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Wilms tumor has been selected as an index tumor by the WHO Global Initiative for Childhood Cancer with the aim to improve cure rates worldwide. Nevertheless, there is a scarcity of published data on outcomes beyond those of the major cooperative groups. Therefore, we conducted a retrospective analysis including all patients with Wilms tumor treated at our referral center in Uruguay between 1995 and 2020. Treatment consisted of North American (NA) strategies in 23 cases (1995-2004), followed by the SIOP strategy in 35 cases thereafter. Staging included: I-II = 28, III = 7, IV = 14, and V = 9. There were no major surgical or medical complications; however, a delay in the administration of local radiotherapy was observed (median of 21 days after surgery). There were no cases of toxicity- or surgery-related deaths or treatment abandonment. Five-year probability of overall survival was 0.72 and 0.92 for the NA and SIOP groups, respectively. We conclude that outcomes were better for the SIOP strategy with no unexpected toxicities and high treatment compliance in both strategies. Timely implementation of radiotherapy was challenging.

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The cytosolic enzymes N-Acetyl Transferases 1 and 2 (NATs) transfer an acetyl group from acetyl-CoA to a xenobiotic substrate. NATs are regulated at the genetic and epigenetic levels by deacetylase enzymes such as sirtuins. The enzymatic expression of NAT1, NAT2, and SIRT1 was evaluated by flow cytometry, as well as the enzymatic activity of NATs by cell culture and HPLC analysis. Six SNPs were determined through genotyping. T2D patients (n = 29) and healthy subjects (n = 25) with a median age of 57 and 50, respectively, were recruited. An increased enzyme expression and a diminished NAT2 enzymatic activity were found in cells of T2D patients compared to the control group, while NAT1 was negatively correlated with body fat percentage and BMI. In contrast, Sirtuin inhibition increased NAT2 activity, while Sirtuin agonism decreased its activity in both groups. The analysis of NAT2 SNPs showed a higher frequency of rapid acetylation haplotypes in T2D patients compared to the control group, possibly associated as a risk factor for diabetes. The enzymatic expression of CD3+NAT2+ cells was higher in the rapid acetylators group compared to the slow acetylators group. The levels and activity of NAT1 were associated with total cholesterol and triglycerides. Meanwhile, CD3+NAT2+ cells and NAT2 activity levels were associated with HbA1c and glucose levels. The results indicate that NAT2 could be involved in metabolic processes related to the development of T2D, due to its association with glucose levels, HbA1c, and the altered SIRT-NAT axis. NAT1 may be involved with dyslipidaemias in people who are overweight or obese.

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Background: Patients with diabetes mellitus (DM) have worse graft and overall survival, but recent evidence suggests that the difference is no longer significant. Objective: To compare the outcomes between patients with end-stage kidney disease due to DM (ESKD-DM) and ESKD due to nondiabetic etiology (ESKD-non-DM) who underwent kidney transplantation (KT) up to 10 years of follow-up. Design: Survival analysis of a retrospective cohort. Setting and Patients: All patients who underwent KT at the Hospital Universitario San Ignacio, Colombia, between 2004 and 2022. Measurements: Overall and graft survival in ESKD-DM and ESKD-non-DM who received KT. Patients who died with functional graft were censored for the calculation of kidney graft survival. Methods: Log-rank test, Cox proportional hazards model, and competing risk analysis were used to compare overall and graft survival in patients with ESKD-DM and ESKD-non-DM who underwent KT. Results: A total of 375 patients were included: 60 (16%) with ESKD-DM and 315 (84%) with ESKD-non-DM. Median follow-up was 83.3 months. Overall survival was lower in patients with ESKD-DM at 5 (75.0% vs 90.8%, P < .001) and 10 years (55.0% vs 86.7%, P < .001). Cardiovascular death was higher in patients with diabetes (27.3% vs 8.2%, P = .021). Death-censored graft survival was similar in both groups (96.7% vs 93.3% at 5 years, P = .324). On multivariate analysis, the factors associated with global survival were DM (hazard ratio [HR] = 2.11, 95% confidence interval [CI] = 1.23-3.60, P = .006), recipient age (HR = 1.05, 95% CI = 1.02-1.08, P < .001), delayed graft function (HR = 2.07, 95% CI = 1.24-3.46, P = .005), and donor age (HR = 1.03, 95% CI = 1.01-1.05, P = .002). In the competing risk analysis, DM was associated with mortality only in the cardiovascular death group (sub-hazard ratio [SHR] = 6.06, 95% CI = 1.01-36.4, P = .049). Limitations: Change in diabetes treatment received over time and adherence to glycemic targets were not considered. The sample size is relatively small, which limits the precision of our estimates. The Kidney Donor Profile Index and the occurrence of treated acute rejection were not included in the regression models. Conclusion: Overall survival is lower in patients with diabetes, possibly due to older age and cardiovascular comorbidities. Therefore, patients with diabetes should be followed more closely to control cardiovascular risk factors. However, there is no difference in graft survival.

Contexte: Les patients diabétiques (DB) sont ceux qui présentent les pires résultats de greffe et de survie globale, mais des données récentes suggèrent que la différence n'est désormais plus significative. Objectif: Comparer les résultats des patients atteints d'insuffisance rénale terminale causée par le DB (IRT-DB) et ceux des patients non-diabétiques (IRT-nonDB) pour une période de 10 ans après une transplantation rénale (TR). Conception: Analyse de la survie d'une cohorte rétrospective. Sujets et cadre de l'étude: Tous les patients qui ont subi une TR à l'Hôpital Universitario San Ignacio (Colombie) entre 2004 et 2022. Mesures: La survie globale et la survie du greffon chez les patients IRT-DB et IRT-nonDB après une TR. Les patients décédés avec un greffon fonctionnel ont été censurés pour le calcul de la survie du greffon. Méthodologie: Le test logarithmique par rangs, un modèle de régression à effet proportionnel de Cox et une analyse des risques concurrents ont été utilisés pour comparer la survie globale et la survie du greffon des patients atteints d'IRT-DB et d'IRT-nonDB après une TR. Résultats: Au total, 375 patients ont été inclus à l'étude, soit 60 patients (16 %) atteints d'IRT-DB et 315 (84 %) atteints d'IRT-nonDB. La durée médiane du suivi était de 83,3 mois. La survie globale était plus faible chez les patients atteints d'IRT-DB à 5 ans (75,0 c. 90,8 %; p<0,001) et à 10 ans (55,0 % c. 86,7 %; p<0,001). Les décès de causes cardiovasculaires ont été plus nombreux chez les patients diabétiques (27,3 % c. 8,2 %; p=0,021). La survie du greffon censurée pour le décès était similaire pour les deux groupes (96,7 % c. 93,3 % à 5 ans, p=0,324). Dans l'analyse multivariée, les facteurs associés à la survie globale étaient le DB (RR=2,11; IC95 : 1,23-3,60; p=0,006), l'âge du receveur (RR=1,05; IC95 : 1,02-1,08; p<0,001), le retard de fonction du greffon (RR = 2,07; IC95 : 1,24-3,46; p = 0,005) et l'âge du donneur (RR = 1,03; IC95 : 1,01-1,05; p=0,002). Dans l'analyse des risques concurrents, le DB a été associé à la mortalité uniquement dans le groupe de patients décédés de causes cardiovasculaires (RRS=6,06; IC95 : 1,01-36,4; p=0,049). Limites: Les modifications dans le traitement du diabète au fil du temps et l'observance des cibles glycémiques n'ont pas été prises en compte. La taille de l'échantillon est relativement faible, ce qui limite la précision des estimations. L'indice de profil du donneur (Kidney Donor Profile Index­KDPI) et la survenue d'un rejet aigu traité n'ont pas été inclus dans les modèles de régression. Conclusion: La survie globale est plus faible chez les patients diabétiques, peut-être en raison de l'âge avancé et des comorbidités cardiovasculaires de ces patients. Les patients diabétiques devraient par conséquent faire l'objet d'un suivi plus rapproché afin de surveiller les facteurs de risque cardiovasculaire. Aucune différence n'a cependant été observée pour la survie du greffon.

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OBJECTIVE: To determine the proximal diffusion distance of radiopaque contrast medium and mepivacaine/methylene blue solution and incidence of inadvertent intrasynovial and intravascular injections of modified sesamoid nerve block (MASB) when compared with traditional plantar nerve analgesia techniques of the equine distal hind limb. SAMPLE: Ex vivo model: 18 hind limbs; and in vivo model: 5 horses in a crossover study. METHODS: In the ex vivo model, a mepivacaine/methylene blue solution was used to compare the diffusion distance between MASB, basisesamoid block (BSB), and traditional low plantar block (TLPB). Ten minutes after injection, skin was dissected and proximal diffusion distance of the dye patch was measured. In the in vivo model, both hind limbs were injected with radiopaque contrast medium with either MASB or TLPB. Ten minutes after injection, a radiograph was acquired and the proximal diffusion of the contrast medium patch was measured. RESULTS: In the ex vivo model, solution proximal diffusion distance for MASB was significantly longer than BSB (P < .050) and significantly shorter than TLPB (P < .050). Both techniques reached the proximal aspect of DFTS similarly (P = .289), and no difference in the incidence of intrasynovial or intravascular injections was observed (P = .292). In the in vivo model, contrast medium proximal diffusion of MASB was significantly shorter than TLPB (P < .050). The proportion of injections that diffused subcutaneously to the proximal aspect of the proximal pouch of the DFTS was not significantly different between techniques (P = .136). No difference in the incidence of DFTS intrasynovial or intravascular injections was observed (P = .305). CLINICAL RELEVANCE: MASB presented significantly more proximal diffusion than BSB and less proximal diffusion than TLPB, consistently reached the proximal aspect of DFTS, and presented a very low risk of intrasynovial and intravascular injections.

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The Water Energy Food nexus is a powerful topic in agricultural systems to elucidate threats to biodiversity conservation and culture. This paper aimed to recapitulate nexus thinking research, focusing on social-ecological transitions of agriculture systems and biodiversity management within the Water-Energy-Food nexus. We developed a systematic review and a bibliometric analysis derived from 529 documents in the Scopus database. The ToS method identified a total of 81 relevant information in the sample of documents (529) categorised into roots (10), trunks (9) and leaves (62). This review paper situates types, focus, and highlights regarding biodiversity and prevalent thematic research areas such as "Food Nexus", "Environmental Flows", "Sustainability", "Transitions", and "Governance". Our results suggest that future research should focus on the nexus of "Water-Energy-Food-Biodiversity" and propose a transdisciplinary approach to elucidate the state of sustainability transitions in the agricultural systems at the landscape level. It could increase stakeholder interest in conservation, and sustainability management, to reverse biodiversity losses in ecosystems.

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The genus Lonomia Walker, 1855 (Lepidoptera: Saturniidae) is of particular interest to the medical community, since the scoli of these caterpillars harbor a venom that induces hemorrhaging in humans. In Colombia, deadly encounters with Lonomia achelous (Cramer, 1777), have been reported since 2000. There is little information on the main biological and ecological aspects of this genus to help better understand and develop prevention strategies. This study aimed to describe morphological and biological aspects (especially of immature stages) of four recently reported species of Lonomia in Colombia that pose a risk to humans. We collected caterpillars and adults from five localities and reared them under laboratory conditions. Specimens were identified using DNA barcoding and dissection of adult male genitalia. We provided the first description, to our knowledge, of part of the life cycles of Lonomia casanarensis Brechlin, 2017 and Lonomia orientoandensis Brechlin & Meister, 2011 and the complete life cycles of Lonomia columbiana Lemaire, 1972 and Lonomia orientocordillera Brechlin, Käch & Meister, 2013. We also present the first records of the parasitoids of L. orientocordillera, and L. casanarensis and new host plants. This information will guide not only their morphological recognition and the identification of their parasitoids and hosts, but also will guide rearing methods of these and other Lonomia species in new studies to prevent incidents with humans and create specific antivenoms.

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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.

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Caterpillars of the Neotropical genus Lonomia (Lepidoptera: Saturniidae) are responsible for some fatal envenomation of humans in South America inducing hemostatic disturbances in patients upon skin contact with the caterpillars' spines. Currently, only two species have been reported to cause hemorrhagic syndromes in humans: Lonomia achelous and Lonomia obliqua. However, species identifications have remained largely unchallenged despite improved knowledge of venom diversity and growing evidence that the taxonomy used over past decades misrepresents and underestimates species diversity. Here, we revisit the taxonomic diversity and distribution of Lonomia species using the most extensive dataset assembled to date, combining DNA barcodes, morphological comparisons, and geographical information. Considering new evidence for seven undescribed species as well as three newly proposed nomenclatural changes, our integrative approach leads to the recognition of 60 species, of which seven are known or strongly suspected to cause severe envenomation in humans. From a newly compiled synthesis of epidemiological data, we also examine the consequences of our results for understanding Lonomia envenomation risks and call for further investigations of other species' venom activities. This is required and necessary to improve alertness in areas at risk, and to define adequate treatment strategies for envenomed patients, including performing species identification and assessing the efficacy of anti-Lonomia serums against a broader diversity of species.

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Introducción: el síndrome hemolítico urémico atípico es una enfermedad severa y huérfana, la cual en su variedad atípica se presenta con manifestaciones clínicas extrarrenales y sistémicas. La presencia de afectación gastrointestinal es infrecuente, pero en los pacientes en los que se manifiesta el pronóstico desfavorable, dado que estos cursan con más recaídas y mayor mortalidad, por lo cual se hace indispensable que el personal de salud esté entrenado en detectar y reconocer las manifestaciones menos frecuentes de esta patología, para así impactar positivamente en el desenlace de estos pacientes. Objetivo: se busca ilustrar un caso singular en cuanto a la sintomatología presentada infrecuente por el paciente y sobre una etiología no descrita previamente en la literatura. Presentación del caso: se reporta el caso de un escolar masculino de 8 años que presentó fiebre, ictericia, dolor abdominal y lumbar, diarrea, hematemesis y hematuria, al cual se le diagnosticó síndrome hemolítico urémico atípico. El paciente presentó un rápido deterioro clínico con compromiso multiorgánico, documentándose hipertensión arterial y lesión renal aguda, que recibió manejo con cristaloides y diurético de asa sin mejoría, por lo que requirió inicio de terapia de reemplazo renal e incluso múltiple soporte transfusional; sin embargo, continuó sin mejoría clínica, por lo que se indicó inicio de anticuerpo monoclonal IgG humanizado recombinante con buenos resultados. Discusión y conclusión: este caso es un claro ejemplo de que la afectación extrarrenal y multiorgánica puede ser la manifestación principal de esta enfermedad, por lo que es importante que el clínico se encuentre sensibilizado y conozca los signos y los síntomas de la presentación atípica de esta patología, con el fin de evitar retrasos diagnósticos y terapéuticos. Asimismo, el abordaje etiológico es de suma importancia para brindar un pronóstico más preciso al paciente y su familia.

Introduction: Atypical hemolytic uremic syndrome is a severe and orphan disease, in its atypical variety courses with extrarenal clinical manifestations. The presence of gastrointestinal compromise is infrequent, but the prognosis is unfavorable, since they have more relapses and higher mortality. Therefore, it is important that physicians are trained in recognizing the rare manifestations of this pathology, in order to improve the outcome in these patients. Purpose: This case illustrates a unique case in terms of symptoms and etiology not previously described. Case presentation: We report the case of an 8-year-old male who presented with fever, jaundice, abdominal and lumbar pain, diarrhea, hematemesis, and hematuria. Atypical hemolytic uremic syndrome was diagnosed. He presented clinical deterioration with multiple organ involvement, documenting high blood pressure and acute kidney injury, who received management with crystalloids and diuretics without improvement, requiring renal replacement therapy and multiple transfusional support. However, there was still no clinical improvement, so the start of recombinant humanized IgG monoclonal antibody was indicated, with satisfactory outcomes. Discussion and conclusions: This case is a clear example that extrarenal and multi-organ involvement can be the main manifestation of this disease, so it is important that clinicians are aware of the clinical course that may develop a patient with atypical presentations, in order to avoid diagnostic and therapeutic delays. Likewise, the etiological approach is important in order to provide an accurate prognosis to the patient and his family.

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Since their discovery, arylamine N-acetyltransferases 1 and 2 (NAT1 and NAT2, respectively) have been associated with the metabolism of xenobiotics. NAT2 is the main factor in the therapeutic success of tuberculosis treatment due to its role in the biotransformation of isoniazid. However, researchers have started to investigate the possible participation of NAT1 and NAT2 (NATs) in carcinogenesis, although the mechanisms have not been elucidated fully. NATs enzymatic activity is essential in some types of cancer, such as breast cancer and acute lymphoblastic leukemia. Whether NAT1 and/or NAT2 participate in insulin resistance level in diabetes mellitus or in the immune system remains to be explored. Therefore, it is clear that its role in cell physiology has more implications than just metabolizing compounds.

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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.

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Mesostructured silica SBA-15 and amino-functionalized silica SBA-15-NH2 were synthesized, and then, characterization, adsorption capacity, and immersion enthalpies in caffeine and glyphosate on SBA-15 and SBA-15-NH2 were evaluated. The enthalpy parameter was determined using a local construction Tian-type heat conduction calorimeter. Calorimetric studies in caffeine solutions exhibit negative enthalpy values; exothermic process characteristics for SBA-15 were between -13.90 and -194.06 J g-1 and those for SBA-15-NH2 were between -7.22 and -60.34 J g-1, and the adsorption capacity of caffeine was better in SBA-15 than that in SBA-15-NH2. In contrast, the enthalpies of immersion in glyphosate solutions were -5.06 to -56.2 J g-1 and the immersion of SBA-15-NH2 in each solution generated enthalpy values of -9.06 to -41.2 J g-1, but the adsorption capacity of glyphosate was better in the amino-functionalized SBA-15. The results show that functionalization of SBA-15 produced differences in physicochemical characteristics of solids, since energy and affinity for the calorimetric liquids are related to the surface properties of solids as well as the chemical nature of the target molecule, immersion enthalpy, was different.

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Mercury and its compounds are toxic substances, whose uncontrolled presence in the environment represents a danger to ecosystems and the organisms that inhabit in it. For this reason, in this work, we carried out a study of mercury [Hg(II)] adsorption from aqueous solution on functionalized activated carbon. The activated carbons were prepared by chemical activation of a mango seed with solutions of CaCl2 and H2SO4 at different concentrations, later, the carbonaceous materials were functionalized with Na2S, with the aim of increasing the sulfur content in the carbonaceous matrix and its affinity to mercury. The materials were characterized using: proximal analysis, scanning electron microscopy, Boehm titrations, point zero charge (pHPZC), and infrared spectroscopy. Additionally, immersion calorimetries were performed in the mercury solution. The results of textural and chemical characterization show materials with low Brunauer-Emmett-Teller (BET) surface areas between 2 and 33 m2·g-1 and low pore volumes. However, they had a rich surface chemistry of oxygenated groups. The enthalpies of immersion in the mercury solutions are between -31.71 and -77.31 J·g-1, showing a correlation between the magnitude of the enthalpic data and the adsorption capacity of the materials. It was evidenced that the functionalization process produces a decrease in the surface area and pore volume of the activated carbons, and an increase in the sulfur content of the carbonaceous matrix. It was evidenced that the functionalization process generated an increase in the mercury [Hg(II)] adsorption capacity between 21 and 49% compared to those of the nonfunctionalized materials, reaching a maximum adsorption capacity of 85.6 mgHg2+g-1.

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The study of CO2 adsorption on adsorbent materials is a current topic of research interest. Although in real operating circumstances, the removal conditions of this gas is carried out at temperatures between 290 and 303 K and 1 Bar of pressure or high pressures, it is useful, as a preliminary approach, to determine CO2 adsorption capacity at 273K and 1 Bar and perform a thermodynamic study of the CO2 adsorption heats on carbonaceous materials prepared by chemical activation from African palm shell with CaCl2 and H3PO4 solutions, later modified with HNO3 and NH4OH, with the aim to establish the influence that these treatments have on the textural and chemical properties of the activated carbons and their relationship with the CO2 adsorption capacity. The carbonaceous materials were characterized by physical adsorption of N2 at 77K, CO2 at 273K, proximate analysis, Boehm titrations and immersion calorimetry in water and benzene. Activated carbons had a BET area between 634 and 865 m2g-1, with a micropore volume between 0.25 and 0.34 cm3g-1. The experimental results indicated that the modification of activated carbon with HNO3 and NH4OH generated a decrease in the surface area and pore volume of the material, as well as an increase in surface groups that favored the adsorption of CO2, which was evidenced by an increase in the adsorption capacity and the heat of adsorption.

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Resumen Introducción: El síncope es un síntoma complejo de evaluar, que además representa un reto diagnóstico; la estratificación inadecuada del riesgo de los pacientes puede conllevar mal uso de los recursos en salud y aumentar así el costo derivado de la atención. Objetivo: Comparar la incidencia de desenlaces a un año en pacientes con síncope de alto y bajo riesgo en cuatro hospitales de Bogotá. Metodología: Estudio de cohorte retrospectiva, en el que se incluyeron pacientes mayores de 18 años que consultaron a urgencias por síncope, y que fueron seguidos desde febrero de 2013 hasta julio de 2015. Fueron clasificados en bajo y alto riesgo según la escala de Martin et al. Se hizo seguimiento telefónico para evaluar los desenlaces a un año. Resultados: Los pacientes de alto riesgo tienen mayor frecuencia de mortalidad, recurrencia del síncope, requerimiento de hospitalización, eventos neurológicos y necesidad de intervención cardiovascular. La mortalidad global está alrededor del 6% y en el subgrupo de pacientes de mayor puntaje (4 puntos) asciende al 16,6%. La mayoría de eventos se presentaron en los primeros 6 meses de seguimiento. La mortalidad y la necesidad de intervención cardiovascular tuvieron un incremento de su frecuencia a medida que aumentó el puntaje de la escala. Conclusión: Los pacientes clasificados en alto riesgo según la escala de Martin et al. tienen mayor frecuencia de desenlaces adversos a un año de seguimiento, y por tanto podrían beneficiarse de un estudio más amplio y expedito de la causa del síncope.

Abstract Introduction: Syncope is a complex symptom to assess, and is a diagnostic challenge. The inadequate risk stratification can lead to the inappropriate use of health resources and to an increase in the costs arising from the care. Objective: To compare the outcomes at one year in patients with high and low risk syncope in four Bogota hospitals. Material and method: A retrospective cohort study was conducted that included patients over 18 years-old that were seen in the Emergency Department due to a syncope. They were followed-up from February 2013 until July 2015. They were classified into low and high risk according to the score on the scale of Martin et al. At one year, a telephone call follow-up was made to assess the outcomes. Results: The high risk patients had higher rates of mortality and recurrence of syncope, required more hospital admissions, had more neurological events, and a greater need for cardiac intervention. The overall mortality was 6%, and in sub-group of patients with a higher score (4 points) it increased to 16.6%. The majority of events occurred in the first 6 months of follow-up. The mortality and the need for cardiovascular intervention were associated with the increase in the score on the scale. Conclusion: Patients classified as high risk according to the scale of Martin et al. are more likely to have adverse outcomes at one year of follow-up, and thus could benefit from a larger study and directed at the cause of the syncope.

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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.

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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.

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