Resumo Objetivos: A disfunção de enxerto renal e agravamento de hipertensão nos pacientes transplantado renais podem ser manifestações de hipoperfusão do enxerto devido a estenose de artéria de transplante renal (EATR) ou estenose da artéria ilíaca proximal à anastomose do enxerto (pseudo-EATR). O tratamento endovascular de EATR é cada vez mais frequente para manter a função do enxerto. Com este estudo, pretendemos avaliar o impacto do tratamento endovascular de EATR na função renal a curto e médio prazo. Materiais e métodos: Este é um estudo observacional, retrospetivo, monocêntrico que inclui todos os pacientes transplantados renais adultos submetidos a tratamento endovascular de EATR entre Setembro de 2017 e Junho de 2020. A função renal foi monitorizada através da medição da creatinina sérica (sCr). Resultados: Treze pacientes foram incluídos (53.8% do sexo feminino), com idade média de 57 (21-70) anos. Onze pacientes (84.6%) desenvolveram disfunção de enxerto. Dez pacientes (76.9%) foram submetidos a angioplastia transluminal e colocação de stent na artéria renal do enxerto e três (23.1%) da artéria ilíaca dadora. A maior parte dos casos (69.2%) foram tratados durante o primeiro ano pós transplante. A taxa de sucesso técnico foi de 100%, sem mortalidade periprocedimento. A taxa de morbilidade aos 30 dias foi de 15.4%. O tempo médio de seguimento foi de 20.2 (1.3 - 36.3) meses. Um doente morreu durante o seguimento e outro sofreu agravamento de disfunção do enxerto com necessidade de hemodiálise e nefrectomia. A redução na sCr foi estatisticamente significativa no primeiro mês pós-intervenção, comparado aos valores pré-intervenção, mas a sCr continuou aumentada quando comparada aos níveis basais (pré-diagnóstico de EATR). Conlusão: A maioria dos pacientes (12/13) melhorou ou estabilizou a função renal após a intervenção em relação ao período pré-intervenção, mostrando a eficácia do procedimento. No entanto, a maior parte dos doentes não retornou aos valores basais de sCr, corroborando a importância da revascularização precoce do enxerto. O atraso no diagnóstico de EATR pode comprometer o benefício da revascularização e impedir a recuperação total da função renal.

Abstract Objective: Renal graft dysfunction or worsened hypertension in renal transplanted patients may be a manifestation of graft hypoperfusion due to transplant renal artery stenosis (TRAS) or stenosis of iliac arteries proximal to renal transplant (pseudo-TRAS). Endovascular management of TRAS has been increasingly used to preserve renal graft function. With this study, we aim to evaluate the impact of endovascular treatment of TRAS on renal function in the short to medium term. Material and methods: This is an observational, retrospective, single-center study that included all adult renal transplant patients who underwent endovascular intervention on TRAS between September 2017 and June 2020. Renal graft function was monitored by serum Creatinine (sCr) levels. Results: Thirteen patients were included (53.8% female), with a median age of 57 (21-70) years. Eleven patients (84.6%) presented with graft dysfunction. Ten subjects (76.9%) underwent transluminal angioplasty and stenting of renal artery and three (23,1%) of donor iliac arteries. Most cases (69.2%) were interventioned in the first-year post-transplant. Overall technical success was 100%, with no periprocedural deaths. Overall 30-day morbidity was 15.4%. Median follow-up time was 20.2 (1,3 - 36,3) months. One patient died during follow up and other worsened graft dysfunction, requiring hemodialysis and nephrectomy. Reduction in sCr levels was statistically significant in the first postoperative month, compared to preoperative values, but sCR levels were still increased when compared to baseline levels (pre-TRAS diagnosis). Conclusions: The majority (12/13) of patients showed improvement or stabilization of renal graft function compared to the preoperative period, during the follow-up period, supporting the procedure’s safety. Despite this, most patients did not recover baseline sCr levels, reinforcing the importance of prompt graft revascularization. Delayed diagnosis of TRAS may compromise the benefit of revascularization and prevent full recovery of renal function.

Introduction: On 5/24 a COVID19 outbreak in the Villa Azul neighborhood was confirmed and an outbreak mitigation strategy was implemented that also was extended to Villa Itatí given the geographical and social proximity. Objective: to systematize the community approach that was carried out in the Villa Itatí neighborhood with the aim of mitigating an outbreak of COVID19 and optimizing the prevention and control of new cases. Methods: a new stage of surveillance and active search for cases was implemented in order to guarantee access to the diagnosis and the recommended isolation measures for the recovery and containment of eventual community outbreaks. An Emergency Operational Committee (COE) with the participation of social and political organizations of the neighborhood, health, safety and community development teams from both the Municipality Quilmes and the Government of the Province of Buenos Aires was created. Results: As of 8/22, 1,067 cases of COVID19 had been confirmed in Villa Itatí, with a downward trend in terms of the number of cases and daily swabs. The total number of cases doubled every 31 days and the percentage of positivity of the swabs has been increasing gradually until today it is 48% of the total. However, of the total number of cases in Villa Itatí, currently only 62 (6%) are currently infected, the rest of the cases being already recovered people. From the beginning of the approach in Villa Itatí, 2860 close contacts were traced, of which 90% (2577) have already been discharged after having completed 14 days of home isolation. Discussion: the community approach to the COVID19 pandemic in Villa Itatí made it possible to strengthen the neighborhood organization to comprehensively optimize all available resources in order to take care of the health of the population.  

Introducción: El 24/5 se confirma la aparición de un brote de COVID19 en el barrio de Villa Azul por lo que se comienza a implementar una estrategia de mitigación de brote que también se extiende a Villa Itatí dada la proximidad geográfica y social. Objetivo: describir el abordaje comunitario que se realizó en el barrio Villa Itatí con el objetivo de mitigar un brote de COVID19 y optimizar la prevención y control de los nuevos casos.  Métodos: se implementó una etapa de vigilancia y búsqueda activa de casos y se formalizó la conformación de un Comité Operativo de Emergencia (COE) con la participación de las organizaciones sociales y políticas del barrio, equipos de salud, seguridad y desarrollo de la comunidad tanto del Municipio de Quilmes como del Gobierno de la Provincia de Buenos Aires. Resultados: Al 22/8 habían confirmado en Villa Itatí 1067 casos de COVID19, con una tendencia a la baja en cuanto al número de casos e hisopados diarios. Los casos se duplicaron cada 31 días y el porcentaje de positividad de los hisopados ha ido aumentando de manera paulatina hasta encontrarse hoy en el 48% del total. Sin embargo, del total de casos de Villa Itatí, actualmente sólo 62 (el 6%) están actualmente infectados, siendo el resto de los casos ya personas recuperadas. Desde el inicio del abordaje en Villa Itatí se realizó el seguimiento de 2860 contactos estrechos, de los cuales el 90% (2577) ya tienen el alta luego de haber cumplido 14 días de aislamiento domiciliario. Discusión: el abordaje comunitario de la pandemia de COVID19 en Villa Itatí permitió fortalecer la organización del barrio para optimizar de manera integral todos los recursos disponibles en pos de cuidar la salud de la población.

Introdução: A presença de múltiplos vasos renais é frequente na população geral e, quando presente num dador, aumenta a complexidade da cirurgia de transplantação renal, aumentando o risco de complicações. Embora a transplantação de enxertos de dador cadáver com estas características seja aceite, o mesmo procedimento em dador vivo permanece controverso. O objetivo deste trabalho é apresentar o caso de uma cirurgia de transplantação de dador vivo com anatomia vascular complexa - duas artérias e duas veias renais Caso Clínico: Mulher de 42 anos, com doença renal crónica terminal (DRCT) por nefropatia IgA, em programa regular de hemodiálise há 9 meses, avaliada em mais de um centro para transplantação renal de dador vivo e recusada pela complexidade da anatomia vascular do par dador - rim direito com duas artérias e duas veias renais curtas No nosso centro, onde a cirurgia vascular integra a equipa multidisciplinar de transplantação renal, foi aceite o transplante considerando-se tecnicamente exequível a reconstrução vascular ex-vivo do enxerto (back table) Na reconstrução arterial foi realizada anastomose látero-lateral das duas artérias renais. A reconstrução venosa incluiu o alongamento das veias renais com veia safena interna (VSI) da recetora e a sua posterior anastomose em “cano de espingarda”. O rim foi implantado na fossa ilíaca direita da recetora Verificou-se diurese imediata após desclampagem, com descida rápida dos valores de creatinina para o normal e com alta ao 16.º dia de pós-operatório Conclusão: A escassez de órgãos é um importante fator limitante à transplantação renal. A inclusão de dadores com múltiplos vasos renais tem demonstrado bons resultados e pode aumentar a disponibilidade de órgãos. A integração de um cirurgião vascular experiente na equipa multidisciplinar de transplantação renal permite a realização de reconstruções arteriais e venosas complexas em enxertos com anatomia vascular menos favorável

Introduction: The presence of multiple renal vessels is frequent in the general population and, when present in a donor, increases the complexity of renal transplantation surgery, increasing the risk of complications. Although transplantation of cadaver donor grafts with these characteristics is accepted, the same procedure in living donor remains controversial. The objective of this work is to present the case of a living donor renal transplant surgery with complex vascular anatomy - two arteries and two renal veins Clinical case: 42-year-old woman with end stage renal disease due to IgA nephropathy, on regular hemodialysis program for 9 months, evaluated in more than one center for living donor renal transplantation and rejected by the complexity of the vascular anatomy of the donor - right kidney with two arteries and two short renal veins. In our center, where vascular surgery integrates the multidisciplinary team of renal transplantation, the transplant was accepted considering that the ex-vivo vascular reconstruction of the graft (back table) was technically feasible Arterial reconstruction was performed on a lateral-lateral anastomosis of the two renal arteries. Venous reconstruction included the stretching of the renal veins with the great saphenous vein of the recipient and its posterior lateral-lateral anastomosis. The kidney was implanted in the recipient's right iliac fossa Immediate diuresis after dislodging was observed, with a rapid decrease in creatinine values to normal and discharged on the 16th postoperative day Conclusion: Organ shortage is an important limiting factor for renal transplantation. Inclusion of donors with multiple renal vessels has shown good results and may increase organ availability. The integration of an experienced vascular surgeon in the multidisciplinary team of renal transplantation allows the accomplishment of complex arterial and venous reconstructions in grafts with less favorable vascular anatomy

Chronic kidney disease (CKD) is associated to significant infection incidence and severity, the cause of death of, approximately, 20% of end-stage renal disease patients. Close to 80% of all infections in these patients can be related to organ or tissue other than vascular access, reflecting immune system dysfunction related to several mechanisms. Strongyloides stercoralis is an endemic nematode found especially in tropical and subtropical areas. The clinical manifestations of stercoralis infection vary according to the acuity of infection and the host response, from asymptomatic to the disseminated presentation, frequently lethal. Risk factors for severe presentations are related to immunosuppression states. The authors report a case of a patient with advanced CKD of unknown etiology, who developed an exuberant eczema, respiratory symptoms and severe hypereosinophilia. The etiological study revealed a disseminated form of Strongyloides stercoralis infection with myocardia involvement, diagnosed solely by serologic testing, despite microbiological tests to identify the infective agent. In this case, the patient has evolved favorably, with remission of symptoms and cardiac features, after adequate anti-helminthic treatment. The importance of parasitic colonization and its potential harm becomes clinically more relevant when patients become immunosuppressed, as in CKD progression or in the immunosuppressive therapy setting, such as solid organ transplant rejection therapy. A brief literature review related to strongyloidiasis and immunosuppression in the CKD setting is also presented

Resumo Introdução: A colocação de cateteres intra-auriculares (IAC) tem surgido como uma técnica life-saving nos doentes em hemodiálise (HD) com exaustão de acessos vasculares. Objetivo: Analisar as complicações decorrentes da colocação de IAC, assim como a sobrevivência dos doentes e do acessos vascular após este procedimento. Métodos: Os autores analisaram retrospetivamente sete doentes com exaustão de acessos vasculares para HD, sem alternativa imediata de terapêutica substitutiva renal, submetidos a colocação de IAC entre Janeiro de 2004 e Dezembro de 2015. Resultados: Os sete doentes foram submetidos à colocação de doze IAC. A hemorragia (6/7) e as infeções (3/7) foram as principais complicações no pós-operatório imediato. Dois (2/7, 29%) doentes faleceram por complicações precoces e 5/7 tiveram alta com cateter funcionante. A complicação tardia mais frequente foi a exteriorização acidental do cateter em todos os doentes, seguida da trombose e infeção relacionada com o cateter, na mesma proporção (2/5). Durante o seguimento, dois dos cinco doentes faleceram por complicações associadas com o acesso vascular. Após a falência do IAC, um doente foi transferido para diálise peritoneal e outro foi submetido a transplantação renal. Apenas um doente permanece em HD após o terceiro IAC, com uma sobrevivência de 50 meses. A sobrevivência média dos doentes após colocação de IAC foi de 19 ± 25 (0-60) meses e a patência média do IAC foi de 8 ± 11 (0-34) meses. Conclusão: A colocação de um IAC para HD esteve associado a riscos significativos e mortalidade elevada. Contudo, quando as terapêuticas de substituição renal alternativas estão esgotadas, ou como uma ponte para outras modalidades, esta opção deve ser considerada.

Abstract Introduction: Intra-atrial catheter (IAC) placement through an open surgical approach has emerged as a life-saving technique in hemodialysis (HD) patients with vascular access exhaustion. Objective: To assess the complications of IAC placement, as well as patient and vascular access survival after this procedure. Methods: The authors retrospectively analyzed all seven patients with vascular capital exhaustion, without immediate alternative renal replacement therapy (RRT), who underwent IAC placement between January 2004 and December 2015 at a single center. Results: Seven patients were submitted to twelve IAC placements. Bleeding (6/7) and infections (3/7) were the main complications in the early postoperative period. Two (2/7, 29%) patients died from early complications and 5/7 were discharged with a properly functioning IAC. The most frequent late complication was catheter accidental dislodgement in all remaining five patients, followed by catheter thrombosis and catheter-related infections in the same proportion (2/5). During follow-up, two of five patients died from vascular accesses complications. After IAC failure, one patient was transferred to peritoneal dialysis and a kidney transplant was performed in the other. Only one patient remains on HD after the third IAC, with a survival of 50 months. The mean patient survival after IAC placement was 19 ± 25 (0-60) months and the mean IAC patency was 8 ± 11 (0-34) months. Conclusion: Placing an IAC to perform HD is associated to significant risks and high mortality. However, when alternative RRT are exhausted, or as a bridge to others modalities, this option should be considered.

The main objective of this research was to analyze whether the Program for Prisoners for Emotional Domestic Violence (Rodríguez-Espartal, 2012) is more effective than cognitive-behavioral treatment or no treatment in inmates imprisoned for violence against women. Participants were 36 male imprisoned for crimes related to violence against women in the Provincial Prison of Jaén II, divided into three groups according to treatment: cognitive-behavioral therapy (n = 11), emotional (n = 13), and control (n = 12). The efficacy of treatment was measured by its influence on a series of cognitive behavioral variables: distorted thoughts about women and the use of violence, expectations about change, aggression, anger, impulsivity, and stages of change. There was a greater decrease in distorted thoughts about women and the use of violence and an increase in the expectations about change in inmates who received emotional treatment. No change was found in other variables among inmates receiving treatment but there was an increase in negative results in the control group. Our results highlight the need for batterer intervention programs and to select the treatment that best fits the characteristics of these men.

El principal objetivo del presente trabajo es comprobar si el Programa Emocional para Presos por Violencia de Género (Rodríguez-Espartal, 2012) resulta más eficaz que el tratamiento cognitivo-conductual o la ausencia de tratamiento en hombres presos por violencia contra las mujeres. Participaron 36 presos por delitos de violencia de género que cumplen condena en la Prisión Provincial Jaén II, distribuidos en tres grupos en función del tratamiento: cognitivo-conductual (n = 11), emocional (n = 13) y control (n = 12). La eficacia del tratamiento se midió por los resultados en una serie de variables cognitivo conductuales: pensamientos distorsionados sobre la mujer y sobre el uso de la violencia, expectativas de cambio, agresividad, ira, impulsividad y etapas de cambio. Los resultados muestran un mayor descenso de los pensamientos distorsionados sobre la mujer y sobre el uso de la violencia y unas mayores expectativas de cambio en aquellos hombres que han recibido el tratamiento emocional. Respecto al resto de variables, no se ha producido ningún cambio en los hombres que han recibido tratamiento, pero sí un aumento de resultados negativos en el grupo control. Los resultados subrayan la necesidad de realizar programas de intervención con maltratadores, así como de seleccionar el tratamiento más adecuado a las características de estos hombres.