HLA genetic polymorphisms and prognosis of patients with COVID-19 / Polimorfismos genéticos de los HLA y pronóstico de pacientes con COVID-19

OBJECTIVE: Different genetic polymorphisms of human leukocyte antigen (HLA) have been associated with the risk and prognosis of autoimmune and infectious diseases. The objectives of this study were to determine whether there is an association between HLA genetic polymorphisms and the susceptibility to and mortality of coronavirus disease 2019 (COVID-19) patients. DESIGN: Observational and prospective study. SETTING: Eight Intensive Care Units (ICU) from 6 hospitals of Canary Islands (Spain). PATIENTS: COVID-19 patients admitted in ICU and healthy subjects. INTERVENTIONS: Determination of HLA genetic polymorphisms. MAIN VARIABLE OF INTEREST: Mortality at 30 days. RESULTS: A total of 3886 healthy controls and 72 COVID-19 patients (10 non-survivors and 62 survivor patients at 30 days) were included. We found a trend to a higher rate of the alleles HLA-A*32 (p = 0.004) in healthy controls than in COVID-19 patients, and of the alleles HLA-B*39 (p = 0.02) and HLA-C*16 (p = 0.02) in COVID-19 patients than in healthy controls; however, all these p-values were not significant after correction for multiple comparisons. Logistic regression analysis showed that the presence of certain alleles was associated with higher mortality, such as the allele HLA-A*11 after controlling for SOFA (OR = 7.693; 95% CI = 1.063-55.650; p = 0.04) or APACHE-II (OR = 11.858; 95% CI = 1.524-92.273; p = 0.02), the allele HLA-C*01 after controlling for SOFA (OR = 11.182; 95% CI = 1.053-118.700; p = 0.04) or APACHE-II (OR = 17.604; 95% CI = 1.629-190.211; p = 0.02), and the allele HLA-DQB1*04 after controlling for SOFA (OR = 9.963; 95% CI = 1.235-80.358; p = 0.03). CONCLUSIONS: The new finding from our preliminary study of small sample size was that HLA genetic polymorphisms could be associated with COVID-19 mortality; however, studies with a larger sample size before definitive conclusions can be drawn

OBJETIVO: Diferentes polimorfismos genéticos de los antígenos leucocitarios humanos (HLA) están asociados con el riesgo y el pronóstico de enfermedades autoinmunes e infecciosas. Los objetivos de estudio fueron determinar si existe una asociación entre polimorfismos genéticos de HLA y la susceptibilidad y mortalidad de pacientes con la enfermedad del coronavirus 2019 (COVID-19). DISEÑO: Estudio observacional y prospectivo. ÁMBITO: Ocho unidades de cuidados intensivos (UCI) de 6 hospitales de las Islas Canarias (España). PACIENTES: Pacientes COVID-19 ingresados en la UCI y sujetos sanos. INTERVENCIONES: Se determinaron los polimorfismos genéticos de los HLA. VARIABLE DE INTERÉS PRINCIPAL: Mortalidad a los 30 días. RESULTADOS: Se incluyeron 3.886 sujetos sanos y 72 pacientes COVID-19 (10 fallecidos y 62 supervivientes a 30 días). Encontramos una tendencia a una mayor frecuencia de los alelos HLA-A*32 (p = 0,004) en sujetos sanos que en pacientes COVID-19, y de los alelos HLA-B*39 (p = 0,02) y HLA-C*16 (p = 0,02) en pacientes COVID-19 que en sujetos sanos; sin embargo, no fueron significativos al corregir por comparaciones múltiples. En la regresión logística encontramos que la presencia de ciertos alelos estuvo asociada con mayor mortalidad, como el alelo HLA-A*11 controlando por SOFA (OR = 7.693; IC del 95% = 1.063-55.650; p = 0,04) o APACHE-II (OR = 11.858; IC del 95% = 1.524-92.273; p = 0,02), el alelo HLA-C*01 controlando por SOFA (OR = 11.182; IC del 95% = 1.053-118.700; p = 0,04) o APACHE-II (OR = 17.604; IC del 95% = 1.629-190.211; p = 0,02) y el alelo HLA-DQB1*04 controlando por SOFA (OR = 9.963; IC del 95% = 1.235-80.358; p = 0,03). CONCLUSIONES: Los nuevos hallazgos de nuestro preliminar estudio de pequeño tamaño muestral fueron que determinados polimorfismos genéticos de los HLA podrían estar asociados con la mortalidad de pacientes COVID-19; sin embargo, son necesarios estudios de mayor tamaño muestral para concluirlo definitivamente

[HLA genetic polymorphisms and prognosis of patients with COVID-19]. / Polimorfismos genéticos de los HLA y pronóstico de pacientes con COVID-19.

OBJECTIVE: Different genetic polymorphisms of human leukocyte antigen (HLA) have been associated with the risk and prognosis of autoimmune and infectious diseases. The objectives of this study were to determine whether there is an association between HLA genetic polymorphisms and the susceptibility to and mortality of coronavirus disease 2019 (COVID-19) patients. DESIGN: Observational and prospective study. SETTING: Eight Intensive Care Units (ICU) from 6 hospitals of Canary Islands (Spain). PATIENTS: COVID-19 patients admitted in ICU and healthy subjects. INTERVENTIONS: Determination of HLA genetic polymorphisms. MAIN VARIABLE OF INTEREST: Mortality at 30 days. RESULTS: A total of 3886 healthy controls and 72 COVID-19 patients (10 non-survivors and 62 survivor patients at 30 days) were included. We found a trend to a higher rate of the alleles HLA-A*32 (p=0.004) in healthy controls than in COVID-19 patients, and of the alleles HLA-B*39 (p=0.02) and HLA-C*16 (p=0.02) in COVID-19 patients than in healthy controls; however, all these p-values were not significant after correction for multiple comparisons. Logistic regression analysis showed that the presence of certain alleles was associated with higher mortality, such as the allele HLA-A*11 after controlling for SOFA (OR=7.693; 95% CI=1.063-55.650; p=0.04) or APACHE-II (OR=11.858; 95% CI=1.524-92.273; p=0.02), the allele HLA-C*01 after controlling for SOFA (OR=11.182; 95% CI=1.053-118.700; p=0.04) or APACHE-II (OR=17.604; 95% CI=1.629-190.211; p=0.02), and the allele HLA-DQB1*04 after controlling for SOFA (OR=9.963; 95% CI=1.235-80.358; p=0.03). CONCLUSIONS: The new finding from our preliminary study of small sample size was that HLA genetic polymorphisms could be associated with COVID-19 mortality; however, studies with a larger sample size before definitive conclusions can be drawn.

HLA genetic polymorphisms and prognosis of patients with COVID-19.

Objective: Different genetic polymorphisms of human leukocyte antigen (HLA) have been associated with the risk and prognosis of autoimmune and infectious diseases. The objectives of this study were to determine whether there is an association between HLA genetic polymorphisms and the susceptibility to and mortality of coronavirus disease 2019 (COVID-19) patients. Design: Observational and prospective study. Setting: Eight Intensive Care Units (ICU) from 6 hospitals of Canary Islands (Spain). Patients: COVID-19 patients admitted in ICU and healthy subjects. Interventions: Determination of HLA genetic polymorphisms. Main variable of interest: Mortality at 30 days. Results: A total of 3886 healthy controls and 72 COVID-19 patients (10 non-survivors and 62 survivor patients at 30 days) were included. We found a trend to a higher rate of the alleles HLA-A*32 (p = 0.004) in healthy controls than in COVID-19 patients, and of the alleles HLA-B*39 (p = 0.02) and HLA-C*16 (p = 0.02) in COVID-19 patients than in healthy controls; however, all these p-values were not significant after correction for multiple comparisons. Logistic regression analysis showed that the presence of certain alleles was associated with higher mortality, such as the allele HLA-A*11 after controlling for SOFA (OR = 7.693; 95% CI = 1.063-55.650; p = 0.04) or APACHE-II (OR = 11.858; 95% CI = 1.524-92.273; p = 0.02), the allele HLA-C*01 after controlling for SOFA (OR = 11.182; 95% CI = 1.053-118.700; p = 0.04) or APACHE-II (OR = 17.604; 95% CI = 1.629-190.211; p = 0.02), and the allele HLA-DQB1*04 after controlling for SOFA (OR = 9.963; 95% CI = 1.235-80.358; p = 0.03). Conclusions: The new finding from our preliminary study of small sample size was that HLA genetic polymorphisms could be associated with COVID-19 mortality; however, studies with a larger sample size before definitive conclusions can be drawn.

Objetivo: Diferentes polimorfismos genéticos de los antígenos leucocitarios humanos (HLA) están asociados con el riesgo y el pronóstico de enfermedades autoinmunes e infecciosas. Los objetivos de estudio fueron determinar si existe una asociación entre polimorfismos genéticos de HLA y la susceptibilidad y mortalidad de pacientes con la enfermedad del coronavirus 2019 (COVID-19). Diseño: Estudio observacional y prospectivo. Ámbito: Ocho unidades de cuidados intensivos (UCI) de 6 hospitales de las Islas Canarias (España). Pacientes: Pacientes COVID-19 ingresados en la UCI y sujetos sanos. Intervenciones: Se determinaron los polimorfismos genéticos de los HLA. Variable de interés principal: Mortalidad a los 30 días. Resultados: Se incluyeron 3.886 sujetos sanos y 72 pacientes COVID-19 (10 fallecidos y 62 supervivientes a 30 días). Encontramos una tendencia a una mayor frecuencia de los alelos HLA-A*32 (p = 0,004) en sujetos sanos que en pacientes COVID-19, y de los alelos HLA-B*39 (p = 0,02) y HLA-C*16 (p = 0,02) en pacientes COVID-19 que en sujetos sanos; sin embargo, no fueron significativos al corregir por comparaciones múltiples. En la regresión logística encontramos que la presencia de ciertos alelos estuvo asociada con mayor mortalidad, como el alelo HLA-A*11 controlando por SOFA (OR= 7.693; IC del 95%= 1.063-55.650; p = 0,04) o APACHE-II (OR= 11.858; IC del 95%= 1.524-92.273; p = 0,02), el alelo HLA-C*01 controlando por SOFA (OR= 11.182; IC del 95%= 1.053-118.700; p = 0,04) o APACHE-II (OR= 17.604; IC del 95%= 1.629-190.211; p = 0,02) y el alelo HLA-DQB1*04 controlando por SOFA (OR= 9.963; IC del 95%= 1.235-80.358; p = 0,03). Conclusiones: Los nuevos hallazgos de nuestro preliminar estudio de pequeño tamaño muestral fueron que determinados polimorfismos genéticos de los HLA podrían estar asociados con la mortalidad de pacientes COVID-19; sin embargo, son necesarios estudios de mayor tamaño muestral para concluirlo definitivamente.

Success with multidisciplinary team work: experience of a primary immunodeficiency unit

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Yogurt in the treatment of Beta-lactoglobulin-induced gastrointestinal cow's milk allergy

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Simultaneous enantiomeric determinations of acid and ester imidazolinone herbicides in a soil sample by two-dimensional direct chiral liquid chromatography.

A two-dimensional HPLC method for the simultaneous direct chiral enantiomeric determination of acid and ester IMI herbicides has been described. Difficulties arising from differences in polarity were overcome. Firstly, the imazaphyr, imazethapyr and imazamethabenz methyl herbicides were separated in a C18 achiral column. Then, their respective enantiomers were separated using a protein chiral AGP(TM) column; a heart-cut mode was used. Mobile phases of the two systems were compatibilized, after optimizing by factorial design using multiple response analysis. The proposed method has been validated by recovery studies from an enriched soil sample. Important enantiomer parameters such as enantioresolution higher than 1.12, enantiomeric ratio (ER) close to 1 and enantiomeric fraction (EF) around 0.5 were obtained for standards, confirming that herbicides are present as racemates.

[The "rendez-vous" maneuver as a technical option to access the bile ducts: case series report]. / Maniobra de "rendez-vous" como una opción técnica de acceso a la vía biliar: reporte de casos.

The "rendez-vous" maneuver is a technical option, to have in mind, for the bile ducts access. This technique assures a "guided" canulation of the bile duct during the laparoscopic cholecystectomy (LC). We analyzed three clinical cases of patients with cholecysto-choledocolithiasis, in whose were planned Endoscopic Retrograde Cholangio-Pancreatography (ERCP) and LC during the same surgical intervention. The "rendez-vous" maneuver was employed as a technical option to access the bile duct, after an initial (failed) endoscopic attempt of cannulation. An intraoperative cholangiography was performed and a guide wire was inserted through the cystic duct, allowing the endoscopic capture and the guided cannulation of the bile duct. The therapeutic objective was achieved in all patients. There was not associated morbid-mortality and all patients were satisfied with the surgical outcome. In these series of cases, the "rendez-vous" maneuver was a viable, safe and useful technical option to access the bile ducts. Futhermore, the cholecysto-choledocolithiasis was treated during the same surgical intervention. A postoperative bile duct exploration becomes unnecessary.

[Pro-hepcidin, its relation with indicators of iron metabolism and of inflammation in patients hemodialyzed treated or not with recombinant erythropoietin]. / Pro-hepcidina, su relación con indicadores del metabolismo del hierro y de inflamación en pacientes hemodializados tratados o no con eritropoyetina recombinante.

UNLABELLED: Hepcidin, an antimicrobial peptide which synthesis is regulated by iron status and inflammation, plays an important role in iron homeostasis in hemodialysed (HD) patients. It is measured by measuring serum prohepcidin. OBJECTIVE: To determine serum prohepcidin levels and their relationship with serum ferritin, C reactive protein (CRP), and albumin in HD patients treated or not with recombinant erythropoietin (EPO) that attended the Health Centre of the Carabobo State in Venezuela. METHODOLOGY: This is a descriptive, correlational, and field investigation with a sample comprised by 71 HD patients of whom 57 were treated with EPO. Serum prohepcidin, ferritin, haemoglobin, hematocrit, CRP, and albumin were determined. Anaemia (haemoglobin < 10 g/dL) and iron deficiency (ferritin < 100 ng/mL) were defined according to the criteria recommended by the K/DOQUI group. Reference values: Albumin 3.5-4.8 g/dL, and for acute inflammatory conditions (CRP > 10 mg/L.). RESULTS: The mean value for prohepcidin was 397.5 ng/mL. A high percentage of anaemia was observed (87.3%) and 22.5% of the patients had low levels of serum ferritin. There were no statistically significant differences for ferritin, albumin, CRP, or prohepcidin, between patients with and without EPO therapy. Only the CRP value was significantly correlated (rho = 0.276; p = 0.020) with prohepcidin. CONCLUSION: HD patients present high levels of prohepcidin, and this may be due to the common ongoing inflammatory process in these patients and not to the iron status measured through serum ferritin levels.

Pro-hepcidina, su relación con indicadores del metabolismo del hierro y de inflamación en pacientes hemodializados tratados o no con eritropoyetina recombinante / Pro-hepcidin, its relation with indicators of iron metabolism and of inflammation in patients hemodialyzed treated or not with recombinant erythropoietin

La hepcidina, péptido antimicrobiano, cuya síntesis se encuentra regulada por el estado del hierro e inflamación, juega un importante papel en la homeostasis del hierro en pacientes hemodializados (HD). Es medida a través de la prohepcidina sérica. Objetivo: Determinar los niveles séricos de prohepcidina y su relación con ferritina sérica, proteína C reactiva (PCR) y albúmina en pacientes HD tratados o no con eritropoyetina recombinante (EPO), que asistieron a un Centro de Salud del Estado Carabobo-Venezuela. Metodología: Esta investigación es de tipo descriptiva, correlacional y de campo, cuya muestra estuvo conformada por 71 pacientes HD; 57 de éstos tratados con EPO. Se determinó prohepcidina sérica, ferritina, hemoglobina, hematocrito, PCR y albúmina. Se definió anemia (hemoglobina < 10 g/dL) y deficiencia de hierro (ferritina < 100 ng/mL) de acuerdo al criterio recomendado por grupo K/DOQUI. Valores de referencia: Albúmina 3,5 a 4,8 g/dL, para procesos inflamatorios agudos (PCR > 10 mg/L). Resultados: El promedio para la prohepcidina fue de 397,5 ng/mL. Se observó un alto porcentaje de anemia (87,3%) y un 22,5% de pacientes con ferritina sérica baja. No se observaron diferencias estadísticamente significativas para ferritina, albúmina, PCR y prohepcidina, entre pacientes con y sin tratamiento con EPO. Solo la variable PCR se correlaciona significativamente (rho = 0,276; p =0,020), con prohepcidina. Conclusión: Pacientes HD presentan niveles elevados de prohepcidina, esto pudiera deberse al proceso inflamatorio frecuentemente observado en estos pacientes y no al estado de hierro medido a través de los niveles de ferritina sérica (AU)

Hepcidin, an antimicrobial peptide which synthesis is regulated by iron status and inflammation, plays an important role in iron homeostasis in hemodialysed (HD) patients. It is measured by measuring serum prohepcidin. Objective: To determine serum prohepcidin levels and their relationship with serum ferritin, C reactive protein (CRP), and albumin in HD patients treated or not with recombinant erythropoietin (EPO) that attended the Health Centre of the Carabobo State in Venezuela. Methodology: This is a descriptive, correlational, and field investigation with a sample comprised by 71 HD patients of whom 57 were treated with EPO. Serum prohepcidin, ferritin, haemoglobin, hematocrit, CRP, and albumin were determined. Anaemia (haemoglobin < 10 g/dL) and iron deficiency (ferritin < 100 ng/mL) were defined according to the criteria recommended by the K/DOQUI group. Reference values: Albumin 3.5-4.8 g/dL, and for acute inflammatory conditions (CRP > 10 mg/L.). Results: The mean value for prohepcidin was 397.5 ng/mL. A high percentage of anaemia was observed (87.3%) and 22.5% of the patients had low levels of serum ferritin. There were no statistically significant differences for ferritin, albumin, CRP, or prohepcidin, between patients with and without EPO therapy. Only the CRP value was significantly correlated (rho = 0.276; p = 0.020) with prohepcidin. Conclusion: HD patients present high levels of prohepcidin, and this may be due to the common ongoing inflammatory process in these patients and not to the iron status measured through serum ferritin levels (AU)

Leptina sérica, su relación con peso y distribución de grasa corporal en mujeres posmenopáusicas / Relation between leptin serun with weight and body fat distribution in postmenopausal women

La leptina es una hormona peptídica secretada por el tejido adiposo, juega un papel importante en la regulación del peso corporal. Después de la menopausia se incrementa la ganancia de peso y la obesidad de tipo androide. Estudios previos sugieren una relación entre concentración de leptina, índice de masa corporal (IMC) y distribución de grasa. Objetivo: Establecer relaciones entre leptina sérica, IMC, circunferencia de cintura (CCi) e índice cintura/cadera (ICC). Metodología: Se evaluaron 48 mujeres menores de 60 años de edad, con amenorrea de un año o más. Se determinó leptina sérica y estradiol (ELISA) vn: 3,63-11,09 ng/mL y 0-65 pg/mL; IMC (OMS), CCi > 88cm e ICC > 0,80 se consideraron riesgo cardiometabólico. Resultados: La edad promedio del grupo fue 54 ± 3,9 años; leptina: 8,4 ± 3,7 ng/ml y estradiol: 17,6 ± 10,0 pg/ml; IMC: 27,0 ± 4,9 kg/m2, CCi: 86,2 ± 8,6 cm e ICC: 0,84 ± 0,06. 20% de las mujeres presentaron hiperleptinemia, 58,4% malnutrición por exceso, 35% estaban en situación de riesgo cardiovascular CCi. Los valores más altos de leptina se observaron en las mujeres obesas. No hubo asociación entre niveles séricos de leptina y variables antropométricas. Encontrándose correlación positiva y significativa entre peso, talla, IMC, CCi, circunferencia de cadera (CCa) y estradiol. Conclusiones: Las mujeres posmenopáusicas presentaron una alta prevalencia de sobrepeso/obesidad, distribución de grasa tipo androide y niveles normales de leptina sérica. El grupo evaluado se considera en riesgo para enfermedades cardiometabólicas según indicadores antropométricos (AU)

Leptin is a peptidic hormone secreted by the fat tissue and plays an important role in body weight regulation. After menopause, weight gain increases as well as android-like obesity. Previous studies suggest a relationship between leptin level, body mass index (BMI) and fat distribution. Objective: To establish the relationships between serum leptin, BMI, waist circumference (WC), and waist/hip ratio (WHR). Methodology: 48 women under the age of 60 years and with amenorrhea for longer than one year were assessed. Leptin and estradiol (ELISA) levels were determined; normal values: 3.63-11.09 ng/mL and 0-65 pg/Ml. BMI (WHO), WC > 88 cm, and WHR > 0.80 were considered as indicators of cardiometabolic risk. Results: Mean age for the group was 54 ± 3.9 years; leptin: 8.4 ± 3.7 ng/mL, and estradiol: 17.6 ± 10.0 pg/mL; BMI: 27.0 ± 4.9 kg/m2; WC: 86.2 ± 8.6 cm; and WHR: 0.84 ± 0.06. Twenty percent of the women had hyperleptinemia, 58.4% malnourishment due to excessive intake, 35% presented WC cardiovascular risk. The highest leptin value was found in obese women. There was no association between serum leptin levels and anthropometrical variables. There was a significantly positive correlation between weight, height, BMI, WC, hip circumference, and estradiol. Conclusions: Postmenopausal women presented a high prevalence of overweight/obesity, android-like body fat distribution and normal serum leptin levels. The group assessed is considered to be at risk for cardiometabolic diseases according to anthropometrical indicators (AU)

A randomized trial comparing two corticosteroid regimens combined with mycophenolate mofetil and cyclosporine for prevention of acute renal allograft rejection.

INTRODUCTION: The launching of mycophenolate mofetil (MMF) has reduced the incidence of acute rejection episodes. We sought to evaluate the efficacy of decreasing the steroid dose. MATERIALS AND METHODS: This was a quasiexperimental, randomized, prospective trial. We enrolled 150 patients who received de novo renal transplantations from living or cadaveric donors, fulfilling the screening criteria. Patients were randomized to one of the following two arms: (A) MMF at a 2 g/d dose, cyclosporine (CsA) at a dose necessary to achieve target levels, and corticosteroids at the usual doses; (B) MMF at a 2 g/d dose, CsA at a dose necessary to achieve target levels, and corticosteroids at doses 50% lower than those of group A. RESULTS: Group A included 72 (48%) and group B, 78 patients (52%). There were no differences among the variables: leukopenia occurred in 11 patients in group A, and five patients in group B. Complications occurred in 67.4% (56) of group A, but only 32.6% (27) were related to infections. One case of urinary infection occurred in group B, while six occurred in group A. There was one case of acute rejection in group A, and none in group B. One graft loss occurred in group A. There were no differences in the remaining variables under study. DISCUSSION: The results showed an increased complication rate related to receiving usual steroid doses. There was no increase in acute rejection episodes among patients receiving 50% of the usual steroid dose.

Further description of early clinically silent lupus nephritis.

Thirty silent lupus nephritis (SLN) patients were compared to 16 individuals bearing overt lupus nephritis (OLN). Results included: years of systemic lupus erythematosus (SLE) diagnosis were significantly earlier (4.6 +/- 2.8 years) in SLN than in OLN (7.18 +/- 3.61) (P < 0.05). Neurological compromise, hypertension, normocitic anemia and lymphopenia were significantly prevalent in OLN than in SLN (P < 0.05). Beside normal urinary sediment and renal function tests, the SLN group showed a moderate increase of both activity (AI) and chronicity (CI) renal pathology index when compared to highly increased AI and CI in OLN (P < 0.05). Seventy percent of SLN patients were ISN/RPS Classes I (6.6%) and II (63.3%) while 81% of OLN cases were Classes III, IV (37.5%) and V. IgG, IgA, IgM, lambda chain, C3 and fibrinogen immune deposits were found in 90% or over in both SLN and OLN individuals while in 60% or over, both groups also showed kappa chain, Clq and C4 deposits. While prevalence of ANA, anti-dsDNA and anti-C1q antibodies were similar in both groups, anti-histone, anti-RNP, CIC and CH50 serum levels were significantly different in OLN versus SLN (P < 0.05). We strongly suggest that indeed SLN is the earliest stage in the natural history of lupus nephritis.

Influence of angiotensin-converting enzyme polymorphism gene, IGF-1, and other factors in the response rate of hematocrit to enalapril treatment in patients with posttransplant erythrocytosis.

A significant relationship between hematocrit values and serum parameters such as the insulin like growth factor (IGF-1) and calcium was observed in patients with posttransplant erythrocytosis (PTE). Since angiotensin-converting enzyme inhibitors (ACEI) decrease hematocrit (Ht) levels in these patients, ACE genotype should play an important role. We designed this study to investigate whether ACE genotype or baseline concentrations of IGF-1, IGF-blood binding protein 3 (BP3), growth hormone (GH), or Ca influenced the response of Ht to ACEI treatment. Twenty-one kidney graft recipients with PTE were treated with enalapril (2.5 to 5 mg/d) for 1 year. IGF-1, BP3, GH, Ca, and Ht were determined before as well as 15, 30, 90, 180, and 365 days after enalapril treatment. ACE polymorphism was also determined. Enalapril treatment significantly decreased Ht levels. Only IGF-1 baseline levels showed a positive correlation to the decreased Ht (P < .025). ACE genotype as determined in 18 patients, showed no correlation with the response to enalapril. Patients with ACE genotype II showed a tendency to an earlier display of PTE. We conclude that low doses of enalapril decrease Ht levels in PTE patients; that PTE begins earlier in patients with II ACE genotype; and that only IGF-1 baseline levels influence the Ht decrease after treatment. These observations suggest that ACEI decrease the Ht via an inhibitory effect on IGF-1, which has a stimulary effect on erythropoiesis.

Hipertrofia ventricular izquierda después del trasplante renal: prevención y tratamiento / No disponible

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IV. Nuevos métodos diagnósticos en el trasplante renal: a) Análisis de factores de riesgo genéticos asociados a la nefropatía crónica del trasplante renal: polimorfismos genéticos de citoquinas, moléculas de adhesión, sistema de coagulación-plaquetar y marcadores de riesgo cardiovascular / No disponible

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Modeling the growth plates in the pediatric knee: implications for anterior cruciate ligament reconstruction.

The authors develop 3-D models of the pediatric knee from magnetic resonance imaging (MRI) image files, with the goal of minimizing injury to the pediatric growth plate during surgery. Computerized tomography (CT) scans have better resolution and contrast between bone and soft tissue than MRI scans; however, surgeons rely upon MRI scans to plan knee-joint surgeries such as anterior cruciate ligament (ACL) reconstruction. Surgeons can use the virtual models to plan and verify surgical procedures such as hole drilling and ligament attachments, and to determine volume removed from a growth plate due to different drill-hole placements with various drill sizes.