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

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Abstract Introduction: Acute kidney injury is a frequent complication in patients with COVID-19 and its occurrence is a potential indicator of multi-organ dysfunction and disease severity. Objective: Develop, through an expert consensus, evidence-based recommendations for the prevention, diagnosis, and management of acute kidney injury in patients with SARS CoV2 / COVID-19 infection. Materials and methods: Based on a rapid systematic review in Embase and Pubmed databases and documents from scientific societies, we made preliminary recommendations and consulted with an expert group through an online tool. Then we defined agreement after at least 70 % consensus approval. Quality evidence was evaluated according to the type of document included. The strength of the recommendations was graded as strong or weak. Results: Fifty clinical experts declared their conflict of interest; the consultation took place between May 2 and 29, 2020. The range of agreement ranged from 75.5 % to 100 %. Recommendations for prevention, diagnosis and management of acute kidney injury in patients with SARS CoV2 infection are presented. Conclusions: Although the good quality information available regarding acute kidney injury in patients with COVID-19 is scarce, the recommendations of clinical experts will guide clinical decision-making and strategies around patients with this complication, guaranteeing care focused on the people, with high quality standards, and the generation of safety, health and wellness policies for multidisciplinary care teams.

Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, el diagnóstico y el manejo de la infección por SARS-CoV-2/COVID-19 en pacientes con Enfermedad Renal Crónica en diálisis / Colombian Expert Consensus on Evidence-Informed Recommendations for the Prevention, Diagnosis, and Management of SARS-CoV-2 / COVID-19 Infection in Patients with Chronic Kidney Disease on Dialysis

Resumen Introducción: Las personas con diálisis de mantenimiento se consideran una población en alto riesgo de infección por SARS-CoV-2, complicaciones y muerte. La periodicidad de la diálisis, la organización y la demanda en las unidades de diálisis y las limitaciones de alfabetización en salud poblacional limitan el cumplimiento del aislamiento y el distanciamiento social. Objetivo: Desarrollar, mediante un consenso de expertos, recomendaciones informadas en evidencia para la prevención, el diagnóstico y el manejo de la infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Materiales y métodos: Se realizó una revisión rápida de literatura en Pubmed, Embase y sociedades científicas. La calidad de evidencia fue evaluada según el tipo de estudio incluido. El acuerdo se definió para cada recomendación con umbral de al menos 70% de aprobación. La fuerza de las recomendaciones fue graduada como fuerte o débil. Resultados: El colectivo fue consultado entre el 17 y 19 de mayo de 2020. Se obtuvo respuesta de 44 expertos clínicos que declararon conflicto de interés previo a la consulta. El acuerdo de las recomendaciones estuvo entre 70,5 y 100%. Se presentan las recomendaciones de un colectivo experto para la prevención, el diagnóstico y el manejo de infección por SARS-CoV-2/COVID-19 en pacientes con enfermedad renal crónica. Conclusión: Debido a la reciente aparición de la infección por SARS-CoV-2 y las incertidumbres respecto a la prevención, el diagnóstico y el manejo, las recomendaciones presentadas se conciben como un estándar colombiano que permita garantizar un cuidado centrado en las personas con enfermedad renal crónica y la protección de los profesionales de la salud.

Abstract Introduction: People with chronic dialysis are considered a population at high risk of SARS CoV2 infection and its derived complications and death. The need to go to strict dialysis schedules, the high demand in the kidney facilities and the difficulties derived from the time and space organization in the rooms in the face to the pandemic added to the difficult learning, teaching and adapting new protocols manifest the needed of standard recommendation according to this problem in people who couldn't have an ideal isolation. Objective: Develop through an expert consensus, evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2/COVID-19 infection in patients with chronic kidney disease on Dialysis. Materials and methods: We carried out a quick literature review, PubMed, Embase and scientific societies were consulted. The quality of the evidence was considered according to the type of study included. The agreement threshold defined for each recommendation was > 70% approval among experts. The strength of the recommendations was rated as strong or weak. Results: Between May 17 and 19, 2020, was conformed a team of 44 clinical experts who declared their interest conflict prior to the consultation. The agreement of the recommendations was between 70.5% and 100%. The recommendations were separated in prevention, early identification, and diagnostic, isolation in hemodialysis facilities and peritoneal dialysis, and team protection. Ethical considerations also were included. Conclusion: Due to the recent appearance of SARS-CoV-2 infection and the uncertainties regarding prevention, diagnosis and management, the recommendations presented are conceived as a Colombian standard that allows guaranteeing focused care for people with chronic kidney disease and the protection of health team.

Ontogenia de los esporangios y esporogénesis del helecho Phymatosorus scolopendria (Polypodiaceae)

Introducción: Las investigaciones sobre ontogenia de los soros, esporangios, paráfisis receptaculares y esporogénesis de los helechos leptosporangiados son escasas en la literatura científica. Objectivos: Describiry analizar la ontogenia de los soros, esporangios, paráfisis receptaculares y esporogénesis de Phymatosorus scolopendria. Métodos: Entre marzo y mayo 2017 (época lluviosa del año) se recolectaron frondas fértiles de P. scolopendria en el campus de la Universidad de Antioquia, Medellín-Colombia.Las frondas fértiles, en diferentes etapas del desarrollo se fijaron y procesaron de acuerdo a protocolos estándar para la inclusión y corte en parafina y resina. Las secciones de 0.5 µm obtenidas en resina se tiñeron con azul de Toluidina que tiñe diferencialmente paredes primarias y secundarias, resalta núcleos celulares, y esporopolenina y de manera secundaria tiñe polifenoles. Para descripciones detalladas, otros cortes se tiñeron con Safranina-azul de alciano que discrimina entre componentes de pared primaria, secundaria, núcleos, cutícula y polifenoles; Hematoxilina-azul de alciano para resaltar núcleos y paredes primarias y Fluoroglucinol ácido para detectar lignina. Las observaciones y registro fotográfico se efectuaron con microscopio fotónico. Para la observación y descripción con microscopía electrónica de barrido (MEB), los soros se deshidrataron con 2,2 dimetoxipropano, se desecaron a punto crítico y se metalizaron con oro. Resultados: Los soros son exindusiados, superficiales, vascularizados y de desarrollo mixto, se encuentran asociados a paráfisis receptaculares multicelulares uniseriadas. Durante el desarrollo del soro primero se diferencian las células epidérmicas receptaculares que darán origen a los esporangios y posteriormente las células que originarán a las paráfisis receptaculares. El esporangio es de tipo leptosporangio de pedicelos largos de una o dos filas de células. Los anillos de los esporangios muestran paredes secundarias con engrosamientos en forma de "U" ricos en lignina. La meiosis es simultánea y las tétradas de esporas se disponen de forma decusada o tetragonal. El tapete celular es inicialmente uniestratificado pero por una división mitótica de tipo periclinal, se torna biestratificado. Las células del estrato interno del tapete pierden la integridad estructural dando origen a un tapete plasmodial que invade los esporocitos en meiosis, el estrato externo persiste hasta la etapa de esporas maduras. En las diferentes etapas de desarrollo del esporodermo, primero se forma el exosporio, compuesto por esporopolenina, seguida del endosporio, conformado por celulosa, pectina y polisacáridos carboxilados y finalmente el perisporio. Los polifenoles fueron detectados, principalmente, en las vacuolas de las células de los esporangios, paráfisis y células receptaculares. Para el momento de la liberación de las esporas, tanto la capa externa del tapete celular como el plasmodial han degenerado por completo. En la cavidad esporangial se aprecian orbículas adyacentes a las esporas. Conclusiones: la ontogenia de los esporangios y esporogénesis de P. scolopendria es similar al descrito previamente para helechos leptosporangiados. Adicionalmente, se indica que las paráfisis receptaculares presentes en los soros de P. scolopendria tienen la función de protección de los esporangios durante las primeras etapas del desarrollo.

Introduction: Research about the ontogeny of sori, sporangia, receptacular paraphyses and sporogenesis of leptosporangiate ferns are scarce in the scientific literature. Objectives: To describe and analyze the ontogeny of sori, sporangia, receptacular paraphyses and sporogenesis of Phymatosorus scolopendria. Methods: Fertile fronds of P. scolopendria were collected in the campus of the Universidad de Antioquia, Medellín, Colombia, during the months March and May (annual rain season) of 2017. The fertile fronds of the samples at different developmental stages were fixed and processed according to the standard protocols for embedding and sectioning in paraffin and resin. Sections of 0.5 µm obtained in resin were stained with Toluidine blue, which differentially stains primary and secondary walls, highlights the cell nucleus and sporopolenin and secondarily stains polyphenols. For detailed descriptions, additional sections were processed with Safranin-Alcian blue, allowing the distinction of components of primary and secondary walls, nuclei, cuticle and polyphenols; Hematoxylin-Alcian blue to enhance nuclei and primary walls and Phloroglucinol-HCl for lignin. Observations and photographic records were done with a photonic microscope. For the observations and descriptions with scanning electron microscopy (SEM), the sori were dehydrated with 2,2-dimethoxypropane, critical point dried and coated with gold. Results: The sori are exindusiate, superficial, vascularized and have mixed development; they are associated with uniseriate and multicellular receptacle paraphyses. During the development of the sori, the epidermal cells of the receptacle that will form the sporangia are the first differentiated followed by those forming the receptacle paraphyses. The sporangium is leptosporangiate, with long stalks formed by one or two cell rows. The annulus of the sporangia displays secondary walls with U-shaped thickenings rich in lignin. The meiosis is simultaneous and the spore tetrads are arranged in a decussate or tetragonal shape. The cellular tapetum is initially unistratified but becomes bistratified after a periclinal division. The cells of the internal strata of the cellular tapetum loose structural integrity giving rise to a plasmodial tapetum that invades the meiotic sporocytes. During the sporoderm development, the sporopollenin-composed exospore is the first formed followed by the endospore, composed by cellulose, pectin and carboxylated polysaccharides; the process ends with the perispore. Polyphenols were mainly detected on vacuoles in cells of the sporangium, paraphysis and receptacle. When the time comes for the spore maturation, the remnants of cellular and the plasmodial tapeta have fully degenerated. Abundant orbicles are seen near the spores in the sporangial cavity. Conclusions: The ontogeny of the sporangia and sporogenesis of P. scolopendria are similar to the previously described for leptosporangiate ferns. Furthermore, in P. scolopendria, the receptacle paraphyses of the sori have a role protecting the sporangium during the early development stages.

Pseudohemoptisis por Serratia Marcescens / Pseudohemoptisis by Serratia Marcescens

Se denomina hemoptisis a la expulsión de sangre procedente del árbol traqueobronquial, es por ello que siempre habrá que descartar sangrado de cavidad oral, nasofaringe y tracto digestivo. De esta forma, la expectoración de sangre de una fuente que no es el tracto respiratorio inferior se denomina pseudohemoptisis, siendo sus causas la hematemesis, los tumores nasofaríngeos y digestivos, la sobredosis de rifampicina y la neumonía por Serratia marcescens. Esta bacteria patógena es la única descripta en la bibliografía como causa de pseudohemoptisis por ser productora de un pigmento rojizo denominado prodigiosina. En su diagnóstico, además de los cultivos de muestras respiratorias y hemocultivos, juega un rol importante la búsqueda de hematíes en esputo, los cuales se encuentran ausentes cuando el pigmento es el responsable de la coloración de la muestra

Effect of radiant exposure and UV accelerated aging on physico-chemical and mechanical properties of composite resins.

Currently, there is no consensus in terms of defining the minimum radiant exposure values necessary for achieving adequate properties of composite resin. In addition, the long-term influence that radiant exposure has on the properties of composite resins is still questionable. OBJECTIVE: The objective of this study was to evaluate the effect of radiant exposure and UV accelerated aging on the physico-chemical and mechanical properties of micro-hybrid and nanofilled composite resins. MATERIAL AND METHODS: A nanofilled (Filtek Supreme; 3M ESPE) and a micro-hybrid composite resin (Filtek Z250; 3M ESPE) were investigated under different radiant exposures (3.75, 9, and 24 J/cm2) and UV accelerated aging protocols (0, 500, 1000, and 1500 aging hours). The degree of conversion (DC), flexural strength (FS), modulus (M), water sorption (WS), and solubility (WL) were evaluated. The results obtained were analyzed using two-way ANOVA and Tukey's test. Comparisons were performed using a significance level of α=0.05. RESULTS: The DC, FS, and M were found to be significantly influenced by both radiant exposure and accelerated aging time. The DC and EM increased with radiant exposure in the no-aging group (0-hour aging) for both micro-hybrid and nanofilled composites, whereas no correlation was found after accelerated aging protocols. WS and WL of micro-hybrid and nanofilled composite resins were scarcely affected by radiant exposure (p>0.05), whereas they were significantly reduced by accelerated aging (p<0.001). CONCLUSIONS: Although increasing radiant exposure affected the degree of conversion and mechanical properties of micro-hybrid and nanofilled composites, no influence on the hydrolytic degradation of the material was observed. In contrast, UV accelerated aging affected both the physico-chemical and mechanical properties of the composites.

Effect of radiant exposure and UV accelerated aging on physico-chemical and mechanical properties of composite resins

Abstract Currently, there is no consensus in terms of defining the minimum radiant exposure values necessary for achieving adequate properties of composite resin. In addition, the long-term influence that radiant exposure has on the properties of composite resins is still questionable. Objective: The objective of this study was to evaluate the effect of radiant exposure and UV accelerated aging on the physico-chemical and mechanical properties of micro-hybrid and nanofilled composite resins. Material and Methods: A nanofilled (Filtek Supreme; 3M ESPE) and a micro-hybrid composite resin (Filtek Z250; 3M ESPE) were investigated under different radiant exposures (3.75, 9, and 24 J/cm2) and UV accelerated aging protocols (0, 500, 1000, and 1500 aging hours). The degree of conversion (DC), flexural strength (FS), modulus (M), water sorption (WS), and solubility (WL) were evaluated. The results obtained were analyzed using two-way ANOVA and Tukey's test. Comparisons were performed using a significance level of α=0.05. Results: The DC, FS, and M were found to be significantly influenced by both radiant exposure and accelerated aging time. The DC and EM increased with radiant exposure in the no-aging group (0-hour aging) for both micro-hybrid and nanofilled composites, whereas no correlation was found after accelerated aging protocols. WS and WL of micro-hybrid and nanofilled composite resins were scarcely affected by radiant exposure (p>0.05), whereas they were significantly reduced by accelerated aging (p<0.001). Conclusions: Although increasing radiant exposure affected the degree of conversion and mechanical properties of micro-hybrid and nanofilled composites, no influence on the hydrolytic degradation of the material was observed. In contrast, UV accelerated aging affected both the physico-chemical and mechanical properties of the composites.

Examining the Effect of Radiant Exposure on Commercial Photopolimerizable Dental Resin Composites.

The objective of this study was to evaluate the effect of radiant exposure on the chemical and physical properties of four commercial dental resin composites. The four dental resin composites used were Kalore, Admira, Tetric N-Ceram Bulk Fill, and Filtek Z350 XT. The composites were subjected to three curing protocols: 1000 mW/cm² for 5 s, 1000 mW/cm² for 10 s, and 400 mW/cm² for 25 s. The flexural strength, elastic modulus, water sorption, water solubility, degree of conversion, and polymerization shrinkage were evaluated. The results were analyzed by means of ANOVA and Tukey tests. For Admira and Kalore, significant differences between light exposure protocols were observed for the elastic modulus (p < 0.001), which was higher when a higher amount of radiant exposure was used. For Filtek Z350, differences were only observed for the degree of conversion (p < 0.001), and a higher amount of radiant exposure allowed us to obtain higher values. The Tetric N-Ceram Bulk Fill analysis showed significant differences for the elastic modulus and water sorption (p < 0.001), and specimens that had been subject to a radiant exposure of 10 J/cm² showed a higher elastic modulus. In most cases, the physical and mechanical properties analyzed were not affected by different radiant exposure values. Other resin-based composite (RBC) characteristics seem to have a greater influence on material properties.

Sexuality Among Women Treated for Breast Cancer: A Survey of Three Surgical Procedures.

BACKGROUND: The quality of life of Mexican patients with breast cancer has been studied, but female sexual function has only been explored superficially. The Female Sexual Function Index (FSFI) questionnaire has been validated as a tool to measure sexual function among women with cancer. However, no study in Mexico has been published. PURPOSE: To evaluate and compare female sexuality of breast cancer survivors treated with three surgical procedures. MATERIALS AND METHODS: This is a cross-sectional questionnaire survey applied in patients without active disease and free of any oncologic treatment who underwent conservative mastectomy, and mastectomy with and without reconstruction. Patients included in this study had no evidence of active disease after at least 2 years of postoperative follow-up and agreed to complete the FSFI questionnaire during a surveillance visit. RESULTS: Seventy-four patients were included: 37.8% had undergone conservative mastectomy, 29.7% radical mastectomy, and 32.4% radical mastectomy plus reconstruction. Patients in the radical mastectomy group were older than those in the other groups (p = 0.002). Female sexual dysfunction was observed in 34% of patients, but in patients who underwent radical mastectomy, it was 63% by contrast with 14 and 29% in women treated with conservative mastectomy and radical mastectomy with reconstruction (p = 0.001). CONCLUSIONS: We found a lower prevalence of female sexual dysfunction in patients treated with conservative mastectomy or reconstruction after radical mastectomy. Alternatively, radical mastectomy was offered to older patients, a condition that could contribute together with a loss of female perception to a higher prevalence of sexual dysfunction. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

La psicosis y la institución

Coloquio realizado los días 22 y 23 de octubre de 1999, La Habana