Eficàcia de la hidratació oral com a mesura preventiva de la lesió renal aguda postcontrast iodat

[cat] INTRODUCCIÓ: La lesió renal aguda postcontrast (LRA-PC) es defineix com un increment de la creatinina sèrica (Cr) ≥ 0,3mg/dl (26,5μmol/l) o ≥ 1,5 vegades comparada amb el valor basal de la Cr que apareix entre les 48-72 hores després de l’administració intravascular del contrast iodat. L’existència d’insuficiència renal crònica (IRC) es considera el factor de risc principal associat a l’aparició de la LRA-PC. La hidratació per via intravenosa (i.v.) és en l’actualitat l’única forma de profilaxi efectiva de la LRA-PC. HIPÒTESI: La hidratació per via oral no és inferior a la hidratació per via i.v. com a mesura profilàctica de la LRA-PC en pacients amb IRC estadi IIIb als que se’ls hi realitzi una tomografia computaritzada (TC) administrant contrast iodat i.v. OBJECTIUS: L’objectiu principal d’aquesta tesi és l’avaluació de forma prospectiva i randomitzada de la no inferioritat de la hidratació per via oral comparada amb la hidratació per via i.v. en la prevenció de la LRA-PC en pacients amb IRC estadi IIIb referits per una TC amb contrast iodat. Els objectius secundaris són: 1) l’anàlisi de la necessitat d’hemodiàlisi durant el mes posterior a la realització de la TC amb contrast iodat en el grup d’hidratació oral i en el d’hidratació i.v.; 2) l’anàlisi de la reversibilitat de la LRA-PC 15 dies després de la realització de la TC amb contrast iodat en els dos grups; 3) l’avaluació de la seguretat en ambdós grups d’hidratació; 4) l’avaluació de la no inferioritat de la hidratació via oral versus la hidratació via i.v. en la prevenció de la LRA-PC en el subgrup de pacients oncològics. MATERIAL I MÈTODES: S’ha realitzat un assaig clínic unicèntric, prospectiu, de distribució aleatòria, no emmascarat, amb dos grups paral·lels, de no inferioritat, l’estudi NICIR. Els pacients s’han randomitzat assignant-se 1:1 per rebre una pauta de profilaxi contra la LRA-PC sigui amb hidratació via oral: 500 ml d’aigua dues hores abans i 2000 ml durant les 24 hores després de l’administració de contrast iodat o amb hidratació i.v.; bicarbonat sòdic (166mmol/l) 3 ml/kg/h començant una hora abans i bicarbonat sòdic (166mmol/l) 1 ml/kg/h durant l’hora posterior a la TC amb contrast iodat. Retrospectivament, també hem analitzat aquesta no inferioritat de la hidratació oral respecte a la hidratació i.v. en el subgrup de pacients oncològics, que suposen el 74% dels pacients de l’estudi NICIR. RESULTATS: Dels 228 pacients que es van randomitzar entre el gener del 2018 fins al gener del 2019, 114 van rebre hidratació i.v. i 114 hidratació oral i van ser avaluables. No es van trobar diferències significatives en els factors de risc i les característiques clíniques associades entre les dues branques de l’estudi (p=0.13->0.95). La ràtio de LRA-PC va ser del 4.4% (95%CI: 1.4-9.9%) a la branca d’hidratació oral i del 5.3% (95%CI: 2.0-11.1%) a la branca d’hidratació i.v. La ràtio de LRA-PC no reversible va ser de 1.8% (95%CI: 0.2-6.2%) a les dues branques. Cap pacient va requerir diàlisi durant el mes posterior a la TC i no hi va haver cap efecte advers relatiu al règim d’hidratació. Dels 174 pacients inclosos en la subanàlisi retrospectiva dels pacients oncològics, 82 van rebre hidratació oral i 92 i.v. La ràtio de LRA-PC va ser del 3.7% a la branca d’hidratació oral i del 5.4% en la i.v. La LRA-PC persistent va ser de 1,8% a la branca oral i de 3.3% a la i.v. CONCLUSIONS: L’estudi NICIR demostra que la hidratació per via oral no és inferior a la hidratació per via i.v. com a mesura profilàctica de la LRA-PC en pacients amb IRC estadi IIIb als que se’ls hi realitza una TC amb contrast iodat. Aquesta hipòtesi també queda demostrada al subgrup de pacients oncològics, que aquest estudi ha avaluat específicament de manera retrospectiva.[eng] TITLE: Oral hydration compared to intravenous hydration in the prevention of post-contrast acute kidney injury in patients with chronic kidney disease stage IIIb: A phase III non-inferiority study (NICIR study) OBJECTIVE: To evaluate the non-inferiority of oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in patients with stage IIIb chronic kidney disease (CKD) referred for an elective contrast-enhanced computed tomography (CE-CT). MATERIAL AND METHODS: This is a prospective, randomized, phase 3, parallel-group, open-label, non-inferiority trial. Patients were randomly assigned 1:1 to receive prophylaxis against PC-AKI either with oral hydration: 500 mL of water two hours before and 2000 mL during the 24 h after performing CE-CT or i.v. hydration: sodium bicarbonate (166 mmol/L) 3 mL/kg/h starting one hour before and sodium bicarbonate (166 mmol/L) 1 mL/kg/h during the first hour after CE-CT. 100 mL of non-ionic iodinated contrast was administered in all cases. The primary outcome was the proportion of PC-AKI in the first 48–72 h after CE-CT. Secondary outcomes were persistent PC-AKI, the need for hemodialysis, and the occurrence of adverse events related to prophylaxis. RESULTS: Of 264 patients randomized between January 2018 and January 2019, 114 received oral hydration, and 114 received i.v. hydration and were evaluable. No significant differences were found (p > 0.05) between arms in clinical characteristics or risk factors. PC-AKI rate was 4.4 % (95 %CI: 1.4-9.9 %) in the oral hydration arm and 5.3 % (95 %CI: 2.0-11.1%) in the i.v. hydration arm. The persistent PC-AKI rate was 1.8 % (95 %CI: 0.2-6.2 %) in both arms. No patient required dialysis during the first month after CE-CT or had adverse effects related to the hydration regime. CONCLUSION: In those with stage IIIb CKD referred for an elective CE-CT, we provide evidence of non-inferiority of oral hydration compared to i.v. hydration in the prevention of PC-AKI

Usefulness of multidetector computed tomography to differentiate between renal cell carcinoma and oncocytoma. A model validation

OBJECTIVE: The purpose of this study is to validate a multivariable predictive model previously developed to differentiate between renal cell carcinoma (RCC) and oncocytoma using CT parameters. METHODS AND MATERIALS: We included 100 renal lesions with final diagnosis of RCC or oncocytoma studied before surgery with 4-phase multidetector CT (MDCT). We evaluated the characteristics of the tumors and the enhancement patterns at baseline, arterial, nephrographic and excretory MDCT phases. RESULTS: Histopathologically 15 tumors were oncocytomas and 85 RCCs. RCCs were significantly larger (median 4.4 cm vs 2.8 cm, p = 0.006). There were significant differences in nodule attenuation in the excretory phase compared to baseline (median: 31 vs 42, p = 0.015), with RCCs having lower values. Heterogeneous enhancement patterns were also more frequent in RCCs (85.9% vs 60%, p = 0.027).Multivariable analysis showed that the independent predictors of malignancy were the enhancement pattern, with oncocytomas being more homogeneous in the nephrographic phase [Odds Ratio (OR) 0.16 (95% CI 0.03 to 0.75, p = 0.02)], nodule enhancement in the excretory phase compared to baseline, with RCCs showing lower enhancement [OR 0.96 (95% CI 0.93 to 0.99, p = 0.005)], and a size > 4 cm, with RCCs being larger [OR 5.89 (95% CI 1.10 to 31.58), p = 0.038]. CONCLUSION: The multivariable predictive model previously developed which combines different MDCT parameters, including lesion size > 4 cm, lesion enhancement in the excretory phase compared to baseline and enhancement heterogeneity, can be successfully applied to distinguish RCC from oncocytoma. ADVANCES IN KNOWLEDGE: This study confirms that multiparametric assessment using MDCT (including parameters such as size, homogeneity and enhancement differences between the excretory and the baseline phases) can help distinguish between RCCs and oncocytomas. While it is true that this multiparametric predictive model may not always correctly classify renal tumors such as RCC or oncocytoma, it can be used to determine which patients would benefit from pre-surgical biopsy to confirm that the tumor is in fact an oncocytoma, and thereby avoid unnecessary surgical treatments

Pointing Out Some Issues Regarding Reproduction Management in Murciano-Granadina Goats

[EN] The hypothesis of this experiment proposes that it could be possible to identify pregnant goats through maximum progesterone milk levels at any time in the pregnancy, and that there is an optimal moment to apply a lactation inhibitor to dry off lactating goats. The maximum progesterone concentration in milk varied depending on the season of the year, and those concentrations were similar for pregnant and non-pregnant goats, but significantly higher in the case of gestating goats with four foetuses, for which it would be possible to distinguish the pregnancy. The milk yield of goats at mating does not affect fertility until a value of at least 3250 mL/day. If using lactation inhibitors, their application up to the 10th week post-mating would be optimal for drying off lactating goats. Two of the most important problems in high-yielding dairy goat farms are early and accurate pregnancy diagnosis and the appropriate dry off of lactating does before the next kidding. The hypothesis posits that it could be possible to identify pregnant does through maximum progesterone milk levels at any time during the pregnancy, and that there is an optimal time to apply a lactation inhibitor to help dry off lactating does. Therefore, 114 Murciano-Granadina breed goats were used, from which 74 goats were inseminated at week 20 of lactation and samples of milk from pregnant and non-pregnant goats were taken at two-week intervals. The average maximum progesterone milk levels were higher outside the natural breeding season (40 degrees latitude) than in the breeding season (11.6 +/- 1.13 vs. 8.6 +/- 1.02 ng/mL), although the levels from pregnant and non-pregnant goats were similar (10.85 +/- 1.3 vs. 9.74 +/- 1.6 ng/mL), except in the case of pregnancy with four foetuses (12.5 +/- 1.3 ng/mL). Milk yield at mating does not affect fertility until a value of at least 3250 mL/day. Pregnancy started to affect milk yield up to the +7th week and was 59.9% lower in the +10th week after mating, so the use of lactation inhibitors could be more effective from this latter week. In conclusion, the results show that it is not possible to detect gestation in goats reliably through the maximum concentration of progesterone in milk at any time during lactation, except in the case of goats gestating four foetuses, that the milk yield of goats at mating does not affect fertility until a value of at least 3250 mL/day, and that from the 10th week post-mating, the application of lactation inhibitors would be optimal.This research was funded by the project RTA2017-00049-C02-02 (Agencia Estatal de Investigación) with ERDF funds.Fernández Martínez, N.; Beltrán Martínez, MC.; Romero, G.; Roca, MA.; Rodríguez Garcia, M.; Balasch Parisi, S. (2021). Pointing Out Some Issues Regarding Reproduction Management in Murciano-Granadina Goats. Animals. 11(6):1-13. https://doi.org/10.3390/ani11061781S11311

Coping with intimate partner violence and the COVID-19 lockdown: The perspectives of service professionals in Spain

Socioeconomic crisis and humanitarian disasters can cause increased stress for women who experience inter-partner violence (IPV). This study analyzed the impact of the COVID-19 lockdown on this important issue, their related health and social services and working conditions from the perspectives of professionals in different sectors. Forty-three semi-structured interviews were carried out with 47 professionals (44 women and 3 men) from 40 different entities (September 2020-April 2021). This content analysis suggests that the pandemic and its associated prevention measures have had a negative impact on women exposed to IPV and their children, which affected their social wellbeing. Professionals described burnout, difficult and slow administrative processes, and problems with coordination and access to information. These negative impacts were mitigated, in part, by the work of professionals, but this suggests that a series of key strategies are needed to improve the response capacity of the service sector to IPV in situations of crisis. These improvements are related to the availability of human and material resources; an efficient coordination network between the professionals from different sectors; existence of informal support networks in the community; protocols/procedures and prior training for better implementation; and greater flexibility and accessibility of basic services that benefit women who experience IPV.This study was financed through the project “Gender violence and social and health responses during the COVID-19 crisis” by the Fondo Supera Covid-19 CRUE-Santander for the period 2020-2021 (Ref. FSCovid19-03). It was also co-supported by the CIBER of Epidemiology and Public Health of Spain for its aid to the Gender-based Violence and Youth Research Program.S

Vacunació COVID-19: guia d’actuació residències

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Vacunació; Residències; Procediment d'actuacióCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Vacunación; Residencias; Procedimiento de actuaciónCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Vaccination; Residences; Action procedureEn aquest document s'exposa el procediment a seguir durant el procés de vacunació contra la COVID-19 a les residències de Catalunya

Exploiting the potential of autophagy in cisplatin therapy: A new strategy to overcome resistance

Resistance to cisplatin is a major challenge in the current cancer therapy. In order to explore new therapeutic strategies to cisplatin resistance, we evaluated, in a model of lung cancer (H1299 and H460 cell lines), the nature of the pathways leading to cell death. We observed that H1299 displayed a natural resistance to cisplatin due to an inability to trigger an apoptotic response that correlates with the induction of autophagy. However, pharmacological and genetic approaches showed how autophagy was a mechanism associated to cell death rather than to resistance. Indeed, pro-autophagic stimuli such as mTOR or Akt inhibition mediate cell death in both cell lines to a similar extent. We next evaluated the response to a novel platinum compound, monoplatin, able to promote cell death in an exclusive autophagy-dependent manner. In this case, no differences were observed between both cell lines. Furthermore, in response to monoplatin, two molecular hallmarks of cisplatin response (p53 and MAPKs) were not implicated, indicating the ability of this pro-autophagic compound to overcome cisplatin resistance. In summary, our data highlight how induction of autophagy could be used in cisplatin resistant tumours and an alternative treatment for p53 mutated patient in a synthetic lethally approach.This work was supported by grants from Fundación Leticia Castillejo Castillo and Ministerio de Economía y Competitividad (grant SAF2012-30862 to RSP and grant CTQ2011-24434 to FAJ). RSP Research Institute, and the work carried out in his laboratory receive support from the European Community through the regional development funding program (FEDER). JGC received funding from the Regional Ministry of Education and Science of Castilla–La Mancha (FPI-JCCM) and from Fundación Leticia Castillejo Castillo. MCC and RSP have a contract from the INCRECYT progra

Exploiting the potential of autophagy in cisplatin therapy: a new strategy to overcome resistance

Resistance to cisplatin is a major challenge in the current cancer therapy. In order to explore new therapeutic strategies to cisplatin resistance, we evaluated, in a model of lung cancer (H1299 and H460 cell lines), the nature of the pathways leading to cell death. We observed that H1299 displayed a natural resistance to cisplatin due to an inability to trigger an apoptotic response that correlates with the induction of autophagy. However, pharmacological and genetic approaches showed how autophagy was a mechanism associated to cell death rather than to resistance. Indeed, pro-autophagic stimuli such as mTOR or Akt inhibition mediate cell death in both cell lines to a similar extent. We next evaluated the response to a novel platinum compound, monoplatin, able to promote cell death in an exclusive autophagy-dependent manner. In this case, no differences were observed between both cell lines. Furthermore, in response to monoplatin, two molecular hallmarks of cisplatin response (p53 and MAPKs) were not implicated, indicating the ability of this pro-autophagic compound to overcome cisplatin resistance. In summary, our data highlight how induction of autophagy could be used in cisplatin resistant tumours and an alternative treatment for p53 mutated patient in a synthetic lethally approach

Failures of 13-Valent Conjugated Pneumococcal Vaccine in Age-Appropriately Vaccinated Children 2-59 Months of Age, Spain

Vaccination with the 13-valent conjugated pneumococcal disease (PCV13) has reduced invasive pneumococcal disease (IPD), but there have been reports of vaccine failures. We performed a prospective study in children aged 2-59 months who received diagnoses of IPD during January 2012-June 2016 in 3 pediatric hospitals in Catalonia, Spain, a region with a PCV13 vaccination coverage of 63%. We analyzed patients who had been age-appropriately vaccinated but who developed IPD caused by PCV13 serotypes. We detected 24 vaccine failure cases. The serotypes involved were 3 (16 cases); 19A (5 cases); and 1, 6B, and 14 (1 case each). Cases were associated with children without underlying conditions, with complicated pneumonia (OR 6.65, 95% CI 1.91-23.21), and with diagnosis by PCR (OR 5.18, 95% CI 1.84-14.59). Vaccination coverage should be increased to reduce the circulation of vaccine serotypes. Continuous surveillance of cases of IPD using both culture and PCR to characterize vaccine failures is necessary

Effectiveness of the 13-valent pneumococcal conjugate vaccine in preventing invasive pneumococcal disease in children aged 7-59 months. A matched case-control study

Background The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed based on the results of immunogenicity studies and correlates of protection derived from randomized clinical trials of the 7-valent conjugate pneumococcal vaccine. We assessed the vaccination effectiveness (VE) of the PCV13 in preventing invasive pneumococcal disease (IPD) in children aged 7-59 months in a population with suboptimal vaccination coverage of 55%. Methods The study was carried out in children with IPD admitted to three hospitals in Barcelona (Spain) and controls matched by hospital, age, sex, date of hospitalization and underlying disease. Information on the vaccination status was obtained from written medical records. Conditional logistic regression was made to estimate the adjusted VE and 95% confidence intervals (CI). Results 169 cases and 645 controls were included. The overall VE of ≥1 doses of PCV13 in preventing IPD due to vaccine serotypes was 75.8% (95% CI, 54.1-87.2) and 90% (95% CI, 63.9-97.2) when ≥2 doses before 12 months, two doses on or after 12 months or one dose on or after 24 months, were administered. The VE of ≥1 doses was 89% (95% CI, 42.7-97.9) against serotype 1 and 86.0% (95% CI, 51.2-99.7) against serotype 19A. Serotype 3 showed a non-statistically significant effectiveness (25.9%; 95% CI, -65.3 to 66.8). Conclusions The effectiveness of ≥1 doses of PCV13 in preventing IPD caused by all PCV13 serotypes in children aged 7-59 months was good and, except for serotype 3, the effectiveness of ≥1 doses against the most frequent PCV13 serotypes causing IPD was high when considered individually