Objective To analyze the benefit of voiding chain cystourethrography (VCC) [placing a radiographic opaque chain into the urethra and bladder and asking the patient to void under fluoroscopy] in the urodynamic evaluation of female bladder outlet obstruction (BOO). Materials and Methods Females with post anti-incontinence operation voiding dysfunction who underwent urodynamic evaluation augmented with VCC and later had urethrolysis were identified. Six diagnostic criteria for obstruction were applied to each patient: (1) VCC ( obstructed: chain was angulated and could not be voiding out) (2) Video urodynamic study (VUDS) (detrusor contraction combined with radiographic obstruction) (3) maximum flow (Qmax) ≤ 15 cc/sec, detrusor pressure (pDet)@ Qmax ≥ 20 cm H20 (4) Qmax ≤ 11 cc/sec, pDet@ Qmax ≥ 25 cm H20 (5) Qmax ≤ 12 cc/sec, pDet@ Qmax ≥ 25 cm H20 (6) Blaivas-Groutz (B-G) nomogram. Urethrolysis results were reviewed. Agreement in assessment of BOO criteria was assessed by estimating the proportion of pair-wise agreements along with an exact binomial 95% confidence interval (CI) and by estimating kappa along with a 95% CI. Results Twenty-one patients were identified. Twenty of the 22 urethrolyses (91%) were clinically successful. Diagnosis of BOO was most common for VCC (86%) and then B-G Nomogram (67%). Agreement with the VCC was relatively poor for each of the five other methods (14%-62%) with the video urodynamic study (VUDS) being the best. Three patients with successful urethrolysis were diagnosed only by the VCC. All of kappa values regarding agreement with the VCC were low; the highest value of 0.15 was observed for VUDS. Conclusion VCC may augment selection criteria for urethrolysis.

Background: Health professionals who care for patients with imported diseases often lack enough training. The aim of the study is to assess the knowledge of Chagas disease among doctors and nurses attending at-risk pregnant women in our province. Method: descriptive study through a performed anonymous and voluntary knowledge questionnaire for 278 physicians and nurses working at maternity and children's health services in the three hospitals in the province. In Poniente Hospital was established in 2007 a program of screening for the disease in pregnant women. For statistical analysis, quantitative variables were described using the mean and standard deviation. For comparison of qualitative variables we used the chi-square test or Fisher exact test as appropriate. Differences in age and years of experience depending on the hospital were measured by Brown-Forsythe robust test. Results: 116 (41.7%) professionals agreed to participate in the study. 80 (69%) were women and 36 (31%) men, mean age 36.78 years. By professional categories, physicians have a mean of 73.9% correct responses, the nurses 50.7%. Poniente Hospital had the highest percentage of correct answers on aspects of the geographical distribution of the disease (73.7%), the mechanisms of transmission (86%) and diagnosis (82.5%). Conclusions: The Poniente Hospital professionals generally have a better Knowledge about Chagas disease compared with two other professionals hospitals, which probably is related to the existence of the screening program for the disease.

Fundamentos: Los profesionales sanitarios de la provincia de Almería atienden a pacientes con enfermedades importadas para las que en muchas ocasiones carecen de suficiente formación. El objetivo del estudio fue valorar los conocimientos que tienen sobre diferentes aspectos de la enfermedad de Chagas los profesionales médicos y de enfermería que trabajan en tres hospitales de Almería atendiendo a mujeres gestantes. Método: estudio descriptivo trasversal realizado en el año 2011 a través de un cuestionario, anónimo y voluntario, a 278 sanitarios (personal médico y personal de enfermería) del área materno-infantil de los tres hospitales de la provincia. En el hospital de Poniente se instauró en 2007 un programa de despistaje de la enfermedad en mujeres embarazadas. Para el análisis estadística, las variables cuantitativas se describieron con la media y su desviación estándar. Para la comparación de las variables cualitativas se utilizó la prueba chi² de Pearson o la prueba exacta de Fisher según correspondiera. Resultados: 116 (41,7%) profesionales aceptaron participar en el estudio. 80 (69%) fueron mujeres y 36 (31%) hombres, con edad media de 36,78 años. El personal médico presentó una media de respuestas correctas del 73,9% y el personal de enfermería del 50,7%. El hospital de Poniente tuvo mayor porcentaje de respuestas correctas en aspectos relativos a la distribución geográfica de la enfermedad (73,7%), los mecanismos de transmisión (86%) y el diagnóstico (82,5%). Conclusiones: Los profesionales del hospital de Poniente presentan de forma general un mejor conocimiento de la enfermedad de Chagas en comparación con los profesionales de los otros dos centros hospitalarios, lo que probablemente se relaciona con la existencia del programa de despistaje de la enfermedad.

Background: Health professionals who care for patients with imported diseases often lack enough training. The aim of the study is to assess the knowledge of Chagas disease among doctors and nurses attending at-risk pregnant women in our province. Method: descriptive study through a performed anonymous and voluntary knowledge questionnaire for 278 physicians and nurses working at maternity and children's health services in the three hospitals in the province. In Poniente Hospital was established in 2007 a program of screening for the disease in pregnant women. For statistical analysis, quantitative variables were described using the mean and standard deviation. For comparison of qualitative variables we used the chi-square test or Fisher exact test as appropriate. Differences in age and years of experience depending on the hospital were measured by Brown-Forsythe robust test. Results: 116 (41.7%) professionals agreed to participate in the study. 80 (69%) were women and 36 (31%) men, mean age 36.78 years. By professional categories, physicians have a mean of 73.9% correct responses, the nurses 50.7%. Poniente Hospital had the highest percentage of correct answers on aspects of the geographical distribution of the disease (73.7%), the mechanisms of transmission (86%) and diagnosis (82.5%). Conclusions: The Poniente Hospital professionals generally have a better Knowledge about Chagas disease compared with two other professionals hospitals, which probably is related to the existence of the screening program for the disease.

Fundamentos: Los profesionales sanitarios de la provincia de Almería atienden a pacientes con enfermedades importadas para las que en muchas ocasiones carecen de suficiente formación. El objetivo del estudio fue valorar los conocimientos que tienen sobre diferentes aspectos de la enfermedad de Chagas los profesionales médicos y de enfermería que trabajan en tres hospitales de Almería atendiendo a mujeres gestantes. Método: estudio descriptivo trasversal realizado en el año 2011 a través de un cuestionario, anónimo y voluntario, a 278 sanitarios (personal médico y personal de enfermería) del área materno-infantil de los tres hospitales de la provincia. En el hospital de Poniente se instauró en 2007 un programa de despistaje de la enfermedad en mujeres embarazadas. Para el análisis estadística, las variables cuantitativas se describieron con la media y su desviación estándar. Para la comparación de las variables cualitativas se utilizó la prueba chi² de Pearson o la prueba exacta de Fisher según correspondiera. Resultados: 116 (41,7%) profesionales aceptaron participar en el estudio. 80 (69%) fueron mujeres y 36 (31%) hombres, con edad media de 36,78 años. El personal médico presentó una media de respuestas correctas del 73,9% y el personal de enfermería del 50,7%. El hospital de Poniente tuvo mayor porcentaje de respuestas correctas en aspectos relativos a la distribución geográfica de la enfermedad (73,7%), los mecanismos de transmisión (86%) y el diagnóstico (82,5%). Conclusiones: Los profesionales del hospital de Poniente presentan de forma general un mejor conocimiento de la enfermedad de Chagas en comparación con los profesionales de los otros dos centros hospitalarios, lo que probablemente se relaciona con la existencia del programa de despistaje de la enfermedad.

BACKGROUND: Endotherapy is the primary modality for the control of bleeding from peptic ulceration. OBJECTIVE: To assess the efficacy of endoscopic intervention for high-risk bleeding peptic ulcer disease and to benchmark our surgical and mortality rates. METHODS: Two hundred and twenty-seven patients with peptic ulcers stratified by Rockall and Forrest scores as being at high risk for rebleeding underwent therapeutic intervention (adrenalin injection) between January 2004 and December 2009. The median age of the patients was 57 years (range 19 - 87 years); 60% were males. RESULTS: Primary endoscopic haemostasis failed in 51/227 patients (22.5%); 18 patients (7.9%) required surgery for bleeding not controlled at initial or second endoscopy; and 29 patients (12.8%) died, 12 by day 3 and 17 by day 30. Fifteen patients, all with significant medical co-morbidity, died after successful primary endotherapy, and 4 died after surgery. Surgical patients required more blood (odds ratio (OR) 1.45, p=0.0001) than those not undergoing surgery, but had similar mortality. Rebleeding was the only predictor of death in patients who died by day 3 (OR 18.77). A high Rockall score was the only predictor of death by day 30 (OR1.98). CONCLUSION: The overall surgical and mortality rates were 7.9% and 12.8%, respectively. Over half the deaths resulted from medical co-morbidity, despite successful primary endotherapy. This finding is supported by the use of the Rockall score as a predictor of mortality at day 30. Improving the technical success of primary endoscopic haemostasis, currently 77.5%, has the potential to reduce rebleeding after primary endotherapy, a predictor of death at day 3 in this study