Perceptions of COVID-19 patients in the use of bioethical principles and the physician-patient relationship: a qualitative approach.

BACKGROUND: The COVID-19 pandemic has influenced the approach to the health-disease system, raising the question about the principles of bioethics present in physician-patient relations. The principles while widely accepted may not be sufficient for a comprehensive ethical analysis. Therefore, the aim of this study was to explore the perception of these principles and the physician-patient relationship during a hospital stay through a qualitative approach. METHOD: Sixteen semi-structured interviews took place to know the patients' perception during their 2020 hospitalization for COVID-19. The data was analyzed through the constant comparison method, creating categories and comparing them. In the end, seven categories were established and were grouped in three: bioethical principles (dignity, charity, vulnerability, autonomy), doctor-patient relationship (participant commitment, informed consent, health staff-patient relationship) and the experience of the disease (illness, the role of the family). RESULTS: The research found that most patients described a positive experience, with the feeling of having been well cared for with no sense of discrimination or injustice done. The majority also reported that their autonomy was respected in the treatment decisions. The evaluation of these attitudes is an area of opportunity, especially when the patients' vulnerability is at risk. CONCLUSIONS: The ethics of virtue offers a better reflection of how human beings manifest themselves by emphasizing the development of virtuous character and behaviors that allow them to realize their values in life. Authorized by the Research Ethics Committee with registration: DI/18/105-B/3/308.

Novel Drugs for the Management of Diabetes Kidney Transplant Patients: A Literature Review.

The management of diabetes and renal failure is changing thanks to the appearance of new drugs such as glucagon-like peptide 1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter type 2 inhibitors (SGLT2i) that have benefits in terms of survival and cardiorenal protection. Based on the potential mechanisms of GLP1-RA, kidney transplant recipients (KTRs) could benefit from their effects. However, high-quality studies are needed to demonstrate these benefits, in the transplant population, especially those related to cardiovascular benefits and renal protection. Studies with SGLT2i performed in KTRs are much less potent than in the general population and therefore no benefits in terms of patient or graft survival have been clearly demonstrated in this population to date. Additionally, the most frequently observed side effects could be potentially harmful to this population profile, including severe or recurrent urinary tract infections and impaired kidney function. However, benefits demonstrated in KTRs are in line with a known potential effects in cardiovascular and renal protection, which may be essential for the outcome of transplant recipients. Better studies are still needed to confirm the benefits of these new oral antidiabetics in the renal transplant population. Understanding the characteristics of these drugs may be critical for KTRs to be able to benefit from their effects without being damaged. This review discusses the results of the most important published studies on KTRs with GLP1-RA and SGLT2i as well as the potential beneficial effects of these drugs. Based on these results, approximate suggestions for the management of diabetes in KTRs were developed.

Role of mTOR inhibitor in the cellular and humoral immune response to a booster dose of SARS-CoV-2 mRNA-1273 vaccine in kidney transplant recipients.

Background: Immunocompromised patients have an increased risk of developing severe COVID disease, as well as a tendency to suboptimal responses to vaccines. The objective of this study was to evaluate the specific cellular and humoral adaptive immune responses of a cohort of kidney transplant recipients (KTR) after 3 doses of mRNA-1273 vaccine and to determinate the main factors involved. Methods: Prospective observational study in 221 KTR (149 non infected), 55 healthy volunteers (HV) and 23 dialysis patients (DP). We evaluated anti-spike (by quantitative chemiluminescence immunoassay) and anti-nucleocapsid IgG (ELISA), percentage of TCD4+ and TCD8+ lymphocytes producing IFNγ against S-protein by intracellular flow cytometry after Spike-specific 15-mer peptide stimulation and serum neutralizing activity (competitive ELISA) at baseline and after vaccination. Results: Among COVID-19 naïve KTR, 54.2% developed cellular and humoral response after the third dose (vs 100% in DP and 91.7% in HV), 18% only showed cell-mediated response, 22.2% exclusively antibody response and 5.6% none. A correlation of neutralizing activity with both the IgG titer (r=0.485, p<0.001) and the percentage of S-protein-specific IFNγ-producing CD8-T cells (r=0.198, p=0.049) was observed. Factors related to the humoral response in naïve KTR were: lymphocytes count pre-vaccination >1000/mm3 [4.68 (1.72-12.73, p=0.003], eGFR>30 mL/min [7.34(2.72-19.84), p<0.001], mTOR inhibitors [6.40 (1.37-29.86), p=0.018]. Infected KTR developed a stronger serologic response than naïve patients (96.8 vs 75.2%, p<0.001). Conclusions: KTR presented poor cellular and humoral immune responses following vaccination with mRNA-1273. The immunosuppression degree and kidney function of these patients play an important role, but the only modifiable factor with a high impact on humoral immunogenicity after a booster dose was an immunosuppressive therapy including a mTOR inhibitor. Clinical trials are required to confirm these results.

Atención Primaria y personas mayores en las residencias: propuestas de mejora tras la experiencia durante la pandemia / Primary Care and the elderly in nursing homes: proposals for improvement after the experience during the pandemic

Con este artículo hemos querido acercarnos a la visión que desde la Atención Primaria (AP) tenemos sobre lo que ha supuesto la pandemia de la COVID-19 en la población mayor y particularmente en las personas ancianas que viven en residencias. La situación previa de los centros residenciales ha influido durante la pandemia en un elevado número de fallecimientos, aislamiento social y problemas de salud derivados. Las personas de estos centros son generalmente más vulnerables, frágiles, dependientes y longevas, pero estos condicionantes no justifican el nivel de contagios y mortalidad por sí mismos. En los momentos de mayor dureza de la crisis sanitaria, se activaron una serie de respuestas sociales y sanitarias variadas y diversas en cada comunidad autónoma. Algunas de estas tuvieron carácter urgente y terminaron por originar diferentes estrategias y/o nuevos modelos de atención y gestión de las residencias. En algunos casos, estos cambios se siguen manteniendo. El objetivo de este artículo es analizar algunas de las principales medidas que se llevaron a cabo, los cambios que se implementaron, los puntos en común, el consenso en la toma de decisiones, la evidencia sobre la que se basaron, los aspectos éticos y legales que inspiraron estas estrategias y los resultados en salud obtenidos. Atendiendo a lo comentado, el grupo hace una serie de propuestas de mejora de cara al futuro.(AU)

This article aims to get closer to the vision from the perspective of primary care about what the COVID 19 pandemic has entailed in the elderly population and especially in those who live in nursing homes. During the pandemic, the previous situation of residential centres has led to a high number of deaths, social isolation and derived health problems. People in these centres are in general more vulnerable, frail, dependent and long-lived. However, these conditions do not in themselves justify the level of infections and mortality. In the most difficult moments of the health crisis, a series of varied and diverse social and health responses were activated according to the different Autonomous Communities. Some were urgent in nature and ended up giving rise to different strategies and/or new care and management models for nursing homes. In some cases, these changes are still maintained. The aim of the article is to analyze some of the main measures that were performed; the changes implemented, the points in common, the consensus in decision-making, the evidence on which they were based, the ethics and legal aspects that inspired these strategies and the health outcomes obtained. In response to what has been said, the group makes a series of proposals for improvement in the future.(AU)

Genome-wide association study biomarkers in T-cell mediated rejection: selective effect according to the Banff classification.

BACKGROUND: A genome-wide association study (GWAS) in kidney transplant recipients reported the association of two polymorphisms located in the PTPRO gene and upstream of the CCDC67 (DEUP1) gene with increased risk of acute T cell-mediated rejection (TCMR). We aimed at replicating the assessment of mentioned associations and additionally ascertaining the influence of treatment and clinical features of the patients. METHODS: The polymorphisms, PTPRO-rs7976329 and CCDC67-rs10765602 were genotyped by TaqMan chemistry in 641 consecutive kidney transplant recipients. The diagnosis of rejection was confirmed by biopsy and categorized according to the Banff classification. Associations were evaluated by Chi-square test or Fisher's exact test when necessary and multivariate logistic regression. RESULTS: Considering the GWAS study we only replicated the association of the PTPRO-rs7976329*C allele in the Banff grade < II subjects. However, the homozygous mutant genotypes of both polymorphism seemed to increase the risk of TCMR Banff grade < II in the overall cohort and after stratification by Thymoglobulin induction therapy. In the multivariate analysis, we confirmed the association of PTPRO-rs7976329 with TCMR Banff grade < II, independently of the Thymoglobulin induction therapy and of CCDC67-rs10765602 only in the group of patients not receiving Thymoglobulin induction therapy. No association of these polymorphisms with TCMR Banff grade ≥ II was observed in either the overall cohort or in the subgroups stratified by Thymoglobulin therapy. CONCLUSIONS: Our study shows that the increased risk of TCMR related to polymorphisms PTPRO-rs7976329 and CCDC67-rs10765602 previously reported in a GWAS was replicated only in homozygous patients who presented TCMR Banff grade < II and for the minor allele of either polymorphism.

Clinical impact of time-to-positivity of blood cultures on mortality in patients with Pseudomonas aeruginosa bacteremia.

OBJECTIVES: To investigate the impact of the time-to-positivity of blood cultures (TTP) on 30-day mortality in patients with Pseudomonas aeruginosa bacteremia. METHODS: All nonduplicated episodes of P. aeruginosa monomicrobial bacteremia in adult patients from January 2013 to February 2020 were analysed. Epidemiological and clinical data were collected. TTP of blood cultures for P. aeruginosa isolates was automatically recorded. Multivariate analysis identified factors predicting 30-day overall mortality. RESULTS: A total of 328 patients were identified. The median TTP for P. aeruginosa isolates was 15 h (interquartile range [IQR] 12-18 h). All multidrug-resistant and extensively drug-resistant (MDR/XDR) episodes were positive within the first 36 h. The 30-day mortality rate was 32.3%. The best cut-off value of the TTP for predicting mortality was 16 h (area under the receiver operating characteristic curve 0.62, 95% confidence interval [CI] 0.56-0.67, P = 0.001). The 30-day mortality rate was significantly higher in the TTP ≤16 h group (41.0% vs. 19.5%, P < 0.001). In a multivariate analysis, severe neutropenia (adjusted odds ratio [aOR] 2.67, 95% CI 1.4-5.09, P = 0.002), septic shock (aOR 3.21, 95% CI 1.57-5.89, P < 0.001), respiratory source (aOR 4.37, 95% CI 2.24-8.52, P < 0.001), nosocomial acquisition (aOR 1.99, 95% CI 1.06-3.71, P = 0.030), TTP ≤16 h (aOR 2.27, 95% CI 2.12-4.25, P = 0.010), and MDR/XDR phenotype (aOR 2.54, 95% CI 1.38-4.67, P = 0.002) were independently associated with 30-day mortality. CONCLUSIONS: A short TTP (≤16 h) was independently associated with increased 30-day mortality. After local validation, this routinely available microbiological parameter might be useful for guiding empirical antipseudomonal therapies and supporting the close monitoring of patients with P. aeruginosa bacteremia.

Hemophagocytic syndrome triggered by donor-transmitted toxoplasmosis as a complication in same-donor recipients of renal transplantation: Case report and review of the literature.

BACKGROUND: Hemophagocytic syndrome (HPS) is an infrequent complication of transplantation caused by an inflammatory response with a benign proliferation of macrophages and defective lytic capability of T lymphocytes and NK cells that can lead to multiorgan failure. Transplant patients are particularly exposed as a result of the increased risk of both infections and malignancies derived from immunosuppressive drugs. There is no consensus for therapy or immunosuppression; mortality is high. We report a case and present a review of all cases of HPS occurring in solid organ transplant recipients.  CASE REPORT: We report two cases of infection by Toxoplasma gondii transmitted by the kidney allograft. One of the recipients was seronegative before transplantation and developed disseminated primary toxoplasmosis. An immune reaction compatible with an HPS ensued. Both were treated with Trimethoprim/sulfamethoxazole, immunosuppression was tapered, and after a 2-week period a complete response was obtained. CONCLUSION: HPS presents therapeutic challenges in the context of transplantation. If HPS is suspected, the search of a very likely underlying infection should be central to the management.

Association of Polymorphisms in T-Cell Activation Costimulatory/Inhibitory Signal Genes With Allograft Kidney Rejection Risk.

The genes CD28, CD86 and CTLA-4 conform the costimulatory (CD28-CD86) or inhibitory (CTLA-4-CD86) signal in T-cell activation. T-cell immune response has a critical role in allograft rejection, and single nucleotide polymorphisms (SNPs) located in these genes have been widely analyzed with controversial results. We analyzed a group of SNPs located in the three genes: CD28: rs3116496; CD86: rs1129055; and CTLA-4: rs231775 and rs3087243 in a cohort of 632 consecutively recruited kidney transplanted subjects. All polymorphisms were genotyped by TaqMan chemistry and the diagnosis of rejection was confirmed by biopsy and categorized according to the Banff classification. The analyses showed a statistically significant protective effect to T cell-mediated rejection (TCMR) in carriers of the CTLA-4 rs3087243*G allele, especially in patients with TCMR Banff ≥2 in the overall cohort and in patients without thymoglobulin induction therapy. Both associations were corroborated as independent factors in the multivariate analysis. Interestingly, associations with rejection were not found for any SNP in patients with thymoglobulin induction therapy. As expected, considering the major role of these genes in T-cell activation, no effect was observed for antibody-mediated rejection (ABMR). In conclusion, the SNP rs3087243 located in the CTLA-4 gene may be considered a useful independent biomarker for TCMR risk especially for severe TCMR in patients who did no received thymoglobulin induction therapy.

Should cyclosporine be useful in renal transplant recipients affected by SARS-CoV-2?

Minimization of immunosuppression and administration of antiretrovirals have been recommended for kidney transplant recipients (KTRs) with coronavirus disease 2019 (COVID-19). However, outcomes remain poor. Given the likely benefit of cyclosporine because of its antiviral and immunomodulatory effect, we have been using it as a strategy in KTRs diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied 29 kidney transplant recipients (KTRs) who were admitted to our institution with COVID-19 between March 15and April, 24, 2020. Mycophenolate and/or mammalian target of rapamycin inhibitors (mTORi) were discontinued in all patients. Two therapeutic strategies were compared: Group 1, minimization of calcineurin inhibitors (N = 6); and Group 2, cyclosporine-based therapy (N = 23), with 15 patients switched from tacrolimus. Hydroxychloroquine was considered in both strategies but antivirals in none. Six patients died after respiratory distress (20.6%). Five required mechanical ventilation (17.2%), and 3 could be weaned. Nineteen patients had an uneventful recovery (65.5%). In group 1, 3 of 6 patients died (50%) and 1 of 6 required invasive mechanical ventilation (16.7%). In group 2, 3 of 23 patients died (12.5%). Renal function did not deteriorate and signs of rejection were not observed in any patient on the second treatment regime. In conclusion, immunosuppressant treatment based on cyclosporine could be safe and effective for KTRs diagnosed with COVID-19.

Fulminant Emphysematous Pyelonephritis by Candida glabrata in a Kidney Allograft.

Emphysematous pyelonephritis (EPN) is a rare and serious necrotizing infection that is potentially life-threatening. It has been seldom reported in kidney grafts and is usually caused by Gram-negative bacteria, with some case reports caused by anaerobic bacteria, and has been closely associated with poorly controlled diabetes mellitus (DM) and urinary tract structural abnormalities. There are no reports of EPN of fungal etiology in kidney grafts. We present a case of a 53-year-old kidney transplant recipient with a history of DM, active vesicoureteral reflux, and recurrent urinary tract infections who developed EPN in the kidney allograft caused by Candida glabrata, 3 weeks after starting treatment with empagliflozin, with an aggressive course that required urgent transplant nephrectomy.

Family Violence, PTSD, and Parent-Child Interactions: Dyadic Data Analysis with Mexican Families.

BACKGROUND: Family violence has been shown to have a dramatic impact on individual and family life in the United States and other countries. Numerous studies have assessed the influence that exposure to violence can have on family dynamics and parent-child relationships. However, less is known about the association between family violence and parent-child relationships with Mexican families. OBJECTIVE: Guided by social interaction learning theory, the purpose of this study was to explore the role of exposure to family violence on PTSD and mother-child interaction patterns. METHODS: Eighty-seven mother-child dyads from Mexico completed assessments for exposure to family violence, PTSD, and observational tasks were analyzed to assess prosocial parent-child interactions (i.e., positive communication and problem solving). We conducted an actor-partner independence model (APIM) to examine the association between exposure to family violence, PTSD and mother-child relationship dynamics. RESULTS: As expected, higher exposure to family violence was linked to higher PTSD symptoms for mothers. Unexpectedly, higher maternal PTSD symptoms were associated with better communication during dyadic interaction tasks with their children. CONCLUSIONS: The present study suggests that individuals from certain cultures (i.e., Mexico) may respond differently to experiencing family violence. The use of multiple measurement methods to assess the relational effects of trauma on family dynamics can advance the scientific understanding of trauma affected families.

Impacts of Interleukin-18 Polymorphisms on the Incidence of Delayed-Onset Cytomegalovirus Infection in a Cohort of Kidney Transplant Recipients.

BACKGROUND: The incidence of cytomegalovirus (CMV) infection in solid organ transplant recipients may be reduced by antiviral prophylaxis, but this strategy may lead to delayed-onset CMV infection. The proinflammatory cytokine interleukin (IL)-18 plays a major role in viral host defense responses. This study examines the impacts of 2 single-nucleotide polymorphisms (SNPs) in the promoter region of the IL-18 gene, -607C/A (rs1946518) and -137G/C (rs187238), on the incidence of delayed-onset CMV infection in patients undergoing kidney transplant. METHODS: This retrospective study analyzed 2 IL-18 SNPs in consecutive adult kidney transplant recipients using real-time polymerase chain reaction with TaqMan probes. Participants were enrolled over the period 2005-2013 and stratified according to their IL-18 SNP genotype. The concordance index (Harrell's c-index) was used as a measure of the discriminatory power of the predictive models constructed with bootstrapping to correct for optimistic bias. RESULTS: Seven hundred nine patients received transplants in the study period, and 498 met selection criteria. Cytomegalovirus infection and disease incidence were 38% and 7.5%, respectively. In multivariate competing risk regression models, carriers of the -607C/-137G haplotype who received prophylaxis showed a higher incidence of CMV replication after antiviral agent discontinuation (hazard ratio = 2.42 [95% confidence interval, 1.11-5.26]; P = .026), whereas CMV disease was not observed in those given prophylaxis who were noncarriers of this polymorphism (P = .009). CONCLUSIONS: Our findings suggest that the -607C/-137G IL-18 haplotype is associated with a higher incidence of postprophylaxis CMV replication. The prior identification of this polymorphism could help select alternative measures to prevent delayed-onset CMV infection in these patients.

Uncontrolled donation after circulatory death: A cohort study of data from a long-standing deceased-donor kidney transplantation program.

Despite good long-term outcomes of kidney transplants from controlled donation after circulatory death (DCD) donors, there are few uncontrolled DCD (uDCD) programs. This longitudinal study compares outcomes for all uDCD (N = 774) and all donation after brain death (DBD) (N = 613) kidney transplants performed from 1996 to 2015 at our center. DBD transplants were divided into those from standard-criteria (SCD) (N = 366) and expanded-criteria (N = 247) brain-dead donors (ECD). One-, 5-, and 10-year graft survival rates were 91.7%, 85.7%, and 80.6% for SCD; 86.0%, 75.8%, and 61.4% for ECD; and 85.1%, 78.1%, and 72.2% for uDCD, respectively. Graft survival was worse in recipients of uDCD kidneys than of SCD (P = .004) but better than in transplants from ECD (P = .021). The main cause of graft loss in the uDCD transplants was primary nonfunction. Through logistic regression, donor death due to pulmonary embolism (OR 4.31, 95% CI 1.65-11.23), extrahospital CPR time ≥75 minutes (OR1.94, 95%CI 1.18-3.22), and in-hospital CPR time ≥50 minutes (OR 1.79, 95% CI 1.09-2.93) emerged as predictive factors of primary nonunction. According to the outcomes of our long-standing kidney transplantation program, uDCD could help expand the kidney donor pool.

Adaptive Recruitment and Parenting Interventions for Immigrant Latino Families with Adolescents.

Parenting programs are an effective strategy to prevent multiple risky outcomes during adolescence. However, these programs usually enroll one caregiver and have low attendance. This study evaluated the preliminary results, cost, and satisfaction of adaptive recruitment and parenting interventions for immigrant Latino families. A mixed methods study was conducted integrating a pre-post design with embedded qualitative and process evaluations. Fifteen immigrant Latino families with an adolescent child aged 10-14 were recruited. Two-caregiver families received a home visit to increase enrollment of both caregivers. All families participated in an adaptive parenting program that included group sessions and a one-to-one component (online videos plus follow-up telephone calls) for those who did not attend the group sessions. The intervention addressed positive parenting practices using a strengths-based framework. Primary outcomes were the proportion of two-parent families recruited and intervention participation. Secondary outcomes were change in parenting self-efficacy, practices, fidelity, costs, and satisfaction. Participants completed questionnaires and interaction tasks before and after participating in the intervention. In addition, participants and program facilitators completed individual interviews to assess satisfaction with the program components. Overall, 23 parents participated in the intervention; 73% of two-parent families enrolled with both parents. Most participants completed 75% or more of the intervention. Fathers were more likely to use the one-to-one component of the intervention than mothers (p = .038). Participants were satisfied with program modifications. In sum, adaptive recruitment and parenting interventions achieved high father enrollment and high participation. These findings warrant further evaluation in randomized trials.

The Interferon-Gamma +874 A/T Polymorphism Is Not Associated With CMV Infection After Kidney Transplantation.

The +874 A/T polymorphism in the interferon gamma (IFNG) gene has been associated with Cytomegalovirus (CMV) infection risk in lung and kidney transplant recipients. To replicate this association, we performed a retrospective observational study of this polymorphism and immunosuppressive therapies considering the prophylactic treatment in 600 consecutive kidney transplanted recipients. We found no association of the aforementioned polymorphism with CMV infection in univariate and multivariate analyses regardless of the prophylactic treatment. In addition, the immunosuppressive treatment with mammalian target of rapamycin inhibitors (imTOR) showed a protective effect in all patients independently of prophylaxis. Moreover, in the adjusted model, we found interactions between prophylaxis with high-risk (Donor+/Recipient-, D+/R-) status (p-interaction = 0.01), with thymoglobulin induction therapy (p-interaction = 0.03) and with thymoglobulin anti-rejection therapy (p-interaction = 0.002). Data also revealed that prophylaxis was not an advantage in the not D+/R- and without thymoglobulin therapy group (HR = 0.98, p = 0.95). The benefit of prophylaxis was observed in all groups with thymoglobulin therapy, but it was maximal in the high-risk CMV infection group with both thymoglobulin induction therapy and thymoglobulin anti-rejection therapy (HR = 0.01, p < 0.001). In conclusion, the IFNG +874 polymorphism is not a predictive marker of CMV infection. The protective effect of imTOR is not improved with prophylaxis. Interestingly, the thymoglobulin therapy associated with prophylaxis is not a risk factor for CMV infection, and prophylaxis is not effective in recipients with no high-risk CMV status and without thymoglobulin therapy.

Sarcomatoid carcinoma of the jejunum presenting as obscure gastrointestinal bleeding in a patient with a history of gliosarcoma.

Small bowel malignant tumors are rare and sarcomatoid carcinomas have rarely been reported at this site. We report a 56-year-old woman, with history of an excised gliosarcoma, who presented with recurrent obscure gastrointestinal bleeding. She underwent endoscopy and colonoscopy, which failed to identify the cause of the bleeding. The abdominal computed tomography scan located a tumor in the small bowel. Pathology revealed a jejunal sarcomatoid carcinoma. She developed tumor recurrence and multiple liver metastases shortly after surgery. Immunohistochemistry is required for accurate diagnosis. Sarcomatoid carcinoma is a rare cause of obscure gastrointestinal bleeding, which is associated with a poor prognosis.

Nonlinear dynamics of confined liquid systems with interfaces subject to forced vibrations.

A review is presented of the dynamic behavior of confined fluid systems with interfaces under monochromatic mechanical forcing, emphasizing the associated spatio-temporal structure of the fluid response. At low viscosity, vibrations significantly affect dynamics and always produce viscous mean flows, which are coupled to the primary oscillating flow and evolve on a very slow timescale. Thus, unlike the primary oscillating flow, mean flows may easily interact with the surface rheology, which generates dynamics that usually exhibit a much slower timescale than that of typical gravity-capillary waves. The review is made with an eye to the typical experimental devices used to measure surface properties, which usually consist of periodically forced, symmetric fluid systems with interfaces. The current theoretical description of these systems ignores the fluid mechanics, which could play a larger role than presently assumed.

Progesterona plasmática y algunas características uterinas y embrionarias en la gestación temprana de yeguas criollas colombianas / Plasma Progesterone and Some Uterine and Embryonic Characteristics in Early Gestation of Colombian Mares / Progesterona plasmática e algumas características uterinas e embrionárias na gestação precoce de éguas crioulas colombianas

Se inseminaron artificialmente 24 yeguas criollas colombianas (CC) de 4 a 14 años de edad. Se cuantificaron los niveles plasmáticos de progesterona (P4) por la técnica de radioinmunoanálisis de fase sólida (RIA), se evaluaron el cuerpo lúteo (CL), el útero y el edema uterino por ultrasonografía desde la ovulación hasta el día 40 posovulación. El diagnóstico de preñez se realizó al detectar un conceptus; desde ese momento hasta el día 40 se evaluó diariamente. Los datos fueron analizados usando estadística descriptiva con valores promedio y desviación estándar (DE). El diagnóstico de gestación se hizo el día 10,4 ± 0,8 (promedio ± DE). La tasa de crecimiento del conceptus fue 1,65 ± 0,1 mm/día; su fijación al útero ocurrió el día 16,8 ± 1,5. El embrión se visualizó dentro de la vesícula el día 20,8 ± 1,7; su tasa de crecimiento fue 0,8 ± 0,3 mm/día. El latido cardiaco se detectó desde el día 23,9 ± 1,3. El 100 % de los embriones tuvieron un desarrollo normal hasta el día 40 de la gestación. El 62,5 % de los CL se ubicaron en el ovario derecho y el 33,3 % en el izquierdo; un animal presentó ovulación doble. El 66,6 % de los conceptus se ubicaron en la unión útero cornual derecha y el 33,3 % en la izquierda; el 79,1 % ipsilateral al CL. La gestación en la yegua CC presenta características fisiológicas similares a las descritas en la literatura. Los datos aquí presentados tienen importancia para las evaluaciones clínicas y constituyen un punto de partida para futuros estudios.

Twenty-four Colombian mares from 4 to 14 years of age were inseminated artificially. Progesterone (P4) plasma levels were quantified by the technique of solid phase radioimmunoassay (RIA); corpus luteum (CL), the uterus and uterine edema were evaluated by ultrasonography from ovulation until day 40 post-ovulation. Pregnancy was diagnosed upon detecting a conceptus; it was evaluated daily from that moment until day 40. Data were analyzed using descriptive statistics with mean values and standard deviation (SD). Pregnancy diagnosis was made on day 10.4 ± 0.8 (mean ± SD). The conceptus growth rate was 1.65 ± 0.1 mm / day; attachment to the uterus occurred on day 16.8 ± 1.5. The embryo was visualized within the gallbladder on day 20.8 ± 1.7; its growth rate was 0.8 ± 0.3 mm/day. Heartbeat was detected from day 23.9 ± 1.3. 100 % of the embryos had normal development until day 40 of gestation. 62.5 % of the CL was located in the right ovary and 33.3 % in the left; one animal had double ovulation. 66.6 % of the conceptus was located in the right utero corneal junction and 33.3 % in the left;79.1 % ipsilateral to the CL. Pregnancy in the mare shows physiological characteristics similar to those described in literature. The data presented here are important for clinical evaluations and provide a starting point for future studies.

Foram inseminadas artificialmente 24 éguas crioulas colombianas (CC) de 4 a 14 anos de idade. Foram quantificados os níveis plasmáticos de progesterona (P4) pela técnica de rádio imune análise de fase sólida (RIA), avaliaram-se o corpo lúteo (CL), o útero e o edema uterino por ultrassonografia desde a ovulação até o dia 40 pós-ovulação. O diagnóstico de prenhez foi feito ao detectar um conceptus; desde esse momento até o dia 40 avaliou-se diariamente. Os dados foram analisados usando estadística descritiva com valores médios e desvio padrão (DP). O diagnóstico de gestação foi feito no dia 10,4 ± 0,8 (média ± DP). A taxa de crescimento do conceptus foi 1,65 ± 0,1 mm/dia; sua fixação ao útero ocorreu no dia 16,8 ± 1,5. O embrião se visualizou dentro da vesícula no dia 20,8 ± 1,7; sua taxa de crescimento foi 0,8 ± 0,3 mm/dia. O batimento cardíaco foi detectado desde o dia 23,9 ± 1,3. 100 % dos embriões tiveram um desenvolvimento normal até o dia 40 da gestação. 62,5 % dos CL se localizaram no ovário direito e 33,3 % no esquerdo; um animal apresentou ovulação dupla. 66,6 % dos conceptus se localizaram na união útero cornual direita e 33,3 % na esquerda; 79,1 % ipsilateral ao CL. A gestação na égua CC apresenta características fisiológicas similares às descritas na literatura. Os dados aqui apresentados têm importância para as avaliações clínicas e constituem um ponto de partida para futuros estudos.

[Removal of retrievable inferior vena cava filters 90 days after implantation in an ovine model: is there a time limit for removal?]. / Cuál es el tiempo límite para retirar un filtro de vena cava? Filtros opcionales de vena cava inferior: recuperación 90 días después de su implantación. Modelo ovino.

OBJECTIVE: To study the feasibility and safety of removing retrievable Günther-Tulip vena cava filters (GTFs) 90 days after their implantation in an ovine model. MATERIAL AND METHODS: Thirty GTFs were implanted in 30 ewes and retrieval was attempted at 90 days. Conventional cavography was performed in all cases before and after retrieval in order to evaluate inferior vena cava patency and record dimensions. The presence of complications related to placement and retrieval of the filter from the inferior vena cava was also recorded. The force required to remove the filters was measured using a modified commercial dynamometer adapted to the GTF retrieval set. Histologic study focused on the inferior vena cava wall. RESULTS: Implantation was performed successfully in all cases (100%). One ewe developed a small focus of thrombosis around 1 of the legs of the filter and another presented a small thrombus within the filter. Retrieval of the filter was attempted in all 30 sheep at 90 days and the result was satisfactory in all but 1 case (96.6%). None of the GTFs required a force greater than 12 N to disengage the hooks of the filter from the wall. No complications were detected on venacavography or at autopsy. Variable degrees of fibrosis were observed in the histologic study. CONCLUSIONS: Retrieval of GTFs 90 days after implantation in an ovine model was feasible, safe, and easy, and required little force (median, 4.2 N).

¿Cuál es el tiempo límite para retirar un filtro de vena cava? Filtros opcionales de vena cava inferior: recuperación 90 días después de su implantación. Modelo ovino / Removal of retrievable inferior vena cava filters 90 days after implantation in an ovine model: is there a time limit for removal?

OBJETIVO: Estudiar la posibilidad y la seguridad de recuperarfiltros opcionales de vena cava Günther-Tulip (FGT)a los 90 días de su implantación inicial en un modelo animalovino.MATERIAL Y MÉTODOS: Se implantaron 30 FGT en otrastantas ovejas hembras y se intentó recuperarlos 90 días despuésde su implantación. Se realizó cavografía convencionalen todos los casos antes y después de la recuperación, paraevaluar la permeabilidad de la vena cava. Se obtuvieron medidasde la vena cava y se documentó la presencia de complicacionesrelativas a la implantación y recuperación delfiltro de vena cava inferior (VCI). Se midió la fuerza requeridapara recuperar los filtros de vena cava con un dinamómetrocomercial modificado y adaptado al equipo de recuperaciónde FGT. El estudio histológico se centró en lapared de la VCI.RESULTADOS: La implantación se efectuó con éxito en todoslos casos (100%). Una oveja desarrolló un pequeño focode trombosis en una de las patas del filtro y otra presentó untrombo pequeño en el interior del filtro. Se intentó la recuperacióndel filtro en las 30 ovejas y, excepto en un caso, elresultado fue satisfactorio (96,6%). En la recuperación delos 30 FGT, la fuerza necesaria para desenganchar las patasdel filtro de la VCI fue menor de 12 newtons (N). No se observóninguna complicación en los cavogramas ni en la autopsia.Se observaron diferentes grados de fibrosis en el estudiohistológico.CONCLUSIONES: En un modelo animal ovino, la recuperaciónde FGT a los 90 días de su implantación es posible, seguray fácil, y requiere poca fuerza (mediana: 4,2 N)

OBJECTIVE: To study the feasibility and safety of removingretrievable Günther-Tulip vena cava filters (GTFs) 90 daysafter their implantation in an ovine model.MATERIAL AND METHODS: Thirty GTFs were implanted in30 ewes and retrieval was attempted at 90 days. Conventionalcavography was performed in all cases before and afterretrieval in order to evaluate inferior vena cava patency andrecord dimensions. The presence of complications related toplacement and retrieval of the filter from the inferior vena cavawas also recorded. The force required to remove the filters wasmeasured using a modified commercial dynamometer adaptedto the GTF retrieval set. Histologic study focused on the inferiorvena cava wall.RESULTS: Implantation was performed successfully inall cases (100%). One ewe developed a small focus ofthrombosis around 1 of the legs of the filter and anotherpresented a small thrombus within the filter. Retrieval ofthe filter was attempted in all 30 sheep at 90 days and theresult was satisfactory in all but 1 case (96.6%). None ofthe GTFs required a force greater than 12 N to disengage thehooks of the filter from the wall. No complications weredetected on venacavography or at autopsy. Variable degreesof fibrosis were observed in the histologic study.CONCLUSIONS: Retrieval of GTFs 90 days after implantationin an ovine model was feasible, safe, and easy, and requiredlittle force (median, 4.2 N)