ABSTRACT
Hypertension treatment and blood pressure (BP) control reduce cardiovascular disease burden. However, prevalence of controlled BP is overall insufficient and lack of adherence to treatment is a suggested major contributor. This prospective, randomized clinical trial was designed to evaluate whether a specific 3-month (m) action plan to improve therapeutic adherence results in a decrease in BP. Patients with ambulatory 24 h-BP ≥ 130/80 mmHg despite receiving ≥2 antihypertensive drugs and with therapeutic non-compliance confirmed by antihypertensive drugs analyzed in urine were randomized (1:1) to receive a specific 3 m program to improve adherence (INT = intervention) or routine follow-up (C = control). Antihypertensive treatment was not modified and knowledge of non-adherence was only notified to patients randomized to the intervention group. Before randomization and at 3 m all patients underwent urinary screening for antihypertensive drugs and 24 h-ambulatory-BP monitoring. Forty-five patients (36% women, mean age: 58 ± 13 yr) were randomized. At 3 m, mean (95% CI) BP differences (INT vs. C) were 12.2 mmHg (4.3-20.8), adjusted-p = 0.032 and 8.7 mmHg (2.5-14.8), adjusted-p = 0.018 for 24 h-systolic and 24 h-diastolic BP, respectively. Differences (INT vs. C) for office SBP and DBP were 18.4 mmHg (6.8-30.1), adjusted-p = 0.005 and 15.7 mmHg (7.2-24.2), adjusted-p < 0.001. Non-detected antihypertensive drugs were median [IQR]: 40% [25-100] and 0% [0-20] at baseline and 3 m, respectively, in the INT group, and 33.3% [25-63.7] and 33.3% [23.8-57.9], in the C group (p < 0.001 for the 3-month between-group comparison). A combined action plan of notifying knowledge of non-adherence plus a 3-month specific nursing intervention to improve therapeutic adherence results in BP reduction in patients with inadequate therapeutic compliance.
ABSTRACT
This report describes multidisciplinary care combining orthodontics and restorative dentistry for a patient with Class II occlusion and stained mandibular and maxillary resin composite veneers. The orthodontic treatment improved severe overjet and malocclusion prior to restorative care. Occlusal assessment was provided with a novel digital device (PlaneSystem, Zirkonzahn) that is integrated with digital workflows for the evaluation of the occlusal plane and condylar path inclination. Diagnostic digital impressions and digital wax-up for intraoral mock-ups led to the patient's treatment acceptance. Minimally invasive tooth preparation, final digital impressions, and bonding under dental dam isolation fulfilled the patient's esthetic and functional demands with all-ceramic restorations.
ABSTRACT
BACKGROUND: There is a close relationship between obstructive sleep apnoea (OSA) and resistant hypertension (RH). However, studies assessing the long-term effect of diagnosing and treating OSA on blood pressure (BP) control in these patients are lacking. METHODS: To address this gap, we recruited 478 RH patients from hypertension units and followed them prospectively after they were screened for OSA through a sleep study. By performing 24-h ambulatory BP monitoring (ABPM) annually, the effect of OSA management was assessed. RESULTS: The patients had a median (interquartile range (IQR)) age of 64.0 (57.2-69.0)â years, 67% were males and most were nonsleepy, with a median (IQR) apnoea-hypopnoea index (AHI) of 15.8 (7.9-30.7)â events·h-1. The median (IQR) follow-up time was 3.01 (2.93-3.12)â years. At baseline, severe OSA was associated with uncontrolled BP, nocturnal hypertension and a nondipper circadian BP pattern. Moreover, these patients had higher BP values during follow-up than did patients in the other groups. However, among patients with moderate and severe OSA, the management of sleep disordered breathing, including the implementation of continuous positive airway pressure treatment, was associated with a reduction in 24-h ABPM parameters, especially night-time BP values, at the 1-year follow-up. These benefits were attenuated over time and only subjects with severe OSA maintained an ABPM night-time reduction at 3â years. Furthermore, clinical variables such as uncontrolled BP, sex and age showed a predictive value for the BP response at 1â year of follow-up. CONCLUSION: A favourable long-term decrease in BP was detected by diagnosing and treating OSA in a cohort of RH patients from hypertension units, but over time this decrease was only partially maintained in severe OSA patients.
Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure , Hypertension , Sleep Apnea, Obstructive , Humans , Male , Female , Middle Aged , Sleep Apnea, Obstructive/therapy , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/complications , Hypertension/complications , Hypertension/physiopathology , Aged , Prospective Studies , Antihypertensive Agents/therapeutic use , Polysomnography , Continuous Positive Airway PressureABSTRACT
BACKGROUND: Prone position (PP) has been widely used in the COVID-19 pandemic for ARDS management. However, the optimal length of a PP session is still controversial. This study aimed to evaluate the effects of prolonged versus standard PP duration in subjects with ARDS due to COVID-19. METHODS: This was a single-center, randomized controlled, parallel, and open pilot trial including adult subjects diagnosed with severe ARDS due to COVID-19 receiving invasive mechanical ventilation that met criteria for PP between March-September 2021. Subjects were randomized to the intervention group of prolonged PP (48 h) versus the standard of care PP (â¼16 h). The primary outcome variable for the trial was ventilator-free days (VFDs) to day 28. RESULTS: We enrolled 60 subjects. VFDs were not significantly different in the standard PP group (18 [interquartile range [IQR] 0-23] VFDs vs 7.5 [IQR 0-19.0] VFDs; difference, -10.5 (95% CI -3.5 to 19.0, P = .08). Prolonged PP was associated with longer time to successful extubation in survivors (13.00 [IQR 8.75-26.00] d vs 8.00 [IQR 5.00-10.25] d; difference, 5 [95% CI 0-15], P = .001). Prolonged PP was also significantly associated with longer ICU stay (18.5 [IQR 11.8-25.3] d vs 11.50 [IQR 7.75-25.00] d, P = .050) and extended administration of neuromuscular blockers (12.50 [IQR 5.75-20.00] d vs 5.0 [IQR 2.0-14.5] d, P = .005). Prolonged PP was associated with significant muscular impairment according to lower Medical Research Council values (59.6 [IQR 59.1-60.0] vs 56.5 [IQR 54.1-58.9], P = .02). CONCLUSIONS: Among subjects with severe ARDS due to COVID-19, there was no difference in 28-d VFDs between prolonged and standard PP strategy. However, prolonged PP was associated with a longer ICU stay, increased use of neuromuscular blockers, and greater muscular impairment. This suggests that prolonged PP is not superior to the current recommended standard of care.
Subject(s)
COVID-19 , Patient Positioning , Respiration, Artificial , Respiratory Distress Syndrome , Humans , Prone Position , COVID-19/complications , COVID-19/therapy , Male , Pilot Projects , Female , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/etiology , Middle Aged , Respiration, Artificial/methods , Patient Positioning/methods , Time Factors , Aged , SARS-CoV-2 , Adult , Treatment OutcomeABSTRACT
Background: The prevalence of neurological disorders is increasing worldwide. In recent decades, the conventional rehabilitation for people with neurological disorders has been often reinforced with the use of technological devices (robots and virtual reality). The aim of this systematic review was to identify the evidence on the economic cost of rehabilitation with robotic and virtual reality devices for people with neurological disorders through a review of the scientific publications over the last 15 years. Methods: A systematic review was conducted on partial economic evaluations (cost description, cost analysis, description of costs and results) and complete (cost minimization, cost-effectiveness, cost utility and cost benefit) studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The main data sources used were PubMed, Scopus and Web of Science (WOS). Studies published in English over the last 15 years were considered for inclusion in this review, regardless of the type of neurological disorder. The critical appraisal instrument from the Joanna Briggs Institute for economic evaluation and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) were used to analyse the methodological quality of all the included papers. Results: A total of 15 studies were included in this review. Ten papers were focused on robotics and five on virtual reality. Most of the studies were focused on people who experienced a stroke. The robotic device most frequently used in the papers included was InMotion® (Bionik Co., Watertown, MA, USA), and for those focused on virtual reality, all papers included used semi-immersive virtual reality systems, with commercial video game consoles (Nintendo Wii® (Nintendo Co., Ltd., Kyoto, Japan) and Kinect® (Microsoft Inc., Redmond, WA, USA)) being used the most. The included studies mainly presented cost minimization outcomes and a general description of costs per intervention, and there were disparities in terms of population, setting, device, protocol and the economic cost outcomes evaluated. Overall, the methodological quality of the included studies was of a moderate level. Conclusions: There is controversy about using robotics in people with neurological disorders in a rehabilitation context in terms of cost minimization, cost-effectiveness, cost utility and cost benefits. Semi-immersive virtual reality devices could involve savings (mainly derived from the low prices of the systems analysed and transportation services if they are applied through telerehabilitation programmes) compared to in-clinic interventions.
ABSTRACT
El hiperaldosteronismo primario (HAP) es una causa importante de hipertensión arterial (HTA) secundaria. El estudio del mismo precisa de una alta sospecha clínica, además de un estudio hormonal que confirme la hipersecreción hormonal. Es importante iniciar el tratamiento adecuado una vez se confirma el diagnóstico, y para ello es preciso demostrar si la hipersecreción hormonal es unilateral (pacientes que podrían ser tributarios a tratamiento quirúrgico) o bilateral (pacientes que son tributarios a tratamiento únicamente farmacológico). En el Hospital del Mar desde el año 2016 existe un equipo de trabajo multidisciplinar en el que participan nefrólogos, endocrinólogos, radiólogos y cirujanos para evaluar los casos con sospecha de hiperaldosteronismo y consensuar el mejor abordaje diagnóstico-terapéutico de estos pacientes, incluyendo la necesidad de cateterismo venoso adrenal, que es una técnica que en los últimos años se ha erigido como gold standard para el estudio del HAP. En el presente estudio recogemos la experiencia de nuestro centro en la realización de cateterismo venoso adrenal y en la utilidad de este para el manejo de tales pacientes (AU)
Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only). At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH. In the present study we collect the experience of our center in performing adrenal vein catheterization and its usefulness for the management of these patients (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Hyperaldosteronism/therapy , Catheterization/methods , Treatment OutcomeABSTRACT
BACKGROUND: Alloantibodies, especially anti-human leukocyte antigen antibodies (HLA antibodies), and autoantibodies, as angiotensin II type 1 receptor antibodies (AT1R antibodies), may complicate the access and the course of transplantation. Pregnancy is a known source of HLA antibodies, with most studies evaluating pregnancy-induced sensitization by complement-dependent cytotoxicity assays, mainly after childbirth. AT1R antibodies have been evaluated in the context of preeclampsia. We aimed to evaluate pregnancy as a natural source of HLA antibodies and AT1R antibodies, their dynamics along gestation and the potential factors involved in antibody appearance. METHODS: Serum samples from pregnant women were collected during the three trimesters of pregnancy (1T, 2T, 3T). Presence of HLA antibodies was assessed by screening beads on Luminex and AT1R antibodies by ELISA. RESULTS: A cohort of 138 pregnant women were included. Samples from all were tested in 1T, 127 in 2T and 102 in 3T. HLA antibodies increased from 29.7 % (1T) to 38.2 % (3T). AT1R antibodies were stable around 30 % along pregnancy. Up to 43.2 % multiparous women had HLA antibodies, with a similar proportion of class I and class II antibodies. In primiparous women HLA antibodies increased along pregnancy (from 17.6 % to 34.1 %), with predominance of class II HLA antibodies. AT1R antibodies were not different in primiparous and multiparous women. CONCLUSIONS: Pregnancy is a relevant source of HLA antibodies sensitization, but not of AT1R antibodies. HLA antibodies increased clearly in primiparous women with predominance of class II. The use of newer solid-phase techniques on Luminex evidence a higher degree of HLA sensitization during pregnancy.
Subject(s)
Kidney Transplantation , Humans , Female , Pregnancy , Receptor, Angiotensin, Type 1 , Graft Rejection , Autoantibodies , HLA AntigensABSTRACT
Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only). At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH. In the present study we collect the experience of our centre in performing AVC and its usefulness for the management of these patients.
Subject(s)
Hyperaldosteronism , Hypertension , Humans , Adrenal Glands/blood supply , Hyperaldosteronism/complications , Hyperaldosteronism/diagnosis , Hypertension/complicationsABSTRACT
The Natural Semantic Networks (NSN) model is highly useful in analyzing the words that define a concept in terms of the value, strength, weight, or density that a specific population assigns to the construction of a learned concept. The main objective of this study was to describe the conceptualization of the concept of neurorehabilitation by Spanish physiotherapists specializing in this field using NSN. A phenomenological study is presented. The participants were physiotherapy professionals who graduated from three Spanish universities and were working in the field of neurorehabilitation. A questionnaire was administered via Google Forms, which was constructed using the NSN technique. A total of 191 physiotherapists participated in this study. The Spanish physiotherapists interviewed used a total of 1247 defining words for the concept of neurorehabilitation. The semantic core of the concept was mainly formed by the words 'treatment', 'recovery', 'functionality', 'neuroplasticity', and 'learning', which carried significant weight. Results were also presented taking into account the academic level and years of professional experience of the sample. The semantic network observed in this study allows us to elucidate the polysemy of the concept of neurorehabilitation, which is composed not only of certain associated words but also the meanings they imply.
ABSTRACT
Introducción: Las últimas evidencias revelan que la infección por COVID-19 no tienen peor pronóstico en los pacientes con enfermedades inflamatorias inmunomediadas (EIMI), aunque desarrollan menor respuesta a la vacunación. Objetivo: Comparar la incidencia de COVID-19 y características clínicas en pacientes con EIMI entre la primera y sexta olas. Método: Estudio observacional prospectivo de 2 cohortes de pacientes con EIMI diagnosticados de COVID-19. Primera cohorte: marzo-mayo de 2020; segunda cohorte: diciembre/2021 a febrero/2022. Se recogieron variables sociodemográficas y clínicas, y en la segunda cohorte el estado de vacunación contra la COVID-19. El análisis estadístico estableció las diferencias de las características y la evolución clínica entre ambas cohortes. Resultados: De un total de 1.627 pacientes en seguimiento, contrajeron COVID-19 durante la primera ola 77 (4,60%) y 184 en la sexta (11,3%). En la sexta hubo menos hospitalizaciones, ingresos en cuidados intensivos y fallecimientos que en la primera (p=0,000) y 180 pacientes (97,8%) tenían al menos una dosis de vacuna. Conclusión: La detección precoz y la vacunación han evitado la aparición de complicaciones graves.(AU)
Introduction: Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination. Objective:To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves. Method: Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022. Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts. Results: In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (P=.000) and 180 patients (97.8%) had at least one dose of vaccine. Conclusion: Early detection and vaccination have prevented the occurrence of serious complications.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Chronic Disease/prevention & control , Vaccination , Nurse Clinicians , /epidemiology , Prospective Studies , Cohort Studies , Incidence , Epidemiology, DescriptiveABSTRACT
INTRODUCTION: Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination. OBJECTIVE: To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves. METHOD: Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022. Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts. RESULTS: In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (p=.000) and 180 patients (97.8%) had at least one dose of vaccine. CONCLUSION: Early detection and vaccination have prevented the occurrence of serious complications.
Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Pandemics , COVID-19 Vaccines , COVID-19/epidemiology , HospitalizationABSTRACT
Introducción: La hipertensión arterial resistente (HTAR) supone un importante impacto a nivel multiorgánico e incrementa la morbimortalidad. Este trabajo evalúa la evolución de la lesión orgánica mediada por hipertensión en pacientes con HTAR tras añadir espironolactona. Material y métodos: Estudio retrospectivo de 58 pacientes con HTAR a quienes se añadió espironolactona (12,5-25mg/día). Se obtuvieron parámetros de presión arterial clínica y MAPA-24h, cociente albúmina/creatinina y datos ecocardiográficos previos a iniciar espironolactona y tras 12 meses de tratamiento. Resultados: El 36,2% de los pacientes eran mujeres y la edad media de 67,3±10,1 años. Se objetivó un descenso en albuminuria (mediana [RIC25-75]) de 27,0 (7,5-255,4) a 11,3 (3,1-37,8) mg/g (p = 0,009), siendo más marcado en pacientes con albuminuria grado A2 y A3: de 371,2 (139,5-797,4) a 68,4 (26,5-186,5) mg/g, p =0,02.. A nivel ecocardiográfico se evidenció: pared posterior: −1,0±0,4mm (p<0,001), tabique interventricular: −0,6±0,5mm (p=0,01), índice de masa del ventrículo izquierdo (VI): −14,7±10,2g/m2 (p=0,006), índice de remodelado del VI: −0,04±0,036 (p=0,03), sin cambios estadísticamente significativos en fracción de eyección VI, diámetro diastólico VI, diámetro sistólico VI, diámetro de aurícula izquierda, relación entre onda de llenado ventricular temprano y contracción auricular ni en índice de presión llenado VI. La presión arterial clínica sistólica/diastólica presentó un descenso de −12,5±4,9/−4,9±3,0mmHg, p<0,001. En los MAPA-24h se observó un descenso significativo de presión arterial sistólica y diastólica en los períodos diurno y nocturno, y un cambio favorable en el patrón circadiano en el 38,1% de los pacientes, p<0,001. Conclusiones: Añadir espironolactona en HTAR contribuye a la reducción de la lesión orgánica mediada por hipertensión a nivel de albuminuria y de parámetros ecocardiográficos de cardiopatía hipertensiva. (AU)
Introduction: Resistant hypertension (RH) represents an important multi-organic impact and increases the morbi-mortality. We aimed to evaluate the evolution of hypertensive mediated organ damage in patients with RH after adding spironolactone. Material and methods: Retrospective study of 58 patients with RH who started spironolactone (12.525mg daily). Office blood pressure, 24-h ambulatory blood pressure monitoring (24h-ABPM), urine albumin-to-creatinine ratio and echocardiographic parameters were analyzed prior to initiation of spironolactone and after 12 months of treatment. Results: Thirty-six percent of patients were women and mean age was 67.3±10.1 years. We observed a decrease in urine albumin-to-creatinine ratio (median [RIQ2575]) of 27.0 (7.5-255.4) to 11.3 (3.137.8) mg/g, P = .009. This was more relevant in patients with albuminuria grade A2 and A3: 371.2 (139.5797.4) to 68.4 (26.5186.5) mg/g, P = .02. The echocardiographic changes were: posterior wall thickness: −1.0±0.4mm (P<.001), interventricular septal thickness: −0.6±0.5mm (P=.01), left ventricular (LV) mass index: −14.7±10.2g/m2 (P=.006), LV remodeling index: −0.04±0.036 (P=.03), without statistically significant changes in LV ejection fraction, LV end-diastolic diameter, LV end-systolic diameter, left atrial diameter, relationship between early ventricular filling wave and atrial contraction and LV filling pressure index. Systolic/diastolic office blood pressure decreased −12.5±4.9/−4.9±3.0mmHg, P<.001. In 24h-ABPM, systolic and diastolic BP had a significant decrease in diurnal and nocturnal periods and 38.1% of patients presented a favorable change in the circadian pattern, P<.001. Conclusions: Adding spironolactone to patients with RH contributes to improve hypertensive mediated organ damage by reducing albuminuria levels and echocardiographic parameters of hypertensive heart disease. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Hypertension/drug therapy , Hypertension/mortality , Spironolactone/therapeutic use , Retrospective Studies , Albuminuria , Arterial Pressure , SpainABSTRACT
Preeclampsia (PE) is characterized by the new onset of hypertension (HT) and proteinuria beyond the 20th week of gestation. We aimed to find the best predictor of PE and find out if it is different in women with or without HT. Consecutively attended pregnant women were recruited in the first trimester of pregnancy and followed-up. Laboratory and office and 24 h-ambulatory blood pressure (BP) data were collected. PE occurred in 6.25% of normotensives (n = 124). Both office mean BP and 24 h-systolic BP in the first trimester were higher in women with versus those without PE (p ≤ 0.001). In women with chronic hypertension (cHT), PE occurred in 55%; office SBP (p = 0.769) and 24 h-SBP (p = 0.589) were similar between those with and those without PE. Regarding biochemistry, in cHT, plasma urea and creatinine were higher in PE women than in those without cHT (p = 0.001 and p = 0.004 for the differences in both parameters). These differences were not observed in normotensives. In normotensives, mean BP was the best predictor of PE [ROC curve = 0.91 (95%CI 0.82-0.99)], best cut-off = 80.3 mmHg. In cHT, plasma urea and creatinine were the best predictors of PE, with ROC curves of 0.94 (95%CI 0.84-1.00) and 0.93 (95%CI 0.83-1.00), respectively. In the first trimester of pregnancy, the strongest predictor of PE in normotensive women is office mean BP, while in cHT, renal parameters are the strongest predictors. Otherwise, office BP is non-inferior to 24 h ambulatory BP to predict PE.
ABSTRACT
INTRODUCTION: Resistant hypertension (RH) represents an important multi-organic impact and increases the morbi-mortality. We aimed to evaluate the evolution of hypertensive mediated organ damage in patients with RH after adding spironolactone. MATERIAL AND METHODS: Retrospective study of 58 patients with RH who started spironolactone (12.5-25mg daily). Office blood pressure, 24-h ambulatory blood pressure monitoring (24h-ABPM), urine albumin-to-creatinine ratio and echocardiographic parameters were analyzed prior to initiation of spironolactone and after 12 months of treatment. RESULTS: Thirty-six percent of patients were women and mean age was 67.3±10.1 years. We observed a decrease in urine albumin-to-creatinine ratio (median [RIQ25-75]) of 27.0 (7.5-255.4) to 11.3 (3.1-37.8)mg/g, p=0.009. This was more relevant in patients with albuminuria grade A2 and A3: 371.2 (139.5-797.4) to 68.4 (26.5-186.5)mg/g, p=0.02. The echocardiographic changes were: posterior wall thickness: -1.0±0.4mm (p<0.001), interventricular septal thickness: -0.6±0.5mm (p=0.01), left ventricular (LV) mass index: -14.7±10.2g/m2 (p=0.006), LV remodeling index: -0.04±0.036 (p=0.03), without statistically significant changes in LV ejection fraction, LV end-diastolic diameter, LV end-systolic diameter, left atrial diameter, relationship between early ventricular filling wave and atrial contraction and LV filling pressure index. Systolic/diastolic office blood pressure decreased -12.5±4.9/-4.9±3.0mmHg, p<0.001. In 24h-ABPM, systolic and diastolic BP had a significant decrease in diurnal and nocturnal periods and 38.1% of patients presented a favorable change in the circadian pattern, p<0.001. CONCLUSIONS: Adding spironolactone to patients with RH contributes to improve hypertensive mediated organ damage by reducing albuminuria levels and echocardiographic parameters of hypertensive heart disease.
ABSTRACT
Women represent almost half of the 20 million refugees worldwide, and although they play a key role in their communities, their voices and needs are often missing from research and policies directed to this population. A qualitative systematic review, or metasynthesis, was conducted to examine the experiences, perceptions, coping mechanisms, and psychological discourses of women refugees in situations of sexual and gender-based violence (SGBV) that occur during the travel, interception, and destination migratory stages. A systematic search was conducted on five multidisciplinary databases and was complemented with a manual search, resulting on a total of 511 articles which were screened for eligibility. Only qualitative, peer-reviewed, and English-written research articles were selected, and they were required to (1) focus on women refugees above 15 years of age and (2) report on their experiences, perceptions, psychological discourses, and/or coping with SGBV during their migration across countries (international migration). Ultimately, a total of 14 qualitative research articles were selected for the review. Using the thematic synthesis approach as a guideline, the results were summarized in the following themes: experiences of SGBV, perception of SGBV, perception of the risk factors creating and perpetuating their vulnerability, coping with SGBV, barriers to help-seeking, and psychological consequences. Despite the broad search, only information about some types of SGBV experiences from Asian and African refugee communities was found. Nonetheless, the available qualitative information on this topic is effectively integrated, knowledge gaps are identified, and future research, interventions, and policies using an integrated and culturally sensitive framework are suggested.
ABSTRACT
The literature has reported the isolation of arsenate-dependent growing microorganisms which lack a canonical homolog for respiratory arsenate reductase, ArrAB. We recently isolated an arsenate-dependent growing bacterium from volcanic arsenic-bearing environments in Northern Chile, Fusibacter sp. strain 3D3 (Fas) and studied the arsenic metabolism in this Gram-positive isolate. Features of Fas deduced from genome analysis and comparative analysis with other arsenate-reducing microorganisms revealed the lack of ArrAB coding genes and the occurrence of two arsC genes encoding for putative cytoplasmic arsenate reductases named ArsC-1 and ArsC-2. Interestingly, ArsC-1 and ArsC-2 belong to the thioredoxin-coupled family (because of the redox-active disulfide protein used as reductant), but they conferred differential arsenate resistance to the E. coli WC3110 ΔarsC strain. PCR experiments confirmed the absence of arrAB genes and results obtained using uncouplers revealed that Fas growth is linked to the proton gradient. In addition, Fas harbors ferredoxin-NAD+ oxidoreductase (Rnf) and electron transfer flavoprotein (etf) coding genes. These are key molecular markers of a recently discovered flavin-based electron bifurcation mechanism involved in energy conservation, mainly in anaerobic metabolisms regulated by the cellular redox state and mostly associated with cytoplasmic enzyme complexes. At least three electron-bifurcating flavoenzyme complexes were evidenced in Fas, some of them shared in conserved genomic regions by other members of the Fusibacter genus. These physiological and genomic findings permit us to hypothesize the existence of an uncharacterized arsenate-dependent growth metabolism regulated by the cellular redox state in the Fusibacter genus.
ABSTRACT
Objetivo: Conocer la prevalencia de la lactancia materna exclusiva al alta de los recién nacidos sanos, y determinar el nivel de satisfacción de las mujeres puérperas con las intervenciones realizadas para la promoción de la lactan- cia materna según recomendaciones de la guía Lactancia materna de la Re- gistered Nurses Association of Ontario (RNAO) aplicadas desde 2017. Método: Estudio descriptivo transversal, llevado a cabo entre junio de 2018 y junio de 2019. La muestra fue de mujeres puérperas ingresadas en la Unidad de Obstetricia del Hospital de la Mujer del Hospital Universitari Vall dHebron de Barcelona. Se analizaron variables sociodemográficas y relacionadas con el grado de satisfacción de las intervenciones de promoción de la lactancia ma- terna que habían recibido todas las madres, tanto si ofrecían el pecho como lactancia artificial, recogidas a través de un cuestionario diseñado ad hoc. Resultados: Se analizaron 337 encuestas realizadas por mujeres que recibie- ron intervenciones de promoción de la lactancia materna. Un total de 306 mu- jeres (90,8 %) alimentaron a su recién nacido con lactancia materna exclusiva en el momento del alta. La proporción de madres que dieron lactancia ma- terna exclusiva al alta fue significativamente superior en el grupo que ya lo había hecho anteriormente. El grado de satisfacción sobre las intervencio- nes de promoción recibidas obtuvo una puntuación media de 5,41 ± 0,88 en la escala de Likert, siendo 1 totalmente insatisfecha y 6 totalmente satisfe- cha. El grado de satisfacción fue alto tanto en el grupo que alimentó con lactancia materna exclusiva como en el que no lo hizo. Conclusiones: Casi la totalidad de las mujeres es dada de alta ofreciendo lactancia materna exclusiva a sus recién nacidos, siendo la lactancia mater- na previa un factor de predisposición hacia la misma. El grado de satisfac- ción con las intervenciones de promoción de la lactancia materna fue alto. (AU)
Objective: To identify the prevalence of exclusive breastfeeding at discharge of healthy newborns and to determine the level of satisfaction of postpartum women with the interventions carried out to promote breastfeeding accord- ing to the recommendations by the Registered Nurses Association of Ontario (RNAO) applied since 2017. Methodology: Cross-sectional descriptive study, carried out between June 2018 and June 2019. The sample was postpartum women admitted to the Obstetrics Unit of the Maternity Hospital of Vall d'Hebron University Hospital in Barcelona. Sociodemographic variables and those related to breastfeeding promotion interventions were collected through an ad hoc designed ques- tionnaire and analysed, which included those mothers who were breastfeed- ing and those choosing to bottle feed their newborn neonates. Results: 337 surveys completed by women who received breastfeeding pro- motion interventions were analysed. 306 women (90.8 %) exclusively breast- fed their newborn at discharge. The proportion of mothers who exclusively breastfed at discharge was significantly higher in multiparous women who breastfed previous siblings. The degree of satisfaction with the interventions received had a mean score of 5.41 ± 0.88 on the Likert scale, with 1 being totally unsatisfied and 6 totally satisfied. The degree of satisfaction was high regardless of having breastfed or not. Conclusions: Almost all women are discharged with exclusive breastfeeding, with previous breastfeeding being a predisposing factor towards it. The de- gree of satisfaction with breastfeeding promotion interventions was high. (AU)
Subject(s)
Humans , Female , Breast Feeding , Health Promotion , MothersABSTRACT
Obesity-related hyperfiltration leads to an increased glomerular filtration rate (GFR) and hyperalbuminuria. These changes are reversible after bariatric surgery (BS). We aimed to explore obesity-related renal changes post-BS and to seek potential mechanisms. Sixty-two individuals with severe obesity were prospectively examined before and 3, 6 and 12 months post-BS. Anthropometric and laboratory data, 24 h-blood pressure, renin-angiotensin-aldosterone system (RAS) components, adipokines and inflammatory markers were determined. Both estimated GFR (eGFR) and albuminuria decreased from the baseline at all follow-up times (p-for-trend <0.001 for both). There was a median (IQR) of 30.5% (26.2-34.4) reduction in body weight. Plasma glucose, glycosylated hemoglobin, fasting insulin and HOMA-index decreased at 3, 6 and 12 months of follow-up (p-for-trend <0.001 for all). The plasma aldosterone concentration (median (IQR)) also decreased at 12 months (from 87.8 ng/dL (56.8; 154) to 65.4 (56.8; 84.6), p = 0.003). Both leptin and hs-CRP decreased (p < 0.001) and adiponectine levels increased at 12 months post-BS (p = 0.017). Linear mixed-models showed that body weight (coef. 0.62, 95% CI: 0.32 to 0.93, p < 0.001) and plasma aldosterone (coef. -0.07, 95% CI: -0.13 to -0.02, p = 0.005) were the independent variables for changes in eGFR. Conversely, glycosylated hemoglobin was the only independent variable for changes in albuminuria (coef. 0.24, 95% CI: 0.06 to 0.42, p = 0.009). In conclusion, body weight and aldosterone are the main factors that mediate eGFR changes in obesity and BS, while albuminuria is associated with glucose homeostasis.
ABSTRACT
High heterogeneity in the blood pressure (BP) response to continuous positive airway pressure (CPAP) exists in patients with resistant hypertension (RH). Only nondipper normotensive and hypertensive patients exhibited BP reductions when treated with CPAP; the baseline BP dipping pattern has been proposed as a predictor of BP response to CPAP but has never been explored in patients with RH. This study aimed to assess the effect of CPAP on BP in subjects with RH with respect to BP dipping pattern or nocturnal hypertension. This is an ancillary study of the SARAH study. RH subjects with an apnea/hypopnea index (AHI) ≥ 15/h and who received CPAP treatment for 1 year were included. Subjects underwent a sleep study and ambulatory BP monitoring (ABPM) at baseline and at the 1-year follow-up. Eighty-nine RH subjects were included. The subjects were mainly male (77.5%) and obese, with a mean age of 66 years (25th-75th percentile; 59.0; 70.0) and an AHI of 32.7/h (25th-75th percentile; 25.0; 54.7). A total of 68.5% of participants were nondippers, and 71.9% had nocturnal hypertension. After 1 year of CPAP, no significant differences in ABPM parameters were observed between dippers and nondippers. According to nighttime BP, subjects with nocturnal normotension did not show significant changes in ABPM parameters, while nocturnal hypertensive subjects achieved a significant reduction in mean nighttime BP of -4.38 mmHg (-7.10 to -1.66). The adjusted difference between groups was 3.04 (-2.25 to 8.34), which was not significant. This study shows that the BP response to CPAP in patients with RH does not differ according to the BP dipping pattern (dipper and nondipper) and suggests a differential response according to the presence of nocturnal hypertension (ClinicalTrials.gov: NCT03002558).
Subject(s)
Continuous Positive Airway Pressure , Hypertension , Aged , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory/methods , Circadian Rhythm , Continuous Positive Airway Pressure/methods , Humans , Hypertension/therapy , MaleABSTRACT
Serology testing for COVID-19 is important in evaluating active immune response against SARS-CoV-2, studying the antibody kinetics, and monitoring reinfections with genetic variants and new virus strains, in particular, the duration of antibodies in virus-exposed individuals and vaccine-mediated immunity. In this study, recombinant S protein of SARS-CoV-2 was expressed in Rachiplusia nu, an important agronomic plague. One gram of insect larvae produces an amount of S protein sufficient for 150 determinations in the ELISA method herein developed. We established a rapid production process for SARS-CoV-2 S protein that showed immunoreactivity for anti-SARS-CoV-2 antibodies and was used as a single antigen for developing the ELISA method with high sensitivity (96.2%) and specificity (98.8%). Our findings provide an efficient and cost-effective platform for large-scale S protein production, and the scale-up is linear, thus avoiding the use of complex equipment like bioreactors.