Estrés, ansiedad y depresión en adultos con enfermedad renal crónica en protocolo de trasplante renal / Stress, anxiety and depression in adults with chronic renal disease under protocol for renal transplant

Objetivo: evaluar el estrés percibido, la ansiedad y la depresión en pacientes con enfermedad renal crónica (ERC) en protocolo de trasplante renal de una unidad de tercer nivel durante la pandemia por COVID-19.Método: estudio descriptivo transversal en pacientes con ERC que se encuentran en lista de espera para trasplante renal. Una muestra de 73 sujetos fue elegida mediante muestreo simple aleatorio de quienes se encontraban en la lista de espera. Se estudiaron variables sociodemográficas y clínicas, además de aplicarse los cuestionarios validados: Escala de Estrés Percibido (Perceived Stress Scale, PSS) y el Inventario de Ansiedad y Depresión de Beck. Como pruebas de contraste de hipótesis fueron utilizadas la t de Student y la Chi cuadrado.Resultados: la edad media de la muestra estudiada fue de 35,3 (DE: 11,9 años), con una mayoría de género masculino (72,9%). En la escala de estrés percibido se obtuvo una puntuación media de 20 (DE: 10). La prevalencia de ansiedad y depresión fue de 12,5% y 10,4%, respectivamente. Los pacientes se encontraron con ansiedad mínima (58,3%) y depresión mínima (75%).Conclusiones: las personas con ERC en protocolo de trasplante renal durante la pandemia por COVID-19, presentan estrés, ansiedad y depresión mínima. Es necesario intervenir de manera oportuna para contribuir a mejorar su calidad de vida en las personas que aún no han recibido un trasplante renal.(AU)

Objective: to evaluate the stress perceived, the anxiety and depression in patients with chronic renal disease (CRD) under protocol for renal transplant at a third level unit during the COVID-19 pandemic.Method: a descriptive cross-sectional study in CRD patients on the waiting list for renal transplant. A sample of 73 individuals was selected through simple random sampling of those on the waiting list. Sociodemographic and clinical variables were studied, and the following validated questionnaires were applied: Perceived Stress Scale (PSS) and the Beck Anxiety and Depression Inventory. Student’s t-test and Square chi-test were used for hypothesis testing.Results: the mean age of the sample studied was 35.3 (SD: 11.9 years), with a majority of male gender (72.9%). A mean score of 20 (SD: 10) was obtained in the perceived stress scale. The prevalence of anxiety and depression was 12.5% and 10.4%, respectively. Patients presented minimal anxiety (58.3%) and minimal depression (75%).Conclusions: patients with CRD under protocol for renal transplant during the COVID-19 pandemic presented minimal stress, anxiety and depression. An appropriate intervention is needed in order to contribute to an improvement in their quality of life when they have not yet received a renal transplant.(AU)

Naturally monozygotic quadruplets in a Braford cow confirmed by DNA analysis: A case report.

Cattle are a monotocous species, despite naturally conceived multiple births are sometimes observed. Although the number of twins has consistently increased, triplet and quadruplet pregnancies represent 0.015% and 0.004% of the total births, respectively. Multiple births are the result of multiple ovulation and/or the spontaneous cleavage of one fertilized oocyte, which is known as monozygotic (MZ) twinning. In cattle, approximately 5% to 14% of all twin births are MZ, and births with more than two MZ calves are extremely rare. Monozygotic animals are genetically identical, and those derived from two or more zygotes are genetically different. Furthermore, the presence of placental vascular anastomosis can result in foetal chimerism. Notwithstanding, animals born as single calves can be chimeras when one of the foetal twins dies undetected in utero. Here, we used DNA testing to study the zygotic condition of an unusual female quadruplet born from a Braford cow bred in a multi-sire natural mating system without hormone stimulation. Two tissues with different embryological origin were sampled to test zygosity and possible chimerism. The results showed an identical genotype, confirming they all originated in an MZ pregnancy and suggesting the lack of chimerism in all animals. The use of MZ twins in breeding and selection systems provides an alternative to the conventional progeny testing. Some works have suggested a genetic background of MZ twins in humans. This female and her daughters could be the founders of a lineage to study the possible inheritance of MZ multiple births in cattle.

Moderate Hypothermia Modifies Coronary Hemodynamics and Endothelium-Dependent Vasodilation in a Porcine Model of Temperature Management.

Background Hypothermia has been associated with therapeutic benefits including reduced mortality and better neurologic outcomes in survivors of cardiac arrest. However, undesirable side effects have been reported in patients undergoing coronary interventions. Using a large animal model of temperature management, we aimed to describe how temperature interferes with the coronary vasculature. Methods and Results Coronary hemodynamics and endothelial function were studied in 12 pigs at various core temperatures. Left circumflex coronary artery was challenged with intracoronary nitroglycerin, bradykinin, and adenosine at normothermia (38°C) and mild hypothermia (34°C), followed by either rewarming (38°C; n=6) or moderate hypothermia (MoHT; 32°C, n=6). Invasive coronary hemodynamics by Doppler wire revealed a slower coronary blood velocity at 32°C in the MoHT protocol (normothermia 20.2±11.2 cm/s versus mild hypothermia 18.7±4.3 cm/s versus MoHT 11.3±5.3 cm/s, P=0.007). MoHT time point was also associated with high values of hyperemic microvascular resistance (>3 mm Hg/cm per second) (normothermia 2.0±0.6 mm Hg/cm per second versus mild hypothermia 2.0±0.8 mm Hg/cm per second versus MoHT 3.4±1.6 mm Hg/cm per second, P=0.273). Assessment of coronary vasodilation by quantitative coronary analysis showed increased endothelium-dependent (bradykinin) vasodilation at 32°C when compared with normothermia (normothermia 6.96% change versus mild hypothermia 9.01% change versus MoHT 25.42% change, P=0.044). Results from coronary reactivity in vitro were in agreement with angiography data and established that endothelium-dependent relaxation in MoHT completely relies on NO production. Conclusions In this porcine model of temperature management, 34°C hypothermia and rewarming (38°C) did not affect coronary hemodynamics or endothelial function. However, 32°C hypothermia altered coronary vasculature physiology by slowing coronary blood flow, increasing microvascular resistance, and exacerbating endothelium-dependent vasodilatory response.

Axl expression is increased in early stages of left ventricular remodeling in an animal model with pressure-overload.

BACKGROUND: AXL is a receptor tyrosine kinase that has been related to kidney and vascular disorders. Heart failure patients with reduced ejection fraction have higher AXL in serum than controls. No information about Axl expression with HF progression is available. METHODS: Thoracic transverse aortic constriction (TAC) was successfully performed on male Wistar rats (n = 25) with different constriction levels. Controls underwent sham surgery (n = 12). Echocardiography measurements were performed 4-8 weeks after surgery. Collagen deposition was measured with picrosirius red staining. Axl mRNA levels in left ventricle (LV), left kidney (LK) and ascending aorta (aAo) and the LV expression of cardiac remodeling and fibrogenic factors were quantified with real-time PCR. AXL LV protein levels were quantified with western blot and localization was analyzed by immunohistochemistry. Soluble AXL levels in plasma were assayed with ELISA. RESULTS: Successful TAC rats were classified into LV hypertrophy (LVH) or heart failure (HF), modeling the progressive cardiac changes after pressure overload. Collagen deposition was increased only in the HF group. LV Axl mRNA levels were higher in LVH and HF than in Sham rats, and correlated with LVHi, and hypertrophic and fibrogenic mediators. However, no association was found with LV systolic function. AXL was expressed in LV myocytes and other cell types. Concentration of circulating sAXL in plasma was increased in the LVH group compared to Sham and HF rats. Axl mRNA levels were similar in all groups in the LK and aAo. CONCLUSIONS: Axl expression pattern suggests a role in the early progression of LV remodeling in HF but not in the later systolic dysfunction. The higher levels of circulating AXL found in HF patients most probably shed from the heart.

Frecuencia y factores asociados a la hipoglicemia en pacientes con diabetes mellitus tipo 2 hospitalizados / Frequency and associated factors of hypoglycemia in hospitalized patients with diabetes mellitus type 2

Determinar la frecuencia y factores asociados a la hipoglicemia en pacientes con diabetes mellitus tipo 2 (DM-2) hospitalizados. MATERIAL y MÉTODOS. Se realizó un estudio observacional, prospectivo y transversal en los servicios de medicina del Hospital Nacional Cayetano Heredia de Lima, durante los meses de julio a diciembre del 2013 en los pacientes adultos que habían ingresado con diagnóstico de DM-2. Se recopiló información sobre edad, sexo, tiempo de enfermedad, glicemia de ingreso, hemoglobina glicosilada, diagnósticos de ingreso, comorbilidades, causas de hospitalización, esquemas de tratamiento hipoglicemiantes antes y durante la hospitalización. RESULTADOS. Ingresaron 159 pacientes, 48 % fueron varones; 61 años, la mediana de la edad; 174 mg/dL, la glicemia de ingreso; 8,6 %, la hemoglobina glicosilada; 34 % tuvieron más de diez años de tiempo de enfermedad. El esquema de insulinoterapia más utilizado fue el de NPH basal (33,3 %), seguido de NPH basal con bolos preprandiales de insulina regular (31,5 %). La frecuencia de hipoglicemia fue 25,2 % Y los factores asociados fueron tiempo de enfermedad mayor de 10 años y el uso del esquema de insulina NPH basal más bolos preprandiales de insulina regular. CONCLUSIÓN. Se halló una alta frecuencia de hipoglicemia en los diabéticos hospitalizados en un hospital general...

To determine the frequency and associated factors with hypoglycemia in hospitalized patients with diabetes mellitus type 2 (DM-2). MATERIAL AND METHODS. An observational, prospective and transversal study was done in the medical services of the Hospital Nacional Cayetano Heredia, Lima, during the months of July to December 2013 in adult patients who had been admitted with a diagnosis of DM-2. It was gathered information on age, gender, disease duration, income, glycosylated hemoglobin glycemia, admission diagnoses, co-morbidities, causes of hospitalization, schemes of hypoglycemic treatment before and during hospitalization. RESULTS. It was included J 59 patients, 48 % males, 61 year- old as median age, 174 mg/dL was the median blood sugar level at entry and 8,6 % was the median of glycosylated hemoglobin. Thirty four patients had more than ten years of disease duration. The most widely used insulin therapy scheme was the basal insulin NPH (33,3 %),followed by basal insulin NPH with boluses of preprandial insulin regular (31,5 %). The frequency of hypoglycemia was 25,2 % and associated factors were time of disease greater than la years and the use of basal insulin NPH plus preprandial regular insulin. CONCLUSION. We found a high frequency of hypoglycemia in hospitalized diabetic patients in a general hospital...

Aging negatively affects estrogens-mediated effects on nitric oxide bioavailability by shifting ERα/ERß balance in female mice.

AIMS: Aging is among the major causes for the lack of cardiovascular protection by estrogen (E2) during postmenopause. Our study aims to determine the mechanisms whereby aging changes E2 effects on nitric oxide (NO) production in a mouse model of accelerated senescence (SAM). METHODS AND RESULTS: Although we found no differences on NO production in females SAM prone (SAMP, aged) compared to SAM resistant (SAMR, young), by either DAF-2 fluorescence or plasmatic nitrite/nitrate (NO2/NO3), in both cases, E2 treatment increased NO production in SAMR but had no effect in SAMP. Those results are in agreement with changes of eNOS protein and gene expression. E2 up-regulated eNOS expression in SAMR but not in SAMP. E2 is also known to increase NO by decreasing its catabolism by superoxide anion (O(2)(-)). Interestingly, E2 treatment decreased O(2)(-) production in young females, while increased O(2)(-) in aged ones. Furthermore, we observed that aging changed expression ratio of estrogen receptors (ERß/ERα) and levels of DNA methylation. Increased ratio ERß/ERα in aged females is associated to a lack of estrogen modulation of NO production and with a reversal in its antioxidant effect to a pro-oxidant profile. CONCLUSIONS: Together, our data suggest that aging has detrimental effects on E2-mediated benefits on NO bioavailability, partially by affecting the ability of E2 to induce up regulation of eNOS and decrease of O(2)(-). These modifications may be associated to aging-mediated modifications on global DNA methylation status, but not to a specific methylation at 5'flanking region of ERα gene.