 Influenza or “the flu” is an illness caused by seasonal influenza viruses which circulate in all parts of the world.  Seasonal influenza viruses circulate worldwide and can affect people in any age group.  In temperate climates, seasonal epidemics occur mainly during winter while in tropical regions, influenza seasonality is less obvious, and epidemics can occur throughout the year.  In Myanmar, June to September is the usual influenza season coinciding with the monsoon.

季節性インフルエンザ(Seasonal Influenza)の総括

https://stacks.cdc.gov/view/cdc/31866/cdc_31866_DS1.pdf

Characteristics and Survival of Patients with End Stage Renal Disease and Spina Bifida in the United States Renal Data System

Introduction At present, a second kidney transplant is considered an established therapeutic option for patients who have lost a previous graft Second transplants show similar graft survival as first transplants A debate exists about the benefit of submitting the patient to a third or fourth renal transplant, or to maintain dialysis Objective We sought to analyze graft and patient survivals as well as associated variables and surgical complications of third and fourth transplantations Material and Methods From July 1985 to December 2008, we performed 74 third and 8 fourth transplantations among 2763 cases We prospectively collected the variables of age, gender, graft origin, hyperimmunization, time on dialysis, location, bench surgery, acute rejection episodes, graft survival, and operative complications Results Third and fourth trasplantations were performed in 49 men and 33 women, with an overall mean age of 4026 years who were on dialysis for an average of 12689 months before transplantation Mean graft survivals of their first and second grafts were 356 and 501 months, respectively Acute or chronic rejection was reason for renal failure in 71% and 75% of cases, respectively Patient survivals at 1 and 5 years were 927% and 906%, for third and both 857% for the fourth transplantation The third and fourth transplantations showed 1- and 5-year graft survivals of 88% and 764% and 714% and 429%, respectively Sixty-eight cases underwent cadaveric donor and 14 living donor (mean age, 421 years) transplantations Nine patients were hyperimmunized In 60 cases, we used the left kidney Orthotopic kidney transplantation was performed in 15 cases; heterotopic transplant to the right iliac fossa in 40 and in the left iliac fossa in 17 cases Arterial bench surgery was necessary in 6 cases and venous in 3 We performed 3 hepatorenal and 1 cardiorenal transplantation The complications included 29 cases (354%) of postoperative acute tubular necrosis, 14 of acute rejection episodes (171%); 12 of perirenal hematoma (146%); 1 urinary fistula (12%); 4 lymphocele (49%); 2 ureteral stenosis (24%); variables arterial kink requiring surgery (12%), and 1 venous thrombosis with graft loss (12%) The 4 patients who died in the perioperative period succumbed to intravascular disseminated coagulation ( n = 1) cardiac failure ( n = 2), and septic shock ( n = 1) Induction antibody therapy, hyperimmunized status, or operative complications were not independent prognostic factors for patient or graft survival Conclusions Third or fourth renal transplantations constitute a valid therapeutic option with reasonable short- and long-term patient and graft survivals Although orthotopic kidney transplantation was used in selected patients, we preferred an iliac fossa approach for most

Third and Fourth Kidney Transplant: Still a Reasonable Option

The transformation of the Information and Communication Technologies (ICT) into knowledge and learning technologies is increasingly becoming a matter of concern. Teaching settings associated with the use of blogs in Higher Education are presented in this paper, proceeding from an innovative learning experience of projects carried out by a group of professors between 2009 and 2013. Both, teachers and students who took part in the subjects that implemented the blog, considered it as helpful resource to create a virtual and learning-teaching environment due to the multiple potentialities it offers. Among some of these potentialities, some stand out: it makes easier the access to knowledge, promotes a more active and reflective learning, expands the social experience of learning, provides evidence about the students’ progress which helps to reorient the teaching-learning process, and encourages the critical judgment. Nevertheless, several problems related with the students’ participation and the teacher’s blog management have been identified.

/pdf/los-blogs-como-entornos-virtuales-de-ensenanza-y-aprendizaje-3eufruqaej.pdf

Los blogs como entornos virtuales de enseñanza y aprendizaje en Educación Superior

Introduction 
Influenza morbidity and mortality are significant in the countries of South America, yet influenza vaccination is as low as 56.7% among pregnant women, reaching 76.7% of adults with chronic diseases. This article measures the relative values for the vaccination hesitancy indicators of confidence, complacency and convenience by risk-groups in urban areas of five countries of South America with contrasting vaccination rates, analyzing their association with sociodemographic variables and self-reported immunization status.


Methods 
An exit survey was applied to 640 individuals per country in Brazil, Chile, Paraguay, Peru and Uruguay, distributed equally across risk groups of older adults, adults with risk factors, children ≤6 and pregnant women. Indicators were constructed for vaccine confidence, complacency and convenience. Analysis of variance and multiple logistic analysis was undertaken.


Results 
Adults with risk factors are somewhat more confident of the influenza vaccine yet also more complacent. Convenience is higher for mothers of minors. Children and older adults report higher levels of vaccination. The 3Cs are more different across countries than across risk groups, with values for Chile higher for confidence and those for Uruguay the lowest. Complacency is lower in Brazil and higher in Uruguay. Results suggest that confidence and complacency affect vaccination rates across risk groups and countries.


Conclusions 
Influenza vaccine confidence, complacency and convenience have to be bolstered to improve effective coverage across all risk groups in the urban areas of the countries studied. The role played by country contextual and national vaccination programs has to be further researched in relation to effective coverage of influenza vaccine.

/pdf/influenza-vaccination-hesitancy-in-five-countries-of-south-12yc2chbcm.pdf

Influenza vaccination hesitancy in five countries of South America. Confidence, complacency and convenience as determinants of immunization rates.

The aim of this study was to analyze the 30 third transplantations performed at our center since 1976. They were all from cadaveric donors. Recipient mean age was 40 years (range, 21-57 years). Twenty-one patients (70%) had hepatitis C virus infection and 16 (53%) were hypersensitized (panel-reactive antibodies [PRA] >50%), with a mean time on dialysis since second graft loss of 65 months (range, 1-250 months). The imaging tests showed iliac calcifications in 14 patients (47%). The graft was preferably placed in the iliac fossa (27/30). Twenty-five patients (83%) had prior graft nephrectomy and transplantectomy was performed at the same surgery in 2 cases. Immunosuppressive protocol was quadruple therapy in 23 patients (77%). At a mean follow-up of 43 months, 24 grafts were functioning. Mean serum creatinine was 1.5 mg/dL and Modification of Diet in Renal Disease (MDRD) clearance was 64.5 mL/min. Six grafts were lost: 3 due to acute rejection, 2 due to chronic allograft nephropathy, and 1 due to venous thrombosis. Four patients died: 2 due to infectious complications, 1 due to hepatic encephalopathy, and 1 to an accident with a functioning graft. The acute rejection rate was 30% and 4 patients had an acute humoral rejection episode. The main surgical complication was lymphocele in 7 cases (23%). Estimated survival at 5 years was 76% for grafts and 86% for patients. Graft survival worsened among patients with PRA > 80% and among those who had lost the previous grafts in the first month posttransplantation (P < .05). In conclusion, the outcomes of the third kidney transplantations encourage us to continue with this procedure. However, worse graft survival should be expected among hyperimmunized patients and among those who had lost previous grafts early in their course.

Third kidney transplantation: a permanent medical-surgical challenge.

Objective We studied the long-term renal graft functions, survivals, and complications among patients with augmented bladders. Patients and Methods Between 1976 and 2008, we performed 6/2600 renal transplantations in patients with augmented bladders. The mean patient age was 52 years. The cause of end-stage renal disease was chronic interstitial kidney disease in all patients, being secondary to lower urinary tract dysfunction. The etiology of bladder dysfunction was tuberculosis in 4 cases, bladder exstrophy in 1, and myelomeningocele in 1. Enterocystoplasty had been performed at a mean of 19 years prior to transplantation. The ureter was implanted into the native ureter in 5 cases and the bowel segment in 1 case. Results With a mean follow-up of 56 months (range, 20–100 months), the overall graft survival was 50%. Three grafts were lost due to venous thrombosis (n = 1), and chronic allograft nephropathy (n = 2) at 37 and 100 months posttransplantation. No patient died during follow-up. Mean serum creatinine was 1.44 mg/dL with Modification of Diet in Renal Disease (MDRD) clearance of 76 mL/min/1.73 m2. One fistula that caused obstructive uropathy and 2 cases of migration of a double J catheter were among the surgical complications. These patients showed a mean of 7 episodes of uncomplicated urinary infections. Only 1 patient was rehospitalized due to a complicated urinary tract infection. Conclusions Patients with enterocystoplasty and renal transplantation show a greater risk of urinary tract infections, albeit mostly uncomplicated. Despite this, the long-term results are acceptable.

Outcome of Renal Transplantation in Adult Patients With Augmented Bladders

Objective 
There are limited published data about the circulation of influenza B/Victoria and B/Yamagata in Latin America and the Caribbean (LAC) and most countries have a vaccine policy that includes the use of the trivalent influenza vaccine. We analyzed influenza surveillance data to inform decision-making in LAC about prevention strategies, such as the use of the quadrivalent influenza vaccine.


Methods 
There are a total of 28 reference laboratories and National Influenza Centers in LAC that conduct influenza virologic surveillance according to global standards, and on a weekly basis upload their surveillance data to the open-access World Health Organization (WHO) platform FluNet. These data include the number of specimens tested for influenza and the number of specimens positive for influenza by type, subtype and lineage, all by the epidemiologic week of specimen collection. We invited these laboratories to provide additional epidemiologic data about the hospitalized influenza B cases. We conducted descriptive analyses of patterns of influenza circulation and characteristics of hospitalized cases. We compared the predominant B lineage each season to the lineage in the vaccine applied, to determine vaccine mismatch. A Chi-square and Wilcoxan statistic were used to assess the statistical significance of differences in proportions and medians at the P<0.05 level.


Findings 
During 2010–2017, the annual number of influenza B cases in LAC was ~4500 to 7000 cases. Since 2011, among the LAC-laboratories reporting influenza B lineage using molecular methods, both B/Victoria and B/Yamagata were detected annually. Among the hospitalized influenza B cases, there were statistically significant differences observed between B/Victoria and B/Yamagata cases when comparing age and the proportion with underlying co-morbid conditions and with history of oseltamivir treatment (P<0.001). The proportion deceased among B/Victoria and B/Yamagata hospitalized cases did not differ significantly. When comparing the predominant influenza B lineage detected, as part of surveillance activities during 63 seasons among 19 countries, to the lineage of the influenza B virus included in the trivalent influenza vaccine used during that season, there was a vaccine mismatch noted during 32% of the seasons analyzed.


Conclusions 
Influenza B is important in LAC with both B/Victoria and B/Yamagata circulating annually in all sub regions. During approximately one-third of the seasons, an influenza B vaccine mismatch was identified. Further analyses are needed to better characterize the medical and economic burden of each influenza B lineage, to examine the potential cross-protection of one vaccine lineage against the other circulating virus lineage, and to determine the potential impact and cost-effectiveness of using the quadrivalent vaccine rather than the trivalent influenza vaccine.

/pdf/patterns-of-influenza-b-circulation-in-latin-america-and-the-52jrolrpij.pdf

Patterns of influenza B circulation in Latin America and the Caribbean, 2010-2017.

A partir del analisis de las diferentes teorias existentes en torno al termino “nativo digital” que han surgido en la ultima decada, se ha esgrimido una taxonomia que explica y define las caracteristicas que implica dicha expresion. Como metodo se ha seguido el analisis documental de las teorias y definiciones preexistentes con el fin de obtener una definicion global que reuna las caracteristicas mas representativas de la generacion digital.

/pdf/senas-de-identidad-del-nativo-digital-una-aproximacion-flef3qhi53.pdf

Señas de identidad del “nativo digital”. Una aproximación teórica para conocer las claves de su unicidad.

Muchos autores de reconocido prestigio apoyan la incorporacion y utilizacion de TICs en las aulas previendo las modificaciones que tendra que efectuar la educacion haciendo uso de estas para poder seguir en lo posible los rapidos cambios que ya se estan dando en la sociedad digital. Este Trabajo de Investigacion sigue la misma linea y adopta como objetivo general contribuir a una posible mejora de la calidad en la ensenanza mediante la utilizacion didactica de edublogs y su efecto dinamizador del proceso de Ensenanza-Aprendizaje. 
PALABRAS CLAVE: Tecnologias de la Informacion y Comunicacion (TIC), Blog, Educacion, Recursos, Dinamizacion.

José Francisco Durán Medina

Papers

Third kidney transplantation: a permanent medical-surgical challenge.

Outcome of Renal Transplantation in Adult Patients With Augmented Bladders

Patterns of influenza B circulation in Latin America and the Caribbean, 2010-2017.

Señas de identidad del “nativo digital”. Una aproximación teórica para conocer las claves de su unicidad.

La utilización del edublog en las aulas como dinamizador del proceso de enseñanza-aprendizaje