10 results on '"Pehuén Fernández"'
Search Results
2. A single-oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve outcomes in the COVID-19 disease: the COVID-VIT-D—a randomised multicentre international clinical trial
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Jorge B. Cannata-Andía, Augusto Díaz-Sottolano, Pehuén Fernández, Carmen Palomo-Antequera, Pablo Herrero-Puente, Ricardo Mouzo, Natalia Carrillo-López, Sara Panizo, Guillermo H. Ibañez, Carlos A. Cusumano, Carolina Ballarino, Vicente Sánchez-Polo, Jacqueline Pefaur-Penna, Irene Maderuelo-Riesco, Jesús Calviño-Varela, Mónica D. Gómez, Carlos Gómez-Alonso, John Cunningham, Manuel Naves-Díaz, Walter Douthat, José L. Fernández-Martín, and the COVID-VIT-D trial collaborators
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SARS-CoV-2 ,COVID-19 disease ,Cholecalciferol ,Vitamin D ,Medicine - Abstract
Abstract Background Vitamin D status has been implicated in COVID-19 disease. The objective of the COVID-VIT-D trial was to investigate if an oral bolus of cholecalciferol (100,000 IU) administered at hospital admission influences the outcomes of moderate-severe COVID-19 disease. In the same cohort, the association between baseline serum calcidiol levels with the same outcomes was also analysed. Methods The COVID-VIT-D is a multicentre, international, randomised, open label, clinical trial conducted throughout 1 year. Patients older than 18 years with moderate-severe COVID-19 disease requiring hospitalisation were included. At admission, patients were randomised 1:1 to receive a single oral bolus of cholecalciferol (n=274) or nothing (n=269). Patients were followed from admission to discharge or death. Length of hospitalisation, admission to intensive care unit (ICU) and mortality were assessed. Results In the randomised trial, comorbidities, biomarkers, symptoms and drugs used did not differ between groups. Median serum calcidiol in the cholecalciferol and control groups were 17.0 vs. 16.1 ng/mL at admission and 29.0 vs. 16.4 ng/mL at discharge, respectively. The median length of hospitalisation (10.0 [95%CI 9.0–10.5] vs. 9.5 [95%CI 9.0–10.5] days), admission to ICU (17.2% [95%CI 13.0–22.3] vs. 16.4% [95%CI 12.3–21.4]) and death rate (8.0% [95%CI 5.2–12.1] vs. 5.6% [95%CI 3.3–9.2]) did not differ between the cholecalciferol and control group. In the cohort analyses, the highest serum calcidiol category at admission (>25ng/mL) was associated with lower percentage of pulmonary involvement and better outcomes. Conclusions The randomised clinical trial showed the administration of an oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve the outcomes of the COVID-19 disease. A cohort analysis showed that serum calcidiol at hospital admission was associated with outcomes. Trial registration COVID-VIT-D trial was authorised by the Spanish Agency for Medicines and Health products (AEMPS) and registered in European Union Drug Regulating Authorities Clinical Trials (EudraCT 2020-002274-28) and in ClinicalTrials.gov ( NCT04552951 ).
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- 2022
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3. Estimation of Glomerular Filtration Rate in Obese Patients: Utility of a New Equation
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Pehuén Fernández, María Laura Nores, Walter Douthat, Javier de Arteaga, Pablo Luján, Mario Campazzo, Jorge de La Fuente, and Carlos Chiurchiu
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glomerular filtration rate ,obesity ,creatinine-based equations ,kidney function tests ,iothalamate meglumine ,chronic kidney disease ,Nutrition. Foods and food supply ,TX341-641 - Abstract
There is no consensus on the best equation to estimate glomerular filtration rate (eGFR) in obese patients (OP). Objective: to evaluate the performance of the current equations and the new Argentinian Equation (“AE”) to estimate GFR in OP. Two validation samples were used: internal (IVS, using 10-fold cross-validation) and temporary (TVS). OP whose GFR was measured (mGFR) with clearance of iothalamate between 2007/2017 (IVS, n = 189) and 2018/2019 (TVS, n = 26) were included. To evaluate the performance of the equations we used: bias (difference between eGFR and mGFR), P30 (percentage of estimates within ±30% of mGFR), Pearson’s correlation (r) and percentage of correct classification (%CC) according to the stages of CKD. The median age was 50 years. Sixty percent had grade I obesity (G1-Ob), 25.1% G2-Ob and 14.9% G3-Ob, with a wide range in mGFR (5.6–173.1 mL/min/1.73 m2). In the IVS, AE obtained a higher P30 (85.2%), r (0.86) and %CC (74.4%), with lower bias (−0.4 mL/min/1.73 m2). In the TVS, AE obtained a higher P30 (88.5%), r (0.89) and %CC (84.6%). The performance of all equations was reduced in G3-Ob, but AE was the only one that obtained a P30 > 80% in all degrees. AE obtained better overall performance to estimate GFR in OP and could be useful in this population. Conclusions from this study may not be generalizable to all populations of obese patients since they were derived from a study in a single center with a very specific ethnic mixed population.
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- 2023
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4. Características clínicas y epidemiológicas de pacientes hospitalizados por infección por SARS-CoV-2 en dos hospitales en Córdoba
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Emanuel José Saad, María Antonella Correa Barovero, Federico Ariel Marucco, Silvina Trinidad Rodríguez Bonazzi, Ayelén Tarditi Barra, Melani Zlotogora, Sofía María Villada, Augusto Douthat y Barrionuevo, María Celeste Heredia, Juan Pablo Caeiro, Pehuén Fernández, and Ricardo Arturo Albertini
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infecciones por coronavirus ,neumonía ,pacientes internos ,pronóstico ,betacoronavirus ,Medicine ,Medicine (General) ,R5-920 - Abstract
Introducción: La enfermedad COVID-19 muestra una marcada heterogeneidad en su curso clínico, habiéndose descripto algunos factores que se asocian un peor pronóstico. El conocimiento del comportamiento de la enfermedad en el escenario local es de gran relevancia para permitir un mejor abordaje. Métodos: Estudio retrospectivo en dos hospitales de la ciudad de Córdoba, Argentina, de pacientes de 18 años o más hospitalizados por infección activa por SARS-CoV-2, desde marzo a octubre del año 2020. Resultados: Se incluyeron 448 pacientes, de los cuales el 95.75% correspondieron a neumonía COVID-19. La mayoría de los episodios ocurrieron en hombres (63.6%), la mediana de edad fue 63 años (RIC:53-75), y las comorbilidades más frecuentes fueron hipertensión arterial (55.1%), obesidad (31.7%) y diabetes mellitus (28.1%). Requirieron ingreso a unidad de cuidados intensivos 162 pacientes (36.2%) y 66 (14.7%), asistencia respiratoria mecánica. Fallecieron 67 pacientes (15%) dentro de los primeros 30 días de seguimiento. En el análisis multivariado la única variable independiente predictora de mortalidad a los 30 días fue la edad (Odds ratio ajustado [ORa]=1.08, IC95%=1.04-1.11, p
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- 2021
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5. Biomarkers of bone and mineral disorders (FGF-23, fetuin-A) and vascular calcification scores as predictive tools for cardiovascular death in dialysis patients, at 10 years of follow-up
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Pehuén, Fernández, Walter, Douthat, Mauro, Castellano, Gabriela, Cardozo, Gabriela, Garay, Javier, de Arteaga, Carlos, Chiurchiu, and Jorge, de la Fuente
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Minerals ,alpha-2-HS-Glycoprotein ,Infectious and parasitic diseases ,RC109-216 ,RC581-607 ,vascular calcifications ,mortality ,bone and mineral metabolism ,Fibroblast Growth Factor-23 ,Renal Dialysis ,chronic renal failure ,Humans ,Kidney Failure, Chronic ,Medicine ,Prospective Studies ,fgf 23 ,Immunologic diseases. Allergy ,Vascular Calcification ,fetuin a ,Biomarkers ,Follow-Up Studies - Abstract
Cardiovascular disorders represent the leading cause of death in dialysis patients. Alterations of bone and mineral metabolism (BMM) and vascular calcifications play a fundamental role in it. The objective of this study was to evaluate the predictive role on cardiovascular mortality of the measurement of biomarkers of BMM and vascular calcifications. A prospective cohort study was performed. All prevalent patients on chronic dialysis in September 2009 at our institution, who completed the total of the complementary studies, were studied. BMM biomarkers were measured (FGF 23, fetuin A, PTH, calcium and phosphorus) and the vascular calcifications were evaluated using the Kauppila and Adragao scores. Follow-up was carried out until 1/1/2019, death or transplant. Of the 30 patients included, 7 (23.3%) died due to cardiovascular causes. The follow-up time was 44.1 ± 30.4 (range = 1.4-112) months. The Adragao score was the only predictive variable of long-term cardiovascular mortality (area under the curve = 0.82; 95% CI 0.64-0.94; p0.001). The best cut-off point was 5 (sensitivity = 85.7%; specificity = 78.3%). It was also an independent risk factor for cardiovascular mortality adjusted for age, diabetes mellitus, coronary heart disease, aortic calcifications, time spent on dialysis and follow-up time (adjusted OR = 1.77; 95% CI = 1.06-2.96; p = 0.028). The vascular calcifications quantified from the Adragao score were the only independent predictor of long-term cardiovascular mortality. This score represents a simple, useful and superior tool to the biomarkers of BMM.Los trastornos cardiovasculares representan la primera causa de muerte en los pacientes en diálisis. Las alteraciones del metabolismo óseo y mineral (MOM) y las calcificaciones vasculares juegan un papel fundamental en la misma. El objetivo de este estudio fue evaluar el rol predictor sobre la mortalidad cardiovascular de la medición de los biomarcadores del MOM y las calcificaciones vasculares. Se realizó un estudio de cohorte prospectivo. Se estudiaron todos los pacientes prevalentes en diálisis crónica en septiembre del 2009 en nuestra institución que completaron el total de los estudios complementarios. Se midieron biomarcadores del MOM (FGF 23, fetuína A, PTH, calcio y fósforo) y se evaluaron las calcificaciones vasculares mediante los scores de Kauppila y de Adragao. Se realizó un seguimiento hasta el 1/1/2019, la muerte o el trasplante. De los 30 pacientes incluidos, 7 (23.3%) fallecieron por causa cardiovascular. El tiempo de seguimiento fue de 44.1 ± 30.4 (rango = 1.4-112) meses. El score de Adragao fue la única variable predictiva de muerte cardiovascular a largo plazo (área bajo la curva = 0.82; IC95% = 0.64-0.94; p0.001). El mejor punto de corte fue de 5 (sensibilidad = 85.7%; especificidad = 78.3%). Además, fue un factor de riesgo independiente de muerte cardiovascular ajustado por edad, diabetes mellitus, enfermedad coronaria, calcificaciones aorticas, tiempo de permanencia en diálisis y tiempo de seguimiento (OR ajustado = 1.77; IC95% = 1.06-2.96; p = 0.028). Las calcificaciones vasculares cuantificadas a partir del score de Adragao fueron el único predictor independiente de mortalidad cardiovascular a largo plazo. Este score representa una herramienta simple, útil y superior a los biomarcadores del MOM.
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- 2021
6. Glomerulopathies after vaccination against COVID-19. Four cases with three different vaccines in Argentina
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Javier de Arteaga, Jorge de la Fuente, María Emilia García Chiple, Walter Douthat, Pehuén Fernández, Carlos Chiurchiu, and María Luján Alaye
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Vaccination ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Nephrology ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Medicine ,business ,Virology ,Letter to the Editor - Published
- 2021
7. Recurrent atypical hemolytic uremic syndrome after renal transplantation: treatment with eculizumab
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Ana B, Latzke, Pehuén, Fernández, Carlos, Chiurchiu, Daniela, Sarmantano, Javier, De Arteaga, Walter, Douthat, and Jorge, De la Fuente
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Graft Rejection ,lcsh:Immunologic diseases. Allergy ,recurrence ,Adolescent ,atypical hemolytic uremic syndrome ,lcsh:R ,lcsh:Medicine ,Acute Kidney Injury ,renal transplantation ,Antibodies, Monoclonal, Humanized ,urologic and male genital diseases ,Kidney Transplantation ,thrombotic microangiopathy ,lcsh:Infectious and parasitic diseases ,Humans ,Female ,eculizumab ,lcsh:RC109-216 ,lcsh:RC581-607 ,Immunosuppressive Agents - Abstract
Atypical hemolytic uremic syndrome (aHUS) is a rare entity. It is characterized by a thrombotic microangiopathy (nonimmune hemolytic anemia, thrombocytopenia, and acute renal failure), with a typical histopathology of thickening of capillary and arteriolar walls and an obstructive thrombosis of the vascular lumen. The syndrome is produced by a genetic or acquired deregulation of the alternative pathway of the complement system, with high rates of end stage renal disease, post-transplant recurrence, and high mortality. Mutations associated with factor H, factor B and complement C3 show the worst prognosis. Even though plasma therapy is occasionally useful, eculizumab is effective both for treatment and prevention of post-transplant recurrence. We describe here an adult case of congenital aHUS (C3 mutation) under preventive treatment with eculizumab after renal transplantation, with neither disease recurrence nor drug-related adverse events after a 36-months follow-up.
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- 2018
8. Inadequate doses of hemodialysis. Predisposing factors, causes and prevention
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Pehuén, Fernández, Silvana, Núñez, Javier, De Arteaga, Carlos, Chiurchiu, Walter, Douthat, and Jorge, De La Fuente
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Male ,lcsh:Immunologic diseases. Allergy ,hemodialysis ,lcsh:R ,lcsh:Medicine ,dialysis dose ,Middle Aged ,lcsh:Infectious and parasitic diseases ,Cross-Sectional Studies ,Renal Dialysis ,Risk Factors ,sub-dialysis ,urea kinetic modeling ,Humans ,Kidney Failure, Chronic ,Female ,lcsh:RC109-216 ,lcsh:RC581-607 ,Algorithms - Abstract
Patients receiving sub-optimal dose of hemodialysis have increased morbidity and mortality. The objectives of this study were to identify predisposing factors and causes of inadequate dialysis, and to design a practical algorithm for the management of these patients. A cross-sectional study was conducted. Ninety patients in chronic hemodialysis at Hospital Privado Universitario de Córdoba were included, during September 2015. Twenty two received sub-optimal dose of hemodialysis. Those with urea distribution volume (V) greater than 40 l (72 kg body weight approximately) are 11 times more likely (OR = 11.6; CI 95% = 3.2 to 51.7, p < 0.0001) to receive an inadequate dose of hemodialysis, than those with a smaller V. This situation is more frequent in men (OR = 3.5; 95% CI 1.01-15.8; p = 0.0292). V greater than 40 l was the only independent predictor of sub-dialysis in the multivariate analysis (OR = 10.3; 95% CI 2.8-37; p < 0.0004). The main cause of suboptimal dialysis was receiving a lower blood flow (Qb) than the prescribed (336.4 ± 45.8 ml/min vs. 402.3 ± 28.8 ml/min respectively, p < 0.0001) (n = 18). Other causes were identified: shorter duration of the session (n = 2), vascular access recirculation (n = 1), and error in the samples (n = 1). In conclusion, the only independent predisposing factor found in this study for sub-optimal dialysis is V greater than 40 l. The main cause was receiving a slower Qb than prescribed. From these findings, an algorithm for the management of these patients was developed
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- 2017
9. Infecciones urinarias en el primer año postrasplante renal
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Paula Vilella, Juan Pablo Maldonado, Pehuen Fernández, María Fernanda Flores, Camila De Bernardi, Karen Y Vilte Velazquez, Daniela Hernández, Jorge Luis De La Fuente, and Emanuel José Saad
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trasplante de riñón ,infecciones urinarias ,infecciones ,huésped inmunocomprometido ,Medicine ,Medicine (General) ,R5-920 - Abstract
Introducción: Las infecciones del tracto urinario (ITU) constituyen la infección más frecuente en los trasplantados renales (TR). El objetivo principal fue determinar las características clínicas y microbiológicas de las ITU que ocurren durante el primer año posterior al TR. Metodología: Estudio de cohorte retrospectivo, donde se incluyeron pacientes mayores 18 años que recibieron un TR entre 2009-2020 en dos hospitales de la ciudad de Córdoba. A través del registro en las historias clínicas se realizó seguimiento de los pacientes durante el primer año postrasplante y se analizaron los que presentaron al menos un episodio de ITU. Resultados: En el período de estudio, se realizaron 568 TR, de los cuales 207(36,4%) tuvieron al menos un episodio de ITU. En total hubo 419 episodios de ITU, 6(1,4%) episodios de ITU polimicrobianos, se identificaron un total de 426 microorganismos en total en los urocultivos. Del total de episodios 206(49,2%) ocurrieron entre los 31-180 días postrasplante. El principal agente etiológico fue E. coli con 225 aislamientos(52,8%) seguido de Klebsiella sp. con 94(22,1%). El 52,1% del total de episodios fueron causados por microorganismos multirresistentes (MMR). Entre los aislamientos de E. coli, 94(41,8%) fueron MMR. El principal factor de riesgo asociado a ITU por MMR fue el antecedente de ITUs recurrentes (RR=1,62; IC95%=1,29-2,02; p
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- 2023
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10. Trasplante renal y disminución de la mortalidad en los programas de diálisis crónica
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Walter G. Douthat, Pehuén Fernández, Jessica Rechene, Carlos R. Chiurchiu, Javier De Arteaga, Pablo U. Massari, and Jorge De La Fuente
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lcsh:Immunologic diseases. Allergy ,Trasplante renal ,lcsh:R ,Diálisis ,lcsh:Medicine ,lcsh:RC109-216 ,Insuficiencia renal crónica ,lcsh:RC581-607 ,lcsh:Infectious and parasitic diseases - Abstract
El trasplante renal (TR) presenta mejor supervivencia, calidad de vida y costos que la diálisis en la insuficiencia renal crónica (IRC). Estudiamos pacientes en diálisis que recibieron TR durante 2010, las causas de finalización del tratamiento y la supervivencia en diálisis. Evaluamos si criterios más amplios para la aceptación de trasplantes hubieran afectado los resultados del procedimiento en ese período. Incluimos 118 pacientes en diálisis, edad media 56.9 ± 18.4 años, tiempo en diálisis 45.5 ± 59.6 meses, 35 (30%) presentaban diabetes como causa de IRC, y 58 (49%) estaban en espera del TR. Treinta y cuatro finalizaron diálisis, 18 por TR y 12 por fallecimiento. Las principales causas de muerte fueron cardiovasculares, 6 (50%) e infecciones, 2 (17%). La supervivencia al año fue 85% para el grupo total, 98% para los pacientes inscriptos en lista de espera y 72% para no inscriptos. Durante 2010 se realizaron 88 TR (62 con donantes cadavéricos [DC], 18 donantes vivos y 8 dobles trasplantes páncreas-riñón). Los receptores de DC tenían en promedio 50.7 años, 67 meses en diálisis, 8 (13%) eran diabéticos, 12 (20%) con TR previos y 3 cross match contra panel de anticuerpos > 20%. Los donantes tenían edad media 45 años, 28 (45%) con criterios expandidos y 27.7 h de isquemia fría. A los 11.4 meses de seguimiento, 13 (21%) presentó rechazo agudo, la supervivencia para injerto fue de 88% y 93% para pacientes. La principal causa de finalización de diálisis fue TR, sin detectarse que el empleo de DC afectara la supervivencia del TR.
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- 2014
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