínios: Impacto da Incontinência, Relacionamentos Pessoais e Emoções para KHQ; Físico para WHOQOL-bref. Houve correlação significativa entre os domínios do King´s Health Questionaire e WHOQOL-bref, demonstrando que ambos são úteis para avaliação da qualidade de vida nessa população. (AU)

Objective: To evaluate quality of life of women with recurrent urinary tract infections in ambulatory care, using two instruments, and verify consistency between them. Methods: Crosssectional study on women with recurrent urinary tract infections, confirmed by a urine culture, using WHOQOL-bref and King's Health Questionaire (KHQ). Results: Participated 30 women aged between 20 and 87 years. According to the WHOQOL-bref, six (20.0%) women reported quality of life bad or very bad and 17 (56.7%) were dissatisfied or very dissatisfied with health. There was good consistency of WHOQOL-bref instrument for the overall quality of life, satisfaction with health and the physical domain; KHQ presented satisfactory consistency for all fields except Severity Measures. The largest commitment of KHQ showed quality of life in the fields: Impact of Incontinence, Personal Relationships and Emotions. There was no significant correlation between the WHOQOL-bref and KHQ in all areas. Conclusion: Women showed greater impairment of the quality of life in the domains: Impact of Incontinence, Personal Relationships and Emotions to the KHQ; and Physical to WHOQOL-bref. There was no significant correlation between the areas of King's Health Questionaire and WHOQOL-bref, demonstrating that both are useful for the assessment of quality of life in this population. (AU)

Incidence of urinary infection among kidney-transplant recipients / Incidência de casos de infecção urinária em receptores pós-transplante renal

Urinary tract infection is the most common bacterial complication in renal transplant. This study investigated the number of urinary infection in renal transplant patients at a transplant center aimed at improving nursing care in order to minimize the incidence of urinary infection. We analyzed 59 medical records of patients subjected to renal transplant from May to June 2015 at a transplant center in a hospital in northwestern state of Paraná. The prevailing age of the patients was between 50 and 60 years (29%), and the hemodialysis time was up to 24 months (30%). In patients diagnosed with urinary tract infection (36%), the prevalent microorganisms were: Enterobacter cloacae (25%), occurring more frequently in the first month after transplantation (67%). It was concluded the nursing team may to act in the control and prevention of urinary tract infection.

A infecção do trato urinário é a intercorrência bacteriana mais comum em transplante renal. O presente trabalho objetivou investigar o número de infecções urinárias em pacientes transplantados renais em um centro transplantador, visando à melhoria dos cuidados de enfermagem a fim de amenizar a incidência de infecção urinária. Analisou-se 59 prontuários de pacientes que foram submetidos ao transplante renal entre janeiro 2012 à janeiro 2015 em um centro transplantador situado em um hospital no Noroeste do estado do Paraná. A idade prevalente dos pacientes foi entre 50 e 60 anos (29%), e o tempo de hemodiálise foi de até 24 meses (30%). Entre os pacientes diagnosticados com infecção urinária (36%) o microorganismo prevalente foi: Enterobacter cloacae (25%), ocorrendo com maior frequência no primeiro mês após o transplante (67%). Conclui-se que a equipe de enfermagem pode atuar satisfatoriamente no controle e prevenção da infecção urinária.

Evaluation of factors associated with urinary incontinence in elderly people in long-term care homes / Avaliação de fatores associados à ocorrência de incontinência urinária em idosos institucionalizados

The aim of this study was to assesses the factors associated with the occurrence of urinary incontinence (UI) in elderly people living in long-term care homes. Reports on Urinary Incontinence coupled to clinical-functional and socio-demographic data were retrieved from the medical records of elderly people. In addition, the application of the protocols: Mini-Mental State Examination, Katz Index, Short Physical Performance Battery. It was considered a significance level of 5%. It was noted that the UI occurred in 80.6% of elderly people, with average age 76.5 years (± 8.3) and average time at the care home reaching 5.2 years (± 6.4) . Significant UI association was reported with gender, education and disease. A discrete increase in scores occurred in protocols for elderly people without UI occurrence. It is concluded that sample was characterized by elderly females with less than five years living in homes. The elderly with UI were similar to elderly people in general with regard to protocols.

O objetivo deste estudo foi avaliar os fatores associados à ocorrência de Incontinência Urinária (IU) em idosos institucionalizados: Foram coletados nos prontuários médicos de idosos a presença de IU, dados sociodemográficos e clínico-funcionais. Além disso, houve a aplicação dos protocolos: O Mini-Exame do Estado Mental, Índice de Katz, Teste Short Physical Performance Battery. Foi considerado um nível de significância de 5%. Constatou-se que a IU esteve presente em 80,6% dos idosos, com média de idade de 76,5 anos (± 8,3) e tempo médio de institucionalização de 5,2 anos (± 6,4). Houve associação significativa de IU com sexo, escolaridade e doenças. Foi observada uma discreta superioridade dos escores nos protocolos para os idosos sem IU. Conclui-se que a amostra foi caracterizada por mulheres, de idade avançada e menos de cinco anos de institucionalização. Nos protocolos, os idosos incontinentes se assemelharam com os idosos em geral.

URINARY DYSFUNCTION AFTER SURGICAL TREATMENT FOR RECTAL CANCER / Disfunção urinária após tratamento cirúrgico do câncer de reto

BackgroundThe impact on quality of life attributed to treatment for rectal cancer remains high. Deterioration of the urinary function is a relevant complication within that context.ObjectiveTo detect the presence of urinary dysfunction and its risk factors among individuals underwent surgical treatment for rectal cancer.MethodsThe present prospective study analyzed 42 patients from both genders underwent surgical treatment for rectal adenocarcinoma with curative intent. The version of the International Prostatic Symptom Score (IPSS) questionnaire validated for the Portuguese language was applied at two time-points: immediately before and 6 months after surgery. Risk factors for urinary dysfunction were analysed by means of logistic regression and Student’s t-test.ResultsEight (19%) participants exhibited moderate-to-severe urinary dysfunction 6 months after surgery; the average IPSS increased from 1.43 at baseline to 4.62 six months after surgery (P<0.001). None of the variables assessed as potential risk factors exhibited statistical significance, i.e., age, gender, distance from tumour to anal margin, neoadjuvant therapy, adjuvant therapy, type of surgery, surgical approach (laparoscopy or laparotomy), and duration of surgery.ConclusionThis study identified an incidence of 19% of moderate to severe urinary dysfuction after 6 months surveillance. No risk factor for urinary dysfunction was identified in this population.

ContextoA perda de qualidade de vida atribuída ao tratamento do câncer retal continua elevada. Neste contexto, a deterioração da função urinária é complicação relevante.ObjetivoIdentificar disfunção urinária e seus fatores de risco em doentes submetidos ao tratamento cirúrgico do câncer de reto.MétodosRealizou-se estudo prospectivo com 42 doentes de ambos os sexos submetidos a tratamento cirúrgico com intenção curativa para adenocarcinoma de reto. Foi utilizado o questionário International Prostatic Symptom Score, validado na língua portuguesa, em dois períodos: imediatamente antes e após 6 meses do procedimento cirúrgico. Os fatores de risco para disfunção urinária foram analisados por regressão logística e teste t de Student.ResultadosApós 6 meses do procedimento cirúrgico, oito (19%) doentes apresentaram disfunção urinária moderada a grave e aumento na média do escore utilizado de 1,43 pontos no pré-operatório para 4,62 pontos no pós-operatório (P<0,001). A análise de fatores de risco para disfunção urinária não mostrou significância para as variáveis estudadas, idade, gênero, distância tumoral da margem anal, neoadjuvância, adjuvância, procedimento cirúrgico realizado, via de acesso cirúrgico (laparoscópica ou laparotômica) e tempo operatório.ConclusãoNos doentes com carcinoma retal operados com intenção curativa, a incidência de disfunção urinária moderada a grave após 6 meses da operação foi de 19%. Não foram identificados fatores de risco para disfunção urinária nesses doentes.

Malformaciones renales y del tracto urinario con daño renal en Pediatría / Renal and urinary tract malformations with renal damage in pediatrics

INTRODUCTION: renal and/or urinary pathway malformations are the frequent cause of chronic renal disease at pediatric ages worldwide. OBJECTIVE: to describe the alteration of the renal functioning in these patients, by age, at the time of diagnosis of renal and urinary pathway malformations. METHODS: a cross-sectional descriptive study of patients diagnosed with renal and urinary duct malformations was made in Villa Clara province from January 2012 through December 2013. RESULTS: forty patients were diagnosed at prenatal phase, 75 % of them were males; 85 were diagnosed after birth and 38 of them after one year of age, 60 % were girls. One hundred and twenty five renal units had reflux and 60 % of them located on the left kidney. It was observed that left kidney malformations prevailed, with 57 patients (45.6 %), but in 28 of patients, the renal damage was bilateral. CONCLUSIONS: vesicoureteral reflux, mainly on the left one, was the most diagnosed malformation; postnatal diagnosis predominated and although there was no difference in terms of sex, males prevailed in patients with prenatal diagnosis and females were the most diagnosed after birth. The left kidney was more frequently affected, but the renal damage was detected more often in bilateral condition.

INTRODUCCIÓN: las malformaciones renales y/o de vías urinarias constituyen una causa frecuente de enfermedad renal crónica en la edad pediátrica a nivel mundial. OBJETIVO: describir la afectación del funcionamiento renal que tenían estos pacientes, según la edad, al diagnóstico de las malformaciones renales y de vías urinarias. MÉTODOS: se realizó un estudio descriptivo, de corte transversal en Villa Clara, con pacientes con diagnóstico de malformaciones renales y de vías urinarias en el período comprendido desde enero de 2012 a diciembre de 2013. RESULTADOS: se diagnosticaron 40 pacientes en etapa prenatal, de ellos 75 % eran del sexo masculino, 85 después del nacimiento y de ellos 38 posterior al año de vida, el 60 % eran niñas; 125 unidades renales tenían reflujo, de los cuales el 60 % correspondía al izquierdo. Se apreció un predominio de las malformaciones en el riñón izquierdo, con 57 pacientes (45,6 %), pero 28 de los enfermos con daño renal tenían afectación bilateral. CONCLUSIONES: el reflujo vesicoureteral, fundamentalmente el izquierdo, fue la malformación más diagnosticada; predominó el diagnóstico posnatal, y aunque de manera general no hubo diferencia en cuanto al sexo, fue más frecuente el masculino en los pacientes con diagnóstico prenatal, y el femenino en los que se realizó el diagnóstico tras el nacimiento. El riñón izquierdo se afectó con mayor frecuencia, pero el daño renal fue más frecuente cuando la afectación fue bilateral.

Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma

Purpose The study evaluated whether preoperative measures of the C-reactive protein-based systemic inflammatory response may predict cancer survival independent of tumor stage in patients with upper urinary tract urothelial carcinoma (UTUC). Materials and Methods Between September 1999 and October 2010, 181 patients submitted to radical nephroureterectomy were available for evaluation. Multivariate survival analyses were performed using Cox’s proportional hazards model and the coefficient for each factor was divided by the highest coefficient, multiplied by 4, and rounded to the nearest integer. Results Multivariate analyses showed that tumor location, pathologic T stage, lymphovascular invasion, margin status, and albumin level were independent contributors. The bootstrap-corrected C statistics of the model were 0.813 for disease-specific survival and 0.755 for overall survival, respectively. For time to disease-specific and overall mortality for patients, integrated area under the curve values were 0.792 and 0.739, respectively. When patients were clustered into three groups according to their model-predicted survival, the 5-year disease-specific survival in the low-, intermediate- and high-risk group was 95.4%, 76.2%, and 36.9%, respectively (p<0.001), and were 87.8%, 54.4%, and 31.8%, respectively, for overall survival (p<0.001). Decision curve analysis revealed that the use of model was associated with net benefit gains relative to the treat-all strategy. Conclusions   Pretreatment albumin is a simple biomarker based on routinely available well-standardized measures, and is not an expensive and time-consuming process. Hypoalbuminemia is an independent marker of poor prognosis in patients with upper urinary tract urothelial carcinoma. .

New head-mounted display system applied to endoscopic management of upper urinary tract carcinomas

Purpose We tested a new head-mounted display (HMD) system for surgery on the upper urinary tract. Surgical Technique Four women and one man with abnormal findings in the renal pelvis on computed tomography and magnetic resonance imaging underwent surgery using this new system. A high definition HMD (Sony, Tokyo, Japan) is connected to a flexible ureteroscope (Olympus, Tokyo, Japan) and the images from the ureteroscope are delivered simultaneously to various participants wearing HMDs. Furthermore, various information in addition to that available through the endoscope, such as the narrow band image, the fluoroscope, input from a video camera mounted on the lead surgeon’s HMD and the vital monitors can be viewed on each HMD. Results Median operative duration and anesthesia time were 53 and 111 minutes, respectively. The ureteroscopic procedures were successfully performed in all cases. There were no notable negative outcomes or incidents (Clavien-Dindo grade ≥1). Conclusion The HMD system offers simultaneous, high-quality magnified imagery in front of the eyes, regardless of head position, to those participating in the endoscopic procedures. This affordable display system also provides various forms of information related to examinations and operations while allowing direct vision and navigated vision. .

Chronic kidney disease among children in Guatemala / Enfermedad renal crónica en niños de Guatemala

OBJECTIVE: To describe the distribution of pediatric chronic kidney disease (CKD) in Guatemala, estimate incidence and prevalence of pediatric end-stage renal disease (ESRD), and estimate time to progress to ESRD. METHODS: This study analyzed the registry of the only pediatric nephrology center in Guatemala, from 2004-2013. Incidence and prevalence were calculated for annual periods. Moran's index for spatial autocorrelation was used to determine significance of geographic distribution of incidence. Time to progress to ESRD and associated risk factors were calculated with multivariate Cox regression. RESULTS: Of 1 545 patients from birth to less than 20 years of age, 432 had chronic renal failure (CRF). Prevalence and incidence of ESRD were 4.9 and 4.6 per million age-related population, respectively. Incidence was higher for the Pacific coast and Guatemala City. The cause of CRF was undetermined in 43% of patients. Average time to progress to ESRD was 21.9 months; factors associated with progression were: older age, diagnosis of glomerulopathies, and advanced-stage CKD at consultation. CONCLUSIONS: Prevalence and incidence of ESRD in Guatemala are lower than in other countries. This may reflect poor access to diagnosis. Areas with higher incidence and large proportion of CKD of undetermined cause are compatible with other studies from the geographic subregion. Findings on progression to ESRD may reflect delayed referral.

OBJETIVO: Describir la distribución de enfermedad renal crónica en niños en Guatemala, y calcular la incidencia y la prevalencia de nefropatía terminal en niños, así como el tiempo de progresión hasta la nefropatía terminal. MÉTODOS: Este estudio analizó el registro del único centro de nefrología pediátrica de Guatemala, del 2004 al 2013. La incidencia y la prevalencia se calcularon por períodos anuales. Se utilizó el índice de Moran como medida de la autocorrelación espacial con objeto de determinar la significación de la distribución geográfica de la incidencia. El tiempo de progresión a la nefropatía terminal, así como los factores de riesgo asociados, se calcularon mediante la regresión de Cox de variables múltiples. RESULTADOS: De 1 545 pacientes menores de 20 años, 432 padecían insuficiencia renal crónica. La prevalencia y la incidencia de nefropatía terminal fueron de 4,9 y 4,6 por millón de habitantes de esa misma edad, respectivamente. La incidencia fue mayor en la costa del Pacífico y en la Ciudad de Guatemala. En 43% de los pacientes la causa de la insuficiencia renal crónica era indeterminada. El tiempo promedio de progresión a una nefropatía terminal fue de 21,9 meses; los factores asociados con esa progresión fueron: la edad mayor, el diagnóstico de glomerulopatía y la enfermedad renal crónica en etapa avanzada en el momento de la consulta. CONCLUSIONES: La prevalencia y la incidencia de la nefropatía terminal en Guatemala son inferiores a las de otros países. Ello podría reflejar un acceso limitado al diagnóstico. La mayor incidencia y la amplia proporción de enfermedad renal crónica de causa indeterminada en algunas zonas son compatibles con las de otros estudios de la subregión geográfica. Los resultados en cuanto a progresión a una nefropatía terminal podrían ser el reflejo de la tardanza en la derivación.

Bacteriuria asintomática como factor asociado al infarto agudo del miocardio / Asymptomatic bacteriuria as a factor associated to acute myocardial infarction

Introducción: la aterosclerosis es una enfermedad inflamatoria en la cual la estabilidad de la placa coronaria y su ruptura con el desencadenamiento de infarto agudo de miocardio podría estar influenciada por infecciones microbianas a través de la producción de mediadores inflamatorios, estas moléculas también se producen en pacientes con bacteriuria asintomática, condición frecuente después de los 65 años. Objetivo: se desarrolló un estudio comparativo para determinar si la bacteriuria asintomática está asociada con el infarto agudo de miocardio. Material y métodos: se incluyeron pacientes mayores de 65 años con enfermedad coronaria aterosclerótica o alto riesgo de padecerla. Como casos se escogieron pacientes con infarto agudo de miocardio en dos instituciones hospitalarias de cuarto nivel en Medellín Colombia. El cálculo del Odds ratio ajustado se realizó mediante un modelo de regresión logística. Resultados: se estudiaron 60 casos y 120 controles. La edad promedio fue 74.94 ± 7.08 años. Se documentaron 37 casos de bacteriuria asintomática entre los 180 pacientes, para una prevalencia igual a 20.6% con predominio en el género femenino (12.4 vs 32%). La proporción de bacteriuria asintomática en los casos fue 15% y en los controles 23.3%, para un OR crudo de 0.58 (IC 95%: 0.25-1.32) y un OR ajustado de 1.31 (IC 95%: 0.53-3.26). Conclusión: no se encontró una asociación entre bacteriuria asintomática e infarto agudo de miocardio. Se requieren estudios adicionales para determinar si existe esta asociación.

Introduction: atherosclerosis is an inflammatory disease in which the stability of coronary plaque and its rupture with the onset of acute myocardial infarction could be influenced by microbial infections through production of inflammatory mediators. These molecules also occur in patients with asymptomatic bacteriuria, common condition after age 65. Objective: a comparative study to determine if asymptomatic bacteriuria is associated with acute myocardial infarction was developed. Material and methods: patients over 65 with atherosclerotic coronary artery disease or patients at high risk of developing it, were included . Patients with acute myocardial infarction in two hospitals in fourth level in Medellin (Colombia) were chosen. The calculation of adjusted Odds ratio was performed using a logistic regression model. Results: 60 cases and 120 controls were studied. The mean age was 74.94 ± 7.08 years. 37 cases of asymptomatic bacteriuria among 180 patients were documented, for a prevalence equal to 20.6% with female predominance (12.4 vs 32%). The proportion of asymptomatic bacteriuria in the cases was 15% and in controls 23.3% for a crude OR of 0.58 (95% CI 0.25 - 1.32) and an adjusted OR of 1.31 (95% CI 0.53 - 3.26). Conclusion: no association between asymptomatic bacteriuria and acute myocardial infarction was found. Further studies are required to determine whether this association exists.

Prevalencia de gérmenes multirresistentes en infecciones del tracto urinario de la comunidad y asociadas a los cuidados de la salud / Prevalence of multidrug resistant pathogens from community and health care associated urinary tract infections

Las infecciones asociadas a los cuidados de la salud (ACS) han sido identificadas como un factor de riesgo de patógenosd resistenes, sin embargo existen escasos datos de ésta categoría epidemiológica en infecciones del tracto urinario (ITU). Métodos: estudio prospectivo y observacional de pacientes ‗> 18 años procedentes de la comunidad con ITU atendidos en un Hospital General de Agudos (Diciembre 2011-Noviembre 2012). Fueron considerados como ITU-aCS aquellos pacientes con hospitalización en los 90 días previos, residencia en geriátricos/centros de rehabilitación, hemodiálisis crónica, infusión de drogas endovenosas/curación de heridas en su domiciliio, o uso crónico de catéter urinario. Aquellos pacientes que no presentaban ninguno de estos criterios fueron considerados como ITU de la comunidad (CO). Resultados: se incluyeron un total de 87 pacientes, de los cuales 42 (48%) y 45 (52%) se consideraron como ITU-CO e ITU-ACS, respectivamente. Los patógenos más frecuentes fueron: E. coli (74% vs 47 %), K pneumoniae (12 % vs 20 %), y E. faecalis (5 % vs 7 %) para ITU-CO e ITU-ACS respectivamente. Se observó una frecuencia de patógenos multirresistentes de 10 % y 49 % (p<001) para la ITU-CO vs ITU-ACS respectivamente. Conclusiones: nuestro estudio sugiere que las ITU-ACS representarían una categoría de ITU epidemiológica y microbiológicamente distinta que ITU-CO. Se deberían identificar correctamente a estos pacientes con el fin de proporcionar un tratamiento empírico adecuado...

Health care-associated infections (HCA) are a risk factor for multidrug resistant pathogens. However, limited data of this epidemiological category for urinary tract infections (UTI) is available. Methods: This was a prospective and observational study of adult patients coming from community who were attended as outpatients or hospitalizaed for urinary tract infections at a general Hospital (December 2011-November 2012). Patients who had drug infusions or wound care at home, prior hospitalization >=2 days in the preceding 90 days and chronic indwelling urinary catheters were considered to have HCA-UTI. Results: A total of 87 patients ere included, of whom 42 (48%) and 45 (52%) were considered to have ommunity acquired UTI (CA-UTI) and HCA-UTI rspectivelvy. The most frequent pathogens were: E. coli (74% vs. 47%), K pneumoniae (12% vs. 20%), and E. faecalis (5% vs. 7%) for CA-UTI and HCA-UTI respectively. Prevalence of MDR: 10% and 49% (p<0.01) for CA-UTI and HCA-UTI respectively. Conclusions: Our study suggests that HCA-UTI should represent a category of UTI epidemiologically and microbiologically distinct from CA-UTI. Physicians should correctly identify these patients in orden to provide optimal clinal management...

Factores que influyen en la intensidad de los síntomas del tracto urinario inferior en pacientes con hiperplasia benigna de próstata / Factores that affect the intensity of the lower urinary tract symptoms in patients with benign prostatic hyperplasia

Objetivo: Determinar los factores que influyen en la intensidad de los síntomas del tracto urinario inferior (STUI) en pacientes con hiperplasia benigna de próstata en un hospital del Perú. Materiales y métodos: Se realizó un estudio transversal durante el año 2011 en 382 varones atendidos en el Hospital IV “Augusto Hernández Mendoza” de Ica. Mediante encuesta se recogió información sociodemográfica y se determinó la intensidad de STUI mediante el International Prostate Symptoms Score. Se aplicó chi cuadrado (X2) para valorar asociación entre variables cualitativas y se estimó el odds ratio(OR). Se realizó regresión logística para evaluar la probabilidad de tener STUI moderados/severos. Resultados:La prevalencia de STUI moderados/severos fue del 85,1%. El 41,1% eran diabéticos y el 80,4% eran hipertensos. La edad mayor o igual a 60 años, frente a edad menor de 60 años, presentó 2,63 veces más frecuencia de STUI moderados/severos (IC95%1,35-5,09), así como el nivel bajo de estudios, respecto al alto, (OR 2,45; IC95% 1,06-5,61), la diabetes (OR 2,17; IC95% 1,15-4,07), la hipertensión (OR 2,4; IC 95% 1,29- 4,47), la ingesta excesiva de alcohol al menos una vez al mes (OR 4,44; IC95% 2,47-7,99) y el consumo de al menos un cigarrillo diario (OR 3,42; IC95% 1,87-6,22). La prostatitis se asoció a una menor prevalencia de STUI moderados/severos (OR 0,36; IC95% 0,20-0,66). Conclusiones: La edad, el nivel bajo de estudios, la hipertensión, la diabetes, el consumo de alcohol y cigarrillos se asociaron con STUI más severos. (AU)

Objective: To determine the factors that influence the severity of lower urinary tract symptoms (LUTS ) in patients with benign prostatic hyperplasia in a hospital in Peru. Materials and methods: A cross-sectional study in 2011 on 382 men treated at the Hospital IV " Augusto Mendoza Hernandez " of Ica. Through survey collected sociodemographic information and intensity of LUTS was determined by the International Prostate Symptoms Score. Chi square ( X2 ) was used to assess association between qualitative variables and the odds ratio (OR) was estimated. Logistic regression was performed to assess the probability of having LUTS moderate / severe. Results: The prevalence of moderate / severe LUTS was 85.1 %.41.1% were diabetic and 8004 % were hypertensive. Greater than or equal to 60 years, compared with less than 60 years old, presented 2.63 times more frequently than moderate / severe (95% Cl 1.35 to 5.09) LUTS and the low level of education, compared to high (OR 2.45,95% Cl 1.06 to 5.61), diabetes (OR 2.17, 95% Cl 1.15 to 4.07), hypertension (OR 2.4,95 % 1,29 -4,47), excessive intake at alcohol at least once a month (OR 4044,95% (12-47 to 7.99) and consumption of at least one cigarette a day (OR 3.42; 95% Cl 1.87 to 6.22). Prostatitis was associated with a lower prevalence of LUTS moderate / severe (OR 0.36,95% Cl 0.20 to 0.66 ) . Conclusions: age, low education, hypertension, diabetes, alcohol and cigarettes were associated with more severe LUTS. (AU)