Trasplante renal en pacientes con infección por virus de la inmunodeficiencia humana (VIH)

El pronóstico de la infección por VIH ha mejorado tras introducir el tratamiento antirretroviral de gran actividad (TARGA), no contraindicando actualmente el trasplante renal (TR). La nefropatía asociada al VIH (HIVAN) es la principal causa de enfermedad crónica terminal (ERCT) en pacientes VIH a nivel mundial. Los criterios de inclusión para TR de pacientes VIH son multidisciplinares: no infecciones oportunistas; CD4>200; carga viral indetectable. Material y métodos. Revisión de historias clínicas de 14 pacientes infectados por VIH receptores de un primera lo injerto renal (2001-2019),seleccionadossegúnrecomendacionesdelasguíasespañolasyamericanas.Lainmunosupresiónserealizósegúnlaprácticahabitualennuestropaís.TARGAseinicióinmediatamentetrasTR.Resultados.LaprincipalcausadeERCTfuelaglomerulonefritis(N=6;42,9%)seguidadeHIVAN(N=4;28,6%).El71,4%(N=10)seencontrabanenhemodiálisisprevioalTRysólo1pacientesetrasplantóensituacióndeprediálisis.Desdeelpuntodevistainmuno-virológico,lamedianadeCD4fue458células/μLytodoslospacientespresentabancargaviralindetectable.El92,9%(N=13)recibíaTARGApreTR.2pacientesprecisarontrasplantectomíaprecozyfueroneliminadosdelanálisisposterior.Conunamedianadeseguimientode61,0meses,el58,3%(7/12)delospacientespresentóunafunciónretrasadadelinjertoyel33,3%(4/12)rechazoagudo.Lamedianadecreatininaalos3mesesyenlaúltimafechadeseguimientofue1,3mg/dL(RIC0,8)y2,1(RIC7,1)respectivamente.Lasupervivenciadelinjertoydelpacientea1y3añosfuede75,0%y100%;y67,0%y89,0%,respectivamente.Conclusión.ElTResunaalternativaterapéuticasegurayefectivaenpacientesseleccionadosconVIH.TheprognosisofHIVinfectionhasimprovedwiththeintroductionofhighlyactiveantiretroviraltherapy(HAART),beingnolongeracontraindicationtotransplantation(KT).HIV-associatednephropathy(HIVAN)isthemostcommoncauseofend-stagerenaldisease(ESRD)amongHIV-infectedpatientsworldwide.TheconsensuscriteriafortheselectionofHIVpatientsfortransplantationaremultidisciplinary:noopportunisticinfections;CD4count>200;undetectableviralload.Materialandmethods.Reviewoftheclinicalchartsof14HIV-infected,recipientsofaprimaryrenalallograft(2001-2019).InclusioncriteriamettheAmericanandSpanishguidelinerecommendations.Immunosuppressiveprotocolfollowedroutinepracticeinourcountry.HAARTwasstartedduringimmediatepost-KT.Results.ThemainESRDetiologywasglomerulonephritis (6;42.9%)followedbyHIVAN(4;28.6%).RegardingrenalsubstitutivetreatmentpriortoKT,themajoritywereonhemodialysis(10;71.4%).InonepatientKTwaspre-emptive.MedianCD4countwas458cells/μLandallpatientspresentedundetectableviralload.13(92.9%)wereonHAARTpriortoKT.Twopatientsunderwentearlytransplantectomy,theremainingpatientswerefollowedforamedianof61.0months(3.7to106.2months).Delayedgraftfunctionandacuterejectionratewere58.3%(7/12)and33.3%(4/12)respectively.Mediancreatininelevelsat3monthsandatthelastfollow-upwere1.3mg/dL(IQR0.8)and2.1mg/dL(IQR7.1)respectively.Graftandpatientsurvivalat1and3yearswererespectively75.0%and100%;and67.0%and89%.Conclusions.KTcanbesafeandeffectiveinselectedHIV-infectedpatient

Use of tocilizumab in kidney transplant recipients with COVID-1

Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin-6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID-19) . In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Transitional Cell Carcinoma of the Kidney Graft: An Extremely Uncommon Presentation of Tumor in Renal Transplant Recipients

Purpose. Transitional cell carcinoma (TCC) affecting the graft after renal transplantation is a very infrequent way of presentation of this tumor. Our aim is to present our single institution experience with 2 cases, as well as to perform a review of the literature about this tumor after the transplant. Materials and Methods. TCC of the graft developed in 2 of 1365 patients from 1977 to 2010, both cases in women. Data were analyzed for incidence, clinical presentation, treatment, and outcomes. Results. Both cases occurred in 2 mid-age women and resulted to be high grade and locally advanced TCCs, representing an incidence of 0,14% (2/1365). Clinical presentation was urinary obstruction for the first case and incidental ultrasound finding for the second. Preoperative staging was made with CT, cytology, pyelography, ureterorenoscopy, and biopsy. Treatment performed was nephroureterectomy of the graft with bladder cuff and regional lymphadenectomy. Pathological examination showed in both cases a locally advanced and high grade urothelial carcinoma of the pelvis allograft. After 24 and 14 months of followup, both patients are disease free. Conclusions. TCC of the kidney graft is an infrequent tumor that has only been reported in a few cases in the literature. It usually appears at a lower age, more often locally advanced, and with poor differentiation. A multidisciplinary approach to treatment should be required in these cases

Bioaccessibility and Intestinal Permeability from Andean Blackberry (Rubus glaucus Benth) Powders Encapsulated with OSA-Modified FHIA-21 Banana Starch

Modified starches for bananas can be used to encapsulate underutilized fruits such as Andean blackberry due to its content of phenolic compounds. This research aimed to assess the bioaccessibility and intestinal permeability of phenolic compounds from Andean blackberry powders encapsulated in octenyl succinic anhydride (OSA)-modified Gros Michel banana starch. Although low bioaccessibilities were found for total phenolics (up to 6%) during the in vitro digestion, most of them were chlorogenic acid and quercetin, released at high apparent permeability values (5&ndash;12 &times; 10&minus;4 cm/s). OSA-banana starches are suitable encapsulating matrices for blackberry polyphenols, ensuring their targeted release at the small intestine

Kidney Autotransplantation and Orthotopic Kidney Transplantation: Two Different Approaches for Complex Cases

Introduction. Transplantation surgery teams often have to face complex cases. In certain circumstances, such as occlusion of the iliac vessels or prior pelvic surgery, heterotopic kidney transplantation may not be feasible and orthotopic kidney transplantation (OKT) could be a good alternative. Kidney autotransplantation (KAT) has been described as a potential treatment for complex renovascular, ureteral, or neoplastic conditions. There are scarce data regarding the complications and outcomes of these procedures; therefore, we present our experience. Materials and Methods. We retrospectively analysed the medical records of both 21 patients who had received OKT and 19 patients who underwent KAT between 1993 and 2020. We collected demographic features and data regarding surgical technique, complications, and graft outcomes. Kidney graft survival was calculated using Kaplan–Meier survival analysis. Results. Regarding OKT, in 15 (71.43%) cases, it was the first kidney transplantation. The most common indication was the unsuitable iliac region due to vascular abnormalities (57.14%). The early postoperative complication rate was high (66.67%), with 23.81% of Clavien grade 3b complications. During the follow-up period (mean 5.76 -SD 6.15- years), we detected 9 (42.85%) graft losses. At 1 year, the survival rate was 84.9%. Concerning KAT, the most frequent indication was ureteral pathology (52.63%), followed by vascular lesions (42.11%). The overall early complication rate was 42.11%. During the follow-up period (mean of 4.47 years), 4 (15.79%) graft losses were reported. Conclusions. Although OKT and KAT have high complication rates, these techniques can be considered as two valuable approaches for complex cases, in the absence of other therapeutic options

Estudio de casos: un método de enseñanza para la formación de emprendedores y empresarios de Colombia

Texto digital.En la vida hay labores que vienen una y otra vez con distinto vestido, pero con patrones similares. En mi caso, lo son la economía del conocimiento y el empoderamiento de las personas. Respecto al conocimiento me interesa el conocimiento práctico que se puede llevar a la vida diaria para hacer de las organizaciones, comunidades y el planeta un lugar mejor; ese conocimiento práctico se puede adquirir con formación, pero también con la experiencia ganada cuando se afrontan situaciones cotidianas. En cuanto al empoderamiento, estoy convencido de que una de las primeras tareas como seres humanos es tomar las riendas de la vida para hacer algo significativo de nosotros y del entorno.Primera edició

Use and safety of remdesivir in kidney transplant recipients with COVID-19

Introduction: Remdesivir has demonstrated antiviral activity against coronavirus, shortening the time to recovery in adults hospitalized with moderate/severe COVID-19. Severe adverse events such as acute kidney injury have been reported. Scant data are available on the use and safety of remdesivir in kidney transplant recipients. Methods: We present a multicenter cohort study of 51 kidney transplant recipients with COVID-19 treated with remdesivir. Outcomes and safety were assessed. Results: Mean age at diagnosis was 60 years, with a median time since kidney transplant of 4.5 years. Mean time since admission to remdesivir was 2 days. Twenty-eight patients (54.9%) required mechanical ventilation (19 noninvasive). Mortality was 18.9% and markedly higher if aged ≥65 years (45% vs. 3.2% in younger patients). Acute kidney injury was present in 27.7% of patients, but was diagnosed in 50% before treatment. No patients required remdesivir discontinuation because of adverse events. We did not find significant hepatoxicity or systemic symptoms resulting from the drug. Conclusion: In our cohort of kidney transplant recipients, remdesivir was well tolerated and safe in renal and hepatic toxicity, but randomized trials are needed to assess its efficacy

Derechos humanos en Paraguay 2005

Indíce. Organizaciones participantes. Presentación. Analisis de coyuntura. Gobernabilidad pragmática y personalista / Line Bareiro. Análisis de coyuntura económica 2004 2005 / Lila Molinier. Derecho a la vida De los reproches locales a la preocupación y condena internacional / Andrés Ramírez. Equipo Editor. Derecho a la libertad, seguridad personal e integridad física Tortura y otros tratos o penas crueles, inhumanos y degradantes: Escasos esfuerzos para eliminar la tortura / Hugo Valiente. Yeny Villaba. Situación penitenciaria: Los avances son todavía imperceptibles / Yeny Villalba. La trata de mujeres con fines de explotación sexual y lasobligaciones impostergables del Estado paraguayo / Elba Beatriz Núñez. Derecho a la proteccion judicial Derecho a las garantías judiciales y al debido proceso: Desilusiones y retrocesos por ineficacia de operadores de justicia en el sistema penal / Juan Martens y Roque Orrego. Detenciones ilegales y arbitrarias: Privaciones ilegítimas de libertad afectan a más sectores organizados / Marcos Köhn Gallardo y Juan Martens Molas. Derecho a la reparación, rehabilitación e indemnización: Avances, estancamientos y deudas / Dionisio Gauto. Nelson García Ramírez. Derecho a la igualdad y a la no discriminación Derechos de las mujeres. Las convenciones que no se aplican / Pilar Codina Clua. Hacia una sociedad paraguaya sin discriminación / Grupo de Acción Gay Lésbico Transgénero (GAG-LT). Faltan políticas claras para abordar los problemas migratorios / Jacqueline Ortega. Derecho de las personas con discapacidad. Otra década perdida / Julio César Fretes, Zulma Ferreira, Claudia Pacheco y Marta Codas. Derecho a la libertad ideológica, religiosa y de conciencia Obstáculos estatales al derecho a la objeción de conciencia violentan otros derechos humanos / Edilberto Álvarez Galeano. Vidal Acevedo. Derecho a la información y a la libertad de expresión Desde poderes del Estado promueven hostigamientos a periodistas y medios / Magdalena Riveros. 10 Años de déficit en el derecho a la información y a la libertad de expresión / Equipo Editor. Derecho a la asociación, reunión y participación ciudadana Movimiento campesino: Siguen los mismos problemas / Quintín Riquelme. Derechos laborales: sin cambios significativos / Roberto Villalba. Pérdida de protagonismo del movimiento sindical y deterioro de las condiciones laborales marcan el final de una década / Dania Pilz.  Participación Ciudadana: las organizaciones sociales coparon el escenario nacional / Laura Bareiro.  Derechos políticos Calidad democrática: Otro año perdido para pensar la participación más allá del voto / Brigitte Colmán. Derecho al desarrollo sostenible Informe sobre pobreza y desigualdad 2005: Más pobres que hace 10 años / Daniel Bogado Méndez.  Desarrollo rural: Sigue postergada la reglamentación de Estatuto Agrario y del Indert  / Walter Lezcano.  Derecho al empleo Derecho al Empleo: Flexibilización y desregulación laboral por la vía de los hechos / Gustavo Zaracho.  Derecho a la salud Continúan reclamos por el exiguo presupuesto destinado a la salud / Desireé Masi. Diez años de falta de compromisos gubernamentales con la salud / Equipo editor. Derecho a la seguridad alimentaria El Derecho a la alimentación y la pérdida de la soberanía alimentaria / Diego Segovia. Derecho a la educación Entre Riesgos y Exclusiones / Ramón Corvalán  Marta Almada. ¿Reforma educativa o exclusión educativa? / Ramón Corvalán y Marta Almada. Derecho a la vivienda digna El Estado no garantiza el acceso a la vivienda digna / Cristina Vila y Ricardo Canese. Derechos de la infancia y la adolescencia Otro año lleno de promesas, postergaciones y amenazas / Luis Claudio Celma. Derechos de los pueblos indígenas Voces discrepantes frente a una crisis terminal. Andrés Ramírez / Equipo Editor. Derecho a la paz y al desarme Las Fuerzas Armadas siguen sin modificaciones fundamentales / Orlando Castillo Caballero.  Continúan prácticas de malos tratos, tortura y reclutamiento forzado / María Noguera Andrés Vázquez. Cumplimiento de compromisos internacionales Presentación del Informe Alternativo al Comité de Derechos Civiles y Políticos de Naciones Unidas / CDE, Centro de Documentación y Estudios. Pacto Internacional de Derechos Civiles y Políticos / CCPR NACIONES UNIDAS. Estrategias de vigilancia ciudadana sobre los derechos de las mujeres / Carolina Thiede Arias. Informe Alternativo de la sociedad civil sobre los Objetivos de Desarrollo del Milenio / Verónica Serafini. Síntesis general de las recomendaciones. Directorio de organizaciones de CODEHUPY

Use and Safety of Remdesivir in Kidney Transplant Recipients With COVID-19

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER); Sociedad Española de Trasplante.Introduction: Remdesivir has demonstrated antiviral activity against coronavirus, shortening the time to recovery in adults hospitalized with moderate/severe COVID-19. Severe adverse events such as acute kidney injury have been reported. Scant data are available on the use and safety of remdesivir in kidney transplant recipients. Methods: We present a multicenter cohort study of 51 kidney transplant recipients with COVID-19 treated with remdesivir. Outcomes and safety were assessed. Results: Mean age at diagnosis was 60 years, with a median time since kidney transplant of 4.5 years. Mean time since admission to remdesivir was 2 days. Twenty-eight patients (54.9%) required mechanical ventilation (19 noninvasive). Mortality was 18.9% and markedly higher if aged ≥65 years (45% vs. 3.2% in younger patients). Acute kidney injury was present in 27.7% of patients, but was diagnosed in 50% before treatment. No patients required remdesivir discontinuation because of adverse events. We did not find significant hepatoxicity or systemic symptoms resulting from the drug. Conclusion: In our cohort of kidney transplant recipients, remdesivir was well tolerated and safe in renal and hepatic toxicity, but randomized trials are needed to assess its efficacy