How kidney clock works: circadian pattern of eGFR based on a population data group.

A circadian regulation of renal function it has been described in the last few years. An intradaily variation in glomerular filtration rate (eGFR) has also been discovered at the individual level. The aim of this study was to check if there exists a circadian pattern of eGFR at population data group level and to compare the population results with those described at individual level. We have studied a total of 446,441 samples analysed in the emergency laboratories of two Spanish hospitals between January 2015 and December 2019. We selected all the records of eGFR values between 60 and 140 mL/min/1.73 m2 using CKD-EPI formula from patients between 18 and 85 years. The intradaily intrinsic eGFR pattern was computed using the extraction time of day in four nested mixed linear and sinusoidal regression models. All models showed an intradaily eGFR pattern, but the estimated model coefficients differed depending on whether age was included. The inclusion of age improved the performance of the model. In this model, the acrophase occurred at 7:46 h. We describe the distribution of eGFR values depending on the time in two different populations. This distribution is adjusted to a circadian rhythm that behaves similarly to the individual rhythm. This pattern is similar in each of the years studied from each hospital as well as between both hospitals. The results found suggest the incorporation of the concept of "population circadian rhythm" into the scientific world.

Risk of Frailty According to the Values of the Ankle-Brachial Index in the Toledo Study for Healthy Aging.

BACKGROUND: Vascular function (VF) is a general term used to describe the regulation of blood flow, arterial pressure, capillary recruitment, filtration and central venous pressure, it´s well known that age has direct effects on the VF, and this may affect the frailty status. OBJECTIVES: To analyse the association between Frailty Trait Scale 5 (FTS 5) with VF and its changes at values below and above a nadir. DESIGN: Prospective population-based cohort study. SETTING AND PARTICIPANTS: Data from 1.230 patients were taken from the first wave (2006-2009) of the Toledo Study for Healthy Aging. MEASUREMENTS: Frailty was evaluated using FTS 5, which evaluates 5 items: Body mass index, progressive Romberg, physical activity, usual gait speed and hand grip strength. VF was assessed using the ankle-brachial index (ABI) as an indirect measure of VF. Screening for cardiovascular and cerebrovascular disease was also performed by self-reporting and by searching medical records, and was used as exclusion criteria. RESULTS: The optimal ABI cut-off point that maximized the adjusted R2 was 1.071. We observed a statistically significant association for FTS 5 score above and below the ABI cut-off points. For every tenth that the ABI decreased below the cut-off point the patient had an increase in the FTS 5 score of 0.47 points and in every tenth that increased above the cut-off point the increase in the FTS 5 score was 0.41 points. Of all FTS 5 items, the gait speed was the only item that showed a significant association with an ABI changes 0.28 and 0.21 points for every tenth below and above the cut-off point, respectively. CONCLUSIONS: Frailty is highly associated with VF. In addition, FTS 5 and its gait speed criteria are useful to detect VF impairments, via changes in ABI.

The Medium-Term Changes in Health-Related Behaviours among Spanish Older People Lifestyles during Covid-19 Lockdown.

OBJECTIVES: The aim was to evaluate general changes and investigate the association between diet quality, physical activity (PA), and sedentary time (ST) during COVID-19 lockdown and the subsequent 7-month changes in health-related behaviours and lifestyles in older people. PARTICIPANTS: 1092 participants (67-97y) from two Spanish cohorts were included. DESIGN: Telephone-based questionaries were used to evaluate health-related behaviours and lifestyle. Multinomial logistic regression analyses with diet quality, PA, and ST during lockdown as predictors for health-related behaviours changes post-lockdown were applied. RESULTS: Diet quality, PA, and ST significantly improved post-lockdown, while physical component score of the SF-12 worsened. Participants with a low diet quality during lockdown had higher worsening of post-lockdown ST and anxiety; whereas those with high diet quality showed less likelihood of remaining abstainers, worsening weight, and improving PA. Lower ST was associated with a higher likelihood of remaining abstainers, and worsening weight and improving social contact; nevertheless, higher ST was linked to improvement in sleep quality. Lower PA was more likely to decrease alcohol consumption, while higher PA showed the opposite. However, PA was more likely to be associated to remain abstainers. CONCLUSIONS: Despite improvements in lifestyle after lockdown, it had health consequences for older people. Particularly, lower ST during lockdown seemed to provide the most medium-term remarkable lifestyle improvements.

Impact of nutritional status according to GLIM criteria on the risk of incident frailty and mortality in community-dwelling older adults.

BACKGROUND & AIMS: Poor nutritional status leads to multiple adverse outcomes, but few studies have assessed its role as a risk factor for incident frailty and death in community-dwelling older adults. Hence, the aim of this paper is to assess the role of nutritional status using the Global Leadership Initiative on Malnutrition (GLIM) criteria in the risk of frailty and mortality in Spanish community-dwelling older adults. METHODS: We used data from two waves (waves 2 (2011-2013) and 3 (2015-2017)) from the Toledo Study of Healthy Ageing, which is an observational, prospective cohort (average follow-up = 3.18 years) of 1660 older (≥65 years) adults living in the community. Nutritional status categories were defined according to the GLIM criteria, which uses a two-step approach. First, screening for malnutrition risk. Once positive, individuals were classified as malnourished according to some phenotypic (body mass index, grip strength and unintentional weight loss) and etiologic (disease burden/inflammation and reduced food intake or assimilation) criteria. Frailty was assessed using both the Frailty Index (FI) and Frailty Trait Scale (FTS). Mortality data was obtained through the National Death Index. RESULTS: From the 1660 older adults, 248 participants (14.04%) were classified as 'at malnutrition risk' (AMR) and 209 (12.59%) as malnourished (MN). AMR and MN subjects were older and with worse functional status (frailer). Adjusted cross-sectional analysis showed an association between nutritional status and frailty by both FI and FTS. Adjusted longitudinal analyses showed that AMR was associated with higher risk of frailty, using both the FTS (OR: 1.262; 95% CI: 1.078-1.815) and the FI (OR: 1.116; 95% CI: 1.098-1.686), while being malnourished was associated with higher mortality risk (OR: 1.748; 95% CI: 1.073-2.849), but not with incident frailty at follow-up period. CONCLUSIONS: Nutritional status, assessed through GLIM, predicts in a dose-dependent manner the risk of frailty and death. Being at malnutrition risk predicts the risk of becoming frail at follow-up period, whereas being malnourished predicts mortality. These findings highlight the importance of assessing the nutritional status of community-dwelling older adults to identify the ones at risk of developing frailty or death and inform targeted nutrition-focused interventions.

Global Performance of Executive Function Is Predictor of Risk of Frailty and Disability in Older Adults.

INTRODUCTION: The executive function is a complex set of skills affected during the aging process and translate into subclinical cerebrovascular disease. Postural instability or motor slowness are some clinical manifestations, being consubstantial with the frailty phenotype, genuine expression of aging. Executive dysfunction is also considered a predictor of adverse health events in the elderly. AIM: To study whether the executive dysfunction can be used as an early marker for frailty and the viability of use as a predictor of mortality, hospitalization and/or disability in a Mediterranean population. DESIGN: A population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA). METHODS: 1690 Spanish elders aged ≥65 years underwent a neuropsychological evaluation in order to measure executive function. To assess whether the accumulation of dysfunctions (in severity and amplitude) could increase the predictive value of adverse health events in relation to each dimension separately an executive dysfunction cumulative index was constructed. Cox proportional hazards model was used to examine mortality and hospitalization over 5.02 and 3.1 years of follow-up, respectively. RESULTS: Executive dysfunction is a powerful predictor of mortality, frailty and disability. Cumulative differences in executive function are associated with high risk of frailty and disability, thus, for each one point increment in the executive function index, the risk of death increased by 7 %, frailty by 13% and disability by 11% (P<0.05). Moreover, the executive impairment exhibits a strong positive tendency with age, comorbidity and mortality. CONCLUSIONS: Cumulative differences in four executive dimensions widely used in clinical practice improves the ability to predict frailty and disability compared to each dimension separately.

Tratamiento quirúrgico del síndrome del desfiladero torácico: nuestra experiencia (1986-2000) / Surgical treatment in the thoracic outlet syndrome: our experience (1986-2000)

Objetivo. Evaluar los resultados del tratamiento quirúrgico del síndrome del desfiladero torácico (SDT) en un servicio de angiología y cirugía vascular. Pacientes y métodos. Estudio retrospectivo. Período de estudio 1986-2000, n= 53 casos en 45 pacientes (8 bilaterales). Edad media: 32,6 años (r= 17-58). Se han incluido 29 mujeres (64 por ciento) y 16 varones (34 por ciento), diagnosticados por exploración clínica, radiología simple, pruebas neurofisiológicas, Doppler y angioRx. SDT arterial n= 43 (30 puros/13 mixtos o neurovasculares); SDT venoso n= 9 (8 TVP y 1 edema intermitente) y un caso SDT neurológico puro. Se apreciaron anomalías óseas en el 62,2 por ciento de los pacientes. Se han practicado 28 resecciones de costilla cervical/megaapófisis C7, 19 de 1.ª costilla, 3 de 1.ª costilla anómala, 1 de clavícula, 1 de músculo subclavio y 1 escalenectomía aislada. Se asoció cirugía arterial o venosa directa en 8 casos (6/2 respectivamente). Los resultados precoces y tardíos se han calculado mediante estadística descriptiva, test exacto de Fisher y Kaplan-Meier, utilizando el programa SPSS. Resultados. Precoces: mortalidad 0 por ciento, morbilidad 13 por ciento, permeabilidad acumulada 87,5 por ciento. Tardíos: seguimiento medio 36 meses (0-15 años). Permeabilidad acumulada: 85,7 por ciento. Tasa actuarial de asintomáticos: 79,2 por ciento. Tasa de asintomáticos y sintomáticos con pruebas postoperatorias normalizadas: 92,4 por ciento (a los 15 años). No se evidenció relación significativa entre sexo, edad y tipo de resección efectuada, con la persistencia de los síntomas en las tablas actuariales (p> 0,05). Se reintervinieron cuatro casos (7.5 por ciento) por recurrencia de los síntomas. Conclusiones. Nuestros resultados justifican el tratamiento quirúrgico del SDT. La selección de los pacientes es fundamental porque un porcentaje mantendrá la sintomatología pese a la normalización de los tests diagnósticos (AU)

Relación entre la arteriografía inguinal preoperatoria y la infección de la herida quirúrgica en cirugía arterial / Relationship between preoperative inguinal arteriography and groin infection after arterial surgery

Objetivos. Determinar y analizar la relación entre la arteriografía inguinal preoperatoria (AIP) y la infección quirúrgica inguinal homolateral en cirugía arterial. Material y métodos. Se incluyeron en el estudio 867 abordajes quirúrgicos inguinales realizados en un período de 5 años, comparando la incidencia de infección quirúrgica según la realización o ausencia de arteriografía previa homolateral al sector intervenido. El período de seguimiento para diagnosticar la infección varió desde 2 días a 7,5 años. Se realizaron un estudio descriptivo y un análisis univariante. Resultados. La tasa de incidencia de infección quirúrgica global fue del 2,65 por ciento (n = 23). En 156 casos (18 por ciento) se había realizado una arteriografía homolateral previa. La frecuencia de infección en los casos con arteriografía homolateral fue del 6,41 por ciento, mientras que en los que no se realizó la misma homolateralmente fue del 1,83 por ciento, objetivándose una relación estadísticamente significativa entre la arteriografía inguinal preoperatoria homolateral y la infección quirúrgica (p = 0,003).Conclusiones. La relación significativa entre la AIP y la infección inguinal confirma la necesidad de adoptar medidas preventivas específicas para evitar la elevada morbimortalidad de esta complicación inherente a la cirugía vascular (AU)

Helicobacter pylori, efficacy of the new triple therapy in six and twelve-day schedules.

OBJECTIVE: Assessment of four eradicating patterns of 6 and 12 days duration with new triple therapies adapted to our environment. PATIENTS: After an endoscopic diagnosis of Duodenal or Gastric Ulcer, and the confirmation of the presence of Helicobacter pylori using a rapid urease test in antral biopsies, 274 patients were treated with one of four eradicating therapies, verifying its efficacy with the C-13 urea breath test, at least one month after the end of the treatment and 10 days after withdrawal of proton pump inhibitors. RESULTS: Maximum eradicating efficacy was achieved with Omeprazole (20 mg/12 hours), Clarithromycin (500 mg/12 hours) and Amoxycillin (1 g/12 hours), given for 12 days (96.6%), and Omeprazole (20 mg/12 hours), Tinidazole (500 mg/12 hours) and Clarithromycin (500 mg/12 hours), also given for 12 days (95.2%). The same drugs and doses, when given during six days, achieved percentages of 78.3% and 82.2% respectively. Results with Tinidazole suggest lack of resistance to this drug in the Community of Madrid.

Extrarenal retroperitoneal angiomyolipoma.

The clinical and pathological findings in a patient with extrarenal angiomyolipoma arising in the perinephric space are presented. This location has been reported only rarely and sets forth some diagnostic and therapeutic difficulties that are also discussed.