Gastrointestinal Cytomegalovirus Infection in a Transplantation Recipient With a Negative Serum Viral Load: Case Report.

BACKGROUND: Kidney transplant recipients are vulnerable to infections, especially cytomegalovirus (CMV) disease. It is recommended that clinicians plan their prophylaxis and therapeutic regimens based on viral load testing. OBJECTIVE: CMV viral load monitoring testing provides useful information for identifying virologic response and possible antiviral resistance. Due to the paucity of medical literature on guiding viral therapy in cases of CMV tissue disease with nondetectable serum viral load, we intend to provide physicians with evidence on how to guide medical therapy in these cases. CASE REPORT: A 49-year-old Hispanic male recipient of a kidney transplant from a cadaver donor presented to the emergency department with anorexia, asthenia, diarrhea, weight loss, and supraclavicular and mediastinal adenomegalies at 2 months post-transplantation. Both patients were serum IgG- and IgM-positive for CMV, which classified them as intermediate risk for developing CMV disease or tissue-invasive disease (donor-positive/recipient-positive [D+/R+]). The patient was induced with basiliximab and methylprednisolone and received maintenance therapy with tacrolimus, mycophenolic acid, and prednisone. Real-time polymerase chain reaction analyses were performed due to suspicion for BK virus, B19 parvovirus, Epstein-Barr virus, and CMV, with an undetectable viral load for all. A biopsy specimen taken from the gastrointestinal tract confirmed CMV infection, which was corroborated through immunocytochemistry. CONCLUSIONS: Histopathologic testing is a possible option for patients with CMV tissue disease symptoms but no detectable serum viral load. Clinical observation is fundamental when viral monitoring is difficult.

Presentation, management and evolution of patients with abdominal gunshot wound. A decade of violence in Mexico.

BACKGROUND: Traumatic injuries represent 9.6% of the global surface of the disease and represent the third most common cause of death in adults and adolescents. Patients were admitted to the hospital presenting traumatic injuries, penetrating abdominal traumatism remains a major cause of morbidity and mortality. OBJECTIVE: To analyze the presentation, handling and development of patient's gunshot wound. METHOD: Retrospective, descriptive, observational study. It was reviewed from 2010-2015 in the statistics department of the University Hospital Dr. José E. González all patients diagnosed with firearm projectile injury in abdomen. RESULTS: Were admitted above an average of 1.22 ± 0.51 lesions, on a Glasgow coma scale of 13.59 ± 2.5, oxygen saturation of 96.2 ± 2.09, heart rate of 94.4 ± 20, respiratory rate of 22 ± 6 and shock degree of 1.5 ± 0.80. CONCLUSION: Vital signs and specific characteristics of the lesion are essential and useful for the prediction of mortality due to abdominal traumatism by firearm projectile, in addition to the quantification of wounds and associated organic lesions, these are being evaluated both as a whole and separately.

ANTECEDENTES: Las lesiones traumáticas representan el 9.6% de la carga global de la enfermedad y son la tercera causa más común de muerte en adultos y adolescentes. Entre los pacientes ingresados en el hospital con lesiones traumáticas, el traumatismo penetrante abdominal sigue siendo una importante causa de morbilidad y mortalidad. OBJETIVO: Analizar la presentación, el manejo y la evolución de los pacientes con herida por proyectil de arma de fuego en el abdomen. MÉTODO: Estudio retrospectivo, descriptivo y observacional. Se revisaron todos los pacientes con diagnóstico de herida por proyectil de arma de fuego en el abdomen en el departamento de estadística del Hospital Universitario Dr. José E. González durante los años 2010-2015. RESULTADOS: Del total, 21 (9.1%) pacientes eran del sexo femenino y 229 (90.9%) del sexo masculino. Se ingresaron con un promedio de 1.22 ± 0.51 lesiones, con una puntuación en la Escala de coma de Glasgow de 13.59 ± 2.5, saturación de oxígeno de 96.2 ± 2.09, frecuencia cardiaca de 94.4 ± 20, frecuencia respiratoria de 22 ± 6 y grado de choque de 1.5 ± 0.80. CONCLUSIÓN: Los signos vitales y las características específicas de la lesión son esenciales y útiles para la predicción de la mortalidad por traumatismo abdominal por proyectil de arma de fuego, además de la cuantificación de heridas y lesiones orgánicas asociadas, siendo evaluadas estas tanto en un todo como por separado.

Spironolactone Effect in Hepatic Ischemia/Reperfusion Injury in Wistar Rats.

INTRODUCTION: Ischemia/reperfusion (IR) injury, often associated with liver surgery, is an unresolved problem in the clinical practice. Spironolactone is an antagonist of aldosterone that has shown benefits over IR injury in several tissues, but its effects in hepatic IR are unknown. OBJECTIVE: To evaluate the effect of spironolactone on IR-induced damage in liver. MATERIALS AND METHODS: Total hepatic ischemia was induced in rats for 20 min followed by 60 min of reperfusion. Spironolactone was administered and hepatic injury, cytokine production, and oxidative stress were assessed. RESULTS: After IR, increased transaminases levels and widespread acute inflammatory infiltrate, disorganization of hepatic hemorrhage trabeculae, and presence of apoptotic bodies were observed. Administration of SPI reduced biochemical and histological parameters of liver injury. SPI treatment increased IL-6 levels when compared with IR group but did not modify either IL-1ß or TNF-α with respect to IR group. Regarding oxidative stress, increased levels of catalase activity were recorded in IR + SPI group in comparison with group without treatment, whereas MDA levels were similar in IR + SPI and IR groups. CONCLUSIONS: Spironolactone reduced the liver damage induced by IR, and this was associated with an increase in IL-6 production and catalase activity.