Patient satisfaction with nursing care in an Intensive Care Unit measured through the Nursing Intensive-Care Satisfaction Scale (NICSS).

BACKGROUND: Patient satisfaction in relation with nursing care has become a key determinant of the quality of hospital care. OBJECTIVES: To evaluate patient satisfaction in relation with nursing care in a critical care context; to determine the correlation between critical patient satisfaction and sociodemographic and clinical variables and to describe patient perceptions with nursing care. METHODS: A descriptive, prospective, correlational study which includes the analysis of some open questions in the intensive care unit (ICU) of a tertiary level university hospital. The degree of satisfaction of all patients discharged from de ICU was evaluated. It was used the validated Spanish version of Nursing Intensive-Care Satisfaction-Scale (NICSS). There were also collected sociodemographic and clinical data and 3 open questions were asked. It was used the inferential and descriptive statistics considering statistically significant p<.05. Open questions were examined using a language context analysis. The approval of the hospital ethical committee was obtained. RESULTS: 111 patients agreed to participate, with a mean age of 64.18 years (CI 95% 61.36-66.88) and with a medium level of satisfaction of 5.83 (CI 95% 5.78-5.88) being 6 the maximum score. Women, older patients and those who reflect a higher degree of recovery, are those who reported greater satisfaction. Three main themes emerged from the analysis of the open-ended questions of the surveys: nurse patient relationship, professional practice environment and ICU nature. CONCLUSION: Patient satisfaction in relation with nursing care was elevated. Age, sex and degree of recovery significantly influenced their perception. Nurse patient relationship and the professional practice environment were aspects highlighted by patients. The professional model incorporated by the institution may encouraged these results.

Carbapenem alternatives for treatment of bloodstream infections due to AmpC producing enterobacterales.

INTRODUCTION: Carbapenems (CR) have traditionally been the first line treatment for bacteremia caused by AmpC-producing Enterobacterales. However, CR have a high ecological impact, and carbapenem-resistant strains continue rising. Thus, other treatment alternatives like Piperacillin-Tazobactam (P-T) or Cefepime (CEF) and oral sequential therapy (OST) are being evaluated. METHODS: We conducted a retrospective, single-centre observational study. All adult patients with AmpC-producing Enterobacterales bacteremia were included. The primary endpoint was clinical success defined as a composite of clinical cure, 14-day survival, and no adverse events. We evaluated the evolution of patients in whom OST was performed. RESULTS: Seventy-seven patients were included, 22 patients in the CR group and 55 in the P-T/CEF group (37 patients received CEF and 18 P-T). The mean age of the patients was higher in the P-T/CEF group (71 years in CR group vs. 76 years in P-T/CEF group, p = 0.053). In the multivariate analysis, age ≥ 70 years (OR 0.08, 95% CI [0.007-0.966], p = 0.047) and a Charlson index ≥ 3 (OR 0.16, 95% CI [0.026-0.984], p = 0.048), were associated with a lower clinical success. Treatment with P-T/CEF was associated with higher clinical success (OR 7.75, 95% CI [1.273-47.223], p = 0.026). OST was performed in 47% of patients. This was related with a shorter in-hospital stay (OST 14 days [7-22] vs. non-OST 18 days [13-38], p = 0.005) without difference in recurrence (OST 3% vs. non-OST 5%, p = 0.999). CONCLUSIONS: Targeted treatment with P-T/CEF and OST could be safe and effective treatments for patients with AmpC-producing Enterobacterales bacteremia.

Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study.

PURPOSE: Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS: This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS: Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION: Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.

Gastrointestinal colonization by OXA-48-producing Enterobacterales: risk factors for persistent carriage.

Carbapenem-resistant Enterobacterales (CRE) infections are a major health problem. Intestinal colonization is a key factor in developing infection. However, factors associated with persistent colonization by CRE are unknown. The aim of the study was to identify factors associated with persistent CRE gut colonization. This is a retrospective, single-centre, observational study of adult patients with CRE gut colonization between January 2015 and January 2020. Epidemiologic characteristics, comorbidities, infectious events, duration of hospitalization and antimicrobial treatment received in the follow-up period were collected. Colonization was defined as isolation in at least 2 rectal swab culture samples of CRE. Decolonization was defined as 3 negative rectal swab cultures or 2 negative cultures and a negative molecular test. A cohort of 86 patients with CRE gut colonization was selected: 44 patients with spontaneous decolonization (DC) and 42 patients with persistent colonization (PC). The mean follow-up period was 24 months (IQR 14-33) in the DC group vs. 25 months (IQR 16-36) in the PC group (p = 0.478). Patient characteristics were similar between both groups. Colonization by other MDR microorganisms was high (44 patients, 51%) and slightly more common in the PC group (PC 60% vs. DC 43%, p = 0.139). The use of ceftazidime-avibactam was more common among the PC group (PC 33% vs. DC 14%, p = 0.041). We observed a higher percentage of antimicrobial therapy in the previous 30 days (PC 68% vs. DC 57%, p = 0.371) and 90 days (PC 81% vs. DC 82%, p = 0.353) in the PC group. Multivariable analysis showed that patients that have received ceftazidime-avibactam therapy (OR 4.9 95% CI [1.45-16.39], p = 0.010), and those colonized by other MDR microorganisms (OR 2.5, 95% CI [0.96-6.25], p = 0.060) presented a higher risk of PC. Ceftazidime-avibactam use and colonization by other MDR microorganisms might be associated with CRE persistent gut colonization.

Ceftazidime-avibactam treatment in bacteremia caused by OXA-48 carbapenemase-producing Klebsiella pneumoniae.

Therapeutic options for bacteremia caused by carbapenem-resistant Enterobacterales (CRE) OXA-48-type are limited. The objective of this study was to analyze clinical success of CAZ-AVI compared with best available therapy (BAT) in patients with Klebsiella pneumoniae carbapenemase-producing OXA-48-type bacteremia (CRKp-OXA-48). We conducted a retrospective, single-center observational study in adult patients with CRKp-OXA-48 between December 2015 and May 2019. We collected the patients' clinical and epidemiological characteristics, antibiotic treatment (CAZ-AVI vs. BAT), and evolution. Factors associated with clinical success were analyzed using binary logistic regression. The study included 76 patients with CRKp-OXA-48-type bacteremia 33 received CAZ-AVI and 43 BAT. CAZ-AVI was mainly used in monotherapy (91%). Clinical success was more common in patients < 70-year-old (OR 4.79, 95% CI [1.435-16.002], p = 0.011) and CAZ-AVI treatment (OR 6.69, 95% CI [1.68-26.604], p = 0.007). Kaplan-Meier survival curve of 14-day mortality showed a lower mortality in patients who received CAZ-AVI (log rank 0.013). However, CAZ-AVI did not achieve statistical difference in IPTW for 14- and 30-day mortality (aOR 0.1, 95% CI [0.02-1.22], p = 0.076 and aOR 1.7, 95% CI [0.48-5.98], p = 0.413, respectively). CAZ-AVI treatment might be associated with a greater clinical success in CRKp-OXA-48 bacteremia.

Ganglio centinela en la metástasis ganglionar por cáncer papilar de tiroides: validez diagnóstica y aplicación en la práctica clínica / Sentinel lymph node biopsy in papillary thyroid cancer: Accuracy and application in clinical practice

Introducción La biopsia selectiva del ganglio centinela (BSGC) puede completar el estudio preoperatorio detectando adenopatías no visibles ecográficamente. De este modo, se puede estadificar a los pacientes y estratificar el riesgo de recidiva de forma más precisa y, por tanto, ayudar a definir el tipo de tratamiento tanto quirúrgico como con 131I que debemos realizar. El objetivo fue validar la BSGC para su utilización en el diagnóstico de la metástasis ganglionar por cáncer papilar de tiroides. Métodos Estudio observacional prospectivo de cohortes que incluye a 55 pacientes intervenidos por cáncer papilar de tiroides sin sospecha de afectación ganglionar clínica o radiológica, desde febrero de 2012 hasta febrero de 2015, con un seguimiento de entre 6 y 8 años. Se utilizó 99Tc con nanocoloide intratumoral y una sonda portátil de la gammacámara para la detección de los ganglios centinelas. Variables: edad, género, histológicas, analíticas y estadificación preoperatoria y postoperatoria. Se calculó la sensibilidad, la especificidad y los valores predictivos de la técnica. La validación se determinó calculando la detectabilidad y los falsos negativos de la prueba. Resultados En 53 de los 55 (96,36%) pacientes hubo detección del ganglio centinela. Los falsos negativos fueron 4 (7,5%) pacientes. Del resto, tras aplicar la BSGC, 24 (48,9%) se mantuvieron como N0, 14 (28,5%) pasaron a ser N1a y 11 (22,4%) se clasificaron como N1b. Las diferencias observadas en el estudio fueron significativas (p<0,05). La sensibilidad fue del 86,21%, la especificidad del 100%, el VPP del 100% y el VPN del 85,71%. La precisión diagnóstica fue del 92,45%. Conclusiones La BSGC es una técnica válida para su utilización en los pacientes afectos de cáncer papilar de tiroides, con una alta precisión diagnóstica (AU)

Introduction The presence of lymph nodes metastasis in papillary thyroid cancer modifies the type of surgical resection as well as the indication of the treatment with 131I in the postoperative period. This therapeutic approach is based on the results of the diagnostic tests, like the cervical ultrasonography. Currently other methods of diagnostic are tested as selective sentinel lymph node biopsy (SLNB). It can complement to the ultrasound results. The aim was to validate the SLNB for use in the diagnosis of lymph node metastasis by papillary thyroid cancer. Methods Observational prospective cohort study of 55 patients who underwent papillary thyroid cancer without suspicion of lymph node involvement clinical or radiological, since February 2012 through February 2015, with a follow-up between 6 and 8 years. It was used 99Tc with intratumoral nanocoloid and a portable tube of the gamma camera for the detection of the sentinel node. Variables: age, gender, histological, analytical and preoperative and postoperative staging. The sensitivity, specificity and predictive values of technique was calculated. The validation was determined by calculating the detectability and the false negative results of the test. Results In 53 of the 55 patients (96.36%) there was the sentinel node detection. The false negative were 4 patients (7.5%). Of the rest, after applying the SLNB, 24 (48.9%) were kept as N0, 14 (28.5%) became N1a and 11 (22.4%) were classified as N1b. The differences observed in the study were significant (P<.05). The sensitivity was 86.21%, the specificity of 100%, the PPV was 100% and the NPV of 85.71%. The diagnostic accuracy was 92.45%. Conclusions The SLNB is a valid technique for use in patients suffering from papillary thyroid cancer with a high diagnostic accuracy (AU)

[Expert opinion on strategies to improve vaccination coverage against seasonal influenza]. / Documento de opinión de expertos para la mejora de la cobertura vacunal frente a la gripe estacional.

Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups.

Discapacidad intelectual y medidas adoptadas durante la pandemia de COVID-19: efectos comportamentales / Intellectual disability and adopted measures during the COVID-19 pandemic: behavioral effects

Actualmente, y en el contexto del estadode emergencia sanitaria, se han implantadouna serie de medidas de prevención y contenciónaplicables a toda la población. Enparticular, los centros sociosanitarios hantenido que adaptarse, diseñando medidasespeciales y aplicando planes de contingencia,que han provocado modificaciones en elentorno habitual de los residentes. Con elfin de observar los efectos de la pandemiasobre la conducta de personas con discapacidadintelectual residentes en un centrosociosanitario, se aplicó el Inventario parala Planificación de Servicios y ProgramaciónIndividual (ICAP). Los resultados, comparadoscon evaluaciones previas a la pandemiapor COVID-19, mostraron que el funcionamientoadaptativo era similar al anterior aeste periodo, pero existía un déficit en destrezasmotoras y en las destrezas de la vidaen comunidad. Así mismo, las alteracionesdel comportamiento habían aumentado, tantoen la puntuación general como en cadauno de sus índices específicos. Además, seencontró una relación inversa entre la edady la conducta adaptativa y una correlación positiva entre la edad y las alteraciones de la conducta. (AU)

Currently, and due to the existing healthemergency context, prevention and containmentmeasures applicable to the entirepopulation have been implemented. In particular,social and health centers have hadto adapt, designing a package of specialmeasures and applying guidelines and contingencyplans that have caused changes inthe habitual environment of the residents.In order to observe the effects of the pandemicon people with intellectual disabilitiesin social health centers, the Inventoryfor Client and Agency Planning (ICAP) wasapplied. The results, compared to previousevaluation, showed that adaptive functioningwas similar to that before this period,but there was a decrease in motor and socialskills. Furthermore, behavioral problems hadincreased, in the general index and in each of its specific index. In addition, an inverse relationship was found between age and adaptive behavior and a positive correlation between age and behavior disorders. (AU)

Instrucciones previas: breve guía para un ejercicio de autonomía / Advance instructions: short guide to an exercise of autonomy

Las instrucciones previas, también denominadas decisiones o voluntades anticipadas,o testamento vital, constituyen una manifestación de la voluntad de los pacientes y, por tanto, son expresión de la autonomía de la persona. Se definen como el proceso en el que una persona planifica los cuidados sanitarios y la asistencia que desea recibir en el futuro, en el momento en que no sea capaz de tomar decisiones por sí misma.La planificación anticipada de cuidados y decisiones (PACD), que incluye elaborar esos documentos de voluntades anticipadas, es un modo de relación asistencial sobre la que todavía hay poca experiencia en nuestro país.La PACD se define como un "proceso voluntario de comunicación y deliberación entre una persona capaz y profesionales implicados en su atención, acerca de los valores, deseosy preferencias que quiere que se tengan encuenta en la atención sanitaria que recibirácomo paciente, fundamentalmente en losmomentos finales de la vida" (1).El objetivo es que la persona, junto conlos profesionales, delibere y establezca cómoquiere ser tratada durante el proceso terapéutico.Incluye los valores relevantes delpaciente, las preferencias sanitarias de caráctergeneral, las indicaciones sanitariasconcretas (rechazo o solicitud de intervenciones,donación de órganos...), expresiónde sentimientos hacia otros ("lo siento","gracias", "te perdono", etc), y/o designarun representante.A través del documento de instruccionesprevias que confirma que se ha dado el procesode reflexión, comunicación y descripciónde esas voluntades anticipadas, las personaspueden decidir acerca de los tratamientos ycuidados de salud que desean o no recibircuando se encuentren en una circunstanciaen la que no puedan manifestar su voluntadpersonalmente.Su fundamento ético es:Respetar y promover la autonomía del paciente.Asegurar que se valoren las situaciones decompetencias limitadas o inexistentes. (AU)

Advance instructions, also called decisionsor advance directives, or living wills,constitute a manifestation of the will of the patients and, therefore, are an expression of the autonomy of the person. They are defined as the process in which a person plans the health care and assistance they want to receive in the future, at the time when they are not able to make decisions for themselves. Advance Care Planning and Decisions(ACPD) which includes developing these advance directives documents. It is something that the law does not collect but does not prevent, and there is very little experience and research on it. They define it as a "voluntary process of communication and deliberation between a capable person and professionals involved in their care, about the values, desires and preferences that they want to betaken into account in the health care thatthey will receive as a patient, fundamentallyin the moments end of life" (1).The objective is for the person, togetherwith the professionals, to establish how theywant to be treated during the therapeuticprocess. It includes the relevant values ofthe patient, general health preferences, specifichealth indications (refusal or requestfor interventions, organ donation ...), expressionof feelings towards others ("I'm sorry","thank you", "I forgive you", etc), and/or appoint a representative.Through the advance directive documentthat confirms that the process of reflection,communication and description of these advancedirectives has been given, people candecide about the treatments and health carethey want or not to receive when they are ina circumstance in the one that cannot expresstheir will personally.Its ethical foundation is:Respect and promote the autonomy of thepatient.Preserve that value in situations of limited or nonexistent skills. (AU)

Differential analysis of the bacterial community in colostrum samples from women with gestational diabetes mellitus and obesity.

Gestational Diabetes Mellitus (GDM) and obesity affect the functioning of multiple maternal systems and influence colonization of the newborn gastrointestinal through the breastmilk microbiota (BMM). It is currently unclear how GDM and obesity affect the human BMM composition. Here, we applied 16S-rRNA high-throughput sequencing to human colostrum milk to characterize BMM taxonomic changes in a cohort of 43 individuals classified in six subgroups according to mothers patho-physiological conditions (healthy control (n = 18), GDM (n = 13), or obesity (n = 12)) and newborn gender. Using various diversity indicators, including Shannon/Faith phylogenetic index and UniFrac/robust Aitchison distances, we evidenced that BMM composition was influenced by the infant gender in the obesity subgroup. In addition, the GDM group presented higher microbial diversity compared to the control group. Staphylococcus, Corynebacterium 1, Anaerococcus and Prevotella were overrepresented in colostrum from women with either obesity or GDM, compared to control samples. Finally, Rhodobacteraceae was distinct for GDM and 5 families (Bdellovibrionaceae, Halomonadaceae, Shewanellaceae, Saccharimonadales and Vibrionaceae) were distinct for obesity subgroups with an absolute effect size greater than 1 and a q-value ≤ 0.05. This study represents the first effort to describe the impact of maternal GDM and obesity on BMM.

Análisis y mejora de la adherencia terapéutica en una farmacia comunitaria de Ourense / Analysis and improvement of therapeutic adherence in a community pharmacy in Ourense

Objetivos: evaluar la adherencia terapéutica de pacientes con patologías prevalentes, identificandofactores relacionados. Cuantificar la mejora en la adherencia conseguida mediante servicios profesionalesfarmacéuticos (SPF). Comprobar la satisfacción con el servicio.Métodos: diseño: 1ª fase: estudio monocéntrico, descriptivo, longitudinal, realizado entre 18/3y 10/4/2019. 2ª fase: estudio cuasiexperimental sin grupo control, con intervención educativa y SPF,revisión del uso de la medicación (RUM) y sistemas personalizados de dosificación (SPD), octubre-noviembre/2019.Sujetos: pacientes mayores de edad con dislipemia, hipertensión o diabetes, que acudieron a lafarmacia y aceptaron participar. Para la 2ª fase se seleccionaron pacientes que resultaron no adherentesen la 1ª.Variables: adherencia (medida con el test Morisky-Green), satisfacción con el servicio. Variables demográficas.Resultados: 1ª fase: 101 pacientes, media de edad de 69 años. 50,5% hombres. La proporción deno adherentes fue del 55,4%. 40 (71,4%) olvidan alguna vez tomar sus medicamentos. La adherenciano resultó relacionada con sexo, edad, acompañamiento, número de patologías o nivel de estudios(p>0,05).2ª fase: RUM: el porcentaje de no adherentes disminuyó al 67%. SPD: 9 de los 10 pacientes resultaron adherentes al final del estudio. 1 paciente resultó no adherente por olvidar esporádicamente algunatoma.El 100% de las encuestas de satisfacción dio como resultado “muy satisfechos”, continuarían visitando la farmacia y la recomendarían.Conclusiones: la adherencia terapéutica resulto baja, menor del 50%. No se encontró relación con losfactores analizados. (AU)

Role of Pneumocystis jirovecii in patients with different pulmonary underlying condition using a nested-PCR.

OBJECTIVE: The prevalence of Pneumocystis jirovecii colonization and its role in pulmonary disease remains unclear. PCR methods have shown an improved sensitivity in the detection of this fungus. It has been suggested that the PCR results be combined with another test such as IFA to create a diagnostic algorithm. METHODS: A multiplex nested-PCR procedure with a 16S rRNA gene as the internal amplification control was evaluated to determine the role of P. jirovecii in pulmonary disease. RESULTS: A 20% of the 199 bronchoalveolar lavage samples were PCR-positive, 13.5% samples were PCR-inhibited, and the rate of Pneumocystis-colonisation was 6.4%. The sensitivity, specificity, positive predictive value and negative predictive value of the nested-PCR were 100%, 93%, 70% and 100%, respectively. The sensitivity of the nested-PCR was higher than the current "gold standard" immunofluorescence assay (IFA) (p< 0.0001). PCR-negative and PCR-positive patients did not show any clinical or radiological differences in the medical variables studied. CONCLUSIONS: PCR could help the diagnosis of Pneumocystis pulmonary disease given the high negative predictive value of the technique. P. jirovecii DNA can frequently be detected in healthy population, so the analysis of the patient medical history is critical to make the correct clinical decision.

Neurorehabilitation and apps: A systematic review of mobile applications. / Apps en neurorrehabilitación. Una revisión sistemática de aplicaciones móviles.

INTRODUCTION: Mobile health or mHealth, defined as the provision of health information or healthcare by means of mobile devices or tablets, is emerging as a major game-changer for patients, care providers, and investors. An app is a program with special characteristics installed on a small mobile device, either a tablet or smartphone, with which the user interacts via a touch-based interface. The purpose of the app is to facilitate completion of a certain task or assist with daily activities. OBJECTIVE: The aim of this study was to conduct a systematic review of published information on apps directed at the field of neurorehabilitation, in order to classify them and describe their main characteristics. MATERIAL AND METHODS: A systematic review was carried out by means of a literature search in biomedical databases and other information sources related to mobile applications. Apps were classified into five categories: health habits, information, assessment, treatment, and specific uses. CONCLUSIONS: There are numerous applications with potential for use in the field of neurorehabilitation, so it is important that developers and designers understand the needs of people with neurological disorders so that their products will be valid and effective in light of those needs. Similarly, professionals, patients, families, and caregivers should have clear criteria and indicators to help them select the best applications for their specific situations.

Combining LCT tools for the optimization of an industrial process: material and energy flow analysis and best available techniques.

Life cycle thinking (LCT) is one of the philosophies that has recently appeared in the context of the sustainable development. Some of the already existing tools and methods, as well as some of the recently emerged ones, which seek to understand, interpret and design the life of a product, can be included into the scope of the LCT philosophy. That is the case of the material and energy flow analysis (MEFA), a tool derived from the industrial metabolism definition. This paper proposes a methodology combining MEFA with another technique derived from sustainable development which also fits the LCT philosophy, the BAT (best available techniques) analysis. This methodology, applied to an industrial process, seeks to identify the so-called improvable flows by MEFA, so that the appropriate candidate BAT can be selected by BAT analysis. Material and energy inputs, outputs and internal flows are quantified, and sustainable solutions are provided on the basis of industrial metabolism. The methodology has been applied to an exemplary roof tile manufacture plant for validation. 14 Improvable flows have been identified and 7 candidate BAT have been proposed aiming to reduce these flows. The proposed methodology provides a way to detect improvable material or energy flows in a process and selects the most sustainable options to enhance them. Solutions are proposed for the detected improvable flows, taking into account their effectiveness on improving such flows.

Livedoid vasculopathy and recurrent thrombosis in a patient with lupus: seronegative antiphospholipid syndrome?

Livedoid vasculopathy is a rare condition which predominantly affects young women. It is characterized by intense painful purpuric maculae in the legs, ankles and feet, due to thrombosis of the small and medium-sized dermal vessels, in the absence of vasculitis. Livedoid vasculopathy has been frequently associated with hypercoagulable states and antiphospholipid syndrome. We describe a 34-year-old White woman suffering from systemic lupus erythematosus, livedo reticularis, haemolytic anaemia, severe thrombocytopenia and recurrent venous thrombosis who was admitted to the hospital for extremely painful purpuric lesions in her lower limbs. The clinical and histological findings were diagnostic of livedoid vasculopathy. Once the initial sub-therapeutic international normalized ratio levels were corrected, livedoid vasculopathy did not recur. Tests for antiphospholipid antibodies were repeatedly negative. This case, the first reported of livedoid vasculopathy in a patient with seronegative antiphospholipid syndrome and systemic lupus erythematosus, draws attention to livedoid vasculopathy, a thrombotic dermopathy that may be under-diagnosed in patients with antiphospholipid syndrome.

Late infection of an embolized renal graft presented as buttock cellulitis.

Graft intolerance syndrome (GIS) is a common complication developed in failed kidney allografts left in situ when the patients returned to hemodialysis. GIS usually develops within the first 6 months after immunosuppression has been withdrawn. When medical treatment has failed, transplantectomy is the conventional therapy. Nevertheless, in recent years, transvascular ethanol embolization has been reported as an effective, safe, and less invasive technique than transplantectomy for the management of patients with GIS. Although infrequent, the most severe complication is infection of the graft or surrounding tissues, which usually appears in the first weeks after the procedure. We present the first case of late infection of an embolized renal graft, more than 2 years after embolization.