Clinical utility of a traditional score system for the evaluation of the peritoneal dialysis exit-site infection in a national multicentric cohort study.

INTRODUCTION: Exit-site infection (ESI) is an important risk factor for peritonitis in patients under chronic peritoneal dialysis (PD). The International Society for Peritoneal Dialysis (ISPD) recommend its diagnosis as the presence of purulent drainage in the exit site (ES) but time-consuming scores using others skin signs are routinely used. OBJECTIVE: To investigate the correlation between the diagnosis of ESI with a score based on five clinical signs obtained from ES inspection, and also if there are interaction with patient's race. METHODS: Multicenter and prospective cohort. We included adult patients from 122 clinics, incident on PD and with a 12-month stay in therapy. The event of interest was ESI, defined as purulent drainage. The clinical score used was composed of hyperemia, edema, pain, scab, and granuloma. Statistical analysis was performed using multilevel logistic regression model, likelihood test, and Cohen concordance analysis. RESULTS: A total of 35,354 ES assessments were performed during the first year of dialysis in 3297 patients. There was a rate of 10.1 (9.1-11.2) episodes of ESI per 1000 patients/month. In patients with ESI, the prevalence of hyperemia was 55.9%, edema 67.3%, pain 31.8%, and scab 23.2%. The agreement with the score was 60.6% and showed differences according to the patient's race, being 53.2% for African Americans descendants and 65.4% for others. The use of scales for the diagnosis of ESI does not add much information in addition to the presence of purulent secretion as currently recommended by the ISPD.

Peritoneal dialysis in Brazil: twenty-five years of experience in a single center.

OBJECTIVES: To evaluate patient and technique survival and to provide an analysis of peritoneal dialysis (PD)-related peritonitis in 25 years of experience in a single center. STUDY DESIGN: Retrospective study of incident patients on PD from July 1980 to July 2005. SETTING: Single, university based, Brazilian dialysis program. PATIENTS: 680 patients were analyzed in our study from July 1980 to July 2005, with a cumulative experience of 15 303 patient-months. All patients over 15 years of age entering the dialysis program were included in the study. Patients with less than 30 days of follow-up were excluded. Biochemical and demographic variables, peritonitis episodes, and patient and technique survival were analyzed. RESULTS: Mean age at start of PD was 53 +/- 16 years; diabetic nephropathy was the main cause of chronic kidney disease. Cardiovascular disease was the main cause of death (44%); peritonitis was responsible for 16% of fatal events. The predictors of death in our study were diabetes [relative risk (RR) 1.23, p < 0.01], advanced age (RR 1.58, p < 0.001), low serum albumin level (RR 1.25, p < 0.01), and low serum phosphate level (RR 1.39, p < 0.001) upon starting PD. There were 1048 cases of peritonitis over the 25-year period, with a significant reduction in incidence after the introduction of the double-bag system. The number of incident PD patients originating from hemodialysis increased threefold over the observation period (p < 0.001), with a similar increase in comorbidities over time. CONCLUSION: In the largest single-center report of PD experience in Latin America, we describe the overall rate and trends over time of peritonitis as well as patient and technique survival, which are similar to previous reports. Significant changes in peritonitis rates and causative organisms as well as a significant time-dependent increase in high-risk patients starting PD were observed.

Incidência de síndromes coronarianas agudas no período da pandemia da COVID-19 em serviço de referência em atendimento de cardiologia na cidade de Curitiba / Incidence of acute coronary syndromes during the pandemic period of COVID-19 in a cardiology reference service in the city of Curitiba

Introdução: As doenças cardiovasculares compõem importante causa de óbito pelo mundo, sendo as doenças isquêmicas do coração responsáveis por um número considerável dessas mortes. A COVID-19, doença causada pelo SARS-CoV-2, pode causar importantes complicações e implicações cardiovasculares, dentre elas as síndromes coronarianas agudas. Este estudo teve como objetivo relacionar dados de prevalência de síndromes coronarianas agudas durante o período de pandemia pela COVID-19 (2020) com os dados do ano anterior (2019). Métodos: Trata-se de estudo retrospectivo, descritivo, analítico e transversal, com obtenção de variáveis por meio da análise dos prontuários de todos os pacientes adultos, de ambos os sexos, internados por infarto agudo do miocárdio, angina instável e doença isquêmica do coração entre os meses de janeiro a dezembro de 2019 e de janeiro a dezembro de 2020, em um hospital de referência para cardiologia em Curitiba (PR). As variáveis obtidas foram sobre diagnóstico dessas doenças, consulta clínica, exames laboratoriais e exames de imagem. Os dados encontrados foram correlacionados entre si para definirmos possíveis relações de causalidade. Resultados: Houve redução de 40,38% na incidência de internamentos pelos diagnósticos citados em 2020 em comparação a 2019. Não houve diferença entre dias de início de sintomas entre os anos comparados, dias de internamento ou número de comorbidades apresentadas pelos pacientes, apesar de haver maior número de diagnósticos de angina instável e de presença de dor torácica nos indivíduos atendidos em 2020. Conclusão: A pandemia da COVID-19 impactou a vida de todas as pessoas, inclusive na busca por atendimento em unidades de saúde e hospitais em todo o mundo, resultando em menor procura aos serviços de saúde, inclusive para doenças graves e agudas, que podem levar ao aumento da morbimortalidade populacional.

Background: Cardiovascular diseases are an important cause of death worldwide, and ischemic heart diseases account for a considerable number of these deaths. COVID-19, a disease caused by SARS-CoV-2, may pose important cardiovascular complications and implications, including acute coronary syndromes. This study aimed to compare prevalence data of acute coronary syndromes during the COVID-19 pandemic period (2020) to the previous year (2019). Methods: This is a retrospective, descriptive, analytical, and cross-sectional study, with variables acquired through the analysis of the medical records of all adult patients of both sexes admitted for acute myocardial infarction, unstable angina, and ischemic heart disease between the months of January to December 2019, and January to December 2020, to a cardiology reference hospital in Curitiba (PR). The variables obtained were about diagnosis of these diseases, clinical consultation, laboratory tests, and imaging tests. The data found were then correlated with each other to define possible causal relations. Results: There was a 40.38% reduction in the incidence of hospitalizations for the cited diagnoses in 2020 compared to 2019. There was no difference between days of onset of symptom between the compared years, days of hospitalization, or number of comorbidities presented by patients, although there was a higher number of diagnoses of unstable angina and presence of chest pain in individuals seen in 2020. Conclusion: The COVID-19 pandemic affected the lives of all people, including the search for care in health facilities and hospitals worldwide, resulting in a lower demand for health services, including for severe and acute diseases, which can lead to increased morbidity and mortality in the population.