The possible renal toxicity of certain antibiotics (AB) is well known. The objective of our work is to know the possible effect of AB treatments in the development of renal failure (RF) in patients ...with infective endocarditis (IE).
Collection from a national multi-centre registry of collection on renal function, both prior and its impairment, if any, during the treatment of IE and in relation to possible causative factors, including the use of AB.
Between 2008 and 2012, 1,853 episodes of IE reported from 26 Spanish centres were analysed. Of these, 21.6% had prior RF. They developed new RF or impairment of renal function in 38.7% of the cases. In patients with prior RF, impairment was more frequent (64 vs. 31.7%, P<.001). Overall, patients with RF were older (70.6 vs. 67 years, P<.01), had more comorbidities (Charlson index 5 vs. 4, P<.01), and IE by Staphylococcus aureus (32.1 vs. 16.5%, P<.01). Potentially nephrotoxic AB use was only associated with RF in patients without prior RF (aminoglycosides: OR=1.47 95% CI 1.096-1.988, P=.010; aminoglycosides with vancomycin: OR=1.49 95% CI 1.069-2.09, P=.019).
In patients without prior RF, the use of nephrotoxic AB is associated with impairment of renal function. In patients with RF prior to the IE episode, impairment of renal function was more frequent but appears to be more related to the severity of infection.
Objetivo: determinar la prevalencia de desnutrición en pacientes con edad igual o superior a 65 años al ingreso hospitalario y los factores asociados a su presencia. Analizar el exceso de estancia ...hospitalaria (EEH), el impacto económico y la tasa de reingresos prematuros asociados a la desnutrición hospitalaria en pacientes de edad avanzada. Material y métodos: estudio retrospectivo realizado en el Hospital Universitario Reina Sofía. Se incluyeron todos los pacientes con edad igual o mayor a 65 años que ingresaron en Medicina Interna durante 2011. Se calculó el tamaño muestral teniendo en cuenta los ingresos del año anterior, y considerando una prevalencia de desnutrición del 50% con un IC 95% y un error del 5%. Para definir el grado de desnutrición se empleó la herramienta Control Nutricional (CONUT), que establece una puntuación basada en la determinación de albúmina, colesterol total y linfocitos. Para determinar los factores asociados a la presencia de desnutrición moderada-grave se realizó un análisis de regresión logística multivariante. Para cada paciente se calculó el EEH, los reingresos prematuros y el coste asociado al EEH. Para todos los análisis se utilizó un dintel de significación estadística de 0,05 y se realizaron con el paquete estadístico SPSS v15.0. Resultados: se incluyeron 310 pacientes, de los cuales el 54,2% fueron mujeres, la edad media fue de 80,1 años (DE: 6,8), con un rango entre 65 y 95 años. En cuanto al diagnóstico al ingreso, el 27,4% correspondían a enfermedades del aparato respiratorio, 22,6% del circulatorio y 11,6% del digestivo. La mediana del Índice de Charlson fue de 2,0, encontrando que el 36,8% de los pacientes presentaban una comorbilidad alta. Las patologías crónicas más prevalentes fueron la diabetes mellitus (44,2%), la enfermedad renal crónica (25,2%) y la demencia (10,6). En relación con el CONUT, el 75,8% de los pacientes presentaban criterios de desnutrición: el 42,6% leve, el 28,7% moderada y el 4,5% grave, de estos, solo un 46,6% tuvo algún tipo de soporte nutricional durante el ingreso. Los factores asociados a la presencia de desnutrición moderada-grave fueron el sexo femenino (OR: 1,7; IC 95%: 1,1 - 2,8), edad mayor de 80 años (OR: 2,0, IC 95%: 1,2 - 3,5), y la demencia (OR: 2,4; IC 95%:1,2 - 5,2). No se encontró asociación con la comorbilidad ni con otras patologías crónicas. Respecto al EEH (días), se encontraron diferencias entre los pacientes con desnutrición moderada-grave (4,7; IC 95%: 2,3 - 7,1) y normonutridos (-0,1; IC 95%: -1,4 - 1,2) (p = 0,001), no siendo así para los casos de desnutrición leve (1,6; IC 95%: 0,5-2,8) (p = 0,07). En relación a la tasa de reingresos prematuros en pacientes desnutridos fue de 28/235 (11,9%). El coste asociado al EEH/100 pacientes fue de 195.479,4 € para la desnutrición grave-moderada, 73.484,8 € desnutrición leve, mientras que en los pacientes normonutridos supuso un ahorro de 12.353 €. Conclusiones: la desnutrición hospitalaria en el paciente anciano sigue siendo un problema sin resolver, dada la elevada prevalencia encontrada, asociándose a un exceso de estancia hospitalaria y a un aumento del gasto hospitalario, especialmente en pacientes con desnutrición moderada- severa. El CONUT es una herramienta de cribado nutricional de gran utilidad por la rapidez y validez de sus resultados, y permite detectar pacientes con riesgo o alerta nutricional, sin suponer un incremento de costes.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Mother’s milk contains a unique microbiome that plays a relevant role in offspring health. We hypothesize that maternal malnutrition during lactation might impact the microbial composition of milk ...and affect adequate offspring gut colonization, increasing the risk for later onset diseases. Then, Wistar rats were fed ad libitum (Control, C) food restriction (Undernourished, U) during gestation and lactation. After birth, offspring feces and milk stomach content were collected at lactating day (L)4, L14 and L18. The V3–V4 region of the bacterial 16S rRNA gene was sequenced to characterize bacterial communities. An analysis of beta diversity revealed significant disparities in microbial composition between groups of diet at L4 and L18 in both milk, and fecal samples. In total, 24 phyla were identified in milk and 18 were identified in feces, with Firmicutes, Proteobacteria, Actinobacteroidota and Bacteroidota collectively representing 96.1% and 97.4% of those identified, respectively. A higher abundance of Pasteurellaceae and Porphyromonas at L4, and of Gemella and Enterococcus at L18 were registered in milk samples from the U group. Lactobacillus was also significantly more abundant in fecal samples of the U group at L4. These microbial changes compromised the number and variety of milk–feces or feces–feces bacterial correlations. Moreover, increased offspring gut permeability and an altered expression of goblet cell markers TFF3 and KLF3 were observed in U pups. Our results suggest that altered microbial communication between mother and offspring through breastfeeding may explain, in part, the detrimental consequences of maternal malnutrition on offspring programming.
To characterize mitochondrial/apoptotic parameters in chronically human immunodeficiency virus (HIV‐1)‐infected promonocytic and lymphoid cells which could be further used as therapeutic targets to ...test pro‐mitochondrial or anti‐apoptotic strategies as in vitro cell platforms to deal with HIV‐infection. Mitochondrial/apoptotic parameters of U1 promonocytic and ACH2 lymphoid cell lines were compared to those of their uninfected U937 and CEM counterparts. Mitochondrial DNA (mtDNA) was quantified by rt‐PCR while mitochondrial complex IV (CIV) function was measured by spectrophotometry. Mitochondrial‐nuclear encoded subunits II–IV of cytochrome‐c‐oxidase (COXII‐COXIV), respectively, as well as mitochondrial apoptotic events voltage‐dependent‐anion‐channel‐1(VDAC‐1)‐content and caspase‐9 levels were quantified by western blot, with mitochondrial mass being assessed by spectrophotometry (citrate synthase) and flow cytometry (mitotracker green assay). Mitochondrial membrane potential (JC1‐assay) and advanced apoptotic/necrotic events (AnexinV/propidium iodide) were measured by flow cytometry. Significant mtDNA depletion spanning 57.67% (P < 0.01) was found in the U1 promonocytic cells further reflected by a significant 77.43% decrease of mitochondrial CIV activity (P < 0.01). These changes were not significant for the ACH2 lymphoid cell line. COXII and COXIV subunits as well as VDAC‐1 and caspase‐9 content were sharply decreased in both chronic HIV‐1‐infected promonocytic and lymphoid cell lines (<0.005 in most cases). In addition, U1 and ACH2 cells showed a trend (moderate in case of ACH2), albeit not significant, to lower levels of depolarized mitochondrial membranes. The present in vitro lymphoid and especially promonocytic HIV model show marked mitochondrial lesion but apoptotic resistance phenotype that has been only partially demonstrated in patients. This model may provide a platform for the characterization of HIV‐chronicity, to test novel therapeutic options or to study HIV reservoirs.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
We aimed to assess the efficacy of biologic therapy in refractory non-Multiple Sclerosis (MS) Optic Neuritis (ON), a condition more infrequent, chronic and severe than MS ON. This was an open-label ...multicenter study of patients with non-MS ON refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were Best Corrected Visual Acuity (BCVA) and both Macular Thickness (MT) and Retinal Nerve Fiber Layer (RNFL) using Optical Coherence Tomography (OCT). These outcome variables were assessed at baseline, 1 week, and 1, 3, 6 and 12 months after biologic therapy initiation. Remission was defined as the absence of ON symptoms and signs that lasted longer than 24 h, with or without an associated new lesion on magnetic resonance imaging with gadolinium contrast agents for at least 3 months. We studied 19 patients (11 women/8 men; mean age, 34.8 ± 13.9 years). The underlying diseases were Bechet’s disease (n = 5), neuromyelitis optica (n = 3), systemic lupus erythematosus (n = 2), sarcoidosis (n = 1), relapsing polychondritis (n = 1) and anti-neutrophil cytoplasmic antibody -associated vasculitis (n = 1). It was idiopathic in 6 patients. The first biologic agent used in each patient was: adalimumab (n = 6), rituximab (n = 6), infliximab (n = 5) and tocilizumab (n = 2). A second immunosuppressive drug was simultaneously used in 11 patients: methotrexate (n = 11), azathioprine (n = 2), mycophenolate mofetil (n = 1) and hydroxychloroquine (n = 1). Improvement of the main outcomes was observed after 1 year of therapy when compared with baseline data: mean ± SD BCVA (0.8 ± 0.3 LogMAR vs. 0.6 ± 0.3 LogMAR; p = 0.03), mean ± SD RNFL (190.5 ± 175.4 μm vs. 183.4 ± 139.5 μm; p = 0.02), mean ± SD MT (270.7 ± 23.2 μm vs. 369.6 ± 137.4 μm; p = 0.03). Besides, the median (IQR) prednisone-dose was also reduced from 40 (10–61.5) mg/day at baseline to. 2.5 (0–5) mg/day after one year of follow-up; p = 0.001. After a mean ± SD follow-up of 35 months, 15 patients (78.9%) achieved ocular remission, and 2 (10.5%) experienced severe adverse events. Biologic therapy is effective in patients with refractory non-MS ON.
Intimate Partner Violence Against Women (IPVAW) has been defined as a violation of human rights and a serious public health problem rooted in social inequality between women and men. Nevertheless, a ...significant amount of scientific literature on the topic of IPVAW continues to exclude the gender perspective in both research design and the interpretation of results, despite its conceptual and explanatory relevance. This paper considers certain gender-blind practices in the research on IPVAW. Based on this analysis, we propose explicitly stating the theoretical assumptions inherent in the definition of the construct and clarifying the intended interpretation for measures, so that they can be incorporated into the analysis of validity, and we argue in favor of the need for interdisciplinary studies based on multicausal explanatory models, which incorporate the category gender as a transversal explanatory factor of this type of violence, as well as multi-method approaches, with the aim of overcoming issues of construct underrepresentation and construct-irrelevant variance.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
La identificación de prejuicios en la población universitaria, con respecto a las personas con discapacidad, es una necesidad para poder diseñar políticas inclusivas adecuadas tendentes a erradicar ...las barreras que impiden una educación universal no discriminativa. En la actualidad, no se dispone de un instrumento de evaluación específico que permita realizar una evaluación de necesidades para la actualización, capacitación o formación en las instituciones universitarias de la población con discapacidad. El objetivo del artículo fue desarrollar una escala psicométrica específica, para el ámbito universitario, que permita cuantificar el prejuicio hacia las personas con discapacidad que garantizara su fiabilidad y evidencias de validez. Desde el enfoque cuantitativo de la construcción de escalas psicométricas, se elaboró una batería de ítems a partir del modelo de prejuicio ambivalente y de un estudio cualitativo previo realizado en los años 2017 y 2018. De acuerdo con las valoraciones de jueces expertos, se diseñó una escala inicial de 72 ítems, que fue administrada a una muestra incidental de 551 personas procedentes de tres instituciones universitarias: Universidad de Costa Rica y Universidad Nacional (Costa Rica), y Universidad Pontificia de Salamanca (España). Tras el análisis psicométrico se obtuvo una escala de 24 ítems con una consistencia interna de .89. El Análisis Factorial Confirmatorio muestra índices de ajuste adecuados, (GFI > .95; AGFI > .90; NFI > .95) para un modelo de 4 factores: Idealización benevolente, Evitación de contacto, Amplificación sexista del prejuicio y Percepción de exceso de demandas. Los resultados permiten concluir que esta escala tiene una fiabilidad satisfactoria, además de suficientes evidencias de validez basadas en el contenido y en la estructura interna.
Blau syndrome (BS) is an autoinflammatory disorder characterized by non-caseating granulomatous dermatitis, arthritis, and uveitis. We present a case of refractory and severe BS that was treated with ...the Janus kinase inhibitors (JAKINIBS), Tofacitinib (TOFA) and then Baricitinib (BARI). Our aim was to describe the clinical and immunological outcomes after treatment with JAKINIBS. Blood tests and serum samples were obtained during follow-up with TOFA and BARI. We assessed their effects on clinical outcomes, acute phase reactants, absolute lymphocyte counts (ALCs), lymphocyte subset counts, immunoglobulins, and cytokine levels. A review of the literature on the use of JAKINIBS for the treatment of uveitis and sarcoidosis was also conducted. TOFA led to a rapid and maintained disease control and a steroid-sparing effect. A decrease from baseline was observed in ALC, CD3+, CD4+, CD8+, and natural killer (NK) cell counts. B-cells were stable. Serum levels of interleukin (IL)-4 and tumor necrosis factor alpha (TNF-α) increased, whereas IL-2, IL-6, IL-10, and IL-17 maintained stable. TOFA was discontinued after 19 months due to significant lymphopenia. The initiation of BARI allowed maintaining adequate control of disease activity with an adequate safety profile. The literature review showed seven patients with uveitis and five with sarcoidosis treated with JAKINIBS. No cases of BS treated with JAKINIBS were found. We report the successful use of JAKINIBS in a patient with refractory and severe BS.
•We studied the reproductive cycle of the lizard S. torquatus without euthanasia.•Steroid concentrations were highest in the late vitellogenic and preovulatory stages.•Temperature-photoperiod were ...negatively correlated with follicular development.•Temperature-photoperiod were negatively correlated with estradiol and progesterone.
Reproduction is regulated by multiple factors that influence physiology and behavior to ensure the continuity of species. However, more work is needed to examine the complex relationships between environmental factors and endocrine transducers that modulate reproductive cycles, particularly in lizards. Here, we aimed to characterize the variation in plasma sex steroid levels in different stages of the reproductive cycle in the lizard Sceloporus torquatus and assess whether sex steroid levels were related to environmental factors (temperature, photoperiod, precipitation, and relative humidity) and body condition. Plasma concentrations of estradiol (E2) and progesterone (P4) from blood samples were quantified by enzyme-linked immunosorbent assay (ELISA) and radioimmunoanalysis (RIA), respectively. Our results indicate that sex steroid concentrations were positively related to follicular development but negatively related to temperature and precipitation. E2 increased as the follicles grew, and its concentrations were highest in the preovulatory phase. P4 showed a similar pattern and persisted during pregnancy. Changes in body condition were non-significant and mainly unrelated to the reproductive stage and plasma sex steroids. Our findings indicate that sex steroids change depending on the season and reproductive stage. We observed high concentrations of E2 and P4 in the late vitellogenic and preovulatory stages, probably because of their role in promoting vitellogenesis and ovulation. Additionally, we observed that follicular development is correlated with temperature and photoperiod. To better understand the mechanisms underlying reproduction, future studies of captive populations where environmental factors can be manipulated are needed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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