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Contexto el rechazo crónico mediado por anticuerpos (cABMR, chronic antibody-mediated rejection) se considera una de las principales causas de disfunción crónica del injerto. Objetivo profundizar en la comprensión de los mecanismos que la ocasionan para diseñar tratamientos efectivos, dado que es muy poco lo que se ha avanzado en el tratamiento de esta patología. Metodología en esta revisión narrativa de la literatura, presentamos los factores de riesgo relacionados con la disfunción crónica del injerto, haciendo énfasis en la fisiopatología, el diagnóstico y el tratamiento del cABMR. Resultados el factor de riesgo más relevante para el desarrollo de disfunción crónica del injerto es el desarrollo de anticuerpos donante específicos (DSA) y ABMR. Para el diagnóstico de cABMR activo, se requieren los criterios de Banff 2017 (los tres deben estar presentes: Evidencia histológica de lesión tisular crónica, evidencia de inflamación actual en el endotelio vascular ocasionada por anticuerpos y evidencia serológica de DSA. El cABMR no tiene un tratamiento efectivo. Conclusiones dado que cABMR no tiene un tratamiento efectivo, es importante disminuir la exposición a los factores de riesgo y hacer un diagnóstico y un tratamiento oportuno de los eventos agudos de lesión renal que contribuyen a la progresión de disfunción crónica del injerto.

Context Chronic antibody-mediated rejection (cABMR) is considered one of the main causes of chronic graft. Objective To review the mechanisms that cause cABMR to design effective treatments, since it is very little what has been advanced in it treatment of this pathology. Methodology In this narrative review of the literature, we present the risk factors related to the chronic dysfunction of the injection, emphasizing the pathophysiology the diagnosis and treatment of cABMR. Results The most relevant risk factor for the development of chronic graft dysfunction is the development of specific donor antibodies (DSA) and ABMR. For the diagnosis of active cABMR, the criteria of Banff 2017 are required (three must be present: histological evidence of chronic tissue injury, evidence of current inflammation in the vascular endothelium caused by antibodies and serological evidence of DSA. The cABMR does not have an effective treatment. Conclusions Since cABMR does not have an effective treatment, it is important reduce exposure to risk factors and carry out a diagnosis and treatment of the acute events of kidney injury that contribute to the progression of chronic injection dysfunction.

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RESUMEN COVID-19 tiene un espectro amplio de manifestaciones clínicas, se ha descrito lesión renal aguda con evidencia de necrosis tubular aguda y diversos tipos de podocitopatías. Se presenta el caso clínico de un paciente con trasplante renal y COVID-19 que debuta con lesión renal aguda y síndrome nefrótico. Proteína C-reactiva para síndrome respiratorio agudo severo 2 en hisopado nasal es positiva y en tejido renal es negativa. Biopsia renal reporta enfermedad de cambios mínimos. A la fecha es el primer reporte de esta podocitopatía asociada a COVID-19 en paciente con trasplante renal.

ABSTRACT COVID-19 disease is a systemic infection associated with renal damage leading to acute kidney injury with acute tubular necrosis and several types of podocytopathies. We report a clinical case in a kidney transplant patient diagnosed with COVID-19 disease, acute kidney injury and nephrotic syndrome. SARS-CoV 2 PCR results in nasal swab was positive and kidney was negative. Renal histopathologic findings described minimal change disease. So far, this case is the first clinical report of minimal change disease associated to COVID-19 in a kidney transplant patient.

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La linfohistiocitosis hemofagocítica (LHH) por Histoplasma capsulatum, presentación rara de la histoplasmosis diseminada, es causada por la fagocitosis de las células hematopoyéticas por macrófagos tisulares. Presentamos el caso de un paciente masculino de 44 años con trasplante renal que asiste por fiebre sin otra sintomatología. Inicialmente se obtiene una gota gruesa positiva para P. vivax, iniciando manejo antimalárico. A los 2 días de tratamiento, el paciente presenta disfunción multiórganica, se rectifica diagnóstico en centro de referencia reportando en extendido de sangre periférica la presencia de levaduras de H. capsulatum en polimorfonucleares, resultado confirmado con prueba de inmunodifusión. Se ajusta manejo, pero el paciente fallece. El diagnóstico de infecciones por gérmenes inusuales con presentaciones inespecíficas es un reto en pacientes con inmunosupresión.

Hemophagocytic Lymphohistiocytosis (HLH) induced by Histoplasma capsulatum is a rare entity who is characterized by phagocytosis of hematopoietic cells by tissue macrophages. A 44-year-old male patient with kidney transplantation was admitted to our ambulatory service with fever. Initially, we performed a thick drop test who was positive for P. vivax, so antimalarial therapy was initiated. Patient then progressed to multiple organ dysfunction after 2 days of treatment. Thus, a reference center went back over the blood smear which revealed the presence of yeast cells H. capsulatum within polymorphonuclear cells. This result was confirmed by an immunodifussion assay. Despite of antifungal treatment, patient passed away. The diagnosis for unusual microorganism with unspecific clinical presentation could be a challenge in immunosupressive patients.

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BACKGROUND: Acute kidney injury (AKI) is a main cause of morbidity, hospitalization, and hospital readmission in kidney transplant recipients. We aimed to determine AKI incidence and risk factors following kidney transplant to assess outcomes such as renal function and graft loss after AKI. METHODS: We conducted a retrospective cohort study with hospitalized kidney transplant recipients during 2016 to 2017. Clinical data of 179 patients were reviewed. The primary outcome was AKI incidence and risk factors. To determine AKI occurrence, we based it on creatinine criteria from Acute Kidney Injury Network classification. RESULTS: We documented a total of 179 hospital admissions; AKI was diagnosed in 104 patients (58.1%). Recipients with higher baseline serum creatinine (odds ratio, 2.6; confidence interval [CI], 1.5-4.5; P < .001) and hospital admission because of infections (odds ratio, 2.4; CI, 1.1-5.2; P = .020) were more likely to experience AKI. A total of 19 recipients (10.6%) had graft loss with a significant AKI association (P = .003) at 12 months after admission. Intensive care unit length of stay (P = .63) and hospital stay (P = .55) were not different in patients with AKI compared with the control group. CONCLUSIONS: As a main clinical finding, we concluded that infections and higher serum creatinine baseline level were associated with the development of AKI.

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Introducción: La irregularidad cardiaca es adecuadamente descrita mediante geometría fractal, la cual fue base para el desarrollo de un diagnóstico del ventriculograma izquierdo. Métodos: Se simularon la totalidad de permutaciones posibles de grados de similitud de las dimensiones fractales del ventrículo en sístole, diástole y totalidad, definidas entre los valores mínimos y máximos de los grados de similitud para anormalidad moderada y severa previamente establecidos. Resultados: Se estableció el número total de prototipos ventriculares entre anormalidad moderada y severa. El número total de prototipos de estructura ventricular posibles fue de 1614: 794 ventrículos con anonnalidad moderada y 820 con anonnalidad severa. Medidas previas de ventrículos con diagnóstico de anonnalidad moderada y severa se encontraron incluidas dentro de la generalización. Conclusiones: Se desarrolló una metodología geométrica objetiva y de ayuda diagnóstica a nivel clínico, que determinó todas las posibles estructuras ventriculares izquierdas con anonnalidad moderada y severa, independientemente de clasificaciones clínicas.

Introduction: The cardiac irregularity is adequately described by means of fractal geometry, which was the basis for the development of a diagnosis of left ventriculography. Methods: All possible pennutations of similarity degrees from fractal dimensions were done for the ventricle in systole. diastole and the totality. Pennutations were defined between the previously established mínimum and máximum valúes of similarity degrees for modérate and severe anonnality. Results: It was established the total number of possible ventricular prototypes between modérate and severe anonnality. The total number of possible ventricular structure prototypes is 1614: 794 of ventricles with modérate anonnality and 820 of ventricles with severe anonnality. Practical measures made previously were found within the generalization. Conclusions: It was developed an objective geometric methodology. which is of diagnostic aid in the clinical practice. It detennined all possible left ventricular structures with modérate and severe anonnality independent of clinical classifications.

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Abstract One of the main and most challenging tasks of managers is to judge their own actions and, even more, the actions of others. There are different biases that might affect the accuracy of their ethical judgment. Two of the most common biases studied are the group affiliation bias and the want/should conflict. In the present study by empirical means, we analyzed these biases in the ethical judgment of managers. Examining answers of 153 effective respondents, we found significant differences in some of the four categories of ethical decision making studied, especially in the use of working time, money management and the use of corporate assets. We also explored some demographic characteristics of the managers, finding gender and level of study as the most relevant ones which play an important role on how they assess their own past and future behavior and the behavior of others. Although, we obtained somehow mixed results, they show that there seems to be a tendency within managers, to judge harder moral behavior of others compared to the judgment of their own ethical behavior Furthermore, managers judge others, contrary to expected, harder if they know them than if they do not.

Resumen Una de las principales y más exigentes obligaciones de un directivo es juzgar sus propias acciones y aún más, las acciones de los demás. Hay diferentes sesgos que pueden afectar la precisión del juicio ético. Dos de los sesgos más comúnmente estudiados son el sesgo por afiliación a grupos y el dilema del conflicto entre el deber y el querer En esta investigación, se analizan estos sesgos en el juicio ético de los directivos, por medio de un estudio empírico. Examinando respuestas de 153 encuestados, encontramos diferencias significativas en algunas de las cuatro categorías estudiadas de toma de decisiones éticas, específicamente, en el uso del tiempo laboral, manejo del dinero y el uso de activos corporativos. Igualmente, se exploraron algunas características demográficas de los directivos, encontrando que el género y el nivel educativo de los directivos, son las variables más explicativas de cómo éstos juzgan su propio pasado, su futuro y el comportamiento de los demás. A pesar de haber encontrado resultados variados, parece haber una tendencia general en los directivos a juzgar más duramente los actos de los demás que los suyos propios. Además, se encontró que, contrario a lo esperado, los directivos juzgan más duramente a las personas que conocen que a las que no conocen.

Resumo Uma das principais e mais exigentes obrigações de um gerente é julgar suas próprias ações e, ainda mais, as ações de outros. Existem diferentes tendências que podem afetar a precisão do julgamento ético. Dois dos viés mais comumente estudados são viés devido à afiliação grupal e ao dilema do conflito entre dever e vontade. Nesta pesquisa, esses preconceitos são analisados no julgamento ético dos gerentes, através de um estudo empírico. Examinando respostas de 153 entrevistados, encontramos diferenças significativas em algumas das quatro categorias de tomada de decisão ética estudadas, especificamente, no uso do tempo de trabalho, gerenciamento de dinheiro e uso de ativos corporativos. Do mesmo modo, foram exploradas algumas características demográficas dos gestores, encontrando que o gênero e o nível educacional dos gerentes são as variáveis mais explicativas de como eles julgam seu próprio passado, seu futuro e o comportamento de outros. Apesar de ter encontrado resultados mistos, parece haver uma tendência geral para que os gerentes julguem as ações dos outros mais severamente do que as suas. Além disso, descobriu-se que, contrariamente às expectativas, os gerentes julgam mais duramente as pessoas que conhecem do que aqueles que não conhecem.

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Antecedentes: Se desarrolló un método diagnóstico fractal para evaluar células del cuello uterino utilizando el concepto de Armonía Matemática Intrínseca (AMI) y variabilidad celular, el cual diferencia matemáticamente células normales de células L-SIL y H-SIL, haciendo innecesario el diagnóstico de células ASCUS. Objetivo: confirmar la capacidad diagnóstica de la metodología desarrollada mediante un estudio ciego de comparación con el Gold Standard. Método: se tomaron fotografías digitales de 50 preparaciones citológicas de mujeres entre 20 y 55 años: 5 con diagnóstico de citología normal y 45 con diferentes grados de lesión hasta carcinoma, incluyendo 5 ASCUS. Se calculó la dimensión fractal de tres objetos matemáticos: núcleo, citoplasma y totalidad, a partir de la superposición de cinco rejillas. Además, se evaluó su dimensión fractal mediante el concepto de AMI y variabilidad celular. Los resultados obtenidos se compararon con el diagnóstico citopatológico convencional determinando su sensibilidad, especificidad y coeficiente kappa. Resultados: La sensibilidad y especificidad fue del 100%, y el coeficiente Kappa de 1. Conclusiones: Los resultados en una población diferente a la inicial son una evidencia de la capacidad de esta metodología para diagnosticar objetiva y cuantitativamente células normales, L-SIL y H-SIL, así como aclarar el diagnóstico de las células ASCUS con base en la dimensión fractal y el concepto de AMI y variabilidad.

Introduction: A new fractal diagnostic method was applied for assessing cervix cells using the Intrinsic Mathematical Harmony (IMH) concept and cellular variability, which mathematically differentiates normal, L-SIL and H-SIL cells making unnecessary the diagnostic of ASCUS cells. Objective: To confirm the diagnostic capability of developed methodology by a blind study of comparison with Gold Standard. Methods: Digital pictures were taken of 50 cells from cytology of 20 to 55 year-old women; 5 with normal diagnosis and 45 with several lesion degrees until carcinoma, including 5 with ASCUS diagnosis. Fractal dimension of three mathematical objects was calculated by superposing five grids: nucleus, cytoplasm and totality. Moreover, their fractal dimension was assessed through the Intrinsic Mathematical Harmony concept and cellular variability. The obtained diagnosis was compared with conventional cytopathologic diagnosis determining sensibility, specificity and Kappa coefficient. Results: 100% Sensibility and specificity, and a Kappa Coefficient of 1 were obtained. Conclusions: The results, in a population different to the initial one, are an evidence of the ability of this methodology for objectively and quantitatively diagnosing the normal, L-SIL and H-SIL cells, as well as for clarifying the ASCUS cells diagnosis, based on fractal dimension and IMH concept and variability.

Introdução: Um novo método de diagnóstico fractal foi aplicado para avaliar as células do colo do útero usando conceito intrínseco harmonia matemática (IMH) e variabilidade celular, que normalmente diferencia matematicamente, LSIL e HSIL células que fazem o diagnóstico de células desnecessários ASCUS. Objetivo: Para confirmar a capacidade de diagnóstico da metodologia desenvolvida por um estudo cego de comparação com Gold Standard. Métodos: Foram tiradas fotos digitais de 50 células de citologia de mulheres com 20 a 55 anos de idade; 5 com diagnóstico normal e 45 com vários graus de lesão até carcinoma, incluindo 5 com diagnóstico de ASCUS. A dimensão fractal de três objetos matemáticos foi calculada através da superposição de cinco grades: núcleo, citoplasma e totalidade. Além disso, sua dimensão fractal foi avaliada através do conceito de harmonia matemática Intrínseca e da variabilidade celular. O diagnóstico obtido foi comparado com o diagnóstico citopatológico convencional, determinando a sensibilidade, especificidade e coeficiente Kappa. Resultados: Foram obtidos 100% de sensibilidade e especificidade e um Coeficiente Kappa de 1. Conclusões: Os resultados, em uma população diferente da inicial, são uma evidência da habilidade desta metodologia para o diagnóstico objetivo e quantitativo das células normais, L-SIL e H-SIL, bem como para esclarecer o diagnóstico das células ASCUS, Baseado na dimensão fractal e no conceito e variabilidade de IMH.

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Previamente se desarrolló un refinamiento de una metodología basada en la teoría de conjuntos y la probabilidad, con el fin de mejorar la capacidad predictiva de linfocitos T CD4 (LT-CD4) para pacientes con VIH/SIDA a partir del número de leucocitos y linfocitos totales. En este trabajo se confirmó en 150 muestras la aplicabilidad clínica del método de predicción refinado. Se tomaron los datos de leucocitos/mm3, linfocitos/mm3 y CD4/mm3 de cada paciente, denominados triplas, y se organizaron de mayor a menor según el número de leucocitos, para evaluarlos en rangos de 1.000 leucocitos. Se estableció la pertenencia de las triplas a los conjuntos A∪C, B∪D y la intersección entre ambas uniones (A∪B)∩(B∪D), mediante la cual se establece una predicción del número de CD4 asociado a valores específicos de leucocitos y linfocitos. Se contabilizó el número de elementos pertenecientes a cada conjunto y se determinó su probabilidad de pertenencia para cada uno de los rangos evaluados. De los 9 rangos de leucocitos medidos, 7 presentaron una probabilidad de acierto igual o superior a 0,76 obteniendo una probabilidad de uno en los rangos inferiores a 4.000/mm3 y 3.000/mm3 respectivamente. La capacidad de la metodología para determinar el valor de los LT-CD4 fue confirmada, logrando una capacidad predictiva superior a la de la metodología sin refinar. Las evidencias corroboran que la metodología aplicada es eficaz para poder ser empleada clínicamente, favoreciendo de esta manera la reducción de costos y recursos

Previously a refinement of a methodology was developed based on set theory and probability, with the aim of improving the predictive ability of CD4 T cells (LT-CD4) for HIV/AIDS from the total number of leukocytes and lymphocytes. In this work the clinical applicability of the method was shown by refining prediction in 150 samples. Taking data of leukocytes/mm3, lymphocytes/mm3, and LT-CD4 cells/mm3 of each patient, called triples, they were organized from highest to lowest based on the number of leukocytes, to evaluate ranges of 1,000 leukocytes. The membership of the triples to the set A∪C, B∪D was established, as well as the intersection between the two sets (A∪B)∩(B∪D), in which a prediction of the number of CD4 associated with specific values of leukocytes and lymphocytes is established. The number of elements belonging to each set was counted and the probability of belonging to each of the ranges tested was determined. A total of 7 out of the 9 ranges of leukocytes measured showed a probability of success equal to or greater than 0,76, achieving a probability of 1 in the ranks lower than 4.000/mm3 and 3.000/mm3, respectively. The ability of the methodology for determining the value of the LT-CD4 was demonstrated, achieving a higher predictive capacity than the unrefined methodology. The evidence shows that the applied methodology is effective for clinical use, thus leading to a reduction of costs and resources

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Los trastornos del espectro autista (TEA) forman un heterogéneo grupo de patologías con muchas posibles causas (mayoritariamente de origen genético, de las que en la actualidad se conoce un gran número) pero que habitualmente (80-90%) quedan sin filiar, al no identificarse dicha causa. Presentamos el caso de un varón inicialmente diagnosticado de TEA idiopático, en quien finalmente pudo encontrarse la patología originaria de su trastorno autista, en este caso una distrofia muscular de Becker. Después se comentan los aspectos teóricos asociados (AU)

The autism spectrum disorders (ASD) are a heterogeneous group of diseases with many possible causes (mostly of genetic origin, that today are known in many cases) but usually (80-90%) remain unidentified, it is not possible to identify the cause. We report the case of a man initially diagnosed with idiopathic ASD, who eventually was diagnosed with the disease in the origin of his autistic disorder, in this case a Becker muscular dystrophy. The associated theoretical aspects are also discussed (AU)

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INTRODUCTION: An increasing number of adults diagnosed with a high-functioning autism spectrum disorder are diagnosed as being adult, so much the treatment applicable conditions, and possibly the clinical outcome. As a complement to medication and individual psychotherapy, group psychotherapy treatment is a clinical tool that offers significant advantages in the treatment of this syndrome. METHODOLOGY: This paper describes the sequence of group treatment we have been doing in our workplace, in the light of what the medical literature contains the subject, and according to the basic needs of this group of patients in adulthood. CONCLUSION: Group psychotherapeutic treatment in adult patients with a high-functioning autism spectrum disorder is a treatment option to consider, and whose clinical effectiveness must be evaluated in future studies.

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En los últimos años se ha observado una prevalencia comórbida de síndrome de Gilles de la Tourette y trastornos del espectro autista muy superior a la esperada sólo por azar, por lo que se supone que ambos trastornos comparten mecanismos neurobiológicos comunes. Se expone un caso clínico con las dos afecciones, y se discuten sus posibles relaciones (AU)

In the past few years a prevalence of comorbidity, higher than expected at random, has been observed in Gilles de la Tourette syndrome and autism spectrum disorders. It is assumed from this that both have common neurobiological mechanisms. A clinical case is presented of a patient suffering from the two conditions, and their possible relationships are discussed (AU)

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Objetivo: La elaboración de un posible test de cribado para la detección de pacientes adultos con síndrome de Asperger. Método: Para ello se han agrupado los signos y síntomas fundamentales del síndrome, tanto en los primeros años de vida como a lo largo de la edad adulta, y se ha cotejado con las propuestas de detección y diagnóstico disponibles. Resultados: Se presentan y discuten los aspectos que se considera esenciales para la sospecha de un cuadro compatible con este diagnóstico. Conclusiones: Que haya adultos con síndrome de Asperger que aún no han sido debidamente diagnosticados hace necesario el empleo de instrumentos que ayuden a reorientar este diagnóstico, aunque éste se deba confirmar posteriormente mediante otras herramientas

Objective: To design a possible screening test to detect adults with Asperger syndrome. Method: The main signs and symptoms of the syndrome, both in the first years of life and throughout adulthood, were grouped and compared with the available screening and diagnostic tools. Results: The aspects considered essential for suspicion of Asperger syndrome are presented and discussed. Conclusions: Because there are still some adults with Asperger syndrome that have not been correctly diagnosed, there is a need for instruments that help to guide this diagnosis, even though the diagnosis should subsequently be confirmed through the use of other tools

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Objetivo: Se presentan los objetivos y las herramientas empleados en el tratamiento psicoterapéutico de pacientes adultos diagnosticados ya durante su vida adulta de síndrome de Asperger. Métodos: Durante 6 meses se han desarrollado sesiones semanales para el abordaje psicoterapéutico del trastorno. Resultados: La satisfacción subjetiva de las sesiones por parte de los pacientes es muy alta, y deberá evaluarse a corto y medio plazo su eficacia terapéutica real. Conclusiones: El síndrome de Asperger es aún un trastorno poco conocido, y más aún en adultos, en el que el abordaje psicoterapéutico parece esencial

Objective: To present the aims of group therapy in individuals with an adult diagnosis of Asperger syndrome and describe the tools to be used in this treatment. Methods: Weekly group therapy sessions were carried out for 6 months. Results: The patients' subjective satisfaction with the sessions was very high. The real effectiveness of this type of treatment in the short- and long-term should be evaluated. Conclusions: Asperger syndrome remains a little-known disorder, especially in adults. A psychotherapeutic approach seems essential

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