Association between Postmortem Kidney Biopsy Findings and Acute Kidney Injury from Patients with SARS-CoV-2 (COVID-19).

BACKGROUND AND OBJECTIVES: AKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our multicenter, observational study of deceased patients with COVID-19 in three third-level centers in Mexico City evaluated postmortem kidney biopsy by light and electron microscopy analysis in all cases. Descriptive and association statistics were performed between the clinical and histologic variables. RESULTS: A total of 85 patients were included. Median age was 57 (49-66) years, 69% were men, body mass index was 29 (26-35) kg/m2, 51% had history of diabetes, 46% had history of hypertension, 98% received anticoagulation, 66% were on steroids, and 35% received at least one potential nephrotoxic medication. Severe AKI was present in 54% of patients. Biopsy findings included FSGS in 29%, diabetic nephropathy in 27%, and arteriosclerosis in 81%. Acute tubular injury grades 2-3 were observed in 49%. Histopathologic characteristics were not associated with severe AKI; however, pigment casts on the biopsy were associated with significantly lower probability of kidney function recovery (odds ratio, 0.07; 95% confidence interval, 0.01 to 0.77). The use of aminoglycosides/colistin, levels of C-reactive protein and serum albumin, previous use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antivirals, nonsteroid anti-inflammatory drugs, and anticoagulants were associated with specific histopathologic findings. CONCLUSIONS: A high prevalence of chronic comorbidities was found on kidney biopsies. Nonrecovery from severe AKI was associated with the presence of pigmented casts. Inflammatory markers and medications were associated with specific histopathologic findings in patients dying from COVID-19.

[Clinical guideline for diagnosis and treatment of atrial fibrillation]. / Guía de práctica clínica. Diagnóstico y tratamiento de la fibrilación auricular.

Atrial fibrillation (AF) is associated with long-term increase in the incidence of cerebrovascular disease, heart failure and mortality. The incidence of ischemic stroke in patients with non-valvular atrial fibrillation averages 5 % per year, from two to seven more frequent than in patients without atrial fibrillation (AF). One in six ischemic stroke occurs in patients with AF. The detection and accurate diagnosis and timely therapeutic intervention have shown a decrease in morbidity and mortality associated with this arrhythmia. The above data by themselves justify the development of a management guide and care for these patients. The purpose of this guide is to provide health professionals recommendations based on the best available evidence with the intent to standardize actions: diagnosis and identification of patients with atrial fibrillation; risk stratification and treatment according to the classification of atrial fibrillation; identification of the risk of thromboembolism and its prevention; and treatment guidelines to determine which patient will require to be referred promptly.

[Clinical guideline for diagnosis and treatment of high blood pressure]. / Guía de práctica clínica. Diagnóstico y tratamiento de la hipertensión arterial.

Hypertension is a disease with numerous etiologies which consequences led to systemic vascular damage leading to other cardio-vascular diseases increasing morbi-morbility. Clinically it goes through a prolonged asymptomatic phase that prevents early diagnosis. Today, a high prevalence is reported in our country so that it is considered a public health issue. The purpose of this guide is to be a useful tool to be used to define the Arterial Hypertension or high blood pressure concept, its epidemiology, prevalence, classification and, according to these concepts, in order to establish a proper treatment program emphasizing the preventive side of the disease in primary care units.

Cellular autotransplantation for ischemic and idiopathic dilated cardiomyopathy. Preliminary report.

BACKGROUND: Heart failure is highly prevalent among patients >65 years old. The incidence increases starting at approximately 45 years of age. Recent therapeutic advances have included stem cell transplantation in the affected areas of the myocardium in order to improve perfusion and myocardial performance. METHODS: Between July 13, 2004 and August 31, 2005, 39 procedures were undertaken in 34 male and 5 female patients, with a mean age of 53.6 +/- 9.08 years (range: 35-71 years old), suffering from terminal heart failure and without any other therapeutic alternative. Thirty four cases presented ischemic cardiomyopathy and five presented idiopathic dilated cardiomyopathy. All patients were treated with autologous stem cell transplantation obtained from the peripheral blood supply through hemophoresis and implanted by means of a left anterior thoracotomy via intramyocardial injection. Functional class, ejection fraction and myocardial perfusion were analyzed preoperatively and postoperatively. RESULTS: Seven patients presented ventricular fibrillation during the procedure, requiring defibrillation. Two patients died due to intractable arrhythmias during the perioperative period; the remaining patients are currently participating in a rehabilitation program with a favorable evolution. A mid-term follow-up has been completed in 27 patients. Preoperatively, the functional class for 26 of these patients was III. Postoperatively, functional classes are II in 5 cases and I in 15 patients at the mid-term evaluation with ejection fraction improvements of 37.7 +/- 14.2 to 42.15 +/- 5.9. CONCLUSIONS: Cell therapy is a safe and useful procedure in selected patients with ischemic and idiopathic dilated cardiomyopathy.

Trasplante pulmonar: experiencia de un grupo quirúrgico / Lung transplantation: experience of a surgical team

Se informan los resultados de un programa de trasplante pulmonar en el Instituto Mexicano del Seguro Social y los requerimientos para obtener mejores resultados. El estudio se realizó en el Hospital General del Centro Médico Nacional La Raza y Hospital de Cardiología del Centro Médico Nacional Siglo XXI. Se incluyeron tres pacientes del sexo femenino con fibrosis intersticial difusa en estado terminal en lista de espera de trasplante unilateral de pulmón, que reunieron los criterios de inclusión. Entre julio de 1992 y noviembre de 1995, se efectuaron dos trasplantes unilaterales de pulmón en el Instituto Mexicano del Seguro Social provenientes de donaciones múltiples, y un trasplante de lóbulo pulmonar a partir de donador vivo no relacionado. El primer procedimiento se efectuó sin accidentes transoperatorios, pero la paciente falleció a las siete horas de operada por edema pulmonar unilateral de etiología multicausal. En el segundo caso, la paciente falleció en el transoperatorio por hemorragia de la anastomosis vascular por alteraciones de la pared de la rama derecha de su arteria pulmonar. El tercer caso evoluciona satisfactoriamente. En trasplantes, la falta de donadores es el principal problema.

Informe del primer trasplante de bloque cardiopulmonar realizado en México / Report of the first cardiopulmonar block transplantation performed in Mexico

Objetivo: Informar sobre el primer trasplante cardiopulmonar que se realiza en México. Diseño: Informe de caso clínico. Se trató de paciente femenino de 47 años de edad, con hipertensión pulmonar severa y defecto septal auricular en clase funcional III. El día 4 de junio de 1995, en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI se obtuvo bloque cardiopulmonar a partir de donación múltiple y se traspantó a la paciente. Resultados: El tiempo de hipotermia isquémica fue de 3 horas. La actividad cardíaca reinició a los 14 segundos de reperfusión. El destete de la derivación cardiopulmonar se efectuó sin problemas. A las 36 horas presentó abdomen agudo por hemoperitoneo, se requirió laparotomía por hemostasia, además de detectarse pancreatitis. El bloque cardiopulmonar funcionó adecuadamente por 5 días al cabo de los cuales presentó aumento de cortocorcuitos, hipoxemia, bajo gasto cardíaco y falleció al sexto día. El informe de la autopsia fue: pancreatitis edematosa, rechazo de corazón y pulmón, cambios isquémicos del miocardio y edema pulmonar. Conclusión: Es factible realizar trasplante cardiopulmonar en nuestro país. Las complicaciones coinciden con las descritas en la literatura mundial

Limitaciones en la donación de órganos: análisis de cinco años / Restrictions on organ donation: analysis o five years

Se revisa la experiencia de cinco años de un comité de trasplante de corazón y pulmón. Fueron valorados 106 donadores potenciales. De ellos se consideraron adecuados 14, pero sólo se lograron cuatro donaciones por negativa familiar en los restantes. El Instituto Mexicano del Seguro Social (IMSS) tuvo la mayor cantidad de donadores potenciales (46.22 por ciento). La principal causa de pérdida de vida fue el trauma craneoencefálico (67.92 por ciento) y el tiempo de aviso al comité después de diagnosticada fue de 26.8 ñ 26.3 horas. Este retraso favoreció que 78.64 por ciento de los donadores potenciales tuvieran dos o más complicaciones. Hubo trauma torácica en 19.81 por ciento con lo que se perdió la posibilidad de utilizar corazón y/o pulmones. Se concluye que debe insitirse a nivel médico y social con información sobre la donación de órganos y la detección oportuna de donadores