Prognostic Factors for Residual Lithiasis in Patients With Staghorn Calculi Undergoing Percutaneous Nephrolithotomy in the Maya Region of Yucatan, Mexico: A Case-Control Study.

BACKGROUND: Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico, placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient's collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula. METHODS: A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate. RESULTS: A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100). A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001). CONCLUSION: Guy's Score Grade IV showed a higher incidence of residual lithiasis, seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.

Perioperative outcomes and risk factors for major complications associated with nephrectomy for Xanthogranulomatous pyelonephritis: a multicenter study.

PURPOSE: To determine the risk factors associated with major complications in patients with histologically confirmed Xanthogranulomatous pyelonephritis (XGP) who underwent nephrectomy. METHODS: A multicenter retrospective study was performed including patients who underwent nephrectomy between 2018 and 2022 with histopathological diagnosis of XGP. Clinical and laboratory parameters at the initial presentation were evaluated. Data on extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of nephrectomy and perioperative outcomes were obtained. The primary outcome was major complications, defined as a CD ≥ grade 3 and the need for intensive care unit (ICU) admission. Secondary outcomes included the comparison of complications evaluating the nephrectomy approach (transperitoneal, retroperitoneal, and laparoscopic). A sub-analysis stratifying patients who needed ICU admission and Malek classification was performed. RESULTS: A total of 403 patients from 10 centers were included. Major complications were reported in 98 cases (24.3%), and organ injuries were reported in 58 patients (14.4%), being vascular injuries the most frequent (6.2%). Mortality was reported in 5 cases (1.2%). A quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2, increased creatinine, paranephric extension of disease (Malek stage 3), a positive urine culture, and retroperitoneal approach were independent factors associated with major complications. CONCLUSION: Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease. Clinical-radiological staging, such as the Malek classification may predict the risk of major complications in patients with XGP who will undergo nephrectomy. A transperitoneal open approach may be the next best option when laparoscopic approach is not feasible.

Retrograde Intrarenal Surgery Versus Miniaturized Percutaneous Nephrolithotomy for Kidney Stones >1cm: A Systematic Review and Meta-analysis of Randomized Trials.

CONTEXT: Although miniaturized percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) are both options for treating >1cm kidney stones, controversies exist on whether one is more effective and safer than the other. OBJECTIVE: To systematically appraise randomized trials comparing the effectiveness and safety of mPCNL and RIRS for treating >1cm kidney stones. EVIDENCE ACQUISITION: A systematic search on PubMed/Medline, Web of Science, Embase, and ClinicalTrials.gov was conducted in August 2020 following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). Randomized trials comparing mPCNL and RIRS for >1cm kidney stones, and reporting stone-free rate (SFR), hemoglobin drop, transfusion rate, length of hospital stay (LOS), and/or complications, were included. EVIDENCE SYNTHESIS: Eight studies compared mPCNL and RIRS, but one was not included due to its high risk of bias. SFR was higher for mPCNL (RR: 1.06 [95% coefficient interval {CI}, 1.01-1.10], p=0.008). Hemoglobin drop was higher for mPCNL (mean difference [MD]: 0.35 [95% CI, 0.05-0.65] g/dl, p=0.02); however, transfusion rates were similar (p=0.44). Complication rate was similar between mPCNL and RIRS (p=0.39), and the LOS was higher for mPCNL (MD: 1.11 [95% CI, 0.06-2.16] d, p=0.04). A subgroup analysis of lower pole stones showed that SFR was higher for mPCNL (RR: 1.09 [95% CI, 1.00-1.19], p=0.05). CONCLUSIONS: Both approaches are effective and safe. Among these approaches, mPCNL has a higher SFR than RIRS for overall >1cm renal and lower pole stones, but longer LOS, and a higher hemoglobin drop that does not translate into higher transfusion rates. Complications are comparable. PATIENT SUMMARY: Randomized trials have evaluated whether miniaturized percutaneous nephrolithotomy (mPCNL) or retrograde intrarenal surgery is more effective and safer for treating >1cm stones. After comparing the stone-free rate, hemoglobin drop, transfusion rate, length of hospital stay, and complications between both the approaches, mPCNL was found to be slightly more effective, but both were equally safe.

High Prevalence of Hypocitraturia in Stone Formers from the Maya Region of Yucatan, Mexico.

BACKGROUND: Urinary Stone Disease (USD) arises from an interaction of genetic and environmental factors. Urinary metabolic abnormalities are well described as risk factors. In Mexico, the Maya region holds the highest prevalence of USD. Treatment of these abnormalities lowers the risk of recurrences. AIM: Assess the underlying metabolic abnormalities of patients with USD to provide a rationale to lead further prevention strategies. METHODS: Clinical and demographical data from patients coming to the Stone Clinic were prospectively collected along with a 24 h urinary panel to identify metabolic abnormalities. All participants signed consent and the study was approved by the hospital's institutional review board. RESULTS: A total of 126 patients were included, with a mean age of 47.2 ± 13 years, 75.4% were female. A positive family history of stones was observed in 40 and 87.3% were overweight/obese. The frequency of hypocitraturia, hypercalciuria, hypomagnesuria, hyperoxaluria, and hyperuricosuria was 91.3, 68.5, 42.1, 36.5, and 26.6%, respectively. Median urinary citrate was 79.5 (37.5-160) mg/24 h and was inversely correlated to glycemia. Urine Calcium/Creatinine index was correlated with Hounsfield units (HU) (p = 0.01). Oxalate was correlated with HU and stone burden. Interestingly, dietary distribution of macro- and micronutrients were similar between groups. Patients with a single kidney had lower citrate and higher urinary calcium. CONCLUSIONS: Interestingly, a shortage of inhibitors such as citrate and magnesium are highly prevalent in patients with USD from the Maya region and seems to be influenced by other metabolic conditions as malnutrition next to the genetic component.

Overactive bladder - 18 years - Part I.

Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals - including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Overactive bladder - 18 years - Part II.

Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part II

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part I

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Desarrollo de habilidades conductuales maternas para promover la alfabetización inicial en niños preescolares / Development of maternal skills to implement early literacy with preschool children / Desenvolvimento de habilidades condutuais maternas para promover a alfabetização inicial em crianças pré-escolares

El objetivo del presente estudio fue probar la efectividad de un programa conductual (taller) dirigido a madres de familia de estrato sociocultural bajo, para capacitarlas en la realización de actividades y estrategias para promover en sus hijos preescolares habilidades lingüísticas y preacadémicas relacionadas con la alfabetización inicial. El programa se enfocó en dos contextos específicos de interacción: la lectura conjunta de cuentos y el juego con títeres. Participaron 20 madres, con prácticas alfabetizadoras limitadas, cuyos hijos preescolares mostraron pocas habilidades preacadémicas y lingüísticas. Diez madres conformaron el Grupo Experimental, recibiendo el programa de intervención y otras diez fungieron como Grupo Control. Se realizaron tres sesiones de evaluación (pre test, post test y seguimiento) y siete sesiones de intervención. El programa se aplicó de manera grupal y se utilizaron técnicas de exposición oral, discusión en grupo, modelamiento, juego de roles, retroalimentación y práctica reforzada. Los resultados mostraron que el programa fue eficaz para desarrollar algunas de las prácticas alfabetizadoras en las madres. Los mayores efectos se observaron en el contexto interactivo de lectura conjunta de cuentos. Se discuten los resultados y limitaciones del estudio, y se derivan algunas sugerencias para programas futuros.

The aim of this study was to test the effectiveness of a behavioral program aimed to mothers from low socio-cultural background in order to train them in conducting activities and strategies to promote language and pre-academic skills related to early literacy in their preschool children. The program was carried out focusing on two interactive contexts: joint reading of stories and puppet play. 20 women participated, with limited literacy practices whose preschool children showed low levels in pre-academic and linguistic skills. 10 mothers formed the experimental group, receiving the intervention program and 10 served as control group. There were three testing sessions (pretest, post-test and follow-up) and seven intervention sessions. The program was implemented in a group mode and it used techniques such as oral presentation, group discussion, modeling, role playing, feedback and reinforced practice. Results showed that the program was effective in developing some of the literacy practices in mothers. The main effects were observed in the interactive context of joint reading of stories. The results and limitations of the study are discussed and some recommendations are given for future programs.

O objetivo do presente estudo foi provar a efetividade de um programa condutual (oficina) dirigido a mães de família de classe sociocultural baixa, para capacitá-las na realização de atividades e estratégias para promover em seus filhos pré-escolares habilidades linguísticas e pré-acadêmicas relacionadas com a alfabetização inicial. O programa enfocou-se em dois contextos específicos de interação: a leitura conjunta de contos e brincadeiras com marionetes. Participaram 20 mães, com práticas alfabetizadoras limitadas, cujos filhos pré-escolares mostraram poucas habilidades pré-acadêmicas e linguísticas. Dez mãe formaram o Grupo Experimental, recebendo o programa de intervenção e outras dez participaram como Grupo de Controle. Realizaram-se três sessões de avaliação (pré-teste, pós-teste e acompanhamento) e sete sessões de intervenção. O programa foi aplicado de maneira grupal e se utilizaram técnicas de exposição oral, discussão em grupo, modelagem, jogo de papéis, retroalimentação e prática reforçada. Os resultados mostraram que o programa foi eficaz para desenvolver algumas das práticas alfabetizadoras nas mães. Os maiores efeitos foram observados no contexto interativo de leitura conjunta de contos. Discutemse os resultados e limitações do estudo, e se derivam algumas sugestões para programas futuros.

Entrenamiento a profesores de preescolar y primer grado de primaria, en el uso de estrategias de enseñanza / Kinder garden and first grade teachers training on the utilization of teaching strategies

La investigación prueba la efectividad de un programa de entrenamiento a profesores de tercer grado de preescolar y primero de primaria, para aplicar una serie de estrategias de enseñanza derivadas de la psicología conductual. Participaron profesoras de escuelas públicas de estrato sociocultural bajo. Antes y después del entrenamiento se filmó una hora de clase de cada profesora, filmaciones que sirvieron para registrar el uso de las estrategias educativas. El entrenamiento consistió en la enseñanza de nueve estrategias que se pueden emplear para optimizar el aprendizaje. En siete participantes se observó un efecto del entrenamiento, durante la pre-evaluación mostraron niveles cercanos a 0 por ciento en el uso de la mayoría de las estrategias, para pos-evaluación se observaron incrementos en casi todas ellas. Se analizan posibles efectos del programa sobre el ambiente afectivo y el clima social dentro del aula. Se discuten los resultados con base en hallazgos de investigaciones empíricas previas, analizándose limitaciones del programa y haciéndose sugerencias para estudios y programas futuros.(AU)

The research shows the effectiveness of a training program for teachers of third grade of kinder garden and first grade of elementary school, for undertaking a series of teaching strategies derived from the conductual psychology. Teachers from public schools of low socio-cultural level participated in this study. An hour of a class of each teacher was filmed before and after the training, in order to record the use of the teaching strategies. The training consisted in teaching strategies that can be used in order to optimize the learning process. In seven participants, the effect of the training was observed. In these cases, the pre-evaluation showed levels closer to 0 percent, meanwhile in the post-evaluation they showed increments in almost all of them. The possible effects of the program are analyzed, on relationship to the affective environment and social clime in the classroom. The results are discussed on the basis of the previous empirical research findings. The limitations of the program are also analyzed and some suggestions are pointed out for undertaking future studies and programs.(AU)

Habilidades matemáticas en alumnos de bajo nivel sociocultural / Mathematical skills in students from a low social and cultural stratum / Habilidades matemáticas em alunos de baixo nível sociocultural

La temática abordada es la calidad de la educación básica en México. Con el propósito de dar cuenta del proceso de desarrollo de diversas habilidades matemáticas en alumnos de primer grado de primaria, se realizó un estudio longitudinal en el cual participaron 169 alumnos de estrato sociocultural bajo. Se aplicó un instrumento referido a criterio y basado en análisis de tareas, que permitió analizar los aciertos y errores a lo largo del ciclo escolar 2004-2005. Los resultados indican que los alumnos ingresaron con deficiencias preacadémicas, que se desarrollaron algunas habilidades, pero que los niveles de aptitud matemática fueron bajos al finalizar el curso. Se discuten las implicaciones de los resultados y se proponen alternativas para la educación, basadas en el modelo conductual de desarrollo psicológico.

In this paper, the quality of primary education in Mexico is dealt with A longitudinal study was carried out with the aim of analyzing the process of development for various mathematical skills with first grade students; 169 students from a low social and cultural stratum participated. An instrument referred to criteria and based on task analysis was used to analyze the errors and the correct responses throughout the 2004-2005 school year Results show that students had enrolled with previous academic deficiencies and developed some skills; however, the levels of mathematical skills were still low at the end of the school term. The implications of these results are discussed and some alternatives for education based on a behavioural model of psychological development are proposed.

Neste artigo, é examinada a qualidade do ensino primária em México. Para dar conta do processo de desenvolvimento de várias habilidades matemáticas nos alunos do primeiro grau de ensino primária, foi realizado um estudo longitudinal em que participaram 169 alunos de estrato sociocultural baixo. Foi aplicado um instrumento referido a critério e baseado em análise de tarefas, que possibilitou a análise de acertos e erros durante o ciclo escolar 2004-2005. Os resultados sinalam que os alunos tenham deficiências pré-acadêmicas, que desenvolveram algumas habilidades, mais que os níveis de aptitude matemática foram baixos ao final do curso. São discutidas as implicações dos resultados e são propostas alternativas para a educação, baseadas no modelo condutista de desenvolvimento psicológico.