Treatment adherence and quality of life in colombian patients with lupus nephritis.

BACKGROUND: As with many other chronic diseases, systemic lupus erythematosus (SLE) and lupus nephritis (LN) have significant impacts on the health-related quality of life (HRQoL). Medication non-adherence is a significant challenge in the management of SLE, with consistently up to 75% of patients being non-adherent with their SLE medications. There is a need to assess the patient's perspective using patient-reported outcomes (PROs) to better understand the current impact of LN on HRQoL and treatment adherence in our region. The aim of this study was to explore the relationship between HRQoL and treatment adherence in patients with LN from the Colombian Caribbean. METHODS: A cross-sectional study was conducted from June to December 2022, including patients with biopsy-proven LN. HRQoL and treatment adherence were assessed using the Lupus Quality of Life (LupusQoL) and the Compliance Questionnaire in Rheumatology 19 (CQR19) instruments, respectively. Patients were categorized as adherent or non-adherent based on medication intake (defined as >80% correct dosage). Principal component analysis (PCA) was employed to identify principal components between adherent and non-adherent patients. RESULTS: A total of 42 patients with LN were included. Of these, 38 (90%) were female, and the mean age was 31 ± 10 years. Proliferative class IV was the predominant histopathological profile (90%). Twenty-five (60%) patients were categorized as non-adherent. Across all LupusQoL domains, a comprehensive range of responses was observed. Pain, planning, and intimate relationships domains remained unaffected, while burden to others domain had the lowest score. Poorer planning score correlated with older age (r = -0.72; p < .05) and longer disease duration (r = -0.74; p < .05). SLEDAI-2 K correlated with the pain domain (r = -0.78; p < .05). Non-adherent patients exhibited significantly worse pain domain scores compared to adherent counterparts (p < .05). PCA showed strong interactions between planning and pain, as well as between physical health and body image domains. CONCLUSIONS: LupusQoL pain domain scores were significantly worse in non-adherent patients compared to adherent patients. Effective pain management could be a determinant in HRQoL and treatment adherence rates in our population.

Chronic Kidney Disease Stage and Cardiovascular and Mortality Events Among Older Adults: The SPRINT Trial.

Rationale & Objective: The risk implications of the Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease classification in older adults are controversial. We evaluated the risk of adverse outcomes in this population across categories of estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR). Study Design: Prospective cohort. Settings & Participants: In total, 2,509 participants aged ≥75 years in the Systolic Blood Pressure Intervention Trial (SPRINT). Exposure: KDIGO eGFR and UACR categories. We combined KDIGO categories G1 and G2, G3b and G4, as well as A2 and A3. Outcomes: Primary SPRINT outcome (composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), and all-cause death. Analytical Approach: Multivariable Cox proportional hazard models. Results: Mean age was 79.8 years, and 37.4% were female. The mean eGFR was 64.0 mL/min/1.73 m2, and the median UACR was 13.1 mg/g. In multivariable Cox proportional hazard analysis, compared with participants with eGFR ≥ 60 mL/min/1.73 m2 and UACR < 30 mg/g, there was no statistically significant difference in the risk of the primary outcome among participants with eGFR 45-59 or 15-44 mL/min/1.73 m2 and UACR < 30 mg/g. However, those with eGFR 45-59 or 15-44 mL/min/1.73 m2 and UACR ≥ 30 mg/g had higher risk of the primary outcome (HR [95% CI], 1.97 [1.27-3.04] and 3.32 [2.23-4.93], respectively). The risk for all-cause death was higher for each category of abnormal eGFR and UACR, with the highest risk observed among those with eGFR 15-44 mL/min/1.73 m2 and UACR ≥ 30 mg/g (3.34 [2.05-5.44]). Limitations: Individuals with diabetes and urine protein >1 g/day were excluded from SPRINT. Conclusion: Among older adults SPRINT participants, low eGFR without albuminuria was associated with higher mortality but not with increased risk of cardiovascular events. Additional studies are needed to evaluate an adapted chronic kidney disease stage-based risk stratification for older adults.

Using data from participants in the SPRINT trial, we evaluated the association of chronic kidney disease stage with adverse clinical outcomes among adults older than 75 years without diabetes. We found that low level of kidney function determined by a low estimated glomerular filtration rate with moderately or severely increased urine albumin excretion was associated with increased risk for cardiovascular events and all-cause mortality. However, low estimated glomerular filtration rate with normal or mildly increased urinary albumin excretion was not consistently associated with these adverse outcomes. This finding supports the need for additional studies to evaluate an age-adapted classification of chronic kidney disease to improve risk stratification among older adults.

Diagnostic criteria and case definitions for abdominal angiostrongyliasis: a systematic review from the Brazilian experience.

Although rare, Angiostrongylus costaricensis infection may be a more prevalent etiology of inflammatory bowel disease than ulcerative colitis and Chron's disease in endemic areas in Central and South America. The present study reviewed the occurrence of A. costaricensis in Brazil, its clinical presentation and pathology; and proposed diagnostic criteria and case definitions for abdominal angiostrongyliasis (AA). Southern and southeastern Brazilian regions are the main endemic areas, and AA affects both genders and all age groups. A review of all 23 published reports of 51 Brazilian patients highlighted the following features that were subsequently classified as minor diagnostic criteria: abdominal pain, palpable mass in the right lower abdominal quadrant, history of exposure, ileocecal tumor, and intestinal perforation with wall thickening. Proposed major criteria include right lower quadrant abdominal pain, blood eosinophilia, positive serology (antibody detection), intense eosinophilic infiltration that involves all strata of the intestinal wall, eosinophilic granulomatous reaction, and eosinophilic vasculitis. In addition to the definitions of suspected and possible cases according to increasing strength of evidence of this infection, demonstration of worms/eggs/larvae in tissues or Angiostrongylus DNA in tissues or serum are required for a confirmed diagnosis. The application of the proposed criteria and definitions may improve patient management, epidemiologic surveillance, and identification of new endemic areas.

Atypical Hemolytic Uremic Syndrome: A Nationwide Colombian Pediatric Series.

Objectives. Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated kidney disease with genetic predisposition and represents up to 10% of pediatric hemolytic uremic syndrome (HUS) cases. Few studies have evaluated aHUS in Latin American population. We studied a Colombian pediatric cohort to delineate disease presentation and outcomes. Methods. A multicenter cohort of 27 Colombian children with aHUS were included. Patients were grouped by age at onset. Clinical features were compared using analysis of variance (ANOVA) and Fisher exact tests. Renal biopsy was performed on 6 patients who were suspected of having other renal diseases before aHUS diagnosis. Results. Most patients were male (70%). The onset of aHUS occurred frequently before age 4 years (60%) and followed gastroenteritis as the main triggering event (52%). Age groups showed comparable clinical presentation, disease severity, treatment, and outcomes. Pulmonary involvement (67%) was the main extrarenal manifestation, particularly in the 1 to 7 age group (P = .01). Renal biopsies were as follows: 3 had membranoproliferative glomerulonephritis (MPGN) type I, one MPGN type III, one C3-glomerulonephritis, and one rapidly progressive GN. Genetic screening was available in 6 patients and identified 2xCFHR5, 2xMCP, 1xADAMTS13/THBD, and 1xDGKE mutations. A total of 15 relapses were seen, of which 8 (72%) occurred in the 1 to 7 age group. The renal outcome was not significantly different regardless of age group. Conclusion. In our cohort, we observed a relatively high frequency of extrarenal involvement at first presentation represented by pulmonary manifestations. The renal prognosis at initial presentation was worse than in previous reports.

Obesity and glomerular filtration rate.

Obesity has received considerable attention in general medicine and nephrology over the last few years. This condition increases the risk of metabolic syndrome, diabetes mellitus, hypertension, and dyslipidemia, which are the main risk factors for developing chronic kidney disease (CKD). Kidney damage caused by obesity can be explained by many mechanisms, such as sympathetic nervous and renin-angiotensin-aldosterone systems activation, mechanical stress, hormonal unbalance, as well as inflammatory cytokines production. Even though creatinine-based glomerular filtration rate (GFR) equations in obese individuals have been validated (Salazar-Corcoran and CKD-MCQ), changes in body weight after bariatric surgery (BS) leads to changes in creatininemia, affecting its reliability. Thus, an average between creatine and cystatin-based GFR equations would be more appropriate in this setting. Bariatric surgery can reverse diabetes mellitus and improve hypertension, which are the main causes of CKD. Conclusion: GFR can be affected by obesity and BS, and its value should be cautiously evaluated in this setting.

Alactic base excess is an independent predictor of death in sepsis: A propensity score analysis.

PURPOSE: Alactic base excess (ABE) is a novel biomarker defined as the sum of lactate and standard base excess and estimates the renal capability of handling acid-base disturbances in sepsis. The objective of this study is to see if ABE is an independent predictor of mortality in septic patients with and without renal dysfunction. MATERIALS AND METHODS: We retrospectively studied 1178 patients with sepsis and septic shock. Patients were divided according to ABE values: 1) negative ABE (<-3 mmol/L); 2) neutral ABE (≥ - 3 and < 4 mmol/L); and 3) positive ABE (≥4 mmol/L). The effect of ABE on mortality was evaluated using Cox regression weight by inverse probability weighting (IPWT) analysis after propensity score assessment. Additionally, we performed a stratified analysis in patients with GFR > 60 mL/min/1.73 m2. RESULTS: Negative ABE patients had higher mortality than patients with neutral ABE (adjusted HR 1.43; 95%CI 1.02-2.01). Also, in patients with GFR > 60 mL/min/1.73 m2 (n = 493), we observed higher mortality in patients with negative ABE (adjusted HR 2.43; 95%CI 1.07-5.53). CONCLUSIONS: Negative ABE is an independent predictor of in-hospital mortality in septic patients with and without renal dysfunction.

Renal tubular dysfunction in COVID-19 patients.

INTRODUCTION: SARS-CoV-2 infection can affect other organs aside from those of respiratory system, particularly the kidney, heart, blood, digestive tract, and nervous system. COVID-19 renal compromise consists of different syndromes since proteinuria, hematuria, and acute kidney injury (AKI), until chronic kidney disease. Since COVID-19-induced renal tubular damage has been described as a potential antecedent condition to AKI installation, it was decided to evaluate how COVID-19 affects tubular function. MATERIALS AND METHOD: Serum inflammatory parameters, urinalysis, and classical urinary indexes in COVID-19 admitted patients who had neither AKI nor chronic kidney disease (CKD) were evaluated. Statistical analysis was performed by applying Student t test. RESULTS: Renal tubular function was evaluated in 41 COVID-19 admitted patients who had neither AKI nor CKD. Patients' mean age was 56 years, males (79%), and with normal creatininemia (0.8 ± 0.2 mg/dL) and eGFR (105.7 ± 6.5 mL/min) values. It was found mild hypocalcemia and a relative increased fractional excretion (FE) of sodium, FE of calcium, FE of phosphorus, calcium-creatinine index, urinary osmolarity, and relative alkaline urine pH values. CONCLUSION: Tubular dysfunction was documented in COVID-19 patients.

Nocturia: its characteristics, diagnostic algorithm and treatment.

Nocturia is the complaint that an individual has to wake up at night one or more times to urinate. It is a frequent condition among older adults and entails detrimental effects with regard to sleeping, sexual activity, comfort, depression, mental function and vitality. It is clinically important to distinguish it from global polyuria, defined as a urinary rate ≥ 125 ml/h (3000 ml/day), as well as from nocturnal polyuria, which is an abnormally large volume of urine during sleep associated with a decreased daytime urine production. A Frequency Volume Chart (FVC), overnight water deprivation test with renal concentrating capacity test, and the nocturnal bladder capacity index are some of the methods that help establish the underlying pathology of this condition and hence define an adequate treatment plan.

Chronic kidney disease (CKD) and chronic kidney insufficiency (CKI) diagnosing equation in cirrhotic patients.

Cirrhotic patients can develop acute kidney injury (AKI), and chronic kidney disease (CKD). Therefore, renal functional evaluation is crucial in cirrhotic patients. However, serum creatinine and urea levels, as well as measured or estimated glomerular filtration rate is not reliable renal functional markers in these patients compared to other patient groups. In the present study, four original equations are designed and tested for screening chronic kidney disease (CKD) and chronic kidney insufficiency (CKI) in stable cirrhotic patients. MATERIAL & METHOD: estimated GFR (CKD-EPI creatinine and cystatin equations) were recorded in 175 adult stable patients suffering from cirrhosis, and these patients were classified as presenting or not CKD and CKI after evaluation by two independent nephrologists. Based on these data, the variables with the significant discriminating capability to identify CKD and CKI (based on creatinine and cystatin) were detected by applying the Student's t-test for two independent groups, later confirmed by the lambda test of Wilks, in order to obtain the renal function equations. RESULTS: CKD equation (creatinine) = 7.094238-0.043104 × CKD-EPI creatinine - 0.057537 × haematocrit. CKD equation (cystatin) = 8.375074-0.117218 × CKD-EPI cystatin. CKI equation (creatinine) = 0.428389-0.043214 × CKD-EPI creatinine +0.183051 × Child-Pugh score + 0.050162 × age (in years). CKI equation (cystatin) = 9.169579-0.139319 × CKD-EPI cystatin. CONCLUSION: Simple and reliable equations have been obtained for screening chronic kidney disease and chronic kidney insufficiency in cirrhotic patients.

Differences between COVID-19-induced acute kidney injury and chronic kidney disease patients / Diferenças entre pacientes com lesão renal aguda induzida por COVID-19 e pacientes com doença renal crônica

Abstract Introduction: This article describes the main differences between COVID-19-induced acute kidney injury (AKI-COVID19) in patients with previous normal renal function (AKI-NRF) and those with chronic kidney disease (AKI-CKD) treated in a high complexity clinic in Barranquilla (Colombia). Material and Methods: The patients included in this study (n: 572) were those with a positive diagnosis of COVID-19 confirmed by detection of a positive PCR for SARS-CoV-2. Of these patients, 188 developed AKI during their hospital stay. Patients' epidemiological data, serum parameters, and clinical frailty status were recorded. Statistical analysis and comparison among AKI-NRF, AKI-CKD, and non-AKI patients were performed. Results: The incidence of COVID-19-induced AKI was 33%, with the majority classified as AKIN 1, 16% requiring renal replacement therapy, and AKI-COVID19 mortality of 68%. A significantly higher prevalence of hypertension, cardiac disease, and serum reactive C-protein and lower albumin values in AKI-CKD patients was recorded. Mortality rate, invasive ventilation requirement, and D-dimer levels were significantly higher in AKI-NRF patients: Conclusion: Different clinical patterns between AKI-NRF and AKI-CKD were documented.

Resumo Introdução: Este artigo descreve as principais diferenças entre a lesão renal aguda induzida por COVID-19 (LRA-COVID19) em pacientes com função renal normal prévia (LRA-FRN) e aqueles com doença renal crônica (LRA-DRC) atendidos em uma clínica de alta complexidade em Barranquilla (Colômbia). Material e Métodos: Os pacientes incluídos neste estudo (n: 572) foram aqueles com um diagnóstico positivo de COVID-19 confirmado pela detecção de PCR positivo para SARS-CoV-2. Destes pacientes, 188 desenvolveram LRA durante sua internação. Foram registrados os dados epidemiológicos, os parâmetros séricos e o estado de fragilidade clínica dos pacientes. Foram feitas a análise estatística e a comparação entre pacientes com LRA-FRN, LRA-DRC, e pacientes sem LRA. Resultados: A incidência de LRA induzida por COVID-19 foi de 33%, com a maioria classificada como AKIN 1, 16% exigindo terapia renal substitutiva, e a mortalidade por LRA-COVID19 foi de 68%. Foi registrada uma prevalência significativamente mais alta de hipertensão, doença cardíaca e proteína C reativa sérica e valores mais baixos de albumina em pacientes com LRA-DRC. A taxa de mortalidade, a necessidade de ventilação invasiva e os níveis de dímero-D foram significativamente mais altos em pacientes com LRA-FRN. Conclusão: Foram documentados padrões clínicos diferentes entre LRA-FRN e LRA-DRC.

Tasa de filtración glomerular conservada en personas mayores. Un estudio de base poblacional en el Cono Sur de América Latina

Introduction: Kidneys are affected by the aging process, usually suffering a progressive glomerular filtration rate (GFR) reduction of around 1 ml/year as of 30 years of age. Nevertheless, few older subjects show a stable GFR over time. This phenomenon has not been exhaustively studied, and even less in the Southern Cone. Aim: The aim was to estimate the prevalence of preserved GFR in a representative sample of older adults and explore the association between cardiovascular risk factors and preserved GFR in older individuals. Methods: We used data from a cross-sectional survey of a random sample of 1571 participants aged 65-74 years from 4 cities of the Southern Cone. We describe the prevalence of eGFR ≥80 ml/min/1.73 m2 and sociodemographic, biological, behavioral risk factors and medication use. Backward stepwise logistic regression analysis was used to study the effect of cardiovascular risk factors on eGFR ≥80 ml/min. Results: In this study, 962 had an eGFR >80 ml/min/1.73 m2 and 154 were healthy adults (Prevalence= 17.01% (95%CI 14.5%; 19.9%)). The median eGFR in the full sample was 85.53 ml/min/1.73 m² (IQR: 73.12-91.26). The prevalence of eGFR >80 ml/min/1.73 m2 was higher among men. Overall, older adults with no cardiovascular risk factors and eGFR >80 ml/min/1.73 m2 were predominantly men and showed a lower prevalence of dyslipidemia. Conclusion: The present study documented that 17% of healthy older individuals have preserved glomerular filtration rate (eGFR>80 ml/min/1.73 m2) despite their advanced age.

Introducción: Los riñones se ven afectados por el proceso de envejecimiento, sufriendo habitualmente una reducción progresiva de la tasa de filtración glomerular (TFG) de alrededor de 1 ml/año a partir de los 30 años de edad. Sin embargo, son pocos los sujetos de edad avanzada que muestran una TFG estable a lo largo del tiempo. Este fenómeno no ha sido estudiado exhaustivamente, y menos aún en el Cono Sur. Objetivo: El objetivo fue estimar la prevalencia de la TFG conservada en una muestra representativa de adultos mayores y explorar la asociación entre los factores de riesgo cardiovascular y la TFG conservada en individuos de edad avanzada. Métodos: Utilizamos datos de una encuesta transversal de una muestra aleatoria de 1571 participantes de 65-74 años de edad de 4 ciudades del Cono Sur. Describimos la prevalencia de FGe ≥80 ml/min/1,73 m2 y los factores de riesgo sociodemográficos, biológicos y conductuales y el uso de medicamentos. Se utilizó un análisis de regresión logística por pasos hacia atrás para estudiar el efecto de los factores de riesgo cardiovascular sobre la TFGe ≥80 ml/min. Resultados: En este estudio, 962 tenían una TFGe >80 ml/min/1,73 m2 y 154 eran adultos sanos (Prevalencia= 17,01% (IC 95% 14,5%; 19,9%)). La mediana de la TFGe en la muestra completa fue de 85,53 ml/min/1,73 m² (IQR: 73,12-91,26). La prevalencia de la TFGe >80 ml/min/1,73 m2 fue mayor entre los hombres. En general, los adultos mayores sin factores de riesgo cardiovascular y con una TFGe >80 ml/min/1,73 m2 eran predominantemente hombres y mostraban una menor prevalencia de dislipidemia. Conclusiones: El presente estudio documentó que el 17% de los individuos mayores sanos tienen una tasa de filtración glomerular preservada (TFGe>80 ml/min/1,73 m2) a pesar de su avanzada edad.

Glomerular Diseases in the Colombian Caribbean: Data from the Colombian Nephropathy Registry (NEFRORED®).

Our study aimed to describe the glomerular diseases, both primary glomerular disease (PGD) and secondary glomerular disease (SGD) in the Colombian Caribbean based on the first regional Colombian Nephropathy Registry (NEFRORED®). A descriptive and retrospective study of adult patients with glomerular diseases from the Colombian Caribbean region was made. All diagnoses by renal biopsy with light microscopy and immunofluorescence obtained between January 2008 and June 2018 were recorded. Eight hundred and seventy-one renal biopsies were obtained. The main clinical indication for biopsy was nephritic syndrome (36%). SGD was more frequent than PGD (55% vs. 45%). Within SGD group, lupus nephritis (LN) was the most frequent etiology (83%). Within PGD group, membranous nephropathy (33%) and focal segmental glomerulosclerosis (FSGS) (19%) were the most common glomerular diseases. At a 24-month follow-up, the patients with FSGS and paraproteinemia-mediated glomerular disease had the worst renal survival prognosis. This is the first Colombian Nephropathy Registry in a Caribbean population, demonstrating a high predominance of SGD due to LN.

Cranberry dosed extract: an effective therapy for recurrent Escherichia coli cystitis in elderly patients. The GerHogar Cysticlean® study / Extracto dosificado de arándano rojo: una terapia eficaz para la cistitis recurrente por Escherichia coli en pacientes de la tercera edad. El estudio GerHogar Cysticlean®

Abstract Introduction: Cystitis is the most prevalent urinary tract infection (UTI), and antibiotics are its conventional therapy. However, the prevalence rate of antibiotic resistance to uropathogens is significantly increased. Cranberry treatment has been associated with the inhibition of Escherichia coli (Ec) adherence to uroepithelial cells due to the anti-adhesive property related to its proanthocyanidins content, and cysticlean® (CYS) is a cranberry extract which contains 240 mg PACs per capsule. Since elderly people is one of the populations mostly exposed to cystitis and bacteria antibiotic resistance, it was decided to originally study the efficacy and safety of CYS, to treat cystitis instead of antibiotic, in elderly individuals. Material & Methods: Two groups were studied: Group 1 (G1): first cystitis episode was recorded within the last 3 months before the study initiation. Group 2 (G2): frequent cystitis recurrent episodes (1-2/month or more) within the last 3 months before the study initiation. G1 patients were treated with 1 capsule of CYS every 12 h for 1 month, while G2 patients were treated up to 12 months. Comparative evaluation was performed using Student test. Results: 160 elderly ambulatory and nursing home patients suffering from recurrent cystitis were treated with CYS. G1 and G2 had 38 and 122 subjects, respectively. Cranberry-based cystitis treatment was successful in 81.57 % and 81.96 % in G1 and G2 patients, respectively. Conclusion: CYS showed to be an effective alternative therapy to antibiotics to treat cystitis recurrences caused by Ec. Neither side effects nor adverse reactions have been reported.

Resumen Introducción: la cistitis es la infección del tracto urinario más común a nivel mundial y los antibióticos son su terapia convencional; sin embargo, la tasa de prevalencia de la resistencia de los uropatógenos a los antibióticos ha aumentado significativamente en los últimos tiempos. El tratamiento con arándano rojo se ha asociado con la inhibición de la adherencia de la Escherichia coli a las células uroepiteliales debido a la propiedad antiadherente relacionada con su contenido de proantocianidinas. La cysticlean® (CYS) es un extracto de arándano rojo que contiene 240 mg de PAC por cápsula. Objetivo: estudiar la eficacia y seguridad de la CYS en el tratamiento de la cistitis como reemplazo de los antibióticos en personas adultas mayores. Material y métodos: se estudiaron dos grupos, uno (G1) en el que el primer episodio de cistitis se registró dentro de los últimos 3 meses antes del inicio del estudio y otro (G2) en el que se registraron episodios recurrentes de cistitis frecuentes (≥1-2 al mes) en los últimos 3 meses antes del inicio del estudio. Los pacientes del G1 fueron tratados con 1 cápsula de CYS cada 12 horas durante 1 mes, mientras que los del G2 fueron tratados por 12 meses con el mismo esquema. La evaluación comparativa se realizó mediante la prueba de Student. Resultados: en el estudio participaron 160 pacientes ambulatorios de la tercera edad residentes de hogares de ancianos y con diagnóstico de cistitis recurrente. De estos, 38 se incluyeron en G1 y 122, en G2. El tratamiento de la cistitis a base de arándano rojo tuvo éxito en el 81,57 % y el 81,96 % de los pacientes de G1 y G2, respectivamente. Conclusión: la CYS demostró ser una terapia alternativa eficaz a los antibióticos para tratar las recurrencias de cistitis causadas por E. coli al no presentarse efectos secundarios ni reacciones adversas.

[Sexually transmissible infections in African-descendant women in maroon communities in Brazil: prevalence and associated factors]. / Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados.

The study aimed to estimate the prevalence of sexually transmissible infections (STIs) and associated factors in women in quilombola (maroon) communities in Brazil. This was a population-based cross-sectional study of quilombola women from March 2017 to January 2019. A questionnaire was used with sociodemographic, behavioral, and clinical information. A gynecological examination was performed for the collection of uterine cervical cells for oncotic cytology and the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus (HPV) via polymerase chain reaction. Rapid tests for HIV and syphilis were performed. The main outcome was defined as infection with one or more sexually transmissible pathogens. The analysis used chi-square test and hierarchical logistic regression. From a total of 380 women, 352 (92.6%) were included in the study. Prevalence of at least one STI was 18.5% (95%CI: 14.76-22.85). The highest prevalence was for HPV, with 11.1%, followed by 6.3% for T. vaginalis and 4.3% for C. trachomatis. There were no cases of N. gonorrhoeae. Prevalence was 0.3% for HIV and 4.3% for syphilis. Cervical-vaginal cytology was altered in 7.7% of the women. Detection of one or more STIs was significantly associated with age 25 to 44 years (OR = 2.33; 95%CI: 1.05-5.18), alcohol consumption (OR = 1.96; 95%CI: 1.06-3.64), altered cervical cytology (OR = 3.96; 95%CI: 1.65-9.48), and bacterial vaginosis (OR = 3.61; 95%CI: 2.01-6.47). Quilombola women showed high prevalence of one or more STIs, emphasizing the importance of organizing prevention strategies targeted to these women.

O objetivo do estudo foi estimar a prevalência de infecções sexualmente transmissíveis (IST) e fatores associados sobre mulheres quilombolas no Brasil. Trata-se de estudo transversal de base populacional com mulheres quilombolas no período de março de 2017 a janeiro de 2019. Utilizou-se um questionário com informações sociodemográficas, comportamentais e clínicas. Foi realizado exame ginecológico para coleta de células cervicais para citologia oncótica e para detecção de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis e papilomavírus humano (HPV), por meio de teste de reação em cadeia pela polimerase. Foi realizado teste rápido para HIV e sífilis. O desfecho principal foi definido como a infecção por um ou mais agentes infecciosos de transmissão sexual. Para a análise, utilizou-se o teste do qui-quadrado e regressão logística hierárquica. De um total de 380 mulheres, 352 (92,6%) foram incluídas no estudo. A prevalência de, pelo menos, uma IST foi de 18,5% (IC95%: 14,76-22,85). A maior prevalência foi de 11,1% por HPV, seguido de 6,3% por T. vaginalis e de 4,3% por C. trachomatis. Não houve nenhum caso de N. gonorrhoeae. Para o HIV, a prevalência foi de 0,3%, e de sífilis foi de 4,3%. A citologia cervicovaginal estava alterada em 7,7%. A detecção de uma ou mais IST foi significativamente associada a idade entre 25 e 44 anos (OR = 2,33; IC95%: 1,05-5,18), a consumo de álcool (OR = 1,96; IC95%: 1,06-3,64), a resultado alterado da citologia (OR = 3,96; IC95%: 1,65-9,48) e a vaginose bacteriana (OR = 3,61; IC95%: 2,01-6,47). Em mulheres quilombolas houve elevada prevalência de uma ou mais IST, o que torna importante a elaboração de estratégias de prevenção direcionadas a essas mulheres.

El objetivo del estudio fue estimar la prevalencia de enfermedades de transmisión sexual (ETS) y sus factores asociados en mujeres quilombolas en Brasil. Estudio transversal de base poblacional con mujeres quilombolas durante el período de marzo de 2017 a enero de 2019. Se utilizó un cuestionario con información sociodemográfica, comportamental y clínica. Se realizó un examen ginecológico, a fin de recoger células cervicales para la citología oncótica, así como para la detección de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, y virus del papiloma humano (VPH) mediante un test de reacción en cadena de la polimerasa. Se realizó un test rápido para VIH y sífilis. El resultado principal, se definió como infección por uno o más agentes infecciosos de transmisión sexual. Para el análisis, se utilizó el test de chi-cuadrado y regresión logística jerárquica. De un total de 380 mujeres, 352 (92,6%) se incluyeron en el estudio. La prevalencia de por lo menos una ETS fue de 18,5% (IC95%: 14,76-22,85). La mayor prevalencia fue por VPH 11,1%, seguida de 6,3% por T. vaginalis y 4,3% por C. trachomatis. No hubo casos de N. gonorrhoeae. Para el VIH, la prevalencia fue de 0,3% y de sífilis fue de 4,3%. La citología cérvico-vaginal estaba alterada en un 7,7%. La detección de una o más ETS estuvo significativamente asociada con la edad entre 25 a 44 años (OR = 2,33; IC95%: 1,05-5,18), el consumo de alcohol (OR = 1,96; IC95%: 1,06-3,64), resultado alterado de la citología (OR = 3,96; IC95%: 1,65-9,48) y vaginosis bacteriana (OR = 3,61; IC95%: 2,01-6,47). Las mujeres quilombolas presentaron una elevada prevalencia por una o más ETS, por lo que es importante la elaboración de estrategias de prevención dirigidas a estas mujeres.

Sexually transmitted infections among women living with HIV in a Brazilian city.

BACKGROUND: Clinical improvements following highly active antiretroviral therapy (HAART) may increase high-risk behaviors resulting in sexually transmitted infections (STI). Optimism related to the success of HAART in slowing disease progression, reducing viral load, and improving health status might be important factors for increasing sexual risk behaviors such as less use of condoms. OBJECTIVE: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, hepatitis B and C, high-risk HPV, and cervical cytological abnormalities among women living with HIV (WLHIV) who attended a Reference Center for STI/AIDS in Brazil. METHODS: A cross-sectional study was conducted among 151 WLHIV attending an STI Clinic in Vitória city, Brazil. A structured questionnaire, including demographic, behavioral, and clinical information, was used for data collection. Serological tests for HIV, syphilis, hepatitis C and B, CD4 counts, and viral load determination were performed. Cervical samples were collected for cytology and real-time PCR for HPV,Chlamydia, and Neisseria gonorrhoeae. RESULTS: In this study, 59% of women had at least one diagnosed STI at the time of the first clinic visit; 31% had clinical forms of anogenital HPV, 10% syphilis, 8%Neisseria gonorrhoeae, 5.0% trichomoniasis, 3% Chlamydia trachomatis, 1% hepatitis B, and 1% hepatitis C; 6.7% of the women presented with cervical cytological abnormalities. Furthermore, 46.3% of women had HR-HPV, and 17.6% had HPV 16/18. Only 5% of the women had a CD4 count <200 cells/mm3, 61.6% had undetectable HIV viral load, and 81.3% were currently on HAART. CONCLUSION: A high prevalence of STI and HR-HPV infections were observed among HIV-infected women in this investigation. Prevention programs need to focus on counseling WLHIV and their regular partners with focused interventions such as couples counseling and education programs.

Sexually transmitted infections among women living with HIV in a Brazilian city

ABSTRACT Background: Clinical improvements following highly active antiretroviral therapy (HAART) may increase high-risk behaviors resulting in sexually transmitted infections (STI). Optimism related to the success of HAART in slowing disease progression, reducing viral load, and improving health status might be important factors for increasing sexual risk behaviors such as less use of condoms. Objective: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, hepatitis B and C, high-risk HPV, and cervical cytological abnormalities among women living with HIV (WLHIV) who attended a Reference Center for STI/AIDS in Brazil. Methods: A cross-sectional study was conducted among 151 WLHIV attending an STI Clinic in Vitória city, Brazil. A structured questionnaire, including demographic, behavioral, and clinical information, was used for data collection. Serological tests for HIV, syphilis, hepatitis C and B, CD4 counts, and viral load determination were performed. Cervical samples were collected for cytology and real-time PCR for HPV, Chlamydia, and Neisseria gonorrhoeae. Results: In this study, 59% of women had at least one diagnosed STI at the time of the first clinic visit; 31% had clinical forms of anogenital HPV, 10% syphilis, 8%Neisseria gonorrhoeae, 5.0% trichomoniasis, 3% Chlamydia trachomatis, 1% hepatitis B, and 1% hepatitis C; 6.7% of the women presented with cervical cytological abnormalities. Furthermore, 46.3% of women had HR-HPV, and 17.6% had HPV 16/18. Only 5% of the women had a CD4 count <200 cells/mm3, 61.6% had undetectable HIV viral load, and 81.3% were currently on HAART. Conclusion: A high prevalence of STI and HR-HPV infections were observed among HIV-infected women in this investigation. Prevention programs need to focus on counseling WLHIV and their regular partners with focused interventions such as couples counseling and education programs.

Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados / Sexually transmissible infections in African-descendant women in maroon communities in Brazil: prevalence and associated factors / Enfermedades de transmisión sexual en mujeres afrodescendientes de comunidades quilombolas en Brasil: prevalencia y factores asociados

Resumo: O objetivo do estudo foi estimar a prevalência de infecções sexualmente transmissíveis (IST) e fatores associados sobre mulheres quilombolas no Brasil. Trata-se de estudo transversal de base populacional com mulheres quilombolas no período de março de 2017 a janeiro de 2019. Utilizou-se um questionário com informações sociodemográficas, comportamentais e clínicas. Foi realizado exame ginecológico para coleta de células cervicais para citologia oncótica e para detecção de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis e papilomavírus humano (HPV), por meio de teste de reação em cadeia pela polimerase. Foi realizado teste rápido para HIV e sífilis. O desfecho principal foi definido como a infecção por um ou mais agentes infecciosos de transmissão sexual. Para a análise, utilizou-se o teste do qui-quadrado e regressão logística hierárquica. De um total de 380 mulheres, 352 (92,6%) foram incluídas no estudo. A prevalência de, pelo menos, uma IST foi de 18,5% (IC95%: 14,76-22,85). A maior prevalência foi de 11,1% por HPV, seguido de 6,3% por T. vaginalis e de 4,3% por C. trachomatis. Não houve nenhum caso de N. gonorrhoeae. Para o HIV, a prevalência foi de 0,3%, e de sífilis foi de 4,3%. A citologia cervicovaginal estava alterada em 7,7%. A detecção de uma ou mais IST foi significativamente associada a idade entre 25 e 44 anos (OR = 2,33; IC95%: 1,05-5,18), a consumo de álcool (OR = 1,96; IC95%: 1,06-3,64), a resultado alterado da citologia (OR = 3,96; IC95%: 1,65-9,48) e a vaginose bacteriana (OR = 3,61; IC95%: 2,01-6,47). Em mulheres quilombolas houve elevada prevalência de uma ou mais IST, o que torna importante a elaboração de estratégias de prevenção direcionadas a essas mulheres.

Abstract: The study aimed to estimate the prevalence of sexually transmissible infections (STIs) and associated factors in women in quilombola (maroon) communities in Brazil. This was a population-based cross-sectional study of quilombola women from March 2017 to January 2019. A questionnaire was used with sociodemographic, behavioral, and clinical information. A gynecological examination was performed for the collection of uterine cervical cells for oncotic cytology and the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus (HPV) via polymerase chain reaction. Rapid tests for HIV and syphilis were performed. The main outcome was defined as infection with one or more sexually transmissible pathogens. The analysis used chi-square test and hierarchical logistic regression. From a total of 380 women, 352 (92.6%) were included in the study. Prevalence of at least one STI was 18.5% (95%CI: 14.76-22.85). The highest prevalence was for HPV, with 11.1%, followed by 6.3% for T. vaginalis and 4.3% for C. trachomatis. There were no cases of N. gonorrhoeae. Prevalence was 0.3% for HIV and 4.3% for syphilis. Cervical-vaginal cytology was altered in 7.7% of the women. Detection of one or more STIs was significantly associated with age 25 to 44 years (OR = 2.33; 95%CI: 1.05-5.18), alcohol consumption (OR = 1.96; 95%CI: 1.06-3.64), altered cervical cytology (OR = 3.96; 95%CI: 1.65-9.48), and bacterial vaginosis (OR = 3.61; 95%CI: 2.01-6.47). Quilombola women showed high prevalence of one or more STIs, emphasizing the importance of organizing prevention strategies targeted to these women.

Resumen: El objetivo del estudio fue estimar la prevalencia de enfermedades de transmisión sexual (ETS) y sus factores asociados en mujeres quilombolas en Brasil. Estudio transversal de base poblacional con mujeres quilombolas durante el período de marzo de 2017 a enero de 2019. Se utilizó un cuestionario con información sociodemográfica, comportamental y clínica. Se realizó un examen ginecológico, a fin de recoger células cervicales para la citología oncótica, así como para la detección de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, y virus del papiloma humano (VPH) mediante un test de reacción en cadena de la polimerasa. Se realizó un test rápido para VIH y sífilis. El resultado principal, se definió como infección por uno o más agentes infecciosos de transmisión sexual. Para el análisis, se utilizó el test de chi-cuadrado y regresión logística jerárquica. De un total de 380 mujeres, 352 (92,6%) se incluyeron en el estudio. La prevalencia de por lo menos una ETS fue de 18,5% (IC95%: 14,76-22,85). La mayor prevalencia fue por VPH 11,1%, seguida de 6,3% por T. vaginalis y 4,3% por C. trachomatis. No hubo casos de N. gonorrhoeae. Para el VIH, la prevalencia fue de 0,3% y de sífilis fue de 4,3%. La citología cérvico-vaginal estaba alterada en un 7,7%. La detección de una o más ETS estuvo significativamente asociada con la edad entre 25 a 44 años (OR = 2,33; IC95%: 1,05-5,18), el consumo de alcohol (OR = 1,96; IC95%: 1,06-3,64), resultado alterado de la citología (OR = 3,96; IC95%: 1,65-9,48) y vaginosis bacteriana (OR = 3,61; IC95%: 2,01-6,47). Las mujeres quilombolas presentaron una elevada prevalencia por una o más ETS, por lo que es importante la elaboración de estrategias de prevención dirigidas a estas mujeres.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, el diagnóstico y el manejo de la lesión renal aguda por SARS-CoV-2/COVID-19 / Colombian consensus of experts on recommendations informed in the evidence for the prevention, diagnosis and management of acute kidney injury by SARS-CoV-2/COVID-19

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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.