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Sample records for microalbuminuria como indicador

  1. Microalbuminuria and diabetes mellitus.

    PubMed

    Konen, J C; Shihabi, Z K

    1993-12-01

    Small concentrations of albumin detected in the urine predict renal dysfunction and reflect vascular abnormalities such as atherosclerosis, retinopathy and, probably, neuropathy. Although microalbuminuria is not specific for diabetic complications, it has been most extensively studied in diabetics. The rate of urinary albumin excretion can also be used to determine therapeutic response to pharmacologic and lifestyle interventions such as diet, smoking cessation and physical activity. The pathophysiology of microalbuminuria and its clinical significance in diabetes is presented, along with a discussion of measurement issues and implications for clinical management. An algorithm for the evaluation of diabetic patients is included. PMID:8249773

  2. Implications of microalbuminuria in diabetes.

    PubMed

    Walker, J D

    1991-01-01

    Microalbuminuria is defined as small elevations of urinary albumin excretion not detected by conventional tests. It is associated with elevated arterial pressure, proliferative retinopathy, lipoprotein abnormalities and left ventricular hypertrophy and is predictive of later diabetic nephropathy. Improved glycaemic control and antihypertensive treatment lower urinary albumin excretion but it is not known whether these manoeuvres affect long-term outcome. PMID:2009439

  3. Percepción de competencia y adiestramiento profesional especializado relativos al VIH/SIDA en estudiantes y profesionales de la salud: el estigma como un indicador de necesidad

    PubMed Central

    RODRÍGUEZ, Yarimar ROSA; DÍAZ, Nelson VARAS

    2009-01-01

    El proceso de estigmatización asume una devaluación de la persona debido a una característica o marca que haya sido identificada socialmente y que permita que se le describa como diferente. Desde que se desató la epidemia del VIH/SIDA, vivir con la enfermedad ha sido señalado de manera social como una marca estigmatizante. Las manifestaciones de dicha estigmatización se han documentado entre profesionales de la salud. Este estigma puede afectar los servicios de salud que las personas que viven con VIH/SIDA reciben de estos profesionales. Los objetivos de esta investigación fueron explorar: 1) la percepción que tienen estudiantes y profesionales de la salud sobre su nivel de competencia para ofrecer servicios a personas que viven con VIH/SIDA, 2) las opiniones de éstos sobre el tipo de adiestramiento profesional recibido y la necesidad del mismo, y 3) la manifestación de actitudes estigmatizantes como indicadores de necesidad de adiestramiento profesional. La muestra total del estudio estuvo compuesta por 80 de diversas profesiones de la salud. Los resultados reflejan que algunos/as de los/as participantes han recibido formación en VIH pero ésta no ha sido suficiente para contrarrestar las nociones estigmatizantes. Discutimos las implicaciones de los resultados para investigaciones futuras y el desarrollo de intervenciones con vías de minimizar las nociones estigmatizantes en los escenarios de salud. PMID:20011236

  4. Prevalence and Association of Microalbuminuria in Essential Hypertensive Patients

    PubMed Central

    Poudel, Bibek; Yadav, Binod Kumar; Nepal, Ashwini Kumar; Jha, Bharat; Raut, Kanak Bahadur

    2012-01-01

    Background: Microalbuminuria in hypertension has been described as an early sign of kidney damage and a predictor for end stage renal disease and cardiovascular disease. Thus, it is of great importance to study urinary albumin creatinine ratio and progression of kidney disease in hypertensive patients. Aims: The present study was undertaken to find out the prevalence and association of microalbuminuria in newly diagnosed essential hypertension. Materials and Methods: Newly diagnosed essential hypertensive cases (n = 106) and normotensive controls (n = 106) were enrolled. Hypertension was defined according to Joint national committee-VII definitions. Microalbuminuria was measured using an U-Albumin (NycoCard, Norway) and adjusted for urine creatinine. Descriptive statistics and testing of hypothesis were used for the analysis using SPSS 16 software. Results: 51.88% of hypertension cases and 13.2% of normotensive controls had microalbuminuria in total population (odds ratio 7.086, P-value <0.001). 46.67% of cases and 12.08% of controls had microalbuminuria in male population (odds ratio 6.375, P-value <0.001). Similarly, 58.7% of cases and 14.58% of controls had microalbuminuria in female population (odds ratio 8.32, P-value <0.001). Conclusions: By showing strong association between microalbuminuria and hypertension, our findings suggest that microalbuminuria could be a useful marker to assess risk management of cardiovascular disease and renal disease. PMID:22912940

  5. Free Triiodothyronine Concentrations Are Inversely Associated with Microalbuminuria

    PubMed Central

    Zhou, Yulin; Ye, Lei; Wang, Tiange; Hong, Jie; Bi, Yufang; Zhang, Jie; Xu, Baihui; Huang, Xiaolin; Xu, Min

    2014-01-01

    Thyroid function and microalbuminuria are both associated with vascular disease and endothelial damage. However, whether thyroid function is associated with microalbuminuria is not well established. The objective was to explore the relationship between thyroid hormones and microalbuminuria in Chinese population. A community-based cross-sectional study was performed among 3,346 Chinese adults (aged ≥ 40 years). Serum free triiodothyronine (FT3), free thyroxine (FT4), and TSH (thyroid stimulating hormone) were determined by chemiluminescent microparticle immunoassay. A single-void first morning urine sample was obtained for urinary albumin-creatinine ratio measurement. The prevalence of microalbuminuria decreased according to FT3 quartiles (13.2, 9.5, 8.6, and 8.2%, P for trend = 0.0005). A fully adjusted logistic regression analysis showed that high FT3 levels were associated with low prevalent microalbuminuria. The adjusted odds ratios for microalbuminuria were 0.61 (95% CI, 0.43–0.87, P = 0.007) when comparing the highest with the lowest quartile of FT3. The exclusion of participants with abnormal FT3 did not appreciably change the results (OR = 0.69, 95% CI, 0.49–0.98, P = 0.02). We concluded that serum FT3 levels, even within the normal range, were inversely associated with microalbuminuria in middle-aged and elderly Chinese adults. FT3 concentrations might play a role in the pathogenesis of microalbuminuria. PMID:25484900

  6. 'Progressive diabetic nephropathy. How useful is microalbuminuria?: contra'.

    PubMed

    MacIsaac, Richard J; Ekinci, Elif I; Jerums, G

    2014-07-01

    The concept of microalbuminuria has been central to the development of clinical practice and research in the area of diabetic kidney disease (DKD). However, in recent times, the value of a paradigm of DKD based solely on microalbuminuria has been questioned. Although both the absolute level and rate of change of microalbuminuria are linked to the development and progression of DKD, microalbuminuria on its own lacks the necessary sensitivity or specificity to accurately predict kidney outcomes for people with diabetes. The development of microalbumiuria can no longer be viewed as a committed and irreversible stage of DKD, as spontaneous remission is now reported as a common occurrence. In addition, the absence of microalbuminuria or its progression to proteinuria does not signify that an individual patient is safe from a progressive decline in glomerular filtration rate (GFR). Furthermore, although reductions in albuminuria within the microalbuminuric range can be linked to a slower GFR decline in observational studies, this relationship has not been robustly demonstrated in intervention studies. Conclusions regarding the kidney health of individuals with diabetes will continue to be flawed if an inappropriate emphasis is placed on the presence or absence of albuminuria or changes in albuminuria within the microalbuminuric range. This has important implications in terms of undermining the value of microalbuminuria as a surrogate renal end point for intervention trials. There is a need to develop broader models of progressive DKD that include novel pathways and risk markers apart from those related to the traditional 'albuminuric pathway' to renal impairment.

  7. Correlation between Microalbuminuria and Hypertension in Type 2 Diabetic Patients

    PubMed Central

    Ali, Alia; Taj, Azeem; Amin, Muhammad Joher; Iqbal, Farrukh; Iqbal, Zafar

    2014-01-01

    Background: Hypertension is commonly found in patients with Diabetic Kidney Disease (DKD). Microalbuminuria is the first clinical sign of involvement of kidneys in patients with type 2 diabetes. Uncontrolled hypertension induces a higher risk of cardiovascular events, including death, increasing proteinuria and progression to kidney disease. Objectives: To determine the correlation between microalbuminuria and hypertension and their association with other risk factors in type 2 diabetic patients. Methods: One hundred and thirteen type 2 diabetic patients attending the diabetic clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan were screened for microalbuminuria and raised blood pressure. The study was conducted from November 2012 to June 2013. Results: Patients were divided into two groups. Group 1, those with normoalbuminuria (n=63) and Group 2, those having microalbuminuria (n=50). Group 2 patients showed higher blood pressure values as compared to Group 1. The results were statistically significant and showed poor glycemic control as a contributing risk factor. Conclusion: The study concluded that there is high frequency of hypertension among type 2 diabetics but still much higher among those having microalbuminuria. So, early recognition of renal dysfunction through detection of microalbuminuria and to start treatment without any delay will confer future protection from end stage renal disease as well as hypertension and its complications in type 2 diabetic patients. PMID:24948969

  8. Association of Microalbuminuria with Metabolic Syndrome among Aged Population.

    PubMed

    Li, Xiao-Hong; Lin, Hai-Yan; Wang, Shu-Hua; Guan, Li-Ying; Wang, Yi-Bing

    2016-01-01

    Background. The impact of the various components of metabolic syndrome (MetS) on chronic kidney disease has been conflicting. We aim to investigate the association between MetS and microalbuminuria and identify the major contributing components of MetS that result in microalbuminuria in the Chinese aged population. Methods. A total of 674 adults aged 55-98 years (males: 266; mean age: 66.5 ± 7.5 years) were studied. MetS was defined by the 2004 Chinese Diabetes Society criteria and microalbuminuria by urine albumin-creatinine ratio (UACR) ≥3 mg/mmoL. Results. The prevalence of microalbuminuria was gradually increased with increasing number of MetS components (P < 0.05). In multivariate regression, after adjusting for age and sex, MetS was the strongest correlate of microalbuminuria (OR = 1.781, 95% CI = 1.226-2.587; P < 0.05) followed by the fasting plasma glucose (FPG) (OR = 1.217, 95% CI = 1.044-1.092; P < 0.05), systolic blood pressure (SBP) (OR = 1.011, 95% CI = 1.107-1.338; P < 0.05), and high-density lipoprotein cholesterol (HDL-C) (OR = 0.576, 95% CI = 0.348-0.953; P < 0.05). Conclusions. MetS is independently associated with microalbuminuria in the Chinese aged population. Elevated FPG is the most predominant component of metabolic syndrome associated with microalbuminuria followed by elevated SBP and reduced HDL-C. PMID:27200378

  9. Relationship between endothelial dysfunction and microalbuminuria in familial Mediterranean fever

    PubMed Central

    Güneş, Hakan; Kıvrak, Tarık; Tatlısu, Mustafa; Kaya, Hakkı; Yılmaz, Mehmet Birhan

    2016-01-01

    Objective The aim of our study is to investigate the relationship between microalbuminuria and flow-mediated dilatation in familial Mediterranean fever (FMF) patients. Material and Methods In our study, there were two groups consisting of 54 patients who were out of the attack period (43 of whom had no microalbuminuria and 11 of whom had microalbuminuria) and 40 healthy controls (M/F: 12/28). Results There was no statistically difference between patient and control groups’age (25.06±8.07, 22.89±6.00 years, respectively). Flow-mediated dilatation (FMD) percentages were significantly different between the three groups (p=0.01). It was observed that there was a correlation between microalbuminuria and FMD percentage. Conclusion Endothelial dysfunction and renal damage occurred as a result of low-grade chronic inflammation. Microalbuminuria, which is the indicator of renal damage and endothelial dysfunction, and FMD show that endothelial functions can be used in the following of early detection of renal damage and endothelial functions in FMF patients.

  10. Microalbuminuria: prognostic and therapeutic implications in diabetes mellitus.

    PubMed

    Gilbert, R E; Cooper, M E; McNally, P G; O'Brien, R C; Taft, J; Jerums, G

    1994-01-01

    Thirty years following the development of the first radioimmunoassay for albumin, microalbuminuria is widely acknowledged as an important predictor of overt nephropathy in patients with Type 1 diabetes and of cardiovascular mortality in Type 2 diabetes. In addition, there is accumulating evidence to suggest that diabetic patients with microalbuminuria may have more advanced retinopathy, higher blood pressure, and worse dyslipidaemia than patients with normal albumin excretion rates. Recent studies have focused on the role of intervention, principally with antihypertensive therapy and intensive glycaemic control, in reducing microalbuminuria. While successful in reducing urinary albumin excretion it remains to be established whether such therapies will be translated into a reduction in renal failure and decreased cardiovascular morbidity and mortality. PMID:7955987

  11. Microalbuminuria measurements by two in-house ELISA methods.

    PubMed

    Ng, L C; Teng, L C; Ng, M L; Sazali, B S; Khalid, B A

    2000-12-01

    Detection of microalbuminuria is important in the management of diabetic patients since it is predictive of development of proteinuria and nephropathy. Two sensitive and specific in-house ELISAs for microalbuminuria were established and validated. One of the ELISAs was based on antigen coating while the other employed antibody coating. Recovery and linearity experiments gave acceptable results of 100 +/- 10%, while precision results were <10% for intra-assay and <12% for inter-assay coefficients of variation (CVs). The standard curve ranged from 10-625 ug/l, equivalent to 0.2-12.5 mg/l for urine samples diluted 1:20 fold. When the antibody coated ELISA was compared to antigen coated ELISA, a correlation of r=0.996 was obtained. When compared to commercial kits, the in-house ELISAs gave good correlations of r=0.961 versus the Boehringer Mannheim Micral Test strips and r=0.940 versus Ames Microalb Turbidimetry. The normal microalbumin reference ranges determined for 12h, first morning and random urine samples were 0.7-5.3 mg, 0.1-10.2 mg/l and 0.8-26.1 mg/l respectively. The normal albumin excretion rate (AER) was 1.0-7.3 ug/min while untimed urine samples gave results of 0.1-0.9 and 0.2-1.6 mg/mmol after dividing by creatinine concentrations. The ELISAs were used to detect microalbuminuria in 338 random urine samples from diabetic patients. A high percentage 47.9% was found to be positive for microalbuminuria and 18.0% had macroalbuminuria >25 mg/mmol. Thus screening for microalbuminuria together with creatinine measurements using random urine samples can be used for management of diabetic patients. PMID:16329538

  12. Microalbuminuria measurements by two in-house ELISA methods.

    PubMed

    Ng, L C; Teng, L C; Ng, M L; Sazali, B S; Khalid, B A

    2000-12-01

    Detection of microalbuminuria is important in the management of diabetic patients since it is predictive of development of proteinuria and nephropathy. Two sensitive and specific in-house ELISAs for microalbuminuria were established and validated. One of the ELISAs was based on antigen coating while the other employed antibody coating. Recovery and linearity experiments gave acceptable results of 100 +/- 10%, while precision results were <10% for intra-assay and <12% for inter-assay coefficients of variation (CVs). The standard curve ranged from 10-625 ug/l, equivalent to 0.2-12.5 mg/l for urine samples diluted 1:20 fold. When the antibody coated ELISA was compared to antigen coated ELISA, a correlation of r=0.996 was obtained. When compared to commercial kits, the in-house ELISAs gave good correlations of r=0.961 versus the Boehringer Mannheim Micral Test strips and r=0.940 versus Ames Microalb Turbidimetry. The normal microalbumin reference ranges determined for 12h, first morning and random urine samples were 0.7-5.3 mg, 0.1-10.2 mg/l and 0.8-26.1 mg/l respectively. The normal albumin excretion rate (AER) was 1.0-7.3 ug/min while untimed urine samples gave results of 0.1-0.9 and 0.2-1.6 mg/mmol after dividing by creatinine concentrations. The ELISAs were used to detect microalbuminuria in 338 random urine samples from diabetic patients. A high percentage 47.9% was found to be positive for microalbuminuria and 18.0% had macroalbuminuria >25 mg/mmol. Thus screening for microalbuminuria together with creatinine measurements using random urine samples can be used for management of diabetic patients.

  13. Risk factors for development of microalbuminuria in insulin dependent diabetic patients: a cohort study. Microalbuminuria Collaborative Study Group, United Kingdom.

    PubMed Central

    1993-01-01

    OBJECTIVE--To investigate the risk factors for the development of persistent microalbuminuria in insulin dependent diabetic patients. DESIGN--Four year follow up of a cohort of diabetic patients. SETTING--Outpatient departments of teaching and district general hospitals in England. SUBJECTS--148 non-microalbuminuric, non-hypertensive insulin dependent diabetic patients. MAIN OUTCOME MEASURES--Urinary albumin excretion rate and arterial blood pressure. RESULTS--137 patients completed four year follow up, of whom 11 developed persistent microalbumin-uria (albumin excretion rate > or = 30 micrograms/min on at least two consecutive occasions), giving a cumulative frequency of 8%. 103 remained normoalbuminuric and 23 exhibited intermittent microalbuminuria. At baseline the persistent microalbuminuric group had had significantly raised blood pressure (mean 137.9 (SD 14.9)/82.3 (7.6) v 123.5 (13.2)/72.8 (9.1) mm Hg), glycated haemoglobin concentration 10.4% (2.0%) v 8-9% (2.0%), and albumin excretion rate (median (interquartile range) 17.5 (13.0-22.3) v 4.8 (3.7-6.7) micrograms/min) (p < 0.05 for all) compared with the normo-albuminuric group. Blood pressure and glycated haemoglobin remained significantly higher in the persistent microalbuminuric group throughout the study (p < 0.05). Multiple regression analysis showed initial albumin excretion rate, blood pressure, and smoking to be significant determinants of persistent microalbuminuria (p < 0.02). CONCLUSION--In insulin dependent diabetic patients with poor glucose control, which may initially increase albumin excretion rate, an early rise of arterial pressure and smoking are implicated in the development of persistent microalbuminuria. Images p1237-a PMID:8499853

  14. Microalbuminuria and hypertension in pregnancy: role of aldosterone and inflammation.

    PubMed

    Armanini, Decio; Ambrosini, Guido; Sabbadin, Chiara; Donà, Gabriella; Clari, Giulio; Bordin, Luciana

    2013-09-01

    Women with a history of hypertension in pregnancy are at increased risk of microalbuminuria later in life. Microalbuminuria is a marker of kidney dysfunction frequently related to an inflammatory event. Pregnancy is a dynamic process characterized by immune tolerance, angiogenesis, and hormonal regulation. Menstruation and pregnancy are associated with a physiological inflammation, which is altered in preeclampsia and probably in other hypertensive situations of pregnancy. An imbalance between pro-oxidant factors and the ability to scavenge these factors produces oxidative stress, which has been evaluated in many cells, but leukocytes are the main source of inflammatory cytokines and experimental and clinical evidence support a possible role of aldosterone as a mediator of placental and renal damage mediated by growth factors, reactive oxygen species, and cytokines. Angiotensin-converting enzyme inhibitors and aldosterone receptor blockers are frequently effective in reducing the risk of progression of cardiovascular and renal disease. PMID:24034651

  15. Retinopathy and microalbuminuria in type II diabetic patients

    PubMed Central

    Manaviat, Masoud R; Afkhami, Mohammad; Shoja, Mohammad R

    2004-01-01

    Background The aim of this study was to identify risk factors for the development of retinopathy and microalbuminuria and their correlation in type II diabetic patients. Methods In this cross-sectional study 590 patients suffering from diabetis type II were examined. Fundoscopy was performed by practising ophthalmologist. The ratio of urinary albumin to creatinine was assessed by clinitek 100 (Bayer corporation–USA). HbA1C, height and weight also were measured. Results The overall prevalence of retinopathy was 39.3% (232 patients), 5.4% of which showed to be prolifrative diabetic retinopathy (PDR). The diabetic retinopathy had significant inverse correlation with body mass index (BMI) (P = 0.02). HbA1C was higher in patients with PDR (mean = 10.5%) than in patients with no signs of retinopathy (mean = 9.5%) and this difference was statistically significant (P = 0.001). The prevalence of microalbuminuria was 25.9% while 14.5% of the patients revealed to have macroalbuminuria. As expected, diabetic retinopathy and renal involvement were highly positively correlated. (P = 0.001). Conclusion Microalbuminuria is associated with diabetic retinopathy in type II diabetic patients and is a reliable marker of retinopathy. PMID:15228626

  16. Prognostic value of microalbuminuria during antihypertensive treatment in essential hypertension.

    PubMed

    Pascual, Jose Maria; Rodilla, Enrique; Costa, Jose Antonio; Garcia-Escrich, Miguel; Gonzalez, Carmen; Redon, Josep

    2014-12-01

    Whether changes over time of urinary albumin excretion have prognostic value is a matter of discussion. The objective was to assess the prognostic value of changes in urinary albumin excretion over time in cardiovascular risk during antihypertensive treatment. Follow-up study of 2835 hypertensives in the absence of previous cardiovascular disease (mean age 55 years, 47% men, BP 138/80 mm Hg, 19.1% diabetics, and calibrated systemic coronary risk estimation 5 or >10.6%). Usual-care of antihypertensive treatment was implemented to maintain blood pressure<140/90 mm Hg. Urinary albumin excretion was assessed yearly, and the values were expressed as the creatinine ratio. Incidence of cardiovascular events, fatal and nonfatal, was recorded during the follow-up. During a median follow-up of 4.7 years (17 028 patients-year), 294 fatal and first nonfatal cardiovascular events were recorded (1.73 CVD per 100 patients/year). Independently of blood pressure, estimated glomerular filtration rate, level of cardiovascular risk, and antihypertensive treatment, microalbuminuria at baseline and at any time during the follow-up resulted in higher risk for events, hazard ratio (HR) 1.35 (95% confidence interval [CI], 1.08-1.79) and HR 1.49 (95% CI, 1.14-1.94), respectively. Likewise, development of microalbuminuria (HR 1.60; 95% CI, 1.04-2.46) or persistence from the beginning (1.53; 95% CI, 1.13-2.06) had a significantly higher rate of events than if remained normoalbuminuric (HR 1) or regress to normoalbuminuria (HR 1.37; 95% CI, 0.92-2.06) with an 18%, 18%, 8%, and 11% events, respectively, P<0.001. The study supports the value of urinary albumin excretion assessment as a prognostic factor for cardiovascular risk, but also opens the way to consider it as an intermediate objective in hypertension.

  17. Líneas UV como indicadores de temperatura y densidad

    NASA Astrophysics Data System (ADS)

    Brusasco, M. A.; Cidale, L. S.

    In order to investigate the behavior of Fe II lines in Be stars, we carry out a statistical analysis over a sample of IUE images. We found that only 4 of the 39 studied stars (with spectral types B2, B5 and B8) show Fe II lines. Synthetic spectra of Fe II lines were computed by means of a rigorous treatment of the line transfer equation for moving flows, considering different effective temperature, velocity and temperature structure. Preliminary results show that the shape of the profiles depends mainly on the velocity structure, while the intensity changes with both the temperature and the density structure.

  18. Performance of 'Micro-Bumintest' tablets for detection of microalbuminuria in Nauruans.

    PubMed

    Collins, V; Zimmet, P; Dowse, G K; Finch, C F; Linnane, A W

    1989-05-15

    Subclinical elevation of urinary albumin excretion (microalbuminuria) is useful for the detection of individuals at high risk of developing nephropathy in both insulin-dependent and non-insulin-dependent diabetes mellitus. We have evaluated the performance of Micro-Bumintest, a semi-quantitative test for the rapid detection of microalbuminuria. A total of 1186 samples from a population-based survey of the high diabetes prevalence community of Nauru were studied. Compared with a radioimmunoassay method, the Micro-Bumintest had a sensitivity of 97.6%, specificity of 93.2% and overall efficiency of 94.8%, when 40 micrograms/ml was used as the discriminating albumin concentration defining microalbuminuria. Significant differences in radioimmunoassay results between categories of the Micro-Bumintest were found, indicating its usefulness as a semi-quantitative test. Compared with subjects with normal glucose tolerance, there was a statistically significant progressive increase in the prevalence of microalbuminuria as detected by Micro-Bumintest in subjects with impaired glucose tolerance and diabetes mellitus. Micro-Bumintest performs well as a screening test for detection of microalbuminuria not only in the clinical situation, but also in population-based epidemiological studies.

  19. Prognostic Impact of Subclinical Microalbuminuria in Patients With Chronic Heart Failure.

    PubMed

    Miura, Masanobu; Sakata, Yasuhiko; Miyata, Satoshi; Nochioka, Kotaro; Takada, Tsuyoshi; Tadaki, Soichiro; Ushigome, Ryoichi; Yamauchi, Takeshi; Takahashi, Jun; Shimokawa, Hiroaki

    2014-10-30

    Background:Microalbuminuria, traditionally defined as urinary albumin/creatinine ratio (UACR) ≥30 mg/g, is a risk factor for mortality even in patients with preserved glomerular filtration rate (GFR). The prognostic impact of subclinical microalbuminuria, however, remains unknown in patients with chronic heart failure (CHF).Methods and Results:In the Chronic Heart Failure Analysis and Registry in the Tohoku District 2 Study, we enrolled 2,039 consecutive symptomatic CHF patients (median age, 67.4 years; 68.9% male) after excluding those on hemodialysis. On classification and regression tree analysis, UACR=10.2 mg/g and 27.4 mg/g were identified as the first and second discriminating points to stratify the risk for composite of death, acute myocardial infarction, HF admission and stroke, therefore subclinical microalbuminuria was defined as UACR ≥10.2 and <27.4 mg/g. There were 506 composite endpoints (24.8%) during the median follow-up of 2.69 years. On Kaplan-Meier analysis and multivariate Cox modeling, subclinical microalbuminuria was significantly associated with increased composite endpoints with hazard ratios of 1.90 (P<0.001) and 2.29 (P<0.001) in patients with preserved (>60 ml·min(-1)·1.73 m(-2), n=1,129) or mildly reduced eGFR (30-59.9 ml·min(-1)·1.73 m(-2), n=789), respectively. In patients with severely reduced GFR (eGFR <30 ml·min(-1)·1.73 m(-2), n=121), >80% had microalbuminuria or macroalbuminuria, and only 9.1% were free from any composite endpoints.Conclusions:Subclinical microalbuminuria was associated with increased risk of cardiovascular events in CHF patients with mildly reduced or preserved renal function. PMID:25354552

  20. Galectin-3 Serum Levels Are Independently Associated With Microalbuminuria in Chronic Heart Failure Outpatients

    PubMed Central

    Iacoviello, Massimo; Aspromonte, Nadia; Leone, Marta; Paradies, Valeria; Antoncecchi, Valeria; Valle, Roberto; Caldarola, Pasquale; Ciccone, Marco Matteo; Gesualdo, Loreto; Serio, Francesca Di

    2015-01-01

    Background: Galectin-3 (Gal-3) is a novel biomarker reflecting inflammation status and fibrosis involving worsening of both cardiac and renal functions. Objectives: The aim of this study was to evaluate the relationship between Gal-3 serum levels and microalbuminuria in a group of chronic heart failure (CHF) outpatients. Patients and Methods: We enrolled CHF outpatients having stable clinical conditions and receiving conventional therapy. All patients underwent clinical evaluation, routine chemistry analysis, echocardiography, and evaluation of the urinary albumin/creatinine ratio (UACR). Results: Among the patients enrolled, 61 had microalbuminuria (UACR, 30-299) and 133 normoalbuminuria (UACR, < 30). Patients with normoalbuminuria showed significantly higher levels of Gal-3 than those without (19.9 ± 8.8 vs. 14.6 ± 5.5 ng/mL). The stepwise regression analysis indicated that Gal-3 was the first determinant of microalbuminuria (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.02 - 1.14, P = 0.012), followed by diabetes (OR 2.14; 95% CI: 1.00 - 4.57; P = 0.049) and high central venous pressure (OR 2.80; 95% CI: 1.04 - 7.58; P= 0.042). Conclusions: Our findings indicate an independent association between Gal-3 levels and microalbuminuria, an early marker of altered renal function. This suggests the possible role of Gal-3 in the progression of cardiorenal syndrome in CHF outpatients. PMID:26870715

  1. TNF-α and Microalbuminuria in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Lampropoulou, I.-Th.; Stangou, M.; Papagianni, A.; Didangelos, T.; Iliadis, F.; Efstratiadis, G.

    2014-01-01

    Aim. Recent evidence suggests that chronic subclinical inflammation plays a key role in the pathogenesis and progression of diabetic nephropathy. Aim of the present study was to investigate possible correlation between the presence and degree of microalbuminuria and markers of inflammation in patients with type 2 diabetes mellitus (DM). Patients-Methods. Eighty patients were enrolled and clinical and laboratory data were recorded. Albumin-creatinine ratio (ACR) was calculated in first-morning urine samples. Serum and urinary tumor necrosis factor-α (TNF-α) levels were determined by ELISA. Results. Forty-five patients had normoalbuminuria, 33 microalbuminuria, and 2 macroalbuminuria. Patients with microalbuminuria were older, with higher glycosylated hemoglobin levels (HbA1c) and they more frequently had diabetic retinopathy, neuropathy, and cardiovascular disease and were on treatment with angiotensin converting enzyme inhibitors (ACEi) and/or angiotensin receptor blockers (ARBs). ACR was significantly correlated with the presence of cardiovascular disease, hypertension, and HbA1c levels and the administration of clopidogrel and ACEi or ARBs. ACR was not correlated with C-reactive protein, fibrinogen, or serum TNF-α levels but had a strong correlation with urinary TNF-α levels. Conclusions. In patients with type 2 DM, urinary, but not serum, TNF-α levels are associated with the presence and severity of microalbuminuria. PMID:25587544

  2. The importance of the relationship between microalbuminuria, subclinical proteinuria and arterial hypertension in diabetics.

    PubMed

    Serban, V; Dabelea, D

    1994-01-01

    Arterial hypertension represents, among others, an important risk factor for the development of microalbuminuria in diabetics. On the other hand, with microalbuminuria, it has been observed an important rise in the prevalence of high blood pressure. This study stresses the importance of the relationship between subclinical proteinuria and microalbuminuria, on one hand, and arterial hypertension on the other hand. There have been studied 343 diabetics hospitalized in our Clinic. We estimated the presence of hypertension (according to WHO criteria) and the values of subclinical proteinuria (biuret method) and microalbuminuria (MICRAL-test). We observed that 70.8% of hypertensives and 49.4% of normotensives presented values of proteinuria that ranked between 300 and 500 mg/24 h (p < 0.001). Meanwhile, 25.8% of proteinuric patients and 14.8% of non-proteinuric ones were hypertensives (p < 0.05). In hypertensive diabetics the prevalence of subclinical proteinuria is higher than in normotensive ones. The prevalence of hypertension is significantly higher in microalbuminuric patients than in normoalbuminuric ones.

  3. A Cost-Benefit and Accurate Method for Assessing Microalbuminuria: Single versus Frequent Urine Analysis

    PubMed Central

    Hemmati, Roholla; Gharipour, Mojgan; Khosravi, Alireza; Jozan, Mahnaz

    2013-01-01

    Background. The purpose of this study was to answer the question whether a single testing for microalbuminuria results in a reliable conclusion leading costs saving. Methods. This current cross-sectional study included a total of 126 consecutive persons. Microalbuminuria was assessed by collection of two fasting random urine specimens on arrival to the clinic as well as one week later in the morning. Results. In overall, 17 out of 126 participants suffered from microalbuminuria that, among them, 12 subjects were also diagnosed as microalbuminuria once assessing this factor with a sensitivity of 70.6%, a specificity of 100%, a PPV of 100%, a NPV of 95.6%, and an accuracy of 96.0%. The measured sensitivity, specificity, PVV, NPV, and accuracy in hypertensive patients were 73.3%, 100%, 100%, 94.8%, and 95.5%, respectively. Also, these rates in nonhypertensive groups were 50.0%, 100%, 100%, 97.3%, and 97.4%, respectively. According to the ROC curve analysis, a single measurement of UACR had a high value for discriminating defected from normal renal function state (c = 0.989). Urinary albumin concentration in a single measurement had also high discriminative value for diagnosis of damaged kidney (c = 0.995). Conclusion. The single testing of both UACR and urine albumin level rather frequent testing leads to high diagnostic sensitivity, specificity, and accuracy as well as high predictive values in total population and also in hypertensive subgroups. PMID:24455207

  4. Corneal Confocal Microscopy Detects Neuropathy in Patients with Type 1 Diabetes without Retinopathy or Microalbuminuria

    PubMed Central

    Chan, Agnes W. S.; Alam, Uazman; Fadavi, Hassan; Marshall, Andrew; Asghar, Omar; Efron, Nathan; Tavakoli, Mitra; Malik, Rayaz A.

    2015-01-01

    Objective Corneal innervation is increasingly used as a surrogate marker of human diabetic peripheral neuropathy (DPN) however its temporal relationship with the other microvascular complications of diabetes is not fully established. In this cross-sectional, observational study we aimed to assess whether neuropathy occurred in patients with type 1 diabetes, without retinopathy or microalbuminuria. Materials and Methods All participants underwent detailed assessment of peripheral neuropathy [neuropathy disability score (NDS), vibration perception threshold (VPT), peroneal motor nerve conduction velocity (PMNCV), sural sensory nerve conduction velocity (SSNCV) and in vivo corneal confocal microscopy (IVCCM)], retinopathy (digital fundus photography) and albuminuria status [albumin: creatinine ratio (ACR)]. Results 53 patients with Type 1 diabetes with (n=37) and without retinopathy (n=16) were compared to control subjects (n=27). SSNCV, corneal nerve fibre (CNFD) and branch (CNBD) density and length (CNFL) were reduced significantly (p<0.001) in diabetic patients without retinopathy compared to control subjects. Furthermore, CNFD, CNBD and CNFL were also significantly (p<0.001) reduced in diabetic patients without microalbuminuria (n=39), compared to control subjects. Greater neuropathic severity was associated with established retinopathy and microalbuminuria. Conclusions IVCCM detects early small fibre damage in the absence of retinopathy or microalbuminuria in patients with Type 1 diabetes. PMID:25853247

  5. Cystatin C, CRP, log TG/HDLc and metabolic syndrome are associated with microalbuminuria in hypertension

    PubMed Central

    Moura, Rafaela do Socorro Souza e Silva; Vasconcelos, Daniel França; Freitas, Eduardo; de Moura, Flavio José Dutra; Rosa, Tânia Torres; Veiga, Joel Paulo Russomano

    2014-01-01

    Background In patients with systemic hypertension, microalbuminuria is a marker of endothelial damage and is associated with an increased risk for cardiovascular disease. Objective To determine the factors that may lead to the occurrence of microalbuminuria in hypertensive patients with serum creatinine lower than 1.5 mg/dL. Methods This cross-sectional study included 133 Brazilians with essential hypertension followed up at a hypertension outpatient clinic. Those with serum creatinine higher than 1.5 mg/dL, as well as those with diabetes mellitus, were excluded. Systolic and diastolic blood pressures were measured, and body mass index (BMI) and GFR estimated by using the CKD-EPI formula were calculated. The serum levels of the following were assessed: CysC, creatinine, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C-reactive protein (CRP) and fasting glucose. Microalbuminuria was determined in 24-hour urine. Hypertensive patients were classified according to the presence of one or more criteria for metabolic syndrome. Results In a multiple regression analysis, the serum levels of CysC and CRP, the atherogenic index log TG/HDLc and the presence of three or more criteria for metabolic syndrome were positively correlated with microalbuminuria (r2: 0.277, p < 0.05). Conclusion CysC, CRP, log TG/HDLc, and the presence of three or more criteria for metabolic syndrome, regardless of serum creatinine, were associated with microalbuminuria, an early marker of kidney damage and cardiovascular risk in patients with essential hypertension. PMID:24162470

  6. The Effect of Resting Heart Rate on the New Onset of Microalbuminuria in Patients With Type 2 Diabetes

    PubMed Central

    Schmieder, Roland E.; Bramlage, Peter; Haller, Hermann; Ruilope, Luis M.; Böhm, Michael

    2016-01-01

    Abstract The association between resting heart rate and new-onset microalbuminuria in patients with type 2 diabetes is not clear. The objective of the current analysis was to assess the relationship between heart rate and incidence of microalbuminuria in patients with type 2 diabetes. Data from the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study were retrospectively analyzed. New-onset microalbuminuria was documented and related to heart rate as recorded at baseline and last assessment, and the mean of the measurements taken during the double-blind part of the ROADMAP trial. Patients (n = 4299) had a mean age of 57.8 ± 8.7 years and 46.3% were male. Characteristics were not different between the olmesartan and the placebo groups, except for a higher systolic blood pressure (136.7 vs 135.7 mm Hg; P = 0.04) and albumin creatinine ratio (5.9 vs 5.5; P = 0.03). Increased risk of microalbuminuria was found with increasing heart rate, independent of whether baseline [highest vs lowest quartile odds ratio (OR) 1.39; 95% confidence interval (95% CI) 1.03–1.87; P = 0.032], last assessment (OR 1.71; 95% CI 1.26–2.31; P = 0.001), or mean heart rate was considered (OR: 1.77; 95% CI: 1.30–2.41; P = 0.0003). The greater risk of new-onset microalbuminuria with a high baseline heart rate was also found when data were adjusted for mean systolic blood pressure (OR: 1.35; 95% CI: 1.00–1.82; P = 0.0496; interaction P < 0.0001). Although there was no risk increase with baseline heart rate in the placebo group (P = 0.8253 for trend), microalbuminuria was less frequent in patients receiving olmesartan in the low heart rate quartiles (P = 0.002 for trend). A low heart rate reduces the risk of patients with type 2 diabetes developing microalbuminuria, independent of blood pressure. The data demonstrate potential benefits of reducing the heart rate of type 2 diabetes patients, and indicate that olmesartan

  7. Regular physical activity and reduced occurrence of microalbuminuria in type 2 diabetic patients.

    PubMed

    Calle-Pascual, A L; Martin-Alvarez, P J; Reyes, C; Calle, J R

    1993-01-01

    In order to evaluate the influence of regular non-strenuous physical exercise on the appearance of microalbuminuria in Type 2 (non-insulin-dependent) diabetic patients, we have studied a cohort of 372 Type 2 diabetic patients (152 males and 220 females, mean age: 63.59 +/- 0.70 years, evolution time: 10.31 +/- 0.4 years, M +/- SEM). One hundred and ninety seven (52.9%) presented normo-albuminuria, 124 (33.3%) microalbuminuria and 51 (13.7%) proteinuria. These three groups were different with regard to evolution time, weight, BMI, waist-hip ratio, Hb1Ac value, prevalence of hypertension and physical activity level. 132 (35.4%) patients had a regular exercise-induced caloric expenditure under 500 kcal/wk whereas 122 (32.7%) were between 500 and 1.000 kcal/wk and 118 (31.7%) over 1.000 kcal/wk. Prevalence of normo-albuminuric patients was 40.1%, 52.4% and 67.7% respectively (p < 0.01). Prevalence of normo-albuminuric patients remained significatively higher in the patient with the greater physical activity level when adjusted to systolic blood pressure, diastolic blood pressure, evolution time and HbA1c value. Our results stress the fact that regular non-strenuous physical activity may have a protective effect on the appearance of microalbuminuria in Type 2 (non-insulin-dependent) diabetic patients. Whether the cardiovascular protective influence of exercise in these patients depends on such an effect remains unknown. On the basis of this cross-sectional evidence, a longitudinal study is now under way.

  8. Lifestyle-Related Factors, Obesity, and Incident Microalbuminuria: The CARDIA (Coronary Artery Risk Development in Young Adults) Study

    PubMed Central

    Chang, Alex; Van Horn, Linda; Jacobs, David R.; Liu, Kiang; Muntner, Paul; Newsome, Britt; Shoham, David; Durazo-Arvizu, Ramon; Bibbins-Domingo, Kirsten; Reis, Jared; Kramer, Holly

    2013-01-01

    Background Modifiable lifestyle-related factors are associated with risk of coronary heart disease and may also influence kidney disease risk. Study Design Community-based prospective cohort study. Setting & Participants 2354 African-American and white participants ages 28–40 years, without baseline microalbuminuria or estimated glomerular filtration rate <60 ml/min/1.73 m2 recruited from four U.S. centers: Birmingham AL, Chicago IL, Minneapolis MN, and Oakland CA. Factors Current smoking, physical activity, fast food habits, obesity, and diet quality, which was based on 8 fundamental components of the Dietary Approaches to Stop Hypertension (DASH) diet, including increased intake of fruits, vegetables, low-fat dairy products, whole grains, nuts and legumes, and reduced intake of sodium, sugar sweetened beverages, and red and processed meats. Outcomes & Measurements Spot urine albumin-creatinine ratios (ACRs) were obtained at baseline (1995–96) and 3 5-year follow-up examinations (5, 10, and 15 years follow-up). Incident microalbuminuria was defined as presence of race and sex-adjusted ACR ≥25 mg/g at 2 or more of the successive follow-up examinations. Results Over the 15-year follow-up period, 77 individuals (3.3%) developed incident microalbuminuria. After multivariable adjustment, poor diet quality (OR, 2.0; 95% CI, 1.1–3.4) and obesity (OR, 1.9; 95% CI, 1.1–3.3) were significantly associated with microalbuminuria; current smoking (OR, 1.6; 95% CI, 0.9–2.8) was associated with microalbuminuria although the CI crossed 1.0. Neither low physical activity (OR, 1.0; 95% CI, 0.5–1.8) nor fast food consumption (OR, 1.2; 95% CI, 0.7–2.3) were associated with microalbuminuria. Compared to individuals with no unhealthy lifestyle-related factors (poor diet quality, current smoking and obesity), adjusted odds of incident microalbuminuria were 131%, 273%, and 634% higher for presence of 1 (OR, 2.3; 95% CI, 1.3–4.3), 2 (OR, 3.7; 95% CI, 1.8–7.7), and 3 (OR

  9. Association of Salivary Osteopontin Levels with Glycaemic Status and Microalbuminuria - in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Rajagambeeram, Reeta; Venkatkumar, Shruthi; Vijayan, Mohana Valli; Murugaiyan, Sathish Babu; Gopal, Shyam Prakash; Ramsamy, Sathiya; Alwar, Velayutharaj

    2016-01-01

    Introduction The monitoring of glycaemic status in patients with T2DM is mainly through blood tests (Fasting plasma glucose and HbA1c), which are invasive and involves painful pricks. This leads to poor patient compliance and soon could lead to various micro and macro vascular complications, which hamper the quality of life. There are no sensitive and specific markers to predict these complications at the earliest. Sialochemistry has recently gained attention for monitoring chronic diseases. Osteopontin is a phospho-glycoprotein molecule, elevated in many inflammatory conditions. Aim The aim of the study was to evaluate the role of serum and salivary osteopontin in Type 2 Diabetes mellitus (T2DM). Materials and Methods In this case-control study, we recruited 33 cases of T2DM and 31 age and gender matched healthy controls. Body Mass Index (BMI), Waist/Hip Ratio (WHR), Waist Circumference (WC) and blood pressure was recorded. Fasting Plasma Glucose (FPG), salivary glucose, HbA1c, microalbuminuria, systolic BP, serum and salivary osteopontin levels were estimated. Results FPG, salivary glucose, HbA1c, microalbuminuria, systolic BP, BMI, waist / hip ratio serum and salivary osteopontin levels were significantly high in T2DM cases compared to control subjects. Serum and salivary osteopontin levels were significantly correlated with HbA1c and microalbuminuria in T2DM cases. Conclusion Serum and salivary osteopontin levels are significantly elevated in subjects with T2DM and are associated with glycaemic control and microalbuminuria. PMID:27656430

  10. Assessment of Carotid Atherosclerosis in Type 2 Diabetes Mellitus Patients with Microalbuminuria by High-Frequency Ultrasonography

    PubMed Central

    Zhang, Yu-Hong; Gao, Yuan; Mao, Xin; Shang, Jing; Su, Ben-Li

    2013-01-01

    The aim of this study is to evaluate carotid atherosclerosis in patients of type 2 diabetes mellitus with microalbuminuria (MA) by high-frequency ultrasonography. Two hundred and fifty patients of type 2 diabetes mellitus were divided into two groups according to urinary albumin excretion rate (UAER): normoalbuminuria group (130 cases) and microalbuminuria group (120 cases). The intimal-medial thickness (IMT) and the atherosclerotic plaques of carotid artery were observed in both groups by high-frequency ultrasound. Fasting blood glucose (FBG), hemoglobin A1c, and lipid profiles were measured. The values of IMT of microalbuminuria group were significantly higher than those of normoalbuminuria group (P < 0.05). In univariate analysis, IMT was positively and significantly associated with age (r = 0.265, P < 0.05), waist circumference (r = 0.263, P < 0.05), body mass index (r = 0.285, P < 0.05), systolic blood pressure (r = 0.276, P < 0.05), UAER (r = 0.359, P < 0.05), HbA1c (r = 0.462, P < 0.05) and, duration of diabetes (r = 0.370, P < 0.05). In multivariate linear regression analysis, UAER and HbA1c were independent predictors of IMT (P < 0.05 for all). In the two groups, the rate of soft plaques was higher than that of dense plaques and calcified plaques. In conclusion, there is a significant association between microalbuminuria and IMT which is regarded as the early sign of carotid atherosclerosis in type 2 diabetic patients. PMID:23573090

  11. Clinical application of a novel sliver nanoparticles biosensor based on localized surface plasmon resonance for detecting the microalbuminuria.

    PubMed

    Lai, Ting; Hou, Qiannan; Yang, Huan; Luo, Xiangang; Xi, Mingrong

    2010-11-01

    In order to explore the clinical application of the nanobiosensor based on localized surface plasmon resonance (LSPR), we used our LSPR biosensor to detect the microalbuminuria in this work. The sliver nanoparticles were fabricated by using nanosphere lithography. The anti-human albumin antibody was immobilized on the sensor surface by amine coupling method. The different concentrations of commercial albumin and albumin in urine samples from three mild preeclampsia patients were determined according to the peak of LSPR extinction spectra. Under optimum conditions, our results showed that the biosensor displayed a detection limit of 1 ng/ml and wide dynamic range of 1 ng/ml to 1 μg/ml. Furthermore, the microalbuminuria of three patients was determined by our biosensor within a short assay time, without sample purification. This biosensor proposed herein is easy to prepare and could be used for low-cost, rapid, label-free, and sensitive screening of the microalbuminuria. This approach provides a promising platform for developing clinical diagnostic applications.

  12. Triad of metabolic syndrome, chronic kidney disease, and coronary heart disease with a focus on microalbuminuria death by overeating.

    PubMed

    Gobal, Freij; Deshmukh, Abhishek; Shah, Sudhir; Mehta, Jawahar L

    2011-06-01

    Coronary heart disease remains a major cause of morbidity and mortality in the United States, and its incidence is rising worldwide. Because atherosclerosis is a chronic process, and it is often associated with certain lifestyle and risk factors such as hypertension, dyslipidemia, and insulin resistance, much emphasis is being placed on lifestyle modification and control of risk factors. It is being recognized that some lifestyle patterns such as overeating result in metabolic syndrome, which may play a role in the development of chronic kidney disease and coronary heart disease. Here, we focus on an important relationship between these 3 conditions, and we provide evidence that microalbuminuria develops in many patients with metabolic syndrome, may be an important correlate of chronic kidney disease and coronary heart disease, and may represent an important prognostic marker. Although the pathogenesis of microalbuminuria in metabolic syndrome is not clear, we suggest that microalbuminuria, chronic kidney disease, and coronary heart disease share common pathways involving inflammation and oxidative stress. We also discuss that a healthy lifestyle is essential for preventing and treating chronic kidney disease and coronary heart disease seen in patients with metabolic syndrome.

  13. Elevated urinary D-lactate levels in patients with diabetes and microalbuminuria.

    PubMed

    Chou, Chu-Kuang; Lee, Ya-Ting; Chen, Shih-Ming; Hsieh, Chi-Wen; Huang, Tzu-Chuan; Li, Yi-Chieh; Lee, Jen-Ai

    2015-12-10

    Diabetic nephropathy (DN) has become the major cause of end-stage renal disease. Early detection of disease risk, to enable intervention before advanced renal damage occurs, is an important goal. Microalbuminuria has been used to monitor renal damage in clinical settings for years. In this study, we divided patients with diabetes into different groups based on their microalbumin values to elucidate the relationship between urinary D-lactate and corresponding microalbumin values. Group DM1 comprised of patients with an albumin-to-creatinine ratio (ACR) of less than 30 μg albumin/mg creatinine (normal range); Group DM2 comprised of patients with an ACR of 30-299 μg albumin/mg creatinine (microalbuminuria); and Group DM3 comprised of patients with an ACR of ≥300 μg albumin/mg creatinine (macroalbuminuria). The urinary D-lactate concentration of patients with diabetes was determined by pre-column fluorescence derivatization with 4-nitro-7-piperazino-2,1,3-benzoxadiazole (NBD-PZ), and the accuracy (recovery) and precision (relative standard deviation; RSD) were validated. The measured values showed an accuracy that was in the acceptable range (91.59-112.96%), with an RSD in the range of 3.13-13.21%. The urinary D-lactate levels of the 3 diabetic groups (groups DM1, DM2, and DM3) were significantly higher than those of healthy subjects (78.31 ± 22.13, 92.47 ± 21.98, and 47.29 ± 17.51 vs. 6.28 ± 2.39 nmol/mg creatinine, respectively; p<0.05), with urinary D-lactate levels in the DM2 group being the highest. This modified fluorescence-based, high-performance liquid chromatography method to quantify D-lactate concentrations in the urine of patients with diabetes was established. Also, measuring the new risk marker identified in this study (D-lactate) in combination with microalbumin may facilitate the prevention of DN. PMID:26166004

  14. Screen-printed carbon electrode-based electrochemical immunosensor for rapid detection of microalbuminuria.

    PubMed

    Tsai, Jang-Zern; Chen, Ching-Jung; Settu, Kalpana; Lin, Yu-Feng; Chen, Chien-Lung; Liu, Jen-Tsai

    2016-03-15

    A urinary microalbumin test is used to detect early signs of kidney damage in people who have a risk of chronic kidney disease, such as those with diabetes or hypertension. In this study, we developed a screen-printed carbon electrode-based immunosensor for the detection of microalbumin in urine. Anti-human albumin antibodies were immobilized on the screen-printed sensor surface by the covalent immobilization method. Cyclic voltammetry (CV) and scanning electron microscopy with an energy dispersive spectroscopical (SEM-EDS) analysis demonstrated that the modification process was well performed. Chronoamperometric (CA) electrochemical measurement technique was employed for the quantitative detection of albumin. The electrochemical measurements performed with some possible interfering compounds normally present in urine (ascorbic acid, uric acid, glucose and creatinine samples) demonstrated a high specificity and selectivity of this immunosensor in albumin detection. Under optimum conditions, the immunosensor can detect urinary albumin in a wide linear range from 10 µg/ml to 300 µg/ml with a detection limit of 9.7 µg/ml. The excellent performance of this immunosensor was confirmed by analyzing microalbumin in urine samples; the results were in good agreement with those obtained by the standard immunoturbidimetric method. The biosensor proposed herein is easy to prepare and can be used for low-cost, rapid, and sensitive screening of microalbuminuria. This approach provides a promising platform for developing clinical point-of-care diagnostic applications. PMID:26579935

  15. The Effect of Resting Heart Rate on the New Onset of Microalbuminuria in Patients With Type 2 Diabetes: A Subanalysis of the ROADMAP Study.

    PubMed

    Schmieder, Roland E; Bramlage, Peter; Haller, Hermann; Ruilope, Luis M; Böhm, Michael

    2016-04-01

    The association between resting heart rate and new-onset microalbuminuria in patients with type 2 diabetes is not clear. The objective of the current analysis was to assess the relationship between heart rate and incidence of microalbuminuria in patients with type 2 diabetes. Data from the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study were retrospectively analyzed. New-onset microalbuminuria was documented and related to heart rate as recorded at baseline and last assessment, and the mean of the measurements taken during the double-blind part of the ROADMAP trial. Patients (n = 4299) had a mean age of 57.8 ± 8.7 years and 46.3% were male. Characteristics were not different between the olmesartan and the placebo groups, except for a higher systolic blood pressure (136.7 vs 135.7 mm Hg; P = 0.04) and albumin creatinine ratio (5.9 vs 5.5; P = 0.03). Increased risk of microalbuminuria was found with increasing heart rate, independent of whether baseline [highest vs lowest quartile odds ratio (OR) 1.39; 95% confidence interval (95% CI) 1.03-1.87; P = 0.032], last assessment (OR 1.71; 95% CI 1.26-2.31; P = 0.001), or mean heart rate was considered (OR: 1.77; 95% CI: 1.30-2.41; P = 0.0003). The greater risk of new-onset microalbuminuria with a high baseline heart rate was also found when data were adjusted for mean systolic blood pressure (OR: 1.35; 95% CI: 1.00-1.82; P = 0.0496; interaction P < 0.0001). Although there was no risk increase with baseline heart rate in the placebo group (P = 0.8253 for trend), microalbuminuria was less frequent in patients receiving olmesartan in the low heart rate quartiles (P = 0.002 for trend). A low heart rate reduces the risk of patients with type 2 diabetes developing microalbuminuria, independent of blood pressure. The data demonstrate potential benefits of reducing the heart rate of type 2 diabetes patients, and indicate that olmesartan could, in

  16. Early Treatment With Olmesartan Prevents Juxtamedullary Glomerular Podocyte Injury and the Onset of Microalbuminuria in Type 2 Diabetic Rats

    PubMed Central

    Sofue, Tadashi; Kiyomoto, Hideyasu; Kobori, Hiroyuki; Urushihara, Maki; Nishijima, Yoko; Kaifu, Kumiko; Hara, Taiga; Matsumoto, Sachiko; Ichimura, Atsuhiko; Ohsaki, Hiroyuki; Hitomi, Hirofumi; Kawachi, Hiroshi; Hayden, Melvin R.; Whaley-Connell, Adam; Sowers, James R.; Ito, Sadayoshi; Kohno, Masakazu; Nishiyama, Akira

    2012-01-01

    Background Studies were performed to determine if early treatment with an angiotensin II (Ang II) receptor blocker (ARB), olmesartan, prevents the onset of microalbuminuria by attenuating glomerular podocyte injury in Otsuka Long-Evans Tokushima Fatty (OLETF) rats with type 2 diabetes mellitus. Methods OLETF rats were treated with either a vehicle, olmesartan (10 mg/kg/day) or a combination of nonspecific vasodilators (hydralazine 15 mg/kg/day, hydrochlorothiazide 6 mg/kg/day, and reserpine 0.3 mg/kg/day; HHR) from the age of 7–25 weeks. Results OLETF rats were hypertensive and had microalbuminuria from 9 weeks of age. At 15 weeks, OLETF rats had higher Ang II levels in the kidney, larger glomerular desmin-staining areas (an index of podocyte injury), and lower gene expression of nephrin in juxtamedullary glomeruli, than nondiabetic Long-Evans Tokushima Otsuka (LETO) rats. At 25 weeks, OLETF rats showed overt albuminuria, and higher levels of Ang II in the kidney and larger glomerular desmin-staining areas in superficial and juxtamedullary glomeruli compared to LETO rats. Reductions in mRNA levels of nephrin were also observed in superficial and juxtamedullary glomeruli. Although olmesartan did not affect glucose metabolism, it decreased blood pressure and prevented the renal changes in OLETF rats. HHR treatment also reduced blood pressure, but did not affect the renal parameters. Conclusions This study demonstrated that podocyte injury occurs in juxtamedullary glomeruli prior to superficial glomeruli in type 2 diabetic rats with microalbuminuria. Early treatment with an ARB may prevent the onset of albuminuria through its protective effects on juxtamedullary glomerular podocytes. PMID:22318512

  17. Abdominal obesity is associated with microalbuminuria and an elevated cardiovascular risk profile in patients with hypertension

    PubMed Central

    Thoenes, Martin; Reil, Jan-Christian; Khan, Bobby Varkey; Bramlage, Peter; Volpe, Massimo; Kirch, Wilhelm; Böhm, Michael

    2009-01-01

    Background Overweight and obesity are frequently associated with preventable death and have emerged as a major challenge to public health. There is an ongoing debate on the role of abdominal obesity and its value in predicting cardiovascular and renal outcomes. The present analysis evaluates the prevalence of microalbuminuria (MAU) and conventional cardiovascular risk factors in relation to measures of general and abdominal obesity. Methods In this multinational, observational study, 20828 hypertensive out-patients from 26 countries including Europe, North and Latin America, Middle East, and Asia were analyzed. Urinary dipstick screening for MAU was performed as well as data on patient demographics, anthropometric measures, cardiovascular risk factors, comorbid conditions, and cardiovascular drug therapy collected. MAU prevalence was determined by a stepwise logistic regression analysis with cardiovascular risk factors as univariate. Results In the univariate analysis, MAU prevalence systematically increased with body mass index (BMI) from 54.4% (1st tertial) to 62.1% (3rd tertial) (p < 0.0001), an increase which was also observed for waist circumference (WC). At any level of BMI, MAU increased with WC from 53.5%, 54.8%, and 55.0% (1st tertial of WC in all three BMI tertials) to 61.4%, 62.1%, and 64.0% (3rd tertial of WC in all BMI tertials) (p < 0.0001). In the multivariate analysis, WC, but not BMI was independently associated with MAU. Furthermore, overweight/obesity were associated with the presence of modifiable and nonmodifiable risk factors. Conclusion An abnormal WC, but not BMI appears to be independently associated with MAU, an early marker of cardiovascular and renal risk. Increasing WC confers an incremental risk for MAU at any level of BMI, underlining the prognostic importance of abdominal fat accumulation beyond general obesity. PMID:19649308

  18. Hyperuricemia Is an Independent Risk Factor for New Onset Micro-Albuminuria in a Middle-Aged and Elderly Population: A Prospective Cohort Study in Taiwan

    PubMed Central

    Chang, Hung-Yu; Lee, Pei-Hsien; Lei, Chen-Chou; Tung, Chun-Wu; Hsu, Yung-Chien; Huang, Tung-Jung

    2013-01-01

    Background Hyperuricemia is now regarded as a risk factor for cardiovascular disease. Micro-albuminuria is associated with increased risk for cardiovascular disease and chronic kidney disease. We hypothesized that elevated serum uric acid (UA) is associated with development of micro-albuminuria in the general population. Methodology/Principal Findings We conducted a community-based prospective cohort study. A total of 1862 subjects from southern Taiwan, all older than 40 years, were screened and 993 of these participants without micro-albuminuria were followed for 4 years. Urinary albumin-to-creatinine ratio was measured two times per year. A multiple linear regression model indicated that serum UA was independently associated with ln(ACR) after adjustment for 8 factors (age, sex, and 6 metabolic metrics) (β = 0.194, p<0.01). Logistic regression analysis indicated that each 1 mg/dL increase of UA was associated with a 1.42-fold increased risk of micro-albuminuria after adjustment for the same 8 factors (OR = 1.42, 95% CI: 1.27–1.59, p<0.01). A Cox regression model using subjects with serum UA less than 5 mg/dL as reference group indicated higher hazard ratios (HRs) only found in subjects with serum UA more than 7 mg/dL (HR = 3.54, 95% CI: 2.11–5.93, p<0.01) and not in subjects with serum UA of 5 to 7 mg/dL (HR = 1.30, 95% CI: 0.82–2.07, p = 0.15). Conclusion Hyperuricemia is significantly associated with micro-albuminuria in middle-aged and elderly males and females from a general population in Taiwan. Elevated serum UA is an independent predictor for development of micro-albuminuria in this population. PMID:23637835

  19. Presence of Cardiometabolic Risk Factors Is Not Associated with Microalbuminuria in 14-to-20-Years Old Slovak Adolescents: A Cross-Sectional, Population Study

    PubMed Central

    Gurecká, Radana; Koborová, Ivana; Šebek, Jozef; Šebeková, Katarína

    2015-01-01

    Introduction In adults, microalbuminuria indicates generalized endothelial dysfunction, and is an independent risk factor for cardiovascular and all cause mortality. Slovak adults present one of the highest cardiovascular mortality rates in Europe. Thus Slovak adolescents are on a high-risk to develop cardiovascular afflictions early, and screening for microalbuminuria might be useful in early assessment of their cardiovascular risk. We aimed to study the prevalence of microalbuminuria in Slovak adolescents, and the association of urinary albumin-to-creatinine ratio (ACR) to cardiovascular risk factors. Subjects and methods Anthropometric data, blood pressure, blood count, glucose homeostasis, lipid profile, renal function, inflammatory status, concentrations of homocysteine and uric acid were determined and associated with ACR in 2 666 adolescents (49.4% boys, 51.6% girls) aged 14-to-20 years. Microalbuminuria was classified as ACR 2.5–25.0 mg/mmol in boys and 3.5–35.0 mg/mmol in girls. Results Prevalence of microalbuminuria in both genders reached 3.3%, and did not differ significantly between lean and centrally obese subjects. Girls presented higher ACR than boys (normoalbuminuric: 0.6±0.5 mg/mmol vs. 0.5±0.4 mg/mmol, p>0.001; microalbuminuric: 9.3±7.3 mg/mmol vs. 5.0±3.8 mg/mmol; p>0.001). Microalbuminuric adolescents and those presenting normoalbuminuria within the upper ACR quartile were slimmer than their normoalbuminuric counterparts or adolescents with normoalbuminuria within the lower quartile, respectively. No association between microalbuminuria and cardiovascular risk markers was revealed. Conclusion Results obtained in this study do not support our assumption that ACR associates with cardiometabolic risk factors in apparently healthy adolescents. Follow-up studies until adulthood are needed to estimate the potential cardiometabolic risk of apparently healthy microalbuminuric adolescents. PMID:26046923

  20. Association between Body Mass Index, Waist Circumference and Prevalence of Microalbuminuria in Korean Adults of Age 30 Years and Older without Diabetes, Hypertension, Renal Failure, or Overt Proteinuria: The 2013 Korean National Health and Nutrition Examination Survey

    PubMed Central

    Seo, Woo-Jeong; Lee, Gong-Myung; Hwang, Ji-Hye; Lee, Mi-Na

    2016-01-01

    Background Microalbuminuria and obesity markers are known risk factors for cardiovascular or renal disease. This study aimed to evaluate the prevalence of microalbuminuria according to body mass index (BMI) and abdominal obesity criteria. Methods The study subjects included 3,979 individuals aged 30 years or older who did not have diabetes, hypertension, renal failure, or overt proteinuria, from among those who participated in The Korean National Health and Nutrition Examination Survey in 2013, a cross-sectional, nationally representative, stratified survey. Microalbuminuria was defined as a urinary albumin to creatinine ratio of 30 to 300 mg/g. BMI and waist circumference were classified according to the Asia-Pacific criteria. Results The prevalence of microalbuminuria was found to be 5.1%. In the normoalbuminuria group, 3.4%, 41.7%, 24%, 27.6%, and 3.2% of participants were included in the underweight, normal, overweight, obesity 1, and obesity 2 groups, respectively. These percentages in the microalbuminuria group were 7.1%, 34.5%, 19.2%, 28.6%, and 10.6%, respectively (P<0.001). The waist circumference in men was 21.4% in the normoalbuminuria group and 36.5% in the microalbuminuria group (P=0.004). Logistic regression analyses were performed to evaluate the relationship between the presence of microalbuminuria and BMI or waist circumference groups. The risk of microalbuminuria was significant only in the underweight group (odds ratio, 13.22; 95% confidence interval, 2.55–68.63; P=0.002) after adjusting for confounding factors, abdominal obesity was not significantly associated with microalbuminuria. Conclusion The prevalence of microalbuminuria in a general population in Korea was associated with underweight in men and was not associated with waist circumference in either men or women. PMID:26885324

  1. Impediment of the progressions of microalbuminuria and hyperlipidemia in normotensive type 2 diabetes by low-dose ramipril.

    PubMed

    Vongterapak, S; Dahlan, W; Nakasatien, S; Anuntakulnatee, T; Suppanich, M; Kittipoom, W; Surasingchaidet, C; Tamwiwat, C; Tepkasetkul, M; Bunnag, P; Ongphiphadhanakul, B; Rajatanavin, R; Himathongkam, T

    1998-09-01

    In a randomized, double-blind, placebo-controlled study, we investigated in normotensive type 2 diabetics with microalbuminuria the effect of ramipril, an ACE inhibitor, on urine albumin excretion and serum lipids. A total of 1,882 patients were screened for urine microalbumin consecutively by dipstick test, Rapi Tex-Albumin test and RIA. The final 28 normotensive and microalbuminuric patients were assigned to receive either ramipril (1.25 mg/d, n = 16) or placebo (n = 12) for 12 weeks. Throughout the study, both groups had no changes in blood pressure, fasting plasma glucose, HbA1C, serum creatinine and electrolytes and no difference in creatinine clearance. At week 12 only the placebo group showed the significant increment of urine albumin excretion and triacylglycerol (30.6 +/- 38.3 to 39.0 +/- 19.7 and 167 +/- 64 to 208 +/- 77 mg/dl, respectively) but the decrement of HDL-cholesterol (46 +/- 16 to 35 +/- 6 mg/dl). During a 3 month period, increased urine albumin excretion was observed in normotensive type 2 diabetes with microalbuminuria who received only placebo. We conclude that ramipril may arrest the progression of albumin excretion and had favorable effects on serum lipids. Ramipril was safe and well-tolerated without untoward side effects during the study period.

  2. Associations between apolipoprotein CIII concentrations and microalbuminuria in type 2 diabetes

    PubMed Central

    HU, ZHI-JUAN; REN, LU-PING; WANG, CHAO; LIU, BING; SONG, GUANG-YAO

    2014-01-01

    Microalbuminuria (MAU) is a strong predictor of diabetic nephropathy (DN), which is the main cause of morbidity and mortality in patients with diabetes mellitus (DM). Dyslipidemia exists in the majority of patients with DM and contributes to micro- and macrovascular complications associated with DM. Apolipoprotein CIII (apoCIII) is an inhibitor of the activity of lipoprotein lipase, which metabolizes triglyceride (TG) in very low-density lipoprotein (VLDL) and facilitates its clearance from plasma. The aim of the present study was to investigate the associations between apoCIII and MAU and the effects of atorvastatin in type 2 diabetes. In total, 120 subjects were divided into type 2 diabetes and type 2 DN groups, while 60 healthy subjects were selected as controls. The patients with DN were administered 20 mg atorvastatin daily for 16 weeks. Blood pressure, body mass index (BMI) and levels of HbA1c, FBG, TG, VLDL-cholesterol (VLDL-C), apoCIII and MAU were markedly elevated in the type 2 diabetes and type 2 DN groups compared with those in the control group (P<0.01), while high-density lipoprotein-cholesterol (HDL-C) levels were decreased significantly (P<0.01). All patients with type 2 DN showed significantly elevated blood pressure, apoCIII levels, MAU, course of the disease and rate of stroke and retinopathy compared with the patients with type 2 diabetes (P<0.01). MAU was significantly positively correlated with the course of the disease, systolic blood pressure, diastolic blood pressure, BMI and HbA1c, FBG, TG, total cholesterol, low-density lipoprotein-cholesterol, VLDL-C and apoCIII levels (P<0.05), whereas negatively correlated with HDL-C levels (r=−0.194, P=0.020). Logistic regression analysis showed that apoCIII levels were independently associated with MAU (odds ratio, 1.100; 95% confidence interval, 1.037–1.153; P<0.001). Atorvastatin improved the lipid profile and MAU in patients with type 2 DN (P<0.01). Therefore, the present study demonstrated

  3. All Components of Metabolic Syndrome Are Associated with Microalbuminuria in a Chinese Population

    PubMed Central

    Lee, Yi-Yen; Yang, Chih-Kai; Weng, Yi-Ming; Chuang, Chung-Hsun; Yu, Wei; Chen, Jih-Chang; Li, Wen-Cheng

    2016-01-01

    Background and Aim Albuminuria is a well-known predictor of poor renal and cardiovascular outcomes and associated with increased risk of all-cause mortality. The study aimed to evaluate the associations between metabolic characteristics and the presence of albuminuria. Methods This cross-sectional study included 18,384 adult Chinese who participated in health examinations during 2013–2014. Differences in clinical characteristics were compared for microalbuminuria (MAU) and albuminuria, and between genders. Potential risk factors associated with the risk of developing MAU and albuminuria were analyzed using univariate logistic regression. Multiple logistic regression was applied to further identify the independent associations between different levels of risk factors and the presence of MAU and albuminuria. The area under the ROC curve (AUC) was used to determine the discriminatory ability of metabolic risk factors in detecting albuminuria. Results There were significant gender differences in clinical characteristics according to albuminuria status. Risk for the presence of albuminuria was significantly associated with age, male gender, waist circumference (WC), waist-to-height ratio (WHtR), hypertension, fasting plasma glucose (FPG), and triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) in univariate logistic regression. Multiple logistic regression analysis indicated that the factors significantly associated with the presence of MAU were WC > 90cm, WHtR at 0.6–0.7, hypertension, FPG > 6.1 mmole/L, and TG/HDL-C ratio > 1.6. The optimal cutoffs for risk factors of metabolic syndrome (MetS) to predict albuminuria in males and females were: WC, 90.8 vs. 80.0 cm; WHtR, 0.53 vs. 0.52; MAP, 97.9 vs. 91.9 mmHg; FPG, 5.40 vs. 5.28 mmole/L; and TG/HDL-C, 1.13 vs. 1.08. Conclusion MetS and all its components were associated with the presence of MAU in a health check-up population in China. Gender specific and optimal cutoffs for MetS components

  4. The Randomized Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) Observational Follow‐Up Study: Benefits of RAS Blockade With Olmesartan Treatment Are Sustained After Study Discontinuation

    PubMed Central

    Menne, Jan; Ritz, Eberhard; Ruilope, Luis M.; Chatzikyrkou, Christos; Viberti, Giancarlo; Haller, Hermann

    2014-01-01

    Background The Randomized Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study showed that 40 mg Olmesartan medoxomil (OM) versus placebo delayed microalbuminuria onset in patients with type 2 diabetes and normoalbuminuria. Methods and Results One thousand seven hundred and fifty‐eight ROADMAP patients (placebo arm: 877; OM arm: 881) participated in the observational follow up (OFU) with an average of 3.3 years. They received standard medical care and micro‐ and macrovascular events were documented. During observational follow‐up 62.9% and 60.1% in the former OM and placebo group, respectively, received treatment with a RAS blocking agent. During the OFU period the systolic blood pressure (SBP) increased to mean values of 135 mm Hg in both groups. Patients who had developed microalbuminuria during ROADMAP had a higher incidence of cardio‐ and cerebrovascular events (OR 1.77, CI 1.03 to 3.03, P=0.039) during the OFU period compared with patients in whom this was not the case. Diabetic retinopathy was significantly reduced in the former OM group (8 [0.9%] versus 23 [2.6%], OR: 0.34, CI 0.15 to 0.78, P=0.011) and the rate of microalbuminuria was numerically reduced. Congestive heart failure requiring hospitalization (3 [0.3%] versus 12 [1.4%], OR: 0.23, CI 0.06 to 0.85, P=0.027) was reduced and there was a trend of reduced cardio‐/cerebrovascular events (OM versus Pb: 73 [8.3%] versus 86 [9.8%] patients). Seven (0.8%) deaths (including 2 CV events) were reported in former placebo patients versus 3 (0.3%) (non‐CV events) in former OM patients. Conclusions Development of microalbuminuria is a valid marker for future CV events. RAS blockade with Olmesartan might cause sustained reduction (legacy effect) of micro‐ and macrovascular events. PMID:24772521

  5. Is there any effect of bolus and/or infusion 5-fluorouracil treatment on microalbuminuria in immediate or long term?

    PubMed

    Tanriverdi, Ozgur

    2014-07-01

    5-Fluorouracil is a widely used cytotoxic chemotherapeutic agent in the treatment settings particularly in patients with gastrointestinal cancer. Various studies on the cardiac adverse effects of 5-fluorouracil, reported the likelihood of altered myocardial contractility and vascular endothelial damage caused by this agent. However, the mechanism underlying 5-fluorouracil-related cardiotoxicity is not clear. In certain experimental studies, thrombotic processes occurring in microvascular field were supposed to play a role in this condition. In the light of this knowledge, the administration of 5-fluorouracil may be considered to cause renal vascular endothelial damage that may result in the altered endothelial permeability. As a result of endothelial dysfunction, increased urinary albumin excretion may be in question and no study investigating this potential direct relationship has been available in medical literature. Based on this evidence, the hypothesis of that 5-fluorouracil might cause renal vascular dysfunction and microalbuminuria, was discussed in this article along with the basic knowledge. PMID:24755457

  6. The use of the Micral-Test strip to identify the presence of microalbuminuria in people with insulin dependent diabetes mellitus (IDDM) participating in the EUCLID study.

    PubMed

    Webb, D J; Newman, D J; Chaturvedi, N; Fuller, J H

    1996-03-01

    In IDDM, microalbuminuria (urinary albumin excretion rate (AER) of 20-200 micrograms/min) is a predictor of persistent proteinuria and diabetic nephropathy. Early intervention may prevent or reduce the rate of progression of renal complications. The Micral-Test strip can be used to establish a semi-quantitative estimate of AER. We assessed the field performance of the Micral-Test strip in detecting microalbuminuria in the EUCLID study, an European wide, 18 centre study of 530 IDDM participants, aged 20 to 59 years. People with macroalbuminuria were excluded. On entry, all participants had albumin concentrations from two overnight urine collections measured by a central laboratory, and the corresponding Micral-Test performed on the two collections locally. a cut off of > or = mg/l albumin from the first Micral-Test, to detect a centrally measured albumin concentration > or = 20 mg/l, yielded 29 (5.8%) false negative results and 58 (11.6%) false positive results (sensitivity 70%, specificity 87%). The mean AER, from two collections, was compared with the corresponding 'pooled' Micral-Test results (mean of the two readings). Receiver Operating Characteristic (ROC) curves were used to assess if there was a suitable 'pooled' Micral-Test result for screening microalbuminuria. A 'pooled' Micral-Test result (> or = 15 mg/l) was used to detect mean AER > or = 20 micrograms/min (sensitivity 78%, specificity 77%). This 'pooled cut-off' had already been used for screening on to the study and led to an over-estimate (154 vs. 77) of the true number of microalbuminuric participants on the study. In conclusion, our findings suggest that the Micral-Test strip is not an effective screening tool for microalbuminuria, using the 'pooled' result from two measurements did not improve the sensitivity of the test.

  7. Hand vein responses to noradrenaline in normotensive patients with insulin-dependent diabetes mellitus and microalbuminuria: effects of alpha-adrenoceptor blockade with doxazosin.

    PubMed

    Bodmer, C W; Lake, D; Savage, M W; Williams, G

    1999-01-01

    Nephropathy commonly develops in patients with insulin-dependent (type 1) diabetes. Administration of an antihypertensive agent to type 1 diabetes patients with microalbuminuria, the first clinically detectable stage of nephropathy, can help slow renal deterioration. It is postulated that the exaggerated vasoconstrictor response to noradrenaline seen in these patients may be relevant in the development of microalbuminuria. This open, non-comparative pilot study was designed to investigate the effects of the alpha-adrenoceptor antagonist doxazosin on noradrenaline-induced hand vein vasoconstriction and on albumin excretion in 14 normotensive type 1 diabetes patients with microalbuminuria. After a three-week placebo run-in period, patients received doxazosin (1, 2, and then 4 mg once-daily, at two-week intervals) for six weeks, followed by a two-week placebo washout period. Vasoconstrictor responses to noradrenaline were measured in dorsal hand veins at the end of each two-week period. Hand vein vasoconstrictor responses to noradrenaline decreased significantly, compared with placebo, at 4 mg/day doxazosin (p = 0.006). The mean albumin excretion rate was lower than baseline at all doses of doxazosin, but changes did not reach statistical significance. Doxazosin was generally well-tolerated; four patients (29%) reported mild-to-moderate treatment-related adverse events. This study indicates that alpha 1-adrenoceptor blockade can blunt the exaggerated vascular reactivity to noradrenaline in normotensive type 1 diabetes patients with microalbuminuria, and supports further research into a potential role for doxazosin in preventing the development of diabetic nephropathy.

  8. Factors Associated With Serum Albumin in Diabetes Mellitus Type 2 With Microalbuminuria Using Non-Normal Mixed Models: A Prospective Cohort Study

    PubMed Central

    Khoundabi, Batoul; Kazemnejad, Anoshirvan; Mansourian, Marjan; Faghihimani, Elham

    2016-01-01

    Background: The globally increasing epidemic of diabetes will lead to serious problems including diabetic nephropathy and kidney diseases in near future. The first clinical diagnosable stage in a diabetic kidney disease is microalbuminuria (urinary albumin excretion of 30 - 300 g/24 hours). Objectives: This prospective cohort study investigated the risk factors of microalbuminuria in patients with type 2 diabetes who had been registered in endocrine and metabolism research center in Isfahan city, Iran. Patients and Methods: This prospective cohort study was performed on 90 diabetic type 2 patients with microalbuminuria, who were selected according to the consecutive sample selection method during 6 years. Data were collected through regular and systematic measurements of serum albumin as the response variable and body mass index, systolic and diastolic blood pressure, the duration of diabetes, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride (TG), fasting blood sugar (FBS), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) as the related factors. Non-normal mixed models were used to investigate the impact of effective factors on the amount of excreted serum albumin. Results: According to the deviance information criterion (DIC = 56.2), the non-normal mixed effects model with the skewed t distribution had a best fit and indicated that HbA1c, HDL and total cholesterol had a significant effect on the amount of albumin in urine (P < 0.05). Conclusions: Using nonnormal mixed models may lead to the best results as compared to common normality assumption. PMID:26889385

  9. Microalbuminuria in rheumatoid arthritis in the post penicillamine/gold era: association with hypertension, but not therapy or inflammation.

    PubMed

    Daoussis, Dimitrios; Panoulas, Vasileios F; John, Holly; Toms, Tracey E; Antonopoulos, Ioannis; Treharne, Gareth; Nightingale, Peter; Douglas, Karen M J; Kitas, George D

    2011-04-01

    Rheumatoid arthritis (RA) associates with excess cardiovascular (CV) morbidity and mortality. New screening tools are needed to better identify patients at increased CV risk. Microalbuminuria (MA) has been shown to associate with inflammation and future cardiovascular disease (CVD). In the present study, we assessed the prevalence of MA in a secondary care cohort of RA patients, aimed to identify factors associated with its presence and addressed its relationship to CVD and the metabolic syndrome (MetS). A total of 342 RA patients were studied. MA was defined as an albumin-creatinine ratio ≥22 (males) or ≥31 (females) milligrams per gram creatinine. The independence of the associations of MA was evaluated using binary logistic regression analysis. Prevalence of MA was 11.9%. Subjects with MA had increased prevalence of hypertension (HT), insulin resistance and type 2 diabetes. In binary logistic regression, only HT (OR = 5.22, 95%CI: 1.51-18.07, p = 0.009) was significantly associated with MA. There was no association between prevalent CVD and MA, but patients with MA had twofold increased odds of having the MetS. MA is relatively common in RA patients and is independently associated with the presence of HT. Given the association of MA with MetS, future prospective studies are needed to establish the use of MA as a screening tool for RA patients at increased CVD risk. PMID:20396921

  10. TUBERCULOSIS COMO ENFERMEDAD OCUPACIONAL

    PubMed Central

    Mendoza-Ticona, Alberto

    2014-01-01

    Existe evidencia suficiente para declarar a la tuberculosis como enfermedad ocupacional en diversos profesionales especialmente entre los trabajadores de salud. En el Perú están normados y reglamentados los derechos laborales inherentes a la tuberculosis como enfermedad ocupacional, como la cobertura por discapacidad temporal o permanente. Sin embargo, estos derechos aún no han sido suficientemente socializados. En este trabajo se presenta información sobre el riesgo de adquirir tuberculosis en el lugar de trabajo, se revisan las evidencias para declarar a la tuberculosis como enfermedad ocupacional en trabajadores de salud y se presenta la legislación peruana vigente al respecto. PMID:22858771

  11. Myocardial infarction worsens glomerular injury and microalbuminuria in rats with pre-existing renal impairment accompanied by the activation of ER stress and inflammation.

    PubMed

    Dong, Zhifeng; Wu, Penglong; Li, Yongguang; Shen, Yuan; Xin, Ping; Li, Shuai; Wang, Zhihua; Dai, Xiaoyan; Zhu, Wei; Wei, Meng

    2014-12-01

    Deterioration of renal function occurs after chronic heart failure in approximately one-third of patients, particularly in those with pre-existing renal impairment such as diabetic nephropathy. Impaired renal function in these patients is always associated with a worse prognosis. However, the mechanisms underlying such deterioration of renal function are still largely unknown. In three separate protocols, we compared 1) sham operation (Ctr, n = 10) with surgically induced myocardial infarction (MI, n = 10); 2) unilateral nephrectomy (UNX, n = 10) with UNX + MI (n = 10); and 3) STZ-induced type 1 diabetes (DB, n = 10) with DB + MI (n = 10). The differences between combined injury models (UNX + MI, DB + MI) and simple MI were also examined. Renal remodeling, function, ER stress (CHOP and GRP78) and inflammation (infiltration of inflammatory cells, NF-κB p65) were evaluated 12 weeks after MI. In common SD rats, MI activated less glomerular ER stress and inflammation, resulting in a minor change of glomerular remodeling and microalbuminuria. However, MI significantly increased the glomerular expression of GRP78 and CHOP in UNX and DB rats. In addition, it also promoted the infiltration of CD4+ T cells, particularly inflammatory cytokine (IFN-γ, IL-17, IL-4)-producing CD4+ T cells, and the expression of NF-κB p65 in the glomeruli. By contrast, significant glomerular fibrosis, glomerulosclerosis, podocyte injury and microalbuminuria were found in rats with UNX + MI and DB + MI. MI significantly increased chronic glomerular injury and microalbuminuria at 12 weeks in rats with pre-existing renal impairment, i.e., UNX and DB, but not common SD rats. These changes were accompanied by increased glomerular ER stress and immune-associated inflammation.

  12. Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors

    PubMed Central

    Thiel, Gilbert T; Nolte, Christa; Tsinalis, Dimitrios; Steiger, Jürg; Bachmann, Lucas M

    2016-01-01

    Objectives To assess the role of nephrectomy as a risk factor for the development of hypertension and microalbuminuria. Design Prospective, long-term follow-up study. Setting Swiss Organ Living-Donor Health Registry. Participants All living kidney donors in Switzerland between 1993 and 2009. Interventions Data on health status and renal function before 1 year and biennially after donation were collected. Primary and secondary outcome measures Comparison of 1-year and 5-year occurrences of hypertension among normotensive donors with 1-year and 5-year estimates from the Framingham hypertension risk score. Multivariate random intercept models were used to investigate changes of albumin excretion after donation, correcting for repeated measurements and cofactors such as age, male gender and body mass index. Results A total of 1214 donors contributed 3918 data entries with a completed biennial follow-up rate of 74% during a 10-year period. Mean (SD) follow-up of donors was 31.6 months (34.4). Median age at donation was 50.5 years (IQR 42.2–58.8); 806 donors (66.4%) were women. Donation increased the risk of hypertension after 1 year by 3.64 (95% CI 3.52 to 3.76; p<0.001). Those participants remaining normotensive 1 year after donation return to a risk similar to that of the healthy Framingham population. Microalbuminuria before donation was dependent on donor age but not on the presence of hypertension. After nephrectomy, hypertension became the main driver for changes in albumin excretion (OR 1.19; 95% CI 0.13 to 2.25; p=0.03) and donor age had no effect. Conclusions Nephrectomy propagates hypertension and increases susceptibility for the development of hypertension-induced microalbuminuria. PMID:27006347

  13. Statin Use and the Presence of Microalbuminuria. Results from the ERICABEL Trial: A Non-Interventional Epidemiological Cohort Study

    PubMed Central

    van der Tol, Arjan; Van Biesen, Wim; Van Laecke, Steven; Bogaerts, Kris; De Lombaert, Koen; Warrinnier, Hans; Vanholder, Raymond

    2012-01-01

    Background Microalbuminuria (MAU) is considered as a predictor or marker of cardiovascular and renal events. Statins are widely prescribed to reduce cardiovascular risk and to slow down progression of kidney disease. But statins may also generate tubular MAU. The current observational study evaluated the impact of statin use on the interpretation of MAU as a predictor or marker of cardiovascular or renal disease. Methodology/Principal Findings We used cross-sectional data of ERICABEL, a cohort with 1,076 hypertensive patients. MAU was defined as albuminuria ≥20 mg/l. A propensity score was created to correct for “bias by indication” to receive a statin. As expected, subjects using statins vs. no statins had more cardiovascular risk factors, pointing to bias by indication. Statin users were more likely to have MAU (OR: 2.01, 95%CI: 1.34–3.01). The association between statin use and MAU remained significant after adjusting for the propensity to receive a statin based on cardiovascular risk factors (OR: 1.82, 95%CI: 1.14–2.91). Next to statin use, only diabetes (OR: 1.92, 95%CI: 1.00–3.66) and smoking (OR: 1.49, 95%CI: 0.99–2.26) were associated with MAU. Conclusions Use of statins is independently associated with MAU, even after adjusting for bias by indication to receive a statin. In the hypothesis that this MAU is of tubular origin, statin use can result in incorrect labeling of subjects as having a predictor or marker of cardiovascular or renal risk. In addition, statin use affected the association of established cardiovascular risk factors with MAU, blurring the interpretation of multivariable analyses. PMID:22359611

  14. Suggested mechanism for the selective excretion of glucosylated albumin. The effects of diabetes mellitus and aging on this process and the origins of diabetic microalbuminuria.

    PubMed

    Kowluru, A; Kowluru, R; Bitensky, M W; Corwin, E J; Solomon, S S; Johnson, J D

    1987-11-01

    In previous studies in the Sprague-Dawley rat, Williams and coworkers reported the phenomenon of selective urinary excretion of glucosylated albumin (editing, i.e., the percent glucosylation of urinary albumin is more than that of plasma albumin) by the mammalian kidney. Ghiggeri and coworkers subsequently found that the extent of editing is reduced in human diabetics. Moreover, the reduction in editing in diabetes correlates inversely with levels of microalbuminuria. We also find reduction in the extent of editing in diabetic humans. We find a striking inverse correlation not only with the magnitude of microalbuminuria but also with the extent of plasma albumin glucosylation. In contrast, we found little correlation between the reduction in editing and the duration of diabetes in human subjects. Stz induced diabetes in the Sprague-Dawley rat is associated with a striking and rapid reduction in editing which develops virtually with the same kinetics exhibited by the appearance of hyperglycemia. This loss of editing is rapidly reversed by daily administration of insulin but not by aldose reductase inhibitors. Mannitol infusion in anesthetized Wistar rats resulted in an increase in urine volume, GFR, and microalbuminuria, and was also accompanied by a marked reduction in editing. This reduction was rapidly reversed by a cessation of mannitol infusion. We propose here that glucosylated albumin (in contrast to unmodified albumin) is not reabsorbed by the proximal tubule, and thus, is preferentially excreted in the urine. We postulate that the increase in GFR which emerges as a consequence of increased plasma osmolality in diabetes mellitus delivers more albumin to the proximal tubule than can be reabsorbed. This results in a dilution of excreted glucosylated albumin molecules by excreted unmodified albumin, which appears as the early microscopic albuminuria of diabetes. Paradoxically, the fall in apparent editing is accompanied by an absolute increase in the total

  15. A pilot study for evaluation of the efficacy and safety of telmisartan in reducing microalbuminuria in hypertensive patients with type 2 diabetes mellitus.

    PubMed

    Kulkarni, R B; Kulkarni, B N; Hariharan, R S; Naikwadi, Akram; Gawde, Ashish; Baliga, Vidyagauri; Desai, Anish

    2005-03-01

    To evaluate efficacy and tolerability of telmisartan, an angiotensim II receptor blocker, in reducing microalbuminuria in adult Indian hypertensive patients with type 2 diabetes mellitus, a prospective, open-label, non-comparative, assessor-blind, multicentric, pilot study was conducted in 60 eligible hypertensive patients with type 2 diabetes mellitus and microalbuminuria after obtaining their informed consent. The study was approved by the respective institutional review boards. Each patient received telmisartan 40 mg initially once daily for first 4 weeks which was titrated upwards to 80 mg once daily for the next 8 weeks. Blood pressure was assessed at the end of every 2 weeks and urinary albumin excretion and creatinine clearance were measured at baseline and after 12 weeks of therapy. Safety outcome measures included monitoring of physical examination, laboratory parameters and monitoring treatment-emergent adverse events. Fifty-five patients completed the study while 5 cases were lost to follow-up. The mean age of the patients was 48.27 years. Of the total patients 63.6% were males and 46.4% were females. At baseline the mean urinary albumin excretion rate was 131.81 +/- 38.82 mg/minute. A statistically significant (p < 0.05) reduction (32.96%) in urinary albumin excretion rate occurred after 12 weeks of therapy (118.36 +/- 37.22). The mean pre-study systolic blood pressure was 165.05 +/- 15.24 mmHg which was significantly (p < 0.05) reduced to 123.72 +/- 5.88 mmHg at the end of 12 weeks. At baseline the mean diastolic blood pressure was 103.55 +/- 9.84 mmHg which was significantly (p < 0.05) reduced to 84.71 +/- 8.54 mmHg. The JNC-VII goal of blood pressure below 130/80 was achieved in 34 (61.8%)of the 55 patients at the end of 12 weeks. Both fasting and postprandial blood sugar levels were well-controlled at the end of the study. Telmisartan was well tolerated with only 9.09% of the patients reported mild and transient adverse events like fatigue

  16. Long term reduction of microalbuminuria after 1 year of angiotensin converting enzyme inhibition by perindopril in hypertensive insulin-treated diabetic patients.

    PubMed

    Brichard, S M; Santoni, J P; Thomas, J R; van de Voorde, K; Ketelslegers, J M; Lambert, A E

    1990-01-01

    We studied the effects of perindopril, an angiotensin converting enzyme (ACE) inhibitor administered during 12 months, on creatinine clearance, albuminuria and glycaemic control in diabetic subjects with mild to moderate hypertension. After 1 month placebo, 40 insulin-treated patients were divided into 3 groups based upon their urinary albumin excretion rate (AER). Group I had a normoalbuminuria (AER less than 15 mg/24 h), group II had a microalbuminuria (AER : 15-150 mg/24 h) and group III had a macroproteinuria (AER greater than 150 mg/24 h and Albustix (+)). They were given perindopril, 4 to 8 mg orally once daily, and received a stable diet. Diastolic blood pressure was normalized within the first 3 months in 80% of the patients. From these, 28 (14.7 and 7 from groups I, II and III respectively) were followed during a total active treatment period of 12 months. They were matched for age, duration of diabetes and hypertension, systolic and diastolic blood pressures, daily insulin dose, postprandial plasma C-peptide and quality of glycaemic control. Mean supine diastolic blood pressure was decreased by 15 and 18% at 1 and 12 months respectively. Heart rate was not significantly modified. At 3 months, plasma ACE activity was nearly totally inhibited while plasma renin activity was markedly increased. In patients of group II, microalbuminuria was reduced from 66 +/- 13 (mean +/- SEM after placebo) to 39 +/- 6 mg/24 h after 1 month perindopril and this effect was maintained at 12 months. In group I, albuminuria remained within the normal range. In group III, macroproteinuria was not consistently modified by perindopril.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Long-Term Effects of Irbesartan Treatment and Smoking on Nucleic Acid Oxidation in Patients With Type 2 Diabetes and Microalbuminuria

    PubMed Central

    Broedbaek, Kasper; Henriksen, Trine; Weimann, Allan; Petersen, Morten; Andersen, Jon T.; Afzal, Shoaib; Jimenez-Solem, Espen; Persson, Frederik; Parving, Hans-Henrik; Rossing, Peter; Poulsen, Henrik E.

    2011-01-01

    OBJECTIVE We tested whether long-term treatment with the angiotensin II receptor antagonist irbesartan reduces nucleic acid oxidation in patients with type 2 diabetes and microalbuminuria. RESEARCH DESIGN AND METHODS The Irbesartan in Patients With Type 2 Diabetes and Microalbuminuria (IRMA 2) study was a 2-year multicenter randomized double-blind trial comparing irbesartan (150 and 300 mg once daily) with placebo. We studied a subgroup of 50 patients where urine samples were available for analysis of albumin and the oxidatively modified guanine nucleosides 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodG) and 8-oxo-7,8-dihydroguanosine (8-oxoGuo). RESULTS During the 2-year trial, no significant differences in 8-oxodG and 8-oxoGuo excretions between placebo and irbesartan treatment were seen. 8-oxodG and albumin excretion decreased with time (P = 0.0004 and P < 0.0001, respectively), whereas treatment-related differences were shown for albumin excretion (P = 0.0008) only, as previously reported. Important secondary findings were significant associations between changes in 8-oxodG excretion and changes in albumin excretion and glycated hemoglobin (HbA1c). During the study period, 8-oxodG excretion decreased by 3 and 26% in smokers and nonsmokers, respectively (P = 0.015), and urinary albumin excretion decreased 22% in smokers and 58% in nonsmokers (P = 0.011). CONCLUSIONS Irbesartan treatment was not significantly more effective than placebo in reducing nucleic acid oxidation. The results indicate that DNA oxidation in diabetes patients is reduced by various components in the treatment of diabetes where glycemic control seems to be important and addition of angiotensin II receptor antagonists does not lead to any substantial additional reduction. Furthermore, the reductions in DNA oxidation and albumin excretion seem to be counteracted by smoking. PMID:21454798

  18. Relationship between urinary albumin excretion rate and renal histology in non-insulin-dependent diabetes mellitus: with reference to the clinical significance of microalbuminuria.

    PubMed

    Inomata, S; Nakamoto, Y; Inoue, M; Itoh, M; Ohsawa, Y; Masamune, O

    1989-01-01

    The present study demonstrates the relationship between urinary albumin excretion rate (AER) and renal structural changes in patients with non-insulin-dependent diabetes mellitus (NIDDM) without clinical proteinuria. Resting AER in 30 control subjects and 67 NIDDM patients were 10.4 +/- 4.8 (mean +/- SD) micrograms/min (range 4.3-21.1 micrograms/min) and 26.4 +/- 32.3 micrograms/min (range 0.4-155 micrograms/min), respectively. Persistent normoalbuminuria (less than 20 micrograms/min) and microalbuminuria (20-200 micrograms/min) were found in 43 (Group A) and 24 (Group B) diabetics. There were significant differences in age, diabetes duration, and frequency of retinopathy (background and proliferative) as well as that of proliferative retinopathy between Groups A and B, but not in the other clinical parameters such as body mass index, HbA1, Ccr, or systolic and diastolic blood pressure (SBP, DBP). When compared with 11 normoalbuminuric patients of similar age and equal diabetes duration to those in Group B, the sole difference in clinical parameters was the existence of proliferative retinopathy in Group B. Renal structural changes were investigated by light microscopy in 14 people in Group A and 13 people in Group B, and additionally in 5 NIDDM patients with both macroalbuminuria (greater than or equal to 200 micrograms/min) and normal or nearly normal renal function (Group C). The diffuse glomerular lesion (Gellman's classification) was grade I or II in A, II or III in B, and III in C.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Blood pressure‐lowering effects of sulodexide depend on albuminuria severity: post hoc analysis of the sulodexide microalbuminuria and macroalbuminuria studies

    PubMed Central

    Heerspink, Hiddo J. L.; de Zeeuw, Dick; Vogt, Liffert

    2016-01-01

    Aims It has been suggested that sulodexide is able to lower blood pressure (BP). This may be attributed to its ability to restore the endothelial surface layer (ESL). As ESL perturbation is known to be related to the degree of kidney damage, we investigated whether albuminuria, reflecting ESL status, modified the BP‐lowering potential of sulodexide. Methods A post hoc analysis of the double‐blind, randomized, placebo‐controlled sulodexide microalbuminuria (Sun‐MICRO) and macroalbuminuria (Sun‐MACRO) studies, including 1056 microalbuminuric and 843 macroalbuminuric subjects with type 2 diabetes receiving maximal tolerated renin–angiotensin‐aldosterone system inhibitor therapy, was carried out. We compared the effect of placebo and sulodexide on systolic BP (SBP) among albuminuria groups. Results Analysis of covariance, including data from both trials, showed that baseline urine albumin‐to‐creatinine ratio (UACR) was the only modifier of the SBP response (interaction with treatment P = 0.001). In subjects with an UACR >1000 mg g–1, sulodexide lowered SBP by 4.6 mmHg [95% confidence interval (CI) 3.6, 5.6; P < 0.001] compared with placebo, whereas a 2.3 mmHg (95% CI 0.9,3.7; P = 0.001) reduction was seen in subjects with a UACR of 300–1000 mg g–1. Sulodexide did not lower SBP in subjects with a UACR <300 mg g–1 (−0.2 mmHg, 95% CI −0.8, 0.5; P = 0.60). SBP‐lowering effects were not accompanied by changes in body weight. Conclusion The BP‐reducing potency of sulodexide is modified by the degree of albuminuria in subjects with type 2 diabetes. As ESL status deteriorates with increasing albuminuria and nephropathy severity, this suggests that ESL restoration may represent a new target for BP treatment in subjects with diabetic nephropathy. PMID:27412828

  20. NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis

    PubMed Central

    2011-01-01

    Intensive multifactorial treatment aimed at cardiovascular (CV) risk factor reduction in type 2 diabetic patients with microalbuminuria can diminish fatal and non-fatal CV. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the utility of P-NT-proBNP in screening for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment. Methods and Results P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score ≥400, carotid intima-media thickness (CIMT) > 0.90 mm, ankle-brachial index < 0.90, and/or toe-brachial index < 0.64, respectively. Carotid artery compliance was also determined and the reactive hyperaemia index (RHI) measured by peripheral artery tonometry was used as a surrogate for endothelial function. P-NT-proBNP was associated with atherosclerosis in the unadjusted analysis, but not after adjustment for conventional risk factors. P-NT-proBNP was not associated with vascular dysfunction. The prevalence of atherosclerosis in the coronary, carotid and peripheral arteries was 35%, 10% and 21% of all patients, respectively. In total 49% had atherosclerosis in one territory and 15.6% and 1.0% in two and three territories. Low RHI was an independent predictor of coronary atherosclerosis (odds ratio [CI], 2.60 [1.15-5.88] and systolic blood pressure was the only independent determinant of CIMT (0.02 mm increase in CIMT per 10 mmHg increase in systolic blood pressure [p = 0.003]). Conclusions Half of asymptomatic patients with type 2 diabetes mellitus and microalbuminuria had significant

  1. Estadísticas de visitas en portales web institucionales como indicador de respuesta del público a propuestas de divulgación

    NASA Astrophysics Data System (ADS)

    Lares, M.

    The presence of institutions on the internet is nowadays very important to strenghten communication channels, both internal and with the general public. The Córdoba Observatory has several web portals, including the official web page, a blog and presence on several social networks. These are one of the fundamental pillars for outreach activities, and serve as communication channel for events and scientific, academic, and outreach news. They are also a source of information for the staff, as well as data related to the Observatory internal organization and scientific production. Several statistical studies are presented, based on data taken from the visits to the official web pages. I comment on some aspects of the role of web pages as a source of consultation and as a quick response to information needs. FULL TEXT IN SPANISH

  2. Como Lo Hago Yo: Myelomeningocele

    PubMed Central

    Lazareff, Jorge

    2014-01-01

    Fortificación con ádico fólico es efectiva, pero aún falta conciencia en los jóvenes. La legalidad del aborto aumenta la importancia de la consulta prenatal. Realizo la cirugía bajo microcoscopio por razones didácticas. Irrigación continua para reducir la temperatura del tejido. Trato a la plaqueta como tejido viable. No suturo la plaqueta. No cierro músculo. ATB por una semana después de cirugía. Hidrocefalia: Válvula en todos los casos de ventriculomegalia. Médula anclada: Desanclar una sola vez. Chiari II: Revisar la válvula. Incluir en el seguimiento rendimiento escolar, puede indicar obstrucción de la válvula o médula anclada. PMID:24791217

  3. Increased plasma serotonin metabolite 5-hydroxyindole acetic acid concentrations are associated with impaired systolic and late diastolic forward flows during cardiac cycle and elevated resistive index at popliteal artery and renal insufficiency in type 2 diabetic patients with microalbuminuria.

    PubMed

    Saito, Jun; Suzuki, Eiji; Tajima, Yoshitaka; Takami, Kazuhisa; Horikawa, Yukio; Takeda, Jun

    2016-01-01

    Although lower extremity arterial disease is frequently accompanied by diabetes mellitus, the association of circulating biomarkers with flow components during the cardiac cycle in lower-leg arteries has yet to be fully elucidated. We enrolled 165 type 2 diabetic patients with normal ankle-brachial index (ABI 1.0-1.4), comprising 106 normoalbuminuric and 59 microalbuminuric patients, and 40 age-matched nondiabetic subjects consecutively admitted to our hospital. Serum high sensitivity C-reactive protein (hsCRP) level and plasma von Willebrand factor ristocetin cofactor activity (VWF) and vasoconstrictor serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) concentrations were measured. An automatic device was used to measure ABI and brachial-ankle pulse wave velocity (baPWV). Flow components during the cardiac cycle, total flow volume, and resistive index at popliteal artery were evaluated using gated magnetic resonance imaging. Although estimated glomerular filtration rate (eGFR), early diastolic flow reversal, heart rate, and ABI were similar between the groups, diabetic patients had higher log hsCRP (p<0.001), VWF (p<0.001), 5-HIAA (p=0.002), resistive index (p<0.001) and baPWV (p<0.001) and lower systolic (p=0.026) and late diastolic (p<0.001) forward flows and total flow volume (p<0.001) than nondiabetic subjects. Multivariate analyses demonstrated that 5-HIAA in microalbuminuric patients showed higher associations with systolic and late diastolic forward flows during the cardiac cycle, total flow volume and resistive index at popliteal artery, and eGFR compared to normoalbuminuric patients. In microalbuminuric patients, 5-HIAA was a significant independent determinant among these factors. Thus, increased plasma 5-HIAA levels are involved in the pathogenesis of impaired blood flow in lower extremities and renal insufficiency in diabetic patients with microalbuminuria.

  4. Como Lo Hago Yo: Mielomeningocele En Bolivia

    PubMed Central

    Dabdoub, Carlos F.; Dabdoub, Carlos B.; Villavicencio, Ramiro; Quevedo, Germán

    2014-01-01

    Introducción: Las malformaciones del tubo neural (MTN) representan la segunda causa más frecuente de anomalías congénitas, luego de las cardiopatías. En este grupo se destaca el mielomeningocele (MMC) por su mayor incidencia, y por ser la más incapacitante y la más compleja entre todas las demás malformaciones del sistema nervioso c`entral (SNC). En Bolivia, como en muchos países de Sudamérica, los bajos niveles socio-culturales y la debilidad en el sistema sanitario, hacen que su incidencia y su morbilidad, sean mayores que en las naciones más desarrolladas. Material y Métodos: Se realizó un estudio retrospectivo y descriptivo de 70 casos de MMC, atendidos por un equipo multidisciplinario en el Hospital Universitario Japonés (HUJ) de Santa Cruz de la Sierra, entre 2008-2011. De ellos, 60 fueron intervenidos quirúrgicamente. Resultados: Se realizaron controles prenatales sólo en 27 mujeres (38.6%), diagnosticándose una disrafia espinal en apenas dos casos (7.4%). La edad de ingreso del MMC en su mayoría fue después de las 24 horas (65.6%), predominando su localización en la región lumbosacra (64.3%). De ellos, 67.2% eran abiertos, presentando un 32.9% un daño neurológico motor parcial mientras que 47.1% tenían paraplejia por debajo de la lesión. De los 70 casos, tres (4.3%) no fueron intervenidos, por presentar defectos congénitos severos o estado general grave. Las principales complicaciones posoperatorias inmediatas fueron: dehiscencia de sutura y/o infección de la herida (16.6%), fístula de líquido cefalorraquídeo (LCR) (10%) e infección del SNC (11.7%). La mortalidad general y postoperatoria fue de 7.1% y 3.3%, respectivamente. Al mes de vida presentaban hidrocefalia un 80% de los pacientes operados, colocándose una derivación ventriculoperitoneal (DVP) de presión media. De 9 pacientes que tuvieron un acompanamiento de dos o más años, seis presentaron una médula anclada, que fueron intervenidas quirúrgicamente. Conclusi

  5. Indicadores de actividad estelar

    NASA Astrophysics Data System (ADS)

    Cincunegui, C. C.; Mauas, P.

    There is a strong correlation between some solar activity indexes and average Earth temperature measurements. Thus, determining the range of variation of the solar constant over the years becomes very important. One way to do so, is to consider a large sample of stars with characteristics similar to those of the Sun, and analyze how the activity levels change from one star to another. With this technique one can infer activity variations that may occur over longer periods of time than the ones allowed by direct observations of the Sun. The main index used to measure stellar activity is the flux in the Ca II H and K lines, which are formed in the star's chromosphere. However, these lines are in the blue side of the spectrum, and are, therefore, not useful to study very cool stars, which are intrinsically faint and very red. In this work observations made at CASLEO are presented. Flux calibration of these lines was done in the usual way. We investigate possible correlations between the Ca II line fluxes and those of lines of longer wavelength, which may allow us to study the variability of stars cooler than the Sun.

  6. 15. Como gatehouse (outlet tower) and access bridge, looking west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. Como gatehouse (outlet tower) and access bridge, looking west from dam crest (Trash rack visible in reservoir pool behind and right of tower) - Bitter Root Irrigation Project, Como Dam, West of U.S. Highway 93, Darby, Ravalli County, MT

  7. Harold Varmus investido bajo juramento como 14.º director d

    Cancer.gov

    Ganador del Premio Nobel, doctor Harold E. Varmus, prestó juramento hoy como 14.º director del Instituto Nacional del Cáncer (NCI).  "Es muy estimulante que estés de regreso con nosotros", dijo la secretaria del Departamento de Salud y Servicios Humanos K

  8. LA BIOÉTICA COMO QUEHACER FILOSÓFICO

    PubMed Central

    Ferrer, Jorge José

    2009-01-01

    El artículo examina el estatuto epistemológico de la bioética como disciplina académica. El autor sostiene que el estatuto epistemológico de un discurso lo determina la pregunta fundamental que se plantea y la respuesta que se busca, focos integradores del discurso. En el caso de la bioética, la pregunta fundamental es de índole moral. La bioética es pues una disciplina ética que tiene su hogar epistemológico en la filosofía. El autor también defiende el concepto de “éticas aplicadas”. Sugiere finalmente que el método de la bioética, sobre todo la que se hace desde nuestras latitudes, debería adoptar el círculo hermenéutico como metodología para su filosofar. PMID:20463860

  9. Recent DDT and PCB contamination in the sediment and biota of the Como Bay (Lake Como, Italy).

    PubMed

    Bettinetti, R; Quadroni, S; Boggio, E; Galassi, S

    2016-01-15

    Due to its peculiar geographical and morphological characteristics, Lake Como (Northern Italy) represents an interesting study-case for investigating the sub-basin scale circulation of persistent organic pollutants (POPs) that, despite being banned since the 1970s, have reached surprisingly high concentrations in some southern alpine lakes as a consequence of their release from melting glaciers in recent years. In particular, the Como Bay, which is located in the city of Como, seems noteworthy because its waters have a longer residence time than the other areas of the lake. The analyses of the historical concentration of PCBs, pp′DDT and its metabolites in a sediment core sampled from the Como Bay covering a time-period from their ban to recent times, showed that the DDTs have never experienced a significant (p < 0.05) decrease over time, with concentrations of the most abundant homologue, pp′DDE, ranging from 27 to 75 ng g(-1) d.w. Conversely PCBs significantly (p < 0.05) decreased towards recent times, reaching concentrations around 80 ng g(-1) d.w. The contribution of high altitude and local sources was recorded also in the food web: both zooplankton and the zooplanktivorous fish agone were mainly contaminated by pp′DDE (81.4 ng g(-1) w.w. and 534.6 ng g(-1) w.w. respectively) and by the PCB metabolite hexa-CB (449.7 ng g(-1) w.w. and 1672.1 ng g(-1) w.w. respectively). The DDT concentrations in the agone (sampled during the years 2006–2009) never exceeded the limits for human consumption in Italy, while concentrations of six selected PCBs exceeded human health advisory recommendations in one of the fish samples analysed, when it was approximately two times higher than the recommended value of 125 ng g(-1) w.w.

  10. Valorisation of Como Historical Cadastral Maps Through Modern Web Geoservices

    NASA Astrophysics Data System (ADS)

    Brovelli, M. A.; Minghini, M.; Zamboni, G.

    2012-07-01

    Cartographic cultural heritage preserved in worldwide archives is often stored in the original paper version only, thus restricting both the chances of utilization and the range of possible users. The Web C.A.R.T.E. system addressed this issue with regard to the precious cadastral maps preserved at the State Archive of Como. Aim of the project was to improve the visibility and accessibility of this heritage using the latest free and open source tools for processing, cataloguing and web publishing the maps. The resulting architecture should therefore assist the State Archive of Como in managing its cartographic contents. After a pre-processing consisting of digitization and georeferencing steps, maps were provided with metadata, compiled according to the current Italian standards and managed through an ad hoc version of the GeoNetwork Opensource geocatalog software. A dedicated MapFish-based webGIS client, with an optimized version also for mobile platforms, was built for maps publication and 2D navigation. A module for 3D visualization of cadastral maps was finally developed using the NASA World Wind Virtual Globe. Thanks to a temporal slidebar, time was also included in the system producing a 4D Graphical User Interface. The overall architecture was totally built with free and open source software and allows a direct and intuitive consultation of historical maps. Besides the notable advantage of keeping original paper maps intact, the system greatly simplifies the work of the State Archive of Como common users and together widens the same range of users thanks to the modernization of map consultation tools.

  11. 78 FR 36163 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ..., thermal cover, old growth, and visual quality. DATES: Comments concerning the scope of the analysis must... document and disclose the effects analysis of the proposed Como Forest Health Project (Como FHP). The Como... carried through the analysis because existing conditions in the project area do not meet forest...

  12. Geophysical investigations of the Olonium Roman site (Northern Como Lake)

    NASA Astrophysics Data System (ADS)

    Arlsan, Ermanno; Biella, Giancarlo; Boniolo, Graziano; Caporusso, Donatella; de Franco, Roberto; Lozej, Alfredo; Veronese, Luigi

    1999-03-01

    The study area is located at S. Agata (Gera Lario), a small center at the northern end of Como Lake, near the junction of Valchiavenna and Valtellina Valleys. This site played a strategic role since ancient times, providing the control on the communications routes to both the Como Lake and the Spluga and Septimer alpine passes. Since the end of the last century archaeological findings are reported in literature, also supported, from the early XI century, by archival documents confirming the existence of the `Olonium' settlement, an administrative and fiscal center of primary importance, as well as a parish amongst the most influential in the Como Lake area. Within an area of 45,000 m 2 an electrical survey has been carried out in conjunction with magnetic and GPR investigations. These studies have indicated the presence of a number of sub-areas characterized by significant anomalies defined by the overlapping of the results obtained from two or more geophysical methods. In two of such sub-areas, excavation tests have been conducted, which have brought to light a number of archaeological findings of interest. In one of the two sub-areas, which is characterized by the superimposition of electrical and radar anomalies, a deposit of large pebbles has been found. The origin of this deposit has not been ascertained, whether it is of fluvial origin, related to the deviation of the Adda river in the Pian di Spagna region in Roman times, or it is part of reclamation works, still of Roman times, of paleolacustrine marshes. The overlapping stratigraphy, however, suggests the development of fluvial channels between Roman and Low-Medieval times. In the other sub-area, excavations were carried out on sites defined by electrical and radar anomalies, and confirmed by the results from magnetic survey. The excavations brought to light, below the fluvial deposits, a large medieval edifice, which could be identified as the S. Stefano church abandoned in 1444. The church is built on

  13. 78 FR 38287 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-26

    .... Correction In the Federal Register of June 17, 2013, in FR DOC 2013- 14229 on page 36163 in the second column... Forest Service Bitterroot National Forest, Darby Ranger District, Como Forest Health Project AGENCY: Forest Service. ACTION: Notice; Correction. SUMMARY: The Department of Agriculture (USDA), Forest...

  14. Como preparar un programa de informacion sobre la asistencia economica (Planning a Financial Aid Awareness Program).

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    This booklet, written in Spanish, is intended to be used with a set of slides as part of a presentation to students on "How To Apply for Federal Student Aid" ("Como Solicitar la Asistencia Economica Federal para Estudiantes"). The first part of the book is a script based on the slides. After the script is a guide to hosting a financial aid…

  15. Cúmulos globulares como trazadores de bimodalidad estelar en galaxias cD

    NASA Astrophysics Data System (ADS)

    Forte, J. C.

    Se muestra que tanto la forma de los perfiles de brillo como de color observados en dos galaxias arquetípicas de tipo cD (NGC 1399 y NGC 4486) son compatibles con la presencia de poblaciones estelares bi-modales que comparten la misma distribución espacial y composición química de las familias dominantes de cúmulos globulares asociadas con ellas. El modelo resultante también predice una variación de la frecuencia específica de los cúmulos como función del radio galactocéntrico. Se discute este resultado en el contexto de una variedad de escenarios astrofísicos que intentan describir la formación de galaxias cD.

  16. Indicadores educacionales (Educational Indicators). ERIC Digest.

    ERIC Educational Resources Information Center

    Lashway, Larry

    Educators use informal theories and assumptions to guide their actions, yet often fail to evaluate these beliefs. This ERIC Digest in Spanish examines the nature and purpose of educational-indicator systems and discusses the design of report cards by which schools can inform the public of their performance. An indicator is any statistic that casts…

  17. Prevalence of previously undiagnosed abdominal aortic aneurysms in the area of Como: the ComoCuore "looking for AAA" ultrasonography screening.

    PubMed

    Corrado, Giovanni; Durante, Alessandro; Genchi, Vincenzo; Trabattoni, Loris; Beretta, Sandro; Rovelli, Enza; Foglia-Manzillo, Giovanni; Ferrari, Giovanni

    2016-08-01

    The prognosis for abdominal aortic aneurysm (AAA) rupture is poor. Long-term follow-up of population-based randomized trials has demonstrated that ultrasound (US) screening for abdominal aortic aneurysms (AAAs) measuring 3 cm or greater decreases AAA-related mortality rates and is cost-effective. We though to prospectively perform during a 26-month period a limited US examination of the infrarenal aorta in volunteers of both gender aged 60-85 years without history of AAA living in the area of Como, Italy. From September 2010 to November 2013 ComoCuore, a no-profit nongovernmental association, enrolled 1555 people (aged 68.8 ± 6.8 years; 48.6 % males). Clinical data and a US imaging of the aorta were collected for each participant. AAA was found in 22 volunteers (1.4 %) mainly males (2.5 % in males vs. 0.4 % in females p = 0.005). Overall, the prevalence of cardiovascular risk factors was higher in patients with vs. without AAA (mean 2.9 ± 3.0 vs. 1.4 ± 1.0 respectively, p < 0.0001). Independent predictors of AAA on multivariate analysis were age (OR 1.14, 1.06-1.22; p < 0.0001), male gender (OR 8.23, 1.79-37.91; p = 0.007), and both current (OR 4.98, 1.57-15.79; p = 0.007) and previous smoking (OR 2.76, 1.12-8.94; p = 0.03). Our study confirms the feasibility of one time US screening for AAA in a large cohort of asymptomatic people. Independent predictors of AAA were male sex, older age and a history of smoking. Accordingly to recent data the prevalence of AAA seems to be declining, maybe due to a reduction of smoking in Italy. PMID:27215751

  18. Prevalence of previously undiagnosed abdominal aortic aneurysms in the area of Como: the ComoCuore "looking for AAA" ultrasonography screening.

    PubMed

    Corrado, Giovanni; Durante, Alessandro; Genchi, Vincenzo; Trabattoni, Loris; Beretta, Sandro; Rovelli, Enza; Foglia-Manzillo, Giovanni; Ferrari, Giovanni

    2016-08-01

    The prognosis for abdominal aortic aneurysm (AAA) rupture is poor. Long-term follow-up of population-based randomized trials has demonstrated that ultrasound (US) screening for abdominal aortic aneurysms (AAAs) measuring 3 cm or greater decreases AAA-related mortality rates and is cost-effective. We though to prospectively perform during a 26-month period a limited US examination of the infrarenal aorta in volunteers of both gender aged 60-85 years without history of AAA living in the area of Como, Italy. From September 2010 to November 2013 ComoCuore, a no-profit nongovernmental association, enrolled 1555 people (aged 68.8 ± 6.8 years; 48.6 % males). Clinical data and a US imaging of the aorta were collected for each participant. AAA was found in 22 volunteers (1.4 %) mainly males (2.5 % in males vs. 0.4 % in females p = 0.005). Overall, the prevalence of cardiovascular risk factors was higher in patients with vs. without AAA (mean 2.9 ± 3.0 vs. 1.4 ± 1.0 respectively, p < 0.0001). Independent predictors of AAA on multivariate analysis were age (OR 1.14, 1.06-1.22; p < 0.0001), male gender (OR 8.23, 1.79-37.91; p = 0.007), and both current (OR 4.98, 1.57-15.79; p = 0.007) and previous smoking (OR 2.76, 1.12-8.94; p = 0.03). Our study confirms the feasibility of one time US screening for AAA in a large cohort of asymptomatic people. Independent predictors of AAA were male sex, older age and a history of smoking. Accordingly to recent data the prevalence of AAA seems to be declining, maybe due to a reduction of smoking in Italy.

  19. The Sefwi-Comoé belt Ghana/Ivory Coast : a major crustal shear zone ?

    NASA Astrophysics Data System (ADS)

    Jessell, Mark

    2010-05-01

    The Palaeoproterozoic Sefwi-Comoé region that straddles Ghana and the Ivory Coast in West Africa has been characterised as resulting from a combination of compression and simple shear during late synkinematic leucogranite intrusion. The analysis of regional geophysical datasets allows us to better define the geometry of the major lithostratigraphic packages and their structural contacts in this region. This analysis reveals a series of well defined leucogranites intrusions enveloped by high strain zones. Recent finite element modelling of two-phase aggregates has shown that we can analyse the geometry of these systems both in terms of their finite defomation and their mechanical contrast. We interpret the geometries we see in the Sefwi-Comoé region as reflecting the activity of a major crustal deformation zone which was dominated by simple shear. The comparison with the modelling suggests a finite shear strain of approximately 5 gamma, which in turn implies a lateral displacement of 400 km across the belt. Our analysis suggests that the leucogranites were already acting as more rigid bodies during the (dextral?) shearing, suggesting that their emplacement was predominantly pre-kinematic, and which has implications for their potential subsequent remobilization by gravitational forces.

  20. Vulnerability and adaptation to climate change in the Comoe River Basin (West Africa).

    PubMed

    Yéo, Wonnan Eugène; Goula, Bi Tié Albert; Diekkrüger, Bernd; Afouda, Abel

    2016-01-01

    Climate change is impacting water users in many sectors: water supply, farming, industry, hydropower, fishing, housing, navigation and health. Existing situations, like population growth, movement of populations from rural to urban areas, poverty and pollution can aggravate the impacts of climate change. The aim of the study is to evaluate the vulnerability of different water user groups to climate change and define communities' adaptation strategies in the Comoe River Basin. Information was collected on communities' concerns and perception on changes in climate and potential adaptation measures and strategies. Results show that 95 % of the sample in the study communities had heard of it and are aware that climate change is occurring. They have been experiencing changes in economic activity and cropping pattern, reduced water level in rivers, crop failure, delay in cropping season, new pests and diseases, food insecurity, drop in income and decline in crop yield. Results also show that communities employ various adaptation strategies including crops diversification, substitution and calendar redefinition, agroforestry, borrowing from friends and money lenders and increasing fertilizer application.

  1. Vulnerability and adaptation to climate change in the Comoe River Basin (West Africa).

    PubMed

    Yéo, Wonnan Eugène; Goula, Bi Tié Albert; Diekkrüger, Bernd; Afouda, Abel

    2016-01-01

    Climate change is impacting water users in many sectors: water supply, farming, industry, hydropower, fishing, housing, navigation and health. Existing situations, like population growth, movement of populations from rural to urban areas, poverty and pollution can aggravate the impacts of climate change. The aim of the study is to evaluate the vulnerability of different water user groups to climate change and define communities' adaptation strategies in the Comoe River Basin. Information was collected on communities' concerns and perception on changes in climate and potential adaptation measures and strategies. Results show that 95 % of the sample in the study communities had heard of it and are aware that climate change is occurring. They have been experiencing changes in economic activity and cropping pattern, reduced water level in rivers, crop failure, delay in cropping season, new pests and diseases, food insecurity, drop in income and decline in crop yield. Results also show that communities employ various adaptation strategies including crops diversification, substitution and calendar redefinition, agroforestry, borrowing from friends and money lenders and increasing fertilizer application. PMID:27386296

  2. DIABETES MELLITUS COMO FACTOR DE RIESGO DE DEMENCIA EN LA POBLACIÓN ADULTA MAYOR MEXICANA

    PubMed Central

    Silvia, Mejía-Arango; Clemente, y Zúñiga-Gil

    2012-01-01

    Introduccion La diabetes mellitus y las demencias constituyen dos problemas crecientes de salud entre la población adulta mayor del mundo y en particular de los paises en desarrollo. Hacen falta estudios longitudinales sobre el papel de la diabetes como factor de riesgo para demencia. Objetivo Determinar el riesgo de demencia en sujetos Mexicanos con diabetes mellitus tipo 2. Materiales y Metodos Los sujetos diabéticos libres de demencia pertenecientes al Estudio Nacional de Salud y Envejecimiento en México fueron evaluados a los dos años de la línea de base. Se estudió el papel de los factores sociodemográficos, de otras comorbilidades y del tipo de tratamiento en la conversión a demencia. Resultados Durante la línea de base 749 sujetos (13.8%) tuvieron diabetes. El riesgo de desarrollar demencia en estos individuos fue el doble (RR, 2.08 IC 95%, 1.59–2.73). Se encontró un riesgo mayor en individuos de 80 años y más (RR 2.44 IC 95%, 1.46–4.08), en los hombres (RR, 2.25 IC 95%, 1.46–3.49) y en sujetos con nivel educativo menor de 7 años. El estar bajo tratamiento con insulina incrementó el riesgo de demencia (RR, 2.83, IC 95%, 1.58–5.06). Las otras comorbilidades que aumentaron el riesgo de demencia en los pacientes diabéticos fueron la hipertensión (RR, 2.75, IC 95%, 1.86–4.06) y la depresión (RR, 3.78, 95% IC 2.37–6.04). Conclusión Los sujetos con diabetes mellitus tienen un riesgo mayor de desarrollar demencia, La baja escolaridad y otras comorbilidades altamente prevalentes en la población Mexicana contribuyen a la asociación diabetes-demencia. PMID:21948010

  3. Ab initio study of energetics and magnetism of sigma phase in Co-Mo and Fe-Mo systems

    NASA Astrophysics Data System (ADS)

    Pavlů, J.; Vřešťál, J.; Šob, M.

    2016-02-01

    We analyse, from first-principles, the energetics and magnetic ordering of sigma phases in Co-Mo and Fe-Mo systems. Total energy differences between the sigma phase and Standard Element Reference (SER) structures are calculated in the whole concentration range at equilibrium volumes by means of the linear muffin-tin orbitals method in the atomic-sphere approximation (LMTO-ASA), the full-potential linearised augmented-plane waves (FLAPW) method and the pseudopotential approach. They are compared with the enthalpy of formation of sigma phase obtained from the phase equilibria calculations at higher temperature based on the semiempirical CALPHAD (CALculation of PHAse Diagram) method. It turns out that the binary sigma phases are more stable than the weighted average of the sigma phase of elemental constituents and that this stability for Fe-Mo is higher than for Co-Mo. On the other hand it was found that the binary sigma phases do not exhibit any stability with respect to the weighted average of the SER structures. The magnetic configurations in all systems are investigated and the stabilizing effect of magnetic order in sigma phase at 0 K is presented. It turns out that the atomic magnetic moment strongly depends on the type of occupied sublattice and total composition of the alloy.

  4. Alejarse como proceso social: niños y ancianos «abandonados» en Ayacucho1

    PubMed Central

    Leinaweaver, Jessaca

    2013-01-01

    En investigaciones previas sobre el acogimiento familiar y la adopción en Ayacucho, se ha podido descubrir cómo los ayacuchanos adquieren y producen relaciones sociales. Mientras negocian creativamente los discursos y espacios construidos simultáneamente por instituciones, comunidades, y estructuras sociales, van adquiriendo nuevas formas de relacionarse. Este artículo discute el proceso opuesto: el deshacerse de relaciones de parentesco, y el proceso social del abandono o alejamiento. Cuando se aleja a una persona de su familia o su comunidad, los que se quedan en ella llegan a entenderse como ciertos tipos de personas. En los estudios de caso discutidos aquí, recopilados a través de una detallada y cuidadosa observación participante y de entrevistas etnográficas grabadas entre 2001 y 2007, se puede ver cómo, después de un alejamiento social, los individuos que alejan se reinterpretan como sujetos que se encuentran superándose o volviéndose modernos, o bien sacrificándose. PMID:25177044

  5. Late Glacial to Holocene environmental variabilities: A new multi-proxy paleolimnological study of sedimentary sequences from Como (northern Italy)

    NASA Astrophysics Data System (ADS)

    Höbig, N.; Martinelli, E.; Motella, S.; Michetti, A. M.; Livio, F.; Tinner, W.; Reicherter, K.; Castelletti, L.

    2012-04-01

    Lake Como (northern Italy) is the deepest Italian lake, reaching a depth of about 425 m. The lambda-shaped lake expands about 45 km in NE-SW direction. Southwards of the hydrologically closed western branch, two sediment cores of 70 m (S1) and 65 m length (S2) were taken in the year 2005 close to the cathedral of Como (Piazza Verdi). The drilling sites are located in the middle of the Southern Alps, some 300 m from the present-day lakeshore. The cores provide the first detailed Late Glacial to Holocene multi-proxy record for the Lake Como basin. Our research is aimed at investigating the environmental and geological evolution of the Insubria Region. The multi-proxy study of the stratigraphic sequences contain geophysical, geotechnical, sedimentological, paleobotanical, and radiocarbon analyses. They have been performed for core S1 and are still in progress on core S2. With this data the working group focuses on two main issues. The first topic is the reconstruction of the natural and anthropogenic processes controlling the ground subsidence in the Como urban area (e.g., Comerci et al., 2007) and another aim is to reconstruct vegetation and land-use dynamics. In particular, 150 samples of vegetal macroremains have been collected in the palustrine deposits along S1 core, down to 31,00 m. Below this depth (dated 14C 12,496 ± 55 yr BP - 15,050 - 14,250 cal yr BP), the amount of plant macroremains in the sediment drops dramatically. The taxonomic determination was carried out on more than 800 macroremains. They are represented by fragments of wood, leaves, needles, seeds, fruits, mosses and tiny charcoals (Motella, 2009, unpublished PhD Thesis). Picea/Larix, Pinus sp., Juniperus with Betula, found in the deeper levels (30.80 - 30.00 m), are the first arboreal taxa that colonized the shores of Lake Como, and show that the reforestation began in this area about 16,000 years ago. During the early Holocene (25.10 m) Abies alba expanded and further upwards the sequence

  6. The stucco decorations from St. Lorenzo in Laino (Como, Italy): The materials and the techniques employed by the "Magistri Comacini".

    PubMed

    Rampazzi, Laura; Rizzo, Biagio; Colombo, Chiara; Conti, Claudia; Realini, Marco; Bartolucci, Ugo; Colombini, Maria Perla; Spiriti, Andrea; Facchin, Laura

    2008-12-01

    The paper reports a cross-cutting and systematic approach to the analytical study of Baroque stucco decorations by Italian artists known as "Magistri Comacini". Samples from the Church of St. Lorenzo in Laino (Como, Italy) were analysed using chemical and mineralogical techniques and the results interpreted with the help of art historians in order to enlighten the artistic techniques. The characterisation of the binder, aggregate and organic fractions was carried out through optical microscopy, scanning electron microscopy with microprobe, X-ray powder diffraction, Fourier transform infrared spectroscopy, gas chromatography-mass spectrometry and laser ablation mass spectrometry equipped with plasma source spectrometry. The results on major, minor and trace components ascertained various recipes. In particular, the investigation of the finishing layers corroborated hypotheses of attribution and chronology and stressed the different skills of the artists working in the building, shedding a light on details of the decoration technique. PMID:19068330

  7. A Utilização da Astronomia como Tema Interdisciplinar e Aplicações de Objetos de Aprendizagem

    NASA Astrophysics Data System (ADS)

    da Silva, L. A.; Voelzke, M. R.

    2008-09-01

    Este trabalho visa analisar a possibilidade de relacionar conteúdos aplicados no ensino fundamental e médio de forma interdisciplinar por intermédio da astronomia, com a intervenção de objetos de aprendizagem que possam integrar as disciplinas e a utilização de recursos tecnológicos. Em uma pesquisa prévia com 20 professores de uma escola estadual situada na cidade de Guarulhos foi observado que apenas 25% dos professores utilizam algum recurso tecnológico para o desenvolvimento de conteúdos pertinentes à sua disciplina, tais como sites e softwares educativos, sendo que a maioria absoluta continua ensinando apenas com livros didáticos. A maior parte dos professores apresenta dificuldades em trabalhar sua disciplina de forma interdisciplinar, ou seja, 75% dos professores preferem aplicar os conteúdos seguindo uma hierarquia linear de tópicos, evitando a discussão de temas que de alguma forma estão relacionados. A astronomia pode vir à fascinar o ser humano e despertar sua curiosidade promovendo um maior interesse no aprendizado, podendo favorecer análises interdisciplinares de forma lógica e objetiva, desta forma colocar a astronomia como tema motivador interdisciplinar, pode ser relevante no que se refere ao distanciamento da fragmentação dos conteúdos. No Estado de São Paulo, a implantação da proposta curricular no ensino fundamental e médio mostra claramente a inserção da astronomia na maior parte das séries, principalmente na 6ª série em que todo o bimestre se fala de astronomia.

  8. Las fulguraciones como manifestación de reconexión en el campo magnético solar

    NASA Astrophysics Data System (ADS)

    Bagalá, L. G.; Mandrini, M. C.; Rovira, M. G.; Démoulin, P.

    Las fulguraciones solares son fenómenos transitorios de liberación de energía que se desarrollan en las estructuras magnéticas de las regiones activas del Sol. Las fulguraciones pueden llegar a liberar hasta 1032 erg en 100 seg. en todo el rango electromagnético, y acelerar partículas. En este trabajo mostramos que la ubicación de los abrillantamientos en Hα de diversas fulguraciones está relacionado con las propiedades de las conexiones de las líneas del campo magnético de la región, como se espera por las teorías de reconexión en 3D recientemente desarrolladas (Démoulin et al, 1996a). El campo magnético coronal se extrapola del campo fotosférico observado suponiendo una configuración libre de fuerzas lineal. Por medio de un algoritmo se determinan las regiones donde existe un cambio drástico en la conectividad de las líneas de campo (límites ``cuasi-discontinuos'', o cuasi-separatrices CS). Las CS son bandas abiertas que identifican zonas donde el campo magnético se reconectará con más probabilidad y, siempre que las mismas sean lo suficientemente finas, se producirá allíla liberación de energía proveniente del campo magnético. Hemos encontrado que en todas las regiones fulgurantes estudiadas (Démoulin et al, 1996b) existen CS en los mismos lugares donde se observaron los abrillantamientos en Hα. Allídonde coinciden los abrillantamientos con las CS, éstas tienen un espesor menor que 1 Mm. Las líneas de campo coronales extrapoladas de nuestro modelo tienen sus orígenes fotosféricos a ambos lados de las CS, como se espera dados los recientes estudios de reconexión magnética en 3D. Estos resultados ponen a prueba los modelos presentes sobre fulguraciones solares.

  9. XAFS study on the sulfidation mechanisms of Co-Mo catalysts supported on activated carbon and alumina: effect of complexing agent.

    PubMed

    Tsuji, K; Umeki, T; Yokoyama, Y; Kitada, T; Iwanami, Y; Nonaka, O; Shimada, H; Matsubayashi, N; Nishijima, A; Nomura, M

    2001-03-01

    The effect of nitrilotriacetic acid (NTA) as a complexing agent on the sulfidation mechanisms of Co-Mo catalysts supported on activated carbon and alumina was examined by the XAFS technique. The XAFS results revealed that NTA interacted with Co atoms and formed the Co-NTA interaction, while it showed almost no influence on the local structures around Mo atoms. The Co-NTA interaction suppressed the aggregation of cobalt atoms and the interaction between cobalt and alumina during sulfiding, and consequently promoted the formation of the Co-Mo-S phase.

  10. Novel Urinary Protein Biomarkers Predicting the Development of Microalbuminuria and Renal Function Decline in Type 1 Diabetes

    PubMed Central

    Schlatzer, Daniela; Maahs, David M.; Chance, Mark R.; Dazard, Jean-Eudes; Li, Xiaolin; Hazlett, Fred; Rewers, Marian; Snell-Bergeon, Janet K.

    2012-01-01

    OBJECTIVE To define a panel of novel protein biomarkers of renal disease. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes in the Coronary Artery Calcification in Type 1 Diabetes study who were initially free of renal complications (n = 465) were followed for development of micro- or macroalbuminuria (MA) and early renal function decline (ERFD, annual decline in estimated glomerular filtration rate of ≥3.3%). The label-free proteomic discovery phase was conducted in 13 patients who progressed to MA by the 6-year visit and 11 control subjects, and four proteins (Tamm-Horsfall glycoprotein, α-1 acid glycoprotein, clusterin, and progranulin) identified in the discovery phase were measured by enzyme-linked immunosorbent assay in 74 subjects: group A, normal renal function (n = 35); group B, ERFD without MA (n = 15); group C, MA without ERFD (n = 16); and group D, both ERFD and MA (n = 8). RESULTS In the label-free analysis, a model of progression to MA was built using 252 peptides, yielding an area under the curve (AUC) of 84.7 ± 5.3%. In the validation study, ordinal logistic regression was used to predict development of ERFD, MA, or both. A panel including Tamm-Horsfall glycoprotein (odds ratio 2.9, 95% CI 1.3–6.2, P = 0.008), progranulin (1.9, 0.8–4.5, P = 0.16), clusterin (0.6, 0.3–1.1, P = 0.09), and α-1 acid glycoprotein (1.6, 0.7–3.7, P = 0.27) improved the AUC from 0.841 to 0.889. CONCLUSIONS A panel of four novel protein biomarkers predicted early renal damage in type 1 diabetes. These findings require further validation in other populations for prediction of renal complications and treatment monitoring. PMID:22238279

  11. XAS Study at Mo and Co K-Edges of the Sulfidation of a CoMo / Al2O3 Hydrotreating Catalyst

    SciTech Connect

    Pichon, C.; Gandubert, A. D.; Legens, C.; Guillaume, D.

    2007-02-02

    Because of its impact on environment, the removal of sulfur is an indispensable step, called hydrotreatment, in the refining of petroleum. One of the most commonly used hydrotreating catalysts is CoMo-type catalyst which is composed of molybdenum disulfide slabs promoted by cobalt atoms (CoMoS phase) and well dispersed on a high specific area alumina. As far as the highest sulfur content allowed in gasoline and diesel is continually decreasing, more and more efficient and active hydrotreating catalysts are required. In order to optimize the reactivity of the CoMo-type catalyst in hydrotreatment, a better understanding of the processes used to produce the active phase (CoMoS slabs) of the catalyst is necessary. The study reported here deals with the sulfiding mechanism of the slabs and the influence of temperature on the phenomenon. Ex situ X-ray absorption spectroscopy (XANES and EXAFS) was used to study the evolution of the structure of CoMo-type catalyst sulfided at various temperatures (from 293 to 873 K). XAS analysis was performed at both molybdenum and cobalt K-edges to obtain a cross-characterization of the sulfidation of the slabs. It evidenced the formation of various compounds, including two molybdenum oxides, MoS3 (or MoS3-like compound) and Co9S8, at specific steps of the sulfiding process. It showed the role of intermediate played by MoS3 (or MoS3-like compound) during the formation of the slabs and the competition between the appearance of promoted slabs (CoMoS phase) and Co9S8. At last, it leaded to the proposal of a mechanism for the sulfidation of the catalyst.

  12. XAS Study at Mo and Co K-Edges of the Sulfidation of a CoMo / Al2O3 Hydrotreating Catalyst

    NASA Astrophysics Data System (ADS)

    Pichon, C.; Gandubert, A. D.; Legens, C.; Guillaume, D.

    2007-02-01

    Because of its impact on environment, the removal of sulfur is an indispensable step, called hydrotreatment, in the refining of petroleum. One of the most commonly used hydrotreating catalysts is CoMo-type catalyst which is composed of molybdenum disulfide slabs promoted by cobalt atoms (CoMoS phase) and well dispersed on a high specific area alumina. As far as the highest sulfur content allowed in gasoline and diesel is continually decreasing, more and more efficient and active hydrotreating catalysts are required. In order to optimize the reactivity of the CoMo-type catalyst in hydrotreatment, a better understanding of the processes used to produce the active phase (CoMoS slabs) of the catalyst is necessary. The study reported here deals with the sulfiding mechanism of the slabs and the influence of temperature on the phenomenon. Ex situ X-ray absorption spectroscopy (XANES and EXAFS) was used to study the evolution of the structure of CoMo-type catalyst sulfided at various temperatures (from 293 to 873 K). XAS analysis was performed at both molybdenum and cobalt K-edges to obtain a cross-characterization of the sulfidation of the slabs. It evidenced the formation of various compounds, including two molybdenum oxides, MoS3 (or MoS3-like compound) and Co9S8, at specific steps of the sulfiding process. It showed the role of intermediate played by MoS3 (or MoS3-like compound) during the formation of the slabs and the competition between the appearance of promoted slabs (CoMoS phase) and Co9S8. At last, it leaded to the proposal of a mechanism for the sulfidation of the catalyst.

  13. Como os Alunos do Ensino Médio da Rede Estadual de São Paulo obtém Conhecimentos Astronômicos?

    NASA Astrophysics Data System (ADS)

    da Cunha, W. S.; Voelzke, M. R.; Amaral, L. H.

    2005-08-01

    Atualmente vivencia-se um mundo globalizado onde os computadores e a internet permitiram um acesso rápido e seguro a todo tipo de informação e conhecimento. O presente trabalho visa analisar a maneira pela qual alunos de segundo grau da rede estadual da cidade de São Paulo obtiveram, caso tenham, conhecimentos básicos de astronomia quanto aos fenômenos celestes que os rodeiam, tais como a sucessão dos dias e das estações do ano, além de questioná~los sobre fatos genéricos tais como: o que vem a ser o Sol, o Big Bang, o que ocasionou a extinção dos dinossauros. Para tanto foi elaborado um formulário constando de questões de múltipla escolha, o qual foi aplicado no primeiro colegial diurno da Escola Estadual Guilherme de Almeida. Num espaço amostral de 44 alunos constatou-se que 41% dos alunos adquiriram seus conhecimentos astronômicos na escola e 59% através da mídia em geral. Neste mesmo espaço amostral apenas 11% dos alunos usaram computadores na escola, 41% na residência, 5% no trabalho e 43% não utilizaram. O presente estudo revelou também que para 50% dos alunos o professor jamais utilizou um programa de computador a respeito de astronomia ou fez alguma apresentação sobre o tema. Embora em sua fase inicial este estudo revela claramente que a maioria dos alunos não obtém na escola seus conhecimentos astronômicos, estes provém de fontes não especificamente didático-pedagógicas tais como filmes e revistas populares que não raramente geram conhecimentos incompletos e em muitos casos inclusive falhos.

  14. Telescópio de pequeno porte como suporte ao ensino em cidades com intensa poluição luminosa II

    NASA Astrophysics Data System (ADS)

    Pereira, P. C. R.; Santos-Júnior, J. M.; Cruz, W. S.

    2003-08-01

    Para a maioria dos estudantes, sua passagem pelo ensino formal fundamental envolve a transmissão de fatos que devem ser guardados para um exame, a habilidade para lembrar fórmulas e, eventualmente, a repetição de experimentos que devem produzir resultados exigidos pelo professor. O resultado deste modelo de ensino, ao longo dos anos, é conhecido por todos: desconhecimento e descontentamento, por parte dos estudantes, de temas relativos ao papel e aos processos da ciência. Acreditamos que a Astronomia, pelo seu caráter observacional, é uma das áreas do conhecimento que pode contribuir neste cenário. A Fundação Planetário da Cidade do Rio de Janeiro possui um telescópio Meade LX-200 (25cm) que, juntamente com as câmeras CCD ST-7E e ST8E, tem sido utilizado em projetos voltados aos estudantes do ensino médio desde o ano 2000. Tais projetos envolvem a condução de um projeto de pesquisa observacional num nível apropriado, e possibilitam o contato com técnicas e novas tecnologias: computador, software para manipulação de dados e gráficos, programas de tratamento e redução de dados, uso de equipamentos óptico-eletrônicos (telescópio e CCD), bem como o processo de aquisição de conhecimento. Dentro da proposta dos anos anteriores, priorizamos projetos de uma noite, ou seja, procuramos trabalhar com fenômenos que apresentem variabilidade com intervalo de recorrência relativamente curto. Em todos os casos, optamos pela fotometria diferencial, que tem se mostrado bastante eficiente para o céu luminoso como o da cidade do Rio de Janeiro. Neste painel, apresentamos alguns dos projetos desenvolvidos no último ano, com 25 estudantes. Apresentamos os resultados da observação da variável pulsante AI Vel (V = 6,6) e da variável cataclísmica FO Aqr (V = 13,5), e do monitoramento do trânsito da lua de Júpiter, Europa, ocorrido em 30 de abril de 2003. As curvas de luz produzidas para as primeiras estão concordantes com as da literatura, assim

  15. [Evaluation of the dose equivalent absorbed by the population of Como and surrounding area following the nuclear reactor accident at Chernobyl].

    PubMed

    Cirla, A; Ostinelli, A; Zingales, A

    1987-12-01

    The effects produced as a consequence of the Chernobyl nuclear reactor accident in the population of Como are assessed on the basis of the measurements taken in the environment and on the food. Exposure measurements produced by external radiation and the activities of the different radionuclides introduced into the body, by ingestion and inhalation, made it possible to obtain an estimate of the dose equivalent and its somatic and genetic effects on the population. The results show that such effects may produce 0.5-2 cases of malignant tumour in the next 25 years and 0.2-1 case of genetic damage in the next 60 years and are therefore statistically insignificant.

  16. Tal Como Somos/Just As We Are: An Educational Film to Reduce Stigma towards Gay and Bisexual Men, Transgender Individuals & Persons Living with HIV/AIDS

    PubMed Central

    Ramirez-Valles, Jesus; Kuhns, Lisa M.; Manjarrez, Dianna

    2013-01-01

    In this paper we describe the development and dissemination of a film-based educational intervention to reduce negative attitudes towards gay and bisexual men and transgender women (GBT) and people living with HIV/AIDS (PLWHA) in Latino communities, with a focus on youth. The intervention, Tal Como Somos/Just as We Are, is based on stigma and attribution theories, extensive formative research, and community input. Evaluation findings among educators and school youth suggest the film has the potential to effectively impact attitudes towards GBT and PLWHA. The film and intervention are being disseminated using diffusion of innovations theory through community-based organizations, schools, television broadcasting and film festivals. PMID:24377496

  17. Tal Como Somos/just as we are: an educational film to reduce stigma toward gay and bisexual men, transgender individuals, and persons living with HIV/AIDS.

    PubMed

    Ramirez-Valles, Jesus; Kuhns, Lisa M; Manjarrez, Dianna

    2014-04-01

    In this article, the authors describe the development and dissemination of a film-based educational intervention to reduce negative attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS in Latino communities, with a focus on youth. The intervention, Tal Como Somos/Just as We Are, is based on stigma and attribution theories, extensive formative research, and community input. Evaluation findings among educators and school youth suggest the film has the potential to effectively influence attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS. The film and intervention are being disseminated using diffusion of innovations theory through community-based organizations, schools, television broadcasting, and film festivals. PMID:24377496

  18. Tal Como Somos/just as we are: an educational film to reduce stigma toward gay and bisexual men, transgender individuals, and persons living with HIV/AIDS.

    PubMed

    Ramirez-Valles, Jesus; Kuhns, Lisa M; Manjarrez, Dianna

    2014-04-01

    In this article, the authors describe the development and dissemination of a film-based educational intervention to reduce negative attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS in Latino communities, with a focus on youth. The intervention, Tal Como Somos/Just as We Are, is based on stigma and attribution theories, extensive formative research, and community input. Evaluation findings among educators and school youth suggest the film has the potential to effectively influence attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS. The film and intervention are being disseminated using diffusion of innovations theory through community-based organizations, schools, television broadcasting, and film festivals.

  19. Hydro-geochemical modeling of subalpine urbanized area: geochemical characterization of the shallow and deep aquifers of the urban district of Como (first results).

    NASA Astrophysics Data System (ADS)

    Terrana, Silvia; Brunamonte, Fabio; Frascoli, Francesca; Ferrario, Maria Francesca; Michetti, Alessandro Maria; Pozzi, Andrea; Gambillara, Roberto; Binda, Gilberto

    2016-04-01

    One of the greatest environmental and social-economics threats is climate change. This topic, in the next few years, will have a significant impact on the availability of water resources of many regions. This is compounded by the strong anthropization of water systems that shows an intensification of conflicts for water resource exploitation. Therefore, it is necessary a sustainable manage of natural resources thorough knowledge of the hosting territories. The development of investigation and data processing methods are essential to reduce costs for the suitable use and protection of resources. Identify a sample area for testing the best approach is crucial. This research aims to find a valid methodology for the characterization, modeling and management of subalpine urban aquifers, and the urban district of Como appears perfect. The city of Como is located at the southern end of the western sector of Lake Como (N Italy). It is a coastal town, placed on a small alluvial plain, therefore in close communication with the lake. The plain is drained by two streams, which are presently artificially buried, and have an underground flow path in the urban section till the mouth. This city area, so, is suitable for this project as it is intensely urbanized, its dimensions is not too extensive and it is characterized by two aquifers very important and little known. These are a shallow aquifer and a deep aquifer, which are important not only for any water supply, but also for the stability of the ground subsidence in the city. This research is also the opportunity to work in a particular well-known area with high scientific significance; however, there is complete absence of information regarding the deep aquifer. Great importance has also the chosen and used of the more powerful open source software for this type of area, such as PHREEQC, EnvironInsite, PHREEQE etc., used for geological and geochemical data processing. The main goal of this preliminary work is the

  20. Congressional Hispanic Caucus: Como Va?

    ERIC Educational Resources Information Center

    Darrow, Denice

    1978-01-01

    The Caucus aims to develop a national policy on behalf of the Spanish-speaking, and to strengthen the Federal commitment toward Hispanics. The Caucus also plans to serve an educational purpose, informing the Hispanic population about the political process and functioning of government. (NQ)

  1. From management to negotiation: technical and institutional innovations for integrated water resource management in the Upper Comoé River Basin, Burkina Faso.

    PubMed

    Roncoli, Carla; Kirshen, Paul; Etkin, Derek; Sanon, Moussa; Somé, Léopold; Dembélé, Youssouf; Sanfo, Bienvenue J; Zoungrana, Jacqueline; Hoogenboom, Gerrit

    2009-10-01

    This study focuses on the potential role of technical and institutional innovations for improving water management in a multi-user context in Burkina Faso. We focus on a system centered on three reservoirs that capture the waters of the Upper Comoé River Basin and servicing a diversity of users, including a sugar manufacturing company, a urban water supply utility, a farmer cooperative, and other downstream users. Due to variable and declining rainfall and expanding users' needs, drastic fluctuations in water supply and demand occur during each dry season. A decision support tool was developed through participatory research to enable users to assess the impact of alternative release and diversion schedules on deficits faced by each user. The tool is meant to be applied in the context of consultative planning by a local user committee that has been created by a new national integrated water management policy. We contend that both solid science and good governance are instrumental in realizing efficient and equitable water management and adaptation to climate variability and change. But, while modeling tools and negotiation platforms may assist users in managing climate risk, they also introduce additional uncertainties into the deliberative process. It is therefore imperative to understand how these technological and institutional innovations frame water use issues and decisions to ensure that such framing is consistent with the goals of integrated water resource management.

  2. Estimación de pequeñas perturbaciones en satélites geocéntricos como un problema inverso

    NASA Astrophysics Data System (ADS)

    Zadunaisky, P. E.

    El movimiento geocéntrico de un satélite artificial es simulado automáticamente por un sistema de ecuaciones diferenciales de segundo orden que incluyen dos funciones perturbadoras. La primera representa el segundo término del potencial gravitatorio de la Tierra y la segunda corresponde al frenado atmosférico. Asumiendo como conocidas, por hipótesis o por mediciones, la posición y velocidad del satélite en instantes sucesivos se estiman las perturbaciones a intervalos sucesivos por un método determinístico. Para ilustrar el método y comprobar la precisión de nuestros resultados hemos simulado dos ejemplos incluyendo valores conocidos de las perturbaciones que luego comparamos con los resultados de nuestro método. El método puede aplicarse por ejemplo para el intervalo de una revolución satelital lo cual permitiría el diseño inmediato de una maniobra correctiva de la órbita satelital.

  3. Detection and identification of pathogenic trypanosome species in tsetse flies along the Comoé River in Côte d’Ivoire

    PubMed Central

    Djohan, Vincent; Kaba, Dramane; Rayaissé, Jean-Baptiste; Dayo, Guiguigbaza-Kossigan; Coulibaly, Bamoro; Salou, Ernest; Dofini, Fabien; Kouadio, Alain De Marie Koffi; Menan, Hervé; Solano, Philippe

    2015-01-01

    In order to identify pathogenic trypanosomes responsible for African trypanosomiasis, and to better understand tsetse-trypanosome relationships, surveys were undertaken in three sites located in different eco-climatic areas in Côte d’Ivoire during the dry and rainy seasons. Tsetse flies were caught during five consecutive days using biconical traps, dissected and microscopically examined looking for trypanosome infection. Samples from infected flies were tested by PCR using specific primers for Trypanosoma brucei s.l., T. congolense savannah type, T. congolense forest type and T. vivax. Of 1941 tsetse flies caught including four species, i.e. Glossina palpalis palpalis, G. p. gambiensis, G. tachinoides and G. medicorum, 513 (26%) were dissected and 60 (12%) were found positive by microscopy. Up to 41% of the infections were due to T. congolense savannah type, 30% to T. vivax, 20% to T. congolense forest type and 9% due to T. brucei s.l. All four trypanosome species and subgroups were identified from G. tachinoides and G. p. palpalis, while only two were isolated from G. p. gambiensis (T. brucei s.l., T. congolense savannah type) and G. medicorum (T. congolense forest, savannah types). Mixed infections were found in 25% of cases and all involved T. congolense savannah type with another trypanosome species. The simultaneous occurrence of T. brucei s.l., and tsetse from the palpalis group may suggest that human trypanosomiasis can still be a constraint in these localities, while high rates of T. congolense and T. vivax in the area suggest a potential risk of animal trypanosomiasis in livestock along the Comoé River. PMID:26035296

  4. Detection and identification of pathogenic trypanosome species in tsetse flies along the Comoé River in Côte d'Ivoire.

    PubMed

    Djohan, Vincent; Kaba, Dramane; Rayaissé, Jean-Baptiste; Dayo, Guiguigbaza-Kossigan; Coulibaly, Bamoro; Salou, Ernest; Dofini, Fabien; Kouadio, Alain De Marie Koffi; Menan, Hervé; Solano, Philippe

    2015-01-01

    In order to identify pathogenic trypanosomes responsible for African trypanosomiasis, and to better understand tsetse-trypanosome relationships, surveys were undertaken in three sites located in different eco-climatic areas in Côte d'Ivoire during the dry and rainy seasons. Tsetse flies were caught during five consecutive days using biconical traps, dissected and microscopically examined looking for trypanosome infection. Samples from infected flies were tested by PCR using specific primers for Trypanosoma brucei s.l., T. congolense savannah type, T. congolense forest type and T. vivax. Of 1941 tsetse flies caught including four species, i.e. Glossina palpalis palpalis, G. p. gambiensis, G. tachinoides and G. medicorum, 513 (26%) were dissected and 60 (12%) were found positive by microscopy. Up to 41% of the infections were due to T. congolense savannah type, 30% to T. vivax, 20% to T. congolense forest type and 9% due to T. brucei s.l. All four trypanosome species and subgroups were identified from G. tachinoides and G. p. palpalis, while only two were isolated from G. p. gambiensis (T. brucei s.l., T. congolense savannah type) and G. medicorum (T. congolense forest, savannah types). Mixed infections were found in 25% of cases and all involved T. congolense savannah type with another trypanosome species. The simultaneous occurrence of T. brucei s.l., and tsetse from the palpalis group may suggest that human trypanosomiasis can still be a constraint in these localities, while high rates of T. congolense and T. vivax in the area suggest a potential risk of animal trypanosomiasis in livestock along the Comoé River.

  5. Single-molecule magnet based on a C-type polyoxomolybdate with an S = 11 ground state: [Fe5CoMo22As2O85(H2O)]15-.

    PubMed

    Zhen, Yanzhong; Liu, Bin; Li, Lili; Wang, Danjun; Ma, Ying; Hu, Huaiming; Gao, Shengli; Xue, Ganglin

    2013-01-01

    A C-type polyoxomolybdate containing a mixed-transition metal cluster Fe(5)Co has been prepared as an ammonium salt, (NH(4))(15)[Fe(5)CoMo(22)As(2)O(85)(H(2)O)]·15H(2)O (1). Interestingly, the magnetism measurements show that the compound exhibits not only an overall ferromagnetic cluster with a large spin ground state of S = 11 but also the behavior of single-molecule magnets.

  6. ?`Y dónde está el turn-over?

    NASA Astrophysics Data System (ADS)

    Ostrov, P. G.

    La distribución de luminosidades de los cúmulos globulares presenta un máximo (turn-over) que no varía significativamente de galaxia en galaxia, por lo que es utilizada como indicador de distancia. En este trabajo se investigan los errores estadísticos de su determinación.

  7. [Nusing-sensitive indicadors: an opportunity for measuring the nurse contribution].

    PubMed

    Planas-Campmany, Carme; Icart-Isern, M Teresa

    2014-01-01

    The measures directed at improving the management and funding of health services that justify the measurement of performance and the purchase of services based on results, have a direct influence on nursing. In this context, concerns about the value and contribution of nursing have been demonstrated worldwide over the last decades. Therefore efforts are being made to ensure that nurses contribute to promote the transformation of health systems. This requires identifying their contribution to the health system and, specifically, in relation to health outcomes. In recent decades, there has been a growing demand to achieve measures which allow nurses to demonstrate and assume responsibility for their contribution. The research and development of nursing-sensitive indicators and results, and its application, provide an opportunity to measure the contribution and professional performance in achieving these set objectives, in order to improve population health.

  8. The Astronomy Club of Araranguá: Educating Science Teachers as Science Communicators. (Breton Title: Clube de Astronomia de AraranguÁ: a Formação de Professores de Ciências Como Divulgadores Científicos. ) Club de Astronomía de Araranguá: la Formación del Profesorado Como Comunicadores de la Ciencia

    NASA Astrophysics Data System (ADS)

    Damasio, Felipe; Allain, Olivier; Antunes Rodrigues, Adriano

    2013-07-01

    The study reported in this work takes place since 2009 at the Federal Institute of Education, Science and Technology of Santa Catarina, Campus Araranguá. Our main goal is to help form teachers, training undergraduate students in Natural Sciences with specialization in Physics as science communicators, as well as to promote actions of broader scientific popularization in the region of the town of Araranguá through an Astronomy Club called CA2. Among the actions of scientific popularization that the students promote are: video production, radio broadcasts, lectures, nightly observations, preparation and exhibition of posters, physics teaching for children, continuing education activities for teachers and regular physics teaching using Astronomy as a theme. The Club's teacher education and scientific dissemination work is based on the Theory of Meaningful Learning, always trying to reach the student's predisposition to learn and produce potentially meaningful material, the two essential conditions for meaningful learning to occur. O estudo que este trabalho relata ocorre desde 2009 no Instituto Federal de Educação, Ciência e Tecnologia de Santa Catarina, campus Araranguá. Nele procura-se formar divulgadores científicos durante a formação inicial de docentes do curso de Licenciatura em Ciências da Natureza com habilitação em Física, além de promover ações de divulgação científica para o público geral da região da cidade de Araranguá por meio de um Clube de Astronomia chamado CA² (Clube de Astronomia de Araranguá). Entre as ações de divulgação científica que os licenciandos promovem estão: produção de vídeos, programas de rádio, palestras, observações noturnas, confecção e exposição de pôsteres, ensino de física para crianças, formação continuada de professores em atividades e ensino de Física regular utilizando a Astronomia como tema gerador. O trabalho de formação docente e divulgação científica do Clube fundamenta

  9. [Auditing as a tool for ongoing improvement in the Stroke Care Plan of the Region of Aragon].

    PubMed

    Gimenez-Munoz, A; Palacin-Larroy, M; Bestue, M; Marta-Moreno, J

    2016-07-16

    Introduccion. El Plan de Atencion al Ictus de Aragon (PAIA) se creo en 2008 en el marco de la Estrategia Nacional en Ictus del Sistema Nacional de Salud. La monitorizacion de la atencion hospitalaria al ictus mediante auditorias periodicas se definio como una de sus lineas de trabajo. Objetivo. Determinar la calidad del proceso asistencial hospitalario prestado al paciente con ictus en Aragon mediante el uso de indicadores de calidad. Materiales y metodos. Se realizaron tres audits (en los años 2008, 2010 y 2012) siguiendo la misma metodologia, basada en la revision retrospectiva de una muestra representativa de ingresos por ictus en cada uno de los hospitales generales del Servicio Aragones de Salud. Se recogio informacion sobre 48 indicadores seleccionados segun su evidencia cientifica o relevancia clinica. Resultados. Se estudiaron 1.011 casos (331 en el primer audit, y 340 en el segundo y en el tercero). Treinta y un indicadores presentaron una mejoria significativa (entre ellos destacan los indicadores de calidad de la historia clinica, de evaluacion neurologica, las medidas preventivas iniciales y, con especial relevancia, la realizacion de test de deglucion), dos sufrieron empeoramiento (relacionados con el tratamiento rehabilitador) y 15 no registraron variaciones significativas. Conclusiones. La implantacion del PAIA ha supuesto una mejoria notable en la mayoria de los indicadores de calidad evaluados, reflejo de una mejora continua en la atencion hospitalaria del ictus. La generalizacion progresiva de la atencion especializada y la creacion de las areas de ictus son algunos de los factores determinantes.

  10. Como Lo Hago Yo: Lipomas Medulares

    PubMed Central

    Portillo, Santiago

    2014-01-01

    Basados en la experiencia de 82 casos; en 5% se observaron anomalías pélvicas asociadas. En los menores de 3 años el motivo de consulta (85%) fue la tumoración. En los mayores de 3 años (42%) tenía problemas neurológicos. Solo el 24% preocupados por la tumoración. El objetivo de la cirugía es desanclar la médula y no remover la totalidad del lipoma. El lipoma de filum es el que es mas simple para operar. Aún cuando la escuela francesa propone operar solamente cuando hay síntomas favorezco cirugía preventiva. Favorezco una segunda cirugía si hay signos de anclaje postoperatorio, aún cuando observamos empeoramiento postoperatorio motor en 2.5% de los operados y urológico a largo plazo en 6% de los operados. PMID:24791218

  11. Magnetares como fuentes para potenciar supernovas superluminosas

    NASA Astrophysics Data System (ADS)

    Bersten, M. C.; Benvenuto, O. G.

    2016-08-01

    Magnetars have been proposed as one of the possible sources to power the light curve of super-luminous supernovae. We have included the energy deposited by a hypothetical magnetar in our one-dimensional hydrodynamical code, and analyzed the dynamical effect on the supernova ejecta. In particular, we present a model for SN 2011kl, the first object associated with a ultra-long-duration gamma-ray burst. Finally, we show its effect on the light curves of hydrogen rich supernovae.

  12. Particle-associated contaminants in street dust, parking lot dust, soil, lake-bottom sediment, and suspended and streambed sediment, Lake Como and Fosdic Lake watersheds, Fort Worth, Texas, 2004

    USGS Publications Warehouse

    Wilson, Jennifer T.; Van Metre, Peter C.; Werth, Charles J.; Yang, Yanning

    2006-01-01

    A previous study by the U.S. Geological Survey of impaired water bodies in Fort Worth, Texas, reported elevated but variable concentrations of particle-associated contaminants (PACs) comprising chlorinated hydrocarbons, polycyclic aromatic hydrocarbons, and trace elements in suspended and bed sediment of lakes and streams affected by urban land use. The U.S. Geological Survey, in cooperation with the City of Fort Worth, collected additional samples during October 2004 to investigate sources of PACs in the watersheds of two impaired lakes: Lake Como and Fosdic Lake. Source materials and aquatic sediment were sampled and analyzed for PACs. Source materials sampled consisted of street dust and soil from areas with residential and commercial land use and parking lot dust from sealed and unsealed parking lots. Aquatic sediment sampled consisted of bottom-sediment cores from the two lakes and suspended and streambed sediment from the influent stream of each lake. Samples were analyzed for chlorinated hydrocarbons (organochlorine pesticides and polychlorinated biphenyls), polycyclic aromatic hydrocarbons, major and trace elements, organic carbon, grain size, and radionuclides.

  13. Essays on Eclipses, Transits and Occultations as Teaching Tools in the Introductory Astronomy College Course. (Spanish Title: Ensayos sobre Eclipses, Tránsitos y Ocultaciones Como Herramientas de Enseñanza en el Curso Universitario Introductorio a la Astronomía.) Ensaios sobre Eclipses, Trânsitos e Ocultações Como Ferramentas de Ensino em um Curso Universitário Introdutório de Astromomia

    NASA Astrophysics Data System (ADS)

    Dcruz, Noella L.

    2014-07-01

    estudiantes que escribieran dos ensayos cortos de tres que se proponían. Los ensayos contenían partes descriptivas y conceptuales. Los mismos estaban destinados a servir como herramientas de enseñanza. 62% de los 106 ensayos de 55 estudiantes obtuvo grados A, B o C. 21% de los 47 encuestados que respondieron al cuestionario posterior consideró que los ensayos aumentaron su interés por la astronomía. 49% de los encuestados consideró que los ensayos no eran educacionalmente útiles y que no deben ser propuestos de nuevo. Las respuestas escritas más comunes a nuestra encuesta indicaran que los estudiantes necesitan más orientación y una mejor preparación en la redacción de ensayos exitosos. Dado que los estudiantes encontraron las piezas conceptuales de los ensayos difíciles, en el futuro vamos a ofrecer actividades pertinentes antes de los plazos de redacción para ayudar a los estudiantes a crear ensayos de mayor calidad. Nós ocasionalmente incluímos projetos em nosso curso universitário introdutório centrado no aluno para permitir aos estudantes que pertencem às carreiras não científicas explorar alguns conceitos astronômicos em mais detalhes do que o normal. Tais projetos também enfatizam eventos astronômicos em curso ou futuros. Esperamos que os alunos se sintam mais interessados na astronomia através de projetos ligados a eventos astronômicos. No termo de Primavera de 2012 (EUA), propomos ensaios curtos focados em eclipses, trânsitos e ocultações para promover o raro trânsito de Vênus que ocorreu no dia 5 de junho de 2012. Pedimos aos alunos que escrevessem dois ensaios curtos dentre três que foram propostos. Os ensaios continham partes descritivas e conceituais. Eles foram feitos para servir como ferramentas de ensino. 62% de 106 ensaios de 55 alunos ganhou graus A, B ou C. 21% dos 47 entrevistados que responderam ao levantamento posterior sentiu que os ensaios aumentaram seu interesse na astronomia. 49% dos inquiridos consideraram que os

  14. Project ES3: attempting to quantify and measure the level of stress.

    PubMed

    Aguiló, Jordi; Ferrer-Salvans, Pau; García-Rozo, Antonio; Armario, Antonio; Corbí, Ángel; Cambra, Francisco J; Bailón, Raquel; González-Marcos, Ana; Caja, Gerardo; Aguiló, Sira; López-Antón, Raúl; Arza-Valdés, Adriana; Garzón-Rey, Jorge M

    2015-11-01

    Introduccion. La Organizacion Mundial de la Salud ha calificado al estres de 'epidemia mundial', debido a su cada vez mayor incidencia en la salud. El trabajo que se presenta en este articulo representa un intento de cuantificar objetivamente el nivel de estres. Objetivo. La metodologia desarrollada tiene como objetivo medir cuan lejos o cuan cerca se encuentra un sujeto de una situacion considerada medica y socialmente como 'normal'. Sujetos y metodos. Se ha realizado un estudio bibliografico de la fisiopatologia del estres y sus metodos de estudio, en experimentacion animal y en humanos. Se han puesto en marcha nueve estudios prospectivos observacionales con distintas tipologias de sujetos y estresores que cubren las diferentes tipologias de estres. Resultados. Como resultado del estudio bibliografico, se han identificado las distintas tipologias de estres, los indicadores que describen resultados significativos, los tests psicometricos y los 'agentes estresantes' bien documentados. Este material ha permitido diseñar la metodologia general y el detalle de los nueve ensayos clinicos. Los resultados preliminares obtenidos en algunos de los estudios han servido para validar los indicadores, asi como la eficacia de las tecnicas utilizadas experimentalmente para disminuir el estres o para producirlo. Conclusiones. Los resultados preliminares obtenidos en los ensayos experimentales muestran que se esta en el camino correcto hacia la definicion y validacion de marcadores multivariable para la cuantificacion de los niveles de estres, y sugieren que la metodologia puede ser aplicada de forma similar al estudio de trastornos mentales.

  15. Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele

    PubMed Central

    Portillo, Santiago

    2014-01-01

    En Argentina hay plan de fortificación con ácido fólico. Diagnostico prenatal no siempre es correcto. Cierre según técnica. Cerramos músculo. No favorecemos corpectomía temprana en casos de cifosis. Suturamos la plaqueta. Cerramos el plano muscular. Hidrocefalia: Válvula de derivación, generalmente dentro de los dos primeros meses. Ventriculostomía no está indicada. Chiari II. Laminectomia cervical alta. Siringomielia: Derivación desde la cavidad al peritoneo. PMID:24791219

  16. Los mitos como memoria colectiva de Los Pueblos.

    NASA Astrophysics Data System (ADS)

    Martín, P. T.

    Myths are essentially something practical that allows those who believe in them to solve any ambiguity which could come up in their relation with nature. Since they bring information about the condition of the reality to which they belong, they are but the appropriate instrument to insert nature into culture by actually achieving an adaptation to the environment. The purpose of this essay is to show how the deification of plants, animals, and stars, which are present in the daily lives of "Amerindian" people, not only constitutes a source of rich mythology but also turns out to be an effective measure towards the continuity of social groups. Similarities or identifications between human life and the life of plants, animals and stars as well as mutual interplay are somehow present in those myths: stars which create or are changed into human being, animals or plants; human beings who create or are transformed into astral bodies; battles between peoples and stars, etc. On this base, mythology can provide not only keys to show how certain human groups have achieved their adaptation to the environment and how the different social systems and their relations to nature have developed, but also hints of changes which have taken place in other heavenly spheres such as the falling of meteors, the appearance of comets or any other significant events of this kind in the lives of these groups.

  17. Los colegios como comunidades (Schools as Communities). ERIC Digest.

    ERIC Educational Resources Information Center

    Royal, Mark A.; Rossi, Robert J.

    A good deal of evidence now suggests that a strong sense of community in schools has benefits for both staff members and students, while providing a necessary foundation for school improvement. This digest in Spanish provides an overview of the literature on schools as communities. The digest identifies the elements of community schools, the…

  18. El Espanol como Idioma Universal (Spanish as a Universal Language)

    ERIC Educational Resources Information Center

    Mijares, Jose

    1977-01-01

    A proposal to transform Spanish into a universal language because it possesses the prerequisites: it is a living language, spoken in several countries; it is a natural language; and it uses the ordinary alphabet. Details on simplification and standardization are given. (Text is in Spanish.) (AMH)

  19. [Parenting Information. Informacion Sobre Como Ser Padres Mejores.

    ERIC Educational Resources Information Center

    Moreno, Steve

    These five booklets, containing information on how parenting can effect children's school achievement, are part of a series of 22 innovative booklets designed specifically to help parents understand and help their children learn. Booklet #1, "Parents--Teach Your Children to Learn [Before They Go to School]," defines intelligence and suggests…

  20. Joint Effect of Early Microvascular Damage in the Eye & Kidney on Risk of Cardiovascular Events

    PubMed Central

    Yip, Wanfen; Sabanayagam, Charumathi; Ong, Peng Guan; Patel, Uptal D; Chow, Khuan Yew; Tai, E Shyong; Ling, Lieng H; Wong, Tien Yin; Cheung, Carol Yim-lui

    2016-01-01

    Microalbuminuria is associated with an increased risk of cardiovascular disease (CVD), but not all individuals require treatment. Retinal microvascular abnormalities and microalbuminuria reflect early systemic microvascular changes. We examined the joint effect of retinal abnormalities and microalbuminuria on CVD risk in an Asian cohort. We conducted a prospective, population-based study. Retinal abnormalities were defined as presence of retinopathy and/or retinal venular widening. Microalbuminuria was defined as urinary albumin: creatinine ratio between 30–300 mg/g. Incident CVD was defined as newly diagnosed clinical stroke, acute myocardial infarction or CVD death. Cox regression models were performed to determine the associations between retinal abnormalities and microalbuminuria with risk of CVD, while controlling for established risk factors. 3,496 participants (aged ≥ 40) were free of prevalent CVD. During the follow-up (5.8 years), 126 (3.60%) participants developed CVD. Persons presenting with both retinal abnormalities and microalbuminuria were 6.71 times (95% CI, 2.68, 16.79) as likely to have incident CVD compared with those without either abnormalities. There was a significant interaction effect between retinal abnormalities and microalbuminuria on incident CVD. Assessment of retinal abnormalities in patients with microalbuminuria may provide additional value in identifying persons at risk of developing CVD. PMID:27273133

  1. Joint Effect of Early Microvascular Damage in the Eye &Kidney on Risk of Cardiovascular Events.

    PubMed

    Yip, Wanfen; Sabanayagam, Charumathi; Ong, Peng Guan; Patel, Uptal D; Chow, Khuan Yew; Tai, E Shyong; Ling, Lieng H; Wong, Tien Yin; Cheung, Carol Yim-Lui

    2016-01-01

    Microalbuminuria is associated with an increased risk of cardiovascular disease (CVD), but not all individuals require treatment. Retinal microvascular abnormalities and microalbuminuria reflect early systemic microvascular changes. We examined the joint effect of retinal abnormalities and microalbuminuria on CVD risk in an Asian cohort. We conducted a prospective, population-based study. Retinal abnormalities were defined as presence of retinopathy and/or retinal venular widening. Microalbuminuria was defined as urinary albumin: creatinine ratio between 30-300 mg/g. Incident CVD was defined as newly diagnosed clinical stroke, acute myocardial infarction or CVD death. Cox regression models were performed to determine the associations between retinal abnormalities and microalbuminuria with risk of CVD, while controlling for established risk factors. 3,496 participants (aged ≥ 40) were free of prevalent CVD. During the follow-up (5.8 years), 126 (3.60%) participants developed CVD. Persons presenting with both retinal abnormalities and microalbuminuria were 6.71 times (95% CI, 2.68, 16.79) as likely to have incident CVD compared with those without either abnormalities. There was a significant interaction effect between retinal abnormalities and microalbuminuria on incident CVD. Assessment of retinal abnormalities in patients with microalbuminuria may provide additional value in identifying persons at risk of developing CVD. PMID:27273133

  2. [Neurological health care activity in a recently created district hospital: model of high efficiency].

    PubMed

    Jiménez-Jiménez, Félix J; Plaza-Nieto, José F; Navacerrada, Francisco; Alonso-Navarro, Hortensia; Pilo-de-la-Fuente, Belén; Arroyo-Solera, Margarita; Guillán, Marta; Calleja, Marisol; Moreno-Puertas, Dolores

    2015-03-01

    Objetivo. Analizar la actividad asistencial de un hospital comarcal de reciente creacion, con especial enfasis en los indicadores asistenciales en consultas externas y en actos medicos de pacientes ingresados. Pacientes y metodos. Describimos la actividad asistencial realizada por nuestra seccion de neurologia durante los años 2008-2013. Se comparan nuestros indicadores asistenciales de los años 2012 y 2013 (quinto y sexto año de actividad), tanto en consultas externas como en pacientes ingresados, con los de otros dos hospitales de caracteristicas similares, otros tres de nivel secundario y otros cuatro de nivel terciario. Resultados. La seccion de neurologia de nuestro hospital fue la que realizo mayor numero de primeras consultas por facultativo, tuvo el mejor indice de consultas sucesivas/primeras y el mayor porcentaje de consultas de alta resolucion, tuvo la menor estancia media en los dos grupos relacionados por el diagnostico (GRD) mas frecuentes en nuestra especialidad, y fue la segunda en ingresos por facultativo del GRD 'ictus con infarto' y la tercera en ingresos por facultativo del GRD 'otros trastornos del sistema nervioso'. Conclusiones. Los indicadores asistenciales de la seccion de neurologia de nuestro hospital muestran un modelo de muy alta eficiencia, al cual solo se aproximan los de otros dos de caracteristicas y desarrollo similares al nuestro. La implantacion gradual de modelos similares al de estos tres hospitales en los niveles secundario y terciario podria ser de utilidad en la mejora de su eficiencia asistencial.

  3. [Pulmonary age-chronological age relation as indicator of improvement and severity of patients with bronchial asthma].

    PubMed

    Castrejón-Vázquez, María Isabel; Galicia-Tapia, Jorge; Guido-Bayardo, Ricardo Leopoldo; Ortiz-Contreras, Felipe; Cícero-Sabido, Raúl; Vargas-Camaño, María Eugenia

    2014-01-01

    Antecedentes: la espirometría es una prueba clínica que se utiliza para evaluar la función pulmonar en asmáticos. La función pulmonar puede estar afectada por el género, tiempo de evolución clínica, edad pulmonar y edad cronológica. Objetivo: evaluar la relación edad pulmonar-edad cronológica (EP/EC) como indicador de gravedad en pacientes asmáticos. Material y método: estudio prospectivo en el que se evaluó la gravedad del asma mediante la clasificación GINA. La espirometría se realizó al inicio del estudio y a los días 46, 96 y 192, durante 10 meses de seguimiento. Se usaron la prueba t Student, ANOVA de dos vías, modelos de correlación y regresión múltiple y curvas ROC; un valor p<0.05 se consideró significativo. Resultados: se incluyeron 70 pacientes asmáticos (22 hombres y 48 mujeres); la media de la edad cronológica (EC) fue de 35 años, la media de la edad pulmonar (EP) fue de 48 años, con valor del indicador EP-EC=1.4 y la evolución clínica de la enfermedad fue de 13 años. El valor del indicador EP-EC=1 (intervalo de 0.5 a 0.9) se observó en pacientes asintomáticos. El indicador EP-EC mayor a 1 se relacionó con obstrucción de la vía aérea y el indicador EP-EC mayor a 2 se correlacionó con grado 3 de GINA. El análisis de la edad cronológica y pulmonar en las mujeres demostró diferencia de más de 10 años entre ambas edades (GINA grados 2 y 3); mientras que en los hombres se observaron (GINA grados 1, 2 y 3). El valor del indicador EP-EC menor o igual que 1 se consideró normal. Conclusiones: la relación edad pulmonar-edad cronológica puede usarse como indicador clínico de la gravedad y mejoría clínica de pacientes asmáticos, con buena correlación entre la función pulmonar y la edad cronológica.

  4. [Primary and secondary outcomes in oncology clinical trials: definitions and uses].

    PubMed

    Vaz-Carneiro, António; Luz, Ricardo; Borges, Margarida; Costa, João

    2014-01-01

    Introdução: A prova de eficácia de uma intervenção terapêutica em oncologia consegue-se através de ensaios clínicos rigorosamente conduzidos. Um dos factores metodológicos mais importantes é a selecção de indicadores clínicos de eficácia (outcomes), necessários ao cálculo das chamadas medidas de associação que permitem a definição de eficácia terapêutica. Material e Métodos: Foi feita uma revisão narrativa baseada em alguns dos documentos de agências reguladoras internacionais, assim como documentos de consenso entre as sociedades científicas oncológicas, procurando listar e avaliar criticamente cada um dos indicadores utilizados em ensaios clínicos oncológicos. Resultados: Identificaram-se como indicadores mais importantes a sobrevivência global, a sobrevivência livre de progressão/sobrevivência livre de doença, a toxicidade/qualidade de vida e taxa objectiva de resposta tumoral. Discussão: A selecção do outcome primário deve basear-se no conceito de eficácia terapêutica, mas também na toxicidade relativa da terapêutica experimental, na sobrevivência esperada após progressão da doença, na existência de fármacos alternativos já estudados com indicações idênticas e até a prevalência da patologia em causa. Conclusão: A selecção de indicadores em ensaios clínicos oncológicos reveste-se de especial importância e a sua selecção deve ser bem fundamentada, dependendo da doença, dos doentes e do fármaco em estudo.

  5. 24-hour urine protein

    MedlinePlus

    ... a blockage of blood vessels, or other causes Multiple myeloma Healthy people may have higher than normal urine ... Distal Hemolytic anemia Macroglobulinemia of Waldenstrom Microalbuminuria test Multiple myeloma Nephrotic syndrome Proximal Wilson disease Update Date 11/ ...

  6. [Hospital efficiency measured by bed space use in a secondary care hospital].

    PubMed

    Moreno-Martínez, Roberto; Martínez-Cruz, Rocío Alejandra

    2015-01-01

    Introducción: reconociendo que los recursos disponibles en las unidades médicas forman parte de los factores que condicionan la atención médica de calidad, resulta de importancia medir su aprovechamiento. El objetivo de este estudio fue determinar la eficiencia hospitalaria a través del recurso cama en un hospital de segundo nivel. Métodos: del Sistema de Información Médico Operativo, se examinaron los cuadros de salida mensuales de julio 2012 a junio 2013 que incluyen variables como egresos, días paciente, porcentaje de ocupación y promedio de días de estancia por especialidad y división, se obtuvieron los resultados por cada indicador estratégico y se relacionaron dichos resultados proponiendo supuestos para valorar la eficiencia hospitalaria. Resultados: de manera global, se identifica una óptima eficiencia hospitalaria, sin embargo el análisis por servicio y división señala una eficiencia deteriorada y baja. El resultado global de los cinco indicadores aplicados ignora la saturación de los servicios al interior de la unidad médica. Sin embargo, el análisis en conjunto revela dicha problemática, demostrando la ventaja de evaluar un mismo escenario desde diferentes perspectivas. Conclusiones: incluir indicadores que midan la eficiencia hospitalaria partiendo del recurso cama, permite considerar deficiencias no identificadas, con lo que se fortalece la toma de decisiones en salud.

  7. [Primary cardiorenal prevention in patients with type-2 diabetes. The Roadmap study].

    PubMed

    Halimi, S

    2005-10-22

    The incidence of type-2 diabetes is increasing throughout the world. By 2010, 350 million people will have this disease. Microalbuminuria is present in more than one third, for some at diabetes diagnosis. Rather than a complication, it is an indication of a vascular disorder that is part of the metabolic syndrome. 25% will develop end-stage kidney failure. Several studies have identified microalbuminuria or proteinuria as an independent cardiovascular risk factor. Others have shown that antihypertensive treatments acting on the renin-angiotensin system (ACE inhibitors, ARBs agents) can reduce the progression of nephropathy in people with hypertension, type 2 diabetes and microalbuminuria. The "nephroprotective" effects of these drug classes, beyond their role in blood-pressure reduction, are suggested by modifications in renal structure and protein expression. But no study has so far examined their value in primary prevention in persons with type 2 diabetes without--but at risk of developing--microalbuminuria. The Roadmap study (Randomized Olmesartan And Diabetes Microalbuminuria Prevention Study) of primary prevention has as its objective measurement of the impact of ARBs (olmesartan 40 mg/d) treatment on renal outcome in 4400 patients with type 2 diabetes without microalbuminuria. Follow-up of this placebo-controlled study will last for 5 years. Conducted in 200 European centers, its results are expected for 2012. PMID:16269993

  8. Como ayudar a su hijo a aprender a leer ingles como segunda lengua. (How Can I Help My Child Learn to Read English as a Second Language.)

    ERIC Educational Resources Information Center

    Garcia, Ricardo L.; Deyoe, Rita Maxine

    Suggestions for ways in which parents can help their children learn to read English are contained in this short booklet written in Spanish. Activities to be performed in the home, such as listening to and talking to the child in any language, reading aloud, reading for oneself, obtaining books for the home, and organizing study time for the child,…

  9. [Not Available].

    PubMed

    Vila Nova, Larissa Pessoa; Araújo Tavares de Sá, Cristiane Maria; Freire Clementino da Silva, Maria Cleide; Lustosa, Marinaldo Freire; Batista de Medeiros, Rafael Augusto; Calado Brito, Daniel; De Araújo Burgos, Maria Goretti Pessoa

    2016-01-01

    Introducción: en los últimos años la importancia de identificar la resistencia a la insulina (RI) en pacientes con enfermedades cardiovasculares isquémicas viene siendo debatida. Métodos alternativos, como los indicadores antropométricos y de composición corporal, han sido señalados como una buena opción y contribuyen para identificar anomalías metabólicas y prevenir complicaciones.Objetivo: asociar indicadores antropométricos y de composición corporal como predictores de la resistencia a la insulina (RI) en pacientes con enfermedad de las arterias coronarias.Métodos: estudio transversal realizado en el hospital de referencia cardiológica de Pernambuco, en el periodo de junio a septiembre de 2014, con pacientes adultos y ancianos hospitalizados, de ambos sexos. Se verificaron los siguientes parámetros: estilo de vida, la presencia del síndrome metabólico (SM) y otras comorbilidades. Se analizó la RI por el cálculo del HOMA-IR. Los pacientes se sometieron a la impedancia bioeléctrica (BIA) y a las verificaciones antropométricas.Resultados: la muestra fue constituida por 75 pacientes con edad media de 63,75 ± 12,43 años, con un 64% de ancianos. Se encontró el diagnóstico de SM en el 65,3% de los pacientes, el 81,3% de sedentarios y el 37,4% con exceso de peso. Se diagnosticó la RI en el 28% de los pacientes. Se observó correlación entre el HOMA-IR y el diámetro abdominal sagital (DAS) (r = 0,476; p = 0,016), el índice de masa corporal (r = 0,233; p = 0,040) y el porcentual de grasa corporal (r = 0,276; p = 0,016).Conclusión: el DAS fue el indicador antropométrico que presentó mejor correlación con la RI en pacientes con enfermedad de las arterias coronarias hospitalizados. PMID:27571654

  10. [Not Available].

    PubMed

    Vila Nova, Larissa Pessoa; Araújo Tavares de Sá, Cristiane Maria; Freire Clementino da Silva, Maria Cleide; Lustosa, Marinaldo Freire; Batista de Medeiros, Rafael Augusto; Calado Brito, Daniel; De Araújo Burgos, Maria Goretti Pessoa

    2016-07-19

    Introducción: en los últimos años la importancia de identificar la resistencia a la insulina (RI) en pacientes con enfermedades cardiovasculares isquémicas viene siendo debatida. Métodos alternativos, como los indicadores antropométricos y de composición corporal, han sido señalados como una buena opción y contribuyen para identificar anomalías metabólicas y prevenir complicaciones.Objetivo: asociar indicadores antropométricos y de composición corporal como predictores de la resistencia a la insulina (RI) en pacientes con enfermedad de las arterias coronarias.Métodos: estudio transversal realizado en el hospital de referencia cardiológica de Pernambuco, en el periodo de junio a septiembre de 2014, con pacientes adultos y ancianos hospitalizados, de ambos sexos. Se verificaron los siguientes parámetros: estilo de vida, la presencia del síndrome metabólico (SM) y otras comorbilidades. Se analizó la RI por el cálculo del HOMA-IR. Los pacientes se sometieron a la impedancia bioeléctrica (BIA) y a las verificaciones antropométricas.Resultados: la muestra fue constituida por 75 pacientes con edad media de 63,75 ± 12,43 años, con un 64% de ancianos. Se encontró el diagnóstico de SM en el 65,3% de los pacientes, el 81,3% de sedentarios y el 37,4% con exceso de peso. Se diagnosticó la RI en el 28% de los pacientes. Se observó correlación entre el HOMA-IR y el diámetro abdominal sagital (DAS) (r = 0,476; p = 0,016), el índice de masa corporal (r = 0,233; p = 0,040) y el porcentual de grasa corporal (r = 0,276; p = 0,016).Conclusión: el DAS fue el indicador antropométrico que presentó mejor correlación con la RI en pacientes con enfermedad de las arterias coronarias hospitalizados.

  11. [Reliability and validity of an instrument to evaluate integral clinical competence in medical residents].

    PubMed

    Sepúlveda-Vildósola, Ana Carolina; Gaspar-López, Nadia; Reyes-Lagunes, Lucina Isabel; Gonzalez-Cabello, Héctor Jaime

    2015-01-01

    Introducción: la evaluación de la competencia clínica de un residente es un proceso complejo. Los profesores requieren de instrumentos confiables y válidos para evaluar objetivamente la competencia clínica. El objetivo fue evaluar la confiabilidad y validez de un instrumento (IECC) diseñado para evaluar la competencia clínica integral de los médicos residentes. Métodos: se diseñó un instrumento a partir de los diferentes pasos del método clínico, y se determinaron tres niveles de competencia para cada uno. El instrumento fue revisado respecto a su claridad, pertinencia y la suficiencia de sus indicadores planteados por cinco médicos pediatras expertos. Cada residente fue evaluado independientemente por tres médicos. Resultados: se obtuvieron en total 651 mediciones en 234 residentes. El instrumento discriminó entre grupos extremos. Se obtuvo un valor de alfa de Cronbach de 0.778 y el análisis factorial distinguió dos factores: competencia clínica y competencias complementarias. No se encontraron diferencias entre evaluadores en las calificaciones globales ni en cada uno de los indicadores. Conclusión: el instrumento propuesto es válido y confiable. Se propone como una herramienta más en la evaluación formativa de los médicos residentes de especialidades clínicas.

  12. [Determination of 2-hydroxyestrone /16α-hydroxyestrone ratio in urine of Mexican women as a risk indicator for breast cancer and its relationship with other risk factors].

    PubMed

    Godínez Martínez, Estela Ytelina; Santillán Ballesteros, René; Lemus Bravo, Ana Elena; Sámano, Reyna; Tolentino Dolores, Maricruz; Rodríguez Ventura, Ana Lilia; Juárez González, Ana Rosa

    2014-10-25

    La relacion 2-hidroxiestrona/16-hidroxiestrona urinaria (RMEO), se ha propuesto en diversas poblaciones del mundo como indicador de riesgo a cancer de mama (CM), sin embargo, en la poblacion mexicana, nunca se ha determinado. Objetivo: Determinar la RMEO en mujeres mexicanas y establecer su relacion con factores de riesgo para CM. Material y Métodos: Estudio transversal analitico de 142 mujeres premenopausicas y 42 posmenopausicas. Se determino la RMEO con el estuche ESTRAMETTM y se relaciono con factores de riesgo para CM. Se realizaron correlaciones y regresiones lineales. Resultados: La mediana de la RMEO fue 0.90 (RIC: 0.64-1.18). El indice de masa corporal (IMC) y la menarca temprana contribuyeron en 5.4% de su variabilidad (F=5.17; p.

  13. Escuelas sin Drogas. Como Actuar. Edicion 1992. (Schools without Drugs. What Works. 1992 Edition).

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    Across the United States, schools and communities have found ways to turn the tide in the battle against drugs. This guidebook describes the methods they have used and the actions they have taken. The first section, "Children and Drugs" outlines the nature and extent of the drug problem and summarizes the latest research on the effects of drugs on…

  14. Contributions of local knowledge to the physical limnology of Lake Como, Italy.

    PubMed

    Laborde, Sarah; Imberger, Jörg; Toussaint, Sandy

    2012-04-24

    This article shows how local knowledge may be valuably integrated into a scientific approach in the study of large and complex hydrological systems where data collection at high resolution is a challenge. This claim is supported through a study of the hydrodynamics of a large lake where qualitative data collected from professional fishers was combined with theory to develop a hypothesis that was then verified by numerical modeling. First the fishermen's narratives were found to describe with accuracy internal wave motions that were evident in water column temperature records, which revealed their practical knowledge of the lake's hydrodynamics. Second, local knowledge accounts emphasized the recurrent formation of mesoscale gyres and return flows in certain zones of the lake in stratified conditions, which did not appear in the physical data because of limitations of sampling resolution. We hypothesized that these features developed predominantly because of the interaction of wind-driven internal motions with the lake's bathymetry, and the Earth's rotation in the widest areas of the basin. Numerical simulation results corroborated the fishers' descriptions of the flow paths and supported the hypothesis about their formation. We conclude that the collaboration between scientific and local knowledge groups, although an unusual approach for a physical discipline of the geosciences, is worth exploring in the pursuit of a more comprehensive understanding of complex geophysical systems such as large lakes.

  15. Como Ayudar a sus Hijos a Aprender Ciencia (Helping Your Child Learn Science).

    ERIC Educational Resources Information Center

    Paulu, Nancy; Martin, Margery

    Because most parents say they do not or cannot help their children with science, this booklet was designed to help them do so, easily and with pleasure for both parent and child. The introduction presents information on why and how parents should help their children and provides a general orientation to the ideas and activities offered in the…

  16. Como pagar tu educacion, 2003-2004 (How To Pay for Your Education, 2003-2004).

    ERIC Educational Resources Information Center

    Office of Federal Student Aid (ED), Washington, DC.

    This Spanish language booklet discusses paying for college. The guide presents information in question-and-answer form about things an applicant should ask and how to obtain financial aid. It describes the criteria for receiving aid and provides information about complying with aid requirements. The booklet also describes federal Pell grants and…

  17. Como pagar to educacion, 2004-2005 (Funding Your Education, 2004-2005).

    ERIC Educational Resources Information Center

    Office of Federal Student Aid (ED), Washington, DC.

    This publication, written in Spanish, describes financial aid programs of the U.S. Department of Education and advises students about paying for college. It outlines things a student should ask about college and how to obtain financial aid, whether grants, work-study, or loans. Chapters provide information on: (1) "Education after High School";…

  18. The New Room Arrangement as a Teaching Strategy = La Nueva Organizacion del Salon como Estrategia Educativa.

    ERIC Educational Resources Information Center

    Dodge, Diane Trister

    Many typical classroom behavior problems--running in the classroom, inability to make choices, failure to stick with activities, fighting over toys, and poor use of materials-- can be traced to how the room is arranged and how materials are displayed. By making a few changes in the classroom environment, early childhood teachers can create a…

  19. La Lengua Escrita como Norma Fonetica (The Written Language as Phonetic Norm)

    ERIC Educational Resources Information Center

    Diaz-Plaja, Guillermo

    1977-01-01

    A collectivity can be defined by the verbal instrument which binds it together. By extension of this thought of Marshall MacLuhan, the importance of the written language as normative for the uniformity, universality and preservation of the phonetic system of the language is discussed. (Text is in Spanish.) (AMH)

  20. Spanish Oral Language Guide: Kindergarten Level. Espanol como Segundo Idioma. Teacher's Guide: Level I.

    ERIC Educational Resources Information Center

    Corbell, Gloria; And Others

    This teacher's guide to Spanish language at the kindergarten level includes a recommended subject presentation sequence for the Spanish curriculum, a sample schedule, a grouping of students using three stations, and a classroom layout. The grouping would be effective when at least one-third of the children are Spanish-speaking or bilingual. The…

  1. Co/Mo bimetallic addition to electrolytic manganese dioxide for oxygen generation in acid medium

    PubMed Central

    Delgado, Dario; Minakshi, Manickam; McGinnity, Justin; Kim, Dong-Jin

    2015-01-01

    An efficient electrocatalyst comprising inexpensive and earth-abundant materials for the oxygen evolution reaction (OER) is crucial for the development of water electrolysis. In this work, in-situ addition of cobalt/molybdenum ions to the electrolytic manganese dioxide has been shown to be beneficial for the OER in acid solution as its overpotential performed better (305 mV) than that of the commercial DSA® (341 mV) at 100 mA cm−2. The OER was investigated at ambient temperature in 2 M H2SO4 solution on the modified EMD (MnMoCoO) electrodes. The energy efficiency of the MnMoCoO electrodes improved significantly with the amount of Co in the plating solution. For the electrodeposited catalysts, physico-chemical and electrochemical measurements were conducted including static overpotentials. The better performance of the modified EMD was attributed to an improved charge transfer resistance (Rct; 0.290 Ω cm2), average roughness factor (rf; 429) and decrease in water content in the electrodeposited catalysts. The kinetic parameters obtained on MnMoCoO catalysts were compared and discussed according to the cobalt concentration. PMID:26469204

  2. Cosmic ray soil moisture observing systems comos in cap fields at El Reno Oklahoma

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Soil water content (SWC) partitions rainfall into runoff and infiltration, modulates surface and atmospheric exchanges of water and energy, affects plant growth and crop yields, and impacts chemical and biological activities of soil, among other things. Thus, SWC, especially over large scales, is a...

  3. International Perspectives on Affirmative Action. A Bellagio Conference (Lake Como, Italy, August 16-20, 1982).

    ERIC Educational Resources Information Center

    Rockefeller Foundation, New York, NY.

    This volume presents nine papers read at a conference on affirmative action, sponsored by the Rockefeller Foundation and held at Columbia University in August 1982; a preface, summary paper, and list of participants are also included. Each paper addresses the issue of affirmative action within a different country and describes: (1) the policies…

  4. "Las Charlas" como expresion oral diaria ["Chats" as Daily Oral Practice].

    ERIC Educational Resources Information Center

    Borden, Matt

    2002-01-01

    An oral practice system of "chats" in the classroom functions as an extemporaneous speaking exercise or chat (without notes or prompt sheets), occurring between two students for a minute or so at the beginning of class, following which the presenters respond to other students' questions. (CNP)

  5. Co/Mo bimetallic addition to electrolytic manganese dioxide for oxygen generation in acid medium

    NASA Astrophysics Data System (ADS)

    Delgado, Dario; Minakshi, Manickam; McGinnity, Justin; Kim, Dong-Jin

    2015-10-01

    An efficient electrocatalyst comprising inexpensive and earth-abundant materials for the oxygen evolution reaction (OER) is crucial for the development of water electrolysis. In this work, in-situ addition of cobalt/molybdenum ions to the electrolytic manganese dioxide has been shown to be beneficial for the OER in acid solution as its overpotential performed better (305 mV) than that of the commercial DSA® (341 mV) at 100 mA cm-2. The OER was investigated at ambient temperature in 2 M H2SO4 solution on the modified EMD (MnMoCoO) electrodes. The energy efficiency of the MnMoCoO electrodes improved significantly with the amount of Co in the plating solution. For the electrodeposited catalysts, physico-chemical and electrochemical measurements were conducted including static overpotentials. The better performance of the modified EMD was attributed to an improved charge transfer resistance (Rct; 0.290 Ω cm2), average roughness factor (rf; 429) and decrease in water content in the electrodeposited catalysts. The kinetic parameters obtained on MnMoCoO catalysts were compared and discussed according to the cobalt concentration.

  6. The Struggle for Mexico's First Gay-Straight Alliance: Como una Novela Real

    ERIC Educational Resources Information Center

    Macgillivray, Ian K.

    2006-01-01

    In 2004, a group of high school students at a private American school in Mexico City started the first gay-straight alliance in Mexico. A small group of conservative parents and a Mormon principal organized in opposition. This paper details the students' struggle to keep their club and offers lessons learned about student activism, school change,…

  7. Materials Data on Co(MoS2)2 (SG:12) by Materials Project

    DOE Data Explorer

    Kristin Persson

    2016-04-23

    Computed materials data using density functional theory calculations. These calculations determine the electronic structure of bulk materials by solving approximations to the Schrodinger equation. For more information, see https://materialsproject.org/docs/calculations

  8. "Tanto Necesitamos De Aqui Como Necesitamos De Alla": "Leer Juntas" among Mexican Transnational Mothers and Daughters

    ERIC Educational Resources Information Center

    de la Piedra, Maria Teresa

    2011-01-01

    This paper presents part of the results of a qualitative study about literacy practices of Mexican transnational mothers, who live in and frequently cross the border between two countries (the United States and Mexico). Drawing on sociocultural approaches to literacy and literature on transnationalism, I analyze one practice: "leer juntas"…

  9. Como Lo Hago Yo: Defectos Del Cierre Del Tubo Neural En Nicaragua

    PubMed Central

    Gonzalez, Juan Bosco

    2014-01-01

    En Nicaragua no hay un plan de forltificación de alimentos con ácido fólico. Las madres son muy jóvenes. En La Mascota operamos mas de cuarenta niños por año. Derivación tardía es un problema. La infección preoperatoria tiene que ser descartada. Vancomicina y Ceftriaxone estan indicadas. Estricta regla de asepsia operatoria. Suturamos la plaqueta para asemejar su forma al cilindro normal de la médula. No ceramos la capa de músculo. PMID:24791221

  10. Como si le Falta un Brazo: Latino Immigrant Parents and the Costs of Not Knowing English

    ERIC Educational Resources Information Center

    Worthy, Jo

    2006-01-01

    This study examined the perspectives of Latino/a immigrant parents about the place of English in their lives. The parents described how they had come to the United States with intentions of learning English, but various obstacles made it an overwhelming challenge. The author questions whether, despite rhetoric to the contrary, financially…

  11. Como ayudar a sus hijos a usar la biblioteca (Helping Your Child Use the Library).

    ERIC Educational Resources Information Center

    Perkinson, Kathryn

    Focusing on the cooperative role of parents and public libraries in stimulating reading interests in children of all ages, this booklet addresses the following issues: (1) getting children interested in reading (reading aloud to children; encouraging children to read to you; starting a home library; showing children that you enjoy reading;…

  12. [Bibliometric analysis of Revista Médica del IMSS in the Scopus database for the period between 2005-2013].

    PubMed

    García-Gómez, Francisco; Ramírez-Méndez, Fernando

    2015-01-01

    Objetivo: analizar la visibilidad de la Revista Médica del Instituto Mexicano del Seguro Social (Rev Med Inst Mex Seguro Soc) en la base de datos Scopus y describir los principales indicadores bibliométricos cuantitativos de la producción científica publicados durante el periodo 2005-2013. Métodos: para el análisis se utilizó la base de datos Scopus y se limitó el periodo de búsqueda a los años 2005-2013. La estrategia de búsqueda se ejecutó en los campos específicos de Título de la Publicación (Source Title) con el término Revista Médica del Instituto Mexicano del Seguro Social y sus posibles variantes, asícomo el número ISSN de la revista. Para el análisis de los datos obtenidos se utilizaron las herramientas de Scopus y los programas Excel y Access. Resultados: se encontraron 864 trabajos publicados durante el periodo 2005-2013 que fueron incluidos en Scopus. Se identificaron los autores con mayor producción científica y mayor número de citas acumuladas a sus trabajos, asícomo las principales revistas que citan a la Rev Med Inst Mex Seguro Soc. Se describen las principales áreas temáticas, tipos de documentos y otros indicadores bibliométricos que caracterizan a la publicación. Conclusiones: el uso de Scopus brinda la posibilidad de analizar con una herramienta externa al IMSS la visibilidad de la producción científica publicada en la Revista Médica del IMSS, además de que contribuye a identificar el estado de la ciencia en México y de los países en vías desarrollo.

  13. [ASSOCIATION BETWEEN MUSCULAR FITNESS AND PHYSICAL HEALTH STATUS AMONG CHILDREN AND ADOLESCENTS FROM BOGOTÁ, COLOMBIA].

    PubMed

    Rodríguez Valero, Francisco Javier; Gualteros, Julian Alberto; Torres, Jorge Andres; Umbarila Espinosa, Luz Marina; Ramírez-Velez, Robinson

    2015-10-01

    Objetivo: la evidencia epidemiológica y experimental sugieren que la disminución de la fuerza muscular en las etapas tempranas de la vida se asocia de manera independiente con la presencia de factores de riesgo asociados a enfermedad cardiometabólica en la edad adulta. El objetivo de este estudio fue examinar la asociación entre el desempeño muscular y el bienestar físico de niños y adolescentes de Bogotá, Colombia. Métodos: estudio transversal, realizado en 921 niños y adolescentes de entre 9 y 17 años de Bogotá, Colombia. Se calculó el Índice General de Fuerza (IGF) como marcador del desempeño muscular con las pruebas de salto longitud sin impulso, salto vertical y dinamometría manual. El IGF se recodificó en cuartiles, siendo el cuartil (Q4) la posición con mejor valor del desempeño muscular. El índice de masa corporal (IMC), los pliegues cutáneos, la circunferencia de cintura y de cadera, la composición corporal por bioimpedancia (BIA), la tensión arterial y la autodeclaración de maduración sexual se midieron como indicadores del bienestar físico asociados a enfermedad cardiovascular futura. Resultados: la edad media de los evaluados fue 13,0 ± 2,6 años. Los participantes con mejor desempeño muscular (Q4) presentaron un bienestar físico más saludable en los indicadores IMC, tensión arterial, porcentaje de grasa y circunferencia de cintura, p (X2 lineal) = 0,01. Los individuos con menor desempeño muscular (Q1-3) presentaron 4,06 veces (IC 95% 2,60–6,34; p = 0,043) riesgo de exceso de grasa corporal y 1,57 veces (IC 95% 1,02–1,89; p = 0,020) riesgo de obesidad abdominal. Conclusión: el mejor desempeño muscular se asoció con mejores indicadores del bienestar físico. La evaluación de la fuerza muscular en edades tempranas permitirá implementar programas de prevención de riesgo cardiovascular y metabólico futuros.

  14. Waist-to-height ratio (WHtR) and triglyceride to HDL-C ratio (TG/HDL-c) as predictors of cardiometabolic risk.

    PubMed

    Weiler Miralles, Clara Silvana; Wollinger, Luana Maria; Marin, Débora; Genro, Julia Pasqualini; Contini, Veronica; Morelo Dal Bosco, Simone

    2015-05-01

    Introducción: La concentracion excesiva de grasa en la region abdominal se relaciona con un mayor riesgo de desarrollar enfermedad cardiovascular (ECV). Se han realizado estudios para identificar los indicadores simples y eficaces de la obesidad abdominal y el riesgo cardiometabolico asociados con el uso de parametros simples, como las medidas antropometricas y bioquimicas. El / alta densidad de colesterol de lipoproteinas de trigliceridos (TG / HDL-c) se ha propuesto como un enfoque mas practico y facil de usar marcador aterogenico, junto con la relacion cintura-estatura (RCEst), lo que hace que una herramienta superior para separar cardiometabolico riesgos relacionados con el sobrepeso / obesidad cuando se compara con el indice de masa corporal (IMC). Objetivo: Verificar la aplicabilidad de la RCEst y la relacion TG / HDL-c como predictores de riesgo cardiometabolico. Métodos: Este estudio transversal se llevo a cabo en el Departamento de Nutricion del Centro Universitario UNIVATES, donde se recogieron datos antropometricos y bioquimicos de los participantes. El analisis estadistico se realizo mediante el paquete estadistico para el software de Ciencias Sociales (SPSS) 20,0, con un nivel de significacion del 5% (p.

  15. Clinical therapeutic strategies for early stage of diabetic kidney disease

    PubMed Central

    Kitada, Munehiro; Kanasaki, Keizo; Koya, Daisuke

    2014-01-01

    Diabetic kidney disease (DKD) is the most common cause of chronic kidney disease, leading to end-stage renal disease and cardiovascular disease. The overall number of patients with DKD will continue to increase in parallel with the increasing global pandemic of type 2 diabetes. Based on landmark clinical trials, DKD has become preventable by controlling conventional factors, including hyperglycemia and hypertension, with multifactorial therapy; however, the remaining risk of DKD progression is still high. In this review, we show the importance of targeting remission/regression of microalbuminuria in type 2 diabetic patients, which may protect against the progression of DKD and cardiovascular events. To achieve remission/regression of microalbuminuria, several steps are important, including the early detection of microalbuminuria with continuous screening, targeting HbA1c < 7.0% for glucose control, the use of renin angiotensin system inhibitors to control blood pressure, the use of statins or fibrates to control dyslipidemia, and multifactorial treatment. Reducing microalbuminuria is therefore an important therapeutic goal, and the absence of microalbuminuria could be a pivotal biomarker of therapeutic success in diabetic patients. Other therapies, including vitamin D receptor activation, uric acid-lowering drugs, and incretin-related drugs, may also be promising for the prevention of DKD progression. PMID:24936255

  16. [Novel biomarkers for diabetic nephropathy].

    PubMed

    Araki, Shin-ichi

    2014-02-01

    Diabetic nephropathy is a leading cause of end-stage renal disease worldwide. An early clinical sign of this complication is an increase of urinary albumin excretion, called microalbuminuria, which is not only a predictor of the progression of nephropathy, but also an independent risk factor for cardiovascular disease. Although microalbuminuria is clinically important to assess the prognosis of diabetic patients, it may be insufficient as an early and specific biomarker of diabetic nephropathy because of a large day-to-day variation and lack of a good correlation of microalbuminuria with renal dysfunction and pathohistological changes. Thus, more sensitive and specific biomarkers are needed to improve the diagnostic capability of identifying patients at high risk. The factors involved in renal tubulo-interstitial damage, the production and degradation of extracellular matrix, microinflammation, etc., are investigated as candidate molecules. Despite numerous efforts so far, the assessment of these biomarkers is still a subject of ongoing investigations. Recently, a variety of omics and quantitative techniques in systems biology are rapidly emerging in the field of biomarker discovery, including proteomics, transcriptomics, and metabolomics, and they have been applied to search for novel putative biomarkers of diabetic nephropathy. Novel biomarkers or their combination with microalbuminuria provide a better diagnostic accuracy than microalbuminuria alone, and may be useful for establishing personal medicine. Furthermore, the identification of novel biomarkers may provide insight into the mechanisms underlying diabetic nephropathy.

  17. Albuminuria induced by exercise in hypertensive type I and type II diabetic patients: a randomised, double-blind study on the effects of acute administration of captopril and nifedipine.

    PubMed

    Romanelli, G; Giustina, A; Cravarezza, P; Caldonazzo, A; Agabiti-Rosei, E; Giustina, G

    1991-06-01

    Physical exercise can increase urinary albumin excretion rate (UAER) in diabetic patients without microalbuminuria at rest (stage II diabetic nephropathy) or with baseline microalbuminuria (stage III diabetic nephropathy). The aim of this study was to compare the acute effects of captopril, an ACE inhibitor, and nifedipine, a calcium channel blocker, on exercise-induced microalbuminuria in hypertensive insulin-dependent (Type I) and non-insulin-dependent (Type II) diabetic patients with early stage nephropathy. Non-obese diabetic patients, 13 Type I (7 with stage II and 6 with stage III nephropathy) and 14 Type II (6 with stage II and 8 with stage III nephropathy), with hypertension, WHO stages I-II, underwent five submaximal cycloergometric tests: the first two in basal conditions, the other three after 24 hour administration of captopril (25 mg twice daily), placebo (1 tab twice daily) or nifedipine AR (20 mg twice daily) according to a randomised, double-blind design. Acute administration of both captopril and nifedipine was able to reduce exercise-induced microalbuminuria in hypertensive Type I and Type II diabetic patients regardless of the stage of their nephropathy. Captopril reduced systolic blood pressure less than nifedipine, in both Type I and Type II diabetics, but was more effective than nifedipine in blunting exercise-induced microalbuminuria, especially in Type I diabetics.

  18. Slowing progression along the renal disease continuum.

    PubMed

    Kopyt, Nelson P

    2005-04-01

    Patients in whom nephropathy develops as a result of hypertension or diabetes mellitus are more likely to die of cardiovascular disease (CVD) than of kidney disease. An early sign of impending nephropathy is microalbuminuria, defined as urinary excretion of albumin at a rate of 28.8 mg/24 h to 288 mg/24 h. Microalbuminuria is a marker of endothelial dysfunction, vascular injury, and renal disease and CVD, and it is associated with increased risk for myocardial infarction. Oxidative stress and endothelial dysfunction are unifying factors mediated by the renin-angiotensin system in renal disease and CVD. Clinical trials show reduced cardiovascular risk and a reversal of microalbuminuria with the use of agents that affect the renin-angiotensin system: angiotensin-receptor blockers in patients with type 2 diabetes mellitus and nephropathy, or angiotensin-converting enzyme inhibitors in patients with type 1 diabetes mellitus.

  19. Proteinuria: an underappreciated risk factor in cardiovascular disease.

    PubMed

    Segura, Julián; Campo, Carlos; Ruilope, Luis M

    2002-11-01

    Changes in renal function produced by hypertension appear to be associated with higher cardiovascular morbidity and mortality. Indices of altered renal function (eg, microalbuminuria, increased serum creatinine concentrations, decrease in estimated creatinine clearance, or overt proteinuria) are independent predictors of cardiovascular morbidity and mortality. The Framingham Heart Study documented the relevance of proteinuria for cardiovascular prognosis in the community. The International Nifedipine GITS study: Intervention as a goal in Hypertension Treatment (INSIGHT) study assessed the role of proteinuria as a very powerful risk factor. Several studies demonstrated that microalbuminuria is a predictor of cardiovascular disease. It has been shown that the presence of microalbuminuria in primary hypertension carries an elevated cardiovascular risk. Furthermore, recent data indicate that even minor derangements of renal function are associated with an increase in cardiovascular risk factors, and promote progression of atherosclerosis. All these parameters should routinely be evaluated in clinical practice, and in the future must be considered in any stratification of cardiovascular risk in hypertensive patients.

  20. The kallikrein-kinin system in early state of diabetes.

    PubMed

    Vila, S B; Peluffo, V A; Alvarado, C; Cresto, J C; Zuccollo, A; Catanzaro, O L

    1992-01-01

    The kallikrein-kinin system was studied in 9 normals, healthy subjects (6 men, 3 women, age range 1 to 14 years) and 15 diabetic patients (9 men, 6 women age range 2 to 14 years) with an evolution of the disease between 1 to 14 years. Diabetic patients with low microalbuminuria (6.62 +/- 0.97 mg/24 h) show increased total and pre-kallikrein respect to control (3 and 2 fold respectively). On the other hand patients with high microalbuminuria (44.7 +/- 13.2 mg/24 h) show a total and pre-kallikrein of more than 4 and 8 fold increased respectively, compare with the control. According with these results we can concluded: 1) The total kallikrein and pre-kallikrein is increased in the diabetic state. 2) When microalbuminuria is high, the total and pre-kallikrein correlates with those increasing. 3) These changes could modified the renal hemodynamic in diabetes.

  1. Renin-angiotensin-aldosterone system inhibition: overview of the therapeutic use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and direct renin inhibitors.

    PubMed

    Mercier, Kelly; Smith, Holly; Biederman, Jason

    2014-12-01

    Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy in hypertensive diabetic patients with macroalbuminuria, microalbuminuria, or normoalbuminuria has been repeatedly shown to improve cardiovascular mortality and reduce the decline in glomerular filtration rate. Renin-angiotensin-aldosterone system (RAAS) blockade in normotensive diabetic patients with normoalbuminuria or microalbuminuria cannot be advocated at present. Dual RAAS inhibition with ACE inhibitors plus ARBs or ACE inhibitors plus direct renin inhibitors has failed to improve cardiovascular or renal outcomes but has predisposed patients to serious adverse events.

  2. Renin-angiotensin-aldosterone system inhibition: overview of the therapeutic use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and direct renin inhibitors.

    PubMed

    Mercier, Kelly; Smith, Holly; Biederman, Jason

    2014-12-01

    Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy in hypertensive diabetic patients with macroalbuminuria, microalbuminuria, or normoalbuminuria has been repeatedly shown to improve cardiovascular mortality and reduce the decline in glomerular filtration rate. Renin-angiotensin-aldosterone system (RAAS) blockade in normotensive diabetic patients with normoalbuminuria or microalbuminuria cannot be advocated at present. Dual RAAS inhibition with ACE inhibitors plus ARBs or ACE inhibitors plus direct renin inhibitors has failed to improve cardiovascular or renal outcomes but has predisposed patients to serious adverse events. PMID:25439533

  3. [Identification of the factors conditioning times and indicators of quality in the intrahospital care of acute stroke].

    PubMed

    Palazón-Cabanes, Begoña; López-Picazo Ferrer, Julio J; Morales-Ortiz, Ana; Tomás-García, Nuria

    2016-02-16

    Introduccion. El ictus es una entidad grave, pero potencialmente reversible. La reduccion del tiempo de atencion en el momento agudo es fundamental para limitar la morbimortalidad. La evaluacion de las actuaciones en la atencion al ictus es esencial, porque permite identificar oportunidades de mejora. Objetivo. Conocer y analizar los factores condicionantes de la demora en los tiempos de atencion intrahospitalaria para la posterior implementacion de un ciclo de mejora. Pacientes y metodos. Estudio retrospectivo de pacientes con ictus isquemico agudo tratados con trombolisis intravenosa (TLIV) y/o trombectomia intraarterial mecanica (TIAM) en un hospital terciario entre 2009-2014. Se analizaron los tiempos intrahospitalarios, los indicadores de calidad y sus factores condicionantes. Resultados. Un total de 337 pacientes fueron tratados con TLIV (66,2%) y/o TIAM (54,1%). Tiempos medios de actuacion (intervalo de confianza al 95%): puerta-TLIV, 75,88 min (71,67-80,16 min); puerta-TC, 43,27 min (40,17-46,37 min); TC-TLIV, 38,01 min (34,08-41,93 min); TLIV-TIAM, 127,44 min (108,7-146,18 min); puerta-TIAM, 155,22 min (140,03-170,4 min). El 36,6% fue tratado en menos de 60 min, la neuroimagen se realizo en menos de 25 min en un 19,9% y el tiempo TLIV-TIAM fue menor de 90 min en un 28,8%. La edad, el tiempo inicio-puerta, la procedencia de otro hospital y el periodo de aprendizaje se identificaron como factores condicionantes. Conclusiones. El conocimiento de la situacion actual de los tiempos e indicadores intrahospitalarios y sus factores condicionantes son el punto de partida y proporcionan la motivacion necesaria para impulsar una iniciativa para la mejora de la calidad asistencial en el paciente con ictus agudo.

  4. Observaciones de la corona solar interior con un coronógrafo de espejo

    NASA Astrophysics Data System (ADS)

    Stenborg, G.; Schwenn, R.; Francile, C.; Rovira, M.

    El plasma de la corona solar es un buen indicador de las líneas de fuerza del campo magnético. Por lo tanto, el análisis de estructuras coronales cuasiestacionarias en la corona da importante información sobre el campo magnético y la actividad asociada. Se trata de poner límites a los modelos teóricos existentes mediante el estudio de distintas estructuras en la corona interior. En agosto de 1997 comenzó a operar el coronógrafo solar (MICA) en El Leoncito como parte del Observatorio Solar Alemán-Argentino. Desde su instalación obtiene imágenes de la corona solar (1.05 a 2.0 radios solares) en 2 líneas espectrales correspondientes a la emisión de Fe XIV y Fe X. El instrumento puede obtener imágenes cada minuto por lo que es ideal para estudiar procesos rápidos. Presentamos observaciones recientes que muestran la capacidad del coronógrafo así como la evolución de algunos eventos dinámicos observados por MICA.

  5. Insertion of Astronomy as a High School Subject. (Spanish Title: Inserción de Astronomia Como Materia del Ciclo Secundario.) Inserção da Astronomia Como Disciplina Curricular do Ensino Médio

    NASA Astrophysics Data System (ADS)

    Dias, Claudio André C. M.; Santa Rita, Josué R.

    2008-12-01

    Astronomy is considered among the first sciences that man dominated, however, the basic skills for the construction of knowledge, relatively to the contents "Earth and the Universe" are not being developed properly for the majority of students concluding the high school level. The students are concluding this teaching cycle without proper knowledge of several subjects in the area of Astronomy, which are mandatory in the national Curricular National Parameters (PCN). Because of this discrepancy, this work stresses the need of the incorporation of a specific subject of Astronomy in the high school, in order to reduce the gap between what is taught and which should be taught. La Astronomía es considerada una de las primeras ciencias que el hombre dominó. Sin embargo, las habilidades básicas para la construcción del conocimento, relativo al eje temático "Tierra y Universo", no vienen siendo trabajadas adecuadamente con la mayoría de los alumnos que concluyen el ciclo escolar medio. Los alumnos están concluyendo este nivel de enseñanza sin conocimentos de varios temas en el área de Astronomía, que son obligatorios según los Parámetros Curriculares Nacionales (PCN). En virtud de esta discrepancia, este trabajo enfatiza la necesidad de incorporar una disciplina específica de Astronomía em el ciclo medio, em pro de la reducción de las distorsiones entre lo que es enseñado y lo que se debe enseñar. A Astronomia é considerada uma das primeiras ciências que o homem dominou, porém as competências básicas para a construção do conhecimento, relativo ao eixo temático "Terra e Universo", não vêm sendo trabalhadas a contento com a maioria dos alunos que concluem o ensino médio. Os alunos estão concluindo este nível de ensino sem conhecimento de vários temas na área de Astronomia, que são obrigatórios nos Parâmetros Curriculares Nacionais (PCN). Em virtude desta discrepância, este trabalho vem evidenciar a necessidade da incorporação de uma disciplina específica de Astronomia, no ensino médio, em prol da redução das distorções entre o que é ensinado e o que se deve ensinar.

  6. Caracteristicas de la Instruccion Programada como Tecnica de Ensenanza (Characteristics of Programed Instruction as a Teaching Technique).

    ERIC Educational Resources Information Center

    Dorrego, Maria Elena

    This discussion of programed instruction begins with the fundamental psychological aspects and learning theories behind this teaching method. Negative and positive reinforcement, conditioning, and their relationship to programed instruction are considered. Different types of programs, both linear and branching, are discussed; criticism of the…

  7. Programa Academico de Dominio de Ingles Como Lengua Extranjera (Academic Program in English as a Foreign Language).

    ERIC Educational Resources Information Center

    Flores Revilla, Maria Teresa; Zoreda, Margaret Lee; Vivaldo Lima, Javier; Blanco Lopez, Guadalupe; Caballero Robles, Teresita del Rosario; Mercau Appiani, Virginia

    The guide presents the newly-developed curriculum of the Universidad Autonoma Metropolitana at Iztapalapa (Mexico) for its program in English as a foreign language. An introductory section provides background information on the initiative to design a new curriculum. The second section presents the principles on which the curriculum and its methods…

  8. Como ayudar a los padres a prevenir el envenenamiento por plomo (Helping Parents Prevent Lead Poisoning). ERIC Digest.

    ERIC Educational Resources Information Center

    Binns, Helen J.; Ricks, Omar Benton

    Children are at greater risk than adults for lead poisoning because children absorb lead more readily than adults, and a small amount of lead in children's bodies can do a great deal of harm. This Spanish-language Digest summarizes some of the causes and effects of childhood lead poisoning and suggests some lead poisoning prevention strategies…

  9. Las líneas de aluminio neutro como diagnóstico cromosférico

    NASA Astrophysics Data System (ADS)

    Fernández Borda, R.; Mauas, P. J. D.

    Se presenta un modelo atómico para el cálculo de las lí neas del Aluminio neutro que se forman en la cromósfera solar. En particular, se estudia la línea λ 3961 Å, que, por estar muy próxima a la lí nea H del Ca II y a Hɛ es muy frecuentemente observada. Observaciones en esta lí nea obtenidas con el espectrógrafo a instalarse en el CASLEO, serán utilizadas para el estudio de fulguraciones solares.

  10. "Tras de un Amoroso Lance" como Estructura Expresiva (The Poem, "Behind the Amorous Cast" as an Expressive Structure).

    ERIC Educational Resources Information Center

    Bratosevich, Nicolas

    1967-01-01

    An analysis of a poem by San Juan de la Cruz (St. John of the Cross), the sixteenth century Spanish mystic, identifies symbols and images, explains themes, and offers a synthesis of his structural patterns. The poem, "Tras de amoroso lance", deals with the theme of the search of the beloved (i.e., the soul) for the lover, and incorporates the…

  11. Estudio de generacion de energia con celdas de combustible con membrana poly diallydimethylammonium chloride (PDADMAC) como polimero de intercambio protonico

    NASA Astrophysics Data System (ADS)

    Nino Galeano, Miguel Angel

    Fuel cells were built with poly diallydimethylammonium chloride or PDADMAC (by its initials in English) as proton exchange membrane and were compared with earlier studies of fuel cells constructed by other methods and / or materials. Also copper, aluminum and nickel were used as electrodes in the electrode membrane ensamble in search of the best performance operational cell. The results of the current were used to justify the use of PDADMAC membranes in 40% volume-volume ratio in different combinations of metals Cu-Al, Ni-Al as electrodes. For the study of conduction performance of membrane electrode ensambles (MEA), copper and aluminum were as cathode and anode for their active behavior as functional electrodes in the experimental cell, walling individually membrane types PDADMAC, PDADMAC + Buffer, PDADMAC + deionized water and PDADMAC + tap water.

  12. Significant Learning Experiences for English Foreign Language Students (Experiencias significativas para estudiantes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Becerra, Luz María; McNulty, Maria

    2010-01-01

    This action research examines experiences that students in a grade 10 EFL class had with redesigning a grammar-unit into a topic-based unit. Strategies were formulating significant learning goals and objectives, and implementing and reflecting on activities with three dimensions of Dee Fink's (2003) taxonomy of significant learning: the human…

  13. The English as a Foreign Language/Lingua Franca Debate: Sensitising Teachers of English as a Foreign Language towards Teaching English as a Lingua Franca (El debate del inglés como lengua extranjera o como lengua franca: sensibilización de docentes de inglés como lengua extranjera hacia la enseñanza del inglés como lengua franca)

    ERIC Educational Resources Information Center

    Mansfield, Gillian; Poppi, Franca

    2012-01-01

    The function of English as a lingua franca for communication needs rethinking in the teaching of English as a foreign language classroom as a consequence of globalisation. The present contribution is an empirical study carried out in an Italian university environment which aims to show how teachers should take on board awareness raising activities…

  14. How To Start a Family Day Care = Como Iniciar una Guarderia en El Hogar. [Videotape and Viewer's Guide].

    ERIC Educational Resources Information Center

    Raphael, Doris; Weisman, Douglas

    Being a family day care provider is work that requires professional responsibilities and attention to the physical, emotional, and educational well-being of children; listening and responding to parents; and running a business. This videotape, in English- and Spanish-language versions, explores the elements involved in starting up a family day…

  15. Contextualizacion y "Expresiones Pragmaticas": "Che" como Senal de Marco (Contextualization and "Pragmatic Expressions": "Che" as Deictic Marker).

    ERIC Educational Resources Information Center

    Carranza, Isolda

    The pragmatic expressions of Argentine Spanish (e.g., "bueno, viste, no? mira") are defined as deictic signals. They are deictic because they indicate elements of the communicative situation: transitions between text segments, conversational roles, or the social relationship between participants. They also signal contextual suppositions and help…

  16. [Rabdomiosarcoma primario de corazón como causa de síncope recurrente en el adulto].

    PubMed

    Díaz-Pérez, Julio Alexander; Gómez-Arbeláez, Diego; Hurtado-Gomez, Gabriel Alexander

    2011-01-01

    Primary or secondary neoplasms can affect the heart. Secondary are more common. However, primary neoplasms are relevant because is a group with diverse genesis, behavior, treatment and clinical manifestations. We present a case of a 45 year-old woman, with recurrent syncope started 1 year before her first consult. She had palpitations and chest pain. Echocardiography identified a left atrium mass of 2.1x1.8 cm. Endomyocardial biopsy document a primary rhabdomyosarcoma of the heart. The patient dies after a overall-survival of 22 months. This case presented had a good study of its symptoms with an accurate diagnosis and early treatment, which provided prolonged survival of this rare and aggressive neoplasm.

  17. La Traduccion Simultanea como Materia en Una Carrera de Lenguas (Simultaneous Translation as a Course in a Foreign Language Program)

    ERIC Educational Resources Information Center

    Bradley, D.

    1977-01-01

    A description of the foreign language curriculum at the university level in which courses in simultaneous translation are required. The size and composition of the groups are described as well as methods used to develop skill in translating and interpreting. Results are assessed. (Text is in Spanish.) (AMH)

  18. How Can We Provide Safe Playgrounds? = Como podemos proveer lugares con juegos infantiles que no sean peligrosos para los ninos?

    ERIC Educational Resources Information Center

    ACCESS ERIC, Rockville, MD.

    Outdoor playgrounds can be exciting places where children explore their environment and develop motor and social skills; however, they can also pose serious safety hazards. With the exception of California, no mandatory state or federal standards currently exist regarding manufacture or installation of playground equipment or surfaces. The…

  19. Como los colegios asignan y utilizan sus recursos? (How Schools Allocate and Use Their Resources). ERIC Digest.

    ERIC Educational Resources Information Center

    Picus, Lawrence O.

    School finance has traditionally concentrated on the distribution of resources to school districts, focusing primarily on the equitable distribution of funds within a state. In recent years, more attention has been paid to the issue of productivity--how effectively school districts use the funds they receive to provide education to students. This…

  20. Diabetic kidney disease: from physiology to therapeutics

    PubMed Central

    Mora-Fernández, Carmen; Domínguez-Pimentel, Virginia; de Fuentes, Mercedes Muros; Górriz, José L; Martínez-Castelao, Alberto; Navarro-González, Juan F

    2014-01-01

    Diabetic kidney disease (DKD) defines the functional, structural and clinical abnormalities of the kidneys that are caused by diabetes. This complication has become the single most frequent cause of end-stage renal disease. The pathophysiology of DKD comprises the interaction of both genetic and environmental determinants that trigger a complex network of pathophysiological events, which leads to the damage of the glomerular filtration barrier, a highly specialized structure formed by the fenestrated endothelium, the glomerular basement membrane and the epithelial podocytes, that permits a highly selective ultrafiltration of the blood plasma. DKD evolves gradually over years through five progressive stages. Briefly they are: reversible glomerular hyperfiltration, normal glomerular filtration and normoalbuminuria, normal glomerular filtration and microalbuminuria, macroalbuminuria, and renal failure. Approximately 20–40% of diabetic patients develop microalbuminuria within 10–15 years of the diagnosis of diabetes, and about 80–90% of those with microalbuminuria progress to more advanced stages. Thus, after 15–20 years, macroalbuminuria occurs approximately in 20–40% of patients, and around half of them will present renal insufficiency within 5 years. The screening and early diagnosis of DKD is based on the measurement of urinary albumin excretion and the detection of microalbuminuria, the first clinical sign of DKD. The management of DKD is based on the general recommendations in the treatment of patients with diabetes, including optimal glycaemic and blood pressure control, adequate lipid management and abolishing smoking, in addition to the lowering of albuminuria. PMID:24907306

  1. Prevalence of hypertension and diabetes and coexistence of chronic kidney disease and cardiovascular risk in the population of the republic of moldova.

    PubMed

    Codreanu, Igor; Sali, Vera; Gaibu, Sergiu; Suveica, Luminita; Popa, Sergiu; Perico, Norberto; Ene-Iordache, Bogdan; Carminati, Sergio; Feehally, John; Remuzzi, Giuseppe

    2012-01-01

    In 2005, the International Society of Nephrology (ISN) established the Global Outreach Program (GO) aimed at building a capacity for detecting and managing chronic kidney disease and its complications in low- and middle-income countries. Here we report data from the 2006-2007 screening program (1025 subjects from the general population) in the Republic of Moldova aimed to determine the prevalence of hypertension, diabetes, and their coexistence with microalbuminuria. The likelihood of a serious cardiovascular (CV) event was also estimated. Hypertension and diabetes were very common among screened subjects. The prevalence of microalbuminuria was 16.9% and that of estimated GFR <60 ml/min/1.73 m(2) (decreased renal function) was 9.4%. Male gender was associated with an increased prevalence of hypertension and microalbuminuria. Hypertension and diabetes clustered in subjects with microalbuminuria and renal dysfunction. Risk factors such as preobesity/obesity, physical inactivity and smoking were relatively common, even in younger participants. The prevalence of subjects with predicted 10-year CV risk ≥10% was 10.0%. In conclusion, in the Republic of Moldova patients with hypertension and diabetes should be screened for the coexistence of renal abnormalities, with the intention of developing disease-specific health-care interventions with the primary goal to reduce CV morbidity and mortality and prevent renal disease progression to end stage renal disease.

  2. CUBN Is a Gene Locus for Albuminuria

    PubMed Central

    Böger, Carsten A.; Chen, Ming-Huei; Tin, Adrienne; Olden, Matthias; Köttgen, Anna; de Boer, Ian H.; Fuchsberger, Christian; O'Seaghdha, Conall M.; Pattaro, Cristian; Teumer, Alexander; Liu, Ching-Ti; Glazer, Nicole L.; Li, Man; O'Connell, Jeffrey R.; Tanaka, Toshiko; Peralta, Carmen A.; Kutalik, Zoltán; Luan, Jian'an; Zhao, Jing Hua; Hwang, Shih-Jen; Akylbekova, Ermeg; Kramer, Holly; van der Harst, Pim; Smith, Albert V.; Lohman, Kurt; de Andrade, Mariza; Hayward, Caroline; Kollerits, Barbara; Tönjes, Anke; Aspelund, Thor; Ingelsson, Erik; Eiriksdottir, Gudny; Launer, Lenore J.; Harris, Tamara B.; Shuldiner, Alan R.; Mitchell, Braxton D.; Arking, Dan E.; Franceschini, Nora; Boerwinkle, Eric; Egan, Josephine; Hernandez, Dena; Reilly, Muredach; Townsend, Raymond R.; Lumley, Thomas; Siscovick, David S.; Psaty, Bruce M.; Kestenbaum, Bryan; Haritunians, Talin; Bergmann, Sven; Vollenweider, Peter; Waeber, Gerard; Mooser, Vincent; Waterworth, Dawn; Johnson, Andrew D.; Florez, Jose C.; Meigs, James B.; Lu, Xiaoning; Turner, Stephen T.; Atkinson, Elizabeth J.; Leak, Tennille S.; Aasarød, Knut; Skorpen, Frank; Syvänen, Ann-Christine; Illig, Thomas; Baumert, Jens; Koenig, Wolfgang; Krämer, Bernhard K.; Devuyst, Olivier; Mychaleckyj, Josyf C.; Minelli, Cosetta; Bakker, Stephan J.L.; Kedenko, Lyudmyla; Paulweber, Bernhard; Coassin, Stefan; Endlich, Karlhans; Kroemer, Heyo K.; Biffar, Reiner; Stracke, Sylvia; Völzke, Henry; Stumvoll, Michael; Mägi, Reedik; Campbell, Harry; Vitart, Veronique; Hastie, Nicholas D.; Gudnason, Vilmundur; Kardia, Sharon L.R.; Liu, Yongmei; Polasek, Ozren; Curhan, Gary; Kronenberg, Florian; Prokopenko, Inga; Rudan, Igor; Ärnlöv, Johan; Hallan, Stein; Navis, Gerjan; Parsa, Afshin; Ferrucci, Luigi; Coresh, Josef; Shlipak, Michael G.; Bull, Shelley B.; Paterson, Andrew D.; Wichmann, H.-Erich; Wareham, Nicholas J.; Loos, Ruth J.F.; Rotter, Jerome I.; Pramstaller, Peter P.; Cupples, L. Adrienne; Beckmann, Jacques S.; Yang, Qiong; Heid, Iris M.; Rettig, Rainer; Dreisbach, Albert W.; Bochud, Murielle

    2011-01-01

    Identification of genetic risk factors for albuminuria may alter strategies for early prevention of CKD progression, particularly among patients with diabetes. Little is known about the influence of common genetic variants on albuminuria in both general and diabetic populations. We performed a meta-analysis of data from 63,153 individuals of European ancestry with genotype information from genome-wide association studies (CKDGen Consortium) and from a large candidate gene study (CARe Consortium) to identify susceptibility loci for the quantitative trait urinary albumin-to-creatinine ratio (UACR) and the clinical diagnosis microalbuminuria. We identified an association between a missense variant (I2984V) in the CUBN gene, which encodes cubilin, and both UACR (P = 1.1 × 10−11) and microalbuminuria (P = 0.001). We observed similar associations among 6981 African Americans in the CARe Consortium. The associations between this variant and both UACR and microalbuminuria were significant in individuals of European ancestry regardless of diabetes status. Finally, this variant associated with a 41% increased risk for the development of persistent microalbuminuria during 20 years of follow-up among 1304 participants with type 1 diabetes in the prospective DCCT/EDIC Study. In summary, we identified a missense CUBN variant that associates with levels of albuminuria in both the general population and in individuals with diabetes. PMID:21355061

  3. Diabetic kidney disease: from physiology to therapeutics.

    PubMed

    Mora-Fernández, Carmen; Domínguez-Pimentel, Virginia; de Fuentes, Mercedes Muros; Górriz, José L; Martínez-Castelao, Alberto; Navarro-González, Juan F

    2014-09-15

    Diabetic kidney disease (DKD) defines the functional, structural and clinical abnormalities of the kidneys that are caused by diabetes. This complication has become the single most frequent cause of end-stage renal disease. The pathophysiology of DKD comprises the interaction of both genetic and environmental determinants that trigger a complex network of pathophysiological events, which leads to the damage of the glomerular filtration barrier, a highly specialized structure formed by the fenestrated endothelium, the glomerular basement membrane and the epithelial podocytes, that permits a highly selective ultrafiltration of the blood plasma. DKD evolves gradually over years through five progressive stages. Briefly they are: reversible glomerular hyperfiltration, normal glomerular filtration and normoalbuminuria, normal glomerular filtration and microalbuminuria, macroalbuminuria, and renal failure. Approximately 20-40% of diabetic patients develop microalbuminuria within 10-15 years of the diagnosis of diabetes, and about 80-90% of those with microalbuminuria progress to more advanced stages. Thus, after 15-20 years, macroalbuminuria occurs approximately in 20-40% of patients, and around half of them will present renal insufficiency within 5 years. The screening and early diagnosis of DKD is based on the measurement of urinary albumin excretion and the detection of microalbuminuria, the first clinical sign of DKD. The management of DKD is based on the general recommendations in the treatment of patients with diabetes, including optimal glycaemic and blood pressure control, adequate lipid management and abolishing smoking, in addition to the lowering of albuminuria.

  4. Diabetic nephropathy--a review of the natural history, burden, risk factors and treatment.

    PubMed Central

    Ayodele, Olugbenga E.; Alebiosu, C. Olutayo; Salako, Babatunde L.

    2004-01-01

    The earliest clinical evidence of diabetic nephropathy is microalbuminuria. Progression from microalbuminuria to overt nephropathy occurs in 20-40% within a 10-year period with approximately 20% of these patients progressing to end-stage renal disease. End-stage renal disease develops in 50% of type-1 diabetes patients with overt nephropathy within 10 years and in more than 75% by 20 years in the absence of treatment. In type-2 diabetes, a greater proportion of patients have microalbuminuria and overt nephropathy at or shortly after diagnosis of diabetes. The incidence of diabetes is increasing worldwide, with subsequent increase in the incidence of diabetic nephropathy. The risk factors identified in the development of DN from longitudinal and cross-sectional studies include race, genetic susceptibility, hypertension, hyperglycemia, hyperfiltration, smoking, advanced age, male sex, and high-protein diet. Treatment interventions in diabetic nephropathy include glycemic control, treatment of hypertension, hyperlipidemia, cessation of smoking, protein restriction, and renal replacement therapy. Multifactorial approach includes combined therapy targeting hyperglycemia, hypertension, microalbuminuria, and dyslipidemia. PMID:15586648

  5. Association between low education and higher global cardiovascular risk.

    PubMed

    Di Chiara, Tiziana; Scaglione, Alessandra; Corrao, Salvatore; Argano, Christiano; Pinto, Antonio; Scaglione, Rosario

    2015-05-01

    This study was designed to evaluate the impact of educational status on global cardiovascular risk in a southern Italian urban population. The study population consisted of 488 consecutive outpatients aged 18 years and older. Educational status was categorized according to the number of years of formal education as follows: (1) low education group (<10 years) and (2) medium-high education group (10-15 years). In both groups, cardiometabolic comorbidities (obesity, visceral obesity, diabetes, dyslipidemia, metabolic syndrome, microalbuminuria, left ventricular hypertrophy) and global cardiovascular risk, according to international guidelines, were analyzed. Left ventricular mass index and ejection fraction by echocardiography and E/A ratio, by pulsed-wave Doppler, were calculated. The low education group was characterized by a significantly higher prevalence of patients with visceral obesity (P=.021), hypertension (P=.010), metabolic syndrome (P=.000), and microalbuminuria (P=.000) and greater global cardiovascular risk (P=.000). Significantly increased levels of microalbuminuria (P=.000) and significantly decreased values of E/A ratio (P=.000) were also detected in the low education group. Global cardiovascular risk correlated directly with waist-to-hip ratio (P=.010), microalbuminuria (P=.015), and the metabolic syndrome (P>.012) and inversely with educational status (P=.000). Education was independently (P=.000) associated with global cardiovascular risk. These data indicate a strong association between low education and cardiometabolic comorbidities suitable to influence the evolution of chronic degenerative diseases. Preventive strategies need to be more efficient and more effective in this patient population.

  6. [Biomarkers of cervical carcinogenesis associated with genital human papillomavirus infection].

    PubMed

    Oliveira, Ana; Delgado, Candida; Verdasca, Nuno; Pista, Angela

    2013-01-01

    Introdução/Objetivos: A infeção persistente pelo Vírus do Papiloma Humano de alto risco (HPVar) é considerada como a causa necessária, embora não suficiente, para o desenvolvimento do cancro do colo do útero, sugerindo que outros fatores estarão envolvidos no processo de carcinogénese. Este estudo pretendeu avaliar indicadores de prognóstico da persistência da infeção por HPV, nomeadamente o estado físico e a carga viral dos HPV 16 e 18 e a superexpressão dos transcritos do RNAm dos HPV 16, 18, 31, 33 e 45, num grupo de mulheres com ou sem sintomatologia clínica e citopatológica. Material e Métodos: Foram estudadas 378 alíquotas de células epiteliais congeladas pertencentes a utentes dos centros de saúde do Serviço Nacional de Saúde e de clínicas privadas, referenciadas para teste HPV, entre Janeiro de 2007 e Dezembro de 2010. De acordo com o diagnóstico citopatológico, foram definidos cinco grupos: normal, ASCUS, LSIL, HSIL e carcinoma invasivo do colo do útero. Para a determinação do estado físico do DNA e da carga viral dos HPV 16 e 18 foi utilizada metodologia de PCR em tempo real, e para a superexpressão dos transcritos dos oncogenes E6 e E7 o sistema comercial NucliSENS EasyQ HPV®. Os indicadores foram analisados em associação com os tipos de lesão do colo do útero. Para a análise estatística foi utilizado o o programa informático SPSS versão 16.0 e o teste de Chi-Quadrado. Resultados: Os resultados mostraram ausência de associação estatisticamente significativa entre a gravidade da lesão e o estado físico do DNA dos HPV 16 e 18. A superexpressão dos transcritos do RNAm E6/E7 e a carga viral dos HPV 16 e 18 aumentaram significativamente em função do grau da lesão. Conclusões: Os resultados obtidos sugerem que a determinação do estado físico do DNA dos HPV 16 e 18, isoladamente, não constitui um indicador de prognóstico para o desenvolvimento e progressão das lesões. A superexpressão dos transcritos

  7. [Prevalence of asthma and determination of symptoms as risk indicators].

    PubMed

    Mancilla-Hernández, Eleazar; Medina-Ávalos, Miguel Alejandro; Barnica-Alvarado, Raúl Humberto; Soto-Candia, Diego; Guerrero-Venegas, Rosario; Zecua-Nájera, Yahvéh

    2015-01-01

    Antecedentes: el asma es una enfermedad inflamatoria crónica de las vías aéreas, su prevalencia se ha incrementado especialmente en países industrializados. Los resultados de estudios de prevalencia del asma son variables en diferentes poblaciones y aun en un mismo país; en México hay fluctuaciones de la prevalencia del asma de 7 a 33%. Objetivo: determinar la prevalencia del asma y la magnitud de los síntomas como indicadores de riesgo en población escolar en ciudades de varios estados de México. Material y método: estudio descriptivo de la detección de prevalencia del asma y analítico-observacional comparativo de la determinación de los síntomas de esta afección. Se realizaron encuestas a población de los niveles educativos preescolar, primaria, secundaria y preparatoria en las ciudades de Puebla, Puebla; Tulancingo, Hidalgo; Tlaxcala, Tlaxcala, y Cancún, Quintana Roo. Como instrumento se usó un nuevo cuestionario validado: Cuestionario Diagnóstico de Asma para Estudios Epidemiológicos, conformado por ocho preguntas con valor sumatorio para su diagnóstico. Resultados: se obtuvieron 8,754 encuestas que mostraron una prevalencia en Puebla de 14%, en Tulancingo de 17%, en Tlaxcala de 7% y en Cancún de 14%; el promedio en las cuatro ciudades fue de 13%. La fuerza de asociación de los síntomas con asma en orden decreciente con razón de momios significativa fue: sibilancias recurrentes, dificultad respiratoria, opresión torácica, tos recurrente, tos con frío, cuadros catarrales recurrentes, tos de predominio nocturno y tos que aumenta con el ejercicio. Conclusiones: el promedio de la prevalencia del asma en las ciudades contempladas para las encuestas fue de 13% y los principales síntomas indicadores de riesgo de asma en población escolar fueron: sibilancias recurrentes, dificultad respiratoria, opresión torácica y tos recurrente.

  8. ANTHROPOMETRIC INDICATORS OF GENERAL AND CENTRAL OBESITY IN THE PREDICTION OF ASTHMA IN ADOLESCENTS; CENTRAL OBESITY IN ASTHMA.

    PubMed

    Jobim Benedetti, Franceliane; Lúcia Bosa, Vera; Mariante Giesta, Juliana; Bueno Fischer, Gilberto

    2015-12-01

    Objetivo: determinar la prevalencia de riesgo de asma asociado con indicadores antropométricos de exceso de peso y la distribución de la grasa corporal. Metodología: estudio transversal que incluye adolescentes entre 10 y 19 años de edad. El indicador antropométrico utilizado para clasificar el exceso de peso fue el índice de masa corporal (IMC-Z); los utilizados para la adiposidad abdominal fueron la circunferencia de la cintura (CC), la relación cintura-estatura (RCE) y el índice de conicidad (IC). Las características del asma se evaluaron utilizando el cuestionario International Study of Asthma and Allergies in Childhood (ISAAC). El nivel de significación fue del 5%, y los análisis se realizaron con el Statistical Package for the Social Sciences (SPSS) versión 18.0. Resultados: fueron evaluados estudiantes adolescentes (n = 1362; 788 [57,9%] mujeres) con una edad media de 15,65 ± 1,24 años. Se observó en las mujeres una alta prevalencia de asma, exceso de peso (IMC-Z) y exceso de adiposidad abdominal (WC y RCE). Solo los valores de IC para el exceso de adiposidad abdominal fueron mayores para los hombres que para las mujeres. Los adolescentes con exceso de adiposidad abdominal, como lo demuestra la RCE, tenían 1,24 veces más riesgo de tener asma en comparación con los adolescentes no obesos. Los niños con exceso de adiposidad abdominal, según la clasificación de IC, presentaron 1,8 veces mayor riesgo de asma. El riesgo de asma grave era 3 veces mayor entre las adolescentes que fueron clasificados como severamente obesos a través del IMC-Z. Conclusión: este estudio mostró que el exceso de peso y la obesidad abdominal se asocian con un mayor riesgo de asma y asma severa en adolescentes. Por lo tanto, se sugieren mediciones de IMC adicionales para los asmáticos.

  9. Design of quality indicators for oral nutritional therapy.

    PubMed

    Gimenez Verotti, Cristiane Comeron; de Miranda Torrinhas, Raquel Susana Matos; Pires Corona, Ligiana; Waitzberg, Dan Linetzky

    2015-06-01

    Objetivo: los indicadores de calidad en la terapia nutricional han sido propuestos como herramientas útiles para mejorar la terapia nutricional (TN). Este estudio pretende diseñar indicadores de calidad de terapia nutricional oral (ICTNO) factibles en el control de calidad de TN oral. Métodos: el diseño de ICTNO fue realizado por una comisión de nutrición clínica compuesta por brasileños expertos en TN del International Life Science Institute (ILSI). Más tarde, la aprobación de estos ICTNO fue valorada con análisis psicométricos recogiendo las opiniones de otros brasileños dedicados independientemente a la TN (n = 40) vía SurveyMonkey (encuesta por internet). Esta consistió en cuatro atributos valorando cada ICTNO (simplicidad, utilidad, objetividad y bajo precio) seguida de una escala Likert con cinco puntos. Resultados: los expertos en TN de ILSI proporcionaron el diseño de 12 QIONT, que fueron todos consistentemente (Alfa de Cronbach = 0,84) clasificados como válidos por expertos independientes en NT. Por orden de relevancia, los nuevos ICTNO valoraron: la frecuencia de screening nutricional, la prescripción de suplementos de nutrición oral para pacientes desnutridos que ya reciben dieta oral, la prescripción de suplementos de nutrición oral para pacientes con bajo riesgo nutricional que ya reciben dieta oral, el consejo nutricional, la adhesión al suplemento nutricional oral, los pacientes hospitalizados con dieta oral insuficiente y prescripción de suplementos nutricionales orales, los pacientes de UCI con dieta oral insuficiente y prescripción de suplementos nutricionales orales, el consejo de nutrición oral en pacientes de UCI, el consejo de nutrición oral en pacientes en planta, la intolerancia al volumen de suplemento oral debido a dosificación inadecuada, la intolerancia al sabor del suplemento oral y la intolerancia al volumen de suplemento oral. Conclusión: según la opinión experta, 12 potenciales y factibles nuevos ICTNO

  10. PubMed

    Rodríguez, Yarimar Rosa; Díaz, Nelson Varas

    2008-01-01

    El proceso de estigmatización asume una devaluación de la persona debido a una característica o marca que haya sido identificada socialmente y que permita que se le describa como diferente. Desde que se desató la epidemia del VIH/SIDA, vivir con la enfermedad ha sido señalado de manera social como una marca estigmatizante. Las manifestaciones de dicha estigmatización se han documentado entre profesionales de la salud. Este estigma puede afectar los servicios de salud que las personas que viven con VIH/SIDA reciben de estos profesionales. Los objetivos de esta investigación fueron explorar: 1) la percepción que tienen estudiantes y profesionales de la salud sobre su nivel de competencia para ofrecer servicios a personas que viven con VIH/SIDA, 2) las opiniones de éstos sobre el tipo de adiestramiento profesional recibido y la necesidad del mismo, y 3) la manifestación de actitudes estigmatizantes como indicadores de necesidad de adiestramiento profesional. La muestra total del estudio estuvo compuesta por 80 de diversas profesiones de la salud. Los resultados reflejan que algunos/as de los/as participantes han recibido formación en VIH pero ésta no ha sido suficiente para contrarrestar las nociones estigmatizantes. Discutimos las implicaciones de los resultados para investigaciones futuras y el desarrollo de intervenciones con vías de minimizar las nociones estigmatizantes en los escenarios de salud. PMID:20011236

  11. PubMed

    Rodríguez, Yarimar Rosa; Díaz, Nelson Varas

    2008-01-01

    El proceso de estigmatización asume una devaluación de la persona debido a una característica o marca que haya sido identificada socialmente y que permita que se le describa como diferente. Desde que se desató la epidemia del VIH/SIDA, vivir con la enfermedad ha sido señalado de manera social como una marca estigmatizante. Las manifestaciones de dicha estigmatización se han documentado entre profesionales de la salud. Este estigma puede afectar los servicios de salud que las personas que viven con VIH/SIDA reciben de estos profesionales. Los objetivos de esta investigación fueron explorar: 1) la percepción que tienen estudiantes y profesionales de la salud sobre su nivel de competencia para ofrecer servicios a personas que viven con VIH/SIDA, 2) las opiniones de éstos sobre el tipo de adiestramiento profesional recibido y la necesidad del mismo, y 3) la manifestación de actitudes estigmatizantes como indicadores de necesidad de adiestramiento profesional. La muestra total del estudio estuvo compuesta por 80 de diversas profesiones de la salud. Los resultados reflejan que algunos/as de los/as participantes han recibido formación en VIH pero ésta no ha sido suficiente para contrarrestar las nociones estigmatizantes. Discutimos las implicaciones de los resultados para investigaciones futuras y el desarrollo de intervenciones con vías de minimizar las nociones estigmatizantes en los escenarios de salud.

  12. [Nutritional characteristics of school lunch menus in Biscay (Basque Country, Spain) in 2012/2013].

    PubMed

    Sancho Uriarte, Patricia; Cirarda Larrea, Francisco Borja; Valcárcel Alonso, Santiago

    2014-09-28

    Introducción: Uno de los elementos abordados desde la Estrategia para la Nutrición, Actividad física y prevención de la Obesidad y Salud (NAOS) es la alimentación en el medio escolar. Objetivo: Evaluar, tomando como referencia el conjunto mínimo de indicadores y recomendaciones de la Estrategia NAOS, una muestra de menús distribuidos en varios comedores escolares de Bizkaia. Métodos: Estudio descriptivo transversal basado en la revisión teórica de los menús basales distribuidos por siete cocinas centrales que abastecen a 324 centros escolares (80.969 alumnos). Se determinó y valoró la frecuencia semanal de varios grupos de alimentos; los documentos de referencia fueron “Evaluación y Seguimiento de la Estrategia NAOS: Conjunto de Indicadores” y las recomendaciones del “Documento de Consenso sobre la alimentación en los centros educativos”. Resultados y discusión: El 100% de los comedores cumple con los mínimos relativos a legumbres, pescados y precocinados y con las recomendaciones relativas a carne y productos cárnicos. Si bien se aproximan bastante, ninguno cumple con los mínimos de fruta, verdura o con la información nutricional complementaria. Se han evidenciado diferencias entre las recomendaciones de La Estrategia NAOS y las condiciones exigidas por el Departamento de Educación, así como dificultades en la cuantificación y clasificación de varios alimentos. Conclusiones: Se recomienda incrementar el contenido en frutas, verduras, huevos y pescado azul de los menús escolares, así como ofrecer a las familias una información de los menús más detallada.

  13. A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa.

    PubMed

    Han, T M; Naicker, S; Ramdial, P K; Assounga, A G

    2006-06-01

    Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is the most common finding on renal biopsy in HIV-infected black patients and is also the commonest cause of end-stage renal disease in these patients. Early detection of HIVAN may be beneficial in evaluating early treatment. This study examined the pattern of renal diseases in HIV-infected South Africans and also attempted to diagnose HIVAN at an early stage. In this single-center cross-sectional study, 615 HIV-infected patients were screened for proteinuria. Thirty patients with varying degrees of proteinuria underwent renal biopsy. Patients with diabetes mellitus, uncontrolled hypertension, known causes of chronic kidney disease, and serum creatinine above 250 mumol/l were excluded. Patients in this study were not on antiretroviral therapy. HIVAN was found in 25 (83%) patients. Six of them (24%) had microalbuminuria. Altogether, seven patients with persistent microalbuminuria were biopsied and six (86%) showed HIVAN. Other biopsy findings included membranoproliferative nephropathy in two (7%) and interstitial nephritis in three (10%). Four patients with HIVAN had associated membranous nephropathy. HIVAN is the commonest biopsy finding among our study patients with HIV infection who present with varying degrees of proteinuria. Microalbuminuria is a manifestation of HIVAN in our study patients. Therefore, microalbuminuria may be an early marker of HIVAN, and screening for its presence may be beneficial. Renal biopsy may be considered in seropositive patients who present with persistent microalbuminuria, especially with low CD4 counts irrespective of good renal function. This will allow diagnosis and treatment of HIVAN at an early stage and may prevent further disease progression. PMID:16672914

  14. The effects of regular aerobic exercise on renal functions in streptozotocin induced diabetic rats.

    PubMed

    Kurdak, Hatice; Sandikci, Sunay; Ergen, Nilay; Dogan, Ayşe; Kurdak, Sanli Sadi

    2010-01-01

    Diabetic nephropathy is a feared complication of diabetes since it can lead to end-stage renal failure and also it is a risk factor of cardiovascular disease. The important clinical problems caused by diabetic nephropathy are proteinuria and decreased renal function. Exercise is a cornerstone of diabetes management, along with diet and medication. Since acute exercise causes proteinuria and decreases glomerular filtration rate, the effect of exercise on diabetic nephropathy is controversial. The aim of this study was to investigate the effect of regular aerobic exercise on microalbuminuria and glomerular filtration rate in diabetic rats. Moderate diabetes was induced by streptozotocin (45 mg/kg IV) in rats and an aerobic exercise- training program on a treadmill was carried out for 8 weeks. Four groups of rats; control sedentary (CS), control exercise (CE), diabetic sedentary (DS) and diabetic exercise (DE) were included in the study. Blood glucose levels were determined from the plasma samples taken at the end of 4 weeks of stabilization period and 8 weeks of training program. Creatinine clearance (CCr) and microalbuminuria (MA) levels were determined to evaluate renal functions. The analyzed data revealed that regular aerobic exercise: 1) significantly decreased the plasma glucose level of the DE group compared to the DS group (p < 0.05), 2) significantly decreased the microalbuminuria level of the DE group compared to those of DS group (p < 0.01), 3) significantly decreased the creatinine clearance levels of the DE and CE groups compared to those of CS group (p < 0.05). The results of this study suggest that despite of decreasing creatinine clearance, regular submaximal aerobic exercise has a preventive effect on development of microalbuminuria and thus may retard nephropathy in diabetic rats. Key pointsRegular submaximal aerobic exercise can facilitate the control of blood glucose level in diabetic rats.Streptozotocin induced diabetes may cause microalbuminuria

  15. The emerging concept of chronic kidney disease without clinical proteinuria in diabetic patients.

    PubMed

    Halimi, J M

    2012-10-01

    The natural history of diabetic nephropathy was defined in the 1980s on the basis of longitudinal studies undertaken in patients with type 1 and type 2 diabetes. However, an increasing number of studies have indicated that certain diabetic patients do not present with the same evolution as was then defined: for example, some often have significant initial deterioration of glomerular filtration rate whereas, in others, microalbuminuria is reduced spontaneously. Chronic kidney disease (CKD) may be accompanied, rather than preceded, by macroalbuminuria, or it may develop in patients with microalbuminuria or even in those with albuminuria levels that revert to normal. CKD can also develop in patients whose albuminuria levels remain normal. Progression to macroalbuminuria is, in fact, less frequent than regression to normoalbuminuria or no change in microalbuminuria status in diabetic patients with microalbuminuria, especially in type 1 diabetes. Some experience progressive deterioration of renal function due to diabetes without developing significant proteinuria: this is seen fairly frequently and can affect 50% of patients with renal insufficiency. Such cases are more often older patients treated with renin-angiotensin system blockers who usually have a history of cardiovascular disease. Evolution to end-stage renal disease is slower in this subgroup of patients, although histological analyses may show surprisingly advanced glomerular lesions. The main parameters of surveillance remain regular monitoring of glycaemia, and control of blood pressure and the evolution of initial albuminuria levels. Nevertheless, why some patients exhibit conventional diabetic nephropathy while others have slower declines in renal function associated with normal albuminuria levels or microalbuminuria is unclear. It is hoped that the new pathological classification of diabetic nephropathy will help in our understanding of these discrepancies.

  16. Follow-up of patients with epidemic poststreptococcal glomerulonephritis.

    PubMed

    Pinto, S W; Sesso, R; Vasconcelos, E; Watanabe, Y J; Pansute, A M

    2001-08-01

    In 1998 there was a large outbreak of acute glomerulonephritis (GN) in Nova Serrana, Brazil, caused by group C Streptococcus zooepidemicus and linked to the consumption of contaminated cheese produced with unpasteurized milk. This study describes the follow-up of these patients after a mean of 2 years following the acute episode. Of 134 patients identified in 1998, 69 patients were reexamined and underwent measurements of blood pressure, 24-hour creatinine clearance, microalbuminuria (radioimmunoassay), and urine sediment analysis. Of the original group of 134 patients, 3 patients died in the acute phase and 5 patients (3.7%) required chronic dialysis. Of 69 patients reevaluated, 65 patients (94%) were adults (mean age, 39 +/- 2 [SE] years) and 47 patients (68%) were women. At the follow-up examination, we found arterial hypertension in 42% of subjects (27 of 64 subjects), serum creatinine levels greater than 1.2 mg/dL in 12% (10 of 68 subjects), reduced creatinine clearance (<80 mL/min/1.73 m(2)) in 30% (20 of 67 subjects, 2 of them on chronic dialysis therapy), and increased microalbuminuria (>20 microg/min) in 34% (22 of 65 subjects). Increased microalbuminuria and/or reduced creatinine clearance were detected in 48% of the subjects (31 of 65 subjects). Patients with microalbuminuria had greater diastolic blood pressure than those without microalbuminuria (mean, 98 +/- 4 versus 88 +/- 2 mm Hg; P = 0.02). In conclusion, after a mean of 2 years, patients with epidemic poststreptococcal GN caused by S zooepidemicus present a high rate of hypertension and frequent abnormalities of renal function, with some having reached end-stage renal disease. Longer follow-up will be important to define the prognosis of these patients.

  17. [Muscular fitness and cardiometabolic risk factors among Colombian young adults].

    PubMed

    Ramírez-Vélez, Robinson; Meneses-Echavez, José F; González-Ruíz, Katherine; Correa, Jorge Enrique

    2014-10-01

    Objetivo: Determinar la relación entre el fitness muscular (FM) con marcadores de riesgo cardio-metabólico en adultos jóvenes de Colombia. Métodos: Un total de 172 hombres (edad 19,7±2,4 años; peso 65,5±10,7 kg; IMC 22,6±2,8 kg•m-1) sin enfermedad cardiovascular previa fueron invitados a participar en el estudio. El FM se determinó mediante el test de dinamometría prensil y los resultados fueron divididos en cuartiles según los valores de FM y FM/peso corporal. Se calculó el índice lipídico-metabólico según las concentraciones de triglicéridos, c-LDL, c-HDL y glucosa. La circunferencia de cintura (CC), porcentaje de grasa, índice de adiposidad corporal (IAC) e índice de masa corporal (IMC) fueron usados como indicadores de adiposidad. Resultados: Después de ajustar por edad, IMC y CC, se observaron relaciones inversas entre el porcentaje de grasa, la CC, los niveles colesterol, HDL-c y LDL-c, con los valores de FM y FM/peso corporal (p.

  18. [Treatment of autism spectrum disorders: union between understanding and evidence-based practice].

    PubMed

    Martos-Pérez, Juan; Llorente-Comí, María

    2013-09-01

    Introduccion. De manera sintetica se da cuenta de las caracteristicas heterogeneas de funcionamiento de las personas con trastornos del espectro autista (TEA) y como dichas caracteristicas tambien pueden estar en la base de la variabilidad en la respuesta al tratamiento. Se recalca la necesidad de combinar, en el tratamiento, la practica basada en la evidencia y una comprension profunda de los TEA. Desarrollo. Se explican algunos de los principios esenciales que deben guiar el tratamiento desde la optica de indicadores de calidad que han de contener los programas de intervencion. Se incide en las caracteristicas y contenidos que forman parte de los programas que se llevan a cabo en el ambito de la intervencion temprana, explicando brevemente algunos de esos programas, y posteriormente se caracteriza la intervencion, con el uso de tecnicas y estrategias, que habitualmente se realiza en niños y adolescentes de alto nivel de funcionamiento. Conclusion. La investigacion y conocimiento acumulados y la cada vez mayor evidencia experimental configuran las caracteristicas que deben adoptar los programas de intervencion y tratamiento usados en personas con TEA. Dicho tratamiento debe comenzar de manera temprana, lo antes posible y extenderse a lo largo del ciclo vital.

  19. [Study of paracetamol levels in serum samples as predictive indicator of gastric emptying].

    PubMed

    Rodríguez Acosta, María Victoria; González Correa, José Antonio; Moreno Fontiveros, Maria Ángeles; Benítez, José Antonio

    2015-06-01

    Introducción: la iniciación temprana de la nutrición en pacientes intervenidos quirúrgicamente es fundamental. Objetivos: analizar las técnicas disponibles para evaluar el vaciado gástrico de los pacientes críticos sometidos a cirugía, y que apoyan la decisión de introducirles un tipo de alimentación u otro. Resultados: los test estándar son la medida del volumen residual gástrico y la auscultación, pero no han demostrado gran eficacia. El test de paracetamol parece una buena herramienta predictiva. Permitiría en una hora saber si el vaciado gástrico es adecuado y con ello seleccionar el tipo de nutrición más conveniente (enteral, parenteral) o evaluar el uso de procinéticos. Discusión: el test de paracetamol es una alternativa económica de alto valor predictivo. Existen estudios cuyo objetivo final es valorar el test como indicador de la tolerancia de la nutrición enteral, pero es necesario ampliar y estandarizar su uso para poder incluirlo en los protocolos de actuación hospitalarios.

  20. Association of Dietary Patterns With Albuminuria and Kidney Function Decline in Older White Women: A Subgroup Analysis From the Nurses’ Health Study

    PubMed Central

    Lin, Julie; Fung, Teresa T.; Hu, Frank B.; Curhan, Gary C.

    2010-01-01

    Background Dietary patterns have been linked to chronic diseases such as cardiovascular disease, but sparse data are currently available on associations between dietary patterns and microalbuminuria or kidney function decline. Study Design Subgroup analysis from a prospective observational cohort study Setting and Participants Female participants in the Nurses’ Health Study who had dietary patterns data from food frequency questionnaires returned in 1984, 1986, 1990, 1994, and 1998 and urinary albumin-creatinine ratios (ACR) from the year 2000 (n=3121); estimated glomerular filtration rate (eGFR) change between 1989 and 2000 was available in 3071. Predictor Prudent (higher intake of fruits, vegetables, legumes, fish, poultry, and whole grains), Western (higher intake of red and processed meats, saturated fats, and sweets), and Dietary Approach to Stop Hypertension (DASH) style dietary patterns (also greater intake of vegetables, fruits, and whole grains). Outcomes and Measurements Microalbuminuria (albumin-to-creatinine ratio 25 to 354 mcg/mg) in 2000 and change in kidney function by eGFR between 1989 and 2000. Results After multivariable adjustment, the highest quartile of Western pattern score compared to the lowest quartile was directly associated with microalbuminuria (OR, 2.17; 95% CI, 1.18 to 3.66; p-for trend=0.01) and rapid eGFR decline of ≥3 ml/min/1.73 m2 per year (OR, 1.77; 95% CI, 1.03 to 3.03). Women in the top quartile of the DASH score had decreased risk for rapid eGFR decline (OR, 0.55; 95% CI, 0.38 to 0.80), but had no association with microalbuminuria. These associations did not vary with diabetes status. The prudent dietary pattern was not associated with microalbuminuria or eGFR decline. Limitations Study cohort included primarily older white women and generalizability of results would benefit from validation in non-whites and men. Conclusions A Western dietary pattern is associated with a significantly elevated risk for microalbuminuria and

  1. Factors of cardiovascular risk in patients with type 2 diabetes and incipient nephropathy

    PubMed Central

    Nelaj, E; Gjata, M; Lilaj, I; Burazeri, G; Sadiku, E; Collaku, L; Bare, O; Tase, M

    2008-01-01

    Background: Microalbuminuria was originally established as a predictor of renal failure and an independent risk factor for cardiovascular disease in patients with diabetes mellitus as well as in general population. The aim of our study is to assess the relationship between microalbuminuria and the other risk factors in diabetics and their prevalence. Methods: Sixty five patients, 22 men and 43 women with mean age 58.6 ±10.09, with type 2 diabetes, were hospitalized in the Department of Internal Medicine in the University Hospital Center "Mother Teresa" in Tirana, Albania, between March 2007 and February 2008. These patients with a mean duration of diabetes 6.09±5.41 were divided in two groups: with (Group A: 24 patients) and without (Group B: 41 patients) microalbuminuria and each group was evaluated for left ventricular mass index (LVMI), body mass index (BMI), glycosylated hemoglobin (HbA1C), lipid profile and intima media thickness (IMT). Results: The prevalence of microalbuminuria in our study was 32.3%. The prevalence of microalbuminuria in males was 37.5 and in females 62.5%. The microalbuminuric patients were older ( 59.71±9.87 vs 57.07±10.32) and had a longer duration of diabetes (7.74±5.74 vs 4.45±5.08) compared with normoalbuminuric patients.(p=0.01). The Group A had significantly higher LVMI compared with Group B ( p= 0.02). The prevalence of obesity (BMI >30kg/m2) in our sample was 44.6%. In Group A the mean BMI (30.13±4.98) was significantly higher compared with Group B (28.00±3.72, p= 0.04). Diabetic retinopathy was more frequent in Group A compared with Group B ( 33.3% vs 14.6%, p=0.05). The mean value of IMT was higher in Group A compared with Group B (1.28±0.35 vs 1.09±0.28, p=0.03) Conclusion: In patients with type 2 diabetes and microalbuminuria LVMI, IMT, BMI, duration of diabetes was significantly higher compared with patients with type 2 diabetes and normoalbuminuria. PMID:19158965

  2. The Fluidez en La Lectura Oral (FLO) Portion of the Indicadores Dinamicos De Exito en La Lectura (IDEL) and the English Language Portion of the Illinois Standard Achievement Test (ISAT): A Correlational Study of Second and Third Grade English Language Learners

    ERIC Educational Resources Information Center

    Ganan, Brian J.

    2012-01-01

    This study examined the relationship between Spanish oral reading fluency (ORF) at the end of second grade and students' performance on the third grade ISAT reading test. The major research question guiding this study was: What is the direction and strength of the relationship between performance on the 2nd grade IDEL FLO, a Spanish language…

  3. Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper.

    PubMed

    López-Sendón, José; González-Juanatey, José Ramón; Pinto, Fausto; Cuenca Castillo, José; Badimón, Lina; Dalmau, Regina; González Torrecilla, Esteban; López-Mínguez, José Ramón; Maceira, Alicia M; Pascual-Figal, Domingo; Pomar Moya-Prats, José Luis; Sionis, Alessandro; Zamorano, José Luis

    2015-11-01

    Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries. PMID:26315766

  4. Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper.

    PubMed

    López-Sendón, José; González-Juanatey, José Ramón; Pinto, Fausto; Cuenca Castillo, José; Badimón, Lina; Dalmau, Regina; González Torrecilla, Esteban; López-Mínguez, José Ramón; Maceira, Alicia M; Pascual-Figal, Domingo; Pomar Moya-Prats, José Luis; Sionis, Alessandro; Zamorano, José Luis

    2015-11-01

    Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries.

  5. [Not Available].

    PubMed

    Flores Navarro-Pérez, Carmen; González-Jiménez, Emilio; Schmidt-RioVilla, Jacqueline; Meneses-Echávez, José Francisco; Correa-Bautista, Jorge Enrique; Correa-Rodríguez, María; Ramírez-Vélez, Robinson

    2016-01-01

    Objetivos: los objetivos de este estudio fueron analizar el nivel nutricional en una población de niños y adolescentes colombianos y determinar la posible relación entre el nivel nutricional y el estado nutricional según el índice de masa corporal (IMC) y la circunferencia de cintura (CC).Material y métodos: estudio transversal en 6.383 niños y adolescentes de entre 9 y 17,9 años de edad, de Bogotá, Colombia. Se aplicó de manera autodiligenciada el cuestionario Krece Plus validado en el estudio enKid como indicador del nivel nutricional con las categorías alto (test ≥ 9), medio (test 6-8) y bajo (test ≤ 5). Se tomaron medidas de peso, talla, CC, y se calculó el IMC como marcadores del estado nutricional.Resultados: de la población general, el 57,9% eran chicas (promedio de edad 12,7 ± 2,3 años). En todas las categorías del IMC, más del 50% de chicos y chicas siguen una dieta de muy baja calidad, que empeora progresivamente con el avance en edad. En ambos sexos, se observaron tendencias entre un nivel nutricional muy bajo con el desarrollo de sobrepeso. Asimismo, la obesidad abdominal por CC se relacionó con una puntuación baja en el Krece Plus en ambos sexos.Conclusiones: en escolares de Bogotá, una dieta de muy baja calidad se relacionó con alteraciones del estado nutricional (IMC y CC), especialmente entre chicas y adolescentes. Estos resultados deben alentar el desarrollo de intervenciones orientadas a mejorar los hábitos nutricionales entre los escolares colombianos. PMID:27571667

  6. [Nutritional status and health-related life quality in school children from the southeast of Spain].

    PubMed

    Gálvez Casas, Arancha; Rosa Guillamón, Andrés; García-Cantó, Eliseo; Rodríguez García, Pedro L; Pérez-Soto, Juan J; Tarraga Marcos, Loreto; Tarraga López, Pedro

    2014-11-30

    Introducción y objetivo: Analizar el nivel de calidad de vida en relación al estado nutricional en una muestra de escolares de primaria. Material y método: Estudio descriptivo transversal con 298 participantes (53,35% mujeres) de 8 a 12 años. Se valoró la calidad de vida mediante el cuestionario KIDSCREEN- 10. Se midió el peso y la talla de los escolares. El índice de masa corporal (normo-peso, sobrepeso y obesidad) fue categorizado usando criterios estándar. Para establecer la relación entre las diferentes variables se realizó un análisis de varianza de un factor. Resultados: El estado nutricional se relaciona de forma significativa con la calidad de vida (F = 5,096; p = ,007). Los escolares con un estado nutricional de normo-peso mostraron índices superiores de calidad de vida con respecto a los escolares con sobrepeso (p = ,015) y obesidad (p = ,013). Conclusiones: Los resultados indican que el estado nutricional se muestra como un elemento diferenciador en el nivel de calidad de vida. La adopción de conductas de estilo de vida activo que favorezcan un estado nutricional saludable no solo puede tener beneficios sobre otros parámetros biológicos de la salud (como la condición física) sino que puede favorecer a su vez la mejora de otros indicadores de calidad de vida y salud mental.

  7. [Not Available].

    PubMed

    Flores Navarro-Pérez, Carmen; González-Jiménez, Emilio; Schmidt-RioVilla, Jacqueline; Meneses-Echávez, José Francisco; Correa-Bautista, Jorge Enrique; Correa-Rodríguez, María; Ramírez-Vélez, Robinson

    2016-07-19

    Objetivos: los objetivos de este estudio fueron analizar el nivel nutricional en una población de niños y adolescentes colombianos y determinar la posible relación entre el nivel nutricional y el estado nutricional según el índice de masa corporal (IMC) y la circunferencia de cintura (CC).Material y métodos: estudio transversal en 6.383 niños y adolescentes de entre 9 y 17,9 años de edad, de Bogotá, Colombia. Se aplicó de manera autodiligenciada el cuestionario Krece Plus validado en el estudio enKid como indicador del nivel nutricional con las categorías alto (test ≥ 9), medio (test 6-8) y bajo (test ≤ 5). Se tomaron medidas de peso, talla, CC, y se calculó el IMC como marcadores del estado nutricional.Resultados: de la población general, el 57,9% eran chicas (promedio de edad 12,7 ± 2,3 años). En todas las categorías del IMC, más del 50% de chicos y chicas siguen una dieta de muy baja calidad, que empeora progresivamente con el avance en edad. En ambos sexos, se observaron tendencias entre un nivel nutricional muy bajo con el desarrollo de sobrepeso. Asimismo, la obesidad abdominal por CC se relacionó con una puntuación baja en el Krece Plus en ambos sexos.Conclusiones: en escolares de Bogotá, una dieta de muy baja calidad se relacionó con alteraciones del estado nutricional (IMC y CC), especialmente entre chicas y adolescentes. Estos resultados deben alentar el desarrollo de intervenciones orientadas a mejorar los hábitos nutricionales entre los escolares colombianos.

  8. [Autism and attention deficit hyperactivity disorder: similarities and differences in executive functioning and theory of mind].

    PubMed

    Miranda-Casas, Ana; Baixauli-Fortea, Immaculada; Colomer-Diago, Carla; Roselló-Miranda, Belén

    2013-09-01

    Introduccion. Aunque los criterios diagnosticos del autismo y del trastorno por deficit de atencion/hiperactividad (TDAH) en el DSM-IV-TR no se solapan, la presencia de sintomas de TDAH en individuos con un diagnostico clinico de autismo es muy elevada. A su vez, los niños con TDAH pueden tener rasgos autistas, aunque los mas prevalentes son las dificultades sociales y de comunicacion. El analisis del perfil en las funciones ejecutivas y en la teoria de la mente (ToM) podria ayudar a explicar el solapamiento y la diferenciacion entre ambos trastornos. Objetivo. Revisar los hallazgos de estudios empiricos en los que se ha comparado a niños con TDAH y con autismo en indicadores de funcionamiento ejecutivo y ToM. Desarrollo. La revision de las investigaciones sugiere la existencia de patrones distintos en el trastorno del espectro autista (TEA) y en el TDAH cuando el funcionamiento ejecutivo se segmenta en componentes. Los niños con TDAH experimentan deficit en el control inhibitorio mientras que los niños con TEA tienen mas problemas en flexibilidad cognitiva y en planificacion. En cuanto al dominio de las habilidades mentales se producen diferencias evolutivas, asi como en su gravedad. Los niños mas pequeños con TEA experimentan mayores deficiencias en la ToM en comparacion con los niños con TDAH y un deficit primario en la orientacion social. Conclusiones. Aunque los avances son importantes, quedan asuntos pendientes por aclarar, entre los que destaca el analisis de como afecta un pobre desarrollo de las funciones ejecutivas al desarrollo de la ToM, con estudios longitudinales que analicen las trayectorias evolutivas de niños con TEA y niños con TDAH.

  9. CUTOFF POINT OF THE PHASE ANGLE IN PRE-RADIOTHERAPY CANCER PATIENTS.

    PubMed

    Souza Thompson Motta, Rachel; Alves Castanho, Ivany; Guillermo Coca Velarde, Luis

    2015-11-01

    Introducción: la desnutrición es una complicación frecuente en los pacientes con cáncer. El ángulo de fase (AF), medición directa del análisis de impedancia bioeléctrica (AIB), puede ser considerado un factor de predicción de la masa celular corporal e indicador de pronóstico. Los puntos de corte para el ángulo de fase (PA) que se asocian con el riesgo nutricional en pacientes con cáncer aún no han sido determinados. Objetivos: evaluar la posibilidad de determinar el punto de corte para el AF para identificar riesgo nutricional en pacientes con cáncer antes de la radioterapia. Métodos: grupo muestreado: pacientes de ambos sexos con diagnóstico de cáncer y enviados para radioterapia ambulatoria. Variables estudiadas: índice de masa corpórea (IMC), porcentaje de pérdida de peso (% PP), circunferencia del brazo (CB), pliegue cutáneo del tríceps (PCT), circunferencia muscular del brazo (CMB), área muscular del brazo (AMB), puntuación y evaluación categóricas obtenidas utilizando la Valoración Global Subjetiva Generada por el Paciente (VGS-GP), AF y ángulo de fase estandarizado (AFS). El coeficiente Kappa se utilizó para probar el grado de concordancia entre los diagnósticos de riesgo nutricional obtenidos de diferentes métodos de evaluación nutricional. Los puntos de corte del AF a través de indicadores antropométricos y VGS-GP se determinaron utilizando la curva ROC (Receiver Operating Characteristic), y la sobrevivencia de los pacientes se analizó con el método de regresión de Cox. Resultados: los puntos de corte con mayor poder discriminatorio fueron los obtenidos de IMC (5,2) y la evaluación categórica del VGS-GP (5,4). El diagnóstico obtenido mediante estos puntos de corte mostró una asociación significativa con el riesgo de muerte de los pacientes incluidos en este trabajo. Conclusión: se recomienda utilizar el punto de corte 5.2 para el AF como criterio para la identificación de riesgo nutricional en pacientes con c

  10. [ACCURACY PARAMETERS AS INDICATORS OF ANTHROPOMETRIC ADIPOSITY VISCERAL SCHEDULED FOR TWO-DIMENSIONAL EQUATION].

    PubMed

    Lira Santos, Andréia; Araújo Tavares de Sá, Cristiane Maria; Calado Brito, Daniel; Lourenço Batista, Camila; Kétteryn Maior Evangelista da Costa, Meury; Araújo Gomes de Lima, Kamilla Brianne; Magalhães Souza, Jaqueline; Tenório Ramos, Irya Laryssa

    2015-11-01

    Introducción: los indicadores antropométricos son fáciles de aplicar y pueden ayudar en la identificación de la acumulación de grasa visceral, lo que favorece la aparición de eventos cardiovasculares, así como, el aumento de la morbilidad y mortalidad por enfermedades crónicas. Objetivo: evaluar la exactitud de los indicadores antropométricos de distribución de la grasa abdominal para determinar la adiposidad visceral. Sujetos/Métodos: estudio transversal realizado con pacientes ambulatorios, de ambos sexos, mayores de 20 años. Fueron evaluados: circunferencia de la cintura (CC); relación cintura-cadera (WHR); cintura-altura (CER); índice Taper (CI); diámetro abdominal sagital (DAS); (DC) de diámetro coronal; índice de masa corporal (IMC); porcentaje de grasa corporal (% GC); adiposidad visceral (AV/AS) predicha por la fórmula; glucosa en sangre en ayunas; colesterol total (TC); lipoproteína de baja densidad (LDL); lipoproteína de alta densidad (HDL); lipoproteínas de muy baja densidad (VLDL) y triglicéridos (TG). Resultados: se evaluaron 129 pacientes, edad media 51, 06 + 14,02 años y una mayor prevalencia de adultos (72,9%) y mujeres (75,2%). CC 102,9 (+ 10,82), HF 2,08 (± 0,13) y AV/AS 1,03 (+ 0,16), mostraron valores altos con significación estadística entre los hombres, p < 0,001. Lo mismo ocurrió con la CT (+ 46,4 212,41), HDL (50,15 + 13,24) y LDL (135,62 + 40,16) entre las mujeres, p < 0,05. DC, RCE, DAS y DC mostraron una correlación inversa y significativa con la AV/AS: r = -0,364; -0.457; -0.403; -0.296; -0.475, respectivamente, p < 0,001. Sin embargo, que mejor explicó la varianza de la obesidad visceral fueron el DC (R² = 0,77), CQ (R² = 0,64) y RCE (R² = 0,59). Discusión/Conclusión: la DC y el CER fueron los mejores predictores para las mediciones antropométricas de la obesidad visceral.

  11. Espectroscopia infravermelha de núcleos ativos de galáxias: resultados adicionais

    NASA Astrophysics Data System (ADS)

    Rodríguez Ardila, A.; Viegas, S.; Pastoria, M. G.

    2003-08-01

    Apresentamos resultados parciais de um levantamento espectroscópico na região do infravermelho próximo (NIR) realizado em 30 núcleos ativos de galáxias (AGN), incluindo vários objetos selecionados do catálogo PG com z de até 0.55. O objetivo é estudar a natureza do contínuo observado e as condições físicas do gas emissor. Todas as fontes de tipo 1 apresentam uma mudança na inclinação do contínuo na região de 1.2mm, associada ao término da contribuição do contínuo emitido pelo AGN e ao início da contribuição do contínuo emitido pela poeira quente atribuída ao tórus que rodeia a fonte central. O índice espectral associado à segunda contribuição varia apreciavelmente de objeto para objeto. Este resultado é comparado com distribuições espectrais de energia preditas por modelos de toroides para testar a validez do modelo unificado. A partir das linhas de FeII observado nos espectros deriva-se, pela primeira vez nessa região espectral, um template empírico de FeII para estudar a intensidade e a origem dessa emissão. A intensidade do FeII é estudada em conjunto com aquela da região visível e comparada às predições de modelos teóricos que incluem fluorescência de Lya, excitação colisional e auto-fluorescência como mecanismos dominantes de exitação. Encontra-se que os dois primeiros processos dominam na formação do espectro de FeII observado. Indicadores de avermelhamento, entre eles Brg/Pab, Pab/Pag, Pab/Pad e [FeII] 1.257/1.644 mm são utilizados para mapear a distribuição de poeira nas regiões emissoras de linhas. Encontra-se valores de extinção Av~3 associados ao último indicador e valores significativamente menores (Av~1.5) para os restantes, o que sugere que o [FeII] se forma em uma região separada da maior parte do gás emissor de linhas estreitas.

  12. Measuring emotional awareness from a cognitive-developmental perspective: Portuguese adaptation studies of the levels of emotional awareness scale.

    PubMed

    Torrado, Marco; Ouakinin, Sílvia; Lane, Richard

    2013-01-01

    Introdução: A Escala de Níveis de Consciência Emocional (LEAS) foi desenvolvida para avaliar o constructo consciência emocional, numa perspectiva cognitivo-desenvolvimentista e influenciada pelas Teorias de Piaget e Werner. É composta por 20 situações ou cenários que evocam emoções e tem sido usada em múltiplas investigações nos domínios da regulação emocional, alexitimia e perturbações psiquiátricas. Trata-se de uma medida bem documentada, validada e precisa. Em virtude da sua extensão, alguns investigadores têm vindo a utilizar uma das formas paralelas que compõe a versão completa, a LEAS-A, sendo contudo notória a vacuidade de estudos que descrevam as qualidades psicométricas desta versão. Face à inexistência de uma medida de caracterização da organização da experiência emocional para a população portuguesa, desenvolveu-se a versão portuguesa da LEAS, caracterizaram-se diversos indicadores de precisão e validade, assim como para a versão reduzida LEAS-A. Materiais e Métodos: Foram desenvolvidos três estudos com estas versões, dois deles com recurso a estudantes universitários e um outro com uma amostra da população em geral. Resultados: A versão portuguesa demonstrou níveis elevados de precisão, mais robustos do que os encontrados em estudos de adaptação da escala noutros países. A LEAS-A apresentou bons níveis de precisão e indicadores de validade discriminante e concorrente. As pontuações obtidas na LEAS-A mostraram-se independentes da presença de afecto negativo e associaram-se significativamente a um estilo cognitivo externalizado, próprio do funcionamento alexitímico. Conclusões: As versões portuguesas da LEAS e da LEAS-A apresentam qualidades psicométricas muito adequadas, o que permite o seu uso científico. São discutidas as implicações da sua utilização nos contextos clínico e de investigação.

  13. EVALUATION OF SEVERAL ANTHROPOMETRIC INDICES OF OBESITY AS PREDICTORS OF METABOLIC SYNDROME IN JORDANIAN ADULTS.

    PubMed

    Obeidat, Ahmad A; Ahmad, Mousa N; Haddad, Fares H; Azzeh, Firas S

    2015-08-01

    Introducción: han sido probados diversos índices antropométricos por su relación con el síndrome metabólico (SM), pero sin establecer puntos de corte entre diferentes grupos de población. Objetivo: este estudio tiene como objetivo evaluar el poder predictivo de varios índices antropométricos de obesidad central como predictores del síndrome metabólico en un grupo de adultos jordanos. Métodos: en este estudio transversal, 630 sujetos adultos (308 hombres y 322 mujeres) de edades comprendidas entre 20 a 70 años fueron reclutados en el Centro Médico Rey Hussein en Amman (Jordania). El diagnóstico de síndrome metabólico fue definido por los criterios de la Federación Internacional de Diabetes. Las medidas antropométricas (circunferencia de la cintura [WC]; relación cintura-cadera [WHpR]; relación cintura-altura [RCEst]; índice de masa corporal [IMC]) se realizaron y registraron siguiendo los procedimientos estándar. Se utilizaron curvas características del receptor (ROC) para determinar la eficacia de las medidas antropométricas como predictores de SM. Resultados: los resultados indican que, en los hombres, para identificar a los sujetos con riesgo de SM el área bajo la curva (AUC) de la curva ROC para WC era 0.851, AUC para WHpR era 0,842, AUC para RCEst fue de 0,85 y el AUC del IMC fue de 0,83. En las mujeres, el AUC para WC, WHpR, RCEst y el IMC fueron: 0,866, 0,871, 0,872 y 0,831, respectivamente. Conclusión: se puede concluir que entre los índices antropométricos, tanto RCEst como WC tenían el poder predictivo más fuerte para identificar a los sujetos con síndrome metabólico en hombres y mujeres. RCEst parece ser el mejor indicador de la obesidad central en mujeres y personas de baja estatura.

  14. [In Process Citation].

    PubMed

    Vivas-Díaz, José Andrés; Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique; Izquierdo, Mikel

    2016-03-25

    Introducción: la evaluación de la fuerza de prensión realizada comúnmente mediante dinamometría manual actualmente es considerada como un indicador del estado nutricional y como un marcador temprano en la morbimortalidad de la enfermedad cardiometabólica. Objetivos: en este estudio, se presentan valores de la fuerza prensil por dinamometría manual en una muestra de estudiantes universitarios de Colombia. Método: estudio descriptivo y transversal realizado en 5.647 estudiantes universitarios aparentemente sanos (58,5% mujeres, edad media 20,6 ± 2,7 años) pertenecientes a instituciones privadas y públicas de Bogotá y Cali (Colombia). La fuerza prensil se midió utilizando dinamómetro manual, ajustado para cada individuo según el tamaño de la mano. Se calcularon percentiles (P 3 , P 10 , P 25 , P 50 , P 75 , P 90 y P 97 ) y curvas centiles ajustado por edad y sexo. Resultados: el valor medio de fuerza prensil fue significativamente mayor en los hombres (37,1 ± 8,3 kg) en comparación con las mujeres (24.2 ± 8.1 kg) (p < 0,001). En ambos sexos, la fuerza prensil aumentó con la edad y fue significativamente mayor y homogénea en los hombres en todas las categorías de edad. Adicionalmente, se presentan tablas de referencia que pueden ser empleadas para identificar estudiantes con niveles de fuerza saludable. Conclusión: este trabajo puede ser tenido en cuenta como referencia para estudiar las tendencias seculares y las variaciones de la fuerza prensil en universitarios y para identificar puntos de corte clínicamente relevantes en el estado nutricional y como un marcador de manifestaciones tempranas asociadas a la enfermedad cardiometabólica en la población Suramericana.

  15. [In Process Citation].

    PubMed

    Vivas-Díaz, José Andrés; Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique; Izquierdo, Mikel

    2016-01-01

    Introducción: la evaluación de la fuerza de prensión realizada comúnmente mediante dinamometría manual actualmente es considerada como un indicador del estado nutricional y como un marcador temprano en la morbimortalidad de la enfermedad cardiometabólica. Objetivos: en este estudio, se presentan valores de la fuerza prensil por dinamometría manual en una muestra de estudiantes universitarios de Colombia. Método: estudio descriptivo y transversal realizado en 5.647 estudiantes universitarios aparentemente sanos (58,5% mujeres, edad media 20,6 ± 2,7 años) pertenecientes a instituciones privadas y públicas de Bogotá y Cali (Colombia). La fuerza prensil se midió utilizando dinamómetro manual, ajustado para cada individuo según el tamaño de la mano. Se calcularon percentiles (P 3 , P 10 , P 25 , P 50 , P 75 , P 90 y P 97 ) y curvas centiles ajustado por edad y sexo. Resultados: el valor medio de fuerza prensil fue significativamente mayor en los hombres (37,1 ± 8,3 kg) en comparación con las mujeres (24.2 ± 8.1 kg) (p < 0,001). En ambos sexos, la fuerza prensil aumentó con la edad y fue significativamente mayor y homogénea en los hombres en todas las categorías de edad. Adicionalmente, se presentan tablas de referencia que pueden ser empleadas para identificar estudiantes con niveles de fuerza saludable. Conclusión: este trabajo puede ser tenido en cuenta como referencia para estudiar las tendencias seculares y las variaciones de la fuerza prensil en universitarios y para identificar puntos de corte clínicamente relevantes en el estado nutricional y como un marcador de manifestaciones tempranas asociadas a la enfermedad cardiometabólica en la población Suramericana. PMID:27238795

  16. Microcirculation and hemorheology in NIDDM patients.

    PubMed

    Catalano, M; Tomasini, M; Annoni, M; Gherardi, E; Scandale, G; Galimberti, P; Porro, T; Milanese, F; Libretti, A

    1990-12-01

    The authors studied 10 patients with non-insulin-dependent diabetes mellitus and 5 controls matched for age, sex, blood lipids, and smoking habit. The two groups were also comparable for hemorheologic characteristics as evaluated by viscosimetry on whole blood, plasma and serum, erythrocyte filtration and aggregation. The microcirculation was studied in the subjects of both groups by microalbuminuria determination, retinal fluorangiography, and capillaroscopic examination of the bulbar conjunctive and nail folds. None of the patients presented microalbuminuria values higher than the upper limit of normal (20mg/24h). Fluoroangiographic alterations were observed in 4 patients, and all 10 presented capillaroscopic alterations at the bulbar conjunctiva (microaneurysms, erythrocyte aggregates) and nail folds (more frequently of the fingers than toes). Similar alterations were detected in controls. Thus these abnormalities seem independent of hemorheologic values.

  17. [Reflexion of French experts on the key points of the symposium].

    PubMed

    Mallion, J M; Forette, F; Hanon, O; Dubourg, O; Marre, M

    2002-10-01

    The French experts present at the Eutherapy Symposium held in Prague confirmed the importance of left ventricular hypertrophy (LVH) and microalbuminuria as major independent risk factors for cardiovascular disease. Factors that must be considered for the treatment of hypertension in patients, particularly with type 2 diabetes. Professor J.M. Mallion stressed the contribution of thiazide and thiazide-like diruetics as indapamid, especially the 1.5 mg SR formulation. Professor F. Forette and Doctor O. Hanon recalled that the HYVET study is expected to confirm the beneficial effect of this same treatment on morbidity and mortality in very elderly patients. Professor O. Dubourg recalled the beneficial effect of indapamid SR on LVH demonstrated in the LIVE study. Likewise, Professor M. Marre emphasized its important impact on microalbuminuria as shown in the NESTOR study. PMID:12356003

  18. Implementation of indicators through balanced scorecards in a nutritional therapy company.

    PubMed

    de Matos Nasser, Emanuele; Reis da Costa, Stella Regina

    2013-01-01

    Introducción: La Balanced Scorecard (BSC) es una herramienta que ayuda en la gestión estratégica, bajo las siguientes cuatro perspectivas: la financiera, la del cliente, los procesos internos de la empresa, y los procesos de crecimiento y aprendizaje. Con el fin de medir el rendimiento de las entidades, la BSC emplea como plataforma indicadores financieros y no financieros. Objetivos: Implantar la BSC en una empresa de terapias nutricionales. Material y métodos: Esta investigación comprende el estudio de un caso que tuvo lugar en una empresa de terapia nutricional, entre enero y noviembre de 2010. Para el análisis de la perspectiva de aprendizaje y crecimiento, se consideraron los 45 colaboradores de la compañía y para el análisis de los clientes, 124 clientes de atención domiciliaria. La muestra del estudio consistió de 39 colaboradores y 44 clientes que participaron en la investigación. Se elaboró material para la recogida de los datos y verificación de las tendencias de las perspectivas mediante el análisis de los principales procesos de la compañía, encuestas de satisfacción del colaborador y hojas de cálculo para la verificación del beneficio neto y el porcentaje de anulaciones. Los datos se introdujeron en una hoja de cálculo de la aplicación informática Excel. Resultados y discusión: Se escogieron los indicadores en función de los objetivos estratégicos y los perfiles organizativos. Perspectivas de aprendizaje y crecimiento personal: eficacia en la capacitación 94%, participación 77%, fidelidad/ retención 93%, satisfacción 75%, ambiente organizativo 88%, bienestar 100%, perspectiva del proceso: análisis microbiológico 100%, auditoría interna 100%, productividad 100%, evaluación nutricional 81%, soporte nutricional 100%, indicación de atención domiciliaria 94%, visitas s domicilio 98%, perspectiva del cliente: percepción de la compañía 97%, priorización 94%, retención 59%, insatisfacción 24%, logística 94%, servicio

  19. Prevalence of renal disease in elderly hypertensive patients with cardiovascular problems.

    PubMed

    Ruilope, L M

    1997-01-01

    Renal vascular damage caused by arterial hypertension participates in the alterations to systemic vascular function and structure. Nephrosclerosis seems to run in parallel with systemic atherosclerosis, which accounts for the increased cardiovascular morbidity and mortality seen in hypertensive patients. Parameters indicating the existence of an alteration in renal function (increased serum creatinine, proteinuria and microalbuminuria) are independent predictors for an increased cardiovascular morbidity and mortality. Hence, parameters of renal function have to be considered in any stratification of cardiovascular risk in hypertensive patients.

  20. Renal implications of arterial hypertension.

    PubMed

    Ruilope, L M

    1997-03-01

    Renal vascular damage caused by arterial hypertension participates in alterations of the systemic vascular function and structure. Nephrosclerosis seems to run in parallel with the systemic atherosclerosis that accounts for the increased cardiovascular morbidity and mortality seen in hypertensive patients. Parameters indicating the existence of an alteration in renal function (increased serum creatinine, proteinuria and microalbuminuria) are independent predictors for an increased cardiovascular morbidity and mortality. Hence, parameters of renal function must be considered in any stratification of cardiovascular risk in hypertensive patients.

  1. PREVALENCE OF METABOLIC SYNDROME IN YOUNG MEXICANS: A SENSITIVITY ANALYSIS ON ITS COMPONENTS.

    PubMed

    Murguía-Romero, Miguel; Jiménez-Flores, J Rafael; Sigrist-Flores, Santiago C; Tapia-Pancardo, Diana C; Jiménez-Ramos, Arnulfo; Méndez-Cruz, A René; Villalobos-Molina, Rafael

    2015-07-28

    Introducción: la obesidad es una epidemia mundial y la alta prevalencia de diabetes tipo II (DM2) y de enfermedad cardiovascular (ECV) es, en gran parte, consecuencia de esta epidemia. El síndrome metabólico (SMet) es una herramienta útil para estimar el riesgo de que una población de jóvenes evolucione a DM2 y ECV. Objetivo: estimar la prevalencia del SMet en jóvenes mexicanos, y evaluar cada parámetro como un indicador independiente mediante análisis de sensibilidad. Métodos: se estimó la prevalencia del SMet en 6.063 jóvenes del área metropolitana de Ciudad de México. Se realizó un análisis de sensibilidad para estimar la eficiencia de cada uno de los componentes del SMet como un indicador de la presencia del mismo SMet. Se calcularon cinco estadísticos del análisis de sensibilidad para cada uno de los componentes del SMet y otros parámetros, incluidos: sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión. Resultados: la prevalencia del SMet en la población de jóvenes mexicanos se estimó en 13.4%. La circunferencia de la cintura presentó la sensibilidad más alta (96.8% mujeres; 90.0% hombres); en las mujeres, la presión arterial presentó la más alta especificidad (97.7%) y en los hombres la glucosa (91.0%). Cuando se consideran los cinco estadísticos, los triglicéridos son el componente con los valores más altos, con valores del 75% o mayores para cuatro de estos. En los jóvenes sin alteraciones se detecta diferencia entre sexos para los promedios de todos los componentes del SMet. Conclusiones: los jóvenes mexicanos son altamente propensos a adquirir SMet: el 71% tiene cuando menos uno y hasta cinco parámetros del SMet alterados, y el 13.4% de ellos tiene SMet. De los cinco componentes del SMet, la circunferencia de la cintura presentó la más alta sensibilidad como predictor del SMet, y los triglicéridos es el mejor parámetro predictor en jóvenes mexicanos si solo se considera un

  2. Neutrophil Gelatinase-Associated Lipocalin as an Early Sign of Diabetic Kidney Injury in Children

    PubMed Central

    Yürük Yıldırım, Zeynep; Nayır, Ahmet; Yılmaz, Alev; Gedikbaşı, Asuman; Bundak, Rüveyde

    2015-01-01

    Objective: There is some evidence indicating that histopathological changes in type 1 diabetes mellitus (T1DM) emerge before onset of microalbuminuria. The aim of our study was to determine whether urine neutrophil gelatinase-associated lipocalin (NGAL) levels can be considered as an early sign of diabetic kidney injury. Methods: Urine NGAL (uNGAL) levels and urinary NGAL/creatinine ratio (uNGAL/Cr) were assessed in 76 patients with T1DM and compared with the findings of 35 healthy individuals. The relationship of uNGAL levels with diabetes duration, body mass index (BMI), serum lipids, HbA1c, and microalbuminuria was also evaluated. Results: Mean uNGAL (100.16±108.28 ng/mL) and uNGAL/Cr (118.93-117.97 ng/mg) levels in both microalbuminuric and non-microalbuminuric diabetic patients were found to be higher than those in the control group (uNGAL: 21.46±18.59 ng/mL and uNGAL/Cr: 32.1±51.48 ng/mg) (p=0.0001). Conclusion: Urine NGAL level increases in the very early phase of T1DM before microalbuminuria develops. The patients with T1DM should be considered to have diabetic kidney injury from the time of diagnosis on and preventive interventions need to be initiated at an early stage to preclude the progression to end-stage renal disease. PMID:26777038

  3. Why 24-h Urine Albumin Excretion Rate Method Still is Used for Screening of Diabetic Nephropathy in Isfahan Laboratories?

    PubMed Central

    Teimoury, Azam; Iraj, Bijan; Heidari-Beni, Motahar; Amini, Massoud; Hosseiny, Seyed-Mohsen

    2014-01-01

    Background: The first step in diagnosis of diabetic nephropathy is measurement of albumin in a spot urine sample. The aim of this study was assessment of the accuracy of urinary albumin to creatinine ratio (UACR) in random urine specimens (RUS) for microalbuminuria and macroalbuminuria screening in Iranian diabetic patients. Methods: A total of 200 diabetic patients participated to our study. 24 h timed urine specimens followed by RUS were collected. 24-h urine albumin excretion (24-h urinary albumin excretion (UAE)) and UACR in RUS were measured. Data were analyzed by Pearson's correlation, receiver operating characteristic (ROC) curve and McNemar test. Results: A total of 165 patients finalized the study. Pearson's correlation of coefficient for 24-h UAE versus UACR was 0.64. The area under ROC curve for UACR was 0.83 in microalbuminuria and 0.91 in macroalbuminuria. The cutoff point of 30 mg/g in UACR method had 86% sensitivity and 60% specificity for microalbuminuria screening and cut-off point of 300 mg/g had 75% sensitivity and 99% specificity for macroalbuminuria screening respectively. Conclusions: UACR in RUS showed acceptable performance as a screening test for diagnosis of both micro and macroalbuminuria in Iranian diabetic patients. PMID:24829719

  4. Kidney Function in Severely Obese Adolescents Undergoing Bariatric Surgery

    PubMed Central

    Xiao, Nianzhou; Jenkins, Todd M; Nehus, Edward; Inge, Thomas H; Michalsky, Marc P; Harmon, Carroll M.; Helmrath, Michael A.; Brandt, Mary L.; Courcoulas, Anita; Moxey-Mims, Marva; Mitsnefes, Mark M

    2014-01-01

    Objective To describe objective measures of kidney function and analyze factors associated with kidney dysfunction in severely obese adolescents undergoing weight loss surgery. Design and Methods We analyzed cross-sectional data from 242 adolescent participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study before weight loss surgery. Kidney status was assessed by measuring urine albumin creatinine ratio to determine microalbuminuria and by calculating serum cystatin C-based estimated glomerular filtration rate (eGFR) to assess kidney function. Results Mean age and median body mass index (BMI) were 17.1 years and 50.5kg/m2, respectively; 76% were females and 65% were non-Hispanic white race. Fourteen percent of the cohort had microalbuminuria, and 3% had macroalbuminuria; 3% had eGFR <60 ml/min/1.73m2, and 7.1% had eGFR >150 ml/min/1.73m2. In adjusted analyses, female gender and increasing ferritin levels were significantly associated with the presence of microalbuminuria/macroalbuminuria. Increasing BMI and HOMA-IR values were significantly associated with lower eGFR. Conclusions A significant number of severely obese adolescents undergoing weight loss surgery have evidence of early kidney dysfunction. Longitudinal studies following weight loss surgery in these individuals are needed to determine whether these kidney abnormalities are reversible following weight loss therapy. PMID:25376399

  5. Prospects for Renovascular Protection by More Aggressive Renin-Angiotensin System Control

    PubMed Central

    Ruilope, Luis Miguel

    2008-01-01

    Risk factors such as hypertension or diabetes result in a continuum of renal damage. Without intervention, initial subclinical endothelial damage progresses to incipient disease, identified by microalbuminuria. Glomerular filtration rate declines, macroalbuminuria develops, and eventually end-stage renal disease (ESRD) emerges. Because of the interrelationship between cardiovascular and renal disease and their common pathophysiologies involving angiotensin II, many patients die of cardiovascular disease before renal replacement therapy is needed. Blood pressure control is key to renoprotection, but blood pressure-independent mechanisms are also implicated. Targeting the renin-angiotensin system (RAS) using angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin receptor blockers (ARBs) is a logical approach to managing all at-risk patients. In advanced nephropathy, therapy aims at retarding progression to ESRD. For incipient nephropathy, ideal therapy should bring about microalbuminuria regression. In patients at risk of renal damage, preventing early target-organ damage is essential. Although evidence of ACE inhibitor benefit is limited, data show that ARBs provide renoprotection throughout the continuum and that this may be related to their cardioprotective effects. More aggressive RAS targeting by combination blockade is under investigation. Telmisartan is an ARB that delays progression of incipient and overt diabetic nephropathy and brings about regression from microalbuminuria to normoalbuminuria in hypertensive and normotensive patients. The ultimate proof of benefit will come from the ONTARGET trial, which will evaluate the cardiovascular and renal protective effects of the combination of telmisartan and ramipril. PMID:18449382

  6. Five-year treatment of chronic venous insufficiency with O-(β-hydroxyethyl)-rutosides: Safety aspects

    PubMed Central

    Stuard, S; Cesarone, Maria Rosaria; Belcaro, Gianni; Dugall, Mark; Ledda, Andrea; Cacchio, Marisa; Ricci, Andrea; Ippolito, Edmondo; Di Renzo, Andrea; Grossi, Maria Giovanna

    2008-01-01

    Chronic venous insufficiency (CVI), and related signs and symptoms of venous and diabetic microangiopathy, can be effectively treated with O-(β-hydroxyethyl)-rutosides (HR). The aim of the present independent registry study was to evaluate HR in a long-term (five-year) period of administration that examined the tolerability and safety of HR. Patients with severe CVI and venous microangiopathy were included in the registry. Subjects who completed five years of treatment were considered in the analysis. Blood parameters, liver and renal function tests, microalbuminuria (in diabetic patients) and cholesterol levels were evaluated to assess the effects of HR treatment. Four groups were studied – group A (98 patients) received oral HR (1500 mg per day), group B (87 diabetic patients with CVI) was treated with 2 g of HR per day, group C (90 controls, including 42 diabetic patients) had no pharmacological treatment and group D (113 patients, including 48 diabetic patients) used elastic stockings. No significant negative changes in blood parameters were recorded at two and five years. Decreases in microalbuminuria and total cholesterol, and an increase in high-density lipoprotein cholesterol were observed in HR-treated patients, particularly in diabetic patients. Minimal (nonsignificant) variations were observed in the groups that did not use HR. In conclusion, HR treatment is safe, and some positive effects from HR on cholesterol levels and microalbuminuria (in diabetic patients) that were previously observed may suggest potential new clinical applications. PMID:22477419

  7. Tips for Parents on Keeping Children Drug Free = Consejos para Los Padres Sobre Como Mantener a Los Hijos Libres de La Droga.

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC. Office of Intergovernmental and Interagency Affairs.

    Research shows that recent trends in youth drug use have stabilized; however, the rates of use remain at high levels. It has been shown that the earlier drug use is initiated, the more likely a person is to develop drug problems later in life. Youth substance abuse may lead to many other problems that affect not only the child, but also the…

  8. Building Your Baby's Brain: A Parent's Guide to the First Five Years = Como estimular el cerebro infantil: Una guia para padres de familia.

    ERIC Educational Resources Information Center

    Dodge, Diane Trister; Heroman, Cate

    Noting that all parents can help their baby's brain to grow, this guide, in English- and Spanish-language versions, explores what science has learned about infant brain development and how parents and caregivers can influence cognitive development. Topics covered include: prenatal care, touching your baby, teaching about feelings and self-control,…

  9. Uso de exámenes de detección como oportunidad para ayudar a fumadores a dejar el tabaco

    Cancer.gov

    El NCI ha publicado un anuncio de financiamiento para ayudar a estimular la investigación sobre métodos óptimos para dejar de fumar cigarrillos que se entreguen junto con los exámenes de detección.

  10. Structural and kinetic study of CoMo/. gamma. Al/sub 2/O/sub 3/ hydrodesulfurization catalyst using EXAFS and XANES

    SciTech Connect

    Parham, T.G.

    1983-01-01

    In situ Extended X-ray Absorption Fine Structure (EXAFS) and X-ray Absorption Near Edge (XANES) spectroscopies were combined in a study designed to elucidate the molecular structure of molybdenum in CoMo/..gamma..Al/sub 2/O/sub 3/ hydrodesulfurization catalysts. This structure was related to catalytic activity using a model thiophene hydrodesulfurization reaction. Oxide CoMo/..gamma..Al/sub 2/O/sub 3/ was found to consist of tetrahedrally coordinated molybdenum with two or three short Mo = O bonds and one or two oxide ligands with longer Mo-O distances. The catalyst reacts with H/sub 2/S at 25 C with terminal Mo = O species being replaced by sulfur ligands. As the sulfiding temperature is increased, oxysulfides are replaced with a MoS/sub 2/-like phase. No evidence was found of oxysulfides at sulfiding temperatures in excess of 200 C. The first shell sulfur and second shell molybdenum coordination numbers were observed to increase linearly with sulfiding temperature, as was the present MoS/sub 2/-like phase. The MoS/sub 2/-like phase is remarkably similar to MoS/sub 2/, but has a Mo-S coordination number of only four. The second shell coordination is also lower, with only three molybdenum neighbors at 3.16 A. Sulfiding is about 90% complete after two hours at 400 C, with only minor change after 24 hours of sulfiding. This information is consistent with a structural model consisting of small MoS/sub 2/ crystallites of c.a. 10 A if the perimeter molybdenums are considered to have lost labile sulfur. Kinetic EXAFS, XANES and sulfur uptake measurements were made in situ during catalyst sulfiding and HDS. These measurements showed that at high temperature (400 C) the rate of sulfur adsorption onto the catalyst limits the rate of reaction between surface sulfur and molybdenum.

  11. Alumina supported Co-Mo oxides as a catalyst for hydrodesulphurisation of organic sulfides and disulphides using stopped flow gas chromatography

    SciTech Connect

    Ali, L.H.; Sulaiman, S.T.; AlTamer, M.Y. )

    1989-01-01

    The authors present a model study on the hydrodesulphurization of dimethyl sulphide, di n-prophyl sulphide, di n-butyl sulphide and dimethyl disulphide on Co-Mo-Al/sub 2/O/sub 3/ surface conducted using stopped-flow chromatographic technique. The plots for the rates of hydrocarbon formation agree well with the first order reaction at the surface of the catalyst.

  12. The Nature of Recognition in TEFL Teachers' Lives (La naturaleza del reconocimiento en la vida de los maestros de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Scholes Gillingsde González, Barbara

    2011-01-01

    This article aims at sharing a vital issue that emerged from the findings of a qualitative research study into collective responses of teachers of English as a foreign language to an extended change process in their Mexican university context from 1989 to 2003. The data generation process employed was comprised of semi-structured interviews as…

  13. "O Ensaio como Forma" ou Um Ensaio acerca da Teoria Critica da Sociedade ("The Essay as Form" or An Essay about the Critical Theory of Society).

    ERIC Educational Resources Information Center

    Giordano, Rosely

    2000-01-01

    Illuminates the critical theory project, with themes permeating the theoretical constructions of Frankfurt (Germany). Debates the predominance of positivism in the production of knowledge. Speculates that "the essay as form" constitutes itself as a representation of the concept of the Enlightenment. Concludes with a dialogue between Theodor Adorno…

  14. The Accented EFL Teacher: Classroom Implications (El acento del profesor de inglés como lengua extranjera: implicaciones pedagógicas)

    ERIC Educational Resources Information Center

    Arboleda Arboleda, Argemiro; Castro Garcés, Ángela Yicely

    2012-01-01

    This article reports the findings of a research study on how significant having a foreign accent is for non-native English as a foreign language teachers and learners at university level. It points out the perceptions that teachers and students have about the most relevant issues in the teaching and learning processes. Data were collected by means…

  15. Interculturalidad y anglofonia en la ensenanza del ingles como lengua extranjera (Interculturalism and Anglophone Studies in the Teaching of English as a Foreign Language).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee; Revilla, Teresa Flores

    This article, written in Spanish, proposes to incorporate the subject "Anglophonism" into the curriculum of English as a Foreign Language (EILE) with a view to providing universities with an intercultural division. It provides a brief summary of John Dewey's philosophy with regard to anthropology, politics, and education. It explains the term…

  16. La anglofonia y literaturas poscoloniales en la ensenanza de ingles como lengua extranjera (Anglophonism and Postcolonial Literature in Teaching English as a Second Language).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper, written in Spanish, focuses on the instruction of English as a Second Language in the context of cultural understanding, rather than from a purely linguistic point of view. It argues that foreign language instruction should include lessons in the field of sociology, anthropology, history, geography, politics, the arts, and popular…

  17. Planeamiento de la unidad didactica en le ensenanza del ingles como idioma extranjero (Planning the Teaching Unit in the Instruction of English as a Foreign Language).

    ERIC Educational Resources Information Center

    Medina T., Rene

    1971-01-01

    This paper discusses the use of the teaching unit as a means for organization in English-as-a-foreign-language classes. It lists the essential elements in the construction of such a unit: cultural topic, linguistic elements, time period, main objectives, instructional materials, focus, specific activities, intended results, evaluation techniques,…

  18. Air pollution positively correlates with daily stroke admission and in hospital mortality: a study in the urban area of Como, Italy.

    PubMed

    Vidale, Simone; Bonanomi, A; Guidotti, M; Arnaboldi, M; Sterzi, R

    2010-04-01

    Some current evidences suggest that stroke incidence and mortality may be higher in elevated air pollution areas. Our study examined the hypothesis of a correlation between air pollution level and ischemic stroke admission and in Hospital mortality in an urban population. Data on a total of 759 stroke admissions and 180 deaths have been obtained over a 4-year period (2000-2003). Five air ambient particles have been studied. A general additive model estimating Poisson distribution has been used, adding meteorological variables as covariates. NO(2) and PM(10) were significantly associated with admission and mortality (P value < 0.05) and with estimated RR of 1.039 (95% CI 1.066-1.013) and 1.078 (95% CI 1.104-1.052) for hospital admission at 2- and 4-day lags, respectively. In conclusion, this study suggests an association between short-term outdoor air pollution exposure and ischemic stroke admission and mortality.

  19. Sound in ecclesiastical spaces in Cordoba. Architectural projects incorporating acoustic methodology (El sonido del espacio eclesial en Cordoba. El proyecto arquitectonico como procedimiento acustico)

    NASA Astrophysics Data System (ADS)

    Suarez, Rafael

    2003-11-01

    This thesis is concerned with the acoustic analysis of ecclesiastical spaces, and the subsequent implementation of acoustic design methodology in architectural renovations. One begins with an adequate architectural design of specific elements (shape, materials, and textures), with the intention of elimination of acoustic deficiencies that are common in such spaces. These are those deficiencies that impair good speech intelligibility and good musical audibility. The investigation is limited to churches in the province of Cordoba and to churches built after the reconquest of Spain (1236) and up until the 18th century. Selected churches are those that have undergone architectural renovations to adapt them to new uses or to make them more suitable for liturgical use. The thesis attempts to summarize the acoustic analyses and the acoustical solutions that have been implemented. The results are presented in a manner that should be useful for the adoption of a model for the functional renovation of ecclesiastical spaces. Such would allow those involved in architectural projects to specify the nature of the sound, even though somewhat intangible, within the ecclesiastical space. Thesis advisors: Jaime Navarro and Juan J. Sendra Copies of this thesis written in Spanish may be obtained by contacting the advisor, Jaime Navarro, E.T.S. de Arquitectura de Sevilla, Dpto. de Construcciones Arquitectonicas I, Av. Reina Mercedes, 2, 41012 Sevilla, Spain. E-mail address: jnavarro@us.es

  20. Un currículo interdisciplinario de base teórica para enseñar inglés como segunda lengua1

    PubMed Central

    Fuentes, Brenda O.; Mas, Francisco Soto; Mein, Erika; Jacobson, Holly E.

    2013-01-01

    Among Hispanic immigrants in the United States (US), learning English is considered necessary for economic and social achievement. As a consequence, there is a high demand for English as a Second Language (ESL) classes. Despite the recognized benefits of ESL programs, both at the individual and social levels, more research is needed to identify education strategies that effectively promote all aspects of learning English as a second language. This article describes an ESL curriculum that incorporates a theory-based pedagogical approach specifically designed for immigrant Hispanic adults on the US-Mexico border region. The article also describes the implementation of the curriculum as well as the results of the evaluation, which was conducted using both quantitative and qualitative methods. Quantitative results indicate that the participants significantly improved their English proficiency (L2). Qualitative results suggest that participants were positively impacted by both the content and pedagogical approaches used by the curriculum. Their experience with the ESL class was positive in general. It can be concluded that the curriculum achieved its objective. This approach could serve as a model for second language teaching for adults. PMID:25284915

  1. "Como Se Dice HIV?" Adapting Human Immunodeficiency Virus Prevention Messages to Reach Homosexual and Bisexual Hispanic Men: The Importance of Hispanic Cultural and Health Beliefs.

    ERIC Educational Resources Information Center

    Bowdy, Matthew A.

    HIV/AIDS prevention messages catered to Anglo homosexual/bisexual men are not effective in teaching preventative behaviors to Hispanic homosexual/bisexual men. Hispanic sociocultural traits associated with homosexuality and bisexuality prevent the effectiveness of these messages. The Hispanic family is also extremely important in influencing…

  2. Geographic Displacement as Spiritual Desolation in Puerto Rican and Chicano Prose Fiction = La Desolacion Espiritual como Resultado del Desplazamiento Geografico en la Prosa Ficcion Puertorriqueno y Chicana.

    ERIC Educational Resources Information Center

    Tatum, Charles

    Geographic displacement as spiritual desolation is a theme that bonds Puerto Rican and Chicano literature. The movement of masses of people to the United States and within the United States itself has had and continues to have severe consequences for the Latino population in this country. Two novels, "Down These Mean Streets" by Piri Thomas and…

  3. Como los padres ocupados pueden ayudar a sus hijos a aprender y desarrollarse (How Busy Parents Can Help Their Children Learn and Develop). Early Childhood Digest.

    ERIC Educational Resources Information Center

    Mayer, Ellen; Kreider, Holly; Vaughan, Peggy

    Although parents are often very busy with work and family responsibilities, there are many things they can do to help their school-age children learn and develop. This Spanish-language early childhood digest for parents provides tips obtained from parents of first and second graders in the School Transition Study on creative ways to stay involved…

  4. Como evalvar la actuacion del profesor en una clase de segundo idioma (How to Evaluate a Teacher in a Second Language Classroom).

    ERIC Educational Resources Information Center

    Galvez de Bracamonte, Teresa

    This guide in Spanish provides performance criteria for evaluating the foreign language teacher. It provides an outline for analyzing the teacher's actions and teaching methods in the classroom. Through the evaluation by an outsider, the teacher can learn his or her faults in the views of others and can improve on them. The aspects to be analyzed…

  5. The Why, What, and How of a Bilingual Approach for Young Children [and] El Porque, el Cual y el Como de un Enfoque Bilingue para Ninos Preescolares.

    ERIC Educational Resources Information Center

    Flores, Alfredo R.; Riley, Mary Tom

    This guide, in parallel English and Spanish volumes, provides information necessary for implementing bilingual/multicultural programs. Section 1 defines and describes the bilingual approach, examining instructional goals, rationale, philosophical justification, legal foundations, and practical considerations. Section 2 discusses attitudinal…

  6. Creacion de un programa de ensenanza de espanol como segunda lengua para ninos de edad prescolar (Creating a Spanish as a Second Language Program for Preschool Children).

    ERIC Educational Resources Information Center

    Rosenbusch, Marcia H.

    1987-01-01

    Presents suggestions for planning a Spanish as a second language program for preschool children. The rationale and means of implementing the program are considered, and guidelines for teaching vocabulary are discussed. A variety of classroom activities are also presented. (TR)

  7. Como Lo Hago Yo: Anomalías del Tubo Neural en Guatemala — Mielomeningocele Unidad de Espina Bífida e Hidrocefalia

    PubMed Central

    Manucci, Graciela; von Quednow, Enzo

    2014-01-01

    En Guatemala nacen por añ 786 niños con defectos de tubo neural. Operamos 65 a 70 niños con mielomenigocele por año. Tenemos equipo multidisciplinario. Recomendamos parto por cesárea. Infección antes de la cirugía es un problema mayor. Derivación tardía es un problema. Disecamos la plaqueta con la técnica clásica. Suturamos la plaqueta para restituir la forma de la médula. Corpectomía en casos de cifósis. Hidrocefalía: Operamos el 80% de los niños. Chiari II: Operamos basados en los síntomas, primero nos aseguramos que la válvula funciona bien. Médula anclada: Operamos basados en los síntomas. PMID:24791216

  8. Finding an Appropriate Preschool for Your Child with Special Needs = Como Encontrar un Programa Pre-escolar para su nino con desabilidades.

    ERIC Educational Resources Information Center

    Bernstein, Sandra; Wonderlick, Mary; Madden, Drina

    This booklet, with English and Spanish versions, provides a step-by-step procedure to help families find an appropriate preschool program in the community for their child with disabilities. The booklet lists six steps for locating a program: (1) decide what kind of program is wanted for the child; (2) complete included form outlining child's needs…

  9. Estudio de NIH indica que la actividad física en tiempo libre alarga la vida tanto como 4,5 años

    Cancer.gov

    La actividad física en tiempo libre está asociada con una expectativa de vida más larga, aun en un grado de actividad relativamente bajo e independientemente del peso corporal, de acuerdo con un estudio llevado a cabo por un equipo de investigadores del I

  10. Prevalence of sarcopenia among community‐dwelling elderly of a medium‐sized South American city: results of the COMO VAI? study

    PubMed Central

    Bielemann, Renata M.; Gonzalez, Maria Cristina; Menezes, Ana Maria B.

    2015-01-01

    Abstract Background There is insufficient data concerning sarcopenia prevalence in South America. The aim of this study was to estimate sarcopenia prevalence and its clinical subgroups in a Southern Brazilian city. Methods A cross‐sectional population‐based study was performed among community‐dwelling elderly aged 60 years or over. Subjects were evaluated according to the European Working Group on Sarcopenia in Older People established criteria. Muscle mass was estimated by calf circumference (CC). Cut‐off CC points were defined by a subsample's dual X‐ray absorptiometry estimation of the appendicular skeletal muscle mass index (ASMI), which was subsequently compared with the values of a young adult population from the same city. Muscle strength was measured by manual dynamometry. Muscle performance was assessed through the 4 m gait speed test. Results The three diagnostic tests were performed in 1291 subjects. CC of ≤34 cm (males) and ≤33 cm (females) were defined as indicatives of low ASMI. The overall sarcopenia prevalence was 13.9% (CI95% 12.0; 15.8%). Its frequency was significantly higher among elderly with low schooling, without a partner, with low socioeconomic status, smokers, inactive, and with low body mass index. A higher prevalence of pre‐sarcopenia was found in the youngest elderly; a higher prevalence of the clinical stages of the syndrome was found in older age groups. Conclusions Approximately one in ten elderly aged 60–69 years was in the preclinical stage of the disease. This is the age group in which public policies should focus to establish early diagnosis and prevent clinical progression of the syndrome. PMID:27493867

  11. Emotions as Learning Enhancers of Foreign Language Learning Motivation (Las emociones como potenciadoras de la motivación en el aprendizaje de una lengua extranjera)

    ERIC Educational Resources Information Center

    Méndez López, Mariza G.; Peña Aguilar, Argelia

    2013-01-01

    The present article reports on a study that explores the effects of the emotional experiences of Mexican language learners on their motivation to learn English. In this qualitative research we present how emotions impact the motivation of university language learners in south Mexico. Results suggest that emotions, both negative and positive,…

  12. Como Comunicarse con la Escuela a Traves de la Correspondencia: Guia para Padres (How To Communicate with the School through Letterwriting: A Parent's Guide).

    ERIC Educational Resources Information Center

    Ferguson, Susan; Ripley, Suzanne

    This guide is intended to help parents understand how a child becomes eligible for special education and related services and how to use letter writing to effectively communicate with the school when necessary. Initial information is presented in question-and-answer format and letters to request services. Sample letters are offered for the parent…

  13. Metodo de Archivar las Observaciones del Comportamiento del Nino, Como Guia para Entenderlo Mejor (Methods of Recording Observations of Children's Behavior, A Guide for Better Understanding)

    ERIC Educational Resources Information Center

    Stamp, Isla M.

    1971-01-01

    Copies of the Behaviour Study Technique described in this article may be obtained in English from the Australian Council for Educational Research, Frederick St., Hawthorn, Victoria, Australia 3122. (RY)

  14. "Mastery Learning" Como Metodo Psicoeducativo para Ninos con Problemas Especificos de Aprendizaje. ("Mastery Learning" as a Psychoeducational Method for Children with Specific Learning Problems.)

    ERIC Educational Resources Information Center

    Coya, Liliam de Barbosa; Perez-Coffie, Jorge

    1982-01-01

    "Mastery Learning" was compared with the "conventional" method of teaching reading skills to Puerto Rican children with specific learning disabilities. The "Mastery Learning" group showed significant gains in the cognitive and affective domains. Results suggested Mastery Learning is a more effective method of teaching reading skills to children…

  15. Collaborative Work as an Alternative for Writing Research Articles (El trabajo colaborativo como alternativa para la escritura de artículos investigativos)

    ERIC Educational Resources Information Center

    Carvajal Medina, Nancy Emilce; Roberto Flórez, Eliana Edith

    2014-01-01

    Academic writing in English in our context is a significant aspect that can be innovative when a convergence model of writing stages is used along with collaborative work. This article reports on a study aimed at analyzing how collaborative work relates to undergraduate electronics students' academic writing development in English as a foreign…

  16. La Imagen Publica y Professional del Espanol en Yanquilandia - y Como Mejorarla (The Public and Professional Image of Spanish in "Yankee-Land" and How to Improve It).

    ERIC Educational Resources Information Center

    Mead, Robert G., Jr.

    1981-01-01

    Decries the stereotypes and prejudices that affect U. S. relations with the Hispanic world and with its own Hispanic minorities. Points out that these attitudes also affect the study of Spanish as a foreign language and suggests means by which educators can improve the Hispanic image among Anglo Americans. (MES)

  17. Cidadania Negada: A Educacao como Instrumento de Combate a Pobreza no Brasil (Denial of Citizenship: Education as a Way to Fight Poverty in Brazil).

    ERIC Educational Resources Information Center

    Germano, Jose Willington

    1995-01-01

    Compares two compensatory social/educational programs developed by the Brazilian government in the last 15 years. States that although one was formulated during the military regime and one during the present government, they both combat poverty and encourage privatization. Concludes that this promotes a process that sees education as social…

  18. La efectividad de la educacion a distancia como metodologia en la desarrollo de destrezas de pensamiento (Effectiveness of Distance Education as a Methodology for Developing Thinking Skills).

    ERIC Educational Resources Information Center

    Melendez Alicea, Juan

    1992-01-01

    Presents steps taken in designing, justifying, and implementing an experimental study designed to investigate the effectiveness of distance education as a methodology for developing thinking skills. A discussion reviews major findings of the study by comparing student experiences from multimedia distance education and student experiences from…

  19. Como Puede Mejorar el Programa de Educacion Migrante con el Poder e Influencia de los Padres. Parent Power in the Migrant Education Program: How to Make a Difference.

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC.

    The bilingual (English-Spanish) handbook explains the established rights that parents with children enrolled in the Elementary and Secondary Education Act Title I Migrant Education Program have and presents ways in which parents can use these rights to help ensure that their children receive a quality education. Chapters discuss: (1) content of…

  20. How To Talk to Your Teens and Children about AIDS = Como hablar con sus adolescentes y sus ninos sobre el SIDA.

    ERIC Educational Resources Information Center

    National PTA, Chicago, IL.

    Two brochures, one in English and one in Spanish, provide parents with basic information that will enable them to educate their children about Acquired Immune Deficiency Syndrome (AIDS). Contents address 11 questions: (1) What is AIDS? (2) How do you get AIDS? (3) How is AIDS not spread? (4) Who can get AIDS? (5) How can you tell if someone has…

  1. [Not Available].

    PubMed

    Perales-García, Aránzazu; Estévez-Martínez, Isabel; Urrialde, Rafael

    2016-07-12

    Introducción: la hidratación se define como el aporte de agua proveniente de alimentos y bebidas. Su estudio constituye desde hace unos años un área en sí misma dentro de la nutrición, que ha supuesto que en 2010 la European Food Safety Authority (EFSA) aprobara las recomendaciones de ingesta de agua; pero el estudio del estado de hidratación implica un elevado nivel metodológico que presenta ciertos desafíos. Objetivo: ofrecer una visión general de los principales problemas metodológicos en estudios sobre el estado de hidratación. Material y métodos: revisión de la bibliografía científica existente. Resultados: los principales problemas metodológicos presentes son: selección de la muestra (ámbito de investigación y diseño muestral), selección del método de evaluación del estado de hidratación (técnicas de dilución, impedancia bioeléctrica, indicadores plasmáticos y urinarios, cambios en la composición corporal, pérdidas de agua y síntomas clínicos), selección del método de valoración de la ingesta de agua (biomarcadores, cuestionarios, programas informáticos, uso de smartphones, registro 24 h, historia dietética y frecuencia de consumo de alimentos), así como sus principales fuentes dietéticas. Conclusiones: el estado de hidratación debe ser entendido como un modelo rutinario, de frecuencia diaria y variable en función de la edad, sexo, actividad física y condiciones ambientales; por todo ello es de especial importancia un correcto diseño metodológico capaz de recoger estos matices.

  2. [Risk management at an Intensive Care Department: conciliation of medication].

    PubMed

    Becerril Moreno, F; Bustamante Munguira, E; García Verdejo, J A; Bartual Lobato, E; Ros Martínez, M; Merino de Cós, P

    2013-01-01

    Objetivo: Explicar el proceso de implantación de la conciliación de la medicación como medida dentro de un plan de gestión de riesgos en un servicio de Medicina Intensiva. Método: Para la realización del plan de gestión de riesgos se creó un equipo de trabajo multidisciplinar. Se realizaron reuniones de trabajo durante los meses de enero a diciembre de 2011. El desarrollo del plan de gestión de riesgos se realizó en fases sucesivas: identificación de los riesgos potenciales, análisis y evaluación, tratamiento, despliegue, implementación, seguimiento y revisión. Resultados: Se identificaron un total de 17 riesgos potenciales, de los cuales se analizaron y trataron aquellos con mayor puntuación otorgada por el grupo de trabajo, entre ellos los errores de conciliación. Para el tratamiento de este riesgo se propuso como medida la conciliación de la medicación donde el farmacéutico se responsabilizó de su implementación. Asimismo, se responsabilizó del proceso de seguimiento y revisión de esta medida, para asegurar su eficacia, mediante el diseño de indicadores que permitiesen una monitorización periódica. Conclusiones: La implantación de un plan de gestión de riesgos clínicos es promover la reducción de errores y, consecuentemente, apostar por una mejora en la seguridad del paciente. La integración del farmacéutico en los servicios de Medicina Intensiva contribuye a la consecución de este objetivo, y por ello debemos aceptar nuestra responsabilidad en la implantación de medidas que vayan en esta línea como puede ser la conciliación de la medicación.

  3. [Not Available].

    PubMed

    Perales-García, Aránzazu; Estévez-Martínez, Isabel; Urrialde, Rafael

    2016-01-01

    Introducción: la hidratación se define como el aporte de agua proveniente de alimentos y bebidas. Su estudio constituye desde hace unos años un área en sí misma dentro de la nutrición, que ha supuesto que en 2010 la European Food Safety Authority (EFSA) aprobara las recomendaciones de ingesta de agua; pero el estudio del estado de hidratación implica un elevado nivel metodológico que presenta ciertos desafíos. Objetivo: ofrecer una visión general de los principales problemas metodológicos en estudios sobre el estado de hidratación. Material y métodos: revisión de la bibliografía científica existente. Resultados: los principales problemas metodológicos presentes son: selección de la muestra (ámbito de investigación y diseño muestral), selección del método de evaluación del estado de hidratación (técnicas de dilución, impedancia bioeléctrica, indicadores plasmáticos y urinarios, cambios en la composición corporal, pérdidas de agua y síntomas clínicos), selección del método de valoración de la ingesta de agua (biomarcadores, cuestionarios, programas informáticos, uso de smartphones, registro 24 h, historia dietética y frecuencia de consumo de alimentos), así como sus principales fuentes dietéticas. Conclusiones: el estado de hidratación debe ser entendido como un modelo rutinario, de frecuencia diaria y variable en función de la edad, sexo, actividad física y condiciones ambientales; por todo ello es de especial importancia un correcto diseño metodológico capaz de recoger estos matices. PMID:27571857

  4. [Electrolytes content in parenteral drugs authorised in Spain].

    PubMed

    Mirchandani Jagwani, J N; Arias Rico, R

    2013-01-01

    Introducción: La fluidoterapia es una de las prácticas más habituales en la práctica clínica diaria pero para un correcto manejo de electrolitos tanto en la sueroterapia como en la Nutrición Parenteral se deben conocer todos los aportes de electrolitos y fluidos y todas aquellas situaciones fisiopatológicos que conllevan alteraciones en la homeostasis de fluidos. Objetivos: Conocer el contenido y tipo de electrolitos de los medicamentos administrados por vía parenteral comercializados y autorizados en España hasta Febrero 2012. Métodos: Revisión de todas las fichas técnicas de todos aquellos medicamentos que estuvieran comercializados en España y con presentación comercial disponible por vía parenteral. Aquellos medicamentos con un contenido menor de 1 miliequivalente o 1 milimol por presentación comercial fueron excluidos. Resultados: De los 1800 principios activos estudiados, sólo 221 formaban parte de alguna presentación comercial por vía parenteral. De estos 221, 52 principios activos cumplían los criterios de inclusión del estudio y la mayoría (51-98,07%) tenían sodio en contenido mayor de un miliequivalente por presentación comercial, luego el potasio estaba presente en 3 y el calcio únicamente en uno. Discusión: La mayoría de medicamentos objeto del estudio contenían como principal electrolito el sodio, siendo la alteración de las concentraciones de este electrolito una de las más frecuentes en el entorno hospitalario y, en algunos casos, indicador de calidad en la atención del paciente. Por ello, para un mejor manejo de la reposición de electrolitos tanto en la sueroterapia como por Nutrición Parenteral es necesario tener en cuenta el aporte recibido por la medicación prescrita en los casos en que sea necesario.

  5. Treatment of the diabetic patient: focus on cardiovascular and renal risk reduction.

    PubMed

    Abbott, Kevin C; Bakris, George L

    2002-01-01

    Diabetes mellitus increases the risk for hypertension and associated cardiovascular diseases, including coronary, cerebrovascular, renal and peripheral vascular disease. The risk for developing cardiovascular disease is increased when both diabetes and hypertension co-exist; in fact, over 11 million Americans have both diabetes and hypertension. These numbers will continue to climb, internationally, since the leading associated risk for diabetes development, obesity, has reached epidemic proportions, globally. Moreover, the frequent association of diabetes with dyslipidemia, as well as coagulation, endothelial, and metabolic abnormalities also aggravates the underlying vascular disease process in patients who possess these comorbid conditions. The renin-angiotensin-aldosterone system (RAS) and arginine vasopressin (AVP) are overactivated in both hypertension and diabetes. Drugs that inhibit this system, such as ACE inhibitors and more recently angiotensin receptor antagonists (ARBs), have proven beneficial effects on the micro- and macrovascular complications of diabetes, especially the kidney. The BRILLIANT study showed that lisinopril reduces microalbuminuria better than CCB therapy. Numerous other long-term studies confirm this association with ACE inhibitors including the HOPE trial. Furthermore, the European Controlled trial of Lisinopril in Insulin-dependent Diabetes (EUCLID) study, showed that lisinopril slowed the progression of renal disease, even in individuals with mild albuminuria. In fact, there are now five appropriately powered randomized placebo-controlled trials to show that both ACE inhibitors and ARBs slow progression of diabetic nephropathy in people with type 2 diabetes. These effects were shown to be better than conventional blood pressure lowering therapy, including dihydropyridine CCBs. In patients with microalbuminuria, ACE inhibitors and ARBs reduce the progression of microalbuminuria to proteinuria and provide a risk reduction of between

  6. [Periarticular Corticosteroid Injection in the Therapeutic Approach of Musculoskeletal Disease in General Practice: A systematic Review].

    PubMed

    Trindade, Irene

    2015-01-01

    Introdução: Internacionalmente constata-se o tratamento de patologia músculo-esquelética em cuidados de saúde primários através de técnicas de infiltração peri-articular de corticosteróides. Este artigo procede à análise da evidência existente, com o objectivo de contribuir para a discussão do desenvolvimento dessa prática, ainda diminuta, em Portugal. Material e Métodos: Análise qualitativa de estudos controlados aleatorizados, custo-efectividade, transversais e coorte restrospectivo, recorrendo ao modelo PRISMA. Fontes de dados: PubMed, Cochrane Library, Essential Evidence Plus. Critérios de elegibilidade: infiltrações de corticosteróides no tratamento de patologia músculo-esquelética e indicação de contexto em cuidados de saúde primários. Resultados: Foram incluídos nove estudos controlados aleatorizados, três estudos de custo-efectividade, três estudos transversais, três estudos descritivos e um estudo coorte retrospectivo. A maioria dos indicadores de sucesso da utilização de infiltrações de corticosteróides por médicos de medicina geral e familiar mostrou eficácia a curto prazo; a longo prazo não mostrou superioridade comparativamenteàs intervenções alternativas. O balanço entre os encargos económicos e o aumento da qualidade de vida é favorável à utilização desta técnica em cuidados de saúde primários. Todos os onze estudos que avaliaram a segurança registaram efeitos adversos ligeiros e nenhum grave. Discussão: O desempenho das técnicas de infiltração peri-articular de corticosteróides permite figurá-las como opção terapêutica no tratamento de patologia músculo-esquelética nos cuidados de saúde primários Portugueses. Importa incentivar estudos, nomeadamente a nível nacional, que suportem tanto os indicadores de eficácia, como de segurança desta técnica. Conclusão: A infiltração peri-articular de corticosteróides constitui uma opção relativamente eficaz, segura e com potencial de

  7. Communicacion Expresiva: Como los ninos nos envian mensajes [and] Comunicacion Receptiva: Como los ninos entienden nuestros mensajes [and] Interacciones de Comunicacion: Hacen falta dos. Hojas informativa de DB-LINK (Communication Interactions: It Takes Two [and] Receptive Communication: How Children Understand Your Messages to Them [and] Expressive Communication: How Children Send Their Messages to You. DB-LINK Fact Sheets).

    ERIC Educational Resources Information Center

    Stremel, Kathleen

    This document consists of three separately published fact sheets combined here because of the close relationship of their subject matter. The first fact sheet, "Communication Interactions: It Takes Two" (Kathleen Stremel), defines communication; suggests ways to find opportunities for interactive communication; offers specific suggestions for…

  8. [ANTHROPOMETRIC INDICATORS AND CARDIOMETABOLIC EVENTS AMONG SCHOOL-AGED CHILDREN FROM SONORA, MEXICO].

    PubMed

    Peralta Peña, Sandra Lidia; Reséndiz González, Eunice; Rubí Vargas, María; Terrazas Medina, Efraín Alonso; Cupul Uicab, Lea Aurora

    2015-10-01

    Introducción: la obesidad durante la niñez es predictiva de obesidad en la adultez y se asocia a eventos adversos para la salud observables desde etapas tempranas; sin embargo, la evaluación conjunta de obesidad y eventos adversos en los menores no es parte de la atención médica habitual. Objetivos: evaluar la asociación de sobrepeso y obesidad, obesidad abdominal y exceso de grasa corporal con la presión arterial sistólica [PAS] y diastólica [PAD], y el perfil de lípidos y glucosa; e identificar el mejor indicador antropométrico de dichos eventos. Material y métodos: estudio transversal en 412 escolares a quienes se les determinó la presencia de sobrepeso y obesidad, obesidad abdominal y exceso de grasa corporal. Los niveles de colesterol total, triglicéridos, lipoproteínas de alta y baja densidad y glucosa se determinaron en una submuestra (n = 133). Las asociaciones se evaluaron con modelos de regresión lineal y logística ajustados. Resultados: el 33% de los participantes tuvieron sobrepeso u obesidad. El sobrepeso, la obesidad, la obesidad abdominal y el exceso de grasa corporal se asociaron con un incremento de PAS y PAD, y con un perfil de lípidos y glucosa que representan riesgos para la salud. El sobrepeso y la obesidad fueron los mejores predictores de dichos eventos. Conclusiones: en nuestra población, la obesidad se asoció con mayor posibilidad de presentar eventos adversos para la salud como PA elevada, niveles de lípidos y glucosa altos. La obesidad puede ser determinada con el IMC, que es un índice de bajo coste, no invasivo y de fácil implementación.

  9. Prevalence of metilentetrahidrofolate reductase C677T polymorphism, consumption of vitamins B6, B9, B12 and determination of lipidic hydroperoxides in obese and normal weight Mexican population.

    PubMed

    Hernández-Guerrero, César; Romo-Palafox, Inés; Díaz-Gutiérrez, Mary Carmen; Iturbe-García, Mariana; Texcahua-Salazar, Alejandra; Pérez-Lizaur, Ana Bertha

    2013-11-01

    Introducción. El estrés oxidativo es un factor clave en el inicio y el desarrollo de las comorbilidades de la obesidad. La enzima metiltetrahidrofolato reductasa (MTHFR) participa en el metabolismo del folato con la acción de las vitaminas B9 y B12. El gen MTHFR puede presentar un polimorfismo de un solo nucleótido (SNP) en la posición 677 (C677T), que puede promover homocisteinemia asociada a la producción de radicales libres. Objetivo. Determinar la frecuencia del SNP C677T de la MTHFR, evaluar el consumo de vitaminas B6, B9, B12 y determinar la concentración de hidroperóxidos lipídicos (LOOH) en plasma en un grupo de obesos y testigo. Métodos. Se clasificaron 128 mexicanos mestizos de acuerdo a su índice de masa corporal en normopeso (Nw; n=75) y obesidad (ObeI-III; n=53). Se identificó el SNP C677T de la MTHFR mediante la técnica de PCR-RFLP. El consumo de vitaminas B6, B9 y B12 se evaluó mediante una encuesta validada. Se determinaron LOOH como un indicador de estrés oxidativo periférico. Resultados. No hubo diferencia estadística significativa en la frecuencia del polimorfismo C677T entre homocigotos TT en Nw (0.19) y ObeI-III (0.25). La frecuencia del alelo T en Nw fue de 0.45, y 0.51 en el grupo ObeI-III. Los LOOH mostraron diferencia estadística significativa (p.

  10. The variability in adherence to dietary treatment and quality of weight loss: overweight and obesity.

    PubMed

    Reig García-Galbis, Manuel; Cortés Castell, Ernesto; Rizo Baeza, Mercedes; Gutiérrez Hervás, Ana

    2015-05-01

    Objetivo: Observación de la pérdida de peso y el tiempo máximo que se muestra el tratamiento dietético individualizado cuali-cuantitativo para ser eficaz. Método: 4625 consultas se llevaron a cabo con 616 pacientes mayores de 25 años, en la consulta de nutrición, utilizando la herramienta de tratamiento dietético individualizado cuali-cuantitativo, como resultado se controló la pérdida de peso, la grasa, la calidad y la variabilidad de la pérdida, mensualmente en función del sexo, la edad y el IMC en una zona urbana del sureste de España. Resultados y discusión: Se demostró un bajo nivel de abandono en los hombres, en los pacientes mayores de 45 años, frente a los obesos que mostraron un mayor grado. La calidad de la pérdida fue mayor en los hombres, los menores de 45 años, los pacientes con sobrepeso, sin embargo, se necesita más investigación en esta área. La medición de la cintura y las caderas ha llevado a un creciente interés en los indicadores de medición de grasa corporal. Conclusión: El tratamiento dietético individualizado ha demostrado ser eficaz en los seis meses y, posteriormente, se recomienda su uso en el modo multidisciplinario. Se propone el uso de nuevas formas de evaluar la pérdida de peso: la calidad y la variabilidad de la pérdida, independientemente del tratamiento utilizado.

  11. Efeitos do binarismo não resolvido na determinação da função de massa de aglomerados

    NASA Astrophysics Data System (ADS)

    Kerber, L. O.; Santiago, B. X.

    2003-08-01

    Através de simulações numéricas buscamos quantificar os efeitos que o binarismo não resolvido causa na determinação da função de massa (MF) de aglomerados estelares. Geramos diagramas cor-magnitude (CMDs) artificiais simulando uma população única, caracterizada por estrelas de mesma idade e composição quí mica, com uma fração de binárias não resolvidas e distribuição em massa das estrelas dada por uma MF do tipo lei de potência. A presença de pares de estrelas não resolvidos faz com que a MF obtida da função de luminosidade (LF) tenha a têndencia de ser mais plana do que a MF que gerou o CMD artificial. Propomos um tratamento de correção para tal efeito. Outro efeito relacionado diz respeito ao alargamento do CMD, que apresenta-se como um indicador do número total de estrelas no domí nio de baixas massas (m < 0.6M¤). Todos os resultados acima possuem uma forte dependência com os erros fotométricos e estão baseados na hipótese de que ambas estrelas do par não resolvido são sorteadas de uma mesma MF de forma independente. O objetivo final é aplicarmos o tratamento aqui desenvolvido para implementarmos a análise da nossa amostra de aglomerados ricos da Grande Nuvem de Magalhães.

  12. The prevalence of overweight and obesity in adolescents in Bahia, Brazil.

    PubMed

    Ferreira Marques, Cibele Dantas; Ribeiro Silva, Rita de Cássia; Machado, Maria Ester C; Portela de Santana, Mônica Leila; Castro de Andrade Cairo, Romilda; Pinto, Elizabete de Jesus; Oliveira Reis Maciel, Leonardo; Rodrigues Silva, Luciana

    2013-01-01

    Objetivo: Un estudio transversal se llevó a cabo con 1477 estudiantes de primaria matriculados en las escuelas públicas de Salvador, Bahía, Brasil, para evaluar la prevalencia del sobrepeso y la obesidad. Métodos: La muestra se determinó por la técnica de muestreo por conglomerados en dos etapas para la selección de escuelas y clases. Más tarde, posteriori error se calculó. Los estudiantes fueron clasificados como sobrepeso u obesos de acuerdo con la clasificación de la Organización Mundial de la Salud, 2007. Ellos también fueron clasificados de acuerdo a la edad, la etapa de maduración sexual, y la presencia de obesidad abdominal. Resultados: En general, el 9,3% de los estudiantes tenían sobrepeso y el 6,4% eran obesos, por lo tanto, el 15,7% de los alumnos se considera que tienen exceso de peso (sobrepeso + obesidad), con un intervalo de confianza del 95%. De la población total estudiada el 12,9% presentaron obesidad abdominal, esta condición se observa en el 13% de su peso normal. Se encontró asociación entre el sobrepeso y la edad < 14 AÑOs (p = 0,030) y obesidad abdominal (p = 0,001). Conclusiones: Los programas de intervención deben ser implementados para prevenir y tratar la obesidad en la infancia y la adolescencia. Además, los profesionales que trabajan con las personas en este grupo de edad deben ser sensibles a este problema. La necesidad de estandarizar los indicadores antropométricos utilizados en los diferentes estudios se enfatiza también.

  13. [Relationship between maternal body mass index, gestational weight gain and birth weight; prospective study in a health department].

    PubMed

    Vila-Candel, Rafael; Soriano-Vidal, Francisco Javier; Navarro-Illana, Pedro; Murillo-Llorente, M Teresa; Martín-Moreno, José M

    2015-04-01

    Objetivo: Contrastar la relación que existe entre la ganancia de peso gestacional y el peso del recién nacido, entre cada categoría de IMC pregestacional. Material y Métodos: Estudio observacional y descriptivo con muestreo bietápico en el Departamento de Salud de la Ribera (Valencia, España). Se clasificaron en cuatro grupos dependiendo del índice de masa corporal (IMC) pregestacional. Resultados: Se estudiaron 140 gestantes. La evolución de la ganancia de peso gestacional (GPG) y de sus gradientes trimestrales fue ascendente. Se produjo un mayor incremento del primer al segundo trimestre que del segundo al tercero para todas las categorías de IMC pregestacional. Según las recomendaciones internacionales de GPG el 16,4% de la muestra tuvo una ganancia de peso inferior a la recomendada, el 38,6% una ganancia de peso igual y el 45% una ganancia de peso superior. El IMC pregestacional categorizado por la OMS, está relacionado con el peso al nacer, mostrando significación estadística (F=6,636 y p<0,001). Las obesas con una ganancia de peso mayor de la recomendada tienen recién nacidos con mayor peso (4.353±821,924 g) y las de bajo-peso con ganancia menor de la recomendada, tienen recién nacidos con pesos menores (2.900±381,83 g) que el resto de grupos. Conclusiones: La GPG de forma absoluta no mostró significación estadística con el peso al nacer con ninguna categoría materna de IMC pregestacional y, como indicador aislado, no es un valor añadido a la calidad del control prenatal.

  14. [Phase angle as an indicator of nutritional status and prognosis in critically ill patients].

    PubMed

    Reis de Lima e Silva, Renata; Porto Sabino Pinho, Cláudia; Galvão Rodrigues, Isa; Gildo de Moura Monteiro Júnior, José

    2014-09-12

    Introducción: El ángulo de fase (AF) viene siendo considerado una herramienta sensible para evaluar el estado nutricional y la efectividad de las intervenciones dietoterápicas. Objetivo: Evaluar el AF como indicador del estado nutricional y pronóstico en pacientes críticos. Métodos: Estudio prospectivo observacional con pacientes admitidos en Unidades de Cuidado Intensivo Coronarias, entre Mayo y Octubre de 2013. El AF se determinó por medio del análisis por Bioimpedancia Eléctrica, considerándose bajo AF valores inferiores a 5º para los hombres y 4,6º para las mujeres. Los valores obtenidos se relacionaron con otros parámetros de evaluación del estado nutricional: antropométricos (circunferencia del brazo – CB, pliegue cutáneo triciptal – PCT, área muscular del brazo corregida - AMBc circunferencia de pantorrilla – CP) y bioquímico (recuento total de linfocitos, hemoglobina, hematocrito), además de los pronósticos clínicos APACHE II (Acute Physiology and Chronic Health Disease Classification System II) y albúmina sérica. La tabulación y análisis de los datos se realizaron a través del paquete estadístico SPSS versión 13.0. Resultados: La muestra se compuso por 110 pacientes, en la cual se verificó asociación entre bajo AF e insuficiencia renal en diálisis (p.

  15. SYSTEMATIC REVIEW OF HEALTHY EATING INDEXES IN ADULTS AND ELDERLY: APPLICABILITY AND VALIDITY.

    PubMed

    Pinto de Souza Fernandes, Dalila; Queiroz Ribeiro, Andréia; Lopes Duarte, Maria Sônia; Castro Franceschini, Sylvia do Carmo

    2015-08-01

    Introducción: los índices de alimentación saludable evalúan la combinación de diferentes tipos de alimentos, nutrientes y componentes de la dieta. Estos indicadores han sido adaptados en algunos países considerando las directrices dietéticas locales. Objetivo: esta revisión sistemática identifica todos los índices de alimentación saludable publicados hasta el momento; así mismo, discute la validez, aplicabilidad y limitaciones de los mismos. Métodos: para ello se realizó una búsqueda electrónica en PubMed, Science Direct, BVS y SciELO utilizando los siguientes términos: Healthy Eating Index, Index of Diet Quality, Quality of diet y Diet surveys con diferentes combinaciones e idiomas. Resultados: un total de 11 estudios fueron seleccionados y analizados críticamente: entre ellos, un estudio que desarrolla el primer índice, seis estudios en los que se proponen ajustes en la metodología utilizada, dos estudios que evaluan la validez y la fiabilidade, así como dos de revisión y actualización. Los datos muestran que los índices de alimentación saludable son buenas herramientas para valorar la calidad de la dieta, pero la falta de estandarización en la metodología hace difícil la comparación entre los resultados de las diferentes poblaciones.

  16. INDICATORS OF SUCCESS IN THE DIETARY MANAGEMENT OF OVERWEIGHT AND OBESITY: WEIGHT, BODY FAT LOSS AND QUALITY.

    PubMed

    Reig García-Galbis, Manuel; Rizo Baeza, Mercedes; Cortés Castell, Ernesto

    2015-09-01

    Conceptos: %WL: Porcentaje de perdida de peso; %FL: Percentage of fat loss. Objetivo: evaluar que unidad de medida en la perdida podria determinar el exito o fracaso del tratamiento dietetico en el sobrepeso y obesidad. Método: 4.625 consultas se llevaron a cabo con 616 pacientes mayores de 25 anos con sobrepeso y obesidad, en el sur-este de Espana, durante los anos 2006-12. Las consultas se realizaban quincenalmente, se utilizo la dieta mediterranea e hipo-calorica. Se formaron cuatro grupos en funcion del menor o mayor %WL y %FL. Resultados: la mayoria de la muestra esta formada por: mujeres; participantes entre 25-45 anos; asistentes a mas de mes y medio; obesos. El 80% de los pacientes obtienen un %FL ≥ 5% (15,5}12,8). Los grupos con mayor %FL obtiene diferencias significativas en la perdida (22,6 vs 11,2%, p=0,000). El analisis multinomial, destaca diferencias significativas cuando se compara los grupos de mayor %FL con el menor %WL y %FL: en el sexo (p=0.006 vs p=0.005), IMC (p=0.010 vs p=0.003) y asistencia (p=0.000 vs p=0.000). Conclusión: los pacientes que pierden < 5% de grasa, muestran parametros iniciales mayores (Porcentaje de peso y grasa); la mayoria de la muestra pierde ≥ 5% de grasa, por lo que el tratamiento dietetico individualizado es un metodo que obtiene una elevada perdida de grasa; la grasa es un indicador de la calidad de la perdida obtenida. Se recomienda: la medicion de la grasa como unidad de medida complementaria al peso; establecer el limite del 5% para evaluar dicha perdida; y aumentar la investigacion en esta linea en cualquier metodo de perdida.

  17. [Not Available].

    PubMed

    Pacheco-Herrera, Javier Darío; Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique

    2016-06-30

    Objetivo: el presente estudio tuvo por objetivos: a) determinar los valores de referencia de la condición muscular mediante el índice general de fuerza (IGF); y b) estudiar si el IGF está asociado con indicadores de adiposidad en niños y adolescentes escolares de Bogotá, Colombia.Métodos: del total de 7.268 niños y adolescentes (9-17,9 años) evaluados en el estudio FUPRECOL, 4.139 (57%) fueron mujeres. Se evaluó el IGF como marcador del desempeño muscular a partir de la tipificación de las pruebas de fuerza prensil (FP) y salto de longitud (SL). El IGF se recodificó en cuartiles (Q), siendo el Q4 la posición con mejor valor del IGF. El índice de masa corporal (IMC), la circunferencia de cintura (CC), el índice cintura/talla (ICT) y el porcentaje de grasa corporal (% GC) por bioimpedancia eléctrica se midieron como marcadores de adiposidad.Resultados: la edad media de los evaluados fue 12,8 ± 2,3 años. Se aprecia una tendencia hacia un incremento del nivel de condición física muscular en los varones conforme aumenta la edad, y hacia la estabilidad o un ligero aumento en el caso de las mujeres. El IGF se relacionóinversamente con el ICT y % GC en los varones (r = -0,280, r = -0,327, p < 0,01), respectivamente. Los escolares ubicados en el Q4 del IGF presentaron menores valores en marcadores de adiposidad IMC, CC, ICT y % GC, p < 0,01, que su contraparte del Q1.Conclusión: se presentan valores de referencia del IGF a partir de la estandarización de los resultados obtenidos en la FP y SL. La evaluación de la fuerza muscular en edades tempranas permitirá implementar programas de prevención de riesgo cardiovascular y metabólico futuro.

  18. Pharmacology and biochemistry undergraduate students' concern for a healthy diet and nutrition knowledge.

    PubMed

    Bernardes Spexoto, Maria Claudia; Garcia Ferin, Giovana; Duarte Bonini Campos, Juliana Alvares

    2015-04-01

    Objetivo: Estimar la preocupación por una alimentación sana y el conocimiento de la nutrición de los estudiantes de un título de grado en Farmacia y Bioquímica y su asociación con variables de interés. Métodos: Este estudio transversal. Participaron 381 estudiantes. Fue utilizado como instrumentos de medición a "Escala El conocimiento nutricional" y "¿Cómo está la comida?". Se realizó un estúdio asociación entre la preocupación por una alimentación sana y el conocimiento nutricional y aquellos con las variables demográficas mediante el uso de la prueba de chi-cuadrado (2) o Fisher. Hemos adoptado un nivel de significación del 5%. Resultados: La edad promedio de los estudiantes fue de 20,6 (SD = 2,7) años, el 78,2% eran varones femenina. El índice de masa corporal (IMC) fue de 22,6 (SD = 3,7) kg/m2 y 73,5% se presentaron con un estado nutricional adecuado para este indicador. La mayoría de los alumnos evaluados fueron categorizados como "estad atentos con la comida" (77,1%) y "el conocimiento nutricional moderado" (79,7%). Se han observado asociaciones significativas entre la preocupación por una alimentación sana y año del curso (p = 0,024), la classe económica (p = 0,012) y la actividad física (p < 0,001). El conocimientos nutricionales sólo se asoció con el año del curso (p < 0,001). No se encontró asociación significativa entre la preocupación por una alimentación saludable y conocimientos sobre nutrición (p = 0,808). Conclusión: Los estudiantes de primer año por supuesto, pertenecen a la clase económica B y no físicamente activos mostraron una menor preocupación por una alimentación saludable. Esta preocupación no se estaba relacionado con el conocimiento nutricional presentado por los estudiantes.

  19. [Psychometric properties of the spanish version of the "Barriers to Being Active Quiz" among university students in Colombia].

    PubMed

    Rubio-Henao, Rubén Fernando; Correa, Jorge Enrique; Ramírez-Vélez, Robinson

    2015-04-01

    Objetivo: El cuestionario Barriers to Being Active Quiz (BBAQ), indaga las barreras para ser físicamente activo. El cuestionario fue traducido al español por el mismo equipo que desarrolló la versión inglésa original, pero carece de estudios de validez en la versión española. El objetivo de esta investigación fue evaluar las propiedades psicométricas del BBAQ (en la versión completa de 21 ítems), centrándose en la fiabilidad y validez. Material y métodos: Un total de 2.634 (1.462 mujeres y 1.172 varones; 18-30 años de edad) estudiantes universitarios completaron el cuestionario BBAQ-21. El alfa de Crombach se estimó como indicador de consistencia interna. El coeficiente de correlación intra-clase (CCI) y el grado de acuerdo se calcularon para evaluar la estabilidad temporal con un periodo de 7 días entre ambas administraciones como estimadores de la reproducibilidad. Se aplicó un análisis factorial exploratorio (AFE) y confirmatorio (AFC) para analizar la validez del BBAQ-21 ítems. Resultados: El BBAQ-21 mostró valores de un alfa de Cronbach entre 0,812 y 0,844 y un CCI entre el 0,46 y 0,87. El porcentaje de acuerdo por todos los conceptos individuales varió de 45 a 80%. El AFE determinó cuatro factores que explicaron el 52,90% de la varianza y el AFC mostró moderadas cargas factoriales. Conclusiones: Los resultados obtenidos en este cuestionario avalan la utilización de este instrumento con este tipo de muestra, desde el punto de vista de la fiabilidad y validez. El BBAQ-21 está disponible para evaluar las barreras para la actividad física en América Latina.

  20. [Ultra-sensitive C-reactive protein associated to nutritional status and biochemical profile in Mexican shoolchildren].

    PubMed

    Haro-Acosta, María Elena; Ruíz Esparza-Cisneros, Josefina; Delgado-Valdez, Jesús Hernán; Díaz-Molina, Raúl; Ayala-Figueroa, Rafael Iván

    2014-01-01

    Introducción: la proteína C-reactiva (PCR) es un marcador no específico de inflamación con séricos bajos, los cuales normalmente no son detectables. A fin de evaluar el riesgo cardiovascular en adultos que en apariencia son sanos, se emplean métodos ultrasensibles y la PCR medida con estas técnicas se conoce como proteína C-reactiva ultrasensible (PCR-us). Algunos investigadores reportan una asociación de la PCR-us con algún parámetro antropométrico o bioquímico en niños sin enfermedad aparente. El objetivo de este artículo consistió en asociar la PCR-us con el estado nutricional y el perfil bioquímico en escolares mexicanos. Métodos: estudio transversal en 300 niños sanos de 10 a 12 años de edad. Se midieron peso, talla, índice de masa corporal (IMC), cintura y grasa corporal, glucosa, perfil de lípidos y PCR-us. El criterio de exclusión fue una PCR-us > 10 mg/L. Se utilizaron modelos de regresión multivariada. Resultados: el 53.7 % fueron niñas y el 46.3 % niños. La mediana de la PCR-us fue de 0.3mg/L (rango: 0.3mg/L-6.8mg/L), se relacionó positiva y significativamente con un IMC (ß = 0.226 p = 0.032), LDL-C (ß = 0.203 p = 0.037) y negativamente con colesterol total (CT) (ß = –0.267 p = 0.007); con el resto de las variables la asociación no fue significativa. Conclusión: se puede inferir que existe asociación entre la PCR-us e indicadores de riesgo cardiovascular, como la obesidad y alguna dislipidemia en escolares, por lo que la PCR-us puede ser utilizada para escrutinio en niños mexicanos.

  1. [Not Available].

    PubMed

    Pacheco-Herrera, Javier Darío; Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique

    2016-01-01

    Objetivo: el presente estudio tuvo por objetivos: a) determinar los valores de referencia de la condición muscular mediante el índice general de fuerza (IGF); y b) estudiar si el IGF está asociado con indicadores de adiposidad en niños y adolescentes escolares de Bogotá, Colombia.Métodos: del total de 7.268 niños y adolescentes (9-17,9 años) evaluados en el estudio FUPRECOL, 4.139 (57%) fueron mujeres. Se evaluó el IGF como marcador del desempeño muscular a partir de la tipificación de las pruebas de fuerza prensil (FP) y salto de longitud (SL). El IGF se recodificó en cuartiles (Q), siendo el Q4 la posición con mejor valor del IGF. El índice de masa corporal (IMC), la circunferencia de cintura (CC), el índice cintura/talla (ICT) y el porcentaje de grasa corporal (% GC) por bioimpedancia eléctrica se midieron como marcadores de adiposidad.Resultados: la edad media de los evaluados fue 12,8 ± 2,3 años. Se aprecia una tendencia hacia un incremento del nivel de condición física muscular en los varones conforme aumenta la edad, y hacia la estabilidad o un ligero aumento en el caso de las mujeres. El IGF se relacionóinversamente con el ICT y % GC en los varones (r = -0,280, r = -0,327, p < 0,01), respectivamente. Los escolares ubicados en el Q4 del IGF presentaron menores valores en marcadores de adiposidad IMC, CC, ICT y % GC, p < 0,01, que su contraparte del Q1.Conclusión: se presentan valores de referencia del IGF a partir de la estandarización de los resultados obtenidos en la FP y SL. La evaluación de la fuerza muscular en edades tempranas permitirá implementar programas de prevención de riesgo cardiovascular y metabólico futuro. PMID:27513488

  2. La salud en personas con discapacidad intelectual en España: estudio europeo POMONA-II

    PubMed Central

    Martínez-Leal, Rafael; Salvador-Carulla, Luis; Gutiérrez-Colosía, Mencía Ruiz; Nadal, Margarida; Novell-Alsina, Ramón; Martorell, Almudena; González-Gordón, Rodrigo G.; Mérida-Gutiérrez, M. Reyes; Ángel, Silvia; Milagrosa-Tejonero, Luisa; Rodríguez, Alicia; García-Gutiérrez, Juan C.; Pérez-Vicente, Amado; García-Ibáñez, José; Aguilera-Inés, Francisco

    2011-01-01

    Introducción Estudios internacionales demuestran que existe un patrón diferenciado de salud y una disparidad en la atención sanitaria entre personas con discapacidad intelectual (DI) y población general. Objetivo Obtener datos sobre el estado de salud de las personas con DI y compararlos con datos de población general. Pacientes y métodos Se utilizó el conjunto de indicadores de salud P15 en una muestra de 111 sujetos con DI. Los datos de salud encontrados se compararon según el tipo de residencia de los sujetos y se utilizó la Encuesta Nacional de Salud 2006 para comparar estos datos con los de la población general. Resultados La muestra con DI presentó 25 veces más casos de epilepsia y el doble de obesidad. Un 20% presentó dolor bucal, y existió una alta presencia de problemas sensoriales, de movilidad y psicosis. Sin embargo, encontramos una baja presencia de patologías como la diabetes, la hipertensión, la osteoartritis y la osteoporosis. También presentaron una menor participación en programas de prevención y promoción de la salud, un mayor número de ingresos hospitalarios y un uso menor de los servicios de urgencia. Conclusiones El patrón de salud de las personas con DI difiere del de la población general, y éstas realizan un uso distinto de los servicios sanitarios. Es importante el desarrollo de programas de promoción de salud y de formación profesional específicamente diseñados para la atención de personas con DI, así como la implementación de encuestas de salud que incluyan datos sobre esta población. PMID:21948011

  3. Predictive ability of the anthropometric and body composition indicators for detecting changes in inflammatory biomarkers.

    PubMed

    de Carvalho Vidigal, Fernanda; Paez de Lima Rosado, Lina Enriqueta Frandsen; Paixão Rosado, Gilberto; de Cassia Lanes Ribeiro, Rita; do Carmo Castro Franceschini, Sylvia; Priore, Silvia Eloiza; Gomes de Souza, Eliana Carla

    2013-01-01

    Introducción: La obesidad ha sido considerada como una inflamación crónica subclínica. La proteína C-reactiva ultrasensible (PCR-us) y el fibrinógeno se han asociado cada vez más con el riesgo cardiovascular. Objetivos: Evaluar la capacidad, de los indicadores antropométricos y de composición corporal, en discriminar mayores niveles séricos de PCR-us y fibrinógeno. Métodos: Se evaluaron 130 hombres (20-59 años). Se midió peso, estatura, circunferencia de la cintura, de la cadera y del muslo, diámetro abdominal sagital (DAS), diámetro coronal (DC) y composición corporal. Se calculó el índice de conicidad, la relación cintura/estatura, el índice de masa corporal, la relación cintura/cadera, la relación cintura/muslo y el índice sagital. Se consideró como punto de corte para los valores de PCR-us ≥?0,12 mg/dl y para el fibrinógeno se utilizó el percentil 50 de la muestra evaluada. Resultados: El índice sagital (r = 0,280), la relación cintura/ muslo (r = 0,233) y la relación cintura/estatura (r = 0,233) mostraron una mejor correlación con la PCR-us (p < 0,01). El índice de conicidad (r = 0,305) y la relación cintura/estatura (r = 0,279) mostraron una mejor correlación con el fibrinógeno (p < 0,01). En el análisis ROC, el DAS (0,698 ± 0,049) y el índice de conicidad (0,658 ± 0,048) mostraron una mayor capacidad predictiva de riesgo cardiovascular determinado a través de mayores niveles de PCR-us y fibrinógeno, respectivamente (p < 0,01). Los puntos de corte de 30 cm, 89,9 cm y 20,5 fueron los que alcanzaron mayor sumatorio entre los valores de sensibilidad y especificidad para el DC, circunferencia de la cintura y DAS, respectivamente. Conclusiones: En hombres adultos sanos, el DAS y el índice de conicidad mostraron una mayor capacidad predictiva para detectar niveles más altos de PCR-us y fibrinógeno respectivamente.

  4. [Food habits and nutritional assessment in a university population].

    PubMed

    Cervera Burriel, Faustino; Serrano Urrea, Ramón; Vico García, Cruz; Milla Tobarra, Marta; García Meseguer, Mariá José

    2013-01-01

    Introducción: Los estudiantes universitarios se encuentran en un periodo crítico para el desarrollo de estilos de vida que tienen mucha importancia en su futura salud, ya que la influencia en el comportamiento alimentario de los compañeros, el consumo de alcohol, su situación económica y la habilidad para cocinar hacen que cambien sus hábitos de alimentación. Los pocos estudios en España sobre calidad de la dieta en este grupo de población reflejan mayoritariamente un inadecuado seguimiento del patrón mediterráneo. Objetivos: Caracterizar los hábitos alimentarios en una población de estudiantes universitarios y evaluar la calidad de su dieta. Métodos: Estudio transversal de una muestra de 80 estudiantes de la Facultad de Enfermería de Albacete (Universidad de Castilla-La Mancha). Los datos se recogieron mediante 9 recordatorios de 24 horas autoadministrados en tres periodos estacionales. El IAS y el MDS2 han sido usados como indicadores de la calidad de la dieta. En todas las pruebas el nivel de significación utilizado fue de 0,05. Resultados y discusión: La dieta de los estudiantes es ligeramente hipocalórica. La contribución de los macronutrientes a la energía total diaria la definen como hiperproteica (17%), pobre en hidratos de carbono, alrededor del 40%, casi duplica las recomendaciones de azúcares simples y es alta en grasa saturada y colesterol. La principal fuente de grasa son los alimentos cárnicos, mientras que el grupo del pescado sólo representa el 3,1%. La ingesta de cárnicos y lácteos supera ampliamente a la de poblaciones universitarias en otros países mediterráneos europeos. Más del 91% de los estudiantes se encuentra en una situación de «necesidad de cambios en la dieta» hacia patrones más saludables. La adherencia a la dieta mediterránea fue sólo del 53%.

  5. Educación sobre sexualidad y prevención del VIH: un diagnóstico para América Latina y el Caribe

    PubMed Central

    DeMaria, Lisa M.; Galárraga, Omar; Campero, Lourdes; Walker, Dilys M.

    2016-01-01

    RESUMEN Objetivo Mostrar, a través de un diagnóstico en América Latina y el Caribe, el panorama legislativo y curricular sobre sexualidad y prevención contra el virus de inmunodeficiencia humana (VIH) en el ámbito escolar, contrastándolo con los comportamientos sexuales reportados en encuestas demográficas y de salud. Métodos En mayo de 2008 se realizó, con el apoyo del Fondo de Población de las Naciones Unidas (UNFPA), una encuesta a informantes clave en 34 países de la Región. El cuestionario autoaplicado solicitó información sustantiva de agentes de las diferentes partes interesadas, como ministerios de educación y de salud, sobre los programas de prevención contra el VIH/Sida que se están aplicando en las escuelas. Resultados Respondieron a la encuesta 27 países que representan 95,5% de la población objetivo (6 a 18 años de edad). La mayoría de los países informó tener al menos un libro de texto o un capítulo específico para enseñar los temas de educación sobre sexualidad y prevención del VIH. En la escuela secundaria se cubren la mayor parte de los temas pertinentes relevantes para la educación sobre sexualidad, pero no todos. Por ejemplo, el problema de la discriminación por orientación o preferencia sexual no se incluye en los programas escolares. Conclusiones El material educativo sobre sexualidad debe ser revisado y actualizado periódicamente de modo que refleje los avances en los temas y en la forma de tratar los contenidos. En cada país el currículo debe abordar el tema del respeto a la diversidad sobre orientación, preferencia e identidad sexuales, y en particular el manejo apropiado de la educación para prevenir infecciones de transmisión sexual (ITS) en hombres que tienen sexo con hombres. Los esfuerzos de evaluación de la efectividad de los programas deben contemplar desenlaces tales como marcadores biológicos (incidencia y prevalencia de ITS y embarazo) y no únicamente indicadores de conocimiento y

  6. ASSESSMENT OF SOMATIC MATURATION OF VENEZUELAN ADOLESCENTS.

    PubMed

    Méndez Pérez, Betty; Marrodán Serrano, María Dolores; Prado Martínez, Consuelo; Aréchiga Viramontes, Julieta; Cabañas Armesillas, María Dolores

    2015-11-01

    Introducción: la adolescencia es un período de cambios en la composición corporal, los cuales deben ser considerados en la evaluación del estado de maduración somática. Objetivos: desarrollar un método no invasivo para evaluar el estado de maduración en una muestra transversal de adolescentes venezolanos, a partir del punto de máxima velocidad de crecimiento (PHV), mediante medidas antropométricas. Métodos: la muestra comprende 681 adolescentes venezolanos entre 9 y 18 años. Se aplicó la ecuación de Mirwald para estimar el PHV. De igual manera se efectuó un análisis de regresión para construir el modelo de la muestra venezolana y se aplicaron curvas ROC para evaluar la sensibilidad y especificidad de las variables antropométricas. Resultados: las ecuaciones predictivas para uno y otro sexo mostraron un elevado coeficiente de determinación (< 0,99) y un mínimo error de estimación (0,06). La edad media decimal a la que se alcanza el punto de PHV obtenido por ambas ecuaciones: criterio y modelo, fueron similares para chicos (13,27 vs. 13,39) y para chicas (11,62 vs. 11,77). El test de Bland-Altman mostró una elevada concordancia entre ambas ecuaciones y todos los indicadores antropométricos mostraron un área bajo la curva > 0,75, en especial la talla sentado. Discusion y conclusiones: dada la dificultad de realizar estudios longitudinales, se han utilizado muestras transversales para estimar la maduración somática en diferentes poblaciones. El presente trabajo proporciona ecuaciones predictivas para este propósito, ajustadas a la población venezolana y desarrolladas a partir de la fórmula de Mirwald. Las mismas pueden ser usadas como ayuda en la evaluación nutricional y de salud en general, así como en la disminución de los riesgos asociados con la clasificación errónea de la edad cronológica.

  7. [ANTHROPOMETRIC PARAMETERS' CUT-OFF POINTS FOR DIAGNOSIS OF SARCOPENIA].

    PubMed

    Canda Moreno, Alicia S

    2015-08-01

    Introducción: la sarcopenia es un síndrome caracterizado por baja masa muscular junto con pérdida de fuerza y/o disminución del rendimiento físico. Debido al envejecimiento de nuestra población, se ha producido un aumento de su prevalencia relacionada con la edad, a la que se suman otros factores causados por ciertas enfermedades o la malnutrición. Objetivo: ofrecer una herramienta para el diagnóstico de sarcopenia que determine de forma accesible la pérdida de masa muscular. Material y métodos: se realizó un protocolo antropométrico estandarizado en 883 varones y 506 mujeres, sanos y activos, de edad entre 20 y 39 años. Se calcularon los siguientes índices de desarrollo muscular: perímetros (brazo, antebrazo, muslo y pierna), perímetros corregidos (brazo, muslo y pierna), áreas musculares transversales (CSA de brazo, muslo y pierna) y masa muscular total (kg), en porcentaje (%) y relativa a la talla (kg/m2) mediante la ecuación de Lee. Se fijó como punto de corte el percentil 2,5 (rango inferior del 95% del intervalo de confianza) para las variables estudiadas. Resultados: se encontraron diferencias significativas (p < 0,0001) entre varones y mujeres en todos los indicadores. Los valores del punto de corte de diagnóstico de baja masa muscular fue en varones de 9,1 kg/m2, y en mujeres de 7,3 kg/m2. Y para las CSA (cm2) varón vs. mujer: brazo, 37,7 vs. 24,2; muslo, 154,3 vs. 115,8; y pierna, 78,8 vs. 60,2. Conclusiones: existe dimorfismo sexual que exige criterios diagnósticos diferenciados. La técnica antropométrica puede servir como screening de sarcopenia en el estudio de grandes poblaciones.

  8. Teaching of Astronomy: Scenarios of Teaching Practice in Elementary Schools. (Spanish Title: Enseñanza de la Astronomía: Semblanzas de la Práctica Docente en Educación Primaria.) Ensino de Astronomia: Cenários da Prática Docente no Ensino Fundamental

    NASA Astrophysics Data System (ADS)

    Marchi Gonzatti, Sônia Elisa; Spessatto De Maman, Andréia; Fernandes Borragini, Eliana; Kerber, Júlia Cristina; Haetinger, Werner

    2013-12-01

    atomización de los asuntos, aunque temas como movimientos de la Tierra y fenómenos astronómicos hayan sido citados por la mayoría de los participantes. En cuanto a las estrategias, se verifico que se emplean principalmente clases con el apoyo de recursos bidimensionales, como películas, textos, mapas y búsqueda en internet. Las principales dificultades fueron la falta de formación específica con respecto a los contenidos de Astronomía, y el nivel de abstracción exigido por los contenidos. De modo general, esos indicadores convergen para los resultados ya encontrados en otros estudios, en el que las deficiencias de la formación inicial de los profesores, o incluso su ausencia, dificulta el adecuado abordaje de la Astronomía en las clases. Neste trabalho são apresentados os principais resultados de uma investigação realizada no campo da Educação em Astronomia, com professores do ensino fundamental de duas regiões do Rio Grande do Sul. O objetivo do estudo foi caracterizar o cenário regional do ensino de Astronomia, estabelecendo um comparativo com o cenário nacional. Esse estudo abordou três questões: identificar os principais temas de astronomia trabalhados em sala de aula, as estratégias metodológicas e quais as dificuldades apresentadas pelos professores ao desenvolver sua prática. Quanto aos conteúdos, encontrouse uma pulverização dos assuntos abordados, embora temas como movimentos da Terra e fenômenos astronômicos tenham sido citados pela maioria dos participantes. Sobre estratégias, são utilizadas principalmente aulas com apoio de recursos bidimensionais, como filmes, textos, mapas e pesquisa na internet. As principais dificuldades foram: falta de formação específica em relação a conteúdos de Astronomia; nível de abstração dos conteúdos, que dificultam sua compreensão, tanto pelos alunos quanto pelos próprios professores. De maneira geral, esses indicadores convergem para resultados já encontrados em outros estudos que

  9. Association Between Albuminuria and Duration of Diabetes and Myocardial Dysfunction and Peripheral Arterial Disease Among Patients With Stable Coronary Artery Disease in the BARI 2D Study

    PubMed Central

    Escobedo, Jorge; Rana, Jamal S.; Lombardero, Manuel S.; Albert, Stewart G.; Davis, Andrew M.; Kennedy, Frank P.; Mooradian, Arshag D.; Robertson, David G.; Srinivas, V. S.; Gebhart, Suzanne S. P.

    2010-01-01

    OBJECTIVE: To evaluate the effect of prior duration of diabetes, glycated hemoglobin level at study entry, and microalbuminuria or macroalbuminuria on the extent and severity of coronary artery disease (CAD) and peripheral arterial disease. PATIENTS AND METHODS: We studied baseline characteristics of the 2368 participants of the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) study, a randomized clinical trial that evaluates treatment efficacy for patients with type 2 diabetes and angiographically documented stable CAD. Patients were enrolled from January 1, 2001, through March 31, 2005. Peripheral arterial disease was ascertained by an ankle-brachial index (ABI) of 0.9 or less, and extent of CAD was measured by presence of multivessel disease, a left ventricular ejection fraction (LVEF) of less than 50%, and myocardial jeopardy index. RESULTS: Duration of diabetes of 20 or more years was associated with increased risk of ABI of 0.9 or less (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.04-2.26), intermittent claudication (OR, 1.61; 95% CI, 1.10-2.35), and LVEF of less than 50% (OR, 2.03; 95% CI, 1.37-3.02). Microalbuminuria was associated with intermittent claudication (OR, 1.53; 95% CI, 1.16-2.02) and ABI of 0.9 or less (OR, 1.31; 95% CI, 0.98-1.75), whereas macroalbuminuria was associated with abnormal ABI, claudication, and LVEF of less than 50%. There was a significant association between diabetes duration and extent of CAD as manifested by number of coronary lesions, but no other significant associations were observed between duration of disease, glycated hemoglobin levels, or albumin-to-creatinine ratio and other manifestations of CAD. CONCLUSION: Duration of diabetes and microalbuminuria or macroalbuminuria are important predictors of severity of peripheral arterial disease and left ventricular dysfunction in a cohort of patients selected for the presence of CAD. PMID:20042560

  10. Preventing renal and cardiovascular risk by renal function assessment: insights from a cross-sectional study in low-income countries and the USA

    PubMed Central

    Cravedi, Paolo; Sharma, Sanjib Kumar; Bravo, Rodolfo Flores; Islam, Nazmul; Tchokhonelidze, Irma; Ghimire, Madhav; Pahari, Bishnu; Thapa, Sanjeev; Basnet, Anil; Tataradze, Avtandil; Tinatin, Davitaia; Beglarishvili, Lela; Fwu, Chyng-Wen; Kopp, Jeffrey B; Eggers, Paul; Ene-Iordache, Bogdan; Carminati, Sergio; Perna, Annalisa; Chianca, Antonietta; Couser, William G; Remuzzi, Giuseppe; Perico, Norberto

    2012-01-01

    Objective To assess the prevalence of microalbuminuria and kidney dysfunction in low-income countries and in the USA. Design Cross-sectional study of screening programmes in five countries. Setting Screening programmes in Nepal, Bolivia, the USA (National Health and Nutrition Examination Survey (NHANES) 2005–2008) Bangladesh and Georgia. Participants General population in Nepal (n=20 811), Bolivia (n=3436) and in the USA (n=4299) and high-risk subjects in Bangladesh (n=1518) and Georgia (n=1549). Primary and secondary outcome measures Estimated glomerular filtration rate (eGFR)<60ml/min/1.73 m2 and microalbuminuria (defined as urinary albumin creatinine ratio values of 30–300 mg/g) were the main outcome measures. The cardiovascular (CV) risk was also evaluated on the basis of demographic, clinical and blood data. Results The prevalence of eGFR<60ml/min/1.73 m2 was 19%, 3.2% and 7% in Nepal, Bolivia and the USA, respectively. In Nepal, 7% of subjects were microalbuminuric compared to 8.6% in the USA. The prevalence of participants with predicted 10-year CV disease (CVD) risk ≥10% was 16.9%, 9.4% and 17% in Nepal, Bolivia and in the USA, respectively. In Bangladesh and Georgia, subjects with eGFR<60 ml/min/1.73 m2 were 8.6% and 4.9%, whereas those with microalbuminuria were 45.4% and 56.5%, respectively. Predicted 10-year CVD risk ≥10% was 25.4% and 25% in Bangladesh and Georgia, respectively. Conclusions Renal abnormalities are common among low-income countries and in the USA. Prevention programmes, particularly focused on those with renal abnormalities, should be established worldwide to prevent CVD and progression to end-stage renal disease. PMID:23002161

  11. Early changes of urinary amylase isoenzymes in diabetes mellitus.

    PubMed

    Recio, F; Villamil, F; Recio, C; Ferrer, C

    1992-10-01

    The altered excretion of isoenzymes of amylase in urine was used as an early indicator of the loss of electric charges in the glomerular basement membrane, in 202 juvenile-onset insulin-dependent diabetic patients, compared with the pattern of excretion in 51 normal subjects matched for age and sex. Diabetics showed an increased excretion of salivary amylase. The salivary to pancreatic amylase ratio in urine (S/P ratio) was always below 1 in control subjects, but was elevated in 33.2% of diabetics, although microalbuminuria was present in only 26.2% of diabetic patients. The concentrations of other proteins in urine were within the reference ranges in nearly all patients, indicating that the kidney was not seriously affected. The increased salivary amylase excretion was not due to changes in the plasma concentration of any of the isoamylases, but to a real increase in excretion, as its fractional excretion in relation to creatinine clearance was clearly increased (1.0 +/- 0.7 vs. 1.52 +/- 1.99, p < 0.05), and the ratio of their clearances was also increased (0.35 +/- 0.18 vs. 0.49 +/- 0.61, p > 0.05). Moreover, the prevalence of altered S/P ratios was higher than the prevalence of microalbuminuria (36.6% vs. 18.8% of patients in the first decade of evolution of insulin-dependent diabetes mellitus). Altered S/P ratios were most prevalent in the first decade, whereas microalbuminuria was most prevalent in the second decade of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Non-albuminuric renal disease among subjects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus.

    PubMed

    Boronat, Mauro; García-Cantón, César; Quevedo, Virginia; Lorenzo, Dionisio L; López-Ríos, Laura; Batista, Fátima; Riaño, Marta; Saavedra, Pedro; Checa, María D

    2014-03-01

    Urinary albumin excretion has been consistently found to be normal in a significant number of subjects with early stages of diabetic kidney disease. This study was aimed to estimate the prevalence and characteristics of non-albuminuric chronic kidney disease associated with type 2 diabetes mellitus among subjects who reach advanced stages of renal failure. Study population was composed of incident patients with advanced chronic kidney disease (glomerular filtration rate <30 mL/min) related to type 2 diabetes in a tertiary hospital from Gran Canaria (Spain) during a period of 2 years. Subjects were classified as normoalbuminuric (urinary albumin-to-creatine ratio [UACR] <30 mg/g), microalbuminuric (UACR ≥30 and <300 mg/g), or proteinuric (UACR ≥300 mg/g). Of 78 eligible patients, 21.8% had normoalbuminuria, 20.5% had microalbuminuria, and 57.7% had proteinuria. Individuals with normoalbuminuria were mostly women and had a lower prevalence of smoking and polyneuropathy than subjects with microalbuminuria or proteinuria. They also presented greater measures of body mass index and waist circumference, higher values of total and LDL cholesterol, and lower values of HbA1c and serum creatinine than subjects with microalbuminuria or proteinuria. Multivariate analysis demonstrated that female sex (positively) and HbA1c and polyneuropathy (negatively) were independently associated with absence of albuminuria. In conclusion, around 20% of subjects with diabetes-related advanced chronic kidney disease, characteristically women, have normal urinary albumin excretion. HbA1c and polyneuropathy are inversely related to this non-albuminuric form of nephropathy.

  13. Type 2 diabetes: RENAAL and IDNT--the emergence of new treatment options.

    PubMed

    Sica, Domenic A; Bakris, George L

    2002-01-01

    The Reduction in End Points in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study and the Irbesartan Diabetic Nephropathy Trial (IDNT) are two recently reported trials with hard end points, conducted in patients in advanced stages of diabetic nephropathy. Two other studies--the Irbesartan Microalbuminuria Study (IRMA)-2 and the Microalbuminuria Reduction with Valsartan study (MARVAL)--were trials conducted in patients with type 2 diabetes with microalbuminuria, a cardiovascular risk factor associated with early-stage diabetic nephropathy. These trials all had a common theme--that is, does an angiotensin receptor blocker (ARB) interfere with the natural history of diabetic nephropathy in a blood pressure-independent fashion? Without question, the results of these trials legitimatize the use of the ARB class in forestalling the deterioration in renal function, which is almost inevitable in the patient with untreated diabetic nephropathy. These data can now be added to the vast array of evidence supporting angiotensin-converting enzyme (ACE) inhibitor use in patients with nephropathy associated with type 1 diabetes. It now appears a safe conclusion that the patient with diabetic nephropathy should receive therapy with an agent that interrupts the renin-angiotensin system. These studies have not resolved the question as to whether an ACE inhibitor or an ARB is the preferred agent in people with nephropathy from type 1 diabetes, though the optimal doses of these drugs remain to be determined. Head-to-head studies comparing ACE inhibitors to ARBs in diabetic nephropathy are not likely to occur, so it is unlikely that comparable information will be forthcoming with ACE inhibitors. An evidence-based therapeutic approach derived from these trials would argue for ARBs to be the foundation of therapy in the patient with type 2 diabetes and nephropathy. PMID:11821641

  14. Kidney disease and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study.

    PubMed

    de Boer, Ian H

    2014-01-01

    OBJECTIVE Kidney disease manifests clinically as elevated albumin excretion rate (AER), impaired glomerular filtration rate (GFR), or both, and is a cause of substantial morbidity and mortality in type 1 diabetes (T1D). The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study tested whether intensive diabetes therapy (INT) aimed at lowering glucose concentrations as close as safely possible to the normal range reduces the risks of kidney disease and other diabetes complications. RESEARCH DESIGN AND METHODS In the DCCT, 1,441 participants with T1D were randomly assigned to INT or conventional diabetes therapy (CON) for a mean duration of 6.5 years. Subsequently, participants have been followed for 18 years in the ongoing observational EDIC. Standardized longitudinal measurements of AER, estimated GFR, and blood pressure were made throughout the DCCT/EDIC. RESULTS During the DCCT, INT reduced the risks of incident microalbuminuria (AER ≥40 mg/24 h) and macroalbuminuria (AER ≥300 mg/24 h) by 39% (95% CI 21-52%) and 54% (29-74%), respectively. During EDIC years 1-8, participants previously assigned to DCCT INT continued to experience lower rates of incident microalbuminuria and macroalbuminuria, with risk reductions of 59% (39-73%) and 84% (67-92%), respectively. Beneficial effects of INT on the development of impaired GFR (sustained estimated GFR <60 mL/min/1.73 m(2)) and hypertension became evident during combined DCCT/EDIC follow-up, with risk reductions of 50% (18-69%) and 20% (6-21%), respectively, compared with CON. CONCLUSIONS In the DCCT/EDIC, INT resulted in clinically important, durable reductions in the risks of microalbuminuria, macroalbuminuria, impaired GFR, and hypertension.

  15. Diabetes disease management in Medicaid managed care: a program evaluation.

    PubMed

    Patric, Kenneth; Stickles, Joyce D; Turpin, Robin S; Simmons, Jeffrey B; Jackson, James; Bridges, Elizabeth; Shah, Manan

    2006-06-01

    The objective of this study was to evaluate the outcomes of a diabetes disease management initiative among TennCare's Medicaid Population. A quasi-experimental group design was conducted using a control group and a diabetes disease management intervention group. Primary outcomes measures were rates for three key recommended tests (ie, microalbuminuria, lipids, and hemoglobin A1c). Secondary performance measures --patient satisfaction and program evaluation issues -- also were assessed. The study was performed among TennCare beneficiaries with diabetes mellitus. It utilized a quasi-experimental nonequivalent control group design, with 993 intervention participants in Knoxville and 1167 control group members in Chattanooga. Variables analyzed included testing rates for hemoglobin A1c, lipids, microalbuminuria, and demographics. A logistic regression model using baseline covariates was constructed to analyze the differences between the intervention and the control groups. Intracluster correlations were accounted for by generalized estimating equations. Statistical process control detected process changes in testing rates over time. There were meaningful changes in the rate of ordering recommended tests. The odds of an individual in the intervention group having at least one microalbuminuria test were 196% more (confidence interval [CI] = 1.50, 5.82; p = 0.002); the odds of having at least one lipid profile were 43% more (CI = 1.01, 2.02; p = 0.042); and the odds of having two or more hemoglobin A1c tests were 39% more (CI = 0.87, 2.23; p = 0.165) than the odds of an individual in the control group. The analysis also showed a high rate of satisfaction among patients in the intervention group. The program was successful in meeting its stated goals of providing effective disease management for TennCare patients with diabetes.

  16. Short-term bioeffects of extracorporeal shockwave lithotripsy.

    PubMed

    Akdaş, A; Türkeri, L N; Ilker, Y; Simşek, F; Emerk, K

    1994-06-01

    Safety guidelines for shockwave delivery during extracorporeal shockwave lithotripsy (SWL) are not yet clear. Renal functions were assessed by using urinary N-acetyl-beta-D-glucosaminidase (NAG), lactate dehydrogenase (LDH), alanine aminotransferase (ALT; EC.2.6.1.2), aspartate aminotransferase (AST; EC. 2.6.1.1), and gamma-glutamyltransferase (GGT) as well as sodium, potassium, and calcium concentrations in respect to tubular functions after SWL with the Dornier MFL 5000 unit in 32 patients. In order to monitor glomerular function, we determined microalbuminuria. Transient glomerular and tubular damage occurs in SWL-treated kidneys. The minimum interval between two shockwave treatments should be at least 7 days.

  17. Impaired endocytosis in proximal tubule from subchronic exposure to cadmium involves angiotensin II type 1 and cubilin receptors

    PubMed Central

    2013-01-01

    Background Chronic exposure to low cadmium (Cd) levels produces urinary excretion of low molecular weight proteins, which is considered the critical effect of Cd exposure. However, the mechanisms involved in Cd-induced proteinuria are not entirely clear. Therefore, the present study was designed to evaluate the possible role of megalin and cubilin (important endocytic receptors in proximal tubule cells) and angiotensin II type 1 (AT1) receptor on Cd-induced microalbuminuria. Methods Four groups of female Wistar rats were studied. Control (CT) group, vehicle-treated rats; LOS group, rats treated with losartan (an AT1 antagonist) from weeks 5 to 8 (10 mg/kg/day by gavage); Cd group, rats subchronically exposed to Cd (3 mg/kg/day by gavage) during 8 weeks, and Cd + LOS group, rats treated with Cd for 8 weeks and LOS from weeks 5–8. Kidney Cd content, glomerular function (evaluated by creatinine clearance and plasma creatinine), kidney injury and tubular function (evaluated by Kim-1 expression, urinary excretion of N-acetyl-β-D-glucosaminidase (NAG) and glucose, and microalbuminuria), oxidative stress (measured by lipid peroxidation and NAD(P)H oxidase activity), mRNA levels of megalin, expressions of megalin and cubilin (by confocal microscopy) and AT1 receptor (by Western blot), were measured in the different experimental groups. Data were analyzed by one-way ANOVA or Kruskal-Wallis test using GraphPad Prism 5 software (Version 5.00). P < 0.05 was considered statistically significant. Results Administration of Cd (Cd and Cd + LOS groups) increased renal Cd content. LOS-treatment decreased Cd-induced microalbuminuria without changes in: plasma creatinine, creatinine clearance, urinary NAG and glucose, oxidative stress, mRNA levels of megalin and cubilin, neither protein expression of megalin nor AT1 receptor, in the different experimental groups studied. However, Cd exposure did induce the expression of the tubular injury marker Kim-1 and decreased

  18. Lisinopril. A review of its pharmacology and use in the management of the complications of diabetes mellitus.

    PubMed

    Goa, K L; Haria, M; Wilde, M I

    1997-06-01

    Lisinopril, like other ACE inhibitors, lowers blood pressure and preserves renal function in hypertensive patients with non-insulin-dependent or insulin-dependent diabetes mellitus (NIDDM or IDDM) and early or overt nephropathy, without adversely affecting glycaemic control or lipid profiles. On available evidence, renoprotective effects appear to be greater with lisinopril than with comparator calcium channel blockers, diuretics and beta-blockers, despite similar antihypertensive efficacy. As shown by the EUCLID (EUrodiab Controlled trial of Lisinopril in Insulin-Dependent Diabetes) trial, lisinopril is also renoprotective in normotensive patients with IDDM and microalbuminuria. The effect in normotensive patients with normoalbuminuria was smaller than in those with microalbuminuria, and no conclusions can yet be made about its use in patients with normoalbuminuria. In complications other than nephropathy, lisinopril has shown some benefit. Progression to retinopathy was slowed during 2 years' lisinopril therapy in the EUCLID study. Although not yet fully published, these results provide the most convincing evidence to date for an effect of an ACE inhibitor in retinopathy. The drug may also improve neurological function, but this finding is preliminary. Lastly, post hoc analysis of the GISSI-3 trial indicates that lisinopril reduces 6-week mortality rates in diabetic patients when begun as early treatment after an acute myocardial infarction. The tolerability profile of lisinopril is typical of ACE inhibitors and appears to be similar in diabetic and nondiabetic individuals. Hypoglycaemia has occurred at a similar frequency with lisinopril and placebo, as shown in the EUCLID trial. In addition, the GISSI-3 study indicates that the incidence of persistent hypotension and renal dysfunction is increased with lisinopril in general, but the presence of diabetes does not appear to confer additional risk of these events in diabetic patients with acute myocardial

  19. [Relevance of chronic kidney disease and cardiovascular prognosis in arterial hypertension].

    PubMed

    Segura de la Morena, Julián; García Donaire, José Antonio; Ruilope Urioste, Luis Miguel

    2004-06-26

    Recently published guidelines recognize the relevance of the finding of chronic kidney disease in the stratification of risk of the hypertensive patient. Determination of the presence of microalbuminuria and estimation of glomerular filtration rate are mandatory in order to ensure an adequate evaluation of global cardiovascular risks in the hypertensive patient. The presence of subtle elevations of serum creatinine concentrations and/or proteinuria are also potent predictors of a poor cardiovascular prognosis. Clustering of associated risk factors seems to justify the elevated cardiovascular risk observed in patients with essential hypertension and mild alterations of renal function.

  20. APPLICATILITY OF THE VISCERAL ADIPOSITY INDEX (VAI) IN THE PREDICTION OF THE COMPONENTS OF THE METABOLIC SYNDROME IN ELDERLY.

    PubMed

    Goldani, Heloisa; Adami, Fernanda Scherer; Antunes, Maria Terezinha; Rosa, Luis Henrique; Fassina, Patrícia; Quevedo Grave, Magali Terezinha; Morelo Dal Bosco, Simone

    2015-10-01

    La evaluación nutricional puede detectar un estado de desnutrición, sobrepeso y riesgo cardiometabólico en los ancianos. Fácil de aplicar, los instrumentos permiten la identificación de factores de riesgo de enfermedades cardiovasculares (ECV). Objetivo: analizar la aplicabilidad del Índice de Adiposidad Visceral (VAI) en la predicción de los componentes del SM en los ancianos. Métodos: estudio transversal con 221 personas mayores con una edad media de 70,65 ± 7,34 años; 53,4% mujeres y 46,4% hombres. Se obtuvieron peso, talla, circunferencia de la cintura (CC), glucosa en ayunas, triglicéridos (TG), colesterol total (CT), colesterol HDL (HDL-C), colesterol LDL (LDL-C) y presión arterial (PA), así como información acerca del estilo de vida. No se calcularon el índice de masa corporal (IMC), la relación cintura-cadera (WHR) y el VAI. Las medidas de adiposidad se compararon con los componentes de la MS, y para el VAI no se determinó la capacidad de predecir la ocurrencia de los componentes del SM. Resultados: el análisis de la asociación entre las variables bioquímicas y de presión y los componentes del SM con los indicadores antropométricos de obesidad evidencia que existe una correlación directa y significativa entre el índice de masa corporal, el peso y el VAI con la glucosa en sangre, colesterol HDL y TG (p < 0,01); el VAI fue el indicador con la correlación más fuerte para todos los parámetros. El WC se asoció significativamente con el HDL y TG, y el RHO solo con el HDL. En lo que respecta a la aplicabilidad de la VAI en la determinación del riesgo relativo de aparición de los componentes del SM, el VAI era buen predictor de obesidad abdominal (OR = 1,27, p < 0,001), hiperglucemia (OR = 1,10, p = 0,043), hipertrigliceridemia (OR = 3,64, p < 0,001) y bajos niveles de HDL-c (OR = 2,26, p < 0,001). Conclusión: el VAI mostró asociación con componentes del síndrome metabólico en los hombres y las mujeres con mayor riesgo de obesidad

  1. Developing Academic Literacy and Voice: Challenges Faced by a Mature ESL Student and Her Instructors (Desarrollo del discurso académico y la voz: retos de una estudiante de inglés como segunda lengua y sus profesores)

    ERIC Educational Resources Information Center

    Correa, Doris

    2010-01-01

    Drawing on critical, socio-cultural and sociolinguistic theories of writing, text and voice, this ethnographic study examines the challenges that a mature ESL student and her instructors in a university course on Spanish Language Media face as they co-construct a common understanding of academic literacy and voice in an undergraduate General…

  2. Systemic Functional Linguistics and Discourse Analysis as Alternatives When Dealing with Texts (La lingüística sistémica funcional y el análisis del discurso como alternativas para trabajar con textos)

    ERIC Educational Resources Information Center

    García Montes, Paula Andrea; Sagre Barboza, Ana María; Lacharme Olascoaga, Alba Isabel

    2014-01-01

    This article presents a case study research with aims to find out which activities, methodological and textual aspects used in a reading strategies course were causing a group of students difficulties when analyzing critically written information. We conducted the study at Universidad de Córdoba (Colombia) with seventh semester students from the…

  3. The Portrayal of EFLTeachers in Official Discourse: The Perpetuation of Disdain (La imagen de los profesores de inglés como lengua extranjera en el discurso oficial: la perpetuación del desdén)

    ERIC Educational Resources Information Center

    Guerrero, Carmen Helena

    2010-01-01

    The purpose of this article is to offer an interpretation of the images of Colombian English teachers constructed in official discourse, particularly (but not exclusively) in the document "Estándares básicos de competencias en lenguas extranjeras: inglés. Formar en lenguas extranjeras, el reto". This is part of a larger critical…

  4. Estudo da utilizacao da biomassa florestal como fonte de produtos quimicos e energia atraves de processos quimicos e biotechnologicos (Utilization of forest biomass for chemicals and energy by chemical and biotechnological processes). Master's thesis

    SciTech Connect

    de Miranda, I.M.S.S.

    1989-04-01

    The chemical composition and the non-structural carbohydrate composition were determined for 1-year-old Eucalyptus globulus Labill trees, grown in an experimental plantation with different nutrient and water supplies (C-trees, where no treatment was made and IL-trees, which received a nutrient supply and irrigation). Leaf carbohydrates were determined for the same conditions. Pulping experiments were made using kraft cooks of eucalyptus wood. The results of the pretreatments are complemented with scanning electron microscopy observations. Average wood composition was: ash 1.6%, total extractives 5.2%, Klason lignin 21.0%, soluble lignin 3.1% (% of o.d. weight). The results did not show statistical significant differences between the two growth conditions. The average wood carbohydrate composition was: glucose 2.7%, frutose 4.1% sucrose 1.3% and starch 0.5%. The average carbohydrate composition of leaves was: glucose 1.0%, frutose 1.7%, sucrose 0.1% and starch 4.1%. The average yield for the kraft wood delinification was 49%. The saccharification of pretreated eucalyptus chips with a steam-explosion pretreatment was: For H2SO4 impregnation 26.6% and for H2O impregnation 44.2%.

  5. Como Promover el Exito de las Ninas y las Minorias en las Ciencias y en las Matematicas. Para Padres/sobre Padres (How To Promote the Science and Mathematics Achievement of Females and Minorities. For Parents/about Parents).

    ERIC Educational Resources Information Center

    Schwartz, Wendy

    Some minority and female students traditionally have not been given the help they need to enroll and succeed in mathematics and science classes. Now, however, various approaches are available to give these students the extra attention they need. Parents can help children develop an interest in science and mathematics by: (1) identifying role…

  6. When Students Say Far Too Much: Examining Gushing in the ELT Classroom (Cuando los alumnos dicen demasiado: análisis del uso excesivo de palabras en clases de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Mugford, Gerrard; Cuevas, Oscar Ramírez

    2015-01-01

    English foreign-language users often overuse words when faced with difficult situations. Called gushing, such excessive use of words is often legitimately employed by native speakers to express, for instance, gratitude and apologies when a simple "thank you" or "sorry" does not sufficiently convey an interlocutor's feelings.…

  7. Exploring Elementary Students' Power and Solidarity Relations in an EFL Classroom (Exploración de las relaciones de poder y solidaridad entre estudiantes de primaria en la clase de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Méndez, Tatiana; García, Andrea

    2012-01-01

    This article derives from a critical discourse analysis study that reports the characteristics of elementary school students' power and solidarity relations in English as a foreign language classroom in Bogotá, Colombia, while we were doing our teaching English as a foreign language practicum. The study was based on theories of power and…

  8. The Preschool Classroom as a Context for Cognitive Development: Type of Teacher Feedback and Children's Metacognitive Control (El aula Preescolar como espacio de desarrollo cognitivo: tipo de feedback docente y control metacognitivo en los niños)

    ERIC Educational Resources Information Center

    Muñoz, Liz; Cruz, Josefina Santa

    2016-01-01

    Introduction: The aim of this work was to determine whether the type of feedback given by the preschool teacher during class impacts the children's metacognitive control. For this purpose, the children's behavior was analyzed while teachers provided feedback during collaborative learning sessions. Method: A quasi-experimental, cross-sectional…

  9. La lectura literaria como arte de "performance": la teoria transaccional de Louise Rosenblatt y sus implicaciones pedagogicas (The Use of Literature as Performance Art: The Transactional Theory of Louise Rosenblatt and Its Pedagogical Implications).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper focuses on the work that Louise Rosenblatt and her followers in the United States have done to improve the teaching and learning of literature at all educational levels. Although these researchers have focused almost exclusively on the use of literature in the native language, the paper uses transactional theory as a basis for teaching…

  10. Introversion/Extroversion & Teachers' Perception on Dominican EFL College Students' Performance = La Introversion/Extroversion vs. La Percepcion Profesoral en el Desempeno de Estudiantes Universitarios Dominicanos de Ingles como Lengua Extranjera

    ERIC Educational Resources Information Center

    Tavarez Da Costa, Pedro

    2012-01-01

    This article discusses the relationship between introversion/extroversion and a student's performance (academic achievement) as perceived by Teachers of English as a Foreign Language in three regional centers of the Universidad Autonoma de Santo Domingo. There have been a great number of international studies already published to try to explain…

  11. Un estudio de evaluacion educativa manipulativos en el aprendizaje de las matematicas con estudiantes hispanos adquiriendo ingles academico como segunda lengua (A Study of the Use of Manipulatives in the Assessment of Mathematics Instruction with ESL Hispanic Students).

    ERIC Educational Resources Information Center

    Lara-Alecio, Rafael; Parker, Richard; Aviles, Claudia; Mason, Samantha; Irby, Beverly J.

    1998-01-01

    As an alternative form of mathematics assessment for use with limited-English-proficient students, 14 mathematics tasks using manipulatives were administered to 45 Hispanic students in grades 1-3 and readministered 2-3 weeks later. Test reliability and validity, task difficulty, and the relationship among test subscales across grades were…

  12. Encuentros esteticos deweyanos con la cultura popular anglofona en la ensenanza de ingles como lengua extranjera (EILE). Working Paper (Deweyan Aesthetic Encounters with Anglophone Popular Culture in the Teaching of English as a Foreign Language. Working Paper).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper discusses how the introduction of Anglophone popular culture in the English-as-a-foreign-language class can serve to foster critical aesthetic experiences. It is argued that the popular culture of the hegemonic Anglophone countries is already part of students' lives and for that reason should be included in any critical Anglophone…

  13. La Capacitacion de Docentes Como Prioridad de los Sistemas Educativos de America Latino y al Caribe (In-Service Teacher Training as a Priority of Latin American and Caribbean Educational Systems).

    ERIC Educational Resources Information Center

    Valle, Victor M.

    Whenever top-level officials in Latin American and Caribbean educational systems are approached, the topic of inservice teacher training is presented as a major priority. This paper outlines some ideas about the subject of inservice teacher training as a priority of educational systems in Latin American and Caribbean countries. The most frequent…

  14. Exploring Authorship Development among Mexican EFL Teacher-Researchers (Exploración sobre el desarrollo de la autoría en los profesores-investigadores de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Trujeque Moreno, Eva Estefania; Encinas Prudencio, Fátima; Thomas-Ruzic, Maria

    2015-01-01

    This article presents a multi-theoretical model to address processes of "authorship development" in the English as a foreign language teaching profession. Working within a sociocultural perspective of second-language teacher education, the authors examined six experienced nonnative English-speaking teacher-researchers. Perceptions of…

  15. Learning & Growing Together: Understanding and Supporting Your Child's Development = Aprender y crecer juntos: Como comprender y fomentar el desarrollo de sus hijos [with] Tip Sheets: Ideas for Professionals in Programs That Serve Young Children and Their Families.

    ERIC Educational Resources Information Center

    Lerner, Claire; Dombro, Amy Laura; Powers, Stefanie

    Based on the view that the primary caregivers for infants and toddlers are their own best resource for understanding and caring for their child and that parenting is a lifelong learning process, this book provides information and tools to help caregivers build a strong foundation for their child's development. The book, both in English and…

  16. Moral Responsibility and Confidence as Factors That Influence Teacher Involvement in Educational Change (Responsabilidad moral y confianza como factores que influyen en la participación del profesor en el cambio educativo)

    ERIC Educational Resources Information Center

    López, Cecilio

    2010-01-01

    Various factors that are not easily observed have a strong impact on educational change. In this paper, I examine some of the issues that emerged from the data collected while exploring my informants' perceptions and attitudes towards their changing roles when confronted with curriculum innovation. This research demonstrates that the…

  17. Coping with Social Change: Programs That Work. Proceedings of a Conference (Acapulco, Mexico, June 1989) = Como enfrentarse al cambio social: programas eficaces. Actas de uno Conferencia (Acapulco, Mexico, Junio de 1989).

    ERIC Educational Resources Information Center

    Hoskins, Irene, Ed.

    Written in English and Spanish, this document contains the proceedings of the 14th International Congress of Gerontology on concerns about the impact of rapid social change on the well-being of older women and families in Latin American and the Caribbean and about effective programs that address the needs of the older populations. The first…

  18. The Role of Genre-Based Activities in the Writing of Argumentative Essays in EFL (El papel de actividades basadas en géneros en la escritura de ensayos argumentativos en inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Chala Bejarano, Pedro Antonio; Chapetón, Claudia Marcela

    2013-01-01

    This article presents the findings of an action research project conducted with a group of pre-service teachers of a program in modern languages at a Colombian university. The study intended to go beyond an emphasis on linguistic and textual features in English as a foreign language argumentative essays by using a set of genre-based activities and…

  19. Adult EFL Reading Selection: Influence on Literacy (Procesos de selección de lecturas en estudiantes adultos de inglés como lengua extranjera y su influencia en la habilidad lectora)

    ERIC Educational Resources Information Center

    Basallo Gómez, Juan Sebastián

    2016-01-01

    This paper is about the impact of systematic reading selection used to promote English as foreign language learning in adult students. A qualitative action research methodology was used to carry out this project. Ten class sessions were designed to provide students an opportunity to select texts according to criteria based upon their language…

  20. Parents as Partners: Planning Early for Your Children's School Success and College Attendance = Los Padres como Socios: Planificando para el Exito Escolar y la Asistencia al Colegio de Sus Ninos.

    ERIC Educational Resources Information Center

    California State Univ., Long Beach.

    Presented in both the English and Spanish Language versions is a booklet which describes what parents can do at home and in the school to support and encourage their children's success in school and college. Discussion emphasizes the extent to which parents influence their children's attitudes about learning and school, and points out that parent…

  1. Como ayudar a su hijo a ser un buen lector: Con actividades para los ninos desde el nacimiento hasta los 6 anos (Helping Your Child Become a Reader: With Activities for Children from Infancy through Age 6).

    ERIC Educational Resources Information Center

    Lehr, Fran; Osborn, Jean

    When parents and other family members read with their children, help them with homework, talk with their teachers, and participate in school or other learning activities, they give their children a tremendous advantage. The foundation for learning to read is in place long before children enter school and begin formal reading instruction. Families…

  2. Parents as Partners: Planning Early for Your Children's School Success and College Attendance. Revised Edition = Los Padres como Socios: Planificando para el Exito Escolar y la Asistencia al Colegio de Sus Ninos. Edicion Revisada.

    ERIC Educational Resources Information Center

    Reyes, Maria; Rothman, Donald

    This booklet, available in English and Spanish, describes what California parents can do at home and in the school to support and encourage their children's success in school and college. Discussion emphasizes the extent to which parents influence their children's attitudes about learning and school, and points out that parent involvement is…

  3. Finding Family Balance: Establishing an Adult Relationship with the Person with a Disability (A Pamphlet for Families) [and] Equilibrio Familiar: Como Establecer una Relacion Adulta con la Persona con Impedimentos (Panfleto para la Familia).

    ERIC Educational Resources Information Center

    Baron, Carla

    Two booklets, in English and Spanish, are addressed to families of disabled adults and offer guidelines for establishing an adult relationship with the disabled individual within the family. Stressed are the importance of helping the disabled adult develop a positive self image, learning to truly listen to the adult as part of improving…

  4. Como ayudar a su hijo durante la edad preescolar, con actividades para los ninos desde el nacimiento hasta los 5 anos (Helping Your Preschool Child, with Activities for Children from Infancy through Age 5).

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC. Office of Intergovernmental and Interagency Affairs.

    The first 5 yeas of a child's life are a time of tremendous physical, emotional, social, and cognitive growth. Noting that research shows that children are more likely to succeed in learning when their families actively support them, this Spanish-language booklet is intended for families and caregivers who want to help their preschool children…

  5. The Impact of Different Types of Journaling Techniques on EFL Learners' Self-Efficacy (El impacto de diferentes tipos de diario en la autosuficiencia de estudiantes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Mortazavi, Mahboobeh

    2014-01-01

    This article reports on an investigation of the impact of different methods of journaling on self-efficacy of learners of English as a foreign language. Sixty upper-intermediate Iranian English language learners were randomly assigned to three experimental conditions, namely no-feedback, teacher-feedback, and peer-feedback, and one control…

  6. Teachers' Beliefs about Assessment in an EFL Context in Colombia (Creencias de los profesores acerca de la evaluación en un contexto de inglés como lengua extranjera en Colombia)

    ERIC Educational Resources Information Center

    Muñoz, Ana Patricia; Palacio, Marcela; Escobar, Liliana

    2012-01-01

    There is evidence that teachers' beliefs on teaching and learning exert an influence on the way they teach and assess learning, and on what students learn. Therefore, it is central that overt attention is devoted to the perceptions teachers have and how they influence teaching and learning. In this article we describe a study on…

  7. EFL Teaching Methodological Practices in Cali (Prácticas metodológicas en la enseñanza de inglés como lengua extranjera en la ciudad de Cali)

    ERIC Educational Resources Information Center

    Chaves, Orlando; Hernández, Fanny

    2013-01-01

    In this article we aim at showing partial results of a study about the profiles of English as a Foreign Language (EFL) teachers in both public and private primary and secondary strata 1-4 schools in Cali, Colombia. Teachers' methodological approaches and practices are described and analyzed from a sample of 220 teachers. Information was gathered…

  8. Como ayudar a su hijo durante los primeros anos de la adolescencia: Para los padres con ninos entre las edades de 10 a 14 anos (Helping Your Child through Early Adolescence: For Parents of Children from 10 through 14).

    ERIC Educational Resources Information Center

    Paulu, Nancy

    Recognizing that parents and families can greatly influence the development of their 10- through 14-year-olds, this Spanish-language booklet is part of a national effort to provide parents with the latest research and practical information to help them support their children both at home and in school. The booklet is organized in 13 sections…

  9. La Migracion Como Una Transicion Critica para la Persona en Su Ambiente. Una Interpretacion Organismico Evolutiva. (Migration as a Critical Person-in-Environment Transition: An Organismic-Developmental Interpretation.)

    ERIC Educational Resources Information Center

    Pacheco, Angel M.; And Others

    In order to explore some of the changes and stresses connected with migration and return migration, a study was conducted among migrants returning from the United States mainland to Puerto Rico. The sample consisted of 75 adolescents participating in a Bilingual Education program in Puerto Rico. Data were collected using Psychological Distance…

  10. The Kindergarten Survival Handbook: The Before School Checklist & a Guide for Parents. (El Manual de Como Sobrevivir El Jardin de Ninos: La Lista Pre-escolar y Una Guia Para Los Padres).

    ERIC Educational Resources Information Center

    Elovson, Allana Cummings

    Written to help parents understand what their children need to know before they start kindergarten, this volume, bound separately in English and Spanish, is intended to help parents become their children's best, as well as their first and most important, teachers. The first part of the book, the before school checklist, is divided into eight…

  11. Estudio del proceso de ebullicion en el interior de un tubo multipuerto extruido en aluminio con mini-canales de geometria triangular usando R32 y R134a como fluidos de trabajo

    NASA Astrophysics Data System (ADS)

    Ramirez Rivera, Francisco Alberto

    The use of multiport mini-channel tubes in compact exchangers has increased in the last few years. They contributing to improve thermal efficient, compactness, energy conservation and required lower refrigerants charge by which reduction of greenhouse gases emission. Those mentioned advantages are very important aspects with regard to modern refrigeration systems design. For that reason, several experimental investigation have been carried out in order to characterize the flow boiling heat transfer process and frictional pressure drop in tubes with parallel channels. Since, the ability to estimate pressure drop and heat transfer coefficient for specific conditions is a fundamental issue to optimise the design of compact heat exchanger. In this study, the characteristics of two- phase flow pressure drop and convective boiling heat transfer have been investigated experimentally inside multiport mini-channel aluminium tube with triangular geometry, hydraulic diameter 0.715 mm and heating length of 1205 mm using R32 and R134a as working fluids. A wide experimental campaign has been carried out to complete an array of measurement under different conditions for both refrigerants studied. The experimental conditions examined included: mass velocity 275-1230 kgm -2s-1, heat flux 0.75-9.30 kWm-2, saturation temperature, 5°C, 7.5°C, 12.5°C, vapour quality 0.012-0.51. The database presented consists of 312 averages values, 223 averages values were recorded for R134a and 89 for R32. The flow boiling averages values were calculated selecting a sample of 40 readings (steps 20s) in stable conditions for all measured variables at each mass velocity tested.

  12. The Impact of Conferencing Assessment on EFL Students' Grammar Learning (Impacto de la evaluación mediante conferencias en el aprendizaje de la gramática en estudiantes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Zarghami, Zahra

    2012-01-01

    This article reports on a study that was carried out in order to examine the impact of conferencing assessment on students' learning of English grammar. Forty-two Iranian intermediate university students were randomly assigned to an experimental and a control group. The participants in the experimental group took part in four individual and…

  13. O Imperio como Argumento: Um Contraponto entre Joaquim Nabuco e o Bispo D. Jose Mauricio da Rocha (The Empire as Argument: A Counterpoint between Joaquim Nabuco and the Bishop Dom Jose Mauricio da Rocha).

    ERIC Educational Resources Information Center

    Marson, Izabel Andrade

    1998-01-01

    Dialogs with the previous article establishing a comparative analysis between the political acceptance present in the reactionary speech of Dom Jose Mauricio da Rocha and in the monarchist words of Joaquim Nabuco. (PA)

  14. A Guide for Reading: How Parents Can Help Their Children Be Ready To Read and Ready To Learn = Guia Para Leer: Como los padres pueden preparar a sus hijos a leer y aprender desde la infancia.

    ERIC Educational Resources Information Center

    White House Initiative on Educational Excellence for Hispanic Americans, Washington, DC.

    As part of the White House Initiative on Educational Excellence for Hispanic Americans, this brochure (in English and Spanish) provides a guide to assist parents in helping their children become ready to read and to learn. The suggestions include: (1) talking to infants/toddlers to help them learn to speak and understand the meaning of words; (2)…

  15. A Comparison of Chinese and Colombian University EFL Students Regarding Learner Autonomy (Comparación entre estudiantes universitarios de inglés chinos y colombianos con respecto a su autonomía como aprendices)

    ERIC Educational Resources Information Center

    Buendía Arias, Ximena Paola

    2015-01-01

    This research seeks to gain deeper understanding of learner autonomy in English as a Foreign Language students from different cultures through the identification and analysis of similarities and differences between Chinese and Colombian students from two public universities: Tianjin Foreign Studies University in China and Universidad Surcolombiana…

  16. What Makes a Good Teacher? Children Speak Their Minds=Qu'est-ce qu'un bon maitre? Les enfants ouvrent leur coeur=Como debe ser un buen maestro? Los ninos opinan.

    ERIC Educational Resources Information Center

    Khawajkie, Elizabeth, Ed.; And Others

    This booklet is a product of the UNESCO Associated Schools Project, a network of some 3,800 schools in 131 countries, which conducts pilot projects to promote education for peace, international understanding, and cooperation. Schools taking part in the project participated in an international contest asking for spontaneous reactions to the…

  17. Kathy Learns How Breastfeeding Can Be Used...To Space Pregnancies. Mother-to-Mother Support = Josefa Aprende como la Lactancia Puede Ser Usada...Para Espaciar los Embarazos. Apoyo Madre a Madre.

    ERIC Educational Resources Information Center

    Magalhaes, Rebecca; Stone-Jimenez, Maryanne; Allen de Smith, Paulina; Smith, Natalia

    These magazine-sized booklets, one in English, one in Spanish, are in cartoon format and designed to be used by people with limited literacy in English or Spanish. They explain how breastfeeding can be used to help space pregnancies, the limitations of its effectiveness as a pregnancy-avoiding method, and that the spacing of pregnancies can be…

  18. Como Trabajar y Vivir en la Realidad: Pasos Basicos Para Jovenes con Incapacidades, sus Padres y sus Profesores (How to Work and Live in the Real World: Basic Steps for Youth with Handicaps and Their Parents and Teachers).

    ERIC Educational Resources Information Center

    Patton, Patricia L.; And Others

    This Spanish version of "How to Work and Live in the Real World: Basic Steps for Youth with Handicaps and Their Parents and Teachers" is for young people with handicaps who are getting ready to graduate from high school and begin working and living in the adult world. The booklet places a special focus on individuals with cultural differences. It…

  19. EFL Students' Perceptions about a Web-Based English Reading Comprehension Course (Percepciones de estudiantes de inglés como lengua extranjera acerca de un curso de comprensión lectora apoyado en la red)

    ERIC Educational Resources Information Center

    Gómez Flórez, Érica; Pineda, Jorge Eduardo; Marín García, Natalia

    2012-01-01

    Web-based distance education is an innovative modality of instruction in Colombia. It is characterized by the separation of the teacher and learners, the use of technological tools and the students' autonomy development. This paper reports the findings of a case study that explores students' perceptions about an English reading…

  20. Los padres como maestros de los ninos. Los padres como recursos para los maestros. Serie E: El logro de la participacion de los padres, cuadernos I y II. Edicion para el estudiante. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as the Children's Teachers. Parents as Resources for the Teachers. Series E: Success with Parent Participation, Books I and II. Student Edition. Bilingual Education Teacher Training Packets.)

    ERIC Educational Resources Information Center

    Lazos, Hector

    The student versions of two learning modules for teacher training in bilingual education are part of a series focusing on promoting parent participation in the school system. An introductory section discussing the overall objectives of the materials is followed by two modules, each consisting of introductory sections and two units containing…

  1. Los padres como maestros de los ninos. Los padres como recursos para los maestros. Serie E: [E1] logro de la participacion de los padres. cuadernos 1 y 2. Edicion para el maestro. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as Their Children's Teachers. Parents as Resources for Teachers. Series E: Parent Participation, Book 1 and 2. Teacher Edition. Bilingual Education Teacher Training Packets).

    ERIC Educational Resources Information Center

    Lazos, Hector, Comp.

    This guide on training bilingual education teachers focuses on parent participation in school activities. The guide addresses three groups of people: paraprofessionals and non-graduate students, bilingual teachers, and graduate students. Two units are presented, one dealing with the important influence parents have on their child's language…

  2. Urinary monocyte chemoattractant protein-1 (MCP-1) and connective tissue growth factor (CCN2) as prognostic markers for progression of diabetic nephropathy.

    PubMed

    Tam, Frederick W K; Riser, Bruce L; Meeran, Karim; Rambow, JoAnn; Pusey, Charles D; Frankel, Andrew H

    2009-07-01

    Profibrotic growth factors and inflammatory chemokines have been implicated in the pathogenesis of diabetic nephropathy (DN). However, measurement of urinary monocyte chemoattractant protein-1 (MCP-1) and connective tissue growth factor (CCN2) as prognostic markers has not previously been reported, and neither have two such molecules in urine been examined in a single study of DN. In this prospective observational study, 43 adult diabetic patients were studied, 40 were followed up for 6years. Urinary MCP-1/creatinine ratios were found to be significantly higher in patients with macroalbuminuria (3.3- and 2.1-fold higher (p<0.01) than normoalbuminuric and microalbuminuric patients, respectively). CCN2 exhibited a pattern different from that of urinary MCP-1. Urinary CCN2/creatinine ratios were greatly elevated in both microalbuminuric and macroalbuminuric patients (125- and 74-fold higher than normoalbuminuric patients, respectively, p<0.01 and p<0.05, respectively). Further, urinary CCN2, but not MCP-1, correlated with progression of microalbuminuria (R=0.49, p<0.05). In contrast, MCP-1, but not CCN2, correlated with the rate of eGFR decline for all patients (R=0.61, p<0.0001), reflective of its predictive value in patients with macroalbuminuria, but not for patients with microalbuminuria or normoalbuminuria. In conclusion, increased urinary CCN2 is associated with the early progression of DN, whereas MCP-1 is associated with later stage disease. PMID:19409809

  3. Monitoring Diabetic Nephropathy by Circulating Gangliosides.

    PubMed

    Ene, Corina Daniela; Penescu, Mircea; Anghel, Amalia; Neagu, Monica; Budu, Vlad; Nicolae, Ilinca

    2016-01-01

    Gangliosides are multifunctional molecules, abundantly expressed in renal cell membrane but also in sera of patients with renal disease. The aim of this study was to quantify the serum levels of sialic acid-ganglioside in patients diagnosed with diabetes for an eventual biomarker stratification of patients with renal complications. We included 35 diabetic patients without metabolic complications, 35 patients with diabetic nephropathy, 35 non-diabetic individuals. We found that sialic acid ganglioside serum level was significantly increased in patients with diabetic nephropathy compared to the level obtained in patients with uncomplicated diabetes and to non-diabetic controls. A statistically significant positive correlation was obtained between serum levels of sialic acid gangliosides, HbA1c, and serum creatinine in patients with diabetes without complications. Moreover positive correlation was found between sialic acid ganglioside and blood glucose, HbA1c, urea, creatinine, microalbuminuria in patients with diabetic nephropathy. We can conclude that serum sialic acid-gangliosides are statistically increased in diabetic nephropathy positively correlated with microalbuminuria. PMID:26359623

  4. Metabolic Acidosis-Induced Insulin Resistance and Cardiovascular Risk

    PubMed Central

    Souto, Gema; Donapetry, Cristóbal; Calviño, Jesús

    2011-01-01

    Abstract Microalbuminuria has been conclusively established as an independent cardiovascular risk factor, and there is evidence of an association between insulin resistance and microalbuminuria, the former preceding the latter in prospective studies. It has been demonstrated that even the slightest degree of metabolic acidosis produces insulin resistance in healthy humans. Many recent epidemiological studies link metabolic acidosis indicators with insulin resistance and systemic hypertension. The strongly acidogenic diet consumed in developed countries produces a lifetime acidotic state, exacerbated by excess body weight and aging, which may result in insulin resistance, metabolic syndrome, and type 2 diabetes, contributing to cardiovascular risk, along with genetic causes, lack of physical exercise, and other factors. Elevated fruits and vegetables consumption has been associated with lower diabetes incidence. Diseases featuring severe atheromatosis and elevated cardiovascular risk, such as diabetes mellitus and chronic kidney failure, are typically characterized by a chronic state of metabolic acidosis. Diabetic patients consume particularly acidogenic diets, and deficiency of insulin action generates ketone bodies, creating a baseline state of metabolic acidosisworsened by inadequate metabolic control, which creates a vicious circle by inducing insulin resistance. Even very slight levels of chronic kidney insufficiency are associated with increased cardiovascular risk, which may be explained at least in part by deficient acid excretory capacity of the kidney and consequent metabolic acidosis-induced insulin resistance. PMID:21352078

  5. Evaluation of Ischemia-Modified Albumin, Malondialdehyde, and Advanced Oxidative Protein Products as Markers of Vascular Injury in Diabetic Nephropathy

    PubMed Central

    Ahmad, Afzal; Manjrekar, Poornima; Yadav, Charu; Agarwal, Ashish; Srikantiah, Rukmini Mysore; Hegde, Anupama

    2016-01-01

    AIM This study aimed at evaluation of ischemia-modified albumin (IMA), malondialdehyde (MDA), and advanced oxidative protein products (AOPP) as markers of vascular injury in diabetic nephropathy (DN) with derivation of cutoff values for the same. MATERIALS AND METHODS Study population comprised 60 diabetes patients and 30 controls, with diabetes patients further categorized into three groups based on urine albumin/creatinine ratio (UACR) of <30 mg/g (diabetes without microalbuminuria), 30–300 mg/g (early DN), and >300 mg/g of creatinine (overt DN). Serum IMA, MDA, and AOPP were estimated by enzyme-linked immunosorbent assay; HbA1c, serum creatinine, urine albumin, and urine creatinine were estimated using automated analyzers. Statistical analysis was done using analysis of variance, Pearson’s correlation coefficient, and receiver-operating characteristic curve. RESULTS A statistically significant difference was found in the levels of IMA among patients with early DN (154 ng/mL), diabetes without nephropathy (109.4 ng/mL), and healthy controls (45.7 ng/mL), with highest levels in early DN cases. Similar increase was seen in AOPP as well. A significant correlation was observed between IMA and UACR in diabetes without nephropathy (r = 0.448). CONCLUSION The present study postulates serum IMA as a novel biomarker for the assessment of disease progression in diabetes even before microalbuminuria, and a cutoff point ≥99 ng/mL can be used for detection of early DN. PMID:27158221

  6. Aldosterone receptor blockers spironolactone and canrenone: two multivalent drugs.

    PubMed

    Armanini, Decio; Sabbadin, Chiara; Donà, Gabriella; Clari, Giulio; Bordin, Luciana

    2014-05-01

    Canrenone is a derivative of spironolactone with lower antiandrogen activity. The drug is used only in few countries and can block all the side effects of aldosterone (ALDO). The drug is effective even in the presence of normal concentrations of ALDO. Mineralcorticoid receptor antagonists block the inflammatory activity of ALDO at the level of target tissues as heart, vessels and mononuclear leukocytes. Canrenone reduces the progression of insulin resistance and of microalbuminuria in type 2 diabetes and other related diseases. Both canrenone and hydrochlorothiazide can enhance the effect of treatment with ACE inhibitors and angiotensin II receptor blockers on microalbuminuria, but ALDO receptor blockers are more active. This different action is due to the fact that only canrenone blocks mineralocorticoid receptors. Serum potassium and renal function should be monitored before and during the treatment. ALDO receptor blockers are recommended in addition to polytherapy for resistant hypertension, but there are no studies on the effect of the drug as first-choice therapy. PMID:24617854

  7. Prevalence and risk factors for micro- and macroalbuminuria in diabetic subjects and entire population of Nauru.

    PubMed

    Collins, V R; Dowse, G K; Finch, C F; Zimmet, P Z; Linnane, A W

    1989-12-01

    Rates of elevated urinary albumin concentration, defined as microalbuminuria (30-299 micrograms/ml) and macroalbuminuria (greater than or equal to 300 micrograms/ml), were determined on random morning urine specimens in the population of Nauru, which has a high prevalence of non-insulin-dependent diabetes mellitus. The prevalence of elevated urinary albumin levels in the total Nauruan population was very high: 26 and 30% of men and women, respectively, had microalbuminuria, whereas 13% of both sexes had macroalbuminuria. Of the subjects with macroalbuminuria, 66% had diabetes. The prevalence increased with worsening glucose tolerance; 26% of subjects with normal glucose tolerance had either micro- or macroalbuminuria, increasing to 43% of subjects with impaired glucose tolerance, 63% of newly diagnosed diabetic subjects, and 75% of previously diagnosed diabetic subjects. Associations between elevated urinary albumin concentration and putative risk factors were assessed for both the total population (n = 1184) and the diabetic subgroup alone (n = 318). Fasting plasma glucose and hypertension were the most important independent correlates for the whole population, whereas plasma creatinine was also important in diabetic subjects. Age at onset and duration of diabetes were not found to be significantly associated with elevated albumin concentration. In subjects with normal glucose tolerance, hypertension and hyperuricemia were the most important associated factors. These results suggest that blood glucose, blood pressure, and possibly obesity and plasma uric acid are important modifiable risk factors for both micro- and macroalbuminuria in this population.

  8. Very long-term follow-up of living kidney donors.

    PubMed

    Fournier, Catherine; Pallet, Nicolas; Cherqaoui, Zoubair; Pucheu, Sylvie; Kreis, Henri; Méjean, Arnaud; Timsit, Marc-Olivier; Landais, Paul; Legendre, Christophe

    2012-04-01

    Knowledge of the very long-term consequences of kidney donors has not been previously reported extensively. The 398 persons who had donated a kidney between 1952 and 2008 at Necker hospital were contacted. Among the 310 donors who were located, the survival probabilities for this population were similar to those of the general population and end stage renal disease incidence was 581 per million population per year. All located donors still alive were asked to complete a medico-psychosocial questionnaire and give samples for serum creatinine and urinary albumin assays. Among the 204 donors who responded to the questionnaire, mean eGFR was 64.4±14.6ml/min per 1.73m(2) and mean microalbuminuria was 27.0±83mg/g. Most donors never regretted the donation and consider that it has no impact on their professional or social lives. Among the 59 donors who gave a kidney more than 30years ago (mean 40.2years, range 30-48years) had a mean eGFR of 67.5±17.4μmol/l, a mean microalbuminuria level of 44.8±123.2mg/g and none was dialyzed. In conclusion, living kidney donation does not impact survival, kidney function, medical condition or psychological or social status over the very long-term. PMID:22356210

  9. Association of Serum Adropin Concentrations with Diabetic Nephropathy

    PubMed Central

    2016-01-01

    Objective. Adropin is a newly identified regulatory protein encoded by the Enho gene and is critically involved in energy homeostasis and insulin sensitivity. This study aims to determine the correlation of serum adropin concentrations with diabetic nephropathy (DN). Methods. This study consisted of 245 patients with type 2 diabetes mellitus (T2DM) and 81 healthy subjects. Then T2DM patients were divided into normoalbuminuria, microalbuminuria, and macroalbuminuria subgroups based on urine albumin to creatinine ratio (ACR). Results. T2DM patients showed significantly lower serum adropin concentrations than those in the controls. T2DM patients with macroalbuminuria had significantly decreased serum adropin concentrations compared with the other three groups. In addition, T2DM patients with microalbuminuria showed lower serum adropin concentrations than those in patients with normoalbuminuria. Logistic regression analysis showed that serum adropin was correlated with decreased risk of developing T2DM and DN. Pearson correlation analysis indicated that serum adropin was negatively correlated with body mass index (BMI), blood urea nitrogen, creatinine, and ACR and positively correlated with glomerular filtration rate. Furthermore, multiple linear regression analysis showed that BMI and ACR were negatively correlated with serum adropin levels. Conclusion. Serum adropin concentrations are negatively associated with renal function. Adropin may be implicated in the pathogenesis of DN development. PMID:27546995

  10. Urinary biomarkers for early diabetic nephropathy in type 2 diabetic patients.

    PubMed

    Fiseha, Temesgen

    2015-01-01

    Diabetic nephropathy (DN) is a serious complication of diabetes associated with increased risk of mortality, and cardiovascular and renal outcomes. Diagnostic markers to detect DN at early stage are important as early intervention can slow loss of kidney function and improve patient outcomes. Urinary biomarkers may be elevated in diabetic patients even before the appearance of microalbuminuria, and can be used as useful marker for detecting nephropathy in patients with normoalbuminuria (early DN). We reviewed some new and important urinary biomarkers, such as: Neutrophil gelatinase associated lipocalin (NGAL), N-acetyl-beta-glucosaminidase (NAG), Cystatin C, alpha 1-microglobulin, immunoglobulin G or M, type IV collagen, nephrin, angiotensinogen and liver-type fatty acid-binding protein (L-FABP) associated with early DN in type 2 diabetic patients. Our search identified a total of 42 studies that have been published to date. Urinary levels of these biomarkers were elevated in type 2 diabetic patients compared with non-diabetic controls, including in patients who had no signs indicating nephropathy (without microalbuminuria), and showed positive correlation with albuminuria. Despite the promise of these new urinary biomarkers, further large, multicenter prospective studies are still needed to confirm their clinical utility as a screening tool for early type 2 DN in every day practice. PMID:26146561

  11. Epidemiology of diabetic kidney disease.

    PubMed

    Reutens, Anne T

    2013-01-01

    The increasing prevalence of diabetes has led to DKD becoming the leading cause of ESRD in many regions. The economic cost of DKD will grow to prohibitive amounts unless strategies to prevent its onset or progression are urgently implemented. In type 1 and type 2 diabetes, the presence of microalbuminuria and macroalbuminuria confers increased risk of developing ESRD and of death. Comparison of recent studies with earlier historical studies shows that the incidence of ESRD and death has decreased in DKD. Increased risk of albuminuria has been identified in certain non-European ethnic groups. However, the initial concept of progression of DKD as an albuminuric phenotype involving development of microalbuminuria, macroalbuminuria, and then ESRD has had to be modified. Albumin excretion frequently regresses, and GFR can decline without abnormality in albumin excretion. There is emerging evidence that changes in renal function occurring early in the course of diabetes predict future outcomes. The major challenges are to prevent DKD onset, to detect it early, and to improve DKD outcomes globally. PMID:23290726

  12. Association of Serum Adropin Concentrations with Diabetic Nephropathy.

    PubMed

    Hu, Wenchao; Chen, Li

    2016-01-01

    Objective. Adropin is a newly identified regulatory protein encoded by the Enho gene and is critically involved in energy homeostasis and insulin sensitivity. This study aims to determine the correlation of serum adropin concentrations with diabetic nephropathy (DN). Methods. This study consisted of 245 patients with type 2 diabetes mellitus (T2DM) and 81 healthy subjects. Then T2DM patients were divided into normoalbuminuria, microalbuminuria, and macroalbuminuria subgroups based on urine albumin to creatinine ratio (ACR). Results. T2DM patients showed significantly lower serum adropin concentrations than those in the controls. T2DM patients with macroalbuminuria had significantly decreased serum adropin concentrations compared with the other three groups. In addition, T2DM patients with microalbuminuria showed lower serum adropin concentrations than those in patients with normoalbuminuria. Logistic regression analysis showed that serum adropin was correlated with decreased risk of developing T2DM and DN. Pearson correlation analysis indicated that serum adropin was negatively correlated with body mass index (BMI), blood urea nitrogen, creatinine, and ACR and positively correlated with glomerular filtration rate. Furthermore, multiple linear regression analysis showed that BMI and ACR were negatively correlated with serum adropin levels. Conclusion. Serum adropin concentrations are negatively associated with renal function. Adropin may be implicated in the pathogenesis of DN development. PMID:27546995

  13. Renal histopathology of a baboon model with type 2 diabetes.

    PubMed

    Rincon-Choles, Hernan; Abboud, Hanna E; Lee, Shuko; Shade, Robert E; Rice, Karen S; Carey, K Dee; Comuzzie, Anthony G; Barnes, Jeffrey L

    2012-10-01

    Naturally occurring type 2 diabetes has been found in a colony of baboons. Ongoing characterization of the baboon colony maintained at the Southwest National Primate Research Center has revealed a significant range of glucose sensitivity with some animals clearly diabetic.   Seven baboons, four with diabetes and three without diabetes, underwent histopathological investigation. Three diabetic animals were diagnosed using fasting blood glucose, hemoglobin A1C, and intravenous glucose tolerance test, and a fourth one was known to have hyperglycemia. One control baboon and three baboons with diabetes had microalbuminuria. On kidney biopsy, diabetic baboons had thickening of the glomerular basement membrane and mesangial matrix expansion compared to controls. Immunohistochemistry showed the diabetic animals had increased mesangial expression of cellular fibronectin ED-A. Two diabetic animals with microalbuminuria had evidence of mesangiolysis with the formation of an early nodule. One diabetic animal had a Kimmestiel-Wilson nodule. We conclude that the baboon represents a useful primate model of diabetes and nephropathy that resembles the nephropathy associated with type 2 diabetes in humans.

  14. Association Between Plasma Selenium and Glutathione Peroxidase Levels And Severity of Diabetic Nephropathy in Patients With Type Two Diabetes Mellitus

    PubMed Central

    Sedighi, Omid; Makhlough, Atieh; Shokrzadeh, Mohammad; Hoorshad, Shiva

    2014-01-01

    Background: Oxidative stress is thought to be involved in the pathogenesis of diabetic nephropathy. Selenium (Se), and antioxidant enzymes such as glutathione peroxidase (GPx) play an important protective role in diabetes complications. Objectives: This study aimed to evaluate the association between plasma Se and GPx levels with severity of diabetic nephropathy. Patients and Methods: In a case-control study, we measured plasma Se and GPx concentrations in patients with type two diabetes without microalbuminuria (group 1), with microalbuminuria (group 2), with macroalbuminuria (group 3), and healthy control subjects (group 4). We also assessed plasma glucose, urea, creatinine, and glycated hemoglobin levels in all study patients. Results: Plasma Se and GPx concentrations were significantly lower in diabetic patients with macroalbuminuria than other study groups (P < 0.001). Albuminuria (Alb/Cr in random urine sample) had a negative correlation with plasma Se (r = -0.40, P = 0.01), and GPx (r = -0.23, P = 0.03) concentrations. Conclusions: Plasma Se and GPx levels were lower in type two diabetic patients with macroalbuminuria and related to the stage of diabetic nephropathy. PMID:25695036

  15. Levels of albuminuria and risk of developing macroalbuminuria in type 2 diabetes: historical cohort study

    PubMed Central

    Chida, Shoma; Fujita, Yoshikuni; Ogawa, Akifumi; Hayashi, Akinori; Ichikawa, Raishi; Kamata, Yuji; Takeuchi, Akihiro; Takano, Koji; Shichiri, Masayoshi

    2016-01-01

    Although increased urinary albumin excretion may increase the risk of adverse renal outcomes in patients with diabetes, it remains unclear whether microalbuminuria is associated with a higher incidence of macroalbuminuria in the absence of non-diabetic kidney events that frequently develop during the long-term course of type 2 diabetes. This historical cohort study included patients with type 2 diabetes, spot urine albumin:creatinine ratio (ACR) <300 mg/gCr and normal serum creatinine concentrations treated between August 1988 and April 2015. Patients with any evidence suggesting non-diabetic kidney diseases at baseline were excluded. Over a median follow-up of 50 months, 70 of the 1760 included patients developed macroalbuminuria. Twenty-one of these patients were diagnosed with non-diabetic renal events. The five-year cumulative incidence of macroalbuminuria in patients with ACRs of 0–7.5 mg/gCr, 7.5–30 mg/gCr, 30–150 mg/gCr, and 150–300 mg/gCr were 0%, 0.53%, 3.5%, and 36.0%, respectively, with significant differences between each pair of ACR categories. In type 2 diabetes, higher urinary ACR, even within a level of normoalbuminuria, was associated with a greater incidence of macroalbuminuria when non-diabetic renal events were excluded. These results conflict with findings suggesting that microalbuminuria is a poor indicator for the progression of diabetic nephropathy. PMID:27210499

  16. Urinary Biomarkers in the Assessment of Early Diabetic Nephropathy

    PubMed Central

    Gluhovschi, Gheorghe; Petrica, Ligia; Timar, Romulus; Velciov, Silvia; Ionita, Ioana; Kaycsa, Adriana; Timar, Bogdan

    2016-01-01

    Diabetic nephropathy (DN) is a frequent and severe complication of diabetes mellitus (DM). Its diagnosis in incipient stages may allow prompt interventions and an improved prognosis. Towards this aim, biomarkers for detecting early DN can be used. Microalbuminuria has been proven a remarkably useful biomarker, being used for diagnosis of DN, for assessing its associated condition—mainly cardiovascular ones—and for monitoring its progression. New researches are pointing that some of these biomarkers (i.e., glomerular, tubular, inflammation markers, and biomarkers of oxidative stress) precede albuminuria in some patients. However, their usefulness is widely debated in the literature and has not yet led to the validation of a new “gold standard” biomarker for the early diagnosis of DN. Currently, microalbuminuria is an important biomarker for both glomerular and tubular injury. Other glomerular biomarkers (transferrin and ceruloplasmin) are under evaluation. Tubular biomarkers in DN seem to be of a paramount importance in the early diagnosis of DN since tubular lesions occur early. Additionally, biomarkers of inflammation, oxidative stress, podocyte biomarkers, and vascular biomarkers have been employed for assessing early DN. The purpose of this review is to provide an overview of the current biomarkers used for the diagnosis of early DN. PMID:27413755

  17. [Influence of polymorphism's of endothelial nitric oxide synthase gene and polymorphism of NADPH oxidase gene on development of complications of arterial hypertension].

    PubMed

    Kuznetsova, T Iu; Gavrilov, D V; Dudanov, I P; Makarevich, P I; Balatskiĭ, A V; Samokhodskaia, L M; Parfenova, E V

    2008-01-01

    The aim of the study was to analyze the prevalence of polymorphism Glu298Asp of endothelial nitric oxide synthase gene and C242T p22 phox polymorphism of NADPH oxidase gene in patients with arterial hypertension (AH) and their influence on AH complications. The study included 272 AH patients, average age 50,7 years. The following analyses were performed: clinical analysis of the blood, general analysis of the urine, lipid spectrum, plasma electrolytes, creatinine, glucose, electrocardiography, echocardioscopy, examination of eye vessels, ultrasound examination of the carotid arteries, determination of microalbuminuria. The polymorphism Glu298Asp of endothelial nitric oxide synthase gene and C242T p22 phox polymorphism of NADPH oxidase gene were detected with two methods: polymerase chain reaction and restrictase reaction. The control group for Glu298Asp polymorphism detection included 102 healthy Russian donors aged 18 to 50 years. Genotypes prevalence in AH patients was as follows: GG 58,8%, GA 32,3%, AA 8,9%, and CC 48,2%, CT 44,9%, TT 6.9%. In the control group: GG 53%, GA 36%, AA 11% and CC 42%, CT 54%, TT 4%. These polymorphisms did not affect the incidence of complications, such as obliterating atherosclerosis of the lower extremity vessels, ischemic heart disease, and acute insufficiency of cerebral circulation, chronic heart failure, left ventricular hypertrophy, microalbuminuria, carotid arteries atherosclerosis. PMID:18429753

  18. Emissão de hidrogênio molecular e [FeII] em núcleos Seyfert

    NASA Astrophysics Data System (ADS)

    Rodríguez-Ardila, A.; Pastoriza, M. G.; Viegas, S.

    2003-08-01

    Um dos problemas fundamentais em núcleos ativos de galáxias (AGN) é determinar os mecanismos de excitação dominantes do gás emissor de linhas estreitas, seja este excitado por mecanismos não-estelares (fotoionização por uma fonte central ou choques produzidos por um jato rádio no gás circumnuclear) ou estelares (fotoionização por estrelas OB ou choques originados por um remanescente de supernova em expansão). Essa ambiguedade se faz mais evidente ao intepretar o espectro de espécies tais como H2 e [FeII]. Na primeira, fluorescência UV, processos térmicos (choques e/ou aquecimento por fótons) ou illuminação por raios-x, podem ser responsáveis pelo espectro observado enquanto que na segunda, os dois últimos mechanismos seriam relevantes. Neste trabalho, utilizando espectroscópia JHK de média resolução para uma amostra de AGN encontramos que o H2 observado é gerado principalmente por processos térmicos associados à presença de episódios de formação estelar circumnuclear. No entanto, em galáxias tais como NGC4151 as observações mostram que o hidrogênio molecular origina-se, principalmente, da interação entre o jato radio e o gás da NLR. Esses resultados baseiam-se nos valores das razões de linhas H2 2.24/2.12 mm e H2 2.03/2.22 mm. H2 2.24/2.12 separa claramente processos não-térmicos dos térmicos enquanto H2 2.03/2.22 serve como indicador de temperatura da componente térmica, e portanto, discrimina entre choques e associações OB. Já para o [FeII], as observações são compatíveis com excitação produzida diretamente pela fonte central ou choques associados com o jato rádio. A comparação da largura dos perfis de linhas observados permite concluir que não há correlação entre a emissão de H2 e [FeII]. Em praticamente todos os casos analisados, os perfis das linhas de H2 são não-resolvidos, enquanto que os perfis de [FeII] indicam, em alguns casos, velocidades de até 600 km/s.

  19. Sodium intake may promote weight gain; results of the FANPE study in a representative sample of the adult Spanish population.

    PubMed

    Navia, Beatriz; Aparicio, Aránzazu; Perea, José Miguel; Pérez-Farinós, Napoleon; Villar-Villalba, Carmen; Labrado, Estefania; Ortega, Rosa María

    2014-06-01

    Introducción: Estudios recientes, han señalado que las dietas ricas en sodio podrían predisponer a la aparición de obesidad, ya sea de forma directa, o por estar asociadas con el consumo de alimentos que favorecen el aumento de peso. Objetivo: El objeto de este estudio fue analizar la asociación entre sodio urinario y presencia de sobrepeso y obesidad, en una muestra representativa de adultos españoles, así como conocer si el mayor consumo de sal, se asocia con unos peores hábitos alimentarios y con una mayor ingesta de alimentos, que puedan predisponer a la aparición de la misma. Métodos: Se ha estudiado un grupo de 418 adultos (196 hombres y 222 mujeres) de 18 a 60 años de edad. Se recogieron datos de peso, talla, circunferencia de cintura y se calculó, a partir de ellos, el IMC y el índice cintura/talla. Con el fin de conocer el consumo de alimentos, se aplicó un “Recuerdo de 24 horas” durante dos días consecutivos y se determinó el sodio en orina de 24 horas. Resultados: Un 34,4% de la población presentó sobrepeso y un 13,6% obesidad. Se observó una asociación positiva entre el IMC y la excreción urinaria de sodio. Los valores de sodio en orina también se relacionaron de forma directa con otros parámetros indicadores de adiposidad, como la circunferencia de la cintura o la relación cintura/talla. Tanto el peso, como el IMC, la circunferencia de la cintura y la relación cintura/talla, fueron mayores en el grupo con una excreción urinaria de sodio ≥154 mmol/l (Percentil 50) (P50). Además, las personas con una mayor eliminación urinaria de sodio presentaron una mayor ingesta calórica y un mayor consumo de alimentos totales y, en concreto, de carnes, precocinados y aperitivos. Tras ajustar por la ingesta de energía, la mayor ingesta de sodio resultó ser un factor de riesgo de tener un IMC más alto (OR = 1.0041, IC 95% 1.0015-1.0067, p < 0,01). Conclusiones: La ingesta de sal estuvo asociada con la presencia de obesidad, ya

  20. Nutritional assessment in surgical oncology patients: a comparative analysis between methods.

    PubMed

    Cunha, Carla de Magalhães; Sampaio, Ethiane de Jesus; Varjão, Maria Lúcia; Factum, Clarissa Simon; Ramos, Lilian Barbosa; Barreto-Medeiros, Jairza Maria

    2014-11-01

    Introducción y objetivos: La desnutrición en el paciente oncológico es responsable por el aumento de la morbilidady la mortalidady produce una disminución de su calidad de vida. En la actualidad, la identificación de la desnutrición se lleva a cabo por medio de métodos subjetivos y objetivos o por la unión de ambos. A pesar de la asociación de estos métodos como examen de rutina en la práctica clínica, son muy pocos los trabajos que evalúan la concordancia entre ellos. De ese modo, el objetivo de este estudio fue comparar diferentes métodos para evaluar el estado nutricional de los pacientes oncológicos quirúrgicos. Métodos: Se analizaron 173 pacientes oncológicos, ingresados para cirugía, se sometieron a una evaluación antropométrica y respondieron a SGA, PG-SGA y NRS- 2002. Se utilizó el test Kappa para evaluar el nível de concordancia entre los métodos. Resultados: Baja concordancia entre el IMC con el NRS-2002 (K=0,286), ASG(K=0,372) y ASG-PPP (K=0,173) fue identificado. Entre los métodos subjetivos, los resultados fueron mejores com ASG y ASG-PPP (K=0,690) y menor entre el NRS-2002 y los otros (ASG: K=0,345; ASG-PPP: K=0,322). Conclusión: Los resultados demostraron baja concordancia entre los métodos objetivos y subjetivos, lo que refuerza La importancia de la asociación de los indicadores en la evaluación nutricional de esta población. Aunque se ha encontrado baja concordancia entre los métodos de evaluación nutricional empleados en este estudio, los pacientes que presentaron una mayor reducción de las reservas corporales, fueron diagnosticados com un mayor grado de mal nutrición por los métodos subjetivos.

  1. [In Process Citation].

    PubMed

    Sánchez-Ramírez, Carmen A; Larrosa-Haro, Alfredo; M Vásquez Garibay, Edgar; Rodríguez-Anguiano, Ana K; Cámara-López, María E

    2016-02-16

    Introducción: la ingestión de cáusticos (IC) en niños y adolescentes puede ocasionar esofagitis erosiva, estenosis esofágica y disfagia, entidades que pueden alterar el proceso de alimentación y originar desnutrición y retraso en el crecimiento.Objetivos: evaluar el estado nutricio de niños con IC y su asociación con disfagia y estenosis esofágica.Métodos: estudio transversal analítico en el que se incluyó a 62 niños atendidos en un hospital pediátrico de referencia que sufrieron IC. Lasvariables independientes fueron la presencia/ausencia de disfagia y/o estenosis esofágica; las dependientes fueron el crecimiento y el estado nutricio evaluados mediante antropometría. Análisis estadístico: c2, OR, IC 95%, kappa y t de Student.Resultados: la edad promedio fue 39,7 meses, el 39,7% eran niñas. Cuarenta y dos (77,8%) presentaron esofagitis erosiva (II-b, III-a, and III-b) en la endoscopia. En 24 (38,7%) ocurrió disfagia y en 40 (64,5%) estenosis esofágica. El puntaje z de la talla para la edad fue <-2 DE en cinco niños (8,1%) y el puntaje z del IMC < -2 DE en tres (4,8%). En 24.2% la z-IMC fue > +1 DE. El puntaje z de los indicadores del brazo relacionados a reservas grasa y masa muscular tanto en el grupo de estenosis como de disfagia se localizó en el lado negativo de la curva y ambos fueron significativamente menores a los del grupo sin disfagia o estenosis.Conclusiones: la proporción de esofagitis erosiva, estenosis o disfagia fue elevada. En los niños con disfagia o estenosis esofágica se identificaron reservas de grasa y masa muscular menores a las de los niños sin estas complicaciones.

  2. [Prevalence and associated factors of hospital malnutrition in a general hospital; Perú, 2012].

    PubMed

    Veramendi-Espinoza, L E; Zafra-Tanaka, J H; Salazar-Saavedra, O; Basilio-Flores, J E; Millones-Sánchez, E; Pérez-Casquino, G A; Quispe-Moore, L M; Tapia-Vicente, M E; Ticona-Rebagliati, D I; Asato N, B; Quispe-Calderón, L; Ruiz García, H J; Chia-Gil, A; Rey-Rodríguez, D E; Surichaqui B, T; Whittembury, Á

    2013-01-01

    Introducción: La desnutrición hospitalaria es un problema prevalente que genera mayor morbi-mortalidad, peor respuesta al tratamiento, mayor estancia y costo hospitalario. Objetivos: Determinar la prevalencia y factores asociados a desnutrición hospitalaria en un hospital general peruano. Métodos: Estudio analítico transversal de 211 pacientes en servicios de Medicina y Cirugía. Se analizó variables demográficas, clínicas e indicadores antropométricos. El análisis multivariado fue de regresión logística binaria. El nivel de significancia fue 5% (p < 0,05). Resultados: La prevalencia de desnutrición hospitalaria fue 46.9% y las de desnutrición calórica y proteica fueron 21,3% y 37,5% respectivamente. En el análisis bivariado, estar hospitalizado en el servicio de Cirugía se asoció a un mayor riesgo de desnutrición calórica (OR = 4,41, IC 95% [1,65-11,78]) y proteica (OR = 2,52, IC 95% [1,30-4,90]). Hubo asociación significativa entre el número de comorbilidades del paciente y desnutrición calórica (p = 0,031), y el tiempo de cambio de ingesta alimentaria y presencia de desnutrición proteica (p = 0,031). El análisis multivariado mostró asociación significativa entre el diagnóstico de neoplasia y la presencia de desnutrición calórica (OR = 5,22, IC 95% [1,43-19,13]). Conclusiones: La prevalencia de desnutrición hospitalaria fue cerca del 50%, coincidiendo con estudios similares. Las prevalencias de desnutrición calórica/proteica halladas difieren de las de un estudio anterior en este hospital, explicándose por parámetros de diagnóstico diferentes y características particulares de las poblaciones, como el servicio de procedencia y comorbilidades. Se encontró asociación entre desnutrición proteica/calórica y estar hospitalizado en el servicio de Cirugía; las razones deben investigarse en estudios posteriores.

  3. [Egg intake and cardiovascular risk factors in adolescents: role of physical activity; the HELENA study].

    PubMed

    Soriano-Maldonado, A; Cuenca-García, M; Moreno, L A; González-Gross, M; Leclercq, C; Androutsos, O; Guerra-Hernández, E J; Castillo, M J; Ruiz, J R

    2013-01-01

    Introducción: Las enfermedades cardiovasculares (ECVs) suponen la principal causa de morbi-mortalidad en los países occidentales. El incremento del colesterol plasmático se ha relacionado con el desarrollo de ECV. El huevo, por su alto contenido en colesterol, ha sido indirectamente relacionado con el riesgo de desarrollar ECVs. Objetivo: Examinar la asociación entre ingesta de huevo y factores de riesgo cardiovascular en adolescentes, estudiando si dicha relación está influenciada por la actividad física. Método: Se estudiaron 380 adolescentes pertenecientes al estudio HELENA (HEalthy Lifestyle in Europe by Nutrition in Adolescence). La ingesta de alimentos se estimó mediante anamnesis nutricional de dos días no consecutivos. Se midieron indicadores de adiposidad, perfil lipídico, glucosa, insulina, resistencia a la insulina, tensión arterial y capacidad aeróbica. Se calculó un índice integrado de riesgo cardiovascular (IRCV) como medida del perfil cardiovascular global. La actividad física se midió mediante acelerometría. Se examinó el desarrollo madurativo. El estatus socioeconómico y consumo de tabaco se obtuvieron mediante cuestionario. La asociación entre ingesta de huevo y factores de riesgo de ECV se examinó mediante un modelo de regresión multinivel ajustado por factores de confusión. Resultados: La ingesta de huevo no se asoció con perfil lipídico, nivel de adiposidad, tensión arterial, resistencia a la insulina, capacidad aeróbica o IRCV (todos P > 0,05). Esta falta de asociación no estuvo influenciada por el nivel de actividad física. Conclusiones: Estos resultados sugieren que no existe asociación entre ingesta de huevo y perfil lipídico, adiposidad, resistencia a la insulina, tensión arterial, capacidad aeróbica o el IRCV en adolescentes. La actividad física no influencia dicha falta de asociación.

  4. Oral health in the agenda of priorities in public health.

    PubMed

    Antunes, José Leopoldo Ferreira; Toporcov, Tatiana Natasha; Bastos, João Luiz; Frazão, Paulo; Narvai, Paulo Capel; Peres, Marco Aurélio

    2016-08-01

    This study describes the scientific production on oral health diffused in Revista de Saúde Pública, in the 50 years of its publication. A narrative review study was carried out using PubMed, as it is the search database that indexes all issues of the journal. From 1967 to 2015, 162 manuscripts specifically focused on oral health themes were published. This theme was present in all volumes of the journal, with increasing participation over the years. Dental caries was the most studied theme, constantly present in the journal since its first issue. Periodontal disease, fluorosis, malocclusions, and other themes emerged even before the decline of dental caries indicators. Oral health policy is the most recurring theme in the last two decades. Revista de Saúde Pública has been an important vehicle for dissemination, communication, and reflection on oral health, contributing in a relevant way to the technical-scientific interaction between professionals in this field. RESUMO Este estudo descreve a produção científica sobre saúde bucal veiculada na Revista de Saúde Pública, nos cinquenta anos de sua publicação. Foi realizado estudo de revisão narrativa, utilizando o PubMed como mecanismo de busca que indexa todos os fascículos da revista. De 1967 a 2015, foram publicados 162 manuscritos com foco específico em temas de saúde bucal. Essa temática esteve presente em todos os volumes da revista, com participação crescente ao longo dos anos. Cárie dentária foi o tema mais estudado, marcando presença constante na revista desde seu primeiro fascículo. Doença periodontal, fluorose, oclusopatias e outros temas emergiram antes mesmo do declínio dos indicadores de cárie. Políticas de saúde bucal é o tema mais recorrente nas duas últimas décadas. A Revista de Saúde Pública tem sido importante veículo de divulgação, comunicação e reflexão sobre saúde bucal, contribuindo de modo relevante para a interação técnico-científica entre os

  5. Policies for control and prevention of infections related to healthcare assistance in Brazil: a conceptual analysis.

    PubMed

    Oliveira, Hadelândia Milon de; Silva, Cristiane Pavanello Rodrigues; Lacerda, Rúbia Aparecida

    2016-01-01

    This article is a theoretical-reflexive study that aims to discuss the development and changes in the quality of healthcare assistance to the patient over the years in Brazil, in light of the policies of control and prevention of Healthcare-associated Infection (HAI). Aspects of HAI and the process of change in health policy in Brazil, as well as the quality of assistance associated with its control, are approached in relation to policies of patient safety. There are various new theoretical and practical proposals created in Brazil. In spite of the difficulty of measuring patient safety, directed to the prevention and control of HAI, we emphasize that to only create policies and establish norms, guidelines, and indicators is not sufficient. If no structural support or conditions exist for interventions in the practices of healthcare professionals, aiming at results in acceptable levels, the control of HAI will not be achieved. Resumo Trata-se um estudo teórico-reflexivo, que objetiva discutir a evolução e as mudanças na qualidade da assistência ao paciente, ao longo dos anos no Brasil, à luz das políticas de controle e prevenção da Infecção Relacionada à Assistência à Saúde (IRAS). Aspectos sobre IRAS e o processo de mudança nas políticas de saúde no Brasil, bem como a qualidade da assistência associada ao seu controle, são abordados em relação às políticas de segurança do paciente. Há novas e várias propostas teóricas e práticas criadas no Brasil. Apesar da dificuldade de medir a segurança do paciente, direcionada à prevenção e controle das IRAS, enfatiza-se que somente criar políticas, estabelecer normas, diretrizes e indicadores não são suficientes. Se não houver suporte de estrutura e condições para as intervenções nas práticas dos profissionais na assistência prestada ao paciente, visando resultados em níveis aceitáveis, o controle das IRAS não será alcançado.

  6. Anthropometric indicators of obesity as predictors of cardiovascular risk in the elderly.

    PubMed

    Vidal Martins, Marcos; Queiroz Ribeiro, Andréia; Martinho, Karina Oliveira; Silva Franco, Fernanda; Danésio de Souza, Jacqueline; Bacelar Duarte de Morais, Keila; Gonçalves Leite, Isabel Cristina; Araújo Tinôco, Adelson Luiz

    2015-06-01

    Introducción: diversos indicadores antropométricos se pueden utilizar como predictores de riesgo cardiovascular en los ancianos. Objetivo: evaluar la capacidad predictiva de las medidas antropométricas en la identificación de riesgo cardiovascular en pacientes ancianos en la Estrategia Salud de la Familia de Viçosa-MG. Metodología: se realizó un estudio epidemiológico transversal con 349 ancianos. El riesgo cardiovascular se calculó mediante la relación de los niveles de triglicéridos con niveles de HDL-colesterol (TG / HDL-c). Las variables antropométricas medidas fueron: circunferencia de la cintura, índice de masa corporal, relación cintura-altura e índice de conicidad. Se realizó una evaluación bioquímica de triglicéridos y HDL-colesterol. Las mediciones antropométricas también estaban relacionados con el riesgo cardiovascular utilizando la característica (ROC) Curvas Receiver Operating. Resultados: los resultados observados indican que todos estos índices antropométricos se pueden usar para predecir el riesgo cardiovascular en los hombres. Sin embargo, en las mujeres, solo el IMC mostró capacidad predictiva. Los puntos de corte identificados aparecieron muy cerca de los puntos de corte recomendados y reconocidos en otros estudios, con la excepción de la circunferencia de la cintura, que se mide en el punto medio entre la última costilla y la cresta ilíaca, que mostró una diferencia considerable. Conclusión: todos los índices antropométricos se pueden usar para predecir el riesgo cardiovascular en hombres y mujeres. La circunferencia de la cintura en el punto medio entre la última costilla y la cresta ilíaca era la mejor medida antropométrica para predecir el riesgo cardiovascular en los varones y la circunferencia de cintura más pequeña y cintura-altura fueron las mejores medidas antropométricas en las mujeres.

  7. [PHYSICAL ACTIVITY LEVELS, PHYSICAL FITNESS AND SCREE TIME AMONG CHILDREN AND ADOLESCENTS FROM BOGOTÁ, COLOMBIA].

    PubMed

    Prieto-Benavides, Daniel Humberto; Correa-Bautista, Jorge Enrique; Ramírez-Vélez, Robinson

    2015-11-01

    Objetivo: examinar la relación entre los niveles de actividad física (AF) de forma objetiva, la condición física (CF) y el tiempo de exposición a pantallas en niños y adolescentes de Bogotá, Colombia. Métodos: estudio descriptivo y transversal, realizado en 149 niños y adolescentes en edad escolar entre 9 y 17 años de Bogotá, Colombia. Los niveles de AF se valoraron con acelerómetro durante siete días. El tipo y tiempo de exposición a pantallas se registró por autorreporte. Se midió el estado de maduración, el peso, la estatura, la circunferencia de cintura/cadera y los pliegues tricipital/ subescapular. La capacidad aeróbica, la fuerza prensil, el salto de longitud y vertical, la velocidad/agilidad y la flexibilidad fueron usados como indicadores de la CF. Resultados: las mujeres clasificadas en la categoría de AF vigorosa mostraron una relación lineal con la capacidad aeróbica (r = 0,366), y una relación inversa con el pliegue tricipital (r = -0,257) y subescapular (r = -0,237), p < 0,05. En varones, los niveles de AF vigorosa se relacionaron con mayores valores de flexibilidad (r = 0,277), mientras que los niveles de AFMV se relacionaron positivamente con la capacidad aeróbica (r = 0,347), p < 0,05. Por último, los escolares que permanecieron menos de 2 h/día frente a pantallas de TV mostraron 1,819 veces de (IC 95% 1,401-2,672) oportunidad para cumplir las recomendaciones de AF. Conclusiones: los escolares que registraron valores de AF moderado y vigoroso de forma objetiva presentaron mejores niveles en la CF, especialmente en la capacidad aeróbica y la flexibilidad, y menores valores en los pliegues cutáneos.

  8. [NUTRITIONAL CONDITION OF SCHOOLCHILDREN AND THEIR ASSOCIATION WITH LEVELS OF FITNESS AND CARDIOVASCULAR RISK FACTORS].

    PubMed

    Delgado Floody, Pedro; Caamaño Navarrete, Felipe; Cresp Barría, Mauro; Osorio Poblete, Aldo; Cofré Lizama, Alfonso

    2015-09-01

    Antecedentes: en Chile, el incremento de la obesidad infantil ha llegado a ser un importante problema de salud pública. El objetivo del estudio es determinar y comparar los niveles de obesidad y sobrepeso de escolares, así como analizar su asociación con los niveles de condición física y predictores de riesgo cardiovascular. Pacientes y métodos: se realizó un estudio de asociación y comparación de variables por género y estado nutricional; se evaluaron 113 escolares (58 hombres y 55 mujeres) de entre 13 y 16 años de edad. Se midió el estado nutricional y el rendimiento físico a través de la batería utilizada por la Agencia de Calidad de la Educación en Chile. Resultados: el 57,5% de la muestra tuvo malnutrición por exceso. El contorno de la cintura y el porcentaje de masa grasa es mayor en las mujeres (p < 0,05). El IMC no presentó diferencias significativas. Los hombres presentaron mejor rendimiento físico, en el salto, abdominales y Test de Navette (p < 0,05). Respecto a la evaluación por estatus de peso en el rendimiento físico existieron diferencias significativas (p < 0,05) en las variables: abdominales, flexo-extensiones, Test de Navette y salto, con resultados superiores en los sujetos con normopeso. Los escolares con obesidad presentaron mayor porcentaje de masa grasa y contorno de cintura (p < 0,05). Respecto a la asociación de variables según IMC, porcentaje de masa grasa y contorno de cintura, estas presentaron asociaciones negativas con el rendimiento físico. Conclusiones: el 57,5 % de los escolares evaluados presentó sobrepeso u obesidad, asociándose estos resultados negativamente con el rendimiento físico y con niveles aumentados de masa grasa y contorno de cintura, todos ellos indicadores de salud y predictores de riesgo cardiovascular.

  9. [Maternal factors associated with low birth weight].

    PubMed

    Heredia-Olivera, Karen; Munares-García, Oscar

    2016-01-01

    Introducción: En el Perú, el bajo peso al nacimiento es un indicador de riesgo de problemas perinatales y de la infancia, el objetivo del estudio fue determinar los factores maternos asociados al bajo peso al nacimiento. Métodos: Estudio de casos y controles, en 123 recién nacidos de bajo peso (casos) y 123 recién nacidos de peso normal (controles) pareados por fecha de nacimiento y distrito. Se indagaron factores maternos asociados al bajo peso al nacimiento y se comparó entre casos y controles. Se aplicó Chi cuadrada, Odds ratio (OR) con sus intervalos de confianza al 95% (IC 95%), regresión logística binaria y curva ROC. Resultados: Se encontraron asociaciones para antecedentes maternos de bajo peso (OR: 41.1; IC 95%: 5.5-306.7); prematuridad (OR: 12.0; IC 95%: 1.5-94.3), antecedente de eclampsia (OR: 5.8; IC 95%: 1.9-17.4), 1 a 3 controles prenatales (OR: 5.7; IC 95%: 2.6-12.3), gestación múltiple (OR: 4.7; IC 95%: 1.3-17.0) y consumo de tabaco (OR: 3.8; IC 95%: 1.5-9.8), el no ser adolescente (OR: 0.3; IC 95%: 0.1-0.6), y no tener un intervalo intergenésico corto (OR: 0.2; IC 95%: 0.1-0.7). El análisis multivariado nos indicó que el tener entre 1 a 3 controles prenatales, gestación múltiple, ser adolescente y un intervalo intergenésico corto se asocian al bajo peso al nacimiento, el modelo propuesto explicó el 18.6% del evento, el área bajo la curva fue 72.9% considerando que predice adecuadamente (p ˂ 0.001). Conclusiones: Existen factores de riesgo materno asociados al bajo peso al nacimiento en gestantes de zona urbana de la costa como el tener de 1 a 3 controles prenatales, gestación múltiple, ser adolescente y tener un periodo entre embarazos menor a dos años.

  10. Women's attachment as a predictor of pain during labour and post-delivery: a prospective observational study.

    PubMed

    Costa Martins, José Manuel; da Silva, Carlos Fernandes; Pereira, Marco; Martins, Henriqueta; Oliveira, Célia; Puga, Alexandra; Coelho, Rui; Tavares, Jorge

    2014-01-01

    IntroduçÉo: O parto é considerado uma das experiências mais dolorosas e significativas na vida de uma mulher. O objectivo deste estudo foi avaliar se o estilo de vinculaçÉo da grávida é um preditor significativo da dor experienciada durante o parto e após o nascimento.Material e Métodos: Trinta e duas grávidas foram avaliadas durante o terceiro trimestre de gravidez e durante o parto. A vinculaçÉo no adulto foi avaliada através da Escala de AvaliaçÉo no Adulto ' Revista. A intensidade da dor de parto foi avaliada através de uma Escala Visual Analógica para a dor durante o parto e após o nascimento.Resultados: As mulheres com um estilo de vinculaçÉo inseguro reportaram maior dor aos 3 cm de dilataçÉo cervical (p < 0,05), antes da administraçÉo da analgesia (p < 0,01) e após o nascimento (p < 0,05) que as mulheres com uma vinculaçÉo segura. Nos modelos multivariados, o estilo de vinculaçÉo mostrou-se um preditor significativo da dor no parto aos 3 cm de dilataçÉo cervical e antes da administraçÉo da analgesia, mas nÉo na dor percebida após o nascimento.DiscussÉo: Estes resultados confirmam que a dor de parto é influenciada por factores psicológicos relevantes e sugerem que o estilo de vinculaçÉo da mulher pode ser um factor de risco para maior intensidade de dor no parto.ConclusÉo: Estudos futuros no contexto da dor obstétrica devem considerar o estilo de vinculaçÉo como um indicador de diferenças individuais na experiência de dor durante o parto. Isto pode ter importantes implicações para a Anestesiologia e promover importantes mudanças nas práticas institucionais e procedimentos terapêuticos.

  11. Applicability of the visceral adiposity index (VAI) in predicting components of metabolic syndrome in young adults.

    PubMed

    Schuster, Jéssica; Vogel, Patrícia; Eckhardt, Cristiane; Morelo, Simone Dal Bosco

    2014-10-01

    Introducción: El síndrome metabólico (SM) es uno de los principales factores de riesgo de enfermedades cardiovasculares (ECV), y la identificación de sus componentes en los adultos jóvenes puede constituir una importante herramienta de prevención. Objetivo: Analizar la aplicabilidad del Visceral Adiposity Index (VAI) para la predicción de componentes del SM en adultos jóvenes. Métodos: Estudio transversal con 444 individuos, edad 25,6 ± 6,5, 77,7% del sexo femenino. Se obtuvieron datos sobre el peso, talla, circunferencia de cintura (CC), el porcentaje de grasa corporal (%GC), glucemia, triglicéridos (TG), colesterol total (CT), colesterol HDL (HDL-c), colesterol LDL (LDL-c), y la presión arterial (PA), así como información sobre sus estilos de vida. Se calculó Índice de Masa Corporal (IMC), la proporción de cintura a la altura (PCA) y VAI. Mediciones de adiposidad se compararon con los componentes del SM, y por VAI, se determinó la capacidad predictiva de ocurrencia de los componentes de SM y el área a bajo la curva ROC. Resultados: VAI se correlaciona a la glucosa (r= 0,136), HDL-c (r=-436) y TG (r=0,825) en las mujeres y entre los hombres, se correlaciona a la glucosa (r=0,258), HDL-c (r=-0,550), TG (r=0,897), y la PAD (r= 0,290). Un aumento de VAI se asoció a un mayor riesgo de obesidad abdominal (OR=1,86), hipertrigliceridemia (OR=30,74), y bajo HDL-c (OR=3,95). Entre los indicadores de obesidad, VAI presentó una mayor área bajo la curva de aumento de triglicéridos y bajos niveles de HDL-c. Conclusión: VAI presentó una asociación a los componentes del SM en hombres, y em mujeres con un mayor riesgo de obesidad abdominal, hipertrigliceridemia y bajos niveles de HDL-c, demostrando ser un buen predictor de componentes de SM, incluso entre adultos jóvenes sanos.

  12. [In Process Citation].

    PubMed

    Sánchez-Ramírez, Carmen A; Larrosa-Haro, Alfredo; M Vásquez Garibay, Edgar; Rodríguez-Anguiano, Ana K; Cámara-López, María E

    2016-01-01

    Introducción: la ingestión de cáusticos (IC) en niños y adolescentes puede ocasionar esofagitis erosiva, estenosis esofágica y disfagia, entidades que pueden alterar el proceso de alimentación y originar desnutrición y retraso en el crecimiento.Objetivos: evaluar el estado nutricio de niños con IC y su asociación con disfagia y estenosis esofágica.Métodos: estudio transversal analítico en el que se incluyó a 62 niños atendidos en un hospital pediátrico de referencia que sufrieron IC. Lasvariables independientes fueron la presencia/ausencia de disfagia y/o estenosis esofágica; las dependientes fueron el crecimiento y el estado nutricio evaluados mediante antropometría. Análisis estadístico: c2, OR, IC 95%, kappa y t de Student.Resultados: la edad promedio fue 39,7 meses, el 39,7% eran niñas. Cuarenta y dos (77,8%) presentaron esofagitis erosiva (II-b, III-a, and III-b) en la endoscopia. En 24 (38,7%) ocurrió disfagia y en 40 (64,5%) estenosis esofágica. El puntaje z de la talla para la edad fue <-2 DE en cinco niños (8,1%) y el puntaje z del IMC < -2 DE en tres (4,8%). En 24.2% la z-IMC fue > +1 DE. El puntaje z de los indicadores del brazo relacionados a reservas grasa y masa muscular tanto en el grupo de estenosis como de disfagia se localizó en el lado negativo de la curva y ambos fueron significativamente menores a los del grupo sin disfagia o estenosis.Conclusiones: la proporción de esofagitis erosiva, estenosis o disfagia fue elevada. En los niños con disfagia o estenosis esofágica se identificaron reservas de grasa y masa muscular menores a las de los niños sin estas complicaciones. PMID:27019238

  13. ANTHROPOMETRIC DIFFERENCES RELATED TO GENDERS AND AGE IN THE ELDERLY.

    PubMed

    Canaan Rezende, Fabiane Aparecida; Queiroz Ribeiro, Andréia; Priore, Sílvia Eloiza; Castro Franceschini, Sylvia do Carmo

    2015-08-01

    Introducción: la antropometría facilita la evaluación de los riesgos asociados con la masa corporal magra reducida, así como con el exceso de adiposidad. Sin embargo, se conoce muy poco acerca de las diferencias antropométricas observadas entre los géneros y entre los grupos de edad en los ancianos. Objetivo: comparar indicadores e índices antropométricos de los ancianos por género y grupo de edad. Métodos: estudio transversal, con una muestra de 621 ancianos. Se evaluó el peso, la talla, circunferencias (cintura, cadera, pantorrilla y brazo), índice de masa corporal, índice de adiposidad corporal, relación cintura-cadera y cintura-talla. Resultados: se encontró que las mujeres tienen un promedio mayor de índice de masa corporal, relación cintura- talla, índice de adiposidad corporal y circunferencia del brazo (p < 0,001); mientras que los hombres presentaron mayores valores para el peso, la talla y la relación cintura-cadera (p < 0,001). Las circunferencias de brazo y pantorrilla, sin embargo, no fueron diferentes entre los géneros (p > 0,05). Se observaron peso y circunferencias de pantorrilla y brazo menores en los grupos de mayor edad (p < 0,001) y lo mismo sucedió para el índice de masa corporal y la talla solo en los hombres (p < 0,05). La circunferencia de cintura, índice de adiposidad corporal, relación cintura-cadera y cintura-talla no fue diferente entre los grupos de edad (p > 0,05). Conclusión: la masa corporal total y periférica, para los hombres, en particular, fue menor entre los sujetos de mayor edad. La adiposidad central no fue diferente entre los grupos de edad en ambos géneros.

  14. Policies for control and prevention of infections related to healthcare assistance in Brazil: a conceptual analysis.

    PubMed

    Oliveira, Hadelândia Milon de; Silva, Cristiane Pavanello Rodrigues; Lacerda, Rúbia Aparecida

    2016-01-01

    This article is a theoretical-reflexive study that aims to discuss the development and changes in the quality of healthcare assistance to the patient over the years in Brazil, in light of the policies of control and prevention of Healthcare-associated Infection (HAI). Aspects of HAI and the process of change in health policy in Brazil, as well as the quality of assistance associated with its control, are approached in relation to policies of patient safety. There are various new theoretical and practical proposals created in Brazil. In spite of the difficulty of measuring patient safety, directed to the prevention and control of HAI, we emphasize that to only create policies and establish norms, guidelines, and indicators is not sufficient. If no structural support or conditions exist for interventions in the practices of healthcare professionals, aiming at results in acceptable levels, the control of HAI will not be achieved. Resumo Trata-se um estudo teórico-reflexivo, que objetiva discutir a evolução e as mudanças na qualidade da assistência ao paciente, ao longo dos anos no Brasil, à luz das políticas de controle e prevenção da Infecção Relacionada à Assistência à Saúde (IRAS). Aspectos sobre IRAS e o processo de mudança nas políticas de saúde no Brasil, bem como a qualidade da assistência associada ao seu controle, são abordados em relação às políticas de segurança do paciente. Há novas e várias propostas teóricas e práticas criadas no Brasil. Apesar da dificuldade de medir a segurança do paciente, direcionada à prevenção e controle das IRAS, enfatiza-se que somente criar políticas, estabelecer normas, diretrizes e indicadores não são suficientes. Se não houver suporte de estrutura e condições para as intervenções nas práticas dos profissionais na assistência prestada ao paciente, visando resultados em níveis aceitáveis, o controle das IRAS não será alcançado. PMID:27556723

  15. [A lower adherence to Mediterranean diet is associated with a poorer self-rated health in university population].

    PubMed

    Barrios-Vicedo, Ricardo; Navarrete-Muñoz, Eva Maria; García de la Hera, Manuela; González-Palacios, Sandra; Valera-Gran, Desirée; Checa-Sevilla, José Francisco; Gimenez-Monzo, Daniel; Vioque, Jesús

    2014-09-15

    Introducción y objetivo: Una mayor adherencia a la dieta mediterránea es un factor protector de la mortalidad atribuida principalmente a las enfermedades crónico-degenerativas en países desarrollados. La salud auto-percibida constituye un buen indicador para medir el estado de salud poblacional y como predictor de la mortalidad. Son escasos los estudios que han explorado la relación entre la adherencia a la dieta mediterránea y la salud auto- percibida especialmente en población joven. En este estudio analizamos los factores relacionados con el estado de salud auto-percibido en población joven universitaria, prestando especial atención a la adherencia a un patrón de dieta mediterránea definido a priori. Método: Se han analizado los datos de 1110 participantes recogidos en el momento de ingreso en el del Estudio Di- SA-UMH (Dieta, Salud y Antropometría en universitarios de la Universidad Miguel Hernández). La dieta se evaluó mediante cuestionario de frecuencia alimentaria validado y se estimó la adherencia a la dieta mediterránea mediante el índice relative Mediterranean Diet Score que incluye 9 componentes y un rango entre 0-18 puntos. El estado de salud auto-percibida se recogió mediante la pregunta “En general, ¿cómo diría que es su salud?” con cinco opciones: muy buena, buena, regular, mala y muy mala. Se recogió información sobre variables sociodemográficas y estilos de vida. Se usó regresión logística multinomial (usando razón de riesgos relativos RRR) para analizar la asociación entre adherencia a la dieta mediterránea (rMED baja: 0-6; media: 7-10 puntos; alta: 11-18) y salud auto-percibida (muy buena (referencia), buena y regular/mala/muy mala). Resultados: Un 26.8%, 58.7% y 14.4% de los participantes presentaron respectivamente una adherencia a la dieta mediterránea baja, media o alta; un 23.1%, 65.1% y 11.8%, refirieron una salud muy buena, buena o regu lar/mala/muy mala, respectivamente. En el análisis multivariante

  16. Efficacy and Safety of Tangshen Formula on Patients with Type 2 Diabetic Kidney Disease: A Multicenter Double-Blinded Randomized Placebo-Controlled Trial

    PubMed Central

    Li, Ping; Chen, Yiping; Liu, Jianping; Hong, Jing; Deng, Yueyi; Yang, Fang; Jin, Xiuping; Gao, Jing; Li, Jing; Fang, Hui; Liu, Geling; Shi, Liping; Du, Jinhang; Li, Yang; Yan, Meihua; Wen, Yumin; Yang, Wenying

    2015-01-01

    Background Persons with diabetes are at high risk of developing diabetic kidney disease (DKD), which is associated with high morbidity and mortality. Current drug therapies for DKD, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are not entirely satisfactory. This study aimed to evaluate the additional benefit and safety of the Chinese herbal granule Tangshen Formula (TSF) in treating DKD. Methods The study was designed as a six-center randomized, double-blind, placebo-controlled trial. From April 2007 through December 2009, 180 patients with DKD were enrolled. In addition to conventional treatment with ACEIs or ARBs, 122 participants were randomly assigned to receive TSF and 58 participants to receive placebo for 24 weeks. Primary outcome was urinary protein level, measured by urinary albumin excretion rate (UAER) for participants with microalbuminuria, 24-hour urinary protein (24h UP) for participants with macroalbuminuria. Secondary outcomes included renal function, serum lipids, quality of life, symptoms, and adverse events. Findings After 24 weeks of treatment, no statistically significant difference in UAER (TSF −19.53 μg/min compared with placebo −7.01 μg/min, with a mean difference of −12.52 μg/min; 95%CI, −68.67 to 43.63, P = 0.696) was found between TSF and placebo groups. However, TSF displayed a statistically significant decrease in 24h UP (TSF−0.21 g compared with placebo 0.36 g, with a mean difference of −0.57g; 95%CI, −1.05 to −0.09, P = 0.024). Estimated glomerular filtration rate (eGFR) was improved in both patients with microalbuminuria and macroalbuminuria, with a mean difference of 15.51 ml/min/1.73 m2 (95%CI, 3.71 to 27.31), 9.01 ml/min/1.73 m2 (95%CI, −0.10 to 18.13), respectively. Other secondary outcomes showed no statistically significant difference between groups or in the incidence of adverse events. Conclusions Based on conventional

  17. Transcriptome Analysis of Proximal Tubular Cells (HK-2) Exposed to Urines of Type 1 Diabetes Patients at Risk of Early Progressive Renal Function Decline

    PubMed Central

    Wanic, Krzysztof; Krolewski, Bozena; Ju, Wenjun; Placha, Grzegorz; Niewczas, Monika A.; Walker, William; Warram, James H.; Kretzler, Matthias; Krolewski, Andrzej S.

    2013-01-01

    Background In patients with Type 1 Diabetes (T1D) who develop microalbuminuria, progressive decline in glomerular filtration rate (GFR) may be initiated by leakage into the urine of toxic proteins (txUPs). This study tested this hypothesis. Methods After archiving baseline urine, we followed T1D patients with microalbuminuria for 8–12 years to distinguish those in whom GFR declined (Decliners) and those in whom it remained stable (Non-decliners). Human proximal tubular cells (HK-2 cells) were grown in serum-free medium enriched with pooled urines from Decliners or Non-decliners. We determined genome-wide expression profiles in extracted mRNA. Results The two pooled urines induced differential expression of 312 genes. In terms of gene ontology, molecular functions of the 119 up-regulated genes were enriched for protein binding and peptidase inhibitor activities. Their biologic processes were enriched for defense response, responses to other organisms, regulation of cellular processes, or response to stress or stimulus, and programmed cell death. The 195 down-regulated genes were disproportionately represented in molecular functions of cation binding, hydrolase activity, and DNA binding. They were disproportionately represented in biological processes for regulation of metabolic processes, nucleic acid metabolic processes, cellular response to stress and macromolecule biosynthesis. The set of up-regulated genes in HK-2 cells overlaps significantly with sets of over-expressed genes in tubular and interstitial compartments of kidney biopsies from patients with advanced DN (33 genes in one study and 25 in the other compared with 10.3 expected by chance, p<10−9 and p<10−4, respectively). The overlap included genes encoding chemokines and cytokines. Overlap of down-regulated genes was no more than expected by chance. Conclusions Molecular processes in tubules and interstitium seen in advanced diabetic nephropathy can be induced in vitro by exposure to urine from

  18. Heat and PAHs Emissions in Indoor Kitchen Air and Its Impact on Kidney Dysfunctions among Kitchen Workers in Lucknow, North India.

    PubMed

    Singh, Amarnath; Kamal, Ritul; Mudiam, Mohana Krishna Reddy; Gupta, Manoj Kumar; Satyanarayana, Gubbala Naga Venkata; Bihari, Vipin; Shukla, Nishi; Khan, Altaf Hussain; Kesavachandran, Chandrasekharan Nair

    2016-01-01

    Indoor air quality and heat exposure have become an important occupational health and safety concern in several workplaces including kitchens of hotels. This study investigated the heat, particulate matter (PM), total volatile organic compounds (TVOCs) and polycyclic aromatic hydrocarbons (PAHs) emissions in indoor air of commercial kitchen and its association with kidney dysfunctions among kitchen workers. A cross sectional study was conducted on 94 kitchen workers employed at commercial kitchen in Lucknow city, North India. A questionnaire-based survey was conducted to collect the personal and occupational history of the kitchen workers. The urine analysis for specific gravity and microalbuminuria was conducted among the study subjects. Indoor air temperature, humidity, wet/ dry bulb temperature and humidex heat stress was monitored during cooking activities at the kitchen. Particulate matter (PM) for 1 and 2.5 microns were monitored in kitchen during working hours using Hazdust. PAHS in indoor air was analysed using UHPLC. Urinary hydroxy-PAHs in kitchen workers were measured using GC/MS-MS. Higher indoor air temperature, relative humidity, PM1 and PM2.5 (p<0.001) was observed in the kitchen due to cooking process. Indoor air PAHs identified are Napthalene, fluorine, acenaphthene, phenanthrene, pyrene, chrysene and indeno [1,2,3-cd) pyrene. Concentrations of all PAHs identified in kitchen were above the permissible OSHA norms for indoor air. Specific gravity of urine was significantly higher among the kitchen workers (p<0.001) as compared to the control group. Also, the prevalence of microalbuminuria was higher (p<0.001) among kitchen workers. Urinary PAH metabolites detected among kitchen workers were 1-NAP, 9-HF, 3-HF, 9-PHN and 1-OHP. Continuous heat exposure in kitchens due to cooking can alter kidney functions viz., high specific gravity of urine in kitchen workers. Exposure to PM, VOCs and PAHs in indoor air and presence of urinary PAHs metabolites may

  19. Heat and PAHs Emissions in Indoor Kitchen Air and Its Impact on Kidney Dysfunctions among Kitchen Workers in Lucknow, North India

    PubMed Central

    Singh, Amarnath; Kamal, Ritul; Mudiam, Mohana Krishna Reddy; Gupta, Manoj Kumar; Satyanarayana, Gubbala Naga Venkata; Bihari, Vipin; Shukla, Nishi; Khan, Altaf Hussain; Kesavachandran, Chandrasekharan Nair

    2016-01-01

    Indoor air quality and heat exposure have become an important occupational health and safety concern in several workplaces including kitchens of hotels. This study investigated the heat, particulate matter (PM), total volatile organic compounds (TVOCs) and polycyclic aromatic hydrocarbons (PAHs) emissions in indoor air of commercial kitchen and its association with kidney dysfunctions among kitchen workers. A cross sectional study was conducted on 94 kitchen workers employed at commercial kitchen in Lucknow city, North India. A questionnaire-based survey was conducted to collect the personal and occupational history of the kitchen workers. The urine analysis for specific gravity and microalbuminuria was conducted among the study subjects. Indoor air temperature, humidity, wet/ dry bulb temperature and humidex heat stress was monitored during cooking activities at the kitchen. Particulate matter (PM) for 1 and 2.5 microns were monitored in kitchen during working hours using Hazdust. PAHS in indoor air was analysed using UHPLC. Urinary hydroxy-PAHs in kitchen workers were measured using GC/MS-MS. Higher indoor air temperature, relative humidity, PM1 and PM2.5 (p<0.001) was observed in the kitchen due to cooking process. Indoor air PAHs identified are Napthalene, fluorine, acenaphthene, phenanthrene, pyrene, chrysene and indeno [1,2,3-cd) pyrene. Concentrations of all PAHs identified in kitchen were above the permissible OSHA norms for indoor air. Specific gravity of urine was significantly higher among the kitchen workers (p<0.001) as compared to the control group. Also, the prevalence of microalbuminuria was higher (p<0.001) among kitchen workers. Urinary PAH metabolites detected among kitchen workers were 1-NAP, 9-HF, 3-HF, 9-PHN and 1-OHP. Continuous heat exposure in kitchens due to cooking can alter kidney functions viz., high specific gravity of urine in kitchen workers. Exposure to PM, VOCs and PAHs in indoor air and presence of urinary PAHs metabolites may

  20. Water-Pipe Smoking and Albuminuria: New Dog with Old Tricks

    PubMed Central

    Ishtiaque, Iqra; Shafique, Kashif; Ul-Haq, Zia; Shaikh, Abdul Rauf; Khan, Naveed Ali; Memon, Abdul Rauf; Mirza, Saira Saeed; Ishtiaque, Afra

    2014-01-01

    Water-pipe (WP) smoking is on rise worldwide for the past few years, particularly among younger individuals. Growing evidence indicates that WP smoking is as harmful as cigarette smoking. To date, most of the research has focused on acute health effects of WP smoking, and evidence remains limited when it comes to chronic health effects in relation to long-term WP smoking. Therefore, the aim of this study was to examine the association between WP smoking and albuminuria in apparently healthy individuals. This analysis was conducted on data of a population-based cross-sectional study—the Urban Rural Chronic Diseases Study (URCDS). The study sample was recruited from three sites in Pakistan. Trained nurses carried out individual interviews and obtained the information on demographics, lifestyle factors, and past and current medical history. Measurements of complete blood count, lipid profile, fasting glucose level, and 24-hour albuminuria were also made by using blood and urine samples. Albumin excretion was classified into three categories using standard cut-offs: normal excretion, high-normal excretion and microalbuminuria. Multiple logistic regression models were used to examine the relationship between WP smoking and albuminuria. The final analysis included data from 1,626 health individuals, of which 829 (51.0%) were males and 797 (49.0%) females. Of 1,626 individuals, 267 (16.4%) were current WP smokers and 1,359 (83.6%) were non-WP smokers. WP smoking was significantly associated with high-normal albuminuria (OR  =  2.33, 95% CI 1.68-3.22, p-value <0.001) and microalbuminuria (OR  =  1.75, 95% CI 1.18-2.58, p-value 0.005) after adjustment for age, sex, BMI, social class, hypertension, and diabetes mellitus. WP smoking was significantly associated with high-normal albuminuria and microalbuminuria when analysis was stratified on hypertension and diabetes mellitus categories. WP smoking has a strong association with albuminuria in apparently healthy

  1. Heat and PAHs Emissions in Indoor Kitchen Air and Its Impact on Kidney Dysfunctions among Kitchen Workers in Lucknow, North India.

    PubMed

    Singh, Amarnath; Kamal, Ritul; Mudiam, Mohana Krishna Reddy; Gupta, Manoj Kumar; Satyanarayana, Gubbala Naga Venkata; Bihari, Vipin; Shukla, Nishi; Khan, Altaf Hussain; Kesavachandran, Chandrasekharan Nair

    2016-01-01

    Indoor air quality and heat exposure have become an important occupational health and safety concern in several workplaces including kitchens of hotels. This study investigated the heat, particulate matter (PM), total volatile organic compounds (TVOCs) and polycyclic aromatic hydrocarbons (PAHs) emissions in indoor air of commercial kitchen and its association with kidney dysfunctions among kitchen workers. A cross sectional study was conducted on 94 kitchen workers employed at commercial kitchen in Lucknow city, North India. A questionnaire-based survey was conducted to collect the personal and occupational history of the kitchen workers. The urine analysis for specific gravity and microalbuminuria was conducted among the study subjects. Indoor air temperature, humidity, wet/ dry bulb temperature and humidex heat stress was monitored during cooking activities at the kitchen. Particulate matter (PM) for 1 and 2.5 microns were monitored in kitchen during working hours using Hazdust. PAHS in indoor air was analysed using UHPLC. Urinary hydroxy-PAHs in kitchen workers were measured using GC/MS-MS. Higher indoor air temperature, relative humidity, PM1 and PM2.5 (p<0.001) was observed in the kitchen due to cooking process. Indoor air PAHs identified are Napthalene, fluorine, acenaphthene, phenanthrene, pyrene, chrysene and indeno [1,2,3-cd) pyrene. Concentrations of all PAHs identified in kitchen were above the permissible OSHA norms for indoor air. Specific gravity of urine was significantly higher among the kitchen workers (p<0.001) as compared to the control group. Also, the prevalence of microalbuminuria was higher (p<0.001) among kitchen workers. Urinary PAH metabolites detected among kitchen workers were 1-NAP, 9-HF, 3-HF, 9-PHN and 1-OHP. Continuous heat exposure in kitchens due to cooking can alter kidney functions viz., high specific gravity of urine in kitchen workers. Exposure to PM, VOCs and PAHs in indoor air and presence of urinary PAHs metabolites may

  2. [Pre and postoperative adherence to Mediterranean-like diet and its effect on weight loss and cardiovascular risk factors after sleeve gastrectomy].

    PubMed

    Ruiz-Tovar, Jaime; Boix, Evangelina; Bozhychko, Maryana; Miren Del Campo, Jone; Martínez, Rosana; Bonete, José María; Calpena, Rafael

    2014-10-01

    Introducción: El cumplimiento de la dieta mediterránea es cada vez menor, incluso en países mediterráneos, a pesar de estar considerada como un ejemplo de dieta saludable. Objetivos: El objetivo principal de este trabajo fue evaluar la adherencia a la dieta mediterránea en pacientes obesos mórbidos antes y después de ser sometidos a una gastrectomía vertical como técnica bariátrica. Así mismo, se analizó también la influencia de la adherencia sobre la pérdida de peso conseguida y sobre la evolución de los factores de riesgo cardiovasculares. Material y métodos: Se realizó un estudio observacional prospectivo de todos los pacientes sometidos a una gastrectomía vertical entre octubre de 2010 y mayo de 2012. Los pacientes rellenaron un test KIDMED (evalúa la adherencia a la dieta mediterránea) antes de la operación y 1 año después de la misma. Resultados: Se incluyeron un total de 50 pacientes en el estudio. Antes de la operación, el 30% de los pacientes estudiados presentaban una baja adherencia a la dieta mediterránea, el 64% una adherencia moderada y sólo un 6% una buena adherencia. Al año de la intervención, sólo un 2% de los casos presentaban una baja adherencia, un 58% una adherencia moderada y un 40% una buena adherencia a la dieta mediterránea (p=0,02). Se estableció una correlación inversa entre el aumento de puntuación del test KIDMED (indicador de mayor adherencia a la dieta mediterránea) y la pérdida de peso (Spearman -0,357; p=0,008), el descenso en los valores de colesterol total (Spearman -0,442; p=0,003) y de LDL-colesterol (Spearman -0,464; p=0,002). Además, se observó una correlación directa entre el aumento de puntuación del test KIDMED y el incremento en los niveles de HDL-colesterol (Spearman 0,562; p=0,001). Conclusiones: Después de la operación, los pacientes cumplen mejor los patrones de dieta mediterránea. Aquellos pacientes con mejor adherencia a la misma, consiguieron una mayor pérdida de peso y una

  3. EFFECTS OF OATS ON LIPID PROFILE, INSULIN RESISTANCE AND WEIGHT LOSS.

    PubMed

    Schuster, Jessica; Benincá, Gabriela; Vitorazzi, Renata; Morelo Dal Bosco, Simone

    2015-11-01

    Introducción: las enfermedades cardiovasculares son la principal causa mundial de morbilidad y mortalidad. Esta prevalencia justifica la importancia de los alimentos funcionales que promueven la salud cardiovascular, como el -glucano, presente en la avena, con potenciales efectos hipocolesterolémicos e hipoglucemiantes. Objetivo: evaluar los efectos de una intervención con la harina de avena en los niveles de glucosa en sangre, el índice HOMA-IR, el perfil de lípidos, el peso y el índice de masa corporal (IMC) de los usuarios adultos de un servicio de salud en Río Grande do Sul, Brasil. Métodos: estudio longitudinal, controlado, realizado con personas de 22-60 años de edad, usuarios de un servicio de salud. Los individuos fueron asignados al grupo control (dieta habitual) o grupo Case (dieta habitual + 40 g de avena/día). Al inicio del estudio y después de ocho semanas de seguimiento se evaluaron el peso y la altura, calculado IMC, la sangre recolectada para la medición de glucemia en ayunas, insulina, triglicéridos, colesterol total y colesterol HDL; y se calculó el colesterol LDL y el índice HOMA-IR. Los datos se expresan como media ± desviación estándar y porcentajes. Se aplicaron el test Kolmogorov-Smirnov, la t de Student, el test Mann-Whitney y las pruebas de Wilcoxon. Se adoptó un nivel de significación del 5% (p < 0,05). Resultados: la muestra estuvo constituida por 82 sujetos, divididos en casos (n = 38) y controles (n = 44) con una edad media de 40,07 ± 10,49 años, 58,5% mujeres. Comparando los resultados de todos los parámetros medidos al inicio del estudio y después de ocho semanas de seguimiento, el grupo de control no obtuvo una reducción significativa en ningún parámetro, mostrando un aumento significativo de la glucosa en sangre y HOMA-IR (p < 0,05). El grupo de intervención obtuvo una reducción significativa de todos los indicadores antropométricos y bioquímicos analizados (p < 0,001). Conclusión: los resultados

  4. [INFLUENCE OF THE NUTRITIONAL COMPOSITION OF DIFFERENT FIBER-ENRICHED ENTERAL NUTRITION FORMULAS ON THE ADMINISTRATION TIME BY GRAVITY AND THE RISK OF TUBE FEEDING OBSTRUCTION].

    PubMed

    Bonada Sanjaume, Anna; Gils Contreras, Anna; Salas-Salvadó, Jordi

    2015-08-01

    Introducción: la administración de nutrición enteral por gravedad es un método de administración muy útil en la práctica clínica, pero a la vez muy poco preciso y que presenta unas limitaciones importantes, como la dificultad a la hora de establecer una velocidad de goteo precisa y la probabilidad de enlentecimiento del goteo según la fórmula administrada. Objetivos: evaluar el tiempo de paso de caída libre y el riesgo de obturación de cinco fórmulas de nutrición enteral ricas en fibra con diferente concentración proteica y densidad calórica, administradas por gravedad a través de sondas nasogástricas (SNG) de diferentes calibres. Valorar la influencia de la composición en la velocidad de paso por gravedad de las fórmulas estudiadas. Métodos: se compararon cinco fórmulas de NE ricas en fibra de distintos tipos y se utilizaron SNG con un calibre de 8, 10 y 12 Fr. La fluidez de las fórmulas de NE por gravedad se estimó cronometrando el tiempo de paso de cada fórmula a máxima velocidad y se calculó el tiempo medio de caída libre (TMCL), registrándose las posibles obturaciones. Posteriormente se realizó una simulación in vitro de la administración de 1.500 ml de cada una de las fórmulas a una velocidad determinada para que el producto pasara en cinco horas. Se registró el enlentecimiento y la detención del paso como indicadores de riesgo de obturación. Resultados: los dos productos que con diferencia presentaron un mayor TMCL fueron los productos de mayor concentración energética. El tiempo de paso en caída libre de estos dos productos a través de la sonda de 8 Fr superó las cuatro horas. Para el resto de los productos y SNG utilizadas el tiempo fue inferior a dos horas y cinco minutos. No se detectó enlentecimiento del paso ni obturación de la sonda en ningún caso cuando se determinó el tiempo de caída libre a máxima velocidad. Cuando se ajustó la velocidad para que el producto pasara en cinco horas, en tres de los

  5. [Mental health indicators and their association with smoking in Guadalajara teenagers by sex].

    PubMed

    Nuño-Gutiérrez, Bertha Lidia; Celis-de la Rosa, Alfredo; García-Pérez, Olga Patricia

    2015-01-01

    Introducción: el objetivo de este estudio fue evaluar la fuerza de asociación entre indicadores de salud mental con el tabaquismo actual en adolescentes según su sexo. Métodos: se incluyeron 1134 estudiantes de primer año de una preparatoria pública. Se evaluaron diez indicadores de salud mental mediante escalas validadas: autoestima, impulsividad, síntomas depresivos, ideación suicida, conductas alimentarias de riesgo, recreación, locus de control, relación con padre/madre y estrés psicosocial. Resultados: encontramos diferentes indicadores asociados al tabaquismo en hombres y mujeres. En el análisis de riesgo crudo los indicadores para los hombres fueron: alta autoestima, impulsividad, tener 16-17 años de edad y tabaquismo en amigos. En mujeres: ideación suicida, impulsividad, conductas alimentarias de riesgo, tener 17 años, tabaquismo en amigos y hermanos. Después de la regresión logística, en ambos grupos hubo asociación entre impulsividad y tabaquismo en amigos. Además en hombres se encontró: alta autoestima y tener 16-17 años de edad, mientras que en mujeres: tabaquismo en hermanos. Conclusiones: los indicadores de salud mental asociados al tabaquismo actual fueron diferentes para hombres y mujeres. En los hombres: alta autoestima, impulsividad, edad y tabaquismo en amigos. En las mujeres: impulsividad, tabaquismo en amigos y hermanos.

  6. Laboratory Markers of Ventricular Arrhythmia Risk in Renal Failure

    PubMed Central

    2014-01-01

    Sudden cardiac death continues to be a major public health problem. Ventricular arrhythmia is a main cause of sudden cardiac death. The present review addresses the links between renal function tests, several laboratory markers, and ventricular arrhythmia risk in patients with renal disease, undergoing or not hemodialysis or renal transplant, focusing on recent clinical studies. Therapy of hypokalemia, hypocalcemia, and hypomagnesemia should be an emergency and performed simultaneously under electrocardiographic monitoring in patients with renal failure. Serum phosphates and iron, PTH level, renal function, hemoglobin and hematocrit, pH, inflammatory markers, proteinuria and microalbuminuria, and osmolarity should be monitored, besides standard 12-lead ECG, in order to prevent ventricular arrhythmia and sudden cardiac death. PMID:24982887

  7. Early renal abnormalities as an indicator of cardiovascular risk in type 2 diabetes.

    PubMed

    Viazzi, Francesca; Bonino, Barbara; Ratto, Elena; De Cosmo, Salvatore; Pontremoli, Roberto

    2014-12-01

    Accurate assessment of cardiovascular (CV) risk is a prerequisite for devising effective therapeutic strategies in patients with type 2 diabetes (T2DM) as it allows to refine prognosis and treatment targets as well as the cost-benefit ratio for specific pharmacological interventions. The presence of subclinical vascular organ damage plays a well known role in determining overall risk and a wider use of low cost, easy to perform diagnostic tools to stratify CV risk is very much needed. Besides their well known prognostic value for progression to end stage renal disease (ESRD), subclinical renal abnormalities such as microalbuminuria and/or a slight reduction in estimation of glomerular filtration rate (eGFR), have been shown to be powerful, independent predictors of CV diseases in patients with T2DM. Through the combined evaluation of these two biomarkers of chronic kidney disease (CKD), clinicians can usefully and reliably get a perspective on global and CV outcome of their diabetic patients.

  8. [Cardiovascular risk stratification and therapeutic implications in arterial hypertension].

    PubMed

    Handschin, Anja; Henny-Fullin, Katja; Buess, Daniel; Dieterle, Thomas

    2015-06-01

    To improve the prevention of cardiovascular complications and events in hypertensive patients, it is of major importance to estimate the patient's individual risk for cardiovascular events. Antihypertensive treatment should not only be based on blood pressure values anymore, but also on the patient's comorbidities and risk profile. Risk stratification takes into account cardiovascular risk factors, diabetes, asymptomatic organ damage and established cardiovascular or renal disease. The most important markers for asymptomatic organ damage which should be searched for are microalbuminuria and LVH. Current guidelines emphasize the importance of the adaption and selection of treatment according to asymptomatic and established organ damage and provide assistance for treatment decisions. They focus also on the different non-pharmacological therapy options and lifestyle modifications. The goal of this article is to summarize the most important innovations and to point out the importance of simple tools for the implementation of cardiovascular risk stratification in hypertensive patients.

  9. Chronic kidney disease and venous thromboembolism: epidemiology and mechanisms

    PubMed Central

    Wattanakit, Keattiyoat; Cushman, Mary

    2010-01-01

    Purpose of review An estimated 13% of Americans have kidney disease. We sought to describe the association of kidney disease with risk of venous thromboembolism and discuss possible mechanisms explaining this association. Recent findings All severities of kidney disease appear to increase the risk of venous thromboembolism. In the general population the risk associated with mild to moderate kidney disease is 1.3–2-fold increased, and present even for microalbuminuria, although stage 1 chronic kidney disease itself has not been studied. End-stage renal disease is also associated with a 2.3-fold increased risk, compared to the general population. Although data are limited, risk increases after kidney transplant and with nephrotic syndrome as well. Summary Rates of kidney disease are increasing rapidly in the population and kidney disease is a risk factor for venous thromboembolism. An improved understanding of mechanisms linking kidney disease with venous thromboembolism will allow further study of best prevention efforts. PMID:19561505

  10. New-onset diabetes mellitus after pediatric liver transplantation.

    PubMed

    Regelmann, Molly O; Goldis, Marina; Arnon, Ronen

    2015-08-01

    In the first five yr after liver transplant, approximately one in 10 pediatric recipients will develop NODAT. Factors associated with higher risk for NODAT have been difficult to identify due to lack of uniformity in reporting and data collection. Limited studies have reported higher risk in those who are at an older age at transplant, those with high-risk ethnic backgrounds, and in those with particular underlying conditions, such as CF and primary sclerosing cholangitis. Immunosuppressive medications, including tacrolimus, cyclosporine A, GC, and sirolimus, have been implicated as contributing to NODAT, to varying degrees. Identifying those at highest risk, appropriately screening, and diagnosing NODAT is critical to initiating timely treatment and avoiding potential complications. In the pediatric population, treatment is limited primarily to insulin, with some consideration for metformin. Children with NODAT should be monitored carefully for complications of DM, including microalbuminuria, hypertension, hyperlipidemia, and retinopathy.

  11. [Interdisciplinary interaction in vascular diseases of the eye, diabetes and diabetic retinopathy].

    PubMed

    Kleophas, W; Dellanna, F

    2014-01-01

    The incidence of diabetes mellitus type 2 is greatly increasing worldwide. An early therapy with intensified control of diabetes and blood pressure is especially important to avoid delayed complications. In addition to diabetic foot syndrome, diabetic retinopathy and diabetic nephropathy still represent commonly occurring problems. Despite improvements in the quality of care, the targets of the St. Vincent Declaration have still not yet been achieved. Diabetic retinopathy and diabetic nephropathy show parallels in the course of the disease and in the pathological anatomical alterations which have led to the inauguration of a diabetic renal-retinal syndrome. The ophthalmological assessment of the retina was previously considered to be a diagnostic aid for assessment of diabetic nephropathy; however, nowadays a simple estimation of the glomerular filtration rate using the modification of diet in renal disease (MDRD) formula and determination of microalbuminuria can in contrast give ophthalmologists an early indication of the possible presence of microangiopathic alterations.

  12. [Epidemiology of cardiovascular diseases in the Spanish elderly population].

    PubMed

    Sáez, T; Suárez, C; Blanco, F; Gabriel, R

    1998-11-01

    This paper is a comprehensive and critical review of the updated information available in Spain for the elderly population on the epidemiology of cardiovascular diseases. Clinical (coronary heart disease, heart failure, and cerebrovascular disease) and subclinical (left ventricular hypertrophy, carotid stenosis) cardiovascular diseases are reviewed. Prevalence and distribution of major classical cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking and information on new risk factors such as microalbuminuria or abdominal obesity are also presented. The article is also focused on the high rates of morbidity, mortality and the burden of handicap in this age group in comparison with middle-aged people. Finally we call attention to the few and inconsistent population data available for some of the mentioned topics in our country, particularly the lack of specific figures of incidence and risk rates from cohort studies of elderly people in Spain. PMID:9859708

  13. [Systemic arterial hypertension in child and adolescent].

    PubMed

    Rosas-Peralta, Martín; Medina-Concebida, Luz Elena; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a through history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Although the evidence of first line therapy for hypertension is still controversial, the recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 of hypertension, or stage 1 of hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus where is the search for microalbuminuria justified. PMID:27284843

  14. [Systemic arterial hypertension in child and adolescent].

    PubMed

    Rosas-Peralta, Martín; Medina-Concebida, Luz Elena; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a through history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Although the evidence of first line therapy for hypertension is still controversial, the recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 of hypertension, or stage 1 of hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus where is the search for microalbuminuria justified.

  15. Hemolytic uremic syndrome: late renal injury and changing incidence-a single centre experience in Canada.

    PubMed

    Robitaille, Pierre; Clermont, Marie-José; Mérouani, Aïcha; Phan, Véronique; Lapeyraque, Anne-Laure

    2012-01-01

    Aims. To assess trends in the incidence of pediatric diarrhea-associated hemolytic uremic syndrome (D(+) HUS) and document long-term renal sequelae. Methods. We conducted a retrospective cohort study of children with D(+) HUS admitted to a tertiary care pediatric hospital in Montreal, Canada, from 1976 to 2010. In 2010, we recontacted patients admitted before 2000. Results. Of 337 cases, median age at presentation was 3.01 years (range 0.4-14). Yearly incidence peaked in 1988 and 1994-95, returning to near-1977 levels since 2003. Twelve patients (3.6%) died and 19 (5.6%) experienced long-term renal failure. Almost half (47%) The patients required dialysis. Need for dialysis was the best predictor of renal sequelae, accounting for 100% of severe complications. Of children followed ≥1 year (n = 199, mean follow-up 8.20 ± 6.78 years), 19 had severe and 18 mild-to-moderate kidney injury, a total sequelae rate, of 18.6%. Ten years or more after-HUS (n = 85, mean follow-up 15.4 ± 5.32 years), 8 (9.4%) patients demonstrated serious complications and 22 (25.9%) mild-to-moderate, including 14 (16%) microalbuminuria: total sequelae, 35.3%. Conclusions. Patients with D(+) HUS should be monitored at least 5 years, including microalbuminuria testing, especially if dialysis was required. The cause of the declining incidence of D(+)HUS is elusive. However, conceivably, improved public health education may have played an important role in the prevention of food-borne disease. PMID:24278685

  16. Evaluation of the predictive value of coronary artery calcium score for obstructive coronary artery disease in asymptomatic Korean patients with type 2 diabetes mellitus

    PubMed Central

    Won, Ki-Bum; Niinuma, Hiroyuki; Sung, Jimin; Shin, Sanghoon; Cho, In-Jeong; Shim, Chi-Young; Hong, Geu-Ru; Kim, Young Jin; Choi, Byung-Wook; Chung, Namsik

    2015-01-01

    Background Compared with coronary computed tomographic angiography (CCTA), the coronary artery calcium score (CACS) may be limited in predicting adverse cardiovascular events in asymptomatic diabetic patients. Methods We evaluated the predictive value of CACS for obstructive coronary plaques (OCPs) assessed by CCTA in 328 consecutive asymptomatic patients with type 2 diabetes mellitus who had an estimated glomerular filtration rate greater than 60 ml/min/1.73 m2. Results In total, 29 (9%) patients had OCPs: calcified or mixed OCPs and noncalcified OCPs were found in 26 (8%) and three (1%) patients, respectively. On the basis of a CACS of 0, 1–10, 11–100, and greater than 100, OCPs were found in 2, 5, 15, and 36% of patients, respectively. On receiver operating characteristic curve analysis, the optimal cutoff CACS for predicting OCPs was found to be 33, with 83% sensitivity and 81% specificity (area under the curve, 0.853; 95% confidence interval, 0.777–0.930; P<0.001). Positive and negative predictive values of a CACS of 33 for OCPs were 30 and 98%, respectively. On multivariate logistic regression analysis, age [odds ratio (OR), 1.09], microalbuminuria (OR, 3.43), current smoking (OR, 3.93), and CACS greater than 33 (OR, 15.85) were found to be independently associated with an increased risk for OCPs (P<0.05, respectively). The predictive significance of CACS greater than 33 for OCPs improved after considering the status of microalbuminuria and current smoking. Conclusion These findings suggest that CACS is an effective gatekeeper for evaluating obstructive coronary artery disease using CCTA in asymptomatic Korean patients with type 2 diabetes mellitus who have near-normal kidney function. PMID:25356815

  17. Diabetic nephropathy: Is it time yet for routine kidney biopsy?

    PubMed Central

    Gonzalez Suarez, Maria L; Thomas, David B; Barisoni, Laura; Fornoni, Alessia

    2013-01-01

    Diabetic nephropathy (DN) is one of the most important long-term complications of diabetes. Patients with diabetes and chronic kidney disease have an increased risk of all-cause mortality, cardiovascular mortality, and kidney failure. The clinical diagnosis of DN depends on the detection of microalbuminuria. This usually occurs after the first five years from the onset of diabetes, and predictors of DN development and progression are being studied but are not yet implemented into clinical practice. Diagnostic tests are useful tools to recognize onset, progression and response to therapeutic interventions. Microalbuminuria is an indicator of DN, and it is considered the only noninvasive marker of early onset. However, up to now there is no diagnostic tool that can predict which patients will develop DN before any damage is present. Pathological renal injury is hard to predict only with clinical and laboratory findings. An accurate estimate of damage in DN can only be achieved by the histological analysis of tissue samples. At the present time, renal biopsy is indicated on patients with diabetes under the suspicion of the presence of nephropathies other than DN. Results from renal biopsies in patients with diabetes had made possible the classification of renal biopsies in three major groups associated with different prognostic features: diabetic nephropathy, non-diabetic renal disease (NDRD), and a superimposed non-diabetic condition on underlying diabetic nephropathy. In patients with type 2 diabetes with a higher degree of suspicion for NDRD, it is granted the need of a renal biopsy. It is important to identify and differentiate these pathologies at an early stage in order to prevent progression and potential complications. Therefore, a more extensive use of biopsy is advisable. PMID:24379914

  18. Hemolytic Uremic Syndrome: Late Renal Injury and Changing Incidence—A Single Centre Experience in Canada

    PubMed Central

    Robitaille, Pierre; Clermont, Marie-José; Mérouani, Aïcha; Phan, Véronique; Lapeyraque, Anne-Laure

    2012-01-01

    Aims. To assess trends in the incidence of pediatric diarrhea-associated hemolytic uremic syndrome (D+ HUS) and document long-term renal sequelae. Methods. We conducted a retrospective cohort study of children with D+ HUS admitted to a tertiary care pediatric hospital in Montreal, Canada, from 1976 to 2010. In 2010, we recontacted patients admitted before 2000. Results. Of 337 cases, median age at presentation was 3.01 years (range 0.4–14). Yearly incidence peaked in 1988 and 1994-95, returning to near-1977 levels since 2003. Twelve patients (3.6%) died and 19 (5.6%) experienced long-term renal failure. Almost half (47%) The patients required dialysis. Need for dialysis was the best predictor of renal sequelae, accounting for 100% of severe complications. Of children followed ≥1 year (n = 199, mean follow-up 8.20 ± 6.78 years), 19 had severe and 18 mild-to-moderate kidney injury, a total sequelae rate, of 18.6%. Ten years or more after-HUS (n = 85, mean follow-up 15.4 ± 5.32 years), 8 (9.4%) patients demonstrated serious complications and 22 (25.9%) mild-to-moderate, including 14 (16%) microalbuminuria: total sequelae, 35.3%. Conclusions. Patients with D+ HUS should be monitored at least 5 years, including microalbuminuria testing, especially if dialysis was required. The cause of the declining incidence of D+HUS is elusive. However, conceivably, improved public health education may have played an important role in the prevention of food-borne disease. PMID:24278685

  19. Preventing microvascular complications in type 1 diabetes mellitus.

    PubMed

    Viswanathan, Vijay

    2015-04-01

    Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM) by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progression starts at glycated hemoglobin (HbA1c) level of 7%. As per the American Diabetes Association, a new pediatric glycemic control target of HbA1c <7.5% across all ages replaces previous guidelines that had called for different targets by age. Evidence shows that prevalence of microvascular complications is greater in patients with age >20 years as compared to patients <10 years of age. Screening of these complications should be done regularly, and appropriate preventive strategies should be followed. Angiotensin converting enzyme inhibitors and angiotensin II receptor blocker reduce progression from microalbuminuria to macroalbuminuria and increase the regression rate to normoalbuminuria. Diabetic microvascular complications can be controlled with tight glycemic therapy, dyslipidemia management and blood pressure control along with renal function monitoring, lifestyle changes, including smoking cessation and low-protein diet. An integrated and personalized care would reduce the risk of development of microvascular complications in T1DM patients. The child with diabetes who receives limited care is more likely to develop long-term complications at an earlier age. Screening for subclinical complications and early interventions with intensive therapy is the need of the hour.

  20. Early Predictors of Renal Dysfunction in Egyptian Patients with β-Thalassemia Major and Intermedia

    PubMed Central

    Tantawy, Azza A.G.; El Bablawy, Nagham; Adly, Amira A.M.; Ebeid, Fatma S.E.

    2014-01-01

    Background Better survival of thalassemia patients allowed previously unrecognized renal complications to emerge. Objectives Assess prevalence and early predictors of renal dysfunction in young β-thalassemia major (β-TM) and intermedia (β-TI) patients. Subjects 66 β-TM (group I), 26 β-TI (group II) Egyptian patients and 40 healthy controls. Methods Clinical assessment and laboratory data including kidney and liver function tests, such as serum ferritin, serum bicarbonate, plasma osmolality and urinary total proteins, microalbuminuria (MAU), N-acetyl-β-D-glucosaminidase (NAG), retinol binding protein (RBP), α-1 microglobulin, bicarbonate, osmolality, creatinine clearance (CrCl), % fractional excretion of bicarbonate (% FE-HCO3). Results The prevalent renal abnormality was proteinuria (71%), followed by increased urinary level of RBP (69.4%), NAG (58.1%), α-1 microglobulin (54.8%) and microalbuminuria (29%) and also decreased urinary osmolality (58.1%). CrCl was a better assessment of renal function and significantly lowered in thalassemia patients. Tubular dysfunctions were more significant in splenectomized β-TM patients who showed more elevation of NAG and α-1 microglobulin and lower urinary osmolality. NAG, RBP and α-1 microglobulin were negatively correlated with CrCl and positively correlated with serum ferritin and urinary total protein. Z-score analysis for identifying patients with renal dysfunction proved superiority of urine total protein and RBP. Comparative statistics of different frequencies revealed significant difference between the urinary total protein and both MAU and % FE-HCO3. Conclusion Asymptomatic renal dysfunctions are prevalent in young β-TM and β-TI patients that necessitate regular screening. Urinary total protein and RBP may be cost-effective for early detection. PMID:25237470

  1. Youth-onset type 2 diabetes mellitus: lessons learned from the TODAY study.

    PubMed

    Narasimhan, Sumana; Weinstock, Ruth S

    2014-06-01

    Type 2 diabetes mellitus is increasingly diagnosed in obese children and adolescents. Evidence suggests that this disease commonly progresses more rapidly in youth compared with adults and is associated with high rates of early microalbuminuria, hypertension, and dyslipidemia. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study was the first multiethnic, multicenter randomized trial in the United States to compare 3 treatment approaches in obese youth with new-onset type 2 diabetes (n=699; ages 10-17 years): monotherapy with metformin, metformin with rosiglitazone, and metformin with an intensive lifestyle intervention. The primary outcome was glycemic control. Diabetes-related complications and cardiovascular risk factors were also examined. Approximately half of the participants could not maintain glycemic control by using metformin alone. Combination therapy with metformin and rosiglitazone resulted in better durability of glycemic control, and metformin plus intensive lifestyle intervention was intermediate but not superior to metformin alone. Deterioration in glycemic control was associated with rapid loss of beta cell function, not worsened insulin sensitivity, and could not be explained by differences in adherence or body mass index. After 3.9 years, 236 (33.8%) of participants had hypertension and 116 participants (16.6%) had microalbuminuria. Only 55.9% of participants had a low-density lipoprotein cholesterol level less than 100 mg/dL (to convert to mmol/L, multiply by 0.0259) after 3 years, and 71 of 517 participants (13.7%) had retinopathy. The significance of the findings from this important trial for the management of youth and young adults with youth-onset type 2 diabetes and its complications is discussed. An aggressive multifaceted approach is needed to prevent or forestall premature microvascular and macrovascular complications in youth-onset type 2 diabetes.

  2. Cardiovascular Effects of Copper Deficiency on Activity of Superoxide Dismutase in Diabetic Nephropathy

    PubMed Central

    Al-Bayati, Mohammed A.; Jamil, Dina A.; Al-Aubaidy, Hayder A.

    2015-01-01

    Background: Copper (Cu) is essential both for its role in antioxidant enzymes, like Cu/zinc (Zn) superoxide dismutase (SOD) and ceruloplasmin, as well as its role in lysyl oxidase, essential for the strength and integrity of the heart and blood vessels. With such a central role in cardiovascular health, Cu has been generally overlooked in the debate over improving our cardiovascular health. Cu deficiency has produced many of the same abnormalities present in cardiovascular disease. It seems almost certain that Cu plays a large role in the development of this killer disease, not because of its excess in the diet, but rather its deficiency. Aim: This study was undertaken to investigate the cardiovascular effects of Cu deficiency on the activity of SOD in patients with type 2 diabetes mellitus (T2DM) with and without diabetic nephropathy. Materials and Methods: Fifty-five patients with T2DM were recruited in this study which were divided into two subgroups based on the presence of microalbuminuria, the first group (microal buminuric group, n = 31) had a microalbuminuria between 30 and 299 μg/mg. The second group (normoal buminuric group, n = 29) had an albumin level less than 30 μg/mg. The two diabetic groups were compared to the control group (n = 37). Results: The results of our study showed a significant reduction in the levels of SOD enzyme associated with an increased urinary Cu excretion in microalbuminuric group compared to the control group at P < 0.05. Conclusions: The current study illustrates that the regulation of the blood concentrations of Cu may be a potential therapeutic target for prevention and treatment of diabetic nephropathy. PMID:25789247

  3. Biochemical changes correlated with blood thiamine and its phosphate esters levels in patients with diabetes type 1 (DMT1).

    PubMed

    Al-Daghri, Nasser M; Alharbi, Mohammed; Wani, Kaiser; Abd-Alrahman, Sherif H; Sheshah, Eman; Alokail, Majed S

    2015-01-01

    Thiamine (vitamin B1) is an essential enzyme cofactor in most organisms required at several stages of anabolic and catabolic intermediary metabolism. However, little is known on the positive effects of thiamine in diabetic type 1 (DMT1) patients. The objectives of this study were to evaluate the biochemical changes related to thiamine deficiency in patients with DMT1 outcomes among Saudi adults. We hypothesized that blood thiamine deficiency in patients with DMT1 manifestations might lead to an increase in metabolic syndrome. A total of 77 patients with DMT1 (age 35.8 ± 5.5) and 81 controls (age 45.0 ± 18.1) (total N = 158) were randomly selected from the Riyadh Cohort Study for inclusion. Saudi adults with diabetes type 1, a significant decrease in systolic (P < 0.001), and diastolic blood pressure (P = 0.008) and microalbuminuria (P = 0.02). Moreover, cholesterol, glucose and triglycerides were significantly increased (P 0.001, 0.001 and 0.008, respectively) in patients with diabetes type 1 compared to controls. On the other hand, HDL, TMP, TDP and thiamine, were significantly decreased in patients with diabetes type 1 (P 0.005, 0.002, 0.005, and 0.002), respectively. A strong association between blood thiamine level and diabetes type 1 was detected in our study population. The results confirmed the role of thiamine and thiamine phosphate esters, in preventing metabolic changes and complications of diabetes type 1. The levels of these thiamine and thiamine phosphate esters were correlated with diabetes related biomarkers including HDL, glucose, triglycerides and cholesterol, as well as microalbuminuria, LDL and urine thiamine. The results support a pivotal role of blood thiamine and its phosphate esters in preventing the biochemical changes and complications in patients with DMT1.

  4. Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village

    PubMed Central

    Laux, Timothy S.; Bert, Philip J.; Barreto Ruiz, Gerardo M.; González, Marvin; Unruh, Mark; Aragon, Aurora; Lacourt, Cecilia Torres

    2015-01-01

    Background Chronic kidney disease (CKD) is found at epidemic levels in certain populations of the Pacific Coast in northwestern Nicaragua especially in younger men. There are knowledge gaps concerning CKD’s prevalence in regions at higher altitudes. Methods A cross-sectional study of adults between the ages of 20 and 60 years in 1 coffee-growing village in Nicaragua located at 1,000 m above sea level (MASL) altitude was performed. Predictors included participant sex, age, occupation, conventional CKD risk factors and other factors associated with CKD suggested by previous surveys in Central America. Outcomes included serum creatinine (SCr) values >1.2 mg/dL for men and >0.9 mg/dL for women, estimated glomerular filtration rate (GFR) <60 ml/min per 1.73 m2, dipstick proteinuria stratified as microalbuminuria (30–300 mg/dL) and macroalbuminuria (>300 mg/dL), hypertension and body mass index. Results Of 324 eligible participants, 293 were interviewed (90.4%), and 267 of those received the physical exam (82.4% overall). Of the sample, 45% were men. Prevalence rate of estimated GFR <60 ml/min per 1.73 m2 was 0 for men (0%) and 2 for women (1.4%). The prevalence of at least microalbuminuria was significantly higher among men compared with women (27.5% vs. 21.4%, respectively; p=0.02). Conclusions The CKD prevalence in this village is comparable to a previously studied Nicaraguan coffee-farming region and much lower than previously screened portions of northwestern Nicaragua. There is heterogeneity in CKD prevalence across Nicaragua. At this time, screenings should target individuals living in previously identified, higher risk regions. More work is needed to understand determinants of CKD in this resource-poor nation. PMID:21956767

  5. The Expression of Tristetraprolin and Its Relationship with Urinary Proteins in Patients with Diabetic Nephropathy

    PubMed Central

    Zhang, Qian; Liu, Dongwei; Wen, Lu; Yang, Yang; Yang, Liu; Liu, Zhangsuo

    2015-01-01

    Objective Tristetraprolin (TTP), also known as zinc finger protein 36, is an RNA binding protein that has a significant role in regulating the expression of mRNAs containing AU-rich elements. We postulated that TTP might regulate interleukin (IL)-6 and IL-18 expression in diabetes. This study aimed to test the hypothesis that the levels of TTP are correlated with nephropathy in patients with type 2 diabetes. Methods Eighty-seven patients (61.3±9.6 years old) who had been diagnosed with type 2 diabetes mellitus and 41 age and sex matched healthy control subjects were enrolled. The diabetes patients were classified into those without proteinuria, with microalbuminuria, and with clinical proteinuria groups according to the ratio of urinary excretion of albumin/creatinine (ACR). Results Serum and urinary levels of IL-6 and IL-18 were significantly elevated, but those of TTP were significantly decreased in patients with diabetes as compared with control subjects. In addition, serum and urinary levels of IL-6 and IL-18 were significantly higher, but those of TTP were significantly lower in patients with proteinuria than in patients without proteinuria or with microalbuminuria. There was a significant correlation between serum TTP and IL-6/IL-18 (correlation coefficients of -0.572 and -0.685, P < 0.05). Conclusion These results show that diabetes with clinical proteinuria is accompanied by decreased urinary and serum level of TTP and increased levels of IL-6 and IL-18. Decreased TTP expression might occur prior to the increase in IL-6 and IL-18, and decrease of TTP might provide an earlier marker for glomerular dysfunction than IL-6 and IL-18. PMID:26517838

  6. Plasma Cardiotrophin-1 as a Marker of Hypertension and Diabetes-Induced Target Organ Damage and Cardiovascular Risk

    PubMed Central

    Gamella-Pozuelo, Luis; Fuentes-Calvo, Isabel; Gómez-Marcos, Manuel A.; Recio-Rodriguez, José I.; Agudo-Conde, Cristina; Fernández-Martín, José L.; Cannata-Andía, Jorge B.; López-Novoa, José M.; García-Ortiz, Luis; Martínez-Salgado, Carlos

    2015-01-01

    Abstract The search for biomarkers of hypertension and diabetes-induced damage to multiple target organs is a priority. We analyzed the correlation between plasma cardiotrophin-1 (CT-1), a chemokine that participates in cardiovascular remodeling and organ fibrosis, and a wide range of parameters currently used to diagnose morphological and functional progressive injury in left ventricle, arteries, and kidneys of diabetic and hypertensive patients, in order to validate plasma levels of CT-1 as clinical biomarker. This is an observational study with 93 type 2-diabetic patients, 209 hypertensive patients, and 82 healthy controls in which we assessed the following parameters: plasma CT-1, basal glycaemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), left ventricular hypertrophy (LVH by electrocardiographic indexes), peripheral vascular disease (by pulse wave velocity—PWV, carotid intima-media thickness—C-IMT, and ankle-brachial index—ABI), and renal impairment (by microalbuminuria, albumin/creatinine urinary ratio, plasma creatinine concentrations, and glomerular filtration rate). Hypertensive or diabetic patients have higher plasma CT-1 than control patients. CT-1 positively correlates with basal glycaemia, SBP, DBP, PP, LVH, arterial damage (increased IMT, decreased ABI), and early renal damage (microalbuminuria, elevated albumin/creatinine ratio). CT-1 also correlates with increased 10-year cardiovascular risk. Multiple linear regression analysis confirmed that CT-1 was associated with arterial injury assessed by PWV, IMT, ABI, and cardiac damage evaluated by Cornell voltage duration product. Increases in plasma CT-1 are strongly related to the intensity of several parameters associated to target organ damage supporting further investigation of its diagnostic capacity as single biomarker of cardiovascular injury and risk and, possibly, of subclinical renal damage. PMID:26222851

  7. Amiloride lowers blood pressure and attenuates urine plasminogen activation in patients with treatment-resistant hypertension.

    PubMed

    Oxlund, Christina S; Buhl, Kristian B; Jacobsen, Ib A; Hansen, Mie R; Gram, Jeppe; Henriksen, Jan Erik; Schousboe, Karoline; Tarnow, Lise; Jensen, Boye L

    2014-12-01

    In conditions with albuminuria, plasminogen is aberrantly filtered across the glomerular barrier and activated along the tubular system to plasmin. In the collecting duct, plasmin activates epithelial sodium channels (ENaC) proteolytically. Hyperactivity of ENaC could link microalbuminuria/proteinuria to resistant hypertension. Amiloride, an ENaC inhibitor, inhibits urokinase-type plasminogen activator. We hypothesized that amiloride (1) reduces blood pressure (BP); (2) attenuates plasminogen-to-plasmin activation; and (3) inhibits urine urokinase-type plasminogen activator in patients with resistant hypertension and type 2 diabetes mellitus (T2DM).In an open-label, non-randomized, 8-week intervention study, a cohort (n = 80) of patients with resistant hypertension and T2DM were included. Amiloride (5 mg/d) was added to previous triple antihypertensive treatment (including a diuretic and an inhibitor of the renin-angiotensin-aldosterone system) and increased to 10 mg if BP control was not achieved at 4 weeks. Complete dataset for urine analysis was available in 60 patients. Systolic and diastolic BP measured by ambulatory BP monitoring and office monitoring were significantly reduced. Average daytime BP was reduced by 6.3/3.0 mm Hg. Seven of 80 cases (9%) discontinued amiloride due to hyperkalemia >5.5 mol/L, the most frequent adverse event. Urinary plasmin(ogen) and albumin excretions were significantly reduced after amiloride treatment (P < .0001). Urokinase activity was detectable in macroalbuminuric urine, with a tendency toward reduction in activity after amiloride treatment. Amiloride lowers BP, urine plasminogen excretion and activation, and albumin/creatinine ratio, and is a relevant add-on medication for the treatment of resistant hypertension in patients with T2DM and microalbuminuria.

  8. Increased plasma Kidney Injury Molecule-1 suggests early progressive renal decline in non-proteinuric patients with Type 1 diabetes

    PubMed Central

    Nowak, Natalia; Skupien, Jan; Niewczas, Monika A.; Yamanouchi, Masayuki; Major, Melissa; Croall, Stephanie; Smiles, Adam; Warram, James H.; Bonventre, Joseph V.; Krolewski, Andrzej S.

    2015-01-01

    Progressively decreasing glomerular filtration rate (GFR), or renal decline, is seen in patients with type 1 diabetes (T1D) and normoalbuminuria or microalbuminuria. Here we examined the associations of kidney injury molecule-1 (KIM-1) in plasma and urine with the risk of renal decline and determine whether those associations are independent of markers of glomerular damage. The study group comprised patients with T1D from the 2nd Joslin Kidney Study of which 259 had normoalbuminuria and 203 had microalbuminuria. Serial measurements over 4 to 10 years of follow-up (median 8 years) of serum creatinine and cystatin C were used jointly to estimate eGFRcr-cys slopes and time of onset of CKD stage 3 or higher. Baseline urinary excretion of IgG2 and albumin were used as markers of glomerular damage, and urinary excretion of KIM-1 and its plasma concentration were used as markers of proximal tubular damage. All patients had normal renal function at baseline. During follow-up, renal decline (eGFRcr-cys loss 3.3% or more per year) developed in 96 patients and 62 progressed to CKD stage 3. For both outcomes, the risk rose with increasing baseline levels of plasma KIM-1. In multivariable models, elevated baseline plasma KIM-1 was strongly associated with risk of early progressive renal decline, regardless of baseline clinical characteristics, serum TNFR1 or markers of glomerular damage. Thus, damage to proximal tubules may play an independent role in the development of early progressive renal decline in non-proteinuric patients with T1D. PMID:26509588

  9. If Your Child Learns in Two Languages: A Parent's Guide for Improving Educational Opportunities for Children Acquiring English as a Second Language = Si su nino aprende en dos idiomes: Una guia para que las familias sepan como mejorar las oportunidades educativas de los ninos que adquieren el ingles como segunda lengua = Neu lon Ban Hoc Bang Hai Thu Tieng: Chi-nam cua phu-huynh de cai tien co hoi hoc van cua con em dang hoc Anh van nhu sinh ngu thu hai.

    ERIC Educational Resources Information Center

    Zelasko, Nancy; Antunez, Beth

    This guide, in English, Spanish, and Vietnamese, aims to inform parents of students who have learned or are learning English as a Second Language about appropriate approaches for educating children so that they can work with schools to ensure a high quality education for their children. The emphasis is on explaining the laws, schools, and research…

  10. [Nutritional status of the persons living with HIV/AIDS; its relationship with T CD4+ cells counts].

    PubMed

    Linares Guerra, Elisa Maritza; Santana Porbén, Sergio; Carrillo Fornés, Olimpia; León Sánchez, Maria Amparo; Sanabria Negrín, José Guillermo; Acosta Núñez, Nadia; Pla Cruz, Alina; Coniell Linares, Emilia

    2013-11-01

    Justificación. La desnutrición puede presentarse en las personas con VIH/sida (PVIH/sida), y asociarse con deterioro del sistema inmune. Objetivo. Evaluar la asociación entre el estado nutricional de la PVIH/sida y el conteo de las células T CD4+. Diseño del estudio. Observacional, analítico y transversal. Métodos. El estado nutricional de 217 PVIH/sida domiciliados en la provincia Pinar del Río, Cuba (Hombres: 72.4%; Edad en el momento del diagnóstico del VIH/sida: < 30 años: 62.2%; Conteos CD4+ < 350 células.mm-3: 32,2%; Terapia antirretroviral: 33.2%) se estableció indistintamente mediante el Índice de Masa Corporal (IMC), la Evaluación Subjetiva Global (ESG) y el algoritmo de Chang. Se evaluó la asociación entre el estado nutricional y el conteo de CD4+ mediante las correspondientes razones de disparidades (OR), estimadas indistintamente de las razones de los productos cruzados de la tabla 2 x 2 de contingencia, o de los coeficientes del modelo de regresión logística. Resultados. La frecuencia de desnutrición fue dependiente del método de evaluación nutricional: IMC: 3.7%; Algoritmo de Chang: 8.8%; ESG: 10.6%; respectivamente. El estado nutricional se asoció débilmente con los conteos CD4+: IMC: ORTablaContingencia = 3.69 (p > 0.05); Algoritmo de Chang: ORTablaContingencia = 2.55 (p = 0.047); y ESG: ORTablaContingencia = 1.72 (p > 0.05); respectivamente. Ajustada la serie de datos según la terapia antirretroviral (TARV), la asociación entre los CD4+ y el estado nutricional fue como sigue: IMC: ORRegresiónLogística = 0.367 (p = 0.083); Algoritmo de Chang: ORRegresiónLogística = 2.604 (p = 0.050); y ESG: ORRegresiónLogística = 1.714 (p = 0.232); respectivamente. Conclusiones. La instauración de la TARV modifica apreciablemente la asociación que pudiera existir entre el sistema inmune y el estado nutricional. La disminución en los conteos de CD4+ en una PVIH/sida se asocia débilmente con el deterioro de los indicadores

  11. Higher hdl levels are a preventive factor for metabolic syndrome in obese Turkish children.

    PubMed

    Özer, Samet; Yılmaz, Resul; Özlem Kazanci, Nafia; Sönmezgöz, Ergün; Karaaslan, Erhan; Altuntaş, Buket; Emre Kuyucu, Yunus

    2014-10-03

    Objetivo: El síndrome metabólico infantil no ha sido definido aún con claridad. La obesidad infantil se está incrementando progresivamente al igual que la incidencia del síndrome metabólico infantil. Nuestro objetivo ha sido mostrar los componentes del síndrome metabólico y sus factores preventivos en los niños obesos. Metodología: Este estudio analizó de forma retrospectiva a 187 niños y adolescentes obesos de entre 5 y 18 años. Los datos demográficos, las medidas antropomórficas, los índices de masa corporal, los valores de presión sanguínea, los niveles de insulina, los resultados de test de tolerancia a la glucosa oral, el total de colesterol, las lipoproteínas de gran densidad y los niveles de triglicéridos fueron obtenidos de registros hospitalarios. Una masa corporal con un índice superior a 95 percentiles fue considerada como obesidad. La resistencia a la insulina se calculó de acuerdo con el test de tolerancia a la glucosa oral con 1,75 g/kg de glucosa y un máximo de 75 gramos de glucosa. Se calculó y comparó el índice de sensibilidad a la insulina y la evaluación del modelos homeostático- resistencia a la insulina (HOMA IR). El síndrome metabólico fue diagnosticado de acuerdo con los nuevos criterios de la OMS adaptados a los síndromes metabólicos infantiles. Resultados: Se observó una homeostasis de glucosa anormal en el 53% de los casos. La dislipidemia estaba presente en el 45,7% de los pacientes y la hipertensión en un 16,6%. El síndrome metabólico fue identificado en un 24,6% de los niños y adolescentes obesos. Altos valores de HOMA-IR y de glucosa, triglicéridos elevados y niveles bajos de HDL eran indicadores de síndrome metabólico. Conclusión: La obesidad y la resistencia a la insulina son factores significativos para el desarrollo del síndrome metabólico en niños y adolescentes. En niños obesos altos niveles de HDL son un factor preventivo del síndrome metabólico. Prevenir la obesidad y la

  12. Chemotherapy near the end of life; assessment of the clinical practise in onco-hematological in adult patients.

    PubMed

    Taberner Bonastre, Pilar; Taberner Bonastre, María Teresa; Soler Company, Enrique; Pérez-Serrano Lainosa, María Dolores

    2016-01-01

    Objetivo: garantizar una buena calidad de vida en la última fase de los pacientes onco-hematológicos debería ser nuestro principal objetivo; a pesar de ello, disponemos de pocos datos a nivel europeo y los estudios publicados son contradictorios. No obstante, la mayoría coinciden en que administrar quimioterapia en la etapa final de la vida impacta de forma negativa en la calidad de vida del paciente. El objetivo principal del estudio es analizar los indicadores de no agresividad del tratamiento en pacientes onco-hematológicos. Como objetivo secundario, realizar un estudio descriptivo de las variables clínicas de los pacientes a los que se les administra quimioterapia en la fase final de la vida y los esquemas más utilizados. Método: se realizó un estudio observacional retrospectivo en un hospital de tercer nivel. Se incluyeron todos los pacientes oncológicos y hematológicos que recibieron quimioterapia (oral o intravenosa) entre enero y diciembre de 2013, a los que se les administró la última quimioterapia en los 90 días previos al fallecimiento. Resultados: se analizaron 823 pacientes que recibieron tratamiento entre enero y diciembre de 2013. De ellos, 106 (13%) cumplían los criterios de inclusión. Un 14,1% (n = 93) de los pacientes oncológicos y un 8,4% (n = 13) de los hematológicos que habían recibido quimioterapia durante el último año de vida lo seguían haciendo en los últimos tres meses. Un 21,7% (n = 23) de los pacientes recibieron quimioterapia en las dos últimas semanas, 41,5% (n = 44) en los últimos 30 días y 78,3% (n = 83) en los últimos dos meses de vida. El 67,9% (n = 72) de los pacientes ingresaron en el hospital durante los últimos tres meses de vida, el 47,2% (n = 50) lo hicieron durante el último mes, el 33% (n = 35) durante las dos últimas semanas y el 10,4% (n = 11) durante los últimos tres días de vida. El 25,5% (n = 27) de los pacientes ingresaron en más de una ocasión durante los 90 días previos al

  13. C-peptide levels predict type 2 diabetes remission after bariatric surgery.

    PubMed

    Ramos-Leví, Ana M; Matía, Pilar; Cabrerizo, Lucio; Barabash, Ana; Torrejón, María José; Sánchez-Pernaute, Andrés; Torres, Antonio J; Rubio, Miguel A

    2013-01-01

    Introducción: La determinación del péptido C (pC) suele emplearse como un indicador de la reserva betapancreática. El objetivo de este estudio es evaluar si el pC basal, es un parámetro predictor de remisión de diabetes mellitus tipo 2 (DM2) tras cirugía bariátrica (CB). Material y métodos: Estudio retrospectivo de 22 pacientes con DM2 e IMC > 35 kg/m2, intervenidos mediante CB. Recogida de datos clínicos, antropométricos y analíticos relativos al metabolismo de la glucosa, antes de la CB y al año. Análisis de pacientes en remisión completa de DM2 al año de la CB (glucosa basal [GB] < 100 mg/dl, HbA1c < 6%, sin tratamiento farmacológico) y las variables preoperatorias asociadas a remisión (regresión logística binaria). Estimación del mejor valor umbral de pC para predecir la remisión de DM2 con curva ROC. Resultados: Características pre-CB (media ± DE): edad 53,3 ± 9,4 años, IMC 42,9 ± 6,8 kg/m2, duración DM2 6,9 ± 5,2 años, GB 159,6 ± 56,6 mg/dl, HbA1c 7,5 ± 1,1%, pC 4,0 ± 2,0 (mediana 3,8, rango 0,1-8,9) ng/ml. 12 pacientes (54,5%) presentaron remisión de DM2. El pC preoperatorio se correlacionó con la HbA1c a los 12 meses (r = - 0,519, p = 0,013). Los valores de pC pre-CB fueron más elevados en los pacientes que alcanzaron remisión de DM2 (5,0 ± 1,7 vs 3,0 ± 1,7 ng/ml, p = 0,013). Un valor de pC > 3,75 ng/ml supuso una sensibilidad y especificidad para remisión de DM2 de 75% y 80%, respectivamente. La tasa de remisión de DM2 fue de 27,3% si el pC basal pre-CB < 3,8 ng/ml, y 81,7% si > 3,8 ng/ml (p = 0,010). Conclusiones: Los pacientes con pC basal preoperatorio elevado son los que mayores tasas de remisión alcanzan al año de la CB. Una concentración de pC basal > 3,75 ng/dL parece un buen predictor de remisión completa de DM2 al año de la CB.

  14. [In Process Citation].

    PubMed

    Martínez González, Olaia; Vélez de Mendizábal, Itsaso Zabaleta; Galarza Iriarte, Uxue; Vicente Martín, María Soledad; De Vega Castaño, María Del Carmen; Salmerón Egea, Jesús

    2016-03-25

    Introducción: la disfagia o dificultad de deglución afecta a 1 de cada 2 mayores hospitalizados y genera problemas de desnutrición o deshidratación, y aparición de neumonía por aspiración. En situaciones de disfagia orofaríngea, cuando la alimentación oral aún es posible, se deben espesar las texturas líquidas de cara a evitar dichas complicaciones. A los alimentos, tanto fríos como calientes, habitualmente se les añaden espesantes comerciales consistentes en almidones modificados siguiendo especificaciones muy generales que hacen difícil conseguir la textura adaptada a las necesidades personales. Objetivo: el objetivo de este trabajo fue estudiar el efecto de la temperatura del alimento (10 oC y 50 oC), la dosificación (néctar, miel y pudin) y el tiempo transcurrido desde la preparación (0, 3, 5, 10, 20 min) sobre los parámetros de textura de agua espesada a base de uno de los espesantes más ampliamente comercializados. Método: las muestras se analizaron por triplicado en un texturómetro TA.XT2i (Stable Micro Systems, UK) mediante ensayo de compresión-extrusión, empleando una sonda de 2,5 cm de diámetro a una velocidad de 3 mm/s y con una célula de carga de 5 kg. A partir de las curvas fuerza vs. tiempo obtenidas se cuantificaron parámetros indicadores de la firmeza, la adhesividad y el trabajo de las muestras. Resultados y conclusión: en general, los parámetros relacionados con la consistencia fueron significativamente (α < 0,05) superiores en las muestras a mayor temperatura, lo que se puede relacionar con fenómenos incipientes de gelatinización. A su vez, se observó un incremento en los valores de todos los parámetros de textura al aumentar la concentración del espesante y a medida que transcurría el tiempo desde la mezcla de este en el agua. Estos resultados apuntan a la necesidad de realizar un trabajo exhaustivo de caracterización, ampliado también a otros productos y matrices alimentarias, de cara a modelizar la

  15. [In Process Citation].

    PubMed

    Martínez González, Olaia; Vélez de Mendizábal, Itsaso Zabaleta; Galarza Iriarte, Uxue; Vicente Martín, María Soledad; De Vega Castaño, María Del Carmen; Salmerón Egea, Jesús

    2016-01-01

    Introducción: la disfagia o dificultad de deglución afecta a 1 de cada 2 mayores hospitalizados y genera problemas de desnutrición o deshidratación, y aparición de neumonía por aspiración. En situaciones de disfagia orofaríngea, cuando la alimentación oral aún es posible, se deben espesar las texturas líquidas de cara a evitar dichas complicaciones. A los alimentos, tanto fríos como calientes, habitualmente se les añaden espesantes comerciales consistentes en almidones modificados siguiendo especificaciones muy generales que hacen difícil conseguir la textura adaptada a las necesidades personales. Objetivo: el objetivo de este trabajo fue estudiar el efecto de la temperatura del alimento (10 oC y 50 oC), la dosificación (néctar, miel y pudin) y el tiempo transcurrido desde la preparación (0, 3, 5, 10, 20 min) sobre los parámetros de textura de agua espesada a base de uno de los espesantes más ampliamente comercializados. Método: las muestras se analizaron por triplicado en un texturómetro TA.XT2i (Stable Micro Systems, UK) mediante ensayo de compresión-extrusión, empleando una sonda de 2,5 cm de diámetro a una velocidad de 3 mm/s y con una célula de carga de 5 kg. A partir de las curvas fuerza vs. tiempo obtenidas se cuantificaron parámetros indicadores de la firmeza, la adhesividad y el trabajo de las muestras. Resultados y conclusión: en general, los parámetros relacionados con la consistencia fueron significativamente (α < 0,05) superiores en las muestras a mayor temperatura, lo que se puede relacionar con fenómenos incipientes de gelatinización. A su vez, se observó un incremento en los valores de todos los parámetros de textura al aumentar la concentración del espesante y a medida que transcurría el tiempo desde la mezcla de este en el agua. Estos resultados apuntan a la necesidad de realizar un trabajo exhaustivo de caracterización, ampliado también a otros productos y matrices alimentarias, de cara a modelizar la

  16. [Physical activity and respiratory function: corporal composition and spirometric values analysis].

    PubMed

    Paulo, Rui; Petrica, João; Martins, Júlio

    2013-01-01

    Objetivo: A presente investigação tem como principal objetivo verificar os efeitos da atividade física na composição corporal (índice de massa corporal e perímetro da cintura), nos valores espirométricos e relacionar esses indicadores com a função respiratória.Material e Métodos: A amostra, constituída por 86 indivíduos, alunos do ensino superior, com média de idade de 21,3 ± 2,4 anos, foi dividida em dois grupos: grupo de controlo constituído por 28 sujeitos sedentários (20,9 ± 1,3 anos), e grupo experimental constituído por 58 sujeitos (21,5 ± 2,8 anos) praticantes de exercício supervisionado. Para caraterizar a amostra quanto ao tipo de atividade física,aplicámos uma adaptação do questionário de Telama et al. Avaliaram-se os valores de espirometria (DEMI, VEF1 e CVF) com o espirómetro Microquark da Cosmed e os valores de índice de massa corporal e perímetro da cintura. Os dados obtidos foram tratados no S.P.S.S. 19.0, através do t-test, do teste de Levene, do teste Mann-Whitney e do teste de correlação de Spearman, adotando-se um nível de significância de 5%.Resultados: O grupo experimental obteve resultados significativamente melhores (p ≤ 0,05) nos valores de índice de massa corporal, do perímetro da cintura e em todos os valores avaliados pela espirometria (DEMI, VEF1 e CVF), comparativamente ao grupo de controlo. Verificámos também que há uma tendência para correlação negativa entre os valores da composição corporal e os valores espirométricos, apenas observável em algumas variáveis (DEMI, VEF1), ou seja, quanto maiores os valores da composição corporal, menores os valores espirométricos.Conclusão: Os alunos com prática de exercício supervisionado, apresentaram melhores índices de composição corporal e de função respiratória. Valores de índice de massa corporal e de perímetro da cintura desajustados poderão provocar disfunção respiratória, aonível da ventilação e respetivos volumes

  17. Los padres como consejeros o coparticipes en la toma de decisiones. Serie E: El logro de la participacion de los padres, cuaderno III. Edicion para el estudiante. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as Advisors or Participants in Decision Making. Series E: Success with Parent Participation, Book III. Student Edition. Bilingual Education Teacher Training Packet).

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

    The student version of a learning module for teacher training in bilingual education is one of three focusing on promoting parent participation in the school system, and concentrates specifically on the role of parents as counselors and co-participants in decisionmaking. An introductory section discussing the overall objectives of the materials is…

  18. EFL Teachers' Perceptions of Continuing Professional Development: A Case of Iranian High School Teachers (La percepción de docentes de inglés como lengua extranjera acerca del desarrollo profesional continuado: el caso de profesores iraníes de bachillerato)

    ERIC Educational Resources Information Center

    Alibakhshi, Goudarz; Dehvari, Najibeh

    2015-01-01

    English, particularly regarding a foreign language teachers' professional development, has been studied in depth. However, it is not known how Iranian English as a foreign language teachers perceive continuing professional development. This study explored the perceptions of Iranian English as a foreign language teachers of continuing professional…

  19. The Impact of a Teacher Development Program for Strategic Reading on EFL Teachers' Instructional Practice (El impacto de un programa de desarrollo profesional en lectura estratégica en la práctica instruccional de docentes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Salimi, Mahin

    2010-01-01

    Research on teacher development has been the focus of attention in recent decades. The overall aim of this study was to explore the impact of reading strategy training on high school teachers' reading instructional practices. The study was conducted in the EFL context of Iran. To meet this aim, four EFL high school teachers voluntarily took…

  20. Effects of Strategy Instruction in an EFL Reading Comprehension Course: A Case Study (Efectos de la instrucción de estrategias en un curso de comprensión de lectura en inglés como lengua extranjera: un estudio de caso)

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2012-01-01

    Strategy instruction is useful in teaching contexts. This paper examines the effects of strategy instruction in an EFL reading comprehension course carried out with 26 undergraduate students at a Colombian university. As a research method, a case study was implemented. There were three instruments with which to collect data: reading comprehension…

  1. Motivation Conditions in a Foreign Language Reading Comprehension Course Offering Both a Web-Based Modality and a Face-to-Face Modality (Las condiciones de motivación en un curso de comprensión de lectura en lengua extranjera (LE) ofrecido tanto en la modalidad presencial como en la modalidad a distancia en la web)

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2014-01-01

    Motivation plays an important in role in education. Based on the ten macro-strategies proposed by Dörnyei and Csizér (1998), this article analyzes the motivation conditions in a foreign language reading comprehension course using both a web-based modality and a face-to-face modality. A case study was implemented as the primary research method, and…

  2. Efectos Especiales de Anclaje (Estudio sobre Regresiones de Juicios Condicionales). Parte 2: Invariancia del Juicio No-Condicional Como Valor Estandar Para el Juicio Condicional (Special Effects of Anchoring (Study of Regression of Conditional Judgements) Part 2: Invariance of Unconditional Judgments as Standard Value for the Conditional Judgment). Publication No. 31.

    ERIC Educational Resources Information Center

    Lopez Alonso, A. O.

    From the best-fit lines corresponding to sets of families of conditional judgements, the constant stimulus family and the constant condition family, both defined for a same scale object, the coordinate values of the point of intersection of both lines (indifference point) are obtained. These values are studied in relation to the mean values of the…

  3. Experiencias interculturales y la pedagogia de la anglofonia en la ensenanza de ingles como lengua extranjera (EILE) desde una perspectiva deweyana. Working Paper (A Deweyan Perspective on Cross-Cultural Experiences and Anglophone Pedagogy in the Teaching of English as a Foreign Language. Working Paper).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper discusses a framework for teaching English as a foreign language that incorporates significant cultural content and fosters critical encounters with Anglophone culture. It reviews relevant contemporary perspectives for understanding cross-cultural processes within the foreign language teaching environment with emphasis on the issue of…

  4. Facilitating Professional Development during International Practicum: Understanding Our Work as Teacher Educators through Critical Incidents (Facilitando el desarrollo profesional durante la práctica internacional: Comprendiendo nuestro trabajo como formadores de profesores a través de incidentes críticos)

    ERIC Educational Resources Information Center

    Williams, Judy; Grierson, Arlene

    2016-01-01

    This collaborative self-study details the experiences of an Australian teacher educator and a Canadian teacher educator, who led teacher candidates on international practicum placements to the Cook Islands and Kenya respectively. Focusing on critical incidents, they collaboratively analyzed dilemmas that occurred when providing professional…

  5. The Implications of Orthographic Intraference for the Teaching and Description of ESL: The Educated Nigerian English Examples (Implicaciones de la Intraferencia Ortográfica para la Enseñanza y Descripción del Inglés como Segunda Lengua: Ejemplos Inglés Nigeriano Formal)

    ERIC Educational Resources Information Center

    Ekundayo, Omowumi Steve Bode

    2015-01-01

    This paper examines orthographic intraference and its implications for teaching and describing English as a second language (ESL). Orthographic intraference is used here to denote instances of single word spelling, acronyms, mix up of homophones, homonyms and compound word spelling arising not from interference but from orthographic rules and…

  6. EFL Teenagers' Social Identity Representation in a Virtual Learning Community on Facebook (Representación de la identidad social de los estudiantes adolescentes de inglés como lengua extranjera en una comunidad de aprendizaje virtual en Facebook)

    ERIC Educational Resources Information Center

    Jiménez Guamán, Laura Verónica

    2012-01-01

    In this article I report the findings of a descriptive and interpretative qualitative study carried out in a public school in Bogotá, Colombia. The study aimed at analyzing, describing and exploring teenage students' social identity representation as observed in their participation in a learning community on Facebook. Data were collected from…

  7. Pronunciation Instruction and Students' Practice to Develop Their Confidence in EFL Oral Skills (La instrucción de la pronunciación y la práctica de los estudiantes para el desarrollo de la confianza en habilidades orales en inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Tlazalo Tejeda, Ana Cristina; Basurto Santos, Nora M.

    2014-01-01

    The aim of this article is to inform on research intended to find out how pronunciation instruction of English as a foreign language was handled in the language classroom with elementary students and also understand if pronunciation instruction had an impact on students' confidence when using it. In order to do this, a qualitative case study was…

  8. How To Talk to Your Doctor (and Get Your Doctor To Talk to You!). An Educational Workshop on Doctor Patient Communication = Como Hablarle a su Doctor (iY que su doctor le hable a usted!). Un seminario educativo sobre la comunicacion entre el doctor y el paciente.

    ERIC Educational Resources Information Center

    Baylor Coll. of Medicine, Houston, TX.

    This workshop, written in both English and Spanish, focuses on improving communication between physician and patient. In the workshop, the trainers will talk about "building bridges" between patient and doctor by understanding the doctor's role and his/her duty to the patient. According to the workshop, a person's doctor should communicate…

  9. Pedagogical Factors That Influence EFL Teaching: Some Considerations for Teachers' Professional Development (Factores pedagógicos que influyen en la enseñanza del inglés como lengua extranjera: algunas consideraciones para el desarrollo profesional de docentes)

    ERIC Educational Resources Information Center

    Abad, José Vicente

    2013-01-01

    In this article we present the results of a qualitative research study on the pedagogical factors that influence English teaching in four public schools of Medellín, Colombia. Twelve teachers were interviewed regarding three linguistic principles: communicative competence, native language effect, and interlanguage. The data analysis led to the…

  10. Metacognitive Awareness and Comprehension Monitoring in Reading Ability of Iranian EFL Learners (Monitoreo de la conciencia metacognitiva y de la comprensión en la habilidad lectora de estudiantes iraníes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Mahmoudi Kojidi, Elahe

    2011-01-01

    We report an investigation on the relationship between metacognitive awareness of reading strategies and comprehension monitoring of language learners in English as a foreign language context. Participants were thirty first year university students majoring in electronics. They completed a questionnaire aimed at discerning the strategies that…

  11. An Exploration of EFL Teachers' Awareness of the Sources of Pedagogical Knowledge in a Teacher Education Program (Una exploración del nivel de conciencia de docentes de inglés como lengua extranjera respecto a las fuentes del conocimiento pedagógico en un programa de formación de docentes)

    ERIC Educational Resources Information Center

    Macías, Diego Fernando

    2013-01-01

    This project set out to investigate the extent to which the sources of English as a foreign language teachers' pedagogical knowledge are acknowledged and addressed in a teacher education program in a public university in Colombia. It involved the participation of teacher educators and novice teachers as well as the analysis of documents. This…

  12. Teachers' Perceptions about Oral Corrective Feedback and Their Practice in EFL Classrooms (Percepciones de los docentes acerca de la retroalimentación correctiva y su práctica en las aulas de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Hernández Méndez, Edith; Reyes Cruz, María del Rosario

    2012-01-01

    Corrective feedback has been discussed mainly in second language acquisition contexts, but less has been done concerning corrective feedback in foreign language settings. In this descriptive study, conducted at a Mexican university, our aims were to identify the perceptions of instructors of English as a foreign language about corrective feedback…

  13. How Do EFL Student Teachers Face the Challenge of Using L2 in Public School Classrooms? (¿Cómo enfrentan los docentes practicantes de inglés como lengua extranjera el reto de usar una segunda lengua en las aulas de clase de la escuela pública?)

    ERIC Educational Resources Information Center

    Viáfara, John Jairo

    2011-01-01

    As an EFL Student teachers' advisor, I had constantly perceived that they regarded using the target language with their pupils inside their classroom as a challenge. That is why I became interested in investigating how thirteen student teachers in Tunja public schools faced this issue. While participants were involved in a reflective teaching…

  14. O Passado como Nacao: Imagens do Imperio nas Falas Reacionarias dos Anos 30 e 40 do Seculo XX: Uma Pequena Arqueologia do Debate Publico e Privado (The Past as Nation: Images of the Empire in the Reactionary Words of the 30s and 40s in the 20th Century: A Small Archaeology of the Public Debate versus the Private One).

    ERIC Educational Resources Information Center

    de Freitas, Marcos Cezar

    1998-01-01

    Suggests an archaeology of the public debate versus the private one in Brazil through analysis of the reactionary speech of a religious leader, Dom Jose Mauricio da Rocha, which produced innumerable representations of the Brazilian Empire. (PA)

  15. ...And That's How It All Began: Putting Information about Your Child's Growth, Health and Safety All within Your Reach...Because the First Years Last Forever! = ...Y asi es como empezo todo: Ponemos a su alcance en forma conjunta la informacion sobre el crecimiento, la salud y la seguridad de su hijo...Porque los primeros anos duran para siempre!

    ERIC Educational Resources Information Center

    North Carolina Partnership for Children, Raleigh.

    Smart Start is North Carolina's model early childhood initiative to help all North Carolina children enter school healthy and prepared for success. This resource guide, in Spanish and English versions, is designed to provide parents with information on infant and child development, health care, and resources for further assistance. Presented in an…

  16. Using the EPOSTL for Dialogic Reflection in EFL Teacher Education (El Uso de EPOSTL para la Reflexión Dialógica en la Educación de los Docentes de Inglés como Lengua Extranjera)

    ERIC Educational Resources Information Center

    Schauber, Holli

    2015-01-01

    For many pre-service English as a Foreign Language (EFL) teachers and their mentors, the theory and practice driven European Portfolio for Student Teachers of Languages (EPOSTL) occupies a prominent and practical role in their preparation programs as a delivery system of core pedagogical skills and knowledge. Interest in the role that dialogical…

  17. Teacher Activities and Adolescent Students' Participation in a Colombian EFL Classroom (Actividades de enseñanza y participación de estudiantes adolescentes en una clase de enseñanza de inglés como lengua extranjera en Colombia)

    ERIC Educational Resources Information Center

    Caicedo, Jefferson

    2015-01-01

    The present study concerns the activities teachers develop and ninth-graders' participation in responses to those activities. The objectives of this study were to identify and describe the types of teaching activities developed and how students respond to them and to show how the target language is used in the classroom. The data collection was…

  18. Building Adult Relationships: Are You Treated as an Equal in Your Family? (A Pamphlet for People with Disbilities) [and] Como Establecer Relaciones Adultas: Se Lo Trata a UD. Igual que a Los Demas Adultos en Su Familia? (Un Panfleto para las Personas con Impedimentos).

    ERIC Educational Resources Information Center

    Baron, Carla

    Two booklets, in English and Spanish, are addressed to disabled adults and offer guidelines for building adult relationships within the family. Stressed are the importance of feeling good about oneself, learning to make decisions, and developing good communication skills so that family balance is maintained. Also included are lists of the types of…

  19. Los padres como consejeros o coparticipes en la toma de decisiones. Serie E: [E1] logro de la participacion de los padres. cuaderno 3. Edicion para el maestro. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as Advisors or Participants in Decision Making. Series E: Parent Participation, Book 3. Teacher Edition. Bilingual Education Teacher Training Packet).

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

    This guide on training bilingual education teachers focuses on parents as advisors in the decision making process at bilingual schools. The two units, "An Introduction to Parent Participation" and "Parent Participation in Educational Decision Making," include objectives, definitions of terms, lists of materials and equipment, and learning…

  20. For a Child, Life is a Creative Adventure: Supporting Development and Learning through Art, Music, Movement, and Dialogue. A Guide for Parents and Professionals. = Para los ninos, la vida es una aventura creativa: Como estimular el desarrollo y el aprendizaje por medio de las artes visuales, la musica, el movimiento y el dialogo. Guia para padres de familia y profesionales.

    ERIC Educational Resources Information Center

    Cohen, Elena

    Recognizing that creativity facilitates children's learning and development, the Head Start Program Performance Standards require Head Start programs to include opportunities for creative self-expression. This guide with accompanying videotape, both in English- and Spanish- language versions, encourages and assists adults to support children's…

  1. [Quality care in an intensive therapy unit at private hospital].

    PubMed

    Tejeda-Miranda, Mauricio; Anthon-Mendez, Francisco Javier; Esponda-Prado, Juan Gerardo; Rendón-Macías, Mario Enrique

    2015-01-01

    Introducción: el objetivo es evaluar la calidad de la atención en una unidad de terapia intensiva con índices internacionales de calidad. Métodos: estudio descriptivo, en una unidad de cuidados intensivos de atención privada en México. Se analizan los indicadores de 2012 con un total de 446 pacientes hospitalizados. Los indicadores de calidad fueron acordes a recomendaciones internacionales. La gravedad fue determinada por la escala SAPS III. Resultados: el indicador de neumonías asociadas a ventilación se encontró por debajo del estándar recomendado (11.7 frente a 12 por mil); la bacteremia relacionada a catéter venoso central en rangos aceptados (5.7 frente a 4 por mil). Las acciones de profilaxis de úlceras, prevención de tromboembolia pulmonar y prevención de caídas en altas proporciones de cumplimiento (> 90, > 95 % y 0 caídas). Las tasas de extubación no programada y reintubaciones estuvieron por debajo de los indicadores (< 1 por mil días intubación y < 12 %). La mortalidad fue menor a la estimada por la gravedad. Conclusión: En esta terapia la implementación de acciones recomendadas a nivel internacional ha permitido mantener una adecuada calidad de atención. El esfuerzo a impactado no solo a los pacientes con condiciones agudas de ingreso, sino también a pacientes con alto riesgo de mortalidad.

  2. Association of excessive GWG with adiposity indicators and metabolic diseases of their offspring: systematic review.

    PubMed

    Pérez-Morales, María Eugenia; Bacardi-Gascon, Montserrat; Jimenez-Cruz, Arturo

    2015-04-01

    Introducción Se ha reportado que el aumento excesivo de la ganancia de peso gestacional (GPG) durante el embarazo está asociada a un aumento en los indicadores de adiposidad y trastornos metabólicos de su descendencia. Objetivo El objetivo fue analizar la asociación del aumento excesivo de GPG en estudios prospectivos, utilizando los criterios del Instituto de medicina (IOM), con indicadores de adiposidad y enfermedades metabólicas de los descendientes y estudiar la asociación del aumento excesivo de GPG en estudios prospectivos con indicadores de adiposidad y enfermedad metabólica de los descendientes ≥ 15 años. Métodos Se realizó una búsqueda electrónica en las bases de datos MEDLINE/PubMed EMBASE y CINAHL, de estudios prospectivos de cohorte publicados de enero de 2004 a septiembre de 2014. La selección de artículos fue restringida a estudios en los que la definición de GPG siguiera las recomendaciones del IOM; y estudios prospectivos de cohorte incluyendo los descendientes ≥ a 15 años de edad, con diferentes definiciones de GPG, independiente de la definición utilizada. Resultados Nueve estudios prospectivos cumplieron los criterios de inclusión. Cinco estudios utilizaron las recomendaciones del IOM para la evaluación de GPG, y seis estudios evaluaron indicadores de adiposidad o enfermedades metabólicas en los descendientes ≥ 15 años. En siete de los nueve estudios, se observó que a mayor GPG de la madre, de cualquier categoría de peso pre gestacional, mayor adiposidad y prevalencia de otros componentes del síndrome metabólico. Debido a las limitaciones explicadas en el estudio la evidencia de la asociación es baja. Conclusiones Los resultados de esta revisión muestran que independientemente de los criterios utilizados para diagnosticar el aumento de la GPG, todos los estudios muestran consistentemente una asociación entre la GPG y los indicadores de adiposidad u otros componentes del síndrome metabólico en la niñez, durante

  3. Low-grade albuminuria in children with obstructive sleep apnea.

    PubMed

    Varlami, Vasiliki; Malakasioti, Georgia; Alexopoulos, Emmanouel I; Theologi, Vasiliki; Theophanous, Eleni; Liakos, Nikolaos; Daskalopoulou, Euphemia; Gourgoulianis, Konstantinos; Kaditis, Athanasios G

    2013-06-01

    Small urinary protein loss (low-grade albuminuria or microalbuminuria) may reflect altered permeability of the glomerular filtration barrier. In the present study, it was hypothesized that children with obstructive sleep apnea have an increased risk of microalbuminuria compared with control subjects without sleep-disordered breathing. Albumin-to-creatinine ratio was measured in morning spot urine specimens collected from consecutive children with or without snoring who were referred for polysomnography. Three groups were studied: (i) control subjects (no snoring, apnea-hypopnea index < 1 episode h(-1) ; n = 31); (ii) mild obstructive sleep apnea (snoring, apnea-hypopnea index = 1-5 episodes h(-1) ; n = 71); and (iii) moderate-to-severe obstructive sleep apnea (snoring, apnea-hypopnea index > 5 episodes∙h(-1) ; n = 27). Indications for polysomnography in control subjects included nightmares, somnambulism and morning headaches. An albumin-to-creatinine ratio > median value in the control group (1.85 mg of albumin per g of creatinine) was defined as elevated. Logistic regression analysis revealed that children with moderate-to-severe obstructive sleep apnea, but not those with mild obstructive sleep apnea, had increased risk of elevated albumin-to-creatinine ratio relative to controls (reference) after adjustment for age, gender and presence of obesity: odds ratio 3.8 (95% confidence interval 1.1-12.6); P = 0.04 and 1.5 (0.6-3.7); P > 0.05, respectively. Oxygen desaturation of hemoglobin and respiratory arousal indices were significant predictors of albumin-to-creatinine ratio (r = 0.31, P = 0.01; and r = 0.43, P < 0.01, respectively). In conclusion, children with moderate-to-severe obstructive sleep apnea are at significantly higher risk of increased low-grade excretion of albumin in the morning urine as compared with control subjects without obstructive sleep apnea. These findings may reflect altered permeability of the glomerular

  4. Four-Year Incidence of Diabetic Retinopathy in a Spanish Cohort: The MADIABETES Study

    PubMed Central

    Salinero-Fort, Miguel Á.; San Andrés-Rebollo, Francisco Javier; de Burgos-Lunar, Carmen; Arrieta-Blanco, Francisco Jesús; Gómez-Campelo, Paloma

    2013-01-01

    Objective To evaluate the incidence of diabetic retinopathy in patients with Type 2 Diabetes Mellitus, to identify the risk factors associated with the incidence of retinopathy and to develop a risk table to predict four-year retinopathy risk stratification for clinical use, from a four-year cohort study. Design The MADIABETES Study is a prospective cohort study of 3,443 outpatients with Type 2 Diabetes Mellitus, sampled from 56 primary health care centers (131 general practitioners) in Madrid (Spain). Results The cumulative incidence of retinopathy at four-year follow-up was 8.07% (95% CI = 7.04–9.22) and the incidence density was 2.03 (95% CI = 1.75–2.33) cases per 1000 patient-months or 2.43 (95% CI = 2.10–2.80) cases per 100 patient-years. The highest adjusted hazard ratios of associated risk factors for incidence of diabetic retinopathy were LDL-C >190 mg/dl (HR = 7.91; 95% CI = 3.39–18.47), duration of diabetes longer than 22 years (HR = 2.00; 95% CI = 1.18–3.39), HbA1c>8% (HR = 1.90; 95% CI = 1.30–2.77), and aspirin use (HR = 1.65; 95% CI = 1.22–2.24). Microalbuminuria (HR = 1.17; 95% CI = 0.75–1.82) and being female (HR = 1.12; 95% CI = 0.84–1.49) showed a non-significant increase of diabetic retinopathy. The greatest risk is observed in females who had diabetes for more than 22 years, with microalbuminuria, HbA1c>8%, hypertension, LDL-Cholesterol >190 mg/dl and aspirin use. Conclusions After a four-year follow-up, the cumulative incidence of retinopathy was relatively low in comparison with other studies. Higher baseline HbA1c, aspirin use, higher LDL-Cholesterol levels, and longer duration of diabetes were the only statistically significant risk factors found for diabetic retinopathy incidence. This is the first study to demonstrate an association between aspirin use and diabetic retinopathy risk in a well-defined cohort of patients with Type 2 Diabetes Mellitus at low risk of

  5. Cadmium Level, Glycemic Control, and Indices of Renal Function in Treated Type II Diabetics: Implications for Polluted Environments.

    PubMed

    Anetor, John I; Uche, Chukwuemelie Z; Ayita, Emmanuel B; Adedapo, Solomon K; Adeleye, Jokotade O; Anetor, Gloria O; Akinlade, Sola K

    2016-01-01

    Cadmium (Cd) has recently emerged as a major concern not only in environmental toxicology but also in metabolic diseases such as diabetes mellitus and its complications. Conflicting data aside, these studies have not been examined in a clinical population undergoing management as well as possible modulation by the prominent metabolic antagonist of Cd such as zinc (Zn). This study examined the relationship between cadmium levels, glycemic control, and renal pathology in established type II diabetic patients with focus on populations exposed to modern environmental health hazards (MEHHs). Sixty-five participants, consisting of 45 type-2 diabetics and 20 non-diabetics were enrolled for the study, mean age 61.51 ± 5.27 years. Glycated hemoglobin (HbA1c) was used to classify them into three sub-groups: (A) good glycemic control (44.4%), (B) fair glycemic control (24.4%), and (C) poor glycemic control (31.1%). Plasma levels of glucose, Cd, Zn, HbA1c, creatinine, urinary creatinine, microalbuminuria, and estimated glomerular filtration rate (eGFR) were determined in all participants using standard methods. Fasting plasma glucose was higher in diabetics than in non-diabetics (p = 0.000) as well as Zn level, though not significantly. Interestingly, Cd level, Cd/Zn ratio, and urinary creatinine were significantly lower in diabetics than in non-diabetics. The group with poor glycemic control (C) had significantly higher Cd level compared to the one with good glycemic control (group A). The renal function revealed that microalbuminuria and urinary albumin/creatinine ratio (UACR) was significantly higher in diabetics than in non-diabetics, while eGFR was found to be similar in both diabetics and non-diabetics. UACR inversely correlated with Cd level, while plasma creatinine level positively correlated with Cd but not significantly. Correlation between Cd and HbA1c revealed non-significant inverse correlation (r = -0.007; p > 0.05), while Zn showed a

  6. Renal effects of Dirofilaria immitis in experimentally and naturally infected cats.

    PubMed

    Atkins, C E; Vaden, S L; Arther, R G; Ciszewski, D K; Davis, W L; Ensley, S M; Chopade, N H

    2011-03-22

    Canine heartworm infection has been associated with glomerular disease and proteinuria. We hypothesized that proteinuria, likely due to glomerular damage, would also be found in cats experimentally and naturally infected with Dirofilaria immitis. Two populations of cats were evaluated, including 80 that were each experimentally infected with 60 infective heartworm larvae as part of a drug safety study, and 31 that were naturally infected with D. immitis. Each had a control population with which to be compared. In the experimentally infected group, we evaluated urine from 64 cats. Ten of these cats were shown to have microalbuminuria 8 months post infection. No cat refractory to infection with larvae and no cats from the control group demonstrated microalbuminuria. All 10 microalbuminuric cats were shown to have significant proteinuria, as measured by the urine protein:creatinine ratio. There was a subtle, but significant, association between worm burden and proteinuria, and although the presence of adult heartworms was required for the development of proteinuria, both microfilaremic and amicrofilaremic cats were affected. Neither the presence of circulating heartworm antibodies and antigen nor the presence of antigenuria predicted the development of proteinuria. Both heavily infected cats (5-25 adult heartworms) and cats with worm burdens compatible with natural infections (1-4 adult heartworms) developed proteinuria, and the relative numbers of cats so affected were similar between heavily and more lightly infected cats. Naturally infected cats, for which only dipstick protein determinations were available, were shown to have a significantly greater incidence of proteinuria (90% vs 35%) than did those in an age- and gender-matched control population. Additionally, the proteinuria in heartworm-infected cats was 3- to 5-fold greater in severity. We conclude that cats infected with mature adult heartworms are at risk for developing proteinuria and that this is

  7. Early Diabetic Nephropathy

    PubMed Central

    Bjornstad, Petter; Snell-Bergeon, Janet K.; Rewers, Marian; Jalal, Diana; Chonchol, Michel B.; Johnson, Richard J.; Maahs, David M.

    2013-01-01

    OBJECTIVE Diabetic nephropathy (DN) is a major cause of mortality in type 1 diabetes. Reduced insulin sensitivity is a well-documented component of type 1 diabetes. We hypothesized that baseline insulin sensitivity would predict development of DN over 6 years. RESEARCH DESIGN AND METHODS We assessed the relationship between insulin sensitivity at baseline and development of early phenotypes of DN—microalbuminuria (albumin-creatinine ratio [ACR] ≥30 mg/g) and rapid renal function decline (glomerular filtration rate [GFR] loss >3 mL/min/1.73 m2 per year)—with three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations over 6 years. Subjects with diabetes (n = 449) and without diabetes (n = 565) in the Coronary Artery Calcification in Type 1 Diabetes study had an estimated insulin sensitivity index (ISI) at baseline and 6-year follow-up. RESULTS The ISI was lower in subjects with diabetes than in those without diabetes (P < 0.0001). A higher ISI at baseline predicted a lower odds of developing an ACR ≥30 mg/g (odds ratio 0.65 [95% CI 0.49–0.85], P = 0.003) univariately and after adjusting for HbA1c (0.69 [0.51–0.93], P = 0.01). A higher ISI at baseline conferred protection from a rapid decline of GFR as assessed by CKD-EPI cystatin C (0.77 [0.64–0.92], P = 0.004) and remained significant after adjusting for HbA1c and age (0.80 [0.67–0.97], P = 0.02). We found no relation between ISI and rapid GFR decline estimated by CKD-EPI creatinine (P = 0.38) or CKD-EPI combined cystatin C and creatinine (P = 0.50). CONCLUSIONS Over 6 years, a higher ISI independently predicts a lower odds of developing microalbuminuria and rapid GFR decline as estimated with cystatin C, suggesting a relationship between insulin sensitivity and early phenotypes of DN. PMID:24026551

  8. Albuminuria, Cognitive Functioning and White Matter Hyperintensities in Homebound Elders

    PubMed Central

    Weiner, Daniel E.; Bartolomei, Keith; Scott, Tammy; Price, Lori Lyn; Griffith, John L.; Rosenberg, Irwin; Levey, Andrew S.; Folstein, Marshal F.; Sarnak, Mark J.

    2009-01-01

    Background Albuminuria, a kidney marker of microvascular disease, may herald microvascular disease elsewhere, including in the brain. Study Design Cross sectional. Setting and Participants Boston, MA (USA) elders receiving home health services to maintain independent living who consented to brain magnetic resonance imaging. Predictor Urine albumin to creatinine ratio (ACR). Outcome Performance on a cognitive battery assessing executive function and memory using principal components analysis and white matter hyperintensity volume on brain imaging, evaluated in logistic and linear regression models. Results Of 335 participants, mean age was 73.4 ± 8.1 years; 123 participants had microalbuminuria or macroalbuminuria. Each doubling of ACR was associated with worse executive function [β=-0.05 (p=0.005) in univariate and β=-0.07 (p=0.004) in multivariable analyses controlling for age, sex, race, education, diabetes, cardiovascular disease, hypertension, medications, and estimated glomerular filtration rate] but not with worse memory or working memory. Individuals with microalbuminuria or macroalbuminuria were more likely to be in the lower versus the highest tertile of executive functioning [Odds ratio =1.18 (1.06 to 1.32) and 1.19 (1.05 to 1.35) per doubling of ACR in univariate and multivariable analyses, respectively]. Albuminuria was associated with qualitative white matter hyperintensity grade [Odds ratio =1.13 (1.02 to 1.25) and 1.15 (1.02 to 1.29) per doubling of ACR] in univariate and multivariable analyses, and with quantitative white matter hyperintensity volume [β=0.11 (p=0.007) and β=0.10 (p=0.01)] in univariate and multivariable analyses of log-transformed data, respectively. Results were similar when excluding individuals with macroalbuminuria. Limitations Single measurement of ACR, indirect creatinine calibration and reliance on participant recall for elements of medical history Conclusions Albuminuria is associated with worse cognitive performance

  9. Cadmium Level, Glycemic Control, and Indices of Renal Function in Treated Type II Diabetics: Implications for Polluted Environments

    PubMed Central

    Anetor, John I.; Uche, Chukwuemelie Z.; Ayita, Emmanuel B.; Adedapo, Solomon K.; Adeleye, Jokotade O.; Anetor, Gloria O.; Akinlade, Sola K.

    2016-01-01

    Cadmium (Cd) has recently emerged as a major concern not only in environmental toxicology but also in metabolic diseases such as diabetes mellitus and its complications. Conflicting data aside, these studies have not been examined in a clinical population undergoing management as well as possible modulation by the prominent metabolic antagonist of Cd such as zinc (Zn). This study examined the relationship between cadmium levels, glycemic control, and renal pathology in established type II diabetic patients with focus on populations exposed to modern environmental health hazards (MEHHs). Sixty-five participants, consisting of 45 type-2 diabetics and 20 non-diabetics were enrolled for the study, mean age 61.51 ± 5.27 years. Glycated hemoglobin (HbA1c) was used to classify them into three sub-groups: (A) good glycemic control (44.4%), (B) fair glycemic control (24.4%), and (C) poor glycemic control (31.1%). Plasma levels of glucose, Cd, Zn, HbA1c, creatinine, urinary creatinine, microalbuminuria, and estimated glomerular filtration rate (eGFR) were determined in all participants using standard methods. Fasting plasma glucose was higher in diabetics than in non-diabetics (p = 0.000) as well as Zn level, though not significantly. Interestingly, Cd level, Cd/Zn ratio, and urinary creatinine were significantly lower in diabetics than in non-diabetics. The group with poor glycemic control (C) had significantly higher Cd level compared to the one with good glycemic control (group A). The renal function revealed that microalbuminuria and urinary albumin/creatinine ratio (UACR) was significantly higher in diabetics than in non-diabetics, while eGFR was found to be similar in both diabetics and non-diabetics. UACR inversely correlated with Cd level, while plasma creatinine level positively correlated with Cd but not significantly. Correlation between Cd and HbA1c revealed non-significant inverse correlation (r = −0.007; p > 0.05), while Zn showed a

  10. Cadmium Level, Glycemic Control, and Indices of Renal Function in Treated Type II Diabetics: Implications for Polluted Environments.

    PubMed

    Anetor, John I; Uche, Chukwuemelie Z; Ayita, Emmanuel B; Adedapo, Solomon K; Adeleye, Jokotade O; Anetor, Gloria O; Akinlade, Sola K

    2016-01-01

    Cadmium (Cd) has recently emerged as a major concern not only in environmental toxicology but also in metabolic diseases such as diabetes mellitus and its complications. Conflicting data aside, these studies have not been examined in a clinical population undergoing management as well as possible modulation by the prominent metabolic antagonist of Cd such as zinc (Zn). This study examined the relationship between cadmium levels, glycemic control, and renal pathology in established type II diabetic patients with focus on populations exposed to modern environmental health hazards (MEHHs). Sixty-five participants, consisting of 45 type-2 diabetics and 20 non-diabetics were enrolled for the study, mean age 61.51 ± 5.27 years. Glycated hemoglobin (HbA1c) was used to classify them into three sub-groups: (A) good glycemic control (44.4%), (B) fair glycemic control (24.4%), and (C) poor glycemic control (31.1%). Plasma levels of glucose, Cd, Zn, HbA1c, creatinine, urinary creatinine, microalbuminuria, and estimated glomerular filtration rate (eGFR) were determined in all participants using standard methods. Fasting plasma glucose was higher in diabetics than in non-diabetics (p = 0.000) as well as Zn level, though not significantly. Interestingly, Cd level, Cd/Zn ratio, and urinary creatinine were significantly lower in diabetics than in non-diabetics. The group with poor glycemic control (C) had significantly higher Cd level compared to the one with good glycemic control (group A). The renal function revealed that microalbuminuria and urinary albumin/creatinine ratio (UACR) was significantly higher in diabetics than in non-diabetics, while eGFR was found to be similar in both diabetics and non-diabetics. UACR inversely correlated with Cd level, while plasma creatinine level positively correlated with Cd but not significantly. Correlation between Cd and HbA1c revealed non-significant inverse correlation (r = -0.007; p > 0.05), while Zn showed a

  11. Renal effects of Dirofilaria immitis in experimentally and naturally infected cats.

    PubMed

    Atkins, C E; Vaden, S L; Arther, R G; Ciszewski, D K; Davis, W L; Ensley, S M; Chopade, N H

    2011-03-22

    Canine heartworm infection has been associated with glomerular disease and proteinuria. We hypothesized that proteinuria, likely due to glomerular damage, would also be found in cats experimentally and naturally infected with Dirofilaria immitis. Two populations of cats were evaluated, including 80 that were each experimentally infected with 60 infective heartworm larvae as part of a drug safety study, and 31 that were naturally infected with D. immitis. Each had a control population with which to be compared. In the experimentally infected group, we evaluated urine from 64 cats. Ten of these cats were shown to have microalbuminuria 8 months post infection. No cat refractory to infection with larvae and no cats from the control group demonstrated microalbuminuria. All 10 microalbuminuric cats were shown to have significant proteinuria, as measured by the urine protein:creatinine ratio. There was a subtle, but significant, association between worm burden and proteinuria, and although the presence of adult heartworms was required for the development of proteinuria, both microfilaremic and amicrofilaremic cats were affected. Neither the presence of circulating heartworm antibodies and antigen nor the presence of antigenuria predicted the development of proteinuria. Both heavily infected cats (5-25 adult heartworms) and cats with worm burdens compatible with natural infections (1-4 adult heartworms) developed proteinuria, and the relative numbers of cats so affected were similar between heavily and more lightly infected cats. Naturally infected cats, for which only dipstick protein determinations were available, were shown to have a significantly greater incidence of proteinuria (90% vs 35%) than did those in an age- and gender-matched control population. Additionally, the proteinuria in heartworm-infected cats was 3- to 5-fold greater in severity. We conclude that cats infected with mature adult heartworms are at risk for developing proteinuria and that this is

  12. Comparison of soluble guanylate cyclase stimulators and activators in models of cardiovascular disease associated with oxidative stress.

    PubMed

    Costell, Melissa H; Ancellin, Nicolas; Bernard, Roberta E; Zhao, Shufang; Upson, John J; Morgan, Lisa A; Maniscalco, Kristeen; Olzinski, Alan R; Ballard, Victoria L T; Herry, Kenny; Grondin, Pascal; Dodic, Nerina; Mirguet, Olivier; Bouillot, Anne; Gellibert, Francoise; Coatney, Robert W; Lepore, John J; Jucker, Beat M; Jolivette, Larry J; Willette, Robert N; Schnackenberg, Christine G; Behm, David J

    2012-01-01

    Soluble guanylate cyclase (sGC), the primary mediator of nitric oxide (NO) bioactivity, exists as reduced (NO-sensitive) and oxidized (NO-insensitive) forms. We tested the hypothesis that the cardiovascular protective effects of NO-insensitive sGC activation would be potentiated under conditions of oxidative stress compared to those of NO-sensitive sGC stimulation. The cardiovascular effects of the NO-insensitive sGC activator GSK2181236A [a low, non-depressor dose, and a high dose which lowered mean arterial pressure (MAP) by 5-10 mmHg] and those of equi-efficacious doses of the NO-sensitive sGC stimulator BAY 60-4552 were assessed in (1) Sprague Dawley rats during coronary artery ischemia/reperfusion (I/R) and (2) spontaneously hypertensive stroke prone rats (SHR-SP) on a high salt/fat diet (HSFD). In I/R, neither compound reduced infarct size 24 h after reperfusion. In SHR-SP, HSFD increased MAP, urine output, microalbuminuria, and mortality, caused left ventricular hypertrophy with preserved ejection fraction, and impaired endothelium-dependent vasorelaxation. The low dose of BAY 60-4552, but not that of GSK2181236A, decreased urine output, and improved survival. Conversely, the low dose of GSK2181236A, but not that of BAY 60-4552, attenuated the development of cardiac hypertrophy. The high doses of both compounds similarly attenuated cardiac hypertrophy and improved survival. In addition to these effects, the high dose of BAY 60-4552 reduced urine output and microalbuminuria and attenuated the increase in MAP to a greater extent than did GSK2181236A. Neither compound improved endothelium-dependent vasorelaxation. In SHR-SP isolated aorta, the vasodilatory responses to the NO-dependent compounds carbachol and sodium nitroprusside were attenuated by HSFD. In contrast, the vasodilatory responses to both GSK2181236A and BAY 60-4552 were unaltered by HSFD, indicating that reduced NO-bioavailability and not changes in the oxidative state of sGC is responsible

  13. Comparison of Soluble Guanylate Cyclase Stimulators and Activators in Models of Cardiovascular Disease Associated with Oxidative Stress

    PubMed Central

    Costell, Melissa H.; Ancellin, Nicolas; Bernard, Roberta E.; Zhao, Shufang; Upson, John J.; Morgan, Lisa A.; Maniscalco, Kristeen; Olzinski, Alan R.; Ballard, Victoria L. T.; Herry, Kenny; Grondin, Pascal; Dodic, Nerina; Mirguet, Olivier; Bouillot, Anne; Gellibert, Francoise; Coatney, Robert W.; Lepore, John J.; Jucker, Beat M.; Jolivette, Larry J.; Willette, Robert N.; Schnackenberg, Christine G.; Behm, David J.

    2012-01-01

    Soluble guanylate cyclase (sGC), the primary mediator of nitric oxide (NO) bioactivity, exists as reduced (NO-sensitive) and oxidized (NO-insensitive) forms. We tested the hypothesis that the cardiovascular protective effects of NO-insensitive sGC activation would be potentiated under conditions of oxidative stress compared to those of NO-sensitive sGC stimulation. The cardiovascular effects of the NO-insensitive sGC activator GSK2181236A [a low, non-depressor dose, and a high dose which lowered mean arterial pressure (MAP) by 5–10 mmHg] and those of equi-efficacious doses of the NO-sensitive sGC stimulator BAY 60-4552 were assessed in (1) Sprague Dawley rats during coronary artery ischemia/reperfusion (I/R) and (2) spontaneously hypertensive stroke prone rats (SHR-SP) on a high salt/fat diet (HSFD). In I/R, neither compound reduced infarct size 24 h after reperfusion. In SHR-SP, HSFD increased MAP, urine output, microalbuminuria, and mortality, caused left ventricular hypertrophy with preserved ejection fraction, and impaired endothelium-dependent vasorelaxation. The low dose of BAY 60-4552, but not that of GSK2181236A, decreased urine output, and improved survival. Conversely, the low dose of GSK2181236A, but not that of BAY 60-4552, attenuated the development of cardiac hypertrophy. The high doses of both compounds similarly attenuated cardiac hypertrophy and improved survival. In addition to these effects, the high dose of BAY 60-4552 reduced urine output and microalbuminuria and attenuated the increase in MAP to a greater extent than did GSK2181236A. Neither compound improved endothelium-dependent vasorelaxation. In SHR-SP isolated aorta, the vasodilatory responses to the NO-dependent compounds carbachol and sodium nitroprusside were attenuated by HSFD. In contrast, the vasodilatory responses to both GSK2181236A and BAY 60-4552 were unaltered by HSFD, indicating that reduced NO-bioavailability and not changes in the oxidative state of sGC is responsible

  14. Sustained Effect of Intensive Treatment of Type 1 Diabetes Mellitus on Development and Progression of Diabetic Nephropathy

    PubMed Central

    2008-01-01

    Context The Diabetes Control and Complications Trial (DCCT) demonstrated the benefits of intensive treatment of diabetes in reducing glycemic levels and slowing the progression of diabetic nephropathy. The DCCT cohort has been examined annually for another 8 years as part of the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, During the EDIC study, glycemic levels no longer differed substantially between the 2 original treatment groups. Objective To determine the long-term effects of intensive vs conventional diabetes treatment during the DCCT on kidney function during the EDIC study. Design, Setting, and Participants Observational study begun in 1993 (following DCCT closeout) in 28 medical centers in the United States and Canada. Participants were 1349 (of 1375) EDIC volunteers who had kidney evaluation at years 7 or 8. Main Outcome Measures Development of microalbuminuria, clinical-grade albuminuria, hypertension, or increase in serum creatinine level. Results Results were analyzed by intention-to-treat analyses, comparing the 2 original DCCT treatment groups. New cases of microalbuminuria occurred during the EDIC study in 39 (6.8%) of the participants originally assigned to the intensive-treatment group vs 87 (15.8%) of those assigned to the conventional-treatment group, for a 59% (95% confidence interval [CI], 39% -73%) reduction in odds, adjusted for baseline values, compared with a 59% (95% CI, 36%-74%) reduction at the end of the DCCT (P<.001 for both comparisons). New cases of clinical albuminuria occurred in 9 (1.4%) of the participants in the original intensive-treatment group vs 59 (9.4%) of those in the original conventional-treatment group, representing an 84% reduction in odds (95% Cl, 67%-92%), compared with a reduction of 57% (95% CI, -1 % to +81%) at the end of the DCCT. Fewer cases of hypertension (prevalence at year 8, 29.9% vs 40.3%; P<.001) developed in the original intensive-treatment group. Significantly fewer

  15. Dealing with spatial heterogeneity

    NASA Astrophysics Data System (ADS)

    Marsily, Gh.; Delay, F.; Gonçalvès, J.; Renard, Ph.; Teles, V.; Violette, S.

    2005-03-01

    ès fins de barrières de perméabilité, qui ont une influence importante sur les écoulement, et, plus encore, sur le transport. Les modè les génétiques récemment apparus ont la capacité de mieux incorporer dans les modèles de faciès les observations géologiques, chose courante dans l'industrie pétrolière, mais insuffisamment développée en hydrogéologie. On conclut que les travaux de recherche ultérieurs devraient s'attacher à développer les modèles de faciès, à les comparer entre eux, et à mettre au point de nouvelles méthodes d'essais in situ, comprenant les méthodes géophysiques, capables de reconnaître la géométrie et les propriétés des faciès. La constitution d'un catalogue mondial de la géométrie et des propriétés des faciès aquifères, ainsi que des méthodes de reconnaissance utilisées pour arriver à la détermination de ces systèmes, serait d'une grande importance pratique pour les applications. La heterogeneidad se puede manejar por medio de la definición de características homogéneas equivalentes, conocidas como promediar o tratando de describir la variabilidad espacial de las características de las rocas a partir de observaciones geológicas y medidas locales. Las técnicas disponibles para estas descripciones son generalmente modelos geoestadísticos continuos o modelos de facies discontinuos como los modelos Boolean, de Indicador o de umbral de Gaussian y el modelo de cadena de Markow. Estos modelos de facies son mas adecuados para tratar la conectvidad de estratos geológicos (por ejemplo canales de alta permeabilidad enterrados o barreras de baja permeabilidad que tienen efectos importantes sobre el flujo y especialmente sobre el transporte en los acuíferos. Los modelos genéticos ofrecen nuevas formas de incorporar más geología en las descripciones de facies, un enfoque que está bien desarollado en la industria petrolera, pero insuficientemente en la hidrogeología. Se concluye que los trabajos futuros deber

  16. Dealing with spatial heterogeneity

    NASA Astrophysics Data System (ADS)

    Marsily, Gh.; Delay, F.; Gonçalvès, J.; Renard, Ph.; Teles, V.; Violette, S.

    2005-03-01

    ès fins de barrières de perméabilité, qui ont une influence importante sur les écoulement, et, plus encore, sur le transport. Les modè les génétiques récemment apparus ont la capacité de mieux incorporer dans les modèles de faciès les observations géologiques, chose courante dans l'industrie pétrolière, mais insuffisamment développée en hydrogéologie. On conclut que les travaux de recherche ultérieurs devraient s'attacher à développer les modèles de faciès, à les comparer entre eux, et à mettre au point de nouvelles méthodes d'essais in situ, comprenant les méthodes géophysiques, capables de reconnaître la géométrie et les propriétés des faciès. La constitution d'un catalogue mondial de la géométrie et des propriétés des faciès aquifères, ainsi que des méthodes de reconnaissance utilisées pour arriver à la détermination de ces systèmes, serait d'une grande importance pratique pour les applications. La heterogeneidad se puede manejar por medio de la definición de características homogéneas equivalentes, conocidas como promediar o tratando de describir la variabilidad espacial de las características de las rocas a partir de observaciones geológicas y medidas locales. Las técnicas disponibles para estas descripciones son generalmente modelos geoestadísticos continuos o modelos de facies discontinuos como los modelos Boolean, de Indicador o de umbral de Gaussian y el modelo de cadena de Markow. Estos modelos de facies son mas adecuados para tratar la conectvidad de estratos geológicos (por ejemplo canales de alta permeabilidad enterrados o barreras de baja permeabilidad que tienen efectos importantes sobre el flujo y especialmente sobre el transporte en los acuíferos. Los modelos genéticos ofrecen nuevas formas de incorporar más geología en las descripciones de facies, un enfoque que está bien desarollado en la industria petrolera, pero insuficientemente en la hidrogeología. Se concluye que los trabajos futuros deber

  17. Eco-hydrology: Groundwater flow and site factors in plant ecology

    NASA Astrophysics Data System (ADS)

    Klijn, Frans; Witte, Jan-Philip M.

    proporciona unas condiciones de vida adecuadas que permiten el crecimiento de una especie o una comunidad botánica. En un material inicialmente homogéneo, el flujo subterráneo gravífico influencia las condiciones del emplazamiento variando la distribución espacial de los nutrientes y de otros agentes químicos relevantes. En especial, el flujo ascendente puede producir y mantener una serie de condiciones que son esenciales para algunas especies y comunidades de plantas relativamente raras. La especial atención hacia este fenómeno ha dado lugar a una cooperación entre ecologistas e hidrogeólogos y a la aparición de una nueva disciplina - eco-hidrología -, en la frontera de los dos campos científicos. En Holanda, se ha usado una clasificación sencilla de tipos de agua para crear una base de datos, a nivel nacional, de lugares donde la presencia de flujos ascendentes pueda ser de interés ecológico. El análisis de correspondencias entre esta base de datos y los tipos de plantas existentes muestra que en los suelos arenosos pobres del Pleistoceno los flujos ascendentes explican la presencia de algunas especies y comunidades de plantas. Por el contrario, en las llanuras fluviales y pólders, con suelos más arcillosos, la influencia de estos flujos es despreciable frente a la relativa a las propias características de los suelos. Se concluye que las especies botánicas se pueden usar como indicadores de la presencia de flujo ascendente sólo en campañas preliminares, pero que el método presenta grandes limitaciones para su extensión a casos generales.

  18. Comprehensive approach to diabetic nephropathy

    PubMed Central

    Satirapoj, Bancha; Adler, Sharon G.

    2014-01-01

    Diabetic nephropathy (DN) is a leading cause of mortality and morbidity in patients with diabetes. This complication reflects a complex pathophysiology, whereby various genetic and environmental factors determine susceptibility and progression to end-stage renal disease. DN should be considered in patients with type 1 diabetes for at least 10 years who have microalbuminuria and diabetic retinopathy, as well as in patients with type 1 or type 2 diabetes with macroalbuminuria in whom other causes for proteinuria are absent. DN may also present as a falling estimated glomerular filtration rate with albuminuria as a minor presenting feature, especially in patients taking renin–angiotensin–aldosterone system inhibitors (RAASi). The pathological characteristic features of disease are three major lesions: diffuse mesangial expansion, diffuse thickened glomerular basement membrane, and hyalinosis of arterioles. Functionally, however, the pathophysiology is reflected in dysfunction of the mesangium, the glomerular capillary wall, the tubulointerstitium, and the vasculature. For all diabetic patients, a comprehensive approach to management including glycemic and hypertensive control with RAASi combined with lipid control, dietary salt restriction, lowering of protein intake, increased physical activity, weight reduction, and smoking cessation can reduce the rate of progression of nephropathy and minimize the risk for cardiovascular events. This review focuses on the latest published data dealing with the mechanisms, diagnosis, and current treatment of DN. PMID:26894033

  19. Podocyte injury in diabetic nephropathy: implications of angiotensin II – dependent activation of TRPC channels

    PubMed Central

    Ilatovskaya, Daria V.; Levchenko, Vladislav; Lowing, Andrea; Shuyskiy, Leonid S.; Palygin, Oleg; Staruschenko, Alexander

    2015-01-01

    Injury to podocytes is considered a major contributor to diabetic kidney disease: their loss causes proteinuria and progressive glomerulosclerosis. Podocyte depletion may result from improper calcium handling due to abnormal activation of the calcium permeant TRPC (Transient Receptor Potential Canonical) channels. Angiotensin II (Ang II) levels are found to be elevated in diabetes; furthermore, it was reported that Ang II causes activation of TRPC6 in podocytes. We hypothesized here that Ang II-mediated calcium influx is aggravated in the podocytes under the conditions of type 1 diabetic nephropathy (DN). Diabetes was induced in the Dahl Salt-Sensitive rats by an injection of streptozotocin (STZ-SS). Eleven weeks post treatment was sufficient for the animals to develop hyperglycemia, excessive urination, weight loss, microalbuminuria, nephrinuria and display renal histological lesions typical for patients with DN. Patch-clamp electrophysiology performed on podocytes of the freshly isolated glomeruli showed enhanced basal TRPC channel activity in the STZ-SS rats, and increased response to Ang II; total calcium influx triggered by Ang II application was also augmented in podocytes of these rats. Our studies have a strong potential for advancing the understanding of TRPC-mediated effects on podocytopenia in DN initiation. PMID:26656101

  20. Mouse Models of Diabetes, Obesity and Related Kidney Disease

    PubMed Central

    Glastras, Sarah J.; Chen, Hui; Teh, Rachel; McGrath, Rachel T.; Chen, Jason; Pollock, Carol A.; Wong, Muh Geot; Saad, Sonia

    2016-01-01

    Multiple rodent models have been used to study diabetic kidney disease (DKD). The purpose of the present study was to compare models of diabetes and obesity-induced metabolic syndrome and determine differences in renal outcomes. C57BL/6 male mice were fed either normal chow or high fat diet (HFD). At postnatal week 8, chow-fed mice were randomly assigned to low-dose streptozotocin (STZ, 55 mg/kg/day, five consecutive days) or vehicle control, whereas HFD-fed mice were given either one high-dose of STZ (100 mg/kg) or vehicle control. Intraperitoneal glucose tolerance tests were performed at Week 14, 20 and 30. Urinary albumin to creatinine ratio (ACR) and serum creatinine were measured, and renal structure was assessed using Periodic Acid Schiff (PAS) staining at Week 32. Results showed that chow-fed mice exposed to five doses of STZ resembled type 1 diabetes mellitus with a lean phenotype, hyperglycaemia, microalbuminuria and increased serum creatinine levels. Their kidneys demonstrated moderate tubular injury with evidence of tubular dilatation and glycogenated nuclear inclusion bodies. HFD-fed mice resembled metabolic syndrome as they were obese with dyslipidaemia, insulin resistance, and significantly impaired glucose tolerance. One dose STZ, in addition to HFD, did not worsen metabolic features (including fasting glucose, non esterified fatty acid, and triglyceride levels). There were significant increases in urinary ACR and serum creatinine levels, and renal structural changes were predominantly related to interstitial vacuolation and tubular dilatation in HFD-fed mice. PMID:27579698

  1. The Incidence of Cardiovascular Events Is Comparable Between Normoalbuminuric and Albuminuric Diabetic Patients With Chronic Kidney Disease.

    PubMed

    Lee, Eunyoung; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Ryu, Dong-Ryeol; Kang, Shin-Wook; Yoo, Tae-Hyun

    2016-04-01

    Diabetic kidney disease leads to microalbuminuria and gradually progresses to overt proteinuria with renal insufficiency. Recent studies have demonstrated that 20% to 40% of patients with diabetic kidney disease are normo- to microalbuminuric, despite reduced renal function. We investigated renal and cardiovascular outcomes in patients with diabetes and renal insufficiency who were normo-, micro-, and macroalbuminuric. Patients with diabetes and stage III or IV chronic kidney disease were recruited and divided into normoalbuminuric, microalbuminuric, and macroalbuminuric groups. New-onset cardiovascular events and renal outcomes, defined by end-stage renal disease or a 50% decline in estimated glomerular filtration rate, were evaluated. Among the 1136 study patients, 255 (22.4%) were normoalbuminuric. During a mean follow-up duration of 44 months, the incidence of cardiovascular disease was similar among groups (P = 0.68). However, renal outcomes were significantly more common in patients with macroalbuminuria than in those who were normoalbuminuric or microalbuminuric (P < 0.001). Multivariate Cox analysis identified macroalbuminuria and estimated glomerular filtration rate as independent predictors of renal outcomes. The amount of albuminuria was not associated with cardiovascular events in this population. Although cardiovascular events were similar in patients with diabetic kidney disease and renal insufficiency, renal outcomes differed significantly according to the amount of albuminuria. PMID:27082557

  2. Managing hypertension in diabetic patients – focus on trandolapril/verapamil combination

    PubMed Central

    Sharma, Sanjib Kumar; Ruggenenti, Piero; Remuzzi, Giuseppe

    2007-01-01

    Hypertensive diabetes individuals are at higher risk for cardiovascular events and progression to end stage renal disease. Several well conducted clinical trials indicate that aggressive treatment of hypertension in individual with diabetes reduces these complications. Combinations of two or more antihypertensive drugs are frequently required to reach the target blood pressure and to improve the cardiovascular and renal outcomes in these patients. There are physiological and clinical rationales for renin-angiotensin system blockade in hypertensive diabetics. Trandolapril/verapamil sustained released (SR) is a fixed-dose combination of trandolapril and a sustained release formulation of verapamil and indicated in treatment of hypertension in patients who require more than one drug to reach target blood pressure. The antihypertensive efficacy of trandolapril/verapamil SR has been evaluated extensively in large trials. In the INVEST trial, a verapamil SR-based treatment strategy that included trandolapril in most patients was effective in reducing the primary outcome in hypertensive patients with coronary artery disease. The new onset of diabetes was also significantly lower in the verapamil SR/trandolapril treatment group in comparison with those on the atenolol/hydroclorothiazide treatment group. The BErgamo NEphrologic DIabetes Complications Trial (BENEDICT) documented that in hypertensive diabetes and normoalbuminuria, trandolapril plus verapamil or trandolapril alone delayed the onset of microalbuminuria independent of their blood pressure-reducing effect. Thus, trandolapril/verapamil is an effective option for treatment of hypertensive diabetes patients requiring more than one agent to achieve target blood pressure. PMID:17969376

  3. A latent autoimmune diabetes in adults patient manifesting severe musculoskeletal complications.

    PubMed

    Yang, In-Ho; Lee, Sun Hee; Chin, Sang Ouk; Chon, Suk

    2014-11-01

    Patients with diabetes have many different kinds of complications involving multiple organs, but those involving the musculoskeletal system are relatively uncommon. Diabetic muscle infarction (DMI) is a rare, painful, and potentially serious condition in patients with poorly controlled diabetes mellitus. A 35-year-old man diagnosed with type 2 diabetes eight years ago, visited with severe muscle pain in the right anteromedial thigh without any event of trauma. He had been treated with metformin, but his glycemic control was very poor with a glycated hemoglobin of 14.5%. Evaluation of his painful thigh lesion did not reveal any evidence of infection or vasculitis, but the magnetic resonance imaging and bone scan showed findings of DMI at vastus medialis muscle and an insufficiency fracture at the right medial tibial condyle. He was diagnosed with retinopathy, neuropathy and microalbuminuria but not macrovascular complications. We also diagnosed his diabetes as latent autoimmune diabetes in adults (LADA) based on his low C-peptide level, positive anti-glutamic acid decarboxylase (GAD) antibody and early onset diabetes. Instead of antibiotics, bed rest, analgesics and strict blood glucose control with multiple daily insulin injections led to symptom improvement. This is an unusual case of a young man with LADA experiencing severe musculoskeletal complication of DMI and insufficiency fracture. If a poorly controlled diabetic patient appears to have unaccounted soft tissue pain, musculoskeletal complications such as DMI associated with hyperglycemia should be considered.

  4. Diagnosis, Epidemiology, and Management of Hypertension in Children.

    PubMed

    Rao, Goutham

    2016-08-01

    National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor. Prevalence estimates are highly variable because of differing standards, populations, and blood pressure (BP) measurement techniques. Estimates in the United States range from 0.3% to 4.5%. Risk factors for primary hypertension include overweight and obesity, male sex, older age, high sodium intake, and African American or Latino ancestry. Data relating hypertension in childhood to later cardiovascular events is currently lacking. It is known that BP in childhood is highly predictive of BP in adulthood. Compelling data about target organ damage is available, including the association of hypertension with left ventricular hypertrophy, carotid-intima media thickness, and microalbuminuria. Guidelines from both the United States and Europe include detailed recommendations for diagnosis and management. Diagnostic standards are based on clinic readings, ambulatory BP monitoring is useful in confirming diagnosis of hypertension and identifying white-coat hypertension, masked hypertension, and secondary hypertension, as well as monitoring response to therapy. Research priorities include the need for reliable prevalence estimates based on diverse populations and data about the long-term impact of childhood hypertension on cardiovascular morbidity and mortality. Priorities to improve clinical practice include more education among clinicians about diagnosis and management, clinical decision support to aid in diagnosis, and routine use of ambulatory BP monitoring to aid in diagnosis and to monitor response to treatment. PMID:27405770

  5. ED 04-3 ASSESSMENT OF RENAL FUNCTION DURING FOLLOW UP OF HYPERTENSIVE SUBJECTS.

    PubMed

    Ito, Sadayoshi

    2016-09-01

    The presence of chronic kidney disease (CKD) is a strong risk factor not only for end stage kidney disease (ESKD) but also cerebro-cardiovascular disease (CVD). CKD is defined as GFR < 60ml/min/1.73m and/or the evidence of renal damages for more than 3 months. Epidemiological studies have shown that albuminuria even as little as 10mg/gCr is a strong risk factor for CVD, especially stroke. The significance of albuminuria can be recognized when we think of the fact that the amount of albumin in 24 hour-GFR is as large as 6 kg (4.0g/dL × 150 L/day) in normal: why such a miniscule amount of albumin in urine (as little as 10 mg of 6 kg) can be so closely related to CVD even in the presence of normal GFR? We have pointed out that in vital organs such as brain, heart and kidney, there are unique circulatory system where microvessels are branched off directly from large high pressure arteries. We refer these vessel as Strain Vessel, and have shown that close linkage between microalbuminuria CVD is based on strain vessel injuries. In addition, we have recently shown that urine pH is associated with vascular and renal damages. In this lecture, I will discuss the meaning of measurement of urinary protein (albumin) and pH as well as renal function during follow up of hypertensive subjects. PMID:27643069

  6. [Vitamin D hormone system and diabetes mellitus: lessons from selective activators of vitamin D receptor and diabetes mellitus].

    PubMed

    Jódar-Gimeno, Esteban; Muñoz-Torres, Manuel

    2013-02-01

    The vitamin D hormone system has significant skeletal and extra-skeletal effects. Vitamin D receptor occurs in different tissues, and several cells other than renal cells are able to locally produce active vitamin D, which is responsible for transcriptional control of hundreds of genes related to its pleiotropic effects. There is increasing evidence relating vitamin D to development and course of type 1 and 2 diabetes mellitus. Specifically, influence of vitamin D on the renin-angiotensin-aldosterone system, inflammatory response, and urinary albumin excretion could explain the relevant impact of vitamin D status on diabetic nephropathy. Selective vitamin D receptor activators are molecules able to reproduce agonistic or antagonistic effects of active vitamin D depending on the tissue or even on the cell type. Specifically, paricalcitol has a beneficial profile because of its potency to reduce parathyroid hormone, with lower effects on serum calcium or phosphate levels. Moreover, in patients with diabetes and renal disease, paricalcitol decreases microalbuminuria, hospitalization rates, and cardiovascular mortality. Therefore, these molecules represent an attractive new option to improve prognosis of renal disease in patients with diabetes.

  7. [Nutritional therapy in diabetes mellitus].

    PubMed

    Toeller, M

    1993-03-01

    Most aspects of the nutritional therapy of diabetes mellitus apply equally to IDDM and NIDDM patients and are also appropriate for people with high risk of cardiovascular diseases. A restriction of energy, a reduction of saturated fatty acids as well as of alcoholic drinks and simple sugars are the most important measures. This modification of nutritional intake together with increased fibre consumption is not only appropriate to avoid hyperglycaemia in diabetic patients but has also its benefits in patients presenting with the metabolic syndrome (possible reduction of hyperinsulinaemia, hypertension and hyperlipoproteinaemia). Diabetic patients should have regular screening for microalbuminuria. At first signs of an early stage of nephropathy patients should be advised to restrict their protein intake. About 50% of daily energy intake should be derived from carbohydrates and fat intake should be no more than 35% of total energy (saturated fatty acids less than 10% of energy). Carbohydrate exchange units are usually not necessary in NIDDM patients. In addition diabetes specialty foods are not an essential part of the nutritional therapy. The success of the nutritional therapy in diabetic patients is substantially dependent upon qualified counselling and education of the patients by the physician (as far as possible with the assistance of a dietitian).

  8. Association between Urine Albumin-to-Creatinine Ratio within the Normal Range and Incident Hypertension in Men and Women

    PubMed Central

    Yadav, Dhananjay; Kang, Dae Ryong; Koh, Sang-Baek; Kim, Jang-Young

    2016-01-01

    Purpose There have been few studies on gender difference in the impact of a urine albumin-to-creatinine ratio (UACR) within the normal range on the risk of hypertension. We evaluated whether the association between the UACR below the microalbuminuria range and the incident risk of hypertension is different between men and women. Materials and Methods A total of 1173 individuals (442 men and 731 women) aged 40 to 70 years without hypertension was examined at baseline (2005–2008) and followed (2008–2011). We defined the UACR as the amount of albumin (mg/dL) divided by creatinine (g/dL) in randomly voided urine. The subjects were classified according to UACR tertile. Results During an average of 2.6 years of follow-up, 57 men (12.9%) and 66 women (9.0%) developed hypertension. In multivariable-adjusted models, the odds ratio for new-onset hypertension comparing the highest and lowest tertiles of UACR was 1.83 [95% confidence interval (CI) 0.85–3.94] in men and 2.69 (95% CI 1.27–5.73) in women. In stratified analyses by menopausal status, higher tertiles of UACR were associated with an increased risk of incident hypertension in postmenopausal women. Conclusion Higher normal UACR levels were associated with an increased risk of incident hypertension in women. The UACR could have a clinical role in predicting the development of hypertension. PMID:27593874

  9. In Vivo Platelet Activation and Aspirin Responsiveness in Type 1 Diabetes.

    PubMed

    Zaccardi, Francesco; Rizzi, Alessandro; Petrucci, Giovanna; Ciaffardini, Flavia; Tanese, Luigi; Pagliaccia, Francesca; Cavalca, Viviana; Ciminello, Angela; Habib, Aida; Squellerio, Isabella; Rizzo, Paola; Tremoli, Elena; Rocca, Bianca; Pitocco, Dario; Patrono, Carlo

    2016-02-01

    Platelet activation is persistently enhanced, and its inhibition by low-dose aspirin is impaired in type 2 diabetes mellitus. We investigated in vivo thromboxane (TX) and prostacyclin (PGI2) biosynthesis and their determinants, as well as aspirin responsiveness, in young adult subjects with type 1 diabetes mellitus (T1DM) without overt cardiovascular disease and stable glycemic control. The biosynthesis of TXA2 was persistently increased in subjects with T1DM versus matched healthy subjects, with females showing higher urinary TX metabolite (TXM) excretion than male subjects with T1DM. Microalbuminuria and urinary 8-iso-PGF2α, an index of in vivo oxidative stress, independently predicted TXM excretion in T1DM. No homeostatic increase in PGI2 biosynthesis was detected. Platelet COX-1 suppression by low-dose aspirin and the kinetics of its recovery after drug withdrawal were similar in patients and control subjects and were unaffected by glucose variability. We conclude that patients with T1DM and stable glycemic control display enhanced platelet activation correlating with female sex and microvascular and oxidative damages. Moreover, aspirin responsiveness is unimpaired in T1DM, suggesting that the metabolic disturbance per se is unrelated to altered pharmacodynamics. The efficacy and safety of low-dose aspirin in T1DM warrant further clinical investigation. PMID:26470782

  10. Cross-talk between the kidney and the cardiovascular system.

    PubMed

    Amann, Kerstin; Wanner, Christoph; Ritz, Eberhard

    2006-08-01

    In recent years, increasing evidence has been provided that even minor renal dysfunction is a powerful cardiovascular risk factor that induces typical cardiovascular alterations and thus predisposes to coronary heart disease as well as to noncoronary cardiovascular problems. This first had been noted in patients with diabetes but now has been confirmed amply in patients without diabetes as well. Numerous heterogeneous abnormalities have been described in patients with early renal dysfunction (e.g., microalbuminuria, reduced estimated GFR). One final common pathway seems to be endothelial cell dysfunction. The link between albuminuria and generalized endothelial cell dysfunction (as indicated by diminished flow-mediated vasodilation, markers of endothelial cell dysfunction, sloughed off endothelial cells, and high transcapillary albumin escape rate) is unclear. In patients with early renal dysfunction, a long list of classical and nonclassical cardiovascular risk factors have been identified: Elevated asymmetric dimethyl-l-arginine concentrations, markers of microinflammation, oxidative stress, features of metabolic syndrome, abnormal adipokine concentrations, dyslipidemia, inappropriate activation of the renin-angiotensin system, and sympathetic overactivity. The mechanisms that link dysfunction of the kidney and the cardiovascular system are being sought. The most interesting unifying concept, however, is deranged fetal programming linking nephron underdosing to the increased cardiovascular risk.

  11. GLP-1 Cleavage Product Reverses Persistent ROS Generation After Transient Hyperglycemia by Disrupting an ROS-Generating Feedback Loop.

    PubMed

    Giacco, Ferdinando; Du, Xueliang; Carratú, Anna; Gerfen, Gary J; D'Apolito, Maria; Giardino, Ida; Rasola, Andrea; Marin, Oriano; Divakaruni, Ajit S; Murphy, Anne N; Shah, Manasi S; Brownlee, Michael

    2015-09-01

    The assumption underlying current diabetes treatment is that lowering the level of time-averaged glucose concentrations, measured as HbA1c, prevents microvascular complications. However, 89% of variation in risk of retinopathy, microalbuminuria, or albuminuria is due to elements of glycemia not captured by mean HbA1c values. We show that transient exposure to high glucose activates a multicomponent feedback loop that causes a stable left shift of the glucose concentration-reactive oxygen species (ROS) dose-response curve. Feedback loop disruption by the GLP-1 cleavage product GLP-1(9-36)(amide) reverses the persistent left shift, thereby normalizing persistent overproduction of ROS and its pathophysiologic consequences. These data suggest that hyperglycemic spikes high enough to activate persistent ROS production during subsequent periods of normal glycemia but too brief to affect the HbA1c value are a major determinant of the 89% of diabetes complications risk not captured by HbA1c. The phenomenon and mechanism described in this study provide a basis for the development of both new biomarkers to complement HbA1c and novel therapeutic agents, including GLP-1(9-36)(amide), for the prevention and treatment of diabetes complications.

  12. Oxidative Stress in Diabetic Nephropathy with Early Chronic Kidney Disease.

    PubMed

    Miranda-Díaz, Alejandra Guillermina; Pazarín-Villaseñor, Leonardo; Yanowsky-Escatell, Francisco Gerardo; Andrade-Sierra, Jorge

    2016-01-01

    The increase in the prevalence of diabetes mellitus (DM) and the secondary kidney damage produces diabetic nephropathy (DN). Early nephropathy is defined as the presence of microalbuminuria (30-300 mg/day), including normal glomerular filtration rate (GFR) or a mildly decreased GFR (60-89 mL/min/1.73 m(2)), with or without overt nephropathy. The earliest change caused by DN is hyperfiltration with proteinuria. The acceptable excretion rate of albumin in urine is <30 mg/day. Albuminuria represents the excretion of >300 mg/day. Chronic kidney disease (CKD) is characterized by abnormalities in renal function that persist for >3 months with health implications. Alterations in the redox state in DN are caused by the persistent state of hyperglycemia and the increase in advanced glycation end products (AGEs) with ability to affect the renin-angiotensin system and the transforming growth factor-beta (TGF-β), producing chronic inflammation and glomerular and tubular hypertrophy and favoring the appearance of oxidative stress. In DN imbalance between prooxidant/antioxidant processes exists with an increase in reactive oxygen species (ROS). The overproduction of ROS diminishes expression of the antioxidant enzymes (manganese superoxide dismutase, glutathione peroxidase, and catalase). The early detection of CKD secondary to DN and the timely identification of patients would permit decreasing its impact on health. PMID:27525285

  13. Estimating relative risks for common outcome using PROC NLP.

    PubMed

    Yu, Binbing; Wang, Zhuoqiao

    2008-05-01

    In cross-sectional or cohort studies with binary outcomes, it is biologically interpretable and of interest to estimate the relative risk or prevalence ratio, especially when the response rates are not rare. Several methods have been used to estimate the relative risk, among which the log-binomial models yield the maximum likelihood estimate (MLE) of the parameters. Because of restrictions on the parameter space, the log-binomial models often run into convergence problems. Some remedies, e.g., the Poisson and Cox regressions, have been proposed. However, these methods may give out-of-bound predicted response probabilities. In this paper, a new computation method using the SAS Nonlinear Programming (NLP) procedure is proposed to find the MLEs. The proposed NLP method was compared to the COPY method, a modified method to fit the log-binomial model. Issues in the implementation are discussed. For illustration, both methods were applied to data on the prevalence of microalbuminuria (micro-protein leakage into urine) for kidney disease patients from the Diabetes Control and Complications Trial. The sample SAS macro for calculating relative risk is provided in the appendix.

  14. Effect of tobacco smoking on renal function.

    PubMed

    Cooper, Ross G

    2006-09-01

    Nicotine is one of many substances that may be acquired through active and passive smoking of tobacco. In man, nicotine is commonly consumed via smoking cigarettes, cigars or pipes. The addictive liability and pharmacological effects of smoking are primarily mediated by the major tobacco alkaloid nicotine. High stress jobs favour repeated smoking and further reinforce addictive behaviours. There are elevated serum cadmium and lead levels in smokers resulting in glomerular dysfunction. Nephropathies are accelerated by nicotine with an increased incidence of microalbuminuria progressing to proteinuria, followed by type-1 diabetes mellitus induced renal failure. Cigarette smoke-induced renal damage is due, at least in part, to activation of the sympathetic nervous system resulting in an elevation in blood pressure. Ethanol, nicotine, or concurrent intake significantly increases lipid peroxidation in liver, and decreased superoxide dismutase activity and increased catalase activity in the kidney. This review describes the effects of nicotine, smoking, smoke extracts and other tobacco constituents on renal and cardiovascular functions, and associated effects on the nervous system. Both active and passive smoking is toxic to renal function. PMID:17085829

  15. Assessment of global risk: a foundation for a new, better definition of hypertension.

    PubMed

    Giles, Thomas D

    2006-08-01

    The prevalence of individuals with increased blood pressure (BP) is growing. A greater understanding of the various pathogenetic mechanisms of hypertension and associated BP increases would provide a better strategy for preventing and treating this condition. Hypertension is strongly associated with other cardiovascular risk factors. Additionally, there is no threshold of BP >115/70 mm Hg that identifies cardiovascular risk (i.e., risk is linear and doubles for each 20/10-mm Hg BP rise). These insights have led a group of hypertension experts to propose a new definition of hypertension as "a progressive cardiovascular syndrome arising from complex and interrelated etiologies," which features early markers that are "often present before blood pressure elevation is sustained." Early cardiovascular markers include widened pulse pressure, left ventricular hypertrophy, increased arterial stiffness, endothelial dysfunction, and microalbuminuria. Importantly, antihypertensive treatment for patients with prehypertension (systolic BP of 120-139 mm Hg or diastolic BP of 80-89 mm Hg) has recently been shown to prevent the development of frank hypertension. This revision of the definition of hypertension and the need to assess BP levels in the context of global cardiovascular risk should lead to earlier detection of at-risk patients.

  16. Glomerular endothelial cell injury and cross talk in diabetic kidney disease

    PubMed Central

    Fu, Jia; Lee, Kyung; Chuang, Peter Y.; Liu, Zhihong

    2014-01-01

    Diabetic kidney disease (DKD) remains a leading cause of new-onset end-stage renal disease (ESRD), and yet, at present, the treatment is still very limited. A better understanding of the pathogenesis of DKD is therefore necessary to develop more effective therapies. Increasing evidence suggests that glomerular endothelial cell (GEC) injury plays a major role in the development and progression of DKD. Alteration of the glomerular endothelial cell surface layer, including its major component, glycocalyx, is a leading cause of microalbuminuria observed in early DKD. Many studies suggest a presence of cross talk between glomerular cells, such as between GEC and mesangial cells or GEC and podocytes. PDGFB/PDGFRβ is a major mediator for GEC and mesangial cell cross talk, while vascular endothelial growth factor (VEGF), angiopoietins, and endothelin-1 are the major mediators for GEC and podocyte communication. In DKD, GEC injury may lead to podocyte damage, while podocyte loss further exacerbates GEC injury, forming a vicious cycle. Therefore, GEC injury may predispose to albuminuria in diabetes either directly or indirectly by communication with neighboring podocytes and mesangial cells via secreted mediators. Identification of novel mediators of glomerular cell cross talk, such as microRNAs, will lead to a better understanding of the pathogenesis of DKD. Targeting these mediators may be a novel approach to develop more effective therapy for DKD. PMID:25411387

  17. Glycosaminoglycan Regulation by VEGFA and VEGFC of the Glomerular Microvascular Endothelial Cell Glycocalyx in Vitro

    PubMed Central

    Foster, Rebecca R.; Armstrong, Lynne; Baker, Siân; Wong, Dickson W.L.; Wylie, Emma C.; Ramnath, Raina; Jenkins, Robert; Singh, Anurag; Steadman, Robert; Welsh, Gavin I.; Mathieson, Peter W.; Satchell, Simon C.

    2014-01-01

    Damage to endothelial glycocalyx impairs vascular barrier function and may contribute to progression of chronic vascular disease. An early indicator is microalbuminuria resulting from glomerular filtration barrier damage. We investigated the contributions of hyaluronic acid (HA) and chondroitin sulfate (CS) to glomerular microvascular endothelial cell (GEnC) glycocalyx and examined whether these are modified by vascular endothelial growth factors A and C (VEGFA and VEGFC). HA and CS were imaged on GEnCs and their resynthesis was examined. The effect of HA and CS on transendothelial electrical resistance (TEER) and labeled albumin flux across monolayers was assessed. Effects of VEGFA and VEGFC on production and charge characteristics of glycosaminoglycan (GAG) were examined via metabolic labeling and liquid chromatography. GAG shedding was quantified using Alcian Blue. NDST2 expression was examined using real-time PCR. GEnCs expressed HA and CS in the glycocalyx. CS contributed to the barrier to both ion (TEER) and protein flux across the monolayer; HA had only a limited effect. VEGFC promoted HA synthesis and increased the charge density of synthesized GAGs. In contrast, VEGFA induced shedding of charged GAGs. CS plays a role in restriction of macromolecular flux across GEnC monolayers, and VEGFA and VEGFC differentially regulate synthesis, charge, and shedding of GAGs in GEnCs. These observations have important implications for endothelial barrier regulation in glomerular and other microvascular beds. PMID:23770346

  18. Endothelial dysfunction as a predictor of cardiovascular disease in type 1 diabetes.

    PubMed

    Bertoluci, Marcello C; Cé, Gislaine V; da Silva, Antônio Mv; Wainstein, Marco V; Boff, Winston; Puñales, Marcia

    2015-06-10

    Macro and microvascular disease are the main cause of morbi-mortality in type 1 diabetes (T1DM). Although there is a clear association between endothelial dysfunction and atherosclerosis in type 2 diabetes, a cause-effect relationship is less clear in T1DM. Although endothelial dysfunction (ED) precedes atherosclerosis, it is not clear weather, in recent onset T1DM, it may progress to clinical macrovascular disease. Moreover, endothelial dysfunction may either be reversed spontaneously or in response to intensive glycemic control, long-term exercise training and use of statins. Acute, long-term and post-prandial hyperglycemia as well as duration of diabetes and microalbuminuria are all conditions associated with ED in T1DM. The pathogenesis of endothelial dysfunction is closely related to oxidative-stress. NAD(P)H oxidase over activity induces excessive superoxide production inside the mitochondrial oxidative chain of endothelial cells, thus reducing nitric oxide bioavailability and resulting in peroxynitrite formation, a potent oxidant agent. Moreover, oxidative stress also uncouples endothelial nitric oxide synthase, which becomes dysfunctional, inducing formation of superoxide. Other important mechanisms are the activation of both the polyol and protein kinase C pathways as well as the presence of advanced glycation end-products. Future studies are needed to evaluate the potential clinical applicability of endothelial dysfunction as a marker for early vascular complications in T1DM. PMID:26069717

  19. How to prevent and treat pharmacological hypoglycemias.

    PubMed

    Reyes García, R; Mezquita Raya, P

    2014-05-01

    A 58 year-old woman with type 2 diabetes diagnosed 3 years before came to our clinic. Her treatment was metformin 850 mg every 12 hours and glimepiride 4 mg every 24 hours. After the initiation of glimepiride 9 months before her weight has increased 5 kg, and she suffers frequent hypoglycemias which have affected her while driving. Her BMI is 35.5 kg/m². She has a normal eye fund exam. She has hypertension treated with telmisartán and hidroclorotiazide with adequate control, and also hypercholesterolemia treated with atorvastatine 40 mg every 24 hours. Her blood test shows an HbA1c of 7.0%, normal values of microalbuminuria, total cholesterol 149 mg/dl, HDL cholesterol 52 mg/dl, LDL cholesterol 98 mg/dl and triglycerides 123 mg/dl. Her blood pressure is 129/81 mmHg, there was no orthostatic hypotension, and her peripheral neurological examination shows normal results. In summary, our case is a young woman with type 2 diabetes and obesity, without chronic complications and which has frequent hypoglycaemia. How must this woman be evaluated and treated?

  20. [Impact of metabolic syndrome on chronic kidney disease].

    PubMed

    Calò, L A

    2006-12-01

    Metabolic syndrome has been recognized as possible risk factor for renal damage and the increased prevalence of both metabolic syndrome and renal disease justifies the increasing interest of the nephrology community toward the metabolic syndrome as another possible inducing cause of chronic renal disease, although the available evidence about a direct causal relationship between metabolic syndrome and development of renal disease so far is scanty. The not easy separation of the negative effects on renal function of metabolic syndrome from those derived from hypertension and diabetes per se, however, does not reduce the interest toward a possible direct impact of metabolic syndrome on renal disease. This also in consideration that other important factors linked with metabolic syndrome, such as for example obesity, have direct independent impact on the development of abnormalities such as microalbuminuria and or overt renal disease. Planning of clinical trials specifically for patients with metabolic syndrome could be helpful to give definitive answers on a possible direct impact of metabolic syndrome on chronic renal disease.

  1. Effect of proteinuria and glomerular filtration rate on cardiovascular risk in essential hypertension.

    PubMed

    Segura, Julian; Campo, Carlos; Ruilope, Luis M

    2004-11-01

    Changes in renal function related with essential hypertension are associated with an elevated cardiovascular morbidity and mortality. Indices of altered renal function (e.g., microalbuminuria, increased serum creatinine concentrations, decrease in estimated creatinine clearance or GFR, and overt proteinuria) are independent predictors of cardiovascular morbidity and mortality. The Framingham Heart Study documented the relevance of proteinuria for cardiovascular prognosis in the community. The INSIGHT Study assessed the role of proteinuria as a risk factor in essential hypertension. The presence of proteinuria at baseline turned out to be a very potent predictor for the development of cardiovascular events and death in patients with essential hypertension and one or more associated cardiovascular risk factors. Recent data indicate that minor derangements of renal function, including proteinuria, are associated, both in the community and in the hypertensive population, with the clustering of cardiovascular risk factors observed in metabolic syndrome that promote progression of atherosclerosis. Renal function has to be routinely evaluated in every hypertensive patient, and the presence of minor alterations considered in the stratification of cardiovascular risk in hypertensive patients.

  2. The calcium channel blocker controversy in patients with diabetic nephropathy: Is there an issue?

    PubMed

    Ruilope, L M; Campo, C; Segura, J

    2001-10-01

    Chronic renal failure, proteinuria, and arterial hypertension run in parallel in the presence of diabetic nephropathy. New goal blood pressure levels have been established in diabetic patients: 130/85 mm Hg and 125/75 mm Hg depending on the level of proteinuria being below or above 1 g/d. New and lower threshold blood pressure (>130/85 mm Hg) to initiate pharmacologic therapy is required in the presence of diabetes mellitus in order to facilitate the strict blood pressure control that is required. It must be considered that both renal and cardiovascular protection are obtained with strict blood pressure control, which otherwise seems to require blockade of angiotensin II effects when proteinuria above 1 g/d is present. While awaiting the publication of long-term follow-up studies looking at renal and cardiovascular outcome in diabetic and other nephropathies in which calcium channel blockers are compared with other antihypertensive drugs, calcium channel blockers will remain the drugs needed to attain the expected goal blood pressure in diabetics, both alone (in the absence of microalbuminuria or macroalbuminuria) or in combination, particularly with angiotensin converting enzyme inhibitors.

  3. Cardiovascular risk reduction by reversing endothelial dysfunction: ARBs, ACE inhibitors, or both? Expectations from the ONTARGET Trial Programme.

    PubMed

    Ruilope, Luis Miguel; Redón, Josep; Schmieder, Roland

    2007-01-01

    Endothelial dysfunction is the initial pathophysiological step in a progression of vascular damage that leads to overt cardiovascular and chronic kidney disease. Angiotensin II, the primary agent of the renin-angiotensin system (RAS), has a central role in endothelial dysfunction. Therefore, RAS blockade with an angiotensin receptor blocker (ARB) and/or angiotensin-converting enzyme (ACE) inhibitor provides a rational approach to reverse endothelial dysfunction, reduce microalbuminuria, and, thus, improves cardiovascular and renal prognosis. ARBs and ACE inhibitors act at different points in the RAS pathway and recent evidence suggests that there are differences regarding their effects on endothelial dysfunction. In addition to blood pressure lowering, studies have shown that ARBs reduce target-organ damage, including improvements in endothelial dysfunction, arterial stiffness, the progression of renal dysfunction in patients with type 2 diabetes, proteinuria, and left ventricular hypertrophy. The ONgoing Telmisartan Alone in combination with Ramipril Global Endpoint Trial (ONTARGET) Programme is expected to provide the ultimate evidence of whether improved endothelial function translates into reduced cardiovascular and renal events in high-risk patients, and to assess possible differential outcomes with telmisartan, the ACE inhibitor ramipril, or a combination of both (dual RAS blockade). Completion of ONTARGET is expected in 2008.

  4. Oxidative Stress in Diabetic Nephropathy with Early Chronic Kidney Disease

    PubMed Central

    Andrade-Sierra, Jorge

    2016-01-01

    The increase in the prevalence of diabetes mellitus (DM) and the secondary kidney damage produces diabetic nephropathy (DN). Early nephropathy is defined as the presence of microalbuminuria (30–300 mg/day), including normal glomerular filtration rate (GFR) or a mildly decreased GFR (60–89 mL/min/1.73 m2), with or without overt nephropathy. The earliest change caused by DN is hyperfiltration with proteinuria. The acceptable excretion rate of albumin in urine is <30 mg/day. Albuminuria represents the excretion of >300 mg/day. Chronic kidney disease (CKD) is characterized by abnormalities in renal function that persist for >3 months with health implications. Alterations in the redox state in DN are caused by the persistent state of hyperglycemia and the increase in advanced glycation end products (AGEs) with ability to affect the renin-angiotensin system and the transforming growth factor-beta (TGF-β), producing chronic inflammation and glomerular and tubular hypertrophy and favoring the appearance of oxidative stress. In DN imbalance between prooxidant/antioxidant processes exists with an increase in reactive oxygen species (ROS). The overproduction of ROS diminishes expression of the antioxidant enzymes (manganese superoxide dismutase, glutathione peroxidase, and catalase). The early detection of CKD secondary to DN and the timely identification of patients would permit decreasing its impact on health. PMID:27525285

  5. Hyperhomocysteinemia predicts renal function decline: a prospective study in hypertensive adults

    PubMed Central

    Xie, Di; Yuan, Yan; Guo, Jiangnan; Yang, Shenglin; Xu, Xin; Wang, Qin; Li, Youbao; Qin, Xianhui; Tang, Genfu; Huo, Yong; Deng, Guangpu; Wu, Shengjie; Wang, Binyan; Zhang, Qin; Wang, Xiaobin; Fang, Pu; Wang, Hong; Xu, Xiping; Hou, Fanfan

    2015-01-01

    Hyper-homocysteinemia (HHcy) is associated with microalbuminuria and glomerular injury in general and diabetic populations. However, HHcy’s role in hypertensive patients was not studied. We investigated whether HHcy is an independent risk factor for renal function decline and development of chronic kidney disease (CKD) in hypertensive men and women. This was a community-based prospective cohort study of 2,387 hypertensive adults without CKD at baseline, with a mean follow-up of 4.4 years. Baseline and follow-up levels of plasma Hcy, folate, vitamin B12, blood pressure and other pertinent covariables were obtained. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/per 1.73 m2 and an eGFR decline rate >1 ml/min/per 1.73 m2/year. There was a graded association between Hcy tertiles and eGFR decline. Subjects in the 3rd tertile of Hcy levels had an accelerated rate of eGFR decline and an increased risk of incident CKD, as compared with those in the 1st tertile, after adjusting for age, gender, baseline diabetes, SBP, BMI, smoking, dyslipidemia, eGFR, folate and vitamin B12 levels. In conclusion, in this prospective cohort of Chinese hypertensive adults, elevated baseline plasma Hcy can serve as an independent biomarker to predict renal function decline and incident CKD. PMID:26553372

  6. The spectrum of kidney disease in patients with AIDS in the era of antiretroviral therapy

    PubMed Central

    Wyatt, Christina M.; Morgello, Susan; Katz-Malamed, Rebecca; Wei, Catherine; Klotman, Mary E.; Klotman, Paul E.; D’Agati, Vivette D.

    2009-01-01

    With prolonged survival and aging of the HIV-infected population in the era of antiretroviral therapy, biopsy series have found a broad spectrum of HIV-related and co-morbid kidney disease in these patients. Our study describes the variety of renal pathology found in a prospective cohort of antiretroviral-experienced patients (the Manhattan HIV Brain Bank) who had consented to postmortem organ donation. Nearly one-third of 89 kidney tissue donors had chronic kidney disease, and evidence of some renal pathology was found in 75. The most common diagnoses were arterionephrosclerosis, HIV-associated nephropathy and glomerulonephritis. Other diagnoses included pyelonephritis, interstitial nephritis, diabetic nephropathy, fungal infection and amyloidosis. Excluding 2 instances of acute tubular necrosis, slightly over one-third of the cases would have been predicted using current diagnostic criteria for chronic kidney disease. Based on semi-quantitative analysis of stored specimens, pre-mortem microalbuminuria testing could have identified an additional 12 cases. Future studies are needed to evaluate the cost-effectiveness of more sensitive methods for defining chronic kidney disease, in order to identify HIV-infected patients with early kidney disease who may benefit from antiretroviral therapy and other interventions known to delay disease progression and prevent complications. PMID:19052538

  7. [The importance of syndrome X in daily practice].

    PubMed

    Daubresse, J C

    2000-12-01

    Metabolic syndrome X includes glucose intolerance or type 2 diabetes, dyslipidemia and arterial hypertension which are classical cardiovascular (CV) risk factors. In course of time, other CV risk factors have been added to the syndrome: rheological alterations, endothelial dysfunction, anomalies in the coagulation/fibrinolysis system, microalbuminuria and so on.... Insulin resistance is the cornerstone of metabolic syndrome X, with secondary hyperinsulinism. Upper body obesity is associated with metabolic syndrome X. Simple waist measurements can detect the subjects (10-15% of the population) at increased CV risk with a sensitivity of 70%. This is invaluable for such a simple and cheap test. Diet is the first step in treating these patients and reducing caloric intake is necessary in most of them. Saturated fats will be replaced by polyunsaturated and mono-unsaturated ones. Long-chain carbohydrates with low glycemic index will be suggested. Regular physical activity will be promoted. If these life style modifications fail, drugs can be added: biguanide and glitazone are good candidates. Orlistat has improved metabolic syndrome X on a long-term basis. Drugs that could increase insulin resistance are to be avoided.

  8. Mineralocorticoid Receptor Antagonists Therapy in Resistant Hypertension: Time to Implement Guidelines!

    PubMed Central

    Maiolino, Giuseppe; Azzolini, Matteo; Rossi, Gian Paolo

    2015-01-01

    Despite the availability of anti-hypertensive medications with increasing efficacy up to 50% of hypertensive patients have blood pressure levels (BP) not at the goals set by international societies. Some of these patients are either not optimally treated or are non-adherent to the prescribed drugs. However, a proportion, despite adequate treatment, have resistant hypertension (RH), which represents an important problem in that it is associated to an excess risk of cardiovascular events. Notwithstanding a complex pathogenesis, an abundance of data suggests a key contribution for the mineralocorticoid receptor (MR) in RH, thus fostering a potential role for its antagonists in RH. Based on these premises randomized clinical trials aimed at testing the efficacy of MR antagonists (MRAs) in RH patients have been completed. Overall, they demonstrated the efficacy of MRAs in reducing BP and surrogate markers of target organ damage, such as microalbuminuria, either compared to placebo or to other drugs. In summary, owing to the key role of the MR in the pathogenesis of RH and on the proven efficacy of MRAs we advocate their inclusion as an essential component of therapy in patients with presumed RH. Conversely, we propose that RH should be diagnosed only in patients whose BP values show to be resistant to an up-titrated dose of these drugs. PMID:26664875

  9. Spot urinary albumin-creatinine ratio predicts left ventricular hypertrophy in young hypertensive African-American men.

    PubMed

    Post, W S; Blumenthal, R S; Weiss, J L; Levine, D M; Thiemann, D R; Gerstenblith, G; Hill, M N

    2000-11-01

    Hypertensive patients with target organ damage are at increased cardiovascular risk, and should be treated most aggressively. The association between urinary albumin excretion and left ventricular hypertrophy (LVH) in prior studies is inconsistent, and has not been described using a single, random spot urine specimen. Therefore, we evaluated the association between the urinary albumin creatinine ratio (ACR) and left ventricular (LV) mass and also tested the hypothesis that a simple random, single-void urine ACR would identify high risk young, hypertensive, African-American men. We measured echocardiographic LV mass and a random spot urinary ACR in 109 untreated, hypertensive, young, inner city, African-American men. The mean age was 41 +/- 6 years and the mean blood pressure (BP) was 157 +/- 19/107 +/- 13 mm Hg. Microalbuminuria (ACR 30 to 300 mg/g) was present in 22% of subjects. The ACR is higher in the men with LVH than in the men without LVH (P < .05). Increased ACR is a predictor of increased LV mass index (P < .003) using multiple linear regression. An ACR >30 mg/g has a sensitivity of 33% and a specificity of 82% for the diagnosis of echocardiographic LVH. In conclusion, elevated random spot ACR is a marker of increased LV mass, independent of BP, in young urban African-American men with hypertension, and may help to determine the aggressiveness of antihypertensive therapy in this high-risk group.

  10. Urinary Markers of Tubular Injury in Early Diabetic Nephropathy.

    PubMed

    Fiseha, Temesgen; Tamir, Zemenu

    2016-01-01

    Diabetic nephropathy (DN) is a common and serious complication of diabetes associated with adverse outcomes of renal failure, cardiovascular disease, and premature mortality. Early and accurate identification of DN is therefore of critical importance to improve patient outcomes. Albuminuria, a marker of glomerular involvement in early renal damage, cannot always detect early DN. Thus, more sensitive and specific markers in addition to albuminuria are needed to predict the early onset and progression of DN. Tubular injury, as shown by the detection of tubular injury markers in the urine, is a critical component of the early course of DN. These urinary tubular markers may increase in diabetic patients, even before diagnosis of microalbuminuria representing early markers of normoalbuminuric DN. In this review we summarized some new and important urinary markers of tubular injury, such as neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), N-acetyl-beta-glucosaminidase (NAG), alpha-1 microglobulin (A1M), beta 2-microglobulin (B2-M), and retinol binding protein (RBP) associated with early DN. PMID:27293888

  11. Renal disease in scleroderma: an update on evaluation, risk stratification, pathogenesis and management

    PubMed Central

    Shanmugam, Victoria K.; Steen, Virginia D.

    2013-01-01

    Purpose of review Renal disease remains an important cause of morbidity and mortality in scleroderma. The spectrum of renal complications in systemic sclerosis includes scleroderma renal crisis (SRC), normotensive renal crisis, antineutrophil cytoplasmic antibodies-associated glomerulonephritis, penacillamine-associated renal disease, and reduced renal functional reserves manifested by proteinuria, microalbuminuria, or isolated reduction in glomerular filtration rate. The purpose of this review is to provide a concise and up-to-date review of the evaluation, risk stratification, pathogenesis, and management of scleroderma-associated renal disease. Recent findings Although SRC survival has significantly improved, mortality of this complication remains high outside of specialized centers. Recent data demonstrate strong associations between anti-RNA polymerase III antibodies and SRC. Subclinical renal impairment affects approximately 50% of scleroderma patients and may be associated with other vascular manifestations. Subclinical renal involvement rarely progresses to end-stage renal failure; however, recent studies suggest it may predict mortality in patients with other vasculopathic manifestations. Summary Testing for anti-RNA polymerase III antibodies should be incorporated into clinical care to identify patients at high risk for SRC. Recommendations from European League Against Rheumatism (EULAR), EULAR Scleroderma Trials and Research, and the Scleroderma Clinical Trials Consortium confirm angiotensin-converting enzyme inhibitors as first-line therapy for SRC, and give recommendations for second-line agents. PMID:22955019

  12. [Glomerulo-tubular balance in diabetes mellitus: molecular evidence and clinical consequences].

    PubMed

    Evangelista, C; Rizzo, M; Cantone, A; Corbo, G; Di Donato, L; Trocino, C; Zacchia, M; Capasso, G

    2006-01-01

    Diabetes mellitus is fast becoming a world epidemic. About one-third of individuals with diabetes, after 10 yrs, develop diabetic nephropathy, the first cause of end-stage kidney disease. The evolution of diabetic nephropathy can be considered in three stages: glomerular hyperfiltration, microalbuminuria (30-300 mg/24 hr) and proteinuria (>300 mg/24 hr). This study was designed to investigate the tubular basis of glomerular hyperfiltration in early diabetes mellitus. Diabetes was inducted in rats with i.p. streptozotocin (65 mg/kg bw) for 6 days. At the end of the treatment, the glomerular filtration rate (GFR), measured by inulin clearance, had substantially increased in diabetic rats compared with controls. Quantitative polymerase chain reaction (PCR) and Western blot analysis reveal that in diabetic rats compared with controls, mRNA and protein abundance was higher for type 3 sodium/hydrogen exchanger (NHE3) in proximal tubule and ascending limbs of Henle's loop, and higher for bumetanide-sensitive sodium-potassium-2 chloride cotransporter (NKCC2) in ascending limbs of Henle's loop. Western blot analysis confirmed the PCR results. Finally, the abundance of á -ENaC protein was unchanged in diabetic rats compared to controls. These results show that the primary sodium reabsorption increase in proximal tubule reduces salt concentrations at the macula densa. This elicits a tubuloglomerular feedback-dependent increase in single nephron GFR.

  13. A local renal renin-angiotensin system activation via renal uptake of prorenin and angiotensinogen in diabetic rats.

    PubMed

    Tojo, Akihiro; Kinugasa, Satoshi; Fujita, Toshiro; Wilcox, Christopher S

    2016-01-01

    The mechanism of activation of local renal renin-angiotensin system (RAS) has not been clarified in diabetes mellitus (DM). We hypothesized that the local renal RAS will be activated via increased glomerular filtration and tubular uptake of prorenin and angiotensinogen in diabetic kidney with microalbuminuria. Streptozotocin (STZ)-induced DM and control rats were injected with human prorenin and subsequently with human angiotensinogen. Human prorenin uptake was increased in podocytes, proximal tubules, macula densa, and cortical collecting ducts of DM rats where prorenin receptor (PRR) was expressed. Co-immunoprecipitation of kidney homogenates in DM rats revealed binding of human prorenin to the PRR and to megalin. The renal uptake of human angiotensinogen was increased in DM rats at the same nephron sites as prorenin. Angiotensin-converting enzyme was increased in podocytes, but decreased in the proximal tubules in DM rats, which may have contributed to unchanged renal levels of angiotensin despite increased angiotensinogen. The systolic blood pressure increased more after the injection of 20 μg of angiotensinogen in DM rats than in controls, accompanied by an increased uptake of human angiotensinogen in the vascular endothelium. In conclusion, endocytic uptake of prorenin and angiotensinogen in the kidney and vasculature in DM rats was contributed to increased tissue RAS and their pressor response to angiotensinogen.

  14. Renal function evaluation in patients with American Cutaneous Leishmaniasis after specific treatment with pentavalent antimonial

    PubMed Central

    2012-01-01

    Background Renal evaluation studies are rare in American Cutaneous Leishmaniasis (ACL). The aim of this study is to investigate whether specific treatment reverts ACL-associated renal dysfunction. Methods A prospective study was conducted with 37 patients with ACL. Urinary concentrating and acidification ability was assessed before and after treatment with pentavalent antimonial. Results The patients mean age was 35.6 ± 12 years and 19 were male. Before treatment, urinary concentrating defect (U/Posm <2.8) was identified in 27 patients (77%) and urinary acidification defect in 17 patients (46%). No significant glomerular dysfunction was observed before and after specific ACL treatment. There was no reversion of urinary concentrating defects, being observed in 77% of the patients before and in 88% after treatment (p = 0.344). Urinary acidification defect was corrected in 9 patients after treatment, reducing its prevalence from 40% before to only 16% after treament, (p = 0.012). Microalbuminuria higher than 30 mg/g was found in 35% of patients before treatment and in only 8% after treatment. Regarding fractional excretion of sodium, potassium, calcium, phosphorus and magnesium, there was no significant difference between pre and post-treatment period. Conclusion As previously described, urinary concentrating and acidification defects were found in an important number of patients with ACL. Present results demonstrate that only some patients recover urinary acidification capacity, while no one returned to normal urinary concentration capacity. PMID:22715954

  15. Values of Alpha 1 Microglobulin Does Not Differ between Individuals with and without Family History of Balkan Endemic Nephropathy

    PubMed Central

    Trnacevic, Senaid; Hodzic, Emir; Atic, Mirza; Dugonjic, Maida; Hasanovic, Evlijana

    2014-01-01

    Aim. The aim of this study was to compare urinary alpha 1 microglobulin (A1MG) in healthy individuals with and without family burden for Balkan endemic nephropathy (BEN) in an endemic village. Methods. Otherwise healthy inhabitants with microalbuminuria or proteinuria were divided into two groups: with (n = 24) and without (n = 32) family BEN burden and screened for urinary A1MG and A1MG/urine creatinine ratio. Results. Average value of urinary A1MG was 10.35 ± 7.01 mg/L in group with and 10.79 ± 8.27 mg/L in group without family history for BEN (NS, P = 0.87). A1MG was higher than 10 mg/L in eight (33.33%) inhabitants with family history and in 12 (37.5%) without (NS, P = 0.187). Average values of urinary A1MG/creatinine ratio were 1.30 ± 1.59 and 0.94 ± 0.78 in group with and group without family BEN history (NS, P = 0.39, resp.). Elevated values of this ratio were found in 13 (54.17%) inhabitants with and 14 (43.75%) without family history for BEN (NS, P = 0.415). Conclusion. We did not find statistically significant difference in the examined markers between healthy individuals with and without family burden for BEN. We concluded that these markers are not predictive of risk for BEN. PMID:24563783

  16. Diabetic Kidney Disease and the Cardiorenal syndrome: Old Disease New Perspectives

    PubMed Central

    Jindal, Ankur; Garcia-Touza, Mariana; Jindal, Nidhi; Whaley-Connell, Adam; Sowers, James R.

    2014-01-01

    Synopsis Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States. There was an estimated 7 million cases of diabetic kidney disease (DKD) in the last National Health and Nutrition Examination survey (2005-2008). High blood pressure, hyperglycemia and other metabolic abnormalities interactively promote DKD, thus there has been increasing interest and renewed focus on the metabolic dysregulation and the interactions between heart and kidney pathologies observed in DKD. Indeed metabolic abnormalities that are observed in overweight or obese individuals are known to impact blood pressure regulation in kidney and cardiovascular disease; e.g. cardiorenal metabolic syndrome. In this context, obesity has been associated with increased blood pressure variability and nocturnal non-dipping which are risk predictors for albuminuria and DKD. These collective metabolic abnormalities have also been observed in earlier stages of DKD in association with micro-albuminuria. Herein we review the current literature regarding the role of blood pressure variability and nocturnal non-dipping of blood pressure as well as the presence of DKD, in the absence of albuminuria, as risk predictors for progressive DKD. We also discuss the importance of glycemic and blood pressure control in patients with diabetes and CKD, and the use of oral hypoglycemic agents and anti-hypertensive agents in this patient cohort. PMID:24286950

  17. Mouse Models of Diabetes, Obesity and Related Kidney Disease.

    PubMed

    Glastras, Sarah J; Chen, Hui; Teh, Rachel; McGrath, Rachel T; Chen, Jason; Pollock, Carol A; Wong, Muh Geot; Saad, Sonia

    2016-01-01

    Multiple rodent models have been used to study diabetic kidney disease (DKD). The purpose of the present study was to compare models of diabetes and obesity-induced metabolic syndrome and determine differences in renal outcomes. C57BL/6 male mice were fed either normal chow or high fat diet (HFD). At postnatal week 8, chow-fed mice were randomly assigned to low-dose streptozotocin (STZ, 55 mg/kg/day, five consecutive days) or vehicle control, whereas HFD-fed mice were given either one high-dose of STZ (100 mg/kg) or vehicle control. Intraperitoneal glucose tolerance tests were performed at Week 14, 20 and 30. Urinary albumin to creatinine ratio (ACR) and serum creatinine were measured, and renal structure was assessed using Periodic Acid Schiff (PAS) staining at Week 32. Results showed that chow-fed mice exposed to five doses of STZ resembled type 1 diabetes mellitus with a lean phenotype, hyperglycaemia, microalbuminuria and increased serum creatinine levels. Their kidneys demonstrated moderate tubular injury with evidence of tubular dilatation and glycogenated nuclear inclusion bodies. HFD-fed mice resembled metabolic syndrome as they were obese with dyslipidaemia, insulin resistance, and significantly impaired glucose tolerance. One dose STZ, in addition to HFD, did not worsen metabolic features (including fasting glucose, non esterified fatty acid, and triglyceride levels). There were significant increases in urinary ACR and serum creatinine levels, and renal structural changes were predominantly related to interstitial vacuolation and tubular dilatation in HFD-fed mice. PMID:27579698

  18. Endothelial dysfunction as a predictor of cardiovascular disease in type 1 diabetes

    PubMed Central

    Bertoluci, Marcello C; Cé, Gislaine V; da Silva, Antônio MV; Wainstein, Marco V; Boff, Winston; Puñales, Marcia

    2015-01-01

    Macro and microvascular disease are the main cause of morbi-mortality in type 1 diabetes (T1DM). Although there is a clear association between endothelial dysfunction and atherosclerosis in type 2 diabetes, a cause-effect relationship is less clear in T1DM. Although endothelial dysfunction (ED) precedes atherosclerosis, it is not clear weather, in recent onset T1DM, it may progress to clinical macrovascular disease. Moreover, endothelial dysfunction may either be reversed spontaneously or in response to intensive glycemic control, long-term exercise training and use of statins. Acute, long-term and post-prandial hyperglycemia as well as duration of diabetes and microalbuminuria are all conditions associated with ED in T1DM. The pathogenesis of endothelial dysfunction is closely related to oxidative-stress. NAD(P)H oxidase over activity induces excessive superoxide production inside the mitochondrial oxidative chain of endothelial cells, thus reducing nitric oxide bioavailability and resulting in peroxynitrite formation, a potent oxidant agent. Moreover, oxidative stress also uncouples endothelial nitric oxide synthase, which becomes dysfunctional, inducing formation of superoxide. Other important mechanisms are the activation of both the polyol and protein kinase C pathways as well as the presence of advanced glycation end-products. Future studies are needed to evaluate the potential clinical applicability of endothelial dysfunction as a marker for early vascular complications in T1DM. PMID:26069717

  19. The Association between Urine Albumin to Creatinine Ratio and Osteoporosis in Postmenopausal Women with Type 2 Diabetes

    PubMed Central

    Lee, Ye Yeon; Kim, Han Byul; Lee, Jong Won; Lee, Gyu Min; Kim, Sang Yoon; Hur, Ji An

    2016-01-01

    Background Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass density and destruction of microstructure, which can lead to an increased risk of fracture. Although many studies have been published about the relationship between end-stage renal disease and osteoporosis, research on the relationship between proteinuria and the prevalence of osteoporosis is still lacking. Methods We assessed 91 postmenopausal women with type 2 diabetes who visited our hospital from January 2009 to January 2012. Results Among 91 patients, the prevalence of osteoporosis and osteopenia was 35.2% (32 cases) and 32.9% (30 cases) according to bone mineral density. The patients with microalbuminuria and macroalbuminuria (urine albumin-to-creatinine ratio [UACR] ≥ 30) had a significantly higher incidence of osteoporosis compared to subjects with normoalbuminuria (P<0.05). Conclusions This study indicates that UACR may be a useful biomarker for increased risk of osteoporosis in postmenopausal women with type 2 diabetes who have been linked to higher UACR levels. PMID:26981514

  20. Comparison of Clinical Trajectories before Initiation of Renal Replacement Therapy between Diabetic Nephropathy and Nephrosclerosis on the KDIGO Guidelines Heat Map.

    PubMed

    Abe, Masanori; Okada, Kazuyoshi; Maruyama, Noriaki; Takashima, Hiroyuki; Oikawa, Osamu; Soma, Masayoshi

    2016-01-01

    This study investigated differences between the clinical trajectories of diabetic nephropathy and nephrosclerosis using the Kidney Disease: Improving Global Outcomes (KDIGO) heat map and the clinical characteristics between the two diseases at RRT initiation. This single-center, retrospective study enrolled 100 patients whose estimated glomerular filtration rate (eGFR) was ≥45 mL/min/1.73 m(2) at their first visit and who were initiated on RRT. Fifty consecutive patients were assigned to each of the diabetic nephropathy and nephrosclerosis groups. All data for simultaneously measured eGFR and urinary albumin to creatinine ratio (UACR) were collected from first visit to RRT initiation and were plotted on the KDIGO heat map. Diabetic nephropathy was characterized by higher blood pressure and UACR and lower age, eGFR, and serum albumin levels compared with nephrosclerosis at RRT initiation. The vast majority of patients with diabetic nephropathy and eGFR < 60 mL/min/1.73 m(2) had concomitant macroalbuminuria, whereas for patients with nephrosclerosis, even when eGFR was <45 mL/min/1.73 m(2), many still had normoalbuminuria or microalbuminuria. The rate of decline of eGFR was significantly faster in the diabetic nephropathy group than that in the nephrosclerosis group. The clinical trajectories of diabetic nephropathy and nephrosclerosis differed markedly on the KDIGO heat map.