ABSTRACT
The maximum expression of hemodynamic instability during liver transplant is the so-called postreperfusion syndrome (PRS) that increases both overall mortality and postoperative complications. It was first defined by Aggarwal et al in 1987, but the results are still conflicting when establishing the relationship between PRS and acute kidney failure (AKF). We conducted a retrospective observational study of transplant recipients with deceased-donor liver grafts between January 2002 and December 2018. We analyzed the incidence of PRS and its potential negative impact over kidney function. A total of 551 transplants were analyzed. PRS was recorded in 130 patients (23.6%). The incidence of AKF was 61.5%. A total of 111 patients required kidney replacement therapy (32.7%). Regarding the severity of AKF, 128 patients were classified as acute kidney injury (AKI) 1 (23.2%), 76 as AKI 2 (13.8%), and 135 as AKI 3 (24.5%). In the group with PRS, 75.4% (n = 98) developed AKF vs 57.2% (n = 241) in the group without PRS. In the multivariate analysis we found a relationship between PRS and AKF with an odds ratio of 2.18 (95% CI, 1.30-3.64; P = .003), once adjusted by the length of the anhepatic phase, donor age, Model for End-Stage Liver Disease score, history of ascites, and need for early surgical reintervention. The incidence of AKF decreased (44.5%) ever since the implementation of delayed calcineurin inhibitors therapy and piggyback surgical technique, but a clear influence of the occurrence of PRS on the development of AKF is still observed, with an OR of 3.78 (95% CI, 1.92-7.43; P < .001), once adjusted by albumin and hemoglobin levels, Model for End-Stage Liver Disease score, and Child classification.
Subject(s)
Acute Kidney Injury , End Stage Liver Disease , Liver Transplantation , Child , Humans , Liver Transplantation/adverse effects , Retrospective Studies , Living Donors , Severity of Illness Index , Risk Factors , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , SyndromeABSTRACT
Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.
Subject(s)
Colitis, Ulcerative , Adalimumab/therapeutic use , Adult , Colitis, Ulcerative/drug therapy , Humans , Infliximab/therapeutic use , Tumor Necrosis Factor Inhibitors , Ustekinumab/therapeutic useABSTRACT
OBJECTIVE: The aim of the study is to compare two confirmatory tests for HIV-1/2 infection. METHODS: A prospective study was carried out between 01/01/2015 and 12/31/2015. Serum samples with repeatedly positive results in the Antibody-Antigen-HIV-1/2 (Architect, Abbott) screening assay were included. The serum samples corresponding to new diagnosed cases were selected and were used to compare the two confirmatory assays: Geenius™ HIV-1/2 (Bio-Rad) and INNO-LIA™ HIV-1/2 score line-immunoassay (Innogene-tics®). The HIV-1 viral load (Cobas® AmpliPrepHIV, Ro-che) was performed in discordant or indeterminate cases. RESULTS: Eight five samples were included. The results of both confirmatory assays were concordant in 80/85 samples: 53 HIV-1, 1 HIV-2, 25 negative and one indeterminate. Cohen's Kappa concordance coefficient between Geenius™ and INNO-LIA™ techniques was very high (0.878). CONCLUSIONS: The concordance between the two assays is high. The procedure for Geenius™ is simple and fast. Geenius™ is a good alternative to include in the HIV-1/2 diagnostic algorithm.
Subject(s)
HIV Antibodies/analysis , HIV Infections/diagnosis , HIV-1/immunology , HIV-2/immunology , Algorithms , HIV Antigens/analysis , HIV Infections/immunology , HIV Infections/virology , Humans , Immunoassay , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Viral LoadSubject(s)
Humans , Female , Middle Aged , Daptomycin/adverse effects , Daptomycin/therapeutic use , Inappropriate ADH Syndrome/chemically induced , Inappropriate ADH Syndrome/complications , Inappropriate ADH Syndrome/therapy , Magnetic Resonance Imaging/methods , Inappropriate ADH Syndrome/drug therapy , Inappropriate ADH Syndrome/physiopathology , Osmolar ConcentrationABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Catatonia/etiology , Bipolar Disorder/complications , Diagnosis, DifferentialABSTRACT
Presentamos un caso de micosis fungoide liquenoide. La paciente presentó prurito intenso, pero con una buena evolución hasta el momento. Tanto clínica como histológicamente se correspondía con un patrón liquenoide, hecho de excepcional frecuencia. Respondió al tratamiento esteroideo tópico de alta potencia.
A 53-years-old woman with a lichenoid mycoses fungoides is reported. Both clinical and histological lichenoid pattern was finding, which is unusual. The treatment with high potency corticoids was successfully and the outcome is favorable up to now.
ABSTRACT
El síndrome de Sneddon, es una vasculitis que afecta principalmente a la piel y al sistema nervioso central. Se caracteriza por la presencia de unalivedo reticularis idiopática junto a accidentes cerebrovasculares isquémicos. De forma menos frecuente puede presentar afectación cardiaca, renalo retiniana. Presentamos el caso de un varón con livedo racemosa desde la tercera década de vida, que a los 44 años de edad sufrió un infartocerebral y tres años después un infarto de miocardio, con normalidad en todas las pruebas realizadas (AU)
Sneddon´s syndrome is a skin and cerebral vasculitis. It is characterize by idiopathic livedo reticularis and ischemic cerebrovascular strokes. Less common,heart, kidneys and retina can be affected. We report a man, with livedo racemosa since third decade of life , who at the age of 44 years, hesuffered a cerebral stroke and three years later a heart stroke, all the tests realised were normal (AU)
Subject(s)
Humans , Male , Middle Aged , Sneddon Syndrome/diagnosis , Livedo Reticularis/diagnosis , Skin Diseases, Vascular/diagnosis , Cerebral Infarction/complications , Myocardial Infarction/complicationsABSTRACT
No disponible
No disponible
Subject(s)
Humans , Male , Middle Aged , Kaposi Varicelliform Eruption/complications , Lymphoma, T-Cell, Cutaneous/complications , Simplexvirus/isolation & purification , Staphylococcus aureus/isolation & purificationABSTRACT
BACKGROUND AND OBJECTIVES: In order to approach in a multidisciplinary way obesity and eating disorders it is necessary to know the implicit theories of personality, the stereotypes, and the current stigmatization of overweight, as well as making the obese individual guilty by attributing his/her state to a "way of being". The objective was to know the perception that students and patients with eating disorders may have about obese people and analyze the differences that might exist between both groups. Setting, population, and interventions: we selected 138 students and 50 patients with anorexia or bulimia that assigned qualifying adjectives to obese people from a given list. RESULTS: We analyzed the most used adjectives and the corresponding personality scales by using the c2 test to determine the differences between the adjectives used and the scales in both samples. A p value < 0.05 was considered to be statistically significant, using the SPSS software, v.13. Obese people were essentially qualified as introverted, inhibited, and cooperative. About the latter scale, we found differences due to the most frequent use of the terms "affectionate", "helping", "obliging", "dependent", and "obedient" by the patients. As a whole, there exists a negative perception of obese people. Among the most commonly used adjectives we may highlight: "excluded", "shy", "touchy", "anxious", "rejected", "insecure", and "passive", the latter being the most repeated one in both groups. The patients tend to preferentially choose some adjectives, which expresses a paradoxical fact: they seem to have a more lenient perception of obese people but they more often choose the terms "anxious", "solitary", "lazy", "lifeless", "dependent", "easily frightened", "lonely", "childish", or "impulsive". CONCLUSIONS: To know the perception of obesity is essential for the psycho-educative work and prevention of associated psychopathological impairments. In eating disorders obesity represents "the most feared" condition so knowing the underlying theories about obesity and overweight in these patients is essential for their management.
Subject(s)
Attitude to Health , Feeding and Eating Disorders/psychology , Obesity , Students/psychology , Adolescent , Adult , Female , Humans , Male , UniversitiesABSTRACT
We report the case of unilocular cystic renal cell carcinoma and its radiological findings. Cystic renal cell carcinomas are among 3 to 7% of kidney cancers and sometimes are difficult to diagnose, as it happened in this case.
Subject(s)
Carcinoma, Renal Cell/diagnosis , Kidney Neoplasms/diagnosis , Humans , Male , Middle AgedABSTRACT
Presentamos el caso de un carcinoma quístico unilocular de riñón y sus imágenes radiológicas. Los carcinomas quísticos de riñón representan un escaso porcentaje de las tumoraciones malignas renales (3-7%). La presencia de masas quísticas en el riñón puede plantear dificultad en su diagnóstico diferencial, como ocurrió en nuestro caso, especialmente las uniloculares
We report the case of unilocular cystic renal cell carcinoma and its radiological findings. Cystic renal cell carcinomas are among 3 to 7% of kidney cancers and sometimes are difficult to diagnose, as it happened in this case
Subject(s)
Male , Middle Aged , Humans , Carcinoma/diagnosis , Carcinoma/surgery , Kidney Neoplasms/diagnosis , Kidney Neoplasms/surgeryABSTRACT
We report two cases of pulmonary BCG-induced pneumonitis recently diagnosed amongst our patients. The first case is a 81 year old man under BCG bladder instillation treatment because of high grade superficial bladder cancer who developed a severe interstitial granulomatous pneumonitis. The patient was treated with corticosteroids and tuberculostatics with a rapid and complete response. The second patient is a young man who presented only with persistent fever and also had a complete response after treatment.
Subject(s)
Adjuvants, Immunologic/adverse effects , BCG Vaccine/adverse effects , Granuloma/chemically induced , Pneumonia/chemically induced , Adjuvants, Immunologic/administration & dosage , Administration, Intravesical , Aged, 80 and over , BCG Vaccine/administration & dosage , Humans , Male , Middle Aged , Urinary Bladder Neoplasms/drug therapyABSTRACT
Presentamos dos casos de afectación pulmonar por BCG diagnosticados recientemente en nuestro servicio. Un primer paciente varón de 81 años de edad que desarrolló un cuadro de neumonitis intersticial granulomatosa severa en el contexto de un tratamiento mediante instilación endovesical de BCG por tumor vesical de alto grado. Este paciente fue tratado mediante corticoterapia y triple asociación de antituberculosos con una respuesta rápida y completa. El segundo caso fue un hallazgo radiológico en un paciente de 56 años que presentaba fiebre persistente como único síntoma y que mejoró tras iniciar doble asociación de tuberculostáticos
We report two cases of pulmonary BCG-induced pneumonitis recently diagnosed amongst our patients. The first case is a 81 year old man under BCG bladder instillation treatment because of high grade superficial bladder cancer who developed a severe interstitial granulomatous pneumonitis. The patient was treated with corticosteroids and tuberculostatics with a rapid and complete response. The second patient is a young man who presented only with persistent fever and also had a complete response after treatment
Subject(s)
Male , Middle Aged , Aged , Humans , Administration, Intravesical , Antitubercular Agents/therapeutic use , Pneumonia, Pneumocystis/diagnosis , Atrial Fibrillation/therapy , Lung Diseases, Interstitial/diagnosisABSTRACT
No disponible
Subject(s)
Humans , Diabetes Mellitus/therapy , Diabetes Mellitus/complications , Insulin/administration & dosage , Clinical Protocols , Hospitalization/trendsABSTRACT
We report a case of a man with erythrocytosis secondary to hydronephrosis in a right horseshoe kidney. The patient had an advanced hydronephrosis because of ureteropelvic junction obstruction occupying the right hemiabdomen. Following nephrectomy of the right kidney erythrocyte count returned to normal values. Secondary polyglobulia may be due to increased erythropoietine values and has been related in some patients with renal diseases such as hydronephrosis, but very rarely in association with hydronephrotic horseshoe kidney.
Subject(s)
Hydronephrosis/complications , Kidney/abnormalities , Polycythemia/etiology , Adult , Humans , Hydronephrosis/diagnostic imaging , Hydronephrosis/surgery , Kidney/pathology , Kidney/surgery , Male , Nephrectomy , Platelet Count , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Presentamos el caso clínico de un paciente en el que se asoció eritrocitosis e hidronefrosis del hemirriñón derecho de un riñón en herradura. El paciente presentaba hidronefrosis masiva avanzada secundaria a obstrucción pieloureteral ocupando todo el hemiabdomen derecho. Después de la nefrectomía la masa eritrocitaria descendió a valores normales. La poliglobulia secundaria puede ser debida a una producción inadecuada de eritropoyetina y se ha descrito en asociación con patología renal de diversa naturaleza, incluida la hidronefrosis, pero en muy escasas ocasiones en relación a hidronefrosis de un riñón en herradura (AU)
We report a case of a man with erythrocytosis secondary to hydronephrosis in a right horseshoe kidney. The patient had an advanced hydronephrosis because of ureteropelvic junction obstruction occupying the right hemiabdomen. Following nephrectomy of the right kidney eritrocyte count returned to normal values. Secondary polyglobulia may be due to increased erytropoietine values and has been related in some patients with renal diseases such as hydronephrosis, but very rarely in association with hydronephrotic horseshoe kidney (AU)
Subject(s)
Male , Adult , Humans , Hydronephrosis/etiology , Ureteral Obstruction/complications , Kidney/abnormalities , Polycythemia/etiology , Nephrectomy , ErythropoietinABSTRACT
No disponible