The M.A.STE.R.S algorithm for acute visual loss management after facial filler injection.

OBJECTIVE: To propose an algorithm of treatment for sudden visual loss following filler injections and perform an English-written literature search for assignment of evidence level and grade recommendation. METHODS: Algorithm of treatment includes ocular physical Maneuvers, hyAluronidase administration, intravenous STEroids, intraocular pressure Reduction, and Supplemental Oxygen (M.A.STE .R.S) based on previous acute management reports. Special consideration for algorithm buildup was made for ophthalmic diseases that share physiopathological features such as central retinal artery occlusion, systemic vasculitis affecting vision, and acute glaucoma. Finally, a systematic cross-review of the reported cases with visual loss was done to identify the level of evidence and grant a recommendation grade. RESULTS: A search through PubMed and Medscape databases for English-written scientific papers using the terms facial filler, retinal artery occlusion, management, treatment, complications, and adverse events quoted a total of 46 papers (190 cases) which were then analyzed. A high variability on management for treatment of sudden visual loss after facial filler injections was observed. This was attributed partially to the great diversity of medical specialists performing cosmetic facial procedures such as dermatologists, plastic surgeons, esthetic doctors and ophthalmologists, and the lack of high evidence level studies. CONCLUSIONS: The proposed algorithm provides an initial guideline based on prior literature reports and physiopathology involving facial filler injection complications. Analysis identified 22 successfully treated cases with vision recovery (11.57%). Ocular physical maneuvers had the best evidence-based level and grade recommendation (A) for the management of acute vision loss secondary to facial filler injections.

Milan-out Criteria and Worse Intention-to-Treat Outcome Postliver Transplantation.

Milan criteria are widely used for liver transplantation selection in hepatocellular carcinoma but have been recognized to be too restrictive. Milan-out criteria are increasingly being adopted. Our aim was to analyze if liver transplantation waitlisted Milan-out hepatocellular carcinoma patients have different outcome than Milan patients. METHODS: Retrospective study including all consecutive patients with hepatocellular carcinoma admitted in the waiting list for liver transplantation between January 2012 and January 2015. We included 177 patients, 146 of which eventually transplanted. Downstaging was achieved in the Milan-out cases (n = 29) before waitlisting. RESULTS: From diagnosis to last follow-up, 29% patients died. Survival at 1 and 5 years from diagnosis was 93% and 75%, respectively in the within Milan group compared with 91% and 61% in the Milan-out group (P = 0.03). Treatment failure occurred in 20% of cases due to tumor progression in the waiting list (44%), death on the waiting list (20%), and hepatocellular carcinoma recurrence postliver transplantation (9%). Milan-out criteria was the only variable predictive of treatment failure remaining in the multivariate analysis with a hazard ratio (HR) of 1.7 (HR, 1.7; 95% confidence interval, 1.34-4.55; P = 0.010) and HR of 1.43 (1.23-6.5) in the hepatocellular carcinoma recurrence. CONCLUSIONS: Milan-out criteria are associated with a higher intention-to-treat liver transplantation failure from time of inclusion in the waiting list. However, survival rates are still >50% at 5 years of follow-up.

Loss of salience as a source of latent inhibition in human associative learning.

Two experiments made use of a procedure known to generate latent inhibition in human associative learning. Participants received training consisting of exposure to a list of actions performed by a fictitious Mr. X. For most of his actions, an outcome was described, but some were not followed by any outcome. The last action performed by Mr. X was novel for participants in the NOVEL condition. For participants in the EXPOSED condition, Mr. X had performed that target action on repeated occasions, without it producing any outcome. After training, all participants were tested on their ability to retrieve what was the last action performed by Mr. X. In both experiments, retrieval of the target action was poorer in the EXPOSED than in the NOVEL condition. Experiment 2 also included a condition in which the target action was followed by a novel outcome and demonstrated a latent inhibition effect-poorer performance in the EXPOSED condition on a test of the association between the target event and its outcome. These results are interpreted in terms of an attention-reducing mechanism, triggered by the repeated preexposure to the target in the absence of a following event. It is argued that the attentional change involves a reduction in the effective salience of the stimulus of the target event, and thus reduces the processing necessary for encoding in memory and the ability of the event to enter into associations.

Impact of hepatitis C virus (HCV) antiviral treatment on the need for liver transplantation (LT).

BACKGROUND: Therapies for hepatitis C virus (HCV) infection have revolutionized the treatment of patients with chronic HCV infection. The effect of these therapies on the epidemiology of liver transplantation (LT) has yet to be elucidated. AIM: To establish whether the indications for LT have changed as a result of the introduction of new therapies for HCV. MATERIALS AND METHODS: We conducted a retrospective study based on a prospectively maintained registry of patients who undergo LT at La Fe Hospital in Valencia from 1997 to 2016. An analysis of outcome measures over time stratified by LT indications was performed. RESULTS: From January 1997 to December 2016, 2379 patients were listed for LT. Of these, 1113 (47%) were listed for HCV cirrhosis±hepatocellular carcinoma (HCC). This percentage varied significantly over time declining from 48.8% in the 1997-2009 initial period (IFN-based regimens) to 33% in the 2014-2016 final period (DAAs regimens) (P = .03). However, during that period, the proportion of those included in the waiting list (WL) due to HCV-HCC increased significantly (P = .001). In addition, among HCV-positive waitlisted patients with decompensated cirrhosis without HCC, the proportion of those with an HCV-alcohol mixed etiology also increased significantly over time (P = .001). Of all HCV-positive waitlisted patients, 203 were eventually removed from the WL due to either clinical improvement (n = 77) or more frequently worsening/death (n = 126). CONCLUSIONS: The proportion of patients wait-listed for LT for decompensated HCV cirrhosis has significantly decreased over time. These changes are possibly related to the large-scale use of direct-acting antivirals.

Actividad y resultados del trasplante hepático durante el período 1984-2012. Análisis del Registro Español de Trasplante Hepático / Activity and results of liver transplantation in Spain during 1984-2012. Analysis of the Spanish Liver Transplant Registry

Fundamento y objetivo: El trasplante hepático (TH) es un tratamiento de eficacia contrastada de la enfermedad hepática grave. El objetivo de este trabajo es analizar los resultados del TH en España durante el período 1984-2012. Pacientes y método: Se analizó la base de datos del Registro Español de Trasplante Hepático. Resultados: Se realizaron 20.288 trasplantes en 18.568 pacientes. La mediana de edad del donante y del receptor aumentó durante el período de análisis, desde 25 años (intervalo de confianza del 95% [IC 95%] 18-40) y 47 años (IC 95% 34-55), respectivamente, en el período 1984-1994, hasta 59 años (IC 95% 33-65; p < 0,05) y 55 años (IC 95% 48-61; p < 0,01), respectivamente, en el período 2010-2012. Las indicaciones más frecuentes fueron cirrosis hepática (63,18%) y hepatocarcinoma (19,62%). La supervivencia global del paciente y del injerto fueron, respectivamente, del 85,1 y 77,8% en el primer año, del 72,6 y 63,5% a los 5 años, y del 62 y 52,6% a los 10 años del TH. La supervivencia del paciente y del injerto al primer año aumentó, respectivamente, desde el 77,8 y 66,3% en el período 1984-1994 al 88,5 y 83% en el período 2010-2012 (p < 0,01). La edad del donante y del receptor, la etiología de la enfermedad de base y la serología positiva para el virus de la hepatitis C del receptor se asociaron a menor supervivencia en los análisis univariado y multivariado. Conclusiones: Los resultados del TH mejoraron significativamente a lo largo del período analizado, a pesar de un progresivo aumento en la edad del donante y del receptor (AU)

Background and objective: Liver transplantation (LT) is a proven effective treatment of severe liver disease. The aim of this paper is to analyze the results of LT in Spain during the period 1984-2012. Patients and method: We analyze the results of the database of Spanish Liver Transplant Registry. Results: A total of 20,288 transplants were performed in 18,568 patients. The median age of the donor and recipient increased during the analysis period: 25 years (95% confidence interval [95% CI] 18-40) and 47 years (95% CI 34-55), respectively, in the period 1984-1994 compared to 59 years (95% CI 33-65; P < .05) and 55 years (95% CI 48-61; P < .01), respectively, in the period 2010-2012. The most frequent indications were liver cirrhosis (63.18%) and hepatocellular carcinoma (19.62%). The overall patient and graft survival was respectively 85.1 and 77.8% in the first year, 72.6 and 63.5% the fifth year and 62 and 52.6% in the tenth year. First year patients and graft survival increased respectively from 77.8 and 66.3% in the period 1984-1994 to 88.5 and 83% in 2010-2012 (P < .01). Donor and recipient age, etiology of underlying disease, and hepatitis C virus serological status, were factors associated with decreased survival in univariate and multivariate analysis. Conclusions: Results of LT improved significantly over the review period, despite a progressive increase in donor and recipient age (AU)

Framingham score, renal dysfunction, and cardiovascular risk in liver transplant patients.

Cardiovascular (CV) events represent major impediments to the long-term survival of liver transplantation (LT) patients. The aim of this study was to assess whether the Framingham risk score (FRS) at transplantation can predict the development of post-LT cardiovascular events (CVEs). Patients transplanted between 2006 and 2008 were included. Baseline features, CV risk factors, and CVEs occurring after LT (ischemic heart disease, stroke, heart failure, de novo arrhythmias, and peripheral arterial disease) were recorded. In total, 250 patients (69.6% men) with a median age of 56 years (range, 18-68 years) were included. At transplantation, 34.4%, 34.4%, and 33.2% of patients, respectively, had a low, moderate, and high FRS with a median FRS of 14.9 (range, 0.09-30); 14.4% of LT recipients developed at least 1 CVE at a median of 2.619 years (range, 0.006-6.945 years). In the univariate analysis, factors associated with the development of CVEs were the continuous FRS at LT (P = 0.003), age (P = 0.007), creatinine clearance [estimated glomerular filtration rate (eGFR); P = 0.020], and mycophenolate mofetil use at discharge (P = 0.011). In the multivariate analysis, only the eGFR [hazard ratio (HR), 0.98; 95% confidence interval (CI), 0.97-1.00; P = 0.009] and FRS (HR, 1.06; 95% CI, 1.02-1.10; P = 0.002) remained in the model. Moreover, an association was also found between the FRS and overall survival (P = 0.004) with 5-year survival rates of 82.5%, 77.8%, and 61.4% for the low-, moderate-, and high-risk groups, respectively. Continuous FRS, eGFR, and hepatitis C virus infection were independent risk factors for overall mortality. In our series, the FRS and eGFR at LT were able to predict the development of post-LT CVEs and poor outcomes. Liver Transpl 21:812-822, 2015. © 2015 AASLD.

[Activity and results of liver transplantation in Spain during 1984-2012. Analysis of the Spanish Liver Transplant Registry]. / Actividad y resultados del trasplante hepático durante el período 1984-2012. Análisis del Registro Español de Trasplante Hepático.

BACKGROUND AND OBJECTIVE: Liver transplantation (LT) is a proven effective treatment of severe liver disease. The aim of this paper is to analyze the results of LT in Spain during the period 1984-2012. PATIENTS AND METHOD: We analyze the results of the database of Spanish Liver Transplant Registry. RESULTS: A total of 20,288 transplants were performed in 18,568 patients. The median age of the donor and recipient increased during the analysis period: 25 years (95% confidence interval [95% CI] 18-40) and 47 years (95% CI 34-55), respectively, in the period 1984-1994 compared to 59 years (95% CI 33-65; P<.05) and 55 years (95% CI 48-61; P<.01), respectively, in the period 2010-2012. The most frequent indications were liver cirrhosis (63.18%) and hepatocellular carcinoma (19.62%). The overall patient and graft survival was respectively 85.1 and 77.8% in the first year, 72.6 and 63.5% the fifth year and 62 and 52.6% in the tenth year. First year patients and graft survival increased respectively from 77.8 and 66.3% in the period 1984-1994 to 88.5 and 83% in 2010-2012 (P<.01). Donor and recipient age, etiology of underlying disease, and hepatitis C virus serological status, were factors associated with decreased survival in univariate and multivariate analysis. CONCLUSIONS: Results of LT improved significantly over the review period, despite a progressive increase in donor and recipient age.

Estado actual y perspectivas futuras del trasplante de hepatocitos / Current status and future perspectives of hepatocyte transplantation

Existe un gran número de enfermedades hepáticas para las cuales el único tratamiento efectivo es el trasplante hepático. La disparidad entre el número de potenciales beneficiarios y de órganos disponibles motiva la búsqueda de nuevas alternativas de tratamiento, entre las que se encuentra el trasplante celular hepático (TCH). Esta terapia representa una alternativa de tratamiento en estos pacientes, sin embargo, la falta de unanimidad de criterios respecto a las indicaciones y técnica, los diferentes protocolos de criopreservación así como la distinta metodología para valorar la respuesta a esta terapia pone de manifiesto la necesidad de una conferencia de consenso que unifique criterios, planteando posibles estrategias futuras que mejoren la técnica y optimicen los resultados. Nuestro objetivo es realizar una revisión y puesta al día del estado actual del TCH, enfatizando las futuras líneas de investigación que tratan de solucionar los problemas y mejorar los resultados de esta terapia

The imbalance between the number of potential beneficiaries and available organs, originates the search for new therapeutic alternatives, such as Hepatocyte transplantation (HT).Even though this is a treatment option for these patients, the lack of unanimity of criteria regarding indications and technique, different cryopreservation protocols, as well as the different methodology to assess the response to this therapy, highlights the need of a Consensus Conference to standardize criteria and consider future strategies to improve the technique and optimize the results. Our aim is to review and update the current state of hepatocyte transplantation, emphasizing the future research attempting to solve the problems and improve the results of this treatment

[Current status and future perspectives of hepatocyte transplantation]. / Estado actual y perspectivas futuras del trasplante de hepatocitos.

The imbalance between the number of potential beneficiaries and available organs, originates the search for new therapeutic alternatives, such as Hepatocyte transplantation (HT).Even though this is a treatment option for these patients, the lack of unanimity of criteria regarding indications and technique, different cryopreservation protocols, as well as the different methodology to assess the response to this therapy, highlights the need of a Consensus Conference to standardize criteria and consider future strategies to improve the technique and optimize the results.Our aim is to review and update the current state of hepatocyte transplantation, emphasizing the future research attempting to solve the problems and improve the results of this treatment.

[Epidemiology of hemolytic uremic syndrome in two regions of Buenos Aires Province]. / Epidemiología del síndrome urémico hemolítico en dos regiones de la Provincia de Buenos Aires.

The objectives of this study were (a) to describe and estimate the frequency of hemolytic uremic syndrome (HUS) in rural and urban populations in two regions of Buenos Aires Province, and (b) to compare the presentation and distribution of factors hypothetically associated with HUS. A total of 82 HUS cases, recorded during the years 2005-2010 in rural and urban areas of the south-central region of Buenos Aires Province, were clinically and epidemiologically characterized. Statistical data analysis included Chi square or Fisher test and median test. The incidence rate of HUS was significantly higher in the rural population, being 12.7 cases per 100 000 (CI 0-23.5) in rural inhabitants vs. 7.1 cases per 100 000 (CI 0-9.5) in urban inhabitants. The median age of the patients was 27 months (5-139 months), significantly lower in children from the rural area. This could be explained by a more frequent contact with bovine feces, the consumption of raw milk and a higher proportion of relatives who work in risk labors found in the rural population. Although HUS is often associated with the consumption of undercooked minced meat, most of the children cases here included did not present this antecedent. Clinical manifestations were similar in both subpopulations. One-third of urban patients had received antibiotics prior to HUS development.

Epidemiología del síndrome urémico hemolítico en dos regiones de la Provincia de Buenos Aires / Epidemiology of hemolytic uremic syndrome in two regions of Buenos Aires Province

Los objetivos de este estudio fueron describir y comparar la frecuencia del síndrome urémico hemolítico (SUH), registrada durante el periodo 2005-2010 en pobladores rurales y urbanos de la región centro-sur de la provincia de Buenos Aires y caracterizar la distribución de factores hipotéticos asociados al SUH en ambas poblaciones. Se caracterizaron 82 casos de SUH clínica y epidemiológicamente. Para el análisis estadístico de los datos se utilizó el test de Chi² o test exacto de Fisher cuando fue necesario, y el test de la mediana. La incidencia específica fue 12.7 casos cada 100 000 habitantes rurales (IC 0-23.5) y 7.1 casos cada 100 000 habitantes urbanos (IC 0-9.5). La mediana de la edad en el total de los pacientes estudiados fue de 27 meses (5-139 meses), siendo significativamente más baja en los niños del área rural. Estos resultados podrían explicarse por el contacto más frecuente con materia fecal de bovinos, el mayor consumo de leche sin pasteurizar y la mayor proporción de familiares que realizan actividades de riesgo, encontrados en la subpoblación rural. Aunque el SUH es una enfermedad que se asocia frecuentemente con el consumo de carne picada, la mayor parte de los niños que enfermaron no presentaron este antecedente. Las manifestaciones clínicas fueron semejantes en ambas subpoblaciones. Un tercio de los pacientes urbanos había recibido tratamiento con antibióticos previo al desarrollo del SUH.

The objectives of this study were (a) to describe and estimate the frequency of hemolytic uremic syndrome (HUS) in rural and urban populations in two regions of Buenos Aires Province, and (b) to compare the presentation and distribution of factors hypothetically associated with HUS. A total of 82 HUS cases, recorded during the years 2005-2010 in rural and urban areas of the south-central region of Buenos Aires Province, were clinically and epidemiologically characterized. Statistical data analysis included Chi square or Fisher test and median test. The incidence rate of HUS was significantly higher in the rural population, being 12.7 cases per 100 000 (CI 0-23.5) in rural inhabitants vs. 7.1 cases per 100 000 (CI 0-9.5) in urban inhabitants. The median age of the patients was 27 months (5-139 months), significantly lower in children from the rural area. This could be explained by a more frequent contact with bovine feces, the consumption of raw milk and a higher proportion of relatives who work in risk labors found in the rural population. Although HUS is often associated with the consumption of undercooked minced meat, most of the children cases here included did not present this antecedent. Clinical manifestations were similar in both subpopulations. One-third of urban patients had received antibiotics prior to HUS development.

Epidemiología del síndrome urémico hemolítico en dos regiones de la Provincia de Buenos Aires / Epidemiology of hemolytic uremic syndrome in two regions of Buenos Aires Province

Los objetivos de este estudio fueron describir y comparar la frecuencia del síndrome urémico hemolítico (SUH), registrada durante el periodo 2005-2010 en pobladores rurales y urbanos de la región centro-sur de la provincia de Buenos Aires y caracterizar la distribución de factores hipotéticos asociados al SUH en ambas poblaciones. Se caracterizaron 82 casos de SUH clínica y epidemiológicamente. Para el análisis estadístico de los datos se utilizó el test de Chi² o test exacto de Fisher cuando fue necesario, y el test de la mediana. La incidencia específica fue 12.7 casos cada 100 000 habitantes rurales (IC 0-23.5) y 7.1 casos cada 100 000 habitantes urbanos (IC 0-9.5). La mediana de la edad en el total de los pacientes estudiados fue de 27 meses (5-139 meses), siendo significativamente más baja en los niños del área rural. Estos resultados podrían explicarse por el contacto más frecuente con materia fecal de bovinos, el mayor consumo de leche sin pasteurizar y la mayor proporción de familiares que realizan actividades de riesgo, encontrados en la subpoblación rural. Aunque el SUH es una enfermedad que se asocia frecuentemente con el consumo de carne picada, la mayor parte de los niños que enfermaron no presentaron este antecedente. Las manifestaciones clínicas fueron semejantes en ambas subpoblaciones. Un tercio de los pacientes urbanos había recibido tratamiento con antibióticos previo al desarrollo del SUH.(AU)

The objectives of this study were (a) to describe and estimate the frequency of hemolytic uremic syndrome (HUS) in rural and urban populations in two regions of Buenos Aires Province, and (b) to compare the presentation and distribution of factors hypothetically associated with HUS. A total of 82 HUS cases, recorded during the years 2005-2010 in rural and urban areas of the south-central region of Buenos Aires Province, were clinically and epidemiologically characterized. Statistical data analysis included Chi square or Fisher test and median test. The incidence rate of HUS was significantly higher in the rural population, being 12.7 cases per 100 000 (CI 0-23.5) in rural inhabitants vs. 7.1 cases per 100 000 (CI 0-9.5) in urban inhabitants. The median age of the patients was 27 months (5-139 months), significantly lower in children from the rural area. This could be explained by a more frequent contact with bovine feces, the consumption of raw milk and a higher proportion of relatives who work in risk labors found in the rural population. Although HUS is often associated with the consumption of undercooked minced meat, most of the children cases here included did not present this antecedent. Clinical manifestations were similar in both subpopulations. One-third of urban patients had received antibiotics prior to HUS development.(AU)

Epidemiología del síndrome urémico hemolítico en dos regiones de la Provincia de Buenos Aires. / [Epidemiology of hemolytic uremic syndrome in two regions of Buenos Aires Province].

The objectives of this study were (a) to describe and estimate the frequency of hemolytic uremic syndrome (HUS) in rural and urban populations in two regions of Buenos Aires Province, and (b) to compare the presentation and distribution of factors hypothetically associated with HUS. A total of 82 HUS cases, recorded during the years 2005-2010 in rural and urban areas of the south-central region of Buenos Aires Province, were clinically and epidemiologically characterized. Statistical data analysis included Chi square or Fisher test and median test. The incidence rate of HUS was significantly higher in the rural population, being 12.7 cases per 100 000 (CI 0-23.5) in rural inhabitants vs. 7.1 cases per 100 000 (CI 0-9.5) in urban inhabitants. The median age of the patients was 27 months (5-139 months), significantly lower in children from the rural area. This could be explained by a more frequent contact with bovine feces, the consumption of raw milk and a higher proportion of relatives who work in risk labors found in the rural population. Although HUS is often associated with the consumption of undercooked minced meat, most of the children cases here included did not present this antecedent. Clinical manifestations were similar in both subpopulations. One-third of urban patients had received antibiotics prior to HUS development.

Caracterización epidemiológica de casos de síndrome urémico hemolítico en la región sur de la provincia de Buenos Aires / Epidemiological characterization of hemolytic-uremic syndrome cases in the south region of Buenos Aires province

INTRODUCCION: El síndrome urémico hemolítico (SUH) es la causa más frecuente de insuficiencia renal aguda en niños menores de 5 años en Argentina y se asocia principalmente a la infección por Escherichia coli shigatoxigénica (STEC). El bovino es el principal reservorio de STEC, las infecciones al hombre pueden producirse directa o indirectamente a partir de él. Es probable que las personas que presentan un mayor contacto con estos animales tengan una mayor exposición a la bacteria.OBJETIVO: Caracterizar epidemiológicamente la presentación de casos de SUH registrados durante 2005-2010 en poblaciones rurales y urbanas de la región centro-sur de la provincia de Buenos Aires.METODOS: El análisis de los datos incluyó estadísticas descriptivas y de comparación.RESULTADOS: La mediana de las edades del total de los pacientes estudiados fue de 27 meses (5-139 meses). El 54,3% de los casos respondió al género femenino y el 17,5%, al medio rural. Aunque la mayoría de los casos de SUH fueron pobladores urbanos, la tasa de incidencia específica fue significativamente mayor en poblaciones rurales y, en este grupo, las edades de los niños fueron más bajas.CONCLUSIONES: Los resultados obtenidos en el presente estudio concuerdan con otros realizados en la Argentina en lo que respecta a edad y género. No obstante, se encontró una mayor incidencia de SUH en pobladores rurales y a edades más bajas, lo que constituye una novedad. Esto podría deberse al contacto más frecuente con bovinos, ya sea directa o indirectamente, lo que aumentaría el riesgo de enfermar, sobre todo a edades más tempranas.

INTRODUCTION: In Argentina, the hemolytic-uremic syndomre (HUS) is the most frequent cause of acute renal failure in children under 5 years old and is associated with shigatoxigenic Escherichia coli (STEC) infection. Cattle are the major reservior for STEC, and the infection in human may be acquired directly or indirectly from cattle. People with increased contact with cattle are more likely to acquire STEC infections.OBJECTIVE: To characterize epidemiologically the HUS cases recorded during 2005-2010 in rural and urban populations in the central-southern region of Buenos Aires province.METHODS: Data analysis included descriptive and comparative statistics.RESULTS: The median age of the patients was 27 months (5-139 months). 54.3% of the cases were female and 17.5% belonged to rural areas. Although most cases of HUS were urban, the specific incidence rate was significantly higher in rural populations and the children were younger.CONCLUSIONS: The results obtaines in ths study are consistent with other studies conducted in Argentina in terms of age and gender. However, it detected a higher HUS incidence in rural populations and at younger ages, which is new in Argentina. This may be due to more frequent contact with cattle, directly or indirectly increasing the risk of developing the disease especially in younger children.

Caracterización epidemiológica de casos de síndrome urémico hemolítico en la región sur de la provincia de Buenos Aires / Epidemiological characterization of hemolytic-uremic syndrome cases in the south region of Buenos Aires province

INTRODUCCION: El síndrome urémico hemolítico (SUH) es la causa más frecuente de insuficiencia renal aguda en niños menores de 5 años en Argentina y se asocia principalmente a la infección por Escherichia coli shigatoxigénica (STEC). El bovino es el principal reservorio de STEC, las infecciones al hombre pueden producirse directa o indirectamente a partir de él. Es probable que las personas que presentan un mayor contacto con estos animales tengan una mayor exposición a la bacteria.OBJETIVO: Caracterizar epidemiológicamente la presentación de casos de SUH registrados durante 2005-2010 en poblaciones rurales y urbanas de la región centro-sur de la provincia de Buenos Aires.METODOS: El análisis de los datos incluyó estadísticas descriptivas y de comparación.RESULTADOS: La mediana de las edades del total de los pacientes estudiados fue de 27 meses (5-139 meses). El 54,3% de los casos respondió al género femenino y el 17,5%, al medio rural. Aunque la mayoría de los casos de SUH fueron pobladores urbanos, la tasa de incidencia específica fue significativamente mayor en poblaciones rurales y, en este grupo, las edades de los niños fueron más bajas.CONCLUSIONES: Los resultados obtenidos en el presente estudio concuerdan con otros realizados en la Argentina en lo que respecta a edad y género. No obstante, se encontró una mayor incidencia de SUH en pobladores rurales y a edades más bajas, lo que constituye una novedad. Esto podría deberse al contacto más frecuente con bovinos, ya sea directa o indirectamente, lo que aumentaría el riesgo de enfermar, sobre todo a edades más tempranas.

INTRODUCTION: In Argentina, the hemolytic-uremic syndomre (HUS) is the most frequent cause of acute renal failure in children under 5 years old and is associated with shigatoxigenic Escherichia coli (STEC) infection. Cattle are the major reservior for STEC, and the infection in human may be acquired directly or indirectly from cattle. People with increased contact with cattle are more likely to acquire STEC infections.OBJECTIVE: To characterize epidemiologically the HUS cases recorded during 2005-2010 in rural and urban populations in the central-southern region of Buenos Aires province.METHODS: Data analysis included descriptive and comparative statistics.RESULTS: The median age of the patients was 27 months (5-139 months). 54.3% of the cases were female and 17.5% belonged to rural areas. Although most cases of HUS were urban, the specific incidence rate was significantly higher in rural populations and the children were younger.CONCLUSIONS: The results obtaines in ths study are consistent with other studies conducted in Argentina in terms of age and gender. However, it detected a higher HUS incidence in rural populations and at younger ages, which is new in Argentina. This may be due to more frequent contact with cattle, directly or indirectly increasing the risk of developing the disease especially in younger children.

Anemia is not predictive of sustained virological response in liver transplant recipients with hepatitis C virus who are treated with pegylated interferon and ribavirin.

In the immunocompetent setting, antiviral therapy-related anemia has recently been shown to be associated with a sustained virological response (SVR). Our goal was to assess whether this is also true for liver transplantation (LT). We included 160 LT patients with recurrent hepatitis C virus (HCV) who were treated with pegylated interferon and ribavirin (RBV) between 2002 and 2010; 76% of the patients were men, the median age of the patients was 56 years (range = 33-75 years), 63% had advanced fibrosis, and 86% were infected with HCV genotype 1a or 1b. The baseline immunosuppression was tacrolimus in 56% of the patients. Mycophenolate mofetil (MMF) was used in 15%. Anemia was defined as a hemoglobin (Hb) level < 10 g/dL. Significant anemia was present when the Hb decline was >5 g/dL. Anemia and significant anemia developed in 67% and 41% of the patients, respectively. Erythropoietin was used in 60%. Factors independently associated with significant anemia included low estimated creatinine clearance [relative risk (RR) = 0.951, 95% confidence interval (CI) = 0.925-0.978, P = 0.0001], a longer time from LT to therapy (RR = 1.001, 95% CI = 1.000-1.001, P = 0.002), high baseline viremia (RR = 3.2, 95% CI = 1.3-8.1, P = 0.01), cyclosporine A (CSA)-based immunosuppression (RR: 3.472, 95% CI: 1.386-8.695; P = 0.008), and the use of MMF (RR: 5.346, 95% CI: 1.398-20.447; P = 0.014). An SVR occurred in 43% of the patients; the factors associated with an SVR included baseline variables (younger recipient age, younger donor age, infections with non-1 HCV genotypes, body mass index, and mild fibrosis) and on-treatment factors related to adherence or viral kinetics. Anemia resulted in RBV dose reductions but was not associated with the virological response at any time. In conclusion, anemia is a very frequent complication in LT patients during antiviral therapy and is associated with increased RBV dose reduction but not with an SVR. Predictors of anemia include MMF or CSA immunosuppression, high viremia, and renal insufficiency.

Effect of calcineurin inhibitors in the outcome of liver transplantation in hepatitis C virus-positive recipients.

BACKGROUND: There is a paucity of good studies evaluating the impact of calcineurin inhibitors on posttransplantation outcome in hepatitis C virus (HCV)-infected liver transplant (LT) recipients. METHODS: We sought to determine whether there are differences on posttransplantation survival and histologic recurrence in HCV-LT recipients based on initial immunosuppression (IS) by conducting a prospective study comparing tacrolimus (Tac) versus cyclosporine-based IS in patients undergoing LT between 2001 and 2007. Protocol liver biopsies were performed. RESULTS: Baseline characteristics (demographics, liver function at LT, genotype distribution, donor, surgery, and IS except for the type of calcineurin inhibitor) did not differ between groups. Severe disease (defined as bridging fibrosis, cirrhosis, cholestatic hepatitis, or allograft loss or death because of recurrent disease in the first year) was present in 67 of 253 (26.5%) and was equally distributed in the CsA and Tac groups (27% vs. 26%; P=0.68). Two thirds of protocol biopsies performed at 1 year showed some fibrosis without differences between CsA and Tac groups (75% vs. 70%). Advanced fibrosis (bridging fibrosis and cirrhosis) was diagnosed in 30% CsA and 24.5% Tac patients (P=NS). No differences in survival at 1 and 7 years were observed (83% and 67% vs. 78% and 64%, respectively, P=0.4). In summary, in patients undergoing LT for HCV-related liver disease, posttransplantation outcome is not related to the calcineurin inhibitor used.

Indicaciones y resultados de retrasplante hepático: experiencia del hospital universitario La Fe (1.181 pacientes) / Indications and results of liver retransplantation: experience with 1181 patients in the hospital universitario La Fe

Resumen El retrasplante hepático (ReTH) constituye la única opción terapéutica para el fracaso irreversible de un injerto hepático y corresponde a un 2,9–24,0% de todos los trasplantes hepáticos (TH). Técnicamente es difícil y conlleva un elevado índice de morbilidad inmediata y una menor supervivencia que el TH primario. Nuestro objetivo fue determinar la tasa de ReTH y las indicaciones, morbilidad, mortalidad postoperatoria y supervivencia actuarial del paciente retrasplantado. Pacientes y método Estudio de cohorte histórica de 1.181 pacientes trasplantados entre los años 1991 y 2006.ResultadosDe los 1.260 TH realizados, 79 fueron ReTH. Al momento del primer TH, no hubo diferencias con aquellos pacientes que no necesitaron ReTH. La tasa de ReTH fue del 6,3% y las causas más frecuentes fueron: trombosis de la arteria hepática (31,6%), recidiva de la cirrosis por VHC (30,4%) y fallo primario del injerto (21,5%). Los tiempos de isquemia, síndrome de reperfusión y congestión hepática no difieren entre el TH primario y el ReTH. Por el contrario, la transfusión de hematíes fue mayor en el ReTH (6,3±4,9 vs 3,5±3,0 unidades, p<0,001). La morbilidad y mortalidad postoperatoria (hasta los 30 días posterior al TH) fue mayor en los pacientes retrasplantados (68,4 vs 57,0%, p=0,04 y 25,3 vs 10,9%, p<0,001; respectivamente). La supervivencia actuarial a 1 y 5 años fue 83% y 69% en aquellos sin ReTH, 71% y 61% en ReTH precoz y 64% y 34% en ReTH tardío (p<0,001).Conclusiones Pese a una elevada morbilidad y mortalidad del ReTH, parece que esta alternativa terapéutica continúa siendo válida en aquellos pacientes con una pérdida precoz del injerto hepático. Por el contrario, cuando la pérdida del injerto es tardía, se hace necesario definir, cuales serían los resultados mínimos aceptables para indicar el ReTH y qué pacientes se pueden beneficiar con este tratamiento (AU)

Abstract Liver retransplantation (LrT) is the only therapeutic option for irreversible failure of a hepatic graft and accounts for 2.9&%#x02013;24.0% of all liver transplantations (LT). It is technically difficult and has a high level of immediate morbidity and a lower survival than primary LT. Our aim was to determine the rate of LrT and its indications, morbidity, post-operative mortality and actuarial survival in the retransplanted patient.Patients and method A historical cohort study of 1181 patients transplanted between 1991 and 2006.ResultsOf the 1260 LT performed, 79 were LrT. At the time of the first LT there were no differences between those patients and those that did not require an LrT. The LrT rate was 6.3% and the most frequent causes were: hepatic artery thrombosis (31.6%), recurrence of cirrhosis due the HVC (30.4%) and primary graft (21.5%). The ischemia times, perfusion syndrome and hepatic congestion were no different between the primary LT and the LrT. On the other hand, red cell transfusions were higher in LrT (6.3±4.9 vs. 3.5±3.0 units, P<0.001). The post-operative morbidity and morbidity (up to 30 days after the LT) was higher in retransplanted patients (68.4% vs. 57.0%, P=0.04 and 25.3% vs. 10.9%, P<0.001; respectively). The actuarial survival at 1 and 5 years was 83% and 69% in those without LrT, 71% and 61% in early LrT and 64% and 34% in delayed LrT (P<0.001).Conclusions Despite the increased morbidity and mortality of LrT, it appears that this treatment alternative is still valid in those patients with an early loss of the liver graft. On the other hand, when the graft loss is delayed, it needs to be defined, what would be the minimum acceptable results to indicate LrT and which patients could benefit from this treatment (AU)

[Indications and results of liver retransplantation: experience with 1181 patients at the University Hospital La Fe]. / Indicaciones y resultados de retrasplante hepático: experiencia del hospital universitario La Fe (1.181 pacientes).

UNLABELLED: Liver retransplantation (LrT) is the only therapeutic option for irreversible failure of a hepatic graft and accounts for 2.9%-24.0% of all liver transplantations (LT). It is technically difficult and has a high level of immediate morbidity and a lower survival than primary LT. Our aim was to determine the rate of LrT and its indications, morbidity, post-operative mortality and actuarial survival in the retransplanted patient. PATIENTS AND METHOD: A historical cohort study of 1181 patients transplanted between 1991 and 2006. RESULTS: Of the 1260 LT performed, 79 were LrT. At the time of the first LT there were no differences between those patients and those that did not require an LrT. The LrT rate was 6.3% and the most frequent causes were: hepatic artery thrombosis (31.6%), recurrence of cirrhosis due the HVC (30.4%) and primary graft (21.5%). The ischemia times, perfusion syndrome and hepatic congestion were no different between the primary LT and the LrT. On the other hand, red cell transfusions were higher in LrT (6.3+/-4.9 vs. 3.5+/-3.0 units, P<0.001). The post-operative morbidity and morbidity (up to 30 days after the LT) was higher in retransplanted patients (68.4% vs. 57.0%, P=0.04 and 25.3% vs. 10.9%, P<0.001; respectively). The actuarial survival at 1 and 5 years was 83% and 69% in those without LrT, 71% and 61% in early LrT and 64% and 34% in delayed LrT (P<0.001). CONCLUSIONS: Despite the increased morbidity and mortality of LrT, it appears that this treatment alternative is still valid in those patients with an early loss of the liver graft. On the other hand, when the graft loss is delayed, it needs to be defined, what would be the minimum acceptable results to indicate LrT and which patients could benefit from this treatment.

Comparative prospective study of two liver graft preservation solutions: University of Wisconsin and Celsior.

University of Wisconsin solution (UWS) is the gold standard for graft preservation. Celsior solution (CS) is a new solution not as yet widely used in liver grafts. The aim of this study was to compare the liver function of transplanted grafts stored in these 2 preservation solutions. The primary endpoints were the rates of primary nonfunction (PNF) and primary dysfunction (PDF). We performed a prospective and pseudorandomized study that included 196 patients (representing 104 and 92 livers preserved in UWS and CS, respectively) at La Fe University Hospital (Valencia, Spain) between March 2003 and May 2005. PNF and PDF rates, liver function laboratory parameters, postoperative bleeding, vascular and biliary complications, and patient and graft survival at 3 years were compared for the 2 groups. The 2 groups were similar in terms of donor variables, recipient variables, and surgical techniques. The PNF rates were 2.2% and 1.9% in the CS and UWS groups, respectively (P = not significant), and the PDF rates were 15.2% and 15.5% in the CS and UWS groups, respectively (P = not significant). There were no significant differences in the laboratory parameters for the 2 groups, except for alanine aminotransferase levels in month 3, which were lower in the CS group (P = 0.01). No significant differences were observed in terms of complications. Three-year patient and graft survival rates were as follows for years 1, 2, and 3: 83%, 80%, and 76% (patient) and 80%, 77%, and 73% (graft) for the UWS group and 83%, 77%, and 70% (patient) and 81%, 73%, and 67% (graft) for the CS group (P = not significant). In conclusion, this study shows that CS is as effective as UWS in liver preservation.