Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes.

INTRODUCTION AND OBJECTIVES: Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. METHODS: We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. RESULTS: Seven hundred twenty-four kidney transplants were included, 12% ​​were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. CONCLUSIONS: The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.

[Spinal cord injury associated with spontaneous spinal epidural hematoma]. / Lesión medular asociada a hematoma epidural espinal espontáneo.

INTRODUCTION: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. MATERIAL AND METHODS: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). RESULTS: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. CONCLUSION: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.

Economic impact of the new oral treatments for multiple sclerosis. / Impacto económico de las nuevas terapias orales en esclerosis múltiple.

INTRODUCTION: Multiple sclerosis (MS) is a chronic disease affecting the central nervous system and is characterised by inflammation, demyelination, gliosis, and axonal damage. The introduction of dimethyl fumarate and teriflunomide has led to an increase in the number of alternative first-line therapies for MS. The objective of this study was to evaluate the economic impact of the incorporation of new oral therapies at the reference unit (CSUR) at Hospital Universitario Puerta de Hierro Majadahonda. MATERIALS AND METHODS: We performed a retrospective observational study including patients diagnosed with MS, who underwent treatment with disease-modifying drugs in 2015 and were followed up for a minimum mean time of one year. Data were collected from patients' electronic clinical histories and the pharmacy service's programme for dispensing drugs to outpatients. RESULTS: Evaluating the cost of changing 125 patients' treatment from other drugs to dimethyl fumarate and teriflunomide, and comparing this with the cost that would have resulted from maintaining their previous treatment, demonstrated a total saving of €169,107.31 over the study period. CONCLUSIONS: In addition to contributing new therapeutic alternatives, dimethyl fumarate and teriflunomide produced an economic saving in MS treatment at our hospital.

Major As species, lipid peroxidation and protein carbonylation in rice plants exposed to increasing As(V) concentrations.

Arsenic (As) uptake by plants is mainly carried out as arsenate (As(V)), whose chemical analogy with phosphate is largely responsible for its elevated toxicity. Arsenate is known to stimulate reactive oxygen species (ROS) formation in plants that provoke oxidative stress. This manuscript reports the results of a hydroponics study using rice (Oryza sativa L.) seedlings as a test plant, where the effects of increasing arsenate concentrations (0-10 mg L-1) on both lipid and protein oxidation, as well as As accumulation and speciation in plant roots and shoots were examined. Plant yield was negatively affected by increasing As concentration. Accumulation in plant roots was higher than in shoots at low arsenate doses (0.5-2.5 mg L-1), while root to shoot transport was drastically enhanced at the highest doses (5 and 10 mg L-1). Moreover, As(V) was the dominating species in the shoots and As(III) in the roots. Rice leaves in the 10 mg As L-1 treatment showed the highest lipid peroxidation damage (malondialdehyde concentration), whilst protein oxidation was not remarkably influenced by As dose. Lipid peroxidation seems to be therefore conditioned by As accumulation in rice plants, particularly by the presence of high As(V) concentrations in the aerial part of the plants as a consequence of unregulated translocation from roots to shoots above a threshold concentration (1.25-2.5 mg L-1) in the growing media. These results provide relevant information regarding As(V) toxic concentrations for rice plants, highlight the importance of major As species analysis in plant tissues regarding As toxicity and contribute to better understand plants response to elevated As concentrations in the growing media.

Combination of soil organic and inorganic amendments helps plants overcome trace element induced oxidative stress and allows phytostabilisation.

Trace element (TE)-contaminated soils require the improvement of their physico-chemical properties in order to allow their restoration through phytostabilization technologies. This study aimed to determine the usefulness of oxidative stress related parameters to validate the suitability of two different combinations of organic (solid fraction of pig slurry) and inorganic (paper mill sludge or a commercial red mud derivative) amendments for the phytostabilization of an acidic (4.2) TE-contaminated mine soil from SE Spain. Two wild species (Silybum marianum and Piptatherum miliaceum) were greenhouse cultivated and the development of the plants, their ionome, and oxidative stress related parameters were determined. Both amendment combinations increased significantly soil pH (to 5-6) and soil/pore water total organic C and total N concentrations, allowing an adequate plant growth and development (plants did not grow in untreated soils). The combination of amendments significantly reduced metal availability and showed to be effective (specially the one including the red mud derivative) in limiting shoot TE concentrations, which were all within common ranges (exclusion based tolerance of these species). Both protein carbonylation and lipid peroxidation were significantly higher in S. marianum plants from phytostabilized soils than in those from non-contaminated soils, which confirms the oxidative stress these plants suffer despite their satisfactory growth in the treated soils. P. miliaceum plants showed no differences between phytostabilized and non-contaminated soils. Therefore, the combination of amendments and TE-tolerant autochthonous species would be a suitable option for the phytostabilisation of soils contaminated by mining activities, reducing TE solubility and allowing an adequate plant growth.

[Medication reconciliation at admission and discharge. A consolidated experience]. / Conciliación de la medicación al ingreso y alta hospitalaria. Una experiencia consolidada.

UNLABELLED: Medication reconciliation is currently one of the main strategies to reduce medication errors related to transitional care. OBJECTIVE: To describe a method that would ensure continuity of patient care as regards drug therapy from admission to discharge. METHODS: A description is presented on the methodology implemented in a tertiary hospital and the main results of medication reconciliation at admission and discharge of patients older than 75 years in the Trauma Unit during 2014. RESULTS: The phases of the methodology were: 1. Obtain medication history (at least two sources of information); 2. Analysis of discrepancies and validation of medication on admission: A checklist was made to standardise the process, 3. Report on the pharmacotherapeutic profile: a form was designed in electronic medical records, and 4. Medication reconciliation at discharge and patient information: presenting the dosing schedule and recommendations to the patient. The medication of 318 patients admitted to Trauma was reconciled (294 at admission and discharge) by applying this methodology during the study period. There was at least one medication reconciliation error in 35% of cases. The mean error per patient reconciled was 0.69. Written discharge information was given to 74.1% of patients. CONCLUSIONS: This methodology has allowed a workflow to be established that facilitates coordination between healthcare providers, in order to reduce medication errors and to respond to one of the main problems of continuity of care.

[Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study]. / Fenómenos de despolarización cortical propagada en los pacientes con lesiones cerebrales traumáticas e isquémicas. Resultados de un estudio piloto.

OBJECTIVES: To determine the frequency and duration of cortical spreading depolarization (CSD) and CSD-like episodes in patients with traumatic brain injury (TBI) and malignant middle cerebral artery infarction (MMCAI) requiring craniotomy. DESIGN: A descriptive observational study was carried out during 19 months. SETTING: Neurocritical patients. PATIENTS: Sixteen patients were included: 9 with MMCAI and 7 with moderate or severe TBI, requiring surgical treatment. INTERVENTIONS: A 6-electrode subdural electrocorticographic (ECoG) strip was placed onto the perilesional cortex. MAIN VARIABLES OF INTEREST: An analysis was made of the time profile and the number and duration of CSD and CSD-like episodes recorded from the ECoGs. RESULTS: Of the 16 patients enrolled, 9 presented episodes of CSD or CSD-like phenomena, of highly variable frequency and duration. CONCLUSIONS: Episodes of CSD and CSD-like phenomena are frequently detected in the ischemic penumbra and/or traumatic cortical regions of patients with MMCAI who require decompressive craniectomy or of patients with contusional TBI.

[Conservative management of splenic lesions: experience in 136 patients with blunt splenic injury]. / Manejo conservador de las lesiones esplénicas: experiencia en 136 pacientes con traumatismo esplénico cerrado.

OBJECTIVE: To evaluate the usefulness of imaging tests in selecting the treatment for patients with blunt splenic trauma. To relate the grade of splenic lesion with the treatment. To describe the benefits of embolization in splenic trauma. MATERIAL AND METHODS: We retrospectively studied 136 splenic lesions. We analyzed the main mechanisms of injury, the imaging findings at focused assessment with sonography for trauma (FAST US) and CT, the spectrum of lesions, the therapeutic management, and the outcome. RESULTS: The mean age of patients was 34.81 years and the most common mechanism of injury was traffic accidents. Signs of hemodynamic instability were observed in 54 (39.70%) patients; the remaining 82 (60.30%) patients remained stable or responded to resuscitation. FAST US was the initial imaging technique and the most commonly used technique in unstable patients, whereas CT was the most commonly used technique in stable patients. Surgical treatment was used in 79.99% of the high grade lesions and conservative treatment was used in 55.69% of the low grade lesions. Angiography and embolization were used to manage 8.54% of the stable patients. CONCLUSION: FAST US is decisive in choosing the surgical treatment in unstable patients. High grade lesions are associated with a higher frequency of surgery and lower grade lesions are associated with a higher frequency of nonsurgical management. Angiography with embolization is efficacious in the treatment of vascular lesions in stable patients.

[Radiological criteria for laryngeal tumors and cervical metastases]. / Criterios radiológicos en los tumores de laringe y sus metástasis cervicales.

Radiological techniques are important for studying the extension of laryngeal tumors. CT and MRI yield high-quality images with few artifacts that can be studied quickly. We reviewed the fundamental criteria for radiologic study of these tumors by ear, nose, and throat specialists on the basis of our personal experience and the literature.

Prevalence of anti-SSA (Ro) antibodies in a Mexican population of patients with various systemic rheumatic diseases.

The prevalence of anti-SSA (Ro) antibodies was investigated in 126 patients with various systemic rheumatic diseases and in 77 normal subjects. Also, we studied the relationship between these autoantibodies and the clinical features of our patients with SLE. Anti-SSA (Ro) occurred with a frequency of 14% in SLE but was not associated with specific clinical features of the disease. In Sjögren's syndrome the frequency was 25%, in rheumatoid arthritis 20.3% and in mixed connective tissue disease 15.4%. Finally, in the control group anti-SSA (Ro) antibodies were not present. We believe that the presence of this antibody is not specific to any rheumatic disease in our Mexican population, and should not be used as a "marker antibody" of some clinical features in patients with SLE.