Abstract Background and Aims Older patients with antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) commonly experience renal impairment and poor prognosis. The European Vasculitis ...Study Group trials showed that approximately 16.7% and 22.5% of older patients with AAV suffered from end-stage renal disease (ESRD) in 5- and 10-year durations. The aim of this study was to analyze differences in course and outcome of patients with AAV with respect to age. Method This retrospective observational study included patients with diagnosis of AAV and biopsy proven renal involvement between 2000-2021. Patients were divided into two groups according to age: ≥65 or <65 years old. We recorded baseline characteristics and clinical data during follow-up. Response was defined as a BVAS reduction of at least 50% or BVAS of 0, while receiving prednisone dose higher than 4 mg; and remission as BVAS of 0 while receiving prednisone dose of 4 mg or less. Results We included 42 patients with AAV diagnosis, 47.6% of which were 65 years-old or older. Mean age of the older age group was 77 ± 8 years. No differences were found between older and younger patients at baseline (BVAS, FFS extra-renal symptoms, serum creatinine at diagnosis, hematuria), Patients > 65 years were significantly more likely to present p-ANCA positive MPA, as shown in Table 1. There was no difference in initial or maintenance immunosuppressive therapy between the two groups. No differences were found between older and younger patients with regard to treatment response. Although we found no statistical differences, older patients had worse renal outcomes. The older adult group had a higher mortality rate, p 0.01. The average time to death was 27 months for patients over 65 years and 34.5 in those who were younger (p 0.71). Conclusion No differences were found between older and younger patients with regard to treatment response. However, mortality was higher during follow-up in the group of older patients. Our results suggest that more attention should be paid to older patients with severe renal impairment.
Abstract Background and Aims Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare but potentially serious diseases with high mortality. Renal involvement is ...frequent in AAV with patients developing end-stage renal disease (ESRD) or becoming dependent on dialysis in up to 23% of patients. Several studies suggest the presence of clinical factors as predictors of survival in these diseases. The objective of this study was to analyze clinical evolution of AAV and to identify potential risk factors for developing renal events (ESRD or dialysis) and death in patients with AAV, with special attention to the implications that the presence of myeloperoxidase (MPO) or proteinase 3 (PR3) antibodies at diagnosis may have on the disease progression. Method We conducted a retrospective observational study of patients under follow-up for AAV. We considered only those with a confirmed diagnosis of AAV through renal biopsy for the present study. We collected clinical and laboratory variables at the time of disease presentation. We divided the patients based on the presence of MPO or PR3. Subsequently, we analyzed the patients' progression towards the occurrence of renal events (ESRD or dialysis) and mortality. Results Out of the 42 studied patients, 29 were MPO-positive and 13 were PR3-positive. We observed statistically significant differences in age and the frequency of hypertension, with the MPO group being older and more hypertensive than the PR3 group. On the contrary, PR3-positive patients exhibited a higher percentage of diabetes and increased severity of vasculitis at diagnosis as measured by the Birmingham Vasculitis Activity Score (BVAS). While most MPO-positive patients met criteria for microscopic polyangiitis (MPA), all PR3-positive patients met criteria for granulomatosis with polyangiitis (GPA) according to the ACR/EULAR 2022 guidelines. There were no statistically significant differences regarding clinical or laboratory variables analyzed, neither with induction nor maintenance treatment. We did not observe differences in the progression towards renal events or mortality between groups. However, we did observe a higher percentage of disease recurrence among PR3-positive patients (Table 1). Conclusion There were no statistically significant differences observed in the progression towards renal events (ESRD and dialysis) or mortality regardless of MPO or PR3 antibodies.
Abstract
A large area of the terrestrial land surface is used for livestock grazing. Trees on grazing lands provide and can enhance multiple ecosystem services such as provisioning, cultural and ...regulating, that include carbon sequestration. In this study, we assessed the above- and belowground carbon stocks across six different land-uses in livestock-dominated landscapes of Mexico. We measured tree biomass and soil organic carbon (SOC) stocks in fodder banks, live fences, pasturelands with dispersed trees, secondary forests, and primary forests from three different geographical regions and compared them with conventional open pasturelands respectively. We also calculated tree diversity indices for each land-use and their similarity with native primary forests. The aboveground woody biomass stocks differed significantly between land-uses and followed the gradient from less diverse conventional open pasturelands to silvopastoral systems and ecologically complex primary forests. The SOC stocks showed a differential response to the land-use gradient dependent on the study region. Multivariate analyses showed that woody biomass, fine root biomass, and SOC concentrations were positively related, while land-use history and soil bulk density showed an inverse relationship to these variables. Silvopastoral systems and forest remnants stored 27–163% more carbon compared to open pasturelands. Our results demonstrate the importance of promoting appropriate silvopastoral systems and conserving forest remnants within livestock-dominated landscapes as a land-based carbon mitigation strategy. Furthermore, our findings also have important implications to help better manage livestock-dominated landscapes and minimize pressures on natural protected areas and biodiversity in the hotspots of deforestation for grassland expansion.
Obstructive sleep apnea (OSA) is associated with impaired glycemic control and a higher risk of vascular complications, such as diabetic kidney disease (DKD). However, the effect of apnea-hypopnea ...suppression on DKD progression is unclear.
To assess the effect of continuous positive airway pressure (CPAP) on the urinary albumin-to-creatinine ratio (UACR) in patients with DKD and OSA.
In a 52-week, multicentric, open-label, parallel, and randomized clinical trial, 185 patients with OSA and DKD were randomized to CPAP and usual care (
= 93) or usual care alone (
= 92).
UACR, estimated glomerular filtration rate, serum concentrations of creatinine and glycated hemoglobin, insulin resistance, lipid concentrations, sleepiness, and quality of life. A 52-week change in UACR from baseline did not differ significantly between the CPAP group and the usual-care group. However, in per-protocol analyses that included 125 participants who met prespecified criteria for adherence, CPAP treatment was associated with a great reduction in UACR (mean difference, -10.56% 95% confidence interval, -19.06 to -2.06;
= 0.015). CPAP effect on UACR was higher in nonsleepy patients with more severe OSA, worse renal function, and a more recent diagnosis of DKD. CPAP treatment also improved glycemic control and insulin resistance, as well as sleepiness and health-related quality of life.
In patients with OSA and DKD, the prescription of CPAP did not result in a statistically significant reduction in albuminuria. However, good adherence to CPAP treatment in addition to usual care may result in long-term albuminuria reduction compared with usual care alone. Clinical trial registered with www.clinicaltrials.gov (NCT02816762).
High environmental temperatures cause heat stress in ewes, resulting in thermoregulatory problems. In this study, the thermoregulatory responses of Blackbelly adult ewes (G1, n = 14) and female lambs ...(G2, n = 7), during the summer under tropical conditions, in southern Mexico were analyzed. Different physiological variables and skin temperatures (ST) of the ewes were recorded. Breathing frequency (BF) values were similar between groups at 116.73 ± 33.598 bpm (G1) and 113.661 ± 34.515 bpm (G2) (p > 0.05). In the case of skin elasticity (SE), there were no significant differences between the time of day and the age of the ewes (p > 0.05). Significant differences were observed between groups for BF, rectal temperature (RT), and heart rate (HR) values (p < 0.05). All ST values, for both groups, were significantly higher during the afternoon (p < 0.001). In general, all Blackbelly adult ewes and female lambs during the summer present severe heat stress conditions as a result of an increase in physiological constants and ST. It is concluded that all ewes thermoregulate body temperature by modifying different physiological variables to counteract the effect of heat stress.
Land use change from forests to grazing lands is one of the important sources of greenhouse gas emissions in many parts of the tropics. The objective of this study was to analyze the extent of soil ...organic carbon (SOC) loss from the conversion of native forests to pasturelands in Mexico. We analyzed 66 sets of published research data with simultaneous measurements of soil organic carbon stocks between native forests and pasturelands in Mexico. We used a generalized linear mixed effect model to evaluate the effect of land use change (forest versus pasture), soil depth, and original native forest types. The model showed that there was a significant reduction in SOC stocks due to the conversion of native forests to pasturelands. The median loss of SOC ranged from 31.6% to 52.0% depending upon the soil depth. The highest loss was observed in tropical mangrove forests followed by highland tropical forests and humid tropical forests. Higher loss was detected in upper soil horizon (0–30 cm) compared to deeper horizons. The emissions of CO2 from SOC loss ranged from 46.7 to 165.5 Mg CO2 eq. ha−1 depending upon the type of original native forests. In this paper, we also discuss the effect that agroforestry practices such as silvopastoral arrangements and other management practices like rotational grazing, soil erosion control, and soil nutrient management can have in enhancing SOC stocks in tropical grasslands. The results on the degree of carbon loss can have strong implications in adopting appropriate management decisions that recover or retain carbon stocks in biomass and soils of tropical livestock production systems.
Síndrome de edorexia: evaluación y diagnóstico López-Morales, José Luis; Garcés de los Fayos Ruiz, Enrique J
Salud pública de México,
2014 May-Jun, Letnik:
56, Številka:
3
Journal Article
Abstract Background and Aims Lupus nephritis (LN) is a major course of morbidity and mortality in patients with systemic lupus erythematosus (SLE), best managed by a multidisciplinary group. Recent ...management advances require greater collaboration between specialists and individualized treatments in severe cases. Method We conducted a retrospective, single-center study of a cohort of incident patients which were diagnosed with LN between 2015 and 2022 and began follow-up in the multidisciplinary rheumatology and nephrology consultation of our institution. Clinical and analytical characteristics at diagnosis and during follow-up were studied. The primary endpoint was complete remission rate at follow-up end, according to GLOSEN (Grupo de Estudio de Enfermedades Glomerulares de la SEN) 1 criteria. Changes in immunosuppression schemes over time were studied. Results 26 patients (92.3% women) were included. Median age at SLE diagnosis was 30.5 years Interquartile range (IQR) 23.7 – 44.2. Most patients were Hispanic (14 patients, 53.8%). Median time between SLE and LN diagnosis was 21 months (IQR 0-129 months). In 9 patients (34.6%), SLE and LN onset happened simultaneously. Most common renal manifestation was hematuria, which appeared in 19 patients (73.1%). Median proteinuria was 1.83 g/d (IQR 0.88-2.92) and serum creatinine level, 0.69 (IQR 0.51-1.18). Hypocomplementemia (88.5%) and positivity to anti-DNA (69.2%) were common. Most frequent classes found in renal biopsies were IV (30.8%) and V (23.1%). At LN debut, SLEDAI score, which assesses SLE manifestations, had a median value of 16 (IQR 12-20). Mycophenolate mofetil (96.2%) was the main induction agent. Intravenous steroids were administered in 14 patients (53.8%) and the rest received steroids at a dose of 0.5 mg/kg/day. Addition of another therapy, mainly tacrolimus (6 patients, 23.1%) and belimumab (4 patients, 15.4%), was needed to achieve remission in 12 patients (46.2%). In 8 of them (66.6%), treatments were added within the first 6 months. These 12 patients had less chronicity in the biopsy (median chronicity index: 0 vs. 2; p 0.004) and had higher proteinuria (median 1.41 g/day vs. 0.4 g/day; p 0.001). Likewise, SLEDAI score at 3 months was significantly higher in these 12 patients than in the standard of care group (median SLEDAI score 13 vs. 8; p 0.016). No differences were found in 3 month serum creatinine (p 0.181) or 3 month hematuria (p 0.496) After a median follow-up of 47 months, 15 (57.7%) and 9 patients (34.6%) achieved complete and partial remission, respectively. No differences in percentages of remission were observed between the 2 groups. Steroids were withdrawn in 12 patients (46.2%). Median steroid dose at the end of follow-up was 5 mg (IQR 3-5). Conclusion In our LN cohort, higher SLEDAI and proteinuria indicated the need for an individualized approach. Collaboration between Rheumatology and Nephrology specialists is essential to identify patients with these needs.
Abstract Background and Aims Technological innovation has revolutionized medical assistance. Peritoneal dialysis (PD) patients, who prioritize their autonomy and freedom choosing to undergo dialysis ...at home, are the paradigm of patients willing to use telemedicine. Remote monitoring allows real-time therapy supervision, ensures proper adherence and empowers the patients by promoting self-care and self-awareness The aim of this study is to assess the feasibility and acceptance of MiDiálisis App. Method MiDiálisis App, developed independently, integrates essential self-care data (such as blood pressure, ultrafiltration and weight), presenting it in real-time graphs and tables for both patients and nephrologists. It also allows asynchronous communication between them. This is a prospective observational pilot study in which MiDiálisis App was offered to PD patients at a tertiary hospital. Results Out of the 10 patients offered the use of the MiDiálisis App, 3 did not use it (NU) due to technical issues. Seven patients used (U) MiDiálisis for a median of 9 4-11 months. The majority were male (n = 6) and on automated PD (n = 6) for a period of 30 (15-38) months. We registered 6.3 (5.6-6.7) days with interaction/week. NU patients were older (U 61 54-69 years vs NU 68 34-75 years, p = 0.5), with higher comorbidity Charlson index (U 5 4-7 points vs NU 7 3-9 points, p = 0.5), and greater Frail index (U 2 1-2 points vs NU 3 2-4 points, p = 0.067). Six patients completed a survey after using MiDiálisis. 100% perceived a better communication with their nephrologist and greater accuracy of data compared to their previous method (paper-based recording). All of them entered the data by themselves and found both learning and using MiDiálisis to be easy; 83% considered the app beneficial for their health, and 100% felt secure using it. Furthermore, 67% reported significant changes in their self-care habits, and 83% mentioned an increased awareness of their health status. All participants would recommend it to other patients. Conclusion MiDiálisis App is applicable and has good acceptance among people undergoing PD. It might be a useful tool that can improve self-care, adherence, and communication with these patients.
PDF
