Predicting chronic kidney disease progression with artificial intelligence.

BACKGROUND: The use of tools that allow estimation of the probability of progression of chronic kidney disease (CKD) to advanced stages has not yet achieved significant practical importance in clinical setting. This study aimed to develop and validate a machine learning-based model for predicting the need for renal replacement therapy (RRT) and disease progression for patients with stage 3-5 CKD. METHODS: This was a retrospective, closed cohort, observational study. Patients with CKD affiliated with a private insurer with five-year follow-up data were selected. Demographic, clinical, and laboratory variables were included, and the models were developed based on machine learning methods. The outcomes were CKD progression, a significant decrease in the estimated glomerular filtration rate (eGFR), and the need for RRT. RESULTS: Three prediction models were developed-Model 1 (risk at 4.5 years, n = 1446) with a F1 of 0.82, 0.53, and 0.55 for RRT, stage progression, and reduction in the eGFR, respectively,- Model 2 (time- to-event, n = 2143) with a C-index of 0.89, 0.67, and 0.67 for RRT, stage progression, reduction in the eGFR, respectively, and Model 3 (reduced Model 2) with C-index = 0.68, 0.68 and 0.88, for RRT, stage progression, reduction in the eGFR, respectively. CONCLUSION: The time-to-event model performed well in predicting the three outcomes of CKD progression at five years. This model can be useful for predicting the onset and time of occurrence of the outcomes of interest in the population with established CKD.

Autosomal dominant polycystic kidney disease in Colombia.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of chronic kidney disease (CKD) that requires dialysis. Knowing geographical clusters can be critical for early diagnosis, progression control, and genetic counseling. The objective was to establish the prevalence, geographic location, and ethnic groups of patients with ADPKD who underwent dialysis or kidney transplant in Colombia between 2015 and 2019. METHODS: We did a cross-sectional study with data from the National Registry of Chronic Kidney Disease (NRCKD) managed by the High-Cost Diseases Fund (Cuenta de Alto Costo [CAC] in Spanish) between July 1, 2015, and June 30, 2019. We included Colombian population with CKD with or without renal replacement therapy (RRT) due to ADPKD. Crude and adjusted prevalence rates were estimated by state and city. RESULTS: 3,339 patients with ADPKD were included, period prevalence was 9.81 per 100,000 population; there were 4.35 cases of RRT per 100,000 population, mean age of 52.58 years (± 13.21), and 52.78% women. Seventy-six patients were Afro-Colombians, six were indigenous, and one Roma people. A total of 46.07% began scheduled dialysis. The highest adjusted prevalence rate was in Valle del Cauca (6.55 cases per 100,000 population), followed by Risaralda, and La Guajira. Regarding cities, Cali had the highest prevalence rate (9.38 cases per 100,000 population), followed by Pasto, Medellin, and Bucaramanga. CONCLUSIONS: ADPKD prevalence is lower compared to Europe and US; some states with higher prevalence could be objective to genetic prevalence study.

Risk factors associated with acute kidney injury in a cohort of hospitalized patients with COVID-19.

BACKGROUND: Patients with COVID-19 have a high incidence of acute kidney injury (AKI), which is associated with mortality. The objective of the study was to determine the factors associated with AKI in patients with COVID-19. METHODOLOGY: A retrospective cohort was established in two university hospitals in Bogotá, Colombia. Adults hospitalized for more than 48 h from March 6, 2020, to March 31, 2021, with confirmed COVID-19 were included. The main outcome was to determine the factors associated with AKI in patients with COVID-19 and the secondary outcome was estimate the incidence of AKI during the 28 days following hospital admission. RESULTS: A total of 1584 patients were included: 60.4% were men, 738 (46.5%) developed AKI, 23.6% were classified as KDIGO 3, and 11.1% had renal replacement therapy. The risk factors for developing AKI during hospitalization were male sex (OR 2.28, 95% CI 1.73-2.99), age (OR 1.02, 95% CI 1.01-1.03), history of chronic kidney disease (CKD) (OR 3.61, 95% CI 2.03-6.42), High Blood Pressure (HBP) (OR 6.51, 95% CI 2.10-20.2), higher qSOFA score to the admission (OR 1.4, 95% CI 1.14-1.71), the use of vancomycin (OR 1.57, 95% CI 1.05-2.37), piperacillin/tazobactam (OR 1.67, 95% CI 1.2-2.31), and vasopressor support (CI 2.39, 95% CI 1.53-3.74). The gross hospital mortality for AKI was 45.5% versus 11.7% without AKI. CONCLUSIONS: This cohort showed that male sex, age, history of HBP and CKD, presentation with elevated qSOFA, in-hospital use of nephrotoxic drugs and the requirement for vasopressor support were the main risk factors for developing AKI in patients hospitalized for COVID-19.

Pancreatic intraductal papillary mucinous neoplasm evolving into adenocarcinoma. Continual follow-up necessary.

We report a 62-year-old female with chronic pancreatitis after three episodes of severe acute pancreatitis. In 2008, an uneven main pancreatic duct (MPD) of 16 mm was found during an abdominal ultrasound. The follow-up was not continued until 2020, when a dilation of 27 mm of the MPD was discovered at magnetic resonance imaging (MRI). In 2022, another radiological test was carried out showing a dilation of the MPD of 40 mm with an intraductal tumoral lesion of 30 mm at the head of the pancreas). An echo-endoscopy was carried out and a pancreatic-duodenal tumour with a mixed pattern was discovered. Atypic cells were observed at the fine needle punction. A total duodenopancreatectomy was successfully carried out. In the anatomopathological macroscopic study a 14 cm-multi-cystic neoformation was seen and a solid tumour was discovered at the head of the pancreas that infiltrated the wall of the duodenum. In the longitudinal cross-section of the pancreatic body the MPD was seen to be severely dilated. A focal adenocarcinoma in a intraductal papillary mucinous neoplasm (IPMN) was finally diagnosed. Pancreatic lesions are usually asymptomatic and are detected by chance during other imaging tests. The IPMN rates of malignancy have been reported of between 19 to 30%. The management of pancreatic cystic lesions still represents a clinical challenge. As always, the multi-disciplinary management is mandatory in this type of tumour.

Prevention and control of COVID-19 outbreak in a hemodialysis center.

BACKGROUND: The prevention and control of SARS-CoV-2 infection in hemodialysis (HD) units is challenging. AIM: To describe the clinical characteristics and outcome of patients with chronic kidney disease (CKD) on HD with COVID-19, between March 2020 and January 28, 2021, attending a single HD unit in Bogotá, Colombia. MATERIAL AND METHODS: In this prospective observational study, incidence, prevalence, and case-fatality rate were estimated, including screening results with RT-PCR and anti-SARS-CoV-2 IgG and IgM antibodies in all patients and health personnel in the HD unit. RESULTS: Among patients and health workers, 55 and 9 cases of COVID-19 were identified, respectively. The median age of patients was 63 years (84% males). Fifty five percent of patients were symptomatic, with fever, cough and/or myalgia. The most common comorbidities were hypertension, type 2 diabetes mellitus, and coronary heart disease. The cumulative incidence of infection was 30.2%, population seroprevalence was 24.9%, and fatality was 9.1%. CONCLUSIONS: The incidence of SARS-CoV-2 infection in this HD unit was high. Strict biosafety protocols are required to prevent outbreaks.

Vitamin E and carotenoid profiles in leaves, stems, petioles and flowers of stinging nettle (Urtica leptophylla Kunth) from Costa Rica.

BACKGROUND: Local leafy vegetables are gaining attention as affordable sources of micronutrients, including vitamins, pro-vitamin carotenoids and other bioactive compounds. Stinging nettles (Urtica spp.) are used as source of fibers, herbal medicine and food. However, despite the relatively wide geographical spread of Urtica leptophylla on the American continent, little is known about its content of vitamin E congeners and carotenoids. We therefore investigated the particular nutritional potential of different plant structures of wild Costa Rican U. leptophylla by focusing on their vitamin E and carotenoid profiles. RESULTS: Young, mature and herbivore-damaged leaves, flowers, stems and petioles were collected and freeze-dried. Vitamin E and carotenoids were determined by high-performance liquid chromatography after liquid/liquid extraction with hexane. α-Tocopherol was the major vitamin E congener in all structures. Flowers had a high content of γ-tocopherol. Herbivore-damaged leaves had higher contents of vitamin E than undamaged leaves. Lutein was the major and ß-carotene the second most abundant carotenoid in U. leptophylla. No differences in carotenoid profiles were observed between damaged and undamaged leaves. CONCLUSION: The leaves of U. leptophylla had the highest nutritional value of all analyzed structures; therefore, they might represent a potential source of α-tocopherol, lutein and ß-carotene. © 2022 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

B-mode ultrasonographic evaluation of long bones in Falconiformes and Strigiformes birds.

Bone fractures in birds are usually diagnosed with the aid of traditional radiography. However, this technique remains limited because of the difficulties associating this examination with real-time procedures. The aim of this study was to describe the use of B-mode ultrasound to assess the long bones of two avian orders. For the study, we used carcases of birds from the orders Falconiformes (n = 9) and Strigiformes (n = 12), with weights ranging from 108 to 1020 g. An ultrasound device with a 5-12 MHz linear probe was employed to produce images of the long bones (humerus, radius, ulna, femur and tibiotarsus). Ultrasound (US) measurements and physical measurements using a caliper were applied to compare the diameter of the bones. Images were also recorded from the US examination performed in two live patients attending the hospital with suspected bone fractures. No statistical difference was found between the two methods of measurement in carcases weighing up to 267 g (P > 0.01). The US examination provided relevant clinical information about the bone cortex and assisted in real-time surgical procedures. RESEARCH HIGHLIGHTS Long bones of Falconiformes and Strigiformes birds were assessed with B-mode ultrasound. Ultrasound analysis is a relevant tool in clinical orthopaedics for avian species. Ultrasound of the bone might be applied for monitoring of healing processes.

[Cystic degeneration of the popliteal artery: Report of one case]. / Degeneración quística de la arteria poplítea: Presentación de caso clínico.

Cystic degeneration of the popliteal artery is an uncommon cause of intermittent claudication. We report a 52 years old male consulting for intermittent claudication referred to the calf. The angiography showed a 93% stenosis in segment of 45 mm length of the left popliteal artery with a smooth surface, suggesting an extrinsic compression. A CT angiography of the lower limb suggested the presence of a cystic degeneration. The patient was operated and the middle third of the popliteal artery was excised. The pathological study of the surgical piece was informed as artery media cystic degeneration.

Duration of the first prone positioning maneuver and its association with 90-day mortality in patients with acute respiratory failure due to COVID-19: A retrospective study of time terciles.

OBJECTIVE: To investigate the association between the duration of the first prone positioning maneuver (PPM) and 90-day mortality in patients with C-ARDS. DESIGN: Retrospective, observational, and analytical study. SETTING: COVID-19 ICU of a tertiary hospital. PATIENTS: Adults over 18 years old, with a confirmed diagnosis of SARS-CoV-2 disease requiring PPM. INTERVENTIONS: Multivariable analysis of 90-day survival. MAIN VARIABLES OF INTEREST: Duration of the first PPM, number of PPM sessions, 90-day mortality. RESULTS: 271 patients undergoing PPM were analyzed: first tertile (n = 111), second tertile (n = 95) and third tertile (n = 65). The results indicated that the median duration of PDP was 14 h (95% CI: 10-16 h) in the first tertile, 19 h (95% CI: 18-20 h) in the second tertile and 22 h (95% CI: 21-24 h) in the third tertile. Comparison of survival curves using the Logrank test did not reach statistical significance (p = 0.11). Cox Regression analysis showed an association between the number of pronation sessions (patients receiving between 2 and 5 sessions (HR = 2.19; 95% CI: 1.07-4.49); and those receiving more than 5 sessions (HR = 6.05; 95% CI: 2.78-13.16) and 90-day mortality. CONCLUSIONS: while the duration of PDP does not appear to significantly influence 90-day mortality, the number of pronation sessions is identified as a significant factor associated with an increased risk of mortality.

HbA1c overestimates the glucose management indicator: a pilot study in patients with diabetes, chronic kidney disease not on dialysis, and anemia using isCGM.

Introduction: There are multiple mechanisms by which HbA1c values can be altered in chronic kidney disease (CKD), which limits its usefulness as a strategy to assess glycemic control in this population. Methods: Concordance and agreement study between two diagnostic tests: HbA1c and glucose management indicator (GMI) measured by intermittently scanned continuous glucose monitoring (isCGM), based in a prospective cohort of patients with diabetes, CKD (glomerular filtration rate between 15 and 60 ml/min/1.73 m²), and anemia. The isCGM was performed for 3 months, and the GMI was compared with the HbA1c levels taken at the end of isCGM. Agreement was evaluated using Bland-Altman graph analysis and Lin's concordance correlation coefficient (CCC). The concordance of the measures with good glycemic control (<7%) was also evaluated. Results: A total of 74 patients were enrolled (median age 68.5 years, 51.3% female, 64.9% with CKD stage 3, hemoglobin 11.1 ± 1.2 g/l). The Bland-Altman analysis shows a mean difference between GMI and HbA1c of 0.757 ± 0.687% (95% limits of agreement: -0.590 and 2.105). Difference was greater as the values of GMI and HbA1c increased. The agreement was poor [CCC 0.477; 95% confidence interval (CI): 0.360-0.594], as well as the concordance of values with good glycemic control according to GMI versus HbA1c (67.5% versus 29.7%, p < 0.001) (Kappa 0.2430; 95% CI: 0.16-0.32). Conclusion: The HbA1c overestimates the GMI values with highly variable ranges of difference, which prevents a precise correction factor. isCGM probably is a safer option for monitoring and decision-making in this population, especially in patients treated with insulin where the risk of hypoglycemia is greater.

Altered Liver Biochemistry and Mortality in Patients Hospitalized With COVID-19.

COVID-19 is an illness caused by the SARS-CoV-2 virus, a type of coronavirus initially identified in China in late 2019, emerging as the leading cause of death attributed to a single infectious agent worldwide. The COVID-19 pandemic poses a substantial challenge to global public health in the first quarter of this century. The rapid evolution of the pandemic and its intricate response have hindered the formulation of definitive conclusions, and it may take years to comprehend its long-term effects. Assessing the extent of organ damage beyond the lungs could guide physicians in the disease's severity or progression. Based on these characteristics, an earlier and more targeted approach can be initiated at the appropriate moment. The association between hepatic profile and mortality in COVID-19 patients is a subject of scientific interest, as SARS-CoV-2 infection can lead to hepatitis. In severe cases, it may induce sepsis-related liver injury, potentially culminating in hepatic failure. METHODOLOGY: The study's objective is to determine the prevalence of mortality in adult patients with elevated hepatic profile hospitalized due to SARS-CoV-2 infection. This cross-sectional, monocentric study was conducted at a healthcare institution in Bogotá, Colombia. RESULTS: This study includes 91 patients with confirmed diagnoses of COVID-19, revealing a prevalence of hepatic profile alterations in 61.5% (n=56) of hospitalized patients. The mortality rate observed is 17.6% (n= 16), with an odds ratio (OR) of 12.4 (95% CI = 1.56-99.0) in patients with hepatic profile alterations. CONCLUSIONS: This research underscores the importance of early detection of hepatic profile alterations in hospitalized patients with COVID-19. Not only are these alterations prevalent, but they are also potentially associated with an increased risk of mortality. These findings emphasize the necessity for further research to enhance strategies and prognostication for patients with COVID-19 in the future.

Therapeutic plasma exchange for optic neuritis attacks in patients with neuromyelitis optica spectrum disorders.

BACKGROUND: Optic neuritis (ON) causes several sequela. Aggressive treatment with plasma exchange (TPE) is an option. This study describes improvement and safety outcomes with TPE. METHODS: We recruited adults with ON in neuromyelitis optica spectrum disorders (NMOSD) patients treated with TPE. The primary outcome was an improvement in the visual acuity scale (VOS). We described the data and used multivariate logistic regression to identify factors associated with response. RESULTS: Eighty-three patients received 558 TPE sessions. Mean age was 40.9 years (±13.7 years); 73.5% were women, 50.1% were first attack, and 10.7% were bilateral. Median VOS: 5 (range [R], 2-7). Median time between onset and TPE was 8 days (R, 1-32). By Keegan's criteria, 82.4% experience improvement and 78.3% improve in at least 1 point in VOS. Age and pre-TPE VOS were related to improvement. Low fibrinogen occurs in 26% sessions. CONCLUSION: TPE is effective and safety for ON in NMOSD patients. There is a need for a clinical trial using a therapeutic equivalent.

Cost-Effectiveness of Rituximab (Fixed Schedule vs Tailored Dose) Compared With Azathioprine Maintenance Therapy in Adults With Generalized Antineutrophil Cytoplasm Antibody-Associated Vasculitis in Colombia.

OBJECTIVES: Azathioprine has been the therapy of choice for the maintenance of remission in patients with antineutrophil cytoplasm antibody (ANCA)-associated systemic vasculitis, but recent studies show that rituximab could be more effective. To evaluate the cost-effectiveness of azathioprine, fixed-schedule rituximab, and tailored-dose rituximab for ANCA-associated systemic vasculitis. METHODS: A Markov model from the perspective of the Colombian healthcare system was designed with annual cycles and a 5-year time horizon, charting the following states: remission, minor relapse, major relapse, and death. The discount rate was 5%. Transition probabilities were obtained from a systematic literature review. The costs (1 US dollar = 2956 Colombian pesos in 2018) were estimated based on national drug registries and official fee manuals for procedures, along with other resources. The main outcomes were quality-adjusted life-years (QALYs) taken from the Tufts registry. Univariate and multivariate sensitivity analyses were performed. RESULTS: Final costs were $1446 for azathioprine, $4898 for tailored-dose rituximab, and $6311 for fixed-schedule rituximab. QALYs gained were 3.18, 4.08, and 3.98, respectively. Rituximab was cost-effective (cost per incremental QALY gained: $4919, and $6865), and tailored-dose administration had a lower cost. Sensitivity analyses did not affect the results. CONCLUSIONS: Tailored-dose rituximab was the most cost-effective treatment for ANCA-associated vasculitis. Azathioprine presented worse effectiveness and lower cost, and fixed-schedule rituximab was dominated by tailored-dose rituximab.

Monitoring the variation in the gut microbiota of captive woolly monkeys related to changes in diet during a reintroduction process.

Microbiome is known to play an important role in the health of organisms and different factors such as diet have been associated with modifications in microbial communities. Differences in the microbiota composition of wild and captive animals has been evaluated; however, variation during a reintroduction process in primates has never been reported. Our aim was to identify changes in the bacterial composition of three individuals of reintroduced woolly monkeys (Lagothrix lagothricha) and the variables associated with such changes. Fecal samples were collected and the V4 region of the 16S rRNA gene was sequenced to determine gut microbial composition and functionality. Individual samples from released individuals showed a higher microbial diversity after being released compared to before liberation, associated with changes in their diet. Beta diversity and functionality analysis showed separation of samples from released and captive conditions and the major factor of variation was the moment of liberation. This study shows that intestinal microbiota varies depending on site conditions and is mainly associated with diet diversity. The intake of food from wild origin by released primates may promote a positive effect on gut microbiota, improving health, and potentially increasing success in reintroduction processes.

Behavior of Bone Mineral Metabolism in Renal Posttransplantation Patients with Severe Hyperparathyroidism.

BACKGROUND: Secondary hyperparathyroidism usually improves after renal transplantation. When it becomes persistent, it is associated with deleterious effects on the graft, bone demineralization, fractures, calcifications, and cardiovascular events. In this study we describe the development of cases of severe hyperparathyroidism occurring after renal transplantation. OBJECTIVE: To describe the behavior of the indicators of bone mineral metabolism in the renal transplantation patient with severe secondary hyperparathyroidism before transplantation, treated with or without parathyroidectomy. METHODS: This is a case series study conducted between 2004 and 2017 on renal transplantation patients presenting with PTH > 800 pg/mL or who required pretransplantation parathyroidectomy. RESULTS: We found 36 patients with severe hyperparathyroidism, corresponding to 10.8% of transplantation recipients, with an average age of 54.5 years (±12.35). The median follow-up after transplantation was 128 months (16-159). Fourteen patients underwent parathyroidectomy before transplantation, with a median intact parathyroid hormone at the time of transplantation of 56 (3-382) pg/mL, with more episodes of hypocalcaemia and oral calcium requirement. The other patients were transplanted with a median intact parathyroid hormone of 1010 (range, 802-1919) pg/mL, reaching a median intact parathyroid hormone of 98.8 (43.8-203) at 3 years of follow-up. Only 2 patients underwent parathyroidectomy for tertiary hyperparathyroidism. CONCLUSIONS: Renal transplantation improves secondary hyperparathyroidism. Sixty-eight percent of patients presented PTH of less than 130 pg/mL after renal transplantation. Only 2 patients underwent posttransplantation parathyroidectomy.

Treatment With Platelet Lysate Inhibits Proteases of Synovial Fluid in Equines With Osteoarthritis.

Osteoarthritis (OA) is the most prevalent arthropathy in sport horses. The administration of a platelet lysate (PL) is an alternative method for the treatment of musculoskeletal conditions. The mechanisms by which PL exerts its beneficial effects have not been determined, and less is known about its effect on the activity of the proteolytic enzymes of the synovial fluid of equines with OA. In this work, the effect of the administration of PL to horses with OA was analyzed both clinically and molecularly by determining the levels of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), a disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS-5), glycosaminoglycans (GAGs), and tissue inhibitor of metalloproteinase 1 (TIMP-1) in synovial fluid. One mL of PL was administered intra-articularly followed by the extraction of synovial fluid on days 0, 10, 30, and 60. Results were evaluated by an analysis of variance for repeated measures. The levels of MMP-9 decreased significantly (P < .05) on day 10 after treatment with PL. A disintegrin and metalloproteinase with thrombospondin motifs 5 decreased significantly on days 10 (P < .05), 30 (P < .05), and 60 (P < .01) after treatment. The levels of synovial TIMP-1 increased significantly on day 30 (P < .001) after treatment. Glycosaminoglycans showed a significant increase on days 10 (P < .05) and 30 (P < .01). A significant decrease was found for MMP-2 on day 10 (P < .01), 30 (P < .01), and 60 (P < .001). In conclusion, the beneficial effects of PL in OA could be attributed to the decreased activity of MMP-2, MMP-9, and ADAMTS-5 and the increased concentration of GAGs and TIMP-1 after the administration of platelet-rich plasma.

Renal Graft Embolization as a Treatment for Graft Intolerance Syndrome.

BACKGROUND: Renal graft intolerance syndrome is an inflammatory process that occurs in up to 40% of patients with graft loss. It is characterized by fever, graft pain, hematuria, and anemia. Traditionally, the treatment has been nephrectomy; however, this procedure is associated with high morbidity and mortality rates. As an alternative, graft embolization is associated with success rates of up to 92%. In this study, we describe the graft embolization experience of 1 center, its clinical outcomes and complications. METHODS: An observational, retrospective study was conducted. It included all patients with graft intolerance syndrome undergoing graft embolization between 2012 and 2018. The success of the procedure was defined by the resolution of the symptoms that motivated the embolization. RESULTS: We found 12 cases of patients undergoing embolization. The time of presentation of the graft intolerance syndrome after admission to dialysis was 6 months (range, 0.6-13). The main clinical manifestation was pain in the area of the graft and macroscopic hematuria. Except for 1 patient, all continued with the immunosuppressive treatment regimen after graft loss for 4 months (range, 0.6-9), received antibiotics for 5.5 days (range, 2-14), and 10 patients received steroid treatment for 6.5 days (range, 5-10). The main complication, secondary to the procedure, was hematoma at the puncture site in 3 patients. Only 1 patient had postembolization syndrome, which resolved with steroid administration. Two patients required postembolization nephrectomy due to persistent renal blood flow and symptoms such as pain and hematuria. The average hospital stay was 5.5 days (range, 1-24). CONCLUSIONS: Renal graft embolization is an effective technique as a treatment strategy in patients with clinical signs of intolerance syndrome, with a success rate ≥83.3%, low morbidity, and short hospital stay; furthermore, it avoids the potential complications of a surgical nephrectomy. Graft infection should be ruled out before embolization, and the use of prophylactic antibiotics and steroid therapy is recommended to reduce the risk of postembolization syndrome and infectious complications.

Abdominoplasty in Hemodialysis Patients Before Transplant.

Morbid obesity in patients with chronic kidney disease is a contraindication for inclusion on the kidney transplant waitlist.Despite intentional weightloss,the persistence of the abdominal adipose panniculus poses postoperative risks, such as infection of the surgical site and seromas. We describe 2 cases of patients on hemodialysis who had a body mass index greater than 35 kg/m² who underwent abdominoplasty before transplant without perioperative complications. One patient received a living-related kidney transplant (donor was the brother) without complications.

Impact of Complicated Urinary Tract Infection on Renal Graft Function.

BACKGROUND: Urinary tract infection (UTI) is the most common infectious complication after renal transplantation. It is uncertain whether the development of UTI has an impact on renal graft function. The objective of this study was to evaluate the effects of complicated and recurrent UTI on 2-year renal graft function. METHODS: This was a historical cohort study in renal transplantation patients in a kidney transplant center. All renal transplant recipients from June 2004 to September 2016 were included. A linear regression analysis was performed to study the association between the outcome (variation in estimated glomerular filtration rate [eGFR] by the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation between month 1 and month 24 post-transplant) and the UTI. The approval of the Ethics and Research Committee to carry out this study was obtained. RESULTS: In total, 276 kidney transplants were performed during the observation period. Of the transplant patients, 193 (69.9%) did not develop a UTI and 83 (30.1%) presented at least 1 complicated UTI. Patients who presented at least 1 UTI had a variation in eGFR during the observation period of -12.6 mL/min/1.73 m2 (95% confidence interval [CI] -4.5 to -20.7 mL/min/1.73 m2; P = .02), compared with those without a UTI. Said difference persisted in the adjusted model controlling for variables that have an impact on the eGFR. This difference was -10.7 mL/min/1.73 m2 (95% CI -3.1 to -18.2 mL/min/1.73 m2; P = .006). CONCLUSION: The findings suggest that the occurrence of complicated UTI has a negative impact on graft function and that prevention and monitoring of UTIs should be stepped up to avoid their deleterious effects on graft function.

Antimicrobial Usage Factors and Resistance Profiles of Shiga Toxin-Producing Escherichia coli in Backyard Production Systems From Central Chile.

Shiga toxin-producing Escherichia coli (STEC) is a zoonotic pathogen and important cause of foodborne disease worldwide. Many animal species in backyard production systems (BPS) harbor STEC, systems characterized by low biosecurity and technification. No information is reported on STEC circulation, antimicrobial resistance (AMR) and potential drivers of antimicrobial usage in Chilean BPS, increasing the risk of maintenance and transmission of zoonotic pathogens and AMR generation. Thus, the aim of this study was to characterize phenotypic and genotypic AMR and to study the epidemiology of STEC isolated in BPS from Metropolitana region, Chile. A total of 85 BPS were sampled. Minimal inhibitory concentration and whole genome sequencing was assessed in 10 STEC strain isolated from BPS. All strains were cephalexin-resistant (100%, n = 10), and five strains were resistant to chloramphenicol (50%). The most frequent serotype was O113:H21 (40%), followed by O76:H19 (40%), O91:H14 (10%), and O130:H11 (10%). The stx1 type was detected in all isolated strains, while stx2 was only detected in two strains. The Stx subtype most frequently detected was stx1c (80%), followed by stx1a (20%), stx2b (10%), and stx2d (10%). All strains harbored chromosomal bla AmpC. Principal component analysis shows that BPS size, number of cattle, pet and horse, and elevation act as driver of antimicrobial usage. Logistic multivariable regression shows that recognition of diseases in animals (p = 0.038; OR = 9.382; 95% CI: 1.138-77.345), neighboring poultry and/or swine BPS (p = 0.006; OR = 10.564; 95% CI: 1.996-55.894), visit of Veterinary Officials (p = 0.010; OR = 76.178; 95% CI: 2.860-2029.315) and close contact between animal species in the BPS (p = 0.021; OR = 9.030; 95% CI: 1.385-58.888) increase significantly the risk of antimicrobial use in BPS. This is the first evidence of STEC strains circulating in BPS in Chile, exhibiting phenotypic AMR, representing a threat for animal and public health. Additionally, we identified factors acting as drivers for antimicrobial usage in BPS, highlighting the importance of integration of these populations into surveillance and education programs to tackle the potential development of antimicrobial resistance and therefore the risk for ecosystemic health.