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Armangue T.,University of Barcelona | Armangue T.,Autonomous University of Barcelona | Titulaer M.J.,University of Barcelona | Malaga I.,Hospital Universitario Central Of Asturias | And 5 more authors.
Journal of Pediatrics | Year: 2013

Objective: To report the clinical features of 20 pediatric patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Study design: Review of clinical data, long-term follow-up, and immunologic studies performed in a single center in Spain in the last 4 years. Results: The median age of the patients was 13 years (range, 8 months-18 years), 70% were female. In 12 patients (60%), the initial symptoms were neurologic, usually dyskinesias or seizures, and in the other 40% psychiatric. One month into the disease, all patients had involuntary movements and alterations of behavior and speech. All patients received steroids, intravenous immunoglobulin or plasma exchange, and 7 rituximab or cyclophosphamide. With a median follow up of 17.5 months, 85% had substantial recovery, 10% moderate or severe deficits, and 1 died. Three patients had previous episodes compatible with anti-NMDAR encephalitis, 2 of them with additional relapses after the diagnosis of the disorder. Ovarian teratoma was identified in 2 patients, 1 at onset of encephalitis and the other 1 year later. Two novel observations (1 patient each) include, the identification of an electroencephalographic pattern ("extreme delta brush") considered characteristic of this disorder, and the development of anti-NMDAR encephalitis as post herpes simplex encephalitis choreoathetosis. Conclusions: The initial symptoms of pediatric anti-NMDAR encephalitis vary from those of the adults (more neurologic and less psychiatric in children), the development of a mono-symptomatic illness is extremely rare (except in relapses), and most patients respond to treatment. Our study suggests a link between post herpes simplex encephalitis choreoathetosis and anti-NMDAR encephalitis. © 2013 Mosby Inc. Source

Buti M.,CIBER ISCIII | Buti M.,Autonomous University of Barcelona | Tabernero D.,CIBER ISCIII | Tabernero D.,Autonomous University of Barcelona | And 19 more authors.
Transplant Infectious Disease | Year: 2015

Aims: To investigate an optimal long-term prophylactic strategy for prevention of hepatitis B virus (HBV) recurrence after liver transplantation, we conducted a randomized study of 29 transplant recipients receiving a short course of hepatitis B immune globulin (HBIg) + lamivudine (LAM), followed by randomization to long-term prophylaxis with LAM with or without HBIg. Methods: The efficacy and safety, and impact on survival and HBV recurrence of these 2 prophylactic regimens were compared over a mean period of 10 years. In patients with viral recurrence, the HBV quasispecies in the surface/polymerase region were studied by ultra-deep pyrosequencing (UDPS). Results: The 10-year survival rate was 76% and was not affected by the type of prophylaxis. Four patients had hepatitis B surface antigen (HBsAg) recurrence within the first 48 months after orthotopic liver transplantation (OLT). HBsAg-positive and -negative patients showed similar mean survival times, with no differences between the 2 regimens. Low HBV DNA levels were transiently detected in 32% of HBsAg-negative patients. UDPS showed major changes after OLT in the HBV quasispecies of patients with viral recurrence, which may be explained by a "bottleneck" effect of OLT together with prophylactic therapy. Conclusion: Long-term survival after OLT in end-stage chronic hepatitis B patients was good with both prophylactic strategies. However, low, transient HBV DNA levels were detected even in the absence of HBsAg, showing the importance of continuing HBV prophylaxis. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Source

Girones P.,Hospital Universitari Politecnic la Fe | Lillo Crespo M.,University of Alicante | Dominguez Santamaria J.M.,University of Alicante
Transplantation Proceedings | Year: 2015

Introduction and Purpose This study explores the family experience when they are told that their recently deceased relative is in a potential position for organ donation, as well as the connotations that develop from that situation and how those nuances have lasted since then for family members. In Spain, and especially in Valencian region (where this study took place), one of the most productive counties for organ donation nationwide, the family interview is considered to be one of the most important tools that transplant coordinators can use to improve and succeed through the process of a potential organ donation. Methodology and Data Analysis This is a qualitative study based on a phenomenological approach using Giorgi's method for data analysis. Members of 11 families who donated their deceased relatives' organs in La Fe Hospital, Valencia, Spain, from 2009 to 2011, participated through in-depth interviews after signing informed consent agreements. Discussion Experiences described have shown how the relatives' overview has been affected by the situation in a way that is very different from the professional staff's view of reality. The difference in perspectives creates a barrier which can make the professional team less effective in understanding family interests to create a helpful and successful relationship for organ donation. Understanding the experiences of the families involved can help healthcare providers to conduct a more supportive family interview when the topic is organ donation. © 2015 by Elsevier Inc. All rights reserved. Source

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