[Key guidelines on the Spanish multi-society consensus on chronic kidney disease]. / Consideraciones sobre el consenso español multisociedad de manejo de la enfermedad renal crónica.

Chronic kidney disease (CKD) is a global health problem and affects approximately 15.1% of the general population in Spain (IBERICAN and ENRCA studies), although most of the literature agrees that there is an underdiagnosis that would further increase this prevalence. This article from the CKD monograph aims to summarize the main consensus guidelines for the management of CKD, highlighting the most important and novel aspects, as well as recently updated terminology and concepts. Sections addressing specific populations and prevention strategies are also included. As the family doctor (MAP) plays a fundamental role in the detection of CKD, recommendations on the multidisciplinary approach to CKD are collected.

Clinical presentation of candidaemia in elderly patients: experience in a single institution.

OBJECTIVE: To analyse the clinical presentation of candidaemia in elderly patients. METHODS: A comparison of clinical presentation of candidaemia cases was carried out in a Spanish tertiary hospital between January 2010 and September 2015. RESULTS: Forty-five cases (32%) corresponded to elderly patients (≥ 75 years) and 95 cases (68%) to non-elderly patients (16-74 years). A higher proportion of elderly patients presented solid tumour (51% versus 32%, p=0.026) and a lower proportion had undergone solid or hematopoietic transplantation (0% versus 28%, p<0.001). Fewer elderly patients (16 patients, 36%) had a central venous line inserted than non-elderly patients (81 patients, 85%, p<0.001). Isolation of Candida parapsilosis was significantly lower among elderly (13.3%) than among non-elderly patients (32%, p=0.015). Fundoscopy was carried out in 20 elderly (44%) and in 64 younger patients (67%, p=0.009). The proportion of patients who underwent echocardiography was similar in both groups (56% vs 66%, respectively; p=0.218). Adequate antifungal treatment within the first 48 hours was administered in16 elderly patients (36%) and 58 younger patients (61%, p=0.005). Catheter removal was carried out in 9 elderly patients (68.1%) and in 40 non-elderly patients (49%, p=0.544). Mortality was higher among elderly patients (55.6%) than non-elderly patients (36.8%; p=0.037). CONCLUSIONS: Elderly patients account for a substantial proportion of patients suffering from candidaemia in recent years. The clinical management of these patients was less appropriate than in younger patients with respect to fundus examination and the prescription of appropriate antifungal treatment. Mortality in elderly patients was higher than in younger patients.

Técnicas psicológicas de rescate en intentos de suicidio / Psychological rescue techniques for use in attempted suicide

El objetivo del presente trabajo es ofrecer desde la psicología unas pautas de actuación para que los profesionales de emergencias puedan abordar la situación de evitar un intento de suicidio “in situ”. Como en muchos supuestos de emergencias, hay que reaccionar rápidamente en un contexto muy estresante. Por ello, nos parece útil la propuesta de un “protocolo de actuación” con una serie de indicaciones de intervención, que aunque no se apliquen todas pueden ayudar a la actuación de los profesionales sanitarios y de emergencias (AU)

From the perspective of psychology, this paper reviews actions emergency care personnel can take to prevent suicide insitu. As in many emergency settings, in which it is essential to act quickly under stress, an action protocol can be useful in providing a series of indications for intervention. Even though all indications may not be applicable, they can helphealth-care and emergency personnel decide how to respond appropriately (AU)

Population-based diallel analyses among nine historically recognized alfalfa germplasms.

Identification of heterotic groups and patterns among breeding populations provides fundamental information to help plant breeders more knowledgeably manipulate heterosis. A diallel analysis was conducted among nine alfalfa ( Medicago sativa L.) germplasms, commonly referred to as African, Chilean, Flemish, Indian, Ladak, M. falcata, M. varia, Peruvian, and Turkistan, which represent a significant proportion of the genetic diversity present in US cultivars. Heterotic responses were determined by evaluating forage yield of the germplasms and their 36 half-diallel hybrids in seeded plots that were harvested five times in each of 2 years. Commercially acceptable yields were obtained from some hybrids of unimproved parents, where at least one parent was adapted to the study environment. Variation among crosses was attributed primarily to general combining ability (GCA) effects; however, specific combining ability effects were also significant. GCA estimates for African, Chilean and Peruvian were positive, while those for Ladak, M. falcata, and M. varia were negative. Estimates for variety heterosis effects were positive for Peruvian and M. falcata and negative for Indian and M. varia. Significant mid-parent heterosis [(MPH) range of -21% to 55%] and high-parent heterosis [(HPH) range of -33% to 23%] was detected. M. falcata hybrids exhibited the highest MPH values. However, this likely reflects the poor yield of M. falcata per se in the study environment and consequently, low MPH values. Peruvian hybrids demonstrated the highest cross mean performance, significant positive MPH in all crosses, and positive HPH in five out of eight crosses. The results indicate that Peruvian should be recognized as a heterotic group. Alfalfa breeders may wish to explore opportunities for heterotic yield gains that are likely to exist in hybrids between the Peruvian germplasm and elite breeding populations, in particular, those adapted to the southwestern United States. MPH results suggest that alfalfa breeders may have capitalized on the heterotic response between Flemish and M. varia during past development of alfalfa synthetics adapted to the central and northern latitudes of the United States.

AFLP-based assessment of genetic diversity among nine alfalfa germplasms using bulk DNA templates.

Improving commercial utilization of perennial Medicago collections requires developing approaches that can rapidly and accurately characterize genetic diversity among large numbers of populations. This study evaluated the potential of using amplified fragment length polymorphism (AFLP) DNA markers, in combination with DNA bulking over multiple genotypes, as a strategy for high-throughput characterization of genetic distances (D) among alfalfa (Medicago sativa L.) accessions. Bulked DNA templates from 30 genotypes within each of nine well-recognized germplasms (African, Chilean, Flemish, Indian, Ladak, Medicago sativa subsp. falcata, Medicago sativa subsp. varia, Peruvian, and Turkistan) were evaluated using 34 primer combinations. A total of 3754 fragments were identified, of which 1541 were polymorphic. The number of polymorphic fragments detected per primer combination ranged from 20 to 85. Pairwise D estimates among the nine germplasms ranged from 0.52 to 1.46 with M. sativa subsp. falcata being the most genetically dissimilar. Unweighted pair-group method arithmetic average (UPGMA) analysis of the marker data produced two main clusters, (i) M. sativa subsp. sativa and M. sativa subsp. varia, and (ii) M. sativa subsp. falcata. Cluster-analysis results and D estimates among the Chilean, Peruvian, Flemish, and M. sativa subsp. varia germplasms supported the hypothesis that Peruvian was more similar to original Spanish introductions into Central and South America than Chilean. Hierarchical arrangement of the nine germplasms was supported by their respective geographic, subspecific, and intersubspecific hybrid origins. Subsets of as few as seven highly informative primer pairs were identified that produced comparable D estimates and similar heirarchical arrangements compared with the complete dataset. The results indicate that use of primer-pair subsets for AFLP analysis of bulk DNA templates could serve as a high-throughput system for accurately characterizing genetic diversity among large numbers of alfalfa populations.

Effect of magnesium deficiency on vitamin B2 and B6 status in the rat.

OBJECTIVE: The present study was undertaken to investigate the effect of dietary magnesium (Mg) deficiency on vitamin B2 (riboflavin) and B6 (pyridoxine) status in rats. METHODS: We fed Wistar rats an Mg-deficient diet (56 mg magnesium per kg food) for 70 days. On days 21, 35 and 70 we measured Mg and manganese (Mn) in plasma and whole blood, alkaline phosphatase in plasma, erythrocyte glutathione reductase activity coefficient (AC-EGR) for riboflavin status, and erythrocyte aspartase transaminase activity coefficient (AC-EAST) for vitamin B6 status. RESULTS: Intake of the Mg-deficient diet significantly decreased plasma and whole blood levels of Mg and plasma alkaline phosphatase activity on all sampling days. The Mg deficit had no effect on plasma concentrations of Mn, but significantly increased whole blood levels of this element on days 35 and 70. The Mg-deficient diet had no effect on AC-EGR, and thus appeared not to affect riboflavin status. However, AC-EAST was significantly increased on day 70, implying that the animals were at risk for vitamin B6 deficiency. CONCLUSION: Mg deficiency impairs vitamin B6 status by depleting intracellular Mg and thus inhibits the activity of alkaline phosphatase, a metalloenzyme required for the uptake of pyridoxal phosphate by tissues. Although part of the intraerythrocyte loss of Mg is countervailed by Mn, which can act as a substitute activator of alkaline phosphatase, the degree of compensation is insufficient to fully offset the decrease in activity caused by Mg depletion.

Changes in the nutritive utilization of protein induced by Mg deficiency in rats.

We studied the effect of an Mg-deficient diet (20 mg Mg/100 g diet) on the nutritive utilization of dietary protein in Wistar rats after 7, 35, 42, 49, 63, and 70 days. Magnesium deficiency significantly increased fecal and urinary excretion of nitrogen, leading to a decrease in apparent absorption and balance of nitrogen. In Mg-deficient animals, the plasma concentration of total protein was significantly lower than in control rats. The results indicate that Mg deficiency can reduce the nutritive utilization of protein, an effect that may contribute to the appearance of the malnutrition syndrome in rats given an Mg-deficient diet.

Changes in bioavailability and tissue distribution of zinc caused by magnesium deficiency in rats.

The effect of a Mg-deficient diet (200 mg Mg/kg feed) on the bioavailability of dietary Zn and the concentration of this cation in plasma, whole blood, skeletal muscle, kidney, heart and brain of Wistar rats was studied after 7, 35, 42, 49, 56, 63 and 70 d. Mg deficiency significantly decreased Zn in whole blood on day 42 of the experiment, but there was no significant change in plasma Zn throughout the 70 d study period. The Mg-deficient diet significantly increased intestinal absorption of Zn, Zn balance, and Zn concentration in femur and kidney, but decreased Zn concentration in the heart despite the increase in dry weight of this organ. No change was found in brain Zn concentration.

Evolution of Mg deficiency in rats.

We performed weekly analyses of the evolution of the bioavailability of the Mg cation over a period of 70 days in adult rats fed an Mg-deficient (0.02%) diet. The results generally showed an increase in digestive utilization (% absorption) and a decrease in Mg balance during the experimental period. The parameters most sensitive to Mg deficiency were increase in body weight and blood concentration of Mg (mg/100 ml), which had declined significantly after 7 days (p < 0.05). Significant declines in plasma (p < 0.02) and muscle Mg (p < 0.01) were not apparent until after 35 days. Magnesium content in bone decreased from day 49 onward (p < 0.05), whereas renal Mg concentration tended to rise slightly during the last 2 weeks of study. No change was found in brain Mg concentration.