Conjugation of Lysozyme and Epigallocatechin Gallate for Improving Antibacterial and Antioxidant Properties.

One of the main interests in the food industry is the preservation of food from spoilage by microorganisms or lipid oxidation. A novel alternative is the development of additives of natural origin with dual activity. In the present study, a chemically modified lysozyme (Lys) with epigallocatechin gallate (EGCG) was developed to obtain a conjugate (Lys-EGCG) with antibacterial/antioxidant activity to improve its properties and increase its application potential. The modification reaction was carried out using a free radical grafting method for the Lys modification reaction, using ascorbic acid and hydrogen peroxide as radical initiators in an aqueous medium. The synthesis of Lys-EGCG conjugate was confirmed by spectroscopic (FT-IR, 1H-RMN, and XPS) and calorimetry differential scanning (DSC) analyses. The EGCG binding to the Lys biomolecule was quantified by the Folin-Ciocalteu method; the antibacterial activity was evaluated by minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MCB) against Staphylococcus aureus and Pseudomonas fluorescens; the antioxidant activity was evaluated by ABTS, DPPH, and FRAP. The spectroscopic results showed that the Lys-EGCG conjugate was successfully obtained, and the DSC analysis revealed a 20 °C increase (P < 0.05) in the denaturation temperature of Lys due to EGCG modification. The EGCG concentration in Lys-EGCG was 97.97 ± 4.7 µmol of EGCG/g of sample. The antibacterial and antioxidant activity of the Lys-EGCG conjugate was higher (P < 0.05) than pure EGCG and Lys. The chemical modification of Lys with EGCG allows for the bioconjugate with a dual function (antibacterial/antioxidant), broadening the range of Lys and EGCG applications to different areas such as food, cosmetic, and pharmaceutical industries.

Big five personality traits, gaming motives, and regular and disordered gaming: A cross-national examination among college student gamers in seven countries.

INTRODUCTION: Previous research has shown that personality traits and gaming motives are important predictors for explaining regular and disordered gaming. However, the mediating role of gaming motives in the relation between personality traits and video game outcomes (e.g., time spent gaming or disordered gaming) has been scarcely studied and limited cross-national studies have addressed this issue. The present study aimed to examine the direct and indirect effects of the Big Five personality traits on weekly gaming and disordered gaming via gaming motives across seven countries. METHOD: 3540 college student gamers (59.5% women) from the U.S., Canada, Spain, Argentina, Uruguay, South Africa and England completed the online survey. Structural equation modeling was conducted to test models. Multigroup models were employed to test model invariance across countries. RESULTS: Significant, albeit weak, relations were found between personality traits and gaming outcomes, and were mediated mostly by coping motives in predicting disordered gaming, and by social interaction and recreation (to a lesser extent) motives in predicting weekly gaming. Some minor, yet significant, differences across countries appeared and are discussed in detail. DISCUSSION: The present findings indicate that the differential interrelations between personality traits, gaming motives, and video gaming outcomes may be generalized in college students across countries.

The Spanish Short Dark Tetrad (SD4): Association With Personality and Psychological Problems.

BACKGROUND: The Short Dark Tetrad (SD4) is a recently developed instrument for assessing the "dark" personality traits of psychopathy, narcissism, Machiavellianism, and sadism. We aimed to examine the SD4's psychometric properties, adapting it into Spanish and exploring its structure, gender invariance, reliability, concurrent validity, and nomological network. METHOD: A sample of 668 adults (Mage = 26.36, SD = 10.64, 69.2% females) completed the SD4 and other self-report questionnaires. RESULTS: The results demonstrated sound indices of reliability and concurrent validity, an adequate four-factor structure, and support for gender invariance. Furthermore, most of the findings about the nomological network were in line with prior hypotheses: All four SD4 scales were associated with low levels of agreeableness and antagonism; psychopathy was also related to low conscientiousness, disinhibition and impulse-control problems; narcissism was positively associated with extraversion and negatively associated with internalizing symptoms; Machiavellianism was uncorrelated with impulsivity-related problems, which made it distinct from the psychopathy profile; finally, sadism showed a similar pattern of associations to psychopathy, albeit less strongly linked to impulsivity problems and externalizing behavior. CONCLUSIONS: Overall, the SD4 presents sound psychometric properties, although the overlap between psychopathy and sadism warrants some caution.

Hypotension prediction index guided goal-directed therapy to reduce postoperative acute kidney injury during major abdominal surgery: study protocol for a multicenter randomized controlled clinical trial.

BACKGROUND: Acute kidney injury (AKI) is a significant postoperative complication associated with increased mortality and hospital costs. Hemodynamic strategies, such as goal-directed therapy, might reduce AKI risk. Predicting and proactively managing intraoperative hypotension may be helpful. This trial aims to investigate if a preemptive hemodynamic strategy guided by the hypotension prediction index (HPI) can decrease the incidence of moderate-to-severe AKI within 30 days following major elective abdominal surgery. METHODS: This is an open-label, controlled, multicenter, randomized clinical trial that involves daily patient follow-up until hospital discharge. Inclusion criteria are patients aged over 65 and/or categorized as ASA III or IV physical status, undergoing major elective abdominal surgery (general, urological, or gynecological procedures) via laparoscopic or open approach under general or combined anesthesia. INTERVENTION: In the intervention group, hemodynamic management will be based on the HPI and the advanced functional hemodynamic variables provided by the Hemosphere platform and the AcumenIQ® sensor (Edwards Lifesciences). The primary outcome is the incidence of moderate-to-severe AKI within 7 days post-surgery. Secondary outcomes include postoperative complications and 30-day mortality. DISCUSSION: This study explores the potential of HPI-guided hemodynamic management in reducing AKI after major elective abdominal surgery, with implications for postoperative outcomes and patient care. TRIAL REGISTRATION: ClinicalTrials.gov NCT05569265. Registered on October 6, 2022.

Three-dimensional Liver Model Application for Liver Transplantation.

BACKGROUND: Children are removed from the liver transplant waitlist because of death or progressive illness. Size mismatch accounts for 30% of organ refusal. This study aimed to demonstrate that 3-dimensional (3D) technology is a feasible and accurate adjunct to organ allocation and living donor selection process. METHODS: This prospective multicenter study included pediatric liver transplant candidates and living donors from January 2020 to February 2023. Patient-specific, 3D-printed liver models were used for anatomic planning, real-time evaluation during organ procurement, and surgical navigation. The primary outcome was to determine model accuracy. The secondary outcome was to determine the impact of outcomes in living donor hepatectomy. Study groups were analyzed using propensity score matching with a retrospective cohort. RESULTS: Twenty-eight recipients were included. The median percentage error was -0.6% for 3D models and had the highest correlation to the actual liver explant (Pearson's R = 0.96, P < 0.001) compared with other volume calculation methods. Patient and graft survival were comparable. From 41 living donors, the median percentage error of the allograft was 12.4%. The donor-matched study group had lower central line utilization (21.4% versus 75%, P = 0.045), shorter length of stay (4 versus 7 d, P = 0.003), and lower mean comprehensive complication index (3 versus 21, P = 0.014). CONCLUSIONS: Three-dimensional volume is highly correlated with actual liver explant volume and may vary across different allografts for living donation. The addition of 3D-printed liver models during the transplant evaluation and organ procurement process is a feasible and safe adjunct to the perioperative decision-making process.

Morphology and diet are decoupled in nearshore notothenoids from King George Island, West Antarctica.

Antarctic notothenioid fishes show wide adaptive morphological radiation, linked to habitat preferences and food composition. However, direct comparisons of phenotypic variability and feeding habits are still lacking, particularly in stages inhabiting nearshore areas. To assess these relationships, we collected juveniles and adults of the most common benthic species inhabiting shallow waters off the South Shetland Islands within a similar size range, the plunderfish Harpagifer antarcticus, the black rockcod Notothenia coriiceps, and the marbled rockcod Notothenia rossii. Individual size ranges varied from 44.0 to 98.9 mm standard length (LS) (H. antarcticus), from 95.8 to 109.3 mm LS (N. coriiceps), and from 63.0 to 113.0 mm LS (N. rossii). Notothenioid fish showed different morphospace variability, being larger for H. antarcticus than the other Notothenia species and associated with the position of the posterior end of the operculum, along with the location and relative size of the eye. The evolutionary allometry was low, but the static allometry was much higher, especially for H. antarcticus and N. rossii. The diet was mainly carnivorous, consisting of amphipods and euphausiids. Macroalgae were scarce or totally absent in the gut contents of all species. Only H. antarcticus showed an increase in the prey number and ingested prey volume with fish size. Finally, there was a significant covariation between shape changes and LS in all species (allometric effects), however, not with prey composition, probably due to the small size range or ontogenetic stage and the relative similarity (or lack of contrast) in the benthic environment that they utilized.

The Spanish Short Dark Tetrad (SD4): Association With Personality and Psychological Problems / El Cuestionario Corto de la Tétrada Oscura (SD4) en Español: Asociación con la Personalidad y los Problemas Psicológicos

Background: The Short Dark Tetrad (SD4) is a recently developed instrument for assessing the “dark” personality traits of psychopathy, narcissism, Machiavellianism, and sadism. We aimed to examine the SD4’s psychometric properties, adapting it into Spanish and exploring its structure, gender invariance, reliability, concurrent validity, and nomological network. Method: A sample of 668 adults (Mage = 26.36, SD = 10.64, 69.2% females) completed the SD4 and other self-report questionnaires. Results: The results demonstrated sound indices of reliability and concurrent validity, an adequate four-factor structure, and support for gender invariance. Furthermore, most of the findings about the nomological network were in line with prior hypotheses: All four SD4 scales were associated with low levels of agreeableness and antagonism; psychopathy was also related to low conscientiousness, disinhibition and impulse-control problems; narcissism was positively associated with extraversion and negatively associated with internalizing symptoms; Machiavellianism was uncorrelated with impulsivity- related problems, which made it distinct from the psychopathy profile; finally, sadism showed a similar pattern of associations to psychopathy, albeit less strongly linked to impulsivity problems and externalizing behavior. Conclusions: Overall, the SD4 presents sound psychometric properties, although the overlap between psychopathy and sadism warrants some caution.(AU)

Antecedentes: El Short Dark Tetrad (SD4) es un instrumento recientemente desarrollado para evaluar los rasgos “oscuros” de personalidad de psicopatía, narcisismo, maquiavelismo y sadismo. Nuestro objetivo fue profundizar en las propiedades psicométricas del SD4 adaptando el instrumento al español, y examinar su estructura, invariancia de género, fiabilidad, validez concurrente y red nomológica. Método: Una muestra de 668 adultos (Medad = 26,36, SD = 10,64, 69,2% mujeres) completaron el SD4 y otros cuestionarios. Resultados: Encontramos índices apropiados de fiabilidad y validez concurrente, una estructura de cuatro factores, y apoyo a la invariancia de género. Además, los hallazgos sobre la red nomológica estuvieron mayoritariamente en línea con las hipótesis prerregistradas: las cuatro escalas SD4 se asociaron con baja amabilidad y antagonismo; la psicopatía se relacionó con baja responsabilidad, desinhibición y problemas de impulsividad; el narcisismo se asoció con extraversión y negativamente con síntomas de interiorización; el maquiavelismo no correlacionó con problemas de impulsividad, por lo que mostró un perfil diferenciado al de psicopatía; el sadismo mostró un patrón de asociaciones similar a psicopatía, aunque menos vinculado a problemas de impulsividad y comportamientos externalizantes. Conclusiones: En general, el SD4 presenta buenas propiedades psicométricas, aunque el solapamiento entre psicopatía y sadismo justifica cierta precaución.(AU)

Role of Crystalloids in the Perioperative Setting: From Basics to Clinical Applications and Enhanced Recovery Protocols.

Perioperative fluid management, a critical aspect of major surgeries, is characterized by pronounced stress responses, altered capillary permeability, and significant fluid shifts. Recognized as a cornerstone of enhanced recovery protocols, effective perioperative fluid management is crucial for optimizing patient recovery and preventing postoperative complications, especially in high-risk patients. The scientific literature has extensively investigated various fluid infusion regimens, but recent publications indicate that not only the volume but also the type of fluid infused significantly influences surgical outcomes. Adequate fluid therapy prescription requires a thorough understanding of the physiological and biochemical principles that govern the body's internal environment and the potential perioperative alterations that may arise. Recently published clinical trials have questioned the safety of synthetic colloids, widely used in the surgical field. A new clinical scenario has arisen in which crystalloids could play a pivotal role in perioperative fluid therapy. This review aims to offer evidence-based clinical principles for prescribing fluid therapy tailored to the patient's physiology during the perioperative period. The approach combines these principles with current recommendations for enhanced recovery programs for surgical patients, grounded in physiological and biochemical principles.

International Liver Transplantation Society Global Census: First Look at Pediatric Liver Transplantation Activity Around the World.

BACKGROUND: Over 16 000 children under the age of 15 died worldwide in 2017 because of liver disease. Pediatric liver transplantation (PLT) is currently the standard of care for these patients. The aim of this study is to describe global PLT activity and identify variations between regions. METHODS: A survey was conducted from May 2018 to August 2019 to determine the current state of PLT. Transplant centers were categorized into quintile categories according to the year they performed their first PLT. Countries were classified according to gross national income per capita. RESULTS: One hundred eight programs from 38 countries were included (68% response rate). 10 619 PLTs were performed within the last 5 y. High-income countries performed 4992 (46.4%) PLT, followed by upper-middle- (4704 [44·3%]) and lower-middle (993 [9·4%])-income countries. The most frequently used type of grafts worldwide are living donor grafts. A higher proportion of lower-middle-income countries (68·7%) performed ≥25 living donor liver transplants over the last 5 y compared to high-income countries (36%; P = 0.019). A greater proportion of programs from high-income countries have performed ≥25 whole liver transplants (52.4% versus 6.2%; P = 0.001) and ≥25 split/reduced liver transplants (53.2% versus 6.2%; P < 0.001) compared to lower-middle-income countries. CONCLUSIONS: This study represents, to our knowledge, the most geographically comprehensive report on PLT activity and a first step toward global collaboration and data sharing for the greater good of children with liver disease; it is imperative that these centers share the lead in PLT.

UNVEILING THE SIGNIFICANCE OF DYNAMIC ARTERIAL ELASTANCE: AN INSIGHTFUL APPROACH TO ASSESSING ARTERIAL LOAD IN AN ENDOTOXIN SHOCK MODEL.

ABSTRACT: Background: The aim of this study was to investigate the relationship between dynamic arterial elastance (EaDyn) and the pulsatile and steady components of arterial load in an endotoxin shock model using a two-element Windkessel model and to describe the behavior of EaDyn in this model. Methods : Ten female Yorkshire pigs were administered lipopolysaccharide intravenously to induce endotoxin shock, while three female pigs served as the control group. Measurements of EaDyn (ratio between pulse pressure variation and stroke volume variation), effective arterial elastance, arterial compliance (Cart), and systemic vascular resistance were taken every 30 min in the endotoxin group until shock was induced. In the control group, these variables were measured every 30 min for 3 h. Subsequently, a fluid load was administered to both groups, and measurements were repeated every 30 min. After 1 hour of shock induction, the endotoxin group was divided into two subgroups: one receiving norepinephrine (END-NE) and the other not receiving it (END-F). Results: EaDyn showed an association with Cart, while pulse pressure variation was connected to both pulsatile and steady components, and stroke volume variation was solely associated with steady components. In addition, EaDyn exhibited higher values in the END groups than in the control group when shock was achieved. Furthermore, after the administration of norepinephrine, EaDyn displayed higher values in END-F than in END-NE. Conclusions: The EaDyn variable helps identify changes in the pulsatile component of arterial load, providing valuable guidance for management strategies aimed at improving cardiac performance.

Estadificación quirúrgica del cáncer de pulmón de células no pequeñas: ¿cuándo deberíamos realizar de rutina la resección de los ganglios supraclaviculares? / Surgical staging of non-small cell lung carcinoma: when should we routinely resect supraclavicular lymph nodes?

RESUMEN Antecedentes: la evaluación precisa del estadio del carcinoma pulmonar luego del diagnóstico es esencial para la selección de una terapia apropiada. Objetivo: describir las características de los pacientes con carcinoma de pulmón de células no pequeñas en los cuales la resección ganglionar supraclavicular permitiría detectar metástasis ganglionares no palpables (N3-supraclavicular). Material y métodos: entre diciembre de 2016 y diciembre de 2019 se registraron los datos de pacientes a quienes se les realizó estadificación quirúrgica mediastinal para cáncer de pulmón de células no pequeñas mediante mediastinoscopia cervical y resección de los ganglios supraclaviculares. Resultados: fueron incluidos 60 pacientes, (hombres 76,7%). La media tumoral fue de 4,7 cm y la de estaciones ganglionares evaluadas fue de 2,37 ± 1,44 (DS). En todos se realizó la resección ganglionar supraclavicular y el resultado fue positivo para malignidad epitelial en 21 casos (35%). De los 21 casos N3-supraclavicular, 2 pacientes se registraron como skip metástasis; el resto se asoció a enfermedad mediastinal N2 (p=0,0424). Se observó una asociación significativa entre le presencia de tumor central y de N3-supraclavicular (p=0,0148). Conclusión: se sugiere realizar la resección ganglionar supraclavicular en pacientes con sospecha o confirmación de enfermedad ganglionar N2 y tumores centrales, antes de considerar un enfoque terapéutico multimodal que incluya la cirugía.

ABSTRACT Background: Accurate staging after the diagnosis of lung carcinoma is essential to select an appropriate therapy. Objective: The aim of the present study is to describe the characteristics of patients with non-small cell lung carcinoma in whom supraclavicular lymph node resection would detect non-palpable (N3 supraclavicular disease) lymph node metastases. Material and methods: Data from patients undergoing mediastinal surgical staging for non-small cell lung cancer using cervical mediastinoscopy and resection of supraclavicular lymph nodes were collected between December 2016 and December 2019. Results: A total of 60 patients were included; 76.6% were men. Mean tumor size was 4.7 cm ad mean lymph node stations evaluated by mediastinoscopy was 2.37 ± 1.44 (SD). All the patients underwent supraclavicular lymph node resection and the result was positive for epithelial carcinoma in 21 cases (35%). Of the 21 cases with N3 supraclavicular disease, 2 patients were recorded as skip metastases and the remaining cases were association with mediastinal N2 disease (p = 0.0424). There was a significant association between central tumor and N3 supraclavicular disease (p = 0.0148). Conclusion: Supraclavicular lymph node resection may be recommended in patients with suspected or confirmed N2 lymph node disease and central tumors, before considering a multimodal therapeutic approach including surgery.

Negative modulation of the GABAAρ1 receptor function by histamine.

Besides its function as a local mediator of the immune response, histamine can play a role as a neurotransmitter and neuromodulator. Histamine actions are classically mediated through four different G protein-coupled receptor subtypes but non-classical actions were also described, including effects on many ligand-gated ion channels. Previous evidence indicated that histamine acts as a positive modulator on diverse GABAA receptor subtypes, such as GABAAα1ß2γ2, GABAAα2ß3γ2, GABAAα3ß3γ2, GABAAα4ß3γ2 and GABAAα5ß3γ2. Meanwhile, its effects on GABAAρ1 receptors, known to stand for tonic currents in retinal neurons, had not been examined before. The effects of histamine on the function of human homomeric GABAAρ1 receptors were studied here, using heterologous expression in Xenopus laevis oocytes followed by the electrophysiological recording of GABA-evoked Cl- currents. Histamine inhibited GABAAρ1 receptor-mediated responses. Effects were reversible, independent of the membrane potential, and strongly dependent on both histamine and GABA concentration. A rightward parallel shift in the concentration-response curve for GABA was observed in the presence of histamine, without substantial change in the maximal response or the Hill coefficient. Results were compatible with a competitive antagonism of histamine on the GABAAρ1 receptors. This is the first report of inhibitory actions exerted by histamine on an ionotropic GABA receptor.

Utility of the Brief Young Adult Alcohol Consequences Questionnaire to Identify College Students At-Risk for Alcohol Related Problems: Relative Operating Characteristics across Seven Countries.

Background: It is important to identify students who would benefit from early interventions to reduce harmful drinking patterns and associated consequences. the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ) could be particularly useful as a screening tool in university settings. Objectives. The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Objectives: The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Methods: A sample of 6382 students (mean age=20.28, SD=3.75, 72.2% females) from seven countries (i.e., U.S., Canada, South-Africa, Spain, Argentina, Uruguay, England) completed the B-YAACQ, the AUDIT and different measures of alcohol use. Results: ROC analyses suggested that a cutoff score of 5 maximized the YAACQ's discrimination utility to differentiate between students at low versus moderate/high risk in the total sample and across countries (except in Canada, where the cutoff was 4). In addition, a cutoff of 7 differentiated between students at low/moderate versus high risk in the total sample, while cutoffs of 10, 9, 8 and 7 differentiate between students at low/moderate versus high risk in Uruguay, U.S and Spain (10), Argentina (9), England (8), and Canada and South-Africa (7), respectively. Students classified at the three risk levels (i.e., low, moderate and high) differed in age (i.e., a younger age was associated with higher risk) and drinking patters (i.e., higher drinking frequency, quantity, binge drinking and AUDIT and B-YAACQ scores in the higher risk groups). Conclusions: This study suggest that the B-YAACQ is a useful tool to identify college students at-risk for experiencing problematic patterns of alcohol use.

Prevalence, management and efficacy of treatment in portal vein obstruction after paediatric liver transplantation: protocol of the retrospective international multicentre PORTAL registry.

INTRODUCTION: Portal vein obstruction (PVO) consists of anastomotic stenosis and thrombosis, which occurs due to a progression of the former. The aim of this large-scale international study is to assess the prevalence, current management practices and efficacy of treatment in patients with PVO. METHODS AND ANALYSIS: The Portal vein Obstruction Revascularisation Therapy After Liver transplantation registry will facilitate an international, retrospective, multicentre, observational study, with 25 centres around the world already actively involved. Paediatric patients (aged <18 years) with a diagnosed PVO between 1 January 2001 and 1 January 2021 after liver transplantation will be eligible for inclusion. The primary endpoints are the prevalence of PVO, primary and secondary patency after PVO intervention and current management practices. Secondary endpoints are patient and graft survival, severe complications of PVO and technical success of revascularisation techniques. ETHICS AND DISSEMINATION: Medical Ethics Review Board of the University Medical Center Groningen has approved the study (METc 2021/072). The results of this study will be disseminated via peer-reviewed publications and scientific presentations at national and international conferences. TRIAL REGISTRATION NUMBER: Netherlands Trial Register (NL9261).

Fano-Like Resonance from Disorder Correlation in Vacancy-Doped Photonic Crystals.

By preparing colloidal crystals with random missing scatterers, crystals are created where disorder is embodied as vacancies in an otherwise perfect lattice. In this special system, there is a critical defect concentration where light propagation undergoes a transition from an all but perfect reflector (for the spectral range defined by the Bragg condition), to a metamaterial exhibiting an enhanced transmission phenomenon. It is shown that this behavior can be phenomenologically described in terms of Fano-like resonances. The results show that the Fano's parameter q experiences a sign change signaling the transition from a perfect crystal exhibiting a reflectance Bragg peak, through a state where background scattering is maximum and Bragg reflectance reaches a minimum to a point where the system reenters a low scattering state recovering ordinary Bragg diffraction. A simple dipolar model considering the correlation between scatterers and vacancies is proposed and the reported evolution of the Fano-like scattering is explained in terms of the emerging covariance between the optical paths and polarizabilities and the effect of field enhancement in photonic crystal (PhC) defects.

Utilization of Segmental Grafts Is Associated With Higher Transplant Rates in Pediatric Patients.

INTRODUCTION: In July 2017, a policy to increase the use of segmental grafts (SGs) was implemented at our institution. The aim was to compare changes in waitlist activity after implementation of this policy. METHODS: A single-center, retrospective study. Pediatric patients on the liver waiting list between January 2015 and December 2019 were screened. Patients were classified as receiving a liver transplant (LT) before (Period 1) or after (Period 2) policy changes. Primary end points were transplant rates and time to transplant. RESULTS: Sixty five first LT performed on 65 patients were included. Twenty nine LT were performed during Period 1 and 36 during Period 2. More than half (55%) of LT in Period 2 were SG, compared to 10.3% in Period 1 (P < 0.001). Forty nine and 56 pediatric candidates on the waiting list accounted for 38.78 and 24.48 person-years during Period 1 and Period 2, respectively. Transplant rates per 100 person-years on the waiting list increased from 85.09 during Period 1 to 187.87 in Period 2 (Rate ratio: 2.20; P < 0.001). Median time to receive a LT decreased from 229 d in Period 1 to 75 d during Period 2 (P = 0.013). One-year patient survival rates were 96.6% in Period 1 and 95.7% in Period 2. One-year graft survival rates were 89.7% and 88% in Period 1 and Period 2, respectively. CONCLUSIONS: A policy to increase the use of SG was associated with significantly higher transplant rates and lower waiting times. Implementation of this policy can be done successfully with no observed negative impact on patient and graft survival.

Fiebre hemorrágica Argentina: comunicación de dos casos en zona no endémica / Argentine hemorrhagic fever: report of two cases in a non-endemic área

Resumen Presentamos el caso de una mujer de 38 años sin antecedentes personales relevantes, residente de Ciudad Autónoma de Buenos Aires, que consultó por fiebre, cefalea retroocular mialgias, ar tralgias y exantema maculopapular pruriginoso en dorso de manos y pies de 6 días de evolución. El laboratorio presentaba linfopenia, trombocitopenia grave y hepatitis anictérica. El cónyuge había cursado internación tres semanas antes por un cuadro de similares características sin diagnóstico etiológico. Posteriormente, la paciente evolucionó con metrorragia y petequias axilares asociados a fotofobia, somnolencia y temblor fino de la lengua, con líquido cefalorraquídeo normal, cumpliendo tratamiento con ceftriaxona 2 g/día intravenoso por 7 días. La tomografía computarizada de abdomen y pelvis evidenciaba un hematoma de pared abdominal izquierdo. Se derivaron muestras serológicas al Instituto Nacional de Enfermedades Virales Humanas Dr. Julio I. Maiztegui para virus dengue, leptospirosis y hantavirus con resultados no reactivos y RT-PCR de virus Junín que resultó positiva. Retrospectivamente se realizó el diagnóstico del cónyuge por detección de anticuerpos IgG para virus Junín por ELISA y prueba de neutralización. Ninguno de los dos casos presentaba un nexo epidemiológico claro. Nuestro objetivo es remarcar la importancia de la sospecha clínica fuera de áreas endémicas.

Abstract We present the case of a 38-year-old woman with no relevant medical history, resident of the City of Buenos Aires, who was admitted in hospital for presenting fever, retroocular headache, myalgia, arthralgia, and maculopapular pruritic rash on the back of the hands and feet of 6 days of evolution. Laboratory tests revealed lymphopenia, severe thrombocytopenia, and anicteric hepatitis. Her husband had been hospitalized three weeks earlier for a condition of similar characteristics without etiological diagnosis. Subsequently, it evolved with metrorrhagia and axillary petechiae associated with photophobia, drowsiness, and fine tremor of the tongue with normal cerebrospinal fluid, treated with intravenous ceftriaxone 2 g/day for 7 days. Computed tomography of abdomen and pelvis showed a left abdominal wall hematoma. Serological samples were sent to the National Institute of Human Viral Diseases Dr. Julio I. Maiztegui for dengue virus, leptospirosis and hantavirus with non-reactive results, and RT-PCR of Junín virus that was positive. Retrospectively, the spouse was diagnosed by detection of IgG antibodies to Junin virus by ELISA and neutralization tests. Neither of the two cases had a clear epidemiological link. Our aim is to highlight the importance of clinical suspicion outside of endemic areas.