Cardiovascular disease is a major cause of death worldwide especially in patients with chronic kidney disease (CKD). Troponin T and troponin I are cardiac biomarkers used not only to diagnose acute myocardial infarction (AMI) but also to prognosticate cardiovascular and all-cause mortality. The diagnosis of AMI in the CKD population is challenging because of their elevated troponins at baseline. The development of high-sensitivity cardiac troponins shortens the time needed to rule in and rule out AMI in patients with normal renal function. While the sensitivity of high-sensitivity cardiac troponins is preserved in the CKD population, the specificity of these tests is compromised. Hence, diagnosing AMI in CKD remains problematic even with the introduction of high-sensitivity assays. The prognostic significance of troponins did not differ whether it is detected with standard or high-sensitivity assays. The elevation of both troponin T and troponin I in CKD patients remains strongly correlated with adverse cardiovascular and all-cause mortality, and the prognosis becomes poorer with advanced CKD stages. Interestingly, the degree of troponin elevation appears to be predictive of the rate of renal decline via unclear mechanisms though activation of the reninangiotensin and other hormonal/oxidative stress systems remain suspect. In this review, we present the latest evidence of the use of cardiac troponins in both the diagnosis of AMI and the prognosis of cardiovascular and all-cause mortality. We also suggest strategies to improve on the diagnostic capability of these troponins in the CKD/end-stage kidney disease population.

Haemophagocytic lymphohistiocytosis (HLH) is an immune-mediated disease driven by abnormal macrophage activation and regulatory cell dysfunction. HLH can be primary due to genetic mutations or secondary due to infection, malignancy or autoimmune conditions. We describe a woman in her early 30s who developed HLH while being treated for newly diagnosed systemic lupus erythematosus (SLE) complicated by lupus nephritis as well as concomitant cytomegalovirus (CMV) reactivation from a dormant infection. The trigger for this secondary form of HLH may have been either aggressive SLE and/or CMV reactivation. Despite prompt treatment with immunosuppressive therapies for SLE consisting of high-dose corticosteroids, mycophenolate mofetil, tacrolimus, etoposide for HLH and ganciclovir for CMV infection, the patient developed multiorgan failure and passed away. We demonstrate the difficulty in identifying a specific cause for secondary HLH when multiple conditions are present (SLE and CMV) and the fact that, despite aggressive treatment for both conditions, the mortality for HLH remains high.

El presente ensayo tiene como objetivo el análisis de las contradicciones que se generan al interior del sistema de protección de la propiedad intelectual cuando este regula aspectos sobre conocimientos tradicionales y propiedad industrial. Se expresa el carácter comunitario de los conocimientos tradicionales en su estrecha relación con las comunidades y grupos sociales que los portan, lo que los hace de difícil encuadre en el sistema de propiedad industrial. Se refieren las características y esencia individual del sistema de propiedad industrial, que lo hacen incompleto a este tipo de saberes, lo que contribuye a la explotación y apropiación indebida por terceras personas ajenas a estas comunidades. Finalmente, se evidencia la importancia del reconocimiento de derechos colectivos a las comunidades sobre su propiedad intelectual en materia de conocimientos tradicionales.

El presente artículo se centra en el estudio de la protección de las obras de la cultura popular tradicional por el derecho de autor y derechos conexos en América Latina, y se detiene en el tratamiento que ofrecen, a instituciones jurídicas autorales clásicas (autoría, obras derivadas y dominio público), algunas legislaciones nacionales. Del mismo modo, se analiza la posibilidad de protección a tales obras, mediante derechos que se reconozcan a otros titulares vinculados a su realización, salvaguarda y desarrollo.