Glomerulopatí del trasplante. Resultados clínicos y seguimiento de casos.

OBJECTIVE: We describe the evolution of graft function in patients with transplant glomerulopathy measure by levels of serum creatinine, proteinuria and estimated glomerular filtration rate. METHOD: Cross-sectional study conducted in the Regional General Hospital No. 46 IMSS. Included patients with kidney allograft and diagnosis of renal biopsy of transplant glomerulopathy grafting between January 1, 2006 to April 31, 2013 serum creatinine, proteinuria and estimated glomerular filtration rate at diagnosis, 6, 12 and 24 was recorded months. The results are shown with numbers, percentages and standard deviations. RESULTS: 42 patients were included. At 6 months of diagnosis, 14% decline in graft function and 7.1% graft loss. At 12 months, 17.9% graft loss, and at 24 months 36.3% had chronic graft dysfunction and graft loss as return to dialysis. CONCLUSIONS: Evolution in our patients seems to be better to other series of cases reported in the literature.

Cost-minimization study comparing annual infusion of zoledronic acid or weekly oral alendronate in women with low bone mineral density.

Cost-minimization study to assess the annual direct costs of 2 antiresorptive strategies in postmenopausal women with low bone mineral densities (BMDs). Patients were randomly assigned to receive 70 mg of oral weekly alendronate or a 1-time 5mg of intravenous zoledronic acid. All medical and nonmedical direct costs were recorded for 1 yr. Student's t-test or the Chi-squared test was used. A total of 101 postmenopausal women were enrolled with a mean age of 58.3 ± 7.6 yr and a postmenopausal period of 13.5 ± 8.3 yr. A total of 50 patients completed 1 yr of alendronate and 51 patients received zoledronic acid. At baseline, no differences were seen between the 2 groups in anthropometric measures, comorbidities, and bone mineral density. The costs for medical attention for low bone mass were $81,532 (US Dollars) for the alendronate group and $69,251 for the zoledronic acid group; the cost per patient was $1631 in the alendronate group vs $1358 in the zoledronic acid group (p<0.0001). Therefore, zoledronic acid treatment provided an annual savings of 15% of the direct costs compared with oral alendronate treatment. Moreover, there was a significant increase in lumbar spine T-scores in the zoledronic acid group when compared with the alendronate group. Annual zoledronic acid infusion as an antiresorptive treatment in women with low BMD provides significant monetary savings when compared with weekly alendronate therapy for 1 yr. Zoledronic acid infusion is also linked to higher increase in BMD and compliance.

[Infections due to Kocuria kristinae: case reports of two patients and review of the literature]. / Infecciones asociadas a Kocuria kristinae: presentación de dos casos y revisión de la literatura.

Kocuria kristinae is a gram-positive coccus of the family of Micrococcaceae. It inhabits the skin and mucous and human oropharynx and some mammals. Clinical cases of proven infections are scarce, affecting patients with indwelling devices and severe underlying diseases. We report two unusual case of a K. kristinae infection in a hemodialysis. First is a case of bacteremia associated with permanent hemodialysis catheter in a 20-year-old female; and second is a case of acute peritonitis in a 68-year-old male patient on continuous ambulatory peritoneal dialysis. A review of other reported K. kristinae infections is provided.

[Epidemiology of glomerular disease in adults: a database review]. / Epidemiología de la enfermedad glomerular en adultos. Revisión de una base de datos.

INTRODUCTION: Glomerular disease is among the top ten leading causes of death in Mexico. AIM: To assess the frequency of glomerulopathy in western Mexico in a Regional Hospital belonging of the Instituto Mexicano Del Seguro Social. METHODS: Single hospital center retrospective analysis. We reviewed all native kidney biopsies between January 2003 and December 2011, in patients more than 16 years old, to establish clinical features, presentation, and histological report. RESULTS: A total of 163 reports were analyzed; patients with a mean age of 32.6 ± 13.3 years, 55% female, 24% had systemic arterial hypertension, and 10% with a family history of chronic renal failure. The most frequent types of primary glomerulonephritis were focal segmental glomerulosclerosis (FSGS) in 47% of cases, followed by membranous nephropathy in 15%. The most frequent types of secondary glomerulonephritis were lupus nephritis in 14%, followed by diabetic nephropathy in 4% and amyloidosis in 1.2%. CONCLUSION: Focal segmental glomerulosclerosis is the most frequent type of glomerulopathy in our population; we observed a minor percentage of Inmunoglobulin A (IgA) nephropathy compared with worldwide reports. This information is a contribution to the understanding of the prevalence of glomerulopathy in western Mexico.

[Frequency of peritoneal transport in a population of the Hospital General Regional No. 46, Instituto Mexicano del Seguro Social]. / Frecuencia de los tipos de transporte peritoneal en la población del Hospital General Regional N.º 46 del Instituto Mexicano del Seguro Social.

BACKGROUND: The peritoneal equilibration test (PET) is a common test used in the adequacy of peritoneal dialysis (PD). AIM: To determine the frequency of presentation of different types of peritoneal transport in patients on PD ranking with Twardowski, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) and Hospital de Especialidades del Instituto Mexicano del Seguro Social Centro Médico Nacional de Occidente (IMSS-HE, CMNO) and establish themselves. METHODS: Descriptive and transversal study. Included with PET on PD patients between April 2011 to September 2012; any gender, 16 years or older, in DP minimum of 4 weeks. PEP performed standardized bags of 2.5%. RESULTS: Performed 235 PET. We can classify peritoneal transport with Twardowski in high (H) 34%, high average (HA) 37%, low average (LA) 25%, and low (L) 4% peritoneal transport rates. INCMNSZ percentages H was 34%, HA 32%, LA 23%, and L 11%; using the CMNO HE was H 26%, HA 31%, LA 31%, and L 12%. From our data, the percentage of patients with H was 22%, HA 33%, LA 32%, and L13%. CONCLUSION: Classifying patients according to type of transport with Twardowski will under-diagnose the low and overestimate high transport, and can alter survival forecasts.

Association of neutrophil/lymphocyte and platelet/lymphocyte ratios with inflammation and survival in Mexican patients on chronic hemodialysis.

INTRODUCTION: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are markers of systemic inflammatory status. The relationship between NLR, PLR, and mortality is controversial among hemodialysis (HD) patients. OBJECTIVE: Evaluate NLR and PLR in the prediction of mortality in chronic HD patients. MATERIALS AND METHODS: We analyzed 130 patients with a follow-up for 66 months. Four groups were established according to NLR-PLR values. Kaplan-Meier curves and Cox proportional hazards analysis were used. RESULTS: NLR-PLR correlated positively with C-reactive protein. Cox regression analysis for overall mortality among the four groups included age (HR 1.027, 95% CI 1.003-1.053) and albumin (HR 0.25, 95% CI 0.073-0.85). For cardiovascular (CV) mortality only pulse pressure differential (PPD) was included (HR 1.033; 95% CI 1.014-1.052). Low NLRs and high PLRs were associated with CV mortality (Log Rank test, p = 0.033). CONCLUSIONS: Low NLRs and high PLRs predict the risk of CV mortality among HD patients.

Idiopathic granulomatous orchitis: A case study.

Idiopathic granulomatous orchitis (IGO) is a rare inflammatory disorder of unknown etiology affecting the testis. Presented here is the case of a young patient who developed IGO, potentially associated with an anti-sperm antibody-mediated autoimmune response.

C4d expression in focal segmental glomerulosclerosis.

BACKGROUND: There is a little information about of expression of C4d (complement fragment) in Focal segmental glomerulosclerosis (FSGS) subtypes. Our aim was to determine the expression of C4d in FSGS subtypes in percutaneous native renal biopsies in a second-level hospital and its correlation with clinical, biochemical and histological variables. MATERIAL AND METHODS: A retrospective study in paraffin blocks of patients with biopsy with FSGS aged 16-65 years, indistinct sex, not diabetic or obese. Immunohistochemistry was performed for C4d and their expression was analyzing in non-sclerosed glomerular capillaries (GC) and sclerosis areas (SA). Clinical and biochemical variables were recorded. The cases were divided into C4d positive and C4d negative groups and compared. The correlation between C4d staining scores in CG and SA with clinical and biochemical variables were analyzed. RESULTS: Twenty samples were analyzed, 4 for each subtype. At the time of biopsy average age 38.8 ±â€¯18.6 years, 65% male, 8.7% were hypertension. The percentage of positivity for C4d was 40% in GC, 30% SA and 35% in mesangium. The highest expression was for cellular and collapsing subtypes. C4d positivity cases had increased proteinuria (p = 0.035). A significant correlation was found between percentage of C4d expression in CG with SA (p = 0.012) and SA with tubular atrophy and interstitial fibrosis (p < 0.05). CONCLUSIONS: C4d expression in FSGS predominated in the cellular and collapsing subtypes, which translates complement activation. C4d is a possible surrogate marker in GSFS.

Prevalence of chronic venous disease in health staff and its impact on quality of life at 6 months.

OBJECTIVE: To determine the frequency and stages of chronic venous disease (CVD) in health staff and its impact on the quality of life. METHOD: Cross-sectional study on health workers, between the ages of 20 and 60, indistinct gender, to remain standing position ≥6.5 hours per day for at least 5 days a week. Socio demographic variables were recorded. The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) scale was used to stage the CVD; to measure the quality of life, the CIVIQ-20 (Chronic Venous Insufficiency Questionnaire) survey was applied at baseline, at 3 and 6 months. All patients underwent detailed clinical examination followed by color Doppler ultrasound and angiology review. RESULTS: Included 37 patients, 62.1% woman. Average age was 36.6 ± 8.8 years. By CEAP the 78.3% of the patients presented CVD and the highest prevalence was C1; corroborating by Doppler ultrasound only in 29.7% of the patients. The predominant symptoms were night cramps (54.5%). CONCLUSION: The frequency of CVD is like the literature. Patients with chronic venous disease have poor quality of life which improves with treatment.

OBJETIVO: Determinar la frecuencia y estadios de la enfermedad venosa crónica (EVC) en personal de salud y su impacto en calidad de vida. MATERIAL Y MÉTODOS: Estudio transversal en trabajadores de la salud, edad de 20 a 60 años, sexo indistinto, con bipedestación ≥ 6.5 horas/día por al menos 5 días a la semana. Se registraron variables sociodemográficas. La EVC se estadifico con la escala CEAP (Clinical-Etiology-Anatomy-Pathophysiology); la calidad de vida se midió basal, a 3 y 6 meses con la encuesta CIVIQ-20 (Chronic Venous Insufficiency Questionnaire 20). Además, se realizó examen clínico, ultrasonido Doppler y valoración por angiología. RESULTADOS: Incluyó 37 participantes, el 62.1% mujeres, edad promedio 36.6 ± 8.8 años. Acorde a la CEAP el 78.3% de los pacientes presentaron EVC (prevalencia mayor de C1). Se corroboró por ultrasonido Doppler en el 29.7%. El 54.5% presentaba calambres nocturnos. CONCLUSIONES: La frecuencia de EVC en personal de salud es similar a la reportada en la literatura; los individuos con EVC tienen mala calidad de vida.

Acute Kidney Injury in COVID-19 Patients: Pathogenesis, Clinical Characteristics, Therapy, and Mortality.

Coronavirus disease 2019 (COVID-19) is a disease caused by infection with the SARS-CoV-2 virus and has represented one of the greatest challenges humanity has faced in recent years. The virus can infect a large number of organs, including the lungs and upper respiratory tract, brain, liver, kidneys, and intestines, among many others. Although the greatest damage occurs in the lungs, the kidneys are not exempt, and acute kidney injury (AKI) can occur in patients with COVID-19. Indeed, AKI is one of the most frequent and serious organic complications of COVID-19. The incidence of COVID-19 AKI varies widely, and the exact mechanisms of how the virus damages the kidney are still unknown. For this reason, the purpose of this review was to assess current findings on the pathogenesis, clinical features, therapy, and mortality of COVID-19 AKI.

What do we know about the antibody responses to SARS-CoV-2?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a pandemic with millions of infected people and deaths. Currently, the scientific community is working hard to develop a specific vaccine or treatment. However, since antibody production is an important part of the adaptive immune response, to develop vaccines and therapies, we must understand the antibody response to SARS-CoV-2 infection. In this work, we summarize the most important findings of antibody-mediated immunity against SARS-CoV-2 and highlight its role in the efficient use of plasma from convalescent patients and the direct application of antibodies as treatment.

[Acute bilateral thalamic infarcts in a young man with patent foramen ovale]. / Infarto agudo talámico bilateral en paciente joven con foramen oval permeable.

BACKGROUND: Patent foramen ovale (PFO) has been associated with cryptogenic stroke in young patients. CLINICAL CASE: A 27-year-old man presented with acute confusional syndrome, altered language, bradypsychia and somnolence. Brain MRI showed symmetrical bilateral thalamic infarctions probably due to occlusion of Percheron's artery type 2b. Echocardiography showed patent foramen ovale. CONCLUSIONS: Cerebrovascular disease is a frequent cause of disability and even death in young patients, and thus its medical approach should be emphasized.

[Bacterial drug resistance and etiology of non-complicated urinary tract infections]. / Patrones de resistencia antimicrobiana y etiología en infecciones urinarias no complicadas.

INTRODUCTION: Bacterial resistance to antibiotics is associated with morbidity, mortality, and an increase in cost. Our objective was to assess bacterial resistance from cultures of patients with non-complicated urinary tract infection (UTI). METHODS: We analyzed antibiotic resistance using the VITEK-II system among patients attending the internal medicine unit with non-complicated UTI. RESULTS: 1,479 urine cultures were performed; we excluded: 98 due to contamination, 924 had no bacterial growth, and 57 had missing data. Among the 404 samples that were positive, 240 were found among out patients and 164 among hospitalized patients. E coli were the most frequent pathogen, followed by Enterococcus, and K pneumonia, in out patients; E coli, P aeruginosa, and fungal infections (23% of cases) in hospitalized patients. Samples with E coli among out patients displayed resistance of 50% to fluoroquinolones and 55% to sulfas. Among hospitalized patients, resistance was observed in 71 and 66% respectively. Resistance to P aeruginosa was 38% for amynoglucosides and carbapenems and 100% for piperacillin; Enterococcus had 50% for fluoroquinolones. CONCLUSION: E. coli is the most common pathogen among UTI patients. We must adapt guidelines to recommend antibiotics and design a comprehensive control program to reduce the high levels of bacterial antibiotic resistance among our population.

Impact of caregiver's burden of peritoneal dialysis patients / Impacto de la sobrecarga de los cuidadores de pacientes en diálisis peritoneal

BACKGROUND: Peritoneal dialysis (PD) requires the support of a main caregiver, who can be subjected to an intense workload, and is susceptible to physical, psychological and social alterations. OBJECTIVE: To determine the prevalence of burden in primary informal caregivers of PD patients, the associated factors and their impact on patients at 12 months. MATERIAL AND MEHOTDS: 180 caregivers were included, with an average age of 42.8 ± 13.9 years, 73.3% were women. The Zarit survey was applied to assess the degree of caregiver overload. RESULTS: We identified that the majority of caregivers do not present overload; however, there is a greater burden in patients with continuous ambulatory PD (CAPD), with higher overall mortality in the group with severe burden (p < 0.05). Linear regression showed an association between hours of patient care, occupation, dialysis modality, and schooling with the presence of caregiver overload (p < 0.05). CONCLUSIONS: The burden presented by the caregiver is similar to that reported in the literature. CAPD patients whose family member has severe burden show higher global mortality at 12 months.

ANTECEDENTES: La diálisis peritoneal (DP) requiere el apoyo de un cuidador principal, quien puede verse sometido a una intensa carga de trabajo y es susceptible de presentar alteraciones físicas, psicológicas y sociales. OBJETIVO: Determinar la prevalencia de sobrecarga en cuidadores informales primarios de pacientes en DP, los factores asociados y su impacto en los pacientes a 12 meses. MATERIAL Y MÉTODOS: Se incluyeron 180 cuidadores, con una edad promedio de 42.8 ± 13.9 años, y el 73.3% eran mujeres. Se aplicó la encuesta Zarit para valorar el grado de sobrecarga del cuidador. RESULTADOS: Se identifica que la mayoría de los cuidadores no presenta sobrecarga; sin embargo, existe mayor sobrecarga en pacientes con DP continua ambulatoria (DPCA), con mayor mortalidad global en el grupo con sobrecarga intensa (p < 0.05). La regresión lineal mostró asociación entre las horas al cuidado del paciente, la ocupación, la modalidad de diálisis y la escolaridad con la presencia de sobrecarga del cuidador (p < 0.05). CONCLUSIONES: La sobrecarga que presenta el cuidador es similar a lo reportado en la literatura. Los pacientes en DPCA cuyo familiar tiene sobrecarga intensa presentan mayor mortalidad global a 12 meses.

Coexistence of emphysematous cystitis and bilateral emphysematous pyelonephritis: a case report and review of the literature.

Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. We report a rare case of a 56-year-old diabetic male suffering from fever, headache and vomiting and in which a diagnosis of septic shock was established due to coexistence of EC and bilateral EPN. The emphysematous diseases improved with a conservative treatment approach using antibiotic therapy and glycemic control, we highlight that the nephrectomy was not necessary in our patient despite the fact that he presented risk factors that predict the failure of conservative treatment.

Prevalence of malnutrition-inflammation complex syndrome and its correlation with thyroid hormones in chronic haemodialysis patients. / Prevalencia del síndrome complejo de malnutrición e inflamación y su correlación con las hormonas tiroideas en pacientes en hemodiálisis crónica.

INTRODUCTION: Low levels of thyroid hormones, total triiodothyronine (T3) and free triiodothyronine (FT3) in haemodialysis patients is a marker of malnutrition and inflammation and are predictors of mortality. The aim of this study was to determine the prevalence of malnutrition-inflammation complex syndrome in haemodialysis and its relationship with the thyroid hormones thyrotropin, T3, FT3 and free thyroxine (FT4), as well as to evaluate the prevalence of low FT3 syndrome and its correlation with nutritional and inflammatory markers. MATERIALS AND METHODS: Cross-sectional, analytical and comparative study that enrolled 128 haemodialysis patients: 50.8% females; mean age 45.05±17.01 years; mean time on haemodialysis 45.4±38.8 months; 29.7% diabetics; 79.7% with hypertension. Serum thyroid hormones thyrotropin, T3, FT3 and FT4 concentrations were measured and Malnutritition-Inflammation Score (MIS) was applie to diagnostic. RESULTS: Mean thyroid hormone values were: thyroid hormones thyrotropin 2.48±1.8 mIU/ml (range: 0.015-9.5), T3 1.18±0.39 ng/ml (range 0.67-2.64), FT3 5.21±0.96pmol/l (range: 3.47-9.75); FT4 1.35±0.4 ng/ml (range: 0.52-2.57). Malnutrition-inflammation complex syndrome prevalence was 53.9%; 11.7% presented low FT3 levels. Serum T3 and FT3 concentrations inversely correlated with Malnutritition-Inflammation Score (MIS), while FT4 correlated positively with Malnutrition-Inflammation Score. In the linear regression analysis, low FT3 was associated with IL-6 (ß= 0.265, p=.031), C-reactive protein (CRP) (ß= -0.313, p=.018) and albumin (ß= 0.276, p=.002). CONCLUSION: Low T3 and FT3 levels are correlated with malnutrition and inflammation parameters. Malnutrition-inflammation complex syndrome can affect serum concentrations of thyroid hormones.

Learning of nature: The curious case of the naked mole rat.

Naked mole rats (NMRs) are the longest-living rodents known, living up to approximately 30 years and showing sustained good health. Nowadays, NMRs are considered excellent models for aging and, additionally, for cancer research, due to the evidence of a remarkable cancer resistance demonstrated through thousands of necropsies performed with very few cases that describe this pathology, which is believed to be a disease that unavoidably accompanies aging. Since some years ago, several studies have tried to explain the possible mechanisms underlying longevity and cancer resistance in NMRs through different perspectives and directions, creating new knowledge that subsequently could be used for cancer prevention and delaying aging in humans. Thus, the purpose of this review is to summarize the recent knowledge on naked mole rats with a particular emphasis on the molecular mechanisms associated with their longevity and cancer resistance.

FLT3-ITD and its current role in acute myeloid leukaemia.

FMS-like tyrosine kinase 3 (FLT3) is a proto-oncogene involved in crucial steps of haematopoiesis such as proliferation, differentiation and survival. In recent years, FLT3 has been an important marker in different haematological malignancies, highlighting in acute myeloid leukaemia, where FLT3 mutations have been associated with the clinical prognosis, treatment and survival of patients. The most common form of FLT3 mutation is an internal tandem duplication (ITD) that promotes ligand-independent auto-phosphorylation and constitutive activation of the receptor. FLT3-ITD has been strongly associated with a bad prognosis, leukocytosis, high blast counts, increased risk of relapse and shorter overall survival. In order to improve the clinical condition of FLT3-ITD-positive patients, several FLT3 inhibitors have been developed showing variable results. Currently, the main challenges to be overcome are the different forms of resistance to FLT3 inhibitors. Thus, the purpose of this review is to present, in a general way, the current role that FLT3-ITD mutation plays in patients with AML, with a particular emphasis on the molecular mechanisms associated with clinical prognosis, treatment, and survival of patients.