Artículos
URI permanente para esta colección
Examinar
Envíos recientes
Mostrando 1 - 20 de 1613
Ítem Adecuación y necesidad de las terapias basadas en incretinas en la enfermedad renal crónica: consenso de expertos RAND/UCLA para América Latina(Sociedad Latinoamericana de Nefrología e Hipertensión, 2026) Rico-Fontalvo, Jorge; Rodrigo Daza-Arnedo; Eduardo Lorca-Herrera; Dina-Batlle, Eliana; Proenca de Moraes, Thyago; Elbert, Alicia; Builes-Montaño, Carlos E.; Correa-Rotter, Ricardo; Sánchez-Polo, VicenteAntecedentes: La evidencia que respalda a las terapias basadas en incretinas como modificadoras del riesgo renal continúa ampliándose; sin embargo, su aplicación clínica sigue siendo heterogénea entre distintos fármacos, fenotipos de enfermedad renal crónica (ERC) y sistemas de salud. En América Latina, la variabilidad en el acceso y la implementación acentúa la necesidad de una priorización guiada por fenotipos y de distinguir entre intervenciones que pueden considerarse razonables y aquellas que deben considerarse necesarias. Método: Se llevó a cabo un estudio formal de consenso de expertos utilizando el método RAND/UCLA de adecuación, reportado de acuerdo con los estándares RAND/UCLA y la guía ACCORD. Un panel multidisciplinario de expertos latinoamericanos (n = 9) evaluó la adecuación de cuatro terapias basadas en incretinas (dulaglutida, liraglutida, semaglutida y tirzepatida) en 18 escenarios clínicamente relevantes de ERC, utilizando una escala de 9 puntos en dos rondas independientes de calificación. Tras la primera ronda, se realizó una reunión presencial moderada para revisar las medianas y las distribuciones de las puntuaciones, así como para refinar la redacción de los escenarios. Las combinaciones escenario-terapia clasificadas como adecuadas tras la segunda ronda se evaluaron posteriormente en cuanto a necesidad en una tercera ronda independiente. El desacuerdo se evaluó mediante el rango interpercentílico y el rango interpercentílico ajustado por simetría, y las clasificaciones finales se establecieron según los criterios estándar RAND/UCLA. Resultados: En los 18 escenarios y las cuatro terapias evaluadas, las calificaciones de adecuación fueron más consistentemente favorables para la semaglutida y más selectivas para la tirzepatida, mientras que la dulaglutida y la liraglutida se clasificaron predominantemente como inciertas. Tras la discusión y la refinación de los escenarios, las calificaciones de la segunda ronda fueron más conservadoras y se resolvió todo el desacuerdo observado en la primera ronda. Dos escenarios orientados a la seguridad, antecedente de pancreatitis aguda y adultos mayores con fragilidad y pérdida de peso involuntaria, se clasificaron de manera uniforme como inapropiados para todas las terapias. La necesidad se estableció principalmente para la semaglutida en fenotipos cardiorrenales albuminúricos de mayor riesgo y para la tirzepatida, en escenarios seleccionados, particularmente cuando la obesidad coexistía con albuminuria persistente. En conjunto, la albuminuria, el riesgo residual a pesar de una terapia basal optimizada (bloqueo del sistema renina-angiotensina e inhibición del cotransportador sodio-glucosa tipo 2), el fenotipo metabólico y la comorbilidad cardiovascular emergieron como los principales determinantes del juicio experto. Conclusiones: En este consenso RAND/UCLA, la necesidad de terapias basadas en incretinas se concentró en fenotipos de ERC albuminúricos de alto riesgo, de forma más consistente para la semaglutida y de manera más limitada para la tirzepatida, mientras que la dulaglutida y la liraglutida se calificaron generalmente como inciertas. Estos hallazgos proporcionan un marco pragmático para apoyar la priorización terapéutica y la toma de decisiones compartida en América Latina, y ponen de relieve vacíos críticos de evidencia en la ERC avanzada, la enfermedad dependiente de diálisis y la ERC no diabética.Ítem Serum and urine electrolyte and nitrogenous waste product changes during the renal functional reserve test(Asociación Colombiana de Nefrología e Hipertensión Arterial, 2026) Musso, Carlos; Juarez, Rossina; González-Torres, Henry Joseth; Capotondo, Mercedes; Terrasa, Sergio; Aroca-Martinez, GustavoContext: Renal functional reserve (RFR) refers to the kidney’s capability to increase its basal glomerular filtration rate (GFR) by at least 20 % after an adequate stimulus, such as a protein overload. As far as we know, no studies have yet reported the behavior of electrolyte excretion during the renal functional reserve test. Material and methods: A prospective study to evaluate serum and urinary changes in electrolytes, nitrogenous waste products, glucose, protein, and albumin during the renal functional reserve test in healthy young adults, evaluating their cimetidine-aided creatinine clearance and renal functional reserve test (Hellerstein). Results: There was a statistically significant increase in glomerular filtration rate (positive renal functional reserve) and serum glucose, as well as a significant reduction in serum values of nitrogen derivatives and electrolytes in 46 healthy young adult volunteers during the renal functional reserve test. Regarding the urinary fractional excretion of these substances, significant increases were observed for nitrogenous waste products and electrolytes, except for phosphorus, glucose, protein, and albumin urinary excretion, which suffered no change. Conclusion: The renal functional reserve significantly modified not only glomerular filtration rate but also nitrogenous waste products and electrolyte serum levels, as well as their urinary fractional excretion values in healthy young adults (mean age: 35 years).Ítem Characterizing hypertension among recreational cyclists in Colombia: The Atlantico cyclists study(Elsevier, 2025) Hernandez Nieto, Bryan; Urina Jassir, Manuel; Mantilla Morron, Mirary; Charris Cogollo, Carolina Rosa; Mercado Marchena, Riguey; Urina Jassir, Daniela; Urina Triana, Manuel; Urina Triana, MiguelObjective: To describe the prevalence of hypertension and exercise-induced hypertension (EIH) among recreational cyclists in addition to their exercise habits and prior medical evaluations. Methods: A cross-sectional study was conducted among adult recreational cyclists from March to April 2024 in the Department of Atlántico, Colombia. Participants were selected via convenience sampling after cycling activities and data were collected with a structured survey (demographics, comorbidities, and exercise habits). Post-exercise blood pressure (BP; two measurements three minutes apart), heart rate, oxygen saturation, weight, height, and waist circumference were measured. EIH was defined as a systolic BP > 210 mmHg for men and > 190 mmHg for women. Data were summarized with descriptive statistics. Results: Three hundred and fifty-five individuals were included. Most were male (84.5 %) and older than 45 years of age (75.8 %). Hypertension was identified in 22 % of participants. Other risk factors included hypercholesterolemia (11.8 %), smoking (10.4 %), and hypertriglyceridemia (7.3 %). The mean post-exercise systolic BPs were 130.4 ± 55.6 mmHg and 122.6 ± 15.5 mmHg, and diastolic BPs were 77.2 ± 10.4 mmHg and 76.8 ± 10.7 mmHg (initial and three minutes later, respectively) and no participants fulfilled the criteria for EIH. Among the participants, 20.6 % underwent prior medical evaluation. Conclusions: Hypertension was a common baseline condition among recreational cyclists, but none was found to have EIH. Despite a high prevalence of cardiovascular risk factors, one-fifth of the participants had a medical evaluation before engaging in cycling activities. Our findings underscore the importance of encouraging routine health screenings in this population.Ítem Guayaquil consensus: financial neutrality in organ donation(Sociedad Latinoamericana de Nefrología e Hipertensión, 2025) Vázquez-Jiménez, Lourdes C.; Matamoros, María A.; Mueller, Thomas; Bisignano, Liliana; Morales-Buenrostro, Luis E.; Rosa-Diez, Guillermo; Mizraji, Raúl; Rico-Fontalvo, Jorge; Dina-Battle, Eliana; Valdés, Régulo A.; Papaginovic, María M.; Ferreiro-Fuentes, Alejandro; Stanley, Idalina; Orué-Simón, María G.; Moura-Netto, José A.; Huertas, Jorge; Márquez, Carlos; Madrid-Mancia, Carlos F.; Arroyo, Rocío C.; Sandoval-Díaz, Mabel; Carlino, María C.; Avellán-Boza, Marta; Rodríguez-Méndez, Guillermo; Cáceres, Adhanellys; De la Cruz, Ana C.; Gómez-Luján, Martín; Cabrera, Sebastián; Bórquez-Villagra, Tamara; Castresana, Josué; Salomé, Mariela; Abbud-Filho, Mario; Sánchez-Cedillo, Aczel; García, Paola; Garcia-Trabanino, Ramon; Pregno, Elian; Sánchez-Polo, VicenteIn the context of projections for Latin America, the Guayaquil Document is expected to serve as a crucial reference framework for establishing policies that ensure financial neutrality in the region. As we move towards 2030, countries in the area will likely adopt stricter measures to ensure donors do not incur economic losses from their altruistic decisions. Considering the recent legislative proposal from the United States—the End Kidney Deaths Act (H.R. 9275, 118th Congress)—which proposes a $50,000 tax deduction for living kidney donors ($10,000 annually for five years), the signing societies express their deep ethical, legal, and social concerns. Although the project states its purpose of reducing mortality from chronic kidney disease (CKD), its implementation sets a precedent that contradicts the universal principles of altruistic donation and financial neutrality enshrined in the Istanbul Declaration (2018) and the WHO Guiding Principles (2010). This document alerts health authorities, legislators, ethics committees, medical societies, and international organizations in Latin America and the Caribbean to the risks that such initiatives may pose to more fragile systems, eroding public trust and compromising distributive justice and human dignity. This document has been consensually agreed upon and approved by all nephrology societies in Latin America that comprise SLANH during the XXI Congress of SLANH, held in Guayaquil, Ecuador, from August 27 to 30, 2025. It has also been subscribed, discussed, consensually agreed upon, and approved by the transplant societies of Latin America and the Caribbean that form STALYC during the XXVI Latin American and Caribbean Transplant Congress and the V Paraguayan Transplant Congress, held in Asunción, Paraguay, from October 1 to 3, 2025.Ítem Use of the thermal camera to assess the perfusion of the nippleAreola complex and lower adipoglandular flap in post explantation mastopexy(Springer Nature, 2024) Lacouture, Alberto M.; Guerrero, Marco E.; Lacouture, Natalia A.; Manzur, Ricardo E.Thermography is a valuable tool for assessing tissue temperature. In recent years, explantation surgery has increased due to the fact that, despite technological advancements, breast implants have a limited lifespan and eventually require explantation, whether for pathological, aesthetic, or personal reasons. Among the complications that can arise in breast surgery are necrosis of the nippleareola complex (NAC) and fat necrosis of the lower dermoglandular flap, which may affect the outcomes. Considering that the blood supply and perfusion of the breast were altered during the initial surgical procedure, and the technique previously used is often unknown, it is crucial to ensure adequate vascularization of the NAC and the flap. This study demonstrates the usefulness of the thermal camera for intraoperative and postoperative monitoring of the NAC and the lower adipoglandular flap, with the goal of determining tissue perfusion and identifying hypoperfused areas for immediate management, thus providing a new safety parameter in breast surgery. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.Ítem Encefalomielitis aguda diseminada fulminante en un paciente pediátrico: reporte de caso y revisión de la literatura(Asociación Colombiana de Medicina Crítica y Cuidado lntensivo, 2025) Mendoza Caballero, Angélica María; Sánchez Algarín, Ricardo AndrésLa encefalomielitis aguda diseminada (ADEM), pertenece a un grupo de trastornos caracterizado por la aparición aguda o subaguda de déficits neurológicos con evidencia de desmielinización inflamatoria del sistema nervioso central (SNC), es una enfermedad poco frecuente que afecta principalmente a ninos ˜ y adultos jóvenes, se considera que entre el 50-80% de los casos se presentan posterior al compromiso de las vías respiratorias inferiores, sistema gastrointestinal o enfermedad exantemática; los agentes infecciosos asociados son los virus. La evaluación diagnóstica incluye estudios del líquido cefalorraquídeo y neuroimagen para evaluar las lesiones cerebrales multifocales características de la ADEM; el tratamiento consiste en corticosteroides intravenosos, intercambio de plasma terapéutico e inmunoglobulina intravenosa. Se trata de un preescolar masculino de 2 anos ˜ de edad, quien cursa inicialmente con síntomas respiratorios y gastrointestinales, posteriormente con deterioro neurológico presentando crisis caracterizadas por postura tónica que progresa a movimientos clónicos bilaterales, poca respuesta pupilar, estado comatoso, sin respuesta a estímulos nociceptivos e hipotonía truncal, realizan RMN cerebral donde se observan lesiones extensas que comprometen la sustancia blanca supra e infratentorial compatibles con ADEM. Afortunadamente es una enfermedad con buen pronóstico y evolución clínica, sin embargo, este caso demuestra que no todos los pacientes tienen una buena respuesta al manejo instaurado, lo que conlleva a la necesidad de establecer marcadores propios de esta enfermedad que permitan hacer un diagnóstico dirigido desde el momento de la sospecha diagnóstica con el fin de prevenir posibles complicaciones y secuelas neurológicas asociadas.Ítem Obesidad y disfunción cardiorrenal: el impacto de la inflamación y la lipotoxicidad(Asociación Colombiana de Nefrología e Hipertensión Arterial, 2026) Rico Fontalvo, Jorge; Daza Arnedo, Rodrigo; Raad Sarabia, Maria; Montejo Hernández, Juan; Rodríguez Yánez, Tomas; Jiménez Quintero, Javier; González Arias, Mauricio; Araiza Garaygordobil, DiegoLa obesidad es una enfermedad sistémica poco reconocida durante años. La enfermedad renal crónica asociada a obesidad (ERC-Ob) es un trastorno multifacético que afecta a pacientes con obesidad en diversos grados. Esta situación se da por mecanismos directos e indirectos y estos pacientes tienen riesgo aumentado de desarrollar enfermedad cardiovascular (ECV) con sus diferentes manifestaciones, incluyendo enfermedad arterial coronaria, insuficiencia cardíaca (IC) o arritmias y muerte súbita cardiaca. Hay una interacción compleja entre obesidad, enfermedad renal crónica (ERC) y el desarrollo de compromiso cardiaco. En los últimos años, se ha incrementado el interés por comprender el papel de la obesidad en el desarrollo de ERC y falla cardíacaÍtem Tormenta tiroidea: abordaje diagnóstico y terapéutico(Asociación Colombiana de Medicina Crítica y Cuidado lntensivo, 2025) Correa Guerrero, José; Corrales Santander, Hugo; Yepes Caro, Jorge; Bello Simanca, Jesús; Rodríguez Arrieta, Luis; Castellanos Pinedo, Alejandro; Rodríguez Garizabalo, Elguis; Dueñas Castell, CarmeloLa tormenta tiroidea (TT) es una patología infrecuente, pero potencialmente mortal si no se detecta y trata oportunamente. Se caracteriza por manifestaciones clínicas graves a nivel del sistema nervioso central, cardiovascular y gastrointestinal, asociado a niveles elevados de triyodotironina (T3) libre y tiroxina (T4) libre. Las infecciones y/o el abandono del tratamiento son los desencadenantes más frecuentes. Identificar el factor desencadenante, reducir los niveles circulantes de hormonas tiroideas, y admitir a unidad de cuidado intensivo se convierten en la piedra angular del tratamiento. En la presente revisión, basados en un escenario clínico, proporcionaremos información con respecto al abordaje diagnóstico y terapéutico de una TT. © 2024 Asociacion Colombiana de Medicina CrÍtica y Cuidado lntensivo. Publicado por Elsevier España, S.L.U. Se reservan todos los derechos, incluidos los de minería de texto y datos, entrenamiento de IA y tecnologías similares.Ítem Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival(MDPI, 2025) Pájaro Huertas, Hernán Javier; Pantoja Echeverri, María Viviana; Martínez, Gustavo Aroca; Guido Musso, Carlos; Dominguez Vargaz, Alex; González Torres, Henry J.Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico, Colombia. Methods: We conducted a retrospective, observational, analytical study including 163 kidney transplant recipients between 2015 and 2020. Clinical and microbiological variables were compared according to UTI status. Renal function was assessed using estimated glomerular filtration rate (eGFR). Graft survival was analyzed with Kaplan–Meier curves, and predictors of graft loss were identified using Cox regression models. Results: UTI prevalence was 17.8% (29/163), with a higher proportion of women in the UTI (+) group compared to the UTI (−) group (62% vs. 34%, p = 0.004). Escherichia coli (59%) and Klebsiella spp. (31%) were the predominant pathogens, with MDR in 66% of isolates and carbapenem resistance in 28%. Patients with UTIs had significantly lower baseline and follow-up eGFR (p ≤ 0.002), yet five-year graft survival was comparable (93% vs. 91%, p = 0.54). Baseline eGFR (HR: 0.95, p < 0.001) and institutional referral (HR: 9.7, p = 0.010) were independent predictors of graft loss, whereas UTIs were not associated with increased risk. Conclusions: Post-transplant UTIs in Atlántico were characterized by high antimicrobial resistance and reduced renal function, but did not affect graft survival. Antimicrobial stewardship and institutional optimization strategies are essential to improve outcomes in this vulnerable population.Ítem Machine learning in lupus nephritis: bridging prediction models and clinical decision-making towards personalized nephrology(Frontiers Media, 2025) Garcia Bañol, Diego Fernando; Arias Choles, Adrianny Mahelis; Aldana Peréz, Silvia; Aroca Martínez, Gustavo J.; Guido Musso, Carlos; Navarro Quiroz, Roberto; Dominguez Vargas, Alex; Gonzalez Torres, Henry J.Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE), affecting up to 65% of patients during the disease (1, 2). Its clinical course is heterogeneous, characterized by alternating periods of exacerbation and remission, and influenced by a complex interplay of immunological, endocrine, genetic, and environmental factors (3–5). Renal involvement ranges from subclinical disease to end-stage renal disease (ESRD), in which a generalized pro-inflammatory state accelerates renal function decline and significantly worsens patient survival (6). There is currently no definitive cure for SLE or LN. Since the 1950s, standard treatment has aimed to induce remission, suppress disease activity, reduce symptoms, preserve renal function, and maintain remission (7). Although therapeutic regimens have evolved over time (induction vs. maintenance strategies), they typically combine an immunosuppressant with an intermediate-acting glucocorticoid to prevent persistent inflammation, irreversible renal damage, and progression to ESRD (8). Multiple factors influence LN progression, including dysregulation of autoantibody production, poor adherence to therapy, excessive sun exposure (9), and socioeconomic disadvantages (10). However, these variables alone have limited predictive value for anticipating disease flares or renal deterioration (5). In this regard, machine learning (ML) algorithms offer the ability to incorporate multiple clinical and biological variables simultaneously, detect hidden patterns, and generate predictive models with greater accuracy (2). The application of ML to LN monitoring provides several potential benefits. These include timely interventions to prevent disease progression and complications (11–15), the development of personalized follow-up strategies based on patient-specific characteristics and trajectories (14–17), and the ability to identify high-risk patients who may require closer surveillance. Moreover, ML models can predict the likelihood of flares by analyzing historical and longitudinal data, enabling clinicians to implement preventive measures such as therapy adjustments or lifestyle modifications.Ítem Inflammatory and lipotoxicity mechanisms in obesity related CKD(Frontiers Media, 2026) Rico Fontalvo, Jorge; Raad Sarabia, Maria; Montejo Hernández, Juan; Rodríguez Yanez, Tomas; Caparroso Ramos, Lacides Rafael; Parra Sánchez, Paula; Ovalle Gomez, Ana Alejandra; Jiménez Quintero, Javier; Daza Ornedo, RodríguezObesity has been a systemic disease that has been underrecognized for years. Obesity-related chronic kidney disease (Ob-CKD) is a multifaceted disorder that affects patients with CKD to varying degrees. Among the structural changes associated with obesity, obesity-related glomerulopathy (ORG) stands out (glomerular hypertrophy, podocytopathy, mesangial matrix expansion, focal segmental glomerulosclerosis, tubulointerstitial fibrosis, vascular lesions, and tubular atrophy) associated with other kidney diseases. There are direct and indirect mechanisms that affect the kidneys of obese patients. Among the direct mechanisms, several effects may occur: hyperfiltration, activation of the reninangiotensin- aldosterone system (RAAS), inflammation, lipotoxicity, and neurohormonal activation. This is a narrative review that will detail the inflammatory and lipotoxicity mechanisms involved in the genesis of Ob-CKD.Ítem Complicaciones infecciosas en pacientes hospitalizados con enfermedad renal crónica en terapia de reemplazo renal: Un estudio observacional en un centro de salud de cuarto nivel en la Costa Caribe colombiana (2019-2024)(Sociedad Ecuatoriana de Nefrología, Diálisis y Trasplantes, 2025) Aroca-Martinez, Gustavo; Pérez Jiménez, Valentina; Perea Rojas, Diana Marcela; Cadena Bonfanti, Andres Angélo; Sarmiento Gutierrez , Joanny Judith; Raad Sarabia, Maria Isabel; daza arnedo, rodrigo andres; Rico-Fontalvo, JorgeIntroducción: La segunda causa de mortalidad en pacientes con insuficiencia renal son las infecciones, entre las cuales la presencia de dispositivos como catéteres constituye un factor de riesgo. Este estudio analiza la mortalidad y los factores que contribuyen a las infecciones relacionadas con catéteres en pacientes con ERC. Métodos: El presente estudio observacional, se realizó en la Clínica de la Costa (Barranquilla, Colombia) de 2019 a 2024. Se incluyeron casos de pacientes en hemodiálisis o diálisis peritoneal, hospitalizados por infecciones de catéteres, con cultivo positivo. La muestra, se dividió en dos grupos según el desenlace hospitalario: vivos y fallecidos. Se recolectaron variables sociodemográficas, clínicas, microbiológicas y de manejo. Se comparan porcentajes con el test de Chi cuadrado y el Odds ratio. Resultados: Se analizan 78 casos, de los cuales 38 en hemodiálisis y 40 en diálisis peritoneal; la mortalidad fue del 25.6% (n=20). No se encontraron diferencias en edad, sexo, comorbilidades crónicas entre los grupos. Los antecedentes de infección previa y de enfermedad neurológica se identificaron como factores de riesgo (OR: 3.714; IC95%: 1.04-13.31; P=0.036). Las muertes se asociaron al choque séptico y al ingreso en la UCI, presentes en el 100% de los fallecidos (P < 0.001). El S. aureus meticilino resistente fue el principal predictor de mortalidad, presente en el 50% de las defunciones (OR: 117; P=0.0014). No hubo asociación entre el tipo de dispositivo de acceso o la modalidad de diálisis y el fallecimiento de los pacientes. Conclusión: la supervivencia en terapia de reemplazo renal depende de una vigilancia microbiológica estricta y de la personalización de los cuidados preventivos en pacientes con compromiso cognitivo, lo que permite una intervención temprana antes de que se establezca una disfunción orgánica irreversible.Ítem Factores impulsores y métodos de puntuación para mejorar el control de la enfermedad renal crónica en la atención primaria. Una propuesta peruana de modelo operativo(Colegio Médico del Perú, 2025) Herrera-Añazco, Percy; Vallejos, Augusto; Depine, Santos; Diaz-Arocutipa, Carlos; Kikushima-Alcántara, Pedro; Benites- Zapata, VicentePara la implementación de la vía de abordaje HEARTS para el manejo del paciente con enfermedad renal crónica (ERC), de la iniciativa HEARTS, es necesaria la incorporación de impulsores del control de la enfermedad basados en la mejor evidencia disponible, así como de sus respectivos índices de madurez y desempeño. Para esto, se creó un grupo interdisciplinario encargado de seleccionar los factores impulsores clave del control de la ERC, basados en la evidencia, y que diseñó un método de puntuación integral para dar seguimiento a su implementación en los centros de primer nivel de atención. Se identificaron siete impulsores, que se agruparon según los componentes del abordaje de la enfermedad: dos impulsores orientados al diagnóstico, dos al tratamiento, y uno a cada uno de los siguientes dominios: continuidad de la atención y seguimiento, sistema de prestaciones y sistema de evaluación del desempeño. Estos impulsores guiarán el proceso de mejora de la calidad con el objetivo de alcanzar los objetivos de control de la ERC a nivel poblacional.Ítem Living with systemic lupus erythematosus in 2024: Latin American experience based on a patient survey(Springer, 2025) Quintana, Rosana; Bellomio, Veronica; Ugarte, Manuel; Fernandez, Diana; Nieto, Romina; Scolnik, Marina; Funes Soaje, Carmen; Alba, Paula; Saurit, Verónica; Garcia, Mercedes; Berbotto, Guillermo; Kerzberg, Eduardo; Gómez, Graciela; Pison, CeciliaObjective To assess the burden of systemic lupus erythematosus (SLE) from the perspective of patients in Latin America (LATAM) in 2024. Methods During May 2024, as part of International SLE Awareness Day, the Grupo Latinoamericano de Estudio del Lupus (GLADEL) disseminated an anonymous, bilingual (Spanish/Portuguese) online survey to patients with SLE. The survey, developed by Lupus Europe, was distributed through physicians and patient associations across LATAM and explored sociodemographic characteristics, disease features, treatments, and the impact on daily life. Results A total of 1991 responses from 21 Latin American countries were analyzed (Argentina, Brazil, the Dominican Republic, Chile, and Peru contributing the highest numbers). Most respondents were women (95.2%), with a mean age of 38.6 years (SD 11.6). Overall, 52.1% were married or partnered, 34.0% had completed secondary/vocational education, and 38.8% were employed. Regarding ethnicity, 25.5% identified as Caucasian and 34.4% as Mestizo. A prior alternative diagnosis was reported by 59.7%, with a mean age at diagnosis of 28.8 years (SD 10.6) and a median delay of 1 year (IQR 0–2). The most frequently affected organs were joints (71.4%), skin (47.4%), and kidneys (37.5%). Emotional and sexual life were negatively affected in 43.2%, and 62.1% reported impacts on education or career. Anxiety and/or depression were reported by 60%. Antimalarials, corticosteroids, immunosuppressives, and biologics were used by 80.9%, 55.7%, 59.9%, and 11.1%, respectively. Notably, 67.7% perceived their disease as under control. Conclusion Understanding patient perspectives is essential to evaluate the burden of SLE, and incorporating patient-reported experiences into decision-making should be prioritized.Ítem Internal ophthalmoplegic migraine during pregnancy: a clinical case(MDPI, 2025) Castillo-Guerrero, Brenda; Londoño-Juliao, Gloria; pianetta, yesenia; Gutiérrez-Rey, Melissa; Zuñiga, Bley Jair; Pestana, Gustavo; Carbonell-Zabaleta, Ana-Karina; Rivera-Porras, Diego; Bermudez, Valmore; VARGAS MANOTAS, JOSEAbstract: Background: Ophthalmoplegic migraine (OM) is an uncommon variant of migraine characterised by headache and cranial nerve palsy, posing significant diagnostic and therapeutic challenges. Objective: This study aimed to describe an extremely rare OM variant with a partial therapeutic response. Clinical Case: A 34-year-old pregnant woman in gestational week 19.1 (G6P2A3) with a history of three consecutive spontaneous abortions presented at the emergency services with insidious onset and mild-to-moderate-intensity pulsatile bifrontal headache for 15 days, and the positional changes exacerbated this. At peak intensity, she experienced nausea, vomiting, tinnitus, and photophobia without phonophobia or osmophobia, prompting multiple visits to the emergency department. Despite a broad range of treatments, including intravenous fluids, analgesia, pericranial blocks, and preventive management, there was a non-significative improvement in the symptomatology described above. However, spontaneous resolution of this clinical picture was observed during the postpartum period. Results: This case highlights the complexity of ophthalmoplegic migraine, especially in the context of pregnancy, and raises questions about the underlying pathophysiological mechanisms. The absence of structural lesions on neuroimaging and postpartum resolution suggests a potential association with the hormonal and physiological changes associated with pregnancy. Conclusions: Despite limited scientific evidence, this report contributes to expanding the knowledge of this rare entity and emphasises the importance of a multidisciplinary approach to its management.Ítem Extracranial vertebral artery dissecting aneurysm presenting as vertebrobasilar stroke in a young adult: Case report of flow-diverter stenting(MDPI, 2025) Coronel, Maria Angelica; Luque-Llano, Melissa; Núñez-Bravo, Narledis; Rebolledo, Carlos; Barceló-Martínez, ErnestoBackground: Extracranial vertebral artery aneurysms (EVAAs) are exceptionally rare vascular lesions and an uncommon cause of posterior circulation stroke. Their diagnosis is often delayed due to nonspecific symptoms, yet prompt recognition is essential to guide management. Objective: This study aimed to report a rare case of an extracranial vertebral artery dissecting aneurysm presenting as a posterior circulation stroke in a young adult, successfully managed with flow-diverter stenting. Clinical Case: A 33-year-old woman presented with sudden-onset dysarthria, vertigo, nausea, and vomiting. Brain magnetic resonance imaging revealed infarcts in the left occipital lobe, cerebellar peduncle, and both cerebellar hemispheres. Computed tomography angiography (CTA) demonstrated a fusiform aneurysm in the V2 segment of the left vertebral artery, and digital subtraction angiography (DSA) confirmed a dissecting aneurysm. The patient was successfully treated with a flow-diverting stent and remained stable at 6 months’ follow-up with mRS 1. Results: EVAA are uncommon but can manifest as posterior circulation ischemic events in young patients. Endovascular treatment with flow-diverting stents has been reported as a feasible option in selected cases, although evidence remains limited to case reports and small series. Conclusions: This case underscores the importance of considering rare yet potentially treatable etiologies of vertebrobasilar stroke in young patients and highlights the value of a multidisciplinary approach to management.Ítem Clinical effectiveness of treatments for mild cognitive impairment in adults: a systematic review(MDPI, 2025) Cepeda-Pineda, Daniel; Sequeda, Gabriela ; Carrillo-Sierra, Sandra-Milena; silvera cruz, kevin; Redondo-Chamorro, Johanna ; ROZO SANCHEZ, ASTRID CAROLINA; Bermudez, Valmore; Contreras-Velásquez, Julio César; Gómez Charris, Yulineth; Rivera-Porras, DiegoBackground/Objectives: Mild cognitive impairment (MCI) represents an intermediate stage between normal ageing and dementia, with a high annual progression rate. Despite its clinical relevance, no pharmacological treatment has been definitively approved for this condition; however, multiple pharmacological and non-pharmacological strategies have been investigated for their potential benefits. This systematic review assessed the effectiveness of both types of interventions in adults with MCI, aiming to identify effective strategies to preserve cognitive function. Methods: A systematic search (2017–2025) was conducted in PubMed, Scopus, ScienceDirect, SpringerLink, and WOS, following PRISMA guidelines. Randomised controlled trials and quasi-experimental studies involving adults aged ≥ 50 years with a diagnosis of MCI were included. Outcomes were evaluated in terms of cognitive, functional, behavioural, and quality-of-life improvements. Risk of bias was assessed using the RoB 2 and ROBINS-I tools. Results: Of 108,700 records screened, 40 studies were included. Non-pharmacological interventions, such as cognitive training (conventional, computerised, or virtual reality-based), consistently improved memory, attention, and executive functions (e.g., MoCA: +3.84 points; p < 0.001). Transcranial magnetic stimulation combined with physical exercise also demonstrated significant benefits (p = 0.025). Among pharmacological treatments, only vortioxetine and choline alfoscerate showed modest improvements; cholinesterase inhibitors had limited effects and frequent adverse events. Complementary therapies (yoga, probiotics, and acupuncture) yielded promising outcomes but require further validation. Conclusions: Non-pharmacological strategies, particularly cognitive training and physical exercise, emerge as the most effective and safe approaches for managing MCI. The inclusion of pharmacological interventions with preliminary evidence of benefit should be considered within a personalised, multimodal approach, while recognising the current absence of approved drug treatments for MCI. Further research is needed in underrepresented populations, such as those in Latin America.Ítem Keller/eGFR ratio as a simple and useful tool to make a first differentiation between renal aging and chronic nephropathy in large populations(Springer, 2025) Cristiano, Fabrizio; Aroca‑Martinez, Gustavo; Guido Musso, 4CarlosBackground Chronic kidney disease (CKD) prevalence increases with age, but distinguishing physiological renal ageing from pathological CKD remains a major diagnostic challenge. Current CKD definitions based solely on estimated glomerular filtration rate (eGFR) often lead to overdiagnosis in elderly individuals with normal age-related decline. This study explores the use of the Keller/eGFR ratio as a simple and useful tool to differentiate normal renal ageing from true nephropathy in large populations. Methods Keller formula (GFR = 130—age) was applied to model the expected physiological GFR decline across the lifespan. The ratio between Keller-derived GFR and measured eGFR (CKD-EPI) was analyzed to distinguish physiological ageing (Keller/eGFR ≤ 1) from pathological decline (Keller/eGFR > 1). The approach was compared with classical biochemical, urinary, and imaging markers and validated using data from the Abruzzo cohort of older adults. Results Keller/eGFR ratio provided a clear separation between individuals with expected age-related GFR reduction and those with evidence of underlying CKD. In patients with Keller/eGFR ≤ 1, biochemical parameters (creatinine, urea, hemoglobin, calcium–phosphorus metabolism) and urinalysis remained within normal limits, and imaging findings were unremarkable. Conversely, Keller/eGFR > 1 was associated with typical CKD features, including anemia, mineral abnormalities, and structural renal alterations. Integrating this ratio with clinical and laboratory data significantly reduced CKD overdiagnosis in elderly subjects. Conclusions The Keller/eGFR ratio represents a practical, low-cost, and easily applicable index for the first-line screening of kidney function in older adults. When combined with biochemical and imaging markers, it enhances diagnostic accuracy and helps avoid excessive medicalization related to CKD misclassification. Wider implementation in population studies could improve epidemiological stratification and resource allocation in nephrology care.Ítem From the field to the assembly hall: the history of the kidney health resolution(Sociedad Internacional de Nefrología, 2025) Lou-Meda, Randall; Depine, Santos; Burgos-Calderón, Rafael; Luyckx, ValerieKey events and a trajectory spanning more than 3 decades that led to the adoption of the World Health Organization resolution on kidney health, a historic milestone for public health, are described, highlighting the pioneering contributions of leaders from Latin America. Milestones include defining the concept of kidney health, framing chronic kidney disease within social determinants, pioneering programs, strategic alliances, and regional policies. Key events are contextualized, including the Puerto Rico Declaration, the Antigua Guatemala Summit, the El Salvador meeting on Mesoamerican endemic nephropathy, and the inclusion of chronic kidney disease medicines into the Pan American Health Organization Strategic Fund. The history of the World Health Organization resolution on kidney health shows how Latin America transformed an overlooked issue into a global political priority, demonstrating how science, cooperation, and a vision of equity have elevated a regional concern into a worldwide commitment. Today, the challenge is to implement this resolution to realize kidney health for all.Ítem Resistencia a la insulina y su impacto en la enfermedad renal crónica asociada a obesidad(Sociedad Paraguaya de Nefrología, 2025) Rico Fontalvo, Jorge; Rodríguez Yánez, Tomas; Montejo Hernández, Juan; Jiménez Quintero, Javier; Daza Arnedo, RodrigoLa obesidad es un problema de salud pública a nivel mundial. Hace parte del llamado síndrome metabólico (SM) y se correlaciona con un elevado riesgo de resultados adversos cardiovasculares. La obesidad se correlaciona con la aparición y progresión de la enfermedad renal crónica (ERC) y se han descrito mecanismos directos e indirectos que afectan los riñones en pacientes obesos. La enfermedad renal crónica relacionada con la obesidad (ERC-Ob) es un trastorno multifacético que afecta a pacientes con ERC en diversos grados. Dentro de los mecanismos inflamatorios, hemodinámicos y metabólicos se destaca la resistencia a la insulina y la hiperinsulinemia compensatoria que contribuyen a la hiperfiltración glomerular, albuminuria, incremento de la permeabilidad vascular, disfunción endotelial, estrés oxidativo y mayor producción citoquinas proinflamatorias que aceleran el deterioro de la función renal. Por ello nos proponemos revisar el impacto y los efectos de la resistencia a la insulina como mecanismo de iniciación y desarrollo de la ERC-Ob.