Valorization of date palm (Phoenix dactylifera L.) pruning biomass by co-composting with urban and agri-food sludge.

In the Mediterranean countries, there is an increasing production of date palm wastes (Phoenix dactylifera L.), not only due to the raising production of date palm fruits, but also derived from the maintenance of urban and peri-urban green areas, especially in those affected by red palm weevil (Rhynchophorus ferrugineus). The management of this increasing volume of green wastes usually concludes with a controlled disposal that implies an important loss of resources, in terms of organic matter, nutrients and energy. In addition, the rise of wastewater generation and the incentive of the wastewater treatment processes have derived in an increase of the amount of the sludge produced, which makes difficult its management. This work studies the feasibility of co-composting palm wastes with sludge from the urban and agri-food sectors as alternative treatment to manage these organic waste streams and to obtain added-value compost. For this, four mixtures (P1, P2, P3 and P4) were prepared using as main component palm leave waste (PL) mixed with different types of sludge. In the piles P1, P2 and P3, sewage sludge (SS) was used as co-composting agent, while agri-food sludge (AS) was used in P4. Throughout composting, the thermal profile of the composting piles was assessed, as were physical, chemical, physico-chemical and maturity parameters. In addition, the changes in water-soluble organic matter were assessed using chemical analytical methods and the excitation-emission matrix (EEM) fluorescence spectroscopy. The results obtained showed the viability of the co-composting process to obtain end-products with adequate maturity degree and physical characteristics for their potential use as substrates, except for the salt contents that can limit their use in some agricultural sectors.

[Urological findings in spinal cord ischemia]. / Manifestaciones urológicas de los accidentes vásculo-medulares.

INTRODUCTION: Spinal cord ischemia is a circulatory disorder of acute or subacute establishment and neurological clinic of medullar section, usually incomplete. We describe clinical and anatomical characteristics, as well as diagnostic methods and therapeuthic used in these patients. MATERIAL AND METHODS: Since 1987 to 2007, 65 patients were diagnosed of spinal cord ischemia in our hospital. Clinical interview, neurological examination and image study were performed. Urodynamic study was performed after medullar shock phase, including cystometry, pressure flow study and external urinary sphincter electromyography. We have reviewed treatment applied in these patients. RESULTS: 65 patients (27 women and 38 men), median age 63 years (15-87). 28 patients (43%) presented high lesion (upper to T7), 32 (49%) middle (T7-L2) and 4 (6%) low lesion (below L2). Flaccid paraplegia and acute urinary retention were the most frequent clinical findings at the begining. Aetiology was determined mainly by Magnetic Resonance. Urodynamic study revealed: 9 patients (47.4%) with high spinal cord lesion and detrusor overactivity (with or without dyssynergia), and 6 (31.5%) with arreflexia; 11 patients (47.8%) with middle spinal cord lesion and detrusor overactivity and 7 patients with arreflexia (30.4%); one patient with low spinal cord lesion and detrusor overactivity, and another one with arreflexia (33%). CONCLUSIONS: There is a good correlation among lesion level and clinical findings in traumatic spinal cord injuries, but this is not the same in spinal cord ischemia. Probably, incomplete and patched lesions in vascular spinal cord injuries could explain this lack of correlation. Therefore, it is mandatory to performe an exhaustive neurological and urological evaluation of these patients in order to select the best treatment and prevent upper urinary tract damage in the future.

Composting of the invasive species Arundo donax with sewage and agri-food sludge: Agronomic, economic and environmental aspects.

This work evaluates several co-composting scenarios based on the use of Arundo donax biomass (AD) as bulking agent for the co-composting of sewage sludge (MS) and agri-food sludge (AS), to manage these organic wastes and to produce balanced organic fertilizers by optimizing the process. For this, six piles were prepared in commercial composting conditions, using AD in a range of 40%-80% (on a dry weight basis). Physico-chemical and chemical parameters and the thermal behaviour were evaluated during the process, as were the physical and chemical parameters of the final composts. The proportion of AD in the mixtures has a significant effect on the development of the thermophilic stage of composting, showing the piles with higher proportion of AD a quicker organic matter degradation. In addition, the evolution of the thermal indices R1 and R2 was different depending on the origin of the sludge used, indicating an increase in the relative concentration of more recalcitrant materials in the piles prepared with AS. The estimation of the global warming potential showed that the use of higher proportion of AD in the composting mixture may be a strategy to mitigate the emission of greenhouse gases during the composting process. Moreover, the end-products obtained had an additional marketable value, with a balanced nutrient content and a good degree of maturity, which indicates the viability of the composting process as a method for the stabilization of these organic wastes.

[Peripheral nerve evaluation:indications, technique and results]. / Exploración de raíces sacras: indicaciones, técnica y resultados.

INTRODUCTION: Sacral nerve neuromodulation is a new treatment modality for patients with chronic voiding dysfunction (CVD). The aim of this treatment is to restore the disbalanced micturition reflexes by electrical stimulation ot the sacral roots. Peripheral Nerve Evaluation (PNE) is the first step needed to determine wether sacral nerve stimulation for the control of lower urinary tract dysfunction is appropriate for a given patient, yielding accurate information about the location, integrity and function of sacral nerves, and motor and sensorial responses to electrical stimulation. PATIENTS AND METHOD: 43 PNE in 28 patients (13 man and 15 women) were performed between january 2000 and november 2001 (mean age 56.3 years old, 22-76). Every patient have been diagnosed of CVD: 13 Urinary Urge Incontinence (UUI). 5 Urgency-Frequency Syndrome (UFS), 7 Dysfunctional Voiding (DV) and 3 Mixed Syndromes (1 patient UFS + DV and two patients with UUI + DV). RESULTS: Every acute stimulation showed positive sensory and motor responses. There was premature lead migration in 8 PNE (18.6%), preventing an appropriate evaluation of the temporal stimulation. 35 PNE were evaluated after a 6.5 days period (3-15) of electrical stimulation. There were no significative complications, and PNE was well tolerated. Good clinical results (> 50% reduction in symptoms) were observed in 7/13 patients with UUI (53.8%), 2/5 patients with UFS (40%), 1/7 patients with DV (14.2%) and 1/3 patients with mixed syndromes (UUI + DV) (33.3%). 11 of 28 patients with CVD (39.2%) have been selected as candidates for permanent implantation. CONCLUSION: Actually, PNE is the first step needed to determine wether sacral nerve stimulation for the control of lower urinary tract dysfunction is appropriate for a given patient. With PNE we can select properly adequate candidates for permanent implantation. It is an easy and well tolerated technique, and can be performed in any medical center in an outpatient basis.

[The development and preliminary validation of the IU-4 questionnaire for the clinical classification of urinary incontinence]. / Elaboración y validación preliminar del cuestionario para la clasificación clínica de la incontinencia urinaria IU-4.

RATIONALE: To prepare and validate a simple and self-administered questionnaire for the clinical rating of patients with urinary incontinence (UI) for use in the clinical practice. METHODS: The questionnaire was prepared based on a review of the literature on urinary incontinence and the views of 7 urodynamic urologists. The initial questionnaire UI-5 included 5 items related to UI symptoms that divided patients into three categories: stress incontinence (UEI), urge incontinence (UUI) or mixed urinary incontinence (MUI). An additional question evaluates the impact of UI type on the quality of life. The of construct validity was analyzed correlating the responses to UI-5 items and the question on quality of life. The area under the ROC curve was calculated for each UI type correlating the UI-5 scores and the results of the urodynamic test. The cut-off values for each scale were determined based on sensitivity (SE) and specificity (SP). RESULTS: The study included 188 females with UI (73.4% with UEI, 13.3% with UUI and 13.3% with MUI; based on the urodynamics). Only 4.3% patients did not answer some UI-5 items. One item related to the protective material used was excluded as it was not related to UI types, and so the final questionnaire included only 4 items (UI-4). The results show that UI-4 discriminates the different types of incontinence: UEI (SE: 0.69/SP: 0.76; 1 item), UUI (SE: 0.83/SP: 0.65; 2 items), MUI (SE: 0.72/SP: 0.65; 1 item). 100% patients with MUI, 84% with UUI and 59.9% with UEI report some impact on their quality of life. CONCLUSIONS: UI-4 is simple, valid and easy to administer, and can be particularly valuable in the clinical rating of UI in settings where urodynamic testing is not easily available such is primary health care.

[Impact of urinary incontinence and overactive bladder syndrome on health-related quality of life of working middle-aged patients and institutionalized elderly patients]. / Impacto de la incontinencia urinaria y del síndrome de vejiga hiperactiva en la calidad de vida relacionada con la salud de pacientes de mediana edad laboralmente activos y mayores de 65 años institucionalizados.

INTRODUCTION: Health-related quality of life (HRQoL) is considered by patients with urinary symptoms as the main outcome variable. Descriptive data about HRQoL in patients with urinary incontinence (UI) and/or overactive bladder (OAB) are reported. These data may serve as a reference for comparison purposes. MATERIALS AND METHODS: Data were taken from EPICC, a national, multicenter, observational, epidemiological study. Data from representative samples of four population groups were analyzed: working patients of both sexes aged 50-64 years, and institutionalized elderly patients of both sexes with no cognitive impairment. In addition to demographic and clinical data, HRQoL data from the Overactive Bladder Questionnaire (OAB-q SF) and the SF-12 Health Survey were also analyzed. RESULTS: Of the total patients in the EPICC study, 26.53% completed the HRQoL questionnaires. Patients with both UI and OAB symptoms had poorer scores than those with OAB or UI respectively in the PCS (41.34 vs. 47.17 and 45) and MCS (46.01 vs. 49.04 and 47.78) of the SF-12, and in the symptom (32.21 vs. 19.19 and 16.65) and quality of life (82.32 vs. 86.72 and 89.45) dimensions of the OAB-q SF. Impact of OAB and UI on HRQoL was higher in men over 65 years of age as compared to women of the same age (76.76 vs. 82.79). CONCLUSIONS: Concurrent symptoms of both UI and VH have a greater impact on HRQoL than those of either UI or VH alone. Impact on HRQoL is similar in middle-aged men and women, but higher in elderly men.

[Analysis of overactive bladder and urinary incontinence in working women aged between 25 and 64 years. EPICC study]. / Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en mujeres laboralmente activas entre 25-64 años. Estudio EPICC.

INTRODUCTION: Urinary symptoms Overactive Bladder (OAB) and Urinary Incontinence (UI) result in an important personal and economic impact. This work concentrates on the detailed analysis of OAB and UI (derived symptoms and tendencies in medical consultation and resource consumption), in a sample of working women aged 25-64. MATERIAL AND METHODS: Study within the framework of the EPICC study of the Spanish Association of Urology (epidemiologic, observational, multicentric, national study) and concentrates on the detailed analysis of the characteristics of the sample of working women aged 25-64 (N=3090) and of the subgroup of individuals with VH and/or IU (N=307). RESULTS: 4.01% of the subjects presented UI alone, 2.69% OAB alone, 3.24% presented both pathologies. There exists association between UI and/or VH presence and frequent urinary infections, hypertension and diabetes. Taking into account individuals with UI and/or OAB, 28.01% had problems to retain urine, and 16.94% suffered leakage daily; 27.36% suffered uncontrollable urge to urinate daily; 57.65% had never sought medical advice, 35.40% had visited an specialist, 23.13% would like to visit an specialist in incontinence; 28.01% had received treatment, from which 55.81% had received physiotherapy and 25.58% pharmacologic treatment. CONCLUSION: In this study, specific data about VH and IU in working women aged 25-64 are presented, including those referring to the magnitude of these conditions and use of sanitary resources in subjects with UI and/or OAB, aiming at contributing to a better diagnose and handling of patients and resources.

[Analysis of overactive bladder and urinary incontinence in males in the age range between 50 and 65 years. EPICC study]. / Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en varones en la franja de edad de los 50 a los 65 años. Estudio EPICC.

INTRODUCTION: The Overactive Bladder syndrome (OAB) and Urinary Incontinence (UI) result in an important personal and economic impact. This work concentrates on the detailed analysis of OAB and UI (derived symptoms and tendencies in medical consultation and resource consumption), in a sample of working men aged 50-65. MATERIAL AND METHODS: This study is within the framework of the EPICC study of the Spanish Association of Urology (epidemiologic, observational, multicentric, national study) and concentrates on the detailed analysis of the characteristics of the sample of working men aged 50-65 (N

[Sexual dysfunction in Parkinson's disease]. / Disfunción sexual en la enfermedad de Parkinson.

Sexual activity, function and libido in 50 patients with idiopathic Parkinson's disease and no signs of mental deterioration were evaluated by an estructured questionnaire. The sample included 36 men and 14 women with a mean age of 57.9 +/- 10.1 years and a mean time elapsed since onset of 7.01 +/- 3.9 years. We found decreased sexual activity in 68% and a lack of libido admitted by 26%. Although the decrease in sexual activity was found more often in women, this dysfunction was not statistically significant. Decreased sexual desire, however, was statistically significant. Erectile dysfunction was found in 38.8% and was more frequent in patients over 61 years of age.

[Neurologic changes in patients with multiple sclerosis]. / Alteraciones neurourológicas en pacientes afectos de esclerosis múltiple.

OBJECTIVE: To evaluate the presence of urinary symptoms in 77 patients with multiple sclerosis. METHODS: The neurological compromise and the degree of functional disability were evaluated through the Minimum Dossier of Disability for Multiple Sclerosis. The pertinent data for the urinary symptoms were collected through a directed survey. A urodynamic study was performed to evaluate bladder function. RESULTS: 81.8% of the patients had urinary symptoms, the most prevalent being the mixed syndrome (52%). Neurological involvement and functional disability were greater in the male patients and there was a higher incidence of urinary symptoms (91%). Urgency (66.6%), frequency (60.3%) and dysuria (53.8%) were the most common urinary symptoms. The complication rate was low; infection was the most common complication (14.28%) and was more prevalent in the females. Detrusor hyperreflexia (60%) was the most frequent urodynamic finding. CONCLUSIONS: Urinary symptoms are frequent in multiple sclerosis (81.8%), the most prevalent being the mixed syndrome. Neurological involvement and functional disability are greater in the male patients and there is a higher incidence of urinary symptoms. There is a significant correlation between the severity of neurological compromise (pyramidal and cerebellar) and the degree of functional disability and the presence of urinary symptoms.

[Urinary and sexual alterations in multiple sclerosis]. / Alteraciones urinarias y sexuales en la esclerosis múltiple.

Urinary and sexual symptoms in patients with multiple sclerosis (MS) are frequent, although this question has scarcely been addressed in our country. The aim of this study is to prospectively evaluate the presence of such symptoms in 77 MS patients. We have valued the neurological involvement and the degree of functional disability through the Minimum Dossier of Disability for Multiple Sclerosis. The urinary and sexual symptoms were collected through a directed survey. We have performed an urodynamic study in order to evaluate the bladder function. Urinary symptoms wire observed in 81.8% of patients, with predominance of the mixed syndrome (52%). Males show greater neurological affectation and functional disability, as well as greater urinary symptoms frequency (91%). The most frequent symptoms have been urgency (66.6%), frequency (60.3%) and dysuria (53.8%). The complications have been scarce, of infectious type (14.28%) and with female predominance. The most frequent urodynamic finding has been the detrusor hyperreflexia (60%). The minimum dossier of Disability for Multiple Sclerosis is useful to establish comparative parameters with other studies and with more specific urologic data. The presence of urinary symptoms in multiple sclerosis correlated with the degree of neurological (pyramidal and cerebellar) involvement and of functional disability in the Dysfunction Status Escale.

A multicentre study of the hospital care of 1500 patients with myelomeningocele.

The purpose of this paper is to describe the medical attention that is given to patients affected by myelomeningocele in Spain. We have used information extracted from the 'Multicentre study of patients suffering from spina bifida in Spain'. This material was collected between 1986 and 1988 from experiences with 1500 patients all over our country. 52.9% of the patients were male, and 47% female, and of the total number, 72.2% were under 15 years of age. Most of these patients attended public hospitals (78.5%) and on average each one had been admitted about seven times. The cost of hospitalisation of the sample has been assessed. Urology, orthopaedic surgery and rehabilitation are the specialties most involved. The most frequent complications were those related to the urinary system (66.1%).

Ambulation in patients with myelomeningocele: a study of 1500 patients.

Data from 1500 patients affected by spina bifida have been collected in a multicentre study in Spain from 1986 to 1988. This paper is concerned with a part of the data, specifically regarding the walking of patients and certain factors that influence the prognosis for ambulation. The neurological level of lesion most commonly present was lumbosacral (65.6%). Hydrocephalus was frequent (62% of the sample), and has significant implications regarding prognosis for walking. Hip dislocation (32%) and scoliosis (22.9%) were orthopaedic problems noted in our sample. Pressure sores appeared in 31.7% of the patients. The onset of walking ability has been studied; 15% of the sample started walking at an age older than 5 years. Finally, different modalities of ambulation are described according to the use of ancillary devices, and in independence in activities of daily living.

[Valves of the anterior urethra]. / Valvas de uretra anterior.

Despite the cases reported in the literature, anterior urethral valves continue to be an uncommon condition. The foregoing has to be considered when evaluating children with urinary obstruction or recurrent infections. A case of anterior urethral valves associated with segmental saccular dilatation of the urethra is described and the diagnostic methods are highlighted.

Urological manifestations of herpes zoster.

Herpes zoster is an infection caused by the varicella virus. Inflammatory reaction can involve the spinal cord and anterior horn cells causing varied neurological disorders including urological alterations. We reviewed 57 patients who suffered herpes zoster between 1984 and 1991. 15 of them (26%) showed urological manifestations: 2 cases acute urinary retention, 3 patients urinary incontinence and 10 cases had a cystitis-like syndrome. The clinical findings and diagnostic procedures are studied. The possible etiological mechanisms are discussed. The literature is reviewed.

Prevalence of urinary incontinence among Spanish older people living at home.

OBJECTIVE: To estimate the prevalence and characteristics of urinary incontinence (UI) in the noninstitutionalized elderly population of Madrid, Spain. METHODS: We carried out a cross-sectional study in a representative sample of all community-dwelling people aged 65 or over. Subjects were interviewed in their homes. The question: Do you currently experience any difficulty in controlling your urine? . In other words, does your urine escape involuntarily? was used to identify UI. Type of UI, use of absorbents and specific drugs were also assessed, as well as consultation behavior. RESULTS: 589 persons were interviewed (response rate: 71.2%). The prevalence of UI was 15.5%. No significant difference was observed between men and women. Urge UI was the main type for men and mixed UI for women. Use of pads was referred by 20.2%. A total of 34.3% of subjects never went to the doctor for their problem (25.2% of men and 39.4% of women). CONCLUSION: Compared to other populations the overall prevalence of UI in Spanish elders living at home is relatively high. A very small difference by gender was found, although a lower response rate in women could in part explain this unexpected finding.