The STARMEN trial indicates that alternating treatment with corticosteroids and cyclophosphamide is superior to sequential treatment with tacrolimus and rituximab in primary membranous nephropathy.

A cyclical corticosteroid-cyclophosphamide regimen is recommended for patients with primary membranous nephropathy at high risk of progression. We hypothesized that sequential therapy with tacrolimus and rituximab is superior to cyclical alternating treatment with corticosteroids and cyclophosphamide in inducing persistent remission in these patients. This was tested in a randomized, open-label controlled trial of 86 patients with primary membranous nephropathy and persistent nephrotic syndrome after six-months observation and assigned 43 each to receive six-month cyclical treatment with corticosteroid and cyclophosphamide or sequential treatment with tacrolimus (full-dose for six months and tapering for another three months) and rituximab (one gram at month six). The primary outcome was complete or partial remission of nephrotic syndrome at 24 months. This composite outcome occurred in 36 patients (83.7%) in the corticosteroid-cyclophosphamide group and in 25 patients (58.1%) in the tacrolimus-rituximab group (relative risk 1.44; 95% confidence interval 1.08 to 1.92). Complete remission at 24 months occurred in 26 patients (60%) in the corticosteroid-cyclophosphamide group and in 11 patients (26%) in the tacrolimus-rituximab group (2.36; 1.34 to 4.16). Anti-PLA2R titers showed a significant decrease in both groups but the proportion of anti-PLA2R-positive patients who achieved immunological response (depletion of anti-PLA2R antibodies) was significantly higher at three and six months in the corticosteroid-cyclophosphamide group (77% and 92%, respectively), as compared to the tacrolimus-rituximab group (45% and 70%, respectively). Relapses occurred in one patient in the corticosteroid-cyclophosphamide group, and three patients in the tacrolimus-rituximab group. Serious adverse events were similar in both groups. Thus, treatment with corticosteroid-cyclophosphamide induced remission in a significantly greater number of patients with primary membranous nephropathy than tacrolimus-rituximab.

Very low doses of direct intravenous iron in each session as maintenance therapy in hemodialysis patients.

BACKGROUND: Intravenous (IV) iron supplementation is widely used in hemodialysis (HD) patients to treat their periodic losses. However, the ideal dose and frequency is unknown. The goal of the study is to see if a 20 mg dose of iron IV at the end of each session of HD as iron maintenance is better than the iron prior therapy. We analyze the erythropoiesis activity (EA) and functional iron (FI) after four weeks of treatment. METHODS: In 36 patients, we measure reticulocyte count and content of hemoglobin reticulocyte (CHr) as EA and FI markers, respectively, before and after the treatment. Before the study, 23 patients received another different therapy with IV iron as maintenance therapy. RESULTS: Reticulocyte count: 49.7 ± 23.8 × 10(3) before and 47.2 ± 17.2 × 10(3) after the treatment (p= 0.51). The CHr: 34.8 ± 3.7 pg and 34.4 ± 3.5 pg, respectively, (p= 0.35), showing an excellent correlation with the other FI markers (serum iron r = 0.6; p = 0.001; saturation transferrin r = 0.49; p = 0.004); that is not shown with the serum ferritin (r = 0.23; p = 0.192) or the hepcidin levels (r = 0.22; p = 0.251). There was not a correlation between the C-Reactive Protein, reticulocyte count, and CHr. The 13 patients who did not receive the iron prior to the study showed high FI levels, but not an increased of the serum ferritin or the serum hepcidin levels. CONCLUSIONS: The administration of a small quantity of iron at the end of every HD session keeps the EA and the FI levels and allows reducing the iron overload administered and/or decreasing the iron stores markers in some patients.

Perfil de riesgo cardiovascular de los jóvenes españoles de la provincia de Cáceres / Cardiovascular risk profile of young Spanish people in the province of Cáceres

Introducción. La identificación y la caracterización de los factores de riesgo cardiovascular en la población juvenil permite identificar a los individuos predispuestos a presentar enfermedad cardiovascular y contribuye a diseñar estrategias de prevención. Objetivos. Conocer las características antropométricas, los datos clínicos y los factores de riesgo cardiovascular de una muestra de jóvenes de ambos sexos de entre 14 y 24 años de la provincia española de Cáceres. Material y métodos. Estudio transversal sobre una muestra de 172 jóvenes de ambos sexos elegidos al azar mediante muestreo trietápico: área de salud, zona de salud y cupo médico. Se les realizó una encuesta de salud, un examen físico y una determinación en sangre venosa de glucemia, triglicéridos y colesterol unido a lipoproteínas de alta densidad. Resultados. El factor de riesgo cardiovascular más prevalente entre los jóvenes españoles de la provincia de Cáceres es el tabaquismo, cuya prevalencia es del 27,9%, el 17,9% de varones y el 36,2% de mujeres (p = 0,01). El 12,2% de los jóvenes presentaba exceso de peso (índice de masa corporal [IMC] ≥ 25 kg/m2), y el 2,3% eran obesos (IMC ≥ 30 kg/m2), sin diferencias entre sexos. Otros factores de riesgo como hipertensión arterial, dislipemia y diabetes mellitus son muy poco prevalentes en jóvenes. Los parámetros antropométricos estudiados se correlacionan de forma significativa con las cifras de presión arterial. Conclusiones. Los resultados de nuestro trabajo confirman una prevalencia elevada de factores de riesgo cardiovascular en la población juvenil española, como el tabaquismo y el exceso de peso, y destacan la importancia de establecer, entre otras medidas, intervenciones de promoción de estilos de vida saludable desde etapas tempranas de la vida(AU)

Introduction. The identification and characterisation of cardiovascular risk factors in the youth population helps to determine those individuals who may be predisposed to cardiovascular disease and in designing prevention strategies. Objectives. To determine the anthropometric characteristics, clinical data and cardiovascular risk factors in a sample of young men and women aged 14 to 24 years in the Spanish province of Caceres. Material and methods. Cross-sectional study on a sample of 172 randomly selected young men and women using three-stage sampling: health area, health district, and medical quota. They completed a health questionnaire, physical examination, and their intravenous blood glucose, triglycerides and HDL-cholesterol levels were determined. Results. The cardiovascular risk factor most prevalent among young people in the Spanish province of Caceres is smoking, with a prevalence of 27.9%, with 17.9% males and 36.2% females (P=.01) . Overweight was observed 12.2% of young people (BMI ≥ 25 kg/m2), and 2.3% were obese (BMI ≥ 30 kg/m2), with no differences seen between gender. Other risk factors, such as hyper-tension, dyslipidaemia and diabetes are very prevalent in young people. The anthropometric parameters studied significantly correlated with blood pressure levels. Conclusions. The results of our work confirm a high prevalence of cardiovascular risk factors in the Spanish youth population, including smoking and excess weight, and our findings stress the importance of establishing measures, including interventions to promote a healthy lifestyle from an early age(AU)

Datos epidemiológicos del tabaquismo en la provincia de Cáceres (España) / No disponible

Introducción y objetivo: El tabaquismo es uno de los principales factores de riesgo cardiovascular y la primera causa de muerte evitable en el mundo. El objetivo de este estudio es analizar la prevalencia del consumo de cigarrillos en individuos mayores de 14 años de la provincia de Cáceres y relacionarlo con otros factores de riesgo cardiovascular y comorbilidades. Métodos: Se realizó una encuesta directa a una muestra poblacional de 1498 individuos mayores de 14 años de la provincia de Cáceres elegidos al azar mediante muestreo aleatorio trietápico. Resultados: Fuman el 29,1% de los cacereños (32,7% de hombres y 26,2% de mujeres), con una edad media de 41,3514,51 años. En la población de entre 14 y 18 años fuman el 11,9% de los hombres frente al 23,9% de las mujeres. Presentan antecedentes de enfermedad cardiovascular el 8,7% de fumadores (frente al 15,6% de no fumadores). Conclusiones: La prevalencia del tabaquismo en la provincia de Cáceres es elevada, mayor en hombres que en mujeres, excepto en el tramo de edad entre 14 y 18 años en que la proporción se invierte. Los fumadores presentan menos antecedentes de enfermedad cardiovascular, menos factores de riesgo cardiovascular y menos comorbilidad que los no fumadores (AU)

Introduction and Objective: Smoking is a major cardiovascular risk factors and the fi rst cause of preventable death in the world. The objective of this study is to analyze the prevalence of smoking in subject over 14 years in the province of Caceres and related cardiovascular risk factors and comorbidities. Methods: A survey was conducted to a population sample of 1498 individuals over 14 years in the province of Cáceres randomly selected three-stage random sample. Results: A 29.1% of cacereños are smokers (32.7% of males and 26.2% women) with a mean age of 41.35±21.98 years. In the population of 14 to 18 years a 11.9% of males compared to 23.9% of women are smokers. A 8.7% of smokers (versus 15.6% non-smoking) have a history of cardiovascular disease. Conclusions: The prevalence of smoking in the province of Cáceres is high, higher in males than females, except between 14 and 18 years that the ratio is reversed. Smokers have less history of cardiovascular disease, fewer cardiovascular risk factors and less comorbidity than non-smokers (AU)