Desensitizing the broadly human leukocyte antigen-sensitized patient awaiting deceased donor kidney transplantation.

For broadly human leukocyte antigen-sensitized patients (HS; calculated panel-reactive antibody >80%), options for deceased donor (DD) transplantation are extremely limited. Data from United Network for Organ Sharing (2000-2009) indicate that <10% of HS patients are transplanted each year. Immune modulation of HS patients using intravenous immunoglobulin (IVIG) and rituximab has shown promise in reducing donor-specific antibody (DSA) titers and improving the chances for successful transplantation for patients awaiting DD transplants. Critical to the success of desensitization with IVIG + rituximab is a coherent antibody-testing strategy aimed at detection of DSA reductions and identification of crossmatch parameters that are associated with a low likelihood of antibody-mediated rejection posttransplant. Here, we discuss data that examine the efficacy of IVIG + rituximab in reducing DSA levels and improving chances for a successful DD transplantation. Patient and graft survival data are also presented as is an analysis of the safety of IVIG + rituximab in sensitized patients.

[Nutritional impact of whole milk supplemented with vitamins and minerals in children]]. / Impacto nutricio del consumo de una leche entera adicionada con vitaminas y minerales en niños.

OBJECTIVE: To evaluate the nutritional impact of the ingestion of a fortified whole milk in children. MATERIAL AND METHODS: Prospective, longitudinal assay in 227 children aged 8-60 months. INTERVENTION: Daily consumption of 500 ml of fortified milk during 90 days. We registered milk acceptance and assessed weight, height; hemoglobin, serum iron, vitamin B12, and folic acid, at the beginning and the end of the study. Statistical evaluation were done with central and dispersion indices in the dimensional variables, using Student's t test and chi 2 test for compare nominal variables at initial and the end of the study. RESULTS: At admission, 45 children were malnourished and 36 were anemic. At the end of the supplementation period there was a reduction to 35 malnourished (p < 0.21) and 18 anemic (p < 0.01). Anthropometric weight/height score in Z at the beginning and end of the study (x +/- S.D) were -0.35 +/- 0.88 vs -0.14 +/- 9 (p < 0.01); Hb g/dl: 11 +/- 1.3 vs 11.9 +/- 1.9 (p < 0.001), Iron mg/dl: 108 +/- 44 vs 115 +/- 31 (p = 0.06) and vitamin B12 pg/ml: 649 +/- 494 to 1053 +/- 854 (p < 0.001). The milk was well tolerated and widely accepted. CONCLUSIONS: The consumption of a fortified whole milk during 90 days improved significantly the nutritional status of the children, the weight for height Z score, the plasma level of vitamin B12 and Hb, and decreased the number of anemic and malnourished children.

[Campylobacter jejuni infection in children of a rural community]. / Infección por Campylobacter jejuni en niños de una comunidad rural.

Colonization of the intestine with Campylobacter jejuni was followed longitudinally from birth in a cohort of 75 rural children with fecal cultures taken every fortnight and every time they had diarrhea. Only 25% of children initially colonized with C. jejuni during the first year of life, and 12% of children initially colonized during the second had diarrhea. The age at which a child was initially infected with C. jejuni was not a risk factor in relation with presence of disease. A higher illness-to-infection ratio (P less than 0.05) was found during subsequent colonization with C. jejuni when initial infection was associated with diarrhea. Risk of diarrhea during initial or subsequent colonization with C. jejuni was not related with the production of cholera-like enterotoxin, a cytotoxic active on HeLa cells or with adhesive ability to HEp-2 cells by the infecting strains.