Successful removal of a telephone cable, a foreign body through the urethra into the bladder: a case report

The variety of foreign bodies inserted into or externally attached to the genitourinary tract defies imagination and includes all types of objects. The frequency of such cases renders these an important addition to the diseases of the genitourinary organs. The most common motive associated with the insertion of foreign bodies into the genitourinary tract is sexual or erotic in nature. In adults this is commonly caused by the insertion of objects used for masturbation and is frequently associated with mental health disorders. We report a case of insertion of telephone cable wire into the urethra. Our case highlights the importance of good history, clinical examination, relevant radiological investigation and simple measures to solve the problem

Chemical control of the invasive weed Araujia sericifera Brot.

[EN] Araujia sericifera Brot. is a weed that was introduced in Europe from South America as an ornamental species. It has had a successfully adaptation to citrus orchards management in the Mediterranean area, especially on poorly weed managed or abandoned ones. The objective of this study was to determine the efficacy of the authorized herbicides in Spain for citrus against A. sericifera and a Natural product under development. The study was conducted in a controlled environmental chamber where the weed was cultivated in pots. The whole study consisted in 2 experiments applying 11 pre-emergent herbicides and mixtures and 3 experiments applying 14 post-emergent herbicides and mixtures in two different phenological stages. In conclusion, post-emergent control was better than pre-emergent treatments, especially with contact herbicides (pelargonic acid, diquat, Natural and pyraflufen ethyl). However, the penoxsulam + florasulam combination applied to the soil was very effective. The Natural herbicide was just effective when it was applied on post-emergence of the weed.[ES] La mala hierba Araujia sericifera Brot. fue introducida en Europa como especie ornamental procedente de Sudamérica. Se ha adaptado al manejo de los huertos de cítricos del área Mediterránea, sobre todo a los que descuidan el control de las malas hierbas y a los abandonados. El objetivo de este estudio fue comprobar la eficacia de los herbicidas autorizados en España en citricultura y de un producto natural en desarrollo frente a esta mala hierba. El trabajo se llevó a cabo en una cámara de crecimiento controlado donde se cultivó la mala hierba en macetas. Se realizaron 2 ensayos en preemergencia de la mala hierba aplicando 11 materias activas y mezclas y otros 3 ensayos en postemergencia, aplicando 14 materias activas y mezclas en dos estados fenológicos diferentes. Se concluyó que la mezcla de penoxsulam + florasulam aplicada al suelo en preemergencia de la mala hierba resultó muy efectiva, sin embargo, el control en postemergencia fue más efectivo que en preemergencia, sobre todo con los herbicidas de contacto (ácido pelargónico, diquat, Natural y piraflufen etil). El herbicida Natural se mostró efectivo solo en postemergencia.Gómez De Barreda, D.; De Luca, V.; Osca Lluch, JM.; Verdeguer Sancho, MM.; Muñoz, M. (2020). Control químico de la mala hierba invasora Araujia sericifera Brot. ITEA-Informacion Tecnica Economica Agraria. 116(3):212-226. https://doi.org/10.12706/itea.2020.001S212226116

Confiabilidad de las Ondas de Activación Local para Evaluar el Sustrato Auricular de Pacientes con Fibrilación Auricular Paroxística

[ES] El análisis de electrogramas (EGMs) del seno coronario (SC) durante la ablación por catérer (AC) de fibrilación auricular (FA) es clave para la evaluación del sustrato auricular. No obstante, los canales del catéter de registro suelen verse afectados por mal contacto y por el movimiento cardíaco. Este trabajo estudia los canales más fiables para preservar las dinámicas de la FA durante el ritmo sinusal (RS). Se han empleado 44 registros bipolares multicanal del SC de 60-300 segundos de 28 pacientes con FA paroxística sometidos a AC. Cada registro contenía cinco canales: distal, medio-distal, medio, medio-proximal, proximal. En cada canal se calcularon características de las ondas de activación local (OALs): duración, área y correlación entre morfologías dominantes. Se han utilizado los tests de KruskalWallis, Mann-Whitney y Mann-Whitney con corrección de Bonferroni para la comparación multicanal, por pares y uno frente a los demás, respectivamente. El canal distal presentó resultados menos fiables, con OALs de duración larga (p = 0,047), amplitud baja (pmax < 0,003) y menos área (pmax < 0,020) y con correlación entre sus OALs y las OALs del canal proximal relativamente baja (85,57 %). Las OALs entre los canales medio y medio-próximal fueron más consistentes, con correlación entre sus OALs muy altas (95,02 %), presentando además duración más corta (p = 0,084) y amplitud (pmax < 0,050) y áreas mayores (pmax < 0,070). En consecuencia, los canales medios y medio-proximales son más robustos, preservando al máximo las dinámicas de la FA, por ello se aconseja su empleo para evaluar el sustrato auricular de pacientes con FA durante el RS.Trabajo cofinanciado por los proyectos de investigación competitiva DPI2017-83952-C3 de MINECO-AEIFEDER-UE, SBPLY/17/180501/000411 de la JCCLM y AICO/2019/036 de la GVA.Vraka, A.; Hornero Sos, F.; Bertomeu-González, V.; Osca Asensi, J.; Alcaraz Martínez, R.; Rieta, JJ. (2020). Confiabilidad de las Ondas de Activación Local para Evaluar el Sustrato Auricular de Pacientes con Fibrilación Auricular Paroxística. Sociedad Española de Ingeniería Biomédica. 430-433. http://hdl.handle.net/10251/178274S43043

Verificación Sobre la Estabilidad de Electrogramas Fragmentados para la Caracterización del Sustrato Auricular en Pacientes con Fibrilación Auricular

[ES] Para caracterizar el sustrato auricular en fibrilacion auricular (FA) se ha investigado un amplio numero de indices aplicados a electrogramas auriculares fragmentados complejos (CFAE). Sin embargo, se ha obviado la evaluacion de su calidad, asi como de su estabilidad interna (intra-canal) e intra-paciente. Este trabajo evalua la estabilidad intracanal e intra-paciente de 204 CFAEs bipolares de FA registrados en pacientes con FA paroxistica (n = 15) y persistente (n = 19) aplicando indices no lineales. Para estimar las diferencias entre los CFAEs se ha utilizado el coeficiente de variacion (CV) de la entropia muestral (SE) y el determinismo (DET) del analisis de cuantificacion de recurrencias (RQA) de los datos. Ademas, tambien se analizaron las variaciones introducidas al descartar los segmentos de CFAEs ruidosos y con artefactos. El analisis intra-canal reporto una variacion significativa del CV( %) para cualquier longitud de segmento analizado tanto para DET como para SE al descartar segmentos ruidosos, habiendo mayores disminuciones para segmentos mas largos. Ademas, se observaron grandes variaciones de CV( %) para DET y SE en cualquier longitud de segmento en el analisis intra-paciente, pero en este caso, el descarte de segmentos ruidosos no mejoro resultados. La prueba de Kruskal-Wallis reporto diferencias estadisticamente significativas para DET y SE entre canales, independientemente del proceso de descarte. Por tanto, la alta variabilidad observada de los CFAEs ha demostrado que promediar los datos en un canal o entre diferentes canales puede conducir a una simplificacion excesiva de la caracterizacion del sustrato auricular basada en CFAEs.El presente trabajo ha sido cofinanciado por los proyectos de investigacion competitiva DPI2017-83952-C3 de MINECO-AEI-FEDER-UE, SBPLY/17/180501/000411 de la JCCLM y AICO/2019/036 de la GVA.Finotti, E.; Hornero Sos, F.; Bertomeu-González, V.; Osca Asensi, J.; Alcaraz Martínez, R.; Rieta, JJ. (2020). Verificación Sobre la Estabilidad de Electrogramas Fragmentados para la Caracterización del Sustrato Auricular en Pacientes con Fibrilación Auricular. Sociedad Española de Ingeniería Biomédica. 422-425. http://hdl.handle.net/10251/178257S42242

Alterations in leukocyte DNA methylome are associated to immunosuppression in severe clinical phenotypes of septic patients

IntroductionSepsis patients experience a complex interplay of host pro- and anti-inflammatory processes which compromise the clinical outcome. Despite considering the latest clinical and scientific research, our comprehension of the immunosuppressive events in septic episodes remains incomplete. Additionally, a lack of data exists regarding the role of epigenetics in modulating immunosuppression, subsequently impacting patient survival.MethodsTo advance the current understanding of the mechanisms underlying immunosuppression, in this study we explored the dynamics of DNA methylation using the Infinium Methylation EPIC v1.0 BeadChip Kit in leukocytes from patients suffering from sepsis, septic shock, and critically ill patients as controls, within the first 24 h after admission in the Intensive Care Unit of a tertiary hospital.Results and discussionEmploying two distinct analysis approaches (DMRcate and mCSEA) in comparing septic shock and critically ill patients, we identified 1,256 differentially methylated regions (DMRs) intricately linked to critical immune system pathways. The examination of the top 100 differentially methylated positions (DMPs) between septic shock and critically ill patients facilitated a clear demarcation among the three patient groups. Notably, the top 6,657 DMPs exhibited associations with organ dysfunction and lactate levels. Among the individual genes displaying significant differential methylation, IL10, TREM1, IL1B, and TNFAIP8 emerged with the most pronounced methylation alterations across the diverse patient groups when subjected to DNA bisulfite pyrosequencing analysis. These findings underscore the dynamic nature of DNA methylation profiles, highlighting the most pronounced alterations in patients with septic shock, and revealing their close association with the disease

Measurement of health-related quality by multimorbidity groups in primary health care

[EN] Background: Increased life expectancy in Western societies does not necessarily mean better quality of life. To improve resources management, management systems have been set up in health systems to stratify patients according to morbidity, such as Clinical Risk Groups (CRG). The main objective of this study was to evaluate the effect of multimorbidity on health-related quality of life (HRQL) in primary care. Methods: An observational cross-sectional study, based on a representative random sample (n = 306) of adults from a health district (N = 32,667) in east Spain (Valencian Community), was conducted in 2013. Multimorbidity was measured by stratifying the population with the CRG system into nine mean health statuses (MHS). HRQL was assessed by EQ-5D dimensions and the EQ Visual Analogue Scale (EQ VAS). The effect of the CRG system, age and gender on the utility value and VAS was analysed by multiple linear regression. A predictive analysis was run by binary logistic regression with all the sample groups classified according to the CRG system into the five HRQL dimensions by taking the ¿healthy¿ group as a reference. Multivariate logistic regression studied the joint influence of the nine CRG system MHS, age and gender on the five EQ-5D dimensions. Results: Of the 306 subjects, 165 were female (mean age of 53). The most affected dimension was pain/discomfort (53%), followed by anxiety/depression (42%). The EQ-5D utility value and EQ VAS progressively lowered for the MHS with higher morbidity, except for MHS 6, more affected in the five dimensions, save self-care, which exceeded MHS 7 patients who were older, and MHS 8 and 9 patients, whose condition was more serious. The CRG system alone was the variable that best explained health problems in HRQL with 17%, which rose to 21% when associated with female gender. Age explained only 4%. Conclusions: This work demonstrates that the multimorbidity groups obtained by the CRG classification system can be used as an overall indicator of HRQL. These utility values can be employed for health policy decisions based on cost-effectiveness to estimate incremental quality-adjusted life years (QALY) with routinely e-health data. Patients under 65 years with multimorbidity perceived worse HRQL than older patients or disease severity. Knowledge of multimorbidity with a stronger impact can help primary healthcare doctors to pay attention to these population groups.The authors would like to thank the Conselleria de Sanitat Universal i Sanitat Pública of the Generalitat Valenciana (the Regional Valencian Health Government) for providing the study data. We would also like to thank Helen Warbuton for editing the English.Milá-Perseguer, M.; Guadalajara Olmeda, MN.; Vivas-Consuelo, D.; Usó-Talamantes, R. (2019). 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Aten Primaria. 2015;47(5):301–7.Agborsangaya CB, Lau D, Lahtinen M, Cooke T, Johnson JA. Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health. 2012;12:201.Orueta JF, García-Álvarez A, García-Goñi M, Paolucci F, Nuño-Solinís R. Prevalence and costs of multimorbidity by deprivation levels in the Basque Country: a population based study using health administrative databases. PLoS One. 2014;9(2):e89787.Mujica-Mota RE, Roberts M, Abel G, Elliott M, Lyratzopoulos G, Roland M, Campbell J. Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey. Qual Life Res. 2015;24(4):909–18.Caballer Tarazona V, Guadalajara Olmeda N, Vivas Consuelo D, Clemente Collado A. Impact of morbidity on health care costs of a Department of Health through clinical risk groups. Valencian Community, Spain. Rev Esp Salud Publica. 2016;90:e1–e15.Calderon-Larranaga A, Abrams C, Poblador-Plou B, Weiner JP, Prados-Torres A. Applying diagnosis and pharmacy-based risk models to predict pharmacy use in Aragon, Spain: the impact of a local calibration. BMC Health Serv Res. 2010;10:22.Hughes JS, Averill RF, Eisenhandler J, Goldfield NI, Muldoon J, Neff JM, Gay JC. Clinical risk groups (CRGs): a classification system for risk-adjusted capitation-based payment and health care management. Med Care. 2004;42(1):81–90.Vivas-Consuelo D, Uso-Talamantes R, Trillo-Mata JL, Caballer-Tarazona M, Barrachina-Martinez I, Buigues-Pastor L. Predictability of pharmaceutical spending in primary health services using clinical risk groups. Health Policy. 2014;116(2–3):188–95.Milla Perseguer M, Guadalajara Olmeda N, Vivas Consuelo D. Impact of cardiovascular risk factors on the consumption of resources in primary care according to clinical risk groups. Aten Primaria. 2018.WHOQOL. 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Predicting health-related quality of life (EQ-5D-5 L) and capability wellbeing (ICECAP-A) in the context of opiate dependence using routine clinical outcome measures: CORE-OM, LDQ and TOP. Health Qual Life Outcomes. 2018;16(1):106.Rivero-Arias O, Ouellet M, Gray A, Wolstenholme J, Rothwell PM, Luengo-Fernandez R. Mapping the modified Rankin scale (mRS) measurement into the generic EuroQol (EQ-5D) health outcome. Med Decis Mak. 2010;30.Argimon Pallás JM, Jiménez Villa J: Métodos de investigación clínica y epidemiológica, vol. Capítulo 15. Tamaño de la muestra; 2013.Yepes-Núñez JJ, García García HI: Preferencias de estados de salud y medidas de utilidad. In., vol. 24. Iatreia; 2011: 365–377.Attema AE, Edelaar-Peeters Y, Versteegh MM, Stolk EA. Time trade-off: one methodology, different methods. Eur J Health Econ. 2013;14(Suppl 1):S53–64.Badia X, Roset M, Herdman M, Kind P. A comparison of United Kingdom and Spanish general population time trade-off values for EQ-5D health states. 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Pseudoneoplastic lesions of the testis and paratesticular structures

Pseudotumors or tumor-like proliferations (non-neoplastic masses) and benign mimickers (non-neoplastic cellular proliferations) are rare in the testis and paratesticular structures. Clinically, these lesions (cysts, ectopic tissues, and vascular, inflammatory, or hyperplastic lesions) are of great interest for the reason that, because of the topography, they may be relevant as differential diagnoses. The purpose of this paper is to present an overview of the pseudoneoplasic entities arising in the testis and paratesticular structures; emphasis is placed on how the practicing pathologist may distinguish benign mimickers and pseudotumors from true neoplasia. These lesions can be classified as macroscopic or microscopic mimickers of neoplasia

withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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