Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 68
Filtrar
1.
Ther Adv Endocrinol Metab ; 15: 20420188241252546, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38827386

RESUMO

Introduction: There are multiple mechanisms by which HbA1c values can be altered in chronic kidney disease (CKD), which limits its usefulness as a strategy to assess glycemic control in this population. Methods: Concordance and agreement study between two diagnostic tests: HbA1c and glucose management indicator (GMI) measured by intermittently scanned continuous glucose monitoring (isCGM), based in a prospective cohort of patients with diabetes, CKD (glomerular filtration rate between 15 and 60 ml/min/1.73 m²), and anemia. The isCGM was performed for 3 months, and the GMI was compared with the HbA1c levels taken at the end of isCGM. Agreement was evaluated using Bland-Altman graph analysis and Lin's concordance correlation coefficient (CCC). The concordance of the measures with good glycemic control (<7%) was also evaluated. Results: A total of 74 patients were enrolled (median age 68.5 years, 51.3% female, 64.9% with CKD stage 3, hemoglobin 11.1 ± 1.2 g/l). The Bland-Altman analysis shows a mean difference between GMI and HbA1c of 0.757 ± 0.687% (95% limits of agreement: -0.590 and 2.105). Difference was greater as the values of GMI and HbA1c increased. The agreement was poor [CCC 0.477; 95% confidence interval (CI): 0.360-0.594], as well as the concordance of values with good glycemic control according to GMI versus HbA1c (67.5% versus 29.7%, p < 0.001) (Kappa 0.2430; 95% CI: 0.16-0.32). Conclusion: The HbA1c overestimates the GMI values with highly variable ranges of difference, which prevents a precise correction factor. isCGM probably is a safer option for monitoring and decision-making in this population, especially in patients treated with insulin where the risk of hypoglycemia is greater.

2.
Artigo em Inglês | MEDLINE | ID: mdl-38688818

RESUMO

OBJECTIVE: To investigate the association between the duration of the first prone positioning maneuver (PPM) and 90-day mortality in patients with C-ARDS. DESIGN: Retrospective, observational, and analytical study. SETTING: COVID-19 ICU of a tertiary hospital. PATIENTS: Adults over 18 years old, with a confirmed diagnosis of SARS-CoV-2 disease requiring PPM. INTERVENTIONS: Multivariable analysis of 90-day survival. MAIN VARIABLES OF INTEREST: Duration of the first PPM, number of PPM sessions, 90-day mortality. RESULTS: 271 patients undergoing PPM were analyzed: first tertile (n = 111), second tertile (n = 95) and third tertile (n = 65). The results indicated that the median duration of PDP was 14 h (95% CI: 10-16 h) in the first tertile, 19 h (95% CI: 18-20 h) in the second tertile and 22 h (95% CI: 21-24 h) in the third tertile. Comparison of survival curves using the Logrank test did not reach statistical significance (p = 0.11). Cox Regression analysis showed an association between the number of pronation sessions (patients receiving between 2 and 5 sessions (HR = 2.19; 95% CI: 1.07-4.49); and those receiving more than 5 sessions (HR = 6.05; 95% CI: 2.78-13.16) and 90-day mortality. CONCLUSIONS: while the duration of PDP does not appear to significantly influence 90-day mortality, the number of pronation sessions is identified as a significant factor associated with an increased risk of mortality.

3.
BMC Nephrol ; 25(1): 148, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38671349

RESUMO

BACKGROUND: The use of tools that allow estimation of the probability of progression of chronic kidney disease (CKD) to advanced stages has not yet achieved significant practical importance in clinical setting. This study aimed to develop and validate a machine learning-based model for predicting the need for renal replacement therapy (RRT) and disease progression for patients with stage 3-5 CKD. METHODS: This was a retrospective, closed cohort, observational study. Patients with CKD affiliated with a private insurer with five-year follow-up data were selected. Demographic, clinical, and laboratory variables were included, and the models were developed based on machine learning methods. The outcomes were CKD progression, a significant decrease in the estimated glomerular filtration rate (eGFR), and the need for RRT. RESULTS: Three prediction models were developed-Model 1 (risk at 4.5 years, n = 1446) with a F1 of 0.82, 0.53, and 0.55 for RRT, stage progression, and reduction in the eGFR, respectively,- Model 2 (time- to-event, n = 2143) with a C-index of 0.89, 0.67, and 0.67 for RRT, stage progression, reduction in the eGFR, respectively, and Model 3 (reduced Model 2) with C-index = 0.68, 0.68 and 0.88, for RRT, stage progression, reduction in the eGFR, respectively. CONCLUSION: The time-to-event model performed well in predicting the three outcomes of CKD progression at five years. This model can be useful for predicting the onset and time of occurrence of the outcomes of interest in the population with established CKD.


Assuntos
Inteligência Artificial , Progressão da Doença , Taxa de Filtração Glomerular , Insuficiência Renal Crônica , Terapia de Substituição Renal , Humanos , Masculino , Feminino , Insuficiência Renal Crônica/terapia , Insuficiência Renal Crônica/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Aprendizado de Máquina , Idoso , Estudos de Coortes , Adulto
5.
Cureus ; 16(2): e54218, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38496100

RESUMO

COVID-19 is an illness caused by the SARS-CoV-2 virus, a type of coronavirus initially identified in China in late 2019, emerging as the leading cause of death attributed to a single infectious agent worldwide. The COVID-19 pandemic poses a substantial challenge to global public health in the first quarter of this century. The rapid evolution of the pandemic and its intricate response have hindered the formulation of definitive conclusions, and it may take years to comprehend its long-term effects. Assessing the extent of organ damage beyond the lungs could guide physicians in the disease's severity or progression. Based on these characteristics, an earlier and more targeted approach can be initiated at the appropriate moment. The association between hepatic profile and mortality in COVID-19 patients is a subject of scientific interest, as SARS-CoV-2 infection can lead to hepatitis. In severe cases, it may induce sepsis-related liver injury, potentially culminating in hepatic failure. METHODOLOGY: The study's objective is to determine the prevalence of mortality in adult patients with elevated hepatic profile hospitalized due to SARS-CoV-2 infection. This cross-sectional, monocentric study was conducted at a healthcare institution in Bogotá, Colombia. RESULTS: This study includes 91 patients with confirmed diagnoses of COVID-19, revealing a prevalence of hepatic profile alterations in 61.5% (n=56) of hospitalized patients. The mortality rate observed is 17.6% (n= 16), with an odds ratio (OR) of 12.4 (95% CI = 1.56-99.0) in patients with hepatic profile alterations. CONCLUSIONS: This research underscores the importance of early detection of hepatic profile alterations in hospitalized patients with COVID-19. Not only are these alterations prevalent, but they are also potentially associated with an increased risk of mortality. These findings emphasize the necessity for further research to enhance strategies and prognostication for patients with COVID-19 in the future.

7.
Rev Med Chil ; 151(1): 72-80, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37906748

RESUMO

BACKGROUND: The prevention and control of SARS-CoV-2 infection in hemodialysis (HD) units is challenging. AIM: To describe the clinical characteristics and outcome of patients with chronic kidney disease (CKD) on HD with COVID-19, between March 2020 and January 28, 2021, attending a single HD unit in Bogotá, Colombia. MATERIAL AND METHODS: In this prospective observational study, incidence, prevalence, and case-fatality rate were estimated, including screening results with RT-PCR and anti-SARS-CoV-2 IgG and IgM antibodies in all patients and health personnel in the HD unit. RESULTS: Among patients and health workers, 55 and 9 cases of COVID-19 were identified, respectively. The median age of patients was 63 years (84% males). Fifty five percent of patients were symptomatic, with fever, cough and/or myalgia. The most common comorbidities were hypertension, type 2 diabetes mellitus, and coronary heart disease. The cumulative incidence of infection was 30.2%, population seroprevalence was 24.9%, and fatality was 9.1%. CONCLUSIONS: The incidence of SARS-CoV-2 infection in this HD unit was high. Strict biosafety protocols are required to prevent outbreaks.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , COVID-19/epidemiologia , SARS-CoV-2 , Estudos Soroepidemiológicos , Diálise Renal/métodos , Surtos de Doenças
8.
Rev Esp Enferm Dig ; 2023 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-37539534

RESUMO

We report a 62-year-old female with chronic pancreatitis after three episodes of severe acute pancreatitis. In 2008, an uneven main pancreatic duct (MPD) of 16 mm was found during an abdominal ultrasound. The follow-up was not continued until 2020, when a dilation of 27 mm of the MPD was discovered at magnetic resonance imaging (MRI). In 2022, another radiological test was carried out showing a dilation of the MPD of 40 mm with an intraductal tumoral lesion of 30 mm at the head of the pancreas). An echo-endoscopy was carried out and a pancreatic-duodenal tumour with a mixed pattern was discovered. Atypic cells were observed at the fine needle punction. A total duodenopancreatectomy was successfully carried out. In the anatomopathological macroscopic study a 14 cm-multi-cystic neoformation was seen and a solid tumour was discovered at the head of the pancreas that infiltrated the wall of the duodenum. In the longitudinal cross-section of the pancreatic body the MPD was seen to be severely dilated. A focal adenocarcinoma in a intraductal papillary mucinous neoplasm (IPMN) was finally diagnosed. Pancreatic lesions are usually asymptomatic and are detected by chance during other imaging tests. The IPMN rates of malignancy have been reported of between 19 to 30%. The management of pancreatic cystic lesions still represents a clinical challenge. As always, the multi-disciplinary management is mandatory in this type of tumour.

9.
BMC Nephrol ; 24(1): 211, 2023 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-37460967

RESUMO

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of chronic kidney disease (CKD) that requires dialysis. Knowing geographical clusters can be critical for early diagnosis, progression control, and genetic counseling. The objective was to establish the prevalence, geographic location, and ethnic groups of patients with ADPKD who underwent dialysis or kidney transplant in Colombia between 2015 and 2019. METHODS: We did a cross-sectional study with data from the National Registry of Chronic Kidney Disease (NRCKD) managed by the High-Cost Diseases Fund (Cuenta de Alto Costo [CAC] in Spanish) between July 1, 2015, and June 30, 2019. We included Colombian population with CKD with or without renal replacement therapy (RRT) due to ADPKD. Crude and adjusted prevalence rates were estimated by state and city. RESULTS: 3,339 patients with ADPKD were included, period prevalence was 9.81 per 100,000 population; there were 4.35 cases of RRT per 100,000 population, mean age of 52.58 years (± 13.21), and 52.78% women. Seventy-six patients were Afro-Colombians, six were indigenous, and one Roma people. A total of 46.07% began scheduled dialysis. The highest adjusted prevalence rate was in Valle del Cauca (6.55 cases per 100,000 population), followed by Risaralda, and La Guajira. Regarding cities, Cali had the highest prevalence rate (9.38 cases per 100,000 population), followed by Pasto, Medellin, and Bucaramanga. CONCLUSIONS: ADPKD prevalence is lower compared to Europe and US; some states with higher prevalence could be objective to genetic prevalence study.


Assuntos
Rim Policístico Autossômico Dominante , Insuficiência Renal Crônica , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Rim Policístico Autossômico Dominante/diagnóstico , Rim Policístico Autossômico Dominante/epidemiologia , Rim Policístico Autossômico Dominante/terapia , Colômbia/epidemiologia , Diálise Renal , Estudos Transversais , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia
10.
BMC Nephrol ; 24(1): 140, 2023 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-37217840

RESUMO

BACKGROUND: Patients with COVID-19 have a high incidence of acute kidney injury (AKI), which is associated with mortality. The objective of the study was to determine the factors associated with AKI in patients with COVID-19. METHODOLOGY: A retrospective cohort was established in two university hospitals in Bogotá, Colombia. Adults hospitalized for more than 48 h from March 6, 2020, to March 31, 2021, with confirmed COVID-19 were included. The main outcome was to determine the factors associated with AKI in patients with COVID-19 and the secondary outcome was estimate the incidence of AKI during the 28 days following hospital admission. RESULTS: A total of 1584 patients were included: 60.4% were men, 738 (46.5%) developed AKI, 23.6% were classified as KDIGO 3, and 11.1% had renal replacement therapy. The risk factors for developing AKI during hospitalization were male sex (OR 2.28, 95% CI 1.73-2.99), age (OR 1.02, 95% CI 1.01-1.03), history of chronic kidney disease (CKD) (OR 3.61, 95% CI 2.03-6.42), High Blood Pressure (HBP) (OR 6.51, 95% CI 2.10-20.2), higher qSOFA score to the admission (OR 1.4, 95% CI 1.14-1.71), the use of vancomycin (OR 1.57, 95% CI 1.05-2.37), piperacillin/tazobactam (OR 1.67, 95% CI 1.2-2.31), and vasopressor support (CI 2.39, 95% CI 1.53-3.74). The gross hospital mortality for AKI was 45.5% versus 11.7% without AKI. CONCLUSIONS: This cohort showed that male sex, age, history of HBP and CKD, presentation with elevated qSOFA, in-hospital use of nephrotoxic drugs and the requirement for vasopressor support were the main risk factors for developing AKI in patients hospitalized for COVID-19.


Assuntos
Injúria Renal Aguda , COVID-19 , Hipertensão , Insuficiência Renal Crônica , Adulto , Humanos , Masculino , Feminino , Antibacterianos/efeitos adversos , Estudos Retrospectivos , COVID-19/epidemiologia , COVID-19/complicações , Fatores de Risco , Hipertensão/complicações , Injúria Renal Aguda/etiologia , Insuficiência Renal Crônica/complicações , Mortalidade Hospitalar
11.
Rev. méd. Chile ; 151(1): 72-80, feb. 2023. tab
Artigo em Inglês | LILACS | ID: biblio-1515423

RESUMO

BACKGROUND: The prevention and control of SARS-CoV-2 infection in hemodialysis (HD) units is challenging. AIM: To describe the clinical characteristics and outcome of patients with chronic kidney disease (CKD) on HD with COVID-19, between March 2020 and January 28, 2021, attending a single HD unit in Bogotá, Colombia. MATERIAL AND METHODS: In this prospective observational study, incidence, prevalence, and case-fatality rate were estimated, including screening results with RT-PCR and anti-SARS-CoV-2 IgG and IgM antibodies in all patients and health personnel in the HD unit. RESULTS: Among patients and health workers, 55 and 9 cases of COVID-19 were identified, respectively. The median age of patients was 63 years (84% males). Fifty five percent of patients were symptomatic, with fever, cough and/or myalgia. The most common comorbidities were hypertension, type 2 diabetes mellitus, and coronary heart disease. The cumulative incidence of infection was 30.2%, population seroprevalence was 24.9%, and fatality was 9.1%. CONCLUSIONS: The incidence of SARS-CoV-2 infection in this HD unit was high. Strict biosafety protocols are required to prevent outbreaks.


INTRODUCCIÓN: La prevención y el control de la infección por SARS-CoV-2 en las unidades de hemodiálisis (HD) es un desafío. OBJETIVO: Describir las características clínicas y la evolución de los pacientes con enfermedad renal crónica (ERC) en HD con COVID-19, entre marzo de 2020 y el 28 de enero de 2021, que acudieron a una unidad de HD en Bogotá, Colombia. MATERIAL Y MÉTODOS: Estudio observacional prospectivo con estimación de incidencia, prevalencia y letalidad, incluyendo los resultados del cribado con RT-PCR y anticuerpos IgG e IgM anti-SARS-CoV-2 en todos los pacientes y personal sanitario de la unidad de HD. RESULTADOS: Se identificaron 55 casos de pacientes en HD y 9 casos de trabajadores de salud con COVID-19. La mediana de edad de los pacientes fue de 63 años y 84% eran hombres. Cincuenta y cinco por ciento de los pacientes eran sintomáticos, con fiebre, tos y/o mialgia. Las comorbilidades más frecuentes fueron hipertensión arterial, diabetes mellitus tipo 2 y enfermedad coronaria. La incidencia acumulada de infección fue del 30,2%, la seroprevalencia poblacional del 24,9% y la letalidad del 9,1%. CONCLUSIONES: La incidencia de infección por SARS-CoV-2 en esta unidad de HD fue alta. Se requieren de protocolos estrictos de bioseguridad para evitar brotes.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diálise Renal/métodos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Estudos Soroepidemiológicos , Surtos de Doenças , Estudos Prospectivos , Diabetes Mellitus Tipo 2 , SARS-CoV-2
12.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1536021

RESUMO

Contexto las personas con diálisis se consideran una población de alto riesgo de infección por SARS-CoV-2, complicaciones y muerte. En Colombia, cerca del 44 % de la población en diálisis es menor de 60 años, adicionalmente, por los mismos retos que ha impuesto la pandemia a los programas de trasplantes, se ha incrementado notoriamente la población joven que debe seguir en diálisis al no tener opción a corto plazo de un trasplante renal, por lo tanto, las limitaciones en el acceso temprano a la vacunación contra SARS-CoV-2 agudizarían los problemas de esta población, provocando pérdidas considerables en años de vida que la vacuna podría salvar. Objetivo el objetivo del presente documento es sintetizar los principales motivos por los que se recomienda la priorización de la vacunación de los pacientes en diálisis crónica y lista de espera para trasplante renal. Metodología se realizó una búsqueda rápida de información sobre la vacunación en pacientes con ERC en diálisis o en espera de trasplante renal. La información resultante fue analizada críticamente por expertos en nefrología para la formulación de recomendaciones. Los resultados de la búsqueda se presentan a manera de síntesis narrativa. Resultados a partir de la información revisada y discutida por los expertos en nefrología se proponen 4 recomendaciones para la vacunación contra el virus SARS-Cov-2. Conclusiones la Asociación Colombiana de Nefrología e Hipertensión Arterial, la Asociación Colombiana de Nefrología Pediátrica y la Asociación Colombiana de Trasplante de Órganos, comprometidos con la salud de los pacientes con enfermedad renal en diálisis y listas de espera de trasplantes en Colombia, se unen a la solicitud mundial de generar recomendaciones para la vacunación contra SARS-CoV-2.


Background People on dialysis are considered a high-risk population for SARS-CoV-2 infection, complications, and death. In Colombia, about 44% of the population on dialysis is under 60 years of age. In addition, due to the same challenges that the pandemic has imposed on transplant programs, the young population that must continue on dialysis has increased markedly, as they have no option in the short term of a kidney transplant, therefore, the limitations in early access to vaccination against SARS-CoV-2 would exacerbate the problems of this population, causing considerable losses in years of life that the vaccine could save. Purpose The objective of this document is to summarize the main reasons why the prioritization of vaccination of patients on chronic dialysis and on the kidney transplant waiting list is recommended. Methodology A rapid search for information on vaccination in patients with CKD on dialysis or awaiting kidney transplantation was performed. The resulting information was critically analyzed by experts in nephrology for the formulation of recommendations. The search results are presented as a narrative synthesis. Results Based on the information reviewed and discussed by nephrology experts, 4 recommendations are proposed for vaccination against the SARS-Cov-2 virus. Conclusions The Colombian Association of Nephrology and Arterial Hypertension (ASOCOLNEF), the Colombian Association of Pediatric Nephrology (ACONEPE) and the Colombian Association of Organ Transplantation (ACTO), committed to the health of patients with kidney disease on dialysis and transplant waiting lists in Colombia, join to generate recommendations for prioritization and vaccination against SARS-CoV-2.

13.
J Sci Food Agric ; 102(14): 6340-6348, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35527679

RESUMO

BACKGROUND: Local leafy vegetables are gaining attention as affordable sources of micronutrients, including vitamins, pro-vitamin carotenoids and other bioactive compounds. Stinging nettles (Urtica spp.) are used as source of fibers, herbal medicine and food. However, despite the relatively wide geographical spread of Urtica leptophylla on the American continent, little is known about its content of vitamin E congeners and carotenoids. We therefore investigated the particular nutritional potential of different plant structures of wild Costa Rican U. leptophylla by focusing on their vitamin E and carotenoid profiles. RESULTS: Young, mature and herbivore-damaged leaves, flowers, stems and petioles were collected and freeze-dried. Vitamin E and carotenoids were determined by high-performance liquid chromatography after liquid/liquid extraction with hexane. α-Tocopherol was the major vitamin E congener in all structures. Flowers had a high content of γ-tocopherol. Herbivore-damaged leaves had higher contents of vitamin E than undamaged leaves. Lutein was the major and ß-carotene the second most abundant carotenoid in U. leptophylla. No differences in carotenoid profiles were observed between damaged and undamaged leaves. CONCLUSION: The leaves of U. leptophylla had the highest nutritional value of all analyzed structures; therefore, they might represent a potential source of α-tocopherol, lutein and ß-carotene. © 2022 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.


Assuntos
Urtica dioica , Vitamina E , Carotenoides/análise , Costa Rica , Flores/química , Hexanos , Luteína/análise , Vitamina E/análise , Vitaminas/análise , alfa-Tocoferol/análise , beta Caroteno/análise , gama-Tocoferol/análise
14.
Ther Apher Dial ; 26(6): 1274-1280, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35353437

RESUMO

BACKGROUND: Optic neuritis (ON) causes several sequela. Aggressive treatment with plasma exchange (TPE) is an option. This study describes improvement and safety outcomes with TPE. METHODS: We recruited adults with ON in neuromyelitis optica spectrum disorders (NMOSD) patients treated with TPE. The primary outcome was an improvement in the visual acuity scale (VOS). We described the data and used multivariate logistic regression to identify factors associated with response. RESULTS: Eighty-three patients received 558 TPE sessions. Mean age was 40.9 years (±13.7 years); 73.5% were women, 50.1% were first attack, and 10.7% were bilateral. Median VOS: 5 (range [R], 2-7). Median time between onset and TPE was 8 days (R, 1-32). By Keegan's criteria, 82.4% experience improvement and 78.3% improve in at least 1 point in VOS. Age and pre-TPE VOS were related to improvement. Low fibrinogen occurs in 26% sessions. CONCLUSION: TPE is effective and safety for ON in NMOSD patients. There is a need for a clinical trial using a therapeutic equivalent.


Assuntos
Neuromielite Óptica , Neurite Óptica , Adulto , Feminino , Humanos , Masculino , Aquaporina 4 , Modelos Logísticos , Neuromielite Óptica/terapia , Neurite Óptica/terapia , Troca Plasmática , Plasmaferese , Pessoa de Meia-Idade
15.
Infectio ; 26(1): 3-10, ene.-mar. 2022. graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1350841

RESUMO

Abstract In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.


Resumen En meses recientes se han reportado casos raros de trombocitopenia y trombosis en sitios inusuales, que ocurren dentro de una ventana de riesgo típica ( por ejemplo de 4 a 28 días) luego de recibir vacunas de SARS CoV 2. Los profesionales de la salud deben estar preparados para detectar estos casos a tiempo. Un panel de expertos y una red de transferencia de conocimiento realizó una búsqueda libre de literatura seleccionada. Con la información disponible y la experticia clínica del grupo de trabajo revisamos y dimos recomendaciones para la sospecha temprana, el diagnostico (definición de caso, el uso de pruebas de laboratorio especificas y de imágenes diagnósticas) para le manejo de estas condiciones tromboticas. Este documento es considerado un documento vivo que debe ser actualizado a medida que surja nueva evidencia y las recomendaciones vayan cambiando con el tiempo

16.
Value Health Reg Issues ; 28: 98-104, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34922060

RESUMO

OBJECTIVES: Azathioprine has been the therapy of choice for the maintenance of remission in patients with antineutrophil cytoplasm antibody (ANCA)-associated systemic vasculitis, but recent studies show that rituximab could be more effective. To evaluate the cost-effectiveness of azathioprine, fixed-schedule rituximab, and tailored-dose rituximab for ANCA-associated systemic vasculitis. METHODS: A Markov model from the perspective of the Colombian healthcare system was designed with annual cycles and a 5-year time horizon, charting the following states: remission, minor relapse, major relapse, and death. The discount rate was 5%. Transition probabilities were obtained from a systematic literature review. The costs (1 US dollar = 2956 Colombian pesos in 2018) were estimated based on national drug registries and official fee manuals for procedures, along with other resources. The main outcomes were quality-adjusted life-years (QALYs) taken from the Tufts registry. Univariate and multivariate sensitivity analyses were performed. RESULTS: Final costs were $1446 for azathioprine, $4898 for tailored-dose rituximab, and $6311 for fixed-schedule rituximab. QALYs gained were 3.18, 4.08, and 3.98, respectively. Rituximab was cost-effective (cost per incremental QALY gained: $4919, and $6865), and tailored-dose administration had a lower cost. Sensitivity analyses did not affect the results. CONCLUSIONS: Tailored-dose rituximab was the most cost-effective treatment for ANCA-associated vasculitis. Azathioprine presented worse effectiveness and lower cost, and fixed-schedule rituximab was dominated by tailored-dose rituximab.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Azatioprina , Adulto , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Azatioprina/uso terapêutico , Colômbia , Análise Custo-Benefício , Citoplasma , Humanos , Rituximab/uso terapêutico
17.
Rev. colomb. nefrol. (En línea) ; 8(1): e202, ene.-jun. 2021. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1347364

RESUMO

Resumen Introducción: la dieta con restricción de proteínas parece tener un papel importante en la progresión de la enfermedad renal crónica (ERC) y la aparición anticipada de síntomas urémicos, además la suplementación de aminoácidos esenciales ofrece aparente seguridad para lograr restricciones agresivas de proteínas. Objetivo: realizar una revisión de la literatura para establecer las recomendaciones de uso práctico sobre la dieta con restricción de proteínas en la ERC avanzada. Materiales y métodos: se realizó una búsqueda estructurada rápida de la literatura en la que se incluyeron revisiones sistemáticas y metaanálisis, de los cuales se extrajeron las respuestas de las preguntas con estructura PICOT diseñadas a priori. Los resultados fueron sometidos a consenso para generar recomendaciones prácticas. Resultados: se incluyeron 6 revisiones sistemáticas de la literatura con una evaluación de calidad moderada. Según los hallazgos, una dieta muy baja en proteínas con suplementación de alfa-cetoanálogos beneficia a los pacientes que ingresan a diálisis o son sometidos a trasplante renal, además reduce la progresión de la enfermedad. No obstante, se requiere de ensayos clínicos con mejor calidad que consideren aspectos como la calidad de vida. Conclusiones: aunque la evidencia es de baja calidad, se establece que la dieta muy baja en proteínas y suplementada con alfa-cetoanálogos en pacientes adecuadamente seleccionados reduce el deterioro de la tasa de filtración glomerular y parece reducir el ingreso a diálisis. Por tanto, se recomienda hacer un seguimiento estricto y periódico en el que se vigilen las medidas antropométricas y el perfil de riesgo de desnutrición.


Abstract Introduction and objective: The protein-restricted diet appears to play an important role in the progression of chronic kidney disease and the early onset of uremic symptoms, the supplementation of essential amino acids offers apparent security in achieving aggressive protein restrictions. The objective of this document is to carry out a literature review to inform practical use recommendations on this behavior in advanced Renal Disease (CKD). Materials and methods: A quick structured search of the literature is carried out, with the selection of systematic reviews and meta-analyzes, from which the answers to the questions with a PICOT structure designed a priori are extracted. The results were submitted to consensus to generate practical recommendations. Results: six systematic reviews of the literature were included, with a moderate quality evaluation, the extraction of the information reports an apparent benefit of the very low protein diet with supplementation of alpha-keto-analogues on admission to dialysis or kidney transplantation and a consistent reduction of disease progression. Better clinical trials that integrate outcomes such as quality of life are required. Conclusions: With low quality of evidence, the very low protein diet, supplemented with alpha-keto analogues, in the properly selected patient, reduces the deterioration of the glomerular filtration rate, seems to reduce admission to dialysis. Regular strict monitoring is recommended, with monitoring of anthropometric measures and malnutrition risk profile.

18.
Sci Rep ; 11(1): 6522, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33753830

RESUMO

Microbiome is known to play an important role in the health of organisms and different factors such as diet have been associated with modifications in microbial communities. Differences in the microbiota composition of wild and captive animals has been evaluated; however, variation during a reintroduction process in primates has never been reported. Our aim was to identify changes in the bacterial composition of three individuals of reintroduced woolly monkeys (Lagothrix lagothricha) and the variables associated with such changes. Fecal samples were collected and the V4 region of the 16S rRNA gene was sequenced to determine gut microbial composition and functionality. Individual samples from released individuals showed a higher microbial diversity after being released compared to before liberation, associated with changes in their diet. Beta diversity and functionality analysis showed separation of samples from released and captive conditions and the major factor of variation was the moment of liberation. This study shows that intestinal microbiota varies depending on site conditions and is mainly associated with diet diversity. The intake of food from wild origin by released primates may promote a positive effect on gut microbiota, improving health, and potentially increasing success in reintroduction processes.


Assuntos
Atelinae/microbiologia , Bactérias/genética , Dieta , Microbioma Gastrointestinal/genética , Animais , Atelinae/genética , Atelinae/fisiologia , Bactérias/classificação , Ingestão de Alimentos/genética , Ingestão de Alimentos/fisiologia , Fezes/microbiologia , RNA Ribossômico 16S/genética
19.
Acevedo-Peña, Juan; Yomayusa-González, Nancy; Cantor-Cruz, Francy; Pinzon-Florez, Carlos; Barrero-Garzón, Liliana; De-La-Hoz-Siegler, Ilich; Low-Padilla, Eduardo; Ramírez-Ceron, Carlos; Combariza-Vallejo, Felipe; Arias-Barrera, Carlos; Moreno-Cortés, Javier; Rozo-Vanstrahlen, José; Correa-Pérez, Liliana; Rojas-Gambasica, José; González-González, Camilo; La-Rotta-Caballero, Eduardo; Ruíz-Talero, Paula; Contreras-Páez, Rubén; Lineros-Montañez, Alberto; Ordoñez-Cardales, Jorge; Escobar-Olaya, Mario; Izaguirre-Ávila, Raúl; Campos-Guerra, Joao; Accini-Mendoza, José; Pizarro-Gómez, Camilo; Patiño-Pérez, Adulkarín; Flores-Rodríguez, Janine; Valencia-Moreno, Albert; Londoño-Villegas, Alejandro; Saavedra-Rodríguez, Alfredo; Madera-Rojas, Ana; Caballero-Arteaga, Andrés; Díaz-Campos, Andrés; Correa-Rivera, Felipe; Mantilla-Reinaud, Andrés; Becerra-Torres, Ángela; Peña-Castellanos, Ángela; Reina-Soler, Aura; Escobar-Suarez, Bibiana; Patiño-Escobar, Bonell; Rodríguez-Cortés, Camilo; Rebolledo-Maldonado, Carlos; Ocampo-Botero, Carlos; Rivera-Ordoñez, Carlos; Saavedra-Trujillo, Carlos; Figueroa-Restrepo, Catalina; Agudelo-López, Claudia; Jaramillo-Villegas, Claudia; Villaquirán-Torres, Claudio; Rodríguez-Ariza, Daniel; Rincón-Valenzuela, David; Lemus-Rojas, Melissa; Pinto-Pinzón, Diego; Garzón-Díaz, Diego; Cubillos-Apolinar, Diego; Beltrán-Linares, Edgar; Kondo-Rodríguez, Emilio; Yama-Mosquera, Erica; Polania-Fierro, Ernesto; Real-Urbina, Evalo; Rosas-Romero, Andrés; Mendoza-Beltrán, Fernán; Guevara-Pulido, Fredy; Celia-Márquez, Gina; Ramos-Ramos, Gloria; Prada-Martínez, Gonzalo; León-Basantes, Guillermo; Liévano-Sánchez, Guillermo; Ortíz-Ruíz, Guillermo; Barreto-García, Gustavo; Ibagón-Nieto, Harold; Idrobo-Quintero, Henry; Martínez-Ramírez, Ingrid; Solarte-Rodríguez, Ivan; Quintero-Barrios, Jorge; Arenas-Gamboa, Jaime; Pérez-Cely, Jairo; Castellanos-Parada, Jeffrey; Garzón-Martínez, Fredy; Luna-Ríos, Joaquín; Lara-Terán, Joffre; Vargas-Fodríguez, Johanna; Dueñas-Villamil, Rubén; Bohórquez-Feyes, Vicente; Martínez-Acosta, Carlos; Gómez-Mesa, Esteban; Gaitán-Rozo, Julián; Cortes-Colorado, Julián; Coral-Casas, Juliana; Horlandy-Gómez, Laura; Bautista-Toloza, Leonardo; Palacios Palacios, Leonardo; Fajardo-Latorre, Lina; Pino-Villarreal, Luis; Rojas-Puentes, Leonardo; Rodríguez-Sánchez, Patricia; Herrera-Méndez, Mauricio; Orozco-Levi, Mauricio; Sosa-Briceño, Mónica; Moreno-Ruíz, Nelson; Sáenz-Morales, Oscar; Amaya-González, Pablo; Ramírez-García, Sergio; Nieto-Estrada, Víctor; Carballo-Zárate, Virgil; Abello-Polo, Virginia.
Acta méd. colomb ; 46(1): 51-72, ene.-mar. 2021. tab, graf
Artigo em Inglês, Espanhol | LILACS, COLNAL | ID: biblio-1278159

RESUMO

resumen está disponible en el texto completo


Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.


Assuntos
Humanos , Masculino , Feminino , Adulto , SARS-CoV-2 , COVID-19 , Embolia e Trombose , Consenso , Anticoagulantes
20.
Rev. colomb. nefrol. (En línea) ; 7(supl.2): 50-69, jul.-dic. 2020. tab
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1251579

RESUMO

resumen está disponible en el texto completo


Abstract Introduction: The numbers of SARS-CoV-2 infection in the pediatric population are low so far. There is limited information about the behavior of SARS-CoV-2 in a pediatric patient with chronic kidney disease. Objective: To formulate informed recommendations to the prevention, diagnosis, and management of SARS-CoV-2 infection in pediatric patients with kidney disease or acute kidney injury associated with COVID-19 in Colombia. Methodology: A rapid systematic review was performed in Embase and Pubmed databases and scientific societies, to answer questions prioritized by clinical experts in pediatric nephrology. The quality of the evidence was evaluated with validated tools according to the type of study. The preliminary recommendations were consulted by an expert group. The agreement was defined when approval was obtained from at least 70% of the experts consulted. Results: A response was obtained from ' 9 experts in pediatric nephrology in Colombia, who declared the conflict of interest before the consultation. The range of agreement for the recommendations ranged from 78.9% to '00%. The recommendations did not require a second consultation. Conclusion: The evidence-based recommendations for the management of a patient with kidney disease and COVID-19 in the Colombian context are presented.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Pediatria , COVID-19 , Pacientes , Sociedades Científicas , Colômbia , Insuficiência Renal Crônica , Injúria Renal Aguda , Nefrologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...