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To assess changes in sleep parameters and circadian rhythm metrics measured by actigraphy in preschool-aged children.Longitudinal analysis over 1 year.Ninety-four children living in Tijuana and Ensenada, Mexico.Children wore accelerometers on the right hip for one continuous week at baseline and 1-year follow-up. Parents recorded child bedtime, waketime, and naps in sleep diaries. We used cosinor and nonparametric approaches to calculate circadian rhythm metrics.At baseline, children had a mean age of 4.2 years, and 51.1% were girls. In multivariable models adjusted for age, gender, BMI category, parental education, household income and city, at follow-up children had significantly earlier waketimes (β = -7.99 minutes, p.001) compared to baseline. Children also had lower sleep onset latency (β = -2.32 minutes, p = .057), and longer nighttime sleep (β = 9.38 minutes, p = .079), but these changes were not significant at the α0.05 level. We found significant increases in log relative amplitude (β = 0.017, p = .009), and decreases in log midline estimated statistic of rhythm (β = -0.084, p = .017) and log of the least active 5-hour period (β = -0.057, p = .010). When we adjusted for co-sleeping, we found significant decreases in the number of nighttime awakenings (β = -1.29, p = .011) but otherwise similar results. There were no other changes in sleep parameters or circadian rhythm metrics.Mean increases in nighttime sleep and earlier wake times over one year were concomitant with decreases in overall activity levels and increases in circadian rhythm robustness. Co-sleeping was a predictor of sleep disturbances. This study provides longitudinal evidence regarding changes in sleep and circadian metrics in a sample of children from an under-researched sociodemographic group during an important, early life period.

Background Labor pain is difficult to measure. The aim of this proof-of-concept study is to implement and test a questionnaire assessing pain sensation during and after vaginal deliveries. Its key aspect is a highly standardized survey of patient-reported outcome (PRO) by staff not involved in routine care. Methods Between January and November 2015 339 women were assessed 24–48 h after spontaneous or operative-vaginal delivery of a singleton. German language skills were a prerequisite to participate. The test–retest reliability was calculated in 38 women 24–36 and 48–72 h postpartum between July and October 2017. Primiparae after spontaneous delivery and multiparae with no history of operative deliveries were compared in a subgroup analysis. Results Maximum labor pain and post-partum pain were reported a median of 9 [8–10] and 4 [3–6]. Higher ratings were associated with younger age, higher gestational ages, infant’s biometrics, and the duration of laboring. Only regional analgesia tended to reduce pain perception (NRS 8 vs. 9). Higher-degree injuries were associated with less pain postpartum. The questionnaire proved to be reliable in most aspects (Cronbach's α > 0.6 for 19/21 questions) and showed an acceptable content and criterion validity (Cohen correlation > ± 0.3, interrelation between items). Conclusion Labor is a very painful experience, irrespective of previous obstetric history. Ratings indicate inadequateness of treatment except for patients receiving preventive postoperative pain management. Systematic postpartum pain assessment, hence, is still a pending issue. Adjustments will be made concerning language skills and specific questions on effectiveness of analgesia otherwise good reliability and validity of the questionnaire were proven.

Background Rates of childhood obesity have accelerated rapidly over the past decade in low- and middle-income countries and in Latin America in particular. At the same time, Latinx children in high-income countries have been disproportionately affected by obesity. Public health and medical experts have called for greater focus on multi-sector approaches to obesity prevention, including policy, systems, and environmental strategies, but current evidence for effective intervention strategies among Latinx children is lacking. Several systematic reviews have investigated obesity prevention interventions in Latinx children in the United States and in Latin America, including our own review, but these are now a decade old. Thus, an updated review of existing interventions is needed. To address this gap, we will conduct a systematic review and summary of interventions for obesity prevention among Latinx children published over the past 10 years. The objective of this paper is to outline the protocol for conducting the systematic review and possible meta-analysis. Methods We will conduct a literature search using PubMed, ERIC, PsycINFO, Scopus, Scientific Electronic Library Online, and Google Scholar databases for studies of interventions to prevent obesity in Latinx children ages birth to 18 years of age. To meet our definition of an intervention, we will include study designs that evaluate the either the efficacy or effectiveness of obesity prevention interventions, including randomized controlled trials, quasi-experimental studies, and non-randomized interventions with a control or comparison group. We will exclude interventions that aimed to treat rather than prevent overweight or obesity. Interventions may take place in any country or setting. The primary outcome of interest will be child overweight or obesity, measured as adiposity, body mass, or similar anthropometric measures. We will assess risk of bias of included studies using the Cochrane risk of bias tool for randomized and non-randomized studies, as appropriate. We may conduct meta-analyses if studies with comparable exposure and outcome variables are available. Discussion This protocol paper establishes a methodology for a future systemic review of obesity prevention interventions in Latinx children. A systematic review of this topic will provide an important update to the literature regarding interventions to prevent obesity in Latinx child populations globally over the past decade. Review results will be relevant to stakeholders across multiple sectors engaged in childhood obesity prevention among Latinx children. Systematic review registration PROSPERO CRD42020161339

Streptococcus equi, an equine commensal bacterium, is a rare etiology of septicemia and meningoencephalitis in humans and is extremely infrequent in children. Scarce literature has been published about its clinical presentation, treatment and outcomes in infants. Here, we describe a case of S. equi subsp. zooepidemicus septicemia and meningoencephalitis in a five-month-old Costa Rican infant that was confirmed by peripheral blood and cerebrospinal fluid (CSF) cultures in a regional hospital of the Pacific coast of Costa Rica who developed multiple ischemic cerebral infarcts secondary to infectious vasculitis, a subdural empyema and serious neurological sequelae. We also reviewed the literature on S. equi meningitis in infants under one year of age. This is the first reported case in our country, the fourth reported in infants under one year of age and the second describing multiple cerebral infarcts and subdural empyema in an infant.

Disseminated histoplasmosis is the most common clinical presentation of histoplasmosis in human immunodeficiency virus (HIV) negative infants from Costa Rica and Latin America. Initial presentation as septic shock and autoimmune hemolytic anemia is uncommon. Even more, detection of Histoplasma capsulatum by culture in peripheral blood and cerebrospinal fluid (CSF) is extremely rare. We describe the case of a three-month-old Costa Rican immunocompetent infant who presented with shock and hemolytic anemia secondary to disseminated histoplasmosis that was confirmed by bone marrow aspirate and positive peripheral blood and CSF cultures.

Background: Atrial Fibrillation (AF) is associated with an increased risk of stroke and systemic embolism. Several studies have suggested that female AF patients could have a greater risk for stroke. There is scarce information about clinical characteristics and use of antithrombotic therapies in Latin American patients with nonvalvular AF. Objective: To describe the gender differences in clinical characteristics, thromboembolic risk, and antithrombotic therapy of patients with nonvalvular AF recruited in Mexico, an upper middle-income country, into the prospective national CARMEN-AF Registry. Methods: A total of 1423 consecutive patients, with at least one thromboembolic risk factor were enrolled in CARMEN-AF Registry during a three-year period (2014–2017). They were categorized according to Gender. Results: Overall, 48.6% were women, mean age 70 ± 12 years. Diabetes, smoking, alcoholism, non-ischemic cardiomyopathy, coronary artery disease, and obstructive sleep apnea were higher in men. Most women were found with paroxysmal AF (40.6%), and most men with permanent AF (44.0%). No gender differences were found in the use of vitamin K antagonists (VKA) (30.5% in women vs. 28.0% in men). No gender differences were found in the use of direct oral anticoagulants (DOAC) (33.8% women vs 35.4% men). Conclusions: CARMEN-AF Registry demonstrates that in Mexico, regardless of gender, a large proportion of patients remain undertreated. No gender differences were found in the use of VKA or DOAC. Keywords: Atrial fibrillation, Gender, Thromboembolic risk, Antithrombotic therapy, Stroke, Mexico

The practice of metabolic and bariatric surgery for adolescents with severe obesity has been increasing, and evidence of the outcomes in the long term remains unclear. The aim of this study was to review and analyze the outcomes of this therapy in adolescents with a follow-up ≥5 years. MEDLINE, EMBASE, and Cochrane databases were systematically searched. Inclusion criteria were 10- to < 20-year-old adolescents, 5 years minimum of follow-up, and a retention rate ≥70% at 5 years of follow-up. Adiposity indicators outcomes, co-morbidity remission, and complications were analyzed. A total of 10 studies met the inclusion criteria. Surgeries performed included gastric bypass, gastric band, and sleeve gastrectomy. The age of the participants ranged from 13 to 17 years. The longest follow-up after intervention was 156 months. Mean body mass index at baseline and follow-up was 47 and 32.4 kg/m 2 , respectively. Most of the studies reported weight regain within 1 to 12 years of follow-up. Remission rate of co-morbidities was 75% for dyslipidemia, 78% for musculoskeletal problems, 85% for hypertension, and 85% for type 2 diabetes. Not all studies stated that they were looking for all complications. Iron deficiency and anemia were high, ranging from 30% to 70% and 16% to 50%, respectively. The review indicates that there is low to moderate evidence that metabolic and bariatric surgery in adolescents with severe obesity after 5 years of follow-up results in substantial reduction in body mass index, and very low to low evidence in the resolution of related co-morbidities. Although long-term complications were inadequately reported or nonreported, a high prevalence of iron deficiency and anemia was found. Because maternal anemia might be implicated in deleterious effects for offspring, monitoring female patients for anemia after metabolic and bariatric surgery is strongly recommended. Further high-quality studies with long-term follow-up are warranted to assess related co-morbidities and long-term complications.

Physical fitness is the ability to perform activities of daily living without excessive fatigue. The potential protective role of fitness against high blood pressure in childhood is relevant to diminish the risk of hypertension in adulthood. A negative association between cardiorespiratory fitness (CRF) and hypertension has been found in the pediatric population. However, the role of body mass as a confounding variable of this association has not been evaluated. This study aimed to analyze whether the association between fitness and blood pressure in Mexican schoolchildren is independent of body mass.A cross-sectional study was conducted with a sample of 1010 children (574 females and 436 males) aged 9-12 years (mean age = 10.3 ± 0.9 years) from 13 elementary schools in Mexico City. Fitness was evaluated with tests from the FitnessGramLow fitness showed a high prevalence (from 45.8% for trunk lift to 77.5% for push-ups). Children with poor CRF (assessed by the 20-m progressive aerobic cardiovascular endurance run test) and upper body strength (assessed by push-ups) showed a higher probability of hypertension (p0.05). However, these differences disappeared after adjusting for BMI.After considering the body mass, cardiorespiratory and musculoskeletal fitness were not independent predictors of blood pressure.La condición física es la habilidad de realizar actividades de la vida diaria sin fatiga excesiva. El potencial papel protector de una buena condición física contra la presión arterial elevada es relevante, ya que, si no se atiende, esta elevación en la presión arterial comúnmente conduce a hipertensión en la vida adulta. Se ha documentado una asociación negativa entre la condición cardiorrespiratoria con la hipertensión de la población pediátrica. Sin embargo, no se ha evaluado el papel de la masa corporal como una variable de confusión de esta asociación. El objetivo de este estudio fue evaluar si la asociación entre la condición física y la presión sanguínea es independiente de la masa corporal en escolares mexicanos.Estudio transversal con una muestra de 1010 escolares (574 de sexo femenino y 436 de sexo masculino) de 9 a 12 años (edad promedio = 10.3 ± 0.9 años) de 13 escuelas de primaria de la Ciudad de México. La condición física se evaluó con la batería FitnessGramLa prevalencia de baja condición física fue alta (de 45.8% en la prueba de levantamiento de tronco a 77.5% en la prueba de lagartijas). Los escolares con baja condición cardiorrespiratoria (evaluada con la carrera progresiva de resistencia cardiovascular aeróbica de 20 m) y fuerza superior del cuerpo (evaluada con la prueba de lagartijas) mostraron una mayor probabilidad de presentar hipertensión (p0.05). Sin embargo, estas diferencias desaparecieron al ajustar por el IMC.Después de considerar la masa corporal, la condición cardiorrespiratoria y musculoesquelética no son predictores independientes de la presión sanguínea.

Objective To evaluate the association between food parenting practices (FPPs) and weight status among preschoolers and the directionality of this association at 1-year follow-up. Methods A longitudinal exploratory study was conducted using linear regression and structural equation modeling to determine directional associations between FPPs and children's body mass index z score and waist circumference. The FPPs were estimated using Child Feeding Questionnaire subscales. Results A total of 91 parent–child dyads completed the study. In structural equation modeling analysis, when identifying the FPPs in a latent variable with its indicators of indulgent feeding, food as a reward and restriction predicted higher body mass index z score at follow-up. Higher baseline waist circumference was also negatively associated with the use of food as a reward. Conclusions and Implications Feeding–weight associations are likely bidirectional. Understanding them, as well as the pathways between them, is critical to developing effective prevention and treatment strategies.

The linear associator is a classic associative memory model. However, due to its low performance, it is pertinent to note that very few linear associator applications have been published. The reason for this is that this model requires the vectors representing the patterns to be orthonormal, which is a big restriction. Some researchers have tried to create orthogonal projections to the vectors to feed the linear associator. However, this solution has serious drawbacks. This paper presents a proposal that effectively improves the performance of the linear associator when acting as a pattern classifier. For this, the proposal involves transforming the dataset using a powerful mathematical tool: the singular value decomposition. To perform the experiments, we selected fourteen medical datasets of two classes. All datasets exhibit balance, so it is possible to use accuracy as a performance measure. The effectiveness of our proposal was compared against nine supervised classifiers of the most important approaches (Bayes, nearest neighbors, decision trees, support vector machines, and neural networks), including three classifier ensembles. The Friedman and Holm tests show that our proposal had a significantly better performance than four of the nine classifiers. Furthermore, there are no significant differences against the other five, although three of them are ensembles.

Water intake has been proposed for weight loss; however, the evidence of its efficacy is limited. The aim of this study was to systematically review the randomized clinical trials that assessed the effect of water consumption on weight with a follow up ≥ 12 weeks. A systematic query-based search was performed on PubMed, EBSCO, and Cochrane Library to identify eligible records that quantitatively measured body weight change after interventions. This review included six RCTs that reported different strategies for weight loss achievement: increasing daily water intake, replacement of caloric beverages with water, and premeal waterload. All the studies showed a weight loss effect after follow-up, ranged from -0.4 kg to -8.8 kg with a mean percentage of weight loss of 5.15%. The most effective intervention among the studies was the replacement of caloric beverages with water. The quality of the evidence for the primary outcome of weight loss was rated low to moderate. The main limitation of these results is the short-term follow up-period. In conclusion, despite 5.15% of weight loss, the low to moderate quality of evidence and the short term of follow-up are limitations to support evidence-based recommendations of water consumption for weight loss.El consumo de agua se ha propuesto como medida para la pérdida de peso; sin embargo, la evidencia de su eficacia es limitada. El objetivo de este estudio fue revisar sistemáticamente los ensayos clínicos aleatorizados que han evaluado el efecto del consumo de agua en el peso corporal con un periodo de seguimiento ≥ 12 semanas. Se realizó una búsqueda sistemática en cadena en PubMed, EBSCO y Cochrane Library para identificar estudios elegibles que midieran cuantitativamente el cambio de peso corporal después de sus intervenciones. Esta revisión incluye seis ECA que reportan diferentes estrategias para alcanzar la pérdida de peso: incremento del consumo diario de agua, reemplazo de bebidas calóricas por agua y sobrecarga con agua previa a las comidas. Todos los estudios mostraron un efecto de pérdida de peso después del seguimiento, con un rango de -0.4 kg a -8.8 kg y con un porcentaje promedio de pérdida de peso del 5.15%. La intervención más efectiva entre los estudios fue el reemplazo de bebidas calóricas por agua. La calidad de la evidencia para el resultado primario de pérdida de peso fue calificada de baja a moderada. La principal limitación de estos resultados es el corto periodo de seguimiento. En conclusión, a pesar de encontrarse una pérdida de peso del 5.15%, la calidad de la evidencia baja a moderada y el corto periodo de seguimiento son limitaciones para sustentar una recomendación basada en la evidencia sobre el consumo de agua para la pérdida de peso.

Background: Documenting the patterns of oral anticoagulation therapy (OAT) is essential to prevent thromboembolic complications of nonvalvular atrial fibrillation (NVAF). Objective: To report the patterns of OAT according to age and thromboembolic risk in patients included in CARMEN-AF, a nationwide registry of NVAF in Mexico, an upper middle-income country. Material and methods: There were 1,423 consecutive patients ≥18 years old and with at least one thromboembolic risk factor enrolled in the CARMEN-AF Registry at their regular clinical visit during a three-year period. They were analyzed according to 1) age, 2) AF type, and 3) CHA2DS2-VASc score. Results: Overall, 16.4% of patients did not receive antithrombotic treatment, 19.4% received antiplatelet drugs (APD), 29.2% vitamin K antagonists (VKA), and 34.6% direct oral anticoagulants (DOAC). With increasing age, the proportion of subjects treated with VKA decreased significantly from 36.2% in subjects

Objective: To apply new mathematical models according to Non Muscle Invasive Bladder Carcinoma (NMIBC) biological characteristics and enabling an accurate risk estimation of multiple recurrences and tumor progression. The classical Cox model is not valid for the assessment of this kind of events becausethe time between recurrencesin the same patient may be strongly correlated. These new models for risk estimation of recurrence/progression lead to individualized monitoring and treatment plan. Materials and methods: 960 patients with primary NMIBC were enrolled. The median follow-up was 48.1 (3-160) months. Results obtained were validated in 240 patients from other center. Transurethral resection of the bladder (TURB) and random bladder biopsy were performed. Subsequently, adjuvant localized chemotherapy was performed, The variables analyzed were: number and tumor size, age, chemotherapy and histopathology. The endpoints were time to recurrence and time to progression. Cox model and its extensions were used as joint frailty model for multiple recurrence and progression. Model accuracy was calculated using Harrell's concordance index (c-index). Results: 468 (48.8%) patients developed at least one tumor recurrence and tumor progression was reported in 52 (5.4%) patients. Variables for multiple-recurrence risk are: age, grade, number, size, treatment and the number of prior recurrences. All these together with age, stage and grade are the variables for progression risk. Concordance index was 0.64 and 0.85 for multiple recurrence and progression respectively. Conclusion: the high concordance reported besides to the validation process in external source, allow accurate multi-recurrence/progression risk estimation. As consequence, it is possible to schedule a follow-up and treatment individualized plan in new and recurrent NMCB cases. (C) 2014 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Los refrigerios que consumen los niños durante el recreo complementan su dieta diaria, y pueden representar un riesgo de obesidad si los padres los preparan con base en alimentos procesados, elevados en azúcar, sal y grasa. El objetivo de este estudio fue identificar el contenido de los refrigerios empacados en casa, así como el estado nutricio de escolares de Reynosa, Tamaulipas, México. Se realizó un estudio descriptivo y transversal. Se trabajó con 769 niños de 12 escuelas públicas de educación básica. Se tomaron peso y talla. Se registraron durante una semana los refrigerios por observación directa, mediante una lista de cotejo. El 44.7 % de los escolares presentó sobrepeso u obesidad. Los alimentos contenidos en los refrigerios fueron el sándwich (50.0 %), tacos (29.5 %) y tortas (14.5 %). Las bebidas azucaradas incluyeron jugo (44 %) y agua saborizada (38.2 %). El 18.8 % llevó frutas, 13.5 % verduras y 31.6 % agua. En promedio, el contenido de energía fue de 327 kcal, por lo tanto, sobrepasaron la recomendación de calorías, e incluían alimentos no saludables (alto contenido de azúcar y grasa en relación a su aportación nutrimental), siendo necesario realizar intervenciones de educación nutricional para promover el consumo de agua y alimentos saludables dentro del entorno escolar, para mejorar la calidad de los hábitos alimenticios, tanto en escuelas de medio tiempo, como de tiempo completo, las cuales, brindan el servicio de alimentación.

Numerous previous studies have reported positive associations between exposure to greenspace and children's physical activity, but in high-income countries only. Prior studies have also examined greenspace and obesity in children, but these have yielded inconsistent results and focused mostly on older children. The purpose of this study was to assess associations between time children spent in greenspace as the primary exposure and our outcomes of interest, including 1) minutes of physical activity, and 2) body mass index (BMI) z-score. Our sample was 102 children ages 3 to 5 years living in Ensenada and Tijuana, Mexico. We fit linear mixed models to estimate associations between greenspace and children's physical activity and BMI z-score. After adjustment for potential confounders, greater time in greenspace was associated with decreased sedentary time (−0.08 min per hour for each additional 30 min in greenspace; 95% CI −0.13, −0.04; p = 0.002) and increased moderate-to-vigorous physical activity (MVPA) (0.06; 95% CI 0.03, 0.10; p

An important challenge to be addressed in the search for an optically based, non-invasive blood glucose quantification method, is related to the spectral interference between glucose and insulin in the mid-infrared region. This work proposes the use of a factorial experimental design in order to understand the optical overlapping of these compounds. The results show how in the 1100–950 cm−1 range, glucose has a greater contribution than insulin to the absorption spectrum, without a significant effect from their interaction. These results and the use of the proposed technique could bring in interesting insights for biomedical applications. Keywords: Non-invasive blood glucose quantification, Glucose - insulin, Factorial experimental design, mid-IR spectroscopy

Introduction . Obesity is a pandemic in Mexico. The purpose of this study was to assess the environmental factors that have the strongest association with obesity and abdominal obesity among adults in Tijuana. Methods . Four neighborhoods differing in socioeconomic status were chosen. A questionnaire for weekly walking, social cohesion, satisfaction with their community, weekly income, and convenience store, education, family income, crime safety, pedestrian safety, street connectivity, walking/cycling facilities, and sociodemographic characteristics was administered. Weight, height, and waist circumference were measured. Univariate and multivariate binomial logistic regressions were conducted. Results . Three hundred and twenty-two (322) individuals, 70% females with a mean age of 39 years, were assessed. The prevalence of obesity and abdominal obesity was 27% and 43.5% respectively. The odds ratio for obesity and abdominal obesity among those living in the lowest-income neighborhood was 2.4 and 7.8 respectively, compared with those living in a middle-class neighborhood. Conclusions . Residence in a low-income neighborhood was a predictor for obesity.

Objective To evaluate if re-grading renal cell carcinoma (CRCC) in two or three-tiered grading schemes vs the traditional Fuhrman classification maintains the same prognostic value. Material and methods A study of a cohort of 383 treated CRCC with radical or partial nephrectomy between 1990 and 2009 was made. We analyzed the demographic data, evolution and survival of these patients. An uropathologist reassigned the Fuhrman grades blindly to the first classification. In order to study if the prognostic value was maintained with the different classification, three Cox multivariate regression analysis were performed, classifying the variable of grade into four categories: (I-II-III-IV), into three (I + II-III-IV) and into two (I + II-III + IV). The explanatory variables were: age, gender, tumor size, study stage and grade. The response variables were progression-free survival (local-regional recurrence/metastasis) and cancer specific survival time. Results The median overall survival was 125 months (95% CI: 92–159). In the three multivariate analyses carried out, the Fuhrman classification showed independent predictive value (p = 0.0001) compared to progression-free survival and cancer specific survival. The predictive power was maintained in the new classifications. In the three categories, the changing from grade I + II to III meant RR: 2.31 (p = 0.0001) and from grade III to IV RR: 2.47 (p = 0.0001) and in two-tiered classification an RR: 2.8 (p = 0.001) was found when changing from I + II to III + IV. Conclusions Our results show that categorizing the Fuhrman grade into three or two-tiered grading schemes provide the same predictive accuracy on progressive free survival and cancer specific survival. Grades III and IV have different outcomes so that the three-tiered classification seems to be more appropriate to described the course of these patients.

Resumen Objetivo Evaluar si la re-clasificacion de los carcinomas renales de celulas claras (CRCC) en dos o tres grados de Fuhrman (GF) frente a la clasificacion clasica mantiene su valor pronostico. Material y metodos Estudio sobre una cohorte de 383 CRCC tratados con nefrectomia radical/parcial (1990-2009). Se analizaron datos demograficos, evolucion y supervivencia de los pacientes. Un uropatologo reasigno los grados de Fuhrman de forma ciega al informe original. Para estudiar si se mantenia el valor pronostico con las distintas clasificaciones se realizaron tres analisis de regresion multiple de Cox, categorizando la variable grado en 4 categorias(I-II-III-IV), en tres (I + II-III-IV) y en dos (I + II-III + IV). Las variables explicativas fueron: edad, sexo, tamano tumoral, estadio y grado. Las variables respuesta fueron: tiempo de supervivencia libre de progresion (recidiva locorregional/metastasis) y de supervivencia cancer-especifica. Resultados La mediana de supervivencia global fue de 125 meses (IC 95%: 92-159). En los tres analisis multivariantes el grado de Fuhrman demostro valor predictivo independiente (p = 0,0001) frente al estadio para la supervivencia libre de progresion y supervivencia cancer-especifica. El valor pronostico se mantuvo en las nuevas clasificaciones. En la de tres categorias el paso del grado I + II al III presento un RR: 2,31(p = 0,0001) y del grado III al IV un RR: 2,47(p = 0,0001) y en la de dos categorias se observo un RR: 2,8 (p = 0,001) al pasar del grado I + II al III + IV. Conclusiones La categorizacion en dos o tres grupos del grado de Fuhrman mantiene la capacidad predictiva sobre la supervivencia libre de progresion y cancer-especifica. Los grados III y IV presentan evoluciones distintas, por lo que la clasificacion en tres categorias parece mas adecuada para describir la evolucion de estos pacientes.

Objective To evaluate the prognostic value of venous tumor thrombus in renal cell carcinoma. Material and methods A retrospective study of 167 patients with renal cell carcinoma and stage pT3 who underwent radical nephrectomy and extended lymphadenectomy from July 1969 to May 2008 was conducted. Patients with any kind of venous involvement were selected for the analysis (73 patients; 43.7%). The Kaplan–Meier survival curves and log-rank test for comparisons were used for the survival analysis. Multivariate analysis was done by Cox regression. Results Lymph node involvement was present in 30 patients (41.1%) and metastatic disease in 9 patients (12.3%). The most frequent histologic renal cell carcinoma subtype was 50 (68.5%) conventional carcinoma, followed by nondifferentiated in 11 (15.5%), and chromophobe in 9 (12.3%). High-grade tumors (Furhman 3–4) were present in 57% of the cases. Venous thrombus level extended to renal vein in 61 patients (83.6%), to inferior vena cava in 9 patients (12.3%) and to the cardiac right atrium in 3 cases (4.1%). The survival analysis showed worse survival in those patients with venous tumor thrombosis ( p = 0.001) and with vein wall invasion ( p = 0.0042), but not in function on the level of the thrombus ( p = 0.12). The multivariate analysis identified the Furhman grade and venous tumor thrombosis as independent survival prognostic factors. Conclusions In our series, venous tumor thrombosis, together with the Furhman nuclear grade, is an independent survival prognostic factor. However, neither cephalic extension of the thrombus nor the invasion of the vein wall showed independent prognostic value.

Resumen Objetivo Analizar el valor pronostico de la trombosis tumoral venosa en el carcinoma de celulas renales (CCR). Material y metodos Estudio retrospectivo de 167 pacientes con carcinoma de celulas renales (estadio pT3) intervenidos mediante nefrectomia radical y linfadenectomia (julio de 1969 a mayo de 2008). Para el analisis se seleccionaron los pacientes con afectacion venosa (73 pacientes; 43,7%). Para el analisis de supervivencia, se utilizaron las curvas de Kaplan-Meyer y el test de log-rank. El analisis multivariante se realizo mediante regresion de Cox. Resultados En 30 pacientes (41,1%) existia afectacion ganglionar, y en 9 pacientes (12,3%) enfermedad metastasica. El subtipo histologico mas frecuente fue el carcinoma convencional en 50 pacientes (68,5%), seguido del indiferenciado en 11 pacientes (15,5%) y el cromofobo en 9 pacientes (12,3%). El 57% de los tumores fueron de alto grado (Furhman 3-4). El nivel de trombo tumoral se extendia hasta la vena renal en 61 pacientes (83,6%), hasta la cava infradiafragmatica en 9 pacientes (12,3%), y en 3 casos (4,1%) al atrio. El analisis de supervivencia mostro peor supervivencia en aquellos pacientes con trombosis tumoral venosa (p=0,001) y con invasion de la pared venosa (p=0,0042) pero no en funcion del nivel del trombo (p= 0,12). El analisis multivariante identifico el grado de Furhman y la trombosis tumoral venosa como factores pronosticos independientes de supervivencia. Conclusiones En nuestra serie la trombosis tumoral venosa es un factor pronostico independiente de supervivencia, junto al grado nuclear de Furhman. Ni el nivel de extension cefalica del trombo ni la invasion de la pared venosa mostraron valor pronostico independiente.

To assess the validity of a questionnaire developed for parents of preschool children to know their physical activity (PA) status, we compared the questionnaire results with the measures of accelerometer for children’s activities. Thirty-five preschoolers who wore the accelerometer for at least 10 hours daily on 3 weekdays and one weekend day were included in the analyses. Time spent in activities of varied intensity was calculated by applying 15-second ActiGraph count cutoffs (ACC). Parents’ perceptions of their children’s PA were associated with the percentage of vigorous and moderate physical activity recorded with ACC at r=0.62 (p=0.0001). An association was shown between the percentage of a child’s time spent in vigorous physical activity, as reported by parents, with that measured by ACC at r=0.53 (p=0.001). Results of this study suggest that the designed questionnaire might be a useful tool for assessing children’s activity while, additionally, it warrants further investigation on larger samples of children DOI: http://dx.doi.org/10.3329/jhpn.v30i4.13327 J HEALTH POPUL NUTR 2012 Dec;30(4):439-446

Previous studies have found increased acculturation to the US lifestyle increases risk for obesity in Latinos. However, methodologies differ, and results in children are inconsistent. Moreover, previous studies have not evaluated risk factors within the heterogeneous US population. We recruited 144 self-identified Latino school children and their mother or father in grades 4–6 in San Francisco parochial schools and South San Francisco public schools using an information letter distributed to all students. Children and parents had weights, heights, demographic information, dietary patterns and lifestyle variables collected in English or Spanish through an interview format. A high percentage of our children were overweight [≥85th percentile body mass index (BMI)] (62.5%) and obese (≥95th percentile BMI) (45.2%). Correspondingly parents also had a high percentage of overweight (BMI ≥ 25 &

Objetivos: La retención aguda de orina (RAO) es poco frecuente en mujeres y puede relacionarse con distintas patologías. Sólo algunas pacientes son remitidas a una Unidad de Urodinámica para un estudio más exhaustivo. Se pretende describir las características y causas de RAO en las mujeres derivadas a nuestra unidad y analizar su evolución a medio plazo. Material y métodos: Estudio descriptivo retrospectivo (enero 1982- diciembre 2006) incluyendo las mujeres derivadas a la Unidad de Urodinámica tras sufrir una RAO. Se revisaron las historias clínicas con especial énfasis en antecedentes personales, exploración física, así como estudio urodinámico completo durante el episodio de RAO y una vez superado este. Resultados: Se incluyeron 202 mujeres, con una mediana de edad de 57 años (12- 87). Previamente 59 pacientes (28,7%) presentaban síntomas de vaciado. Los patrones urodinámicos que se encontraron fueron: 65 hipocontractilidad vesical (32,2%), 64 estudio normal (31,7%), 37 acontractilidad (18,3%), 21 obstrucción infravesical (10,4%) y 15 ausencia de relajación de suelo pélvico (7,4%). Las principales causas de RAO fueron: 53 neurológica (26,2%); 46 causa desconocida (22,8%); 19 ginecológica (9,4%); 22 diabetes mellitus (10,9%); y 16 urológica (7,9%). Deterioraron la función renal 14 mujeres (6,9%). Tras la RAO 106 mujeres (52,4%) necesitaron continuar con algún tipo de tratamiento. Conclusiones: En nuestra serie la RAO en mujeres suele ser consecuencia de una enfermedad neurológica o uroginecológica subyacente, aunque en un porcentaje importante de pacientes no se logra filiar la causa. La mitad de las pacientes se recuperaron totalmente y no precisaron ningún tipo de tratamiento. Objectives: Acute urinary retention (AUR) is uncommon in women and can be related to different conditions. Only some patients are referred to the urodynamics units for a more extensive study. We intend to describe the charcteristics and causes of AUR in women referred to our unit and to analyze their middle term evolution. Material and Methods: We performed a descriptive retrospective study (January 1982-December 2006), including the women referred to our Uro-Neurology and Urodynamics Unit after suffering an AUR. Medical charts were reviewed with special emphasis on medical history, physical examination, and also complete urodynamics study during the AUR event and after its resolution. Results: A total of 202 women were included, median age of 57 years (12-87 years). Prior to the AUR, 59 women (28.7%) reported voiding symptoms. The urodynamics findings were: 65 (32.2%) detrusor hypocontractility; 64 (31.7%) normal study; 37 (18.3%) detrusor acontractility; 21 (10.4%) bladder outlet obstruction; 15 (7.4%) poor pelvic floor relaxation. The causes of the AUR were: 53 neurological (26.2%); 46 unknown (22.8%); 19 gynecological (9.4%); 22 diabetes mellitus (10.9%); 16 urological (7.9%). Renal insufficiency was observed in 14 patients (6.9%). After the AUR 106 women (52.4%) needed some kind of prolonged treatment. Conclusions: In our experience, AUR in the female is mainly related to underlying neurologic/urogynecologic disease, even though the etiology could not be known in a significant percentage of patients. Half of the patients recovered completely and did not require any treatment.

Objetivo: Evaluar si el uso sistemático de catéter ureteral doble J en las ureteroneocistostomías de los trasplantes renales reduce la tasa de complicaciones. Material y métodos: Estudio prospectivo comparativo no aleatorizado de grupos paralelos, en 194 trasplantes renales. Se establecieron dos grupos homogéneos: 111 pacientes con catéter doble J y otro de 83 pacientes sin catéter. Analizamos la incidencia de complicaciones entre ambos grupos, mediante análisis univariante comparativo (test de χ²) y el análisis multivariante (regresión logística). Resultados: En el grupo con catéter las complicaciones globales aparecieron en el 22,2% frente al 43,3% del grupo sin catéter (p=0,04). En función del reimplante ureteral aparecieron complicaciones en el 38,12% del reimplante tipo Paquin frente al 20,3% en Lich-Gregoir (p=0,09). En el grupo con catéter se evidenció una (0,9%) fístula urinaria frente a 5 (6%) del grupo sin catéter (p=0,08), y 3 (2,7%) estenosis de la anastomosis ureterovesical en el grupo con catéter frente a 7 (8,4%) del grupo sin él (p=0,13). El análisis multivariante demostró que la no utilización de catéter aumenta el riesgo de sufrir complicaciones relacionadas con el reimplante (OR 2,55; IC 95%: 1,37-4,75). El riesgo de fístula aumentó significativamente al no colocar catéter (OR: 9,19; IC 95%: 1,01-84,7). No hubo diferencias entre ambos grupos en cuanto a las infecciones del tracto urinario, produciéndose tres (2,7%) en el grupo con catéter y una (1,2%) en el grupo sin catéter (p=0,63). Conclusiones: La colocación de catéter doble J reduce las complicaciones relacionadas con el reimplante ureteral sin aumentar la morbilidad asociada a su uso. Objective: To assess if the systematic use of double J ureteral catheters in ureteroneocystostomies of kidney transplants reduces the rate of complications. Materials and methods: Non-randomized prospective, comparative study of parallel groups in 194 kidney transplants. We established two equal groups, 111 patients with double J catheter and another of 83 catheter-free patients. We studied the incidence of complications between both groups by means of a univariate comparative study (χ² test)and a multivariate analysis (logistic regression). Results: In the catheter group, the overall complications appeared in 22.2% as opposed to 43.3% of the catheter-free group (p=0.04). Depending on the ureteral transplant, complications appeared in 38.12% of the Paquin type reimplantation as opposed to the 20.3% in Lich-Gregoir (p=0.09). There was evidence of 1 (0.9%) urinary fistula in the catheter group as opposed to 5 (6%) in the catheter-free group (p=0.08), and 3 (2.7%) ureterovesical anastomosis stricture in the group with catheter against 7 (8.4%) of the catheter-free group (p=0.13). The multivariate analysis showed that not using the catheter increases the risk of suffering complications related to reimplantation (OR: 2.55; IC 95%, 1.37-4.75). The risk of fistula increased significantly when a catheter was not placed (OR 9.19, IC 95%, 1.01-84.7). There were no differences between the two groups as regards urinary tract infections; there were 3 (2.7%) in the catheter group and 1 (1.2%) in the catheter-free group (p=0,63). Conclusions: The placement of a double J catheter reduces complications related to ureteral reimplantation without increasing the morbidity associated with their use.

Resumen Introduccion La enuresis nocturna es un trastorno con un interes historico mantenido, no solo en cuanto a su patogenia, probablemente multifactorial pero todavia hoy desconocida, sino tambien en cuanto a su frecuencia. Objetivo Nos planteamos revisar la literatura medica al respecto para conocer la problematica en el calculo de su casuistica. Material y metodo Realizamos una busqueda en la base de datos PubMed, mediante los terminos Mesh «enuresis», «nocturnal enuresis» y «bedwetting», e incluimos en el cuadro de busqueda los terminos «epidemiology OR prevalence». Incluimos todos los trabajos en lengua inglesa o espanola. Seleccionamos los trabajos con una muestra mayor de 1.000 pacientes, e incluimos estos y los articulos de revision. Procedemos al analisis de la metodologia empleada por los grupos mas relevantes, asi como los resultados globales de frecuencia; ademas, cuando es posible, estratificamos los resultados por edad, sexo y frecuencia de los escapes. Resultados La metodologia de los trabajos analizados es heterogenea y las comparaciones se hacen, por tanto, dificiles. La prevalencia global es dificil de estimar y dar resultados globales carece de interes pues para interpretarlos es necesario pormenorizar la metodologia, la muestra y los criterios diagnosticos. Conclusiones Se hace necesario un estudio epidemiologico propio que resuelva nuestra problematica.

SummaryHaemophilia is the most frequent hereditary haemorrhagic illness and it is due to the deficiency of coagulation factors VIII (haemophilia A, HA) or IX (haemophilia B, HB).The prevalence of this disease varies according to the country, those having better survival rates having also higher prevalences. Specifically in Costa Rica, there are around 130 HA and 30 HB families. This study reports the prevalence and a spatial distribution analysis of both types of the disease in this country. The prevalence of haemophilia in this country is 7 cases per 100 000 men, for HA it is 6 cases per 100 000 and for HB it is 1 case per 100 000 male inhabitants. The prevalence of this disease is low when compared with other populations. This low prevalence could be due to the many patients that have died because of infection with human immunodeficiency virus during the 1980s. The prevalence of haemophilia in Costa Rica is almost one half of that present in developed countries. Nevertheless, the ratio between HA and HB follows world tendency: 5 : 1. In this study, nationwide geographical distribution maps were drawn in order to visualize the origin of severe cases and how this influences the pattern of distribution for both types of haemophilia. By means of these maps, it was possible to state that there is no association between the sites of maximum prevalence of mutated alleles and ethnicity. With this study, haemophilia prevalence distribution maps can be used to improve efforts for the establishment of hemophilia clinics or specialized health centers in those areas which hold the highest prevalences in this country. Also, this knowledge can be applied to improve treatment skills and offer the possibility of developing focused genetic counseling for these populations.

Introduction Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. Objective To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. Materials and methods A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. Results Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2–121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17–70) years, and median age at tumor diagnosis was 56.4 (19–79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. Conclusions In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate.

Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE To determine the validity of a Fournier’s gangrene severity index (FGSI), developed to assign a numerical score describing the severity of FG, and evaluate factors in the survival of patients with FG. PATIENTS AND METHODS We retrospectively reviewed 51 patients diagnosed with FG between 1994 and 2006. Data were collected on their medical history, which included vital signs (temperature, heart and respiratory rates) and metabolic variables (sodium, potassium, creatinine, bicarbonate levels, haematocrit, and white blood cell count). We computed a score relating to the severity of the disease at the time, and compared it to other features according to whether the patient survived or died. The different prognostic factors were assessed by univariate analysis with the Mann–Whitney U and Kendall A-B tests. RESULTS Of the evaluated 51 inpatients, eight died (16%) and 43 survived (84%). The median (range) age was 63 (17–85) years and the median time from the onset of the symptoms until the admission to the emergency room was 7.8 (1–60) days. The mean hospital stay was 33 (2–90) days and 17 patients were admitted to the intensive-care unit for a mean of 4.5 days. There was no statistically significant difference between the groups. Body surfaces involved were the scrotum in five patients (10%), the penis and scrotum in 11 (22%), the scrotum and perineum in 30 (59%) and the abdominal wall in five (10%). There was no statistically significant difference in the distribution in those who survived or died (P = 0.131). The median age of 60 (17–81) years in the survivors was significantly lower than that of 73.5 (50–85) years in those who died (P = 0.02). There was no significant difference (P = 0.06) between the number of repeated debridements in the survivors (3.23) and those who died (5.25). The mean (range) FGSI score for survivors was 6.7 (0–14), vs 8.7 (6–13) for those who died (P = 0.12). The only laboratory variables associated with death were serum bicarbonate (P = 0.04) and serum sodium (P = 0.02) levels. CONCLUSIONS FG is an unpredictable disease process with wide variability in its presentation. In our experience, the FGSI gives no indication of the likelihood of survival, but the risk factors for predicting the severity of FG seem to be greater in older patients and those with high sodium and low bicarbonate levels.

Overweight and obesity have dramatically increased in recent years. In 2006, the prevalence of overweight and obesity among 6- to 12-year-old children was 26% in Mexico. Food advertising has shown to be a contributor to childhood obesity. The purpose of this study was to evaluate the frequency and types of food advertisements geared toward children living in Baja California.Two local channels and three national channels, during a period of 7 h on weekday afternoons and 6 h on weekend mornings, were recorded for 7 days. A total of 235 h were recorded and analyzed.A total of 8299 advertisements were registered; 22% were food-related and 50% were geared toward children. The average of food-related advertisements (FRAs) per half an hour was 4, and half of them were geared toward children. During the time that children may be watching television, 50% of all FRAs were potato and corn chips, desserts and cakes, juices, sweetened cereals, candies, cookies, sweetened beverages and fast foods, which comprises a higher percentage of adult-oriented FRA (32 versus 22%).Children are systematically more exposed than adults to advertisements for high-energy-dense foods.

The objectives of this study were to compare the trends of obesity from 2001-02 to 2006-07 in school children of Tijuana, Mexico and to investigate the relationship with the child's gender and type of school attended. Bietapic random sample was selected by cluster of schools and groups. Results of the 1684 children from 6-14 years of age assessed showed an overall prevalence of obesity (> 95(th)) of 28%. An overall increase of overweight and obesity of 7-percentage points (p=0.0003), from 41 to 48%, being higher among boys and younger girls. Prevalence of obesity was higher among boys and children from private schools.

Zusammenfassung Das Spermiogramm bei Uro-Genital-Tuberkulose Bei 50 Patienten - alle unter 40 Jahre alt - mit der Diagnose Nierentuberkulose wurde ein Spermiogramm angefertigt, um zu sehen, ob es irgendwelche cytomorphologischen oder biochemischen Veranderungen gibt. Die Patienten wurden in 2 Gruppen unterteilt: die 1. Gruppe umfaste Patienten, die eine klinische Beteiligung des Genitaltraktes aufweisen, die 2. Gruppe Patienten ohne irgendeine klinische Symptomatologie am auseren Genital. Die Veranderung des Spermiogramms in ubereinstimmung mit dem Schadigungsgrad der Nierentuberkulose und der spezifischen Behandlung wurde auch ausgewertet. Alle Patienten mit klinischen Veranderungen des Genitaltraktes zeigten Veranderungen in den cytomorphologischen und/oder biochemischen Untersuchungen. 75% der Patienten ohne Schadigung des Genitales zeigten eine Oligoasthenozoospermie. Trotz eingeleiteter Behandlung wurde keine Besserung des Spermiogramms beobachtet.

Introducción y objetivo: En la mayoría de los casos el aprendizaje de la prostatectomía radical laparoscópica no se completa durante la residencia. Ante esta problemática internacional surgen las becas o "fellowships" de los centros de excelencia europeos y norteamericanos. El objetivo del presente trabajo es evaluar la eficiencia de la beca de formación propuesta por el grupo alemán. Material y método: Describimos la evolución de un becario durante el entrenamiento progresivo, tutorizado por módulos descrito por el grupo de Leipzig, evaluamos la eficiencia del modelo describiendo los resultados de las primeras 30 prostatectomías radicales del becario como cirujano autónomo, comparamos los resultados con la serie histórica del centro, con la curva de aprendizaje de residentes del mismo centro y de otros centros. Resultados: El becario cumplimentó el entrenamiento por módulos en 7 meses posteriormente se le asignaron 30 prostatectomías radicales sin la obligatoriedad de ser ayudado por un cirujano experto. En el 46,67% de los pacientes se aplicó una técnica intrafascial. El tiempo quirúrgico medio fue de 2h y 27 minutos, incluida la linfadenectomía (realizada en 20/30 pacientes). Dos pacientes presentaron márgenes positivos, todas las anastomosis, menos un paciente, fueron estancas. La sonda se retiró al quinto día (mediana). No se detectaron complicaciones intraoperatorias ni en el posoperatorio tardío. Los resultados de éstas, se superponen a la de los residentes del mismo centro y a la de otros urólogos que siguen un entrenamiento tutelado de larga duración. Conclusiones: El aprendizaje de la prostatectomía radical laparoscópica debe seguir un modelo tutorizado progresivo de larga duración. Hasta la expansión definitiva de la técnica, el programa de formación tipo "fellow" que imparte el grupo de Leipzig es un modelo de formación completo y efectivo.

Complete removal of metastatic lesions can contribute to improve clinical prognosis of renal cancer. Nowadays, it is accepted that surgical extirpation of solitary metastases for patients with renal cancer is the only potential for long-term survival. Provided that the metastases could be technical and functionally resected. This review addresses the current evidence about resecable renal cancer metastases at lung, liver, bone, kidney and other organs. The criteria to consider a patient as candidate for resection of metastases are: control of primary tumor, surgical extirpation feasibility and lack of systemic disease. In patients with synchronous metastases, the surgical extirpation should be performed at the same time than nephrectomy. The clinical prognosis is worse when metastases are asynchronous. After the introduction of novel anti-angiogenic agents, surgery is also justified in patients with good responses. Although, this approach remains in the field of investigation.

Objetivo: Evaluar la eficacia de la analgesia intravenosa con meperidina frente a la infiltración del plexo periprostático con lidocaína,y seguridad de la anestesia local periprostática. Material y métodos: Estudio prospectivo aleatorizado con 100 pacientes sometidos a primera o segunda biopsia de próstata. Distribuimos a los pacientes en dos grupos; grupo A (50 pacientes) al que se le administra 50 mg de meperidina intravenosa y grupo B (50 pacientes) que reciben 5 mL de lidocaína al 2% en el ángulo prostatoseminal. El dolor fue evaluado mediante la Escala Analógico Visual (VAS) y un cuestionario a cerca del impacto emocional de la prueba. La seguridad del procedimiento se obtuvo mediante cuestionario telefónico sobre las complicaciones aparecidas tras la biopsia. Para el análisis estadístico se uso el test de chi cuadrado, la t de Student y test no paramétrico de Kruskal-Wallis. Resultados: La mediana de edad fue 66 años (47-80) siendo ambos grupos homogéneos respecto a: PSA, volumen prostático, número de cilindros y nivel de estudios, sin diferencias significativas. Se trató de una primera biopsia en 74 pacientes (74%) y 26 (26%) de una segunda. El número medio de cilindros fue de 10,9±2. La puntuación media del VAS para el grupo A fue 3,6±1,8 frente a 3,2±2 del grupo B sin diferencias significativas (p0,05). Si comparamos el dolor con la introducción del transductor (grupo A 3,9±1,9 / grupo B 4,3±2,2) frente a la toma de cilindro (grupo A 3,6±1,8/grupo B 3,2±22) sí encontramos diferencias significativas (p0,05). Aparecieron complicaciones en 12 pacientes (12%); 5 en el grupo de meperidina frente a 7 en el de lidocaína sin observar diferencias entre ambos. Conclusión: El bloqueo del plexo periprostático con lidocaína no ofrece ventajas analgésicas respecto a la meperidina, a pesar de que se trata de un método seguro que no aumenta el número de complicaciones. El paso del transductor transrrectal produce más dolor que la propia toma de los cilindros.

To review the evidence about frozen sections during radical prostatectomy (RP) and its ability to decrease the incidence of positive margins, the impact on PSA postoperatively and the significance of residual benign prostatic cells after prostatectomy.The information for this review was compiled by searching the Pubmed database. We used Mesh Terms "Prostatectomy" and "Prostatic Neoplasms" and we added "frozen sections" and/or "hyperplasic cells" and/or "benign cells" and/or "positive margins". Furthermore, we review the articles referenced in those studies and editorials letters.Several groups have studied the performance of frozen section during RP to try and assess the risk of positive margins intraoperatively. The controversial sites where they should be performed are the apex, the dorsolateral zones and the bladder neck. They have been performed routinely or when the surgeon decides it, depending on the preoperative or intraoperative findings.At the present time there is no standardisation in the number, the site and the type of patient where this procedure should be done. The improvement in functional outcomes and biochemical control is not proven.

Resumen Introduccion La Prostatectomia radical es el tratamiento estandar para el cancer de prostata organoconfinado. Clasicamente se presta atencion a los margenes positivos para celulas tumorales, pero no a la presencia de celulas hiperplasicas residuales a la cirugia capaces de generar antigeno prostatico especifico (PSA) y dificultar el seguimiento de los pacientes intervenidos. Esta situacion nos lleva a plantear una revision de la literatura, donde evaluemos la frecuencia de esta presencia, las posibles causas que lo justifiquen y la influencia de estas celulas en la evolucion bioquimica de la enfermedad. Material y metodo Realizamos una busqueda bibliografica a traves de la base de datos “Pubmed” utilizando los terminos “Mesh” “Prostatectomy” y “Prostatic Neoplasms” y “Prostate-Specific Antigen” a los que anadimos los terminos “biochemical failure” y/o “hyperplasic cells” y/o “benign cells”. Asimismo, seleccionamos los trabajos en lengua inglesa, espanola y alemana, revisamos los articulos que dichos trabajos referencian e incluimos las series con mas de 50 pacientes, cartas al editor, editoriales y revisiones de conjunto. Conclusiones La presencia de celulas hiperplasicas microscopicas residuales a la cirugia prostatica radical, es un hecho frecuente que probablemente este infra-evaluado. Los margenes positivos para celulas benignas procederan del apex o del cuello vesical donde la capsula prostatica no esta bien definida, en ningun caso de la zona dorsolateral de la prostata, lo que traduciria un defecto de la tecnica quirurgica. La capacidad de estas celulas para generar PSA en cantidad suficiente para interferir en el seguimiento de los pacientes operados es controvertida. Recomendamos la inspeccion macroscopica de la pieza por el cirujano, tras la prostatectomia, para evaluar la integridad del apex, zona craneal y capsula dorsolateral.

Para explorar la frecuencia y peso con que los factores de riesgo psicosocial predisponen a los des­enlaces de embarazo temprano y deserción escolar en las adolescentes, se realizó una revisión des­criptiva. Materiales y métodos: Se realizó una búsqueda y revisión de los resultados presentados por los estudios observacionales en la base de datos indexada de Pubmed desde el 27 de julio de 2010 hasta el 25 de julio de 2013, restringiendo la búsqueda a estudios en humanos, escritos en español o inglés, no realizados en países de África o Asia; se amplió la búsqueda a la base de lilacs para los años entre 2006-2013, para países de América Latina. Fueron elegibles para inclusión, todos los estudios de casos y controles que compararan diferentes tipos de intervenciones y factores de riesgo psicosocial en adolescentes. Resultados: La revisión sugiere, como principales factores psicosociales relacionados con el embarazo y la deserción escolar en las adolescentes, la violencia experimentada durante la adolescencia, el abuso sexual, pertenecer a un estrato socioeconómico bajo, baja autoes­tima, trastornos en la conducta alimentaria, el tabaquismo, alcoholismo y drogadicción, los tras­tornos mentales, el inicio temprano de relaciones sexuales, baja unidad familiar y falta de acceso a información y recursos para la planificación. Conclusiones: Se describieron los factores de riesgo relacionados con embarazo y deserción escolar, intervenciones dirigidas a los factores de riesgo descritos potencialmente podrían contribuir a la disminución de estos desenlaces. To explore the frequency and weight that psychosocial risk factors predispose to outcomes of early pregnancy and scholar dropout, a descriptive review was conducted. Materials and Meth­ods: A search and review of the results reported by observational studies in the PubMed data­base indexed from July 27, 2010 until July 25, 2013 was performed, restricting the search to studies in humans, Spanish or English written, not made in countries in Africa or Asia. Search was widened to LILACS database for the years 2006 to 2013 for Latinamerican countries. For inclusion, all case-control studies comparing different types of interventions and psychosocial risk factors in adolescents were eligible. Results: The review suggests violence experienced dur­ing adolescence, sexual abuse, belonging to a low socioeconomic status, low self-esteem, eating behavior disorders, smoking, alcoholism and drug addiction, mental disorders, early initiation of sex, poor family ties, lack of access to information, and resources for family planning as main psychosocial factors related to early pregnancy and scholar dropout in adolescents. Conclusions: Both risk factors associated with pregnancy and scholar dropout were described, and interven­tions targeting the described risk factors could potentially contribute to the reduction of these outcomes were described. Para explorar a frequência e peso com que os fatores de risco psicossocial predispõem aos desenlaces de gravidez precoce e deserção escolar nas adolescentes, se realizou uma revisão descritiva. Materiais e métodos: realizou-se uma busca e revisão dos resultados apresentados pelos estudos observacionais na base de dados indexada de Pubmed desde o 27 de julho de 2010 até o 25 de julho de 2013, restrin­gindo a busca a estudos em humanos, escritos em espanhol ou inglês, não realizados em países da África o da Ásia. Ampliou-se a busca à base de lilacs para os anos compreendidos de 2006 ao 2013, para países da América Latina. Foram elegíveis para inclusão, todos os estudos de casos e controles que compararam diferentes tipos de intervenções e fatores de risco psicossocial em adolescentes. Resultados: a revisão sugere, como principais fatores psicossociais relacionados com a gravidez e a deserção escolar nas adolescentes, à violência experimentada durante a adolescência, o abuso sexual; pertencer a um estrato socioeconómico baixo; baixa autoestima; transtornos na conduta alimentaria; o tabaquismo, alcoolismo e toxicomania; os transtornos mentais; o início precoce de relações sexuais, baixa unidade familiar e falta de acesso a informação e recursos para a planificação. Conclusões: des­creveram-se os fatores de risco relacionados com gravides e deserção escolar, intervenções dirigidas aos fatores de risco descritos potencialmente poderiam contribuir à diminuição destes desenlaces.

Objectives Three-dimensional (3D) spheroids are a good model for studying in vitro chemosensitivity because they reproduce unicellular and multicellular mechanisms of drug resistance. We aimed to develop a chemosensitivity test for intravesical drugs and to also verify the effects of verapamil (VPM) and ciprofloxacin (CIPRO). Methods Cold cup biopsies from 40 superficial bladder tumours were taken, fragmented, and left in culture. 3D-spheroids were obtained and transferred into a 24 multiwell dish containing (1) wells 1–3: 1mg/ml epirubicin (EPI); (2) 4–6: 1mg/ml EPI+0.5mg/ml VPM; (3) 7–9: 1mg/ml adriamycin (ADR); (4) 10–12: 1mg/ml thiotepa (THIO); (5) 13–15: 1mg/ml mitomycin C (MMC); (6) 16–18: 1mg/ml EPI+0.2mg/ml CIPRO; (7) 19–21: 0.2mg/ml CIPRO; (8) 22–24: controls. Sensitivity was calculated by using the trypan blue assay. Results Evaluability of clinically relevant tests (G1–G2 lesions) was 84% (21 of 25 patients). MMC was the best agent ( p 0.001) with mean sensitivity being 50%, followed by THIO (37%), EPI (7%), and ADR (3%). We found no significant difference ( p =0.370) between CIPRO and the control, or between EPI+CIPRO and EPI alone ( p = 0 .550). VPM markedly enhanced sensitivity to EPI compared with EPI alone (97% vs. 7%, p Conclusions Our assay allows determining sensitivity to several drugs in superficial bladder tumours. It might be used in clinical practice to select the best drug for each patient. It also has experimental utility in investigating the effect of new drugs or combinations. VPM reverted resistance to EPI. CIPRO showed no effect on bladder tumour spheroids.

Cancer renal incidental en pacientes menores de 40 anos: hallazgos clinicos e histopatologicos Objetivo: Evaluar las caracteristicas clinicas y patologicas del cancer renal (CR) en nuestra serie de tumores, analizando su impacto en el grupo de edad de menores de 40 anos. Material y metodo: Se estudiaron 294 pacientes con CR. En 252 se realizo un estudio del ADN tumoral mediante citometria de flujo e histopatologico de las piezas quirurgicas. Los pacientes fueron divididos en dos grupos en funcion de la edad, mayores y menores de 40 anos. Las caracteristicas clinicas e histopatologicas fueron comparadas entre ambos grupos. Resultados: De los 294 pacientes, 26 (8,94%) se incluyeron en el grupo de edad menor o igual a 40 anos. No hallamos diferencias significativas entre los grupos al comparar estadio, tamano tumoral o tratamiento realizado, aunque encontramos un mayor numero de tumores indiferenciados en los pacientes de menor edad (p=0,018). El analisis del ADN no evidencio diferencias en el porcentaje de aneuplodias al comparar ambos grupos. Tampoco encontramos diferencias al comparar la probabilidad de supervivencia actuarial cancer especifica en funcion de la edad. Conclusiones: El comportamiento biologico del CR en pacientes menores de 40 anos (jovenes) no parece diferente al del grupo de mayor edad. Por ello pensamos que los esquemas de tratamiento y seguimiento no deben diferir en funcion de la variable edad.

Introducción: Los traumatismos genitourinarios constituyen el 8-10% de los traumatismos abdominales y en el 50% de los casos es el riñón el órgano más afectado, sobretodo el izquierdo. La decisión de adoptar un tratamiento conservador o quirúrgico en estos casos dependerá del tipo de lesión que encontremos en la unidad renal afecta y de las condiciones clínicas del paciente. Objetivo: Los objetivos del estudio son determinar la posibilidad de llevar acabo un tratamiento conservador en los traumatismos renales de alto grado y estudiar la evaluación y aparición de complicaciones en los mismos. Material y métodos: Hemos analizado retrospectivamente los 309 casos de traumatismos renales acontecidos en nuestro Servicio en el período de tiempo comprendido entre Enero 1984 y Enero 2006, estudiando variables como la etiología del traumatismo, lesiones asociadas en otros órganos, actitud terapéutica adoptada y presencia de complicaciones, tanto a largo como a corto plazo. Resultados: De los 309 traumatismos renales analizados, el 94,1% (291 casos) fueron traumatismos renales cerrados o contusos. La distribución por grados del total de traumatismos fue: Grado I: 213 casos (69%), grado II: 39 casos (12.6%), grados III y IV: 32 casos (10,3%) y grado V: 25 casos (8%). Realizamos tratamiento conservador en el 84,6% de los casos etiquetados como grados III y grado IV (24 casos en total). Se practicaron 4 nefrectomías de urgencia en los grado III por inestabilidad hemodinámica y 4 nefrectomías en grados IV por el mismo motivo, una de ellas parcial, diferidas a las 48-72 horas del traumatismo. En 67% de los traumatismos grado V se realizó nefrectomía de urgencia. Conclusiones: De acuerdo a nuestra experiencia y a los resultados obtenidos, consideramos adecuado el manejo conservador en los traumatismos renales de alto grado siempre y cuando las condiciones hemodinámicas del paciente lo permitan.

This article reviews the current status of the prostatic cryosurgery in the management of patients with prostate cancer. Recent advances in cryoablative technology have allowed to treat these patients successfully with decreased morbidity. Using transrectal high-resolution ultrasound imaging, prostate cryotherapy is delivered with multiple ultrathin (17-gauge) cryo-needles, via percutaneous transperineal approach. The extent of freezing can be precisely controlled and monitored with thermic devices, tissue destruction is monitored with real-time visualization of the prostate and surrounding structures, and urethral warming is used to avoid urethral sloughing. However, the results with the second and third-generation cryosurgical equipment will have to be confirmed by means of prospective and randomized trials, because up to now we only have data based on retrospective analyses, which are very heterogeneous. The ability of prostate-specific antigen (PSA) to predict long-term outcome after cryotherapy for localized prostate cancer is not well known because experience with this treatment modality is still limited; however, it seems that a PSA value of 0.5 ng/ml or less after 6 months or longer after cryotherapy would be associated with a high probability (greater than 95%) of negative post-treatment biopsy. Cryosurgery could also be an option of treatment for men with recurrent local disease who have undergone radiotherapy or radical prostatectomy. We have to keep in mind possible complications (incontinence, impotency, urethrorectal fistula or bladder outlet obstruction. The favorable side effect profile and preliminary oncologic and funtional results could suggest that cryosurgery will have a role in the minimally invasive management of selected patients with prostate cancer.

Resumen Introduccion Desde que en 1987 se describio la ecografia transrectal como tecnica para dirigir la biopsia de prostata, diferentes modalidades de la misma han sido utilizadas para la deteccion del cancer de prostata. Material y Metodo Realizamos una revision de las diferentes tecnicas y esquemas de distribucion de los cilindros de la biopsia prostatica, asi mismo describimos la preparacion del paciente y las complicaciones mas relevantes. Resultados La mayoria de los trabajos al respecto comunica una mejora de la sensibilidad de la prueba con las biopsias prostaticas transrectales ecodirigidas ampliadas respecto a la tecnica sextante clasica. Dicha ampliacion se da a expensas de cilindros generalmente de las zonas mas laterales de la zona periferica. Conclusiones Hasta el momento, dado que se cuenta con una amplia experiencia y la tasa de complicaciones es asumible, la biopsia prostatica transrectal ecodirigida, debiera ser ampliada respecto a la sextante clasica a expensas de cilindros de las zonas perifericas laterales prostaticas.

New predictive factors for bladder tumor progression have been analyzed in many publications, often with contradictory results. Very few papers have referred specifically to T1G3 tumors. Our objective was to find new, clinically useful markers which either alone or in association with classical prognostic factors would allow the early selection of the correct therapeutic approach.This was a retrospective study of 83 patients with T1G3 bladder tumors who were initially treated with transurethral resection + bacillus Calmette-Guérin therapy, with a minimum follow-up period of 3 years. We analyzed eight variables. New factors considered were: the level of submucosal invasion; microvessel density; and immunostaining for Ki-67 and p53. Independent prognostic variables for progression were established using logistic regression analysis, and risk groups were created from mathematical models.Five variables were determined as unfavorable: tumor multiplicity; tumor size3 cm; carcinoma in situ; T1b substage; and p53 positivity. The first three factors predicted progression in only 32% of cases, while the addition of the new prognostic factors (T1b substage and p53 positivity) increased this rate to 65%. We established four risk groups, with rates of progression of 67% and 100% in the high-risk and very high-risk groups, respectively. For inclusion in these groups, both new predictive factors had to be unfavorable; if either one were absent then the three classical factors had to be present.Microstaging and p53 positivity have a prognostic value for predicting progression in T1G3 tumors, providing 33% more information than that obtained with classical prognostic factors alone. The application of mathematical models identifies risk groups and allows the use of an early and more aggressive treatment.