Chronic kidney disease in the type 2 diabetic patients: prevalence and associated variables in a random sample of 2642 patients of a Mediterranean area

Background: Kidney disease is associated with an increased total mortality and cardiovascular morbimortality in the general population and in patients with Type 2 diabetes. The aim of this study is to determine the prevalence of kidney disease and different types of renal disease in patients with type 2 diabetes (T2DM). Methods: Cross-sectional study in a random sample of 2,642 T2DM patients cared for in primary care during 2007. Studied variables: demographic and clinical characteristics, pharmacological treatments and T2DM complications (diabetic foot, retinopathy, coronary heart disease and stroke). Variables of renal function were defined as follows: 1) Microalbuminuria: albumin excretion rate & 30 mg/g or 3.5 mg/mmol, 2) Macroalbuminuria: albumin excretion rate & 300 mg/g or 35 mg/mmol, 3) Kidney disease (KD): glomerular filtration rate according to Modification of Diet in Renal Disease < 60 ml/min/1.73 m2 and/or the presence of albuminuria, 4) Renal impairment (RI): glomerular filtration rate < 60 ml/min/1.73 m2, 5) Nonalbuminuric RI: glomerular filtration rate < 60 ml/min/1.73 m2 without albuminuria and, 5) Diabetic nephropathy (DN): macroalbuminuria or microalbuminuria plus diabetic retinopathy. Results: The prevalence of different types of renal disease in patients was: 34.1% KD, 22.9% RI, 19.5% albuminuria and 16.4% diabetic nephropathy (DN). The prevalence of albuminuria without RI (13.5%) and nonalbuminuric RI (14.7%) was similar. After adjusting per age, BMI, cholesterol, blood pressure and macrovascular disease, RI was significantly associated with the female gender (OR 2.20; CI 95% 1.86-2.59), microvascular disease (OR 2.14; CI 95% 1.8-2.54) and insulin treatment (OR 1.82; CI 95% 1.39-2.38), and inversely associated with HbA1c (OR 0.85 for every 1% increase; CI 95% 0.80-0.91). Albuminuria without RI was inversely associated with the female gender (OR 0.27; CI 95% 0.21-0.35), duration of diabetes (OR 0.94 per year; CI 95% 0.91-0.97) and directly associated with HbA1c (OR 1.19 for every 1% increase; CI 95% 1.09-1.3). Conclusions: One-third of the sample population in this study has KD. The presence or absence of albuminuria identifies two subgroups with different characteristics related to gender, the duration of diabetes and metabolic status of the patient. It is important to determine both albuminuria and GFR estimation to diagnose KD

Remodelación total de glúteos en pacientes con inyección masiva de sustancias desconocidas

Resumen Introducción y objetivo. Presentamos 2 casos clínicos de extirpación de gran cantidad de tejido afectado en pacientes con inyección masiva de materiales extraños en glúteos y el procedimiento reconstructivo empleado Material y método. Describimos el procedimiento quirúrgico seguido tras la extirpación del material de infiltración, mediante disección de un colgajo dermograso de amplia base lateral que permite su avance en dirección medial para proveer tejido de la región superior del muslo lateral y conformar el nuevo glúteo. Resultados. El contorno final de los glúteos y la ubicación de las cicatrices obtuvo un alto grado de satisfacción en ambas pacientes. El postoperatorio fue largo y algo tórpido por retardo de la cicatrización. Uno de los casos requirió revisión. Conclusiones. Consideramos que los resultados obtenidos pueden ser una alternativa interesante para el tratamiento de esta patología, muy frecuente en la actualidad y de difícil resolución

Automatic Arteriovenous Ratio Computation: Emulating the Experts

Part 19: Workshop on Data Analysis and Modeling Retina in Health and DiseaseInternational audienceThe arteriovenous ratio is an objective way to assess the arteriolar narrowing related to several diseases such as hypertension. It is computed as the ratio between the artery and vein mean widths. However, its calculus is not straightforward since the experts do not use all the retinal vessels. This paper presents an automatic, precise and reproducible methodology for the AVR computation. We analyze the way the experts select the vessels in order to build a system which emulates them. The system was evaluated by two ophthalmologists in a data set of 86 images. The correlation results among the system and the experts are an indication of the reproducibility of the results

Egg pecking and puncturing behaviors in shiny and screaming cowbirds: effects of eggshell strength and degree of clutch completion

Abstract: Shiny cowbirds (Molothrus bonariensis) are generalist brood parasites that use hosts varying in body and egg size. On the contrary, screaming cowbirds (M. rufoaxillaris), which are larger than shiny cowbirds, are host specialist that use mainly one host of similar body and egg size. Both parasites peck and puncture eggs when visiting nests. Through puncturing eggs, cowbirds can reduce the competition for food their chicks face (reduction of competition hypothesis), but the same behavior could also be a mechanism to enforce host to renest when nests are found late in the nesting cycle (farming hypothesis). Eggshell strength increases the difficulty to puncture eggs and therefore may modulate egg-pecking behavior. To test these hypotheses, we studied the effect of the degree of clutch completion and egg size on egg-puncturing behavior. Moreover, we evaluated if morphological differences between cowbird species and eggshell strength affected egg-pecking behavior. We presented captive females a nest with complete (four eggs) or incomplete (one egg) clutches of house wren (small egg size, low eggshell strength), chalk-browed mockingbird (large egg size, intermediate eggshell strength), or shiny cowbird (medium egg size, high eggshell strength). The proportion of nests with punctured eggs was similar for complete and incomplete clutches. Cowbirds punctured more eggs in complete than in incomplete clutches, but in complete clutches, they did not destroy the entire clutch. There were no differences in the egg-pecking behavior between cowbird species, which pecked more frequently the eggs with the strongest eggshell. Our findings are consistent with the reduction of competition hypothesis. Significance statement: Brood parasitic birds do not build nests and raise their chicks. Instead, they lay eggs in nests of other species (hosts), which carry out all parental care. Some brood parasites, like the cowbirds, peck and puncture eggs when they visit host nests. This behavior may help to reduce the competition for food that their chicks face in the nest (reduction of competition hypothesis) or may enforce hosts to renest (farming hypothesis). We experimentally studied egg-pecking and egg-puncturing behaviors in the host generalist shiny cowbird and the host specialist screaming cowbird. We found that the degree of clutch completion and egg size modulate egg-puncturing behavior and eggshell strength modulates egg-pecking behavior. Our results indicate that by puncturing eggs, cowbirds reduce nest competition.Fil: Cossa, Natalia Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución; ArgentinaFil: Tuero, Diego Tomas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución; ArgentinaFil: Reboreda, Juan Carlos. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución; ArgentinaFil: Fiorini, Vanina Dafne. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución; Argentin

Unidad didáctica : la vegetación en Asturias

Disponer de un material didáctico aplicable al aula, con contenidos relacionados entre sí y acabados para servir de guía sin tener que recurrir a otros libros y que se abran a nuevas posibilidades. Elaborar materiales que puedan aplicar los profesores que estén experimentando las reformas de las enseñanzas propugnadas por el MEC de forma interdisciplinar desde todas las asignaturas, planteando una metodología activa. Realizar una unidad didáctica sobre la vegetación en Asturias, estudiando los 6 tipos de ecosistemas más frecuentes en Asturias. La elaboración de la unidad didáctica estuvo guiada por tres líneas complementarias de principios didácticos: 1.Los principios explicitados en los documentos de las reformas de EGB y Enseñanzas Medias. 2.Los corolarios que se deducen de la teoría psicológica del aprendizaje significativo de Ausubel. 3.La referencia al entorno concreto donde se encuentran, intentando asturianizar el currículo. Se tratan los siguientes contenidos: la adaptación y a partir de ella la diversidad y las clasificaciones de plantas; el ecosistema, como resultado de un equilibrio dinámico y los ecosistemas más frecuentes en Asturias: bosques (hayedos, mixtos, ribereños); praderas; litoral (dunas y zona intermareal), para terminar con la influencia del hombre en el medio ambiente. Los documentos utilizados para el desarrollo de la unidad didáctica aparecen en la bibliografía divididos en los siguientes apartados: 1.Pedagogía y didáctica. 2.Reformas de las enseñanzas. 3.Desarrollo de las actividades y los contenidos. Se desarrolla la unidad partiendo de unos conceptos amplios y generales que sirven para organizar el resto de los contenidos. Es una unidad didáctica resultado del trabajo de diseño y elaboración de materiales curriculares que el grupo de profesores de ciencias experimentales de Gijón llevaron a cabo durante los cursos 1985-87 en el ciclo superior de EGB y BUP sin exponer los resultados obtenidos en el aula. Se presentan los contenidos apoyados con dibujos, fotos, lecturas fundamentales, esquemas, actividades, explicación de manejo de materiales y de realización de las actividades. Además, se dan unas recomendaciones a los profesores que vayan a utilizar esta unidad como material didáctico. Los ecosistemas asturianos caracterizan la unidad y se justifica explicando que el ejemplo cercano resulta al alumno familiar a la vez que posibilita la visita escolar al sistema estudiado, contribuyendo a conocer mejor el medio. Los autores de este trabajo intentan que sirva como guía a otros profesores y de punto de arranque para que formen grupos de trabajo como el de ellos.AsturiasES

Factors influencing soccer referee's intentions to quit the game

The number of football referees in England has declined significantly over recent years, posing a threat to the future of competitive soccer. This exploratory study investigates the factors which influence referee's intention to quit the game. Unstructured qualitative interviews (N = 12) were conducted with 3 past and 9 present referees. Interviews were transcribed and analysed using inductive content analysis. Three higher order dimensions emerged: Organizational factors (e.g. support, training and feedback on performance), Personal factors (e.g. psychological impact, intention to quit and personal benefits) and Match factors (e.g. psychological intimidation, physical intimidation and RESPECT protocol). Organizational factors were cited more than any others in relation to intention to quit and thus, ultimately, have the most impact on attrition. Ways in which the findings might inform efforts to retain referees are discussed. © 2014 © 2014 Taylor & Francis

Towards the personalization of septic shock resuscitation:The fundamentals of ANDROMEDA-SHOCK-2 trial

Septic shock is a highly lethal and prevalent disease. Progressive circulatory dysfunction leads to tissue hypoperfusion and hypoxia, eventually evolving to multiorgan dysfunction and death. Prompt resuscitation may revert these pathogenic mechanisms, restoring oxygen delivery and organ function. High heterogeneity exists among the determinants of circulatory dysfunction in septic shock, and current algorithms provide a stepwise and standardized approach to conduct resuscitation. This review provides the pathophysiological and clinical rationale behind ANDROMEDA-SHOCK-2, an ongoing multicenter randomized controlled trial that aims to compare a personalized resuscitation strategy based on clinical phenotyping and peripheral perfusion assessment, versus standard of care, in early septic shock resuscitation.</p

High levels of fasting glucose and glycosylated hemoglobin values are associated with hyperfiltration in a Spanish prediabetes cohort. The PREDAPS study

AimThis study aimed to investigate whether different levels of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) in prediabetes are associated with hyperfiltration.MethodsA prospective cohort of 2,022 individuals aged 30-74 years took part in the PREDAPS Study. One cohort of 1,184 participants with prediabetes and another cohort of 838 participants with normal FPG and normal HbA1c were followed for 5 years. Hyperfiltration was defined as an estimated glomerular filtration rate (eGFR) above the age- and gender-specific 95th percentile for healthy control participants, while hypofiltration was defined as an eGFR below the 5th percentile. The prevalence of hyperfiltration was compared for different levels of prediabetes: level 1 of prediabetes: FPG ResultsThe participants with hyperfiltration were significantly younger, had a higher percentage of active smokers, and lower levels of hemoglobin and less use of ACEIs or ARBs. Only level 3 prediabetes based on FPG 100-109 mg/dL plus HbA1c 6.1-6.4% or FPG 110-125 mg/dL plus HbA1c 5.7-6.4% had a significantly higher odds ratio (OR) of hyperfiltration (OR 1.69 (1.05-2.74); P ConclusionsLevel 3 of prediabetes based on FPG 100-109 mg/dL plus HbA1c 6.1-6.4% or FPG 110-125 mg/dL plus HbA1c 5.7-6.4% had a significantly higher OR of hyperfiltration compared with participants without prediabetes

Towards the personalization of septic shock resuscitation:The fundamentals of ANDROMEDA-SHOCK-2 trial

Septic shock is a highly lethal and prevalent disease. Progressive circulatory dysfunction leads to tissue hypoperfusion and hypoxia, eventually evolving to multiorgan dysfunction and death. Prompt resuscitation may revert these pathogenic mechanisms, restoring oxygen delivery and organ function. High heterogeneity exists among the determinants of circulatory dysfunction in septic shock, and current algorithms provide a stepwise and standardized approach to conduct resuscitation. This review provides the pathophysiological and clinical rationale behind ANDROMEDA-SHOCK-2, an ongoing multicenter randomized controlled trial that aims to compare a personalized resuscitation strategy based on clinical phenotyping and peripheral perfusion assessment, versus standard of care, in early septic shock resuscitation.</p