Strongyloides stercoralis; relato do caso em pós-transplante renal

Hyperinfection strongyloidiasis is a pretty uncommon disease within immunocompetent individuals but it can affect immunosuppressed patients like post renal transplantation and that is because it is important to review the literature about it. In this article, we will write about the case report of a transplanted patient who developed hyperinfection strongyloidiasis after started the Immunosuppressive Therapy. This patient was diagnosed and treated successfully.La hiperinfección por Strongyloides spp (HS) es una enfermedad rara dentro de la población inmunocompetente, pero puede presentarse en pacientes inmunocomprometidos como los pacientes trasplantados renales por lo que al realizar un análisis de la literatura actual acerca del tema se hace importante. En el presente artículo presentamos el caso clínico de un paciente trasplantado renal que después de iniciar la terapia inmunosupresora, presenta síntomas y signos de HS, diagnosticado y tratado de forma exitosa. Hiperinfecção a forteoidilidíase é uma doença bastante incomum em indivíduos imunocompetentes, mas pode afetar pacientes imunossuprimidos, como transplante pós-renal, e é porque é importante revisar a literatura sobre isso. Neste artigo, iremos escrever sobre o relato de caso de um paciente transplantado que desenvolveu hiperinfecção da solidioclíase após o início da terapia imunossupressora. Este paciente foi diagnosticado e tratado com êxito

Nefrectomía laparoscópica en un programa de donante vivo en la Costa Caribe de Colombia

Laparoscopic nephrectomy in living donor is the best option during the process of kidney transplantation for patients with end-stage chronic renal failure. The aim of this article is to describe the experience in a kidney living donor program since 2013 to 2018 at “Colombiana de Trasplantes” in the Colombian Caribbean region. A descriptive study was performed in which a consecutive sample of 55 living donors operated in “Colombiana de Trasplantes” since January 2013 to January 2018. Statistical analysis was done on the relevant variables. The mean of the age was 41 years. 57.4% of the living donors were female. Surgical time had mean time of 1.9 hours. None of the donors died after 6 months follow-up and the mean time of postoperative stay was 2 days. Important variables and main outcomes in living donors are similar to what is shown by other groups. However, there are specific characteristics that could help to improve health strategies in the Caribbean Region.La nefrectomía laparoscópica en donante vivo es la mejor opción en el proceso del trasplante para pacientes con enfermedad renal crónica en estadio cuatro y cinco. El objetivo del artículo es describir la experiencia en el programa de donante vivo de riñón entre el 2013 y el 2018 en Colombiana de Trasplantes en la costa Caribe colombiana. Se realizó un estudio descriptivo que incluyó una muestra consecutiva de 55 donantes vivos de riñón operados por Colombiana de Trasplantes, entre enero de 2013 y enero de 2018; se llevó a cabo el análisis estadístico de las variables relevantes. La media de la edad fue de 41 años. El 57,4% de los donantes fueron mujeres. El tiempo de cirugía tuvo una media de 1,9 horas. Ninguno de los pacientes falleció en el seguimiento a los seis meses y el promedio de la estancia hospitalaria posterior a la cirugía fue de dos días. Las variables relevantes y los desenlaces de los pacientes son similares a los de otros grupos de trasplantes, sin embargo, hay características específicas que pueden ayudar a mejorar las estrategias en salud en la costa Caribe colombiana

Critical appraisal on the use of everolimus in renal transplantation as an immunosuppressant to prevent organ transplant rejection

Fernando Giron, Yenny BaezKidney Transplant Service, Colombiana de Trasplantes, Bogota, ColombiaAbstract: Everolimus is a proliferation inhibitor designed to target chronic allograft nephropathy including prevention of acute rejection. Acute renal allograft rejection incidence varies with the therapy used for immunosuppression. Registry data show that 15% to 35% of kidney recipients will undergo treatment for at least one episode of acute rejection within the first post-transplant year. Everolimus has been used as therapy with full- or reduced-dose cyclosporine A without evidence of increasing the acute rejection incidence. This review will summarize the available clinical trial data on the use of everolimus and its role in preventing acute rejection incidence in renal transplantation.Keywords: calcineurin inhibitors, cyclosporine, everolimus, biopsy-proven acute rejection, renal transplantation, acute rejectio

Strongyloides stercoralis; reporte de un caso en el post-trasplante renal

Hyperinfection strongyloidiasis is a pretty uncommon disease within immunocompetent individuals but it can affect immunosuppressed patients like post renal transplantation and that is because it is important to review the literature about it. In this article, we will write about the case report of a transplanted patient who developed hyperinfection strongyloidiasis after started the Immunosuppressive Therapy. This patient was diagnosed and treated successfully.Hiperinfecção a forteoidilidíase é uma doença bastante incomum em indivíduos imunocompetentes, mas pode afetar pacientes imunossuprimidos, como transplante pós-renal, e é porque é importante revisar a literatura sobre isso. Neste artigo, iremos escrever sobre o relato de caso de um paciente transplantado que desenvolveu hiperinfecção da solidioclíase após o início da terapia imunossupressora. Este paciente foi diagnosticado e tratado com êxito.La hiperinfección por Strongyloides spp (HS) es una enfermedad rara dentro de la población inmunocompetente, pero puede presentarse en pacientes inmunocomprometidos como los pacientes trasplantados renales por lo que al realizar un análisis de la literatura actual acerca del tema se hace importante. En el presente artículo presentamos el caso clínico de un paciente trasplantado renal que después de iniciar la terapia inmunosupresora, presenta síntomas y signos de HS, diagnosticado y tratado de forma exitosa.

Nefrectomía laparoscópica en un programa de donante vivo en la Costa Caribe de Colombia

Laparoscopic nephrectomy in living donor is the best option during the process of kidney transplantation for patients with end-stage chronic renal failure. The aim of this article is to describe the experience in a kidney living donor program since 2013 to 2018 at “Colombiana de Trasplantes” in the Colombian Caribbean region. A descriptive study was performed in which a consecutive sample of 55 living donors operated in “Colombiana de Trasplantes” since January 2013 to January 2018. Statistical analysis was done on the relevant variables. The mean of the age was 41 years. 57.4% of the living donors were female. Surgical time had mean time of 1.9 hours. None of the donors died after 6 months follow-up and the mean time of postoperative stay was 2 days. Important variables and main outcomes in living donors are similar to what is shown by other groups. However, there are specific characteristics that could help to improve health strategies in the Caribbean Region.La nefrectomía laparoscópica en donante vivo es la mejor opción en el proceso del trasplante para pacientes con enfermedad renal crónica en estadio cuatro y cinco. El objetivo del artículo es describir la experiencia en el programa de donante vivo de riñón entre el 2013 y el 2018 en Colombiana de Trasplantes en la costa Caribe colombiana. Se realizó un estudio descriptivo que incluyó una muestra consecutiva de 55 donantes vivos de riñón operados por Colombiana de Trasplantes, entre enero de 2013 y enero de 2018; se llevó a cabo el análisis estadístico de las variables relevantes. La media de la edad fue de 41 años. El 57,4% de los donantes fueron mujeres. El tiempo de cirugía tuvo una media de 1,9 horas. Ninguno de los pacientes falleció en el seguimiento a los seis meses y el promedio de la estancia hospitalaria posterior a la cirugía fue de dos días. Las variables relevantes y los desenlaces de los pacientes son similares a los de otros grupos de trasplantes, sin embargo, hay características específicas que pueden ayudar a mejorar las estrategias en salud en la costa Caribe colombiana

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)