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1.
SAGE Open Nurs ; 10: 23779608241260862, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38854696

RESUMO

Introduction: Nurses, comprising the largest profession in healthcare, play a significant role in the identification and management of mental health disorders in hospitals. Objectives: The study assessed the knowledge and attitudes of non-psychiatric nurses and their encounters with depressive patients throughout their careers. Methods: This was a cross-sectional descriptive study with 400 non-psychiatric nurses from different hospitals in the Kurdistan Region of Iraq during October and November 2022. The independent Student's t-test, one-way analysis of variance, and binary logistic regression were used to assess possible factors associated with knowledge and attitude toward depression. Results: In this study, 400 non-psychiatric nurses were examined, revealing a mean age of 31.57 ± 8.59 years. Their mean scores for knowledge and attitude toward depression were 5.41 out of a maximum of 11 (standard deviation 1.15) and 5.15 out of 18 (standard deviation 1.83), respectively. Notably, differences in mean knowledge scores were observed concerning participant marital status (P = .044), while disparities in mean attitude scores are related to participant gender (P = .010). Upon binary logistic regression analysis, none of the independent variables exhibited an association with good knowledge. Nevertheless, gender emerged as a significant factor influencing attitude toward depression (odds ratio: 0.51; 95% confidence interval: 0.30-0.86; P = .012). Subsequently, in the multivariate binary logistic regression analysis, gender sustained significance (adjusted odds ratio: 0.573; 95% confidence interval: 0.348-0.942; P = .028) as the key variable impacting attitudes toward depression among non-psychiatric nurses. Conclusion: Based on the results of this study, nurses have insufficient awareness and management skills for depression. It has been experienced and reported that nurses lack knowledge and an attitude toward depression management. The study highlights a significant gap in nurses' skills for managing depression, urging the immediate improvement of training programs. Customizing these programs to enhance nurses' abilities in identifying and managing depression is crucial.

2.
World J Transplant ; 14(1): 89255, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38576755

RESUMO

BACKGROUND: Detection of early chronic changes in the kidney allograft is important for timely intervention and long-term survival. Conventional and novel ultrasound-based investigations are being increasingly used for this purpose with variable results. AIM: To compare the diagnostic performance of resistive index (RI) and shear wave elastography (SWE) in the diagnosis of chronic fibrosing changes of kidney allograft with histopathological results. METHODS: This is a cross-sectional and comparative study. A total of 154 kidney transplant recipients were included in this study, which was conducted at the Departments of Transplantation and Radiology, Sindh Institute of Urology and Transplan tation, Karachi, Pakistan, from August 2022 to February 2023. All consecutive patients with increased serum creatinine levels and reduced glomerular filtration rate (GFR) after three months of transplantation were enrolled in this study. SWE and RI were performed and the findings of these were evaluated against the kidney allograft biopsy results to determine their diagnostic utility. RESULTS: The mean age of all patients was 35.32 ± 11.08 years. Among these, 126 (81.8%) were males and 28 (18.2%) were females. The mean serum creatinine in all patients was 2.86 ± 1.68 mg/dL and the mean estimated GFR was 35.38 ± 17.27 mL/min/1.73 m2. Kidney allograft biopsy results showed chronic changes in 55 (37.66%) biopsies. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SWE for the detection of chronic allograft damage were 93.10%, 96.87%%, 94.73%, and 95.87%, respectively, and the diagnostic accuracy was 95.45%. For RI, the sensitivity, specificity, PPV, and NPV were 76.92%, 83.33%, 70.17%, and 87.62%, respectively, and the diagnostic accuracy was 81.16%. CONCLUSION: The results from this study show that SWE is more sensitive and specific as compared to RI in the evaluation of chronic allograft damage. It can be of great help during the routine follow-up of kidney transplant recipients for screening and early detection of chronic changes and selecting patients for allograft biopsy.

4.
Exp Clin Transplant ; 21(7): 562-567, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37584536

RESUMO

OBJECTIVES: Gram-negative rods are the most common cause of bloodstream infection in renal transplant recipients. Acute rejection, urologic abnormalities, and ureteral stents are risk factors. Graft dysfunction is independently associated with gram-negative rod bloodstream infection. Our aim is to investigate the incidence, risk factors, and outcome among living donor renal transplant recipients from Pakistan. MATERIALS AND METHODS: In this case-control study, we reviewed the medical records until June 2021 of renal transplant recipients seen from 2015 to 2019 for gram negative bacteremia. For every case, controls were matched by age, date of transplant, and sex. Demographics, risk factors, graft function, and mortality were compared. Clinical features, immunosuppression, source of blood stream infection, and microbiology were noted in cases. RESULTS: Of 1677 renal transplant recipients, 44 developed gram negative bacteremia. The incidence was 5.9 per 1000 person-years. Median time since transplant was 5 months. The most common source was urinary tract infection. On univariate analysis, antithymocyte globulin, urinary tract infection, and recurrent urinary tract infections were associated with gram negative bacteremia. On multivariate analysis, urinary tract infection (adjusted odds ratio = 3.46; 95% CI, 1.27-9.37) and recurrent urinary tract infections (adjusted odds ratio = 4.03; 95% CI, 1.15-14.15) were significant risk factors. We found no difference in 30-day mortality and estimated glomerular filtration rate on last follow-up between cases and controls. Kaplan-Meier survival curves showed significant differences in graft survival in patients with gram negative bacteremia. Escherichia coli was the most common organism, with 75% ceftriaxone and 13% imipenem resistance. CONCLUSIONS: The most significant risk factor for gram negative rod bloodstream infection was recurrent urinary tract infections. Timely treatment and prevention of recurrent urinary tract infections areimperative for prevention of gram negative bacteremia.


Assuntos
Bacteriemia , Transplante de Rim , Sepse , Infecções Urinárias , Humanos , Transplante de Rim/efeitos adversos , Estudos de Casos e Controles , Paquistão/epidemiologia , Doadores Vivos , Sepse/complicações , Fatores de Risco , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Bactérias Gram-Negativas , Estudos Retrospectivos , Transplantados
5.
Clin Transplant ; 37(5): e14935, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36799009

RESUMO

INTRODUCTION/AIM: The Luminex assay, where beads are coated with a single HLA antigen, has been shown to detect HLA antibodies with more sensitivity and specificity as compared to microlymphocytotoxicity (CDC) assay and flow cross match (FCXM). We report the impact of low Mean Flourescence intensity (MFI) pre-transplant DSA by Luminex with negative CDC and FCXM on acute rejection, graft function, and survival. METHODS: In this retrospective study between January 2015 to December 2021, 45 recipients had pre-transplant anti-HLA donor-specific antibodies (DSAs) detected by Luminex. Two control groups of 45 patients each matched for age and gender, first with non-DSA HLA antibodies and second with no antibodies by Luminex were selected to compare outcomes with DSA group. RESULTS: In the DSA group of 45, 22 (48.8%) had class I (MFI mean 4043 ± 1909, range: 1096-7111), 20 (44.4%) class II (MFI mean 3601 ± 2310, range: 1031-9259), and 3 (6.6%) both class I (MFI mean 4746 ± 1922) and class II (MFI mean 3940 ± 2312) antibodies. Acute rejection episodes were reported in 15.6%, DSA group, 17.8% in non-DSA, and 24.4% in no antibody group (p = .538). Death censored graft survival at 1 and 5 years was 98% and 93% in DSA group, 100% and 95% in non-DSA and 93% and 85% in the no antibody group (p = .254). CONCLUSIONS: Patients with low MFI DSA pre-transplant, with a negative CDC and FCXM under ATG induction, have similar graft outcomes at 1 and 5 years when compared to non-DSA and no antibody groups.


Assuntos
Transplante de Rim , Humanos , Transplante de Rim/efeitos adversos , Estudos Retrospectivos , Anticorpos , Doadores de Tecidos , Transplantados , Soro Antilinfocitário , Sobrevivência de Enxerto , Rejeição de Enxerto/etiologia , Antígenos HLA , Teste de Histocompatibilidade , Isoanticorpos
7.
Hum Mutat ; 43(12): 1757-1779, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36259736

RESUMO

Primary hyperoxalurias (PH) are a group of rare heterogeneous disorders characterized by deficiencies in glyoxylate metabolism. To date, three genes have been identified to cause three types of PH (I, II, and III). The HOGA1 gene caused type III in around 10% of the PH cases. Disease-associated pathogenic variants have been reported from several populations and a comprehensive spectrum of these mutations and genotype-phenotype correlation has never been presented. In this study, we describe new cases of the HOGA1 gene pathogenic variants identified in our population. We report the first case of ESKD with successful kidney transplantation with 5 years of follow-up. Furthermore, a comprehensive overview of PH type III associated HOGA1 gene variants was carried out. Compiling the data from the literature, we reviewed 57 distinct HOGA1 gene pathogenic variants in 175 patients worldwide. The majority of reported variants are missense variants that predicted a loss of function mechanism as the underlying pathology. There has been evidence of the presence of founder mutations in several populations like Europeans, Ashkenazi Jews, Arab, and Chinese populations. No significant genotype-phenotype correlation was identified concerning the ages of onset of the disease and biochemical and metabolic parameters. Nephrocalcinosis was rare in patients with disease-associated variants. Most of the patients were presented with urolithiasis early in life; only five cases reported disease progression after the second decade of life. The establishment of impairment of renal function in 8% of all the reported cases makes this type a relatively severe form of primary hyperoxaluria, not a benign etiology as suggested previously.


Assuntos
Hiperoxalúria Primária , Oxo-Ácido-Liases , Humanos , Hiperoxalúria Primária/diagnóstico , Hiperoxalúria Primária/genética , Hiperoxalúria Primária/metabolismo , Mutação , Oxo-Ácido-Liases/genética , Oxo-Ácido-Liases/metabolismo
8.
Transpl Infect Dis ; 24(1): e13769, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34837443

RESUMO

INTRODUCTION: Whipple's disease (WD) is a rare multi-systemic disorder caused by actinomycetes, Tropheryma whipplei. It presents with weight loss, arthralgia, and diarrhea and may involve the heart, lung, or central nervous system. The use of immunosuppressive medications or underlying immunodeficiency states are associated risk factors. Six cases in transplant recipients have so far been reported worldwide. We describe our experience of WD in renal transplant recipients. METHODS: All renal transplant recipients who presented with diarrhea and were diagnosed with WD on duodenal biopsy from 2016 till 2019 were included. Their data regarding duration since transplantation, immunosuppressive therapy, symptoms, treatment response, and outcome were analyzed. RESULTS: Seven cases were diagnosed as WD based on duodenal biopsy, with histological findings of periodic acid Schiff-positive granules in macrophages. All were males. The most common symptoms were chronic diarrhea and weight loss. Average time since transplantation was 4.8 years. All patients were on azathioprine and everolimus. Clinical relapse or adverse effects was seen in five of seven patients treated with doxycycline and hydroxychloroquine which was discontinued. Trimethoprim/sulfamethoxazole for 1 year, with initial intravenous ceftriaxone in two patients, resulted in complete remission in all patients at a follow-up period averaging 1.5 years. CONCLUSION: WDs in renal transplant recipients most commonly presents as an intestinal disorder. Treatment of 1 year with trimethoprim/sulfamethoxazole has good response with complete remission at 1.5 years of follow up.


Assuntos
Transplante de Rim , Doença de Whipple , Antibacterianos/uso terapêutico , Humanos , Transplante de Rim/efeitos adversos , Masculino , Paquistão , Transplantados , Tropheryma , Doença de Whipple/diagnóstico , Doença de Whipple/tratamento farmacológico
9.
Transpl Infect Dis ; 23(5): e13709, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34331355

RESUMO

INTRODUCTION: Renal transplant recipients are at high risk of tuberculosis (TB). We started isoniazid (INH) prophylaxis of 1 year duration in all renal transplant recipients from April 2009. Our aim was to assess the incidence of TB on INH prophylaxis and its tolerability. METHODS: This was a retrospective observational study. The files of renal transplant recipients from April 2009 to December 2011 were reviewed till June 2015. We noted the incidence of TB, INH tolerability, and development of resistance. We compared the incidence of TB with the historical controls who never received the prophylaxis. RESULTS: A total of 910 patients were reviewed and followed up for 4.8 years. INH prophylaxis was completed by 825 (91%) patients. A total of 46 patients (5%) developed active TB as compared to 15% in the historical controls. The median time of TB diagnosis from transplantation was 2.8 years. In the first-year post transplant, out of total TB cases, 52% occurred in the historical controls whereas 13% occurred in study cohort. Around 67% had TB >2 years after transplant. Overall 1.43% had hepatotoxicity. There was a significant reduction in TB among those who completed prophylaxis to those who did not (p < 0.001). Of 14 cultures, one isolate was INH resistant (7%). CONCLUSION: INH prophylaxis was well tolerated. The incidence of TB decreased in the first 2 years. However there was a surge in TB cases 1 year after stopping INH therapy. We should consider prolonging the duration of INH prophylaxis in high TB burden countries in renal transplant recipients.


Assuntos
Transplante de Rim , Tuberculose , Antituberculosos/uso terapêutico , Humanos , Isoniazida/uso terapêutico , Transplante de Rim/efeitos adversos , Estudos Retrospectivos , Transplantados , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
11.
Transpl Infect Dis ; 23(4): e13659, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34057810

RESUMO

Multidrug-resistant tuberculosis (MDR-TB) is caused by Mycobacterium tuberculosis that is resistant to isoniazid and rifampicin (Rif). The use of immunosuppressive drugs in solid organ transplant recipients can increase the risk of TB. Management of MDR-TB is quite challenging in the general population with poor compliance owing to lengthy treatment duration and drug toxicities. New drugs as well as shorter regimen have been used to increase the likelihood of adherence. The experience of treating MDR-TB in the transplant recipients is limited. New drugs like bedaquiline, linezolid, clofazimine, and delamanid have rarely been used in transplant recipients. To the best of our knowledge, only 14 cases of MDR-TB in transplant population have been reported in the literature and no case from Pakistan, a high TB burden country. We are reporting our experience of treating 4 renal transplant recipients. We used new drug regimen and found many side effects. Treatment outcome was successful with complete cure in 3 of our patients, however one died of severe drug toxicity. The most worrisome drug interaction was between azathioprine and linezolid, with life-threatening thrombocytopenia. There was no graft dysfunction noted at the end of the therapy. The management of MDR-TB in transplant recipients is challenging; excellent coordination between transplant team and Infectious Diseases Physician for close monitoring and follow-up is needed.


Assuntos
Transplante de Rim , Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Antituberculosos/efeitos adversos , Humanos , Transplante de Rim/efeitos adversos , Transplantados , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia
12.
J Pak Med Assoc ; 70(11): 2043-2045, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33341856

RESUMO

Furunculosis in renal transplant recipients may be associated with increased morbidity. With the aim to study the presentation, morbidity, and risk factors for furunculosis, this observational study was conducted at the Sindh Institute of Urology and Transplantation, between January to December 2014. All patients with furuncles or abscesses were included. The clinical presentation and risk factors were recorded. A morbidity scale of 0 and 1 was made on the basis of hospital stay for ≥7 days, bacteraemia, large abscesses and repeated furunculosis. Out of 38 patients, 29 (76%) had large abscesses and 9 (24%) had furuncles, with gluteal region being the most common site. Twelve (32%) had severe disease; 29 (76%) had morbidity scale of ≥1. High dose immunosuppression was significantly associated with severe disease while repeated furunculosis had significantly more risk factors. Furunculosis is a severe disease with high morbidity in renal transplant recipients and more studies are needed on skin colonisation and preventive strategies.


Assuntos
Furunculose , Transplante de Rim , Urologia , Animais , Furunculose/epidemiologia , Humanos , Transplante de Rim/efeitos adversos , Morbidade , Estudos Retrospectivos
13.
Gastroenterol Hepatol Bed Bench ; 13(2): 141-146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32308935

RESUMO

AIM: we aimed to determine the virological response and safety of Sofosbuvir-based direct-acting antiviral agents (DAAs) in chronic hepatitis C (CHC) patients on long-term hemodialysis (HD). BACKGROUND: With the advent of interferon-free DAAs, the treatment of CHC has been revolutionized. Pakistan is among the countries where novel sofosbuvir (SOF)-free antiviral agents are not available. METHODS: This non-randomized, single-arm, open-label study enrolled all HD patients with chronic HCV infection after informed consent. They were treated with SOF in combination with Ribavirin (RBV) with either interferon (IFN group) or daclatasvir (DAC group), with the virological response assessed according to standard guidelines. Data were analyzed using SPSS version 20.00. RESULTS: Out of 133 patients, the majority (72.9%) were males with the mean age of 31.92 ± 9.88 years. Most patients (50.3%) had HCV genotype (GN) 1, followed by GN 3 in 42.9%, 4 in 1.48% and 2 in 0.7%, while mix GN was documented in 6 (4.4%) patients. Among these, 60 (45.1 %) patients received standard SOF, IFN, and RBV (IFN group) and 73 (54.9 %) received SOF, DAC and RBV (DAC group). End of treatment and sustained virological response at 12 weeks post-treatment were achieved in 133 (100%) and 129 (97 %) patients, respectively. The adverse effects were anemia in 58 (43.6 %) patients and elevated alanine transaminases in 11 (8.1%) patients. CONCLUSION: SOF in combination with either IFN or DAC is an equally efficacious and effective treatment regimen for patients on maintenance HD, especially in resource-poor countries.

14.
J Pak Med Assoc ; 69(4): 584-587, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000868

RESUMO

Highly Human Leukocyte antigen sensitized patients have relatively fewer chances of being transplanted successfully and may remain dialysis dependent for a long time. In the last few years with the development of immunomodulatory therapies and advancements in immunological investigations, the chance s of transplantation in these sensitized patients have improved. Desensitization therapies in these patients include plasma exchange, intravenous immune globulins and immunomodulatory agents such as rituximab and bortezomib. These agents used together in desensitization protocols across the world have shown encouraging results in highly Human Leukocyte Antigen sensitized recipients awaiting renal transplant. We used a desensitization protocol using rituximab followed by bortezomib with concurrent plasma exchange sessions and Intravenous Immune Globulins. Our aim was to assess improvement in renal function and quality of life in these patients after desensitization and renal transplantation. To the best of our knowledge, this is the first account of desensitization prior to renal transplantation from Pakistan.


Assuntos
Bortezomib/uso terapêutico , Dessensibilização Imunológica/métodos , Antígenos HLA/imunologia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Rituximab/uso terapêutico , Adulto , Feminino , Rejeição de Enxerto/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Troca Plasmática/métodos , Cuidados Pré-Operatórios/métodos , Qualidade de Vida
15.
Exp Clin Transplant ; 17(Suppl 1): 198-201, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777554

RESUMO

OBJECTIVES: Direct-acting antiviral agents have recently been recommended in renal transplant recipients. Considering our previous encouraging responses with combined sofosbuvir and ribavirin in renal transplant recipients and the availability of daclatasvir, we aimed to evaluate the effectiveness and safety of sofosbuvir-based direct-acting antiviral agents in our population. MATERIALS AND METHODS: All renal transplant recipients who received sofosbuvir-based direct-acting antivirals from August 2015 to March 2018 were included in our study. Patients were treated with sofosbuvir and ribavirin for 24 weeks or with combined sofosuvir, daclatasvir, and ribavirin for 12 weeks. Patient demographics and baseline laboratory parameters were collected. Rapid virologic response, end of treatment response, and sustained virologic response at 12 weeks were analyzed. Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 20.0, IBM Corporation, Armonk, NY, USA). RESULTS: In our study group of 79 patients, mean age was 36.5 ± 10.2 years and 60 were men (78.5%). Fiftysix patients (70.9%) were treatment naive; of the remaining patients, 20 received interferon before transplant and 3 were treated with sofosbuvir and ribavirin after renal transplant. Genotype 1 was observed in 42 patients (53.2%), whereas mixed genotype (1 and 3) was shown in 10 patients (12.6%). Sixty-two patients (78.5%) received sofosbuvir and ribavirin, and 17 patients (21.5%) received sofosbuvir, daclatasvir, and ribavirin. End of treatment response was achieved in 78 recipients (98.1%). Anemia was observed in 13 patients (16.4%). CONCLUSIONS: Hepatitis C virus was successfully eradicated in renal transplant recipients who received a combination of sofosbuvir plus ribavirin or sofosbuvir, daclatasvir, and ribavirin. These combinations were effective and well tolerated in our study population, even in those with mixed genotype, with no major adverse events.


Assuntos
Antivirais/uso terapêutico , Hepacivirus/efeitos dos fármacos , Hepatite C/tratamento farmacológico , Transplante de Rim , Sofosbuvir/uso terapêutico , Adulto , Antivirais/efeitos adversos , Carbamatos , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/genética , Hepacivirus/patogenicidade , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hepatite C/virologia , Humanos , Imidazóis/uso terapêutico , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Pirrolidinas , Ribavirina/uso terapêutico , Sofosbuvir/efeitos adversos , Resposta Viral Sustentada , Fatores de Tempo , Resultado do Tratamento , Valina/análogos & derivados , Carga Viral
16.
Exp Clin Transplant ; 17(Suppl 1): 212-215, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777557

RESUMO

OBJECTIVES: Gastrointestinal complications are common in kidney transplant patients, with the most frequent being diarrhea (60%). Chronic diarrhea affects the patient's quality of life, causes fatigue and weight loss and malabsorption, increases the number of hospitalizations, increases serum creatinine levels, and causes alterations in immunosuppressive drug levels. Diarrhea is also associated with an increased risk of graft failure and death. In this study, we aimed to determine the frequencies of common infectious organisms causing chronic diarrhea in renal transplant patients. MATERIALS AND METHODS: Our study included 124 renal transplant patients who presented with chronic diarrhea over a 6-month period at the Sindh Institute of Urology and Transplantation Department tertiary care hospital (Karachi, Pakistan). Stool analysis was performed in all transplant recipients. Upper and lower gastrointestinal endoscopy was also performed in patients with chronic diarrhea, and biopsy specimens underwent histopathologic evaluations. RESULTS: Of 124 renal transplant recipients, 29 were female (23.4%) and 95 were male (76.6%). Giardia was the most common organism found (n = 37 patients; 29.8%) followed by Cryptosporidium (n = 36; 29.0%), Entameba histolytica (n = 29; 23.4%), tuberculosis (n = 14; 11.3%), and sprue (n =8; 6.5%). The mean duration since renal transplant was 78.5 ± 63.37 months. Although not statistically significant, the frequency of diarrhea was higher in patients who had transplant procedures ≥ 2 years previously. CONCLUSIONS: Chronic diarrhea is prevalent in renal transplant patients irrespective of age, sex, and duration since transplant. Giardiasis and Cryptosporidium species infections are important causes of chronic diarrhea, but other causative factors need to be further studied, including comorbid conditions and immunosuppressive agents.


Assuntos
Diarreia/epidemiologia , Transplante de Rim/efeitos adversos , Infecções Oportunistas/epidemiologia , Adulto , Doença Crônica , Comorbidade , Estudos Transversais , Diarreia/diagnóstico , Diarreia/imunologia , Fezes/microbiologia , Fezes/parasitologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Paquistão/epidemiologia , Prevalência , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Exp Clin Transplant ; 17(1): 42-46, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29534661

RESUMO

OBJECTIVES: Plasma cell-rich acute rejection is an aggressive form of acute rejection that occurs late after transplant and is usually resistant to standard antirejection therapy. This study reports the safety, efficacy, and outcomes of plasma cell-rich acute rejection after treatment with bortezomib, a proteasome inhibitor, in 10 patients after a first living-related renal transplant. MATERIALS AND METHODS: Plasma cell-rich acute rejection was diagnosed using the 2007 Banff classification. The treatment protocol for plasma cell-rich acute rejection included methylprednisolone (500 mg/kg), 7 sessions of plasmapheresis, antithymocyte globulin (3-5 mg/kg/day for 10 days), rituximab (2 doses at 375 mg/m2), and bortezomib (1 cycle at 1.3 mg/m2). RESULTS: The mean age of recipients and donors was 23.70 ± 11.39 and 37.30 ± 12.82 years, respectively. The mean time to plasma cell-rich acute rejection was 3.1 ± 2.5 years. The mean serum creatinine level at rejection was 4.8 ± 2.7 mg/dL. After treatment, serum creatinine decreased to 3.3 ± 1.8 mg/dL. Serum creatinine levels at 1-year and 2-year follow-up were 3.0 ± 2.3 and 3.3 ± 0.9 mg/dL, respectively. There was 1 graft failure due to recurrence of glomerulonephritis/de novo glomerulonephritis. No significant adverse effects were noted in the patients. Bortezomib successfully reverted plasma cell-rich acute rejection and stabilized graft function, with patients showing 2-year graft survival after rejection of 90%. CONCLUSION: Bortezomib-based treatment was successful in reverting plasma cell-rich acute rejection and stabilizing graft function, with graft survival of 90% at 2 years. Further studies with large cohorts and randomized trials with or without bortezomib will help in better evaluation of its efficacy, safety, and outcomes.


Assuntos
Bortezomib/uso terapêutico , Família , Rejeição de Enxerto/tratamento farmacológico , Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Doadores Vivos , Plasmócitos/efeitos dos fármacos , Inibidores de Proteassoma/uso terapêutico , Doença Aguda , Adolescente , Adulto , Bortezomib/efeitos adversos , Feminino , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/imunologia , Humanos , Imunossupressores/efeitos adversos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Plasmócitos/imunologia , Inibidores de Proteassoma/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Exp Clin Transplant ; 16(6): 656-659, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29292682

RESUMO

OBJECTIVES: The aim of the present study was to evaluate the short- and intermediate-term outcomes of living-related kidney donors in terms of renal function and postnephrectomy complications at a single center in Pakistan. MATERIALS AND METHODS: Our study included healthy donors who underwent unilateral nephroureterectomy for living-related renal transplant procedures at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan) between January 2005 and January 2006. All patients were evaluated for early postoperative complications and renal functions at last follow-up. The mean follow-up duration was 1.7 ± 1.3 years. RESULTS: A total of 256 living-related donors underwent nephroureterectomy during the study period, which included 142 men (55.5%) and 114 women (44.5%). The mean age of donors was 33.7 ± 10.0 years. Most donors were between 21 and 40 years old. Of total donors, most were siblings (n = 143, 55.8%), followed by offspring, parents, and spouses. Left nephrectomy was performed in 206 donors (80.4%) and right in 50 donors (19.5%). There were no deaths during transplant. The mean postoperative hospital stay was 6.37 ± 0.95 days. A total of 38 donors (14.8%) had one or more surgical complication. Hypertension developed in 25 (9.7%) and diabetes mellitus in 9 donors (5%). Creatinine clearance was > 90 mL/min in 96 (41%), 60 to 90 mL/min in 120 (51%), and ≤ 60 mL/min in 18 donors (8%). CONCLUSIONS: Living-related donor nephrectomy remains a valuable source of kidneys for transplant procedures and carries a small risk. With careful donor selection and good surgical management, operative complications can be minimized.


Assuntos
Família , Transplante de Rim/métodos , Doadores Vivos , Nefrectomia , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Creatinina/sangue , Diabetes Mellitus/etiologia , Seleção do Doador , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/etiologia , Rim/fisiologia , Transplante de Rim/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Paquistão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Nephrology (Carlton) ; 23(3): 279-286, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27943514

RESUMO

AIM: Living donor kidney is the main source of donor organs in low to middle income countries. We aimed to develop a living donor risk model that predicts graft and patient survival in an emerging economy. METHODS: We used data from the Sindh Institute of Urology and Transplantation (SIUT) database (n = 2283 recipients and n = 2283 living kidney donors, transplanted between 1993 and 2009) and conducted Cox proportional hazard analyses to develop a composite score that predicts graft and patient survivals. RESULTS: Donor factors age, creatinine clearance, nephron dose (estimated by donor/recipient body weight ratio) and human leukocyte antigen (HLA) match were included in the living donor risk model. The adjusted hazard ratios (HRs) for graft failures among those who received a kidney with living donor scores (reference to donor score of zero) of 1, 2, 3 and 4 were 1.14 (95%CI: 0.94-1.39), 1.24 (95%CI:1.03-1.49), 1.25 (95%CI:1.03-1.51) and 1.36 (95%CI:1.08-1.72) (P-value for trend =0.05). Similar findings were observed for patient survival. CONCLUSIONS: Similar to findings in high income countries, our study suggests that donor characteristics such as age, nephron dose, creatinine clearance and HLA match are important factors that determine the long-term patient and graft survival in low income countries. However, other crucial but undefined factors may play a role in determining the overall risk of graft failure and mortality in living kidney donor transplant recipients.


Assuntos
Países em Desenvolvimento/economia , Seleção do Doador , Sobrevivência de Enxerto , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Doadores Vivos , Adolescente , Adulto , Aloenxertos , Bases de Dados Factuais , Técnicas de Apoio para a Decisão , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Paquistão/epidemiologia , Complicações Pós-Operatórias/mortalidade , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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