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Influencia de los determinantes sociales de la salud en la elección de tratamiento renal sustitutivo en la enfermedad renal crónica avanzada: necesidad de un enfoque multidisciplinar
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Introduction: The influence of socioeconomic and cultural barriers in the choice of renal replacement therapy (RRT) techniques in advanced chronic kidney disease (ACKD) has been scarcely explored, which can generate problems of inequity, frequently unnoticed in health care. The aim of this study is to identify the “non-medical” barriers that influence the choice of RRT in an ACKD consultation in Spain.
Material and methods: Retrospective analysis including the total number of patients seen in the ACKD consultation in a tertiary hospital from 2009 to 2020. Inclusion in the ACKD consultation began with an eligibility test and a decision-making process, conducted by a specifically trained nurse. The variables considered for the study were: age, sex, etiology of CKD, level of dependence for basic activities of daily living (Barthel scale) and instrumental activities of daily living (Lawton and Brody scale), Spanish versus foreign nationality, socioeconomic level and language barrier. The socioeconomic level was extrapolated according to home and health district by primary care center to which the patients belonged.
Results: A total of 673 persons were seen in the ACKD consultation during the study period, of whom 400 (59.4%) opted for hemodialysis (HD), 156 (23.1%) for peritoneal dialysis (PD), 4 (0.5%) for early living donor renal transplantation and 113 (16.7%) chose conservative care (CC). The choice of PD as the chosen RRT technique (vs. HD) was associated with people with a high socioeconomic level (38.7 vs. 22.5%) (p = 0.002), Spanish nationality (91 vs. 77.7%) (p < 0,001), to a lower language barrier (0.6 vs. 10.5%) (p < 0.001), and to a higher score on the Barthel scale (97.4 vs. 92.9) and on the Lawton and Brody scale (7 vs. 6.1) (p < 0.001). Neither age nor sex showed significant differences in the choice of both techniques. Patients who opted for CC were significantly older (81.1 vs. 67.7 years; p < 0.001), more dependent (p < 0.001), with a higher proportion of women (49.6 vs. 35.2%; p = 0.006) and a higher proportion of Spaniards (94.7 vs. 81%, p = 0.001) in relation to the choice of other techniques (PD and HD). Socioeconomic level did not influence the choice of CC.
Conclusion: Despite a regulated decision-making process, there are factors such as socioeconomic status, migration, language barrier and dependency of the population that influence the type of RRT chosen. To address these aspects that may cause inequity, an intersectoral and multilevel intervention is required with interdisciplinary teams that include, among others, social workers, to provide a more holistic and person-centered assessment.Instituto de Investigación Sanitaria del Principado e Asturias (ISPA
Role of Klotho and AGE/RAGE-Wnt/ -Catenin Signalling Pathway on the Development of Cardiac and Renal Fibrosis in Diabetes
Get PDFAbstract: Fibrosis plays an important role in the pathogenesis of long-term diabetic complications and
contributes to the development of cardiac and renal dysfunction. The aim of this experimental study,
performed in a long-term rat model, which resembles type 1 diabetes mellitus, was to investigate
the role of soluble Klotho (sKlotho), advanced glycation end products (AGEs)/receptor for AGEs
(RAGE), fibrotic Wnt/ -catenin pathway, and pro-fibrotic pathways in kidney and heart. Diabetes
was induced by streptozotocin. Glycaemia was maintained by insulin administration for 24 weeks.
Serum and urine sKlotho, AGEs, soluble RAGE (sRAGE) and biochemical markers were studied. The
levels of Klotho, RAGEs, ADAM10, markers of fibrosis (collagen deposition, fibronectin, TGF- 1,
and Wnt/ -catenin pathway), hypertrophy of the kidney and/or heart were analysed. At the end
of study, diabetic rats showed higher levels of urinary sKlotho, AGEs and sRAGE and lower serum
sKlotho compared with controls without differences in the renal Klotho expression. A significant
positive correlation was found between urinary sKlotho and AGEs and urinary albumin/creatinine
ratio (uACR). Fibrosis and RAGE levels were significantly higher in the heart without differences in
the kidney of diabetic rats compared to controls. The results also suggest the increase in sKlotho and
sRAGE excretion may be due to polyuria in the diabetic rats.Instituto de Investigación Sanitaria del Principado de Asturias (ISPA
Synthesis of substituted benzylboronates by light promoted homologation of boronic acids with N-sulfonylhydrazones
No full textThe synthesis of benzylboronates by photochemical homologation of boronic acids with N-tosylhydrazones under basic conditions is described. The reaction involves the photolysis of the N-tosylhydrazone salt to give a diazoalkane followed by the geminal carboborylation of the diazoalkane. Under the mild reaction conditions, the protodeboronation of the unstable benzylboronic acid is circumvented and the pinacolboronates can be isolated after reaction of the benzylboronic acid with pinacol. The metholodogy has been applied to the reactions of alkylboronic acids with N-tosylhydrazones of aromatic aldehydes and ketones, and to the reactions of arylboronic acids with N-tosylhydrazones of aliphatic ketones. Moreover, the employment of the DBU/DIPEA bases combination allows for homogeneous reactions which have been adapted to photochemical continuous flow conditions. Additionally, the synthetic versatility of boronates enables their further transformation via Csp3–C or Csp3–X bond forming reactions converting this methodology into a novel method for the geminal difunctionalization of carbonyls via N-tosylhydrazones.Financial support of this work by Ministerio de Ciencia e Innovación of Spain (Agencia Estatal de Investigaci´on: PID2019-107580GB-I00/AEI/10.13039/501100011033). A FICYT (Principality of Asturias) “Margarita Salas Joven” postdoctoral grant to M. P. (AYUD/2021/58397) is gratefully acknowledged
Outcomes of COVID-19 in peritoneal dialysis patients: A report by the European Renal Association COVID-19 Database
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Background: The clinical course of COVID-19 in peritoneal dialysis (PD) patients has so far only been analysed in relatively small, often single-centre case series. Therefore, we studied patient- and disease-related characteristics and outcomes of COVID-19 in a larger European cohort of PD patients.
Methods: We used data from the European Renal Association COVID-19 Database (ERACODA) on PD and
haemodialysis (HD) patients with COVID-19 (presentation between February 2020 and April 2021). Hazard
ratios (HR) for mortality at 3 months were calculated using Cox proportional-hazards regression. In addition, we
examined functional and mental health status among survivors at this time point as determined by their treating
physician.
Results: Of 216 PD patients with COVID-19, 80 (37%) were not hospitalised and 136 (63%) were hospitalised, of whom 19 (8.8%) were admitted to an intensive care unit. Mortality at 3 months for these subgroups was 18%, 40%, and 37%, respectively (p ¼ 0.0031). Compared with HD patients, PD patients had higher mortality (crude HR: 1.49; 95% CI: 1.33–1.66), even when adjusted for patient characteristics and disease severity (adjusted HR: 1.56; 95% CI: 1.39–1.75). Follow-up data on 67 of 146 patients who survived COVID-19 showed functional recovery to pre-COVID-19 levels in 52 (78%) and mental recovery in 58 patients (87%) at 3 months after the COVID-19 diagnosis.Instituto de Investigación Sanitaria del Principado de Asturias (ISPA
Benefits of the Neurogenic Potential of Melatonin for Treating Neurological and Neuropsychiatric Disorders
Get PDFAbstract: There are several neurological diseases under which processes related to adult brain
neurogenesis, such cell proliferation, neural differentiation and neuronal maturation, are affected.
Melatonin can exert a relevant benefit for treating neurological disorders, given its well-known
antioxidant and anti-inflammatory properties as well as its pro-survival effects. In addition, melatonin
is able to modulate cell proliferation and neural differentiation processes in neural stem/progenitor
cells while improving neuronal maturation of neural precursor cells and newly created postmitotic
neurons. Thus, melatonin shows relevant pro-neurogenic properties that may have benefits for
neurological conditions associated with impairments in adult brain neurogenesis. For instance, the
anti-aging properties of melatonin seem to be linked to its neurogenic properties. Modulation of
neurogenesis by melatonin is beneficial under conditions of stress, anxiety and depression as well
as for the ischemic brain or after a brain stroke. Pro-neurogenic actions of melatonin may also be
beneficial for treating dementias, after a traumatic brain injury, and under conditions of epilepsy,
schizophrenia and amyotrophic lateral sclerosis. Melatonin may represent a pro-neurogenic treatment
effective for retarding the progression of neuropathology associated with Down syndrome. Finally,
more studies are necessary to elucidate the benefits of melatonin treatments under brain disorders
related to impairments in glucose and insulin homeostasis.Instituto de Investigación Sanitaria del Principado de Asturias (ISPA
Embarazo ectópico. Hospital Universitario Central de Asturias
Get PDFProtocolo del Servicio de Obstetricia y Ginecología el HUCA. Área Sanitaria I
Guía de respuesta a solicitudes de acceso a información pública (SAIP)
No full textGuía elaborada por la Universidad de Oviedo en colaboración con la Dirección General de de Gobernanza Pública, Transparencia, Participación Ciudadana y Agenda 2030 y coordinada por Eva Menéndez Sebastián.La Administración del Principado de Asturias y su sector público tienen un firme compromiso con la ciudadanía y con la denominada gobernanza pública, una nueva forma de gestión pública que trata de dar respuesta a la idea de una relación entre sociedad y poderes públicos renovada, basada en la transparencia, la ética pública, la participación, la rendición de cuentas, la eficiencia y eficacia, la innovación y, especialmente, la igualdad e
inclusión.
En este contexto un pilar fundamental de esa nueva relación es el acceso a la información pública, pues ello permite que los/as ciudadanos/as conozcan a la Administración, qué está haciendo, pueden valorar si su actuación es correcta, pueden participar con criterio en la acción pública, etc.
En definitiva, la transparencia es en cierto modo el presupuesto básico o elemento que conecta en gran medida los otros aspectos clave de un buen gobierno y de una Administración eficaz y responsable (ética pública, participación, rendición de cuentas, etc.).En esta dirección el Principado de Asturias cuenta con un portal de transparencia que ha sido el mejor valorado entre todas las páginas de las Administraciones públicas en la evaluación realizada por el CTBG de España (en adelante CTBG) en los últimos años.
No obstante, junto a la transparencia pasiva que es a la que responde el portal de transparencia, también es preciso atender a la transparencia activa, es decir, aquella que da respuesta al ejercicio del derecho de acceso a la información pública.
En aras de mejorar esa respuesta y facilitar la labor que a este respecto lleva a cabo el personal encargado de estas solicitudes, se ofrece aquí una guía básica con conceptos, criterios y modelos que permitan alcanzar una mayor seguridad jurídica y uniformidad en el ejercicio de esta función
Point‑of‑care ultrasonography in diagnosing necrotizing fasciitis—a literature review
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Introduction
Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the fascial layer with a high mortality rate. It is a life-threatening medical emergency that requires urgent treatment. Lack of skin finding in NF made diagnosis difficult and required a high clinical index of suspicion. The use of ultrasound may guide clinicians in improving diagnostic speed and accuracy, thus leading to improved management decisions and patient outcomes. This literature search aims to review the use of point-of-care ultrasonography in diagnosing necrotizing fasciitis.
Method
We searched relevant electronic databases, including PUBMED, MEDLINE, and SCOPUS, and performed a systematic review. Keywords used were “necrotizing fasciitis” or “necrotising fasciitis” or “necrotizing soft tissue infections” and “point-of-care ultrasonography” “ultrasonography” or “ultrasound”. No temporal limitation was set. An additional search was performed via google scholar, and the top 100 entry was screened.
Results
Among 540 papers screened, only 21 were related to diagnosing necrotizing fasciitis using ultrasonography. The outcome includes three observational studies, 16 case reports, and two case series, covering the period from 1976 to 2022.
Conclusion
Although the use of ultrasonography in diagnosing NF was published in several papers with promising results, more studies are required to investigate its diagnostic accuracy and potential to reduce time delay before surgical intervention, morbidity, and mortality.Instituto de Investigación Sanitaria del Principado de Asturias (ISPA
Análisis de la producción científica en el Área Sanitaria IV. Servicio de Salud del Principado de Asturias (2018-2022).
No full textEste trabajo fin de máster pretende alcanzar el objetivo de conocer y analizar la
producción científica del Área Sanitaria IV, del Servicio de Salud del Principado de
Asturias, durante el periodo comprendido entre el 2018-2022. Se obtuvieron 3.808
registros, de los cuales solamente 3.501 procedían de una institución normalizada: El
Hospital Universitario Central de Asturias (HUCA). Se utilizó para el análisis los
indicadores disponibles en la Web of Science (WoS), y se analizaron con la suite de
Incites y se utilizó como software de análisis de datos Biblioshiny. Para la visualización
de las redes de colaboración se trabajó con la herramienta VOSviewer. Los resultados
de la investigación reflejaron que la mayor parte de la producción científica se concentra
en el Hospital Universitario Central de Asturias, siendo este un referente para Asturias
en materia sanitaria. La tendencia de la colaboración es local, ya que la mayor parte de
las instituciones con más documentos en colaboración son de organizaciones locales
como son la Universidad de Oviedo y el Instituto de Investigación Sanitaria del
Principado de Asturias (ISPA). Las áreas temáticas donde más se publica son Oncología
y Cardiología; la autora con mayor número de publicaciones es Paula Jiménez-Fonseca.
Con este trabajo se pretende aportar información a la institución para concienciar a los
gestores de la importancia de conocer los patrones de comportamiento de su producción
científica que puede servir para establecer una política científica a la hora de determinar
proyectos, alianzas de colaboración y planes de formación para mejorar la situación del
Servicio de Salud de Asturias.With this work the objective of knowing and analyzing the scientific production of the
Health Area IV, of the Health Service of the Principality of Asturias, during the period
from 2018-2022. A total of 3,808 records were obtained, of which only 3,501 came
from a standardized institution: the Hospital Universitario Central de Asturias (HUCA).
The indicators available in the Web of Science (WOS) were used for the analysis, and
were analyzed with the Incites suite and Biblioshiny data analysis software. The
VOSviewer tool was used to visualize the collaborative networks. The results of the
research showed that most of the scientific production is concentrated in the Hospital
Universitario Central de Asturias, which is a reference point for Asturias in the field of
health. The tendency of collaboration is local, since most of the institutions with more
documents in collaboration are local organizations such as the University of Oviedo and
the Institute for Health Research of the Principality of Asturias (ISPA). Oncology and
Cardiology are the most published thematic areas; the author with the highest number of
publications is Paula Jiménez-Fonseca. The aim of this work is to provide information
to the institution in order to make managers aware of the importance of knowing the
behavioral patterns of its scientific production, which can be used to establish an
appropriate methodology for the management of the institution
Chronic Kidney Disease–Associated Pruritus and Quality of Life: Learning from Our Patients
Get PDFChronic kidney disease–associated pruritus is itching directly related to kidney disease that cannot be explained by any other condition. Despite technological advances in the different aspects of dialysis sessions and the best treatment for chronic kidney disease patients, it is still a common problem in our patients. The many complex physiological mechanisms involved, the different hypotheses made over the years on the aetiology of the condition, and the great clinical variability may partially explain the limited knowledge about this problem and the difficulties in treating it. The presence of all these factors leads to the persistence of unpleasant symptoms, which must affect the disease burden and quality of life of kidney patients. Through the presentation of an illustrative clinical case, the aim of this review article is to highlight the need for adequate diagnosis and an improved approach to all aspects of chronic kidney disease–associated pruritus, in view of
the heavy burden of the disease and the huge impact on the patient’s quality of life.Instituto de Investigación Sanitaria del Principado de Asturias (ISPA