Pigmented purpura and cutaneous vascular occlusion syndromes

Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes

Plan de Responsabilidad Social para la Panadería Merca Max.

https://www.youtube.com/watch?v=C3W9wh06XR8En este estudio de investigación se examina el papel del Plan de Responsabilidad Social Empresarial mediante el análisis de varias fases donde identificamos los Stakeholders que influyen en el éxito de la empresa; partiendo de los impactos económicos, sociales y ambientales generados por la Panadería Merca Max, incluyendo además diferentes estrategias de solución o mitigación de estos que al ser adoptados aportaran una mayor competitividad a la organización. Se tienen en cuenta los conceptos del código de conducta, marketing corporativo, marketing social, modelos gerenciales y la responsabilidad social corporativa, los cuales constituyen un papel importante el ámbito empresarial. Mediante la implementación del código de conducta se da a conocer a todos los miembros de la organización cual ha de ser el comportamiento a seguir en sus relaciones con los distintos grupos de interés de la empresa. Los datos analizados sugieren que determinar los recursos financieros y decisiones de inversión en el código de conducta ayudara a conocer la importancia de aplicarlos dentro del modelo de informe recomendado. Para el desarrollo del Plan de Responsabilidad Social Empresarial planteamos objetivos, recursos, plazos estimados, indicadores y tipo de seguimiento el cual complementamos con el diseño del Plan de Comunicaciones. Es importante que cada área de la empresa conozca y este comprometida con la implementación para que el plan se mantenga a largo plazo.This research project examines the role of the Corporate Social Responsibility Plan through the analysis of several phases where we identify the Stakeholders that influence the success of the company; starting from the economic, social and environmental impacts generated by Merca Max Bakery. Including in addition different strategies of solution or mitigation of these, that at the moment of being adopted contribute a greater competitiveness to the organization. The concepts of the code of conduct, corporate marketing, social marketing, managerial models and corporate social responsibility are taken into account, which constitute an important role for the business world. Through the implementation of the code of conduct, all the members of the organization are made aware of the behavior to be followed in their relations with the different interest groups of the company. The data analyzed suggest that determining financial resources and investment decisions in the code of conduct will help to know the importance of applying them within the recommended reporting model. For the development of the Corporate Social Responsibility Plan we set objectives, resources, estimated deadlines, indicators and type of monitoring which we complement with the design of the Communications Plan. It is important that each area of the company knows and is committed to the execution so that the long-term plan is maintained

Recomendaciones sobre la vacunación contra SAR S-CoV-2/COVID-19 en pacientes con enfermedad renal crónica y trasplante renal

– Los pacientes con enfermedad renal en todas sus etapas (ERC etapas 1-5, diálisis, trasplante renal) deben ser una población prioritaria en el plan de vacunación contra SARS-CoV-2. – En todos los casos, la vacunación debe administrarse sin importar si los pacientes tuvieron antes COVID-19 o si tienen títulos de IgG positivos para SARS-CoV-2. – Debe vacunarse a todos los pacientes con ERC avanzada, con o sin diálisis crónica, con los esquemas habituales propuestos para las diferentes vacunas disponibles en el medio. – Debe vacunarse a todos los pacientes en lista de espera de trasplante renal. En quienes se encuentran programdos para trasplante inter vivos es deseable que completen la vacunación un mes antes del procedimiento. – Hay que vacunar a todos los pacientes receptores de trasplante renal luego del primer mes del trasplante y aprovechar las situaciones clínicas de estabilidad y menor requerimiento de inmunosupresión. En las situaciones en que se administra timoglobulina o rituximab al trasplante se recomienda diferir la vacunación hasta el tercer mes. Cuando se indica tratamiento contra el rechazo (bolos de metilprednisolona, recambio plasmático terapéutico, gammaglobulina), se recomienda posponer la vacunación al menos dos semanas. – Es preciso vacunar a los pacientes con enfermedades autoinmunitarias (enfermedades autoinmunitarias sistémicas, glomerulopatías), con o sin tratamiento inmunosupresor, de preferencia en el momento en que la enfermedad subyacente esté estable y en el mejor momento de la inmunosupresión

Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts

International audienceIntroduction: Despite recognized geographic and sex-based differences in hemoglobin in the general population, these factors are typically ignored in patients with chronic kidney disease (CKD) in whom a single therapeutic range for hemoglobin is recommended. We sought to compare the distribution of hemoglobin across international nondialysis CKD populations and evaluate predictors of hemoglobin. Methods: In this cross-sectional study, hemoglobin distribution was evaluated in each cohort overall and stratified by sex and estimated glomerular filtration rate (eGFR). Relationships between candidate predictors and hemoglobin were assessed from linear regression models in each cohort. Estimates were subsequently pooled in a random effects model. Results: A total of 58,613 participants from 21 adult cohorts (median eGFR range of 17–49 ml/min) and 3 pediatric cohorts (median eGFR range of 26–45 ml/min) were included with broad geographic representation. Hemoglobin values varied substantially among the cohorts, overall and within eGFR categories, with particularly low mean hemoglobin observed in women from Asian and African cohorts. Across the eGFR range, women had a lower hemoglobin compared to men, even at an eGFR of 15 ml/min (mean difference 5.3 g/l, 95% confidence interval [CI] 3.7–6.9). Lower eGFR, female sex, older age, lower body mass index, and diabetic kidney disease were all independent predictors of a lower hemoglobin value; however, this only explained a minority of variance (R2 7%–44% across cohorts). Conclusion: There are substantial regional differences in hemoglobin distribution among individuals with CKD, and the majority of variance is unexplained by demographics, eGFR, or comorbidities. These findings call for a renewed interest in improving our understanding of hemoglobin determinants in specific CKD populations

Grams ME, Sang Y, Ballew SH, et al, for the Chronic Kidney Disease Prognosis Consortium. Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate. Kidney Int. 2018;93:1442–1451

International audienceFirst-line therapy of minimal change nephrotic syndrome (MCNS) in adults is extrapolated largely from pediatric studies and consists of high-dose oral corticosteroids. We assessed whether a low corticosteroid dose combined with mycophenolate sodium was superior to a standard oral corticosteroid regimen. We enrolled 116 adults with MCNS in an open-label randomized controlled trial involving 32 French centers. Participants randomly assigned to the test group (n=58) received low-dose prednisone (0.5 mg/kg/day, maximum 40 mg/day) plus enteric-coated mycophenolate sodium 720 mg twice daily for 24 weeks; those who did not achieve complete remission after week 8 were eligible for a second-line regimen (increase in the prednisone dose to 1 mg/kg/day with or without Cyclosporine). Participants randomly assigned to the control group (n=58) received conventional high-dose prednisone (1 mg/kg/day, maximum 80 mg/day) for 24 weeks. The primary endpoint of complete remission after four weeks of treatment was ascertained in 109 participants, with no significant difference between the test and control groups. Secondary outcomes, including remission after 8 and 24 weeks of treatment, did not differ between the two groups. During 52 weeks of follow-up, MCNS relapsed in 15 participants (23.1%) who had achieved the primary outcome. Median time to relapse was similar in the test and control groups (7.1 and 5.1 months, respectively), as was the incidence of serious adverse events. Five participants died from hemorrhage (n=2) or septic shock (n=3), including 2 participants in the test group and 3 in the control group. Thus, in adult patients, treatment with low-dose prednisone plus enteric-coated mycophenolate sodium was not superior to a standard high-dose prednisone regimen to induce complete remission of MCNS