Search

Background The prevalence of kidney involvement during SARS-CoV-2 infection has been reported to be high. Nevertheless, data are lacking about the determinants of acute kidney injury (AKI) and the combined effect of chronic kidney disease (CKD) and AKI in COVID-19 patients. Methods We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution. Chronic kidney disease was defined as eGFR 2 or proteinuria at urinalysis within 180 days prior to hospital admission. AKI was defined according to KDIGO criteria. The primary and secondary outcomes were the development of AKI and death. Results Of 777 patients eligible for the study, acute kidney injury developed in 176 (22.6%). Of these, 79 (45%) showed an acute worsening of a preexisting CKD, and 21 (12%) required kidney replacement therapy. Independent associates of AKI were chronic kidney disease, C-reactive protein (CRP) and ventilation support. Among patients with acute kidney injury, 111 died (63%) and its occurrence increased the risk of death by 60% (HR 1.60 [95% IC 1.21–2.49] p = 0.002) independently of potential confounding factors including hypertension, preexisting kidney damage, and comorbidities. Patients with AKI showed a significantly higher rate of deaths attributed to bleeding compared to CKD and the whole population (7.5 vs 1.5 vs 3.5%, respectively). Conclusion Awareness of kidney function, both preexisting CKD and development of acute kidney injury, may help to identify those patients at increased risk of death.

Objective: The aim of this study is to investigate the relationship of Metabolic Syndrome (MetS) and its components with arterial stiffness in general population without cardiovascular diseases. Design and method: Cross-sectional study of general population without cardiovascular diseases. There were included 500 subjects between 35–75 years old, selected by random sampling with replacement, stratified by age and gender groups using the Sanitary Card base of 5 urban health centers. Measurements: Pulse wave velocity femoral carotid (cfPWV) was determined using the SphygmoCor System, Cardio Ankle Vascular Index (CAVI) using the VaSera. MetS was defined based on the Joint Scientific Statement National Cholesterol Education Program III. Results: Mean age was 55.9 ± 14.2years, mean cfPWV was 6.5 ± 2.0 m/sec and mean CAVI was:8.0 ± 1.4. MetS was found in 14% of the subjects. cfPWV and CAVI were higher in subjects with MetS. All MetS components, except reduced HDL-cholesterol, were correlated with cfPWV and CAVI. With correlation coefficient between r = 0.450 (cfPWV and diastolic blood pressure) and r = 0.128 (between CAVI and triglycerides). After adjustment for age and sex the correlation remains the same with the cfPWV. However, it is only maintained with the CAVI only with blood pressure. Subjects with MetS have odds ratio (OR) for both cfPWV ≥ 10 m/sec (OR = 1.884, 95 % CI 0.996–3.486) and CAVI ≥ 9 (OR = 1.810, 95 % CI 0.749–4.372). Conclusions: The cfPWV showed the positive correlation, after adjusting it for age and sex with all the components of the MetS, however the CAVI showed the positive correlation with the arterial pressure.

Oceanic archipelagos are considered hot-spots of biodiversity because they harbor unique biota with a high level of endemicity. However, the endemic biodiversity of oceanic islands is very vulnerable to extinction. In recent decades, intensive exploitation of these territories and human-mediated introduction of alien species have posed unprecedented threats to the long-term survival of the endemic contingent. The very limited population genetic information available until now for the 28 Canarian endemic Echium taxa has hindered the development of conservation strategies for the ca. 25% of them that are under threat. In this paper, we analyze the levels and distribution of genetic isozyme diversity in 23 natural populations of three endangered endemics of restricted distribution (E. acanthocarpum, CR; E. onosmifolium ssp. spectabile, EN; and E. callithyrsum, VU), and two endemics of wide distribution and in principle free of threat (E. decaisnei and E. onosmifolium). Our results reveal high levels of genetic variability in all these taxa that have plausibly been reached despite a predominance of selfing. They also point out a high incidence of inbreeding in the reproductive dynamics of populations and suggest the potential value of hybridisation processes in shaping the genetic makeup of these species. Among-population differentiation, as estimated by Gst, and genetic distances within taxa are low overall, but they do support the current taxonomic separation between the two subspecies of E. onosmifolium and do not furnish evidence that the current status of the endangered species may be attributed to genetic factors. We use the genetic parameters to suggest some guidelines to help implement a conservation strategy of these taxa.

The aging of the population has led to the increase of chronic diseases, especially dementia and cardiovascular diseases, and it has become necessary for their relatives to dedicate more time in caregiving. The objective in the first phase of this study is to evaluate the effectiveness of a Primary Health Care procedure to increase the physical activity of people with dementia and their relative caregivers. Also the effect on the cognitive state and cardiovascular risk will be assessed. Design: Clinical, multicentric and randomized trial. A simple random sampling to select 134 patients diagnosed with dementia will be carried out. After contacting their relatives, his/her participation in the trial will be requested. A basal assessment will be made and the participants will be asigned to control or intervention group (1:1). Variables: The main measure will be the assessment of physical activity (podometer and 7-PAR) in patients and caregivers. In patients with dementia: ADAS-cog, functional degree and cardiovascular risk. In caregivers: cardiovascular risk, general health and quality of life. Intervention: For 3 months, participants will receive instructions to do physical activity with an adapted program. This program will be designed and applied by Primary Health Care professionals in patients with dementia and their caregivers. The control group will receive regular care. Analysis: An intention-to-treat analysis will be carried out by comparing the observed differences between basal, 6 and 12 months measures. Change in the mean of daily steps assessed with the podometer and 7-PAR will be the main result. If the main hypothesis is confirmed, it could be useful to improve the cognitive state of patients with dementia, as well as the cardiovascular risk of all of them. The results can be good to improve technical features of the devices that register the physical activity in the patients with dementia, and it could facilitate its commercialization. Clinical Trials.gov Identifier: NCT02044887 .

Background Few data are available on the prevalence of cognitive impairment (CI) in Spain, and the existing information shows important variations depending on the geographical setting and the methodology employed. The aim of this study was to determine the prevalence of CI in individuals aged over 65 in an urban area, and to analyze its associated risk factors. Methods Design: A descriptive, cross-sectional, home questionnaire-based study; Setting: Populational, urban setting. Participants: The reference population comprised over-65s living in the city of Salamanca (Spain) in 2009. Randomized sampling stratified according to health district was carried out, and a total of 480 people were selected. In all, 327 patients were interviewed (68.10%), with a mean age of 76.35 years (SD: 7.33). Women accounted for 64.5% of the total. Measurements: A home health questionnaire was used to obtain the following data: age, sex, educational level, family structure, morbidity and functionality. All participants completed a neuropsychological test battery. The prevalence data were compared with those of the European population, with direct adjustment for age and sex. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment - no dementia (CIND), and dementia. Results The prevalence of CI among these over-65s was 19% (14.7% CIND and 4.3% dementia). The age-and sex-adjusted global prevalence of CI was 14.9%. CI increased with age (p < 0.001) and decreased with increasing educational level (p < 0.001). Significant risk factors were found with the multivariate analyses: age (OR = 1.08, 95%CI: 1.03-1.12), anxiety-depression (OR = 3.47, 95%CI: 1.61-7.51) and diabetes (OR = 2.07, 95%CI: 1.02-4.18). In turn, years of education was found to be a protective factor (OR = 0.79, 95%CI: 0.70-0.90). Although CI was more frequent among women and in people living without a partner, these characteristics were not significantly associated with CI risk. Conclusions The observed raw prevalence of CI was 19% (14.9% after adjusting for age and sex). Older age and the presence of diabetes and anxiety-depression increased the risk of CI, while higher educational level reduced the risk.