Prevalencia de insuficiencia renal «oculta» en población diabética tipo 2

ObjetivoDeterminar la prevalencia de insuficiencia renal en diabéticos tipo 2 y comparar dos criterios de definición: el basado en la estimación del filtrado glomerular por la fórmula de Cockcroft-Gault corregida para la superficie corporal y el basado en la creatinina sérica.DiseñoEstudio descriptivo y transversal.EmplazamientoZona básica del Centro de Salud de El Cristo, Oviedo.ParticipantesLa totalidad de pacientes diabéticos tipo 2 diagnosticados de la zona básica.Mediciones principalesSe recogieron datos demográficos, clínicos, factores de riesgo y enfermedad cardiovascular. Se diagnosticó insuficiencia renal (IR) según unas cifras de creatinina plasmática ≥ 1,3 mg/dl en mujeres y ≥ 1,4 mg/dl en varones y según el filtrado glomerular (FG) estimado mediante la fórmula de Cockcroft-Gault: moderada para FG, 60-30 ml/min/1,73 m2; grave para FG, 29-15 ml/min/1,73 m2, y terminal para FG, < 15 ml/min/1,73 m2.ResultadosSe incluyó a 499 pacientes. El 52,3% era mujer con una edad de 69,7 ± 0,4 años. La prevalencia de IR según la creatinina sérica fue del 12%, y según la fórmula de Cockcroft-Gault del 40,5%. Los pacientes con FG reducido y creatinina normal tenían mayor edad (75,5 ± 7,9 frente a 65,4 ± 9,8 años; p < 0,001), predominaban las mujeres (76,3 frente a 41,7%; p < 0,001), tenían un menor índice de masa corporal (27,3 ± 3,7 frente a 30,9 ± 4,4), presentaban un peor control glucémico (HbA1c 7,1 ± 1,8 frente a 6,9 ± 1,9%; p = 0,007) y la prevalencia de insuficiencia cardíaca era superior (6,4 frente a 2,1%; IC del 95%, 1,1-8,8; p = 0,02) en comparación con los pacientes con FG y creatinina normales.ConclusiónLa estimación del FG por la fórmula de Cockcroft-Gault corregida para la superficie corporal muestra una insuficiencia renal no conocida en uno de cada 3 pacientes diabéticos tipo 2.ObjectiveTo determine the prevalence of renal failure (RF) in type-2 diabetics and to compare two criteria of definition: that based on the calculation of glomerular filtration by the Cockcroft-Gault formula corrected for body surface area and that based on serous creatinine.DesignCross-sectional, descriptive study.SettingEl Cristo Health Centre,Oviedo, north of Spain.ParticipantsAll patients in the catchment area diagnosed with type-2 diabetes.MethodDemographic, clinical, risk factor, and cardiovascular pathology details were gathered. Renal failure was diagnosed on figures of plasma creatinine ≥1.3 mg/dL in women and ≥1.4 mg/dL in men, and glomerular filtration (GF) calculated by means of the Cockcroft-Gault formula: moderate GF, 60-30 mL/min/1.73 m2; severe GF, 29-15 mL/min/1.73 m2, and terminal GF: <15 mL/min/1.73 m2.Results499 patients were included. 52.3% were women, aged 69.7±10.4 years old. Prevalence of RF by serous creatinine was 12%; and by the Cockcroft-Gault formula, 40.5%. Patients with lower glomerular filtration and normal creatinine were older (75.5±7.9 vs 65.4±9.8; P<.001), mainly female (76.3% vs 41.7%; P<.001), had lower BMI (27.3±3.7 vs 30.9±4.4) and had worse glucaemia control (HbA1c 7.1±1.8% vs 6.9±1.9%; P=.007) and higher indices of cardiac failure (6.4% vs 2.1%; 95% CI, 1.1- 8.8; P=.02) than patients with normal glomerular filtration and creatinine.ConclusionCalculation of glomerular filtration by the Cockcroft-Gault formula corrected for body surface area revealed unknown renal failure in 1 in 3 type-2 diabetes patients

On the incorporation of interval-valued fuzzy sets into the Bousi-Prolog system: declarative semantics, implementation and applications

In this paper we analyse the benefits of incorporating interval-valued fuzzy sets into the Bousi-Prolog system. A syntax, declarative semantics and im- plementation for this extension is presented and formalised. We show, by using potential applications, that fuzzy logic programming frameworks enhanced with them can correctly work together with lexical resources and ontologies in order to improve their capabilities for knowledge representation and reasoning

Sleep-Related Falling Out of Bed in Parkinson's Disease

Background and purposeSleep-related falling out of bed (SFOB), with its potential for significant injury, has not been a strong focus of investigation in Parkinson's disease (PD) to date. We describe the demographic and clinical characteristics of PD patients with and without SFOB.MethodsWe performed a retrospective analysis of 50 consecutive PD patients, who completed an REM sleep behavior disorder screening questionnaire (RBDSQ), questionnaires to assess for RBD clinical mimickers and questions about SFOB and resulting injuries. Determination of high risk for RBD was based on an RBDSQ score of 5 or greater.ResultsThirteen patients reported history of SFOB (26%). Visual hallucinations, sleep-related injury, quetiapine and amantadine use were more common in those patients reporting SFOB. Twenty-two patients (44%) fulfilled criteria for high risk for RBD, 12 of which (55%) reported SFOB. Five patients reported injuries related to SFOB. SFOB patients had higher RBDSQ scores than non-SFOB patients (8.2±3.0 vs. 3.3±2.0, p&lt;0.01). For every one unit increase in RBDSQ score, the likelihood of SFOB increased two-fold (OR 2.4, 95% CI 1.3-4.2, p&lt;0.003).ConclusionsSFOB may be a clinical marker of RBD in PD and should prompt confirmatory polysomnography and pharmacologic treatment to avoid imminent injury. Larger prospective studies are needed to identify risk factors for initial and recurrent SFOB in PD

Improving Cognitive Visual-Motor Abilities in Individuals with Down Syndrome

Down syndrome causes a reduction in cognitive abilities, with visual-motor skills being particularly affected. In this work, we have focused on this skill in order to stimulate better learning. The proposal relies on stimulating the cognitive visual-motor skills of individuals with Down Syndrome (DS) using exercises with a gestural interaction platform based on the KINECT sensor named TANGO:H, the goal being to improve them. To validate the proposal, an experimental single-case study method was designed using two groups: a control group and an experimental one, with similar cognitive ages. Didactic exercises were provided to the experimental group using visual cognitive stimulation. These exercises were created on the TANGO:H Designer, a platform that was designed for gestural interaction using the KINECT sensor. As a result, TANGO:H allows for visual-motor cognitive stimulation through the movement of hands, arms, feet and head. The “Illinois Test of Psycholinguistic Abilities (ITPA)” was applied to both groups as a pre-test and post-test in its four reference sections: visual comprehension, visual-motor sequential memory, visual association, and visual integration. Two checks were made, one using the longitudinal comparison of the pre-test/post-test of the experimental group, and another that relied on comparing the difference of the means of the pre-test/post-test. We also used an observational methodology for the working sessions from the experimental group. Although the statistical results do not show significant differences between the two groups, the results of the observations exhibited an improvement in visual-motor cognitive skills

Interdependent network reciprocity in evolutionary games

Besides the structure of interactions within networks, also the interactions between networks are of the outmost importance. We therefore study the outcome of the public goods game on two interdependent networks that are connected by means of a utility function, which determines how payoffs on both networks jointly influence the success of players in each individual network. We show that an unbiased coupling allows the spontaneous emergence of interdependent network reciprocity, which is capable to maintain healthy levels of public cooperation even in extremely adverse conditions. The mechanism, however, requires simultaneous formation of correlated cooperator clusters on both networks. If this does not emerge or if the coordination process is disturbed, network reciprocity fails, resulting in the total collapse of cooperation. Network interdependence can thus be exploited effectively to promote cooperation past the limits imposed by isolated networks, but only if the coordination between the interdependent networks is not disturbe

The Ultimatum Game in Complex Networks

We address the problem of how cooperative (altruistic-like) behavior arises in natural and social systems by analyzing an ultimatum game in complex networks. Specifically, three types of players are considered: (a) empathetic, whose aspiration level and offer are equal, (b) pragmatic, who do not distinguish between the different roles and aim to obtain the same benefit, and (c) agents whose aspiration level and offer are independent. We analyze the asymptotic behavior of pure populations on different topologies using two kinds of strategic update rules. Natural selection, which relies on replicator dynamics, and Social Penalty, inspired in the Bak-Sneppen dynamics, in which players are subjected to a social selection rule penalizing not only the less fitted individuals, but also their first neighbors. We discuss the emergence of fairness in the different settings and network topologies.Comment: version publishe

Recognition and diagnosis of sleep disorders in Parkinson's disease

Contains fulltext : 109296.pdf (publisher's version ) (Open Access)Sleep disturbances are among the most frequent and incapacitating non-motor symptoms of Parkinson's disease (PD), and are increasingly recognized as an important determinant of impaired quality of life. Here we review several recent developments regarding the recognition and diagnosis of sleep disorders in PD. In addition, we provide a practical and easily applicable approach to the diagnostic process as a basis for tailored therapeutic interventions. This includes a stepwise scheme that guides the clinical interview and subsequent ancillary investigations. In this scheme, the various possible sleep disorders are arranged not in order of prevalence, but in a 'differential diagnostic' order. We also provide recommendations for the use of sleep registrations such as polysomnography. Furthermore, we point out when a sleep specialist could be consulted to provide additional diagnostic and therapeutic input. This structured approach facilitates early detection of sleep disturbances in PD, so treatment can be initiated promptly

Electron quantum metamaterials in van der Waals heterostructures

In recent decades, scientists have developed the means to engineer synthetic periodic arrays with feature sizes below the wavelength of light. When such features are appropriately structured, electromagnetic radiation can be manipulated in unusual ways, resulting in optical metamaterials whose function is directly controlled through nanoscale structure. Nature, too, has adopted such techniques -- for example in the unique coloring of butterfly wings -- to manipulate photons as they propagate through nanoscale periodic assemblies. In this Perspective, we highlight the intriguing potential of designer sub-electron wavelength (as well as wavelength-scale) structuring of electronic matter, which affords a new range of synthetic quantum metamaterials with unconventional responses. Driven by experimental developments in stacking atomically layered heterostructures -- e.g., mechanical pick-up/transfer assembly -- atomic scale registrations and structures can be readily tuned over distances smaller than characteristic electronic length-scales (such as electron wavelength, screening length, and electron mean free path). Yet electronic metamaterials promise far richer categories of behavior than those found in conventional optical metamaterial technologies. This is because unlike photons that scarcely interact with each other, electrons in subwavelength structured metamaterials are charged, and strongly interact. As a result, an enormous variety of emergent phenomena can be expected, and radically new classes of interacting quantum metamaterials designed

Exploring cognitive and biological correlates of sleep quality and their potential links with Alzheimer's disease (ALFASleep project): protocol for an observational study

The growing worldwide prevalence of Alzheimer's disease (AD) and the lack of effective treatments pose a dire medical challenge. Sleep disruption is also prevalent in the ageing population and is increasingly recognised as a risk factor and an early sign of AD. The ALFASleep project aims to characterise sleep with subjective and objective measurements in cognitively unimpaired middle/late middle-aged adults at increased risk of AD who are phenotyped with fluid and neuroimaging AD biomarkers. This will contribute to a better understanding of the pathophysiological mechanisms linking sleep with AD, thereby paving the way for the development of non-invasive biomarkers and preventive strategies targeting sleep.We will invite 200 participants enrolled in the ALFA+ (for ALzheimer and FAmilies) prospective observational study to join the ALFASleep study. ALFA+ participants are cognitively unimpaired middle-aged/late middle-aged adults who are followed up every 3 years with a comprehensive set of evaluations including neuropsychological tests, blood and cerebrospinal fluid (CSF) sampling, and MRI and positron emission tomography acquisition. ALFASleep participants will be additionally characterised with actigraphy and CSF-orexin-A measurements, and a subset (n=90) will undergo overnight polysomnography. We will test associations of sleep measurements and CSF-orexin-A with fluid biomarkers of AD and glial activation, neuroimaging outcomes and cognitive performance. In case we found any associations, we will test whether changes in AD and/or glial activation markers mediate the association between sleep and neuroimaging or cognitive outcomes and whether sleep mediates associations between CSF-orexin-A and AD biomarkers.The ALFASleep study protocol has been approved by the independent Ethics Committee Parc de Salut Mar, Barcelona (2018/8207/I). All participants have signed a written informed consent before their inclusion (approved by the same ethics committee). Study findings will be presented at national and international conferences and submitted for publication in peer-reviewed journals.NCT04932473.© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ