Estudios recientes han reportado la ocurrencia de fenómenos trombóticos o coagulopatía en pacientes con COVID-19. Hay posiciones divergentes en cuanto a la prevención, diagnóstico y tratamiento de ...estos fenómenos y la práctica clínica actual está basada únicamente en deducciones por extensión a partir de estudios retrospectivos, series de casos, estudios observacionales y guías internacionales desarrolladas previas a la pandemia. En este contexto, el objetivo del presente trabajo fue establecer un grupo de recomendaciones sobre prevención, diagnóstico y manejo de las complicaciones trombóticas asociadas a COVID-19. Métodos: Se desarrolló una guía rápida aplicando el marco de la evidencia a la decisión (EtD) de GRADE y un sistema de participación iterativo, con análisis estadísticos y cualitativos de sus resultados. Resultados: Se generaron 31 recomendaciones clínicas enfocadas a: a) Pruebas de coagulación en adultos sintomáticos con sospecha de infección o infección confirmada por SARS-CoV-2; b) Tromboprofilaxis en personas adultas con diagnóstico de COVID-19 (Escalas de riesgo, Tromboprofilaxis de manejo ambulatorio, intrahospitalario, y duración de tromboprofilaxis después del egreso de hospitalización), c) Diagnóstico y tratamiento de las complicaciones trombóticas y d) Manejo de personas con indicación previa de usar agentes anticoagulantes. Conclusiones: Las recomendaciones clínicas del presente consenso orientan la toma de decisiones clínicas respecto a prevención, diagnóstico y tratamiento de fenómenos trombóticos en pacientes con COVID-19, y representan un acuerdo que ayudará a disminuir la dispersión en las prácticas clínicas acorde con el desafío que nos impone la pandemia. (Acta Med Colomb 2021; 46. DOI: Palabras clave: COVID-19; SARS CoV-2; Anticoagulantes; Embolia y Trombosis; Consenso Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic. (Acta Med Colomb 2021; 46. DOI: Key terms: COVID-19; SARS CoV-2; Anticoagulants; Embolism and Thrombosis; Consensus
estudios recientes han reportado fenómenos trombóticos o coagulopatía en pacientes con COVID-19. Hay posiciones divergentes en cuanto a la prevención, el diagnóstico y el tratamiento de estos ...fenómenos, y la práctica clínica actual está basada únicamente en deducciones por extensión a partir de estudios retrospectivos, series de casos, estudios observacionales y guías internacionales desarrolladas previas a la pandemia.
establecer una serie de recomendaciones sobre prevención, diagnóstico y manejo de las complicaciones trombóticas asociadas a COVID-19.
se desarrolló una guía rápida en la que se aplicó el marco de la evidencia a la decisión (EtD) de GRADE y un sistema de participación iterativo, con análisis estadísticos y cualitativos de sus resultados.
se generaron 31 recomendaciones clínicas enfocadas a: a) Pruebas de coagulación en adultos sintomáticos con sospecha de infección o infección confirmada por SARS-CoV-2; b) Tromboprofilaxis en personas adultas con diagnóstico de COVID-19 (escalas de riesgo, tromboprofilaxis de manejo ambulatorio, intrahospitalario y duración de tromboprofilaxis después del egreso de hospitalización), c) Diagnóstico y tratamiento de las complicaciones trombóticas y d) Manejo de personas con indicación previa a usar agentes anticoagulantes.
las recomendaciones clínicas de este consenso orientan la toma de decisiones clínicas respecto a prevención, diagnóstico y tratamiento de fenómenos trombóticos en pacientes con COVID-19, y representan un acuerdo que ayudará a disminuir la dispersión en las prácticas clínicas acorde con el desafío que impone la pandemia.
recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic.
to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19.
a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis.
31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents.
recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.
The rumen microbiome plays a fundamental role in all ruminant species, it is involved in health, nutrient utilization, detoxification, and methane emissions. Methane is a greenhouse gas which is ...eructated in large volumes by ruminants grazing extensive grasslands in the tropical regions of the world. Enteric methane is the largest contributor to the emissions of greenhouse gases originating from animal agriculture. A large variety of plants containing secondary metabolites essential oils (terpenoids), tannins, saponins, and flavonoids have been evaluated as cattle feedstuffs and changes in volatile fatty acid proportions and methane synthesis in the rumen have been assessed. Alterations to the rumen microbiome may lead to changes in diversity, composition, and structure of the methanogen community. Legumes containing condensed tannins such as
Leucaena leucocephala
have shown a good methane mitigating effect when fed at levels of up to 30–35% of ration dry matter in cattle as a result of the effect of condensed tannins on rumen bacteria and methanogens. It has been shown that saponins disrupt the membrane of rumen protozoa, thus decreasing the numbers of both protozoa and methanogenic archaea. Trials carried out with cattle housed in respiration chambers have demonstrated the enteric methane mitigation effect in cattle and sheep of tropical legumes such as
Enterolobium cyclocarpum
and
Samanea saman
which contain saponins. Essential oils are volatile constituents of terpenoid or non-terpenoid origin which impair energy metabolism of archaea and have shown reductions of up to 26% in enteric methane emissions in ruminants. There is emerging evidence showing the potential of flavonoids as methane mitigating compounds, but more work is required
in vivo
to confirm preliminary findings. From the information hereby presented, it is clear that plant secondary metabolites can be a rational approach to modulate the rumen microbiome and modify its function, some species of rumen microbes improve protein and fiber degradation and reduce feed energy loss as methane in ruminants fed tropical plant species.
AbstractThis work studies the hydration kinetics of portland cement pastes blended with multiwalled carbon nanotubes (MWCNTs) aqueous dispersions. Anionic, cationic, and nonionic ...surfactants—i.e., surfactants that have different charged functional groups in their structure—were used as dispersing agents. MWCNTs in powder form were dispersed in deionized water with sodium dodecyl sulfate, cetylpyridinium chloride, and triton TX-100. Three concentrations of each surfactant (1, 10, and 100 mM) were tested, and all samples were sonicated until an adequate dispersion degree was obtained. Cement pastes blended with carbon nanotubes were prepared, and their hydration kinetics were studied using the Vicat needle and isothermal calorimetry tests. It was concluded that the effect of MWCNTs on the hydration kinetics of portland cement can be masked by the effect of surfactants used as dispersing agents for the nanotubes in the mixing water.
Antiretroviral therapy (ART) has modified the natural history of HIV-infection: the incidence of opportunistic infections (OIs) has decreased and mortality associated to HIV has improved ...dramatically. The reasons for hospitalization have changed; OIs are no longer the most common reason for admission. This study describes the patient population, admission diagnosis and hospital course of HIV patients in Colombia in the ART era.
Patients admitted with HIV/AIDS at six hospitals in Medellin, Colombia between August 1, 2014 and July 31, 2015 were included. Demographic, laboratory, and clinical data were prospectively collected.
551 HIV-infected patients were admitted: 76.0% were male, the median age was 37 (30-49). A new diagnosis of HIV was made in 22.0% of patients during the index admission. 56.0% of patients of the entire cohort had been diagnosed with HIV for more than 1 year and 68.9% were diagnosed in an advanced stage of the disease. More than 50.0% of patients had CD4 counts less than 200 CD4 cells/μL and viral loads greater than 100,000 copies. The main reasons for hospital admissions were OIs, tuberculosis, esophageal candidiasis and Toxoplasma encephalitis. The median hospital stay was 14 days (IQR 8-23). Admission to the intensive care unit (ICU) was required in 10.3% of patients and 14.3% were readmitted to the hospital; mortality was 5.4%.
Similar to other countries in the developing world, in Colombia, the leading cause of hospitalization among HIV-infected patients remain opportunistic infections. However, in-hospital mortality was low, similar to those described for high-income countries. Strategies to monitor and optimize the adherence and retention in HIV programs are fundamental to maximize the benefit of ART.
Highly ordered TiO
2
nanotubes were obtained by anodization on Ti6Al4V substrates manufactured by electron beam powder bed fusion (E-PBF). Effects of anodization parameters such as anodizing time, ...stirring, fluoride concentration, and water content were analyzed in an organic electrolyte (ethylene glycol) that contains ammonium fluoride. The ordering of the nanotubes was measured by regularity ratio calculations based on fast Fourier transform (FFT) from SEM images. It was found that for the processed specimens, the highest ordering of the TiO
2
nanotubes was reached at 30 V for 5000 s with a concentration of 9 vol% H
2
O and 0.4 wt.% NH
4
F, exhibiting nanotubes free of delamination, cracks, and coral-like structures with a regularity ratio (RR) of 1.91. This work offers a simple method for creating homogeneous and organized TiO
2
nanotubes on Ti6Al4V substrates manufactured by E-PBF which potentially improves its functionality in diverse industrial applications such as nanosensors, controlled-release substances, solar cells, water splitting, electrochromic devices, and Li-ion battery anodes.
Graphical Abstract
Decoupling the individual effects of multiwalled carbon nanotubes (MWCNTs) and surfactants when used as reinforcement materials in cement-based composites is aimed in this study. Powder MWCNTs were ...dispersed in deionized water using different types of surfactants as chemical dispersing agents and an ultrasonic tip processor. Cement pastes with carbon nanotubes additions of 0.15% by mass of cement were produced in two steps: first, the MWCNT/surfactant dispersions were combined with the mixing water, and then, cement was added and mixed until a homogeneous paste was obtained. Mechanical properties of the pastes cured at 7 days were measured, and their fracture behavior was characterized using the linear elastic finite element analysis. It was found that the reinforcing effect of MWCNT was masked by the negative effect of surfactants in the cement matrix; nevertheless, nanotubes were capable of increasing both stress and strain capacity of the composite by controlling the crack propagation process at the tip of the crack.
El retinoblastoma constituye el tumor ocular más prevalente en la infancia, con diversas presentaciones clínicas. Los principales fines del tratamiento se enfocan en la supervivencia y la ...preservación de la visión; sin embargo, debe ser individualizado. Existen diferentes alternativas terapéuticas como enucleación, quimioterapia sistémica, radioterapia y terapias locales. Dentro de las alternativas más recientes está la quimioterapia intrarterial, que permite la administración directa de agentes quimioterapéuticos a patologías malignas intraoculares como el retinoblastoma por medio de la arteria oftálmica. El presente artículo tuvo como objetivo llevar a cabo una revisión no sistematizada sobre las indicaciones, ventajas, desventajas, técnica, tasas de supervivencia, costos y complicaciones de la quimioterapia intrarterial como tratamiento del retinoblastoma. Palabras clave retinoblastoma; quimioterapia; neoplasias; enucleación del ojo; melfalán. Retinoblastoma is the most prevalent ocular tumor in childhood, with various clinical presentations. The main goals of treatment focus on survival and preservation of vision; however, treatment must be individualized. There are different therapeutic alternatives such as enucleation, systemic chemotherapy, radiotherapy and local therapies. Among the most recent alternatives is intra-arterial chemotherapy, which allows the direct administration of chemotherapeutic agents to intraocular malignant pathologies such as retinoblastoma through the ophthalmic artery. The objective of this article is to carry out a non-systematic review of the indications, advantages, disadvantages, technique, survival rates, costs, and complications of intra-arterial chemotherapy as a treatment for retinoblastoma. Keywords retinoblastoma; chemotherapy; neoplasms; eye enucleation; melphalan.
El retinoblastoma constituye el tumor ocular más prevalente en la infancia, con diversas presentaciones clínicas. Los principales objetivos del tratamiento se enfocan en la supervivencia y la ...preservación de la visión; sin embargo, el tratamiento debe ser individualizado. Existen diferentes alternativas terapéuticas como la enucleación, quimioterapia sistémica, radioterapia y terapias locales. Dentro de las alternativas más recientes esta la quimioterapia intra-arterial, que permite la administración directa de agentes quimioterapéuticos a patologías malignas intraoculares como el retinoblastoma por medio de la arteria oftálmica. El presente artículo tiene como objetivo realizar una revisión no sistematizada sobre las indicaciones, ventajas, desventajas, técnica, tasas de supervivencia, costos y complicaciones de la quimioterapia intraarterial como tratamiento del retinoblastoma.
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