Resumen ejecutivo de la Declaración de consenso del Grupo de Estudio de la Infección en el Trasplante (GESITRA) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y la Organización Nacional de Trasplantes (ONT) sobre los criterios de selección de donantes de órganos sólidos en relación con las enfermedades infecciosas

The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence.This work was supported by GESITRA/SEIMC, ONT and‘Plan Nacional de I+D+I’ and Instituto de Salud Carlos III(Fondo de Investigaciones Sanitarias 12/02269 and ProyectoIntegrado de Excelencia 13/00045), Subdirección General de Redesy Centros de Investigacion Cooperativa, Spanish Ministry of Econ-omy and Competitiveness, Spanish Network for Research inInfectious Diseases (REIPI RD16/0016), co-financed by the Euro-pean Development Regional Fund A way to achieve Europe

Acute-phase reactants after paediatric cardiac arrest. Procalcitonin as marker of immediate outcome

<p>Abstract</p> <p>Objective</p> <p>Procalcitonin (PCT) and C reactive protein (CRP) have been used as infection parameters. PCT increase correlates with the infection's severity, course, and mortality. Post-cardiocirculatory arrest syndrome may be related to an early systemic inflammatory response, and may possibly be associated with an endotoxin tolerance. Our objective was to report the time profile of PCT and CRP levels after paediatric cardiac arrest and to assess if they could be use as markers of immediate survival.</p> <p>Materials and methods</p> <p>A retrospective observational study set in an eight-bed PICU of a university hospital was performed during a period of two years. Eleven children younger than 14 years were admitted in the PICU after a cardiac arrest. PCT and CRP plasma concentrations were measured within the first 12 and 24 hours of admission.</p> <p>Results</p> <p>In survivors, PCT values increased 12 hours after cardiac arrest without further increase between 12 and 24 hours. In non survivors, PCT values increased 12 hours after cardiac arrest with further increase between 12 and 24 hours. Median PCT values (range) at 24 hours after cardiac arrest were 22.7 ng/mL (0.2 – 41.0) in survivors vs. 205.5 ng/mL (116.6 – 600.0) in non survivors (p < 0.05). CRP levels were elevated in all patients, survivors and non-survivors, at 12 and 24 hours without differences between both groups.</p> <p>Conclusion</p> <p>Measurement of PCT during the first 24 hours after paediatric cardiac arrest could serve as marker of mortality.</p

Recommendations for screening, monitoring, prevention, and prophylaxis of infections in adult and pediatric patients receiving CAR T-cell therapy : a position paper

Chimeric antigen receptor (CAR) T-cell therapy is one of the most promising emerging treatments for B-cell malignancies. Recently, two CAR T-cell products (axicabtagene ciloleucel and tisagenlecleucel) have been approved for patients with aggressive B-cell lymphoma and acute lymphoblastic leukemia; many other CAR-T constructs are in research for both hematological and non-hematological diseases. Most of the patients receiving CAR-T therapy will develop fever at some point after infusion, mainly due to cytokine release syndrome (CRS). The onset of CRS is often indistinguishable from an infection, which makes management of these patients challenging. In addition to the lymphodepleting chemotherapy and CAR T cells, the treatment of complications with corticosteroids and/or tocilizumab increases the risk of infection in these patients. Data regarding incidence, risk factors and prevention of infections in patients receiving CAR-T cell therapy are scarce. To assist in patient care, a multidisciplinary team from hospitals designated by the Spanish Ministry of Health to perform CAR-T therapy prepared these recommendations. We reviewed the literature on the incidence, risk factors, and management of infections in adult and pediatric patients receiving CAR-T cell treatment. Recommendations cover different areas: monitoring and treatment of hypogammaglobulinemia, prevention, prophylaxis, and management of bacterial, viral, and fungal infections as well as vaccination prior and after CAR-T cell therapy

Non invasive ventilation after extubation in paediatric patients: a preliminary study

<p>Abstract</p> <p>Background</p> <p>Non-invasive ventilation (NIV) may be useful after extubation in children. Our objective was to determine postextubation NIV characteristics and to identify risk factors of postextubation NIV failure.</p> <p>Methods</p> <p>A prospective observational study was conducted in an 8-bed pediatric intensive care unit (PICU). Following PICU protocol, NIV was applied to patients who had been mechanically ventilated for over 12 hours considered at high-risk of extubation failure -elective NIV (eNIV), immediately after extubation- or those who developed respiratory failure within 48 hours after extubation -rescue NIV (rNIV)-. Patients were categorized in subgroups according to their main underlying conditions. NIV was deemed successful when reintubation was avoided. Logistic regression analysis was performed in order to identify predictors of NIV failure.</p> <p>Results</p> <p>There were 41 episodes (rNIV in 20 episodes). Success rate was 50% in rNIV and 81% in eNIV (p = 0.037). We found significant differences in univariate analysis between success and failure groups in respiratory rate (RR) decrease at 6 hours, FiO₂at 1 hour and PO₂/FiO₂ratio at 6 hours. Neurologic condition was found to be associated with NIV failure. Multiple logistic regression analysis identified no variable as independent NIV outcome predictor.</p> <p>Conclusions</p> <p>Our data suggest that postextubation NIV seems to be useful in avoiding reintubation in high-risk children when applied immediately after extubation. NIV was more likely to fail when ARF has already developed (rNIV), when RR at 6 hours did not decrease and if oxygen requirements increased. Neurologic patients seem to be at higher risk of reintubation despite NIV use.</p

Estudios culturales : prácticas diversas, enfoques pluralistas

1 archivo PDF (294 páginas) : incluye ilustracionesDesde el ámbito de los estudios culturales plantea un acercamiento teórico y metodológico multidisciplinar en el que a partir de la reflexión y el estudio de casos se analizan problemáticas reales de la historia de la cultura mexicana. Ciencia y humanismo, empirismo y reflexión son las caras de la moneda de una tendencia epistemológica que en las últimas décadas se ha planteado en el ámbito de la investigación sociológica y antropológica bajo el marbete de estudios culturales, con el objetivo de aprehender el complejo funcionamiento de los procesos culturales en las sociedades modernas. Recoge colaboraciones que abordan aspectos esenciales en el debate sobre los estudios culturales como el estado de las instituciones y la acción política, los exilios, desexilios y los movimientos migratorios entre México y Estados Unidos y sus influencias en la adaptación de los migrantes a ambos lados de la frontera, la problemática de la sexualidad y las formas de violencia, el tratamiento de la enfermedad y de la muerte, la crisis socioeconómica, el incipiente debate sobre las culturas digitales o la conciencia ecológica y medioambiental en el México de hoy. En primer lugar encontramos cuatro textos que analizan la problemática de la migración en México desde cuatro perspectivas distintas. Ana Ochoa O’Leary analiza las nuevas perspectivas de la movilización política en el sur de Estados Unidos ante los graves problemas de adaptación de los migrantes derivados de las decisiones legislativas de los últimos gobiernos nacionales y federales estadounidenses. Adriana María Eugenia Cabrera destaca la influencia de los movimientos migratorios en el patrimonio cultural de las zonas afectadas a través del estudio del proceso de identidad social del migrante y su intensa relación con los edificios históricos. También en el culto a las imágenes hay una influencia evidente del fenómeno de la migración, como muestran Pablo Martínez y María del Refugio Piña en el caso de los exvotos donados al Niño de Atocha. Política, arquitectura, antropología y también la literatura como paradigma de la migración en el trabajo de Teresita Quiroz sobre los movimientos migratorios hacia la ciudad de México en la narrativa de Mariano Azuela. El segundo apartado recoge colaboraciones bajo el epígrafe “Narratividad, discursos e identidades” en el que se mezclan perspectivas de configuración de identidades en el periodo virreinal en el estudio de Beatriz Aracil sobre el viaje de Cortés a la Mar del Sur y la transformación del sujeto colonial y reflexiones sobre lo hispano en pleno proceso de Independencia durante las primeras décadas del siglo XIX a través de artículos y monografías de Anselmo Portilla y Niceto Zamaçois planteadas por Alfredo Moreno Flores. El viaje continúa con el trabajo de Blanca Estela López y José Silvestre Revueltas sobre la narratividad para juegos y rituales, que antecede a las reflexiones literarias de Daniel Santillán sobre la identidad nacional en Margarita de Niebla, de Jaime Torres Bodet y el acercamiento a la mujer mexicana del xix a través de las referencias literarias a la lencería en cuatro autores de la época que plantea Margarita Alegría. El apartado concluye con análisis del viaje de escritores diplomáticos del XIX en China propuesto por María Fernanda García de los Arcos. “Justicia, ciudadanos y luchas sociales” propone una reflexión histórica sobre el sistema judicial y el estado de las cárceles mexicanas a partir del estudio de María Elvira Buelna y Antonio Salcedo Flores y dos ejemplos de articulación ciudadana y lucha social en los estudios de Marta Ochman y Reyna Sánchez Estévez. “Imágenes, redes y fotoperiodismo” refleja la importancia de la imagen en la sociología contemporánea y su revalorización en el estudio de textos histórico-literarios como el Diario de guerra de Simone de Beauvoir que plantea Ma. Eugenia Rabadán Villalpando y en el contexto musical hardcorero del trabajo de José A. Trejo Sánchez, que destaca la importancia de la conexión en red como emblema de pertenencia a un grupo social entre los jóvenes artistas del Valle de Toluca. “Discapacidad y muerte” enfrenta un problema crucial entre los jóvenes indígenas en Chiapas: el suicidio, a propuesta de Jorge Magaña Ochoa y debate la asistencia a niños con Síndrome de Down en el México contemporáneo en el estudio de Janeth Rojas Contreras. José Carlos Vizuete Mendoza reflexiona en el apartado “Iglesias” sobre la evolución centralizadora y descentralizadora de la estructura de gobierno, los rituales de culto, el calendario festivo y la lengua de la liturgia cristiana. Para concluir, Judith Catalina Navarro Gómez presenta en “Energía y Medio Ambiente” la problemática energética en el mundo contemporáneo y unas pautas para mejorar el medio ambiente a partir de una nueva cultura de la energía y Martha Eugenia Rodríguez y Jimena Pérez plantean un estudio de la conciencia ambiental en la ciudad de México en tres momentos históricos: siglo XVIII, siglo XIX y siglo XX y su repercusión en la salud pública

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years