Toxoplasmosis gastrointestinal en un paciente trasplantado renal / Gastrointestinal toxoplasmosis in a renal transplant patient

Resumen La toxoplasmosis posterior al trasplante renal es una condición infrecuente, pero asociada con alta morbilidad y mortalidad. Generalmente ocurre en los primeros tres meses cuando la inmunosupresión es mayor, siendo más común la presentación con encefalitis y neumonitis. El compromiso del tracto gastrointestinal es inusual y con síntomas inespecíficos. Su diagnóstico es un reto pues no siempre existe seroconversión en estadios tempranos de la infección o no hay evidencia histológica del parásito; es aquí donde la biología molecular y la historia clínica pueden resultar útiles para el diagnóstico oportuno que favorezca un buen desenlace. Describimos el caso de un paciente con síntomas generales, náuseas y emesis en el periodo postrasplante renal temprano atribuidos primero a reactivación de citomegalovirus con diagnóstico posterior de gastritis por Toxoplasma gondii. Recibió tratamiento con trimetoprim sulfametoxazol por seis semanas con resolución completa de los síntomas. (Acta Med Colomb 2016; 40: 266-268).

Abstract Toxoplasmosis following renal transplantation is an uncommon condition, but is associated with high morbidity and mortality. It usually occurs in the first three months when immunosuppression is greater, being more common the presentation with encephalitis and pneumonitis. The involvement of the gastrointestinal tract is unusual and with nonspecific symptoms. Its diagnosis is a challenge because there is not always seroconversion in the early stages of infection or there is no histological evidence of the parasite; it is here that molecular biology and clinical history can be useful for a timely diagnosis that may favor a good outcome. The case of a patient with general symptoms, nausea and emesis in the early renal transplant period attributed initially to reactivation of cytomegalovirus with subsequent diagnosis of gastritis by Toxoplasma gondii, is described. He received treatment with trimethoprim sulfamethoxazole for six weeks with complete resolution of symptoms. (Acta Med Colomb 2016; 40: 266-268).

Falla renal aguda asociada a síndrome de hiperestimulación ovárica / Acute renal failure associated with ovarian hyperstimulation syndrome

El síndrome de hiperestimulación ovárica es una complicación frecuente que se puede presentar en pacientes que reciben tratamientos de inducción de la ovulación y como consecuencia pueden desarrollar un síndrome edematoso grave con falla de uno o varios órganos; presentamos el caso de una paciente con falla renal aguda asociada a síndrome de hiperestimulación ovárica. (Acta Med Colomb 2016; 41:58-61).

Ovarian hyperstimulation syndrome is a common complication that can occur in patients receiving treatment for ovulation induction and as a consequence may develop a severe edematous syndrome with failure of one or more organs; the case of a patient with acute renal failure associated with ovarian hyperstimulation syndrome is presented. (Acta Med Colomb 2016; 41:58-61).

Ticitlser y hacer: personajes divinos antecesores de la enfermería perinatal mexicana / Ticitl: being and doing: divine ancestral characters of Mexican perinatal nursing / Ticitl ser e fazer: personagens divinos antecesores da enfermagem perinatal mexicana

La historia influye en la concepción del significado de enfermería, razón para desarrollar esta investigación de corte histórico, cualitativa, siendo su objeto de estudio el devenir histórico de la Ticitl durante la época precolonial. Tiene como objetivo mostrar el nivel jerárquico de la cuidadora de salud de esa época, y las intervenciones realizadas para cuidar la salud. Se realizo un abordaje sistémico para la recolección, organización y evaluación crítica de los datos. El nombramiento del cargo estaba dado de acuerdo con el derecho romano; al designarla era señalada su responsabilidad de origen divino; antes de ejercer su profesión, adquirían una práctica que duraba varios años, convirtiéndolas en seres respetados y estimados en la sociedad, debiendo presentarse ante un consejo anualmente para verificar sus conocimientos. La Ticitl ejercía un verdadero "matriarcado obstétrico", y era tratada con veneración por los valiosos servicios que prestaba durante el embarazo, mediante cuidados, orientaciones y ceremonias religiosas.

History influences one's conception of the meaning of nursing. This statement gave way to developing this qualitative, cross-sectional historical investigation. The object of this study is the pre-colonial historical origin of Ticitl, and the objective of this study is to show the hierarchical level of the healthcare giver at that time, as well as the health care interventions carried out then. A systemic approach was carried out to collect, organize, and critically evaluate the data. The nomination of the task was given according to Roman law; the designation of responsibility was of divine origin; before exercising their profession they acquired a practice that lasted several years, converting them into respected and esteemed beings within society, having needed to annually appear before a council to verify their knowledge. The Ticitl exercised a true "obstetrics matriarchy" and was treated with reverence for the valuable services they provided during pregnancy through giving care, guidance, and religious ceremonies.

A história influi na concepção do significado da enfermagem, razão esta para desenvolver esta investigação de corte histórico, qualitativo, sendo seu objeto de estudo as origens históricas da Ticitl durante a época pré-colonial. Teve como objetivo mostrar o nível hierárquico da cuidadora de saúde dessa época e as intervenções que efetuava para cuidar a saúde. Realizou-se uma abordagem sistêmica para coleta, organização e avaliação critica dos dados. A designação do cargo estava baseada no direito romano. Ao designá-la, era assinalada sua responsabilidade de origem divina e, antes de exercer formalmente sua profissão, era submetida a uma prática que durava vários anos. Isto a convertia em ser respeitado e estimados na sociedade, devendo apresentar-se a um conselho anualmente para verificar seus conhecimentos. A Ticitl exercia um verdadeiro "matriarcado obstétrico" e era tratada com veneração pelos valiosos serviços prestados durante a gestação, por meio de cuidados, orientações e cerimônias religiosas.

Varicela complicada en un paciente inmunocompetente: reporte de un caso / Complicated varicella affecting an immunocompetent patient: report of a case

La varicela es una enfermedad infecciosa que ocurre principalmente en los niños y la gran mayoría de los casos tiene una presentación benigna, autolimitada y es suficiente con un tratamiento sintomático. En pacientes inmunocompetentes generalmente no hay complicaciones, y si aparecen son de severidad leve, por ejemplo sobreinfecciones cutáneas, otitis, hepatitis subclínicas y ocasionalmente ataxia cerebelosa. Por el contrario en pacientes inmunocomprometidos, el grado de severidad de la enfermedad es mayor, con una duración más prolongada, lesiones cutáneas extensas y profundas y pueden presentarse complicaciones letales como la Neumonía por Varicela, la falla hepática fulminante, las infecciones sistémicas y los trastornos de la coagulación. Se presenta el caso no fatal de un paciente masculino de 10 años sin historia ni paraclínicos sugestivos de inmunocompromiso, que desarrolla varicela con extenso compromiso cutáneo, que por signos y síntomas sugestivos de falla hepática, síndrome de respuesta inflamatoria sistémica y Coagulopatía, requirió hospitalización prolongada, con lenta recuperación y posterior desarrollo de cerebelitis y que después de realizarse estudios extensos no logro demostrarse inmunodeficiencia de base que explicara la severidad de la enfermedad.

Chickenpox is and infectious disease that occurs mainly in children. In the vast majority of cases it has a benignand self limited course and with a symptomatic management is enough. In immunocompetent host thereusually aren’t complications and if appear, they are generally mild, like cutaneous infections, otitis, subclinicalhepatitis and cerebellar ataxia. In immunocompromised host instead, the severity of the disease is higher, with amore prolonged course, bigger and deeper lesions, and even lethal complications like fulminant liver failure, pneumonia, systemic infections and coagulopathy. A non fatal case is presented, about a male, 10 years old patient without a suggestive history of immunologicalincompetence that developed chickenpox with extended andprofound cutaneous involvement, that because of signs and symtoms suggestive of liver dysfunction, systemic inflammatory response syndrome and coagulopathy, herequired a prolonged hospitalization with slow recovery and posterior development of cerebelitis and after several studies we failed to demonstrate an immunodeficiency thatexplained the severity of the disease.

North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE Criteria.

Acute kidney injury (AKI) in the intensive care unit (ICU) is associated with an enhanced mortality. The Acute Dialysis Quality Initiative group has proposed the RIFLE (Risk-Injury-Failure-Loss-ESRD) classification to standardize the approach to AKI. This study was performed to estimate the AKI incidence in ICU patients in northeastern Italy and describe clinical characteristics and outcomes of patients with AKI on the basis of their RIFLE class. A prospective multicenter observational study was performed of patients who fulfilled AKI criteria in 19 ICU in northeastern Italy. Data were analyzed using multivariate logistic regression and survival curve analysis. Of 2164 ICU patients who were admitted during the study period, 234 (10.8%; 95% confidence interval 9.5 to 12.1%) developed AKI; 19% were classified as risk (R), 35% as injury (I), and 46% as failure (F). Preexisting kidney disease was present in 36.8%. The most common causes of AKI were prerenal causes (38.9%) and sepsis (25.6%). At diagnosis of AKI, median serum creatinine and urine output were 2.0 mg/dl and 1100 ml/d, respectively. ICU mortality was 49.5% in class F, 29.3% in I, and 20% in R. Independent risk factors for mortality included RIFLE class, sepsis, and need for renal replacement therapy, whereas a postsurgical cause of AKI, exposure to nephrotoxins, higher serum creatinine, and urine output were associated with lower mortality risk. In this study, AKI incidence in the ICU was between 9 and 12%, with 3.3% of ICU patients requiring renal replacement therapy. Sepsis was a significant contributing factor. Overall mortality was between 30 and 42%, and was highest among those in RIFLE class F.

Effectiveness of sodium hypochlorite in the prevention of catheter related infections.

Vascular access in hemodialysis is a major point of concern in the management of chronic patients. Although arteriovenous fistula remains as the access of first choice, tunneled central venous catheters are still commonly used. Infection remains the principal cause of catheter dysfunction or loss. Many protocols have been used in order to prevent exit site infections and bacteremia. We describe our experience with the use of sodium hypochlorite, an electrolytic chloroxidizer used as a topical disinfectant. It has been shown to be active against a broad spectrum of potential pathogens and has other specific advantages compared to other cleansing agents, including its non-toxic, non-irritating nature and its low cost. We conclude that sodium hypochlorite solution in different concentrations (10 and 50%) is effective in preventing exit site infections and bacteremia associated with tunneled central venous catheters in chronic hemodialysis patients.

Flow distribution analysis by helical scanning in polysulfone hemodialyzers: effects of fiber structure and design on flow patterns and solute clearances.

The efficiency of a hemodialyzer is largely dependent on its ability to facilitate diffusion, as this is the main mechanism by which small solutes are removed. The diffusion process can be impaired if there is a mismatch between blood and dialysate flow distribution in the dialyzer. The objective of the paper was to study the impact of different fiber bundle configurations on blood and dialysate flow distribution and urea clearances. The Optiflux 200 NR hemodialyzer was studied and the standard F 80 A hemodialyzer was used as a control for the study. Six dialyzers of each type were studied in vitro in the radiology department utilizing a new generation of helical computed tomography (CT) scan following contrast medium injection into the blood and dialysate compartment. Dynamic sequential imaging of longitudinal sections of the dialyzer was undertaken to detect flow distribution, average and peak velocities, and calculate wall shear rates. Six patients were dialyzed with 2 different dialyzers in random consecutive sequence. In these patients, 2 consecutive dialyses were carried out with identical operational parameters (Qb = 300 mL/min, Qd = 500 mL/min). In each session, blood and dialysate side urea clearances were measured at 30 and 150 min of treatment. Macroscopic and densitometrical analysis revealed that flow distribution was most homogeneous in the dialyzer with a new bundle configuration. Significantly increased urea clearances (p < 0.001) were seen with the Optiflux dialyzer compared with the standard dialyzer. In conclusion, more homogeneous dialysate blood and dialysate flow distribution and improved small solute clearances can be achieved by modifying the configuration of the filter bundle. These effects are achieved probably as a result of reduced blood to dialysate mismatch with reduction of flow channeling. The used radiological technique allows detailed flow distribution analysis and has the potential for testing future modifications to dialyzer design.

Extracorporeal blood purification therapies for prevention of radiocontrast-induced nephropathy: a systematic review.

BACKGROUND: Radiocontrast-induced nephropathy (RCIN) causes acute kidney injury and increases mortality. Studies have examined the capacity of various forms of extracorporeal blood purification therapies for the prevention of RCIN, with conflicting results. We conducted a systematic review of published trials to determine whether periprocedural extracorporeal blood purification prevents RCIN. METHODS: We searched PubMed, the Cochrane Collaboration Database, EMBASE, and CINAHL through January 2006 and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Published studies of extracorporeal blood purification for the prevention of RCIN in patients receiving radiocontrast were included. Two authors reviewed all citations. The primary end point is the incidence of RCIN, defined as an increase in serum creatinine concentration (>or=0.5 mg/dL [>or=44 micromol/L]). Results were combined on the risk ratio scale. Random-effects models were used. Sensitivity analyses were performed to evaluate the effects of extracorporeal blood purification modality, study design, and sample size. RESULTS: Eight trials (6 randomized controlled trials, 2 nonrandomized trials) were included in the analysis (pooled sample size, 412). Six trials assessed hemodialysis, whereas 1 trial each assessed continuous venovenous hemofiltration and continuous venovenous hemodiafiltration. The incidence of RCIN was 35.2% in the standard-medical-therapy group and 27.8% in the extracorporeal-blood-purification group. Extracorporeal blood purification did not decrease the incidence of RCIN significantly compared with standard medical therapy (risk ratio, 0.97; 95% confidence interval, 0.44 to 2.14); however, intertrial heterogeneity was high. Limiting analysis to only randomized trials did not eliminate heterogeneity, but limiting analysis to only hemodialysis trials did. Periprocedural hemodialysis did not decrease the incidence of RCIN. CONCLUSION: This critical analysis of the published literature suggests that periprocedural extracorporeal blood purification does not decrease the incidence of RCIN compared with standard medical therapy.