Various mechanisms are related to arterial hypertension in obesity. Central blood pressure (BP) seems to correlate more than peripheral BP with future cardiovascular risk. Bariatric surgery is an ...effective method to reduce BP along with weight loss in patients with morbid obesity. The study of the relationship between weight modification after bariatric surgery and ambulatory BP measurement, not only peripheral BP, but also central BP, could provide information regarding the mechanisms of organic damage associated with elevated BP in obesity. In this review we analyze the available evidence regarding the association between central BP with obesity and its modifications after bariatric surgery.
COVID‐19 in elderly kidney transplant recipients Crespo, Marta; Pérez‐Sáez, María J.; Redondo‐Pachón, Dolores ...
American journal of transplantation,
October 2020, Letnik:
20, Številka:
10
Journal Article
Recenzirano
Odprti dostop
The SARS‐Cov‐2 infection disease (COVID‐19) pandemic has posed at risk the kidney transplant (KT) population, particularly the elderly recipients. From March 12 until April 4, 2020, we diagnosed ...COVID‐19 in 16 of our 324 KT patients aged ≥65 years old (4.9%). Many of them had had contact with healthcare facilities in the month prior to infection. Median time of symptom onset to admission was 7 days. All presented with fever and all but one with pneumonia. Up to 33% showed renal graft dysfunction. At infection diagnosis, mTOR inhibitors or mycophenolate were withdrawn. Tacrolimus was withdrawn in 70%. The main treatment combination was hydroxychloroquine and azithromycin. A subset of patients was treated with anti‐retroviral and tocilizumab. Short‐term fatality rate was 50% at a median time since admission of 3 days. Those who died were more frequently obese, frail, and had underlying heart disease. Although a higher respiratory rate was observed at admission in nonsurvivors, symptoms at presentation were similar between both groups. Patients who died were more anemic, lymphopenic, and showed higher D‐dimer, C‐reactive protein, and IL‐6 at their first tests. COVID‐19 is frequent among the elderly KT population and associates a very early and high mortality rate.
The authors report early and high mortality rates for elderly kidney transplant recipients.
La obesidad está asociada con la hipertensión arterial por mecanismos diversos. La presión arterial (PA) central parece estar más correlacionada que la PA periférica con el riesgo cardiovascular ...futuro. La cirugía bariátrica constituye un método eficaz para disminuir la PA paralelamente a una pérdida de peso significativa en pacientes con obesidad severa. El estudio de la relación entre la modificación de peso tras cirugía bariátrica y la medición ambulatoria de PA, no solo a nivel periférico, sino también a nivel central, podría aportar información respecto a los mecanismos del daño orgánico asociado a la PA elevada en la obesidad.
En esta revisión analizamos la evidencia disponible respecto a la asociación entre la PA central con la obesidad y sus modificaciones tras la cirugía bariátrica.
Various mechanisms are related to arterial hypertension in obesity. Central blood pressure (BP) seems to correlate more than peripheral BP with future cardiovascular risk. Bariatric surgery is an effective method to reduce BP along with weight loss in patients with morbid obesity.
The study of the relationship between weight modification after bariatric surgery and ambulatory BP measurement, not only peripheral BP, but also central BP, could provide information regarding the mechanisms of organic damage associated with elevated BP in obesity.
In this review we analyze the available evidence regarding the association between central BP with obesity and its modifications after bariatric surgery.
Various mechanisms are related to arterial hypertension in obesity. Central blood pressure (BP) seems to correlate more than peripheral BP with future cardiovascular risk. Bariatric surgery is an ...effective method to reduce BP along with weight loss in patients with morbid obesity.
The study of the relationship between weight modification after bariatric surgery and ambulatory BP measurement, not only peripheral BP, but also central BP, could provide information regarding the mechanisms of organic damage associated with elevated BP in obesity.
In this review we analyze the available evidence regarding the association between central BP with obesity and its modifications after bariatric surgery.
La obesidad está asociada con la hipertensión arterial por mecanismos diversos. La presión arterial (PA) central parece estar más correlacionada que la PA periférica con el riesgo cardiovascular futuro. La cirugía bariátrica constituye un método eficaz para disminuir la PA paralelamente a una pérdida de peso significativa en pacientes con obesidad severa. El estudio de la relación entre la modificación de peso tras cirugía bariátrica y la medición ambulatoria de PA, no solo a nivel periférico, sino también a nivel central, podría aportar información respecto a los mecanismos del daño orgánico asociado a la PA elevada en la obesidad.
En esta revisión analizamos la evidencia disponible respecto a la asociación entre la PA central con la obesidad y sus modificaciones tras la cirugía bariátrica.
La hipertensión arterial resistente (HTAR) supone un importante problema de salud de manejo complejo. Este trabajo evalúa los riesgos y beneficios de añadir espironolactona para tratar la HTAR.
Se ...evaluaron 216 pacientes con HTAR a quienes se añadió espironolactona (12,5-25mg/día) como antihipertensivo. Ciento veinticinco se analizaron retrospectivamente y 91 prospectivamente. Se analizaron parámetros de presión arterial (PA) y laboratorio (creatinina plasmática Creap, filtrado glomerular FGe y potasio plasmático Kp) al momento basal y tras 3-6-12 meses con espironolactona.
Se objetivó una variación de PA sistólica/diastólica (media± desviación estándar) de −10,9±2,7/−4,3±1,6mmHg a los 3 meses y −13,6±2,8/−6,0±1,6mmHg a los 12 meses; p<0,001. Valores confirmados mediante monitorización ambulatoria de PA a los 12 meses. A los 3 meses, la Creap incrementó 0,10±0,04mg/dl, el FGe disminuyó −5,4±1,9ml/min/1,73m2 y el Kp incrementó 0,3±0,1mmol/l; p<0,001 para todos los casos. Estas variaciones se mantuvieron a los 12 meses. No hubo diferencias significativas en las variaciones de PA, Creap, FGe y Kp entre los 3 y 12 meses. Los resultados al analizar las cohortes retrospectiva y prospectiva por separado fueron superponibles. En la cohorte prospectiva, espironolactona fue suspendida en 9 pacientes (9,9%) por efectos adversos.
Tras 3 meses con espironolactona se observó un descenso de PA asociado a descenso del FGe y aumento de Creap y Kp, cambios que se mantuvieron a los 12 meses. Espironolactona es un tratamiento eficaz y seguro para la HTAR en pacientes con FGe basal ≥30ml/min/1,73m2.
Resistant hypertension (RH) is a significant health problem with complex management. The aim of this study was to evaluate the risks and benefits of adding spironolactone to treat RH.
In total, 216 patients with RH in whom spironolactone (12.5-25mg daily) was added as an antihypertensive were evaluated. One-hundred and twenty-five (125) were analysed retrospectively and 91 prospectively. Blood pressure (BP) and laboratory parameters (serum creatinine sCrea, estimated glomerular filtration rate eGFR and serum potassium sK) were analysed at baseline and at 3-6-12 months after introducing spironolactone.
A change of systolic/diastolic BP (mean±standard deviation) of −10.9±2.7/−4.3±1.6mmHg at 3 months and −13.6±2.8/−6.0±1.6mmHg at 12 months; p<0.001 was observed. These values were confirmed with ambulatory-BP monitoring at 12 months. At 3 months, an increase in sCrea of 0.10±0.04mg/dl, a decrease in eGFR of −5.4±1.9ml/min/1.73m2 and an increase in sK of 0.3±0.1mmol/l; p<0.001 was observed for all cases. These changes were maintained after 12 months. There were no significant differences in changes of BP, sCrea, eGFR and sK between 3 and 12 months. Results of the retrospective and prospective cohorts separately were superimposable. In the prospective cohort, spironolactone was withdrawn in 9 patients (9.9%) because of adverse effects.
After 3 months with spironolactone, a decrease in BP associated with a decrease in the eGFR and an increase in sCrea and sK was observed. These changes were maintained at 12 months. Spironolactone is an effective and safe treatment for RH in patients with baseline eGFR ≥30ml/min/1.73m2.
Resistant hypertension (RH) is a significant health problem with complex management. The aim of this study was to evaluate the risks and benefits of adding spironolactone to treat RH.
In total, 216 ...patients with RH in whom spironolactone (12.5-25mg daily) was added as an antihypertensive were evaluated. One-hundred and twenty-five (125) were analysed retrospectively and 91 prospectively. Blood pressure (BP) and laboratory parameters (serum creatinine sCrea, estimated glomerular filtration rate eGFR and serum potassium sK) were analysed at baseline and at 3-6-12 months after introducing spironolactone.
A change of systolic/diastolic BP (mean±standard deviation) of -10.9±2.7/-4.3±1.6mmHg at 3 months and -13.6±2.8/-6.0±1.6mmHg at 12 months; p<0.001 was observed. These values were confirmed with ambulatory-BP monitoring at 12 months. At 3 months, an increase in sCrea of 0.10±0.04mg/dl, a decrease in eGFR of -5.4±1.9ml/min/1.73m
and an increase in sK of 0.3±0.1mmol/l; p<0.001 was observed for all cases. These changes were maintained after 12 months. There were no significant differences in changes of BP, sCrea, eGFR and sK between 3 and 12 months. Results of the retrospective and prospective cohorts separately were superimposable. In the prospective cohort, spironolactone was withdrawn in 9 patients (9.9%) because of adverse effects.
After 3 months with spironolactone, a decrease in BP associated with a decrease in the eGFR and an increase in sCrea and sK was observed. These changes were maintained at 12 months. Spironolactone is an effective and safe treatment for RH in patients with baseline eGFR ≥30ml/min/1.73m
.
The COVID-19 pandemic has led to frequent referrals to the emergency department on suspicion of this infection in maintenance hemodialysis (MHD) and kidney transplant (KT) patients. We aimed to ...describe their clinical features comparing confirmed and suspected non-confirmed COVID-19 cases during the Spanish epidemic peak. Confirmed COVID-19 ((+)COVID-19) corresponds to patient with positive RT-PCR SARS-CoV-2 assay. Non-confirmed COVID-19 ((−)COVID-19) corresponds to patients with negative RT-PCR. COVID-19 was suspected in 61 patients (40/803 KT (4.9%), 21/220 MHD (9.5%)). Prevalence of (+)COVID-19 was 3.2% in KT and 3.6% in MHD patients. Thirty-four (26 KT and 8 MHD) were (+)COVID-19 and 27 (14 KT and 13 MHD) (−)COVID-19. In comparison with (−)COVID-19 patients, (+)COVID-19 showed higher frequency of typical viral symptoms (cough, dyspnea, asthenia and myalgias), pneumonia (88.2% vs. 14.3%) and LDH and CRP while lower phosphate levels, need of hospital admission (100% vs. 63%), use of non-invasive mechanical ventilation (36% vs. 11%) and mortality (38% vs. 0%) (p < 0.001). Time from symptoms onset to admission was longer in patients who finally died than in survivors (8.5 vs. 3.8, p = 0.007). In KT and MHD patients, (+)COVID-19 shows more clinical severity than suspected non-confirmed cases. Prompt RT-PCR is mandatory to confirm COVID-19 diagnosis.
El libro “Attracting visitors to ancient neighbourhoods. Creation and management of the tourist-historic city of Plymouth” trata de los aspectos mencionados aplicados a la ciudad de Plymouth, en el ...suroeste de Inglaterra. La investigación se desarrolla siguiendo una serie de objetivos que van concentrando el foco desde el contexto general nacional hasta el análisis de experiencias locales.
Purpose>The purpose of this paper is to explore, through the analysis case, how the revitalization of a historic centre has been carried out and the role of tourism in this ...process.Design/methodology/approach>This case study area is well-documented as there has been extensive fieldwork on the transformation of the commercial sector in the Monumental Zone of Pontevedra in the last three decades. In order to prepare this paper, a bibliographic review, in-depth interviews, premises registration data and population data have been used.Findings>The findings show that the processes of change and revitalization do not conform to a single reality common to all historical centres, although similar strategies are developed, the role of the participating actors and, especially, the idiosyncrasy of these spaces change the outcomes. On the one hand, gentrification does not occur and the increase of residential uses is still a goal. On the other hand, the tourism strategy brings more visitors and complements the commerce activity and attraction.Social implications>The new challenge of these spaces, and the urban contribution from this research, is that in the appropriation of space by citizens, tourism may be a complement for commerce, and shops and hospitality (facilities) make these spaces more livable. Although tourism does not necessarily increase the number of residents, the revenue from tourism may prevent the reoccurrence of abandonment.Originality/value>The paper focusses on both gentrification and touristification; processes that have led to the substitution of residents and activities and the conflict with the local population and the normalization of urban life. This case has been selected because despite a seemingly successful revitalization process, recently some old threats seem to be returning.
In this book the author gives us the opportunity to discuss the policies of heritage protection, tourism management and the social actors' participation through the analysis of the city of Plymouth ...as a case study. Ultimately, the research allows us to understand how urban regeneration has been carried out, which economic and social impacts it has had, and how it has affected citizens.
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