Complications Associated With Liver Transplantation in Recipients With Body Mass Index >35 kg/m(2): Would It Be a Poor Prognosis Predictive Factor?

BACKGROUND: Obesity is a global epidemic that continues to increase in a great number of countries, and it has become a major public health problem in Spain. Unfortunately, the impact of obesity on survival in liver transplantation (LT) recipients is underestimated and controversial. The aim of this study was to determine if obesity is a risk factor for morbidity and mortality after LT. METHODS: In a retrospective cohort study of the records of 180 consecutive patients who had undergone to LT from 2007 to 2013, 11 obese patients with body mass index (BMI) >35 kg/m(2) were identified. Their data have been compared with recipients with BMI 20-25 kg/m(2). RESULTS: There were no differences in demographic data, Child-Pugh score, Model for End-Stage Liver Disease score, or cause of liver failure. BMI >35 kg/m(2) recipients had a significantly higher rate of portal vein thrombosis before LT, compared with the BMI 20-25 kg/m(2) group (36.5% vs 13.9%; P = .041). There were also no differences in development of post-reperfusion syndrome. The groups were also comparable concerning morbidity rate after LT, stay in the intensive care unit, and global hospital stay. However, the mortality rate was significantly higher in the obese group compared with the nonobese group (72.7% vs 38.9%; P = .032). CONCLUSIONS: The results of the study clearly demonstrate higher mortality rates in obese patients undergoing LT; thus, it is fair to consider obesity as a poor prognosis predictive factor concerning mortality rate.

Prevalencia de eschericia coli enterohemorrágico en una zona ganadera de Argentina: caracterización genotípica de las cepas de origen animal / Animal reservoir and genotipic characterization of enterohemorrhagic escherichia coli in Argentina

Background: There is a high prevalence of infection by Enterohemorrhagic Escherichia coli (EHEC) and patients with hemolytic uremic syndrome (HUS) in Argentina. Aim: To study cattle and pigs as a possible reservoir of EHEC in Argentina. Material and methods: One hundred two healthy animals (68 cattles and 31 pigs) from a livestock in Argentina, were studied. Stool samples were obtained with a rectal swab. The strains were identified by DNA hybridization with specific gene probes detecting Shiga-like toxin 1 and 2 (Stx1, Stx2), and hly gen related to fimbrial adhesin-associated plasmid. EHEC strains were serogrouped using comercial antisera. Results: EHEC was isolated from 30 out of 68 bovines cultures (44.1 percent) and from 25 out of 31 pigs (58.1 percent). Isolates carrying genes codifying both Stx1 and Sxt2, were observed in 50 percent of cattle and 63.9 percent of pigs. The gene which codifies for hemolysin (associated to fimbrial adhesin) was observed in about 41 percent of EHEC isolates. Strains belonging to serogroups O26, O111, and O157 were isolated from cattle, and O111, and O157 from pigs. Conclusions: The high percentage of EHEC in both cattle and pigs and the presence of human infection-associated serogroups, suggests that these animals are a reservoir of EHEC associated with disease in humans

[Intensive postoperative treatment in obstetrics and gynecology: proposal for a score system for medico-surgical assessment of the abdominal surgery patient]. / Terapia intensiva post-operatoria in ostetricia e ginecologia. Proposta di uno score per la valutazione medico-chirurgica dellia paziente addominale.

It is often necessary in routine clinical practice to take a decision on therapeutic conduct regarding patients with abdominal type postoperative complications. A score system has been devised which increases with the gravity of objective findings and the laboratory data most frequently observed in this pathology. The theoretical score is applied a posteriori to 12 serious cases of abdominal surgery. The values suggest an appropriate therapeutic approach: in effect, a score of less than 50 would point to wait-and-see medical treatment, not to be prolonged beyond 72 hours; values higher than 50 point to medical treatment preparatory to indispensable surgery.