Albuminuria and cardiovascular risk.

Cardiovascular risk (CVR) estimation is a fundamental tool for guiding therapy. Albuminuria indicates target organ damage in an accessible, economic and non-invasive manner. Improves high-risk patient identification, especially in chronic kidney disease (CKD) and diabetes mellitus (DM). In addition, anti-albuminuric treatments may improve CVR. This would position albuminuria as a guide and therapeutic objective. Although the capacity of albuminuria as an epidemiological CVR marker in specific populations (hypertension, CKD, DM) is accepted, its profile as a risk marker in the general population and as a therapeutic target is controversial. There is ambiguous evidence regarding its predictive capacity, added to the fact that treatments such as SLGT2 blockers reduce CVR events regardless of albuminuria presence or magnitude. This review analyzes the available evidence on albuminuria as a CVR marker, a treatment goal and therapeutic guide.

Albuminuria and cardiovascular risk / Albuminuria y riesgo cardiovascular

Cardiovascular risk (CVR) estimation is a fundamental tool for guiding therapy. Albuminuria indicates target organ damage in an accessible, economic and non-invasive manner. Improves high-risk patient identification, especially in chronic kidney disease (CKD) and diabetes mellitus (DM). In addition, anti-albuminuric treatments may improve CVR. This would position albuminuria as a guide and therapeutic objective. Although the capacity of albuminuria as an epidemiological CVR marker in specific populations (hypertension, CKD, DM) is accepted, its profile as a risk marker in the general population and as a therapeutic target is controversial. There is ambiguous evidence regarding its predictive capacity, added to the fact that treatments such as SLGT2 blockers reduce CVR events regardless of albuminuria presence or magnitude. This review analyzes the available evidence on albuminuria as a CVR marker, a treatment goal and therapeutic guide. (AU)

La estimación de riesgo cardiovascular (RCV) es una herramienta fundamental para dirigir la terapéutica. Albuminuria indica daño en órgano blanco de manera accesible, económica y no invasiva. Mejora la identificación de pacientes de alto riesgo, especialmente en enfermedad renal crónica (ERC) y diabetes mellitus (DM). Además, tratamientos antialbuminúricos mejorarían el RCV y la ocurrencia de eventos. Esto posicionaría a la albuminuria como guía y objetivo terapéutico. Si bien la capacidad de albuminuria como marcador epidemiológico de RCV en poblaciones específicas es aceptado, su perfil de marcador de riesgo en población general y como objetivo terapéutico es controvertido. Existe evidencia contrapuesta respecto a su capacidad de predicción, sumado a que tratamientos como los bloqueadores SGLT2 reducen eventos CV independientemente de la presencia y/o magnitud de albuminuria. En esta revisión se analiza la evidencia disponible sobre albuminuria como marcador de RCV, como objetivo de tratamiento y como guía terapéutica. (AU)

Prevalence of negative behaviour in the dental setting and association with sociodemographic, oral health-related and psychosocial factors amongst Brazilian preschool children.

PURPOSE: To investigate the prevalence of negative behaviour in preschool children attending dental clinics and its association with sociodemographic, oral health-related and parental psychosocial factors. METHODS: A cross-sectional study was carried out with 145 parents/guardians and their children aged 4-6 years attending paediatric dentistry training programmes in a capital city of Midwest Brazil. Data were obtained from children's dental records, interviews, and questionnaires for parents/guardians. The outcome was negative child behaviour, based on the dentists' use or indication of behavioural control measures during the dental appointments, as registered in the children's dental records. Covariates were sociodemographic, clinical and parent/guardian psychosocial factors religiosity (DUREL index) and Sense of Coherence (SOC-13 scale). Bivariate analyses and Poisson regression with robust variance were performed. RESULTS: The prevalence of negative behaviour was 24.1% (95% CI = 17.9-31.7). In the bivariate analyses, the variables initially selected for the regression models (p < 0.25) were the parent/guardians' number of children and religiosity, and the children's dental pain and caries status in deciduous teeth. After adjustment, the prevalence of negative behaviour was 2.12 higher in children with teeth extracted due to caries. CONCLUSION: The prevalence of negative behaviour was high and associated with the presence of missing teeth due to caries, regardless of sociodemographic, psychosocial, and other oral health factors.

Electron microscopy contribution to diagnosing transplant glomerulopathy: a single-center experience.

BACKGROUND: Transplant glomerulopathy (TG) may occur early after transplantation, and electron microscopy may contribute to diagnose it. METHODS: We analyzed kidney transplant biopsies from September 2009 to September 2012 to identify the presence of histologic changes associated with TG. RESULTS: Forty-eight biopsies from 65 patients, met the study criteria and were evaluated. The average evolution time of transplantation was 13.6 months. Sixty percent of patients received deceased-donor renal transplants, and biopsies were performed per protocol in most cases. Electron microscopy diagnosed the presence of changes associated with TG in 23% of patients. Light microscopy was not useful in the diagnosis of such graft pathology. The average transplantation time was significantly higher in patients with TG compared to patients without TG (20.6 mo vs 11.5 mo; P = .03). Light microscopy diagnosed mild interstitial fibrosis/tubular atrophy in 27 patients, of which 6 had early changes of TG according to the analysis by electron microscopy. CONCLUSIONS: Electron microscopy improves accurate diagnosis of TG, in patients both with and without graft dysfunction. It also allows diagnosis of early TG and thereby identification of patients who may have lower graft survival.

Preemptive kidney transplantation: experience in two centers.

INTRODUCTION: End-stage renal disease (ESRD) is a prevalent, important cause of death. Transplantation increases survival and improves the quality of life of patients with ESRD while long-term dialysis is related to poor outcomes even among patients who undergo subsequent transplantations. OBJECTIVES: To compare the advantages of preemptive procedures with kidney transplants among patients on renal replacement therapy. METHODS: This retrospective study was performed in two Córdoba city transplantation centers. Patients were divided into three groups: preemptive kidney transplant (PKT), patients on hemodialysis who received living donor kidney transplants (LDT), and subjects who received grafts from deceased donors (DDT). Serum creatinine, delayed graft function (DGF), subclinical rejection, and interstitial fibrosis/tubular atrophy (IF/TA) were evaluated at 6 months. RESULTS: Eighty patients were included: PKT (n = 28), LDT (n = 27), DDT (n = 25) mean age 29, 30, and 35 years, respectively. Women predominated among PKT and men in the other groups. In all groups, cyclosporine was the calcineurin inhibitor mostly used. Creatinine at 6 months was lower in the living donor groups (1.26 mg/dL PKT and 1.32 mg/dL LDT; P = NS) in relation to the deceased donor group (1.96 mg/dL; P < .05). DDT had the highest rate of DGF: 44% DDT versus 11.5% LDT vs 0% PKT (P < .05). Subclinical rejection was significantly lower among preemptive transplantations: PKT 7.6% versus LDT 18.5% versus DDT 24% (P < .05). IF/TA was higher in transplants from deceased donors: PKT 11.1%; LDT 11.5%; DDT 32%. CONCLUSIONS: Preemptive kidney transplantation offered the advantages of a lower creatinine, no DGF, as well as a reduced incidence of subclinical rejection and chronic allograft nephropathy at 6 months posttransplantation.

Monitoring of group A rotaviruses in wild-living birds in Hungary.

Rotavirus is a common pathogen causing gastroenteritis in humans and domesticated animals. The incidence of rotavirus in wild-living animals, particularly in avian species, has not been systematically investigated. In this study 1220 fecal samples and cloacal swabs collected from wild-living birds during 2008 in Hungary were tested for the presence of group A rotaviruses by a VP6 gene-specific reverse-transcription-polymerase-chain-reaction assay. Of the 1220 samples, 276 and 944 were processed as individual and pooled specimens, respectively. Rotavirus was identified in two pooled pheasant (Phasianus colchicus) samples and two individual reed bunting samples (Emberiza schoeniclus). These data indicated a very low prevalence of group A rotaviruses (0.3%) in our sample set. Nonetheless, the present study, together with existing literature data, implies that rotavirus infections occur in a wide spectrum of feral bird species. These findings are exciting and suggest that pursuing rotavirus monitoring is needed to uncover avian rotavirus strain diversity and understand rotavirus ecology in nature.

Autochthonous Dirofilaria immitis infection in a ferret with aberrant larval migration in Europe.

A two-year-old male ferret (Mustela putorius furo) was presented to the Faculty of Veterinary Science, Szent István University, for investigation of somnolence. Following unsuccessful therapeutic attempts, the ferret was euthanased and a male Dirofilaria immitis worm was found in the pulmonary artery and a female D. immitis specimen in the subdural space of the cranial cavity. To the authors' knowledge, this is the first European record of D. immitis infection in a ferret, and the first case in which aberrant larval migration and consequent central nervous system signs were observed in a ferret in the course of D. immitis infection.

[The head nurse and conflicts]. / Caposala e conflitti.

The management of organizational conflicts is one of the most relevant skills for headnurses. The data were collected from a sample of 97 headnurses of general hospitals, using the "Rahim Organizational Conflict Inventories". The results show that the most important type of conflict measured is the "intragroup". The ways of handling interpersonal conflict used most often are "integrating" and "obliging". Besides verifying the validity and the reliability of the inventories, the differences connected with sex and age are analyzed. "Integrating" style is more widely used with increasing age while with increasing working years, interpersonal conflicts decrease.

[Monitoring of arterial pressure according to the "womb to tomb" program taking into account the human chronome]. / Monitorirovanie arterial'nogo davleniia po programme "ot rozhdeniia do smerti" s uchetom khronoma u cheloveka.

The concept of "chronome" is discussed in this article. A lot of data of monitoring of arterial blood pressure in healthy people from babies till senile people are reported. This chronobiologic approach allows to optimize diagnosis in a group of people with elevated blood pressure and to exclude people with false positive and false negative diagnosis of hypertension. At the same time physicians can optimize therapy of hypertensive people with taking into account chronotherapy principle.