Association of neutrophil/lymphocyte and platelet/lymphocyte ratios with inflammation and survival in Mexican patients on chronic hemodialysis.

INTRODUCTION: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are markers of systemic inflammatory status. The relationship between NLR, PLR, and mortality is controversial among hemodialysis (HD) patients. OBJECTIVE: Evaluate NLR and PLR in the prediction of mortality in chronic HD patients. MATERIALS AND METHODS: We analyzed 130 patients with a follow-up for 66 months. Four groups were established according to NLR-PLR values. Kaplan-Meier curves and Cox proportional hazards analysis were used. RESULTS: NLR-PLR correlated positively with C-reactive protein. Cox regression analysis for overall mortality among the four groups included age (HR 1.027, 95% CI 1.003-1.053) and albumin (HR 0.25, 95% CI 0.073-0.85). For cardiovascular (CV) mortality only pulse pressure differential (PPD) was included (HR 1.033; 95% CI 1.014-1.052). Low NLRs and high PLRs were associated with CV mortality (Log Rank test, p = 0.033). CONCLUSIONS: Low NLRs and high PLRs predict the risk of CV mortality among HD patients.

C4d expression in focal segmental glomerulosclerosis.

BACKGROUND: There is a little information about of expression of C4d (complement fragment) in Focal segmental glomerulosclerosis (FSGS) subtypes. Our aim was to determine the expression of C4d in FSGS subtypes in percutaneous native renal biopsies in a second-level hospital and its correlation with clinical, biochemical and histological variables. MATERIAL AND METHODS: A retrospective study in paraffin blocks of patients with biopsy with FSGS aged 16-65 years, indistinct sex, not diabetic or obese. Immunohistochemistry was performed for C4d and their expression was analyzing in non-sclerosed glomerular capillaries (GC) and sclerosis areas (SA). Clinical and biochemical variables were recorded. The cases were divided into C4d positive and C4d negative groups and compared. The correlation between C4d staining scores in CG and SA with clinical and biochemical variables were analyzed. RESULTS: Twenty samples were analyzed, 4 for each subtype. At the time of biopsy average age 38.8 ±â€¯18.6 years, 65% male, 8.7% were hypertension. The percentage of positivity for C4d was 40% in GC, 30% SA and 35% in mesangium. The highest expression was for cellular and collapsing subtypes. C4d positivity cases had increased proteinuria (p = 0.035). A significant correlation was found between percentage of C4d expression in CG with SA (p = 0.012) and SA with tubular atrophy and interstitial fibrosis (p < 0.05). CONCLUSIONS: C4d expression in FSGS predominated in the cellular and collapsing subtypes, which translates complement activation. C4d is a possible surrogate marker in GSFS.

Idiopathic granulomatous orchitis: A case study.

Idiopathic granulomatous orchitis (IGO) is a rare inflammatory disorder of unknown etiology affecting the testis. Presented here is the case of a young patient who developed IGO, potentially associated with an anti-sperm antibody-mediated autoimmune response.

Acute Kidney Injury in COVID-19 Patients: Pathogenesis, Clinical Characteristics, Therapy, and Mortality.

Coronavirus disease 2019 (COVID-19) is a disease caused by infection with the SARS-CoV-2 virus and has represented one of the greatest challenges humanity has faced in recent years. The virus can infect a large number of organs, including the lungs and upper respiratory tract, brain, liver, kidneys, and intestines, among many others. Although the greatest damage occurs in the lungs, the kidneys are not exempt, and acute kidney injury (AKI) can occur in patients with COVID-19. Indeed, AKI is one of the most frequent and serious organic complications of COVID-19. The incidence of COVID-19 AKI varies widely, and the exact mechanisms of how the virus damages the kidney are still unknown. For this reason, the purpose of this review was to assess current findings on the pathogenesis, clinical features, therapy, and mortality of COVID-19 AKI.

Prevalence of chronic venous disease in health staff and its impact on quality of life at 6 months.

OBJECTIVE: To determine the frequency and stages of chronic venous disease (CVD) in health staff and its impact on the quality of life. METHOD: Cross-sectional study on health workers, between the ages of 20 and 60, indistinct gender, to remain standing position ≥6.5 hours per day for at least 5 days a week. Socio demographic variables were recorded. The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) scale was used to stage the CVD; to measure the quality of life, the CIVIQ-20 (Chronic Venous Insufficiency Questionnaire) survey was applied at baseline, at 3 and 6 months. All patients underwent detailed clinical examination followed by color Doppler ultrasound and angiology review. RESULTS: Included 37 patients, 62.1% woman. Average age was 36.6 ± 8.8 years. By CEAP the 78.3% of the patients presented CVD and the highest prevalence was C1; corroborating by Doppler ultrasound only in 29.7% of the patients. The predominant symptoms were night cramps (54.5%). CONCLUSION: The frequency of CVD is like the literature. Patients with chronic venous disease have poor quality of life which improves with treatment.

OBJETIVO: Determinar la frecuencia y estadios de la enfermedad venosa crónica (EVC) en personal de salud y su impacto en calidad de vida. MATERIAL Y MÉTODOS: Estudio transversal en trabajadores de la salud, edad de 20 a 60 años, sexo indistinto, con bipedestación ≥ 6.5 horas/día por al menos 5 días a la semana. Se registraron variables sociodemográficas. La EVC se estadifico con la escala CEAP (Clinical-Etiology-Anatomy-Pathophysiology); la calidad de vida se midió basal, a 3 y 6 meses con la encuesta CIVIQ-20 (Chronic Venous Insufficiency Questionnaire 20). Además, se realizó examen clínico, ultrasonido Doppler y valoración por angiología. RESULTADOS: Incluyó 37 participantes, el 62.1% mujeres, edad promedio 36.6 ± 8.8 años. Acorde a la CEAP el 78.3% de los pacientes presentaron EVC (prevalencia mayor de C1). Se corroboró por ultrasonido Doppler en el 29.7%. El 54.5% presentaba calambres nocturnos. CONCLUSIONES: La frecuencia de EVC en personal de salud es similar a la reportada en la literatura; los individuos con EVC tienen mala calidad de vida.

What do we know about the antibody responses to SARS-CoV-2?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a pandemic with millions of infected people and deaths. Currently, the scientific community is working hard to develop a specific vaccine or treatment. However, since antibody production is an important part of the adaptive immune response, to develop vaccines and therapies, we must understand the antibody response to SARS-CoV-2 infection. In this work, we summarize the most important findings of antibody-mediated immunity against SARS-CoV-2 and highlight its role in the efficient use of plasma from convalescent patients and the direct application of antibodies as treatment.

Coexistence of emphysematous cystitis and bilateral emphysematous pyelonephritis: a case report and review of the literature.

Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. We report a rare case of a 56-year-old diabetic male suffering from fever, headache and vomiting and in which a diagnosis of septic shock was established due to coexistence of EC and bilateral EPN. The emphysematous diseases improved with a conservative treatment approach using antibiotic therapy and glycemic control, we highlight that the nephrectomy was not necessary in our patient despite the fact that he presented risk factors that predict the failure of conservative treatment.

Impact of caregiver's burden of peritoneal dialysis patients / Impacto de la sobrecarga de los cuidadores de pacientes en diálisis peritoneal

BACKGROUND: Peritoneal dialysis (PD) requires the support of a main caregiver, who can be subjected to an intense workload, and is susceptible to physical, psychological and social alterations. OBJECTIVE: To determine the prevalence of burden in primary informal caregivers of PD patients, the associated factors and their impact on patients at 12 months. MATERIAL AND MEHOTDS: 180 caregivers were included, with an average age of 42.8 ± 13.9 years, 73.3% were women. The Zarit survey was applied to assess the degree of caregiver overload. RESULTS: We identified that the majority of caregivers do not present overload; however, there is a greater burden in patients with continuous ambulatory PD (CAPD), with higher overall mortality in the group with severe burden (p < 0.05). Linear regression showed an association between hours of patient care, occupation, dialysis modality, and schooling with the presence of caregiver overload (p < 0.05). CONCLUSIONS: The burden presented by the caregiver is similar to that reported in the literature. CAPD patients whose family member has severe burden show higher global mortality at 12 months.

ANTECEDENTES: La diálisis peritoneal (DP) requiere el apoyo de un cuidador principal, quien puede verse sometido a una intensa carga de trabajo y es susceptible de presentar alteraciones físicas, psicológicas y sociales. OBJETIVO: Determinar la prevalencia de sobrecarga en cuidadores informales primarios de pacientes en DP, los factores asociados y su impacto en los pacientes a 12 meses. MATERIAL Y MÉTODOS: Se incluyeron 180 cuidadores, con una edad promedio de 42.8 ± 13.9 años, y el 73.3% eran mujeres. Se aplicó la encuesta Zarit para valorar el grado de sobrecarga del cuidador. RESULTADOS: Se identifica que la mayoría de los cuidadores no presenta sobrecarga; sin embargo, existe mayor sobrecarga en pacientes con DP continua ambulatoria (DPCA), con mayor mortalidad global en el grupo con sobrecarga intensa (p < 0.05). La regresión lineal mostró asociación entre las horas al cuidado del paciente, la ocupación, la modalidad de diálisis y la escolaridad con la presencia de sobrecarga del cuidador (p < 0.05). CONCLUSIONES: La sobrecarga que presenta el cuidador es similar a lo reportado en la literatura. Los pacientes en DPCA cuyo familiar tiene sobrecarga intensa presentan mayor mortalidad global a 12 meses.

Prevalence of malnutrition-inflammation complex syndrome and its correlation with thyroid hormones in chronic haemodialysis patients. / Prevalencia del síndrome complejo de malnutrición e inflamación y su correlación con las hormonas tiroideas en pacientes en hemodiálisis crónica.

INTRODUCTION: Low levels of thyroid hormones, total triiodothyronine (T3) and free triiodothyronine (FT3) in haemodialysis patients is a marker of malnutrition and inflammation and are predictors of mortality. The aim of this study was to determine the prevalence of malnutrition-inflammation complex syndrome in haemodialysis and its relationship with the thyroid hormones thyrotropin, T3, FT3 and free thyroxine (FT4), as well as to evaluate the prevalence of low FT3 syndrome and its correlation with nutritional and inflammatory markers. MATERIALS AND METHODS: Cross-sectional, analytical and comparative study that enrolled 128 haemodialysis patients: 50.8% females; mean age 45.05±17.01 years; mean time on haemodialysis 45.4±38.8 months; 29.7% diabetics; 79.7% with hypertension. Serum thyroid hormones thyrotropin, T3, FT3 and FT4 concentrations were measured and Malnutritition-Inflammation Score (MIS) was applie to diagnostic. RESULTS: Mean thyroid hormone values were: thyroid hormones thyrotropin 2.48±1.8 mIU/ml (range: 0.015-9.5), T3 1.18±0.39 ng/ml (range 0.67-2.64), FT3 5.21±0.96pmol/l (range: 3.47-9.75); FT4 1.35±0.4 ng/ml (range: 0.52-2.57). Malnutrition-inflammation complex syndrome prevalence was 53.9%; 11.7% presented low FT3 levels. Serum T3 and FT3 concentrations inversely correlated with Malnutritition-Inflammation Score (MIS), while FT4 correlated positively with Malnutrition-Inflammation Score. In the linear regression analysis, low FT3 was associated with IL-6 (ß= 0.265, p=.031), C-reactive protein (CRP) (ß= -0.313, p=.018) and albumin (ß= 0.276, p=.002). CONCLUSION: Low T3 and FT3 levels are correlated with malnutrition and inflammation parameters. Malnutrition-inflammation complex syndrome can affect serum concentrations of thyroid hormones.

Learning of nature: The curious case of the naked mole rat.

Naked mole rats (NMRs) are the longest-living rodents known, living up to approximately 30 years and showing sustained good health. Nowadays, NMRs are considered excellent models for aging and, additionally, for cancer research, due to the evidence of a remarkable cancer resistance demonstrated through thousands of necropsies performed with very few cases that describe this pathology, which is believed to be a disease that unavoidably accompanies aging. Since some years ago, several studies have tried to explain the possible mechanisms underlying longevity and cancer resistance in NMRs through different perspectives and directions, creating new knowledge that subsequently could be used for cancer prevention and delaying aging in humans. Thus, the purpose of this review is to summarize the recent knowledge on naked mole rats with a particular emphasis on the molecular mechanisms associated with their longevity and cancer resistance.

FLT3-ITD and its current role in acute myeloid leukaemia.

FMS-like tyrosine kinase 3 (FLT3) is a proto-oncogene involved in crucial steps of haematopoiesis such as proliferation, differentiation and survival. In recent years, FLT3 has been an important marker in different haematological malignancies, highlighting in acute myeloid leukaemia, where FLT3 mutations have been associated with the clinical prognosis, treatment and survival of patients. The most common form of FLT3 mutation is an internal tandem duplication (ITD) that promotes ligand-independent auto-phosphorylation and constitutive activation of the receptor. FLT3-ITD has been strongly associated with a bad prognosis, leukocytosis, high blast counts, increased risk of relapse and shorter overall survival. In order to improve the clinical condition of FLT3-ITD-positive patients, several FLT3 inhibitors have been developed showing variable results. Currently, the main challenges to be overcome are the different forms of resistance to FLT3 inhibitors. Thus, the purpose of this review is to present, in a general way, the current role that FLT3-ITD mutation plays in patients with AML, with a particular emphasis on the molecular mechanisms associated with clinical prognosis, treatment, and survival of patients.

Synchronous Renal Neoplasm: Clear Cell Renal Cell Carcinoma and Papillary Urothelial Carcinoma in the Same Kidney.

Abdominal computed tomography in a 64 year-old male presenting hematuria showed two malignant tumors in the left kidney, thus radical nephrectomy was realized. In histological preparations a clear cell renal cell carcinoma and a papillary urothelial carcinoma were identified occurring synchronously, which is a rare occurrence having only about 50 cases reported in the literature.

Thyroid disorders among dialysis patients / Alteraciones tiroideas en pacientes en diálisis

The thyroid gland and the kidney are closely related. Thyroid hormones (TH) contribute to the homeostasis of the human being through complex interactions of fluids and electrolytes, protein synthesis, etc. The effects on the kidney of TH may be pre renal or direct actions. Decreasing glomerular filtration (GF) this balance especially in advanced stages of chronic kidney disease (CKD) is altered. CKD is linked to alterations in TH levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low free triiodothyronine (FT3) syndrome. These alterations are linked in micro inflammation, endothelial damage, cardiac abnormalities, and high mortality. In this study, we describe the most common thyroid abnormalities reported in CKD with dialytic stage approach.

La glándula tiroides y el riñón están estrechamente relacionados. Las hormonas tiroideas (HT) contribuyen en la homeostasis del ser humano a través de complejas interacciones de líquidos y electrolitos, síntesis de proteínas, etc. Los efectos de las HT sobre el riñón pueden ser pre-renales o directos. Está demostrado que al disminuir la filtración glomerular (FG) se altera este equilibrio, sobre todo en estadios avanzados de la enfermedad renal crónica (ERC). La ERC está vinculada con alteraciones en los niveles de HT y/o su metabolismo, lo que resulta en una alta prevalencia de hipotiroidismo subclínico y el síndrome de T3 libre baja. Estas alteraciones están relacionadas con micro inflamation, daño endotelial, alteraciones cardiacas y alta mortalidad. El presente estudio, describe las alteraciones tiroideas más frecuentes reportadas en ERC con enfoque en la etapa dialítica.

Glomerulopatí del trasplante. Resultados clínicos y seguimiento de casos.

OBJECTIVE: We describe the evolution of graft function in patients with transplant glomerulopathy measure by levels of serum creatinine, proteinuria and estimated glomerular filtration rate. METHOD: Cross-sectional study conducted in the Regional General Hospital No. 46 IMSS. Included patients with kidney allograft and diagnosis of renal biopsy of transplant glomerulopathy grafting between January 1, 2006 to April 31, 2013 serum creatinine, proteinuria and estimated glomerular filtration rate at diagnosis, 6, 12 and 24 was recorded months. The results are shown with numbers, percentages and standard deviations. RESULTS: 42 patients were included. At 6 months of diagnosis, 14% decline in graft function and 7.1% graft loss. At 12 months, 17.9% graft loss, and at 24 months 36.3% had chronic graft dysfunction and graft loss as return to dialysis. CONCLUSIONS: Evolution in our patients seems to be better to other series of cases reported in the literature.