Study of the incidence of dialysis in São Paulo, the largest Brazilian city

OBJECTIVES: Chronic kidney disease is a major public health problem worldwide. In Brazil, approximately 100,000 patients (January 2012) receive renal replacement therapy. Nevertheless, data on dialysis incidence in the Brazilian population are scarce. This study aims to analyze the incidence of patients starting dialysis therapy in São Paulo City, the largest Brazilian metropolis. METHOD: This cohort study analyzed data from 9,994 patients starting hemodialysis or peritoneal dialysis funded by the Brazilian Public Health System during a 5-year period (2007-2011). Patient data for this study (recorded as electronic files) were obtained from the São Paulo City's Dialysis Regulatory Bureau, which regulates the allocation of patients requiring dialytic therapy. RESULTS: The dialysis incidence rates were 178, 174, 170, 185 and 188 per million population for the years 2007, 2008, 2009, 2010 and 2011, respectively. The incidence rates increased with age. Hypertension and diabetes were the main etiologies diagnosed. Hemodialysis was the chosen dialysis modality in the majority of patients (92.6%), whereas the percentage of patients referred for peritoneal dialysis decreased from 10.1% to 5.5%. CONCLUSION: The incidence of patients starting renal replacement therapy from 2007-2011 in São Paulo was stable but higher than the projected incidence for the entire country. The authors emphasize the need for further studies of the incidence of dialysis in the Brazilian population and for the creation of a Brazilian registry of dialysis patients, which would be a valuable tool for developing healthcare policies and renal replacement therapy strategies

Different drug incorporation routes in ethylene oxide based copolymers

Coumarin is successfully incorporated in poly(ethylene oxide)-poly(propylene oxide) block copolymers functionalized with terminal alkynes, PEO-b-PPO-b-GPE, by click reactions at atmospheric pressure and in CO2 supercritical conditions (scCO2). The presence of glycidyl propargyl ether (GPE), an alkynyl-terminated monomer, in the copolymer chain allows the covalent attachment of the coumarin by click chemistry, obtaining polymer–drug conjugates. First, the most suitable synthesis procedure for the above-mentioned copolymers was established. Then, the click reactions were carried out confirming the coumarin attachment by Fourier transform IR and 1H NMR analyses, achieving good yields in both cases with a coumarin content of about 9.3 wt% and avoiding the use of toxic solvents in the case of scCO2. In addition, thanks to the amphiphilic character of the copolymer due to the presence of hydrophilic (PEO) and hydrophobic (PPO) segments, micelle formation is also possible and was confirmed by dynamic light scattering and high resolution SEM. Finally, coumarin incorporation was achieved by micelle formation using the direct dissolution method in order to compare the polymer–drug system properties. This second route allows a drug entrapment efficiency of 14 wt% to be reached. In both cases, the size of the polymeric micelles obtained is in a suitable range to enable permeability. However, an interesting point is the reduction in the size of the micelles with increase in the GPE percentage and with the covalent attachment of the coumarin to the copolymer, which is supposed to improve their permeability. © 2019 Society of Chemical IndustryLa cumarina se incorpora con éxito en copolímeros en bloque de poli(óxido de etileno)-poli(óxido de propileno) funcionalizados con alquinos terminales, PEO- b -PPO- b -GPE, mediante reacciones clic a presión atmosférica y en condiciones supercríticas de CO 2 (scCO 2 ). La presencia de glicidil propargil éter (GPE), un monómero terminado en alquinilo, en la cadena del copolímero permite la unión covalente de la cumarina por química clic, obteniendo conjugados polímero-fármaco. En primer lugar, se estableció el procedimiento de síntesis más adecuado para los copolímeros mencionados anteriormente. Luego, se llevaron a cabo las reacciones de clic confirmando la unión de la cumarina por transformada de Fourier IR y 1Análisis de RMN H, consiguiendo buenos rendimientos en ambos casos con un contenido en cumarina del orden del 9,3 wt% y evitando el uso de disolventes tóxicos en el caso del scCO 2. Además, gracias al carácter anfifílico del copolímero debido a la presencia de segmentos hidrofílicos (PEO) e hidrofóbicos (PPO), también es posible la formación de micelas y se confirmó mediante dispersión de luz dinámica y SEM de alta resolución. Finalmente, la incorporación de cumarina se logró mediante la formación de micelas utilizando el método de disolución directa para comparar las propiedades del sistema polímero-fármaco. Esta segunda ruta permite alcanzar una eficacia de atrapamiento del fármaco del 14% en peso. En ambos casos, el tamaño de las micelas poliméricas obtenidas está en un rango adecuado para permitir la permeabilidad. Sin embargo, un punto interesante es la reducción del tamaño de las micelas con el aumento del porcentaje de GPE y con la unión covalente de la cumarina al copolímero, lo que se supone mejora su permeabilidad. © 2019 Sociedad de la Industria Químic

Ethylene oxide based copolymers functionalized with terminal alkynes: Structure influence on their micelle formation

Copolymers from ethylene oxide (EO) and propylene oxide (PO) functionalized with glycidyl propargyl ether (GPE) are synthesized. The GPE allows further attachment of drugs but its influence on the polymeric micelle formation is unknown. In this work, the influence of the structure of these copolymers on their critical micellar concentration (CMC) in water and in the size and stability of obtained micelles is studied. For this purpose, the presence of GPE, the copolymer type (gradient or block), the EO:PO ratio and the initiator (water or ethanol) are modified. Gradient copolymers can be synthesized in a single step thanks to the different monomers reactivity, simplifying the process and obtaining similar CMC values to the block copolymers. The use of ethanol as initiator decreases the block copolymer CMC and increases the polydispersity. Besides, the presence of the GPE does not impede the micelle formation and has low effect on the copolymer CMCs. Finally, the higher the EO:PO ratio, the higher the CMC and the smaller the size of micelles. Moreover, Z-potential, DLS and HRSEM analyses show that the micelles are stable, spherical, capable to incorporate coumarin (a hydrophobic drug) and with apparent hydrodynamic sizes suitable to be absorbed by target cells.Se sintetizan copolímeros de óxido de etileno (EO) y óxido de propileno (PO) funcionalizados con glicidil propargil éter (GPE). El GPE permite una mayor unión de fármacos pero se desconoce su influencia en la formación de micelas poliméricas. En este trabajo se estudia la influencia de la estructura de estos copolímeros en su concentración micelar crítica (CMC) en agua y en el tamaño y estabilidad de las micelas obtenidas. Para ello se modifica la presencia de GPE, el tipo de copolímero (gradiente o bloque), la relación EO:PO y el iniciador (agua o etanol). Los copolímeros de gradiente se pueden sintetizar en un solo paso gracias a la reactividad de los diferentes monómeros, simplificando el proceso y obteniendo valores de CMC similares a los copolímeros de bloque. El uso de etanol como iniciador disminuye la CMC del copolímero en bloque y aumenta la polidispersidad. Además, la presencia del GPE no impide la formación de micelas y tiene un efecto bajo sobre las CMC del copolímero. Finalmente, cuanto mayor sea la relación EO:PO, mayor será la CMC y menor el tamaño de las micelas. Además,Los análisis de potencial Z , DLS y HRSEM muestran que las micelas son estables, esféricas, capaces de incorporar cumarina (un fármaco hidrofóbico) y con tamaños hidrodinámicos aparentes adecuados para ser absorbidos por las células diana

Hypogonadism associated with muscle atrophy, physical inactivity and ESA hyporesponsiveness in men undergoing haemodialysis

AbstractBackgroundTestosterone deficiency (hypogonadism) is common among men undergoing haemodialysis, but its clinical implications are not well characterized. Testosterone is an anabolic hormone that induces erythrocytosis and muscle synthesis. We hypothesized that testosterone deficiency would be associated with low muscle mass, physical inactivity and higher dosages of erythropoietin-stimulating agents (ESA).MethodsSingle-center cross-sectional study of 57 male haemodialysis patients. None of the patients was undergoing testosterone replacement therapy. Total testosterone was measured in serum. Body composition (by bioelectrical impedance analysis) and physical activity (by the use of pedometers) were assessed. Patients with testosterone levels below the normal range were considered hypogonadal.ResultsMean testosterone level was 321±146ng/dL; 20 patients (35%) were hypogonadal. Hypogonadal patients were older and had lower mean arterial blood pressure, higher interleukin-6 levels, lower lean body mass and higher fat body mass. A negative association between testosterone and normalized ESA dose was found in uni- and multivariate regression analyses. Testosterone levels directly correlated with lean body mass regardless of confounders. Hypogonadal patients had lower physical activity than their counterparts [2753±1784 vs. 4291±3225steps/day (p=0.04)]. The relationship between testosterone and physical activity was independent of age, comorbidities and inflammatory markers, but dependent on the proportion of muscle mass.ConclusionHypogonadism is common in our male haemodialysis population and is associated with higher ESA doses, reduced muscle mass and lower physical activity. The link between low testosterone levels and physical inactivity may conceivably relate to reduced muscle mass due to inadequate muscle protein synthesis

Принципы лечения очаговой гиперплазии эндометрия в постменопаузе

МЕНОПАУЗАЭНДОМЕТРИЯ ГИПЕРПЛАЗИ

Prevalence of chronic kidney disease in women of reproductive age and observed birth rates

INTRODUCTION: Women of reproductive age with chronic kidney disease (CKD) are recognised to have decreased fertility and a higher risk of adverse pregnancy outcomes. How often CKD afflicts women of reproductive age is not well known. This study aimed to evaluate the burden of CKD and associated birth rates in an entire region.METHODS: This was a retrospective cohort study including women of childbearing age in Stockholm during 2006-2015. We estimated the prevalence of "probable CKD" by the presence of an ICD-10 diagnosis of CKD, a single estimated glomerular filtration rate (eGFR) &lt; 60 mL/min/1.73 m2 or history of maintenance dialysis. By linkage with the Swedish Medical Birth Register we identified births during the subsequent three years from study inclusion and evaluated birth rates.RESULTS: We identified 817,730 women in our region, of whom 55% had at least one creatinine measurement. A total of 3938 women were identified as having probable CKD, providing an age-averaged CKD prevalence of 0.50%. Women with probable CKD showed a lower birth rate 3 years after the index date (35.7 children per 1000 person years) than the remaining women free from CKD (46.5 children per 1000 person years).CONCLUSION: As many as 0.50% of individuals in this cohort had probable CKD, defined on the basis of at least one eGFR&lt;60 ml/min1.73 m2 test result, dialysis treatment (i.e. CKD stages 3-5) or an ICD-10 diagnosis of CKD. This prevalence is lower than previous estimates. Women with probable CKD, according to a study mainly capturing CKD 3-5, had a lower birth rate than those without CKD, illustrating the challenges of this population to successfully conceive.</p

Optimization of injection parameters to obtain selected properties on foamed PP with hollow glass microspheres and thermally expandable microspheres using Taguchi method

Se utilizó un sistema de espumación compuesto por microesferas de vidrio huecas (HGM) y microesferas térmicamente expandibles (EM) para lograr un equilibrio entre las propiedades seleccionadas de polipropileno (PP) espumado mediante moldeo por inyección, combinando las mayores propiedades de flexión y menor densidad requeridas en las piezas interiores de los automóviles. El L16 de Taguchi (44.23) se empleó para el plan experimental y la relación señal/ruido (S/N) para la optimización del sistema planteado. Los dos parámetros importantes de moldeo por inyección que afectan a las propiedades seleccionadas fueron la temperatura de la masa fundida y del molde. El efecto más importante efecto sobre el módulo de flexión fue la cantidad de HGM, y para la densidad la cantidad de EM.Ministerio de Economía, Industria y Competitividad (project MAT2017-85101-C2-1-R

Infarto agudo de miocardio y angina sin lesiones coronarias obstructivas minoca-anoca, implicaciones pronosticas y terapéuticas de una compleja entidad

Myocardial infarction without obstructive coronary artery lesions and angina without obstructive lesions are puzzling clinical entities characterized by clinical evidence of angina or myocardial infarction with normal or near-normal coronary arteries on angiography (&lt;50% stenosis). A bibliographic review was carried out on the etiology, classification and mechanisms responsible for these entities. The selection methods of the articles were based on the medical literature generated in this regard from the year 2000 to the year 2022 through pubmed, all meta-analyses, randomized controlled trials, reviews, experimental studies in patients older than 18 years, were included. excluding those that did not meet the selection criteria. The precise pathogenesis is not well understood and is being further studied and examined. The guidelines indicate that MINOCA or ANOCA are a group of heterogeneous diseases with different pathophysiological mechanisms. Since there are multiple mechanisms involved, it is uncertain whether the classical secondary prevention and treatment strategy for obstructive coronary artery disease is optimal for these patients. The use of optical coherence tomography, cardiac magnetic resonance imaging and intravascular ultrasound have been proposed as stratification studies. Many doubts remain about the pathophysiology, prognosis, post-hoc studies after cardiac catheterization as well as optimal therapeutic behaviors. Within therapeutic management, anti-aggregating drugs, beta-blockers, calcium antagonists and lipid-lowering drugs have been described. The next studies with large cohorts of patients will be the ones that will allow us to respond adequately, since highly relevant scientific evidence is available in this regardEl infarto de miocardio sin lesiones en arterias coronarias obstructivas y la angina sin&nbsp; lesiones obstructivas, son entidades clínicas desconcertantes que se caracterizan por evidencia clínica de angina o infarto de miocardio con arterias coronarias normales o casi normales en la angiografía (estenosis &lt;50%). Se realizo una revision bibliografica sobre la etiologia, clasificacion y mecanismos responsables de estas entidades. Los metodos de selección de los articulos se basaron en la literatura medica generada al respecto desde el año 2000 hasta el año 2022 a traves de pubmed, se incluyeron todos los metanalisis, estudios aleatorizados controlados, revisiones, estudios experimentales en pacientes mayores de 18 años, excluyendose aquellos que no cumplieran con los criterios de seleccion. La patogenia precisa no se comprende bien y se está estudiando y examinando más a fondo. Las guías indican que MINOCA o ANOCA son un grupo de enfermedades heterogéneas con diferentes mecanismos fisiopatologicos. Dado que existen múltiples mecanismos implicados, no es seguro que la prevención secundaria clásica y la estrategia de tratamiento para la enfermedad arterial coronaria obstructiva sea óptima para estos pacientes. La utilizacion de la tomografia de coherencia optica, la resonancia magnetica cardiaca y el ultrasonido intravascular se han planteado como estudios de estratificacion Siguen siendo muchas las dudas sobre la fisiopatologia, pronostico, estudios a posteriori tras el cateterismo cardiacos asi como conductas terapeuticas optimas. Dentro del manejo terapeutico se han descrito los farmacos anti agregantes, betabloqueantes, calcio antagonistas y los hipolipemiantes. Seran los proximos estudios con grandes cohortes de pacientes las que permitan responder adecuadamente al disponerse de evidencia cientifica de alta relevancia al respecto

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

Relationship between renal function and renal volume in autosomal dominant polycystic kidney disease: cross-sectional study

Objetivo Determinar en pacientes con poliquistosis renal autosómica dominante la relación entre el volumen renal total (suma de ambos riñones, VRT) medido con resonancia magnética y la función renal; y su comportamiento según el sexo y la presencia de hipertensión arterial, hipercolesterolemia e hiperuricemia. Método Estudio transversal en el que se incluyen pacientes con poliquistosis renal autosómica dominante que realizan revisiones periódicas en las consultas externas de Nefrología del Hospital Virgen de las Nieves de Granada, a quienes entre enero de 2008 y marzo de 2011 se les realizó una resonancia magnética para estimar el volumen renal. Resultados Se evaluaron 67 pacientes (59,7% mujeres, edad media 48 ± 14,4 años). Encontramos asociación positiva significativa entre VRT y creatinina sérica o urea, que resultó inversa frente al filtrado glomerular estimado por MDRD-4 y Cockcroft-Gault. Las mujeres mostraron un nivel medio de creatinina sérica y VRT inferior respecto al varón de forma significativa. Los subgrupos afectos de hipertensión arterial e hiperuricemia mostraron valores medios de creatinina sérica, urea y VRT más altos y filtrados glomerulares estimados inferiores. El subgrupo con hipercolesterolemia mostró valores medios de urea más altos y filtrados glomerulares estimados inferiores sin detectarse diferencias significativas respecto al VRT. Conclusión El volumen de los riñones poliquísticos medido por resonancia magnética se asocia con la función renal, y puede ser útil como estudio complementario para monitorizar la progresión de la enfermedad. La presencia de hipertensión arterial, hiperuricemia o hipercolesterolemia están asociados a una peor función renal.Objective: To determine in patients with autosomal dominant polycystic kidney disease the relationship between total renal volume (the sum of both kidneys, TRV) as measured by magnetic resonance and renal function; and its behaviour according to sex and the presence of arterial hypertension, hypercholesterolaemia and hyperglycemia. Method: Cross-sectional study including patients with autosomal dominant polycystic kidney disease who underwent periodic reviews at Nephrology external consultations at Hospital de las Nieves de Granada, and who underwent an magnetic resonance to estimate renal volume between January 2008 and March 2011. Results: We evaluated 67 patients (59.7% women, average age of 48±14.4 years) and found a significant positive association between TRV and serum creatinine or urea, which was reversed compared with estimated glomerular filtration by MDRD-4 and Cockcroft-Gault. Women showed an average serum creatinine level and a significantly lower TRV level compared with males. Subgroups affected by arterial hypertension and hyperuricemia presented average values for serum creatinine and urea, higher for TRV and lower for estimated glomerular filtration. The hypercholesterolaemia subgroup showed higher average values for urea and lower for estimated glomerular filtration, without detecting significant differences compared with TRV. Conclusion: The volume of polycystic kidneys measured by magnetic resonance is associated with renal function, and can be useful as a complementary study to monitor disease progression. The presence of arterial hypertension, hyperuricemia or hypercholesterolaemia is associated with a poorer renal function