Protein-energy wasting syndrome in advanced chronic kidney disease: Prevalence and specific clinical characteristics

Introduction: Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%. Objective: To evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA). Patients and methods: Cross-sectional study of 186 patients (101 men) with a mean age of 66.1 ± 16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis. Results: The prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p < 0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2 methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio.The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084â1.457, p = 0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893â0.983, p = 0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998â0.999, p = 0.001) and cell mass index (OR: 0.995; 95% CI: 0.992â0.998). Conclusion: Malnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria. Resumen: Introducción: El desgaste proteico energético (DPE) se asocia a mayor mortalidad y difiere dependiendo del estadio de la enfermedad renal y de la técnica de diálisis. Su prevalencia en pacientes sin diálisis se encuentra poco estudiada y oscila entre el 0 y el 40,8%. Objetivo: Evaluar el estado nutricional según criterios de DPE y por valoración global subjetiva (VGS) de un colectivo de pacientes españoles con enfermedad renal crónica avanzada (ERCA). Pacientes y métodos: Estudio transversal de 186 pacientes (101 hombres) con edad media de 66,1 ± 16 años. Se realizó evaluación nutricional mediante: VGS, criterios de DPE, registro dietético de 3 días, parámetros antropométricos y bioimpedancia vectorial. Resultados: Un 30,1% presentaba DPE, con diferencias significativas entre hombres y mujeres (22,8 vs. 33,8%; p < 0,005) y un 27,9% tenía valores de VGS en rangos de desnutrición. Sin diferencia entre los 2 métodos estudiados. Los hombres presentaron mayores niveles de proteinuria, porcentaje de masa muscular e ingesta de nutrientes. Las mujeres tuvieron mayores niveles de colesterol total, HDL y porcentaje de masa grasa. Las características de los pacientes con DPE fueron: bajos valores de albúmina y recuento total de linfocitos, elevada proteinuria, baja masa grasa, baja masa muscular y cociente Na/K elevado.El análisis multivariante mostró asociación de DPE con proteinuria (OR: 1,257; IC 95%: 1,084-1,457; p = 0,002), porcentaje de ingesta lipídica (OR: 0,903; IC 95%: 0,893-0,983; p = 0,008), recuento total de linfocitos (OR: 0,999; IC 95%: 0,998-0,999; p = 0,001) y el índice de masa celular (OR: 0,995; IC 95%: 0,992-0,998). Conclusión: Existe malnutrición en población española con ERCA, medida por diferentes herramientas. Consideramos conveniente adecuar nuevos elementos diagnósticos a los criterios de DPE. Keywords: Nutritional status, Malnutrition, Wasting, Advanced chronic kidney disease, Body composition, Diet, Nutrition, Palabras clave: Estado nutricional, Malnutrición, Desgaste, Enfermedad renal crónica avanzada, Composición corporal, Dieta, Nutrició

Sarcoma da Artéria Pulmonar â dificuldades diagnósticas e terapêuticas

RESUMO: O Sarcoma da Artéria Pulmonar é um tumor raro, apresentando-se com sinais e sintomas inespecíficos, simulando por vezes o Tromboembolismo Pulmonar (TEP), o que torna o seu diagnóstico difícil e tardio.A este propósito os autores apresentam um caso de um homem de 59 anos, ex-fumador, internado por dispneia de esforço, toracalgia e sintomas gerais.Portador de uma radiografia e TAC torácicas, ambas evidenciando imagens sugestivas de Trombose da Artéria Pulmonar Direita.Analiticamente e antes de qualquer terapêutica: Inibidor Lúpico â e anticardiolipina IgM +.Presumido diagnóstico inicial de TEP crónico em doente com provável Síndroma de Hipercoaguabilidade, iniciou terapêutica hipocoagulante, com melhoria.Reinternado 2 meses após alta por agravamento clínico e radiológico. Proposto e aceite para Tromboendarterectomia Pulmonar, sob circulação extracorporal e paragem cardiocirculatória em hipotermia profunda (18 ºC). Durante a cirurgia constatou-se a presença de «mega-artérias pulmonares» preenchidas por massa trombosada que se estendia às ramificações arteriais segmentares. Após a exérese dessa massa houve necessidade de realizar Pneumectomia direita por hemorragia progressiva incontrolável.Veio a falecer ao 7.º dia de pós-operatório, por ARDS em pulmão único.Resultado Anatomopatológico: Sarcoma da Artéria Pulmonar com Metastização Pulmonar e Pleural.REV PORT PNEUMOL IX (1): 41-51 ABSTRACT: Primary Pulmonary Artery Sarcoma is a rare entity, which shares some clinical features with Thromboembolic Pulmonary Disease (TEPD), complicating differential diagnosis.The authors report a Clinical Case of a Primary Pulmonary Artery Sarcoma in a 59 years old man, admitted with a history of dyspnoea on exertion, chest pain and general symptoms. Chest X-ray, Computed Tomography Scan, Angiographies and Magnetic Resonance Imaging suggested TEPD.Blood Analysis performed before anticoagulation therapy: Lupus Anticoagulant - and Ig M Anticardiolipin+.Our presumptive initial diagnosis was TEPD in a patient with a hypercoagulable state.Intravenous heparin was started, with some clinical improvement but 2 months later he was readmitted, due to clinical and radiological deterioration. Pulmonary Thromboendarterectomy was considered but a right pneumonectomy was necessary because of bleeding. He died of ARDS in a single lung in the 7 th day after surgery. Pathology revealed pulmonary artery sarcoma with pulmonary and pleural metastases.REV PORT PNEUMOL IX (1): 41-51 Palavras-chave: Sarcoma da Artéria Pulmonar, Tumores Vasculares, Key-words: Pulmonary Artery Sarcoma, Vascular Tumou

Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure. the SEMICA-2 study

Objective: Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). Methods: We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups. Results: We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115–2.811; p = 0.016), and 1.939 (95% CI 1.114–3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance. Conclusions: Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days

Search for resonant pair production of Higgs bosons decaying to bottom quark-antiquark pairs in proton-proton collisions at 13 TeV

A search for a narrow-width resonance decaying into two Higgs bosons, each decaying into a bottom quark-antiquark pair, is presented. The search is performed using proton-proton collision data corresponding to an integrated luminosity of 35.9 fb$^{-1}$ at $\sqrt{s}=$ 13 TeV recorded by the CMS detector at the LHC. No evidence for such a signal is observed. Upper limits are set on the product of the production cross section for the resonance and the branching fraction for the selected decay mode in the resonance mass range from 260 to 1200 GeV

Search for supersymmetric partners of electrons and muons in proton–proton collisions at s=13TeV

A search for direct production of the supersymmetric (SUSY) partners of electrons or muons is presented in final states with two opposite-charge, same-flavour leptons (electrons and muons), no jets, and large missing transverse momentum. The data sample corresponds to an integrated luminosity of 35.9 fb−1 of proton–proton collisions at s=13TeV, collected with the CMS detector at the LHC in 2016. The search uses the MT2 variable, which generalises the transverse mass for systems with two invisible objects and provides a discrimination against standard model backgrounds containing W bosons. The observed yields are consistent with the expectations from the standard model. The search is interpreted in the context of simplified SUSY models and probes slepton masses up to approximately 290, 400, and 450 GeV, assuming right-handed only, left-handed only, and both right- and left-handed sleptons (mass degenerate selectrons and smuons), and a massless lightest supersymmetric particle. Limits are also set on selectrons and smuons separately. These limits show an improvement on the existing limits of approximately 150 GeV.0info:eu-repo/semantics/publishe