ABSTRACT
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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.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Pediatrics , COVID-19 , Patients , Societies, Scientific , Colombia , Renal Insufficiency, Chronic , Acute Kidney Injury , NephrologyABSTRACT
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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.
Subject(s)
Humans , Male , Female , COVID-19 , Patients , Colombia , Diagnosis , Acute Kidney InjuryABSTRACT
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.
Subject(s)
Humans , Male , Female , Renal Insufficiency, Chronic , COVID-19 , Patients , Renal Dialysis , Colombia , DiagnosisABSTRACT
Los ácidos linoleicos conjugados (CLAs) son microcomponentes naturales de la grasa láctea de los rumiantes que han ganado un creciente interés por sus efectos potenciales sobre la salud humana. El ácido ruménico (CLA cis-9, trans-11 C18:2) es la iso-forma de CLA más importante por su abundancia y por sus efectos. Nuestro objetivo fue la identificación y cuantificación del ácido ruménico en la grasa láctea de la sabana de Bogotá, y la búsqueda de algunas relaciones entre la dieta y las concentraciones de A. ruménico, utilizando diecisiete muestras de leche de diferentes fincas de la sabana de Bogotá y cuatro muestras de leches de marcas comerciales. Para esto, se estandarizó un método de cromatografía de gases que permitió separar y cuantificar más de 30 ácidos grasos, desde el butírico (C4:0) hasta el araquídico (C20:0) y el ruménico (C18:2). La concentración promedio de ácido ruménico fue 13.6 mg/g de grasa, y varió desde 6.38 mg hasta 19.54 mg/g. Estos resultados son coherentes con otros reportes de literatura realizados bajo pastoreo y se ubican dentro de los valores esperados para condiciones de alimentación como las de este estudio. La suplementación de MS, el consumo de forrajes conservados, el consumo de ensilaje de maíz, y el consumo de semilla de algodón tuvieron una correlación negativa con la concentración de ácido ruménico (valores de r de -0.66, -0.54, -0.48 y -0.7, respectivamente), sin embargo, los valores de los coeficientes de determinación (r2) fueron bajos para estas variables, sugiriendo que cada variable puede tener efectos, pero, de manera individual, ninguna explica completamente la variación en la concentración de ácido ruménico. Se observó una disminución del contenido de ácido ruménico con el aumento de la suplementación bajo pastoreo, especialmente cuando esta incluye ensilaje de maíz y una tendencia a la disminución del contenido de ácido ruménico con el aumento en el consumo de semilla de algodón.
Conjugated linoleic acids are natural micro-components of ruminants fat milk, which have gained an increasing interest because of their valuable potential effects on human health. Rumenic acid (CLA cis-9, trans-11 C18:2) is the most important of the CLA iso-forms because of its abundance and its effects. Our main objective was the identification and quantification of the rumenic acid content of fat in milks of the Bogotá savannah. Additionally, we looked for associations between dietary factors and rumenic acid concentration. In this study, seventeen milk samples coming from the Bogotá savannah and four commercial milk samples were used. A gas chromatography method that allowed us to separate and quantify more than thirty fatty acids, from butyric (C4:0) to araquidic (C20:0) and rumenic acid (conjugated 18:2) was standardized. The mean rumenic acid content of the samples was 13.6 mg/g of fat, and ranged from 6.38 mg to 19.54 mg/g of fat (3 fold variation). These results showed similar values to other literature reports conducted under grazing conditions and are in the expected range for the amount consumed by the cows. The correlation (r) values were significant for dry matter supplementation, conserved forages supplementation, silage intake, and cotton seed intake and had a negative correlation with the rumenic acid content of fat milk (r values of -0.62, -0.54, -0.48 and -0.7, respectively). However, the values for the determination coefficients (r2) of these variables were very low, suggesting that each variable had individual effect, although none of them explains completely the variation of the rumenic acid content in fat milk. In general, a clear tendency to a decrease in rumenic acid content was observed with an increase in supplementation under grazing conditions, especially when corn silage was included.