Prospective Observational Cohort Study of the Efficacy of Bacterial Immune Prophylaxis in the Prevention of Uncomplicated, Recurrent Urinary Tract Infections.

OBJECTIVE: To investigate the long-term prophylactic effect of a vaccine on lower urinary tract infections (UTI) of bacterial and the impact of the intensity of the symptoms on the quality of life (QoL). METHODS: Adult female could be enrolled in this study if they had acute UTI at the enrolment visit and bacterial microbiological count of ≥103 CFU/mL of Escherichia coli. RESULTS: A total of 21 patients were included. Fifteen days after the administration of a vaccine for 3 months, the number of infections dropped almost to zero. Significant differences were observed in the QoL score (p < 0.05). The safety profile was good. CONCLUSIONS: In patients diagnosed with recurrent UTI and treated for 3 months with the vaccine the number of UTI episodes fell very quickly (15 days), and patients remained free of episodes and improved their QoL significantly for 1 year. These results suggest that bacterial vaccines are a possible effective alternative in the prevention of recurrent UTI.

Evaluation of four commercial virological assays for early infant HIV-1 diagnosis using dried blood specimens.

BACKGROUND: Early infant diagnosis (EID) of HIV-1 is necessary to reduce HIV-related mortality. As maternal antibodies transferred across the placenta may persist up to 18 mo, commercial virological assays (CVAs) are needed. This study compares four CVAs for EID using dried blood specimens (DBS) from HIV-1-exposed infants. METHODS: DBS from 68 infants born to HIV-1-infected women were collected from November 2012 to December 2013 in Equatorial Guinea. Four CVAs were performed: Siemens VERSANT HIV-1 RNA 1.0 kPCR assay, Roche CAP/CTM Quantitative Test v2.0, CAP/CTM Qualitative Tests v1.0 and v2.0. Definitive diagnosis was established following World Health Organization (WHO) recommendations. RESULTS: Two HIV-1-infected infants (2.9%) were detected by the four CVAs while 49 (72%) resulted negative. Discordant results were observed in 17 (25%) infants and HIV-1 infection was excluded in 14 patients when virological and serological testing was performed in additional DBS. Different false-positive rates HIV-1 were observed with Roche assays. CONCLUSION: CVAs using DBS were useful for EID, although discrepant results were common. Further research is required to reduce false-positive results that could result in wrong diagnosis and unneeded treatment. We propose caution with low viral load (VL) values when using VL assays. Clear guidelines are required for EID of HIV-exposed infants with discrepant virological results.

[EVIDENCE BASED NURSING: EARLY AND SAFE PROTOCOL FOR ICU PATIENT'S MOBILIZATION]. / Enfermería basada en La evidencia. Protocolo para la movilización temprana y segura del paciente en UCI.

UNLABELLED: Patients admitted to the ICU are at risk of immobility and an early and important physical deconditioning. OBJECTIVE: To develop and to implement an early and safe protocol for ICU patients' mobilization. METHODOLOGY: The Evidence Based Practice Model for Staff Nurses was used. It encompasses Assessment, Problem Identification, Planning, Implementation and Evaluation, Integration and Maintenance in Practice. RESULTS: The research team (Advanced Practice Nurse and expert clinical nurses), along with the medical team and rehabilitation service, identified the need to develop the protocol. For its elaboration, a literature search on the data bases PubMed, CINA-HL and Cochrane Library was performed; a questionnaire was administered and structured observations were conducted. For the implementation training sessions were offered to nurses, posters were placed in the unit and protocol was included in the computer program. Finally, an assessment of the knowledge, perceptions and practices of nurses in the unit and a recording of adverse events related to the mobilization will take place. CONCLUSIONS: The development and implementation of a protocol for early mobilization of ICU patients has facilitated the integration of this care in daily practice. This model of evidence-based practice allows nurses an active part in changing the culture in terms of the integration of research into practice.

Randomized clinical trial comparing high versus standard dose of ribavirin plus peginterferon alfa-2a in hepatitis C genotype 3 and high viral load. Dargen-3 study.

INTRODUCTION: Less than half of patients with chronic hepatitis C genotype 3 (G3) and high viral load (HVL) without a rapid virological response (RVR) achieve a sustained virological response (SVR) when treated with peginterferon plus ribavirin (RBV). OBJECTIVES: To assess the impact of high doses of RBV on SVR in patients with G3 and HVL. METHODS: Ninety-seven patients were randomized to receive peginterferon α-2a+RBV 800 mg/day (A; n=42) or peginterferon α-2a+RBV 1600 mg/day+epoetin ß 400 IU/kg/week SC (B; n=55). Patients allocated to group B who achieved RVR continued on RBV (800mg/day) for a further 20 weeks (B1; n=42) while non-RVR patients received a higher dose of RBV (1600 mg/day)+epoetin ß (B2; n=13). RESULTS: RVR was observed in 64.3% of patients in A and in 76.4% in B (p=0.259). Intention-to-treat (ITT) analysis showed SVR rates of 64.3% (A) and 61.8% (B), with a reduction of -2.5% (-21.8% to 16.9%) (p=0.835). The SVR rate was 61.9% in arm B1 and 61.5% in arm B2. No serious adverse events were reported, and the rate of moderate adverse events was < 5%. CONCLUSIONS: G3 patients with high viral load without RVR did not obtain a benefit from a higher dose of RBV. Higher doses of RBV plus epoetin ß were safe and well tolerated (Clin Trials Gov NCT00830609).

Development of a scale to gain insight into the experience of living with chronic heart failure: The UNAV-Experience of Living with Chronic Heart Failure Scale.

BACKGROUND: To date, there are no tools for the nursing staff to gain systematic insight on the experience lived by patients with chronic heart failure. The objective of this study was to develop a scale for this purpose. METHODS: The study was conducted between January 2018 and December 2020 in three Spanish hospitals. The process described by DeVellis was used for the development of the scale. The items were built based on a phenomenological study and a systematic review of the literature. Next, feedback from a panel of experts was obtained, the scale was administered to a sample of patients with chronic heart failure, and a cognitive interview and an observational study were conducted to create the final version of the scale. RESULTS: The first version of the scale had in seven domains and 76 items. After its evaluation by a panel of experts, it was reduced to a second version with six domains and 55 items. Following the administration of Version 2 to 17 patients (58.8% male, mean age 59.53, 70.6% classified as NYHA functional class II), five items were modified and two eliminated. Thus, the third version of the UNAV-CHF Experience Scale was composed of six domains and 53 items. CONCLUSIONS: This study presents the development of the UNAV-experience of living with chronic heart failure scale. It is an original and novel instrument that allows systematically explore this experience. A larger-scale study is necessary to confirm the validity of our scale.

Stem Cell Therapy for Erectile Dysfunction: A Step towards a Future Treatment.

Background: The improvement of absent or partial response in the medical treatment of erectile dysfunction (ED) has led to the development of minimally invasive new treatment modalities in the field of regenerative medicine. Methods: A literature review on stem cell therapy for the treatment of ED was performed. We searched for the terms "erectile dysfunction" and "stem cell therapy" in PubMed and Clinicaltrials.gov. Literature searching was conducted in English and included articles from 2010 to 2022. Results: New treatment modalities for ED involving stem cell therapy are not only conceived with a curative intent but also aim to avoid unnecessary adverse effects. Several sources of stem cells have been described, each with unique characteristics and potential applications, and different delivery methods have been explored. A limited number of interventional studies over the past recent years have provided evidence of a safety profile in their use and promising results for the treatment of ED, although there are not enough studies to generate an appropriate protocol, dose or cell lineage, or to determine a mechanism of action. Conclusions: Stem cell therapy is a novel treatment for ED with potential future applications. However, most urological societies agree that further research is required to conclusively prove its potential benefit.

Identification of Glaucoma in Diabetics Using the Laguna-ONhE Colourimetric Method and OCT Spectralis.

BACKGROUND: Previous retrospective results are evaluated prospectively and blinded. METHODS: A total of 221 eyes previously classified as normal (G1), 279 as moderate risk of glaucoma (G2) and 217 as high risk (G3) according to the Globin Discriminant Function (GDF) Laguna-ONhE index were examined with OCT Spectralis- Results: In G1, the Bruch's Membrane Opening Minimum Rim Width (BMO-MRW) was 332 ± 55 microns; in G2, it was 252 ± 47 (p < 0.0001); and in G3, 231 ± 44 (p < 0.0001). In G1, the 1% and 5% percentiles were 233 and 248, respectively; in G2, they were lower in 28.80% and 42.29% of cases, respectively; and in G3, in 50.23% and 63.59% of cases, respectively. Most of the cases were normal-tension glaucomas. Laguna-ONhE indices showed a curvilinear correlation with BMO-MRW results. The Retinal Nerve Fibre Layer (RNFL) showed a poor relationship with BMO. Assuming G1 to be truly normal, BMO-MRW would have a Receiver operating characteristic (ROC) curve area of 0.901 for G2 and G3 and 0.651 for RNFL. A significant reduction in pixels corresponding to vessels was found in G2 and G3 vs. G1 (p < 0.0001). CONCLUSIONS: In some cases, these defects appear to be mainly glaucomatous, and in others, they are associated with diabetic microangiopathy. In normal tension glaucoma, RNFL defects may be less severe than those inside the nerve.

Most HIV type 1 non-B infections in the Spanish cohort of antiretroviral treatment-naïve HIV-infected patients (CoRIS) are due to recombinant viruses.

HIV-1 group M is classified into 9 subtypes, as well as recombinants favored by coinfection and superinfection events with different variants. Although HIV-1 subtype B is predominant in Europe, intersubtype recombinants are increasing in prevalence and complexity. In this study, phylogenetic analyses of pol sequences were performed to detect the HIV-1 circulating and unique recombinant forms (CRFs and URFs, respectively) in a Spanish cohort of antiretroviral treatment-naïve HIV-infected patients included in the Research Network on HIV/AIDS (CoRIS). Bootscanning and other methods were used to define complex recombinants not assigned to any subtype or CRF. A total of 670 available HIV-1 pol sequences from different patients were collected, of which 588 (87.8%) were assigned to HIV-1 subtype B and 82 (12.2%) to HIV-1 non-B variants. Recombinants caused the majority (71.9%) of HIV-1 non-B infections and were found in 8.8% of CoRIS patients. Eleven URFs (accounting for 13.4% of HIV-1 non-B infections), presenting complex mosaic patterns, were detected. Among them, 10 harbored subtype B fragments. Four of the 11 URFs were found in Spanish natives. A cluster of three B/CRF02_AG recombinants was detected. We conclude that complex variants, including unique recombinant forms, are being introduced into Spain through both immigrants and natives. An increase in the frequency of mosaic viruses, reflecting the increasing heterogeneity of the HIV epidemic in our country, is expected.

Application of Pediatric Appendicitis Score on the emergency department of a secondary level hospital.

BACKGROUND: Acute appendicitis is the most common surgical emergency during childhood. Accurate early diagnosis is important to avoid complications and unnecessary interventions. In 2002, Samuel developed the Pediatric Appendicitis Score (PAS) based on a series of data obtained from anamnesis, physical examination, and laboratory tests. The main purpose of this study was to check the validity of PAS and its applicability to our population. METHODS: Prospective observational study, carried out at Hospital Río Hortega (Valladolid, Spain), between June 2009 and May 2010. Data from 101 patients who presented to the emergency department experiencing abdominal pains were recovered. RESULTS: A total of 101 patients were included in the study: 55 were boys and 46 girls. The mean age was 9.51 (2.76) years. Diagnosis was acute appendicitis in 28 patients, adenitis in 8 patients, nonspecific abdominal pain in 51 patients, and other diagnoses in 14 patients. The mean (SD) PAS for children with and without appendicitis was 7.43 (1.79) and 4.97 (1.67), respectively (P < 0.001). CONCLUSIONS: With a cutoff PAS of 3 or lower, there were no patients diagnosed with acute appendicitis; hence, these patients could be discharged without any image studies. If all the patients with a PAS of 8 or higher undergo surgery, we would find in our sample a 4.95% rate of negative appendicectomy, less than other studies have shown. The application of this score in the emergency department could help in the decision making process, aiding in the identification of patients with a low risk of having appendicitis and enabling a better use of resources by avoiding unnecessary diagnostic tests.

Drug resistance prevalence and HIV-1 variant characterization in the naive and pretreated HIV-1-infected paediatric population in Madrid, Spain.

BACKGROUND: Drug resistance mutations affect antiretroviral therapy (ART) effectiveness in HIV-1-infected children, compromising long-term therapy. HIV-1 variants and drug resistance mutations were identified in HIV-infected children from Madrid, Spain. METHODS: Patients from the Madrid cohort of HIV-infected children (1993-2009) with available pol sequences or infected samples stored at the Spanish HIV-1 BioBank were selected. Specimens were used to perform new pol sequences when not available. HIV-1 variants were characterized by phylogenetic analysis. Resistance mutations were identified according to the International AIDS Society-USA list (2009). RESULTS: In 198 patients, pol sequences were recovered from routine resistance testing (n = 98) or newly performed using stored plasma, lymphocytes or DNA (n = 100). Patients were mostly Europeans (90%), with moderate to severe AIDS symptoms (65%), on ART (85%) when the specimen was sequenced and infected by subtype B (90%). Among the 19 HIV-1 non-B variants found, 58% were recombinants (8CRF02_AG, 1CRF08_BC, 1CRF12_BF and 1CRF13_cpx) and the rest were 'pure' non-B subtypes (1A2, 2C, 2D, 1F1, 1G and 1H). Transmitted drug resistance (TDR) mutations were detected in 13% of naive children; 4%, 7% and 10% for protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), respectively. Global resistance prevalence was higher (66%) among ART-exposed children; 37% for PIs, 54% for NRTIs and 35% for NNRTIs. CONCLUSIONS: HIV-1 non-B variants infected 10% of the cohort during 1993-2009. Resistant viruses were present in 26.5% and 66% of naive and pretreated children, respectively. Our data suggest that TDR prevalence in children could be higher than that reported in adults in Spain. The provided data will help to improve clinical management of HIV-infected children in Spain.

Esophageal motor abnormalities in eosinophilic esophagitis identified by high-resolution manometry.

BACKGROUND AND AIM: Esophageal motility abnormalities, as measured by conventional manometry (CM), are non-specific in the majority of patients with eosinophilic esophagitis (EoE). Moreover, the study of CM is limited by poor interobserver agreement. The aims of the present study were: (i) to assess the esophageal patterns in EoE by a topographic analysis of high-resolution manometry (HRM) data; and (ii) to establish a relationship between motility abnormalities and symptoms of EoE, such as dysphagia and bolus impaction. METHODS: All adult patients with EoE diagnosed according to histological criteria, and controls with gastroesophageal reflux disease symptoms and dysphagia, were included. HRM was done in EoE patients and controls. For the analysis of data, the Chicago classification was followed. RESULTS: HRM was performed in 21 patients with EoE, as well as in 21 controls. Of the 21 patients with EoE, 10 (48%) showed pan-esophageal pressurization, six (28%) showed peristaltic dysfunction, and in five cases (24%), HRM was normal. There was no pan-esophageal pressurization in controls. Nine of 10 patients with pan-esophageal pressurization required endoscopic bolus removal (P < 0.05); none had obstructive endoscopy findings. CONCLUSIONS: The most frequent esophageal motor abnormality measured by HRM was a pan-esophageal pressurization. Bolus impaction in patients with EoE was associated with pan-esophageal pressurization.

Plagiarism: a case study of quality improvement in a taught postgraduate programme.

BACKGROUND: Plagiarism is a common issue in education. Software can detect plagiarism but little is known about prevention. AIMS: To identify ways to reduce the incidence of plagiarism in a postgraduate programme. METHODS: From 2006, all student assignments were monitored using plagiarism detection software (Turn It In) to produce percentage text matches for each assignment. In 2007, students were advised software was being used, and that plagiarism would result in penalties. In 2008, students attending a key module took part in an additional interactive seminar on plagiarism. A separate cohort of students did not attend the seminar, allowing comparison between attendees and non-attendees. RESULTS: Between 2006 and 2007, mean percentage text match values were consistent with a stable process, indicating advice and warnings were ineffective. Control chart analysis revealed that between 2007 and 2008, mean percentage text match changes showed a reduced text match in all nine modules, where students attended the interactive seminar, but none where students did not. This indicated that the interactive seminar had an effect. In 2008, there were no occurrences of plagiarism. Improvements were maintained in 2009. CONCLUSIONS: Advice and warnings against plagiarism were ineffective but a subsequent interactive seminar was effective at reducing plagiarism.

Prostatic abscess: diagnosis and treatment of an infrequent urological entity.

OBJECTIVE: To report two cases of prostatic abscess of difficult management and review the literature on diagnosis and management of this entity. METHODS /RESULTS: We describe two patients with prostatic abscess. The first one, a 73-year-old diabetic male, was treated using a more passive approach with percutaneous transrectal drainage; after a slow response, the patient passed away due to sepsis. The second case was a 59-year-old male who experienced a negative clinical response to antibiotic treatment. While under antibiotic ambulatory care the patient was treated with a transurethral resection of the prostate, which yielded a successful outcome. CONCLUSION: Prostatic abscess is a rare entity that affects individuals experiencing weakness and can be a serious condition. Measures taken to arrive at a resolution must be rapid and appropriate.

Prostatic nephrogenic adenoma. Case report.

OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate. METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection. CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation.

Management of Helicobacter pylori infection in the pediatric age.

The management of Helicobacter pylori infection in children is a consistent problem in clinical practice. Over the years, many questions have been raised regarding symptoms associated with the infection, the diagnostic methods and type of treatment. What is most controversial is determining the criteria that enable us to initiate and carry out the study in children. In the last 10 years, pediatricians have followed the joint ESPGHAN/NASPGHAN guidelines published in 2011 and updated in 2017 in the management of H. pylori in children. This document aims to unify the study indication criteria as well as the diagnosis and treatment recommendations for H. pylori infection in children and adolescents, so they can be used in both Primary and Hospital care.

[Management of Helicobacter pylori infection in the pediatric age]. / Manejo de la infección por Helicobacter pylori en la edad pediátrica.

The management of Helicobacter pylori infection in children is a consistent problem in clinical practice. Over the years, many questions have been raised regarding symptoms associated with the infection, the diagnostic methods and type of treatment. What is most controversial is determining the criteria that enable us to initiate and carry out the study in children. In the last 10 years, pediatricians have followed the joint ESPGHAN/NASPGHAN guidelines published in 2011 and updated in 2017 in the management of H.pylori in children. This document aims to unify the study indication criteria as well as the diagnosis and treatment recommendations for H.pylori infection in children and adolescents, so they can be used in both Primary and Hospital care.

Prospective evaluation of a clinical guideline recommending early patients discharge in bleeding peptic ulcer.

BACKGROUND AND AIM: To validate an early discharge policy in patients admitted with upper gastrointestinal bleeding (UGIB) due to ulcers. METHODS: Patients with gastroduodenal ulcer or erosive gastritis/duodenitis were included in a previous study aiming to develop a practice guideline for early discharge of patients with UGIB. Variables associated with unfavorable evolution were analyzed in order to identify patients with low-risk of re-bleeding. After that, a one-year prospective analysis of all UGIB episodes was carried out. RESULTS: A total of 341 patients were identified in the retrospective study. Variables associated with unfavorable evolution were: systolic blood pressure < or = 100 mmHg, heart rate > or = 100 bpm, and a Forrest endoscopic classification of severe. 10% of patients were immediately discharged; however, if predictive variables obtained in the multivariate analysis had been used, hospitalization could have been prevented in 34% of patients. A total of 77 patients were included in the prospective analysis. Although only 19.5% of patients were immediately discharged without complications, 29 patients (37.7%) were theoretically suitable for early discharge. CONCLUSIONS: Patients with UGIB who have clean-based ulcers and are stable on admission can be safely discharged immediately after endoscopy. Implementation of the clinical practice guideline safely reduced hospital admission for those patients.

Adrenal myelolipoma. Contribution of a case and bibliographic review.

OBJECTIVE: We report the case of adrenal gland myelolipoma. METHODS/RESULTS: The patient was a 29 year old who is diagnosed with an adrenal adenoma during an endocrinology review. He underwent laparoscopic adrenalectomy. The pathological study confirmed the diagnosis of adrenal myelolipoma. CONCLUSIONS: The myelolipoma is a rare tumor composed of hematopoietic elements in different maturation stages and without histological changes, combined with mature adipose tissue in varying proportions. Most of them are incidental findings during radiologic complementary tests. Treatment should be tailored to each particular case. Surgery is indicated when the mass exceeds the size 4-6 cm or when it is a functioning mass.

[Metabolic syndrome and erectile dysfunction]. / Síndrome metabólico y disfunción eréctil.

OBJECTIVES: To update a syndrome that has increased the number of pathologies included such as obesity, hypertension, hypercholesterolemia, type II diabetes mellitus, and the recent addition of erectile dysfunction and androgen deficiency METHODS: Global review of bibliography taking the last articles as a reference and mainly those from Prof. M. Serrano Rios and his group in Madrid. RESULTS: Metabolic syndrome seems to be consolidated as a universally accepted term, despite its complex semantic and gnoseologic itinerary. The inclusion of erectile dysfunction and androgen deficiency gives more pathogenic solidity and makes the professional field of endocrinology closer to two mainly urological processes. The urologist has a new perspective of processes that are of his own, that he has to take care of in a comprehensive manner, with physical examination, blood tests and therapy. CONCLUSIONS: Metabolic syndrome may be more frequently than suspected recognized in the urologist office. Urologists are compelled, in this typically medical process, to exercise with more dedication and fullness the medical compromise of our medical-surgical specialty.

Efficacy and Safety of the Combination of Pravastatin and Sorafenib for the Treatment of Advanced Hepatocellular Carcinoma (ESTAHEP Clinical Trial).

Pravastatin has demonstrated anti-tumor activity in preclinical and clinical studies. This multicentric randomized double-blind placebo-controlled phase II study (NCT01418729) investigated the efficacy and safety of sorafenib + pravastatin combination on the overall survival (OS) and time to progression (TTP) of patients with advanced hepatocellular carcinoma (aHCC). A total of 31 patients were randomized. Median OS did not differ between both groups (12.4 months for the sorafenib + pravastatin group vs. 11.6 months for the control group). Of note, however, the radiological TTP was higher in patients treated with sorafenib + pravastatin than in the control group (9.9 months vs. 3.2 months; p = 0.008). Considering all the study population, the presence of portal vein thrombosis (PVT) was associated with worse OS, being lower in patients with PVT compared to patients without PVT (6.3 months vs. 14.8 months; p = 0.026). Data also showed a decrease in OS in patients with vascular invasion (VI) compared to patients who did not present it (6.3 months vs. 14.8 months; p = 0.041). The group of patients without dermatological events (DE) showed lower OS (6.9 months vs. 14.5 months; p = 0.049). In conclusion, combination of sorafenib + pravastatin was safe and well-tolerated, prolonging the TTP of patients with aHCC but not improving the OS compared to sorafenib + placebo. The absence of PVT and VI and the development of DE are positive prognostic factors of sorafenib response.