Narrativas del donante de plasma convaleciente en EsSalud: motivaciones, miedos, expectativas y experiencias

Objetivos: Explorar, desde las narrativas de la población de donantes de plasma convaleciente en un ensayo clínico, las experiencias en el proceso de donación de sangre. Métodos: Se realizó un estudio cualitativo con diseño fenomenológico. La investigación se llevó a cabo en un hospital de la seguridad social del Perú aplicándose entrevistas semiestructuradas a profundidad. Resultados: Se entrevistó a once donantes de plasma convaleciente. Se identificó que las principales motivaciones de los donantes fueron tanto el poder contribuir a la investigación nacional como, apoyar a pacientes afectados por la COVID-19. Los principales miedos se centran en el posible riesgo de contagio dentro del hospital. Por otro lado, los donantes resaltaron la atención y acompañamiento del personal de salud en el proceso. Las principales expectativas y sugerencias apuntan hacia una mayor difusión de las campañas de donación de sangre en general, con especial énfasis en el tema de seguridad, la mejora en el tiempo del procedimiento de donación (en el caso de la donación de plasma convaleciente, desde el enrolamiento hasta la extracción de plasma convaleciente) y, la implementación de espacios amigables para incentivar las futuras campañas de donación de sangre en general. Conclusiones: Las experiencias de los donantes de plasma convaleciente fueron positivas. Sin embargo, aún hay mejoras que realizar a nivel de procesos e infraestructuras para asegurar campañas exitosas de donación de sangre futuras.

Objectives: To know and explore from convalescent plasma donators' voices the experience in the blood donation process at a social security hospital. Methods: Qualitative study with a phenomenological design. The investigation was carried out in 01 hospitals of the social security of Peru. Semi-structured interviews were carried out. Results: Eleven donors of convalescent plasma were interviewed. The main motivations for donating were being able to contribute to national research and supporting patients affected by COVID-19. Fears focus on the possible risk of contagion within the hospital. Donors emphasised the attention and support of health personnel alongside the donation procedure. The main expectations and suggestions point towards greater dissemination of donation campaigns with special emphasis on safety. Likewise, an improvement in the time of the donation procedure (from enrolment to the extraction of convalescent plasma), and the implementation of friendly spaces to encourage future blood donation campaigns were highlighted. Conclusions: The experience of the convalescent plasma donors was positive. However, improvements must be made in terms of processes and infrastructure to ensure future successful blood donation campaigns.

Trasplante renal grupo sanguíneo ABO incompatible. Experiencia colaborativa inédita España y Perú / Incompatible ABO blood group renal transplant. Unprecedented collaborative experience between Spain and Peru

La incompatibilidad de grupo sanguíneo ABO y la sensibilización al HLA constituyen grandes barreras a vencer en pro de la óptima utilización de riñones de donante vivo. Describimos en nuestro medio el primer trasplante renal exitoso ABO incompatible en un paciente de 24 años, retrasplantado renal, altamente sensibilizado (PRA: 89%) y sin opción alguna en disponer de donantes cadavéricos ni familiares. Sin embargo, su único donante vivo HLA compatible era de grupo sanguíneo A incompatible con el grupo O del receptor. El paciente requirió de un régimen precondicionante consistente en recambios plasmáticos, rituximab, imunoglobulina y terapia inmunosupresora cuádruple, a fin de reducir los títulos elevados de isoaglutininas anti A de 1:128 a niveles de seguridad de 1:8, para el éxito del trasplante. Este fue realizado en Coordinación con la Unidad de Trasplante Renal del Hospital Clínic de Barcelona España (HCB). La ausencia de rechazo mediado por isoaglutininas muestra el potencial beneficio del protocolo al remover los anticuerpos anti grupo sanguíneo. A los dos años del trasplante, la función renal se mantiene estable con niveles de creatinina 1,5 mg%. Concluimos que el trasplante renal ABO incompatible (ABOi) es opción viable para pacientes cuyo único donante sea grupo sanguíneo incompatible, y entre nosotros representa esperanzadora fuente de órganos.

ABO blood group incompatibility and HLA sensitization are major barriers that need to be overcome in order to make optimum use of kidneys from living donors possible. We report the first successful ABO- incompatible kidney transplant in a 24-year old, highly sensitized (panel reactive antibodies (PRA) 89% kidney retransplantation patient, who lacked any option to get a cadaveric or family donor. However, the patient's sole HLA-compatible living donor had group A blood incompatible with the recipient's O blood group. The < patient required a pre-conditioning regime that consisted of plasma exchange, rituximab, immunoglobulin, and quadruple immunosuppressive therapy in order to reduce high titers of anti-A isoagglutinins from 1:128 to a safe level of 1:8, for successful transplant. This was performed in coordination with the Renal Transplant Unit of Hospital Clinic de Barcelona (HCB), Spain. Absence of rejection mediated by isoagglutinins shows the potential benefit of a protocol consisting in removing antibodies from the anti-blood group. Two yearsafter transplantation, the kidney function remains stable, with creatinine levels of 1.5 mg%. We conclude that an ABO-incompatible kidney transplant is a viable option for patients whose only donor has blood of an incompatible blood group and for us this represents a hope-inspiring source of organs .

Carga viral del Virus Epstein Barr en sangre total como biomarcador diagnóstico en los desórdenes linfoproliferativos en pacientes inmunocompetentes / Viral load of Epstein Barr Virus in whole blood as a biomarker diagnosis in lymphoproliferative disorders in immunocompetent

La cuantificación de la carga viral en sangre del Virus Epstein Barr (VEB) ha demostrado ser útil como marcador diagnóstico y pronóstico en específicos tipos de linfomas asociados al virus. 59 pacientes con desórdenes linfoproliferativos fueron reclutados al diagnóstico y se les realizó un estudio de carga viral para la determinación del DNA del VEB en sangre total. Se incluyeron: 46 Linfomas difuso de Células Grandes B Difuso, 3 Linfomas Hodgkin, 3 Linfomas nasal T/NK, 4 Leuce-mia/lymphoma T del Adulto (ATLL), 1 Linfoma T periférico no especificado, 1 Linfoma T paniculítico y 1 Linfoma Hidroa vaciniforme-like. Los resultados arrojaron: 13 casos positivos (rango 0.25-46,400 copies/ul): 7 fueron LCGBD, 2 Linfomas T/NK nasal, 2 ATLL, 1 Linfoma Hodgkin y 1 Linfoma Hidroa vaciniforme–like. 11/13 casos positivos tuvieron estudio de EBER-CISH en tejido tumoral, el cual fue positivo en todos los casos. El estudio sugiere que la cuantificación en sangre total del DNA del VEB correlaciona con la presencia del virus en células tumorales y podría ser útil como biomarcador diagnóstico.

Cuantification of viral blood load for EBV has demonstrated to be useful as marker in diagnosis and prognosis in diferent specific lymphomas related to virus. 59 patients with diverse lymphoprolife-rative disorders were recluted at diagnosis to evaluate viral load of EBV DNA in whole blood. We included: 46 Diffuse large B cell Lymphoma (DLBCL), 3 Hodgkin Lymphoma, 3 T/NK nasal type lym-phoma, 4 Adult T Leukemia/lymphoma (ATLL), 1 T cell lymphoma unspecified, 1 T panicullitic lym-phoma and 1 Hydroa vacciniform –like lymphoma . Results showed: 13 cases were positive (range 0.25-46,400 copies/ul): 7 were DLBCL, 2 T/NK nasal type Lymphoma, 2 ATLL, 1 Hodgkin Lymphoma y 1 Hidroa vacciniforme–like lymphoma. 11/13 positive cases had EBER-CISH in tumoral tissue and it was positive in all cases.This study suggests cuantification in total whole blood for EBV DNA correlates with the presence of EBV in tumoral cells and it could be a useful diagnostic biomarker.

Bypass grafts and cell transplant in heart failure with low ejection fraction.

From June 2004 to October 2007, 34 patients with chronic heart failure and low ejection fraction underwent surgical revascularization; 23 received bypass grafting plus transplantation of bone marrow-derived stem cells (study group) and 11 had revascularization only (control group). The stem cells were implanted into nonviable myocardial areas, bypass grafting was performed in viable myocardial areas. In the study group, the ejection fraction increased from the baseline 26.4% ± 4% to 37.3% ± 11.5% after 26 months. In the control group, ejection fraction increased from 29% ± 2% to 31.5% ± 4.3% after 27 months. The improvement in the study group was significantly greater than that in the control group. Functional class improved significantly from 3.2 to 1.2 in the study group vs. 3.0 to 2.3 in the control group. Stem cell transplantation associated with bypass grafting is feasible and safe in patients with chronic heart failure with low ejection fractions, and it improves ventricular systolic function and functional class.

Creando vida: posibilidad de células madre / Building lives: the possibility of stem cell

En las primeras ediciones de Actualidad Odontológica y Salud, comentamos el ingreso de la odontología en la era molecular. En esta edición profundizamos el estudio y reflexiones sobre "células madre" basado en la disyuntiva científico - ético y política internacional que debate el mundo en torno a la investigación y aplicación terapéutica de células madre.

Hepatitis C virus F protein sequence reveals a lack of functional constraints and a variable pattern of amino acid substitution.

Hepatitis C virus (HCV) is an important human pathogen that affects 170 million people worldwide. The HCV genome is an RNA molecule that is approximately 9.6 kb in length and encodes a polyprotein that is cleaved proteolytically to generate at least 10 mature viral proteins. Recently, a new HCV protein named F has been described, which is synthesized as a result of a ribosomal frameshift. Little is known about the biological properties of this protein, but the possibility that the F protein may participate in HCV morphology or replication has been raised. In this work, the presence of functional constraints in the F protein was investigated. It was found that the rate of amino acid substitutions along the F protein was significantly higher than the rate of synonymous substitutions, and comparisons involving genes that represented independent phylogenetic lineages yielded very different divergence/conservation patterns. The distribution of stop codons in the F protein across all HCV genotypes was also investigated; genotypes 2 and 3 were found to have more stop codons than genotype 1. The results of this work suggest strongly that the pattern of divergence in the F protein is not affected by functional constraints.

Evidence of intratypic recombination in natural populations of hepatitis C virus.

Hepatitis C virus (HCV) has high genomic variability and, since its discovery, at least six different types and an increasing number of subtypes have been reported. Genotype 1 is the most prevalent genotype found in South America. In the present study, three different genomic regions (5'UTR, core and NS5B) of four HCV strains isolated from Peruvian patients were sequenced in order to investigate the congruence of HCV genotyping for these three genomic regions. Phylogenetic analysis using 5'UTR-core sequences found strain PE22 to be related to subtype 1b. However, the same analysis using the NS5B region found it to be related to subtype 1a. To test the possibility of genetic recombination, phylogenetic studies were carried out, revealing that a crossover event had taken place in the NS5B protein. We discuss the consequences of this observation on HCV genotype classification, laboratory diagnosis and treatment of HCV infection.