Cistitis hemorrágica por adenovirus en trasplante renal: revisión epidemiológica y resultados clínicos

Contexto la infección de vías urinarias (IVU), causada por adenovirus (ADV) posterior al trasplante renal, tiene el potencial de causar disfunción o pérdida del injerto. La presentación clínica es variable y el tratamiento difiere según la disponibilidad de medicamentos en el medio y la experiencia clínica. Objetivo el estudio describe las características clínicas, de laboratorio y la respuesta al tratamiento de una serie de casos de pacientes trasplantados renales con IVU por ADV en un hospital de Cali, Colombia. Metodología estudio retrospectivo que incluye a todos los pacientes adultos trasplantados con diagnóstico de IVU por ADV entre enero del 2015 hasta enero del 2021. El diagnóstico se realizó basado en la clínica, el resultado positivo de la prueba de reacción de cadena de polimerasa (PCR) y la carga viral del ADV. Resultados de 256 pacientes trasplantados, ocho presentaron diagnóstico de cistitis hemorrágica o nefritis intersticial secundaria a infección por ADV. Se presentó de forma temprana (≤ 3 meses) en el 62 % de los casos, quienes debutaron con macrohematuria asociada a piuria estéril y linfopenia. Por otra parte, se presentó alteración en la función renal en el 87,5 % de los casos y la reducción de la inmunosupresión fue el pilar fundamental en el manejo clínico. Conclusiones el reconocimiento de la infección por ADV en pacientes trasplantados renales ha ido en aumento. La sospecha clínica es clave para el diagnóstico (macrohematuria, síntomas urinarios irritativos y falla renal) y la reducción de la dosis de inmunosupresión para restaurar la función inmune puede ser suficiente en la resolución de la infección y la reversión de la disfunción renal.

Introduction Urinary tract infection (UTI) caused by adenovirus (ADV) after kidney transplantation has the potential to cause graft dysfunction or loss. The clinical presentation is variable, from an asymptomatic course to a multisystemic compromise. Treatment varies based on the availability of different medications and clinical experience. Objective The study describe the clinical, laboratory characteristics and results of a series of cases of kidney transplant patients with hemorrhagic cystitis secondary to ADV infection in a hospital in Cali, Colombia. Methods Retrospective study based on the records of patients with a diagnosis of UTI caused by ADV between January 2015 to January 2021 were included. The diagnosis was made by clinical suspicion and polymerase chain reaction (PCR) - Adenovirus DNA viral load. Results Of 256 transplant patients, eight patients had a diagnosis of hemorrhagic cystitis or interstitial nephritis secondary to ADV infection. It presented early (≤ 3 months) in 62%, who presented with macrohematuria, associated with sterile pyuria and lymphopenia. Alterations in renal function were presented in 87.5%. The reduction of immunosuppression was the fundamental pillar in the management. Conclusions The recognition of ADV infection in kidney transplant patients has been increasing. Clinical suspicion is the key for the diagnosis, with a predominance of macrohematuria, irritative urinary symptoms and kidney graft dysfunction. Reducing the dose of immunosuppression by restoring immune function may be sufficient in resolving the infection and reversing renal dysfunction.

Formation of Self-organized Structures in Drying Droplets: a Promising Analytical Tool for Homeopathy Basic Research

The droplet evaporation method (DEM) is based on the evaporation-induced pattern formation in droplets and is applied mainly for medical diagnosis[1].Here, we present aseries of experiments performed by our team showing DEMs potential also forhomeopathy basic research, in particular, for the investigation of(i) low potencies, (ii) low potency complexes (physical model), and (iii) the action of high potencies (plant-based model).Methods:(i) DEM differentiated significantly between Luffa, Baptisia, Echinacea, and Spongiauntil 4x[2]. Furthermore, the patterns varied in function of the numberof succussion strokes (0, 10, or 100) applied during potentization[3]. The performance of chaotic succussions vs. laminar flow vs. slight mixing during the potentization of Viscum album quercus3x influenced the DEM patterns; the chaotic succussions reduced, whereas laminar flow enhanced the patterns complexity vs. the unsuccussed control.(ii) The addition of Mercurius bijodatus9x to Luffa4x changed significantly the DEM patterns, even if the material quantity present in the 9x potency lied far beyond that of ultrapure water.(iii) Leakages obtained by placing healthy or arsenic-damaged wheat-seeds into Arsenicum album45x orheat-damaged intoZincum metallicum30c vs. water created significantly different DEM structures [4, 5]. Results:The damaged seeds put into the potency created structures characterized by a higher complexity than those obtained from damaged seeds put into control water. Furthermore, the potency action seemed to increase with rising numbers ofsuccussion strokes applied during potentization,ascould be shown by means of DEM patterns and germination rate using the same wheat-seed model[6].In all our studies, the pattern evaluation was computerized (texture and fractal analysis performed by means of ImageJ) or based on deep-learning algorithms and the robustness of the experimental system was checked by means of systematic control experiments.Conclusion:DEM together with other similarmethods has also been reviewed by our team for what concerns theapplication in homeopathy basic research[7].

Farmacocinética de vancomicina en niños hospitalizados en una unidad de paciente crítico / Pharmacokinetics of vancomycin in children hospitalized in a critical care unit

Introduction: Monitoring PK/PD of vancomycin with basal and peak serum levels and the area under the curve of drug exposure 24 h/MIC (ABC 24 h/MIC) could optimize the management of children. Objective: To study the PK of vancomycin in children hospitalized in the Pediatric Intensive Care Unit (PICU), assessing PK/PD parameters withABC24 h/MIC. Methods: Retrospective, descriptive study in the PICU (Hospital Luis Calvo Mackenna) between January 2008-March 2010. We included children < 18 years who required antimicrobial treatment with vancomycin for suspected/confirmed staphylococcal infection using a dose of 40 mg/k/day. Plasmatic levels were performed one hour postinfusion and 30 min prior to the next dose. The following PK/PD parameters were calculated: vancomycin clearance, elimination rate constant, volume of distribution, half-life (T1/2) and ABC 24 h/ MIC. Results: We enrolled eighty-four children. According to ABC 24 h/MIC obtained, 54% (45/84) of children reached an optimal level (> 400 mg*hr/L). Based on the traditional PK/PD parameters, 49% of cases (41/84) presented a basal level of vancomycin in the therapeutic range (5-15 μg/mL) and of those, only 39% (16/41) had a ABC 24 h/MIC over 400 mg*h/L. Discussion: Based on our results, children admitted to PICU could be exposed to sub therapeutic doses of vancomycin. We recommend to implement tailored antimicrobial treatment monitoring vancomycin PK/PD parameters.

Introducción: El monitoreo farmacocinético-farmacodinámico (PK/PD) de vancomicina podría optimizar el manejo de niños que reciben vancomicina y se encuentran en shock séptico grave. Objetivo: Estudiar PK/PD de vancomicina en niños hospitalizados en una unidad de paciente crítico, relacionando parámetros farmacocinéticos (PFC) tradicionales con ABC 24 h/CIM. Material y Método: Estudio retrospectivo, descriptivo, en la Unidad de Paciente Crítico Pediátrico (UPCP) del Hospital Luis Calvo Mackenna en el período enero de 2008 - marzo de 2010. Se incluyeron niños < 18 años tratados con vancomicina por sospecha/confirmación de infección estafilocóccica y recibieron dosis de 40 mg/kg/día. Se midieron concentraciones plasmáticas pico y basales. Los PFC calculados fueron realizados con software de farmacocinética TDMS®. Resultados: Se enrolaron 84 niños. En relación del parámetro ABC 24h/CIM obtenido, 54% (45/84) de los niños alcanzaron niveles óptimos (> 400 mg*h/L). Del análisis por PFC tradicionales, 49% de los casos (41/84) presentó concentraciones basales de vancomicina en rango terapéutico (5-15 μg/mL) y de ellos, sólo 39% (16/41) presentó un ABC 24 h/CIM > 400 mg*h/L. Todos los pacientes con concentraciones basales > 15 μg/mL alcanzan un ABC 24 h/CIM > 400 mg*h/L. Discusión: Los pacientes pediátricos que ingresan a la UPCP podrían estar expuestos a dosis sub-terapéuticas de vancomicina. Es recomendable individualizar el tratamiento de vancomicina utilizando monitoreo con parámetros PK/PD.