Síntomas reveladores de la presencia de reacciones de estrés en personal de primera respuesta a emergencias en Cali, Colombia / Revealing symptoms of the presence of stress reactions in first responders to emergencies in Cali, Colombia

Resumen Introducción: Los trabajadores de primera respuesta a emergencias se encuentra expuestos a factores psicosociales que pueden incrementar el riesgo de estrés, debido, entre otras variables, a las condiciones propias de las funciones ejercidas lo cual puede menoscabar el estado de salud de esta población. Objetivo: Determinar los síntomas reveladores de la presencia de reacciones de estrés en personal de primera respuesta a emergencias y su asociación con la edad y la antigüedad en la institución. Método: Se realizó un estudio transversal que incluyó el personal de primera respuesta a emergencias de una institución de bomberos en Colombia, 215 participantes. Se realizó asociación entre el nivel de estrés y las variables edad y antigüedad. Resultados: Se encontró un nivel de estrés alto y muy alto del 50.3%. Los síntomas fisiológicos y de comportamiento social presentaron los niveles más altos. Los trabajadores con mayor edad presentaron mayor estrés. No se presentó asociación con la antigüedad en el cargo. Conclusión: Más de la mitad de la población tiene niveles de estrés alto y muy alto. Los trabajadores de primera respuesta a emergencias con mayor edad fueron los que presentaron niveles de riesgo más alto de estrés.

Abstract Introduction: First responders in emergencies are exposed to psychosocial factors that can increase the risk of stress, due, among other variables, to the conditions of the functions performed, which can undermine the health status of this population. Objective: Determine the symptoms that reveal the presence of stress reactions in first responders to emergencies and their association with age and seniority in the institution. Method: A cross-sectional study was carried out that included first responders to emergencies from a fire department in Colombia, 215 participants. An association was made between the level of stress and the variables age and seniority. Results: A high and very high stress level of 50.3% was found. Physiological and social behavior symptoms presented the highest levels. Older workers had greater stress. There was no association with length of service. Conclusion: More than half of the population has high and very high stress levels. The oldest emergency first responders were those with the highest risk levels of stress.

Tips to improve patient's experience in consultation / Consejos para mejorar la experiencia del paciente en la consulta

The physician­patient relationship is a complex consensual association based on trust, vulnerability, authority, empathy, and compassion1. Its main objective is to achieve the best patient health outcomes possible. Nonetheless, factors affect how the goal is achieved, such as ineffective communication and low emotional intelligence2. Historically, health professionals have recognized how relevant the physician­patient relationship is and the patient's experience. Accordingly, patient satisfaction positively impacts clinical effectiveness, health outcomes, patient safety, and adherence to preventive care actions, medication, and clinical practice3. That is why we consider that physicians must use different strategies to improve patients' experiences in consultation. Consequently, we aimed to describe a few tips for improving a patient's experience in consultation. Good communication is the main issue in the doctor­patient relationship, significantly affecting patient safety and satisfaction. According to Burgener, using the AIDET technique to communicate with patients will enhance their relationships with them. AIDET includes five communication behaviors: acknowledge, introduce, duration, explanation, and thank you. The technique consists of first acknowledging the patient by his name; also, the patient's companion, in the case, there is one, smiling and making eye contact (acknowledge). Second, the physician introduces themselves with their name, professional certification, and role in the patient's care (introduce). The next step is letting the patient know which phases of the consultation and the approximate duration of each. Furthermore, explaining to the patient what is next, seeing other physicians, the treatment to receive, laboratory tests, other issues, and answering questions (explanation). Finally, thank the patient for their communication and cooperation and thank the patient's companion for support4. Learning cultural metaphors of illness that is part of the cultural group is another vital strategy to improve communication5. Furthermore, explain the diagnosis and treatment options in a common language, using some active listening strategies to show the patient that you are paying attention. Using questions, affirmations, and non-verbal manifestations of attention, summarizing what they have said to make sure that you understand correctly6, and using the teach-back method, which consists of asking the patients to explain in their own words what they understood about their diagnosis, treatment, and self-care. These tools will also make communication more effective for both7. Other ways of enhancing the patient's experience are being empathetic by recognizing and understanding the patient's feelings, concerns, and situations. This will communicate that you know and care about what they need8 ­ starting the appointment at the scheduled time. Furthermore, if this is not possible, informing the patients about any delays will reduce anxiety and increase tolerance. Apologizing for the delays can positively impact emotions arising from the patient, such as irritation, anger, and frustration. Some ideas may include offering entertainment options such as magazines or televisions in the waiting room to make it more enjoyable9. Being empathetic is the foundation of the patient experience. We understand empathy as the ability to connect with others and see their situation from their perspective and context rather than from our values and life view. It begins with a warm and kindly initial contact, represented by direct eye contact, a respectful greeting appropriate to the patient's cultural background and age, and a welcoming statement that makes the patient feel comfortable and shows our genuine interest in helping them10. Following that, we ask the patient, in the most open-ended way possible, about the reasons for their visit to the clinic. This moment is crucial, but we recommend approaching it like news headlines. In other words, we only need a brief phrase that describes the different concerns of the patient. This moment may be intimidating for doctors, as we might think the patient will go on without limits, but 50% of patients will not take more than 90 s, and 90% will not take more than 3 min. The task, then, is to prioritize that list of issues and collectively determine if we can address all of them in this visit or if we need to defer some points from the list11. Next, we proceed to ask open-ended questions, actively listen, maintain a good posture, be mindful of our gestures, and, as mentioned before, use sounds and gestures to indicate that we are attentive and fully present with the patient. During this conversation, we pay attention to the emotional tone and cues regarding underlying concerns that may not be immediately apparent to respond empathetically. Finally, we summarize the information and ask the patient to clarify or provide further details on anything that may not have been fully understood. A third critical strategy is involving the patients in the decision-making process, which can be done by explaining the alternatives and the pros and cons. According to other authors, greater patient involvement in decision-making is associated with higher patient satisfaction12-14. Patient-reported outcome measures (PROMs) can also help improve patients' experiences. PROMs are standardized, validated surveys that can be used to assess various health-relevant concepts, including patient care experience. Using this tool, physicians and care providers can learn more about the patient's preferences and values, valuable information for shared decision-making, allowing the physician to propose treatment options that match the patient's preferences. It will also be possible to assess patient reports about their actual experiences with health-care services, giving them the opportunity to recognize which aspects need to be enhanced15. In addition, physicians who wear white coats are perceived as more reliable, experienced, friendly, and professional than those who do not wear white coats. This will impact patient satisfaction16-19. Accordingly, we suggest wearing white coats during consultations. Nevertheless, we may highlight that patients' preferences can vary according to different sociodemographic characteristics, such as age19. To conclude, we might like to emphasize that patients' well-being must be a vital physician's goal, which is why we encourage health-care professionals to put into practice the tips we describe in this document. Finally, thank the patient for their communication and cooperation. Furthermore, you may thank the patient's companion for their support

Assessing safety and efficacy of flexible ureteroscopy and laser lithotripsy in elderly patients / Evaluación de la seguridad y eficacia de la ureteroscopia flexible y la litotricia láser en pacientes de edad avanzada

Objective: The objective of the study was to determine the efficacy and safety of flexible ureteroscopy (F-URS) for the management of intrarenal or proximal ureteral lithiasis in aged patients. Materials and methods: In this retrospective, multicenter observational study, we collected the anonymized clinical data of patients who underwent F-URS at two institutions in Cali, Colombia between June 2015 and May 2018. The patients were divided into two groups based on age: Group A defined as aged patients (> 65 years) and Group B as patients of non-advanced age (< 65 years). Results: A total of 201 patients were included in this study. The average age for Group A was 75 years (± 4.5) and for Group B was 51 years (± 10). The anesthetic risk classification (American Society of Anesthesiology [ASA]) and comorbidities were significantly higher for Group A with an ASA II and III of 74% versus 50% in Group B. No significant differences were shown in the stone-free rates (SFRs) or significant ureteral injury (Grade III and IV). There was no difference in intraoperative or post-operative complications between both groups. Conclusions: Age > 65 years was not associated with a negative impact on the outcomes of F-URS for the management of intrarenal or proximal ureteral lithiasis in this cohort of patients. F-URS appears as a safe and effective procedure and should not be withheld from older patients

Objetivo: Determinar la efectividad y seguridad de la ureteroscopia flexible (F-URS) para el manejo de la litiasis ureteral intrarrenal o proximal en pacientes ancianos. Materiales y métodos: En este estudio observacional multicéntrico y retrospectivo, se recogieron los datos clínicos de los pacientes sometidos a F-URS en dos instituciones de Cali, Colombia, entre junio de 2015 y mayo de 2018. Los pacientes se dividieron en dos grupos según la edad. El grupo A se definió como pacientes de edad avanzada (> 65 años) y el grupo B como pacientes de edad no avanzada (< 65 años). Resultados: Un total de 201 pacientes fueron incluidos en este estudio. La edad media para el grupo A fue de 75 años (± 4,5) y para el grupo B fue de 51 años (± 10). La clasificación de riesgo anestésico (ASA) y las comorbilidades fueron significativamente mayores para el grupo A con un ASA II y III del 74% frente al 50% en el grupo B. No se observaron diferencias significativas en las tasas libres de cálculos ni en la lesión ureteral significativa (grado III y IV). No hubo diferencias en las complicaciones anestésicas, intraoperatorias o postoperatorias entre ambos grupos. Conclusiones: La edad > 65 años no se asoció con un impacto negativo en los resultados urológicos ni en la tasa de éxito de la F-URS para el manejo de la litiasis ureteral intrarrenal o proximal en esta cohorte de pacientes. La F-URS es un procedimiento seguro y eficaz, y no debe contraindicarse en los pacientes de edad avanzada

Lo particular que resulta el trato cosificante que se le da a una persona cuando se vuelve paciente / The particularity of the objectifying treatment of a person when he or she becomes a patient

La cosificación en salud representa una forma de trato peyorativo que el personal de salud da a sus pacientes. Este trato cosificante tiene su origen en la deshumanización en salud, que debido a los avances tecnológicos cada vez es más fuerte. Este es un problema multicausal, que un estudiante y médico pueden abordar desde un enfoque académico promoviendo activades que lleven a un fortalecimiento en la relación médico-paciente y la implementación de una política de humanización en cada institución

Reification in health care represents a form of pejorative treatment given by health care personnel to their patients. This objectifying treatment has its origin in the dehumanization of health, which due to technological advances is increasingly stronger. This is a multicausal problem, which a student and a physician can address from an academic approach promoting activities that lead to a strengthening of the doctor-patient relationship and the implementation of a humanization policy in each institution

Tips para un apropiado desenlace con el uso de las prótesis de pene / Tips for a proper outcome with the use of penile prostheses

Las prótesis peanas marcaron un cambio importante en la historia del manejo de la disfunción eréctil, principalmente en hombres refractarios a otros métodos existentes. En la actualidad se cuenta con tres opciones de implantes de prótesis peneanas: prótesis de dos piezas, de tres piezas y las semirrígidas; cada una de ellas con una indicación específica. Existen también diferentes tipos de abordajes quirúrgicos, de los cuales los más usados son el abordaje penoescrotal y suprapúbico. En cuanto a las complicaciones quirúrgicas, la infección es una de las más frecuentes, por lo que se han desarrollado implantes impregnados con antibióticos e implantes irrigables con solución antibiótica y/o antifúngicas a elección con el fin de mitigar la infección, puesto que se ha reportado que los dispositivos recubiertos reducen la incidencia de infección del dispositivo en aproximadamente un 50%, al igual que la implementación de otras técnicas como la de no tocar para reducir la infección. La prótesis peneana es una estrategia efectiva para el tratamiento de la disfunción eréctil en hombres refractarios a otras intervencione

Penile prostheses marked an important change in the history of erectile dysfunction management, mainly in men refractory to other existing methods. Currently, there are three options for penile prosthesis implants, which are: two-piece, three-piece and semi-rigid prostheses; each with a specific indication. There are also different types of surgical approaches, of which the most used are the penoscrotal and suprapubic approaches. Regarding surgical complications, infection is one of the most frequent, which is why implants impregnated with antibiotics and irrigable implants with antibiotic and/or antifungal solution of choice have been developed to mitigate infection, since it has been Coated devices have been reported to reduce the incidence of device infection by approximately 50%, as has the implementation of other techniques such as no-touch to reduce infection. Objective: This review aims to provide a detailed contextualization on the surgical management of erectile dysfunction with penile prosthesis implants, placement indications, types of prosthesis, placement tips, most used surgical approaches, and prevention of complications; with the objective of educating doctors and health personnel to become familiar with the procedure, better guide patients, and increase their satisfaction. Conclusions: The penile prosthesis is an effective strategy for the treatment of erectile dysfunction in men refractory to other interventions

Una aproximación práctica al marketing digital en salud

El enfoque del marketing digital se ha trasladado en las últimas décadas al campo de la salud, dando lugar a la creación de diversas estrategias que facilitan tanto la comunicación e interacción entre los profesionales de la salud y los pacientes. Estas pueden aplicarse en tres grandes etapas: la captación, la retención y el seguimiento de los pacientes, con una gama amplia de alternativas que varían desde la creación de un sitio web personal hasta la participación del profesional en equipos de salud con un enfoque de atención multidisciplinaria, mediante diversas plataformas o aplicaciones digitales. El uso de estas modalidades ha traído consigo múltiples beneficios, desde una atención integral de los pacientes hasta el incremento de la oferta de los diferentes servicios en salud y la opción de la participación en estudios científicos de gran aporte para la comunidad. Así, el marketing digital en salud representa un gran avance en este gremio y se vaticina de alto impacto para la sociedad.

The focus of digital marketing has moved in recent decades to the health field, giving rise to create different strategies that facilitate both communication and interaction between health! professionals and patients. The application has three main stages: the recruitment, retention, and follow-up of patients, with a wide range of alternatives that vary from creating a personal website to multidisciplinary professional participation in health teams for patients through various platforms or digital applications. Using these modalities brought multiple benefits, from comprehensive patient care, including increased supply of different health services and the option of participating in scientific studies of significant contribution to the community. Thus, digital marketing in health represents a fundamental advance in this guild and a high impact on society.

Manejo del cáncer de vejiga invasor de músculo con enfoque preservador de órgano: terapia trimodal / Management of muscle-invasive bladder cancer with an organ-sparing approach: trimodal therapy

El cáncer de vejiga es una patología frecuente del tracto genitourinario, cuyo tratamiento acarrea morbilidad y alteración de la calidad de vida y en particular en el subgrupo de pacientes con tumores vesicales clasificados como invasores de músculo. En los últimos años se han venido buscando alternativas terapéuticas para la cistectomía radical + linfadenectomía pélvica extendida, que es en la actualidad el estándar de manejo para los pacientes con carcinoma de vejiga invasor de músculo. Con el advenimiento de perfiles de manejo oncológico menos ablativos pero sin sacrificar resultados oncológicos y con las nuevas técnicas de radioterapia y quimioterapia, las modalidades terapéuticas preservadoras de órgano como la terapia trimodal (resección transuretral de tumor vesical + quimioterapia + radioterapia) se convierte en una alternativa terapéutica viable y con resultados oncológicos satisfactorios a largo plazo. Objetivo y metodología: Con esta revisión se pretende mostrar la actualidad de la terapia trimodal en el manejo de los tumores vesicales con invasión muscular, definir los mejores pacientes a considerar para recibir esta terapia, exponer los resultados oncológicos comparados con el estándar de manejo y los resultados en calidad de vida. También se propone un algoritmo de manejo y se presentar las recomendaciones al respecto en guías de práctica clínica. Conclusiones: La terapia trimodal es una alternativa al estándar de manejo que conduce a resultados oncológicos aceptables y puede considerarse una opción de tratamiento en pacientes bien seleccionados.

Introduction: Bladder cancer is a frequent pathology of the genitourinary tract, whose treatment causes morbidity and impaired quality of life, particularly in the subgroup of patients with bladder tumors classified as muscle invaders. In recent years, therapeutic alternatives have been sought for radical cystectomy + extended pelvic lymphadenectomy, which is currently the standard of care for patients with muscle-invasive bladder carcinoma. With the advent of less ablative oncological management profiles but without sacrificing oncological results and with new radiotherapy and chemotherapy techniques, organ-sparing therapeutic modalities such as trimodal therapy (transurethral resection of bladder tumor + chemotherapy + radiotherapy) becomes a viable therapeutic alternative with satisfactory long-term oncological results. Objective and methodology: This review aims to show the current status of trimodal therapy in the management of muscle-invasive bladder tumors, define the best patients to consider for receiving this therapy, present the oncological results compared with the management standard and the results in quality of life. A management algorithm is also proposed and recommendations in this regard are presented in clinical practice guidelines. Conclusions: Trimodal therapy is an alternative to standard management that leads to acceptable oncological outcomes and can be considered a treatment option in well-selected patients.

Trauma renal cerrado de alto grado: el rol de la angioembolización en el manejo secuencial / High-grade blunt renal trauma: the role of angioembolization in the sequential management

El trauma renal corresponde a un 10% de todos los traumas abdominales; de ellos, un 90% comprende el trauma cerrado. Con respecto a las intervenciones asociadas, el manejo secuencial conservador o «paso a paso¼ ha logrado disminuir las tasas de nefrectomía innecesarias, ubicándose en un 28% en la actualidad. Una de las herramientas disponibles en la actualidad como parte del tratamiento del paciente con trauma renal cerrado de alto grado es la angioembolización. Consecuentemente, vale la pena conocer cuáles son los factores predictores para realizar una intervención temprana con fines de detener el sangrado, las tasas de éxito de la primera o segunda angioembolización y los predictores de falla.

Renal trauma accounts for 10% of all abdominal traumas; of these, 90% comprise blunt trauma. With respect to associated interventions, sequential conservative or "step-by-step" management has managed to reduce unnecessary nephrectomy rates, currently standing at 28%. One of the tools currently available as part of the treatment of patients with high-grade blunt renal trauma is angioembolization. 2 Consequently, it is worth knowing the predictors of early intervention to stop bleeding, the success rates of the first or second angioembolization and the predictors of failure.

Conceptos básicos para aprender a llevar una vida con cáncer / Basic concepts for learning to live a life with cancer

El cáncer es una enfermedad altamente prevalente que afecta a millones de personas de todas las edades y más allá de comprometer la parte física del paciente, juega un papel muy importante en la salud no solo del enfermo, sino incluso de todo su núcleo familiar. Es bien conocido que los pacientes oncológicos tienen una mayor susceptibilidad y una mayor prevalencia a padecer trastornos clínicos psiquiátricos como ansiedad y depresión, y otros síntomas subclínicos que se pueden presentar en etapas tan tempranas como el diagnóstico, entre los que se encuentran: baja autoestima (debido a los cambios corporales producto del tratamiento: calvicie, cicatrices, amputaciones, etc.), miedo al tratamiento, culpa, enfado hacia sí mismo, negación, fatiga y preocupación por los otros, entre otros. En conjunto y sin una intervención adecuada, el gran distrés psicológico al que se enfrenta un paciente con cáncer en sus diferentes etapas puede afectar de forma muy negativa su calidad de vida, la adherencia al tratamiento, las relaciones familiares y sociales, e incluso aumentar la mortalidad de las personas diagnosticadas, como muestra un estudio de cohortes con 9.138 hombres diagnosticados con cáncer en el cual una baja resiliencia a estos estresores psicológicos anteriormente descritos aumentaron la tasa de mortalidad en un 61% en todos los tipos de cáncer.

Cancer is a highly prevalent disease that affects millions of people of all ages and beyond compromising the physical part of the patient, it plays a very important role in the health not only of the patient, but also of the entire family. It is well known that cancer patients have a greater susceptibility and a higher prevalence of clinical psychiatric disorders such as anxiety and depression, and other subclinical symptoms that can present themselves in stages as early as the diagnosis, among which are: low self-esteem (due to body changes resulting from the treatment: baldness, scars, amputations, etc.), fear of treatment, guilt, anger towards oneself, denial, fatigue and concern for others, among others. Taken together and without adequate intervention, the great psychological distress faced by a cancer patient in its different stages can negatively affect quality of life, adherence to treatment, family and social relationships, and even increase the mortality of those diagnosed, as shown in a cohort study of 9,138 men diagnosed with cancer in which low resilience to these psychological stressors described above increased the mortality rate by 61% in all types of cancer.

Enhancing the importance of value-based urology and uro-oncology / Realzar la importancia de la urología y la uro-oncología basadas en valores

With the ongoing advances and evolution in healthcare, we have witnessed new breakpoints in patient management. As a result, there have been tireless efforts to identify and eradicate barriers to care and minimize their impact on patients.

Con los continuos avances y la evolución de la asistencia sanitaria, hemos sido testigos de nuevos puntos de inflexión en la gestión de los pacientes. Como resultado, se han realizado incansables esfuerzos para identificar y erradicar las barreras a la atención y minimizar su impacto en los pacientes.

Abordaje quirúrgico de la aorta para urólogos / Surgical approach to the aorta for urologists

A propósito de un caso clínico surgió la pregunta, ¿los urólogos estamos familiarizados con el abordaje de las lesiones de la aorta abdominal o una de sus ramas? Teniendo en cuenta que dentro de nuestro accionar quirúrgico podríamos llegar a estar inmersos en una complicación de tipo vascular, es fundamental que conozcamos con detalle estas maniobras.

A clinical case raised the question: are urologists familiar with the approach to lesions of the abdominal aorta or one of its branches? Bearing in mind that in our surgical actions we could be involved in a vascular complication, it is essential that we know these maneuvers in detail.

Risk factors associated with failed weaning from mechanical ventilation in septic patients admitted to an intensive care unit: a case-control study / Factores de riesgo de destete ventilatorio fallido en pacientes sépticos en una unidad de cuidado intensivo: estudio de casos y controles

Abstract Introduction: Several risk factors associated with weaning failure may be observed in septic patients requiring invasive mechanical ventilation. Objective: To determine the risk factors associated with weaning failure in septic patients admitted to an intensive care unit (ICU) in Cali, Colombia, between January 2014 and June 2018. Materials and methods: Case-control study conducted in 315 patients who required mechanical ventilation for more than 48 hours and were distributed as follows: 105 cases (weaning failure) and 210 controls (successful weaning). Information about sociodemographic and clinical variables was obtained from their medical records. A bivariate analysis was performed to determine the association between each independent variable and weaning failure. A multivariate analysis was also carried out using a logistic regression model in which the variables with a p<0.20 in the bivariate analysis were entered. A significance level of p≤0.05 was considered. Results: Requiring mechanical ventilation for more than 7 days (OR: 15.13; 95%CI: 8.25-27.74), having a high APACHE II score (mortality risk >50%) on ICU admission (OR: 3.16; 95%CI: 1.73-5.77), and having diuresis ≤0.5 mL/kg/h (OR: 1.87; 95%CI: 1.0-3.50) were significantly associated with weaning failure. Conclusions: Requiring mechanical ventilation for more than 7 days, having diuresis ≤0.5ml/kg/h, as well as a high APACHE ll score on ICU admission were risk factors associated with failed weaning from mechanical ventilation in this study; however, age, blood urea nitrogen, creatinine, and positive fluid balance were not significantly associated with it, despite being described as risk factors in the literature.

Resumen Introducción. En pacientes sépticos con requerimiento de ventilación mecánica invasiva pueden presentarse diferentes factores de riesgo de destete ventilatorio fallido. Objetivo. Determinar los factores de riesgo de destete ventilatorio fallido en pacientes sépticos admitidos a una unidad de cuidados intensivos (UCI) de Cali, Colombia, entre enero de 2014 y junio 2018 Materiales y métodos. Estudio de casos y controles realizado en 315 pacientes que requirieron ventilación mecánica por más de 48 horas distribuidos así: 105 casos (destete fallido) y 210 controles (destete exitoso). La información sobre variables sociodemográficas y clínicas se obtuvo a partir de la revisión de historias clínicas. Se realizó un análisis bivariado para determinar las asociaciones de cada variable independiente con el destete fallido y un análisis multivariado mediante un modelo de regresión logística en el que se ingresaron las variables que en el análisis bivariado tuvieron un valor p<0.20. Se consideró un nivel de significancia de p≤0.05. Resultados. Haber requerido ventilación mecánica por más de 7 días (OR: 15.13; IC95% 8.25-27.74), tener un puntaje APACHE II alto (riesgo de mortalidad >50%) al ingreso a UCI (OR: 3.16; 95%IC: 1.73-5.77) y tener diuresis ≤0.5 mL/kg/h (OR: 1.87; IC95% 1.0-3.50) se asociaron significativamente con el destete ventilatorio fallido. Conclusiones. En el presente estudio, el requerimiento de ventilación mecánica mayor a 7 días, la diuresis ≤0.5 mL/kg/h y un puntaje APACHE II alto al ingreso a UCI fueron factores de riesgo para destete ventilatorio fallido, pero no se observó asociación con la edad, el nitrógeno ureico en sangre, la creatinina y el balance de líquidos positivos, a pesar de que estos han sido descritos como factores de riesgo en la literatura.

Cannabis medicinal: puntos críticos para su uso clínico / Medical cannabis: Critical points for clinical application

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.

Since ancient times cannabis has been used for recreational and medicinal purposes. It is a significant source of chemical compounds, most of them called phytocannabinoids. These compounds have several physiological effects and produce their effects primarily by binding to endogenous cannabinoid receptors such as CB1 and CB2, among others. Cannabis has potential therapeutic properties and its preparations have been used as traditional remedies to treat pain and emesis. Synthetic cannabinoids are used clinically as analgesics, antispastics, antiemetics, and appetite stimulants. Significant cannabis toxicity is rare in adults; however, it can produce countless acute and chronic side effects. The quality of the evidence in this field is limited by the short duration of the trials, poor sample sizes, lack of a control group, and the existence of bias in most of the reviewed studies. Therefore, a larger number of studies with better methodological quality is required to support the safe use of this therapy. The decision to include cannabinoids as a treatment for any of the conditions described will depend on the evidence, the use of previous therapies, and the type of patient.

Uma revisão sistemática e meta-análise em escolares e adolescentes com Distúrbios gastrointestinais funcionáis de acordo com os critérios de Roma IV / A systematic review and meta-analysis in schoolchildren and adolescents with functional gastrointestinal disorders according to rome iv criteria

ABSTRACT 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.

Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review

ABSTRACT Purpose: To describe the current scientific knowledge and clinical experience in low-grade-non-muscle-invasive bladder cancer (LG-NMIBC) patients in challenging scenarios. Materials and Methods: Medline, Embase, Google Scholar, and Cochrane Central were searched until March 2021. Results: A total of 841 studies were identified, and abstracts were analyzed. Twenty-one relevant studies were then identified and reviewed. After all, information was gathered from 16 studies, the authors discussed the specific topics, and expert opinions were also included in the discussion. There have been some studies that can help us to have some insights on how to manage these patients. Very distinctive strategies have been reported in the literature, mainly anecdotally or in small randomized studies. Some of these treatments outlined in the present manuscript include repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, chemotherapy, and future perspectives. In the current manuscript, we have combined these strategies in a proposed algorithm. Conclusion: For those LG-NMIBC patients in challenging scenarios, we have found repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, and chemotherapy are attractive modalities to treat them effectively. Also, the current manuscript proposes an algorithm to overcome these challenges.

Impact of lifestyle in prostate cancer patients. What should we do?

ABSTRACT Objective: This review aimed to analyze interventions raised within primary and tertiary prevention concerning the disease's incidence, progression, and recurrence of Prostate Cancer (PCa). Priority was given to the multidisciplinary approach of PCa patients with an emphasis on modifiable risk factors. Materials and Methods: We conducted a comprehensive literature review in the following databases: Embase, Central, and Medline. We included the most recent evidence assessing cohort studies, case-control studies, clinical trials, and systematic reviews published in the last five years. We only included studies in adults and in vitro or cell culture studies. The review was limited to English and Spanish articles. Results: Preventive interventions at all levels are the cornerstone of adherence to disease treatment and progression avoidance. The relationship in terms of healthy lifestyles is related to greater survival. The risk of developing cancer is associated to different eating habits, determined by geographic variations, possibly related to different genetic susceptibilities. Discussion: PCa is the second most common cancer in men, representing a leading cause of death among men in Latin America. Prevention strategies and healthy lifestyles are associated with higher survival rates in PCa patients. Also, screening for anxiety and the presence of symptoms related to mood disorders is essential in the patient's follow-up concerning their perception of the condition.