Anosmia como manifestación inicial de COVID-19 en pacientes de hemodiálisis

Contexto Los pacientes en hemodiálisis son una población susceptible para la enfermedad causada por el SARS-CoV-2, enfermedad por el coronavirus 2019 (COVID-19), siendo el diagnóstico temprano una necesidad urgente por considerarse una población de riesgo por presentar cuadros severos y graves. Objetivo Estimar si la anosmia de inicio súbito permite una detección temprana de la infección por COVID-19, en pacientes de hemodiálisis sin síntomas clásicos (que no presentaron malestar general, síntomas respiratorios o gastrointestinales al inicio de la enfermedad). Metodología Se realizó un estudio de prueba diagnóstica durante los meses de septiembre y octubre del 2020 en tres unidades de hemodiálisis en Colombia. Fueron incluidos pacientes adultos, sin síntomas clásicos para COVID-19. Se excluyó a los pacientes con infección previa por COVID-19 o con antecedentes de alteración del olfato. Se recolectaron datos demográficos, clínicos y de laboratorio, previa firma de consentimiento informado avalado por el comité de ética (CEI-487). La anosmia se exploró con una prueba subjetiva para detección de olores antes del inicio de la hemodiálisis. Resultados Se incluyeron 587 pacientes. La prevalencia de anosmia fue de 0,85 % (cinco pacientes) y una incidencia de COVID-19 de 1,19 % (siete pacientes). No hubo diferencia estadística al comparar las variables demográficas, clínicas y de laboratorio entre pacientes con y sin anosmia. La presencia de anosmia tuvo una sensibilidad y un valor predictivo positivo del 0 %, pero una especificidad del 99,14 % y un valor predictivo negativo del 98,8 %. La exactitud fue del 97,9 %. Conclusiones La prevalencia de anosmia en nuestra población de hemodiálisis fue baja. Se debería indagar en el triaje cualquier síntoma (incluida la alteración del sentido del olfato) como estrategia para detectar de forma temprana casos individuales de COVID-19 o un brote en las unidades de hemodiálisis.

Background Hemodialysis patients are susceptible population for COVID-19 the disease caused by SARS-CoV-2, with early diagnosis being an urgent and needed because they are considered a population with high risk for severe and serious conditions. Purpose The objective of our study was to estimate whether sudden-onset anosmia allow to detect COVID-19 infection early in hemodialysis patients without classic symptoms (who did not present malaise, respiratory or gastrointestinal symptoms at the beginning of the disease). Methodology A diagnostic test study was accomplished during the months of September and October 2020 in three hemodialysis units in Colombia. Adult patients without classic symptoms for COVID-19 were included. Patients with previous COVID-19 infection or with a history of smell alteration were excluded. Demographic, clinical, and laboratory data were collected, prior signature of informed consent endorsed by the ethics committee. Anosmia was evaluated with objective test for odor detection before the start of hemodialysis session. Results 587 patients were included. Anosmia prevalence was 0.85% (5 patients) and the incidence of COVID-19 was 1.19% (7 patients). There was no statistically difference in demographic, clinical, and laboratory comparison between patients with and without anosmia. The presence of anosmia had a sensitivity and a positive predictive value of 0%, but a specificity of 99.14% and a negative predictive value of 98.8%. The accuracy was 97.9%. Conclusions The prevalence of anosmia in our hemodialysis population was low. Any symptoms (including altered sense of smell) should be investigated in TRIAGE as a strategy to detect early individual cases of COVID-19 or an outbreak in hemodialysis units.

Cistitis hemorrágica por adenovirus en trasplante renal: revisión epidemiológica y resultados clínicos

Contexto la infección de vías urinarias (IVU), causada por adenovirus (ADV) posterior al trasplante renal, tiene el potencial de causar disfunción o pérdida del injerto. La presentación clínica es variable y el tratamiento difiere según la disponibilidad de medicamentos en el medio y la experiencia clínica. Objetivo el estudio describe las características clínicas, de laboratorio y la respuesta al tratamiento de una serie de casos de pacientes trasplantados renales con IVU por ADV en un hospital de Cali, Colombia. Metodología estudio retrospectivo que incluye a todos los pacientes adultos trasplantados con diagnóstico de IVU por ADV entre enero del 2015 hasta enero del 2021. El diagnóstico se realizó basado en la clínica, el resultado positivo de la prueba de reacción de cadena de polimerasa (PCR) y la carga viral del ADV. Resultados de 256 pacientes trasplantados, ocho presentaron diagnóstico de cistitis hemorrágica o nefritis intersticial secundaria a infección por ADV. Se presentó de forma temprana (≤ 3 meses) en el 62 % de los casos, quienes debutaron con macrohematuria asociada a piuria estéril y linfopenia. Por otra parte, se presentó alteración en la función renal en el 87,5 % de los casos y la reducción de la inmunosupresión fue el pilar fundamental en el manejo clínico. Conclusiones el reconocimiento de la infección por ADV en pacientes trasplantados renales ha ido en aumento. La sospecha clínica es clave para el diagnóstico (macrohematuria, síntomas urinarios irritativos y falla renal) y la reducción de la dosis de inmunosupresión para restaurar la función inmune puede ser suficiente en la resolución de la infección y la reversión de la disfunción renal.

Introduction Urinary tract infection (UTI) caused by adenovirus (ADV) after kidney transplantation has the potential to cause graft dysfunction or loss. The clinical presentation is variable, from an asymptomatic course to a multisystemic compromise. Treatment varies based on the availability of different medications and clinical experience. Objective The study describe the clinical, laboratory characteristics and results of a series of cases of kidney transplant patients with hemorrhagic cystitis secondary to ADV infection in a hospital in Cali, Colombia. Methods Retrospective study based on the records of patients with a diagnosis of UTI caused by ADV between January 2015 to January 2021 were included. The diagnosis was made by clinical suspicion and polymerase chain reaction (PCR) - Adenovirus DNA viral load. Results Of 256 transplant patients, eight patients had a diagnosis of hemorrhagic cystitis or interstitial nephritis secondary to ADV infection. It presented early (≤ 3 months) in 62%, who presented with macrohematuria, associated with sterile pyuria and lymphopenia. Alterations in renal function were presented in 87.5%. The reduction of immunosuppression was the fundamental pillar in the management. Conclusions The recognition of ADV infection in kidney transplant patients has been increasing. Clinical suspicion is the key for the diagnosis, with a predominance of macrohematuria, irritative urinary symptoms and kidney graft dysfunction. Reducing the dose of immunosuppression by restoring immune function may be sufficient in resolving the infection and reversing renal dysfunction.

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

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

Evaluación de suplementos alimenticios conteniendo torta de higuerilla sobre la degradación in situ de dietas con pasto kikuyo y la producción lechera en vacas Holstein / Evaluation of dietary supplements containing castor cake on in situ degradation, diets with Kikuyu grass and dairy production in Holstein cows / Avaliação de suplementos dietéticos contendo torta do higuerilla na degradação in situ dietas com grama Kikuyu e produção leiteira em vacas Holstein

Resumen La torta de higuerilla es un subproducto protéico proveniente de la extracción mecánica del aceite de ricino, la cual podría remplazar fuentes proteicas importadas en suplementos para ganado lechero. Se realizaron dos experimentos con el propósito de evaluar el efecto de la suplementación con torta de higuerilla sobre la degradación in situ de la MS, PB, FDN y la producción de leche de vacas Holstein. En el experimento 1, se utilizaron tres vacas fistuladas al rumen, bajo un diseño experimental de bloques completos al azar. Se evaluaron cinco suplementos con cinco niveles de inclusión de torta de higuerilla (0, 8, 16, 24 y 32%), los cuales conformaron parte de cinco dietas compuestas por 70% de pasto Cenchrus clandestinus y 30% del respectivo suplemento. La inclusión entre 8 y 16% de torta de higuerilla en el suplemento no afectó (P>0,05) los parámetros de degradación de las fracciones evaluadas. En el experimento 2, se evaluó un suplemento alimenticio conteniendo 10% de torta de higuerilla tratada con CaOH2 sobre el consumo de forraje, producción y calidad de la leche en vacas Holstein en el primer tercio de lactancia, comparándolo con un concentrado conteniendo 10% de torta de soya. Se utilizaron ocho vacas, las cuales fueron asignadas aleatoriamente a uno de dos tratamientos, en un diseño experimental de Sobre Cambio o Change-Over Simple o Cross-Over 2 x 2. La suplementación con concentrado conteniendo 10% de torta de higuerilla tratada con CaOH2, no afecto el consumo de MS, la producción y composición de la leche.

Abstract Meat castor cake is a protein byproduct from the mechanical extraction of castor oil, which could replace imported protein sources in dairy supplements. Two experiments were carried out with the purpose of evaluating the effect of the supplementation with castor cake on the in situ degradation of DM, CP, NDF and milk yield of Holstein cows. In experiment 1, three rumen fistulated cows were used, under an experimental design of complete random blocks. Five supplements were evaluated with five levels of inclusion of castor cake (0, 8, 16, 24 and 32%), which formed part of five diets composed of 70% of grass kikuyo, Cenchrus clandestinus and 30% of the respective supplement. The inclusion of 8 to 16% of castor cake in the supplement did not affect (P> 0.05) the degradation parameters of the fractions evaluated. In experiment 2, a feed supplement containing 10% CaOH2-treated castor cake was evaluated for feed intake, milk yield and quality in Holstein cows in the first third of lactation, comparing it to a concentrate containing 10% soy cake. Eight cows were used, which were randomly assigned to one of two treatments, in an experimental or Change-Over Simple or 2 x 2 Cross-Over design. Supplementation with concentrate containing 10% of castor cake treated with CaOH2 did not affect DM consumption, milk production and composition.

Resumo O torta do Higuerilla é um subproduto de proteína da extração mecânica do óleo de rícino, que pode substituir as fontes de proteína importadas em suplementos de produtos lácteos. Foram realizados dois experimentos com o objetivo de avaliar o efeito da suplementação com torta de higuerilla sobre a degradação in situ de DM, CP, NDF e produção de leite de vacas Holstein. No experimento 1, foram utilizadas três vacas fissuladas no rúmen, sob um delineamento experimental de blocos completos ao acaso. Cinco suplementos foram avaliados com cinco níveis de inclusão de torta de higuerilla (0, 8, 16, 24 e 32%), que faziam parte de cinco dietas composta por 70% de grama Cenchrus clandestinus e 30% do respectivo suplemento. A inclusão de 8 a 16% de bolo no suplemento não afetou (P> 0,05) os parâmetros de degradação das frações avaliadas. No experimento 2, foi avaliado um suplemento alimentar contendo bolo de manga de 10% tratado com CaOH2 quanto à ingestão de alimentos, rendimento e qualidade do leite em vacas Holstein no primeiro terço da lactação, comparando-o com um concentrado contendo 10% Bolo de soja Foram utilizadas oito vacas, que foram distribuídas aleatoriamente para um dos dois tratamentos, em um projeto experimental de Over Change ou Over-Change ou Cross-Over 2 x 2. Suplemento de concentrado contendo 10% de bolo de manga manchado com CaOH2 , não afetaram o consumo de DM, a produção de leite e a composição.

Calcificación de aorta abdominal de pacientes en hemodiálisis en una unidad renal / Calcification of the abdominal aorta in patients on hemodialysis in a renal unit

Objetivo: describir la prevalencia de calcificaciones de aorta abdominal y factores de riesgo relacionados de pacientes en hemodiálisis en una unidad renal de la ciudad de Cali. Introducción: las calcificaciones vasculares son prevalentes en pacientes con enfermedad renal crónica (ERC). Los pacientes en hemodiálisis presentan mayor riesgo de mortalidad cardiovascular y factores como la edad, enfermedades asociadas y algunas alteraciones metabólicas incrementan el riesgo de calcificaciones vasculares. Material y métodos: se incluyeron 47 pacientes en hemodiálisis mayores de 18 años y con más de tres meses en hemodiálisis. La radiografía lumbar lateral fue usada para evaluar las calcificaciones de los segmentos L1 a L4 utilizando un puntaje para su cuantificación y un único observador entrenado. Se realizaron mediciones de calcio, fósforo, PTH, colesterol, triglicéridos en sangre y tensión arterial. Fue utilizado análisis de regresión para determinar asociaciones entre las calcificaciones de aorta abdominal y las características de los pacientes. Resultados: se encontró que la edad promedio fue de 60,8 años (rango 25-84), el 57.4% fueron mujeres, el tiempo promedio en hemodiálisis 44.6 meses (rango 3-156). El 63.8% de los pacientes presentaron calcificaciones en algún segmento de la aorta abdominal. Se encontró que a mayor edad (P = 0.0006) y menor tensión arterial diastólica (TAD) (P = 0.036), el riesgo de prevalencia de calcificación es mayor. Conclusiones: la calcificación de aorta abdominal es prevalente en los pacientes con ERC en hemodiálisis. Factores como la edad y la disminución de la TAD se encontraron asociadas al grupo de calcificaciones. La radiografía lumbar lateral es una herramienta ampliamente disponible y menos costosa que puede ser tenida en cuenta en el tratamiento y evaluación de riesgo cardiovascular en los pacientes en hemodiálisis y como predictor de complicaciones. (Acta Med Colom 2012; 37: 14-20).

Objective: to describe the prevalence of abdominal aortic calcifications and risk factors in patients on hemodialysis in the renal unit Imbanaco Medical Center in the city of Cali. Background: vascular calcification is prevalent in patients with chronic kidney disease. Hemodialysis (HD) patients are at increased risk of cardiovascular mortality and factors such as age, associated diseases and some metabolic abnormalities increase the risk of vascular calcification. Material and methods: we included 47 hemodialysis patients over 18 years and more than three months in dialysis. The lateral lumbar radiography was used to assess the calcification of the segments L1 to L4 using a score for quantification and a single trained observer. Regression analysis was used to determine associations between AAC and patient characteristics. Results: median age of patients was 60.8 years (range 25-84), 57.4% were female, median duration of HD 44.6 months (range 3-156). We found that in 63.8% of patients had calcifications in any segment of the abdominal aorta. We found that older age (P = 0.0006) and lower diastolic blood pressure (DBP) (P = 0.036) the risk is greater prevalence of calcification. Conclusions: abdominal aortic calcification is prevalent in patients with CKD on hemodialysis. Factors such as age and decreased DBP were associated with the group of calcifications.The lateral lumbar radiograph is a tool widely available and less expensive than can be taken into account in the assessment of cardiovascular risk in hemodialysis patients and as a predictor of complications. (Acta Med Colom 2012; 37: 14-20).

Biological control of Rhizoctonia solani in tomatoes with Trichoderma harzianum mutants

Biocontrol of Rhizoctonia solani in tomatoes cultivated under greenhouse and field conditions was analyzed using the Trichoderma harzianum mutants Th650-NG7, Th11A80.1, Th12A40.1, Th12C40.1 and Th12A10.1 and ThF2-1, respectively. Their innocuousness on tomato cultivars 92.95 and Gondola (greenhouse assays), and on cultivar Fortaleza (field assays) was established. Alginate pellets (1.7 g pellets/L soil) containing c.a1 x 10(5) colony forming units (cfu)/g pellet were applied to a soil previously inoculated with R. solani at transplant (greenhouse) or to a naturally infected soil (field). Controls considered parental wild strains, a chemical fungicide and no additions. Th11A 80.1, Th12A10.1 and Th650-NG7 prevented the 100% mortality of tomato plants cv. 92.95 caused by R. solani, and the 40% mortality in tomato plants cv. Gondola (greenhouse assays). Mortality reduction was reflected in canker level lessening and in plant parameters increases (development, fresh and dry weights). A different degree of susceptibility of tomato plants was observed, being Gondola cv. more resistant than 92.95 cv. to infection in a soil previously inoculated with R. solani. Tomato plants of cv. Fortaleza did not show mortality in naturally infected soils (field assays), where the mutant ThF2-1 reduced significantly the canker level caused by R. solani.

Prevalencia de anticuerpos contra el virus de hepatitis C en unidades de diálisis de Cali-Colombia / Prevalence of anti-HCV antibodies among patients on dialysis in Cali-Colombia

Los pacientes con falla renal terminal en proceso de diálisis tienen un riesgo mayor de infección por el virus de la hepatitis C que la población general. El presente estudio se realizó con el objetivo de determinar la prevalencia actual de anticuerpos contra el virus de la hepatitis C en los pacientes que asisten a terapia dialítica en las unidades de diálisis de Cali. Se estudiaron 999 pacientes y se encontraron 29 (2,9%) con anti-HCV reactivo mediante la prueba de Elisa de 3ª generación en estos pacientes; el RNA viral fue detectado por técnica de Real Time-PCR cualitativo-Amplicor Monitor 2.0 Roche Molecular Systems en 26 casos (89%). Conclusión: La prevalencia actual de anticuerpos contra el virus de la hepatitis C en las unidades de diálisis de Cali es muy baja (2,9%), y es comparable a lo reportado en países industrializados.

The prevalence of anti-HCV antibodies among patients on dialysis is consistently higher than in healthy populations, suggesting that dialysis patients may be at higher risk of acquiring HCV infection. The aim of our study was to determinate the prevalence of anti-HCV antibodies in patients whom attend to dialysis facilities in Cali, Colombia. 999 patients were tested using the third generation enzyme linked immunosorbent assay (ELISA-3), 29 patients were Anti-HCV positive (2,9% prevalence). All Anti-HCV positive patients were tested to detect the HCV- RNA using a real time-PCR qualitative test (Amplicor Monitor 2.0 Roche Molecular Systems), 26/29 patients were HCV-RNA positive (89%). Conclusions: The prevalence of anti-HCV antibodies in the dialysis facilities in Cali (2.9%) is very similar to the prevalence reported by industrialized countries.

Biocontrol capacity of wild and mutant Trichoderma harzianum (Rifai) strains on Rhizoctonia solani 618: effect of temperature and soil type during storage

Wild (Th11, Th12 and Th650) and mutant (Th11A80.1, Th12A40.1, Th12C40.1 and Th650-NG7) Trichoderma harzianum strains were stored for 180 days at 5ºC or at 22ºC, in two types of soils. Strains recovered at 90, 120 and 180 days from the two types of soils, retained their full capacity to biocontrol Rhizoctonia solani 618, that produces crown and root rot of tomatoes. Recovery, estimated as colony forming units (cfu) of the wild and mutant strains, showed that all increased their cfu after storage independently of the type of soil and temperature, although kinetic behavior differed among strains. Ratios of recovery after storage in type B soil/ type A soil or at 22ºC/5ºC, higher or lower than one respectively, allowed to establish that Th11 and Th12 were the most appropriate strains for the biocontrol of R. solani in conditions where growth of the phytopathogen is optimal.