Swimming With Sharks: Left Main Coronary Obstruction Following Transcatheter Aortic Valve Implantation.

Delayed coronary obstruction (DCO) occurs when there is obstruction of the coronary ostia following a transcatheter aortic valvular implantation (TAVI). It is an uncommon but serious complication that often leads to death, usually presents as severe hypotension after TAVI, and should be suspected if migration of the valve occurs. We report the case of a 70-year-old female patient with severe aortic stenosis who underwent TAVI using a 26-mm CoreValve Evolut Pro (Medtronic, Dublin, Ireland). Although the valve was implanted successfully, she experienced hypotension with intermittent ST elevations and had a cardiac arrest shortly after, requiring Advanced Cardiovascular Life Support (ACLS). An aortogram showed sealing of the sinotubular junction (STJ) by CoreValve, without coronary flow. CoreValve was then snared and repositioned in the ascending aorta recovering coronary flow and cardiac pulsatility. A second TAVI was performed and an Edwards 20 mm Sapiens 3 valve (Edwards Lifesciences, Irvine, CA, USA) was implanted as standard procedure.

Influence of donor capnometry on renal graft evolution in uncontrolled donation after circulatory death.

AIM: To analyse the association between donor capnometry data and the short-term evolution of kidney grafts in cases of uncontrolled donation after circulatory death (uDCD). METHOD: We used an ambispective observational study design, conducted in the Community of Madrid between January and December 2019, inclusive. Patients who suffered out-of-hospital cardiac arrest (CA) with no response to advanced cardiopulmonary resuscitation (CPR) were selected as potential donors. Donor capnometry levels were measured at the start, midpoint and transfer to hospital then compared with indicators of renal graft evolution. RESULTS: The initial selection included 34 possible donors, of which 12 (35.2%) were viable donors from whom 22 (32.3%) kidneys were recovered. There was a correlation between the highest capnometry values and less need for post-transplant dialysis (≥24 mmHg, p < 0.017), fewer dialysis sessions and fewer days to recover correct renal function (Rho -0.47, p < 0.044). There was a significant inverse correlation between the capnometry values at transfer and 1-month post-transplant creatinine levels (Rho -0.62, p < 0.033). There were no significant differences between the capnometry values at transfer and primary nonfunction (PNF) or warm ischaemia time. One-year patient survival was 100% for patient receiving organ donation, while graft survival was 95%. CONCLUSIONS: Capnometry levels at transfer are a useful predictor of the short-term function and viability of kidney transplants from uncontrolled donations after circulatory death.

Impact of different COVID-19 waves on kidney replacement therapy epidemiology and mortality: REMER 2020.

BACKGROUND: Kidney replacement therapy (KRT) confers the highest risk of death from coronavirus disease 2019 (COVID-19). However, most data refer to the early pandemic waves. Whole-year analysis compared with prior secular trends are scarce. METHODS: We present the 2020 REMER Madrid KRT registry, corresponding to the Spanish Region hardest hit by COVID-19. RESULTS: In 2020, KRT incidence decreased 12% versus 2019, while KRT prevalence decreased by 1.75% for the first time since records began and the number of kidney transplants (KTs) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008-2019). The 2019-2020 increase in mortality was larger for KTs (+68%) than for haemodialysis (+24%) or peritoneal dialysis (+38%). The most common cause of death was infection [n = 419 (48% of deaths)], followed by cardiovascular [n = 200 (23%)]. Deaths from infection increased by 167% year over year and accounted for 95% of excess deaths in 2020 over 2019. COVID-19 was the most common cause of death (68% of infection deaths, 33% of total deaths). The bulk of COVID-19 deaths [209/285 (73%)] occurred during the first COVID-19 wave, which roughly accounted for the increased mortality in 2020. Being a KT recipient was an independent risk factor for COVID-19 death. CONCLUSIONS: COVID-19 negatively impacted the incidence and prevalence of KRT, but the increase in KRT deaths was localized to the first wave of the pandemic. The increased annual mortality argues against COVID-19 accelerating the death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.

Inseguridad alimentaria y nivel de ansiedad en productores de quínoa de la provincia de Chimborazo / Food insecurity and level of anxiety in quinoa producers in the province of Chimborazo

Introducción: La seguridad alimentaria es uno de los objetivos principales a lograr por parte de las autoridades en Ecuador. Se describe que la inseguridad alimentaria es un elemento facilitador de estados displacenteros en la población que generan elevados niveles de ansiedad y depresión. Objetivo: Describir el comportamiento de la seguridad alimentaria y los niveles de ansiedad en productores de quinua de la provincia Chimborazo. Métodos: Se realizó una investigación básica, con diseño no experimental, de campo, transversal y descriptivo que incluyó como población de estudio a los 410 productores de quínoa del cantón Colta en la provincia Chimborazo, Ecuador. La muestra quedó conformada por 210 agricultores. Se utilizó la Escala Latinoamericana y Caribeña de Seguridad Alimentaria para determinar la seguridad alimentaria y la escala de ansiedad de Hamilton para identificar los niveles de ansiedad. Resultados: Se obtuvo un promedio de edad de 56,67 años, predominaron las agricultoras femeninas (60,95 por ciento) y la no referencia de nivel de instrucción (46,19 por ciento). El 56,67por ciento de los agricultores mostró inseguridad alimentaria predominando el nivel ligero (73,95 por ciento). La ansiedad fue identificada en el 45,24 por ciento de los agricultores con predominio de la ansiedad ligera (82,11 por ciento). La ansiedad estuvo presente en el 57,98 por ciento de los agricultores con inseguridad alimentaria y en el 28,57 por ciento de los que presentaron seguridad alimentaria. Conclusiones: Se identificaron elevados porcentajes de agricultores con inseguridad alimentaria y ansiedad. Esta última alcanzó mayor porcentaje en agricultores con inseguridad alimentaria(AU)

Introduction: Food security is one of the main goals to be achieved by the authorities in Ecuador. For its part, it is described that food insecurity is a facilitator of unpleasant states in the population, generating high levels of anxiety and depression. Objective: To describe the behavior of food security and anxiety levels in quinoa producers in the Chimborazo province. Methods: A basic research was carried out, with a non-experimental, field, cross-sectional and descriptive design that included as a study population the 410-quinoa producers of the Colta canton in the Chimborazo province, Ecuador. The sample was made up of 210 farmers. The Latin American and Caribbean Food Security Scale was used to determine food security and the Hamilton Anxiety Scale to identify anxiety levels. Results: an average age of 56.67 years was obtained, female farmers predominated (60.95 percent) and the non-reference level of education (46.19 percent). 56.67 percent of the farmers showed food insecurity, predominating the light level (73.95 percent). Anxiety was identified in 45.24 percent of the farmers with a predominance of light anxiety (82.11 percent). Anxiety was present in 57.98 percent of the farmers with food insecurity and in 28.57 percent of those with food security. Conclusions: High percentages of farmers with food insecurity and anxiety were identified. The latter reached the highest percentage in food insecure farmers(AU)

Inseguridad alimentaria y afectación psicológica en población rural / Food insecurity and psychological affectation in the rural population

RESUMEN Introducción: Lograr la seguridad alimentaria de la población es el mayor reto alimentario en la actualidad. A pesar de los esfuerzos realizados aún esta distante esta meta, sobre todo en las comunidades rurales. La inseguridad alimentaria es considerada un elemento que condiciona afectación psicológica en la población. Objetivo: Determinar las características de la seguridad alimentaria en población rural de la provincia Chimborazo y la presencia de manifestaciones psicológicas relacionadas. Métodos: Se realizó una investigación no experimental, de campo, transversal y descriptiva que incluyó una población de 410 productores de quínoa del cantón Colta. La muestra quedó conformada por 210 agricultores. Se utilizó la Escala Latinoamericana y Caribeña de Seguridad Alimentaria para determinar la seguridad alimentaria y la Escala de Ansiedad de Hamilton para identificar presencia de esta afección. Resultados: Promedio de edad de 56,67 años con desviación estándar de 36,38; predominio de agricultoras femeninas (60,95 %) y de personas sin nivel de instrucción (46,19 %). El 56,67 % de los agricultores mostró inseguridad alimentaria; predominó el nivel ligero (73,95 %). La ansiedad fue identificada en el 45,24 % de los agricultores con predominio de la ansiedad ligera (82,11 %). La ansiedad estuvo presente en el 57,98 % de los agricultores con inseguridad alimentaria y en el 28,57 % de los que presentaron seguridad alimentaria. Conclusiones: Existen elevados porcentajes de agricultores con inseguridad alimentaria y ansiedad. Esta última alcanzó mayor porcentaje en agricultores con inseguridad alimentaria.

ABSTRACT Introduction: Achieving food security for the population is perhaps the greatest food challenge today. Despite the efforts made, this goal is still distant, especially in rural communities. Food insecurity is considered as an element that conditions psychological affectation in the population. Objective: To determine the characteristics of food security in the rural population of the Chimborazo province and the presence of related psychological manifestations. Method: Non-experimental, field, cross-sectional and descriptive research was carried out that included a population of 410 quinoa producers from the Colta canton. The sample was made up of 210 farmers. The Latin American and Caribbean Food Safety Scale was used to determine food safety and the Hamilton Anxiety Scale to identify the presence of this condition. Results: Average age of 56.67 years with standard deviation of 36.38; predominance of female farmers (60.95 %) and people with no level of education (46.19 %); 56.67 % of the farmers showed food insecurity, predominantly the light level (73.95 %). Anxiety was identified in 45.24 % of farmers with a predominance of mild anxiety (82.11 %). Anxiety was present in 57.98 % of farmers with food insecurity and in 28.57 % of those with food security. Conclusions: High percentages of farmers with food insecurity and anxiety were identified. The latter reached the highest percentage in food insecure farmers.

Seguridad alimentaria en áreas rurales de la provincia Chimborazo, Ecuador / Food security in rural areas of the Chimborazo province, Ecuador

RESUMEN Introducción: La seguridad alimentaria es un amplio concepto que incluye múltiples factores que de una forma u otra inciden en que la población pueda acceder a una alimentación de calidad. Solo de esta forma se podrá cumplir con la ansiada meta de disponer de una alimentación saludable que no solo permita minimizar la aparición de enfermedades, sino que también contribuya a controlar las ya existentes. Objetivo: Determinar el comportamiento de la seguridad alimentaria en la población rural del cantón Colta, provincia de Chimborazo, Ecuador. Métodos: Investigación básica, de campo, descriptiva y de corte transversal realizada en el cantón Colta, provincia Chimborazo, con una población total de 410 familias dedicadas al cultivo de la quínoa. La muestra quedó conformada por 210 agricultores. Se utilizó la Escala Latinoamericana y Caribeña de Seguridad Alimentaria para determinar la seguridad alimentaria y sus elementos relacionados. Resultados: En el 56,67 % de las familias se identificó inseguridad alimentaria; y fue más significativa en familias con menores de 18 años (66,67 %). Predominó la inseguridad alimentaria ligera (73,95 %). La falta de recursos económicos (86,55 %), el elevado costo de los alimentos (76,49 %), los problemas relacionados con el acceso físico a los alimentos (74,79 %) y la inadecuada cobertura de salud (74,79 %) fueron las determinantes más referidas como causa de inseguridad alimentaria. Conclusiones: El elevado porcentaje de inseguridad alimentaria fue más predominante en las familias con personas menores de 18 años dentro de su composición familiar. Los elementos relacionados con el tema económico fueron los más referenciados como condicionantes de inseguridad alimentaria.

ABSTRACT Introduction: Food security is a broad concept that includes multiple factors that in one way or another affect the population's access to quality food. Only in this way will it be possible to meet the long-awaited goal of having a healthy diet that not only minimizes the appearance of diseases, but also helps to control existing ones. Objective: To determine the behavior of food security in the rural population of the Colta canton, Chimborazo province, Ecuador. Methods: Basic, field, descriptive and cross-sectional research carried out in the Colta canton, Chimborazo province, with a total population of 410 families dedicated to the cultivation of quinoa. The sample was made up of 210 farmers. The Latin American and Caribbean Food Security Scale was used to determine food security and its related elements. Results: In 56.67% of the families food insecurity was identified; being more significant in families with children under 18 years of age (66.67%). Slight food insecurity predominated (73.95%). The lack of economic resources (86.55%), the high cost of food (76.49%), problems related to physical access to food (74.79%) and inadequate health coverage (74, 79%) were the determinants most referred to as a cause of food insecurity. Conclusions: The high percentage of food insecurity was more prevalent in families with people under 18 years of age within their family composition. The elements related to the economic issue were the most referenced as determinants of food insecurity.

La pandemia COVID-19 inductor de tecnoestrés en docentes de la educación ecuatoriana de segundo nivel / The COVID-19 pandemic inducer of technostress in teachers of the Ecuadorian education of second level

Casi dos años después de que se impuso la adecuación del trabajo docente a la modalidad remota, la política pública educativa no visualiza en su discurso actual la atención al tecnoestrés docente como prioridad y no existen acciones concretas encaminadas en ese sentido. Se realizó un estudio cuantitativo, observacional, descriptivo y correlacional en tres colegios fiscales, a fin de obtener información sobre la prevalencia de tecnoestrés en docentes y aportar evidencia empírica acerca de las diferencias entre ambos sexos, en cuanto a algunos factores asociados a este. Los resultados tecnoestrés en los y las docentes participantes, independientemente a la edad, sexo y años de experiencias y correlacionado con la sobre carga tecnológica, la intensidad de trabajo diario, tecno-invasión y las consecuencias socioemocionales al trabajar fuera el horario laboral, en contexto COVID-19 y, como consecuencias impacto negativo en su bienestar psicológicos; los datos aportados sugieren implicancias interesantes del uso de las TICs que se extienden más allá de lo educativo y lo tecnológico, alcanzando además los campos: social, salud ocupacional y psicológico. Por lo que se recomienda seguir realizando investicaciones acerca de este fenómeno durante y post COVID-19(AU)

Almost two years after the adaptation of teaching work to the remote modality was imposed, the educational public policy does not visualize in its current discourse the attention to teaching techno-stress as a priority and there are no concrete actions directed in that direction. A quantitative, observational, descriptive and correlational study was carried out in three public schools, in order to obtain information on the prevalence of technostress in teachers and provide empirical evidence about the differences between the sexes, in terms of some factors associated with it. The results of techno-stress in the participating teachers, regardless of age, sex and years of experience and correlated with technological overload, intensity of daily work, techno-invasion and the socio-emotional consequences of working outside working hours, in context COVID-19 and, as consequences, a negative impact on their psychological well-being; the data provided suggest interesting implications of the use of ICTs that extend beyond education and technology, also reaching the fields: social, occupational health and psychological. Therefore, it is recommended to continue conducting research on this phenomenon during and after COVID-19(AU)

Family Refusal to Consent Donation: Retrospective Quantitative Analysis of Its Increasing Tendency and the Associated Factors Over the Last Decade at a Spanish Hospital.

BACKGROUND: Organ and tissue recovery remains limited by several factors. This study retrospectively analyzes the factors associated with family refusal to consent to donation at a high-donor-volume Spanish hospital. METHODS: Data regarding the annual number of potential donors and family refusal rates at hospital and regional levels were retrieved from 2008 to 2017. Descriptive, bivariate, and multivariate analyses were performed to detect those factors independently associated with family refusal. Results were cross-validated using the data from years 2018 and 2019 as the validation group. To explore potential inter-relations between factors a Multiple Correspondence Analysis was performed. RESULTS: A total of 601 family interviews for petition of consent were conducted between 2008 and 2017, 531 (88.4%) resulted in acceptance and 70 (11.6%) resulted in refusal of the donation. Lesser experience of the interviewers (odds ratio [OR], 2.980; P = .001), donation after brain death (OR, 2.485; P = .013), number of interviews conducted per family (OR, 1.892; P < .001), age of the main decision maker (OR, 1.025; P = .045), and high or middle attributed cultural levels (OR, 0.142; P < .001 and OR, 0.199; P < .001 respectively) were observed to be independently associated with the family final decision. The logistic regression model displayed good predictive power for both derivation and validation cohorts, with an overall predictive accuracy of 80.9% (95% confidence interval, 0.747-0.870; P < .001) and 74.4% (95% confidence interval, 0.635-0.854; P = .001), respectively. CONCLUSIONS: Transplant coordination team members having a thorough knowledge of the family decision mechanisms may be a key factor in donation process optimization.

Transplantation of a heart donated after circulatory death via thoraco-abdominal normothermic regional perfusion and results from the first Spanish case.

BACKGROUND: Controlled donation after circulatory death (cDCD) has emerged as one of the main strategies for increasing the organ donor pool. Because of the ischemic injury that follows the withdrawal of life-sustaining therapies, hearts from cDCD donors have not been considered for transplantation until recently. The ex-situ perfusion of hearts directly procured from cDCD donors has been used to allow the continuous perfusion of the organ and the assessment of myocardial viability prior to transplantation. Based on our experience with abdominal normothermic regional perfusion in cDCD, we designed a protocol to recover and validate hearts from cDCD donors using thoraco-abdominal normothermic regional perfusion without the utilization of an ex-situ device. CASE PRESENTATION: We describe the first case of a cDCD heart transplant performed with this approach in Spain. The donor was a 43-year-old asthmatic female diagnosed with severe hypoxic encephalopathy. She was considered a potential cDCD donor and a suitable candidate for multiorgan procurement including the heart via thoraco-abdominal normothermic regional perfusion. The heart recipient was a 60-year-old male diagnosed with amyloid cardiomyopathy. Cold ischemia time was 55 min. The surgery was uneventful. CONCLUSIONS: This case report, the first of its kind in Spain, supports the feasibility of evaluating and successfully transplanting cDCD hearts without the need for ex-situ perfusion based on the use of thoraco-abdominal normothermic regional perfusion opening the way for multiorgan donation in cDCD.

Implementation of a mobile team to provide normothermic regional perfusion in controlled donation after circulatory death: Pilot study and first results.

Normothermic regional perfusion (NRP) in controlled donation after circulatory death is becoming a popular method due to the favorable results of the grafts procured under this technique. This procedure requires experience, and, sometimes, the availability of extracorporeal membrane oxygenation (ECMO) machines to implement NRP is limited to tertiary hospitals. In order to provide support with NRP in controlled donation after circulatory death across the different hospitals of the Autonomous Community of Madrid, a mobile NRP team was created. In the first 18 months since its creation, the mobile NRP team participated in 33 procurements across nine different hospitals, representing 72% of all controlled donations after circulatory death in the Autonomous Community of Madrid. NRP was successfully performed in 29 (88%) cases, with a mean duration of 69 ± 27 minutes. A total of 39 kidneys, 12 livers, and 5 bilateral lungs were recovered and transplanted. None of the livers were discarded due to an elevation in transaminases during NRP. A mobile NRP team is a feasible option and, in our series, aided in the optimization and recovery of organs from donors after controlled circulatory death in centers where ECMO technology was not available.

Incidencia de infección y trombosis asociadas a catéter central de inserción periférica (PICC) colocado por Radiología Intervencionista / Incidence of infection and thrombosis associated with peripheral insertion central catheter (PICC) placed by Interventional Radiology / Incidência de infecção e trombose associada a cateteres centrais de inserção periférica (linhas PICC) implantados pelo Serviço de Radiologia Intervencionista

Resumen: Objetivo general: Determinar la incidencia de la trombosis venosa (TV) e infección asociada con el catéter central de inserción periférica (PICC). Material y métodos: Se realizó un estudio retrospectivo, replicativo y descriptivo, cuya duración fue de 38 meses. Los catéteres centrales de inserción periférica se colocaron por el Servicio de Radiología Intervencionista con la misma técnica en las extremidades superiores. Se guardó una imagen del procedimiento con el nombre y diámetro de la vena usada. En el estudio se incluyó a partir del primer catéter PICC colocado en marzo de 2015 hasta el último en abril de 2018. Se registraron las trombosis venosas demostradas por ultrasonido Doppler, la duración del catéter y las bacteriemias relacionadas con el PICC (BRC-PICC). Resultados: Se colocaron 448 PICC y, de éstos, se excluyeron 78. Los 370 catéteres restantes sumaron 3,363 días-catéter. El 99.45% de los procedimientos resultaron exitosos. La incidencia de trombosis encontrada fue de 0.016% (n = 6) y la de infección de 0.03% (n = 12). El vaso más frecuentemente utilizado fue la vena basílica derecha. Conclusiones: La incidencia tanto de trombosis como de infección se mantiene por debajo de las reportadas en la literatura. Las venas mayores a 3.8 mm de diámetro tienen una probabilidad muy baja de presentar trombosis venosa.

Abstract: Objective: To determine the incidence of venous thrombosis (VT) and infection associated with PICC lines. Material and methods: A retrospective, replicative and descriptive study was conducted over 38 months. The PICC line was inserted in the upper extremities by the Interventional Radiology Service with the same technique. An image of the procedure with the name and diameter of the selected vein was saved. Venous thrombosis, demonstrated by Doppler ultrasound, the duration of the catheter and bacteremia related to the PICC line (BRC-PICC) were recorded. Results: 448 PICCs were placed and 78 were excluded. The remaining 370 catheters added 3,363 catheter days. 99.45% of the procedures were technically successful. The incidence of thrombosis was 0.016% (n = 6) and that of infection 0.03% (n = 12). The most frequently selected vessel was the right basilic vein. Conclusions: The incidence of thrombosis and infection were below the reported in the literature. Veins greater than 3.8 mm have a very low probability of having TV.

Resumo: Objetivo: Determinar a incidência de trombose venosa (TV) e infecção associada ao PICC. Material e métodos: Foi realizado um estudo retrospectivo, replicativo e descritivo, durante 38 meses. Os cateteres PICC foram colocados nas extremidades superiores pelo serviço de Radiologia Intervencionista com a mesma técnica. Guardou-se uma imagem do procedimento com o nome e o diâmetro da veia utilizada. Incluíu-se desde o primeiro cateter PICC colocado em março de 2015 até abril de 2018. Registraram-se as tromboses venosas por ultrassom Doppler, duração do cateter e bacteremias relacionadas ao PICC (BRC-PICC). Resultados: Colocaram-se 448 PICC e foram excluídos 78. Os 370 cateteres restantes somaram 3363 dias de cateter. 99.45% dos procedimentos foram bem sucedidos. A incidência de trombose encontrada foi de 0.016% (n = 6) e a de infecção de 0.03% (n = 12). O vaso mais utilizado foi a veia basílica direita. Conclusões: A incidência de trombose e infecção permanece abaixo da relatada na literatura. Veias com diâmetro superior a 3.8 mm têm uma probabilidade muito baixa de apresentar trombose venosa.

Catheter directed hepatic artery thrombolysis following liver transplantation. Case report and review of the literature.

Hepatic artery thrombosis is the most frequent vascular complication following orthotopic liver transplantation, and often results in biliary complications, early graft loss and death. Surgical revascularization and retransplantation are considered the mainstay of treatment. However, intraarterial endovascular therapy is an alternative that has shown low morbidity and mortality, thereby avoiding the need for retransplantation. We describe a case of orthotopic liver transplantation complicated with hepatic artery thrombosis that was successfully treated with endovascular therapy.

Resultados de las entrevistas familiares en donación en asistolia no controlada / Results of interviews with families of non-heart-beating donor candidates

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HPV Could be a Potential Factor of Survival in Laryngeal Cancer: a Preliminary Study in Mexican Patients

Introduction: In Head and Neck (HN) cancer, the High-Risk Human Papillomavirus (hr HPV) infection has been associated in about 40% of these tumors. The hr HPV infection is one of the etiological factors of several epithelial tumors; however, its association with the prognosis has not yet been established for patients with Laryngeal Squamous Cell Carcinoma (LSCC). On the other hand, Epidermal Growth Factor Receptor (EGFR) is a molecular marker widely studied in cancer and its overexpression has been associated with poor prognosis in some types of cancer, including the HN cancer. In the present study, we analyzed EGFR expression and HPV detection in a cohort of Mexican patients with LSCC and define their association with clinical-pathological and survival parameters. Methods: EGFR expression analysis was performed by immunohistochemistry assay. A tissue array was constructed based on 30 paraffin-embedded tissue samples. HPV detection was performed by PCR. The results were then compared with the clinical-pathological variables and outcome measures (Kaplan Meier and Cox analysis). Results: High expression of EGFR was observed in 43% of the samples and 20% of HPV detection. The statistical analyses provided evidence of disassociation between clinical-pathological parameters and EGFR expression, but there was an association with poor prognosis. Interestingly, HPV detection is slightly associated with good prognosis. Conclusion: Both, EGFR overexpression and HPV presence could be associated with an unfavorable prognosis in patients with LSCC, independently of other clinical-pathological factors.

Noncholestatic acute hepatocellular injury following candesartan administration.

Arterial hypertension is a highly manageable disorder due to a variety of drugs available for its treatment. Since the late 1990s, angiotensin II receptor blockers have been widely prescribed, achieving appropriate control in patients' blood pressure. Few cases of serious adverse effects have been reported to date. Here, we present a case of acute hepatocellular injury secondary to candesartan administration. Further studies should be performed in patients who present with this adverse effect, in order to prevent more serious outcomes.

[Factors affecting the survival of transplants from donors after prehospital cardiac death]. / Factores que influyen en la evolución de los injertos de donantes tras muerte cardiaca extrahospitalaria.

OBJECTIVES: To evaluate factors that influence the survival of transplanted organs from donors after prehospital cardiac death. MATERIAL AND METHODS: Retrospective observational study of data collected from hospital emergency service records. Information included prehospital cardiac deaths evaluated as donors as well as patients who received transplants. RESULTS: Two hundred cases from 2008 through 2011 were studied. Sixty-nine potential donors (34.5%) were rejected. Three hundred organs were extracted from the remaining 131 donor cases, to yield a mean (SD) of 2.32 (0.83) transplanted organs/donor or 1.52 (1.29) organs/potential donor. One hundred fifty-two potential donors (76%) were treated with mechanical cardiopumps during transport. We detected no significant differences between cases transported with manual chest compressions and cases treated with cardiopumps regarding age (40.1 vs 43.5 years, P=.06), responder arrival times (13 min 54 s vs 12 min 54 s, P=.45), or transport times (1 h 27 min vs 1 h 32 min). However, case transported with manual chest compressions yielded significantly more kidneys (mean, 1.96/potential donor) than those transported with cardiopump compressions (mean, 1.38/potential donor) (P=.008). Eleven of the 229 kidneys harvested (4%) were not transplanted. The median (interquartile range) serum creatinine concentrations after kidney transplants at 6 and 12 months, respectively, were 1.37 (1.10-1.58) mg/dL and 1.43 (1.11-1.80) mg/dL. CONCLUSION: Our findings suggest that the use of a cardiopump reduces donor recruitment. Long-term creatinine levels are similar after transplantation of kidneys from donors transported with a cardiopump or with manual compressions.

OBJETIVO: Valorar los factores extrahospitalarios que pueden influir en la viabilidad de los injertos en los receptores. METODO: Estudio observacional retrospectivo que recoge datos de los registros del sistema de emergencias (pacientes con muerte cardiaca extrahospitalaria que fueron trasladados al hospital para valorar) y del hospital (pacientes trasplantados) de aquellos pacientes con muerte cardiaca extrahospitalaria que fueron trasladados al hospital para valorar. RESULTADOS: Se recogen 200 casos entre los años 2008 y 2011, de los que 69 (34,5%) no fueron donantes. De los 131 donantes utilizados se extrajeron 300 órganos [media de 2,32 (DE 0,83) órganos/donante utilizado y 1,52 (DE 1,29) órganos/donante potencial]. De los 200 pacientes, 152 fueron trasladados bajo cardiocompresión mecánica (76%). No hay diferencia significativa en edad (40,1 frente a 43,5 años, p = 0,06) y tiempo de llegada (13' 54' ' frente a 12' 54' ' , p = 0,45) y tiempo de trasferencia (1 h y 27' frente a 1 h y 32') entre el grupo de pacientes trasladados con cardiocompresión manual y con cardiocompresión mecánica, pero si en la media de órganos por donante potencial en favor de la cardiocompresión manual (1,96 frente a 1,38, p = 0,008). De los 229 riñones extraídos, no se trasplantaron 11 (4%). La mediana de la creatinina a los 6 meses de los riñones fue de 1,37 mg/dl (RIC: 1,10-1,58) y a los 12 meses de 1,43 mg/dl (RIC: 1,11-1,80), sin diferencias entre ambos grupos. CONCLUSIONES: Nuestros datos sugieren que el uso de compresores mecánicos disminuye el reclutamiento de donantes. A largo plazo la concentración de creatinina en los riñones trasplantados es similar independientemente del tipo de compresión usada durante el traslado y ninguna variable extrahospitalaria predice la evolución de los injertos.

Factores que influyen en la evolución de los injertos de donantes tras muerte cardiaca extrahospitalaria / Factors affecting the survival of transplants from donors after prehospital cardiac death

Objetivo: Valorar los factores extrahospitalarios que pueden influir en la viabilidad de los injertos en los receptores. Método: Estudio observacional retrospectivo que recoge datos de los registros del sistema de emergencias (pacientes con muerte cardiaca extrahospitalaria que fueron trasladados al hospital para valorar) y del hospital (pacientes trasplantados) de aquellos pacientes con muerte cardiaca extrahospitalaria que fueron trasladados al hospital para valorar. Resultados: Se recogen 200 casos entre los años 2008 y 2011, de los que 69 (34,5%) no fueron donantes. De los 131 donantes utilizados se extrajeron 300 órganos [media de 2,32 (DE 0,83) órganos/donante utilizado y 1,52 (DE 1,29) órganos/donante potencial]. De los 200 pacientes, 152 fueron trasladados bajo cardiocompresión mecánica (76%). No hay diferencia significativa en edad (40,1 frente a 43,5 años, p = 0,06) y tiempo de llegada (13' 54'' frente a 12' 54'', p = 0,45) y tiempo de trasferencia (1 h y 27' frente a 1 h y 32') entre el grupo de pacientes trasladados con cardiocompresión manual y con cardiocompresión mecánica, pero si en la media de órganos por donante potencial en favor de la cardiocompresión manual (1,96 frente a 1,38, p = 0,008). De los 229 riñones extraídos, no se trasplantaron 11 (4%). La mediana de la creatinina a los 6 meses de los riñones fue de 1,37 mg/dl (RIC: 1,10-1,58) y a los 12 meses de 1,43 mg/dl (RIC: 1,11-1,80), sin diferencias entre ambos grupos. Conclusiones: Nuestros datos sugieren que el uso de compresores mecánicos disminuye el reclutamiento de donantes. A largo plazo la concentración de creatinina en los riñones trasplantados es similar independientemente del tipo de compresión usada durante el traslado y ninguna variable extrahospitalaria predice la evolución de los injertos

Objective: To evaluate factors that influence the survival of transplanted organs from donors after prehospital cardiac death. Methods: Retrospective observational study of data collected from hospital emergency service records. Information included prehospital cardiac deaths evaluated as donors as well as patients who received transplants. Results: Two hundred cases from 2008 through 2011 were studied. Sixty-nine potential donors (34.5%) were rejected. Three hundred organs were extracted from the remaining 131 donor cases, to yield a mean (SD) of 2.32 (0.83) transplanted organs/donor or 1.52 (1.29) organs/potential donor. One hundred fifty-two potential donors (76%) were treated with mechanical cardiopumps during transport. We detected no significant differences between cases transported with manual chest compressions and cases treated with cardiopumps regarding age (40.1 vs 43.5 years, P=.06), responder arrival times (13 min 54 s vs 12 min 54 s, P=.45), or transport times (1 h 27 min vs 1 h 32 min). However, case transported with manual chest compressions yielded significantly more kidneys (mean, 1.96/potential donor) than those transported with cardiopump compressions (mean, 1.38/potential donor) (P=.008). Eleven of the 229 kidneys harvested (4%) were not transplanted. The median (interquartile range) serum creatinine concentrations after kidney transplants at 6 and 12 months, respectively, were 1.37 (1.10-1.58) mg/dL and 1.43 (1.11-1.80) mg/dL. Conclusions: Our findings suggest that the use of a cardiopump reduces donor recruitment. Long-term creatinine levels are similar after transplantation of kidneys from donors transported with a cardiopump or with manual compressions

[Neuroendocrine carcinoma of the urinary bladder. A case report]. / Carcinoma neuroendocrino de vejiga. Reporte de un caso.

BACKGROUND: Small cell carcinoma of the urinary bladder is an infrequent lesion. CLINICAL CASE: We present the case of a 68-year-old male who arrived at the emergency room with a history of 24-h gross hematuria. Imaging studies show a urinary bladder tumor with a 218 cc volume that during a 20-day period increased to 426 cc. Histopathological images with hematoxylin-eosin show an infiltrating solid mass with uneven borders. It is composed of neoplastic cells with evident nuclei predominance and scant cytoplasm (small cells). Chromogranin immunohistochemical staining shows a diffusely positive cytoplasmic granular pattern on neoplastic cells. High molecular weight cytokeratin staining shows a negative pattern on neoplastic cells along with a positive pattern on reporsurrounding normal urothelium. Tumoral mass is positive for synaptophysin and CD-56 and negative for CK-7 and CK-20. Patient therapy was based on radiation plus chemotherapy. CONCLUSION: Small cell carcinoma of the urinary bladder represents 0.35-0.70% of urinary bladder tumors. Histological and immunohistochemical identification are key elements in the diagnosis. Treatment approach is based on cisplatin-based chemotherapy plus radical cystectomy, except when metastatic disease is present.

Antecedentes: el carcinoma neuroendocrino de células pequeñas primario de vejiga es una lesión maligna muy poco frecuente. Caso clínico: paciente masculino de 68 años de edad, que tuvo hematuria macroscópica de 24 horas de evolución. Estudios de imagen mostraron tumoración vesical de 218 cc, que en 20 días alcanzó un volumen de 426 cc. A la tinción con hematoxilina-eosina, histológicamente se apreció: placa sólida infiltrante de bordes irregulares, compuesta por células neoplásicas con claro predominio de núcleo y escaso citoplasma (células pequeñas). A la tinción inmunohistoquímica con cromogranina parecía difusamente positivo en células neoplásicas, en un patrón granular citoplasmático. A la tinción con citoqueratina de alto peso molecular se observó patrón negativo en células neoplásicas con control interno positivo en el urotelio acompañante en espécimen. De igual manera, la tumoración fue positiva para sinaptofisina y CD-56 y negativa para CK-7 y CK-20. El paciente recibió tratamiento a base de radioterapia y quimioterapia. Conclusión: el carcinoma neuroendocrino de células pequeñas primario de vejiga representa de 0.35 a 0.70% de los tumores vesicales primarios. Su diagnóstico se basa en el reconocimiento histológico e inmunohistoquímico. El tratamiento se fundamenta en quimioterapia con cisplatino más cistectomía radical, excepto cuando existe enfermedad metastásica.