Glomerular hyperfiltration and albuminuria in critically ill patients.

Glomerular hyperfiltration and albuminuria are two pathological conditions that could alter renal drug elimination, but they have been rarely studied in a critical care setting. The aims of this descriptive, prospective study performed on 89 critically ill patients are to determine rates of glomerular hyperfiltration (main objective) and albuminuria (secondary objective). On admission, 17.9% of patients presented with glomerular hyperfiltration, climbing to rates as high as 30% during the first week of admission. Seventy-five percent showed albuminuria on admission, with rates remaining high throughout the week of the study. Since glomerular hyperfiltration as well as albuminuria are frequent pathophysiological conditions in critical care patients, the implications that these phenomena may have regarding drug elimination need further evaluation.

[Prevalence of metabolic syndrome in the province of Albacete (Spain)]. / Prevalencia del síndrome metabólico en la provincia de Albacete.

OBJECTIVE: The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). PATIENTS AND METHODS: A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. RESULTS: Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. CONCLUSIONS: Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome.

Prevalencia del síndrome metabólico en la provincia de Albacete / Prevalence of metabolic syndrome in the province of Albacete (Spain)

Objetivo. El objetivo principal del estudio es determinar la prevalencia del síndrome metabólico (SM) en personas entre 40 y 70 años en la provincia de Albacete. Pacientes y métodos. Se trata de un estudio transversal poblacional en personas entre 40 y 70 años en tres municipios representativos de la provincia de Albacete. La participación total del estudio fue de 425 individuos. La edad media de la muestra fue de 53,1 años (intervalo de confianza [IC] 95%: 52,3-54), con un 50,4% de mujeres y un 49,6% de hombres. A todos los participantes se les realizó una analítica general y una exploración física con medición de parámetros antropométricos. El SM se definió según los criterios del Adult Treatment Panel-III (ATP-III). En el análisis estadístico se calculó la prevalencia del SM, así como su distribución según sus características epidemiológicas. Resultados. La prevalencia total del SM fue del 20,9% (88/421), con una edad media de 57 años (IC 95%: 55,1-59). Su prevalencia aumenta con la edad, siendo de hasta un tercio de la población mayor de 60 años. Por otra parte, se han encontrado diferencias significativas con antecedentes de cardiopatía isquémica, elevación de la proteína C reactiva ultrasensible y la detección de microalbuminuria en los pacientes con SM. La hipertensión arterial y la obesidad abdominal fueron los criterios más prevalentes en los pacientes con SM. Conclusiones. Teniendo en cuenta la importante comorbilidad que este síndrome conlleva, el conocimiento de su prevalencia y sus características en nuestro medio, así como su identificación y la intervención precoz sobre los distintos factores que la componen, contribuirían a una disminución de eventos cardiovasculares que se relacionan con este síndrome

Objective. The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). Patients and methods. A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. Results. Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. Conclusions. Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome

Prevención de hematomas de pared abdominal cuando se emplean heparinas de bajo peso molecular / Prevention of abdominal wall hematomas in patients receiving low molecular weight heparin therapy

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Espermiograma para control de la vasectomía / Semen examination after vasectomy

La vasectomía está considerada como uno de los métodos más efectivos y populares para el control de la natalidad. Tiene el inconveniente de que no es efectiva de modo inmediato, ya que los espermatozoides tardan un tiempo variable en ser eliminados del tracto genitourinario masculino y, a veces, no lo hacen completamente. Además, existe un mínimo riesgo de que se recanalice el conducto seccionado y vuelvan a aparecer espermatozoides en el semen. Por estos motivos, es necesario realizar un espermiograma para comprobar que la intervención ha tenido éxito y que se ha conseguido la esterilidad. Esto ha supuesto que el análisis del semen sea muy importante a la hora de intentar asegurar el éxito de la operación y de tratar de evitar las consecuencias médico-legales de los fallos. Los diversos estudios existentes sobre el control de la vasectomía ponen de manifiesto la necesidad de implantar unos protocolos económicamente rentables, basados en la evidencia científica, que arranquen con la información exhaustiva preoperatoria y se continúen con un análisis estructurado posoperatorio del semen. En este sentido, la Sociedad Británica de Andrología ha publicado una guía de práctica clínica sobre el análisis seminal posvasectomía para ayudar a los profesionales del laboratorio en la estandarización de los espermiogramas de control y en el informe de los resultados. Para la recogida de semen, esta guía sigue las recomendaciones de la Organización Mundial de la Salud

Vasectomy is regarded as one of the most reliable and popular method of birth control. It has the disadvantage that it is not immediately effective because spermatozoa take some time to be cleared from the genitourinary tract of the male and sometimes they do not disappear completely. In addition, there is a minimal risk of recanalisation of the dissected duct and renewed patency. Because of this, it is necessary to do a spermiogram to confirm the success of the operation and that sterility has been achieved. This has produced that seminal examination becomes an important tool to document operative success and to avoid medicolegal consequences of failure. The studies about semen examination after vasectomy reveal the need of cost-efective evidence-based protocol, which begin by the adequate preoperative counselling and follow with a postoperative structurated semen analysis. The British Andrology Society guidelines about the assessment of semen samples after vasectomy were published to give guidance to laboratory staff to ensure standarisation of seminal analysis protocols and reporting of results that, for semen collection, follows the World Health Organization recommendation

[The serine proteases and their function in neuronal death processes]. / Las serina proteasas y su funcion en los procesos de muerte neuronal.

AIMS: In this review we analyse the role played by the serine proteases in the nervous system and we focus on the role they play in degenerative processes. DEVELOPMENT: These proteolytic enzymes, together with the caspases, play a vital role in the processes regulating cell functioning, both in the development stages and following the response to a harmful stimulus. This family of proteases includes the granzymes and thrombin (TR). The former, which are closely related to proteases I and II and cathepsin G, are situated in the cytoplasmic granules of the activated T lymphocytes, together with other proteins such as perforin or cytolysin. Granzymes A and B are linked to degenerative processes. These enter the target cells thanks to the action of perforin and once inside they are translocated to the nucleus. Granzyme A has been isolated and identified as the agent responsible for the immediate and complete retraction of neurites in different models. Its physiological substrates include fibronectin, type IV collagen and the proteoglycans. Granzyme B is characterised by its being a cysteine protease with substrates such as prointerleukin 1 beta, TR receptor and poly(ADP ribose) polymerase. The family of TR type proteases includes proteases such as TR itself, plasmin, kallikrein, urokinase plasminogen activator and tissue plasminogen activator. TR is considered to be an early modulator in damaged tissues which acts as an extracellular signal of death, leading to the activation of intracellular mechanisms that appear to be mediated by calcium. Serine protease activity is regulated by endogenous inhibitors, such as plasminogen activator inhibitor, protease nexin 1 and neuroserpin. CONCLUSIONS: Upsets in the protease inhibitor balance are crucial in the processes involved in the neuronal plasticity and death induced by ischemia in the brain and by excitotoxins.

Las serina proteasas y su función en los procesos de muerte neuronal / The serine proteases and their function in neuronal death processes

Objetivo. En esta revisión analizamos el papel de las serina proteasas en el sistema nervioso y nos centramos en su participación en los procesos degenerativos. Desarrollo. Estas enzimas proteolíticas, junto a las caspasas, desempeñan un papel esencial en los procesos de regulación de funciones celulares, tanto en etapas del desarrollo como tras la respuesta ante un estímulo dañino. Dentro de esta familia de proteasas se engloban las granzimas y la trombina (TR). Las primeras, altamente relacionadas con las proteasas I y II y la catepsina G, se localizan en los gránulos citoplasmáticos de los linfocitos T activados, junto a otras proteínas como la perforina o citolisina. Las granzimas A y B se relacionan con los procesos degenerativos. Éstas entran en el interior de las células diana gracias a la acción de la perforina, y una vez en su interior se translocan al núcleo. La granzima A se ha aislado e identificado como el agente responsable de la inmediata y completa retracción de las neuritas en diversos modelos, y entre sus sustratos fisiológicos se encuentran la fibronectina, el colágeno de tipo IV y los proteoglicanos. La granzima B se caracteriza por ser una cisteína proteasa con sustratos como la prointerleucina-1Beta, el receptor de TR y la polimerasa poli(ADP-ribosa). La familia de las proteasas del tipo TR engloba proteasas como la propia TR, la plasmina, la kallikreína, el activador del plasminógeno urocinasa, y el activador del plasminógeno tisular. La TR se considera como un modulador temprano en los tejidos dañados, que sirve como señal extracelular de muerte que conduce a la activación de mecanismos intracelulares por un mecanismo que parece mediarse por calcio. La actividad de las serina proteasas se regula por inhibidores endógenos, como el inhibidor de activador del plasminógeno, la proteasa nexina-1 y la neuroserpina. Conclusión. Alteraciones en el equilibrio proteasainhibidor resultan cruciales en los procesos implicados en plasticidad y muerte neuronal inducidos por isquemia en el cerebro y por excitotoxinas (AU)

Aims. In this review we analyse the role played by the serine proteases in the nervous system and we focus on the role they play in degenerative processes. Development. These proteolytic enzymes, together with the caspases, play a vital role in the processes regulating cell functioning, both in the development stages and following the response to a harmful stimulus. This family of proteases includes the granzymes and thrombin (TR). The former, which are closely related to proteases I and II and cathepsin G, are situated in the cytoplasmic granules of the activated T lymphocytes, together with other proteins such as perforin or cytolysin. Granzymes A and B are linked to degenerative processes. These enter the target cells thanks to the action of perforin and once inside they are translocated to the nucleus. Granzyme A has been isolated and identified as the agent responsible for the immediate and complete retraction of neurites in different models. Its physiological substrates include fibronectin, type IV collagen and the proteoglycans. Granzyme B is characterised by its being a cysteine protease with substrates such as prointerleukin-1β, TR receptor and poly(ADP-ribose) polymerase. The family of TR-type proteases includes proteases such as TR itself, plasmin, kallikrein, urokinase plasminogen activator and tissue plasminogen activator. TR is considered to be an early modulator in damaged tissues which acts as an extracellular signal of death, leading to the activation of intracellular mechanisms that appear to be mediated by calcium. Serine protease activity is regulated by endogenous inhibitors, such as plasminogen activator inhibitor, protease nexin-1 and neuroserpin. Conclusions. Upsets in the proteaseinhibitor balance are crucial in the processes involved in the neuronal plasticity and death induced by ischemia in the brain and by excitotoxins (AU)