Pathophysiology of bone disease in chronic kidney disease : from basics to renal osteodystrophy and osteoporosis

Chronic kidney disease (CKD) is a highly prevalent disease that has become a public health problem. Progression of CKD is associated with serious complications, including the systemic CKD-mineral and bone disorder (CKD-MBD). Laboratory, bone and vascular abnormalities define this condition, and all have been independently related to cardiovascular disease and high mortality rates. The "old" cross-talk between kidney and bone (classically known as "renal osteodystrophies") has been recently expanded to the cardiovascular system, emphasizing the importance of the bone component of CKD-MBD. Moreover, a recently recognized higher susceptibility of patients with CKD to falls and bone fractures led to important paradigm changes in the new CKD-MBD guidelines. Evaluation of bone mineral density and the diagnosis of "osteoporosis" emerges in nephrology as a new possibility "if results will impact clinical decisions". Obviously, it is still reasonable to perform a bone biopsy if knowledge of the type of renal osteodystrophy will be clinically useful (low versus high turnover-bone disease). However, it is now considered that the inability to perform a bone biopsy may not justify withholding antiresorptive therapies to patients with high risk of fracture. This view adds to the effects of parathyroid hormone in CKD patients and the classical treatment of secondary hyperparathyroidism. The availability of new antiosteoporotic treatments bring the opportunity to come back to the basics, and the knowledge of new pathophysiological pathways [OPG/RANKL (LGR4); Wnt-ß-catenin pathway], also affected in CKD, offers great opportunities to further unravel the complex physiopathology of CKD-MBD and to improve outcomes

Pathophysiology of bone disease in chronic kidney disease: from basics to renal osteodystrophy and osteoporosis

Chronic kidney disease (CKD) is a highly prevalent disease that has become a public health problem. Progression of CKD is associated with serious complications, including the systemic CKD-mineral and bone disorder (CKD-MBD). Laboratory, bone and vascular abnormalities define this condition, and all have been independently related to cardiovascular disease and high mortality rates. The “old” cross-talk between kidney and bone (classically known as “renal osteodystrophies”) has been recently expanded to the cardiovascular system, emphasizing the importance of the bone component of CKD-MBD. Moreover, a recently recognized higher susceptibility of patients with CKD to falls and bone fractures led to important paradigm changes in the new CKD-MBD guidelines. Evaluation of bone mineral density and the diagnosis of “osteoporosis” emerges in nephrology as a new possibility “if results will impact clinical decisions”. Obviously, it is still reasonable to perform a bone biopsy if knowledge of the type of renal osteodystrophy will be clinically useful (low versus high turnover-bone disease). However, it is now considered that the inability to perform a bone biopsy may not justify withholding antiresorptive therapies to patients with high risk of fracture. This view adds to the effects of parathyroid hormone in CKD patients and the classical treatment of secondary hyperparathyroidism. The availability of new antiosteoporotic treatments bring the opportunity to come back to the basics, and the knowledge of new pathophysiological pathways [OPG/RANKL (LGR4); Wnt-ß-catenin pathway], also affected in CKD, offers great opportunities to further unravel the complex physiopathology of CKD-MBD and to improve outcomes

Socio-Demographic Health Determinants Are Associated with Poor Prognosis in Spanish Patients Hospitalized with COVID-19

Introduction Social vulnerability is a known determinant of health in respiratory diseases. Our aim was to identify whether there are socio-demographic factors among COVID-19 patients hospitalized in Spain and their potential impact on health outcomes during the hospitalization. Methods A multicentric retrospective case series study based on administrative databases that included all COVID-19 cases admitted in 19 Spanish hospitals from 1 March to 15 April 2020. Socio-demographic data were collected. Outcomes were critical care admission and in-hospital mortality. Results We included 10,110 COVID-19 patients admitted to 18 Spanish hospitals (median age 68 (IQR 54–80) years old; 44.5% female; 14.8% were not born in Spain). Among these, 779 (7.7%) cases were admitted to critical care units and 1678 (16.6%) patients died during the hospitalization. Age, male gender, being immigrant, and low hospital saturation were independently associated with being admitted to an intensive care unit. Age, male gender, being immigrant, percentile of average per capita income, and hospital experience were independently associated with in-hospital mortality. Conclusions Social determinants such as residence in low-income areas and being born in Latin American countries were associated with increased odds of being admitted to an intensive care unit and of in-hospital mortality. There was considerable variation in outcomes between different Spanish centers.JPA is under contract within the Ramón y Cajal Program (RYC-2016-20155, Ministerio de Economía, Industria y Competitividad, Spain). Investigators of Spanish Social-Environmental COVID-19 Register: Steering Committee: F. Javier Martín-Sánchez, Adrián Valls Carbó, Carmen Martínez Valero, Juan de D. Miranda, Juan Pedro Arrebola, Marta Esteban López, Annika Parviainen, Òscar Miró, Pere Llorens, Sònia Jiménez, Pascual Piñera, Guillermo Burillo, Alfonso Martín, Jorge García Lamberechts, Javier Jacob, Aitor Alquézar, Juan González del Castillo, Amanda López Picado and Iván Núñez. Participating centers: Oscar Miró y Sonia Jimenez. Hospital Clinic de Barcelona. José María Ferreras Amez. Hospital Clínico Universitario Lozano Blesa. Rafael Rubio Díaz. Complejo Hospitalario de Toledo. Julio Javier Gamazo del Rio. Hospital Universitario de Galdakao. Héctor Alonso. Hospital Universitario Miguel de Valdecilla. Pablo Herrero. Hospital Universitario Central de Asturias. Noemí Ruiz de Lobera. Hospital San Pedro de Logroño. Carlos Ibero. Complejo Hospitalario de Navarra. Plácido Mayan. Hospital Clínico Universitario de Santiago. Rosario Peinado. Complejo Hospitalario Universitario de Badajoz. Carmen Navarro Bustos. Hospital Universitario Virgen de la Macarena. Jesús Álvarez Manzanares. Hospital Universitario Rio Hortega. Francisco Román. Hospital Universitario General de Alicante. Pascual Piñera. Hospital Universitario Reina Sofia de Murcia. Guillermo Burillo. Hospital Universitario de Canarias de Tenerife. Javier Jacob. Hospital Universitario de Bellvitge. Carlos Bibiano. Hospital Universitario Infanta Leonor.Peer reviewe

Los contratos sobre el buque en Derecho Español. Análisis práctico

Prólogo / José Luis Gabaldón García (pp. 9-13). -- Introducción (pp. 15-18). -- El contrato de construcción naval: aspectos prácticos / Gonzalo Alvar Ezquerra (pp. 19-37). -- El contrato de compraventa / Carlos López-Quiroga, Luz Martínez de Azcoitia y José Sánchez-Fayos Martín-Peña (pp. 39-58). -- El contrato de arrendamiento de buque / Rodolfo González Lebrero (pp. 59-75). -- El contrato de fletamento por tiempo / José María Alcántara González (pp. 77-102). -- El contrato de fletamento por viaje: contenido obligacional / Juan Pablo Rodríguez Delgado (pp. 103-144). -- El contrato de transporte marítimo en régimen de conocimiento de embarque / Javier del Corte (pp. 145-186). -- Los documentos de transporte / Carlos Llorente (pp. 187-205). -- Contratos de utilización del buque para fines distintos del transporte de mercancías / José Manuel G. Pellicer (pp. 207-221). -- El contrato de arrendamiento náutico / León von Ondarza (pp. 223-244). -- El contrato de pasaje marítimo / Hannah de Bustos, Antonio Quirós de Sas y Julio López Quiroga (pp. 245-260). -- Los contratos de gestión naval para la dotación del buque / Bernardo Ruiz Lima (pp. 261-279). -- El contrato de gestión naval / Víctor Mata Garrido (pp. 281-302). -- El contrato de consignación de buques /Jesús Barbadillo Eyzaguirre (pp. 303-323). -- El contrato de manipulación portuaria / Carlos Pérez (pp. 325-338). -- El contrato de practicaje / Alicia Velasco Nates (pp. 339-356). -- Los contratos de mediación en la explotación del buque / Carmen Codes Cid y Martín Prieto Sulleiro (pp. 357-372). -- El contrato de remolque / Ana Sánchez Horneros (pp. 373- 392). -- El contrato de remolque / Jaime de Castro (pp. 393-412). -- El contrato de salvamento / Luis Souto (pp. 413-430). -- El contrato de remoción de restos / Verónica Meana (pp. 431-446). -- El contrato de clasificación del buque / Jaime Rodrigo de Larrucea (pp. 447-463). -- El seguro de casco y máquina / Carlos Cerdá Donat y Diego de San Simón Palacios (pp. 465-491). -- Los clubes de protección e indemnización (P&I) / Miguel Caballero (pp. 493-504). -- El seguro de protección e indemnización (P&I) / Jaime Albors (pp. 505-524). -- El seguro del acreedor hipotecario / Luis F. Gómez de Mariaca Fernández (pp. 525-540)

Proyecto Ensamblando en Colombia

Los dos volúmenes de esta obra reúnen los resultados del proyecto ganador de la «Convocatoria nacional de proyectos bicentenario 1810-2010 “Historia social de la ciencia, la tecnología y la innovación en Colombia: ciudadanía, saberes y nación”», lanzada por Colciencias en el 2009. El proyecto, titulado «Ensamblado en Colombia: producción de saberes y construcción de ciudadanías» se propuso estudiar la manera como se constituyen en el presente y se han constituido en el pasado «asuntos de interés público» que tienen una clara dimensión epistémica y ontológica, pues la producción de saberes nos interpela y convoca como académicos y como ciudadanos, como académicas y como ciudadanas. Se trata de comprender cómo se ensamblan saberes, naturalezas, tecnologías y ciudadanías y de ensayar diálogos de estilos, enfoques y miradas que reconozcan la alteridad, la multiplicidad y la heteroglosia como partes esenciales en y para la producción simultánea de conocimiento y formas de sociedad

El lado humano de la sostenibilidad : reflexiones desde lo privado y lo público

1 documento en PDF de 31 páginasPara hablar de sostenibilidad, es preciso aclarar que el término va más allá del concepto medio ambiente; aborda todas las actividades del ser humano, desde su ámbito privado y cotidiano, hasta las acciones públicas que comparte con diferentes actores sociales; de tal manera que unos y otros son responsables del equilibrio de la vida. Los autores de este libro, por ejemplo, investigan y analizan el concepto de cuidado y sus dinámicas al interior de la familia, la percepción masculina del cuidado doméstico; cómo se perciben e interiorizan los términos educación y ciudadanía en la vida cotidiana; qué significa la discapacidad y cómo funcionan las familias con integrantes discapacitados. Y así como se tocan temas que, por su carácter doméstico y corriente, afectan la balanza de la sostenibilidad, de igual manera se revisan otros con igual o mayor peso en la sostenibilidad humana, como la responsabilidad social empresarial y la gobernanza del sistema de salud. El Cuidado En El Ámbito Privado || El Cuidado En El Ámbito Públic

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men