ABSTRACT
INTRODUCTION: SARS-CoV2 pandemic has altered the normal activity in our day-to-day life. During the most critical moments of the pandemic at the hospital, attendance and programmed activities had to be reduced to a minimum, including kidney transplants. Hospitals with this kind of activity had to suspend or restructure it due to the decrease in the number of donors with a solid organ donation profile, the lack of knowledge as to whether the disease could be transmitted through transplantation or the risk that was believed to be associated with the admission of patients with end-stage chronic kidney disease or immunosuppressive treatment. METHODS: A retrospective review of all patients who had received a kidney transplant at Doctor Peset University Hospital in Valencia was performed from March 2020 to March 2021. The objective was to study the safety of kidney transplantation and the incidence of COVID-19 disease in kidney transplant patients during this pandemic period. RESULTS: 56 cases of kidney transplantation were included, most of them male with an average age of 56 years old, and variable comorbidity such as hypertension, dyslipidemia, an average body mass index of 26 and undergoing renal replacement therapy by hemodialysis. Regarding the organ donors, more than 50% were male patients and the donation was in encephalic death. The average cold ischemia time was 15 hours. Postoperative complications were mostly graded I and II in the Clavien-Dindo classification. 5.4% of the recipients had passed the SARS-CoV2 infection prior to the transplant and 5.4% were infected with COVID-19 after the transplant. CONCLUSION: In our experience, the current kidney transplant program seems viable and safe, even during periods of health emergencies.
Subject(s)
COVID-19 , Kidney Failure, Chronic , Kidney Transplantation , Female , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Pandemics , RNA, Viral , SARS-CoV-2ABSTRACT
Objetivo Optimizar el uso de antibióticos en la profilaxis de la cistoscopia flexible estudiando los patógenos más frecuentes de nuestro entorno y eligiendo el antibiótico según sus antibiogramas. Métodos Desde Enero del 2015 hasta Noviembre del 2015, se analizaron los urinocultivos de nuestra área, se eligió el antibiótico en función a su sensibilidad frente a los patógenos más frecuentes y se comparó con un antibiótico de amplio espectro. Desde Enero del 2016 hasta Diciembre del 2016, se realizaron las cistoscopias agrupando a los pacientes en: Grupo 1: Pacientes sin profilaxis; Grupo 2: Profilaxis con Gentamicina 240 mg; Grupo 3: Profilaxis con antibiótico seleccionado. Como variables principales se definieron la presencia de bacteriuria asintomática e ITU tras la realización de la cistoscopia flexible. Resultados Se analizaron 8.530 urinocultivos y se eligió la Fosfomicina Trometamol 3 gr como profilaxis. Se realizaron 244 cistoscopias distribuidas: Grupo 1: 86 (35%); Grupo 2: 72 (30%); Grupo 3: 86 (35%). Se detectó bacteriuria asintomática postcistoscopia en 6 pacientes (2,5%) en el Grupo 1, 7 pacientes (2,9%) en el grupo 2 y 5 pacientes (2%) en el grupo 3 no presentando diferencias significativas (p 0.120). Desarrollaron ITUs postcistoscopia 1 paciente (0,4%) en el Grupo 1, 5 pacientes (2%) en el Grupo 2 y 2 pacientes (0,8%) en el Grupo 3 sin diferencias significativas (p 0.105). Conclusión La Fosfomicina es tan efectiva como la Gentamicina en la profilaxis de la cistoscopia. Para un uso correcto de los antibióticos, se recomienda el estudio de los patógenos de nuestro entorno.
Objective To optimize the use of antibiotics in the prophylaxis of flexible cystoscopy by studying the most frequent pathogens in our environment and choosing the antibiotic according to its antibiograms. Method Between January 2015 and November 2015, urine cultures were analyzed in our area, the antibiotic was chosen based on its sensitivity to the most frequent pathogens and compared with a broad spectrum antibiotic. From January 2016 to December 2016, cystoscopy was performed by grouping patients into: Group 1 - Patients without prophylaxis, Group 2 - Prophylaxis with 240 mg gentamicin, Group 3 - Selected antibiotic prophylaxis. The main variables were the presence of asymptomatic bacteriuria and UTI after flexible cystoscopy. Results 8530 urine cultures were analyzed and 3 g of fosfomycin trometamol was chosen as the prophylactic. There were 244 cystoscopies: Group 1: 86 (35%); Group 2: 72 (30%); Group 3: 86 (35%). Asymptomatic bacteriuria was detected in 6 patients (2.5%) in Group 1, 7 patients (2.9%) in Group 2 and 5 patients (2%) in Group 3, showing no significant differences (p = 0.120). Post-cystoscopic urinary tract infection developed in 1 patient (0.4%) in Group 1, 5 patients (2%) in Group 2 and 2 patients (0.8%) in Group 3, which showed no significant differences (p 0.105). Conclusion Fosfomycin is as effective as Gentamicin as a prophylactic in cystoscopy. The study of the pathogens in each environment is recommended to correctly prescribe the antibiotic.
Subject(s)
Humans , Microbial Sensitivity Tests , Cystoscopy , Anti-Bacterial Agents , Bacteriuria , Triacetoneamine-N-Oxyl , Tromethamine , Urinary Tract Infections , Gentamicins , Antibiotic ProphylaxisABSTRACT
OBJECTIVE: To analyze our experience in the treatment of recurrences of bladder tumor using Holmium-YAG (Ho:YAG) laser, assessing recurrence rates, tumor progression, degree of safety, and patient satisfaction, as well as the economic repercussions of the technique. MATERIALS AND METHODS: The study included 109 patients between February 2013 and 2016, who had a superficial recurrence of bladder tumor. Patients were treated by Ho:YAG laser photocoagulation on an outpatient basis and under local anesthetic. Cytology and previous biopsy were collected. The number of tumors, size, time of technique, and any complications were recorded. Subsequently, urine culturing was carried out and we recorded the visual analogue scale, a satisfaction questionnaire, and possible complications. The economic cost of the procedures was calculated. Data were analyzed using a chi-square test for continuous variables and Student's t for independent samples for dichotomous qualitative-quantitative variables. RESULTS: We carried out 139 procedures on 25 women (20%) and 114 men (80%) with a mean age of 67.85 ± 10.41 years and 246 tumors were treated. The consultation time was 21.5 minutes and the photocoagulation time was 7 minutes (1-35). As intraoperative complications, two patients presented monosymptomatic hematuria without requiring treatment and there were no postoperative complications. The total recurrence rate at 6 months was 20%. A value ≤4 on the EVA scale was reported for 94.7% of the patients. The saving per procedure compared with transurethral bladder resection was calculated at 2,007.09. CONCLUSION: The treatment of small recurrences of bladder tumor by photocoagulation with Ho:YAG laser is a well-tolerated technique that offers an acceptable level of cancer control and a lower cost compared with transurethral resection.
