Impact of pretransplant CMV-specific T-cell immune response in the control of CMV infection after solid organ transplantation: a prospective cohort study.

INTRODUCTION: Although solid organ transplant (SOT) recipients with pretransplant serology for cytomegalovirus (CMV-R+) are considered at intermediate risk for CMV infection post transplantation, CMV infection remains a major cause of morbidity in this population. We prospectively characterized whether having pretransplant CMV-specific cellular immunity is independently associated with controlling infection after transplantation in R + SOT recipients. METHODS: A prospective cohort of consecutive R + SOT recipients that received pre-emptive treatment for CMV infection was monitored after transplantation and variables were recorded during the follow-up. The cytomegalovirus-specific T-cell immune response was characterized by intracellular cytokine staining and viral loads determined using real-time PCR. RESULTS: One hundred and thirty-five R + SOT recipients were included (67 kidney, 64 liver, four liver-kidney). Only one-third of the patients (42; 31.85%) had CMV-specific T-cell immunity (CD8+CD69+INF-γ+ T cells >0.25%) before transplantation. Patients with negative pretransplant immunity had more CMV infection (49, 52.7% vs. 15, 35.7%; p 0.07) and received more antiviral therapy than those with immunity (32, 34.4% vs. 6, 14.3%, p 0.016). Having CMV specific immunity was an independent factor for protection from developing viraemia ≥2000 IU/mL (OR 0.276, 95% CI 0.105-0.725, p < 0.01) and lower administration of treatment (OR 0.398, 95% CI 0.175-0.905, p 0.028). Only patients with no pretransplant CMV-specific T-cell response were diagnosed with CMV-disease (8, 8.6% vs. 0, 0%, p 0.05). DISCUSSION: Our results show that having a pretransplant CMV specific T-cell response may be associated with a lower rate of CMV viraemia and less antiviral treatment after transplantation; however, more prospective studies are needed to confirm these findings.

[Acute myocardial infarction in pregnancy of 39 week treated with fibrinolysis]. / Infarto agudo de miocardio en gestante a término de 39 semanas tratado con fibrinolisis.

We report a 39-year-old woman in her 39th week of pregnancy who presented acute myocardial infarction with clinical and electrocardiography criteria and was treated with systemic fibrinolysis. After this, she was transported to the hemodynamic service of a referral hospital where heart catheterization was done that confirmed the coronary lession. 24 hours after, she had a newborn without sequellae.

Infarto agudo de miocardio en gestante a término de 39 semanas tratado con fibrinolisis / Acute miocardial infarction in pregnancy of 39 week treated with fibrinolysis

Exponemos el caso de una paciente de 39 años de edad con gestación a término de 39 semanas que sufre un cuadro de infarto agudo de miocardio con criterios clínicos y electrocardiográficos y que fue tratada con fibrinolisis sistémica. Posteriormente fue trasladada al servicio de hemodinámica del Hospital de referencia donde se realizó cateterismo confirmando la lesión coronaria. A las 24 horas de éste episodio dio a luz un recién nacido a término sin complicaciones mediante parto vaginal

We report a 39 years old woman at ehr 39th week of pregancy who presented acute miocardial infarction with clinics and electrocardiography criteria and was trated with systemic fibrynolisis. After this was traslated to hemodynamic service of referency hospital were was done cateterism thas confirmed the coronary lession. 24 hours after she had an newborn without secuels

Síndrome de distrés respiratorio del adulto secundario a inhalación de cocaína / Adult respiratory distress syndrome secondary to cocaine inhalation

Presentamos un caso de síndrome de distrés respiratorio del adulto tras inhalación de cocaína de gran pureza. El paciente sufrió un rápido deterioro de su función respiratoria. Hubo de instaurarse ventilación mecánica durante 15 días. Se descartó la existencia de neumonía y de patología cardíaca que justificase el cuadro. Finalmente el enfermo mejoró y fue dado de alta sin secuelas (AU)