Psychosocial and biological predictors of resident physician burnout.

BACKGROUND: A high proportion of health professionals in training suffer from work-related stress and may develop a burnout syndrome. OBJECTIVES: To study the incidence of burnout after the first year of residency in a teaching hospital and to identify baseline psychological, psychosocial work conditions, and biological risk factors. METHODOLOGY: We assessed the following in a prospective cohort of residents at baseline (first month residence) and after 1 year: background factors (socio-demographics, psychiatric history), perceived stress score (Perceived Stress Scale), Maslach Burnout Inventory score, and psychosocial factors (Job Content Questionnaire). Blood samples were obtained to study serum cortisol, IL-6, and TNF-α concentrations. The cumulative incidence was modelled by multivariate log-binomial regression analysis. RESULTS: We included 71 participants with a female majority (64.8%), age 26.4 (2.65) years, psychiatric history in 20%, and burnout in 13%. Among those without burnout initially (N = 59), it had developed by 1 year in 22% of residents. Increased job demand (RR = 1.259, 95%CI = 1.019-1.556, p = 0.033) and decreased cortisol levels (RR = 0.877, 95%CI = 0.778-0.989, p = 0.032) predicted burnout after 1 year of residency among medical trainees. CONCLUSION: Burnout syndrome develops in 22% of residents by 1 year of training and can be predicted by increased work demands and decreased cortisol levels.

Luto e enfrentamento em portadoras de esclerose múltipla: diálogo com a teoria de Kübler-Ross / Grief and coping in patients with multiple sclerosis: dialogue with Kübler-Ross

A Esclerose Múltipla (EM) é uma doença crônica e progressiva, que causa perdas motoras,sensoriais e psicológicas. Objetivo: Compreender o processo de luto e enfrentamento de pes-soas com esclerose múltipla, em diferentes períodos do diagnóstico, sob enfoque das propo-sições teóricas de Kübler-Ross sobre o processo de luto. Método: Foram realizadasentrevistas semiestruturadas e foi feita a aplicação das pranchas um e 11 do Teste de Aper-cepção Temática a três mulheres, uma delas estava em investigação diagnóstica para EM,uma tinha diagnóstico de EM há um ano e a terceira havia sido diagnosticada com EM há cin-co anos. Utilizou-se análise de conteúdo temática para organização dos dados e a teoria doluto de Kübler-Ross para analisá-los. Resultados: Diferenças na forma como cada participantelidava com a EM puderam ser observadas. As participantes com diferentes períodos de diag-nóstico/investigação vivenciavam fases distintas do processo de luto e utilizavam diferentestipos de estratégias de enfrentamento. Conclusões: O adoecimento conduz ao luto, que podeser uma forma para realizar o enfrentamento e ressignificar a vida na nova condição(AU)

A Mn(iii) single ion magnet with tridentate Schiff-base ligands.

Single ion magnet behaviour is reported for a mononuclear Mn(iii) ion with tridentate Schiff-base ligands which exhibits a tetragonal Jahn-Teller elongation along the Namine-Mn-Namine axis and crystallises with two crystallographically distinct Mn(iii) cations (unit A and unit B). While magnetic measurements show a large and negative axial zero-field splitting (D = -4.73 cm(-1)), HF-EPR reveal two distinct large axial Ds (D = -4.60 cm(-1) for unit A and D = -4.18 cm(-1) for unit B), thus resulting in the largest D known to date for a Mn(iii) single ion magnet. AC magnetic measurements at 2000 Oe allowed determination of the energy barrier for spin reversal (10.19 K) and spin reversal relaxation time (1.476 × 10(-6) s) for the Mn(iii) ion. Computational studies were used to characterise the electronic structure and substantiate the zero field splitting in the Mn(iii) complex.

Resistance exercise training does not affect plasma irisin levels of hemodialysis patients.

Irisin, a hormone secreted by myocytes induced in exercise, acts as a muscle-derived energy-expenditure signal that binds to undetermined receptors on the white adipose tissue surface, stimulating its browning and uncoupling protein 1 (UCP1) expression. The purpose of this study was to assess the effect of an intradialytic resistance exercise training program (RETP) on plasma irisin levels of hemodialysis (HD) patients and compare the baseline plasma irisin levels of HD patients to healthy subjects. This longitudinal study enrolled 26 patients undergoing HD (50% men, 44.8±14.1 years, body mass index (BMI) 23.5±3.9 kg/m²). The healthy subjects group consisted of 11 women and 7 men with mean age of 50.9±6.6 years and BMI, 24.2±2.7 kg/m². Anthropometric and biochemistry parameters (Irisin by Enzyme-Linked Immunosorbent Assay) were measured at the baseline and after 6 months of RETP (in both lower limbs). There was no difference regarding gender, age, and BMI between HD patients and healthy subjects. Plasma irisin levels in HD patients were lower than in healthy subjects (71.0±41.6 vs. 101.3±12.5 ng/ml, p<0.05). Although the muscle mass increased in consequence of exercise [evaluated by arm muscle area from 27.9 (24.1) to 33.1 (19.0) cm²], plasma irisin did not differ significantly after exercises (71.0±41.6 vs. 73.3±36.0 ng/ml). HD patients seem to have lower plasma irisin when compared to healthy subjects. Moreover, a resistance exercise training program was unable to augment plasma irisin despite increasing muscle mass.

ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making.

Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis at an earlier stage, the burden of disease and mortality is still high. Improvement of diagnostic and treatment options increased staging accuracy, functional outcome for early stages as well as survival. Although high quality surgery is still the mainstay of curative treatment, the management of CRC must be a multi-modal approach performed by an experienced multi-disciplinary expert team. Optimal choice of the individual treatment modality according to disease localization and extent, tumour biology and patient factors is able to maintain quality of life, enables long-term survival and even cure in selected patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations. This ESMO guideline is recommended to be used as the basis for treatment and management decisions.

Measurement of the proton-air cross section at √s=57 TeV with the Pierre Auger Observatory.

We report a measurement of the proton-air cross section for particle production at the center-of-mass energy per nucleon of 57 TeV. This is derived from the distribution of the depths of shower maxima observed with the Pierre Auger Observatory: systematic uncertainties are studied in detail. Analyzing the tail of the distribution of the shower maxima, a proton-air cross section of [505±22(stat)(-36)(+28)(syst)] mb is found.

C7 deficiency and meningococcal infection susceptibility in two spanish families.

In this work, we report the genetic basis of C7 deficiency in two different Spanish families. In family 1, by using exon-specific polymerase chain reaction and sequencing, a recently described mutation was found in homozygosity in the patient; a single base change in exon 15 (C2107T) leading to a stop codon that causes truncation of the C-terminal portion of C7 (Q681X). Patient's father, mother and sister were heterozygous for this mutation. Interestingly, patient's parents were not related. In family 2, a new single base mutation in exon 2 (G90A), leading to a stop codon that causes the premature truncation of C7 (W8X), was found in the patient, mother and sister 1. Additionally, patient 2, her father and sisters, displayed a missense mutation in exon 9 (G1135C) resulting in a change of aminoacid (G357R). Although sister 1 bore the same mutations in the C7 gene that patient 2, she remains asymptomatic. Because both mutations were found in the patient and her sister, we analyse other defence mechanisms such as FcgammaR polymorphisms as well as mannose-binding lectin alleles (MBL2 gene) and MBL levels. Results showed that both siblings bore identical combinations of FcgammaR allotypes and different MBL2 alleles, exhibiting patient 2 a MBL-insufficient genotype. Normal MBL levels were found in patient 1 and in two previously studied C7-deficient siblings, suggesting the involvement of other mechanisms of immunity distinct of FcgammaR variants and the MBL pathway, for the absence of meningococcal recurrent infections in certain C7-deficient individuals.

Measurement of the depth of maximum of extensive air showers above 10{18} eV.

We describe the measurement of the depth of maximum, X{max}, of the longitudinal development of air showers induced by cosmic rays. Almost 4000 events above 10;{18} eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106{-21}{+35}) g/cm{2}/decade below 10{18.24+/-0.05} eV, and (24+/-3) g/cm{2}/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm{2}. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.

Diagnóstico incidental de tumor vesical por ecografía ginecológica transvaginal / Incidental findings of bladder tumor by transvaginal ultrasonography

Se presenta el caso clínico de una mujer de 60 años que acude al Servicio de Ginecología y Obstetricia del Hospital Padre Hurtado, bajo la sospecha de un mioma cervical pequeño. Se realiza una ecografía transva-ginal la cual evidencia incidentalmente un tumor vesical sólido, vascularizado, intravesical y dependiente de la mucosa. La paciente no refería espontáneamente hematuria. El estudio urológico definitivo es de un carcinoma papilar de células transicionales. El tratamiento endoscópico logró la resección completa del tumor. El hallazgo ecográfico permitió realizar el diagnóstico en una forma poco habitual para esta enfermedad, aprovechando una instancia definida para otros fines. Se rescata la importancia de observar detenidamente todas las estructuras pélvicas al alcance visual del equipo de ecografía.

We present a clinical case of a 60 year-old patient, who concurs to the Obstetrics and Gynecology Department of the Padre Hurtado Hospital under the suspect of a uterine-cervical myoma. A transvaginal ultrasonography was performed which incidentally revealed a bladder tumor which was solid, vascularized, clearly inside of the bladder and attached to the bladder mucosa. The definitive urological study was compatible with a transitional cells papillary carcinoma. The woman did not refer hematuria spontaneously. The finding allowed an unusual diagnosis in an ultrasound aimed for different purposes, which underlines the potential use of this method in other pelvic organs.

Control de la presión arterial en Extremadura: resultados del estudio de control de factores de riesgo de Extremadura (estudio COFRE) / Blood pressure control in Extremadura. Results from a study on Risk Control Factors in Extremadura (COFRE Study)

Objetivo: Evaluar la prevalencia y el control de la hipertensión arterial (HTA) en una muestra de la población extremeña con otros factores de riesgo cardiovascular. Diseño y método: Se han recogido los factores de riesgo cardiovascular y su control en una muestra de 1.022 pacientes visitados consecutivamente en consulta que presentaban al menos un factor de riesgo cardiovascular. Se realizó analítica general a todos los pacientes y se registraron sus características antropométricas y el tratamiento que estaban realizando. La presión arterial (PA) se midió dos veces en consulta y se hizo la media de las dos mediciones. Resultados: De los 978 pacientes aceptados para el análisis estadístico, 719 (73,5%) habían sido diagnosticados previamente de HTA (236 varones y 311 mujeres con una media ± desviación estándar de edad de 65,9 ± 10,7 años. En las cifras recogidas en el estudio un 8,3% más presentaban PA sistólica (PAS) > 140 mmHg y un 3,37%, PA diastólica (PAD) > 90 mmHg. El 72,7% de estos pacientes presentaban PAD < 90 mmHg, el 40% tenía una PAS < 140 mmHg y solamente 264 (36,7%) sujetos tenían controlados ambos componentes de la PA. Para el objetivo de PA en diabéticos (n = 215) (< 130/80 mmHg) las cifras eran inferiores (PAD controlada, 33,3%; PAS controlada, 20,9%; control simultáneo de PAS y PAD, 15,9%). El 8,3% de la muestra de hipertensos no recibía tratamiento farmacológico y el 52,9% eran tratados con más de un fármaco antihipertensivo. El tratamiento combinado de la hipertensión arterial (más de un fármaco) era más frecuente en las mujeres (p <0,001). En cuanto al tipo de fármacos utilizado destaca el elevado uso de antagonistas de receptores de la angiotensina, que era mayor en mujeres al igual que los diuréticos. Conclusiones: La HTA es el factor de riesgo cardiovascular más prevalente en la muestra obtenida. El grado de control de la PAS es bajo, pero similar que en la mayor parte de los estudios publicados en España. La gravedad de la hipertensión arterial parece mayor en las mujeres(AU)

Objective: Our study aimed to assess the BP control in a sample of patients with othercardiovascular risk factors attended in primary care in Extremadura.Patients and method: The presence and control of cardiovascular risk factors wascollected in a sample of 1022 patients consecutively seen in the consultation offi ce whohad at least one cardiovascular risk factor. General analysis was done for all the patientsand their anthropometric characteristics and treatment done were recorded. The BP wasmeasured twice in the medical offi ce and the mean of the two measurements wasobtained.Results: A total of 978 patients were accepted for the statistical analysis, 719 (73.5% withprevious diagnosis of BPB (236 men and 311 women with mean age of 65.9 ± 10.7 years).A total of 8.3% more patients had have high blood pressure in offi ce control (SBP > 140mmHg) without known diagnosis of hypertension and 3.37% had DBP > 90 mmHg. Theremaining 72.7% of the patients had DBP<90 mmHg, 40% had SBP < 140 mmHg and only264 subjects were controlled with both components of the blood pressure (36.7%),Regarding the target BP in diabetics (n = 215) (< 130/80 mmHg), the values were lower(controlled DBP, 33.3%, controlled SBP, 20.9%; simultaneous control of SBP and DPB,15.9%). A total of 8.3% of the hypertensive sample were not receiving drug treatment and52.9% were treated with more than one antihypertensive drug. The combined treatmentof high blood pressure (more than one drug) is more frequent among women patients (p< 0.001). Regarding drug type used, the elevated use of angiotensive receptor antagoniststhat was greater in women as were the diuretics stands out.Conclusions: The results of the COFRE study indicate that hypertension was the mostcommon cardiovascular risk in the sample obtained. The optimal BP control grade waslow but similar to the results reported by other Spanish studies. High blood pressureseems to be more severe in women

Free D-amino acids determination in ready-to-eat cooked ham irradiated with electron-beam by indirect chiral HPLC.

Potential racemization of L-amino acids (AA) in ready-to-eat (RTE) cooked ham after hygienization by electron-beam irradiation between 1 and 8kGy was studied. An indirect chiral method based on the derivatization reaction of AA with o-phthaldialdehyde and N-acetyl-L-cysteine followed by reversed-phase HPLC and fluorimetric detection was applied to detect ten enantiomeric pairs of free AA (Asp, Ser, Thr, Ala, Tyr, Val, Trp, Phe and Leu). Five of the D-AA were not found in any of the samples analyzed; the other five remaining D-AA (D-Asp, D-Ser, D-Ala, D-Val and D-Leu) were detected both in irradiated and non-irradiated cooked ham samples, their content being in the range 1.25-13.79µg/g. Although significant differences appeared for a few of the samples and doses, no positive correlation between the D-AA content and the irradiation doses was observed. Therefore, the electron-beam irradiation technique could be useful for sanitation of packed RTE cooked ham at doses allowed by WHO and EU, since it remains chemically safe to eat.

Inovando el tema de glaucoma en la materia de oftalmología / Innovating the issue of glaucoma in the field of ophthalmology

El paso de un nivel educativo a otro nivel ha generado desde hace años,diferentes opiniones críticas que oscilan entre responzabilizar y desacreditar la eficiencia de uno de los niveles y por otro lado justificar los mecanismos de selección y exclusión de alumnos ingresantes al nivel superior. Siempre, con base en esas posiciones críticas se expresa como mensaje y demanda sociopolítica la necesidad de mojorar la calidad de la educación. La presente propuesta introduce un principio de coherencia nucleado alrededor de los tres ámbitos del aprendizaje-conceptual, procedimental, actitudinal- como elementos a los que todos los componentes del diseño curricular deben someterse. Ello permite vincular de manera lógica los propósitos, los contenidos, las metodologías y los instrumentos de evaluación, impidiendo que el maestro incurra en el habitual error de evaluar lo que no enseña. Debemos integrar la práctica hospitalaria con el conocimiento teórico adecuado en cada especialidad y esto sólo se puede conseguir con un desarrollo simultáneo de práctica y teoría, que permita demostrar las competencias, y conocimientos durante la práctica. El propósito de esta materia es que el estudiante conozca el concepto de glaucoma, haga su diagnóstico oportuno, y sepa iniciar el tratamiento o remitirlo en el momento más indicado, ya que consiste actualmente una de las cinco primeras causas de ceguera, y la primera causa prevenible de ceguera en el mundo.

Inovando el tema de glaucoma en la materia de oftalmología / Innovating the issue of glaucoma in the field of ophthalmology

El paso de un nivel educativo a otro nivel ha generado desde hace años,diferentes opiniones críticas que oscilan entre responzabilizar y desacreditar la eficiencia de uno de los niveles y por otro lado justificar los mecanismos de selección y exclusión de alumnos ingresantes al nivel superior. Siempre, con base en esas posiciones críticas se expresa como mensaje y demanda sociopolítica la necesidad de mojorar la calidad de la educación. La presente propuesta introduce un principio de coherencia nucleado alrededor de los tres ámbitos del aprendizaje-conceptual, procedimental, actitudinal- como elementos a los que todos los componentes del diseño curricular deben someterse. Ello permite vincular de manera lógica los propósitos, los contenidos, las metodologías y los instrumentos de evaluación, impidiendo que el maestro incurra en el habitual error de evaluar lo que no enseña. Debemos integrar la práctica hospitalaria con el conocimiento teórico adecuado en cada especialidad y esto sólo se puede conseguir con un desarrollo simultáneo de práctica y teoría, que permita demostrar las competencias, y conocimientos durante la práctica. El propósito de esta materia es que el estudiante conozca el concepto de glaucoma, haga su diagnóstico oportuno, y sepa iniciar el tratamiento o remitirlo en el momento más indicado, ya que consiste actualmente una de las cinco primeras causas de ceguera, y la primera causa prevenible de ceguera en el mundo.

Pielonefritis xantogranulomatosa: conceptos actuales en el diagnóstico y tratamiento / Xanthogranulomatous pyelonephritis: current concepts of diagnosis and treatment

Introducción: La Pielonefritis Xantogranulomatosa (PNF XG) es una patología de baja prevalencia, frecuentemente asociada a litiasis y destrucción del parénquima renal. Dada la gran masificación de la tomografía axial computada su diagnóstico y manejo es cada vez más precoz disminuyendo así la morbi-mortalidad perioperatoria. Objetivos: Describir la experiencia de nuestro servicio en PNF XG y realizar un análisis de la literatura sobre los conceptos actuales en el diagnóstico y tratamiento de esta patología. Materiales y métodos: Análisis retrospectivo de todas la nefrectomías totales realizadas en nuestro servicio entre los años 2000 y 2007. Se incluyeron sólo las piezas con el diagnóstico histológico de PNF XG. Resultados: Se encontraron 11 casos con el diagnóstico histológico de PNF XG. La edad promedio de presentación fue de 54 años con una leve tendencia al sexo femenino. En todos los pacientes se encontró una historia actual o reciente de litiasis urinaria. En todos los casos se realizó un estudio imagenológico preoperatorio, siendo 9 de ellos estudiados con TAC de abdomen y encontrándose la presencia de litiasis en 7 pacientes. Todos los pacientes fueron manejados mediante una nefrectomía total por lumbotomía, sin registrarse mortalidad. Conclusiones: La PNF XG constituye un desafío en sí misma. A pesar de ser una patología rara y de difícil diagnóstico, una cuidadosa evaluación preoperatoria y alto índice de sospecha, pueden ayudarnos a realizar un diagnóstico oportuno y realizar el manejo más adecuado, disminuyendo así las complicaciones perioperatorias.

Introduction: Xanthogranulomatous pyelonephritis (XG PNF) is a low prevalence disease, often associated with lithiasis and renal parenchymal destruction. The wide availability of tomographic (CT) diagnosis allows for frequent early management decreasing perioperative morbidity and mortality. We describe the experience at our institution in XG PNF and perform an analysis of the literature onthe current concepts in diagnosis and treatment of this condition. Materials and methods: Retrospective analysis of all nephrectomies performed at our department between 2000 and 2007. Only surgical specimens with histological diagnosis of XG PNF were included. Results: We found 11 cases with histologic diagnosis of XG PNF. Average age of presentation was 54 years with a slight tendency towards females. All patients had a current or recent history of urolithiasis. In all cases a preoperative imaging study was made, 9 of them were studied with abdominal CT scan and found the presence of stones in 7 patients. All patients were treated by an open total nephrectomy without mortality. Conclusions: The XG PNF is a challenge in itself. Despite being infrequent and difficult to diagnosis, a careful preoperative evaluation and a high index of suspicion can help to make an early diagnosis and management, thus reducing perioperative complications.

Observation of the suppression of the flux of cosmic rays above 4 x 10 (19) eV.

The energy spectrum of cosmic rays above 2.5 x 10;{18} eV, derived from 20,000 events recorded at the Pierre Auger Observatory, is described. The spectral index gamma of the particle flux, J proportional, variantE;{-gamma}, at energies between 4 x 10;{18} eV and 4 x 10;{19} eV is 2.69+/-0.02(stat)+/-0.06(syst), steepening to 4.2+/-0.4(stat)+/-0.06(syst) at higher energies. The hypothesis of a single power law is rejected with a significance greater than 6 standard deviations. The data are consistent with the prediction by Greisen and by Zatsepin and Kuz'min.

Upper limit on the diffuse flux of ultrahigh energy tau neutrinos from the Pierre Auger Observatory.

The surface detector array of the Pierre Auger Observatory is sensitive to Earth-skimming tau neutrinos that interact in Earth's crust. Tau leptons from nu(tau) charged-current interactions can emerge and decay in the atmosphere to produce a nearly horizontal shower with a significant electromagnetic component. The data collected between 1 January 2004 and 31 August 2007 are used to place an upper limit on the diffuse flux of nu(tau) at EeV energies. Assuming an E(nu)(-2) differential energy spectrum the limit set at 90% C.L. is E(nu)(2)dN(nu)(tau)/dE(nu)<1.3 x 10(-7) GeV cm(-2) s(-1) sr(-1) in the energy range 2 x 10(17) eV< E(nu)< 2 x 10(19) eV.

¿Es el Kt/V el mejor indicador de la dosis de diálisis? / No disponible

No disponible

Correlation of the highest-energy cosmic rays with nearby extragalactic objects.

Using data collected at the Pierre Auger Observatory during the past 3.7 years, we demonstrated a correlation between the arrival directions of cosmic rays with energy above 6 x 10(19) electron volts and the positions of active galactic nuclei (AGN) lying within approximately 75 megaparsecs. We rejected the hypothesis of an isotropic distribution of these cosmic rays with at least a 99% confidence level from a prescribed a priori test. The correlation we observed is compatible with the hypothesis that the highest-energy particles originate from nearby extragalactic sources whose flux has not been substantially reduced by interaction with the cosmic background radiation. AGN or objects having a similar spatial distribution are possible sources.

[Either calcium carbonate or sevelamer decreases urinary oxalate excretion in chronic renal failure patients]. / Carbonato cálcico o sevelamer reducen la excreción urinaria de oxalato en pacientes con insuficiencia renal avanzada.

The rate of oxalate absorbed from intestine is highly influenced by calcium intake in healthy subjects. It is unknown whether commonly used phosphate binders modify intestinal absorption and renal excretion of oxalate in chronic kidney disease (CKD) patients. This study aims to determine if calcium carbonate or sevelamer influences on urinary oxalate excretion. Twenty patients with CKD (stage 4 and 5 pre-dialysis) were included. Two treatment (1500 mg of calcium carbonate or 2400 mg of sevelamer), two-period (21 days each), crossover study with balanced assignment of the order of administration, and two washout periods were the main characteristics of this study design. Laboratory analyses in each phase included: serum creatinine, calcium, phosphorus, bicarbonate, total cholesterol, and 24 h urinary excretion of oxalate, creatinine, and urea. Creatinine clearance, protein catabolic rate (PNNA), total urinary oxalate excretion, and urinary oxalate / creatinine ratio were determined. Seventeen patients completed both treatment sequences. Total urinary oxalate excretion and urinary oxalate / creatinine ratios decreased significantly with respect to washout periods either after sevelamer or calcium carbonate treatment. The decrease in urinary oxalate excretion was greater after calcium carbonate (41.2+/-17.4%) than after sevelamer treatment (30.4+/-23.8%). There were not significant changes in renal function or PNNA values throughout the study periods. In conclusion, either calcium carbonate or sevelamer significantly reduces urinary oxalate excretion in CKD patients. Further studies will be needed to ascertain whether the type of phosphate binder influences on the accumulation of oxalate in CKD patients.

Papel de la cistatina C en la valoración de la función renal y su relación con el riesgo cardiovascular / Role of cystatin C in the assessment of renal function and its relationship with cardiovascular risk

Actualmente no hay consenso sobre la forma ideal de medir la función renal. Durante décadas se ha utilizado la creatinina plasmática como el principal método de medición de la función renal, pero es una medición grosera y con frecuentes resultados erróneos. Para salvar estos obstáculos se han introducido fórmulas para calcular el aclaramiento de creatinina (fórmula de Cockroft-Gault) o el filtrado glomerular (ecuación del estudio Modification of Diet in Renal Disease). Por otra parte, se ha propuesto la cistatina C como un buen marcador de la función renal. Desgraciadamente, y a pesar del entusiasmo despertado, la cistatina C sólo parece mejorar ligeramente el poder predictor de la creatinina. La necesidad de esta medición ha ganado en importancia tras comprobarse que incluso pacientes con leves reducciones de la función renal presentan una morbilidad y mortalidad cardiovasculares elevadas. En este sentido la cistatina C podría ser un marcador de importancia pronóstica de la aparición de acontecimientos cardiovasculares independientemente de la función renal

Currently there is no agreement on the ideal way to measure renal function. Plasma creatinine has been used for decades as the principal method of renal function measurement. However, it is a rude measurement with frequent erroneous results. To overcome these obstacles, formulas have been introduced to calculate creatinine clearance (Cockroft-Gault formula) or glomerular filtration rate (equation of the Modification of Diet in Renal Disease Study). On the other hand, cystatin C has been proposed as a good marker of renal function. Unfortunately, and in spite of the enthusiasm provoked, cystatin C only seems to slightly improve the predictive power of creatinine. The need for this measurement has gained importance after verifying that even patients with mild reductions in renal function have elevated cardiovascular morbidity and mortality. In this sense, cystatin C could be a marker of prognostic importance of the appearance of cardiovascular events independently of the renal function