Organization of outpatient consultations at a hand surgery department in a French university hospital during the COVID-19 lockdown.

The COVID-19 health crisis has greatly impacted the organization of outpatient consultations, especially in hand surgery. Five reorganization stages were described during the crisis (from week 11 to week 21 in 2020): preparatory stage, 1st organizational stage, wait-and-see stage, 2nd organizational stage, and progressive return stage. The number of patients seen on-site decreased 64% in 2020 compared to 2019, while 78% of consultations were canceled. The logistics (teleconsultation, dedicated COVID-19 patient pathways) and human resources (sick leave, telework, reassignment to other departments) were adapted to ensure that patients who are usually seen in our hand surgery department received adequate care.

Small low-risk pulmonary nodules on chest digital radiography: can we predict whether the nodule is benign?

AIM: To evaluate digital chest radiography (CR) performance compared to computed tomography (CT) for characterising small low-risk pulmonary nodules detected incidentally in non-oncological patients. A second aim was to assess the prevalence of calcification and possible false-positive findings mimicking nodules. MATERIALS AND METHODS: Two hundred and seven patients who presented with a pulmonary nodule on CR and underwent CT were included prospectively. Nine radiologists blinded to the CT images reviewed the CRs assessing for the presence of nodules. Afterwards, the same radiologists evaluated the corresponding CT for the presence of nodules, dimensions, and calcification. If the nodule was not present on CT, it was considered a false-positive finding, and possible confounding factors on CR were investigated. RESULTS: Among all 213 nodules seen on CR, 32.4% were revealed to be false-positive findings on CT, mostly due to images formed by vessels (53.6%), osseous aetiologies (30.4%), and skin lesions (13%). Most nodules <6 mm detected on radiographies had benign calcification on CT (n=90; 67.7%). Comparatively, only 41.2% of nodules ≥6 mm on the CR had benign calcification. Among all nodules <6 mm detected on CR, 95.5% were calcified or not present at CT against 81.2% for those ≥6 mm (p<0.001). CONCLUSION: The present study demonstrated that 95.5% of pulmonary nodules smaller than 6 mm on CRs are either calcified (benign) or represent a false-positive finding on CT. These results suggest that nodule measures on CR smaller than 6 mm most likely represent a benign finding.

Factors Associated With Delayed Graft Function and Their Influence on Outcomes of Kidney Transplantation.

BACKGROUND: One of the main postoperative complications of kidney transplant is delayed graft function (DGF), which means absence of graft function after transplant or the need for dialysis during the first week post procedure. The occurrence of DGF currently in our hospital is high and has been attributed to a combination of many factors. The aim of this study was to evaluate the factors associated to DGF and their influence in the outcome of kidney transplants. METHODS: Historical cohort of 150 patients transplanted with live or deceased donor kidneys from 2011 to 2013. RESULTS: DGF was associated to time in dialysis and the number of recipient pre-transplant transfusions, donors age, serum creatinine level, use of vasoactive drugs in the donor, distance from place of organ retrieval and transplant center, and duration of cold ischemia time. DGF influenced post-transplantation outcome in regard to length of stay in intensive care, length of hospital stay, acute rejection episodes, and higher creatinine levels at discharge. Patients and graft survival were shorter in the DGF group. CONCLUSIONS: There are multiple factors related to DGF, the most important being those related to donors, and organ storage. The most important factor related to the recipient was the dialysis vintage. We did not find a correlation between DGF and HLA-compatibility. DGF consequences are important, including worse graft function and survival, as well as impact in recipient morbidity and mortality.

Kidney Transplantation at a Southern Brazilian University Hospital: A 35-Year Practice Review.

BACKGROUND: The Nephrology Unit at São Lucas Hospital, a University Hospital in Southern Brazil, has recently reached 35 years since its first kidney transplant. Few centers in the area have made a longitudinal analysis of processes, problems, grafts, and patient survival changes along this time. METHODS: A single-center, retrospective study was performed. Data were separated into different eras, based on the nature of immunosuppression used: pre-cyclosporine (1978-1986), cyclosporine (1987-1997), mycophenolate introduction (1998-2002), new immunosuppressant drugs (2003-2007), and the current period (2008-2013). RESULTS: Between April 27, 1978, and April 30, 2013, 1231 transplants were performed. Significant differences were detected among different eras. The number of transplants has been progressively increasing, to include significantly older recipients (and donors), at a longer waiting list time, receiving organs that underwent longer cold ischemia time (P < .001). Yet, fewer acute rejection episodes and lower incidence of myocardial infarction and post-transplant diabetes mellitus (P < .001) were detected. In the present era, patient survival at 1, 3, and 5 years is 98.3%, 94.6%, and 90.5% respectively, for living donors, and 92.4%, 87.2%, and 80.7% for deceased donors, respectively. Living donor graft survival is 92.2%, 88.7%, and 82.4%, respectively, whereas deceased donor survival is 80.4%, 71.1%, and 63.7%, respectively. CONCLUSIONS: This retrospective analysis has significant historical value. It assembles and depicts a long follow-up period of a transplant series at a single Brazilian center. Throughout the eras, organ and patient survival increased, with fewer rejection episodes or complications, yet with overall decreased graft function.

Does Thymoglobulin Induction Increase Susceptibility to Carbapenem-Resistant Acinetobacter baumannii Sepsis-related Death in Expanded Criteria Donors?

BACKGROUND: Solid organ transplant recipients are susceptible to antibiotic-resistant infections and carbapenem-resistant Acinetobacter baumannii (CRAB) has recently been recognized as a serious complication in solid organ recipients. High mortality rates have been described. METHODS: We retrospectively analyzed 807 transplantations and detected 10 patients who died 24 hours after the diagnosis of septicemia, all with CRAB-positive blood cultures. Recipients were followed up for at least 1 year and were stratified into the following groups: Group 1, patients alive; Group 2, patients that died due to other causes except Acinetobacter infection; and Group 3, patients who died within 24 hours of CRAB diagnosis. RESULTS: CRAB-positive patients died a median of 3.17 (range, 1.81-18.7) months after transplantation. In these patients, expanded criteria donors (ECDs) were more frequent (P < .001), as were the use of anti-thymocyte globulin (ATG) induction (P = .02) and delayed graft function (P = .01). For ECD recipients, death rate from any cause, whether induced with ATG or not, was 25% and 20.6%, respectively (odds ratio [OR], 1.28; confidence interval [CI] 95%, 0.56-2.91; P = .68). The death rate from CRAB-related sepsis was 10.3% and 0% whether receiving ATG or not, respectively (OR, 15.49; CI 95%, 0.87-277.16; P = .014). There was a 25.75-fold increase in the death rate in ECD kidney recipients induced with thymoglobulin and with CRAB-related sepsis. CONCLUSION: Transplants from ECDs and induced with thymoglobulin may be at increased risk of CRAB death in 24 hours when compared with patients with standard donors and induced with thymoglobulin.

Acute Graft Pyelonephritis Occurring up to 30 Days After Kidney Transplantation: Epidemiology, Risk Factors, and Survival.

Acute graft pyelonephritis is a very common infection in renal transplantation. The impact of acute graft pyelonephritis (AGPN) on graft and patient outcome has not yet been established. Eight hundred seventy kidney and kidney-pancreas transplants were retrospectively studied, over last 13 years, to verify occurrence of AGPN in the first 30 days post-transplantation. We found that 112 patients (15.8%) presented post-transplantatiom AGPN up to 30 days after a kidney transplantation. The occurrence was higher in older patients (P = .005) and in those with ureteral stents (P = .06). Escherichia coli was the most frequent microorganism in urine cultures (32%). Ureteral stent (relative risk = 1.7; confidence interval [CI], 1.1-2.5; P = .018) was a major risk factor for AGPN as well as older ages (RR = 1.02; CI 1.01-1.04; P = .001), length of hospitalization stay (RR = 1.01; CI, 1.01-1.02; P < .001), and anti-thymocyte globulin (ATG) induction (RR = 1.6; CI, 1.022-2.561; P = .04). Long-term graft and patient survival was significantly lower in patients with pyelonephritis in the first 30 days after transplantation (OR 1.43; 95% CI, 0.95-2.16; P = .024 and OR 1.77; 95% CI, 1.12-2.80; P = .006, respectively). Acute pyelonephritis in the first 30 days after transplantation is therefore associated with a lower long-term graft and patient survival.

Placental expression of eNOS, iNOS and the major protein components of caveolae in women with pre-eclampsia.

Caveolae regulate many cardiovascular functions and thus could be of interest in relation to pre-eclampsia, a pregnancy specific disorder characterised by hypertension and proteinuria. We examined placental mRNA and protein expression/localisation of the caveolae components Caveolin 1-3, Cavin 1-4 as well as eNOS/iNOS in normotensive control (n = 24) and pre-eclamptic pregnancies (n = 19). Placental mRNA expression of caveolin-1, cavin 1-3, was lower and eNOS expression was increased in pre-eclampsia (P < 0.05 for all). Additionally Caveolin-1 protein expression was also reduced in pre-eclampsia (P = 0.007); this could be an adaptive response in pre-eclampsia, possibly to attenuate the oxidative stress/inflammation.

PP040. Expression of RANTES (CCL5) in maternal plasma, fetal plasma and placenta in pre-eclampsia and normotensive controls.

INTRODUCTION: Studies have shown pre-eclampsia (PE) as an exacerbation of gestational inflammatory process. RANTES (Regulated upon Activation, Normal T-cell Expressed, and Secreted)/CCL5 is a chemokine, which is involved in chronic inflammation by the recruitment of inflammatory cells. It is secreted by many cell types such as endothelial cells, smooth muscle cells, macrophages, platelets and activated T-cells. Thus we hypothesized that RANTES expression is altered in PE and may be different in gestational tissues (maternal plasma, fetal plasma and placenta). OBJECTIVES: The purpose of the study is to analyze the expression of RANTES (CCL5) in three different tissues: maternal plasma, fetal plasma and placenta, in PE and normotensive controls (NC). METHODS: PE was diagnosed by the National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy guidelines. The patients were assisted in the São Lucas Hospital from PUCRS, Porto Alegre, Brazil. Following ethical approval and informed written consent, maternal and umbilical plasma and placental biopsies were taken from 33 PE and 35 NC. Samples were centrifuged immediately after blood collection and plasma was stored at -80°C until assay. Placental Biopsies were taken midway between the cord and periphery, from the central region of cotyledons and were stored as well. RANTES expression was made by the ELISA test, in duplicates. They were also analyzed in each group: maternal age, maternal parity, gestational age on delivery, glucose, body mass index, proteinúria creatinuria ratio, systolic blood pressure (SBP), diastolic blood pressure (DBP), delivery method, birth weight, placental weight and Apgar index in 1st and 5th minute. RESULTS: Maternal age at the time of blood collection was not significantly different between the two groups. The women with preeclampsia delivered earlier and had smaller babies compared with the controls. Significant associations between groups (p<0.001) were seen in SBP, DBP, birth weight and delivery method. RANTES was increased in maternal plasma and placenta in patients with PE and decreased in fetus plasma in the same group (p<0.001). CONCLUSION: In this study, we have shown that RANTES expression in maternal plasma and placenta tissues, in women with established pre-eclampsia, is higher than in gestation-matched women with a healthy pregnancy. It confirms the hypotheses that physiology of PE is associated with an increase of normal gestational inflammatory process. However in fetus tissue, the inflammatory chemokine is decreased in PE women. FUNDING: CAPES Foundation, Ministry of Education of Brazil, Brasília - DF 70040-020, Brazil.

PP050. Distribution of ABO and Rhesus blood groups in patients withpre-eclampsia.

INTRODUCTION: The ABO-system of antigens and the Rh-system (D-antigen) is genetically determined and remains the most important blood group systems clinically. Several studies have examined the association between ABO and Rhesus blood group systems and pre-eclampsia. At present there is no consensus to define this association, especially not in a Brazilian population. OBJECTIVES: The purpose of the present study was to evaluate the association between pre-eclampsia versus ABO and Rhesus blood group systems in pregnant women hospitalized in a University Hospital in Porto Alegre, Brazil -Hospital São Lucas (HSL). METHODS: Pre-eclampsia/eclampsia (PE/E) was diagnosed by the National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy guidelines. This study consisted of 14,894 pregnant women admitted to the Maternity Department between 2005 and 2010. The patients were reviewed retrospectively for inclusion. Complications in pregnancy not related to pre-eclampsia/eclampsia (PE/E) and those with uncompleted data were excluded. Medical records of 410 women were used to diagnose PE/E. The control group consisted of 8781 women. Each group was subdivided according to their blood groups. RESULTS: In comparison to the PE/E women and controls, no specific relation in blood groups was observed. With respect to ABO and Rh groups, no differences between PE/E and controls were observed (P=0.479 and P=0.169 respectively). When analyzed with both Rh and ABO Pearson Chi-Square also showed no differences (P=0.569). CONCLUSION: This study aimed to demonstrate some association between blood groups and PE/E using a large sample from the south of Brazil, a population not investigated before. In our study, no specific differences were observed between PE/E and controls in the distribution of the blood groups. In conclusion, the results of this study suggest no association between ABO and Rhesus blood group systems and PE/E in our population. FUNDING: CAPES Foundation-Ministry of Education of Brazil.

Increased serum phosphodiesterase activity in women with pre-eclampsia.

OBJECTIVE: To measure the activity of serum phosphodiesterase (PDE) in pre-eclampsia. DESIGN: Case-control study. SETTING: Nephrology Laboratory and Obstetrics Unit at São Lucas Hospital from Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil. SAMPLE: Twenty-nine normal and 28 pregnant women with pre-eclampsia. METHODS: Serum was collected from women with pre-eclampsia, at the time of diagnosis, and from gestation-matched controls. Circulating PDE activity was assessed by measuring consumption of the substrate thymidine 5'-monophosphate p-nitrophenyl ester and expressed as PDE units/l. MAIN OUTCOME MEASURES: Serum PDE Activity. RESULTS: Mean substrate consumption was higher in pre-eclamptic condition (V(max)= 15.8 +/- 1.4 versus 12.7 +/- 0.9 U/L, P= 3.7 x 10(-14)). CONCLUSION: These data suggest that altered PDE activity may play a role in pre-eclampsia endothelial dysfunction.

Quality of life and sexuality in chronic dialysis female patients.

Patients in end-stage renal disease (ESRD) present reduced quality of life (QOL) and impaired sexual function. Previous studies have mostly addressed male sexual dysfunction. This was a cross-sectional controlled study that applied a general and the World Health Organization Quality of Life-bref questionnaires to assess demographic, marital, and sexual conditions, and QOL in 86 healthy women aged 18 or more years (Group 1), and 38 female ESRD patients on dialysis for at least 2 months (Group 2). The effect of several explanatory variables upon QOL components was estimated. Quality of life was lower in Group 2 -- overall, and on physical and environment domains. To undergo dialysis and to be poorly educated negatively affected the QOL. Yet age, a stable marital relationship or being sexually active had no effect. Female patients undergoing chronic dialysis had lower QOL and were significantly more sexually dysfunctional than comparable healthy women. Decline in sexual function had no effect on the QOL.

A novel mechanism of silicon uptake.

Crystal-like structures in vacuoles, precipitates in the cytoplasm and on the tonoplast membrane have been found to store remarkable amounts of Si in a number of higher plants. In most of the cases the final storage product is a SiO(2) gel. Accumulation inside the cells presumes a membrane and cytoplasm passage, driven by unknown transporters. Beside this uptake into the cytoplasm, Si-accumulating species possess a mechanism that does not involve a membrane and cytoplasm passage. Unusual small invaginations comprising the two membranes, plasmalemma and tonoplast, which enclose a small border of cytoplasm, were observed. The same cells contained vacuolar vesicles surrounded by two membranes, obviously derived from the invaginations. By energy-dispersive X-ray analysis and electron spectroscopic imaging, Si was shown in the invaginations and vacuolar vesicles. This novel endocytotic process allows the uptake of condensed, higher-molecular-weight Si compounds. In Zn hyperaccumulators, frequently SiO(2) precipitates were found in different cell compartments. Such plants showed the same invaginations and vacuolar vesicles, but Zn, colocalized with Si, was detected in these structures. Electron energy loss spectra confirmed the assumption that Zn-silicate is present in the vesicles. In the vacuoles the unstable Zn-silicate is degraded, forming SiO(2) precipitates, while the released Zn is bound to an unknown partner.

Efficacy of chemical sterilization and storage conditions of gutta-percha cones.

AIM: The objective of the present study was to assess the efficacy of 2.5% sodium hypochlorite and 2.2% glutaraldehyde ('Cidex') as sterilizing agents for gutta-percha cones. The efficacy of storage of gutta-percha cones in the presence or absence of paraformaldehyde was also evaluated. METHODOLOGY: Gutta-percha cones artificially contaminated with a suspension of Bacillus stearothermophilus (ATCC/7953) were treated with either 2.2% glutaraldehyde for 10, 15, 30 and 60 min and 10 and 12 h, or 2.5% sodium hypochlorite for 5, 10 and 15 min. The cones were then incubated in thioglycollate medium for the determination of microbial growth. In parallel, additional sterile gutta-percha cones were stored in sealed containers with or without paraformaldehyde tablets for 30 days. The containers were opened 30 min a day and exposed to the environment of a functioning dental clinic. Twelve cones were removed weekly from the containers to determine whether contamination had occurred. RESULTS: The results showed that 2.5% sodium hypochlorite was effective after 5, 10 and 15 min, whereas 10 and 12 h contact with 2.2% glutaraldehyde was necessary to obtain sterilization. There was no contamination of the gutta-percha cones when stored with or without paraformaldehyde. CONCLUSIONS: Sodium hypochlorite (2.5%) and 2.2% glutaraldehyde ('Cidex') proved to be effective as sterilizing agents for gutta-percha cones, with sodium hypochlorite requiring shorter periods of use. No difference was observed between the two methods of cone storage.

[Human leptospirosis in Belo Horizonte City, Minas Gerais, Brazil: a geographic approach]. / Leptospirose humana no município de Belo Horizonte, Minas Gerais, Brasil: uma abordagem geográfica.

A retrospective study on human leptospirosis, was done in Belo Horizonte in 1995, using geographic processing resources. Thirty suspected and 19 confirmed cases of leptospirosis were mapped in the area. The majority of confirmed cases (68.4 +/- 13%) were located in North, Northeast and West of the city. The main foci of disease were found in slums and other poor areas: 73.7 +/- 12% of the confirmed cases and 26.7 +/- 12% of suspected cases. Ninety-five percent +/- 6% of the confirmed cases were found in the outskirts of the city where there was a population increase and inadequate infrastructure. It was observed that 50 +/- 14% of the suspected cases and 42 +/- 14% of the confirmed cases were found in areas of high concentration of water resources. Suspected (83.3 +/- 10%) and confirmed cases (79 +/- 11%) occurred in lower altitude areas of the city (750 to 1,000m) and 78 +/- 12% of the individuals had been in contact with contaminated water and/or animals.