ABSTRACT
BACKGROUND: The clinical benefits of the common off-label use of cytomegalovirus (CMV)-specific immunoglobulin (CMV-Ig) combined with antivirals in organ transplantation have not been previously assessed. The objective was to compare the risk of CMV infection and other post-transplantation outcomes between two CMV-Ig prophylaxis regimens in lung transplant recipients; Methods: Retrospective study of 124 donor CMV positive/recipient negative (D+/R-) patients receiving preventive ganciclovir/valganciclovir for 12 months, of whom 62 received adjunctive CMV-Ig as per label indication (short regimen [SR-Ig]; i.e., 7 doses over 2.5 months) and were compared to 62 who received an extended off-label regimen (ER-Ig) consisting of 17 doses over one year after transplantation. RESULTS: The incidence of CMV infection or disease, acute rejection, chronic lung allograft dysfunction, and survival did not differ between the two CMV-Ig schedules. Although the time to the first CMV infection after transplantation was shorter in the ER-Ig than in the SR-Ig adjunctive group (log-rank: p = 0.002), the risk was independently predicted by antiviral cessation (odds ratio = 3.74; 95% confidence interval = 1.04-13.51; p = 0.030), whereas the CMV-Ig schedule had no effect. CONCLUSIONS: Extending the adjunctive CMV-Ig prophylaxis beyond the manufacturer's recommendations up to one year does not confer additional clinical benefits regarding lung post-transplantation outcomes.
ABSTRACT
Resumen La temática en salud de la mujer toca demasiados aspectos, desde el nacimiento hasta la senectud. Hay ciertas afecciones que están relacionadas con el sexo biológico, pero también con problemas de sexualidad, desigualdad social y muchos tipos de violencia. Por ello se requiere analizar y adaptar la información en materia de salud, para implementar acciones hacia la población objetivo. Si bien en primera instancia la atención médica involucra la salud física, se han vuelto equiparables la salud mental y la social. Con el enfoque en este grupo de riesgo, se integran lineamientos prácticos, normas e información científica actualizada, para explicar las principales medidas que debe tomar cualquier mujer en todo el curso de su vida, y con ello mantener un estado de salud satisfactorio, buscar atención oportuna en ginecología y obstetricia, ademís de poder definir el plan de seguimiento médico personalizado. Se presentan herramientas prácticas mediante la exposición de un decálogo, denominados mandamientos, que sirven tanto para el médico como para la paciente, a fin de favorecer el bienestar físico, mental y social; sin perder la connotación de los distintos grupos etarios, así como lo alusivo a la función reproductiva y el ciclo gestacional.
Abstract The subject of women's health touches too many aspects, from birth to old age. There are certain conditions that are related to biological sex, but also to problems of sexuality, social inequality, and many types of violence. Therefore, it is necessary to analyze and adapt the information on health, to implement actions towards the target population. Although at first instance medical care involves physical health, mental and social health have become comparable. Focusing on this risk group, practical guidelines, standards and updated scientific information are integrated to explain the main measures that any woman should take throughout her life, and thereby maintain a satisfactory state of health, seek care in Gynecology and Obstetrics, in addition to being able to define the personalized medical follow-up plan. Practical tools are presented through the exposition of a decalogue, called commandments, which serve both the doctor and the patient, in order to promote physical, mental and social well-being; without losing the connotation of the different age groups, as well as the allusion to the reproductive function and the gestational cycle.
ABSTRACT
This study describes the clinical presentation, treatment, and outcomes of SARS-CoV-2 infection in lung transplant recipients (LTRs). This is a multicenter, retrospective study of all adult LTRs with confirmed SARS-CoV-2 infection from March 4 until April 28, 2020 in six Spanish reference hospitals for lung transplantation. Clinical and radiological data, treatment characteristics, and outcomes were reviewed. Forty-four cases were identified in that period. The median time from transplantation was 4.2 (interquartile range: 1.11-7.3) years. Chest radiography showed acute parenchymal abnormalities in 32 (73%) cases. Hydroxychloroquine was prescribed in 41 (93%), lopinavir/ritonavir (LPV/r) in 14 (32%), and tocilizumab in 19 (43%) patients. There was a strong interaction between tacrolimus and LPV/r in all cases. Thirty-seven (84%) patients required some degree of respiratory support and/or oxygen therapy, and 13 (30%) were admitted to intermediate or intensive critical care units. Seventeen (39%) patients had died and 20 (45%) had been discharged at the time of the last follow-up. Deceased patients had a worse respiratory status and chest X-ray on admission and presented with higher D-dimer, interleukin-6, and lactate dehydrogenase levels. In this multicenter LTR cohort, SARS-CoV-2 presented with high mortality. Additionally, the severity of disease on presentation predicted subsequent mortality.
