Abstract Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender SGA (≤ 10th) and large for gestational age (LGA) (> 90th). Results: the percentage of newborns with weight percentile ≤ 10 was 14.8%. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs. 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight.

Resumen Objetivo: el tratamiento para la diabetes gestacional se basa en la dieta y esto puede modificar el aumento de peso materno. Un aumento de peso materno limitado está relacionado con recién nacidos con bajo peso para su edad gestacional (SGA). Muchos estudios han encontrado un aumento de niños con bajo peso en mujeres con diabetes gestacional, pero la razón de esto no está clara. El objetivo de este estudio es evaluar los efectos del tratamiento de la diabetes gestacional sobre el aumento de peso materno y el peso neonatal. Métodos: estudio de cohortes retrospectivo en 1765 pacientes con diabetes gestacional, según los criterios de los National Diabetes Data Groups (NDDG). Evaluamos: IMC antes del embarazo, aumento de peso materno total (MWG), aumento de peso durante el tercer trimestre, semana gestacional de inicio del tratamiento y modalidad de tratamiento (dieta o dieta más insulina). El peso al nacer se ajustó por edad gestacional y género: SGA (percentil de ≤ 10) y grande para la edad gestacional (LGA) (percentil de > 90). Resultados: el porcentaje de recién nacidos con peso percentil de ≤ 10 fue del 14,8%. La dieta y el momento de inicio del tratamiento se relacionaron con el aumento de peso materno en el tercer trimestre. Por cada 1 kcal/kg de variación en la dieta (aumento o disminución) se produjo una variación de aumento del peso materno de 0,03 (0,001-0.06) kg (p < 0,01). Por cada semana antes de inicio del tratamiento, la madre dejó de ganar 0,13 ± [(- 0,15) - (- 0,11)] kg en el tercer trimestre (p < 0,01). El SGA se relacionó con un aumento de peso materno más bajo en el total de la gestación: 7,0 (IQR 3,0-10,4) kg vs. 8,4 (IQR 5,0-11,6) kg (p < 0,01), y en el tercer trimestre: 0,3 (IQR -0,9-1,5) kg vs. 0,9 (IQR -0,3-2,2) kg (p < 0,01). Conclusión: el tratamiento dietético para la diabetes gestacional puede conducir a un menor aumento de peso materno y a su vez inducir un impacto en el peso neonatal.

ABSTRACT Objectives: To reach a situation diagnosis on the status of patient management at digestive care units (DCUs) in Spain. Material and methods: A cross-sectional descriptive study across DCUs in general acute care hospitals within the Spanish National Health System (data referred to 2015). The study variables were collected with a questionnaire including items on structure, services portfolio, activity, education, research, and good practice. Hospital discharge rates for digestive diseases were also assessed using the minimum basic data set (2005-2014). Results: Two hundred and nine hospitals invited, 55 responders (26.3%). Average discharges from hospital were 1,139 ± 653 per DCU/year, and 100 ± 66 per year per dedicated gastroenterologist. In 2014, admission rate to DCUs per 1,000 population and year was 280, with a mean stay of 7.4 days. The analysis of the MBDS for 2005-2014 reveals a progressive increase in the number of discharges (37% more in 2014 versus 2005), with a 28% decrease in hospital gross mortality rate (3.7% in 2014) and a slightly reduced (14%) mean stay (7.6 days in 2014). Considerable variability may be seen in structure, activity, and results indicators. Mortality and readmission rates, as well as mean stay, vary more than 100% amongst DCUs, and major dispersions also exist in frequentation and results amongst autonomous communities. Conclusions: The RECALAD 2015 survey unveiled relevant aspects related to DCUs organization, structure, and management. The notable variability encountered likely reflects relevant differences in efficiency and productivity, and thus points out there is ample room for improvement.

RESUMEN Objetivo: elaborar un diagnóstico de situación sobre la asistencia en las unidades de aparato digestivo (UAD) en España. Material y métodos: estudio descriptivo transversal entre las UAD en hospitales generales de agudos del Sistema Nacional de Salud (datos referidos a 2015). Las variables de estudio fueron recogidas mediante un cuestionario sobre su estructura, cartera de servicios, actividad, formación, investigación y buenas prácticas. Asimismo, se analizaron las altas hospitalarias por enfermedades del área de digestivo mediante el Conjunto Mínimo Básico de Datos (2005-2014). Resultados: fueron invitados 209 hospitales, con 55 respuestas (26,3%). El promedio de altas de hospitalización es de 1.139 ± 653 por UAD/año y de 100 ± 66/año por digestólogo dedicado. La tasa de ingresos por mil habitantes y año en UAD en 2014 fue de 280, con una estancia media de 7,4 días. El análisis del CMBD 2005-2014 muestra un progresivo aumento en el número de altas dadas (37% más en 2014 frente a 2005), con una disminución del 28% en la tasa bruta de mortalidad intrahospitalaria (3,7% en 2014) y un ligero descenso (14%) de la estancia media (7,6 días en 2014). Se aprecia notable variabilidad en indicadores de estructura, actividad y resultados. Las tasas de mortalidad y reingresos, así como la estancia media, varían más del 100% entre UAD y existen asimismo notables dispersiones en frecuentación y resultados entre comunidades autónomas. Conclusiones: la encuesta RECALAD 2015 desvela aspectos relevantes sobre la organización, estructura y gestión de las UAD. La notable variabilidad hallada probablemente indica notables diferencias en eficiencia y productividad y, por tanto, un amplio margen de mejora.

Resumo Justificativa: A terapia hemodinâmica alvo-dirigida (THAD) é uma abordagem focada no uso do débito cardíaco (DC) e parâmetros relacionados, como desfechos para fluidos e medicamentos para aprimorar a perfusão tecidual e o fornecimento de oxigênio. Objetivo primário: determinar os efeitos da THAD sobre as taxas de complicações no pós-operatório. Métodos: Metanálise dos efeitos da THAD em cirurgias não cardíacas de adultos sobre as complicações pós-operatórias e mortalidade, com a metodologia PRISMA. Uma busca sistemática foi feita no Medline PubMed, Embase e Biblioteca Cochrane (última atualização, outubro de 2014). Os critérios de inclusão foram estudos clínicos randômicos (ECRs) nos quais a THAD no intraoperatório foi comparada com a terapia convencional de reposição de líquidos em cirurgia não cardíaca. Os critérios de exclusão foram traumatismo e estudos de cirurgia pediátrica e aqueles que usaram cateter de artéria pulmonar. Os desfechos, primário e secundário, foram complicações pós-operatórias e mortalidade, respectivamente. Os estudos que atenderam aos critérios de inclusão foram examinados na íntegra e submetidos à análise quantitativa, análise de subgrupo pré-definido (estratificada por tipo de monitor, terapia e objetivo hemodinâmico) e análise de sensibilidade pré-definida. Resultados: 51 ECRs foram identificados inicialmente, 24 atenderam aos critérios de inclusão. Cinco ECRs foram adicionados por busca manual, resultando em 29 ECRs para análise final, incluindo 2.654 pacientes. Uma redução significativa das complicações para a THAD (RR: 0,70, IC de 95%: 0,62-0,79, p < 0,001). Nenhuma diminuição significativa na mortalidade foi observada (RR: 0,76, IC de 95%: 0,45-1,28, p = 0,30). Análises de sensibilidade qualitativa confirmaram os principais resultados gerais. Conclusões: THAD no intraoperatório com monitoração minimamente invasiva diminui as complicações no pós-operatório de cirurgia não cardíaca, embora não tenha mostrado uma redução significativa da taxa de mortalidade.

Abstract Background: The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates. Methods: A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A systematic search was performed in Medline PubMed, Embase, and the Cochrane Library (last update, October 2014). Inclusion criteria were randomized clinical trials in which intraoperative goal directed hemodynamic therapy was compared to conventional fluid management in noncardiac surgery. Exclusion criteria were trauma and pediatric surgery studies and that using pulmonary artery catheter. End-points were postoperative complications (primary) and mortality (secondary). Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by type of monitor, therapy, and hemodynamic goal), and predefined sensitivity analysis. Results: 51 RCTs were initially identified, 24 fulfilling the inclusion criteria. 5 randomized clinical trials were added by manual search, resulting in 29 randomized clinical trials in the final analysis, including 2654 patients. A significant reduction in complications for goal directed hemodynamic therapy was observed (RR: 0.70, 95% CI: 0.62-0.79, p < 0.001). No significant decrease in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p = 0.30). Quality sensitive analyses confirmed the main overall results. Conclusions: Intraoperative goal directed hemodynamic therapy with minimally invasive monitoring decreases postoperative complications in noncardiac surgery, although it was not able to show a significant decrease in mortality rate.

Background: Evidence comparing the effectiveness of tension-free vaginal tape (TVT) with Burch colposuspension (CS) over a long-term follow-up is scarce. Purpose: To compare TVT with CS as primary treatment for female stress urinary incontinence (SUI). Design: Open randomised clinical trial with a three-year follow-up period. Participants: 49 consecutive women aged 35 to 70 with SUI demonstrated by a urodynamic study. Setting: Urology department of Severo Ochoa general hospital in Leganés, Madrid, Spain. Intervention: 24 random patients treated with TVT and 25 with CS. Measurements: Main variable: assessment before treatment and at six months, one year and three years after the operation using the incontinence severity symptoms index (SSI) and the incontinence impact symptoms index (SII). Secondary variable: three groups for assessing cure, improvement and failure rates. Results: Time in surgery, consumption of postoperative analgesics and length of the postoperative hospital stay were lower in the TVT group (41.1 ± 10.9 minutes; 6 [2.8-10.5] capsules and 1 [1-2] days vs. 57.1 ± 18.3 minutes, 23.5 [18.0-31.5] capsules and 3 [3-3] days [p < 0.0001]). There was a significant reduction in SSI and SII scores in both groups and no differences in surgical complications, urgency, obstruction, one-hour pad test, urine culture, flowmetry, costs and cure rates at any moment during follow-up (cured/improved 76.2%, 78.3% and 77.3% at six months, one year and three years for TVT vs. 87.5%, 87.5% and 91.3% for CS; p = 0.32, p = 0.4 and p = 0.19). Limitations: The trial is open, which can create observer bias. A study with a higher number of patients or a longer follow-up time could show differences between the procedures that we were unable to observe in this study, due to our budget and time limits. Discussion: Based on both short-term and long-term results, TVT is as effective as CS for the treatment of SUI, and has similar subjective cure and surgical complication rates. Time in surgery, consumption of analgesics and length of postoperative hospital stay are all lower in the TVT group. In our clinical setting, with a one-day postoperative stay for TVT, the two procedures have similar costs.

Antecedentes: Las evidencias que comparan la eficacia a largo plazo de TVT (tension free vaginal tape) y la de colposuspensión (CS) de Burch son escasas. Objetivos: Comparar la eficacia de TVT con CS como tratamiento de la incontinencia urinaria de esfuerzo femenina (IUE). Diseño: Estudio clínico, aleatorizado, abierto, de 3 años de seguimiento. Participantes: Se incluyó a 49 mujeres consecutivas de 35 a 70 años con IUE demostrada en estudio urodinámico. Ámbito de estudio: Servicio de Urología del Hospital Severo Ochoa de Leganés (Madrid), España. Intervención: Se aleatorizó a 24 pacientes a tratamiento con TVT y 25 con CS. Mediciones: Variable principal: evaluación antes del tratamiento y a los 6 meses, 1 año y 3 años postoperatorios con un cuestionario de severidad de síntomas de incontinencia (SSI) y de impacto de síntomas de incontinencia (SII). Variable secundaria: 3 grupos para evaluar las proporciones de curación, mejoría y fallo. Resultados: El tiempo quirúrgico, el consumo de analgésicos postoperatorios y la estancia postoperatoria fueron inferiores en el grupo TVT (41,1 ± 10,9 min, 6 [2,8-10,5] dosis y 1 [1-2] días frente a 57,1 ± 18,3 min, 23,5 [18-31,5] dosis y 3 [3-3] días [p < 0,0001]). Las puntuaciones SSI y SII se redujeron significativamente en ambos grupos después del tratamiento y no hubo diferencias significativas en las complicaciones operatorias, urgencia, obstrucción, test de la compresa de 1 h, urocultivo, flujometría, costes totales y proporciones de curación en ningún momento del seguimiento (curación/mejoría del 76,2, el 78,3 y el 77,3% a los 6 meses, 1 y 3 años con TVT, y del 87,5, el 87,5 y el 91,3% con CS; p = 0,32, p = 0,4 y p = 0,19). Limitaciones: El estudio es abierto, lo que puede generar sesgos. Un número mayor de pacientes o un mayor tiempo de seguimiento podrían demostrar diferencias entre los procedimientos que no se han observado en el estudio, pero las limitaciones presupuestarias y en el tiempo no lo han permitido. Discusión: Tanto a corto como a largo plazo, la técnica TVT es tan eficaz como la CS para el tratamiento de la IUE femenina, con una proporción similar de curaciones subjetivas y de complicaciones. El tiempo quirúrgico, consumo de analgésicos y la estancia postoperatoria son inferiores con TVT. En nuestro medio, con 1 día de estancia postoperatoria con TVT, los dos procedimientos tienen costes totales similares.

Introduction: Lower urinary tract symptoms (LUTS) related with benign prostatic hyperplasia (BPH) are present nowadays in approximately 20 to 30% of the Spanish male population from the age of 50 onwards. The purpose of this study was to assess clinical and epidemiological characteristics of patients with LUTS. Methods: A cross-sectional study was performed, between 1999 and 2000, among 1,804 men aged 40 or older who were living in Madrid. Subjects were interviewed by telephone; socio-demographic information was requested and the presence of LUTS was assessed using the International Prostate Symptoms Score. Informed consent was requested. Association between qualitative variables was evaluated by c2 or Fisher´s test. A logistic regression model was performed to control confusion. Results: Prevalence of moderate/severe LUTS was 16.6% (95%CI: 14.8-18.3). Nearly 90% of the subjects consumed olive oil, 71.5% alcohol, 63.1% did not smoke and 96.9% did not consume drugs. A 27.7% of the subjects had hypertension and 8.8% referred diabetes. Men aged 70 or older had a threefold increased frequency of serious symptoms compared to younger men (OR: 3.31; 95%CI: 2.10-5.22). Low level of studies increased this frequency by a factor of 2.2 (95%CI: 1.42-3.46) and men who consumed only seed oil had twice more serious symptoms than those who consumed olive oil (OR: 1.86; 95%CI: 0.98-3.55). Conclusions: Family history of urological diseases, age, low level of studies, hypertension, diabetes and seed oil consumption were independently associated with more serious symptoms, while medium alcohol consumption and mild smoking habit were associated with slighter symptoms.

Introducción: Los síntomas del tracto urinario inferior (STUI) asociados con la hiperplasia benigna de próstata están presentes en el 20-30% de la población española masculina de 50 años o más. El objetivo de este estudio es analizar las características clínicas y epidemiológicas de los pacientes con STUI. Material y métodos: Estudio transversal realizado entre los años 1999 y 2000 en 1804 hombres de 40 años o más residentes en Madrid. Mediante entrevista telefónica se recabó información sociodemográfica de los participantes y se evaluó la presencia de STUI mediante el I-PSS (International Prostate Symptoms Score). La asociación entre variables cualitativas se evaluó con el test c2 o el exacto de Fisher. Se ajustó un modelo de regresión logística para evaluar la probabilidad de tener STUI moderados/severos controlando la confusión. Resultados: La prevalencia de STUI moderados/severos fue del 16,6% (IC95%: 14,8-18,3). Cerca del 90% de los participantes consumían aceite de oliva, el 71,5% alcohol, el 63,1% no fumaba y el 96,9% no consumían drogas. Un 27,7% refería hipertensión y un 8,8% diabetes. Los hombres de 70 años o más tenían una frecuencia de STUI moderados/severos tres veces mayor que los hombres más jóvenes (OR: 3,31; IC95%: 2,10-5,22). El nivel bajo de estudios, frente al alto, mostró una frecuencia 2,2 veces mayor de STUI moderados/severos (IC95%: 1,42-3,46), así como el consumo de aceite de semillas, frente al de oliva (OR: 1,86; IC95%: 0,98-3,55). Conclusiones: La historia familiar de enfermedades urológicas, la edad, el nivel bajo de estudios, la hipertensión, la diabetes y el consumo de aceite de semillas se asociaron de forma independiente con la presencia de STUI más severos, mientras el consumo moderado de alcohol y tabaco se asoció de forma independiente a la presencia de STUI leves.