The role of Nephrology in the influenza A (H1N1) pandemic. Update
Rol de la Nefrología en la pandemia por Influenza A (H1N1). Puesta al día
Read
8660
Timeswas read the article
2262
Total PDF
6398
Total HTML
Share statistics
array:21 [ "pii" => "X2013251409033501" "issn" => "20132514" "doi" => "10.3265/Nefrologia.2009.29.6.5666.en.full" "estado" => "S300" "fechaPublicacion" => "2009-12-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2009;29:576-81" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4445 "formatos" => array:3 [ "EPUB" => 288 "HTML" => 3564 "PDF" => 593 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699509033504" "issn" => "02116995" "doi" => "10.3265/Nefrologia.2009.29.6.5666.en.full" "estado" => "S300" "fechaPublicacion" => "2009-12-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2009;29:576-81" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8657 "formatos" => array:3 [ "EPUB" => 241 "HTML" => 7936 "PDF" => 480 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Rol de la Nefrología en la pandemia por Influenza A (H1N1). Puesta al día" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "576" "paginaFinal" => "581" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The role of Nephrology in the influenza A (H1N1) pandemic. Update" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "442527_figura1.jpg" "Alto" => 341 "Ancho" => 600 "Tamanyo" => 105620 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Augusto Vallejos" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Augusto" "apellidos" => "Vallejos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251409033501" "doi" => "10.3265/Nefrologia.2009.29.6.5666.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409033501?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509033504?idApp=UINPBA000064" "url" => "/02116995/0000002900000006/v0_201502091341/X0211699509033504/v0_201502091342/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251409033708" "issn" => "20132514" "doi" => "10.3265/Nefrologia.2009.29.6.5483.en.full" "estado" => "S300" "fechaPublicacion" => "2009-12-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2009;29:582-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5120 "formatos" => array:3 [ "EPUB" => 249 "HTML" => 4170 "PDF" => 701 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Practical Guide to genetic association studies. Considerations on their clinical usefulness" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "582" "paginaFinal" => "588" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Guía práctica a los estudios de asociación genética. Consideraciones sobre su utilidad clínica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "43718078_t1_p583.jpg" "Alto" => 610 "Ancho" => 827 "Tamanyo" => 88807 ] ] "descripcion" => array:1 [ "en" => "Variables that influence sample size assessment" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Rodríguez Esparragón, José Carlos Rodríguez Pérez, M.A. García Bello" "autores" => array:3 [ 0 => array:2 [ "Iniciales" => "F." "apellidos" => "Rodríguez Esparragón" ] 1 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Rodríguez Pérez" ] 2 => array:2 [ "Iniciales" => "M.A." "apellidos" => "García Bello" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699509033700" "doi" => "10.3265/Nefrologia.2009.29.6.5483.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509033700?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409033708?idApp=UINPBA000064" "url" => "/20132514/0000002900000006/v0_201502091611/X2013251409033708/v0_201502091612/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251409033536" "issn" => "20132514" "doi" => "10.3265/Nefrologia.2009.29.6.5655.en.full" "estado" => "S300" "fechaPublicacion" => "2009-12-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2009;29:569-75" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4509 "formatos" => array:3 [ "EPUB" => 278 "HTML" => 3715 "PDF" => 516 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Expression of nephrin, podocin and α-actinin-4 in renal tissue of patients with proteinuria" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "569" "paginaFinal" => "575" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Expresión de nefrina, podocina y α-actinina-4 en tejido renal de pacientes con proteinuria" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "45018078_f1_p571_copy1.jpg" "Alto" => 306 "Ancho" => 399 "Tamanyo" => 27867 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => " Grupo PRYT, Luis F. Arias, B.E. Vieco, A.A. Arteta" "autores" => array:4 [ 0 => array:1 [ "apellidos" => "Grupo PRYT" ] 1 => array:2 [ "nombre" => "Luis F." "apellidos" => "Arias" ] 2 => array:2 [ "Iniciales" => "B.E." "apellidos" => "Vieco" ] 3 => array:2 [ "Iniciales" => "A.A." "apellidos" => "Arteta" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699509033539" "doi" => "10.3265/Nefrologia.2009.29.6.5655.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509033539?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409033536?idApp=UINPBA000064" "url" => "/20132514/0000002900000006/v0_201502091611/X2013251409033536/v0_201502091612/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "The role of Nephrology in the influenza A (H1N1) pandemic. Update" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "576" "paginaFinal" => "581" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Augusto Vallejos" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Augusto" "apellidos" => "Vallejos" "email" => array:1 [ 0 => "acvallejos@yahoo.com.ar" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Argerich. Coordinación Nacional del Grupo de Trabajo de Hemodiálisis. Sociedad Argentina de Nefrología, Buenos Aires, Argentina, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rol de la Nefrología en la pandemia por Influenza A (H1N1). Puesta al día" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "44218078_f1_p578.jpg" "Alto" => 463 "Ancho" => 824 "Tamanyo" => 43729 ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">In early April this year, a new influenza A virus was identified, hemagglutinin 1 and neuraminidase 1 (H1N1), with significant changes in both proteins, 27.2% and 18.2% of the amino acid sequence, respectively, when compared with the previous H1N1 strain isolated in 2008. This implies a lack of immunity in the population, except for some people older than 60,<span class="elsevierStyleSup">1</span> and high human to human transmission.<span class="elsevierStyleSup">2,3</span> It has spread widely and rapidly in both hemispheres, prompting the World Health Organisation (WHO) to declare a Pandemic alert Phase 6 on 10 June. Given the historical context, it could infect 30% of the world population.<span class="elsevierStyleSup">4</span> This new virus of swine origin (S-OIV, swine-origin influenza virus) appears clinically as a febrile respiratory influenza, ranging from mild to severe which can affect all ages, although 80% has occurred in people under 30 years of age. Both fever and cough occur in more than 90% of cases, and a third of them are associated with gastrointestinal symptoms (vomiting and diarrhoea). It occurs equally in both sexes,<span class="elsevierStyleSup">5,6</span> and has an adequate therapeutic response to neuraminidase inhibitors, oseltamivir and zanamivir.<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">The nephrologist has an important role in the pandemic, since we are part of the health team treating patients with kidney problems such as acute renal failure associated with infection by S-OIV (H1N1), and we are also involved in the care of patients with chronic kidney problems (undergoing transplant, dialysis or treated with peritoneal dialysis, PD) and in organ donation in areas with infected patients.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">INVOLVEMENT OF THE HEALTH TEAM SPECIALISING IN RENAL PATIENTS</span></p><p class="elsevierStylePara">Although there is significant asymmetry between the countries of the region, generally the number of nurses trained in renal replacement treatment and physicians specialising in nephrology is reduced in Latin America, and this contrasts with the increased incidence of chronic kidney disease (CKD) in need for replacement therapies.<span class="elsevierStyleSup">8,9</span> The care provided by personnel during a pandemic is a priority. Frequent hand washing, use of equipment and specific strategies for treating infected patients reduce the risk of personnel passing on the disease. According to the Pan American Health Organisation (PAHO), the overall impact is still moderate in countries such as Uruguay, and mild in the USA. In Argentina, this information has not been provided to the PAHO, but it is clear that in some dialysis units the level of absenteeism has reached a third of staff. This is due to several factors: the first is the risk of spreading the disease by health workers (nurses, doctors, administrators, etc.), who stay at home for a week to prevent contact with patients and the rest of the team. The second reason is government regulation. Personnel at high risk if they catch the disease (e.g. pregnant women, patients with chronic bronchial or immunosuppressant problems) make use of compulsory permits until the end of the pandemic. Finally, as a precautionary measure, the Argentinean Ministry of Education ordered the closure of schools, based on nonpharmacological strategies which have proven effective in alleviating the pandemic.<span class="elsevierStyleSup">11</span> This has resulted in many children being left at home in metropolitan areas, forcing staff, especially mothers of young children, to seek special permission to stay at home to care for their children. For all these reasons, the Argentinian Nephrology Society together with companies and organisations in nuclear dialysis centres have prepared recommendations to protect health personnel, and to prevent and adequately treat patients on dialysis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">ACUTE RENAL FAILURE ASSOCIATED WITH INFLUENZA A (H1N1)</span></p><p class="elsevierStylePara">Since the first cases in Mexico, USA and Canada, it was reported that infected patients may develop serious respiratory symptoms<span class="elsevierStyleSup">12,13</span> and some of these with acute renal injury (ARI). The typical case we see in Argentina is the young adult patient, with or without comorbidities, who rapidly develops acute respiratory failure (ARF) 2-3 days after the onset of the symptoms, requiring mechanical ventilation, due to severe persistent hypoxaemia, usually with PAO2/FIO2 ratio values < 150. During the first week of, oliguric ARI may occur, requiring renal replacement therapy. The ARI is no different to that in seasonal influenza cases, particularly in children.<span class="elsevierStyleSup">14</span> It occurs in the context of systemic inflammatory response syndrome typical of viral infection that some experts call ¿viral sepsis¿, with multiorgan dysfunction, in this case respiratory, haemodynamic, hepatic, renal and haematological. The renal involvement of the sepsis is by hypoperfusion mediated by cytokines and other endocrine systems, and occasionally is accompanied by disseminated intravascular coagulation.<span class="elsevierStyleSup">15</span> The organ of greatest impact on influenza infection is the lung, so another mechanism of renal lesion is probably induced ischemia due to severe persistent hypoxaemia. The association of the latter with acute renal involvement is clearly established.<span class="elsevierStyleSup">16-18</span> Finally, rhabdomyolysis is a process directly related to renal injury in seasonal influenza.<span class="elsevierStyleSup">19-27</span> Rhabdomyolysis induces an aggression by vasoconstriction, formation of tubular casts and direct cytotoxicity due to heme.<span class="elsevierStyleSup">28</span> During the pandemic in Argentina, there were different levels of creatine kinase reported, up to 30,000U/ml.<span class="elsevierStyleSup">29</span> Although to date there is no documented direct cytopathic injury in kidneys of patients with influenza, some authors have suggested it as cause of ARF.<span class="elsevierStyleSup">30</span> Viremia is transient and extrapulmonary tissue injury limited, therefore, this mechanism is unlikely.<span class="elsevierStyleSup">31</span> In one reported case of ARI associated with seasonal influenza A, the histopathological changes observed were due to toxicity and myoglobin deposition, without any injury directly attributable to the virus observed.<span class="elsevierStyleSup">32</span> Of the cases reported as influenza-like illness (ILI) in adults and studied with virological techniques in the current pandemic in Argentina, the majority was influenza A (Figure 1). 1% of these patients required admittance to the hospital. One fifth of those hospitalised were referred to the ICU and the majority required mechanical ventilation.<span class="elsevierStyleSup">33</span> Although the possibility that an infected patient displays a shift towards respiratory failure with ARI is less than 0.5%, experience shows that these patients have a mortality exceeding 90%. A feature of the pandemic is that the cases steadily appear until reaching a peak, and in Argentina during epidemiological week 26, there were 29.7 suspected cases of ILI per 10,000 population (Figure 2). In this period of increased case mix in the metropolitan area, it was common to see an increase in critically ill patients requiring mechanical ventilation, especially in referral centres (Figure 3). Simultaneously, more nephrological services were demanded, which put the public health system on a state of alert.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CHRONIC RENAL PATIENTS</span></p><p class="elsevierStylePara">The patient with chronic kidney disease is considered an infection risk, and specifically with the influenza virus, so different organisations recommend preseasonal prophylaxis by vaccination.<span class="elsevierStyleSup">34-36</span> Pharmaceutical companies are already developing a new vaccine against H1N1, which will probably be offered in a triple formulation (H1N1, H3N2 and influenza B). After the epidemic of H5N1 (bird flu) vaccine production was improved.<span class="elsevierStyleSup">37</span> Today, the WHO estimates that in an optimal setting production could reach 4.9 billion doses annually. The possibility of vaccinating patients in Argentina will then depend on world production, the cost, the amount purchased by industrialised countries and the reserve ratio for emerging countries with little or no access to new vaccines.<span class="elsevierStyleSup">38</span></p><p class="elsevierStylePara">The patient undergoing chronic haemodialysis is in a particular situation: he is ambulatory but spends several hours with other patients in an enclosed area. Thus, there is a strong possibility of infection in the haemodialysis room. In the above recommendations, the Argentinian Nephrology Society stresses the importance of treating suspected cases inside and outside the dialysis room, and how to prevent such patients from spreading the disease. In addition, it highlights the need to adjust the dose of oseltamivir to renal function.<span class="elsevierStyleSup">39</span> Work is currently proceeding in the reporting of patients undergoing chronic dialysis with suspected cases and their evolution, to show how the pandemic affected this population.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">ORGAN DONATION AND SOLID ORGAN TRANSPLANTS</span></p><p class="elsevierStylePara">In 2008, Argentina reached a rate of 13.1 cadaver donors per million inhabitants. There are seasonal and geographical variations (e.g., in the City of Buenos Aires, the equivalent rate was 24.9 pmp). During the month of June, which is winter in this hemisphere, the number of areas was reduced by approximately 50% in the metropolitan area.<span class="elsevierStyleSup">40</span> This coincided with the progression of patients with acute lung injury in the ICU of referral and donor hospitals, displacing the more prevalent pathologies that lead to brain death. Literally, the ICUs were filled to capacity with patients requiring mechanical ventilation. Then came questions about whether donors could be sought from those in contact with patients diagnosed with H1N1, if there was a possibility of horizontal, intranosocomial, transmission in the ICU, etc. So much so that experts from procurement agencies along with transplant organisations, infectious diseases and intensive care departments met and agreed on a donor selection algorithm during the pandemic, based on the history and clinic, as well as viral detection by RT-PCR (Fig. 4). Some kidney transplant patients developed unfavourably, as with the general population. Transplant centres in the metropolitan area chose to avoid scheduled periodic inspections and erformed triage of patients with febrile syndrome and, at the above meeting, developed recommendations for treatment.<span class="elsevierStyleSup">41</span></p><p class="elsevierStylePara"> These stated that antiviral therapy in suspected cases should continue for 10 days (antiviral treatment in the general population is 5 days). This is supported by some work that identified a prolonged respiratory viral excretion in inmunocompromised patients.<span class="elsevierStyleSup">42,43</span> In addition, the SAT Committee on Infectious Diseases is implementing a register of transplant patients infected with influenza A.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">The first reported pandemic in the twentieth century, the ¿Spanish flu¿ (1918), coincidentally influenza A H1N1, caused the death of 20 to 40 million people. At the dawn of this new century, we find ourselves in the same situation but with knowledge of the viral biology and genetics that give us therapeutic and technological tools to deal with it. Nephrologists carry out a major role in the influenza pandemic. The high mortality of, mostly young, patients with ARI presents a challenge. Adequate and timely use of antivirals may improve the development, and it is hoped that the specific vaccine to immunise staff and uninfected patients will arrive soon. Education and protection of persons under renal replacement treatment and the care staff working with us are a priority. The recommendations of experts may help to reduce infection rates and mortality.</p><p class="elsevierStylePara">Thus, with adequate health measures, medical management of high risk potential infection scenarios and the use of new technologies, we may improve the results of previous pandemic experiences.<br></br></p><p class="elsevierStylePara"><a href="grande/44218078_f1_p578.jpg" class="elsevierStyleCrossRefs"><img src="44218078_f1_p578.jpg"></img></a></p><p class="elsevierStylePara">Figure 1. </p><p class="elsevierStylePara"><a href="grande/44218078_f2_p579.jpg" class="elsevierStyleCrossRefs"><img src="44218078_f2_p579.jpg"></img></a></p><p class="elsevierStylePara">Figure 2. </p><p class="elsevierStylePara"><a href="grande/44218078_f3_p579.jpg" class="elsevierStyleCrossRefs"><img src="44218078_f3_p579.jpg"></img></a></p><p class="elsevierStylePara">Figure 3. </p><p class="elsevierStylePara"><a href="grande/44218078_f4_p580.jpg" class="elsevierStyleCrossRefs"><img src="44218078_f4_p580.jpg"></img></a></p><p class="elsevierStylePara">Figure 4. </p>" "pdfFichero" => "P-E-S-A442-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438153" "palabras" => array:1 [ 0 => "Procuración de órganos" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438155" "palabras" => array:1 [ 0 => "Trasplante Renal" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438157" "palabras" => array:1 [ 0 => "Hemodiálisis" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438159" "palabras" => array:1 [ 0 => "Fallo Renal Agudo" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438161" "palabras" => array:1 [ 0 => "Influenza A(H1N1)" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438163" "palabras" => array:1 [ 0 => "Pandemia" ] ] ] "en" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438154" "palabras" => array:1 [ 0 => "Organs procurement" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438156" "palabras" => array:1 [ 0 => "Renal transplantation" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438158" "palabras" => array:1 [ 0 => "Hemodialysis" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438160" "palabras" => array:1 [ 0 => "Acute renal failure" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438162" "palabras" => array:1 [ 0 => "Swine origin influenza A virus (H1N1)" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438164" "palabras" => array:1 [ 0 => "Pandemic" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "In June 2009, WHO declared pandemic swine origin influenza A virus (H1N1). Since then, nephrologists were involved in several of our activities. Decreased work attendance of healthcare for chronic renal patients. Appeared new cases of acute renal failure associated with viral infection, mostly in young adults, with high mortality rate. There were infections in renal transplant patients and temporarily decreased the organs procurement in the weeks of further spread. Scientific institutions were mobilized to agree on protocols for assessment and treatment in order to lessen the impact of the pandemic in renal patients." ] "es" => array:1 [ "resumen" => "<p class="elsevierStylePara">En junio de 2009, la OMS declaró la pandemia por virus de la influenza A de origen porcino (H1N1). Desde entonces, los nefrólogos fuimos afectados en varias de nuestras actividades. Disminuyó la asistencia al trabajo del personal de salud al cuidado de pacientes renales crónicos. Aparecieron nuevos casos de fallo renal agudo asociados a la infección viral, la mayoría en adultos jóvenes, con alta tasa de mortalidad. Hubo contagios en pacientes trasplantados renales y se retrajo transitoriamente la procuración de órganos en la semanas de mayor contagio. Entidades científicas se movilizaron para consensuar protocolos de evaluación y tratamiento con el fin de disminuir el impacto de la pandemia en pacientes renales.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "44218078_f1_p578.jpg" "Alto" => 463 "Ancho" => 824 "Tamanyo" => 43729 ] ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "44218078_f2_p579.jpg" "Alto" => 518 "Ancho" => 824 "Tamanyo" => 46513 ] ] ] 2 => array:7 [ "identificador" => "fig3" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "44218078_f3_p579.jpg" "Alto" => 282 "Ancho" => 398 "Tamanyo" => 12683 ] ] ] 3 => array:7 [ "identificador" => "fig4" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "44218078_f4_p580.jpg" "Alto" => 458 "Ancho" => 823 "Tamanyo" => 35046 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shetty P. Swine-origin influenza A H1N1 update. Lancet Infect Dis 2009; 9:401. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19562860" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gallaher W. Towards a sane and rational approach to management of Influenza H1N1. Virol J 2009;6:51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19422701" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jeeninga R, et al. The New Influenza A (H1N1) Pandemic. J Formos Med Assoc 2009;108:523-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19586824" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gatherer, et al. The 2009 H1N1 influenza outbreak in its historical context. J Clin Virol 2009;45:174-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19540156" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Malik Peiris JS, et al. Emergence of a novel swine-origin influenza A virus (S-OIV) H1N1 virus in Humans. J Clin Virol 2009;45:169-73. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19540800" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team. Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans. N Engl J Med 2009;360:2605-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19423869" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Neumann G. Emergence and pandemic potential of swine-origin H1N1 influenza virus. Nature 2009;459:931-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19525932" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Challu A, Feler D, Manzor D. Desarrollo de la nefrología en América Latina. Nefrología 2004;24:124-30." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Correa-Rotter R, Cusumano AM. Present, prevention, and management of chronic kidney disease in Latin America. Blood Purif 2008;26:90-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18182804" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Goldfrank L, et al. Understanding the Risk of Influenza to Healthcare Workers. En: Preparing for an Influenza Pandemic: Personal Protective Equipment for Healthcare Workers. Washington DC: The National Academy Press; 2008.pp. 47-76." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cauchemez S, et al. Closure of schools during an influenza pandemic. Lancet Infect Dis 2009;9:473-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19628172" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "CDC Report. Update: Swine Infuenza A (H1N1) Infections-California and Texas, April 2009. En http://www.cdc.gov/mmwr" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cutler J, et al. Investigation of the first cases of human-to-human infection with the new swine-origin influenza A (H1N1) virus in Canada. CMAJ 2009;181:159-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19620268" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Watanabe T, et al. Renal involvement in children with influenza A virus infection. Pediatr Nephrol 2003;18:541-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12698331" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Schrier R, Wang W. Acute renal failure and sepsis. N Engl J Med 2004;351:159-69. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15247356" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Darmon M, et al. Conséquences de l¿hypoxémie aiguë sur la fonction rénale. Réanimation (2009). En prensa. 17. Kuiper J, Groeneveld J, Slutsky A, Plotz F. Mechanical ventilation and acute renal failure. Crit Care Med 2005;33:1408-15." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Legrand M, et al. Renal hypoxia and dysoxia after reperfusion of the ischemic kidney. Mol Med 2008;14:502-16. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18488066" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pesik N, et al. Severe rhabdomyolisis following a viral illness: a case report and review of the literature. J Emerg Med 1996;14:425-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8842914" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shenouda A, Hatch FE. Influenza A viral infection associated with acute renal failure. Am J Med 1976;61:697-702. <a href="http://www.ncbi.nlm.nih.gov/pubmed/984071" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cunningham E, Kohli R, Venuto RC. Influenza-associated myoglobinuric renal failure. JAMA 1979;242:2428-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/490855" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Berry L, Braude S. Influenza A infection with rhabdomyolysis and acute renal failure-a potentially fatal complication. Postgrad Med J 1991;67:389-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2068037" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Dell KM, Schulman SL. Rhabdomyolysis and acute renal failure in a child with influenza A infection. Pediatr Nephrol 1997;11:363-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9203195" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Watanabe T, Oda Y. Rhabdomyolysis and acute renal failure in acute necrotizingencephalopathy with influenza A. Pediatr Nephrol 1998;12:85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9502578" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wakabayashi Y, Nakano T, Kikuno T, Ohwada T, Kikawada R. Massive rhabdomyolysis associated with influenza A infection. Intern Med 1994;33:450-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7949648" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Annerstedt M, Herlitz H, Mölne J, Oldfors A, Westberg G. Rhabdomyolysis and acute renal failure associated with influenza virus type A. Scand J Urol Nephrol 1999;33:260-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10515090" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Watanabe T. Rhabdomyolysis and acute renal failure in children. Pediatr Nephrol 2001;16:1072-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11793103" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol 2000;11:1553-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10906171" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Alemano G. Influenza N1H1, experiencia en los primeros dias de epidemia en un Servicio de Nefrología de un Hospital de alta complejidad. En: http://www.san.org.ar/" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "West SD, Brunskill NJ. Complications associated with influenza infection. Postgrad Med J 2002;78:107-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mori I, et al. Viremia induced by influenza virus. Microbl Path 1995;19:237-44." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Annerstedt M, et al. Rhabdomyolysis and acute renal failure associated with influenza virus type A. Scand J Urol Nephrol 1999;33:260-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10515090" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Encuentro Experiencia Clínica Gripe A. H1N1. Sociedad Argentina de Medicina. En: http://www.sam.org.ar/" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Centers for Disease Control and Prevention: Prevention and control of influenza. Recommendations of the Advisory Committee on Inmunizations Practices (ACIP). MMWR 1999;48(RR-4):1-28." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Harris K, et al. influenza vaccination coverage among adult solid organ transplant recipients at three health maintenance organizations, 1995-2005. Vaccine 2009;27:2335-41." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Di Gioia MC. Recomendaciones de vacunación para pacientes con insuficiencia renal crónica terminal y tratamiento dialítico. Rev Nefrol Dial Transpl 2003;23:107-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Palache B, Krause R. Progress with human H5N1 vaccines: a perspective from industry. Expert Rev Vaccines 2009;8:391-400. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19348556" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Collin N, De Radiguès X. Vaccine production capacity for seasonal and pandemic (H1N1) 2009 influenza. Vaccine 2009. En prensa. doi:10.1016/j.vaccine.2009.06.034 <a href="http://www.ncbi.nlm.nih.gov/pubmed/21440641" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Robson R. The pharmacokinetics and tolerability of oseltamivir suspension in patients on haemodialysis and continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2006;21:2556-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16799169" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "INCUCAI. Central de Reportes y Estadísticas del SINTRA. https://cresi.incucai.gov.ar/" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sociedad Argentina de Trasplante, Sociedad Argentina de Terapia Intensiva, Sociedad Argentina de Infectología, INCUCAI, Buenos Aires Trasplante, CUCAIBA." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 40 => array:3 [ "identificador" => "bib41" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Procuración y Trasplante frente a la Epidemia de Influenza A (H1N1). En: http://www.buenosaires.gov.ar/areas/salud/bsas_trasplante/gripe_a.php" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Aoki F, et al. influenza virus shedding-Excretion patterns and effects of antiviral treatment. J Clin Virol 2009;44:255-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19272835" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gooskens J, et al. Prolonged influenza virus excretion during lymphocytopenia and frequent detection of drug-resistant viruses [abstract]. En: Oral presentations, ESCV 2009, Amsterdam. J Clin Virol 2008;44(Suppl 1):S5-S16." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002900000006/v0_201502091611/X2013251409033501/v0_201502091612/en/main.assets" "Apartado" => array:4 [ "identificador" => "35446" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000006/v0_201502091611/X2013251409033501/v0_201502091612/en/P-E-S-A442-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409033501?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 11 | 15 |
| 2024 October | 67 | 41 | 108 |
| 2024 September | 60 | 33 | 93 |
| 2024 August | 64 | 53 | 117 |
| 2024 July | 55 | 40 | 95 |
| 2024 June | 90 | 32 | 122 |
| 2024 May | 119 | 49 | 168 |
| 2024 April | 77 | 32 | 109 |
| 2024 March | 59 | 20 | 79 |
| 2024 February | 39 | 27 | 66 |
| 2024 January | 48 | 33 | 81 |
| 2023 December | 27 | 15 | 42 |
| 2023 November | 40 | 30 | 70 |
| 2023 October | 51 | 37 | 88 |
| 2023 September | 38 | 31 | 69 |
| 2023 August | 44 | 25 | 69 |
| 2023 July | 57 | 28 | 85 |
| 2023 June | 47 | 24 | 71 |
| 2023 May | 55 | 31 | 86 |
| 2023 April | 35 | 24 | 59 |
| 2023 March | 37 | 24 | 61 |
| 2023 February | 37 | 24 | 61 |
| 2023 January | 42 | 26 | 68 |
| 2022 December | 39 | 22 | 61 |
| 2022 November | 55 | 29 | 84 |
| 2022 October | 46 | 32 | 78 |
| 2022 September | 44 | 33 | 77 |
| 2022 August | 43 | 49 | 92 |
| 2022 July | 30 | 40 | 70 |
| 2022 June | 52 | 46 | 98 |
| 2022 May | 36 | 33 | 69 |
| 2022 April | 44 | 44 | 88 |
| 2022 March | 48 | 53 | 101 |
| 2022 February | 57 | 35 | 92 |
| 2022 January | 43 | 31 | 74 |
| 2021 December | 60 | 38 | 98 |
| 2021 November | 46 | 42 | 88 |
| 2021 October | 55 | 44 | 99 |
| 2021 September | 40 | 40 | 80 |
| 2021 August | 37 | 29 | 66 |
| 2021 July | 66 | 34 | 100 |
| 2021 June | 48 | 35 | 83 |
| 2021 May | 34 | 25 | 59 |
| 2021 April | 67 | 60 | 127 |
| 2021 March | 71 | 19 | 90 |
| 2021 February | 57 | 14 | 71 |
| 2021 January | 35 | 16 | 51 |
| 2020 December | 36 | 12 | 48 |
| 2020 November | 39 | 14 | 53 |
| 2020 October | 39 | 7 | 46 |
| 2020 September | 28 | 17 | 45 |
| 2020 August | 49 | 7 | 56 |
| 2020 July | 64 | 7 | 71 |
| 2020 June | 42 | 10 | 52 |
| 2020 May | 45 | 15 | 60 |
| 2020 April | 75 | 23 | 98 |
| 2020 March | 47 | 15 | 62 |
| 2020 February | 41 | 16 | 57 |
| 2020 January | 52 | 13 | 65 |
| 2019 December | 46 | 23 | 69 |
| 2019 November | 49 | 16 | 65 |
| 2019 October | 18 | 12 | 30 |
| 2019 September | 23 | 15 | 38 |
| 2019 August | 17 | 9 | 26 |
| 2019 July | 19 | 19 | 38 |
| 2019 June | 36 | 19 | 55 |
| 2019 May | 24 | 9 | 33 |
| 2019 April | 45 | 31 | 76 |
| 2019 March | 22 | 22 | 44 |
| 2019 February | 15 | 15 | 30 |
| 2019 January | 23 | 19 | 42 |
| 2018 December | 65 | 27 | 92 |
| 2018 November | 47 | 15 | 62 |
| 2018 October | 46 | 9 | 55 |
| 2018 September | 58 | 15 | 73 |
| 2018 August | 26 | 19 | 45 |
| 2018 July | 47 | 13 | 60 |
| 2018 June | 43 | 13 | 56 |
| 2018 May | 56 | 13 | 69 |
| 2018 April | 31 | 4 | 35 |
| 2018 March | 36 | 11 | 47 |
| 2018 February | 35 | 7 | 42 |
| 2018 January | 31 | 7 | 38 |
| 2017 December | 42 | 12 | 54 |
| 2017 November | 33 | 15 | 48 |
| 2017 October | 39 | 6 | 45 |
| 2017 September | 68 | 10 | 78 |
| 2017 August | 96 | 14 | 110 |
| 2017 July | 72 | 11 | 83 |
| 2017 June | 67 | 14 | 81 |
| 2017 May | 37 | 27 | 64 |
| 2017 April | 32 | 12 | 44 |
| 2017 March | 27 | 11 | 38 |
| 2017 February | 41 | 12 | 53 |
| 2017 January | 38 | 10 | 48 |
| 2016 December | 64 | 9 | 73 |
| 2016 November | 74 | 7 | 81 |
| 2016 October | 134 | 9 | 143 |
| 2016 September | 181 | 9 | 190 |
| 2016 August | 224 | 13 | 237 |
| 2016 July | 166 | 10 | 176 |
| 2016 June | 127 | 0 | 127 |
| 2016 May | 127 | 0 | 127 |
| 2016 April | 92 | 0 | 92 |
| 2016 March | 91 | 0 | 91 |
| 2016 February | 98 | 0 | 98 |
| 2016 January | 113 | 0 | 113 |
| 2015 December | 116 | 0 | 116 |
| 2015 November | 87 | 0 | 87 |
| 2015 October | 76 | 0 | 76 |
| 2015 September | 67 | 0 | 67 |
| 2015 August | 61 | 0 | 61 |
| 2015 July | 62 | 0 | 62 |
| 2015 June | 25 | 0 | 25 |
| 2015 May | 56 | 0 | 56 |
| 2015 April | 5 | 0 | 5 |
Show all
