Consenso colombiano de expertos sobre recomendaciones informadas en la evidencia para la prevención, diagnóstico y manejo de la infección por SARS-CoV-2/COVID-19 en paciente pediátrico con enfermedad renal crónica o lesión renal aguda asociada a COVID-19 / Colombian consensus of experts on evidence-informed recommendations for the prevention, diagnosis, and management of SARS-CoV-2 / COVID-19 infection in pediatric patients with chronic kidney disease or acute kidney injury associated with COVID-19

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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.

Absceso cerebral por Cladophialophora bantiana en un paciente con trasplante renal: reporte de un caso / Brain abscess caused by Cladophialophora bantiana after renal allograft loss: A case report

Resumen Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.

Abstract Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections. Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests. We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.

Inmunosupresores y principales complicaciones en el trasplante renal pediátrico / Imunossupressores e principais complicações no transplante renal pediátrico / Immunosuppressive drugs and major complications in pediatric renal transplantation

El trasplante renal pediátrico es el tratamiento de elección en los niños con enfermedad renal crónica terminal. Muchos agentes se utilizan en dos regímenes de terapia inmunosupresora, primero en una fase de inducción y posteriormente para el mantenimiento. Existen dos estrategias para disminuir el riesgo de rechazo del injerto renal: la primera consiste en suministrar altas dosis de los inmunosupresores convencionales, y la segunda, en la utilización en la fase de inducción de anticuerpos monoclonales o policlonales contra antígenos de los linfocitos T. Los dos anticuerpos policlonales más usados son las globulinas antitimocito de caballo (ATGAM) y de conejo (rATG). Los anticuerpos monoclonales más usados son aquellos contra el receptor de IL-2 (basiliximab y daclizumab) y el dirigido contra el antígeno CD52 (alemtuzumab). La terapia de mantenimiento consiste en un esquema que combina el uso de tres drogas inmunosupresoras convencionales: glucocorticoides, inhibidores de la calcineurina, inhibidores de mTOR y antiproliferativos. Entre las principales complicaciones del trasplante renal pediátrico están: rechazo agudo del injerto, infecciones virales (por poliomavirus-BK y citomegalovirus) y aparición del trastorno linfoproliferativo postrasplante (PTLD, por la sigla en inglés de Post-transplant lymphoproliferative disorder).

Pediatric renal transplantation is the treatment of choice in children with chronic kidney disease. Many agents are available for immunosuppressive therapy, which are used in two different regimes: first for the induction phase, and then for maintenance. There are two strategies for reducing the risk of renal graft rejection: the first is the use of high doses of conventional immunosuppressive agents, and the second is the use in the induction phase of monoclonal or polyclonal antibodies against antigens of T cells. The two most frequently used polyclonal antibodies are horse and rabbit anti-thymocyte globulins, ATGAM and rATG, respectively. The most frequently used monoclonal antibodies are those against IL-2 receptor (basiliximab and daclizumab) and the one against antigen CD52 (alemtuzumab). Maintenance therapy is a scheme that combines the use of three conventional immunosuppressive drugs: glucocorticoids, calcineurin inhibitors, mTOR inhibitors and antiproliferatives. The following are among the major complications of renal transplantation: acute graft rejection, viral infection (cytomegalovirus and BK polyomavirus) and appearance of PTLD (posttransplant lymphoproliferative disorder).

O transplante renal pediátrico é o tratamento de eleição nas crianças com doenças renais crónica terminal. Muitos agentes utilizam em dois regimes de terapia imunossupressora, primeiro em uma fase de indução e posteriormente para a manutenção. Existem duas estratégias para diminuir o risco de rejeição do inserto renal: a primeira consiste em subministrar altas dose dos imunossupressores convencionais, e a segunda, na utilização na fase de indução de anticorpos monoclonais ou policlonais contra antígenos dos linfócitos T. os dois anticorpos policlonais mais usados são as globulinas antitimócito de cavalo (ATGAM) e de coelho (rATG). Os anticorpos monoclonais mais usados são: aqueles contra o receptor de IL-2 (basiliximab e daclizumab) e o dirigido contra o antígeno CD52 (alemtuzumab). A terapia de manutenção consiste num esquema que combina o uso de três drogas imunossupressoras convencionais: glicocorticoides, inibidores da calcineurina, inibidores de mTOR e antiproliferativos. Entre as principais complicações do transplante renal pediátrico estão: rejeição aguda do inserto, infecções virais (por poliomavirus-BK e citomegalovírus) e aparição do transtorno linfoproliferativa pós-transplante (PTLD, pela sigla em inglês de Post-transplant lymphoproliferative disorder).

Aislamiento y caracterización estructural de un nuevo triterpeno del octocoral Plexaura Flexuosa Lamoroux. / Isolation and structural caracterization of a new triterpene from the octocoral Plexaura Flexuosa Lamoroux / Isolamento e caracterização estrutural de um novo triterpeno do octocoral Plexaura Flexuosa Lamoroux.

Estudios previos de productos naturales de origen marino han demostrado que los octocorales producen una variedad de metabolitos con diversas estructuras químicas y bioactividades. Con el objetivo de estudiar al octocoral Plexaura flexuosa Lamoroux se analizó el extracto en acetona de un ejemplar colectado en la Bahía de Mochima, estado Sucre, Venezuela. Se evaluaron las propiedades antibacteriana, antifúngica y tóxica del extracto, revelándose una marcada actividad antibacteriana contra las bacterias Gram positiva Staphylococcus aureus y Bacillus cereus, así como una letalidad significativa mediante el bioensayo de Artemia salina. La fracción soluble en hexano de dicho extracto exhibió actividad antifúngica contra Candida albicans y Trichosporum sp. A partir de dicha fracción se aisló un sólido blanquecino, usando sucesivas cromatografías de columna eluidas con mezclas de hexano:AcOEt en diferentes proporciones. El compuesto se cristalizó con AcOEt, obteniéndose cristales blancos en forma de agujas con punto de fusión de 194,8-195,0°C. Para la identificación estructural de este sólido se realizaron análisis espectroscópicos (IR, RMN¹H, RMN13C, HMQC, HMBC y COSY¹H-¹H), los cuales evidenciaron la presencia de un esqueleto triterpenoidal tetracíclico con cadena lateral, ocho metilos, un doble enlace trisustituído y un grupo epóxido exocíclico. El análisis sistemático de los datos espectrales y su posterior comparación con estructuras reportadas permitieron establecer la estructura posible del compuesto como un derivado 3,5-epoxi del dinosterol.

Previous studies of natural products of marine origin have showen that octocorals produce a variety of metabolites with diverse chemical structures and significant bioactivities. The acetone extract of the octocoral Plexaura flexuosa Lamoroux collected at Mochima Bay, Sucre state, Venezuela, was analyzed and evaluated for its antibacterial, antifungal and toxic properties, showing a significant antibacterial activity against the Gram positive bacteria Staphylococcus aureus and Bacillus cereus, and also a significant lethality in the Artemia salina bioassay. The hexane-soluble fraction of this extract exhibited antifungal activity against Candida albicans and Trichosporum sp. A white solid was isolated from this fraction by successive column chromatography with different proportions of hexane:EtOAc mixtures as eluting solvents. The compound was crystallized with EtOAc, forming needle-shaped white crystals with a melting point of 194.8-195.0°C. Subsequently, spectroscopy analyses were performed for the structural identification of this solid, employing IR, ¹HNMR, 13CNMR, HMQC, HMBC and ¹H-¹HCOSY, which revealed the presence of tetra-cyclical triterpene skeleton with a side chain, eight methyl groups, a trisubstituted double bond and an exocyclical epoxy group. Spectral data analysis and comparison with reported structures permitted the establishment of a of 3.5-epoxy dinosterol derivative as the possible structure of the compound.

Estudos prévios de produtos naturais de origem marinho têm demonstrado que os octocorais produzem uma variedade de metabolitos com diversas estruturas químicas e bioatividades. Com o objetivo de estudar ao octocoral Plexaura flexuosa Lamoroux se analisou o extrato em acetona de um exemplar recolhido na Bahia de Mochima, estado Sucre, Venezuela. Avaliaram-se as propriedades antibacteriana, antifúngica e tóxica do extrato, revelando-se uma marcada atividade antibacteriana contra as bactérias Gram positiva Staphylococcus aureus e Bacillus cereus, assim como uma letalidade significativa mediante o bioensaio de Artêmia salina. A fração solúvel em hexano de dito extrato exibiu atividade antifúngica contra Candida albicans e Trichosporum sp. A partir de dita fração se isolou um sólido branco, usando sucessivas cromatografias de coluna eluídas com misturas de hexano: AcOEt em diferentes proporções. O composto se cristalizou com AcOEt, obtendo-se cristais brancos em forma de agulhas com ponto de fusão de 194,8 - 195,0°C. Para a identificação estrutural de este sólido se realizaram análises espectroscópicas (IR, RMN¹H, RMN13C, HMQC, HMBC e COSY¹H-¹H), as quais evidenciaram a presença de um esqueleto triterpenoide tetracíclico com cadeia lateral, oito metilos, um duplo enlace trisubstituído e um grupo epóxido exocíclico. A análise sistemática dos dados espectrais e sua posterior comparação com estruturas relatadas permitiram estabelecer a estrutura possível do composto como um derivado 3,5-epóxi do dinosterol.