Less invasive surfactant administration reduces incidence of severe intraventricular haemorrage in preterms with respiratory distress syndrome: a cohort study.

OBJECTIVE: Less invasive surfactant administration (LISA) has proved to safely improve morbidity in extreme preterms with respiratory distress syndrome (RDS). Its effect regarding intraventricular hemorrhage (IVH) remains controversial between most recent systematic reviews. We aimed to evaluate its effect over incidence of severe IVH in this population. STUDY DESIGN: We compared the incidence of IVH in a prospective cohort of consecutively born preterm infants <34 weeks' gestation receiving LISA (n = 108) with a historical cohort receiving surfactant delivery via tracheal tube and managed with mechanical ventilation (n = 100). RESULTS: No significant differences regarding perinatal characteristics were observed between both groups. There was a significant reduction in the incidence of severe IVH in LISA group as compared with the historical group [OR = 0.054 (95% CI 0.01-0.2) p = 0.000. NNT 5]. In addition, a significant trend towards decreased mortality was also observed in the study group [OR = 0.2 (95% CI 0.04-0.9) p = 0.027, NNT 9]. Intervention group infants also showed lower oxygenation requirements during the first 72 h post surfactant administration and a reduced incidence of pneumothorax. They were less frequently intubated [31 infants (28.4%) vs. 100 [100%]; P < 0.001] and required fewer days of mechanical ventilation. However, no significant difference in bronchopulmonary dysplasia incidence was observed between both groups. CONCLUSIONS: LISA approach effectively reduces severe IVH in very low and low birth weight (BW) preterms with RDS. In addition we observe a significant trend towards reduction in both need and duration of MV support, air leak, and overall mortality in the intervention group.

Is it necessary to treat all asthmatic children with raised levels of exhaled nitric oxide? Treating the patient or the data

Background: The aim of the present study is to assess whether a single determination of the fraction of exhaled nitric oxide (FENO), added to the measurements usually taken during a routine checkup, helps in the prediction of the recurrence of asthma attacks in controlled patients who are not receiving any baseline treatment; and whether or not treatment of the said latent inflammation is appropriate. Methods: Observational study of prospective cohorts. Over a period of three months, data was collected from 28 patients (6 to 14 years) who met the conditions of the inclusion criteria, with a follow up appointment after six months. Results: Patients were divided into two groups: 13 with FENO values of 49 and over, and 15 with values of under 49. Five patients in the subgroup with low FENO values suffered recurrence, in contrast to only one in the group with high values. The positive predictive value of the high values of the FENO was 7.69, with no significant differences between the two groups. Conclusions: Certain doubts were raised about the usefulness of the FENO, as opposed to the traditional methods of asthma control with regard to the therapeutic management of clinically controlled patients who are not receiving treatment and who have high FENO values. It would appear unwise to recommend the systematic treatment of patients with high FENO values, when measured during a routine check-up, in cases of asthma with an allergic component and are asymptomatic or in a phase of asthma under good control (AU)

Is it necessary to treat all asthmatic children with raised levels of exhaled nitric oxide?: treating the patient or the data.

BACKGROUND: The aim of the present study is to assess whether a single determination of the fraction of exhaled nitric oxide (FENO), added to the measurements usually taken during a routine checkup, helps in the prediction of the recurrence of asthma attacks in controlled patients who are not receiving any baseline treatment; and whether or not treatment of the said latent inflammation is appropriate. METHODS: Observational study of prospective cohorts. Over a period of three months, data was collected from 28 patients (6 to 14 years) who met the conditions of the inclusion criteria, with a follow up appointment after six months. RESULTS: Patients were divided into two groups: 13 with FENO values of 49 and over, and 15 with values of under 49. Five patients in the subgroup with low FENO values suffered recurrence, in contrast to only one in the group with high values. The positive predictive value of the high values of the FENO was 7.69, with no significant differences between the two groups. CONCLUSIONS: Certain doubts were raised about the usefulness of the FENO, as opposed to the traditional methods of asthma control with regard to the therapeutic management of clinically controlled patients who are not receiving treatment and who have high FENO values. It would appear unwise to recommend the systematic treatment of patients with high FENO values, when measured during a routine check-up, in cases of asthma with an allergic component and are asymptomatic or in a phase of asthma under good control.

Novedades en el campo de los factores de progresión en la Enfermedad Renal Crónica / No disponible

La lucha contra la progresión de la enfermedad renal crónica es uno de los aspectos más relevantes de la práctica nefrológica, tanto desde la perspectiva de la actividad clínica como desde el campo de la investigación dentro del campo de la Nefrología. En este breve artículo presentamos, de forma muy resumida, algunos de los aspectos que a los autores nos han resultado de interés en el último año en este contexto. Dado que lo que en estas pocas páginas se recoge ha de pasar de forma obligada por el filtro de la subjetividad de quien escribe, asumimos que otros muchos temas de gran interés quedan fuera de este resumen. En cualquier caso, esperamos que lo aquí publicado sea de interés y utilidad, y al mismo tiempo, sirva como elemento de debate en los foros nefrológicos (AU)

The fight against chronic kidney disease is one of the most relevant aspects of nephrological practice, from both the perspective of clinical activity and research within the field of nephrology. In this brief article, we present in very summarized form some of the aspects in this field in the last year that the authors found of interest. Because the content of the next few pages was necessarily chosen on the basis of the authors’ preferences, we assume that many other topics of great interest have been left out of this summary. In any case, we hope that this article will be interesting and useful and also serve as an subject of debate in nephrology forums (AU)

[Novelties in the field of progression factors in chronic kidney disease]. / Novedades en el campo de los factores de progresión en la Enfermedad Renal Crónica.

The fight against chronic kidney disease is one of the most relevant aspects of nephrological practice, from both the perspective of clinical activity and research within the field of nephrology. In this brief article, we present in very summarized form some of the aspects in this field in the last year that the authors found of interest. Because the content of the next few pages was necessarily chosen on the basis of the authors' preferences, we assume that many other topics of great interest have been left out of this summary. In any case, we hope that this article will be interesting and useful and also serve as an subject of debate in nephrology forums.

[Characteristics of the diabetic patients referred for the first time to the nephrologist]. / Características de los pacientes diabéticos referidos por primera vez a las consultas de atención especializada de Nefrología.

BACKGROUND: Diabetic nephropathy (DN) has become the main cause of end-stage renal disease. In our country, this problem is specially relevant in Canary Islands, where DN is the cause of renal failure in 39% of patients included in dialysis programs. The importance of this situation and the relevance of an adequate referral to the nephrologist, prompt us to study the characteristics of diabetic patients referrred to our outpatient clinic. SUBJECTS AND METHODS: One-hundred and fifty patients with diabetes consecutively referred to the outpatient nephrology clinic at the Hospital Universitario Nuestra Señora de Candelaria were included in the study. We analysed demographic and epidemiologic characteristics, therapeutic strategies, as well as serum and urine biochemical parameters. RESULTS: Ninety-eight percent of patients suffered from type 2 diabetes, and 90% were referred by the primary physician. Renal insufficiency and proteinuria were the main causes of referral (48% and 30.6%, respectively). Overweight or obesity were present in 82.6% of patients, 97% were hypertensive and 92.6% presented dyslipidemia. Medical history of cardiovascular disease was present 16% of patients. Two-thirds of patients had a creatinine clearance below 60 ml/min. One-third of patients did not receive therapy with blockers of the renin-angiotensin system, and only 37% were treated with statins. CONCLUSIONS: An elevated percentage of diabetic patients referred to nephrologist did not reach the recommended therapeutic goals. These findings prompt us to reflect on the therapeutic approach in these patients and the referral to the nephrologist.

Desfibrilador automático implantable en pacientes en hemodiálisis / Automatic implantable cardioverter defibrillator in hemodialysis patients

No disponible

No disponible

Características de los paciente diabéticos referidos por primera vez a las consultas de atención especializada de Nefrología / Characteristics of the diabetic patients referred for the first time to the nephrologist

Introducción: La nefropatía diabética (ND) se ha convertido en la primera causa de insuficiencia renal crónica en nuestro país. Esta patología es especialmente relevante en las Islas Canarias, donde el porcentaje de pacientes en programas de diálisis con ND como enfermedad de base era a 31 de diciembre de 2005 del 39%. Dada la importancia de esta situación, y la trascendencia que en los últimos años ha cobrado la problemática relacionada con la remisión de los pacientes con enfermedad renal a los servicios de Nefrología, el objetivo del presente estudio ha sido analizar las características de la población diabética que es derivada a las unidades de atención especializada de Nefrología. Pacientes y Métodos: Estudio de los 150 primeros pacientes diabéticos que, a partir de octubre de 2001, fueron remitidos de forma consecutiva a las consultas de Nefrología del Hospital Universitario Nuestra Señora de Candelaria de Santa Cruz de Tenerife. Se realizó una historia clínica y exploración física completas, se recogieron datos relativos a las pautas terapéuticas, se realizó una analítica de sangre y orina de 24 horas. Resultados: El 98% de los pacientes eran diabéticos tipo 2, y en el 90% de los casos fueron remitidos por su médico de Atención Primaria. La presencia de insuficiencia renal y de proteinuria fueron los dos motivos más frecuentes de derivación (48% y 30,6%, respectivamente). El 82,6% de los pacientes presentaba sobrepeso u obesidad, el 88% hipertensión arterial y el 92,6% dislipemia. Un 16% de los pacientes 6% presentaba algún antecedente de enfermedad cardiovascular. Dos tercios de los pacientes presentaban un aclaramiento de creatinina inferior a 60 ml/min. Un tercio de los pacientes no recibían tratamiento con bloqueadores del sistema renina-angiotensina, y sólo un 37% estaban tratados con estatinas. Conclusiones: Un elevado porcentaje de los pacientes diabéticos remitidos a los Servicios de Nefrología no presenta un cumplimiento adecuado de los objetivos terapéuticos. Es preciso reflexionar sobre la actitud terapéutica en estos pacientes y su remisión al nefrólogo

Background: Diabetic nephropathy (DN) has become the main cause of endstage renal disease. In our country, this problem is specially relevant in Canary Islands, where DN is the cause of renal failure in 39% of patients included in dialysis programs. The importance of this situation and the relevance of an adequate referral to the nephrologist, prompt us to study the characteristics of diabetic patients refered to our outpatient clinic. Subjects and methods: One-hundred and fifty patients with diabetes consecutively referred to the outpatient nephrology clinic at the Hospital Universitario Nuestra Señora de Candelaria were included in the study. We analysed demographic and epidemiologic characteristics, therapeutic strategies, as well as serum and urine biochemical parameters. Results: Ninety-eight percent of patients suffered from type 2 diabetes, and 90% were referred by the primary physician. Renal insufficiency and proteinuria were the main causes of referral (48% and 30.6%, respectively). Overweight or obesity were present in 82.6% of patients, 97% were hypertensive and 92.6% presented dyslipidemia. Medical history of cardiovascular disease was present 16% of patients. Two-thirds of patients had a creatinine clearance below 60 ml/min. One-third of patients did not receive therapy with blockers of the renin-angiotensin system, and only 37% were treated with statins. Conclusions: An elevated percentage of diabetic patients referred to nephrologist did not reach the recommended therapeutic goals. These findings prompt us to reflect on the therapeutic approach in these patients and the referral to the nephrologist

Acceso vascular central para hemodiálisis y disfonía / No disponible

No disponible