Hypospadias: a review

Hypospadias is a congenital malformation of the male external genitalia, which includes: anomalous location proximal to the urethral meatus, in any portion of the glans penis and perineum, hooded dorsal foreskin, and inverted penile curvature on the dorsal side of the foreskin. The etiology has been considered multifactorial, secondary to the interaction of environmental factors with specific genetic background. It represents the second most frequent congenital defect in male newborns. It has increasing prevalence rates of 0.25 new cases per 10,000 newborns per year. Risk factors that have been identified include infants small for gestational age with weight below the 10th percentile, head length and/or circumference, intrauterine growth restriction, and placental insufficiency. Regarding environmental risk factors, maternal exposure to pesticides has been linked. Prenatal diagnosis has been described, however proximal hypospadias is usually detected, making it difficult to diagnose distal hypospadias using this method. So usually the diagnosis is made after birth during the physical examination. To date, more than 300 surgical techniques are known for the correction of hypospadias. The treatment of distal hypospadias is currently performed in one time; the management of proximal hypospadias is controversial; one group favors the one-stage procedure, while other groups choose to perform the two-stage procedure

Pseudoaneurysm due to femoral artery puncture: a review

The femoral artery is the most used percutaneous access site for different endovascular therapeutic options, this being an excellent anatomical site to achieve adequate compression after its puncture, which frequently makes it the site with the highest incidence of complications associated with posterior to arterial puncture. The most frequent complications related to arterial puncture are: hematoma, pseudoaneurysm, retroperitoneal hematoma, and arterial occlusion. The pseudoaneurysm is defined as the interruption in the wall of the artery, product of the lesion of the wall, which causes blood leakage towards the surrounding tissues, remaining contained in a fibrin sac, therefore, the importance of an adequate diagnosis and treatment lies above all in the high risk of rupture or thromboembolism.

Xanthogranulomatous pyelonephritis: a review

Xanthogranulomatous pyelonephritis (XP), first described in 1916, is a rare form of chronic granulomatous inflammation. The etiology is still unclear; however, the development of the disease is associated with chronic urinary obstruction secondary to lithiasis, tumors and urological malformations, among others. This leads to the destruction of the renal parenchyma and its replacement by solid sheets of lipid-laden macrophages. Female gender, diabetes and obesity are attributed as predisposing factors to the development of XP. It is estimated that the incidence presents a maximum peak between 50 and 70 years, with a ratio of 2:1 women-men respectively. Computed tomography (CT) is described as the mainstay in the evaluation. However, the definitive diagnosis is made by histopathological study, where a mixture of lipid-laden foamy macrophages, lymphocytes, neutrophils, giant cells, and plasma cells can be seen. Nephrectomy (open or laparoscopic) continues to be the first-line treatment. The laparoscopic approach is associated with an increase in operating time; however, the recovery time is shorter compared to the open approach. Given the natural history of the disease and the associated complications, this makes it a challenging approach for the surgeon. Therefore, a surgeon experienced in laparoscopic skills is necessary. This review seeks to synthesize existing information regarding the appropriate surgical approach in conjunction with the clinical context

Biliary atresia: a review

Bile duct atresia (BA) is a severe, progressive cholangiopathy characterized by fibrous and inflammatory obliteration of the intrahepatic and extrahepatic bile ducts. It leads to liver failure, scarring, and end-stage cirrhosis if timely treatment is not achieved. It represents the number one indication for pediatric liver transplantation as a single disease worldwide. Various etiological factors have been associated with BA, such as structural malformations, viral, immune-mediated, and genetic infections. The incidence of BA varies around the world. Untreated BA patients have a 2-year mortality of nearly 100%. The clinical picture is characterized by jaundice, acholia, and jaundice that persists beyond the first 2 weeks of life. Direct or conjugated bilirubin remains the primary screening laboratory test for BA; elevated values ​​occur within the first 2 days of life. Currently, the primary treatment of choice is the Kasai portoenterostomy; the success of surgery has been based on the restoration of bile flow and the elimination of jaundice. However, more than 70% of patients develop liver cirrhosis secondary to persistent liver inflammation, which will require liver transplantation. The following review of the literature aims to collect relevant information from what has been published in recent years on bile duct atresia; focused on the study of etiology, pathophysiology, advances in genetics and immunology. As well as the results associated with surgical treatment and the requirement for liver transplantation

Staghorn renal stones: a review

Staghorn lithiasis is described as the presence of stones in the urinary tract that create a mold of the renal collecting system, with the characteristic of being branched. It has a strong association with urinary tract infections caused by urea-splitting organisms. The composition of the stone usually consists of pure magnesium ammonium phosphate (struvite), or a mixture of struvite and calcium carbonate apatite. It is classified as complete and partial. In the complete one, the stones occupy the renal pelvis and the calyceal system, or more than 80% of the collecting system; unlike the partial ones that occupy the renal pelvis and at least two calyces. Computed tomography without intravenous contrast is the imaging method of choice for diagnosis and planning of surgical intervention. Allowing an accurate assessment of the morphology and location of the stones; that will set the standard for guiding percutaneous access. Complete stone cleaning is the cornerstone of staghorn lithiasis treatment. The guidelines of the European Association of Urology and the American Association of Urology mention that percutaneous nephrolithotomy continues to be the treatment of choice for large stones. Conservative management is related to renal loss and urosepsis, reporting a mortality of 28 % up to 30% within 10 years, as well as a 36% risk of developing chronic kidney disease

Algunas tendencias histórico-metodológicas de la evolución del Programa Materno Infantil en Cuba

En este trabajo se ofrece una valoración de la evolución histórica sobre algunas tendencias históricas metodológicas de la evolución del programa materno-infantil con énfasis en el desarrollo alcanzado en Cuba. Desde el siglo XVI hasta la actualidad.

Hidradenitis suppurativa: a review

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder that is characterized by recurrence, as well as the characteristic location of skin lesions. Patients usually develop very painful inflammatory nodules that generally end in the formation of multiple abscesses and fistulas that typically occur in the skin of the axillary, inguinal, buttock, and perianal folds. It significantly affects the quality of life of patients, leaving physical, economic and psychological sequelae. There is a wide therapeutic arsenal available, but each patient must be individualized and the best possible treatment determined. Early assessment and intensive treatment of the disease can prevent and even avoid significant sequelae and permanent deformities

Current strategies for the reconstruction of the nipple-areola complex: a review

The reconstruction of the nipple-areola complex after a mastectomy is essential for the bio-psycho-social recovery of the patient, it is generally performed 4 to 6 months after surgery and there are multiple surgical reconstruction techniques depending on the experience of the surgeon and of the individual characteristics of the patients. The most widely used for its safety and for having shown the best results is the local flap technique combined with the use of autologous, alloplastic and allograft grafts. However, currently there is still no technique that shows long-term lasting results. For this reason, in this article we describe the five categories of reconstruction techniques for the nipple-areola complex that currently exist, their advantages and disadvantages, as well as the lines of research in tissue engineering in which the world is working to find a therapeutic strategy that can reproduce a nipple-areola complex with the characteristics of the biologic.

Biodegradable electrospun scaffolds for skin wound regeneration: a review

Over the years, skin substitutes have been sought as an alternative for the treatment of different pathologies. In this article, we focus on describing the use of different biodegradable nanofibrillar polymers as skin substitutes in the treatment of acute and chronic wounds, obtained by the electrospinning technique. Electrospinning is a tissue engineering technique used to generate nanofibers of different polymers that are characterized by having a high surface area, low molecular weight, high resistance rates, and nanoporosity, which is why they are particularly interesting for biomedicine, with potential applicability. in the replacement of skin and tubular organs. In this context, the skin created by tissue engineering has high expectations of application in the study of treatment of skin wounds

MKK6 controls T3-mediated browning of white adipose tissue

El aumento de la capacidad termogénica del tejido adiposo para mejorar el gasto de energía del organismo se considera una estrategia terapéutica prometedora para combatir la obesidad. Aquí nosotros informe que la expresión del activador MAPK p38 MKK6 está elevada en el tejido adiposo blanco de individuos obesos. Usando animales knockout y shRNA, mostramos que la eliminación de Mkk6 aumenta el gasto de energía y la capacidad termogénica del tejido adiposo blanco, protegiendo a los ratones contra la obesidad inducida por la dieta y el desarrollo de la diabetes. La eliminación de Mkk6 aumenta la expresión de UCP1 estimulada por T3 en los adipocitos, lo que aumenta su capacidad termogénica. De manera mecánica, demostramos que, en el tejido adiposo blanco, p38 se activa mediante una ruta alternativa que involucra AMPK, TAK y TAB. Nuestros resultados identifican MKK6 en los adipocitos como un posible objetivo terapéutico para reducir la obesidad.Increasing the thermogenic capacity of adipose tissue to enhance organismal energy expenditure is considered a promising therapeutic strategy to combat obesity. Here, we report that expression of the p38 MAPK activator MKK6 is elevated in white adipose tissue of obese individuals. Using knockout animals and shRNA, we show that Mkk6 deletion increases energy expenditure and thermogenic capacity of white adipose tissue, protecting mice against diet-induced obesity and the development of diabetes. Deletion of Mkk6 increases T3-stimulated UCP1 expression in adipocytes, thereby increasing their thermogenic capacity. Mechanistically, we demonstrate that, in white adipose tissue, p38 is activated by an alternative pathway involving AMPK, TAK, and TAB. Our results identify MKK6 in adipocytes as a potential therapeutic target to reduce obesity.• Guadalupe Sabio Buzo y Rebeca Acin Pérez pertenecen a Programa Ramón y Cajal • Elisa Manieri pertenece a Caixa • Ministerio de Economía y Competitividad. Proyecto FPI BES-2014-069332, para Valle Montalvo Romeral • Ministerio de Economía y Competitividad. Proyecto FPI BES-2011-043428, para Edgar Bernardo • Ministerio de Economía y Competitividad y FEDER SAF2016-79126-R y Comunidad de Madrid S2010 / BMD-2326, para Guadalupe Sabio Buzo • ISCIII y FEDER, PI10 / 01692 e I3SNS-INT12 / 049, para Miguel Marcos Martín • Junta de Castilla y León GRS 681 / A / 11, para Lourdes Hernández Cosido • Ministerio de Economía y Competitividad. BFU2015-70664-R, Xunta de Galicia 2015-CP080 y PIE13 / 00024, y ERC281408, para Rubén Nogueiras Pozo • Unión Europea. Becas europeas UE0 / MCA1108 y UE0 / MCA1201; y la Comunidad de Madrid CAM / API1009, para Rubén Nogueiras Pozo • Junta de Extremadura y FEDER BR15164, para Francisco Centeno Velázquez • Ministerio de Economía y Competitividad. . BFU2013-46109-R, para Clara V. Álvarez Villamarín • European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no. ERC 260464peerReviewe