Suicide among physicians: Major risk for women physicians.

INTRODUCTION: The risk of suicide is related to professional activity. Preliminary data suggest that being in the medical profession increases the risk of suicide in women. The objective of this nationwide study is to compare the death rate of physicians due to suicide with that of the general population and to assess the differences based on gender. MATERIALS AND METHODS: All physicians and the general population who died by suicide in Spain between 2005 and 2014, both inclusive, were studied. Between these years, the Spanish population grew from 43,662,613 to 46,455,123 persons and from 199,123 to 238,240 number of doctors. The data relating to the deaths of physicians were extracted from the databases of the General Council of Official Medical Associations (CGCOM) and data related to the general population were obtained from the National Institute of Statistics (INE). The variables included in the analyses are gender, age, specialty, place of residence and death, and causes of death according to the ICD-10. RESULTS: The annual mean of physician deaths was 918, with an annual crude rate of 4.8 per 1,000 registered physicians. It is confirmed that physicians have a significantly higher suicide rate (average of 1.3%) than the general population (average of 0.8%) (p = 0.003). The comparison of suicide between men and women doctors is significantly higher in women (X2= 53.068, p<0.001). In addition, if we separate by gender, female physicians have a suicide rate 7.5% higher than women from the general population, although the difference is not significant (X2 = 2.614, p = 0.107). CONCLUSIONS: . Suicide is higher among physicians than the general population and affects female physicians significantly more.

Impacto de la tuberculosis en el hospital de Puerto Montt / Impact of tuberculosis in Puerto Montt hospital, Chile

Resumen Objetivo: Dimensionar la demanda de atención y/u hospitalización de la tuberculosis (TBC) en el Hospital de Puerto Montt (HPM). Método: Revisión retrospectiva de los registros de TBC del Servicio de Salud del Reloncaví (SSDR) y del HPM entre los años 2011 y 2015. Se incluyeron todos los casos de TBC activa vistos en forma ambulatoria u hospitalizada en el HPM. Resultados: Se diagnosticaron en el SSDR 298 casos de TBC, y de ellos un 64% (192/298) fue pesquisado en el HPM. Se presentan datos socioeconómicos, epidemiológicos, clínicos, de laboratorio y forma de diagnóstico de 180 casos, que cumplieron criterios de inclusión: varones 62%, edad media 44 ± 19 años. El 72% correspondieron al estrato social de menores ingresos, 4% indigentes, solo 14% poseía enseñanza media completa, 11% analfabetos, ruralidad 19%. Las principales co-morbilidades fueron alcoholismo (17%), VIH (12%), Diabetes (10%). En aquellos con TBC pulmonar o pleural (128) el tiempo con síntomas con frecuencia era prolongado (15% > 90 días) y la radiología mostraba enfermedad avanzada: infiltrados bilaterales 73%, compromiso > 3 lóbulos 55%, una o más cavitaciones 34%. Se hospitalizó el 71% (126/180), 50% por necesidad de estudio, 48%por gravedad. El 8% necesitó Unidad de Paciente Crítico (UPC). Fallecieron 24 pacientes (13%). Se asoció significativamente a mortalidad el analfabetismo y necesidad de UPC. Conclusiones: En el SSDR la TBC es un problema sanitario que afecta principalmente a poblaciones más pobres y vulnerables.

Backgroud: Tuberculosis (TB) is still a problem that impacts on hospitals of high complexity. Aim: To assess demand for care and/or hospitalization because of TB in Puerto Montt Hospital (PMH), located in the southern of Chile. Patients and Methods: Retrospective study of all Reloncaví Health Service (RHS) and PMH clinical records, between 2011 and 2015. We include all ambulatory or hospitalized cases of active TB registered in PMH during the period of the study. Results: In RHS there were 298 cases of TB and 64% of them (192/298) was detected in HPM. We present social, economic, epidemiological, clinical, laboratory studies, and specific type of diagnosis of 180 cases that met inclusion criteria: men 62%, mean age 45 ± 19 years-old. The population with lower income was 72%, 4% homeless, 14% with complete high school, 11% illiterate and 19% lived at country side. Main co-morbidities were alcoholism 17%, HIV 12%, Diabetes Mellitus 10%. In the specific group of lung/pleural TB (128 cases) the time with symptoms was often prolonged (15% > 90 days) and imagen studies showed advanced pathology: bilateral infiltrates 73%>, affecting three or more lobes 55%, cavitations 34%. 71% (126/180) were hospitalized, because of necessity of more study (50%) or severity (48%), 8% required to enter to the Critical Care Unit (CCU). Twenty-four patients died (13%). Illiteracy and the need for CCU were associated with mortality. Conclusions: In RHS TB is a sanitary problem that affects principally the most poor and vulnerable populations.

Primera evidencia de Chlamydia psittaci en huron sable (Mustella putorios furo) en Venezuela / First evidence of Chlamydia psittaci in the sable ferret (Mustella putorios furo) in Venezuela

RESUMEN Chlamydia psittaci (Cp) es una bacteria intracelular obligada transmitida a través de aerosoles derivados de secreciones nasales y ópticas, tejidos, heces y plumas. Comúnmente es identificada en aves, sin embargo, han emergido genotipos capaces de infectar nuevos reservorios mamíferos. Por ello, se buscó ADN de Cp en muestras de cinco individuos de Mustella putorios furo y un hisopado cloacal de un individuo de Colinus cristatus en cautiverio en Venezuela a través de la PCR-anidada, amplificando un segmento del gen 16S ADNr. Se demostró la presencia de Cp en un Colinus cristatus con signos de clamidiosis y en cuatro Mustella putorios furo sin signos clínicos de clamidiosis. Se indica un posible nuevo reservorio para Cp, donde el contacto con productos de excreción de Colinus cristatus con manifestaciones clínicas de clamidiosis, hacinamiento, inadecuada ventilación, contacto con productos de excreción de Psittaciformes y condiciones sanitarias deficientes favoreció la infección por Cp. Se desconoce el total de reservorios de Cp, por ello la notificación de los aislados permite el entendimiento, distribución y diversidad de agentes clamidiales en fauna silvestre y en cautiverio.

ABSTRACT Chlamydia psittaci (Cp) is an obligate intracellular bacterium, transmitted through aerosols from nasal and optic secretions, tissues, feces, and feathers. Although commonly identified in birds, genotypes have emerged that can infect new mammalian reservoirs. Therefore, of rectal swabs samples of five Mustella putorios furo individuals and a cloacal swab sample of Colinus cristatus in captivity, in Venezuela, were tested for Cp, using the nested PCR amplifying a segment of the 16S rDNA gene. The presence of Cp was found in four asymptomatic Mustela putorios furo and one symptomatic Colinus cristatus for avian chlamydiosis, indicating a new potential reservoir for Cp. The contact with excretions of infected Colinus cristatus and Psittaciformes, as well as overcrowding, inadequate ventilation, and inadequate sanitary conditions can favor Cp infection. The total number of Cp reservoirs is unknown; therefore, the noting and molecular characterization of isolates enable the understanding, distribution, and diversity of chlamydial agents in wildlife and animals in captivity.

[Predictive psychophysiological stress symptoms in dentists]. / Síntomas psicofisiológicos predictores del estrés en odontólogos.

BACKGROUND: Dentistry has been identified as one of the most stressful occupations in which a dentist's mental and/or physical health may be affected. The objective of this study was to identify chronic psychophysiological stress symptoms in relation with the presence of high stress levels perceived in dentists at a Social Security institution in Guadalajara, Mexico. METHODS: The design was cross-sectional and analytical by means of a 2011 census consisting of 87 dentists. The Stress Profile and the Stress Symptom Inventory were applied and the analysis was performed with multiple regression. RESULTS: The perceived stress levels were: high (67.8 %), medium (29.9 %) and low (2.3 %). The most frequent psychophysiological symptom of perceived high level of stress was fatigue with 51 %, and the female gender was the most affected. The existence of a meaningful association was shown between the chronic psychophysiological stress symptoms of insomnia, fatigue and the female gender, and perceived high level stress. CONCLUSIONS: Early identification of the symptoms of chronic stress in dentists would favor the implementation of appropriate preventive programs to care for their health and work place security.

Introducción: la odontología ha sido identificada como una de las ocupaciones más estresantes que pueden afectar la salud mental y/o física de los profesionales de la salud bucal. El objetivo del estudio fue identificar los síntomas psicofisiológicos de estrés crónico relacionados con la presencia de niveles altos de estrés percibido en odontólogos de una institución de seguridad social en la ciudad de Guadalajara, México. Métodos: diseño transversal y analítico, mediante un censo en 2011 conformado por 87 odontólogos. Se aplicó el Perfil de estrés y el Inventario de Síntomas de Estrés, el análisis se realizó con regresión múltiple. Resultados: los niveles de estrés percibido fueron: alto (67.8 %), medio (29.9 %) y bajo (2.3 %). El síntoma psicofisiológico más frecuente con el nivel alto de estrés percibido fue fatiga con 51 %, siendo el género femenino el más afectado. Se demostró la existencia de una asociación significativa entre los síntomas psicofiológicos de estrés crónico: insomnio, fatiga y género femenino con el nivel de estrés percibido alto. Conclusiones: La identificación temprana de los síntomas del estrés crónico en los odontólogos favorecería la puesta en práctica de programas de prevención adecuados para cuidar de su seguridad sanitaria en el lugar de trabajo.

Estrés académico y síntomas físcios, psicológicos y comportamentales en estudiantes mexicanos de una universidad pública / Academic stress and physical, psychological and behavioral factors in Mexican public university students

La capacidad de afrontamiento ante el estrés académico puede verse vulnerable en algunos estudiantes, manifestando varias alteraciones. Este artículo reporta la relación entre el estrés académico y sintomatología. Se compara los resultados entre hombres y mujeres. Se encuestó aleatoriamente a 527 estudiantes de una universidad pública en México. Con el Inventario de Estrés Académico y se utilizó la clasificación de Rossi. La regresión múltiple determinó que la sobrecarga académica y participación en clase fueron predictoras de síntomas físicos; trabajos obligatorios y en grupo, falta de tiempo, sobrecarga académica y participación en clase con síntomas psicológicos; trabajos obligatorios, sobrecarga académica, participación en clase y masificación en el aula con síntomas comportamentales; las mujeres presentan mayor frecuencia de estrés académico, síntomas físicos y psicológicos. Identificar oportunamente la presencia de condiciones generadoras de estrés puede prevenir síntomas, como somnolencia, fatiga, migraña, absentismo, inquietud, ansiedad, o problemas de memoria en estudiantes

The capacity to cope with academic stress can be deemed as vulnerable in some students who have shown several alterations. The article reports on the relationship among academic stress and symptomology. Results were compared between men and women. A survey of 527 public university students was taken in Mexico, with the Academic Stress Inventory using the Rossi Classification. Data were analyzed with multiple regression and it was deter-mined that academic overload and class participation were predictors of physical symptoms; mandatory and group work as well as insufficient time, academic overload, and class participation were predictors of psychological symptoms while mandatory work, academic overload and classroom participation and massification were predictors of behavioral symptoms. In addition, women showed a higher frequency of academic stress and of physical and psychological symptoms. So a timely identification of conditions that generate stress may lessen symptoms in students such as drowsiness, fatigue, migraines, absenteeism, restlessness, anxiety and/or memory problems

Hepatitis C virus recurrence after liver transplantation: how to treat and when.

Chronic hepatitis C (CHC) is an important cause of cirrhosis and hepatocellular carcinoma and a common indication of liver transplantation (LT). Recurrence of hepatitis C occurs universally after LT with an accelerated course of the natural history of CHC in the graft. Treatment of hepatitis C before transplantation is the most effective strategy because it prevents graft reinfection, but applicability is low with pegylated interferon regimens. Treatment after LT is the strategy more frequently used. A sustained viral response (SVR) is achieved by one-third of those treated with dual therapy and is associated with better outcomes after LT. Triple therapy with protease inhibitors after LT has efficacy to 60%-70% of SVR but is associated with higher rates of secondary effects and drug-drug interactions that require an intensified and frequent monitoring of calcineurin inhibitors during treatment. In the near future, interferon-free regimens with new oral antiviral drugs will likely prevent viral reinfection before or after LT, and shorter treatment regimens and less toxicity are expected.

Seguro Popular, condiciones psicosociales de trabajo y violencia en empleados de una institución de salud en méxico: un análisis desde el modelo de los determinantes sociales de la salud / Popular Health Insurance, psychosocial factors at workplace, and violence in employees from a health institution in Mexico: an analysis from the model of the social determinants of health

OBJETIVO : analizar el impacto de la implementación y operación del Seguro Popular en las condiciones psicosociales de trabajo y la exposición a situaciones y comportamientos de violencia de un grupo de trabajadores que laboran en una institución de salud. METODOLOGIA: se realizó un estudio cualitativo bajo el marco de la sociología fenomenológica. Se aplicó una encuesta a 206 trabajadores para valorar las condiciones psicosociales negativas en el entorno laboral. Posteriormente, se identificaron 18 sujetos caso por haber obtenido puntajes negativos altos en la encuesta y haber estado expuestos o haber participado en situaciones y comportamientos de violencia en el trabajo. RESULTADOS Y DISCUSIÓN :la implementación y operación del Seguro Popular provocó un deterioro y precarización de las condiciones psicosociales y del proceso de trabajo. La exposición a situaciones y comportamientos de violencia se manifestó como estrés , desgaste emocional, pérdida de la motivación, minusvalía y depresión. CONCLUSIONES : las reformas laborales y de la administración pública, expresadas en un nuevo modelo de gestión organizacional orientado a la eficiencia y reducción de costos prioriza los criterios administrativos y desestima la satisfacción y bienestar de los trabajadores.

OBJECTIVE: to analyze the impact of the implementation and operation of the Popular Health Insurance underwork psychosocial conditions and violence of a group of workers from a health institution. METHODOLOGY a qualitative study was realized under the framework of the phenomenological sociology. A survey was applied to two hundred six workers for the evaluation of the negative psychosocial conditions in the work environment. Later, it was identified to eighteen individual «cases¼for having obtained high negatives scores in the survey and having been exposed or for having taken part in situations and behaviors of violence at workplace. RESULTS AND DISCUSSION:the implementation and operation of the Popular Health Insurance provoked deterioration and precarious psychosocial conditions and work process alterations. Violence at workplace expressed like distress, emotional exhaustion, loss of motivation, disability and depression. CONCLUSIONS : labor and public administration, reforms in a new model of organizational management oriented to efficiency and cost reductions, prioritizes the administrative criteria and rejects the satisfaction and subjective well-being of workers.

Liver transplantation and hepatitis C.

Hepatitis C virus (HCV)-related end-stage cirrhosis with/without hepatocellular carcinoma is the primary indication for liver transplantation in many countries. Unfortunately, HCV is not eliminated by transplantation and graft re-infection is the rule, resulting in HCV-related graft disease. The natural history of recurrent hepatitis is variable; overall, progression to cirrhosis occurs in 20-30% and allograft failure in 10% after 5-10 years from transplantation. The use of poor quality organs, particularly from old donors, has a significant negative impact on disease severity and transplant outcome. In contrast, antiviral therapy, particularly if it results in permanent eradication of the virus, is associated with improved histology, reduced rate of graft decompensation and enhanced outcome. Disease monitoring, through protocol liver biopsies and new non-invasive tools, is essential to select patients at need of antiviral therapy. Peginterferon with ribavirin, used similarly to what is done in the non-transplant setting, is currently the treatment of choice; sustained viral response is achieved in about 35% of cases. Side effects, particularly anemia, are extremely frequent and sometimes severe (rejection, de novo autoimmune hepatitis). Retransplantation (RT) is the last option for the small subset of patients with allograft failure due to HCV recurrence who fulfil minimum criteria based on RT survival models.

Indications for and results of liver retransplantation.

Liver retransplantation (LReTx) is the therapeutic option for the irreversible failure of a hepatic graft. Our aim was to evaluate the rate of and indications for LReTx and actuarial patient survivals. Among 1260 LTx were 79 LReTx (6.3%). During the first LTx, there were no apparent differences between patients who did or did not required LReTx. The most frequent reasons were hepatic artery thrombosis (31.6%), recurrence of the VHC cirrhosis (30.4%), and primary graft failure (21.5%). The actuarial survivals at 1 and 5 years were 83% and 69% among those without LReTx versus 71% and 61% among early LReTx, and 64% and 34% among late LReTx (P < .001). Although there exists high morbidity and mortality with LReTx, it seems that this therapeutic alternative continues to be valid for patients with early hepatic loss, but not when the graft loss was late. It becomes necessary to define the minimal acceptable results that patient can benefit from LReTx.

Indications for and results of liver retransplantation.

Liver retransplantation (LRT) is the only therapeutic option for the irreversible failure of a hepatic graft. The aim of this study was to evaluate our rate, indications, postoperative morbidity and mortality and patient survival at one and 5 years after LRT. 1,260 liver transplants (LT) were performed between 1991 and 2006, 79 were LRT (6.3%). During the first LT, there were no apparent differences between patients who did or did not require LRT. The most common reasons for LRT were hepatic artery thrombosis (31.6%), recurrence of hepatitis C virus cirrhosis (30.4%) and primary graft non function (21.5%). The actuarial survival rates at one and 5 years were 83% and 69% among those without LRT versus 71% and 61% among those with early LRT, and 64% and 34% among those with late LRT (p < 0.001). Although high morbidity and mortality were associated with LRT, it seems that this therapeutic option is valid for patients with early hepatic loss, although not when the graft loss is late. It becomes necessary to define the minimal acceptable results so that patients can benefit from LRT.

Clinical benefits of antiviral therapy in patients with recurrent hepatitis C following liver transplantation.

Pegylated interferon (pegIFN) and ribavirin eradicates hepatitis C virus (HCV) in one third of liver recipients with recurrent disease. Side effects are frequent and potentially life threatening. Our aim was to define the long-term benefits of antiviral therapy in recurrent HCV. Eighty-nine (89) recipients (genotype 1: 86.5%) were treated with IFN (n = 31) or pegIFN (n = 58) plus ribavirin and 75 untreated contemporaneous disease-matched controls. The major end point was survival from transplantation. Survival, progression to cirrhosis and clinical decompensation since start of therapy were compared between sustained virologic responders (SVRs) and nonresponders (NRs). Results revealed 44 patients died during the follow-up (20% treated vs. 35% controls; p = 0.05). Patient survival was higher in treated compared to controls (7 years: 74% vs. 62%; p = 0.04). Among treated patients, an SVR was achieved in 37% (IFN 16% vs. peg-IFN 48%; p = 0.03). About 2/33 SVRs and 16/56 NRs died (p = 0.01) due to HCV-disease (56%), IFN-induced rejection (11%), both causes (11%) or others (22%). Five-year survival was greater in SVRs than in NRs (93% vs. 69%, p = 0.032). In patients without baseline cirrhosis, progression to cirrhosis occurred more frequently in NRs (27/42 vs. 6/16; p = 0.06). The 5-year risk of graft decompensation was higher in NRs (33% vs. 16%; p = 0.04). Antiviral therapy is associated with improved long-term outcome in recurrent HCV.

Tratamiento del paciente con cirrosis hepática descompensada por el virus de la hepatitis B / No disponible

No disponible

[Old donors in liver transplantation for chronic hepatitis C]. / Utilización de los donantes añosos en pacientes transplantados por cirrosis por virus C.

BACKGROUND: the natural history of recurrent hepatitis C after liver transplantation (LT) is extremely variable, with progression to allograft failure in a substantial proportion of patients. The identification of factors associated with this poorer outcome may improve results. While donor age has been identified as one of the most important factors, the actual options to modify this variable are limited. OBJECTIVES: a) to describe the natural history of HCV(+) liver transplant recipients depending on donor age ( < or = 50 years), including clinical, biochemical, and histological outcomes; and b) to identify in the subgroup of organ recipients from aged donors (= 50 years) factors associated with an aggressive course. METHODS: a retrospective study of clinical and histological data including protocol liver biopsies for 162 HCV (+) liver transplant patients between 1997 and 2001 with at least one year of follow-up. Aggressive recurrent hepatitis C was defined as a progression to fibrosis > 1 during the first year post-LT, development of a cholestatic form of recurrent hepatitis C, and /or graft failure due to HCV during the first five years post-LT. Factors analyzed as potentially associated with recurrent hepatitis C included: a) recipient-related: demographics (age, sex), pre-transplantation (hepatocellular carcinoma, Child-Pugh classification, history of alcohol, HBV serological markers, antiviral treatment, nutritional status, biochemical variables); b) donor-related: demographics (age, sex), cause of death, grade of steatosis defined as minimal vs. moderate-severe > 10%); c) surgery-related: cold preservation and rewarming time, duration of procedure, blood transfusion; and d) post-LT management-related: immunosuppression, liver enzymes in the first 14 days post-LT, acute hepatitis post-LT, surgical complications (vascular and/or biliary). RESULTS: patients were divided into two groups according to donor age group 1 ( < 50 years), n = 83, 51%, and group 2 (= 50 years), n = 79, 49%). Median follow-up was 5 years (range: 3 months-8.5 years). Aggressive recurrent hepatitis C occurred significantly more frequently in the older donor group (64 vs. 20.5%, p < 0.0001). In this group, potent immunosuppression -triple and quadruple regimens- (p = 0.04) and acute hepatitis post-LT (p = 0.03) were the only variables associated with aggressive recurrence. Degree of donor steatosis was not associated with the prognosis of recurrent hepatitis C. CONCLUSION: the use of aged donors is partly responsible for the accelerated progression of hepatitis C after LT. When old donors are used we should avoid over-immunosuppression, and probably evaluate antiviral therapy in those with acute recurrent hepatitis C.

Utilización de los donantes añosos en pacientes trasplantados por cirrosis por virus C / Old donors in liver transplantation for chronic hepatitis C

Introducción: la historia natural de la hepatitis C recurrentetras el trasplante hepático (TH) es muy heterogénea, existiendoun porcentaje no despreciable de pacientes con evolución desfavorable.La identificación de factores asociados con peor evoluciónpuede ayudar a mejorar el pronóstico de estos pacientes. Laedad del donante se perfila como uno de los factores más importantes,pero es una variable difícilmente modificable.Objetivos: a) describir la historia natural de los receptoresVHC (+) en función de la edad del donante (< o ≥ 50 años) incluyendola evolución clínica, analítica e histológica; b) identificar enel grupo de receptores de donantes >= 50 años, aquellos factoresprecoces asociados con una evolución agresiva.Métodos: estudio descriptivo y retrospectivo de la evolución clínicae histológica mediante biopsias de protocolo, de 162 trasplantadosVHC (+) entre 1997-2001 con tiempo de seguimiento post-trasplantede al menos 12 meses. La hepatitis C relevante del injerto se definiópor la progresión a fibrosis mayor a 1 durante el primer año, desarrollode hepatitis colestásica fibrosante y/o pérdida del injerto por enfermedadVHC recurrente en cualquier momento durante los primeros5 años. Los factores analizados como posibles factores predictivos dehepatitis C relevante fueron: a) relacionados con el receptor: demográficos(edad, sexo), pre-trasplante (hepatocarcinoma, estadio deChild, alcohol, marcadores serológicos del VHB, tratamiento antiviral,estado nutricional, analítica); b) relacionados con el donante: demográficos(edad, sexo), causa de fallecimiento, grado de esteatosisdefinido como ausente o mínima vs. moderada-grave > 10%; c) relacionadoscon la cirugía: tiempos isquemia fría y recalentamiento,duración intervención, número de concentrados de hematíes transfundidos;y d) relacionados con el post-trasplante: inmunosupresión,analítica en el post-TH precoz (< 14 días), hepatitis aguda post-TH, complicaciones quirúrgicas precoces (vasculares y/o biliares).Resultados: los pacientes se dividieron en dos grupos segúnla edad del donante (< 50 años = grupo 1, n = 83, 51% y >= 50años = grupo 2, n = 79, 49%). La mediana de seguimiento fuede 5 años (rango: 3 meses-8,5 años). El desarrollo de enfermedadrelevante fue significativamente mayor en el grupo de donanteañoso (64 vs. 20,5%, p < 0,0001). En este grupo, la inmunosupresiónpotente –triple/cuadruple terapia– (p = 0,04) y eldesarrollo de hepatitis aguda post-TH (p = 0,03) fueron las únicas variables asociadas con el desarrollo de hepatitis relevante. Elgrado de esteatosis del donante no se asoció con el pronósticode la hepatitis C recurrente.Conclusión: la utilización de donantes añosos es, en parte,responsable de la progresión acelerada de la hepatitis tras el trasplantehepático. En caso de donantes añosos, debe evitarse la sobre-inmunosupresión y valorar la posibilidad de administrar tratamientoantiviral en los pacientes con hepatitis aguda recurrente

Background: the natural history of recurrent hepatitis C afterliver transplantation (LT) is extremely variable, with progression toallograft failure in a substantial proportion of patients. The identificationof factors associated with this poorer outcome may improveresults. While donor age has been identified as one of themost important factors, the actual options to modify this variableare limited.Objectives: a) to describe the natural history of HCV(+) livertransplant recipients depending on donor age (< or >= 50 years),including clinical, biochemical, and histological outcomes; and b)to identify in the subgroup of organ recipients from aged donors(>= 50 years) factors associated with an aggressive course.Methods: a retrospective study of clinical and histological dataincluding protocol liver biopsies for 162 HCV (+) liver transplantpatients between 1997 and 2001 with at least one year of followup.Aggressive recurrent hepatitis C was defined as a progressionto fibrosis > 1 during the first year post-LT, development of acholestatic form of recurrent hepatitis C, and /or graft failure dueto HCV during the first five years post-LT. Factors analyzed aspotentially associated with recurrent hepatitis C included: a) recipient-related: demographics (age, sex), pre-transplantation (hepatocellularcarcinoma, Child-Pugh classification, history of alcohol,HBV serological markers, antiviral treatment, nutritional status,biochemical variables); b) donor-related: demographics (age, sex),cause of death, grade of steatosis defined as minimal vs. moderate-severe > 10%); c) surgery-related: cold preservation and rewarmingtime, duration of procedure, blood transfusion; and d)post-LT management-related: immunosuppression, liver enzymesin the first 14 days post-LT, acute hepatitis post-LT, surgical complications(vascular and/or biliary).Results: patients were divided into two groups according todonor age group 1 (< 50 years), n = 83, 51%, and group 2 (≥ 50years), n = 79, 49%). Median follow-up was 5 years (range: 3months-8.5 years). Aggressive recurrent hepatitis C occurred significantlymore frequently in the older donor group (64 vs.20.5%, p < 0.0001). In this group, potent immunosuppression–triple and quadruple regimens– (p = 0.04) and acute hepatitispost-LT (p = 0.03) were the only variables associated with aggressiverecurrence. Degree of donor steatosis was not associated withthe prognosis of recurrent hepatitis C. Conclusion: the use of aged donors is partly responsible forthe accelerated progression of hepatitis C after LT. When olddonors are used we should avoid over-immunosuppression, andprobably evaluate antiviral therapy in those with acute recurrenthepatitis C

Actualización del trasplante hepático en la hepatitis C crónica / No disponible

No disponible

Profilaxis de la hepatitis B después de trasplante hepático y tratamiento de la recidiva / Hepatitis B prophylaxis following liver transplantation and treatment of recurrence

No disponible

No disponible

Indicadores de calidad en la gestión del personal / Quality indicators in personnel management

El desarrollo de sistemas de evaluación que midan el desempeño y motiven al cumplimiento de las metas institucionales es fundamental en la gestión del personal. Nuestro centro ha desarrollado indicadores de calidad y productividad que pueden ser utilizados con este fin. La reducción de la capacidad instalada, de dos a un tomógrafo computado y de cinco a cuatro salas de radiología convencional, además de los distintos cambios en los procesos, hicieron imprescindible un aumento en las competencias del personal de las unidades involucradas.