Acute Kidney Injury and Urinary and Histopathological Disorders in Kidney Transplant Patients with SARS-CoV-2 Infection.

BACKGROUND: Acute kidney injury (AKI) is a manifestation of SARS-CoV-2 infection. The evidence in kidney transplant (KT) is limited, as there are scarce data about the histologic features in graft biopsies of these patients. MATERIAL AND METHODS: A retrospective cohort study of KTs with SARS-CoV-2 infection from August 28, 2020, to April 23, 2021. We collected the incidence of AKI and the presence of urinary and histopathological disorders. Both groups were compared (AKI vs no AKI). Immunohistochemical and reverse transcription-polymerase chain reaction studies were performed on the anatomopathological samples. RESULTS: In our study, 72 KTs had SARS-CoV-2 infection and, among them, 27 patients (35.1%) developed AKI related to increased severity and a worse evolution of the infection, defined by a greater presence of pneumonia (P < .001), hospitalization (P < .001), admission to the intensive care unit (P < .001), the need for ventilation support (P < .001), and continuous renal replacement therapy (P < .001). In the multivariable analysis, pneumonia behaved as an independent predictor for AKI development (P = .046). No differences were observed between proteinuria a month before and after infection (P = .224). In addition, 5 patients showed microhematuria and 2 patients presented transient glycosuria without hyperglycemia. Of the 5 kidney biopsies performed, 1 biopsy (20%) showed positive reverse transcription polymerase chain reaction for SARS-CoV-2. CONCLUSIONS: AKI is a frequent and potentially serious complication in KT patients. Occasionally it could be accompanied by abnormalities in the urinary sediment. Of 5 biopsied patients, 1 patient had positive reverse transcription polymerase chain reaction in renal tissue, which suggests the systemic spread of the virus and the tropism for the renal graft.

Genetic variability of functional longevity in five rabbit lines.

The objectives of this study were to analyse the differences in the genetic determination of functional longevity in five Spanish lines of rabbits and to check how different systematic factors might affect this genetic determination. Four of the lines were maternal (lines A, V, H and LP), these lines were established selecting base generation animals according to different criteria, but in the subsequent generations all of them were selected for litter size at weaning. The other is the paternal line R, this line was constituted by selecting animals with an outstanding daily growth rate. The trait analysed, length of productive life, was the time in days between the date of the first positive pregnancy test and the date of culling or death of a doe. Four models extended from the Cox proportional hazard model were used to analyse data of each line separately and jointly. The complete model (Model 1) included the fixed effect of year-season (YS) combination, positive palpation order (OPP), that is, reproductive cycle, physiological status of the doe (PS) at service and number of kits born alive (NBA) in each kindling as time-dependent factors. The inbreeding coefficient was fitted as a continuous covariate and the animal's additive genetic effect was also fitted to the model (Model 1). The other models were identical to Model 1 but excluding OPP (Model 2) or PS (Model 3) or NBA (Model 4), which were explored to assess the consequence on additive variance estimates of not correcting for these animal-dependent factors. Estimated effective heritabilities of longevity were 0.07 ± 0.03, 0.03 ± 0.02, 0.14 ± 0.09, 0.05 ± 0.04, 0.02 ± 0.01 and 0.04 ± 0.01 for lines A, V, H, LP, R and for the merged data set, respectively. Removing the PS from the model led to an increase in the estimated additive genetic variance in all lines (0.17 ± 0.05, 0.05 ± 0.03, 0.29 ± 0.19, 0.29 ± 0.20, 0.07 ± 0.04 and 0.05 ± 0.02 for lines A, V, H, LP, R and the merged data set, respectively). The highest hazard of death and/or culling was observed during the first two parities and decreased as the order of parity progressed. Does non-pregnant-non-lactating had the highest risk of death or culling. The does that had zero kits born alive incurred the highest risk, and this risk decreased as the NBA increased. In conclusion, the consideration of longevity as selection criterion for the studied rabbit lines is not recommended.

Effect of supplementation with fresh orange pulp (Citrus sinensis) on mortality, growth performance, slaughter traits and sensory characteristics in meat guinea pigs.

The objective of this research was to investigate the effect of the partial replacement of alfalfa (Medicago sativa) with fresh orange pulp (Citrus sinensis) in a diet fed to guinea pigs on their mortality, growth performance, slaughter traits and sensory characteristics during the fattening period. A total of 450 guinea pigs were housed in collective pens of ~10 animals. Animals were divided into three groups: Control group (CG), supplied with fresh alfalfa as forage and treatment groups (G15 and G30), in which 15 and 30% of alfalfa was replaced by orange pulp, respectively. No significant differences were found between CG and G15 for traits studied. However, G30 showed the lowest values for growth and carcass traits. No significant differences were found for sensory characteristics. In conclusion, a moderate inclusion of orange pulp could contribute to diminishing dependence of alfalfa on guinea pig meat production.

Coexistence of GH-Producing Pituitary Macroadenoma and Meningioma in a Patient with Multiple Endocrine Neoplasia Type 1 with Hyperglycemia and Ketosis as First Clinical Sign.

We present the clinical case of a patient who was admitted with an onset of diabetes mellitus (DM) with associated ketosis and whose clinical, hormonal, and radiological evolution revealed the presence of primary hyperparathyroidism, pancreatic neuroendocrine tumor, and GH-producing pituitary macroadenoma in the context of multiple endocrine neoplasia type 1 (MEN1). DM is relatively common in cases of acromegaly, but it is not generally associated with ketosis. Simultaneously, the patient presented a meningioma, which is associated with pituitary macroadenoma only in extremely rare cases.

Genetic analysis of meat quality traits in maternal lines of rabbit and their diallel cross.

Young rabbits, the dams of which came from a full diallel cross among four maternal lines (A, V, H and LP) and the sires from a single paternal line (R), that produce sixteen genetic groups, was carried out to evaluate the genetic groups and to estimate the crossbreeding genetic parameters of meat quality. The meat quality traits were recorded by NIRS from a sample of 285 longissimus lumborum muscles. Crossbreeding parameters were estimated according to Dickerson model. No differences in protein were found. The line A had significant differences with V line for intramuscular fat, and fatty acids groups. Significant differences for these traits appeared between the crossbred AH and VV (in favor of AH). As conclusion, the significant contrasts between genetic types for chemical composition of the meat are mainly consequence of direct-maternal genetic effects, having grandmaternal and maternal heterosis effects a less relevant role.

Crossbreeding effects on rabbit reproduction from four maternal lines of rabbits.

Litter size is essential for an efficient production of rabbit meat. A diallel cross between four maternal lines was carried out and the analysis of the components of litter size has been already done. This paper presents the analysis of litter size traits themselves (total born (TB), number born alive (NBA), number weaned (NW)) and kindling interval (KI), that complete the analysis of the reproductive performance. The 16 genetic groups were distributed in four Spanish farms. The V line was present in all farms in order to be used as reference group. A total of 34 546 parities from 7111 does, were analysed. The crossbreeding parameters were estimated according to Dickerson model. The differences between lines performance were of low magnitude and not significant for litter size traits. The LP line showed the shortest KI followed by H respect to lines A and V. These differences reflected the differences between direct and maternal genetic effects. The differences between the average of all crosses and line V were found to be significant and seemed to be important, being 0.46 for TB, 0.56 for NBA, 0.75 for NW and -2.21 days for KI. The differences between reciprocal crosses for litter size were of low magnitude and non-significant, which indicate that the maternal effects are not important between these lines. In general, the lines did not show significant differences in direct and maternal genetic effects for TB, NBA and NW but there were some significant differences for KI, which ranged from 1.54 to 6.85 days in direct effects and from 0.63 to 3.38 days for maternal effects. A positive and, in some cases, relevant heterosis was found. The largest heterosis was for TB in the HV cross (1.05 rabbits), followed by the AH (0.74 rabbits), AV (0.57 rabbits) and LH (0.55 rabbits) crosses. For NBA, significant heterosis was found in HV (1.11 rabbits) and AV (0.49 rabbits) and for NW in AV (0.90 rabbits), LH (0.70 rabbits) and LV (0.58 rabbits). Favourable and significant heterosis for KI was found in AV and LV crosses, whereas it was unfavourable in AL and in LH. The more recommended crosses were AV and LH, showing the greatest performances on NW, while the cross HV, which shows the greatest performances an NBA, could be highly recommended when cross-fostering is practised to equalise litter sizes after birth, in this situation the lower NW performance observed could be improved.

Growth traits of four maternal lines of rabbits founded on different criteria: comparisons at foundation and at last periods after selection.

The objective was to compare growth traits in four maternal lines of rabbits (A, V, H and LP), with the aim of understanding the consequence of the different foundation and selection processes on the growth performance of the lines. The lines are currently in the 43th, 38th, 22th and 8th generations, respectively. Two comparisons were performed. One compared the values of the lines at their foundation, using the complete data set, the full pedigree and a two-trait analysis, including data on the selection criteria, litter size. The other comparisons were done during the last period when all the lines were housed together with the same feeding and management. The numbers of records were 323 208 for weaning weight, and 300 553 for slaughter weight and average daily Gain (from 46 708 l). The pedigree file included 346 638 animals. The second analysis used only the data corresponding to each period, and the analysis was conducted using a one-trait model. The model was the same as that defined for the comparisons at the foundation, but the additive effects were excluded. The H and LP lines showed highest values for all the traits compared. In the last periods, a good agreement was observed between the estimated differences, computed with the complete model and data set, or computed with an incomplete model and only data from the comparison period. At last periods, the differences were smaller than at foundation. The importance of the correlated response in growth after selection for litter size at weaning or the importance of a non-programmed intramating selection for the growth traits can explain the changes since foundation.

Litter size components in a full diallel cross of four maternal lines of rabbits.

A crossbreeding experiment between 4 Spanish maternal lines of rabbits was performed to estimate crossbreeding effects on litter size components. The experiment was designed as a complete diallel cross involving 4 lines selected for litter size at weaning (A, V, H, and LP [L]) and their 12 simple crosses. Does from these 16 genetic groups were distributed among 4 Spanish farms, but only V line was present in all farms, allowing connectivity of the data. A total of 2,015 does in the third, fourth, or fifth gestations were subjected to laparoscopy. The recorded traits were ovulation rate (OR), number of implanted embryos (IE), total born (TB), embryo survival (ES), foetal survival (FS), and prenatal survival (PS). The differences in direct genetic effects, maternal genetic effects, and individual heterosis between the lines were estimated according to Dickerson's model. Line A was significantly inferior to lines V and H, whereas line LP was similar to A line, but for FS and PS, line A showed the best values, followed by line LP. Comparing crossbred groups to line V, significant differences were shown favoring crossbred groups for OR and IE. The crossbred groups presented high implantation rate, but the foetal survival was lower than in V line. Important values for commercial production were presented by some crosses for OR (HV, 1.26 ova), IE (AH, 1.50 embryos; HV, 1.41 embryos), and TB (AH, 0.82 rabbits; HV, 0.78 rabbits). Relevant and significant reciprocal effects were found, especially for OR in all cases except the LV and VL crosses. These differences become nonsignificant in most of the other traits. Regarding direct genetic effects, line A presented lower estimates than the other lines with important values for OR, but the opposite was observed for FS. The maternal effects were significant only for some contrasts in OR and revealed that the LP line was inferior to the others (1.08 ova compared to the A line, 1.23 compared to the H line, and 0.38 compared to the V line). In general, high positive values for heterosis were found in crossbred does for OR and IE. The crosses, where lines A and H were involved, showed significant heterosis. The highest values were obtained by crossing lines A and H (1.18 ova for OR, 1.87 embryos for IE) followed by the cross between lines H and V. Crosses between line LP and the other lines had a negative heterosis for FS and PS.

Sepsis, miocardiopatía e infección por el virus de la inmunodeficiencia humana: a propósito de un caso / Sepsis, cardiomyopathy and human immunodeficiency virus infection: presentation of a case

La sepsis en los pacientes con el virus de la inmunodeficiencia humana (VIH) puede asociarse a la aparición de una disfunción cardiaca, que puede resultar difícil de manejar, tanto a la hora de realizar el diagnóstico diferencial, como deorientar un tratamiento correcto, ya que existen numerosos factores de riesgo asociados: la miocarditis por el propio VIH, la presencia o ausencia de tratamiento antirretroviral de gran actividad, el consumo de sustancias tóxicas y la miocardiopatía asociada a la sepsis. Describimos la estrategia diagnóstica y el enfoque terapéutico de un paciente portador de VIH con shock séptico y disfunción cardiaca, haciendo una breve revisión de las distintas causas de miocardiopatía que pueden afectar a este grupo de pacientes (AU)

Sepsis in patients with human immunodeficiency virus (HIV) may be associated with the appearance of cardiac dysfunction. This is a challenge, both when making the differential diagnosis and determining the proper treatment, as there are numerous risk factors: Myocarditis due to the HIV itself, the presence or absence of highly active antiretroviral therapy, toxic substances, and cardiomyopathy associated with sepsis. The diagnostic and therapeutic approach to an HIV positive patient with septic shock and cardiac dysfunction is described, as well as a brief review of the different causes of cardiomyopathy which may affect this group of patients is also presented (AU)

[Sepsis, cardiomyopathy and human immunodeficiency virus infection: presentation of a case]. / Sepsis, miocardiopatía e infección por el virus de la inmunodeficiencia humana: a propósito de un caso.

Sepsis in patients with human immunodeficiency virus (HIV) may be associated with the appearance of cardiac dysfunction. This is a challenge, both when making the differential diagnosis and determining the proper treatment, as there are numerous risk factors: Myocarditis due to the HIV itself, the presence or absence of highly active antiretroviral therapy, toxic substances, and cardiomyopathy associated with sepsis. The diagnostic and therapeutic approach to an HIV positive patient with septic shock and cardiac dysfunction is described, as well as a brief review of the different causes of cardiomyopathy which may affect this group of patients is also presented.

SU-E-T-290: Dosimetric Verification of Helical Tomotherapy against Experimental Measurements for Head and Neck Treatments.

PURPOSE: To verify a Tomotherapy plan for a typical head and neck treatment against experimental measurements. METHODS: The treatment plan for a head and neck case was generated by the Tomotherapy treatment planning system (TPS) to deliver ∼70 Gy in 33 sessions to the contoured PTV. The plan was calculated on a CIRS ATOM anthropomorphic phantom that provides a grid spacing of 3×3 cm2 holes to accommodate thermoluminescent detectors (TLD). The plan was verified against experimental measurements carried out by 7 LiF:Mg,Ti (TLD-700) TLD. Up to 20 locations were selected within the irradiated region and three detectors were used simultaneously at each point to decrease the statistical uncertainty. TLD locations were labeled in the planning system and dose comparisons between TPS prediction and experimental measurements were performed in terms of absolute dose to water for a single fraction. We examined the dose from (i) the corresponding 3.5MV Tomo-scan alone and (ii) the complete treatment. TLD-700 were found to fulfill the requirements of reproducibility, linearity and flat energy response in a previous study. In particular, TLD energy response was previously checked for 6 MV flattening filter free and conventional radiation beams under reference conditions. RESULTS: Doses derived from the TPS were in most cases in good agreement (4% on average) with TLD dose measurements within TLD statistical uncertainties (about 3%). Larger discrepancies up to 7% were found for points close to complex tissue inhomogeneities, such as bony structures. Dose from the scanning procedure alone is about 1 % of the dose per fraction. CONCLUSIONS: This work indicates that dose delivery plans created with Tomotherapy TPS are accurate for head and neck tumor localizations.

Effect of simplification from protease inhibitors to boosted atazanavir-based regimens in real-life conditions.

BACKGROUND: Atazanavir (ATV) boosted with ritonavir (ATV/r) is a potent, well-tolerated, once-daily protease inhibitor (PI). Few data are available on this agent as a treatment simplification option for patients taking other PIs. OBJECTIVE: The aim of the study was to determine the effectiveness and safety of ATV-containing regimens in patients who have simplified their antiretroviral treatment. METHODS: SIMPATAZ was a multicentre, prospective, noninterventional study in patients who had undetectable HIV RNA on their current PI-containing therapy and who were switched to an ATV/r-based regimen. Patients underwent a routine physical examination, and data were collected on HIV RNA levels, CD4 cell counts, liver function, lipid parameters, adverse reactions, adherence to treatment and patient satisfaction. RESULTS: A total of 183 patients were enrolled in the study and included in the analysis (80% were male, 29% had AIDS, and 52% were coinfected with HIV and hepatitis B virus or hepatitis C virus). The median baseline CD4 count was 514 cells/µL. Median exposure to previous HIV therapy was 8 years, and 32% of patients had a history of PI failures. Lopinavir boosted with ritonavir was the most frequent PI replaced (62%) and tenofovir+lamivudine /emtricitabine the backbone most used during the study (29%). The study drug was discontinued early by 25 patients (14%), two of whom discontinued as a result of adverse events (Hodgkin lymphoma and vomiting). Two patients died (lung cancer and myocardial infarction). At month 12, 93% of the study population had an undetectable HIV RNA viral load. Hyperbilirubinaemia >3 mg/dL and increased alanine aminotransferase levels>200 IU/L were observed in 38.5% and 4.4% of patients, respectively. Median changes from baseline to month 12 in total cholesterol, triglycerides and low-density lipoprotein cholesterol were -13 mg/dL (-7%; P<0.0001), -19 mg/dL (-13%; P<0.0001) and -7 mg/dL (-6%; P=0.021), respectively. CONCLUSIONS: In a real-world setting, switching from other PIs to ATV/r is a well-tolerated and safe option for improving the lipid profile and for retaining virological response in controlled pretreated patients.

Metahemoglobinemia severa por intoxicación con anilina / No disponible

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Constitution and evaluation of a long-lived productive rabbit line.

An evaluation of a new maternal line (LP) of rabbits was carried out. This new line was founded following a scheme similar to that applied in the selection for hyperprolificacy in rabbits or pigs. In this case, the selection criteria were hyperlongevity and an independent culling level near the average for prolificacy. Evaluation was carried out by comparison of the reproductive and longevity performance of the LP line with another maternal line recognized for good reproductive performance and standard longevity (V line). The results indicate that the LP line could be a valuable resource for inclusion in the current 3-way cross schema used in rabbit production, because females showed better survival ability and nearly the same prolificacy as the well-reputed V line. A V doe was 1.3 times more likely to leave the herd than an LP doe, and the probability of the differences in prolificacy between lines being greater than 0 was not extreme (no more than 0.22). Differences in relative performance of the lines were observed across farms for prolificacy, longevity, cumulative production, and fertility; however, based on deviance information criterion results, the data supported the hypothesis of only these differences being generated under a genotype x environment interaction for prolificacy traits. The longer productive life of LP females could partially be understood as an indication of success of the selection procedure during the foundation of this line.

[Renal failure and insulin resistance: effect of the dialysis dose]. / Insuficiencia renal y resistencia insulínica: efecto de la dosis de diálisis.

BACKGROUND: The main cause of death in patients undergoing hemodialysis are cardiovascular events. We have analyzed the association between intradialysis fractional clearance of urea or Kt/V index in patients with chronic renal failure in hemodialysis as an indicator of adequate dialysis and the classical factors of cardiovascular risk. PATIENTS AND METHODS: A total of 47 patients with chronic renal failure on hemodialysis were included. Diabetes mellitus was considered an exclusion criteria. Optimization of dialysis was analyzed by Kt/v index in accordance with the Daugirdas formula. The cardiovascular risk factors evaluated were: insulin resistance, calculated according to the HOMA method, total cholesterol, LDL-cholesterol, triglycerides, arterial hypertension, obesity and metabolic syndrome. The relationship between cardiovascular risk factors and Kt/V index was analyzed with the variant and multivariant analysis. RESULTS: The HOMA median (interquartile range) of the patients was 1.16 (0.53-5.77). HOMA was correlated with triglycerides and HDL-cholesterol levels. HOMA was significantly greater in those who had less adapted dialysis (Kt/V < 1.4) (1.9 +/- 1.3 vs 1.0 +/- 0.3, p = 0.02). Furthermore, a negative correlation was found between HOMA and Kt/V. The multivariant analysis of the factors associated to HOMA demonstrated that the only associated parameters were Kt/V greater than 1.4, body mass index and age. CONCLUSIONS: In patients with chronic renal failure, adapted dialysis, determined by the Kt/V index, correlated negatively with insulin resistance. Based on these data, we suggest the need for longitudinal studies that consider this index as a predictive variable of cardiovascular events in this type of patients.

Insuficiencia renal y resistencia insulínica: efecto de la dosis de diálisis / Renal failure and insulin resistance: effect of the dialysis dose

Antecedentes. La principal causa de muerte en pacientes sometidos a hemodiálisis son los eventos cardiovasculares. Hemos analizado en pacientes con insuficiencia renal crónica en hemodiálisis la asociación entre el aclaramiento fraccionado intradiálisis de urea o índice Kt/V, como indicador de diálisis adecuada, y los factores clásicos de riesgo cardiovascular. Pacientes y métodos. Se han incluido 47 enfermos con insuficiencia renal crónica en hemodiálisis. La diabetes mellitus fue considerada criterio de exclusión. La optimización de la diálisis se analizó por el índice Kt/V de acuerdo con la fórmula de Daugirdas. Los factores de riesgo cardiovascular evaluados fueron: resistencia insulínica, calculada según el método HOMA, colesterol total, colesterol ligado a lipoproteínas de baja densidad (c-LDL), triglicéridos, hipertensión arterial, obesidad y síndrome metabólico. La relación entre los factores de riesgo cardiovascular y el índice Kt/V se analizó mediante análisis bivariante y multivariante. Resultados. La mediana de HOMA (rango intercuartil) de los pacientes fue de 1,16 (0,53-5,77). El HOMA se correlacionó con los niveles de triglicéridos y colesterol ligado a lipoproteínas de alta densidad (c-HDL). El HOMA fue significativamente superior en aquellos con diálisis menos adecuada (Kt/V < 1,4) (1,9 ± 1,3 frente a 1,0 ± 0,3, p = 0,02). Asimismo, se detectó una correlación negativa entre HOMA y Kt/V. El análisis multivariante de los factores asociados al HOMA demostró que los únicos parámetros asociados fueron un Kt/V superior a 1,4, el índice de masa corporal y la edad. Conclusiones. En pacientes con insuficiencia renal crónica una diálisis adecuada, determinada por el índice Kt/V, se correlaciona de forma negativa con la resistencia insulínica. Ante estos datos sugerimos la necesidad de estudios longitudinales que consideren dicho índice como variable predictora de eventos cardiovasculares en este tipo de pacientes (AU)

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