Viajes: Dubai inaugura la piscina infinita más alta del mundo

 

 

El Burj Khalifa, Ain Dubai, At.Mosphere, Dubai Mall, Dubai Frame... Dubái es conocido en el mundo por ser en un referente mundial batiendo cualquier tipo de récords. Ahora se ha sumado un nuevo coloso en su larga lista de edificaciones: la piscina infinita más alta del mundo, suspendida a 200 metros de altura.   Esta extraordinaria obra se erige en pleno corazón de la icónica isla artificial en forma de palmera: el Palm Jumeirah, que este año celebra 20 años desde su construcción, ofreciendo unas majestuosas vistas en 360 grados de toda la ciudad y su esplendor natural y arquitectónico. Este lugar, de visita obligada, está perfectamente dividido en dos espacios distintos, pero complementarios: una cubierta de piscina de 750 metros cuadrados con elegantes tumbonas y salones hechos a medida, y un Lounge & Bar interior.   Con un menú inspirado en el ambiente cosmopolita, pero desenfadado de las ciudades asiáticas más emblemáticas, el Lounge & Bar de Aura Skypool se ha convertido en uno de los lugares más excepcionales de la ciudad. La colección de platos internacionales con un toque panasiático ha sido cuidadosamente elaborada por el chef Craig Best e incluye la ensalada de pato confitado y pegajoso Aura, el salmón glaseado al miso, la coliflor a la parrilla cargada y postres refrescantes como el Sundae de piña marinada.   Aura Skypool no sólo ofrece un impresionante telón de fondo donde capturar la foto perfecta, sino que también actuará como otro destino focal que proporciona a los visitantes un acceso panorámico a la brillante arquitectura de Palm Jumeirah, así como a los hitos clave de los alrededores que han sido fundamentales para el crecimiento de Dubai como destino turístico.   Aura Skypool está abierta todos los días desde las 10 de la mañana hasta la puesta de sol. Con tres franjas horarias de venta de entradas, los huéspedes pueden elegir su experiencia Aura Skypool perfecta, ya sea una relajada mañana junto a la piscina, una sesión vespertina al atardecer o un día completo para disfrutar de todo lo que ofrece este concepto vanguardista.   Además, Aura Skypooles también es el lugar perfecto para reuniones corporativas, lanzamientos de productos y grandes celebraciones privadas. El equipo interno de eventos promete una experiencia inolvidable en el cielo, creando paquetes a medida para cada ocasión.   Ya puedes reservar tus entradas en www.auraskypool.com

Smokers at twice risk of prostate cancer recurring after surgery‏

 Current smokers, and those who have quit smoking less than 10 years previously, have twice the risk of a recurrence of prostate cancer after surgery, according to new research presented at the European Association of Urology conference in Madrid.

Prostate cancer is the third most common male cancer in Europe, accounting for over 92,000 deaths in 2012 (9% of male deaths). Around 30% of all prostate cancer patients treated with radical prostatectomy experience biochemical recurrence (defined by an increase in PSA, prostate specific antigen) within 10 years after surgery

An international group of scientists and clinicians from the USA and Europe retrospectively looked at biochemical prostate cancer recurrence - in 7191 men who had had their prostate removed by radical prostatectomy.  Of these men, roughly a third were never smokers (2513, or 34.9%), a third were former smokers (2269, or 31.6%) and a third were current smokers (3409, or 33.5%). These patients were followed up for an average of 28 months.

The results showed that after a median of 28 months, current smokers had around double (HR 2.26) the chance of the cancer recurring than did patients who had never smoked (see abstract below for full results). Even those who had quit smoking within the last 10 years still had a significantly higher risk of cancer recurrence, at about the same level (HR 2.03) as that for current smokers. It wasn’t until 10 years after a patient had quit smoking that the risk of cancer recurrence dropped significantly.

According to lead researcher Dr Malte Rieken (University Hospital, Basel, Switzerland):

“This is a new analysis, but it seems to confirm results we have seen in many other types of cancer:  basically, smoking increases the risk of cancer recurrence after initial treatment. Prostate cancer mortality varies widely throughout Europe. The fact that cancer recurrence can vary so dramatically due to smoking is probably one of the factors which may contribute to differences in prostate cancer mortality. It’s just another reason not to smoke at all, but the fact that the risk drops after 10 years means that anyone who has prostate cancer, would be well advised to quit immediately”.

Commenting former EAU Secretary-General, Per-Anders Abrahamsson (Malmo, Sweden) said:

“Prostate cancer is a leading cause of cancer death for man in the western world. A number of studies have addressed how diet and environmental factors affect the risk of prostate cancer. This is the first report that clarifies that smoking increases the risk of prostate cancer recurring after surgery and, therefore, a major step forward to advise our patients to stop smoking when diagnosed with prostate cancer”.

Changes in surgery methods significantly reduces antibiotic resistance

A new study shows how changing working methods in surgery can significantly reduce bacterial resistance to antibiotics, while maintaining protection against infection and reducing costs by up to 60%.  This work is being presented at the European Association of Urology conference in Madrid.

Antibiotic resistance is one of the most important medical problems facing the 21st century, with the medical world acknowledging a lack of new antibiotics in development. In the absence of new drugs in the worldwide pharmacopeia and in the pharmaceutical pipelines, the only way to contain the development of resistance is by changing the way we use antibiotics. However, too often it is easier just to carry on using antibiotics as before. Now a new multi-centre study shows that adherence to guidelines can significantly reduce bacterial resistance in urology surgery.

Antibiotic use is common in urological surgery. In 2010 the European Association of Urology introduced new guidelines* on urological infection in the hope of containing some of the problems associated with antibiotic resistance. In early 2011 an international group of clinicians from Italy, Germany, Norway, and the UK began to work strictly to these new guidelines, with a view to testing just how effective the procedures might be.

Over a period of 33 months they measured outcomes of 3,529 urological procedures (including open, laparoscopic, endoscopic and robotic surgery) which took place under strict adherence to the EAU Guidelines. The results were compared with 2,619 similar procedures from 2006-8 carried out before the new guidelines were implemented.  They found that the rate of infections was similar in the two periods. However, the costs of the antibiotic drugs, and other indirect costs, were significantly lower in the period the guidelines were followed. The antibiotic resistance rates also dropped significantly.

Lead researcher Dr Tommaso Cai (Santa Chiara Hospital, Trento, Italy), commented:

“The changes we made were fairly significant, and required monthly audits to ensure that we were sticking to the new system. For example, under the old system it was standard practice to give a patient who was having an operation** for benign prostatic hyperplasia, the antibiotic ciprofloxacin  both before surgery, and then for 7 days afterwards. But when we adhered to the guidelines we only gave the antibiotic prior to the surgery”.

“We were pleased to find that infection rates did not change between the ‘before’ and ‘after’ periods. However, we also saw significant costs savings, and perhaps most importantly we were able to show a significant decrease in bacterial resistance. For example, E.Coli resistance to ciprofloxacin  decreased by around 15% after we adopted rigorous adherence to the guidelines”.

The reduction in drug-related costs was highly significant: cost-per-procedure was €46.90 in the ‘before guideline’ period, but these dropped to €18.77 when working to the guidelines, a drop of 60%.

Professor Robert Pickard (Professor of Urology, Newcastle University, UK), Chair of the EAU Guideline Panel on Urological Infections (and a co-author of the study) said:

“The main bacterium that causes all types of urinary infection, Escherichia coli (E.coli), is becoming increasingly resistant to treatment using the antibiotics we have available in 2015. This antibiotic resistance is a major health threat, particularly to countries in the EAU community with our advanced healthcare systems. The only proven way to reduce the threat is by antibiotic stewardship to control the overuse and misuse of antibiotics in healthcare. This study shows that by following a few simple rules hospital usage of antibiotics can be dramatically reduced without affecting patient safety, and results in lower resistance and reduced costs”.

*See current EAU guidelines http://uroweb.org/guideline/urological-infections/

**The example given is for a TURP (Transurethral resection of the prostate) operation for BHP. Standard procedure before guideline implementation would be to give 400 mg ciprofloxacin before the operation, then 2 tablets a day for 7 days afterwards. After guideline implementation this changed to only 400 mg ciprofloxacin before the operation.

Study shows regaining normal sexual functioning is “rare” after prostate operations

Regaining normal erectile function is rare after the most common prostate operation, radical prostatectomy. This is the main result of a new study which is presented at the European Association of Urology Congress in Madrid.

Radical Prostatectomy is the removal of the prostate gland during a prostate cancer operation. This can often remove the cancer, but there is a major possible side-effect*, erectile dysfunction – the inability to have an erection. This is because the nerves which surround the prostate are often damaged during the operation, and these nerves control the ability to have an erection. In many cases, this improves with time, but now new research indicates that achieving an erection of the same quality as before the operation is rare, and may have been significantly overestimated by doctors.

The standard way of measuring erectile function is via a questionnaire, the International Index of Erectile Function (IIEF), but this is not specifically aimed at prostate cancer patients. Some researchers had felt that the questionnaire did not take account of the special circumstances of a sudden change in erectile function brought on by surgery, or allow comparison with sexual activity prior to the operation (the IIEF questions only deal with sexual activity within the previous four weeks).

A group led by Dr Mikkel Fode, from the Herlev Hospital in Copenhagen, asked 210 patients to complete the IIEF questionnaire, around 23 months after Radical Prostatectomy surgery. However they added an additional question: “Is your erectile function as good as before the surgery (yes/no)”. Only 14 patients (6.7% of respondents) reported that their erections were as good as before surgery. This compared with 49 patients (23.3%) who showed no decline in the in the IIEF score.

As Mikkel Fode said:

“The occurrence of sexual dysfunction after prostate cancer surgery is well known but our method of evaluating it is new. What this work shows is that having an erection as good as before surgery is a rare event, with the vast majority of men, more than 93% in our sample, experiencing some sexual problems after prostate cancer surgery. Fundamentally, we may have been asking patients the wrong question, but of course we really need bigger trials to confirm this.  We think that this work gives a more realistic, idea of the real problems which most men have after prostate surgery.

This is important to know before deciding on undergoing the treatment as your choice might be affected. For men who have already undergone surgery it is important to know that they are not alone in the situation and that their physician will likely be able to help if they discuss the problem”.

Commenting, Professor Francesco Montorsi, Chair Department of Urology, Vita Salute San Raffaele University, Milan, Italy and Editor Emeritus European Urology said:

“As the average age of patients undergoing radical prostatectomy is decreasing, maintaining the ability to have an erection after an operation is increasingly important to men facing surgery. This is the first study of its kind, so we need to confirm the findings but above all to learn from problems which can face patients after prostate cancer operations. We need to look more closely at nerve sparing techniques, and ensure that good post-operative care is available for each patient”.

 *Incontinence is also a possible side-effect, but this is less common.

Major new study suggests younger men need to review priorities with time after surgery for high-risk prostate cancer

Does age affect the outcomes of men after radical prostatectomy for high-risk prostate cancer? Does a long post-operative cancer specific survival make a difference in outcomes in such patients? A major new study suggests that both the age of the patient and the time survived since the operation have a significant impact in terms of cause of death. In practical terms this means that, for young men with high-risk prostate cancer, doctors may have to re-evaluate long-term clinical priorities with increasing time since surgery. This study is being presented at the European Association of Urology conference in Madrid.

These conclusions are based on the efforts of a multi-institutional international collaboration (the EMPACT group) developed to record long-term outcomes of patients classified as having “high-risk” prostate cancer (see below for definition*) and treated with radical prostatectomy. The study team was able to compile a database of 7650 patients from 14 different tertiary care centres in Italy, the USA, France, Belgium, Germany, Poland, Switzerland, and the Netherlands. Within this population, they were able to identify 612 patients treated with radical prostatectomy (RP) over a 26 year period, from 1987 to 2013 who were under the age of 60. The median follow up time was of 89 months. For each patient the number of cancer-specific related deaths (CSM) were recorded, and compared with the number of non-cancer related deaths (OCM).

They found that in patients younger than 60 years of age, there was a higher probability of dying of prostate cancer than of other causes in the first 10 years after a radical prostatectomy operation. However, after that initial period, cancer deaths diminish and other causes of death become more significant. This means that with increasing time since radical prostatectomy, care for these patients should gradually shift from prioritising prostate cancer towards prioritising other health risks (such as heart disease), even though regular urological check-ups should continue.

	Probability of succumbing to Prostate cancer after 5 yrs from last assessment  (CSM)	Probability of succumbing to other causes (OCM) after 5 yrs from last assessment
Time of last assessment	-	-
After 5 years from surgery	7.3%	2.6%
After 8 years from surgery	6.7%	5.8%
After 10 years from surgery	5.3%	9.9%

Commenting, lead author Dr Marco Bianchi (Ospedale San Raffaele, Milano, Italy) said:

“These results confirm that if you are under 60 when you undergo a radical prostatectomy you need close follow-up, concentrating on possible cancer recurrence for the first 10 years. After that time, patients should worry less about prostate cancer and priorities may need to shift to other health risks, even though regular urological check-ups should be continued.

What this means in practice is that each patient needs close, personalised regular monitoring, where the urologist should not focus only on prostate cancer features, but also on the general health status of the patients. This is particularly important especially with increasing time after surgery, since new comorbidities, such heart disease, may develop and become a more immediate risk to the patient’s health”.

*High risk was defined according to the D’Amico criteria (PSA>20 and/or cT3 or higher and/or biopsy Gleason sum 8-10). 

Los síntomas urinarios llegan a afectar al 70% de los varones a partir de los 60 años

 Astellas Pharma anuncia la comercialización en España a partir de hoy de una nueva fórmula combinada de dos principios activos – solifenacina y tamsulosina OCAS- para tratar conjuntamente los síntomas miccionales de llenado y vaciado asociados a hiperplasia benigna de próstata (HBP) en el varón adulto. Estos síntomas urinarios son altamente molestos y aumentan con la edad, llegando a afectar hasta el 70% de los hombres adultos, quienes ven alterada  su vida diaria, social y de pareja.

Esta nueva fuerza combinada en un solo comprimido de administración oral de solifenacina 6 mg  y de tamsulosina (TOCAS) 0,4 mg, de nombre comercial Vesomni^®, alivia tanto los síntomas de llenado -caracterizados por la necesidad de ir frecuentemente al baño junto con urgencia miccional- como los síntomas de vaciado -principalmente la dificultad en iniciar la micción, el chorro débil y el goteo terminal, entre otros. Está indicado para varones con estos trastornos miccionales que no habían respondido adecuadamente al tratamiento con un solo medicamento.

“La gran oportunidad de contar a partir de ahora con esta fuerza combinada deriva de haber conseguido una formulación en una dosis fija única diaria de dos fármacos, para el tratamiento de estos síntomas avalado con un preciso desarrollo clínico dirigido a pacientes en los que la respuesta a los tratamientos en monoterapia no era la adecuada”, resalta el Dr. Joaquín Carballido, jefe del Servicio de Urología del Hospital Universitario Puerta de Hierro-Majadahonda (Madrid) y catedrático de Urología de la Facultad de Medicina de la Universidad Autónoma de Madrid.

Hasta ahora, el tratamiento más frecuente para los hombres con síntomas del tracto urinario inferior asociados a HBP abordaba principalmente los síntomas de vaciado pero no lograban un control suficiente  de los síntomas de llenado, que son los más molestos para el paciente, afectando a su comodidad y calidad de vida.  Una necesidad médica a cubrir ya que aproximadamente en el 49% de los hombres con síntomas del tracto urinario inferior se solapan los síntomas de llenado y de vaciado.

En este sentido, el vicepresidente de Astellas Europa Sur, José María Martín Dueñas explica que “siempre es una satisfacción para Astellas Pharma poder proporcionar a los pacientes una nueva opción terapéutica frente a  necesidades médicas no resueltas y, en concreto y en esta ocasión, estamos orgullosos de poner a disposición de estos pacientes con fracasos terapéuticos previos una alternativa eficaz frente a los síntomas que sufren”, a lo que añade que “también estamos contentos de que, como resultado de nuestra constante investigación en Urología, área terapéutica en la que somos líderes, se amplíe significativamente el arsenal terapéutico con el que cuentan los profesionales sanitarios para el tratamiento de los síntomas miccionales del varón”.

Eficacia en el alivio de los síntomas miccionales tanto de llenado como vaciado

La aprobación del fármaco desarrollado por Astellas Pharma ha estado respaldado por varios ensayos clínicos que demostraron su eficacia y seguridad gracias a las mejoras estadísticas significativas alcanzadas. “Los datos procedentes de la investigación clínica, muy bien diseñada y planificada, han sido realmente atractivos. Un dato como ejemplo: el 89% de los pacientes que iniciaron el tratamiento lo mantuvieron en todas las fases de la investigación y con unas tasas de satisfacción muy elevadas”, explica el Dr. Carballido.

El especialista resalta que “el resultado final de todo el cuidadoso desarrollo clínico permite afirmar que la eficacia y seguridad del fármaco está más que demostrada y que se concreta en el efecto, ya a las cuatro semanas de tratamiento, sobre los síntomas miccionales de llenado y vaciado vesical y sobre la calidad de vida con un favorable perfil de seguridad tras la administración de un solo comprimido con dosis fija.”

El estudio fase II SATURN, realizado en Europa en 937 varones con STUI/HBP, demostró que la combinación de solifenacina  -eficaz frente a la vejiga hiperactiva- y de  TOCAS -efectivo frente a los STUI- ofrecía mejoras estadísticamente significativas de los síntomas miccionales en comparación con tamsulosina en monoterapia. Además se seleccionaron varias dosis posibles de combinación para su evaluación posterior⁷.

El estudio fase III NEPTUNE y el estudio a largo plazo NEPTUNE II, en el que participaron más de 1.000 varones,  se ratificó que la combinación de solifenacina y TOCAS 0,4 mg mejoraba los STUI (Internacional Prostate Symptom Score) y los síntomas de llenado (Total Urgency and Frequency Score), tras cuatro semanas de tratamiento y que esta mejora se mantenía durante un periodo de hasta 52 semanas de tratamiento⁶.

La combinación de solifenacina + TOCAS 0,4 mg se toleró bien, con un perfil de tolerabilidad y seguridad similar al de los componentes individuales. Los acontecimientos adversos más frecuentes fueron sequedad de boca y estreñimiento.

Por ello, actualmente las guías de la Asociación Europea de Urología (EAU) recomiendan considerar el tratamiento combinado de unbloqueante-α1 y un fármaco antimuscarínico en los pacientes con STUI moderados o graves, si el alivio de los síntomas de llenado ha sido insuficiente en monoterapia⁸.

Las molestias que causan en el varón los síntomas miccionales

Los síntomas del tracto urinario inferior (STUI) son frecuentes en los hombres y pueden incluir síntomas de llenado (frecuencia, urgencia y nocturia) y/o vaciado (vacilación, intermitencia, chorro débil)². Los STUI se asocian generalmente al agrandamiento benigno de la próstata, aunque recientemente se está llegando a la conclusión de que en su origen pueden influir múltiples factores.

A medida que el varón envejece, aumenta el riesgo de que presente o desarrolle alguno de estos síntomas. En el estudio EPIC, una encuesta telefónica poblacional que incluyó a 7.454 varones mayores de 18 años de 5 países (Canadá, Alemania, Italia, Suecia y Reino Unido), el 62,5% de los encuestados notificaron  algún STUI.  Prevalencia que aumentaba hasta el 80,7% de los varones mayores de 60 años³. “La prevalencia real en nuestro país es difícil de establecer, pero en cualquier caso es muy elevada, pudiendo alcanzar hasta el 70% en los varones adultos. Si bien es preciso ser riguroso ya que estos síntomas suelen aparecer combinados y es difícil concretar su incidencia”, asevera el Dr. Carballido.

Los STUI en el varón pueden ser muy molestos y tener consecuencias graves. Alteran el sueño de los pacientes al tener que levantarse varias veces en la noche; entorpecen las actividades sociales y el trabajo; pueden afectar a las relaciones personales y de pareja. Y muchos pacientes suelen tener la preocupación de que sus síntomas indiquen la presencia de un cáncer subyacente o de que puedan necesitar cirugía.

Los síntomas de llenado, como la urgencia o la incontinencia urinaria,  además de ser los más molestos para los pacientes, pueden provocar vergüenza y reticencia a participar en actividades sociales, viajar o visitar lugares con los que no se está familiarizado. En los casos más graves, puede provocar ansiedad y depresión.

En este sentido, la combinación de solifenacina + TOCAS 0,4 mg demostró en un estudio aleatorizado de 12 semanas que mejora significativamente la calidad del sueño y la calidad de vida de los pacientes. En concreto, la calidad de vida de los pacientes mejoró en la semana 4, con nuevas mejoras a las 16 semanas, que se mantuvieron hasta el final del tratamiento.