Social abilities in young Mexicans with Down syndrome during the COVID-19 pandemic.

Background: Social abilities include interpersonal skills, interaction, and social responsibility. The nature of these abilities has not been explored in young people with Down syndrome (DS) during the social isolation of the COVID-19 pandemic. Method: The aim of this online study was to describe the social profile of a group of 30 Mexican people with DS, with a chronological age of 15-29 years, and explore the variables related to their psychosocial profiles. A sociodemographic questionnaire, mental age examination, and socialization battery were applied. Social behavior was analyzed in domains that facilitate socialization (leadership, joviality, social sensitivity, respect/self-control), in domains that disrupt socialization (aggressiveness/stubbornness, apathy/withdrawal, anxiety/shyness), and on a global scale. Results: Participants' scores in the facilitative domains were above average, and their scores in the disruptive domains were below average, as expected. Scores on the respect/self-control scale were associated with chronological age (CA), and those on the global scale with mental age (MA). Discussion: No impairments were found in the social skills of young people with DS according to the parameters of the scale. The development of the social profile with CA and MA stimulates cognition and promotes independence, autonomy, and proactivity. Parents' role in regulating children's behavior was an important factor in managing their social isolation during the COVID-19 pandemic.

Surgical wound infection in urology. Analysis of risk factors and associated microorganisms. / Infección de herida quirúrgica en urología. Análisis de factores de riesgo y microorganismos asociados.

OBJECTIVES: Open surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. MATERIAL AND METHODS: This was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. RESULTS: For genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam. In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. CONCLUSIONS: We found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance.

Uncontrolled non-heartbeating donors (types i-ii) with normothermic recirculation vs. heartbeating donors: evaluation of functional results and survival.

OBJECTIVE: Non-heartbeating donors (NHBD) are an alternative to heartbeating donors (HBD). Our objective was to compare functional results and kidney survival from NHBDs and HBDs. MATERIAL AND METHODS: A retrospective study comparing the results of 236 normothermically preserved kidneys from type i and ii type NHBDs with the results of 250 from HBDs that were transplanted in our center between 2005 and 2012. Homogeneity between groups was tested and we evaluated the presence of delayed graft function (DGF) associated with pretransplant variables of the donor and recipient. RESULTS: Both groups show homogeneity in pretransplant characteristics in terms of: age, HLA incompatibilities, and recipient hemodialysis time. Average follow-up time was 33 months (range 0-87) for NHBDs and 38 months (range 0-90) for HBDs. 5.5% of NHBDs showed primary non-function (PNF) vs. 4% of HBDs (P=.42) and 80.9% of DGF vs. 46.8% of HBDs (P<.001). At the end of the follow-up, there were no statistically significant differences in the survival of grafts (92.8% for NHBD vs. 93.6% for HBD, P=.71) and recipients (99.1% NHBD vs. 98.6% HBD, P=.28). CONCLUSIONS: Although the DGF percentage was greater for NHBDs, final creatinine as well as graft and recipient survival were similar for both groups. Therefore, in our experience, kidneys from NHBDs have similar results to those from HBDs and are an excellent source of organs for transplantation.

Evolution of primary care referrals to urology. Impact of a protocol on prostate disease and continuing education.

OBJECTIVE: To analyze the evolution of primary care referrals to the Urology Department after the implementation of a joint protocol on prostate disease and a continuing education program in our healthcare area. MATERIAL AND METHODS: In January 2011, we launched an action protocol on prostate disease, which was complemented by training sessions and an e-mail-based consultation system. We analyzed primary care referrals to the Urology Department between 2011 and 2013 and determined the reasons for the consultations and the compliance with the established criteria on prostate disease. We obtained data from the "Request for Appointment in Specialized Care" program of the Community of Madrid. We calculated the sample size with a 95% confidence level and a 50% heterogeneity. RESULTS: A total of 19,048 referrals were conducted. The most common reason for the referrals was lower urinary tract symptoms associated with benign prostate hyperplasia, with a 27% reduction and a compliance that went from 46% at 67%. Although prostate-specific antigen consultations increased by 40%, they improved their appropriateness (from 55% to 72%). This was the main type of consultation for suspicion of malignancy (30%). Also worth mentioning were female incontinence, which doubled in number, and a 41% reduction in erectile dysfunction, which could be due to the primary care training. CONCLUSIONS: The collaboration between the Department of Urology and primary care succeeded in improving the appropriateness of prostate disease referrals and modified the tendency to refer the rest of the diseases included in the project.

Community-associated urinary infections requiring hospitalization: risk factors, microbiological characteristics and patterns of antibiotic resistance.

OBJECTIVE: Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. MATERIAL AND METHODS: A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. RESULTS: Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2±19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + ß lactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. CONCLUSIONS: CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates.

Dual kidney transplantation involving organs from expanded criteria donors: a review of our series and an update on current indications.

BACKGROUND: Our purpose was to review our kidney transplantation program based on the use of expanded criteria donors, and to determine current indications for dual kidney transplantation (DKT). In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation. METHODS: In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation. DKT were performed with donors >75 and donors between 60 and 74 years of age and glomerulosclerosis of >15%. The kidneys of donors between 60 and 74 years of age and with glomerulosclerosis of <15% were used for single kidney transplantation (SKT). In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics. RESULTS: From 1996 to 2004, 222 SKTs and 88 DKTs were performed. Graft survival after 1 and 4 years was, respectively, 91% and 78% for SKT and 95% and 79% for DKT. In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics. From 2005 to 2011, 328 SKT and 32 DKT were performed. During this period most kidneys used for DKT were from female donors >75 years old, weighing <65 kg, with a creatinine of >1 mg/dL and glomerulosclerosis of >15%. The recipients for DKT were mostly male, <70 years old and whose weight was >75 kg. CONCLUSION: DKT from expanded criteria donors shows good outcomes. However, in many cases SKT may fulfill the need of the recipient. The archetype for DKT is an older female weighing <65 kg and the most common recipient is an overweight male who is <70 years old.

Effects of ipratropium on exercise-induced bronchospasm.

Exercise-induced bronchospasm (EIB) is the transient narrowing of the airways that follows vigorous exercise. Ipratropium bromide may be used to prevent EIB, but its effect varies among individuals. We hypothesized that time of administration of ipratropium interferes with its action. This was a prospective, double-blind, cross-over study carried out to evaluate the bronchoprotective and bronchodilatory effect of ipratropium at different times of day. The study consisted of 4 exercise challenge tests (2 at 7 am and 2 at 6 pm). In the morning, one of the tests was performed after placebo administration and the other one after ipratropium (80 microg) and the two tests (placebo and ipratropium) were repeated in the evening. Twenty-one patients with severe or moderate asthma and previous confirmation of EIB were enrolled in this prospective trial. The bronchodilatory effect of ipratropium was 0.25+/-0.21 L or 13.11+/-10.99% (p=0.001 compared to baseline values) in the morning, and 0.14+/-0.25 L or 7.25+/-11.37% (p>0.05) in the evening. In the morning, EIB was 0.58+/-0.29 L on the placebo day and 0.38+/-0.22 L on the treatment day (p=0.01). In the evening, EIB was 0.62+/-0.28 L on the placebo day and 0.51+/-0.35 L on the treatment day (p>0.05). We suggest that the use of ipratropium for the treatment of asthma and EIB should take into consideration the time of administration.

Erosive arthropathy: clinical variance in lupus erythematosus and association with anti-CCP case series and review of the literature.

OBJECTIVE: To describe the occurrence of erosive arthropathy in systemic lupus erythematosus (SLE) and its relationship to anti-CCP antibodies. METHODS: Retrospective medical record review of a case series of five female patients with SLE and erosive arthropathies. RESULTS: The initial disease presentation in all patients was a polyarthritis. Anti-CCP antibodies were detected in 4 out of 5 (80%) patients, 2 of whom had a positive rheumatoid factor. CONCLUSION: Erosive arthritis was strongly associated with the presence of anti-CCP antibodies in these patients with SLE, who presented with polyarthritis. Anti-CCP in patients with SLE may be a marker of a more severe joint disease.

Robotic assisted, laparoscopic pelvic lymph node dissection in humans.

PURPOSE: We evaluate the feasibility and efficacy of robotic assisted, laparoscopic pelvic lymph node dissection for locally advanced prostate cancer staging. MATERIALS AND METHODS: Robotic assisted, laparoscopic pelvic lymph node dissection was performed in 10 consecutive patients with mainly T3 M0 prostatic carcinoma (robotic group). Operative, postoperative and pathological parameters were compared with the results of the last 10 patients undergoing conventional, laparoscopic pelvic lymph node dissection performed with similar indications by the same operator (laparoscopy group). RESULTS: All operations were performed according to the established protocol with no specific intraoperative or postoperative complications. No conversion was required, and no technical incidents were observed in the robotic group. Mean operating time plus or minus standard deviation for the robotic group was 125 +/- 57 minutes (range 75 to 215), significantly longer than that for the laparoscopy group, which was 60 +/- 15 minutes (p = 0.0013). In the robotic group 2 patients presented with postoperative lymphoceles revealed in 1 by deep venous thrombosis and in the second by obturator pain. In the laparoscopy group 1 patient presented with acute urinary retention. The histological results concerning the number of lymph nodes removed were similar in both groups (p = 0.5). CONCLUSIONS: We show the technical feasibility of robotic assisted, laparoscopic pelvic lymph node dissection in humans. Although the benefit of this technique has not yet been established, predictable technological improvements would suggest the development of telesurgery and an improved precision of surgical procedure.

Experimental factors governing the internal stress state of the intervertebral disc.

This paper presents an experimental study of the response of the intervertebral disc to short-term static-axial loading within the conceptual framework of mechanical consolidation as applied to swelling materials. An experimental technique developed previously for articular cartilage was used to load the disc in compression and measure simultaneously the matrix internal excess pore pressure under both radially constrained and radially unconstrained conditions. Specifically the short-term pattern of development of the hydrostatic excess pore pressure was investigated. The average ratio of the maximum excess pore pressure u(i) to the nominal applied stress for unconstrained loading was approximately 1.9 while for constrained loading it was about 1.4. This behaviour is interpreted in terms of the generation of a pore pressure in the nucleus which reflects a non-uniform partitioning of the applied load across the inhomogeneous structure of the disc. These results provide a quantitative insight into the role that physico-chemically generated swelling plays in determining the internal mechanical response of the disc to an externally applied load and suggest a quantitative means of investigating the important influence of degenerative changes on the internal stress state of the disc without needing to pierce the annular wall in order to insert a pressure sensing device.

Biomechanics of load-bearing of the intervertebral disc: an experimental and finite element model.

This paper presents an experimental and finite element study of the biomechanical response of the intervertebral disc to static-axial loading in which classical consolidation theory was used to analyse its time-dependent response. A newly developed experimental technique was employed to load the disc in compression and measure simultaneously the matrix internal pressure and creep strain for the full consolidation process. It is shown that, upon loading, the disc develops a maximum hydrostatic excess pore pressure which gradually decays as water is exuded from the matrix. During this decay process, the applied load is progressively transferred to the solid components of the matrix until the load is borne in full by the solid at the end of consolidation. Material properties for the tissue were then obtained from the experimental stress-strain data and used in the finite element study in the development of a finite element solution based on Biot's theory of coupled solid-fluid interaction. An axisymmetric formulation was employed and the disc modelled as an anisotropic, non-linear poroelastic solid. A sensitivity analysis of the material properties for the structural components of the disc was carried out and the biomechanical response to compressive loading evaluated and compared to experimental data. The results show that the matrix permeability plays a significant role in determining the transient response of the tissue. Annular disruptions of the disc were shown to result in an increase in the nuclear principal stresses suggesting that disrupted regions of the annulus fibrosus play a reduced role in load bearing.

[The cardiology consultation in a health-service area hospital. The clinical aspects and the demand for diagnostic procedures]. / La consulta de cardiología en un hospital de área sanitaria. Aspectos clínicos y demanda de exploraciones diagnósticas.

Four consecutive years (1987-1990) outpatients attendance at a cardiology clinic was recorded in a district hospital with a catchment area of 200,000 inhabitants. The aim being to identify and evaluate the demand for cardiology consultations. A system for recording diagnoses was developed, based on the WONCA. The total number of consultations was 26,273, 27% being new patients, 78% of whom were referred by family doctors and health centers. Of the total, 57% were male. The most common age groups being from 60 to 69 (25%) and from 50 to 59 (23%); 22% were over 69. In 13.7% of the consultations, the find diagnosis was of "healthy hearts", in 16.7% valvular heart disease, in 31.5% ischaemic heart disease, in 15.1% arrhythmias, in 8.4% hypertension, and the remainder were other diseases. We carried out 4,406 echocardiograms, 1,408 exercise tests and 511 Holter monitoring traces. There were 322 direct hospital admissions, and 6,094 discharges in the four years period. We consider this type of records to be useful organizing cardiology outpatients clinics, analyzing the demand, and planning the use of health care resources, as well as estimating future needs and assessing quality of care.

Esophageal resection through a translaparotomic-transcervical approach.

The authors present their experience obtained from January/78 to March/90 with transhiatal esophagectomy. Two hundred and eighty-nine patients were operated on using this procedure; 171 of them underwent the operation for cancer of the esophagus, 76 for cancer of the cardia, 11 for cancer of the hypopharynx, and 31 for benign conditions. The esophageal replacement was made with stomach in 63.6% of the cases, ileo-ceco-coloplasty in 28.5%, left colon in 7.6%, jejunum in 0.3%. Cancer patients were mainly in advanced stages (stage III in 67.3% of esophageal cancer, and in 69.7% of cardial cancer). Average blood requirements for the different diseases ranged between 500 and 1,100 cc. Only 16 patients required admission in the ICU. Mean hospital stay ranged from 16.7 to 20.6 days. Surgical complications were hemorrhage (0.3%), and tracheal injury (0.6%). Overall operative mortality (at 30 days) was 5.8%, as a result of respiratory insufficiency (35.2%), pulmonary sepsis (17.8%), and others (23.5%). Long term survival at five years was 11.8% for cancer of the esophagus, 48.5% for cancer of the cardia, and 57.1% for cancer of the hypopharynx.