Discontinuation of Peritoneal Dialysis after Late Initiation of Eculizumab in a Case of Familial Atypical Hemolytic-Uremic Syndrome: A Case Report.

BACKGROUND: Atypical hemolytic-uremic syndrome is caused by a thrombotic microangiopathy and manifests itself with hemolytic anemia, thrombocytopenia, and organ ischemia. Its etiology is a mutation affecting the genes encoding for proteins of the complement system. Early treatment with eculizumab (8.6 months from the moment of presentation), a humanized monoclonal antibody against complement, is shown to be effective in controlling symptoms and reversing organ damage. We present a patient with a mutation not previously described in the literature. Late treatment with eculizumab resulted in a good therapeutic response, eliminating the need for peritoneal dialysis. CASE PRESENTATION: A 34-year-old woman showed symptoms and laboratory findings consistent with atypical hemolytic-uremic syndrome. Genetic analysis revealed an unusual mutation of the complement regulatory gene not seen previously. Due to unavailability of eculizumab at the time of presentation, conventional treatment was started with poor response. Late initiation of eculizumab resulted in discontinuation of peritoneal dialysis and yielded a good and sustained clinical response. CONCLUSIONS: This case shows that eculizumab treatment for patients with atypical hemolytic-uremic syndrome, even when initiated many months after beginning on dialysis, might offer substantial benefits and improve the patients' quality of life.

A preliminary report on multiple family discussion groups for patients with chronic medical illness and its repercussions in the management of the hemodialysis process.

The hemodialysis (HD) process involves an important degree of stress, not only for the patient but also for the family. The available data suggest that the quality of the family's performance predicts the degree of commitment that the patient acquires with the dialysis center. The establishment of a program of multiple family discussion groups allows exploration of the effect of the treatment on the patient in their context, not only regarding the illness, but also regarding the quality of life related to health, satisfaction and functional state. After the startup in the Hospital Virxe da Xunqueira of the multiple family discussion group (MFDG) for patients with chronic medical illness, the objective of this work was to evaluate the repercussions of the MFDG over the therapeutic fulfillment, the quality of life and the expectations of the patients in the chronic HD program, through the assessment of these indicators before and after their participation in this group. The MFDG was performed for a total of eight people, the families of four patients in the chronic HD program. Six weekly 1.5 hour sessions were performed and structured according to the following general contents: chronic illness impact component (2 sessions), family development component (3 sessions) and family illness integration component (1 session). Although no objectives were made for changes in relation to the therapeutic fulfillment, the average auto-effectiveness, locus of control, success and family general expectations went up slightly after the participation in the MFDG. The average specific self-effectiveness and family expectations in the presence of the illness reflected a modest increase, while the specific expectations of control locus and success in the presence of the illness decreased slightly. The scores obtained regarding the general state of health reflected a small decrease, while the evaluation of the quality of life of patients and family members showed a slight increase. We can conclude in the first place highlighting the viability of the MFDG, since no impediments were found either in recruitment of the families of the participants, or in preventing their excellent participation in the beginning and through the course of the group. Although no objectives were made for changes in relation to the therapeutic fulfillment, the high indices of satisfaction which the group obtained indicate that the discussion group is useful for the patients to find more support from their families, to change their view of the illness, to learn from other families new ways to resolve the difficulties and to increase their perception of capacity in the presence of the illness. The obtained data are preliminary and derived from only four families, but are encouraging as far as the improvement in the quality of life and the adjustment of the participants to the illness. Studies with the inclusion of more families are still pending in order to be able to arrive at conclusions based on a greater empiric basis. The records of MFDG for the families of HD patients are scarce. With this work it is attempted to reveal that these types of groups can be applied with these patients and their families, and they seem to prove beneficial for all those involved: patients, family and health professionals.

Esquistosomiasis genitourinaria como causa de macrohematuria persistente en paciente de 20 años natural de Madagascar, asociado a parasitosis intestinal por Trichuris trichuria y Necator americanus / Genitourinary schistosomiasis in a 20-year-old patient from Madagascar with persistent hematuria, associated with parasitosis from Trichuris trichuria and Necator americanus

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El color sí importa / No disponible

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Protocolo de recogida de muestras para cultivo del dializado y del agua tratada. Metodología y resultados / A protocol for the collection of samples for the cultivation of dialysis liquid and of treated water. Methodology and results

El objetivo del estudio microbiológico del dializado y del agua tratada es prevenir las reacciones pirógenas y bacteriemias en los pacientes sometidos a diálisis: La contaminación de las muestras por una deficiente manipulación y/o defectos en el procedimiento se traducen en una situación de alarma. En los controles previos a la puesta en funcionamiento de nuestra unidad, se detectó que 3 cultivos de agua tratada, de 5 monitores eran positivos. Ante la posibilidad de que los cultivos fueran positivos por una manipulación inadecuada, se decidió establecer un protocolo para la recogida de muestras en el que se extremaran las medidas de asepsia. Tras la aplicación de dicho protocolo los resultados han sido negativos en todas las ocasiones (AU)