Screening for tropical and imported infections in migrant kidney transplant candidates from the kidney transplant access consultation.

BACKGROUND AND OBJECTIVE: Kidney transplantation (KT) should be postponed in those people with active bacterial, fungal, viral and parasitic processes, since these must be treated and resolved previously. The objective of this study is to present the screening circuit implemented by the Nephrology clinic and describe the prevalence of tropical and imported infections in KT candidates born or coming from endemic areas. MATERIALS AND METHODS: Descriptive cross-sectional study, carried out in 2021. Sociodemographic and clinical variables, serological data of general infections and specific tests of tropical infectious diseases were collected. A descriptive analysis of the data was carried out. RESULTS: 67 TR candidates from Latin America (32.8%), North Africa (22.4%), Sub-Saharan Africa (14.9%) and Asia (29.9%) were included. 68.7% were men and the mean age was 48.9 ±â€¯13.5 years. After the general and specific studies, 42 (62.7%) patients were referred to the Infectious Diseases Service to complete this study or indicate treatment. 35.8% of the patients had eosinophilia, and in one case parasites were detected in feces at the time of the study. Serology for strongyloidiasis was positive in 18 (26.9%) cases, while positive serology for other tropical infections was hardly detected. 34.3% of patients had latent tuberculosis infection. CONCLUSIONS: The prevalence of tropical and imported infections in migrant candidates for RT was low, except for strongyloidiasis and latent tuberculosis infection. Its detection and treatment are essential to avoid serious complications in post-TR. To this end, the implementation of an interdisciplinary screening program from the KT access consultation is feasible, necessary and useful.

ATP Bioluminescence Assay To Evaluate Antibiotic Combinations against Extensively Drug-Resistant (XDR) Pseudomonas aeruginosa.

Time-kill curves are used to study antibiotic combinations, but the colony count method to obtain the results is time-consuming. The aim of the study was to validate an ATP assay as an alternative to the conventional colony count method in studies of antibiotic combinations. The cutoff point for synergy and bactericidal effect to categorize the results using this alternative method were determined in Pseudomonas aeruginosa. The ATP assay was performed using the GloMax 96 microplate luminometer (Promega), which measures bioluminescence in relative light units (RLU). To standardize this assay, background, linearity, and the detection limit were determined with one strain each of multidrug-resistant P. aeruginosa and Klebsiella pneumoniae. Twenty-four-hour time-kill curves were performed in parallel by both methods with 12 strains of P. aeruginosa. The conventional method was used as a "gold" standard to establish the pharmacodynamic cutoff points in the ATP method. Normal saline solution was established as washing/dilution medium. RLU signal correlated with CFU when the assay was performed within the linear range. The categorization of the pharmacodynamic parameters using the ATP assay was equivalent to that of the colony count method. The bactericidal effect and synergy cutoff points were 1.348 (93% sensitivity, 81% specificity) and 1.065 (95% sensitivity, 89% specificity) log RLU/mL, respectively. The ATP assay was useful to determine the effectiveness of antibiotic combinations in time-kill curves. This method, less laborious and faster than the colony count method, could be implemented in the clinical laboratory workflow. IMPORTANCE Combining antibiotics is one of the few strategies available to overcome infections caused by multidrug-resistant bacteria. Time-kill curves are usually performed to evaluate antibiotic combinations, but obtaining results is too laborious to be routinely performed in a clinical laboratory. Our results support the utility of an ATP measurement assay using bioluminescence to determine the effectiveness of antibiotic combinations in time-kill curves. This method may be implemented in the clinical laboratory workflow as it is less laborious and faster than the conventional colony count method. Shortening the obtention of results to 24 h would also allow an earlier guided combined antibiotic treatment.

Aminoglycoside or Polymyxin Monotherapy for Treating Complicated Urinary Tract Infections Caused by Extensively Drug-Resistant Pseudomonas aeruginosa: A Propensity Score-Adjusted and Matched Cohort Study.

INTRODUCTION: Extensively drug-resistant (XDR) Pseudomonas aeruginosa (PA) infections are difficult to treat. We aimed to compare aminoglycosides or polymyxin monotherapy versus other antibiotic regimens (carbapenems, aztreonam, ceftazidime, cefepime, ceftolozane-tazobactam, or ceftazidime-avibactam) in complicated urinary tract infections (cUTI) caused by XDR-PA. METHODS: Study performed at a tertiary-care hospital from 2010 to 2019. All consecutive adult patients with XDR-PA urine cultures and diagnosed with cUTI were retrospectively reviewed. XDR phenotype was defined according to Magiorakos et al. A propensity score was used as a covariate in multivariate analyses and for matching. Primary outcome was early clinical failure and at end of treatment (EOT). Main secondary outcomes were 30- and 90-day mortality, microbiological clearance, and antibiotic-related side effects. RESULTS: Of the 465 episodes screened, 101 were included, 48% were treated with aminoglycoside or colistin monotherapy. Most XDR-PA were susceptible to colistin (100%) and amikacin (43%). Patients treated with antibiotic regimens other than aminoglycosides or polymyxin monotherapy were more likely to have hematologic malignancy (p < 0.001), higher SOFA score (p = 0.048), and bacteremia (p = 0.003). In multivariate models adjusted by propensity score, aminoglycoside or colistin monotherapy was not associated with worse outcomes. After propensity score matching, 28 episodes in each treatment group were matched. Adjusted ORs (95% CI) for early clinical failure and at EOT with aminoglycosides or polymyxin monotherapy were 0.53 (0.18-1.58) and 1.29 (0.34-4.83), respectively. Aminoglycoside or colistin monotherapy was not associated with higher 30-day (HR 0.93, 95% CI 0.17-5.08) or 90-day mortality (HR 0.68, 95% CI 0.20-2.31), nor with absence of microbiological clearance (OR 0.72, 95% CI 0.33-1.58). No statistically significant differences were found in terms of nephrotoxicity. Clostridioides difficile infection was observed only in the "other antibiotic regimens" group (n = 6, 11.3%). CONCLUSIONS: Aminoglycosides or polymyxin monotherapy showed good efficacy and safety profile in treating cUTI caused by XDR-PA. These results may be useful for antibiotic stewardship activities.

Eficacia y seguridad del rituximab en el tratamiento de la esclerosis múltiple: una postura racional en el contexto colombiano / Efficacy and safety of rituximab in the treatment of multiple sclerosis: a rational position in the Colombian context

RESUMEN INTRODUCCIÓN: La esclerosis múltiple es una enfermedad neuroinflamatoria, crónica, degenerativa e incurable, asociada a pérdida neuronal, grados crecientes de discapacidad y deterioro cognoscitivo. Su manejo conlleva grandes costos para los sistemas de salud y la sociedad en general. OBJETIVO: Evaluar la eficacia y la seguridad del uso del rituximab en el manejo de la esclerosis múltiple. MATERIALES Y MÉTODOS: Revisión de la literatura y evaluación de la tecnología en salud tipo mini-HTA en red colaborativa con el Comité de Esclerosis Múltiple de la Asociación Colombiana de Neurología y el Instituto Global de Excelencia Clínica. RESULTADOS: Se identificaron 27 referencias de texto completo para el análisis de la seguridad y la eficacia del rituximab en el manejo de la esclerosis múltiple. Se utilizaron análisis de costos, indicadores epidemiológicos y estudios pivótales de rituximab. CONCLUSIÓN: La evidencia analizada confirma que la terapia con rituximab es efectiva y segura en el manejo de las formas de esclerosis múltiple remitente-recurrente (EMRR) y esclerosis múltiple primaria-progresiva (EMPP), con menor tasa de eventos adversos y tasas de interrupción o abandono del tratamiento más bajas que otras terapias modificadoras de la enfermedad (TME).

SUMMARY INTRODUCTION: Multiple sclerosis is a neuroinflammatory, chronic, degenerative, and incurable disease, associated with neuronal loss, increasing degrees of disability, and cognitive control. Its treatment causes great costs for health systems and society in general. OBJECTIVE: To evaluate the efficacy and safety of the use of rituximab in the management of multiple sclerosis. MATERIALS AND METHODS: Literature review and evaluation of mini-HTA type health technology in a collaborative network with the Multiple Sclerosis Committee of the Colombian Association of Neurology and the Global Institute of Clinical Excellence. RESULTS: 27 full-text references were identified for the safety and efficacy analysis of rituximab in the management of multiple sclerosis. Cost analysis, epidemiological indicators, and pivotal studies of rituximab were incorporated into the analysis. CONCLUSION: The evidence analyzed confirms that rituximab therapy is effective and safe in the management of the forms of Recurrent-Remittent Multiple Sclerosis (RRMS) and Primary-Progressive Multiple Sclerosis (PPMS), with a lower rate of adverse events and discontinuation or withdrawal rates of treatment lower than other disease-modifying therapies.

Toxicodermia as an adverse event in a covid-19 patient: case report

ABSTRACT: Introduction: SARS-COV2 infection, which was initially associated with respiratory manifestations only, can also cause gastrointestinal, kidney, neurological and cardiovascular symptoms according to some reports. Case presentation: A 36-year-old female patient attended the emergency department due to dyspnea, asthenia, adynamia, mild odynophagia. and headache. The patient's medical history included obesity, smoking, and working as a health care worker. Considering the symptoms, antimalarial and antiretroviral treatment was indicated to treat COVID-19, a diagnosis that was confirmed three days after admission. However, on the fourth day of treatment, the patient presented with polydipsia and macular, pruritic, and generalized rash. Due to suspicion of toxicoderma, the treatment was suspended, and the skin condition improved. After 8 days of hospitalization, the patient was discharged with biosecurity recommendations and mandatory isolation for 28 days. Conclusion: The described case is a report of toxicoderma in a patient with COVID-19 under treatment with antiretroviral and antimalarial drugs. Based on the findings, a thorough examination of skin and mucosa of patients with suspected or confirmed COVID-19 will undoubtedly contribute to the correct characterization of this new disease.

RESUMEN Introducción. La infección por SARS-COV2, que en principio se pensó solo causaba manifestaciones respiratorias, también puede ocasionar síntomas gastrointestinales, renales, neurológicos, cardiovasculares e incluso cutáneos según algunos reportes. Presentación del caso. Paciente femenina de 36 años quien asistió al servicio de urgencias por cuadró clínico consistente en disnea, astenia, adinamia, odinofagia leve y cefalea. Como antecedentes de relevancia se registró obesidad, tabaquismo y ocupación como trabajadora de la salud. Dados los síntomas, se indicó tratamiento antimalárico y antirretroviral para tratar COVID-19, diagnóstico que fue confirmado a los tres días de ingreso, pero al cuarto día de instaurado este manejo la mujer presentó polidipsia y rash macular, pruriginoso y generalizado. Por sospecha de toxicodermia, el tratamiento fue suspendido y con esto el cuadro cutáneo mejoró. Luego de 8 días de hospitalización, la paciente recibió el alta, junto con recomendaciones de bioseguridad y confinamiento durante 28 días. Conclusiones. El caso descrito corresponde a un evento de toxicodermia en una paciente con COVID-19 en manejo con antirretroviral y antimalárico. A partir de los hallazgos, se establece que la exploración minuciosa de piel y mucosas en los pacientes con sospecha o diagnóstico confirmado de COVID-19 puede ser de gran ayuda para la correcta caracterización de esta nueva enfermedad.

Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adult patients with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

resumen está disponible en el texto completo

Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Manejo deglutorio del adulto mayor institucionalizado por parte de técnicos en enfermería: un estudio cualitativo / Swallowing Management of Institutionalized Older Adults by Nursing Technicians: A Qualitative Study / Manejo deglutório do idoso institucionalizado por parte de técnicos em enfermagem: um estudo qualitativo

Resumen Introducción: se busca profundizar acerca del manejo cotidiano de las complicaciones de la deglución en centros del adulto mayor, las cuales generalmente asume el técnico o auxiliar de enfermería (TENS), quienes son los encargados de su alimentación. Materiales y métodos: se llevó a cabo un estudio con enfoque cualitativo basado en la teoría fundamentada. Se realizaron grupos de discusión y entrevistas en profundidad a dieciocho TENS de tres establecimientos de larga estadía en la Araucanía (Chile). Se analizaron los datos a través de codificación abierta y axial, con los cuales se obtuvieron seis categorías analíticas sobre esta situación. Resultados: los TENS y los auxiliares de la alimentación reportaron desconocimiento del uso y pertinencia de estas; además, comentaron que dichas maniobras las aprendieron mediante la observación a otros profesionales itinerantes dentro del centro, y no producto de la formación o trabajo interdisciplinario. Conclusión: dado el contexto y las limitaciones derivadas de la formación de los TENS, surge la necesidad de incrementar sus conocimientos y mejorar sus prácticas relacionadas con la deglución y alimentación, con el objetivo de disminuir el riesgo de ocurrencia de situaciones que agraven la salud de los adultos mayores. Se discute, así mismo, la pertinencia de que estos centros cuenten con profesionales capacitados en cuanto al abordaje de los trastornos de la deglución, pues ello contribuirá a mejorar este aspecto, en función del trabajo coordinado con el resto del equipo.

Abstract Introduction: This study examines the daily management of swallowing complications of older adults in centers, which generally assumes that the technician or auxiliary nurses (TENS) are the ones in charge of their feeding. Materials and Methods: A study was conducted with a qualitative approach based on the grounded theory. A focus group and in-depth interviews were performed with 18 nursing technicians and assistants from 3 long-stay facilities in Araucanía, Chile. Data were analyzed through open and axial coding, obtaining 6 analytical categories on this situation. Results: The TENS and auxiliary feeding reported to have no knowledge of the use and relevance of these maneuvers and reported that these were learned via the observation of other traveling professionals within the center and were not a product of interdisciplinary training. Conclusion: Given the context and the limitations derived from the formation of TENS, there is the need to increase their knowledge and improve their practices related to swallowing and feeding, with the aim of reducing the risk of occurrence of situations that aggravate the health of older adults. The relevance of these centers incorporating qualified professionals in the management of swallowing disorders, who would also contribute to improving these aspects, based on coordinated work with the rest of the team was also discussed.

Resumo Introdução: se busca aprofundar acerca do manejo cotidiano das complicações da deglução em centros do idoso, os quais geralmente os assume o técnico ou auxiliar de enfermagem (TENS) os quais são os encarregados de sua alimentação. Materiais e métodos: levou-se a cabo um estudo com enfoque qualitativo baseado na teoria fundamentada. Se realizaram focus group e entrevistas em profundidade a 18 TENS de 3 estabelecimentos de longa estadia em Auracanía, Chile. Se analisaram os dados através de codificação aberta e axial, obtendo-se 6 categorias analíticas sobre esta situação. Resultados: os TENS e auxiliares da alimentação reportaram desconhecimento do uso e pertinência destas, comentando para além de ditas manobras foram aprendidas através da observação a outros profissionais itinerantes dentro do centro, e não produto da formação ou trabalho interdisciplinar. Conclusão: devido ao contexto e às limitações derivadas da formação dos TENS, surge a necessidade de incrementar seus conhecimentos e melhorar suas práticas relacionadas à deglução e alimentação, com o objetivo de diminuir o risco de ocorrência de situações que agravem a saúde dos idosos. Se discute para além da pertinência de que estes centros contem com profissionais idóneos em quanto à abordagem dos transtornos da deglução, que contribuíram também a melhorar estes aspectos, em função do trabalho coordenado com o resto da equipe.

Eficacia y seguridad de la cloroquina, la hidroxicloroquina y la azitromicina en pacientes con COVID-19. Resumen de evidencia / Efficacy and safety of chloroquine, hydroxychloroquine and azithromycin in patients with COVID-19: Summary of evidence

Resumen Introducción: hasta el momento, no se ha demostrado la efectividad de ningún tratamiento para afrontar la emergencia sanitaria por COVID-19. Objetivo: presentar la evidencia disponible respecto a la eficacia y seguridad del uso de cloroquina, hidroxicloroquina y azitromicina en la profilaxis y el manejo de pacientes con COVID-19. Materiales y métodos: se realizó una revisión de la literatura en las bases de datos MEDLINE, Scopus y PubMed sobre publica- ciones que registraran el uso de cloroquina, hidroxicloroquina y azitromicina en pacientes con COVID-19. Resultados: se seleccionaron 12 publicaciones que incluyeron revisiones rápidas de literatura, estudios observacionales y ensayos clínicos. No se encontró información sobre la profilaxis con cloroquina, hidroxicloroquina ni azitromicina para SARS-CoV-2. Los eventos adversos reportados incluyeron emesis, dolor abdominal, náuseas, diarrea, erupción cutánea y picazón. Conclusiones: según la evidencia recopilada el uso de hidroxicloroquina o de cloroquina sola o en combinación con azitromicina en pacientes con COVID-19 no ha mostrado beneficio. Además, cada uno de estos esquemas de tratamiento se asocia con un mayor riesgo de muerte y de episodios de arritmias. En síntesis, la efectividad de estos medicamentos sigue sin estar esclarecida, por lo cual se sugiere evitar su uso en el tratamiento de personas con infección por SARS-CoV-2/COVID-19.

Abstract Introduction: The COVID-19 disease is a health emergency; treatment has not yet been proven. Objective: To present the available evidence of efficacy and safety of the use of hydroxychloroquine and azithromycin in the prophylaxis and management of patients with COVID-19. Methods: A rapid literature review was performed; we consulted Medline, scopus and pubmed databases. Results: Eleven publications were included including rapid literature reviews, observational studies, and clinical trials. No data were found studying prophylaxis with hydroxychloroquine and azithromycin for SARS-CoV-2. Reports of adverse events include episodes of emesis, abdominal pain, nausea, diarrhea, rash, and itching. Conclusions: The evidence collected suggests that the use of hydroxychloroquine and azithromycin in patients with COVID-19, could abnormal electrocardiogram and increased risk of mortality in-hospital. The effectiveness remains unclear.

Uso de resúmenes de evidencia para informar el tratamiento farmacológico de personas con sospecha o diagnóstico de infección respiratoria por SARS-CoV-2/COVID-19 / Use of evidence summaries to inform pharmacological treatment of people with suspected or diagnosedSARS-CoV-2/COVID-19 respiratory infection

Resumen Introducción: debido a la emergencia del coronavirus SARS-CoV-2 desde diciembre del 2019, se ha generado un gran volumen de producción científica, en algún caso incierta o controvertida especialmente en el manejo farmacológico de los pacientes con esta infección; por lo tanto, se considera relevante buscar alternativas metodológicas para realizar su síntesis rigurosa, sistemática y de calidad, pero con menor tiempo de ejecución y menor costo. Objetivo: presentar la evidencia disponible respecto al manejo farmacológico de personas con sospecha o diagnóstico de infección respiratoria por SARS-CoV-2 (COVID-19) utilizando el método de revisiones sistemáticas rápidas (RS-R) en medicamentos poten- cialmente eficaces para su manejo. Metodología: se realizó una búsqueda sistemática y estructurada en Medline, Embase, Scopus, Cochrane Library, Clinical trials y Google Scholar en inglés. Los estudios incluidos fueron guías de práctica clínica, consensos, revisiones sistemáticas, metaanálisis, ensayos clínicos y otros estudios primarios. La búsqueda y extracción de datos se realizó por múltiples revisores, pero ninguna fue pareada. Resultados: dieciseis preguntas de interés clínico fueron resueltas, relacionadas con el uso en COVID-19 de lopinavir/ ritonavir, nelfinavir, oseltamivir, remdesivir, ribavirina, teicoplanina, umifenovir, favipiravir, tocilizumab, ivermectina y plasma convaleciente; también se evaluó el uso de medicamentos de soporte e incluidos en el manejo como la dexametasona, así como el uso concomitante de medicamentos que generaron dudas como son los AINES, los IECA y los ARA II. Conclusiones: los resúmenes de evidencia se muestran dentro del escenario de la pandemia como una buena alternativa metodológica para ofrecer información de calidad a corto plazo para los tomadores de decisiones.

Abstract Introduction: Due to the emergence of the SARS-CoV-2 coronavirus since December 2019, a large volume of scientific production has been generated, in some cases uncertain or controversial, especially in the pharmacological management of patients with this infection; therefore, it is considered a relevant search for methodological alternatives to carry out its rigorous, systematic and quality synthesis, but with less execution time and lower cost. Objective: To present the available evidence regarding the pharmacological management of people with suspected or diagnosed respiratory SARS-CoV-2 (COVID-19) using the method of rapid systematic reviews (RS-R) in potentially effective drugs for their management. Methodology: A systematic and structured search was conducted in Medline, Embase, Scopus, Cochrane Library, Clinical trials and Google Scholar in English. Studies included clinical practice guidelines, consensus, systematic reviews, meta-analyses, clinical trials, and other primary studies. Data search and extraction were performed by multiple reviewers, but none were paired. Results: Sixteen questions of clinical interest were resolved, related to the use in COVID-19 of lopinavir/ritonavir, nelfinavir, oseltamivir, remdesivir, ribavirin, teicoplanin, umifenovir, favipiravir, tocilizumab, ivermectin, convalescent plasma; the use of support management drugs such as dexamethasone were also evaluated, as well as the concomitant use of drugs that generated doubts, such as NSAIDs, ACEis, and ARA IIs. Conclusions: Summaries of evidence are within the pandemic scenario as a good methodological alternative to offer quality information in the short term for decision-makers.

Consenso colombiano para la prevención, el diagnóstico y el tratamiento de condiciones trombóticas en adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adults with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

Introducción estudios recientes han reportado fenómenos trombóticos o coagulopatía en pacientes con COVID-19. Hay posiciones divergentes en cuanto a la prevención, el diagnóstico y el tratamiento de estos fenómenos, y la práctica clínica actual está basada únicamente en deducciones por extensión a partir de estudios retrospectivos, series de casos, estudios observacionales y guías internacionales desarrolladas previas a la pandemia. Objetivo establecer una serie de recomendaciones sobre prevención, diagnóstico y manejo de las complicaciones trombóticas asociadas a COVID-19. Métodos se desarrolló una guía rápida en la que se aplicó el marco de la evidencia a la decisión (EtD) de GRADE y un sistema de participación iterativo, con análisis estadísticos y cualitativos de sus resultados. Resultados se generaron 31 recomendaciones clínicas enfocadas a: a) Pruebas de coagulación en adultos sintomáticos con sospecha de infección o infección confirmada por SARS-CoV-2; b) Tromboprofilaxis en personas adultas con diagnóstico de COVID-19 (escalas de riesgo, tromboprofilaxis de manejo ambulatorio, intrahospitalario y duración de tromboprofilaxis después del egreso de hospitalización), c) Diagnóstico y tratamiento de las complicaciones trombóticas y d) Manejo de personas con indicación previa a usar agentes anticoagulantes. Conclusiones las recomendaciones clínicas de este consenso orientan la toma de decisiones clínicas respecto a prevención, diagnóstico y tratamiento de fenómenos trombóticos en pacientes con COVID-19, y representan un acuerdo que ayudará a disminuir la dispersión en las prácticas clínicas acorde con el desafío que impone la pandemia.

Abstract Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. Objective: to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Recomendaciones para el uso de la hormona de crecimiento humana recombinante en pacientes pediátricos de talla baja en Colombia / Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

resumen está disponible en el texto completo

Abstract In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinant human growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation, the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order to standardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium of clinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada de Servicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private health institutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia Clínica Keralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm, biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use among the indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consent and a medication fact sheet available for parents and patients.

Recomendaciones para el uso racional de la prueba 25-hidroxivitamina D Resumen de política

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The exponential increase in the request for laboratory tests of 25-Hydroxyvitamin D or [25 (OH) D has ignited the alarms and generated a strong call for attention, since it may reflect deficiencies in the standardization of clinical practice and in the use non-systematic scientific evidence for decision-making in real life, which allows to analyze the indications of the test, its frequency, interpretation and even to assess the impact for health systems, especially when contrasted with the minimum or almost. No effects of the strategy of screening or supplying indiscriminately to the general population, without considering a comprehensive clinical assessment of risks and needs of people. From a purely public health impact point of view, the consequence of massive and unspecified requests is affecting most of the health systems and institutions at the global level. The primary studies that determined average population intake values have been widely used in the formulation of recommendations in Clinical Practice Guidelines, but unfortunately misinterpreted as cut points to diagnose disease and allow the exaggerated prescription of nutritional substitution. The coefficient of variation in routine tests to measure blood levels of 25 (OH) D is high (28%), decreasing the overall accuracy of the test and simultaneously, increasing both the falsely high and falsely low values. The most recent scientific evidence analyzes and seriously questions the usefulness and the real effect of the massive and indiscriminate practice of prescribing vitamin D without an exhaustive risk analysis. The available evidence is insufficient to recommend a general substitution of vitamin D to prevent fractures, falls, changes in bone mineral density, incidence of cardiovascular diseases, cerebrovascular disease, neoplasms and also to modify the growth curve of mothers' children. They received vitamin D as a substitute during pregnancy. The recommendations presented in the document are based on the critical analysis of current evidence and the principles of good clinical practice and invite to consider a rational use of 25 (OH) D tests in the context of a clinical practice focused on people and a comprehensive assessment of needs and risks. The principles of good practice suggest that clinicians may be able to justify that the results of the 25 (OH) D test strongly influence and define clinical practice and modify the outcomes that interest people and impact their health and wellness. Currently there is no clarity on how to interpret the results, and the relationship between symptoms and 25 (OH) D levels, which may not be consistent with the high prevalence of vitamin D deficiency reported. For this reason, it is suggested to review the rationale of the request for tests for systematic monitoring of levels of 25 (OH) D or in all cases where substitution is performed. Consider the use of 25 (OH) D tests within the comprehensive evaluation of people with suspicion or confirmation of the following conditions: rickets, osteomalacia, osteoporosis, hyper or hypoparathyroidism, malabsorption syndromes, sarcopenia, metabolic bone disease.

Ambulatory care sensitive conditions hospitalization for emergencies rates in Colombia

ABSTRACT OBJECTIVE To analyze the emergency hospitalizations trend for ambulatory care sensitive conditions between 2011 and 2015 in a health insureance company of the Colombian Social Security General System. METHODS A log-linear analysis based on age-adjusted hospitalization rates for ambulatory care sensitive conditions in the Entidad Promotora de Salud Sanitas was used to estimate the annual percentage change in these rates and to identify joinponts of the rates. Data was collected from administrative sources. RESULTS There were 38,530 hospitalizations for ambulatory care sensitive conditions in 26,501 Entidad Promotora de Salud Sanitas enrollees, with a significant decrease in hospitalization rates. The annual percentage change estimated for the period was -9.5% with no significant joinpoints throughout the time interval. CONCLUSIONS A significant reduction in hospital admissions due to ambulatory care sensitive conditions in Entidad Promotora de Salud Sanitas enrollees were reported for the last five years in this study.

Verticillium dahliae LysM effectors differentially contribute to virulence on plant hosts.

Chitin-binding lysin motif (LysM) effectors contribute to the virulence of various plant-pathogenic fungi that are causal agents of foliar diseases. Here, we report the LysM effectors of the soil-borne fungal vascular wilt pathogen Verticillium dahliae. Comparative genomics revealed three core LysM effectors that are conserved in a collection of V. dahliae strains. Remarkably, and in contrast with the previously studied LysM effectors of other plant pathogens, no expression of core LysM effectors was monitored in planta in a taxonomically diverse panel of host plants. Moreover, targeted deletion of the individual LysM effector genes in V. dahliae strain JR2 did not compromise virulence in infections on Arabidopsis, tomato or Nicotiana benthamiana. Interestingly, an additional lineage-specific LysM effector is encoded in the genome of V. dahliae strain VdLs17, but not in any other V. dahliae strain sequenced to date. Remarkably, this lineage-specific effector is expressed in planta and contributes to the virulence of V. dahliae strain VdLs17 on tomato, but not on Arabidopsis or N. benthamiana. Functional analysis revealed that this LysM effector binds chitin, is able to suppress chitin-induced immune responses and protects fungal hyphae against hydrolysis by plant hydrolytic enzymes. Thus, in contrast with the core LysM effectors of V. dahliae, this lineage-specific LysM effector of strain VdLs17 contributes to virulence in planta.

Effect of ditaxin and heteranthin and inhibitory effect of Ditaxis heterantha extract on L5178Y tumor development in mice.

Ditaxis heterantha seeds are used as spices for flavoring and coloring food. Two new apocarotenoids derived from the seeds, heteranthin and ditaxin, were evaluated for their in vitro cytotoxic effects in murine lymphoma cells lines. Bioabsorption in mice and preventive and antitumor effects of the apocarotenoids were determined. Ditaxin and heteranthin showed cytotoxic effects in vitro against murine malignant cells and normal splenocyte cells. The 50% inhibitory concentration (IC(50)) for ditaxin in splenocytes was 0.1825 mM; in L5178Y, the IC(50) was 0.1923 mM. The heteranthin IC(50) in splenocytes was 0.1325 mM; in L5178Y, the value was 0.3889 mM. The maximum ditaxin plasma concentration was found after 2 hours of administration (mean±standard deviation, 7.5±2.05 µg/mL). Oral administration of the D. heterantha extract (100 mg/kg per day) for 14 days after the L5178Y lymphoma cell implantation showed no significant effect compared with groups that were not pretreated. However, tumor inhibition in groups treated intraperitoneally before inoculation with the L5178Y cells showed a significant difference (P<.001) compared with the groups not pretreated.

Comparison of the sodium hydroxide specimen processing method with the C18-carboxypropylbetaine specimen processing method using independent specimens with auramine smear, the MB/BacT liquid culture system, and the COBAS AMPLICOR MTB test.

A study was performed to diagnose tuberculosis by smear, culture, and nucleic acid amplification. The study was comprised of two independent arms. Each arm used a different specimen processing method; in one arm, all specimens were processed with N-acetyl-l-cysteine-sodium hydroxide, and in the other arm, all specimens were processed with C(18)-carboxypropylbetaine and lytic enzymes. In each arm, all processed sediments were split for analysis by auramine smear, by culture using the MB/BacT liquid culture system and solid media, and by nucleic acid amplification using the COBAS AMPLICOR MTB test. In the N-acetyl-l-cysteine-sodium hydroxide arm, 1,468 specimens were analyzed: 65 were smear positive; 88 and 42 were culture positive for Mycobacterium tuberculosis and nontuberculous mycobacteria, respectively; and 103 were PCR positive. Relative to cultures positive for M. tuberculosis, the sensitivity and specificity of the smear were 68.2% and 99.6%, respectively, and those of PCR were 75.0% and 97.3%, respectively. In the C(18)-carboxypropylbetaine study arm, 1,423 specimens were analyzed: 44 were smear positive; 82 and 31 were culture positive for M. tuberculosis and nontuberculous mycobacteria, respectively; and 91 were PCR positive. The sensitivity and specificity of the smear were 48.8% and 99.7%, respectively, and those of PCR were 78.0% and 98.0%, respectively. When the two arms were compared, C(18)-carboxypropylbetaine specimen processing significantly increased the number of smear-negative and culture-positive specimens and significantly increased the PCR sensitivity among this same group of specimens while at the same time significantly reducing the inhibition rate.

Dolor abdominal en el servicio de urgencias pediátricas / Abdominal pain in the pediatric emergency department

Antecedentes: el dolor abdominal es una causa frecuente de consulta en los servicios de urgencias pediátricas. El objeto del estudio fue encontrar si existe un perfil clínico y paraclínico de los pacientes con dolor abdominal que sugiera si su patología requiere tratamiento quirúrgico o médico. Métodos: se realizó un trabajo observacional, prospectivo, de los pacientes que ingresaban al servicio de urgencias pediátricas con diagnóstico del dolor abdominal. Se comparon las variables clínicas, de laboratorio y gabinete de las alteraciones quirúrgicas y médicas mediante la prueba de la ji cuadrada, considerando a p significativa <0.005. Resultados: el 15 por ciento de 188 pacientes ingresaron por dolor abdominal. De ellos, 102 tenían alteración médica y 86 quirúrgica. Los diagnósticos más frecuentes fueron: apendicitis, dolor abdominal inespecífico, infección de vías urinarias y constipasión. En apoyo de la alteración quirúrgica fueron estadísticamente significativos (p<0.005) el signo de rebote, hiperestesia, resistencia muscular, leucocitosis con neutrofilia y borramiento del psoas. Para alteración médica lo fueron la constipación y los síntomas urinarios. Conclusiones: los pacientes con rebote, hiperestesia, resistencia muscular, leucocitosis con neutrofilia y borramiento del psoas, probablemente presentan alteración abdominal "quirúrgica". Como estos datos no existen en todos los enfermos, si existe duda en el diagnóstico, conviene la vigilancia constante

Evaluación prospectiva de modificaciones en la kalemia postinfusión de diferentes soluciones endovenosas en la resucitación pediátrica / Prospective evaluation o kalemia prior to and following the use of different intravenous solutions in pediatric resuscitation

Objetivo: Determinar las modificaciones de la kalemia postinfusión de soluciones endovenosas rápidas (IV) en el tratamiento del estado de choque o deshidratación severa en pacientes pediátricos. Diseño: Prospectivo, observacional, comparativo. Material y Métodos: Se determinó edad, sexo, diagnóstico, frecuencia cardiaca y respiratoria, tensión arterial al momento de la admisión, así como exámenes de laboratorio: hematócrito, pH, densidad específica del plasma, sodio y potasio sanguíneos previos y posteriores a la infusión endovenosa de carga rápida. Las variables mencionadas fueron comparadas mediante análisis de varianza (ANOVA). Se calculó el gradiente de potasio (final-inicial) (DK) y se comparó del DK hallado y el DK esperado de acuerdo a la modificación del pH sanguíneo (DKcalc). Resultados: Se estudiaron 50 pacientes con los diagnósticos de gastroenteritis y deshidratación severa, 26 (52 por ciento); septicemia y choque séptico ocho (16 por ciento y 16 pacientes postoperados (32 por ciento). Las soluciones de carga rápida utilizadas por el pediatra tratante fueron: NaCI 0.9 por ciento en 39 pacientes, y solución Hartmann en 11. Al finalizar la infusión los pacientes tuvieron elevación de la tensión arterial sistólica y diastólica; descenso de la frecuencia cardiaca y respiratoria; elevación del pH sanguíneo y descenso de la densidad del plasma, en relación a la medición inicial, con diferencias estadísticamente significativas (p < 0.01). El potasio sérico postinfusión mostró un descenso en relación al potasio sérico inicial (X ñ DS) 0.23 ñ 0.36 mEq/L. El descenso de la kalemia fue estadísticamente significativo en el grupo de pacientes que recibieron solución NaCI 0.9 por ciento (p < 0.001) en comparación con los otros tipos de solución intravenosa utilizada. Los pacientes que recibieron solución Ringer lactado durante la resucitación no presentaron reducción en la Kalemia en relación a la determinación inicial. En 19 pacientes el gradiente DK fue menor al DKcal según modificación del pH. Conclusiones: La infusión endovenosa de soluciónes NaCI 0.9 por ciento para la resucitación produce un descenso estadísticamente significativo de la kalemia preinfusión. El descenso de la kalemia es mayoir al esperado por la elevación del pH sanguíneo, por lo que en pacientes con hipookalemia preinfusión de cargas rápidas o en pacientes con gastroenteritis y disminución del potasio corporal total, la solución recomendable para infusión endovenosa rápida para resucitación debe ser preferntemente solución isotónica que contenga potasio como la solución Ringer