Standardizing health outcomes for chronic kidney disease. Adaptation of the international consortium for health outcomes measurement standard set to the Spanish setting.

BACKGROUND AND OBJECTIVES: We aim to adapt the International Consortium for Health Outcomes Measurements standard set for chronic kidney disease (CKD) patients to the Spanish setting and supplement it with those variables agreed upon through initiatives proposed by the Spanish Society of Nephrologists (S.E.N.). MATERIAL AND METHODS: The working group defined a first standard set of variables based on a literature review. The S.E.N. members then assessed the suitability of each variable for inclusion (Consensus≥75%). A second draft of the standard set was generated and evaluated by the Patient advocacy group Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón (ALCER). Lastly, the working group established the final standard set of variables (Consensus≥75%). RESULTS: The standard set targets patients with very high-risk CKD (G3a/A3 and G3b/A2-G5) in pre-end-stage kidney disease (pre-ESKD), hemodialysis (HD), peritoneal dialysis (PD), kidney transplantation (KT) or conservative care (CC). The essential follow-up variables agreed for all patients (All) were patient survival, hospitalizations, cardiovascular events, smoking status, health-related quality of life, pain, fatigue, physical function, daily activities, depression, renal function and hemoglobin. Additionally, it was agreed to collect PD survival (in PD patients), peritonitis (PD), infection/bacteremia (PD, HD, KT), vascular access type (HD), vascular access survival (HD), acute rejection (KT), post-transplant cancer (KT), albuminuria (KT) and kidney allograft survival (KT). The optional variables agreed were phosphorus (All), potassium (All), diabetes control (All with diabetes), and albuminuria (pre-ESKD). CONCLUSIONS: This standard set may constitute a highly efficient tool allowing the evaluation of patient outcomes and helping to define strategies to enhance CKD patients' quality of care in the Spanish healthcare system.

Beneficios de la terapia asistida por caballos en las variables de la marcha en personas mayores de 18 años, con deficiencias motoras secundarias, ante un accidente cerebrovascular o esclerosis múltiple / Benefits of Equine-Assisted Therapy on the Gait Variables in People Older Than 18 Years with Motor Impairments Secondary to Stroke or Multiple Sclerosis / Benefícios da terapia assistida por cavalo nas variáveis de marcha em pessoas maiores de 18 anos com alterações motoras secundárias a acidente vascular cerebral ou esclerose múltipla

Resumen El propósito de este artículo es analizar los resultados obtenidos sobre los beneficios de la terapia asistida por caballos, en variables de la marcha (equilibrio, coordinación y control postural), en personas mayores de 18 años con deficiencias corporales o fisiológicas, transitorias o permanentes, secundarias, ante un accidente cerebrovascular (isquémico o hemorrágico) o EM (recaída-remisión o secundaria progresiva), luego de haber participado en entrenamientos de dicha terapia. La metodología utilizada fue una revisión narrativa de la literatura existente, con método de búsqueda sistemático, en las siguientes bases de datos: PubMed, SciELO, LILACS y Scopus, con el fin de realizar una actualización bibliográfica del tema. Finalmente, se seleccionaron 11 artículos (revisiones sistemáticas, ECA, estudio control) para su posterior análisis. Los resultados de estos artículos coinciden en que el uso de la terapia asistida por caballos pudiera ser efectiva en la mejora de las variables ya mencionadas. No obstante, la información existente en las distintas plataformas de búsqueda es escasa, por lo que surge la necesidad de llevar a cabo estudios con un tamaño de muestra representativo, en los que se utilicen las mismas escalas de evaluación, con el propósito de poder objetivar y homologar los resultados. A modo de conclusión, se establece que hoy existen estudios, originados en diferentes partes del mundo, los cuales indican que la terapia asistida por caballos podría ser una herramienta efectiva en la rehabilitación de los distintos componentes que afectan la marcha, como el equilibrio o la coordinación, en personas con deficiencias motoras secundarias, ante un ACV (isquémico o hemorrágico) o EM (recaída-remisión o secundaria progresiva). En consecuencia, se podría considerar la utilización de la terapia asistida por caballos como una herramienta terapéutica, en el proceso de rehabilitación de la marcha en personas mayores de 18 años con daño neurológico.

Abstract We analyzed the results obtained from the benefits of equine-assisted therapy in gait variables (balance, coordination and postural control) on people over eighteen years old with transitory or permanent physical and/or physiological deficiencies secondary to stroke (ischemic or hemorrhagic) or multiple sclerosis (relapseremission and/or secondary progressive) after their participation in the therapy. The methodology used was a narrative review of the existing up-to-date literature with a systematic research method on the following databases: PubMed, SciELO, LILACS, and Scopus in order to make a bibliographical update about the topic. At last, eleven articles were selected for further analysis (systematic reviews, Randomized Clinical Trial, a case-control study). The results of these articles agree that the use of equine-assisted therapy can be effective in improving the variables mentioned above. However, there is not enough information available on different search engines, so there is a need to conduct studies with a representative sample size where they have to use the same evaluation scales in order to be able to objectify and standardize the results. Conclusion: nowadays around the world there are different studies, which indicate that equine-assisted therapy can be an effective tool in the rehabilitation of the different components that affect gait, such as balance or coordination, in people with motor impairments secondary to stroke (ischemic or hemorrhagic) or Multiple Sclerosis (relapseremission and/or secondary progressive). Therefore, we could consider the use of equine-assisted therapy as a therapeutic tool in the rehabilitation process of gait in people over eighteen years old with neurological damage.

Resumo O objetivo deste artigo é analisar os resultados obtidos sobre os benefícios da terapia assistida por cavalo nas variáveis de marcha (equilíbrio, coordenação e controle postural) em pessoas maiores de 18 anos com deficiências fisiológicas e/ou corporais transitórias ou permanentes, secundárias a um Acidente Cerebrovascular (isquêmico e/ou hemorrágico) ou EM (recidiva-remissão e/ou secundário progressivo), após terem participado do treinamento dessa terapia. A Metodologia utilizada foi uma revisão narrativa da literatura existente atualizada com método de busca sistemática, nas seguintes bases de dados: PubMed, SciELO, LILACS e Scopus a fim de atualizar a bibliografia sobre o assunto. Onze artigos (revisões sistemáticas, ECRs, estudo de controle) foram finalmente selecionados para análise posterior. Os resultados desses artigos concordam que o uso da terapia assistida por cavalo pode ser eficaz para melhorar as variáveis já mencionadas. No entanto, a informação existente nas diferentes plataformas de pesquisa é escassa, pelo que existe a necessidade de realizar estudos com um tamanho amostral representativo, em que sejam utilizadas as mesmas escalas de avaliação, a fim de se poder objetivar e padronizar os resultados. Conclusão: Atualmente existem estudos realizados em diferentes partes do mundo que indicam que a terapia assistida por cavalo pode ser uma ferramenta eficaz na reabilitação dos diferentes componentes que afetam a marcha, como o equilíbrio ou a coordenação, em pessoas com alterações motoras secundárias a um AVC (isquêmico e/ou hemorrágico) ou EM (recaída-remissão e/ou secundário progressivo). Consequentemente, o uso da terapia assistida por cavalo pode ser considerado como uma ferramenta terapêutica no processo de reabilitação da marcha em pessoas maiores de 18 anos com lesão neurológica.

An ortho-carbonyl substituted hydroquinone derivative is an anticancer agent that acts by inhibiting mitochondrial bioenergetics and by inducing G2/M-phase arrest in mammary adenocarcinoma TA3.

Tumor cells present a known metabolic reprogramming, which makes them more susceptible for a selective cellular death by modifying its mitochondrial bioenergetics. Anticancer action of the antioxidant 9,10-dihydroxy-4,4-dimethyl-5,8-dihydroanthracen-1(4H)-one (HQ) on mouse mammary adenocarcinoma TA3, and its multiresistant variant TA3-MTXR, were evaluated. HQ decreased the viability of both tumor cells, affecting slightly mammary epithelial cells. This hydroquinone blocked the electron flow through the NADH dehydrogenase (Complex I), leading to ADP-stimulated oxygen consumption inhibition, transmembrane potential dissipation and cellular ATP level decrease, without increasing ROS production. Duroquinol, an electron donor at CoQ level, reversed the decrease of cell viability induced by HQ. Additionally, HQ selectively induced G2/M-phase arrest. Taken together, our results suggest that the bioenergetic dysfunction provoked by HQ is implicated in its anticancer action.

Effect of a quality improvement strategy on several haemodialysis outcomes.

BACKGROUND: Intermediate outcomes are associated with the survival of long-term haemodialysis patients; however, outcome variability across centres may result in heterogeneous quality of care. The study aim was to evaluate a multifaceted quality improvement activity (QIA) targeting several haemodialysis clinical performance measures. METHODS: A total (prevalent and incident) of 313 patients from four dialysis units were included. The QIA was based on a multifaceted strategy involving collection of haemodialysis clinical performance measures every 6-8 months, feedback about results, improvement plans and benchmarking, and it was tested in a 3-year prospective interventional study. Two timepoints of clinical performance measures were considered for evaluating the QIA: baseline (February 2003, pre-QIA) and final (February 2006, post-QIA). RESULTS: Centres showed significant improvement in percentage of patients with haemoglobin <11 g/dl, mean haemoglobin; percentage of patients with Kt/v <1.2, mean Kt/v; percentage of patients with phosphorous >5.5 mg/dl, mean phosphorous; percentage of patients with calcium phosphate product >55, mean calcium phosphate product; and percentage of patients with ferritin <200 ng/ml, mean ferritin. No change was observed in percentage of patients with haemoglobin between 11 and 13 g/dl, erythropoietin consumed; percentage of patients with ferritin <100 ng/ml; percentage of patients with ferritin >800 ng/ml; percentage of patients with albumin <3.5 g/dl, mean albumin; or percentage of native arteriovenous fistula. The percentage of patients with haemoglobin >13 g/dl was increased. CONCLUSIONS: Quality-improvement strategies can help improve haemodialysis performance for anaemia, dialysis dose and bone metabolism. The importance of assessing patients with high haemoglobin level should be stressed.

Caracteristicas clinicas de recien nacidos internados mielomeningocele en el Hospital del Niño Dr. Ovidio Lara Uria. 1993-2002 / Clinic characteristic of myelomeningocele in newborns admited to the Hospital del niño

Objetivos: determinar las características clínicas de los recién nacidos (RN) con mielomeningocele (MMC) en el Hospital del Niño Dr. Ovidio Aliaga Uría. Diseño: estudio retrospectivo y descriptivo (serie de casos). Lugar: Hospital pediátrico institucional de tercer nivel. Pacientes: 55 RN hospitalizados por MMC en la sala de eonatología del Hospital del Niño, entre enero del 1993 y diciembre del 2002. Método de muestreo: consecutivo no robabilístico. Mediciones de los resultados principales: los casos clínicos se ubicaron revisando los archivos de alta, con el nombre o número de historia clínica se encontraron las fichas en el servicio de estadística. En un formulario preestablecido se registraron las variables y para el análisis se emplearon estadísticas descriptivas. Resultados: los RN con MMC representaron 2.1porciento de los ingresos neonatales. 73 porciento provinieron del área urbana. La mediana de edad materna fue 25 años y fueron multíparas 73 porciento de ellas. 55 porciento realizó control prenatal. 45 porcieno nacieron en sus domicilios. 75 porciento de los pacientes fueron derivados de un centro asistencial. 33 porciento de los RN ingresaron con menos de 24 horas de vida. 71 porciento tuvieron el MMC roto a su ingreso. Los MMC se ubicaron en la región lumbar en 47.28 porciento y en la región lumbosacro en 38.18 porciento; de los casos. 71 porciento de los RN con MMC desarrollaron hidrocefalia. Fallecieron 27 porciento durante el período neonatal. Solo el 12.5 porciento concurrió a controles por neurólogo o pediatra Conclusiones: el diagnostico prenatal del defecto fue ocasional. La derivación al hospital de los RN con MMC fue tardía. La mayoría de los MMC estuvieron ubicados en la región lumbar y lumbosacro, muchos pacientes ingresaron con el MMC roto y un alto porcentaje desarrollaron hidrocefalia. La mortalidad fue mayor a la reportada en la literatura y un mínimo porcentaje realizó controles posteriores al alta