ABSTRACT Objective To show the main indications of retroperitoneoscopy (RP) for the treatment of urolithiasis. The use of RP approach has been limited, being narrow working space the major issue to overcome (1), especially in non-expert hands. However, RP has the added advantages of no peritoneal contamination, a quick recovery of bowel function (2) and the possibility to use it in combination with other endourological techniques (3) and innovative technology. Materials and Methods We performed a retrospective analysis of 22 patients treated by the retroperitoneoscopic approach due to urolithiasis disease between 2015-2017. Type of surgery, stone free rate (SFR), complications according to Clavien-Dindo classification and mean hospital stay were recorded. Radical and partial nephrectomy cases were excluded for the SFR calculation. Descriptive statistical analysis was done using SPSS v21. Results Of the 22 patients treated by the retroperitoneoscopic approach, 9 underwent a ureterolithotomy, 4 underwent a nephrolithotomy, 8 were nephrectomies and 1 was a polar nephrectomy. In 3 cases we used the indocianine green fluorescence (ICG) to find avascular planes, reduce the bleeding, permitting enhanced visualization and reconstruction. In 3 cases an additional percutaneous approach was used, increasing the SFR chances. Eleven of thirteen (84.6%) patients were stone free following the procedure. Tree complications were recorded, two Clavien II and one Clavien III complications. Mean hospital stay was 4 days. Conclusions Retroperitoneoscopic approach is a good alternative for the treatment of large impacted ureteral stones, large pielic stones and for non-functional kidney removal due to stone disease. In expert hands, it can be safely used with a good SFR. The combination with ICG or other endourological techniques is feasible, allowing higher SFR.

ABSTRACT Introduction: COVID-19 disease spreads rapidly. Seroprevalence in pregnant women entering for hospitalization and clinical characteristics in this type of population in Peru is not known. Objective: To determine the prevalence and clinical-epidemiological characteristics of pregnant women with anti-SARS-CoV-2 antibodies at a level III hospital in Peru. Methods: Observational and cross-sectional study performed at the National Maternal Perinatal Institute of Peru. Pregnant women admitted for hospitalization were screened for COVID-19 infection. Results of anti-SARSCoV-2 serological tests and information on maternal and perinatal characteristics were obtained. Data analysis was performed using descriptive statistics and 95% confidence intervals. Results: In 2 419 pregnant women screened we identified a prevalence of 7.0% of anti-SARS-CoV-2 antibodies (95% IC: 6.1% to 8.1%), including IgM in 10% (95% IC: 6.1% to 15.8%), IgM / IgG in 78.8% (95% IC: 71.8% to 84.6%), IgG in 11.2% (95% IC: 7.0% to 17.1%). 89.4% of the seropositive pregnant women were asymptomatic. Most frequent complications were premature rupture of membranes (11.8%) and preeclampsia (6.5%). No association was found between clinical and epidemiologic characteristics and type of serological response to SARS-CoV-2 (p > 0.05). Conclusions: Pregnant women had prevalence of anti-SARS-CoV-2 antibodies of 7.0% on admission to the hospital; most of them were asymptomatic. There was no association between clinical-epidemiological characteristics analyzed and type of anti-SARS-CoV-2 antibody response.

RESUMEN Introducción . La enfermedad de COVID-19 se propaga rápidamente. Se desconoce la seroprevalencia en mujeres embarazadas que ingresan a hospitalización y sus características propias en este tipo de población en Perú. Objetivo . Determinar la prevalencia y características clínico-epidemiológicas de gestantes con anticuerpos anti-SARS-CoV-2 en un hospital nivel III de Perú. Métodos . Estudio observacional de tipo transversal, realizado en el Instituto Nacional Materno Perinatal de Perú, entre el 15 de abril y 15 de mayo de 2020. Participaron todas las gestantes que ingresaron a hospitalización y fueron tamizadas para la infección por SARS-CoV-2 mediante pruebas serológicas, cuyos resultados fueron analizados conjuntamente con sus características clínicas y epidemiológicas, utilizando estadígrafos descriptivos e intervalos de confianza al 95%, y mediante la prueba de independencia de chi cuadrado con una significancia de 0,05. Resultados . Se tamizaron 2 419 embarazadas, identificando una prevalencia de 7,0% con resultados positivos a los anticuerpos anti-SARS-CoV-2 (IC95%: 6,1% a 8,1%). Se observó IgM en 10% (IC95%: 6,1% a 15,8%), IgM/IgG en 78,8% (IC95%: 71,8% a 84,6%), IgG en 11,2% (IC95%: 7% a 17,1%). El 89,4% de gestantes seropositivas fueron asintomáticas. Se observó como complicaciones obstétricas más frecuentes la rotura prematura de membranas (11,8%) y la preeclampsia (6,5%). No se halló asociación de las características clínico epidemiológicas y el tipo de respuesta serológica para el virus SARS-CoV-2 (p>0,05). Conclusiones . Las gestantes con ingreso hospitalario en el periodo estudiado presentaron prevalencia de anticuerpos anti-SARS-CoV-2 de 7,0%, siendo mayormente asintomáticas. No se evidenció asociación entre las características clínico-epidemiológicas analizadas y el tipo de respuesta de los anticuerpos anti- SARS-CoV-2.

ABSTRACT Objectives: To show our single-center experience in retroperitoneoscopic approach for highly complex posterior hilar tumors. Minimally invasive nephron sparing surgery for renal hilar tumors is extremely challenging due to their anatomic location, close to the main renal vessels and the collecting system (1). Transperitoneal approach is feasible, but highly complex because the anterior disposition of the vasculature. Retroperitoneal approach can easily provide access to the posterior hilar structures and the posterolateral surface of the kidney(2, 3). Materials and Methods: We retrospectively reviewed our hilar renal tumor database and analyzed those in which a retroperitoneoscopic approach was chosen. The RENAL score was then calculated, and operative and ischemia times were recorded. We also collected the mean hospital stay and the presence of complications. Pathology reports and follow-up were also gathered. Results: Five of our twelve highly complex hilar renal tumor patients were treated using a retroperitoneoscopic approach. Mean RENAL score was 10. Mean operative time was 135 minutes. Mean warm ischemia time was 14 minutes. Mean hospital stay was 4 days. We have recorded 2 complications. One patient required a transfusion and another presented with an urinary fistula which was treated by double J stent placement. The pathology report showed a clear cell renal cell carcinoma pT1a in most of the cases. Only one patient had a positive margin. To date, no recurrences have been noticed. Conclusions: The treatment of complex renal hilar tumors in a minimally invasive fashion is highly challenging even in experienced hands. Retroperitoneal partial nephrectomy is feasible, safe and effective for the treatment of such lesions. Long-term oncologic outcomes of this approach are awaited.

Introduction. In Peru, hypertensive disorders of pregnancy are the second cause of maternal mortality. Objective. This evidence-based clinical practice guideline (EB-CPG) provides recommendations for the prevention and treatment of pre-eclampsia and eclampsia. Methods. An adapted EB-CPG was elaborated through a systematic, rigorous and transparent process with a group consisting of methodologists and health professionals who are experts in the management of the disease. The guide has sixteen clinical questions and sixteen recommendations. The search and pre-selection of EB-CPGs were performed, which were evaluated through the "Appraisal of Guidelines for Research and Evaluation II" tool (AGREE-II), for its adaptation. The systematic search for evidence to answer the 16 clinical questions were made in multiple databases: MEDLINE / PubMed, EMBASE / Ovid, Cochrane Library, LILACS and SciELO. Evidences were selected and analyzed critically by clinicians and methodologists in pairs, recommendations were elaborated through the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). Results. With the participation of a panel of clinical experts from the National Perinatal Maternal Institute, representatives from health care networks and other reference institutions, 16 recommendations were established for the prevention and treatment of pregnant women at risk of pre-eclampsia, for pregnant women with pre-eclampsia, eclampsia or hypertensive disease. Conclusions. This article summarizes the evidence-based clinical practice guidelines for the prevention and treatment of preeclampsia and eclampsia in peruvian pregnant women for the national reference institute for maternal and neonatal health of Peru.

Introducción. En Perú, los trastornos hipertensivos del embarazo son la segunda causa de mortalidad materna. Objetivo. La presente guía de práctica clínica basada en evidencias (GPC-BE) brinda recomendaciones para la prevención y tratamiento de la pre-eclampsia y eclampsia. Métodos. Se elaboró una GPC-BE adaptada mediante un proceso sistemático, riguroso y transparente con un grupo elaborador conformado por metodólogos y profesionales de la salud expertos en el manejo de la enfermedad. La guía cuenta con dieciséis preguntas clínicas y dieciséis recomendaciones. Se realizó la búsqueda y preselección de GPC, las mismas que fueron evaluadas mediante el instrumento "Appraisal of Guidelines for Research and Evaluation II" (AGREE II), para su adaptación. La búsqueda sistemática de evidencias para responder las preguntas clínicas se realizó en múltiples bases de datos: MEDLINE/PubMed, EMBASE/Ovid, Cochrane Library, LILACS y SciELO. Las evidencias fueron seleccionadas y analizadas críticamente por pares clínicos y metodológicos; las recomendaciones fueron elaboradas mediante la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados. Con la participación de un panel de expertos clínicos del Instituto Nacional Materno Perinatal, redes de salud y otras instituciones de referencia, se elaboraron 16 recomendaciones dirigidas a la prevención y tratamiento de mujeres gestantes en riesgo de pre-eclampsia, gestantes con pre-eclampsia, eclampsia o enfermedad hipertensiva. Conclusiones. Este artículo resume la guía de práctica clínica basada en evidencias para la prevención y tratamiento de pre-eclampsia y eclampsia en gestantes en el instituto de referencia nacional en salud materna y neonatal del Perú.

Rounds for patient safety is a recommended practice to increase the quality of clinical and non-clinical services involved in patient care. It consists of planned visits of the relevant executive staff in order to establish direct relationship with personnel and patients with an educational attitude and with the general objective to strengthen the culture of patient safety. In the Instituto Nacional Materno Perinatal, a category III-2 establishment specialized in the care of women, pregnant women and newborns, these rounds have been in practice since 2011, and improvements in safe care for patients have been obtained. We present the experience of the Institute between years 2011 and 2017.

Las rondas de seguridad para los pacientes es una práctica recomendada para incrementar la calidad en los servicios clínicos y no clínicos relacionados al cuidado de los pacientes. Consiste en una visita planificada del personal ejecutivo relacionado con el área, para establecer una relación directa con el personal y los pacientes, cuidando en todo momento de guardar una actitud educativa y cuyo objetivo general es fortalecer la cultura por la seguridad del paciente. En el Instituto Nacional Materno Perinatal, establecimiento de categoría III-2 para la atención especializada de la mujer, gestante y recién nacido, se vienen llevando a cabo estas rondas desde el año 2011, y gracias a ellas se han obtenido mejoras en la atención con seguridad de los pacientes. Se presenta la experiencia del Instituto entre los años 2011 y 2017.