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.

Inclusión Educativa de los estudiantes con discapacidad en la Universidad Central del Ecuador / Educational inclusion of students with disabilities at theCentral University of Ecuador

Introducción: La inclusión educativa en la educación superior pública y privada, es un problema que ha sido abordado de diversas maneras por las diferentes instituciones de educación superior ecuatorianas. La Universidad Central del Ecuador, es una institución pública en la que estudian 40.000 estudiantes aproximadamente y esto la obliga a imple-mentar culturas, políticas y prácticas inclusivas, que analicen las barreras y las oportunida-des para el acceso a una educación de calidad y en igualdad de condiciones.Objetivo: Identificar las características personales de los estudiantes con discapacidad, los factores contextuales de la Universidad Central del Ecuador y su relación con el nivel de inclusión educativa. Materiales y métodos: Estudio descriptivo, correlacional de tipo observacional, que inclu-yó a 108 estudiantes de la Universidad Central del Ecuador que presentan al menos una discapacidad, y que respondieron vía on line la encuesta de inclusión educativa. Análisis estadístico. Se usó el SPSS 22.0, para el análisis univarial se aplicó la estadística descrip-tiva apoyados en medidas de proporción, mientras que las pruebas x2 cuadrada y Spear-man fueron usadas para el análisis bivarial. Resultados: El 54% de los investigados registra un bajo nivel de inclusión educativa, 22,52% presenta limitaciones para movilizarse, 17,59% para aprender/estudiar y el 14,81% para las interacciones personales. El 35% requieren ayuda de compañeros y familiares, de servicios universitarios y ayudas técnicas para realizar varias de sus actividades académi-cas y acceder al medio físico universitario. Aquellos con limitaciones graves y moderadas para realizar sus actividades tienen 1,4 a 1,8 veces más probabilidad de tener un bajo nivel de inclusión que aquellos con limitaciones leves; este patrón se repite con otras variables personales y contextuales, y refleja la asociación entre los factores personales-contextua-les y la inclusión educativa.Conclusiones:La inclusión es un proceso sistémico en el cual intervienen e interactúan de manera concurrente variables bio-psico-sociales. Las condiciones para crear la inclusión educativa de los estudiantes con discapacidad en la UCE deben estar sustentadas en un cambio de paradigma, y orientadas a la implementación de políticas y procesos de inclusión educativa, que incorporen las necesidades expresadas por los investigados en este estudio.

Introduction: Educational inclusion in public and private higher education is a problem that has been addressed in various ways by different Ecuadorian higher education institutions. The Central University of Ecuador is a public institution where approximately 40,000 stu-dents study, is committed to implementing inclusive cultures, policies and practices, which analyzes the barriers and opportunities for access to quality education and on equal terms.Aim. Identify the personal characteristics of students with disabilities, the contextual factors of the Central University of Ecuador and their relationship with the level of inclusion.Material and methods. Descriptive, correlational, observational study, which investigated 108 students from the Central University of Ecuador who present at least one disability, and who answered the inclusion survey online. Statistic analysis. SPSS 22.0 was used, for the univariate analysis applied descriptive statistics supported by measures of proportion while x2 squared and Spearman tests were used for the bivariate analysis.Results. 54% of those investigated register a low level of educational inclusion, 22.52% pre-sent limitations to move around, 17.59% to learn/study and 14.81% for personal interactions. 35% require help from classmates and family, university services and technical aids to carry out several of their academic activities and access the university physical environment with severe and moderate limitations to carry out their activities are 1.4 to 1.8 times more likely to have a low level of inclusion than those with mild limitations. This pattern is repeated with other personal and contextual variables and reflects the association between personal-con-textual factors and educational inclusion.Conclusions. Inclusion is a systemic process in which bio-psycho-social variables intervene and interact concurrently. The conditions to create the educational inclusion of students with disabilities in the Central University of Ecuador must be supported by a paradigm shift, and oriented towards the implementation of educational inclusion policies and processes, which incorporate the needs expressed by those investigated in this study.

Kidney injury after sodium phosphate solution beyond the acute renal failure / Daño renal después de preparación colónica con soluciones de fosfato. Más allá del fracaso renal agudo

Antecedentes y objetivos: La colonoscopia con polipectomía con fines de cribado reduce la incidencia del cáncer colorrectal y la mortalidad por esta enfermedad. Una preparación colónica aceptable es una de las claves para conseguir mejores resultados con esta técnica. Las soluciones de fosfato de sodio oral (OSP) fueron muy utilizadas en la década de los noventa del siglo pasado. Su eficacia era similar a la de las soluciones de polietilenglicol (PEG), pero más baratas y con una administración sencilla. Se han descrito series de casos de pacientes con insuficiencia renal aguda provocada por OSP. Sin embargo, en cohortes amplias de pacientes no se observó ninguna diferencia en la incidencia de daño renal entre estas dos soluciones. Métodos: Entre 2006 y 2009 identificamos 12 casos de nefropatía por fosfato tras preparación con OSP para colonoscopia. Se realizó el seguimiento de todos los pacientes durante 6 meses. Todos los pacientes habían recibido una única dosis. Resultados: Analizamos 12 casos de nefropatía por fosfato; 3 se manifestaron con IRA y 9 presentaron daño renal crónico. Cuatro de los casos se confirmaron mediante biopsia renal. Un paciente con IRA precisó hemodiálisis en el momento del diagnóstico, sin que experimentara recuperación posterior. Dos pacientes (ambos con daño crónico) recuperaron totalmente su función renal anterior. Los demás pacientes (9) presentaron una pérdida media en la filtración glomerular estimada de 24ml/min/1,73m2. Conclusiones: El uso de OSP puede ocasionar daño renal tanto agudo como crónico. Sin embargo, el daño crónico fue el más frecuente. Ambas formas de presentación suponen una pérdida considerable e irreversible de función renal. Nuevos estudios que analicen el daño renal secundario a preparación colónica deben considerar estos dos patrones distintos de daño (AU)

Background and objectives: Screening colonoscopy with polipectomy reduces colonorectal cancer incidence and mortality. An adequate bowel cleansing is one of the keys to achieving best results with this technique. Oral sodium phosphate solution (OSP) had a widespread use in the 90s decade. Its efficacy was similar to polyethylene glycol (PEG) solution, but with less cost and convenient administration. Series of patients with acute renal failure due to OSP use have been reported. However, large cohorts of patients found no difference in the incidence of renal damage between these two solutions. Methods: From 2006 to 2009 we identified twelve cases of phosphate nephropathy after colonoscopy prepared with OSP. All patients were followed up to six months. All patients had received just a single dose. Results: We analyzed 12 cases with phosphate nephropathy; three patients debuted with AKI and nine patients had chronic renal injury. Four cases were confirmed with renal biopsy. One patient with AKI needed hemodialysis at diagnosis without subsequent recovery. Two patients (both with chronic damage) fully recovered their previous renal function. The remaining patients (nine) had an average loss of estimated glomerular filtration rate of 24ml/min/1.73m2. Conclusions: The use of OSP can lead to both acute and chronic renal damage. However, chronic injury was the most common pattern. Both forms of presentation imply a significant and irreversible loss of renal function. Further studies analyzing renal damage secondary to bowel cleaning should consider these two different patterns of injury (AU)

Kidney injury after sodium phosphate solution beyond the acute renal failure.

BACKGROUND AND OBJECTIVES: Screening colonoscopy with polipectomy reduces colonorectal cancer incidence and mortality. An adequate bowel cleansing is one of the keys to achieving best results with this technique. Oral sodium phosphate solution (OSP) had a widespread use in the 90s decade. Its efficacy was similar to polyethylene glycol (PEG) solution, but with less cost and convenient administration. Series of patients with acute renal failure due to OSP use have been reported. However, large cohorts of patients found no difference in the incidence of renal damage between these two solutions. METHODS: From 2006 to 2009 we identified twelve cases of phosphate nephropathy after colonoscopy prepared with OSP. All patients were followed up to six months. All patients had received just a single dose. RESULTS: We analyzed 12 cases with phosphate nephropathy; three patients debuted with AKI and nine patients had chronic renal injury. Four cases were confirmed with renal biopsy. One patient with AKI needed hemodialysis at diagnosis without subsequent recovery. Two patients (both with chronic damage) fully recovered their previous renal function. The remaining patients (nine) had an average loss of estimated glomerular filtration rate of 24ml/min/1.73m(2). CONCLUSIONS: The use of OSP can lead to both acute and chronic renal damage. However, chronic injury was the most common pattern. Both forms of presentation imply a significant and irreversible loss of renal function. Further studies analyzing renal damage secondary to bowel cleaning should consider these two different patterns of injury.