Which Antibiotic for Urinary Tract Infections in Pregnancy? A Literature Review of International Guidelines.

Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50-60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important and management guidelines have been published worldwide to assist physicians in selecting the right antibiotic for each patient, taking into account the maternal and fetal safety profile. A review of the literature was carried out and all international guidelines giving recommendations about antibiotic treatments for pregnancy-related UTI were selected. The search came back with 13 guidelines from 4 different continents (8 from Europe, 3 from South America, 1 from North America and 1 from Oceania). Our review demonstrated concordance between guidelines with regard to several aspects in the antibiotic treatment of UTI during pregnancy and in the follow-up after treatment. Nonetheless, there are some areas of discordance, as in the case of antenatal screening for bacteriuria and the use of fluoroquinolones in lower or upper UTI. Given the current evidence that we have from international guidelines, they all agree on several key points about antibiotic use.

Guía de práctica clínica para el tratamiento quirúrgico de pacientes con urolitiasis en el Seguro Social del Perú (EsSalud) / Clinical practice guideline for the surgical treatment of patients with urolithiasis for the Peruvian Social Security (EsSalud)

Introducción. El presente artículo resume la guía de práctica clínica (GPC) para el tratamiento quirúrgico de pacientes con urolitiasis en el Seguro Social del Perú (EsSalud). Objetivo. Proveer recomendaciones clínicas basadas en evidencias para la para el tratamiento quirúrgico de los pacientes con urolitiasis en EsSalud. Método. Se conformó un grupo elaborador de la guía (GEG) constituido por médicos urólogos y metodólogos, los cuales formularon las preguntas clínicas que fueron respondidas dentro de la presente GPC. Para cada una de estas preguntas se realizó búsquedas de revisiones sistemáticas y de estudios primarios (cuando se consideró pertinente) en PubMed durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas, posteriormente se evaluó la certeza de la evidencia usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Se programaron reuniones de trabajo periódicas en las cuales el GEG revisó la evidencia y formuló recomendaciones, puntos de buenas prácticas clínicas y flujogramas usando la metodología GRADE. La GPC fue aprobada con Resolución N° 66- IETSI-ESSALUD-2018. Resultados. Se abordó 6 preguntas clínicas sobre el tema de tratamiento quirúrgico en urolitiasis. En base a dichas preguntas se formularon 5 recomendaciones (2 recomendaciones fuertes y 3 recomendaciones condicionales), 21 puntos de buena práctica clínica, y 3 flujogramas de manejo. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el tratamiento quirúrgico de pacientes con urolitiasis en EsSalud.

Introduction. This article summarizes the clinical practice guide (CPG) for the surgical treatment of patients with urolithiasis in the Social Security of Peru (EsSalud). Objective. To provide clinical recommendations based on evidence for the surgical treatment of patients with urolithiasis in EsSalud. Method. A guideline group (GEG) constituted by urologists and methodologists was formed, who formulated the clinical questions that were answered within the present CPG. For each of these questions systematic searches of systematic reviews and primary studies (when considered pertinent) were carried out in PubMed during 2018. The evidence was selected to answer each one of the clinical questions posed, later the certainty was evaluated of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Regular work meetings were scheduled, in which the GEG reviewed the evidence and made recommendations, points of good clinical practice, and flow charts; using the GRADE methodology. The CPG was approved with Resolution No. 66-IETSI-ESSALUD-2018. Results. Six clinical questions on the subject of surgical treatment in urolithiasis were addressed. Based on these questions, 5 recommendations were formulated (2 strong recommendations and 3 conditional recommendations), 21 points of good clinical practice, and 3 management flow charts. Conclusion. This article summarizes the methodology and conclusions based on evidence from the CPG for the surgical treatment of patients with urolithiasis in EsSalud.

Case Report: Penile necrosis associated to paraphimosis with calciphylaxis due to terminal chronic kidney disease.

Background: Penile necrosis is a rare condition that may present in patients with diabetes mellitus or chronic kidney disease (CKD). The recommended treatment is controversial. We report a case of penile necrosis in a diabetic patient caused by episode of paraphimosis associated with uremic arteriopathy treated with partial amputation. Clinical Case: A 53-year-old male with a background of arterial hypertension, diabetes mellitus and CKD in hemodialysis. The patient presented with paraphimosis and glans necrosis. An emergency circumcision was carried out. A doppler ultrasound found fluid collection in the left corpus cavernosum, parietal vascular calcifications and vascular insufficiency in the corpus cavernosum that suggested necrosis. A partial amputation of the penis was carried out. After three years of follow-up, the outcome has remained favorable. Conclusions: Penile necrosis is a rare but serious complication of terminal CKD. In these patients, systemic calciphylaxis is usually observed. The main take-away lesson is that a multidisciplinary approach is necessary.

Alteraciones hematológicas en pacientes pediátricos con tuberculosis pulmunar y extrapulmonar en el Instituto Nacional de Salud del Niño en el año 2010 / Haematological Disorders in pediatric patients with extrapulmonary tuberculosis pulmunar and at the National Institute of Child Health in the year 2010

INTRODUCCIÓN: La tuberculosis es una patología infecciosa de importante prevalencia en la población infantil, siendo de mayor frecuencia hasta los 4 años. En la actualidad hay un incremento de los casos de enfermedad extrapulmonar. La mayoría de pacientes no manifiesta mayores alteraciones hematológicas. A pesar de ello, en la tuberculosis crónica pueden tener alteraciones hematológicas. OBJETIVO: Determinar la prevalencia de las alteraciones hematológicas presentadas en pacientes pediátricos hospitalizados con tuberculosis pulmonar y/o extrapulmonar. MATERIALES Y MÉTODOS: Tipo de estudio descriptivo, observacional, retrospectivo. Se incluyeron a pacientes con diagnóstico de tuberculosis pulmonar y/o extrapulmonar hospitalizados en el INSN durante el año 2010 que tengan menos de 18 años. Se consignó la frecuencia de las alteraciones hematológicas. RESULTADOS: El grupo etario prevalente fue el de los púber (30 por ciento). El sexo masculino predominó (57 por ciento)...

INTRODUCTION: Tuberculosis is a frequent infection in pediatric patients, with a maximum incidence before 4 years of age. Nowadays there has been an increase in extrapulmonary cases. The majority of patients do not show hematological alterations, however, these are more frequent in chronic cases. OBJECTIVES: To determine the prevalence of hematological abnormalities in hospitalized patients with tuberculosis. METHODS: This was a descriptive, observational and retrospective study, including patients with pulmonary and/or extrapulmonary tuberculosis hospitalized in the INSN during 2010 and younger than 18. We recorded the frequencies of hematological alterations in these patients. RESULTS: The most frequent age group included in the investigation comprehended patients between 14 and 16 years of age (30 per cent). There were more male than female patients (57 per cent were males)...