Psychological Health of Surgeons in a Time of COVID-19: A Global Survey.

OBJECTIVE: To assess the degree of psychological impact among surgical providers during the COVID-19 pandemic. SUMMARY OF BACKGROUND DATA: The COVID-19 pandemic has extensively impacted global healthcare systems. We hypothesized that the degree of psychological impact would be higher for surgical providers deployed for COVID-19 work, certain surgical specialties, and for those who knew of someone diagnosed with, or who died, of COVID-19. METHODS: We conducted a global web-based survey to investigate the psychological impact of COVID-19. The primary outcomes were the depression anxiety stress scale-21 and Impact of Event Scale-Revised scores. RESULTS: A total of 4283 participants from 101 countries responded. 32.8%, 30.8%, 25.9%, and 24.0% screened positive for depression, anxiety, stress, and PTSD respectively. Respondents who knew someone who died of COVID-19 were more likely to screen positive for depression, anxiety, stress, and PTSD (OR 1.3, 1.6, 1.4, 1.7 respectively, all P < 0.05). Respondents who knew of someone diagnosed with COVID-19 were more likely to screen positive for depression, stress, and PTSD (OR 1.2, 1.2, and 1.3 respectively, all P < 0.05). Surgical specialties that operated in the head and neck region had higher psychological distress among its surgeons. Deployment for COVID- 19-related work was not associated with increased psychological distress. CONCLUSIONS: The COVID-19 pandemic may have a mental health legacy outlasting its course. The long-term impact of this ongoing traumatic event underscores the importance of longitudinal mental health care for healthcare personnel, with particular attention to those who know of someone diagnosed with, or who died of COVID-19.

¿Cómo se muestra la actividad de las enfermeras por las Consejerías de Salud? / How is the nursing activity shown by the Spanish regional health ministries?

Objetivo: Analizar los indicadores de enfermería y los resultados de su actividad publicados por las Consejerías de Salud de las comunidades autónomas. Método: Estudio observacional descriptivo por 2 observadores con buscadores web localizando las memorias de actividad de las organizaciones sanitarias autonómicas. Para cada página web institucional se evaluó la existencia de información de actividad relacionada con «enfermería/enfermera/matrona». Se analizaron los indicadores de resultados asistenciales, de calidad y seguridad clínica y su presentación. Resultados: Configuración de listado de 19 entradas de servicios públicos de salud con los indicadores específicos de actividad enfermera de cada uno, partiendo de 56 webs institucionales analizadas. El perfil de indicadores más frecuentes resultante es: actividad mostrada desagregada por áreas de salud, de 2019, en «PDF», sin visión de género ni de edad, centrados en el número de consultas, frecuentación y presión asistencial en atención primaria. Conclusiones: La oferta de indicadores sanitarios presenta una gran variabilidad estatal. Se puede valorar los aportes cualitativos y cuantitativos autonómicos, centrados más en la estructura, en medir la actividad para la gestión y en el nivel de la atención primaria, pero con un escaso enfoque en la medición de buenas prácticas. Se confirma que la información publicada no refleja la realidad de la actividad enfermera, siendo llamativa la deficiencia de indicadores a nivel hospitalario.(AU)

Objective: To analyse the nursing records and the results of their activity published by the Spanish regional health ministries. Method: Descriptive observational study by two observers with web search engines locating the activity reports of the regional health organizations. The existence of activity information related to «nursing/nurse/midwife» was evaluated for each institutional web page. The indicators of care results, quality and clinical safety and their presentation were analysed. Results: Preparation of a table including 19 public health services entries with specific indicators/records of nursing activity for each one, based on 56 institutional websites. The most frequently resulting profile of indicators is activity shown disaggregated by health areas, from 2019, in «PDF» format, without gender or age vision, focused on the number of consultations, frequentation and healthcare pressure in primary care. Conclusions: The supply of health indicators presents a great state variability. Regional qualitative and quantitative contributions can be valued, focused more on structure, on measuring activity for management and at the level of primary care but with little focus on measuring good practices. It is confirmed that the published information does not reflect the reality of nursing activity. Being striking the deficiency of hospital activity indicators.(AU)

How is the nursing activity shown by the Spanish regional health ministries?

OBJECTIVE: To analyse the nursing records and the results of their activity published by the Spanish regional health ministries. METHOD: Descriptive observational study by two observers with web search engines locating the activity reports of the regional health organizations. The existence of activity information related to "nursing/nurse/midwife" was evaluated for each institutional web page. The indicators of care results, quality and clinical safety and their presentation were analysed. RESULTS: Preparation of a table including 19 public health services entries with specific indicators/records of nursing activity for each one, based on 56 institutional websites. The most frequently resulting profile of indicators is activity shown disaggregated by health areas, from 2019, in "PDF" format, without gender or age vision, focused on the number of consultations, frequentation and healthcare pressure in primary care. CONCLUSIONS: The supply of health indicators presents a great state variability. Regional qualitative and quantitative contributions can be valued, focused more on structure, on measuring activity for management and at the level of primary care but with little focus on measuring good practices. It is confirmed that the published information does not reflect the reality of nursing activity. Being striking the deficiency of hospital activity indicators.

Higher HLA class I expression in renal cell carcinoma than in autologous normal tissue.

A total of 93 frozen primary renal cell carcinoma (RCC) samples and 31 frozen samples of corresponding normal renal tissue were analyzed for human leukocyte antigen (HLA) class I and HLA-DR expression. Unexpectedly, HLA class I expression was much higher on RCC cells than on normal renal tubular cells. Immunohistochemistry analysis of frozen and paraffin-embedded tissue samples, applying an extended panel of specific anti-HLA monoclonal antibodies, showed elevated HLA class I antigen expression in 95.6% of the tumors vs only 12.9% of normal renal tissues. These findings were confirmed by molecular analysis of HLA heavy chain and beta2-microglobulin (beta2m) transcription levels using quantitative real-time polymerase chain reaction (PCR) on microdissected tissue samples (isolated tumor nests and autologous normal renal tubules) from four patients. These results might help to explain the relatively high success rate of immunotherapy in patients with RCC. The molecular mechanism underlying the increased HLA class I expression in RCC has yet to be elucidated.

Open partial nephrectomy in renal cancer: a feasible gold standard technique in all hospitals.

Introduction. Partial nephrectomy (PN) is playing an increasingly important role in localized renal cell carcinoma (RCC) as a true alternative to radical nephrectomy. With the greater experience and expertise of surgical teams, it has become an alternative to radical nephrectomy in young patients when the tumor diameter is 4 cm or less in almost all hospitals since cancer-specific survival outcomes are similar to those obtained with radical nephrectomy. Materials and Methods. The authors comment on their own experience and review the literature, reporting current indications and outcomes including complications. The surgical technique of open partial nephrectomy is outlined. Conclusions. Nowadays, open PN is the gold standard technique to treat small renal masses, and all nonablative techniques must pass the test of time to be compared to PN. It is not ethical for patients to undergo radical surgery just because the urologists involved do not have adequate experience with PN. Patients should be involved in the final treatment decision and, when appropriate, referred to specialized centers with experience in open or laparoscopic partial nephrectomies.

Analysis of the expression of HLA class I, proinflammatory cytokines and chemokines in primary tumors from patients with localized and metastatic renal cell carcinoma.

Changes in the human leukocyte antigen (HLA) class I expression and cytokine and chemokine production both by cancer cells and by normal surrounding tissue are believed to be responsible for immune escape and tumor progression. In this study, we compared the tumor expression levels of HLA heavy chain (HLAhc), beta-2-microglobulin (beta2m), chemokines (Interferon-gamma-inducible Protein-10 (IP-10), Interferon-inducible T-cell Alpha-Chemoattractant (I-TAC), Stromal cell-Derived Factor-1 (SDF-1), Macrophage Inflammatory Protein-1-alpha (MIP-1-alpha) and Regulated upon Activation, Normally T-Expressed, and presumably Secreted (RANTES)) and cytokines (Vascular Endothelial Growth Factor (VEGF), Interferon-gamma (IFN-gamma), Interleukin-10 (IL-10), Tumor Growth Factor-beta (TGB-beta)) in primary tumors and adjacent normal tissues from patients with localized and metastatic renal cell carcinoma (RCC) using a quantitative real-time polymerase chain reaction technique. We report that the expression of HLAhc, beta2m and the studied cytokines and chemokines (except for SDF-1) was significantly higher in the tumor (29 samples) than in the normal tissue (14 samples). When we compared the tumor expression levels between patients with localized RCC and patients with advanced metastatic stage, we found that the messenger RNA expression levels of HLAhc and beta2m were much lower in patients with metastatic RCC (6 cases) than in patients with localized cancer (23 cases), with levels similar to those in normal tissue. This was also confirmed on a protein level by immunohistological labeling of tumor tissues. Thirty-nine percent of the analyzed RCC tumors showed partial loss of HLA class I molecules, while 6% of the tumors showed HLA class I total loss. The expression of IP-10, SDF-1 and VEGF-c was also significantly lower in patients with advanced tumor, while the IFN-gamma expression in metastatic RCC was not detectable. Our findings show that primary RCC tumors are characterized by a high expression of HLAhc and a presence of proinflammatory mediators and chemokines. We also observed that disease progression and development of metastasis in RCC are associated with decreased expression of HLAhc, beta2m, IP-10, SDF-1 and IFN-gamma. This microenvironment may suppress the cytotoxic response, creating conditions that favor tumor escape and cancer progression.

Urinary tract infections and lupus erythematosus.

BACKGROUND: Infections are one of the main causes of morbidity and mortality in patients with systemic lupus erythematosus. OBJECTIVE: To analyse urinary tract infection (UTI) risk factors in lupus patients; the influence of these factors on disease activity, organ damage, and disease development; the type and prevalence of UTI; and the micro-organisms involved. METHOD: 86 control subjects and 81 lupus patients were studied prospectively over a 12 month period and examined on five occasions. Epidemiological data and information on urinary symptoms, disease activity (SLEDAI), and organ damage (SLICC/ACR) data were collected. Autoantibodies, complement levels, urine culture, and antibiogram were determined; urological studies were also carried out. SPPS 10.0 and STATA 6.0. were used for statistical analysis. RESULTS: The prevalence of UTI in lupus patients was 36%. Lupus influences the onset of UTI (p = 0.001), regardless of other variables. UTI risk factors in lupus patients were age (p = 0.002), previous cases of UTI (p = 0.0001), antinuclear antibodies (ANA) >1/80 IU/ml (p = 0.022), thrombocytopenia (p = 0.02), and admission to hospital due to UTI (p = 0.002). Leucopenia (p = 0.09) and the weekly administration of methotrexate (p = 0.06) had a bearing on the onset of UTI; disease development (p = 0.99), lupus activity (p = 0.32), and organ damage (p = 0.36) do not. The uropathogen most frequently isolated was E coli (60%). CONCLUSIONS: Lupus patients are likely to have UTI, usually manifesting in the lower tract. They are community acquired, basically caused by E coli, and favoured by age, previous UTI, admissions to hospital due to UTI, thrombopenia, ANA, leucopenia, and methotrexate treatments.

HLA class I expression in bladder carcinomas.

HLA class I molecules are frequently lost in a large variety of human carcinomas, possibly because of T-cell immune selection of major histocompatibility complex class I deficient tumor variants. We report that this phenomenon is also a frequent event in bladder carcinomas. Of a total of 72 bladder carcinomas, 72% of the tumors had at least one alteration in HLA class I expression. These altered HLA class I phenotypes were classified as total HLA class I loss (25%; phenotype I); HLA-A or/and HLA-B locus-specific loss (12%; phenotype III); and HLA class I allelic loss (35%; phenotype II or IV). Comparison of histopathological parameters with HLA class I expression showed a statistically significant relationship with the degree of differentiation and tumor recurrence.

Estado actual de la inmunoterapia en el cáncer renal diseminado / State of the art of immunotherapy for disseminated renal cancer

Se presenta una revisión acerca de las perspectivas terapéuticas actuales en el manejo del carcinoma renal diseminado, con especial hincapié en las diversas formas de inmunoterapia. Los tratamientos basados en quimioterapia y hormonoterapia no han aportado resultados efectivos. A partir de la década de los 70 se han desarrollado terapias inmunológicas, modificadoras de la respuesta biológica del individuo, con éxito variable según pautas y dosis. Se trata de terapias con intención paliativa, que en un porcentaje importante de casos (entre el 15 y el 40 per cent) alcanzan respuestas objetivas parciales o incluso completas, y en ocasiones duraderas. Esta revisión presenta la evolución histórica de las diversas modalidades de inmunoterapia y los resultados descritos para cada una de ellas. La secuencia temporal ha llevado a plantear modalidades que combinen estrategias, a la par que intenten reducir la toxicidad. En este sentido se presenta la bioquimioterapia y la administración de inmunoterapia mixta por vía subcutánea como las opciones más atractivas. Se destacan los criterios clínicos que predicen la buena respuesta a dichas terapias y se describen las complicaciones del tratamiento. También se describen las complicaciones del tratamiento. También se revisan las opciones terapéuticas más complejas (inmunoterapia mixta e inmunoterapia génica) reservadas a los centros que desarrollan terapias experimentales, en el contexto de ensayos clínicos que permitan obtener en un futuro información de relevancia clínica (AU)

Neuropsychological long-term sequelae of perinatal asphyxia.

OBJECTIVE: To investigate the long-term neuropsychological consequences of perinatal asphyxia (PA). METHODS: A group of adolescents were assessed with antecedents of mild (n = 8) and moderate (n = 20) PA, and a matched group of 28 healthy adolescents as a control group. Neuropsychological assessment included tests of memory, perceptual-motor skills, and frontal lobe functions, because these are areas of cognitive functioning susceptible to hypoxic conditions. RESULTS: Subjects with moderate PA showed significant differences from the control group on tests related to delayed recall for both verbal and visual information, perceptual-motor speed, and tests assessing attention and executive functions. Conversely, subjects in the mild PA group exhibited scores which were similar to those of the control group in all the assessed variables. CONCLUSION: The present findings demonstrate that subtle but persistent neuropsychological deficits were observed in adolescents with antecedents of moderate PA, but not in those classified with mild asphyxia.

(1)H-MR spectroscopy is sensitive to subtle effects of perinatal asphyxia.

The authors performed neuropsychological and (1)H-MRS studies in 18 subclinical patients with antecedents of perinatal asphyxia (PA) and in 18 matched control subjects. Patients with PA showed reduced values of N-acetylaspartate (NAA) in both the basal ganglia and the midtemporal region (MTR) and reduced NAA/choline values in the MTR. Neuropsychological testing showed group differences in tasks related to attention and memory. These results indicate persistent dysfunctions in cerebral structures vulnerable to hypoxia and demonstrate the utility of MRS for the long-term evaluation of cerebral sequelae of neonatal asphyxia.

[Psychogenic urinary retention. Diagnostic-therapeutic approach]. / Retención urinaria de origen psicógeno. Actitud diagnóstico-terapéutica.

OBJECTIVE: The influence of psychogenic factors on voiding generally manifests as an irritative syndrome and rarely in the form of acute or chronic urinary retention. The diagnosis and treatment of this uncommon urological pathology are reviewed and our experience is presented. METHODS: We conducted a retrospective study on 5 patients with psychogenic urinary retention (3 males and 2 females), aged 20 to 28 years (mean age 23.4), that had been treated at our urological services over the last 6 years. Three patients (2 males and 1 female) had a history of depression, one patient had a somatic form of disorder (mimicking) and one patient was diagnosed as having schizophrenia one year after he had presented with urinary retention. The physical and neurological examinations were normal in all 5 patients and the radiological evaluation was normal in all but one patient who had bilateral hydronephrosis. The pressure/flow test disclosed absence of detrusor muscle contraction in all 5 patients; 3 had incomplete voiding by abdominal pressure and had more than 500 ml residual urine. All patients received psychiatric therapy, and intermittent catheterization and urinary rehabilitation until residual urine less than 100 ml was achieved. CONCLUSIONS: The importance of the urodynamic study in the diagnosis of this condition is underscored. Definitive diagnosis can only be established after discarding other pathologies. The initial treatment must always be conservative; irreversible surgical procedures must not be performed. Treatment is by intermittent catheterization, urinary rehabilitation and supportive psychiatric therapy.

[Xanthogranulomatous pyelonephritis in renal allograft. Report of a case and review of the literature]. / Pielonefritis xantogranulomatosa en un aloinjerto renal. Presentación de un caso y revisión de la literatura.

Clinic report case of a kidney-transplanted female who, after one year of normal functioning, developed xantogranulomatous pyelonephritis in the renal allograft. Clinical presentation was mesorenal tumoration causing pyelocaliecstasis, which coincided with a progressive decline of renal function due to interstitial rejection. Diagnosis by eco-doppler imaging, CAT, arteriography, renogram and descending pyelography were non-specific in relation to the process benignant or malignant nature. Surgical examination with obtention of biopsy was not conclusive with regard to diagnosis and so, during a second surgery, transplanctectomy was chosen. The histological examination showed that the expansive process of the allograft corresponded to a case of xantogranulomatous pyelonephritis. After reviewing the existing literature, only 4 cases were found reporting this rare condition in a renal allograft.

[Ureteral obstruction caused by periureteral venous dilatation secondary to infrarenal caval obstruction]. / Obstrucción ureteral por dilatación venosa periureteral secundaria a obstrucción de la cava infrarrenal.

Presentation of a case report of a female patient with single right kidney and background of left nephrectomy 21 years earlier due to hypertension who presented to the clinic after an episode of oliguria with lower limbs oedema and renal failure. Renal ultrasound evidenced moderate hydronephrosis, and backward pyelography showed medialization and lumbar ureter compression. CAT examination confirmed the ureteropyelocalycectasis as well as the reduction of the infrarenal lower cava vein to a fibrous cord with internal calcification. Axillary cavography and venography through both femorals demonstrated absence of the infrarenal cava vein segment and existence of a large replacement venous network. During surgery it became evident that the latter was displacing a retrovenous right lumbar ureter medially. Ureterolysis and ureter section with transposition, and termino-terminal anastomosis were performed. The morphological and functional results were excellent with recovery of the renal function (normal serum creatinine) which is still maintained after 7 years follow-up. As a consequence of this case, a review was made of different cava vein anomalies with repercussion in the urine excretory tract.

[A sickness called unemployment: a long-term unemployment. Association of Community Development (ACD)]. / Una enfermedad llamada paro: la trastienda del desempleo del larga duración. Asociación para el Desarrollo Comunitario (ADC).

OBJECTIVES: The general objective of this investigation is to know the possible consequences of long-term unemployment on the family and social environment, as well as the mechanisms which lead to the appearance of health problems among long-term unemployed people. METHODS: The subjects of this study were long-term unemployed people of 35 to 55 years of age of the municipal term of Madrid, with families depending on them. This is a qualitative-intensive investigation, with special emphasis on the individual, social, sanitary and economical aspects. The instrument of common measurement was the combination of the discussion group integrated by five people, during approximately 120 minutes, with focused and individual interviews (48) over a semistructured script, during approximately 60 minutes, using recording instruments (audio tape). RESULTS: During the development of the discussion group a worsening of the psychological health and family situation was observed as a consequence of remaining unemployed. In the more thorough interviews we could detect clear differences according to the impact of unemployment on health depending on the low socioeconomical area, women and older unemployed people. CONCLUSIONS: The effects of unemployment on health cannot be isolated from other underlying bad social and economical conditions, that is to say, from social, economical, educative inequalities, etc., previous to the unemployment situation.

[Clinical impact of idiopathic bladder instability]. / Repercusiones clínicas de la inestabilidad vesical idiopática (I.V.I.).

Idiopathic vesical instability (I.V.I.), defined as the detrusor's spontaneous contraction during vesical filling or at its end, with a pressure higher than 15 cm H2O, is a urodynamic concept of unknown origin related to clinical disorders such as urinary incontinence, urgency-frequency syndrome, vesicoureteral reflux, repeat urinary infections, upper urological diseases due to pseudo-obstruction and morphological changes in vesicourethral X-rays. From January 1988 to January 1994, 2500 patients have been urodynamically examined. In 24% cases the diagnosis arrived at was vesical instability, 72% of them being I.V.I. I.V.I. was present as single diagnosis in 53% of prostate post-surgical incontinence, 71% of enuresis, 11% of clinically labelled stress incontinence, 46% of non-subsidiary incontinence, 16% of patients examined for prostatism, 55% of vesicoureteral reflux and 59% of repeat urinary infections.

[Antimicrobial prophylaxis in urethrocystoscopy. Comparative study]. / Profilaxis antimicrobiana en uretrocistoscopias. Estudio comparativo.

Instrumentation of lower urinary tract is a predisposing factor for the development of urinary infection. Incidence of infective complications following urethrocystoscopy has been evaluated in a multicenter, prospective, comparative and randomized study in 2,284 patients, who had a previous negative urine culture. Patients were randomized into two groups: one to be used as control and the other one to received antimicrobial prophylaxis prior to instrumentation (ceftriazone, 1 gr intramuscular). Clinical and microbiological responses were evaluated at 48-72 hours and 4 weeks after cystoscopy. Symptomatic bacteriuria was observed in 10.2% of patients in the control group and in 2.5% in the prophylaxis group (p < 0.000); asymptomatic bacteriuria in 3.02% and 1.52% (p > 0.05) and irritative syndrome with sterile urine in 2.93% and 2.60% (p > 0.05), respectively. Thus, the use of prophylaxis reduced the incidence of infective complications in these patients.

Abnormal local-circuit neurons in epilepsia partialis continua associated with focal cortical dysplasia.

A limited cortical resection including the rolandic fissure and the pre- and postcentral cortical regions was carried out in a patient suffering from epilepsia partialis continua resistant to antiepileptic drugs. The histological examination revealed several foci of very large neurons distributed with no laminar organization in the depth of the rolandic fissure and in the crown of the primary motor and primary somatosensory areas; these lesions were consistent with focal cortical dysplasia. In addition, decreased numbers of neurons, astrocytosis and proliferation of capillaries, compatible with chronic tissue necrosis, were found in the inferior regions of the banks of the rolandic fissure. Subpopulations of local-circuit neurons were examined with parvalbumin, calbindin D-28k and somatostatin immunocytochemistry. Focal areas of cortical dysplasia contained abnormal immunoreactive neurons. Huge parvalbumin-immunoreactive cells were distributed at random and resembled axo-axonic (chandelier) and basket neurons. Abnormal calbindin D-28k-immunoreactive cells were reminiscent of double-bouquet neurons and multipolar cells. Very large somatostatin-immunoreactive cells were seldom observed in the dysplastic foci. On the other hand, areas of tissue necrosis displayed massive reduction of immunoreactive cells and fibers. Abnormalities in the morphology and distribution of local-circuit (inhibitory) neurons observed here for the first time in focal cortical dysplasia may have a pivotal role in the appearance and prolongation of electrical discharges and continuous motor signs in human focal epilepsy.