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Scoliosis frequently causes problems in geriatrics, particularly pain. Pain that persists for a long time can result in a decreased quality of life and disability. Thus, pain management is needed in patients with scoliosis. We report the case of a 71-year-old man referred from the Neurology Department with pain due to scoliosis and an old compression fracture, making him incapable of walking, became dependent, and had a high risk of falling, thus resulting in a decreased quality of life. Physical examination revealed hyperkyphotic thoracal, tenderness and spasms on the paralumbar muscles, with no weakness in the extremities but decreased sensory function on both dorsum of the feet. The patient also had decreased chest expansion. The patient was conservatively managed. The goals of this treatment are to relieve pain, improve sensory function, and improve the quality of life. He underwent a staged rehabilitation program, starting from a combination of Transcutaneous Electrical Nerve Stimulation (TENS) and microwave diathermy, breathing, and core muscle strengthening exercises. After 10 weeks, there was an improvement in pain, risk of falls, chest expansion, and quality of life. Improving the quality of life of geriatric patients requires a multi-dimensional approach. Relieving pain, enhancing cardiorespiratory endurance and preventing falls were the main goals of this patient. Each exercise must be safe considering the patient’s age, health condition, and vertebral fractures. Family support is important to monitor and encourage patient during the program.

Worldwide, 3.9 million individuals rely on kidney replacement therapy. They experience heightened susceptibility to cardiovascular diseases and mortality, alongside an increased risk of infections and malignancies, with inflammation being key to explaining this intensified risk. This study utilized semi-targeted metabolomics to explore novel metabolic pathways related to inflammation in this population. We collected pre- and post-session blood samples of patients who had already undergone one year of chronic hemodialysis and used liquid chromatography and high-resolution mass spectrometry to perform a metabolomic analysis. Afterwards, we employed both univariate (Mann–Whitney test) and multivariate (logistic regression with LASSO regularization) to identify metabolites associated with inflammation. In the univariate analysis, indole-3-acetaldehyde, 2-ketobutyric acid, and urocanic acid showed statistically significant decreases in median concentrations in the presence of inflammation. In the multivariate analysis, metabolites positively associated with inflammation included allantoin, taurodeoxycholic acid, norepinephrine, pyroglutamic acid, and L-hydroorotic acid. Conversely, metabolites showing negative associations with inflammation included benzoic acid, indole-3-acetaldehyde, methionine, citrulline, alphaketoglutarate, n-acetyl-ornithine, and 3-4-dihydroxibenzeneacetic acid. Non-inflamed patients exhibit preserved autophagy and reduced mitochondrial dysfunction. Understanding inflammation in this group hinges on the metabolism of arginine and the urea cycle. Additionally, the microbiota, particularly uricase-producing bacteria and those metabolizing tryptophan, play critical roles.

Abstract Aims Patients with heart failure (HF) admitted for decompensation often require high doses of intravenous diuretics. This study aims to analyse whether the use of peripheral ultrafiltration (UF) in patients hospitalized for acute HF with systemic‐predominant congestion results in better hydric control, renal protection, and reduction of hospital stay compared with conventional treatment. Methods and results This study was a retrospective, comparative, single‐centre study of 56 patients admitted for HF with systemic congestion with a poor diuretic response after diuretic escalation. One group underwent peripheral UF (35 patients) and others were maintained on intense diuretic treatment (control group, 21 patients). The diuretic response and days of hospital stay were compared between and within groups. The baseline characteristics of both groups were similar: males with right ventricular failure and renal dysfunction. The inter‐group analysis showed that patients who received UF had better glomerular filtration rate (GFR; UF: 39.2 ± 18.2 vs. control: 28.7 ± 13.4 mL/min; P = 0.031) and higher diuresis (UF: 2184 ± 735 vs. control: 1335 ± 297 mL; P = 0.0001) at hospital discharge despite less need for diuretic drugs. Days of hospital stay were shorter in the UF group (UF: 11.7 ± 10.1 vs. control: 19.1 ± 14.4 days; P = 0.027). Intra‐group analysis showed that patients receiving UF improved GFR, increased diuresis, and reduced weight at discharge (P

Chronic kidney disease (CKD) affects approximately 12% of the global population, posing a significant health threat. Inflammation plays a crucial role in the uremic phenotype of non-dialysis-dependent (NDD) stage 5 CKD, contributing to elevated cardiovascular and overall mortality in affected individuals. This study aimed to explore novel metabolic pathways in this population using semi-targeted metabolomics, which allowed us to quantify numerous metabolites with known identities before data acquisition through an in-house polar compound library. In a prospective observational design with 50 patients, blood samples collected before the initial hemodialysis session underwent liquid chromatography and high-resolution mass spectrometer analysis. Univariate (Mann–Whitney test) and multivariate (logistic regression with LASSO regularization) methods identified metabolomic variables associated with inflammation. Notably, adenosine-5′-phosphosulfate (APS), dimethylglycine, pyruvate, lactate, and 2-ketobutyric acid exhibited significant differences in the presence of inflammation. Cholic acid, homogentisic acid, and 2-phenylpropionic acid displayed opposing patterns. Multivariate analysis indicated increased inflammation risk with certain metabolites (N-Butyrylglycine, dimethylglycine, 2-Oxoisopentanoic acid, and pyruvate), while others (homogentisic acid, 2-Phenylpropionic acid, and 2-Methylglutaric acid) suggested decreased probability. These findings unveil potential inflammation-associated biomarkers related to defective mitochondrial fatty acid beta oxidation and branched-chain amino acid breakdown in NDD stage 5 CKD, shedding light on cellular energy production and offering insights for further clinical validation.

Introduction: Home hemodialysis (HDD) is implemented in the Valencian Community with a higher prevalence than to the rest of the national territory, with a prevalence of 13.4 patients pmp in December 2018. We carried out an assessment of the patients characteristics and the overall and technical survival in HDD depending on the historical moment of onset and its origin. Material and methods: We conducted a retrospective and descriptive study including patients of the Valencian Registry of Renal Patients from the beginning of data reported until December 2020. We calculated overall survival (combined event death-technical failure, censoring transplantation) and technical survival (event technical failure, censoring exitus and transplantation). Comparing technical survival according to the starting era: ancient (1976−2000) vs modern (2001−2020) and according to the modality of origin. We performed univariate and multivariate Cox regression in the total series for both overall and technical survival. Results: 236 patients on HDD (611.4 patient-years of follow-up), mean age 49.7 ± 16.3 years; median time of prior renal replacement therapy 0.2 years. The ratio of transplantation, death, and technical failure were 13.2, 4.4, and 7 events per 100 patient-years, respectively. In the comparison by ancient (n = 57) vs modern (n = 179) eras, age (37.5 vs 53.5 years), DM (3.5 vs 13.4%) and chronic tubuleinterstitial nephropathy (24.6 vs 8.9%) as a cause of chronic kidney disease were statistically significant. The probability of coming from outpatient consultation (33.3 vs 48.6%) and peritoneal dialysis (1.8 vs 12.8%) were higher in modern era with statistical significance. In the ancient era a single hospital centralized 57.9% of the patients, and in the modern era between two hospitals centralized 55.8% of the patients. Overall survival in the ancient era was 83.7% at 1 year, 77.4% at 2 years, and 61% at 5 years; and in the modern era 87.3% per year, 83% 2 years and 47.8% 5 years (Log Rank 0.521). Technical survival in the ancient era was 85.4% at 1 year, 79% 2 years, and 64.1% 5 years; and in the modern era 91.4% per year, 88.5% 2 years and 74.5% 5 years (Log Rank 0.195). There were no statistical differences in the comparison based on technical of provenance. In the Cox regression it was statistically significant for overall survival: the age and being diagnosed with heart disease, vascular disease or active neoplasia and for technical survival liver disease or social problem, both in univariate and multivariate. Conclusions: In the modern era there is a considerable increase in HDD patients in the Valencian Community. There was a center effect in the development of HDD programs, most of the patients depended on few healthcare centers. The patients were older and had greater comorbidity in the modern era, despite this without affecting the technical and overall survival of the HDD. Resumen: Introducción: La hemodiálisis (HD) domiciliaria (HDD) está especialmente implementada en la Comunidad Valenciana en comparación al resto del territorio nacional, con una prevalencia de 13,4 pacientes pmp a diciembre del 2018. Realizamos una valoración de las características de los pacientes y de la supervivencia global y técnica del paciente en HDD en función del momento histórico de inicio y de su procedencia. Material y métodos: Pacientes incluidos en el Registro de Enfermos Renales de la Comunidad Valenciana desde que se reportan datos al mismo hasta diciembre del 2020. Estudio descriptivo y retrospectivo, calculando supervivencia global (evento combinado muerte-fallo técnico, censurando trasplante) y supervivencia técnica (evento fallo técnico, censurando muerte y trasplante). Comparamos la supervivencia de la técnica en función de era de inicio: antigua (1976−2000) vs moderna (2001−2020), y en función de la modalidad de procedencia. Realizamos regresión de Cox uni y multivariante en el total de la serie tanto para supervivencia global como técnica. Resultados: 236 pacientes en HDD (611,4 pacientes-año de seguimiento), edad media 49,7 ± 16,3 años; tiempo terapia renal sustitutiva previa 0,2 años de mediana. Los ratios de trasplante, muerte y fallo técnico fueron 13,2; 4,4 y 7 eventos por 100 pacientes-año respectivamente. En la comparación por eras según inicio en HDD, antigua (n = 57) vs moderna (n = 179) fue estadísticamente significativo la edad (37,5 vs 53,5 años), la DM (3,5 vs 13,4%) y la nefropatía tubulointersiticial crónica (24,6 vs 8,9%) como causa de enfermedad renal crónica Hubo en la era moderna mayor probabilidad de provenir de consulta externa (33,3 vs 48,6%) y de diálisis peritoneal (1,8 vs 12,8%) con significación estadística. En era antigua un único hospital centralizaba el 57,9% de los pacientes, y en era moderna entre dos hospitales centralizaban el 55,8% de los pacientes. La supervivencia global en era antigua fue de 83,7% al año, 77,4% 2 años y 61% 5 años; y en era moderna 87,3% al año, 83% 2 años y 47,8% 5 años (Log Rank 0,521). La supervivencia técnica en era antigua fue 85,4% al año, 79% 2 años y 64,1% 5 años; y en era moderna 91,4% al año, 88,5% 2 años y 74,5% 5 años (Log Rank 0,195). No hubieron diferencias estadísticas en la comparación en función de la procedencia. En la regresión de Cox fue estadísticamente significativo para supervivencia global la edad y estar diagnosticado de cardiopatía, enfermedad vascular o neoplasia activa y para la supervivencia técnica hepatopatía o problema social, tanto en análisis uni como en multivariante. Conclusión: En la era moderna existe un incremento considerable de pacientes en HDD en la Comunidad Valenciana. Existió un efecto centro en el desarrollo de los programas de HDD, la mayoría de los pacientes dependían de pocos centros asistenciales. Los pacientes fueron de mayor edad y mayor comorbilidad en la era moderna, pese a ello sin afectar ni la supervivencia técnica y ni global de la HDD.

Abstract Patients on peritoneal dialysis (PD) have an increased risk of cardiovascular disease (CVD) and an atherogenic lipid profile generated by exposure to high glucose dialysis solutions. In the general population, the reduction of classic lipids biomarkers is associated with improved clinical outcomes; however, the same results have not been seen in PD population, a lack of data this study aims to fulfill. Single-center prospective observational study of a cohort of CKD patients who started renal replacement therapy with continuous ambulatory peritoneal dialysis. The differences in the lipid profile and analytical variables before and 6 months after the start of peritoneal dialysis were analyzed. Samples were analyzed on an Ultra-Performance Liquid Chromatography system. Thirty-nine patients were enrolled in this study. Their mean age was 57.9 ± 16.3 years. A total of 157 endogenous lipid species of 11 lipid subclasses were identified. There were significant increases in total free fatty acids (p

Resumen: Introducción: La hemodiálisis domiciliaria (HDD) está especialmente implementada en la Comunidad Valenciana en comparación con el resto del territorio nacional, con una prevalencia de 13,4 pacientes pmp a diciembre de 2018. Realizamos una valoración de las características de los pacientes y de la supervivencia global y técnica del paciente en HDD en función del momento histórico de inicio y de su procedencia. Material y métodos: Pacientes incluidos en el Registro de Enfermos Renales de la Comunidad Valenciana desde que se reportan datos al mismo hasta diciembre de 2020. Estudio descriptivo y retrospectivo, calculando supervivencia global (evento combinado muerte-fallo técnico, censurando trasplante) y supervivencia técnica (evento fallo técnico, censurando muerte y trasplante). Comparamos la supervivencia de la técnica en función de era de inicio: antigua (1976-2000) vs. moderna (2001-2020), y en función de la modalidad de procedencia. Realizamos regresión de Cox uni- y multivariante en el total de la serie tanto para supervivencia global como técnica. Resultados: Doscientos treinta y seis pacientes en HDD (611,4 pacientes-año de seguimiento), edad media 49,7 ±16,3 años; tiempo terapia renal sustitutiva previa 0,2 años de mediana. Los ratios de trasplante, muerte y fallo técnico fueron 13,2; 4,4 y 7 eventos por 100 pacientes-año respectivamente. En la comparación por eras según inicio en HDD, antigua (n = 57) vs. moderna (n = 179) fue estadísticamente significativa la edad (37,5 vs. 53,5 años), la DM (3,5 vs. 13,4%) y la nefropatía tubulointersiticial crónica (24,6 vs. 8,9%) como causa de enfermedad renal crónica. Hubo en la era moderna mayor probabilidad de provenir de consulta externa (33,3 vs. 48,6%) y de diálisis peritoneal (1,8 vs. 12,8%) con significación estadística. En era antigua un único hospital centralizaba el 57,9% de los pacientes, y en era moderna entre 2 hospitales centralizaban el 55,8% de los pacientes. La supervivencia global en era antigua fue del 83,7% al año, del 77,4% a 2 años y del 61% a 5 años; y en era moderna del 87,3% al año, del 83% a 2 años y del 47,8% a 5 años (Log Rank: 0,521). La supervivencia técnica en era antigua fue 85,4% al año, 79% a 2 años y 64,1% a 5 años; y en era moderna 91,4% al año, 88,5% a 2 años y 74,5% a 5 años (Log Rank: 0,195). No hubo diferencias estadísticas en la comparación en función de la procedencia. En la regresión de Cox fueron estadísticamente significativos para supervivencia global la edad y estar diagnosticado de cardiopatía, enfermedad vascular o neoplasia activa, y para la supervivencia técnica hepatopatía o problema social, tanto en análisis univariante como en multivariante. Conclusión: En la era moderna existe un incremento considerable de pacientes en HDD en la Comunidad Valenciana. Hubo un efecto centro en el desarrollo de los programas de HDD, la mayoría de los pacientes dependían de pocos centros asistenciales. Los pacientes fueron de mayor edad y mayor comorbilidad en la era moderna, pese a ello sin afectar ni la supervivencia técnica y ni global de la HDD. Abstract: Introduction: Home hemodialysis (HDD) is implemented in the Valencian Community with a higher prevalence than to the rest of the national territory, with a prevalence of 13.4 patients’ pmp in December 2018. We carried out an assessment of the patients’ characteristics and the overall and technical survival in HDD depending on the historical moment of onset and its origin. Material and methods: We conducted a retrospective and descriptive study including patients of the Valencian Registry of Renal Patients from the beginning of data reported until December 2020. We calculated overall survival (combined event death-technical failure, censoring transplantation) and technical survival (event technical failure, censoring exitus and transplantation). Comparing technical survival according to the starting era: ancient (1976–2000) vs modern (2001–2020) and according to the modality of origin. We performed univariate and multivariate Cox regression in the total series for both overall and technical survivals. Results: 236 patients on HDD (611.4 patient-years of follow-up), mean age 49.7 ± 16.3 years; median time of prior renal replacement therapy 0.2 years. The ratio of transplantation, death, and technical failure were 13.2, 4.4, and 7 events per 100 patient-years, respectively. In the comparison by ancient (n = 57) vs modern (n = 179) eras, age (37.5 vs 53.5 years), DM (3.5 vs 13.4%) and chronic tubuleinterstitial nephropathy (24.6 vs 8.9%) as a cause of chronic kidney disease were statistically significant. The probability of coming from outpatient consultation (33.3 vs 48.6%) and peritoneal dialysis (1.8 vs 12.8%) were higher in modern era with statistical significance. In the ancient era a single hospital centralized 57.9% of the patients, and in the modern era between two hospitals centralized 55.8% of the patients. Overall survival in the ancient era was 83.7% at 1 year, 77.4% at 2 years, and 61% at 5 years; and in the modern era 87.3% per year, 83% 2 years and 47.8% 5 years (Log Rank 0.521). Technical survival in the ancient era was 85.4% at 1 year, 79% 2 years, and 64.1% 5 years; and in the modern era 91.4% per year, 88.5% 2 years and 74.5% 5 years (Log Rank 0.195). There were no statistical differences in the comparison based on technical of provenance. In the Cox regression it was statistically significant for overall survival: the age and being diagnosed with heart disease, vascular disease or active neoplasia and for technical survival liver disease or social problem, both in univariate and multivariate. Conclusion: In the modern era there is a considerable increase in HDD patients in the Valencian Community. There was a center effect in the development of HDD programs, most of the patients depended on few healthcare centers. The patients were older and had greater comorbidity in the modern era, despite this without affecting the technical and overall survival of the HDD.

Worldwide, 3.9 million individuals rely on kidney replacement therapy. They experience heightened susceptibility to cardiovascular diseases and mortality, alongside an increased risk of infections and malignancies, with inflammation being key to explaining this intensified risk. This study utilized semi-targeted metabolomics to explore novel metabolic pathways related to inflammation in this population. We collected pre- and post-session blood samples of patients who had already undergone one year of chronic hemodialysis and used liquid chromatography and high-resolution mass spectrometry to perform a metabolomic analysis. Afterwards, we employed both univariate (Mann–Whitney test) and multivariate (logistic regression with LASSO regularization) to identify metabolites associated with inflammation. In the univariate analysis, indole-3-acetaldehyde, 2-ketobutyric acid, and urocanic acid showed statistically significant decreases in median concentrations in the presence of inflammation. In the multivariate analysis, metabolites positively associated with inflammation included allantoin, taurodeoxycholic acid, norepinephrine, pyroglutamic acid, and L-hydroorotic acid. Conversely, metabolites showing negative associations with inflammation included benzoic acid, indole-3-acetaldehyde, methionine, citrulline, alphaketoglutarate, n-acetyl-ornithine, and 3-4-dihydroxibenzeneacetic acid. Non-inflamed patients exhibit preserved autophagy and reduced mitochondrial dysfunction. Understanding inflammation in this group hinges on the metabolism of arginine and the urea cycle. Additionally, the microbiota, particularly uricase-producing bacteria and those metabolizing tryptophan, play critical roles. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 virus spreading across the world has led to surges of COVID-19 illness, hospitalizations, and death. The complex and multifaceted pathophysiology of life-threatening COVID-19 illness including viral mediated organ damage, cytokine storm, and thrombosis warrants early interventions to address all components of the devastating illness. In countries where therapeutic nihilism is prevalent, patients endure escalating symptoms and without early treatment can succumb to delayed in-hospital care and death. Prompt early initiation of sequenced multidrug therapy (SMDT) is a widely and currently available solution to stem the tide of hospitalizations and death. A multipronged therapeutic approach includes 1) adjuvant nutraceuticals, 2) combination intracellular anti-infective therapy, 3) inhaled/oral corticosteroids, 4) antiplatelet agents/anticoagulants, 5) supportive care including supplemental oxygen, monitoring, and telemedicine. Randomized trials of individual, novel oral therapies have not delivered tools for physicians to combat the pandemic in practice. No single therapeutic option thus far has been entirely effective and therefore a combination is required at this time. An urgent immediate pivot from single drug to SMDT regimens should be employed as a critical strategy to deal with the large numbers of acute COVID-19 patients with the aim of reducing the intensity and duration of symptoms and avoiding hospitalization and death.

Resumen: Se describe la experiencia de un hospital terciario y cuatro centros concertados de hemodiálisis adscritos al mismo durante la epidemia de COVID-19. Se resume la organización asistencial que se ha llevado a cabo y el curso clínico de los 16 casos de COVID-19 en pacientes en hemodiálisis. La aplicación conjunta de medidas que incluyen el cribado de pacientes, la investigación precoz de casos posibles, el aislamiento de los casos confirmados, en investigación o en contactos, así como la utilización de medidas de protección individuales, han permitido controlar la epidemia. Se compara el curso clínico de estos 16 pacientes con la serie publicada por el Hospital Universitario de Wuhan y con los datos del registro de infecciones COVID-19 de la Sociedad Española de Nefrología. En nuestra experiencia, y a diferencia de lo comunicado por el centro de Wuhan, la enfermedad COVID-19 en los pacientes en hemodiálisis es grave en un porcentaje importante de los casos y la letalidad, elevada, es mayormente causada por la propia infección. Las medidas de contención de la epidemia son eficaces. Abstract: The experience of a tertiary hospital and four hemodialysis centers attached to it during the COVID-19 epidemic is described. The organization of care that has been carried out and the clinical course of the 16 cases of COVID-19 in hemodialysis patients are summarized. The joint application of measures, including patient screening, the early investigation of possible cases, the isolation of confirmed, investigational or contact cases, as well as the use of individual protection measures, has enabled the epidemic to be controlled. The clinical course of these 16 patients is compared with the series published by the Wuhan University Hospital and with the data from the COVID-19 infection registry of the Spanish Society of Nephrology. In our experience, and unlike what was reported by the Wuhan Center, COVID-19 disease in hemodialysis patients is severe in a significant percentage of cases, and high lethality is mostly caused by the infection itself. Measures to contain the epidemic are effective.