The Major Histocompatibility Complex in Transplantation

The transplant of organs is one of the greatest therapeutic achievements of the twentieth century. In organ transplantation, the adaptive immunity is considered the main response exerted to the transplanted tissue, since the principal target of the immune response is the MHC (major histocompatibility complex) molecules expressed on the surface of donor cells. However, we should not forget that the innate and adaptive immunities are closely interrelated and should be viewed as complementary and cooperating. When a human transplant is performed, HLA (human leukocyte antigens) molecules from a donor are recognized by the recipient's immune system triggering an alloimmune response Matching of donor and recipient for MHC antigens has been shown to have a significant positive effect on graft acceptance. This paper will present MHC, the innate and adaptive immunities, and clinical HLA testing

Dieta elemental vs caseinato de calcio en el manejo del paciente con pérdida de peso e infección por VIH

Tesis (Maestría en Ciencias en Investigación Clínica), Instituto Politécnico Nacional, SEPI, ESM, 2007, 1 archivo PDF, (92 páginas). tesis.ipn.m

Inducción de péptidos antimicrobianos en epitelio de vías respiratorias

Antecedentes. El epitelio respiratorio produce péptidos antimicrobianos (PAMs), que previenen la colonización por una amplia diversidad de patógeno. La β-defensina 2 humana (hBD-2) y la Catelicidina son los PAMs major documentados en humanos. Diferentes moléculas bacterianas y el colecalciferol han sido implicados su producción. Objetivo. Inducir la producción de hBD-2 y catelicidina después de la estimulación del epitelio respiratorio con bacterias inactivadas y colecalciferol. Métodos. Primero se realizó un estudio in vitro, estimulando células A-549 con bacterias inactivadas y colecalciferol. En un segundo estudio, esta vez con un modelo in vivo, se realizaron lavados nasales a 12 voluntarios sanos, en condiciones basales, y posterior a un reto nasal, donde por separado se estimuló con bacterias inactivadas (20 millones), colecalciferol (400 IU), mezcla de bacterias inactivada y colecalciferol, o con un placebo que contenía solución salina isotónica y glicerol. Finalmente se realizó inmunohistoquímica en biopsias nasales, después de la estimulación por 48 h con bacterias inactivadas, para identificar la presencia y localización de hBD-2. Resultados. No se detectó hBD-2 o catelicidina por ELISA en el sobrenadante del cultivo de células A-549, después de ser estimuladas con bacterias inactivadas y/o colecalciferol. Se detectaron niveles elevados de hBD-2 (4668.99 ± 2829.33 pg/ml) por ELISA, en el liquido de lavado nasal, posterior al reto con bacterias inactivadas. De manera interesante, cuando se aplicó una prueba t de student para muestras dependientes, se encontró que los valores de hBD-2 se incrementaban aún más, al estimular con la mezcla de bacterias inactivadas y colecalciferol (p=0.013). No se detectó hBD-2 posterior al reto nasal con colecalciferol solo, ni posterior al reto con el placebo. Por medio de inmunohistoquímica fue posible localizar a la hBD-2 en el epitelio. Conclusiones. la hBD-2 puede ser inducida en el epitelio nasal, tras la estimulación con bacterias inactivadas. El colecalficerol podría tener un efecto sinergistico con las bacterias inactivadas, en la producción de hBD-2, al menos en el epitelio nasal. La estimulación de la inmunidad innata para producir hBD-2, podría ser utilizada para prevenir e inclusive tratar infecciones causadas por patógenos respiratorios

The Major Histocompatibility Complex in Transplantation

The transplant of organs is one of the greatest therapeutic achievements of the twentieth century. In organ transplantation, the adaptive immunity is considered the main response exerted to the transplanted tissue, since the principal target of the immune response is the MHC (major histocompatibility complex) molecules expressed on the surface of donor cells. However, we should not forget that the innate and adaptive immunities are closely interrelated and should be viewed as complementary and cooperating. When a human transplant is performed, HLA (human leukocyte antigens) molecules from a donor are recognized by the recipient's immune system triggering an alloimmune response Matching of donor and recipient for MHC antigens has been shown to have a significant positive effect on graft acceptance. This paper will present MHC, the innate and adaptive immunities, and clinical HLA testing

Quality of Life and Persistence of Symptoms in Outpatients after Recovery from COVID-19

Background and Objectives: Patients infected with SARS-CoV-2 can have persistent symptoms after acute illness, which affects their quality of life (QoL). Research and data about this topic in Latin American ambulatory patients are scarce. Materials and Methods: We conducted an observational, prospective, transversal, and analytical study. To measure QoL, we used a validated Spanish version of the MOS/RAND 36-Item Short Form Health Survey (SF-36). Results: We included 206 outpatients in the study. A total of 73.3% patients had persistence of one or more symptoms. The most frequent persistent symptoms were fatigue (36.9%), anxiety (26.2%), and headache (24.8%). No statistically significant difference in the SF-36 QoL scores and the frequency of persistent COVID-19 symptoms was found when comparing the ≤5 and >5 months groups, except for myalgia, which was less frequently observed in the >5 months group after COVID-19 (26.2% vs. 14.1%, p Conclusion: Most outpatients had persistent COVID-19 symptoms after infection. Persistence of symptoms was associated with poor MCS and PCS. It is important to follow-up not only patients discharged from the hospital after SARS-CoV-2 infection, but also those under ambulatory management to provide them with rehabilitation and psychological therapy to improve their QoL

Primary Immunodeficiency Diseases at Reference and High-Specialty Hospitals in the State of Guanajuato, Mexico

Background. In general, primary immunodeficiency diseases (PIDs) are underdiagnosed in most countries. The objective of this study was to describe the frequency and clinical spectrum of PID in the most important tertiary hospitals in our region. Methods. An observational, cross-sectional, with retrospective chart, review study was conducted. A total of 26 patients were included and grouped according to the updated classification of PIDs. Results. PIDs spectra were as follows: predominantly antibody deficiency diseases were the most common category (65.38%), followed by other well-defined immunodeficiency syndromes (11.55%), congenital defects of phagocyte number and/or function (7.69%), complement deficiencies (3.85%), combined T- and B-cell immunodeficiencies (3.85%), and defects in innate immunity (3.85%). The mean time elapsed from the onset of symptoms to the reference and diagnosis by a tertiary hospital was of 4.65 ± 6.95 years. Conclusions. Predominant antibody deficiency disease was the most common group of PIDs, agreeing with international reports. Awareness of underdiagnosis by physicians is crucial for a prompt diagnosis and treatment, which in turn should improve the quality of life among patients with PIDs

Diagnostic Accuracy of the RDW for Predicting Death in COVID-19

Background and Objectives: An association between high red blood cell distribution width (RDW) and mortality has been found in several diseases, including infection and sepsis. Some studies have aimed at determining the association of elevated RDW with adverse prognosis in COVID-19, but its usefulness has not been well established. The objective of this study was to determine the accuracy of the RDW, measured at hospital admission and discharge, for predicting death in patients with COVID-19. Materials andMethods: An observational, retrospective, longitudinal, and analytical study was conducted in two different COVID-19 reference centers in the state of Guanajuato, Mexico. A total of 323 patients hospitalized by COVID-19 were included. Results: We found higher RDW levels at the time of hospital admission in the non-survivors group compared to levels in survivors (median = 13.6 vs. 13.0, p < 0.001). Final RDW levels were even higher in the deceased group when compared with those of survivors (median = 14.6 [IQR, 12.67–15.6] vs. 12.9 [IQR, 12.2–13.5], p < 0.001). For patients who died, an RDW > 14.5% was more common at the time of death than for patients who survived at the time of discharge (81 vs. 13 patients, p < 0.001; RR = 2.3, 95% CI 1.89–2.81). Conclusions: The RDW is an accessible and economical parameter that, together with other characteristics of the presentation and evolution of patients with COVID-19, can be helpful in determining the prognosis. An RDW that increases during hospitalization could be a more important mortality predictor than the RDW at hospital admission

Disease burden for patients with primary immunodeficiency diseases identified at reference hospitals in Guanajuato, Mexico.

In addition to the deleterious effect on health, there is considerable economic and psychosocial morbidity associated with primary immunodeficiency diseases (PID). Also, the cost of a late diagnosis frequently results in a heavy disease burden on the patient. The objective of this study was to collect and analyze data on patients with PID in the state of Guanajuato in Mexico, to indirectly estimate the burden of the disease.An observational, longitudinal, and comparative study was conducted. A total of 44 patients were included and grouped according to the updated classification of PID.The median time elapsed from the onset of symptoms to the reference and diagnosis by a tertiary hospital was of 2.17 (IQR = 6.44) years. Before diagnosis, the number of hospitalizations/year per patient was 0.86 (IQR = 2.28), the number of visit to emergency room/year per patient was 0.92 (IQR = 1.77), the number of doctor's visits/year per patient was 15 (IQR = 11.25), whereas the school/work absence days per patient were reported in 52.72 (IQR = 56.35) days per year. After diagnosis, 20 patients (45.45%) received IVIG replacement therapy, and all of them presented a significant improvement (p <0.05) in all the mentioned variables. Characteristically, even when patients with PID received IVIG, there was still an important disease burden when comparing them against healthy controls. Complications secondary to PID were detected in 19 patients (43.18%). The reported overall mortality rate was 6.82% (n = 3).We were able to indirectly estimate an important disease burden in patients with PID; which is considered to be preventable, at least in part, with effective interventions like health planning, research, collaboration with primary care providers, and generation of policies and practices, in order to improve the quality of life and care of families with PID

Disease burden in PID at reference hospitals in Guanajuato, Mexico.

<p>Disease burden in PID at reference hospitals in Guanajuato, Mexico.</p