Pretransplant CD28 Biomarker (Levels of Expression and Quantification of Molecules per Cell) in Peripheral CD4+ T Cells Predicts Acute Rejection Episodes in Liver and Kidney Recipients.

BACKGROUND: Acute rejection (AR) remains a significant cause of graft loss. Better approaches to predict AR are being investigated. Surface CD28 protein is essential for T-cell proliferation and survival as well as cytokine production. PATIENTS AND METHODS: Pretransplant CD4+CD28+ peripheral T cells were examined in 30 liver recipients (LRs) and 31 kidney recipients (KRs) by flow cytometry. RESULTS: Pretransplant CD4+CD28+ T cells in LRs were significantly lower in rejectors than nonrejectors (P = .002). Furthermore, the total number of CD28 molecules per cell in LRs (P = .02) as well as KRs (P = .047) was significantly lower in rejectors than nonrejectors. The healthy group did not display differences when compared with patients with end-stage liver disease or renal failure; however, stratification analysis displayed higher levels of CD4+CD28+ when compared with rejected LRs (P = .04) but not KRs. CD28 levels <41.94% were able to discriminate LRs at high risk of AR (P = .003). Similarly, a total number of CD28 molecules ≤8359 (P = .031) in LRs and ≤7669 (P = .046) in KRs correlated with high risk of AR. CONCLUSION: The preliminary results presented herein exhibit a fast and noninvasive method that assists clinicians to prevent AR by monitoring CD4+CD28+ peripheral T cells.

Definitive treatment for persistent hypoparathyroidism in a kidney transplant patient: parathyroid allotransplantation.

Post-surgical hypocalcemia is usually a transitory complication in thyroid and parathyroid surgery that can be resolved quickly, although it becomes a delicate matter when the problem persists. Parathyroid transplantation is the choice of treatment; however, the associated immunosuppression can cause side effects. The following case study shows the transplantation of parathyroid tissue from a patient with secondary hyperparathyroidism to another kidney transplant patient with severe hypocalcemia that was medically intractable. The graft is functioning after 2 years.

Influence of angiotensin-converting enzyme polymorphism gene, IGF-1, and other factors in the response rate of hematocrit to enalapril treatment in patients with posttransplant erythrocytosis.

A significant relationship between hematocrit values and serum parameters such as the insulin like growth factor (IGF-1) and calcium was observed in patients with posttransplant erythrocytosis (PTE). Since angiotensin-converting enzyme inhibitors (ACEI) decrease hematocrit (Ht) levels in these patients, ACE genotype should play an important role. We designed this study to investigate whether ACE genotype or baseline concentrations of IGF-1, IGF-blood binding protein 3 (BP3), growth hormone (GH), or Ca influenced the response of Ht to ACEI treatment. Twenty-one kidney graft recipients with PTE were treated with enalapril (2.5 to 5 mg/d) for 1 year. IGF-1, BP3, GH, Ca, and Ht were determined before as well as 15, 30, 90, 180, and 365 days after enalapril treatment. ACE polymorphism was also determined. Enalapril treatment significantly decreased Ht levels. Only IGF-1 baseline levels showed a positive correlation to the decreased Ht (P < .025). ACE genotype as determined in 18 patients, showed no correlation with the response to enalapril. Patients with ACE genotype II showed a tendency to an earlier display of PTE. We conclude that low doses of enalapril decrease Ht levels in PTE patients; that PTE begins earlier in patients with II ACE genotype; and that only IGF-1 baseline levels influence the Ht decrease after treatment. These observations suggest that ACEI decrease the Ht via an inhibitory effect on IGF-1, which has a stimulary effect on erythropoiesis.

Therapy of visceral leishmaniasis in renal transplant recipients intolerant to pentavalent antimonials.

Visceral leishmaniasis should be suspected in renal transplant recipients in whom a fever develops of unknown origin. A 53-year-old renal transplant recipient developed pyrexia, hepatosplenomegaly, and pancytopenia 4 years after transplantation. Antileishmaniasis serology was negative, and the diagnosis was confirmed through bone marrow examination. Treatment with glucantine (N-methylglucamine antimoniate) led to acute pancreatitis, and treatment with ketoconazole plus allopurinol for 21 days was effective to eradicate Leishmania donovani.

Anesthesia for ruptured cerebral aneurysm surgery associated with chronic renal failure.

The management of patients with chronic renal failure (CRF) undergoing cerebral aneurysm surgery has been documented on only a few occasions. We report a 58-year-old man with CRF and subarachnoid hemorrhage (SAH) due to aneurysm rupture. We describe the patient's perioperative anesthetic management, discussing the current methods for maintaining an appropriate cerebral perfusion pressure and for preventing rehemorrhage from the aneurysm. We suggest that heparin-aided hemodialysis be avoided in these cases.

Immunoprophylaxis with Simulect (basiliximab) in kidney transplantation: results from routine clinical practice at 18 kidney transplant units.

OBJECTIVE: The objective of this study is to assess a Simulect (basiliximab) regimen in routine clinical practice in the Spanish kidney transplantation units to evaluate efficacy and safety. METHODS: In this prospective, observational study, data on demographics, parameters of efficacy, and safety in patients who under with kidney transplantation treated with Simulect (basiliximab) were collected through an on-line collection system. RESULTS: One hundred sixty three patients at 18 kidney transplant units included 12 months follow-up. The patient mean age was 52 years (DS 13,67) including 96 (58.90%) men and 67 (41.10%) women. Cold ischemia time was 19 hours (DS 6,79). Only 2 patients presented with PRA >50%. For prophylactic immunosuppression, 67.13% of patients received triple therapy with CNI (cyclosporine 49.65% or tacrolimus 17.48%), MMF (66.43%) or AZA (10.49%), and steroids. Incidence of acute rejection (AR) at 12 months was 12.27% (1.84% steroid-resistant). In subgroup analysis, AR was 13.5% in nondiabetics and 4.5% in diabetics, including 3 steroid-resistant episodes (1.84%) in nondiabetics and none in diabetics. In relation to donor age, AR was incidence 10.3% in patients with kidneys from donors aged 50 years or younger and 10.6% when donors were older than 50 years, including 1 (1.73%) and 2 (1.93%) steroid-resistant episodes, respectively. The graft and patient survival rates at 12 months were 90% and 98%, respectively. CONCLUSIONS: Simulect (basiliximab) used in routine clinical practice provided good prophylaxis against acute rejection in several kidney transplant patient populations, similar to that observed in randomized clinical studies with excellent tolerability and safety.

[Corynebacterium urealyticum in renal trasplantation. CT and sonography imaging characteristics of encrusted cistitis and pielitis]. / Corynebacterium urealyticum en pacientes con trasplante renal. Imágenes características de la TC y ultrasonografía de la cistitis y pielitis incrustante.

PURPOSE: Its described three cases of Corynebacterium urealyticum (CU) infection in patients with renal transplantation and one of its most serious consequences: encrusted pyelitis and cystitis. It is explained the principal keys for its diagnosis, based in the appearance of alkaline pH in in urine analysis (alkaline urine), positives urinary cultures for CU, and the CT and US studies revealed the characteristic images of calcifications in the wall of renal pelvis and bladder. PATIENTS: Three male patients with renal transplantation and CU infection that caused encrusted pyelitis in two of the cases and encrusted cystitis in one case. RESULTS: Calcifications of the urinary tract were noticed in CT in all the patients. In two cases bladder stones were linear, and in the third case they were fundamentally coarse and placed in pelvis. The diagnosis suspicion showed by the images was confirmed by the use of prolonged urine cultures, necessary for detecting CU. All the patients were treated with vancomycin, with success in two of the cases and, finally needing surgery, and after loss of the graft, in the other case. CONCLUSION: Encrusted pyelitis and cystitis are cronic and severe infections of the urinary tract. Calcic struvite incrustations in the urothelium are characteristics of this infection. CT is a choice technique for the diagnosis and followup of the calcifications after treatment.

[Changes in the upper airway in patients with sleep obstructive apnea and/or chronic snoring treated with mandibular appliances]. / Cambios en la vía aérea superior de pacientes con apnea obstructiva del sueño y/o roncopatía crónica en tratamiento con posicionadores mandibulares.

We have analysed the possible modifications in the upper airways (UA) of the lateral cranial teleradiography in 25 adult males with Obstructive Sleep Apnea (OSAS) and/or chronic snoring, with dental and squeletal Class I, treated with advance mandibular appliances (MAD). Results of our study showed a clear increase of the UA in the oropharynx in all the subjects studied. The study of the changes in the UA using the lateral cranial teleradiography in order to evaluate the effectiveness of the MAD can contribute to consider its effectiveness in the cases with OSAS when they are indicated. However it will be needed to contrast these results with polisomnography.

"Lo mejor es no empezar a fumar". Campaña preventiva del hábito tabáquico en alumnos de 1º de la ESO desde la farmacia comunitaria / "It's best not to start smoking". Preventive campaign of the tobacco habit in 1st of "ESO" students from the community pharmacy

Introducción: el tabaco es un enorme problema de salud pública. Los preadolescentes son población diana ideal para las campañas antitabaco. Objetivos: analizar prevalencia, actitudes y creencias de alumnos de 1º de la Enseñanza Secundaria Obligatoria (ESO) sobre el hábito tabáquico. Sensibilizar a la población preadolescente contra el hábito tabáquico. Presentar al farmacéutico comunitario a los centros educativos como profesional sanitario implicado en la prevención tabáquica. Material y métodos: estudio descriptivo observacional durante 4 meses de la campaña Lo mejor es no empezar a fumar (www.lomejoresnoempezarafumar.com), en la que participaron 1.298 alumnos, de 20 localidades extremeñas. Los datos fueron recogidos en las aulas, con encuesta online, anónima, estandarizada y autoadministrada, creada con Google Drive. Resultados: muestra con el 51,3 % chicos y 48,7 % chicas. El 10,2 % de ellos de zonas rurales. Un 96,2 % considera que fumar es perjudicial para la salud. Un 86,7 % es consciente de que es una droga. El 12,5 % lo ha probado y un 3,4 % admite fumar. El 64,3 % cree que el cigarro electrónico es mejor que el cigarro tradicional. La razón que más motivaría, a los fumadores, a dejarlo es su salud (40,4 %). Si necesitaran ayuda para dejar de fumar, la mayoría se dirigiría a un psicólogo (38,5 %) y sólo un 5,1 % acudiría a un farmacéutico. Conclusiones: la muestra obtenida es de una generación asentada en principios básicos de salud y casi la totalidad considera perjudicial fumar. Sin embargo, 1 de cada 8 admite haber probado un cigarro. Por ello consideramos que la prevención podría ser útil y necesaria. Aunque se estima la edad media de inicio al consumo de tabaco a los 14 años, sería conveniente desarrollar campañas preventivas a edades más tempranas. A los farmacéuticos aún nos queda mucho trabajo por hacer para ser percibidos como profesionales sanitarios de primera línea en la lucha contra el tabaco

Introduction: Tobacco is an enormous public health problem. Preteens are a target population for anti-smoking campaigns. Objectives: To analyse the consumption data, attitudes and general beliefs regarding tobacco habit of 1st of ESO students. Sensitize the preadolescent population against smoking. Present the pharmacist to the educational community as a health professional involved in smoking prevention. Material and methods: A descriptive, observational study conducted over four months as part of campaign "IT'S BEST NOT TO START SMOKING" (www.lomejoresnoempezarafumar.com) in which 1298 students participated from 20 Extremadura localities. Data collected in the classroom, via an online survey, anonymous, standardised and self-administered, collected on Google Drive

C1q-fixing human leukocyte antigen assay in immunized renal patients: correlation between Luminex SAB-C1q and SAB-IgG.

BACKGROUND: There is no consensus about the impact of thresholds of complement-fixing antibody assays. Recently, a C1q-SAB assay has been developed to identify complement-fixing HLA antibodies with high sensitivity and specificity. Our aim was to determine the correlation between IgG single antigens beads (SAB) and C1q-SAB assay results among patients on the renal waiting list. PATIENTS AND METHODS: Serum samples from immunized renal waiting list patients as well as negative and positive controls were valided by Luminex (LMX). These sera, which were positive for 166 antibody specificities, were tested for HLA class I in parallel by LMX-IgG and LMX-C1q. RESULTS: Comparison of antibody detection revealed no correlation based on median fluorescent intensity (MFI), levels between the IgG SAB and the C1qSAB assay (P > .05). IgG-positive sera with MFIs as low as 700 were able to fix C1q, whereas other sera with MFIs as high 14,500 did not. Furthermore, there appeared to be disparities in the profiles of class I antigens able to fix C1q-SAB. In our series, only 34% class I IgG SAB antibodies were also C1qSAB+. In several patients, we detected C1qSAB+ against IgGSAB- that was surely due to IgM antibodies. So, the C1qSAB assay detected IgM antibodies that fix complement. CONCLUSION: These data suggested that the C1q-SAB assay could be an important method to evaluate pretransplant virtual crossmatch and to define nonpermitted specificities (C1q-fixing) in kidney transplantation.

[Evaluation of program coverage of the hepatitis B vaccination in a school population. Navarra 1992-1993]. / Evaluación de la cobertura del programa de vacunación contra la hepatitis B en población escolar. Navarra 1992-1993.

OBJECTIVE: To evaluate the coverage of the programme of control and coverage of Hepatitis B among children doing their 7th year of EGB (basic) in Navarra. DESIGN: Descriptive study. SETTING: School centres in Navarra. PARTICIPANTS: 7th-year EGB students in the 1992-3 school year. INTERVENTION: Vaccination of the susceptible population with three doses of anti-HB vaccine on the 0-1-6 months pattern. MEASUREMENTS AND MAIN RESULTS: Nominal data of children vaccinated were obtained from 171 schools out of a total of 185 (92.43%). For the rest of the centres, it is known only that vaccinations took place within the School Health Programme. The susceptible population was 6,955 children, of whom 97.8% received the first dose, 97% the second and 95.6% the third. The most common cause of non-vaccination in these children was lack of parental authorization, which reached 1.8%. CONCLUSIONS: A School Health programme, which is well-established and closely linked to the Primary Care network, together with a broad diffusion of information about the adolescent Vaccination Programme were key to its widespread introduction and the excellent coverage attained.

La historia clínica informatizada: ¿es posible aplicarla a la asistencia domiciliaria en Cuidados Paliativos? / No disponible

La accesibilidad y actualización de la información de la historia clínica de los pacientes constituyen los elementos claves para dar una respuesta asistencial ágil y eficaz ante los cambios en la evolución clínica. Es en el campo de los Cuidados Paliativos y especialmente en el ámbito domiciliario donde se manifiestan con mayor intensidad las dificultades del equipo asistencial interdisciplinar en lograr una toma de decisiones rápida y acertada ante un cambio evolutivo del paciente. La historia clínica convencional, en este contexto, se muestra limitada para dicha respuesta asistencial coordinada, rápida y acertada que exige la atención de nuestros pacientes. En este artículo se presenta el proceso de aplicación de las nuevas tecnologías informáticas en la mejora de la calidad de atención continuada de pacientes a domicilio, mediante el desarrollo e implantación de la historia clínica informatizada on-line. Fases del proceso: Fase I. Diseño de la historia clínica informatizada. Fase II. Desarrollo del software. Fase III. Aplicación del programa. Fase IV. Evaluación y mejoras continuadas (AU)

Accessibility to and maintenance of patient records are key elements to provide an efficient, dynamic, appropriate healthcare response when facing changes in the clinical outcome of patients. It is in the field of palliative care, specifically in home care assistance, that an interdisciplinary palliative team has most difficulties in making quick, accurate clinical decisions in case of patient worsening. In this context traditional patient records fail to make possible an appropriate, fast, coordinated response, all of them necessary requirements in the management of such patients. In this article the process of using new computer science technologies for improved quality in the continual care of patients in their homes through the development and implementation of computerized patientrecords on-line is discussed. Process phases: Phase I. Design of a computerized patient record. Phase II. Software development. Phase III. Software application. Phase IV. Continued evaluation and improvements (AU)

Cambios en la vía aérea superior de pacientes con apnea obstructiva del sueño y/o roncopatía crónica en tratamiento con posicionadores mandibulares / Upper airway changes in patients with obstructive sleep apnea and/or chronic snoring treated with mandibular appliances

Se han estudiado las variaciones de las vías aéreas superiores (VAS) en la telerradiografía lateral de cráneo en 25 adultos varones con apnea obstructiva del sueño (SAOS) y/o roncopatía crónica (RC), con Clase I dental y esquelética, tratados con posicionadores de avance mandibular (PAM). Los resultados de nuestro trabajo muestran un claro incremento de las VAS a nivel de orofaringe en todos los casos estudiados. El estudio de los cambios en las VAS, utilizando la telerradiografía lateral de cráneo, para valorar la eficacia de los PAM puede contribuir a considerar su eficacia en los casos con SAOS en los que estén indicados, aunque será necesario contrastarlos con los resultados de la polisomnografía (AU)

We have analysed the possible modifications in the upper airways (UA) of the lateral cranial teleradiography in 25 adult males with Obstructive Sleep Apnea (OSAS) and/or chronic snoring, with dental and squeletal Class I, treated with advance mandibular appliances (MAD). Results of our study showed a clear increase of the UA in the oropharynx in all the subjects studied. The study of the changes in the UA using the lateral cranial teleradiography in order to evaluate the effectiveness of the MAD can contribute to consider its effectiveness in the cases with OSAS when they are indicated. However it will be needed to contrast these results with polisomnography (AU)