Nueva evidencia en el tratamiento de la enfermedad renal diabética: ¿qué aporta la finerenona?

Contexto: la enfermedad renal diabética (ERD) es la primera causa a nivel mundial de enfermedad renal crónica (ERC) e impacta directamente en el riesgo cardiovascular y mortalidad de los pacientes con diabetes mellitus (DM). La finerenona, un antagonista selectivo del receptor mineralocorticoide (ARM), ha sido descrito en diversos estudios recientes como un fármaco que contribuye a la reducción de la progresión de la ERD y la disminución del riesgo cardiovascular, con un adecuado perfil de seguridad. Objetivo: realizar una revisión de la literatura sobre el impacto de la finerenona en la progresión del daño renal y el riesgo cardiovascular en los pacientes con ERD. Metodología: se realizó una búsqueda sistemática en diversas fuentes: PubMed (Medline, Biblioteca del Congreso de los Estados Unidos), Science Direct, Scopus, Embase y Lilacs; la búsqueda fue restringida a referencias en idioma español e inglés, sin límites en la fecha de publicación. Se utilizaron las siguientes palabras clave en el idioma inglés: diabetic renal disease, chronic kidney disease, diabetes mellitus, spironolactone, eplerenone, finerenone, mineralocorticoid receptor antagonist y sus correspondientes versiones en español. Resultados: Las referencias encontradas en la búsqueda fueron revisadas entre los diferentes autores para, posteriormente, proceder a realizar la elaboración del documento. Conclusiones: la finerenona es un medicamento que brinda cardio y nefroprotección en pacientes con ERD de fenotipo albuminúrico.

Background: Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) worldwide and has a direct impact on cardiovascular risk and mortality in patients with diabetes mellitus (DM). Finerenone, a selective mineralocorticoid receptor (MRA) antagonist, has been described in several recent studies as a drug that contributes to slowing the progression of CKD and reducing cardiovascular risk, with an adequate safety profile. Purpose: To carry out a review of the literature on the impact of finerenone on the progression of renal damage and cardiovascular risk in patients with DKD. Methodology: A systematic search were carried out in various sources: PubMed (Medline, United States Library of Congress), Science Direct, Scopus, Embase and Lilacs; the search was restricted to references in Spanish and English, with no limits on publication date. The following keywords in the English language were used: diabetic renal disease, chronic kidney disease, diabetes mellitus, spironolactone, eplerenone, finerenone, mineralocorticoid receptor antagonist and their corresponding Spanish versions. Results: The references found in the search were reviewed among the different authors to subsequently proceed to prepare the document. Conclusions: Finerenone is a drug that provides cardio and nephroprotection in patients with DKD albuminuric phenotype.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, el diagnóstico y el manejo de la lesión renal aguda por SARS-CoV-2/COVID-19 / Colombian consensus of experts on recommendations informed in the evidence for the prevention, diagnosis and management of acute kidney injury by SARS-CoV-2/COVID-19

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Abstract Introduction: Acute kidney injury is a frequent complication in patients with COVID-19 and its occurrence is a potential indicator of multi-organ dysfunction and disease severity. Objective: Develop, through an expert consensus, evidence-based recommendations for the prevention, diagnosis, and management of acute kidney injury in patients with SARS CoV2 / COVID-19 infection. Materials and methods: Based on a rapid systematic review in Embase and Pubmed databases and documents from scientific societies, we made preliminary recommendations and consulted with an expert group through an online tool. Then we defined agreement after at least 70 % consensus approval. Quality evidence was evaluated according to the type of document included. The strength of the recommendations was graded as strong or weak. Results: Fifty clinical experts declared their conflict of interest; the consultation took place between May 2 and 29, 2020. The range of agreement ranged from 75.5 % to 100 %. Recommendations for prevention, diagnosis and management of acute kidney injury in patients with SARS CoV2 infection are presented. Conclusions: Although the good quality information available regarding acute kidney injury in patients with COVID-19 is scarce, the recommendations of clinical experts will guide clinical decision-making and strategies around patients with this complication, guaranteeing care focused on the people, with high quality standards, and the generation of safety, health and wellness policies for multidisciplinary care teams.

Tiempo medio en alcanzar un embarazo deseado y factores influyentes / Time to reach a desired pregnancy and influence factors

Introducción: En la actualidad, en los países desarrollados la mayoría de los embarazos son planificados. La fertilidad es el resultado de la interacción de numerosos factores. El tiempo medio en alcanzar un embarazo constituye un marcador de fertilidad, y su estimación puede ser útil para facilitar la planificación de la gestación así como la determinación de la influencia de diversos factores. Objetivo: Conocer el tiempo medio en alcanzar un embarazo deseado en una pareja fértil y determinar la forma en la que influyen factores como la edad de ambos cónyuges, el número de gestación, el número de relaciones sexuales, la toma de ácido fólico preconcepcional, la fórmula menstrual y la menarquia. Método: Estudio descriptivo retrospectivo de 491 gestantes que alcanzaron un embarazo deseado espontáneo en una Zona Básica de Salud de Guadalajara. Se recogieron los datos por medio de una encuesta anónima autocumplimentada que se administró en la primera visita de embarazo atendida por la matrona. Tras su realización, la encuesta fue depositada en un sobre para garantizar el anonimato y la confidencialidad de los datos. Resultados: El tiempo medio en alcanzar un embarazo deseado fue de 7,3 ciclos. Esta estimación estuvo influenciada significativamente por la edad tanto materna como paterna, el número de gestación, la duración de la menstruación y la menarquia. Sin embargo, no se puede asegurar la existencia de relaciones significativas con la toma de ácido fólico preconcepcional, con la duración del ciclo menstrual ni con el número de relaciones sexuales practicadas en la búsqueda de la gestación respecto al tiempo medio requerido para alcanzar un embarazo deseado (AU)

Background: Nowadays, on the developed countries most of the pregnancies are planned. Fertility depends on many influential factors. Time to pregnancy is a fertility marker and its estimation can be useful to make planning of gestation and the determination of the influence factors easier. Objective: The aim of this paper is to study the average time in reaching a desired pregnancy in a fertile couple, determining the dependency with some influence factors like parental age, number of gestation, frequency of sexual relations, pre-conceptional folic acid use, menstrual formula and menarche age. Methods: We carried out a retrospective descriptive study over 491 pregnant who reached a desired spontaneous pregnancy in the health basic area of Guadalajara. The study consists in an anonymous and voluntary survey which is offered and executed during the first pregnancy consult by the midwife. After its accomplishment, the survey was deposited in a closed envelope guaranteeing the anonymity and the confdentiality of the data. Results: Average time to desired pregnancy is 7.3 cycles. This estimation is significantly influenced by maternal and paternal ages, the number of gestation, the duration of menstruation and the menarche age. Nevertheless, we could not find significant relationships between the use of the folic acid before pregnancy, the duration of menstrual cycle or frequency of sexual relations and the average to the time to a desired pregnancy (AU)

Nuevas tecnologías en atención primaria: personas, máquinas, historias y redes. Informe SESPAS 2012 / New technologies in primary care: people, machines, records, and networks. SESPAS Report 2012

Las nuevas tecnologías y la importancia de su desarrollo en la atención primaria de salud se dibujan hoy de forma clara. La tecnología es importante en tanto en cuanto contribuye a resolver los problemas prácticos que aparecen cuando intentamos mejorar la atención al paciente. Bajo el epígrafe de «nuevas tecnologías de información y comunicación» en salud podemos encontrar muchas utilidades, pero nos centraremos en dos de sus exponentes más cualificados: la historia clínica electrónica e Internet, sin olvidar que más importante que las tecnologías es el fin para lo que se crean y se usan, y por supuesto las personas que las utilizan (AU)

The new technologies and the importance of their development in primary care are clear. Technology is important insofar as it helps to resolve practical problems that arise when attempts are made to improve patient care. Many applications can be found under the heading of "new information and communication technologies" in healthcare, but the present article focusses on two of the most significant examples: the electronic health record and the Internet, bearing in mind that the aims being sought and the people using these applications are more significant than the technologies themselves (AU)

[New technologies in primary care: people, machines, records, and networks. SESPAS Report 2012]. / Nuevas tecnologías en atención primaria: personas, máquinas, historias y redes. Informe SESPAS 2012.

The new technologies and the importance of their development in primary care are clear. Technology is important insofar as it helps to resolve practical problems that arise when attempts are made to improve patient care. Many applications can be found under the heading of "new information and communication technologies" in healthcare, but the present article focusses on two of the most significant examples: the electronic health record and the Internet, bearing in mind that the aims being sought and the people using these applications are more significant than the technologies themselves.

Cognitive changes and quality of life in neurocysticercosis: a longitudinal study.

BACKGROUND: Few studies have focused on the cognitive morbidity of neurocysticercosis (NCC), one of the most common parasitic infections of the central nervous system. We longitudinally assessed the cognitive status and quality of life (QoL) of patients with incident symptomatic NCC cases and matched controls. METHODOLOGY/PRINCIPAL FINDINGS: The setting of the study was the Sabogal Hospital and Cysticercosis Unit, Department of Transmissible Diseases, National Institute of Neurological Sciences, Lima, Peru. The design was a longitudinal study of new onset NCC cases and controls. Participants included a total of 14 patients with recently diagnosed NCC along with 14 healthy neighborhood controls and 7 recently diagnosed epilepsy controls. A standardized neuropsychological battery was performed at baseline and at 6 months on NCC cases and controls. A brain MRI was performed in patients with NCC at baseline and 6 months. Neuropsychological results were compared between NCC cases and controls at both time points. At baseline, patients with NCC had lower scores on attention tasks (p<0.04) compared with epilepsy controls but no significant differences compared to healthy controls. Six months after receiving anti-parasitic treatment, the NCC group significantly improved on tasks involving psychomotor speed (p<0.02). QoL at baseline suggested impaired mental function and social function in both the NCC and epilepsy group compared with healthy controls. QoL gains in social function (p=0.006) were noted at 6 months in patients with NCC. CONCLUSIONS/SIGNIFICANCE: Newly diagnosed patients with NCC in this sample had mild cognitive deficits and more marked decreases in quality of life at baseline compared with controls. Improvements were found in both cognitive status and quality of life in patients with NCC after treatment.

Neuropsychologic assessment of a population-based sample of Gulf War veterans.

OBJECTIVE: The objective of this project was to compare neuropsychologic performance and quality of life in a population-based sample of deployed Gulf War (GW) veterans with and without multisymptom complaints. BACKGROUND/METHODS: The study participants were obtained from the 30,000 member population-based National Health Survey of GW-era veterans conducted in 1995. Cases (N=25) were deployed to the year 1990 and 1991 GW and met Center for Disease Control and Prevention criteria for multisymptom GW illness (GWI). Controls (N=16) were deployed to the 1990 and 1991 GW but did not meet Center for Disease Control and Prevention criteria for GWI. RESULTS: There were no significant differences in composite scores on the traditional and computerized neuropsychologic battery (automated neuropsychologic assessment metrics) between GW cases and controls using bivariate techniques. Multiple linear regression analyses controlling for demographic and clinical variables revealed composite automated neuropsychologic assessment metrics scores were associated with age (b=-7.8; P=0.084), and education (b=22.9; P=0.0012), but not GW case or control status (b=-63.9; P=0.22). Compared with controls, GW cases had significantly more impairment on the Personality Assessment Inventory and the short form-36. CONCLUSIONS: Compared with GW controls, GW cases meeting criteria for GWI had preserved cognition function but had significant psychiatric symptoms and lower quality of life.