Are Sodium-Glucose Cotransporter-2 Inhibitors the Cherry on Top of Cardio-Oncology Care?

The increasing aging of the population combined with improvements in cancer detection and care has significantly improved the survival and quality of life of cancer patients. These benefits are hampered by the increase of cardiovascular diseases being heart failure the most frequent manifestation of cardiotoxicity and becoming the major cause of morbidity and mortality among cancer survivor. Current strategies to prevent cardiotoxicity involves different approaches such as optimal management of CV risk factors, use of statins and/or neurohormonal medications, and, in some cases, even the use of chelating agents. As a class, SGLT2-i have revolutionized the therapeutic horizon of HF patients independently of their ejection fraction or glycemic status. There is an abundance of data from translational and observational clinical studies supporting a potential beneficial role of SGLT2-i in mitigating the cardiotoxic effects of cancer patients receiving anthracyclines. These findings underscore the need for more robust clinical trials to investigate the effect on cardiovascular outcomes of the prophylactic SGLT2-i treatment in patients undergoing cancer treatment.

Development of an online optical prototype for the simultaneous analysis of defects or gels in industrially synthesized polypropylene films. Part 1: Comparison with ASTM D 3351-93 methods.

Polypropylene (PP) films are crucial in various industrial applications, from packaging to medical products. However, a common challenge in PP manufacturing is the presence of gel-like defects. These gels are minor defects on the surface of the films that significantly affect the physicochemical, mechanical, and organoleptic properties of the films, compromising the quality of the final product. This first research focuses on developing and validating an in-line optical method to replace the international method ASTM D 3351-93. The main objective was to create a methodology that has the same scope and analytical performance as those reported by ASTM D 3351-93 in such a way that it can compete with it in terms of precision and accuracy, thus allowing end users to this ASTM, such as PP producers, PP marketers, PP film producers, among others internationally, can use this new methodology with necessary analytical support. This analytical methodology integrates the PP extrusion zones, the film processing stages, and the optical zone for reading and processing analytical data. Additionally, it has the advantage of working with a sample size that is even more representative of the population and has less human error since only one operator is required to carry out the test; this method also has much shorter response times. The developed prototype had 14 online stages that allowed representative quantities of samples to be taken and processed thermally and mechanically for ideal optical measurement. For the online method, a 6-point calibration curve is carried out at concentrations of 40, 10, 5, 2, 1 and 0 ppm for the gel or defect sizes of 200, 400, 500, 600, 700, 800 and 900 µm, showing excellent linearity where the correlation coefficient varied between 0.997 and 0.999, the limits of detection (LOD) varied between 0.85 and 2.61 and the limits of quantification (LOQ) ranged between 2.82 and 8.71. The statistical analyzes by ANOVA of the comparison between the ASTM D 3351-93 method and the proposed simultaneous method indicate that the p value of the evaluation of the means was 0.946, which suggests that the means are not statistically different. To complement, the Tukey test was carried out at 95 %, indicating that the methods have statistical equivalence.•Process optimization•Determination of defects or imperfections in PP films.

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort.

BACKGROUND: Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster. METHODS: Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3. RESULTS: Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3. CONCLUSIONS: During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis.

Benefitting productivity and the environment: Current and future maize cropping systems improve yield while reducing nitrate load.

Increases in cereal crop yield per area have increased global food security. "Era" studies compare historical and modern crop varieties in controlled experimental settings and are routinely used to understand how advances in crop genetics and management affect crop yield. However, to date, no era study has explored how advances in maize (Zea mays L.) genetics and management (i.e., cropping systems) have affected environmental outcomes. Here, we developed a cropping systems era study in Iowa, USA, to examine how yield and nitrate losses have changed from "Old" systems common in the 1990s to "Current" systems common in the 2010s, and to "Future" systems projected to be common in the 2030s. We tested the following hypothesis: If maize yield and nitrogen use efficiency have improved over previous decades, Current and Future maize systems will have benefits to water quality compared to Old systems. We show that not only have maize yield and nitrogen use efficiency (kg grain kg-1 N), on average, improved over time but also yield-scaled nitrate load + soil nitrate was reduced by 74% and 91% from Old to Current and Future systems, respectively. Continuing these trajectories of improvement will be critical to meet the needs of a growing and more affluent population while reducing deleterious effects of agricultural systems on ecosystem services.

International Alliance of Urolithiasis guideline on retrograde intrarenal surgery.

OBJECTIVES: To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. MATERIALS AND METHODS: After a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. RESULTS: A total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. CONCLUSION: The series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.

Micronized Recycle Rubber Particles Modified Multifunctional Polymer Composites: Application to Ultrasonic Materials Engineering.

There is a growing interest in multifunctional composites and in the identification of novel applications for recycled materials. In this work, the design and fabrication of multiple particle-loaded polymer composites, including micronized rubber from end-of-life tires, is studied. The integration of these composites as part of ultrasonic transducers can further expand the functionality of the piezoelectric material in the transducer in terms of sensitivity, bandwidth, ringing and axial resolution and help to facilitate the fabrication and use of phantoms for echography. The adopted approach is a multiphase and multiscale one, based on a polymeric matrix with a load of recycled rubber and tungsten powders. A fabrication procedure, compatible with transducer manufacturing, is proposed and successfully used. We also proposed a modelling approach to calculate the complex elastic modulus, the ultrasonic damping and to evaluate the relative influence of particle scattering. It is concluded that it is possible to obtain materials with acoustic impedance in the range 2.35-15.6 MRayl, ultrasound velocity in the range 790-2570 m/s, attenuation at 3 MHz, from 0.96 up to 27 dB/mm with a variation of the attenuation with the frequency following a power law with exponent in the range 1.2-3.2. These ranges of values permit us to obtain most of the material properties demanded in ultrasonic engineering.

Methodology of a Large Multicenter Observational Study of Patients with COVID-19 in Spanish Intensive Care Units.

INTRODUCTION: The COVID-19 pandemic created tremendous challenges for health-care systems. Intensive care units (ICU) were hit with a large volume of patients requiring ICU admission, mechanical ventilation, and other organ support with very high mortality. The Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), a network of Spanish researchers to investigate in respiratory disease, commissioned the current proposal in response to the Instituto de Salud Carlos III (ISCIII) call. METHODS: CIBERESUCICOVID is a multicenter, observational, prospective/retrospective cohort study of patients with COVID-19 admitted to Spanish ICUs. Several work packages were created, including study population and ICU data collection, follow-up, biomarkers and miRNAs, data management and quality. RESULTS: This study included 6102 consecutive patients admitted to 55 ICUs homogeneously distributed throughout Spain and the collection of blood samples from more than 1000 patients. We enrolled a large population of COVID-19 ICU-admitted patients including baseline characteristics, ICU and MV data, treatments complications, and outcomes. The in-hospital mortality was 31%, and 76% of patients required invasive mechanical ventilation. A 3-6 month and 1 year follow-up was performed. Few deaths after 1 year discharge were registered. Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. These antibodies contribute to prevent systemic dissemination of SARS-CoV-2. The severity of COVID-19 impacts the circulating miRNA profile. Plasma miRNA profiling emerges as a useful tool for risk-based patient stratification in critically ill COVID-19 patients. CONCLUSIONS: We present the methodology used in a large multicenter study sponsored by ISCIII to determine the short- and long-term outcomes in patients with COVID-19 admitted to more than 50 Spanish ICUs.

Clinical performance of alveolar ridge augmentation with xenogeneic bone block grafts versus autogenous bone block grafts. A systematic review.

INTRODUCTION: This systematic literature review aimed to evaluate the feasibility of xenogeneic bone blocks for ridge augmentation compared with autogenous blocks by analyzing block survival rates, block resorption, subsequent implant survival rate, post-surgical complications, and histomorphometric findings. MATERIALS AND METHODS: Electronic searches were conducted in the Medline (PubMed), Web of Science and Cochrane databases, complimented by a manual search in specialist journals, for relevant articles published up to March 2020. Inclusion criteria were human studies in which the outcomes of xenogeneic bone block grafts were evaluated by means of their survival rates and subsequent implant survival rates. RESULTS: Sixteen articles fulfilled the inclusion criteria and were analyzed. 333 patients were recruited with a total of 337 xenogeneic bone blocks and 82 autogenous bone blocks, showing block failure rates of 6.82% and 6.1%, respectively. Bone gain, in both height and width, was similar among xenogeneic and autogenous bone blocks, but autogenous bone blocks suffered greater resorption. Implant survival rates were slightly lower for xenogeneic bone blocks. Histological and histomorphometric analysis observed more bone formation and less residual bone substitute with autogenous bone blocks than xenogeneic bone blocks. CONCLUSIONS: Atrophic alveolar crest reconstruction with xenogeneic bone block grafts would appear to offer a viable alternative to autogenous bone block grafts, obtaining similar block graft failure rate, fewer sensitive postoperative complications but a slightly lower implant survival rate. Further investigations generating long term data are needed to confirm the feasibility of xenogeneic bone blocks in different clinical scenarios.

Poly(acrylonitrile-co-butadiene) as polymeric crosslinking accelerator for sulphur network formation.

The major controlling factors that determine the various mechanical properties of an elastomer system are type of chemical crosslinking and crosslink density of the polymer network. In this study, a catalytic amount of acrylonitrile butadiene copolymer (NBR) was used as a co-accelerator for the curing of polybutadiene (BR) elastomer. After the addition of this copolymer along with other conventional sulphur ingredients in polybutadiene compounds, a clear and distinct effect on the curing and other physical characteristics was noticed. The crosslinking density of BR was increased, as evidenced by rheometric properties, solid-state NMR and swelling studies. The vulcanization kinetics study revealed a substantial lowering of the activation energy of the sulphur crosslinking process when acrylonitrile butadiene copolymer was used in the formulation. The compounds were also prepared in the presence of carbon black and silica, and it was found that in the carbon black filled system the catalytic effect of the NBR was eminent. The effect was not only reflected in the mechanical performance but also the low-temperature crystallization behavior of BR systems was altered.

Recomendaciones para el uso de la hormona de crecimiento humana recombinante en pacientes pediátricos de talla baja en Colombia / Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

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Abstract In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinant human growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation, the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order to standardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium of clinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada de Servicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private health institutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia Clínica Keralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm, biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use among the indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consent and a medication fact sheet available for parents and patients.

Soil organic matter fractions and carbon management index under integrated crop-livestock system / Frações da matéria orgânica do solo e índice de manejo de carbono em sistema de integração lavoura-pecuária

The objective of this work was to evaluate the carbon content of the physical, chemical and oxidizable fractions of soil organic matter (SOM) and to calculate the carbon management index (CMI) in an area managed under an integrated crop-livestock system (ICLS) in the western region of Paraná - Brazil. The experiment was carried out at the experimental farm, belonging to the Universidade Estadual do Oeste do Paraná. Seventeen areas, which are managed in different ways, fifteen in ICLS and two areas of controls (Forest and Haymaking), using the design divided with two nested controls, with three replications were evaluated. Deformed and undisturbed soil samples were collected from all the areas to determine the total organic carbon (TOC), carbon stock, the physical, chemical and oxidizable fractions of SOM and the CMI in the layers of 0-0.05, 0.05-0.1 and 0.1-0.2 m. Little significant changes in the fractions were found for the management of the ICLS area in relation to the Forest and the area of Haymaking, although the Forest presented the best values for most of the studied fractions. It is recommended to adopt sustainable practices, such as ICLS, even though the average fractions tend to take time to match reference areas.

O objetivo desse trabalho foi avaliar os teores de carbono das frações física, química e oxidável da matéria orgânica do solo (MOS) e calcular o índice de manejo de carbono (IMC) em uma área manejada em sistema de integração lavoura pecuária (ILP) na região Oeste do Paraná - Brasil. O experimento foi realizado na fazenda experimental, pertencente à Universidade Estadual do Oeste do Paraná. Foram avaliadas dezessete áreas, que foram manejadas de diferentes formas, quinze em ILP e duas testemunhas (Mata e Fenação), sendo empregado o delineamento subsubsubdividido com duas testemunhas aninhadas, com três repetições. Em todas as áreas foram coletadas amostras deformadas e indeformadas de solo para serem determinados o carbono orgânico total, estoque de carbono e as frações físicas granulométricas, oxidáveis e químicas da MOS e o IMC nas camadas de 0-0,05, 0,05-0,1 e 0,1-0,2 m. Alterações pouco significativas das frações foram encontradas para os manejos da área em ILP em relação a mata e a área de fenação, entretanto a mata apresentou os melhores valores para a maioria das frações estudadas. Recomenda-se a adoção de práticas sustentáveis, como a ILP, mesmo que os teores médios das frações tendem a demorar tempo para igualar-se a áreas de referência.

New mutation of the ceruloplasmin gene in the case of a neurologically asymptomatic patient with microcytic anaemia, obesity and supposed Wilson's disease.

BACKGROUND: Aceruloplasminaemia is a very rare autosomal recessive disorder caused by a mutation in the ceruloplasmin gene, which is clinically manifested by damage to the nervous system and retinal degeneration. This classical clinical picture can be preceded by diabetes mellitus and microcytic anaemia, which are considered to be early manifestations of aceruloplasminaemia. CASE PRESENTATION: In our report, we describe the case of a patient with aceruloplasminaemia detected in an early stage (without clinical symptoms of damage to the nervous system) during the search for the cause of hepatopathy with very low values of serum ceruloplasmin. Molecular genetic examination of the CP gene for ceruloplasmin identified a new variant c.1664G > A (p.Gly555Glu) in the homozygous state, which has not been published in the literature or population frequency databases to date. Throughout the 21-month duration of chelatase treatment, the patient, who is 43 years old, continues to be without neurological and psychiatric symptomatology. We observed a decrease in the serum concentration of ferritin without a reduction in iron deposits in the brain on magnetic resonance imaging. CONCLUSION: Currently, there is no unequivocal recommendation of an effective treatment for aceruloplasminaemia. Early diagnosis is important in the neurologically asymptomatic stage.

Quantification of poisons for Ziegler Natta catalysts and effects on the production of polypropylene by gas chromatographic with simultaneous detection: Pulsed discharge helium ionization, mass spectrometry and flame ionization.

This article describes a new simultaneous method for the analysis of sulfur-type poisons, hydrocarbons and permanent gases affecting the productivity of the Ziegler Natta catalyst during the synthesis of polypropylene on an industrial scale in a fluidized-bed reactor. The identification was achieved employing a configuration of the seven-valve chromatographic system, with events at different times, allowing distribution of the sample through multiple columns, and finally reaching the helium ionization detectors of pulsed discharge, flame ionization and mass spectrometry. The results obtained show a good precision of the method used because the variability was less than 1.02% in area and 0.49% in retention time for short term precisión and longer term precision . The quantification of these species was successful after performing the calibration curve with the dynamic mixer showing an r2 higher than 0.9945 and excellent linearity. The lowest LOD value was 0.01 mg kg-1 for carbonyl sulphide, hydrogen sulfide, ethylmercaptan and propylmercaptan and the lowest LOQ was 0.03 mg kg-1 for hydrogen sulfide. The highest LOD and LOQ values were for oxygen and carbon dioxide with 0.40 and 0.93 mg kg-1 respectively. With this configuration, the correlation of data between the three detectors was simplified, having almost identical retention times for the analytes studied. The poisons detected and quantified in the samples were: hydrogen sulfide (0.1-0.5 mg kg-1), carbonyl sulphide (0.012-0.06 mg kg-1), carbon disulphide (0.04-0.22 mg kg-1), methylmercaptan (0.12-12.51 mg kg-1), ethylmercaptan (0.9-5.5 mg kg-1), carbon dioxide (0.10-3.0 mg kg-1), oxygen (0.55-6.1 mg kg-1), acetylene (0.15-3.5 mg kg-1) and methylacetylene (0.04-0.2 mg kg-1). The productivity losses were between 5 and 22%.

Bleeding from gallbladder varices in a patient with an unknown liver cirrhosis. An exceptional entity.

Liver cirrhosis is a disease related to numerous severe complications such as portal hypertension or collateral circulation. Varices that are located outside the gastroesophageal region (ectopic varices) such as the anorectal region, colon, ileum or gallbladder are unusual. In many cases, they are related to the existence of portal vein thrombosis. We report the case of a patient with a severe hemorrhage of gallbladder varices due to alcohol-related cirrhosis.

Remaining straw and release of nutrients from oat managed in integrated crop-livestock / Palhada remanescente e liberação de nutrientes da aveia preta manejada em sistema de integração lavoura-pecuária

This study aimed to evaluate the decomposition and nutrient release from residues of the culture of oats and fallow in crop-livestock integration system. The experimental design was a randomized complete block design with two replications, as parcels being formed by four managements (fallow, oats without grazing, oats grazed once and twice), and the subplots for evaluation periods along the soybean crop in succession (0, 10, 20, 30, 50, 100 and 120 days after sowing). The residual amounts of dry matter and the contents of Carbon (C), Nitrogen (N), Phosphorus (P) and Potassium (K) were determined. Oats without grazing and fallow with natural reappearance of turnip + ryegrass were the treatments that presented the highest amount of dry matter remaining, reaching 5,219 and 6,781 kg ha-1, respectively. The amount of nutrients, N, P and K released from the residues, were similar independent from the management adopted, with exponential reduction proportional to the reduction of the remaining dry matter. K was the nutrient released faster from the residues and should be considered at the time of fertilization calculation of the culture to be implanted. The integrated crop-livestock system in which takes place one and two grazing oats, even reducing soil cover, enables high nutrient cycling.

O objetivo do trabalho foi avaliar a decomposição e liberação de nutrientes dos resíduos da cultura da aveia preta e do pousio conduzidos em sistema de integração lavoura-pecuária. O delineamento experimental utilizado foi o de blocos casualizados, em esquema de parcelas subdivididas, com duas repetições, sendo as parcelas constituídas por quatro manejos (pousio, aveia sem pastejo, aveia pastejada uma e duas vezes) e as subparcelas, pelas épocas de avaliação ao longo do cultivo da soja em sucessão (0, 10, 20, 30, 50, 100 e 120 dias após a semeadura). Foram determinadas as quantidades residuais de matéria seca e os teores de Carbono (C), Nitrogênio (N), Fósforo (P) e Potássio (K). A aveia sem pastejo e o pousio com ressemeadura natural de aveia + azevém, foram os manejos que apresentaram as maiores quantidades de matéria seca remanescentes, chegando a 5.219 e 6.781 kg ha-1, respectivamente. A quantidade dos nutrientes, N, P e K liberados dos resíduos, foram semelhantes independente do manejo adotado, com redução exponencial e proporcional à redução da matéria seca remanescente. O K foi o nutriente liberado mais rapidamente dos resíduos e deve ser considerado no momento do cálculo de adubação da cultura a ser implantada. O sistema de integração lavoura-pecuária no qual se realiza um e dois pastejos da aveia, mesmo reduzindo a cobertura do solo, possibilita elevada ciclagem de nutrientes.

Characterization and evaluation of liver fibrosis grade in patients with chronic hepatitis B virus infection and normal transaminases.

Backgrounds/Aims: The objective of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis. METHODS: A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ≥7.9 kPa. RESULTS: A total of 214 patients were included in the analysis, and 62% of them had a BMI ≥25 kg/m2 . During follow-up, 4% of patients showed transaminase elevation (<1.5 times normal). Most patients had a viral DNA level <2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P<0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ≥25 kg/m2 versus 56% of patients without SF (P<0.05). CONCLUSION: In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients.

Clinical and functional results in patients with cervical spondylotic myelopathy treated surgically by anterior approach in a tertiary health care center / Resultados clínicos e funcionais em pacientes com mielopatia espondilótica tratados cirurgicamente através de uma abordagem anterior em um centro de referência para cuidados / Resultados clínicos y funcionales en pacientes con mielopatía espondilótica cervical tratados quirúrgicamente mediante abordaje anterior en un centro de tercer nivel de atención

ABSTRACT Objective: To evaluate the clinical and functional results in patients with cervical spondylotic myelopathy treated surgically by anterior approach in a reference center. Methods: An observational, longitudinal, analytical study was carried out. The patients were evaluated using the JOA, Nurick and SF12v2 scales at hospital admission, at 3 and 6 months after surgery, analyzing the data with the Student's T test in the IBM SPSS Statistics version 24. Results: The male sex predominated, the mean age was 61 years; the mean JOA score before surgery, at 3 and 6 months was 8, 10.9, and 11.6, respectively. The Nurick scale obtained a presurgical score, at 3 and 6 months of 2.8, 2.2, and 1.9, respectively. Regarding the quality of life (PCS), 93.3% of the patients were found to be below the mean, 2.2% in the mean, and 4.5% above the mean, while at 6 months, 91.1% of the patients were below the mean, 6.7% in the mean, and 2.2% above the mean. In the preoperative evaluation the SF 12v2 scale, 68.9% of the patients were below the mean, 2.2% in the mean, and 28.9% above the mean, being that at 6 months, 31.1% of the patients were below the mean, 15.6% in the mean, and 53.3% above the mean. A statistically significant improvement was observed with the JOA and Nurick scales from preoperative to 3 and 6 months (p<0.05) with a statistically significant difference in the mental component of quality in the same periods. Conclusions: Anterior approach decompression gives a significant clinical improvement at 3 and 6 months. However, this improvement does not correlate with the patient's perception of his or her health condition. Level of Evidence III; Case control study.

RESUMO Objetivo: Avaliar os resultados funcionais clínicos em pacientes com compressão da medula espinhal (CME) tratados cirurgicamente pela abordagem anterior, em um centro de referência. Métodos: Foi realizado um estudo observacional, longitudinal e analítico. Os pacientes foram avaliados na admissão hospitalar através das escalas JOA, Nurick e SF12v2, aos três e seis meses após a cirurgia, analisando os dados com o teste t de Student, no programa IBM SPSS Statistics versão 24. Resultados: O estudo mostrou uma predominância no sexo masculino, com idade média de 61 anos. Avaliação do JOA pré-cirúrgica teve uma pontuação média, no terceiro e no sexto mês, de 8, 10,9 e 11,6. Por sua vez, a escala de Nurick, obtida em um pré-operatório, foi nos mesmos meses, com pontuação de 2.8, 2.2 e 1.9. Tal como para a qualidade de vida (PCS), que foi encontrado na avaliação pré-operatória, 93,3% dos pacientes estavam abaixo da média, 2,2%,na média e 4,5% superior à média. Enquanto aos 6 meses, 91,1% dos pacientes estavam abaixo da média, 6,7%, na média e 2,2% superior à média. Na avaliação pré-operatória de escala 12v2 SF, 68,9% dos pacientes estavam abaixo da média, 2,2% na média e 28,9% superior à média, sendo que aos 6 meses, 31,1% dos pacientes estavam abaixo da média, 15,6%, na média e 53,3% superior à média. Uma melhoria estatisticamente significativa com as escalas JOA e Nurick de pré-operatória em 3 e 6 meses (p <0,05) foi observada e, também, uma melhoria estatisticamente significativa na qualidade do componente mental nos mesmos períodos. Conclusões: Pode-se concluir que a abordagem da descompressão anterior proporciona uma melhoria clínica significativa, mas esta melhoria não está correlacionada com a percepção do paciente sobre sua saúde. Nível de Evidencia II;Estudo de caso.

RESUMEN Objetivo: Valorar los resultados clínicos y funcionales en pacientes con mielopatía espondilótica cervical tratados quirúrgicamente mediante abordaje anterior en un centro de referencia. Métodos: Se realizó un estudio observacional, longitudinal y analítico. Los pacientes fueron evaluados mediante las escalas JOA, Nurick y SF12v2 a su ingreso hospitalario, a los 3, y 6 meses de la cirugía, analizando los datos con prueba T de Student en el programa IBM SPSS Statistics versión 24. Resultados: Predominó el sexo masculino, el promedio de edad fue 61 años; la valoración de JOA media antes de la cirugía, a los 3 y 6 meses fue de 8, 10,9 y 11,6, respectivamente. La escala de Nurick obtuvo una puntuación prequirúrgica, a los 3 y 6 meses de 2,8, 2,2 y 1,9 respectivamente. En cuanto a la calidad de vida (PCS), se encontró en la evaluación prequirúrgica que el 93,3% de los pacientes estaba por debajo de la media, 2,2% en la media y el 4,5% por arriba de la media, mientras que a los 6 meses, el 91,1% de los pacientes estaba por debajo de la media, el 6,7% en la media y el 2,2% por arriba de la media. En la evaluación prequirúrgica la puntuación de la escala SF 12v2, el 68,9% de los pacientes estaba por debajo de la media, 2,2% en la media y el 28,9% por arriba de la media, siendo que a los 6 meses, el 31,1% de los pacientes estaba por debajo de la media, el 15,6% en la media y el 53,3% por arriba de la media. Se observó una mejoría estadísticamente significativa con las escalas de JOA y Nurick desde el prequirúrgico hasta los 3 y 6 meses (p < 0,05) con una diferencia estadísticamente significativa en el componente mental de la calidad en los mismos periodos. Conclusiones: La descompresión por vía anterior otorga una mejoría clínica significativa a los 3 y 6 meses; sin embargo esta mejoría no se correlaciona con la percepción que tiene el paciente sobre su estado de salud. Nivel de evidencia III; Estudio de caso control.

Iron deficiency in chronic kidney disease patients with diabetes mellitus.

BACKGROUNDS: Iron deficiency has been studied extensively in patients with chronic kidney disease on hemodialysis therapy. However, few studies looked at iron treatment in the non-dialysis chronic kidney disease population. METHODS: Five hundred and eighty patients were studied (247 were diabetic persons). Patients were divided into 4 groups: non-diabetic subjects without CKD, non-diabetic ones with GFR < 60 mL/min, diabetic persons without CKD and diabetic ones with GFR < 60 mL/min). Iron deficiency was diagnosed when serum ferritin level was <100 mg/dl. It was defined as diminished iron availability when ferritin was above 100 mg/dl and serum transferrin saturation (TSAT) was <20%. RESULTS: Anemia was more frequent in the diabetic CKD patients group (52.4%, p < 0.001). Anemia prevalence was also higher in all CKD patients as well as in diabetic patients compared with non-diabetic ones. Iron deficiency was more frequent in diabetic patients. Among CKD diabetic patients the prevalence of iron deficiency was higher than in non-diabetic CKD ones. Diminished iron availability prevalence was higher in non-diabetic patients. Logistic regression analysis showed that only sex and diabetes mellitus were independently associated with iron deficiency. CONCLUSIONS: Anemia was more common in diabetic CKD patients. Diabetes mellitus was independently associated with iron deficiency. Surprisingly, diminished iron availability was not more frequent in diabetic patients. The physio-pathological mechanisms that could explain these findings remain to be elucidated.