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Abstract Objective: To evaluate hypothalamic-pi- tuitary-gonadal (HPG) axis alterations at 1 and 12 months after kidney transplan- tation (KT) and their association with in- sulin resistance. Methods: A retrospective clinical study was conducted in a tertiary care center in kidney transplantation recipients (KTRs) aged 18- 50 years with primary kidney disease and stable renal graft function. LH, FSH, E2/T, and HOMA-IR were assessed at 1 and 12 months after KT. Results: Twenty-five KTRs were included; 53% were men, and the mean age was 30.6±7.7 years. BMI was 22.3 (20.4-24.6) kg/m2, and 36% had hypogonadism at 1 month vs 8% at 12 months (p=0.001). Re- mission of hypogonadism was observed in all men, while in women, hypogonadotropic hypogonadism persisted in two KTRs at 12 months. A positive correlation between go- nadotrophins and age at 1 and 12 months was evident. Fifty-six percent of patients had insulin resistance (IR) at 1 month and 36% at 12 months (p=0.256). HOMA-IR showed a negative correlation with E2 (r=- 0.60; p=0.050) and T (r=-0.709; p=0.049) at 1 month, with no correlation at 12 months. HOMA-IR at 12 months after KT correlated positively with BMI (r=0.52; p=0.011) and tacrolimus dose (r=0.53; p=0.016). Conclusion: Successful KT restores the HPG axis in the first year. Hypogonadism had a negative correlation with IR in the early pe- riod after KT, but it was not significant at 12 months.

Resumo Objetivo: Avaliar as alterações do eixo hipotálamo-hipófise-gonadal (HHG) em 1 e 12 meses após transplante renal (TR) e sua associação com a resistência à insulina. Métodos: Foi realizado um estudo clínico retrospectivo em um centro de cuidados terciários em receptores de transplante renal (RTR) com idade entre 18-50 anos com doença renal primária e função do enxerto renal estável. LH, FSH, E2/T e HOMA-IR foram avaliados em 1 e 12 meses após o TR. Resultados: foram incluídos 25 RTR; 53% eram homens e a média de idade foi de 30,6±7,7 anos. O IMC foi de 22,3 (20,4-24,6) kg/m2 e 36% apresentaram hipogonadismo em 1 mês vs 8% aos 12 meses (p=0,001). A remissão do hipogonadismo foi observada em todos os homens, enquanto nas mulheres, o hipogonadismo hipogonadotrófico persistiu em dois RTR aos 12 meses. Ficou evidente uma correlação positiva entre gonadotrofinas e idade em 1 e 12 meses. Cinquenta e seis por cento dos pacientes apresentaram resistência à insulina (RI) em 1 mês e 36% aos 12 meses (p=0,256). O HOMA-IR mostrou uma correlação negativa com E2 (r=-0,60; p=0,050) e T (r=-0,709; p=0,049) em 1 mês, sem correlação em 12 meses. O HOMA-IR aos 12 meses após TR correlacionou-se positivamente com o IMC (r=0,52; p=0,011) e a dose de tacrolimus (r=0,53; p=0,016). Conclusão: O TR bem-sucedido restaura o eixo HHG no primeiro ano. O hipogonadismo apresentou uma correlação negativa com a RI no período inicial após o TR, mas essa correlação não foi significativa aos 12 meses.

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OBJECTIVE: To evaluate hypothalamic-pi- tuitary-gonadal (HPG) axis alterations at 1 and 12 months after kidney transplan- tation (KT) and their association with in- sulin resistance. METHODS: A retrospective clinical study was conducted in a tertiary care center in kidney transplantation recipients (KTRs) aged 18- 50 years with primary kidney disease and stable renal graft function. LH, FSH, E2/T, and HOMA-IR were assessed at 1 and 12 months after KT. RESULTS: Twenty-five KTRs were included; 53% were men, and the mean age was 30.6±7.7 years. BMI was 22.3 (20.4-24.6) kg/m2, and 36% had hypogonadism at 1 month vs 8% at 12 months (p=0.001). Re- mission of hypogonadism was observed in all men, while in women, hypogonadotropic hypogonadism persisted in two KTRs at 12 months. A positive correlation between go- nadotrophins and age at 1 and 12 months was evident. Fifty-six percent of patients had insulin resistance (IR) at 1 month and 36% at 12 months (p=0.256). HOMA-IR showed a negative correlation with E2 (r=- 0.60; p=0.050) and T (r=-0.709; p=0.049) at 1 month, with no correlation at 12 months. HOMA-IR at 12 months after KT correlated positively with BMI (r=0.52; p=0.011) and tacrolimus dose (r=0.53; p=0.016). CONCLUSION: Successful KT restores the HPG axis in the first year. Hypogonadism had a negative correlation with IR in the early pe- riod after KT, but it was not significant at 12 months.

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OBJECTIVE: To determine the most frequent dermatoses in patients with kidney transplant in the dermatology consultation, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, in Mexico City, in the period from March 2016 to March 2020. METHOD: Descriptive, cross-sectional study that included 153 patients with a complete medical history with prior informed consent and authorization from the hospital ethics committee. RESULTS: All patients presented one or more dermatoses. The most frequent were infectious (mycosis, viral) and, in decreasing order, other dermatoses (keratosis pilaris, melasma), tumorous (benign), inflammatory (seborrheic dermatitis, eczema), probably secondary to drugs and autoimmune (alopecia areata). CONCLUSIONS: All kidney transplant patients presented at least one dermatosis, predominantly those of infectious origin. We recommend dermatological evaluation prior to transplantation for timely diagnosis and treatment of dermatoses that could increase the morbi-mortality of patients.

OBJETIVO: Determinar las dermatosis más frecuentes en pacientes con trasplante renal en la consulta de dermatología del Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, en Ciudad de México, en el período de marzo de 2016 a marzo de 2020. MÉTODO: Estudio descriptivo, transversal que incluyó 153 pacientes con historia clínica completa, previo consentimiento informado y autorización del comité de ética del hospital. RESULTADOS: Todos los pacientes presentaron una o más dermatosis. Las más frecuentes fueron las infecciosas (micosis, virales) y, en orden decreciente, otras dermatosis (queratosis pilar, melasma), tumorales (benignas), inflamatorias (dermatitis seborreica, eccemas), probablemente secundarias a fármacos y autoinmunitarias (alopecia areata). CONCLUSIONES: Todos los pacientes receptores de trasplante renal presentaron al menos una dermatosis, predominando las de origen infeccioso. Recomendamos una valoración dermatológica previa al trasplante para el diagnóstico y el tratamiento oportuno de las dermatosis que podrían aumentar la morbimortalidad de los pacientes.

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Background: Knowledge of the functionality of the graft and patient survival is essential to assess the success of kidney transplantation. Objective: To determine the survival of transplanted patients by type of donor and the functionality of kidney grafts in a cohort in Mexico. Material and methods: Kidney transplant cohort from 2013 to 2017 in Mexico. 790 patients followed up for one year were analyzed to assess the survival of transplanted patients by type of donor and the functionality of kidney grafts. For this, measures of central tendency and dispersion were used, as well as Kaplan-Meier survival tables with SPSS, version 25. Results: Out of the 790 patients, 518 were from living donors (65.56%) with patient survival of 97.88% and graft function of 93.24% at 12 months of follow-up; 272 patients received the graft from a deceased donor with patient survival of 91.18% and renal graft function of 84.19%. Conclusions: There is still a difference of almost 5% in the survival of the recipient patient from a living donor compared to a deceased donor. For the functionality of the kidney graft, this difference is > 7%. Cadaveric donation has increased; however, even at low figures is of approximately 35% in Mexico.

Introducción: el conocimiento de la funcionalidad del injerto y la supervivencia del paciente es fundamental para valorar el éxito del trasplante renal. Objetivo: determinar la supervivencia de los pacientes trasplantados por tipo de donante y la funcionalidad de los injertos renales en una cohorte en México. Material y métodos: cohorte de trasplante renal de 2013 a 2017 en México. Se analizaron 790 pacientes seguidos por un año para valorar la supervivencia de los pacientes trasplantados por tipo de donante y la funcionalidad de los injertos renales. Para ello se usaron medidas de tendencia central y dispersión, así como tablas de supervivencia de Kaplan-Meier con SPSS, versión 25. Resultados: de los 790 pacientes, 518 fueron de donante vivo (65.56%) con supervivencia del paciente de 97.88% y de funcionalidad del injerto de 93.24% a 12 meses de seguimiento; 272 pacientes recibieron el injerto de donante fallecido con supervivencia del paciente de 91.18% y funcionalidad del injerto renal de 84.19%. Conclusiones: aún existe una diferencia de casi 5% en la supervivencia del paciente receptor de un donante vivo en referencia con un donante fallecido. Para la funcionalidad del injerto renal esta diferencia es > 7%. La donación cadavérica ha aumentado; sin embargo, incluso en cifras bajas es de aproximadamente el 35% en México.

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OBJECTIVE: To determine the evolution, associated factors and the outcomes of transplanted people one year after the evolution of a cohort in Mexico. METHOD: Kidney transplant cohort from 2013 to 2017 in Mexico. 1118 patients were analyzed. Five outcomes were studied: overall survival, kidney graft, patient survival, delayed function, and acute dysfunction. Kaplan-Meier was used for kidney graft survival. For risk, bivariate and multivariate analyzes were performed with a significant value of p < 0.05. RESULTS: Of the 1118 kidney transplant patients, 57 (5.09%) had kidney graft loss, 52 (4.65%) died during the one-year follow-up; survival of the patient of 95.35% and of the graft 90.25%. CONCLUSIONS: The risk factors for the outcomes were transplantation from a deceased donor, recipient over 50 years of age and use of polyclonal agents. Infections and age are related to the death of the patient.

OBJETIVO: Determinar la funcionalidad del injerto renal a 1 año en una cohorte retrospectiva en México. MÉTODO: Cohorte de trasplante renal de 2013 a 2017 en México. Se analizaron 1118 pacientes. Se estudiaron cinco desenlaces: supervivencia global, supervivencia del injerto renal, supervivencia del paciente, función retardada y disfunción aguda. Para la supervivencia del injerto renal se usó Kaplan-Meier. Para el riesgo se realizó análisis bivariado y multivariado con valor significativo p < 0.05. RESULTADOS: De los 1118 pacientes con trasplante renal, 57 (5.09%) tuvieron pérdida del injerto, 52 (4.65 %) fallecieron durante el año de seguimiento; la supervivencia del paciente fue del 95.35% y la supervivencia del injerto fue del 90.25%. CONCLUSIONES: Los factores de riesgo para los desenlaces fueron trasplante de donante fallecido, receptor mayor de 50 años y uso de agentes policlonales. Las infecciones y la edad están relacionadas con la muerte del paciente.

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Introducción: el conocimiento de la funcionalidad del injerto y la supervivencia del paciente es fundamental para valorar el éxito del trasplante renal. Objetivo: determinar la supervivencia de los pacientes trasplantados por tipo de donante y la funcionalidad de los injertos renales en una cohorte en México. Material y métodos: cohorte de trasplante renal de 2013 a 2017 en México. Se analizaron 790 pacientes seguidos por un año para valorar la supervivencia de los pacientes trasplantados por tipo de donante y la funcionalidad de los injertos renales. Para ello se usaron medidas de tendencia central y dispersión, así como tablas de supervivencia de Kaplan-Meier con SPSS, versión 25. Resultados: de los 790 pacientes, 518 fueron de donante vivo (65.56%) con supervivencia del paciente de 97.88% y de funcionalidad del injerto de 93.24% a 12 meses de seguimiento; 272 pacientes recibieron el injerto de donante fallecido con supervivencia del paciente de 91.18% y funcionalidad del injerto renal de 84.19%. Conclusiones: aún existe una diferencia de casi 5% en la supervivencia del paciente receptor de un donante vivo en referencia con un donante fallecido. Para la funcionalidad del injerto renal esta diferencia es > 7%. La donación cadavérica ha aumentado; sin embargo, incluso en cifras bajas es de aproximadamente el 35% en México

Background: Knowledge of the functionality of the graft and patient survival is essential to assess the success of kidney transplantation. Objective: To determine the survival of transplanted patients by type of donor and the functionality of kidney grafts in a cohort in Mexico. Material and methods: Kidney transplant cohort from 2013 to 2017 in Mexico. 790 patients followed up for one year were analyzed to assess the survival of transplanted patients by type of donor and the functionality of kidney grafts. For this, measures of central tendency and dispersion were used, as well as Kaplan-Meier survival tables with SPSS, version 25. Results: Out of the 790 patients, 518 were from living donors (65.56%) with patient survival of 97.88% and graft function of 93.24% at 12 months of follow-up; 272 patients received the graft from a deceased donor with patient survival of 91.18% and renal graft function of 84.19%. Conclusions: There is still a difference of almost 5% in the survival of the recipient patient from a living donor compared to a deceased donor. For the functionality of the kidney graft, this difference is > 7%. Cadaveric donation has increased; however, even at low figures is of approximately 35% in Mexico

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OBJECTIVE: To describe mortality of in-hospital patients with COVID-19 and compare risk factors between survivors and non-survivors. DESIGN: Prospective cohort of adult inpatients. SETTING: Tertiary healthcare teaching hospital in Guadalajara, Mexico. PARTICIPANTS: All patients with confirmed COVID-19 hospitalised from 25 March to 7 September 2020 were included. End of study: 7 November 2020. PRIMARY OUTCOME MEASURES: Patient survival analysed by the Kaplan-Meier method and comparison of factors by the log-rank test. Mortality risk factors analysed by multivariate Cox's proportional-hazard model. RESULTS: One thousand ten patients included: 386 (38%) died, 618 (61%) alive at discharge and six (0.6%) remained hospitalised. There was predominance of men (63%) and high frequency of overweight-obesity (71%); hypertension (54%); diabetes (40%); and lung (9%), cardiovascular (8%) and kidney diseases (11%); all of them significantly more frequent in non-survivors. Overweight-obesity was not different between groups, but severity of disease (Manchester Triage System and quick Sequential Organ Failure Assessment) was significantly worse in non-survivors, who were also significantly older (65 vs 45 years, respectively) and had haematological, biochemical, coagulation and inflammatory biomarkers more altered than survivors. Mortality predictors were invasive mechanical ventilation (IMV; OR 3.31, p<0.0001), admission to intensive care unit (ICU; OR 2.18, p<0.0001), age (OR 1.02, p<0.0001), Manchester Triage System (urgent OR 1.44, p=0.02; immediate/very urgent OR 2.02, p=0.004), baseline C reactive protein (CRP; OR 1.002, p=0.009) and antecedent of kidney disease (OR 1.58, p=0.04) CONCLUSIONS: Mortality in hospitalised patients with COVID-19 in this emerging country centre seemed to be higher than in developed countries. Patients displayed a high frequency of risk factors for poor outcome, but the need for IMV, ICU admission, older age, more severe disease at admission, antecedent of kidney disease and higher CRP levels significantly predicted mortality.

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Bone mineral metabolism disease, which included persistent hyperparathyroidism, is common after successful kidney transplantation (KT) and is related with negative outcomes in kidney transplant recipients. There is a lack of information about bone mineral metabolism, persistent hyperparathyroidism, and its risk factors in Latin kidney transplant recipients (KTRs). Material and Methods: A retrospective study was conducted in 74 patients aged 18-50 years with evolution of 12 months after KT and estimated glomerular filtration rate (eGFR) >60 ml/min; biochemical data of bone mineral metabolism before and at 1, 3, 6, and 12 months of KT were registered. Results. Age was 33 (IQR 27-37) years; 54% (n = 40) were men. Before KT, all patients had hyperparathyroidism, 40% (n = 30) hypocalcemia, 86% (n = 64) hyperphosphatemia, and 42% (n = 31) hyperphosphatasemia. After KT, an increase of calcium and a diminution of PTH, phosphorus, and alkaline phosphatase were corroborated (p=0.001). All patients had hypovitaminosis D (deficiency: 91% (n = 67); insufficiency: 9% (n = 7)); 40% (n = 30) had persistent hyperparathyroidism at 12 months. Hyperphosphatasemia before KT (OR = 4.17 (95% CI: 1.21-14.44); p=0.04), hyperparathyroidism at 6 months (OR = 1.84 (95% CI; 1.67-2.06); p=0.02), hypovitaminosis D at 6 months (OR = 3.94 (95% CI: 1.86-17.9); p=0.01), and hyperphosphatasemia at 6 months (OR = 1.47 (95% CI: 1.07-2.86); p=0.03) were risk factors for persistent hyperparathyroidism at 12 months after KT. Conclusion. Persistent hyperparathyroidism at 6 months, hypovitaminosis D, and hyperphosphatasemia are risk factors for persistent hyperparathyroidism at 1 year of KT in Latin population.

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INTRODUCTION: Renal transplantation presents multiple complications after its completion, some of them related to the behavior of hemoglobin levels. The objective of this study is to determine the behavior and prevalence of anemia and erythrocytosis in the first year after renal transplantation. MATERIAL AND METHODS: A retrospective, observational study was conducted of a cohort of patients of the 21st Century National Medical Center in Mexico of transplants performed from January 1, 2013 to December 31, 2017. A total of 649 met the inclusion criteria. Pre-transplant hemoglobin (Hb) levels were determined, as well as levels 1 month, 3, 6, 9, and 12 months after transplantation, and the prevalence of anemia and erythrocytosis was determined in each month. Descriptive analysis was performed with measures of central tendency and measures of dispersion. The statistical program SPSS version 25 was used. RESULTS: The mean pre-transplant Hb was 10.69 g/dL (standard deviation [SD] 2.04). One year after the renal transplant, Hb averaged 14.45 g/dL (SD 2.30), which meant an increase over the first year after renal transplantation of 3.76 g/dL. Pre-transplant anemia occurred in 73.1% of patients, and erythrocytosis in 0.1%; 12.9% of patients and 5.9% in erythrocytosis continued with anemia for a year. CONCLUSIONS: Renal transplantation allows Hb levels to recover in a multifactorial way; however, the persistence of anemia and erythrocytes creates a study challenge in any transplant unit, due to their prevalence of 12.9 and 5.9% respectively.

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INTRODUCTION: Classic post-transplant complications are highly studied and monitored; however, other unusual complications may occur due to immunosuppression. The objective of this study is to show these rare complications in a kidney transplant center. MATERIAL AND METHODS: Retrospective, observational, longitudinal study of renal transplants carried out from 2013 to 2017 in the Renal Transplant Unit of the National Medical Center Siglo XXI. A total of 790 transplants were performed, with surveillance for 1 year and rare events described. An analysis of frequencies and percentages of the events was performed using the statistical package SPSS version 25. RESULTS: Of the 790 patients, 110 (13.92%) experienced rare events, classified into 9 types of complications. DISCUSSION AND CONCLUSIONS: Complications exist in renal transplantation that are often ignored or minimized. A considerable number have been observed in this study, 110 events (13.92%); this result allows us to consider multiple possibilities in a kidney transplant program, especially infectious complications (34 patients) and surgical complications (29 cases). With the increase in diabetic receptor transplantation, metabolic complications will surely increase in the coming years.

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BACKGROUND: Renal transplants (RTs) from deceased donors have increased in Mexico because of the high need of people with terminal kidney damage. The objective of this study is to determine the impact of cold ischemia time (CIT) on clinical outcomes in the deceased donor kidney transplant. METHODS: A retrospective, observational study of deceased donor RTs performed from 2013 to 2017 in the RT unit of the CMN Siglo XXI was completed. Data were collected from 202 patient records in this period; 7 clinical outcomes were determined, and logistic regression analysis was performed with CIT and extended criteria. The statistical package SPSS version 25 was used. RESULTS: No risk was observed for clinical outcomes with a CIT of 1080 minutes, risk of delayed function and medical complications was observed with a CIT of 1260 minutes, and risk of surgical complications was observed with a CIT of 1309 minutes. There was a correlation of 0.556 between the Maryland classification score and post-transplant medical complications. The extended criteria are related to risk for death with an odds ratio of 6.91 (95% CI, 2.27-21.01; P = .001) CONCLUSIONS: CIT continues to be an extremely important factor in renal graft survival and post-transplant clinical conditions. The extended criteria represent a considerable risk of death.

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BACKGROUND: Bone mineral disease after transplantation persists and is an issue that must be addressed owing to the cardiovascular impact it presents. The objective of this study is to present the behavior of calcium, phosphorus, and parathormone (PTH) before renal transplantation (RT) and throughout the 12 months after transplant surgery. METHODS: A longitudinal observational study of RT patients was performed from 2013 to 2017 in 2 renal transplant units in Mexico. In total, 1009 records of patients with RT were analyzed. Calcium, phosphorus, and PTH levels were studied before transplantation and for 12 months after. Central tendency and dispersion were measured, the difference of means was established with chi square or student t tests, and the significant value of P was set at <.05. We also used the SPSS statistical package, version 25. RESULTS: Phosphorus had a median pre-RT of 5.73, which decreased to 2.8 in the first month post-transplant and then increased to 3.41 at 12 months post-RT. The median PTH, on the other hand, started at 420.60 and decreased to 67.45. Calcium began at 9.04 and hit a plateau of 9.58 during month 12 after the surgical event. CONCLUSIONS: Of the 3 biochemical parameters evaluated, phosphorus was the one that most corrected itself after transplantation. Despite a tendency toward hypophosphatemia in the first month after transplantation, it began to normalize from month 6 on. Meanwhile, calcium was the biochemical value that changed the least after transplantation.

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INTRODUCTION: Renal transplantation (RT) has evolved to improve its functionality. Some factors have been little studied, one of which is hyperuricemia and its impact on renal graft function. The objective of this study is to determine the prevalence of complications of renal transplantation and its influence on hyperuricemia values in the first year of evolution. MATERIAL AND METHODS: The authors completed a retrospective, observational study of 2 RT units in Mexico from January 2013 to December 2017. In total, 1009 files met the inclusion criteria; the levels of uric acid (UA) and creatinine (Cr) were determined before transplantation and in months 1, 3, 6, 9, and 12 after transplantation. Descriptive analysis was performed with measures of central tendency, measures of dispersion, difference of means with Student t test, and SPSS version 25 (IBM, Armonk, NY, United States). RESULTS: The mean pretransplant UA was 6.24 mg/dL (standard deviation [SD] 1.97); per month was 4.73 mg/dL (SD 1.49). There is a difference in means between categorized groups of UA in the 5 post-RT moments (1, 3, 6, 9, and 12 months). A positive correlation of 0.41 to 0.47 was found with Spearman's test. The delayed function of the graft influenced in the first month after transplant in presenting hyperuricemia and acute dysfunction in month 6 showed that the rejection had no significance at any time. CONCLUSIONS: The relationship between the values of UA and Cr in the RT represents a moderate positive correlation; delayed graft function in the first month impacts the presence of hyperuricemia, as well as acute dysfunction at month 6 after transplantation.

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RESUMEN Fundamento: La diabetes mellitus constituye una causa frecuente de ingreso hospitalario. Los autores han elaborado una Guía para el manejo terapéutico farmacológico de diabéticos, la cual propone un conjunto de acciones dirigidas a organizar la asistencia médica a los pacientes diabéticos hospitalizados en el Servicio de Medicina Interna. Objetivo: valorar el proceso de implementación de una Guía para el manejo terapéutico farmacológico de diabéticos hospitalizados con mal control metabólico o estado de hiperglucemia aguda no complicada. Métodos: estudio descriptivo, realizado en el Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos, en mayo de 2018. Se analizó el cumplimiento de las acciones generales propuestas en la Guía, así como la introducción del esquema de insulina subcutánea programada; para ello fueron utilizados varios indicadores "de proceso" y "de resultados". Resultados: entre los indicadores con resultados negativos, se situaron los siguientes: registro de la glucemia en la Orden de Ingreso (49 %), estratificación de los enfermos (29 %), calidad de la estratificación (60 %), entre otros. Algunos con resultados positivos, fueron la referencia en la Orden de Ingreso al factor descompensante (82 %), adherencia a la conducta propuesta para cada grupo (86 %), utilización del esquema de insulina subcutánea programada (71 %), consideración del factor de descompensación en el manejo terapéutico (100 %), y cumplimiento global del esquema. El control metabólico se fue logrando progresivamente. Conclusión: se evidenció la factibilidad de aplicación del esquema de insulinoterapia subcutánea programada propuesto en la Guía, y su utilidad para el control metabólico de los pacientes.

ABSTRACT Foundation: Diabetes mellitus is a frequent cause of hospital admission. The authors have developed a Guide for the pharmacological therapeutic management of diabetics, which proposes a set of actions aimed at organizing medical care for diabetic patients in the Internal Medicine Service. Objective: to evaluate the process of implementing a Guide for the pharmacological therapeutic management of admitted diabetic patients with poor metabolic control or uncomplicated acute hyperglycemia status. Methods: a descriptive study, conducted at Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos, in May 2018. Compliance with the general actions proposed in the Guide was analyzed, as well as the introduction of the programmed subcutaneous insulin scheme; for this, several "process" and "results" indicators were used. Results: among the negative results indicators, the following were recorded: glycemic registration at the admission order (49%), patients´ stratification (29%), and stratification quality (60%), among others. Some with positive results were at the admission order to the decompensating factor (82%), adherence to the proposed behavior for each group (86%), use of the programmed subcutaneous insulin scheme (71%), consideration of the decompensation factor in therapeutic management (100%), and overall compliance with the scheme. The metabolic control was progressively achieved. Conclusion: the feasibility of applying programmed subcutaneous insulin therapy scheme proposed in the Guide, and its usefulness for the metabolic control of patients was confirmed.

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RESUMEN Fundamento: La asistencia médica de los diabéticos hospitalizados en salas del Servicio de Medicina Interna del hospital Gustavo Aldereguía Lima, de Cienfuegos, se caracteriza por una gran variabilidad en la actuación, determinada por criterios y enfoques muy personales de los facultativos. Objetivo: elaborar una guía para el manejo farmacológico de diabéticos con mal control metabólico o estado de hiperglucemia aguda no complicada, hospitalizados en el Servicio de Medicina Interna. Métodos: estudio que incluyó una revisión bibliográfica, a partir de la cual fue elaborada una primera versión de la guía, posteriormente discutida en el colectivo del Servicio de Medicina Interna del Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos. En las discusiones grupales fueron registradas las críticas y sugerencias a la propuesta. Finalmente, fue elaborado el documento. Resultados: entre las acciones más importantes propuestas por la guía, estuvo la estratificación de los pacientes en cuatro grupos diferentes según el grado de control metabólico al ingreso, o por su condición de debut de la enfermedad. Además, se sugirió una conducta terapéutica farmacológica particular para cada uno de esos cuatro grupos. En el caso de los pacientes que ingresan por mal control metabólico o hiperglucemia aguda no complicada, se introdujo el esquema de "insulinoterapia subcutánea programada". Fueron precisados los objetivos metabólicos a alcanzar, y los aspectos diagnósticos y terapéuticos relacionados con la hipoglucemia. Conclusión: la Guía para la atención al diabético puede ser de gran utilidad en todos aquellos servicios no críticos (incluyendo los quirúrgicos), donde con muy elevada frecuencia son admitidos estos pacientes.

ABSTRACT Foundation: The medical care of diabetics hospitalized in Internal Medicine Service wards of the Gustavo Aldereguía Lima Hospital, Cienfuegos, is characterized by a great variability in the performance, determined by criteria and very personal approaches of the physicians. Objective: to develop a guide for the pharmacological management of diabetics with poor metabolic control or a state of uncomplicated acute hyperglycemia, hospitalized in the Internal Medicine Service. Methods: a study which included a bibliographic review, from which a first version of the guide was elaborated, later discussed in the staff of the Internal Medicine Service of the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos. In the group discussions the criticisms and suggestions to the proposal were registered. Finally, the document was prepared. Results: among the most important actions proposed by the guide, was the patient stratification of into four different groups according to the degree of metabolic control at admission, or due to their condition of disease debut. In addition, a particular pharmacological therapeutic behavior was suggested for each of these four groups. In the case of patients admitted due to poor metabolic control or uncomplicated acute hyperglycemia, the "scheduled subcutaneous insulin therapy" scheme was introduced. The metabolic objectives to be achieved were specified, as well as the diagnostic and therapeutic aspects related to hypoglycemia. Conclusion: the Guide for diabetic care can be very useful in all non-critical services (including surgical ones), where these patients are very frequently admitted.

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Thy-1/CD90 is a glycoprotein attached to the outer face of the plasma membrane with various functions, which depend on the context of specific physiological or pathological conditions. Many of these reported functions for Thy-1/CD90 arose from studies by our group, which identified the first ligand/receptor for Thy-1/CD90 as an integrin. This finding initiated studies directed toward unveiling the molecular mechanisms that operate downstream of Thy-1/CD90 activation, and its possible interaction with proteins in the membrane plane to regulate their function. The association of Thy-1/CD90 with a number of cell surface molecules allows the formation of extra/intracellular multiprotein complexes composed of various ligands and receptors, extracellular matrix proteins, intracellular signaling proteins, and the cytoskeleton. The complexes sense changes that occur inside and outside the cells, with Thy-1/CD90 at the core of this extracellular molecular platform. Molecular platforms are scaffold-containing microdomains where key proteins associate to prominently influence cellular processes and behavior. Each component, by itself, is less effective, but when together with various scaffold proteins to form a platform, the components become more specific and efficient to convey the messages. This review article discusses the experimental evidence that supports the role of Thy-1/CD90 as a membrane-associated platform (ThyMAP).

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INTRODUCTION: Chronic kidney disease accounts for part of overall health expenditure; a potential etiology is related to variations, absence or presence of some human leukocyte antigen (HLA) alleles. METHOD: An analysis of HLA reports of 1965 kidney recipients with no determined etiology, and 1361 kidney donors was performed. It was carried out with Luminex based in cell flow fluorometry for the A, B, DRB1 and DQA loci. An analysis was performed with contingency tables in order to determine the odds ratio (OR) and confidence intervals (CI). Quantitative analysis was also carried out. RESULTS: Of the 101 alleles found, 13 showed association, 7 with risk for chronic kidney disease, with the most significant being HLA-DR17 with an OR of 3.91 (95 % CI = 2.96-5.17) and the one with the highest significance for protection being HLA-DR9, with an OR of 0.043 (95 % CI = 0.005-0.3224). CONCLUSIONS: It is necessary to understand that kidney diseases can be associated with yet unknown immune processes, where the association of the absence or presence of any allele should be known.

INTRODUCCIÓN: La enfermedad renal crónica representa parte del gasto en salud en general; una potencial etiología es la relacionada con variaciones, ausencia o presencia de algunos alelos del human leucocyte antigen (HLA). MÉTODO: Se realizó el análisis de 1965 reportes de HLA sin etiología determinada y de 1361 donadores renales. Se llevó a cabo tecnología Luminex con base en fluorimetría de flujo celular para los locus A, B, DRB1 y DQA. Se realizó análisis con tablas de contingencia para determinar razón de momios (RM) e intervalos de confianza (IC). Se efectuó análisis cuantitativo. RESULTADOS: De 101 alelos encontrados, 13 presentaron asociación, siete con riesgo para enfermedad renal crónica, de los cuales el más significativo fue HLA-DR17, con RM = 3.91 (IC 95 % = 2.96-5.17), y el de mayor significación de protección fue HLA-DR9, con RM = 0.043 (IC 95 % = 0.005-0.3224). CONCLUSIONES: Es necesario entender que las enfermedades renales pueden estar ligadas a procesos inmunológicos, en los que se tiene que conocer la asociación de la ausencia o presencia de algún alelo.

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Resumen Introducción: La enfermedad renal crónica representa parte del gasto en salud en general; una potencial etiología es la relacionada con variaciones, ausencia o presencia de algunos alelos del human leucocyte antigen (HLA). Método: Se realizó el análisis de 1965 reportes de HLA sin etiología determinada y de 1361 donadores renales. Se llevó a cabo tecnología Luminex con base en fluorimetría de flujo celular para los locus A, B, DRB1 y DQA. Se realizó análisis con tablas de contingencia para determinar razón de momios (RM) e intervalos de confianza (IC). Se efectuó análisis cuantitativo. Resultados: De 101 alelos encontrados, 13 presentaron asociación, siete con riesgo para enfermedad renal crónica, de los cuales el más significativo fue HLA-DR17, con RM = 3.91 (IC 95 % = 2.96-5.17), y el de mayor significación de protección fue HLA-DR9, con RM = 0.043 (IC 95 % = 0.005-0.3224). Conclusiones: Es necesario entender que las enfermedades renales pueden estar ligadas a procesos inmunológicos, en los que se tiene que conocer la asociación de la ausencia o presencia de algún alelo.

Abstract Introduction: Chronic kidney disease accounts for part of overall health expenditure; a potential etiology is related to variations, absence or presence of some human leukocyte antigen (HLA) alleles. Method: An analysis of HLA reports of 1965 kidney recipients with no determined etiology, and 1361 kidney donors was performed. It was carried out with Luminex based in cell flow fluorometry for the A, B, DRB1 and DQA loci. An analysis was performed with contingency tables in order to determine the odds ratio (OR) and confidence intervals (CI). Quantitative analysis was also carried out. Results: Of the 101 alleles found, 13 showed association, 7 with risk for chronic kidney disease, with the most significant being HLA-DR17 with an OR of 3.91 (95 % CI = 2.96-5.17) and the one with the highest significance for protection being HLA-DR9, with an OR of 0.043 (95 % CI = 0.005-0.3224). Conclusions: It is necessary to understand that kidney diseases can be associated with yet unknown immune processes, where the association of the absence or presence of any allele should be known.

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OBJECTIVE: The hypoxic milieu at tumor microenvironment is able to drive the behavior of infiltrating tumor cells. Considering that hypoxia-mediated HMGB1 release is known to promote tumor growth, as well to enhance the pro-tumoral profile of M2 macrophages by a RAGE-dependent mechanism, it is tempting to evaluate the potential contribution of HMGB1 under hypoxia to restrain M2 macrophages mobility. METHODS: CCR-2 expression was evaluated in M2 polarized macrophages by western blotting and immunocytochemistry. The secreted levels of CCL-2 and the migration capability were evaluated using an ELISA and a chemotaxis assay, respectively. RESULTS: HMGB1, under hypoxic conditions, markedly reduce both the production of CCL-2 and the expression of its receptor CCR-2; and reduced the migration capacity of M2 macrophages. CONCLUSIONS: These results provided new insights into the mechanisms that regulate M2 macrophages mobility at the tumor microenvironment.

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OBJECTIVE: The number of successful pregnancies in kidney transplant (KT) recipients has increased in recent years. Little evidence is available about the risk of in utero immunosuppressive exposure for long-term cognitive consequences. The aim of this study was to evaluate the impact of immunosuppression during pregnancy on intellectual performance of children born to KT recipients. METHODS: Using a cross-sectional design, women who had undergone KT and their children (aged 4+ years) were recruited at the outpatient follow-up in five transplant centers. Women who did not receive immunosuppression during pregnancy with similar distributions of socioeconomic status and length of gestation and their children were also recruited. Children were assessed with Wechsler Intelligence Scales. RESULTS: The study sample included 50 exposed and 50 unexposed children. No differences between groups in all the proposed confounding factors were found. Full-scale IQ did not differ significantly between both groups. Also, significant differences in any index or subscale score were not observed, with the exception of time required to complete the Wechsler preschool and primary scale of intelligence (WPPSI) Zoo locations subtest, which was done quicker in the unexposed group (p = .007). Exposure to immunosuppression during pregnancy was not a significant predictor of low IQ in logistic regression after adjustment for other factors. CONCLUSIONS: Immunosuppression therapy during pregnancy of KT women did not affect global intellectual performance of their offspring, except maybe for visuospatial working memory in preschool children.

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