ABSTRACT
La enfermedad renal crónica (ERC) es un factor de riesgo independiente para presentar fibrilación auricular (FA) lo que condiciona un incremento del riesgo ya presente en la ERC de sufrir un evento tromboembólico; y este riesgo es mayor aún en la población en hemodiálisis (HD). Por otro lado, en estos pacientes también es mayor la probabilidad de sufrir una hemorragia grave. Por ello, decidir si se debe anticoagular o no a un paciente con FA en diálisis es motivo de controversia entre la comunidad nefrológica.Tomando como modelo lo aconsejado para la población general, la actitud más común entre los nefrólogos ha sido la de optar por la anticoagulación, pese a que no haya estudios randomizados que lo apoyen.Clásicamente la anticoagulación se ha hecho con antagonistas de la vitamina K, con alto coste para nuestros pacientes: eventos hemorrágicos graves, calcificación vascular y progresión de la nefropatía entre otras complicaciones.Con el surgimiento de los anticoagulantes de acción directa, se abrió un panorama esperanzador en el campo de la anticoagulación, al postularse como fármacos más eficaces y seguros que los antivitamina K. Sin embargo, en la práctica clínica, esto no ha sido así.En esta revisión repasamos diversos aspectos de la FA y de su tratamiento anticoagulante en la población en HD. (AU)
Chronic kidney disease (CKD) is an independent risk factor for presenting atrial fibrillation (AF), which conditions an increased risk already present in CKD of suffering a thromboembolic event. And this risk is even higher in the hemodialysis (HD) population. On the other hand, in CKD patients and even more so in HD patients, the probability of suffering serious bleeding is also higher. Therefore, there is no consensus on whether or not to anticoagulate this population.Taking as a model what is advised for the general population, the most common attitude among nephrologists has been to opt for anticoagulation, even though there are no randomized studies to support it.Classically, anticoagulation has been done with vitamin K antagonists, at high cost for our patients: severe bleeding events, vascular calcification, and progression of nephropathy, among other complications.With the emergence of direct-acting anticoagulants, a hopeful outlook was opened in the field of anticoagulation, as they were postulated as more effective and safer drugs than antivitamin K. However, in clinical practice, this has not been the case.In this paper we review various aspects of AF and its anticoagulant treatment in the HD population. (AU)
Subject(s)
Humans , Atrial Fibrillation , Renal Dialysis , Anticoagulants , Vitamin K , Risk FactorsABSTRACT
Objetivos: El objetivo de esta revisión sistemática es evaluar la infección por herpes zoster (HZ) publicada en los ensayos clínicos faseII y faseIII de pacientes con AR en tratamiento con inhibidores de JAK (iJAK). Material y métodos: Revisión sistemática de la literatura que evalúa la incidencia de HZ publicada en los ensayos clínicos de los distintos iJAK comercializados o en estudio. Resultados: Las tasas de HZ variaron entre el 1,51 y 20,22. Los resultados se expresaron principalmente en porcentaje de eventos. Los estudios más recientes categorizaron mejor la incidencia de HZ y su gravedad. Conclusión: Los iJAK se asocian a mayor riesgo de HZ. Aunque las tasas de HZ de los iJAK selectivos de JAK1 son menores, son necesarios más estudios que confirmen estos resultados.(AU)
Objectives: JAK kinase inhibitors (JAKi) are a new therapeutic option in the treatment of rheumatoid arthritis, but they are not without risks, especially the incidence of herpes zoster (HZ). Material and methods: Systematic literature review that evaluates the incidence of HZ published in the clinical trials of the different JAKis marketed or under study. Results: The HZ rates ranged between 1.51 and 20.22. The results were expressed mainly as a percentage of events. The most recent studies better categorized the incidence of HZ and its severity. Conclusion: JAKis are associated with an increased risk of HZ. Although the HZ rates of the selective JAK1 JAKis are lower, more studies are needed to confirm these results.(AU)
Subject(s)
Humans , Male , Female , Herpes Zoster , Arthritis, Rheumatoid , Arthritis, Rheumatoid/complications , Janus Kinase Inhibitors , Communicable Diseases , Chickenpox , Rheumatology , Spain/epidemiology , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/epidemiology , Clinical Trials, Phase III as Topic , Clinical Trials, Phase II as TopicABSTRACT
Nutritional monitoring in advanced chronic kidney disease (ACKD) units provides personalized care and improves clinical outcomes. This study aimed to identify mortality risk factors in chronic kidney disease (CKD) patients on nutritional follow-up in the multidisciplinary ACKD unit. A retrospective cross-sectional observational study was conducted in 307 CKD patients' stage 3b, 4−5 followed-up for 10 years. Clinical and nutritional monitoring was performed by malnutrition-inflammation score (MIS), biochemical parameters (s-albumin, s-prealbumin, and serum C-reactive protein (s-CRP), body composition measured by bioelectrical impedance analysis (BIA), anthropometry, and handgrip strength measurements. The sample was classified into non-survivors, survivors, and censored groups. Of the 307 CKD patients, the prevalence of protein-energy wasting (PEW) was 27.0% using MIS > 5 points, s-CRP > 1 mg/dL was 19.20%, and 27.18% died. Survivors had higher significant body cell mass (BCM%) and phase angle (PA). Survival analyses significantly showed that age > 72 years, MIS > 5 points, s-prealbumin ≤ 30 mg/dL, PA ≤ 4°, and gender-adjusted handgrip strength (HGS) were associated with an increased risk of mortality. By univariate and multivariate Cox regression, time on follow-up (HR:0.97), s-prealbumin (HR:0.94), and right handgrip strength (HR:0.96) were independent predictors of mortality risk at 10 years of follow-up in the ACKD unit. Nutritional monitoring in patients with stage 3b, 4−5 CKD helps to identify and treat nutritional risk early and improve adverse mortality prognosis.
Subject(s)
Malnutrition , Renal Insufficiency, Chronic , Aged , Body Composition , C-Reactive Protein/metabolism , Cross-Sectional Studies , Electric Impedance , Follow-Up Studies , Hand Strength , Humans , Inflammation , Malnutrition/complications , Nutritional Status , Prealbumin/metabolism , Renal Insufficiency, Chronic/complications , Retrospective StudiesABSTRACT
Background: Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods: This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results: A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P = .001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P = .693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P = .001), lower time from booster (P = .043) and past breakthrough SARS-CoV-2 infection (P < .001). Conclusions: In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection.
ABSTRACT
OBJECTIVES: JAK kinase inhibitors (JAKi) are a new therapeutic option in the treatment of rheumatoid arthritis, but they are not without risks, especially the incidence of herpes zoster (HZ). MATERIAL AND METHODS: Systematic literature review that evaluates the incidence of HZ published in the clinical trials of the different JAK is marketed or under study. RESULTS: The HZ rates ranged between 1.51 and 20.22. The results were expressed mainly as a percentage of events. The most recent studies better categorized the incidence of HZ and its severity. CONCLUSION: JAK is are associated with an increased risk of HZ. Although the HZ rates of the selective JAK1 JAK is are lower, more studies are needed to confirm these results.
Subject(s)
Arthritis, Rheumatoid , Herpes Zoster , Janus Kinase Inhibitors , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/drug therapy , Herpes Zoster/epidemiology , Herpes Zoster/etiology , Humans , Janus Kinase Inhibitors/adverse effectsABSTRACT
Chronic kidney disease (CKD) is an independent risk factor for presenting atrial fibrillation (AF), which conditions an increased risk already present in CKD of suffering a thromboembolic event. And this risk is even higher in the hemodialysis (HD) population. On the other hand, in CKD patients and even more so in HD patients, the probability of suffering serious bleeding is also higher. Therefore, there is no consensus on whether or not to anticoagulate this population. Taking as a model what is advised for the general population, the most common attitude among nephrologists has been to opt for anticoagulation, even though there is no randomized studies to support it. Classically, anticoagulation has been done with vitamin K antagonists, at high cost for our patients: severe bleeding events, vascular calcification, and progression of nephropathy, among other complications. With the emergence of direct-acting anticoagulants, a hopeful outlook was opened in the field of anticoagulation, as they were postulated as more effective and safer drugs than antivitamin K. However, in clinical practice, this has not been the case. In this paper we review various aspects of AF and its anticoagulant treatment in the HD population.
Subject(s)
Atrial Fibrillation , Renal Insufficiency, Chronic , Humans , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Renal Dialysis , Anticoagulants/therapeutic use , Hemorrhage/chemically induced , Hemorrhage/prevention & control , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Renal Insufficiency, Chronic/chemically inducedABSTRACT
OBJECTIVES: To determine cardiovascular (CV) mortality and incidence of the first CV event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) after 5 years of follow-up. METHODS: This is an analysis of the CARdiovascular in rheMAatology (CARMA) study after 5 years of follow-up. It includes patients with RA (n = 775), AS (n = 738) and PsA (n = 721), and individuals without CIRD (n = 677) attending outpatient rheumatology clinics from 67 public hospitals in Spain. Descriptive analyses were performed for the CV mortality at 5 years. The Systematic COronary Risk Evaluation (SCORE) function at 5 years was calculated to determine the expected risk of CV mortality. Poisson models were used to estimate the incidence rates of the first CVE. Hazard ratios of the risk factors involved in the development of the first CVE were evaluated using the Weibull proportional hazard model. RESULTS: Overall, 2382 subjects completed the follow-up visit at 5 years. Fifteen patients died due to CVE. CV deaths observed in the CIRD cohort were lower than that predicted by SCORE risk charts. The highest incidence rate of CVE [7.39 cases per 1000 person-years (95% CI 4.63, 11.18)] was found in PsA patients. However, after adjusting for age, sex and CV risk factors, AS was the inflammatory disease more commonly associated with CVE at 5 years [hazard ratio 4.60 (P =0.02)], compared with those without CIRD. CONCLUSIONS: Cardiovascular mortality in patients with CIRD at 5 years of follow-up is lower than estimated. Patients with AS have a higher risk of developing a first CVE after 5 years of follow-up.
Subject(s)
Arthritis, Psoriatic/complications , Arthritis, Rheumatoid/complications , Cardiovascular Diseases/etiology , Cardiovascular Diseases/mortality , Spondylitis, Ankylosing/complications , Adult , Aged , Cohort Studies , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Prospective Studies , Risk FactorsABSTRACT
OBJECTIVES: To determine the incidence and risk factors of first cardiovascular event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD). METHODS: Analysis of data after 2.5 years of follow-up from the prospective study CARMA project, that includes patients with CIRD [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)] and matched individuals without CIRD from 67 hospitals in Spain. CVE cumulative incidence per 1000 patients was calculated after 2.5 years from the start of the project. Weibull proportional hazard model was used to calculate hazard ratio (HR) and 95% confidence interval (95% CI) of the risk factors. RESULTS: 2595 (89.1%) patients completed the 2.5 years of follow-up visit. Cumulative incidence of CVE in patients with CIRD was 15.30 cases per 1000 patients (95% CI: 12.93-17.67), being higher in the subgroup with AS; 22.03 (95% CI: 11.01-33.04). Patients with AS (HR: 4.11; 95% CI: 1.07-15.79), those with older age (HR: 1.09; 95% CI: 1.05-1.13), systolic hypertension (HR: 1.02; 95% CI: 1.00-1.04) and long duration of the disease (HR: 1.07; 95% CI: 1.03-1.12) were at higher risk of first CVE during the 2.5 years of follow-up. In contrast, female gender was a protective factor (HR: 0.43; 95% CI: 0.18-1.00). CONCLUSIONS: Among CIRD patients prospectively followed-up at rheumatology outpatient clinics, those with AS show higher risk of first CVE. Besides cardiovascular risk factors, such as hypertension, being a man and older as well as having a long disease duration increase the risk of CVE in patients with CIRD.
Subject(s)
Arthritis, Psoriatic/epidemiology , Arthritis, Rheumatoid/epidemiology , Cardiovascular Diseases/epidemiology , Spondylitis, Ankylosing/epidemiology , Aged , Comorbidity , Female , Humans , Incidence , Male , Prospective Studies , Rheumatic Diseases/epidemiology , Risk Factors , Spain/epidemiologyABSTRACT
Background: The prevalence of low- turnover bone disease (LTBD) in peritoneal dialysis (PD) patients is higher than in hemodialysis (HD) patients. LTBD patients may be at risk for vascular calcification, and cardiovascular disease. Current therapy for chronic kidney disease metabolic bone disorders (CKD-MBD) is guided by biochemical parameters, as bone biopsy is not used in routine clinical care. Methods: We assessed intact PTH (iPTH: 1-84PTH plus non-1-84PTH), 1-84PTH, and the 1-84PTH/non-1-84PTH ratio in 129 hemodialysis and 73 PD prevalent patients dialyzed with solutions containing 1.75 mmol/L calcium. Results: Hemodialysis and PD patients presented similar iPTH and tCa values and prevalence of putative LTBD as defined according to KDOQI iPTH cut-off levels or 1-84 PTH levels. However, iCa accounted for a higher percentage of tCa in PD (53%) than in hemodialysis (39%) p < 0.001, and the 1-84PTH/non-1-84PTH ratio was lower in PD than in hemodialysis patients (0.44 ± 0.12) vs. (0.60 ± 0.10), p < 0.001. The prevalence of putative LTBD when using the coexistence of 1-84PTH/non-1-84PTH ratio < 1.0 and iPTH < 420 pg/m, was higher in PD than in hemodialysis patients (73 vs. 16% respectively, p < 0.001). In a multivariate logistic regression analysis, dialysis modality was the main determinant of the 1-84PTH/non-1-84PTH ratio. Conclusion: Solutions containing 1.75 mmol/L calciums are associated to a higher proportion of non-1-84PTH fragments in PD than in HD patients. Different analytical criteria result in widely different estimates of LTBD prevalence, thus impairing the ability of clinicians to optimize therapy for CKD-MBD.
ABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Intercellular Signaling Peptides and Proteins/metabolism , Amyloidosis/diagnosis , Amyloidosis/metabolism , Gas Chromatography-Mass Spectrometry , GenotypeABSTRACT
Una de las principales causas de morbimortalidad en el paciente con enfermedad renal crónica es la cardiovascular. La inflamación y las alteraciones en el metabolismo óseo mineral son una condición patológica que conlleva aumento del riesgo cardiovascular en la enfermedad renal crónica. Los parámetros bioquímicos clásicos del metabolismo óseo mineral como fósforo, calcio, vitamina D y PTH tienen una implicación muy conocida en el riesgo cardiovascular. Los nuevos marcadores, FGF23 y klotho, también podrían estar implicados en la enfermedad cardiovascular (AU)
Cardiovascular factors are one of the main causes of morbidity and mortality in patients with chronic kidney disease. Bone mineral metabolism disorders and inflammation are pathological conditions that involve increased cardiovascular risk in chronic kidney disease. The cardiovascular risk involvement of bone mineral metabolism classical biochemical parameters such as phosphorus, calcium, vitamin D and PTH is well known. The newest markers, FGF23 and klotho, could also be implicated in cardiovascular disease (AU)
Subject(s)
Humans , Renal Insufficiency, Chronic/physiopathology , Bone Resorption/etiology , Cardiovascular Diseases/epidemiology , Bone Density/physiology , Risk Factors , Inflammation/physiopathologyABSTRACT
Cardiovascular factors are one of the main causes of morbidity and mortality in patients with chronic kidney disease. Bone mineral metabolism disorders and inflammation are pathological conditions that involve increased cardiovascular risk in chronic kidney disease. The cardiovascular risk involvement of bone mineral metabolism classical biochemical parameters such as phosphorus, calcium, vitamin D and PTH is well known. The newest markers, FGF23 and klotho, could also be implicated in cardiovascular disease.
Subject(s)
Chronic Kidney Disease-Mineral and Bone Disorder , Animals , Biomarkers , Bone and Bones/metabolism , Calcineurin/physiology , Cardiovascular Diseases/etiology , Chronic Kidney Disease-Mineral and Bone Disorder/complications , Chronic Kidney Disease-Mineral and Bone Disorder/metabolism , Fibroblast Growth Factor-23 , Fibroblast Growth Factors/physiology , Glucuronidase/physiology , Humans , Klotho Proteins , Mice , Minerals/metabolism , Models, Biological , Parathyroid Hormone/physiology , Phosphorus/metabolism , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/metabolism , Risk Factors , Vascular Calcification/etiology , Vascular Calcification/prevention & control , Vitamin D/metabolismABSTRACT
Introducción: la parathormona (PTH) presenta buena correlación con los parámetros histomorfométricos y bioquímicos de remodelado óseo, aunque su cuantificación presenta limitaciones por la variabilidad según el método empleado. La PTH circulante es una mezcla de péptidos, y solo la PTH 1-84 es responsable de su actividad. Los fragmentos carboxiterminales tienen acción antagónica y, al aclararse por el riñón, varía su proporción según el estadio de enfermedad renal crónica. Nos planteamos estudiar posibles diferencias en su proporción en función del tipo de diálisis: hemodiálisis (HD) o diálisis peritoneal (DP). Material y métodos: En 73 pacientes en DP (46 varones y 27 mujeres entre 22 y 82 años) se cuantificó calcio total (Ca) y iónico (Cai), fosforo (P), telopéptidos carboxiterminales del colágeno tipo I (BCTx) y PTH mediante seis métodos de segunda generación (uno isotópico (IRMA) y cinco inmunoquimioluminescentes (ECLIA) y por el único método PTH de tercera generación (IRMA) disponible en ese momento. Resultados: Las concentraciones medias de Ca, Cai, P y BCTx fueron respectivamente, 9.03, 4.76, 4.73 mg/dl y 1181 pmol/l. Se observaron diferencias significativas en la PTH dependiendo del método de segunda generación utilizado. Los valores de PTH ajustados al rango equivalente a 150-300 de la PTH Allegro de Nichols en los pacientes en DP fueron superiores a los obtenidos en el estudio previo de HD. El porcentaje de PTH 1-84 biológicamente activa y el ratio PTH 1-84/7-84 fueron significativamente menores, indicando que, a igualdad de valor de PTH intacta, el porcentaje de fragmentos 7-84 circulantes es mayor en los pacientes en DP. Conclusión: Los pacientes en DP tienen una mayor proporción de fragmentos 7-84 PTH. Por este motivo las fórmulas de corrección inter-método utilizadas en los pacientes en HD no son aplicables en DP. En este estudio sugerimos otras fórmulas para aplicar en DP (AU)
Introduction: Parathyroid hormone (PTH) shows a strong correlation with histomorphometric and biochemical parameters of bone turnover, however its measurement presents limitations due to inter-method variability. Circulating PTH is a mixture of peptides, but only on its whole form (1-84 PTH) is responsible of PTH biological activity. Carboxyl-terminal fragments exhibit antagonist actions and their proportion differs at each stage of chronic kidney disease, as consequence of differences on their renal clearance. The aim of this study is to evaluate possible differences in the proportion of these fragments according to dialysis type: haemodialysis (HD) or peritoneal dialysis (PD). Material and methods: Serum total (Ca) and ionized calcium (iCa), phosphate (P), carboxyl-terminal telopeptides of collagen type I (BCTx) were measured in 73 patients on PD (46 men and 27 women with an age between 22 and 82 years). PTH was quantified by six second generation assays (one isotopic and five chemiluminescence assays) and by one third generation PTH method. Results: Mean serum levels of Ca, iCa, P and BCTx were 9.03, 4.76, 4.73 mg/dl and 1181 pmol/l, respectively. Significant differences were observed in PTH values according to the method used. Adjustment of PTH results to PTH Allegro (Nichols) range of 150-300 nmol/l in PD patients showed higher values than those assessed previously for HD population. The percentage of biologically active 1-84 PTH as the 1-84 PTH/ 7-84 PTH ratio in PD were significantly lower than in HD patients, reflecting the higher proportion of 7-84 PTH circulating fragments for a given intact PTH result in PD. Conclusions: PD patients have a higher proportion of 7-84 PTH circulating fragments. Consequently, the inter-method adjustment algorithms proposed for HD patients are not useful for PD patients. This study proposes alternative algorithms for PTH inter-method adjustment to be applied in PD (AU)
Subject(s)
Humans , Parathyroid Hormone/analysis , Peritoneal Dialysis , Renal Dialysis , Hypoparathyroidism/drug therapy , Bone Density/physiology , Hemodialysis Solutions/pharmacology , Risk FactorsABSTRACT
INTRODUCTION: Parathyroid hormone (PTH) shows a strong correlation with histomorphometric and biochemical parameters of bone turnover, however its measurement presents limitations due to inter-method variability. Circulating PTH is a mixture of peptides, but only on its whole form (1-84 PTH) is responsible of PTH biological activity. Carboxyl-terminal fragments exhibit antagonist actions and their proportion differs at each stage of chronic kidney disease, as consequence of differences on their renal clearance. The aim of this study is to evaluate possible differences in the proportion of these fragments according to dialysis type: haemodialysis (HD) or peritoneal dialysis (PD). MATERIAL AND METHODS: Serum total (Ca) and ionized calcium (iCa), phosphate (P), carboxyl-terminal telopeptides of collagen type I (BCTx) were measured in 73 patients on PD (46 men and 27 women with an age between 22 and 82 years). PTH was quantified by six second generation assays (one isotopic and five chemiluminescence assays) and by one third generation PTH method. RESULTS: Mean serum levels of Ca, iCa, P and BCTx were 9.03, 4.76, 4.73 mg/dl and 1181 pmol/l, respectively. Significant differences were observed in PTH values according to the method used. Adjustment of PTH results to PTH Allegro (Nichols) range of 150-300 nmol/l in PD patients showed higher values than those assessed previously for HD population. The percentage of biologically active 1-84 PTH as the 1-84 PTH/ 7-84 PTH ratio in PD were significantly lower than in HD patients, reflecting the higher proportion of 7-84 PTH circulating fragments for a given intact PTH result in PD. CONCLUSIONS: PD patients have a higher proportion of 7-84 PTH circulating fragments. Consequently, the inter-method adjustment algorithms proposed for HD patients are not useful for PD patients. This study proposes alternative algorithms for PTH inter-method adjustment to be applied in PD.
Subject(s)
Kidney Failure, Chronic/blood , Kidney Failure, Chronic/therapy , Parathyroid Hormone/blood , Renal Dialysis , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Peritoneal Dialysis , Young AdultABSTRACT
Se propone una metodología: Talleres por la excelencia en la mejora continua de la calidad de los servicios estomatológicos, que permitió evaluar la calidad y consta de dos momentos fundamentales. Un primer momento de preparación de taller, revisión de los supervisores, confección del instrumento evaluativo, colaboración de observadores, selección de los sujetos-objetos de proceso y un segundo momento de desarrollo del taller, además se plantea la forma del seguimiento. La aplicación de esta metodología permitió un mayor compromiso de los proveedores de los servicios con los resultados del proceso y con las medidas conectivas que de él derivaron, por lo que hicieron más factibles las soluciones a los problemas que se detectaron. Los talleres hicieron reflexionar a todo el personal involucrada logrando la transformación deseada hacia la calidad y fueron un medio excelente para inducir los cambios en el ambiente de trabajo(AU)
Subject(s)
Humans , Male , Female , Quality of Health Care/trends , Dental Health Services/trendsABSTRACT
Los objetivos de este estudio son: a) conocer la frecuencia del dolor postoperatorio en pacientes tratados endodónticamente en una cita y b) establecer qué relación existe entre el diagnóstico pulpar y el dolor postoperatorio. Para el estudio se tomaron en cuenta 50 casos de dientes anteriores a los cuales se les estableció un diagnóstico pulpar, se les realizó el trabajo biomecánico del conducto y se obturó con la técnica de condensación lateral. Se observó el comportamiento del dolor postoperatorio a las 24, 48 horas y a la semana del tratamiento. A los datos obtenidos se les aplicó la prueba estadística X2 (chi cuadrado) a fin de comparar frecuencias de dolor contra su ausencia. De los 50 casos tratados: 12 de ellos (24 por ciento) presentaron algún tipo de dolor posoperatorio a las 24 horas, a las 48 horas o a la semana del tratamiento. No se encontró una correlación entre el diagnóstico pulpar y el dolor posoperatorio. La terapia de conducto en una cita puede ser practicada en la mayoría de los casos. El dolor posoperatorio es el principal síntoma que se presenta. Las condiciones del pacinetes y la habilidad del profesional también son factores que se deben tomar en cuenta para la selección de la técnica de tratamiento