Resumen Actualmente el trasplante de corazón es la mejor opción terapéutica para aumentar la esperanza y la calidad de vida en los pacientes con insuficiencia cardíaca terminal refractaria al ...tratamiento convencional. La escasez de donantes es un problema difícil y pendiente de resolver, y constituye el principal factor limitante en el incremento de las cifras de trasplante. En la actual situación de estancamiento y disparidad entre el número de donantes de órganos potenciales, donantes reales y las necesidades clínicas de implantación se requieren estrategias efectivas para reducir esta diferencia y para mantener las mejores posibilidades de éxito en el pronóstico de los receptores. Estas estrategias deben ir dirigidas hacia una óptima selección del donante, así como hacia un incremento del número de potenciales donantes mediante la ampliación de los criterios de aceptación de éstos y hacia una mejora en el aprovechamiento de los donantes subóptimos. Además, debemos lograr un mantenimiento fisiológico adecuado del órgano. Todo este tipo de actuaciones, junto con la estandarización de tratamientos futuros (tratamiento hormonal de reemplazamiento o valoración genómica), nos tiene que llevar, sin duda, a un aumento en las cifras de transplantes a corto y a medio plazo, ya que la opción del transplante cardíaco sigue teniendo escasa repercusión en el gran alto grado de prevalencia de la insuficiencia cardíaca terminal en nuestro medio.
Generally, the need for information about varicella-zoster virus (VVZ) infection in cardiac transplantation (CT) is greater than that for other organ transplants. All cases of VVZ infection among the ...175 CT patients included herpes zoster as the clinical syndrome in all 11 cases (men, 90.9%; mean age, 50.3 ± 5 years; incidence, 6.3%). The infection was limited to one dermatome in seven patients (63.6%: thoracic, 6%; ophthalmic, 1), or two contiguous dermatomes in four patients (36.4%). The infection onset was after the first semester in seven patients (63.6%). All patients received three drug immunosuppressive therapy. Cardiac rejection during the three previous months occurred in one patient (3A grade). Previous CMV disease was observed in three patients (27.3%: range, 7–14 months). Intravenous acyclovir was administered to five patients (ophthalmic and several dermatome forms), and oral therapy for the rest. All the patients recovered; there were no complications or postherpetic neuralgia (mean follow-up: 16.5 months). VVZ infection, a frequent late infection among CT recipients, presents as a clinical syndrome of herpes zoster, frequently in patients with previous CMV infection. In CT, herpes zoster frequently affects two dermatomes, but the clinical courses and responses to treatment are favorable. There was no postherpetic neuralgia.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Severe pulmonary hypertension with no response to vasodilators on an acute hemodynamic study is a contraindication to cardiac transplantation. The development of oral pulmonary vasodilators improves ...the prognosis in these patients. We present the case of a patient whose admission to the waiting list for cardiac transplantation was possible after 6 months of combination therapy with Sildenafil and Bosentan.
The patient was a 50-year-old man with severe dilated alcohol-induced cardiomyopathy. A pretransplantation study, including a right hemodynamic analysis, revealed irreversible pulmonary hypertension, with 59 mm Hg mean pulmonary artery pressure and 6.4 Wood IU pulmonary vascular resistance, with no response to acute vasodilators with nitric oxide or prostacyclin. Initially, heart transplantation was not possible and the patient started treatment with oral Sildenafil. After 6 months there was no improvement in echocardiographic or hemodynamic parameters, and combination therapy with Bosentan was started. With the combination therapy, the patient progressively improved clinically and hemodynamically, the pressures becoming normal at the sixth month, at which time he was included on the waiting list for a heart transplantation. Eight months later he received a graft with a good posttransplantation course, no right ventricular failure in the acute phase, and absence of pulmonary hypertension on echocardiogrphic and invasive studies.
Combinations of an oral pulmonary vasodilator with diverse action mechanisms may represent an alternative for patients with irreversible pulmonary hypertension who do not respond to monotherapy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
El objetivo fue identificar los factores que ocasionan bajos resultados de explotación en el sistema de producción de alpacas del departamento de Huancavelica, en función del componente estructural, ...realizando un muestreo aleatorio estratificado con afijación proporcional. Se visitó 224 unidades productivas con alpacas (UPA) de más de 100 cabezas, analizando 40 variables, encontrando una dimensión media de 133,3 ha y 143,8 cabezas. El empadre es estacional de enero a marzo (37%) y continuo todo el año (63%), sin registros reproductivos idóneos (70%). La hembra entra al primer empadre a los 22,6 meses en que su peso promedio bordea los 40 kg dentro de una relación de 11,3 hembras/macho, con alimentación a base de pastos naturales (100%) mediante pastoreo continuo (96%) y diferido (4%). La carga animal es 0,8 UA/ha/año (p>0,05). El descarte de machos y hembras se realiza a los 8,8±1,0 años (p≤0,05) y 7,9±0,7 años (p≤0,05), respectivamente. El tratamiento en salud animal se realiza en el 97% de las UPA, frente a una tasa de natalidad del 57,3±2,7 % y peso al nacimiento 7,8±1,0 kg; tasa de mortalidad de 5,6% en adultos y de 33,6% en crías. Los factores que ocasionan bajos resultados de explotación son: infraestructura inadecuada, instalaciones de manejo deficientes, ineficaz planificación de la reproducción, suplementación deficiente e ineficientes programas en salud animal.
Heart transplantation is contraindicated in patients with acute irreversible pulmonary hypertension (PH), but new drugs are opening up therapeutic possibilities. Sildenafil citrate is a nonselective ...pulmonary vasodilator that is being used in our hospital to treat several patients with PH and which has allowed the inclusion of 1 patient on the waiting list for heart transplantation. A 20-year-old man with Becker muscular dystrophy was diagnosed at the age of 19 years with dilated cardiomyopathy with severe pulmonary artery systolic pressure (PH = 60 mm Hg). A pretransplantation study, including a right hemodynamic analysis with an acute vasodilator test using intravenous epoprostenol, revealed the irreversible character of the PH. Inasmuch as the administration of dobutamine did not achieve an adequate reduction of PH, oral sildenafil was started (25 mg every 12 hours) as salvage therapy. An echocardiogram obtained 2 months after starting sildenafil therapy showed normal right cavities, previously dilated, as well as minimal protosystolic tricuspid regurgitation without PH. A new right hemodynamic study performed after 4 months showed a reduction in pulmonary vascular resistance, from 8 U to 3.5 U Woods. As a result, the patient has now been included on the waiting list for heart transplantation. The promising example of this patient confirms the necessity to carry out controlled trials to establish definitively the indications for the use of sildenafil in patients with irreversible PH.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objective: For many neurodevelopmental disorders, the presumption is of some deviation from typical brain development in one or more functional systems. With many disorders (e.g., ADHD, LD), no hard ...evidence of neurological difference (MRI, CT Scan, EEC) exists. The purpose of this study was to compare the performance of children with identified ...
Heart transplantation is currently the best treatment option to improve hope and quality of life in patients with terminal heart failure that is refractory to conventional treatment. The scarcity of ...donors remains a difficult problem and is the main factor limiting the number of transplants that can be performed. Given the current situation of stagnation and disparity between the number of potential organ donors, actual donors, and patients requiring transplants, we need effective strategies to reduce the differences between supply and demand and to ensure the best possible prognosis in organ recipients. These strategies should aim to ensure optimal donor selection. Likewise, it is essential to increase the number of potential donors by widening the criteria for donation and to improve our ability to take advantage of suboptimal donors. Moreover, we need to achieve acceptable physiological maintenance of donated organs. All these actions, together with the standardization of future treatments like hormone replacement therapy and genomic evaluation, will undoubtedly lead to an increase in the rate of transplants in the short and mid term, because the option of heart transplantation continues to have only slight repercussions in the high prevalence of terminal heart failure in our environment.
Sirolimus is a potent, nonnephrotoxic immunosuppressant with antiproliferative activity in nonimmune cells. Recent data support the conversion in late renal failure secondary to calcineurin ...inhibitors (CNIs), with limited experience in de novo regimens in patients with predictive factors of postoperative renal impairment.
We evaluated our experience of sirolimus-based immunosuppression administered to 25 heart transplant recipients.
A retrospective analysis of 25 heart transplant recipients who received sirolimus included 17 conversions due to late CNI-related chronic renal dysfunction, six patients with a de novo regimen, and two patients who developed posttransplant pulmonary neoplasms. The conversion from CNI to sirolimus was started with 2 mg, with an average time after transplantation of 78 ± 43 months and a mean baseline serum creatinine level of 2.1 ± 0.45 mg/dL. The mean clinical follow-up was 17 ± 9 months postconversion, and included echocardiography and laboratory studies. In the de novo group successive endomyocardial biopsies were performed during the first semester.
Serum creatinine fell from 2.1 ± 0.45 mg/dL to 1.8 ± 0.51 mg/dL (
P = .012). Mean sirolimus levels were 15 ± 9 ng/mL (doses 2.2 ± 0.4 mg). This improvement continued until 3 months (creatinine 1.5 ± 0.35
P < .01)/sirolimus levels 11.7 ± 5 ng/mL 1.9 ± 0.7 mg), with maintenance at 6 months (1.58 ± 0.3 mg/dL/14 ± 4 ng/mL 1.85 ± 0.7 mg) and 1-year postconversion (1.53 ± 0.39 mg/dL;
P = .019/10.7 ± 2.5 ng/mL 1.5 ± 0.7 mg). De novo, after a mean follow-up of 13 months (range 3 to 35), sirolimus appeared to increase the incidence of a moderate histological grade of rejection without hemodynamic compromise. Side effects were common (63%), including peripheral edema, skin eruptions, and pericardial effusion. Only one patient discontinued treatment, due to intestinal intolerance. Four patients died during follow-up: two because of lung neoplasms and two because of progressive graft vessel disease.
Sirolimus improved late CNI-related chronic renal dysfunction. Kidney function was preserved using a de novo CNI-free immunosuppressive regimen for recent cardiac transplant recipients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The field of drug delivery focuses primarily on delivering small organic molecules or DNA/RNA as therapeutics and has largely ignored the potential for delivering catalytically active transition ...metal ions and complexes. The delivery of a variety of transition metals has potential for inducing apoptosis in targeted cells. The chief aims of this work were the development of a suitable delivery vector for a prototypical transition metal, Cu
2+
, and demonstration of the ability to impact cancer cell viability via exposure to such a Cu-loaded vector. Carboxylate-functionalized nanoparticles were synthesized by free radical polymerization and were subsequently loaded with Cu
2+
via binding to particle-bound carboxylate functional groups. Cu loading and release were characterized via ICP MS, EDX, XPS, and elemental analysis. Results demonstrated that Cu could be loaded in high weight percent (up to 16 wt.%) and that Cu was released from the particles in a pH-dependent manner. Metal release was a function of both pH and the presence of competing ligands. The toxicity of the particles was measured in HeLa cells where reductions in cell viability greater than 95% were observed at high Cu loading. The combined pH sensitivity and significant toxicity make this copper delivery vector an excellent candidate for the targeted killing of disease cells when combined with an effective cellular targeting strategy.
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