Difficulties of gender affirming treatment in trans women with BRCA1+ mutation: A case report.

Gender affirming treatment in transgender women is based on a combination of antiandrogens and estrogens, with the latter maintained over the long term. When prescribing these treatments, we must consider the possibility of developing estrogen-dependent breast cancer. In transgender women, a breast cancer incidence of 4.1 per 100,000 has been estimated, which would increase the risk by 46% in relation to cisgender men but decrease it by 70% in relation to cisgender women. It is known that certain gene mutations such as BRCA1 imply an increased risk of breast cancer, but at present the risk in transgender women with BRCA1 treated with estrogens is not well established. We present the case of a transgender woman with a family history of breast cancer and BRCA1 mutation and the therapeutic decisions made in a multidisciplinary team. Following this case, we review and discuss the published literature.

Necrotizing external otitis: diagnostic clues in the emergency department.

PURPOSE: The assessment of necrotizing external otitis requires a high index of suspicion by the attending physician. The purpose of the study is to determine the accuracy of parameters available at the Emergency Department for the diagnosis of this pathology. METHODS: Retrospective diagnostic accuracy study. Patients consulting at the Emergency Department for longstanding ear swelling, severe otalgia, and failure to respond to topical treatment were included. Otoscopy, physical examination, CT appearance, and analytical results were tested for the diagnosis of necrotizing external otitis, using nuclear imaging as gold standard. Sensitivity, specificity, likelihood ratios and ROC curves were calculated. RESULTS: 24 patients were included; 13 cases were necrotizing external otitis, and 11 cases were other external ear pathologies. Erythrocyte sedimentation rate and C-reactive protein levels were significantly associated with necrotizing external otitis (AUC 0.92 p < 0.001, and 0.8 p < 0.001). Positive likelihood ratios were 10.15 for values of erythrocyte sedimentation rate over 26 mm/h, and 8.25 for C-reactive protein levels over 10 mg/L. Negative likelihood ratios were 0.08 and 0.28, respectively. These results were significant. The rest of clinical and radiological parameters were less accurate. CONCLUSIONS: Erythrocyte sedimentation rate and C-reactive protein are useful parameters in the evaluation of a case of longstanding otitis with clinical suspicion of necrotizing external otitis. If any of them is elevated, the probability of suffering this condition is significantly increased. If they are within normal ranges, an alternative diagnosis should be sought.

Prescribing the dialysis dose and treatment frequency in home haemodialysis.

BACKGROUND: There is growing interest in home haemodialysis (HHD) performed with low-flow dialysate devices and variable treatment schedules. The target standard Kt/V (stdKt/V) should be 2.3 volumes/week, according to KDOQI guidelines (2015). The current formula for stdKt/V does not help prescribe the dialysis dose (eKt/V) and treatment frequency (TF). The aim of this study was to obtain a formula for stdKt/V that is able to define the minimum required values of eKt/V and TF to achieve the targeted stdKtV. METHODS: Thirty-eight prevalent patients on HHD were enrolled. A total of 231 clinical datasets were available for urea modelling using the Solute-Solver software (SS), recommended by KDOQI guidelines. A new formula (stdKt/V = a + b × Kru + c × eKt/V) was obtained from multivariable regression analysis of stdKt/V vs eKt/V and residual kidney urea clearance (Kru). The values of coefficients a, b and c depend on the treatment schedules and the day of the week of blood sampling for the kinetic study (labdayofwk) and then vary for each of their foreseen 62 combinations. For practical purposes, we used only seven combinations, assuming Monday as a labdayofwk for each of the most common schedules of the 7 days of the week. RESULTS: The stdKt/V values obtained with SS were compared with the paired ones obtained with the formula. The mean ± standard deviation stdKt/V values obtained with SS and the formula were 3.043 ± 0.530 and 2.990 ± 0.553, respectively, with 95% confidence interval +0.15 to -0.26. A 'prescription graph' was built using the formula to draw lines expressing the relationship between Kru and required eKt/V for each TF. Using this graph, TF could have been reduced from the delivered 5.8 ± 0.8 to 4.8 ± 0.8 weekly sessions. CONCLUSIONS: The new formula for stdKtV is reliable and can support clinicians to prescribe the dialysis dose and TF in patients undergoing HHD.

Opportunities to improve the management of anemia in peritoneal dialysis patients: lessons from a national study in routine clinical practice.

Background: Current guidelines establish the same hemoglobin (Hb) and iron biomarkers targets for hemodialysis (HD) and peritoneal dialysis (PD) in patients receiving erythropoiesis-stimulating agents (ESAs) even though patients having PD are usually younger, more active and less comorbid. Unfortunately, specific renal anemia [anemia in chronic kidney disease (aCKD)] trials or observational studies on PD are scanty. The aims of this study were to describe current aCKD management, goals and adherence to clinical guidelines, identifying opportunities for healthcare improvement in PD patients. Methods: This was a retrospective, nationwide, multicentre study including patients from 19 PD units. The nephrologists collected baseline data, demographics, comorbidities and data related to anemia management (laboratory values, previously prescribed treatments and subsequent adjustments) from electronic medical records. The European adaptation of KDIGO guidelines was the reference for definitions, drug prescriptions and targets. Results: A total of 343 patients (mean age 62.9 years, 61.2% male) were included; 72.9% were receiving ESAs and 33.2% iron therapy [20.7% intravenously (IV)]. Eighty-two patients were receiving ESA without iron therapy, despite 53 of them having an indication according to the European Renal Best Practice guidelines. After laboratory results, iron therapy was only started in 15% of patients. Among ESA-treated patients, 51.9% had an optimal control [hemoglobin (Hb) 10-12 g/dL] and 28.3% between 12-12.9 g/dL. Seventeen patients achieved Hb >13 g/dL, and 12 of them remained on ESA after overshooting. Only three patients had Hb <10 g/dL without ESAs. Seven patients (2%) met criteria for ESA resistance (epoetin dose >300 IU/kg/week). The highest tertile of erythropoietin resistance index (>6.3 UI/kg/week/g/dL) was associated with iron deficiency and low albumin corrected by renal replacement therapy vintage and hospital admissions in the previous 3 months. Conclusion: Iron therapy continues to be underused (especially IV). Low albumin, iron deficiency and prior events explain most of the ESA hyporesponsiveness. Hb targets are titrated to/above the upper limits. Thus, several missed opportunities for adequate prescriptions and adherence to guidelines were identified.

Reliable, standardized measurements for cell mechanical properties.

Atomic force microscopy (AFM) has become indispensable for studying biological and medical samples. More than two decades of experiments have revealed that cancer cells are softer than healthy cells (for measured cells cultured on stiff substrates). The softness or, more precisely, the larger deformability of cancer cells, primarily independent of cancer types, could be used as a sensitive marker of pathological changes. The wide application of biomechanics in clinics would require designing instruments with specific calibration, data collection, and analysis procedures. For these reasons, such development is, at present, still very limited, hampering the clinical exploitation of mechanical measurements. Here, we propose a standardized operational protocol (SOP), developed within the EU ITN network Phys2BioMed, which allows the detection of the biomechanical properties of living cancer cells regardless of the nanoindentation instruments used (AFMs and other indenters) and the laboratory involved in the research. We standardized the cell cultures, AFM calibration, measurements, and data analysis. This effort resulted in a step-by-step SOP for cell cultures, instrument calibration, measurements, and data analysis, leading to the concordance of the results (Young's modulus) measured among the six EU laboratories involved. Our results highlight the importance of the SOP in obtaining a reproducible mechanical characterization of cancer cells and paving the way toward exploiting biomechanics for diagnostic purposes in clinics.

Validation of formulas calculating normalized protein catabolic rate in patients undergoing home hemodialysis.

Depner and Daugirdas developed a simplified formula to estimate the normalized protein catabolic rate in patients on twice- or thrice-weekly hemodialysis (JASN, 1996). The aim of our work was to establish formulas in more frequent schedules and validate them in home-based hemodialysis patients. We realized that the structure of Depner and Daugirdas' normalized protein catabolic rate formulas has a general meaning and can be expressed as PCRn = C0/[a + b*(Kt/V) + c/(Kt/V)] + d, where C0 is pre-dialysis blood urea nitrogen, Kt/V is dialysis dose, a, b, c, d are the specific coefficients for each combination of home-based hemodialysis schedules and the day of blood sampling. The same applies to the formula that adjusts C0 (C'0) for residual kidney clearance of blood water urea (Kru) and urea distribution volume (V): C'0 = C0*[1 + (a1 + b1/(Kt/V))*Kru/V]. On this basis, we computed the six coefficients (a, b, c, d, a1, b1) for each of the 50 possible combinations and simulated a total of 24,000 weekly dialysis cycles using the Daugirdas Solute Solver software recommended by the KDOQI 2015 guidelines. From the associated statistical analyses we obtained 50 sets of coefficient values, which were validated comparing the paired normalized protein catabolic rate values (i.e., those estimated with our formulas with those modeled with Solute Solver) in 210 datasets of 27 patients on home-based hemodialysis. The mean values ± SD were 1.06 ± 0.262 and 1.07 ± 0.283 g/kg/day, respectively, with a mean difference of 0.004 ± 0.034 g/kg/day (p = 0.11). The paired values were highly correlated (R2 = 0.99). In conclusion, even if the coefficient values were validated in a relatively small sample of patients, they allow an accurate estimation of normalized protein catabolic rate in home-based hemodialysis patients.

Influence of cantilever tip geometry and contact model on AFM elasticity measurement of cells.

We have measured the elastic properties of live cells by Atomic Force Microscope (AFM) using different tip geometries commonly used in AFM studies. Soft 4-sided pyramidal probes (spring constant = 12 and 30 mN/m, radius 20 nm), 3-sided pyramidal probes (spring constant = 100 mN/m, radius 65-75 nm), flat (circular) probes (spring constant = 63 mN/m, radius 290 nm) and spherical probes (spring constant = 43 mN/m, radius 5 µm) have been used. Cells (3T3 fibroblasts) having elastic moduli around 0.5 kPa were investigated. We found that cell measured stiffness shows a systematic dependence on tip geometry: the sharper the tip, the higher the average modulus values. We hypothesize that the blunter the tip, the larger the contact area over which the mechanical response is measured or averaged. If there are small-scale stiffer areas (like actin bundles) they will be easier to pick up by a sharp probe. This effect can be seen in the wider distribution of the histograms of the measured elastic moduli on cells. Furthermore, non-linear responses of cells may be present due to the high average pressures applied by sharp probes, which would lead to an overestimation of the Young's modulus. Pressure versus contact radius simulations for the different tip geometries for a 0.5 kPa sample suggested similar average pressure for Bio-MLCTs, PFQNM and cut tips, except spherical tips that showed much lower average pressure at the same 400 nm indentation. However, real data of the cells suggested different results. Using the same indentation depth (400 nm), PFQNM and Bio-MLCTs showed similar average pressure and it decreased for cut and spherical tips. The calculated contact area at 400 nm cell indentation, using the obtained apparent Young's modulus for each tip geometry, showed the following distribution: Bio-MLCTs < PFQNM < cut << spherical. In summary, tip geometry as well as average pressure and tip-sample contact area are important parameters to take into account when measuring mechanical properties of soft samples. The larger the tip radius, the larger the contact area that will lead to a more evenly distribution of the applied pressure.

Comparison of Rheological Properties of Healthy versus Dupuytren Fibroblasts When Treated with a Cell Contraction Inhibitor by Atomic Force Microscope.

Mechanical properties of healthy and Dupuytren fibroblasts were investigated by atomic force microscopy (AFM). In addition to standard force curves, rheological properties were assessed using an oscillatory testing methodology, in which the frequency was swept from 1 Hz to 1 kHz, and data were analyzed using the structural damping model. Dupuytren fibroblasts showed larger apparent Young's modulus values than healthy ones, which is in agreement with previous results. Moreover, cell mechanics were compared before and after ML-7 treatment, which is a myosin light chain kinase inhibitor (MLCK) that reduces myosin activity and hence cell contraction. We employed two different concentrations of ML-7 inhibitor and could observe distinct cell reactions. At 1 µM, healthy and scar fibroblasts did not show measurable changes in stiffness, but Dupuytren fibroblasts displayed a softening and recovery after some time. When increasing ML-7 concentration (3 µM), the majority of cells reacted, Dupuytren fibroblasts were the most susceptible, not being able to recover from the drug and dying. These results suggested that ML-7 is a potent inhibitor for MLCK and that myosin II is essential for cytoskeleton stabilization and cell survival.

Nanomechanical Study of Enzyme: Coenzyme Complexes: Bipartite Sites in Plastidic Ferredoxin-NADP+ Reductase for the Interaction with NADP.

Plastidic ferredoxin-NADP+ reductase (FNR) transfers two electrons from two ferredoxin or flavodoxin molecules to NADP+, generating NADPH. The forces holding the Anabaena FNR:NADP+ complex were analyzed by dynamic force spectroscopy, using WT FNR and three C-terminal Y303 variants, Y303S, Y303F, and Y303W. FNR was covalently immobilized on mica and NADP+ attached to AFM tips. Force-distance curves were collected for different loading rates and specific unbinding forces were analyzed under the Bell-Evans model to obtain the mechanostability parameters associated with the dissociation processes. The WT FNR:NADP+ complex presented a higher mechanical stability than that reported for the complexes with protein partners, corroborating the stronger affinity of FNR for NADP+. The Y303 mutation induced changes in the FNR:NADP+ interaction mechanical stability. NADP+ dissociated from WT and Y303W in a single event related to the release of the adenine moiety of the coenzyme. However, two events described the Y303S:NADP+ dissociation that was also a more durable complex due to the strong binding of the nicotinamide moiety of NADP+ to the catalytic site. Finally, Y303F shows intermediate behavior. Therefore, Y303, reported as crucial for achieving catalytically competent active site geometry, also regulates the concerted dissociation of the bipartite nucleotide moieties of the coenzyme.

Extracción de calostro durante la gestación. Reporte de un caso / Colostrum extraction during pregnancy. Report of a case

Se expone el caso de una mujer que inicia la extracción prenatal de calostro en la semana 32 + 6 de gestación, tras ser informada del diagnóstico que justifica la finalización de la gestación a las 33 + 6 semanas de amenorrea mediante una cesárea programada. La madre logró así alimentar a su hijo en sus primeras horas de vida con el calostro materno extraído y estableció una lactancia materna exitosa. (AU)

A case is presented of a woman who began prenatal colostrum extraction at week 32 + 6 of gestation after being informed of the diagnosis that justifies termination of pregnancy at 33 + 6 weeks of amenorrhea through a scheduled cesarean section; managing to feed her child in the first hours of life with the maternal colostrum extracted and establishing successful breastfeeding. (AU)

Comportamiento de la sepsis en el Hospital Pediátrico Provincial Docente Eduardo Agramonte Piña

Introducción: En la actualidad la sepsis es considerada una de las principales causas de disfunción orgánica múltiple y del incremento en la mortalidad de los pacientes que son diagnosticados en los servicios de urgencias. El impacto es negativo en la salud de la población y los gastos generados en el sistema de salud se calculan en varios miles de millones de dólares. Objetivo: Determinar el comportamiento de la sepsis en el Hospital Pediátrico Provincial Docente Eduardo Agramonte Piña. Métodos: Se realizó un estudio observacional descriptivo, retrospectivo de corte transversal para determinar el comportamiento de la sepsis en el Hospital Pediátrico Provincial Docente Eduardo Agramonte Piña desde el 1ro de enero del año 2016 al 31 de diciembre de 2020. El universo de estudio estuvo constituido por todos los niños ingresados 1 180 con ese diagnóstico en dicho hospital que cumplieron con los criterios de inclusión y exclusión. Resultados: Se observó una tendencia descendente de los casos de sepsis desde el año 2016 hasta el año 2020. Con predominio del grupo de edad de 1-4 años y sexo masculino. El diagnóstico principal que motivó la sepsis fue la infección respiratoria aguda seguida de la neumonía. El 90,1 % de los pacientes egresaron vivos. Conclusiones: Reconociendo que la sepsis es una prioridad, se hace necesario su ingreso precoz en las unidades de terapia intensiva, para lograr un manejo integral de estos pacientes y de esta forma reducir la mortalidad por esta causa.

Introduction: Currently, sepsis is considered one of the main causes of multiple organ dysfunction and the increase in mortality of patients diagnosed in emergency services. The impact is negative on the health of the population, and the expenses generated in the health system are estimated at several billion dollars. Objective: To determine the behavior of sepsis in the Eduardo Agramonte Piña Provincial Pediatric Hospital. Methods: A cross-sectional, retrospective descriptive, observational study was carried out to determine the behavior of sepsis at the Eduardo Agramonte Piña Provincial Pediatric Hospital from January 1st, 2016 to December 31st, 2020. The universe of the study consisted of all the children admitted (1 180) with this diagnosis to the hospital who met the inclusion and exclusion criteria. Results: A downward trend in sepsis cases was observed from 2016 to 2020. With a predominance of the age group of 1-4 years and male sex. The main diagnosis was acute respiratory infections followed by pneumonia. Most of the patients(90.1 %) were discharged alive. Conclusions: Recognizing that sepsis is a priority, early admission to intensive care units is necessary to achieve comprehensive management of these patients and thus reduce mortality from this cause.

Análisis de las infecciones del orificio de salida del catéter peritoneal. Efectividad de un protocolo basado en la aplicación de mupirocina tópica diaria / Analysis of peritoneal catheter exit-site infections. Effectiveness of a protocol based on daily topical mupirocin application

Objetivos: Analizar las infecciones del orificio de salida del catéter peritoneal, identificando los principales factores relacionados con las mismas; asimismo se ha comparado la efectividad de un protocolo basado en la utilización diaria de mupirocina tópica en la cura del orificio de salida frente a la utilización suero salino.Material y Método:Estudio observacional, retrospectivo. Recogimos variables demográficas, clínicas, la etiología y evolución de los episodios de infección del orificio en un periodo de 2 años. Utilizamos un protocolo de profilaxis con suero fisiológico y con mupirocina crema al 2%.Resultados:Estudiamos 75 pacientes, edad media 60,3±13,9 años, 66,7% varones, mediana de tiempo en diálisis peritoneal 24,3 meses (rango intercuartílico 11-48,7). La incidencia de infección del orificio de salida fue del 26,7%, el 77% fueron originadas por microorganismos de piel y mucosas. La infección del orificio de salida se relacionó con el estado portador nasal de Staphylococcus aureus (p=0,048) y la extrusión del dacron externo (p=0,004). De los 4 pacientes que presentaron una peritonitis secundaria a la infección del orificio de salida, 3 fueron trasferidos a hemodiálisis (p=0,025). Con el protocolo de antibioterapia tópica diaria se redujo un 68% la tasa de infecciones.Conclusiones:La exteriorización del anillo externo del catéter peritoneal es un factor predisponente de infecciones. La aplicación diaria de mupirocina es una estrategia efectiva para reducir la incidencia de infección del orificio y peritonitis. La erradicación de portadores nasales de Staphylococcus aureus puede contribuir a reducir la pérdida del catéter y la transferencia a hemodiálisis. (AU)

Objectives: To analyze the characteristics of catheter related exit-site infections, identifying the main related factors. Likewise, the effectiveness of a protocol based on the daily use of topical mupirocin in the exit site prophylaxis strategy has been compared with the use of saline solution.Material and Method: Observational retrospective study. Demographic and clinical variables, the etiology and evolution of the episodes of infection of the orifice in a period of 2 years were collected. A prophylaxis protocol with saline solution and 2% mupirocin cream was used.Results:We recruited 75 patients, mean age 60.3±13.9 years, 66.7% male, median time on peritoneal dialysis 24.3 months (interquartile range 11-48.7). The incidence of exit site infection was 26.7%, 77% were produced by skin and mucous microorganisms. The exit site infection was associated to Staphylococcus aureus nasal carriage (p=0.048) and the superficial cuff extrusion (p=0.004). 4 of the patients who presented peritonitis secondary to exit site infection, 3 were switch to hemodialysis (p=0.025). Daily topical antibiotic therapy protocol reduced the exit site infection rate by 68%.Conclusions:The superficial cuff externalization is a predisposing factor for infections. Daily application of mupirocin is an effective strategy in reducing the incidence of exit site infections and peritonitis. The eradication of nasal carriers of Staphylococcus aureus can help reduce catheter loss and transfer to hemodialysis. (AU)

The role of an electronic alert system to detect acute kidney injury in hospitalized patients: DETECT-H Project / Utilidad de un sistema de alerta electrónica para la detección de fracaso renal agudo en pacientes hospitalizados. Proyecto DETECT-HP

BACKGROUND AND AIMS: Acute kidney injury (AKI) is associated with higher mortality and length of stay (LOS) for hospitalized patients. To improve outcomes, an electronic detection system could be a useful tool for early diagnosis. METHODS: A fully automated real-time system for detecting decreased glomerular filtration rate in adult patients was developed in our hospital, DETECT-H project. AKI was established according to KDIGO guidelines. RESULTS: In six months, 1241 alerts from 11,022 admissions were issued. Overall incidence of AKI was 7.7%. Highest AKI stage reached was: stage 1 (49.8%), 2 (24.5%) and 3 (25.8%), in-hospital mortality was 10.9%, 22.7%, 33.9% respectively and 57.1% in AKI requiring dialysis; mortality in stable CKD was 4.3%. Median LOS was 8 days versus 5 days for all patients. AKI was associated with a mortality of 3.18 (95% CI 1.80-5.59) and a LOS 1.52 (1.11-2.08) times as high as that for admissions without AKI. Multivariate analysis indicated that a LOS higher than 8 days was associated with AKI. Previous CKD was noted in 31.9% and AKI in 45.3% at discharge. As compared to the use of the detect system, only one third of CKD patients and half of AKI episodes were identified. CONCLUSIONS: CKD and in-hospital AKI are under-recognized entities. Mortality and LOS are increased in-hospital patients with renal dysfunction. AKI severity was associated with higher mortality and LOS. An automated electronic detection system for identifying renal dysfunction would be a useful tool to improve renal outcomes

INTRODUCCIÓN Y OBJETIVOS: El fracaso renal agudo (FRA) aumenta la mortalidad y la estancia hospitalarias (EH). El empleo de sistemas de detección electrónica podría ser una herramienta beneficiosa para mejorar estos resultados. MÉTODOS: Se desarrolló un sistema de detección automático a tiempo real de pacientes ingresados con función renal alterada, denominado proyecto DETECT-H. El FRA se estableció de acuerdo con las guías KDIGO. RESULTADOS: En 6 meses, 1.241 alertas fueron recogidas de 11.022 ingresos. La incidencia global del FRA fue del 7,7%. La distribución en función del estadio máximo del FRA alcanzado fue: estadio 1: 49,8%, estadio 2: 24,5% y estadio 3: 25,8%; con una mortalidad hospitalaria del 10,9, 22,7 y 33,9%, respectivamente. En el caso del FRA con necesidad de diálisis fue del 57,1%. La mortalidad en pacientes con enfermedad renal crónica (ERC) estable fue del 4,3%. La mediana de EH en pacientes detectados fue 8 vs. 5 días para todos los pacientes hospitalizados. El FRA se asoció con una mortalidad 3,18 (1,8-5,59) y una EH 1,52 (1,11-2,08) veces superior que aquellos ingresos sin FRA. El análisis multivariante indicó que el FRA se asociaba con la EH > 8 días. En los informes de alta, la presencia de ERC previa solo fue registrada en el 31,9% de los pacientes con ERC y el FRA hospitalario en el 45,3%. Conclusiones : La ERC y el FRA intrahospitalario son entidades infradiagnosticadas. La mortalidad y la EH están aumentadas en pacientes con disfunción renal. La gravedad del FRA se asoció con mayor mortalidad y EH. Un sistema de detección automático para identificarlos podría ser útil para mejorar estos resultados

Evolocumab para el tratamiento de la hipercolesterolemia familiar heterocigota en enfermedad renal crónica avanzada y diálisis / Evolocumab for the treatment of heterozygous familial hypercholesterolemia in end-stage chronic kidney disease and dialysis

No disponible

The role of an electronic alert system to detect acute kidney injury in hospitalized patients: DETECT-H Project.

BACKGROUND AND AIMS: Acute kidney injury (AKI) is associated with higher mortality and length of stay (LOS) for hospitalized patients. To improve outcomes, an electronic detection system could be a useful tool for early diagnosis. METHODS: A fully automated real-time system for detecting decreased glomerular filtration rate in adult patients was developed in our hospital, DETECT-H project. AKI was established according to KDIGO guidelines. RESULTS: In six months, 1241 alerts from 11,022 admissions were issued. Overall incidence of AKI was 7.7%. Highest AKI stage reached was: stage 1 (49.8%), 2 (24.5%) and 3 (25.8%), in-hospital mortality was 10.9%, 22.7%, 33.9% respectively and 57.1% in AKI requiring dialysis; mortality in stable CKD was 4.3%. Median LOS was 8 days versus 5 days for all patients. AKI was associated with a mortality of 3.18 (95% CI 1.80-5.59) and a LOS 1.52 (1.11-2.08) times as high as that for admissions without AKI. Multivariate analysis indicated that a LOS higher than 8 days was associated with AKI. Previous CKD was noted in 31.9% and AKI in 45.3% at discharge. As compared to the use of the detect system, only one third of CKD patients and half of AKI episodes were identified. CONCLUSIONS: CKD and in-hospital AKI are under-recognized entities. Mortality and LOS are increased in-hospital patients with renal dysfunction. AKI severity was associated with higher mortality and LOS. An automated electronic detection system for identifying renal dysfunction would be a useful tool to improve renal outcomes.

Amiloidosis secundaria (AA) a infecciones de repetición en el síndrome de hipergammaglobulinemia IgE / AA amyloidosis associated with recurrent infections in the hyperimmunoglobulin E syndrome

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Absceso alveolar agudo en pacientes mayores de 19 años. Municipio Unión de Reyes / Acute alveolar abscess in patients elder 19 years old. Municipality Union de Reyes

Introducción: frecuentemente las infecciones de la cavidad bucal son el resultado del deterioro que provoca la caries con exposición de la pulpa dental. Una higiene dental descuidada o inadecuada, y complicaciones asociadas a enfermedades periodontales, son otras de las causas, que pueden incidir en la aparición de procesos infecciosos. Objetivo: caracterizar el comportamiento del absceso alveolar agudo en los pacientes mayores de 19 años en la consulta de urgencia estomatológica del poblado de Alacranes, Municipio Unión de Reyes. Materiales y Métodos: se realizó un estudio observacional descriptivo en pacientes mayores de 19 años, del área de Alacranes municipio Unión de Reyes. El universo de estudio estuvo constituido por los pacientes que acudieron a la consulta de urgencia estomatológica, de enero de 2011 a enero 2012. Con previo consentimiento informado la muestra la constituyó 135 pacientes, con patológica de absceso alveolar agudo, teniendo en cuenta las variables: edad, sexo, etiología y complicaciones. Los datos obtenidos fueron registrados en una base de datos y se procesaron estadísticamente. Resultados: los grupos de 20-29 años y el sexo masculino fueron los más afectados, con 38 % y 54.8 %, respectivamente. La causa fundamental fue la caries dental con un 91.8 %. La celulitis facial resultó la complicación más frecuente. Conclusiones: la etiología más usual del absceso alveolar agudo fue la caries dental. Los pacientes afectados que no recibieron una puntual asistencia sufrieron complicaciones (AU).

Introduction: frequently, oral cavity infections are due to the deterioration caused by caries with dental pulp exposition. An inadequate and careless dental hygiene and complications associated to periodontal diseases are other reasons the may lead to the occurrence of infectious processes. Objective: Characterise the behaviour of the absceso alveolar acute in the greater patients of 19 years in the query of urgency estomatológica of the populated of Alacranes, municipality Union de Reyes. Materials and Methods: a descriptive, observational study was carried out in patients elder 19 years old, in the health area Alacranes, municipality Union de Reyes. The studied universe was formed by the patients assisting to the dentist emergency consultation from January 2011 to January 2012. With previous informed consent, the sample was formed by 135 patients with acute alveolar abscess, taking into account the following variables: age, sex, etiology and complications. The obtained data were recorded in the database and statistically processed. Results: the most affected groups were the 20-29 years-old group and the male sex, with 38 % and 54.8 % respectively. Dental caries was the main cause with 91.8 %. Facial cellulitis was the most frequent complication. Conclusions: dental caries was the most usual etiology of the acute alveolar abscess. The affected patients who did not receive opportune health care suffered complications (AU).