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Ortega MJ, Martínez-Belotto M, García-Majado C, Belmar L, López del Moral C, Gómez-Ortega JM, Valero R, Ruiz JC, Rodrigo E. Consequences of Nephrotic Proteinuria and Nephrotic Syndrome after Kidney Transplant. Biomedicines 2024; 12:767. [PMID: 38672122 PMCID: PMC11048274 DOI: 10.3390/biomedicines12040767] [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: 02/28/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Proteinuria is the main predictor of kidney graft loss. However, there is little information regarding the consequences of nephrotic proteinuria (NP) and nephrotic syndrome (NS) after a kidney transplant. We aimed to describe the clinical and histopathological characteristics of kidney recipients with nephrotic-range proteinuria and compare the graft surveillance between those who developed NS and those who did not. A total of 204 patients (18.6% of kidney transplants in the study period) developed NP, and 68.1% of them had NS. Of the 110 patients who underwent a graft biopsy, 47.3% exhibited ABMR, 21.8% the recurrence of glomerulonephritis, 9.1% IFTA, and 7.3% de novo glomerulonephritis. After a median follow-up of 97.5 months, 64.1% experienced graft loss. The graft survival after the onset of NP declined from 75.8% at 12 months to 38% at 5 years, without significant differences between those with and those without NS. Patients who developed NS fewer than 3 months after the onset of NP exhibited a significantly higher risk of death-censored graft loss (HR: 1.711, 95% CI: 1.147-2.553) than those without NS or those with late NS. In conclusion, NP and NS are frequent conditions after a kidney transplant, and they imply extremely poor graft outcomes. The time from the onset of NP to the development of NS is related to graft survival.
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Affiliation(s)
- María José Ortega
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Miguel Martínez-Belotto
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Cristina García-Majado
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Lara Belmar
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Covadonga López del Moral
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Jose María Gómez-Ortega
- Pathological Anatomy Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - Rosalía Valero
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Juan Carlos Ruiz
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Emilio Rodrigo
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
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Pujol-Fontrodona G, Domínguez-Roldán JM, Valero R. Organic law regulating euthanasia: knowledge and involvement of doctors in Spain one year after its implementation. Rev Clin Esp 2023; 223:596-603. [PMID: 37898356 DOI: 10.1016/j.rceng.2023.10.004] [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: 06/15/2023] [Accepted: 09/27/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND AND AIMS The Organic Law Regulating Euthanasia (LORE, for its initials in Spanish) came into force in June 2021. This study aims to examine knowledge of the LORE among physicians licensed in Spain as well as their involvement with and the impact of the law. METHODS This work is a descriptive, cross-sectional study conducted by means of a survey. Information was gathered through a self-administered questionnaire. RESULTS The survey was answered by 1446 physicians licensed in Spain. The samples' demographic characteristics were as follows: 54.7% were women, the mean age was 52 ± 14 years, and 66.0% worked in a hospital. Catalonia was the autonomous community with the most participants (44.6%). Regarding specialties, anesthesiology and resuscitation had the highest number of participants (21.9%), followed by family and community medicine (18.5%). The LORE was known in detail by 24.3% of physicians, 58.0% had a positive opinion of it, and 31.1% had direct experience with the euthanasia procedure. Practitioners working in the hospital setting perceived the law more favorably compared to those in the primary care setting (62.3% vs. 47.3%, p < 0.01). CONCLUSIONS Most doctors did not have in-depth knowledge of the LORE, although a majority supported its existence, particularly those in hospital medicine. Most physicians who viewed the LORE negatively were male, older, and worked in primary care. A minority of physicians considered registering as conscientious objectors.
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Affiliation(s)
- G Pujol-Fontrodona
- Servicio de Anestesiología y Reanimación, Hospital Clínic Barcelona, Barcelona, España
| | - J M Domínguez-Roldán
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España
| | - R Valero
- Servicio de Anestesiología y Reanimación, Hospital Clínic Barcelona, Barcelona, España; Departamento de Cirugía y Especialidades Médico quirúrgicas, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, España.
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González-López E, Ocejo-Vinyals JG, Renuncio-García M, Roa-Bautista A, San Segundo Arribas D, Escagedo C, García-Saiz MDM, Valero R, García-Berbel P, Ruíz San Millán JC, Rodrigo E. Donor-Derived Cell-Free DNA at 1 Month after Kidney Transplantation Relates to HLA Class II Eplet Mismatch Load. Biomedicines 2023; 11:2741. [PMID: 37893114 PMCID: PMC10604614 DOI: 10.3390/biomedicines11102741] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Kidney transplantation is the preferred therapeutic option for end-stage renal disease; however, the alloimmune response is still the leading cause of renal allograft failure. To better identify immunologic disparities in order to evaluate HLA compatibility between the donor and the recipient, the concept of eplet load has arisen. Regular kidney function monitoring is essential for the accurate and timely diagnosis of allograft rejection and the appropriate treatment. Donor-derived cell-free DNA (dd-cfDNA) has been proposed as a potential biomarker of acute rejection and graft failure in kidney transplantation. The proportion of plasma dd-cfDNA was determined in forty-two kidney patients at 1 month after transplantation. A total of eleven (26.2%) patients had a dd-cfDNA proportion of ≥1.0%. The only pretransplant variable related to dd-cfDNA > 1.0% was the HLA class II eplet mismatch load, mainly the HLA-DQB1 eplet mismatch load. Furthermore, dd-cfDNA was able to discriminate the patients with antibody-mediated rejection (AbMR) (AUC 87.3%), acute rejection (AUC 78.2%), and troubled graft (AUC 81.4%). Increased dd-cfDNA levels were associated with kidney allograft deterioration, particularly rejection, as well as a greater HLA class II eplet mismatch load. Consequently, combining dd-cfDNA determination and HLA eplet mismatch load calculation should improve the assessment of the risk of short- and long-term allograft damage.
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Affiliation(s)
- Elena González-López
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain; (E.G.-L.); (M.R.-G.); (A.R.-B.); (D.S.S.A.)
| | - Javier Gonzalo Ocejo-Vinyals
- Immunology Department, Infectious Diseases and Clinical Microbiology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain;
| | - Mónica Renuncio-García
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain; (E.G.-L.); (M.R.-G.); (A.R.-B.); (D.S.S.A.)
| | - Adriel Roa-Bautista
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain; (E.G.-L.); (M.R.-G.); (A.R.-B.); (D.S.S.A.)
| | - David San Segundo Arribas
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain; (E.G.-L.); (M.R.-G.); (A.R.-B.); (D.S.S.A.)
| | - Clara Escagedo
- Nephrology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain; (C.E.); (R.V.); (J.C.R.S.M.)
| | - María del Mar García-Saiz
- Clinical Pharmacology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain;
| | - Rosalía Valero
- Nephrology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain; (C.E.); (R.V.); (J.C.R.S.M.)
| | - Pilar García-Berbel
- Pathological Anatomy Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain;
| | - Juan Carlos Ruíz San Millán
- Nephrology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain; (C.E.); (R.V.); (J.C.R.S.M.)
| | - Emilio Rodrigo
- Nephrology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39008 Santander, Spain; (C.E.); (R.V.); (J.C.R.S.M.)
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López-Oliva MO, Pérez-Flores I, Molina M, José Aladrén M, Trujillo H, Redondo-Pachón D, López V, Facundo C, Villanego F, Rodríguez M, Carmen Ruiz M, Antón P, Rivas-Oural A, Cabello S, Portolés J, de la Vara L, Tabernero G, Valero R, Galeano C, Moral E, Ventura A, Coca A, Ángel Muñoz M, Hernández-Gallego R, Shabaka A, Ledesma G, Bouarich H, Ángeles Rodríguez M, Pérez Tamajón L, Cruzado L, Emilio Sánchez J, Jiménez C. Management of immunosuppressive therapy in kidney transplant recipients with COVID-19. A multicentre national study derived from the Spanish Society of Nephrology COVID registry. Nefrologia 2023; 43:442-451. [PMID: 37661514 DOI: 10.1016/j.nefroe.2023.08.004] [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: 12/08/2021] [Accepted: 03/27/2022] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION SARS CoV2 infection has had a major impact on renal transplant patients with a high mortality in the first months of the pandemic. Intentional reduction of immunosuppressive therapy has been postulated as one of the cornerstone in the management of the infection in the absence of targeted antiviral treatment. This has been modified according to the patient`s clinical situation and its effect on renal function or anti-HLA antibodies in the medium term has not been evaluated. OBJECTIVES Evaluate the management of immunosuppressive therapy made during SARS-CoV2 infection, as well as renal function and anti-HLA antibodies in kidney transplant patients 6 months after COVID19 diagnosis. MATERIAL AND METHODS Retrospective, national multicentre, retrospective study (30 centres) of kidney transplant recipients with COVID19 from 01/02/20 to 31/12/20. Clinical variables were collected from medical records and included in an anonymised database. SPSS statistical software was used for data analysis. RESULTS renal transplant recipients with COVID19 were included (62.6% male), with a mean age of 57.5 years. The predominant immunosuppressive treatment prior to COVID19 was triple therapy with prednisone, tacrolimus and mycophenolic acid (54.6%) followed by m-TOR inhibitor regimens (18.6%). After diagnosis of infection, mycophenolic acid was discontinued in 73.8% of patients, m-TOR inhibitor in 41.4%, tacrolimus in 10.5% and cyclosporin A in 10%. In turn, 26.9% received dexamethasone and 50.9% were started on or had their baseline prednisone dose increased. Mean creatinine before diagnosis of COVID19, at diagnosis and at 6 months was: 1.7 ± 0.8, 2.1 ± 1.2 and 1.8 ± 1 mg/dl respectively (p < 0.001). 56.9% of the patients (N = 350) were monitored for anti-HLA antibodies. 94% (N = 329) had no anti-HLA changes, while 6% (N = 21) had positive anti-HLA antibodies. Among the patients with donor-specific antibodies post-COVID19 (N = 9), 7 patients (3.1%) had one immunosuppressant discontinued (5 patients had mycophenolic acid and 2 had tacrolimus), 1 patient had both immunosuppressants discontinued (3.4%) and 1 patient had no change in immunosuppression (1.1%), these differences were not significant. CONCLUSIONS The management of immunosuppressive therapy after diagnosis of COVID19 was primarily based on discontinuation of mycophenolic acid with very discrete reductions or discontinuations of calcineurin inhibitors. This immunosuppression management did not influence renal function or changes in anti-HLA antibodies 6 months after diagnosis.
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Affiliation(s)
| | | | - María Molina
- Servicio de Nefrología, Hospital U. Germans Trias y Pujol, Barcelona, Spain
| | | | | | | | - Verónica López
- Servicio de Nefrología, Hospital U. Carlos Haya, Málaga, Spain
| | - Carme Facundo
- Servicio de Nefrología, Hospital U. Fundación Puigvert, Barcelona, Spain
| | | | - Marisa Rodríguez
- Servicio de Nefrología, Hospital U. Gregorio Marañón, Madrid, Spain
| | - Maria Carmen Ruiz
- Servicio de Nefrología, Hospital U. Virgen de las Nieves, Granada, Spain
| | - Paula Antón
- Servicio de Nefrología, Hospital U. Bellvitge, Barcelona, Spain
| | - Alba Rivas-Oural
- Servicio de Nefrología, Hospital U. Central de Asturias, Oviedo, Spain
| | - Sheila Cabello
- Servicio de Nefrología, Hospital U. Son Espases, Palma de Mallorca, Spain
| | - José Portolés
- Servicio de Nefrología, Hospital U. de Albacete, Spain
| | | | | | - Rosalía Valero
- Servicio de Nefrología, Hospital U. Marqués de Valdecilla, Santander, Spain
| | - Cristina Galeano
- Servicio de Nefrología, Hospital U. Ramón y Cajal, Madrid, Spain
| | | | - Ana Ventura
- Servicio de Nefrología, Hospital U. La Fe, Valencia, Spain
| | - Armando Coca
- Servicio de Nefrología, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | - Amir Shabaka
- Servicio de Nefrología, Hospital Fundación Alcorcón, Madrid, Spain
| | - Gabriel Ledesma
- Servicio de Nefrología, Hospital U. Infanta Sofía, Madrid, Spain
| | - Hanane Bouarich
- Servicio de Nefrología, Hospital U. Príncipe de Asturias, Madrid, Spain
| | | | | | | | - José Emilio Sánchez
- Servicio de Nefrología, Hospital de Cabueñes, Asturias, Coordinador Registro COVID S.E.N., Spain
| | - Carlos Jiménez
- Servicio de Nefrología, Hospital U. La Paz, Madrid, Spain
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Cañamero L, Benito-Hernández A, González E, Escagedo C, Rodríguez-Vidriales M, García-Saiz MDM, Valero R, Belmar L, de Cos MA, Francia MV, Ruiz JC, Rodrigo E. Torque Teno Virus Load Predicts Opportunistic Infections after Kidney Transplantation but Is Not Associated with Maintenance Immunosuppression Exposure. Biomedicines 2023; 11:biomedicines11051410. [PMID: 37239081 DOI: 10.3390/biomedicines11051410] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Measuring the non-pathogenic Torque Teno Virus (TTV) load allows assessing the net immunosuppressive state after kidney transplantation (KTx). Currently, it is not known how exposure to maintenance immunosuppression affects TTV load. We hypothesized that TTV load is associated with the exposure to mycophenolic acid (MPA) and tacrolimus. We performed a prospective study including 54 consecutive KTx. Blood TTV load was measured by an in-house PCR at months 1 and 3. Together with doses and trough blood levels of tacrolimus and MPA, we calculated the coefficient of variability (CV), time in therapeutic range (TTR) and concentration/dose ratio (C/D) of tacrolimus, and the MPA-area under the curve (AUC-MPA) at the third month. TTV load at the first and third month discriminated those patients at risk of developing opportunistic infections between months 1 and 3 (AUC-ROC 0.723, 95%CI 0.559-0.905, p = 0.023) and between months 3 and 6 (AUC-ROC 0.778, 95%CI 0.599-0.957, p = 0.028), respectively, but not those at risk of acute rejection. TTV load did not relate to mean tacrolimus blood level, CV, TTR, C/D and AUC-MPA. To conclude, although TTV is a useful marker of net immunosuppressive status after KTx, it is not related to exposure to maintenance immunosuppression.
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Affiliation(s)
- Lucía Cañamero
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - Adalberto Benito-Hernández
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - Elena González
- Immunopathology Group, Immunology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - Clara Escagedo
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - María Rodríguez-Vidriales
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - María Del Mar García-Saiz
- Clinical Pharmacology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - Rosalía Valero
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - Lara Belmar
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - María Angeles de Cos
- Clinical Pharmacology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - María Victoria Francia
- Infectious Diseases and Clinical Microbiology Group, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39011 Santander, Spain
| | - Juan Carlos Ruiz
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - Emilio Rodrigo
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
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Valencia JA, Fabregas N, Tercero J, Valero R. Assessment of cerebral blood flow velocities, brain midline shift and optic nerve sheath diameter by ultrasound in patients undergoing elective craniotomy: A prospective observational feasibility study. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:269-275. [PMID: 37150439 DOI: 10.1016/j.redare.2022.02.008] [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] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/16/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Brain ultrasound allows measuring the cerebral flow velocity, brain midline shift and optic nerve sheath diameter. Literature is scarce in determining the feasibility to perioperatively perform these measurements altogether and the cerebrovascular behavior in patients scheduled for elective craniotomy. METHODS We assessed bilateral cerebral flow velocities, composite index, brain midline shift and optic nerve sheath diameter by cerebral ultrasound in patients scheduled for elective craniotomy before anesthetic induction, at extubation, and at 6 and 24 h after. The aim was to assess the feasibility of brain ultrasound in patients for elective craniotomy and to describe the changes in cerebral flow velocities, brain midline shift and optic nerve sheath diameter from baseline values at different times in the postoperative period. RESULTS Sixteen patients were included, of these two were excluded from analysis due to an inadequate sonographic window. There were no changes throughout the study regarding cerebral flow velocity, brain midline shift nor optic nerve sheath diameter assessments. All parameters were maintained in the physiological range without significant variations during the procedure. No perioperative complications were detected. CONCLUSIONS The results of our study show the feasibility to perform a perioperative assessment of cerebral flow velocity, brain midline shift or optic nerve sheath diameter jointly and successfully to obtain additional information of baseline cerebral hemodynamics in patients scheduled for elective craniotomy and their postoperative changes during the first 24 h. Future studies with lager samples are needed to address the efficacy of cerebral ultrasound as a monitoring tool.
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Affiliation(s)
- J A Valencia
- Sección Neuroanestesia, Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| | - N Fabregas
- Sección Neuroanestesia, Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - J Tercero
- Sección Neuroanestesia, Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - R Valero
- Sección Neuroanestesia, Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Caravaca-Fontán F, Polanco N, Villacorta B, Buxeda A, Coca A, Ávila A, Martínez-Gallardo R, Galeano C, Valero R, Ramos N, Allende N, Cruzado-Vega L, Pérez-Sáez MJ, Sevillano Á, González E, Hernández A, Rodrigo E, Fernández-Ruiz M, Aguado JM, Pérez Valdivia MÁ, Pascuall J, Andrés A, Praga M. Recurrence of immune complex and complement-mediated membranoproliferative glomerulonephritis in kidney transplantation. Nephrol Dial Transplant 2023; 38:222-235. [PMID: 35404425 DOI: 10.1093/ndt/gfac148] [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: 01/09/2022] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Membranoproliferative glomerulonephritis (MPGN) represents a histologic pattern of glomerular injury that may be due to several aetiologies. Few studies have comprehensively analysed the recurrence of MPGN according to the current classification system. METHODS We collected a multicentre, retrospective cohort of 220 kidney graft recipients with biopsy-proven native kidney disease due to MPGN between 1981 and 2021 in 11 hospitals. Demographic, clinical and histologic parameters of prognostic interest were collected. The main outcomes were time to kidney failure, time to recurrence of MPGN and disease remission after recurrence. RESULTS The study group included 34 complement-mediated and 186 immune complex-mediated MPGN. A total of 81 patients (37%) reached kidney failure in a median follow-up of 79 months. The main predictors of this event were the development of rejection episodes and disease recurrence. In all, 54 patients (25%) had a disease recurrence in a median of 16 months after kidney transplantation. The incidence of recurrence was higher in patients with dysproteinaemia (67%) and complement-mediated MPGN (62%). In the multivariable model, complement-mediated MPGN emerged as a predictor of recurrence. A total of 33 patients reached kidney failure after recurrence. The main determinants of no remission were early time to recurrence (<15 months), estimated glomerular filtration rate <30 mL/min/1.73 m2 and serum albumin <3.5 g/dL at the time of recurrence. CONCLUSIONS One-fourth of the patients with native kidney disease due to MPGN developed clinical recurrence in the allograft, especially in cases with complement-mediated disease or in those associated with dysproteinaemia. The kidney outcomes of disease recurrence with currently available therapies are heterogeneous and thus more effective and individualized therapies are needed.
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Affiliation(s)
- Fernando Caravaca-Fontán
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Natalia Polanco
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Blanca Villacorta
- Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Anna Buxeda
- Department of Nephrology, Hospital del Mar, Institut Mar for Medical Research, Barcelona, Spain
| | - Armando Coca
- Department of Nephrology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ana Ávila
- Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - Cristina Galeano
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rosalía Valero
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Natalia Ramos
- Department of Nephrology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Natalia Allende
- Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - María José Pérez-Sáez
- Department of Nephrology, Hospital del Mar, Institut Mar for Medical Research, Barcelona, Spain
| | - Ángel Sevillano
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Esther González
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Hernández
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Emilio Rodrigo
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Mario Fernández-Ruiz
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.,Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José María Aguado
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.,Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Julio Pascuall
- Department of Nephrology, Hospital del Mar, Institut Mar for Medical Research, Barcelona, Spain
| | - Amado Andrés
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Praga
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, 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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9
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Barreda P, Cañamero L, Boya M, García-Saiz MDM, Valero R, Belmar L, Kislikova M, De Cos MA, Ruiz JC, Rodrigo E. Lower Time in Therapeutic Range Relates to a Worse Kidney Graft Outcome. Transplant Proc 2022; 54:2446-2449. [DOI: 10.1016/j.transproceed.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/23/2022] [Accepted: 09/02/2022] [Indexed: 12/23/2022]
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10
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Mourre F, Giorgi R, Beliard S, Valero R. Maternal inheritance of a genetic mutation for familial hypercholesterolemia predispose to coronary atherosclerosis in adulthood. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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López-Oliva MO, Pérez-Flores I, Molina M, José Aladrén M, Trujillo H, Redondo-Pachón D, López V, Facundo C, Villanego F, Rodríguez M, Carmen Ruiz M, Antón P, Rivas-Oural A, Cabello S, Portolés J, de la Vara L, Tabernero G, Valero R, Galeano C, Moral E, Ventura A, Coca A, Muñoz MÁ, Hernández-Gallego R, Shabaka A, Ledesma G, Martínez P, Ángeles Rodríguez M, Tamajón LP, Cruzado L, Emilio Sánchez J, Jiménez C. [Management of immunosuppressive therapy in kidney transplant recipients with COVID19. A multicentre national study derived form the S.E.N. COVID registry.]. Nefrologia 2022; 43:S0211-6995(22)00076-5. [PMID: 35528867 PMCID: PMC9055748 DOI: 10.1016/j.nefro.2022.03.008] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/27/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION SARS CoV2 infection has had a major impact on renal transplant patients with a high mortality in the first months of the pandemic. Intentional reduction of immunosuppressive therapy has been postulated as one of the cornerstone in the management of the infection in the absence of targeted antiviral treatment. This has been modified according to the patient`s clinical situation and its effect on renal function or anti-HLA antibodies in the medium term has not been evaluated. OBJECTIVES Evaluate the management of immunosuppressive therapy made during SARS-CoV2 infection, as well as renal function and anti-HLA antibodies in kidney transplant patients 6 months after COVID19 diagnosis. MATERIAL AND METHODS Retrospective, national multicentre, retrospective study (30 centres) of kidney transplant recipients with COVID19 from 01/02/20 to 31/12/20. Clinical variables were collected from medical records and included in an anonymised database. SPSS statistical software was used for data analysis. RESULTS 615 renal transplant recipients with COVID19 were included (62.6% male), with a mean age of 57.5 years.The predominant immunosuppressive treatment prior to COVID19 was triple therapy with prednisone, tacrolimus and mycophenolic acid (54.6%) followed by m-TOR inhibitor regimens (18.6%). After diagnosis of infection, mycophenolic acid was discontinued in 73.8% of patients, m-TOR inhibitor in 41.4%, tacrolimus in 10.5% and cyclosporin A in 10%. In turn, 26.9% received dexamethasone and 50.9% were started on or had their baseline prednisone dose increased.Mean creatinine before diagnosis of COVID19, at diagnosis and at 6 months was: 1.7±0.8, 2.1±1.2 and 1.8±1 mg/dl respectively (p<0.001).56.9% of the patients (N=350) were monitored for anti-HLA antibodies. 94% (N=329) had no anti-HLA changes, while 6% (N=21) had positive anti-HLA antibodies. Among the patients with donor-specific antibodies post-COVID19 (N=9), 7 patients (3.1%) had one immunosuppressant discontinued (5 patients had mycophenolic acid and 2 had tacrolimus), 1 patient had both immunosuppressants discontinued (3.4%) and 1 patient had no change in immunosuppression (1.1%), these differences were not significant. CONCLUSIONS The management of immunosuppressive therapy after diagnosis of COVID19 was primarily based on discontinuation of mycophenolic acid with very discrete reductions or discontinuations of calcineurin inhibitors. This immunosuppression management did not influence renal function or changes in anti-HLA antibodies 6 months after diagnosis.
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Affiliation(s)
| | | | - María Molina
- Servicio de Nefrología, Hospital U. Germans Trias y Pujol, Barcelona, Spain
| | - Mª José Aladrén
- Servicio de Nefrología, Hospital U. Miguel Servet, Zaragoza, Spain
| | | | | | - Verónica López
- Servicio de Nefrología, Hospital U. Carlos Haya, Málaga, Spain
| | - Carme Facundo
- Servicio de Nefrología, Hospital U. Fundación Puigvert, Barcelona, Spain
| | | | - Marisa Rodríguez
- Servicio de Nefrología, Hospital U. Gregorio Marañón, Madrid, Spain
| | - Mª Carmen Ruiz
- Servicio de Nefrología, Hospital U. Virgen de las Nieves, Granada, Spain
| | - Paula Antón
- Servicio de Nefrología, Hospital U. Bellvitge, Barcelona, Spain
| | | | - Sheila Cabello
- Servicio de Nefrología, Hospital U. Son Espases, Palma de Mallorca, Spain
| | - José Portolés
- Servicio de Nefrología, Hospital U. Puerta de Hierro, Madrid, Spain
| | | | | | - Rosalía Valero
- Servicio de Nefrología, Hospital U. Marqués de Valdecilla, Santander, Spain
| | - Cristina Galeano
- Servicio de Nefrología, Hospital U. Ramón y Cajal, Madrid, Spain
| | | | - Ana Ventura
- Servicio de Nefrología, Hospital U. La Fe, Valencia, Spain
| | - Armando Coca
- Servicio de Nefrología, Hospital Clínico U. Valladolid, Spain
| | | | | | - Amir Shabaka
- Servicio de Nefrología, Hospital Fundación Alcorcón, Madrid, Spain
| | - Gabriel Ledesma
- Servicio de Nefrología, Hospital U. Infanta Sofía, Madrid, Spain
| | - Patricia Martínez
- Servicio de Nefrología, Hospital U. Príncipe de Asturias, Madrid, Spain
| | | | | | | | - J Emilio Sánchez
- Servicio de Nefrología, Hospital de Cabueñes, Asturias, Coordinador Registro COVID S.E.N, Spain
| | - Carlos Jiménez
- Servicio de Nefrología, Hospital U. La Paz, Madrid, Spain
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Gómez Tarradas JM, Calvo A, Belda I, Topczewski T, Tercero FJ, Valero R. Anaesthetic management in neurosurgery in a patient with Eisenmenger syndrome and Down syndrome. A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:109-113. [PMID: 35168917 DOI: 10.1016/j.redare.2020.10.014] [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] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/09/2020] [Indexed: 06/14/2023]
Abstract
Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.
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Affiliation(s)
- J M Gómez Tarradas
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - A Calvo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain
| | - I Belda
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T Topczewski
- Servicio de Neurocirugía, Hospital Clínic de Barcelona, Barcelona, Spain
| | - F J Tercero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain
| | - R Valero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, Spain
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13
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Gómez Tarradas JM, Calvo A, Belda I, Topczewski T, Tercero FJ, Valero R. Anaesthetic management in neurosurgery in a patient with Eisenmenger syndrome and Down syndrome. A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(20)30294-2. [PMID: 34565573 DOI: 10.1016/j.redar.2020.10.014] [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] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 07/23/2020] [Accepted: 10/09/2020] [Indexed: 10/20/2022]
Abstract
Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger Syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.
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Affiliation(s)
- J M Gómez Tarradas
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España.
| | - A Calvo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - I Belda
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - T Topczewski
- Servicio de Neurocirugía, Hospital Clínic de Barcelona, Barcelona, España
| | - F J Tercero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - R Valero
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Barcelona, España
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14
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Ortiz A, Roger M, Jiménez VM, Perez JCR, Furlano M, Atxer LS, Zurro DG, Casabona CMR, Zurro DG, Gómez CG, Bermúdez PP, Armisen MA, López SA, Porras IG, Ruiz JG, Orgaz JMM, Barón MM, Ortiz PDS, Fuente GDADL, Gili BQ, Fresnedo GF, Cabrera SS, Contreras JP, Pelicano MB, Blanca AM, Portillo MR, Álvarez JES, Romeo MJS, Pérez MG, Diezhandino MG, Marrero DH, Campo CF, García EM, Carmona DGC, Ramírez AT, Bellvis LM, Haym MB, Gómez MB, Martínez JMC, Garrit JMC, Garrido RSJ, Delgado JB, Marimont MB, Muñoz MOV, Villares JMP, Velázquez ÁS, Bonet LA, Bravo MÁG, Mateos FJM, Amador MM, Blanca AM, Miñano JAP, Belmonte AA, Jover AS, Rituerto DC, Sánchez FP, Arenas MD, Hernández RM, Serrano BM, Arduan AO, Sanz AB, Ramos AM, Córdoba-David G, García-Jiménez J, Fontecha-Barriuso M, Guerrero-Mauvecin J, Lopez-Díaz AM, Sánchez-Niño MD, Valiño-Rivas L, Cuarental L, Ribagorda M, Pintor-Chocano A, Favero C, Alvarez-Llamas G, Catalina MC, Fernández-Fernández B, Pérez-Gómez MV, Montaner ERAD, Prado RF, Rivera JR, Verde AMR, Luis-Lima S, Sánchez-Rodríguez J, Sánchez SP, Ortega MR, Parra EG, Mateos SR, Ortiz PJC, Expósito LM, Tejera-Muñoz A, Marchant V, Tejedor-Santamaria L, Agilar MA, Diekmann F, Genis BB, Salinas FO, Bajo MJR, Maneus EB, Guillen MA, Juárez JR, Rodríguez ML, Vicente IR, Pelicano JMB, Porras LFQ, Aguiar PVA, Font MX, Andujar AM, Cucchiari D, Marrah EM, M J, Piñeiro GJ, Salgado CM, Morales Martín AI, López Hernández FJ, Balboa NE, Vicente MP, Calvo IF, González LR, Vicente LV, Martínez SMS, Casanova Paso AG, Garriel MP, López JJV, Palacios AMC, Saénz DS, García PG, Bonilla JLA, Fernández Rodríguez MA, Galán AD, Marcos EM, Pérez-Aradros JC, José RMS, Zelaya FM, Panadés ES, Molina ÁG, Salido JA, Balcells RT, Criach EA, Encarnación MD, Perich LG, Furlano M, Girol CC, Terroba YA, Oliveras MP, Vila LE, Cabañas NS, Molas CF, Torres IS, Pelaez SL, Serra CR, Torres CC, Fajardo JPT, Lahuerta JIH, Herranz VM, Portillo MR, Malo AM, Cabrera SS, Castañeda JRM, Ortiz MER, Moreno JMM, Bermúdez AIR, Olmo RS, Pavón FG, Peregrin CM, Tejero EA, Villalba IL, Muñoz AC, Mier MVPRD, Martos CMP, Baltanas RL, Haad CR, Bartolomé MF, Valdemoros RL, Serres FEB, Díaz MN, Mariño FJJ, Sole LC, Saborido MIT, Majoral JS, Martínez ML, Calabia ER, Millán JCRS, López-Hoyos M, Benito-Hernández A, Fresnedo GF, Segundo DS, Valero R, García EC, Ona JGD, Llavona EC, Rodríguez FS, Gutiérrez RL, Peña HG, Pérez MG, Marrero DH, López V, Sola E, Cabello M, Caballero A, León M, Ruiz P, Alonso J, Navarro-González J, Mora-Fernández MDC, Donate-Correa J, Martín-Nuñez E, Delgado NP, Gigarrán-Guldris S, Pérez JCR, Teruel JLG, Castelao AM, Revilla JMV, Martínez CM, Stanojevic MB, Boque EC, Rosell MNS, Lamo VMD, Tocados JMD, Carrasco AG, López MB, Enriquez MC, Bardaji AM, Masot ND, Gómez AP, Sanjuan AE, Ortega AO, Fuentes RW, Guindo MDCDG, Fuentes MDCR, Ravassa FO, Molina MC, Tortosa CLR, Garrido RGDM, Romeo MJS, Jacobs-Cachá C, Matamoros OB, Mateos FM, Meneghini MAE, Roig JS, Betsabé IT, Larrea CL, Álvarez BS, Corte MDCD, Rodrigues-Diez RR, Vázquez AL, Rodríguez SG, Castiñeira JRV, Martín CM, Álvarez MLS, Iglesias VC, Borra JM, Rubio MAB, Gilsanz GDP, Cabrera ML, Heffernan JAJ, González MO, González OC, García MEG, Martín CJ, Correa PS, Ramos SA, Oliva ML, Becerra BR, Cabrera CV, Mateo GTG, Villanueva RS, García LÁ, Cannata Andía JB, Díaz MN, Martín JLF, López NC, García SP, Montes CA, García MR, Luengas ILM, Álvarez ES, Arias LM, Carro BM, Virgala JM, González MG, Barreiro JML, Fontan MP, González AO, Barja LMC, Barreiro AS, Arias BP, Hernández ÁA, Pérez MP, Varela JC, Lechuga JA, Rodríguez CD, Murias MG, Iglesia AMBDL, Piñeiro PB, González ÁG, Eijo AC, Cachaza NC, González MV, Garrit JMC, Blanch NL, Martínez AMS, Val MH, BordignonDraibe J, Melilli E, Montero AM, Pérez NM, Oliveras XF, Barrio MC, Santos JP, Barrera CB, Sáez MJP, Pachón MDR, Cabrales CA, Porras AB, García ER, Atxer LS, González VP, Mallol LL, Oliva MR, Puyol DR, Torres MPR, Ongil SL, Basilio LC, Centenera GO, Miguel PMD, Rodríguez LF, Nadah HB, Fernández MP, Chamond MRR, Ortiz PS, Fernández NG, Boillos AB, Cenarruzabeitia NV, Seara MAF, Moreno IDDPM, Lavilla FJ, Torres A, Miranda DM, Hernández APR, Redondo EDB, Porrini E, Caso MDLÁC, Tamajón MLP, Hernández MR, Rebollo MSG, Mallen PD, González AÁ, Rinne AMG, Rodríguez RM, Torres SE, Sosa DÁ, Cabrera BE, Rodríguez NZ, Hernández AF, Gamboa MJR, Caso C, Angeles MDL, Tamajon P, Lourdes M, Hernandez MR, Rebollo G, Sagrario M, Mallen PD, Gonzalez A, Alejandra, Rinne G, Maria A, Rodriguez RM, Torres SE, Sosa DA, Cabrera BE, Rodiguez NZ, Hernandez AF, Gamboa R, Jose M, Bermejo MLG, Lucas MF, Moreno EC, Muñoz LS, Huertas SS, Serrano EMR, Muñoz MER, Toro LC, Agudo CPB, Álvarez CG, Portoles J, Marqués M, Rubio E, Sánchez-Sobrino B, García-Menéndez E, Fernández AL, Diezhandin MG, Benítez PR, González MÁGN, Gallardo ML, Juárez GMF, Martínez EG, Terente MP, Ribera AT, Escribano TC, Fontan FC, Fernández AS, Pérez - Monteoliva NRR, Huerta EL, Rodríguez GG, Hernández SB, Zamorano SM, Gómez JML, Gallego RH. RICORS2040: the need for collaborative research in chronic kidney disease. Clin Kidney J 2021; 15:372-387. [PMID: 35211298 PMCID: PMC8862113 DOI: 10.1093/ckj/sfab170] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 01/17/2023] Open
Abstract
Abstract
Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is ‘solved’ by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020–2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true.
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Martin-Moreno PL, Sánchez-Fructuoso AI, Mazuecos A, Mir M, Lopez-Lopez I, González-Rinne A, Coca A, Valero R, Ventura Galiano A, Ridao N, Toapanta-Gaibor NG, Fernández-Tagarro E, Cruzado-Vega L, Pérez-Mir M, Jiménez C. Paternal safety of the use of mycophenolic acid in kidney transplant recipients. Results of the EMVARON study. Clin Transplant 2021; 35:e14256. [PMID: 33599030 DOI: 10.1111/ctr.14256] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/06/2021] [Accepted: 02/12/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The use of mycophenolic acid (MPA) in women during pregnancy causes an increase in miscarriages and birth defects with a typical embryopathy profile. Although epidemiological data does not suggest a greater risk among the offspring of male kidney transplant recipients, the European Medicines Agency and The Spanish Agency of Medicines and Medical Devices introduced the recommendation of using contraceptive methods. METHODS We conducted a national retrospective study in 15 Spanish Kidney Transplant Centers to evaluate the frequency of miscarriages and birth defects between the offspring from male kidney transplants recipients. We included 151 males who had fathered 239 offspring, 225 under MPA and 14 without MPA. RESULTS The results of our study showed an incidence of miscarriages in the MPA group of 9.8%, and of birth defects of 4%. CONCLUSIONS We observed an incidence of miscarriages between the offspring fathered by kidney transplant males under MPA lower than the general population. The incidence of birth defects was similar to the incidence described in other studies and the fact that we did not find the typical embryopathy profile makes it difficult to associate them to the use of MPA. Because of that, we urge the European and Spanish Agencies to reconsider their recommendations for males.
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Affiliation(s)
- Paloma L Martin-Moreno
- Nephrology Department, Clínica Universidad de Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | | | - Marisa Mir
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Isabel Lopez-Lopez
- Nephrology Department, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ana González-Rinne
- Nephrology Department, Hospital Universitario de Canarias, Instituto de Tecnologías Biomédicas (ITB)-Universidad de La Laguna, Tenerife, Spain
| | - Armando Coca
- Nephrology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Rosalía Valero
- Nephrology Department, H.U. Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Ana Ventura Galiano
- Kidney Transplant Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Natalia Ridao
- Nephrology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Ernesto Fernández-Tagarro
- Nephrology Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas, Spain
| | | | - Mónica Pérez-Mir
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Jiménez
- Nephrology Department, Hospital Universitario La Paz, Madrid, Spain
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Mourre F, Beliard S, Valero R, Giorgi R. Cardiovascular Events According To Maternal Or Paternal Heritability Of Genetic Mutation In Familial Hypercholesterolemia. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rodrigo E, Miñambres E, Gutiérrez-Baños JL, Valero R, Belmar L, Ruiz JC. COVID-19-related collapse of transplantation systems: A heterogeneous recovery? Am J Transplant 2020; 20:3265-3266. [PMID: 32515039 PMCID: PMC7300796 DOI: 10.1111/ajt.16125] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Emilio Rodrigo
- Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain,Correspondence Emilio Rodrigo
| | - Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - José L. Gutiérrez-Baños
- Service of Urology, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Rosalía Valero
- Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Lara Belmar
- Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Juan C. Ruiz
- Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
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Miñambres E, Rodrigo E, Suberviola B, Valero R, Quintana A, Campos F, Ruiz-San Millán JC, Ballesteros MÁ. Strict selection criteria in uncontrolled donation after circulatory death provide excellent long-term kidney graft survival. Clin Transplant 2020; 34:e14010. [PMID: 32573027 DOI: 10.1111/ctr.14010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/01/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND We aimed to report our experience in uncontrolled donation after circulatory death (uDCD) kidney transplantation applying a strict donor selection and preservation criteria. METHODS All kidney recipients received a graft from a local uDCD. As controls, we included all renal transplants from local standard criteria donation after brain death (SDBD) donors. Normothermic regional perfusion was the preservation method in all cases. RESULTS A total of 19 kidneys from uDCD donors were included and 67 controls. Delayed graft function (DGF) was higher in the uDCD group (42.1% vs 17.9%; P = .033), whereas no differences were observed in primary nonfunction (0% cases vs 3% controls; P = .605). The estimated glomerular filtration rate was identical in both groups. No differences were observed in graft survival censored for death between the uDCD and the SDBD groups at 1-year (100% vs 95%) or 5-year follow-up (92% vs 91%). uDCD kidney recipients did not have higher risk of graft loss in the multivariate analysis adjusted by recipient age, cold ischemic time, presence of DGF, and second kidney transplant (HR: 0.4; 95% CI 0.02-6; P = .509). CONCLUSIONS Obtaining renal grafts from uDCD is feasible in a small city and provides similar outcomes compared to standard DBD donors.
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Affiliation(s)
- Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,School of Medicine, University of Cantabria, Santander, Spain
| | - Emilio Rodrigo
- School of Medicine, University of Cantabria, Santander, Spain.,Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Borja Suberviola
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Rosalía Valero
- Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Alfredo Quintana
- Extrahospitalary Emergency, Gerencia de Atención Primaria-061, Santander, Spain
| | - Félix Campos
- Service of Urology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Juan Carlos Ruiz-San Millán
- School of Medicine, University of Cantabria, Santander, Spain.,Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - María Á Ballesteros
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
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Hurtado P, Herrero S, Valero R, Valencia L, Fàbregas N, Ingelmo I, Badenes R, Iturri F, Carrero E. Postoperative circuits in patients undergoing elective craniotomy. A narrative review. ACTA ACUST UNITED AC 2020; 67:404-415. [PMID: 32561114 DOI: 10.1016/j.redar.2020.04.006] [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: 12/24/2019] [Revised: 03/17/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
In 2017, the Neurosciences section of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy published a national survey on postoperative care and treatment circuits in neurosurgery. The survey showed that practices vary widely, depending on the centre, the anaesthesiologist and the pathology of the patient. There is currently no standard postoperative circuit for cranial neurosurgical procedures in Spanish hospitals, and there is sufficient evidence to show that not all patients undergoing elective craniotomy should be routinely admitted to a postsurgical critical care unit. The aim of this study is to perform a narrative review of postoperative circuits in elective craniotomy in order to standardise clinical practice in the light of published studies. For this purpose, we searched MEDLINE (PubMed) to retrieve studies published in the last ten years, up to November 2019, using the keywords neurosurgery and postoperative care, craniotomyand postoperative care.
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Affiliation(s)
- P Hurtado
- Servicio de Anestesiología, Hospital Clínic, Universitat de Barcelona, España
| | - S Herrero
- Área Quirúrgica, Dirección de Enfermería, Hospital Clínic, Universitat de Barcelona, España
| | - R Valero
- Servicio de Anestesiología, Hospital Clínic, Universitat de Barcelona, España
| | - L Valencia
- Servicio de Anestesiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Gran Canaria, España
| | - N Fàbregas
- Servicio de Anestesiología, Hospital Clínic, Universitat de Barcelona, España
| | - I Ingelmo
- Servicio de Anestesiología, Hospital Ramón y Cajal, Madrid, España
| | - R Badenes
- Servicio de Anestesiología, Hospital General de Valencia, España
| | - F Iturri
- Servicio de Anestesiología, Hospital de Cruces, Baracaldo, Bilbao, España
| | - E Carrero
- Servicio de Anestesiología, Hospital Clínic, Universitat de Barcelona, España.
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López AM, Belda I, Bermejo S, Parra L, Áñez C, Borràs R, Sabaté S, Carbonell N, Marco G, Pérez J, Massó E, Soto JM, Boza E, Gil JM, Serra M, Tejedor V, Tejedor A, Roza J, Plaza A, Tena B, Valero R. Recommendations for the evaluation and management of the anticipated and non-anticipated difficult airway of the Societat Catalana d'Anestesiologia, Reanimació i Terapèutica del Dolor, based on the adaptation of clinical practice guidelines and expert consensus. ACTA ACUST UNITED AC 2020; 67:325-342. [PMID: 32471791 DOI: 10.1016/j.redar.2019.11.011] [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: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Abstract
The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines.
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Affiliation(s)
- A M López
- Hospital Clínic de Barcelona, Barcelona, España
| | - I Belda
- Hospital Clínic de Barcelona, Barcelona, España
| | - S Bermejo
- Consorci Mar Parc de Salut de Barcelona, Barcelona, España
| | - L Parra
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - C Áñez
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, España
| | - R Borràs
- Hospital Universitari Dexeus, Barcelona, España
| | - S Sabaté
- Fundació Puigvert (IUNA), Barcelona, España
| | - N Carbonell
- Hospital Universitari Dexeus, Barcelona, España
| | - G Marco
- Hospital Universitari Santa Maria de Lleida, Lleida, España
| | - J Pérez
- Hospital Universitari Parc Taulí, Sabadell, España
| | - E Massó
- Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - J Mª Soto
- Hospital d' Igualada, SEM, Igualada, España
| | - E Boza
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, España
| | - J M Gil
- Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Serra
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - V Tejedor
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - A Tejedor
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - J Roza
- Hospital Universitari de Vic, Vic, España
| | - A Plaza
- Hospital Clínic de Barcelona, Barcelona, España
| | - B Tena
- Hospital Clínic de Barcelona, Barcelona, España
| | - R Valero
- Hospital Clínic de Barcelona, Barcelona, España.
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21
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Valero R, Sawczyn G, Garisto J, Yau R, Kaouk J. Multiquadrant Combined Robotic Radical Prostatectomy And Left Partial Nephrectomy: A Combined procedure by A Single Approach. Actas Urol Esp 2020; 44:119-124. [PMID: 31864774 DOI: 10.1016/j.acuro.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/23/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION To present the first case of a concomitant robotic radical prostatectomy and a left robotic partial nephrectomy performed by a single-port approach using the SP® da Vinci surgical system (Intuitive Surgical, Sunnyvale CA, EE.UU.). PATIENT AND METHODS A 66-year-old male diagnosed with localized prostate cancer and a left kidney renal mass incidentally found on computed tomography (CT) scan during prostate cancer evaluation. Procedures were performed using a single supra-umbilical 3cm incision, plus one additional laparoscopic port, utilizing a standard Gelpoint® (Applied Medical, Rancho Santa Margarita, CA, EE.UU.) and replicating the technique previously described for single-port transperitoneal radical prostatectomy and partial nephrectomy with the use of the SP® robotic platform. RESULTS Total operative time was 256minutes (min) with a console time of 108min for radical prostatectomy, and 101min for the partial nephrectomy respectively, including a warm ischemia time of 26min. Estimated blood loss was 250cc. Blood transfusion was not needed. Final pathology for prostate was adenocarcinoma Gleason 7 (4+3) and for the kidney lesion was renal cell carcinoma. After two months of follow-up, PSA was undetectable and no complications or recurrence were detected. CONCLUSIONS The single-port approach has advantages as easier surgical planning and transition for combined and multi-quadrants surgeries: faster recovery, minimal postoperative pain and need for opioids, and excellent cosmetic outcome. We suggest that combined procedures should be performed only in high volume institutions by surgeons with vast experience in robotic surgery in selected patients.
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García-Orellana M, Valero R, Fàbregas N, de Riva N. Is "normal" arterial blood pressure "optimal" in all patients? Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:53-54. [PMID: 31952812 DOI: 10.1016/j.redar.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | - R Valero
- Consultor Senior. Servicio de Anestesiología. Hospital Clínic de Barcelona
| | - N Fàbregas
- Consultor Senior. Servicio de Anestesiología. Hospital Clínic de Barcelona
| | - N de Riva
- Consultor 1. Servicio de Anestesiología. Hospital Clínic de Barcelona.
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23
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Irure-Ventura J, San Segundo D, Rodrigo E, Merino D, Belmar-Vega L, Ruiz San Millán JC, Valero R, Benito A, López-Hoyos M. High Pretransplant BAFF Levels and B-cell Subset Polarized towards a Memory Phenotype as Predictive Biomarkers for Antibody-Mediated Rejection. Int J Mol Sci 2020; 21:ijms21030779. [PMID: 31991734 PMCID: PMC7037386 DOI: 10.3390/ijms21030779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 01/05/2023] Open
Abstract
Antibody-mediated rejection (AbMR) is one of the leading causes of graft loss in kidney transplantation and B cells play an important role in the development of it. A B-cell activating factor (BAFF) is a cytokine involved in B cell ontogeny. Here, we analyzed whether B cell maturation and the effect of B cell soluble factors, such as BAFF could be involved in AbMR. Serum BAFF levels and B and T cell subpopulations were analyzed 109 kidney transplant patients before transplantation and at 6 and 12 months after kidney transplantation. Pretransplant serum BAFF levels as well as memory B cell subpopulations were significantly higher in those patients who suffered clinical AbMR during the first 12 months after kidney transplantation. Similar results were observed in the prospective analysis of patients with subclinical antibody-mediated rejection detected in the surveillance biopsy performed at 12 months after kidney transplantation. A multivariate analysis confirmed the independent role of BAFF in the development of AbMR, irrespective of other classical variables. Pretransplant serum BAFF levels could be an important non-invasive biomarker for the prediction of the development of AbMR and posttransplant increased serum BAFF levels contribute to AbMR.
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Affiliation(s)
- Juan Irure-Ventura
- Immunology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain; (J.I.-V.); (D.S.S.)
| | - David San Segundo
- Immunology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain; (J.I.-V.); (D.S.S.)
| | - Emilio Rodrigo
- Nephrology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain, (L.B.-V.); (J.C.R.S.M.); (R.V.)
| | - David Merino
- Health Research Institute-IDIVAL, 39011 Santander, Spain; (D.M.); (A.B.)
| | - Lara Belmar-Vega
- Nephrology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain, (L.B.-V.); (J.C.R.S.M.); (R.V.)
| | - Juan Carlos Ruiz San Millán
- Nephrology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain, (L.B.-V.); (J.C.R.S.M.); (R.V.)
| | - Rosalía Valero
- Nephrology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain, (L.B.-V.); (J.C.R.S.M.); (R.V.)
| | - Adalberto Benito
- Health Research Institute-IDIVAL, 39011 Santander, Spain; (D.M.); (A.B.)
| | - Marcos López-Hoyos
- Immunology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain; (J.I.-V.); (D.S.S.)
- Correspondence: (M.L.-H.); Tel.: +34-942-202520 (ext. 73225)
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Iturri F, Valencia L, Honorato C, Martínez A, Valero R, Fàbregas N. Narrative review of acute post-craniotomy pain. Concept and strategies for prevention and treatment of pain. ACTA ACUST UNITED AC 2019; 67:90-98. [PMID: 31761317 DOI: 10.1016/j.redar.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/17/2019] [Revised: 08/05/2019] [Accepted: 09/02/2019] [Indexed: 01/03/2023]
Abstract
The aim of this narrative review is to confirm that acute pain after craniotomy is frequent and presents with moderate to severe intensity. We also highlight the importance of not only treating post-craniotomy pain, but also of preventing it in order to reduce the incidence of chronic pain. Physicians should be aware that conventional postoperative analgesics (non-steroidal anti-inflammatory, paracetamol, cyclooxygenase inhibitors 2, opioids) are not the only options available. Performing a scalp block prior to surgical incision or after surgery, the use of intraoperative dexmedetomidine, and the perioperative administration of pregabalin are just some alternatives that are gaining ground. The management of post-craniotomy pain should be based on perioperative multimodal analgesia in the framework of an "enhaced recovery after surgery" (ERAS) approach.
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Affiliation(s)
- F Iturri
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Cruces, Barakaldo, España
| | - L Valencia
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, España.
| | - C Honorato
- Servicio de Anestesiología y Reanimación, Clínica Universitaria de Navarra, Pamplona, España
| | - A Martínez
- Servicio de Anestesiología y Reanimación, Clínica Universitaria de Navarra, Pamplona, España
| | - R Valero
- Servicio de Anestesiología y Reanimación, Hospital Clinic, Barcelona, España
| | - N Fàbregas
- Servicio de Anestesiología y Reanimación, Hospital Clinic, Barcelona, España
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25
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Alegret N, Serra P, Pessas JP, Curià X, Vidal J, Valero R. Anesthetic management of the diaphragmatic pacemaker placement surgery. Our experience in the Institut Guttmann. ACTA ACUST UNITED AC 2019; 66:497-505. [PMID: 31759615 DOI: 10.1016/j.redar.2019.10.005] [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: 05/02/2019] [Revised: 08/06/2019] [Accepted: 10/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diaphragm pacemaker (DP) has proven its utility in replacing mechanical ventilation in patients with chronic spinal cord injury (SCI) and amyotrophic lateral sclerosis (ALS). The DP improves patient quality of life and reduces morbidity and mortality and their associated health care costs. The anesthetic management of these patients and the particularities of the surgical procedure are challenging. The aim of our study is to analyze anesthetic management and intraoperative complications in patients undergoing DP placement in our hospital. METHODS We performed a chart review of patients treated between December 2007 and July 2017, recording the patients' preoperative status, anesthetic management and intraoperative complications. RESULTS The study included 16 patients (5 pediatric) undergoing DP implantation for chronic SCI (63%), ALS (25%) and other neurologic conditions (12%). Abdominal laparoscopy was performed under general anesthesia, with intravenous (87%) or inhalational (13%) induction and maintenance using total intravenous (50%) or balanced (50%) anesthesia. Rocuronium was administered in one case to permit airway management. Complications included: hypotension (50%), difficulties in mechanical ventilation during laparoscopy (31%), pneumothorax (12.5%) and autonomic dysreflexia (6%). CONCLUSIONS DP placement under general anesthesia is a safe intervention in both adult and pediatric patients. Complications derived from both the underlying disease and the surgical technique may appear, and must be rapidly identified and treated to obtain a satisfactory surgical outcome.
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Affiliation(s)
- N Alegret
- Servicio de Anestesiología y Reanimación, Institut Guttmann, Badalona, Barcelona, España.
| | - P Serra
- Servicio de Anestesiología y Reanimación, Institut Guttmann, Badalona, Barcelona, España
| | - J P Pessas
- Servicio de Anestesiología y Reanimación, Institut Guttmann, Badalona, Barcelona, España
| | - X Curià
- Medicina Interna, Institut Guttmann, Badalona, Barcelona, España
| | - J Vidal
- Unidad Lesionados Medulares, Institut Guttmann, Badalona, Barcelona, España
| | - R Valero
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
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Belhassen M, Van Ganse E, Ginoux M, Nolin M, Bada H, Bruckert E, Krempf M, Rebours V, Valero R, Moulin P. Identification Of Medical Complications And Real-Life Care Of Familial And Multifactorial Chylomicronaemia Syndromes: The Esthym Study. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pérez-Sáez MJ, Lafuente Covarrubias O, Hernández D, Moreso F, Melilli E, Juega J, de Sousa E, López-Sánchez P, Rodríguez-Ferrero ML, Maruri-Kareaga N, Navarro MD, Valero R, Mazuecos MA, Llamas F, Martín-Moreno P, Fernández-García A, Espí J, Jiménez C, Ramos A, Gavela E, Pascual J, Portolés JM. Early outcomes of kidney transplantation from elderly donors after circulatory death (GEODAS study). BMC Nephrol 2019; 20:233. [PMID: 31242927 PMCID: PMC6593497 DOI: 10.1186/s12882-019-1412-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/06/2019] [Indexed: 01/20/2023] Open
Abstract
Background Spain has dramatically increased the number of controlled circulatory death donors (cDCD). The initial selection criteria for considering cDCD for kidney transplantation (KT) have been expanded progressively, with practically no limits in donor age during the last years. We aimed to analyze the early clinical outcomes using expanded (> 65 years) cDCD in comparison with standard ones. Methods Observational multicenter study including 19 transplant centers in Spain. We performed a systematic inclusion in a central database of every KT from expanded cDCD at each participant unit from January-2012 to January-2017. Surgical procedures and immunosuppressive protocols were based on local practices. Data was analyzed in the central office using logistic and Cox regression or competitive-risk models for multivariate analysis. Median time of follow-up was 18.1 months. Results 561 KT were performed with kidneys from cDCD, 135 from donors older than 65 years. As expected, recipients from older cDCD were also older (65.8 (SD 8.8) vs 53.7 (SD 11.4) years; p < 0.001) and with higher comorbidity. At 1 year, no differences were found amongst older and younger cDCD KT recipients in terms of serum creatinine (1.6 (SD 0.7) vs 1.5 (SD 0.8) mg/dl; p = 0.29). Non-death censored graft survival was inferior, but death-censored graft survival was not different (95.5 vs 98.2% respectively; p = 0.481). They also presented a trend towards higher delayed graft function (55.4 vs 46.7%; p = 0.09) but a similar rate of primary non-function (3.7 vs 3.1%; p = 0.71), and acute rejection (3.0 vs 6.3%; p = 0.135). In the multivariate analysis, in short follow-up, donor age was not related with worse survival or poor kidney function (eGFR < 30 ml/min). Conclusions The use of kidneys from expanded cDCD is increasing for older and comorbid patients. Short-term graft outcomes are similar for expanded and standard cDCD, so they constitute a good-enough source of kidneys to improve the options of KT wait-listed patients.
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Affiliation(s)
- María José Pérez-Sáez
- Nephrology Department and Kidney Transplantation Program, Hospital del Mar, Parc de Salut Mar, Universitat Autónoma Barcelona and Universitat Pompeu Fabra, Nephropaties Research Group Institute Mar for Medical Research, Passeig Maritim 25-29, 08003, Barcelona, Spain
| | - Omar Lafuente Covarrubias
- Nephrology & Transplant Department, University Hospital Puerta de Hierro, Universidad Autónoma Madrid, Public Research Net RedInRen ISCIII 016/009, C/Manuel de Falla s/n, 28222, Majadahonda, Madrid, Spain
| | | | | | | | | | | | - Paula López-Sánchez
- Nephrology & Transplant Department, University Hospital Puerta de Hierro, Universidad Autónoma Madrid, Public Research Net RedInRen ISCIII 016/009, C/Manuel de Falla s/n, 28222, Majadahonda, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Julio Pascual
- Nephrology Department and Kidney Transplantation Program, Hospital del Mar, Parc de Salut Mar, Universitat Autónoma Barcelona and Universitat Pompeu Fabra, Nephropaties Research Group Institute Mar for Medical Research, Passeig Maritim 25-29, 08003, Barcelona, Spain.
| | - Jose M Portolés
- Nephrology & Transplant Department, University Hospital Puerta de Hierro, Universidad Autónoma Madrid, Public Research Net RedInRen ISCIII 016/009, C/Manuel de Falla s/n, 28222, Majadahonda, Madrid, Spain.
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Belhassen M, Van Ganse E, Nolin M, Bruckert E, Krempf M, Rebours V, Valero R, Moulin P. Complications et prise en charge en soins courants des sujets présentant une hypertriglycéridémie majeure : appariement d’un observatoire avec la base du SNDS (étude ESTHYM). Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Werner M, López-Rueda A, Zarco F, Blasco J, San Román L, Amaro S, Carrero E, Valero R, Oleaga L, Macho J, Bargalló N. Value of Posterior circulation ASPECTS and Pons-Midbrain Index on non-contrast CT and CT Angiography Source Images in patients with basilar artery occlusion recanalized after mechanical thrombectomy. Radiología (English Edition) 2019. [DOI: 10.1016/j.rxeng.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Arlaban M, Barreda P, Ballesteros M, Rodrigo E, Suberviola B, Valero R, Miñambres E, Ruiz-San Millán J. Static Cold Storage vs Ex Vivo Machine Perfusion: Results From a Comparative Study on Renal Transplant Outcome in a Controlled Donation After Circulatory Death Program. Transplant Proc 2019; 51:311-313. [DOI: 10.1016/j.transproceed.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/29/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
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Valero R, Sanchez-Fructuoso A, Rodrigo E, Belmar L, Cos MA, Perez-Flores I, Delgado J, San Millan JCR. Variability of the Mammalian Target of Rapamycin Inhibitors Is Correlated With Long-Term Renal Graft Survival. Transplant Proc 2018; 51:341-343. [PMID: 30879537 DOI: 10.1016/j.transproceed.2018.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Many studies demonstrate the relationship between the high intrapatient variability of calcineurin inhibitor (CNI) levels and poor long-term renal graft outcome. Our objective is to analyze the intrapatient variability observed in the mammalian target of rapamycin inhibitors (mTOR-i) blood levels, to compare the variability of sirolimus (SRL) with that of everolimus (EVL) in kidney transplant patients converted to an mTOR-i, and to analyze whether the coefficient of variation (CV) was correlated with long-term graft survival. METHODS We analyzed 279 adult renal transplant patients converted to an mTOR-i. CV was calculated using at least 3 blood trough levels between 3 and 18 months postconversion. RESULTS The mean and median CV of the entire group was 25.54% and 23.7%, respectively. SRL and EVL mean CV was 23.8% and 27.1% (P = .03), respectively. The group of patients into the last tertile with CV> 28.52% presented a lower death-censored graft survival (75.26% vs. 93.01%, P < .0001) with a mean follow-up of 66.5 months. CONCLUSION The CV of mTOR-i is correlated with long-term renal graft survival, so it should be considered a prognostic factor. SRL has a lower CV than EVL in renal transplant patients converted to mTOR-i in the stable posttransplant phase.
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Affiliation(s)
- R Valero
- Nephrology Department, Valdecilla University Hospital, Santander, Spain.
| | - A Sanchez-Fructuoso
- Nephrology Department, Clinico San Carlos University Hospital, Madrid, Spain
| | - E Rodrigo
- Nephrology Department, Valdecilla University Hospital, Santander, Spain
| | - L Belmar
- Nephrology Department, Valdecilla University Hospital, Santander, Spain
| | - M A Cos
- Pharmacology Department, Valdecilla University Hospital, Santander, Spain
| | - I Perez-Flores
- Nephrology Department, Clinico San Carlos University Hospital, Madrid, Spain
| | - J Delgado
- Nephrology Department, Clinico San Carlos University Hospital, Madrid, Spain
| | - J C R San Millan
- Nephrology Department, Valdecilla University Hospital, Santander, Spain
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Lobo LM, Masson W, Molinero G, Siniawski D, Huerin M, Nogueira JP, Valero R. 52Therapy with cholesteryl ester transfer protein (CETP) inhibitors and diabetes risk. A Meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.52] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L M Lobo
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, CABA, Argentina
| | - W Masson
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, CABA, Argentina
| | - G Molinero
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, CABA, Argentina
| | - D Siniawski
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, CABA, Argentina
| | - M Huerin
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, CABA, Argentina
| | | | - R Valero
- Aix-Marseille University, Department of Nutrition, Metabolic, Marseille, France
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Calabrese A, Nicolay A, Wolff E, Dupont J, Valero R, Beliard S, Maraninchi M. Growth hormone (GH) and triglyceride-rich lipoprotein (TRL) metabolism: Effect of one month of discontinued growth hormone treatment in growth hormone deficient patients. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Romero Kräuchi O, Valencia L, Iturri F, Mariscal Ortega A, López Gómez A, Valero R. National survey on perioperative anaesthetic management in the endovascular treatment of acute ischaemic stroke. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:13-23. [PMID: 28923240 DOI: 10.1016/j.redar.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. MATERIALS AND METHOD A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. RESULTS Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72.9%). Health coverage for AIS endovascular treatment was available 24hours a day in 63% of the hospitals. The anaesthesiologist in charge of the procedure was physically present in the hospital in 55.3%. There was large inter-hospital variability in non-standard monitoring and type of anaesthesia. The most important criterion for selecting type of anaesthesia was multidisciplinary choice made by the anaesthesiologist, neurologist and neuroradiologist (59.3%). The duration of time from arrival to arterial puncture was 10-15minutes in 59.2%. In 44.4%, systolic blood pressure was maintained between 140-180mmHg, and diastolic blood pressure<105mmHg. Glycaemic levels were taken in 81.5% of hospitals. Intravenous heparinisation was performed during the procedure in 66.7% with different patterns of action. In cases of moderate neurological deterioration with no added complications, 85.2% of the included hospitals awakened and extubated the patients. CONCLUSIONS The wide variability observed in the anaesthetic management and the organization of the endovascular treatment of AIS demonstrates the need to create common guidelines for anaesthesiologists in Spain.
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Affiliation(s)
- O Romero Kräuchi
- Servicio de Anestesiología, Hospital Universitario de Son Espases, Palma de Mallorca, España.
| | - L Valencia
- Servicio de Anestesiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| | - F Iturri
- Servicio de Anestesiología, Hospital Universitario Cruces, Bilbao, Vizcaya, España
| | - A Mariscal Ortega
- Servicio de Anestesiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A López Gómez
- Servicio de Anestesiología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - R Valero
- Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
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Valero R, Carrero E, Fàbregas N, Iturri F, Saiz-Sapena N, Valencia L. National survey on postoperative care and treatment circuits in neurosurgery. Rev Esp Anestesiol Reanim 2017; 64:441-452. [PMID: 28318531 DOI: 10.1016/j.redar.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/18/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country. MATERIAL AND METHODS From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR. RESULTS We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%. CONCLUSIONS There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period.
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Affiliation(s)
- R Valero
- Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
| | - E Carrero
- Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - N Fàbregas
- Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - F Iturri
- Servicio de Anestesiología, Hospital Universitario Cruces, Bilbao, Vizcaya, España
| | - N Saiz-Sapena
- Servicio de Anestesiología, Hospital 9 de Octubre, Valencia, España
| | - L Valencia
- Servicio de Anestesiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
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Portolés J, Perez-Saez MJ, Sanchez-Sobrino B, Hernandez D, Rodriguez-Ferrero ML, Moreso F, Lafuente O, Valero R, Mazuecos MA, Juega J, Alonso A, Jimenez C, Ramos A, Melilli E, Pascual J. SP776EXPANDED CRITERIA DONORS AFTER CARDIAC DEATH: AN INCREASING AND USEFUL SOURCE FOR KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx158.sp776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cabedo N, Valero R, Alcón A, Gomar C. Prevalence and characterization of postoperative pain in the Postanaesthesia Care Unit. ACTA ACUST UNITED AC 2017; 64:375-383. [PMID: 28363327 DOI: 10.1016/j.redar.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/20/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Immediate postoperative pain occurs initially after surgery, while the patient is in the Post-Anaesthesia Recovery Unit. Very few studies assess this pain in this most immediate phase. OBJECTIVE Cross-sectional study of the prevalence and characteristics of immediate postoperative pain in patients after surgery. MATERIAL AND METHODS Between August 2014 and February 2015, a sample of 503 patients from the Post-Anaesthesia Recovery Unit was followed. Immediate postoperative pain was assessed (by the patient and the researcher) using the visual analogue scale (VAS; range 0-10) on 5 occasions after surgery. The impact of numerous factors (age, gender, type of surgery, type of anaesthesia and analgesic) on the pain, as well as variation in vital signs and the presence of side effects, were analysed. RESULTS Assessment of the pain showed overall VAS values of 2.2±2.8 on all occasions. Pain was reported to be of greatest intensity 20min after the patients' arrival in the Post-Anaesthesia Recovery Unit (P<.001). The VAS values reported by the researcher (1.4±2.0) were lower than those reported by the patients. Although there was a very strong correlation (R2=0.82; P<.001) and they followed a parallel distribution, there was moderate concordance (kappa=0.4). Plastic surgery and neurosurgery were the specialties with the highest percentages of VAS values in the strong intensity range (8-10). Patients with regional block techniques (with or without general anaesthesia) had lower VAS values than other general anaesthesia groups. Male patients and older patients displayed less pain than female and young patients, respectively (P<.001). CONCLUSIONS Studying the characteristics of postoperative pain at such an early stage allows for improved management. It helps to predict, according to the type of surgery and the anaesthesia used, those patients in which higher VAS values may be seen and to better adapt analgesic therapy.
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Affiliation(s)
- N Cabedo
- Departament de Cirurgia i Especialitats Quirúrgiques, Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - R Valero
- Departament de Cirurgia i Especialitats Quirúrgiques, Facultat de Medicina, Universitat de Barcelona, Barcelona, España; Departamento de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
| | - A Alcón
- Departamento de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - C Gomar
- Departament de Cirurgia i Especialitats Quirúrgiques, Facultat de Medicina, Universitat de Barcelona, Barcelona, España; Departamento de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
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Targher G, Dauriz M, Laroche C, Temporelli PL, Hassanein M, Seferovic PM, Drozdz J, Ferrari R, Anker S, Coats A, Filippatos G, Crespo‐Leiro MG, Mebazaa A, Piepoli MF, Maggioni AP, Tavazzi L, Crespo‐Leiro M, Anker S, Coats A, Ferrari R, Filippatos G, Maggioni A, Mebazaa A, Piepoli M, Amir O, Chioncel O, Dahlström U, Jimenez JD, Drozdz J, Erglis A, Fazlibegovic E, Fonseca C, Fruhwald F, Gatzov P, Goncalvesova E, Hassanein M, Hradec J, Kavoliuniene A, Lainscak M, Logeart D, Merkely B, Metra M, Otljanska M, Seferovic P, Kostovska ES, Temizhan A, Tousoulis D, Andarala M, Ferreira T, Fiorucci E, Gracia G, Laroche C, Pommier C, Taylor C, Cuculici A, Gaulhofer C, Casado EP, Szymczyk E, Ramani F, Mulak G, Schou IL, Semenka J, Stojkovic J, Mehanna R, Mizarienne V, Auer J, Ablasser K, Fruhwald F, Dolze T, Brandner K, Gstrein S, Poelzl G, Moertl D, Reiter S, Podczeck‐Schweighofer A, Muslibegovic A, Vasilj M, Fazlibegovic E, Cesko M, Zelenika D, Palic B, Pravdic D, Cuk D, Vitlianova K, Katova T, Velikov T, Kurteva T, Gatzov P, Kamenova D, Antova M, Sirakova V, Krejci J, Mikolaskova M, Spinar J, Krupicka J, Malek F, Hegarova M, Lazarova M, Monhart Z, Hassanein M, Sobhy M, El Messiry F, El Shazly A, Elrakshy Y, Youssef A, Moneim A, Noamany M, Reda A, Dayem TA, Farag N, Halawa SI, Hamid MA, Said K, Saleh A, Ebeid H, Hanna R, Aziz R, Louis O, Enen M, Ibrahim B, Nasr G, Elbahry A, Sobhy H, Ashmawy M, Gouda M, Aboleineen W, Bernard Y, Luporsi P, Meneveau N, Pillot M, Morel M, Seronde M, Schiele F, Briand F, Delahaye F, Damy T, Eicher J, Groote P, Fertin M, Lamblin N, Isnard R, Lefol C, Thevenin S, Hagege A, Jondeau G, Logeart D, Le Marcis V, Ly J, Coisne D, Lequeux B, Le Moal V, Mascle S, Lotton P, Behar N, Donal E, Thebault C, Ridard C, Reynaud A, Basquin A, Bauer F, Codjia R, Galinier M, Tourikis P, Stavroula M, Tousoulis D, Stefanadis C, Chrysohoou C, Kotrogiannis I, Matzaraki V, Dimitroula T, Karavidas A, Tsitsinakis G, Kapelios C, Nanas J, Kampouri H, Nana E, Kaldara E, Eugenidou A, Vardas P, Saloustros I, Patrianakos A, Tsaknakis T, Evangelou S, Nikoloulis N, Tziourganou H, Tsaroucha A, Papadopoulou A, Douras A, Polgar L, Merkely B, Kosztin A, Nyolczas N, Nagy AC, Halmosi R, Elber J, Alony I, Shotan A, Fuhrmann AV, Amir O, Romano S, Marcon S, Penco M, Di Mauro M, Lemme E, Carubelli V, Rovetta R, Metra M, Bulgari M, Quinzani F, Lombardi C, Bosi S, Schiavina G, Squeri A, Barbieri A, Di Tano G, Pirelli S, Ferrari R, Fucili A, Passero T, Musio S, Di Biase M, Correale M, Salvemini G, Brognoli S, Zanelli E, Giordano A, Agostoni P, Italiano G, Salvioni E, Copelli S, Modena M, Reggianini L, Valenti C, Olaru A, Bandino S, Deidda M, Mercuro G, Dessalvi CC, Marino P, Di Ruocco M, Sartori C, Piccinino C, Parrinello G, Licata G, Torres D, Giambanco S, Busalacchi S, Arrotti S, Novo S, Inciardi R, Pieri P, Chirco P, Galifi MA, Teresi G, Buccheri D, Minacapelli A, Veniani M, Frisinghelli A, Priori S, Cattaneo S, Opasich C, Gualco A, Pagliaro M, Mancone M, Fedele F, Cinque A, Vellini M, Scarfo I, Romeo F, Ferraiuolo F, Sergi D, Anselmi M, Melandri F, Leci E, Iori E, Bovolo V, Pidello S, Frea S, Bergerone S, Botta M, Canavosio F, Gaita F, Merlo M, Cinquetti M, Sinagra G, Ramani F, Fabris E, Stolfo D, Artico J, Miani D, Fresco C, Daneluzzi C, Proclemer A, Cicoira M, Zanolla L, Marchese G, Torelli F, Vassanelli C, Voronina N, Erglis A, Tamakauskas V, Smalinskas V, Karaliute R, Petraskiene I, Kazakauskaite E, Rumbinaite E, Kavoliuniene A, Vysniauskas V, Brazyte‐Ramanauskiene R, Petraskiene D, Stankala S, Switala P, Juszczyk Z, Sinkiewicz W, Gilewski W, Pietrzak J, Orzel T, Kasztelowicz P, Kardaszewicz P, Lazorko‐Piega M, Gabryel J, Mosakowska K, Bellwon J, Rynkiewicz A, Raczak G, Lewicka E, Dabrowska‐Kugacka A, Bartkowiak R, Sosnowska‐Pasiarska B, Wozakowska‐Kaplon B, Krzeminski A, Zabojszcz M, Mirek‐Bryniarska E, Grzegorzko A, Bury K, Nessler J, Zalewski J, Furman A, Broncel M, Poliwczak A, Bala A, Zycinski P, Rudzinska M, Jankowski L, Kasprzak J, Michalak L, Soska KW, Drozdz J, Huziuk I, Retwinski A, Flis P, Weglarz J, Bodys A, Grajek S, Kaluzna‐Oleksy M, Straburzynska‐Migaj E, Dankowski R, Szymanowska K, Grabia J, Szyszka A, Nowicka A, Samcik M, Wolniewicz L, Baczynska K, Komorowska K, Poprawa I, Komorowska E, Sajnaga D, Zolbach A, Dudzik‐Plocica A, Abdulkarim A, Lauko‐Rachocka A, Kaminski L, Kostka A, Cichy A, Ruszkowski P, Splawski M, Fitas G, Szymczyk A, Serwicka A, Fiega A, Zysko D, Krysiak W, Szabowski S, Skorek E, Pruszczyk P, Bienias P, Ciurzynski M, Welnicki M, Mamcarz A, Folga A, Zielinski T, Rywik T, Leszek P, Sobieszczanska‐Malek M, Piotrowska M, Kozar‐Kaminska K, Komuda K, Wisniewska J, Tarnowska A, Balsam P, Marchel M, Opolski G, Kaplon‐Cieslicka A, Gil R, Mozenska O, Byczkowska K, Gil K, Pawlak A, Michalek A, Krzesinski P, Piotrowicz K, Uzieblo‐Zyczkowska B, Stanczyk A, Skrobowski A, Ponikowski P, Jankowska E, Rozentryt P, Polonski L, Gadula‐Gacek E, Nowalany‐Kozielska E, Kuczaj A, Kalarus Z, Szulik M, Przybylska K, Klys J, Prokop‐Lewicka G, Kleinrok A, Aguiar CT, Ventosa A, Pereira S, Faria R, Chin J, De Jesus I, Santos R, Silva P, Moreno N, Queirós C, Lourenço C, Pereira A, Castro A, Andrade A, Guimaraes TO, Martins S, Placido R, Lima G, Brito D, Francisco A, Cardiga R, Proenca M, Araujo I, Marques F, Fonseca C, Moura B, Leite S, Campelo M, Silva‐Cardoso J, Rodrigues J, Rangel I, Martins E, Correia AS, Peres M, Marta L, Silva GF, Severino D, Durao D, Leao S, Magalhaes P, Moreira I, Cordeiro AF, Ferreira C, Araujo C, Ferreira A, Baptista A, Radoi M, Bicescu G, Vinereanu D, Sinescu C, Macarie C, Popescu R, Daha I, Dan G, Stanescu C, Dan A, Craiu E, Nechita E, Aursulesei V, Christodorescu R, Otasevic P, Seferovic P, Simeunovic D, Ristic A, Celic V, Pavlovic‐Kleut M, Lazic JS, Stojcevski B, Pencic B, Stevanovic A, Andric A, Iric‐Cupic V, Jovic M, Davidovic G, Milanov S, Mitic V, Atanaskovic V, Antic S, Pavlovic M, Stanojevic D, Stoickov V, Ilic S, Ilic MD, Petrovic D, Stojsic S, Kecojevic S, Dodic S, Adic NC, Cankovic M, Stojiljkovic J, Mihajlovic B, Radin A, Radovanovic S, Krotin M, Klabnik A, Goncalvesova E, Pernicky M, Murin J, Kovar F, Kmec J, Semjanova H, Strasek M, Iskra MS, Ravnikar T, Suligoj NC, Komel J, Fras Z, Jug B, Glavic T, Losic R, Bombek M, Krajnc I, Krunic B, Horvat S, Kovac D, Rajtman D, Cencic V, Letonja M, Winkler R, Valentincic M, Melihen‐Bartolic C, Bartolic A, Vrckovnik MP, Kladnik M, Pusnik CS, Marolt A, Klen J, Drnovsek B, Leskovar B, Anguita MF, Page JG, Martinez FS, Andres J, Genis A, Mirabet S, Mendez A, Garcia‐Cosio L, Roig E, Leon V, Gonzalez‐Costello J, Muntane G, Garay A, Alcade‐Martinez V, Fernandez SL, Rivera‐Lopez R, Puga‐Martinez M, Fernandez‐Alvarez M, Serrano‐Martinez J, Crespo‐Leiro M, Grille‐Cancela Z, Marzoa‐Rivas R, Blanco‐Canosa P, Paniagua‐Martin M, Barge‐Caballero E, Cerdena IL, Baldomero IFH, Padron AL, Rosillo SO, Gonzalez‐Gallarza RD, Montanes OS, Manjavacas AI, Conde AC, Araujo A, Soria T, Garcia‐Pavia P, Gomez‐Bueno M, Cobo‐Marcos M, Alonso‐Pulpon L, Cubero JS, Sayago I, Gonzalez‐Segovia A, Briceno A, Subias PE, Hernandez MV, Cano MR, Sanchez MG, Jimenez JD, Garrido‐Lestache EB, Pinilla JG, Villa BG, Sahuquillo A, Marques RB, Calvo FT, Perez‐Martinez M, Gracia‐Rodenas M, Garrido‐Bravo IP, Pastor‐Perez F, Pascual‐Figal D, Molina BD, Orus J, Gonzalo FE, Bertomeu V, Valero R, Martinez‐Abellan R, Quiles J, Rodrigez‐Ortega J, Mateo I, ElAmrani A, Fernandez‐Vivancos C, Valero DB, Almenar‐Bonet L, Sanchez‐Lazaro I, Marques‐Sule E, Facila‐Rubio L, Perez‐Silvestre J, Garcia‐Gonzalez P, Ridocci‐Soriano F, Garcia‐Escriva D, Pellicer‐Cabo A, Fuente Galan L, Diaz JL, Platero AR, Arias J, Blasco‐Peiro T, Julve MS, Sanchez‐Insa E, Aured‐Guallar C, Portoles‐Ocampo A, Melin M, Hägglund E, Stenberg A, Lindahl I, Asserlund B, Olsson L, Dahlström U, Afzelius M, Karlström P, Tengvall L, Wiklund P, Olsson B, Kalayci S, Temizhan A, Cavusoglu Y, Gencer E, Yilmaz M, Gunes H. In‐hospital and 1‐year mortality associated with diabetes in patients with acute heart failure: results from the
ESC‐HFA
Heart Failure Long‐Term Registry. Eur J Heart Fail 2016; 19:54-65. [DOI: 10.1002/ejhf.679] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Cécile Laroche
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
| | | | | | | | | | - Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research E.S: Health Science Foundation Cotignola Italy
| | - Stephan Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Andrew Coats
- Monash University Australia and University of Warwick Coventry UK
| | | | - Maria G. Crespo‐Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna CHUAC La Coruna Spain
| | - Alexandre Mebazaa
- Inserm 942, Hôpital Lariboisière Université Paris Diderot Paris France
| | - Massimo F. Piepoli
- Department of Cardiology Polichirurgico Hospital G. da Saliceto Piacenza Italy
| | - Aldo Pietro Maggioni
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
- ANMCO Research Center Florence Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research E.S. Health Science Foundation Cotignola Italy
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Togo AH, Valero R, Delerce J, Raoult D, Million M. "Anaerotruncus massiliensis," a new species identified from human stool from an obese patient after bariatric surgery. New Microbes New Infect 2016; 14:56-57. [PMID: 27699051 PMCID: PMC5035336 DOI: 10.1016/j.nmni.2016.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022] Open
Abstract
We report the main characteristics of a new bacterial species strain AT3T (CSUR = P2007, DSM = 100567) that was isolated from the stool sample collected from a 47-year-old obese French man after he underwent bariatric surgery.
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Affiliation(s)
- A H Togo
- Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de médecine, France
| | - R Valero
- Aix Marseille Université, NORT "Nutrition, Obesity and Risk of Thrombosis," Inserm 1062, INRA1260, France; APHM, CHU Hôpital de la Conception, Service Nutrition, Maladies Métaboliques et Endocrinologie, Marseille, France
| | - J Delerce
- Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de médecine, France
| | - D Raoult
- Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de médecine, France; Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M Million
- Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de médecine, France
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40
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Vázquez-Alonso E, Iturri Clavero F, Valencia Sola L, Fábregas N, Ingelmo Ingelmo I, Valero R, Cassinello C, Rama-Maceiras P, Jorques A. Clinical practice guideline on thromboprophylaxis and management of anticoagulant and antiplatelet drugs in neurosurgical and neurocritical patients. Rev Esp Anestesiol Reanim 2016; 63:406-418. [PMID: 26965554 DOI: 10.1016/j.redar.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Affiliation(s)
- E Vázquez-Alonso
- Servicio de Anestesiología, Complejo Hospitalario Universitario Granada, Granada, España.
| | - F Iturri Clavero
- Servicio de Anestesiología, Hospital Universitario Cruces, , Bilbao, Vizcaya, España
| | - L Valencia Sola
- Servicio de Anestesiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| | - N Fábregas
- Servicio de Anestesiología, Hospital Clinic, Universitat de Barcelona, Barcelona, España
| | - I Ingelmo Ingelmo
- Servicio de Anestesiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Valero
- Servicio de Anestesiología, Hospital Clinic, Universitat de Barcelona, Barcelona, España
| | - C Cassinello
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - P Rama-Maceiras
- Servicio de Anestesiología, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, España
| | - A Jorques
- Servicio de Neurocirugía, Complejo Hospitalario Universitario Granada, Granada, España
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41
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Togo AH, Khelaifia S, Valero R, Cadoret F, Raoult D, Million M. 'Negativicoccus massiliensis', a new species identified from human stool from an obese patient after bariatric surgery. New Microbes New Infect 2016; 13:43-4. [PMID: 27408741 PMCID: PMC4930332 DOI: 10.1016/j.nmni.2016.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 12/01/2022] Open
Abstract
We report here the main characteristics of ‘Negativicoccus massiliensis’ strain AT7 (CSURP = P2082, DSM = 100853) isolated from a stool sample collected from a 47-year-old obese French man before bariatric surgery.
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Affiliation(s)
- A H Togo
- Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de médecine, Marseille, France
| | - S Khelaifia
- Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de médecine, Marseille, France
| | - R Valero
- Aix Marseille Université, NORT 'Nutrition, Obesity and Risk of Thrombosis', INSERM1062, INRA1260, Marseille, France; APHM, CHU Hôpital de la Conception, Service Nutrition, Maladies Métaboliques et Endocrinologie, Marseille, France
| | - F Cadoret
- Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de médecine, Marseille, France
| | - D Raoult
- Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de médecine, Marseille, France; Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M Million
- Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de médecine, Marseille, France
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López AM, Muñoz-Rojas G, Fontanals M, de San José I, Hermoso A, Valero R. Clinical evaluation of the Baska Mask laryngeal mask in adult patients in ambulatory surgery. ACTA ACUST UNITED AC 2015; 62:551-6. [PMID: 25698608 DOI: 10.1016/j.redar.2015.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 07/20/2014] [Revised: 01/02/2015] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the clinical performance of the Baska Mask, a new second-generation supraglottic airway device with a self-inflating cuff and two side suction channels for continuous aspiration. MATERIAL AND METHODS Eighty adult patients without difficult airways were prospectively included. Ease of insertion and number of attempts needed, quality of ventilation, airway seal pressure, fibreoptic view, ease of gastric access, and complications were assessed. Sizes 3, 4, 5 were analyzed and compared. RESULTS First attempt insertion success rate was 88% and the overall rate was 100%, although additional maneuvers were necessary in 44% of the cases. The ventilation was adequate in 96%, with 39% of them requiring adjusting maneuvers. Size 3 needed significantly less adjustments, and achieved a higher seal pressure than sizes 4 and 5 combined. The airway seal pressure was 33 ± 7 cm H2O. Complete or partial vocal cords were visible in 90% of the 66 cases assessed. Partial obstruction, caused by distortion of the cuff-free border, was seen in 5%, and no glottic structures were identified in 5%. Gastric access was easy in all cases. Complications were mild and transient. CONCLUSIONS The Baska Mask achieves a high seal pressure, effective ventilation, and a quick access to drain gastric contents. However, additional adjustment maneuvers are frequently required to insert the mask and to optimize ventilation.
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Affiliation(s)
- A M López
- Servicio de Anestesiología, Hospital Clínico, Barcelona, España.
| | - G Muñoz-Rojas
- Servicio de Anestesiología, Hospital Clínico, Barcelona, España
| | - M Fontanals
- Servicio de Anestesiología, Hospital Clínico, Barcelona, España
| | - I de San José
- DUE, Unidad de Cirugía Mayor Ambulatoria, Hospital Clínico, Barcelona, España
| | - A Hermoso
- DUE, Unidad de Cirugía Mayor Ambulatoria, Hospital Clínico, Barcelona, España
| | - R Valero
- Servicio de Anestesiología, Hospital Clínico, Barcelona, España
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Gárate J, Sánchez-Salas R, Valero R, Matheus R, León A, Dávila H. Pentafecta outcomes after robot-assisted laparoscopic radical prostatectomy: first 100 cases in Latinoamerican Hospital. Actas Urol Esp 2015; 39:20-5. [PMID: 24974068 DOI: 10.1016/j.acuro.2013.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 08/23/2013] [Revised: 11/10/2013] [Accepted: 12/01/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Radical prostatectomy (RP) is the standard treatment for cancer control in the long term. The rise of minimally invasive surgery and new technologies have yielded better results and enabled us to pursue more ambitious objectives. The main works still use the trifecta as classic presentation, but this does not cover all aspects of surgery. Pentafecta is a new and more comprehensive methodology to report outcomes after RP, including complications and surgical margin status with the three major outcomes classically reported. The purpose of this study is to report our experience with robot-assisted laparoscopic radical prostatectomy (RALRP) by applying the concept of pentafecta. MATERIAL AND METHOD Describe the experience in this institution from March 2009 to December 2012 of RALRP by pentafecta. RESULTS We performed 101 interventions and obtained the following results: Average age 60.89 ± 7.32 years (40-77), total PSA 8.5 ± 5.57 ng/dl (0.2-29); D'Amico classification: Low 29 (28.71%), Medium 65 (64.36%), High 7 (6.93%); Operative time 253.44 ± 51.51 min (90-540), Complications 12.9% (Clavien I-II 10.89% and Clavien IIIa 1.98%); Positive surgical margins 20.83%; Biochemistry recurrence 12.5% follow-up (6-44 months); and Continence 87.5% per year and Potency 59.52%. CONCLUSIONS RALRP is a safe and reproducible procedure with excellent results in terms of pentafecta, inclusive during the initial experience at a low volumen center for prostate cancer. A longer follow-up study and experience with higher volume of patients are required to obtain better results and data to be compared with excellence centers.
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Affiliation(s)
- J Gárate
- Unidad de Cirugía Robótica, Servicio de Urología, Hospital Universitario de Caracas, Caracas, Venezuela.
| | - R Sánchez-Salas
- Unidad de Cirugía Robótica, Servicio de Urología, Hospital Universitario de Caracas, Caracas, Venezuela
| | - R Valero
- Unidad de Cirugía Robótica, Servicio de Urología, Hospital Universitario de Caracas, Caracas, Venezuela
| | - R Matheus
- Unidad de Cirugía Robótica, Servicio de Urología, Hospital Universitario de Caracas, Caracas, Venezuela
| | - A León
- Unidad de Cirugía Robótica, Servicio de Urología, Hospital Universitario de Caracas, Caracas, Venezuela
| | - H Dávila
- Unidad de Cirugía Robótica, Servicio de Urología, Hospital Universitario de Caracas, Caracas, Venezuela
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Pardoi Camps F, García Carrión C, Beneit Montesinos J, Lázaro Martínez. J, Gomez F, Valero R, Chana P. Efficacy of a platelet-rich plasma treatment in subjects with plantar fasciosis. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Valero R, Atín M, Ballestero R, Martin P, Gomez F, Gómez S, Chana P. Effectiveness of exercise to reduce falls and injuries in elderly people. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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López AM, Valero R, López S, Zaballos M, García ML. LMA Supreme: new design or a pig in a poke? Rev Esp Anestesiol Reanim 2013; 60:597-598. [PMID: 24199913 DOI: 10.1016/j.redar.2013.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 06/26/2013] [Indexed: 06/02/2023]
Affiliation(s)
- A M López
- Servicio de Anestesiología, Hospital Clínic Barcelona, Spain.
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Valero R, Varela E, Küçükdeveci AA, Oral A, Ilieva E, Berteanu M, Christodoulou N. Spinal pain management. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med 2013; 49:715-725. [PMID: 24145230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the PRM interventions. The aim of this paper is to describe the role of PRM physicians in the management of spinal pain focusing particularly on low back pain and neck pain. These disorders are associated with significant disability that results in activity limitations and participation restrictions. A wide variety of PRM interventions including patient education, behavioural therapies, exercise, a number of physical modalities, manual techniques, and multidisciplinary rehabilitation may help patients with low back pain and cervical pain in improving their functioning. PRM physicians may address many of the problems encountered by these patients in many life areas taking the International Classification of Functioning, Disability and Health as a reference guide and may have an important role in improving the quality of their lives.
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Affiliation(s)
- R Valero
- Member, Board Committee, UEMS Board of PRM, Departamento de Medicina Física y Rehabilitacion, Facultad de Medicina UCM Ciudad Universitaria, Madrid, Spain -
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Varela E, Oral A, Ilieva E, Küçükdeveci AA, Valero R, Berteanu M, Christodoulou N. Musculoskeletal perioperative problems. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med 2013; 49:753-759. [PMID: 24145233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the physical and rehabilitation medicine interventions. According to the UEMS-PRM section, the role of PRM physician in musculoskeletal perioperative settings has to be situated inside general pain management. Musculoskeletal surgery (MSS) represents a frequent medical situation among patients suffering from musculoskeletal disorders (MSDs), in which PRM physicians need to be involved. A wide number of MSDs have to be operated in order to diminish disability and relieve symptoms, thus improving the patient´s functioning and social participation: Joint replacements, spine decompressions, vertebroplasties, internal fixation of unstable fractures, arthroscopies for tendon and joint repairs, and others. This paper describes the role of the PRM physician during the perioperative period. A well-coordinated rehabilitation programme followed by a good home rehabilitation programme results in pain reduction, faster recovery with better patient participation and increased cost effectiveness. PRM physicians have to identify patients at risk of continuing activity limitation and participation restriction who will benefit from an early rehabilitation process and formulate a PRM programme of care taking into account each patient's environmental factors.
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Affiliation(s)
- E Varela
- Member, Professional Practice Committee, UEMS Section of PRM, Departamento de Medicina Física y Rehabilitación, Facultad de Medicina UCM, Ciudad Universitaria, Madrid, Spain -
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Oral A, Ilieva EM, Küçükdeveci AA, Varela E, Valero R, Berteanu M, Christodoulou N. Local soft tissue musculoskeletal disorders and injuries. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med 2013; 49:727-742. [PMID: 24145231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of PRM interventions. Soft tissue musculoskeletal disorders (MSDs) and injuries are associated with significant pain and loss of function that may lead to significant disability. The aim of this paper is to define the role of PRM physician in the management of local soft tissue MSDs and injuries with their specific focus on assessing and improving function as well as participation in the community. The training of PRM specialists make them well equipped to successfully treat MSDs including soft tissue MSDs and injuries. PRM specialists may well meet the needs of patients with soft tissue MSDs and injuries using PRM approaches including 1) assessment based on the comprehensive model of functioning, the International Classification of Functioning, Disability and Health (ICF), that enable them to identify the areas of impaired functioning in order to apply necessary measures; 2) accurate diagnosis using instrumental diagnostic procedures in addition to clinical examination; 3) outcome measurements available to them; 4) evidence-based pharmacological and nonpharmacological treatments; and finally 5) maintenance of social involvement including "return to work" based on restoration of function, all of which will eventually result in improved quality of life for patients with soft tissue MSDs and injuries.
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Affiliation(s)
- A Oral
- Member, Board Committee, UEMS Board of PRM, Department of Physical Medicine and RehabilitationIstanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey -
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Varela E, Valero R, Küçükdeveci AA, Oral A, Ilieva E, Berteanu M, Christodoulou N. Shoulder pain management. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med 2013; 49:743-751. [PMID: 24145232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of the physical and rehabilitation medicine interventions. According to the PCC of the UEMS-PRM Section, the role of PRM physician in the management of shoulder pain (SP) has to be situated inside the general pain management field. SP is a common condition that can place limitations on the activity and restriction in social life participation of sufferers. A variety of shoulder problems, commonly including subacromial impingement, calcifying tendinitis, frozen shoulder, acromio-clavicular disturbances, gleno-humeral instability and gleno-humeral arthritis, can cause pain, and patients should be assessed and treated in order to relieve symptoms and reduce disability. This position paper describes the role of the PRM specialist in the management of such patients. Many assessment methods and treatment interventions are usually used in the management of patients with SP. Depending on the process, disability and patient characteristics, some intervention modalities have reported evidence in pain relief, movement and daily life activity (DLA) restoration, thus permiting a patient early recovery and social participation. Oral medications, local injections, physical therapy modalities and exercises are normally used for the management of SP. The PRM specialist should, always use this best medical evidence to decide how to efficiently and effectively reduce SP-related disability. An adequate therapeutic algorithm is also proposed in order to channelize the above mentioned evidence and reach the best results.
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Affiliation(s)
- E Varela
- Member, Professional Practice Committee, UEMS Section of PRM, Departamento de Medicina Física y Rehabilitación, Facultad de Medicina UCM, Ciudad Universitaria, Madrid, Spain -
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