Inflammatory Cytokines as Uremic Toxins: “Ni Son Todos Los Que Estan, Ni Estan Todos Los Que Son”

Chronic kidney disease is among the fastest growing causes of death worldwide. An increased risk of all-cause and cardiovascular death is thought to depend on the accumulation of uremic toxins when glomerular filtration rate falls. In addition, the circulating levels of several markers of inflammation predict mortality in patients with chronic kidney disease. Indeed, a number of cytokines are listed in databases of uremic toxins and uremic retention solutes. They include inflammatory cytokines (IL-1β, IL-18, IL-6, TNFα), chemokines (IL-8), and adipokines (adiponectin, leptin and resistin), as well as anti-inflammatory cytokines (IL-10). We now critically review the cytokines that may be considered uremic toxins. We discuss the rationale to consider them uremic toxins (mechanisms underlying the increased serum levels and evidence supporting their contribution to CKD manifestations), identify gaps in knowledge, discuss potential therapeutic implications to be tested in clinical trials in order to make this knowledge useful for the practicing physician, and identify additional cytokines, cytokine receptors and chemokines that may fulfill the criteria to be considered uremic toxins, such as sIL-6R, sTNFR1, sTNFR2, IL-2, CXCL12, CX3CL1 and others. In addition, we suggest that IL-10, leptin, adiponectin and resistin should not be considered uremic toxins toxins based on insufficient or contradictory evidence of an association with adverse outcomes in humans or preclinical data not consistent with a causal association

Práctica Médica: Exploración Mental - ME159 - 202102

III: INTRODUCCION Curso de la especialidad de la carrera de medicina, de carácter teórico práctico del ciclo 6 en el que los estudiantes al establecer una buena relación con el paciente realizan la anamnesis y examen mental para establecer un diagnostico por síndromes o problemas de las patologías más frecuentes de la esfera psiquiátrica. El curso de Práctica Médica - Exploración Mental busca desarrollar la competencia general de Comunicación Escrita nivel 2, y las competencias específicas de la carrera de Práctica Clínica: Diagnóstico y Profesionalismo: Sentido ético (nivel 2 en ambos

Externado de Psiquiatría - ME220 - 202102

Curso de especialidad de la carrera de medicina, de carácter principalmente práctico además de clases teóricas, del ciclo 11 en el que los estudiantes, con un previo conocimiento de la entrevista en salud mental y las características psicopatológicas de los trastornos mentales, al establecer un adecuado diagnóstico de salud mental, definirán la conducta medica apropiada a seguir según el nivel de atención que corresponda. El curso de Externado Medico de Psiquiatría busca desarrollar la competencia específicas de la carrera de Práctica Clínica: Diagnóstico (nivel 3

Anti-Spike antibodies 3 months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study

Background Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P = .001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P = .693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P = .001), lower time from booster (P = .043) and past breakthrough SARS-CoV-2 infection (P < .001). Conclusions In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection. Lay Summary Patients on hemodialysis present higher rates of complications derived from SARS-CoV-2 infections. Initial vaccination schedules have demonstrated suboptimal responses in those patients. The aim of the present study is to evaluate the time-course of the humoral response after a booster dose of SARS-CoV-2 RNA-based vaccines (BNT162b2 or mRNA-1273) in patients on hemodialysis. We included 711 patients that had received a booster dose: 545 (77%) 6 months before the initial vaccination and 166 (23%) between 6 and 9 months from the initial vaccination. After the booster, only 6

Externado de Psiquiatría - ME220 - 202101

Curso de especialidad de la carrera de medicina, de carácter principalmente práctico además de clases teóricas, del ciclo 11 en el que los estudiantes, con un previo conocimiento de la entrevista en salud mental y las características psicopatológicas de los trastornos mentales, al establecer un adecuado diagnóstico de salud mental, definirán la conducta medica apropiada a seguir según el nivel de atención que corresponda. El curso de Externado Medico de Psiquiatría busca desarrollar la competencia específicas de la carrera de Práctica Clínica: Diagnóstico (nivel 3