Epilepsia felina

Traballo Fin de Grao en Veterinaria. Curso 2016-2017[ES] En este Trabajo de Fin de Grado se aborda la epilepsia felina con la intención de proporcionar un documento de utilidad al veterinario clínico sobre la enfermedad, que le permita no solo enfrentarse a su diagnóstico y tratamiento, sino también acercarse al universo del paciente epiléptico y a su propietario. Así, primero se expone el conocimiento actual de su fisiopatología, incluyendo los mecanismos de inicio y finalización de una crisis epiléptica. A continuación se propone una clasificación sencilla de los distintos tipos de epilepsia en base a su etiología, y se dan pautas para reconocer las crisis epilépticas en función de su cuadro clínico y etiología. En el apartado de diagnóstico se detallan técnicas y procedimientos de elección para intentar alcanzar un diagnóstico definitivo, descartando otras patologías que puedan cursar con signos clínicos similares. Finalmente se abordan las opciones de tratamiento para la enfermedad en el gato, y se exponen los factores que hay que tener en cuenta para proporcionarle al propietario un pronóstico fiable de la enfermedad que padece su mascota. Todo el abordaje teórico se intenta resumir de forma operativa en un caso práctico ficticio que se incluye en la última parte del trabajo.[GL] Neste Traballo de Fin de Grao abórdase a epilepsia felina coa intención de proporcionar un documento de utilidade ao veterinario clínico sobre a enfermidade, que lle permita non só enfrontarse ao seu diagnóstico e tratamento, senón tamén achegarse ao universo do paciente epiléptico e ao seu propietario. Así, primeiro exponse o coñecemento actual da súa fisiopatoloxía, incluíndo os mecanismos de inicio e finalización dunha crise epiléptica. A continuación proponse unha clasificación sinxela dos distintos tipos de epilepsia en base á súa etioloxía, e danse pautas para recoñecer as crises epilépticas en función do seu cadro clínico e etioloxía. No apartado de diagnóstico detállanse técnicas e procedementos de elección para tentar alcanzar un diagnóstico definitivo, descartando outras patoloxías que poidan cursar con signos clínicos similares. Finalmente abórdanse as opcións de tratamento para a enfermidade no gato, e expóñense os factores que hai que ter en conta para proporcionarlle ao propietario un prognóstico fiable da enfermidade que padece a súa mascota. Toda a abordaxe teórica téntase resumir dun xeito operativo nun caso práctico ficticio que se inclúe na última parte do traballo.[EN] This Final Year Dissertation focuses on feline epilepsy with the purpose of providing a useful document to the clinician about the disease, not only to deal with its diagnosis and treatment, but also to approach the universe of the epileptic patient and its owner. Thus, the current knowledge of its pathophysiology is first presented, including mechanisms of epileptic seizure onset and finalization. Then, a simple classification of the different types of epilepsy is proposed based on their etiology, and keys are given to identify epileptic seizures on the basis of their clinical picture and etiology. Next, in the diagnosis section, techniques and procedures to reach a final diagnosis are described, while dismissing other diseases that may cause similar clinical signs. Finally, options for the treatment of feline epilepsy are addressed, including factors that can influence the prognosis of the disease in cats. The theoretical approach is summarized operatively in a fictitious clinical case in the last part of the document

Narrativas de subjetivación en académicas de Chile y Colombia: neoliberalismo y género en la universidad

Nuestro objetivo en este artículo es analizar la construcción de la subjetividad de algunas académicas en Chile y en Colombia a partir de dos ejes: la neoliberalización de la educación superior, y la generización de la academia neoliberal. Nuestros resultados se basan en la realización de entrevistas narrativas con 34 académicas de universidades públicas del sur de Chile y del centro de Colombia. Los hallazgos nos permiten señalar que las dos principales narrativas de subjetivación son: 1) la productividad, en donde el éxito es vinculado con un self perseverante y disciplinado, y la falta de éxito asociada con la no inteligencia y la indisciplina-culpa; y 2) las marcas de género en el trabajo académico, con claros indicios de síndrome de la impostora, y la idea de una academia desgenerizada. Finalmente, realizamos una discusión sobre las implicaciones de los resultados para avanzar en los feminismos dentro de las universidades

The Losartan renal Protection study. Rational study design and baseline characteristics of RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan)

The RENAAL Study is a double-blind, placebocontrolled trial to evaluate the renal protective effects of losartan in Type 2 diabetic patients with nephropathy. The study has enrolled 1513 patients and is expected to continue for 3.5 years after the last patient has been entered. Eligible patients must have a urinary albumin:creatinine ratio of at least 300 mg/g and serum creatinine between 1.3 to 3.0 mg/dL. Eligible hypertensive or normotensive patients are randomised to receive either losartan or placebo, in addition to their existing antihypertensive therapy. Medications that block angiotensin production or action, are excluded. The primary endpoint is a composite of the time to first event of doubling of serum creatinine, end-stage renal disease, or death; secondary endpoints include cardiovascular events, progression of renal disease, and changes in proteinuria; tertiary endpoints include quality of life, healthcare resource utilisation, and amputations. Patients include Caucasians (48.6%), Blacks (15.2%), Asians (16.7%), and Hispanics (18.2%). Baseline urinary albumin:creatinine ratio and serum creatinine levels average 1867 mg/g and 1.9 mg/dL, respectively. Mean systolic and diastolic blood pressures are 153 and 82 mmHg, respectively. RENAAL will document whether blockade of the AII receptor with losartan produces clinical benefits in patients with Type 2 diabetes and nephropathy

The pleiotropic effects of paricalcitol: Beyond bone-mineral metabolism

Secondary hyperparathyroidism (SHPT) is a common complication in patients with chronic kidney disease (CKD) that is characterised by elevated parathyroid hormone (PTH) levels and a series of bone-mineral metabolism anomalies. In patients with SHPT, treatment with paricalcitol, a selective vitamin D receptor activator, has been shown to reduce PTH levels with minimal serum calcium and phosphorus variations. The classic effect of paricalcitol is that of a mediator in mineral and bone homeostasis. However, recent studies have suggested that the benefits of treatment with paricalcitol go beyond PTH reduction and, for instance, it has a positive effect on cardiovascular disease and survival. The objective of this study is to review the most significant studies on the so-called pleiotropic effects of paricalcitol treatment in patients with CK

Vitamin D, vitamin D receptor and the importance of its activation in patients with chronic kidney disease

El déficit de vitamina D se asocia a distintas patologías, siendo especialmente significativa con la morbimortalidad en pacientes con enfermedad renal crónica (ERC). La pérdida progresiva de la función renal conduce a una reducción de calcitriol y alteración de la homeostasis de calcio, fósforo, FGF-23 y PTH, entre otros, los cuales influyen a su vez sobre la activación del receptor de vitamina D (RVD) y el desarrollo de hiperparatiroidismo secundario (HPS). El RVD media las acciones biológicas tanto de la vitamina D como de sus análogos sintéticos, actuando sobre distintos genes; existe una estrecha asociación entre niveles bajos de calcitriol y la prevalencia del HPS. Así, la activación de los RVD y la restricción de fósforo, entre otros, desempeñan un papel importante en el tratamiento de la «alteración óseo-mineral asociada a la ERC». La Sociedad Española de Nefrología, dada la uniforme e importante asociación con mortalidad y niveles altos de fósforo, aconseja su normalización, así como la de los niveles de calcidiol. Igualmente considera que, aparte de la utilización de activadores selectivos/no selectivos de RVD para la prevención y tratamiento del HPS, se podría asegurar la activación de los RVD en pacientes en diálisis, con vitamina D nativa o incluso bajas dosis de paricalcitol, independientemente de la PTH, dado que algunos estudios de cohortes y un metaanálisis reciente han observado una asociación entre el tratamiento con vitamina D activa y la disminución de la mortalidad en pacientes con ERC. En general, se considera que es razonable utilizar toda esta información para individualizar la toma de decisionesVitamin D deficiency has been linked to many different pathologies, especially with morbimortality in patients with chronic kidney disease. The progressive loss of renal function leads to calcitriol deficiency and homeostatic changes in calcium, phosphorus, FGF- 23 and PTH, among others. All these changes can also influence vitamin D receptor (VDR) activation and the development of secondary hyperparathyroidism (SHPT). The biologic actions of both vitamin D and its synthetic analogues are mediated by binding to the same VDR, acting on different genes. There is a narrow relationship between low levels of calcitriol and SHPT. The combined approach of VDR activation and phosphate restriction, among others, plays an important role in the early treatment of the chronic kidney disease-mineral and bone disorder (CKD-MBD). The Spanish Society of Nephrology, in order to reduce the uniform and significant association with CKD-associated mortality, calcidiol and high phosphate levels suggests normalization of phosphate as well as calcidiol levels in both CKD and dialysis patients. Moreover, it considers that, in addition to selective/non selective activation of VDR for the prevention and treatment of SHPT, VDR could be activated in dialysis patients by native vitamin D or even low paricalcitol doses, independently of PTH levels, as some cohort studies and a recent metaanalysis have found an association between treatment with active vitamin D and decreased mortality in patients with CKD. In general it is considered reasonable to use all this information to individualise decision makin

Guia de medicaments d’Atenció Primària que requereixen una vigilància especial per la seva dispensació en pacients amb funció renal disminuïda.

Projecte: AVCRI 279 Requeriments tècnics: L’entorn és l’EXCEL de Microsoft. L'accés al codi no estarà disponible fins la fi de la data d'embargament. Si esteu interessats a accedir-hi, contacteu amb idea(at)fbg.ub.eduAquesta Base de Dades (Guia de Medicaments) recull informació per tal d’indicar quins medicaments són susceptibles d'ajustos de dosi per evitar la iatrogènia medicamentosa en pacients amb deteriorament de la funció renal. Aquesta informació s'ha consensuat entre farmacèutics i metges nefròlegs a partir de la informació disponible en diferents bases de dades nacionals i internacionals. Per agilitzar l'ús de la Guia s'ha consensuat categoritzar en nivell baix, moderat o alt el risc que suposa pel pacient l’ús d'aquests medicaments segons el seu filtrat glomerular. A més la Guia recull els ajustos de dosi a realitzar, les interaccions medicamentoses i la simptomatologia per sobre dosificació en pacients amb funció renal disminuïda. A partir d'aquesta Base de Dades, s'ha dissenyat una aplicació web que facilita al professional sanitari la presa de decisions per a l'ajust de dosis de medicaments en funció del filtrat glomerular del pacient

Nephroprotection by Hypoglycemic Agents: Do We Have Supporting Data?

Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, renin angiotensin-aldosterone system blockade and multifactorial intervention. However, the renal protection provided by these therapeutic modalities is incomplete. There is a scarcity of studies analysing the nephroprotective effect of antihyperglycaemic drugs beyond their glucose lowering effect and improved glycaemic control on the prevention and progression of diabetic nephropathy. This article analyzes the exisiting data about older and newer drugs as well as the mechanisms associated with hypoglycemic drugs, apart from their well known blood glucose lowering effect, in the prevention and progression of diabetic nephropathy. Most of them have been tested in humans, but with varying degrees of success. Although experimental data about most of antihyperglycemic drugs has shown a beneficial effect in kidney parameters, there is a lack of clinical trials that clearly prove these beneficial effects. The key question, however, is whether antihyperglycemic drugs are able to improve renal end-points beyond their antihyperglycemic effect. Existing experimental data are post hoc studies from clinical trials, and supportive of the potential renal-protective role of some of them, especially in the cases of dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors. Dedicated and adequately powered renal trials with renal outcomes are neccessary to assess the nephrotection of antihyperglycaemic drugs beyond the control of hyperglycaemia

The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease

Background: Anemia is a common condition in CKD that has been identified as a cardiovascular (CV) risk factor in end-stage renal disease, constituting a predictor of low survival. The aim of this study was to define the onset of anemia of renal origin and its association with the evolution of kidney disease and clinical outcomes in stage 3 CKD (CKD-3). Methods: This epidemiological, prospective, multicenter, 3-year study included 439 CKD-3 patients. The origin of nephropathy and comorbidity (Charlson score: 3.2) were recorded. The clinical characteristics of patients that developed anemia according to EBPG guidelines were compared with those that did not, followed by multivariate logistic regression, Kaplan-Meier curves and ROC curves to investigate factors associated with the development of renal anemia. Results: During the 36-month follow-up period, 50% reached CKD-4 or 5, and approximately 35% were diagnosed with anemia (85% of renal origin). The probability of developing renal anemia was 0.12, 0.20 and 0.25 at 1, 2 and 3 years, respectively. Patients that developed anemia were mainly men (72% anemic vs. 69% non-anemic). The mean age was 68 vs. 65.5 years and baseline proteinuria was 0.94 vs. 0.62 g/24h (anemic vs. non anemic, respectively). Baseline MDRD values were 36 vs. 40 mL/min and albumin 4.1 vs. 4.3 g/dL; reduction in MDRD was greater in those that developed anemia (6.8 vs. 1.6 mL/min/1.73 m(2)/3 years). These patients progressed earlier to CKD-4 or 5 (18 vs. 28 months), with a higher proportion of hospitalizations (31 vs. 16%), major CV events (16 vs. 7%), and higher mortality (10 vs. 6.6%) than those without anemia. Multivariate logistic regression indicated a significant association between baseline hemoglobin (OR=0.35; 95% CI: 0.24-0.28), glomerular filtration rate (OR=0.96; 95% CI: 0.93-0.99), female (OR=0.19; 95% CI: 0.10-0.40) and the development of renal anemia. Conclusions: Renal anemia is associated with a more rapid evolution to CKD-4, and a higher risk of CV events and hospitalization in non-dialysis-dependent CKD patients. This suggests that special attention should be paid to anemic CKD-3 patients

Basic life support training programme in schools by school nurses: how long and how often to train?

Background: Cardiopulmonary resuscitation (CPR) training in schools, despite being legislated in Spain, is not established as such within the subjects that children are taught in schools. Objective: to evaluate the acquisition of CPR skills by 11-year-old children after a brief theoretical-practical teaching programme taught by nurses at school. Methods: 62 students were assessed in a quasi-experimental study on 2 cohorts (51.4% of the sample in control group [CG]). In total, 2 sessions were given, a theoretical one, and a practical training for skill development in children, in which the CG performed the CPR in 2-minute cycles and the intervention group in 1-minute cycles. The anthropometric variables recorded were weight and height, and the variables compression quality and ventilation quality were recorded using the Laerdal ResusciAnne manikin with Personal Computer/Wireless SkillReport. Results: The assessment showed better results, in terms of BLS sequence performance and use of automated external defibrillator, in the CG and after training, except for the evaluation of the 10-second breathing assessment technique. The quality of chest compressions was better in the CG after training, as was the quality of the ventilations. There were no major differences in CPR quality after training and 4 months after the 1-minute and 2-minute training cycles. Conclusions: 11-year-old children do not perform quality chest compressions or ventilations but, considering their age, they are able to perform a BLS sequence correctly