Reuse of the digestate obtained from the biomethanization of olive mill solid waste (OMSW) as soil amendment or fertilizer for the cultivation of forage grass (Lolium rigidum var. Wimmera).

The principal by-product from the two-phase olive oil production process is olive mill solid waste (OMSW). It is a highly-pollutant by-product, not only because of its characteristics, but also because of the considerable volume of OMSW which is generated, amounting to 2 to 4 million tons per year in Spain. The anaerobic digestion of this by-product is a well-studied process, and results in the generation of biogas, methane and carbon dioxide mainly of high calorific values (20-25 MJ m-3), and an effluent or digestate. The digestate of this by-product has never been characterized. This study presents an informative view on how the composition of OMSW digestate shows promising implications as a soil amendment or fertilizer due to the quality of the biomass from Lolium rigidum, a useful grass specie for the production of forage. Three OMSW digestate alternative applications or treatments were investigated: the digestate and the solid fraction of the digestate for a nutrient-poor soil amendment and the liquid fraction of the digestate as fertilizer. The results confirm that all the OMSW digestate treatments studied presented suitable characteristics for agricultural use, and showed an optimal Carbon/Nitrogen ratio with adequate values for heavy metals which are below the limits established by the Spanish and European legislation in the absence of pathogens. However, fertirrigation was the treatment that provided Lolium rigidum with the best characteristics, improving its shoot biomass, photosynthetic rate and nutritional content.

Evolución del estado nutricional y de la función pulmonar en una cohorte de pacientes con fibrosis quística seguidos en un centro de atención integral / Change over time of nutritional status and lung function in a cohort of patients with cystic fibrosis followed in a multidisciplinary care center

Cystic Fibrosis is a multisystemic inherited disease that requires ongoing care by multidisciplinary teams. The objective of this study is to describe changes on nutrition and lung function in a cohort of patients in a Cystic Fibrosis (CF) Care Center at the Hospital Infantil Universitario San José in Bogotá (HIUSJ), between 2010 and 2013.Is a descriptive study in a cohort of CF patients during four years of follow-up. The quantitative variables were described using medians and interquartile ranges, and the qualitative variables with absolute frequencies and percentages. Descriptive statistics was used to summarize the findings. Of the 63 patients in the initial group, 47 (74.6%) completed the follow-up time. The age range was between 3 to 30 years. The median BMI increased as follows: 17.9 (RIQ: 12.5-25.6) in 2010, 18.6 (RIQ: 12.9-24.8) in 2011, 18.9 RIQ (13.6-26.5) in 2012 and 19.0 (RIQ: 13.5-25.8) in 2013, with lower values in men. The forced expiratory volume in the first second (FEV1) at admission was classified as severe (FEV1 <40%) in 7.1%, moderate (FEV1 40-69%) in 35.7%, mild (FEV1 70-79%) in 7.1% and as normal (FEV1> 80%) in 50%. It is concluded that during the 4 years of follow-up at the HIUSJ CF Center there is an improvement in BMI and a deterioration in lung function in the whole group. The importance of establishing more reference centers to improve clinical outcomes and of implement a National registry to follow up over time are highlighted.

La fibrosis quística es una enfermedad hereditaria, multisistémica, cuyo manejo continuo requiere de equipos multidisciplinarios de salud. El objetivo de este trabajo es describir la evolución nutricional y de la función pulmonar en una cohorte de pacientes en el centro de atención integral de la fibrosis quística (FQ), del Hospital Infantil Universitario San José de Bogotá (HIUSJB), entre 2010 y 2013. Estudio descriptivo, en una cohorte de pacientes, en seguimiento durante cuatro años. Las variables cuantitativas fueron descritas mediante medianas y rangos intercuartílicos y las cualitativas con frecuencias absolutas y porcentajes. De los 63 pacientes del grupo inicial, 47 (74.6%), completaron el tiempo de seguimiento. El rango de edad fue de 3 a 30 años. La mediana del IMC (índice de masa corporal) se incrementó así: 17.9 (RIQ:12.5-25.6) en el 2010, 18.6 (RIQ:12.9-24.8) en el 2011, 18.9 ( RIQ(13.6-26.5) en el 2012 y 19.0 (RIQ:13.5-25.8) en el 2013, con menores valores en los hombres. El volumen espiratorio forzado en el primer segundo (VEF1) al ingreso fue clasificado como severo (VEF1<40%) en el 7.1%, moderado (VEF1 40-69%) en el 35.7%, leve (VEF1 70-79%) en el 7.1% y como normal (VEF1>80%) en el 50%. Se concluye que durante los 4 años de seguimiento en el programa de FQ del HIUSJ, ocurre una mejoría del IMC en todo el grupo y un deterioro de la función pulmonar. Se resalta la importancia de constituir más centros de referencia para mejorar los desenlaces clínicos e implementar un registro Nacional para hacer seguimiento a través del tiempo.

Effect of ultrasonic pretreatment on biomethane potential of two-phase olive mill solid waste: kinetic approach and process performance.

The effect of ultrasound (US) pretreatment on two-phase olive mil solid waste (OMSW) composition and subsequent anaerobic biodegradation was evaluated by chemical oxygen demand solubilization and biochemical methane potential (BMP) tests. OMSW was ultrasonically pretreated at a power of 200 W and frequency of 24 kHz for time periods of 20, 40, 60, 90, 120, and 180 minutes, corresponding to specific energies of 11367, 21121, 34072, 51284, 68557, and 106003 kJ/kg total solids, respectively. In order to evaluate the US pretreatment, a low, medium, and high exposure time, that is, 20, 90, and 180 min, were selected for BMP tests. Methane yields of 311 ± 15, 393 ± 14, and 370 ± 20 mL CH4/g VSadded (VS: volatile solids) were obtained for 20, 90, and 180 minutes, respectively, while the untreated OMSW gave 373 ± 4 mL CH4/g VSadded. From a kinetic point of view, the BMP tests showed a first exponential stage and a second sigmoidal stage. In the first stage, the kinetic constant obtained for US pretreated OMSW at 20 minutes was 46% higher than those achieved for the pretreated OMSW at 90 and 180 minutes and 48% higher than that for untreated OMSW. The maximum methane production rate achieved was 12% higher than that obtained for untreated OMSW.

Assessment of two-phase olive mill solid waste and microalgae co-digestion to improve methane production and process kinetics.

Olive mill solid waste (OMSW) is a pollutant waste coming from olive oil elaboration by the two-phase centrifugation system. OMSW has a high organic matter content and unbalanced carbon to nitrogen (C/N) ratio, 31/1, which avoids obtaining high methane yields in the anaerobic digestion of this waste. In the present study a microalgae, Dunaliella salina, was employed as co-substrate for the OMSW anaerobic digestion in order to decrease the C/N ratio and increase its biodegradability. Different co-digestion mixtures (C/N ratios) were studied. The increase of D. salina from 25% to 50% in the co-digestion mixture clearly increased the biodegradability of the sole substrates. The highest biodegradability was found for the co-digestion mixture 50% OMSW-50% D. salina. Nevertheless, the maximum methane production, 330mLCH4/gVSadded, and the highest methane production rate were obtained for the co-digestion mixture 75% OMSW-25% D. salina, keeping a C/N ratio near to 26.7/1.

Biochemical methane potential of two-phase olive mill solid waste: influence of thermal pretreatment on the process kinetics.

The effect of thermal pretreatment on two-phase olive mill solid waste was evaluated by chemical oxygen demand solubilisation and biochemical methane potential (BMP) tests. Temperatures of 100, 120, 160 and 180°C were applied during 60, 120 and 180 min for each temperature studied. The highest chemical oxygen demand solubilisation after pretreatment (42%) was found for 120 and 180°C during 180 min in both cases. These two conditions were selected for the BMP tests. BMP tests showed two different stages: a first exponential stage and a sigmoidal zone after a lag period. No influence of the pretreatment was observed on the kinetic constant of the first-stage. Clear difference was observed in the maximum methane production rate of the second stage, 76.8 mL CH4/(g VS day) was achieved after pretreatment at 180°C (180 min), value 22% and 40% higher than that obtained for the untreated and pretreated OMSW at 120°C, respectively.

Trastornos psicopatológicos y calidad de vida en el infarto cerebral / Psychopathological disorders and quality of life in patients with brain infarction

Objetivos: Estudiar la influencia de diversos factores en la calidad de vida relacionada con la salud (CVRS) de los pacientes tras un infarto cerebral (IC), con especial atención a los trastornos psicopatológicos (TP). Pacientes y métodos: Estudio observacional prospectivo sobre 45 pacientes ingresados por IC, evaluados a las 4, 12 y 26 semanas del evento agudo. Se recogieron antecedentes y datos sociodemográficos previos, se utilizó la escala SF-36 para la valoración de la CVRS, para la valoración psicopatológica, cognitiva, neurológica y funcional se utilizó el inventario neuropsiquiátrico (NPI), MMSE, escala de Canadá, escala de Rankin modificada y otras escalas. Para determinar los posibles factores predictivos de las puntuaciones del SF-36 a las 26 semanas se realizó un estudio de regresión lineal, introduciendo como variables independientes los antecedentes médicos y psiquiátricos, las características sociodemográficas y la evaluación funcional, neuropsicológica y psicopatológica a las 4 semanas. Resultados: Se obtuvieron modelos predictivos válidos para todos los índices del SF-36, en los que el antecedente de depresión, las puntuaciones más altas en el NPI y la escala de Rankin, y más baja en la escala canadiense fueron los principales indicadores predictivos de una peor CVRS a largo plazo. El distrés del cuidador asociado a la psicopatología del paciente (medido a través del NPI) tuvo una influencia negativa sobre el índice de función social. Conclusiones: Los TP y la situación funcional fueron los principales determinantes de la CVRS de los pacientes tras un IC (AU)

Objectives: To study the influence of various factors on the health related quality of life (HRQOL) of patients who have suffered a brain infarction (BI), with special attention to psychopathological disorders (PD). Patients and methods: Prospective observational study on 45 patients admitted due to a BI, evaluated at 4, 12 and 26 weeks of the acute event. Social and demographic data, and medical history were collected; the SF-36 scale was used for the assessment of HRQOL, and the Neuropsychiatric Inventory (NPI), MMSE, Canadian Neurological Scale, Modified Rankin Scale and other instruments for assessing psychopathological, cognitive, neurological and functional status. A linear regression analysis was performed to identify potential predictors of the SF-36 scores at 26 weeks, introducing, as independent variables, medical and psychiatric history, demographic characteristics and the functional, neuropsychological and psychopathological assessments at 4 weeks. Results: Valid predictive models for all the SF-36 domains were obtained, in which a history of pre-morbid depression, higher scores in the NPI and Rankin Scale, and lowest in the Canadian Neurological Scale were the main predictors of a worse HRQOL in the long term. Psychopathology related caregiver's distress (assessed with the NPI) was associated with a lower score in the social function index. Conclusions: PDs and functional status were the main determinants of HRQOL in patients with BI (AU)

[Psychopathological disorders and quality of life in patients with brain infarction]. / Trastornos psicopatológicos y calidad de vida en el infarto cerebral.

OBJECTIVES: To study the influence of various factors on the health related quality of life (HRQOL) of patients who have suffered a brain infarction (BI), with special attention to psychopathological disorders (PD). PATIENTS AND METHODS: Prospective observational study on 45 patients admitted due to a BI, evaluated at 4, 12 and 26 weeks of the acute event. Social and demographic data, and medical history were collected; the SF-36 scale was used for the assessment of HRQOL, and the Neuropsychiatric Inventory (NPI), MMSE, Canadian Neurological Scale, Modified Rankin Scale and other instruments for assessing psychopathological, cognitive, neurological and functional status. A linear regression analysis was performed to identify potential predictors of the SF-36 scores at 26 weeks, introducing, as independent variables, medical and psychiatric history, demographic characteristics and the functional, neuropsychological and psychopathological assessments at 4 weeks. RESULTS: Valid predictive models for all the SF-36 domains were obtained, in which a history of pre-morbid depression, higher scores in the NPI and Rankin Scale, and lowest in the Canadian Neurological Scale were the main predictors of a worse HRQOL in the long term. Psychopathology related caregiver's distress (assessed with the NPI) was associated with a lower score in the social function index. CONCLUSIONS: PDs and functional status were the main determinants of HRQOL in patients with BI.

Evaluation of the methanogenic step of a two-stage anaerobic digestion process of acidified olive mill solid residue from a previous hydrolytic-acidogenic step.

A study of the second step or methanogenic stage of a two-stage anaerobic digestion process treating two-phase olive oil mill solid residue (OMSR) was conducted at mesophilic temperature (35 degrees C). The substrate fed to the methanogenic step was the effluent from a hydrolytic-acidogenic reactor operating at an organic loading rate (OLR) of 12.9 g chemical oxygen demand (COD) L(-1) d(-1) and at a hydraulic retention time (HRT) of 12.4 days; these OLR and HRT were found to be the best values to achieve the maximum total volatile fatty acid concentration (14.5 g L(-1) expressed as acetic acid) with a high concentration in acetic acid (57.5% of the total concentration) as the principal precursor of methane. The methanogenic stage was carried out in an anaerobic stirred tank reactor containing saponite as support media for the immobilization of microorganisms. OLRs of between 0.8 and 22.0 g COD L(-1) d(-1) were studied. These OLRs corresponded to HRTs of between 142.9 and 4.6 days. The methanogenic reactor operated with high stability for OLRs lower than 20.0 g COD L(-1) d(-1). This behaviour was shown by the total volatile fatty acids/total alkalinity ratio, whose values were always kept 0.12 for HRTs>4.6 days. The total COD (T-COD) removed was in the range of 94.3-61.3% and the volatile solids (VS) removed between 92.8% and 56.1% for OLRs between 0.8 and 20.0 g COD L(-1) d(-1). In the same way, a reduction of 43.8% was achieved for phenolic content. The low concentration of total volatile fatty acids (TVFA) observed (below 1 g L(-1) expressed as CH(3)COOH) in the methanogenic reactor effluents showed the high percentage of consumption and conversion of these acids to methane. A methane yield of 0.268+/-0.003 L CH(4) at standard temperature and pressure conditions (STP) g(-1) COD eliminated was achieved.

Evaluation of the hydrolytic-acidogenic step of a two-stage mesophilic anaerobic digestion process of sunflower oil cake.

The influence of the hydraulic retention time (HRT) and organic loading rate (OLR) on the performance of the hydrolytic-acidogenic step of a two-stage anaerobic digestion process of sunflower oil cake (SuOC) were assessed. The experiments were performed in laboratory-scale completely stirred tank reactors at mesophilic (35 degrees C) temperature. Six OLR (ranging from 4 to 9 g VS L(-1) d(-1)) for four HRTs (8, 10, 12 and 15 days) were tested to check the effect of each operational variable. Based on the results obtained, it can be concluded that the hydrolysis yields obtained for all HRTs and OLRs assayed were in the range of 20.5-30.1%. In addition, the acidification degree of the substrate was mainly influenced by the OLR but not by the HRTs, the highest value (83.8%) being achieved for an HRT of 10 days and an OLR of 6 g VS L(-1) d(-1).

Assessment of a microalgae pond for post-treatment of the effluent from an anaerobic fixed bed reactor treating distillery wastewater.

An evaluation of the performance of a laboratory-scale microalgae pond treating effluent from an anaerobic fixed bed reactor digesting distillery wastewater was carried out. The microalgae pond operated with an effluent recycling (R) of 10:1 with respect to the influent and at surface organic loading rates of 418 kg COD ha(-1) day(-1) and 92 kg BOD5 ha(-1) day(-1). During the experiment total chemical oxygen demand (COD), biochemical oxygen demand (BOD5), total solids (TS), total suspended solids (TSS), volatile suspended solids (VSS), total nitrogen, ammonia, total phosphorus, orthophosphate, total chlorophyll (CT) and chlorophyll a (Ca) concentrations were monitored. Overall COD and BOD5 removal efficiencies of 98.2% and 98.8% were obtained. The global solids removal efficiencies were of 93.2%, 92.6% and 97.6% for TS, TSS and VSS, respectively. The removal efficiencies obtained for organic nitrogen and ammonia were 90.2% and 84.1%, respectively. Finally, the removals for total phosphorus and orthophosphate were 85.5% and 87.3%, respectively. It was demonstrated that microalgae grew in this waste by determination of the total chlorophyll and chlorophyll a in the effluent.

Effect of the organic loading rate on the performance of anaerobic acidogenic fermentation of two-phase olive mill solid residue.

A study of the effect of the organic loading rate (OLR) on the anaerobic acidogenic fermentation of two-phase olive mill solid residue (OMSR) derived from fruits with a low ripening index was carried out in a laboratory-scale completely stirred tank reactor at mesophilic temperature (35 degrees C). Eight experimental runs were carried out at OLRs of 3.2, 5.6, 7.4, 9.6, 11.0, 12.9, 14.0 and 15.1g T-COD/ld, which were equivalent to hydraulic retention times of 50.0, 28.8, 21.8, 16.9, 14.7, 12.4, 11.5 and 10.7d, respectively. The experimental results obtained demonstrated that the optimum value of OLR for the acidogenic fermentation process was 12.9 g T-COD/ld, for which a maximum production of acetic acid was achieved. It was found that inhibition of the process occurred at OLRs higher than 12.9 g T-COD/ld. This was characterized by a significant decrease in the acetic acid concentration in the effluent and an increase in the concentration of other volatile acids that may affect the methanogenic step. The process inhibition was also characterized by the plateau in the curves of the effluent substrate concentration versus the OLR applied. It was found that a first-order kinetics satisfactorily described the influence of non-acetic acid soluble organic matter concentration (S-COD( *)) on the rate of soluble organic matter conversion to acetic acid (R(S-COD)( *)), and the influence of acetic acid concentration (AcH) on the rate of acetic acid production (R(AcH)), while a potential equation type adequately described the influence of acetic acid concentration on the volumetric hydrogen production (R(ACH) ). The kinetic constant for soluble organic matter removal was 0.145 d(-1), while the constant for acetic acid formation was found to be 0.075 d(-1).

Piggery waste treatment by using down-flow anaerobic fixed bed reactors.

A study of the role of the depth in the performance of laboratory-scale down-flow anaerobic fixed-bed reactors (DFAFBR) was carried out at different nominal hydraulic retention times (HRT(N)) using piggery waste as substrate at different influent concentrations (2, 4, 6 and 8 g COD/L). The profiles of soluble chemical oxygen demand (COD) (SCOD), organic nitrogen (O.N.), ammonia nitrogen (A.N.), pH and electrical conductivity (E.C.) through the reactor depths showed an initial highly active zone, which was located around the first half of the reactor depth, and a second zone with a lower biological activity. It was found that the depth of the active zone decreased as the HRT(N) increased and that the slopes of the profiles obtained increased with the rise in the influent concentration. A hydraulic test showed an increase in the dispersion number when the HRT(N) increased. The reactors showed a hydraulic pattern between plug-flow and back-mix. The real values of HRT (Theta) also defined as real contact times were determined to be 0.7, 2.1, 3.4, 4.7, 6.4 and 8 days for values of HRT(N) of 1, 2, 3, 4, 5 and 6 days, respectively. It was found that the concentration of SCOD within the reactor decreased exponentially with the increase in the value of theta. Additionally, the influent concentration had a strong influence on the SCOD variation concentration, mainly at values of theta under 1.5 days, which corresponded to the first part of the reactors.

A study of the natural biodegradation of two-phase olive mill solid waste during its storage in an evaporation pond.

A study of the natural biodegradation of two-phase olive mill solid waste (OMSW) during its storage in an evaporation pond was carried out. This system is traditionally used as the final disposal of this waste or constitutes a previous stage before being processed by cogeneration or anaerobic digestion processes. A laboratory-scale pond with a total volume of 520 l was used. The experiment was carried out between December 2002 and August 2003 covering a total period of 269 days. During the experiment, the variations of temperature (outside and inside the pond), the effective volume of the OMSW in the pond, moisture content, total solids (TS), volatile solids (VS), the total chemical oxygen demand (TCOD), total volatile acids (TVA), pH and cumulative methane production as a function of the operation time were evaluated. The experimental results obtained showed that the characteristics of the two-phase OMSW in the pond were dependent on the time of operation and temperature. During the experiment, three periods were clearly observed and differentiated: (a) An initial period with a rapid reduction of moisture content and effective volume, with an increase of TS, VS and TCOD removals, a decrease of pH and an increase of TVA and methane production until day 21. (b) A second period of slow decrease of moisture content and effective volume, due to the decrease of the ambient temperature. This period took place between day 21 and days 120-150 of assay, and it was characterised by a slight change in the OMSW properties. (c) A third period where the characteristics of the waste in the pond changed considerably due to the increase of the temperature outside the pond. The methane gas production also showed an increase due to the increase of methanogenic activity with the increase of temperature. An empirical model to describe the changes of two-phase OMSW characteristics and methane production with the operation time was developed. The proposed model, based on the use of polynomial equations, took into account the influence of the temperature and fit adequately into the experimental results obtained. It was found that the pond could probably be used as preliminary treatment of two-phase OMSW before its anaerobic digestion process, because a maximum conversion of organic matter to TVA was obtained after an operation time of around 200 days.

Performance and microbial communities of a continuous stirred tank anaerobic reactor treating two-phases olive mill solid wastes at low organic loading rates.

A study of the performance and microbial communities of a continuous stirred tank reactor (CSTR) treating two-phases olive mill solid wastes (OMSW) was carried out at laboratory-scale. The reactor operated at a mesophilic temperature (35 degrees C) and an influent substrate concentration of 162 g total chemical oxygen demand (COD)L(-1) and 126 g volatile solids (VS)L(-1). The data analyzed in this work corresponded to a range of organic loading rates (OLR) of between 0.75 and 3.00 g CODL(-1)d(-1), getting removal efficiencies in the range of 97.0-95.6%. Methane production rate increased from 0.164 to 0.659 L CH(4)L(reactor)(-1)d(-1) when the OLR increased within the tested range. Methane yield coefficients were 0.225 L CH(4)g(-1) COD removed and 0.290 L CH(4)g(-1) VS removed and were virtually independent of the OLR applied. A molecular characterization of the microbial communities involved in the process was also accomplished. Molecular identification of microbial species was performed by PCR amplification of 16S ribosomal RNA genes, denaturing gradient gel electrophoresis (DGGE), cloning and sequencing. Among the predominant microorganisms in the bioreactor, the Firmicutes (mainly represented by Clostridiales) were the most abundant group, followed by the Chloroflexi and the Gamma-Proteobacteria (Pseudomonas species as the major representative). Other bacterial groups detected in the bioreactor were the Actinobacteria, Bacteroidetes and Deferribacteres. Among the Archaea, the methanogen Methanosaeta concilii was the most representative species.

Doxazosina asociada a la combinación bloqueante del eje-renina-angiotensina y calcioantagonista en pacientes con insuficiencia renal crónica / Doxazosine associated to renin-angiotensin blockers and calcioantagonists in chronic renal failure patients

Objetivo. El estudio ZAFRA se diseñó para evaluar la seguridad de un nuevo bloqueantede los canales del calcio, lercanidipino, en la insuficiencia renal crónica, ysu posible sobre la función renal en los pacientes tratados con fármacos que bloqueanel eje renina-angiotensina. Los pacientes que no controlaron su PA con estos fármacosfueron tratados con doxazosina.Diseño y métodos. El estudio reclutó 203 pacientes con insuficiencia renal (creatinina> 1,4 mg/dl en varones o > 1,2 mg/dl en mujeres, o aclaramiento de creatinina< 80 ml/min). Todos los pacientes estaban siendo tratados con IECA o antagonistasde receptores y la medicación se mantuvo a lo largo del estudio, sin quepudieran recibir diuréticos a lo largo del seguimiento. Los pacientes eran evaluadosclínica y analíticamente 1, 3 y 6 meses después de iniciar tratamiento con lercanidipino.Aquellos pacientes que en la segunda visita no estaban controlados añadierondoxazosina GITS (4 mg en dosis única) al tratamiento.Resultados: 57 pacientes que iniciaron el estudio fueron tratados con doxazosina(edad media 64,8 ± 12,7 años, 47,4 varones y 52,6 mujeres). La PA se redujo significativamentedesde 164 ± 17/92 ± 9 hasta 135 ± 13/78 ± 8 mmHg (p < 0,001). Seprodujeron reducciones significativas de la PA en el 67,6% de los enfermos y el32,4% de los pacientes redujeron su PA hasta los límites recomendados (<130/85mmHg). Únicamente 2 (3,6) pacientes han presentado reacciones adversas. No sedetectó aumento de la incidencia de edema. La creatinina plasmática (1,9 ± 0,6mg/dl) no se había modificado al final del estudio (2,0 ± 0,8 mg/dl) ni el aclaramientode creatinina (38,7 ± 15,7 vs 38,5 ± 14,5). También se detectó un descensosignificativo del urato plasmático (7,0 ± 1,9 vs 6,7 ± 1,6 mg/dl, p < 0,05).Conclusiones: La doxazosina ha presentado un excelente perfil de seguridad enlos pacientes renales, destacando la ausencia de edemas a pesar de la insuficienciarenal de los pacientes

Objective. To evaluate the safety and effectiveness of the alfa-blocker doxazosinGITS in CRF patients.Design and methods. The study recruited 203 CRF patients (creatinine > 1,4mg/dl for males, creatinine > 1,2 mg/dl for females, or creatinine clearance < 80ml/min). All patients were receiving ACE inhibitores (63.4%) or angiotensin II antagonist(36.6%) therapy but they had higher blood pressure than recommended forCRF (130/85 mmHg). Patients were clinically evaluated 1, 3 and 6 moths after startingtreatment with lercanidipine (10 mg once daily). Patients with high blood pressurein spite of combined therapy with two drugs added doxazosin GITS 4-8 mgonce daily to treatment.Result: 57 patients rendered evaluable for the study (age 64.8 ± 12.7 years,47.4% males and 52.6 females). BP significantly decrease from 164 ± 17/92 ± 9mmHg to 135 ± 13/78 ± 8 mmHg. 67.6% patients showed a significant BP reductionand 32.4% gets optimal BP control (< 130/85 mmHg). Two patients (3.6%)showed untoward effects. No biochemical changes were detected.Conclusions: Doxazosin showed a good antihypertensive effect in CRF patientswhen used as third drug in resistant severe hypertension. It has a good tolerabilityprofile and showed a neutral profile on biochemical parameters

Lercanidipine in patients with chronic renal failure: the ZAFRA study.

OBJECTIVE: The objective was primary to evaluate the safe use of a new calcium channel blocker, lercanidipine, in patients with chronic renal failure (CRF). The secondary objective was to study the protective effect of calcium channel blocker on renal function in CRF patients previously treated with ACE inhibitors or angiotensin receptor blockers. DESIGN AND METHODS: The study recruited 203 CRF patients (creatinine >1.4 mg/dL for males, creatinine > 1.2 mg/dL for females, or creatinine clearance <70 mL/min). All patients were receiving ACE inhibitors (63.4%) or angiotensin II antagonist (36.6%) therapy, but they had higher blood pressure than recommended for CRF (130/85 mmHg). No patients were under diuretic treatment. Patients were clinically evaluated 1, 3, and 6 months after starting treatment with lercanidipine. Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to the treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection. RESULTS: 175 patients rendered valuable for the study (age 63.9+/-11.9 years, 52.9% males and 47.1% females). Blood pressure (BP) significantly decreased from 162+/-17/93+/-8.3 mmHg to 132+/-12/78+/-6 mmHg. 89.2% of patients showed a significant BP reduction, and 58.1% achieved optimal BP control (<130/85 mmHg). Seven patients (3.4%) showed untoward effects. Not one case of edema was detected, and the prevalence of adverse effects related to vasodilatation was extremely low (three patients, 1.48%). Plasmatic creatinine did not change (1.9+/-0.5 baseline versus 1.9+/-0.6 mg/dL), but creatinine clearance increased at the end visit (41.8+/-16.0 baseline versus 45.8+/-18.0 mL/min, p=0.019). Plasmatic cholesterol also decreased from 221+/-46 to 211+/-35 mg/dL (p=0.001). CONCLUSIONS: Lercanidipine showed a high antihypertensive effect in CRF patients. It has a good tolerability profile and showed an interesting effect on plasmatic lipids. An improvement in renal function, measured through creatine clearance, was detected.

[Doxazosine associated to renin-angiotensin blockers and calcioantagonists in chronic renal failure patients]. / Doxazosina asociada a la combinación bloqueante del eje-renina-angiotensina y calcioantagonista en pacientes con insuficiencia renal crónica.

OBJECTIVE: To evaluate the safety and effectiveness of the alfa-blocker doxazosin GITS in CRF patients. DESIGN AND METHODS: The study recruited 203 CRF patients (creatinine > 1,4 mg/dl for males, creatinine > 1,2 mg/dl for females, or creatinine clearance < 80 ml/min). All patients were receiving ACE inhibitores (63.4%) or angiotensin II antagonist (36.6%) therapy but they had higher blood pressure than recommended for CRF (130/85 mmHg). Patients were clinically evaluated 1, 3 and 6 moths after starting treatment with lercanidipine (10 mg once daily). Patients with high blood pressure in spite of combined therapy with two drugs added doxazosin GITS 4-8 mg once daily to treatment. RESULT: 57 patients rendered evaluable for the study (age 64.8 +/- 12.7 years, 47.4% males and 52.6 females). BP significantly decrease from 164 +/- 17/92 +/- 9 mmHg to 135 +/- 13/78 +/- 8 mmHg. 67.6% patients showed a significant BP reduction and 32.4% gets optimal BP control (< 130/85 mmHg). Two patients (3.6%) showed untoward effects. No biochemical changes were detected. CONCLUSIONS: Doxazosin showed a good antihypertensive effect in CRF patients when used as third drug in resistant severe hypertension. It has a good tolerability profile and showed a neutral profile on biochemical parameters.

[Lercanidipine in diabetic patients with renal failure]. / Lercanidipino en pacientes diabéticos it con insuficiencia renal.

OBJECTIVE: To evaluate the safe use of a new calcium channel blocker, lercanidipine, in diabetic chronic renal failure (CRF) patients. DESIGN AND METHODS: The study recruited 42 diabetic CRF patients (creatinine > 1.4 mg/dl for males, creatinine > 1.2 mg/dl for females, or creatinine clearance < 70 ml/min). Mean age was 68.2 +/- 9.1 years. 53.8% were males and 46.2% females. Three patients were type 1 diabetics and 39 ones were type II. All patients were receiving ACE inhibitors (67.4%) or angiotensin II antagonist (32.6%) therapy but they had higher blood pressure than recommended for CRF patients (130/85 mmHg). No patients were under diuretic treatment. Patients were clinically evaluated 1, 3 and 6 months after starting treatment with lercanidipine. Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection. RESULTS: BP significantly decrease from 163 +/- 18/90 +/- 8 mmHg to 134 +/- 12/77 +/- 9 mmHg. One half of patients showed significant reduction of blood pressure, 26.7% reached the target blood pressure (< 130/85 mmHg) and 20.0% gets optimal BP control (< 130/85 mmHg). No one patient showed untoward effects. No edema was detected nor adverse effects related to vasodilatation were found. Plasmatic creatinine did not change (1.9 +/- 0.5 baseline vs 1.8 +/- 0.5 mg/dl) and creatinine clearance increased at the end visit (40.1 +/- 14.5 baseline vs 45.4 +/- 18.2 ml/min) but the difference was not significant. Proteinuria was unchanged. CONCLUSIONS: Lercanidipine showed a good antihypertensive effect in diabetics CRF patients. It has a good tolerability profile and showed neutral effect on plasmatic lipids. Neither impairment of renal function nor increment in proteinuria were detected.

Normal expression of IFN-gammaR in four patients with uncommon mycobacterial infection phenotypes

Several primary immunodeficiency diseases affecting the interleukin 12/interferon gamma (IFN-gamma) pathway have been identified, most of them characterized by recurrent and protracted infections produced by intracellular microorganisms, particularly by several species of mycobacteria. In the present study we analyzed the expression of IFN-gamma receptor (IFN-gammaR) and signal transducer and activator of transcription 1 (STAT-1) in 4 children with Mycobacterium tuberculosis infection of uncommon clinical presentation. These molecules were evaluated by flow cytometry and Western blotting in B cells transformed with Epstein-Barr virus and mutations were scanned by single-strand conformational polymorphisms and DNA sequencing. The expression of IFN-gammaR1 was normal in all 4 patients. The genetic analysis of IFN-gammaR1 and IFN-gammaR2 coding sequences did not reveal any mutation. The expression of the STAT-1 molecule was similar in patients and healthy controls; however, when the phosphorylation of this transcription factor in response to IFN-gamma activation was evaluated by Western blot, a significant lower signal was evident in one patient. These data indicate that there are no alterations in the expression or function of the IFN-gammaR chains in these patients. However, the low level of STAT-1 phosphorylation found in one of these patients might be explained by a defect in one of the molecules involved in the signal transduction pathway after IFN-gamma interacts with its receptor. In the other three patients the inability to eliminate the mycobacteria may be due to a defect in another effector mechanism of the mononuclear phagocytes.

Normal expression of IFN-gammaR in four patients with uncommon mycobacterial infection phenotypes.

Several primary immunodeficiency diseases affecting the interleukin 12/interferon gamma (IFN-gamma) pathway have been identified, most of them characterized by recurrent and protracted infections produced by intracellular microorganisms, particularly by several species of mycobacteria. In the present study we analyzed the expression of IFN-gamma receptor (IFN-gammaR) and signal transducer and activator of transcription 1 (STAT-1) in 4 children with Mycobacterium tuberculosis infection of uncommon clinical presentation. These molecules were evaluated by flow cytometry and Western blotting in B cells transformed with Epstein-Barr virus and mutations were scanned by single-strand conformational polymorphisms and DNA sequencing. The expression of IFN-gammaR1 was normal in all 4 patients. The genetic analysis of IFN-gammaR1 and IFN-gammaR2 coding sequences did not reveal any mutation. The expression of the STAT-1 molecule was similar in patients and healthy controls; however, when the phosphorylation of this transcription factor in response to IFN-gamma activation was evaluated by Western blot, a significant lower signal was evident in one patient. These data indicate that there are no alterations in the expression or function of the IFN-gammaR chains in these patients. However, the low level of STAT-1 phosphorylation found in one of these patients might be explained by a defect in one of the molecules involved in the signal transduction pathway after IFN-gamma interacts with its receptor. In the other three patients the inability to eliminate the mycobacteria may be due to a defect in another effector mechanism of the mononuclear phagocytes.