[E-health tools to overcome the gap in epilepsy care before, during and after COVID-19 pandemics]. / Herramientas de salud digital para superar la brecha de atención en epilepsia antes, durante y después de la pandemia de COVID-19.

INTRODUCTION: Epilepsy is a common chronic neurological disorder that affects around 50 million worldwide and there is an abundance of literature on the health care gap for this sector of the population. This gap will increase with the current pandemic due to COVID-19. AIM: To evaluate the current availability of digital health tools for the care of people with epilepsy according to the world medical literature and their use during said pandemic. DEVELOPMENT: We reviewed the publications in scientific journals in the last decade that had as their main topic the use of digital health tools or telemedicine focused on the care of patients with epilepsy, including 4 months after the national quarantines due to the appearance of the virus SARS-CoV-2. Seventeen publications were found on the use of telemedicine focused on epilepsy. The most widely used tools internationally are online platforms, followed by mobile applications, videoconferences, epileptic seizure capture systems, checklists, algorithms for understanding medical data, phone calls, tele-encephalography and text messages. None was published during the COVID-19 current pandemic. CONCLUSIONS: Although there is little literature on the use of digital health tools focused on epilepsy, there are several that can be used to fight the attention gap, especially in this global pandemic by COVID-19 that forces quarantines of people and communities for long periods. It is necessary to remove barriers and facilitate patient access to these new information technologies.

TITLE: Herramientas de salud digital para superar la brecha de atención en epilepsia antes, durante y después de la pandemia de COVID-19.Introducción. La epilepsia es un trastorno neurológico crónico común que afecta alrededor de 50 millones de personas en el mundo y abunda la bibliografía sobre la brecha de atención en salud a este sector de la población. Dicha brecha aumentará con la pandemia actual de COVID-19. Objetivo. Evaluar la disponibilidad actual de herramientas de salud digital para la atención a personas con epilepsia según la literatura médica mundial y su uso durante dicha pandemia. Desarrollo. Se hizo una revisión de las publicaciones en revistas científicas en la última década que tuvieran como tema principal el uso de herramientas de salud digital o telemedicina enfocada a la atención de los pacientes con epilepsia, incluyendo cuatro meses después de las cuarentenas nacionales por la aparición del virus SARS-CoV-2. Se encontraron 17 publicaciones sobre el uso de telemedicina enfocada a la epilepsia. Las herramientas más utilizadas internacionalmente son las plataformas en línea, seguidas de las aplicaciones móviles, videoconferencias, sistemas de captación de crisis epilépticas, listas de verificación, algoritmos de comprensión de datos médicos, llamadas telefónicas, telelectroencefalografía y mensajes de texto. Ninguna se publicó durante la presente pandemia. Conclusiones. Hay poca bibliografía sobre herramientas de salud digital enfocadas a epilepsia, pero existen varias que pueden emplearse para luchar contra la brecha de atención, especialmente en esta pandemia mundial de COVID-19 que obliga a las personas y comunidades a mantenerse en cuarentena por la emergencia sanitaria. Es necesario eliminar barreras y facilitar el pronto acceso de los pacientes a estas nuevas tecnologías de información.

Antibody-Mediated Rejection Treatment With Bortezomib in Renal Transplant Recipients: A Single-Center 24-Month Follow-up Case Report.

INTRODUCTION: Antibody-mediated rejection (AMR) is related to a poor prognosis in graft survival, with 27% to 40% of patients experiencing graft loss within the first year. The mechanism of damage in AMR is mediated by donor-specific antibodies (DSA). No standard treatment for AMR exists, and conventional management includes high doses of steroids, plasmapheresis, intravenous immunoglobulin, and either rituximab or bortezomib. Because of the high cost of these medications and the lack of prospective studies to evaluate their efficacy and safety, their routine use is limited. In the following study, we describe the use of bortezomib for the treatment of AMR in 5 renal transplant recipients with a 24-month follow-up and compare this case with the reviewed literature. MATERIAL AND METHODS: Five cases of AMR diagnosed by biopsy are reported, and these patients received bortezomib at a rate of 1.3 mg/m2 on days 1, 4, 8, and 11; plasmapheresis; and 1 patient received 30 g of intravenous immunoglobulin. RESULTS: All patients received his or her first transplant; 4 were from a cadaveric donor, and 1 patient received thymoglobulin at a standard dose. All patients had maintenance therapy based on cyclosporine, mycophenolate mofetil, and prednisone, with an average baseline creatinine level of 1.3 mg/dL. The average days until rejection event were 952 days. DISCUSSION AND CONCLUSION: AMR treatment with bortezomib was effective, showing stable renal function at 24 months. Patients had adequate tolerance for administration. So far, these results contrast with the literature reviewed, so additional studies and follow-up are required for a new evaluation.

Metabolic Syndrome, a Real Barrier for Living Kidney Donor Transplant.

INTRODUCTION: Renal transplantation is the optimal renal replacement therapy. In Mexico, most of the kidney transplants are from living donors. It is essential to identify conditions that increase the risk of developing chronic kidney disease (CKD) in donors, such as metabolic syndrome (MS). MATERIALS AND METHODS: In retrospect from January 2008 to December 2018, the donation protocols for renal transplantation of the Hospital Central Sur Alta Especialidad "Picacho" were reviewed, classifying all the cases of donors by nephrectomy or no nephrectomy and describing the demographic characteristics, prevalence of metabolic diseases, and cause of rejection of the protocol. RESULTS: A total of 178 donors were studied: 82 women (46%), 96 men (54%), mean age of 42 years, average body mass index (BMI) 27.9 kg/m2, glomerular filtration rate (GFR) by Chronic Kidney Disease Epidemiology Collaboration 99 mL/min, 59 patients with grade I and II obesity (BMI ≥ 30 kg/m2), and 1 patient with morbid obesity (BMI ≥ 40 kg/m2). A total of 39 patients (22%) underwent nephrectomy and 139 (78%) did not. The following characteristics and alterations were found: Of the 139 patients who did not undergo nephrectomy, 91 had metabolic disorders, 20 had low GFR, 21 had albuminuria, and 4 recipients received cadaveric transplants, 3 due to critical conditions of the recipient. The metabolic alterations in the rejected donors were as follows: MS 54 (59%), prediabetes 55 (39%), newly diagnosed hypertension 70 (76%), diabetes mellitus 20 (14%), obesity 47 (51.6%), dyslipidemia 76 (83%), hyperuricemia 17 (12%). DISCUSSION: The prevalence of MS in apparently healthy donors is similar to that of other studies in Mexico. Both MS and its components are independently associated with an increased risk of cardiovascular disease and CKD. It has been shown that these donors have a greater degree of glomerular and interstitial fibrosis; therefore, diagnosis, prevention, and timely treatment in this group are important.