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.

Cancer centers of excellence for the multidisciplinary management of urologic cancers The intersection between education, research, and healthcare.

Urologic cancers are among the leading causes of morbidity and mortality in the world, representing more than 10% of the total number of new cancer cases worldwide. These complex diseases are linked to several issues related to their diagnosis, management, monitoring, and treatment - issues that require multidisciplinary solutions that encompass and manage patients as complex entities. In response to this, the so-called cancer centers of excellence (CCEs) emerged, defined as multidisciplinary institutions specialized in the diagnosis, management, monitoring, and treatment of specific diseases, including cancer. Different institutions, such as the European Association of Urology (EAU), have proposed and encouraged its consolidation, especially for the management of prostate cancer. These institutions must be composed of three areas: healthcare, education, and research, which have complementary interactions and relationships, stimulating research and problem-solving from a multidisciplinary approach and also covering elements of basic science and mental health. The implementation of these CCEs has generated positive results; therefore, it is necessary to stimulate their implementation with a uro-oncologic approach.

Implications of using conversational robots (chatbots) in uro-oncology: A patient and physician perspective.

Chatbots, or conversational robots, have become a strategy or support tool for urologic patient care, diagnostic communication, and treatment. With regard to patients, studies have shown that chatbots can answer medical questions with similar percentages of acceptability as urologists. In addition, they can contribute to patient education, allowing them to ask questions that do not arise during medical consultation. They have also proven to be good tools for health promotion and disease prevention. These benefits can also serve doctors, as robots can support medical consultation and the reading of medical records, making patient care more efficient; however, there are several limitations, including the accuracy of bot-generated answers and the acceptability that urologists give to this type of tool.

Effectiveness of the pharmacological therapy to prevent post ERCP acute pancreatitis: a network meta-analysis.

OBJECTIVE: To determine the effectiveness of the different pharmacological agents in preventing post-ERCP acute pancreatitis. METHODS: We included clinical trials of pharmacological interventions for prophylaxis of acute post-ERCP pancreatitis. The event evaluated was acute pancreatitis. We conducted a search strategy in MEDLINE (OVID), EMBASE, and Cochrane Central Register of Controlled Trials from inception to nowadays. We reported the information in terms of relative risks (RR) with a 95% confidence interval. We assessed the heterogeneity using the I2 test. RESULTS: We included 84 studies for analysis (30,463 patients). The mean age was 59.3 years (SD ± 7.01). Heterogeneity between studies was low (I2 = 34.4%) with no inconsistencies (p = 0.2567). Post ERCP pancreatitis was less in prophylaxis with NSAIDs (RR 0.65 95% CI [0.52 to 0.80]), aggressive hydration with Lactate Ringer (RR 0.32 95% CI [0.12-0.86]), NSAIDs + isosorbide dinitrate (RR 0.28 95% CI [0.11-0.71]) and somatostatin and analogues (RR 0.54 [0.43 to 0.68]) compared with placebo. CONCLUSIONS: NSAIDs, the Combination of NSAIDs + isosorbide dinitrate, somatostatin and analogues, and aggressive hydration with lactate ringer are pharmacological strategies that can prevent post-ERCP pancreatitis when compared to placebo. More clinical trials are required to determine the effectiveness of these drugs.

Urethral cancer: a comprehensive review endorsed by the Global Society of Rare Genitourinary Tumours.

OBJECTIVE: To determine the effectiveness and adverse effects of urethrectomy alone or as part of multimodal therapy (MMT). METHODS: A comprehensive search was conducted across MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) databases, from their inception to the present date. The study cohort comprised individuals aged 16 years and older diagnosed with urethral tumours at any stage who underwent either isolated urethrectomy or urethrectomy as an integral component of MMT. RESULTS: Ninety-two studies comprising 25 480 patients met the inclusion criteria. Surgical outcomes for urethral cancer vary considerably, with 5-year overall survival (OS) ranging from 10% to 68% based on disease extent, approach, and gender. Radiotherapy (RT) alone provides 5-year OS of approximately 40%. Combined regimens provide better outcomes compared to single modalities, including reduced recurrence and enhanced survival. However, trimodal therapy showed survival benefits only for urothelial subtypes, indicating the need to tailor management according to cancer type. MMT with neoadjuvant chemotherapy prior to surgery demonstrated the most consistent survival gains. CONCLUSIONS: The management of urethral cancer demands a nuanced, personalised approach, accounting for factors such as tumour location, sex, and tumour stage. MMT combining surgery, chemotherapy and RT has shown the ability to enhance outcomes in advanced disease. More extensive collaborative studies through specialised centres are imperative to advance evidence-based protocols and refine treatment in order to improve survival.

Metabolomics for the diagnosis of bladder cancer: A systematic review.

Objective: Metabolomics has been extensively utilized in bladder cancer (BCa) research, employing mass spectrometry and nuclear magnetic resonance spectroscopy to compare various variables (tissues, serum, blood, and urine). This study aimed to identify potential biomarkers for early BCa diagnosis. Methods: A search strategy was designed to identify clinical trials, descriptive and analytical observational studies from databases such as Medline, Embase, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Literature in Health Sciences. Inclusion criteria comprised studies involving BCa tissue, serum, blood, or urine profiling using widely adopted metabolomics techniques like mass spectrometry and nuclear magnetic resonance. Primary outcomes included description of metabolites and metabolomics profiling in BCa patients and the association of metabolites and metabolomics profiling with BCa diagnosis compared to control patients. The risk of bias was assessed using the Quality Assessment of Studies of Diagnostic Accuracy. Results: The search strategy yielded 2832 studies, of which 30 case-control studies were included. Urine was predominantly used as the primary sample for metabolite identification. Risk of bias was often unclear inpatient selection, blinding of the index test, and reference standard assessment, but no applicability concerns were observed. Metabolites and metabolomics profiles associated with BCa diagnosis were identified in glucose, amino acids, nucleotides, lipids, and aldehydes metabolism. Conclusion: The identified metabolites in urine included citric acid, valine, tryptophan, taurine, aspartic acid, uridine, ribose, phosphocholine, and carnitine. Tissue samples exhibited elevated levels of lactic acid, amino acids, and lipids. Consistent findings across tissue, urine, and serum samples revealed downregulation of citric acid and upregulation of lactic acid, valine, tryptophan, taurine, glutamine, aspartic acid, uridine, ribose, and phosphocholine.

Cancer centers of excellence for the multidisciplinary management of urologic cancers: The intersection between education, research, and healthcare.

Urologic cancers are among the leading causes of morbidity and mortality in the world, representing more than 10% of the total number of new cancer cases worldwide. These complex diseases are linked to several issues related to their diagnosis, management, monitoring, and treatment - issues that require multidisciplinary solutions that encompass and manage patients as complex entities. In response to this, the so-called cancer centers of excellence (CCEs) emerged, defined as multidisciplinary institutions specialized in the diagnosis, management, monitoring, and treatment of specific diseases, including cancer. Different institutions, such as the European Association of Urology (EAU), have proposed and encouraged its consolidation, especially for the management of prostate cancer. These institutions must be composed of three areas: healthcare, education, and research, which have complementary interactions and relationships, stimulating research and problem-solving from a multidisciplinary approach and also covering elements of basic sciences and mental health. The implementation of these CCEs has brought positive results; therefore, it is necessary to stimulate their implementation with a uro-oncologic approach.

Perspectives on prostate cancer: advances and pending challenges for a multidisciplinary oncological approach in South America.

Prostate cancer is one of the tumors with the highest incidence and mortality among men worldwide, and this situation is no different in South America. However, epidemiological data are highly variable for each country and even more so than in North America. These data may be influenced by the very low rate of early detection of disease, availability of diagnostic methods, proper data collection, and limited access to specialized multidisciplinary treatment. For many South American countries, academic referral centers can only offer state-of-the-art diagnostics and multidisciplinary cancer treatment for patients who live in or can travel to large cities, so most patients are cared for by non-expert urologists with limited resources, which can have a negative impact on their prognosis and worsen oncologic outcomes. We aimed to show the clinical management of prostate cancer patients, the current advances in management, limitations present in South America, and how a multidisciplinary approach in referral cancer centers conformed of specialized urologists, medical oncologists, and mental health professionals can maximize patient outcomes.

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

Incidence of congenital heart disease in fetuses diagnosed with single isolated umbilical artery. Systematic review and meta-analysis.

OBJECTIVE: To estimate the proportion of heart disease in fetuses with a prenatal diagnosis of a single isolated umbilical artery. METHODS: We performed a search strategy in MEDLINE (OVID), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to the present. We assessed the risk of bias and performed a meta-analysis. We completed the subgroup analysis according to the region. RESULTS: We found 1384 studies by the search strategy. After carefully reviewing the full-text, 15 studies were included. A total of 2008 fetuses with a single isolated umbilical artery were included, and 177 had cardiac malformations. There was an overall incidence of 9% 95%CI (0.05-0.14) I2 90%. The incidence by country of origin was between 5% and 19%. The most common heart disease reported was a ventricular septal defect. Seven studies were found describing 25 cases. We described other malformations, such as tetralogy of Fallot, coarctation of the aorta, and hypoplastic left ventricle, among others. CONCLUSION: The incidence of congenital heart disease in fetuses with a single isolated umbilical artery was high. In addition, half of these correspond to significant heart disease. Based on the above, we suggest that fetuses with a single isolated umbilical artery should have a complete anatomic evaluation emphasizing cardiac evaluation.

Lymphocele Complication After Kidney Transplant: Current Literature Review and Management Algorithm.

Kidney transplant is the best treatment option for patients with end-stage renal disease. It reduces mortality and improves the quality of life. However, kidney transplant presents medical and surgical complications, and one of the most common is the posttransplant lymphocele. Lymphocele complication has an incidence of up to 20% and presents with variable clinical symptoms, which are directly associated with the size and compression effect on the adjacent organs. There are reported risk factors that favor the appearance of lymphocele. Despite known factors, there are more relevant factors (male sex, deceased donor, and corticosteroids) to carry out a stricter follow-up. The treatment of lymphoceles can vary according to the severity of the symptoms, characteristics of the collection, and the patient's clinical status. Despite the high recurrence, percutaneous intervention is the initial approach in this condition. If percutaneous aspiration, drainage, and sclerotherapy are unsuccessful, then open or laparoscopic fenestration can be performed; laparoscopy is the standard of treatment since it is highly effective and has few adverse effects.

Unveiling Disrupted Lipid Metabolism in Benign Prostate Hyperplasia, Prostate Cancer, and Metastatic Patients: Insights from a Colombian Nested Case-Control Study.

Prostate cancer is a significant global health concern, and its prevalence is increasing worldwide. Despite extensive research efforts, the complexity of the disease remains challenging with respect to fully understanding it. Metabolomics has emerged as a powerful approach to understanding prostate cancer by assessing comprehensive metabolite profiles in biological samples. In this study, metabolic profiles of patients with benign prostatic hyperplasia (BPH), prostate cancer (PCa), and metastatic prostate cancer (Met) were characterized using an untargeted approach that included metabolomics and lipidomics via liquid chromatography and gas chromatography coupled with high-resolution mass spectrometry. Comparative analysis among these groups revealed distinct metabolic profiles, primarily associated with lipid biosynthetic pathways, such as biosynthesis of unsaturated fatty acids, fatty acid degradation and elongation, and sphingolipid and linoleic acid metabolism. PCa patients showed lower levels of amino acids, glycerolipids, glycerophospholipids, sphingolipids, and carnitines compared to BPH patients. Compared to Met patients, PCa patients had reduced metabolites in the glycerolipid, glycerophospholipid, and sphingolipid groups, along with increased amino acids and carbohydrates. These altered metabolic profiles provide insights into the underlying pathways of prostate cancer's progression, potentially aiding the development of new diagnostic, and therapeutic strategies.