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Royo-Villanova M, Miñambres E, Sánchez JM, Torres E, Manso C, Ballesteros MÁ, Parrilla G, de Paco Tudela G, Coll E, Pérez-Blanco A, Domínguez-Gil B. Maintaining the permanence principle of death during normothermic regional perfusion in controlled donation after the circulatory determination of death: Results of a prospective clinical study. Am J Transplant 2024; 24:213-221. [PMID: 37739346 DOI: 10.1016/j.ajt.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023]
Abstract
One concern about the use of normothermic regional perfusion (NRP) in controlled donation after the circulatory determination of death (cDCD) is that the brain may be perfused. We aimed to demonstrate that certain technical maneuvers preclude such brain perfusion. A nonrandomized trial was performed on cDCD donors. In abdominal normothermic regional perfusion (A-NRP), the thoracic aorta was blocked with an intra-aortic occlusion balloon. In thoracoabdominal normothermic regional perfusion (TA-NRP), the arch vessels were clamped and the cephalad ends vented to the atmosphere. The mean intracranial arterial blood pressure (ICBP) was invasively measured at the circle of Willis. Ten cDCD donors subject to A-NRP or TA-NRP were included. Mean ICBP and mean blood pressure at the thoracic and the abdominal aorta during the circulatory arrest were 17 (standard deviation [SD], 3), 17 (SD, 3), and 18 (SD, 4) mmHg, respectively. When A-NRP started, pressure at the abdominal aorta increased to 50 (SD, 13) mmHg, while the ICBP remained unchanged. When TA-NRP was initiated, thoracic aorta pressure increased to 71 (SD, 18) mmHg, but the ICBP remained unmodified. Recorded values of ICBP during NRP were 10 mmHg. In conclusion, appropriate technical measures applied during NRP preclude perfusion of the brain in cDCD. This study might help to expand NRP and increase the number of organs available for transplantation.
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Affiliation(s)
- Mario Royo-Villanova
- Donor Transplant Coordination Unit, Service of Intensive Care, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Eduardo Miñambres
- Donor Transplant Coordination Unit, Service of Intensive Care, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, Universidad de Cantabria, Santander, Spain.
| | - José Moya Sánchez
- Donor Transplant Coordination Unit, Service of Intensive Care, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Eduardo Torres
- Neuro-intervention Unit, Hospital Universitario de Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Clara Manso
- Service of Intensive Care, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - María Ángeles Ballesteros
- Donor Transplant Coordination Unit, Service of Intensive Care, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Guillermo Parrilla
- Interventional Neurovascular Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Gonzalo de Paco Tudela
- Interventional Neurovascular Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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Barreda P, Miñambres E, Ballesteros MÁ, Mazón J, Gómez-Román J, Gómez Ortega JM, Belmar L, Valero R, Ruiz JC, Rodrigo E. Controlled Donation After Circulatory Death Using Normothermic Regional Perfusion Does Not Increase Graft Fibrosis in the First Year Posttransplant Surveillance Biopsy. EXP CLIN TRANSPLANT 2022; 20:1069-1075. [PMID: 36718005 DOI: 10.6002/ect.2022.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The number of kidney transplants obtained from controlled donations after circulatory death is increasing, with long-term outcomes similar to those obtained with donations after brain death. Extraction using normothermic regional perfusion can improve results with controlled donors after circulatory death; however, information on the histological impact and extraction procedure is scarce. MATERIALS AND METHODS We retrospectively investigated all kidney transplants performed from October 2014 to December 2019, in which a follow-up kidney biopsy had been performed at 1-year follow-up, comparing controlled procedures with donors after circulatory death and normothermic regional perfusion versus donors after brain death. Interstitial fibrosis/tubular atrophy was assessed by adding the values of interstitial fibrosis and tubular atrophy, according to the Banff classification of renal allograft pathology. RESULTS When we compared histological data from 66 transplants with donations after brain death versus 24 transplants with donations after circulatory death and normothermic regional perfusion, no differences were found in the degree of fibrosis in the 1-year follow-up biopsy (1.7 ± 1.3 vs 1.7 ± 1.1; P = .971) or in the ratio of patients with increased fibrosis calculated as interstitial fibrosis/tubular atrophy >2 (18% vs 13%; P = .522). In our multivariate analysis, which included acute rejection, expanded criteria donation, and the type of donation, no variable was independently related to an increased risk of interstitial fibrosis/tubular atrophy >2. CONCLUSIONS The outcomes of kidney grafts procured in our center using controlled procedures with donors after circulatory death and normothermic regional perfusion were indistinguishable from those obtained from donors after brain death, showing the same degree of fibrosis in the 1-year posttransplant surveillance biopsy. Our data support the conclusion that normothermic regional perfusion should be the method of choice for extraction in donors after circulatory death.
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Affiliation(s)
- Paloma Barreda
- From the Nephrology Department/Transplantation and Autoimmunity Groupt, University Hospital Marqués de Valdecilla/IDIVAL, University of Cantabria, Cantabria, Spain
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3
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Ballesteros MÁ, Sánchez‐Arguiano MJ, Chico‐Fernández M, Barea‐Mendoza JA, Serviá‐Goixart L, Sánchez‐Casado M, García Sáez I, Pino‐Sánchez FI, Antonio Llompart‐Pou J, Miñambres E. Chronic critical illness in polytrauma. Results of the Spanish trauma in ICU registry. Acta Anaesthesiol Scand 2022; 66:722-730. [PMID: 35332519 DOI: 10.1111/aas.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/11/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Chronic critical illness after trauma injury has not been fully evaluated, and there is little evidence in this regard. We aim to describe the prevalence and risk factors of chronic critical illness (CCI) in trauma patients admitted to the intensive care unit. MATERIAL AND METHODS Retrospective observational multicenter study (Spanish Registry of Trauma in ICU (RETRAUCI)). Period March 2015 to December 2019. Trauma patients admitted to the ICU, who survived the first 48 h, were included. Chronic critical illness (CCI) was considered as the need for mechanical ventilation for a period greater than 14 days and/or placement of a tracheostomy. The main outcomes measures were prevalence and risk factors of CCI after trauma. RESULTS 1290/9213 (14%) patients developed CCI. These patients were older (51.2 ± 19.4 vs 49 ± 18.9); p < .01) and predominantly male (79.9%). They presented a higher proportion of infectious complications (81.3% vs 12.7%; p < .01) and multiple organ dysfunction syndrome (MODS) (27.02% vs 5.19%; p < .01). CCI patients required longer stays in the ICU and had higher ICU and overall in-hospital mortality. Age, injury severity score, head injury, infectious complications, and development of MODS were independent predictors of CCI. CONCLUSION CCI in trauma is a prevalent entity in our series. Early identification could facilitate specific interventions to change the trajectory of this process.
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Affiliation(s)
| | | | - Mario Chico‐Fernández
- UCI de Trauma y Emergencias Servicio de Medicina Intensiva, Hospital Universitario Madrid Spain
| | | | - Luis Serviá‐Goixart
- Servicio de Medicina Intensiva Hospital Universitario Arnau de Vilanova Lleida Spain
| | | | - Iker García Sáez
- Servicio de Medicina Intensiva Hospital Universitario Donostia Donostia‐San Sebastian Spain
| | | | - Juan Antonio Llompart‐Pou
- Servei de Medicina Intensiva Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa) Palma Spain
| | - Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care University Hospital Marqués de Valdecilla‐IDIVAL School of Medicine University of Cantabria Santander Spain
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4
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Vidal-Cortés P, Díaz Santos E, Aguilar Alonso E, Amezaga Menéndez R, Ballesteros MÁ, Bodí MA, Bordejé Laguna ML, Garnacho Montero J, García Sánchez M, López Sánchez M, Martín-Loeches I, Ochagavía Calvo A, Ramírez Galleymore P, Alcántara Carmona S, Andaluz Ojeda D, Badallo Arébalo O, Barrasa González H, Borges Sa M, Castellanos-Ortega Á, Estella Á, Ferrer Roca R, Fraile Gutiérrez V, Fuset Cabanes M, Giménez-Esparza Vich C, González Iglesias C, Hernández-Tejedor A, Igeño Cano JC, Iglesias Posadilla D, Jiménez Rivera JJ, Llanos Jorge C, Llompart-Pou JA, López Camps V, Lorencio Cárdenas C, Marcos Neira P, Martín Delgado MC, Martín-Macho González M, Martín Villén L, Nuvials Casals X, Ortiz Suñer A, Quintana Díaz M, Rascado Sedes P, Recuerda Núñez M, Del Río Carbajo L, Rodríguez Aguirregabiria M, Rodríguez Oviedo A, Seijas Betolaza I, Soriano Cuesta C, Suberviola Cañas B, Vera Ching C, Vidal González Á, Zapata Fenor L, Zaragoza Crespo R. Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units. Med Intensiva 2021; 46:81-89. [PMID: 34903475 PMCID: PMC8664080 DOI: 10.1016/j.medine.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.
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Affiliation(s)
- P Vidal-Cortés
- Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
| | - E Díaz Santos
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain; Departament de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - E Aguilar Alonso
- Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - R Amezaga Menéndez
- Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - M Á Ballesteros
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - M A Bodí
- Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain; Universitat Rovira i Virgili, Tarragona, Spain
| | - M L Bordejé Laguna
- Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | | | - M López Sánchez
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - I Martín-Loeches
- Intensive Care Medicine, St James's Hospital, Dublin, Ireland; Trinity College Dublin, School of Medicine, Dublin, Ireland
| | - A Ochagavía Calvo
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | | | - S Alcántara Carmona
- Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - D Andaluz Ojeda
- Medicina Intensiva, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - O Badallo Arébalo
- Medicina Intensiva, Hospital Universitario de Cruces, Bizkaia, Spain
| | | | - M Borges Sa
- Medicina Intensiva, Hospital Universitario Son Llátzer, Palma de Mallorca, Spain
| | | | - Á Estella
- Medicina Intensiva, Hospital Universitario de Jerez, Jerez, Spain; Departamento de Medicina, INIBICA, Universidad de Cádiz, Cádiz, Spain
| | - R Ferrer Roca
- Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - V Fraile Gutiérrez
- Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, Spain
| | - M Fuset Cabanes
- Medicina Intensiva, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - J C Igeño Cano
- Medicina Intensiva, Hospital San Juan de Dios, Córdoba, Spain
| | | | - J J Jiménez Rivera
- Medicina Intensiva, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - C Llanos Jorge
- Medicina Intensiva, Hospital QuirónSalud Tenerife, Tenerife, Spain
| | - J A Llompart-Pou
- Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - V López Camps
- Medicina Intensiva, Hospital de Sagunto, Sagunto, Spain
| | - C Lorencio Cárdenas
- Medicina Intensiva, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - P Marcos Neira
- Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - M C Martín Delgado
- Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | | | - L Martín Villén
- Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - X Nuvials Casals
- Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - A Ortiz Suñer
- Medicina Intensiva, Hospital Arnau de Vilanova, Valencia, Spain; Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Valencia, Spain
| | - M Quintana Díaz
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Departamento de Medicina Universidad Autónoma de Madrid, Madrid, Spain
| | - P Rascado Sedes
- Medicina Intensiva, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - M Recuerda Núñez
- Medicina Intensiva, Hospital Universitario Puerto Real, Cádiz, Spain
| | - L Del Río Carbajo
- Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | | | - I Seijas Betolaza
- Medicina Intensiva, Hospital Universitario de Cruces, Bizkaia, Spain
| | - C Soriano Cuesta
- Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - B Suberviola Cañas
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Vera Ching
- Medicina Intensiva, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | | | - L Zapata Fenor
- Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Zaragoza Crespo
- Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, Spain
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Vidal-Cortés P, Santos ED, Alonso EA, Menéndez RA, Ballesteros MÁ, Bodí MA, Laguna MLB, Garnacho Montero J, Sánchez MG, Sánchez ML, Martín-Loeches I, Calvo AO, Galleymore PR, Carmona SA, Ojeda DA, Arébalo OB, González HB, Sa MB, Castellanos-Ortega Á, Estella Á, Roca RF, Gutiérrez VF, Cabanes MF, Vich CGE, Iglesias CG, Hernández-Tejedor A, Carlos Igeño Cano J, Posadilla DI, Rivera JJJ, Jorge CL, Llompart-Pou JA, Camps VL, Cárdenas CL, Neira PM, Delgado MCM, González MMM, Villén LM, Casals XN, Suñer AO, Díaz MQ, Sedes PR, Núñez MR, Carbajo LDR, Aguirregabiria MR, Oviedo AR, Betolaza IS, Cuesta CS, Cañas BS, Ching CV, González ÁV, Fenor LZ, Crespo RZ. [Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. Med Intensiva 2021; 46:81-89. [PMID: 34545260 PMCID: PMC8443328 DOI: 10.1016/j.medin.2021.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022]
Abstract
La pandemia por COVID-19 ha provocado el ingreso de un elevado número de pacientes en UCI, generalmente por insuficiencia respiratoria severa. Desde la aparición de los primeros casos de infección por SARS-CoV-2, a finales de 2019, en China, se ha publicado una cantidad ingente de recomendaciones de tratamiento de esta entidad, no siempre respaldadas por evidencia científica suficiente ni con el rigor metodológico necesario. Gracias al esfuerzo de distintos grupos de investigadores, actualmente disponemos de resultados de ensayos clínicos, y otro tipo de estudios, de mayor calidad. Consideramos necesario realizar un documento que incluya recomendaciones que recojan estas evidencias en cuanto al diagnóstico y tratamiento de la COVID-19, pero también aspectos que otras guías no han contemplado y que consideramos fundamentales en el manejo del paciente crítico con COVID-19. Para ello se ha creado un comité redactor, conformado por miembros de los Grupos de Trabajo de SEMICYUC más directamente relacionados con diferentes aspectos específicos del manejo de estos pacientes.
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Affiliation(s)
- Pablo Vidal-Cortés
- Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Emili Díaz Santos
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain.,Departament de Medicina, Univ Autonoma de Barcelona, Spain
| | | | | | - María Ángeles Ballesteros
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - María A Bodí
- Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain.,Universitat Rovira i Virgili, Tarragona, Spain
| | | | | | | | - Marta López Sánchez
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ignacio Martín-Loeches
- Intensive Care Medicine, St James´s Hospital, Dublin, Spain.,Trinity College Dublin, School of Medicine, Dublin, Spain
| | - Ana Ochagavía Calvo
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | | | | | | | | | | | - Marcio Borges Sa
- Medicina Intensiva, Hospital Universitario Son Llátzer, Palma de Mallorca, Spain
| | | | - Ángel Estella
- Medicina Intensiva, Hospital Universitario de Jerez, Jerez, Spain.,Departamento de Medicina, INIBICA, Universidad de Cádiz, Cádiz, Spain
| | - Ricard Ferrer Roca
- Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - MariPaz Fuset Cabanes
- Medicina Intensiva, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | - Juan Antonio Llompart-Pou
- Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain.,Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | | | | | - Pilar Marcos Neira
- Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - María Cruz Martín Delgado
- Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain.,Universidad Francisco de Vitoria, Spain
| | | | - Luis Martín Villén
- Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Andrea Ortiz Suñer
- Medicina Intensiva, Hospital Arnau de Vilanova, Valencia, Spain.,Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Valencia, Spain
| | - Manuel Quintana Díaz
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain.,Departamento de Medicina Universidad Autónoma de Madrid, Madrid, Spain
| | - Pedro Rascado Sedes
- Medicina Intensiva, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | | | | | | | - Claudia Vera Ching
- Medicina Intensiva, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | | | - Lluis Zapata Fenor
- Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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García-Alfaro MD, Pérez-Nuñez MI, Amigo MT, Arbona C, Ballesteros MÁ, González-Lamuño D. PlA2 Polymorphism of Platelet Glycoprotein IIb/IIIa and C677T Polymorphism of Methylenetetrahydrofolate Reductase ( MTHFR), but Not Factor V Leiden and Prothrombin G20210A Polymorphisms, Are Associated with More Severe Forms of Legg-Calvé-Perthes Disease. Children (Basel) 2021; 8:children8070614. [PMID: 34356593 PMCID: PMC8307051 DOI: 10.3390/children8070614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022]
Abstract
The possible association of common polymorphic variants related to thrombophilia (the rs6025(A) allele encoding the Leiden mutation, rs1799963(A), i.e., the G20210A mutation of the prothrombin F2 gene, the rs1801133(T) variant of the methylenetetrahydrofolate reductase (MTHFR) gene that encodes an enzyme involved in folate metabolism, and rs5918(C), i.e., the ‘A2’ allele of the platelet-specific alloantigen system that increases platelet aggregation induced by agonists), with the risk of Legg–Calvé–Perthes disease (LCPD) and the degree of hip involvement (Catterall stages I to IV) was analyzed in a cohort study, including 41 children of ages 2 to 10.9 (mean 5.4, SD 2.2), on the basis of clinical and radiological criteria of LCPD. In 10 of the cases, hip involvement was bilateral; thus, a total of 51 hips were followed-up for a mean of 75.5 months. The distribution of genotypes among patients and 118 controls showed no significant differences, with a slightly increased risk for LCPD in rs6025(A) carriers (OR: 2.9, CI: 0.2–47.8). Regarding the severity of LCPD based on Catterall classification, the rs1801133(T) variant of the MTHFR gene and the rs5918(C) variant of the platelet glycoprotein IIb/IIIa were associated with more severe forms of Perthes disease (Catterall III–IV) (p < 0.05). The four children homozygous for mutated MTHFR had a severe form of the disease (Stage IV of Catterall) and a higher risk of non-favorable outcome (Stulberg IV–V).
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Affiliation(s)
- María Dolores García-Alfaro
- Department of Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla, Avda Valdecilla s/n, 39008 Santander, Spain; (M.D.G.-A.); (M.I.P.-N.); (C.A.)
| | - María Isabel Pérez-Nuñez
- Department of Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla, Avda Valdecilla s/n, 39008 Santander, Spain; (M.D.G.-A.); (M.I.P.-N.); (C.A.)
| | - María Teresa Amigo
- Laboratorio de Pediatría, Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Cantabria, Cardenal Herrera Oria s/n, 39011 Santander, Spain;
| | - Carmelo Arbona
- Department of Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla, Avda Valdecilla s/n, 39008 Santander, Spain; (M.D.G.-A.); (M.I.P.-N.); (C.A.)
| | - María Ángeles Ballesteros
- Department of Critical Care Medicine, Hospital Marqués de Valdecilla-IDIVAL, Avda Valdecilla s/n, 39008 Santander, Spain;
| | - Domingo González-Lamuño
- Laboratorio de Pediatría, Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Cantabria, Cardenal Herrera Oria s/n, 39011 Santander, Spain;
- Division of Pediatrics, Hospital Universitario Marqués de Valdecilla-IDIVAL, Avda Valdecilla s/n, 39008 Santander, Spain
- Correspondence: ; Tel.: +34-942-202-604
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7
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Egea-Guerrero JJ, Ballesteros MÁ, Quintana-Díaz M. Tranexamic acid in patients with multiple injuries: good, elegant, and cheap? Emergencias 2020; 31:281-282. [PMID: 31347809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Juan José Egea-Guerrero
- Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla, Sevilla, España
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8
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Ballesteros MÁ, Llompart-Pou JA, Egea-Guerrero JJ. Temporary inferior vena cava filters in major trauma. Med Intensiva 2018; 43:500-502. [PMID: 30385089 DOI: 10.1016/j.medin.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- M Á Ballesteros
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - J J Egea-Guerrero
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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