Autosomal dominant polycystic kidney disease in Colombia.

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.

Hemodialysis vs Peritoneal Dialysis: Comparison of Net Survival in Incident Patients on Chronic Dialysis in Colombia.

BACKGROUND: In the area of nephrology, the practical application of relative survival methodologies can provide information regarding the impact of outcomes for patients with kidney failure on dialysis compared with what would be expected in the absence of this condition. OBJECTIVE: Compare the net survival of hemodialysis (HD) and peritoneal dialysis (PD) patients in a cohort of incident patients on chronic dialysis in Colombia, according to the dialysis therapy modality. DESIGN: Observational, analytic, historical cohort. SETTING: Renal Therapy Services (RTS) clinic network across Colombia. PATIENTS: Patients over 18 years old with chronic kidney disease, incidents in dialytic therapy, which reached day 90 of therapy. Recruitment took place from January 1, 2008, to December 31, 2013, with a follow-up until December 31, 2018. The final cohort for analysis corresponds to a total of 12 508 patients, of which 5330 patients (42.6%) began HD and 7178 patients (57.4%) began PD. MEASUREMENTS: Demographic, socioeconomic, and clinical variables were measured. METHODS: Analyses were conducted according to the treatment assigned (PD or HD) at the time of the inception of the cohort and another approach of analysis was done with a subsample of those patients who never changed the initial modality. To calculate expected survival, life tables were constructed for Colombia for the years 2006 to 2018. Net survival estimates were made using the Pohar Perme estimator. The comparison of the net survival curves was done using the method developed by Pavlic and Perme, the log-rank type. RESULTS: Net survival at 5 years compared with the general population was estimated at 0.53 (95% confidence interval 0.52-0.54) in the dialysis cohort. In intention-to-treat analyses of 7178 patients on PD and 5330 patients on HD, by global and Pohar-Perme methods, survival (expressed as a ratio of survival in patients on dialysis to survival in an age-, sex- and geographic-matched general Colombian population) was higher in patients on HD than in those on PD. In year 1, net survival by Pavlov-Perme on PD was 0.79 (95% confidence intervals [CI] 0.78 - 0.80) and on HD 0.85 (95% CI 0.84 - 0.86); in year 5, 0.36 (95% CI 0.34 - 0.38) and 0.57 (95% CI 0.55 - 0.59) for PD and HD respectively. LIMITATION: There may be imbalances among the populations analyzed (HD vs PD), in which one or more variables other than the type of therapy may influence the survival of the patients. In Colombia there are marginal levels of underreporting of demographic data in some subpopulations that may affect life-tables construction. CONCLUSION: An important difference was observed in terms of survival between the dialysis population and the population of reference without dialysis. Statistically significant differences were found in net survival between HD and PD, net survival was higher in patients on HD than in those on PD.

CONTEXTE: En néphrologie, l'application pratique des méthodologies de survie relative peut fournir des renseignements sur l'impact des résultats des patients atteints d'insuffisance rénale suivant des traitements de dialyse comparativement à ce qui serait attendu en l'absence de cette affection. OBJECTIF: Comparer la survie nette, selon la modalité de dialyse, dans une cohorte de patients colombiens traités par hémodialyse (HD) ou par dialyse péritonéale (DP) de façon chronique. TYPE D'ÉTUDE: Étude de cohorte observationnelle, analytique et historique. CADRE: Le réseau Renal Therapy Services (RTS) de la Colombie. SUJETS: Des patients adultes souffrant d'insuffisance chronique ayant nouvellement débuté la dialyse depuis plus de 90 jours. Le recrutement a eu lieu du 1er janvier 2008 au 31 décembre 2013, et le suivi s'est poursuivi jusqu'au 31 décembre 2018. L'analyse porte sur un total de 12 508 patients, dont 5 330 (42,6 %) avaient entrepris des traitements d'hémodialyse et 7 178 (57,4 %) de dialyse péritonéale. MESURES: Les données démographiques, socio-économiques et cliniques des patients. MÉTHODOLOGIE: Les analyses ont été menées en fonction du traitement attribué (DP ou HD) au moment de la création de la cohorte. Une autre analyse a été réalisée sur un sous-échantillon de patients n'ayant jamais changé la modalité depuis le début du traitement. Des tables de survie spécifiques à la Colombie entre les années 2006 et 2018 ont été élaborées pour calculer la survie attendue. Les estimations de survie nette ont été faites en utilisant l'estimateur de Pohar Perme. Et la méthode développée par Pavlic et Perme, soit le test du log-rank a servi à la comparaison des courbes de survie nette. RÉSULTATS: La survie nette après cinq ans, comparée à celle de la population générale, a été estimée à 0,53 (IC 95 %: 0,52 à 0,54) dans la cohorte de patients dialysés. Dans les analyses en intention de traiter portant sur 7 178 patients sous HD et 5 330 patients sous DP ­ réalisées par méthode globale et avec l'estimateur Pohar Perme ­ la survie (exprimée sous forme de rapport entre la survie de patients dialysés et la survie de Colombiens de la population générale du même âge, sexe et région géographique) s'est avérée plus élevée chez les patients sous HD que chez les patients sous DP. Au cours de la première année, la survie nette (Pavlov Perme) des patients sous DP s'établissait à 0,79 (IC 95 % : 0,78-0,80) et celle des patients sous HD à 0,85 (IC 95 % : 0,84-0,86); après cinq ans, elle était passée à 0,36 (IC 95 % : 0,34-0,38) pour les patients sous DP et à 0,57 (IC 95 % : 0,55-0,59) pour les patients sous HD. LIMITES: Il pourrait exister des disparités parmi les populations analysées (HD vs DP), où des variables autres que la modalité pourraient influencer la survie des patients. Il existe, dans certaines sous-populations de Colombie, des niveaux marginaux de sous-déclaration des données démographiques qui pourraient affecter l'élaboration des tables de survie. CONCLUSION: Une différence importante a été observée entre la survie des patients dialysés et celle d'une population de référence (personnes non dialysées). On a également constaté des différences statistiquement significatives entre le groupe sous HD et le groupe sous DP en ce qui concerne la survie nette, laquelle s'est avérée plus élevée chez les patients sous HD.

Validación de material educativo del programa "Niñ@s en Movimiento" para el tratamiento de la obesidad infantil / Validation of educational material of the "Niñ@s en Movimiento" program for the treatment of childhood obesity / Avaliação de material educativo do programa "Menin@s em Movimento" para o tratamento do sobrepeso infantil

Resumen Objetivo: Validar, en un contexto colombiano, el contenido de la primera cartilla del programa "Niñ@s en Movimiento" (diseñada en España), dirigida a padres o cuidadores, y a los niños que padecen sobrepeso u obesidad, disponible en internet con acceso libre. Metodología: Investigación cualitativa. Tras el proceso de selección, participaron 14 niños con sobrepeso y sus padres o cuidadores, del Colegio Básico "Camino de Paz" de Medellín. Para la clasificación de los datos antropométricos se utilizó el programa de la Organización Mundial de la Salud. Para la validación de la cartilla se elaboró una guía de preguntas y se realizaron grupos focales; se usaron los criterios de atractividad, entendimiento, identificación, aceptación e inducción a la acción. Los datos se analizaron mediante el software spss® versión 21.0, y un protocolo de análisis de datos. Resultados: En la sección "La importancia del desayuno", del material educativo, algunos padres o cuidadores manifestaron que es necesario indicar la forma adecuada para preparar los alimentos, en qué condiciones y qué cantidad deben servirles a sus hijos, lo cual no es claro en la cartilla. Respecto a los niños, en las secciones "Mis desayunos" y "Clasificación de los alimentos" se encontró que las palabras técnicas dificultan la comprensión; además, al hablar de la clasificación de alimentos, algunos no los han visto ni consumido. En la evaluación de los criterios por parte del padre o cuidador, el entendimiento fue mal calificado, porque no son claros algunos términos; los niños también calificaron negativamente este criterio, por la dificultad para entender vocabulario desconocido debido a su contexto extranjero. Conclusiones: El desayuno, aunque es un hábito establecido, puede mejorar; sin embargo, las orientaciones de la cartilla tendrían que adaptarse al lenguaje y a la cultura alimentaria local, para que las recomendaciones mejoren la aplicabilidad de este recurso educativo.

Abstract Objective: To validate the content of the first booklet "Niñ@s en Movimiento" (designed in Spain), in the Colombian setting, targeting parents or caretakers, and overweight or obese chil dren, which is available free online. Methodology: Qualitati ve research. After a selection process, 14 overweight children and their parents or caretakers were selected to participate. The children were students at the Colegio Básico "Camino de Paz" School in Medellin. To classify anthropometric data, the study used the World Health Organization program. To validate the booklet, a question guideline was drawn up and focus groups were held. The criteria used included attraction, comprehen sion, identification, acceptance and induction to action. Data were analyzed using the SPSS® software Version 21.0, and a data analysis protocol. Results: In the section "the impor tance of breakfast", in the educational material, some parents or caretakers stated that it is necessary to indicate an adequa te way to prepare food, how to serve it and the amounts that they should their children, which is not clear in the booklet. Regarding the children, in the sections "my breakfasts" and "food classification", there were technical words that compli cated comprehension. Furthermore, when talking about food classification, there are foods they have not seen nor eaten. In the parent or caretaker criteria evaluation, comprehension was poorly scored, as some of the terms were not clear. The children also ranked negatively this criterion. Vocabulary was difficult to understand because it had a foreign context. Con clusions: Breakfast, although an established habit, can impro ve; nevertheless, the guidelines of the booklet would have to be adapted to local language and food culture so that these recommendations may improve the applicability of this edu cational resource.

Resumo Objetivo: Avaliar, num âmbito colombiano, o conteúdo da primeira apostilha do programa "Menin@s em Movimento" (desenhada na Espanha), voltada aos pães ou cuidadores, e aos meninos que padecem sobrepeso ou obesidade, disponível na internet com ingresso libre. Metodologia: Investigação qua litativa. Trás o processo de escolha, participaram 14 meninos com sobrepeso e os seus pães ou cuidadores, da Escola Básica "Caminho de Paz" do Medellín. Para a classificação dos da dos antropométricos se utilizou o programa da Organização Mundial da Saúde. Para a avaliação da apostilha se elaborou uma guia de perguntas e se realizaram grupos focais; se usaram os critérios de atratividade, entendimento, identificação, acei tação e indução pra ação. Os dados se analisaram mediante o software SPSS® versão 21.0, e um protocolo de análises de dados. Resultantes: Na seção "A importância do dejejum", do material educativo, alguns pães ou cuidadores manifestaram que é quesito indicar o jeito mais pertinente na preparação dos alimentos, em que condições e qual quantidade devem servir-lhes aos seus filhos, o qual não apresenta clareza na cartilha. Aludindo aos meninos, nas secções "Meus cafés da manhã" e "Classificação dos alimentos" se encontrou que as expressões técnicas dificultam a compreensão; além disso, ao mencionar a classificação dos alimentos, alguns nem os conhecem nem consumiram jamais. Na avaliação dos critérios por parte do pai ou cuidador, ou entendimento foi mal qualificado, porque não são simples alguns termos; os meninos também qualificaram negativamente este critério, pela dificuldade para compreender glossário desconhecido devido ao seu contexto estrangeiro. Conclusões: O dejejum, ainda que é um hábito estabelecido, pode melhorar; contudo, as dicas do caderno teriam que se customizar com a linguajem e as tradições alimentares locais, para que as recomendações melhorem a aplicabilidade de este recurso educativo.

Sistemas de liberación controlada de antimicrobianos en periodoncia: revisión de literatura / Drug delivery systems in periodontics: review of the literature

El uso de los antibióticos ha sido uno de los pilares en el tratamiento de muchas enfermedades entre ellas la enfermedad periodontal, en algunas ocasiones la efectividad del antibiótico se pierde por la baja liberación de éste en el área en donde se necesita. Los sistemas de liberación local(SDL- drug delivery systems) controlada de medicamentos pretenden mantener una concentración adecuada del medicamento en el área a tratar. Estos SDL son sistemas compuestos por un agente bioactivo incorporado en un vehículo, el cual es usualmente un polímero o una biocerámica; estos han tenido, entre muchas otras aplicaciones, mayor utilidad en terapias oculares, control natal y periodoncia. Este artículo tiene como propósito revisar las características de los sistemas deliberación controlada de medicamentos, sus vehículos y sus posibles aplicaciones en pacientes con periodontitis.

The use of antibiotics has been widely reported as one of main approaches for treatment of many diseases including periodontal disease. In some instances however, its effectiveness is lost dueto the lack of a slow release in the area where it is needed. Local drug delivery systems (SDL) seek to maintain an appropriate concentration of the medication in the treated area. SDL systems consist of a bioactive agent incorporated into a vehicle, which is usually a polymer or a bioceramic which have among many other applications, use for ocular therapies, birth control and periodontics.The purpose of this paper is to review the characteristics of SDL systems, their characteristics, vehicles and their possible use in patients with periodontitis.