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Patients with end-stage renal disease (ESRD) who undergo kidney transplantation are at an increased risk of developing surgical and/or medical complications. Posterior reversible encephalopathy syndrome (PRES) is a rare complication that occurs in 0.34% of kidney transplant patients. It is characterized by a combination of neurological manifestations, risk factors, and characteristic radiological findings in neuroimaging studies. The development of PRES has been associated with various medical conditions and factors, including hypertension, the use of cytotoxic and immunosuppressive drugs, acute or chronic kidney disease, pre-eclampsia/eclampsia, autoimmune diseases, and solid organ and bone marrow transplantation. This report presents the case of a 19-year-old woman diagnosed with ESRD on hemodialysis due to lupus nephritis who experienced an episode of PRES with intraparenchymal hemorrhage during the postoperative period of kidney transplantation. The case emphasizes the importance of closely monitoring these patients during this period to enable early diagnosis and timely treatment of complications, ensuring a favorable prognosis.
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The aim was to compare the effectiveness of Brandt-Daroff, Semont and Epley maneuver in BPPV resolution. A Single Blind RCT in a Secondary Care Center was performed. Inclusion criteria were: patients with unilateral rotatory nystagmus on Dix-Hallpike Maneuver (DHM). Exclusion criteria: other causes of peripheral or central vertigo. Patients were randomized into 4 groups: Brandt-Daroff, "sham", Semont and Epley. Patients underwent allocation, 1st visit (at 1 week with reprise of original maneuver if persistent nystagmus) and 2nd visit (2 to 4 weeks) with repetitions of both DHM and DHI. Main Outcome Measures: Absence of nystagmus on DHM at 1st and 2nd visit evaluations and DHI score. Resolution was defined as the abscence of nystagmus. We included 34 patients (25 females, 9 males). Patients were randomized to Brandt-Daroff (n = 9), "sham" (n = 7), Semont (n = 9) and Epley (n = 9) group. Overall mean age was 59.85 years (SD ± 13.10). A total of 47.06% patients (n = 16) had negative DHM at 1st visit. Resolution for Brandt-Daroff was 22.22%, "sham" 28.57%, Semont 44.44% and Epley 88.88% (p = 0.024); at 2nd visit follow up, Epley achieved 100% resolution (other maneuvers: 42.86%, 16.67%, 44.44%, respectively. P = 0.006). The DHI improvement at 2nd visit for Brandt-Daroff was 21.17 points, "sham" 8.05, Semont 14.67 and Epley 61.78 (p = 0.001). Epley maneuver was superior to Brandt Daroff, "sham" and Semont maneuvers on nystagmus resolution and DHI improvement in patients with BPPV.
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BACKGROUND: The co-administration of loop diuretics with thiazide diuretics is a therapeutic strategy in patients with hypertension and volume overload. The aim of this study was to assess the efficacy and safety of treatment with bumetanide plus chlorthalidone in patients with chronic kidney disease (CKD) stage 4-5 KDIGO. METHODS: A double-blind randomized study was conducted. Patients were randomized into two groups: bumetanide plus chlorthalidone group (intervention) and the bumetanide plus placebo group (control) to evaluate differences in TBW, ECW and ECW/TBW between baseline and 30 Days of follow-up. Volume overload was defined as 'bioelectrical impedance analysis as fluid volume above the 90th percentile of a presumed healthy reference population. The study's registration number was NCT03923933. RESULTS: Thirty-two patients with a mean age of 57.2 ± 9.34 years and a median estimated glomerular filtration rate (eGFR) of 16.7 ml/min/1.73 m2 (2.2-29) were included. There was decreased volume overload in the liters of total body water (TBW) on Day 7 (intervention: -2.5 vs. control: -0.59, p = 0.003) and Day 30 (intervention: -5.3 vs. control: -0.07, p = 0.016); and in liters of extracellular water (ECW) on Day 7 (intervention: -1.58 vs. control: -0.43, p < 0.001) and Day 30 (intervention: -3.05 vs. control: -0.15, p < 0.000). There was also a decrease in systolic blood pressure on Day 7 (intervention: -18 vs. control: -7.5, p = 0.073) and Day 30 (intervention: -26.1 vs. control: -10, p = 0.028) and in diastolic blood pressure on Day 7 (intervention: -8.5 vs. control: -2.25, p = 0.059) and Day 30 (intervention: -13.5 vs. control: -3.4, p = 0.018). CONCLUSION: In CKD stage 4-5 KDIGO without renal replacement therapy, bumetanide in combination with chlorthalidone is more effective in treating volume overload and hypertension than bumetanide with placebo.
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Hipertensión , Insuficiencia Renal Crónica , Desequilibrio Hidroelectrolítico , Anciano , Bumetanida/uso terapéutico , Clortalidona/uso terapéutico , Humanos , Hipertensión/tratamiento farmacológico , Persona de Mediana Edad , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/tratamiento farmacológico , Terapia de Reemplazo Renal , Inhibidores de los Simportadores del Cloruro de Sodio/uso terapéutico , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/uso terapéutico , AguaRESUMEN
ABSTRACT BACKGROUND: Coronavirus disease 19 (COVID-19) is a multisystemic disease with high incidence of acute kidney injury (AKI). OBJECTIVE: To describe the clinical characteristics and factors associated with AKI among patients hospitalized with COVID-19. DESIGN AND SETTING: Retrospective cohort conducted at Hospital Civil de Culiacan, Mexico. METHODS: We included 307 patients hospitalized due to COVID-19. AKI was defined and staged based on serum creatinine levels in accordance with the criteria of the Acute Kidney Injury Network (AKIN). Multivariate logistic regression analysis was used to determine factors associated with AKI. RESULTS: The patients' age was 56 ± 15 years (64.5% male). The incidence of AKI was 33.6% (n = 103). Overall, 53.4% of patients had community-acquired AKI, and 46.6% had hospital-acquired AKI. Additionally, 15.5% of them presented AKIN stage 1; 34% had AKIN stage 2; and 50.5% had AKIN stage 3. Hemodialysis was required for 10.7% of the patients. The factors associated with AKI were chronic kidney disease (odds ratio, OR: 10.8; P = 0.04), use of norepinephrine (OR: 7.3; P = 0.002), diabetes mellitus (OR: 2.9; P = 0.03), C-reactive protein level (OR: 1.005; P = 0.01) and COVID-19 severity index based on chest tomography (OR: 1.09; statistical trend, P = 0.07). Hospital stay (11 ± 7 days; P < 0.001) and mortality (83.5 versus 31.4%; P < 0.05) were greater among patients with AKI. CONCLUSION: AKI was a frequent and serious complication in our cohort of patients hospitalized with COVID-19, which was associated with high mortality and long hospital stay.
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BACKGROUND: Coronavirus disease 19 (COVID-19) is a multisystemic disease with high incidence of acute kidney injury (AKI). OBJECTIVE: To describe the clinical characteristics and factors associated with AKI among patients hospitalized with COVID-19. DESIGN AND SETTING: Retrospective cohort conducted at Hospital Civil de Culiacan, Mexico. METHODS: We included 307 patients hospitalized due to COVID-19. AKI was defined and staged based on serum creatinine levels in accordance with the criteria of the Acute Kidney Injury Network (AKIN). Multivariate logistic regression analysis was used to determine factors associated with AKI. RESULTS: The patients' age was 56 ± 15 years (64.5% male). The incidence of AKI was 33.6% (n = 103). Overall, 53.4% of patients had community-acquired AKI, and 46.6% had hospital-acquired AKI. Additionally, 15.5% of them presented AKIN stage 1; 34% had AKIN stage 2; and 50.5% had AKIN stage 3. Hemodialysis was required for 10.7% of the patients. The factors associated with AKI were chronic kidney disease (odds ratio, OR: 10.8; P = 0.04), use of norepinephrine (OR: 7.3; P = 0.002), diabetes mellitus (OR: 2.9; P = 0.03), C-reactive protein level (OR: 1.005; P = 0.01) and COVID-19 severity index based on chest tomography (OR: 1.09; statistical trend, P = 0.07). Hospital stay (11 ± 7 days; P < 0.001) and mortality (83.5 versus 31.4%; P < 0.05) were greater among patients with AKI. CONCLUSION: AKI was a frequent and serious complication in our cohort of patients hospitalized with COVID-19, which was associated with high mortality and long hospital stay.
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Lesión Renal Aguda , COVID-19 , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/virología , Adulto , Anciano , Proteína C-Reactiva/análisis , COVID-19/complicaciones , Creatinina/sangre , Femenino , Mortalidad Hospitalaria , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Norepinefrina/efectos adversos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Introduction Asymmetric sensorineural hearing loss is the main early symptom of retrocochlear lesions, hence its importance in screening for vestibular schwannomas. Currently, there is no consensus regarding its definition. The objective was to identify the audiometric pattern that would serve as a predictor for vestibular schwannoma in patients with asymmetric hearing loss. Materials and methods A cross-sectional study was conducted that included patients with asymmetric hearing loss attending a secondary care center and a tertiary care center. Clinical, audiometric and imaging (MRI with gadolinium) variables were collected. Asymmetric hearing loss was defined as a difference of 15 dB in one or more frequencies between both ears. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of different audiometric patterns were analyzed. Results A total of 107 patients were studied and divided into two groups: group 1 without vestibular schwannoma (n=98); and group 2 with vestibular schwannoma (n=9). No significant difference in demographic characteristics or audiometric patterns was found in patients with and without vestibular schwannoma. The audiometric pattern with the best sensitivity as a screening test was a difference >20 dB in the 4,000 Hz frequency, with a sensitivity of 77.78%, specificity of 30.61%, PPV of 8.33%, NPV of 93.75% and accuracy of 34.50%. Conclusion The audiometric pattern with the best results was a difference >20 dB in the 4,000 Hz frequency range; however, patients with asymmetric hearing loss could not be differentiated from patients with retrocochlear lesions based only on audiometry. Asymmetrical hearing loss must be studied with MRI.
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Introduction COVID-19 is an emerging disease and the neurotologic symptoms are still not well understood. Furthermore, the development of a neurotological profile and its associated factors can help the clinician in the diagnosis and treatment of this disease. The objective is to determine the neurotologic manifestations experienced by COVID-19 positive health care workers and their associated factors. Methods A symptoms survey was administered to health care workers who were positive to COVID-19 from September to October 2020. An informed consent form was digitally signed and Google Forms software was used for the survey. Frequencies and percentages were used for categorical variables, and associated clinical features were reported with odds ratios. Results We included 209 COVID-19 positive health care workers, 55.5% (n = 116) were women, and 44.5% (n = 93) were men. Fifty-three percent of patients were 20 to 30 years old and 56.4% had at least one comorbidity. The prevalence of neurotological manifestations was 18.6% (n = 39/209), the most frequent symptoms were vertigo (61.5%, n = 24/39), tinnitus (43.5%, n = 17/39), imbalance (43.5%, n = 17/39), and one case of facial paralysis (2.5%, n = 1/39). Neurotological manifestations were associated predominantly with asthenia (p = 0.021), loss of smell (p = 0.002) and taste dysfunction (p = 0.002). Conclusion The most common neurotological manifestations were vertigo, tinnitus and imbalance. Clinical features associated with a neurotologic profile were asthenia, hyposmia and dysgeusia.
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BACKGROUND: This cohort study assessed the effect of disease-related malnutrition (DRM) and fluid overload (FO) evaluated by bioimpedance vector analysis (BIVA) on mortality among hospitalized patients. METHODS: We examined adult patients hospitalized in an internal medicine ward. The malnutrition risk was assessed using the NRS2002 questionnaire, and body composition was estimated via BIVA. Clinical, epidemiological, and laboratory characteristics were compared between patients with and without DRM by BIVA (DRM-B). The effect of DRM and FO by BIVA on mortality was assessed via logistic regression analysis. RESULTS: The study included 130 adult patients (62.3% men) with a mean age of 63 ± 19 years. Malnutrition risk at hospital admission was present in 43.8%. According to BIVA, 63.1% had normal body composition, 27.7% had DRM, and 9.2% obesity while FO was present in 53.1%. Patients with DRM-B were older (70 ± 16 vs. 61 ± 20 years, p = 0.05) and had a higher prevalence of cerebrovascular disease than patients without DRM-B (11% vs. 0%, p = 0.001). The overall mortality rate was 8.5% (n = 11) and was higher among patients with DRM-B than among those without DRM-B (16.7% vs. 5.3%, p = 0.03). No differences existed in mortality between patients with and without FO (8.7% vs. 8.2%, p = 0.91). DRM-B was associated with higher mortality rates adjusted for FO and comorbidities (odds ratio = 3.7, 95% confidence interval: 1.01-13.53, p = 0.04). CONCLUSION: DRM and FO by BIVA were very frequent in our population. DRM-B was associated with a higher mortality rate, which emphasizes the importance of evaluating body composition in hospitalized patients.
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Desnutrición , Desequilibrio Hidroelectrolítico , Adulto , Estudios de Cohortes , Impedancia Eléctrica , Femenino , Hospitalización , Humanos , Recién Nacido , Masculino , Desnutrición/diagnóstico , Desnutrición/epidemiologíaRESUMEN
Sedation during medical procedures poses a risk to any patient, and the use of specific anesthetic agents should be carefully considered to avoid adverse outcomes. We report on a patient with propofol infusion syndrome diagnosed during the post-operative period of a renal transplant. A 58-year-old female on chronic hemodialysis due to end stage kidney disease secondary to microscopic polyangiitis underwent kidney transplant from a deceased donor. Anesthetic induction was performed with fentanyl, propofol, and cisatracurium, and maintained with continuous propofol infusion. In the recovery room, the patient developed somnolence, tachypnea, and thoracoabdominal dissociation secondary to residual neuromuscular block. An arterial-blood gas test indicated acidemia, high pCO2, low HCO3, and mildly increased serum lactate. The patient remained hemodynamically stable, on volume-controlled ventilation, with sedation by continuous propofol infusion. Blood gas tests revealed persistent acidemia without tissue hypoperfusion. Doppler ultrasound of the renal graft reported adequate blood flow and serum triglycerides were elevated. A diagnosis of propofol infusion syndrome was made, and infusion ceased. A decrease in serum lactate levels was observed, with normalization 4 h later. This case highlights the importance of considering adverse effects of anesthetic agents as the cause of post-operative complications when prolonged sedation is required.
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INTRODUCCIÓN: La evaluación del desempeño docente y -sobre todo- la valoración de sus competencias docentes y clínicas es un proceso vital en las residencias médicas. Con el fin de lograr una adecuada evaluación docente se han propuesto diversos modelos, sin embargo aquellos que involucran la opinión de los alumnos son los más accesibles y completos hasta ahora. OBJETIVO: Evaluar el desempeño docente a través de la opinión de los residentes por medio de un cuestionario estandarizado que tiene evidencia de validez y confiabilidad. MÉTODO: Estudio observacional, transversal. Lugar: hospital de segundo nivel. Se incluyeron las especialidades de medicina interna, cirugía general, anatomía patológica, oftalmología, otorrinolaringología, traumatología, imagenología diagnóstica, anestesiología y ginecología. Se incluyó a todos los docentes y alumnos de las especialidades médicas de un hospital de segundo nivel. Se aplicó el cuestionario de evaluación del desempeño docente desarrollado por Martínez-González et al., de manera anónima. Se eliminaron las variables demográficas y se añadió un comentario libre en cada evaluación. RESULTADOS: Se incluyeron 160 maestros y 100 alumnos. Se realizaron 703 encuestas. La media de cada dimensión fue: relación profesor-residente y motivación 4,66±0,78, metodología 4,58±0,88, evaluación 4,61±0,85, capacidad de solucionar problemas 4,68±0,81, conocimiento de la materia 4,68±0,78. El promedio global fue de 4,64±0,80. La evaluación más baja fue metodología. Los residentes de mayor jerarquía fueron los que evaluaron más alto a los docentes (p = 0,02). Las especialidades quirúrgicas contaron con evaluaciones inferiores que las especialidades médicas (4,60±0,84 vs 4,82±0,45, p=<0,001). CONCLUSIÓN: Los docentes cursaron con una buena evaluación global, encontrando como áreas de mejora las dimensiones de metodología y evaluación. Se recomienda eliminar las variables demográficas del instrumento y añadir comentarios libres en cada evaluación
INTRODUCTION: Clinical teacher performance evaluation, and above all the evaluation of teaching skills and clinical competences among medical teachers are of the utmost importance for medical residents. A number of different tools have been proposed in order to obtain a reasonable assessment of teacher performance. Nonetheless, residents?? appraisal is currenlty the most simple and complete measurement tool available. OBJECTIVE: To evaluate clinical tutor performance through the opinion of residents using a validated and reliable questionnaire. METHOD: Observational and cross-sectional study conducted in a secondary care hospital. The following specialties were included: internal medicine, general surgery, pathology, ophthalmology, ear, nose and throat, traumatology, radiology, anaesthesiology, and gynaecology. All medical teachers and residents were included. A standardised questionnaire, developed by Martínez-González et al., was completed anonymously by. RESULTS: The study included 160 teachers and 100 residents, with 703 questionnaires being answered. The dimension means were: teacher-resident relationship and motivation 4.66±0.78, methodology 4.58±0.88, evaluation 4.61±0.85, problem solving capacity 4.68±0.81, and subject knowledge 4.68±0.78. Mean overall assessment was 4.64±0.80. Methodology was the dimension with lowest scores. Residents with highest grades evaluated the teacher with higher scores (P=.02). Surgical residents had lower scores than medical residents (4.60±0.84 vs 4.82±0.45, P<.001). CONCLUSION: Medical teachers obtained a good overall evaluation by the students, although there are areas like methodology and assessment that need improvement. It is recommended to eliminate demographic variables from the evaluation tool, as well allowing to add free comments for each evaluation
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Humanos , Masculino , Femenino , Adulto , Educación Médica/métodos , Docentes Médicos/educación , Evaluación Educacional , Relaciones Interprofesionales , Encuestas y Cuestionarios , Estudios TransversalesRESUMEN
INTRODUCTION: Acute appendicitis is the most common surgical disease in emergency surgery, however, it remains a diagnostic problem and represents a challenge despite the experience and the different clinical and paraclinical diagnostic methods. OBJECTIVE: To evaluate in a comparative way the scale of Alvarado, AIR and RIPASA to determine which one is best as a diagnostic test of acute appendicitis in our population in order to arrive to an accurate diagnosis in the shortest possible time and cost. METHOD: Observational, prospective, transversal and comparative study of 137 patients to whom the scale of Alvarado, AIR and RIPASA was applied, who entered the emergency service of the Civil Hospital of Culiacán (México) with abdominal pain syndrome suggestive of acute appendicitis. RESULTS: The Alvarado scale presented sensitivity 97.2% and specificity of 27.6%. AIR presented sensitivity of 81.9% and specificity of 89.5%. RIPASA showed the same results as Alvarado. All tests showed diagnostic accuracy above 80. CONCLUSIONS: Alvarado and RIPASA presented good sensitivity, however, AIR is more specific, and has better accuracy for the diagnosis of acute appendicitis, making a better screening and thus reducing unnecessary surgeries. Therefore, it is recommended to use more AIR than Alvarado and RIPASA.
INTRODUCCIÓN: La apendicitis aguda es la enfermedad quirúrgica más común en cirugía de urgencia; sin embargo, sigue siendo un problema diagnóstico y representa un reto a pesar de la experiencia y los diferentes métodos de diagnóstico clínicos y paraclínicos. OBJETIVO: Evaluar en forma comparativa las escalas de Alvarado, AIR y RIPASA para determinar cuál es superior como prueba diagnóstica de apendicitis aguda en nuestra población, llegando a un diagnóstico preciso en el menor tiempo y costo posibles. MÉTODO: Estudio observacional, prospectivo, transversal y comparativo de 137 pacientes a quienes se aplicó las escalas de Alvarado, AIR y RIPASA, que ingresaron al servicio de urgencias del Hospital Civil de Culiacán (México) con síndrome doloroso abdominal sugestivo de apendicitis aguda. RESULTADOS: La escala de Alvarado presentó una sensibilidad del 97.2% y una especificidad del 27.6%. AIR tuvo una sensibilidad del 81.9% y una especificidad del 89.5%. RIPASA arrojó los mismos resultados que Alvarado. Todas las pruebas tuvieron una exactitud diagnóstica por arriba del 80. CONCLUSIONES: Alvarado y RIPASA presentaron buena sensibilidad, mientras que AIR es más específica y tiene mayor exactitud diagnóstica de apendicitis aguda, realizando un mejor tamizaje y permitiendo disminuir las cirugías innecesarias, por lo que se recomienda usar más AIR que Alvarado y RIPASA.
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Apendicitis/diagnóstico , Evaluación de Síntomas/métodos , Enfermedad Aguda , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Estudios ProspectivosRESUMEN
BACKGROUND & AIMS: No universally accepted diagnostic criteria for malnutrition are available to date. The aim was to assess the concordance for the diagnosis of hospital malnutrition between the bioelectrical impedance vector analysis (BIVA) and the new definition of malnutrition proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN). METHODS: A total of 140 adult hospitalized patients were included. The malnutrition risk was assessed by the Nutritional Risk Screening. The ESPEN malnutrition criteria (body mass index (BMI) <18.5 kg/m2, weight loss (WL) + low BMI, and WL + low fat free mass index (FFMI) were applied to each patient. The bioelectrical impedance of each patient was measured, and malnutrition was diagnosed using the BIVA method. Diagnostic concordance between the BIVA and the new ESPEN definition was assessed with the Kappa coefficient. RESULTS: The malnutrition prevalence was higher with the BIVA vs ESPEN definition (22.1% vs 13.6%) in the global population and was similar (12.8% vs 12.1%) in the population at risk of malnutrition. The diagnostic performance of the BIVA was acceptable, with higher sensitivity in patients with fluid overload (FO) and more specificity in euvolemic patients. Diagnostic concordance between the BIVA and the ESPEN definition was poor for the global population (kappa = 0.56) and the population at risk of malnutrition (kappa = 0.67) but was acceptable in patients with FO (kappa = 0.78). However, the discordant BIVA+/ESPEN- patients classified as false positives for BIVA showed clinical and body composition data (low FFMI, low phase angle) consistent with malnutrition. CONCLUSIONS: According to the clinical and bioelectrical characteristics of the discordant BIVA+/ESPEN- patients, the BIVA could perform better that the new ESPEN definition for the diagnosis of hospital malnutrition, which should be confirmed with other studies.
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Hospitalización , Desnutrición/diagnóstico , Evaluación Nutricional , Terminología como Asunto , Anciano , Impedancia Eléctrica , Femenino , Humanos , Masculino , México , Estado Nutricional , Valor Predictivo de las Pruebas , PrevalenciaRESUMEN
PURPOSE: To translate the Kidney Disease Quality of Life Short Form 36 (KDQOL-SF36) v1.3 questionnaire into the Spanish language, adapt it culturally, and validate it in the Mexican population. METHODS: The translation and transcultural adaptation were performed according to the recommendations of RAND Health (translation/pilot test/back-translation). We used coefficient alpha to determine the internal consistency, intra- and interobserver intraclass correlation coefficients (ICCs) to determine the test-retest reliability, and Pearson correlation coefficients to confirm the construct validity. RESULTS: The questionnaires were applied to 194 Mexican on haemodialysis. In total, 37.6 % lived in the northern region of Mexico, 28.9 % lived in the southern region, and 33.5 % lived in the central region. The average age was 54 ± 16 years, and 54.6 % were male. The intra- and interobserver ICCs were ≥0.7 for most dimensions evaluated (range 0.5-0.9). The internal consistency was acceptable, with coefficient alpha values ≥0.7 for 12 of the 18 dimensions (range 0.4-0.9). The construct validity was acceptable, especially in the generic component SF36, with correlation coefficients >0.5 for most dimensions. CONCLUSIONS: Psychometric testing indicated that the Mexican version of the KDQOL-SF36 provided valid and reliable scores that were similar to the results obtained with the original English version.
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Enfermedades Renales/psicología , Psicometría/métodos , Diálisis Renal/psicología , Perfil de Impacto de Enfermedad , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Diálisis Renal/métodos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , TraduccionesRESUMEN
BACKGROUND: End-stage renal disease and its treatment have a negative impact on the quality of life of patients. OBJECTIVE: To determine the clinical, dialytic, and laboratory factors associated with poor health-related quality of life in Mexican patients on hemodialysis. METHODS: A multicenter, cross-sectional study. The KDQOL-SF36 v1.3 questionnaire was applied to patients with end-stage renal disease on hemodialysis in different regions of Mexico. Patients were classified according to their overall score on the questionnaire: poor health-related quality of life (overall score below the median) or good health-related quality of life (overall score above the median). Clinical, dialytic, and laboratory variables associated with poor health-related quality of life were analyzed using linear correlation and multivariate logistic regression. RESULTS: We included 194 adult patients with a median age of 55 (45-64) years. The diagnosis of poor health-related quality of life was present in 47.4% of patients. A poor correlation was found between the clinical, dialytic, and biochemical parameters and the health-related quality of life score (range of correlations r = -0.4 to 0.2). Serum albumin level showed the highest number of weak, statistically significant correlations. Factors associated with poor health-related quality of life in the multivariate analysis were: time spent on hemodialysis (OR = 1.02; 95% CI; 1.00-1.04; p = 0.02), use of a venous catheter (OR = 3.2; 95% CI: 1.36-7.75; p = 0.01), and serum albumin < 4 g/dl (OR = 3.55; 95% CI: 1.44-8.74; p < 0.01). CONCLUSIONS: Poor health-related quality of life was common in Mexican patients undergoing hemodialysis. No strong correlation was found between the clinical, dialytic, or laboratory factors with health-related quality of life. Factors associated with poor health-related quality of life were: time on hemodialysis, use of a venous catheter, and serum albumin level < 4 g/dl.
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Fallo Renal Crónico/terapia , Calidad de Vida , Diálisis Renal/métodos , Albúmina Sérica/metabolismo , Adulto , Anciano , Catéteres Venosos Centrales , Estudios Transversales , Femenino , Humanos , Fallo Renal Crónico/fisiopatología , Modelos Logísticos , Masculino , México , Persona de Mediana Edad , Análisis Multivariante , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
INTRODUCTION: Thrombotic events constitute a frequent complication in patients with systemic lupus erythematosus (SLE) and are associated with increased morbidity and mortality of these patients. OBJECTIVE: To identify clinical and laboratorial factors associated with the development of arterial or venous thrombosis in patients with SLE and lupus nephritis (LN). MATERIAL AND METHODS: We reviewed 200 files of patients with SLE and LN to determine if any patients had presented a symptomatic episode of thrombosis confirmed by an image study. We collected demographic, clinical and laboratory data. Logistic regression was used to determine clinical and laboratorial factors associated with thrombotic complications. RESULTS: There were 25 thrombotic events in 23 patients, of which 68% (n = 17) occurred in the venous bed. The overall incidence rate of thrombotic events was 29.1 per 1,000 patient-years. The class IV was the most frequent class of LN with 40.8% of cases. There were no differences in the distribution of the different classes of NL, eGFR, magnitude of proteinuria and markers of lupus activity among patients with and without thrombotic complications. In multivariate analysis, previous diagnosis of antiphospholipid-antibody syndrome (APS) (OR = 126; IC95% 11.3-1419; p < 0.001), serositis (OR = 5; IC95% 0.95-26.9; p = 0.05) and history of arterial thrombosis (OR = 24; IC95% 1.8-314; p = 0.01) were associated with thrombotic complications and the use of ACE inhibitors showed a protective effect (RM = 0.19; IC95% 0.03-0, 98; p = 0.04). CONCLUSIONS: Thrombotic complications were frequent in our population. Risk factors related with thrombotic complications were a personal history of arterial thrombosis, serositis and previous diagnosis of APS. Interestingly, the use of ACE inhibitors was associated with reduced risk. We found no greater or lesser risk of thrombosis with renal factors such as proteinuria, histological type of LN and eGFR.
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Lupus Eritematoso Sistémico/complicaciones , Trombofilia/etiología , Trombosis/epidemiología , Adulto , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Síndrome Antifosfolípido/epidemiología , Comorbilidad , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Inmunosupresores/uso terapéutico , Incidencia , Pruebas de Función Renal , Lupus Eritematoso Sistémico/tratamiento farmacológico , Nefritis Lúpica/complicaciones , Nefritis Lúpica/tratamiento farmacológico , Masculino , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Serositis/epidemiología , Trombosis/etiología , Trombosis de la Vena/epidemiología , Trombosis de la Vena/etiología , Adulto JovenRESUMEN
OBJECTIVES: Our aim was to analyze a retrospective cohort of renal transplant recipients to determine the risk factors for infections that require hospitalization. METHODS: This was a cohort study that included patients who had received kidney transplants from January 1990 to December 2003. The statistical analysis was performed according to the distribution of variables, and p<0.05 was considered statistically significant. RESULTS: We analyzed 366 transplants in 350 patients, of whom 161 (46%) presented with an episode of infection requiring hospitalization. These 161 patients developed 323 infections (a median of two infections per patient). The incidence rate was 0.46 episodes per 1000 transplant-days. Urinary tract infection, pneumonia, bacteremia, and gastroenteritis were the most common diseases. A high incidence of infections due to Escherichia coli and Enterococcus species, as well as Candida species, was found. By multivariate Cox model, significant risk factors for infections requiring hospitalization were systemic lupus erythematosus (relative risk (RR) 4.8, 95% confidence interval (CI) 1.64-14.1), cancer (RR 3.81, 95% CI 1.05-13.7), previous renal transplant (RR 5.6, 95% CI 1.4-22.4), history of anti-rejection therapy (RR 3.2, 95% CI 1.3-8.0), and a basal serum albumin concentration<3.5mg/dl (RR 1.77, 95% CI 1.17-2.68). Interestingly, dyslipidemia (RR 0.5, 95% CI 0.37-0.69) and end-stage renal disease of unknown etiology (RR 0.5, 95% CI 0.3-0.8) were protective factors against hospitalization. CONCLUSIONS: These data suggest that the most common infections requiring hospitalization in our cohort were those caused by microorganisms commonly related with community-acquired infections rather than those classically associated with immunosuppressant therapy. These findings will be useful for refining medical care.
Asunto(s)
Infecciones Comunitarias Adquiridas/epidemiología , Hospitalización/estadística & datos numéricos , Trasplante de Riñón/estadística & datos numéricos , Adulto , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Humanos , Incidencia , Masculino , México/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To determine clinical and laboratorial factors related to progression to chronic kidney disease in patients with autosomal dominant polycystic kidney disease (ADPKD). MATERIAL AND METHODS: Retrolective cohort. We reviewed the files of patients with diagnosis of ADPKD between 1980 and 2008. We collected demographic, clinical and laboratory data. The primary endpoint was the development of advanced kidney disease (GFR estimated < 15 mL/min with MDRD, renal replacement therapy or kidney transplantation). The Cox proportional hazards model was used to investigate the effect of clinical and laboratorial covariates on the progression to advanced kidney disease. RESULTS: Advanced chronic kidney disease developed in 37.4% (n = 34) of the patients with median survival renal of 57 years (IC95% 50.3-63.8). Variables associated with progression to advanced chronic kidney disease in the multivariate analysis were the levels of serum creatinine (HR = 1.59 IC95% 0.99-2.55 p = 0.05) and dyslipidemia (HR = 3.40; IC95% 1.23-9.39; p = 0.01). CONCLUSIONS: Progression to advanced chronic renal failure was common in our population and the predicting factors for progression were the levels of serum creatinine and dyslipidemia.