ABSTRACT
Dominance of neotropical tree communities by a few species is widely documented, but dominant trees show a variety of distributional patterns still poorly understood. Here, we used 503 forest inventory plots (93,719 individuals ≥2.5 cm diameter, 2609 species) to explore the relationships between local abundance, regional frequency and spatial aggregation of dominant species in four main habitat types in western Amazonia. Although the abundance-occupancy relationship is positive for the full dataset, we found that among dominant Amazonian tree species, there is a strong negative relationship between local abundance and regional frequency and/or spatial aggregation across habitat types. Our findings suggest an ecological trade-off whereby dominant species can be locally abundant (local dominants) or regionally widespread (widespread dominants), but rarely both (oligarchs). Given the importance of dominant species as drivers of diversity and ecosystem functioning, unravelling different dominance patterns is a research priority to direct conservation efforts in Amazonian forests.
Subject(s)
Ecosystem , Forests , Humans , Trees , Brazil , BiodiversityABSTRACT
BACKGROUND: Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are rare autoimmune diseases characterized by inflammation of blood vessels. This study aimed to assess the cost-utility of avacopan in combination with rituximab (RTX) or cyclophosphamide (CYC) compared with glucocorticoids (GC) for the treatment of severe, active AAV in Spain. METHODS: A 9-state Markov model was designed to reflect the induction of remission and sustained remission of AAV over a lifetime horizon. Clinical data and utility values were mainly obtained from the ADVOCATE trial, and costs ( 2022) were sourced from national databases. Quality-adjusted life years (QALYs), and incremental cost-utility ratio (ICUR) were evaluated. An annual discount rate of 3% was applied. Sensitivity analyses were performed to examine the robustness of the results. RESULTS: Avacopan yielded an increase in effectiveness (6.52 vs. 6.17 QALYs) and costs (16,009) compared to GC, resulting in an ICUR of 45,638 per additional QALY gained. Avacopan was associated with a lower incidence of end-stage renal disease (ESRD), relapse and hospitalization-related adverse events. Sensitivity analyses suggested that the model outputs were robust and that the progression to ESRD was a driver of ICUR. CONCLUSIONS: Avacopan is a cost-effective option for patients with severe, active AAV compared to GC in Spain.
Subject(s)
Aniline Compounds , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , Kidney Failure, Chronic , Nipecotic Acids , Humans , Antibodies, Antineutrophil Cytoplasmic/therapeutic use , Cost-Benefit Analysis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/chemically induced , Spain , Remission Induction , Rituximab , Glucocorticoids/adverse effectsABSTRACT
El enfoque más utilizado en el tratamiento inmunoterápico del cáncer es la administración de anticuerpos monoclonales dirigidos contra moléculas reguladoras del control inmunitario que inhiben la activación de las células T, los llamados inhibidores del check-point (ICP). La epidemiología y patología de la nefrotoxicidad por los ICP, su diagnóstico con o sin biopsia renal, el tipo y la duración del tratamiento, la posibilidad de retratar después del daño renal, y su indicación en pacientes con cáncer y trasplante renal son ciertamente controvertidas. En ausencia de estudios definitivos, este documento está destinado a concretar unas recomendaciones consensuadas por el grupo de expertos de Onconefrología de la SEN en aquellas áreas relacionadas con la nefrotoxicidad por los ICP, con la finalidad de ayudar en la toma de decisiones en la práctica clínica diaria de las consultas de Onconefrología. (AU)
The most widely used approach in the immunotherapy treatment of cancer is the administration of monoclonal antibodies directed against regulatory molecules of immune control that inhibit the activation of T cells, the so-called check point inhibitors (ICI). ICI nephrotoxicity epidemiology and pathology; its diagnosis with or without kidney biopsy; the type and duration of treatment; the possibility of rechallenging after kidney damage; and its indication in patients with cancer and renal transplantation are certainly controversial. In the absence of definitive studies, this document is intended to specify some recommendations agreed by the group of onconephrology experts of the Spanish Society of Nephrology in those areas related to ICI nephrotoxicity, in order to help decision-making in daily clinical practice in onconephrology consultations. (AU)
Subject(s)
Humans , Renal Insufficiency , Nephritis , Checkpoint Kinase 1/adverse effects , Neoplasms/therapy , Spain , Societies , Immunotherapy , Kidney Transplantation , Neoplasms/therapyABSTRACT
Un número importante de pacientes con lupus eritematoso sistémico (entre 20 a 60%, según diferentes series) desarrolla nefritis lúpica en el curso de su evolución, lo que influye directamente en su calidad de vida y pronóstico vital. En años recientes, el mayor conocimiento sobre la patogénesis del lupus sistémico y de la nefritis lúpica ha permitido avances relevantes en el abordaje diagnóstico y en el tratamiento de estos pacientes, lográndose desarrollar fármacos dirigidos específicamente a bloquear vías patogénicas claves de la enfermedad. Alentadoramente estos agentes inmunomoduladores han demostrado en ensayos clínicos aleatorizados, y bien ponderados, buena eficacia clínica a mediano plazo, definida como remisión de proteinuria y preservación de la función renal, con un aceptable perfil de seguridad y buena tolerabilidad del paciente. Todo esto ha permitido reducir el uso de corticoides y de otras terapias potencialmente más tóxicas, así como incrementar el uso de terapias combinadas. El presento documento de consenso realizado por el Grupo de Trabajo de Enfermedades Glomerulares de la Sociedad Española de Nefrología (GLOSEN) recoge de manera práctica y resumida, pero rigurosa, la mejor evidencia actual disponible acerca del diagnóstico, tratamiento y seguimiento del paciente con nefritis lúpica, incluyendo casos de situaciones especiales, con el objetivo principal de brindar información actualizada y recomendaciones clínicas bien fundamentadas a los médicos tratantes, para mejorar el enfoque diagnóstico y terapéutico a nuestro pacientes. (AU)
A significant number of patients with systemic lupus erythematosus (between 20% to 60% according to different reported series) develop lupus nephritis in the course of its evolution, which directly influences their quality of life and vital prognosis. In recent years, the greater knowledge about the pathogenesis of systemic lupus and lupus nephritis has allowed relevant advances in the diagnostic approach and treatment of these patients, achieving the development of drugs specifically aimed at blocking key pathogenic pathways of the disease. Encouragingly, these immunomodulatory agents have shown in well-powered, randomized clinical trials good clinical efficacy in the medium-term, defined as proteinuria remission and preservation of kidney function, with an acceptable safety profile and good patient tolerability. All this has made it possible to reduce the use of corticosteroids and other potentially more toxic therapies, as well as to increase the use of combined therapies. The present consensus document carried out by the Glomerular Diseases Working Group of the Spanish Society of Nephrology (GLOSEN), collects in a practical and summarized, but rigorous way, the best currently available evidence about the diagnosis, treatment, and follow-up of lupus nephritis patients, including cases of special situations, with the main objective of providing updated information and well-founded clinical recommendations to treating physicians, to improve the diagnostic and therapeutic approach to our patients. (AU)
Subject(s)
Humans , Lupus Nephritis/diagnosis , Lupus Nephritis/drug therapy , Spain , Consensus , Nephrotic Syndrome , Biological TherapyABSTRACT
El incremento de la demanda asistencial por afección renal asociada a enfermedades neoplásicas es una realidad en la mayoría de los servicios de nefrología. Para dar respuesta a esta situación, debe considerarse la creación de modelos asistenciales como consultas monográficas y desarrollar programas de formación en onconefrología que permitan optimizar la atención de estos pacientes. A través de un estudio exploratorio y descriptivo, identificamos cuál es la situación actual de la afectación renal en pacientes con cáncer. El objetivo del presente estudio es establecer los criterios para la asistencia específica en el ámbito de la onconefrología. Para ello hemos revisado aspectos clave y analizado la situación actual en nuestro entorno, mediante una encuesta dirigida a todos los nefrólogos a través de la SEN, junto a la experiencia de 2 centros españoles. A partir de esta información hemos establecido una serie de requisitos y recomendaciones para la puesta en marcha de estas consultas
The increase in demand for medical care for renal complications associated with neoplastic diseases is a reality in most nephrology departments. In response to this overall situation, the creation of healthcare models such as monographic consultations and develop training programs in onconephrology could improve the care of these patients. Through an exploratory and descriptive study, we identified current situation of kidney involvement in cancer patients. The objective of the present study is to establish the criteria for specific assistance in the field of onconephrology. For this, we have reviewed key aspects and analyzed the current situation in our country, through a survey addressed to all nephrologists through the Spanish Society of Nephrology, together with the experience of 2 Spanish centers. From this information, we have established some requirements and recommendations for the start-up of these consultations
Subject(s)
Humans , Neoplasms/complications , Kidney Diseases/etiology , Kidney Diseases/therapy , Referral and Consultation/standards , Early Detection of Cancer , Kidney Diseases/diagnosis , Neoplasms/therapy , Risk Factors , Patient Care Team , Surveys and Questionnaires , Nephrology , Medical Oncology , SpainABSTRACT
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Subject(s)
Humans , Coronary Thrombosis/diagnosis , Coronavirus Infections/complications , Thrombotic Microangiopathies/epidemiology , Disseminated Intravascular Coagulation/epidemiology , Inflammation/physiopathology , Blood Coagulation Disorders/epidemiology , Pandemics , Severe acute respiratory syndrome-related coronavirus/pathogenicityABSTRACT
La enfermedad renal crónica (ERC), el cáncer y las enfermedades hematológicas comparten áreas de influencia recíproca. El cáncer puede afectar al riñón bien como lesiones glomerulares o como consecuencia de los efectos tóxicos de la medicación o radiación, con procesos agudos (microangiopatía trombótica, insuficiencia renal aguda, nefropatías intersticiales, entre otros) o crónicos (empeoramiento de la ERC tras la nefrectomía por cáncer renal, fibrosis intersticial, trastornos hidroelectrolíticos). En sentido opuesto, los pacientes que precisan tratamiento renal sustitutivo con diálisis y particularmente con trasplante renal son de alto riesgo para la aparición de cáncer debido a la situación de inmunosupresión que generan. Además de la quimioterapia convencional, se han desarrollado tratamientos innovadores: agentes diana contra factores de crecimiento y su receptor, fármacos antiangiogénicos, proteínas inmunorreguladoras, reguladoras del ciclo celular o bloqueantes enzimáticos. También otros enfoques inmunoterapéuticos, como vacunas, terapia celular adoptiva (células CAR T) o desarrollo de anticuerpos. Todas estas novedades terapéuticas mejorarán los resultados frente al cáncer y enfermedades hematológicas pero no están exentas de problemas secundarios con afectación renal. La Onco-Nefrología es ya un área importante para la Sociedad Española de Nefrología, con gran número de interconsultas. El especialista en Nefrología precisa una mejor comprensión de áreas de tan rápida evolución de la biología del cáncer y su tratamiento, para convertirse en miembro valioso del equipo de atención del cáncer y proporcionar la mejor atención nefrológica posible
Chronic kidney disease (CKD), cancer and haematological diseases share areas of reciprocal influence. Cancer can affect the kidney either as glomerular lesions or as a result of the toxic effects of medication or radiation with acute (thrombotic microangiopathy, acute kidney injury, interstitial nephropathies among others) or chronic processes (worsening of CKD after nephrectomy due to renal cancer, interstitial fibrosis, hydroelectrolytic disorders). On the other hand, patients who require renal replacement therapy with dialysis and particularly with kidney transplantation are at high risk of onset of cancer due to the immunosuppression situation that they generate. In addition to conventional chemotherapy, innovative treatments have been developed: target agents against growth factors and their receptor; anti-angiogenic drugs; immunoregulatory proteins; cell cycle regulators; and enzyme inhibitors. Other immunotherapeutic approaches have also been developed, such as vaccines, adoptive cell therapy (CAR T cells) or development of antibodies. All these therapeutic advances will improve the outcomes against cancer and haematological diseases, but they are not free from secondary renal problems. Onco-Nephrology is already an important area for the Spanish Society of Nephrology with a large number of inter-consultations. Nephrologists need a better understanding of rapidly evolving areas of cancer biology and its treatment in order to become valued members of the cancer care team and to provide the best nephrology care possible
Subject(s)
Humans , Kidney Neoplasms/drug therapy , Kidney Neoplasms/immunology , Immunotherapy , Kidney Neoplasms/epidemiology , Kidney/drug effects , Kidney/pathologyABSTRACT
INTRODUCTION: Several studies have reported greater success of fertilisation by ART in couples who were not infected by Ureaplasma. Increased semen quality and better results have also been observed in couples who were treated with antibiotics to eradicate the infection. The aim of this study was to determine the prevalence of genital mycoplasmas in urine samples from male partners enrolled in the Assisted Reproduction Program (ARP) in our healthcare area so that, positive cases can be treated prior to the use of ART in order to increase the quality of semen, improve the embryo implantation rates and minimize the risk of adverse effects during pregnancy. MATERIAL AND METHODS: This study included couples enrolled in the ARP during 2016. Mycoplasma detection was made using real-time PCR. In positive cases, both members of the couple were treated with antibiotics until eradication of the microorganism. The antibiotics used were: azithromycin, doxycycline, levofloxacin, moxifloxacin, and clindamycin. RESULTS: Of the 205 men studied, 33 were positive: Ureaplasma urealyticum 15.1%, Mycoplasma hominis 3.9%. Eradication treatment with azithromycin failed in 50% compared to 10.2% for doxycycline. Of the 5 cases treated with levofloxacin, only 2 achieved elimination of U. urealyticum. CONCLUSIONS: We consider that genital mycoplasma routine screening could be useful in order to increase the quality of semen which could simplify the in vitro fertilisation procedures and raise the success rate of embryo implantation and pregnancy, especially when fast, sensitive and specific technics as real time PCR are used
INTRODUCCIÓN: Se han publicado estudios que demuestran mayores tasas de éxito en las técnicas reproducción asistida (TRA) en parejas no infectadas por micoplasmas. El objetivo de este estudio fue determinar la prevalencia de los micoplasmas genitales en muestras de orina del miembro masculino de las parejas incluidas en el Programa de Reproducción Asistida en nuestro Área Sanitaria realizando un tratamiento descolonizador con el fin de incrementar la calidad del semen, mejorar las tasas éxito de la embriotransferencia y minimizar los efectos adversos sobre la gestación. MATERIAL Y MÉTODOS: Participaron parejas incluidas en el Programa de Reproducción Asistida durante 2016. La detección de los micoplasmas se realizó por PCR en tiempo real. En los casos positivos, la pareja fue tratada con antibióticos hasta la erradicación del microorganismo. Los antibióticos usados fueron: azitromicina, doxiciclina, levofloxacino, moxifloxacino y clindamicina. RESULTADOS: De los 205 hombres estudiados, 33 fueron positivos: Ureaplasma urealyticum 15,1%, Mycoplasma hominis 3,9%. Azitromicina fracasó en el 50% de los casos y doxiciclina en el 10,2%. Con levofloxacino solo en 2 de 5 se consiguió la erradicación de U. urealyticum. CONCLUSIONES: El cribado de rutina de los micoplasmas genitales puede ser útil para mejorar la calidad del semen. Esto permitiría simplificar los procedimientos de fertilización in vitro e incrementar las tasas de éxito en la implantación de los embriones y en la gestación, especialmente con la aplicación de técnicas diagnósticas rápidas y específicas como la PCR en tiempo real
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Anti-Bacterial Agents/therapeutic use , Genital Diseases, Male/drug therapy , Mycoplasma Infections/drug therapy , Reproductive Techniques, Assisted , Semen Analysis , Azithromycin/therapeutic use , Clindamycin/therapeutic use , Doxycycline/therapeutic use , Embryo Implantation , Genital Diseases, Female/drug therapy , Genital Diseases, Female/microbiology , Genital Diseases, Male/microbiology , Genital Diseases, Male/urine , Levofloxacin/therapeutic use , Moxifloxacin/therapeutic use , Mycoplasma hominis/genetics , Mycoplasma hominis/isolation & purification , Prevalence , Real-Time Polymerase Chain Reaction , Sex Factors , Treatment Outcome , Ureaplasma Infections/drug therapy , Ureaplasma urealyticum/geneticsABSTRACT
Este artigo discute o conceito, os sentidos e o papel da educação na promoção da saúde e bem-estar no contexto do tema da "intersectorialidade e participação comunitária para o alcance dos Objectivos de Desenvolvimento Sustentável". Para o efeito, começa por indicar os três sentidos de educação, designadamente, educação como escolaridade; educação como socialização; e, educação como consciencialização como sendo elementos conceptuais centrais para uma abordagem robusta e consistente com vista à operacionalização eficaz dos ODS. O artigo argumenta, ainda, que para uma implementação eficaz dos ODS, sobretudo na promoção de saúde e bem-estar num país como Moçambique, é estratégico desenvolver duas consciências nos actores e partes interessadas; a consciência holística dos ODS e a consciência demográfica decorrente da estrutura social do país. Conclui sublinhando que munidos duma consciência demográfica, por um lado, e da consciência holística dos ODS, por outro, poderão estar criadas as condições necessárias uma competência dialógica e comunicativa adequada, onde a linguagem e conteúdos a adoptar para cada segmento social, para a promoção da saúde e bem-estar são uma condição dessa eficácia pretendida.
Subject(s)
Humans , Male , Female , Health , Community Participation , Sustainable Development , Socialization , Social Structure , Health Promotion , MozambiqueABSTRACT
El síndrome hemolítico urémico (SHU) es una entidad clínica definida por la tríada anemia hemolítica no inmune, trombocitopenia e insuficiencia renal aguda, en la que las lesiones subyacentes están mediadas por un proceso de microangiopatía trombótica (MAT) sistémico. Distintas causas pueden desencadenar el proceso de MAT que caracteriza el SHU. En este documento consideramos SHU atípico (SHUa) como el subtipo de SHU en el que los fenómenos de MAT son fundamentalmente consecuencia del daño producido en el endotelio de la microvasculatura renal y de otros órganos por desregulación de la actividad del sistema del complemento. En los últimos años se han identificado diversas mutaciones en genes del sistema del complemento asociados a SHUa, que explicarían aproximadamente el 60% de los casos de SHUa, y se han caracterizado funcionalmente numerosasmutaciones y polimorfismos asociados a SHUa que han permitido determinar que la patología se produce como consecuencia de la deficiente regulación de la activación del complemento sobre las superficies celulares y que lleva al daño endotelial mediado por la activación del C5 y de la vía terminal del complemento. Eculizumab es un anticuerpo monoclonal humanizado que inhibe la activación del C5, bloqueando la generación de la molécula proinflamatoria C5a y la formación del complejo de ataque de membrana. En estudios prospectivos en pacientes con SHUa su administración ha demostrado la interrupción rápida y sostenida del proceso de MAT, con una mejora significativa de la función renal a largo plazo y una reducción importante de la necesidad de diálisis y el cese de la terapia plasmática. En función de las evidencias científicas publicadas y la experiencia clínica acumulada, el Grupo Español de SHUa publicamos un documento de consenso con recomendaciones para el tratamiento de la enfermedad (Nefrología 2013;33(1):27-45). En la presente versión online del documento se actualizan los contenidos sobre la clasificación etiológica de las MAT, la fisiopatología del SHUa, su diagnóstico diferencial y su manejo terapéutico (AU)
Haemolytic uraemic syndrome (HUS) is a clinical entity defined as the triad of nonimmune haemolytic anaemia, thrombocytopenia, and acute renal failure, in which the underlying lesions are mediated by systemic thrombotic microangiopathy (TMA). Different causes can induce the TMA process that characterizes HUS. In this document we consider atypical HUS (aHUS) a sub-type of HUS in which the TMA phenomena are the consequence of the endotelial damage in the microvasculature of the kidneys and other organs due to a disregulation of the activity of the complement system. In recent years, a variety of aHUs-related mutations have been identified in genes of the the complement system, which can explain approximately 60% of the aHUS cases, and a number ofmutations and polymorphisms have been functionally characterized. These findings have stablished that aHUS is a consequence of the insufficient regulation of the activiation of the complement on cell surfaces, leading to endotelial damage mediated by C5 and the complement terminal pathway. Eculizumab is a monoclonal antibody that inhibits the activation of C5 and blocks the generation of the pro-inflammatory molecule C5a and the formation of the cell membrane attack complex. In prospective studies in patients with aHUS, the use of Eculizumab has shown a fast and sustained interruption of the TMA process and it has been associated with significative long-term improvements in renal function, the interruption of plasma therapy and important reductions in the need of dialysis. According to the existing literature and the accumulated clinical experience, the Spanish aHUS Group published a consensus document with recommendations for the treatment of aHUs (Nefrologia 2013;33[1]:27-45). In the current online version of this document, we update the aetiological classification of TMAs, the pathophysiology of aHUS, its differential diagnosis and its therapeutic management (AU)
Subject(s)
Humans , Hemolytic-Uremic Syndrome/diagnosis , Hemolytic-Uremic Syndrome/therapy , Thrombotic Microangiopathies/classification , Diagnosis, Differential , Biological Therapy , Prognosis , Kidney Transplantation , Postoperative Complications/epidemiology , Antibodies, Monoclonal/therapeutic useABSTRACT
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Subject(s)
Humans , Sarcoma, Kaposi/diagnosis , Kidney Transplantation , Postoperative ComplicationsABSTRACT
El diagnóstico temprano de los siameses es el punto clave de esta patología, tanto para la interrupción de la gestación como para la posible intervención posnatal de los mismos. Se presenta un caso clínico de siameses unidos por la cabeza, el tórax y el abdomen (céfalo-toracópago), destacando la clasificación de los siameses y la importancia del diagnóstico prenatal temprano ecográfico (AU)
Early diagnosis of conjoined twins is essential, both for pregnancy interruption and for possible postnatal intervention. We report a case of Siamese twins joined at the head, thorax and abdomen (cephalothoracopagus). The classification of conjoined twins and the importance of early ultrasonographic diagnosis are highlighted (AU)
Subject(s)
Humans , Female , Adult , Twins, Conjoined/pathology , Early Diagnosis , Pregnancy Complications/genetics , Pregnancy Complications/physiopathology , Pregnancy ComplicationsABSTRACT
Over the last decade vancomycin-resistant enterococci (VRE) have emerged as nosocomial pathogens. The aim of this study was to determine the prevalence of VRE in clinical samples from hospitalized patients in the Canary Islands. From April to November 2000, 437 enterococci were isolated from patients hospitalized at the four main health care centers in those islands. Identification to the species level was performed with the GPS-TA (Vitek 1) or the Wider I system. A PCR assay was used to determine the genotype of glycopeptide resistance ( vanA, vanB, vanC1, and vanC2/C3 genes). Only three (0.7%) VRE were detected: one vanA Enterococcus faecalis, and two vanC1 Enterococcus gallinarum. To our knowledge, this is the first VRE study carried out in the Canary Islands hospitals, and the results showed a low prevalence of VRE (AU)
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