Impact of anti-HCV direct antiviral agents on graft function and immunosuppressive drug levels in kidney transplant recipients: a call to attention in the mid-term follow-up in a single-center cohort study.

The medium-term impact on graft function and immunosuppressive drug pharmacokinetics of direct antiviral agents (DAAs) among hepatitis C virus (HCV)-infected kidney transplant (KT) recipients remain unclear. We compared pre- and post-treatment 12-month trajectories of estimated glomerular filtration rate (ΔeGFR) and 24-h proteinuria (Δ24-h proteinuria) in 49 recipients treated with DAAs (mostly sofosbuvir plus ledipasvir). Among evaluable patients, 66.7% and 100.0% had undetectable viral load by week 4 and end of therapy (EoT). The sustained virologic response rate at 12 weeks was 95.8%. Overall, 80.6% of patients receiving tacrolimus required dose escalation while on DAA-based therapy (median increase of 66.7%) to maintain target levels. Tacrolimus levels resulted to be higher at 12 months compared to EoT (7.8 ± 2.1 vs. 6.7 ± 2.0 ng/ml; P-value = 0.002). No changes in graft function during the course of therapy were observed. However, eGFR significantly decreased (P-value <0.001) throughout the first 12 months after EoT. Median ΔeGFR and Δ24-h over pre- and post-treatment periods were 3.9% and -6.1% (P-value = 0.002) and -5.3% and 26.2% (P-value = 0.057). Caution should be exercised when adjusting immunosuppression in HCV-infected KT recipients upon initiation of DAAs, followed by mid-term monitoring of immunosuppressive drug levels and graft function.

Sustained attention, visual processing speed, and IQ in children and adolescents with Schizophrenia Spectrum disorder and Psychosis Not Otherwise Specified.

To investigate the cognitive functioning of children and adolescents with Schizophrenia Spectrum disorders and Psychosis Not Otherwise Specified, 22 child and adolescent psychiatric inpatients and day-hospital patients at a state psychiatric hospital with Schizophrenia Spectrum disorders, 30 with Psychosis Not Otherwise Specified, and 130 with other psychiatric disorders, ages 8 to 17 years, were administered the Wechsler Intelligence Scale for Children-III for psychological assessment at admission. The Performance IQs of the ADHD and the Conduct Disorder and Oppositional Defiant Disorder groups were significantly higher than those of the Schizophrenia Spectrum and the Psychosis Not Otherwise Specified groups, and the Full Scale IQs of the Conduct Disorder and Oppositional Defiant Disorder group were significantly higher than those of the Schizophrenia Spectrum group and the Psychosis Not Otherwise Specified group. The Coding scores of the ADHD group were significantly higher than those of the Schizophrenia Spectrum, the Psychosis Not Otherwise Specified, and the Bipolar Disorder groups. There was a significant negative correlation between age and Digit Span for the Schizophrenia Spectrum disorders group.

Fracaso renal agudo en pacientes con mieloma: Nuestra experiencia con hemodiálisis extendidas con dializadores de alto poro / Acute renal failure in patients with myeloma: Experience with extended high cut-off hemodialysis

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