Publications by authors named "Pablo Ramirez"

188 Publications

A high concentration of TGF-β correlates with opportunistic infection in liver and kidney transplantation.

Hum Immunol 2021 Apr 1. Epub 2021 Apr 1.

Department of Immunology, University Clinical Hospital Virgen de la Arrixaca - Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.

Transforming growth factor-β (TGF-β) has been associated with numerous human infections, but its role in the occurrence of opportunistic infection (OI) after solid organ transplantation remains unexplored. This study aimed to assess the utility of the TGF-β following in vitro stimulation of whole peripheral blood (WPB) as a surrogate biomarker of post-transplant OI in a cohort of liver and kidney recipients. Thirty liver and thirty-one kidney transplant recipients were recruited to be prospectively monitored for one-year post-transplantation. Enzyme-linked immunosorbent assay (ELISA) was performed to calculate IFN-γ, IL-17, IL-10 and TGF-β concentration in the supernatant from the activated WPB. Recipients showed higher TGF-β concentrations compared to IFN-γ, IL-17, IL-10 at baseline, although these differences were not significant between INF and NoINF. However, recipients who developed an OI within the first sixth months had a higher concentration of TGF-β than those without OI. A concentration of TGF-β > 363.25 pg/ml in liver and TGF-β > 808.51 pg/ml in kidney recipients were able to stratify patients at high risk of OI with a sensitivity and specificity above 70% in both types of solid organ transplantations. TGF-β could provide valuable information for the management of liver and kidney recipients at risk of post-transplant infection.
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http://dx.doi.org/10.1016/j.humimm.2021.03.007DOI Listing
April 2021

Efficiency of Machine Learning Algorithms for the Determination of Macrovesicular Steatosis in Frozen Sections Stained with Sudan to Evaluate the Quality of the Graft in Liver Transplantation.

Sensors (Basel) 2021 Mar 12;21(6). Epub 2021 Mar 12.

Experimental Pathology Service, Institute for Biomedical Research of Murcia (IMIB), 30120 Murcia, Spain.

Liver transplantation is the only curative treatment option in patients diagnosed with end-stage liver disease. The low availability of organs demands an accurate selection procedure based on histological analysis, in order to evaluate the allograft. This assessment, traditionally carried out by a pathologist, is not exempt from subjectivity. In this sense, new tools based on machine learning and artificial vision are continuously being developed for the analysis of medical images of different typologies. Accordingly, in this work, we develop a computer vision-based application for the fast and automatic objective quantification of macrovesicular steatosis in histopathological liver section slides stained with Sudan stain. For this purpose, digital microscopy images were used to obtain thousands of feature vectors based on the RGB and CIE L*a*b* pixel values. These vectors, under a supervised process, were labelled as fat vacuole or non-fat vacuole, and a set of classifiers based on different algorithms were trained, accordingly. The results obtained showed an overall high accuracy for all classifiers (>0.99) with a sensitivity between 0.844 and 1, together with a specificity >0.99. In relation to their speed when classifying images, KNN and Naïve Bayes were substantially faster than other classification algorithms. Sudan stain is a convenient technique for evaluating ME in pre-transplant liver biopsies, providing reliable contrast and facilitating fast and accurate quantification through the machine learning algorithms tested.
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http://dx.doi.org/10.3390/s21061993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001362PMC
March 2021

Assessment of Fennel Oil Microfluidized Nanoemulsions Stabilization by Advanced Performance Xanthan Gum.

Foods 2021 Mar 24;10(4). Epub 2021 Mar 24.

Departamento de Ingeniería Química, Facultad de Química, Universidad de Sevilla c/P, García González, 1, E41012 Sevilla, Spain.

In this work, nanoemulsion-based delivery system was developed by encapsulation of fennel essential oil. A response surface methodology was used to study the influence of the processing conditions in order to obtain monomodal nanoemulsions of fennel essential oil using the microchannel homogenization technique. Results showed that it was possible to obtain nanoemulsions with very narrow monomodal distributions that were homogeneous over the whole observation period (three months) when the appropriate mechanical energy was supplied by microfluidization at 14 MPa and 12 passes. Once the optimal processing condition was established, nanoemulsions were formulated with advanced performance xanthan gum, which was used as both viscosity modifier and emulsion stabilizer. As a result, more desirable results with enhanced physical stability and rheological properties were obtained. From the study of mechanical spectra as a function of aging time, the stability of the nanoemulsions weak gels was confirmed. The mechanical spectra as a function of hydrocolloid concentration revealed that the rheological properties are marked by the biopolymer network and could be modulated depending on the amount of added gum. Therefore, this research supports the role of advanced performance xanthan gum as a stabilizer of microfluidized fennel oil-in-water nanoemulsions. In addition, the results of this research could be useful to design and formulate functional oil-in-water nanoemulsions with potential application in the food industry for the delivery of nutraceuticals and antimicrobials.
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http://dx.doi.org/10.3390/foods10040693DOI Listing
March 2021

Comprehensive identification of pathogenic gene variants in patients with neuroendocrine disorders.

J Clin Endocrinol Metab 2021 Mar 17. Epub 2021 Mar 17.

Instituto de Biociencias, Biotecnología y Biología Traslacional (IB3), Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina.

Purpose: Congenital hypopituitarism (CH) can present in isolation or with other birth defects. Mutations in multiple genes can cause CH, and the use of a genetic screening panel could establish the prevalence of mutations in known and candidate genes for this disorder. It could also increase the proportion of patients that receive a genetic diagnosis.

Methods: We conducted target panel genetic screening using single-molecule molecular inversion probes sequencing to assess the frequency of mutations in known hypopituitarism genes and new candidates in Argentina. We captured genomic DNA from 170 pediatric patients with CH, either alone or with other abnormalities. We performed promoter activation assays to test the functional effects of patient variants in LHX3 and LHX4.

Results: We found variants classified as pathogenic, likely pathogenic or with uncertain significance in 15.3% of cases. These variants were identified in known CH causative genes (LHX3, LHX4, GLI2, OTX2 and HESX1), in less frequently reported genes (FOXA2, BMP4, FGFR1, PROKR2, PNPLA6) and in new candidate genes (BMP2, HMGA2, HNF1A, NKX2-1).

Conclusion: In this work, we report the prevalence of mutations in known CH genes in Argentina and provide evidence for new candidate genes. We show that CH is a genetically heterogeneous disease with high phenotypic variation and incomplete penetrance, and our results support the need for further gene discovery for CH. Identifying population-specific pathogenic variants will improve the capacity of genetic data to predict eventual clinical outcomes.
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http://dx.doi.org/10.1210/clinem/dgab177DOI Listing
March 2021

The impact of information and communications technology and broadcasting on YouTube for improving attitude toward organ donation in secondary education with the creation of short films.

Patient Educ Couns 2021 Feb 19. Epub 2021 Feb 19.

General Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigaciones Biosanitarias (IMIB), Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Spain.

Objective: There is a lack of awareness about organ donation among teenagers, a fact that could decrease future donation rates. The objective is to analyze the impact of an educational proposal based on the creation of short films.

Methods: Fifteen schools were randomly selected: ten for the experimental group (EG), and five for the control group (CG). In both groups all students from the selected classes participated (EG: n = 543, CG: n = 320). An intervention was undertaken in the EG, providing a website to make a short film about organ donation and transplantation (ODT) to be broadcast on YouTube. The students completed a questionnaire before and after the proposal.

Statistics: Mann-Whitney test was conducted to compare the pre-test data, McNemar test compare the pre and post test results of each group, and Chi-square test to compare the change in responses between the two groups.

Results: The change to a more favorable response was greater in the EG in all variables. The YouTube channel received 104,912 viewings.

Conclusions: An innovative educational intervention has a positive influence on teenage attitude and knowledge about ODT; it also has important social repercussions.

Practice Implications: Implementing this educational proposal about ODT could help improve future donation rates.
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http://dx.doi.org/10.1016/j.pec.2021.02.037DOI Listing
February 2021

Ehlers-Danlos syndrome: molecular and clinical characterization of TNXA/TNXB chimeras in congenital adrenal hyperplasia.

J Clin Endocrinol Metab 2021 Jan 22. Epub 2021 Jan 22.

Endocrinology Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires.

Context: The syndrome CAH-X is due to a contiguous gene deletion of CYP21A2 and TNXB resulting in TNXA/TNXB chimeras.

Objective: To analyze TNXB gene status and to clinically evaluate the Ehlers-Danlos syndrome phenotype in a large cohort of Argentine congenital adrenal hyperplasia (CAH) patients to assess the prevalence of this condition in our population.

Design, Settings, Participants, Intervention: TNXB-gene analysis was performed in 66 non-related CAH patients that were carriers of the CYP21A2 gene deletion. A molecular strategy based on Multiplex ligation-dependent probe amplification and Sanger sequencing analysis was developed allowing for the detection of different, previously described TNXA/TNXB chimeras, named CH1, CH2, and CH3.

Main Outcome Measures: TNXB status of CAH patients that were carriers of the CYP21A2 deletion in the homozygous or heterozygous state.

Results: TNXA/TNXB CH1 was found in 41%, CH2 in 29% and CH3 in 1.5% of non-related alleles carrying the CYP21A2 deletion. Thus, overall 71% of alleles were found to carry a contiguous gene deletion. 67% of patients analyzed had a monoallelic and 6% a biallelic form. All patients with the biallelic form had severe skin hyperextensibility and generalized joint hypermobility.

Conclusions: Based on the high frequency of TNXB alterations in CYP21A2-deletion carrier alleles found, we recommend to evaluate TNXB status in these patients, and to assess connective tissue dysplasia including cardiologic alterations in positive cases. The number of patients undergoing cardiological evaluation should be expanded to determine the incidence of structural and functional abnormalities in this cohort.
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http://dx.doi.org/10.1210/clinem/dgab033DOI Listing
January 2021

Complete Genome Sequence of sp. Strain SH5A2, a Dye-Degrading Halotolerant Bacterium Isolated from the Salinas and Aguada Blanca National Reserve in Peru.

Microbiol Resour Announc 2021 Jan 14;10(2). Epub 2021 Jan 14.

Laboratory of Molecular Microbiology and Biotechnology, Faculty of Biological Sciences, Universidad Nacional Mayor de San Marcos, Lima, Peru

sp. strain SH5A2 is a halotolerant bacterium isolated from Salinas Lake at 4,300 m above sea level in Peru. Here, we report its complete genome sequence with a length of 3,849,224 bp and highlight the presence of genes putatively related to dye degradation, such as NADPH-dependent oxidoreductases.
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http://dx.doi.org/10.1128/MRA.01083-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849697PMC
January 2021

Severe COVID-19 after liver transplantation, surviving the pitfalls of learning on-the-go: Three case reports.

World J Hepatol 2020 Oct;12(10):870-879

Department of Surgery and Organ Transplantation, Virgen de la Arrixaca University Hospital, Murcia 30120, Spain.

Background: The novel coronavirus 2019 (COVID-19) pandemic has dramatically transformed the care of the liver transplant patient. In patients who are immunosuppressed and with multiple comorbidities, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with increased severity and mortality. The main objective of this report is to communicate our experience in the therapeutic management of SARS-CoV-2 infection in 3 liver transplant patients. Secondly, we stress the management and investigation of the contagious spreading into a liver transplant ward.

Case Summary: The patients were two women (aged 61 years and 62 years) and one man (aged 68 years), all of them having recently received a liver transplant. All three patients required intensive care unit admission and invasive mechanical ventilation. Two of them progressed severely until death. The other one, who received tocilizumab, had a good recovery. In the outbreak, the wife of one of the patients and four healthcare professionals involved in their care were also infected.

Conclusion: We illustrate in detail the evolution of a nosocomial COVID-19 outbreak in a liver transplant ward. We believe that these findings will contribute to a better understanding of the natural history of the disease and will improve the treatment of the liver transplant patient with COVID-19.
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http://dx.doi.org/10.4254/wjh.v12.i10.870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643211PMC
October 2020

Evidences of SARS-CoV-2 virus air transmission indoors using several untouched surfaces: A pilot study.

Sci Total Environ 2021 Jan 8;751:142317. Epub 2020 Sep 8.

Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Murcia, Spain.

Nowadays, there is an important controversy about coronavirus air transmission. The aim of this study was to determine aerosol transmission from patients with coronavirus infection using "COVID-19 traps" that included different untouched surfaces within them. 42 swab samples of 6 different surfaces placed in the rooms of 6 patients with a positive diagnostic of COVID-19 were analyzed with RT-PCR technique to evaluate the presence of the virus and its stability. Samples were collected at 24, 48 and 72 h. Patients were in an intensive care unit (ICU) and in a COVID-19 ward unit (CWU) at a Spanish referral hospital. None of the samples placed in the ICU unit were positive for COVID-19. However, two surfaces, placed in a CWU room with a patient that required the use of respiratory assistance were positive for coronavirus at 72 h. Surfaces could not be touched by patients or health workers, so viral spreading was unequivocally produced by air transmission. Thus, fomites should be considered as a possible mode of transmission of coronavirus and frequent disinfection of surfaces should be taken into account. Our results, although preliminary, point the importance of SARS-CoV-2 virus air transmission indoors and may shed some light in this debate.
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http://dx.doi.org/10.1016/j.scitotenv.2020.142317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836800PMC
January 2021

Mid-term follow-up of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: An experience in Latin America.

Catheter Cardiovasc Interv 2020 Oct 15. Epub 2020 Oct 15.

Division of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile.

Objectives: To describe the characteristics of patients who undergo balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) and report the mid-term outcomes.

Background: BPA has been recently introduced in Latin America. Mid-term results have not been published.

Methods: Prospective Chilean Registry of inoperable CTEPH patients who underwent BPA. Clinical variables were analyzed at baseline, after each procedure and at follow-up. Hemodynamic variables were recorded before and after the last BPA.

Results: Between August 2016 and September 2019, 22 patients (17 women), 59 ± 12.7 years, underwent 81 BPA and were followed for as long as 33.1 months (mean 17.3 ± 7.5). Mean pulmonary artery pressure decreased by 17.4% (51.1 ± 12 vs. 42.2 ± 13 mmHg, p = .001), pulmonary vascular resistance by 23.9% (766.7 ± 351 vs. 583 ± 346 dynes/s/cm , p = .001), cardiac index increased by 8% (2.3 ± 0.54 vs. 2.5 ± 0.54 L/min/m , p = .012), N-terminal pro-B-type natriuretic peptide decreased by 73.8% (1,685 ± 1,045 vs. 441.8 ± 276 pg/dl, p = .006), and 6-min walk distance improved by 135 m (316.7 ± 94 vs. 451.1 ± 113 m, p = .001). One patient (4.5%) developed lung reperfusion injury and four patients (18.2%) had minor bleeding (hemoptysis), after the procedure. There was no mortality associated with BPA.

Conclusions: Our results confirm that BPA for inoperable CTEPH is a relatively safe procedure that improves clinical and hemodynamic parameters in the mid-term. This therapy should be considered as an alternative, mainly in places where access to PAH therapy or surgery is restricted.
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http://dx.doi.org/10.1002/ccd.29322DOI Listing
October 2020

Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients.

J Hepatol 2021 01 1;74(1):148-155. Epub 2020 Aug 1.

Liver Transplantation Unit, Liver Unit, Department of Surgery, IMIB, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.

Background & Aims: The incidence and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients are a matter of debate.

Methods: We performed a prospective nationwide study including a consecutive cohort of liver transplant patients with COVID-19 recruited during the Spanish outbreak from 28 February to 7 April, 2020. The primary outcome was severe COVID-19, defined as the need for mechanical ventilation, intensive care, and/or death. Age- and gender-standardised incidence and mortality ratios (SIR and SMR) were calculated using data from the Ministry of Health and the Spanish liver transplant registry. Independent predictors of severe COVID-19 among hospitalised patients were analysed using multivariate Cox regression.

Results: A total of 111 liver transplant patients were diagnosed with COVID-19 (SIR = 191.2 [95% CI 190.3-192.2]). The epidemiological curve and geographic distribution overlapped widely between the liver transplant and general populations. After a median follow-up of 23 days, 96 patients (86.5%) were admitted to hospital and 22 patients (19.8%) required respiratory support. A total of 12 patients were admitted to the ICU (10.8%). The mortality rate was 18%, which was lower than in the matched general population (SMR = 95.5 [95% CI 94.2-96.8]). Overall, 35 patients (31.5%) met criteria of severe COVID-19. Baseline immunosuppression containing mycophenolate was an independent predictor of severe COVID-19 (relative risk = 3.94; 95% CI 1.59-9.74; p = 0.003), particularly at doses higher than 1,000 mg/day (p = 0.003). This deleterious effect was not observed with calcineurin inhibitors or everolimus and complete immunosuppression withdrawal showed no benefit.

Conclusions: Being chronically immunosuppressed, liver transplant patients have an increased risk of acquiring COVID-19 but their mortality rates are lower than the matched general population. Upon hospital admission, mycophenolate dose reduction or withdrawal could help in preventing severe COVID-19. However, complete immunosuppression withdrawal should be discouraged.

Lay Summary: In liver transplant patients, chronic immunosuppression increases the risk of acquiring COVID-19 but it could reduce disease severity. Complete immunosuppression withdrawal may not be justified. However, mycophenolate withdrawal or temporary conversion to calcineurin inhibitors or everolimus until disease resolution could be beneficial in hospitalised patients.
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http://dx.doi.org/10.1016/j.jhep.2020.07.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395653PMC
January 2021

Mass Spectrometry: A Rosetta Stone to Learn How Fungi Interact and Talk.

Life (Basel) 2020 Jun 20;10(6). Epub 2020 Jun 20.

Instituto de Ciencias Ómicas y Biotecnología Aplicada (ICOBA), Pontificia Universidad Católica del Perú (PUCP), Av. Universitaria 1801, San Miguel 15088, Lima, Peru.

Fungi are a highly diverse group of heterotrophic organisms that play an important role in diverse ecological interactions, many of which are chemically mediated. Fungi have a very versatile metabolism, which allows them to synthesize a large number of still little-known chemical compounds, such as soluble compounds that are secreted into the medium and volatile compounds that are chemical mediators over short and long distances. Mass spectrometry (MS) is currently playing a dominant role in mycological studies, mainly due to its inherent sensitivity and rapid identification capabilities of different metabolites. Furthermore, MS has also been used as a reliable and accurate tool for fungi identification (i.e., biotyping). Here, we introduce the readers about fungal specialized metabolites, their role in ecological interactions and provide an overview on the MS-based techniques used in fungal studies. We particularly present the importance of sampling techniques, strategies to reduce false-positive identification and new MS-based analytical strategies that can be used in mycological studies, further expanding the use of MS in broader applications. Therefore, we foresee a bright future for mass spectrometry-based research in the field of mycology.
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http://dx.doi.org/10.3390/life10060089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345136PMC
June 2020

Testis formation in XX individuals resulting from novel pathogenic variants in Wilms' tumor 1 () gene.

Proc Natl Acad Sci U S A 2020 06 3;117(24):13680-13688. Epub 2020 Jun 3.

Human Developmental Genetics Unit, Institut Pasteur, 75724 Paris, France;

Sex determination in mammals is governed by antagonistic interactions of two genetic pathways, imbalance in which may lead to disorders/differences of sex development (DSD) in human. Among 46,XX individuals with testicular DSD (TDSD) or ovotesticular DSD (OTDSD), testicular tissue is present in the gonad. Although the testis-determining gene is present in many cases, the etiology is unknown in most -negative patients. We performed exome sequencing on 78 individuals with 46,XX TDSD/OTDSD of unknown genetic etiology and identified seven (8.97%) with heterozygous variants affecting the fourth zinc finger (ZF4) of Wilms' tumor 1 (WT1) (p.Ser478Thrfs*17, p.Pro481Leufs*15, p.Lys491Glu, p.Arg495Gln [x3], p.Arg495Gly). The variants were de novo in six families ( = 4.4 × 10), and the incidence of WT1 variants in 46,XX DSD is enriched compared to control populations ( < 1.8 × 10). The introduction of ZF4 mutants into a human granulosa cell line resulted in up-regulation of endogenous Sertoli cell transcripts and XX mice display masculinization of the fetal gonads. The phenotype could be explained by the ability of the mutated proteins to physically interact with and sequester a key pro-ovary factor β-CATENIN, which may lead to up-regulation of testis-specific pathway. Our data show that unlike previous association of WT1 and 46,XY DSD, ZF4 variants of WT1 are a relatively common cause of 46,XX TDSD/OTDSD. This expands the spectrum of phenotypes associated with WT1 variants and shows that the WT1 protein affecting ZF4 can function as a protestis factor in an XX chromosomal context.
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http://dx.doi.org/10.1073/pnas.1921676117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306989PMC
June 2020

Molecular analysis of the CYP21A2 gene in dried blood spot samples.

Medicina (B Aires) 2020 ;80(3):197-202

Laboratorio de Pesquisa Neonatal, Laboratorio de Biología Molecular y Diagnóstico, Servicio de Endocrinología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina. E-mail:

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder due to a deficiency of enzymes involved in cortisol biosynthesis. In more than 90% of cases, CAH is secondary to deleterious mutations in the CYP21A2 gene leading to 21-hydroxilase deficiency (21OHD). The CYP21A2 gene is located on the short arm of chromosome 6 (6p21·3) and encodes the cytochrome P450C21 enzyme. Neonatal screening programs detect the classic forms of CAH-21OHD quantifying 17OH-progesterone in dried blood spots (DBS). This test is very sensitive, but it has a low specificity, requiring a second sample to confirm the result. In these cases, a second-tier test in the same sample may be useful. Our aim was to evaluate a DNA extraction method from DBS and assess the performance of such DNA in the molecular analysis of the CYP21A2 gene mutations. Twelve individuals, who presumably had CAH based on the initial neonatal screening results, were analyzed using DNA extracted from freshly collected blood on EDTA and DBS. The CYP21A2 gene was analyzed by automated sequencing of all exons and intron boundaries and MLPA analysis in DBS. Molecular analysis results from both extraction methods were compared. In this study, we show that DNA extracted from neonatal screening DBS is a useful tool to define CYP21A2 gene mutations in 21-OHD diagnostic confirmation for the newborn screening program and that its results are comparable to traditional genotyping.
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June 2020

Differences in Attitude Toward Organ Donation in the Three Main Cities of Cuba.

Transplant Proc 2020 Jun 11;52(5):1435-1438. Epub 2020 May 11.

International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain.

Background: Cuba is one of the Latin American countries with the highest rates of organ donation. Social and cultural differences among the population throughout the country may also affect attitudes toward donation. Knowledge of these characteristics would facilitate awareness of the population most reluctant to donate and transplant.

Objective: We sought to analyze the differences in attitudes toward organ donation among Cubans living in the main capitals of Cuba.

Materials And Methods: Study population. The study group was the Cuban population living in the cities of Cienfuegos (n=636), Havana (n=920), and Santiago de Cuba (n=455), extracted from the database of the International Collaborative Donor Project. Sample of the population. Participants were older than 15 years, and data were stratified by geographic area, age, and sex. Assessment instrument. We used a validated questionnaire of attitude toward organ donation for transplant (PCID-DTO-Ríos), anonymously filled in and self-administered.

Statistics: Student t test was applied together with the χ test, complemented by an analysis of the remainders.

Results: The favorable attitude among inhabitants in Cienfuegos was 71.2% (n=453), 68.3% (n=628) among those in Havana, and 69.5% (n=316) among those in Santiago de Cuba (P < .05). The psycho-social profile of respondents favoring organ donation was similar in the 3 cities.

Conclusions: The attitude toward organ donation among the population of the main cities of Cuba was favorable and similar in all of them. The psycho-social profile toward organ donation was similar in the 3 cities.
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http://dx.doi.org/10.1016/j.transproceed.2020.02.066DOI Listing
June 2020

Resilience Related to Quality of Life Perceived in Elderly Patients With Orthotopic Liver Transplant for More Than 10 Years.

Transplant Proc 2020 Jun 8;52(5):1511-1513. Epub 2020 Apr 8.

Transplant Unit, Surgery Service, University Clinical Hospital Virgen de la Arrixaca, Murcia, Spain; Biomedical Research Institute of Murcia IMIB-Arrixaca, Murcia, Spain.

Introduction: Resilience is the ability to recover or adequately face adverse situations. It acts as a protective factor against negative events and/or complex stages of life, such as a chronic and complex disease requiring liver transplant. Age can also have an effect on a patient's ability to deal with liver transplant, resilience here being a predictor of well-being.

Objective: To analyze the level of resilience and its relationship with health-related quality of life (HRQoL) in patients over 60 years of age who underwent an orthotopic liver transplant (OLT) more than 10 years ago.

Materials And Methods: We conducted a cross-sectional descriptive study at the Hospital Clínico Virgen Arrixaca.

Instrument: 1. To analyze resilience we used the Connor-Davidson Resilience Scale (CD-RISC 17) which measures 3 dimensions (tenacity/self-efficacy, personal control, and social competence). 2. To evaluate HRQoL, we used the Short Form-36 Health Survey (SF-36) questionnaire which covers 8 dimensions and produces 2 summary scores. Variables included age, sex, and post-OLT survival. Non-parametric statistical analysis was performed (P < .05).

Results: We analyzed 47 patients, 68% men (n = 32). The average age was 70.85 ± 0.98 years and average post-OLT survival was 15.79 ± 0.78 years. In terms of resilience, men had higher scores in tenacity/self-efficacy (90.82 ± 2.71 vs 84.79 ± 3.49; P = .029) and personal control (82.5 ± 3.79 vs 69.33 ± 5.23; P = .023). The longer the post-OLT period, the less personal control (R = -0.298; P = .042). Regarding HRQoL, the dimension of personal control is positively related: physical function (R = 0.388; P = .007); general health (R = 0.429; P = .003); vitality (R = 0.560; P = .000); social function (R = 0.402; P = .005); mental health (R = 0.311; P = .034); and physical summary (R = 0.381; P = .008). Like social competence, it is related to mental health (R = 0.360; P = .013) and mental summary (R = 0.384; P = .008).

Conclusion: These patients showed adequate levels of resilience. A greater resilience is related to greater general health, vitality, social functioning, and mental health.
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http://dx.doi.org/10.1016/j.transproceed.2020.01.087DOI Listing
June 2020

Exploring Health Science Students' Notions on Organ Donation and Transplantation: A Multicenter Study.

Transplant Proc 2020 Jun 4;52(5):1428-1431. Epub 2020 Apr 4.

Transplant Unit, Surgery Service, University Clinical Hospital Virgen de la Arrixaca, Murcia, Spain; Biomedical Research Institute of Murcia IMIB-Arrixaca, Murcia, Spain; International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Regional Transplant Centre, Consejería de Sanidad y Consumo de la Región de Murcia, Spain; Department of Surgery, Paediatrics, Obstetrics y Gynaecology, University of Murcia, Spain. Electronic address:

The knowledge acquired during university education about organ donation and transplantation (ODT) decisively influences the information future health professionals transmit. This is important in ODT where the participation of the general public is essential to obtain organs.

Objective: To determine notions of Spanish medicine and nursing students on ODT and its relationship with attitude toward ODT.

Methods And Design: and design. We conducted a sociologic, multicenter, and observational study. The population for our study consisted of medical and nursing students in Spanish universities. Our database was the Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. Our sample consisted of 9598 medical and 10,566 nursing students (99% confidence interval; precision of ±1%), stratified by geographic area and year of study.

Results: The completion rate for our study was 90%. Only 20% (n=3640) of students thought their notions on ODT were good; 41% (n=7531) thought their notions were normal; 36% (n=6550) thought their notions were scarce. Comparing groups, there were differences between those who believed that their notions on ODT were good (44% nursing vs 56% medical students; P < .000), and those who believed it scarce (54% nursing vs 46% medical students; P < .000). Notions on ODT were related with attitude toward the donation of one's own organs: those who considered their notions were good were more in favor then those who considered it scarce (88% vs 72%; P < .000).

Conclusion: Only 20% of Spanish medical and nursing students thought their notions on ODT were good. Having good knowledge is related to a favorable attitude towards ODT. Receiving specific information on the subject could improve their knowledge about ODT during their training.
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http://dx.doi.org/10.1016/j.transproceed.2020.01.086DOI Listing
June 2020

Analysis of the Socio-Personal Profile of Latin Americans Living in Spain and the United States: Does It Justify the Differences in Attitude Toward Organ Donation?

Transplant Proc 2020 Jun 23;52(5):1439-1441. Epub 2020 Mar 23.

International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain.

Introduction: There are differences in the attitude toward organ donation between Latin Americans living in Spain and those living in the United States.

Objective: We sought to analyze the socio-personal factors that can condition the difference in attitude toward donation between Latin Americans living in the United States and those living in Spain.

Materials And Methods: Participants in the study were Latin Americans living in Spain (group A; n=1237) and the United States (Florida) (group B; n=1450), extracted from the database of the International Collaborative Donor Project (PCID). Inclusion criteria were a sample population stratified by area, country of birth, age, and sex. The instrument used was a validated attitude questionnaire toward living kidney donation (PCID-DTO-Rios.) Participants were randomly selected to be surveyed according to stratification.

Results: The attitude in favor of Latin Americans residing in Spain (group A) was 60% (n=745) vs 33% (n=485) of residents in the United States (group B) (P < .001). The socio-personal profile of the Latin Americans in Spain compared with those in the United States indicates that they are mainly women (63.5% vs 43.7%, respectively), younger (31.78 vs 37.31 years, respectively), have more secondary education (21.2% vs 16.3%, respectively) and university studies (11% vs 6%, respectively), are of South American origin vs those who are Mexican and Central American, respectively, and there is a higher percentage of atheists/agnostics (8.1% vs 3.7%). However, the personal profile toward donation is similar in both groups, both for and against organ donation.

Conclusions: The personal social profile of the Latin American resident in Spain is different from that of the resident in the United States. However, the psycho-social profile for and against organ donation is similar in both countries.
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http://dx.doi.org/10.1016/j.transproceed.2020.02.065DOI Listing
June 2020

Impact of Catholicism on the Attitude Toward the Donation of Organs Among African Residents in Spain.

Transplant Proc 2020 Jun 24;52(5):1432-1434. Epub 2020 Mar 24.

International Collaborative Donor Project, ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain.

Introduction: The African population is one of the largest immigrant groups in Europe. Religious beliefs are deeply rooted in most African societies and condition their attitude toward organ donation.

Objective: We sought to analyze the influence of Catholicism in the attitude toward organ donation among Africans residing in Spain.

Materials And Methods: Study participants were born in Africa and were residents in Spain. Data were obtained from the database of the International Donor Collaborative Project, which includes a sample of the population for 15 years, stratified by those who were born in Africa, as well as age and sex. The instrument used was a validated attitude questionnaire toward living kidney donation (PCID-DTO-Ríos).

Results: Of the population under study, 13% are Catholics (n = 475) and 80% (n = 2896) are Muslims. The favorable attitude toward the donation of cadaver organs is 53.7% (n = 255) among Catholics compared with 25.6% (n = 742) among Muslims (P < .001). On the contrary, 17.7% of Catholics have an unfavorable opinion (n = 84), while 45.5% (n = 1280) of Muslims have an unfavorable opinion; 28.6% of Catholics and 29.2% of Muslims are undecided. In addition, among Catholics who believe that their doctrine accepts organ donation and transplantation, 70.6% (n = 132) are in favor of donating a corpse compared to those who believe that Catholic doctrine is against (P < .001 ), with only 35% (n = 7) in favor of the donation.

Conclusions: Africans who have converted to Catholicism have a more favorable attitude toward donating their own organs than those who continue in Islam.
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http://dx.doi.org/10.1016/j.transproceed.2020.02.064DOI Listing
June 2020

Estrogens in Human Male Gonadotropin Secretion and Testicular Physiology From Infancy to Late Puberty.

Front Endocrinol (Lausanne) 2020 25;11:72. Epub 2020 Feb 25.

Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina.

Several reports in humans as well as transgenic mouse models have shown that estrogens play an important role in male reproduction and fertility. Estrogen receptor alpha (ERα) and beta (ERβ) are expressed in different male tissues including the brain. The estradiol-binding protein GPER1 also mediates estrogen action in target tissues. In human testes a minimal ERα expression during prepuberty along with a marked pubertal up-regulation in germ cells has been reported. ERβ expression was detected mostly in spermatogonia, primary spermatocytes, and immature spermatids. In Sertoli cells ERβ expression increases with age. The aromatase enzyme (cP450arom), which converts androgens to estrogens, is widely expressed in human tissues (including gonads and hypothalamus), even during fetal life, suggesting that estrogens are also involved in human fetal physiology. Moreover, cP450arom is expressed in the early postnatal testicular Leydig cells and spermatogonia. Even though the aromatase complex is required for estrogen synthesis, its biological relevance is also related to the regulation of the balance between androgens and estrogens in different tissues. Knockout mouse models of aromatase (ArKO) and estrogen receptors (ERKOα, ERKOβ, and ERKOαβ) provide an important tool to study the effects of estrogens on the male reproductive physiology including the gonadal axis. High basal serum FSH levels were reported in adult aromatase-deficient men, suggesting that estrogens are involved in the negative regulatory gonadotropin feedback. However, normal serum gonadotropin levels were observed in an aromatase-deficient boy, suggesting a maturational pattern role of estrogen in the regulation of gonadotropin secretion. Nevertheless, the role of estrogens in primate testis development and function is controversial and poorly understood. This review addresses the role of estrogens in gonadotropin secretion and testicular physiology in male humans especially during childhood and puberty.
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http://dx.doi.org/10.3389/fendo.2020.00072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051936PMC
March 2021

Influence of Preformed Antibodies in Liver Transplantation.

J Clin Med 2020 Mar 5;9(3). Epub 2020 Mar 5.

Immunology Service, Murcia Institute of Biosanitary Research (IMIB) and Biomedical Research Center in Liver and Digestive Diseases Network (CIBERehd), Virgen de la Arrixaca University Clinical Hospital (HCUVA), 30120 Murcia, Spain.

The significance of human leukocyte antigen (HLA) matching and preformed donor-specific antibodies (DSAs) in liver transplantation remains unclear. The aim of this study was to analyze the presence of DSAs in a large cohort of 810 liver recipients undergoing liver transplant to determine the influence on acute (AR) or chronic liver rejection (CR), graft loss and allograft survival. DSAs were identified using complement dependent cytotoxicity crossmatch (CDC-CM) and multiplexed solid-phase-based flow cytometry assay (Luminex). CDC-CM showed that a 3.2% of liver transplants were positive (+CDC-CM) with an AR frequency of 19.2% which was not different from that observed in negative patients (-CDC-CM, 22.3%). Only two patients transplanted with +CDC-CM (7.6%) developed CR and suffered re-transplant. +CDC-CM patients showed a significantly lower survival rate compared to -CDC-CM patients (23.1% vs. 59.1%, = 0.0003), developing allograft failure within the first three months ( < 0.00001). In conclusion, we have demonstrated a relationship between the presence of preformed DSAs and the low graft liver survival, indicating the important role and the potential interest of performing this analysis before liver transplantation. Our results could help to detect patients with an increased risk of graft loss, a better choice of liver receptors as well as the establishment of individualized immunosuppressive regimens.
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http://dx.doi.org/10.3390/jcm9030708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141359PMC
March 2020

Video Education to Promote Skin Cancer Awareness and Identification in Spanish-speaking Patients.

J Clin Aesthet Dermatol 2020 Jan 1;13(1):41-43. Epub 2020 Jan 1.

Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California.

We sought to evaluate the efficacy of a Spanish-language educational video in teaching primary Spanish speaking patients to recognize benign and malignant lesions and to increase their awareness about skin cancer. Thirty-seven subjects were enrolled in study. An instructional video was developed to increase knowledge of benign and malignant lesions, skin cancer awareness, and prevention among Spanish-speaking patients. Two examples each of six common skin lesions (e.g., malignant melanoma, cherry angioma, seborrheic keratosis, benign melanocytic nevus, basal cell carcinoma, and squamous cell carcinoma) were presented as high-quality images to the participants before and after watching the two-minute educational video. A pre- and postvideo survey was used to assess competency. The prevideo baseline median score was six points (interquartile range [IQR]: 5-6 points); postviewing median score improved to 11 points (IQR: 11-12 points), which was statistically significant (Median=5 points, IQR: 4-6 points; <.001). The ability of the participants to identify nonmelanoma skin cancers improved from 74 percent to 98 percent and from 35 percent to 99 percent for squamous cell carcinoma and basal cell carcinoma. Initially, only 30 percent of participants could identify melanoma prior to viewing the video. Afterwards, 97 percent of participants could identify this malignancy. However, the video format preferences were not statistically significant: 67.6 percent of the participants preferred the video format. These results suggest that this educational video is an effective and valuable method to enhance knowledge about skin health and improve identification of skin cancer among Spanish-speaking patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028375PMC
January 2020

Confident Perception of Primary Care Physicians Correlates to the Attitude Toward Donation and Organ Transplantation: A Multicenter Study of Medical And Nursing Spanish Students.

Transplant Proc 2020 Mar 13;52(2):491-495. Epub 2020 Feb 13.

Transplant Unit, Surgery Service, University Clinical Hospital Virgen de la Arrixaca, Murcia, Spain; Biomedical Research Institute of Murcia IMIB-Arrixaca, Murcia, Spain; International Collaborative Donor Project (Proyecto Colaborativo Internacional Donante), Murcia, Spain.

A primary care physician (PCP) not only accompanies the patient in the process of an illness, but throughout his or her life. The confidence we have in these health professionals is fundamental, and their favorable attitude toward organ donation and transplantation (ODT) has a significant influence on the population.

Objective: To analyze trust in PCPs among Spanish medical and nursing students, the relationship with their attitude toward ODT, and the factors that condition it.

Methods And Design: A sociologic, multicenter, and observational study.

Population: medical and nursing students in Spanish universities.

Database: Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students (99% confidence and precision of ±1%), stratified by geographic area and year of study.

Results: Completion rate: 90%. With respect to students' trust in their physician, 18% (n = 3267) of them totally trust (completely), 45% (n = 8101) trust enough, 30% (n = 5478) of them have not enough trust, and 7% not at all. Comparing groups, medical students totally trust more in PCPs than nursing students (55% vs 45%; P < .000), however, nursing students have less than enough trust in their PCP than medical students (53% vs 47%; P < .000). Students that totally trust in their PCP were more in favor toward ODT than students with not enough trust (83% vs 77%; P < .000).

Conclusion: Only 18% of Spanish medical and nursing students totally trust in their PCP. Attitude toward ODT is related to a higher level of trust in PCPs among these students.
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http://dx.doi.org/10.1016/j.transproceed.2019.12.025DOI Listing
March 2020

Self-Esteem Related to Quality of Life in Patients Over 60 Years Old Who Received an Orthotopic Liver Transplantation More Than 10 Years Ago.

Transplant Proc 2020 Mar 11;52(2):562-565. Epub 2020 Feb 11.

Transplant Unit, Surgery Service, University Clinical Hospital Virgen de la Arrixaca, Murcia, Spain; Biomedical Research Institute of Murcia IMIB-Arrixaca, Murcia, Spain.

Background: Orthotopic liver transplantation (OLT) represents an improvement in the quality of life (QoL) in the short to medium term. However, there is little information about QoL in the long-term post-transplant and its relation with psychological variables such as self-esteem.

Objective: To analyze the perceived QoL in relation to the level of self-esteem in patients over 60 years of age who received an OLT more than 10 years ago.

Materials And Methods: Cross-sectional descriptive study. Including patients from the Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA).

Instrument: to evaluate the QoL: EuroQol-5D questionnaire; to evaluate health status: 1. social transfer index and 2. visual analog scale (VAS); to measure self-esteem level: Rosenberg scale. Sociodemographic and clinical variables. Nonparametric analysis (P < .05).

Results: Analyzed 46 patients, 70% men (n = 32) and 30% women (n = 14); mean age of 70.85 ± 6.7 years and mean years of post-OLT survival of 15.91 ± 5.3 years. Average score in QoL: 0.8 ± 0.17 in the social transfer index and 77.07 ± 16.82 in the VAS. Average level of self-esteem: 34 ± 3.55 point. When analyzing the variables, there are no differences in age or post-OLT years. There are significant differences according to sex (P = .001). However, the diagnosis influences the patient's perception of QoL (P < .001). The post-OLT survival correlates negatively with social transfer index (P = .017) and self-esteem level (P = .045). In addition, those patients living in the city presented a higher level of self-esteem (P = .03).

Conclusion: Sex, diagnosis, post-OLT years, social environment, and place of residence have an influence on the QoL and self-esteem of patients.
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http://dx.doi.org/10.1016/j.transproceed.2019.12.017DOI Listing
March 2020

Does Knowledge of the Concept of Brain Death Affect the Attitude Toward Donation of Algerians Residing in Spain?

Transplant Proc 2020 Mar 8;52(2):465-468. Epub 2020 Feb 8.

International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain; Department of Surgery, University of Murcia, Murcia, Spain.

Introduction: Algeria is an important source of immigrants to Europe. A population with a low culture of donation and transplantation and little knowledge of related concepts such as brain death (BD).

Objective: Analyze the knowledge and acceptance of the BD concept of the population born in Algeria and residing in Spain.

Material And Methods: Population under study. Population born in Algeria and resident in Spain.

Inclusion Criteria: Sample of population over 15 years stratified by age and sex.

Instrument: Attitude validated questionnaire for organ donation for transplant PCID-DTO-Ríos. Field work. Random selection of people to be surveyed according to stratification.

Results: A total of 441 respondents have been included in the study; of these, 27.2% know the concept of BD and accept it as a person's death. Of the rest, 18% do not know or have doubts about the concept, and 54% have a misconception or do not accept it as the death of a person. Those who know the concept of BD have a more favorable attitude toward donation (P = .001). When making the correlation to see which psychosocial factors are related to the knowledge of the concept of brain death, it is obtained that those respondents who have spoken with family about organ transplantation have a better knowledge of it (P < .001).

Conclusions: The Algerian population immigrating to Spain has little knowledge of the BD concept, which has a direct relationship to their attitude toward organ donation. The family-level approach to the donation and transplant process sensitizes and improves the knowledge of this concept.
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http://dx.doi.org/10.1016/j.transproceed.2019.12.020DOI Listing
March 2020

Population of Senegal Residents in Spain: Acceptance of Organ Xenotransplantation.

Transplant Proc 2020 Mar 8;52(2):473-475. Epub 2020 Feb 8.

International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain; Department of Surgery, University of Murcia, Murcia, Spain.

Introduction: Spain is a great receptor of immigration from sub-Saharan people like the Senegalese. This population is not very familiar with the process of organ donation and transplantation, and even less toward new therapies related to transplantation, such as xenotransplantation (XenoTx).

Objective: Analyze the attitude toward XenoTx among the Senegalese population living in Spain.

Material And Methods: Population under study. Population born in Senegal and resident in Spain.

Inclusion Criteria: Sample of population over 15 years stratified by age and sex, according to census data and immigrant assistance associations.

Instrument: Validated questionnaire of attitude toward donation and organ transplantation "PCID-XenoTx-Ríos." Field work. Random selection of respondents based on stratification. The support of immigration support associations was required to obtain sample locations. The completion was anonymous and self-administered.

Results: A sample of 468 Senegalese was obtained. Twenty percent (n = 92) would accept a solid organ xenotransplant if the results were similar to human organs, 40% (n = 188) have doubts, and 40% (n = 188) would not accept it. If the results were worse than with human organs, only 8% would accept it (n = 38). Respondents with a favorable attitude toward XenoTx presented a more favorable attitude toward cadaveric donation (70.5% vs 31.3%; P < .001). The attitude toward acceptance of XenoTx is related to socio-personal factors (P < .05), knowledge about the process of organ donation and transplantation (P < .05), social interaction factors (P < .001), and religious factors (P < .05).

Conclusions: Senegalese residing in Spain do not have a favorable attitude toward XenoTx. A direct relationship between the attitude toward XenoTx and organ donation is observed.
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http://dx.doi.org/10.1016/j.transproceed.2019.11.045DOI Listing
March 2020

Predisposition Toward Living Liver Donation Is Low Among Relatives of Patients on the Waiting List for Transplantation in Spain.

Transplant Proc 2020 Mar 8;52(2):476-479. Epub 2020 Feb 8.

International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Department of Surgery, University of Murcia, Murcia, Spain; Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain.

Introduction: The attitude toward living liver donation (LLD) among the Spanish population is mostly positive; however, the reality is that liver transplants from live donations are currently minimal. Given this situation, studies that analyze these discrepancies should be carried out.

Objective: Analyze the attitude toward LLD among family members of patients on the waiting list for liver transplantation.

Method: Population under study. First-degree relatives of the patients included in the waiting list for liver transplantation.

Inclusion Criteria: 1. Have the patient's authorization for family members to participate; 2. Accept, the relative, to participate in this investigation; and 3. Be over 18 years old. Opinion survey. The attitude toward LLD is assessed through a questionnaire on psychosocial aspects.

Results: Patients who accepted family members' participation in the study were 21 of 112, of which 9 placed restrictions on family access, and 12 authorized family members without restrictions. The participants were 1. children: 52.2% (n = 24); 2. brothers: 30.5% (n = 14); and 3. partners: 17.3% (n = 14). Finally, the authorized relatives and participants in the study were 45. Of these, only 44% (n = 20) would accept to be donors.

Conclusions: The access to the LLD of the relatives starts from the restriction and initial rejection of the patients themselves on the waiting list. The promotion of LDD is to initially sensitize patients.
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http://dx.doi.org/10.1016/j.transproceed.2019.12.022DOI Listing
March 2020

Are Ghanaians Residing in Spain Aware of the Donation of Living Related Kidney?

Transplant Proc 2020 Mar 8;52(2):469-472. Epub 2020 Feb 8.

International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain; Department of Surgery, University of Murcia, Murcia, Spain.

Introduction: The population of Ghana has an emerging migratory flow to Europe and especially to Spain. Therefore, there is an increase in waiting lists in kidney transplantation.

Objective: To analyze the attitude toward related living kidney donation (LKD) among the population born in Ghana and residing in Spain.

Material And Methods: Population under study. Population born in Ghana and resident in Spain.

Inclusion Criteria: Sample of population over 15 years stratified by age and sex, according to census data and immigrant assistance associations.

Instrument: Validated attitude questionnaire toward LKD "PCID-DVR-Ríos." Field work. Random selection of people to be surveyed according to stratification.

Results: A total of 237 respondents have been included in the study. 72% are in favor of LKD, not just related. The remaining 28% do not accept the related living donation or have doubts about it. Respondents in favor of the related LKD have a more positive attitude toward ODT (P < .001). The attitude toward related LKD is linked to socio-personal factors, knowledge factors about the donation and organ transplantation process, social interaction factors, attitude factors toward the body, religious factors, and the risk assessment that comes with a living donation (P < .05). In the multivariate analysis persists: the attitude toward the cadaveric OTD (odds ratio [OR] = 6.993), perform pro-social activities (OR = 14.084), fear of body mutilation (OR = 20.408) and renal risk (OR = 29.411).

Conclusions: The Ghanaian population immigrating to Spain has an unfavorable attitude toward related LKD compared with existing studies of Western European and Spanish populations, which is conditioned by multiple psychosocial factors.
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http://dx.doi.org/10.1016/j.transproceed.2019.12.021DOI Listing
March 2020

Is the Population of Santiago de Cuba Sensitized to Xenotransplantation? A Multivariate Analysis.

Transplant Proc 2020 Mar 6;52(2):484-486. Epub 2020 Feb 6.

International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain; Department of Surgery, University of Murcia, Murcia, Spain.

Introduction: New transplant-related therapies such as xenotransplantation of solid cells, tissues, and organs are still poorly understood, especially in countries without preclinical xenotransplantation programs.

Objective: Analyze the attitude toward xenotransplantation among the population of Santiago de Cuba.

Method: Type of study. Cross-sectional observational study.

Sample: Random sampling of 455 individuals residing in Santiago de Cuba. Assessment instrument. Validated questionnaire of attitude toward the xenotransplant, "PCID-XenoTx-Ríos." Field work. Random selection based on stratification. Anonymous and self-administered completion.

Results: A total of 49.9% would accept a solid organ xenotransplant if they needed it and the results were similar to those currently obtained with human organs, 27.5% have doubts, and the remaining 22.6% would not accept it. They are presented as statistically significant variables (P < .05): level of studies; comment with the family about the donation; opinion of a partner; religion; opinion of religion; performing prosocial activities; attitude toward donation; previous relationship with the organ donation and transplant; favorable attitude toward live kidney donation. In the multivariate analysis, the following persist: 1. level of university studies: odds ratio (OR) = 5.076; 2. not having a partner: OR = 5.154; 3. belonging to another religion: OR = 2.061; 4. favorable attitude toward organ donation: OR = 5; and 5. favorable attitude toward living donation: OR = 3.759.

Conclusions: The population of Santiago de Cuba is less sensitized toward xenotransplantation, possibly due to ignorance of the issue due to lack of preclinical trials in their countries.
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http://dx.doi.org/10.1016/j.transproceed.2019.11.046DOI Listing
March 2020

Attitude Toward Related Living Donation Among Patients on Waiting List for Liver Transplantation.

Transplant Proc 2020 Mar 7;52(2):462-464. Epub 2020 Feb 7.

International Collaborative Donor Project ("Proyecto Colaborativo Internacional Donante"), Murcia, Spain; Department of Surgery, University of Murcia, Murcia, Spain; Transplant Unit, Surgery Service, IMIB - Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain.

Introduction: In liver transplantation, living donation shows better and better results. However, rates of living liver donation (LLD) are low.

Objective: To analyze the attitude towards LLD among patients on the waiting list for liver transplantation.

Method: Study population: Patients included in the waiting list for liver transplantation who are not in code 0 and do not present with encephalopathy above grade I.

Protocol: After being included in the waiting list, they are informed of the study and they are cited in the Psychology Consultation.

Instruments: attitude questionnaire towards LLD, carried out in the Psychological Care consultation.

Results: Of the 147 patients included in the waiting list, 112 fulfilled the inclusion criteria in the study. After being cited in the consultation, 100% of respondents are in favor of living liver donation. However, when considering the related LLD, 80% of the respondents indicated that they would not accept a living donation from a family member and therefore did not want to complete the questionnaire. Of the remaining 20% who completed the study, 11% would accept it from any family member, 8% only from some family members (mainly excluding children and grandchildren), and the remaining 1% would accept it but excluded all their family members.

Conclusion: Currently, there is a disconnect between patients' intentions in favor of living liver donation and the real attitude when they are on the waiting list and related living donation is raised.
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http://dx.doi.org/10.1016/j.transproceed.2019.12.019DOI Listing
March 2020