Renal Tubular Dysgenesis in a Case of Fetus Acardius Amorphus.

Fetus acardius amorphus is a rare congenital malformation characterized by the lack of a functional heart, the presence of a bivascular umbilical cord, as well as a developed and organized skeletal system and partially organized inner organs. Fetus acardii mostly occur in multiple gestations. The pathogenesis of this entity is not clarified yet. It has been hypothesized that, although formation of anastomosing vessels between the co-twin and the anomalous embryo as well as reverse directed blood flow within the umbilical arteries of the weaker twin may allow sufficient blood flow to form rudimentary internal organs, it is insufficient to develop a fully functional heart. We had a case of fetus acardius amorphus, where we performed autopsy as well as routine histology assessment to identify different types of tissues. We showed that our fetus acardius amorphus demonstrated histomorphological features of renal tubular dysgenesis, confirmed by lack of proximal tubules, extramedullary hematopoiesis and increased number of smooth muscle actin positive vessels. This is a novel finding and has not been reported previously.

Eficacia de una intervención educativa breve sobre el correcto uso de los inhaladores en la prevención de agudizaciones en pacientes con enfermedad pulmonar obstructiva crónica / Effectiveness of a brief educational intervention relating to the correct use of inhalers on the prevention of exacerbation in patients suffering from chronic obstructive pulmonary disease

OBJETIVO: Estimar el efecto de una intervención educativa breve dirigida a mejorar la técnica de uso de dispositivos de inhalación sobre la reducción del número de agudizaciones en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) durante un año. MATERIAL Y MÉTODOS: Ensayo clínico aleatorizado con diseño en paralelo y triple ciego. CRITERIOS DE INCLUSIÓN: edad entre 40-75 años, diagnóstico de EPOC y tratamiento con inhaladores. Se seleccionó aleatoriamente a 97 pacientes. Asignación aleatoria estratificada por gravedad espirométrica a 2 grupos: grupo intervención (GI): evaluación de técnica inhalatoria, corrección de errores y visita refuerzo a los 2 y 7 meses, y grupo control (GC): evaluación de técnica inhalatoria y citación anual. Se realizó medición de las agudizaciones a los 12 meses. Variables estudiadas: sociodemográficas, nivel de estudios, IMC, tabaquismo, grado de disnea, FEV1, FEV1/FVC, estadio de EPOC, índice BODEX, técnica inhalatoria, agudizaciones previas. Se realizó análisis mediante inferencia bayesiana utilizando modelos de regresión logística. RESULTADOS: Cincuenta y seis pacientes fueron asignados al GI y 41 al GC. Hubo 16 y 14 pérdidas, respectivamente. En el GI agudizaron el 44,6% de los pacientes frente al 56,1% en el GC, OR ajustada = 0,57 (ICred 95%: 0,22-1,22). Probabilidad posterior OR < 1 = 93%. Las agudizaciones que requirieron ingreso hospitalario presentan un OR = 0,21 (ICred 95%: 0,02-0,76) con probabilidad posterior OR < 1 = 99%. CONCLUSIONES: La intervención educativa muestra eficacia en la reducción del número de agudizaciones

OBJECTIVE: To predict the effect of a brief educational intervention aimed at improving the inhaler technique on the reduction of exacerbations in patients with COPD over a year. MATHERIAL AND METHODS: A triple blind, randomised controlled clinical trial with parallel design. Inclusion criteria: to be between 40-75 years, having been diagnosed with COPD, and being on treatment with inhalers. A total of 97 patients were randomly selected. They were randomly assigned into 2 groups according to their functional severity measured with spirometry. Intervention group: evaluation of the inhalation technique. Their mistakes were corrected using a brief educational intervention. Reinforcement visits were made in the second and seventh month. CONTROL GROUP: evaluation of the inhalation technique. No educational intervention was made. After 1 year of follow-up, the number of exacerbations in each group was checked. Variables measured: social and demographic, study, dyspnoea level, body-mass index, tobacco use, FEV1, FEV1/FVC, COPD stage, BODEX index, number, type, and inhaler technique, number of previous exacerbations. Bayesian inference analysis was performed using logistic regression models. RESULTS: A total of 56 patients were assigned to de intervention group and 41 to the control one. There were 16 and 14 lost to follow-up, respectively. In the intervention group, 44.6% of the patients had an exacerbation, compared to the control group, with 56.1%. OR adjusted = 0.57 (95% CI: 0.22-1.22). Posterior probability OR < 1 = 93%. Exacerbations which required hospital admission had an OR = 0.21 (95% CI: 0.02-0.75) with posterior probability OR < 1= 99%. CONCLUSIONS: A brief educational technique is an effective method for reducing the number of exacerbations in patients with COPD

[Effectiveness of a brief educational intervention relating to the correct use of inhalers on the prevention of exacerbation in patients suffering from chronic obstructive pulmonary disease]. / Eficacia de una intervención educativa breve sobre el correcto uso de los inhaladores en la prevención de agudizaciones en pacientes con enfermedad pulmonar obstructiva crónica.

OBJECTIVE: To predict the effect of a brief educational intervention aimed at improving the inhaler technique on the reduction of exacerbations in patients with COPD over a year. MATHERIAL AND METHODS: A triple blind, randomised controlled clinical trial with parallel design. INCLUSION CRITERIA: to be between 40-75 years, having been diagnosed with COPD, and being on treatment with inhalers. A total of 97 patients were randomly selected. They were randomly assigned into 2groups according to their functional severity measured with spirometry. Intervention group: evaluation of the inhalation technique. Their mistakes were corrected using a brief educational intervention. Reinforcement visits were made in the second and seventh month. CONTROL GROUP: evaluation of the inhalation technique. No educational intervention was made. After 1 year of follow-up, the number of exacerbations in each group was checked. VARIABLES MEASURED: social and demographic, study, dyspnoea level, body-mass index, tobacco use, FEV1, FEV1/FVC, COPD stage, BODEX index, number, type, and inhaler technique, number of previous exacerbations. Bayesian inference analysis was performed using logistic regression models. RESULTS: A total of 56 patients were assigned to de intervention group and 41 to the control one. There were 16 and 14 lost to follow-up, respectively. In the intervention group, 44.6% of the patients had an exacerbation, compared to the control group, with 56.1%. OR adjusted = 0.57 (95% CI: 0.22-1.22). Posterior probability OR < 1 = 93%. Exacerbations which required hospital admission had an OR = 0.21 (95% CI: 0.02-0.75) with posterior probability OR < 1= 99%. CONCLUSIONS: A brief educational technique is an effective method for reducing the number of exacerbations in patients with COPD.

Epidemiología y manejo de la neumonía adquirida en la comunidad durante más de una década / Epidemiology and management of community acquired pneumonia: more than 10 years experience

Objetivo: Describir las características de los pacientes diagnosticados de neumonía adquirida en la comunidad (NAC) en nuestra zona básica de salud, su manejo, evolución y utilización de escalas pronósticas impulsados por los escasos estudios realizados desde Atención Primaria (AP) sobre estos aspectos. Material y métodos: Estudio observacional descriptivo transversal sobre la población de 3 centros de salud urbanos, diagnosticada de NAC en el periodo del 1/1/2000 al 31/7/2013, obteniéndose una muestra de 1.290 pacientes. Resultados: El 56,1% eran hombres y la edad media de la población era de 61,9 años. El 22,7% eran fumadores. El 59,9% presentaba patología existente en las escalas pronósticas, estando presente la diabetes mellitus en un 20%. El 36,1% tenía patología pulmonar (17,6% EPOC, 11,8% asma). En AP se diagnosticaron el 43,2% del total. La radiografía diagnóstica estaba presente en el 92,7% de los casos y la de control en el 59,4%. Se registraron escalas pronósticas en el 2% de los casos. Los antibióticos más utilizados fueron amoxicilina-clavulánico (30,7%) y levofloxacino (30,4%). Tener patología previa incrementa en 1,6 el riesgo de retratamiento [ICred 95% (1,1-2,2)]. El riesgo de mortalidad se multiplica por 5,3 en caso de presentar patología previa [ICred 95% (1,3-19,2]. Conclusiones: En nuestro medio la NAC es una enfermedad frecuente y potencialmente grave, la cual la presentan -en la mitad de los casos- pacientes con comorbilidad asociada. Si hablamos de tratamiento y manejo, cabe destacar el amplio uso que hacemos de amoxicilina-clavulánico frente a un uso escaso de amoxicilina, terapia combinada y escalas pronósticas

Objective: To describe the characteristics of patients diagnosed with Community Acquired Pneumonia in this basic health area, their management, outcomes, and use of prognostic scales driven by the few studies carried out from Primary Care on these aspects. Material and methods: Descriptive cross-sectional study on a population diagnosed with Community Acquired Pneumonia if three urban health centres, during the period January 2000 to 31 July 2103. Results: Out of a sample of 1,290 patients obtained, 56.1% were men, and the mean age of the population was 61.9 years. There were 22.7% smokers. More than half (59.9%) had a disease in the prognostic scales, with Diabetes Mellitus present in 20%, and 36.1% with pulmonary disease (17.6% COPD, 11.8% asthma). Just under half (43.2%) of the total patients were diagnosed in Primary Care. There was a diagnostic X-ray in 92.7% of the cases, and a follow-up X-ray in 59.4%. Prognostic scales were recorded in 2% of the cases. The most commonly used antibiotics were amoxicillin-clavulanic (30.7%) and levofloxacin (30.4%). Having prior disease increases the risk of re-treatment by 1.6 (95% CI; 1.1-2.2)]. The mortality risk is multiplied by 5.3 on having a previous disease (95% CI; 1.3-19.2). Conclusions: In the Primary Care setting, Community Acquired Pneumonia is a common and potentially serious disease which, in half the cases, occurs in patients with associated comorbidity. As regards treatment and management, is highlighted the wide use made of amoxicillin-clavulanic, compared to the low use of amoxicillin, combined therapy, and prognostic scales

[Epidemiology and management of community acquired pneumonia: more than 10 years experience]. / Epidemiología y manejo de la neumonía adquirida en la comunidad durante más de una década.

OBJECTIVE: To describe the characteristics of patients diagnosed with Community Acquired Pneumonia in this basic health area, their management, outcomes, and use of prognostic scales driven by the few studies carried out from Primary Care on these aspects. MATERIAL AND METHODS: Descriptive cross-sectional study on a population diagnosed with Community Acquired Pneumonia if three urban health centres, during the period January 2000 to 31 July 2103. RESULTS: Out of a sample of 1,290 patients obtained, 56.1% were men, and the mean age of the population was 61.9 years. There were 22.7% smokers. More than half (59.9%) had a disease in the prognostic scales, with Diabetes Mellitus present in 20%, and 36.1% with pulmonary disease (17.6% COPD, 11.8% asthma). Just under half (43.2%) of the total patients were diagnosed in Primary Care. There was a diagnostic X-ray in 92.7% of the cases, and a follow-up X-ray in 59.4%. Prognostic scales were recorded in 2% of the cases. The most commonly used antibiotics were amoxicillin-clavulanic (30.7%) and levofloxacin (30.4%). Having prior disease increases the risk of re-treatment by 1.6 (95% CI; 1.1-2.2)]. The mortality risk is multiplied by 5.3 on having a previous disease (95% CI; 1.3-19.2). CONCLUSIONS: In the Primary Care setting, Community Acquired Pneumonia is a common and potentially serious disease which, in half the cases, occurs in patients with associated comorbidity. As regards treatment and management, is highlighted the wide use made of amoxicillin-clavulanic, compared to the low use of amoxicillin, combined therapy, and prognostic scales.

Cribado de retinopatía diabética en atención primaria. Concordancia diagnóstica entre médicos de familia y oftalmólogos / Diabetic retinopathy screening programme in primary health care. Diagnostic concordance between family and eye care practitioners

Objetivo. Valorar la concordancia diagnóstica en la interpretación de retinografías entre el médico de atención primaria y el oftalmólogo, así como presentar los índices de validez de un programa de cribado de retinopatía diabética durante su fase de implantación. Material y métodos. Estudio descriptivo observacional de una muestra de 243 pacientes diabéticos (tipo 1 y 2) mayores de 14 años, de 2 centros de salud urbanos, captada de manera oportunista cuando acudían a consulta entre el 21/07/2011 y el 26/01/2012. Se les realizó retinografía digital bilateral de campo único a 45°, toma de presión intraocular y agudeza visual. Los médicos de atención primaria elaboraban un informe que se remitía junto con las retinografías telemáticamente al oftalmólogo, quien revisaba las imágenes y generaba un nuevo informe con su diagnóstico. La ausencia de retinografía y/o informe valorables se consideraron como pérdidas. Se estimaron la concordancia diagnóstica entre los observadores y los índices de validez del programa de cribado. Resultados. Se obtuvo un índice kappa de 0,62 (IC 95% 0,42-0,82) y un índice PABAK de 0,89 tras ajustar por prevalencia y sesgos. Se obtuvieron los siguientes índices de validez: sensibilidad 68,8%, especificidad 96,5%, valores predictivos positivo y negativo del 61,1 y 97,5%, respectivamente. El 57,2% de los pacientes no presentó enfermedad que requiriera derivación al oftalmólogo. Conclusiones. El grado de concordancia obtenido varía entre considerable/casi perfecto dependiendo del índice usado en el análisis (kappa/PABAK, respectivamente). La realización de retinografías en los centros de salud mejora la capacidad resolutiva del médico de atención primaria y la accesibilidad de los pacientes al cribado (AU)

Aim. To evaluate the diagnostic concordance in retinography interpretation between primary care and eye care practitioners and assess the soundness index of a diabetic retinography screening programme during its implementation stage. Material and methods. Descriptive, observational study was conducted on a sample of 243 patients with diabetes mellitus (type 1 and 2) over age 14, in 2 urban health care centers, gathered in an opportunistic manner between the dates of 21/07/2011 and 26/01/2012. A 45° digital bilateral retinography, intraocular pressure and visual acuity were obtained from each patient. The primary care practitioners prepared a report for each patient, which was telematically sent to the eye care doctor within the corresponding retinographies. A new diagnostic report was prepared then by the eye care doctor after revising the images. The lack of retinographies and/or reports were considered both as losses. The diagnostic concordance between the observers and the validity and reliability from the screening programme were estimated. Results. The kappa value obtained was 0.62 (95% CI 0.42-0.82) and 0.89 PABAK. The following validity indexes were obtained: Sensitivity 68.8%, specificity 96.5%, positive and negative predictive values: 61.1 and 97.5%, respectively. A percentage of 57.2 of the patients were not observed any pathology requiring referral to a eye care doctor. Conclusions. The concordance value obtained varied between considerable and almost perfect, depending on the index used for the analysis (kappa/PABAK, respectively). It's worth highlighting that carrying out retinographies in the primary care centers enhances patient-treatment capacity of the primary care doctors and the patients accessibility to screening (AU)

[Diabetic retinopathy screening programme in primary health care. Diagnostic concordance between family and eye care practitioners]. / Cribado de retinopatía diabética en atención primaria. Concordancia diagnóstica entre médicos de familia y oftalmólogos.

AIM: To evaluate the diagnostic concordance in retinography interpretation between primary care and eye care practitioners and assess the soundness index of a diabetic retinography screening programme during its implementation stage. MATERIAL AND METHODS: Descriptive, observational study was conducted on a sample of 243 patients with diabetes mellitus (type 1 and 2) over age 14, in 2 urban health care centers, gathered in an opportunistic manner between the dates of 21/07/2011 and 26/01/2012. A 45° digital bilateral retinography, intraocular pressure and visual acuity were obtained from each patient. The primary care practitioners prepared a report for each patient, which was telematically sent to the eye care doctor within the corresponding retinographies. A new diagnostic report was prepared then by the eye care doctor after revising the images. The lack of retinographies and/or reports were considered both as losses. The diagnostic concordance between the observers and the validity and reliability from the screening programme were estimated. RESULTS: The kappa value obtained was 0.62 (95% CI 0.42-0.82) and 0.89 PABAK. The following validity indexes were obtained: Sensitivity 68.8%, specificity 96.5%, positive and negative predictive values: 61.1 and 97.5%, respectively. A percentage of 57.2 of the patients were not observed any pathology requiring referral to a eye care doctor. CONCLUSIONS: The concordance value obtained varied between considerable and almost perfect, depending on the index used for the analysis (kappa/PABAK, respectively). It's worth highlighting that carrying out retinographies in the primary care centers enhances patient-treatment capacity of the primary care doctors and the patients accessibility to screening.

Association between low 25-hydroxyvitamin D, insulin resistance and arterial stiffness in nondiabetic women with systemic lupus erythematosus.

OBJECTIVE: The objective of this paper is to examine if there is an association between low levels of 25-hydroxyvitamin D (25(OH)D) and insulin resistance (IR) in nondiabetic women with systemic lupus erythematosus (SLE) and to evaluate its impact on arterial stiffness. PATIENTS AND METHODS: In this cross-sectional study 25(OH)D, insulin, insulin resistance measured by the homeostatic model assessment (HOMA-IR), homocysteine, fibrinogen, characteristics of SLE, medications and pulse-wave velocity (PWV) were measured in 106 nondiabetic women with SLE and 101 matched controls. RESULTS: Women with SLE tended to have lower 25(OH)D levels (p = 0.078) and a higher frequency of 25(OH)D deficiency (defined as < 10 ng/ml) than controls (p = 0.058). Patients from the lowest quartile of the 25(OH)D range had higher PWV (p = 0.043), fasting glucose (p = 0.035), insulinemia (p ≤ 0.001), HOMA-IR (p = 0.006), C4 (p = 0.012), as well as more frequent IR (p = 0.002) and metabolic syndrome (p = 0.052) than those in the upper quartile, and no differences were found in age, body mass index (BMI), blood pressure, lipid levels and renal function. In women with SLE, 25(OH)D inversely correlated with insulin (p = 0.006), HOMA-IR (p = 0.008) and C4 (p = 0.048) and tended to correlate with fibrinogen (p = 0.060) after adjustment for BMI, age, SLEDAI, prednisone dose, renal function, inflammation markers and seasonal variation, but not with PWV. In controls, 25(OH)D correlated only with homocysteine after the same adjustment, and the correlation with PWV tended to be significant after adjustment for BMI and age (r = -0.190, p = 0.10). CONCLUSION: Low 25(OH)D levels were found to be associated with increased IR in nondiabetic women with SLE independently of BMI. Low 25(OH)D levels, but not IR, could be associated with increased arterial stiffness in these patients.

Influence of the polyelectrolyte molecular weight on exponentially growing multilayer films in the linear regime.

Alternated deposition of polyanions and polycations on a charged solid substrate leads to the buildup of polyelectrolyte multilayer (PEM) films. Two types of PEM films were reported in the literature: films whose thickness increases linearly and films whose thickness increases exponentially with the number of deposition steps. However, it was recently found that, for exponentially growing films, the exponential increase of the film thickness takes place only during the initially deposited pairs of layers and is then followed by a linear increase. In this study, we investigate the growth process of hyaluronic acid/poly(L-lysine) (HA/PLL) and poly(L-glutamic acid)/poly(allylamine) (PGA/PAH) films, two films whose growth is initially exponential, when the growth process enters the linear regime. We focus, in particular, on the influence of the molecular weight (Mw) of the polyelectrolytes. For both systems, we find that the film thickness increment per polyanion/polycation deposition step in the linear growth regime is fairly independent of the molecular weights of the polyelectrolytes. We also find that when the (HA/PLL)n films are constructed with low molecular weight PLL, these chains can diffuse into the entire film during each buildup cycle, even for very thick films, whereas the PLL diffusion of high molecular weight chains is restricted to the upper part of the film. Our results lead to refinement of the buildup mechanism model, introduced previously for the exponentially growing films, which is based on the existence of three zones over the entire film thickness. The mechanism no longer needs all the "in" and "out" diffusing polyanions or polycations to be involved in the buildup process to explain the linear growth regime but merely relies on the interaction between the polyelectrolytes with an upper zone of the film. This zone is constituted of polyanion/polycation complexes which are "loosely bound" and rich in the polyelectrolyte deposited during the former deposition step.