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Made available in DSpace on 2022-04-28T19:50:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 The Latin American Society of Nephrology and Hypertension conducted a prospective cohort, multinational registry of Latin American patients with kidney impairment associated to COVID-19 infection with the objective to describe the characteristics of acute kidney disease under these circumstances. The study was carried out through open invitation in order to describe the characteristics of the disease in the region. Eight-hundred and seventy patients from 12 countries were included. Median age was 63 years (54-74), most of patients were male (68.4%) and with diverse comorbidities (87.2%). Acute kidney injury (AKI) was hospital-acquired in 64.7% and non-oliguric in 59.9%. Multiorgan dysfunction syndrome (MODS) due to COVID-19 and volume depletion were the main factors contributing to AKI (59.2% and 35.7% respectively). Kidney replacement therapy was started in 46.2%. Non-recovery of renal function was observed in 65.3%. 71.5% of patients were admitted to ICU and 72.2% underwent mechanical ventilation. Proteinuria at admission was present in 62.4% of patients and proteinuria during hospital-stay occurred in 37.5%. Those patients with proteinuria at admission had higher burden of comorbidities, higher baseline sCr, and MODS was severe. On the other hand, patients with de novo proteinuria had lower incidence of comorbidities and near normal sCr at admission, but showed adverse course of disease. COVID-19 MODS was the main cause of AKI in both groups. All-cause mortality of the general population was 57.4%, and it was associated to age, sepsis as cause of AKI, severity of condition at admission, oliguria, mechanical ventilation, non-recovery of renal function, in-hospital complications and hospital stay. In conclusion, our study contributes to a better knowledge of this condition and highlights the relevance of the detection of proteinuria throughout the clinical course. Department of Nephrology Universidad de la República Clinical Hospital of Botucatu School Medicine HCFMB University of Sao Paulo State UNESP Hospital Obrero #2-C. N.S. School of Medicine Universidad Mayor de San Simón Universidad Simón Bolívar Hospital Nacional Arzobispo Loayza Servicio de Nefrología School of Medicine University of São Paulo Division of Nephrology Hospital Civil de Guadalajara Departamento de Nefrología Hospital General de Agudos Dr Cosme Argerich Serviço de Nefrología, Jau Santa Casa de Jau Department of Nephrology Hospital Provincial Nefrologia Pontificia Universidade Catolica do Rio de Janeiro Internal Medicine University of Rio de Janeiro Nephrology Hospital Universitario Dr JoséEleuterio González Centros de Diagnóstico y Medicina Avanzada Servicio de Nefrología Hospital Italiano Departamento de Medicina Interna Salud Renal MSP Department of Nephrology Pontificia Universidad Católica de Chile Servicio de Nefrología Hospital Español Departamento de Nefrología Hospital de Especialidades de las Fuerzas Armadas Servicio de Nefrología y Diálisis Hospital Rojas Nephrology School of Medicine University of São Paulo Hospital Federal Cardozo Fontes Universidade de Sá Departamento de Nefrología Hospital Regional General Dr Carlos Mac Gregor Sanchez Navarro Departamento de Nefrología Hospital de Pediatría CMN Siglo XXI Department of Nephrology School of Medicine University of Sao Paulo Centro Infantil del Riñón, Tucumán Hospital Regional de Ica Hospital Nacional Hipólito Unanue Clinical Hospital of Botucatu School Medicine HCFMB University of Sao Paulo State UNESP

It is becoming increasingly common that cities are being negatively impacted by extreme weather events. Moreover, climate projections point to an increase in the frequency and severity of those events. Cities across the world must thus assess their vulnerabilities to extreme events and adapt accordingly. Compared to big metropolises, smaller cities face more opportunities to adapt their practices to defend and protect from these impacts, since in many cases they are still not locked-in by existing infrastructure, and show greater potential for future sustainable urban planning. Nevertheless, few studies have assessed the vulnerability of small cities, which generally present fastest population growth rates, along with lack of capacities, resources and financing options. This paper investigates the vulnerability of Ciudad del Este, Paraguay, which is expected to be among the top five fastest growing cities in Latin America by 2030. The analysis is based on a mixed methods approach, combining quantitative and qualitative techniques. Quantitatively, an Urban Vulnerability Index was built using 73 economic, social, climatic and environmental indicators, in order to quantify the sensitivity of the city to extreme weather events, as well as its capacity to cope and adapt to those events. In qualitative terms, data collected from interviews was used to complement the quantitative findings. The results show that the city is highly sensitive to extreme weather events, due to its vastly urbanised area, lack of green spaces and amount of vulnerable and exposed population. The city also shows a lack of adequate urban planning and a low capacity to plan for weather and climate disasters. The paper, in this sense, highlights areas of urgent attention to reduce its vulnerability.

Objectives: The aim of this cross-sectional study was to describe QoL in a large sample of women attending menopause centres and compare untreated postmenopausal women and matched HRT users by employing the Women's Health Questionnaire (WHQ) and two generic instruments, the SF-36 and the EQ-5D. Methods: Overall, 2906 women were recruited by 64 menopause centres throughout Italy, of whom 2160 filled in the questionnaire (1093 on HRT and 1067 not on HRT; response rate: 74%). Results: HRT users tended to be younger, healthier and with shorter menopause duration as opposed to non users, while no major socio-economic differences were present. At multivariate analysis, the presence of chronic diseases, low socio-economic status and living in Southern Italy represented the most important predictors of poor QoL. Furthermore, HRT users showed a lower probability of reporting problems in usual activities and pain/discomfort (EQ-5D), role limitations due to emotional problems (SF-36) and anxiety/fears (WHQ). HRT users also showed highly significant better outcomes in those areas that are more directly attributable to hormonal changes of mid age, namely vasomotor symptoms and sexual problems. Conclusions: Although QoL is mainly influenced by socio-economic and cultural factors, HRT has the potential for improving not only symptoms, but also more general aspects of physical and psychological well-being of symptomatic postmenopausal women.

Background: Dengue fever, a mosquito-borne viral disease, is a rapidly emerging public health problem in Ecuador and throughout the tropics. However, we have a limited understanding of the disease transmission dynamics in these regions. Previous studies in southern coastal Ecuador have demonstrated the potential to develop a dengue early warning system (EWS) that incorporates climate and non-climate information. The objective of this study was to characterize the spatiotemporal dynamics and climatic and social-ecological risk factors associated with the largest dengue epidemic to date in Machala, Ecuador, to inform the development of a dengue EWS. Methods: The following data from Machala were included in analyses: neighborhood-level georeferenced dengue cases, national census data, and entomological surveillance data from 2010; and time series of weekly dengue cases (aggregated to the city-level) and meteorological data from 2003 to 2012. We applied LISA and Moran’s I to analyze the spatial distribution of the 2010 dengue cases, and developed multivariate logistic regression models through a multi-model selection process to identify census variables and entomological covariates associated with the presence of dengue at the neighborhood level. Using data aggregated at the city-level, we conducted a time-series (wavelet) analysis of weekly climate and dengue incidence (2003-2012) to identify significant time periods (e.g., annual, biannual) when climate co-varied with dengue, and to describe the climate conditions associated with the 2010 outbreak. Results: We found significant hotspots of dengue transmission near the center of Machala. The best-fit model to predict the presence of dengue included older age and female gender of the head of the household, greater access to piped water in the home, poor housing condition, and less distance to the central hospital. Wavelet analyses revealed that dengue transmission co-varied with rainfall and minimum temperature at annual and biannual cycles, and we found that anomalously high rainfall and temperatures were associated with the 2010 outbreak. Conclusions: Our findings highlight the importance of geospatial information in dengue surveillance and the potential to develop a climate-driven spatiotemporal prediction model to inform disease prevention and control interventions. This study provides an operational methodological framework that can be applied to understand the drivers of local dengue risk.

Background: the total number of harvested lymph nodes has been demonstrated to be of prognostic significance for colon cancer. Differences can occur in the total number of harvested lymph nodes between different specialists (surgeons and pathologists). Objective: the aim of this study was to analyse if, in our centre, the number of analysed lymph nodes in patients with colon cancer that are classified as pN0 is also related to survival. Material and methods: a retrospective study was designed, where 148 patients with colon adenocarcinoma (pN0 of TNM classification) who underwent elective surgery between 1 January 1995 and 31 December 2001, with curative intent were included. Three groups were created according to the number of analysed lymph nodes (< 7, 7-14, > 14 lymph nodes). For survival analysis the Kaplan-Meier and CUSUM curves methods were used. Results: the total number of analysed lymph nodes was 1,493 (mean 10.1 lymph nodes per patient). The rate of 5-years survival was 63.0% in the group with < 7 lymph nodes; 7-14 lymph nodes: 80.6% and those with > 14 lymph nodes: 91.8% (p < 0.01). Prognostic significance was also present for multivariate analysis. Conclusion: in our centre, harvesting a larger number of lymph nodes is related to improved rates of 5-years survival for patients with colon cancer staged as pN0. It seems reasonable to recommend obtaining as many lymph nodes as possible, and not to establish a minimum number of lymph nodes to be harvested. Introducción: el número total de ganglios analizados ha demostrado su influencia pronóstica en el cáncer de colon. Pueden existir grandes diferencias en el número de ganglios obtenidos por diferentes especialistas (cirujanos y anatomopatólogos). Objetivo: el objetivo del presente estudio fue analizar si, en nuestro medio, el número de ganglios analizados en pacientes con cáncer de colon clasificados como pN0 se relaciona también con la supervivencia. Material y métodos: estudio retrospectivo, con inclusión de 148 pacientes con adenocarcinoma de colon (pN0 de la clasificación TNM) intervenidos de forma programada con intención curativa entre 1 de enero de 1995 y 31 de diciembre de 2001. Se establecieron 3 grupos según el número de ganglios analizados (< 7, 7-14, > 14 ganglios). Para el análisis de la supervivencia se utilizaron el método de Kaplan Meier y las gráficas CUSUM. Resultados: el número total de ganglios analizados fue 1.493 (media 10,1 ganglios por paciente). La supervivencia a 5 años fue del 63,0% en el grupo con < 7 ganglios; del 80,6% en el grupo con 7-14; y del 91,8% en el grupo con > 14 ganglios analizados (p < 0,01). La influencia pronóstica se mantuvo en el análisis multivariante. Conclusión: en nuestro medio, la obtención de un mayor número de ganglios analizados se relaciona con una mayor supervivencia a los 5 años en pacientes con cáncer de colon clasificados como pN0. Parece razonable recomendar la obtención de tantos ganglios como sea posible en este tipo de cirugía y no recomendar un número mínimo de ganglios que se deberían analizar.

Introduction: controversy remains about the management of gallstone ileus. While some authors propose enterotomy, others defend the one-stage procedure (simultaneously fistula repair). The objective of the present study was to analyze management options and comparative study their results. Material and methods: retrospective and descriptive study with revision of clinical stories of patients with the diagnosis of gallstone ileus between 1987 and 2008. All the following variables were recorded: dates of hospital admission, surgery and discharge, age, sex, pathological antecedents, preoperative or intraoperative diagnosis, treatment, location of the fistula and location of the obstruction. End-result variables were: postoperative complications, mortality, complications during the follow-up and biliary complications. Results: a total of 40 patients were included of 46,648 admissions. Age, comorbidity, and intraoperative diagnosis were related with poorer short- and long-outcomes. The percentage of postoperative complications was similar for groups with and without fistula repair. Mortality was higher in the group with fistula repair (15vs. 25%). Biliary complications were more frequent in the group without fistula repair (11 vs. 0%). Sex, location of the fistula and location of the obstruction did not be related with the prognosis. Conclusion: one-stage procedure is related with higher mortality rate than enterotomy alone. Nevertheless, fistula repair reduces the number of biliary complications during the follow-up. Introducción: todavía existe gran controversia sobre el mejor tratamiento del íleo biliar. Algunos autores proponen la enterotomía aislada, mientras otros defienden la reparación de la fístula bilioentérica en el mismo acto quirúrgico. El objetivo del presente estudio fue analizar las opciones terapéuticas en estos pacientes y estudiar sus resultados. Material y métodos: estudio retrospectivo y descriptivo, con revisión de las historias clínicas de los pacientes diagnosticados de íleo biliar desde 1987 hasta 2008. Se recogieron las fechas de ingreso, de intervención y del alta, edad, sexo, antecedentes patológicos, diagnóstico preoperatorio o intraoperatorio, tratamiento, lugar de la fístula y lugar de la obstrucción. Como variables de resultado se utilizaron las complicaciones postoperatorias, mortalidad, complicaciones en el seguimiento y complicaciones biliares. Resultados: se incluyeron 40 pacientes sobre 46.648 ingresos. La edad, la comorbilidad y el diagnóstico intraoperatorio se relacionaron con peores resultados a corto y largo plazo. El porcentaje de complicaciones postoperatorias fue similar para el grupo con abordaje de la fístula y para el grupo con enterotomía aislada. La mortalidad fue superior en el grupo con abordaje de la fístula (15 frente a 25%). Las complicaciones biliares fueron más frecuentes en el grupo sin abordaje de la fístula biliar (11 frente a 0%). El sexo, lugar de la fístula o el lugar de la obstrucción no demostraron diferencias. Conclusión: la cirugía en un solo tiempo se relaciona con mayor mortalidad que la enterotomía aislada. No obstante, añadir la reparación de la fístula reduce el número de complicaciones biliares en el seguimiento.

To validate the Italian version of the World Health Organization (WHO)-Well-Being Questionnaire (WBQ) and the WHO-Diabetes Treatment Satisfaction Questionnaire (DTSQ) in Type 1 and Type 2 diabetic patients.The cultural adaptation of the questionnaires was performed by using standard forward/backward techniques. Internal consistency reliability was estimated by Cronbach's alpha coefficient. Construct validity was evaluated using the Short Form-36 (SF-36) Health Status Questionnaire. Finally, the discriminative properties of the questionnaires were evaluated relative to the patients' characteristics. The questionnaires were administered to a random sample of patients identified in twelve outpatient diabetes clinics.Overall, 412 subjects were recruited, of whom 96 (23%) with Type 1 diabetes. Item-scale correlations were0.40 for all the items. Cronbach's alpha coefficient was 0.86 for the WHO-DTSQ and ranged between 0.79 and 0.91 for the WHO-WBQ. High correlations were found between WHO-WBQ scales and the mental dimensions of the Short Form-36 (SF-36) questionnaire, but not between WHO-DTSQ and SF-36 scores. Women, obese subjects, those with longer diabetes duration and multiple complications showed a worse quality of life in all of the four areas of the WHO-WBQ. In Type 2 diabetic subjects, SF-36 scores, but not WHO-WBQ scores, were able to discriminate the population according to the treatment modalities. Lower levels of treatment satisfaction were related to female gender, longer diabetes duration, insulin treatment, presence of diabetes complications and HbA1c levels7.0%. The flexibility of the treatement was perceived as a major problem even among patients treated with oral agents.The WHO-DTSQ can be considered as a valuable instrument to be used internationally for the description of diabetes treatment satisfaction. The WHO-WBQ also shows adequate psychometric properties, but additional data are needed to clarify whether it is more sensitive than SF-36, the most widely used generic instrument.

Forty-five diabetic patients were studied to evaluate adaptation and coping strategies. The authors have also analysed personality traits mainly to study different behaviour in compliance conduct. The results revealed an important psychological dimension made up of difficulties in accepting insulin immediately, in fear of addiction and doubts about the therapy. On the basis of these results the sample was then divided into two subgroups, which were then tested and compared with the Adjective Check List. The subgroup that showed more fear, insecurity and initial resistance towards insulin therapy appeared to be more rigid and seemingly conforming. These people also revealed personality aspects compatible with the presence of passive-aggressive and avoidant traits.