RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Evaluation Of Quality Of Life Of Patients Submitted To Pulmonary Resection Due To Neoplasia [avaliação Da Qualidade De Vida Em Pacientes Submetidos A Ressecção Pulmonar Por Neoplasia]

Objective: To evaluate the health-related quality of life of patients submitted to resection of the pulmonary parenchyma due to neoplasia. Methods: The Medical Outcomes Study 36-item Short-Form Health Survey was used to evaluate patients in the preoperative period and on postoperative days 30, 90 and 180. We used the GEE statistical model, in which the dependent variable (quality of life) changes for each patient over the course of the evaluation. Independent variables were gender, age, educational level, type of surgery, radiotherapy, chemotherapy, forced vital capacity and 6-minute walk test. The level of significance adopted was 5%. Results: The final study sample comprised 36 patients, 20 of whom were men. Of those 36 patients, 17 were submitted to lobectomy, 10 to pneumonectomy, 6 to segmentectomy, and 3 to bilobectomy. Chemotherapy was used in 15 patients, radiotherapy in 2, and a combination of radiotherapy and chemotherapy in 2. Improved quality of life was seen in the following domains: social (on postoperative day 90); physical/functional (some patients presenting better forced vital capacity and 6-minute walk test performance); and physical (in patients undergoing smaller resections). Lowered quality of life was seen in the following domains: social (for female patients); physical/social (resulting from radiotherapy, chemotherapy or both); and physical/functional (by postoperative day 30). Conclusions: It is important that studies evaluating the various determinants of quality of life, as well as the impact that cancer treatment modalities have on such variables, be conducted. The knowledge provided by such studies can contribute to improving the quality of life of patients undergoing pulmonary resection due to neoplasia.3211015Romano, P.S., Mark, D.H., Patient and hospital characteristics related to in-hospital mortality after lung cancer resection (1992) Chest, 101 (5), pp. 1332-1337Parkin, D.M., Global cancer statistics in the year 2000 (2001) Lancet Oncol, 2 (9), pp. 533-543. , ReviewWelcker, K., Marian, P., Thetter, O., Siebeck, M., Cost and quality of life in thoracic surgery - A health economic analysis in a German center (2003) Thorac Cardiovasc Surg, 51 (5), pp. 260-266(2003) Estimativa Da Incidência e Mortalidade Por Câncer No Brasil 2003, , Brasil. Ministério da Saúde. Instituto Nacional do Câncer. 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(1993) BMJ, 306 (6890), pp. 1440-1444Myrdal, G., Valtysdottir, S., Lambe, M., Stahle, E., Quality of life following lung cancer surgery (2003) Thorax, 58 (3), pp. 194-197Chuter, T.A., Weissman, C., Starker, P.M., Gump, F.E., Effect of incentive spirometry on diaphragmatic function after surgery (1989) Surgery, 105 (4), pp. 488-493Pastó, M., Gea, J., Aguar, M.C., Barreiro, E., Orozco-Levi, M., Félez, M., Broquetas, J., Caracteristicas de la actividad mecánica de los músculos respiratórios durante la tecnica de "respiracion diafragmatica" (2000) Arch Bronconeumol, 36 (1), pp. 13-18Montgomery, D.C., (1991) Design and Analisys of Experiments. 3rd Ed., , New York: John Wiley(1999) The SAS System for Windows (Statistical Analysis System), Versão 8.02, , USA: SAS Institute IncSarna, L., Evangelista, L., Tashkin, D., Padilla, G., Holmes, C., Brecht, M.L., Grannis, F., Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer (2004) Chest, 125 (2), pp. 439-445Handy Jr., J.R., Asaph, J.W., Skokan, L., Reed, C.E., Koh, S., Brooks, G., What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery (2002) Chest, 122 (1), pp. 21-30Brunelli, A., Al Refai, M., Monteverde, M., Borri, A., Salati, M., Fianchini, A., Predictors of exercise oxygen desaturation following major lung resection (2003) Eur J Cardiothorac Surg, 24 (1), pp. 145-148Patel, R.L., Townsend, E.R., Fountain, S.W., Elective pneumonectomy: Factors associated with morbidity and operative mortality (1992) Ann Thorac Surg, 54 (1), pp. 84-88Cykert, S., Kissling, G., Hansen, C.J., Patient preferences regarding possible outcomes of lung resection: What outcomes should preoperative evaluations target? (2000) Chest, 117 (6), pp. 1551-1559Fiedler, R., Neef, H., Rosendahl, W., Functional outcome and quality of life at least 6 months after pneumonectomy - Effect of operation, adjuvant therapy, tumor stage, sex, type of pneumonia and recurrence (1999) Pneumologie, 53 (1), pp. 45-9.Id:GerLubbe, A.S., Krischke, N.R., Dimeo, F., Forkel, S., Petermann, F., Health-related quality of life and pulmonary function in lung cancer patients undergoing medical rehabilitation treatment (2001) Wien Med Wochenschr, 151 (1-2), pp. 29-34Zieren, H.U., Müller, J.M., Hamberger, U., Pichlmaier, H., Quality of life after surgical therapy of bronchogenic carcinoma (1996) Eur J Cardiothorac Surg, 10 (4), pp. 233-237Buccheri, G.F., Ferrigno, D., Tamburini, M., Brunelli, C., The patient's perception of his own quality of life might have an adjunctive prognostic significance in lung cancer (1995) Lung Cancer, 12 (1-2), pp. 45-58Montarezi, A., Milroy, R., Hole, D., McEwen, J., Gillis, C.R., How quality of life data contribute to our understanding of cancer patients' experiences? 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Malignant Mesothelioma Of The Pleura With Etiological Association To Asbestos: Report Of 3 Clinical Cases [mesotelioma Maligno De Pleura Com Associação Etiológica A Asbesto: A Propósito De Três Casos Clínicos.]

Diffuse Malign Mesotheliomas (DMM) has a low background prevalence. High incidences of this tumor have been related to asbestos exposure in the past. PURPOSE: To describe and discuss three clinical cases treated in our hospital, in which precise histopathologic diagnosis was made, and detailed occupational and environmental histories were taken, trying to identify in their past some kind of asbestos exposure. METHODS: Three cases of DMM are described. Diagnosis was confirmed by histochemical analysis and electronmicroscopy. Detailed occupational and environmental histories were taken from subjects and their families, searching for past contact with asbestos. RESULTS: The cases were diagnosed in a short period of time (two years), in a region of the country where many asbestos cement plants are located since the mid sixties. Skillful histological procedures were used. From these cases we found out that one had a twelve months period of exposure, 24 years before, in one of those plants. Another patient had an exposure for three years, as a bystander, in the same plant (also 24 years before) and a third patient was contaminated by asbestos brought home by his father in the 1950s (latency period of 30 years). All cases were histochemically studied and diagnosis confirmed by the presence of microvilli at electronmicroscopic examination. CONCLUSIONS: These three cases seem to confirm the existence of the epidemiologic association with asbestos exposure in our country. Definition of diagnosis criteria, centralization of cases registry and the necessity of more attention to this kind of asbestos related disease are discussed and stressed, as many new cases like those described are thought to occur in the near future, as the latency period of the disease seems to match with that of industrial asbestos manipulation in Brazil.43326527

Detección De Pneumocystis Jirovecii Mediante Pcr Anidada En Pacientes Vih Negativos Con Enfermedad Pulmonar

Nested PCR can be used to determine the status of Pneumocystis jirovecii infection in other lung diseases. Aims This study sought to detect a target DNA fragment (mitochondrial large subunit rRNA or mtL SUrRNA) of P. jirovecii in patients with lung disease who underwent bronchoscopy with collection of bronchoalveolar lavage (BAL). Methods The results from toluidine blue staining were compared with those obtained using molecular methods that included an “in house” DNA extraction procedure, PCR and nested PCR. Results Fifty-five BAL samples from patients with atypical chest X-rays were screened for P. jirovecii. None of the samples was positive for P. jirovecii using toluidine blue staining. In contrast, P. jirovecii DNA was detected by nested PCR in BAL samples from 36 of 55 patients (65.5%). The lung diseases in the patients included cancer, pneumonia, tuberculosis, and chronic obstructive pulmonary disease (COPD). Other chronic problems in the patients included hypertension, diabetes, smoking, and alcoholism. Conclusions Nested PCR showed high sensitivity for detecting P. jirovecii, especially when compared with toluidine blue staining. Using this method, P. jirovecii infection was detected in HIV-negative patients with lung disease. © 2016 Asociación Española de Micología342838

Detección de Pneumocystis jirovecii mediante PCR anidada en pacientes VIH negativos con enfermedad pulmonar

Nested PCR can be used to determine the status of Pneumocystis jirovecii infection in other lung diseases. This study sought to detect a target DNA fragment (mitochondrial large subunit rRNA or mtL SUrRNA) of P. jirovecii in patients with lung disease who underwent bronchoscopy with collection of bronchoalveolar lavage (BAL). The results from toluidine blue staining were compared with those obtained using molecular methods that included an “in house” DNA extraction procedure, PCR and nested PCR. Fifty-five BAL samples from patients with atypical chest X-rays were screened for P. jirovecii. None of the samples was positive for P. jirovecii using toluidine blue staining. In contrast, P. jirovecii DNA was detected by nested PCR in BAL samples from 36 of 55 patients (65.5%). The lung diseases in the patients included cancer, pneumonia, tuberculosis, and chronic obstructive pulmonary disease (COPD). Other chronic problems in the patients included hypertension, diabetes, smoking, and alcoholism. Nested PCR showed high sensitivity for detecting P. jirovecii, especially when compared with toluidine blue staining. Using this method, P. jirovecii infection was detected in HIV-negative patients with lung disease.3428388El diagnóstico de laboratorio mediante la técnica de PCR anidada permite determinar estados de infección por Pneumocystis jirovecii en otras enfermedades pulmonares. El objetivo de este estudio fue detectar fragmentos de ADN mitocondrial (mtLSU rRNA) de P. jirovecii en muestras de lavado broncoalveolar (LBA) de pacientes con enfermedades pulmonares, sometidos a broncoscopia. Se compara la técnica de coloración con azul de toluidina para la microscopia, con los métodos moleculares PCR y PCR anidada; se realizó una extracción in house de ADN para las reacciones moleculares. La presencia de P. jirovecii fue estudiada en 55 muestras de LBA de pacientes que presentaron patrones radiográficos de tórax atípicos. Ninguna de las muestras fue positiva para P. jirovecii con la técnica de coloración con azul de toluidina. Por la técnica de PCR anidada se detectó el ADN de P. jirovecii en 36 de los 55 pacientes (65,5%). Las enfermedades pulmonares de los pacientes fueron cáncer, neumonía, tuberculosis y enfermedad pulmonar obstructiva crónica (EPOC). Las otras enfermedades crónicas presentadas por los pacientes fueron hipertensión, diabetes, alcoholismo y tabaquismo. La PCR anidada mostró ser altamente sensible en la detección de P. jirovecii en comparación con la coloración por azul de toluidina. Este método permite detectar infecciones por P. jirovecii en pacientes VIH negativos con enfermedades pulmonares