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Long-term changes in burnout and its predictors in hospital staff during the COVID-19 pandemic were investigated in an international study.Two online surveys were distributed to hospital staff in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) between May and October 2020 (T1) and between February and April 2021 (T2), using the following variables: Burnout (emotional exhaustion and depersonalization), job function, age, gender, and contact with COVID-19 patients; individual resources (self-compassion, sense of coherence, social support) and work-related resources and demands (support at the workplace, risk perception, health and safety at the workplace, altruistic acceptance of risk). Data were analyzed using linear mixed models repeated measures, controlled for age.A total of 612 respondents were included (76% women). We found an increase in burnout from T1 to T2. Burnout was high among personnel with high contact with COVID-19 patients. Individual factors (self-compassion, sense of coherence) and work-related factors (support at the workplace, risk perception, health and safety at the workplace) showed associations with burnout. Low health and safety at the workplace at T1 was associated with an increase in emotional exhaustion at T2. Men showed an increase in depersonalization if they had much contact with COVID-19 patients.Burnout represents a potential problematic consequence of occupational contact with COVID-19 patients. Special attention should be paid to this group in organizational health management. Self-compassion, sense of coherence, support at the workplace, risk perception, and health and safety at the workplace may be important starting points for interventions.Müller, M. M. (2020, August 30). Cope-Corona: Identifying and strengthening personal resources of hospital staff to cope with the Corona pandemic. Open Science Foundation.

Sol·licitant de l’informe: Districte 1. Ciutat Vella

OBJECTIVES To determine the most frequent urodynamic observations associated with bladder calculi, and to assess whether the presence of calculi alters these observations. PATIENTS AND METHODS Fifty patients with bladder stones were included in a prospective study in which two urodynamic tests were used, one at inclusion and another once the patient was stone- free after treatment by noninvasive methods (mainly extracorporeal shockwave lithotripsy). RESULTS The results from the urodynamic evaluation with the stone in the bladder were: bladder outlet obstruction in 51%, detrusor overactivity in 68%, detrusor under-activity in 10%, and a normal study in 18%. There were no significant differences between the urodynamic study before or after treatment in maximum flow rate and postvoid residual volume, detrusor overactivity and detrusor pressure at maximum flow. CONCLUSIONS Conversely to what has been accepted for years, bladder calculi are not always associated with bladder outlet obstruction and the urodynamic results are not influenced by the presence of bladder stones during the urodynamic testing.

"EXTRACORPOREAL WAVE LITHOTRIPSY ASSISTED DRAWING OF A CALCIFIED URETERAL STENT LEFT OUT FOR TWO YEARS" A 45 year old man with a 2 year forgotten left double-pigtail ureteric stent was referred to our hospital. Because of distal calcifications, the stent could not be removed by means of a cystoscopy. So, extracorporeal wave lithotripsies were performed and then the stent were easily removed in two fragments by cystoscopy and ureteroscopy.

Resumen Objetivos Evaluar la eficacia del AM3 (Inmunoferon®) como coadyuvante del tratamiento antibiotico en la cistitis recidivante de la mujer (CRM) para conocer la proporcion de respuesta al mismo con la intencion de disenar posteriormente un ensayo clinico. Material y Metodos Se estudiaron consecutivamente 24 mujeres que presentaron en los seis ultimos meses dos episodios documentados de cistitis no asociada a otra patologia y que no respondieron al tratamiento antibiotico. Se les pauto tratamiento antibiotico y 3 g diarios de AM3 durante 9 meses. Se evaluo la presencia de infeccion y de sintomatologia miccional irritativa en la visita inicial, y al primer, tercer, sexto y noveno mes. Resultados Completaron el estudio 19 pacientes. La proporcion de infeccion disminuyo del 100% en la visita inicial al 26% al primer mes para estabilizarse en torno al 50% en los meses sucesivos. La sintomatologia miccional irritativa disminuyo del 46% en la visita inicial a proporciones inferiores al 10% en los meses sucesivos. Conclusion El AM3 redujo la presencia de infeccion urinaria manifiesta en un 50% y la sintomatologia miccional irritativa caracteristica de CRM en un 90%. Estos hechos sugieren la necesidad de realizar estudios controlados para confirmar el efecto de AM3 en esta patologia.

Cystinuria type I: Identification of eight new mutations inSLC3A1.BackgroundCystinuria is a heritable disorder of amino acid transport characterized by the defective transport of cystine and the dibasic amino acids through the brush border epithelial cells of the renal tubule and intestine tract. Three types of cystinuria (I, II, and III) have been described based on the urinary excretion of cystine and dibasic amino acids in obligate heterozygotes. The SLC3A1 gene coding for an amino acid transporter named rBAT is responsible for type I cystinuria, whereas the SLC7A9 gene coding for a subunit (b0,+AT) of rBAT is involved in determining non-type I (types II and III) cystinuria.MethodsThe SLC3A1 gene sequence was investigated in a sample of seven type I/type I, three type I/non-type I, six type I/untyped, and four untyped unrelated cystinuric patients by RNA single-strand conformation polymorphism (RNA-SSCP).ResultsEight new point mutations (S168X, 765+1G>T, 766-2A>G, R452Q, Y461X, S547W, L564F, and C673W) and seven previously reported mutations were detected. These new mutations increase the number of mutated alleles so far characterized in SLC3A1 to 62.ConclusionsWe have found SLC3A1 mutations in 0.739 of the type I chromosomes studied. The relatively high proportion of uncharacterized type I chromosomes suggests either that there may be mutations not yet found in SLC3A1 or that many of the assigned type I chromosomes in mixed type I/non-type I patients may have mutations in SLC7A9. If the hypothesis is excluded in the future, we believe that a third gene may be involved in cystinuria.

Resumen fundamento Valorar la eficacia y los factores pronosticos de exito del tratamiento de la litiasis vesical (LV), mediante litotricia extracorporea por ondas de choque (LEOC) Metodos Estudio retrospectivo de 183 pacientes afectos de LV tratados mediante LEOC. Las variables independientes estudiadas fueron sexo, edad, obstruccion, tamano de la LV, numero de LV y numero de ondas. La variable dependiente fue la desaparicion total de la LV. Estudio de los factores pronosticos mediante analisis multivariante por regresion de Cox, y analisis de Kaplan-Meier. Variacion del tamano de la LV estudiada mediante la prueba t de Student Resultados Eficacia global del 73%. El analisis multivariante mostro que el unico factor pronostico fue el tamano inicial de la litiasis (p = 0,0035). A menor tamano de la LV mejor resultado (log rank p = 0,00001): eficacia del 92% en las LV menores de 1 cm2, 73% entre 1-2 cm2, 57% de 2-3 cm2 y 42% en mayores de 3 cm2. Disminucion media del tamano de la LV tras la primera sesion de LEOC de 2 cm2 (p = 0,0001) Conclusiones El unico factor pronostico fue el tamano inicial de la LV. La eficacia global de la tecnica es del 73%, aumentando considerablemente en LV menores a 2 cm2

The case observed was a non-affective psychotic syndrome associated with an antiretroviral regimen containing tenofovir plus emcitrabine which had not been previously described for any of these drugs. Suppression of these antiretroviral agents led to re-mission of symptoms, but not the antipsychotic treatment.

To assess treatment options for calculi in horseshoe kidneys and the impact of extracorporeal shockwave lithotripsy (ESWL) on the management of renal stones.From June 1971 to January 1998, 52 patients with horseshoe kidneys and calculi received treatment at our Urologic Stone Unit. There were 40 men (77%) and 12 women (23%). Average patient age was 41 years (range: 10-70 years). Clinical onset, treatment received and outcome were evaluated retrospectively. A successful outcome was defined as a patient without residual calculi or with fragments0.4 cm in size.Clinical onset was mainly low back pain in 37 patients (71%). Eighty-nine stones were treated, i.e. an average of 1.7 treatments per patient. Before the ESWL era (May 1987), we performed two heminephrectomies, 16 pyelolithotomies, 12 pyelolithotomies combined with ureteropyeloplasty and one percutaneous nephrolithotomy. Since the advent of ESWL, seven pyelolithotomies and three pyelolithotomies combined with ureteropyloplasty have been done. ESWL was used to treat 48 calculi. In three cases the patient was placed in the prone position due to difficulties in stone focusing. In 37 cases (77%) patients were either rendered stone-free or had residual fragments0.4 cm in size. Urinary diversion for obstruction was carried out in two cases (4%).At present ESWL is the first-choice treatment for calculi in horseshoe kidneys. It involves no significant focusing difficulties and is associated with a low incidence of obstructive complications. Open surgery is indicated in cases of stone-related pyeloureteral stenosis and in the presence of calculi2-2.5 cm in size.

Context There is heterogeneity of criteria on the utility of urinary stone analysis as well as on which is the most suitable methodology. This review presents the analysis of the lithiasis using the morphoconstitutional analysis technique based on the combination of the stereoscopic microscopy (SM) with infrared study (IRS). Summary of the evidence There are many techniques to analyze the stone: chemical analysis, electron microscopy, X-ray diffraction, SM and IRS. Reviewing each one of these techniques and through the study of several clinical cases, this review shows the usefulness of stone analysis and the pros and cons of each one of the mentioned techniques. Furthermore, it can be clearly seen how the morphoconstitutional analysis is the one that offers the most useful clinical information to the urologist. In addition, classification of the lithiasis based on this method and its clinical correlation with patients are presented. Conclusions Using the morphoconstitutional study to analyze the stone offers more information than the other techniques and it makes it possible to establish a stone classification of important clinical and diagnostic utility.

Resumen Objetivo evaluar un nuevo enfoque en el analisis de la litiasis urinaria en funcion de la combinacion de sus componentes. Material y metodos se analizaron un total de 7.949 litiasis y sus componentes principales y combinaciones, y se clasificaron en funcion del sexo y la edad. El analisis estadistico fue mediante el test de ji cuadrado. Resultados oxalato calcico monohidrato (OCM) fue el componente mas frecuente en hombres (39%) y mujeres (37,4%), seguido de oxalato calcico dihidrato (OCD) (28%) y acido urico (URI) (14,6%) en hombres y de fosfato (FOS) (22,2%) y OCD (19,6%) en mujeres (p = 0,0001). En la gente joven OCD y FOS fueron los componentes mas frecuentes en hombres y mujeres, respectivamente (p = 0,0001). En los pacientes mayores OCM y URI (por este orden) fueron los componentes mas frecuentes en ambos sexos (p = 0,0001). OCM es oxalatodependiente y esta relacionado con las dietas de alto contenido en oxalato y baja ingesta de agua. El aumento progresivo de URI con la edad se relaciona principalmente con el sobrepeso y el sindrome metabolico. Respecto a la combinacion de componentes, las mas frecuentes fueron OCM (26,3%), OCD + Apatita (APA) (15,5%), URI (10%) y OCM + OCD (7,5%) (p = 0,0001). Conclusiones este estudio presenta no solo la composicion de las litiasis, sino tambien las principales combinaciones de componentes en funcion de la edad y el sexo. Los resultados muestran que la composicion de la litiasis esta relacionada con los cambios en los habitos dieteticos y de estilo de vida que ocurren durante la vida, y la estructura morfologica de las litiasis es indicativa de los mecanismos etiopatogenicos.

Objective To evaluate a new approach to urinary stone analysis based on the combination of their components. Materials and methods We analyzed a total of 7,949 stones and their main components and combinations of components and we classified them according to gender and age. We performed statistical analysis using the chi-square test. Results Calcium oxalate monohydrate (COM) was the most frequent component in both males (39%) and females (37.4%), followed by calcium oxalate dihydrate (COD) (28%) and uric acid (URI) (14.6%) in males and by phosphate (PHOS) (22.2%) and COD (19.6%) in females (p = 0.0001). In young people, COD and PHOS were the most frequent components in males and females respectively (p = 0.0001). In older patients, COM and URI (in that order) were the most frequent components in both genders (p = 0.0001). COM is oxalatedependent and is related to diets with a high oxalate content and low water intake. The progressive increase in URI with age is related mainly to overweight and metabolic syndrome. Regarding the combinations of components, the most frequent were COM (26.3%), COD+Apatite (APA) (15.5%), URI (10%) and COM+COD (7.5%) (p = 0.0001). Conclusions This study reports not only the composition of stones but also the main combinations of components according to age and gender. The results prove that stone composition is related to the changes in dietary habits and life-style that occur over a lifetime, and the morphological structure of stones is indicative of the etiopathogenic mechanisms.

Objetivo: Realizar un análisis de la composición de las aguas disponibles en España para ofrecer unas recomendaciones de consumo a los pacientes litiásicos. Material y Métodos: Búsqueda de información sobre la composición de aguas de grifo y embotelladas en publicaciones, supermercados e Internet. Estudio descriptivo y de la correlación entre los distintos componentes mediante el coeficiente de correlación de Pearson. Resultados: Se obtuvo información sobre la composición de agua de grifo de la mayoría de capitales españolas y de 85 marcas de agua embotellada. Se encontró una correlación entre la concentración de calcio y magnesio (p=0,0001) y una intensa relación entre la de bicarbonato y sodio (p=0,0001, coeficiente Pearson 0,958). Se ofrece clasificación de las aguas en función de la concentración de calcio, bicarbonato, sodio y magnesio. Conclusión: Se propone una guía de elección de agua del paciente litiásico en función de su procedencia geográfica y de sus preferencias dietéticas, principalmente el consumo de lácteos.