Deficit sustainability and fiscal theory of price level: the case of Italy, 1861-2020.

We test sustainability of the Italian government deficit over the period 1861-2020 using the fiscal theory of the price level (FTPL). This approach takes into account monetary and fiscal policy interactions and assumes that fiscal policy may determine the price level even if monetary authorities pursue an inflation-targeting strategy. We consider a cointegrated model with multiple structural changes to characterize the sustainability of public finances and the prevalence of monetary or fiscal dominance during subperiods. We also use recursive unit root tests for explosiveness to test fiscal sustainability and to detect episodes of potential explosive behaviour in Italian public debt. We find two structural changes for the public debt and one change in the primary budget surplus, the alternation of monetary and fiscal dominant regimes, as well as evidence of bubbles related to three episodes of the Italian fiscal performance. Our results reveal the sensitiveness of the primary balance and the debt paths to shocks hitting fiscal, macroeconomic, and financial variables.

Human disturbance and shifts in vertebrate community composition in a biodiversity hotspot.

Understanding how human modification of the landscape shapes vertebrate community composition is vital to understanding the current status and future trajectory of wildlife. Using a participatory approach, we deployed the largest camera-trap network in Mesoamerica to date to investigate how anthropogenic disturbance shapes the occupancy and co-occurrence of terrestrial vertebrate species in a tropical biodiversity hotspot: the Osa Peninsula, Costa Rica. We estimated species richness in different categories of land protection with rarefaction analysis and estimated the expected occupancy with a joint species distribution model that included covariates for anthropogenic disturbance, land protection, habitat quality, and habitat availability. Areas with the most stringent land-use protections (e.g., Corcovado National Park, 24 species [95% CI 23-25]) harbored significantly more species than unprotected areas (20 species [19.7-20.3]), mainly due to a reduced presence of large-bodied species of conservation concern in unprotected areas (e.g., jaguar Panthera onca and white-lipped peccary Tayassu pecari). Small-bodied generalist species, such as opossums (Didelphidae) and armadillos (Dasypus novemcinctus), in contrast, were more common at disturbed sites, resulting in a significant difference in vertebrate community composition between sites with low and high disturbance. Co-occurrence of species was also mainly associated with response to disturbance. Similar responses to disturbance create two groups of species, those whose site-level occupancy usually increased as anthropogenic disturbance increased and those whose estimated occupancy decreased. The absence of large-bodied species entails an important loss of ecological function in disturbed areas and can hinder forest development and maintenance. Efforts to protect and restore forested landscapes are likely having a positive effect on the abundance of some threatened species. These efforts, however, must be sustained and expanded to increase connectivity and ensure the long-term viability of the wildlife community.

Perturbaciones Humanas y Cambios en la Composición de la Comunidad de Vertebrados en un Punto Caliente de Biodiversidad Resumen El entendimiento de cómo las modificaciones humanas del paisaje conforman la composición de las comunidades de vertebrados es vital para entender el estado actual y la trayectoria futura de la fauna. Mediante una estrategia participativa, desplegamos la mayor red de cámaras trampa en Mesoamérica hasta la fecha para investigar cómo la perturbación antropogénica determina la ocupación y coocurrencia de las especies terrestres de vertebrados en un punto caliente de biodiversidad tropical: la Península de Osa, Costa Rica. Estimamos la riqueza de especies en diferentes categorías de protección de suelo con un análisis de rarefacción y estimamos la ocupación esperada con un modelo de distribución conjunta de especies que incluyó covariables para la perturbación antropogénica, la protección del suelo, la calidad del hábitat y la disponibilidad del hábitat. Las áreas con la protección más estricta de uso de suelo (p. ej.: Parque Nacional Corcovado, 24 especies [95% CI 23-25]) albergaron significativamente a más especies que las áreas desprotegidas (20 especies [19.7-20.3]), principalmente debido a la presencia reducida de especies de talla grande de interés para la conservación en las áreas desprotegidas (p. ej.: el jaguar Panthera onca, el pecarí de labios blancos, Tayassu pecari). Al contrario, las especies generalistas de talla pequeña, como las zarigüeyas (Didelphidae) y el armadillo (Dasypus novemcinctus) fueron más comunes en los sitios perturbados, lo que resulta en una diferencia significativa en la composición de las comunidades de vertebrados entre los sitios con una perturbación baja y alta. La coocurrencia de especies también estuvo asociada principalmente con la respuesta a la perturbación. Las respuestas similares a la perturbación crean dos grupos de especies: aquellas cuya ocupación a nivel de sitio generalmente incrementó conforme incrementó la perturbación antropogénica y aquellas cuya ocupación estimada disminuyó. La ausencia de especies de talla grande conlleva una pérdida importante de la función ecológica en las áreas perturbadas y puede dificultar el desarrollo y mantenimiento del bosque. Los esfuerzos para proteger y restaurar los paisajes forestales probablemente estén teniendo un efecto positivo sobre la abundancia de algunas especies amenazadas. Estos esfuerzos, sin embargo, deben ser sostenidos y expandidos para incrementar la conectividad y asegurar la viabilidad a largo plazo de la comunidad faunística.

Redefining monetary policy rules: A threshold approach.

In this paper, we try to analyse the extent to which a redefinition of the monetary policy rule would help to avoid the zero-lower bound, as well as to explore the conditions needed to avoid that constraint. To that aim, we estimate the threshold values of the key variables of the policy rule: the inflation gap and the output gap. The threshold model allows us to know which are the turning points from which the relationship between the key variables and the interest rate revert. In the Eurozone countries, we have found that the inflation gap always contributes to increasing the nominal interest rate. On the contrary, the output gap works differently when it reaches values above or below the threshold value, which would favour the reduction of the interest rates towards the zero level.

Diálisis peritoneal en pacientes incidentes con glomerulonefritis primaria. Resultados de un registro multicéntrico durante 20 años de seguimiento / Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study

ANTECEDENTES Y OBJETIVOS: Las glomerulonefritis (GN) constituyen una de las principales causas de enfermedad renal crónica estadio 5 en diálisis, sin embargo, pocos estudios se centran en su pronóstico en diálisis. Analizamos la supervivencia y características de los pacientes con GN primaria (GNP) en diálisis peritoneal (DP) y comparamos sus resultados con otros enfermos. MÉTODOS: Estudio observacional con recogida de datos de manera prospectiva durante 2 décadas (1995-2014). Incluimos a todos los pacientes del registro Levante que iniciaron DP como primera técnica dialítica. Los datos se transfirieron a una base de datos anonimizada en Access. El análisis estadístico se realizó mediante el programa SPSS (versión 19.0). RESULTADOS: El estudio incluyó a 2.243 pacientes, siendo las GN la principal causa de enfermedad renal primaria (21,5%). La nefropatía IgA fue la GNP con confirmación histológica más frecuente. Comparados con el resto de la muestra, los pacientes con GNP fueron en mayor proporción varones (65 vs. 58%, p = 0,004), con menor edad (48 vs. 55 años, p < 0,001), menos comorbilidad y mayor tasa de inclusión en lista de espera de trasplante renal (87 vs. 63%, p < 0,001). Asimismo, los pacientes con GNP se trasplantaron más (48,9%, p < 0,001) y este fue su motivo más frecuente de salida de DP; además de presentar menor tasa global de peritonitis (0,34 vs. 0,45 episodios/paciente-año, p < 0,001). La supervivencia técnica fue del 90,6% al año, del 71,7% a los 3 años y del 59% a los 5 años (mediana 76,8 meses), sin diferencias entre grupos. La supervivencia de los pacientes fue del 94,9% al año, del 80,1% a los 3 años y del 63,7% a los 5 años (mediana 90,7 meses). Los enfermos con GNP presentaron mejor supervivencia media que el resto de patologías (153,5 meses [IC 95%: 137-169,9) vs. 110,3 meses [IC 95%: 100,8-119,7], p < 0,001). En el multivariante, se relacionó de manera negativa con la supervivencia técnica tener mayor transporte peritoneal (p = 0,018), y con la supervivencia del paciente tener mayor edad (p < 0,001) y alguna comorbilidad, especialmente diabetes y hepatopatía (p < 0,001). Por el contrario, la inclusión en lista de espera y la función renal residual (p < 0,001) favorecieron ambas supervivencias. CONCLUSIONES: A la vista de nuestros resultados y teniendo en cuenta las ventajas de la DP como primer tratamiento dialítico, consideramos que esta terapia es una excelente técnica para los enfermos con GNP mientras esperan un trasplante renal

BACKGROUND AND OBJECTIVES: Glomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients. METHODS: This prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0). RESULTS: The study included 2,243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, P =. 004), and they were on average younger (48 years vs 55 years, P < .001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, P < .001). Patients with PGN also had more transplants (48,9%, P < .001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, P < .001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0 to 169,9] vs 110,3 months [95% CI: 100,8 to 119,7], P < .001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (P = .018). Factors with a negative influence on mortality were being older (P < .001) and having any comorbidity, mainly diabetes and liver disease (P < .001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (P = .001). CONCLUSIONS: PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant

Análisis de la relación entre Diabetes Mellitus tipo 2 y la obesidad con los factores de riesgo cardiovascular / Analysis of the relationship between Type 2 Diabetes Mellitus and obesity with cardiovascular risk factors

La “diabesidad” es un concepto en auge que hace referencia a los individuos con diabetes mellitus tipo 2 y obesidad. Ambos conceptos se encuentran íntimamente relacionados.Se ha llevado a cabo una búsqueda en Web Of Science para realizar una revisión bibliográfica con el objetivo de establecer la relación existente entre la obesidad, la diabetes mellitus tipo 2 y los factores de riesgo cardiovascular.El tejido adiposo es una glándula endocrina capaz de secretar hormonas, citoquinas y sustancias vasoactivas. En los individuos obesos, este tejido adiposo se muestra disfuncional, secretando de forma inusual ciertas adipocinas como la leptina y adiponectina. Tanto es así, que en individuos obesos sometidos a una cirugía bariátrica se ha visto como la relación adiponectina/leptina se invierte. Además, en un ambiente obesogénico, el tejido adiposo muestra un fenotipo proinflamatorio, que ayuda a perpetuar el proceso de resistencia a la insulina y el consiguiente desarrollo de prediabetes y diabetes mellitus tipo 2.Es importante determinar nuevas dianas terapéuticas para la diabesidad, como el factor de transcripción GPS2, que muestra una disminución de sus niveles en sujetos obesos, lo cual predispone a un fenotipo pro-diabético.Recientemente se ha demostrado que mi-483-5p se expresa en tejidos relevantes de diabetes y enfermedad cardiovascular, lo cual predice su potencial como biomarcador en sangre de dichas enfermedades.En conclusión, esta revisión pretende recalcar la importancia de controlar los factores de riesgo cardiovascular, como la obesidad, para impedir el desarrollo posterior de una enfermedad estrechamente ligada a ésta como es la diabetes tipo 2.(AU)

"Diabesity" is a booming concept that refers to individuals with type 2 diabetes mellitus and obesity. Both concepts are closely related.A search of Web Of Science was carried out to carry out a bibliographic review with the aim of establishing the relationship between obesity, type 2 diabetes mellitus and cardiovascular risk factors.Adipose tissue is an endocrine gland capable of secreting hormones, cytokines, and vasoactive substances. In obese individuals, this adipose tissue is dysfunctional, secreting certain adipokines such as leptin and adiponectin in an unusual way. So much so, that in obese individuals undergoing bariatric surgery, the adiponectin / leptin ratio has been reversed. Furthermore, in an obesogenic environment, adipose tissue displays a proinflammatory phenotype, which helps perpetuate the process of insulin resistance and the consequent development of prediabetes and type 2 diabetes mellitus.It is important to determine new therapeutic targets for diabesity, such as the GPS2 transcription factor, which shows a decrease in its levels in obese subjects, which predisposes to a pro-diabetic phenotype.Mi-483-5p has recently been shown to be expressed in relevant tissues of diabetes and cardiovascular disease, which predicts its potential as a blood biomarker for these diseases.In conclusion, this review aims to emphasize the importance of controlling cardiovascular risk factors, such as obesity, to prevent the subsequent development of a disease closely related to it, such as type 2 diabetes.(AU)

Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study.

BACKGROUND AND OBJECTIVES: Glomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients. METHODS: This prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0). RESULTS: The study included 2243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, p = .004), and they were on average younger (48 years vs 55 years, p < .001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, p < .001). Patients with PGN also had more transplants (48,9%, p < .001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, p < .001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0-169,9] vs 110,3 months [95% CI: 100,8-119,7], p < .001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (p = .018). Factors with a negative influence on mortality were being older (p < .001) and having any comorbidity, mainly diabetes and liver disease (p < .001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (p = .001). CONCLUSIONS: PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.

Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study. / Diálisis peritoneal en pacientes incidentes con glomerulonefritis primaria. Resultados de un registro multicéntrico durante 20 años de seguimiento.

BACKGROUND AND OBJECTIVES: Glomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients. METHODS: This prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0). RESULTS: The study included 2,243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, P=.004), and they were on average younger (48 years vs 55 years, P<.001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, P<.001). Patients with PGN also had more transplants (48,9%, P<.001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, P<.001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0 to 169,9] vs 110,3 months [95% CI: 100,8 to 119,7], P<.001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (P=.018). Factors with a negative influence on mortality were being older (P <.001) and having any comorbidity, mainly diabetes and liver disease (P <.001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (P=.001). CONCLUSIONS: PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.

No to Neocosmospora: Phylogenomic and Practical Reasons for Continued Inclusion of the Fusarium solani Species Complex in the Genus Fusarium.

This article is to alert medical mycologists and infectious disease specialists of recent name changes of medically important species of the filamentous mold FusariumFusarium species can cause localized and life-threating infections in humans. Of the 70 Fusarium species that have been reported to cause infections, close to one-third are members of the Fusarium solani species complex (FSSC), and they collectively account for approximately two-thirds of all reported Fusarium infections. Many of these species were recently given scientific names for the first time by a research group in the Netherlands, but they were misplaced in the genus Neocosmospora In this paper, we present genetic arguments that strongly support inclusion of the FSSC in Fusarium There are potentially serious consequences associated with using the name Neocosmospora for Fusarium species because clinicians need to be aware that fusaria are broadly resistant to the spectrum of antifungals that are currently available.

The phosphatase Ptc6 is involved in virulence and MAPK signalling in Fusarium oxysporum.

Mitogen-activated kinase (MAPK) signalling pathways are involved in several important processes related to the development and virulence of Fusarium oxysporum. Reversible phosphorylation of the protein members of these pathways is a major regulator of essential biological processes. Among the phosphatases involved in dephosphorylation of MAPKs, type 2C protein phosphatases (PP2Cs) play important roles regulating many developmental strategies and stress responses in yeasts. Nevertheless, the PP2C family is poorly known in filamentous fungi. The F. oxysporum PP2C family includes seven proteins, but only Ptc1 has been studied so far. Here we show the involvement of Ptc6 in the stress response and virulence of F. oxysporum. Expression analysis revealed increased expression of ptc6 in response to cell wall and oxidative stresses. Additionally, targeted inactivation of ptc6 entailed enhanced susceptibility to cell wall stresses caused by Calcofluor White (CFW). We also demonstrate that the lack of Ptc6 deregulates both the Mpk1 phosphorylation induced by CFW and, more importantly, the Fmk1 dephosphorylation induced by pH acidification of the extracellular medium, indicating that Ptc6 is involved in the regulation of these MAPKs. Finally, we showed, for the first time, the involvement of a phosphatase in the invasive growth and virulence of F. oxysporum.

A new solitary, interstitial species of Loxosomatidae (Entoprocta) from the coast of Galicia (NW Spain), Loxosoma discoides n. sp.

A new solitary species of Loxosomatidae (Entoprocta), Loxosoma discoides n. sp., is described. The specimens were found in the intertidal level of two locations in the Galician (NW Spain) coast. This new species, with "table-tennis bat" appearance, is characterised by showing large lateral wings in the calyx, which confer the singular aspect. It is the first record of this genus at the coast of the Iberian Peninsula.

Adherencia a la dieta mediterránea en pacientes diabéticos con mal control / Adhesion to the Mediterranean diet in diabetic patients with poor control

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Pero, doctor, ¿entonces qué puedo comer? / So doctor, what could I eat then?

Introducción: las estrictas restricciones dietéticas que imponemos en la enfermedad renal crónica avanzada (ERCA) tienen un impacto negativo en la calidad de vida. Objetivo: determinar si estas restricciones están justificadas y si un programa de educación nutricional mejoraría los parámetros de calidad de vida relacionada con la salud (CVRS). Material y métodos: realizamos un ensayo clínico de intervención educativa, unicéntrico, randomizado y controlado en los pacientes de la consulta ERCA de Albacete. Se incluyeron 75 pacientes, 35 en el grupo control y 40 en el de intervención. Se realizó la valoración nutricional mediante valoración global subjetiva (VGS) e índice de masa corporal (IMC). Para medir la CVRS se empleó el cuestionario de salud SF-36. En el grupo intervención se realizó la intervención nutricional individual, colectiva y por recuerdo telefónico, adaptando a cada paciente el consejo dietético y ajustando las restricciones de forma personalizada. Resultados: la malnutrición medida por VGS fue del 20% en el grupo control y del 29,3% en el grupo intervención, donde mejoró aunque no fue significativo. El IMC mostró sobrepeso con una media de 28,83 (DE: 5,4) y 26,96 kg/m2 (DE: 4,09) respectivamente, sin cambios a lo largo del estudio. La intervención nutricional supuso una mejoría en las puntuaciones de todas las subescalas excepto en el dolor corporal. Además, los componentes físico y mental también mejoraron sus puntuaciones en el grupo intervención y empeoraron significativamente (p < 0,001) en el control. Conclusiones: la calidad de vida se puede mejorar en los pacientes con ERCA aplicando un programa de educación nutricional

Introduction: the strict dietary recommendations we impose on patients with advanced chronic kidney disease (ACKD) have negative impact on quality of life. Objective: determine whether such restrictions are justified and if an educational program can improve health-related quality of life (HRQL) parameters. Methods: we carried out an educational intervention, single center, randomized, controlled clinical trial on ACKD outpatients in Albacete. Seventy-five patients were included, 35 in the control group and 40 in the intervention group. Nutritional assessment was based on the Subjetive Global Assessment (SGA) and body mass index (BMI). We used the SF-36 health questionnaire to measure HRQL. In the intervention group we carried out individual, collective and telephone nutritional interventions, adapting diet advice and restrictions in a personalized way. Results: malnutrition measured by Subjective Global Assessment (SGA) in the control group was 20%; meanwhile, in the intervention group it was 29.3% and it improved at the end of the study, but not significantly. BMI showed overweight with a mean of 28.83 kg/m² (DE: 5.4) and 26.96 kg/m² (DE: 4.09), respectively, and did not change throughout the study. The nutritional intervention improved the score in all the subscales except for body pain score. Besides, mental and physical components also improved their scores in the intervention group and worsened them in the control group (p < 0.001). Conclusions: quality of life can be improved in ACKD patients applying an educational nutrition program

[So doctor, what could I eat then?] / Pero, doctor, ¿entonces qué puedo comer?

INTRODUCTION: Introduction: the strict dietary recommendations we impose on patients with advanced chronic kidney disease (ACKD) have negative impact on quality of life. Objective: determine whether such restrictions are justified and if an educational program can improve health-related quality of life (HRQL) parameters. Methods: we carried out an educational intervention, single center, randomized, controlled clinical trial on ACKD outpatients in Albacete. Seventy-five patients were included, 35 in the control group and 40 in the intervention group. Nutritional assessment was based on the Subjetive Global Assessment (SGA) and body mass index (BMI). We used the SF-36 health questionnaire to measure HRQL. In the intervention group we carried out individual, collective and telephone nutritional interventions, adapting diet advice and restrictions in a personalized way. Results: malnutrition measured by Subjective Global Assessment (SGA) in the control group was 20%; meanwhile, in the intervention group it was 29.3% and it improved at the end of the study, but not significantly. BMI showed overweight with a mean of 28.83 kg/m² (DE: 5.4) and 26.96 kg/m² (DE: 4.09), respectively, and did not change throughout the study. The nutritional intervention improved the score in all the subscales except for body pain score. Besides, mental and physical components also improved their scores in the intervention group and worsened them in the control group (p < 0.001). Conclusions: quality of life can be improved in ACKD patients applying an educational nutrition program.

INTRODUCCIÓN: Introducción: las estrictas restricciones dietéticas que imponemos en la enfermedad renal crónica avanzada (ERCA) tienen un impacto negativo en la calidad de vida. Objetivo: determinar si estas restricciones están justificadas y si un programa de educación nutricional mejoraría los parámetros de calidad de vida relacionada con la salud (CVRS). Material y métodos: realizamos un ensayo clínico de intervención educativa, unicéntrico, randomizado y controlado en los pacientes de la consulta ERCA de Albacete. Se incluyeron 75 pacientes, 35 en el grupo control y 40 en el de intervención. Se realizó la valoración nutricional mediante valoración global subjetiva (VGS) e índice de masa corporal (IMC). Para medir la CVRS se empleó el cuestionario de salud SF-36. En el grupo intervención se realizó la intervención nutricional individual, colectiva y por recuerdo telefónico, adaptando a cada paciente el consejo dietético y ajustando las restricciones de forma personalizada. Resultados: la malnutrición medida por VGS fue del 20% en el grupo control y del 29,3% en el grupo intervención, donde mejoró aunque no fue significativo. El IMC mostró sobrepeso con una media de 28,83 (DE: 5,4) y 26,96 kg/m2 (DE: 4,09) respectivamente, sin cambios a lo largo del estudio. La intervención nutricional supuso una mejoría en las puntuaciones de todas las subescalas excepto en el dolor corporal. Además, los componentes físico y mental también mejoraron sus puntuaciones en el grupo intervención y empeoraron significativamente (p < 0,001) en el control. Conclusiones: la calidad de vida se puede mejorar en los pacientes con ERCA aplicando un programa de educación nutricional.

Adhesion to the Mediterranean diet in diabetic patients with poor control. / Adherencia a la dieta mediterránea en pacientes diabéticos con mal control.

OBJECTIVE: To analyse the relationship between the level of adherence to the Mediterranean diet and the control of cardiovascular risk factors. METHOD: A descriptive, observational study was conducted on patients diagnosed with Diabetes Mellitus type 2, with poor blood glucose control and a Body Mass Index greater than 25kg/m2. The relationship between the adherence to the Mediterranean diet and cardiovascular risk factors was evaluated before and after education about the Mediterranean diet. The patients were given a questionnaire on the level of adherence to the Mediterranean diet (the Mediterranean diet score), at the beginning of the study and at 6 month after having education about the Mediterranean diet in the Primary Care medical and nursing clinics. An analysis was carried out on the variables including, gender, age, weight, height, and Body Mass Index, as well as the analytical parameters of blood glucose, glycosylated haemoglobin, total, HDL, LDL cholesterol, and triglycerides. The relationship between the primary variable, 'adherence to the Mediterranean diet', and the rest of the variables was calculated before and after the educational intervention. RESULTS: The initial 'adherence to the Mediterranean diet score' in the questionnaire was relatively low (6.22). Excess weight, as well as to have an elevated Body Mass Index are associated with a lower adherence to the Mediterranean diet, as well as low adherence to treatment (P<.00 and P<.02, respectively). The values of HDL cholesterol values increased with greater adherence (P<.04). Elevated LDL and total cholesterol are associated with a lower adherence to the Mediterranean diet (P<.01 and P<.05, respectively), similar to that of elevated triglycerides (P<.00). Elevated baseline blood glucose levels are also associated with low adherence to the Mediterranean diet (P<.04), as well as the increase in glycosylated haemoglobin (P<.06). Thus the cardiovascular risk increases with low adherence (P<.08). After the educational intervention, a moderate increase was observed in the adherence to the Mediterranean diet (a score of 6.84) as well as a notable improvement in the control of the cardiovascular risk factors. CONCLUSIONS: Adherence to the Mediterranean diet is associated with improved control of cardiovascular risk factors.

[Scedosporium apiospermum infection in a kidney transplant recipient]. / Infección por Scedosporium apiospermum en una paciente con trasplante renal.

BACKGROUND: Emerging fungi infections, although being not the most frequent, are a cause of major morbidity and mortality in recipients of solid organ transplants. The infections caused by the fungi Scedosporium apiospermum are a paradigmatic example of these. CASE REPORT: We present the clinical case of a 55 year-old female kidney transplant recipient that got infected with S. apiospermum through the skin. Intensive antifungal therapy was started, especially considering that the patient had an arteriovenous fistula at the site of infection. The fungus could have kept in the fistula, and a subsequent reinfection took place. The patient required both medical and surgical treatment (removal of the prosthetic material), that led to a complete recovery. CONCLUSIONS: S. apiospermum infections carry a high risk of complications, and are a frequent cause of morbidity and mortality in immunosuppressed/transplant patients. Therefore, the adequate knowledge of this type of mycosis, as well as the making of an adequate differential diagnosis, become fundamental for the prevention of the complications arising from them.

Infección por Scedosporium apiospermum en una paciente con trasplante renal / Scedosporium apiospermum infection in a kidney transplant recipient

Antecedentes: Las infecciones por hongos emergentes, si bien no son las más frecuentes, son causantes de una importante morbimortalidad en receptores de trasplante de órgano sólido. Las infecciones por el hongo Scedosporium apiospermum suponen un ejemplo paradigmático de las mismas. Caso clínico: Se presenta el caso clínico de una paciente trasplantada renal de 55 años, que a través de la piel sufre una infección por S. apiospermum. Se comenzó una terapia antifúngica intensiva ya que la paciente, además, era portadora de una fístula arteriovenosa en la zona de entrada de la infección. El hongo pudo quedar acantonado y la paciente sufrió una reinfección que requirió tratamiento de nuevo, tanto médico como quirúrgico (retirada del material protésico), que llevó a la curación de la paciente. Conclusiones: Las infecciones por S. apiospermum conllevan un alto riesgo de complicaciones y son una causa frecuente de morbimortalidad en el paciente inmunodeprimido/trasplantado. Por ello, el adecuado conocimiento de este tipo de micosis, así como la realización de un adecuado diagnóstico diferencial, se tornan fundamentales para la prevención de las complicaciones derivadas de las mismas

Background: Emerging fungi infections, although being not the most frequent, are a cause of major morbidity and mortality in recipients of solid organ transplants. The infections caused by the fungi Scedosporium apiospermum are a paradigmatic example of these. Case report: We present the clinical case of a 55 year-old female kidney transplant recipient that got infected with S. apiospermum through the skin. Intensive antifungal therapy was started, especially considering that the patient had an arteriovenous fistula at the site of infection. The fungus could have kept in the fistula, and a subsequent reinfection took place. The patient required both medical and surgical treatment (removal of the prosthetic material), that led to a complete recovery. Conclusions: S. apiospermum infections carry a high risk of complications, and are a frequent cause of morbidity and mortality in immunosuppressed/transplant patients. Therefore, the adequate knowledge of this type of mycosis, as well as the making of an adequate differential diagnosis, become fundamental for the prevention of the complications arising from them

Role of the phosphatase Ptc1 in stress responses mediated by CWI and HOG pathways in Fusarium oxysporum.

Reversible protein phosphorylation is crucial for cell signal transduction in stress response. Fusarium oxysporum is a soil inhabiting fungus that can adapt to a wide range of ecological niches and environmental conditions. Three mitogen activated protein kinase (MAPK) cascades have been shown to orchestrate the response of the fungus to external insults such as high temperature, cell wall, oxidative or hyperosmotic stress in F. oxysporum. However, the protein phosphatases that fine-tune phosphorylation levels of different MAPKs in this fungus are unknown. In this study we show that the serine/threonine phosphatase Ptc1 regulates phosphorylation of the high osmolarity glycerol response (HOG) MAPK Hog1 and the cell wall integrity (CWI) MAPK Mpk1. A Δptc1 mutant showed decreased phosphorylation levels of the Mpk1 and was more sensitive to cell wall damaging agents in comparison to the wild type strain. In contrast, this mutant exhibited higher phosphorylation levels of the p38 MAPK Hog1, increased tolerance to osmotic stress compounds and higher expression of genes induced by osmotic stress. Moreover, Δptc1 contained fragmented vacuoles even in absence of the osmotic stressor, supporting the involvement of Ptc1 in the HOG pathway.

Comparación entre bioimpedancia espectroscópica y fórmula de Watson para medición de volumen corporal en pacientes en diálisis peritoneal / Comparison of bioimpedance spectroscopy and the Watson formula for measuring body volume in patients on peritoneal dialysis

Introducción: Conocer el volumen corporal total (V) es fundamental en los pacientes en diálisis peritoneal (DP). Habitualmente calculado mediante fórmula de Watson, el empleo de bioimpedancia espectroscópica (BIS), cada vez está más generalizado. Frecuentemente, al medir el V con ambos métodos surgen amplias diferencias. Objetivo: Evaluar si aparecen diferencias entre ambas formas de medir el V en una unidad de DP y analizar qué factores clínicos se asocian a estas diferencias. Métodos: Estudio observacional. Se incluyó a 74 pacientes en DP. Medimos el V empleando BIS (Vbis) y fórmula de Watson (Vw); se recogieron 271 mediciones por cada método. Calculamos diferencia entre volúmenes en cada medición y los clasificamos en 2 grupos: diferencia mayor o igual a10% o <10% de Vbis. Evaluamos la presencia de una serie de parámetros clínicos en nuestros pacientes. Analizamos si existen diferencias entre Vbis y Vw (de Student). Valoramos si existe asociación entre las diferencias entre volúmenes y la presencia de los parámetros clínicos analizados (chi cuadrado). Resultados: V fue 2,15 l mayor medido con fórmula de Watson que con BIS. El 58,67% de las mediciones tenían diferencia entre Vw y Vbis mayor o igual a10%. Aparecen diferencias significativas al comparar la presencia de diferencia entre volúmenes y la presencia o no de diabetes (p=0,03), hipertensión (p=0,036), hipoalbuminemia (p<0,01), hipoprealbuminemia (p<0,01), bajo ángulo de fase a 50Hz (p<0,01), proteína C reactiva elevada (p<0,01), obesidad (p=0,027), exceso de grasa corporal (p<0,01), E/I ratio (cociente entre agua extracelular y agua intracelular)mayor o igual a1 (p<0,01) y diuresis residual (p=0,029). Conclusiones: Existen diferencias en el V de los pacientes de una unidad de DP según sea calculado por fórmula de Watson o por BIS. La presencia de hipertensión, diabetes, hipoalbuminemia, obesidad, malnutrición, inflamación, E/I ratio mayor o igual a1 y la ausencia de diuresis residual se asocia con la aparición de estas diferencias (AU)

Introduction: Knowing total body volume (V) is crucial in patients on peritoneal dialysis (PD). It is usually calculated by the Watson anthropometric formula, although the use of bioimpedance spectroscopy (BIS) is becoming increasingly widespread. Measuring V with both methods can at times produce quite different results. Objective: We aimed to identify differences between the 2 forms of measuring volume in a PD unit and determine which clinical factors are associated with these differences. Methods: Ours is an observational study of 74 patients on PD. We measured V using BIS (Vbis) and the Watson formula (Vw); 271 measurements were made with each method. We calculated the difference between Vbis and Vw in each patient and classified them into 2 groups: Difference between volumes greater than or equal to10% or <10% Vbis. We assessed the presence of several clinical parameters in our patients. We assessed whether there were any differences between Vbis and Vw (Student t-test). We determined whether there was any association between the difference in volumes and the presence of the clinical parameters analysed (chi square test). Results: V was 2.15 l higher measured by the Watson formula than with BIS (P<.01). In 58.67% of the measurements, the difference between Vbis and Vw was greater than or equal to10%. Significant differences were found when comparing the presence of difference between volumes and the presence or not of diabetes mellitus (DM) (p=0,03), hypertension (HTN) (p=0,036), hypoalbuminemia (p<0,01), hypoprealbuminemia (p<0,01), low phase angle at 50 Hz (p<0,01), high C reactive protein (p<0,01), obesity (p=0,027), E/I ratio (ratio between extracellular and intracellular water) greater than or equal to1 (p<0.01) and residual diuresis (p=0.029). Conclusions: There are significant differences in the V of PD Unit patients when obtained by Watson formula or by BIS. A difference between the measurements is associated with the presence of DM, HTN, hypoalbuminaemia, obesity, malnutrition, inflammation, E/I ratio greater than or equal to1 and the absence of residual dieresis (AU)

Comparison of bioimpedance spectroscopy and the Watson formula for measuring body volume in patients on peritoneal dialysis.

INTRODUCTION: Knowing total body volume (V) is crucial in patients on peritoneal dialysis (PD). It is usually calculated by the Watson anthropometric formula, although the use of bioimpedance spectroscopy (BIS) is becoming increasingly widespread. Measuring V with both methods can at times produce quite different results. OBJECTIVE: We aimed to identify differences between the 2 forms of measuring volume in a PD unit and determine which clinical factors are associated with these differences. METHODS: Ours is an observational study of 74 patients on PD. We measured V using BIS (Vbis) and the Watson formula (Vw); 271 measurements were made with each method. We calculated the difference between Vbis and Vw in each patient and classified them into 2 groups: Difference between volumes ≥10% or <10% Vbis. We assessed the presence of several clinical parameters in our patients. We assessed whether there were any differences between Vbis and Vw (Student t-test). We determined whether there was any association between the difference in volumes and the presence of the clinical parameters analysed (chi square test). RESULTS: V was 2.15 l higher measured by the Watson formula than with BIS (P<.01). In 58.67% of the measurements, the difference between Vbis and Vw was ≥10%. Significant differences were found when comparing the presence of difference between volumes and the presence or not of diabetes mellitus (DM) (p=0,03), hypertension (HTN) (p=0,036), hypoalbuminemia (p<0,01), hypoprealbuminemia (p<0,01), low phase angle at 50 Hz (p<0,01), high C reactive protein (p<0,01), obesity (p=0,027), E/I ratio (ratio between extracellular and intracellular water) ≥1 (p<0.01) and residual diuresis (p=0.029). CONCLUSIONS: There are significant differences in the V of PD Unit patients when obtained by Watson formula or by BIS. A difference between the measurements is associated with the presence of DM, HTN, hypoalbuminaemia, obesity, malnutrition, inflammation, E/I ratio ≥1 and the absence of residual diuresis.

Antimicrobial evaluation of quaternary ammonium polyethyleneimine nanoparticles against clinical isolates of pathogenic bacteria.

Peritonitis is a disease caused by bacterial strains that have become increasingly resistant to many antibiotics. The development of alternative therapeutic compounds is the focus of extensive research, so novel nanoparticles (NPs) with activity against antibiotic-resistant bacteria should be developed. In this study, the antibacterial activity of quaternary ammonium polyethyleneimine (QA-PEI) NPs was evaluated against Streptococcus viridans, Stenotrophomonas maltophilia and Escherichia coli. To appraise the antibacterial activity, minimal inhibitory concentration (MIC), minimal bactericidal concentration and bactericidal assays were utilised with different concentrations (1.56-100 µg/ml) of QA-PEI NPs. Moreover, 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) and annexin V/propidium iodide toxicity assays were performed in cell cultures. MICs for S. maltophilia and E. coli isolates were 12.5 and 25 µg/ml, respectively, whereas the MIC for S. viridans was 100 µg/ml. Furthermore, the growth curve assays revealed that these QA-PEI NPs at a concentration of 12.5 µg/ml significantly inhibited bacterial growth for the bacterial isolates studied. On the other hand, QA-PEI NPs lacked significant toxicity for cells when used at concentrations up to 50 µg/ml for 48 h. The present findings reveal the potential therapeutic value of this QA-PEI NPs as alternative antibacterial agents for peritonitis, especially against Gram-negative bacteria.