Evaluación de la función renal para la detección y seguimiento de la enfermedad renal crónica. Documento multidisciplinario de consenso 2021. Especial atención sobre situaciones clínicas específicas / Evaluation of renal function for the detection and follow-up of chronic kidney disease. Multidisciplinaryconsensus document 2021. Special attention to specific clinical situations

Resumen El filtrado glomerular (FG) se considera el mejor índice para evaluar la función renal en la práctica clínica. Recientemente, ha ganado popularidad la utilización de ecuaciones que estiman el FG, en distintas poblaciones, a partir de los niveles séricos de algunos biomarcadores. Sin embargo, no todas las fórmulas han sido validadas en los diversos escenarios clínicos probables. Las sociedades participantes: Sociedad Argentina de Nefrología, Asociación Bioquímica Argentina, Fundación Bioquímica Argentina y Confederación Unificada Bioquímica de la República Argentina, integradas por nefrólogos y bioquímicos, realizaron un consenso actualizado sobre la utilización del FG como herramienta de detección de la enfermedad renal crónica (ERC) en la Argentina. Se analizó la bibliografía existente y, teniendo en cuenta aspectos de nuestra realidad sanitaria, se establecieron sugerencias para su utilización. Se actualizaron las indicaciones del uso del FG medido. En sucesivos capítulos se puso foco en distintos estados del FG en diversas poblaciones y situaciones. En los estados de reducción del FG, se mencionaron tanto los fisiológicos propios del envejecimiento, como los determinados por situaciones patológicas, por ejemplo, el observado en la ERC avanzada o el determinado en aquellos pacientes que recibieron un trasplante renal. Se revisaron, por otro lado, las situaciones de incremento del FG, como las observadas en el embarazo o en la obesidad. Se refirieron, asimismo, las limitaciones de la estimación del FG, se reconoció su valor en situaciones de la práctica clínica habitual, o en contextos epidemiológicos definidos y se sugirieron las ecuaciones más adecuadas para su utilización en cada caso.

Abstract The glomerular filtration rate (GFR) is considered the best index to assess the renal function in clinical practice. Recently, the use of equations to estimate GFR in different populations, based on the serum levels of some biomarkers, has gained popularity. However, not all the equations have been validated in the various likely clinical scenarios. Thus, the participating societies, i.e. the Argentine Society of Nephrology, the Argentine Association of Biochemistry, the Argentine Foundation of Biochemistry, and the Unified Confederation of Biochemistry of Argentina, composed of nephrologists and biochemists, have established an updated consensus on the use of the GFR as a tool for the detection of chronic kidney disease (CKD) in Argentina. The consensus was established on the basis of the analysis of the existing literature and taking into account aspects of the health situation in Argentina. Suggestions for the use of the GFR were made, and the indications for its use were updated. The successive chapters of the consensus consider different values of the GFR in different populations and situations. The different situations considered and reviewed include cases of a decrease in the GFR, such as the physiological one related to aging and that related to pathological situations, as observed in advanced CKD or in patients who have received a kidney transplant, as well as cases of an increase in the GRF, such as that observed in pregnancy or obesity. The consensus also mentions the advantages and limitations of the estimation of the GFR in situations of usual clinical practice or in specific epidemiological contexts, and the most appropriate equations for its use in each case is suggested.

Resumo A filtração glomerular (FG) é considerada o melhor índice para avaliar a função renal na prática clínica. Recentemente, a utilização de equações que calculam a FG, em diferentes populações, ganhou popularidade a partir dos níveis séricos de alguns biomarcadores. Entretanto, nem todas as fórmulas têm sido validadas nos diversos cenários clínicos prováveis. As sociedades participantes: Sociedade Argentina de Nefrologia, Associação Bioquímica Argentina, Fundação Bioquímica Argentina e Confederação Unificada Bioquímica da República Argentina, integradas por nefrologistas e bioquímicos, realizaram um consenso atualizado sobre a utilização da FG, como ferramenta de detecção da doença renal crônica (DRC) na Argentina. Foi analisada a bibliografia existente e, considerando aspectos da nossa realidade sanitária, foram estabelecidas sugestões para sua utilização. Foram atualizadas as indicações do uso da FG medida. Em sucessivos capítulos se colocou o foco em diferentes estados da FG em populações e situações diversas. Nos estados de redução da FG, foram mencionados tanto os fisiológicos próprios do envelhecimento, quanto os determinados por situações patológicas, por exemplo, aquele observado na DRC avançada ou o determinado naqueles pacientes que receberam um transplante renal. Por outra parte, foram revistas as situações de aumento da FG como as observadas na gravidez ou na obesidade. Foram referidas, também, as limitações da estimativa da FG, foi reconhecido o seu valor em situações da prática clínica habitual, ou em contextos epidemiológicos definidos e se sugeriram equações mais adequadas para sua utilização em cada caso.

Digital asthenopia: blue-blocking lenses and + 0,40D additional power in the near zone, for eye strain, accommodation and convergence functions / Astenopia digital: avaliação de lentes com filtro de luz azul e poder adicional de +0,40D na zona de perto, para fadiga visual e nas funções de convergência e acomodação

ABSTRACT Purpose Evaluate blue-violet light filter and additional power of +0.40 D in the near zone ophthalmic lenses, on convergence, accommodative functions, and symptoms of digital asthenopia (DA). Methods Randomized study in cross-over design conducted on 49 volunteers (age, 29 ± 5.5 years; male: female, 18:31). Each subject wore test (+0.40 D in the near zone) and control lenses (regular single vision) for 4 weeks in randomized order. Both lenses had a selective blue-violet light filter. A baseline measurement was taken with the subjects' current updated glasses. Accommodation amplitude (AA) and near point of convergence (NPC) were measured binocularly with the RAF ruler. DA was evaluated by a questionnaire. Results No significant difference (p=.52) was found for AA comparing baseline (11.50±1.88 D), test (11.61± 1.62 D), and control SV lenses (11.88±1.50 D). No significant difference was found for NPC (p=.94), between baseline (6.50 ± 2.89cm), test (6.71± 3.49) and control SV lenses (6.82± 3.50 cm). No significant difference was found comparing test and control SV lenses in symptoms of DA (p=0.20). Conclusions The +0.40 D lenses have no negative impact on convergence or loss of accommodation power. The +0.40 D and control SV lenses had a similar impact on attenuating symptoms of DA.

RESUMO Objetivo Avaliar os efeitos do uso de lentes oftálmicas com filtro seletivo de luz azul-violeta, sem e com poder adicional de + 0,4D na zona de perto nas funções de acomodação e convergência e para sintomas de astenopia digital (AD). Métodos Ensaio clínico controlado, randomizado e mascarado, com 49 voluntários (idade, 29 ± 5,5 anos; masculino: feminino, 18: 31). Cada participante usou lentes de teste (+0,40 D na zona de perto) e controle (visão simples), por 4 semanas de forma randomizada. Ambas as lentes tinham filtro seletivo de luz azul-violeta. A medição inicial (baseline) foi feita com os óculos atualizados de cada participante. A amplitude de acomodação (AA) e o ponto de convergência próximo (PPC) foram medidos binocularmente com a régua RAF. A AD foi avaliada por um questionário. Resultados Não houve diferença estatisticamente significante (p=0,52) para as medidas de AA comparando as lentes baseline (11,50±1,88 D), teste (11,61±1,62 D) e controle VS (11,88±1,50 D). Nenhuma diferença significativa foi encontrada para a medida do PPC (p=0,94), entre as lentes baseline (6,50 ± 2,89cm), teste (6,71±3,49) e controle VS (6,82±3,50 cm). Nenhuma diferença significativa foi encontrada comparando lentes teste de VS e controle nos sintomas de AD (p=0,20). Conclusões As lentes com +0,40 D não têm impacto negativo na convergência ou na perda de acomodação. As lentes +0,40 D e controle VS, tiveram impacto semelhante na redução dos sintomas de AD.

Efecto de la temperatura y concentración de microplásticos en la tasa de filtración del mejillón Semimytilus algosus (Mytiloida: Mytilidae) / Effect of temperature and microplastic concentration on the filtration rate of the mussel Semimytilus algosus (Myiloida: Mytilidae)

Resumen Introducción: La presencia de microplásticos (MPs, partículas menores a 5 mm) y el incremento de la temperatura en los océanos, vienen generando perturbaciones en la vida marina, que se pueden relacionar con alteraciones en el metabolismo de organismos filtradores, como los mitílidos. Objetivo: Se evalúa el efecto de diferentes temperaturas y concentraciones de MPs sobre la tasa de filtración (TF) de Semimytilus algosus. Métodos: Una muestra de organismos (N = 72) fue expuesta a cuatro temperaturas (17, 20, 23 y 26 °C), y un testigo sin microplásticos (MPs0) y dos concentraciones de MPs (< 125 µm) de 0.125 mg/l (MPs1) y 0.250 mg/l (MPs2), todos en combinación con la microalga Isochrysis galbana (1x106 cel/ml/día) por 21 días. Resultados: A medida que aumentó la concentración de MPs, se redujo la TF de S. algosus. Respecto a la temperatura, durante el día 7 se observó una mayor TF a 23 °C en todos los tratamientos, y para los días 14 y 21 se obtuvieron los menores valores de TF a 23 y 26 °C. La acción conjunta del incremento de temperatura y MPs, afectó negativamente la TF de S. algosus, donde ambos factores ocasionaron el descenso de la TF para todos los tiempos de evaluación. No se registró mortalidad a 17 °C para ningún tratamiento, y en el caso de mitílidos expuestos a MPs1 y temperaturas de 20 y 26 °C se presentó la mayor mortalidad (67 %). Conclusiones: El estudio demuestra el efecto adverso del incremento de temperatura y MPs sobre la TF de S. algosus.

Abstract Introduction: The presence of microplastics (MPs, particles smaller than 5 mm) and the increase in temperature in the oceans, have been generating disturbances in marine life, which can be related to alterations in the metabolism of filter-feeders, such as Mythilids. Objective: The effect of different temperatures and concentrations of MPs on the filtration rate (TF) of Semimytilus algosus is evaluated. Methods: A sample of organisms (N = 72) was exposed to four temperatures (17, 20, 23 and 26 °C), and a control without microplastics (MPs0) and two concentrations of MPs (< 125 µm) of 0.125 mg/l (MPs1) and 0.250 mg/l (MPs2), all in combination with Isochrysis galbana microalgae (1x106 cells/ml/day) for 21 days. Results: As the concentration of MPs increased, the TF of S. algosus decreased. Regarding temperature, during day 7 a higher TF was observed at 23 °C in all treatments, and during days 14 and 21 the lowest TF values were obtained at 23 and 26 °C. The joint action of the increase in temperature and MPs, negatively affected the TF of S. algosus, where both factors caused the decrease in TF for all evaluation times. No mortality was recorded at 17 °C for any treatment, and in the case of mytylids exposed to MPs1 at 20 °C and 26 °C, the highest mortality (67 %) occurred. Conclusions: The study demonstrates the adverse effect of the increase in temperature and MPs on the TF of S. algosus.

Metodología para evaluar el nivel de protección respiratoria de mascarillas y respiradores ante partículas similares a las que transmiten el SARS-CoV-2 / Methodology for evaluating the level of respiratory protection of masks and respirators against particles similar to those that transmit SARS-CoV-2

RESUMEN Objetivo: Desarrollar una metodología para evaluar el nivel de protección respiratoria de respiradores, mascarillas quirúrgicas y mascarillas comunitarias que usa la población peruana, usando partículas de un tamaño similar a las que contienen al virus activo del SARS-CoV-2. Materiales y métodos: Se ha determinado una relación lineal directa entre el logaritmo de la concentración de partículas suspendidas en aire y el tiempo transcurrido; por lo cual es posible comparar la cantidad de partículas internas y externas a la mascarilla o respirador en un mismo periodo y conocer el porcentaje de protección respiratoria de cada muestra evaluada. Resultados: Se ha logrado implementar una metodología para evaluar el nivel de protección respiratoria ante aerosoles menores a 5,0 µm. Asimismo, el empleo de accesorios como ligas o ajustadores detrás de cabeza y nuca, y el uso de clips nasales robustos, incrementan significativamente el nivel de protección respiratoria ante partículas con alta probabilidad de contener al SARS-CoV-2. Conclusiones: Se observa una concordancia entre los valores de protección respiratoria obtenidos y los esperados, considerando el nivel de filtración del material empleado de cada mascarilla quirúrgica o respirador, y su nivel de ajuste. Se observó un incremento significativo en los niveles de protección respiratoria.

ABSTRACT Objective: To develop a methodology for evaluating the level of respiratory protection provided by respirators, surgical masks and community face masks used by the Peruvian population; protection was evaluated against particles of a size similar to those containing active SARS-CoV-2 virus. Materials and methods: A direct linear relationship has been determined between the logarithm of the concentration of airborne particles and the elapsed time; thus, it is possible to compare the quantity of particles inside and outside of the mask or respirator in the same time period, as well as to obtain the percentage of respiratory protection for each evaluated sample. Results: A methodology was established to evaluate the level of respiratory protection against aerosols smaller than 5.0 μm. Also, the use of accessories such as rubber bands or adjusters behind the head and neck, and the use of robust nasal clips, significantly increased the level of respiratory protection against particles with a high probability of containing SARS-CoV-2. Conclusions: We found concordance between the obtained respiratory protection values and those expected, considering the filtration level of the material used for each surgical mask or respirator, as well as the tightness. A significant increase in the levels of respiratory protection was observed.

Evaluación del daño renal por cadmio en población expuesta a contaminación por éste en agricultores de Quila-Quila, Potosí / Evaluation of kidney damage by cadmium in a population exposed to its contamination in farmers from Quila-Quila, Potosí

El cadmio es un metal pesado presente en desechos mineros y otros, y tiene efectos deletéreos en la salud humana especialmente en el riñón en el que destruye células tubulares. En una investigación de la calidad del lecho de los ríos que reciben aguas residuales en el norte de Potosí, Bolivia, se reportó presencia de cadmio en papas regadas con esa agua en Quila-quila, una población rural de la zona. OBJETIVO: de este trabajo fue el de identificar posibles daños del cadmio en la salud de los pobladores de Quila-quila. MÉTODOS: para ello se realizó revisión clínica y análisis laboratorial clínico y químico de sangre y orina de los pobladores de Quila-quila, y se calculó la tasa de filtración glomerular (TFG) y se correlacionó ésta con indicadores de lesión glomerular. RESULTADOS: se encontraron niveles elevados de cadmio en sangre en algunas personas, y una correlación de la TFG con la concentración de cadmio en sangre y con indicadores de lesión de membrana glomerular. CONCLUSIONES: en conclusión, los pobladores de Quila-quila estuvieron contaminados por cadmio, el cual produjo lesión renal leve.

Cadmium is a heavy metal present in mining and other wastes, and has deleterious effects on human health especially in the kidney in which it destroys tubular cells. In an investigation of the quality of the river beds that receive wastewater in the north of Potosí, Bolivia, the presence of cadmium was reported in potatoes watered with these water in Quila-quila, a rural town in the area. OBJECTIVE: of this work was to identify possible damage from cadmium to the health of the inhabitants of Quila-quila. METHODS: for this, clinical review and clinical and chemical laboratory analysis of blood and urine from the inhabitants of Quila-quila, and the filtration rate was calculated glomerular (GFR) and this was correlated with indicators of glomerular injury. RESULTS: elevated levels of cadmium were found in the blood in some people, and a correlation of GFR with blood cadmium concentration and indicators of membrane injury glomerular. CONCLUSIONS: in conclusion, the inhabitants of Quila-quila were contaminated by cadmium, which caused mild kidney damage.

Método de filtrado de CO2 para cirugía laparoscópica en tiempos de pandemia de COVID-19 / Carbon dioxide filtering system for laparoscopic surgery in times of COVID-19 pandemic

RESUMEN Antecedentes: la pandemia de COVID-19 presentó nuevos desafíos en el manejo de la patología quirúrgica laparoscópica. Objetivos: presentar el sistema de filtrado de bajo costo utilizado para la laparoscopia durante la pandemia en nuestro Servicio de Cirugía. Material y métodos: se realizó búsqueda bibliográfica y se diseñó un protocolo y sistema de filtrado para evacuar el CO2 contenido en el neumoperitoneo para evitar el contagio por el virus SARS-CoV-2. Resultados: se pone en práctica el empleo de un sistema de filtrado del neumoperitoneo en época de pandemia, el cual es de bajo costo y armado sencillo con materiales disponibles habitualmente en las áreas quirúrgicas. Conclusiones: la cirugía laparoscópica es factible durante la pandemia de SARS-CoV-2 utilizando un método sencillo y económico de filtrado del neumoperitoneo.

ABSTRACT Background: Background: the COVID-19 pandemic gave rise to new challenges in the management of laparoscopic surgery. Objectives: the aim of this study is to present a low-cost filtering system used for laparoscopic surgery during the pandemic in our Department of Surgery. Material and methods : a bibliographic search was conducted and a protocol and filtering system were designed to evacuate the pneumoperitoneum avoiding contact with the SARS-CoV-2. Results: this low-cost filtering system to evacuate the pneumoperitoneum during the pandemic is easy to assemble using materials that are usually available at the operating room. Conclusions: laparoscopic surgery is feasible during the COVID-19 pandemic using a simple, low-cost carbon dioxide filtering system.

Correlación de cistatina "C" y creatinina sérica frente al filtrado glomerular en pacientes con nefropatía diabética / Correlation cystatin "C" and serum creatinine regarding to glomerular filtration in patients with diabetic nephropathy

INTRODUCCIÓN. La Nefropatía Diabética es una complicación vascular crónica que ori-gina una serie de alteraciones funcionales y estructurales de manera principal a nivel glomerular. La cistatina C y la creatinina sérica son marcadores de la función renal. OBJE-TIVO. Correlacionar las pruebas de la función renal cistatina C y la creatinina sérica frente al filtrado glomerular en pacientes con Nefropatía Diabética. MATERIALES Y MÉTODOS. Estudio descriptivo, transversal. De una población de 418 se seleccionó una muestra de 124 datos de Historias Clínicas. Se analizaron los datos de resultados de medición de la cistatina C y creatinina sérica frente al filtrado glomerular de pacientes con Nefropatía Diabética en el período de junio a diciembre de 2017. RESULTADOS. Frecuencia de edad de 36 a 93 años, media: 69 años, desviación estándar 10,76; un 56% (69; 124) del sexo femenino y 44% (54; 124) del sexo masculino. La cistatina C vs la creatinina sérica frente al filtrado glomerular presentaron una correlación de 92% (114; 124) y 66% (81; 124) de forma respectiva, se obtuvo una mayor correlación con la cistatina C y una estrecha sig-nificancia bilateral de 0,000. El daño renal más frecuente fue del estadío II en pacientes de 66 a 75 años. CONCLUSIÓN. La cistatina C y la creatinina sérica mostraron una alta correlación con el filtrado glomerular en pacientes con Nefropatía Diabética, la principal fue la cistatina C que detectó cambios precoces en el filtrado.

INTRODUCTION. Diabetic Nephropathy is a chronic vascular complication that causes a series of functional and structural alterations, mainly at the glomerular level. Cystatin C and serum creatinine are markers of kidney function. OBJECTIVE. To correlate the tests of renal function cystatin C and serum creatinine against glomerular filtration in patients with Diabetic Nephropathy. MATERIALS AND METHODS. Descriptive, cross-sectional study. From a population of 418, a sample of 124 data from Medical Records was selected. The data from the measurement results of cystatin C and serum creatinine were analyzed against glomerular filtration of patients with Diabetic Nephropathy in the period from june to december 2017. RESULTS. Frequency of age from 36 to 93 years, means: 69 years, standard deviation 10,76; 56% (69; 124) of the female sex and 44% (54; 124) of the male sex. Cystatin C vs serum creatinine versus glomerular filtration showed a correlation of 92% (114; 124) and 66% (81; 124), respectively, was obtained, a higher correlation was obtained with cystatin C and a close bilateral significance of 0,000. The most frequent kidney damage was stage II in patients aged 66 to 75 years. CONCLUSION. Cystatin C and serum creatinine showed a high correlation with glomerular filtration in patients with Diabetic Nephropathy, the main one being cystatin C, which detected early changes in the filtrate.

Relationship between Bacterial Filtration Efficiency and Non-oil Particle Filtration Efficiency in Surgical Masks / 中国医疗器械杂志

OBJECTIVE@#In order to find whether there is the correlation between the non-oil particle filtration efficiency(PFE) and the bacterial filtration efficiency(BFE) of medical surgical masks.@*METHODS@#Non-oil particle filtration efficiency and bacterial filtration efficiency were compared and analyzed through the test data of medical surgical masks from 2012 to 2018.@*RESULTS@#When the non-oil particle filtration efficiency of medical surgical mask is over 80%, the bacterial filtration efficiency can reach 95%.@*CONCLUSIONS@#In order to reach the requirement of 95% bacterial filtration efficiency, surgical medical mask must improve the limit of non-oil particle filtration efficiency. The results of data analysis can provide reference for emergency inspection and filter material rapid inspection, and also provide reference for the revision of YY 0469 standard.

Research of Disposable Respiratory Filter to the Measurement of Impulse Oscillometery / 中国医疗器械杂志

OBJECTIVE@#To study the influence of disposable respiratory filter on the results of impulse oscillometery.@*METHODS@#90 healthy subjects were randomly selected and impulse oscillometery results were taken repeatedly through disposable respiratory filter and control device. All results were statistically analyzed.@*RESULTS@#When using the disposable respiratory filter, respiratory impedance (Zrs) and resistance at all frequency (R5Hz-R35Hz) were significantly increased compared with the control device (P<0.01). The two measurements had a significant linear correlation (P<0.01) and a regression equation was established. The disposable respiratory filter did not exist in statistic difference to response frequency (Fres) and the elastic resistance (X5Hz-X15Hz) at all frequency(P>0.05).@*CONCLUSIONS@#The disposable respiratory filter can be used when testing pulmonary compliance, chest wall disease and obstruction outside the airway in impulse oscillometery system to avoid infection and ensure quality.

Clinical Impact of Implantable Cardioverter-Defibrillator Therapy and Mortality Prediction Model for Effective Primary Prevention in Korean Patients

BACKGROUND: Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention.METHODS: Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138).RESULTS: During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, P = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, P = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) (P < 0.001).CONCLUSION: In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention.

Métodos de desinfección y reutilización de mascarillas con filtro respirador durante la pandemia de SARS-CoV-2 / Decontamination methods and reuse of filtering facepiece respirators during SARS-CoV-2 outbreak

El SARS-CoV-2 es un tipo de coronavirus con un alto grado de contagio entre pacientes y personal de salud, por lo que ha provocado la emergencia sanitaria más grande de los últimos años. Los equipos de protección personal (EPP) tienen como indicación un único uso, sin embargo, la escasez de estos ha llevado a buscar métodos para descontaminarlos y reutilizarlos, asegurando su disponibilidad. La evidencia presenta múltiples procedimientos para descontaminar mascarillas con filtro respirador tipo N95 (MFR N95), pero el método ideal debe inactivar al patógeno, asegurar la integridad del filtro respirador, el ajuste de la mascarilla y la salud del personal que la utilizará. La descontaminación con peróxido de hidrógeno vaporizado, irradiación germicida ultravioleta e incubación con calor húmedo se presentan como los métodos más eficaces contra distintos patógenos. Ante la creciente demanda de EPP y MFR N95, se sugiere realizar más estudios clínicos, que evalúen la eficacia de los métodos de descontaminación específicamente contra SARS-CoV-2 y se generen protocolos que permitan reutilizar con total seguridad este vital elemento para el personal de salud.

SARS-CoV-2 is a type of coronavirus with a high risk of contagion among patients and health care workers (HCW), being the cause of the largest health emergency in recent years. Personal Protective Equipment (PPE) are indicated for a single use. However, shortage has led to research new methods to decontaminate and reuse them, ensuring its availability. Evidence presents multiple procedures to decontaminate Filtering Facepiece Respirators type N95 (FFR), despite this, the ideal treatment should inactivate the pathogen, to ensure filter integrity, mask adjustments and the safety of who use this elements. Decontamination methods as vaporized hydrogen peroxide, ultraviolet germicidal irradiation and moist heat are the most effective procedures against different pathogens. Facing the rising demand of PPE and FFR, it's suggested to conduct researches to evaluate decontamination methods efficacy, and specifically against SARS-CoV-2, to generate protocols in ways to let to HCW reuse FFR N95 totally safe.

Release of formaldehyde during the biofiltration of methanol vapors in a peat biofilter inoculated with Pichia pastoris GS115

Background: Methanol can be effectively removed from air by biofiltration. However, formaldehyde is one of the first metabolic intermediates in the consumption of methanol in methylotrophic microorganisms, and it can be released out of the cell constituting a secondary emission. Results: The total removal of methanol was achieved up to input loads of 263 g m−3 h−1 and the maximum elimination capacity of the system was obtained at an empty bed residence times of 90 s and reached 330 g m− 3 h−1 at an input methanol load of 414 g m−3 h−1 and 80% of removal efficiency. Formaldehyde was detected inside the biofilter when the input methanol load was above 212 g m−3 h−1 . Biomass in the filter bed was able to degrade the formaldehyde generated, but with the increase of the methanol input load, the unconsumed formaldehyde was released outside the biofilter. The maximum concentration registered at the output of the system was 3.98 g m−3 when the methanol load was 672 g m−3 h−1 in an empty bed residence times of 60 s. Conclusions: Formaldehyde is produced inside a biofilter when methanol is treated in a biofiltration system inoculated with Pichia pastoris. Biomass present in the reactor is capable of degrading the formaldehyde generated as the concentration of methanol decreases. However, high methanol loads can lead to the generation and release of formaldehyde into the environment

Efeito do processo de microfiltração na qualidade de salmoura para queijos / Effect of the microfiltration process in the quality of brine for cheeses

No processo de fabricação de queijos a salga é uma etapa de grande importância, um dos métodos mais utilizados é a imersão em salmoura. Pensando no custo benefício e qualidade do produto vem sendo utilizado o sistema de microfiltração para regeneração de salmoura permanente, que consiste na filtragem através de membranas, permitindo o uso contínuo da salmoura. Diante disso, realizou-se uma avaliação da eficiência do tratamento de salmoura, utilizada na fabricação dos queijos tipo mussarela, provolone, prato e parmesão, através do sistema de microfiltração. Foram coletadas amostras de salmoura e realizadas análises físico-químicas e microbiológicas para monitoramento diário durante o período de três meses. Os resultados obtidos foram satisfatórios podendo observar que não houve variação significativa das análises físico-químicas e que os efeitos são benéficos na estabilidade das análises microbiológicas.

The Impact of Perioperative Factors on Changes in Diastolic Function after Kidney Transplantation: A Retrospective Analysis

PURPOSE: Cardiac changes in end-stage renal disease are the most common causes of death after kidney transplantation (KT). Chronic kidney disease presents a major risk factor for the development and progression of diastolic dysfunction. The purpose of this study was to identify the association between changes in left ventricular (LV) diastolic function and perioperative clinical factors in patients with preserved ejection fraction following KT. MATERIALS AND METHODS: We reviewed 115 patients who underwent KT between January 2011 and December 2015 with both preand post-transplant echocardiograms; patients with LV systolic dysfunction were excluded. LV diastolic function was measured using the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′). RESULTS: Patients with normal pre-operative LV systolic function (n=97) showed improvement in E/e′ after KT (11.9±4.4 to 10.5±3.8, p=0.023). Additionally, post-KT estimated glomerular filtration ratio was associated with changes in E/e′ (odds ratio, −0.056; 95% confidence interval, −0.014 to −0.007; p=0.026). Among patients with preexisting diastolic dysfunction (20/97 patients), the amount of intraoperative fluid administration was related to E/e′ changes (odds ratio, 0.003; 95% confidence interval, 0.000 to 0.005; p=0.029). CONCLUSION: KT is associated with improved diastolic function. Post-KT renal function was significantly related to changes in LV diastolic function. The amount of intraoperative fluid was a risk factor for worsening diastolic function after KT in patients with preexisting diastolic dysfunction.

In-line Filtration in Parenteral Nutrition

Metabolic abnormalities and catheter-related infections are common complications of parenteral nutrition (PN). Particulate contamination is a catheter-related complication can occur when administering PN: mixing the electrolytes, trace elements, vitamins into the PN, or puncturing a rubber stopper at the PN formulation. In addition, the aggregation of the components of the PN solution by a drug incompatibility reaction could be related to particulate contamination. PN contaminated with precipitates, insoluble particles, and bacteria was reported as the cause of the death of a patient. The Food and Drug Administration recommended that the filters be used during PN administration. In-line filters can retain the bacteria and insoluble particles in PN solutions, and prevent their infusion into the patient. Therefore, in-line filters are recommended to prevent catheter-related complications that can occur during PN infusion. A 0.2µ filter for lipid-free PN and a 1.2µ filter for lipid-containing PN solutions can be used. On the other hand, when a filter is applied, the infusion rate can decrease and the economic burden will increase for patients requiring long-term PN. In addition, small particles, such as viruses, polymers, and proteins cannot be filtered out completely. In conclusion, in-line filers are recommended to prevent catheter-related complications that can occur during PN administration, but there are no international standardized guidelines. Therefore, standardized guidelines will be needed based on evidence accompanied by clinical trials. In addition, in-line filter applications should be considered in the clinical field depending on the patient's condition.

Pathogenesis of Minimal Change Nephrotic Syndrome: A Review of the Underlying Molecular Mechanisms

Nephrotic syndrome (NS) is the most common glomerular disorder in childhood, and a vast majority of cases are idiopathic. The precise cause of this common childhood disease is not fully elucidated despite significant advancements in our understanding of podocyte biology. Idiopathic NS has been considered “a disorder of T-cell function” mediated by a circulating factor that alters podocyte function resulting in massive proteinuria since the last four decades. Several circulatory factors released from T-cells are considered to be involved in pathophysiology of NS; however, a single presumptive factor has not been defined yet. Extended evidence obtained by advances in the pathobiology of podocytes has implicated podocytes as critical regulator of glomerular protein filtration and podocytopathy. The candidate molecules as pathological mediators of steroid-dependent NS are CD80 (also known as B7-1), hemopexin, and angiopoietin-like 4. The “two-hit” hypothesis proposes that the expression of CD80 on podocytes and ineffective inhibition of podocyte CD80 due to regulatory T-cell dysfunction or impaired autoregulation by podocytes results in NS. Recent studies suggest that not only T cells but also other immune cells and podocytes are involved in the pathogenesis of MCNS.

Sodium-Glucose Cotransporter 2 Inhibitors: Mechanisms of Action and Various Effects / 임상당뇨병

The basic action mechanism of sodium-glucose cotransporter 2 (SGLT2) inhibitor is to lower the glucose burden by excreting the glucose filtered by the kidney into the urine. Although SGLT2 inhibitors are primarily indicated as glucose-lowering agents, they have a broad range of effects on renal function and plasma volume homeostasis, as well as on adiposity and energy metabolism across the entire body. That might be why SGLT2 inhibition causes spill-over of sodium and glucose beyond the proximal tubule, triggering dynamic and reversible realignment of energy metabolism, renal filtration, and plasma volume. A better understanding of SGLT2 inhibition in the kidney and the entire body will lead to more benefits in people with and without diabetes.

Evaluation of the Impact of Iterative Reconstruction Algorithms on Computed Tomography Texture Features of the Liver Parenchyma Using the Filtration-Histogram Method

OBJECTIVE: To evaluate whether computed tomography (CT) reconstruction algorithms affect the CT texture features of the liver parenchyma. MATERIALS AND METHODS: This retrospective study comprised 58 patients (normal liver, n = 34; chronic liver disease [CLD], n = 24) who underwent liver CT scans using a single CT scanner. All CT images were reconstructed using filtered back projection (FBP), hybrid iterative reconstruction (IR) (iDOSE4), and model-based IR (IMR). On arterial phase (AP) and portal venous phase (PVP) CT imaging, quantitative texture analysis of the liver parenchyma using a single-slice region of interest was performed at the level of the hepatic hilum using a filtration-histogram statistic-based method with different filter values. Texture features were compared among the three reconstruction methods and between normal livers and those from CLD patients. Additionally, we evaluated the inter- and intra-observer reliability of the CT texture analysis by calculating intraclass correlation coefficients (ICCs). RESULTS: IR techniques affect various CT texture features of the liver parenchyma. In particular, model-based IR frequently showed significant differences compared to FBP or hybrid IR on both AP and PVP CT imaging. Significant variation in entropy was observed between the three reconstruction algorithms on PVP imaging (p 0.75) for CT imaging without filtration. CONCLUSION: CT texture features of the liver parenchyma evaluated using the filtration-histogram method were significantly affected by the CT reconstruction algorithm used.

Hepatocellular Carcinoma: Texture Analysis of Preoperative Computed Tomography Images Can Provide Markers of Tumor Grade and Disease-Free Survival

OBJECTIVE: To investigate the usefulness of computed tomography (CT) texture analysis (CTTA) in estimating histologic tumor grade and in predicting disease-free survival (DFS) after surgical resection in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Eighty-one patients with a single HCC who had undergone quadriphasic liver CT followed by surgical resection were enrolled. Texture analysis of tumors on preoperative CT images was performed using commercially available software. The mean, mean of positive pixels (MPP), entropy, kurtosis, skewness, and standard deviation (SD) of the pixel distribution histogram were derived with and without filtration. The texture features were then compared between groups classified according to histologic grade. Kaplan-Meier and Cox proportional hazards analyses were performed to determine the relationship between texture features and DFS. RESULTS: SD and MPP quantified from fine to coarse textures on arterial-phase CT images showed significant positive associations with the histologic grade of HCC (p < 0.05). Kaplan-Meier analysis identified most CT texture features across the different filters from fine to coarse texture scales as significant univariate markers of DFS. Cox proportional hazards analysis identified skewness on arterial-phase images (fine texture scale, spatial scaling factor [SSF] 2.0, p <001; medium texture scale, SSF 3.0, p <001), tumor size (p = 0.001), microscopic vascular invasion (p = 0.034), rim arterial enhancement (p = 0.024), and peritumoral parenchymal enhancement (p = 0.010) as independent predictors of DFS. CONCLUSION: CTTA was demonstrated to provide texture features significantly correlated with higher tumor grade as well as predictive markers of DFS after surgical resection of HCCs in addition to other valuable imaging and clinico-pathologic parameters.

Perirenal fat thickness is associated with metabolic risk factors in patients with chronic kidney disease

BACKGROUND: Adipose tissue accumulation in specific body compartments has been associated with diabetes, hypertension and dyslipidemia. Perirenal fat (PRF) may lead to have direct lipotoxic effects on renal function and intrarenal hydrostatic pressure. This study was undertaken to explore the association of PRF with cardiovascular risk factors and different stages of chronic kidney disease (CKD). METHODS: We studied 103 patients with CKD of different stages (1 to 5). PRF was measured by B-mode renal ultrasonography in the distal third between the cortex and the hepatic border and/or spleen. RESULTS: The PRF thickness was greater in CKD patients with impaired fasting glucose than in those with normal glucose levels (1.10 ± 0.40 cm vs. 0.85 ± 0.39 cm, P < 0.01). Patients in CKD stages 4 and 5 (glomerular filtration rate [GFR] < 30 mL/min/1.73 m²) had the highest PRF thickness. Serum triglyceride levels correlated positively with the PRF thickness; the PRF thickness was greater in patients with triglyceride levels ≥ 150 mg/dL (1.09 ± 0.40 cm vs. 0.86 ± 0.36 cm, P < 0.01). In patients with a GFR < 60 mL/min/1.73 m², uric acid levels correlated positively with the PRF thickness (P < 0.05). CONCLUSION: In CKD patients, the PRF thickness correlated significantly with metabolic risk factors that could affect kidney function.