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Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Presents opinions of several topics related to nephrology. Proposal of expanding the kidney organ donor system; Complications of renal transplantation; Estimation of the selectivity of proteinuria from samples of second-morning urine.

The aim of this study was to evaluate the utility of a volume-modified blood culture system to diagnose bacteremia in newborns and infants. A total of 793 paired blood cultures, obtained from 464 patients (173 newborns and 291 infants), were analyzed. Vacutainer® tubes containing 18 ml supplemented peptone broth sodium-polyanethol-sulfonate were used as the gold standard, in comparison with a blood micro-culture system containing 1.8 ml of the broth. Prior to antibiotic treatment, 2.2 ml of blood was obtained from each patient; 0.2 ml was inoculated in a blood micro-culture tube and 2 ml in a routine tube. Sensitivity, specificity and predictive values were calculated. Microorganisms were isolated in 153 standard blood culture tubes and 151 blood micro-culture tubes. The sensitivity of the blood micro-culture system was 95%, specificity 99% and positive and negative predictive values 96% and 99% respectively. The sensitivity and specificity of blood micro-culture in neonates and infants is high. We recommend that this system be used for the diagnosis of bacteremia in newborns and infants in laboratories where manual systems are still in use. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions., Methods: We compared retrospectively two periods of time: the pre-COVID (1 January 2019-11 March 2020) and the COVID era (12 March 2020-30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy., Results: A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed., Conclusions: COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period., (© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.)

Objective: to determine frequency, serotypes, biotypes and susceptibility to eight antibiotics in Haemophilus influenzae nasopharyngeal isolates in children under five years old from Mexico City., Methods: cross-sectional survey including children two months to five years old. A nasopharyngeal sample was taken. Haemophilus influenzae identification, serotyping, biotyping and antimicrobial susceptibility were performed., Results: a sample of 573 children were included. In 88/573 (15.3 %) H. influenzae was isolated, corresponding in 7/573 (1.2 %) to Hib, 3/573 (0.5 %) to Hi a, c, d, f and 78/573 (13.6 %) to Nontypable Hi. Among Hib carriers, 6 had received only one or two doses of specific vaccine. Biotype VIII (76.1 %) was the predominant. All isolates were susceptible to the antibiotics, but one Hib strain was resistant to erithromycin., Conclusions: nontypable Haemophilus influenzae was predominant. Colonization by Hib in children under 5 years old was low (1.2 %), occurring in children with an incomplete vaccination schedule.

Objective: To determine the risk of pediatric end stage renal disease patients undergoing continuous ambulatory peritoneal dialysis to develop a subsecuent peritonitis episode caused by an identical Staphylococcus aureus (SA) strain., Methods: Longitudinal survey carried out in a CAPD center at the nephrology department of a tertiary care (reference) pediatric hospital. At recruitment, swabs were collected from the nares, exit site, and hands, respectively from 29 patients who were followed-up for a mean period of 369 +/- 80 days (range 224-516 days), and from the nares and hands of their mothers. Isolated SA strains were kept in BHI glycerol at -20 degrees C for subsequent analysis. Peritonitis episodes were monitored and registered. When a SA strain was isolated from the dialysate effluent it was compared with the preexisting strain by PFGE., Results: We report 7 SA-mediated peritonitis episodes among 6 patients. Only one of these patients was a previous nasal carrier, and 2 were previous exit site carriers of the same SA strain. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the exit site was 0.948. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the nares was 0.525., Conclusions: SA carriers do not appear to be at higher risk of developing peritonitis by an SA related strain than non-carriers. Our results do not lend support to the recommendation of monitoring nasal or exit site carrier status in CAPD patients. The need of attempting to eradicate SA from nose or exit site is also questioned.

Background and Objective: Analysis of the evolution of the donation rates in different Spanish regions within the last years. Description of the factors with more specific weight related to the number of donors., Material and Method: Retrospective descriptive study, including numbers about donation, population, population aged 70 or more, traffic mortality, interviews for donation and refusals, according to the region between 2001 and 2006. Besides the descriptive analysis, correlation between factors was studied stratifying by year. To evaluate time evolution, a general linear regression model of repeated measures was performed., Results: Inhabitants number, population over 70 years and traffic victims correlated with the general number of donors, donors of these age group and donors deceased in traffic accidents, respectively. These relationships do not apply to every region. Refusals percentage to donation was not related to the number of interviews performed and its decrease was related to higher donation rates. Even though not so constantly, higher percentages of donors aged >or= 70 and lower traffic death ones were related to higher donation rates., Conclusions: Evolution in the number of donors follows the population growth and the decrease of refusals to donation, even though there are different explanations according to the region.

Objective: To describe an epidemiological study of one case of pertusis., Clinical Case: a five-year old boy was diagnosed with pneumonia and he had incomplete DPT vaccination scheme; pertusis was diagnosed by using the PCR technique and culture. An epidemiological study with family contacts was carried out, in which 20 samples for both tests were obtained. These were taken twice., Results: The average age of the family members was 26.5 years, 50 % were women, 62 % did not have social security and 30 % had three doses of DPT. 35 % were positive to PCR and, 20 % out of these had positive cultures., Conclusions: In children smaller than five years suffering from pneumonia, is relevant to ascertain about DPT vaccination status and to consider the possibility of carrying out an epidemiological study with the family.-

Background: combinations of drugs has been proposed as an alternative for oxacillin-resistant staphylococci infections, however, limited information about in vitro combinations are available for multi-resistant strains. The objective of this study was to describe the interaction of beta-lactams in combination with vancomycin or amikacin against 26 oxacillin and amikacin-resistant nosocomial Staphylococcus spp. isolates., Methods: activity of dicloxacillin plus amikacin, cephalothin plus amikacin, cephalothin plus vancomycin, imipenem plus vancomycin and vancomycin plus amikacin was evaluated by checkerboard synergy tests and the fractional inhibitory concentration index (FIC) was calculated., Results: dicloxacillin plus amikacin, and cephalothin plus amikacin were synergistic or partially synergistic in 84.6% and 100% respectively. For nearly half of the isolates the mean concentrations of dicloxacillin, cephalothin and amikacin at which FIC indexes were calculated were achievable therapeutically. Vancomycin plus amikacin had synergistic effect only against two isolates, and partially synergistic in 38.6%. For the combinations vancomycin plus cephalothin and vancomycin plus imipenem the effect was additive in 76.9% and 80.7% respectively., Conclusion: in this study the checkerboard analysis showed that amikacin in combination with cephalothin or dicloxacillin was synergistic against most of the resistant strains of S. aureus and coagulase-negative Staphylococcus. Vancomycin in combination with a beta-lactam (cephalothin or imipenem) showed additivity. An indifferent effect predominated for the combination vancomycin plus amikacin. Even though a synergistic effect is expected when using a beta-lactam plus amikacin combination, it is possible that the effect cannot be clinically achievable. Careful selection of antimicrobial combinations and initial MICs are mandatory for future evaluations.

Solid organ transplant may be the only therapeutic alternative in some HIV-infected patients. Experience in North America and Europe during the last five years shows that survival at three years after an organ transplant is similar to that observed in HIV-negative patients. The criteria agreed upon to select HIV patients for transplant are: no opportunistic infections (except tuberculosis, oesophageal candidiasis or P. jiroveci -previously carinii- pneumonia), CD4 lymphocyte count above 200 cells/.L (100 cells/.L in the case of liver transplant) and an HIV viral load which is undetectable or suppressible with antiretroviral therapy. Another criterion is a two-year abstinence from heroin and cocaine, although the patient may be in a methadone programme. The main problems in the post-transplant period are pharmacokinetic and pharmacodynamic interactions between antiretorivirals and immunosuppressors, rejection and the management of relapse of HCV infection, which is one of the main causes of post-liver transplant mortality. Up to now, experience with pegylated interferon and ribavirin is scarce in this population. The English version of the manuscript is available at http://www.gesidaseimc.com.

Background: There is an ever-increasing demand for cadaveric solid organs for transplantation all over the world. Partial strategies in many countries have resulted in small or transient increases in organ donation or even no improvement at all. In the early nineties, Spain started an original integrated approach designed to improve cadaveric organ donation., Methods: In 1989 an official agency, the National Transplant Organization (ONT), and a national network of specially trained, dedicated and strongly motivated hospital physicians in charge of the whole process of organ donation, was created. The network now covers 139 hospitals., Results: Cadaveric organ donors grew from 550 in 1989 to 1334 in 1999, a 142% increase, Cadaveric kidney transplants from 1021 to 2005 (96% increase), and total solid organs transplanted from 1302 to 3330 in ten years (156%). The rates of cadaveric organ donation per million inhabitants (33.6), kidney and liver transplantation (50.6 and 24.2) are the highest in the world., Conclusions: Spain is the only example in the world of continuous improvement in cadaveric organ donation registered in a large country over a ten-year period. Organ shortage is not due to a lack of potential donors, but rather to a failure to turn many potential into actual donors. A proactive donor detection program performed by well trained transplant coordinators, the introduction of systematic death audits in hospitals and the combination of a positive social atmosphere with adequate economic reimbursement for the hospitals have accounted for this success. This model can be partially or totally translated to other countries if basic conditions are satisfied.

1. Donor Action takes a systematic approach towards achieving quality assurance in the whole donation process. It is designed to give hospitals participation and ownership of donation practices that can be tailored to meet identified needs in critical care units (CCUs). The program has been successfully introduced in 18 countries and in over 250 CCUs in North and South America, Europe and Asia. 2. Aggregated data collected in 162 CCUs in 10 countries showed significant losses of potential donors along the donation pathway. The major factor impacting on converting medically suitable cases with signs of brain death into potential donors was the willingness of CCU staff to formally diagnose brain death. Major reasons for non-donation in BD-diagnosed cases were non-referral (26.5%), family refusal (20%), or no approach of next-of-kin (13.2%). 3. Pre-intervention data show that professional training, clear role definitions, teamwork, comprehensive guidelines and consistent protocols dealing with all donation-related tasks in the CCU setting are critical to achieve optimal donation rates. 4. Implementation of these improvement measures in 10 countries have shown an immediate overall increase of donation rates of 59% after 1 year and a sustained, even growing effect on referral and donation rates in those countries with sufficient follow-up, proving a permanent impact of DA's methodology. 5. As a health-economic evaluation, based on the German case, shows that the implementation cost of the program in pilot centers was far below the investment thresholds. Donor Action is more cost-effective than other publicly reimbursed medical interventions. Incorporating health economic consequences of other cadaveric organ transplants into the analysis could even further improve the cost-benefit ratio of Donor Action compared with current organ donation practices.