Acute Kidney Injury and Urinary and Histopathological Disorders in Kidney Transplant Patients with SARS-CoV-2 Infection.

BACKGROUND: Acute kidney injury (AKI) is a manifestation of SARS-CoV-2 infection. The evidence in kidney transplant (KT) is limited, as there are scarce data about the histologic features in graft biopsies of these patients. MATERIAL AND METHODS: A retrospective cohort study of KTs with SARS-CoV-2 infection from August 28, 2020, to April 23, 2021. We collected the incidence of AKI and the presence of urinary and histopathological disorders. Both groups were compared (AKI vs no AKI). Immunohistochemical and reverse transcription-polymerase chain reaction studies were performed on the anatomopathological samples. RESULTS: In our study, 72 KTs had SARS-CoV-2 infection and, among them, 27 patients (35.1%) developed AKI related to increased severity and a worse evolution of the infection, defined by a greater presence of pneumonia (P < .001), hospitalization (P < .001), admission to the intensive care unit (P < .001), the need for ventilation support (P < .001), and continuous renal replacement therapy (P < .001). In the multivariable analysis, pneumonia behaved as an independent predictor for AKI development (P = .046). No differences were observed between proteinuria a month before and after infection (P = .224). In addition, 5 patients showed microhematuria and 2 patients presented transient glycosuria without hyperglycemia. Of the 5 kidney biopsies performed, 1 biopsy (20%) showed positive reverse transcription polymerase chain reaction for SARS-CoV-2. CONCLUSIONS: AKI is a frequent and potentially serious complication in KT patients. Occasionally it could be accompanied by abnormalities in the urinary sediment. Of 5 biopsied patients, 1 patient had positive reverse transcription polymerase chain reaction in renal tissue, which suggests the systemic spread of the virus and the tropism for the renal graft.

Coexistence of GH-Producing Pituitary Macroadenoma and Meningioma in a Patient with Multiple Endocrine Neoplasia Type 1 with Hyperglycemia and Ketosis as First Clinical Sign.

We present the clinical case of a patient who was admitted with an onset of diabetes mellitus (DM) with associated ketosis and whose clinical, hormonal, and radiological evolution revealed the presence of primary hyperparathyroidism, pancreatic neuroendocrine tumor, and GH-producing pituitary macroadenoma in the context of multiple endocrine neoplasia type 1 (MEN1). DM is relatively common in cases of acromegaly, but it is not generally associated with ketosis. Simultaneously, the patient presented a meningioma, which is associated with pituitary macroadenoma only in extremely rare cases.

[Sepsis, cardiomyopathy and human immunodeficiency virus infection: presentation of a case]. / Sepsis, miocardiopatía e infección por el virus de la inmunodeficiencia humana: a propósito de un caso.

Sepsis in patients with human immunodeficiency virus (HIV) may be associated with the appearance of cardiac dysfunction. This is a challenge, both when making the differential diagnosis and determining the proper treatment, as there are numerous risk factors: Myocarditis due to the HIV itself, the presence or absence of highly active antiretroviral therapy, toxic substances, and cardiomyopathy associated with sepsis. The diagnostic and therapeutic approach to an HIV positive patient with septic shock and cardiac dysfunction is described, as well as a brief review of the different causes of cardiomyopathy which may affect this group of patients is also presented.

SU-E-T-290: Dosimetric Verification of Helical Tomotherapy against Experimental Measurements for Head and Neck Treatments.

PURPOSE: To verify a Tomotherapy plan for a typical head and neck treatment against experimental measurements. METHODS: The treatment plan for a head and neck case was generated by the Tomotherapy treatment planning system (TPS) to deliver ∼70 Gy in 33 sessions to the contoured PTV. The plan was calculated on a CIRS ATOM anthropomorphic phantom that provides a grid spacing of 3×3 cm2 holes to accommodate thermoluminescent detectors (TLD). The plan was verified against experimental measurements carried out by 7 LiF:Mg,Ti (TLD-700) TLD. Up to 20 locations were selected within the irradiated region and three detectors were used simultaneously at each point to decrease the statistical uncertainty. TLD locations were labeled in the planning system and dose comparisons between TPS prediction and experimental measurements were performed in terms of absolute dose to water for a single fraction. We examined the dose from (i) the corresponding 3.5MV Tomo-scan alone and (ii) the complete treatment. TLD-700 were found to fulfill the requirements of reproducibility, linearity and flat energy response in a previous study. In particular, TLD energy response was previously checked for 6 MV flattening filter free and conventional radiation beams under reference conditions. RESULTS: Doses derived from the TPS were in most cases in good agreement (4% on average) with TLD dose measurements within TLD statistical uncertainties (about 3%). Larger discrepancies up to 7% were found for points close to complex tissue inhomogeneities, such as bony structures. Dose from the scanning procedure alone is about 1 % of the dose per fraction. CONCLUSIONS: This work indicates that dose delivery plans created with Tomotherapy TPS are accurate for head and neck tumor localizations.

Effect of simplification from protease inhibitors to boosted atazanavir-based regimens in real-life conditions.

BACKGROUND: Atazanavir (ATV) boosted with ritonavir (ATV/r) is a potent, well-tolerated, once-daily protease inhibitor (PI). Few data are available on this agent as a treatment simplification option for patients taking other PIs. OBJECTIVE: The aim of the study was to determine the effectiveness and safety of ATV-containing regimens in patients who have simplified their antiretroviral treatment. METHODS: SIMPATAZ was a multicentre, prospective, noninterventional study in patients who had undetectable HIV RNA on their current PI-containing therapy and who were switched to an ATV/r-based regimen. Patients underwent a routine physical examination, and data were collected on HIV RNA levels, CD4 cell counts, liver function, lipid parameters, adverse reactions, adherence to treatment and patient satisfaction. RESULTS: A total of 183 patients were enrolled in the study and included in the analysis (80% were male, 29% had AIDS, and 52% were coinfected with HIV and hepatitis B virus or hepatitis C virus). The median baseline CD4 count was 514 cells/µL. Median exposure to previous HIV therapy was 8 years, and 32% of patients had a history of PI failures. Lopinavir boosted with ritonavir was the most frequent PI replaced (62%) and tenofovir+lamivudine /emtricitabine the backbone most used during the study (29%). The study drug was discontinued early by 25 patients (14%), two of whom discontinued as a result of adverse events (Hodgkin lymphoma and vomiting). Two patients died (lung cancer and myocardial infarction). At month 12, 93% of the study population had an undetectable HIV RNA viral load. Hyperbilirubinaemia >3 mg/dL and increased alanine aminotransferase levels>200 IU/L were observed in 38.5% and 4.4% of patients, respectively. Median changes from baseline to month 12 in total cholesterol, triglycerides and low-density lipoprotein cholesterol were -13 mg/dL (-7%; P<0.0001), -19 mg/dL (-13%; P<0.0001) and -7 mg/dL (-6%; P=0.021), respectively. CONCLUSIONS: In a real-world setting, switching from other PIs to ATV/r is a well-tolerated and safe option for improving the lipid profile and for retaining virological response in controlled pretreated patients.

[Cardiac tamponade caused by aortic pseudoaneurysm with fistula in the right ventricle]. / Taponamiento cardíaco por pseudoaneurisma aórtico fistulizado a ventrículo derecho.

A 69-year-old woman, with an aortic replacement valve for rheumatic aortic insufficiency suffered a sudden cardiac tamponade caused by a ruptured pseudoaneurysm of the ascending aorta which had its origin in the suture of the aorta performed 10 years earlier. The cardiac tamponade presented as syncope, absent central pulse, and respiratory failure. Hemodynamic variables recovered with early detection and start of cardiopulmonary resuscitation maneuvers. After fluids were replaced and following catecholamine treatment, a transesophageal echocardiogram revealed a pseudoaneurysm and continuous flow between the aorta and the right ventricle. The aneurysm and an unusual right ventricular fistula were repaired surgically through an emergency exploratory sternotomy. Cardiovascular recovery was satisfactory although hospital discharge was delayed because of pulmonary complications leading to severe hypoxia, pleural effusion, and pneumonia, with tracheal aspirate and bronchoalveolar lavage cultures positive for Pseudomonas aeruginosa, Acinetobacter spp, and Aspergillus flavus. We stress that immediate start of cardiopulmonary resuscitation prevented multiorgan failure and allowed for satisfactory recovery from surgery in spite of the presence of risk factors for mortality.

[Cesarean section in a patient with threatening hemoptysis caused by tracheal carcinoid]. / Cesárea a una paciente con hemoptisis amenazante por carcinoide traqueal.

A woman 29 weeks pregnant presented with acute respiratory insufficiency and massive hemoptysis of unknown origin. An emergency cesarean section was performed to avoid hypoxic fetal damage during episodes of maternal hypoxemia. Bleeding was due to an unsuspected endotracheal carcinoid tumor located near the carina. The tumor obstructed the distal portion of the trachea, leading to life-threatening complications during tracheal intubation because of its histological characteristics and placement. Pulse oximetry response to standard mechanical ventilation was unsatisfactory. Special measures to ventilate mother and fetus were successful, in spite of iatrogenic pneumothorax and pneumomediastinum. We report an exceptional case of tracheal carcinoid tumor during the pregnancy and recommend that tracheal or bronchial intubation take place under fiber optic guidance in cases of hemoptysis with no firm etiologic diagnosis.

[Chromophobe renal cell carcinoma: immunohistochemical study of 7 cases]. / Carcinoma renal de células cromófobas: estudio inmunohistoquímico de siete casos.

UNLABELLED: A series of 7 cases of chromophobe cell carcinoma with clinicopathological correlation is studied. The immunohistochemistry analysis was carried out evaluating in all cases: low and high cytoqueratines (AE1, AE3), membrane epithelial antigen (EMA), vimentin, carcinoembrionary antigen (CEA), proliferative cell nuclear antigen (PCNA) and the oncoproteins p53 and focal c-erbB2. In all cases a diffuse positivity for EMA, AE3 and focal for AE1 was observed, while vimentin and CEA were negative. The positivity for PCNA was always less than 25% of tumoral cells. The oncoprotein p53 was in all cases negative and only in one case a mild and focal positivity for c-erbB2 was observed. CONCLUSIONS: 1) The negativity for vimentin and positivity for EMA, AE1 and AE3 allows to differentiate this carcinoma from clear cell carcinoma. This corroborate a distinct histogenesis, thus suggesting their origin in the intercalar cells of distal collector tubules. 2) The low values of PCNA and the negativity for both oncoproteins p53 and c-erbB2 supports the low aggresivity of this tumor and a better prognostic than other types of kidney carcinomas.

[Primary signet ring cell adenocarcinoma of the bladder. Report of 2 cases of bladder plastic linitis]. / Adenocarcinoma de células en anillo de sello primario de vejiga. Presentación de dos casos de linitis plástica vesical.

OBJECTIVES: Two additional cases of signet-ring cell adenocarcinoma of the urinary bladder, an uncommon highly malignant tumor type, are described. METHODS/RESULTS: The clinical features, histopathological findings and immunohistochemical study are presented. CONCLUSIONS: Both cases previously had cystic glandular cystitis, which supports the totipotent urothelium origin of this neoplasm. Signet-ring cell adenocarcinoma or linitis plastica of the bladder has a highly malignant course despite neoadjuvant chemotherapy and total cystectomy.