Incremental dialysis for preserving residual kidney function-Does one size fit all when initiating dialysis?

While many patients have substantial residual kidney function (RKF) when initiating hemodialysis (HD), most patients with end stage renal disease in the United States are initiated on 3-times per week conventional HD regimen, with little regard to RKF or patient preference. RKF is associated with many benefits including survival, volume control, solute clearance, and reduced inflammation. Several strategies have been recommended to preserve RKF after HD initiation, including an incremental approach to HD initiation. Incremental HD prescriptions are personalized to achieve adequate volume control and solute clearance with consideration to a patient's endogenous renal function. This allows the initial use of less frequent and/or shorter HD treatment sessions. Regular measurement of RKF is important because HD frequency needs to be increased as RKF inevitably declines. We narratively review the results of 12 observational cohort studies of twice-weekly compared to thrice-weekly HD. Incremental HD is associated with several benefits including preservation of RKF as well as extending the event-free life of arteriovenous fistulas and grafts. Patient survival and quality of life, however, has been variably associated with incremental HD. Serious risks must also be considered, including increased hospitalization and mortality perhaps related to fluid and electrolyte shifts after a long interdialytic interval. On the basis of the above literature review, and our clinical experience, we suggest patient characteristics which may predict favorable outcomes with an incremental approach to HD. These include substantial RKF, adequate volume control, lack of significant anemia/electrolyte imbalance, satisfactory health-related quality of life, low comorbid disease burden, and good nutritional status without evidence of hypercatabolism. Clinicians should engage patients in on-going conversations to prepare for incremental HD initiation and to ensure a smooth transition to thrice-weekly HD when needed

Ahora / Ara

La cinquena edició del microrelatari per l’eradicació de la violència contra les dones de l’Institut Universitari d’Estudis Feministes i de Gènere «Purificación Escribano» de la Universitat Jaume I vol ser una declaració d’esperança. Aquest és el moment en el qual les dones (i els homes) hem de fer un pas endavant i eliminar la violència sistèmica contra les dones. Ara és el moment de denunciar el masclisme i els micromasclismes començant a construir una societat més igualitària. Cadascun dels relats del llibre és una denúncia i una declaració que ens encamina cap a un món millor

Risk Factors for Severe–Critical COVID-19 in Pregnant Women

Risk factors associated with severe–critical COVID-19 (coronavirus disease 2019) are based on findings in the general population. Pregnant women are at increased risk of severe–critical infection, and few reports are based on these women. A multicentric case–control study was conducted at the Mexican Institute of Social Security, State of Mexico, during the COVID-19 pandemic. We included pregnant women who were consecutively admitted to respiratory care units and were followed until 30 days after the resolution of pregnancy. A total of 758 pregnant women with a positive RT-PCR test for SARS-CoV-2 were enrolled from June 2020 to July 2021. We defined groups using the World Health Organization Severity Classification; cases were pregnant women with severe–critical COVID-19 (n = 123), and controls were subjects with non-severe COVID-19 (n = 635). Data was gathered from clinical files. A multivariate logistic regression analysis was used to adjust odds ratios and their 95% confidence intervals of factors associated with severe–critical COVID-19. Risk factors associated with severe–critical COVID-19 in pregnancy were non-vaccination (OR 10.18), blood type other than O (OR 6.29), maternal age > 35 years (OR 5.76), history of chronic hypertension (OR 5.12), gestational age at infection ≥ 31 weeks (OR 3.28), and multiparity (OR 2.80)

Fichero de trabajo para los conceptos básicos

Colección de fichas para el aprendizaje de conceptos simples como arriba, lejos, pocos, nunca, siempre, etc. El material ha sido elaborado a lo largo de dos años por un grupo de trabajo del colegio público Juan XXIII de Mérida (Badajoz) para responder a la demanda del profesorado de un material que permitiese a los alumnos el aprendizaje de conceptos a través de fichas didácticas fáciles de utilizar.ExtremaduraES

Prevalence and characterization of undiagnosed arterial hypertension in the eastern zone of Mexico

Abstract Arterial hypertension is considered a public health problem with severe consequences at an individual and public health levels. However, there is a lack of information regarding its characterization in Mexico. The objective of this study is to estimate the proportion of undiagnosed arterial hypertension (UAH) and the overall prevalence and clinical management of arterial hypertension within the Eastern Zone of Mexico. Additionally, we explore associated factors related with both UAH and uncontrolled arterial hypertension. We obtained information from the May Measure Month (MMM) 2019 study. People were asked for cardiovascular risk factors and blood pressure was measured according to the protocols of the European Society of Hypertension (ESH). Data from 5901 subjects were extracted: 76.04% from the Eastern Zone of the State of Mexico. The overall prevalence of hypertension was 32.4% (95% CI 31.2‐33.6). From all subjects living with hypertension, 28.3% had UAH, 22.1% had previous diagnosis but were untreated; 29.3% were treated but had uncontrolled hypertension. Younger men adults living in the State of Michoacán had increased proportion of UAH and untreated hypertension. We observed that male sex, age, obesity, living at Michoacán were risk factors for UAH. Finally, male sex, diabetes, and living at Michoacán were related risk conditions for having uncontrolled arterial hypertension. In summary, there is a high proportion of UAH in Easter Zone of Mexico. Younger adults had higher proportion of UAH and untreated hypertension profiles. Efficient actions are required to make a timely diagnosis in the young adult population to prevent long‐term complications

Factores biopsicosociales en estudiantes de bachillerato en Ciudad Juárez, Chihuahua.

El objetivo general del estudio fue conocer la dinámica de los factores biopsicosociales en adolescentes escolarizados de bachillerato en Ciudad Juárez, que permita comprender la forma de conceptualizar la adolescencia en un contexto de posviolencia masivo-social. Se analizaron elementos que se puedan considerar en el diseño de programas preventivos y de atención psicosocial oportunos. Con un enfoque de predominancia cuantitativa, con diseños no experimentales correlacionales-causales y temporalidad transversal, se utilizaron instrumentos de cuestionario cerrado para identificar relaciones significativas entre variables biopsicosociales en una muestra representativa de estudiantes de bachillerato de escuelas públicas juarenses. Se encontraron hallazgos relevantes sobre la relación entre conductas saludables de autocuidado con anomalías de la conducta alimentaria; consumo de alcohol según la sociabilidad en grupos de pares; participación activa de adolescentes femeninos en la sexualidad; así como violencia interpersonal en el noviazgo relacionada con síntomas depresivos en varones contrario a los roles tradicionales de género en México. Las interacciones familiares fueron asociadas con el neuroticismo como rasgo de personalidad adolescente, con altos grados de adicción a internet y de ansiedad, que afectaron el rendimiento académico y la autoeficacia vocacional independientemente del estado civil de los padres. Asimismo, los jóvenes mostraron actitudes favorables hacia la integración socioafectiva de compañeros discapacitados, que permiten la consolidación paulatina de una cultura de aceptación. Así, es posible reconceptualizar la adolescencia en los análisis del desarrollo humano en las ciencias sociales y la psicología, desde la frontera norte de México

Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial

Background In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (−13.5 [1.3] mmHg) and the SMC (−5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (−6.9 [0.9] mmHg) and SMC (−2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (−6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care