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1.
Clin Appl Thromb Hemost ; 27: 1076029620987900, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33517715

RESUMEN

Patients with renal impairment require dose adjustments for direct oral anticoagulants (DOACs), though there is uncertainty regarding their use in severe chronic kidney disease. Inappropriately dosed DOACs may increase risk of ischemic events when under-dosed, or risk of bleeding when over-dosed. The purpose of this study was to describe DOAC selection, dosing strategies, and associated clinical outcomes in patients with moderate to severe renal impairment at our institution. This was a single-center retrospective analysis of adult outpatients with moderate to severe renal impairment (estimated creatinine clearance <50 mL/min, including need for hemodialysis) who were prescribed a DOAC by a cardiologist between June 1, 2015 and December 1, 2018. Outcomes evaluated included the percentage of patients who received appropriate and inappropriate DOAC dosing, prescriber reasons for inappropriate DOAC dosing if documented, and incidence of thrombotic and bleeding events. A total of 207 patients were included. Overall, 61 (29.5%) patients received inappropriate dosing, with 43 (70.5%) being under-dosed and 18 (29.5%) being over-dosed as compared to FDA-labeled dosing recommendations for atrial fibrillation or venous thromboembolism (VTE). By a median follow-up duration of 20 months, stroke occurred in 6 (3.3%) patients receiving DOACs for atrial fibrillation, and VTE occurred in 1 (4.3%) patient receiving a DOAC for VTE. International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding occurred in 25 (12.1%) patients. Direct oral anticoagulants were frequently prescribed at off-label doses in patients with moderate to severe renal impairment, with a tendency toward under-dosing.


Asunto(s)
Fibrilación Atrial/tratamiento farmacológico , Inhibidores del Factor Xa/administración & dosificación , Enfermedades Renales/fisiopatología , Riñón/fisiopatología , Pautas de la Práctica en Medicina , Tromboembolia/prevención & control , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Utilización de Medicamentos , Inhibidores del Factor Xa/efectos adversos , Femenino , Hemorragia/inducido químicamente , Humanos , Prescripción Inadecuada , Incidencia , Enfermedades Renales/complicaciones , Enfermedades Renales/terapia , Masculino , Uso Fuera de lo Indicado , Diálisis Renal , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tromboembolia/etiología , Factores de Tiempo , Resultado del Tratamiento
2.
Gan To Kagaku Ryoho ; 48(2): 260-262, 2021 Feb.
Artículo en Japonés | MEDLINE | ID: mdl-33597375

RESUMEN

Herein, we report a case of laparoscopic surgery for sigmoid lymph node metastases after surgery for rectal cancer. A 58- year-old man underwent laparoscopic surgery for rectal cancer. He underwent D2 lymph node dissection, and he was undergoing dialysis for renal disease as a complication of diabetes. CT imaging performed 15 months after surgery revealed recurrence of tumors in the sigmoid lymph nodes. Subsequently, laparoscopic removal of the sigmoid lymph nodes was planned, as the patient had no tumor recurrence at any other location, and because his condition was not suitable for chemotherapy. The postoperative course was uneventful, and the patient was discharged a few days after surgery.


Asunto(s)
Laparoscopía , Neoplasias del Recto , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/cirugía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugía , Diálisis Renal
3.
Gan To Kagaku Ryoho ; 48(2): 279-281, 2021 Feb.
Artículo en Japonés | MEDLINE | ID: mdl-33597381

RESUMEN

Dialysis patients are at increased risk of ischemic colitis and are likely to develop irreversible ischemic colitis. We report a rare case of ischemic colitis after the closure of a temporary ileostomy for low anterior resection(LAR)of rectal cancer in a dialysis patient. A 77-year-old man undergoing maintenance dialysis was diagnosed as having colorectal cancer with a type 2 tumor at the anastomosis site of high anterior resection performed for sigmoid colon cancer 14 years ago. After undergoing excision which included the anastomosis site of the previous operation, LAR with anastomosis in the transverse colon and rectum and temporary ileostomy were performed. Seven months later, closure of the temporary ileostomy was performed, which resulted in ileus and septic shock. Computed tomography(CT)revealed inflammation in the colon on the oral side of the anastomosis, which was diagnosed as ischemic colitis. Ischemic colitis did not improve with conservative treatment, and fever reoccurred at each maintenance dialysis session. Therefore, ileostomy was performed again, but multiple organ failure due to disseminated intravascular coagulopathy(DIC)progressed and he died. It is considered that Hartmann's operation should be selected for dialysis patients with serious underlying diseases, and if ischemic colitis is observed after closure of the stoma temporary colostomy in such patients, the lesion site of ischemic colitis should be excised promptly and colostomy should be performed again.


Asunto(s)
Colitis Isquémica , Neoplasias del Recto , Anciano , Anastomosis Quirúrgica , Colitis Isquémica/etiología , Colitis Isquémica/cirugía , Colostomía , Humanos , Ileostomía , Masculino , Complicaciones Posoperatorias/etiología , Neoplasias del Recto/cirugía , Diálisis Renal
4.
Medicine (Baltimore) ; 100(5): e24313, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592876

RESUMEN

RATIONALE: Hyperammonemia encephalopathy is a rare but severe complication that has been reported in association with the use of sunitinib, a tyrosine kinase inhibitor. We report here a unique case of a patient with end stage renal disease that was initiated on sunitinib for metastatic renal cell carcinoma. PATIENT CONCERNS: A 65-year-old man with end stage renal disease on maintenance conventional hemodialysis and had concomitant stable Child-Pugh class B liver cirrhosis consequent of hepatitis C infection was started on sunitinib for metastatic renal cell carcinoma. He developed confusion few weeks after starting therapy with no other indication of worsening liver dysfunction otherwise. DIAGNOSIS: He was later diagnosed with hyperammonemia encephalopathy. INTERVENTIONS: His treatment was discontinued and reinitiated at a lower dose after recovery and titrated according to tolerance. As ammonia is a very low molecular weight molecule and is cleared well with diffusive clearance, we intensified his dialysis regimen by increasing intensity for each session and frequency per week. OUTCOMES: With this change in dialysis regimen, patient was able to continue treatment with sunitinib. LESSONS: Clinicians prescribing sunitinib should be vigilant to monitor for this complication in patients receiving sunitinib, apart from the more usual presentation of hepatotoxicity. We found that a more intensive hemodialysis regimen consisting of 4× a week conventional high-flux hemodialysis (HD) can permit the continuation of treatment with sunitinib in an end stage renal disease (ESRD) patient with Child-Pugh class B liver cirrhosis.


Asunto(s)
Antineoplásicos/efectos adversos , Carcinoma de Células Renales/tratamiento farmacológico , Hiperamonemia/inducido químicamente , Neoplasias Renales/tratamiento farmacológico , Síndromes de Neurotoxicidad/etiología , Sunitinib/efectos adversos , Anciano , Carcinoma de Células Renales/virología , Hepacivirus , Hepatitis C/complicaciones , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Neoplasias Renales/virología , Cirrosis Hepática/virología , Masculino , Diálisis Renal
5.
Zhonghua Yi Xue Za Zhi ; 101(6): 416-420, 2021 Feb 09.
Artículo en Chino | MEDLINE | ID: mdl-33611891

RESUMEN

Objective: To summarize the clinical effect of ultrasound-guided percutaneous transluminal angioplasty (PTA) in the treatment of arteriovenous fistula (AVF) immaturation under day surgery mode. Methods: The clinical data was retrospective analyzed of patients with AVF immaturation who were treated by ultrasound-guided PTA under day surgery mode from November 2016 to June 2019 in Renji Hospital. The basic information, lesion location, puncture approach, number and diameter of balloon used were counted. The primary and secondary patency rates were calculated at 6 and 12 months after operation. Results: In all of the 21 patients, 11 patients were male and 10 patients were female. The mean age was (52.6±12.9) years old. There were 20 of the 21 patients who were treated successfully. One patient had AVF reconstruction with vascular rupture, and the complication rate was 4.8% (1/21). The length of hospitalization was (1.05±0.71) days, and the cost was (11 487.7±4 401.4) yuan. The follow-up time was (19.7±8.3) months. The 6-month and 12-month primary patency rate were 70% and 55%, and the 6-month and 12-month secondary patency rate were both 90%. Conclusion: Ultrasound-guided PTA in the treatment of AVF immaturation under day surgery mode is safe and effective, which has a high technical success rate and good patency rate for AVF maturation.


Asunto(s)
Angioplastia de Balón , Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Adulto , Anciano , Procedimientos Quirúrgicos Ambulatorios , Angioplastia , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/terapia , Femenino , Oclusión de Injerto Vascular , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía Intervencional , Grado de Desobstrucción Vascular
6.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547114

RESUMEN

Tumour lysis syndrome (TLS) is a constellation of metabolic derangements caused by lysis of tumour cells. It is an oncological emergency that is considered a rare occurrence in multiple myeloma (MM) and usually occurs after patients have been treated with chemotherapy. We describe a very rare case of TLS occurring before the official diagnosis or treatment of MM. We report infrequent karyotype abnormalities, including loss of 17p13.1 (TP53 mutation), t(4;14) (FGFR3/IGH fusion) and monosomy 13, that have not been explicitly described in association with spontaneous tumour lysis syndrome (STLS) in MM. This case adds to the sparse literature available on STLS in MM, which is a life-threatening situation requiring urgent medical intervention.


Asunto(s)
Mieloma Múltiple/complicaciones , Síndrome de Lisis Tumoral/genética , Diagnóstico Diferencial , Quimioterapia Combinada , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Monosomía , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/terapia , Diálisis Renal , Síndrome de Lisis Tumoral/diagnóstico , Síndrome de Lisis Tumoral/terapia
7.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563667

RESUMEN

Goodpasture's syndrome is a rare vasculitis associated with anti-glomerular basement membrane (anti-GBM) autoantibodies that target type IV collagen found in the basement membranes of glomeruli and alveoli. We present a case of a 79-year-old man with seronegative Goodpasture's syndrome with predominant respiratory symptoms and mild acute kidney injury that initially improved. Final diagnosis was made by immunofluorescent staining on open lung biopsy which also revealed concomitant organising pneumonia. The patient underwent treatment with corticosteroids, cyclophosphamide, haemodialysis and plasmapheresis. This was an atypical presentation wherein the patient only exhibited pulmonary symptoms early in the course of illness in the setting of negative anti-GBM antibody serum testing, which made diagnosis challenging. With this case, we emphasise that clinicians should have a high suspicion for Goodpasture's syndrome in the setting of unexplained severe pulmonary or renal disease despite negative anti-GBM antibody testing.


Asunto(s)
Lesión Renal Aguda/diagnóstico , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico , Neumonía/diagnóstico , Lesión Renal Aguda/terapia , Anciano , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/terapia , Antiinfecciosos/uso terapéutico , Biomarcadores/análisis , Broncoscopía , Diagnóstico Diferencial , Resultado Fatal , Humanos , Intubación Intratraqueal , Masculino , Plasmaféresis , Neumonía/terapia , Diálisis Renal , Esteroides/uso terapéutico
8.
Medicine (Baltimore) ; 100(6): e24617, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578571

RESUMEN

ABSTRACT: Nutritional status is a predictor of mortality and morbidity in dialysis patients. This study aimed to assess dietary behaviors in dialysis patients compared to the recommendations of the Kidney Disease Outcomes Quality Initiative.Ninety five dialysis patients recruited from a hospital completed a 24-hour dietary recall questionnaire. Body weight, energy requirements, protein requirements, albumin, normalized protein catabolic rate, and 25(OH) vitamin D levels were measured.Of the 95 patients, 11 (11.6%) were below the desirable body mass index range, 59 (62.1%) were within the desired range, and 25 (26.3%) were above the desired range. However, only 32.7% of patients met the target energy intake, 29.5% reached the protein intake target, and 20.0% had adequate vitamin D concentrations. Vegetarian patients had lower energy, protein, fat, vitamin D intake, lower body mass index, serum blood urea nitrogen, creatinine, phosphate, normalized protein catabolic rate, and vitamin D status than the omnivorous patients (P < .05). After adjusting for age, sex, and body weight, vegetarianism was an independent risk factor for severe vitamin D deficiency (<10 ng/ml, P < .01).Most dialysis patients do not meet their dietary recommendations or goals. The risk of a vegetarian diet may outweigh the benefits in dialysis patients. Careful consideration of dietary behaviors is required for dialysis patients to prevent malnutrition, more so in vegetarians.


Asunto(s)
Dieta Vegetariana , Ingestión de Energía , Fallo Renal Crónico/terapia , Necesidades Nutricionales , Estado Nutricional , Diálisis Renal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
9.
Niger J Clin Pract ; 24(1): 81-88, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33473030

RESUMEN

Background: Patients on maintenance hemodialysis (HD) are at risk of blood transmitted infections such as hepatitis B and C. Objectives: To determine the prevalence and risk factors for hepatitis B and hepatitis C virus infections among end-stage renal disease (ESRD) patients on maintenance hemodialysis in Gaborone, Botswana. Materials and Methods: A cross-sectional study with a retrospective longitudinal approach involving all eligible public patients undergoing hemodialysis was carried out for a period of 3 months. Data on socio-demographic, clinical characteristics, and hepatitis serology was collected using a case report form. Statistical Software Package for Social Sciences (SPSS) version 24 was used for data entry, cleaning, and analysis. The risk factors associated with Hepatitis B and C infections were determined using bivariate logistic regression analyses. A P value of less than 0.05 was considered statistically significant. Results: Of the 168 participants, 5 (2.98%) were HBsAg seropositive at the initiation of hemodialysis, whereas 2 (1.19%) were seropositive for anti-HCV antibodies at the initiation of hemodialysis. Two patients out of 163 (1.23%) were found to have seroconverted to HBsAg positivity during hemodialysis. One out of 166 patients (0.61%) seroconverted to HCV antibodies positivity during hemodialysis. The duration of hemodialysis, history of invasive procedures, HIV status, frequency of hospitalization, and blood transfusion were not associated with seroconversion for both Hepatitis B and C. Conclusions: The prevalence hepatitis B and C infections among ESRD patients on hemodialysis is low. There was no significant association between the identified risk factors and HBV/HCV infection. Regular audits on seroconversion status for hepatitis B and C are recommended as a way of assessing and supporting the current strategies for infection control among HD patients.


Asunto(s)
Hepatitis B , Hepatitis C , Fallo Renal Crónico , Botswana/epidemiología , Estudios Transversales , Hepatitis B/complicaciones , Hepatitis B/epidemiología , Antígenos de Superficie de la Hepatitis B , Hepatitis C/epidemiología , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/terapia , Prevalencia , Diálisis Renal , Estudios Retrospectivos , Factores de Riesgo
10.
Medicine (Baltimore) ; 100(2): e24102, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466179

RESUMEN

BACKGROUND: Music therapy and music-based interventions have been used widely in numerous medical procedures to reduce the physical and psychological disorders. However, the effect of music therapy on pain relief in hemodialysis patients still remains unclear. METHODS: Electronic databases were comprehensively searched through MEDLINE, Web of Science, EMBASE, Cochrane, and WANFANG. All studies met inclusion criteria were eligible for systematic review and meta-analysis. Clinical variables were extracted and pooled results were obtained using STATA software. RESULTS: A total of 10 studies with 722 participants were included for systematic review. Overall, music therapy showed a significantly favorable effect on reducing pain for patients undergoing hemodialysis (SMD: -0.90, 95%CIs: -1.25 to -0.55, P < .001). No publication bias was observed. CONCLUSIONS: Music-based interventions could significantly relieve pain for patients undergoing hemodialysis, which should be promoted as an effective and safe complementary method.


Asunto(s)
Musicoterapia/métodos , Manejo del Dolor/métodos , Diálisis Renal/efectos adversos , Ansiedad/terapia , Humanos , Musicoterapia/normas , Manejo del Dolor/psicología , Manejo del Dolor/normas , Diálisis Renal/métodos
11.
Zhonghua Yi Xue Za Zhi ; 101(4): 265-270, 2021 Jan 26.
Artículo en Chino | MEDLINE | ID: mdl-33486935

RESUMEN

Objective: To investigate the changes of spontaneous brain activity in patients with end-stage renal disease (ESRD) by combining three different resting state functional magnetic resonance low frequency amplitude algorithms, including amplitude of low-frequency fluctuations (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), and percent amplitude of fluctuation (PerAF), and to analyze the associations between spontaneous brain activity changes and clinical variables. Methods: The data of 31 ESRD patients treated with maintenance hemodialysis and 37 healthy volunteers in the Department of Nephrology and Renal Transplantation of the Affiliated Hospital of Qingdao University from August 2018 to December 2019 were retrospectively collected. The resting state functional magnetic resonance imaging (rs-fMRI) scan was performed to calculate the ALFF, fALFF, and PerAF values of the whole brain of the subjects in each group. Independent sample t test was used for comparison between groups, and Pearson correlation analysis was used to investigate the correlation between spontaneous brain activity changes in brain regions with significant differences and clinical variables. Results: Compared to healthy volunteers, patients with ESRD had decreased mean ALFF(mALFF) values of the right lingual gyrus, bilateral anterior precuneus, left inferior frontal gyrus, and right middle cingulate gyrus (FDR (false discovery rate) correction, all P<0.01); and decreased mean PerAF (mPerAF) values of the bilateral anterior precuneus, bilateral posterior cingulate cortex, right calcarine fissure and surrounding cortex, bilateral inferior parietal lobule/temporoparietal junction (including bilateral angular gyrus, middle temporal gyrus, left supramarginal gyrus), and bilateral inferior frontal gyrus (FDR (false discovery rate) correction, all P<0.01); but there was no significant difference in mean fALFF (mfALFF) value between the two groups. Correlation analysis showed that the mPerAF values of the right angular gyrus (r=-0.509, P=0.003) and the left supramarginal gyrus (r=-0.405, P=0.024) were negatively correlated with serum potassium concentration in ESRD patients, while mALFF values of the bilateral anterior precuneus (r=0.058, P=0.004) and mPerAF values of the left gyrus (r=0.415, P=0.020) were positively correlated with hemoglobin level. Conclusions: In ESRD patients, spontaneous brain activity was reduced in multiple brain regions, mainly located in default mode network(DMN), which might be the underlying pathophysiological mechanisms of their brain damage. Controlling serum potassium and hemoglobin levels was essential to prevent the progression of brain damage in ESRD patients.


Asunto(s)
Fallo Renal Crónico , Imagen por Resonancia Magnética , Algoritmos , Encéfalo/diagnóstico por imagen , Mapeo Encefálico , Humanos , Espectroscopía de Resonancia Magnética , Mantenimiento , Diálisis Renal , Estudios Retrospectivos
12.
Khirurgiia (Mosk) ; (1): 90-92, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33395518

RESUMEN

We report a complex reconstruction of arteriovenous fistula (AVF). Proximal stenosis of cephalic vein was followed by aneurysms of fistulous veins (distal segment of cephalic vein and median cubital vein) complicated by AVF thrombosis. Blood outflow from AVF was retrograde. One week after thrombosis, an aneurysm of median cubital vein containing dense clots was excised. We resected cephalic vein wall and repaired the vessel. Anastomosis with the brachial artery was created distal to the last anastomosis. Proximal cephalic vein repair was performed using resected aneurysm walls. After a year, AVF has been successfully used for hemodialysis.


Asunto(s)
Derivación Arteriovenosa Quirúrgica , Arteria Braquial/cirugía , Diálisis Renal , Enfermedades Vasculares/cirugía , Venas/cirugía , Aneurisma/etiología , Aneurisma/cirugía , Derivación Arteriovenosa Quirúrgica/efectos adversos , Derivación Arteriovenosa Quirúrgica/métodos , Arteria Braquial/diagnóstico por imagen , Humanos , Resultado del Tratamiento , Enfermedades Vasculares/etiología , Grado de Desobstrucción Vascular , Procedimientos Quirúrgicos Vasculares/métodos , Insuficiencia Venosa/etiología , Insuficiencia Venosa/cirugía , Trombosis de la Vena/etiología , Trombosis de la Vena/cirugía
15.
BMC Infect Dis ; 21(1): 68, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33441085

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that was first discovered in December 2019 in Wuhan, China. With the growing numbers of community spread cases worldwide, the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic on March 11, 2020. Like influenza viruses, SARS-CoV-2 is thought to be mainly transmitted by droplets and direct contact, and COVID-19 has a similar disease presentation to influenza. Here we present a case of influenza A and COVID-19 co-infection in a 60-year-old man with end-stage renal disease (ESRD) on hemodialysis. CASE PRESENTATION: A 60-year-old man with ESRD on hemodialysis presented for worsening cough, shortness of breath, and diarrhea. The patient first developed a mild fever (37.8 °C) during hemodialysis 3 days prior to presentation and has been experiencing worsening flu-like symptoms, including fever of up to 38.6 °C, non-productive cough, generalized abdominal pain, nausea, vomiting, and liquid green diarrhea. He lives alone at home with no known sick contacts and denies any recent travel or visits to healthcare facilities other than the local dialysis center. Rapid flu test was positive for influenza A. Procalcitonin was elevated at 5.21 ng/mL with a normal white blood cell (WBC) count. Computed tomography (CT) chest demonstrated multifocal areas of consolidation and extensive mediastinal and hilar adenopathy concerning for pneumonia. He was admitted to the biocontainment unit of Nebraska Medicine for concerns of possible COVID-19 and was started on oseltamivir for influenza and vancomycin/cefepime for the probable bacterial cause of his pneumonia and diarrhea. Gastrointestinal (GI) pathogen panel and Clostridioides difficile toxin assay were negative. On the second day of admission, initial nasopharyngeal swab came back positive for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The patient received supportive care and resumed bedside hemodialysis in strict isolation, and eventually fully recovered from COVID-19. CONCLUSIONS: We presented a case of co-infection of influenza and SARS-CoV-2 in a hemodialysis patient. The possibility of SARS-CoV-2 co-infection should not be overlooked even when other viruses including influenza can explain the clinical symptoms, especially in high-risk patients.


Asunto(s)
/diagnóstico , Gripe Humana/diagnóstico , /diagnóstico por imagen , Coinfección/diagnóstico , Coinfección/diagnóstico por imagen , Coinfección/virología , Hospitalización , Humanos , Virus de la Influenza A/genética , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza A/fisiología , Gripe Humana/diagnóstico por imagen , Gripe Humana/virología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Pandemias , Diálisis Renal , /aislamiento & purificación , Tomografía Computarizada por Rayos X
16.
BMC Infect Dis ; 21(1): 102, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33482747

RESUMEN

BACKGROUND: In non-uremic subjects, IFNL4 rs368234815 predicts HCV clearance. We investigated whether rs368234815 is associated with spontaneous HCV clearance in haemodialysis patients and whether it is a stronger predictor of HCV resolution than the IFNL polymorphisms already associated with HCV clearance in dialysis subjects. We also evaluated an association of rs368234815 with patients` survival and alterations in transcription factor binding sites (TFBS) caused by IFNL polymorphisms. METHODS: Among 161 haemodialysis patients with positive anti-HCV antibodies, 68 (42.2%) spontaneously resolved HCV infection, whereas 93 remained HCV RNA positive. Patients were tested for near IFNL3 rs12980275, IFNL3 rs4803217, IFNL4 rs12979860, IFNL4 rs368234815, and near IFNL4 rs8099917. IFNL4 rs368234815 polymorphism (TT/TT, ΔG/TT, ΔG/ΔG) was genotyped by restriction fragment length polymorphism analysis; other IFNL polymorphisms - by high resolution melting curve analysis. We used the Kaplan-Meier method with the log-rank test for survival analysis. In silico analysis included the use of ENCODE TFBS ChIP-seq data, HOCOMOCO, JASPAR CORE, and CIS-BP databases, and FIMO software. RESULTS: The probability (OR, 95%CI, P) of spontaneous HCV clearance for rs368234815 TT/TT patients was higher than for the ΔG allele carriers (2.63, 1.38-5.04, 0.003). This probability for other major homozygotes varied between 2.80, 1.45-5.43, 0.002 for rs12980275 and 2.44, 1.27-4.69, 0.007 for rs12979860. In the additive model, rs368234815 TT/TT was the strongest predictor of HCV clearance (6.38, 1.69-24.2, 0.003). Survival analysis suggested an association of the ΔG allele with mortality due to neoplasms (log-rank P = 0.005). The rs368234815 ∆G allele caused TFBS removal for PLAGL1. CONCLUSIONS: In haemodialysis patients, the association of rs368234815 with the spontaneous HCV clearance is better than that documented for other IFNL3/IFNL4 polymorphisms only in the additive mode of inheritance. However, identifying the homozygosity in the variant ∆G allele of rs368234815 means a more potent prediction of persistent HCV infection in haemodialysis subjects that we observe in the case of the variant homozygosity of other tested IFNL3/IFNL4 polymorphisms. Removal of PLAGL1 TFBS in subjects harbouring the rs368234815 ∆G allele may contribute to cancer susceptibility. The association of rs368234815 with cancer-related mortality needs further studies in HCV-exposed subjects.


Asunto(s)
Hepacivirus/aislamiento & purificación , Hepatitis C/genética , Hepatitis C/virología , Interleucinas/genética , Diálisis Renal/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alelos , Estudios de Casos y Controles , Niño , Femenino , Genotipo , Hepatitis C/epidemiología , Humanos , Interferones/genética , Masculino , Persona de Mediana Edad , Polimorfismo Genético , Polimorfismo de Nucleótido Simple , Adulto Joven
17.
Anticancer Res ; 41(2): 993-997, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517306

RESUMEN

BACKGROUND/AIM: Surgery on hemodialysis patients requires special attention, as the tissue of these patients is vulnerable and hemorrhagic. This study explored the feasibility of laparoscopic surgery for colorectal cancer in hemodialysis patients. PATIENTS AND METHODS: This was a retrospective study of patients who underwent laparoscopic surgery for colorectal cancer in a single institute from April 2007 to December 2016. RESULTS: A total of 2668 patients were included: 24 (0.9%) were on hemodialysis, and 2644 (99.1%) were not. After 1:1 propensity score matching, there were no significant differences in the short-term postoperative results, the disease-free survival rate (p=0.0813) or the cancer-specific survival rate (p=0.555). However, the overall survival rate was significantly lower in hemodialysis patients than in non-hemodialysis patients (p=0.0135). CONCLUSION: Standard laparoscopic operative procedures can be safely performed for hemodialysis patients, and there was no marked difference in the long-term oncological outcomes between the two groups.


Asunto(s)
Neoplasias Colorrectales/cirugía , Laparoscopía/métodos , Puntaje de Propensión , Diálisis Renal/estadística & datos numéricos , Anciano , Neoplasias Colorrectales/mortalidad , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía/efectos adversos , Masculino , Complicaciones Posoperatorias , Estudios Retrospectivos , Tasa de Supervivencia
18.
Am J Case Rep ; 22: e928900, 2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33487629

RESUMEN

BACKGROUND This is of the first fatal case of coronavirus disease 2019 (COVID-19) pneumonia at a National Heart Center in Indonesia following planned elective triple-vessel coronary artery bypass graft (CABG) who was considered to be at low risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when admitted for surgery. CASE REPORT A 48-year-old man was diagnosed with coronary artery disease (CAD) in 3 vessels (3VD) with an ejection fraction (EF) of 61% and chronic kidney disease (CKD) with routine hemodialysis. The patient was scheduled for a coronary artery bypass graft (CABG) surgery. He underwent surgery after COVID-19 screening using a checklist provided by the hospital. The patient's condition worsened on the 3rd postoperative day in the ward, and he was transferred back to the Intensive Care Unit (ICU), reintubated, and tested for COVID-19 with a real time-polymerase chain reaction (PCR) test. Because of the COVID-19 pandemic, we excluded the other possible pneumonia causes (e.g., influenza). An RT-PCR test performed after surgery revealed that the patient was positive for COVID-19. COVID-19 tracing was performed for all health care providers and relatives; all results were negative except for 1 family member. The patient was treated for 4 days in the isolation ICU but died due to complications of the infection. CONCLUSIONS This report shows the importance of testing patients for SARS-CoV-2 infection before hospital admission for elective surgery and during the hospital stay, and the importance of developing rapid and accurate testing methods that can be used in countries and centers with limited health resources.


Asunto(s)
/diagnóstico , Puente de Arteria Coronaria , Procedimientos Quirúrgicos Electivos , Resultado Fatal , Humanos , Indonesia , Masculino , Persona de Mediana Edad , Diálisis Renal , Insuficiencia Renal Crónica/terapia
19.
Curr Opin Nephrol Hypertens ; 30(2): 190-197, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33395035

RESUMEN

PURPOSE OF REVIEW: Using case vignettes, we highlight challenges in communication, prognostication, and medical decision-making that have been exacerbated by the coronavirus disease-19 (COVID-19) pandemic for patients with kidney disease. We include best practice recommendations to mitigate these issues and conclude with implications for interdisciplinary models of care in crisis settings. RECENT FINDINGS: Certain biomarkers, demographics, and medical comorbidities predict an increased risk for mortality among patients with COVID-19 and kidney disease, but concerns related to physical exposure and conservation of personal protective equipment have exacerbated existing barriers to empathic communication and value clarification for these patients. Variability in patient characteristics and outcomes has made prognostication nuanced and challenging. The pandemic has also highlighted the complexities of dialysis decision-making for older adults at risk for poor outcomes related to COVID-19. SUMMARY: The COVID-19 pandemic underscores the need for nephrologists to be competent in serious illness communication skills that include virtual and remote modalities, to be aware of prognostic tools, and to be willing to engage with interdisciplinary teams of palliative care subspecialists, intensivists, and ethicists to facilitate goal-concordant care during crisis settings.


Asunto(s)
Comunicación , /epidemiología , Humanos , Cuidados Paliativos , Pandemias , Diálisis Renal
20.
Zhonghua Nei Ke Za Zhi ; 60(1): 35-40, 2021 Jan 01.
Artículo en Chino | MEDLINE | ID: mdl-33397019

RESUMEN

Objective: To retrospectively analyze the early mortality and related risk factors in adult patients with maintenance hemodialysis (MHD). Methods: Adult MHD patients from 2008 to 2018 were enrolled and divided into training data group and validation data group. In training data group, multivariate logistic regression was used to analyze the risk factors of early death within 120 days after hemodialysis and establish a prediction model. The receiver operating characteristic (ROC) curve was applied to evaluate the prediction ability of the model. Results: A total of 4 885 patients were included. The cumulative mortality within 120 days was 20.97/100 person years, and that within 365 days was 12.25/100 person years. A total of 3 603 patients in the training data group were analyzed. The following risk factors were correlated with early mortality (all P<0.05), including age at start of dialysis over 60 years old (OR=1.792), non-chronic glomerulonephritis (OR=2.214), cardio-cerebrovascular disease (OR=2.695), plasma albumin less than 35 g/L (OR=1.358), platelet count less than 120×109/L (OR=2.194), serum creatinine less than 600 µmol/L (OR=1.652), blood urea nitrogen over 30 mmol/L (OR=1.887), blood phosphorus less than 1.13 mmol/L (OR=1.783), pulse pressure over 55 mmHg(1 mmHg=0.133 kPa) (OR=1.656), low density lipoprotein less than 1.5 mmol/L (OR=1.873), and blood calcium over 2.5 mmol/L (OR=1.876). Risk prediction model was established. The other 1 282 cases in the validation data group were verified. The area under ROC curve was 0.810, with sensitivity 85.7%, and specificity 62.5%. Conclusion: The mortality rate of adult MHD patients within 120 days after dialysis is high. The established prediction model can effectively predict the risk of early death.


Asunto(s)
Mantenimiento , Diálisis Renal , Adulto , Humanos , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo
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