Impacto de los factores de riesgo cardiovascular en el paciente transplantado renal

Consultable des del TDXTítol obtingut de la portada digitalitzadaObjetivo: El objetivo fundamental del presente trabajo de tesis es estudiar la influencia de los factores de riesgo cardiovascular sobre la morbi-mortalidad cardiovascular, sobre la supervivencia del injerto renal y sobre la supervivencia del paciente trasplantado renal. Material y métodos: Estudio con diseño longitudinal, de cohortes prospectivo y retrospectivo con una muestra aleatorizada de 250 pacientes trasplantados renales en el período 1980-2004. Estudio de múltiples variables independientes a lo largo del seguimiento y su relación con las variables dependientes (evento cardiovascular, pérdida del injerto renal y muerte del paciente) mediante análisis bivariantes y multivariantes. Resultados: El 23.6% de los pacientes tuvieron un evento cardiovascular después del trasplante renal. El hábito tabáquico y el índice de Charlson en el momento del trasplante, junto a la presión arterial diastólica y al colesterol total post-trasplante, son las variables predictoras más importantes de evento cardiovascular post-trasplante renal. El 26% de los pacientes perdieron su injerto renal. La presión arterial diastólica, el filtrado glomerular, el nivel de albúmina plasmática, el ejercicio físico y la edad del donante son los factores predictores más importantes de la supervivencia del injerto renal. El 16% de los pacientes fallecieron. La presión arterial diastólica, el nivel de LDL-colesterol, el ejercicio físico, la edad del receptor, la edad del donante y el índice de Charlson en el momento del trasplante son los factores más importantes en la predicción de la supervivencia del paciente trasplantado renal. Un filtrado glomerular bajo, la hipoalbuminemia y un producto calcio-fósforo elevado son factores de riesgo de mortalidad después de un evento cardiovascular post-trasplante renal. Discusión: Una de las aportaciones del estudio es la influencia negativa de los factores de riesgo cardiovascular mayores sobre la evolución del paciente trasplantado renal, de la que se deriva la necesidad de establecer intervenciones terapéuticas enérgicas y precoces. Otro interesante aspecto a comentar es el gran beneficio que la práctica de ejercicio físico regular confiere a este grupo poblacional. Por otro lado, todas aquellas medidas encaminadas a mejorar el filtrado glomerular son básicas en la evolución tanto del injerto como del paciente trasplantado renal. Aunque existe la limitación de que parte del estudio ha sido retrospectivo, la precisión de los datos es alta y el análisis de las variables ha sido longitudinal lo que confiere una mayor consistencia a los resultados encontrados. Asimismo, se ha realizado un amplio seguimiento de los pacientes después de haber padecido un evento cardiovascular, hecho muy poco frecuente en el análisis de la patología cardiovascular después del trasplante renal. Conclusiones: Los factores de riesgo cardiovascular mayores tienen un impacto negativo sobre la evolución del paciente trasplantado renal. La corrección de los factores de riesgo cardiovascular modificables debe ser precoz, en especial el abandono del tabaquismo en fases precoces de la enfermedad renal crónica, y la reducción de las cifras de presión arterial y de los niveles de colesterol total y de LDL-colesterol."Objective: The fundamental objective of this thesis is to study the impact of cardiovascular risk factors on cardiovascular morbi-mortality, on the survival of the renal graft and on the survival of the kidney transplant patient. Material and methods: Study with longitudinal design, of prospective and retrospective cohorts in a randomised sample of 250 kidney transplant patients in the 1980-2004 period. Study of multiple independent variables throughout the follow up and their relation with the dependent variables (cardiovascular event, loss of the renal graft and death of the patient) by means of bivariate and multivariate means. Results: 23.6% of the patients had a cardiovascular event after the kidney transplant. Smoking and the Charlson index at the time of the transplant, together with the diastolic blood pressure and total post-transplant cholesterol are the most important predicting variables of the post-kidney transplant cardiovascular event. Twenty-six percent of the patients lost the renal graft. The diastolic blood pressure, glomerular filtrate, level of plasma albumin, physical exercise and the age of the donor are the most important predicting factors of the survival of the renal graft. Sixteen percent of the patients died. The diastolic arterial pressure, LDL-cholesterol level, physical exercise, age of the receiver, age of the donor and the Charlson index at the time of the transplant are the most important factors in the survival prediction of the kidney transplant patient. A low glomerular filtrate, hypoalbuminemia and a high calcium-phosphorus product are risk factors of mortality after a post-kidney transplant cardiovascular event. Discussion: One of the contributions of the study is the negative impact of the major cardiovascular risk factors on the evolution of the kidney transplant patient, from which is derived the need to establish energetic and early therapeutic interventions. Another interesting aspect to discuss is the great benefit the practice of regular physical exercise has on this population group. On the other hand, all those measures aimed at improving the glomerular filtrate are basic in the evolution of the graft as well as the kidney transplant patient. Although there exists the limitation of part of the study being retrospective, the precision of the data is high and the analysis of the variables has been longitudinal, which gives greater consistency to the results. Likewise, an ample follow up of the patients has been conducted after their having suffered a cardiovascular event, a fact quite infrequent in the analysis of cardiovascular pathology of the kidney transplant. Conclusions: The major cardiovascular risk factors have a negative impact on the evolution of the kidney transplant patient. The correction of the modifiable cardiovascular risk factors must be early, especially stopping smoking in the early phases of chronic kidney disease, and the reduction of the blood pressure levels as well as the total cholesterol and LDL-cholesterol levels

La prosperidad de los recursos de Casación ante la Corte Suprema de Justicia en su Sala de Casación Civil, por la causal de ser la sentencia violatoria de una norma de derecho sustancial, en sede indirecta en el año 2014

CD-T 347.05 R14;174 p.La causal que se pretende investigar a fondo en el presente trabajo, tiene estricta relación con los medios de prueba que las partes en sus actos procesales, han arrimado al proceso o no, pues los desaciertos que se postulan como cargos, tienen nexo directo con la valoración que efectúa el fallador, porque “puede derivarse de la infracción de un precepto de derecho probatorio a la hora de considerar una prueba, caso en el cual se trata de error de derecho; pero también puede desprenderse de un error de hecho en la apreciación de la demanda, o de su contestación o de un medio de prueba”Universidad Libre Seccional Pereir

Renal replacement therapy in ADPKD patients : a 25-year survey based on the Catalan registry

Background: Some 7-10% of patients on replacement renal therapy (RRT) are receiving it because of autosomal dominant polycystic kidney disease (ADPKD). The age at initiation of RRT is expected to increase over time. Methods: Clinical data of 1,586 patients (7.9%) with ADPKD and 18,447 (92.1%) patients with other nephropathies were analysed from 1984 through 2009 (1984-1991, 1992-1999 and 2000-2009). Results: The age at initiation of RRT remained stable over the three periods in the ADPKD group (56.7 ± 10.9 (mean ± SD) vs 57.5 ± 12.1 vs 57.8 ± 13.3 years), whereas it increased significantly in the non-ADPKD group (from 54.8 ± 16.8 to 63.9 ± 16.3 years, p < 0.001). The ratio of males to females was higher for non-ADPKD than for ADPKD patients (1.6-1.8 vs 1.1-1.2). The prevalence of diabetes was significantly lower in the ADPKD group (6.76% vs 11.89%, p < 0.001), as were most of the co-morbidities studied, with the exception of hypertension. The survival rate of the ADPKD patients on RRT was higher than that of the non-ADPKD patients (p < 0.001). Conclusions: Over time neither changes in age nor alterations in male to female ratio have occurred among ADPKD patients who have started RRT, probably because of the impact of unmodifiable genetic factors in the absence of a specific treatment

Métodos para la de degradación de pesticidas (carbamatos) en matrices acuosas

The population growth promoted increases in agricultural production. This is associated with the use of synthetic pesticides that aim to protect crops and increase production volume. Synthetic crop protection chemicals include carbamates, which are pesticides derived from N-methyl or dimethyl carbamic acids, with oxide reducing properties and include nematicides, insecticides, herbicides, and fungicides. These are pesticides with a medium acute toxicity. However, in this family, there are compounds that are highly toxic. As a consequence of the indiscriminate use of pesticides, currently residues of these substances are found in water bodies and represent a potential risk to human and animal health, as well as to the environment. Several methods of carbamate removal have been developed, such as: oxidation, adsorption, biodegradation with microorganisms and advanced oxidation processes (AOPs). The objective of this work is to analyze the methods that are proposed for the treatment of aqueous matrices with the presence of carbamates, through the evaluation of the advantages and disadvantages of each one in terms of the efficiency of pesticide removal. Keywords: Carbamates, oxidation, adsorption, biodegradation with microorganisms, advanced oxidation processes.El crecimiento poblacional que registra el mundo en los últimos años generó la necesidad de incrementar la producción agrícola de alimentos. Esto tiene asociado el empleo de pesticidas sintéticos que tienen como objetivo la protección de los cultivos y aumentar volumen de producción. Entre los productos químicos sintéticos para la protección de los cultivos se encuentran los carbamatos, que son pesticidas derivados de ácidos N-metil o dimetil carbámico, con propiedades óxido reductoras que incluyen nematicidas, insecticidas, herbicidas y fungicidas. Estos son pesticidas con una toxicidad aguda media, aunque dentro de esta familia hay compuestos que son altamente tóxicos. Como consecuencia del uso indiscriminado de pesticidas, en la actualidad se hallan residuos de estas sustancias en los cuerpos de agua y representan un riesgo potencial para la salud humana y animal, así como para el ambiente. Se han desarrollado varios métodos de remoción de carbamatos como son: oxidación, adsorción, biodegradación con microrganismos y procesos de oxidación avanzada (POAs). El objetivo de este trabajo es analizar los métodos que se proponen para el tratamiento de matrices acuosas con presencia de carbamatos, a través de la valoración de las ventajas y desventajas de cada uno en cuanto a la eficiencia de remoción del pesticida. Palabras clave: Carbamatos, oxidación, adsorción, biodegradación con microrganismos, procesos de oxidación avanzada. Abstract The population growth promoted increases in agricultural production. This is associated with the use of synthetic pesticides that aim to protect crops and increase production volume. Synthetic crop protection chemicals include carbamates, which are pesticides derived from N-methyl or dimethyl carbamic acids, with oxide reducing properties and include nematicides, insecticides, herbicides, and fungicides. These are pesticides with a medium acute toxicity. However, in this family, there are compounds that are highly toxic. As a consequence of the indiscriminate use of pesticides, currently residues of these substances are found in water bodies and represent a potential risk to human and animal health, as well as to the environment. Several methods of carbamate removal have been developed, such as: oxidation, adsorption, biodegradation with microorganisms and advanced oxidation processes (AOPs). The objective of this work is to analyze the methods that are proposed for the treatment of aqueous matrices with the presence of carbamates, through the evaluation of the advantages and disadvantages of each one in terms of the efficiency of pesticide removal. Keywords: Carbamates, oxidation, adsorption, biodegradation with microorganisms, advanced oxidation processes. Información del manuscrito:Fecha de recepción: 28 de julio de 2021. Fecha de aceptación: 09 de septiembre de 2021.Fecha de publicación: 10 de enero de 2023

Evaluation of two enzyme-linked immunosorbent assays for diagnosis of bluetongue virus in wild ruminants

Bluetongue (BT) is a reportable re-emerging vector-borne disease of animal health concern. Enzyme-linked immunosorbent assays (ELISA) are frequently used in BT surveillance programs in domestic ruminants, but their diagnostic accuracy has not been evaluated for wild ruminants, which can play an important role as natural reservoirs of bluetongue virus (BTV). The aim of this study was to assess two commercial ELISAs for BT diagnosis in wild ruminants using control sera of known BTV infection status and field samples. When control sera were tested, the double recognition ELISA (DR-ELISA) showed 100 % sensitivity (Se) and specificity (Sp), while the competitive ELISA (C-ELISA) had 86.4 % Se and 97.1 % Sp. Using field samples, the selected latent-class analysis model showed 95.7 % Se and 85.9 % Sp for DR-ELISA, 58.2 % Se and 95.8 % Sp for C-ELISA and 84.2 % Se for the serum neutralization test (SNT). Our results indicate that the DR-ELISA may be a useful diagnostic method to assess BTV circulation in endemic areas, while the C-ELISA should be selected when free-areas are surveyed. The discrepancy between control and field samples point out that the inclusion of field samples is required to assess the accuracy of commercial ELISAs for the serological diagnosis of BTV in wild ruminants.info:eu-repo/semantics/acceptedVersio

Pulmonary vascular remodeling and prognosis in patients evaluated for heart transplantation: insights from the OCTOPUS-CHF study

[Abstract] Objective: In patients with advanced heart failure, the intravascular optical coherence tomography (OCT) of subsegmental pulmonary artery measurements is correlated with right heart catheterization parameters. Our aim was to study the prognostic value of pulmonary OCT, right heart catheterization data, and the echocardiographic estimation of pulmonary pressure in patients studied for elective heart transplants. Methods: This research is an observational, prospective, multicenter study involving 90 adults with a one-year follow-up. Results: A total of 10 patients (11.1%) died due to worsening heart failure before heart transplantation, 50 underwent a heart transplant (55.6%), and 9 died in the first year after the transplant. The patients with and without events (mortality or heart failure-induced hospitalization) had similar data regarding echocardiography, right heart catheterization, and pulmonary OCT (with a median estimated pulmonary artery systolic pressure of 42.0 mmHg, interquartile range (IQR) of 30.3-50.0 vs. 47.0 mmHg, IQR 34.6-59.5 and p = 0.79, median pulmonary vascular resistance of 2.2 Wood units, IQR 1.3-3.7 vs. 2.0 Wood units, IQR 1.4-3.2 and p = 0.99, and a median pulmonary artery wall thickness of 0.2 ± 0.5 mm vs. 0.2 ± 0.6 mm and p = 0.87). Conclusion: Pulmonary vascular remodeling (evaluated with echocardiography, right heart catheterization, and pulmonary OCT) was not associated with prognosis in a selected sample of adults evaluated for elective heart transplants. Pulmonary OCT is safe and feasible for the evaluation of these patients.Instituto de Salud Carlos III; PI18/00254European Regional Development Fund; CB16/11/0050

Pulmonary Vascular Remodeling and Prognosis in Patients Evaluated for Heart Transplantation: Insights from the OCTOPUS-CHF Study

Objective: In patients with advanced heart failure, the intravascular optical coherence tomography (OCT) of subsegmental pulmonary artery measurements is correlated with right heart catheterization parameters. Our aim was to study the prognostic value of pulmonary OCT, right heart catheterization data, and the echocardiographic estimation of pulmonary pressure in patients studied for elective heart transplants. Methods: This research is an observational, prospective, multicenter study involving 90 adults with a one-year follow-up. Results: A total of 10 patients (11.1%) died due to worsening heart failure before heart transplantation, 50 underwent a heart transplant (55.6%), and 9 died in the first year after the transplant. The patients with and without events (mortality or heart failure-induced hospitalization) had similar data regarding echocardiography, right heart catheterization, and pulmonary OCT (with a median estimated pulmonary artery systolic pressure of 42.0 mmHg, interquartile range (IQR) of 30.3-50.0 vs. 47.0 mmHg, IQR 34.6-59.5 and p = 0.79, median pulmonary vascular resistance of 2.2 Wood units, IQR 1.3-3.7 vs. 2.0 Wood units, IQR 1.4-3.2 and p = 0.99, and a median pulmonary artery wall thickness of 0.2 +/- 0.5 mm vs. 0.2 +/- 0.6 mm and p = 0.87). Conclusion: Pulmonary vascular remodeling (evaluated with echocardiography, right heart catheterization, and pulmonary OCT) was not associated with prognosis in a selected sample of adults evaluated for elective heart transplants. Pulmonary OCT is safe and feasible for the evaluation of these patients

Information and communication technologies for approaching smokers : a descriptive study in primary healthcare

Background: Common interventions for smoking cessation are based on medical advice and pharmacological aid. Information and communication technologies may be helpful as interventions by themselves or as complementary tools to quit smoking. The objective of the study was to determine the use of information and communication technologies (ICTs) in the smoking population attended in primary care, and describe the major factors associated with its use. Methods: Descriptive observational study in 84 health centres in Cataluña, Aragon and Salamanca. We included by simple random sampling 1725 primary healthcare smokers (any amount of tobacco) aged 18-85. Through personal interview professionals collected Socio-demographic data and variables related with tobacco consumption and ICTs use were collected through face to face interviews Factors associated with the use of ICTs were analyzed by logistic regression. Results: Users of at least one ICT were predominantly male, young (18-45 years), from most favoured social classes and of higher education. Compared with non-ICTs users, users declared lower consumption of tobacco, younger onset age, and lower nicotine dependence. The percentages of use of email, text messages and web pages were 65.3%, 74.0% and 71.5%, respectively. Factors associated with the use of ICTs were age, social class, educational level and nicotine dependence level. The factor most closely associated with the use of all three ICTs was age; mainly individuals aged 18-24. Conclusions: The use of ICTs to quit smoking is promising, with the technology of mobile phones having a broader potential. Younger and more educated subjects are good targets for ICTs interventions on smoking cessation

GNIP1 E3 ubiquitin ligase is a novel player in regulating glycogen metabolism in skeletal muscle.

Background: Glycogenin-interacting protein 1 (GNIP1) is a tripartite motif (TRIM) protein with E3 ubiquitin ligase activity that interacts with glycogenin. These data suggest that GNIP1 could play a major role in the control of glycogen metabolism. However, direct evidence based on functional analysis remains to be obtained. Objectives: The aim of this study was 1) to define the expression pattern of glycogenin-interacting protein/ Tripartite motif containing protein 7 (GNIP/TRIM7) isoforms in humans, 2) to test their ubiquitin E3 ligase activity, and 3) to analyze the functional effects of GNIP1 on muscle glucose/glycogen metabolism both in human cultured cells and in vivo in mice. Results: We show that GNIP1 was the most abundant GNIP/TRIM7 isoform in human skeletal muscle, whereas in cardiac muscle only TRIM7 was expressed. GNIP1 and TRIM7 had autoubiquitination activity in vitro and were localized in the Golgi apparatus and cytosol respectively in LHCN-M2 myoblasts. GNIP1 overexpression increased glucose uptake in LHCN-M2 myotubes. Overexpression of GNIP1 in mouse muscle in vivo increased glycogen content, glycogen synthase (GS) activity and phospho-GSK-3α/β (Ser21/9) and phospho-Akt (Ser473) content, whereas decreased GS phosphorylation in Ser640. These modifications led to decreased blood glucose levels, lactate levels and body weight, without changing whole-body insulin or glucose tolerance in mouse. Conclusion: GNIP1 is an ubiquitin ligase with a markedly glycogenic effect in skeletal muscle