Prevalence of Protein-Energy Wasting in Dialysis Patients Using a Practical Online Tool to Compare with Other Nutritional Scores: Results of the Nutrendial Study

Diàlisi; Puntuació d'inflamació de desnutrició; Valoració nutricionalDiálisis; Puntuación de inflamación de desnutrición; Valoración nutricionalDialysis; Malnutrition inflammation score; Nutritional assessmentThis cross-sectional study aims to explore the prevalence of protein-energy wasting (PEW) in dialysis patients in Catalonia, Spain, using a new and practical online tool which enables rapid calculation and comparison with other nutritional scores. Methods: A web tool (Nutrendial) was created to introduce different variables and automatically calculate PEW, Malnutrition inflammation Score (MIS) and Subjective Global Assessment (SGA) in 1389 patients (88% in haemodialysis (HD)), 12% in peritoneal dialysis (PD) from different regions of Catalonia. Results: A prevalence of 23.3% (26% HD, 10.2% PD) of PEW was found, with a mean MIS score of 6 and SGA score of C in 7% of the patients. ROC analysis showed MIS as the best nutritional score to diagnose PEW (AUC 0.85). Albumin delivered lower diagnostic precision (AUC 0.77) and sensitivity (66%). A cut off point of 7 (86% sensitivity and 75% specificity) for MIS and 3.7 mg/dL for albumin were found to predict the appearance of PEW in this population. SGA B or C showed an 87% sensitivity and 55% specificity to diagnose PEW. Very low nutritional intervention (14%) was recorded with this tool in patients with PEW. Conclusions: This new online tool facilitated the calculation of PEW, enabling different professionals-including nephrologists, dieticians and nurses-to efficiently obtain insights into the nutritional status of the Catalonian dialysis population and implement the required nutritional interventions. MIS is the score with more sensitivity to diagnose PEW

Factors related to attitudes toward organ donation after death in the immigrant population in Spain

The version posted must contain the text: This is the accepted version of the following article: [full citation], which has been published in final form at [Link to final article]Considering the relevance of the migratory processes in Western societies, the attitudes toward organ donation after death are analyzed bymeans of a survey applied to a representative random sample of the resident immigrant population in Spain, comprising 1202 subjects (estimated marginof error of ±2.88%, p = q, p < 0.05). Considered variables were disposition toward own organ donation, disposition toward deceased relatives donation in different situations, arguments against donation, socio-demographic indicators, religious beliefs, social integration, and information about organ donation and transplantation. Predisposition to donate varies strongly across geographical origin and religious beliefs and also shows relationships with additional socio-demographic, social integration, and informative variables. In turn, the relationship between religious beliefs and attitude toward donation varies as a function of the degreeof social integration. In Spain, the immigrant population is a heterogeneous collective that requires differential strategies to promote donation. Such strategies should be aimed at reinforcing the existing positive attitudes ofcitizens from West Europe and Latin America, and at familiarizing and informing about donation in citizens from the East, and at making specific efforts to break down the cultural and religious barriers toward donation in African citizens, with special emphasis on people of the Muslim faith

Prevalence of anaemia and its clinical management in patients with stages 3-5 chronic kidney disease not on dialysis in Catalonia: MICENAS I study

Introducción: La anemia es una complicación frecuente de la enfermedad renal crónica (ERC). El objetivo de este estudio fue conocer la prevalencia de anemia en pacientes con ERC estadios 3-5 no en diálisis atendidos en consultas externas (CCEE) de Nefrología en Cataluña y su manejo clínico. Metodología: Estudio epidemiológico, de cohorte transversal, multicéntrico, en condiciones de práctica clínica habitual. Recogida de datos mediante un e-CRD que incluía datos de filiación y aquellos relacionados con la anemia (hemoglobina, estatus férrico, tratamiento con agentes estimuladores de la eritropoyesis [AEE] y con otros coadyuvantes). Se definió anemia como unos niveles de hemoglobina < 13,5 g/dl en varones o < 12 g/dl en mujeres o pacientes que recibieran tratamiento con AEE. Resultados: Se incluyeron 504 pacientes (56,4 % varones, edad media de 67,8 ± 15,5 años): 61,5 % presentaban ERC estadio 3, 30,2 % estadio 4 y 8,3 % estadio 5. Las principales causas de ERC fueron la vascular y la nefropatía diabética. La prevalencia de anemia fue del 58,5 % (n = 295); sin embargo, solo un 14,9 % de los pacientes tenían niveles de hemoglobina < 11 g/dl. Los niveles medios de hemoglobina disminuían y el tratamiento con AEE era más frecuente a medida que progresaba la ERC, pero no se observaron diferencias significativas respecto a la prescripción de hierro, según estadios. Los AEE e intervalos más frecuentemente prescritos fueron darbepoetina alfa con una dosis mediana de 40 μg/bisemanal, seguida por C.E.R.A., con una dosis mediana de 75 μg/mensual y epoetina beta con una dosis mediana de 5000 UI/semanal. De los pacientes con anemia (n = 295), un 36,3 % (n = 107) presentaban ferropenia y de ellos solo un 53,3 % recibía tratamiento con suplementos de hierro. Conclusiones: Este estudio demuestra la alta prevalencia de anemia, la cual aumenta a medida que progresa la enfermedad, así como el buen control de la misma en la población de pacientes con ERC atendidos en CCEE de Nefrología en Cataluña. Este control se consigue con dosis moderadas de AEE y prescripción de suplementos de hierro en más del 50 % de los pacientes anémicos

C4-C5 fused pyrazol-3-amines: when the degree of unsaturation and electronic characteristics of the fused ring controls regioselectivity in Ullmann and acylation reactions

Pyrazol-3-amine is a scaffold present in a large number of compounds with a wide range of biological activities and, in many cases, the heterocycle is C4-C5 fused to a second ring. Among the different reactions used for the decoration of the pyrazole ring, Ullmann and acylation have been widely applied. However, there is some confusion in the literature regarding the regioselectivity of such reactions (substitution at N1 or N2 of the pyrazole ring) and no predictive rule has been so far established. As a part of our work on 3-amino-pyrazolo[3,4-b]pyridones 13, we have studied the regioselectivity of such reactions in different C4-C5 fused pyrazol-3-amines. As a rule of thumb, the Ullmann and acylation reactions take place, predominantly, at the NH and non-protonated nitrogen atom of the pyrazole ring respectively, of the most stable initial tautomer (1H- or 2H-pyrazole), which can be easily predicted by using DFT calculations

Carotid atherosclerotic disease predicts cardiovascular events in hemodialysis patients: A prospective study

Background To evaluate the predictive value of carotid atherosclerotic disease (CAD) and intima-media thickness (IMT) on incident cardiovascular disease and mortality in hemodialysis patients. Methods Multicenter, observational, prospective study including 110 patients, followed-up to 6 years. Carotid doppler ultrasonographic findings were classified in 4 degrees of severity: 1) IMT 0.9 mm, 3) carotid plaque with stenosis 50%. The associations between IMT and CAD and cardiovascular events, total and cardiovascular mortality were assessed. Results 83% of the patients had atherosclerotic plaques (CAD degrees 3-4). During follow-up, 29.1% of patients experienced cardiovascular events, and 28.2% died, 38.7% of cardiovascular origin. The presence of plaques was associated with cardiovascular events (p = 0.03) while calcified plaques were associated with both cardiovascular events (p = 0.01), cardiovascular mortality (p = 0.03) and non-significantly with overall mortality (p = 0.08) in the survival analysis. Carotid IMT was not associated with outcomes. Cardiovascular events correlated with CAD severity (HR 2.27, 95% CI 1.13-4.54), age (HR 1.04, 1.01-1.06), previous cardiovascular disease (HR 1.75, 1.05-4.42), dyslipidemia (HR 2.25, 1.11-4.53), lipoprotein (a) (HR 1.01, 1.00-1.02), troponin I (HR 3.89, 1.07-14.18), fibrinogen levels (HR 1.38, 0.98-1.94) and antiplatelet therapy (HR 2.14, 1.04-4.4). In an age-adjusted multivariate model, cardiovascular events were independently associated with previous coronary artery disease (HR 3.29, 1.52-7.15) and lipoprotein (a) (HR 1.01, 1.00-1.02). Conclusions The presence of carotid plaques and, especially, calcified plaques, are predictors of new cardiovascular events and cardiovascular mortality in hemodialysis patients, while IMT was not. The prognostic value of calcified plaques should be confirmed in future studies

A common cognitive, psychiatric, and dysmorphic phenotype in carriers of NRXN1 deletion

Altres ajuts: Fundació Parc Taulí - Institut Universitari UAB CIR2009/33 i CIR2010/034Deletions in the 2p16.3 region that includes the neurexin (NRXN1) gene are associated with intellectual disability and various psychiatric disorders, in particular, autism and schizophrenia. We present three unrelated patients, two adults and one child, in whom we identified an intragenic 2p16.3 deletion within the NRXN1 gene using an oligonucleotide comparative genomic hybridization array. The three patients presented dual diagnosis that consisted of mild intellectual disability and autism and bipolar disorder. Also, they all shared a dysmorphic phenotype characterized by a long face, deep set eyes, and prominent premaxilla. Genetic analysis of family members showed two inherited deletions. A comprehensive neuropsychological examination of the 2p16.3 deletion carriers revealed the same phenotype, characterized by anxiety disorder, borderline intelligence, and dysexecutive syndrome. The cognitive pattern of dysexecutive syndrome with poor working memory and reduced attention switching, mental flexibility, and verbal fluency was the same than those of the adult probands. We suggest that in addition to intellectual disability and psychiatric disease, NRXN1 deletion is a risk factor for a characteristic cognitive and dysmorphic profile. The new cognitive phenotype found in the 2p16.3 deletion carriers suggests that 2p16.3 deletions might have a wide variable expressivity instead of incomplete penetrance

Toll-like receptor orchestrates a tumor suppressor response in non-small cell lung cancer

Targeting early-stage lung cancer is vital to improve survival. However, the mechanisms and components of the early tumor suppressor response in lung cancer are not well understood. In this report, we study the role of Toll-like receptor 2 (TLR2), a regulator of oncogene-induced senescence, which is a key tumor suppressor response in premalignancy. Using human lung cancer samples and genetically engineered mouse models, we show that TLR2 is active early in lung tumorigenesis, where it correlates with improved survival and clinical regression. Mechanistically, TLR2 impairs early lung cancer progression via activation of cell intrinsic cell cycle arrest pathways and the proinflammatory senescence-associated secretory phenotype (SASP). The SASP regulates non-cell autonomous anti-tumor responses, such as immune surveillance of premalignant cells, and we observe impaired myeloid cell recruitment to lung tumors after Tlr2 loss. Last, we show that administration of a TLR2 agonist reduces lung tumor growth, highlighting TLR2 as a possible therapeutic target.F.R.M. is funded by a Wellcome Trust clinical research fellowship through the Edinburgh Clinical Academic Track (ECAT) program (203913/Z/16/Z), a Wellcome Trust-ISSF3 award (IS3-R1.07 20/21), and a Wellcome Trust iTPA award (209710/Z/17/Z). J.C.A. core lab funding was received from Cancer Research UK (C47559/A16243, Training and Career Development Board – Career Development Fellowship), the University of Edinburgh (Chancellor’s Fellowship), and the Ministry of Science and Innovation of the Government of Spain (Proyecto PID2020-117860GB-100 financiado por MCIN/AEI/10.13039/501100011033). S.W. is supported by a Cancer Research UK senior fellowship (A29576). J.C. is supported by a Wellcome Trust clinical lectureship through the ECAT program (203913/Z/16/Z). M.M. is supported by a CRUK Edinburgh Centre Award (C157/A25140). S.V. and J.F.P. are funded by National Institute on Aging (NIA) grants (R01AG 68048-1 and UG3CA 268103-1)

C.E.R.A. en administración mensual corrige y mantiene niveles estables de hemoglobina en pacientes con enfermedad renal crónica no en diálisis: estudio observacional MICENAS II

BACKGROUND AND OBJECTIVE: C.E.R.A. (continuous erythropoietin receptor activator, pegilated-rHuEPO ß) corrects and maintains stable hemoglobin levels in once-monthly administration in chronic kidney disease (CKD) patients. The aim of this study was to evaluate the management of anemia with C.E.R.A. in CKD patients not on dialysis in the clinical setting. METHODS: Two hundred seventy two anemic CKD patients not on dialysis treated with C.E.R.A. were included in this retrospective, observational, multicentric study during 2010. Demographical characteristics, analytical parameters concerning anemia, treatment data and iron status were recorded. RESULTS: C.E.R.A. achieved a good control of anemia in both naïve patients (mean Hemoglobin 11.6g/dL) and patients converted from a previous ESA (mean Hemoglobin 11.7g/dL). Most naïve patients received C.E.R.A. once monthly during the correction phase and required a low monthly dose (median dose 75 µg/month). The same median dose was required in patients converted from a previous ESA, and it was lower than recommended in the Summary of Product Characteristics (SPC). Iron status was adequate in 75% of anemic CKD patients, but only 50% of anemic patients with iron deficiency received iron supplementation. CONCLUSIONS: C.E.R.A. corrects and maintains stable hemoglobin levels in anemic CKD patients not on dialysis, requiring conversion doses lower than those recommended by the SPC, and achieving target hemoglobin levels with once-monthly dosing frequency both in naïve and converted patients

Survival-Related Profile, Pathways, and Transcription Factors in Ovarian Cancer

Ate van der Zee and colleagues analyze the gene expression profiles of ovarian cancer samples from 157 patients, and identify an 86-gene expression profile that seems to predict overall survival

Recomanacions per a la prevenció de la transmissió vertical del VIH

Transmissió vertical; Transmissió mare-fill; VIHTransmisión vertical; Transmisión madre-hijo; VIHVertical transmission; Mother-son transmission; HIVLa transmissió vertical o mare-fill del virus de la immunodeficiència humana (VIH) és la principal via d’infecció en l’edat pediàtrica. Es pot produir durant la gestació, el part i durant el postpart a través de l’alletament matern. En aquest document s’exposen les recomanacions per a la prevenció de la transmissió vertical del VIH a Catalunya. Parteix de la necessitat d’establir l’estat serològic de la futura mare, tant si ja està embarassada i el desconeix, com si es tracta d’una dona infectada pel VIH que es planteja tenir un fill. Analitza en primer lloc el procediment que cal seguir perquè la gestant conegui el seu estat serològic i també què han de tenir en compte les dones infectades pel VIH abans d’iniciar un embaràs. A continuació s’exposen els controls i tractaments que ha de seguir la gestant infectada, en quines condicions s’ha de desenvolupar el part i a quins controls i procediments s’ha de sotmetre el nadó per protegir-lo de la infecció. Aquest material té l’objectiu de millorar i facilitar la informació necessària en el moment del part, als professionals sanitaris de la xarxa de centres hospitalaris de Catalunya, especialment els pediatres, ginecòlegs, obstetres, infermeres i llevadores, que habitualment estan treballant a la sala de parts i facilitar la presa de decisions en el dia a dia.La transmisión vertical o madre-hijo del virus de la inmunodeficiencia humana (VIH) es la principal vía de infección en la edad pediátrica. Se puede producir durante la gestación, el parto y durante el posparto a través de la lactancia materna. En este documento se exponen las recomendaciones para la prevención de la transmisión vertical del VIH en Cataluña. Parte de la necesidad de establecer el estado serológico de la futura madre, tanto si ya está embarazada y desconoce, como si se trata de una mujer infectada por el VIH que se plantea tener un hijo. Analiza en primer lugar el procedimiento a seguir para que la gestante conozca su estado serológico y también que deben tener en cuenta las mujeres infectadas por el VIH antes de iniciar un embarazo. A continuación se exponen los controles y tratamientos que debe seguir la gestante infectada, en qué condiciones se debe desarrollar el parto y en qué controles y procedimientos se someterá al bebé para protegerlo de la infección. Este material tiene el objetivo de mejorar y facilitar la información necesaria en el momento del parto, a los profesionales sanitarios de la red de centros hospitalarios de Cataluña, especialmente los pediatras, ginecólogos, obstetras, enfermeras y matronas, que habitualmente están trabajando en la sala de partes y facilitar la toma de decisiones en el día a día