Mortality Due to COVID-19 in Renal Transplant Recipients, Related to Variants of SARS-CoV-2 and Vaccination in Mexico.

BACKGROUND: SARS-CoV-2 infection in transplant patients has shown greater lethality and vaccination in this group of patients has shown less information. The objective of this study is to show the statistics in Mexico of lethality in kidney recipients infected with COVID-19 in relation to vaccination and variants of the coronavirus. METHODS: This is a bibliographic search of kidney transplant recipient patients since the start of the pandemic in Mexico to determine lethality after SARS-CoV-2 compared to the general population and in relation to patients, the 4 most important infectious peaks in the country due to identified variants, and also before and after vaccination. RESULTS: The global lethality is 26.91% from the beginning of the pandemic to April 9, 2022 in kidney recipients in Mexico (130 deaths of 483 infected kidney transplant recipients) compared to the national lethality of 5.60%. Variant B. 1.1.220 represented the highest lethality with 30.43% and the lowest lethality was Omicron with 16.41%. The lethality prior to vaccination was 30.94% and 23.46% after it. CONCLUSION: Both some variants and vaccination have influenced a lower lethality due to COVID-19 in Mexico in kidney transplant patients; It is important to consider global recommendations, such as a third or fourth dose, a combination of mRNA vaccines and vectors in order to reduce lethality in this group of patients.

Elective laparoscopic sigmoidectomy with preservation of the superior rectal artery prior to endoscopic decompression in sigmoid volvulus

Sigmoid volvulus is a frequent cause of intestinal obstruction. Its management has evolved with the use of laparoscopic surgery, achieving an elective sigmoid resection with anastomosis after a flexible endoscopic detorsion. A female patient was admitted to the emergency room with abdominal pain, distention, and constipation. The abdominal computed tomography showed a whirled sigmoid mesentery in addition to dilated sigmoid loops, and coffee bean sign. The patient successfully underwent a flexible endoscopic detorsion and was scheduled for elective sigmoid colectomy with rectal superior artery preservation and primary anastomosis. During the sigmoid resection, the superior rectal artery preservation is related to a better prognostic, with less bleeding, anastomotic leakage, and hospital stay. Currently, there are few reports of the laparoscopic preservation of the superior rectal artery in patients with sigmoid volvulus. (AU)

Development of a new compound based on low-density polyethylene degraded with zeolite waste for the removal of diesel from water.

A new adsorbent composite has been developed based on low-density polyethylene and zeolite. This material was used to remove diesel as pollutant in an aqueous system. In the synthesis of the composite and diesel removal were combined these effects: capacity of the zeolite to degrade polyethylene, partial filling of the zeolite with the polyethylene degradation products, favorable thermodynamic interactions between composite-diesel and porosity of the composite (imbibition effect). The term composite is used in the sense that partially degraded-polyethylene oligomers (waxes) are introduced into the zeolite pores in intergranular positions, insuring a good cohesion of waxes and zeolite. The material was synthetized easily by mixing low-density polyethylene and zeolite (1:1) and degraded at 200 °C at three different times: 2, 4 and 6 h. Several techniques as Differential Scanning Calorimeter, Thermogravimetric analysis, Size Exclusion Chromatography and X-Ray Diffraction are combined to study the steps of synthesis and the mechanism of diesel adsorption. The molecular weight obtained at different degradation time varied between 8470 and 99,100, while the molecular weight of the original LDPE was 136,300 g/mol. Diesel removal capacity was determined by TGA through the difference of weight loss at diesel evaporation temperatures (115-275 °C). All the prepared materials presented buoyancy in water and swelling of diesel. Highlighting among them the material prepared at 2 h with a weight loss of 39%, meanwhile the materials prepared for 4 and 6 h presented a weight loss of 29% and 23% respectively, that corresponded to the diesel removed from the water.

Repeated-sprint training under cyclic hypoxia improves body composition in healthy women.

BACKGROUND: To investigate if the cyclic hypoxia exposure combined with repeat-sprints training would be more effective in reducing body fat of health women than the same protocols performed in normoxia. METHODS: Twelve female volunteers were randomly divided into two groups: 1) repeated-sprint in hypoxia (RSH; N.=6; FiO2: 17.2%); and 2) repeated-sprint in normoxia (RSN; N.=6; FiO2: 20.9%). During 6 weeks, both groups undertook 30 seconds of all-out (130%Wmax) followed by 3 minutes of active recovery at 55-65%Wmax on a cycle ergometer. Anthropometric, body composition and biochemical parameters were assessed at baseline and after intervention. RESULTS: RSH experimented a greater significant decrease of body mass index (P=0.017) and percentage of fat mass (P=0.05) respect to normoxia group. Total cholesterol of RSN experimented a significant (P=0.001) reduction (-12.66±14.35) compared with RSH (24.00±14.61). CONCLUSIONS: Repeated-sprint training under normobaric cyclic hypoxia during 6-weeks could be a more effective prevention program because it causes a higher decrease in body mass index and fat mass compared with the same training in normoxic conditions in healthy women.

Opioid Use for Pain Management After Implementation of a Medicaid Short-Acting Opioid Quantity Limit.

BACKGROUND: The United States is currently experiencing an opioid abuse epidemic. Many policies and programs have been implemented at local, state, and national levels in an attempt to decrease prescription opioid addiction and overdose. On August 1, 2014, Colorado Medicaid implemented a policy change that limited the quantity of short-acting opioids (SAOs) that could be filled through the Medicaid benefit to no more than 4 tablets per day, or 120 tablets in 30 days. OBJECTIVE: To compare mean total daily dose (TDD) of opioids purchased by Kaiser Permanente Colorado (KPCO) Medicaid patients before and after implementation of the Medicaid SAO quantity limit. METHODS: This investigation used a pre/post study design to compare opioid use in Medicaid-eligible patients during the 90 days before implementation of the Medicaid quantity limit on August 1, 2014, and 90 days after full implementation of the change on December 31, 2014. The study was conducted at KPCO, an integrated care delivery system providing medical care for approximately 615,000 patients, of which over 54,000 are Medicaid members. Electronic medical and pharmacy records were used to identify patients and assess medication use. RESULTS: There was a small difference in opioid use in the population of Medicaid opioid users as evidenced by the median TDD of oral morphine equivalents (OME) purchased decreasing from 6.8 mg (IQR = 2.2-25.8) in the pre-implementation period to 6.6 mg (IQR = 1.7-24.0) in the postimplementation period (P = 0.027). The proportion of patients purchasing more than 120 mg OME per day and the proportion of patients purchasing long-acting opioids (LAOs) did not change significantly from the pre- to postimplementation period (OME > 120 of 4.2% vs. 3.6%, respectively, P = 0.290; LAO use of 12.9% vs. 13.6%, respectively, P = 0.465). CONCLUSIONS: This study found a statistically significant 3% decrease of 0.2 mg OME per day in the primary study population. A 24% reduction of 10 mg OME per day before and after implementation of the Medicaid SAO quantity limit was found in those patients identified as exceeding the Medicaid SAO quantity limit at baseline. These patients tended to be purchasing low to moderate total daily doses of opioids at baseline. DISCLOSURES: Internal funding was provided by the Department of Pharmacy at Kaiser Permanente Colorado. There are no external funding sources to disclose. Riggs, Milchak, Patel, and Heilmann are employed by Kaiser Permanente Colorado. The authors report no other potential conflicts of interest. Study concept and design were contributed by Riggs, Heilmann, and Billups, along with the other authors. Billups collected the data, and data interpretation was performed by Riggs, Milchak, and Flores, with assistance from the other authors. The manuscript was written primarily by Riggs, along with Flores, and revised by Billups, Milchak, Patel, and Heilmann.

Evaluating a bilingual voluntary community-based healthcare organization.

The current study compared traditional recovery homes for individuals with substance use disorders with homes that had been modified to feature culturally congruent communication styles. Findings indicated significant increases in employment income, with the size of the change significantly greater in the culturally modified houses. Significant decreases in alcohol use over time were also found, with larger decreases over time in the traditional recovery homes. Use of prescribed medications and days using drugs significantly decreased over time, but not differentially for those in the two types of recovery homes. The implications of these findings are discussed.

Examining the impact of obesity on individuals with chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a complex disorder affecting multiple body systems. The most commonly used definition of CFS is 6 or more months of fatigue and the presence of at least four of eight minor symptoms. In addition, many health and psychological conditions, including severe obesity-body mass index (BMI) of 40 kg/m(2) or greater-exclude individuals from a diagnosis of CFS. Obesity has been correlated with fatigue, sleep problems, and less satisfaction with general health, functioning, and vitality. The current study investigated weight trends over time in a community-based sample of individuals with CFS and healthy controls. The study further investigated the impact of comorbid weight issues on several health and disability outcomes in a subset of overweight individuals. Overweight and obese individuals with CFS demonstrated poorer functioning than controls who were similarly weighted. One participant was excluded because she had gained weight at a monitoring visit and her BMI was greater than 40 kg/m(2). The implications of these findings for health care workers are discussed.

Energy Conservation/Envelope Theory Interventions to Help Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

OBJECTIVES: Treatment approaches for patients with Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been controversial. This paper provides the theoretical and conceptual background for the Energy Envelope Theory to assist patients with ME/CFS and reviews evidence of its treatment efficacy. METHODS: Over a 15-year period, efforts were directed to develop a non-pharmacologic intervention that endeavored to help patients with ME/CFS self-monitor and self-regulate energy expenditures and learn to pace activities and stay within their energy envelope. CONCLUSIONS: Studies show that the energy envelope approach, which involves rehabilitation methods, helps patients with ME/CFS pace activities and manage symptoms and can significantly improve their quality of life.

Contrasting Case Definitions: The ME International Consensus Criteria vs. the Fukuda et al. CFS Criteria.

This article contrasts the Myalgic Encephalomyelitis International Consensus Criteria (ME-ICC) (Carruthers et al., 2011) with the Fukuda et al. (1994) CFS criteria. Findings indicated that the ME-ICC case definition criteria identified a subset of patients with more functional impairments and physical, mental and cognitive problems than the larger group of patients meeting the Fukuda et al. (1994) criteria. The sample of patients meeting ME-ICC criteria also had significantly greater rates of psychiatric comorbidity. These findings suggest that utilizing the ME-ICC may identify a more homogenous group of individuals with severe symptomatology and functional impairment. Implications of the high rates of psychiatric comorbidity found in the ME sample are discussed.

One-year surveillance of ESKAPE pathogens in an intensive care unit of Monterrey, Mexico.

BACKGROUND: Bacterial species from the ESKAPE group (i.e. Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species) are frequently resistant to antibiotics. The purpose of this study was to monitor the incidence of ESKAPE pathogens at the intensive care unit (ICU) of a tertiary care hospital in Monterrey, Mexico. METHODS: All clinically relevant organisms isolated from June 2011 to June 2012 were included. Identification and susceptibility testing was performed using panels from Sensititre. Resistance to oxacillin, for S. aureus, and the production of extended spectrum ß-lactamases (ESBLs), for K. pneumonia, were determined as defined by the Clinical Laboratory Standards Institute. Also, the presence of vanA and vanB genes was determined in E. faecium vancomycin (VAN)-resistant isolates. RESULTS: The majority of pathogens (64.5%) isolated in the ICU unit were from the ESKAPE group. The organisms most frequently isolated were A. baumannii (15.8%) and P. aeruginosa (14.3%). A high resistance to carbapenems was detected for A. baumannii (75.3%) while 62% of S. aureus isolates were confirmed to be methicillin resistant. Of the K. pneumoniae isolates, 36.9% were ESBL producers. We detected three E. faecium VAN-resistant isolates, all of which contained the vanA gene. CONCLUSION: The presence of the ESKAPE group of pathogens is a major problem in the ICU setting. The results of this study support the implementation of special antimicrobial strategies to specifically target these microorganisms.