Percutaneous Left Atrial Appendage Closure in Patients with Non-Valvular Atrial Fibrillation and End-Stage Renal Disease on Hemodialysis: A Case Series.

Non-valvular atrial fibrillation (NVAF) is the most common cardiac arrhythmia in the general population, and its prevalence increases among patients with chronic kidney disease (CKD) undergoing hemodialysis. This population presents high risk of both hemorrhagic and thrombotic events, with little evidence regarding the use of oral anticoagulation treatment (OAT) and multiple complications arising from it; however, stroke prevention with percutaneous left atrial appendage closure (LAAC) is an alternative to be considered. We retrospectively describe the safety and efficacy of percutaneous LAAC in eight patients with NVAF and CKD on hemodialysis during a 12-month follow-up. The mean age was 78.8 years (range 64-86; SD ± 6.7), and seven patients were male. The mean CHA2DS2-VASC and HAS-BLED scores were high, 4.8 (SD ± 1.5) and 3.8 (SD ± 1.3), respectively. Seventy-five percent of the patients were referred for this intervention due to a history of major bleeding, with gastrointestinal bleeding being the most common type, while the remaining twenty-five percent of the patients were referred because of a high risk of bleeding. The percutaneous LAAC procedure was successfully completed in 100% of the patients, with complete exclusion of the appendage without complications or leaks exceeding 5 mm. There was one death not related to the procedure four days after the intervention. Among the other seven patients, no deaths, cardioembolic events or major bleeding were reported during the follow-up period. In our sample, percutaneous LAAC appears to be a safe and effective alternative to anticoagulation in patients with NVAF and CKD on hemodialysis.

Double Hit of Hydroxichloroquine and Amiodarone Induced Renal Phospholipidosis in a Patient with Monoclonal Gammopathy and Sclerodermiform Syndrome: A Case Report and Review of the Literature.

Phospholipidosis is a rare disorder which consists of an excessive intracellular accumulation of phospholipids and the appearance of zebra bodies or lamellar bodies when looking at them using electron microscopy. This disease is associated with certain genetic diseases or is secondary to drugs or toxins. Drug-induced phospholipidosis encompasses many types of pharmaceuticals, most notably chloroquine, amiodarone or ciprofloxacin. Clinically and histologically, renal involvement can be highly variable, with the diagnosis not being made until the zebra bodies are seen under an electron microscope. These findings may require genetic testing to discount Fabry disease, as its histological findings are indistinguishable. Most of the chemicals responsible are cationic amphiphilic drugs, and several mechanisms have been hypothesized for the formation of zebra bodies and their pathogenic significance. However, the relationship between drug toxicity and phospholipid accumulation, zebra bodies and organ dysfunction remains enigmatic, as do the renal consequences of drug withdrawal. We present, to our knowledge, the first case report of acute renal injury with a monoclonal gammopathy of renal significance, lesions, and sclerodermiform syndrome, with zebra bodies that were associated with the initiation of a hydroxychloroquine and amiodarone treatment, as an example of drug-induced-phospholipidosis.

Europium-tannic acid nanocomplexes devised for bone regeneration under oxidative or inflammatory environments.

Europium ions (Eu3+) are gaining attention in the field of regenerative medicine due to increasing evidence of their osteogenic properties. However, inflammatory and oxidative environments present in many bone diseases, such as osteoporosis or rheumatoid arthritis, are known to hinder this regenerative process. Herein, we describe a straightforward synthetic procedure to prepare Eu3+-tannic acid nanocomplexes (EuTA NCs) with modulable physicochemical characteristics, as well as antioxidant, anti-inflammatory, and osteogenic properties. EuTA NCs were rationally synthesized to present different contents of Eu3+ on their structure to evaluate the effect of the cation on the biological properties of the formulations. In all the cases, EuTA NCs were stable in distilled water at physiological pH, had a highly negative surface charge (ζ ≈ -25.4 mV), and controllable size (80 < Dh < 160 nm). In vitro antioxidant tests revealed that Eu3+ complexation did not significantly alter the total radical scavenging activity (RSA) of TA but enhanced its ability to scavenge H2O2 and ferrous ions, thus improving its overall antioxidant potential. At the cellular level, EuTA NCs reduced the instantaneous toxicity of high concentrations of free TA, resulting in better antioxidant (13.3% increase of RSA vs. TA) and anti-inflammatory responses (17.6% reduction of nitric oxide production vs. TA) on cultures of H2O2- and LPS-stimulated macrophages, respectively. Furthermore, the short-term treatment of osteoblasts with EuTA NCs was found to increase their alkaline phosphatase activity and their matrix mineralization capacity. Overall, this simple and tunable platform is a potential candidate to promote bone growth in complex environments by simultaneously targeting multiple pathophysiological mechanisms of disease.

Workforce readiness for pharmacogenomics and key elements for sustainment within the Veterans Health Administration.

Aim: Understanding barriers and facilitators to pharmacogenomics (PGx) implementation and how to structure a clinical program with the Veterans Health Administration (VA). Materials & methods: Healthcare provider (HCP) survey at 20 VA facilities assessing PGx knowledge/acceptance and qualitative interviews to understand how best to design and sustain a national program. Results: 186 (12% response rate) surveyed believed PGx informs drug efficacy (74.7%) and adverse events (71.0%). Low confidence in knowledge (43.0%) and ability to implement (35.4-43.5%). 23 (60.5% response rate) interviewees supported a nationally program to oversee VA education, consultation and IT resources. Prescribing HCPs should be directing local activities. Conclusion: HCPs recognize PGx value but are not prepared to implement. Healthcare systems should build system-wide programs for implementation education and support.

An Unusual Case of Immune Complex-Mediated Membranoproliferative Glomerulonephritis as Renal Manifestation of Idiopathic Hypereosinophilic Syndrome: A Case Report and Literature Review.

BACKGROUND: Idiopathic hypereosinophilic syndrome (IHES) is a disorder characterized by abnormal and persistent peripheral blood hypereosinophilia (eosinophil count ≥ 1.5 × 109/L and ≥10% eosinophils) with duration ≥ 6 months, associated organ damage, and/or dysfunction attributable to tissue eosinophilic infiltrate of unknown cause. IHES affects different organs such as the heart, lungs, nervous system, and skin, with renal involvement being rare in this condition. CASE PRESENTATION: We present a case of a young patient with IHES and immune complex-mediated membranoproliferative glomerulonephritis with nephrotic syndrome, as a rare renal manifestation. We discuss the clinical, analytical, and histopathologic renal and hematologic features, comparing them with other reported cases in the literature.

Feasibility and Safety of Percutaneous Kidney Biopsy in Small Kidneys: Breaking the Paradigm.

INTRODUCTION: The percutaneous kidney biopsy (PKB) is an essential tool in nephrology; small kidney size has been a relative contraindication to PKB and there is limited data on the safety and utility of performing PKB in this setting. Our aim was to describe the complications of PKB in small kidneys and to assess if kidney biopsy results have an impact on medical decisions and outcomes. METHODS: This was a retrospective, descriptive, and observational study. Patients older than 16 years of age with a decreased kidney size (≤8 cm) and undergoing PKB of native kidneys from July 2019 to December 2022 were included. RESULTS: Twenty-five patients were included, 19 women and 6 men. The mean age was 42.3 ± 18.04. The mean kidney length was 7.56 ± 0.33 and the mean width was 4.2 cm. All patients received only 1 puncture, obtaining an average of 12 glomeruli. The mean blood urea nitrogen and serum creatinine were 36 mg/dL and 1.94 mg/dL, respectively and the mean Hgb (hemoglobin) was 12.87 ± 2.81 g/dL. Minor complications occurred in 5 patients, perirenal hematoma in 3 patients, hematuria in 1 patient, and hematoma plus hematuria in 1 patient. Histological examination showed FSGS, lupus nephritis, other Glomerular disease, crescentic glomerulonephritis, and tubulointerstitial nephritis in 36%, 20%, 16%, 16%, and 12% of the cases, respectively. Biopsy resulted in management modification in 64% of cases. In a bivariate analysis, kidney size was not associated with higher complication rates. CONCLUSIONS: PKB in small kidneys is a feasible and safe procedure when properly planned, providing an adequate sample in all cases, with an insignificant number of minor complications, and that is clinically relevant.

Waldenström's Macroglobulinemia and Cryoglobulinemic Glomerulonephritis: An Unusual Case of Monoclonal Gammopathy of Renal Significance.

Cryoglobulins are immunoglobulins that precipitate at temperatures below 37 °C and dissolve upon reheating. They can induce small-vessel vasculitis with renal involvement. Cryoglobulinemic glomerulonephritis is a rare manifestation that occurs in patients with monoclonal gammopathy, specifically Waldenström's macroglobulinemia. We present the case of a 52-year-old patient with a history of cutaneous vasculitis and hypothyroidism, who presented with generalized edema, moderate anemia, hypercholesterolemia, nephrotic range proteinuria of 12.69 g/day, microhematuria, arterial hypertension, and hypocomplementemia via the classical pathway, without acute kidney injury and with negative serological studies and positive cryoglobulins in the second determination. Serum and urine protein electrophoresis and immunofixation studies showed a monoclonal band of IgM and kappa light chain. Renal biopsy was consistent with cryoglobulinemic glomerulonephritis. In the context of dysproteinemia and cryoglobulinemic glomerulonephritis, bone-marrow aspiration and biopsy were performed, leading to the diagnosis of Waldenström's macroglobulinemia. Monoclonal gammopathies have been described in association with type I cryoglobulinemias. This described association is uncommon, which is why we present this case, along with a review of the literature.

Estudio de la función ventricular izquierda con eco-Doppler cardíaco y Doppler tisular en deportistas y sedentarios: correlación con la capacidad aeróbica máxima / Doppler echocardiography and tisular Doppler study of the ventricular function in athletes and sedentary people: correlation with maximun aerobic capacity

Objetivo: Evaluar la función ventricular izquierda (VI) sistodiastólica en reposo entre deportistas y sedentarios y su relación con la capacidad aeróbica maxima al esfuerzo (CAMáx). Material y métodos: Se estudiaron dos grupos: G1, deportistas: 35 hombres, jugadores de rugby, edad 25 ± 7 años y G2, sedentarios: 22 hombres, edad 27 ± 7 años. A todos se les efectuó eco-Doppler cardíaco en reposo y ergometría máxima. Se midieron: a)variables de composición corporal, b) dimensiones y variables de función VI sistodiastólica mediante ecocardiografía Doppler y Doppler pulsado tisular y c) variables ergométricas en reposo, máximo esfuerzo y recuperación incluido máximo de O2 indirecto (VO2 Máx). Resultados: El G1 presentó valores superiores en peso, superficie corporal, índices de función sistólica y alcanzó una CAMáx mayor en la ergometría (p < 0,05). No hubo diferencias en los índices de función diastólica y masa VI. El análisis univariado demostró correlación significativa del VO2Máx con la relación E/A y con la onda E tisular en deportistas. La regresión múltiple encontró relación lineal entre el VO2Máx y la E tisular en el mismo grupo (p < 0,05). Conclusiones: La función sistólica VI en el grupo de deportistas mostró mejor eficiencia contráctil que el grupo de sedentarios, a expensas del aumento de la precarga, sin presentar cambios de significancia en la masa ventricular. La función diastólica fue similar en ambas poblaciones. La onda Et del doppler pulsado tisular en reposo resultó ser la única variable predictora de la CAMáx alcanzada por los deportistas en el esfuerzo, lo cual confirma la importancia del componente diastólico miocárdico en el ejercicio.

Cierre del ductus arterioso permeable con un nuevo tipo de dispositivo: Nit-Occlud / Patent ductus arteriosus closure using a new device: the Nit-Occlud device

Entre mayo de 2003 y julio de 2006, efectuamos cierre ductal con dispositivo Nit-Occlud en 28 pacientes con edades de 0,5-21 años (mediana, 1,8 años) y peso de 5,9-64 kg (mediana, 10,9 kg). Los conductos tuvieron una variada morfología, e incluían una recanalización posquirúrgica. Las medias del diámetro ductal mínimo y el extremo aórtico fueron de 1,8 y 6,5 mm, respectivamente. La tasa de oclusión inmediata fue del 53,5%, y llegó al 95,2% al año y al 100% a los 18 meses. La media de seguimiento fue de 20,5 meses. El Nit-Occlud resultó útil y seguro para el cierre ductal, independientemente de su tipo morfológico (AU)

Between May 2003 and July 2006, we carried out percutaneous patent ductus arteriosus closure using a Nit-Occlud device in 28 patients, who had a median age of 1.8 years (range 0.5-21 years) and a median weight of 10.9 kg (range 5.9-64 kg). The ductus arteriosus had several different morphologic forms, and there was one postsurgical recanalization of the ductus arteriosus. The median minimum ductal diameter was 1.8 mm and the median maximum aortic ampulla diameter was 6.5 mm. The occlusion rate immediately after intervention was 53.5%, which increased to 95.2% by 12 months and to 100% by 18 months. The median follow-up time was 20.5 months. The Nit-Occlud device provided an effective and safe means of patent ductus arteriosus closure, irrespective of ductus morphology (AU)

Análisis de la función ventricular izquierda en pacientes con hipertensión arterial inducida por el embarazo con ecocardiografía doppler y doppler tisular / Analysis of the left ventricular function in patients with pregnancy-induced hpertension by doppler echocardiography and pulsed tisular doppler

El objetivo del trabajo es la evaluación de la función ventricular izquierda en mujeres con hipertensión arterial inducida por el embarazo mediante la ecocardiografía Doppler y el Doppler pulsado tisular

Efecto de la ventilación por presión positiva sobre los parámetros productivos de pollo de engorda, durante siete semanas en casetas de ambiente natural / Comparison of productive performance in broilers using ventilation by positive pressure during seven weks in houses with a natural environment

Se evaluó el efecto de la ventilación por presión positiva sobre los parámetros productivos en pollo de engorda. Se utilizaron 1524 pollos de engorda de un día de edad, Peterson X Avin Farm no sexados, que se alojaron en una casete de ambiente natural que estaba dividida en dos secciones. Cada sección se dividió en seis subdivisiones. Las aves se asignaron aleatoriamente en dos grupos con seis réplicas cada uno. En la sección donde se alojó el grupo experimental, se instaló un ventilador con un motor de 1/3 HP, con 0.5 m de diámetro en sus aspas y con capacidad para desplazar 300 m cubicos de aire por minuto. En este grupo experimental se aplicó ventilación por presión positiva manteniendo un caudal de 301 de aire/minuto/kg de peso vivo, se hicieron los ajuste necesarios cada cuatro días para mantener el caudal de ventilación adecuado al peso de las aves. El grupo testigo no recibió ventilación por presión positiva. Se administró un sistema de alimentación dividido en tres estapas (iniciación, crecimiento y finalización), no se aplicó ningún tipo de restricción y las aves tuvieron libre acceso al agua y alimento. A los 49 días se determinaron los parámetros productivos de ambos grupos y se compararon mediante prueba "t" de Student, la mortalidad total y por síndrome ascítico fueron normalizados. El grupo experimental consumió menos alimentos que el testigo con 4.41 y 4.58 kg, respectivamente (P< 0.05). Se obtuvo mejor índice de conversión en las aves experimentales (1.853:1) en comparación con las aves testigo (1.940:1) con diferencia estadísticamente significativa (P< 0.05). La mortalidad general y la ocasionada por SA fueron menores en el grupo experimental (11.67 por ciento y 9.44 por ciento, respectivamente), en comparación con las aves testigo (16.53 por ciento y 12.94 por ciento), existiendo diferencias significativas en ambos valores (P< 0.05). Al final del experimento, el grupo experimental alcanzó el mejor índice de productividad (P< 0.05) con 227.84, a diferencia del testigo con 204.32. Finalmente se produjeron 23.76 kg de pollo/m² en el grupo experimental y 22.24/m² en el testigo (P< 0.05). Los resultados demuestran que la aplicación de un sistema de ventilación forzada por presión positiva tuvo un efecto positivo en la mayoría de los parámetros productivos