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BACKGROUND: The use of tools that allow estimation of the probability of progression of chronic kidney disease (CKD) to advanced stages has not yet achieved significant practical importance in clinical setting. This study aimed to develop and validate a machine learning-based model for predicting the need for renal replacement therapy (RRT) and disease progression for patients with stage 3-5 CKD. METHODS: This was a retrospective, closed cohort, observational study. Patients with CKD affiliated with a private insurer with five-year follow-up data were selected. Demographic, clinical, and laboratory variables were included, and the models were developed based on machine learning methods. The outcomes were CKD progression, a significant decrease in the estimated glomerular filtration rate (eGFR), and the need for RRT. RESULTS: Three prediction models were developed-Model 1 (risk at 4.5 years, n = 1446) with a F1 of 0.82, 0.53, and 0.55 for RRT, stage progression, and reduction in the eGFR, respectively,- Model 2 (time- to-event, n = 2143) with a C-index of 0.89, 0.67, and 0.67 for RRT, stage progression, reduction in the eGFR, respectively, and Model 3 (reduced Model 2) with C-index = 0.68, 0.68 and 0.88, for RRT, stage progression, reduction in the eGFR, respectively. CONCLUSION: The time-to-event model performed well in predicting the three outcomes of CKD progression at five years. This model can be useful for predicting the onset and time of occurrence of the outcomes of interest in the population with established CKD.
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Inteligencia Artificial , Progresión de la Enfermedad , Tasa de Filtración Glomerular , Insuficiencia Renal Crónica , Terapia de Reemplazo Renal , Humanos , Masculino , Femenino , Insuficiencia Renal Crónica/terapia , Insuficiencia Renal Crónica/fisiopatología , Persona de Mediana Edad , Estudios Retrospectivos , Aprendizaje Automático , Anciano , Estudios de Cohortes , AdultoRESUMEN
We developed an algorithm to explore unexpected growth in the usage and costs of health technologies. We exploit data from the expenditures on technologies funded by the Colombian government under the compulsory insurance system, where all prescriptions for technologies not included in an explicit list must be registered in a centralized information system, covering the period from 2017 to 2022. The algorithm consists of two steps: an outlier detection method based on the density of the expenditures for selecting a first set of technologies to consider (39 technologies out of 106,957), and two anomaly detection models for time series to determine which insurance companies, health providers, and regions have the most notorious increases. We have found that most medicines associated with atypical behavior and significant monetary growth could be linked to the use of recently introduced drugs in the market. These drugs have valid patents and very specific clinical indications, often involving high-cost pharmacological treatments. The most relevant case is the Burosumab, approved in 2018 to treat a rare genetic disorder affecting skeletal growth. Secondly, there is clear evidence of anomalous increasing trend evolutions in the identified enteral nutritional support supplements or Food for Special Medical Purposes. The health system did not purchase these products before July 2021, but in 2022 they represented more than 500,000 USD per month.
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Gastos en Salud , Enfermedades Raras , Humanos , ColombiaRESUMEN
Background: Colombia is a Latin American country with a very complex social and political context that has not allowed the allocation of sufficient resources to the fields of science, technology, and innovation (STI). This is particularly worrying for the area of health since not enough resources are allocated for public health, research, or education. Methods: The so-called "Great Survey in Health 2019" was administered online through the SurveyMonkey platform to 5298 people in different regions of the country, representing the public, private, and academic sectors. The questionnaire consisted of 46 open and closed questions, including demographic inquiries. Data analysis involved textual analytics and sentiment analysis. Results: Overall, 56% of those surveyed were women within the adult life cycle. Most respondents had a postgraduate education. Greater participation was observed in the Oriental, Bogotá, and Antioquia regions, which also concentrate the largest number of resources for STI. Among the main recommendations derived from the results, priorities include investing in research, personalised medicine, promoting the social appropriation of knowledge, addressing mental health, regulating research through a statute, promoting undergraduate research, and establishing recertification exams to pursue excellence. Conclusion: The results of this original study serve as a fundamental input to promote and strengthen the STI processes in life sciences and health. They serve as a guide to generate public policies and actions that guarantee better health and well-being for the Colombian population, strategically proposing a clear roadmap for the next 20 years.
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BACKGROUND: The interaction between modelers and policymakers is becoming more common due to the increase in computing speed seen in recent decades. The recent pandemic caused by the SARS-CoV-2 virus was no exception. Thus, this study aims to identify and assess epidemiological mathematical models of SARS-CoV-2 applied to real-world data, including immunization for coronavirus 2019 (COVID-19). METHODOLOGY: PubMed, JSTOR, medRxiv, LILACS, EconLit, and other databases were searched for studies employing epidemiological mathematical models of SARS-CoV-2 applied to real-world data. We summarized the information qualitatively, and each article included was assessed for bias risk using the Joanna Briggs Institute (JBI) and PROBAST checklist tool. The PROSPERO registration number is CRD42022344542. FINDINGS: In total, 5646 articles were retrieved, of which 411 were included. Most of the information was published in 2021. The countries with the highest number of studies were the United States, Canada, China, and the United Kingdom; no studies were found in low-income countries. The SEIR model (susceptible, exposed, infectious, and recovered) was the most frequently used approach, followed by agent-based modeling. Moreover, the most commonly used software were R, Matlab, and Python, with the most recurring health outcomes being death and recovery. According to the JBI assessment, 61.4% of articles were considered to have a low risk of bias. INTERPRETATION: The utilization of mathematical models increased following the onset of the SARS-CoV-2 pandemic. Stakeholders have begun to incorporate these analytical tools more extensively into public policy, enabling the construction of various scenarios for public health. This contribution adds value to informed decision-making. Therefore, understanding their advancements, strengths, and limitations is essential.
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COVID-19 , SARS-CoV-2 , Humanos , Estados Unidos , COVID-19/epidemiología , COVID-19/prevención & control , Pandemias/prevención & control , Vacunación , Evaluación de Resultado en la Atención de SaludRESUMEN
To mitigate the effects of the coronavirus disease 2019 (COVID-19) pandemic, different countries have developed computational tools and dashboards that generate value for decision-making in public health. We aimed to build an interactive geographic viewer for vulnerability to COVID-19 at the block level in Colombia to identify the location of populations that, because of sociodemographic characteristics and health conditions, could have more complications from COVID-19 infections. The vulnerability levels of the different blocks of 1,102 municipal capitals were calculated. Additionally, the institutions that provide health services and hotels were georeferenced, and changes in people's mobility dynamics in large cities were identified.
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Resumen La enfermedad renal crónica (ERC) es de alta prevalencia en América Latina y en todo el mundo. Se estima que entre 10 y 20% de la población adulta es portadora de ERC y su prevalencia va en aumento. La ERC progresa en forma silenciosa. Su diagnóstico temprano y oportuno permite iniciar un tratamiento efectivo, en la mayoría de los casos, para detener la enfermedad. Desde hace mucho tiempo, el análisis de la creatininemia es la principal prueba utilizada para valorar la función renal, pero su confiabilidad es limitada. De acuerdo con las recomendaciones de las GUIAS KDOQI del año 2002 la tasa de filtración glomerular estimada (TFGe) obtenida a través de fórmulas, se estableció como una de las herramientas principales para detectar la enfermedad renal de manera precoz, ya que alerta de forma precisa al médico y al equipo de salud sobre el nivel de función renal del paciente. La detección de una TFGe disminuida (menor de 60 mL/min/1,73 m2) es clínicamente relevante, ya que permite establecer el diagnóstico de enfermedad renal en adultos. En el año 2022, en una encuesta realizada por SLANH y COLABIOCLI dirigida a los laboratorios de análisis clínicos de América Latina (n: 237), el 49% de los mismos no informaban la TFGe rutinariamente. En base a esta realidad SLANH y COLABIOCLI elaboraron estas recomendaciones de consenso en referencia al uso de la TFGe.
Abstract Chronic kidney disease (CKD) has a high prevalence worldwide and in Latin America (10 to 20% of the adult population) and is increasing. CKD progresses silently. Opportune diagnosis and treatment are effective in most cases to improve outcomes. Serum creatinine was the main test to assess kidney function, but its reliability is limited. Through the KDOQI Guidelines 2002, the estimated glomerular filtration rate (eGFR) obtained from equations was established as one of the main tools for the early detection of kidney disease in clinical practice. The detection of a decreased eGFR (less than 60 mL/min/1.73 m2) is clinically relevant. This cut-off level establishes the diagnosis of kidney disease in adults. In 2022 SLANH and COLABIOCLI conducted a survey among the clinical laboratories from Latin America. The survey included 237 laboratories, 49% of which did not routinely report the eGFR. Based on this situation, SLANH and COLABIOCLI have elaborated the following consensus recommendations regarding the use of eGFR.
Resumo A doença renal crônica (DRC) é altamente prevalente na América Latina e em todo o mundo. Estima-se que entre 10 e 20% da população adulta seja portadora de DRC e sua prevalência esteja aumentando. A DRC progride silenciosamente. Seu diagnóstico precoce e oportuno permite iniciar um tratamento eficaz, na maioria dos casos, para estancar a doença. Faz muito tempo, a análise da creatinina tem sido o principal teste usado para avaliar a função renal mas sua confiabilidade é limitada. De acordo com as recomendações dos GUIAS KDOQI do ano de 2002, a estimativa da taxa de filtração glomerular (eGFR), obtida por meio de fórmulas, consolidou-se como uma das principais ferramentas para a detecção precoce da doença renal, visto que alerta com precisão ao médico e ao equipe de saúde sobre o nível de função renal do paciente. A detecção de uma eGFR diminuída (inferior a 60 mL/min/1,73 m2) é clinicamente relevante, pois permite estabelecer o diagnóstico de doença renal em adultos. No ano de 2022, em pesquisa realizada pela SLANH e COLABIOCLI dirigida a laboratórios de análises clínicas da América Latina (n: 237), 49% deles não relataram rotineiramente eGFR. Com base nessa realidade, SLANH e COLABIOCLI prepararam essas recomendações de consenso sobre o uso de eGFR.
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INTRODUCTION: The Red Nacional de Donación y Trasplantes of the Colombian Instituto Nacional de Salud reported that in 2014, 1,059 organ transplants were performed, of which 761 were kidney transplants, and 643 (84.5%) of these were from cadaveric organ donors. OBJECTIVE: To describe the socio-demographic characteristics of patients who received renal transplants, as well as their outcomes in terms of survival. MATERIALS AND METHODS: National kidney transplants were analyzed through an observational retrospective cohort study. Overall survival was estimated using the Kaplan-Meier method. The survival curves by sex, age, type of donor, type of insurance, and time on the waiting list were compared utilizing the log rank hypothesis and a Cox regression. RESULTS: A total of 3,980 patients were included, of whom 338 died according to the Registry of Affiliates. The median follow-up time was 49 months, overall survival was 6.35 years (95% CI: 6.30 to 6.40), the one-year survival following transplantation was 97.2%, the three-year survival, 93.2%, and the five-year survival, 90.8%. The survival rate was higher in patients under 50 years of age, receptors of living donor transplants, and with less than six months on the waiting list. CONCLUSIONS: The results obtained serve as the basis for future studies with strict monitoring of survival among kidney transplant recipients in Colombia.
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Trasplante de Riñón/estadística & datos numéricos , Riñón/cirugía , Colombia , Humanos , Riñón/fisiopatología , Trasplante de Riñón/métodos , Sistema de Registros , Estudios Retrospectivos , Donantes de Tejidos , Listas de EsperaRESUMEN
Contexto las personas con diálisis se consideran una población de alto riesgo de infección por SARS-CoV-2, complicaciones y muerte. En Colombia, cerca del 44 % de la población en diálisis es menor de 60 años, adicionalmente, por los mismos retos que ha impuesto la pandemia a los programas de trasplantes, se ha incrementado notoriamente la población joven que debe seguir en diálisis al no tener opción a corto plazo de un trasplante renal, por lo tanto, las limitaciones en el acceso temprano a la vacunación contra SARS-CoV-2 agudizarían los problemas de esta población, provocando pérdidas considerables en años de vida que la vacuna podría salvar. Objetivo el objetivo del presente documento es sintetizar los principales motivos por los que se recomienda la priorización de la vacunación de los pacientes en diálisis crónica y lista de espera para trasplante renal. Metodología se realizó una búsqueda rápida de información sobre la vacunación en pacientes con ERC en diálisis o en espera de trasplante renal. La información resultante fue analizada críticamente por expertos en nefrología para la formulación de recomendaciones. Los resultados de la búsqueda se presentan a manera de síntesis narrativa. Resultados a partir de la información revisada y discutida por los expertos en nefrología se proponen 4 recomendaciones para la vacunación contra el virus SARS-Cov-2. Conclusiones la Asociación Colombiana de Nefrología e Hipertensión Arterial, la Asociación Colombiana de Nefrología Pediátrica y la Asociación Colombiana de Trasplante de Órganos, comprometidos con la salud de los pacientes con enfermedad renal en diálisis y listas de espera de trasplantes en Colombia, se unen a la solicitud mundial de generar recomendaciones para la vacunación contra SARS-CoV-2.
Background People on dialysis are considered a high-risk population for SARS-CoV-2 infection, complications, and death. In Colombia, about 44% of the population on dialysis is under 60 years of age. In addition, due to the same challenges that the pandemic has imposed on transplant programs, the young population that must continue on dialysis has increased markedly, as they have no option in the short term of a kidney transplant, therefore, the limitations in early access to vaccination against SARS-CoV-2 would exacerbate the problems of this population, causing considerable losses in years of life that the vaccine could save. Purpose The objective of this document is to summarize the main reasons why the prioritization of vaccination of patients on chronic dialysis and on the kidney transplant waiting list is recommended. Methodology A rapid search for information on vaccination in patients with CKD on dialysis or awaiting kidney transplantation was performed. The resulting information was critically analyzed by experts in nephrology for the formulation of recommendations. The search results are presented as a narrative synthesis. Results Based on the information reviewed and discussed by nephrology experts, 4 recommendations are proposed for vaccination against the SARS-Cov-2 virus. Conclusions The Colombian Association of Nephrology and Arterial Hypertension (ASOCOLNEF), the Colombian Association of Pediatric Nephrology (ACONEPE) and the Colombian Association of Organ Transplantation (ACTO), committed to the health of patients with kidney disease on dialysis and transplant waiting lists in Colombia, join to generate recommendations for prioritization and vaccination against SARS-CoV-2.
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Covering denuded areas in the extremes of life is challenging for the plastic surgeon. In newborns, this becomes a greater challenge because of the immaturity of all of their systems, making any injury a potential risk for death. We present in this case report a successful treatment of 2 cases covered with cultured autologous keratinocytes. In this procedure, a small skin biopsy is taken from the retroauricular area and the keratinocytes are cultured. After 5 days, a membrane with the cells cultured is applied covering the denuded area. We find the autologous keratinocyte method a suitable option for the treatment of denuded areas in newborns, without causing any additional morbidity and in a very short period of time.
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Abstract Introduction: The numbers of SARS-CoV-2 infection in the pediatric population are low so far. There is limited information about the behavior of SARS-CoV-2 in a pediatric patient with chronic kidney disease. Objective: To formulate informed recommendations to the prevention, diagnosis, and management of SARS-CoV-2 infection in pediatric patients with kidney disease or acute kidney injury associated with COVID-19 in Colombia. Methodology: A rapid systematic review was performed in Embase and Pubmed databases and scientific societies, to answer questions prioritized by clinical experts in pediatric nephrology. The quality of the evidence was evaluated with validated tools according to the type of study. The preliminary recommendations were consulted by an expert group. The agreement was defined when approval was obtained from at least 70% of the experts consulted. Results: A response was obtained from ' 9 experts in pediatric nephrology in Colombia, who declared the conflict of interest before the consultation. The range of agreement for the recommendations ranged from 78.9% to '00%. The recommendations did not require a second consultation. Conclusion: The evidence-based recommendations for the management of a patient with kidney disease and COVID-19 in the Colombian context are presented.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Pediatría , COVID-19 , Pacientes , Sociedades Científicas , Colombia , Insuficiencia Renal Crónica , Lesión Renal Aguda , NefrologíaRESUMEN
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Abstract Introduction: Acute kidney injury is a frequent complication in patients with COVID-19 and its occurrence is a potential indicator of multi-organ dysfunction and disease severity. Objective: Develop, through an expert consensus, evidence-based recommendations for the prevention, diagnosis, and management of acute kidney injury in patients with SARS CoV2 / COVID-19 infection. Materials and methods: Based on a rapid systematic review in Embase and Pubmed databases and documents from scientific societies, we made preliminary recommendations and consulted with an expert group through an online tool. Then we defined agreement after at least 70 % consensus approval. Quality evidence was evaluated according to the type of document included. The strength of the recommendations was graded as strong or weak. Results: Fifty clinical experts declared their conflict of interest; the consultation took place between May 2 and 29, 2020. The range of agreement ranged from 75.5 % to 100 %. Recommendations for prevention, diagnosis and management of acute kidney injury in patients with SARS CoV2 infection are presented. Conclusions: Although the good quality information available regarding acute kidney injury in patients with COVID-19 is scarce, the recommendations of clinical experts will guide clinical decision-making and strategies around patients with this complication, guaranteeing care focused on the people, with high quality standards, and the generation of safety, health and wellness policies for multidisciplinary care teams.
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Humanos , Masculino , Femenino , COVID-19 , Pacientes , Colombia , Diagnóstico , Lesión Renal AgudaRESUMEN
Resumen Introducción: Las personas con diálisis de mantenimiento se consideran una población en alto riesgo de infección por SARS-CoV-2, complicaciones y muerte. La periodicidad de la diálisis, la organización y la demanda en las unidades de diálisis y las limitaciones de alfabetización en salud poblacional limitan el cumplimiento del aislamiento y el distanciamiento social. Objetivo: Desarrollar, mediante un consenso de expertos, recomendaciones informadas en evidencia para la prevención, el diagnóstico y el manejo de la infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Materiales y métodos: Se realizó una revisión rápida de literatura en Pubmed, Embase y sociedades científicas. La calidad de evidencia fue evaluada según el tipo de estudio incluido. El acuerdo se definió para cada recomendación con umbral de al menos 70% de aprobación. La fuerza de las recomendaciones fue graduada como fuerte o débil. Resultados: El colectivo fue consultado entre el 17 y 19 de mayo de 2020. Se obtuvo respuesta de 44 expertos clínicos que declararon conflicto de interés previo a la consulta. El acuerdo de las recomendaciones estuvo entre 70,5 y 100%. Se presentan las recomendaciones de un colectivo experto para la prevención, el diagnóstico y el manejo de infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Conclusión: Debido a la reciente aparición de la infección por SARS-CoV-2 y las incertidumbres respecto a la prevención, el diagnóstico y el manejo, las recomendaciones presentadas se conciben como un estándar colombiano que permita garantizar un cuidado centrado en las personas con enfermedad renal crónica y la protección de los profesionales de la salud.
Abstract Introduction: People with chronic dialysis are considered a population at high risk of SARS CoV2 infection and its derived complications and death. The need to go to strict dialysis schedules, the high demand in the kidney facilities and the difficulties derived from the time and space organization in the rooms in the face to the pandemic added to the difficult learning, teaching and adapting new protocols manifest the needed of standard recommendation according to this problem in people who couldn't have an ideal isolation. Objective: Develop through an expert consensus, evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2/COVID-19 infection in patients with chronic kidney disease on Dialysis. Materials and methods: We carried out a quick literature review, PubMed, Embase and scientific societies were consulted. The quality of the evidence was considered according to the type of study included. The agreement threshold defined for each recommendation was > 70% approval among experts. The strength of the recommendations was rated as strong or weak. Results: Between May 17 and 19, 2020, was conformed a team of 44 clinical experts who declared their interest conflict prior to the consultation. The agreement of the recommendations was between 70.5% and 100%. The recommendations were separated in prevention, early identification, and diagnostic, isolation in hemodialysis facilities and peritoneal dialysis, and team protection. Ethical considerations also were included. Conclusion: Due to the recent appearance of SARS-CoV-2 infection and the uncertainties regarding prevention, diagnosis and management, the recommendations presented are conceived as a Colombian standard that allows guaranteeing focused care for people with chronic kidney disease and the protection of health team.
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Humanos , Masculino , Femenino , Insuficiencia Renal Crónica , COVID-19 , Pacientes , Diálisis Renal , Colombia , DiagnósticoRESUMEN
Resumen Introducción. La Red Nacional de Donación y Trasplantes del Instituto Nacional de Salud reportó que durante 2014 se realizaron en Colombia 1.059 trasplantes de órganos, de los cuales 761 fueron de riñón y, de estos, 643 (84,5 %) correspondieron a órganos provenientes de cadáveres. Objetivo. Describir las características sociodemográficas de los pacientes con trasplante renal y los resultados en términos de supervivencia. Materiales y métodos. Se hizo un estudio observacional y retrospectivo de cohorte mediante el análisis de la base nacional de datos de receptores de trasplante renal. Se estimó la supervivencia global con el método de Kaplan-Meier, se compararon las curvas según sexo, edad, tipo de donante, tipo de régimen de afiliación al sistema de salud y tiempo en lista de espera mediante la prueba de hipótesis de Mantel-Cox (log rank) y una regresión de Cox. Resultados. De los 3.980 pacientes incluidos en el estudio, 338 fallecieron según el Registro Único de Afiliados. Con una mediana de seguimiento de 49 meses, la supervivencia global fue de 6,35 años (IC95% 6,30-6,40), la supervivencia al año del trasplante fue de 97,2 %, a los tres años, de 93,2 %, y a los cinco años, de 90,8 %. La supervivencia fue mayor en los pacientes menores de 50 años receptores de trasplante con donante vivo y con menos de seis meses en lista de espera. Conclusiones. Los resultados reflejaron el panorama de los pacientes con trasplante renal en el país en términos de supervivencia, lo cual sirve de base para estudios prospectivos con seguimiento estricto.
Abstract Introduction: The Red Nacional de Donación y Trasplantes of the Colombian Instituto Nacional de Salud reported that in 2014, 1,059 organ transplants were performed, of which 761 were kidney transplants, and 643 (84.5%) of these were from cadaveric organ donors. Objective: To describe the socio-demographic characteristics of patients who received renal transplants, as well as their outcomes in terms of survival. Materials and methods: National kidney transplants were analyzed through an observational retrospective cohort study. Overall survival was estimated using the Kaplan-Meier method. The survival curves by sex, age, type of donor, type of insurance, and time on the waiting list were compared utilizing the log rank hypothesis and a Cox regression. Results: A total of 3,980 patients were included, of whom 338 died according to the Registry of Affiliates. The median follow-up time was 49 months, overall survival was 6.35 years (95% CI: 6.30 to 6.40), the one-year survival following transplantation was 97.2%, the three-year survival, 93.2%, and the five-year survival, 90.8%. The survival rate was higher in patients under 50 years of age, receptors of living donor transplants, and with less than six months on the waiting list. Conclusions: The results obtained serve as the basis for future studies with strict monitoring of survival among kidney transplant recipients in Colombia.
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Humanos , Trasplante de Riñón/estadística & datos numéricos , Riñón/cirugía , Donantes de Tejidos , Sistema de Registros , Estudios Retrospectivos , Listas de Espera , Trasplante de Riñón/métodos , Colombia , Riñón/fisiopatologíaRESUMEN
El citomegalovirus es una de las principales causas de infección y enfermedad en receptores de trasplante renal, con un notorio impacto en términos de morbilidad, mortalidad y costos. Sin embargo, no existe en Colombia una práctica clínica estandarizada entre los centros de trasplante, por lo cual, es de suma importancia disponer de guías con el fin de orientar la estratificación, el diagnóstico de laboratorio, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal. A través de la metodología ADAPTE para la evaluación de calidad y transculturización de guías de práctica clínica a nuestro medio, un grupo multidisciplinario realizó una revisión sistemática de la literatura: se seleccionaron las guías internacionales, las cuales fueron evaluadas con el instrumento AGREE II en términos de calidad. Con la guía base seleccionada se buscó la evidencia existente para contestar a las preguntas, de acuerdo con el método de desarrollo de recomendaciones GRADE. Se realizaron recomendaciones para la estratificación, el diagnóstico, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal en Colombia.
Cytomegalovirus is a primary cause of infection and illness in patients who have had renal transplantation, with a significant impact on morbidity, mortality and economic costs. However, there is no standardized clinical practice in transplant centers in Colombia, and it is important to have guidelines to stratify, diagnose, treat and prevent cytomegalovirus infection and disease. Through ADAPTE's methodology for the quality evaluation and adaptation of clinical practice guidelines in our setting, a multidisciplinary group carried out a systematic review of the medical literature, selecting international guidelines that were evaluated with the AGREE-II instrument in terms of quality. With each selected guideline, an evidence table was constructed and the GRADE strategy was performed to develop recommendations. Recommendations related to stratification, laboratory diagnosis, treatment and prevention of infections and disease caused by cytomegalovirus in adult transplant patients were developed.
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Humanos , Femenino , Embarazo , Adulto , Trasplante de Riñón , Infecciones por Citomegalovirus , Citomegalovirus , Consenso , Infecciones , Morbilidad , Mortalidad , Guías de Práctica Clínica como Asunto , Técnicas de Laboratorio Clínico , Trasplantes , DiagnósticoRESUMEN
Objetivo. Describir el uso tradicional de 26 plantas, identificando la droga vegetal, su preparación y administración, los fines medicinales para los que se recomiendan y posibles prácticas de uso inadecuado. Materiales y métodos. Se aplicaron 16 entrevistas semiestructuradas a vendedores de plantas medicinales en 8 plazas de mercado de la ciudad de Bogotá, D.C. Adicionalmente se realizó la identificación taxonómica de las plantas con mayor reporte por parte de los vendedores y su uso tradicional fue comparado con las indicaciones farmacológicas reportadas en el Vademecum Colombiano de Plantas Medicinales. Resultados. Las plantas de mayor citación entre los vendedores entrevistados fueron: "Cidrón", "caléndula" y "manzanilla", seguidas por "cola de caballo", "ruda" y "albahaca" las cuales presentaron al menos tres reportes cada una. Se encontró que algunas de las plantas mencionadas por los vendedores no se reportan en el Vademécum Colombiano de Plantas Medicinales, entre ellas "paico", "chitato", "alfalfa", "laurel" y "suelda consuelda". Se detectó poco conocimiento por parte de los vendedores, sobre las posibles contraindicaciones o efectos adversos de las plantas medicinales lo que conlleva a prácticas inadecuadas en la comunidad. También se evidenció desconocimiento de las diferencias entre las formas de preparación infusión y decocción. Se identificaron plantas medicinales que pueden ser promisorias terapéuticamente por nuevos usos reportados, entre ellas "albahaca", "caléndula", "cidrón", "cola de caballo" y "manzanilla".
Objective. To describe information about traditional use of 26 plants, identifying plant drug, preparation and administration, medicinal purposes for recommended practices and possible misuse. Materials and Methods. This work was performed in 8 popular markets of Bogotá. By applying semi-structured interviews with 16 sellers of medicinal plants. Further taxonomic identification of medicinal plants was carried out with greater reporting by sellers and their traditional use was compared with pharmacological indications reported in the Vademecum Colombiano de Plantas Medicinales. Results. Report higher plants between sellers respondents were "cidrón", "calendula" and "manzanilla", followed by "cola de caballo", "ruda" and "albahaca", which presented at least three reports each one. It was found that some of the plants mentioned by the sellers do not appear in the Vademecum Colombiano de Plantas Medicinales plants including "paico", "chitato", "alfalfa", "laurel" and "suelda consuelda". Little knowledge was detected by sellers about possible contraindications or adverse effects of medicinal plants which leads to inadequate practices within the community. Ignorance of the differences between the forms of decoction and infusion preparation was also evidenced. Plants that may be promising therapeutic for new uses reported were identified including "albahaca", "calendula", "cidrón", "cola de caballo" and "manzanilla".
Asunto(s)
Humanos , Etnofarmacología , Terapias Complementarias , Fitoterapia , Medicina TradicionalRESUMEN
El síndrome de Sjogren (SS) es un desorden crónico de tipo inflamatorio autoinmune que compromete las glándulas salivares y oculares. Debido a que sólo se realizan prueban indirectas que midan la funcionalidad del ojo se propuso estandarizar la técnica de biopsia conjuntival en el estudio de los pacientes con síndrome de Sjogren (SS) por medio de un estudio descriptivo y de concordancia en el Hospital Universitario de San Ignacio; se concluyeron 17 voluntarios sanos, 13 pacientes con diagnóstico de ojo seco y 13 pacientes con diagnóstico de SS por los criterios preliminares para clasificación de SS de 1993. Se realizó valoración oftalmológica con tiempo de ruptura de película lagrimal, Schirmer y biopsia conjuntival. Las muestras fueron leídas por 2 patólogos en forma ciega por duplicado. El principal hallazgo histopatológico útil en la diferenciación de la población sana y enferma es la hipoplasia de las células caliciformes (p = 0.054). La arquitectura acinar y ductal e infiltrado linfoplasmocitario no fueron estadísticamente significativas (p = 0.19). En cuanto al estudio de concordancia, para la variación intraobservador para el patólogo A el kappa obtenido mayor de 0.726 y para el patólogo B, mayor de 0.799 indica que la concordancia es buena. La variación intraobservador tiene un kappa aceptable, pero no es el ideal. Por lo que consideramos que la biopsia conjuntival se podría utilizar en el estudio de los pacientes con SS, pero es necesario ampliar el tamaño de la muestra para establecer con mayor exactitud las diferencias entre sanos y enfermos