Sparing confirmatory testing in primary aldosteronism (SCIPA): a multicenter retrospective diagnostic accuracy study.

BACKGROUND: The diagnosis of primary aldosteronism (PA) is comprehensive, which includes case-detection testing, case confirmation followed by subtype classification. In certain instances, such as in the setting of spontaneous hypokalemia, suppressed renin activity (PRA) plus plasma aldosterone concentration (PAC) of > 15 ng/dL, one may not proceed with confirmatory tests. However, the quality of evidence behind this approach is very low. This study sought to evaluate the proposed "simplified confirmatory pathway" that can spare confirmatory testing for primary aldosteronism by evaluating the diagnostic performances of the various pre-specified PAC thresholds in combination with findings of suppressed renin and spontaneous hypokalemia. METHODS: This is a multi-center, retrospective diagnostic accuracy cohort-selected cross-sectional study. A total of 133 participants aged 18 years and above underwent saline infusion test between January 2010 to March 2024. The outcome measures comprise of the diagnostic performances of the different index test combinations (baseline PAC, baseline PRA and presence of spontaneous hypokalemia): sensitivity, specificity, negative predictive value, positive predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic accuracy. Data analysis was performed using SPSS 29.0.1.0 & MedCalc 20.218. RESULTS: Of the 133 patients who underwent saline infusion test, 88 (66.17%) were diagnosed with PA. A PAC of > 25 ng/dL plus PRA < 1.0 ng/dL/hr with spontaneous hypokalemia showed the highest specificity at 100% (95% CI 90.51%, 100.00%) and positive predictive value at 100% (85.18 - 100.00%). The minimum acceptable combination criteria were determined to be a PAC of > 20 ng/dL plus PRA < 0.6 ng/dL/hr, and presence of spontaneous hypokalemia. It has high specificity (94.59%; 95% CI 81.81%, 99.34%), positive predictive value (93.55%, 95% CI 78.49%, 98.29%), and moderate positive likelihood ratio (LR+) (6.39, 95% CI 1.61, 25.38) CONCLUSION: A hypertensive patient with spontaneous hypokalemia and screening findings of PAC > 20 ng/dL and suppressed PRA of < 0.6 ng/ml/hr, may be classified as "overt primary aldosteronism confirmed" and may not need to proceed with dynamic confirmatory testing. PROTOCOL REGISTRATION NUMBER: SRCTN34186253.

High resting energy expenditure, less fat-free mass, and less muscle strength in HIV-infected children: a matched, cross-sectional study.

Background and aims: Many improvements have been made in the treatment of human immunodeficiency virus (HIV) in pediatric patients; however, challenges remain in terms of achieving normal growth, body composition, and metabolism during treatment, etc. Current nutritional recommendations are based on studies performed in adults, with limited data on the HIV-infected pediatric population. Therefore, this study aimed to compare the resting energy expenditure (REE) of asymptomatic HIV-infected pediatric patients with healthy counterparts and to compare body composition, dietary intake, and physical activity between the two groups. Methods: This was a cross-sectional study of asymptomatic HIV-infected children who were receiving antiretroviral therapy; the infected group was compared with the uninfected group, matched by age (± 6 months), sex, and body mass index (± 0.5 z-score). Participants were recruited between 2021 and 2022, as outpatients. In both groups, REE was determined by indirect calorimetry and body composition by bioelectrical impedance analysis and hand strength, measured using a hydraulic hand dynamometer. Results: Seventy-eight participants were enrolled, where n = 39 HIV-infected children and n = 39 controls, with a mean age of 11.6 ± 3.4 years old. REE was significantly higher in the HIV group (1254.4 ± 334.7 kcal/day vs. 1124.7 ± 321 kcal/day, p = 0.013) than in the control group. Fat-free mass (FFM) was lower in the HIV group (28.2 ± 10.5 kg vs. 32 ± 11.2 kg, p = 0.001); this trend continued when the index skeletal muscle was evaluated (7.2 ± 1.2 vs. 7.6 ± 1.5, p = 0.04). The strength of the dominant hand was also lower in the HIV group (12 (8-18) kg vs. 20 (10.5-26) kg, p < 0.0001). Conclusions: Children with asymptomatic HIV infection have higher REE than their uninfected peers. They also present decreased FFM, skeletal muscle mass index, and muscle strength. These parameters should be considered during nutritional assessment in this population to have a favorable impact on nutritional status and growth.

Association between phase angle and the nutritional status in pediatric populations: a systematic review.

Background and aims: Malnutrition is prevalent in pediatric populations with any disease, and it is also related to changes in body composition. In addition, recent studies have documented relationships between these changes and phase angle (PhA), an important parameter of functional nutritional assessment. PhA could be a new marker of nutritional status. Many studies have generated information about the association between PhA and malnutrition in various pathologies, although the vast majority of this information is from adult populations. In this systematic review, we answered the following question: What is the association between PhA and the nutritional status in pediatric populations? Methods: We performed a systematic search of the Medline/PubMed and Latin American and Caribbean Health Sciences Literature databases (LILACS) databases for studies published up to October 2022. The inclusion criteria were pediatric subjects, which reported the relationship between PhA and the nutritional status with any objective nutritional indicator, and PhA was measured by electric impedance and reported at 50 kHz. We synthesized data from the studies that reported cutoff analysis of PhA with receiver operating characteristic (ROC) curves, mean PhA values presented by nutritional status strata, and correlations between PhA and nutritional status indicators. We assessed the risk of bias by using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Quality Assessment for Diagnostic Accuracy Studies. Results: Of the 126 studies we identified, 15 met the inclusion criteria. The included studies reported the association between PhA and objective indicators of nutritional status, including weight-for-age z-score (WAZ) <-1 standard deviation (SD) for malnutrition, height-for-age z-score (HAZ) for malnutrition-stunting, body mass index (BMI) for the starvation state, body mass index z-score (BMIz) and BMI for malnutrition, mid-upper arm circumference (MUAC) <11 cm for severe acute malnutrition (SAM), and fat-free mass index z-score (FFMIz) <-2 z-score for moderate malnutrition, among others. The report of these associations between PhA and nutritional status was based on cutoff points generated with ROC curve analysis or comparison of mean PhA values, which were reported stratified by the presence or absence of malnutrition, and correlations between PhA and anthropometric indicators for the evaluation of the nutritional status in the pediatric population. It was difficult to compare the studies due to the heterogeneity of the bioelectrical impedance analysis models used, how PhA was reported (standardized, percentiles, or degrees), and the anthropometric indicators used to diagnose malnutrition. Conclusion: The early identification of malnutrition is relevant to establish the correct nutritional treatment; PhA appears to be a sensitive indicator of nutritional status and is easy to obtain. Although the results of this review are inadequate to establish PhA cutoff points associated with malnutrition in pediatric populations, in most of the studies, there was an association between PhA and objective indicators of nutritional status. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022362413, identifier: PROSPERO 2022 CRD42022362413.

Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage.

We report our postpartum haemorrhage protocol focussing on the use of Bakri Balloon, describing its placement and affixing method, effectiveness rates, risk factors that might contribute to Bakri Balloon's failure and complications associated. We designed a retrospective study including 147 cases where a Bakri Balloon was necessary to control the postpartum uterine bleeding to assess the efficacy and to determine which clinical, obstetric or delivery variables could be associated with successful treatment. Failed treatment was defined when surgery or any other technique was needed after a Bakri Balloon placement in order to control uterine bleeding. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.IMPACT STATEMENTWhat is already known on this subject? Postpartum haemorrhage is one of the most severe situations in the immediate postpartum period entailing a major cause of maternal morbimortality if an accurate and quick intervention is not carried out.What do the results of this study add? The use of Bakri Balloon was effective in 94.6% of patients. No statistically significant differences were found in the success rates according to obstetric or delivery characteristics. No major complications occurred due to the placement of a Bakri Balloon. In the failure group, blood loss was significantly higher and all required blood products transfusion.What are the implications of these findings for clinical practice and/or further research? Bakri Balloon is an easy-to-use device that provides an effective therapeutic alternative to more aggressive techniques in postpartum haemorrhages when medical treatment fails. Obstetrics or delivery characteristics should not entail a contraindication in its use. A continuous training system based on an agreed protocol is recommended in order to guarantee the best care possible.

Early prenatal diagnosis of fetal abdominal cyst. Differential diagnosis of choledochal cyst / Diagnóstico prenatal temprano de quiste abdominal fetal. Diagnóstico diferencial de quiste del conducto colédoco

OBJECTIVE: To improve differential diagnosis of choledochal cyst, a rare pathology but whose prenatal diagnosis improves neonatal prognosis. CASE REPORT: Choledochal cysts are a rare congenital abnormality of biliary ducts that present as an anechoic mass in the right upper quadrant of the abdomen. In sonographic examination, a connection between the cyst and the common bile duct must be observed to confirm this diagnosis. It is more frequently diagnosed in females and in Asian countries. We describe a pregnant woman diagnosed of an intra-abdominal fetal cyst at 17-weeks of gestation. Ultrasound assessment showed a cystic mass separated from the stomach, moving other abdominal organs from its normal location and growing progressively. Postnatal study confirmed a choledochal cyst of 8-centimeters in diameter. Surgical treatment was recommended and post-surgical evolution was favourable. CONCLUSIONS: Prenatal diagnosis of choledochal cyst allowed to intensify controls to check the growth. Early surgical treatment improved neonatal prognosis and reduced the risk of sequelae

OBJETIVO: mejorar el diagnóstico diferencial del quiste de colédoco, una patología rara pero cuyo diagnóstico prenatal mejora el pronóstico neonatal. CASO CLÍNICO: los quistes de colédoco son una anormalidad congénita rara de los conductos biliares que se presentan como anecoicos, una masa en el cuadrante superior derecho del abdomen. En el examen ecográfico hay una conexión entre el quiste y se debe observar el conducto biliar común para confirmar este diagnóstico. Se diagnostica con mayor frecuencia en mujeres y en países asiáticos. Describimos a una mujer embarazada diagnosticada de un quiste fetal intrabdominal a las 17 semanas de gestación. La evaluación por ultrasonido mostró una masa quística separada del estómago, moviendo otros órganos abdominales desde su ubicación normal y creciendo progresivamente. El estudio posnatal confirmó un quiste de colédoco de 8 centímetros de diámetro. Se recomendó tratamiento quirúrgico y la evolución posquirúrgica fue favorable. CONCLUSIONES: el diagnóstico prenatal del quiste de colédoco permitió intensificar los controles para supervisar el crecimiento temprano. El tratamiento quirúrgico mejoró el pronóstico neonatal y redujo el riesgo de secuelas

Síndrome de Ballantyne: segundo episodio en una embarazada. Reporte de caso y revisión de la bibliografía / Ballantyne syndrome: Second episode in a pregnant woman. Case report and literature review

Resumen ANTECEDENTES: El síndrome de Ballantyne es un cuadro poco frecuente asociado con hidrops fetal, en el que la madre refleja los síntomas fetales. Es decisivo diferenciarlo de la preeclampsia porque comparten signos de hipertensión y proteinuria. Su etiopatogenia se desconoce pero se han propuesto teorías asociadas con el desequilibrio entre factores angiogénicos y antiangiogénicos. CASO CLÍNICO: Paciente de 29 años, controlada en la consulta de Medicina Materno-Fetal debido al antecedente de síndrome de Ballantyne en el embarazo previo. En la ecografía de control a las 26 semanas se detectaron placentomegalia, ascitis fetal e incremento del líquido amniótico. Las ecografías posteriores demostraron polihidramnios e hidrops a las 28 semanas. Enseguida de la aparición del edema se estableció el diagnóstico de síndrome del espejo recidivante e hidrops no inmunitario. Se hospitalizó para drenaje del líquido. La amniorrexis se produjo a las 29 + 6 semanas. Una semana después se inició la dinámica uterina y el embarazo finalizó a las 31 semanas, después de la ruptura prematura de membranas. El neonato fue un varón de 3200 g, Apgar 2-6-8 al minuto, 5 y 10 minutos, respectivamente. Después del estudio postnatal se estableció el diagnóstico de perforación ileal múltiple. El recién nacido requirió 5 intervenciones quirúrgicas, con posoperatorio tórpido y se dio de alta a los 3 meses de vida. CONCLUSIONES: El síndrome del espejo es infradiagnosticado, a pesar de su potencial para complicar gravemente el embarazo asociado con hidrops. La recuperación de la madre suele ser favorable a los pocos días de posparto aunque la morbilidad y la mortalidad fetal son elevadas.

Abstract BACKGROUND: Ballantyne syndrome is characterized by the triad: fetal, placental and maternal edema. It is an uncommon condition associated with fetal hydrops, in which mother reflects fetal symptoms. It is essential to differentiate from preeclampsia, since there are common signs such as hypertension and proteinuria. Etiopathogenesis is unknown, although theories associated with an imbalance between angiogenic and antiangiogenic factors have been postulated. Treatment consists of ending the pregnancy or improving the fetal situation. CLINICAL CASE: We present the case of a 29-years pregnant woman controlled in the Maternal-Fetal Medicine Unit due to the history of Ballantyne Syndrome in the previous gestation. In the follow-up ultrasound performed at 26-weeks, placentomegaly, fetal ascites and increased amniotic fluid were detected. Subsequent ultrasounds showed polyhydramnios and fetal hydrops at 28-weeks. After maternal edema began, she was diagnosed with recurrent Mirror Syndrome and non-immune hydrops. Admission was indicated and amniodrainage was performed due to symptomatic polyhydramnios. Finally, premature rupture of membranes occurred at 29+6-weeks. She started uterine dynamic after one week, ending in a preterm delivery at 31-weeks after premature rupture of membranes. A 3200gr male was born with Apgar Scores 2-6-8 at 1, 5 and 10min respectively and, after postnatal study, he was diagnosed with multiple ileal perforation. Five surgical interventions were necessary, with a complicated postoperative period and could be discharged at 3 months of age. CONCLUSIONS: Mirror syndrome is an underdiagnosed pathology of unknown incidence that can seriously complicate gestation associated with fetal hydrops. Maternal recovery is favorable few days after delivery, but it leads to high fetal morbi-mortality.

Is it too late to quit? Premature placental aging and smoking / ¿Demasiado tarde para dejarlo? Envejecimiento placentario prematuro y tabaquismo

Objetive: The aim of this study was to determine the relationship between being smoker, ex-smoker or passive smoker and the risk of developing a placental Grannum-grade- III and the interval of time necessary between stop smoking and becomepregnant. Material and methods: A retrospective case-control analysis was performed for women with singleton pregnancy that had ultrasound in the third trimester, establishing two groups according to the classification of placental aging purposed by Grannum: Grannum grade III and Grannum grade I-II. In both groups,maternal characteristics and perinatal outcomes were studied, and also the risk of placental premature aging in pregnant smokers, ex-smokers and passive smokers. Results: Being smokers (p < 0.01) or suffer from a hypertensive disorder (p = 0.01)is associated with a higher risk of premature placental aging. Smokers who quit during early pregnancy and passive smokers behave like smokers,withno significant differences between them. We have also studied ex-smokers and the period of time between quit and became pregnant and the findings show a decrease of six times risk of to develop a Grannum grade III placenta for women who retires from smoke more than a year beforepregnancy. Conclusions: The main causes of developing a premature aging of the placenta are being a smoker and developing a hypertensive disorder. Smoking cessation should occur before becoming pregnant, ideally more than 18 months earlier, in order to avoid placentalabnormalities

Objetivo: el objetivo de este estudio fue determinar la relación entre ser fumadora, exfumadora o fumadora pasiva y el riesgo de desarrollar una placenta Grannum grado III y el intervalo de tiempo necesario entre dejar de fumar y quedarembarazada. Material y métodos: se realizó un análisis retrospectivo de casos y controles para mujeres con embarazos únicos a las que se realizó una ecografía en el tercer trimestre, estableciendo dos grupos según la clasificación de envejecimiento placentario propuesta por Grannum: Grannum grado III y Grannum grado I-II. En ambos grupos, se estudiaron las características maternas y los resultados perinatales, así como el riesgo de envejecimiento prematuro de placenta en mujeres embarazadas fumadoras, exfumadoras y fumadoraspasivas. Resultados: ser fumador (p < 0,01) o padecer un trastorno hipertensivo (p = 0,01) se asocia con mayor riesgo de envejecimiento prematuro de placenta. Las fumadoras que abandonan el hábito al inicio del embarazo y las fumadoras pasivas se comportan como fumadoras, sin diferencias significativas entre ellas. Asimismo se ha estudiado a las exfumadoras y el período de tiempo entre dejar de fumar y quedar embarazada y los hallazgos muestran un riesgo seis veces menor de desarrollar una placenta de grado III de Grannum en mujeres que abandonaron el hábito más de doce meses antes de quedar gestantes. Conclusiones: las principales causas de desarrollar envejecimiento prematuro de placenta son ser fumadora y desarrollar un trastorno hipertensivo. El abandono del hábito tabáquico debe producirse antes de quedar embarazada, idealmente más de 18 meses antes, para evitar anormalidades placentarias

HyRA: A Hybrid Recommendation Algorithm Focused on Smart POI. Ceutí as a Study Scenario.

Nowadays, Physical Web together with the increase in the use of mobile devices, Global Positioning System (GPS), and Social Networking Sites (SNS) have caused users to share enriched information on the Web such as their tourist experiences. Therefore, an area that has been significantly improved by using the contextual information provided by these technologies is tourism. In this way, the main goals of this work are to propose and develop an algorithm focused on the recommendation of Smart Point of Interaction (Smart POI) for a specific user according to his/her preferences and the Smart POIs' context. Hence, a novel Hybrid Recommendation Algorithm (HyRA) is presented by incorporating an aggregation operator into the user-based Collaborative Filtering (CF) algorithm as well as including the Smart POIs' categories and geographical information. For the experimental phase, two real-world datasets have been collected and preprocessed. In addition, one Smart POIs' categories dataset was built. As a result, a dataset composed of 16 Smart POIs, another constituted by the explicit preferences of 200 respondents, and the last dataset integrated by 13 Smart POIs' categories are provided. The experimental results show that the recommendations suggested by HyRA are promising.

Prostate health index (phi) and prostate cancer antigen 3 (PCA3) significantly improve diagnostic accuracy in patients undergoing prostate biopsy.

BACKGROUND: Prostate health index (phi) and prostate cancer antigen 3 (PCA3) have been recently proposed as novel biomarkers for prostate cancer (PCa). We assessed the diagnostic performance of these biomarkers, alone or in combination, in men undergoing first prostate biopsy for suspicion of PCa. METHODS: One hundred sixty male subjects were enrolled in this prospective observational study. PSA molecular forms, phi index (Beckman coulter immunoassay), PCA3 score (Progensa PCA3 assay), and other established biomarkers (tPSA, fPSA, and %fPSA) were assessed before patients underwent a 18-core first prostate biopsy. The discriminating ability between PCa-negative and PCa-positive biopsies of Beckman coulter phi and PCA3 score and other used biomarkers were determined. RESULTS: One hundred sixty patients met inclusion criteria. %p2PSA (p2PSA/fPSA × 100), phi and PCA3 were significantly higher in patients with PCa compared to PCa-negative group (median values: 1.92 vs. 1.55, 49.97 vs. 36.84, and 50 vs. 32, respectively, P ≤ 0.001). ROC curve analysis showed that %p2PSA, phi, and PCA3 are good indicator of malignancy (AUCs = 0.68, 0.71, and 0.66, respectively). A multivariable logistic regression model consisting of both the phi index and PCA3 score allowed to reach an overall diagnostic accuracy of 0.77. Decision curve analysis revealed that this "combined" marker achieved the highest net benefit over the examined range of the threshold probability. CONCLUSIONS: phi and PCA3 showed no significant difference in the ability to predict PCa diagnosis in men undergoing first prostate biopsy. However, diagnostic performance is significantly improved by combining phi and PCA3.

Intoxicación accidental por amitraz / Accidental poisoning with amitraz

Se presenta el caso de una niña de cuatro años de edad que ingirió amitraz, un acaricida, accidentalmente. Presentó pupilas mióticas, irritabilidad y somnolencia, bradicardia, hipotensión arterial, hipotermia, alcalosis respiratoria e hiperglicemia. Recibió fluidos, se hizo aspiración gástrica y se le administró carbón activado. A las 12 horas, la paciente estuvo recuperada y no hubo secuelas en el seguimiento.

This is the case of a 4 year-old who accidentally ingested amitraz, an acaricide. She developed miotic pupils, irritability and somnolence, bradycardia, arterial hypotension, respiratory alkalosis and hyperglycemia. She received fluids, gastric aspiration was done and activated charcoal was administrated. Twelve hours later, the patient was fully recovered and there was no sequelae on following up.

Saturación sensorial y lactancia materna como métodos analgésicos no farmacológicos: estudio randomizado controlado / Sensory overload and breastfeeding as analgesic method no pharmacologic: control randomized study

OBJETIVO: Verificar el efecto analgésico de la saturación sensorial (Sat) y compararlo con la lactancia materna (LM) y un grupo control. MATERIAL Y MÉTODOS: Ensayo clínico, randomizado con 167 recién nacidos a término sanos, en quiénes se cuantificó la intensidad de dolor agudo al recibir una vacuna (hepatitis B) a las 48 horas de vida. Se formaron tres grupos de manera aleatoria: grupo 1 (control, sin método analgésico), grupo 2 (analgesia con LM) y grupo 3 (analgesia con Sat); los estímulos sensoriales fueron: táctil (caricias de la madre sobre el rostro y espalda), olfatorio (colonia sin alcohol), auditivo (voz de la madre), gustativo (lactancia materna), visual (rostro de la madre frente a su bebé). Se utilizó la Escala para Dolor Agudo Neonatal (DAN: Douleur Aiguë du Nouveau-né), con un score de dolor del 1 al 10 y 7 categorías de dolor. RESULTADOS: El grupo con saturación sensorial tuvo menos dolor (3.02 en la escala de DAN); el grupo dos (lactancia materna): 4.15, y control: 9.02. Hubo diferencia significativa entre grupos. Dolor extremo, se presentó en 60% del grupo control, 3,8% en el grupo lactancia materna y 0% en el grupo con saturación sensorial. La categoría NO DOLOR fue más frecuente en el grupo tres (Sat): 33,3% versus 16,9% del grupo con LM y 0% grupo control, p<0.0001. CONCLUSIONES: La saturación sensorial tuvo mayor efecto analgésico que la lactancia materna. Ambas demostraron buen efecto analgésico, comparadas con el grupo control.

OBJECTIVES: To verify the analgesic effect of sensory overload (SO) and compared with breastfeeding (BF) and a control group. MATERIAL AND METHODS: We conducted a randomized clinical trial in 167 healthy term infants, in which the intensity acute pain was quantified to receive hepatitis B vaccine within 48 hours of life. Three groups were formed at random: one group (control, no method of analgesia), group two (analgesia with BF) and group three (analgesia with SO), sensory stimuli were: touch (petting of the mother on baby face and back), olfactory (colony nonalcoholic), auditory (motherÆs voice), gustatory (breastfeeding), visual (mother and baby - face to face). We used the Neonatal Acute Pain Scale (DAN: Douleur Aigue du Nouveau-né), which gives a pain score of 1 to 10, giving 7 categories of pain. RESULTS: In group three (sensory overload) expressed less pain with an average score of 3.02 on the scale of DAN, the group two (breastfeeding): 4.15, and one group (control): 9.02, with significant difference between groups. The category of extreme pain occurred in 60% of the control group, 3.8% of the breastfed group and there was not extreme pain in the sensory overload group. NO PAIN category was more frequent in all three group (Sat): 33.3% versus 16.9% (group LM) and 0% (control group), p <0.0001. CONCLUSIONS: The sensory overload has greater analgesic effect of breastfeeding. Both demonstrate good analgesic effect compared with the control group.

Dolor agudo neonatal con estímulos dolorosos repetitivos, estudio randomizado comparando tres métodos analgésicos no farmacológicos / Neonatal acute pain with repetitive painful stimuli, randomized trial comparing three analgesic non pharmacological methods

Introducción: La analgesia no farmacología es raramente utilizada en las unidades de neonatología. Los estímulos dolorosos repetitivos tienen efectos negativos a largo plazo. Objetivos: Verificar que los métodos analgésicos no farmacológicos son afectivos en estímulos dolorosos repetitivos; determinar cuál método es más efectivo. Material y método; Se realice un ensayo clínica, randomizado, con tres grupos formados de manera aleatoria, con recién nacidos sanos a termino por grupo. Fueron sometidos a tres estímulos dolorosos durante los tres primero días de vida (vacuna contra hepatitis B, BCG y muestra para grupo sanguíneo). El primer grupo (A) recibió lactancia materna y contacto piel como método analgésico no farmacológico durante el estímulo doloroso, el grupo (B) recibió dextrosa al 10 por ciento y el grupo (C) una tetina sin nada. Se utilizó la escala para el Dolor Agudo Neonatal (DAN, Carbajal y col.) y la Escala ABC (Bellieni y col.) para la cuantificación del dolor. Fueron comparados los 3 grupos en cada uno de los tres estímulos repetitivos. Resultados: Para ambas escalas el grupo B expresó menor dolor en los tres estímulos, con 97,5 por ciento de NO DOLOR vs 87,5 por ciento (A) y 85 por ciento (C) (p<0.036) en la escala ABC, y 95 por ciento vs 85 por ciento (A) y 70 por ciento (C) para la categoría NO DOLOR con a categoría DAN (p<0.022). Esta diferencia se mantuvo en las otras categorías de dolor. Se observó que el efecto analgésico es mayor con el estimulo repetitivos. Siendo la categoría NO DOLOR en el grupo B para el primer estimulo 70 por ciento, 85 por ciento en el segundo y 95 por ciento en el tercero (p<0.020). Este efecto se observó también en los grupos A y C. Conclusiones: la dextrosa al 10 por ciento tuvo mayor efecto analgésico comparada con los otros grupos. Los métodos analgésicos no farmacológicos estudiados aumentan su efectividad con estimulo dolorosos repetitivos.

Introduction: Non pharmacological methods are rarely used in neonatal units. repeated painful stimuli have long noxious effects. Objective: To verify the effectiveness of non pharmacological methods in repeated painful procedures; to determine which method is more effective. Material and methods: We conducted a randomized controlled trial. Newborns were randomly assigned into 3 groups (n=40 per group). All of them underwent painful procedures during the first 3 days of life (hepatitis B, BCG and blood sample for determine group and factor). Group A received breast feeding and skin to skin contact as non pharmacological method during the painful stimuli, group B receive dextrose 10 por ciento and group C only suction. Douleur Aigue Nouveauûne scores (DAN, Carvajal et al.) and ABC scale (Bellieni et al.) were used to assess neonatal pain. The 3 groups were compared in each stimulus to determine the most effective method, and the effectiveness in repeated painful stimuli. Results: Group B showed the most analgesic effect in the stimuli, with 97, 5 percent for NO PAIN vs. 87, 5 percent (A) and 85 percent (C) (p<0,036) with ABC scale, and 95 percent vs. 85 (A) and 70 percent (C) for NO PAIN with DAN scale (p<0,022). This difference was constant with all categories of pain. We observed that analgesic effect is greater in repeated painful stimuli. NO PAIN category was 70 percent in group B in the first stimuli, 85 percent in the second and 95 percent in third (9<0,020). This effect was also observed in groups A and C. Conclusions: Dextrose 10 percent seems to offer the best analgesic effect compared with breast feeding and suction. Non pharmacological methods studied increase their effectiveness in repeated painful stimuli.

Comparación de tres géneros musicales como método analgésico no farmacológico: estudio randomizado ciego simple / Comparison of three musical genders as a non pharmacological method: randomized simple blind trial

Objetivo: Comparación de tres géneros musicales como método analgésico no farmacológico para la determinación del género musical que posee mayor efecto analgésico entre niños de 2 a 11 años de edad. Material y Métodos: 150 niños participantes en una campaña de despistaje de anemia realizada en el Hospital Nacinal Arzobispo Laoyza, fueron agrupados aleatoriamente en 4 grupos con 3 distintos géneros musicales y un grupo control (A=Mozart; B=Daddy Yankee; C=Marc Anthony; D= sin estímulo musical). Los niños fueron expuestos a 2 minutos de música o silencio, realizándose el estímulo doloroso (punción para la toma de muestra) a los 60 segundos. Se evaluó la intensidad del dolor según dos escalas: CHEOPS y Autoinforme (según el grupo etario: 2-6 años y 7-11 años, respectivamente); además, se midió la frecuencia cardíaca y saturación de oxígeno, un minuto antes, durante y un minuto después del estímulo doloroso. Se utilizó para el análisis, la pureba de Kruskal-Wallis (prueba no paramétrica). Resultados: El grupo C (Marc Anthony) mostró mayor efecto analgésico al ser comparado con los grupos A y D, al utilizar la escala de Autoinforme (p:0,03); no hubo diferencia significativa con el grupo B. Al comparar los géneros musicales en el grupo etáreo menor (2-6 años, CHEOPS), se encontró un mayor efecto analgésico en el grupo A (Mozart), aunque sin significancia estadística (p: 0,859). Se encontró también mayores niveles de dolor en los grupos B y C. No se hallo diferencia significativa al comparar las curvas de saturación de oxígeno ni frecuencia cardiaca entre los grupos. Conclusiones: La salsa parece otorgar un mayor efecto analgésico en los niños entre 7 y 11 años al ser evaluados con la escala de Autoinforme, comparándolos con los otros géneros musicales y el control; mientras que en los niños entre 2 y 6 años, al ser evaluados con la escala de CHEOPS, ...

Objetive: To compare three music genders as a non pharmacological analgesic method to determine which one has the most analgesic effect in children between 2 and 11 years old. Material and Methods: our study population was a hundred and fifty children who participated on an anemia screening campaign held at the Hospital Nacional Arzobispo Loayza. They were grouped randomly in 4 groups with 3 different musical genders and 1 control group (A=Mozart; B=Daddy Yankee; C=Marc Anthony; D=no musical stimuli). The pain level was assessed by 2 scales: The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Self assessment Scale (the younger age group from 2 to 6 years old, the older age group from 7 to 11 years old respectably), it was also measured heart rate and oxygen saturation 60 seconds before painful stimuli, during stimuli and 30 and 60 seconds post-stimuli. The Kruskal-Wallis Test (non parametric test) was used to analyze the results we obtained. Results: When Self-assessment scale was used, Group C (Marck Anthony) showed the most analgesic effect, compared to groups A and D (p: 0,03); on the other side there was nor significant effect with Group B. When the 3 musical genders where compared in the younger age group (from 2 to 6 years old, CEHOPS), it was found that Group A (Mozart) had the best analgesic effect, even though it did not have any statistic significance (p:0,859). It was also found higher pain levels in Group B and C. No statistical significant difference was found when Oxygen Saturation curves where compared between the four groups, neither heart rate curves. Conclusions: Salsa seems to offer the best analgesic effects in children from 7 to 11 years old, when self-assessment scale was used. Children from 2 to 6 years old were evaluated by CHEOPS scale. We found out that without any statistical significance classical music seems to have the best analgesic effect during painful stimuli.

The pattern of p53 mutations caused by PAH o-quinones is driven by 8-oxo-dGuo formation while the spectrum of mutations is determined by biological selection for dominance.

PAHs (polycyclic aromatic hydrocarbons) are suspect lung cancer carcinogens that must be metabolically converted into DNA-reactive metabolites. P4501A1/P4501B1 plus epoxide hydrolase activate PAH to (+/-)- anti-benzo[ a]pyrene diol epoxide ((+/-)- anti-BPDE), which causes bulky DNA adducts. Alternatively, aldo-keto reductases (AKRs) convert intermediate PAH trans-dihydrodiols to o-quinones, which cause DNA damage by generating reactive oxygen species (ROS). In lung cancer, the types or pattern of mutations in p53 are predominantly G to T transversions. The locations of these mutations form a distinct spectrum characterized by single point mutations in a number of hotspots located in the DNA binding domain. One route to the G to T transversions is via oxidative DNA damage. An RP-HPLC-ECD assay was used to detect the formation of 8-oxo-dGuo in p53 cDNA exposed to representative quinones, BP-7,8-dione, BA-3,4-dione, and DMBA-3,4-dione under redox cycling conditions. Concurrently, a yeast reporter system was used to detect mutations in the same cDNA samples. Nanomolar concentrations of PAH o-quinones generated 8-oxo-dGuo (detected by HPLC-ECD) in a concentration dependent manner that correlated in a linear fashion with mutagenic frequency. By contrast, micromolar concentrations of (+/-)- anti-BPDE generated (+)- trans- anti-BPDE-N (2)-dGuo adducts (detected by stable-isotope dilution LC/MS methodology) in p53 cDNA that correlated in a linear fashion with mutagenic frequency, but no 8-oxo-dGuo was detected. Previous studies found that mutations observed with PAH o-quinones were predominately G to T transversions and those observed with (+/-)- anti-BPDE were predominately G to C transversions. However, mutations at guanine bases observed with either PAH-treatment occurred randomly throughout the DNA-binding domain of p53. Here, we find that when the mutants were screened for dominance, the dominant mutations clustered at or near hotspots primarily at the protein-DNA interface, whereas the recessive mutations are scattered throughout the DNA binding domain without resembling the spectra observed in cancer. These observations, if extended to mammalian cells, suggest that mutagenesis can drive the pattern of mutations but that biological selection for dominant mutations drives the spectrum of mutations observed in p53 in lung cancer.

Comparing two different ballistic intracorporeal lithotripters in the management of ureteral stones.

INTRODUCTION: During the 1990s, two different in situ 'ballistic' lithotripters were introduced into clinical practice. The Swiss Lithoclast (SLC) was the first to be clinically tested. After a few years, a very similar device, the electrokinetic lithotripter (EKL), was described and has recently become available to us. In this paper we compare the clinical efficacy and features of these two ballistic lithotripters in the ureteroscopic treatment of ureteral stones. MATERIALS AND METHODS: Thirty-eight patients with ureteral stones were randomized into two equal groups to undergo fragmentation using the SLC or the EKL via semirigid ureteroscope. In both groups the stones were in the mid- or lower ureter. The following parameters were evaluated: total procedure duration, complete fragmentation rate, time to complete fragmentation, proximal migration rate, complications and need for further procedures. RESULTS: Although not statistically significant, a trend towards a higher fragmentation rate, a shorter time to fragmentation and a slightly higher proximal migration rate emerged in the SLC group. No difference was found in the stone-free rate in the two groups (94.7 vs. 89.4%). Only 2 cases of minor ureteric injury were observed in each group. CONCLUSIONS: As previously described by others, the SLC and EKL are both attractive cost-effective options in the treatment of ureteral stones. Ten years after its introduction, the SLC still remains probably the best choice for most urologists.

Expanding applications of the access sheath to ureterolithotripsy of distal ureteral stones. A frustrating experience.

OBJECTIVE: Distal ureteral stones are routinely managed with semirigid ureteroscopy without the need for ureteral dilatation, but some conditions, e.g. large stone burden or difficult catheterization of the ureteral meatus, are time-consuming and would require a tool to facilitate multiple insertions of the ureteroscope and to avoid ureteral injury. An access sheath is now available and it facilitates ureteroscopy of the upper ureter. To answer the question whether its application could be expanded to the distal ureter is the aim of our paper. PATIENTS AND METHODS: 12 distal ureteral stone patients, 8 with stone size >1 cm and 4 with a large prostate, underwent ballistic ureterolithotripsy with the aid of the Access Sheath. The results of the procedure were compared to a second group of 16 patients from our archives. RESULTS: There was no significant difference in operating time and stone-free rate. Although no complications were related to the ureteroscopy, in 42% (5 patients) of the access group the procedure could be completed only after removing the sheath. CONCLUSION: The Access Sheath does not improve the results of the semirigid ureteroscopy of difficult stones in the distal ureter.

Role of cytokeratins, nuclear matrix proteins, Lewis antigen and epidermal growth factor receptor in human bladder tumors.

The content of urinary bladder cancer antigen (UBC), tissue polypeptide specific antigen (TPS), nuclear matrix protein 22 (NMP22), and the expression of LewisY carbohydrate antigens and of epidermal growth factor receptor (EGF-R) in bladder tumor tissues were determined. These included 14 well, 6 moderately and 11 poorly differentiated bladder cancers. Cytosol UBC and TPS were higher in the well and in the moderately differentiated bladder tumors than in the poorly differentiated bladder cancers; whereas cytosol NMP22 was higher in the poorly differentiated bladder cancers than in the well and in the moderately differentiated bladder tumors. The Lewis related carbohydrate antigens, evaluated by the reactivity of the tissues to monoclonal antibody B3, were highly expressed in poorly differentiated tumors. The EGF-R was strongly expressed in a large number of poorly differentiated bladder tumors. These data suggest that the determination of cytosol NMP22 and the immunoblotting with B3 and EGF-R antibodies might be useful to obtain more information on the differentiation of bladder tumors.

[Questionnaire based evaluation of prostate biopsy complication comparing different bioptic schemes]. / Questionnaire based evaluation of prostate biopsy complication comparing different bioptic schemes.

OBJECTIVES: The systematic parasagittal sextant biopsy technique under transrectal ultrasound guidance, routinely performed to diagnose and stage prostate cancer, has been shown to outperform directed or random biopsies, revolutioning our ability to detect carcinoma of the prostate. Different biopsy schemes have been proposed with similar positive percentage of cancer detection. The present study evaluate from the patient's perspective the complications with the use of two different systematic biopsy protocols with 14 and 8 cores. MATERIAL AND METHODS: Between January 1999 and February 2000, 177 consecutive patients, mean age 64.1 +/- 7.7 years, referred for normal screening digital rectal examination (DRE) and prostate specific antigen (PSA) level 4-10 ng/ml, were submitted to a transrectal US examination followed by lesion directed and 14 scheme systematic biopsies to detect prostate cancer. Biopsies were obtained from conventional sextant biopsies (6 core) and 3 alternate sites which included: the right and left extreme lateral peripheral zone between anterior tissue and posterior gland base (2 core); the right and left transition zone, immediately adjacent to the urethra anterior and posterior (4 core) and the right and left central gland in the mid zone typical of benign prostatic hyperplasia (BPH) (2 core). All specimens were separated for specific location identification. Cancer was identified in 61 patients (34.46%). Traditional sextant biopsies showed 23 patients (37.7%) with positive core to detect cancer, while a sextant regimen incorporating lateral peripheral zone biopsies and transitional zone detected 19 cancer (31.1%). The combination of lateral peripheral and transitional zone alone detected cancer in 59 patients. No cancer was detected in central gland. The lateral peripheral zone was the most frequently positive site biopsy followed by the transitional zone. According the results of our study from April 2000 we started to consider a novel scheme to reduce number of biopsies maintaining the same sensitivity. A subsequent group of 121 patients, mean age 61 +/- 4.6 years, enrolled from April 2000 to May 2001, underwent a transrectal US examination followed by lesion directed and 8 scheme systematic biopsies. None of the patients had previously undergone prostate biopsy. In all patients a visual analog score (VAS) questionnaire about pain and complications was obtained 7 days after the procedure. RESULTS: Of the 149 patients who completed the questionnaire 9.9% found the procedure moderately to extremely painful afterwards, with a VAS > 5, the commonest of these complications being pain and voiding difficulties with a mean value of 15.8%, systemic symptoms as fever or sweats with a mean value of 7.65% of cases. Between the two groups submitted to 14 or 8 scheme biopsies, we detect a statistically significant difference for urethral bleeding (7.3% vs 4.9% p value 0.05) and rectal bleeding (10.3% vs 3.7% p value 0.04), systemic symptoms 10.3% vs 5.0% p value 0.05) and painful voiding afterwards (5.8% vs 2.4% p value 0.02). CONCLUSIONS: Ultrasound guided transrectal biopsy of the prostate is a well tolerated and effective method for obtaining multiple biopsy specimens from the prostate with low incidence of serious complications. The absolute value of referred complications with VAS < 5 results high, but the rate of major complications results low. The 8 biopsy scheme, including sampling in peripherial zone at midgland and transition zone periuretrally toward the base, should be considered in a initial biopsy scheme to reduce number of biopsy and enhancing sensitivity, with a significant less degree of complication rate compared to a extensive 14 biopsy scheme.

Early and late complications of double pigtail ureteral stent.

OBJECTIVES: To analyze the early and late complications of indwelling ureteral stents in a series of 146 patients with nephroureteral lithiasis. MATERIALS AND METHODS: 146 patients with obstructing nephrolitiasis were treated for urinary diversion with double pigtail ureteral stent before extracorporeal shock-wave lithotripsy (ESWL) and following ureterorenoscopic treatment of lithiasis. All patients were scheduled for stent removal or replacement at specific 3-month intervals until stone-free status was achieved. RESULTS: Early complications during the first 4 weeks after stent insertion were stent discomfort (37.6%), irritative bladder symptoms (18.8%), hematuria (18.1%), bacteriuria (15.2%), fever >104 degrees F (12.3%) and flank pain (25.3%); late complications included hydronephrosis (5.7%), and stent migration (9.5%), encrustation (21.6%), fragmentation (1.9%) and breakage (1.3%). CONCLUSIONS: Ureteral stents have proven to be an invaluable tool for endourologists. Morbidity is minimal for up to three months but longer indwelling times are associated with an increasing frequency of incrustation, infections, secondary stone formation and obstruction of the stented tract.