Infectious complications in patients with chronic kidney disease are described as the second main cause of hospitalization and generate an impact on mortality, which is why vaccination becomes one of the pillars to prevent infections in patients with kidney disease. Patients diagnosed with chronic kidney disease present immunological dysfunction, which makes them prone to complications of an infectious type, mediated by viruses, bacteria, parasites and other microorganisms. This is why the benefits obtained by applying a correct immunization scheme in this type of patient are enormous, frankly impacting on the possible complications that they may have. Methodology: An advanced search was carried out with the terms DeSC and MeSH: Chronic kidney disease; Vaccination; Hepatitis B; Hepatitis A; Pneumococcus; Influenza; Herpes zoster. The Clinical Key, Embase, PubMed and Ovid search engines were used, obtaining a total of 146 results, including original articles, case reports, and literature reviews; Through narrative analysis, and based on selection criteria such as epidemiological data from the last 5 years on chronic kidney disease and infections, in addition to clinical practice guidelines on the different vaccination schemes, a total of 45 articles were selected that were used to the preparation of this literature review.

Cardiovascular diseases are the leading cause of death worldwide and their management implies an early diagnosis and early coronary reperfusion. In Colombia, the department of Tolima registers the highest death rate from this cause, therefore the objective of the study is to analyze the factors associated with the care time of patients with STEMI undergoing reperfusion therapy in two IPS in the city. This study was conducted in Ibague between 2016 and 2017, longitudinal, analytical, retrospective from time to event. A review of medical records was carried out and of the total of 2755 catheterizations performed during this period, 126 were selected with STEMI, analyzing sociodemographic and clinical conditions of each of the patients. For the analysis of care times, 49 patients who were admitted to the institution from the emergency service were studied. As results, it was found that the average age was 63 years, 71.4% were men. The most prevalent comorbidities were hypertension, dyslipidemia and DM-2. No patient received prehospital medical care. Median gate time - EKG was 27 minutes, gate - needle 75 minutes, and gate - balloon 26 hours. It is concluded that it is necessary to carry out similar studies to know the Latin American statistics since most of the interventions carried out are not within the optimal times established in the international guidelines. Gate time - EKG less than 10 minutes was achieved in 35% of cases. 80% of the patients consulted the window for thrombolysis and only 39% received fibrinolysis in less than 60 minutes; 6.1% were taken to ICCP in less than 90 minutes. With the availability of the hemodynamic unit, a reduction in attention times was achieved compared to the consultation during hours without its availability (p value: 0.033).

Background: COVID-19 could affect clinical trials because avoidance of close contact between people constitutes one of the approaches that have been recommended to ensure that individuals do not become exposed to the coronavirus. Objectives: To discuss the impact of COVID-19 on clinical trials within the pharmaceutical industry. In addition, the paper examines some strategies that can be adopted to cope with impact of COVID-19 on clinical trials and thus ability to continue conducting the trials. Methods: This is a narrative review article. We provided a synthesis of current literature and guidelines obtained from searches on many electronic databases (PubMed/Medline, EMBASE, and Cochrane Library), Google search engine, the United States (US) Food and Drug Administration (FDA) website, and hand searches on the bibliography of the articles. Results: There is a significant impact of COVID-19 on clinical trials. The impact includes: undermining sponsors’ economic ability to fund clinical trials, social distancing, impeding recruitment of participants for non-COVID-19 clinical trials, discouraging participants from visiting clinical sites due to fear of COVID-19 infections, and making trial staff to opt for remote working. The US FDA published new guidelines to be applied during the ongoing pandemic. Mitigation strategies to ensure continuity of clinical trials include: adopting participant enabling measures, modifying clinical trial protocol, providing logistical and supply chain management support, embracing remote data review and clinical site monitoring, and offering extra site support services. Conclusions: COVID-19 pandemic is disrupting the initiation and continuing ongoing clinical trials. Guidelines have to be followed and strategies for mitigating adverse impacts of COVID-19 need to be applied. Modifying monitoring methods should be done to accommodate the constraints posed by the ongoing COVID-19 pandemic.

Background: Myofibroblastic inflammatory tumors are a group of mesenquimatous tumors that have predilection for children and young adults. It´s diagnose represents a challenge due to the unspecific symptoms and image studies findings. The definitive diagnose is given by characteristic histopathological findings. The complete tumor resection is the accepted treatment. Case Presentation: A 21 year old woman with previous history of one year of abdominal pain, localized on the epigastrium, accompanied with fever, asthenia, adynamia and weight loss. Laboratory exams showed microcytic anemia and thrombocytosis. The computerized tomography showed a cystic heterogeneous tumor on the left hepatic lobe. Patient underwent a laparotomy finding a cystic tumor on hepatic segments II and III, surgical resection was made with any complications. The histopathological study reported a myofibroblastic inflammatory tumor. Conclusiones: Myofibroblastic inflammatory tumors are entities difficult to diagnose. A radical resection should be considered for its treatment with patient follow up due to its potential recurrence.

espanolLas alteraciones de la funcion tiroidea son emergencias clinicas y endocrinologicas que rapidamente progresan a disfuncion organica siendo condiciones potencialmente mortal. Dentro de estos desordenes tiroideos se encuentran el coma mixedematoso siendo la manifestacion mas extrema del hipotiroidismo y la tormenta tiroidea resultante del hipertiroidismo. Lasestrategias terapeuticas se basan en el rapido reconocimiento de la condicion, medidas de soporte en la unidad de cuidado critico; sin olvidar el tratamiento del factor desencadenante, con la finalidad de disminuir las complicaciones y la mortalidad. EnglishThyroid function disorders are clinical and endocrinological emergencies that rapidly progress to organic failure and are life threatening conditions. Among these thyroid disorders are myxedematous coma being the most extreme manifestation of hypothyroidism, and the thyroid storm resulting from hyperthyroidism. Therapeutic strategies are based on the rapid recognition of the condition, support measures in the critical care unit; without forgetting the treatment of the triggering factor, in order to reduce complications and mortality.

espanolLa Diabetes Mellitus es una enfermedad muy prevalente y con alto riesgo de complicaciones micro y macrovasculares. Hasta el 20-40% de los pacientes diabeticos desarrollan enfermedad renal diabetica en algun momento de su evolucion. Recientemente, el tratamiento hipoglucemiante no solo se orienta al control glucemico, sino tambien a impactar en desenlaces cardiovasculares y renales. Dentro de estas moleculas, encontramos los analogos GLP-1, considerados un pilar en el tratamiento hipoglucemiante para los pacientes diabeticos con enfermedad cardiovascular. Objetivo: Describir los principales aspectos clinicos de los agonistas GLP-1, su mecanismo de accion y su rol fisiologico en los desenlaces cardiovasculares y renales de la diabetes mellitus. Metodologia: Se realizo una busqueda avanzada con los terminos DeCS: “Nefropatia Diabetica; Agonistas del receptor GLP-1, Peptidos Similares al Glucagon; Diabetes Mellitus” utilizando los motores de busqueda Clinical Key, Embase, PubMed y Ovid, obteniendo un total de 413 resultados, entre articulos originales, reportes de casos, series de casos y revisiones de la literatura, se seleccionaron un total de 70 articulos utilizados para la elaboracion de la revision de la literatura. Conclusion: Las terapias basadas en analogos GLP-1 en la diabetes mellitus, es un pilar terapeutico en individuos con factores de riesgo para enfermedad renal diabetica, debido a sus beneficios demostrados en la disminucion de los desenlaces renales compuestos. EnglishDiabetes Mellitus is a very prevalent disease with a high risk of micro and macrovascular complications. Up to 20 - 40% of diabetic patients develop diabetic kidney disease at some point in their evolution. Recently, hypoglycemic treatment is not only aimed at glycemic control, but also at impacting cardiovascular and kidney outcomes. Among these molecules, we find the GLP-1 analogs (Type 1 glucagon-like peptide), considered a mainstay in hypoglycemic treatment for diabetic patients with cardiovascular disease. Objective: To describe the main clinical aspects of GLP-1 agonists, their mechanism of action and their physiological role in the cardiovascular and renal outcomes of diabetes mellitus. Methodology: An advanced search was carried out with the DeCS terms: “Diabetic Nephropathy; GLP-1 Receptor Agonists, Glucagon-Like Peptides; Diabetes Mellitus” using the Clinical Key, Embase, PubMed and Ovid search engines, obtaining a total of 413 results, among original articles, case reports, case series and literature reviews, a total of 72 articles were selected used for the preparation of the literature review. Conclusion: Therapies based on GLP-1 analogues in diabetes mellitus are a therapeutic mainstay in individuals with risk factors for diabetic kidney disease, due to its proven benefits in reducing composite kidney outcomes.

Objetivo: Describir el sindrome metabolico en adultos, caracteristicas clinico epidemiologicas, sus alternativas diagnosticas y preventivas disponibles en la actualidad, por medio de una revision narrativa de la literatura. Materiales y metodos: Se realizo una revision narrativa a traves de una busqueda avanzada con 31 articulos de alto prestigio cientifico entre el periodo del 2010 - 2020, seleccionando aquellos articulos que contenian informacion sobre el sindrome metabolico en adultos. Resultados: Se logro describir al detalle las caracteristicas clinico epidemiologicas, las alternativas diagnosticas y los mecanismos de prevencion para sindrome metabolico en adultos en base a la evidencia actual. Conclusion: Se concluyo que el sindrome metabolico es un estado fisiopatologico complejo que se origina principalmente por un desequilibrio en la ingesta de calorias y el gasto energetico, pero tambien se ve afectado por la composicion genetica/epigenetica del individuo, el predominio del estilo de vida sedentario sobre la actividad fisica y otros factores como la microbiota intestinal y la calidad y composicion de los alimentos, por lo cual se debe educar a la poblacion sobre el peligro para la salud del sindrome metabolico.

espanolEl tenofovir es un medicamento antirretroviral inhibidor de la transcriptasa inversa, que cuenta con gran efectividad, lo que se traduce en un aumento en las cifras de uso para pacientes con VIH (Virus de inmunodeficiencia humana) [1]. Pero, a pesar de tener un historial de seguridad bastante amplio y de ser un medicamento relativamente seguro y libre de eventos adversos, se han descrito en la literatura casos de falla renal aguda y tubulopatias secundarias al uso de este antirretroviral (ARV); siendo de mayor riesgo si existe un antecedente de insuficiencia renal previa en los pacientes seropositivos o cuando se emplea concomitantemente con inhibidores de la protease [2]. Por ello, se describe el siguiente caso clinico de un paciente de sexo masculino de 27 anos de edad con diagnostico final de nefropatia secundaria a la ingesta de tenofovir y atazanavir, de forma concomitante. EnglishTenofovir is a highly effective reverse transcriptase inhibitor antiretroviral drug, resulting in increased usage rates for patients with HIV (Human Immunodeficiency Virus) [1]. However, despite having a fairly broad safety record and being a relatively safe drug free of adverse events, cases of acute renal failure and tubulopathies secondary to the use of this antiretroviral (ARV) have been described in the literature; being of greater risk if there is a history of previous renal failure in seropositive patients or when it is used concomitantly with protease inhibitors, for example [2]. Therefore, the following clinical case of a 27-year-old male patient with a final diagnosis of nephropathy secondary to the concomitant ingestion of tenofovir and atazanavir is described.

Introduccion: la enfermedad hepatica grasa no alcoholica (EHGNA) es la causa mas comun de enfermedad hepatica cronica a nivel mundial. Se considera la expresion hepatica del sindrome metabolico, los distintos componentes de este sindrome se comportan como factores potenciales de aparicion y progresion de la EHGNA; dentro de estos pacientes la enfermedad cardiovascular constituye la causa primaria de mortalidad y morbilidad. En consecuencia se ha desarrollado un interes mayor en generar estrategias que permitan impactar el efecto de la EHGNA sobre la enfermedad cardiovascular. Objetivo: evaluar la contribucion de la enfermedad hepatica grasa no alcoholica a la enfermedad cardiovascular. Metodologia: se realiza busqueda electronica en las bases de datos: PubMed, ScienciaDirect, Scopus y Medline de articulos originales y de revision en el periodo entre 1997 y 2019. Conclusion: La EHGNA es un componente fundamental del riesgo cardiovascular, constituye un elemento asociado a desenlaces cardiovasculares adversos, por lo tanto demanda un mayor interes por parte del clinico. Las opciones terapeuticas aunque variadas, distan de dar una solucion eficiente al problema metabolico desencadenado por esta condicion, siendo las estrategias no farmacologicas la piedra angular en su abordaje. Palabras clave: Enfermedad hepatica grasa no alcoholica; Esteatohepatitis no alcoholica; Elevacion de enzimas hepaticas; Sindrome metabolico; Riesgo cardiovascular

La falla hepaItica aguda es la peIrdida suIbita de la funcioIn hepaItica en un corto plazo en un paciente sin hepatopatia previa, que se acompanI?a de coagulopatiIa y encefalopatiIa. Es una enfermedad con un deterioro organico grave que progresa rapidamente. Existen multiples causas, en paises desarrollados el consumo de paracetamol y en subdesarrollados las hepatitis virales. El reconocimiento temprano y manejo en unidad de cuidado critico es fundamental para dar terapia de soporte integral. La supervivencia ha aumentado debido a las mejoras en el tratamiento medico y al uso apropiado del trasplante de higado de emergencia en pacientes seleccionados.