Liver Transplant From Controlled Cardiac Death Donors Using Normothermic Regional Perfusion: Comparison With Liver Transplants From Brain Dead Donors.

BACKGROUND: Liver transplantation from donors after either controlled or uncontrolled cardiac death (DCD) is associated with considerable rates of primary nonfunction (PNF) and ischemic cholangiopathy (IC). Normothermic regional perfusion (NRP) could significantly reduce such rates. METHODS: Retrospective study to analyze short-term (mortality, PNF, vascular complications) and long-term (IC, survival) complications in 11 liver transplants from controlled DCDs using NRP with extracorporeal membrane oxygenation (ECMO) (group 1). They were compared with 51 patients transplanted with grafts from donors after brain death (DBD) (group 2). Mean recipient age, sex, and Model for End-stage Liver Disease (MELD) score were not significantly different. RESULTS: In group 1, mean functional warm ischemia time was 15.8 (range, 7-40) minutes and 94.1 (range, 20-150) minutes on NRP. The ischemic damage was minimal, as shown by the slight alanine aminotransferase (ALT) and aspartate aminotransferase (AST) rises in the donor serum after 1 hour on NRP and similar rises 24 hours after transplantation in both groups. No patient had IC or acute renal failure. No significant difference was found between the groups for vascular or biliary complications. One group 1 patient had PNF (9.1%), resulting in death. Overall retransplantation and in-hospital death rates were 8.1% and 4.8%, respectively, with no significant difference between groups. Estimated mean survival was 24.6 (95% confidence interval [CI], 20.2-29.1) months in group 1 and 32.3 (95% CI, 30.4-34.2) months in group 2 (not a statistically significant difference). CONCLUSION: In our experience, liver transplants from controlled DCDs using NRP with ECMO is associated with a low risk of PNF and IC, with short- and long-term results comparable to those in DBD transplants.

Una mirada al examen profesional por áreas de conocimiento en la licenciatura en Enfermería / A look into the baccalaureate of nursing professional exam by areas of knowledge

El Examen General por Áreas de Conocimiento (EPAC) es una opción de titulación que ofrece la Escuela Nacional de Enfermería y Obstetricia de la UNAM a estudiantes de los sistemas escolarizado; abierto e incorporado; para obtener el grado de licenciatura o profesional técnico en Enfermería. El propósito del artículo es socializar y evidenciar el trabajo realizado con el EPAC de nivel licenciatura a partir de la creación de la Unidad de Apoyo para la Evaluación de los Aprendizajes. Ello ha permitido; con el trabajo de un equipo multidisciplinar; mejorar el proceso del examen; hacer innovaciones informáticas y administrativas; mantener un apoyo educativo directo y confiable tanto a instituciones participantes como a sustentantes. Los resultados que se muestran fueron extraídos de las cuatro aplicaciones realizadas hasta el año 2006; las que se juzgaron a partir de estudios de tipo descriptivo y transversal; con muestra censal. Es innegable que el trabajo permanente con este proceso reorientará las acciones para una mejora continua; que posibiliten altos estándares de confiabilidad lo que garantizará la obtención de resultados más objetivos y oportunos.

The General Test by Knowledge Areas (EPAC) is an option for obtaining the nurse licentiate or technician degree that the National Nursery and Obstetrics School (ENEO, UNAM) offers to the students of the traditional, open and incorporated systems. The purpose of this article is to share what has been done regarding the licentiate level EPAC since the Support Unit for Knowledge Evaluation was created. This has allowed, with the work of a multidisciplinary team, to improve the general exam process, to attain computer and administrative innovations and to give a direct, realiable educative support to both institutions and individual participants. The results shown in this article proceed from the four exams presented until the year 2006, which were judged based on descriptive, transversal studies with census sample. It is undeniable that the permanent work with this process will redirect the actions for a continuous improvement, that will allow high reliability standards that guarantee the attainment of more objective, convenient results.