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Developments in cancer care, automation of care, rationing of time and fragmentation of the work process for institutional imperatives can often lead to the dehumanization of care. Although, it is indisputable that these interventions have significantly improved outcomes in oncology, they may have caused the emotional needs of patients, families, and health professionals to be considered secondary concerns. Therefore, humanized care can help dispel the negative emotions associated with cancer diagnosis and treatment and may even contribute to improve patient outcomes. This empathetic and respectful approach to patients leads to increase patient expectations of recovery, accountability, control over their own health, satisfaction, safer care, patient happiness and healthcare professional resilience, resulting in time and cost savings. The humanization of care has emerged as a response to the needs and concerns of patients and their families that go beyond the biological.

Objective: To determine the association between the presence of genetic disease in the offspring and the paternal age. Methods: We carried out a systematic review in: Medline (Ovid), EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), from inception to October 2022. We included RCTs, Cohort, case-control and cross-sectional studies. Every study was evaluated according to eligibility criteria. Meta-analysis was not possible given the clinical and methodological heterogeneity. Results: We identified 502 studies through the database search. Forty-five studies were selected for data collection and were included in the qualitative analysis. In this systematic review we did not find associations with anomalies such as Trisomy 18, Obsessive Compulsive Disorder, Tourette syndrome, schizoaffective disorder, adverse perinatal outcomes, hematologic disturbances, microcephaly, hydrocephalus, gastrointestinal disturbances, cleft lip with or without cleft palate, cleft palate, and genitourinary disturbances. In contrast, we found a tendency of association between older fathers and psychiatric disorders (schizophrenia, autism, bipolar disorder syndrome, intellectual disability), nervous system cancer and overall musculoskeletal congenital anomalies. Conclusion: There is a tendency of association among the advanced paternal age and an increased number of birth defects regarding some specific conditions.

The Coronavirus (COVID-19) pandemic, typified as such in March 2020 by the World Health Organization (WHO), has exceeded the capacity of health systems to aid victims, and triggered a radical change in medical research, and in the monitoring of the enrollment for clinical trials in urologic fields around the world. Last year, almost 90% of clinical sites closed patient enrollment, while at the same time, researchers around the world initiated almost 1000 COVID-19 clinical trials. This catastrophic pandemic has allowed us to expand our medical knowledge exponentially. The global urological community has created and published an infinity of scientific articles: establishing guideline reactions for diagnosis, treatment, and follow-up of the different urologic conditions across all areas of the field, reporting the experiences at urology services, and putting forward new strategies. The Confederación Americana de Urología (CAU) has promoted international collaborative projects that have led to gaining insight into how the Latin American Urology Services faced the pandemic, including the challenges, strengths, and the areas of opportunity for urologic care. It also allowed us to increase the number and quality of publications. Also, we have created new virtual platforms and international networks to exchange our knowledge. We have as well transformed this social, economic and health crisis brought upon us by COVID-19, into a source of opportunities for the growth and promotion of research in Latin America. Urologic patients, require researchers to work on favoring their goals. A collaborative network, the established and coordinated protocols, the safety of patients and researchers, assertive and constant communication, and effective technology use, are the essential tools to resume institutional investigation under these critical conditions.

Objective:The objective of the present work was to characterize the coping strategies used by first responders to emergencies in the face of exposure to traumatic events.Methods:A systematic search was performed in the databases MEDLINE (Ovid), EMBASE, LILACS (Latin American and Caribbean Literature in Health Sciences), and the Cochrane Central Registry of Controlled Clinical Trials (CENTRAL) from their inception through February 2022. First responders to emergencies with training in the prehospital area and who used validated measurement instruments for coping strategies were included.Results:First responders to emergencies frequently used nonadaptive coping strategies, with avoidance or disconnection being one of the main strategies, as a tool to avoid confronting difficult situations and to downplay the perceived stressful event. The nonadaptive coping strategies used by these personnel showed a strong relationship with posttraumatic stress disorder (PTSD) symptoms, burnout syndrome, psychiatric morbidity, and chronic stress. As part of the adaptive strategies, active coping was found, which includes acceptance, positive reinterpretation, focusing on the problem, self-efficacy, and emotional support, either social or instrumental, as protective strategies for these personnel.Conclusions:Developing adaptive coping strategies, whether focused on problems or seeking emotional support, can benefit emergency personnel in coping with stressful situations. These coping strategies should be strengthened to help prevent people from experiencing long-term negative effects that could arise from the traumatic events to which they are exposed. Active coping strategies instead of avoidance strategies should be promoted.

El cannabis se ha utilizado desde la antigüedad con fines recreativos y medicinales. Es una fuente muy rica de compuestos químicos, la mayoría denominados fitocannabinoides, que tienen una variedad de efectos fisiológicos, principalmente por su unión a receptores cannabinoides endógenos como el CB1 y CB2, entre otros.El cannabis tiene propiedades terapéuticas potenciales y sus preparaciones se han utilizado como remedios tradicionales para tratar el dolor y la emesis. Los cannabinoides sintéticos se utilizan clínicamente como analgésicos, antiespasmódico, antieméticos y estimulantes del apetito. La toxicidad significativa del cannabis es poco común en los adultos, sin embargo, puede tener múltiples efectos adversos agudos y crónicos. La calidad de la evidencia en este campo se ha visto limitada por la corta duración de los estudios, los reducidos tamaños de las muestras, la falta de grupos de control y la existencia de sesgos en la mayoría de los estudios revisados. En este contexto, son necesarios más estudios de mejor calidad metodológica para apoyar el uso seguro de esta terapia en otras enfermedades. La decisión de incorporar los cannabinoides como terapia en alguna de las condiciones descritas depende de la evidencia, el uso de terapias previas y el tipo de paciente.

ResumenLa enfermedad cardiovascular aterosclerótica es la primera causa de muerte en todo el mundo, y la principal causa de años de vida perdidos por discapacidad (AVADs) en los adultos. Sus factores de riesgo son muy prevalentes en la población, y su ocurrencia se ha asociado con disfunción sexual tanto en hombres como en mujeres, debido a que comparten un mecanismo fisiopatológico similar en el caso de la disfunción eréctil en los hombres y potencialmente en la disfunción sexual femenina. Además, los trastornos mentales asociados (principalmente ansiedad y depresión) y los efectos adversos de los medicamentos antihipertensivos y antidepresivos también contribuyen a las disfunciones sexuales. Por otro lado, los inhibidores de la fosfodiesterasa 5 (iFDE5s) han demostrado seguridad y beneficios cardiovasculares en los hombres, y en las mujeres hay evidencia creciente de su utilidad en las disfunciones sexuales. En esta revisión, se presentan las implicaciones de la enfermedad cardiovascular aterosclerótica y su tratamiento en la vida sexual de hombres y mujeres, los efectos cardiovasculares de los tratamientos de las disfunciones sexuales, y la consejería a los pacientes.

In the last two decades, a new purpose has collected great efforts from scientists in all branches of medicine. It is about the possibility to make the body regenerate ill tissues and organs by itself with de right artificial stimuli or the construction of new functional organs to replace the damaged ones. This process comprises various interdisciplinary approaches to healthcare, such as tissue engineering, molecular medicine, biotechnology, and three-dimensional printing. Urologists have been remarkably active in this field of medicine called Regenerative Medicine. The searching of the different requirements like suitable and compatible biomaterials, versatile cells, adequate techniques to construct tissues, available biomolecules, and the knowledge of all these minimizing risks, are some of the aims and the approximations until now. Despite many obstacles, in vitro and in vivo studies are already showing encouraging options. We will review the advances related to the bladder, urethra, ureter, and kidneys. Difficulties such as ethical issues, time investment and high costs, have been some of the drawbacks encountered. Further studies are still required for its clinical application in daily life.

Fernando Munayco-Guillén,1,2 Miguel Angel Vazquez-Membrillo,1,2 Marlon Rafael Garcia-Roa,1,2 Jhony Alberto De La Cruz-Vargas,3 Herney Andrés García-Perdomo,4 Rafael Pichardo-Rodriguez3 1Department of Retina and Vitreous Surgery, Instituto Mexicano de Oftalmología (IMO), Querétaro, México; 2Universidad Nacional Autónoma de México (UNAM), México City, México; 3Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Lima, Perú; 4Division of Urology/Urooncology, Deparment of Surgery, School of Medicine, Universidad del Valle, Cali, ColombiaCorrespondence: Fernando Munayco-Guillén, Fray Servando Teresa de Mier 202, Quintas del Marqués, Querétaro, México, Tel +51 985-558886, Email fernando.munayco.guillen@gmail.comPurpose: It has been reported that intravitreal Ziv-aflibercept is a safe and effective drug for the treatment of diabetes macular edema (DME). The objective of this study was to evaluate in a real-life setting, the efficacy of intravitreal Ziv-aflibercept in the treatment of DME after the administration of three consecutive monthly doses.Methods: A single arm, prospective cohort study. We included patients with DME who received three doses of intravitreal Ziv-aflibercept. Data such as best corrected visual acuity (BCVA) and tomographic biomarkers before treatment and a month after the third dose were collected. DME was staged using the Panozzo classification.Results: Thirty-eight patients participated for a total of 53 eyes. The mean age was 59 ± 8.1 years. We observed significant changes after the third dose in the parameters studied (BCVA in LogMAR pre-treatment (0.6 ± 0.33) and post-treatment (0.4 ± 0.29) [p< 0.001], macular thickness pre-treatment (501 ± 167 μm) and post-treatment (324 ± 114 μm) [p< 0.001], macular volume pre-treatment 10.8 (7.5– 17.8) mm3 and post-treatment 9.3 (0– 13.6) mm3 [p< 0.005]). And 73.6% of the patients presented an advanced severe stage during their pre-treatment evaluation and after post-treatment, 64.2% of the patients no longer presented edema. No systemic or ocular adverse events occurred.Conclusion: The use of three consecutive monthly doses of intravitreal Ziv-aflibercept in a real-life setting is effective and safe in the management of diabetic macular edema.Keywords: antiangiogenic, diabetes mellitus, intravitreal injection, macular edema, optical coherence tomography, Ziv-aflibercept

BACKGROUND: Previous studies have challenged the concept of contrast material–induced acute kidney injury (AKI) in adults; however, limited data exist for children and adolescents. PURPOSE: To calculate the incidence and determine the risks of AKI in patients who received intravenous iodinated contrast media for CT. MATERIALS AND METHODS: This retrospective study was performed at a children’s hospital from January 2008 to January 2018 and included patients aged 0–17 years in whom serum creatinine levels were measured within 48 hours before and after CT with or without contrast media. The incidence of AKI was measured according to the AKI Network guidelines. A subgroup analysis with propensity score matching of cases with control patients was performed. Differences before and after stratification based on estimated glomerular filtration rate (eGFR) were explored. Adjusted risk models were developed using log-binomial generalized estimating equations to estimate relative risk (RR). RESULTS: From a total of 54 000 CT scans, 19 377 scans from 10 407 patients (median age, 8.5 years; IQR, 3–14; 5869 boys, 4538 girls) were included in the analysis. Incidence rate of AKI for the entire sample was 1.5%; it was 1.4% (123 of 8844) in the group that underwent contrast-enhanced CT and 1.6% (171 of 10 533) in the group that did not (P = .18). In the contrast-enhanced CT group, AKI incidence was higher in the group with eGFR of at least 60 mL/min/1.73 m(2) and in the group with eGFR lower than 60 mL/min/1.73 m(2) (1.3% and 8.5%, respectively; P < .001) compared with the noncontrast group (0.1% and 2.7%, respectively; P < .001). Age was found to be a protective factor against AKI, with an RR of 0.96 (95% CI: 0.94, 0.99; P = .01), and contrast media increased risk in the subgroup analysis, with an RR of 2.19 (95% CI: 1.11, 4.35; P = .02). CONCLUSION: The overall incidence of acute kidney injury after contrast-enhanced CT in children and adolescents was very low, and exposure to contrast media did not increase the risk consistently for acute kidney injury among different groups and analyses.

Background: Alpha-adrenoreceptor antagonists or alpha-blockers are used in the treatment of hypertension, in the therapy of benign prostatic hyperplasia and in medical expulsive treatment of ureteral stones. These agents may affect the sexual function, with differences between drugs within the same class, depending on their selectivity for receptor subtypes. The aim of this review was to analyze the effects of alpha-blockers on sexual function. Materials and methods: We conducted a systematic review and meta-analysis by searching PubMed, EMBASE and other databases for randomized controlled trials (RCTs) reporting sexual adverse effects in patients treated with alpha-blockers. Odds ratios for sexual dysfunction were calculated using random effects Mantel-Haenszel statistics. Results: Out of 608 records retrieved, 75 eligible RCTs were included in the meta-analysis. Compared with placebo, alphablockers were associated with increased odds of ejaculatory disorders both in patients with lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia (BPH) (OR: 7.53, 95% CI: 3.77-15.02, Z = 5.73, p < 0.00001, I2 = 55%) and in patients with ureteral stones (OR: 2.88, 95% CI: 1.50-5.44, Z = 3.19, p < 0.001, I2 = 31%). Uroselective alpha-blockers showed higher odds of ejaculatory disorders. Conversely, nonselective alpha-blockers were not associated with higher odds of ejaculatory dysfunction. Silodosin was associated with increased odds of ejaculatory dysfunction compared with tamsulosin (OR: 3.52, 95% CI: 2.18-5.68, 15 series, 1512 participants, Z = 5.15, p < 0.00001, I2 = 0%). Naftopidil and alfuzosin showed lower odds of ejaculatory dysfunction compared to uroselective alpha-blockers.No statistically significant differences in the odds of erectile dysfunction were observed when alpha-blockers were compared to placebo.

Purpose To identify metabolites in humans that can be associated with the presence of malignant disturbances of the prostate. Methods In the present study, we selected male patients aged between 46 and 82 years who were considered at risk of prostate cancer due to elevated levels of prostate-specific antigen (PSA) or abnormal results on the digital rectal examination. All selected patients came from two university hospitals (Hospital Universitario del Valle and Clínica Rafael Uribe Uribe) and were divided into 2 groups: cancer (12 patients) and non-cancer (20 patients). Cancer was confirmed by histology, and none of the patients underwent any previous treatment. Standard protocols were applied to all the collected blood samples. The resulting plasma samples were kept at -80°C, and a profile of each one was acquired by nuclear magnetic resonance (NMR) using established experiments. Multivariate analyses were applied to this dataset, first to establish the quality of the data and identify outliers, and then, to model the data. Results We included 12 patients with cancer and 20 without it. Two patients were excluded due to contamination with ethanol. The remaining ones were used to build an Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) model (including 15 non-cancer and 10 cancer patients), with acceptable discrimination (Q2 = 0.33). This model highlighted the role of lactate and lipids, with a positive association of these two metabolites and prostate cancer. Conclusions The primary discriminative metabolites between patients with and without prostate cancer were lactate and lipids. These might be the most reliable biomarkers to trace the development of cancer in the prostate.

To describe the association between partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome.A scoping review was performed according to the recommendations of the Joanna Briggs Institute. Moreover, we performed a search strategy using the MEDLINE, EMBASE, and CENTRAL databases. We included the available information, evaluating the conditions of partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome, and their molecular and physiological mechanisms and clinical presentation.We identified 207 articles and chose eight studies published between 2001 and 2021. The total number of patients was 34, and their mean age was 28.2 years. Moreover, in 84% of the studies, the pathophysiology of the events was related to microtrauma or prolonged perineal compression. Additionally, 94.2% of the patients had some degree of erectile dysfunction. In addition, out of all patients, 94% underwent magnetic resonance imaging (MRI). However, patients with hard flaccid syndrome did not show relevant findings in these studies. Conversely, MRI showed asymmetry in the proximal corpora cavernosa, thrombosed corpus cavernosum segments, and mainly cavernous fibrous septum in patients with partial cavernous thrombosis and partial priapism.Partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome occurred more frequently in young patients, possibly related to microtraumas that generate cavernous fibrosis and trigger alterations in the erection of the distal portion of the penis. Additionally, they cause proximal hardening of the pelvis, perineal pain, painful ejaculations, and cavernous asymmetry. Moreover, the imaging characteristics are similar in patients with partial priapism and partial cavernous thrombosis.

Interleukins (ILs)—which are important members of cytokines—consist of a vast group of molecules, including a wide range of immune mediators that contribute to the immunological responses of many cells and tissues. ILs are immune-glycoproteins, which directly contribute to the growth, activation, adhesion, differentiation, migration, proliferation, and maturation of immune cells; and subsequently, they are involved in the pro and anti-inflammatory responses of the body, by their interaction with a wide range of receptors. Due to the importance of immune system in different organisms, the genes belonging to immune elements, such as ILs, have been studied vigorously. The results of recent investigations showed that the genes pertaining to the immune system undergo progressive evolution with a constant rate. The occurrence of any mutation or polymorphism in IL genes may result in substantial changes in their biology and function and may be associated with a wide range of diseases and disorders. Among these abnormalities, single nucleotide polymorphisms (SNPs) can represent as important disruptive factors. The present review aims at concisely summarizing the current knowledge available on the occurrence, properties, role, and biological consequences of SNPs within the IL-1 family members.

Resumen El cáncer de vejiga es la undécima neoplasia maligna más frecuente a nivel mundial y conlleva una alta morbimortalidad. Para su diagnóstico, múltiples ayudas como la urotomografía y la cistoscopia, que permanecen como el estándar de oro en la actualidad. Se realizó una revisión narrativa en múltiples bases de datos (Medline, Scopus, ScienceDirect). El diagnóstico fotodinámico, al igual que la reconstrucción vesical por tomografía para realización de cistoscopia virtual son herramientas que se han introducido más recientemente. Asimismo, la ecografía contrastada y particularmente la Resonancia Magnética Multiparamétrica vesical con la clasificación de VI-RADS se han propuesto como alternativas novedosas. Éstos últimos son tal vez las herramientas más promisorias, sin embargo, se requieren más estudios que permitan recomendar su uso generalizado, que aún se vería limitado por su disponibilidad.

Objetivo: Describir las características clínicas/epidemiológicas y estrategia de priorización en pacientes adultos sometidos a cirugía electiva durante la pandemia por SARS- CoV2. Métodos: Estudio observacional descriptivo, de 297 pacientes quirúrgicos en una clínica de alta complejidad de la ciudad de Cali-Colombia, del 27 abril al 5 agosto del 2020. Se establecieron cuatro fases en los pacientes: estratificación de riesgo, estrategia pre-quirúrgica, fase quirúrgica y seguimiento postquirúrgico. Resultados: En la institución 9 de los 20 servicios quirúrgicos habilitados en la institución desarrollaron intervenciones quirúrgicas en el periodo de estudio. Se presentó un 21.9% de complicaciones de baja gravedad (tipo I y II) según clasificación de Clavien-Dindo. Se realizaron 189 procedimientos oncológicos (63%) y 108 no oncológicos (36%). La estratificación del riesgo según puntaje MeNTS fue predominantemente ≤50 (294 pacientes). El seguimiento postquirúrgico se realizó vía telefónica y presencial, solo un paciente presento síntomas sugestivos de infección por SARS-CoV2. Conclusión: Durante el reinicio de las actividades quirúrgicas ambulatoria se establecieron protocolos estrictos con criterios para la selección de los pacientes con procedimiento quirúrgico y medidas para minimizar el riesgo de infección nosocomial del SARS-CoV2 en pacientes y personal del equipo de salud

Background: It has been described that, at the medullary level, SARS-COV2 can compromise hematopoiesis, manifesting with cytopenias and there are only studies carried out in autopsies. Objective: to describe the morphological characteristics of the bone marrow of patients hospitalized for COVID-19 pneumonia at the Hospital Nacional “Dos de Mayo”. Material and methods: Retrospective cross-sectional observational study carried out in patients over 18 years of age with a confirmed diagnosis of COVID-19 by rapid or molecular testing, and those with incomplete, illegible or missing medical history and / or bacterial or fungal pneumonia were excluded. The findings of the bone marrow readings were confirmed by a trained hematologist, collecting data such as: hemosiderin, cellularity, myelo / erythroid ratio, myeloid series, megakaryocytic and plasma cells. Descriptive statistics based on frequencies and percentages were used for qualitative variables and mean and standard deviation for quantitative variables. Results: A total of 30 patients were included. The most frequent marrow findings were: macrophages with cytophagocytosis in 87% (n = 26), hyperplasia with arrest in the maturation of myeloid progenitors in 70% (n = 21). 87% (n = 26) of the samples presented eosinophilia. No or little evidence of platelet formation was observed in 57% (n = 17) of the samples. In 40% (n= 12) 6% of plasma cells were found. Conclusion: Patients with SARS-COV2 infection present medullary alterations, among which are: cytophagocytosis with hyperplasia and maturation arrest in the myeloid series, little or no platelet production in megakaryocytes and eosinophilia. Introducción: Se ha descrito que, a nivel medular, el SARS-COV2 puede comprometer la hematopoyesis, manifestándose con citopenias y solo se cuenta con estudios realizados en autopsias. Objetivo: describir las características morfológicas de las médulas óseas de los pacientes hospitalizados por neumonía por COVID-19 en el Hospital Nacional “Dos de Mayo”. Material y métodos: Estudio observacional transversal retrospectivo llevado a cabo en pacientes mayores de 18 años con diagnóstico confirmado de COVID-19 mediante prueba rápida o molecular y se excluyeron a aquellos con historia clínica incompleta, ilegible o extraviada y/o neumonía bacteriana o fúngica. Los hallazgos de las lecturas de las médulas óseas fueron confirmados por un hematólogo entrenado, recabándose datos como: Hemosiderina, celularidad, relación mielo/eritroide, serie mieloide, megacariocítica y células plasmáticas. Se utilizó estadística descriptiva basada en frecuencias y porcentajes para las variables cualitativas y media y desviación estándar para las variables cuantitativas. Resultados: Se incluyeron a un total de 30 pacientes. Los hallazgos medulares más frecuentes fueron: macrófagos con citofagocitosis 87% (n=26), hiperplasia con detención en la maduración de los progenitores mieloides en el 70% (n=21). El 87% (n=26) de las muestras presentó eosinofilia. En el 57% (n=17) de las muestras se observó ninguna o poca evidencia de formación plaquetaria. En el 40% (n=12) se encontró 6% de células plasmáticas. Conclusión: Los pacientes con infección por SARS-COV2, presentan alteraciones medulares entre los que destacan: la citofagocitosis con hiperplasia y detención de la maduración en la serie mieloide, poca o nula producción plaquetaria en los megacariocitos y eosinofilia.

Objetivo: Identificar las lesiones dermatológicas en los genitales externos y describir los posibles factores relacionados, en la población adulta atendida en el servicio de dermatología del Hospital Universitario del Valle. Métodos: Se realizó un estudio observacional descriptivo, aplicando una encuesta para recolectar los datos clínicos y sociodemográficos, y se efectuó el examen físico para describir las lesiones y las enfermedades dermatológicas en los genitales externos de los pacientes atendidos. Resultados: Se incluyeron 59 pacientes (34 mujeres [57.6%] y 25 hombres [42.4%]). Veintiún pacientes (35.6%) presentaron lesiones en los genitales externos, de las cuales, nueve (42.9%) fueron pápulas, ocho (38,1%) lesiones tipo placa, dos (9.5%) máculas, uno (4.8%) pápula + placa, uno (4.8%) pápula + pústula. Entre las impresiones diagnósticas registradas se encontró: foliculitis (4), tiña inguinal (3), psoriasis (2), vitíligo (2), verrugas virales (2), balanitis (1), condilomas (1), fibroma laxo (1), intertrigo candidiásico (1), papulosis bowenoide (1) y angioqueratoma de Fordyce (1). 52.5% (31) de los encuestados tenían sobrepeso y obesidad, 15.3% (9) diabetes mellitus tipo 2 y 15.3% (9) hipertensión arterial, como comorbilidades. 57.6% (34) tuvo actividad sexual en el último año; 74.6% (44) negó uso de preservativo, 15.3% (9) uso ocasional y 10.2% (6) uso rutinario. 92% (23) de los hombres encuestados presentaba antecedente de circuncisión. 61% (36) refirió el uso de algún método de depilación de los cuales 92% (33) fue por rasurado. Conclusiones: Se encontró una frecuencia de lesiones dermatológicas en los genitales externos del 35,6%; fueron las pápulas y las placas las lesiones primarias más reportadas en este estudio. El síntoma predominante encontrado fue prurito; relacionadas a etiología infecciosa (tiñas, foliculitis, verrugas), y a manifestaciones locales de una enfermedad general (psoriasis, vitíligo, micosis fungoide).

Resumen Objetivo Determinar la efectividad y la seguridad a corto, mediano y largo plazo de LISWT en pacientes con disfuncion erectil no respondedores a inhibidores de iPDE5. Metodologia Estudio clinico, cuasiexperimental de cohortes y revision sistematica siguiendo los lineamientos de la colaboracion Cochrane y las guias de escritura PRISMA. La medicion de las variables se determino como desenlace primario a la evaluacion de la funcion erectil, por medio de un cuestionario validado. Se evaluaron la escala basal, asi como la diferencia a 1, 3 y 6 meses, evidenciandose mediante la posibilidad de mantener una ereccion o responder a la terapia con iPDE5. Se realizo una busqueda de informacion desde su inicio hasta la fecha actual, en las bases de datos: Medline, Embase, Central, Science Direct y Lilacs. Resultados Los estudios que se encontraron utilizaron distintas variables de desenlace para evidenciar la eficacia en el seguimiento: Todos los estudios utilizaron el IIEF-EF como variable de desenlace en sus distintas variaciones. Conclusion LISWT podria ser un tratamiento efectivo y seguro en pacientes no respondedores a la iPDE5. Es importante senalar que la evidencia actualmente es limitada, se necesitan estudios aleatorizados con mayor rigidez metodologica y seguimiento mayor a 12 meses con la finalidad de comprobar el efecto a mediano y largo plazo de la aplicacion de ondas de choque en este grupo de pacientes.

Objective: Proton pump inhibitors are widely used as treatment of acid-related disorders. They are considered safe although their long-term use has been associated with some adverse effects including an increased propensity for urinary calculi formation. The aim of this study was to systematically review available data from studies evaluating the association of PPIs and nephrolithiasis. Materials and methods: We searched two electronic databases (PubMed and EMBASE) for cohort studies or case-control studies evaluating the relationship between treatment with proton pump inhibitors and the risk of stone formation published up to 31 October 2022. The overall association of PPIs and urinary calculi was analyzed using a random effects model (RevMan5). The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Results: A total of 550 studies were retrieved; 7 were selected by title and abstract screening; after removal of duplicates, 4 records were evaluated by full-text examination. An additional study was retrieved by handsearching the references included in screened studies. In the unadjusted analysis, the odds of urinary calculi were greater in subjects taking PPIs compared to controls (unadjusted OR = 2.10, 95% CI 1.74-2.52, p < 0.00001). The pooled odds ratio of two case-control studies confirmed that use of PPIs increased the odds of urinary calculi compared with non-use (OR 2.44, 95% CI 2.29 to 2.61). Pooled analysis of three cohort studies evaluating incident nephrolithiasis showed an overall hazard ratio estimate of 1.34 (95% CI = 1.28-1.40). One study found lower urinary citrate and urinary magnesium levels in subjects exposed to PPIs. The Newcastle-Ottawa Quality Assessment Scale scores ranged between 6 and 8. Conclusions: PPIs showed an association with urinary calculi in patients included in the studies included in this review. If these data will be confirmed in adequately powered randomized trials, clinicians may consider limiting the long-term use of PPIs, to avoid unnecessary prolongation of treatment. Urinary magnesium and citrate should be evaluated in renal stone forming patients taking PPIs to supplement their intake when requested.

Urothelial carcinoma (UC) is the fourth most prevalent malignancy in adults, accounting for 2.1% of cancer-related deaths. We aimed to describe the most frequent telomerase reverse transcriptase (TERT) gene mutations in this type of cancer and their relationship with the prognosis and treatment of this disease.We performed a search strategy in Medline and Embase with the following keywords: telomerase reverse transcriptase (TERT) gene and upper tract UC. We included reviews and observational studies to support the statements throughout the manuscript.The transcriptional activation of the TERT gene and subsequent telomerase activity is a prerequisite step in malignant transformation and progression. In advanced upper tract UC, TERT mutations are the most common genomic alterations in the Foundation Medicine database. C228T mutations predict distant metastasis in 60% of patients with renal pelvis cancer and 11% with ureteral cancer. Also, C228T and C250T mutations in urine DNA had a sensitivity of 87% and specificity of 94.7%. All TERT genomic alterations are inactivating short variant sequence mutations. There are no copy number gains or losses in TERT and no TERT gene rearrangements or fusions.Multiple markers, and mutations regarding the TERT gene and its promoter have been found in upper tract UC. The C250T and C228T mutations have shown promising results as diagnostic markers detected with urine tests.

Description: Pelvic floor therapy is a fundamental part of the rehabilitation process for patients. According to the American College of Physicians, techniques such as Kegel exercises are part of the rehabilitation of the pelvic floor, these are used in the non-pharmacological management of female urinary incontinence. in patients with multiple clinical conditions that affect the quality of life of patients. In this article, it is intended to review the importance of pelvic floor muscle therapy in urinary incontinence, pregnancy, and chronic pelvic pain, as well as to focus on the concept of therapy itself. Relevance: Pelvic floor muscle therapy is a low-cost tool, indicated in international guidelines and which, to date, has not reported large deleterious effects for people who practice it as a treatment for urinary incontinence. It is vitally important not only to emphasize the pelvic muscles, as stated in the text, since working the muscles in the center of the body, which includes the abdominal and lower back muscles, provide better results for people in this type of exercise. treatment. Conclusions: This review allows providing clear concepts and perspectives within the reach of medical personnel and physiotherapists in general.

The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self-esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.

Objective: To determine the prevalence of functional gastrointestinal disorders (FGIDs) in children according to Rome IV criteria. Methods: We included cohorts and observational descriptive studies, including information for the prevalence of FGIDs according to Rome IV criteria in children 4 to 18 years old. We searched the MEDLINE (Ovid), EMBASE, LILACS, and CENTRAL databases from May 2016 to nowadays. Gray literature and other databases were also consulted. The risk of bias was assessed using the STROBE Statement. The results were reported in forest plots of the estimated effects of the included studies with a 95% confidence interval (95%CI). Results: We included 14 studies involving a total of 17427 participants. Three studies were conducted in Europe, two in North America, and nine in Latin America. Most studies were school-based (n=14670, 84.18%), participants were mostly female (55.49%), white (51.73%), 8 to 18 years old (77.64%), and assisted to a public school (81.53%). Thirteen studies used the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS-RIV) to assess FGIDs. We found a global prevalence for FGIDs of 23% (95%CI 21-25%, I2 99%). Main disorders were functional constipation (FC) with 12% (95%CI 11-15%) followed by functional dyspepsia (FD) (5%, 95%CI 11-15%) and irritable bowel syndrome (IBS) (3%, 95%CI 2-4%). The prevalence of FGIDs was higher in the Americas, representing 23.67% (95%CI 21.2-26.2%, I2 91.3%). Conclusion: FGIDs are present in one of four children and adolescents, representing a common condition in this age group the central disorders were FC, FD, and IBS. RESUMO Objetivo: Determinar a prevalência de distúrbios gastrointestinais funcionáis (DGF) em crianças de acordo com os critérios de Roma IV. Métodos: Incluímos coortes e estudos observacionais descritivos, incluindo informações para a prevalência de DGF de acordo com os critérios de Roma IV em crianças de 4 a 18 anos. Pesquisamos nas bases de dados MEDLINE (Ovid), EMBASE, LILACS e CENTRAL de maio de 2016 até os dias atuais. A literatura cinzenta e outras bases de dados também foram consultadas. O risco de viés foi avaliado usando a Declaração STROBE. Os resultados foram relatados em parcelas florestais dos efeitos estimados dos estudos incluídos com um intervalo de confiança de 95% (95%IC). Resultados: Foram incluídos 14 estudos envolvendo um total de 17.427 participantes. Três estudos foram realizados na Europa, dois na América do Norte e nove na América Latina. A maioria dos estudos foi de base escolar (n=14.670, 84,18%), os participantes eram em sua maioria do sexo feminino (55,49%), brancos (51,73%), de 8 a 18 anos (77,64%) e atendidos em escola pública (81,53%). Treze estudos usaram o Questionário de Sintomas Gastrointestinais Pediátricos (QPGS-RIV) para avaliar DGF. Encontramos uma prevalência global de DGF de 23% (95%IC 21-25%, I2 99%). Os principais distúrbios foram constipação funcional (CF) com 12% (95%IC 11-15%) seguido de dispepsia funcional (DF) (5%, 95%IC 11-15%) e síndrome do intestino irritável (SII) (3%, 95%IC 2-4%). A prevalência de DGF foi maior nas Américas, representando 23,67% (95%IC 21, 2-26,2%, I2 91,3%). Conclusão: DGF estão presentes em uma de quatro crianças e adolescentes, representando uma condição comum nessa faixa etária. Os distúrbios centrais foram CF, DF e SII.

El cáncer de próstata es el tipo de cáncer más frecuente diagnosticado en los hombres. Específicamente en Estados Unidos, corresponde a la segunda causa de muerte por cáncer. El uso generalizado de antígeno prostático específico desde principios de la década de 1990 ha aumentado significativamente su incidencia. Sin embargo, el cribado del cáncer de próstata sigue siendo uno de los temas más controvertidos en la literatura urológica. La evidencia científica más reciente sugiere que el cribado no afecta la mortalidad por todas las causas y solo un pequeño efecto en la mortalidad específica de la próstata. Al mismo tiempo, existen riesgos asociados con la biopsia y el tratamiento del cáncer de próstata, como incontinencia urinaria, infección y disfunción eréctil. Las recomendaciones actuales proponen la toma de decisiones compartida con los hombres, aunque existen diferencias notables, especialmente en lo que respecta a las edades adecuadas de detección y los intervalos de seguimiento.

Descripción resumida del tema: La patología de la luz uretral se desarrolla debido al proceso de cicatrización y fibrosis de la mucosa uretral y/o de los tejidos adyacentes, desencadenando funcionalmente obstrucción del tracto urinario inferior generando alteración de la micción con un eventual deterioro del tracto urinario y un impacto directo en la calidad de vida. Relevancia: La estenosis y la estrechez uretral afectan, de manera importante, la calidad de vida de los pacientes. Con un adecuado enfoque diagnóstico y terapéutico son quirúrgicamente curables. El planteamiento terapéutico dependerá de múltiples factores relacionados con la edad del paciente, las comorbilidades, la etiología, nivel y extensión de la enfermedad. Las opciones terapéuticas se dividen en tratamiento paliativo y curativo contemplando en este grupo técnicas mínimamente invasivas y las cirugías reconstructivas como lo son la uretroplastia término-terminal, con injerto genital o extragenital, y con colgajo de tejido genital. Conclusión: Cada técnica quirúrgica de reconstrucción uretral tiene un campo preciso de aplicación con resultados aceptables. Sin embargo, la literatura disponible sobre uretroplastía tiene bajos niveles de evidencia, predominando series de casos y la opinión de expertos.

The purpose of this study is to determine the effectiveness and safety of endoscopic management compared to ureterovesical reimplantation in pediatric patients with high-grade vesicoureteral reflux in terms of urinary tract infection. We performed a network meta-analysis. We searched in MEDLINE, EMBASE, LILACS, and CENTRAL. We included clinical experiments, quasi-experiments, and cohorts studies. The population was men and women between 1 month and 15 years old. Patients had primary high-grade VUR diagnosed by voiding cystourethrography. The interventions were subureteric bulking agent endoscopic injection (polytetrafluoroethylene, hyaluronic acid, collagen, Dx/Ha, and PPC) vs vesicoureteral reimplantation (Cohen, Politano-Leadbetter, Glenn-Anderson, and Lich-Gregoir), and the primary outcome was urinary infections. Nine studies accomplished the inclusion criteria (seven observational and two clinical experiments). A total of 1448 renal units underwent surgical treatments for the correction of high-grade VUR. Regarding the primary outcome, we compared Dx/Ha with Cohen, Lich-Gregoir, and PPC, finding an RD of −0.02 (95%CI −0.09 to 0.06), RD of −0.02 (95%CI −0.10 to 0.07), and an RD of −0.03 (− 0.13 to 0.07), respectively. Conclusion: Our study showed that there were no differences in UTI episodes after VUR correction in patients undergoing endoscopic management compared with vesicoureteral reimplantation.

Background We performed a systematic review (SR) and meta-analysis (MA) to determine the diagnostic accuracy of chest ultrasound (US) compared with a pericardial window (PW) for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Methods A literature search in five databases identified relevant articles for inclusion in this SR and MA. Studies were eligible if they evaluated the diagnostic accuracy of chest US, compared with a PW, for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients presenting with penetrating thoracic trauma. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test accuracy within the bivariate mixed-effects logistic regression modeling framework. Results We included five studies in our SR and MA. These studies included a total of 556 trauma patients. The MA found that, compared with PW, the US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients. The presence of a concomitant left hemothorax was frequent in patients with false-negative results. Conclusion This SR and MA found that, compared with PW, US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Caution interpretation of pericardial US results is suggested in the presence of left hemothorax. In these cases, a second diagnostic test should be performed. Level of evidence Systematic Review and Meta-analysis, level II.