Previous studies showed that a combination of posttransplant total lymphoid irradiation (TLI), rabbit antithymocyte globulin (ATG), and a single donor blood transfusion induced tolerance to ACI heart ...allografts in Lewis rats. All three modalities were required to achieve tolerance. The objective of the current study was to determine the subset(s) of cells in the donor blood that facilitated long-term allograft survival.
Lewis hosts received TLI, ATG, and donor cell infusion after heart transplantation. Graft survival, mixed leukocyte reaction (MLR), and intragraft cytokine mRNA were studied.
The intravenous injection of 25 x 10(6) ACI peripheral blood mononuclear cells (PBMC) significantly prolonged graft survival as compared with that of Lewis hosts given TLI and ATG alone. Injection of highly enriched blood T cells or splenic B cells adjusted for the number contained in 25 x 10(6) PBMC failed to induce significant graft prolongation. Unexpectedly, depletion of monocytes (CD11b+ cells) from PBMC resulted in the loss of graft prolongation activity. Enriched populations of monocytes obtained by plastic adherence were more efficient in prolonging graft survival than PBMC on a per cell basis. Hosts with long-term grafts (>100-day survival) showed evidence of immune deviation, because the MLR to ACI stimulator cells was vigorous, but secretion of interferon-gamma in the MLR was markedly reduced. In situ hybridization studies of long-term grafts showed markedly reduced levels of interferon-gamma mRNA as compared with rejecting grafts.
Infusion of donor monocytes facilitated graft prolongation via immune deviation.
de hemodiálisis se producen muchas interferencias en la comunicación ya que simultáneamente atendemos a otros pacientes y se presentan complicaciones que tendremos que resolver de forma inmediata. ...Mediante la consulta de enfermería se pretende evitar esto, y darle el valor y tiempo que tienen las intervenciones enfermeras que son parte del tratamiento. Debemos asegurar que el paciente recibe instrucciones terapéuticas correctamente escritas, revisarlas y verificarlas con él para poder hacer un ajuste de niveles de comprensión, además de motivarlo y corresponsabilizarlo para lograr la adquisición de conductas implicadas en su autocuidado.
Objetivo: Evaluar el efecto de la consulta de enfermería al paciente renal en hemodiálisis sobre el cumplimiento terapéutico.
Material y Método: Estudio observacional longitudinal prospectivo de cohorte. Muestra de 42 pacientes en programa de hemodiálisis desde enero a junio 2014. Los pacientes seleccionados para la consulta son aquellos para los que la investigadora del estudio es enfermera referente y colaboradora (Grupo A). Se recogen datos de las diferentes variables revisando las historias clínicas y mediante la entrevista con el paciente y cuidador principal.
Resultados: Encontramos diferencias significativas al comparar las variables estudiadas entre el Grupo A y Grupo B (resto pacientes) en cuanto al fósforo y cumplimiento farmacológico, pero no se encontraron en cuanto al potasio aunque la tendencia es a mejorar los niveles.
Conclusiones: La consulta de enfermería mejora la adherencia terapéutica en dieta y medicación, relacionándose con un mayor tiempo de dedicación al tratamiento y mayor contacto con el cuidador principal.
We searched for clonalbe committed T cell progenitors in the adult mouse bone marrow and isolated rare (==0.05%) cells with the Thy-1hiCD2-CD16+CD44hiCD25-Lin- phenotype. In vivo experiments showed ...that these cells were progenitors committed only to reconstitutin the T cell lineage of irradiated Ly5 congenic hosts.
To assess the impact of blood cultures negative infective endocarditis (BCNIE) on in-hospital mortality.
Prospective multicentre study with retrospective analysis of a Spanish cohort including adult ...patients with definite IE. Cardiac implantable devices infection were excluded. Comparisons between blood cultures positive and BCNIE groups were performed to analyse in-hospital mortality.
1001 cases were included of which 83 (8.3%) had BCNIE. Alternative microbiological diagnosis was achieved for 39 (47%) out 83 cases. The most frequent identifications were: Coxiella burnetii (11; 28.2%), Tropheryma whipplei (4; 10.3%), Streptococcus gallolyticus (4;10.3%) and Staphylococcus epidermidis (3; 7.7%). Surgery was performed more frequently in BCNIE group (57.8 vs. 36.9%, p < .001). All-cause in-hospital mortality rate was 26.7% without statistical difference between compared groups. BCNIE was not associated to worse mortality rate in Cox regression model (aHR = 1.37, 95% CI 0.90-2.07, p = .14). Absence of microbiological diagnosis was also not associated to worse in-hospital prognosis (aHR = 1.62, 95% CI 0.99-2.64, p = .06).
In our cohort, BCNIE was not associated to greater in-hospital mortality based in multivariate Cox regression models. The variables most frequently associated with mortality were indicated but not performed surgery (aHR = 2.48, 95% CI 1.73-3.56, p < .001), septic shock (aHR = 2.24, 95% CI 1.68-2.99, p < .001), age over 65 years (aHR = 1.88, 95% CI 1.40-2.52, p < .001) and complicated endocarditis (aHR = 1.79, 95% CI 1.36-2.37, p < .001).
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
The prevalence of hepatitis C virus infection (HCV) in patients with inflammatory bowel disease (IBD) ranges from 1–6%. Direct-acting antivirals (DAAs), with cure rates >90%, ...represent a radical change from interferon-based therapies. The ECCO guidelines (Kucharzik JCC 2021) warns about the risk of IBD reactivation due to the effect of DAAs, but HCV management in this situation is uncertain given the lack of evidence. AIMS: To evaluate: 1) Effectiveness and safety of DAAs in IBD; 2) Interaction of DAAs with IBD drugs, particularly immunosuppressants and/or biologics.
Methods
Multicenter retrospective study of patients with IBD and HCV treated with DAAs identified on the ENEIDA registry (January 2011-February 2021). Variables evaluated: age, gender, location, extent, phenotype and activity of IBD, treatments, anti-HCV and viral load, DAA treatment and duration, fibrosis and hepatic decompensations, adverse effects (AE) and interactions.
Results
We included 79 patients with IBD and HCV treated with DAAs (47 sofosbuvir, 28 ledipasvir, 7 daclatasvir, 8 velpatasvir, 1 simeprevir, 16 paritaprevir+ritonavir+ombitasvir, 14 dasabuvir, 3 grazoprevir+elbasvir, 13 glecaprevir+pibrentasvir). Clinical and demographic characteristics: mean age (years) 54+/-12.66SD; 62% male, 77.2% genotype 1, 32.6% advanced fibrosis (none Child B-C). A 78.5% (n=62) received IBD treatment (39 salicylates, 20 azathioprine, 1 methotrexate, 4 corticosteroids, 10 antiTNF, 2 vedolizumab, 2 ustekinumab, 1 apheresis). A 17.7% (n=14) had active IBD (64.3% remained unchanged, 21.4% improved and 14.3% worsened) and 82.3% (n=65) were inactive at the onset of ADD. Of these, 9.2% (n=6) developed mild-moderate activity (4 mild and 2 moderate). In 85% (n=67) no treatment changes were made, in 9% (n=7) it was intensified and in 6% (n=5) it was de-intensified. Adherence to DAAs and sustained virologic response was obtained in 96.2% (n=76). A total of 7 (8.9%) AE were notified, of which 5 were possibly/probably related to DAAs (100% mild) and 2 were unrelated (1 azathioprine withdrawal due to pancytopenia). The AE were unrelated with the presence of inflammatory activity, type of IBD, liver fibrosis, use of immunosuppressants, biologics, or with any DAA regimen.
Conclusion
This is the first reported series of IBD patients infected with HCV and treated with DAAs, we showed that DAA are effective and safe. They do not trigger IBD flare-ups, nor have more AE than in patients without IBD. Moreover, they do not have clinically significant pharmacological interactions with immunosuppressants and/or biologics. Thus, the eradication of HCV with DAA in IBD patients must be the same of the HCV infected patients without IBD, based on EASL recommendations.
Resumen: En los últimos años se ha constatado un aumento de la demanda asistencial en los servicios de salud mental y, por tanto, un aumento de interconsultas que se reciben desde atención primaria, ...siendo necesario filtrar dichas derivaciones para poder llevar a cabo una atención adecuada. El principal objetivo de este estudio es la evaluación del modelo de derivación del Servicio de Salud Mental del Departamento del Arnau de Vila-nova-Llíria mediante un análisis descriptivo y el seguimiento a lo largo de 6 meses de las interconsultas derivadas desde atención primaria y rechazadas por salud mental en el año 2019. Durante esos meses se recibieron 2029 interconsultas, de las cuales 623 fueron rechazadas, correspondiéndose estas a 504 pacientes. De estas personas, 164 fueron finalmente citadas en salud mental tras realizar una nueva interconsulta. Este análisis pone de manifiesto la necesidad de implementar un modelo colaborativo entre atención primaria y salud mental que se traduzca en una mayor detección de casos, una mejor derivación y, en definitiva, una mejor atención a los y las pacientes.
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