Publications by authors named "Alejandra G Miranda-Díaz"

6 Publications

  • Page 1 of 1

Cytomegalovirus in Renal Transplant Recipients from Living Donors with and without Valgancyclovir Prophylaxis and with Immunosuppression Based in Anti-thymocyte globulin or Basiliximab.

Int J Infect Dis 2021 Apr 13. Epub 2021 Apr 13.

Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Mexico.

Background: In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) of moderate risk (R+), to reduce costs. Our objective was to determine the incidence and risk for the development of cytomegalovirus (CMV) with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL).

Patients And Methods: A retrospective cohort included 265 RTRs with follow up of 12 months. Prophylaxis was used in R-/D + and only some R + . Tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisone (PDN) were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC.

Results: Cytomegalovirus was documented in 46 (17.3%) patients: twenty (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 (85%): 32 "R+", 6 "D+/R-," and 1 "D-/R-". In 90% (27/30) of patients with CMV and without prophylaxis, ATG was used. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; CI 95%, 1,08-4.86), ATG use (RR 3.7; CI 95%, 1.50-9.13), TAC toxicity (RR 3,77; CI 95%, 1,41 -10,13), and lymphocytes at the sixth post-transplant month (RR 1,77; CI 95%, 1,0-3.16).

Conclusions: Low doses of ATG favor the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, one acceptable strategy could be the use of BSL.
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April 2021

Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort.

Int J Immunopathol Pharmacol 2021 Jan-Dec;35:20587384211000545

Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, México.

Minimization in immunosuppression could contribute to the appearance the donor-specific HLA antibodies (DSA) and graft failure. The objective was to compare the incidence of DSA in renal transplantation (RT) in recipients with immunosuppression with and without steroids. A prospective cohort from March 1st, 2013 to March 1st, 2014 and follow-up (1 year), ended in March 2015, was performed in living donor renal transplant (LDRT) recipients with immunosuppression and early steroid withdrawal (ESW) and compared with a control cohort (CC) of patients with steroid-sustained immunosuppression. All patients were negative cross-matched and for DSA pre-transplant. The regression model was used to associate the development of DSA antibodies and acute rejection (AR) in subjects with immunosuppressive regimens with and without steroids. Seventy-seven patients were included (30 ESW and 47 CC). The positivity of DSA class I (13% vs 2%;  < 0.05) and class II (17% vs 4%,  = 0.06) antibodies were higher in ESW versus CC. The ESW tended to predict DSA class II (RR 5.7; CI (0.93-34.5,  = 0.06). T-cell mediated rejection presented in 80% of patients with DSA class I ( = 0.07), and 86% with DSA II ( = 0.03), and was associated with DSA class II, (RR 7.23; CI (1.2-44),  = 0.03). ESW could favor the positivity of DSA. A most strictly monitoring the DSA is necessary for the early stages of the transplant to clarify the relationship between T-cell mediated rejection and DSA.
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March 2021

The effect of ubiquinone in diabetic polyneuropathy: a randomized double-blind placebo-controlled study.

J Diabetes Complications 2012 Jul-Aug;26(4):352-8. Epub 2012 May 16.

Unidad de Investigación Cardiovascular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.

Introduction: Diabetic polyneuropathy aetiology is based on oxidative stress generation due to production of reactive oxygen species. Ubiquinone is reduced to ubiquinol and redistributed into lipoproteins, possibly to protect them from oxidation.

Aims: To evaluate the impact of oral ubiquinone in diabetic polyneuropathy, and the role of lipid peroxidation (LPO) and nerve growth factor (NGF-β).

Methods: We conducted a double-blind, placebo-controlled clinical trial, patients were randomized to ubiquinone (400 mg) or placebo daily for 12 weeks. Main outcomes were clinical scores, nerve conduction studies, LPO, NGF-β and safety.

Results: Twenty four patients on experimental group and twenty five on control group met the inclusion criteria (mean age 56 years, 22% male and 78% female, mean evolution of type 2 diabetes mellitus 10.7 years). Significant improvement on experimental vs control group was found in neuropathy symptoms score (from 2.5 ± 0.7 to 1 ± 0.8, p<0.001), neuropathy impairment score (5.5 ± 4 to 3.1 ± 2.6, p<0.001), sural sensory nerve amplitude (13.0 ± 6.1 to 15.8 ± 5.1 μV, p=0.049), peroneal motor nerve conduction velocity (39.7 ± 5.0 to 47.8 ± 4.9 m/s, p=0.047), and ulnar motor nerve conduction velocity (48.8 ± 6.8 to 54.5 ± 6.1m/s, p=0.046). There was a significant reduction of LPO in subjects treated with ubiquinone vs placebo (16.7 ± 8.6 and 23.2 ± 15.8 nmol/mL, respectively) with p<0.05, and NGF-β did not change (control 66.5 ± 26.7 vs. experimental 66.8 ± 28.4 pg/mL, p=0.856). No drug-related adverse reactions were reported.

Conclusions: Twelve weeks treatment with ubiquinone improves clinical outcomes and nerve conduction parameters of diabetic polyneuropathy; furthermore, it reduces oxidative stress without significant adverse events.
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January 2013

[Tumor necrosis factor-alpha and interleukin-6 levels among patients suffering a bile duct injury during cholecystectomy].

Rev Med Chil 2010 Oct 10;138(10):1259-63. Epub 2011 Jan 10.

Departamento de Clínicas Quirúrgicas, Centro Universitario de Ciencias de la salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.

Background: During cholecystectomy, the bile duct may be injured. When this complication occurs, Kupffer cells are activated and produce tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL6) to phagocyte toxic products

Aim: To measure serum levels of TNF-α and IL-6 among patients that suffered a bile duct injury after a cholecystectomy.

Patients And Methods: Serum levels of TNF-α and IL-6 were measured prior to the bile-enteric derivation and after one year of follow up, in 31 patients that had a complete bile duct obstruction after open or laparoscopic cholecystectomy and in 5 healthy controls.

Results: At baseline TNF-α levels in healthy subjects and patients with bile duct injury were 0 and 43.9 ± 2.9 ng/mL, respectively (p < 0.01). At one year of follow up, TNF-á became undetectable among patients. At baseline, the values for IL-6 among healthy controls and patients were 3.0 ± 2.0 and 72.0 ± 94.7 pg/mL respectively, (p < 0,004). After one year of follow up, IL-6 levels decreased to 6.4 ± 0.3 pg/mL among patients.

Conclusions: TNF-α and IL-6 levels were elevated before bile-enteric derivation among patients with bile duct injury and became normal one year later.
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October 2010

[Histological evaluation of hepatic fibrosis in patients with post surgical bile duct injury].

Rev Med Inst Mex Seguro Soc 2008 Nov-Dec;46(6):663-8

Departamento de Cirugía General, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (CMNO IMSS), Guadalajara, Jalisco, México.

Background: Bile duct injuries after cholecystectomy can produce fibrous and collagen deposit tissue. Our objective was to evaluate the liver fibrosis measured in histological tissue in patients with bile duct injury after cholecystectomy.

Methods: Three normal liver biopsies and 21 from patients with bile duct injuries were studied. Group I: with three normal liver biopsies. Group II: with external abdominal fistula alone in six patients. Group III with complete bile duct obstruction in 15 patients. The surgical biliary enteric reconstructions were performed 8 weeks after bile duct injury in all cases. The fibrosis and collagen deposits were studied by Masson's trichrome and Sirius red stains and they were measured by a digital program.

Results: Group I showed 2 % of fibrosis tissue and 1% of collagen deposit and was considered as normal. Group II showed unexpected 1 fold more liver fibrosis and 9 fold more collagen deposit in extracellular matrix macromolecule (p < 0.05, Anova) against group I. Patients in group III, had fibrous tissue increase 43 folds more and 14 collagen folds more (p < 0.0001, Bonferroni's post hoc) versus group I.

Conclusions: The patients in groups II and III showed liver fibrosis, being this more important in group III.
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April 2009

[Association of hyperinsulinemia with left ventricular hypertrophy and diastolic dysfunction in patients with hypertension].

Rev Med Chil 2007 Sep 15;135(9):1125-31. Epub 2007 Nov 15.

Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, México.

Background: Hypertension is the main independent cardiovascular risk factor. However, there are additional factors that induce organic damage.

Aim: To assess the association between hyperinsulinemia, ventricular hypertrophy and left ventricular diastolic function.

Patients And Methods: Seventy-four patients aged 30 to 65 years, with mild or moderate systemic hypertension, with overweight or mild obesity and normal glucose tolerance curve (GTC), were studied. Serum insulin was measured during GTC. The maximum levels of insulin and glucose were observed 60 minutes after the oral glucose load and they were expressed as rG/1. Patients were stratified in three groups according to their glucose and insulin fasting levels (I0) and post-glucose challenge levels (rG/I): Group 1 (normoinsulinemic patients) I0 <17 mU/mL and rG/I >2 (2.45+0.4). Group 2 (post-prandial hyperinsulinemic patients) I0 <17 mU/mL and rG/I <2> 1 (1.34+0.3). Group 3 (persistently hyperinsulinemic patients) I0 >17 mU/mL and <1 (0.7+0.3). Left ventricular mass and its diastolic function were measured by Doppler echocardiography.

Results: No differences in blood pressure or age were observed between groups. There was a negative correlation between ventricular mass and rG/1 (r =-0.282, p =0.015). Left ventricular diastolic dysfunction was significantly more deteriorated in group 3, as compared with group 1 (p <0.001 ANOVA). There was a significant correlation between g/GI and diastolic dysfunction (r =0.232 p =0.047).

Conclusions: Fasting, post challenge hyperinsulinemia and a rG/I <1 are associated with higher ventricular mass and left ventricular diastolic dysfunction, independent of blood pressure and age.
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September 2007