Pyeloureteral Anastomosis as a Reconstructive Technique for Post-Renal Transplant Ureteral Stenosis.

OBJECTIVE: Ureteral stenosis in renal transplant patients is a frequent urological complication that involves significant morbidity and may compromise graft function. Despite the common use of minimally invasive techniques, surgery continues to be the definitive treatment for ureteral stenosis, and pyeloureteral anastomosis is an infrequent but effective technique in the management of this pathology and has been described as a safe treatment with a low percentage of complications. METHODS: This is a retrospective study of patients in whom surgical intervention via pyeloureteral anastomosis was carried out in our center in the last 12 years. A descriptive analysis of perioperative management, complications, and functional results is provided. A comparison of renal function at diagnosis and after surgery was made to evaluate the effectiveness of the procedure. RESULTS: Thirteen patients underwent surgery within the described time frame. Time to diagnosis of stenosis was 60 days [interquartile range (IQR) 31-368]. Creatinine at diagnosis was 2.2 mg/dL [IQR 1.9-3] with a glomerular filtration rate, estimated by the modification of diet in renal disease equation, of 29 mL/min/1.73 m2 [IQR 22.6-34.5]. Of these patients, 92.3% underwent percutaneous nephrostomy, and 38.5% also had a ureteral catheter. The mean duration of surgery was 265 minutes [IQR 240-300], and hospital stay was 9 days [IQR 7.5-16]. A double J was placed in all cases, which was maintained for 36 days [IQR 30-49]. Postoperative complications occurred in 15.4% of patients. Serum creatinine 1 year after surgery was 1.6 ± 0.4 mg/dL. Among the patients, 76.9% had no new pyelocalyceal dilatation on follow-up Doppler ultrasound scans at a mean follow-up time of 12 months. The restenosis rate was 23.1%, and all were successfully treated by endoscopic approach. There was an improvement in renal function figures at 1, 3, 6, and 12 months compared to renal function at diagnosis, both in terms of serum creatinine and glomerular filtration rate, with statistically significant results. CONCLUSION: Pyeloureteral anastomosis as a reconstructive technique of the urinary tract in renal transplant patients is an effective and reproducible technique with good long-term results.

Navigating through the Controversies and Emerging Paradigms in Early Detection of Prostate Cancer: Bridging the Gap from Classic RCTs to Modern Population-Based Pilot Programs.

Over the last three decades, the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening have steered the conversation around the early detection of prostate cancer. These two randomized trials assessed the effect of screening on prostate cancer disease-specific mortality. Elevated PSA levels were followed by a systematic sextant prostate biopsy. Standard repeat testing intervals were applied. After controversies from 2009 to 2016 due to contradicting results of the two trials, the results aligned in 2016 and showed that early PSA detection reduces prostate cancer-specific mortality. However, overdiagnosis rates of up to 50% were reported, and this sparked an intense debate on harms and benefits for almost 20 years. The balance between harms and benefits is highly debated and has initiated further research to investigate new ways of early detection. In the meantime, the knowledge and tools for the diagnostic algorithm improved. This is a continuously ongoing effort which focuses on individual risk-based screening algorithms that preserve the benefits of the purely PSA-based screening algorithms, while reducing the side effects. An important push towards investigating new techniques for early detection came from the European Commission on the 20th of September 2022. The European Commission published its updated recommendation to investigate prostate, lung, and gastric cancer early detection programs. This opened a new window of opportunity to move away from the trial setting to population-based early detection settings. With this review, we aim to review 30 years of historical evidence of prostate cancer screening, which led to the initiation of the 'The Prostate Cancer Awareness and Initiative for Screening in the European Union' (PRAISE-U) project, which aims to encourage the early detection and diagnosis of PCa through customized and risk-based screening programs.

The Use of Radiomic Tools in Renal Mass Characterization.

The incidence of renal mass detection has increased during recent decades, with an increased diagnosis of small renal masses, and a final benign diagnosis in some cases. To avoid unnecessary surgeries, there is an increasing interest in using radiomics tools to predict histological results, using radiological features. We performed a narrative review to evaluate the use of radiomics in renal mass characterization. Conventional images, such as computed tomography (CT) and magnetic resonance (MR), are the most common diagnostic tools in renal mass characterization. Distinguishing between benign and malignant tumors in small renal masses can be challenging using conventional methods. To improve subjective evaluation, the interest in using radiomics to obtain quantitative parameters from medical images has increased. Several studies have assessed this novel tool for renal mass characterization, comparing its ability to distinguish benign to malign tumors, the results in differentiating renal cell carcinoma subtypes, or the correlation with prognostic features, with other methods. In several studies, radiomic tools have shown a good accuracy in characterizing renal mass lesions. However, due to the heterogeneity in the radiomic model building, prospective and external validated studies are needed.

WNT Signaling in Tumors: The Way to Evade Drugs and Immunity.

WNT/ß-catenin signaling is involved in many physiological processes. Its implication in embryonic development, cell migration, and polarization has been shown. Nevertheless, alterations in this signaling have also been related with pathological events such as sustaining and proliferating the cancer stem cell (CSC) subset present in the tumor bulk. Related with this, WNT signaling has been associated with the maintenance, expansion, and epithelial-mesenchymal transition of stem cells, and furthermore with two distinctive features of this tumor population: therapeutic resistance (MDR, multidrug resistance) and immune escape. These mechanisms are developed and maintained by WNT activation through the transcriptional control of the genes involved in such processes. This review focuses on the description of the best known WNT pathways and the molecules involved in them. Special attention is given to the WNT cascade proteins deregulated in tumors, which have a decisive role in tumor survival. Some of these proteins function as extrusion pumps that, in the course of chemotherapy, expel the drugs from the cells; others help the tumoral cells hide from the immune effector mechanisms. Among the WNT targets involved in drug resistance, the drug extrusion pump MDR-1 (P-GP, ABCB1) and the cell adhesion molecules from the CD44 family are highlighted. The chemokine CCL4 and the immune checkpoint proteins CD47 and PD-L1 are included in the list of WNT target molecules with a role in immunity escape. This pathway should be a main target in cancer therapy as WNT signaling activation is essential for tumor progression and survival, even in the presence of the anti-tumoral immune response and/or antineoplastic drugs. The appropriate design and combination of anti-tumoral strategies, based on the modulation of WNT mediators and/or protein targets, could negatively affect the growth of tumoral cells, improving the efficacy of these types of therapies.

Escala numérica para evaluar síntomas espirituales en cuidados paliativos / A scale to assess spiritual symptoms in palliative care

Background: Spiritual issues are an important dimension of health care, but seldom addressed by professionals. Thus, a scale that assesses the presence and intensity of seven spiritual symptoms was developed. Aim: To validate the instrument in palliative care settings. Material and Methods: The spiritual symptoms scale was applied to 103 patients, aged 59 ± 17 years (58% women), admitted to hospice care in two centers located in Santiago. The reproducibility of the scale was evaluated in 33 patients and its internal consistency and liability in 70. Results: The Fleiss Kappa to assess reproducibility was 0.82 and the analysis of variance had a p of 0.94. Cronbach alpha to assess internal consistency was 0.74. Conclusions: The scale renders similar results when applied by different evaluators and has a good liability. Therefore, it can be a reliable instrument to assess spiritual symptoms in palliative care settings. Further studies would be needed to verify its utility in other settings.

Evaluation of PCBs and DDTs in endemic Iberian barbel Barbus bocagei (Steindachner, 1864) populations.

PCB and DDT levels were evaluated in populations of endemic Iberian barbel (Barbus bocagei) in the Jarama River in Spain via a pollution gradient from well-preserved areas upstream to contaminated downstream areas. Age structure, abundance, recruitment and levels of morphological abnormalities and ectoparasites were assessed. Upstream to downstream PCB concentrations ranged from 3.4 to 101.4 ng/g (ww) and from 0.9 to 19.6 ng/g ww for DDTs. The PCB pattern was dominated by the PCB 153, 138 and 180 congeners, and the less chlorinated ones had a relatively high contribution upstream. Barbels exposed to low PCB and DDT levels had a well-balanced population with a predominant cohort of young fish, indicating good recruitment. The most contaminated sites displayed a disrupted age distribution, where the proportion of young fish was clearly under-represented. Recruitment and total density of barbel populations decreased downstream where the highest PCB and DDT levels were found. In addition, a higher incidence of abnormalities and ectoparasites was observed at these sites. High concentrations of PCBs and DDTs most likely contribute to the reduction of Iberian barbel reproductive performance in the most contaminated sites, as shown by the disrupted age-distribution found in our study.

Thermal carrying capacity for a thermally-sensitive species at the warmest edge of its range.

Anthropogenic environmental change is causing unprecedented rates of population extirpation and altering the setting of range limits for many species. Significant population declines may occur however before any reduction in range is observed. Determining and modelling the factors driving population size and trends is consequently critical to predict trajectories of change and future extinction risk. We tracked during 12 years 51 populations of a cold-water fish species (brown trout Salmo trutta) living along a temperature gradient at the warmest thermal edge of its range. We developed a carrying capacity model in which maximum population size is limited by physical habitat conditions and regulated through territoriality. We first tested whether population numbers were driven by carrying capacity dynamics and then targeted on establishing (1) the temperature thresholds beyond which population numbers switch from being physical habitat- to temperature-limited; and (2) the rate at which carrying capacity declines with temperature within limiting thermal ranges. Carrying capacity along with emergent density-dependent responses explained up to 76% of spatio-temporal density variability of juveniles and adults but only 50% of young-of-the-year's. By contrast, young-of-the-year trout were highly sensitive to thermal conditions, their performance declining with temperature at a higher rate than older life stages, and disruptions being triggered at lower temperature thresholds. Results suggest that limiting temperature effects were progressively stronger with increasing anthropogenic disturbance. There was however a critical threshold, matching the incipient thermal limit for survival, beyond which realized density was always below potential numbers irrespective of disturbance intensity. We additionally found a lower threshold, matching the thermal limit for feeding, beyond which even unaltered populations declined. We predict that most of our study populations may become extinct by 2100, depicting the gloomy fate of thermally-sensitive species occurring at thermal range margins under limited potential for adaptation and dispersal.

Gestión de la calidad de atención en laboratorios clínicos de hospitales públicos en Maracaibo, Venezuela / Managing the quality of attention in public hospitals' clinical laboratories in Maracaibo, Venezuela

Objetivo Evaluar la gestión de calidad de los laboratorios según la perspectiva de sus usuarios externos, determinándose las dimensiones de la calidad relacionadas con su satisfacción y con las características sociodemográficas. Métodos El estudio es descriptivo, la muestra estuvo conformada por 1 875 pacientes de consulta externa que asistieron a laboratorios de hospitales públicos tipo III y IV nivel de atención ubicados en el área metropolitana del Estado Zulia, entre Octubre a Diciembre de 2008. Se aplicó una encuesta previamente validada. Para el análisis, se empleó distribución de frecuencias, análisis multivariante y análisis de la varianza. Resultados Los resultados mostraron que la mayoría de los usuarios son pacientes de sexo femenino (72,7 por ciento), de procedencia local (87,9 por ciento); en edades entre 15 y 45 años (65,7 por ciento) y con grado de instrucción primaria y secundaria (70,5 por ciento). El análisis multifactorial demostró que el componente Gestión de Calidad, puede ser valorado por las dimensiones: Accesibilidad, Elementos tangibles, Capacidad de Respuesta, Competencias profesionales y Seguridad. Hubo diferencias altamente significativas (p<0,001) entre los distintos grados de instrucción y la edad al calificar la gestión de calidad. Se detectaron debilidades en cuanto a tiempo de espera en recepción, comodidad de la sala de espera y uso de medidas de seguridad del personal técnico. Conclusión Los resultados permitirán establecer acciones tendentes a evaluar el grado de mejoramiento del servicio y las metas propuestas en pro de mejorar la calidad de atención, medidas que formarán parte de un programa de aseguramiento de la calidad conforme la normativa internacional.

Objective Evaluating how clinical laboratories' quality was being managed according to the view of external users, thereby determining the dimensions of quality related to their satisfaction and sociodemographic characteristics. Methods The study was descriptive; the sample consisted of 1,875 outpatients attending the laboratories of type 3 and 4 care level public hospitals located in the metropolitan area of Zulia State in Venezuela between October and December 2008. A previously validated survey was applied. Frequency allocation, multivariate analysis and variance analysis were used for analysing data. Results The results showed that the most users were female (72.7 percent), of local origin (87.9 percent), aged between 15 and 45 (65.7 percent) and had received primary and secondary education (70.5 percent). Multivariate analysis showed that quality management could be evaluated in terms of accessibility, tangible elements, response ability, safety and professional competence. There were highly significant differences (p<0.001) between educational level and age when evaluating management quality. Weaknesses were revealed concerning time spent waiting in reception, waiting room comfort and safety measures used by technical staff. Conclusions The results should lead to establishing action aimed at evaluating the degree of improvement in service and proposed targets for improving the quality of attention; such measures will form part of a quality assurance programme in accordance with international standards.

[Managing the quality of attention in public hospitals' clinical laboratories in Maracaibo, Venezuela]. / Gestión de la calidad de atención en laboratorios clínicos de hospitales públicos en Maracaibo, Venezuela.

OBJECTIVE: Evaluating how clinical laboratories' quality was being managed according to the view of external users, thereby determining the dimensions of quality related to their satisfaction and sociodemographic characteristics. METHODS: The study was descriptive; the sample consisted of 1,875 outpatients attending the laboratories of type 3 and 4 care level public hospitals located in the metropolitan area of Zulia State in Venezuela between October and December 2008. A previously validated survey was applied. Frequency allocation, multivariate analysis and variance analysis were used for analysing data. RESULTS: The results showed that the most users were female (72.7 %), of local origin (87.9 %), aged between 15 and 45 (65.7 %) and had received primary and secondary education (70.5 %). Multivariate analysis showed that quality management could be evaluated in terms of accessibility, tangible elements, response ability, safety and professional competence. There were highly significant differences (p<0.001) between educational level and age when evaluating management quality. Weaknesses were revealed concerning time spent waiting in reception, waiting room comfort and safety measures used by technical staff. CONCLUSIONS: The results should lead to establishing action aimed at evaluating the degree of improvement in service and proposed targets for improving the quality of attention; such measures will form part of a quality assurance programme in accordance with international standards.

Presencia de rabia urbana en el estado Zulia Venezuela: años 1996-2006 / Presence of urban rabies in Zulia state Venezuela: years 1996-2006

La rabia es una enfermedad viral zoonótica y en el estado Zulia constituye un problema de salud pública de alto impacto social, debido al reporte de casos en humanos. En este estudio se determinó la presencia de rabia urbana en el estado Zulia y se identificó su distribución según municipios y especies afectadas durante los años 1996 -2006. En el marco de un estudio descriptivo, se realizó revisión documental de los registros de la Coordinación Regional de Zoonosis del estado Zulia para el período en estudio. Se observó una ocurrencia total de 1033 casos de rabia, de los cuales 1017 fueron en animales y 16 en humanos. La mayor incidencia fue para los Municipios Maracaibo (31,40 por ciento) y San Francisco (15,68 por ciento). El tipo de rabia predominante fue la urbana, el principal reservorio y transmisor fue el canino (91,60 por ciento). De los casos reportados en humanos la mayor incidencia fue en el Municipio Maracaibo (37,5 por ciento) y el grupo etario más afectado fueron menores de 15 años (81,2 por ciento). Se presentó un bajo porcentaje en la cobertura de vacunación (33 por ciento). Se evidencia una alta incidencia de rabia en el estado Zulia a pesar de ser ésta una enfermedad inmunoprevenible. Se determinó una correlación positiva entre el número de ingresos y de casos (rs=0,948 p < 0,01). Es necesario implementar un abordaje efectivo de los focos de infección y mantener una cobertura mínima de vacunación del 80 por ciento en caninos; además, implementar programas de educación comunitaria, para disminuir el riesgo de infección y la ocurrencia de casos.

Accidentabilidad por exposición muco cutánea a fluidos biológicos en profesionales de laboratorios clínicos / Accidentality from mucocutaneous exposure to biological fluids among clinical laboratory professionals

Se determinó la exposición laboral accidental a fluidos biológicos por contacto muco-cutáneo y factores asociados, mediante un estudio descriptivo dirigido a una muestra de 156 bioanalistas adscritos a laboratorios clínicos públicos del área metropolitana del estado Zulia. Para la recolección de datos se diseñó un instrumento que explora la exposición y factores vinculados así como el cumplimiento de medidas post exposición biológica. El promedio de edad de los Bioanalistas fue de 41.9 ± 9.7 años con predominio del sexo femenino 87,2 por ciento. Se evidencia exposición por accidentes muco-cutáneos con una tasa de prevalencia de 176,2 accidentes por cada 100 trabajadores, representados principalmente por salpicaduras 44,3 por ciento y spray 32,7 por ciento detectados en razón de su ocurrencia en un nivel de exposición moderado, en las edades , 54-60 y 26-32 años, en sexo femenino, entre 1-8 años de antigüedad, durante la jornada diurna. La accidentabilidad en relación a los factores asociados, se registra en un nivel de exposición moderado, con todos los fluidos biológicos indagados, en pequeño volumen, a nivel de mucosa ocular, en áreas de procesamiento de muestras y disposición de desechos en el laboratorio. Un nivel de mediano cumplimiento se obtuvo para el manejo post exposición identificándose diferencia estadísticamente significativa entre las medidas indagadas (p> 0.01). La magnitud y características de la exposición a fluidos biológicos revisten una problemática que puede impactar en la salud del personal y debe ser abordada institucionalmente para una efectiva gestión de prevención y control de riesgo.

Occupational exposure to biological fluids through mucocutaneous contact and related factors was determined through a descriptive study using a sample of 156 medical technicians working in public clinical laboratories in the metropolitan area of Zulia. A survey for data collection was designed which explored exposure and related factors such as compliance with post biological exposure measures. The age average of the bioanalysts was 41.9± 9.7; 87.2 percent were female. Results evidenced occupational exposure through mucocutaneous accidents, with a prevalence rate of 172.6 accidents for every 100 workers, represented primarily by splashes 44.3 percent and spray 32.7 percent, detected at a moderate level involving female workers with age ranges 54-60 and 26-32, 1-8 years on the job, during day shifts. Biological accidentality according to associate factors showed moderate exposure levels for all the biological fluids investigated in small volumes, at the level of the ocular mucosa, in sample processing and waste disposal areas. A medium compliance level was recorded for post-exposure handling, with a statistically significant difference (p>0.01) among the measures investigated. The magnitude and characteristics of exposure to biological fluids poses a problem that could impact personnel health, and it should be addressed institutionally to achieve effective prevention and risk control management.

[Presence of urban rabies in Zulia State, Venezuela. Years 1996-2006]. / Presencia de rabia urbana en el estado Zulia, Venezuela. Años 1996-2006.

Rabies is a zoonotic viral disease and in Zulia State, it constitutes a public health problem of a high social impact, due to the report of cases in human beings. In this study, the presence of urban rabies was determined in Zulia's State and its distribution was identified according to municipalities and affected species during 1996-2006. In the scope of a descriptive study, a documented revision of Zulia's State Zoonosis Regional Coordination registries for the period in study was carried out. A total occurrence of 1.033 rabies cases was observed, 1.017 were in animals and 16 in human beings. The biggest incidences were for Maracaibo (31.40%) and San Francisco (15.68%) municipalities. The type of predominant rabies was the urban one; the principal reservoir and transmitter was the canine one (91.60%). Of the reported cases in human beings, the biggest incidence was in in Maracaibo Municipality (37.5%) and the most affected age group was <15 years (81.2%). A low percentage in the coverage of vaccination was presented (33%). A high incidence of rabies is demonstrated in Zulia's State in spite of this being a preventable immune disease. A positive correlation was determined between the number of admissions and cases (rs=0.948 P<0.01). It is necessary to implement an effective control of the sources of infection and to support a minimal coverage of vaccination of 80% in canines and furthermore, to implement community education programs, to diminish the risk of infection and the occurrence of cases.