Pub Date : 2023-04-30DOI: 10.32440/ar.2023.140.01.rev07
E. Blázquez Fernández
The presence of the messenger RNA for GLP-1 receptor (GLP-1R), GLUT-2 (isoform 2 of glucose transporter ) and GK (glucokinase) in brain areas might be related to the glucose sensing process that was recently described in pancreatic β cells. GLUT-2, GK and the regulatory protein of GK (GKRP) were identified in both human and rat brains. The GK gene expression generates a 52 kDa protein, identified by biochemical and immunochemical methods; it shows a high Km for glucose and a high capacity to phosphorylate glucose in the hypothalamus and in the brain cortex. Its physiological importance is related to its activation secondary to an increase in glycaemia related to food ingestion. GK and GKRP modulate the enzymatic activity according to the metabolic needs of the cells. This is necessary for the sensing process that is controlled by GK and GKRP, and could also contribute to a sensation of satiety. It would be interesting to know if mutations in the genes codifying the mentioned proteins can produce pathological alterations, or whether changes in the feeding behavior are related to the brain glucose sensing process. Until now, our work has focused on the role of hypothalamic glucokinase as a glucose sensor related to food behavior, but we cannot forget that this enzyme is widely expressed in the brain cortex, where it could also carry out other important functions. These observations, together with the anorexigenic activity of GLP-1 (glucagon-like peptide-1), suggest a combined role of these peptides on food intake control.
{"title":"Molecular and pathophysiological basis of the brain glucose sensing ability","authors":"E. Blázquez Fernández","doi":"10.32440/ar.2023.140.01.rev07","DOIUrl":"https://doi.org/10.32440/ar.2023.140.01.rev07","url":null,"abstract":"The presence of the messenger RNA for GLP-1 receptor (GLP-1R), GLUT-2 (isoform 2 of glucose transporter ) and GK (glucokinase) in brain areas might be related to the glucose sensing process that was recently described in pancreatic β cells. GLUT-2, GK and the regulatory protein of GK (GKRP) were identified in both human and rat brains. The GK gene expression generates a 52 kDa protein, identified by biochemical and immunochemical methods; it shows a high Km for glucose and a high capacity to phosphorylate glucose in the hypothalamus and in the brain cortex. Its physiological importance is related to its activation secondary to an increase in glycaemia related to food ingestion. GK and GKRP modulate the enzymatic activity according to the metabolic needs of the cells. This is necessary for the sensing process that is controlled by GK and GKRP, and could also contribute to a sensation of satiety. It would be interesting to know if mutations in the genes codifying the mentioned proteins can produce pathological alterations, or whether changes in the feeding behavior are related to the brain glucose sensing process. Until now, our work has focused on the role of hypothalamic glucokinase as a glucose sensor related to food behavior, but we cannot forget that this enzyme is widely expressed in the brain cortex, where it could also carry out other important functions. These observations, together with the anorexigenic activity of GLP-1 (glucagon-like peptide-1), suggest a combined role of these peptides on food intake control.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47653951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32440/ar.2022.139.03.rev07
R. González-Alday, F. Peinado, D. Carrillo, V. Maojo
Sexually transmitted diseases (STDs) are one of the world’s major health emergencies. Given its incidence and prevalence, particularly in developing countries, it is necessary to find new methods for early diagnosis and treatment. However, this can be complicated in geographical areas where medical care is limited. In this article, we present the basis of a deep learning-based system for image classification of genital lesions caused by these diseases, built using a convolutional neural network model and methods such as transfer learning and data augmentation. In addition, an explainability method (GradCam) is employed to enhance the interpretability of the obtained results. Finally, we developed a web framework to facilitate additional data collection and annotation. This work aims to be a starting point, a “proof of concept” to test various different approaches, for the development of more robust and trustworthy Artificial Intelligence approaches for medical care in STDs, which could substantially improve medical assistance in the near future, particularly in developing regions.
{"title":"Deep Learning for Clinical Image Classification of Genital Lesions Caused by Sexually Transmitted Diseases","authors":"R. González-Alday, F. Peinado, D. Carrillo, V. Maojo","doi":"10.32440/ar.2022.139.03.rev07","DOIUrl":"https://doi.org/10.32440/ar.2022.139.03.rev07","url":null,"abstract":"Sexually transmitted diseases (STDs) are one of the world’s major health emergencies. Given its incidence and prevalence, particularly in developing countries, it is necessary to find new methods for early diagnosis and treatment. However, this can be complicated in geographical areas where medical care is limited. In this article, we present the basis of a deep learning-based system for image classification of genital lesions caused by these diseases, built using a convolutional neural network model and methods such as transfer learning and data augmentation. In addition, an explainability method (GradCam) is employed to enhance the interpretability of the obtained results. Finally, we developed a web framework to facilitate additional data collection and annotation. This work aims to be a starting point, a “proof of concept” to test various different approaches, for the development of more robust and trustworthy Artificial Intelligence approaches for medical care in STDs, which could substantially improve medical assistance in the near future, particularly in developing regions.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69672244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32440/ar.2023.140.02.rev01
A. Armiñana, C. Montón-Gómez, A. Puig-Chilet, T. Infante-Fuenzalida, C. Fontenla-Martínez, I. Torres-Espallardó, L. Martí-Bonmatí
Dual energy CT is a recent upgrade to this diagnostic imaging technique. The purpose of this critical narrative review is to lay out the clinical applications of Hounsfield Units and their variation across the x-ray energy spectrum using DECT. We explore new reconstruction methods and parametric maps helpful for the diagnosis of prevalent pathologies such as fatty liver disease, urolithiasis, and to identify complications after interventions or determine the aggressiveness of tumoral lesions. The energy-resolving capabilities of DECT make it a reliable method for the characterisation of tissue and lesion composition. Lower energy monoenergetic images allow us to increase soft tissue contrast and easily identify tissues with higher contrast uptake. Higher energy monoenergetic images are useful to distinguish between contrast uptake and high attenuation calcium deposits and for metal artifact reduction. Parametric images showing uric acid, iodine, calcium, and other material decompositions can be obtained from spectral data for the diagnosis of tumoral or metabolic diseases, vascular lesions and characterisation of deposition arthritis and urolithiasis.
{"title":"Spectral CT and Hounsfield Units: basis for correct interpretation","authors":"A. Armiñana, C. Montón-Gómez, A. Puig-Chilet, T. Infante-Fuenzalida, C. Fontenla-Martínez, I. Torres-Espallardó, L. Martí-Bonmatí","doi":"10.32440/ar.2023.140.02.rev01","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.rev01","url":null,"abstract":"Dual energy CT is a recent upgrade to this diagnostic imaging technique. The purpose of this critical narrative review is to lay out the clinical applications of Hounsfield Units and their variation across the x-ray energy spectrum using DECT. We explore new reconstruction methods and parametric maps helpful for the diagnosis of prevalent pathologies such as fatty liver disease, urolithiasis, and to identify complications after interventions or determine the aggressiveness of tumoral lesions. The energy-resolving capabilities of DECT make it a reliable method for the characterisation of tissue and lesion composition. Lower energy monoenergetic images allow us to increase soft tissue contrast and easily identify tissues with higher contrast uptake. Higher energy monoenergetic images are useful to distinguish between contrast uptake and high attenuation calcium deposits and for metal artifact reduction. Parametric images showing uric acid, iodine, calcium, and other material decompositions can be obtained from spectral data for the diagnosis of tumoral or metabolic diseases, vascular lesions and characterisation of deposition arthritis and urolithiasis.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135600240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32440/ar.2022.139.03.rev01
C. F. Sánchez Ferrer, I. Valencia Fernández, C. Peiró Vallejo
The main physiologic function of adipokines on the energy metabolism and the cardiovascular homeostasis, among others, are well known. In the last years, our laboratory is providing increasing evidence about the possible role of adipokines as mediators of vascular damage, by inducing different pro-inflammatory and pro-senescent mechanisms. The secretion of adipokines like visfatin or dipeptidylpeptidase-4 (DPP4) by adipose tissue, particularly by the visceral fat, is enhanced in obese and type 2 diabetic patients. Both adipokines are enzymes metabolically active that can induce the activation of specific receptors, namely type 4 “toll like receptors” (TLR4) for visfatin and “protease activated receptor 2” (PAR2) for DPP4. Stimulation of such receptors is triggering well known pro-inflammatory and pro-senescent mechanisms, like the nuclear transcription factor-κB (NF-κB) or the inflammasome NLRP3 (“nucleotide-binding, leucine-rich-repeat, pyrin domain containing 3”), a cell structure that transforms the immature forms of classic cytokines in their active derivates, interleukin-1β (IL-1β) or interleukin 18 (IL-18). It is worth to note that these classic cytokines are the final effectors for the harmful effects of the adipokines and its blockade can be a very relevant therapeutic approach. In our experiments, the specific antagonism of IL-1 receptors with anakinra prevents the inflammatory and senescent effects evoked by visfatin and DPP4. Moreover, this finding is in agreement with data from other researchers, as well as with the results of the CANTOS clinical trial, which demonstrate a very important cardioprotective cardiovascular effect mediated by the anti-inflammatory effect of the monoclonal antibody canakinumab. On the other hand, we have also provided experimental evidence about possible vasculopotective adipokines, such angiotensin-(1-7), which is able to induce, through activation of Mas receptors, the expression of klotho protein and the activation of antioxidant pathways, like the well known Nrf2-HO-1 (“nuclear factor erythroid-2 y hemoygenase-1”).
{"title":"Adipokines, ageing, and vascular damage","authors":"C. F. Sánchez Ferrer, I. Valencia Fernández, C. Peiró Vallejo","doi":"10.32440/ar.2022.139.03.rev01","DOIUrl":"https://doi.org/10.32440/ar.2022.139.03.rev01","url":null,"abstract":"The main physiologic function of adipokines on the energy metabolism and the cardiovascular homeostasis, among others, are well known. In the last years, our laboratory is providing increasing evidence about the possible role of adipokines as mediators of vascular damage, by inducing different pro-inflammatory and pro-senescent mechanisms. The secretion of adipokines like visfatin or dipeptidylpeptidase-4 (DPP4) by adipose tissue, particularly by the visceral fat, is enhanced in obese and type 2 diabetic patients. Both adipokines are enzymes metabolically active that can induce the activation of specific receptors, namely type 4 “toll like receptors” (TLR4) for visfatin and “protease activated receptor 2” (PAR2) for DPP4. Stimulation of such receptors is triggering well known pro-inflammatory and pro-senescent mechanisms, like the nuclear transcription factor-κB (NF-κB) or the inflammasome NLRP3 (“nucleotide-binding, leucine-rich-repeat, pyrin domain containing 3”), a cell structure that transforms the immature forms of classic cytokines in their active derivates, interleukin-1β (IL-1β) or interleukin 18 (IL-18). It is worth to note that these classic cytokines are the final effectors for the harmful effects of the adipokines and its blockade can be a very relevant therapeutic approach. In our experiments, the specific antagonism of IL-1 receptors with anakinra prevents the inflammatory and senescent effects evoked by visfatin and DPP4. Moreover, this finding is in agreement with data from other researchers, as well as with the results of the CANTOS clinical trial, which demonstrate a very important cardioprotective cardiovascular effect mediated by the anti-inflammatory effect of the monoclonal antibody canakinumab. On the other hand, we have also provided experimental evidence about possible vasculopotective adipokines, such angiotensin-(1-7), which is able to induce, through activation of Mas receptors, the expression of klotho protein and the activation of antioxidant pathways, like the well known Nrf2-HO-1 (“nuclear factor erythroid-2 y hemoygenase-1”).","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69672025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32440/ar.2022.139.03.rev05
R. Navarro-Suay, J. A. Rodríguez-Montes, F. Gilsanz Rodríguez, J. Sanz Serrulla, F. Vázquez de Quevedo, A. Campos Muñoz
Year 2021 marks a century since the Annual Disaster, an evento that ocurred in the Spanish Protectorate of Morocco bewtween July 21 and August 9 of that year, one of the most tragic defeats suffered by the Spanish Army through its history. Between September 8 and October 13, 1925, the SPanish Navy and Army in collaboration with French tropos, successfully landed at Alhucemas Bay, occupying and pacifying the área, which contributed to end the Rif War. The circumstances that occurred in this war period gave rise to important medical and health advances. In just a few years, wounded transport was improved emplying ambulances, hospital ships and medical planes; filed hospital were deployed in the Forefront to shorten the time from the battle field to the first treatment facility; surgical procedures were performed with innovative techniques at that time, epidural anesthesia was discovered and finally, thanks to an agile health system adapted to the área, sicks and wounded soldiers were recovered in hospital located in the Iberian Peninsula. Military and civil doctors, nurses from Spanish Red Cross, nuns, friars, health workers, soldiers, volunteers…applied their knowledge, tenacity and work for the sake of caring for patient, without any doubt, the ultimate goal for any health professional.
{"title":"Health memories from Annual to Alhucemas: Medical advances between 1921 and 1925","authors":"R. Navarro-Suay, J. A. Rodríguez-Montes, F. Gilsanz Rodríguez, J. Sanz Serrulla, F. Vázquez de Quevedo, A. Campos Muñoz","doi":"10.32440/ar.2022.139.03.rev05","DOIUrl":"https://doi.org/10.32440/ar.2022.139.03.rev05","url":null,"abstract":"Year 2021 marks a century since the Annual Disaster, an evento that ocurred in the Spanish Protectorate of Morocco bewtween July 21 and August 9 of that year, one of the most tragic defeats suffered by the Spanish Army through its history. Between September 8 and October 13, 1925, the SPanish Navy and Army in collaboration with French tropos, successfully landed at Alhucemas Bay, occupying and pacifying the área, which contributed to end the Rif War. The circumstances that occurred in this war period gave rise to important medical and health advances. In just a few years, wounded transport was improved emplying ambulances, hospital ships and medical planes; filed hospital were deployed in the Forefront to shorten the time from the battle field to the first treatment facility; surgical procedures were performed with innovative techniques at that time, epidural anesthesia was discovered and finally, thanks to an agile health system adapted to the área, sicks and wounded soldiers were recovered in hospital located in the Iberian Peninsula. Military and civil doctors, nurses from Spanish Red Cross, nuns, friars, health workers, soldiers, volunteers…applied their knowledge, tenacity and work for the sake of caring for patient, without any doubt, the ultimate goal for any health professional.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69672175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32440/ar.2023.140.02.op01
M. Díaz-Rubio García
{"title":"Are the teachers disappearing?","authors":"M. Díaz-Rubio García","doi":"10.32440/ar.2023.140.02.op01","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.op01","url":null,"abstract":"","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135599689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32440/ar.2022.139.03.ed01
P. Crespo Ferrer
{"title":"Twenty years of biomedical network research","authors":"P. Crespo Ferrer","doi":"10.32440/ar.2022.139.03.ed01","DOIUrl":"https://doi.org/10.32440/ar.2022.139.03.ed01","url":null,"abstract":"","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69672013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32440/ar.2022.139.03.rev02
J. A. Moreno Bravo
The brain is the most complex organ we have, and it is the one that defines us as human beings. It is the basis of intelligence, of our thoughts and memories. In addition, it interprets the world through the senses, initiates movement and controls our behaviors. The correct functioning of this organ is based on the correct establishment of connectivity patterns between the millions of neurons which enable a precise and efficient communication between them. These neural networks emerge during embryonic and postnatal development. The formation of proper neuronal circuitry relies on diverse and very precisely orchestrated events controlled by specific molecular mechanisms. Therefore, failures in these early events will lead to brain pathologies and complex disorders. In the last decades, remarkable progress has been made in identifying and in understanding the mechanisms of action of the molecular that direct axon and neural circuitry development. However, their role in vivo in many aspects of neural circuit formation remains largely unknown, particularly how the impairment of this initial connectivity derives in complex neurodevelopmental pathologies. Here, I highlight part of my contributions and recent advances that shed light on the complexity of mechanisms that regulate axon guidance and the wiring of the bilateral circuits of the central nervous system. Furthermore, I discuss about how understanding the development of bilateral circuits of the cerebellum is essential to understand the emergence of diverse neurodevelopmental pathologies.
{"title":"Development of bilateral circuits of the nervous system: From molecular mechanisms to the cerebellum and its implication in neurodevelopmental disorders","authors":"J. A. Moreno Bravo","doi":"10.32440/ar.2022.139.03.rev02","DOIUrl":"https://doi.org/10.32440/ar.2022.139.03.rev02","url":null,"abstract":"The brain is the most complex organ we have, and it is the one that defines us as human beings. It is the basis of intelligence, of our thoughts and memories. In addition, it interprets the world through the senses, initiates movement and controls our behaviors. The correct functioning of this organ is based on the correct establishment of connectivity patterns between the millions of neurons which enable a precise and efficient communication between them. These neural networks emerge during embryonic and postnatal development. The formation of proper neuronal circuitry relies on diverse and very precisely orchestrated events controlled by specific molecular mechanisms. Therefore, failures in these early events will lead to brain pathologies and complex disorders. In the last decades, remarkable progress has been made in identifying and in understanding the mechanisms of action of the molecular that direct axon and neural circuitry development. However, their role in vivo in many aspects of neural circuit formation remains largely unknown, particularly how the impairment of this initial connectivity derives in complex neurodevelopmental pathologies. Here, I highlight part of my contributions and recent advances that shed light on the complexity of mechanisms that regulate axon guidance and the wiring of the bilateral circuits of the central nervous system. Furthermore, I discuss about how understanding the development of bilateral circuits of the cerebellum is essential to understand the emergence of diverse neurodevelopmental pathologies.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69672063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32440/ar.2023.140.02.rev03
A. Ortiz, M.D. Sánchez-Niño
There are 850 million people in the world with chronic kidney disease (CKD), one of the fastest growing global causes of death that was the most important risk factor for fatal COVID-19. The remaining life expectancy of people with CKD on renal replacement therapy is up to 40 years less than in the general population. While healthy lifestyles and control of risk factors such as diabetes and hypertension can help protect against the development of CKD, the global burden of CKD continues to increase. Despite these poor results, recent clinical trials indicate that the concept of primary prevention of CKD must be developed. In post-hoc analyses of at least two clinical trials, SGLT2 inhibitors prevented the development of CKD in people without prior CKD but at high risk for CKD. We propose a working definition of primary prevention of CKD with the aim of preserving renal health, which should include the target population (who), the moment (when) and the intervention (what).
{"title":"Primary prevention of chronic kidney disease","authors":"A. Ortiz, M.D. Sánchez-Niño","doi":"10.32440/ar.2023.140.02.rev03","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.rev03","url":null,"abstract":"There are 850 million people in the world with chronic kidney disease (CKD), one of the fastest growing global causes of death that was the most important risk factor for fatal COVID-19. The remaining life expectancy of people with CKD on renal replacement therapy is up to 40 years less than in the general population. While healthy lifestyles and control of risk factors such as diabetes and hypertension can help protect against the development of CKD, the global burden of CKD continues to increase. Despite these poor results, recent clinical trials indicate that the concept of primary prevention of CKD must be developed. In post-hoc analyses of at least two clinical trials, SGLT2 inhibitors prevented the development of CKD in people without prior CKD but at high risk for CKD. We propose a working definition of primary prevention of CKD with the aim of preserving renal health, which should include the target population (who), the moment (when) and the intervention (what).","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135599950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.32440/ar.2022.139.03.rev06
M. Molina-García, C. Arango
Introduction: There is great variability in the cognitive performance profile, clinical presentation, course of symptoms, and subsequent functioning in individuals with a first episode of psychosis (FEP). Premorbid IQ (pIQ) and age of onset are two important prognostic factors relevant to clinical practice and broadly explored in psychosis research (1,2) that could help to explain heterogeneity in cognitive performance after FEP. Methods: The present prospective longitudinal (two-year) observational study examines the neurocognitive performance profiles of 255 individuals with FEP and 326 controls. Using ANOVA, we compared four FEP subgroups according to the following criteria: age of onset before or after 18 years old, and pIQ below or above 85. We examined cognitive changes in the subgroups with pair-wise comparisons, two-way mixed ANOVA, and repeated measures ANOVA. General objective: to characterize the neuropsychological profiles of the four subsets of individuals with a FEP defined by age of onset of psychosis (<18 or ≥ 18) and p-IQ (low or average) and to compare these subgroups’ neuropsychological performance, at baseline and at two-year follow-up. Results: The subgroups with early-onset and adult-onset low pIQ showed cognitive deficits more than 1 SD below the control mean and significantly different from early- and adult-onset average pIQ subsets at both the baseline evaluation and the two-year follow-up. These deficits were in attention and processing speed (p <0.001), working memory (p <0.001), verbal learning and memory (p <0.001), executive function (p <0.001), and global cognition (p <0.001). Cognitive performance in the early-onset average pIQ subgroup did not differ from that of the adults with average pIQ, and the former subgroup showed improved scores over time. Discussion: Our results suggest that the presentation of psychotic symptoms in patients with a lower than average pIQ is associated with a globally impaired profile. Estimating pIQ in the early stages of the disorder can help identify individuals who require early personalized neurocognitive intervention.
{"title":"Cognitive performance in individuals with a first psychotic episode according to age at onset of psychotic symptoms and premorbid intelligence quotient","authors":"M. Molina-García, C. Arango","doi":"10.32440/ar.2022.139.03.rev06","DOIUrl":"https://doi.org/10.32440/ar.2022.139.03.rev06","url":null,"abstract":"Introduction: There is great variability in the cognitive performance profile, clinical presentation, course of symptoms, and subsequent functioning in individuals with a first episode of psychosis (FEP). Premorbid IQ (pIQ) and age of onset are two important prognostic factors relevant to clinical practice and broadly explored in psychosis research (1,2) that could help to explain heterogeneity in cognitive performance after FEP. Methods: The present prospective longitudinal (two-year) observational study examines the neurocognitive performance profiles of 255 individuals with FEP and 326 controls. Using ANOVA, we compared four FEP subgroups according to the following criteria: age of onset before or after 18 years old, and pIQ below or above 85. We examined cognitive changes in the subgroups with pair-wise comparisons, two-way mixed ANOVA, and repeated measures ANOVA. General objective: to characterize the neuropsychological profiles of the four subsets of individuals with a FEP defined by age of onset of psychosis (<18 or ≥ 18) and p-IQ (low or average) and to compare these subgroups’ neuropsychological performance, at baseline and at two-year follow-up. Results: The subgroups with early-onset and adult-onset low pIQ showed cognitive deficits more than 1 SD below the control mean and significantly different from early- and adult-onset average pIQ subsets at both the baseline evaluation and the two-year follow-up. These deficits were in attention and processing speed (p <0.001), working memory (p <0.001), verbal learning and memory (p <0.001), executive function (p <0.001), and global cognition (p <0.001). Cognitive performance in the early-onset average pIQ subgroup did not differ from that of the adults with average pIQ, and the former subgroup showed improved scores over time. Discussion: Our results suggest that the presentation of psychotic symptoms in patients with a lower than average pIQ is associated with a globally impaired profile. Estimating pIQ in the early stages of the disorder can help identify individuals who require early personalized neurocognitive intervention.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69672187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：