A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI).

INTRODUCTION: Ideal timing of Renal Replacement Therapy (RRT) discontinuation in Acute Kidney Injury (AKI) is still unknown. We aimed to study the role of creatinine-related variables in predicting RRT successful discontinuation and to propose a clinical predictive score. METHODS: In this single-centre retrospective study, we evaluated all AKI patients in whom RRT was interrupted for at least 48 hours. Patients who were still RRT-independent 7 days after initial RRT cessation were included in the "Success" group and opposed to the "Failure" group. We evaluated baseline characteristics and variables collected at the time of RRT interruption, as well as the Kinetic estimated Glomerular Filtration Rate (KeGFR), the simple variation in serum Creatinine (ΔsCr), and the incremental creatinine ratio on the first three days after RRT interruption. Multivariable analysis was performed to evaluate prediction of success. Internal validation using a simple binomial generalized regression model with Lasso estimation and 5-fold cross validation method was performed. RESULTS: We included 124 patients, 49 in the "Failure" group and 75 in the "Success" group. All creatinine-related variables predicted success in simple and multiple logistic regression models. The best model generated a clinical score based on the odds ratio obtained for each variable and included urine output, non-renal SOFA score, fluid balance, serum urea, serum potassium, blood pH, and the variation in sCr values after RRT discontinuation. The score presented an area under the ROC of 0.86 (95% CI 0.76‒1.00). CONCLUSION: Creatinine variation between the first 2 consecutive days after RRT discontinuation might predict success in RRT discontinuation. The developed clinical score based on these variables might be a useful clinical decision tool to guide hemodialysis catheter safe removal.

A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI)

Abstract Introduction Ideal timing of Renal Replacement Therapy (RRT) discontinuation in Acute Kidney Injury (AKI) is still unknown. We aimed to study the role of creatinine-related variables in predicting RRT successful discontinuation and to propose a clinical predictive score. Methods In this single-centre retrospective study, we evaluated all AKI patients in whom RRT was interrupted for at least 48 hours. Patients who were still RRT-independent 7 days after initial RRT cessation were included in the "Success" group and opposed to the "Failure" group. We evaluated baseline characteristics and variables collected at the time of RRT interruption, as well as the Kinetic estimated Glomerular Filtration Rate (KeGFR), the simple variation in serum Creatinine (ΔsCr), and the incremental creatinine ratio on the first three days after RRT interruption. Multivariable analysis was performed to evaluate prediction of success. Internal validation using a simple binomial generalized regression model with Lasso estimation and 5-fold cross validation method was performed. Results We included 124 patients, 49 in the "Failure" group and 75 in the "Success" group. All creatinine-related variables predicted success in simple and multiple logistic regression models. The best model generated a clinical score based on the odds ratio obtained for each variable and included urine output, non-renal SOFA score, fluid balance, serum urea, serum potassium, blood pH, and the variation in sCr values after RRT discontinuation. The score presented an area under the ROC of 0.86 (95% CI 0.76‒1.00). Conclusion Creatinine variation between the first 2 consecutive days after RRT discontinuation might predict success in RRT discontinuation. The developed clinical score based on these variables might be a useful clinical decision tool to guide hemodialysis catheter safe removal.

Continuous renal replacement therapy in COVID-19-associated AKI: adding heparin to citrate to extend filter life-a retrospective cohort study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) may predispose patients to thrombotic events. The best anticoagulation strategy for continuous renal replacement therapy (CRRT) in such patients is still under debate. The purpose of this study was to evaluate the impact that different anticoagulation protocols have on filter clotting risk. METHODS: This was a retrospective observational study comparing two different anticoagulation strategies (citrate only and citrate plus intravenous infusion of unfractionated heparin) in patients with acute kidney injury (AKI), associated or not with COVID-19 (COV + AKI and COV - AKI, respectively), who were submitted to CRRT. Filter clotting risks were compared among groups. RESULTS: Between January 2019 and July 2020, 238 patients were evaluated: 188 in the COV + AKI group and 50 in the COV - AKI group. Filter clotting during the first filter use occurred in 111 patients (46.6%). Heparin use conferred protection against filter clotting (HR = 0.37, 95% CI 0.25-0.55), resulting in longer filter survival. Bleeding events and the need for blood transfusion were similar between the citrate only and citrate plus unfractionated heparin strategies. In-hospital mortality was higher among the COV + AKI patients than among the COV - AKI patients, although it was similar between the COV + AKI patients who received heparin and those who did not. Filter clotting was more common in patients with D-dimer levels above the median (5990 ng/ml). In the multivariate analysis, heparin was associated with a lower risk of filter clotting (HR = 0.28, 95% CI 0.18-0.43), whereas an elevated D-dimer level and high hemoglobin were found to be risk factors for circuit clotting. A diagnosis of COVID-19 was marginally associated with an increased risk of circuit clotting (HR = 2.15, 95% CI 0.99-4.68). CONCLUSIONS: In COV + AKI patients, adding systemic heparin to standard regional citrate anticoagulation may prolong CRRT filter patency by reducing clotting risk with a low risk of complications.

Cov-hep study: heparin in standard anticoagulation based on citrate for continuous veno-venous hemodialysis in patients with COVID-19: a structured summary of a study protocol for a randomized controlled trial.

OBJECTIVES: The primary objective is to test if heparin added to a standard regional anticoagulation protocol based on citrate is able to reduce dialysis circuit losses by clotting without increasing the risk of thrombocytopenia or bleeding, in patients with COVID-19 with acute kidney injury requiring dialysis. TRIAL DESIGN: Randomized, parallel-group, open-label trial, with two arms (ratio 1:1) comparing different continuous renal replacement therapy anticoagulation strategies. PARTICIPANTS: Eligibility conditions: All ICU patients of University of Sao Paulo General Hospital (Hospital das Clínicas), Brazil will be screened for eligibility conditions. Adults (> 18 years old) with confirmed COVID-19 and acute kidney injury requiring dialysis with agreement between ICU and nephrology teams for the introduction of renal continuous replacement therapy in daily ICU rounds. Continuous renal replacement therapy will be prescribed by consulting nephrologists based on standard clinical guidelines, including acute kidney injury with hemodynamic instability plus hyperkalemia, severe acidosis, volume overload, respiratory distress, multiorgan failure or some combination of these factors. DATA COLLECTION: Patients demographics and associated clinical data and comorbidities will be recorded at ICU entry. Demographic information will include the patient's age, sex, and admission dates. Clinical data comprise comorbidities, APACHE 2, SAPS 3, need for mechanical ventilation, and use of vasopressor drugs. Physiological data collected by the day of CRRT start will be vital signs, the arterial oxygen tension/fraction of inspired oxygen (PaO2/FiO2) index, and serum creatinine, blood urea nitrogen, bilirubin, hemoglobin, hematocrit, platelets, white blood cell count levels and Peak D-dimer levels. Patients will be analyzed for the first 72h of CRRT, and they will be evaluated regarding clinical variables, filter patency and any adverse events that could be related to the anticoagulation choice, as bleeding (mild or major) or low platelets counts (<100.000 ui/uL) during treatment period. Mild and major bleeding will be defined by hemorrhagic event without clinical impact or hemoglobin (Hb) fall lesser than 1g/dL and hemorrhagic event with clinical impact or Hb fall higher than 1g/dL, respectively. EXCLUSION CRITERIA: Hypersensitivity to any of the substances going to be used in the study (Citric acid dextrosol 2.2% and unfractionated heparin); Previous diagnosis of coagulopathy or thrombophilia; Contraindication to the use of unfractionated heparin; Risk of citrate poisoning - (Lactate> 30 mg/dL, international normalized ratio > 2.5, Total bilirubin> 15 mg/dL); Pregnancy; Patients unlikely to survive for more than 24 hours. The trial is being undertaken at the University of Sao Paulo General Hospital (Hospital das Clinicas), Brazil. INTERVENTION AND COMPARATOR: Group A (control) - Patients on continuous renal replacement therapy (blood flow 150 ml/min, dose of 30 mL/Kg/h) receiving anticoagulation with sodium citrate at 4 mmol/L Group B (experiment): Patients on continuous hemodialysis (blood flow 150 mL/min, dose of 30 mL/Kg/h) receiving anticoagulation with sodium citrate at 4 mmol/L associated with unfractionated heparin at 10 U/Kg/h. MAIN OUTCOMES: The percentage of clotted dialyzers within 72 hours in each of the studied groups (Primary outcome) Secondary outcomes: Number of dialyzers used in the first 72 hours of dialysis protocol, Mortality in the first 72 h of dialysis protocol, Bleeding events (Major or minor) in the first 72 h of dialysis protocol, Thrombocytopenia (less than 50.000 platelets) proportion in the first 72 h of dialysis protocol, Dialysis efficiency (Urea sieving) - variation in urea sieving between the first, second and third days of dialysis protocol, Continuous renal replacement therapy pressures (Arterial, Venous, dialysate and pre-filter pressure) in the first 72 h of dialysis protocol, in-hospital mortality. RANDOMIZATION: RedCap→ randomization - 2 blocks randomization by D-dimer level (5000ng/dL cut-off) and catheter site (Right Internal Jugular versus other sites) with 1:1 allocation ratio. BLINDING (MASKING): No blinding - Open label format NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): Total number of patients 90 (45 per group) TRIAL STATUS: Trial version 2.0 - ongoing recruitment. First recruitment: June 29, 2020 Estimated date for last recruitment: December 31, 2020 TRIAL REGISTRATION: Responsible Party: University of Sao Paulo General Hospital (Hospital das Clinicas) ClinicalTrials.gov Identifier: NCT04487990 , registered July 27, 2020, ReBec www.ensaiosclinicos.gov.br/rg/RBR-45kf9p/ Other Study ID Numbers: U1111-1252-0194 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1) In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

El cuidado espiritual un camino para trascender en la razón de ser de la Enfermería / Spiritual care a way to transcend the reason of being of Nursing

Resumen

¿Cómo se relaciona la espiritualidad con el arte del cuidado?

La espiritualidad acompaña al hombre desde sus orígenes, al igual que el cuidado se reconoce como una dimensión humana; en la contemporaneidad, se explica dentro del paradigma de la Nueva Era como respuesta a las concepciones tradicionales. Se relaciona con la comunicación enfermera-persona durante el proceso de cuidado que, en esencia, se trata de recuperar el sentido de la vida-muerte, la conciencia de sí y su trascendencia.

La espiritualidad se fundamenta en procesos de vida, posee orientaciones y significados diferentes; así es como el cuidado espiritual se convierte en un proceso dinámico continuo de interacción, del estar ahí con la persona, de ayudarle en su necesidad de trascender y de vivir acorde con sus creencias y significados.

El profesional de enfermería, al apropiarse de estos conceptos y ponerlos en práctica desarrolla su propia espiritualidad, promueve en las personas preguntarse por el sentido de su existencia, elaborar proyectos de vida y comprender su historia de vida; dichas acciones, favorecen que el profesional de enfermería se identifique consigo mismo y con el otro en el momento de brindar cuidado, y convierte el acto del cuidado en una experiencia trascendente, donde convergen el crecimiento personal y profesional.

Abstract

How is spirituality related to the art of care?

Spirituality accompanies man from his origins just as care is recognized as a human dimension; in contemporaneity, it is explained within the paradigm of the New Age as a response to traditional conceptions. It is related to the nurse-person communication during the care process, which in essence, is about recovering the meaning of life-death, self-awareness and its transcendence. Spirituality is based on life processes, and it has different orientations and meanings; that is how, spiritual care becomes a continuous dynamic process of interaction, of being there with the person, of helping him in his need to transcend and live according to his beliefs and meanings.

The nursing professional, by appropriating these concepts and putting them into practice, develops his own spirituality; promotes in people, the question of the meaning of their existence, develop life projects and understand their life history; these actions favor that the nursing professional identifies himself with himself and with the other at the time of providing care, and turns the act of care into a transcendent experience, where personal and professional growth converge.

Encuesta sobre prácticas de prevención de infecciones asociadas a la broncoscopía en la República Argentina 2014 / Survey about Practices to Prevent Bronchoscopy-Associated Infections in the Republic of Argentina in 2014

Introducción y objetivo: Encuestas nacionales sobre la práctica broncoscópica se han repetido desde hace tres décadas en el mundo. En Argentina la broncoscopía tiene una larga historia, sin embargo, hay poca información disponible sobre esta práctica. El objetivo del estudio es obtener información sobre las características específicas de las prácticas de prevención de infecciones en los procedimientos broncoscópicos. Métodos: En 2014, distribuimos una encuesta para broncoscopistas y asistentes en la reunión anual de neumólogos. Resultados: Se completaron un total de 41 cuestionarios. No recibió capacitación específica en prevención de infecciones el 68%. Es neumonólogo el 85%. Infecciones, pseudoinfeciones o pseudoepidemias asociadas a broncoscopía fueron registradas por el 7%. No refiere haber sufrido un accidente laboral relacionado con la broncoscopía el 87%. Conoce la conducta a adoptar ante un accidente el 80%. Utiliza detergente enzimático para el proceso de limpieza 97%. Reutiliza este detergente 40%. Ortofitalaldehído, glutaraldehído o ambos es empleado como agente de desinfección de alto nivel (DAN) por el 95%. Realiza DAN sobre el broncoscopio siempre el 75%, lo hace a veces 9% y no lo hace el 14%. Realiza DAN o esterilización sobre material reutilizable el 87%. Los accesorios reutilizables (pinzas o cepillos) son esterilizados, reprocesados con DAN o ambas cosas por el 77%; y sometidos sólo a limpieza de nivel medio por el 12%. Emplea “Single Use Device” 78%, de ellos reprocesa este material 84%. Posee procesador automático el 5%. Conclusiones: Se identificaron características específicas locales de prácticas de prevención de infecciones en los procedimientos broncoscópicos.

Background and objective: Nationwide surveys about bronchoscopic practice have been carried out for three decades over the world. In Argentina, bronchoscopy has a long history; however, little information is available about this practice. The aim of this study is to obtain information regarding specific characteristics of practices to prevent in the bronchoscopy-associated infections. Methods: In 2014, we carried out a survey addressed to bronchoscopists and bronchoscopy assistants at the annual meeting of lung specialists. Results: 41 persons were surveyed. 68% did not receive any specific training in infection prevention practices. 85% were pulmonologists. 7% recorded infections, pseudoepidemics or pseudoinfections. 80% knew how to manage bronchoscopy-related accidents. 97% used enzymatic detergents in the cleaning process. 40% knew when to reuse the detergent. 95% used orthophthaldehyde, glutaraldehyde, or both of them as a high level disinfection agent (HLD). 75% used always HLD to clean the bronchoscope while 9% did it sometimes, and 14% never did it. 87% used HLD or sterilization for reusable materials. 77% sterilized reusable accessories (biopsy forceps or brushes), 77% reprocessed them with HLD, and 12% exposed them to mid level cleaning. 78% used a single device. 84% reprocessed the materials. 5% had an automatic processor. Conclusions: Local specific characteristics on the practice to prevent infections in the bronchoscopic procedures were identified.

Advancing bag-of-visual-words representations for lesion classification in retinal images.

Diabetic Retinopathy (DR) is a complication of diabetes that can lead to blindness if not readily discovered. Automated screening algorithms have the potential to improve identification of patients who need further medical attention. However, the identification of lesions must be accurate to be useful for clinical application. The bag-of-visual-words (BoVW) algorithm employs a maximum-margin classifier in a flexible framework that is able to detect the most common DR-related lesions such as microaneurysms, cotton-wool spots and hard exudates. BoVW allows to bypass the need for pre- and post-processing of the retinographic images, as well as the need of specific ad hoc techniques for identification of each type of lesion. An extensive evaluation of the BoVW model, using three large retinograph datasets (DR1, DR2 and Messidor) with different resolution and collected by different healthcare personnel, was performed. The results demonstrate that the BoVW classification approach can identify different lesions within an image without having to utilize different algorithms for each lesion reducing processing time and providing a more flexible diagnostic system. Our BoVW scheme is based on sparse low-level feature detection with a Speeded-Up Robust Features (SURF) local descriptor, and mid-level features based on semi-soft coding with max pooling. The best BoVW representation for retinal image classification was an area under the receiver operating characteristic curve (AUC-ROC) of 97.8% (exudates) and 93.5% (red lesions), applying a cross-dataset validation protocol. To assess the accuracy for detecting cases that require referral within one year, the sparse extraction technique associated with semi-soft coding and max pooling obtained an AUC of 94.2 ± 2.0%, outperforming current methods. Those results indicate that, for retinal image classification tasks in clinical practice, BoVW is equal and, in some instances, surpasses results obtained using dense detection (widely believed to be the best choice in many vision problems) for the low-level descriptors.

[Rituximab-induced interstitial lung disease]. / Enfermedad pulmonar intersticial asociada a rituximab.

The introduction of the anti-CD20 antibody rituximab into clinical practice has improved substantially the prognosis of a variety of haematological and autoimmune diseases. The interstitial lung disease is one of most serious and potentially fatal complications of rituximab therapy. This diagnosis should be considered in patients who have received the drug and present with dyspnea, fever and cough without clear evidence of infection. We report a case of rituximab-induced interstitial lung disease.

Enfermedad pulmonar intersticial asociada a rituximab / Rituximab-induced interstitial lung disease

La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evidencia de infección. Presentamos un caso de enfermedad pulmonar intersticial asociada a rituximab.

The introduction of the anti-CD20 antibody rituximab into clinical practice has improved substantially the prognosis of a variety of haematological and autoimmune diseases. The interstitial lung disease is one of most serious and potentially fatal complications of rituximab therapy. This diagnosis should be considered in patients who have received the drug and present with dyspnea, fever and cough without clear evidence of infection. We report a case of rituximab-induced interstitial lung disease.

Enfermedad pulmonar intersticial asociada a rituximab / Rituximab-induced interstitial lung disease

La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evidencia de infección. Presentamos un caso de enfermedad pulmonar intersticial asociada a rituximab.(AU)

The introduction of the anti-CD20 antibody rituximab into clinical practice has improved substantially the prognosis of a variety of haematological and autoimmune diseases. The interstitial lung disease is one of most serious and potentially fatal complications of rituximab therapy. This diagnosis should be considered in patients who have received the drug and present with dyspnea, fever and cough without clear evidence of infection. We report a case of rituximab-induced interstitial lung disease.(AU)

Enfermedad pulmonar intersticial asociada a rituximab. / [Rituximab-induced interstitial lung disease].

The introduction of the anti-CD20 antibody rituximab into clinical practice has improved substantially the prognosis of a variety of haematological and autoimmune diseases. The interstitial lung disease is one of most serious and potentially fatal complications of rituximab therapy. This diagnosis should be considered in patients who have received the drug and present with dyspnea, fever and cough without clear evidence of infection. We report a case of rituximab-induced interstitial lung disease.

Sono e aprendizagem / Sleep and learning

É grande a importância do sono na vida diária, especialmente pensando no desenvolvimento físico e psicológico da criança, e suas influências sobre o comportamento infantil e o aprendizado. Objetivo: A identificação dos distúrbios do sono em crianças. Método: O questionário do sono de Reimão e Lefèvre (QRL) aborda diversos distúrbios do sono na infância, com questões respondidas pelos pais. Foi tomada uma amostra de 258 escolares, na faixa etária de 6 a 9 anos, em cinco escolas de ensino fundamental na cidade de Poços de Caldas, em Minas Gerais. Resultados: Entre os resultados, verificou-se que apenas 13 (5%) pais admitiam a influência do sono na aprendizagem. Discussão: A literatura relata as relações do sono com a aprendizagem, atenção e memória, porém poucos trabalhos avaliam o grau de informação dos pais quanto às conseqüências dos distúrbios do sono para a aprendizagem. Conclusão: A utilização do QRL para pesquisas sobre o sono pode facilitar o diagnóstico e possibilitar tratamentos eficazes, especialmente quando a grande maioria dos pais e pessoal envolvido na escola, ainda desconhece a relação entre problemas no sono e transtornos na aprendizagem(AU)

Sono e aprendizagem / Sleep and learning

É grande a importância do sono na vida diária, especialmente pensando no desenvolvimento físico e psicológico da criança, e suas influências sobre o comportamento infantil e o aprendizado. Objetivo: A identificação dos distúrbios do sono em crianças. Método: O questionário do sono de Reimão e Lefèvre (QRL) aborda diversos distúrbios do sono na infância, com questões respondidas pelos pais. Foi tomada uma amostra de 258 escolares, na faixa etária de 6 a 9 anos, em cinco escolas de ensino fundamental na cidade de Poços de Caldas, em Minas Gerais. Resultados: Entre os resultados, verificou-se que apenas 13 (5%) pais admitiam a influência do sono na aprendizagem. Discussão: A literatura relata as relações do sono com a aprendizagem, atenção e memória, porém poucos trabalhos avaliam o grau de informação dos pais quanto às conseqüências dos distúrbios do sono para a aprendizagem. Conclusão: A utilização do QRL para pesquisas sobre o sono pode facilitar o diagnóstico e possibilitar tratamentos eficazes, especialmente quando a grande maioria dos pais e pessoal envolvido na escola, ainda desconhece a relação entre problemas no sono e transtornos na aprendizagem.

Bronquiectasias en pacientes HIV positivos / Bronchiectasis in patients infected with HIV

Entre el 1 de julio de 1995 y 30 de junio de 1997 se internaron 295 pacientes con serología positiva para HIV. En 25 de ellos (18 hombres y 7 mujeres) se hizo diagnóstico de bronquiectasias (BE). La edad media fue de 32 años, en su mayoría adictos endovenosos, en todos los casos se detectó antecedentes de infección pulmonar previa (neumonía por Pneumocystis carinii en 14 pacientes, tuberculosis en 9, neumonía recurrente en 6) y compromiso de la inmunidad celular (CD4 media = 64.8 mm3). La presencia de expectoración purulenta habitual, infecciones respiratorias bajas reiteradas y radiología patológica se correlacionó con el hallazgo de BE en la tomografía computada de tórax (TC). Hemos observado que la frecuencia de BE en esta población fue notoriamente mayor a la de la población general adulta (sin factores de riesgo para HIV) que se internó en nuestro Hospital en el mismo período de tiempo, utilizando la misma metodología diagnóstica (8.5 por ciento vs 0.12 por ciento); por lo tanto la BE constituyen una patología relativamente frecuente en los pacientes con HIV, son motivo de internaciones repetidas por infección respiratoria baja bacteriana, y de aumento de morbimortalidad en estos pacientes.

Bronquiectasias en pacientes HIV positivos / Bronchiectasis in patients infected with HIV

Entre el 1 de julio de 1995 y 30 de junio de 1997 se internaron 295 pacientes con serología positiva para HIV. En 25 de ellos (18 hombres y 7 mujeres) se hizo diagnóstico de bronquiectasias (BE). La edad media fue de 32 años, en su mayoría adictos endovenosos, en todos los casos se detectó antecedentes de infección pulmonar previa (neumonía por Pneumocystis carinii en 14 pacientes, tuberculosis en 9, neumonía recurrente en 6) y compromiso de la inmunidad celular (CD4 media = 64.8 mm3). La presencia de expectoración purulenta habitual, infecciones respiratorias bajas reiteradas y radiología patológica se correlacionó con el hallazgo de BE en la tomografía computada de tórax (TC). Hemos observado que la frecuencia de BE en esta población fue notoriamente mayor a la de la población general adulta (sin factores de riesgo para HIV) que se internó en nuestro Hospital en el mismo período de tiempo, utilizando la misma metodología diagnóstica (8.5 por ciento vs 0.12 por ciento); por lo tanto la BE constituyen una patología relativamente frecuente en los pacientes con HIV, son motivo de internaciones repetidas por infección respiratoria baja bacteriana, y de aumento de morbimortalidad en estos pacientes. (AU)

Diferencias entre la tuberculosis pulmonar con baciloscopia positiva y negativa / Differences between smear positive and smear negative pulmonary tuberculosis

En el análisis de 318 pacientes con tuberculosis (TB) pulmonar activa, tratados entre enero de 1980 y diciembre de 1990, en un Hospital General del Gran Buenos Aires, el grupo (n = 48) con baciloscopía negativa (D-) tuvo diferencias clínicas y radiológicas significativas con respecto al grupo (n = 270) con baciioscopía positivia (D+). Estas diferencias fueron la mayor edad, la mayor frecuencia de otras enfermedades pulmonares y de Rx "secuela", con menos antecedentes clínicos y cavidades pulmonares radiológicas. Dos subgrupos se distinguem en el grupo D-, de acuerdo a la iniciación empírica del tratamiento. Por un lado un subgrupo con características similares al grupo D+, lo que facilitó la decisión de comenzarlo aún con la baciloscopía negativa (D-TI). El otro subgrupo tuvo características totalmente diferentes al grupo D+, lo que hizo pensar en otros diagnósticos, difiriendo así la decisión del tratamiento hasta la obtención del cultivo (D-TD). (AU)

Diferencias entre la tuberculosis pulmonar con baciloscopia positiva y negativa / Differences between smear positive and smear negative pulmonary tuberculosis

En el análisis de 318 pacientes con tuberculosis (TB) pulmonar activa, tratados entre enero de 1980 y diciembre de 1990, en un Hospital General del Gran Buenos Aires, el grupo (n = 48) con baciloscopía negativa (D-) tuvo diferencias clínicas y radiológicas significativas con respecto al grupo (n = 270) con baciioscopía positivia (D+). Estas diferencias fueron la mayor edad, la mayor frecuencia de otras enfermedades pulmonares y de Rx "secuela", con menos antecedentes clínicos y cavidades pulmonares radiológicas. Dos subgrupos se distinguem en el grupo D-, de acuerdo a la iniciación empírica del tratamiento. Por un lado un subgrupo con características similares al grupo D+, lo que facilitó la decisión de comenzarlo aún con la baciloscopía negativa (D-TI). El otro subgrupo tuvo características totalmente diferentes al grupo D+, lo que hizo pensar en otros diagnósticos, difiriendo así la decisión del tratamiento hasta la obtención del cultivo (D-TD).