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OBJECTIVE: To assess safety, urinary symptoms, and feasibility of JJ stent removal with exteriorized threads through the percutaneous tract after percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: Prospective, transversal, comparative, experimental, randomized 1-to-1 cohort study in 52 patients who underwent "tubeless" PCNL from October 2020 to November 2022. Group A with threads through the urethra and Group B through the percutaneous tract. The validated USSQ (Ureteral Stent Symptom Questionnaire) was applied in the Urology office a week after the procedure, and the JJ stent was withdrawn by pulling the threads. Hemoglobin and urine culture, and pre- and post-surgery were evaluated. RESULTS: There is a statistically significant difference in favor of group B when comparing urinary symptoms (p = 0.008), body pain (p = 0.009), and general condition (p = 0.042), mainly for non-urgency incontinence, frequency of analgesic use, and dysuria. There were significant differences between groups (p = 0.028, p = 0.026, p = 0.027, respectively). There is no association with urinary infections (p = 0.603) nor an increased risk of bleeding (p = 0.321). CONCLUSION: The removal of the JJ stent with exteriorized threads through the percutaneous tract after PCNL in the office is a feasible and safe procedure if it is removed before 8 days and has better tolerance regarding the urinary symptoms.

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BACKGROUND: Accumulated evidence indicates that patients with lung cancer are a vulnerable population throughout the pandemic. Limited information is available in Latin America regarding the impact of the pandemic on medical care. The goal of this study was to describe the clinical and social effect of COVID-19 on patients with thoracic cancer and to ascertain outcomes in those with a confirmed diagnosis. MATERIALS AND METHODS: This cohort study included patients with thoracic neoplasms within a single institution between March 1, 2020, and February 28, 2021. All variables of interest were extracted from electronic medical records. During this period, the Depression Anxiety and Stress Scale 21 (DASS-2) was applied to evaluate and identify more common psychological disorders. RESULTS: The mean age for the total cohort (n = 548) was 61.5 ± 12.9 years; non-small cell lung cancer was the most frequent neoplasm (86.9%), advanced stages predominated (80%), and most patients were under active therapy (82.8%). Any change in treatment was reported in 23.9% of patients, of which 78.6% were due to the COVID-19 pandemic. Treatment delays (≥7 days) were the most frequent modifications in 41.9% of cases, followed by treatment suspension at 37.4%. Patients without treatment changes had a more prolonged progression-free survival and overall survival (hazard ratio [HR] 0.21, p < .001 and HR 0.28, p < .001, respectively). The mean DASS-21 score was 10.45 in 144 evaluated patients, with women being more affected than men (11.41 vs. 9.08, p < .001). Anxiety was reported in 30.5% of cases, followed by depression and distress in equal proportions (18%). Depressed and stressed patients had higher odds of experiencing delays in treatment than patients without depression (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.53-13.23, p = .006 and OR 3.18, 95% CI 1.2-10.06, p = .006, respectively). CONCLUSION: Treatment adjustments in patients with thoracic malignancies often occurred to avoid COVID-19 contagion with detrimental effects on survival. Psychological disorders could have a role in adherence to the original treatment regimen. IMPLICATIONS FOR PRACTICE: The pandemic has placed an enormous strain on health care systems globally. Patients with thoracic cancers represent a vulnerable population, with increased morbidity and mortality rates. In Mexico, treatment modifications were common during the pandemic, and those who experienced delays had worse survival outcomes. Most treatment modifications were related to a patient decision rather than a lockdown of health care facilities in which mental health impairment plays an essential role. Moreover, the high case fatality rate highlights the importance of improving medical care access. Likewise, to develop strategies facing future threats that may compromise health care systems in non-developed countries.

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PURPOSE: The ultrasound-guided (US) puncture in percutaneous nephrolithotomy (PCNL) has demonstrated advantages over traditional fluoroscopy access. The aim of this study was to demonstrate the reduction of fluoroscopy time using this technique during PCNL as the surgeon gained experience. METHODS: Transversal study performed on 30 consecutive patients undergoing PCNL from March to November 2019. All punctures were performed with US guidance. The patients were divided into 2 groups of 15 each according to the chronological order of the intervention. Demographic data, preoperative parameters, puncture time, fluoroscopy time, stone-free rate and complications were analyzed. RESULTS: The time of fluoroscopy was considerably reduced as the experience in the number of cases increased, reducing from 83.09 ± 47.8 s in group 1 to 22.8 ± 10.3 s in group 2 (p < 0.01), the time required to perform the puncture was reduced of 108.1 ± 68.9 s in group 1, to 92.6 ± 94.7 s in group 2 (p < 0.67). Stone free rate of 83.3% was obtained globally. CONCLUSION: US percutaneous renal access is safe and reproducible technique; the main advantage is to reduce exposure to radiation without compromising clinical results and has a short learning curve for urologists with prior experience in PCNL.

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IMPORTANCE: Metformin hydrochloride is emerging as a repurposed anticancer drug. Preclinical and retrospective studies have shown that it improves outcomes across a wide variety of neoplasms, including lung cancer. Particularly, evidence is accumulating regarding the synergistic association between metformin and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs). OBJECTIVE: To assess the progression-free survival (PFS) in patients with advanced lung adenocarcinoma who received treatment with EGFR-TKIs plus metformin compared with those who received EGFR-TKIs alone. DESIGN, SETTING, AND PARTICIPANTS: Open-label, randomized, phase 2 trial conducted at the Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. Eligible patients were 18 years or older, had histologically confirmed stage IIIB-IV lung adenocarcinoma with an activating EGFR mutation. INTERVENTIONS: Patients were randomly allocated to receive EGFR-TKIs (erlotinib hydrochloride, afatinib dimaleate, or gefitinib at standard dosage) plus metformin hydrochloride (500 mg twice a day) or EGFR-TKIs alone. Treatment was continued until occurrence of intolerable toxic effects or withdrawal of consent. MAIN OUTCOMES AND MEASURES: The primary outcome was PFS in the intent-to-treat population. Secondary outcomes included objective response rate, disease control rate, overall survival (OS), and safety. RESULTS: Between March 31, 2016, and December 31, 2017, a total of 139 patients (mean [SD] age, 59.4 [12.0] years; 65.5% female) were randomly assigned to receive EGFR-TKIs (n = 70) or EGFR-TKIs plus metformin (n = 69). The median PFS was significantly longer in the EGFR-TKIs plus metformin group (13.1; 95% CI, 9.8-16.3 months) compared with the EGFR-TKIs group (9.9; 95% CI, 7.5-12.2 months) (hazard ratio, 0.60; 95% CI, 0.40-0.94; P = .03). The median OS was also significantly longer for patients receiving the combination therapy (31.7; 95% CI, 20.5-42.8 vs 17.5; 95% CI, 11.4-23.7 months; P = .02). CONCLUSIONS AND RELEVANCE: To our knowledge, this is the first study to prospectively show that the addition of metformin to standard EGFR-TKIs therapy in patients with advanced lung adenocarcinoma significantly improves PFS. These results justify the design of a phase 3, placebo-controlled study. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03071705.

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BACKGROUND: Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN. METHODS: It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome. RESULTS: 73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p <0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p <0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p < 0.001) were factors significantly associated with adverse outcome. CONCLUSION: Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.

Introducción: La pielonefritis enfisematosa es una infección grave del tracto urinario caracterizada por la presencia de gas en los sistemas colectores, en el parénquima renal o en el tejido perirrenal; su causa no es del todo conocida, pero se ha sugerido que se debe a la fermentación de glucosa por enterobacterias y anaerobios. El objetivo fue evaluar los factores pronósticos de morbimortalidad en pacientes con diagnóstico de pielonefritis enfisematosa. Métodos: estudio de cohorte histórica en pacientes con diagnóstico de pielonefritis enfisematosa que ingresaron a nuestro hospital de marzo de 2005 a diciembre de 2014. Se identificaron los pacientes con desenlace adverso definido como aquel que requirió estancia en unidad de cuidados intensivos, nefrectomía o muerte. Se realizó una regresión logística múltiple para obtener la relación de cada factor pronóstico con el desenlace adverso. Resultados: Fueron evaluados 73 pacientes (48 mujeres [65.8 %]). Diabetes, litiasis urinaria, infección por Escherichia coli y el estado de choque se presentaron en 68.5 %, 68.5 %, 63 % y 15.1 %, respectivamente. Fueron factores significativos para desenlace adverso la leucocitosis ≥ 12 000 µL (RM 43.65, IC 95 % 2.36-805, p < 0.001), la trombocitopenia ≤ 120 000 µL (RM 363, IC 95 % 9.2-14208, p < 0.0001), y la clase radiológica 3 de Huang (RM 62, IC 95 % 4-964, p < 0.001). Conclusión: la trombocitopenia, la leucocitosis y la clase radiológica 3 se asociaron con un desenlace adverso en los pacientes con pielonefritis enfisematosa.

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El objetivo general de este trabajo es presentar una revisión teórica de los factores y elementos que la literatura describe como obstáculos en las trayectorias profesionales de mujeres hacia cargos directivos. A pesar de la masiva incorporación de las mujeres al mercado laboral en las últimas décadas, éstas continúan jugando en desventaja respecto a sus homónimos masculinos, haciéndose esta desigualdad más patente en el acceso a cargos de poder. Para apoyar esta hipótesis, se realiza una revisión, en el contexto español y europeo, desde los años setenta a la actualidad, de estudios sobre las principales barreras que las mujeres deben enfrentar en el camino hacia la dirección, entre ellas: la menor formación, los estereotipos de género, el liderazgo femenino, los trabajos y sectores tradicionalmente femeninos, el menor acceso a las redes sociales o networks, las dificultades de conciliación familiar y profesional y la brecha salarial. Esta revisión destaca la necesidad de investigar las distintas formas en las que se abordan las limitaciones-barreras-facilitadores de la trayectoria laboral femenina en relación a las acciones que a nivel organizativo e institucional se proponen.(AU)

The main objective of this paper is to review the factors and elements described in the literature as obstacles of professional careers of women in leadership positions. Despite the massive incorporation of women into the labour market in recent decades, they are still in disadvantage compared to their fellow men. This inequality becomes more evident when women are accessing to leadership positions. To support this hypothesis, studies in an European context, on the main barriers that women must face in the path to leadership, have been reviewed from the seventies to the present, including: less professional training, gender stereotypes, the leadership of women, jobs and sectors which are traditionally female, less access to social networks, difficulties of reconciling family and professional life and salary differences. This review highlights the need for research addressing various forms of constraints, barriers, facilitators of the careers of women in relation to actions proposed at the organizational and institutional level.(AU)

O objetivo deste trabalho é analisar os fatores e elementos que a literatura descreve como obstáculos na carreira de mulheres para cargos gerenciais. Apesar da incorporação massiva das mulheres no mercado de trabalho nas últimas décadas, elas continuam a jogar em desvantagem em relação ao seu homônimo masculino, tornando-se mais evidente a desigualdade no acesso a posições de poder. Para apoiar esta hipótese, analisamos no contexto europeu, e mais especialmente espanhol, a partir dos anos setenta até o presente, estudos sobre os principais obstáculos que as mulheres enfrentam no caminho para cargos de direção, tendo entre eles: a menor formação profissional, os estereótipos de gênero, a liderança feminina, os trabalhos e setores tradicionalmente femininos, menos acesso a redes sociais ou networks, as dificuldades de conciliação da vida familiar e profissional e as diferenças salariais. Conclui-se neste estudo sobre a necessidade de investigação das diferentes formas das limitações, barreiras e facilitadores da trajetória laboral feminina no contexto das ações, em nível organizativo e institucional.(AU)

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El objetivo general de este trabajo es presentar una revisión teórica de los factores y elementos que la literatura describe como obstáculos en las trayectorias profesionales de mujeres hacia cargos directivos. A pesar de la masiva incorporación de las mujeres al mercado laboral en las últimas décadas, éstas continúan jugando en desventaja respecto a sus homónimos masculinos, haciéndose esta desigualdad más patente en el acceso a cargos de poder. Para apoyar esta hipótesis, se realiza una revisión, en el contexto español y europeo, desde los años setenta a la actualidad, de estudios sobre las principales barreras que las mujeres deben enfrentar en el camino hacia la dirección, entre ellas: la menor formación, los estereotipos de género, el liderazgo femenino, los trabajos y sectores tradicionalmente femeninos, el menor acceso a las redes sociales o networks, las dificultades de conciliación familiar y profesional y la brecha salarial. Esta revisión destaca la necesidad de investigar las distintas formas en las que se abordan las limitaciones-barreras-facilitadores de la trayectoria laboral femenina en relación a las acciones que a nivel organizativo e institucional se proponen.

The main objective of this paper is to review the factors and elements described in the literature as obstacles of professional careers of women in leadership positions. Despite the massive incorporation of women into the labour market in recent decades, they are still in disadvantage compared to their fellow men. This inequality becomes more evident when women are accessing to leadership positions. To support this hypothesis, studies in an European context, on the main barriers that women must face in the path to leadership, have been reviewed from the seventies to the present, including: less professional training, gender stereotypes, the leadership of women, jobs and sectors which are traditionally female, less access to social networks, difficulties of reconciling family and professional life and salary differences. This review highlights the need for research addressing various forms of constraints, barriers, facilitators of the careers of women in relation to actions proposed at the organizational and institutional level.

O objetivo deste trabalho é analisar os fatores e elementos que a literatura descreve como obstáculos na carreira de mulheres para cargos gerenciais. Apesar da incorporação massiva das mulheres no mercado de trabalho nas últimas décadas, elas continuam a jogar em desvantagem em relação ao seu homônimo masculino, tornando-se mais evidente a desigualdade no acesso a posições de poder. Para apoiar esta hipótese, analisamos no contexto europeu, e mais especialmente espanhol, a partir dos anos setenta até o presente, estudos sobre os principais obstáculos que as mulheres enfrentam no caminho para cargos de direção, tendo entre eles: a menor formação profissional, os estereótipos de gênero, a liderança feminina, os trabalhos e setores tradicionalmente femininos, menos acesso a redes sociais ou networks, as dificuldades de conciliação da vida familiar e profissional e as diferenças salariais. Conclui-se neste estudo sobre a necessidade de investigação das diferentes formas das limitações, barreiras e facilitadores da trajetória laboral feminina no contexto das ações, em nível organizativo e institucional.

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Resumen:

Introducción: La enfermera en el escenario asistencial realiza a la par actividades docentes sin estar del todo consciente en muchas ocasiones de la trascendencia en su papel docente.

Objetivo: evaluar una estrategia educativa participativa para el desarrollo de capacidades de lectura crítica. Metodología: estudio de intervención educativa con medición pre-intervención (PI) y pos-intervención (PoI), respectivamente en un grupo de ocho enfermeras asistenciales. Se estimó la postura, mediante un instrumento construido con dos concepciones divergentes en educación Postura ante la Educación del Personal de Enfermería (PEPE). Se midió la validez conceptual y de contenido con dos rondas de expertos utilizando el consenso de 4 de 4 y acuerdo mayoritario de 3 de 4. Se estimó la consistencia interna con la prueba de semipartición. El desarrollo de lectura crítica fue medido con el instrumento Lectura Crítica de Textos Teóricos en Educación (LECTTE), a partir de documentos teóricos -artículos de revisión y capítulos de libro-. Se midió la correlación entre el desarrollo de postura y lectura crítica con la rho de Spearman. Resultados: se identificó el desarrollo de postura en 100 % de la muestra estudiada: PI de 41 y en PoI de 66.5, p < 0.001 y el desarrollo de lectura crítica: PI 31 y PoI de 65, p < 0.001. El coeficiente de correlación de Spearman entre el desarrollo de postura y la lectura crítica fue de 0.87, p < 0.05. Conclusiones: se identificó una asociación importante entre la exposición a la lectura crítica con respecto al desarrollo de postura de enfermería ante la actividad docente.

Abstract:

Introduction: Alongside the daily work in the caring scenario, the nurse performs many teaching activities without always being fully conscious of the importance of the teaching role-Objective: To evaluate an educational strategy for developing participatory skills in critical reading. Methodology: Educational intervention study with pre-intervention (PI) and post-intervention (Pol) measurements with a group of eight staff nurses. Posture was estimated by an instrument that was constructed of two divergent concepts in education Stance of Education Nursing Staff; in Spanish (PEPE). Conceptual and content validity were measured with two rounds of experts utilizing 4 of 4 consensus and majority agreement of 3 of 4. Internal consistency was estimated with semi-partition test The development of critical reading was measured with the Critical Reading of Theoretical Texts in Education instrument (LECTTE in Spanish), with theoretical texts (review articles and book chapters). Correlation between the development of the posture and critical reading were measured with Spearman's rho. Results: The position developed was identified in 100 % of the sample: PI 41 and Pol 66.5, p < 0.001 and the development of critical reading: PI 31 and Pol 65, p < 0.001. The Spearman's correlation coefficient between the development of posture and critical reading was 0.87, p < 0.05. Conclusion: We found a significant association between exposure to critical reading and the development of the posture of the nurse towards teaching.

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OBJECTIVE: To build, validate and apply an instrument to evaluate the clinical aptitude in intraepitelial cervical neoplasia (ICN) in residents. METHODS: The instrument included four clinical real cases, validated by experts and included 106 items using true, false and don't know answers. A pilot test and the 21 Kuder-Richardson formula were used to estimate consistency. It was applied to residents, in an observational, transversal, comparative and open study, including 11 second year residents, 13 third year residents and 12 fourth year residents. RESULTS: Consistency of 0.88 was obtained; 22% were located in the middle level, 39% were located in the low level and 39% in the very low level. There were no residents in the high or very high level or by chance answer level. The Kruskal-Wallis test showed significant differences among the three groups and with the U test of Mann Whitney there were no differences between groups. CONCLUSIONS: The year of residence did not show differences in the development of clinical aptitude in ICN. Most of the residents were located in the inferior level of clinical aptitude. This study makes evident the need to reframe our educative processes in a qualitative different manner.

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BACKGROUND: The professor's education posture (PEP) is a clearly indicator of the teaching practice that he or she realizes. Our objective was to estimate the presence of the PEP on medic groups with teaching formation: participative, traditional and without formation. METHODS: AN instrument was constructed and validated to estimate the presence of the PEP on three medic groups that work in two different medic units of high specialty in the north zone of Mexico City. RESULTS: The instrument was applied in the evaluation of the PEP to 86 physicians, it was observed significant statistical differences in the development of the physicians that had realized a methodology qualify in teaching with a participative focus. CONCLUSIONS: It is observed the development of an PEP in the physicians that have a teaching formation under a participative focus versus other physicians that had not the same teaching formation.

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We present the first results of four projects of a second phase of a Mexican Project Computer Assisted Surgery and Medical Robotics, supported by the Mexican Science and Technology National Council (Consejo Nacional de Ciencia y Tecnología) under grant SALUD-2002-C01-8181. The projects are being developed by three universities (UNAM, UAM, ITESM) and the goal of this project is to integrate a laboratory in a Hospital of the ISSSTE to give service to surgeons or clinicians of Endoscopic surgeons, urologist, gastrointestinal endoscopist and neurosurgeons.

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Estudio descriptivo realizado en el lapso de septiembre de 1993 a marzo de 1995. Del total de pacientes atendidas en el hospital, conocer la incidencia real de infección puerperal, como base para plantear hipótesis y tomar medidas de control. Se tomó registro diario de datos de interés en población sujeta a criterios de inclusión. Captura de datos en computadora personal. Análisis y gráficos utilizando programas Lotus 123, Statgraphics, EPI-6 y Freelance. Descripción de tasas, insidencias, riesgo relativo, media, desviación e estándar, variaciones temporales y tiempos de hospitalización. La tasa acumulada de infección puerperal, postcesárea, postparto y postaborto fue de 2.1 por ciento, 5.4 por ciento, 0.8 por ciento y 0.3 por ciento, respectivamente. Predominó la infección postcesárea, seguida por la infección post parto y postaborto, (media mensual de 24.6, 7.3 y 0.47, respectivamente). Con desviación estándar de 6.2, 3 y 0.6, respectivamente. Predominaron pacientes primigestas y secundigestas, para I y II y cesárea I. Las pacientes sujetas a cesárea (Riesgo incidencia acumulada 0.015), tuvieron un riesgo de infección 5.76 y 18.66 veces mayor que las atendidas por parto y legrado respectivamente. (riesgo relativo de 6.76 y 19.66). La localización de la infección se encuadró en nueve situaciones clínicas; las más importantes en orden de frecuencia fueron: deciduitis, deiduitis con absceso, deciduitis con infección urinaria, deciduitis complicada y absceso de pared aislado. El absceso de pared aislado o combinado y la deciduitis complicada impusieron la mayor estancia hospitalaria. La deciduitis complicada, (incidencia de 0.0010), obligó a histerectomía en 15 casos. No hubo muerte por infección

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