Advanced glycation end products (AGEs) estimated by skin autofluorescence are related with cardiovascular risk in renal transplant.

BACKGROUND: Advanced glycation end products (AGEs) accumulation, a measure of cumulative metabolic stress, constitute a novel pathogenic mechanism involved in aging, diabetes, cardiovascular (CVD) and chronic kidney disease (CKD). Despite removal of uremic toxins and AGEs after a successful renal transplant (RT), CVD remains the leading cause of mortality. We hypothesized that AGEs measurement by Skin Autofluorescence (SAF) might be useful even after a successful RT and thus reflect the high cardiovascular risk burden of these patients. METHODS: 189 stable RT (61% men, aged 56±13.0 years), CKD stages 1-4 and >12 months since RT were enrolled. Variables collected comprised comorbid history, medication use, smoking habit, routine biochemistry, subclinical atheromatosis by ankle-brachial-index (ABI) and allograft resistivity index (RI), 24-h ABPM, anthropometry and handgrip strength. AGEs were measured by SAF and expressed in arbitrary units (AU). Vascular age was estimated by Koetsier´s formula (SAF-0.83/0.024) and expected 10-years cardiovascular death risk was calculated with the REGICOR score. RESULTS: Mean SAF was 3.00±0.83 AU and estimated vascular age 90±34.7 years (30 years above biological age). SAF was higher among men (3.10±0.91 vs 2.81±0.66), diabetic nephropathy (3.49±0.75 vs 2.96±0.83) and steroid users (3.14±0.86 vs 2.71±0.69). We observed a positive correlation of SAF with night-systolic blood pressure (r = 0.25, p = 0.001), parathormone (r = 0.20, p<0.01), phosphate (r = 0.28, p<0.001) and negative with hemoglobin (r = -0.29, p<0.001), CKD-EPI (r = -0.32, p<0.001), albumin (r = -0.17, p<0.05), and dynamometry (r = -0.20, p<0.01). Subclinical vascular atheromatosis (ABI and RI) as well as the REGICOR scale (r = 0.35 p<0.001) were also correlated with SAF. In multivariable analysis age, gender, steroid use, serum phosphate and handgrip strength remained independently associated with SAF. CONCLUSIONS: SAF levels are elevated in RT patients and correlate with CVD risk. Besides age and male sex, our results suggest that phosphate overload, steroid use and nutritional status are important factors linking to AGEs accumulation.

Cumplimiento del bundle de neumonía asociada a ventilación mecánica en el Hospital Universitario La Paz / Compliance with the pneumonia bundle associated with mechanical ventilation in La Paz University Hospital, Madrid

Introducción: Los bundles son grupos de medidas que buscan reducir la incidencia de la infección nosocomial. Decidimos evaluar el cumplimiento del bundle de neumonía asociada a ventilación mecánica y, en función de los resultados, promover un plan de mejora. Pacientes y método: El bundle incluye: elevar el cabecero 30° o más, valorar diariamente la necesidad de sedación, aplicar profilaxis antitrombótica y de úlcera de estrés. Se evaluó en la unidad de cuidados intensivos (UCI), en la reanimación de la primera planta (REA1) y en la de la tercera (REA3) diariamente desde el 25 de junio hasta el 20 de julio de 2007. Resultados: En la UCI se realizaron 222 observaciones (189 completas); en la REA1, 34 observaciones (26 completas), y en la REA3, 35 observaciones (27 completas). El cumplimiento del bundle fue del 77,2% en UCI, el 50% en REA1 y el 70,2% en REA3. El menor cumplimiento correspondió a la elevación del cabecero (UCI, el 85,8%; REA1, el 57,6% y REA3, el 69%). Las medidas propuestas fueron: incluir orden estandarizada de elevación de la cabeza a 45°, realización de ventanas de sedación por enfermería y reflejar en la historia cuando no se pueda realizar alguna medida. Conclusiones: Las estrategias de mejora mediante bundles son una forma fácil y rápida de obtener medidas de proceso que nos ayudan a mejorar la prevención de la infección nosocomial

Introduction: Bundles are groups of interventions to reduce nosocomial infection rates. We evaluated the current status of ventilator-associated pneumonia bundle compliance in our hospital to propose an improvement plan on the basis of the results. Patients and method: Bundle includes: raising the head of the bed $ 30°, daily assessment of sedation requirements, peptic ulcer disease and deep venous thrombosis prophylaxis. It was evaluated in the intensive care unit (ICU) and two postoperative recovery units (called REA1 and REA3) from June 25 until July 20, 2007. Results: In ICU, 222 observations were made (189 complete), in REA1 34 observations (26 complete) and in REA3, 35 observations (27 complete). Bundle compliance was 77.2% in ICU, 50% in REA1 and 70.2% in REA3. Lowest compliance component was raising the head of the bed (UCI, 85.8%; REA1, 57.6%, and REA3, 69%). Improved interventions proposed were to include standardised requirements for raising the head of the bed to 45°, to empower nurses to make daily "sedation vacations" (interruption of sedation to point of alertness) and mention in medical history when an item cannot be carried out. Conclusions: Improvement strategies through bundles are a quick and easy way to obtain process indicators that help us improve the prevention of nosocomial infections (AU)

[Not Available]. / Cumplimiento del bundle de neumonía asociada a ventilación mecánica en el Hospital Universitario La Paz.

INTRODUCTION: Bundles are groups of interventions to reduce nosocomial infection rates. We evaluated the current status of ventilatorassociated pneumonia bundle compliance in our hospital to propose an improvement plan on the basis of the results. PATIENTS AND METHOD: Bundle includes: raising the head of the bed (30°, daily assessment of sedation requirements, peptic ulcer disease and deep venous thrombosis prophylaxis. It was evaluated in the intensive care unit (ICU) and two postoperative recovery units (called REA1 and REA3) from June 25 until July 20, 2007. RESULTS: In ICU, 222 observations were made (189 complete), in REA1 34 observations (26 complete) and in REA3, 35 observations (27 complete). Bundle compliance was 77.2% in ICU, 50% in REA1 and 70.2% in REA3. Lowest compliance component was raising the head of the bed (UCI, 85.8%; REA1, 57.6%, and REA3, 69%). Improved interventions proposed were to include standardized requirements for raising the head of the bed to 45°, to empower nurses to make daily "sedation vacations" (interruption of sedation to point of alertness) and mention in medical history when an item cannot be carried out. CONCLUSIONS: Improvement strategies through bundles are a quick and easy way to obtain process indicators that help us improve the prevention of nosocomial infections.