SEOM clinical guidelines for cancer anorexia-cachexia syndrome (2023).

Cancer-related anorexia-cachexia syndrome (CACS) is a debilitating condition afflicting up to 80% of advanced-stage cancer patients. Characterized by progressive weight loss, muscle wasting, and metabolic abnormalities, CACS significantly compromises patients' quality of life and treatment outcomes. This comprehensive review navigates through its intricate physiopathology, elucidating its stages and diagnostic methodologies. CACS manifests in three distinct stages: pre-cachexia, established cachexia, and refractory cachexia. Early detection is pivotal for effective intervention and is facilitated by screening tools, complemented by nutritional assessments and professional evaluations. The diagnostic process unravels the complex interplay of metabolic dysregulation and tumor-induced factors contributing to CACS. Management strategies, tailored to individual patient profiles, encompass a spectrum of nutritional interventions. These include dietary counseling, oral nutritional supplements, and, when necessary, enteral nutrition and a judicious use of parenteral nutrition. Specific recommendations for caloric intake, protein requirements, and essential nutrients address the unique challenges posed by CACS. While pharmacological agents like megestrol acetate may be considered, their use requires careful evaluation of potential risks. At its core, this review underscores the imperative for a holistic and personalized approach to managing CACS, integrating nutritional interventions and pharmacological strategies based on a nuanced understanding of patient's condition.

Metodología para el desarrollo de las cualidades coordinativas básicas, en la Educación Física del nivel inicial 2

El profesional de cultura física contribuye, con aportes importantes, al perfeccionamiento de los programas; aplica a la educación el ejercicio físico desde las primeras edades y favorece la formación integral. El objetivo de este trabajo consistió en diseñar una metodología para el desarrollo de las cualidades coordinativas básicas en la Educación Física del nivel inicial 2. Para ello, se realizó un estudio de diseño preexperimental de control mínimo, con dos años de duración (2020-2021). La muestra seleccionada respondió a un muestreo intencional estratificado, no probabilístico. Se emplearon métodos de los niveles teórico y empírico, tales como: análisis y síntesis, inductivo-deductivo, sistémico-estructural funcional, medición, experimento, criterio de expertos y estadística descriptiva, así como técnicas de investigación entre los que destacan, análisis documental, observación estructurada, entrevista y encuesta. La metodología se realizó mediante la implementación de ejercicios físicos. Participaron 229 niños del nivel inicial 2; a partir del diagnóstico realizado se determinó que el equilibrio dinámico (46,3 %) y la coordinación dinámica general (43,7%) fueron evaluados de regular, además de dificultades en todos los patrones de movimiento, la motricidad gruesa, la fina, los reflejos, las reacciones y patrones posturales. El estudio mostró que se puede mejorar el desarrollo de las cualidades coordinativas básicas en la Educación Física del nivel inicial 2.

O profissional de cultura física contribui, com contribuições importantes, para o aprimoramento dos programas; Aplica o exercício físico à educação desde tenra idade e promove uma formação integral. O objetivo deste trabalho foi desenhar uma metodologia para o desenvolvimento de qualidades coordenativas básicas em Educação Física do nível inicial 2. Para tanto, foi realizado um estudo de desenho pré-experimental de controle mínimo, com duração de dois anos (2020-2021). ). ). A amostra selecionada respondeu a uma amostragem estratificada e não probabilística intencional. Foram utilizados métodos dos níveis teórico e empírico tais como: análise e síntese indutivo-dedutivo sistêmico-estrutural-funcional medição experimento julgamento de especialistas e estatística descritiva bem como técnicas de pesquisa dentre as quais se destacam a análise documental observação estruturada, entrevista e inquérito. A metodologia foi realizada por meio da execução de exercícios físicos. Participaram 229 crianças do nível inicial 2; A partir do diagnóstico realizado, constatou-se que o equilíbrio dinâmico (46,3%) e a coordenação dinâmica geral (43,7%) foram avaliados como regulares, além de dificuldades em todos os padrões de movimento, motricidade grossa e fina, reflexos, reações e padrões posturais. O estudo mostrou que o desenvolvimento das qualidades coordenativas básicas pode ser melhorado na Educação Física no nível inicial 2.

The physical culture professional contributes, with important contributions, to the improvement of the programs; applies physical exercise to education, from the earliest ages and promotes comprehensive training. The objective of this work was to design a methodology for the development of basic coordinative qualities in Physical Education of the initial level 2. To this end, a pre-experimental design study of minimum control was carried out, lasting two years (2020-2021). The selected sample responded to a stratified, non-probabilistic intentional sampling. Methods from the theoretical and empirical levels were used, such as: analysis and synthesis, inductive-deductive, systemic-structural-functional, measurement, experiment, expert judgment and descriptive statistics, as well as research techniques, among which stand out documentary analysis, structured observation, interview and survey. The methodology was carried out through the implementation of physical exercises. 229 children from initial level 2 participated. Based on the diagnosis made, it was determined that dynamic balance (46.3 %) and general dynamic coordination (43.7 %) were evaluated as fair, in addition to difficulties in all movement patterns, gross and fine motor skills, reflexes, reactions and postural patterns. The study showed that the development of basic coordinative qualities can be improved in Physical Education at initial level 2.

EL SUEÑO EN ESTUDIANTES DE ENFERMERÍA EN UNA UNIVERSIDAD DEL SUR DE CHILE / SLEEP IN NURSING STUDENTS AT A UNIVERSITY IN SOUTHERN CHILE

El sueño es una función y necesidad básica en el ser humano; permite el descanso de la mente y cuerpo, recuperar energías y restablecer funciones para un buen rendimiento. Los trastornos del sueño pueden desencadenar problemas gástricos, cardiovasculares, cognitivas, desequilibrio en el rendimiento académico, alterando negativamente la capacidad de concentración, aprendizaje, memoria; dormir poco se asocia a fatiga y disminución de las capacidades cognitivas y motoras durante el día. Las demandas sociales, familiares y académicas de estudiantes universitarios los hace adoptar patrones de sueño irregulares, dando lugar a cambios en el hábito del sueño, especialmente en el contexto de la pandemia por COVID-19, debido al incremento de horas de conexión tele presencial y el uso de aparatos electrónicos para sus actividades académicas. Por ello el presente estudio evaluado y aprobado por Comité De Ética, certificado ORD: Nº 145- 2021/RevOct.2021, pretende describir la calidad del sueño en estudiantes de Enfermería en una Universidad del sur de Chile durante el segundo semestre del 2021; aplicando el Índice de Calidad de Sueño de Pittsburgh a 165 estudiantes de primero a quinto año, a través de un estudio de tipo cuantitativo, observacional, descriptivo, de secuencia transversal, con muestreo probabilístico estratificado y con afijación simple. Solo el 12% de los estudiantes de Enfermería presentó óptima calidad del sueño; el 64% sugiere problemas de sueño y el 24% se acercan a una peor calidad de sueño. La existencia de una alta prevalencia de la mala calidad del sueño indica la necesidad de adquirir una buena higiene del sueño que permita el descanso adecuado y necesario para realizar sus actividades de manera óptima.

Sleep is a basic function and need in humans; it allows the brain and body to rest, recover energy, and restore functions for good performance. Sleep disorders can trigger gastric, cardiovascular, and cognitive problems, as well as affect academic performanceby negatively altering the ability to concentrate, learn, and recall. Insufficient sleep is associated with fatigue and decreased cognitive and motor skills during the day. The social, family, and academic demands of university students often make them adopt irregular sleep patterns, leading to changes in sleep habits. This was especially true during the COVID-19 pandemic, due to the increase in hours of online connection and the use of electronic devices for academic activities. This study, evaluated and approved by the Ethics Committee, certified ORD: Nº 145- 2021/RevOct.2021, aims to describe the quality of sleep in Nursing students at a university in southern Chile during the second semester of 2021. The Pittsburgh Sleep Quality Index was administered to 165 first-year to fifth-year Nursing students, through a quantitative, observational, descriptive, cross-sectional sequence study, with stratified probabilistic sampling and simple assignment. Only 12% of Nursing students had optimal sleep quality; 64% suggest sleep problems and 24% indicated a worse quality of sleep. The high prevalence of poor sleep quality indicates the need for students to adopt good sleep hygiene that allows adequate and necessary rest for optimal academic performance.

One-year efficacy and safety of naloxegol on symptoms and quality of life related to opioid-induced constipation in patients with cancer: KYONAL study.

OBJECTIVES: Naloxegol is a peripherally acting µ-opioid receptor antagonist (PAMORA) for treatment of opioid-induced constipation (OIC). The main objective was to analyse the long-term efficacy, quality of life (QOL) and safety of naloxegol in patients with cancer in a real-world study. METHODS: This one-year prospective study included patients older than 18 years, with active oncological disease who were under treatment with opioids for pain control and Karnofsky≥50 and OIC with inadequate response to treatment with laxative (s). All the patients received treatment with naloxegol according to clinical criteria. The main efficacy objectives were measured by the patient assessment of constipation QOL questionnaire (PAC-QOL), the PAC symptoms (PAC-SYM), the response rate at day 15, and months 1-3-6-12, and global QOL (EuroQoL-5D-5L). RESULTS: A total of 126 patients (58.7% males) with a mean age of 61.5 years (95% CI 59.4 to 63.7) were included. PAC-SYM and PAC-QOL total score and all their dimensions improved from baseline (p<0.0001). At 12 months, 77.8% of the patients were responders to naloxegol treatment. Global QOL was conserved from baseline. A total of 28 adverse reactions, mainly gastrointestinal were observed in 15.1% of the patients (19/126), being 75% (21) mild, 17.9% (5) moderate and 7.1% (2) severe. Most adverse reactions (67.9%) appeared the first 15 days of treatment. CONCLUSION: The results of this first long-term and real-world-data study in patients with cancer, showed the sustained efficacy and safety of naloxegol for the treatment of OIC in this group of patients.

Reeducación al esfuerzo en pacientes con neumonía por COVID-19 / Effort reeducation in patients with COVID-19 pneumonia / Reeducação de esforço em pacientes com pneumonia por COVID-19

Los pacientes con neumonía por COVID-19, presentan secuelas como disnea, fatiga, problemas cognitivos, disminución de la capacidad aeróbica y funcional. La reeducación al esfuerzo requiere de ejercicios de bajo impacto, que exigen un trabajo progresivo de fuerza máxima en un tiempo límite para enseñarles a resistir la fatiga. El objetivo general de este trabajo es demostrar los beneficios del Programa de reeducación al esfuerzo en pacientes con neumonía por COVID-19 atendidos en el Hospital General IESS Milagro. Estudio de enfoque cuantitativo, alcance explicativo, diseño experimental e instrumentos de evaluación como: Historia clínica y escalas de mMRC, IBF, MRC Modificado, PCFS, Sit to stand y Mini mental, la muestra fue de 50 pacientes en edades entre los 20 a 70 años. Después de realizar el Programa de Reeducación al esfuerzo el 100% de los pacientes presentaron fatiga leve (IBF), el 100% no presentó deterioro cognitivo (Mini-mental); el 44% no manifestó disnea y el 56% disnea leve (mMRC). El 100% aumentaron su fuerza muscular (MRC) y el 40% realiza sus actividades de la vida diaria a pesar de presentar pocos síntomas (PCFS). El 100% mejoró en la capacidad aeróbica (Sit to Stand). Se concluye que los ejercicios de reeducación al esfuerzo coadyuvan de forma positiva a mejorar la calidad de vida de los pacientes con neumonía por COVID-19, mediante la utilización de diversas técnicas que les permita el regreso progresivo a la actividad física y los deportes, lo cual fue demostrado en los resultados.

Patients with COVID-19 pneumonia present sequelae such as dyspnea, fatigue, cognitive problems, decreased aerobic and functional capacity. The re-education to effort requires low impact exercises, which require a progressive work of maximal strength in a time limit to teach them to resist fatigue. The general objective of this work is to demonstrate the benefits of the stress reeducation program in patients with COVID-19 pneumonia treated at the General Hospital IESS Milagro. A quantitative approach study, explanatory scope, experimental design and evaluation instruments such as: Clinical history and mMRC scales, IBF, Modified MRC, PCFS, sit to stand and Mini mental, the sample consisted of 50 patients aged between 20 and 70 years. After the Exertion Re-education Program, 100% of the patients presented mild fatigue (IBF), 100% did not present cognitive deterioration (Mini-mental); 44% did not manifest dyspnea and 56% mild dyspnea (mMRC). 100% increased their muscle strength (MRC) and 40% performed their activities of daily living despite presenting few symptoms (PCFS). 100% improved in aerobic capacity (Sit to Stand). It is concluded that exertional re-education exercises contribute positively to improve the quality of life of patients with COVID-19 pneumonia, through the use of various techniques that allow them to progressively return to physical activity and sports, which was demonstrated in the results.

Os pacientes com pneumonia COVID-19 têm seqüelas como dispneia, fadiga, problemas cognitivos, diminuição da capacidade aeróbica e funcional. A reeducação do exercício requer exercícios de baixo impacto, que requerem um trabalho progressivo de máxima força em um limite de tempo para ensiná-los a resistir à fadiga. O objetivo geral deste estudo é demonstrar os benefícios do Programa de Reeducação do Exercício em pacientes com pneumonia COVID-19 tratados no Hospital Geral IESS Milagro. Um estudo de abordagem quantitativa, escopo explicativo, desenho experimental e instrumentos de avaliação tais como: história clínica e escalas mMRC, IBF, MRC modificado, PCFS, sit to stand e Mini mental, a amostra consistiu de 50 pacientes com idade entre 20 e 70 anos. Após o Programa de Reeducação do Exercício, 100% dos pacientes apresentaram fadiga leve (IBF), 100% não apresentaram deterioração cognitiva (Mini-mental); 44% não manifestaram dispneia e 56% dispneia leve (mMRC). 100% aumentaram sua força muscular (MRC) e 40% realizaram suas atividades de vida diária apesar de terem poucos sintomas (PCFS). 100% melhorada em capacidade aeróbica (Sente-se para ficar de pé). Conclui-se que os exercícios de reeducação por esforço contribuem positivamente para melhorar a qualidade de vida dos pacientes com pneumonia COVID-19, através do uso de várias técnicas que lhes permitem retornar progressivamente à atividade física e ao esporte, o que foi demonstrado nos resultados.

Rol de la familia en el cuidado del adulto mayor: un estudio de caso de la ciudadela pacheco / Role of the family in the care of the elderly: A case study of the citadel pacheco

La familia se ha convertido en la base importante de apoyo en la vida de los adultos mayores, convirtiéndose estos en personas dependientes de otra ya sea por distintos determinantes, un adulto mayor dependiente requiere de apoyo de un cuidador principal perteneciendo al mismo círculo familiar, específicamente de sexo femenino. Los cuidados directos a una adulta mayor recaen en una sola persona, trayendo consecuencias en la misma, como es la sobrecarga de trabajo en la cuidadora. Objetivo: indagar el Rol de la Familia en el cuidado del adulto mayor y a su vez analizar el nivel de sobrecarga del cuidador y la calidad de vida de ambas personas en estudio. Materiales y métodos: Corresponde a un estudio de caso, de tipo observacional, descriptivo y analítico, cualitativo, en base al rol de la familia en el cuidado de la adulta mayor Esperanza Mera de la ciudadela Francisco Pacheco de la ciudad de Portoviejo. Resultados: Existe poca satisfacción en la calidad de vida y el nivel de sobrecarga es intensa, al igual que manifiestan disfunción familiar leve, para lo cual se diseñó un plan el mismo que deben de llevar a cabo en el Centro de Salud al que pertenecen. Conclusión: Es fundamental que la cuidadora este completamente orientada y capacitada por profesionales de salud en el cuidado del adulto mayor dependiente y en su auto cuidado, ya que la misma es la única responsable del cuidado sin recibir apoyo del resto de la familia(AU)

The family has become the important base of support in the lives of older adults, making them dependent on another, either due to different determinants, a dependent older adult requires support from a primary caregiver belonging to the same family circle. specifically female. Direct care for an older adult falls on a single person, bringing consequences to it, such as work overload for the caregiver. Objective: to investigate the Role of the Family in the care of the elderly and, in turn, to analyze the level of burden of the caregiver and the quality of life of both people under study. Materials and methods: Corresponds to an observational, descriptive and analytical, qualitative case study, based on the role of the family in the care of the elderly Esperanza Mera from the Francisco Pacheco citadel in the city of Portoviejo. Results: There is little satisfaction in the quality of life and the level of overload is intense, as well as manifesting mild family dysfunction, for which a plan was designed that must be carried out in the Health Center to which they belong. Conclusion: It is essential that the caregiver is completely oriented and trained by health professionals in the care of the elderly dependent adult and in their self-care, since they are the only one responsible for the care without receiving support from the rest of the family(AU)

SEOM-GETTHI clinical guideline for the practical management of molecular platforms (2021).

The improvement of molecular alterations in cancer as well as the development of technology has allowed us to bring closer to clinical practice the determination of molecular alterations in the diagnosis and treatment of cancer. The use of multidetermination platforms is spreading in most Spanish hospitals. The objective of these clinical practice guides is to review their usefulness, and establish usage guidelines that guide their incorporation into clinical practice.

Therapeutic impact and routine application of next-generation sequencing: A single institute study.

Genomic sequencing of tumor tissues provides information on actionable gene aberrations that have diagnostic and therapeutic significance and may guide clinical management through the use of targeted therapies. The indications for these techniques and their possible limitations for application in daily practice should be established as a priority. In the present study, a group of patients with few suitable therapeutic options who were eligible for a next-generation sequencing (NGS) analysis were analyzed, and the molecular targets identified and their therapeutic impact are described. A series of 26 patients treated at the Virgen Macarena Hospital for whom an NGS study was requested between January 2017 and December 2019 were reviewed. Actionable molecular alterations were identified in 20 of the cases, and 4 patients received NGS-guided treatment. NGS techniques represent a novel opportunity for guiding treatment in cancer patients. Patients with few therapeutic alternatives, either due to diagnosis, atypical evolution or resistance to standard therapy, may be suitable candidates.

SEOM-GETTHI clinical guideline for the practical management of molecular platforms (2021)

The improvement of molecular alterations in cancer as well as the development of technology has allowed us to bring closer to clinical practice the determination of molecular alterations in the diagnosis and treatment of cancer. The use of multidetermination platforms is spreading in most Spanish hospitals. The objective of these clinical practice guides is to review their usefulness, and establish usage guidelines that guide their incorporation into clinical practice.

Insulin Withdrawal in Diabetic Kidney Disease: What Are We Waiting for?

The prevalence of type 2 diabetes mellitus worldwide stands at nearly 9.3% and it is estimated that 20-40% of these patients will develop diabetic kidney disease (DKD). DKD is the leading cause of chronic kidney disease (CKD), and these patients often present high morbidity and mortality rates, particularly in those patients with poorly controlled risk factors. Furthermore, many are overweight or obese, due primarily to insulin compensation resulting from insulin resistance. In the last decade, treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have been shown to be beneficial in renal and cardiovascular targets; however, in patients with CKD, the previous guidelines recommended the use of drugs such as repaglinide or dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), plus insulin therapy. However, new guidelines have paved the way for new treatments, such as SGLT2i or GLP1-RA in patients with CKD. Currently, the new evidence supports the use of GLP1-RA in patients with an estimated glomerular filtration rate (eGFR) of up to 15 mL/min/1.73 m2 and an SGLT2i should be started with an eGFR > 60 mL/min/1.73 m2. Regarding those patients in advanced stages of CKD, the usual approach is to switch to insulin. Thus, the add-on of GLP1-RA and/or SGLT2i to insulin therapy can reduce the dose of insulin, or even allow for its withdrawal, as well as achieve a good glycaemic control with no weight gain and reduced risk of hypoglycaemia, with the added advantage of cardiorenal benefits.

Efficacy of naloxegol on symptoms and quality of life related to opioid-induced constipation in patients with cancer: a 3-month follow-up analysis.

OBJECTIVES: Opioid-induced constipation (OIC) can affect up to 63% of all patients with cancer. The objectives of this study were to assess quality of life as well as efficacy and safety of naloxegol, in patients with cancer with OIC. METHODS: An observational study was made of a cohort of patients with cancer and with OIC exhibiting an inadequate response to laxatives and treated with naloxegol. The sample consisted of adult outpatients with a Karnofsky performance status score ≥50. The Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) and the Patient Assessment of Constipation Symptoms (PAC-SYM) were applied for 3 months. RESULTS: A total of 126 patients (58.2% males) with a mean age of 61.3 years (range 34-89) were included. Clinically relevant improvements (>0.5 points) were recorded in the PAC-QOL and PAC-SYM questionnaires (p<0.0001) from 15 days of treatment. The number of days a week with complete spontaneous bowel movements increased significantly (p<0.0001) from 2.4 to 4.6 on day 15, 4.7 after 1 month and 5 after 3 months. Pain control significantly improved (p<0.0001) during follow-up. A total of 13.5% of the patients (17/126) presented some gastrointestinal adverse reaction, mostly of mild (62.5%) or moderate intensity (25%). CONCLUSIONS: Clinically relevant improvements in OIC-related quality of life, number of bowel movements and constipation-related symptoms were recorded as early as after 15 days of treatment with naloxegol in patients with cancer and OIC, with a good safety profile.

La pandemia por la COVID-19: una oportunidad para cambiar la forma de atender a nuestros pacientes / The COVID-19 pandemic: an opportunity to change the way we care for our patients

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COVID-19 y enfermedad cardiovascular y renal: ¿dónde estamos? ¿Hacia dónde vamos? / COVID-19 and cardiovascular and kidney disease: where are we? Where are we going?

La pandemia SARS-CoV-2, es una emergencia sanitaria global y necesitamos conocer más sobre ella. Los pacientes con riesgo cardiovascular (ECV) y renal previo, se han identificado especialmente vulnerables para una mayor morbi-mortalidad cuando sufren la COVID-19; y una proporción considerable de pacientes puede desarrollar una lesión vascular en el contexto de la enfermedad que conlleva una mayor letalidad. Las complicaciones cardiovasculares y renales representan un problema y, probablemente en un futuro próximo, puedan suponer una amenaza para los pacientes que han sobrevivido a la COVID-19. Cómo médicos no podemos olvidar que durante una epidemia como esta, otras enfermedades -crónicas- siguen presentes, y los pacientes continúan precisando atención. Estamos obligados a vigilar de una forma incluso más intensa, sus tratamientos y grado de control. Además, no debemos olvidar que las situaciones urgentes siguen presentándose en esta situación de pandemia y precisando atención rápida; en esta situación actual es muy probable que muchos pacientes, por miedo, no hayan buscado atención médica. La situación durante la epidemia y la incertidumbre de la época post COVID-19, exige la intensificación en el control y seguimiento de la ECV y renal de nuestros pacientes. La atención primaria constituye un nivel asistencial clave para el cuidado de la población con ECV. Del mismo modo, y ante este nuevo escenario sanitario, necesitamos impulsar las medidas de prevención y control que emanen de los estudios actualmente en desarrollo. Ahora, más que nunca, necesitamos la investigación, crucial para mejorar el pronóstico cardiovascular y renal de nuestros pacientes

The SARS-CoV-2 pandemic is a global health emergency and we need to know more about it. Patients with cardiovascular risk (CVD) and previous kidney risk have been identified as especially vulnerable for greater morbidity and mortality when they suffer from COVID-19. A considerable proportion of patients can develop a vascular lesion in the context of the disease that entails a greater lethality. Cardiovascular and renal complications represent a problem and, probably in the near future, may pose a threat to patients who have survived COVID-19. As physicians, we cannot forget that during an epidemic like this, other chronic diseases are present, and patients continue to require care. We are obliged to monitor even more intensely their treatments and control degree. Furthermore, we must not forget that urgent situations continue to arise in this pandemic situation and require prompt attention. In this current situation, it is very likely that many patients, out of fear, have not sought medical attention. The situation during the epidemic and the uncertainty of the post-COVID-19 period, requires intensification in the control and monitoring of CVD and kidney in our patients. Primary care constitutes a key level of care for the care of the population with CVD. Likewise, and in the face of this new health scenario, we need to promote the prevention and control measures that emanate from the studies currently underway. Now, more than ever, we need research, crucial to improve the cardiovascular and renal prognosis of our patients

GLP-1 Receptor Agonists and Diabetic Kidney Disease: A Call of Attention to Nephrologists.

Type 2 diabetes mellitus (T2DM) represents the main cause of chronic kidney disease (CKD) and end-stage renal disease (ESKD), and diabetic kidney disease (DKD) is a major cause of morbidity and mortality in diabetes. Despite advances in the nephroprotective treatment of T2DM, DKD remains the most common complication, driving the need for renal replacement therapies (RRT) worldwide, and its incidence is increasing. Until recently, prevention of DKD progression was based around strict blood pressure (BP) control, using renin-angiotensin system blockers that simultaneously reduce BP and proteinuria, adequate glycemic control and control of cardiovascular risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are a new class of anti-hyperglycemic drugs shown to improve cardiovascular and renal events in DKD. In this regard, GLP-1RA offer the potential for adequate glycemic control in multiple stages of DKD without an increased risk of hypoglycemia, preventing the onset of macroalbuminuria and slowing the decline of glomerular filtration rate (GFR) in diabetic patients, also bringing additional benefit in weight reduction, cardiovascular and other kidney outcomes. Results from ongoing trials are pending to assess the impact of GLP-1RA treatments on primary kidney endpoints in DKD.

Change in the Pattern of Posttransplantation Anemia in Kidney Receptors: Sex Role in Recipients and Type of Donor.

OBJECTIVE: Posttransplant anemia (PTA) in kidney recipients is a complication that has repercussions mainly of cardiovascular consequence. The objective of this study is to determine the prevalence of anemia, as well as the relationship between kidney recipient and donor sex, in the presence or absence of anemia at 12 months after kidney transplant (KT). MATERIAL AND METHODS: Observational, longitudinal study of KTs made over a 5-year period, from 2013 to 2017, in a renal transplant unit from La Raza National Health Care Medical Center. Three hundred twenty-eight records were analyzed. Hemoglobin (Hb) and the presence or absence of anemia according to the definition by the World Health Organization were analyzed. The association between kidney recipient sex and donor type (living or deceased) was evaluated. Analysis of central tendency and dispersion were performed and the mean difference was established with χ2 test or Student t test. Significance level was set at P < .05. RESULTS: The mean Hb (standard deviation) before KT was 10.38 (2.16) g/dL; Hb at 12 months was 14.47 (2.37) g/dL with an absolute increase of 4.09 g/dL. Before KT, male kidney recipients had a mean Hb of 10.54 (2.17) g/dL. At 12 months post-KT, mean Hb was 15.33 (2.25) with a change of 4.79 g/dL. Before KT, female kidney recipients had a mean Hb of 10.16 (2.13) g/dL. At 12 months post-KT, mean Hb was 13.31 (2.01) with a change of 3.15 g/dL. The difference between both sexes was 1.64 g/dL at the end of 12 months. Sixteen out of 152 (10.5%) patients had a serum creatinine (Cr) < 1.2 mg/dL and anemia; 36 out of 176 (20.5%) patients had a Cr ≥ 1.2 mg/dL and anemia (P = .014). In the bivariate logistic regression with an odds ratio of 2.047 (95% confidence interval, 1027-4078; P = .042) for higher Cr levels and the presence of persistent anemia. CONCLUSIONS: There is a prevalence of anemia in female kidney recipients and recipients of kidneys from deceased donors. There is a higher risk of persistent anemia in the case of patients with some degree of graft failure at 12 months.

El cuidado humanizado en los futuros enfermeros del sur de Chile / The humanized care in the nursing futures of south Chile

OBJETIVO: Reconocer la percepción que tienen estudiantes de enfermería, en una Universidad del sur de Chile, respecto de los cuidados humanizados que entregan durante el año 2018. MATERIAL Y MÉTODO: Estudio cuantitativo, transversal, no experimental realizado en 2018 en 197 estudiantes, entre 18 y 25 años, de segundo a quinto año de enfermería, se autoadministra instrumento validado basado en los comportamientos humanizados: Caring Efficacy Scale (CES). RESULTADOS: El 73% de los futuros enfermeros poseen un alto grado de percepción de cuidados humanizados, el 26% una percepción regular y solo el 1% posee un bajo nivel de percepción de cuidados humanizados de su atención. Además, se comprobó que no existe diferencia en el género al momento de entregar cuidados humanizados y que a mayor nivel académico la percepción de cuidados humanizados también aumenta. CONCLUSIÓN: Al analizar las variables entre los comportamientos positivos y negativos, en relación con el género, se pudo comprobar que no existe significancia; sin embargo, en relación al nivel académico, se pudo determinar que mientras mayor es el nivel académico, mayor es la percepción del cuidado humanizado que poseen los estudiantes de enfermería.

OBJECTIVE: To recognize the perception that nursing student shave, in a University of southern Chile, regarding the humanized care they deliver during 2018. MATERIAL AND METHOD: Quantitative, cross-sectional, non-experimental study conducted in 2018 in 197 students, among 18 and 25 years, from second to fifth year of nursing, validated instrument is self-administered based on humanized behaviors: Caring Efficacy Scale (CES). RESULTS: 73% of future nurses have a high degree of perception of humanized care, 26% have a regular perception and only 1% have a low level of perception of humanized care of their care. In addition, it was found that there is no difference in gender when delivering humanized care and that at a higher academic level the perception of humanized care also increases. CONCLUSION: When analyzing the variables between positive and negative behaviors, in relation to gender, it was found that there is no significance; However, in relation to the academic level, it was determined that the higher the academic level, the greater the perception of the humanized care that nursing students possess.

Relación entre el conocimiento y la intención de uso del anticonceptivo oral masculino (DMAU) en estudiantes varones en edad fértil de una universidad del sur de Chile / Relationship between the knowledge and the intention of use of the male oral contraception (DMAU) in students male in the fertile age of a university of the south of Chile

A lo largo de la historia las mujeres han sido las responsables de la reproducción biológica, han cargado mayormente con la responsabilidad de la anticoncepción (1); surge la necesidad de incorporar a hombres en salud reproductiva con métodos modernos, efectivos y reversibles, como la Píldora Anticonceptiva Oral Masculina, que se encuentra en fase II de investigación, y así participar activamente en la planificación familiar. OBJETIVO: Establecer la relación entre el conocimiento e intención de uso de la Píldora Anticonceptiva Oral Masculina, en varones en edad fértil de una Universidad del Sur de Chile, durante segundo semestre del 2018. MATERIAL Y MÉTODO: Investigación Cuantitativa, correlacional, no experimental y transversal, en 301 estudiantes regulares, se autoadministra instrumento: "Encuesta Anticonceptivos Orales en Varones en Edad Fértil", validado por medio de comité de expertos, con Coeficiente de Alpha de Cronbach de 0,81. RESULTADOS: Respecto al nivel de conocimiento acerca de la Píldora, sólo un 16% tuvo un puntaje mayor o igual a 17 puntos considerándose como alto conocimiento. Respecto de intención de uso, un 58% de los estudiantes varones tiene una alta intención de uso, además de que el 42% estaría dispuesto a utilizar este método anticonceptivo de forma diaria. CONCLUSIÓN: No existe una relación entre el nivel de conocimiento y la intención de uso de la píldora, pues independiente del nivel de conocimiento siempre se mantuvo una alta intención de uso investigación y así participar activamente en la planificación familiar

Throughout history, women have been responsible for biological reproduction, they have been mostly responsible for contraception (1); There is a need to incorporate men into reproductive health with modern, effective and reversible methods, such as the Male Oral Contraceptive Pill, which is in phase II of research, and thus actively participate in family planning. OBJECTIVE: To establish the relationship between the knowledge and intention to use the Male Oral Contraceptive Pill, in men of childbearing age of a University of Southern Chile, during the second half of 2018. MATERIAL AND METHOD: Quantitative, correlational, non-experimental research and Transversal, in 301 regular students, self-administered instrument: "Survey of Oral Contraceptives in Men of Fertile Age", validated through an expert committee, with Cronbach's Alpha Coefficient of 0.81. RESULTS: Regarding the level of knowledge about the Pill, only 16% had a score greater than or equal to 17 points, considered ashigh knowledge. Regarding intention to use, 58% of male students have a high intention to use, in addition to 42% would be willing to use this method of contraception on a daily basis. CONCLUSION: There is no relationship between the level of knowledge and the intention to use the pill, because independent of the level of knowledge, a high intention to use research was always maintained and thus actively participate in family planning.

High-Intensity Exercise Reduces Cardiac Fibrosis and Hypertrophy but Does Not Restore the Nitroso-Redox Imbalance in Diabetic Cardiomyopathy.

Diabetic cardiomyopathy refers to the manifestations in the heart as a result of altered glucose homeostasis, reflected as fibrosis, cellular hypertrophy, increased oxidative stress, and apoptosis, leading to ventricular dysfunction. Since physical exercise has been indicated as cardioprotective, we tested the hypothesis that high-intensity exercise training could reverse the cardiac maladaptations produced by diabetes. For this, diabetes was induced in rats by a single dose of alloxan. Diabetic rats were randomly assigned to a sedentary group or submitted to a program of exercise on a treadmill for 4 weeks at 80% of maximal performance. Another group of normoglycemic rats was used as control. Diabetic rat hearts presented cardiomyocyte hypertrophy and interstitial fibrosis. Chronic exercise reduced both parameters but increased apoptosis. Diabetes increased the myocardial levels of the mRNA and proteins of NADPH oxidases NOX2 and NOX4. These altered levels were not reduced by exercise. Diabetes also increased the level of uncoupled endothelial nitric oxide synthase (eNOS) that was not reversed by exercise. Finally, diabetic rats showed a lower degree of phosphorylated phospholamban and reduced levels of SERCA2 that were not restored by high-intensity exercise. These results suggest that high-intensity chronic exercise was able to reverse remodeling in the diabetic heart but was unable to restore the nitroso-redox imbalance imposed by diabetes.