RESUMEN
Vaccine-preventable infections are occurring at epidemic rates both nationally and internationally. At the same time, rates of vaccine hesitancy and refusal are increasing across the country leading to decreased herd immunity. For immunosuppressed transplant recipients, this situation poses great risk. Currently, 1 in 6 pediatric solid organ transplant recipients is hospitalized with a vaccine-preventable infection in the first 5 years posttransplant. For many recipients, these infections result in significant morbidity, mortality, and increased hospitalization costs. Surprisingly, despite this risk many transplant recipients are not up-to-date on age appropriate immunizations at the time of transplant and thereafter. As a transplant community, we must prioritize immunizations in both pre and posttransplant care. Research is needed to understand how to monitor immune response to vaccines in immunosuppressed patients and when to optimally immunize patients posttransplant. Finally, recommendations about administration of live vaccines posttransplant may need to be reevaluated in the setting of measles outbreaks and decreased herd immunity.
Asunto(s)
Brotes de Enfermedades/prevención & control , Trasplante de Órganos/efectos adversos , Complicaciones Posoperatorias/prevención & control , Receptores de Trasplantes/psicología , Vacunación/psicología , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/microbiología , Periodo Posoperatorio , Periodo Preoperatorio , Negativa a la Vacunación/psicologíaRESUMEN
AIM: The maintenance of stable graft function in renal transplanted recipients (RTR) is a challenge for healthcare staff. The ideal biomarkers must have significant predictive values to monitor the intricate renal function response triggered after renal transplantation. The main purpose in this study was to evaluate the regulatory and pro-inflammatory cytokines as biomarkers of allograft function in living-related renal transplant patients. METHODS: Regulatory and pro-inflammatory cytokine plasma levels were measured by flow cytometry in 120 living-related renal transplanted patients categorized into three groups according to creatinine plasma levels: creatinine less than 1.4 mg/dL (C1), creatinine within 1.4-2.0 mg/dL (C2) and more than 2.0 mg/dL (C3). Patients were also classified as 'low' or 'high' cytokine producers. Clinical data were obtained from patients' medical record. RESULTS: We have found a peak of regulatory cytokines in RTR with low creatinine levels as well as a peak of IL-6 pro-inflammatory cytokine in patients with high creatinine levels. C1 and C3 groups showed a mixed pro-inflammatory (IL-8, IL-6, IL-1ß, TNF-α, IL-12 and IFN-γ) and regulatory (IL-4, IL-5 and IL-10) cytokine pattern and C2 had a predominant pro-inflammatory profile. C3 group showed a higher frequency of high pro-inflammatory cytokine producers compared to C1. CONCLUSION: Our data suggest that regulatory cytokines IL-4, IL-5 and IL-10 could be good biomarkers associated with stable renal function, while pro-inflammatory cytokines seems to be potential markers in RTR related to high creatinine plasma levels, specially IL-6 despite of its borderline values.
Asunto(s)
Citocinas/sangre , Familia , Mediadores de Inflamación/sangre , Trasplante de Riñón , Riñón/inmunología , Donadores Vivos , Adulto , Anciano , Aloinjertos , Biomarcadores/sangre , Brasil , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Supervivencia de Injerto , Humanos , Riñón/fisiopatología , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/fisiopatología , Valor Predictivo de las Pruebas , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Hospital-acquired infection, often with Staphylococcus aureus, is an important complication in intestinal transplant. CLINICAL CASE: A 2-year-old girl underwent small bowel transplantation owing to a small bowel volvulus. On the first postoperative day, lymphocyte phenotypes, serum immunoglobulins and chemotactic and phagocytic activity of neutrophils were assessed in peripheral blood. A decrease in the ingestion phase of phagocytosis by neutrophils was identified, in comparison with the results of 20 healthy children. On the second day, the patient had low fever and, on the third, abdominal pain. In view of this, she underwent a laparotomy that revealed purulent ascites due to Staphylococcus aureus. Specific treatment resulted in rapid regression of the infectious condition and good evolution of the patient. CONCLUSIONS: A decrease in the ingestion stage of phagocytosis by neutrophils preceded staphylococcal purulent ascites clinical manifestations, and immunologic assessment contributed to early diagnosis and treatment of the infection. We believe evaluation of neutrophilic activity is important in patients undergoing intestinal transplantation in order for possible hospital-acquired infections to be early diagnosed.
Antecedentes: La infección hospitalaria, frecuentemente por Staphylococcus aureus, es una complicación importante en los pacientes con trasplante intestinal. Caso clínico: Niña de 2 años de edad sometida a trasplante de intestino delgado debido a vólvulo yeyunal. En el primer día del posoperatorio, en la sangre periférica fueron evaluados fenotipo de linfocitos, inmunoglobulinas séricas, actividad quimiotáctica y fagocitaria de neutrófilos. Se identificó disminución de la etapa de ingestión de fagocitosis neutrofílica, en comparación con los resultados de 20 niños saludables. En el segundo día, la paciente presentó fiebre baja y en el tercero, dolor abdominal. Debido a lo anterior fue sometida a laparotomía que reveló ascitis purulenta por Staphylococcus aureus. El tratamiento específico derivó en regresión rápida del cuadro infeccioso y buena evolución. Conclusiones: La disminución de la etapa de ingestión de la fagocitosis neutrofílica precedió a las manifestaciones clínicas de ascitis purulenta estafilocócica; la evaluación inmunológica contribuyó al diagnóstico y tratamiento precoces de la infección. Creemos que es importante la evaluación de la actividad neutrofílica en pacientes sometidos a trasplante intestinal, con la finalidad de diagnosticar tempranamente posibles infecciones hospitalarias.
Asunto(s)
Ascitis/sangre , Intestino Delgado/trasplante , Neutrófilos/inmunología , Peritonitis/sangre , Complicaciones Posoperatorias/sangre , Infecciones Estafilocócicas/sangre , Ascitis/inmunología , Quimiotaxis de Leucocito , Preescolar , Infección Hospitalaria/sangre , Infección Hospitalaria/inmunología , Diagnóstico Precoz , Femenino , Humanos , Inmunoglobulinas/sangre , Vólvulo Intestinal/cirugía , Enfermedades del Yeyuno/cirugía , Peritonitis/inmunología , Fagocitosis , Complicaciones Posoperatorias/inmunología , Infecciones Estafilocócicas/inmunologíaRESUMEN
Chikungunya (CHIK) is a mosquito-borne virus (CHIKV) infection that recently appeared in the Americas and thousands of confirmed cases have been reported in Brazil since the first autochthonous cases were reported in September 2014. We reported four cases of CHIK in kidney transplant recipients. The diagnosis was confirmed by positive CHIKV real-time polymerase chain reaction in two cases and positive CHIKV-IgM serology in two patients. The time between transplantation and CHIKV infection ranged from 2 to 11 years. All of them had arthralgia, and 3 of them had fever. Other symptoms were mild conjunctivitis, rash, and retro-orbital pain. Kidney function remained stable in all cases. In three patients prednisone doses were temporally increased and the symptoms disappeared concurrently with the increase of the dose. As for the fourth patient, the prednisone dose remained unchanged and yet she improved. Other immunosuppressive drugs were not changed for the four cases. As far as we know, there are only two previously reported cases of CHIK among solid organ transplant recipients besides the four cases reported here. Despite the small number of cases, we can speculate that the use of immunosuppression might have played a role in the paucity of symptoms and the gradual complete recovery with no complication.
Asunto(s)
Fiebre Chikungunya , Trasplante de Riñón , Complicaciones Posoperatorias/virología , Anciano , Animales , Brasil , Fiebre Chikungunya/diagnóstico , Fiebre Chikungunya/inmunología , Fiebre Chikungunya/virología , Virus Chikungunya/genética , Exantema , Femenino , Fiebre , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/inmunología , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
BACKGROUND: BK polyomavirus-associated nephropathy is an important cause of post-transplantation renal failure. We present two cases of BK polyomavirus-associated nephropathy who were submitted to contrasting strategies of clinical follow-up to BK polyomavirus reactivation, but progressed to a similar final outcome. CASE PRESENTATION: Case 1 is a 37-year-old white man whose graft had never presented a good glomerular filtration rate function, with episodes of tacrolimus nephrotoxicity, and no urinary monitoring for BK polyomavirus; stage B BK polyomavirus-associated nephropathy was diagnosed by biopsy at 14 months post-transplant. Despite clinical treatment (dosage decrease and immunosuppressive drug change), he progressed to stage C BK polyomavirus-associated nephropathy and loss of graft function 30 months post-transplant. Case 2 is a 49-year-old mulatto man in his second renal transplantation who was submitted to cytological urinary monitoring for BK polyomavirus; he presented early, persistent, and massive urinary decoy cell shedding and concomitant tacrolimus nephrotoxicity. Even with decreasing immunosuppression, he developed BK polyomavirus-associated nephropathy 1-year post-transplant. Loss of graft function occurred 15 months post-transplant. CONCLUSIONS: Cytological urinary monitoring was an efficient strategy for monitoring BK virus reactivation. Decoy cell shedding may be related to BK polyomavirus-associated nephropathy when extensive and persistent. The presence of associated tacrolimus nephrotoxicity may be a confounding factor for the clinical diagnosis of BK polyomavirus-associated nephropathy.
Asunto(s)
Virus BK/aislamiento & purificación , Huésped Inmunocomprometido/inmunología , Enfermedades Renales/virología , Trasplante de Riñón , Infecciones por Polyomavirus/diagnóstico , Infecciones por Polyomavirus/virología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/virología , Adulto , Relación Dosis-Respuesta a Droga , Rechazo de Injerto/inmunología , Humanos , Inmunosupresores/efectos adversos , Enfermedades Renales/complicaciones , Enfermedades Renales/diagnóstico , Enfermedades Renales/orina , Masculino , Persona de Mediana Edad , Infecciones por Polyomavirus/inmunología , Infecciones por Polyomavirus/orina , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/inmunología , Diálisis Renal , Tacrolimus/efectos adversos , Receptores de Trasplantes , Resultado del Tratamiento , Activación Viral/efectos de los fármacos , Activación Viral/inmunologíaRESUMEN
This study evaluated the effect of an immune-modulatory diet on patients with gastric cancer and identified the parameters associated with postoperative outcomes. This was a single-arm prospective intervention study. At baseline, patients were assessed for nutrition (Patient-Generated Subjective Global Assessment), inflammatory markers (albumin, C-reactive protein, and interleukin 6 [IL-6]), and immune markers (percentage NK, CD4, CD8, and CD4:CD8 ratio); they also received nutrition counseling and high-calorie/protein supplement. A week before surgery, they were assessed for nutrition and inflammatory/immune markers and started on an immune-modulatory supplement until the day before surgery, when they were evaluated again. On the second postoperative day, patients were assessed for inflammatory/immune parameters, and a final nutrition evaluation was performed until the day of discharge. Complications were recorded daily and up to 30 days after discharge. Thirty-seven patients (60 ± 10 years old) were included, and 57% were classified as malnourished. Maintenance of nutrition and immune parameters occurred throughout the study period, but we found a preoperative increase in C-reactive protein (0.1-1.5 mg/dL) and IL-6 (2.0-14.2 pg/mL) and a postoperative increase in the CD4:CD8 ratio (2.3 ± 1.0). Complications and death were seen in 35%, especially patients with higher preoperative IL-6 (2.2-46 pg/mL), lower CD4:CD8 ratio (1.7 ± 0.5), and lower protein (1.2 ± 0.5 g/kg/d) and calorie intake (1552 ± 584 kcal/kg/d). The high-calorie/protein supplementation with the immune-modulating diet was able to maintain the nutrition and immune status of patients with gastric cancer.
Asunto(s)
Proteínas en la Dieta/uso terapéutico , Suplementos Dietéticos , Gastrectomía/efectos adversos , Inmunomodulación , Desnutrición/dietoterapia , Complicaciones Posoperatorias/prevención & control , Neoplasias Gástricas/cirugía , Anciano , Biomarcadores/sangre , Brasil/epidemiología , Instituciones Oncológicas , Ingestión de Energía , Femenino , Humanos , Mediadores de Inflamación/sangre , Masculino , Desnutrición/complicaciones , Desnutrición/epidemiología , Desnutrición/prevención & control , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/inmunología , Prevalencia , Estudios Prospectivos , Riesgo , Estómago/inmunología , Estómago/patología , Estómago/cirugía , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/inmunología , Neoplasias Gástricas/patologíaRESUMEN
ABSTRACT BACKGROUND: Among the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation of the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis. METHODS: 34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols: spinal anesthesia and combined spinal-epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cytometry, along with lymphocyte apoptosis using fluorescent microscopy. RESULTS: Peripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery. CONCLUSION: Peripheral blood lymphocyte apoptosis is an early event in the postoperative period that lasts up to seven days and is not affected by the choice of the anesthetic technique.
RESUMO JUSTIFICATIVA E OBJETIVO: Dentre as muitas alterações causadas por uma ferida cirúrgica, uma das menos estudadas é a imunossupressão pós-operatória. Esse fenômeno é uma causa importante das complicações infecciosas relacionadas à cirurgia, como infecção do sítio cirúrgico ou pneumonia nosocomial. Um dos mecanismos que levam à imunossupressão pós-operatória é a apoptose de células imunológicas. Durante a cirurgia, a anestesia se destina a minimizar as alterações prejudiciais e manter a homeostase perioperatória. O objetivo deste estudo foi avaliar o efeito da técnica anestésica usada para artroplastia total de joelho sobre a apoptose em linfócitos de sangue periférico no pós-operatório. MÉTODOS: Trinta e quatro pacientes submetidos à artroplastia total primária de joelho foram randomicamente designados para dois protocolos de anestesia regional: raquianestesia e bloqueio combinado raqui-peridural. Onze pacientes submetidos à artroplastia total do joelho sob anestesia geral formaram o grupo controle. Antes da cirurgia, logo após a cirurgia, durante o primeiro dia de pós-operatório e sete dias após a cirurgia, amostras de sangue venoso foram colhidas e o estado imunológico do paciente foi avaliado com o uso deflow cysts 87 m, juntamente com apoptose de linfócitos com o uso de microscopia de fluorescência. RESULTADOS: Apoptose em linfócitos de sangue periférico foi observada imediatamente no pós-operatório e acompanhada por uma redução do número de células T e B. Não houve diferença significativa no número de linfócitos apoptóticos de acordo com o protocolo anestésico. Alterações no número de células T CD3/8 e no número de linfócitos apoptóticos foram observadas no sétimo dia após a cirurgia. CONCLUSÃO: Apoptose em linfócitos de sangue periférico é um evento precoce no período pós-operatório que dura até sete dias e não é afetado pela escolha da técnica anestésica.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Apoptosis/inmunología , Artroplastia de Reemplazo de Rodilla/métodos , Anestesia Epidural/métodos , Anestesia Raquidea/métodos , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/epidemiología , Linfocitos B/inmunología , Linfocitos T/inmunología , Artroplastia de Reemplazo de Rodilla/efectos adversos , Citometría de Flujo , Tolerancia Inmunológica , Anestesia General/métodos , Microscopía Fluorescente , Persona de Mediana EdadRESUMEN
BACKGROUND: Among the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation of the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis. METHODS: 34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols: spinal anesthesia and combined spinal-epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cytometry, along with lymphocyte apoptosis using fluorescent microscopy. RESULTS: Peripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery. CONCLUSION: Peripheral blood lymphocyte apoptosis is an early event in the postoperative period that lasts up to seven days and is not affected by the choice of the anesthetic technique.
Asunto(s)
Anestesia Epidural/métodos , Anestesia Raquidea/métodos , Apoptosis/inmunología , Artroplastia de Reemplazo de Rodilla/métodos , Anciano , Anciano de 80 o más Años , Anestesia General/métodos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Linfocitos B/inmunología , Femenino , Citometría de Flujo , Humanos , Tolerancia Inmunológica , Masculino , Microscopía Fluorescente , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/inmunología , Linfocitos T/inmunologíaRESUMEN
Lactobacillus rhamnosus is a rare clinical pathogen. A case of bacteremia caused by L. rhamnosus in a kidney transplant recipient is described. Once considered only as a contaminant or a low-virulence organism, L. rhamnosus might be an opportunistic pathogen in immunocompromised patients. To our knowledge, this is the first report of primary bloodstream infection caused by L. rhamnosus in a kidney transplant recipient.
Asunto(s)
Bacteriemia/diagnóstico , Huésped Inmunocomprometido , Trasplante de Riñón , Lacticaseibacillus rhamnosus/aislamiento & purificación , Complicaciones Posoperatorias/diagnóstico , Adulto , Bacteriemia/inmunología , Femenino , Humanos , Complicaciones Posoperatorias/inmunologíaRESUMEN
This study compared the incidence of CMV infection/disease in de novo kidney transplant recipients receiving everolimus or mycophenolate and no CMV pharmacological prophylaxis. We randomized 288 patients to receive a single 3 mg/kg dose of antithymocyte globulin, tacrolimus, everolimus, and prednisone (r-ATG/EVR, n = 85); basiliximab, tacrolimus, everolimus, and prednisone (BAS/EVR, n = 102); or basiliximab, tacrolimus, mycophenolate, and prednisone (BAS/MPS, n = 101). The primary end-point was the incidence of first CMV infection/disease in the intention-to-treat population at 12 months. Patients treated with r-ATG/EVR showed a 90% proportional reduction (4.7% vs. 37.6%, HR 0.10, 95% CI 0.037-0.29; p < 0.001), while those treated with BAS/EVR showed a 75% proportional reduction (10.8% vs. 37.6%, HR 0.25, 95% CI 0.13-0.48; p < 0.001) in the incidence of CMV infection/disease compared to BAS/MPS. There were no differences in the incidence of acute rejection (9.4 vs. 18.6 vs. 15.8%, p = 0.403), wound-healing complications, delayed graft function, and proteinuria. Mean estimated glomerular filtration rate was lower in BAS/EVR (65.7 ± 21.8 vs. 60.6 ± 20.9 vs. 69.5 ± 21.5 ml/min, p = 0.021). In de novo kidney transplant recipients receiving no pharmacological CMV prophylaxis, reduced-dose tacrolimus and everolimus was associated with a significant reduction in the incidence of CMV infection/disease compared to standard tacrolimus dose and mycophenolate (ClinicalTrials.gov NCT01354301).
Asunto(s)
Infecciones por Citomegalovirus/prevención & control , Everolimus/administración & dosificación , Rechazo de Injerto/prevención & control , Inmunosupresores/administración & dosificación , Trasplante de Riñón , Complicaciones Posoperatorias/prevención & control , Tacrolimus/administración & dosificación , Adulto , Anticuerpos Monoclonales/uso terapéutico , Suero Antilinfocítico/uso terapéutico , Basiliximab , Infecciones por Citomegalovirus/epidemiología , Infecciones por Citomegalovirus/inmunología , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Everolimus/uso terapéutico , Femenino , Humanos , Inmunosupresores/uso terapéutico , Incidencia , Masculino , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/inmunología , Prednisona/uso terapéutico , Estudios Prospectivos , Proteínas Recombinantes de Fusión/uso terapéutico , Sirolimus/uso terapéutico , Tacrolimus/uso terapéutico , Resultado del TratamientoRESUMEN
Our previous study has shown that mangiferin (MGF), a glucosylxanthone from Mangifera indica, exerts gastrointestinal prokinetic action involving a cholinergic mechanism. Postoperative ileus (POI) is a temporary disturbance in gastrointestinal motility following surgery, and intestinal inflammatory response plays a critical role in the pathogenesis of POI. The present study investigated to know whether MGF having anti-inflammatory and prokinetic actions can ameliorate the intestinal inflammation and impaired gastrointestinal transit seen in the mouse model of POI. Experimental POI was induced in adult male Swiss mice by standardized small intestinal manipulation (IM). Twenty-four hours later, gastrointestinal transit was assessed by charcoal transport. MGF was administered orally 1 h before the measurement of GIT. To evaluate the inflammatory response, plasma levels of proinflammatory cytokines TNF-α, IL-1ß, IL-6, and chemokine MCP-1, and the myeloperoxidase activity, nitrate/nitrite level, and histological changes of ileum were determined in mice treated or not with MGF. Experimental POI in mice was characterized by decreased gastrointestinal transit and marked intestinal and systemic inflammatory response. MGF treatment led to recovery of the delayed intestinal transit induced by IM. MGF in ileum significantly inhibited the myeloperoxidase activity, a marker of neutrophil infiltration, and nitrate/nitrite level and reduced the plasma levels of TNF-α, IL-1ß, IL-6, and MCP-1 as well. MGF treatment ameliorates the intestinal inflammatory response and the impaired gastrointestinal motility in the mouse model of POI.
Asunto(s)
Enterocolitis/prevención & control , Fármacos Gastrointestinales/uso terapéutico , Motilidad Gastrointestinal/efectos de los fármacos , Ileus/prevención & control , Complicaciones Posoperatorias/prevención & control , Xantonas/uso terapéutico , Animales , Citocinas/sangre , Modelos Animales de Enfermedad , Enterocolitis/etiología , Enterocolitis/inmunología , Enterocolitis/patología , Fármacos Gastrointestinales/administración & dosificación , Fármacos Gastrointestinales/aislamiento & purificación , Íleon/efectos de los fármacos , Íleon/inmunología , Íleon/patología , Ileus/etiología , Ileus/inmunología , Ileus/patología , Masculino , Mangifera/química , Ratones , Corteza de la Planta/química , Raíces de Plantas/química , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/patología , Xantonas/administración & dosificación , Xantonas/aislamiento & purificaciónRESUMEN
BK polyomavirus (BKPyV) is a causal agent of nephropathy, ureteral stenosis and hemorrhagic cystitis in kidney transplant recipients, and is considered an important emerging disease in transplantation. Regular screening for BKPyV reactivation mainly during the first 2 years posttransplant, with subsequent pre-emptive reduction of immunosuppression is considered the best option to avoid disease progression, since successful clearance or reduction of viremia is achieved in the vast majority of patients within 6 months. The use of drugs with antiviral properties for patients with persistent viremia has been attempted despite unclear benefits. Clinical manifestations of BKPyV nephropathy, current strategies for diagnosis and monitoring of BKPyV infection, management of immunosuppressive regimen after detection of BKPyV reactivation and the use of antiviral drugs are discussed in this review.
Asunto(s)
Virus BK , Trasplante de Riñón , Infecciones por Polyomavirus/diagnóstico , Infecciones por Polyomavirus/terapia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Infecciones Tumorales por Virus/diagnóstico , Infecciones Tumorales por Virus/terapia , Humanos , Terapia de Inmunosupresión/efectos adversos , Monitoreo Fisiológico , Infecciones por Polyomavirus/inmunología , Complicaciones Posoperatorias/inmunología , Infecciones Tumorales por Virus/inmunologíaRESUMEN
BACKGROUND: The use of immunosuppresive drugs in patients with kidney transplantation (KT) could influence the development of oral lesions (OL). The aim of this study was to establish the OL prevalence in a group of KT patients, and explore some possible associations of their presence. METHODS: Cross-sectional study. We examined the oral mucosa (OM) of 190 KT patients searching for OL. Our findings were analyzed by multiple logistic regression, and possible associations between OLs and several variables (demographic, clinical, of immunosuppressor drugs, and of lab results) were explored. RESULTS: Overall OL prevalence was 28.4 %; 15.8 % had oral candidiasis (which was more prevalent in diabetic cases, p = 0.002), herpes simplex 7.4 %, hairy leukoplakia 5.3 %, oral verruca vulgaris 3.7 %, and OM ulcers 2.6 %. The combination of cyclosporin A + azathioprine + prednisone had the highest OL prevalence. Hairy leukoplakia was related to a lower total leukocyte count, p = 0.006, and oral verruca vulgaris to a cadaveric KT donor. CONCLUSIONS: Oral candidiasis was the most prevalent OL, and it was more prevalent in diabetic cases. The association of hairy leukoplakia to a lower total leukocyte count might agree with previous reports classifying it as an immunosuppression marker.
Introducción: el uso de medicamentos inmunosupresores en pacientes con trasplante renal (TR) predispone el desarrollo lesiones bucales (LB) asociadas a inmunosupresión. El objetivo de este estudio fue determinar la prevalencia de LB en un grupo de pacientes con TR y explorar algunas posibles asociaciones de presencia. Métodos: estudio transversal en el que se examinó la mucosa bucal de 190 pacientes con TR, en búsqueda de LB. Los hallazgos se analizaron mediante regresión logística múltiple y se exploraron posibles asociaciones entre las LB y variables demográficas, clínicas, de los medicamentos inmunosupresores, y de laboratorio. Resultados: la prevalencia de LB fue de 28.4 %; la candidiasis bucal (CB), con 15.8 %, fue más frecuente en diabéticos (p = 0.002); el herpes simple 7.4 %; la leucoplasia vellosa 5.3 %; las verrugas vulgares peribucales 3.7 %, y las úlceras 2.6 %. La combinación de ciclosporina A + azatioprina + prednisona tuvo la mayor frecuencia de LB. La leucoplasia vellosa se asoció a una cifra más baja de leucocitos totales (p = 0.006) y las verrugas peribucales a TR de donador cadavérico. Conclusión: la LB más frecuente fue la CB, la cual fue más frecuente en diabéticos. La asociación de leucoplasia vellosa con una cuenta más baja de leucocitos concuerda con su clasificación previa como marcador de inmunosupresión.
Asunto(s)
Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Trasplante de Riñón , Enfermedades de la Boca/inmunología , Complicaciones Posoperatorias/inmunología , Adulto , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedades de la Boca/epidemiología , Enfermedades de la Boca/etiología , Mucosa Bucal/inmunología , Mucosa Bucal/patología , Complicaciones Posoperatorias/epidemiología , PrevalenciaRESUMEN
PURPOSE: To evaluate the effects of sustained deep inspiration in the prevention of postoperative pulmonary complications, the hormonal and immunological responses in patients submitted to abdominal surgery. METHODS: This randomized clinical trial study included 75 patients submitted to abdominal surgery, of which 36 were randomly allocated in the experimental group and underwent sustained deep inspiration during five seconds, in three sets of ten repetitions per day. The others 39 patients were allocated in the control group and were not submitted to any breathing exercise. The following parameters were measured preoperatively, 24h and 48h postoperatively: chest x-ray, serum ACTH, cortisol, IL-4, IL-10, TNF-α, forced expiratory volume in first second (FEV1), forced expiratory flow 25-75% (FEF 25-75), forced vital capacity (FVC), paO2 and paCO2. RESULTS: Mean serum cortisol in patients of the experimental and control groups before surgery were 12.8 mcg/dl (4.6-50) and 10.48 mcg/dl (1-29.1), respectively (p=0.414). The experimental group had significantly increase in serum cortisol levels, 23.6 mcg/dl (9.3-45.8), especially 24h postoperatively (p=0.049). CONCLUSION: Sustained deep inspiration in patients submitted to abdominal surgery determined important changes in serum cortisol, however, without significantly influence the postoperative pulmonary complications and the endocrine and immune responses.
Asunto(s)
Abdomen/cirugía , Ejercicios Respiratorios , Complicaciones Posoperatorias/prevención & control , Hormona Adrenocorticotrópica/sangre , Adulto , Citocinas/sangre , Femenino , Humanos , Hidrocortisona/sangre , Inhalación/fisiología , Masculino , Complicaciones Posoperatorias/inmunología , Espirometría , Estadísticas no Paramétricas , Resultado del Tratamiento , Capacidad VitalRESUMEN
PURPOSE: To evaluate the effects of sustained deep inspiration in the prevention of postoperative pulmonary complications, the hormonal and immunological responses in patients submitted to abdominal surgery. METHODS: This randomized clinical trial study included 75 patients submitted to abdominal surgery, of which 36 were randomly allocated in the experimental group and underwent sustained deep inspiration during five seconds, in three sets of ten repetitions per day. The others 39 patients were allocated in the control group and were not submitted to any breathing exercise. The following parameters were measured preoperatively, 24h and 48h postoperatively: chest x-ray, serum ACTH, cortisol, IL-4, IL-10, TNF-α, forced expiratory volume in first second (FEV1), forced expiratory flow 25-75% (FEF 25-75), forced vital capacity (FVC), paO2 and paCO2. RESULTS: Mean serum cortisol in patients of the experimental and control groups before surgery were 12.8 mcg/dl (4.6-50) and 10.48 mcg/dl (1-29.1), respectively (p=0.414). The experimental group had significantly increase in serum cortisol levels, 23.6 mcg/dl (9.3-45.8), especially 24h postoperatively (p=0.049). CONCLUSION: Sustained deep inspiration in patients submitted to abdominal surgery determined important changes in serum cortisol, however, without significantly influence the postoperative pulmonary complications and the endocrine and immune responses.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Abdomen/cirugía , Ejercicios Respiratorios , Complicaciones Posoperatorias/prevención & control , Hormona Adrenocorticotrópica/sangre , Citocinas/sangre , Hidrocortisona/sangre , Inhalación/fisiología , Complicaciones Posoperatorias/inmunología , Espirometría , Estadísticas no Paramétricas , Resultado del Tratamiento , Capacidad VitalRESUMEN
Post transplant lymphoproliferative disease (PTLD) associated with EBV infection is one of the most life-threatening complications in SOT and HSCT. Risk factors for infection or reactivation of EBV in SOT are the use of greater immunosuppression, seronegative receptor and CMV infection. In HSCT, the risk factors are related to type of transplant, HLA disparity, the greater immunosuppression, T-cell depletion and severe GVHD. There is no scientific evidence to support the use of specific therapy for prophylaxis of EBV infection. Prophylaxis recommendations focus on avoid exposure of transplant recipients to sources of virus, through hygiene practices such as hand washing (A3), avoid sharing utensils (B3) and avoid contact with potentially infected secretions (respiratory or saliva) (A2). For PTLD prevention, the recommendation is regular EBV viral load monitoring by rtPCR. In SOT with logarithmic rising of EBV loads, it is recommended to reduce immunosuppression and periodically perform exams to diagnose PTLD. In HSCT, it is recommended to reduce immunosuppression whenever possible, and use rituximab according to speciic protocol. Acyclovir or gancyclovir have not proven to be of any eficacy in PTLD prophylaxis in SOT (C3) or HSCT (D2), so their administration as preemptive therapy is no recommended.
El síndrome linfoproliferativo (SLP) asociado a VEB constituye una grave complicación en TOS y en TPH. Los factores de riesgo de infección o reactivación de VEB en TOS son el uso de mayor inmunosupresión, la seronegatividad del receptor previa al trasplante y la infección por CMV. En TPH se consideran factores de riesgo el tipo de trasplante, disparidad HLA, mayor inmunosupresión, depleción linfocitaria y enfermedad injerto contra hospedero (EICH) grave. No hay evidencia cientíica que apoye el uso de medidas especíicas de proilaxis en prevención de infección por VEB. Se recomienda evitar la exposición a fuentes del virus de los candidatos a trasplantes a través de prácticas de higiene tales como lavado de manos (A3), evitar el compartir utensilios (B3) y evitar el contacto con potenciales secreciones infectadas (respiratorias o saliva) (A2). Para la prevención de SLP, se recomienda un esquema de monitoreo periódico de carga viral de VEB por RPC-TR. En el caso de TOS con cargas de VEB en ascenso logarítmico, se recomienda disminuir inmuno-supresión y buscar activa y periódicamente la aparición de SLP. En TPH, se recomienda, en lo posible, disminuir la inmunosupresión y se reserva el uso de rituximab para casos especíicos según protocolo. El uso de aciclovir o ganciclovir no han demostrado constituir medidas profilácticas efectivas en TOS (C3) ni en TPH (D2), no siendo recomendada su administración en esquemas de terapia anticipada.
Asunto(s)
Adulto , Niño , Humanos , Antivirales/uso terapéutico , Infecciones por Virus de Epstein-Barr/prevención & control , Trastornos Linfoproliferativos/prevención & control , Trasplante de Órganos , Complicaciones Posoperatorias/prevención & control , Trasplante de Células Madre , Infecciones por Virus de Epstein-Barr/epidemiología , Infecciones por Virus de Epstein-Barr/inmunología , Incidencia , Trastornos Linfoproliferativos/epidemiología , Trastornos Linfoproliferativos/virología , Guías de Práctica Clínica como Asunto , Complicaciones Posoperatorias/inmunología , Factores de RiesgoRESUMEN
BACKGROUND: Parenteral lipid emulsions (LEs) can influence leukocyte functions. The authors investigated the effect of 2 LEs on leukocyte death in surgical patients with gastrointestinal cancer. MATERIAL AND METHODS: Twenty-five patients from a randomized, double-blind clinical trial (ID: NCT01218841) were randomly included to evaluate leukocyte death after 3 days of preoperative infusion (0.2 g fat/kg/d) of an LE composed equally of medium/long-chain triglycerides and soybean oil (MCTs/LCTs) or pure fish oil (FO). Blood samples were collected before (t0) and after LE infusion (t1) and on the third postoperative day (t2). RESULTS: After LE infusion (t1 vs t0), MCTs/LCTs did not influence cell death; FO slightly increased the proportion of necrotic lymphocytes (5%). At the postoperative period (t2 vs t0), MCTs/LCTs tripled the proportion of apoptotic lymphocytes; FO maintained the slightly increased proportion of necrotic lymphocytes (7%) and reduced the percentage of apoptotic lymphocytes by 74%. In the postoperative period, MCT/LCT emulsion increased the proportion of apoptotic neutrophils, and FO emulsion did not change any parameter of apoptosis in the neutrophil population. There were no differences in lymphocyte or neutrophil death when MCT/LCT and FO treatments were compared during either preoperative or postoperative periods. MCT/LCTs altered the expression of 12 of 108 genes related to cell death, with both pro- and antiapoptotic effects; FO modulated the expression of 7 genes, demonstrating an antiapoptotic effect. CONCLUSION: In patients with gastrointestinal cancer, preoperative MCT/LCT infusion was associated with postoperative lymphocyte and neutrophil apoptosis. FO has a protective effect on postoperative lymphocyte apoptosis.
Asunto(s)
Apoptosis/efectos de los fármacos , Emulsiones Grasas Intravenosas/uso terapéutico , Aceites de Pescado/uso terapéutico , Neoplasias Gastrointestinales , Leucocitos/efectos de los fármacos , Complicaciones Posoperatorias/prevención & control , Triglicéridos/uso terapéutico , Apoptosis/genética , Emulsiones Grasas Intravenosas/farmacología , Femenino , Aceites de Pescado/farmacología , Neoplasias Gastrointestinales/inmunología , Neoplasias Gastrointestinales/cirugía , Expresión Génica/efectos de los fármacos , Humanos , Infusiones Parenterales , Masculino , Persona de Mediana Edad , Neutrófilos/efectos de los fármacos , Complicaciones Posoperatorias/inmunología , Cuidados Preoperatorios , Triglicéridos/farmacologíaRESUMEN
BACKGROUND AND OBJECTIVES: The number of patients allergic to latex has increased significantly. It is crucial to recognize the cases in order to prevent and apply adequate treatment. The objective of this study was to evaluate the prevalence of allergy to latex in meningomyelocele patients. MATERIALS AND METHODS: A retrospective evaluation of medical records of patients with meningomyelocele diagnosis from January 2002 to December 2007 was conducted. Patients were grouped into allergics and non-allergics. The comparison of groups for gender was made by the Chi-Squared test, the Student's t test was used to compare age, and Mann-Whitney test was used to compare groups for clinical manifestations of allergy, number of procedures under anesthesia, hospital admissions and vesical catheterizations. RESULTS: The mean number of procedures under anesthesia was 7 in the group with allergy and 4 in the group without allergy; this difference was statistically significant (p=0.028). The mean number of hospital admissions was 4.5 in the group with allergy and 3.4 in group without allergy and mean vesical catheterization was 24.5 in allergic patients and 21.7 in non allergic ones. CONCLUSIONS: Meningomyelocele patients undergoing multiple procedures under anesthesia have high risk of developing clinical signals of allergy to latex. It is necessary that patients with meningomyelocele diagnosis should undergo exclusively latex-free procedures, avoiding high risk of sensitization and its complications. Specific tests to evaluate sensitization, genetic markers and latex-fruit relationship may contribute to a better understanding of risk factors related to allergy to latex and ways to prevent it.
Asunto(s)
Hipersensibilidad al Látex/epidemiología , Meningomielocele/inmunología , Meningomielocele/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/inmunología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
Reperfusion injury remains one of the major problems in transplantation. Repair from ischaemic acute renal failure (ARF) involves stimulation of tubular epithelial cell proliferation. The aim of this exploratory study was to evaluate the effects of preconditioning donor animals with rapamycin and tacrolimus to prevent ischaemia-reperfusion (I/R) injury. Twelve hours before nephrectomy, the donor animals received immunosuppressive drugs. The animals were divided into four groups, as follows: group 1 control: no treatment; group 2: rapamycin (2 mg/kg); group 3 FK506 (0, 3 mg/kg); and group 4: FK506 (0, 3 mg/kg) plus rapamycin (2 mg/kg). The left kidney was removed and after 3 h of cold ischaemia, the graft was transplanted. Twenty-four hours after transplant, the kidney was recovered for histological analysis and cytokine expression. Preconditioning treatment with rapamycin or tacrolimus significantly reduced blood urea nitrogen and creatinine compared with control [blood urea nitrogen (BUN): P < 0·001 versus control and creatinine: P < 0·001 versus control]. A further decrease was observed when rapamycin was combined with tacrolimus. Acute tubular necrosis was decreased significantly in donors treated with immunosuppressants compared with the control group (P < 0·001 versus control). Moreover, the number of apoptotic nuclei in the control group was higher compared with the treated groups (P < 0·001 versus control). Surprisingly, only rapamycin preconditioning treatment increased anti-apoptotic Bcl2 levels (P < 0·001). Finally, inflammatory cytokines, such as tumour necrosis factor (TNF)-α and interleukin (IL)-6, showed lower levels in the graft of those animals that had been pretreated with rapamycin or tacrolimus. This exploratory study demonstrates that preconditioning donor animals with rapamycin or tacrolimus improves clinical outcomes and reduce necrosis and apoptosis in kidney I/R injury.
Asunto(s)
Inmunosupresores/administración & dosificación , Trasplante de Riñón , Complicaciones Posoperatorias/prevención & control , Premedicación , Daño por Reperfusión/prevención & control , Sirolimus/administración & dosificación , Tacrolimus/administración & dosificación , Animales , Apoptosis/efectos de los fármacos , Nitrógeno de la Urea Sanguínea , Complemento C3/análisis , Creatinina/sangre , Citocinas/sangre , Evaluación de Medicamentos , Sinergismo Farmacológico , Quimioterapia Combinada , Inmunosupresores/uso terapéutico , Necrosis Tubular Aguda/sangre , Necrosis Tubular Aguda/etiología , Necrosis Tubular Aguda/inmunología , Necrosis Tubular Aguda/prevención & control , Masculino , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/inmunología , Proteínas Proto-Oncogénicas c-bcl-2/biosíntesis , Distribución Aleatoria , Ratas , Ratas Wistar , Daño por Reperfusión/sangre , Daño por Reperfusión/etiología , Daño por Reperfusión/inmunología , Sirolimus/uso terapéutico , Tacrolimus/uso terapéuticoRESUMEN
Post transplant lymphoproliferative disease (PTLD) associated with EBV infection is one of the most life-threatening complications in SOT and HSCT. Risk factors for infection or reactivation of EBV in SOT are the use of greater immunosuppression, seronegative receptor and CMV infection. In HSCT, the risk factors are related to type of transplant, HLA disparity, the greater immunosuppression, T-cell depletion and severe GVHD. There is no scientific evidence to support the use of specific therapy for prophylaxis of EBV infection. Prophylaxis recommendations focus on avoid exposure of transplant recipients to sources of virus, through hygiene practices such as hand washing (A3), avoid sharing utensils (B3) and avoid contact with potentially infected secretions (respiratory or saliva) (A2). For PTLD prevention, the recommendation is regular EBV viral load monitoring by rtPCR. In SOT with logarithmic rising of EBV loads, it is recommended to reduce immunosuppression and periodically perform exams to diagnose PTLD. In HSCT, it is recommended to reduce immunosuppression whenever possible, and use rituximab according to speciic protocol. Acyclovir or gancyclovir have not proven to be of any eficacy in PTLD prophylaxis in SOT (C3) or HSCT (D2), so their administration as preemptive therapy is no recommended.