Cantharidin is a poisonous substance secreted by blister beetles, including the ‘Spanish fly’. Historically, cantharidin was used as an aphrodisiac, vesicant and abortifacient. Symptoms of poisoning include gastrointestinal and genitourinary mucosal irritation along with renal dysfunction. We present the case of a reckless 23-year-old soldier who accepted the challenge of eating a beetle (Berberomeloe majalis). Six hours later he was admitted to the emergency room with abdominal pain, dysuria, gross haematuria with clots, hypotension, fever and renal insufficiency. With intravenous fluid therapy, he recovered clinically. Laboratory parameters returned to normal within 1 week.

No abstract

Vaccination is a promising strategy to control the ongoing pandemic; however, solid organ recipients tend to develop a weaker immune response to vaccination. Anti-spike SARS-CoV-2 antibodies titers were measured 2-4 weeks post-vaccination completion in 131 KT patients without previous infection. Demographic, clinical, and laboratorial parameters were analyzed to identify which factors contributed to seroconversion. Factors that influenced seroconversion, that occurred in 76 patients (58%), were longer time post-transplant, immunosuppression without an antiproliferative drug and vaccination with mRNA vaccines. Patients who received mRNA vaccines had significantly higher rates of seroconversion compared with adenovirus vector vaccines (67% vs 33%, P < .001) and higher anti-spike IgG titers.These findings reinforce the need to discuss the vaccination strategy in this population, including a third dose with a mRNA vaccine.

Native AV fistulas are considered to be the best VA for most dialysis patients. A careful preoperative process of care is essential to maximize the proportion of fistulas that achieve adequacy for dialysis. An individualized and timely evaluation of patients starts early with the identification of risk factors, followed by a physical examination which should be complemented by ultrasound vascular mapping in most cases. Vascular mapping includes any technique that leads to information on patient's inflow and outflow anatomy (± hemodynamics) as they relate to arteriovenous access creation and may predict maturation. There is increasing evidence favoring the utilization of preoperative Doppler ultrasound which is recommended in all patients by NFK-KDOQI Guidelines. It allows noninvasive evaluation of both structural and functional aspects of vessels that play an important role in access maturation. Its major limitation is the relative inability to assess central vein patency. Although conventional venography is still the gold standard to evaluate central veins, it provides otherwise limited information and can incur serious adverse effects related to its invasive nature and contrast use. Alternatives to these two imaging techniques are rarely used, especially because of their higher costs and low availability.

National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines recommend Doppler ultrasound (DU) for surveillance of vascular access (VA), but trials have not been unanimous about its benefit on VA patency. The aim of this study was to evaluate the accuracy of DU for patency, as well as to highlight additional data provided by this method. A transversal study was conducted to evaluate DU method in correlation with BTM using paired t-test and Pearson test. Ultrasonography evaluation was performed with a Siemens Acuson X150 Ultrasound device and BTM-Qa with the Blood Temperature Monitor BTM(®). Access blood flow (Qa) values were correlated with several factors by nonparametric tests. Fifty hemodialysis patients were included, with mean age of 64.5 ± 13.7 years; durations of hemodialysis and VA were 51.4 ± 47.3 and 47.6 ± 42.1 months, respectively. The mean difference between DU and BTM flows was 20.5 ml/minute (p 0.624). Pearson correlation was 0.851 (p < 0.001). DU-Qa values varied significantly with several factors: type of VA, reason for DU referral, the presence of artery stenosis, and the location and number of stenosis. BTM-Qa values only varied significantly with the presence and number of stenosis. Various silent abnormalities were detected with DU. DU provides accurate anatomic and hemodynamic data to further knowledge regarding the etiology of stenosis and other abnormalities that compromise VA well functioning.