: Our primary objective was to study the clinical and biochemical characteristics associated with acute kidney injury (AKI) remission in a group of Mexican patients.
: We retrospectively enrolled 75 ...patients who were diagnosed with AKI and separated the sample into two groups: nonremitting patients (
= 27, 36%) vs. remitting patients (
= 48, 64%).
: We found significant relationships between nonremitting AKI and previous diagnosis of chronic kidney disease (
= 0.009), higher serum creatinine (Cr) at admission (
< 0.0001), lower estimated glomerular filtration rate (eGFR) (
< 0.0001), maximum serum creatinine during hospitalization (
< 0.0001), higher fractional excretion of sodium (FENa) (
< 0.0003) and 24-h urine protein (
= 0.005), higher serum potassium on admission (
= 0.025), abnormal levels of procalcitonin (
= 0.006), and increased risk of death (
= 0.015).
: Chronic kidney disease (CKD), lower eGFR, higher levels of serum creatinine during hospitalization, higher FENa and 24-h urine protein, abnormal levels of procalcitonin, and higher serum potassium on admission were associated with nonremitting AKI. These findings may facilitate the rapid identification of patients at risk for nonremitting AKI based on clinical and biochemical characteristics. Furthermore, these findings may inform the design of timely strategies for the vigilance, prevention, and treatment of AKI.
Lima bean (
Phaseolus lunatus
L.) is composed of two major gene pools. The Andean gene pool gave rise to the Gran Lima cultigroup, and the Mesoamerican gene pool gave rise to the Papa and Sieva ...cultigroups. In the Yucatan Peninsula, Lima bean presents a great diversity of landraces that belong to the Mesoamerican gene pool. However, studies so far have not been able to determine whether the Papa and Sieva cultigroup germplasm resources managed by Maya farmers can be morphologically or genetically differentiated. In addition, the physiological seed quality traits of
P. lunatus
are still unknown. Therefore, the objectives of the study were: (1) To evaluate morphological differentiation of the Papa and Sieva cultigroups of Lima bean and (2) To evaluate the physiological seed quality based on standard germination and emergence of seedlings tests. Results showed two well-defined groups. Group A comprised landraces JMC1288, JMC1336, JMC1364 and JMC1271 belonging to the Sieva cultigroup; group B included landraces JMC1208, JMC1264, JMC1313 and JMC1337 belonging to the Papa cultigroup. The germination percentage was 84%, and rate was 15 seeds germinated d
−1
. The percentage of seedling emergence was 86%, and seedling emergence rate was 14 emerged seedlings d
−1
. Results confirmed the presence of the Papa and Sieva cultigroups in the Yucatan Peninsula. The landraces of Papa cultigroup produced seeds with the best physiological quality for use in breeding and conservation programmes.
In all organ transplantation programs, election of the proper protocol relies primarily on the professionals involved in the detection of potential donors. The objective of our study was to assess ...the impact of a series of prehospital training sessions, as well as to develop several positive feedback strategies within the uncontrolled organ donation after circulatory death (uDCD) program in our city.
A before–after intervention study was carried out in 3 steps. First, professionals enrolled in the Emergency Health Services Agency-061 (EPES-061) program underwent specific training to identify potential donors. Second, a specific logotype was designed to alert emergency health care professionals that in cases where cardiopulmonary resuscitation was ineffective and after treatment of all potentially reversible causes, the “chain of survival” should be considered a “chain of opportunities.” Third, a positive feedback strategy was put in place, whereby each time a donation was procured, the EPES-061 personnel that had identified the potential donor were notified by phone and in a personal letter.
The mean age for donors was 50.5 years of age (interquartile range 37–52.5), and 89.5% of all donations came from male subjects. Positive feedback letters and phone calls, including information on final outcome, were provided to the appropriate personnel in 100% of the cases. Postintervention information showed an increase in both eligible and utilized donors.
Interventions outside the hospital setting that facilitate optimal implementation of the uDCD program are an essential part of this strategy to increase the donor pool and make the wait shorter for transplant patients.
El presente estudio tuvo como objetivo analizar el nivel de conocimiento de los conceptos de cuidados paliativos, sedación paliativa y eutanasia, lo que podría influir en la toma de decisiones éticas ...relacionadas con final de vida. Para ello, se elaboró un cuestionario ad hoc administrado entre los asistentes a unas Jornadas de Cuidados Paliativos en la Comunidad de Madrid (n = 142). La T de Student mostró que existen diferencias significativas (p < 0.05) entre los tres pares de conceptos y se encontraron correlaciones entre el grado de conocimiento de los tres constructos. La experiencia laboral y el nivel de conocimientos en cuidados paliativos correlaciona con un mayor conocimiento sobre eutanasia y sedación paliativa, encontrando diferencias estadísticamente significativas por nivel de estudios. Estos resultados sugieren que fomentar el conocimiento de cuidados paliativos disminuirá la presencia de ideas erróneas en deliberaciones relacionadas con el final de la vida, sedación y eutanasia.
El soporte nutricional (SN) en pacientes adultos que reciben terapia de oxigenación por membrana extracorpórea (ECMO, extracorporeal membrane oxygenation) es controvertido. Si bien existen guías para ...el SN en pacientes pediátricos con ECMO, en adultos no se cuenta con estos lineamientos para el uso, tipo, ruta y momento de la terapia nutricional. En pacientes críticamente enfermos es bien sabido que la nutrición enteral (NE) temprana es beneficiosa, no obstante existe la posibilidad de que en pacientes con ECMO la NE temprana condicione complicaciones gastrointestinales. Asimismo, no se han establecido metas calóricas, proteicas y dosis o tipos de micronutrimentos que usar para esta población en específico, siendo un reto para el clínico encargado de brindar el SN. Aunado a esto los pacientes con ECMO son algunos de los más gravemente enfermos en las unidades de cuidados intensivos, donde la desnutrición se asocia con una mayor morbilidad y mortalidad. En cuanto al uso de nutrición parenteral (NP), no se tiene descrito si implica riesgo de falla en el circuito al momento de introducir lípidos al oxigenador. Por lo anterior es imperativa una correcta evaluación e intervención nutricional específica, realizada por expertos en el tema para mejorar el pronóstico y la calidad de vida en esta población, siendo un objetivo primordial en los cuidados de los pacientes adultos que reciben terapia de ECMO.
A new approach to the analytical solution of the 2-D Poisson equation including the inversion-charge density in undoped square gate-all-around metal-oxide-semiconductor field-effect transistors has ...been developed. We have obtained functions with different degrees of complexity to calculate the electric potential in the devices under study. The results obtained are compared with the data simulated by solving the Poisson equation numerically. A good fit is achieved both for the electric potential and the inversion charge, which are calculated by means of Gauss's law.
El paciente politraumatizado se define como aquel que tiene múltiples lesiones que involucran diferentes órganos y sistemas, suelen ser graves y conllevan una disfunción respiratoria o circulatoria ...que pone en riesgo la vida. El estrés traumático en el paciente politraumatizado da lugar a muchos cambios metabólicos que son evidentes desde los primeros días, pero suelen persistir durante semanas y exigen un adecuado soporte nutricional, ya que influyen en los desenlaces. El tratamiento nutricional debe ser una prioridad en el tratamiento integral de los pacientes politraumatizados, porque atenúa la respuesta metabólica al trauma y evita el deterioro de las reservas corporales (cabe mencionar que algunos pacientes presentan riesgo nutricional previo). La intervención nutricional debe considerarse al mismo nivel que cualquier otra terapia que apoye las funciones orgánicas, sobre todo en pacientes en la unidad de terapia intensiva. La intervención nutricional en pacientes politraumatizados es un pilar en el tratamiento que tiene múltiples beneficios y puede mejorar el pronóstico. Todo esfuerzo debe ir encaminado a la detección temprana de pacientes desnutridos o en riesgo nutricional, y proporcionar de manera oportuna terapias que mejores los desenlaces clínicos.
To evaluate the volume reduction rate (VRR) of thyroid nodules over a long period of time after radiofrequency (RF) ablation treatment in both solid and mixed nodules; to determine ablation ...parameters; and to evaluate complications and success rates and safety of RF ablation.
In this prospective study, 24 patients (83% females and 17% males; age 50.17 ± 13.6 years) underwent ultrasound-guided percutaneous RF ablation of benign thyroid nodules with radiologic follow-up at 1, 3, 6, 12, 24, and 36 months after treatment. All patients presented with compressive or cosmetic complaints and with Thyroid Imaging Reporting and Data System 1 or 2 nodules under ultrasound and were confirmed to be Bethesda Category II after 2 fine-needle aspirations.
A total of 24 nodules (54.2% solid, 37.5% solid predominance, and 8.3% cystic predominance) were included in this study. Significant results in VRR (%) were found at 24 months and 36 months of 69.92 ± 19.23 and 76.84 ± 15.92, respectively. Furthermore, a logarithmic relationship was found when VRR was plotted over time, in both solid and mixed nodules. No correlations were found with any of the ablation parameters. The success rate reached 72.22% at 12 months, and the total complication rate was 16.67% (12.5% minor complications and 4.2% major complications-1 laryngeal nerve palsy), reaching an 83.3% safety.
RF ablation can be an alternative treatment modality in the management of benign symptomatic thyroid nodules. The results show that it is a safe and effective treatment if trans-isthmic approach and moving-shot techniques are correctly followed.
Knowledge of the features of patients with familial hypercholesterolaemia (FH) who are protected from atherosclerotic cardiovascular disease (ASCVD) is important for the clinical and prognostic care ...of this apparently high-risk condition. Our aim was to investigate the determinant and characteristics of patients with FH who are protected from ASCVD and have normal life expectancy, so-called 'resilient' FH (R-FH).
Spanish Familial Hypercholesterolaemia cohort study (SAFEHEART) is an open, multicentre, nation-wide, long-term prospective cohort study in genetically defined patients with heterozygous FH in Spain. Patients in the registry who at the time of analysis were at least 65 years or those who would have reached that age had they not died from an ASCVD event were analysed as a case-control study. Resilient FH was defined as the presence of a pathogenic mutation causative of FH in a patient aged ≥65 years without clinical ASCVD. Nine hundred and thirty registrants with FH met the study criteria. A defective low-density lipoprotein (LDL)-receptor mutation, higher plasma level of high-density lipoprotein cholesterol (HDL-C), younger age, female gender, absence of hypertension, and lower plasma lipoprotein (a) Lp(a) concentration were independently predictive of R-FH. In a second model, higher levels of HDL-C and lower 10-year score in SAFEHEART-RE were also independently predictive of R-FH.
Resilient FH may be typified as being female and having a defective LDL-receptor mutation, higher levels of plasma HDL-C, lower levels of Lp(a), and an absence of hypertension. The implications of this type of FH for clinical practice guidelines and the value for service design and optional care of FH remains to be established.
ClinicalTrials.gov number NCT02693548.
