ABSTRACT Purpose: To assess the impact of thinness on the outcome of the percutaneous nephrolithotomy (PCNL). Materials and Methods: A matched case–control study was performed using a prospectively collected database of all patients who underwent PCNL between June 2011 and October 2021. The patients were stratified into two groups according to their phenotypic characteristics, arbitrarily defined according to their body mass index (BMI): <20 kg/m2 (Group 1, very thin patients, G<20) and ≥25 kg/m2 (Group 2, non-thin patients, G≥25). Patients were randomly matched based on Guy's Stone Score (GSS) according to case complexity at a ratio of 1:3. Results: A total of 204 patients were enrolled in this study: 51 patients (G<20) and 153 controls (G≥25). Complications occurred in 15.2% of the patients, with 5.4% of these complications classified as major complications (Clavien grade ≥ 3). According to complications there were no significant differences between the groups. The overall complication rates were 17.6% in the G<20 and 14.4% in the G≥25 (p = 0.653). The major complication rates were 3.9% in the G<20 and 5.8% in the G≥25 (p=0.429). No differences in transfusion or urinary fistula rates were found. Conclusions: In this study, very thin patients were not at a higher risk of complications when submitted to PCNL than in those with a BMI of ≥25 kg/m2. Apparently, this technique can be used in these patients, just as it is used in any other type of patient, independently of their BMI. Purpose PCNL. . (PCNL) Methods casecontrol control 201 2021 characteristics (BMI) 20 <2 kgm2 kgm kg m2 m kg/m Group 1 G20 G 25 ≥2 2 nonthin non G≥25. G25 G≥25) Guys Guy s GSS (GSS 13. 13 3. 3 1:3 Results 5 (G<20 15 (G≥25) 152 15.2 54 4 5.4 Clavien 3) 176 17 6 17.6 G<2 144 14 14.4 G≥2 p 0.653. 0653 0.653 0 653 0.653) 39 9 3.9 58 8 5.8 p=0.429. p0429 p=0.429 429 (p=0.429) found Conclusions Apparently patient (PCNL 202 (BMI < G2 1: (G<2 (G≥25 15. 5. 17. G< 14. G≥ 065 0.65 65 p042 p=0.42 42 (p=0.429 (G< (G≥2 06 0.6 p04 p=0.4 (p=0.42 (G (G≥ 0. p0 p=0. (p=0.4 p=0 (p=0. p= (p=0 (p=

ABSTRACT Objective: To describe the evidence of Platelet Rich Plasma (PRP), Stem cells therapy (SCT) and Extracorporeal shockwave therapy (ESWL) for the treatment of Peyronies disease (PD), including information from the main urological society guidelines. Materials and Methods: A literature review of PubMed articles published between 2000 and 2023 was conducted, utilizing keywords such as "Peyronie's Disease", "Penile curvature", "Platelet Rich Plasma", "Stem cells", and "Extracorporeal shockwave therapy". Only full-text articles in English were included, excluding case reports and opinions. Results: A considerable number of clinical trials were conducted using PRP penile injections for therapy of PD, showing reduction of curvature, plaque size and improvement in quality of life. Preclinical studies in rats have shown the potential benefit of adipose-derived stem cells, with improvements in erectile function and fibrosis. Human studies with mesenchymal stem cells demonstrated promising results, with reduction of curvature and plaque size. ESWL effects on PD were investigated in randomized clinical trials and demonstrated no significant impact in curvature or plaque size, but reasonable effect on pain control. Conclusion: Restorative therapies has emerged as an innovative treatment option for PD and the results from current studies appear to be promising and demonstrated good safety profile. Unfortunately, due to scarce evidence, PRP and SCT are still considered experimental by American Urological Association (AUA) and European Association of Urology (EAU) guidelines. ESWT is recommended, by the same guidelines, for pain control only. More high-quality studies with long-term follow-up outcomes are needed to evaluate efficacy and reproducibility of those therapies. Objective PRP, , (PRP) (SCT (ESWL (PD) guidelines Methods 200 202 Peyronie s Disease, Disease Disease" Penile curvature" Plasma, Plasma" cells" therapy. . therapy" fulltext full text included opinions Results life adiposederived adipose derived fibrosis Conclusion profile Unfortunately AUA (AUA EAU (EAU recommended only highquality high longterm long term followup follow up (PRP (PD 20 2

ABSTRACT Introduction: Ureteral lithiasis represents a substantial proportion of consultations within the field of urology. The therapeutic techniques that may be employed are contingent upon the location and characteristics of the stones in question. The objective of this study is to: The objective of this study is to evaluate the management and success of treatment of lower ureteral lithiasis at the Hospital de Clínicas. Materials and Methods: A retrospective, descriptive, and observational non-probabilistic study was conducted on consecutive cases comprising 31 patients diagnosed with lower ureteral lithiasis. Techniques such as ureteroscopy, meatotomy, and Gibson incision ureterolithotomy were utilized. The success rate and incidence of complications associated with each procedure were evaluated. The results: of the study are presented in the following section. The success rate was 93% for ureteroscopy, 83% for ureterolithotomy, and 100% for combined meatotomy/approach. The use of a double J catheter was more prevalent in open approaches. The postoperative recovery period was shorter for endourologic techniques. It can be concluded: that all techniques proved to be effective in the management of lower ureteral lithiasis. Endourological techniques offer the advantages of a shorter recovery period and a reduced need for catheters, which are typically required for open approaches. The selection of the most appropriate procedure should be based on an assessment of the individual patient's characteristics and the availability of resources, in order to ensure the most effective and appropriate treatment plan.

RESUMEN Introducción: La litiasis ureteral constituye una de las principales causas de consulta en urología. Dependiendo de la ubicación y características de los cálculos, se dispone de diversas técnicas terapéuticas. Objetivo: Evaluar el manejo y éxito del tratamiento de las litiasis ureterales inferiores en el Hospital de Clínicas. Materiales y métodos: Estudio retrospectivo, descriptivo y observacional no probabilístico de casos consecutivos que incluyó a 31 pacientes diagnosticados con litiasis ureteral inferior. Se utilizaron técnicas como ureteroscopía, meatotomía y ureterolitotomía por incisión de Gibson. Se evaluó la tasa de éxito y complicaciones de cada procedimiento. Resultados: La tasa de éxito fue del 93% para ureteroscopía, 83% para ureterolitotomía y 100% para meatotomía/enfoque combinado. El uso de catéter tipo doble J fue mayor en los abordajes abiertos. El tiempo de recuperación postoperatoria fue menor para las técnicas endourológicas. Conclusiones: Todas las técnicas demostraron ser efectivas en el manejo de las litiasis ureterales inferiores. Las técnicas endourológicas ofrecen ventajas en términos de menor tiempo de recuperación y menor necesidad de catéteres. La elección del procedimiento debe considerar factores individuales del paciente y la disponibilidad de recursos.

ABSTRACT Introduction Obstructive azoospermia occurs when there is a blockage in the male reproductive tract, leading to a complete absence of sperm in the ejaculate. It constitutes around 40% of all cases of azoospermia (1, 2). Blockages in the male reproductive tract can arise from either congenital or acquired factors, affecting various segments such as the epididymis, vas deferens, and ejaculatory ducts (3). Examples of congenital causes encompass conditions like congenital bilateral absence of the vas deferens and unexplained epididymal blockages (4). Acquired instances of obstructive azoospermia may result from factors like vasectomy, infections, trauma, or unintentional injuries caused by medical procedures (5). This complex condition affecting male fertility, presents two main treatment options: microsurgical reconstruction and surgical extraction of sperm followed by in vitro fertilization (IVF). Microsurgical reconstruction proves to be the most cost-effective option for treating obstructive azoospermia when compared with assisted reproductive techniques (6, 7). However, success rates of reconstruction defined by patency are as high as 99% for vasovasostomy (VV) but decline to around 65% if vasoepididymostomy (VE) is required (8, 9). Thus, continued refinement in technique is necessary in order to attempt to improve patency for patients undergoing VE. In this video, we show a comprehensive demonstration of microsurgical VE, highlighting the innovative epididymal occlusion stitch. The goal of this innovative surgical technique is to improve outcomes for VE. Materials and Methods The patient is a 39-year-old male diagnosed with obstructive azoospermia who presents for surgical reconstruction via VE. His partner is a 37-years-old female with regular menstrual cycles. The comprehensive clinical data encompasses a range of factors, including FSH levels, results from semen analysis, and outcomes from testicular sperm aspiration. This thorough exploration aims to provide a thorough understanding of our innovative surgical technique and its application in addressing complex cases of obstructive azoospermia. Results The procedure was started on the right, the vas deferens was identified and transected. The abdominal side of the vas was intubated and a vasogram performed, there was no obstruction. There was no fluid visible from the testicular side of the vas for analysis, thus we proceeded with VE. Upon inspection of the epididymis dilated tubules were identified. After selecting a tubule for VE, two 10-0 nylon sutures were placed, and it was incised. Upon inspection of the fluid motile sperm was identified. After VE, we performed a novel epididymal occlusion stitch technique. This was completed distal to the anastomosis by placing a 7-0 prolene through the tunica of the epididymis from the medial to lateral side. This stitch was then tightened down with the goal to largely occlude the epididymis so that sperm will preferentially travel through the anastomosis. The steps were then repeated on the left. At 3-month follow up, the patient had no change in testicular size as compared with preoperative size (18cc), he had no testicular or incisional discomfort, and on semen analysis he had presence of motile sperm. After 3 months post-surgery, the patient had motile sperm seen on semen analysis. Discussion The introduction of a novel epididymal occlusion stitch demonstrates a targeted strategy to enhance the success of microscopic VE. Encouragingly, a 3-month post-surgery follow-up reveals the presence of motile sperm, reinforcing the potential efficacy of our approach. This is promising given the historical lower patency, delayed time to patency, and higher delayed failure rates that patients who require VE experience (10). In total, 40% of all azoospermia cases can be attributed to obstruction. The conventional treatments for obstructive azoospermia involve microsurgical reconstruction and surgical sperm retrieval followed by IVF. While microsurgical reconstruction has proven to be economically viable, the quest for enhanced success rates has led to the exploration of innovative techniques. Historically, the evolution of VV and VE procedures, initially performed in the early 20th century, laid the foundation for contemporary microsurgical approaches (11). Notably, the microscopic VV demonstrated significant improvements in patency rates and natural pregnancy likelihood, as evidenced by the seminal Vasovastomy Study Group study in 1991 (8). In contemporary literature, success rates particularly for VE remain unchanged for the past three decades since the original published success rates by the Vasectomy Reversal Study Group (12). VE is associated with a longer time to patency as well with patients taking 2.8 to 6.6 months to have sperm return to ejaculate as compared to 1.7 to 4.3 months for those undergoing VV. Additionally, of those patients who successfully have sperm return to the ejaculate after VE up to 50% will have delayed failure compared to 12% for those undergoing VV who are patent. Finally, of those who experience delayed failure after undergoing VE it usually occurs earlier with studies reporting as early as 6 months post-operatively (20). Given the lack of improvement and significantly worsened outcomes with VE further surgical refinement is a constant goal for surgeons performing this procedure. Conclusion: In conclusion, this video is both a demonstration and a call to action for commitment to surgical innovation. We aim to raise the bar in VE success rates, ultimately bringing tangible benefits to patients and contributing to the ongoing evolution of reproductive medicine. The novel epididymal occlusion stitch emerges as a beacon of progress, promising not only enhanced safety but also potential reductions in patency time. Surgical excellence and methodological refinement, as exemplified in this video, lay the foundation for a future where male reproductive surgery continues to break new ground. 40 1, 1 (1 2. 2 . 2) 3. (3) 4. 4 (4) vasectomy infections trauma 5. 5 (5) fertility options IVF (IVF) costeffective cost effective 6, (6 7. 7 7) However 99 (VV 65 (VE 8, 8 (8 9. 9 9) Thus 39yearold yearold 39 year old 37yearsold yearsold 37 years cycles levels aspiration right transected obstruction 100 10 0 10- placed incised 70 7- left 3month month 18cc, 18cc cc , (18cc) discomfort postsurgery, postsurgery post surgery, Encouragingly followup approach 10. (10) total viable Historically th century 11. 11 (11) Notably likelihood 199 8. (8) literature 12. 12 (12) 28 66 6. 17 1. 43 Additionally 50 patent Finally postoperatively operatively 20. 20 (20) Conclusion conclusion innovation medicine progress ground ( (3 (4 (5 (IVF (18cc (10 (11 19 (12 (20 (2

ABSTRACT Background Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site. Methods This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization. Results None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien–Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%. Conclusion The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC. Roboticassisted Robotic assisted (RARC (ICUD mortality vessels site 3 female 201 2023 surgeon analysis mesenterysparing sparing preservation mesenterysparing, sparing, hernias days 19 Clavien–Dindo ClavienDindo Clavien Dindo III I II I-II 276 27 27.6 IIIV V III-V 206 20 20.6% 202 1 2 27. 20.6 20.

Resumen Marca-Zevallos, M. J.; W. Galiano, R. Chevarría, G. Sebastián, K. Huamani, J. A. Ochoa & J. Mendoza. 2024. Influencia de factores ambientales en la composición de macrofitas acuáticas en lagos (cochas) de la Amazonía sur del Perú. Darwiniana, nueva serie 12(1): 170-191. La riqueza y composición de macrofitas acuáticas está influenciada por la morfometría y las condiciones físicas y químicas del cuerpo acuático. Sin embargo, el efecto de estos factores en las comunidades vegetales no ha sido corroborado para los lagos con forma de herradura o comúnmente llamados como “cochas” de la Amazonía peruana. En el presente estudio se evaluó 10 cochas desconectadas del curso principal del río en la Amazonia Sur del Perú para conocer 1) la riqueza de macrofitas acuáticas, 2) su forma de vida y 3) la influencia del área y la profundidad del cuerpo acuático, la transparencia, pH, oxígeno disuelto, sólidos totales disueltos y la temperatura del agua en la riqueza y en los cambios de la composición de especies. Se reportó 68 taxones, donde Cyperaceae y Poaceae fueron las familias más diversas. Además, las formas de vida predominantes fueron las emergentes (47,1 %) y anfibias (36,8 %). Finalmente, se encontró que cochas con mayor área, pH y oxígeno disuelto, a la vez, con menor temperatura, abrigan una mayor riqueza de especies y favorecen el establecimiento de especies estrictamente acuáticas, indicando que existe un recambio de especies a lo largo de la gradiente conformada por la asociación de estas variables. Estos resultados demuestran que la Amazonía sur del Perú posee una importante riqueza de macrofitas acuáticas que está asociada al área, pH, oxígeno disuelto y temperatura del cuerpo acuático.

Abstract. Marca-Zevallos, M. J.; W. Galiano, R. Chevarría, G. Sebastián, K. Huamani, J. A. Ochoa & J. Mendoza. 2024. Influence of environmental factors on aquatic macrophytes composition in oxbow lakes in the Southern Peruvian Amazon. Darwiniana, nueva serie 12(1): 170-191. Species richness and composition of aquatic macrophytes are influenced by morphometry and physical and chemical conditions of the aquatic body. However, the influence of these variables has not been confirmed for oxbow lakes or commonly called “cochas” in the Peruvian Amazon. 10 cochas disconnected from the main course of the river were investigated in the Southern Amazon of Peru to know 1) the species richness of aquatic macrophytes, 2) their life form, and 3) the influence of area and depth of the water body and, transparency, pH, dissolved oxygen, total dissolved solids, and temperature of the water on species richness and composition changes of aquatic macrophytes. 68 taxa were reported, where Cyperaceae and Poaceae were the most diverse families. Moreover, he predominant life forms were emergent (47,1 %) and amphibian (36,8 %). Finally, cochas with greater area, pH, and dissolved oxygen, at the same time, with lower temperature, shelter a higher species richness and favour strictly aquatic species establishment, indicating that exists a species turnover along the conformed gradient by the association of these variables. These results demonstrate that southern Amazon of Peru has an important aquatic macrophytes richness that is associated with area, pH, dissolved oxygen, and temperature of the aquatic body.

ABSTRACT Introduction: The superiority of the functional results of robot-assisted radical prostatectomyis still controversial. Despite this, it is known that minimally invasive surgery obtains better results when analyzing blood loss, blood transfusion and length of stay, for example. Several studies have analyzed the impact of the resident physician's involvement on the results of urological surgeries. The simple learning curve for robot-assisted radical prostate surgery is estimated to be around 10 to 12 cases. Learning curve data for robotic surgeons is heterogeneous, making it difficult to analyze. Rare studies compare the results of a radical prostatectomy of an inexperienced surgeon starting his training in open surgery, with the results of the same surgeon, a few years later, starting training in robotic surgery. Objective: to analyze the results of open radical prostatectomy surgeries (ORP) performed by urology residents, comparing them to the results of robot-assisted radical prostatectomy (RARP), performed by these same surgeons, after completing their training in urology. Materials and methods: a retrospective analysis of the cases of only 3 surgeons was performed. 50 patients underwent ORP (group A). The surgeons who operated on the ORP patients were in the 3rd and final year of the urology residency program and beginners in ORP surgery, but with at least 4 years of experience in open surgery. The same surgeons, already trained urologists, began their training in robotic surgery and performed 56 RARP surgeries (group B). For the comparative analysis, data were collected on age, number of lymph nodes removed, surgery time, hospitalization time, drain volume, drain permanence time, indwelling bladdercateter (IBC) permanence time, positive surgical margin, biochemical recurrence, risk classification (ISUP), intra and postoperative complications, urinary incontinence (UI) and erectile dysfunction (ED). The console used was the Da Vinci Si, from Intuitive®. For statistical analysis, the Shapiro-Wilk test verified that the data did not follow normality, the Levene test guaranteed homogeneity, and the Mann-Whitney test performed the comparative analysis of the quantitative data. For the analysis of qualitative data, the Chi-square test was used for nominal variables and the Mann-Whitney U test for ordinal variables. Additionally, the Friedman test analyzed whether there was an improvement in the perception of UI or ED over the months, for each group individually (without comparing them), and the post-hoc Durbin-Conover test, for the results with statistically significant difference. We used a p-value < 0.05, and the Jamovi® program (Version 2.0). Results: there was no statistically significant difference between the groups for age, number of lymph nodes removed, positive surgical margin, biochemical recurrence, risk classification and urinary incontinence. Additionally, we observed that the surgical time was longer in group B. On the other hand, the length of stay, drain volume, drain time, IBC time, complication rate and levels of erectile dysfunction in the third and sixth months were higher in group A, when compared to group B. We also observed that there was no evolutionary improvement in ED over the months in both groups, and that there was a perception of improvement in UI from the 1st to the 3rd month in group A, and from the 1st to the 6th month, and from the 3rd to the 12th month, in group B. Conclusion: the learning curve of RARP is equivalent to the curve of ORP. In general, the results for the robotic group were better, however, the functional results were similar between the groups, with a slight tendency of advantage for the robotic arm. Introduction robotassisted robot assisted controversial this loss stay example physicians physician s 1 heterogeneous later Objective (ORP residents RARP, , (RARP) methods 5 A. A . A) rd urologists B B) age removed volume (IBC margin recurrence ISUP, ISUP (ISUP) complications (UI ED. (ED) Si Intuitive Intuitive® ShapiroWilk Shapiro Wilk normality homogeneity MannWhitney Mann Whitney Chisquare Chi square Additionally without them, them) posthoc post hoc DurbinConover Durbin Conover pvalue p value 005 0 05 0.05 Jamovi Version 2.0. 20 2.0 2 2.0) Results hand st th Conclusion general however arm (RARP (ISUP (ED 00 0.0 2. 0.

ABSTRACT Purpose: Statins are one of the most prescribed classes of drugs worldwide to treat hypercholesterolemia and dyslipidemia. By lowering the level of cholesterol, the use of statin could cause a reduction in testosterone levels. The objective was to evaluate whether the continued use of statins in patients with hypercholesterolemia causes a deficiency in testosterone and other sex hormones. Materials and Methods: Systematic Review with Meta-analysis, performed in Embase, Medline and Cochrane databases, until May 2023; PROSPERO CRD42021270424protocol. Selection performed by two independent authors with subsequent conference in stages. Methodology based on PRISMA statement. There were selected comparative studies, prospective cohorts (CP), randomized clinical trials (RCT) and cross-sectional studies (CSS) with comparison of testosterone levels before and after statin administration and between groups. Bias analysis were evaluated with Cochrane Tool, The Newcastle-Ottawa Scale (NOS), and using the Assess the Quality of Cross-sectional studies (AXIS) tool. Results: There were found on MedLine, Embase and Cochrane, after selected comparative studies, 10CP and 6RCT and 6CSS for the meta-analysis. In the Forrest plot with 6CSS, a correlation between patients with continuous use of statins and a reduction in total testosterone was evidenced with a statistically significant reduction of 55.02ng/dL (95%CI=[39.40,70.64],I²=91%,p<0.00001). In the analysis with 5RCT, a reduction in the mean total testosterone in patients who started continuous statin use was evidenced, with a statistical significance of 13.12ng/dL (95%CI=[1.16,25.08],I²=0%,p=0.03). Furthermore, the analysis of all prospective studies with 15 articles showed a statistically significant reduction in the mean total testosterone of 9.11 ng/dL (95%CI=[0.16,18.06],I²=37%,p=0.04). A reduction in total testosterone has been shown in most studies and in its accumulated analysis after statin use. However, this decrease was not enough to reach levels below normal. Conclusion: Statins use causes a decrease in total testosterone, not enough to cause a drop below the normal range and also determines increase in FSH levels. No differences were found in LH, Estradiol, SHBG and Free Testosterone analysis. Purpose dyslipidemia cholesterol hormones Methods Metaanalysis, Metaanalysis Meta analysis, Meta-analysis databases 2023 CRD42021270424protocol CRDprotocol CRD protocol stages statement CP, CP , (CP) RCT (RCT crosssectional cross sectional CSS (CSS groups Tool NewcastleOttawa Newcastle Ottawa NOS, NOS (NOS) Crosssectional Cross AXIS (AXIS tool Results MedLine metaanalysis. metaanalysis meta meta-analysis 5502ngdL ngdL 55 02ng dL ng 95%CI=39.40,70.64,I²=91%,p<0.00001. 95CI39407064I²91p000001 CIIp 95%CI= 39.40,70.64 ,I²=91%,p<0.00001 . 95 CI 39 40 70 64 I² 91 p 0 00001 I (95%CI=[39.40,70.64],I²=91%,p<0.00001) 5RCT 1312ngdL 13 12ng 95%CI=1.16,25.08,I²=0%,p=0.03. 95CI1162508I²0p003 1.16,25.08 ,I²=0%,p=0.03 1 16 25 08 03 (95%CI=[1.16,25.08],I²=0%,p=0.03) Furthermore 911 9 11 9.1 95%CI=0.16,18.06,I²=37%,p=0.04. 95CI0161806I²37p004 0.16,18.06 ,I²=37%,p=0.04 18 06 37 04 (95%CI=[0.16,18.06],I²=37%,p=0.04) However Conclusion LH Estradiol 202 (CP (NOS 5 95%CI=39.40,70.64,I²=91%,p<0.00001 95CI39407064I²91p00000 95CI 95%CI 39407064 39.40,70.6 I²91p000001 Ip ,I²=91%,p<0.0000 3 4 7 6 0000 (95%CI=[39.40,70.64],I²=91%,p<0.00001 95%CI=1.16,25.08,I²=0%,p=0.03 95CI1162508I²0p00 1162508 1.16,25.0 I²0p003 ,I²=0%,p=0.0 2 (95%CI=[1.16,25.08],I²=0%,p=0.03 9. 95%CI=0.16,18.06,I²=37%,p=0.04 95CI0161806I²37p00 0161806 0.16,18.0 I²37p004 ,I²=37%,p=0.0 (95%CI=[0.16,18.06],I²=37%,p=0.04 20 95%CI=39.40,70.64,I²=91%,p<0.0000 95CI39407064I²91p0000 3940706 39.40,70. I²91p00000 ,I²=91%,p<0.000 000 (95%CI=[39.40,70.64],I²=91%,p<0.0000 95%CI=1.16,25.08,I²=0%,p=0.0 95CI1162508I²0p0 116250 1.16,25. I²0p00 ,I²=0%,p=0. (95%CI=[1.16,25.08],I²=0%,p=0.0 95%CI=0.16,18.06,I²=37%,p=0.0 95CI0161806I²37p0 016180 0.16,18. I²37p00 ,I²=37%,p=0. (95%CI=[0.16,18.06],I²=37%,p=0.0 95%CI=39.40,70.64,I²=91%,p<0.000 95CI39407064I²91p000 394070 39.40,70 I²91p0000 ,I²=91%,p<0.00 00 (95%CI=[39.40,70.64],I²=91%,p<0.000 95%CI=1.16,25.08,I²=0%,p=0. 95CI1162508I²0p 11625 1.16,25 I²0p0 ,I²=0%,p=0 (95%CI=[1.16,25.08],I²=0%,p=0. 95%CI=0.16,18.06,I²=37%,p=0. 95CI0161806I²37p 01618 0.16,18 I²37p0 ,I²=37%,p=0 (95%CI=[0.16,18.06],I²=37%,p=0. 95%CI=39.40,70.64,I²=91%,p<0.00 95CI39407064I²91p00 39407 39.40,7 I²91p000 ,I²=91%,p<0.0 (95%CI=[39.40,70.64],I²=91%,p<0.00 95%CI=1.16,25.08,I²=0%,p=0 1162 1.16,2 I²0p ,I²=0%,p= (95%CI=[1.16,25.08],I²=0%,p=0 95%CI=0.16,18.06,I²=37%,p=0 0161 0.16,1 I²37p ,I²=37%,p= (95%CI=[0.16,18.06],I²=37%,p=0 95%CI=39.40,70.64,I²=91%,p<0.0 95CI39407064I²91p0 3940 39.40, I²91p00 ,I²=91%,p<0. (95%CI=[39.40,70.64],I²=91%,p<0.0 95%CI=1.16,25.08,I²=0%,p= 116 1.16, ,I²=0%,p (95%CI=[1.16,25.08],I²=0%,p= 95%CI=0.16,18.06,I²=37%,p= 016 0.16, ,I²=37%,p (95%CI=[0.16,18.06],I²=37%,p= 95%CI=39.40,70.64,I²=91%,p<0. 95CI39407064I²91p 394 39.40 I²91p0 ,I²=91%,p<0 (95%CI=[39.40,70.64],I²=91%,p<0. 95%CI=1.16,25.08,I²=0%,p 1.16 (95%CI=[1.16,25.08],I²=0%,p 95%CI=0.16,18.06,I²=37%,p 01 0.16 (95%CI=[0.16,18.06],I²=37%,p 95%CI=39.40,70.64,I²=91%,p<0 39.4 I²91p ,I²=91%,p< (95%CI=[39.40,70.64],I²=91%,p<0 1.1 0.1 95%CI=39.40,70.64,I²=91%,p< 39. ,I²=91%,p (95%CI=[39.40,70.64],I²=91%,p< 1. 0. 95%CI=39.40,70.64,I²=91%,p (95%CI=[39.40,70.64],I²=91%,p

Abstract Background Patients with kidney disease on Hemodialysis (HD) are susceptible to Coronavirus Disease (COVID-19) due to multiple risk factors. Aim This study aims to report the prevalence of antibodies against SARS-CoV-2 among patients on hemodialysis before vaccination in Brazil and to compare with clinical, demographic, and laboratory data. Methods Blood samples from 398 Chronic Kidney Disease (CKD) patients treated in three different private institutions in Rio de Janeiro State, Brazil were submitted to the total anti-SARS-CoV-2 testing. Kidney, liver, and hematological markers were also determined. Respiratory samples were tested by real-time PCR for SARS-CoV-2 RNA and positive samples were subjected to high-throughput sequencing on the MinION device. Results Overall, anti-SARS-CoV-2 prevalence was 54.5 % (217/398) and two individuals had SARS-CoV-2 RNA with variant B.1.1. High anti-SARS-CoV-2 seroprevalence was found in male gender and those with hospital admission in the last 3-months before the inclusion in the study. Lower red blood cell count was observed in the anti-SARS-CoV-2 seropositive group. High levels of anti-SARS-CoV-2 were found in those who reported symptoms, had low levels of eosinophils and low hematocrit, and who practiced physical activity. Conclusion High prevalence of anti-SARS-CoV-2 was found in CKD patients before the universal immunization in Brazil suggesting that dialysis patients were highly exposed to SARS-CoV-2. HD (HD COVID19 COVID 19 (COVID-19 factors SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- clinical demographic data 39 (CKD State antiSARSCoV2 antiSARSCoV anti anti-SARS-CoV- testing liver determined realtime real time highthroughput high throughput device Overall 545 54 5 54. 217/398 217398 217 (217/398 B11 B 1 B.1.1 3months months 3 group symptoms hematocrit activity SARSCoV2. 2. COVID1 (COVID-1 SARS-CoV anti-SARS-CoV 217/39 21739 21 (217/39 B1 B.1. (COVID- 217/3 2173 (217/3 B.1 (COVID 217/ (217/ B. (217 (21 (2 (

RESUMO: Diante da importância de descrever o acúmulo de matéria seca total em acessos de alho e a vantagem dos Modelos Não Lineares Mistos (MNLM) nesse processo, o presente trabalho teve como objetivo comparar quatro equações não lineares (Gompertz, Logístico, Richards e von Bertalanffy) no ajuste do acúmulo de matéria seca total por planta de 30 acessos de alho. O objetivo também foi identificar os melhores acessos de acordo com cada parâmetro de crescimento, estimando os efeitos aleatórios em torno da média através do melhor entre os modelos. A análise foi realizada com o uso do software R. O melhor modelo foi o Logístico segundo os critérios utilizados para comparação (AIC, BIC, R a j . 2, EQM e EAM), apresentando estimativas mais próximas dos valores reais observados. De acordo com os efeitos aleatórios estimados por este modelo, que representam desvios da média, os acessos que apresentaram maior peso assintótico foram 4505, 4826 e 4500, enquanto os acessos 4826, 4837 e 4491 demoraram mais para atingir o ponto de inflexão da curva. A abordagem NLME utilizou apenas um ajuste por equação para obter informações sobre todos os indivíduos da amostra, ajustando eficientemente a matéria seca total acumulada e identificando os melhores acessos de acordo com os efeitos aleatórios estimados de seus parâmetros. RESUMO MNLM (MNLM processo Gompertz, Gompertz (Gompertz Bertalanffy 3 crescimento modelos AIC, AIC (AIC BIC 2 EAM, EAM , EAM) observados 4505 482 4500 483 449 curva amostra parâmetros 450 48 44 45 4

ABSTRACT: Given the importance of describing the accumulation of total dry matter in garlic accessions and the advantage of Nonlinear Mixed Effect Models (NLME) in this process, the present work research compared four nonlinear equations (Gompertz, Logistic, Richards, and von Bertalanffy) in the fit of accumulation of total dry matter per plant of 30 garlic accessions. The objective was also to identify the best accessions according to each growth parameter by estimating the random effects around the mean through the best among the models. The analysis was carried out using the R software. The best model was the Logistic according to the criteria used for comparison (AIC, BIC, R a j . 2, MSE and MAE), presenting estimates closer to the actual observed values. According to the random effects estimated by this model, which represent deviations from the mean, the accessions that showed the highest asymptotic weight were 4505, 4826 and 4500, while accessions 4826, 4837 and 4491 took longer to reach the inflection point of the curve. The NLME approach used one fit per equation to obtain information on all individuals in the sample, efficiently adjusting the accumulated total dry matter and identifying the best accessions according to the estimated random effects of its parameters. ABSTRACT (NLME process Gompertz, Gompertz (Gompertz Richards Bertalanffy 3 models software AIC, AIC (AIC BIC 2 MAE, MAE , MAE) values 4505 482 4500 483 449 curve sample parameters 450 48 44 45 4

Abstract Introduction The COVID-19 pandemic has disproportionately affected individuals residing in Long-Term Care Facilities (LTCFs), necessitating tailored strategies to manage outbreaks. This study examines the outcomes of the ILPI BH project, a collaborative effort between the Municipal Health Department and the Hospital das Clínicas of the Federal University of Minas Gerais, designed to mitigate COVID-19 spread within LTCFs. Methods Prospective cohort of secondary data: 1,794 old residents in 99 long-term care facilities of Belo Horizonte, Brazil, were followed from May 2020 to January 2021. The study analyzed the prevention strategies, residents’ clinical data, and the characteristics of the long-term care facilities, correlating these variables with the number of infections, hospitalizations, and deaths from COVID-19. It checked absolute numbers and rates of incidence, hospitalization, mortality, and lethality. Results There have been 58 COVID-19 outbreaks in long-term care facilities. There were 399 cases among residents, 96 hospitalizations for COVID-19 and 48 deaths from COVID-19 (2.7 % of the cohort), with a case fatality rate of 12 %. After multivariate analysis, the intrinsic variables to residents associated with higher mortality risk were higher degree of frailty (OR=1.08; p = 0.004) and the fact of living in a long-term care facility with a considerable proportion of residents’ coverage by health plans (OR = 1.01; p = 0.028). Early geriatric follow-up showed an association with a reduction in the number of hospitalizations due to COVID-19. Conclusion The correct classification of the degree of frailty of institutionalized older people seems to have been relevant for predicting mortality from COVID-19. The extensive assistance by private health plans, contrary to what is supposed, did not result in better health protection. Early geriatric follow-up was beneficial and may be an attractive strategy in the face of health emergencies that affect long-term care facilities to reduce hospital admissions. COVID19 COVID 19 COVID-1 LongTerm Long Term LTCFs, LTCFs , (LTCFs) project Gerais data 1794 1 794 1,79 9 longterm long term Horizonte Brazil 202 2021 infections COVID19. 19. incidence hospitalization lethality 5 39 4 2.7 27 2 7 (2. cohort, cohort) analysis OR=1.08 OR108 OR 08 (OR=1.08 0.004 0004 0 004 1.01 101 01 0.028. 0028 0.028 . 028 0.028) followup follow up supposed protection admissions COVID1 COVID- (LTCFs 179 79 1,7 20 3 2. (2 OR=1.0 OR10 (OR=1.0 0.00 000 00 1.0 10 002 0.02 02 17 1, ( OR=1. OR1 (OR=1. 0.0 1. OR=1 (OR=1 0. OR= (OR=

ABSTRACT Background: The primary aim of this study is to assess the survival rates of individuals diagnosed with Community-Acquired Pneumonia (CAP) post-hospitalization in Colombia. Additionally, explore potential risk factors associated with decreased long-term survival. Methods: A retrospective cohort study was conducted in a hospital in Colombia, evaluating survival at 3, 6 and 12 months in CAP patients, using the Kaplan-Meier method. Stratifications were made by age, sex, comorbidity, and severity. The comparison of survival curves was performed using the Log-Rank test, a multivariate analysis with Cox regression was performed to study possible risk factors that affected 12-month survival in patients with CAP. Results: 3688 subjects were admitted, with a mortality of 16.3 % per year. Survival at three, six, and twelve months was 92.9 % (95 % CI 92–93 %), 88.8 % (95 % CI 87–90 %), and 84.2 % (95 % CI 82–85 %), respectively. Analysis stratified by pneumonia severity index, 12-month survival was 98.7 % in Class I, 95.6 % in Class II, 87.41 % in Class III, 77.1 % in Class IV, and 65.8 % in class-V (p < 0.001). Cox-regression showed that being male (HR = 1.44; 95 % CI 1.22–1.70; p < 0.001), an elevated pneumonia severity index (HR = 4.22; 95 % CI 1.89–9.43; p < 0.001), a high comorbidity index (HR = 2.29; 95 % CI 1.89–2.84; p < 0.001) and vasopressor requirement (HR = 2.22; 95 % CI < 0.001) were associated with a lower survival at twelve months of follow-up. Conclusion: Survival in patients with CAP who require hospitalization decreases at 3, 6, and 12 months of follow-up, being lower in patients older than 65 years, men, high comorbidity, and in subjects with severe presentation of the disease. Background CommunityAcquired Community Acquired (CAP posthospitalization post Colombia Additionally longterm long term Methods 3 1 KaplanMeier Kaplan Meier method age sex LogRank Log Rank test 12month month Results 368 admitted 163 16 16. year three six 929 92 9 92. (9 9293 93 92–9 %, , %) 888 88 8 88. 8790 87 90 87–9 842 84 2 84. 8285 82 85 82–8 respectively 987 98 7 98. I 956 95. II 8741 41 87.4 III 771 77 77. IV 658 65. classV class V 0.001. 0001 0.001 . 0 001 Coxregression HR 1.44 144 44 1.22–1.70 122170 22 70 0.001, 4.22 422 4 1.89–9.43 189943 89 43 2.29 229 29 1.89–2.84 189284 2.22 222 followup. followup follow up. up follow-up Conclusion followup, up, years men disease 36 ( 92– 879 87– 828 82– 874 87. 000 0.00 00 1.4 14 1.22–1.7 12217 4.2 42 1.89–9.4 18994 2.2 1.89–2.8 18928 0.0 1. 1.22–1. 1221 4. 1.89–9. 1899 2. 1.89–2. 1892 0. 1.22–1 122 1.89–9 189 1.89–2 1.22– 1.89– 18 1.22 1.89 1.2 1.8

ABSTRACT Objectives: To provide an overview of low-intensity extracorporeal shockwave therapy (LIEST) for erectile dysfunction (ED), pointing out which concepts are already consolidated and which paths we still need to advance. Materials and Methods: We performed a narrative review of the literature on the role of shockwave therapies in erectile dysfunction, selecting publications in PUBMED, including only relevant clinical trials, systematic reviews and meta-analyses. Results: We found 11 studies (7 clinical trials, 3 systematic review and 1 meta-analysis) that evaluated the use of LIEST for the treatment of erectile dysfunction. One clinical trial evaluated the applicability in Peyronie’s Disease and one other clinical trial evaluated the applicability after radical prostatectomy. Conclusions: The literature presents little scientific evidence but suggests good results with the use of LIEST for ED. Despite a real optimism since it is a treatment modality capable of acting on the pathophysiology of ED, we must remain cautious, until a larger volume of higher quality studies allows us to establish which patient profile, type of energy and application protocol will achieve clinically satisfactory results. Objectives lowintensity low intensity (LIEST ED , (ED) advance Methods PUBMED trials metaanalyses. metaanalyses meta analyses. analyses meta-analyses Results 7 ( metaanalysis analysis meta-analysis Peyronies Peyronie s prostatectomy Conclusions cautious profile (ED

ABSTRACT Purpose To analyze the learning curve regarding complication rates of transrectal prostate biopsy (TRPB) versus transperineal prostate biopsy (TPPB), using real time software-based magnetic resonance imaging ultrasound (MRI-US) fusion techniques, along with first year experience of transperineal approach. Materials and Methods retrospective unicentric cohort study at a quaternary care hospital. Medical records of all consecutive patients that underwent TPPB between March 2021 and February 2022, after the introduction of MRI-US fusion device, and those who underwent TRPB throughout the entire years of 2019 and 2020 were analyzed. All complications that occurred as consequences of the procedure were considered. Descriptive statistics, Chi-squared and Fisher tests were used to describe complications and compare the two groups. Results A total of 283 patients were included in the transperineal group and 513 in the transrectal group. The analysis of a learning curve for the transperineal method showed lower complications rates comparing the first six months of TPPB procedures (group 1); The complication rate for TPPB was lower than that of TRPB (55.1% versus 81.9%, respectively; p<0.01). TPPB showed specifically lower rates of hematuria (48.8% versus 66.3%;p<0.001) and rectal bleeding(3.5% versus 18.1%; p<0.001). There were no cases of prostatitis after transperineal biopsies and three cases (0.6%) after transrectal procedures. Conclusions We evidenced the learning curve for performing the transperineal biopsy, with a lower rate of complications for the experienced team, after 142 cases after 6 months of practice. The lower complication rate of TPPB and the absence of infectious prostatitis imply a safer procedure when compared to TRPB. (TRPB TPPB, , (TPPB) softwarebased software based MRIUS MRI US (MRI-US techniques approach hospital 202 2022 device 201 analyzed considered statistics Chisquared Chi squared groups 28 51 1 1) 55.1% 551 55 (55.1 819 81 9 81.9% respectively p<0.01. p001 p p<0.01 . 0 01 p<0.01) 48.8% 488 48 8 (48.8 66.3%p<0.001 663p0001 66.3% p<0.001 66 3 001 66.3%;p<0.001 bleeding3.5% bleeding35 bleeding 3.5% 5 bleeding(3.5 18.1% 181 18 p<0.001. p0001 p<0.001) 0.6% 06 (0.6% team 14 practice (TPPB 20 2 55.1 (55. 81.9 p00 p<0.0 48.8 4 (48. 66.3%p<0.00 663p000 663 66.3 p<0.00 00 66.3%;p<0.00 bleeding3 bleeding3.5 35 3.5 bleeding(3. 18.1 p000 0.6 (0.6 55. (55 81. p0 p<0. 48. (48 66.3%p<0.0 663p00 66. 66.3%;p<0.0 bleeding3. 3. bleeding(3 18. 0. (0. (5 p<0 (4 66.3%p<0. 663p0 66.3%;p<0. bleeding( (0 ( p< 66.3%p<0 663p 66.3%;p<0 66.3%p< 66.3%;p< 66.3%p 66.3%;p