Search

Background Sodium–glucose cotransporter-2 inhibitors (SGLT2is) have cardioprotective and renoprotective effects. However, experience with SGLT2is in diabetic kidney transplant recipients (DKTRs) is limited. Methods This observational multicentre study was designed to examine the efficacy and safety of SGLT2is in DKTRs. The primary outcome was adverse effects within 6 months of SGLT2i treatment. Results Among 339 treated DKTRs, adverse effects were recorded in 26%, the most frequent (14%) being urinary tract infection (UTI). In 10%, SGLT2is were suspended mostly because of UTI. Risk factors for developing a UTI were a prior episode of UTI in the 6 months leading up to SGLT2i use {odds ratio [OR] 7.90 [confidence interval (CI) 3.63–17.21]} and female sex [OR 2.46 (CI 1.19–5.03)]. In a post hoc subgroup analysis, the incidence of UTI emerged as similar in DKTRs treated with SGLT2i for 12 months versus non-DKTRs (17.9% versus 16.7%). Between baseline and 6 months, significant reductions were observed in body weight [−2.22 kg (95% CI −2.79 to −1.65)], blood pressure, fasting glycaemia, haemoglobin A1c [−0.36% (95% CI −0.51 to −0.21)], serum uric acid [−0.44 mg/dl (95% CI −0.60 to −0.28)] and urinary protein:creatinine ratio, while serum magnesium [+0.15 mg/dl (95% CI 0.11–0.18)] and haemoglobin levels rose [+0.44 g/dl (95% CI 0.28–0.58]. These outcomes persisted in participants followed over 12 months of treatment. Conclusions SGLT2is in kidney transplant offer benefits in terms of controlling glycaemia, weight, blood pressure, anaemia, proteinuria and serum uric acid and magnesium. UTI was the most frequent adverse effect. According to our findings, these agents should be prescribed with caution in female DKTRs and those with a history of UTI.

Hypertension is a risk factor for the development of heart failure and has a negative impact on the survival of these patients. Although patients with these two conditions usually take different antihypertensive medications, some patients do not achieve adequate blood pressure control and their hypertension becomes resistant or refractory. In this scenario, percutaneous renal denervation has emerged in recent years as an alternative to achieve blood pressure control goals. We present the case of a 53-year-old woman with a medical history of essential hypertension, hypercholesterolemia, unipolar depression, and diabetes, who was diagnosed with dilated cardiomyopathy with reduced left ventricular ejection fraction (33%). Despite the initiation of multiple antihypertensive medications and placement of a cardiac resynchronization therapy pacemaker, the patient remained hypertensive with a left ventricular ejection fraction of 40%. At that time, percutaneous renal denervation was performed without complications, and one year after the procedure, the patient had improved better blood pressure control and the left ventricular ejection fraction increased to 51%. This case illustrates one of the clinical scenarios in which it has been suggested that renal denervation may be more beneficial, as in the situation of patients with refractory hypertension and heart failure.

Background The treatment of coronavirus disease 2019 (COVID-19) is based on the patient's clinical status and levels of inflammatory biomarkers. The comparative activity of these biomarkers in kidney transplant (KT) patients with COVID-19 pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and non–SARS-CoV-2 etiologies is unknown. The aim of this study was to compare the clinical presentation and inflammatory parameters at admission of KT patients with COVID-19 pneumonia and those with non–COVID-19 pneumonia over the same period. Methods Biomarkers were measured and compared between KT patients with COVID-19 pneumonia (n = 57) and non-COVID-19 pneumonia (n = 20) from March 2020 to March 2021. Results Both groups showed comparable demographics. The KT patients with COVID-19 had fewer neutrophils (6824 ± 5000 vs 8969 ± 4206; P = .09) than the non-COVID group, although there was no significant difference in the lymphocyte count. Non–COVID-19 pneumonia was associated with higher d -dimer (median, 921 [interquartile range (IQR), 495-1680] vs median, 2215 [IQR, 879-3934]; P = 0.09) and interleukin-6 (median, 35 [IQR, 20-128] vs median, 222 [IQR, 38-500]; P = 0.006) levels. The ferritin level was higher in the COVID-19 group (median, 809 [IQR, 442-1,330] vs median, 377 [IQR, 276-885]; P = 0.008). In multivariable analysis, only d -dimer (hazard ratio [HR], 1; 95% confidence interval [CI],1-1.002; P = .02) and ferritin (HR, 1; 95% CI, 0.9-0.9; P = .02) increase the statistic signification. Conclusion COVID-19 pneumonia in KT patients shows a different presentation of inflammatory biomarkers than other non-COVID pneumonias. It could be useful to identify KT patients with COVID-19. More detailed studies are necessary to understand the presentation of biomarkers in KT with COVID-19.

SARS-CoV-2 infection (COVID-19) has had a significant impact on transplant activity in our country. Mortality and the risk of complications associated with COVID-19 in kidney transplant recipients (KT) were expected to be higher due to their immunosuppressed condition and the frequent associated comorbidities. Since the beginning of the pandemic in March 2020 we have rapidly improved our knowledge about the epidemiology, clinical features and management of COVID-19 post-transplant, resulting in a better prognosis for our patients. KT units have been able to adapt their programs to this new reality, normalizing both donation and transplantation activity in our country.This manuscript presents a proposal to update the general recommendations for the prevention and treatment of infection in this highly vulnerable population such as KT.

Background. The rapid identification of the viral load from hepatitis C virus (HCV) in seropositive donors enables the determination of their infection capacity and the subsequent design of a strategy to optimize the use of direct-action antivirals (DAA) in seronegative recipients. In 2017, we designed an optimization protocol; this study aims to assess its efficacy and safety. Methods. This is a prospective, multicenter observational study that complies with the Declarations of Helsinki and Istanbul. Donors were HCV seropositive. The HCV and human immunodeficiency virus loads were immediately determined in the donors. For viremic donors, recipients were treated with DAA for 8 weeks. For nonviremic donors, DAA was started if a viral load was detected during the follow-up period. The minimum follow-up period was 6 months posttransplant. Results. This study recruited 28 donors. Just over half of the donors (n = 15; 53.5%) had a nonactive history of injection drug use. Eight (22.4%) donors were viremic, and 20 (87.6%) were nonviremic; 13 (65%) had been treated previously. Nine grafts were ineligible for the protocol. We performed a total of 47 transplants. Procedure I (viremic donors) was performed in 13 recipients (27.7%). Posttransplant viremia was observed in 6 participants. Posttransplant viremia was low (

The main purpose of this research has been to evaluate and optimize the application of hydrodynamic cavitation (HC), combined with hydrogen peroxide, as a promising process for the effective degradation of cyanide in aqueous effluents. The experimental work was carried out using cavitation equipment with a venturi device connected to a tubular circuit which allowed a closed-cycle flow to run for 120 min, in which the effect of control parameters as inlet pressure, H2O2:CN─ ratio, pH, and temperature have been evaluated for the treatment of solutions with initial cyanide concentration in range 100 to 550 mg L─1. The results showed that in optimal conditions cyanide degradation using only HC reached 70% and, using solely H2O2 as oxidizing agent it reached 63%. Efficiency of the combined treatment process was evaluated on the basis of their synergetic effect as it turned out to be more effective showing a 99.9 % cyanide degradation in less than 120 min. The optimum set of conditions that produced the highest degradation rate and efficiency was: inlet pressure 4 bar; pH 9.5; and H2O2:CN─ ratio = 1.5:1. The process was also evaluated on the basis of cavitational yield and in terms of energy and chemical treatment costs. The results have demonstrated that the combined treatment technology of HC + H2O2 can be effectively used as a fast and highly efficient treatment of wastewater containing cyanide.

Background Improving cytomegalovirus (CMV) immune-risk stratification in kidney transplantation is highly needed to establish guided preventive strategies. Methods This prospective, interventional, multicenter clinical trial assessed the value of monitoring pretransplant CMV-specific cell-mediated immunity (CMI) using an interferon-γ release assay to predict CMV infection in kidney transplantation. One hundred sixty donor/recipient CMV-seropositive (D+/R+) patients, stratified by their baseline CMV (immediate-early protein 1)–specific CMI risk, were randomized to receive either preemptive or 3-month antiviral prophylaxis. Also, 15-day posttransplant CMI risk stratification and CMI specific to the 65 kDa phosphoprotein (pp65) CMV antigen were investigated. Immunosuppression consisted of basiliximab, tacrolimus, mycophenolate mofetil, and corticosteroids in 80% of patients, whereas 20% received thymoglobulin induction therapy. Results Patients at high risk for CMV based on pretransplant CMI developed significantly higher CMV infection rates than those deemed to be at low risk with both preemptive (73.3% vs 44.4%; odds ratio [OR], 3.44 [95% confidence interval {CI}, 1.30–9.08]) and prophylaxis (33.3% vs 4.1%; OR, 11.75 [95% CI, 2.31–59.71]) approaches. The predictive capacity for CMV-specific CMI was only found in basiliximab-treated patients for both preemptive and prophylaxis therapy. Fifteen-day CMI risk stratification better predicted CMV infection (81.3% vs 9.1%; OR, 43.33 [95% CI, 7.89–237.96]). Conclusions Pretransplant CMV-specific CMI identifies D+/R+ kidney recipients at high risk of developing CMV infection if not receiving T-cell–depleting antibodies. Monitoring CMV-specific CMI soon after transplantation further defines the CMV infection prediction risk. Monitoring CMV-specific CMI may guide decision making regarding the type of CMV preventive strategy in kidney transplantation. Clinical Trials Registration NCT02550639.

Recurrence of idiopathic focal segmental glomerulosclerosis (FSGS) is a serious complication after kidney transplantation. FSGS relapse is suspected by a sudden increase in proteinuria but there is not an accurate noninvasive diagnostic tool to confirm this entity or to detect patients at risk. We aimed to validate the diagnostic performance of ApoA-Ib to detect FSGS relapses by measuring urinary ApoA-Ib in a retrospective cohort of 61 kidney transplanted patients (37 FSGS and 24 non-FSGS). In addition, to assess the ApoA-Ib predictive ability, ApoA-Ib was measured periodically in a prospective cohort of 13 idiopathic FSGS patients who were followed during 1 year after transplantation. ApoA-Ib had a sensitivity of 93.3% and a specificity of 90.9% to diagnose FSGS relapses, with a high negative predictive value (95.2%), confirming our previous results. In the prospective cohort, ApoA-Ib predated the recurrence in four of five episodes observed. In the nonrelapsing group (n = 9), ApoA-Ib was negative in 37 of 38 samples. ApoA-Ib has the potential to be a good diagnostic biomarker of FSGS relapses, providing a confident criterion to exclude false positives even in the presence of high proteinuria. It has also the potential to detect patients at risk of relapse, even before transplantation.

To describe the clinical and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) strains that were collected in the Hospital Regional de Alta Especialidad de Veracruz (HRV).A total of 107 MRSA strains from individual patients were examined. The strains were collected between September 2009 and September 2010. The clinical and demographic characteristics of patients were analyzed; molecular typing by pulsed-field gel electrophoresis (PFGE), staphylococcal chromosomal cassette mec (SCCmec) typing and multilocus sequence typing were used to characterize the isolates.Two PFGE patterns (NY/J and IB) were identified with 4 and 3 subtypes respectively. The isolates analyzed showed two SCCmec types (I and II) and two sequence types (ST): ST247 and ST5 related with the Iberian and New York/Japan clones respectively.This study establishes the presence of two very important clonal lineages of MRSA: New York/Japan and Iberian clone in the hospital environment.Describir las características clínicas y moleculares de cepas de Staphylococcus aureus resistentes a meticilina (SARM) que fueron recolectadas en el Hospital Regional de Alta Especialidad de Veracruz (HRV).Un total de 107 cepas de SARM fueron analizadas en el presente estudio. Las cepas estudiadas fueron recolectadas de septiembre de 2009 a septiembre de 2010. Las características clínicas y demográficas de los pacientes fueron analizadas; la tipificación molecular de las cepas se hizo por electroforesis en campos pulsados, casete cromosomal estafilococócico (SCCmec, en inglés) y secuenciación de múltiples locus.Dos patrones electroforéticos (NY/J y IB) fueron identificados con 4 y 3 subtipos respectivamente. Los aislamientos analizados mostraron dos tipos de SCCmec (I y II) y dos secuencias tipo (ST): ST247 y ST5 relacionados con las clonas Ibérica y Nueva York/Japón respectivamente.. Este estudio estableció la presencia en el medio hospitalario de dos linajes clonales de SARM importantes: Nueva York/Japón e Ibérico.

Activated carbons (ACs) play a key role in applications such as treatment and purification of water and polluting gases and new application as supercapacitators. The present work is related to the synthesis of new green adsorbents from the seeds and shells of Inga feuilleei and Passiflora ligularis, wood of Kageneckia lanceolata, Baccharis salicifolia and Baccharis latifolia. Both the porous texture and adsorption capacity of the new activated carbon were studied. The ACs were synthesized by conventional chemical activation using phosphoric acid. Results indicated that each synthesized AC presented a microporous/mesoporous texture and the three best iodine numbers obtained were 978.55, 905.8 and 865.9 mg.g−1. These results were achieved for the ACs from Passiflora ligularis, Kageneckia lanceolata and Baccharis salicifolia, respectively. The optimal conditions to achieve the best iodine number (978.55 mg.g−1) and BET surface area (1244.62 m2. g−1) were found for the Passiflora ligularis, at carbonization temperature of 500 °C, for 120 min, impregnation ratio of 1:4 (raw material/H3PO4) and concentration of activating agent H3PO4 of 60 %. The FT-IR spectroscopy method was used to characterize the functional groups present on the surface of the AC and the raw materials. On the other hand, the TGA analysis was carried out to show the AC mass loss as the temperature increased. Both analyzes showed that the activation was fully achieved under the optimal conditions described above. The results confirmed that the shell of Passiflora ligularis is a promising material as a highly adsorptive, low cost and renewable adsorbent.

Kidney Transplantation; Hepatitis C; Direct-acting antivirals therapy Trasplante de riñón; Hepatitis C; Terapia antiviral de acción directa Trasplantament de ronyó; Hepatitis C; Teràpia antiviral d’acció directa Background. Direct-acting antivirals (DAA) allow effective and safe eradication of hepatitis C virus (HCV) in most patients. There are limited data on the long-term effects of all-oral, interferon-free DAA combination therapies in kidney transplant (KT) patients infected with HCV. Here we evaluated the long-term tolerability, efficacy, and safety of DAA combination therapies in KT patients with chronic HCV infection. Methods. Clinical data from KT patients treated with DAA were collected before, during, and after the treatment, including viral response, immunosuppression regimens, and kidney and liver function. Results. Patients (N = 226) were mostly male (65.9%) aged 56.1 ± 10.9 years, with a median time from KT to initiation of DAA therapy of 12.7 years and HCV genotype 1b (64.6%). Most patients were treated with sofosbuvir-based therapies. Rapid virological response at 1 month was achieved by 89.4% of the patients and sustained virological response by week 12 by 98.1%. Liver function improved significantly after DAA treatment. Tacrolimus dosage increased 37% from the beginning of treatment (2.5 ± 1.7 mg/d) to 1 year after the start of DAA treatment (3.4 ± 1.9 mg/d, P < 0.001). Median follow-up was 37.0 months (interquartile range, 28.4–41.9) and death-censored graft survival was 91.1%. Adverse events resulting from DAA treatment, especially anemia, were reported for 31.0% of the patients. Conclusions. Chronic HCV infection can be treated efficiently and safely with DAA therapy in KT patients. Most patients retained stable kidney function and improved liver function. Tacrolimus dose had to be increased in most patients, potentially as a result of better liver function. This work was partially supported by a grant from the Instituto de Salud Carlos III co-funded by the Fondo Europeo de Desarrollo Regional-FEDER, RETICS (REDinREN RD16/0009). Astellas Pharma S.A. provided financial support for medical writing and editing of the manuscript.

In the present work, the equilibrium, thermodynamics, and kinetics of boron removal from aqueous solutions by the adsorption on commercial magnesium oxide powder were studied in a batch reactor. The adsorption efficiency of boron removal increases with temperature from 25°C to 50°C. The experimental results were fitted to the Langmuir, Freundlich, and Dubinin–Radushkevich (DR) adsorption isotherm models. The Freundlich model provided the best fitting, and the maximum monolayer adsorption capacity of MgO was 36.11 mg·g−1. In addition, experimental kinetic data interpretations were attempted for the pseudo-first-order kinetic model and pseudo-second-order kinetic model. The results show that the pseudo-second-order kinetic model provides the best fit. Such result suggests that the adsorption process seems to occur in two stages due to the two straight slopes obtained through the application of the pseudo-first-order kinetic model, which is confirmed by the adjustment of the results to the pseudo-second-order model. The calculated activation energy (Ea) was 45.5 kJ·mol−1, and the values calculated for ∆G°, ∆H°, and ∆S° were −4.16 kJ·mol−1, 21.7 kJ·mol−1, and 87.3 kJ·mol−1, respectively. These values confirm the spontaneous and endothermic nature of the adsorption process and indicated that the disorder increased at the solid-liquid interface. The results indicate that the controlling step of boron adsorption process on MgO is of a physical nature.

CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO Efluentes contendo cianeto estão presentes em indústrias de importância como a minero-metalúrgica, siderúrgica, entre outras, constituindo estes potenciais riscos para os ecossistemas, devido à elevada toxicidade do cianeto. O alvo do presente trabalho foi estudar a cinética de degradação do cianeto com ácido de Caro (H2SO5), um poderoso oxidante produto da reação entre o H2SO4 e H2O2, e desenvolver um modelo matemático que envolvesse a oxidação de CN - e a decomposição simultânea do H2SO5. Os ensaios foram realizados em regime de batelada, e as amostras utilizadas na degradação foram soluções sintéticas de CN - livre. A metodologia experimental envolveu um desenho fatorial 24, levando em conta 4 variáveis: [CN-] mg/L, razão molar [H2SO5]:[CN-], pH e tipo de ácido de Caro, com a finalidade de avaliar o efeito de cada variável na cinética da degradação. A análise estatística mostrou que as variáveis mais preponderantes na cinética de degradação foram [CN-] mg/L e [H2SO5]:[CN-]. Uma avaliação físicoquímica mostrou também uma maior velocidade de degradação a um pH 9 em relação a um pH 11, enquanto que um tipo de [H2SO5] de razão molar H2SO4//H2O2 igual a 3:1 teve uma maior eficiência que utilizando um [H2SO5] de razão estequiométrica 1:1. O ácido de Caro mostrou-se efetivo na degradação de cianeto, permitindo que em condições de: [CN-]o = 400 mg/L, , pH = 9, razão molar [H2SO5]/[CN-] = 3:1, e tipo de [H2SO5] = 3:1, atingi-se uma concentração final de [CN-] < 0,2 mg/L em um t = 10 min. Effluents containing cyanides are generated in important industrial áreas such as mining-metallurgical, steelmaking, petrochemical, amongst others, carrying potential risks to the environment due to the high toxicity of cyanide. The aim of the present work is to study the kinetics of cyanide degradation with Caro s Acid (H2SO5), a powerful oxidant generated by the reaction between concentrated grades of H2SO4 and H2O2, and to develop a mathematical model involving CN - oxidation and simultaneous self-decomposition of H2SO5. The experiments were conducted in batches using synthetic solutions of free cyanide. The experimental methodology employed involved a 24 factorial design with the four factors: initial [CN-] mg/L, molar rate [H2SO5]:[CN-], pH e type of Caro s acid, with the aim to evaluate the effect of these factors in the process reaction kinetics. The statistical analyses showed that the most affecting variables were initial [CN-] mg/L and [H2SO5]:[CN-] molar ratio. Nevertheless a physicalchemical evaluation showed that also pH and type of Caro s Acid made of 1 or 3 moles of H2SO4 with 1 mole of H2O2, had effect on the kinetics. The highest observed reaction rate was obtained in the following conditions: initial [CN-] = 400 mg/L, molar ratio [H2SO5]/[CN-]= 3:1, pH = 9 and type of Caro s acid = 3 moles H2SO4 to 1 mole H2O2, achieving a value of [CN-] < 0,2 mg/L in t = 10 min.