Reduced Salivary Lactoferrin Levels in Early-Onset Alzheimer's Disease

Grants from Instituto de Salud Carlos III (PI22CIII/00042), CIBERNED (CB07/502, CB06/05/1111, PI2021/03), the Spanish Ministry of Economy and Competitiveness (PID2020-119978RB-I00) and the Andalucía-FEDER Program (UPO-1380913).S

Health Care Resource Utilization and Related Costs of Patients With CKD From the United States: A Report From the DISCOVER CKD Retrospective Cohort

Introduction: It is well established that chronic kidney disease (CKD) results in a significant burden on patients’ health and health care providers. However, detailed estimates of the health care resource utilization (HCRU) of CKD are limited, particularly those which consider severity, comorbidities, and payer type. This study aimed to bridge this evidence gap by reporting contemporary HCRU and costs in patients with CKD across the US health care providers. Methods: Cost and HCRU estimates of CKD and reduced kidney function without CKD (estimated glomerular filtration rate [eGFR]: 60−75 and urine albumin-to-creatinine ratio [UACR]: <30) were derived for US patients included in the DISCOVER CKD cohort study, using linked inpatient and outpatient data from the limited claims-EMR data set (LCED) and TriNetX database. Patients with a history of transplant or undergoing dialysis were not included. HCRU and costs were stratified by CKD severity using UACR and eGFR. Results: Overall health care costs ranged from $26,889 (A1) to$42,139 (A3), and from $28,627 (G2) to$42,902 (G5) per patient per year (PPPY), demonstrating a considerable early disease burden which continued to increase with declining kidney function. The PPPY costs of later stage CKD were particularly notable for patients with concomitant heart failure ($50,191 [A3]) and those covered by commercial payers ($55,735 [A3]). Conclusions: Health care costs and resource use associated with CKD and reduced kidney function pose a substantial burden across health care systems and payers, increasing in line with CKD progression. Early CKD screening, particularly of UACR, paired with proactive disease management may provide both an improvement to patient outcomes and a significant HCRU and cost saving to health care providers

Graphene-based materials behaviour for dyes adsorption

Due to the environmental damage caused by dye dumping, the scientific community has been researching into different adsorbents in order to mitigate this impact. In this respect, different graphene-based materials with a high adsorption capacity were studied (graphite and graphene oxide and two different types of reduced graphene oxide). In this work, four graphene-based materials with different properties and structures were evaluated. All materials were those obtained at each step in the pathway of oxidation, exfoliation, and reduction of graphite for conversion into reduced graphene. These four materials were characterized in depth by different methods (RAMAN, XRD, EDX, SEM, FTIR). Adsorption variables were researched to demonstrate their great adsorptive rate, which reached in some cases values of over 300 mg/g of adsorbed dye. Therefore, this study established a relationship between the physicochemical properties of the materials and their adsorption capacity. Furthermore, the effect of different variables on the process was studied: temperature, contact time and amount of adsorbent.This study creates new adsorbent materials with a long lifespan, reducing the environmental impact of industry on nature.Debido al daño ambiental causado por el vertido de colorantes, la comunidad científica ha estado investigando diferentes adsorbentes para mitigar este impacto. En este sentido, se estudiaron diferentes materiales a base de grafeno con una alta capacidad de adsorción (grafito y óxido de grafenoy dos tipos diferentes de óxido de grafeno reducido). En este trabajo se evaluaron cuatro materiales a base de grafeno con diferentes propiedades y estructuras. Todos los materiales fueron los obtenidos en cada paso del proceso de oxidación, exfoliación y reducción del grafito para convertirlo en grafeno reducido. Estos cuatro materiales se caracterizaron en profundidad por diferentes métodos (RAMAN, XRD, EDX, SEM, FTIR). Se investigaron variables de adsorción para demostrar su gran tasa de adsorción, que alcanzó en algunos casos valores superiores a 300 mg/g de colorante adsorbido. Por lo tanto, este estudio estableció una relación entre las propiedades fisicoquímicas de los materiales y su capacidad de adsorción. Además, se estudió el efecto de diferentes variables en el proceso: temperatura, tiempo de contacto y cantidad de adsorbente

Healthcare resource utilisation and related costs of patients with CKD from the UK: a report from the DISCOVER CKD retrospective cohort

Background Chronic kidney disease (CKD) is widely reported to decrease quality of life, increase morbidity and mortality and cause increased healthcare resource utilisation (HCRU) as the disease progresses. However, there is a relative paucity of accurate and recent estimates of HCRU in this patient population. Our aim was to address this evidence gap by reporting HCRU and related costs in patients with CKD from the UK primary and secondary care settings. Methods HCRU and cost estimates of CKD were derived for UK patients included in the DISCOVER CKD cohort study using clinical records from the Clinical Practice Research Datalink linked to external databases. Patients with a history of transplant or undergoing dialysis were not included. HCRU and costs were stratified by CKD severity using the urinary albumin:creatinine ratio (UACR) and estimated glomerular filtration rate. Results Hospitalisation rates more than tripled between low (A1) and high (A3) UACR categories and the mean annual per-patient costs ranged from £4966 (A1) to £9196 (A3) and from £4997 (G2) to £7595 (G5), demonstrating that a large healthcare burden can be attributed to a relatively small number of patients with later stage CKD, including those with kidney failure and/or albuminuria. Conclusions HCRU and costs associated with CKD impose a substantial burden on the healthcare system, particularly in the more advanced stages of CKD. New interventions that can delay the progression of CKD to kidney failure may not only prolong the patient’s life, but would also provide significant resource and cost savings to healthcare providers

Glucose-lowering treatment pathways of individuals with chronic kidney disease and type 2 diabetes according to the Kidney Disease: Improving Global Outcomes 2012 risk classification

Aims: To describe treatment pathways for key glucose-lowering therapies in individuals with chronic kidney disease (CKD) and type 2 diabetes (T2D) using retrospective data from DISCOVER CKD (NCT04034992). // Methods: Data were extracted from the UK Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics data (2008–2020) and the US integrated Limited Claims and Electronic Health Records Database (LCED; 2012–2019). Eligible individuals were aged ≥18 years with CKD, identified by two consecutive estimated glomerular filtration rate (eGFR) measures (15–<75 mL/min/1.73 m2; 90–730 days apart; index date was the second measurement) and T2D. Chronological treatment pathways for glucose-lowering therapies prescribed on or after CKD index to end of follow-up were computed. Median time and proportion of overall follow-up time on treatment were described for each therapy by database and by eGFR and urinary albumin-to-creatinine ratio (UACR) categories. // Results: Of 36,951 and 4339 eligible individuals in the CPRD and LCED, respectively, median baseline eGFR was 67.8 and 64.9 mL/min/1.73 m2; 64.2 and 63.9% received metformin prior to index; and median (interquartile range) time on metformin during follow-up was 917 (390–1671) and 454 (192–850) days (accounting for ~75% of follow-up time in both databases). The frequency of combination treatment increased over time. There were trends towards decreased metformin prescriptions with decreasing eGFR and increasing UACR within each eGFR category. // Conclusions: Individuals with CKD and T2D had many combinations of therapies and substantial follow-up time on therapy. These results highlight opportunities for improved CKD management

Improvement of the mechanical and flame-retardant properties of polyetherimide membranes modified with Graphene oxide

Polyetherimide (PEI) membranes doped with different amounts (1–5 wt.%) of Graphene Oxide (GO) were prepared through a solution casting method. The effect of the Graphene Oxide incorporation on mechanical and flame-retardant properties was investigated by XDR, FTIR and SEM analyses. Results showed that the addition of 5 wt.% of GO into the membranes caused a 30% of improvement in the tensile strength and a significant increase in the glass transition temperature. Flame-retardant properties were improved when the amount of Graphene Oxide into PEI membrane was increased. These improvements in the membrane composites expand its application for aerospace and building industries.Se prepararon membranas de polieterimida (PEI) dopadas con diferentes cantidades (1–5% en peso) de óxido de grafeno (GO) mediante un método de fundición en solución. El efecto de la incorporación de óxido de grafeno sobre las propiedades mecánicas y retardantes de llama se investigó mediante análisis XDR, FTIR y SEM. Los resultados mostraron que la adición del 5% en peso de GO en las membranas provocó una mejora del 30% en la resistencia a la tracción y un aumento significativo en la temperatura de transición vítrea. Las propiedades ignífugas mejoraron cuando se incrementó la cantidad de óxido de grafeno en la membrana PEI. Estas mejoras en los compuestos de membrana amplían su aplicación para las industrias aeroespacial y de construcción

Effects of oxidizing procedures on carbon nanofibers surface and dispersability in an epoxy resin

Different oxygen functionalities were introduced in fishbone-type carbon nanofibers (CNFs) using three different oxidation procedures. The differences between these procedures are mainly based in the oxidizing agent used and the acid medium in which the process was carried out. Potassium permanganate-, ferrate- and chromate-based approaches were employed in conjunction with exfoliation and subsequent reduction with hydrazine. A complete evaluation of the effects produced by the different oxidative treatments on the resulting materials was carried out. The obtained materials were characterized by Scanning Electron Microscopy (SEM), EDX, RAMAN, Fourier Transform Infrared (FTIR), X-ray diffraction (XRD), N2 adsorption/desorption measurements, particle size and thermogravimetric analysis. The results suggest that only those procedures in which H2SO4 was used as acid medium (i.e., potassium permanganate and ferrate processes) were fit to achieve intercalation of suitable species (SO42− ions) that weaken the van der Waals forces. The weakening of these forces facilitates the attack of the carbon skeleton by the strong oxidants MnO4− or FeO42–and, as a consequence, the fragmentation of the material occurs. Dispersibility of carbon materials are affected by functional groups and oxidation degree. Turbiscan stability index provide a useful tool in order to study the stability of carbon material into different solvents with different dipole moments: water, epoxy resin and decane.Se introdujeron diferentes funcionalidades de oxígeno en nanofibras de carbono tipo espina de pescado (CNF) utilizando tres procedimientos de oxidación diferentes. Las diferencias entre estos procedimientos se basan principalmente en el agente oxidante utilizado y el medio ácido en el que se llevó a cabo el proceso. Se emplearon enfoques basados ​​en permanganato, ferrato y cromato de potasio junto con la exfoliación y la posterior reducción con hidracina. Se realizó una evaluación completa de los efectos producidos por los diferentes tratamientos oxidativos sobre los materiales resultantes. Los materiales obtenidos se caracterizaron por microscopía electrónica de barrido (SEM), EDX , RAMAN, infrarrojo transformado de Fourier (FTIR), difracción de rayos X (XRD), medidas de adsorción/desorción de N 2 , tamaño de partícula yanálisis termogravimétrico . Los resultados sugieren que solo aquellos procedimientos en los que se usó H 2 SO 4 como medio ácido (es decir, procesos de permanganato y ferrato de potasio ) fueron aptos para lograr la intercalación de especies adecuadas (iones SO 4 2− ) que debilitan las fuerzas de van der Waals. El debilitamiento de estas fuerzas facilita el ataque de la estructura carbonada por los oxidantes fuertes MnO 4 − o FeO 4 2–y, como consecuencia, se produce la fragmentación del material. La dispersabilidad de los materiales de carbono se ve afectada por los grupos funcionales y el grado de oxidación. El índice de estabilidad Turbiscan proporciona una herramienta útil para estudiar la estabilidad del material de carbono en diferentes solventes con diferentes momentos dipolares : agua, resina epoxi y decano

Bocio multinodular tóxico (enfermedad de Plummer): reporte de un caso

El bocio multinodular tóxico (BMNT) o enfermedad de Plummer, se define como un aumento de volumen crónico de la glándula tiroides asociado a hipertiroidismo en ausencia de enfermedad autoinmune o neoplasia. Existen factores de riesgo asociados como tabaquismo, sexo, edad y predisposición genética. En el presente trabajo se analiza el caso de un paciente masculino de 75 años de edad que presentó aumento de volumen en región cervical anterior izquierda, asociado a dolor de moderada intensidad, signos de flogosis y, concomitantemente, disfagia y pérdida de peso. Como antecedente importante refirió tabaquismo. Se realizó hematología completa, glicemia y perfil de hormonas tiroideas; se evidenciaron niveles aumentados de T4 con niveles normales de TSH y ausencia de anticuerpos TPO. Se realizó ecografía tiroidea de alta resolución, reportando un aumento difuso del tamaño de la glándula tiroides a predominio del lóbulo izquierdo en todos sus ejes, sin evidencia de ganglios linfáticos aumentados de tamaño. Se estableció diagnóstico de BMNT asociado a diabetes mellitus tipo II, instaurándose un tratamiento con metimazol y metformina combinado con sitagliptina. Posterior a 10 días se evidenció mejoría en el perfil tiroideo, glicemia y disminución del bocio. Es importante considerar la presentación clínica de esta enfermedad, la cual es poco frecuente y se relaciona con la clínica manifestada por el paciente, así como los beneficios de la terapia con drogas antitiroideas en los casos de BMNT en pacientes ancianos. Palabras clave: Bocio; hipertiroidismo; tirotoxicosis; bocio multinodular tóxico; terapia antitiroidea

The role of an electronic alert system to detect acute kidney injury in hospitalized patients: DETECT-H Project

Background and aims: Acute kidney injury (AKI) is associated with higher mortality and length of stay (LOS) for hospitalized patients. To improve outcomes, an electronic detection system could be a useful tool for early diagnosis. Methods: A fully automated real-time system for detecting decreased glomerular filtration rate in adult patients was developed in our hospital, DETECT-H project. AKI was established according to KDIGO guidelines. Results: In six months, 1241 alerts from 11,022 admissions were issued. Overall incidence of AKI was 7.7%. Highest AKI stage reached was: stage 1 (49.8%), 2 (24.5%) and 3 (25.8%), in-hospital mortality was 10.9%, 22.7%, 33.9% respectively and 57.1% in AKI requiring dialysis; mortality in stable CKD was 4.3%. Median LOS was 8 days versus 5 days for all patients. AKI was associated with a mortality of 3.18 (95% CI 1.80–5.59) and a LOS 1.52 (1.11–2.08) times as high as that for admissions without AKI. Multivariate analysis indicated that a LOS higher than 8 days was associated with AKI. Previous CKD was noted in 31.9% and AKI in 45.3% at discharge. As compared to the use of the detect system, only one third of CKD patients and half of AKI episodes were identified. Conclusions: CKD and in-hospital AKI are under-recognized entities. Mortality and LOS are increased in-hospital patients with renal dysfunction. AKI severity was associated with higher mortality and LOS. An automated electronic detection system for identifying renal dysfunction would be a useful tool to improve renal outcomes. Resumen: Introducción y objetivos: El fracaso renal agudo (FRA) aumenta la mortalidad y la estancia hospitalarias (EH). El empleo de sistemas de detección electrónica podría ser una herramienta beneficiosa para mejorar estos resultados. Métodos: Se desarrolló un sistema de detección automático a tiempo real de pacientes ingresados con función renal alterada, denominado proyecto DETECT-H. El FRA se estableció de acuerdo con las guías KDIGO. Resultados: En 6 meses, 1.241 alertas fueron recogidas de 11.022 ingresos. La incidencia global del FRA fue del 7,7%. La distribución en función del estadio máximo del FRA alcanzado fue: estadio 1: 49,8%, estadio 2: 24,5% y estadio 3: 25,8%; con una mortalidad hospitalaria del 10,9, 22,7 y 33,9%, respectivamente. En el caso del FRA con necesidad de diálisis fue del 57,1%. La mortalidad en pacientes con enfermedad renal crónica (ERC) estable fue del 4,3%. La mediana de EH en pacientes detectados fue 8 vs. 5 días para todos los pacientes hospitalizados. El FRA se asoció con una mortalidad 3,18 (1,8-5,59) y una EH 1,52 (1,11-2,08) veces superior que aquellos ingresos sin FRA. El análisis multivariante indicó que el FRA se asociaba con la EH > 8 días.En los informes de alta, la presencia de ERC previa solo fue registrada en el 31,9% de los pacientes con ERC y el FRA hospitalario en el 45,3%. Conclusiones: La ERC y el FRA intrahospitalario son entidades infradiagnosticadas. La mortalidad y la EH están aumentadas en pacientes con disfunción renal. La gravedad del FRA se asoció con mayor mortalidad y EH. Un sistema de detección automático para identificarlos podría ser útil para mejorar estos resultados. Keywords: Acute kidney injury, Automated electronic detection system, Chronic kidney disease, Diagnosis, Health information technology, Mortality, Palabras clave: Fracaso renal agudo, Sistema de detección electrónica automática, Enfermedad renal crónica, Diagnóstico, Tecnología de información de la salud, Mortalida

EXTRAE: EXTRaction of Associations between Diseases and Other Medical Concepts

El propósito de este proyecto es investigar en la mejora de las técnicas de extracción de Reglas de Asociación (RA) entre enfermedades, o entre enfermedades y otros conceptos médicos. Estas reglas permiten representar el conocimiento médico subyacente a un conjunto de Historias Clínica Electrónica (HCE). Concretamente nos planteamos explorar técnicas semisupervisadas que nos permitan alcanzar resultados equiparables a los de las técnicas supervisadas con una mínima supervisión. El proyecto se propone realizar avances significativos en la selección de reglas de asociación relevantes en el dominio de la salud, que pueden tener una alta aplicabilidad en la ayuda al diagnóstico y en la prevención de enfermedades.This project aims to improve the techniques for extracting Association Rules (AR) between diseases, or between diseases and other medical concepts. These rules allow the representation of medical knowledge underlying a set of Electronic Medical Records (EHR). Particularly, we plan to explore semi-supervised techniques that allow us to achieve similar results to those obtained using supervised techniques, but requiring minimal supervision. The project intends to make significant progress in the selection of relevant AR, which may be applied in the health domain for developing diagnostic help systems, or for disease prevention.Este trabajo ha sido parcialmente financiado por los proyectos EXTRAE (IMIENS 2017) y PROSA-MED (TIN2016-77820-C3-2-R)