Strength of association of classical vascular risk factors in young patients with ischaemic stroke: a case-control study.

INTRODUCTION: Recent studies have reported an increasing incidence of ischaemic stroke among young adults. However, the strength of the association between traditional vascular risk factors has not been fully established. METHODS: We compared 120 patients with a first ischaemic stroke before the age of 55 years admitted to the stroke unit of our centre with 600 healthy non-stroke controls from a population-based cohort study (HERMEX), matched for sex. Risk factors assessed included: hypertension, obesity, auricular fibrillation, current smoking, estimated glomerular filtration rate (eGFR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, high-density lipoprotein cholesterol (HDL-C) and diabetes mellitus. We used logistic regression analysis and calculated population attributable risk. We performed an overall analysis, by sex and aetiological subgroup. RESULTS: Using logistic regression analysis, we found that overall, the significant risk factors were: hypertension (OR: 1.58; 95%CI: 1.01-2.50), atrial fibrillation (OR: 4.77; 95%CI: 1.20-19.00), low eGFR (OR: 4.74; 95%CI: 1.3-21.94) and low HDL-C (OR: 5.20; 95%CI: 3.29-8.21), as well as smoking for males (OR: 1.86; 95%CI: 1.14-3.03). LDL-C showed an inverse association with stroke. The population attributable risk for HDL-C was 37.8% and for hypertension 21.1%. In terms of aetiological subgroups, only low HDL-C was associated with stroke of undetermined aetiology. CONCLUSIONS: Hypertension, auricular fibrillation, low eGFR, and low HDL-C, plus tobacco use in men, are the main risk factors among patients under 55 years of age with a first ischaemic stroke. We believe that it would be of particular interest to further explore the management of low HDL-C levels as part of preventive strategies in young stroke patients.

Methodology for assessing the individual role of fish, oyster, phytoplankton and macroalgae in the ecology of integrated production in earthen ponds.

Production costs in extensive and semi-intensive fish culture in earthen ponds are often too high to offer sustainable economic activity due to the low productivity of these systems. The right combination of commercial finfish species with inorganic (primary producers) and organic extractive (bivalves) species in Integrated MultiTrophic Aquaculture (IMTA) create a balanced system with higher profitability and risk reduction. To achieve this, it is crucial to understand the role of each functional groups within the system what we did by comparing three different IMTA production three different IMTA production treatments with distinct combinations of trophic levels: •fish, filter feeders, phytoplankton and macroalgae,•fish, filter feeders and phytoplankton•fish, phytoplankton and macroalgae Each treatment was carried out in two similar ponds under semi-intensive conditions and flow through system, in a total of 6 earthen ponds of 500 m2 surface and depth of 1.5 m. Results showed that the presence of oysters in the ponds enhanced water quality by decreasing turbidity and by controlling phytoplankton which led to regulation of dissolved oxygen levels. The enhanced water quality in these systems lead to improved fish performance and higher biomass production contributing to greater profitability. The combination of fish, oyster, phytoplankton and macroalgae was particularly good providing much more fish supply compared with the other two treatments. •Oysters enhanced water quality in the ponds by decreasing turbidity and controlling phytoplankton which regulated the dissolved oxygen levels.•The enhanced water quality in systems with oysters improve fish performance resulting in higher biomass production and greater profitability.•The combination of fish, oyster, phytoplankton and macroalgae was particularly good providing much more fish supply compared with the other two treatments.

La carga económica de las condiciones cardíacas en venezuela / The economic burden of heart conditions in venezuela

En Venezuela, las condiciones cardíacas imponen limitaciones físicas, sociales, financieras y de salud relacionadas con la calidad de vida de los individuos. Objetivos: Este estudio valoró la carga económica de cuatro condiciones cardíacas en Venezuela: hipertensión, insuficiencia cardíaca, infarto de miocardio y fibrilación auricular. Adicionalmente se evaluó el costo-efectividad de la telemedicina y el soporte telefónico estructurado para el manejo de la insuficiencia cardíaca.Métodos: Se utilizó un marco de costo de enfermedad estándar para valorar los costos asociados con las cuatro condiciones en 2015. El análisis evaluó la prevalencia e (en caso de infarto de miocardio) incidencia de las condiciones, los gastos asociados con el tratamiento médico, las pérdidas de productividad por reducción en el empleo, los costos de proveer cuidado formal e informal y la pérdida de bienestar. El análisis estuvo basado en información recolectada mediante una revisión de literatura y estadísticas, y modulación de datos. Todas las entradas de datos y métodos fueron validados mediante la consulta de quince clínicos y expertos en Venezuela. El análisis de costo-efectividad fue basado en un meta-análisis y en una evaluación económica de programas para pacientes con insuficiencia cardíaca dados de alta, valorado desde la perspectiva del Programa Nacional de Salud. Resultados: El infarto de miocardioimpone el mayor costo financiero (3,5 millones de bolívares/553 millones de USD), seguido por hipertensión arterial (3,4 millones de bolívares/539 millones de USD), la insuficiencia cardíaca (3,3 millones debolívares/522 millones de USD) y, finalmente, fibrilación auricular (0,4 miles de millones de bolívares/66 millones de USD). La telemedicina y el soporte telefónico estructurado son intervenciones costo-efectivas para alcanzar mejoras en el manejo de la insuficiencia cardíaca. Conclusiones: Las condiciones cardíacas imponen una pérdida sustancial de bienestar y de costos financieros en Venezuela y deberían ser una prioridad de salud pública

Heart conditions impose physical, social, financial and health related quality of life limitations on individuals in Venezuela. Objectives: This study assessed the economic burden of four main heart conditions in Venezuela: hypertension, heart failure, myocardial infarction, and atrial fibrillation. In addition, the cost-effectiveness of telemedicine and structured telephone support for the management of heart failure was assessed. Methods: A standard cost of illness framework was used to assess the costs associated with the four conditions in 2015. The analysis was informed by a targeted literature review, data scan and modeling. All inputs and methods were validated by consulting fifteen clinicians and other stakeholders in Venezuela. The cost-effectiveness analysis was based on a meta-analysis and economic evaluation of post-discharge programs in patients with heart failure, assessed from the perspective of the National Health Fund. Results: Myocardial infarction imposes the greatest financial cost (3.5 million bolivares/553 million USD), followed by hypertension (3.4 million bolivares/539 million USD), heart failure (3.3 million bolivares/522 million USD) and, finally, atrial fibrillation (0.4 billion bolivares/66 million USD).Telemedicine and structured telephone support are cost effective interventions for achieving improvements in the management of heart failure. The analysis assessed the prevalence and (in the case of myocardial infarction) incidence of the conditions, the associated expenditures on health care treatment, productivity losses from reduced employment, costs of providing formal and informal care, and lost wellbeing. Conclusions: Heart conditions impose substantial loss of wellbeing and financial costs in Venezuela and should be a public health priority(AU)

Fracaso renal agudo como presentación de pancreatitis aguda hemorrágica con amilasa normal / Acute renal failure secondary to haemorrahagic acute pancreatitis with normal serum amylase levels

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Hiperpotasemia en el medio hospitalario: un problema creciente / Hyperkalemia in hospitals. An increasing trouble

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Actualización clínica y fisiopatológica de la hiponatremia / Clinical and physiology update of hyponatremia

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[Acute obstructive renal failure secondary to retroperitoneal mass]. / Fracaso renal agudo obstructivo por masa retroperitoneal.

The acute renal failure is a grave pathology, of rapid establishment and relatively frequent in the hospital environment. We can describe three etiological groupS, which are responsible for it, amongst which are emphasized the pre-renal reasons. The obstructive pathology, of minor incidence, increases with the age. It is described the case of a 67-yr-old patient who was admitted in the Nephrology Service because of abrupt decline of the renal function. Among the initial symptoms, he presented arterial hypertension (190/90) and preserved diuresis. Blood analysis: urea 199 mg/dl, creatinine 7.7 mg/dl, without proteinuria. Sonography reported a bilateral ureteral hydronephrosis with simple cyst of possible ischemic origin. In view of the absence of previous biochemical data of renal failure, we considered possible reasons which start with an acute pattern. In initial evaluation, pre-renal etiology was not seen (high blood pressure, right cardiac systole function). The absence of prostatic syndrome and sonography discovery did not justify a diagnosis of urinary tract obstruction. Finally, abdominal-pelvic scan showed a periaortic retroperitoneal mass which included both ureters and appeared to trigger the obstruction. Combined efforts were pursued with the Urology Service, which implanted a bilateral "double J" catheter and later operated surgically on the patient, carrying out an alternating ureterolysis of both ureters. The biopsy manifested a retroperitoneal fibrosis, and the renogram showed a residual renal function of 20% in the right kidney and 80% in the left kidney. Due to the failure of the previous measures and as a last therapeutic recourse when one year had passed from the diagnosis, a continuous regimen with tamoxifen (anti-estrogen drug) in dose of 20 mg/dl each 12 hours was started, which began a progressive remission in the size of the observed mass by scan (CT) and magnetic resonance (MR). The treatment was completed during 12 months and in this time, the levels of blood urea nitrogen and creatinine were reduced gradually too. Finally, at the end of the treatment, the magnetic resonance demonstrate the complete disappearance of the fibrosis.

Hipertensión arterial maligna y fallo renal irreversible, asociado a toma de anticonceptivos orales

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Fracaso renal agudo obstructivo por masa retroperitoneal / Acute obstructive renal failure secondarty to retroperitoneal mass

El fracaso renal agudo es un proceso grave, de instauración rápida y relativamente frecuente en el medio hospitalario. Clásicamente se describen tres grupos etiológicos responsables del mismo, entre los cuales destacan las causas prerrenales. La patología obstructiva, de menor incidencia, aumenta con la edad. Se describe el caso de un paciente de 67 años que ingresa en el Servicio de Nefrología por un deterioro brusco de la función renal. Entre los síntomas iniciales, presenta hipertensión arterial (190/90) y diuresis conservada. La analítica pone de manifiesto una urea de 199 mg/dl, con creatinina de 7,7 mg/dl, sin proteinuria. La ecografía informa una hidronefrosis renoureteral bilateral con quistes simples de posible origen isquémico. Dada la ausencia de datos bioquímicos previos de insuficiencia renal, se consideran posibles causas desencadenantes del cuadro agudo. En la valoración inicial, la etiología prerrenal no tienen fundamento clínico (tensión arterial elevada, correcta función sistólica cardíaca por ecocardiografía), ni bioquímico. La ausencia de síndrome prostático y los hallazgos ecográficos tampoco justifican una obstrucción del tracto urinario. Por último, la tomografía abdomino-pélvica evidencia una masa retroperitoneal periaórtica que engloba ambos uréteres y parece desencadenante del cuadro obstructivo. Se inicia un seguimiento conjunto con el Servicio de Urología, que implanta unos catéteres «doble J» bilaterales y más adelante, interviene quirúrgicamente al paciente llevando a efecto una ureterolisis alterna de ambos uréteres. El material de biopsia informa de fibrosis retroperitoneal, y el renograma evalúa una función renal residual del 20% en riñón derecho y del 80% en el izquierdo. Ante el fracaso de las medidas quirúrgicas anteriores y como último recurso terapéutico, se ensaya al año del diagnóstico, una pauta continua con tamoxifeno (antiestrógeno) a dosis de 20 mg/dl cada 12 horas, que inicia una remisión progresiva en el tamaño de la masa, objetivada por tomografía (TAC) y resonancia magnética (RMN). La pauta se completa durante 12 meses y en este tiempo se reducen también de forma paulatina, los niveles de nitrógeno uréico y creatinina en sangre. Finalmente al término del tratamiento, la RMN evidencia la desaparición total de la fibrosis (AU)

The acute renal failure is a grave pathology, of rapid establishment and relatively frecuent in the hospital environment. We can describe three etiological group, which are responsible of himself, amongst which are emphasized the pre-renal reasons. The obstructive pathology, of minor incidence, increase with the age. It in described the case of a patient with 67 years old who is admitted in the Nephrology Service because of abrupt spoiling of the renal function. Between initials symptons, he presents arterial hipertension (190/90) and preserved diuresis. The analytics manifest: urea 199 mg/dl, creatinine 7.7 mg/dl, without proteinuria. Sonography reports a bilateral ureteral hydronephrosis with simple cyst of possible ischemia origin. In view of the absence of previus biochemicals data of renal failure, it is considered possibles reasons which start acute pattern. In initial evaluation, pre-renal etiology has not clinical basis (high blood pressure, right cardiac systole function). The absence of prostatic syndrome and sonography discovery, neither justify an urinary tract obstruction. Finally, abdominal-pelvic scan show a periaortic retroperitoneal mass which include both ureter and appear like outbreak ob obstruent patern. It is begun a combined pursuit with the Urology Service, which implant a bilateral «double J» catheter and later, operate on surgicaly the patient, carrying out an alternating ureterolysis of both ureter. The equipment of byopsy manifested a retroperitoneal fibrosis, and the renogram evaluate a residual renal function of 20% inside right kidney and 80% inside left kidney. Before the failure of the previous measuring and like last therapeutic recourse, it is tried when one year has passed from the diagnostic, a continuous guide with tamoxifen (anti-estrogen drug) in dose of 20 mg/dl each 12 hours, which begins a progressive remission in the size of the objectified mass by scan (CT) and magnetic resonance (MR). The guide is completed during 12 months and in this time, the levels of ureic nitrogen and creatinine in blood, are reduced gradually too. Finally, at the end of the treatment, the magnetic resonance demonstrate the complete disappearance of the fibrosis (AU)

Síndrome nefrótico por amiloidosis AL, asociado a gammapatía monoclonal IgM lambda / No disponible

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Respuesta al mofetil micofenolato en un caso de nefropatía lúpica resistente a ciclofosfamida IV y ciclosporina A / No disponible

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