Anemia and chronic kidney disease are potential risk factors for mortality in stroke patients: a historic cohort study.

BACKGROUND: Chronic kidney disease (CKD) is associated to a higher stroke risk. Anemia is a common consequence of CKD, and is also a possible risk factor for cerebrovascular diseases. The purpose of this study was to examine if anemia and CKD are independent risk factors for mortality after stroke. METHODS: This historic cohort study was based on a stroke registry and included patients treated for a first clinical stroke in the stroke unit of one academic hospital over a three-year period. Mortality predictors comprised demographic characteristics, CKD, glomerular filtration rate (GFR), anemia and other stroke risk factors. GFR was estimated by means of the simplified Modification of Diet in Renal Disease formula. Renal function was assessed according to the Kidney Disease Outcomes Quality Initiative (K/DOQI)-CKD classification in five groups. A value of hemoglobin < 120 g/L in women and < 130 g/L in men on admission defined anemia. Kaplan-Meier survival curves and Cox models were used to describe and analyze one-year survival. RESULTS: Among 890 adult stroke patients, the mean (Standard Deviation) calculated GFR was 64.3 (17.8) ml/min/1.73 m2 and 17% had anemia. Eighty-two (10%) patients died during the first year after discharge. Among those, 50 (61%) had K/DOQI CKD stages 3 to 5 and 32 (39%) stages 1 or 2 (p < 0.001). Anemia was associated with an increased risk of death one year after discharge (p < 0.001). After adjustment for other factors, a higher hemoglobin level was independently associated with decreased mortality one year after discharge [hazard ratio (95% CI) 0.98 (0.97-1.00)]. CONCLUSIONS: Both CKD and anemia are frequent among stroke patients and are potential risk factors for decreased one-year survival. The inclusion of patients with a first-ever clinical stroke only and the determination of anemia based on one single measure, on admission, constitute limitations to the external validity. We should investigate if an early detection and management of both CKD and anemia could improve survival in stroke patients.

Obertura: Escriure el desig

En que consisteix "escriure el desig"?. La literatura contemporània,com tants altres discursos (la filosofia, la psicoanalisi...), atorga una gran rellevància a la relació amb l'Altre, amb tot allo que no sóc jo, i, sobretot, a la força que m'empeny cap a l'altre, que podríem anomenar la «lleidel desig». També s'ha afirmat que la consciencia de ser un subjecte autonom existeix gracies als altres que m'envolten. Sartre ho formula així: «necessito l'altre per captar plenament totes les estructures del meu ésser»...

Obertura: Escriure el desig

En que consisteix "escriure el desig"?. La literatura contemporània,com tants altres discursos (la filosofia, la psicoanalisi...), atorga una gran rellevància a la relació amb l'Altre, amb tot allo que no sóc jo, i, sobretot, a la força que m'empeny cap a l'altre, que podríem anomenar la «lleidel desig». També s'ha afirmat que la consciencia de ser un subjecte autonom existeix gracies als altres que m'envolten. Sartre ho formula així: «necessito l'altre per captar plenament totes les estructures del meu ésser»...

Is use of nifurtimox for the treatment of Chagas disease compatible with breast feeding? A population pharmacokinetics analysis.

Introduction Women with Chagas disease receiving treatment with nifurtimox are discouraged from breast feeding. Many patients who would receive treatment with nifurtimox live in extreme poverty, have limited access to resources such as clean water and baby formula and may not have safe alternatives to breast milk. Aim We aimed to estimate, using limited available pharmacokinetics data, potential infant exposure to nifurtimox through breast milk. Methods Original nifurtimox plasma concentrations were obtained from published studies. Pharmacokinetic parameters were estimated using non-linear mixed-effect modelling with NONMEM V.VI. A total of 1000 nifurtimox plasma-concentration profiles were simulated and used to calculate the amount of drug that an infant would be exposed to, if breast fed 150 ml/kg/day. Results Breast milk concentrations on the basis of peak plasma levels (1361 ng/ml) and milk-plasma ratio were estimated. We calculated infant nifurtimox exposure of a breastfed infant of a mother treated with this drug to be below 10% of the maternal weight-adjusted dose, even if milk-plasma ratio were overestimated. Simulation led to similar estimates. Discussion Risk for significant infant exposure to nifurtimox through breast milk seems small and below the level of exposure of infants with Chagas disease receiving nifurtimox treatment. This potential degree of exposure may not justify discontinuation of breast feeding.

Combined intermittent hypoxia and surface muscle electrostimulation as a method to increase peripheral blood progenitor cell concentration.

Background: Our goal was to determine whether short-term intermittent hypoxia exposure, at a level well tolerated by healthy humans and previously shown by our group to increase EPO and erythropoiesis, could mobilizehematopoietic stem cells (HSC) and increase their presence in peripheral circulation. Methods: Four healthy male subjects were subjected to three different protocols: one with only a hypoxic stimulus (OH), another with a hypoxic stimulus plus muscle electrostimulation (HME) and the third with only muscle electrostimulation (OME). Intermittent hypobaric hypoxia exposureconsisted of only three sessions of three hours at barometric pressure 540 hPa (equivalent to an altitude of 5000 m) for three consecutive days, whereas muscular electrostimulation was performed in two separate periods of 25 min in each session. Blood samples were obtained from an antecubital vein on three consecutive days immediately before the experiment and 24 h, 48 h, 4 days and 7 days after the last day of hypoxic exposure. Results: There was a clear increase in the number of circulating CD34+ cells after combined hypobaric hypoxia and muscular electrostimulation. This response was not observed after the isolated application of the same stimuli. Conclusion: Our results open a new application field for hypobaric systems as a way to increase efficiency in peripheral HSC collection.

Combined intermittent hypoxia and surface muscle electrostimulation as a method to increase peripheral blood progenitor cell concentration.

Background: Our goal was to determine whether short-term intermittent hypoxia exposure, at a level well tolerated by healthy humans and previously shown by our group to increase EPO and erythropoiesis, could mobilizehematopoietic stem cells (HSC) and increase their presence in peripheral circulation. Methods: Four healthy male subjects were subjected to three different protocols: one with only a hypoxic stimulus (OH), another with a hypoxic stimulus plus muscle electrostimulation (HME) and the third with only muscle electrostimulation (OME). Intermittent hypobaric hypoxia exposureconsisted of only three sessions of three hours at barometric pressure 540 hPa (equivalent to an altitude of 5000 m) for three consecutive days, whereas muscular electrostimulation was performed in two separate periods of 25 min in each session. Blood samples were obtained from an antecubital vein on three consecutive days immediately before the experiment and 24 h, 48 h, 4 days and 7 days after the last day of hypoxic exposure. Results: There was a clear increase in the number of circulating CD34+ cells after combined hypobaric hypoxia and muscular electrostimulation. This response was not observed after the isolated application of the same stimuli. Conclusion: Our results open a new application field for hypobaric systems as a way to increase efficiency in peripheral HSC collection.

Is it appropriate to index glomerular filtration rate for body surface area

Purpose: Obesity is an established independent risk factor for chronic kidney disease. Thus, measurement of glomerular filtration rate (GFR) is important in this population. Traditionally, GFR has been indexed for body surface area (BSA), but this indexation may not be appropriate in obese individuals. Therefore, the objective of the study was to compare absolute GFR with GFR indexed for BSA and with GFR indexed for height. Methods and materials: The study was conducted in 66 families from the Seychelles islands that included several members with hypertension. GFR and effective renal plasma flow (ERPF) were measured using inulin and PAH clearances, respectively. Antihypertensive treatment, if used, was withheld 2 weeks before conducting the clearances. Participants with diabetes mellitus were excluded from the analysis. BSA was calculated using the Dubois formula. We assessed trend across BMI categories using a non parametric test. Results: Participants included 174 women and 127 men. The prevalence of hypertension was 61%, of which 68% were treated. The table shows that absolute GFR, GFR indexed for height, ERPF, filtration fraction were significantly higher across BMI categories. When GFR was indexed for BSA, the association between GFR and BMI categories was lost. Conclusion: Indexing GFR for BSA in overweight and obese individuals leads to a substantial underestimation of GFR. Filtration fraction, which does not depend on BSA, is higher in obese individuals, which suggests glomerular hyperfiltration. Indexing GFR for BSA therefore would mask the underlying glomerular hyperfiltration. As the number of nephrons does not increase with weight gain, absolute GFR represents a better marker of single nephron GFR and is more appropriate.

Issue review : school aid law changes.

This issue review examines law changes made during the past three legislative sessions, 2006 through 2008, that directly impact the Iowa School Aid Formula.

Issue review : Area Education Agency review update.

Information presented provides an update of the Area Education Agency issue review published in 1997, including history, organization, funding formula, revenues, expenditures, and authority.

Issue review : school district cash reserve levy.

During the recent economic crisis, school district budgets have been impacted by state school aid funding shortfalls and state aid reductions due to across-the-board general fund reductions in fiscal year 2009 and fiscal year 2010. Additionally, in fiscal year 2011, the state school aid appropriation was capped and was 156.1 million dollars short of fully funding the state portion of the school aid formula. This issue review examines the impact that the reductions in state aid have had on school district cash reserve levies.

Transcranial Doppler Pulsatility Index: What it is and What it Isn't.

BACKGROUND: Transcranial Doppler (TCD) pulsatility index (PI) has traditionally been interpreted as a descriptor of distal cerebrovascular resistance (CVR). We sought to evaluate the relationship between PI and CVR in situations, where CVR increases (mild hypocapnia) and decreases (plateau waves of intracranial pressure-ICP). METHODS: Recordings from patients with head-injury undergoing monitoring of arterial blood pressure (ABP), ICP, cerebral perfusion pressure (CPP), and TCD assessed cerebral blood flow velocities (FV) were analyzed. The Gosling pulsatility index (PI) was compared between baseline and ICP plateau waves (n = 20 patients) or short term (30-60 min) hypocapnia (n = 31). In addition, a modeling study was conducted with the "spectral" PI (calculated using fundamental harmonic of FV) resulting in a theoretical formula expressing the dependence of PI on balance of cerebrovascular impedances. RESULTS: PI increased significantly (p < 0.001) while CVR decreased (p < 0.001) during plateau waves. During hypocapnia PI and CVR increased (p < 0.001). The modeling formula explained more than 65% of the variability of Gosling PI and 90% of the variability of the "spectral" PI (R = 0.81 and R = 0.95, respectively). CONCLUSION: TCD pulsatility index can be easily and quickly assessed but is usually misinterpreted as a descriptor of CVR. The mathematical model presents a complex relationship between PI and multiple haemodynamic variables.

Las UTE en la normativa contable española. Referencia a las NIC

Revision actual de las Uniones Temporales de Empresas (UTE), con el objeto de constatar si la informacion contable que presentan las empresas asociadas mediante esta formula es fidedigna y cual es su situacion ante la reforma contable. La investigacion consta de una parte teorica y una parte empirica. La parte teorica define la union temporal de empresas, sus caracteristicas y objetivos, el origen historico y la regulacion contable, fiscal y juridica que les afecta. Asimismo, se trata con especial relevancia la adaptacion sectorial del PGC a las Empresas Constructoras (PSEC). Por otra parte, se analizan las Normas Internacionales de Informacion Financiera (NIIF) relacionadas con las UTE. Finalmente, se comparan las normas contables españolas, internacionales y francesas referidas a los contratos de larga duracion. La parte empirica, resulta de un analisis de los estados financieras del periodo 2002-2004 de una poblacion de treinta empresas constructoras que habitualmente realizan UTE, la mayoria de las mismas forman parte del SEOPAN (Asociacion de Empresas Constructoras de ambito nacional).

Issue review : Instructional support program funding inequities.

School districts may receive funding for the instructional support program subject to school board or voter approval. Program funding is based on a formula that includes a local funding provision, property tax and income surtax and a state aid component. When initially implemented, state aid was distributed through a formula designed to provide property tax equity and equalize the property tax burden between school districts. Since the initial year of the program, the state aid portion has not been fully funded and in fiscal year 2012, no state dollars were appropriated for the program. The result of underfunding the state-aid portion of the program has led to an inequity in the amount of funds school districts receive from the program. In fiscal year 2012, the portion of actual program funding for school districts ranged from a low of 52.6 percent to a high of 92.8 percent. This issue review examines the inequity in more detail.

Issue review : IPERS retirement dividend payments.

The Iowa Public Employees' Retirement System, or IPERS, does not apply a traditional cost-of-living adjustment for retirement benefits. A retiree's monthly benefit payment is determined by a formula at the time of retirement and the amount does not change. Instead of adjusting the monthly benefit for inflation, the General Assembly creates two separate once-a-year payments for retirees, the November dividend for pre-1990 retirees and the favorable experience dividend, or FED for 1990 and later retirees. Available funding for the FED is estimated to be depleted within the next three years.

Issue review : salary growth of Iowa teachers and school administrators.

In recent years in both Iowa and nationally, there has been a strong focus on increasing salary levels for teachers. Iowa initiated the Student Achievement and Teacher Quality Program in fiscal year 2002 to improve the quality of K-12 teachers in Iowa schools. The program's funding to improve teacher salaries continues and is now part of the school-aid formula. During the same time period, there has been a growing focus on recruiting and improving the quality of school district superintendents and other school administrators. This issue review looks at the growth of salaries over the past ten years for Iowa's full-time teachers, superintendents and other administrators.