Contrast-induced encephalopathy in patients with advanced chronic kidney disease: What the nephrologist needs to know.

Contrast-induced encephalopathy is a neurological complication related to contrast used in endovascular procedures or computed tomography (CT). The main risk factors are arterial hypertension, diabetes mellitus, chronic kidney disease (CKD), hyperosmolar contrasts, the amount of infused contrast and its direct infusion in the posterior cerebral territory, or pathologies with blood-brain barrier damage. Symptomatology is non-specific and may present as altered level of consciousness, neurological focality or seizures. Diagnosis is done by exclusion after ischemic or hemorrhagic stroke has been ruled out; CT or MRI are useful for differentiation. Generally, it appears shortly after exposure and the symptoms lasts 48-72h with complete recovery, although cases with persistence of symptoms or longer duration have been described. Treatment consists of monitoring, supportive measures and kidney replacement therapy (KRT) with hemodialysis (HD) in patients in chronic KRT program. It is important for the nephrologist to be aware of this entity given the susceptibility of the patient on HD as well as its potential therapeutic role in these patients.

Quantitative Assessment of Stress Through EEG During a Virtual Reality Stress-Relax Session.

Recent studies have addressed stress level classification via electroencephalography (EEG) and machine learning. These works typically use EEG-based features, like power spectral density (PSD), to develop stress classifiers. Nonetheless, these classifiers are usually limited to the discrimination of two (stress and no stress) or three (low, medium, and high) stress levels. In this study we propose an alternative for quantitative stress assessment based on EEG and regression algorithms. To this aim, we conducted a group of 23 participants (mean age 22.65 ± 5.48) over a stress-relax experience while monitoring their EEG. First, we stressed the participants via the Montreal imaging stress task (MIST), and then we led them through a 360-degree virtual reality (VR) relaxation experience. Throughout the session, the participants reported their self-perceived stress level (SPSL) via surveys. Subsequently, we extracted spectral features from the EEG of the participants and we developed individual models based on regression algorithms to predict their SPSL. We evaluated stress regression performance in terms of the mean squared percentage error (MSPE) and the correlation coefficient (R 2). The results yielded from this evaluation (MSPE = 10.62 ± 2.12, R 2 = 0.92 ± 0.02) suggest that our approach predicted the stress level of the participants with remarkable performance. These results may have a positive impact in diverse areas that could benefit from stress level quantitative prediction. These areas include research fields like neuromarketing, and training of professionals such as surgeons, industrial workers, or firefighters, that often face stressful situations.

Elderly breast cancer patients treated with Nab-paclitaxel: Results in real clinical practice / Cáncer de mama en pacientes ancianas: experiencia con Nab-paclitaxel en la práctica clínica real

Objective Clinical trials have shown that Nab-paclitaxel is more effective than paclitaxel in the treatment of metastatic breast cancer (MBC). Although the incidence of cancer increases with age, elderly patients are under-represented in clinical trials and tend to receive suboptimal treatment to avoid toxicity. The main aim of our study was to compare progression-free survival (PFS) among patients older and younger than 65 years treated with Nab-paclitaxel in real-world clinical practice. A secondary aim was to assess overall survival (OS) as well as the response rate and toxicity. Methods and patients This single-centre study retrospectively analyzed a cohort of 60 patients with MBC treated with Nab-paclitaxel monotherapy in Hospital Clínico Lozano Blesa de Zaragoza. Results The median PFS was 5.92 months (3.62–11.2) in patients<65 years and was 5.06 months (4.31–12.4) in those ≥65 years (p=0.868). The median OS was 26.9 months (18.6–30.7) in patients < 65 years and was 20.3 months (11.4–33.6) in those ≥65 years (p=0.138). Conclusions Although patients in the cohort studied had a median age of 60.45 years, which is higher than the median age in most clinical trials, PFS and OS in conditions of real-world clinical practice were similar to previously published data. The results of the use of Nab-paclitaxel in patients older than 65 years are similar to those in younger patients, with no additional toxicity problems. The results of our study agree with those of other notable studies. (AU)

Objetivo En los ensayos clínicos se ha demostrado que el Nab-paclitaxel es más eficaz que el paclitaxel en el tratamiento del cáncer de mama metastásico (CMM). Aunque la incidencia del cáncer aumenta con la edad, los pacientes ancianos están infrarrepresentados en los ensayos clínicos, y tienden a recibir un tratamiento subóptimo para evitar toxicidades. El objetivo principal de nuestro estudio es comparar la supervivencia libre de progresión (SLP) entre las mayores y menores de 65 años tratadas con Nab-paclitaxel en la práctica clínica real. El objetivo secundario es evaluar la supervivencia global (SG), así como la tasa de respuestas y la toxicidad. Métodos y pacientes Se ha analizado de forma unicéntrica y retrospectiva, una cohorte de 60 pacientes con CMM tratadas con Nab-paclitaxel en monoterapia en el Hospital Clínico Lozano Blesa de Zaragoza. Resultados Mediana SLP<65 años: 5,92 meses (3,62-11,2) y ≥65 años, mediana: 5,06 meses (4,31-12,4) (p=0,868). Mediana de SG en <65 años: 26,9 meses (18,6-30,7) y ≥65 años: 20,3 meses (11,4-33,6) (p=0,138). Conclusiones Aunque las pacientes de la cohorte estudiada tienen una mediana de edad de 60,45 años, que es superior a la mediana de edad de la mayoría de los ensayos clínicos, la SLP y la SG en condiciones de práctica clínica real son similares a los datos publicados anteriormente. En cuanto al uso de Nab-paclitaxel en pacientes de edad avanzada, se obtienen resultados similares a las de aquellas pacientes más jóvenes, sin observarse problemas de seguridad adicionales. Además, con los datos disponibles, los resultados son congruentes con los presentados en otros estudios de impacto. (AU)

Mini Nutritional Assessment - Short Form Is a Useful Malnutrition Screening Tool in Patients with Liver Cirrhosis, Using the Global Leadership Initiative for Malnutrition Criteria as the Gold Standard.

BACKGROUND: The use of nutrition-screening tools in cirrhotic patients is not systematized. Recently, specific tools have been proposed for patients with cirrhosis, but their diagnostic capabilities have been scarcely studied. METHODS: This was a prospective study that includes outpatients with liver cirrhosis undergoing follow-up in the hepatology consultations of a tertiary-care university hospital. A trained gastroenterologist applied the screening tools: Liver Disease Universal Screening Tool (LDUST), Royal Free Hospital-Nutrition Prioritizing Tool (RFH-NPT), and Mini Nutritional Assessment-Short Form (MNA-SF). Subsequently, the diagnosis of malnutrition was made according to Global Leadership Initiative for Malnutrition (GLIM) criteria by an endocrinologist, who was blind to the results of the screening tools. RESULTS: Sixty-three patients (38.1% women, mean age 63.1 ± 9.9 years) with cirrhosis (60.3% Child-Pugh A, 34.9% Child-Pugh B, and 4.8% Child-Pugh C) were evaluated. The prevalence of malnutrition was 38.1% (15.9% moderate, 22.2% severe). Advanced stages of cirrhosis were associated with a higher prevalence of malnutrition (P = .021). MNA-SF was the most accurate screening tool, being superior to RFH-NPT and LDUST. It presented better sensitivity than RFH-NPT (88% [0.68-0.97] vs 67% [0.45-0.84], P = .031) and better specificity than both LDUST (97% [0.87-0.99] vs 62% [0.45-0.77], P < .001) and RFH-NPT (97% [0.87-0.99] vs 82% [0.67-0.93], P = .016). CONCLUSIONS: According to the GLIM criteria, malnutrition affected 38.1% of patients with cirrhosis, being severe in 22% of the patients. MNA-SF is the most accurate screening test, superior even to tools specifically designed for cirrhotic patients (LDUST).

Virtual Reality Customized 360-Degree Experiences for Stress Relief.

The latest studies in virtual reality (VR) have evidenced the potential of this technology to reproduce environments from multiple domains in an immersive way. For instance, in stress relief research, VR has been presented as a portable and inexpensive alternative to chromotherapy rooms, which require an adapted space and are expensive. In this work, we propose a portable and versatile alternative to the traditional chromotherapy color-loop treatment through four different 360-degree virtual experiences. A group of 23 healthy participants (mean age 22.65 ± 5.48) were conducted through a single-session experience divided into four phases while their electroencephalography (EEG) was recorded. First, they were stressed via the Montreal imaging stress task (MIST), and then relaxed using our VR proposal. We applied the Wilcoxon test to evaluate the relaxation effect in terms of the EEG relative gamma and self-perceived stress surveys. The results that we obtained validate the effectiveness of our 360-degree proposal to significantly reduce stress (p-value = 0.0001). Furthermore, the participants deemed our proposal comfortable and immersive (score above 3.5 out of 5). These results suggest that 360-degree VR experiences can mitigate stress, reduce costs, and bring stress relief assistance closer to the general public, like in workplaces or homes.

A Review of Automated Techniques for Assisting the Early Detection of Alzheimer's Disease with a Focus on EEG.

In this paper, we review state-of-the-art approaches that apply signal processing (SP) and machine learning (ML) to automate the detection of Alzheimer's disease (AD) and its prodromal stages. In the first part of the document, we describe the economic and social implications of the disease, traditional diagnosis techniques, and the fundaments of automated AD detection. Then, we present electroencephalography (EEG) as an appropriate alternative for the early detection of AD, owing to its reduced cost, portability, and non-invasiveness. We also describe the main time and frequency domain EEG features that are employed in AD detection. Subsequently, we examine some of the main studies of the last decade that aim to provide an automatic detection of AD and its previous stages by means of SP and ML. In these studies, brain data was acquired using multiple medical techniques such as magnetic resonance imaging, positron emission tomography, and EEG. The main aspects of each approach, namely feature extraction, classification model, validation approach, and performance metrics, are compiled and discussed. Lastly, a set of conclusions and recommendations for future research on AD automatic detection are drawn in the final section of the paper.

Effect of Active-Edible Coating and Essential Oils on Lamb Patties Oxidation during Display.

The use of natural products to reduce the use of synthetic additives in meat products, reducing the oxidation and improving the shelf life is a current challenge. Meat quality from lamb patties during 10 days of display on modified atmosphere packaging (MAP) and active-edible coating were tested under six treatments: uncoated patties without coating (CON); patties with alginate coating (EC) and patties with coating and 0.1 or 0.05% of essential oils (EOs) from either thyme (TH 0.1; TH 0.05) or oregano (OR 0.1; OR 0.05). Display and treatment significantly modified (P < 0.001) all the studied meat quality variables (pH, color, water holding capacity, weight losses, thiobarbituric acid reactive substances (TBARS), antioxidant activity). Display produced discoloration and lipid oxidation, however, the samples with essential oils presented lower (P < 0.001) lipid oxidation than the CON or EC groups. Coated samples with or without EOs showed better color (lower lightness but higher redness and yellowness) and lower water losses (P < 0.001) than the CON. The addition of thyme EO caused a decrease (P < 0.001) in the consumer's overall acceptability, whereas no statistical differences appeared between CON, EC and oregano EO addition. Thus, using EOs as natural antioxidants, especially those from oregano at low dosages (0.05%), could be considered a viable strategy to enhance the shelf life and the product quality of lamb meat patties without damaging the sensory acceptability.

Virtual Reality as a Portable Alternative to Chromotherapy Rooms for Stress Relief: A Preliminary Study.

Chromotherapy rooms are comfortable spaces, used in places like special needs schools, where stimuli are carefully selected to cope with stress. However, these rooms are expensive and require a space that cannot be reutilized. In this article, we propose the use of virtual reality (VR) as an inexpensive and portable alternative to chromotherapy rooms for stress relief. We recreated a chromotherapy room stress relief program using a commercial head mounted display (HD). We assessed the stress level of two groups (test and control) through an EEG biomarker, the relative gamma, while they experienced a relaxation session. First, participants were stressed using the Montreal imaging stress task (MIST). Then, for relaxing, the control group utilized a chromotherapy room while the test group used virtual reality. We performed a hypothesis test to compare the self- perceived stress level at different stages of the experiment and it yielded no significant differences in reducing stress for both groups, during relaxing (p-value: 0.8379, α = 0.05) or any other block. Furthermore, according to participant surveys, the use of virtual reality was deemed immersive, comfortable and pleasant (3.9 out of 5). Our preliminary results validate our approach as an inexpensive and portable alternative to chromotherapy rooms for stress relief.

Eficacia y seguridad de ustekinumab en la práctica clínica real. Estudio multicéntrico retrospectivo. Cohorte ARAINF / Efficacy and safety of ustekinumab in real clinical practice. Retrospective multicentre study. ARAINF cohort

INTRODUCCIÓN: Ustekinumab, anticuerpo monoclonal que bloquea las interleucinas 12/23, ha demostrado en ensayos clínicos su eficacia para inducir y mantener la remisión clínica en la enfermedad de Crohn (EC). Su efectividad y su seguridad en la práctica clínica real es menos conocida y podría diferir respecto a los ensayos. OBJETIVO: Evaluar en la práctica clínica su efectividad y seguridad (pauta de inducción intravenosa esencialmente), como inducción y a largo plazo, en pacientes con EC refractarios a tratamiento biológico. MATERIAL Y MÉTODOS: Análisis retrospectivo multicéntrico (6 hospitales aragoneses), que incluye a todos los pacientes (N=69) con EC en tratamiento con ustekinumab (fuese con inducción intravenosa o subcutánea) que hubiesen alcanzado al menos 16 semanas de seguimiento. La respuesta o remisión clínica se ha evaluado en las semanas 16, 24, 32 y 48 mediante el índice de Harvey-Bradshaw. RESULTADOS: Se han incluido un total de 69 pacientes, edad media 42 años, 54% hombres. Un 89,86% (IC 95% [0,805, 0,949]) de los pacientes ha presentado mejoría clínica en la semana 16 (15,95% remisión, 73,92% respuesta). En el seguimiento posterior dicha respuesta se ha mantenido. Se han identificado mediante un modelo de regresión ordinal la edad (OR 0,95, p = 0.028) y el hábito tabáquico (OR 0,19, p = 0,027) como predictores de mala respuesta al tratamiento, mientras que la necesidad de cambio de biológico por efecto adverso (OR 96, p = 0,00017) y por pérdida de respuesta secundaria (OR 7,07, p = 0,034) han sido factores predictores de buena respuesta. No se han reportado efectos adversos graves que obligasen a interrumpir el tratamiento con ustekinumab. CONCLUSIÓN: Ustekinumab es efectivo y seguro en la práctica clínica real para lograr la inducción y el mantenimiento de la respuesta en pacientes con EC refractaria. El tabaco y la edad han mostrado ser predictores de mala respuesta, mientras que la indicación por efecto adverso a biológico previo y por pérdida de respuesta secundaria han mostrado ser predictores de buena respuesta

INTRODUCTION: Ustekinumab, a monoclonal antibody that blocks interleukins 12/23, has proven in clinical trials its efficacy in inducing and maintaining clinical remission of Crohn's disease (CD). Its effectiveness and safety in actual clinical practice is less known and may differ from trials. OBJECTIVE: To evaluate its effectiveness and safety in clinical practice (intravenous induction pattern essentially), such as induction and over the long term, in patients with CD refractory to biological treatment. MATERIAL AND METHODS: Multicentre retrospective analysis (6 hospitals in Aragón), which includes all patients (N=69) with CD undergoing treatment with ustekinumab (either with intravenous or subcutaneous induction), who had at least 16 weeks of follow-up. The clinical response or remission has been evaluated at weeks 16, 24, 32 and 48 using the Harvey-Bradshaw index. RESULTS: A total of 69 patients have been included, mean age 42 years, 54% men. A percentage of 89.86 (95% CI [0.805, 0.949]) of the patients presented clinical improvement at week 16 (15.95% remission, 73.92% response). In the subsequent follow-up, this response has been maintained. Age (OR 0.95, P=.028) and smoking habits (OR 0.19, P=.027) have been identified by an ordinal regression model as predictors of poor treatment response while the need for biological change due to adverse effect (OR 96, P=.00017) and due to loss of secondary response (OR 7.07, P=.034) have been predictors of good response. No serious adverse effects have been reported that forced them to stop taking ustekinumab. CONCLUSION: Ustekinumab is effective and safe in real clinical practice to achieve induction and maintenance of the response in patients with refractory CD. Tobacco and age have been shown to be predictors of poor response, while the indication for adverse effect to previous biological and for loss of secondary response has been shown to be predictors of good response

Efficacy and safety of ustekinumab in real clinical practice. Retrospective multicentre study. ARAINF cohort. / Eficacia y seguridad de ustekinumab en la práctica clínica real. Estudio multicéntrico retrospectivo. Cohorte ARAINF.

INTRODUCTION: Ustekinumab, a monoclonal antibody that blocks interleukins 12/23, has proven in clinical trials its efficacy in inducing and maintaining clinical remission of Crohn's disease (CD). Its effectiveness and safety in actual clinical practice is less known and may differ from trials. OBJECTIVE: To evaluate its effectiveness and safety in clinical practice (intravenous induction pattern essentially), such as induction and over the long term, in patients with CD refractory to biological treatment. MATERIAL AND METHODS: Multicentre retrospective analysis (6 hospitals in Aragón), which includes all patients (N=69) with CD undergoing treatment with ustekinumab (either with intravenous or subcutaneous induction), who had at least 16 weeks of follow-up. The clinical response or remission has been evaluated at weeks 16, 24, 32 and 48 using the Harvey-Bradshaw index. RESULTS: A total of 69 patients have been included, mean age 42 years, 54% men. A percentage of 89.86 (95% CI [0.805, 0.949]) of the patients presented clinical improvement at week 16 (15.95% remission, 73.92% response). In the subsequent follow-up, this response has been maintained. Age (OR 0.95, P=.028) and smoking habits (OR 0.19, P=.027) have been identified by an ordinal regression model as predictors of poor treatment response while the need for biological change due to adverse effect (OR 96, P=.00017) and due to loss of secondary response (OR 7.07, P=.034) have been predictors of good response. No serious adverse effects have been reported that forced them to stop taking ustekinumab. CONCLUSION: Ustekinumab is effective and safe in real clinical practice to achieve induction and maintenance of the response in patients with refractory CD. Tobacco and age have been shown to be predictors of poor response, while the indication for adverse effect to previous biological and for loss of secondary response has been shown to be predictors of good response.

Effect of Texel crossbreeding on productive traits, carcass and meat quality of Segureña lambs.

BACKGROUND: The present study aimed to assess the effect of crossbreeding a local breed (Segureña, S × S) with Texel as the sire line (Texel × Segureña crossbred, T × S) on productive traits and meat quality attributes. Sixty-eight lambs (both males and females) from each genotype, weaned at about 45 days old and intensively fed with concentrates and cereal straw ad libitum until they were 72 days old, were used to assess productive traits, and ten animals from each genotype were used to assess meat quality. RESULTS: The crossbreeding with Texel improves productivity, with a greater weight at birth (+1 kg) and at slaughter (+3 kg) and a greater average daily gain (+29 g). T × S lambs had a better conformation, less carcass fatness, and higher content of muscle (+45 g kg-1 ) as opposed to a lower fat content (-50.6 g kg-1 ). With regard to meat quality, crossbreeding with Texel provided a meat with a higher protein content (+4 g kg-1 ) and a lower oleic acid content (21% less), although the differences were very scarce from a sensory point of view, and non-existent with respect to instrumental quality. CONCLUSION: Crossbreeding could comprise a useful tool in the production of ovine meat in local breeds, such as Segureña, within the Mediterranean Area, and, consequently, a way of increasing the profitability of the farms. © 2018 Society of Chemical Industry.

Duration of Treatment with Corticosteroids and Recovery of Kidney Function in Acute Interstitial Nephritis.

BACKGROUND AND OBJECTIVES: Drug-induced acute interstitial nephritis represents an emerging cause of acute kidney disease, especially among polymedicated elderly patients. Although corticosteroids are frequently used, controversy exists about the timing of initiation, efficacy, safety, and duration of treatment. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a retrospective study of 182 patients with biopsy-proven drug-induced acute interstitial nephritis from 13 Spanish centers. Exposure was defined as the length of corticosteroid treatment. The main outcome was the level of serum creatinine at month 6, with respect to baseline values. RESULTS: The most common offending agents were nonsteroidal anti-inflammatory drugs (27%). In 30% of patients, the offending drug could not be identified. The median time to suspected drug withdrawal was 11 days (interquartile range, 5-22). All patients presented with acute kidney disease and were treated with corticosteroids. The mean initial dose of prednisone was 0.8±0.2 mg/kg per day. High-dose corticosteroid treatment was maintained for 2 weeks (interquartile range, 1-4). After 6 months, the mean recovered GFR was 34±26 ml/min per 1.73 m2 and ten patients required maintenance dialysis. Use of high-dose corticosteroids for 3 weeks or treatment duration >8 weeks were not associated with better recovery of kidney function. In the multivariable analysis, delayed onset of steroid treatment (odds ratio, 1.02; 95% confidence interval, 1.0 to 1.04) and the presence of interstitial fibrosis of >50% on the kidney biopsy specimen (odds ratio, 8.7; 95% confidence interval, 2.7 to 27.4) were both associated with serum creatinine level at month 6 of >75%, with respect to baseline values. CONCLUSIONS: High-dose corticosteroid treatment for 3 weeks or prolonged treatment for >8 weeks were not associated with greater kidney function recovery in drug-induced acute interstitial nephritis. A delay in the initiation of corticosteroids resulted in worse recovery of kidney function.

Respiratory polygraphy monitoring of intensive care patients receiving non-invasive ventilation.

INTRODUCTION: Patients that started on Non-Invasive Ventilation (NIV) need to define several parameters selected on the basis of diurnal arterial blood gas and underlying disease. We hypothesize that respiratory polygraphy (RP) could be useful to monitor NIV. This retrospective work describes RP findings and their impact on the setting of continuous flow ventilators from patients on NIV of Intensive Care Unit (ICU). MATERIAL AND METHODS: Patient's data on NIV from at the ICU of Hospital Británico were included in this study. RP recordings were performed in all of them. Respiratory events, such as ventilatory pattern changes, impact on oximetry or tidal volume, were observed to modify the ventilatory mode after RP. RESULTS: The RP findings have contributes to change the ventilatory mode for one third of the patients. The mean values of expiratory positive airway pressure (EPAP) and inspiratory positive airway pressure (IPAP) were not significantly different across all the population before or after RP: 8.7±0.3 vs. 8.6±0.4; p<0.88 and 18.6±0.6 vs. 17.7±0.7; p<0.26 respectively, however, half the patients presented > 2 cmH2O pressure value changes after RP. CONCLUSIONS: RP recordings could contribute to broad range of data useful to make decisions about changes in programming and allowed to identify adverse events related to positive pressure.

Titulaciones de CPAP autoajustable domiciliarias y correlación entre un algoritmo automático y la fórmula de Hoffstein / Auto-adjusting CPAP Titrations at Home and Correlation between an Automatic Algorithm and the Hoffstein Formula

Introducción: La presión positiva en la vía aérea (CPAP) ha demostrado ser eficaz en el síndrome de apneas e hipopneas obstructivas durante el sueño (SAHOS). La presión efectiva se adquiere tradicionalmente con polisomnografía (PSG). El desempeño de estrategias no convencionales, como la CPAP autoajustable (APAP) y fórmulas de titulación (Ft) varía según la población donde se aplican. Objetivo: Describir la titulación con APAP y correlacionar la presión media en la vía aérea (Pmed), la Pef y la presión por Ft de Hoffstein y Mateikas (Fhoff). Resultados: Incluimos 192 pacientes; 52 mujeres (27%) y 140 hombres, edad; 60.2 años ± 11.7 e IMC de 33.8 ± 6.7 kg/m². El índice de apneas e hipopneas (IAH) fue: 33.1 ± 16.6 en mujeres y 36.5 ± 16 en varones (p > 0.24) y 190 casos (98.9%) presentaron IAH > 15 ev/hora. El cumplimiento medio con APAP fue: 380 minutos ± 101 mujeres y 370 ± 91.2 en hombres (p > 0.54). Menos del 10% de la población tuvo criterios de inaceptabilidad del registro. Hallamos correlación entre Pmed y la Pef; rho: 0.73 (IC95% 0.57-0.84) p < 0.001. Sin embargo entre Pef y Fhoff; β: 0.519 y r²: 0.269 (p < 0.001) existió subestimación por Fhoff: - 1.98 cm H2O (IC95% 1.48-2.49) e índice de correlación intraclase: 0.60 (IC95%: 0.47-0.80) p < 0.0001. Conclusiones: Una elevada proporción de pacientes titulan en domicilio con APAP sin vigilancia y con criterios de aceptabilidad. No hallamos adecuada correlación entre Fhoff y Pef en nuestra población.

Introduction: Continuous positive airway pressure (CPAP) has proven to be effective in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS). Effective pressure is traditionally acquired with a polysomnography (PSG). The performance of unconventional strategies, such as auto-adjusting positive airway pressure (APAP) and titration formulas (Tf) varies according to the population where they are applied. Objective: To describe the APAP titration and correlate the mean airway pressure (Mean p), the Eff p and the Hoffstein and Mateika Tf pressure (Hoff f). Results: We included 192 patients, 52 female (27%) and 140 male; age, 60.2 years old ± 11.7 and BMI (body mass index) of 33.8 ± 6.7 kg/m². The apnea-hypopnea index (AHI) was: 33.1 ± 16.6 in females and 36.5 ± 16 in males (p > 0.24); and 190 cases (98.9%) had an AHI > 15 ev/hour. Mean compliance with APAP was: 380 minutes ± 101 in females and 370 ± 91.2 in males (p > 0.54). Less than 10% of the population presented unacceptability criteria. We found a correlation between the Mean p and the Eff p; rho: 0.73 (95% CI [confidence interval] 0.57-0.84) p < 0.001. However, between the Eff p and the Hoff f β: 0.519 and r²: 0.269 (p < 0.001) there was an underestimation by Hoff f: - 1.98 cm H2O (95% CI, 1.48-2.49) and intraclass correlation index: 0.60 (95% CI: 0.47-0.80) p < 0.0001. Conclusions: A high proportion of patients titrate at home with APAP without supervision and with acceptability criteria. We did not find a suitable correlation between the Hoff f and the Eff p in our population.

Auto-adjusting CPAP Titrations at Home and Correlation between an Automatic Algorithm and the Hoffstein Formula

Introduction: Continuous positive airway pressure (CPAP) has proven to be effective in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS). Effective pressure is traditionally acquired with a polysomnography (PSG). The performance of unconventional strategies, such as auto-adjusting positive airway pressure (APAP) and titration formulas (Tf) varies according to the population where they are applied. Objective: To describe the APAP titration and correlate the mean airway pressure (Meanp), the Effp and the Hoffstein and Mateika Tf pressure (Hofff). Results: We included 192 patients, 52 female (27%) and 140 male; age, 60.2 years old ± 11.7 and BMI (body mass index) of 33.8 ± 6.7 kg/m2. The apnea-hypopnea index (AHI) was: 33.1 ± 16.6 in females and 36.5 ± 16 in males (p > 0.24); and 190 cases (98.9%) had an AHI > 15 ev/hour. Mean compliance with APAP was: 380 minutes ± 101 in females and 370 ± 91.2 in males (p > 0.54). Less than 10% of the population presented unacceptability criteria. We found a correlation between the Meanp and the Effp; rho: 0.73 (95% CI [confidence interval] 0.57-0.84) p < 0.001. However, between the Effp and the Hofff ß: 0.519 and r2: 0.269 (p < 0.001) there was an underestimation by Hofff: - 1.98 cm H2O (95% CI, 1.48-2.49) and intraclass correlation index: 0.60 (95% CI: 0.47-0.80) p < 0.0001. Conclusions: A high proportion of patients titrate at home with APAP without supervision and with acceptability criteria. We did not find a suitable correlation between the Hofff and the Effp in our population

Papel del sexo y de la edad como predictores de un índice de apneas e hipopneas superior a 5/hora en pacientes con índice de masa corporal normal usando poligrafía respiratoria domiciliaria / Role of sex and age as predictors of an apnea and hypopnea index higher than 5/hour in patients with normal body mass index using respiratory polygraphy

Introducción: Conocer predictores de apneas del sueño (SAHOS) en pacientes con índice de masa corporal (IMC) normal podría facilitar la priorización de los candidatos a estudios de sueño. Objetivo Describir el papel del sexo y la edad como factores predictores de un índice de apneas e hipopneas (IAH)>5 episodios por hora en pacientes con IMC normal (<25kg/m2). Métodos: Estudio retrospectivo en pacientes referidos para poligrafía respiratoria domiciliaria y autoadministrada. Resultados: Se analizaron 143 pacientes con IMC<25kg/m2, de los cuales 70 tuvieron SAHOS definido por un IAH>5/h. Las variables clínicas para predicción de IAH>5/h en un modelo de regresión logística múltiple halló significación para la edad>60 años (OR=5,67; IC 95% 2,38-13,53; p<0,0001) y el sexo masculino (OR=3,15; IC 95% 1,47-6,73; p<0,003. Conclusión: El 48,95% de los pacientes normopeso en una población de riesgo tuvieron SAHOS definido por un IAH>5/h. El sexo y la edad serían predictores de riesgo en esta población con mayor probabilidad en los varones (AU)

Introduction. To establish whether predictors of sleep apnea (OSAHS) from patients with normal body mass index (BMI) could facilitate the prioritization of candidates for sleep tests. Aim To describe the role of sex and age as predictors of apnea and hypopnea index (AHI)>5 events per hour in patients with normal BMI (<25kg/m2). Methods: Retrospective study of patients referred for home respiratory polygraphy level III. Results: One hundred and forty-three patients with BMI<25kg/m2, of which 70 had OSA defined by an AHI>5/h were analyzed. The clinical variables to predict AHI>5/h in a multiple logistic regression model, found statistical significance for age>60 years (OR=5.67; 95% CI 2.38-13.53; P<.0001) and male (OR=3.15; 95% CI 1.47-6.73; P<.003). Conclusion: Forty-eight point ninety-five percent of normal weight patients in a population at risk had OSAHS defined by an AHI>5/h. The sex and age would be risk predictors in this population and most likely in men (AU)

[Role of sex and age as predictors of an apnea and hypopnea index higher than 5/hour in patients with normal body mass index using respiratory polygraphy]. / Papel del sexo y de la edad como predictores de un índice de apneas e hipopneas superior a 5/hora en pacientes con índice de masa corporal normal usando poligrafía respiratoria domiciliaria.

INTRODUCTION: To establish whether predictors of sleep apnea (OSAHS) from patients with normal body mass index (BMI) could facilitate the prioritization of candidates for sleep tests. Aim To describe the role of sex and age as predictors of apnea and hypopnea index (AHI)>5 events per hour in patients with normal BMI (<25kg/m(2)). METHODS: Retrospective study of patients referred for home respiratory polygraphy level iii. RESULTS: One hundred and forty-three patients with BMI<25kg/m(2), of which 70 had OSA defined by an AHI>5/h were analyzed. The clinical variables to predict AHI>5/h in a multiple logistic regression model, found statistical significance for age>60 years (OR=5.67; 95% CI 2.38-13.53; P<.0001) and male (OR=3.15; 95% CI 1.47-6.73; P<.003). CONCLUSION: Forty-eight point ninety-five percent of normal weight patients in a population at risk had OSAHS defined by an AHI>5/h. The sex and age would be risk predictors in this population and most likely in men.

An update for atypical haemolytic uraemic syndrome: diagnosis and treatment. A consensus document.

Haemolytic uraemic syndrome (HUS) is a clinical entity defined as the triad of nonimmune haemolytic anaemia, thrombocytopenia, and acute renal failure, in which the underlying lesions are mediated by systemic thrombotic microangiopathy (TMA). Different causes can induce the TMA process that characterizes HUS. In this document we consider atypical HUS (aHUS) a sub-type of HUS in which the TMA phenomena are the consequence of the endotelial damage in the microvasculature of the kidneys and other organs due to a disregulation of the activity of the complement system. In recent years, a variety of aHUs-related mutations have been identified in genes of the the complement system, which can explain approximately 60% of the aHUS cases, and a number of mutations and polymorphisms have been functionally characterized. These findings have stablished that aHUS is a consequence of the insufficient regulation of the activiation of the complement on cell surfaces, leading to endotelial damage mediated by C5 and the complement terminal pathway. Eculizumab is a monoclonal antibody that inhibits the activation of C5 and blocks the generation of the pro-inflammatory molecule C5a and the formation of the cell membrane attack complex. In prospective studies in patients with aHUS, the use of Eculizumab has shown a fast and sustained interruption of the TMA process and it has been associated with significative long-term improvements in renal function, the interruption of plasma therapy and important reductions in the need of dialysis. According to the existing literature and the accumulated clinical experience, the Spanish aHUS Group published a consensus document with recommendations for the treatment of aHUs (Nefrologia 2013;33[1]:27-45). In the current online version of this document, we update the aetiological classification of TMAs, the pathophysiology of aHUS, its differential diagnosis and its therapeutic management.

Actualización en síndrome hemolítico urémico atípico: diagnóstico y tratamiento. Documento de consenso / An update for atypical haemolytic uraemic syndrome: Diagnosis and treatment. A consensus document

El síndrome hemolítico urémico (SHU) es una entidad clínica definida por la tríada anemia hemolítica no inmune, trombocitopenia e insuficiencia renal aguda, en la que las lesiones subyacentes están mediadas por un proceso de microangiopatía trombótica (MAT) sistémico. Distintas causas pueden desencadenar el proceso de MAT que caracteriza el SHU. En este documento consideramos SHU atípico (SHUa) como el subtipo de SHU en el que los fenómenos de MAT son fundamentalmente consecuencia del daño producido en el endotelio de la microvasculatura renal y de otros órganos por desregulación de la actividad del sistema del complemento. En los últimos años se han identificado diversas mutaciones en genes del sistema del complemento asociados a SHUa, que explicarían aproximadamente el 60% de los casos de SHUa, y se han caracterizado funcionalmente numerosasmutaciones y polimorfismos asociados a SHUa que han permitido determinar que la patología se produce como consecuencia de la deficiente regulación de la activación del complemento sobre las superficies celulares y que lleva al daño endotelial mediado por la activación del C5 y de la vía terminal del complemento. Eculizumab es un anticuerpo monoclonal humanizado que inhibe la activación del C5, bloqueando la generación de la molécula proinflamatoria C5a y la formación del complejo de ataque de membrana. En estudios prospectivos en pacientes con SHUa su administración ha demostrado la interrupción rápida y sostenida del proceso de MAT, con una mejora significativa de la función renal a largo plazo y una reducción importante de la necesidad de diálisis y el cese de la terapia plasmática. En función de las evidencias científicas publicadas y la experiencia clínica acumulada, el Grupo Español de SHUa publicamos un documento de consenso con recomendaciones para el tratamiento de la enfermedad (Nefrología 2013;33(1):27-45). En la presente versión online del documento se actualizan los contenidos sobre la clasificación etiológica de las MAT, la fisiopatología del SHUa, su diagnóstico diferencial y su manejo terapéutico (AU)

Haemolytic uraemic syndrome (HUS) is a clinical entity defined as the triad of nonimmune haemolytic anaemia, thrombocytopenia, and acute renal failure, in which the underlying lesions are mediated by systemic thrombotic microangiopathy (TMA). Different causes can induce the TMA process that characterizes HUS. In this document we consider atypical HUS (aHUS) a sub-type of HUS in which the TMA phenomena are the consequence of the endotelial damage in the microvasculature of the kidneys and other organs due to a disregulation of the activity of the complement system. In recent years, a variety of aHUs-related mutations have been identified in genes of the the complement system, which can explain approximately 60% of the aHUS cases, and a number ofmutations and polymorphisms have been functionally characterized. These findings have stablished that aHUS is a consequence of the insufficient regulation of the activiation of the complement on cell surfaces, leading to endotelial damage mediated by C5 and the complement terminal pathway. Eculizumab is a monoclonal antibody that inhibits the activation of C5 and blocks the generation of the pro-inflammatory molecule C5a and the formation of the cell membrane attack complex. In prospective studies in patients with aHUS, the use of Eculizumab has shown a fast and sustained interruption of the TMA process and it has been associated with significative long-term improvements in renal function, the interruption of plasma therapy and important reductions in the need of dialysis. According to the existing literature and the accumulated clinical experience, the Spanish aHUS Group published a consensus document with recommendations for the treatment of aHUs (Nefrologia 2013;33[1]:27-45). In the current online version of this document, we update the aetiological classification of TMAs, the pathophysiology of aHUS, its differential diagnosis and its therapeutic management (AU)