Fitorremediación con Brassicaceae y Apiaceae en suelos contaminados con metales pesados

Introducción: La cuenca media del río Bogotá viene sufriendo contaminación por metales pesados debido a los vertidos industriales. Esta fuente de agua ha sido utilizada para el riego de cultivos de ciclo corto, lo que ha provocado la contaminación por metales pesados de los suelos productivos. Objetivo: Evaluar un proceso de fitorremediación con las especies de Brócoli (Brassica oleracea var. italica Plenck) y Cilantro (Coriandrum sativum L.) en suelos contaminados con metales pesados en Mosquera, Colombia. Métodos: El muestreo se realizó con un diseño factorial al azar: a) proporciones de cilantro/brócoli (30 cilantro/70 brócoli, 50/50, 70 cilantro/30 brócoli y dos controles de tipo monocultivo de cada especie) y b) tiempo de fitorremediación (3, 6 y 9 meses), cada tratamiento con cuatro parcelas experimentales. El suelo y el tejido vegetal se analizó mediante espectrofotometría de absorción atómica para determinar la concentración de los metales pesados. Resultados: Las concentraciones de metales pesados en las muestras de tejido vegetal para brócoli y cilantro mostraron valores de Cd, Pb y Cr más altos que Hg y As, respecto al control. Las concentraciones de Cd, Pb y Cr presentaron valores significativamente más altos (P < 0.05) en suelos con cilantro y brócoli mezclados, respecto al sitio de control donde la concentración de Cd registró niveles significativamente más bajos que en los otros suelos. Las concentraciones de Cd, Pb y Cr fueron más altas en tejidos de cilantro y en suelos con cilantro en comparación con el control. Conclusiones: La fitorremediación por medio de las especies Brassica oleracea var. itálica Plenck y Coriandrum sativum L. en proporciones 70/30 o 30/70 a suelos con pH entre 5.5 y 6.0 permiten una buena recuperación de suelos con contenidos de metales pesados en términos de concentraciones altas a cortos plazos, iniciando la biorremediación a los tres meses y finalizando cargas de disponibilidad variable a los nueve meses.

Introduction: The middle basin of the Bogotá River has been suffering from heavy metal contamination due to industrial discharges. This water source has been used to irrigate short-cycle crops, which has resulted in heavy metal contamination of productive soils. Objective: To evaluate a phytoremediation process with the plant species Broccoli (Brassica oleracea var. Italica plenck) and Cilantro (Coriandrum sativum L.) in soils contaminated with heavy metals in Mosquera, Colombia. Methods: Sampling was performed with a randomized factorial design: a) cilantro/broccoli proportions (30 cilantro/70 broccoli, 50/50, 70 cilantro/30 broccoli and two monoculture type controls of each species) and b) phytoremediation time (3, 6 and 9 months), each treatment with four experimental plots. Soil and plant tissue were analyzed in the laboratory by atomic absorption spectrophotometry to determine the concentration of heavy metals. Results: The concentrations of heavy metals in plant tissue samples for broccoli and cilantro showed higher values of Cd, Pb and Cr than Hg and As, with respect to the control. The concentrations of Cd, Pb and Cr presented significantly higher values (P < 0.05) in soil where there was a mixed presence of cilantro and broccoli, with respect to the control site where the concentration of Cd registered significantly lower levels than in the other soils. Finally, Cd, Pb and Cr concentrations were higher in cilantro tissues and in soils with cilantro compared to the control. Conclusions: Phytoremediation by means of Brassica oleracea var. italica Plenck and Coriandrum sativum L. in 70/30 or 30/70 proportions in soils with pH between 5.5 and 6.0 allows a good recovery of soils with heavy metal contents in terms of high concentrations in short terms, starting bioremediation after three months and ending loads of variable availability after nine months.

Early outcomes of peritoneal dialysis in a middle-income country: A retrospective cohort study of a large dialysis network in Colombia.

BACKGROUND: The first year of dialysis is critical given the significant risk for complications following dialysis initiation. We analysed complications during the first year among incident peritoneal dialysis (PD) patients. METHODS: This retrospective cohort study comprised adult kidney failure patients starting PD in Baxter Renal Care Services in Colombia, receiving their first PD catheter between 1 January 2017 and 31 December 2020 and were followed up for up to 1 year. We analysed incidence, causes and factors associated with complications using logistic regression and transfer to haemodialysis (HD) using the Fine-Gray regression model. RESULTS: Among 4743 patients receiving their first PD catheter: 4628 (97.6%) of catheter implantations were successful; 377 (7.9%) patients experienced early complications. The incidence rate of complications during the year was 0.51 events per patient-year (95% CI: 0.48-0.54). Age, obesity and urgent start were associated with higher probability of complications after catheter implantation. The cumulative incidence of transfer to HD within 1 year of PD initiation was 10.1% [95% CI: 9.2-11.1%]. The hazard function for transfer to HD showed an accelerating pattern during the first month followed by progressive decrease during the first year. CONCLUSIONS: In this large population of incident PD patients, there is a high primary catheter placement success rate. Urgent start, age ≥65 years, obesity, centre size ≥150 PD patients and diabetes were risk factors associated with early complications. The follow-up of the cohort from day 1 of PD treatment showed that the risk for transfer to HD was higher during the first month.

Time on Therapy of Automated Peritoneal Dialysis with and without Remote Patient Monitoring: A Cohort Study.

Background: Remote patient monitoring (RPM) of patients undergoing automated peritoneal dialysis (APD-RPM) may potentially enhance time on therapy due to possible improvements in technique and patient survival. Objective: To evaluate the effect of APD-RPM as compared to APD without RPM on time on therapy. Methods: Adult incident APD patients undergo APD for 90 days or more in the Baxter Renal Care Services (BRCS) Colombia network between January 1, 2017, and June 30, 2019, with the study follow-up ending June 30, 2021. The exposure variable was APD-RPM vs. APD-without RPM. The outcomes of time on therapy and mortality rate over two years of follow-up were estimated in the full sample and in a matched population according to the exposure variable. A propensity score matching (PSM) 1:1 without replacement utilizing the nearest neighbor within caliper (0.035) was used and created a pseudopopulation in which the baseline covariates were well balanced. Fine & Gray multivariate analysis was performed to assess the effect of demographic, clinical, and laboratory variables on the risk of death, adjusting for the competing risks of technique failure and kidney transplantation. Results: In the matched sample, the time on APD therapy was significantly longer in the RPM group than in the non-RPM group, 18.95 vs. 15.75 months, p < 0.001. The mortality rate did not differ between the two groups: 0.10 events per patient-year in the RPM group and 0.12 in the non-RPM group, p=0.325. Conclusion: Over two years of follow-up, the use of RPM vs. no RPM in APD patients was associated with a significant increase in time on therapy, by 3.2 months. This result indicates that RPM-supported APD therapy may improve the clinical effectiveness and the overall quality of APD.

Medium Cutoff Versus High-Flux Hemodialysis Membranes and Clinical Outcomes: A Cohort Study Using Inverse Probability Treatment Weighting.

Rationale & Objective: This study investigated the effects on patients' outcomes of using medium cutoff (MCO) versus high-flux (HF) dialysis membranes. Study Design: A retrospective, observational, multicenter, cohort study. Setting & Participants: Patients aged greater than 18 years receiving hemodialysis at the Baxter Renal Care Services dialysis network in Colombia. The inception of the cohort occurred from September 1, 2017, to November 30, 2017, with follow-up to November 30, 2019. Exposure: The patients were divided into 2 cohorts according to the dialyzer used at the inception: (1) MCO membrane or (2) HF membrane. Outcomes: Primary outcomes were the hospitalization rate from any cause and hospitalization days per patient-year. Secondary outcomes were acute cardiovascular events and mortality rates from any cause and secondary to cardiovascular causes. Laboratory parameters were assessed throughout the 2-year follow-up period. Analytical Approach: Descriptive statistics were used to report population characteristics. Inverse probability of treatment weighting was applied to each group before analysis. All categorical variables were compared using Pearson's χ2 test, and continuous variables were analyzed with the t test. Baseline differences between groups with a value of >10% were considered clinically meaningful. Laboratory variables were measured at 5 consecutive time points. A between-patient effect was analyzed using a split-plot factorial analysis of variance. Results: The analysis included 1,098 patients, of whom 564 (51.3%) were dialyzed with MCO membranes and 534 (48.7%) with HF membranes. Patients receiving hemodialysis with MCO membranes had a lower all-cause hospitalization incidence rate (IR) per patient-year (IR = 0.93; 95% CI, 0.82-1.03) than those receiving hemodialysis with HF membranes (IR = 1.13; 95% CI, 0.96-1.30), corresponding to a significant incident rate ratio (MCO/HF) of 0.82 (95% CI, 0.68-0.99; P = 0.04). The frequency of nonfatal cardiovascular events showed statistical significance, with a lower incidence in the MCO group (incident rate ratio = 0.66; 95% CI, 0.46-0.96; P = 0.03). No statistically significant differences in all-cause time until death were observed (P = 0.48). Albumin levels were similar between the 2 dialyzer cohorts. Limitations: Despite the robust statistical analysis, there remains the possibility that unmeasured variables may still generate residual imbalance and, therefore, skew the results. Conclusions: The incidences of hospitalization and cardiovascular events in patients receiving hemodialysis were lower when dialyzed with MCO membranes than HF membranes. A randomized controlled trial would be desirable to confirm these results. Trial Registration: Clinical Trials.gov, ISRCTN12403265.

Dialysis Outcomes in a Middle-Income Country: An Updated Comparison of Patient Mortality between Hemodialysis and Peritoneal Dialysis.

INTRODUCTION: Comparisons of survival between dialysis modalities is of great importance to patients with kidney failure, their families, and healthcare systems. OBJECTIVE: This study's objective was to compare mortality of patients on chronic hemodialysis (HD) or peritoneal dialysis (PD) and identify variables associated with mortality. METHODS: This retrospective cohort study included adult incident patients with kidney failure treated with HD or PD by the Baxter Renal Care Services network in Colombia. The study was conducted between January 1, 2008, and December 31, 2013 (recruitment period), with follow-up until December 31, 2018. The outcome was the cumulative mortality rate at 1, 2, 3, 4, and 5 years. Propensity score matching (PSM) and the Gompertz parametric survival model were used to compare mortality in HD versus PD. RESULTS: The analysis included 12,499 patients, of whom 57.4% were on PD at inception. The overall mortality rate was 14.0 events per 100 patient-years (95% confidence interval [CI], 13.61-14.42). Using an intention-to-treat approach, crude mortality rates were significantly lower in patients receiving HD (HD: 12.3 deaths per 100 patient-years [95% CI, 11.7-12.8] vs. PD: 15.5 [14.9-16.1], p < 0.01). Using a Gompertz parametric survival model, dialysis modality was not significantly associated with mortality (hazard ratio HD vs. PD 1.0, 95% CI, 0.9-1.1). After PSM, the mortality cumulative incidence functions between HD and PD were not statistically significantly different (p = 0.88). CONCLUSIONS: The present study in a large cohort of incident dialysis patients with at least 5 years follow-up and using PSM methods showed no differences in cumulative mortality between HD and PD patients. This evidence from a middle-income country may facilitate the process of dialysis modality selection globally.

Technique failure in remote patient monitoring program in patients undergoing automated peritoneal dialysis: A retrospective cohort study.

BACKGROUND: Remote patient monitoring (RPM) programs in automated peritoneal dialysis (APD) allow clinical teams to be aware of many aspects and events of the therapy that occur in the home. The present study evaluated the association between RPM use and APD technique failure. METHODS: A retrospective, multicentre, observational cohort study of 558 prevalent adult APD patients included between 1 October 2016 and 30 June 2017 with follow-up until 30 June 2018 at Renal Therapy Services network in Colombia. Patients were divided into two cohorts based on the RPM use: APD-RPM (n = 148) and APD-without RPM (n = 410). Sociodemographic and clinical characteristics of all patients were summarized descriptively. A propensity score was used to create a pseudo-population in which the baseline covariates were well balanced. The association of RPM with technique failure was estimated adjusting for the competing events death and kidney transplant. RESULTS: Five hundred fifty-eight patients were analyzed. 26.5% had APD-RPM. In the matched sample comprising 148 APD-RPM and 148 APD-without RPM patients, we observed a lower technique failure rate of 0.08 [0.05-0.15] episodes per patient-year in APD-RPM versus 0.18 [0.12-0.26] in APD-without RPM cohort; incidence rate ratio = 0.45 95% confidence interval: [0.22-0.91], p-value = 0.03. CONCLUSIONS: The use of an RPM program in APD patients may be associated with a lower technique failure rate. More extensive and interventional studies are needed to confirm its potential benefits and to measure other patient-centered outcomes.

Medium cut-off dialyzers in a large population of hemodialysis patients in Colombia: COREXH registry.

Expanded hemodialysis (HDx) provides increased clearance of conventional and large middle molecules through innovative medium cutoff (MCO) membranes. However, there is a paucity of real-world data regarding the benefits and safety of HDx. This large observational study evaluated outcomes among patients in Colombia undergoing HDx at a extended dialysis clinical services provider. This was a prospective single cohort study of prevalent patients who were treated with HDx; baseline information was collected from the most recent data before patients were started on HDx. Patients were followed prospectively for 1 year for changes in serum albumin and other laboratory parameters compared with the baseline. Survival, hospitalization and safety were assessed from the start of HDx. A total of 1000 patients were invited to enroll; 992 patients met the inclusion criteria for data analysis and 638 patients completed the year of follow-up. Seventy-four (8%) patients died during 866 patient-years (PY) of follow-up; the mortality rate was 8.54 deaths/100 PY (95% confidence interval [CI], 6.8-10.7). There were 673 hospitalization events with a rate of 0.79 events/PY (95% CI, 0.73-0.85) with 6.91 hospital days/PY (95% CI, 6.74-7.09). The observed variability from baseline and maximum average change in mean serum albumin levels were -1.8% and -3.5%, respectively. No adverse events were related to the MCO membrane. HDx using an MCO membrane maintains stable serum albumin levels and is safe in terms of nonoccurrence of dialyzer related adverse events.

Impact of Medium Cut-Off Dialyzers on Patient-Reported Outcomes: COREXH Registry.

INTRODUCTION: A new generation of hemodialysis (HD) membranes called medium cut-off (MCO) membranes possesses enhanced capacities for middle molecule clearance, which have been associated with adverse outcomes in this population. These improvements could potentially positively impact patient-reported outcomes (PROs). OBJECTIVE: The objective of this study was to evaluate the impact of MCO membranes on PROs in a cohort of HD patients in Colombia. METHODS: This was a prospective, multicenter, observational cohort study of 992 patients from 12 renal clinics in Colombia who were switched from high-flux HD to MCO therapy and observed for 12 months. Changes in Kidney Disease Quality of Life 36-Item Short Form Survey (KDQoL-SF36) domains, Dialysis Symptom Index (DSI), and restless legs syndrome (RLS) 12 months after switching to MCO membranes were compared with time on high-flux membranes. Repeated measures of ANOVA were used to evaluate changes in KDQoL-SF36 scores; severity scoring was used to assess DSI changes over time; Cochran's Q test was used to evaluate changes in frequency of diagnostic criteria of RLS. RESULTS: During 12 months of follow-up, 3 of 5 KDQoL-SF36 domains improved compared with baseline: symptoms (p < 0.0001), effects of kidney disease (p < 0.0001), and burden of kidney disease (p < 0.001). The proportion of patients diagnosed with RLS significantly decreased from 22.1% at baseline to 10% at 12 months (p < 0.0001). No significant differences in the number of symptoms (DSI, p = 0.1) were observed, although their severity decreased (p = 0.009). CONCLUSIONS: In conventional HD patients, the expanded clearance of large middle molecules with MCO-HD membranes was associated with higher health-related quality of life scores and a decrease in the prevalence of RLS.

[Lymphadenopathies in patients with rheumatic diseases. Review of 19 cases]. / Poliadenopatías de origen reumatológico y las claves del diagnóstico diferencial: Análisis de 19 casos.

BACKGROUND: The presence of multiple lymphadenopathies can be a diagnostic challenge. AIM: To describe the clinical, laboratory and imaging characteristics of 19 patients with lymphadenopathies of rheumatologic origin. MATERIAL AND METHODS: Review of medical records of 19 patients aged 16 to 72 years (68%) with lymphadenopathies presumably secondary to a rheumatic disease. RESULTS: Six patients had systemic lupus erythematosus, six had Sjogren's disease, three had sarcoidosis, two had rheumatoid arthritis, one had IgG4 related disease and one had mixed connective tissue disease. A lymph node biopsy was performed in 11 patients and in eight a lymphoid follicular hyperplasia was found. Systemic symptoms were reported by 68% of patients. Blood lactate dehydrogenase was elevated only in cases associated with hemolytic anemia. There was no specific or predictable localization of the lymphadenopathies in imaging studies, except in the cases of sarcoidosis. The average size of the lymphadenopathies was 13.5 mm in diameter in short axis and there was no presence of necrosis, calcification, or conglomerate formation. Only one case presented splenomegaly. All patients responded favorably to corticosteroids. CONCLUSIONS: Lymphadenopathies associated with rheumatologic diseases can occur in a wide variety of diseases, especially systemic lupus erythematosus and Sjögren's disease. The absence of LDH elevation and splenomegaly and the absence of imaging findings such as conglomerates can orient to a rheumatologic origin.

Poliadenopatías de origen reumatológico y las claves del diagnóstico diferencial: Análisis de 19 casos / Lymphadenopathies in patients with rheumatic diseases. Review of 19 cases

Background: The presence of multiple lymphadenopathies can be a diagnostic challenge. Aim: To describe the clinical, laboratory and imaging characteristics of 19 patients with lymphadenopathies of rheumatologic origin. Material and Methods: Review of medical records of 19 patients aged 16 to 72 years (68%) with lymphadenopathies presumably secondary to a rheumatic disease. Results: Six patients had systemic lupus erythematosus, six had Sjogren's disease, three had sarcoidosis, two had rheumatoid arthritis, one had IgG4 related disease and one had mixed connective tissue disease. A lymph node biopsy was performed in 11 patients and in eight a lymphoid follicular hyperplasia was found. Systemic symptoms were reported by 68% of patients. Blood lactate dehydrogenase was elevated only in cases associated with hemolytic anemia. There was no specific or predictable localization of the lymphadenopathies in imaging studies, except in the cases of sarcoidosis. The average size of the lymphadenopathies was 13.5 mm in diameter in short axis and there was no presence of necrosis, calcification, or conglomerate formation. Only one case presented splenomegaly. All patients responded favorably to corticosteroids. Conclusions: Lymphadenopathies associated with rheumatologic diseases can occur in a wide variety of diseases, especially systemic lupus erythematosus and Sjögren's disease. The absence of LDH elevation and splenomegaly and the absence of imaging findings such as conglomerates can orient to a rheumatologic origin.

Evaluating a remote patient monitoring program for automated peritoneal dialysis.

BACKGROUND: The benefits of automated peritoneal dialysis (APD) have been established, but patient adherence to treatment remains a concern. Remote patient monitoring (RPM) programs are a potential solution; however, the cost implications are not well established. This study modeled, from the payer perspective, expected net costs and clinical consequences of a novel RPM program in Colombia. METHODS: Amarkov model was used to project costs and clinical outcomes for APD patients with and without RPM. Clinical inputs were directly estimated from Renal Care Services data or taken from the literature. Dialysis costs were estimated from national fees. Inpatient costs were obtained from a recent Colombian study. The model projected overall direct costs and several clinical outcomes. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were also conducted to characterize uncertainty in the results. RESULTS: The model projected that the implementation of an RPM program costing US$35 per month in a cohort of 100 APD patients over 1 year would save US$121,233. The model also projected 31 additional months free of complications, 27 fewer hospitalizations, 518 fewer hospitalization days, and 6 fewer peritonitis episodes. In the DSA, results were most sensitive to hospitalization rates and days of hospitalization, but cost savings were robust. The PSA found there was a 91% chance for the RPM program to be cost saving. CONCLUSION: The results of the model suggest that RPM is cost-effective in APD patients which should be verified by a rigorous prospective cost analysis.

Remote Patient Monitoring Program in Automated Peritoneal Dialysis: Impact on Hospitalizations.

Background:Automated peritoneal dialysis (APD) is a growing PD modality but as with other home dialysis methods, the lack of monitoring of patients' adherence to prescriptions is a limitation with potential negative impact on clinical outcome parameters. Remote patient monitoring (RPM) allowing the clinical team to have access to dialysis data and adjust the treatment may overcome this limitation. The present study sought to determine clinical outcomes associated with RPM use in incident patients on APD therapy.Methods:A retrospective cohort study included 360 patients with a mean age of 57 years (diabetes 42.5%) initiating APD between 1 October 2016 and 30 June 2017 in 28 Baxter Renal Care Services (BRCS) units in Colombia. An RPM program was used in 65 (18%) of the patients (APD-RPM cohort), and 295 (82%) were treated with APD without RPM. Hospitalizations and hospital days were recorded over 1 year. Propensity score matching 1:1, yielding 63 individuals in each group, was used to evaluate the association of RPM exposure with numbers of hospitalizations and hospital days.Results:After propensity score matching, APD therapy with RPM (n = 63) compared with APD-without RPM (n = 63) was associated with significant reductions in hospitalization rate (0.36 fewer hospitalizations per patient-year; incidence rate ratio [IRR] of 0.61 [95% confidence interval (CI) 0.39 - 0.95]; p = 0.029) and hospitalization days (6.57 fewer days per patient-year; IRR 0.46 [95% CI 0.23 - 0.92]; p = 0.028).Conclusions:The use of RPM in APD patients is associated with lower hospitalization rates and fewer hospitalization days; RPM could constitute a tool for improvement of APD therapy.

[Oligoarthritis, panniculitis and pyoderma gangrenosum associated with non-Hodgkin lymphoma. Report of one case]. / Oligoartritis, paniculitis y pioderma gangrenoso como manifestaciones de un Linfoma no Hodgkin.

An assortment of clinical and laboratory abnormalities may occur as paraneoplastic syndromes in lymphomas. Rheumatological and dermatological manifestations such as paraneoplastic arthritis and pyoderma gangrenosum must be underscored. We report a 28 years old woman who developed pyoderma gangrenosum and two years later presented with arthritis of knees and ankles associated with panniculitis interpreted as erythema induratum that was pathologically confirmed. She developed a reactivation of pyoderma gangrenosum, that was refractory to treatment. Complementary studies showed a pulmonary nodule and a right paravertebral mass with involvement of the psoas muscle. Biopsies of both masses and a new pathological skin study demonstrated a large B-cell non-Hodgkin's lymphoma.

Oligoartritis, paniculitis y pioderma gangrenoso como manifestaciones de un Linfoma no Hodgkin / Oligoarthritis, panniculitis and pyoderma gangrenosum associated with non-Hodgkin lymphoma: report of one case

An assortment of clinical and laboratory abnormalities may occur as paraneoplastic syndromes in lymphomas. Rheumatological and dermatological manifestations such as paraneoplastic arthritis and pyoderma gangrenosum must be underscored. We report a 28 years old woman who developed pyoderma gangrenosum and two years later presented with arthritis of knees and ankles associated with panniculitis interpreted as erythema induratum that was pathologically confirmed. She developed a reactivation of pyoderma gangrenosum, that was refractory to treatment. Complementary studies showed a pulmonary nodule and a right paravertebral mass with involvement of the psoas muscle. Biopsies of both masses and a new pathological skin study demonstrated a large B-cell non-Hodgkin's lymphoma.

[IgG4 associated nephritis and recurrent hemoptysis: Case report]. / Hemoptisis recurrente asociada a falla renal y hematuria: otra de las mil caras de la enfermedad relacionada a IgG4.

IgG4 disease is a multi-systemic condition involving pancreas, salivary glands and lymph nodes. Less frequently, it causes interstitial nephritis and involves the lungs. We report a 58 years old male with a four years history of hemoptysis and renal dysfunction characterized by hematuria and proteinuria, responsive to steroidal therapy. The renal biopsy established the diagnosis of IgG4 associated interstitial nephritis. Lung involvement was considered secondary to the same systemic disease.

Hemoptisis recurrente asociada a falla renal y hematuria: otra de las mil caras de la enfermedad relacionada a IgG4 / IgG4 associated nephritis and recurrent hemoptysis: case report

IgG4 disease is a multi-systemic condition involving pancreas, salivary glands and lymph nodes. Less frequently, it causes interstitial nephritis and involves the lungs. We report a 58 years old male with a four years history of hemoptysis and renal dysfunction characterized by hematuria and proteinuria, responsive to steroidal therapy. The renal biopsy established the diagnosis of IgG4 associated interstitial nephritis. Lung involvement was considered secondary to the same systemic disease.

CONTENIDOS DE PLOMO EN ACELGA COMÚN Beta vulgaris L, PRODUCIDA EN EL CONTEXTO DE LA AGRICULTURA URBANA (BOGOTÁ, COLOMBIA) / LEVELS OF LEAD IN COMMON CHARD Beta vulgaris L, PRODUCED IN THE CONTEXT OF URBAN AGRICULTURE (BOGOTÁ, COLOMBIA)

Dentro de las posibles formas de contaminación de las hortalizas con plomo se encuentran el suelo cultivado, el agua de riego y la atmósfera; esta última debido a la suspensión de las partículas resultantes de la combustión principalmente de hidrocarburos. Con el objetivo de lograr determinar la cantidad de plomo presente en Acelga común Beta vulgaris L. producida en el contexto de la agricultura urbana, se implementó una huerta con dicho sistema productivo en la ciudad, la cual se localiza en las coordenadas: Latitud 4°42'39,6036" y Longitud 74°5'46,6152", a menos de 500 metros de distancia de dos vías vehiculares principales de la ciudad de Bogotá. Previo a la siembra, se realizaron dos tipos de análisis: contenidos de plomo en suelo cultivado y en agua para riego, con la finalidad de obtener un diagnóstico preliminar sobre los contenidos de este metal pesado en estas dos posibles fuentes de contaminación. Las labores de sistema productivo relacionadas con prácticas culturales se realizaron de manera artesanal, por lo tanto no se realizó ningún tipo de fertilización y en el manejo de plagas no hubo intervención de ningún tipo de producto con la finalidad de evitar sesgos en el presente trabajo. Al momento de la cosecha, se muestreó al azar el 10% de la población total de plantas sembradas; esta muestra fue analizada por medio de espectrofotometría de absorción atómica según procedimiento del método oficial 968.08 de la AOAC, arrojando como resultado 0 ppm de plomo. Estos resultados permiten afirmar que la producción agrícola urbana es una alternativa que fomenta la seguridad alimentaria, no solo desde los aspectos de ingesta de macro y micronutrientes, sino también desde el punto de vista de calidad e inocuidad de los alimentos al no detectarse plomo en el tejido vegetal.

Cultivated soil, irrigation water and the atmosphere are among the possible forms of contamination with lead of vegetables, the latter due to suspension of the particles resulting from the combustion, mainly hydrocarbons. In order to be able to determine the levels of lead present in common Chard Beta vulgaris L. produced in the context of urban agriculture, a vegetable garden with this production system was implemented in the city, which is located at coordinates: Latitude 4°42'39.6036" and Longitude 74°5'46.6152", less than 500 meters away from two main vehicular roads in the city of Bogotá. Before sowing, two types of analysis were performed: lead content in cultivated soil and irrigation water, with the purpose of obtaining a preliminary diagnosis of the contents of this heavy metal in these two possible sources of contamination. The productive system work related to culture practices were made using traditional methods, therefore no fertilization was performed and there was no intervention of any type of product for pest management with the aim of avoiding bias in this study. At harvest time, 10% of the total of plants population planted was randomly selected; this sample was analyzed by atomic absorption spectrophotometry through the AOAC official method 968.08 yielding a result of 0 ppm of lead. These results allow the confirmation that urban farming is an alternative that promotes food security, not only from the intake of macro and micro nutrients aspect, but also from the of quality and food safety point of view, since for lead was not detect in the plant tissue.

Outcomes of a peritoneal dialysis program in remote communities within Colombia.

BACKGROUND AND OBJECTIVE: Colombia is a country of diverse geographic regions, some with mountainous terrain that can make access to urban areas difficult for individuals who live in remote areas. In 2005, a program was initiated to establish remote peritoneal dialysis (PD) centers in Colombia to improve access to PD for patients with end-stage renal disease who face geographic or financial access barriers. PATIENTS AND METHODS: The present study was a multi-center cohort observational study of prevalent home PD patients who were at least 18 years of age and were being managed by one of nine established remote PD centers in Colombia over a 2-year period. Data were collected from clinical records, databases, and patient interviews. Patient survival, incidence of peritonitis, and rate of withdrawal from PD therapy were assessed. RESULTS: A total of 345 patients were eligible for the study. The majority (87.8%) of patients lived on one to two times a minimum monthly salary (equivalent to US$243 - US$486). On average, patients traveled 1.2 hours and 4.3 hours from their home to their remote PD center or an urban reference renal clinic, respectively. The incidence rate of peritonitis was 2.54 episodes per 100 patient-months of therapy. A bivariate analysis showed a significantly higher risk of peritonitis in patients who were living on less than one times a monthly minimum salary (p < 0.05) or who had a dirt, cement, or unfinished wood floor (p < 0.05). The 1-year and 2-year patient survival rates were 92.44% and 81.55%, respectively. The 1-year and 2-year technique survival rates were 97.27% and 89.78%, respectively. CONCLUSIONS: With the support of remote PD centers that mitigate geographic and financial barriers to healthcare, home PD therapy is a safe and appropriate treatment option for patients who live in remote areas in Colombia.

Economic Burden of Incident Unplanned Starts on Peritoneal Dialysis in a High Specialty Health Care Facility in Mexico City.

OBJECTIVES: Few studies have examined hospitalization costs for unplanned initiation of peritoneal dialysis (PD). We used data from a health care facility in Mexico to examine first hospitalization costs associated with the unplanned initiation of PD. METHODS: Descriptive analyses focusing on initial hospitalization costs during the unplanned initiation of PD were conducted. In addition, multivariate regression models examined the association of costs with requiring urgent hemodialysis (HD) at the time of starting PD, and the association of driving distance with requiring urgent HD. RESULTS: Of 195 patients hospitalized in 2010 for PD catheter placement, 51 patients met criteria for unplanned PD initiation and 25 of them required urgent HD prior to PD initiation. Ninety-two percent of the patients received 90% or greater government subsidy of hospital costs. Average inpatient costs for the first hospitalization related to the unplanned initiation of PD were 64,174 Mexican Pesos (MXN) (US $4,657). Costs were 78,683 MXN ($5,710) per patient for those requiring urgent HD and 50,225 MXN ($3,645) for those who did not, a difference (P<0.05) of roughly 28,000 MXN ($2,032), and regression results were similar. In addition, long driving distance to the institution was significantly associated with requiring urgent HD. CONCLUSIONS: Our findings highlight potential cost savings to payers for developing better strategies to manage PD starts in Mexico and should help inform policy regarding oversight and coverage of low-income patients at risk of dialysis.