Clinical presentation and management of atypical hemolytic uremic syndrome in Latin America: a narrative review of the literature.

INTRODUCTION: Comprehensive information about atypical hemolytic uremic syndrome (aHUS) is relatively scarce outside of Europe and North America. This narrative review assembles available published data about the clinical presentation and management of aHUS in Latin America. AREAS COVERED: A search conducted in February 2023 of the MEDLINE (from inception), Embase (from inception), and LILACS/IBECS (1950 to 2023) databases using search terms 'atypical hemolytic uremic syndrome' and 'Latin America' and their variations retrieved 51 records (full papers and conference abstracts) published in English, Spanish, or Portuguese. After de-duplication, manual screening of titles/abstracts and addition of author-known articles, 25 articles were included of which 17 (68%) are full papers. All articles were published during the years 2013-2022. Articles include cohort studies, a registry analysis, and case reports from Argentina, Brazil, Chile and Columbia. Overall, Latin American patients with aHUS present the classic epidemiological, clinical, and genetic characteristics associated with this condition as described in other world regions. Depending on the country and time of reporting, aHUS in Latin America was treated mainly with plasma therapy and/or eculizumab. Where reported, eculizumab substantially improved aHUS-related outcomes in almost all adult and pediatric patients. EXPERT OPINION: Eculizumab has dramatically altered the natural course of aHUS, improving prognosis and patient outcomes. Addressing economic challenges and investing in healthcare infrastructure will be essential to implement strategies for timely detection and early treatment of aHUS in Latin America.

Time of Cold Ischemia and Delayed Graft Function in a Cohort of Renal Transplant Patients in a Reference Center.

There are many factors involved in the delayed graft function of a renal graft, with prolonged cold ischemia time being one of the most relevant. The aim of this study is to evaluate the relationship between the time of cold ischemia and the delayed graft function, and acute rejection and graft loss at 1 year of follow-up. A retrospective cohort of 347 renal transplant patients were evaluated during the years 2009-2013. The incidence of delayed graft function was 18.4% (n = 65). The cold ischemia time was an independent risk factor for delayed graft function (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.04-1.16). By grouping the time of cold ischemia by intervals, the risk of delayed graft function was greater in the 12-18 hours group (OR 2.06, 95% CI 1.02-4.15) and in the >18 hours group (OR 3.38, 95% CI 1.57-7.27). The risk of acute rejection did not increase with longer cold ischemia (p = 0.69), and cold ischemia time was not a risk factor for renal graft loss at 1-year follow-up (hazard ratio 0.97, 95% CI 0.88-1.06). In conclusion the time of cold ischemia (>12 hours) in renal transplant recipients of optimal deceased donors increases the risk of delayed graft function; however, this does not negatively impact the results in acute rejection or graft loss in the first year of the transplant.

Produção e morfogênese de capim BRS Tamani sob diferentes doses de nitrogênio e intensidades de desfolhação / Production and morphogenesis of BRS Tamani grass under different nitrogen rates and defoliation intensities

Objetivou-se com este trabalho avaliar a produção de forragem e as características morfogênicas e estruturais do Panicum maximum cv. BRS Tamani, em função de doses de nitrogênio e intensidades de corte. O experimento foi conduzido em casa de vegetação. Foram avaliadas quatro doses de nitrogênio (0, 50, 100 e 200 mg/dm-³) e duas intensidades de corte (5 cm e 15 cm), em esquema fatorial 4 × 2, num delineamento inteiramente casualizado com quatro repetições. A taxa de alongamento foliar do capim BRS Tamani foi influenciada pela adubação nitrogenada, com resposta linear e positiva. Não foi observado efeito da intensidade de desfolhação para essa variável. A duração de vida da folha foi influenciada pela adubação nitrogenada, pela intensidade de desfolhação e pela interação entre os fatores. As características morfogênicas do capim BRS Tamani são influenciadas pela adubação nitrogenada. Plantas com maior aporte de nitrogênio alongam maior número de folhas, sendo o intervalo de aparecimento menor. Em ausência de adubação nitrogenada o capim BRS Tamani mantem as folhas vivas por mais tempo e em menor número. Plantas de capim BRS Tamani cortadas mais intensamente apresentam maior número de perfilhos. A adubação nitrogenada aumentou a produção de forragem da parte aérea de capim BRS Tamani, sem efeito na produção de raiz. Plantas submetidas a cortes mais intensos (5 cm) apresentaram maior produção de matéria seca da parte aérea.

The objective of this work was to evaluate the forage production, and the morphogenic and structural characteristics of Panicum maximum cv. BRS Tamani, as a function of nitrogen doses and cut intensities. The experiment was conducted under greenhouse conditions. Four nitrogen doses (0, 50, 100 and 200 mg/dm³) and two cut intensities (5 cm and 15 cm) were evaluated in a 4x2 factorial in a completely randomized design with four replicates. The leaf elongation rate of the Tamani grass was influenced by nitrogen fertilization, with a linear and positive response. No effect of defoliation intensity was observed for this variable. The leaf life had a negative linear influence of the nitrogen fertilization without effect of the defoliation intensity. The morphogenic characteristics of the Tamani grass are influenced by nitrogen fertilization. Plants with greater nitrogen supply lengthen more leaves, with a shorter appearance interval. In absence of nitrogen fertilization the BRS Tamani grass keeps the leaves alive longer and in smaller numbers. More intensely cut BRS Tamani grass plants have a greater number of tillers. Nitrogen fertilization increased forage yield of BRS tamani grass, with no effect on root production. Plants submitted to moreintense cuts (5 cm) presented greater dry matter production of the aerial part.

Produção e morfogênese de capim BRS Tamani sob diferentes doses de nitrogênio e intensidades de desfolhação / Production and morphogenesis of BRS Tamani grass under different nitrogen rates and defoliation intensities

Objetivou-se com este trabalho avaliar a produção de forragem e as características morfogênicas e estruturais do Panicum maximum cv. BRS Tamani, em função de doses de nitrogênio e intensidades de corte. O experimento foi conduzido em casa de vegetação. Foram avaliadas quatro doses de nitrogênio (0, 50, 100 e 200 mg/dm-³) e duas intensidades de corte (5 cm e 15 cm), em esquema fatorial 4 × 2, num delineamento inteiramente casualizado com quatro repetições. A taxa de alongamento foliar do capim BRS Tamani foi influenciada pela adubação nitrogenada, com resposta linear e positiva. Não foi observado efeito da intensidade de desfolhação para essa variável. A duração de vida da folha foi influenciada pela adubação nitrogenada, pela intensidade de desfolhação e pela interação entre os fatores. As características morfogênicas do capim BRS Tamani são influenciadas pela adubação nitrogenada. Plantas com maior aporte de nitrogênio alongam maior número de folhas, sendo o intervalo de aparecimento menor. Em ausência de adubação nitrogenada o capim BRS Tamani mantem as folhas vivas por mais tempo e em menor número. Plantas de capim BRS Tamani cortadas mais intensamente apresentam maior número de perfilhos. A adubação nitrogenada aumentou a produção de forragem da parte aérea de capim BRS Tamani, sem efeito na produção de raiz. Plantas submetidas a cortes mais intensos (5 cm) apresentaram maior produção de matéria seca da parte aérea.(AU)

The objective of this work was to evaluate the forage production, and the morphogenic and structural characteristics of Panicum maximum cv. BRS Tamani, as a function of nitrogen doses and cut intensities. The experiment was conducted under greenhouse conditions. Four nitrogen doses (0, 50, 100 and 200 mg/dm³) and two cut intensities (5 cm and 15 cm) were evaluated in a 4x2 factorial in a completely randomized design with four replicates. The leaf elongation rate of the Tamani grass was influenced by nitrogen fertilization, with a linear and positive response. No effect of defoliation intensity was observed for this variable. The leaf life had a negative linear influence of the nitrogen fertilization without effect of the defoliation intensity. The morphogenic characteristics of the Tamani grass are influenced by nitrogen fertilization. Plants with greater nitrogen supply lengthen more leaves, with a shorter appearance interval. In absence of nitrogen fertilization the BRS Tamani grass keeps the leaves alive longer and in smaller numbers. More intensely cut BRS Tamani grass plants have a greater number of tillers. Nitrogen fertilization increased forage yield of BRS tamani grass, with no effect on root production. Plants submitted to moreintense cuts (5 cm) presented greater dry matter production of the aerial part.(AU)

Protothecal bursitis after simultaneous kidney/liver transplantation: a case report and review.

Solid organ transplantation is an accepted therapy for end-stage diseases of the kidneys, liver, heart, and lungs. Unfortunately, transplantation is associated with infectious complications. Here, we present a case report of Prototheca wickerhamii olecranon bursitis and review all of the cases in solid organ transplant (SOT) recipients published in the literature to date. In our patient, the infection resolved with surgical therapy and limited antifungal therapy, and no symptoms have recurred over 24 months of follow-up. A review of the literature suggests that 50% of SOT recipients with Prototheca infection present with disseminated infection, and the overall mortality is 75%. More studies are required to determine the optimal management of protothecosis in this population.

Histoplasmosis in renal transplant patients in an endemic area at a reference hospital in Medellin, Colombia.

BACKGROUND: Histoplasmosis is an uncommon systemic fungal infection, but it is potentially fatal in immunosuppressed populations. In Latin America, which is considered an endemic area for this mycosis, there have been no published reports regarding the incidence, clinical presentation, morbidity, and mortality of histoplasmosis in renal transplant patients. The objective of this study was to describe cases of histoplasmosis in renal transplant patients treated at the Pablo Tobon Uribe Hospital (Medellin, Colombia) between 2006 and 2013. METHODS: This is a descriptive, retrospective study. RESULTS: The incidence of histoplasmosis in our renal transplant population was 1.1%. The ages of the 9 patients (4 men and 5 women) ranged between 27 and 59 years. In 2 of these patients, histoplasmosis appeared during the first year after transplantation. At the time of transplantation, 66% of patients received induction with alemtuzumab; 88% had a prior rejection episode and required increased immunosuppressive medication; 88% had renal graft dysfunction with creatinine levels >1.5 mg/dL; and the primary clinical presentation was disseminated histoplasmosis followed by the pulmonary form of the disease. Diagnoses were performed by histology in 6 patients, blood culture in 2 patients, and antigenuria in 1 patient. Three patients required treatment with amphotericin B for the severity of their infection, and 2 of these patients died before receiving the cumulative dose of amphotericin B. The 7 remaining patients received itraconazole for 12 months and had a successful treatment response. Regarding complications, 2 patients had hemophagocytic syndrome. At the 1-year follow-up appointment, renal function remained stable in all patients, and no patients had acute rejection or required renal replacement therapy. Thus, the overall mortality rate observed was 22.2%. CONCLUSIONS: In this series, histoplasmosis in renal transplant patients presented as an aggressive opportunistic infection with a higher incidence than that previously reported in the literature. The following risk factors have been associated with histoplasmosis: renal graft dysfunction, previous acute rejection, immunosuppression with tacrolimus-mycophenolate, and induction with alemtuzumab. The clinical presentation of histoplasmosis was nonspecific, which complicated disease diagnosis, and the treatment regimens were highly toxic and associated with significant morbidity and mortality rates.

Survival of renal transplantation patients older than 60 years: a single-center experience.

BACKGROUND: Elderly patients are the fastest growing population requiring renal replacement therapy. It has been stated that renal transplantation may be the best treatment option for these patients. However, it has been observed that older patients have a higher mortality rate than those who are younger. Yet the factors that determine post-transplantation outcomes in this population remain poorly defined. The aims of this study were to evaluate the graft and patient survival in kidney transplant recipients who are older than 60 years of age to identify relevant predictive factors. METHODS: In this population-based retrospective cohort study of 201 kidney transplantations performed in elderly patients from January 2002 throughout June 2009, we estimated the 1-,3-,and 5-year patients and graft survival rates. We also evaluated the complications and the predictors of poor outcomes. Survival times were analyzed using the Kaplan-Meier method and survival differences assessed with Mantel-Cox log rank-test. We performed a Cox proportional hazards regression models to evaluate the impact of baseline and treatment characteristics on patient and graft survival. RESULTS: Graft and patient survival rates at 1, 3, and 5 years were 76.4%, 71.3%, and 54.3%, and 78.2%, 73.8%, and 56.4%, respectively. Graft survival rates censored for patient death with a functioning graft were 93.1, 92.1, and 89%. Patient survival rates differed between diabetic and nondiabetic subjects at 1, 3 and 5 years (69.5% versus 83.6%; 59.8% versus 72.3%; 43.6% versus 65.7%; P = .008). On multivariate analysis, the factors associated with patients survival were diabetes mellitus (hazard ratio [HR] 2.058, 95% confidence interval [CI] 1.173-3.611, P = .012) and the 1-month serum creatinine value was > 1.6 mg/dL (HR 2.108 for each point increase, 95% CI 1.521-2.921, P = .000). Furthermore, there was an insignificant trend forward an association between active or past smoker and lower patient survival (HR 1.689, 95% CI 0.937-3.043, P = .08). The main causes of graft loss were patient death (79.5%). acute rejection (6.8%), and chronic allograft nephropathy (5.5%). CONCLUSION: Renal transplantation can be performed safely and with acceptable outcomes in elderly patients after appropriate clinical evaluation. The grafts show excellent survival albeit that deaths with a functional graft continue to be an important issue.

Dermatomiositis asociado a adenocarcinoma de vesicula biliar: reporte de un caso / Dermatomyositis associated to gallbladder adenocarcinoma: a case report

La dermatomiositis asociada a neoplasias ha sido reportada en el 11.8 por ciento de los casos. Hasta el momento, solo se ha descrito en la literatura un caso de asociación entre dermatomiositis y adenocarcinoma de vesícula biliar. Presentamos el caso de una paciente de 53 años con debilidad muscular proximal de cinturas escapular y pélvica, manifestaciones cutáneas (Gottron y eritema en heliotropo), e incremento de enzimas musculares, en quién se hizo el diagnóstico de Dermatomiositis y se le prescribió el tratamiento adecuado sin embargo, a los 3 meses de evolución acudió con pérdida de peso, mala respuesta a esteroides y metotrexate, síndrome ictérico, hemorragia de tubo digestivo; se le realizó ultrasonido de hígado y vías biliares reportándose datos compatibles con coledocolitiasis y daño hepático difuso, se le realizó colecistectomía y el reporte histopatológico fue de adenocarcinoma de vesícula biliar. El objetivo de este reporte es la presentación del segundo caso en que asocia la dermatomiositis y el adenocarcinoma de vesícula biliar en la literatura médica internacional.

[The Granada-90 geriatric angiological study (1)]. / Estudio angiogeriátrico Granada-90 (primera parte).

Because the high incidence of cardiovascular disease between aged people and because the problematic features of Andalusian community, like its vast extension, high percentage of people older than 65 years, low sociocultural level and lack of physicians specialized on Angiology; an important study was made in order to analyze such type of disorders as well as their factors of risk. Study was made transversally with 443 hospitalized aged patients.

Mal de Pott em lactantes de 11 meses de idade / Pott's disease in an infant of 11 months old

Apresenta-se um paciente do sexo masculino, de 11 meses e 6 dias, que apresentava adenopatia cervical, axilar e inguinal há 1 semana e diminuiçäo de atividade, palidez, vômitos pós-alimentares e dificuldade respiratória há 3 dias. Antecedentes familiares: baixa condiçäo sócio-econômica e mäe com Tbc, e tratamento irregular durante esta gestaçäo. O paciente nasceu com desnutriçäo intra-uterina, apresentava retardo de desenvolvimento deformidade torácica. Pelo exame clínico e radiológico tratava-se de paciente com tuberculose pulmonar e vertebral. Foi iniciado esquema tríplice, imobilizaçäo no leito e posteriormente colete de gesso. Após 5 meses de tratamento a criança passou a sentar sozinha e trocar passos e com 2 anos estava andando e correndo, apesar do quadro radiológico de coluna ficar inalterado