Different Perspectives of Spanish Patients and Professionals on How a Dialysis Unit Should Be Designed.

Aim: The opinion of hemodialysis patients, professionals and family members is rarely considered in the design of a hemodialysis unit. Purpose: To know and compare the opinion and preferences of patients, family members and professionals regarding the design of a dialysis unit and the potential activities they believe should be carried out during the session in order to provide architects with real information for the construction of a dialysis center. Patients and Methods: Anonymous and voluntary survey in electronic format addressed to patients, relatives and professionals belonging to the 18 hemodialysis centers of the renal foundation and to ALCER and its different delegations, in relation to leisure activities to be carried out in the dialysis center and preferred design of the treatment room. The results obtained between the patient-family group and the professionals were compared. Results: We received 331 responses, of which 215 were from patients and family members (65%) and 116 (35%) from professionals. The most represented category among professionals was nursing (53%), followed by assistants (24%) and physicians (12.9%). A higher proportion of patients (66%) preferred rooms in groups of 10-12 patients as opposed to professionals who preferred open-plan rooms (p<0.001). The options that showed the most differences between patients and professionals were chatting with colleagues and intimacy (options most voted by patients/families), versus performing group activities and visibility (professionals). Conclusion: The professionals' view of patients' needs does not always coincide with the patients' perception. The inclusion of the perspective of people with kidney disease continues to be a pending issue in which we must improve both patient organizations and professionals, and the opinion of professionals and patients must be included in the design of a dialysis unit and the activities to be developed in it.

Impact of the COVID-19 Pandemic in Spain in the Successive Pandemic Waves on Hemodialysis Patients and Healthcare Personnel.

(1) Background: The impact of SARS-CoV-2 has been variable over the time course of the pandemic and in different populations. The aim was to analyze the impact of COVID-19 infection in a known population of hemodialysis (HD) patients and professionals in Spain at different times of the pandemic. (2) Methods: We conducted an observational, descriptive study with a follow-up from 3 March 2020 to 23 April 2022 (776 days), using in average of 414 professionals and 1381 patients from 18 HD units in Spain. The data from the positive PCR or the rapid antigen detection test (RADT) subject were analyzed and segmented into six periods (waves). (3) Results: Of 703 positive COVID-19 tests, 524 were HD patients (74.5%), and 179 were HD professionals (25.5%). Overall, 38% of staff and 43% of patients were affected. Differences were observed in regard to incidence (21% vs. 13%), mortality (3.5% vs. 0%), and symptomatology between the patients and professionals and throughout the pandemic. (4) Conclusions: COVID-19 severity varied during different pandemic waves, with a greater impact seen in the first wave. HD professionals and patients had similar infection rates, but patients had higher mortality rates. Community transmission was the primary route of infection.

Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres.

Background: The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods: We compared retrospectively two periods of time: the pre-COVID (1 January 2019-11 March 2020) and the COVID era (12 March 2020-30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy. Results: A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed. Conclusions: COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.

Luz, giberelinas y profundidad de siembra inciden sobre la germinación de semillas de Amaranthus hybridus L / Light, gibberellins and burial depth affect seed germination of Amaranthus hybridus L

RESUMEN Amaranthus hybridus L., conocido como bledo, es una planta maleza en una gran variedad de cultivos en el mundo, que se caracteriza por producir alto número de semillas latentes. Para generar estrategias de manejo sostenibles en esta especie es necesario comprender mejor la fisiología de sus semillas. Por tanto, el objetivo fue evaluar el efecto de la luz, de las giberelinas y la profundidad de la siembra sobre la germinación de semillas de bledo. En un primer experimento, se evaluaron cuatro tratamientos de luz (rojo, azul, sin luz y luz natural «testigo¼); en el segundo, se imbibieron semillas en diferentes concentraciones de ácido giberélico (0, 200, 400 y 800mg L-1 de GA3) y, en un último experimento, se evaluaron ocho profundidades de siembra (10, 20, 30, 40, 50, 60, 70 y 80mm), utilizando turba como sustrato. Se encontró mayor porcentaje de germinación en oscuridad, indicando que son semillas fotoblásticas negativas. Para el experimento de giberelinas, el mejor resultado se obtuvo con 400 y 800mg L-1 de ácido giberélico. En el tercer experimento, se observó alto porcentaje de emergencia de plántulas en las primeras profundidades (10mm a 30mm); a mayor profundidad hubo menor emergencia. La respuesta diferencial a la luz, a la aplicación de las giberelinas y el alto porcentaje de semillas viables que no germinaron permite concluir que semillas de bledo poseen latencia fisiológica.

ABSTRACT Amaranthus hybridus L., known as bledo, is a weed in a wide variety of crops worldwide, characterized by producing high number of seeds with dormancy. To generate sustainable management strategies of this species, it is necessary to better understand the physiology of its seeds. Therefore, the objective was to evaluate the effect of light, gibberellins, and seed burying depth on seed germination of bledo. In the first experiment, four light conditions were evaluated (red, blue, without light and natural light (control)), in the second experiment the seeds were imbibed in different concentrations of gibberellic acid (0, 200, 400 and 800mg L-1 of GA3), and in the last experiment, 8 planting depths were evaluated (10, 20, 30, 40, 50, 60, 70 or 80mm) using peat as a substrate. A higher percentage of seed germination in darkness was found, indicating that this species had negative photoblastic seeds. For the gibberellin experiment, the best result was obtained with treatment with 400 and 800mg L-1 of gibberellic acid. In the third experiment, a high percentage of seedling emergence was observed from the first depths (10mm to 30mm); the greater was the depth, the less emergence was found. The differential responses to light, the application of gibberellins, and the high percentage of non-germinated viable seeds allowed to conclude that bledo seeds possess physiological dormancy.

CardioResyncApp: Un aplicativo móvil para recolectar datos de investigación en Cardiología / CardioResyncApp: A mobile phone application for recording research data in Cardiology

Resumen Objetivo: diseñar y desarrollar un aplicativo móvil, innovador y útil que facilite el registro, la extracción y el análisis de datos en cardiología, y que permita la realización de investigaciones de alta calidad en pacientes con insuficiencia cardiaca llevados a terapia de resincronización. Metodología: se utilizó el marco de trabajo Scrum, ya que ofrece características de agilidad necesarias para la definición de requerimientos en un entorno colaborativo y en equipo; se realizaron entregas parciales de un producto final, lo cual facilitó la rapidez en el desarrollo de la aplicación. CardioResyncApp es una aplicación móvil que estará disponible en las dos plataformas móviles más importantes: App Store y Google Play. Resultado: se diseñó y desarrolló un aplicativo móvil, innovador, especializado en la recolección de datos para estudios de investigación en cardiología referentes a insuficiencia cardiaca y terapia de resincronización. Conclusiones: CardioResyncApp es un aplicativo móvil, ágil, fácil de usar, que revolucionará la recolección de datos en Colombia, para investigación en cardiología. No tendrá limitaciones geográficas para la recolección de datos ya que se encuentra disponible en las plataformas móviles más populares, como IOS y Android, lo cual facilitará la realización de estudios multicéntricos en Colombia, aproximándonos a la realidad de la enfermedad en las diversas poblaciones a pesar de las variaciones sociodemográficas.

Abstract Objective: The aim of this study is to design and develop a new and useful mobile application that facilitates the recording, extraction and analysis of data in cardiology, and can help in the carrying out of high quality research on patients with heart failure receiving resynchronisation therapy. Methodology: Scrum development technology was used, since it offers the dynamic features necessary to define the requirements in collaborative and team environment. Partial deliveries will be made of a final product, which will help to speed up the development of the application. CardioResyncApp is a mobile phone application that will be available on the two most important mobile platforms: App Store and Google Play. Results: A novel mobile application was designed and developed to collect data for research studies in cardiology as regards heart failure and resynchronisation therapy. Conclusions: CardioResyncApp is a dynamic, easy to use, mobile application what will revolutionise data collection in Colombia for cardiology research. It will have no geographic limitations for the collection of data, since it is available on the most popular mobile platforms such as IOS and Android, which will help in the conducting of multicentre studies in Colombia, and approaching the reality of the disease in the various populations despite the sociodemographic variations.

Dialysis arteriovenous access monitoring and surveillance according to the 2017 Spanish Guidelines.

The Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology (S.E.N.), vascular surgery (SEACV), interventional radiology (SERAM-SERVEI), infectious diseases (SEIMC), and nephrology nursing (SEDEN)), along with the methodological support of the Iberoamerican Cochrane Centre, has developed the Spanish Clinical Guidelines on Vascular Access for Hemodialysis. This article summarizes the main issues from the guideline's chapter entitled "Monitoring and surveillance of arteriovenous access." We will analyze the current evidence on conflicting topics such as the value of the flow-based screening methods for the arteriovenous access surveillance or the role of Doppler ultrasound as the imaging exploration to confirm suspected stenosis. In addition, the concept of significant stenosis and the criteria to perform the elective intervention for stenosis were reviewed. The adoption of these guidelines will hopefully translate into a reduced risk of thrombosis and increased patency rates for both arteriovenous fistulas and grafts.

Spanish Clinical Guidelines on Vascular Access for Haemodialysis. / Guía Clínica Española del Acceso Vascular para Hemodiálisis.

Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.

Presentación de tres casos y revisión en la literatura: Síndrome de Cushing / Presentation of three cases and review in the literature: Cushing's syndrome

El hipercortisolismo es una enfermedad rara, con afección de múltiples sistemas, asociada a elevada morbilidad y mortalidad sino es tratada a tiempo. El sistema cardiovascular es uno de los que más se afecta en esta enfermedad. El pronóstico de la enfermedad se ve afectado principalmente por las dificultades en el diagnóstico y el tratamiento, los cuales siguen siendo un desafío actualmente. El síndrome de Cushing se clasifica como dependiente o independiente de hormona adrenocorticotrópica (ACTH). Los ACTH dependientes son los más comunes. Los ACTH independientes corresponden a menos de 15% de los casos y son causados por enfermedades suprarrenales.A continuación, describimos los casos de los tres pacientes, a quienes se les estableció el diagnóstico de síndrome de Cushing de origen adrenal y se realiza una revisión acerca de los tópicos principales en este tema..(AU)

Hypercortisolims is an infrequent disease with multi-systemic compromise and increases morbility and mortality. Cardiovascular disease is one of the most common complica-tions associaded with Cushing syndrome. The prognosis of this disease is affected by the difficulties associated with its diagnosis and treatment. Clearly, Cushing syndrome is still a clinical challenge. Cushing syndrome can be classified in ACTH dependent or ACTH independent. ACTH-dependent causes are more frequent, however, CTHindependent causes are responsible of less than 15% of Cushing`s syndrome and are secondary to adrenal tumors. Three cases of adrenal Cushing are reported with a review of the main clinical points of Cushing syndrome..(AU)

Guía Clínica Española del Acceso Vascular para Hemodiálisis / Spanish Clinical Guidelines on Vascular Access for Haemodialysis

El acceso vascular para hemodiálisis es esencial para el enfermo renal tanto por su morbimortalidad asociada como por su repercusión en la calidad de vida. El proceso que va desde la creación y mantenimiento del acceso vascular hasta el tratamiento de sus complicaciones constituye un reto para la toma de decisiones debido a la complejidad de la patología existente y a la diversidad de especialidades involucradas. Con el fin de conseguir un abordaje consensuado, el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV), que incluye expertos de las cinco sociedades científicas implicadas (nefrología [S.E.N.], cirugía vascular [SEACV], radiología vascular e intervencionista [SERAM-SERVEI], enfermedades infecciosas [SEIMC] y enfermería nefrológica [SEDEN]), con el soporte metodológico del Centro Cochrane Iberoamericano, ha realizado una actualización de la Guía del Acceso Vascular para Hemodiálisis publicada en 2005. Esta guía mantiene una estructura similar, revisando la evidencia sin renunciar a la vertiente docente, pero se aportan como novedades, por un lado, la metodología en su elaboración, siguiendo las directrices del sistema GRADE con el objetivo de traducir esta revisión sistemática de la evidencia en recomendaciones que faciliten la toma de decisiones en la práctica clínica habitual y, por otro, el establecimiento de indicadores de calidad que permitan monitorizar la calidad asistencial (AU)

Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare (AU)

Seguimiento del cumplimiento del tratamiento en casa del paciente que egresa con diagnóstico de falla cardíaca / Follow-up of compliance with home treatment of the patient who leaves hospital with a diagnosis of heart failure

Resumen Introducción: según la Organización Mundial de la Salud, las enfermedades cardiovasculares constituyen una de las principales causas de mortalidad. Latinoamérica es una de las regiones que tiene una de las cargas más altas de factores de riesgo cardiovascular y una de las principales causas documentadas del fracaso en el control de estas enfermedades es el incumplimiento del tratamiento farmacológico y no farmacológico. Objetivo: evaluar el cumplimiento al tratamiento con el test de Morisky Green, así como la funcionalidad familiar y las redes de apoyo con instrumentos como el Apgar familiar y el ECO-MAPA a los 30 días del alta hospitalaria, y de las recomendaciones no farmacológicas a los 90 días. Métodos: se hizo seguimiento prospectivo a una cohorte. Treinta días después del egreso hospitalario, se hizo una visita domiciliaria, para evaluar el cumplimiento del tratamiento utilizando el test de Morisky Green y se reforzaron medidas para el tratamiento no farmacológico. A los 90 días del egreso, se llamó para evaluar el cumplimiento a las recomendaciones que se impartieron en la visita domiciliaria. Resultados: se analizaron 54 pacientes. La adherencia por el test de Morisky Green evaluada a los 30 días fue de 72% (n=39), a los 30 días en la visita domiciliaria se observó que la funcionalidad familiar fue buena en 60% (n=33), y buena red de apoyo el 63% (n=34) de los pacientes. A los 90 días el cumplimiento de las recomendaciones no farmacológicas fue de 96% (n=51) para la actividad física y la restricción hídrica, no así para la ingesta de sodio 78% (n=42). Conclusión: a los 30 días del alta hospitalaria un alto porcentaje de los pacientes no cumplen con el tratamiento. La funcionalidad familiar y las redes de apoyo no son adecuadas en el 40% de los pacientes. Indagar estas razones y hacer seguimiento al cumplimiento podrían mejorar los resultados en esta población de pacientes. Los programas de acompañamiento y la visita domiciliaria ayudan a reforzar el cumplimiento del autocuidado y deberían ser implementados para brindar a los pacientes herramientas con las cuales afrontar con una visión más amplia sus enfermedades crónicas. (Acta Med Colomb 2016; 40: 243-247).

Abstract Introduction: According to the World Health Organization, cardiovascular diseases are one of the main causes of mortality. Latin America is one of the regions that has one of the highest burdens of cardiovascular risk factors, and one of the main documented causes of failure in the control of these diseases is non-compliance with pharmacological and non-pharmacological treatment. Objective: to evaluate treatment compliance with the Morisky Green test, as well as family functionality, and support networks with instruments such as the family Apgar and ECOMAPA at 30 days after discharge, and the non-pharmacological recommendations at 90 days. Methods: Prospective cohort follow-up. Thirty days after hospital discharge, a home visit was conducted to evaluate treatment compliance with the Morisky Green test and measures for non-pharmacological treatment were reinforced. At 90 days after the discharge, a phone call was made to evaluate the compliance with the recommendations given in the home visit. Results: 54 patients were analyzed. Adherence by the Morisky Green test evaluated at 30 days was 72% (n = 39), at 30 days in the home visit it was observed that the family functionality was good in 60% (n = 33), and good support network in 63% (n = 34) of patients. At 90 days, compliance with non-pharmacological recommendations was 96% (n = 51) for physical activity and water restriction, and not for sodium intake in 78% (n = 42). Conclusion: At 30 days after hospital discharge, a high percentage of patients do not comply with the treatment. Family functionality and support networks are not adequate in 40% of patients. Investigating these reasons and following up compliance could improve outcomes in this patient population. Accompanying programs and home visits help reinforce self-care compliance and should be implemented to provide patients with tools to cope with a wider vision their chronic diseases. (Acta Med Colomb 2016; 40: 243-247).

Takotsubo syndrome: Advances in the understanding and management of an enigmatic stress cardiomyopathy.

Takotsubo cardiomyopathy is a syndrome mimicking an acute myocardial infarction in absence of obstructive epicardial coronary artery disease to explain the degree of the wall motion abnormalities. Typically more common in the elderly women, this condition is usually triggered by unexpected emotional or physical stress situations, and is associated with electrocardiogram abnormalities and slight elevation of cardiac biomarkers. The pathophysiological mechanism is not clear yet, but it is believed that a high circulating concentration of catecholamines causes an acute dysfunction of the coronary microcirculation and metabolism of cardiomyocytes, leading to a transient myocardial stunning. Typically, it presents with acute left ventricular systolic dysfunction that in most cases is completely resolved at short term. Recurrences are rare and it is thought that the long-term prognosis is good. We present here a review of the clinical features, pathophysiology and management of this enigmatic condition.

Cambios fisiológicos de la función tiroidea en el embarazo: bases para la interpretación de las pruebas tiroideas / Physiological changes in thyroid function during pregnancy: an approach to the interpretation of thyroid tests

Entender la fisiología tiroidea y sus cambios a lo largo de la gestación es fundamental para sospechar las enfermedades que afectan el funcionamiento del eje hipotálamo-hipófisistiroides y para interpretar adecuadamente las pruebas que lo evalúan. Son comunes las alteraciones en dichas pruebas durante el embarazo y puede ser difícil distinguirlas de las que denotan enfermedad. En las mujeres embarazadas son raros el hipotiroidismo y el hipertiroidismo clínicos (0,2% a 0,36%) y más frecuentes las formas subclínicas (alrededor del 2%). Para diagnosticar estas últimas se precisa un alto índice de sospecha. Los requerimientos de yodo, sustrato esencial para la síntesis de las hormonas tiroideas, varían según la población y el momento del embarazo. Las alteraciones tiroideas son cinco a diez veces más frecuentes en las parejas con infertilidad, por lo cual se las debe estudiar desde este punto de vista con miras a dilucidar las causas de la misma. La autoinmunidad se ha relacionado con complicaciones materno-perinatales como aborto, parto prematuro y tiroiditis posparto; los estudios han mostrado que la levotiroxina disminuye su incidencia. En esta revisión se incluyen los siguientes aspectos: fisiología tiroidea durante el embarazo, función tiroidea y fertilidad, yodo y embarazo, anticuerpos antitiroideos y embarazo, pruebas de función tiroidea durante el embarazo y tamización para trastornos tiroideos en las mujeres gestantes.

A proper understanding of thyroid physiology and its changes through pregnancy is critical to suspect diseases affecting the functioning of the hypothalamic-pituitary-thyroid axis, and to make a proper interpretation of the tests that measure its function. Alterations in thyroid function tests are common during pregnancy, and it may be difficult to distinguish them from those due to disease. Clinical hypothyroidism and hyperthyroidism are rare during pregnancy (0.2% to 0.36%), but subclinical forms are more frequent (around 2%). Iodine is essential as substrate for thyroid hormone synthesis, and the requirements vary according to the population and the moment of pregnancy. Infertile couples have five to ten times more thyroid disorders; for that reason they should be studied as to thyroid function when searching for the cause of the infertility. Autoimmunity has been associated with maternal and perinatal complications such as abortion, preterm delivery and postpartum thyroiditis; some studies have shown that their incidence decreases with levothyroxine. This review includes the following aspects: thyroid physiology during pregnancy, thyroid function and fertility, iodine and pregnancy, anti-thyroid antibodies and pregnancy, thyroid function tests during pregnancy, and screening for thyroid disorders in pregnant women.

Diagnóstico y tratamiento de los trastornos tiroideos durante el embarazo: un enfoque para el cuidado integral del binomio madre-hijo / Diagnosis and management of thyroid disorders during pregnancy: an approach to comprehensive care of mother and child

Los trastornos tiroideos son frecuentes en mujeres en edad reproductiva. Sin embargo, a menudo no se diagnostican porque su sintomatología se confunde con el estado hipermetabólico característico del embarazo. A los cambios fisiológicos en el embarazo de índole cardiovascular, pulmonar, hematológica, inmunológica, etc., se añaden las modificaciones en el eje tiroideo que a lo largo de la gestación presenta diferentes estados, lo que hace aún más difícil el diagnóstico y tratamiento correctos en los casos patológicos. Los trastornos del eje tiroideo tienen repercusiones negativas sobre la madre y el feto, entre otras: preeclampsia, aborto, parto prematuro y trastornos del sistema nervioso central del feto. El tratamiento se debe dirigir a contrarrestar los efectos del aumento o la disminución del funcionamiento de la glándula teniendo en cuenta las diferencias en cuanto a requerimientos y seguridad de los fármacos en el feto. Actualmente es motivo de controversia la tamización de rutina en gestantes para trastornos tiroideos, pues hasta el momento se destinan las pruebas a mujeres embarazadas de alto riesgo.

Thyroid disorders are frequent in women of reproductive age. However, they are often overlooked because their manifestations may be confused with those of the hypermetabolic state that is characteristic of pregnancy. To the physiological changes that occur during pregnancy –cardiovascular, pulmonary, hematological, immunological, etc., it is necessary to add modifications in the thyroid axis that presents different situations during pregnancy; those variations make it difficult to correctly diagnose and treat pathological situations. Disorders of thyroid axis have negative consequences on both mother and fetus, among them: preeclampsia, abortion, premature delivery and disorders of the fetal central nervous system. Treatment must be oriented to counteract the effects of either increased or diminished thyroid function; for that purpose, differences concerning requirements and safety of medicines must be taken into account. Presently there is controversy concerning routine screening of pregnant women for thyroid disorders; so far, the available tests are usually performed only in high-risk women.

Osteoporosis en pacientes con hepatopatías crónicas: una complicación tardía poco conocida / Osteoporosis in patients with chronic liver disease: An unfamiliar late complication

La osteodistrofia hepática es una complicación tardía frecuente en las enfermedades hepáticas crónicas; los pacientes comúnmente presentan disminución de la densidad mineral ósea, osteopenia, osteoporosis y fracturas. En la práctica clínica aún no se han implementado estrategias para disminuir su incidencia y evitar comorbilidades y mejorar la calidad de vida. La fisiopatología es pobremente entendida. Existe controversia acerca del uso de pruebas de tamización en esta población, con énfasis a quiénes se deben realizar, en qué momento de su enfermedad y cada cuánto tiempo. Se han encontrado factores de riesgo que son dependientes y no de las hepatopatías, los cuales influyen en la historia natural de la osteodistrofia hepática y deben ser tenidos en cuenta para la tamización, seguimiento y tratamiento. Las recomendaciones para el tratamiento son ampliamente discutidas, pero se centran principalmente en disminución de factores de riesgo, fármacos antirresortivos y suplementos de calcio y vitamina D.

Hepatic osteodystrophy is a frequent late complication in chronic liver diseases in which patients usually present bone mineral density reduction, osteopenia, osteoporosis and fractures. Strategies to decrease incidence, avoid comorbidity and improve patient quality of life have yet to be implemented in clinical practice. Hepatic osteodystrophy’s pathophysiology is poorly understood. There is controversy about the use of screening tests especially regarding which patients are eligible, at what moment of the disease and with what frequency. Risk factors which are dependent on liver disease and other risk factors which are not liver disease dependent have been identified, all of which affect the natural history of hepatic osteodystrophy and all of which must be taken into account for screening, checkups and treatment. Recommendations for treatment are widely discussed but focus mainly on reduction of risk factors, antiresorptive drugs, calcium supplements and vitamin D.

Cuantificación de ADN libre en plasma sanguíneo de voluntarios sanos en una población bogotana / Quantification of free DNA in blood plasma of healthy volunteers in Bogotá population

El ADN libre en sangre incrementa con algunas condiciones patológicas y ciertos estados fisiológicos. Varios reportes en la literatura han resaltado que el ADN libre en plasma o suero tiene potencial clínico como una posible herramienta para el pronóstico de cáncer en humanos. Sin embargo, hasta el momento no se tienen valores de referencia de individuos sanos con un tamaño de muestra representativo y tampoco se han descrito valores para poblaciones específicas como la bogotana. Es por ello que en el presente estudio se cuantificó la concentración de ADN libre en personas sanas de la población bogotana y así se estableció un rango normal o valor de referencia, adicionalmente se analizó la relación entre los niveles de ADN libre y las características como edad y género. La concentración de ADN libre en la población bogotana fue de 0,72 ng/μL y no se encontraron diferencias significativas entre las edades y los géneros.