Upward-directed exit-site of the swan-neck catheter and "Easy-to-disinfect the backside area of exit-site" may prevent PD complications.

BACKGROUND: Upward-directed exit-site has been believed to be the worst for frequent ESI by an old retrospective study using straight catheters. No comparison study of 3 exit-site directions using swan-neck catheter has been performed regarding which direction is the best for our endpoints, Easy-to-see the backside area of exit-site: ESBE, Easy-to-disinfect the backside area of exit-site: EDBE, reduction of both exit-site infection (ESI), symptomatic catheter dislocation and peritonitis. METHODS: We assessed the relationship of exit-site direction with our endpoints in a quantitative cross-sectional, multicentered questionnaire survey. Patients who received either non-surgical catheter implantation or exit-site surgery were excluded. RESULTS: The numbers (percentage) of exit-site directions in included 291 patients were upward 79 (26.0), lateralward 108 (37.5) and downward 105 (36.5). Cochran-Armitage analysis showed a significant step-ladder increase in the prevalence of ESI as the direction changed from upward to lateralward to downward (0.15 ± 0.41, 0.25 ± 0.54, 0.38 ± 0.69 episodes/patient-year, p = 0.03). Multivariable regression analysis revealed the upward exit-site independently associates with both higher frequency of ESBE (OR 5.55, 95% CI 2.23-16.45, p < 0.01) and reduction of prevalence of ESI (OR 0.55, 95%CI 0.27-0.98, p = 0.04). Positive association between the prevalence of symptomatic catheter dislocation and ESI (OR 2.84, 95% CI 1.27-7.82, p = 0.01), and inverse association between EDBE and either prevalence of symptomatic catheter dislocation (OR 0.27, 95% CI 0.11-0.72) or peritonitis (OR 0.48, 95% CI 0.23-0.99) observed. CONCLUSION: Upward-directed swan-neck catheter exit-site may be the best for both ESBE and prevention of ESI. EDBE may reduce catheter dislocation and peritonitis. Symptomatic catheter dislocation may predict ESI.

Effect of different exit-site care dressings on preventing peritoneal dialysis related infection from nontropical area: a systematic review and network meta-analysis.

OBJECT: This study aims to conduct a systematic review and network meta-analysis to comprehensively evaluate the efficacy of various dressings in preventing exit-site infection (ESI) and peritonitis. METHODS: We searched PubMed, Embase, Web of Science, CINAHL Plus with Full Text (EBSCO), Sino Med, Wan Fang Data, China National Knowledge Infrastructure (CNKI) from 1 January 1999 to 10 July 2023. The language restrictions were Chinese and English. Randomized controlled trials, non-randomized controlled trials, and self-controlled trials were included in this study. We used ROB 2 tool to evaluate the quality of the included literature. Two authors independently extracted the data according to the Cochrane Handbook. A Frequentist network meta-analysis was performed using Stata17.0 according to PRISAMA with a random effects model. RESULTS: From 2092 potentially eligible studies, thirteen studies were selected for analysis, including nine randomized controlled studies, three quasi-experimental studies and one self-controlled trial. A total of 1229 patients were included to compare five types of exit site care dressings, named disinfection dressings, antibacterial dressings, non-antibacterial occlusive dressings, sterile gauze, and no-particular dressings. The outcome of prevention ESI is antibacterial dressings (SUCRA = 97.6) >non-antibacterial occlusive dressings (SUCRA = 68.3) >disinfection dressings (SUCRA = 50.6) >no-particular dressings (SUCRA = 23.9) >sterile gauze (SUCRA = 9.5). The antibacterial dressings were more effective than sterile gauze (OR = 0.13, 95%CI 0.04∼0.44), and no-particular dressing (OR = 0.18, 95%CI 0.07∼0.50) in preventing ESI; the non-antibacterial occlusive dressings were effective than sterile gauze (OR:0.30, 95%CI 0.16∼0.57). There is no statistical significance between no-particular dressings and other types of dressings in preventing the mature ESI. There is no statistical significance in the effectiveness of five types of dressings in preventing peritonitis. CONCLUSIONS: The no-particular dressings maybe more cost-effective for preventing mature ESI. None of the dressings was more effective than another in preventing peritonitis. Then, none of the different types of dressing is strongly recommended for preventing ESI or peritonitis.RegistrationCRD42022366756.

[Renal distress syndrome in surgery and uronephrology: concept, pathogenesis, basics of prevention and correction]. / Renal'nyi distress-sindrom v khirurgii i uronefrologii: ponyatie, patogenez, osnovy profilaktiki i korrektsii.

OBJECTIVE: Based on objective criteria of the structural and functional state of the kidneys in various urgent surgical and uronephrological pathologies (peritonitis, pancreonecrosis, intestinal obstruction, urinary peritonitis, acute purulent secondary pyelonephritis) to identify and prove the general pattern of development of renal changes, their influence on the pathogenesis of homeostasis disorders at the organizational level and to form the evidence base of a new symptom complex - renal distress syndrome in surgery and uronephrology; to establish the effectiveness of Remaxol in its correction. MATERIAL AND METHODS: Experimentally on 60 mongrel dogs with acute peritonitis, pancreatitis, intestinal obstruction of varying severity, the state of renal function, including detoxification, was assessed based on the assessment of the inflow-outflow difference in the level of toxins and in the parenchyma of organs - the composition of lipids, the activity of peroxidation of membrane lipids and phospholipases. Clinical and laboratory studies included patients with acute peritonitis (48), acute pancreatitis (18), intestinal obstruction (21), acute purulent secondary pyelonephritis (19). Patients with peritonitis (20) underwent standardized therapy (the first subgroup) or with the inclusion of Remaxol (28) (the second subgroup). RESULTS: In the experiment and in the clinic, in acute surgical and some urological diseases with a different nature of the inflammatory process, there is a significant decrease in renal function. The recorded acute renal injury is combined with a pronounced membrane-stabilizing process in the tissue structures of the kidneys, the degree of which is associated with the severity of the disease. In order to correct and stabilize the indicated changes, Remaxol was used. The drug increased kidney tolerance to trigger pathogenetic agents, which improved the functional status of the kidneys. These data confirm the significance of the studied molecular mechanisms in kidney damage in urgent pathology. CONCLUSION: Experimental and clinical evidence has been obtained for the formation of a new concept - a symptom complex in acute surgical and uronephrological diseases of the abdominal cavity and retroperitoneal space called renal distress syndrome. Renal distress syndrome in surgery and uronephrology is a set of pathological processes of the body, the most important manifestation of which is the progression of endogenous intoxication due to a violation of the functional status of the kidneys as a result of membrane-stabilizing phenomena of organ cells due to oxidative stress and phospholipase activity.

Educational interventions and identification of risk factors to prevent and reduce peritonitis in peritoneal dialysis: A scoping review.

BACKGROUND: Peritonitis is a common and serious complication of peritoneal dialysis and is one of the main causes of peritoneal dialysis technique failure and long-term hemodialysis conversion. OBJECTIVES: The aim of the review was to identify and clarify peritonitis risk factors and learn about strategies employed at international level to prevent and reduce the occurrence of peritoneal dialysis associated infections and their complications. DESIGN: A scoping review. PARTICIPANTS: Adults in pertitoneal dialysis. MEASUREMENTS: The methodology framework of Arksey and O'Malley and PRISMA for Scoping Reviews guidelines were applied. A search was conducted of PubMed, Scopus and CINAHL using terms to identify peritoneal dialysis -associated risk factors and interventions carried out for the prevention and reduction of peritonitis in adult persons living at home. RESULTS: The 17 studies selected were based on work carried out in nine different countries. Eleven articles analysed modifiable risk factors (low educational level, being a foreigner and low adherence to aseptic technique) and non-modifiable risk factors (age and comorbidities) that predispose to peritonitis in peritoneal dialysis. The other six studies applied an intervention to improve the prevalence of peritonitis considering educational practices adapted to patient characteristics and the application of retraining. CONCLUSIONS: Personalised patient training and the identification of risk factors for peritonitis are key to reducing complications and enhancing the survival of peritoneal dialysis patients and the effectiveness of the technique.

Effect of chewing gum in reducing postoperative ileus after gastroduodenal perforation peritonitis surgery: A prospective randomised controlled trial.

Chewing gum reduces the duration of postoperative ileus and early recovery of bowel function following elective abdominal surgery. However, its role has not been studied in cases of gastroduodenal perforation peritonitis, prompting us to conduct this study. Patients were randomised into two groups, 39 patients received chewing gum (study group) and 43 patients were in the control group. Sensation of hunger, appearance of first bowel sound, and passages of flatus and faeces were significantly early in the study group; their hospital stay was also shorter. Chewing gum reduces the duration of postoperative ileus in cases of gastroduodenal perforation peritonitis.Registration number: IEC/2020-23/3359 dated 13 December 2020, Institutional Ethics Committee, Netaji Subhash Chandra Bose Medical College, Jabalpur, India.

The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVES: The efficacy of fluconazole as a prophylactic strategy in patients with chronic kidney disease (CKD) on peritoneal dialysis (PD) with prior antibiotic exposure is controversial in the current literature. This study aimed to compare a strategy of fluconazole prophylaxis versus no-prophylaxis for patients in PD on antibiotics for previous episodes of peritonitis. MATERIALS AND METHODS: We performed a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) comparing fluconazole prophylaxis with no prophylaxis for PD-related peritonitis. The search was conducted on PubMed, EMBASE, and Cochrane Central in January 23, 2023. The outcome of interest was the occurrence of fungal peritonitis (FP). RESULTS: We included six studies (1 RCT, 5 observational) with 4515 occurrences of peritonitis, of which 1098 (24.8%) received fluconazole prophylaxis in variable doses, whereas 3417 (75.6%) did not receive prophylaxis during peritonitis episodes. Overall, fluconazole prophylaxis was associated with a lower incidence of FP (OR 0.22; 95% CI 0.12-0.41; p<0.001; I2=0%). Subgroup analysis of studies that administered daily doses of fluconazole also demonstrated a reduced incidence of FP in patients who received antifungal prophylaxis (OR 0.31; CI 0.14-0.69; p=0.004; I2=0%). CONCLUSIONS: In this meta-analysis of 4515 episodes of PD-related peritonitis, prophylaxis with fluconazole significantly reduced episodes of FP as compared with no antifungal prophylaxis.

Allopurinol Prevents Cirrhosis-Related Complications: A Quadruple Blind Placebo-Controlled Trial.

BACKGROUND: Complications associated with liver cirrhosis are various and potentially fatal. The treatment options to counteract hepatic decompensation are limited. Therefore, the study aimed to explore the use of allopurinol in preventing the recurrence of liver cirrhosis-related complications. METHODS: One hundred patients with hepatic decompensation were randomized into 1:1 ratio to receive either allopurinol 300 mg or placebo tablets once daily for 6 months. The primary endpoint was the incidence of cirrhosis-related complications (overt ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatorenal syndrome, and hepatic encephalopathy). RESULTS: Six months following treatment, allopurinol reduced the relative risk (RR) of any first complication experienced after enrollment by 56% (hazard ratio [HR] 0.44; 95% confidence interval [CI], 0.27-0.62); P ˂ .001). Allopurinol decreased the RR of overt ascites by 67% (HR 0.33; 95% CI, 0.0098-0.94); P = .039] and reduced the RR of spontaneous bacterial peritonitis by about 75% (HR 0.25; 95% CI, 0.05-0.76; P = .01). Likewise, allopurinol was linked to an 80% reduction in the RR of developing hepatorenal syndrome (HR 0.2; 95% CI, 0.04-0.87; P = .033). CONCLUSION: Allopurinol significantly decreased the recurrence of overall liver cirrhosis-related complications. Therefore, allopurinol may constitute a promising agent for patients with hepatic decompensation. These positive outcomes could be a result of its ability to reduce bacterial translocation and inflammation. GOV IDENTIFIER: NCT005545670.

Visita domiciliar como suporte da enfermagem na diálise peritoneal: revisão integrativa / Visita domiciliaria como asistencia de enfermería en la diálisis peritoneal: revisión integradora / Home visit as a support for nursing in peritoneal dialysis: an integrative review

Resumo Objetivo Identificar na literatura como a visita domiciliar é utilizada pelo enfermeiro como ferramenta do cuidado em dialise peritoneal domiciliar. Métodos Revisão integrativa da literatura de artigos em periódicos, a partir de uma questão norteadora, no período de janeiro de 2014 a janeiro de 2019. A busca bibliográfica foi realizada nas bases Scielo; Web of Science, Pubmed, Scopus, Embase e Cinahl. Resultados Identificaram-se 10 artigos de acordo com as etapas da revisão e as respostas à pergunta norteadora. A visita domiciliar realizada pelo enfermeiro foi descrita como ferramenta de adesão ao tratamento. A prevenção de complicações, como a peritonite, foi citada pelos autores, que em sua maioria, eram médicos e enfermeiros. Conclusão O enfermeiro assiste integralmente ao paciente e família e, assegura o tratamento proposto com fidedignidade. As intervenções de enfermagem no domicílio previnem eventos adversos e frequente avaliação de indicadores do tratamento. Estimular estudos primários nessa área é imprescindível, visto que poucos estudos sobre a temática foram identificados na presente revisão.

Resumen Objetivo Identificar en la literatura cómo se utiliza la visita domiciliaria del enfermero como herramienta de cuidado en diálisis peritoneal domiciliaria. Métodos Revisión integradora de la literatura de artículos en revistas especializadas, a partir de una pregunta orientadora, en el período de enero de 2014 a enero de 2019. La búsqueda bibliográfica fue realizada en las bases Scielo, Web of Science, Pubmed, Scopus, Embase y Cinahl. Resultados Se identificaron diez artículos de acuerdo con las etapas de la revisión y las respuestas a la pregunta orientadora. La visita domiciliaria realizada por el enfermero se describió como herramienta de adherencia al tratamiento. La prevención de complicaciones, como la peritonitis, fue citada por los autores que, en su mayoría eran médicos y enfermeros. Conclusión El enfermero asiste al paciente y a la familia de forma integral y garantiza que el tratamiento propuesto sea fidedigno. Las intervenciones de enfermería en el domicilio previenen eventos adversos y una evaluación frecuente de indicadores del tratamiento. Es imprescindible estimular estudios primarios en esta área, ya que se identificaron pocos estudios sobre esta temática en la presente revisión.

Abstract Objective To identify in the literature how home visit is used by nurses as a tool of care in home peritoneal dialysis. Methods An integrative review of the literature of articles in journals, from a guiding question, from January 2014 to January 2019. The bibliographic search was carried out at Scielo, Web of Science, Pubmed, Scopus, Embase, and CINAHL databases. Results Ten articles were identified according to the review steps and the answers to the guiding question. The home visit performed by nurses was described as a treatment adherence tool. Complication prevention, such as peritonitis, was cited by the authors, who were mostly physicians and nurses. Conclusion Nurses assist patients and family members in full and ensure the proposed treatment with reliability. Nursing interventions at home prevent adverse events and frequent assessment of treatment indicators. Boosting primary studies in this area is essential, since few studies on the subject have been identified in the present review.

Apendicitis aguda en niños, Hospital José Carrasco Arteaga. Cuenca, 2012 - 2016 / Acute appendicitis in children, José Carrasco Arteaga Hospital. Cuenca, 2012-2016

De entre las emergencias pediátricas, la apendicitis aguda es la patología más frecuente, siendo importante observar su comportamiento en nuestro medio y por variables como la edad y diagnósticos diferenciales. Objetivo: determinar las características de los pacientes menores de 16 años ingresados al Servicio de Cirugía Pediátrica del Hospital José Ca-rrasco con diagnóstico de apendicitis aguda entre enero 2012 y diciembre 2016.Métodos: estudio descriptivo basado en las historias clínicas de niños in-gresados a emergencia con dolor abdominal en el período enero 2012 a diciembre 2016 y diagnosticados de apendicitis. Los datos fueron analiza-dos y tabulados en Excel. Se tomaron en cuenta consideraciones éticas.Resultados: se analizaron 614 niños con dolor abdominal; 334 fueron diagnosticados de apendicitis aguda (246 niños) y peritonitis apendicular (88 niños), corresponden al sexo masculino 54.19%. La media de edad fue 9.9 años; la leucocitosis fue el hallazgo de laboratorio más frecuente encontrado en 82.93%. El estudio ecográfico resultó positivo para apendi-citis en 55.69%. Todos recibieron tratamiento laparoscópico por el mismo equipo quirúrgico, las complicaciones se presentaron en el 8.69%.Conclusiones: la apendicitis aguda es la principal causa de cirugía de emergencia en pacientes pediátricos, afecta más al género masculino, en-tre 6 y 11 años de edad (media 9.9 años), es requiere un diagnóstico y tratamiento inmediato para evitar complicaciones; el tratamiento laparos-cópico es un procedimiento seguro.(AU)

Among pediatric emergencies, acute appendicitis is the most frequent pathology, it is important to observe their behavior in our environment and variables such as age and differential diagnoses should be taken into account.Objective: to determine the characteristics of patients under 16 admitted to the Pediatric Surgery Service of the José Carrasco Hospital with a diagnosis of acute appendicitis between January 2012 and December 2016.Methods: It is a descriptive study based on the medical records of children admitted to the emergency department with abdominal pain in the period January 2012 to December 2016 and diagnosed with appendicitis. The data was analyzed and tabulated in the Excel program. All ethical considerations were taken into account.Results: 614 children with abdominal pain were analyzed; 334 were diagnosed with acute appendicitis (246 children) and appendicular peritonitis (88 children), 54.19% correspond to the male sex. The average age was 9.9 years; the leukocytosis was the most frequent laboratory finding in 82.93%. The ultrasound study was positive for appendicitis in 55.69%. All received laparoscopic treatment by the same surgical team, complications occurred in 8.69%.Conclusions: acute appendicitis is the main cause of emergency surgery in pediatric patients, it affects more to the male gender, between 6 and 11 years of age (average 9.9 years), immediate diagnosis and treatment is required to avoid complications; laparoscopic treatment is a safe procedure.(AU)

Estudio de pacientes ingresados por peritonitis en el Centro Nacional de Cirugía de Mínimo Acceso / Study of patients with peritonitis admitted to the National Center for Minimal Access Surgery

Introducción: La peritonitis postoperatoria es una de las complicaciones más frecuentes que se presenta tras procederes laparoscópicos. Objetivo: Caracterizar la evolución de los pacientes complicados con peritonitis después de un proceder laparoscópico. Material y método: Se realizó un estudio observacional descriptivo de los pacientes con peritonitis ingresados en la terapia intensiva, del Centro Nacional de Cirugía de Mínimo Acceso, desde septiembre de 2010 hasta diciembre de 2015. Se analizaron algunas variables demográficas, procederes laparoscópicos que se complicaron con este diagnóstico, complicaciones clínicas, antibioticoterapia utilizada, tipo de nutrición y la escala de evaluación fisiológica APACHE II como predictor de pronóstico. La información se obtuvo de las historias clínicas. Las variables cualitativas se resumieron utilizando frecuencias absolutas y porcentajes. Para las cuantitativas se utilizó la media y la desviación estándar. Resultados: Se complicaron con peritonitis 26 de 298 pacientes ingresados en el período (8,7 ), la edad media fue de 60 años, predominó el sexo femenino (57,7 por ciento). Se complicaron más con este diagnóstico los pacientes perforados postcolonoscopia (50 por ciento). El disbalance hidroelectrolítico (73,1 por ciento) fue la complicación asociada más frecuente. Se usó precozmente la nutrición enteral en 57,7 por ciento y los antibióticos más utilizados fueron ceftriaxone, amikacina y metronidazol. Predominó la evolución favorable a pesar que el score APACHE II se mantuvo en valores elevados. Conclusiones: Las perforaciones intestinales después de una colonoscopía tienen un alto riesgo de sufrir peritonitis secundaria, pero si se realiza un diagnóstico y tratamiento precoz su evolución es favorable(AU)

Introduction: Endoscopic dilatation is the first therapeutic option to eliminate benign esophageal stenosis and improve the symptoms and the quality of life of those patients who suffer from it. Objective:To describe the results of endoscopic dilatation in patients with benign esophageal stenosis treated in the National Center for Endoscopic Surgery from January 2015 to December 2016. Material and Methods:A case series longitudinal observational study was conducted in 59 patients with benign esophageal stenosis. Dilatations were done with Savary-Gilliard bougie and balloons. Results:The mean age was 52,5 years, and the condition predominated in 37 male patients (62,7 percent). Post-surgical, peptic, and caustic were the most frequent etiologies with 25, 14, and 6 cases, respectively. Short stenosis predominated in 51 cases. Bougies were used in 48 patients for a total of 149 dilatations, corresponding to a mean of 3,1 dilatations/ patients. Correction of the stenosis was made in 1-3 sessions in 47 percent of patients; 11 cases were dilated with balloon, corresponding to a mean of 1- 3 dilatations/ patients. Four patients from the group that were dilated with Savary-Gilliard bougies showed refractoriness. A perforation, and two bleedings occurred. After the dilatations, dysphagia improved or disappeared in 93,2 percent of patients. Conclusions:Endoscopic therapy through dilatation of benign esophageal stenosis indicated to be a good alternative method in achieving corrections in a few dilatation sessions, with a low number of complications, and an improvement of the dysphagia(AU)

Peritonites em pacientes com insuficiência renal crônica em tratamento de diálise peritoneal / Peritonitis among patients with chronic kidney disease undergoing peritoneal dialysis / Peritonitis en pacientes con insuficiencia renal crónica en tratamiento de diálisis peritoneal

Objetivo: analisar a taxa das peritonites no Serviço de Diálise Peritoneal de um Hospital-Escola e conhecer o perfil dos pacientes do programa de diálise peritoneal. Metodologia: estudo observacional, descritivo, retrospectivo, de natureza quantitativa, realizado no serviço de diálise no interior de São Paulo de janeiro a dezembro de 2015. RESULTADOS: dos 39 pacientes em diálise peritoneal, 51,3% eram do sexo masculino, 64,1% não idosos, 51,3% procediam de outros municípios, 69,2% aposentados, 66,7% estavam em diálise peritoneal ambulatorial contínua, 43,6% estavam em tratamento de um a dois anos e 79,5% não estavam na lista de transplante, sendo 41% em virtude de início recente na terapia. Dos 20 pacientes que apresentaram peritonite, 50% tiveram dois episódios no ano, 20% causados por Staphylococcus aureus. Em 90% o antibiótico foi administrado por via endovenosa, 95% tiveram associação de antibióticos, sendo os mais comuns ceftazidima, vancomicina e cefalotina. Dos 90% dos pacientes que saíram da terapia, 65% eram do sexo feminino, 55% moravam no município da instituição de tratamento, 70% eram aposentados e 65% estavam em diálise peritoneal ambulatorial contínua, com média de idade de 56 anos (DP=14,6 anos) e média de 1,7 ano de tratamento. A taxa de peritonite em diálise peritoneal ambulatorial contínua e diálise peritoneal automatizada foi de 2,79% e em diálise peritoneal intermitente 13,33%. CONCLUSÃO: a maioria dos pacientes que teve peritonite eram mulheres. A média de peritonites foi maior entre as pessoas com menos idade e menos tempo de tratamento e 90% dos pacientes saíram da terapia.

Objective: analyze peritonitis rates in the Peritoneal Dialysis Service of a university hospital and identify the profile of patients attending the peritoneal dialysis program. Methods: This observational, retrospective, and descriptive study with a quantitative approach was conducted at adialysis service in the interior of São Paulo, Brazil, from January to December 2015. Results: Of the 39 patients on peritoneal dialysis, 51.3% were men;64.1% were non-elderly patients; 51.3% were from towns other than where the service was located; 69.2% were retired; 66.7% were in continuous ambulatory peritoneal dialysis; the duration of treatment of 43.6% ranged from one to two years; 79.5% were not on the transplant waiting list;and 41% had recently started therapy. Of the 20 patients presenting peritonitis, 50% had two episodes and 20% of the episodes were causedby Staphylococcus aureus. The antibiotic was administered intravenously in 90% of the patients; antibiotics were associated with ceftazidime, vancomycin or cephalothin (the most common ones) in 95%. Among those who dropped out of therapy (90%): 65% were women, 55% lived in thesame town as the health facility; 70% were retired; 65% were undergoing continuous ambulatory peritoneal dialysis, and were aged 56 years old onaverage, while treatment duration was 1.7 years on average. The peritonitis rate among those on continuous ambulatory peritoneal dialysis andautomated peritoneal dialysis was 2.79%, while 13.33% were on intermittent peritoneal dialysis. Conclusion: Most patients with peritonitis werewomen, lived in the same town as the facility, were retired and underwent continuous ambulatory peritoneal dialysis, and treatment duration was1.7 years on average, and 90% of the patients dropped out of therapy.

Objetivo: analizar la tasa de peritonitis en el servicio de diálisis peritoneal de un hospital escuela; conocer el perfil de los pacientes del programa dediálisis peritoneal. Metodología: Estudio observacional, descriptivo, retrospectivo, cuantitativo realizado en el servicio de diálisis de un hospital delinterior del estado de São Paulo, entre enero y diciembre de 2015. Resultados: De los 39 pacientes en diálisis peritoneal, 51,3% eran varones, 64,1% noancianos, 51,3% venían de otros municipios, 69,2% jubilados, 66,7% en diálisis peritoneal continua ambulatoria, 43,6% en tratamiento entre uno y dosaños,79,5% no estaban en la lista de trasplantes y, entre ellos, 41% habían reiniciado recientemente el tratamiento. De los 20 paciente que presentaron peritonitis, 50% tuvieron dos episodios en el año, 20% causado por Staphylococcus aureus. En 90%, el antibiótico se administró vía venosa, 95%tuvieron asociación de antibióticos, siendo los más comunes ceftazidima, vancomicina y cefalotina, y 90% de los pacientes interrumpieron la terapia,65% eran mujeres, 55% vivían en el municipio de la institución de tratamiento, 70% eran jubilados y 65% estaban en CAPD con promedio de 56 añosde edad y 1,7 años de tratamiento. La tasa de peritonitis en diálisis peritoneal continua ambulatoria y diálisis peritoneal automatizada fue de 2,79%y en diálisis peritoneal intermitente 13,33%. Conclusión: Entre los pacientes con peritonitis, la mayoría eran mujeres, el promedio de peritonitis fuemayor entre las personas más jóvenes y con menos tiempo de tratamiento y 90% de los pacientes interrumpieron el tratamiento.

Copaiba oil effect on induced fecal peritonitis in rats

PURPOSE: To evaluate the effects of copaiba oil as a prophylactic and/or therapeutic substance on survival of rats subjected to cecal ligation and puncture, describing histopathological and oxidative stress findings.METHODS:Forty rats (Ratus norvegicus) were distributed into five study groups (N=8): Sham group (ShG): normal standard animals; Sepse group (SepG): submitted a cecal ligation and puncture (CLP); Pre group (PreG): administered copaiba oil once daily by subcutaneous injection for five days before carrying out CLP; Post CLP group (PostG): administered copaiba oil once daily by subcutaneous injection from the first day of CLP until death by sepsis; and Pre/Post group (Pre/PostG): administered copaiba oil once daily by subcutaneous injection for five days before carrying out CLP and from the first day of CLP until de death by sepsis. After the death of the animals, blood was collected for assessment of oxidative stress and histological analysis were performed. The Kaplan-Meier curves of surviving time were realized.RESULTS: Survival analysis demonstrated that animals treated with copaiba oil prior to the execution of the CLP (PreG and Pre/Post groups) had longer survival compared to the sepsis group (p<0.0001) whereas animals receiving copaiba only after the completion of CLP (PostG) showed no statistically significant difference compared to the sepsis group. However, when comparing the two groups in which was administered copaiba previously (PreG and Pre/PostG groups), there was no statistical significance between the groups (p=0.4672). There was no statistical difference between histopathological findings or the levels of oxidative stress.CONCLUSION: Prophylactic subcutaneous administration of copaiba increases survival of rats subjected to severe sepsis by cecal ligation and puncture.

Complicaciones infecciosas de la diálisis peritoneal ambulatoria en niños / Ambulatory peritoneal dialysis-related infectious complications in children

Introducción: la diálisis peritoneal es la mejor alternativa terapéutica para los niños con enfermedad renal crónica terminal, y en las modalidades de diálisis peritoneal ambulatoria ha permitido el tratamiento fuera del hospital, lo que proporciona un mejor estilo y calidad de vida. No es un método exento de riesgos. Las complicaciones infecciosas relacionadas a la diálisis peritoneal son la causa más importante de morbilidad y es la peritonitis su principal complicación. Objetivo: determinar retrospectivamente la frecuencia y las características de complicaciones infecciosas relacionadas al proceder dialítico. Métodos: nuestro hospital es referente como unidad de diálisis pediátrica del país, así que recibe la mayoría de los niños con enfermedad renal crónica terminal de Cuba. Se revisaron los expedientes clínicos de niños con enfermedad renal crónica terminal en programa de diálisis peritoneal ambulatoria en el Hospital Pediátrico de Centro Habana durante el período 2008-2011. Resultados: se estudiaron 12 pacientes con un promedio de edad de 11 años, 58 por ciento del sexo femenino. Se documentaron 24 episodios infecciosos. Las complicaciones encontradas fueron infección del sitio de salida del catéter, con 62,5 por ciento, peritonitis 33,3 por ciento e infección del túnel submucoso 4,2 por ciento. Predominaron cultivos positivos a bacterias grampositivas (66,7 por ciento). Las bacterias más comunes fueron: Staphylococcus coagulasa positivo (48 por ciento) y Staphylococcus coagulasa negativo (22 por ciento). Otros gérmenes identificados fueron E. coli, Enterobacter spp. y Candida spp., con 8,3 por ciento respectivamente. Conclusiones: la infección del sitio de salida del catéter fue la complicación infecciosa más frecuente en nuestra serie. Las bacterias grampositivas son los gérmenes más comunes que causan infección del sitio de salida y peritonitis en pacientes en diálisis peritoneal ambulatoria

Introduction: peritoneal analysis is the best therapeutic alternative for children suffering terminal chronic renal disease and it has allowed, in the ambulatory peritoneal dialysis variant, providing out of hospital treatment to improve life style and quality. It is not risk-free method since the peritoneal dialysis-related infectious complications are the most important cause of morbidity, being peritonitis the main one. Objective: to retrospectively determine the frequency and the characteristics of dialysis-related infectious complications. Methods: our hospital is a point of reference in the country as pediatric dialysis unit where most of children with terminal chronic renal disease in Cuba are referred to. The medical histories of children with this type of disease, who were included in the ambulatory peritoneal dialysis program of Centro Habana pediatric hospital for the 2008-2011 period, were checked over. Results: twelve patients aged 11 years as average were studied. Fifty eight percent were girls. Twenty four infectious events were documented. The most frequent complications were infection at the outlet site of the catheter (62.5 percent), peritonitis (33.3 percent) and submucous tunnel infection (4.2 percent). Positive cultures to Grampositive bacteria (66.7 percent) were predominant. The most common bacteria were positive Staphylococcus coagulase (48 percent) and negative Staphylococcus coagulase (22 percent). Other germs were E E. coli, Enterobacter spp. and Candida spp, with 8.3 percent, respectively. Conclusions: the most frequent complication was infection at the outlet site of the catheter in our sample. The most common germs were Grampositive bacteria that cause this type of infection and peritonitis in patients under ambulatory peritoneal dialysis treatment

Apendicitis epiploica primaria, la otra apendicitis: reporte de un caso / Primary epiploic appendicitis, the other appendicitis: report of a case

Reportamos un caso de apendicitis epiploica, así como revisión de la literatura. Se trata de un paciente masculino de 38 años, que ingresa por presentar dolor en fosa iliaca izquierda de aparición brusca , de severidad creciente , distensión y malestar, sin leucocitosis Al examen físico el abdomen esta distendido y muy doloroso a la palpación, a predominio de flanco y fosa iliaca izquierda. Trae ecosonograma abdominal que reporta esteatosis hepática y aglomeración de asas en fosa iliaca izquierda. La colonoscopía solo muestra hemorroides, el dolor abdominal persiste y hay signos de peritonismo. Es intervenido quirúrgicamente con los siguientes hallazgos apéndice epiploica gangrenosa; colon sigmoide con adherencia a pared lateral del abdomen con apéndice epiploica necrosada; realizan resección de apéndice epiploica y apendicetomía. Lo más relevante de este caso, es lo poco frecuente y en el cual sus síntomas se confunden con patologías comunes tales como la apendicitis y la diverticulitis. Sin embargo el manejo de imágenes y su característico aspecto en las misma, juega un papel determinante en el adecuado y efectivo diagnostico lo que hace de su reconocimiento un factor importante...

We report a case of epiploic appendicitis, as well as the review of the literature. This is a 38 year old male patient who was admitted due to left iliac fossa pain of sudden onset; of increasing severity, bloating and discomfort, without leukocytosis. At physical examination the abdomen is distended and very tender, with predominance in left iliac flank. He brought abdominal ultrasonography which shows hepatic steatosis and loops agglomeration in left iliac fossa. Colonoscopy shows hemorrhoids, persistent abdominal pain and there are signs of peritonitis. The patient underwent surgery with the following findings: gangrenous epiploic appendix, sigmoid colon with adherence to lateral abdominal wall with necrotic epiploic appendix; they performed the resection of the epiploic appendix and appendectomy. What is special about this case is how rare it is and that his symptoms are mistaken with common pathologies, such as appendicitis and diverticulosis. However, the imaging management and the epiploic appendix characteristic appearance in these images, play a determining role in the effective and appropriate diagnosis; which makes, its recognition an important factor...

Cirrosis hepática: medidas preventivas de algunas de sus complicaciones / Liver cirrhosis: some complications preventive measures

Cirrosis hepática es una enfermedad prevalente en el mundo. Su diagnóstico y tratamiento debe ser dominio de todo médico general e internista. En los últimos años han ocurrido notables avances en el diagnóstico, fisiopatología, tratamiento y en la identificación de factores pronósticos de cirrosis y de sus complicaciones mayores. Particular atención ha existido en desarrollar medidas preventivas de sus complicaciones como por ejemplo: hemorragia por várices esofágicas, peritonitis bacteriana espontánea, síndrome hepatorrenal. Estas medidas preventivas han influido de forma muy favorable en el pronóstico de los pacientes cirróticos. En este artículo se discuten las diversas estrategias preventivas que han demostrado su efectividad en cirrosis hepática

Liver cirrhosis is a prevalent disease around the world. Its diagnosis and treatment must be in the knowledge of every general physicians and internist.Over the last years, there have been notorious advances in the diagnosis, pathophysiology, treatment and the identification of prognosis factors for cirrhosis major complications.There has been particular attention to the development of preventive measures for its complications, such as variceal bleeding, spontaneous bacterial peritonitis, hepatorenal syndrome. These preventive measures have had a favorable influence on the prognosis of cirrhotic patients. This article discusses several preventive strategies that have proven its effectiveness in hepatic cirrhosis

Resistência de ratos à peritonite fecal quando submetidos a esplenectomia e auto-implante do baço no retroperitônio / Rats resistence to fecal peritonitis when subjected to total spleenectomy and auto-implant of the spleen in the retroperitoniun

OBJETIVO: O estudo foi desenvolvido para avaliar os efeitos do autotransplante esplênico na proteção contra sepse abdominal em ratos Wistar jovens e adultos. MÉTODOS: Foram utilizados 54 ratos Wistar jovens e adultos (90 e 180 dias respectivamente) sendo distribuídos em 3 grupos: Grupo Sham, onde os animais eram submetidos a laparotomia com manipulação de alças apenas (n=6 animais jovens adultos), Grupo Esplenectomia, no qual os animais eram submetidos a esplenectomia total (n=10 animais jovens e adultos) e Grupo Auto-implante, onde os animais eram submetidos a esplenectomia total e um terço do baço era implantado em uma bolsa no retroperitônio (n=10 animais jovens e adultos). Após três meses os animais eram submetidos a nova laparotomia com ligadura e perfuração do ceco para estimular a sepse abdominal e acompanhados até o momento do óbito para estabelecimento de uma curva de mortalidade. RESULTADOS: Houve recuperação do baço implantado em todos os animais. Não houve diferença significativa entre o tempo de óbito entre os grupos. Os animais jovens aparentemente tiveram uma melhor resposta embora não estatisticamente significativa. CONCLUSÃO: Este estudo demonstrou que o auto-implante de baço no retroperitônio não provê proteção efetiva contra sepse abdominal em comparação aos ratos esplenectomizados.

Trimethoprim-sulfamethoxazole versus norfloxacin in the prophylaxis of spontaneous bacterial peritonitis in cirrhosis

RACIONAL: Devido ao prognóstico sombrio que a peritonite bacteriana espontânea acarreta aos pacientes com doença crônica parenquimatosa de fígado, a prevenção desta condição é fundamental.OBJETIVO: Comparar a eficácia da sulfametoxazol/trimetoprima versus norfloxacino para a prevenção de peritonite bacteriana espontânea em pacientes com cirrose e ascite. PACIENTES E MÉTODOS: Cinqüenta e sete pacientes com cirrose e ascite foram avaliados entre março de 1999 e março de 2001. Todos haviam apresentado um episódio prévio de peritonite bacteriana espontânea ou tinham proteína do líquido de ascite <1 g/dL e/ou bilirrubinas séricas > 2,5 mg dL. Os pacientes foram randomizados para receber sulfametoxazol/trimetoprima 800/160 mg por dia, 5 dias por semana, ou norfloxacino 400 mg diariamente. O período médio de acompanhamento foi de 163 dias para o grupo norfloxacino, 182 dias para o grupo sulfametoxazol/trimetoprima. Na análise estatística foi considerado um nível de significância de 5%. RESULTADOS: De acordo com os critérios de inclusão, 32 pacientes (56%) foram tratados com o norfloxacino e 25 (44%) com a sulfametoxazol/trimetoprima. A peritonite bacteriana espontânea ocorreu em três pacientes tratados com o norfloxacino (9,4%), comparado com quatro tratados com a sulfametoxazol/trimetoprima (16%). Infecções extra-peritoniais ocorreram em 10 pacientes recebendo o norfloxacino (31,3%) e em 6 recebendo a sulfametoxazol/trimetoprima (24,0%). Ocorreram sete óbitos entre os pacientes que receberam o norfloxacino (21,9%) e cinco entre os que receberam a sulfametoxazol/trimetoprima (20,0%). No que tange aos efeitos colaterais das medicações, estes só foram observados no grupo da sulfametoxazol/trimetoprima. CONCLUSÃO: A despeito do número de pacientes e do tempo de acompanhamento, a sulfametoxazol/trimetoprima e o norfloxacino foram igualmente efetivas na profilaxia da peritonite bacteriana espontânea, sugerindo que a primeira seja uma opção viável.

Translocación bacteriana e infecciones en un modelo experimental de cirrosis en la rata / Bacterial translocation and infections in an experimental model

In summary the carbon tetrachloride/phenobarbital of cirrhosis in rats mimics human cirrhosis very closely, with development of ascites and SBP. This model shows us that bacterial overgrowth occurs as cirrhosis progresses and that bacterial translocation from the gut to extra-intestinal sites is part of the early pathogenesis of SBP. SID with norfloxacin dramatically reduced translocation and SBP at the expense of grampositive overgrowth and infection with gram-positives and colonization with strange gram negatives. SID with TMP-SMZ actually delayed development of ascites and prolonged survival.