[Antimicrobial stewardship program in an Intensive Care Unit: A retrospective observational analysis of the results 15 months after its implementation]. / Programa de optimización del uso de antimicrobianos en un Servicio de Medicina Intensiva: análisis retrospectivo observacional de los resultados 15 meses después de su implementación.

OBJECTIVE: We aim to evaluate the adherence rate to an Antimicrobial Stewardship Program (ASP) in an Intensive Care Unit (ICU), and to assess its effect on the use of antibiotics, quality indicators and clinical outcomes. METHODS: Retrospective description of the interventions proposed by the ASP. We compared antimicrobial use, quality and safety indicators in an ASP versus a non-ASP period. The study was performed in a polyvalent ICU of a medium-size University Hospital (600 beds). We studied patients admitted to the ICU for any cause during the ASP period, provided that a microbiological sample aiming to diagnose a potential infection has been drawn, or antibiotics have been started. We elaborated and registered of non-mandatory recommendations to improve antimicrobial prescription (audit and feedback structure) and its registry during the ASP period (15 months, October 2018-December 2019). We compared indicators in a period with ASP (April-June 2019) and without ASP (April-June 2018). RESULTS: We issued 241 recommendations on 117 patients, 67% of them classified as de-escalation type. The rate of adherence to the recommendations was high (96.3%). In the ASP period, the mean number of antibiotics per patient (3.3±4.1 vs 2.4±1.7, p=0.04) and the days of treatment (155 DOT/100 PD vs 94 DOT/100 PD, p <0.01) were reduced. The implementation of the ASP did not compromise patient safety or produce changes in clinical outcomes. CONCLUSIONS: The implementation of an ASP is widely accepted in the ICU, reducing the consumption of antimicrobials, without compromising patient safety.

Anxiety prevalence in lymphoma: A systematic review and meta-analysis.

OBJECTIVE: Hodgkin and non-Hodgkin lymphoma patients are at high risk of experiencing anxiety because the clinical processes and therapies they undergo produce strong adverse effects. In this review we discuss the prevalence of anxiety among these patients and examine the methods used for data collection, intervention frequency, types of instruments used to recognize anxiety, and data collection purposes, both in Hodgkin and non-Hodgkin lymphoma survivors and patients being treated or diagnosed with these diseases. METHODS: This systematic review and meta-analysis of the literature was carried out using the following sources: PubMed, Scopus, LILACS, and PsycINFO. RESULTS: The meta-analysis sample was n = 2,138 and the overall prevalence of anxiety was 19% (95% CI [12%, 25%]). According to the Egger test, there were no publication biases and no studies were eliminated after the sensitivity analysis. The I2 for the heterogeneity analysis was 92.6%. CONCLUSIONS: Hodgkin and non-Hodgkin lymphoma patients are vulnerable to suffering anxiety. It is important to focus on the psychological effect of anxiety during remission or current cancer treatments because they can affect patient outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Lichen rehydration in heavy metal-polluted environments: Pb modulates the oxidative response of both Ramalina farinacea thalli and its isolated microalgae.

Lichens are adapted to desiccation/rehydration and accumulate heavy metals, which induce ROS especially from the photobiont photosynthetic pigments. Although their mechanisms of abiotic stress tolerance are still to be unravelled, they seem related to symbionts' reciprocal upregulation of antioxidant systems. With the aim to study the effect of Pb on oxidative status during rehydration, the kinetics of intracellular ROS, lipid peroxidation and chlorophyll autofluorescence of whole Ramalina farinacea thalli and its isolated microalgae (Trebouxia TR1 and T. TR9) was recorded. A genetic characterization of the microalgae present in the thalli used was also carried out in order to assess possible correlations among the relative abundance of each phycobiont, their individual physiological responses and that of the entire thallus. Unexpectedly, Pb decreased ROS and lipid peroxidation in thalli and its phycobionts, associated with a lower chlorophyll autofluorescence. Each phycobiont showed a particular pattern, but the oxidative response of the thallus paralleled the TR1's, agreeing with the genetic identification of this strain as the predominant phycobiont. We conclude that: (1) the lichen oxidative behaviour seems to be modulated by the predominant phycobiont and (2) Pb evokes in R. farinacea and its phycobionts strong mechanisms to neutralize its own oxidant effects along with those of rehydration.

[Renal involvement by AA amyloidosis in inclusion body myositis]. / Afectación renal por amiloidosis AA en paciente con miositis por cuerpos de inclusión.

Inclusion body myositis is currently considered a variant of adult inflammatory myopathies. Clinical course is insidious and besides typical proximal muscles disorder, extension to distal ones is found in up to 95% of cases. Mean survival ranges from 3 to 5 years. Infections are the first death cause, secondary to existing disability a few years after diagnosis. Chronic rheumatic diseases related amyloidosis has became the most frequent kind of reactive amyloidosis or AA amyloidosis. Clinical manifestations of AA amyloidosis mainly affect the kidney. We present the case of a woman with Inclusion body myositis and renal involvement by AA amyloidosis. In our review of literature we haven t found any article relating AA amyloidosis with idiopathic inflammatory myopathies of the adult, what would turn this case into the first ever reported. We can probably find the reason in the bad prognosis of this entity. So we propose making a renal biopsy to all those patients with a long lasting rheumatologic disease and unexpected impaired renal function.

Afectación renal por amiloidosis AA en paciente con miositis por cuerpos de inclusión / Renal involvement vy AA amyloidosis in inclusion body myositis

La miositis por cuerpos de inclusión (MCI) se considera actualmente una variante de las miopatías inflamatorias del adulto. El curso clínico es insidioso y además de la típica afectación de la musculatura proximal termina involucrando a los músculos distales en el 95% de los casos. La supervivencia media oscila entre los 3-5 años. La primera causa de muerte son las complicaciones infecciosas, debido a la incapacidad a los pocos años de su diagnóstico. La amiloidosis secundaria a enfermedades reumáticas crónicas se ha convertido en el tipo más frecuente de amiloidosis secundaria o tipo AA. Las manifestaciones clínicas de la amiloidosis AA predominan principalmente en riñón. Presentamos el caso de una mujer con MCI y afectación renal por amiloidosis AA. En la bibliografía no hemos encontrado ninguna comunicación relacionando la amiloidosis AA con miopatías inflamatorias idiopáticas del adulto, por lo que nuestra paciente sería el primer caso descrito. Probablemente el sombrío pronóstico de esta entidad sea el motivo por el que no han sido descritos otros casos. Creemos conveniente plantear la realización de biopsia renal en los pacientes con enfermedad reumatológica de larga evolución y deterioro inexplicado de la función renal

Inclusion body myositis is currently considered a variant of adult inflammatory myopathies. Clinical course is insidious and besides typical proximal muscles disorder, extension to distal ones is found in up to 95% of cases. Mean survival ranges from 3 to 5 years. Infections are the first death cause, secondary to existing disability a few years after diagnosis. Chronic rheumatic diseases related amyloidosis has became the most frequent kind of reactive amyloidosis or AA amyloidosis. Clinical manifestations of AA amyloi- dosis mainly affect the kidney. We present the case of a woman with Inclusion body myositis and renal involve- ment by AA amyloidosis. In our review of literature we haven´t found any article rela- ting AA amyoloidosis with idiopatic inflamatory myopaties of the adult, what would turn this case into the first ever reported.We can probably find the reason in the bad prognosis of this entity. So we propose making a renal biopsy to all those patients with a long lasting rheumatologic disease and unexpected impaired renal function

Infarto renal agudo: complicación de displasia fibromuscular / Acute renal infarction: complication of fibromuscular dysplasia

La hipertensión renovascular (HTRV) es una de las formas identificables de hipertensión arterial (HTA). A pesar de que la mayoría de las lesiones renovasculares corresponden a aterosclerosis, la displasia fibromuscular (DFM) es la principal causa en el resto de los casos. La fibrodisplasia de la capa media suele ser la lesión más común y presenta un curso menos progresivo. La afectación intimal y periarterial es menos frecuente pero presenta una evolución más rápida hacia la oclusión arterial, pudiendo ocasionar infarto en diferentes localizaciones. Presentamos el caso de una mujer diagnosticada de HTRV en relación con DFM complicada con infarto renal derecho por oclusión de arteria renal

Renovascular hypertension (RVHT) is one of the forms of identifiable hypertension. Whereas most renovascular lesions are caused by atherosclerosis, in the remaining cases fibromuscular dysplasia is the causative factor. Fibrous dysplasia of the tunica media is generally the most common lesion and a progressive course may be less frequently seen. Intimal and periarterial lesions are less common but usually show rapid progression to arterial occlusion, and can cause infarction of several systems. We report the case of a woman with RVHT secondary to fibromuscular dysplasia complicated with renal infarction

Programa de apoyo y asesoramiento para familias con enfermo crónico y su repercusión en la gestión del proceso de hemodiálisis / No disponible

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[Association between membranous glomerulonephritis and Crohn's disease]. / Asociación de glomerulonefritis membranosa y enfermedad de Crohn.

We report the case of a 37 year old man who suffered from Crohn's Disease (CD), and was receiving treatment with mesalazine (5-ASA). Nine years after the diagnosis, because of detecting a slight proteinuria, a renal biopsy is made, being the anatomo-pathologic result compatible with membranous glomerulonephritis (MGN). Checking previous literature we have only found two cases reported of MGN in coincidence with Inflammatory Bowel Disease (IBD), one in association with Ulcerative Colitis and the other with Crohn's Disease in a 12 years old boy. This is, therefore, the second case presenting MGN associated with CD and the first in an adult patient.

Osteal complications as first manifestation in a patient with primary Sjögren's Syndrome and with associated distal tubular acidosis (type 1) and chronic renal insufficiency.

Renal affection is among the complications associated with the Sjögren's Syndrome. Tubulo-interstitial nephritis constitutes the most frequent renal lesion and distal tubular acidosis (Type 1) is the most important clinical manifestation of this tubular dysfunction, although the occurrence of chronic renal insufficiency is not an uncommon finding in the presence of distal renal tubular acidosis. Osteomalacia is a clinical consequence of tubular acidosis caused by buffering of H+ in the bone. We present the case of a woman with osteal complication a year before being diagnosed with primary Sjögren's Syndrome and with distal tubular acidosis and renal insufficiency associated at diagnosis.

Nefrotoxicidad por imatinib / No disponible

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[Simultaneous presence of antibodies against the glomerular basement membrane and anti-myeloperoxidase antibodies in 2 patients with rapidly progressive glomerulonephritis]. / Presencia simultánea de anticuerpos anti-membrana basal glomerular y anticuerpos anti-mieloperoxidasa en dos pacientes con glomerulonefritis rápidamente progresiva.

We report two patients with rapidly progressive glomerulonephritis without alveolar hemorrhage. Renal biopsy showed extracapillary glomerulonephritis with linear deposits of immunoglobulin G. Serologically anti-glomerular basement membrane antibodies (Ac AMBG) and ANCA anti-myeloperoxidase were present. All patients were treated with steroids, cyclophosphamide and plasma exchange. One patient needed dialysis, and other one died from a renal biopsy complication. We discuss the epidemiologic, pathogenic and prognostic aspects of this association.

Presencia simultánea de anticuerpos anti-membrana basal glomerular y anticuerpos anti-mieloperoxidasa en dos pacientes con glomerulonefritis rápidamente progresiva / Coexistent anti-glomerular basement membrane antibodies and anti-myeloperoxidasa antibodies in two patients with rapidly progressive glomerulonephritis

Presentamos dos casos de insuficiencia renal rápidamente progresiva, sin hemorragia pulmonar. Las biopsias renales mostraron glomerulonefritis extracapilar con depósitos lineales de IgG. Serológicamente se evidenció positividad para anticuerpos antimembrana basal glomerular (Ac AMBG) y ANCA anti-mieloperoxidasa. A pesar del tratamiento con esteroides, ciclofosfamida y plasmaféresis, una paciente precisó hemodiálisis periódica y la otra falleció por complicaciones de la biopsia renal. Se discuten factores epidemiológicos, etipopatógenicos y pronósticos de la asociación (AU)

[Progressive systemic sclerosis associated with anti-myeloperoxidase ANCA vasculitis with renal and cutaneous involvement]. / Esclerosis sistémica progresiva asociada a vasculitis ANCA anti-mieloperoxidasa con afectación renal y cutánea.

Sclerodema renal crisis is the usual form of presentation of renal disease in systemic sclerosis. We report a woman who at age 63 was given a diagnosis of scleroderma with Raynaud's phenomenon and cutaneous, oesophageal and lung involvement but no evidence of renal disease and no treatment with D-penicillamine. Two years later she developed progressive renal failure, nephrotic range proteinuria, haematuria and the presence of serum MPO-ANCA; she was normotensive. Renal biopsy revealed extracapillary and necrotizing glomerulonephritis and skin biopsy showed leucocytoclastic vasculitis. This clinical picture was compatible with necrotizing vasculitis of the microscopic polyarterits type. After treatment with pulse steroids followed by oral steroids and monthly intravenous cyclophosphamide her renal function stabilised and the serum MPO-ANCA disappeared.

Esclerosis sistémica progresiva asociada a vasculitis ANCA antimieloperoxidasa con afectación renal y cutánea / Systemic sclerosis with MPO-ANCA associated vasculitis with renal and skin involvement

La afectación renal que sucede habitualmente en pacientes con Esclerosis sistémica progresiva es la denominada 'Crisis renal esclerodérmica'. Presentamos una paciente de 65 años diagnosticada dos años antes de Esclerosis sistémica progresiva con afectación cutánea, esofágica y pulmonar y fenómeno de Raynaud, sin evidencia de afectación renal ni antecedente de tratamiento con D-penicilamina. Un mes antes del ingreso desarrolla exantema generalizado e insuficiencia renal progresiva, con proteinuria en rango nefrótico y hematuria, sin hipertensión arterial, y presencia de ANCA de especificidad MPO en suero. En el estudio histológico renal se observó una glomerulonefritis necrotizante con proliferación extracapilar, y a nivel cutáneo, una vasculitis leucocitoclástica, siendo el cuadro compatible con Poliangeitis microscópica. Tras instaurar tratamiento con pulsos de esteroides seguidos de Prednisona oral y Ciclofosfamida IV en pulsos mensuales se obtuvo una estabilización de la función renal y desaparición de los ANCA anti-MPO (AU)