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Early acute kidney rejection remains an important clinical issue. METHODS: The current study included 552 recipients who had 1-2 surveillance or indication biopsy within the 1 y posttransplant. We evaluated the impact of type of allograft inflammation on allograft outcome. They were divided into 5 groups: no inflammation (NI: 95), subclinical inflammation (SCI: 244), subclinical T cell-mediated rejection (TCMR) (SC-TCMR: 110), clinical TCMR (C-TCMR: 83), and antibody-mediated rejection (AMR: 20). Estimated glomerular filtration rate (eGFR) over time using linear mixed model, cumulative chronic allograft scores/interstitial fibrosis and tubular atrophy (IFTA) ≥2 at 12 mo, and survival estimates were compared between groups. RESULTS: The common types of rejections were C-TCMR (15%), SC-TCMR (19.9%), and AMR (3.6%) of patients. Eighteen of 20 patients with AMR had mixed rejection with TCMR. Key findings were as follows: (i) posttransplant renal function: eGFR was lower for patients with C-TCMR and AMR (P < 0.0001) compared with NI, SCI, and SC-TCMR groups. There was an increase in delta-creatinine from 3 to 12 mo and cumulative allograft chronicity scores at 12 mo (P < 0.001) according to the type of allograft inflammation. (ii) Allograft histology: the odds of IFTA ≥2 was higher for SC-TCMR (3.7 [1.3-10.4]; P = 0.04) but was not significant for C-TCMR (3.1 [1.0-9.4]; P = 0.26), and AMR (2.5 [0.5-12.8]; P = 0.84) compared with NI group, and (iii) graft loss: C-TCMR accounted for the largest number of graft losses and impending graft losses on long-term follow-up. Graft loss among patient with AMR was numerically higher but was not statistically significant. CONCLUSIONS: The type of kidney allograft inflammation predicted posttransplant eGFR, cumulative chronic allograft score/IFTA ≥2 at 12 mo, and graft loss.
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INTRODUCTION: Chronic kidney disease (CKD) is an emerging public health priority in Central America. However, data on the prevalence of CKD in Guatemala, Central America's most populous country, are limited, especially for rural communities. METHODS: We conducted a population-representative survey of 2 rural agricultural municipalities in Guatemala. We collected anthropometric data, blood pressure, serum and urine creatinine, glycosylated hemoglobin, and urine albumin. Sociodemographic, health, and exposure data were self-reported. RESULTS: We enrolled 807 individuals (63% of all eligible, 35% male, mean age 39.5 years). An estimated 4.0% (95% confidence interval [CI] 2.4-6.6) had CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m2. Most individuals with an eGFR below 60 ml/min per 1.73 m2 had diabetes or hypertension. In multivariable analysis, the important factors associated with risk for an eGFR less than 60 ml/min per 1.73 m2 included a history of diabetes or hypertension (adjusted odds ratio [aOR] 11.21; 95% CI 3.28-38.24), underweight (body mass index [BMI] <18.5) (aOR 21.09; 95% CI 2.05-217.0), and an interaction between sugar cane agriculture and poverty (aOR 1.10; 95% CI 1.01-1.19). CONCLUSIONS: In this population-based survey, most observed CKD was associated with diabetes and hypertension. These results emphasize the urgent public health need to address the emerging epidemic of diabetes, hypertension, and CKD in rural Guatemala. In addition, the association between CKD and sugar cane in individuals living in poverty provides some circumstantial evidence for existence of CKD of unknown etiology in the study communities, which requires further investigation.
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BACKGROUND: Population-representative household survey methods require up-to-date sampling frames and sample designs that minimize time and cost of fieldwork especially in low- and middle-income countries. Traditional methods such as multi-stage cluster sampling, random-walk, or spatial sampling can be cumbersome, costly or inaccurate, leading to well-known biases. However, a new tool, Epicentre's Geo-Sampler program, allows simple random sampling of structures, which can eliminate some of these biases. We describe the study design process, experiences and lessons learned using Geo-Sampler for selection of a population representative sample for a kidney disease survey in two sites in Guatemala. RESULTS: We successfully used Epicentre's Geo-sampler tool to sample 650 structures in two semi-urban Guatemalan communities. Overall, 82% of sampled structures were residential and could be approached for recruitment. Sample selection could be conducted by one person after 30 min of training. The process from sample selection to creating field maps took approximately 40 h. CONCLUSION: In combination with our design protocols, the Epicentre Geo-Sampler tool provided a feasible, rapid and lower-cost alternative to select a representative population sample for a prevalence survey in our semi-urban Guatemalan setting. The tool may work less well in settings with heavy arboreal cover or densely populated urban settings with multiple living units per structure. Similarly, while the method is an efficient step forward for including non-traditional living arrangements (people residing permanently or temporarily in businesses, religious institutions or other structures), it does not account for some of the most marginalized and vulnerable people in a population-the unhoused, street dwellers or people living in vehicles.
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Composición Familiar , Sistemas de Información Geográfica , Estudios de Factibilidad , Guatemala/epidemiología , Encuestas Epidemiológicas , Humanos , Población Rural , MuestreoRESUMEN
The aim of the study is to provide a comprehensive overview of identical twin kidney transplantation in the modern era. We provide epidemiologic trends in the US twin population from 1959 to 2000, current methods to identify zygosity, outcomes for identical twin transplants, and a comprehensive management strategy for identical twin kidney transplantation. By 2019, we project that 433 010 dizygotic and monozygotic twins will be alive and at risk for developing ESRF. Monozygosity between a donor-recipient pair can be confirmed by concordance in sex, blood type, and HLA antigen match with precision testing using 13/17 Short Tandem Repeat sequencing to a likelihood of nearly 100%. Among identical twin transplants from 2001 to 2017, excellent patient and kidney graft survival rates were noted. Approximately 50% of kidney transplant recipients of identical twins transplant did not receive maintenance immunosuppression, and no differences in graft survival were noted among patients with and without immunosuppression at 6 and 12 months (P = .8 and .7). Patients with glomerulonephritis as the cause of ESRF had lower graft survival (P = .06) suggesting that recurrent glomerulonephritis as a likely cause of graft loss among these recipients.
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Fallo Renal Crónico , Trasplante de Riñón , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/epidemiología , Rechazo de Injerto/etiología , Supervivencia de Injerto , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Donadores Vivos , Gemelos MonocigóticosRESUMEN
Identifying promoters of cerebral small vein integrity is important to counter vascular contributions to cognitive impairment and dementia. PURPOSE: In this preliminary investigation, the effects of a randomized 24-month physical activity (PA) intervention on changes in cerebral small vein integrity were compared to those of a health education (HE) control. METHODS: Cerebral small vein integrity was measured in 24 older adults (n = 8, PA; n = 16, HE) using ultra-high field MRI before and at the end of the 24-month intervention. Deep medullary veins were defined as straight or tortuous; percent change in straight length, tortuous length, and tortuosity ratio were computed. Microbleed count and white matter hyperintensities were also rated. RESULTS: Accelerometry-based values of PA increased by 17.2% in the PA group but declined by 28.0% in the HE group. The PA group, but not the HE group, had a significant increase in straight vein length from baseline to 24-month follow-up (P = 0.02 and P = 0.21, respectively); the between-group difference in percent change in straight length was significant (increase: median, 93.6%; interquartile range, 112.9 for PA; median, 28.4%; interquartile range, 90.6 for HE; P = 0.07). Between group differences in other markers were nonsignificant. CONCLUSIONS: Increasing PA in late-life may promote cerebral small vein integrity. This should be confirmed in larger studies.
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Venas Cerebrales/fisiología , Ejercicio Físico/fisiología , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/fisiopatología , Venas Cerebrales/diagnóstico por imagen , Venas Cerebrales/patología , Circulación Cerebrovascular , Disfunción Cognitiva/patología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/prevención & control , Demencia/patología , Demencia/fisiopatología , Demencia/prevención & control , Femenino , Educación en Salud , Humanos , Angiografía por Resonancia Magnética , Masculino , Sustancia Blanca/irrigación sanguínea , Sustancia Blanca/diagnóstico por imagenRESUMEN
BACKGROUND: We investigated the effect of clinical and subclinical T cell-mediated rejection (C-TCMR and SC-TCMR) on allograft histology, function, and progression. METHODS: Adult kidney recipients with 2 protocol biopsies were divided into No-TCMR on biopsies (n = 104), SC-TCMR (n = 56), and C-TCMR (n = 32) in at least 1 biopsy. Chronicity (ci + ct + cg + cv) scores, renal function, and the burden of renal disease measured by area under the curve (serum creatinine, mg mo/dL) were compared. RESULTS: Baseline characteristics were similar except for mean donor age and Kidney Donor Profile index scores. Patients with C-TCMR had higher mean serum creatinine, lower mean estimated glomerular filtration rate, and higher area under the curve with 95% confidence interval (75.2 [67.7-82.7]) as opposed to patients with SC-TCMR and No-TCMR (58.3 [53.6-62.9], 65.1 [58.8-71.5]), P = 0.0004. Chronicity scores were higher at 3 months in C-TCMR (2.30 ± 1.58) compared with SC-TCMR (2.02 ± 1.42) and No-TCMR (1.31 ± 1.18), P = 0.0001 and also at 12 months. At last follow-up, 18.8% patients with C-TCMR had ≥50% decline in estimated glomerular filtration rate from 3 months compared with 7% and 1% among No-TCMR and SC-TCMR groups (P = 0.038). Multivariate analyses revealed higher odds of Δ-creatinine ≥ 0.5 mg/dL from 3 months to last follow-up for C-TCMR (3.39 [95% confidence interval, 1.25-9.20]) versus No-TCMR (P = 0.016). CONCLUSIONS: Kidney transplant recipients with C-/SC-TCMR have heightened early allograft chronicity and worse renal function compared with those with No-TCMR. Progressive renal dysfunction was noted among patients with C-TCMR as opposed to SC-TCMR and No-TCMR.
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Rechazo de Injerto/inmunología , Inmunidad Celular , Enfermedades Renales/inmunología , Trasplante de Riñón/efectos adversos , Riñón/inmunología , Linfocitos T/inmunología , Adulto , Biopsia , Creatinina/sangre , Progresión de la Enfermedad , Femenino , Tasa de Filtración Glomerular , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/fisiopatología , Humanos , Riñón/patología , Riñón/fisiopatología , Enfermedades Renales/diagnóstico , Enfermedades Renales/fisiopatología , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Transducción de Señal , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: The rate of urinary tract infection (UTI) after pelvic reconstructive surgery ranges from 9 to 48% and the most common uropathogen is Escherichia coli (E. coli). The aim of the study is to identify the predominant uro-pathogen from urine cultures in women undergoing pelvic reconstructive surgery. METHODS: A retrospective review was conducted on women who underwent pelvic reconstructive surgery at a tertiary care center from July 2013 to June 2015. Data was collected from each postoperative visit to evaluate urinary tract symptoms, culture results and treatment in the 3-month postoperative interval. RESULTS: There were 880 cases reviewed (mean age of 59.6 years) during the study period. The most common organism in positive cultures was E. coli after surgery. The total UTI rate was 11.3%. Patients discharged with a Foley catheter had a UTI rate of 65.6% (p = 0.003). Diabetes, neurologic disease, tobacco use, recurrent UTIs and breast or gynecologic cancers had no significant association with UTI after surgery. CONCLUSION: The most common organism identified is E. coli. Almost 12% of patients will develop a UTI after pelvic reconstructive surgery. The results of this study can influence management of lower urinary tract symptoms in the postoperative period.
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BACKGROUND: In mass vaccination campaigns, large volumes of data must be managed efficiently and accurately. In a reactive oral cholera vaccination (OCV) campaign in rural Haiti during an ongoing epidemic, we used a mobile health (mHealth) system to manage data on 50,000 participants in two isolated communities. METHODS: Data were collected using 7-inch tablets. Teams pre-registered and distributed vaccine cards with unique barcodes to vaccine-eligible residents during a census in February 2012. First stored on devices, data were uploaded nightly via Wi-fi to a web-hosted database. During the vaccination campaign between April and June 2012, residents presented their cards at vaccination posts and their barcodes were scanned. Vaccinee data from the census were pre-loaded on tablets to autopopulate the electronic form. Nightly analysis of the day's community coverage informed the following day's vaccination strategy. We generated case-finding reports allowing us to identify those who had not yet been vaccinated. RESULTS: During 40 days of vaccination, we collected approximately 1.9 million pieces of data. A total of 45,417 people received at least one OCV dose; of those, 90.8% were documented to have received 2 doses. Though mHealth required up-front financial investment and training, it reduced the need for paper registries and manual data entry, which would have been costly, time-consuming, and is known to increase error. Using Global Positioning System coordinates, we mapped vaccine posts, population size, and vaccine coverage to understand the reach of the campaign. The hardware and software were usable by high school-educated staff. CONCLUSION: The use of mHealth technology in an OCV campaign in rural Haiti allowed timely creation of an electronic registry with population-level census data, and a targeted vaccination strategy in a dispersed rural population receiving a two-dose vaccine regimen. The use of mHealth should be strongly considered in mass vaccination campaigns in future initiatives.
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Vacunas contra el Cólera/administración & dosificación , Cólera/epidemiología , Cólera/prevención & control , Telemedicina/organización & administración , Vacunación/métodos , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Cólera/inmunología , Femenino , Haití/epidemiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Población Rural , Adulto JovenRESUMEN
BACKGROUND: Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4-6 weeks postpartum in our community. SUBJECTS AND METHODS: Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4-6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from "1" (exclusive formula feeding) to "5" (exclusive breastfeeding) characterized feeding practices. Paired-sample t tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4-6 weeks. RESULTS: We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6±1.2 to 2.9±1.4; p<0.05) and then decreased by 4-6 weeks (2.9±1.4 to 2.5±1.44; p<0.05), without significant change between WBN and 4-6 weeks. Higher levels of education [ß=0.21 (0.08, 0.56)], breastfeeding a previous child for ≥6 months [ß=0.35 (0.57, 1.8)], foreign birth [ß=0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [ß=0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio=1.18 (1.05, 1.32)]. CONCLUSIONS: Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.
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Alimentación con Biberón , Lactancia Materna , Conducta de Elección , Hispánicos o Latinos , Madres , Adolescente , Adulto , Alimentación con Biberón/etnología , Alimentación con Biberón/psicología , Lactancia Materna/etnología , Lactancia Materna/psicología , Conducta Alimentaria , Femenino , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Recién Nacido , Madres/psicología , Ciudad de Nueva York/epidemiología , Pobreza , Embarazo , Autoeficacia , Encuestas y CuestionariosRESUMEN
Understanding the factors that influence health beliefs, attitudes, and service use among Haitians in the United States is increasingly important for this growing population. We undertook a qualitative analysis to explore the factors related to cancer screening and utilization of health services among Haitians in Boston. Key informant interviews (n=42) and nine focus groups (n=78) revealed that Haitians experience unique barriers to health services. These include language barriers, unfamiliarity with preventive care, confidentiality concerns, mistrust and stigma concerning Western medicine, and a preference for natural remedies. Results suggest that many Haitians could benefit from health system navigation assistance, and highlight the need for comprehensive, rather than disease-focused programs, to decrease stigma and increase programmatic reach. Faith-based organizations, social service agencies, and Haitian media were identified as promising channels for disseminating health information. Leveraging positive cultural traditions and existing communication networks could increase the impact of Haitian health initiatives.
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Actitud Frente a la Salud/etnología , Atención a la Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención a la Salud/etnología , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Grupos Focales , Haití/etnología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto JovenRESUMEN
In nine patients in anaerobic septic shock, five of them with hepatic injury compatible with sepsis liver failure, hematic chloramphenicol concentration was determined at 5 minutes, 1, 2, 3 and 6 hours after intravenous administration of the first of three daily dose (50 mg/k/day); in the hepatic failure group the procedure was repeated with the next dose, previous attempt of haemodynamic compensation with two hours dopamine (3-10 mcg/k/min.) infusion. Starting from experimental data computation adjustment of time-concentration curve and lineal regression with a p = 0.0001 adjustment was done, determining half live (HL), distribution volume (DV), constant of elimination (K) and clearance (CL). In septic shock without hepatic injury patient group, there was noticed a uniform behavior in time-concentration graphic, withdrawn from chloramphenicol bone-marrow depression levels and pharmacokinetics parameters quite near the normal ones, with a reasonable extension of (DV). When attempting hepatic injury patient group, though an individual variability, drug concentration reach bone marrow depression levels and there was a significant lowering of Cl (p = 0.001) and a reasonable one of DV. Dopamine haemodynamic compensation attempt results in an increase of chloramphenicol hematic concentration in the sepsis liver group and the pharmacokinetics levels bear new deterioration. Practical meaning of the methodology used in drug handling in severe hepatic failure is stressed, to allow mathematic valuation of different pathogenic compounds. Though each patient should be individually evaluated, in septic shock without liver injury chloramphenicol dosification should not been any changes but in presence of sepsis liver doses should be diminished to half and administration interval extended to 11.5 hours.
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Cloranfenicol/metabolismo , Hígado/metabolismo , Choque Séptico/metabolismo , Humanos , Cinética , Análisis de RegresiónRESUMEN
En nueve pacientes en shock séptico por anaerobios, cinco de ellos con diverso grado de fallo hepático (hígado de sepsis), se determinó concentración hemática de cloramfenicol a 5 minutos, 1, 2, 3 y 6 horas de inyección IV de la primeira de 3 dosis diarias correspondientes a 50 mg/k/día; en el grupo con comp5romiso hepático se repitió el procedimiento con la siguiente dosis, previa infusión de dos horas con dopaminas 3- 10 mcg/k/minuto, como intento de compensación hemodinámica. A partir de los datos experimentales se realizó el ajuste por computación de la curva concentración-tiempo y la regresión lineal con un ajuste p=0.001, determinándose vida media (VM), volumen de distribución (Vd), constante de eliminación (K) y clearance (CI). En el grupo shock séptico sin compromiso hepático se observó comportamiento uniformes, con concentraciones alejadas de niveles tóxico-medulares, y parámetros farmacocinéticos sensiblemente cercanos a los normales, con moderada prolongación de Vm. Ante el fallo hepático, aunque con variabilidad individual, las concentraciones alcanzan niveles tóxico-medulares (25 mcg/ml), destacándose un descenso estadísticamente significativo del CI promedio (p=0.001), con moderado descenso del Vd respecto a normales. Ante el intento de compensación hemodinámica con dopamina, vuelven a incrementarse concentraciones de cloramfenicol en el grupo con hígado de sepsis sufriendo nuevos deterioros Vm, Vd y CI promedios, aunque también com comportamiento no-uniforme. Se enfatiza en la significación práctica de esta metodología en el manejo de drogas en la insuficiencia hepática severa, lo que permitirá valorar matemáticamente diversos componentes patogénicos. Se concluye, que si bien cada paciente debiera ser individualmente evaluado, la dosificación de cloramfenicol no debe sufrir modificaciones en shock séptico sin fallo hepático, mientras que ante esta eventualidad, la dosis debiera disminuirse a la mitad, prolongándose el intervalo al doble apróximadamente
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Humanos , Cloranfenicol/metabolismo , Choque Séptico/metabolismo , Hígado/metabolismo , CinéticaRESUMEN
In nine patients in anaerobic septic shock, five of them with hepatic injury compatible with sepsis liver failure, hematic chloramphenicol concentration was determined at 5 minutes, 1, 2, 3 and 6 hours after intravenous administration of the first of three daily dose (50 mg/k/day); in the hepatic failure group the procedure was repeated with the next dose, previous attempt of haemodynamic compensation with two hours dopamine (3-10 mcg/k/min.) infusion. Starting from experimental data computation adjustment of time-concentration curve and lineal regression with a p = 0.0001 adjustment was done, determining half live (HL), distribution volume (DV), constant of elimination (K) and clearance (CL). In septic shock without hepatic injury patient group, there was noticed a uniform behavior in time-concentration graphic, withdrawn from chloramphenicol bone-marrow depression levels and pharmacokinetics parameters quite near the normal ones, with a reasonable extension of (DV). When attempting hepatic injury patient group, though an individual variability, drug concentration reach bone marrow depression levels and there was a significant lowering of Cl (p = 0.001) and a reasonable one of DV. Dopamine haemodynamic compensation attempt results in an increase of chloramphenicol hematic concentration in the sepsis liver group and the pharmacokinetics levels bear new deterioration. Practical meaning of the methodology used in drug handling in severe hepatic failure is stressed, to allow mathematic valuation of different pathogenic compounds. Though each patient should be individually evaluated, in septic shock without liver injury chloramphenicol dosification should not been any changes but in presence of sepsis liver doses should be diminished to half and administration interval extended to 11.5 hours.
RESUMEN
En nueve pacientes en shock séptico por anaerobios, cinco de ellos con diverso grado de fallo hepático (hígado de sepsis), se determinó concentración hemática de cloramfenicol a 5 minutos, 1, 2, 3 y 6 horas de inyección IV de la primeira de 3 dosis diarias correspondientes a 50 mg/k/día; en el grupo con comp5romiso hepático se repitió el procedimiento con la siguiente dosis, previa infusión de dos horas con dopaminas 3- 10 mcg/k/minuto, como intento de compensación hemodinámica. A partir de los datos experimentales se realizó el ajuste por computación de la curva concentración-tiempo y la regresión lineal con un ajuste p=0.001, determinándose vida media (VM), volumen de distribución (Vd), constante de eliminación (K) y clearance (CI). En el grupo shock séptico sin compromiso hepático se observó comportamiento uniformes, con concentraciones alejadas de niveles tóxico-medulares, y parámetros farmacocinéticos sensiblemente cercanos a los normales, con moderada prolongación de Vm. Ante el fallo hepático, aunque con variabilidad individual, las concentraciones alcanzan niveles tóxico-medulares (25 mcg/ml), destacándose un descenso estadísticamente significativo del CI promedio (p=0.001), con moderado descenso del Vd respecto a normales. Ante el intento de compensación hemodinámica con dopamina, vuelven a incrementarse concentraciones de cloramfenicol en el grupo con hígado de sepsis sufriendo nuevos deterioros Vm, Vd y CI promedios, aunque también com comportamiento no-uniforme. Se enfatiza en la significación práctica de esta metodología en el manejo de drogas en la insuficiencia hepática severa, lo que permitirá valorar matemáticamente diversos componentes patogénicos. Se concluye, que si bien cada paciente debiera ser individualmente evaluado, la dosificación de cloramfenicol no debe sufrir modificaciones en shock séptico sin fallo hepático, mientras que ante esta eventualidad, la dosis debiera disminuirse a la mitad, prolongándose el intervalo al doble apróximadamente (AU)