ABSTRACT
Background: Chronic kidney disease (CKD) is a major worldwide public health problem and is associated with increased risk of cardiovascular disease and death. Aim: To assess CKD prevalence in urban Primary Care Services (PCS) of Concepcion, Chile. Material and Methods: The clinical records of 27.894 adults aged 55 ± 18 years (66 percent females), consulting in outpatient clinics and in whom serum creatinine was measured, with or without assessment of urine albumin levels, were reviewed. The glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease (MDRD)-4 equation. CKD was defined as an eGFR < 60 ml/min/1.73 m2 and classified according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NFK-KDOQI) guidelines. Results: Mean eGFR was 77.1 ± 16.3 ml/min/1.73 m2. Twelve percent of subjects had CKD (women, 14.5 percent and men 7,4 percent, p < 0,05). The prevalence of stages 3, 4 and 5 of CKD were 11.6, 0.3 and 0.2 percent respectively. eGFR was negatively correlated with age ( r = -0,54, p < 0,05). Among patients with an eGFR < 60 ml/min/1.73 m2, 96.3 percent had eGFR 30-59, 2.3 percent 15-29 and 1.4 percent < of 15. Seventy nine percent were women. 75.1 percent were aged 65 years or more, 26.8 percent had a serum creatinine equal or less than 1.0 mg/dL and 40.5 percent had microalbuminuria. Only 1 percent of outpatients ascribed to Cardiovascular or Diabetes Programs had the diagnosis of CKD registered. Independent risk predictors of CKD were age > 60 years, female sex and microalbuminuria. Conclusions: This study showed a high prevalence of CKD in ambulatory patients, mainly among women and older people. The low level of diagnosis of CKD in cardiovascular and diabetes programs is of concern.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Kidney Diseases/epidemiology , Urban Health Services/statistics & numerical data , Age Distribution , Chile/epidemiology , Chronic Disease , Creatinine/urine , Epidemiologic Methods , Glomerular Filtration Rate , Reference Values , Sex DistributionABSTRACT
BACKGROUND: Chronic kidney disease (CKD) is a major worldwide public health problem and is associated with increased risk of cardiovascular disease and death. AIM: To assess CKD prevalence in urban Primary Care Services (PCS) of Concepcion, Chile. MATERIAL AND METHODS: The clinical records of 27.894 adults aged 55 ± 18 years (66% females), consulting in outpatient clinics and in whom serum creatinine was measured, with or without assessment of urine albumin levels, were reviewed. The glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease (MDRD)-4 equation. CKD was defined as an eGFR < 60 ml/min/1.73 m2 and classified according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NFK-KDOQI) guidelines. RESULTS: Mean eGFR was 77.1 ± 16.3 ml/min/1.73 m2. Twelve percent of subjects had CKD (women, 14.5% and men 7,4%, p < 0,05). The prevalence of stages 3, 4 and 5 of CKD were 11.6, 0.3 and 0.2 % respectively. eGFR was negatively correlated with age ( r = -0,54, p < 0,05). Among patients with an eGFR < 60 ml/min/1.73 m2, 96.3% had eGFR 30-59, 2.3% 15-29 and 1.4 % < of 15. Seventy nine percent were women. 75.1% were aged 65 years or more, 26.8% had a serum creatinine equal or less than 1.0 mg/dL and 40.5% had microalbuminuria. Only 1% of outpatients ascribed to Cardiovascular or Diabetes Programs had the diagnosis of CKD registered. Independent risk predictors of CKD were age > 60 years, female sex and microalbuminuria. CONCLUSIONS: This study showed a high prevalence of CKD in ambulatory patients, mainly among women and older people. The low level of diagnosis of CKD in cardiovascular and diabetes programs is of concern.
Subject(s)
Kidney Diseases/epidemiology , Urban Health Services/statistics & numerical data , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Chile/epidemiology , Chronic Disease , Creatinine/urine , Epidemiologic Methods , Female , Glomerular Filtration Rate , Humans , Male , Middle Aged , Reference Values , Sex Distribution , Young AdultABSTRACT
Introduction: Community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) are prevalent in several countries of the world. These infections seem to differ clinically from those occurring within the health care system (HCS-MRSA). Objective: To compare clinical characteristics of infections by CA-MRSA and HCA-MRSA in the same communitty. Material and Methods: Prospective, multicentric and comparative study. Children with clinically and microbiologicaly documented CA-MRSA were included. Results: Between 11/2006 and 11/2007, 840 infections caused by S. aureus were diagnosed. Of them 582 (68 percent) were community-acquired. Among these 356 (61 percent) were CA-MRSA. In this group, 75 (21 percent) were HCA-MRSA and 281 (79 percent) CA-MRSA. The median age was 36months (range: 1-201). Chronic skindisease (13) and chronic disease of CNS (9) were the underlying disease predominant. Children with CA-MRSAhad more frequency of previous antibiotic treatment (63 vs 34 percent) and previous medical consult (76 vs 52 percent), invasive procedures (31 vs 8 percent), surgery (15 vs 0,3 percent) and fever (94 vs 74 percent) (p = <05). Children with CA-MRSAhad subcutaneous abscesses (34 vs 15 percent) (p = <.05) more frequently. Bacteremia and sepsis rate was similar in both groups (21 vs 18 percent) and 17 vs 11 percent) respectively) (p = NS). Antibiotic resistance was more frequent in children with HCA-MRSA: Rifampin (7 vs 1 percent), trimethoprim-sulphametoxazole (7 vs 1 percent) and clindamycin (25 vs 9 percent) (p = <.05). Four children (5 percent) with HCA-MRSA infections died and 3 (1 percent) mCA-MRSAgroup (p = .05). Conclusión: Children with HCA-MRSA infections more frequent antibiotic resistance than CA-MRSA should be reconsider the empiric antibiotic treatment of community-acquired infections in children in our área.
Introducción: Staphylococcus aureus meticilina-resistente proveniente de la comunidad (SAMRC) es altamente prevalente en diversos países del planeta. Objetivos: Realizar un análisis clínico comparativo entre las infecciones por SAMRC en niños antes sanos (SAMR-CO) y aquellos con S. aureus MR en pacientes con patologías previas (SAMR-RH). Material y Métodos: Estudio multicéntrico, prospectivo y comparativo. Fueron incluidos los niños que tenían infección clínica y microbiológicamente documentada por SAMRC. Resultados: Entre 11/2006 y 11/2007 fueron diagnosticadas 840 infecciones porS. aureus. De ellas 582 (69 por ciento) fueron detectadas en la comunidad. Entre estas 356 (61 por ciento) fueron SAMRC. Entre estas últimas 75 (21 por ciento) fueron SAMR-RH y 281 (79 por ciento) SAMR-CO. La mediana de edad fue de 36 meses (rango: 1-201). Las enfermedades de base más frecuentes fueron: dermatopatías crónicas (13) y enfermedad crónica del SNC (9). Los niños con infección por SAMR-RH presentaron con mayor frecuencia tratamiento antimicrobiano previo (63 vs 34 por ciento), consultas médicas previas (76 vs 52 por ciento), procedimiento invasor previo (31 vs 8 por cientoo), cirugía (15 vs 0,3 por ciento) y fiebre al momento de la consulta (94 vs 74 por ciento) (p < 0,05). Los niños con infección por SAMR-CO tuvieron con mayor frecuencia abscesos subcutáneos (34 vs 15 por ciento) (p < 0,05). La tasa de bacteriemia y se sepsis fue semejante en ambos grupos (21 vs 18 por ciento y 17 vs 11 por ciento)) (p =NS). La resistencia a antimicrobianos fue mayor en niños con SAMR-RH: rifampicina (7 vs l por cientoo), cotrimoxazol (7 vs 1 por ciento) y clindamicina (25 vs 9 por ciento) (p < 0,05). Fallecieron 4 niños con SAMR-RH (5 por ciento) y 3 niños con SAMR-CO (1 por ciento) (p = 0,05). Conclusión: Los niños con SAMR-RH presentan mayor tasa de resistencia a antimicrobianos que SAMR-CO. Debe replantearse el tratamiento antimicrobiano empírico en niños con ...
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Community-Acquired Infections/microbiology , Cross Infection/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/microbiology , Anti-Bacterial Agents/therapeutic use , Argentina/epidemiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Prospective Studies , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiologyABSTRACT
BACKGROUND: Health-related quality of life (HRQOL) among patients on chronic hemodialysis (CHD), is associated with mortality, complications and compliance to treatment. AIM: To assess HRQOL in a group of patients on CHD. PATIENTS AND METHODS: A cross-sectional multicenter study was carried out, involving 224 patients from five CHD units (3 private and 2 public) in Bio Bio Region, using the Kidney Disease Quality of Life -36 items (KDQOL-36) questionnaire and Karnofsky scale. Scores range from 0 to 100, with higher values representing a better HRQOL. RESULTS: Physical and Mental scales and subscales of symptoms, effect and the burden of kidney disease subscales rendered scores below 50 (the referential value), in 80%, 61%, 8%, 43% and 80% of evaluations, respectively. The lower scores were observed in patients with diabetes, coronary artery disease, hypoalbuminemia, serum creatinine below 9.4 mg/dL, age >or=55 years and in those with a low economic and educational level (p <0.05). CONCLUSIONS: HRQOL in patients on hemodialysis had values below the referential score in subjects with diabetes and coronary artery disease, poor nutritional status and a low educational and socioeconomic level. The incorporation of support professionals, such as social workers, psychologists, dieticians, covering psychosocial factors, could improve the patients quality of life.
Subject(s)
Health Status , Kidney Failure, Chronic/therapy , Quality of Life , Renal Dialysis , Surveys and Questionnaires/standards , Adolescent , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Cross-Sectional Studies , Female , Humans , Karnofsky Performance Status , Male , Middle Aged , Renal Dialysis/adverse effects , Socioeconomic Factors , Young AdultABSTRACT
patients on chronic hemodialysis Background: Health-related quality of life (HRQOL) among patients on chronic hemodialysis (CHD), is associated with mortality, complications and compliance to treatment. Aim: To assess HRQOL in a group of patients on CHD. Patients andmethods: A cross-sectional multicenter study was carried out, involving 224 patients from five CHD units (3 private and 2 public) in Bio Bio Region, using the Kidney Disease Quality of Life 36 items (KDQOL-36) questionnaire and Karnofsky scale. Scores range from 0 to 100, with higher values representing a better HRQOL. Results: Physical and Mental scales and subscales of symptoms, effect and the burden of kidney disease subscales rendered scores below 50 (the referential value), in 80%, 61%, 8%, 43% and 80% of evaluations, respectively. The lower scores were observed in patients with diabetes, coronary artery disease, hypoalbuminemia...
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Health Status , Kidney Failure, Chronic/therapy , Quality of Life , Surveys and Questionnaires/standards , Renal Dialysis , Chi-Square Distribution , Cross-Sectional Studies , Karnofsky Performance Status , Renal Dialysis/adverse effects , Socioeconomic Factors , Young AdultSubject(s)
Humans , Acute Kidney Injury/etiology , Iatrogenic Disease , Acute Kidney Injury/mortality , Acute Kidney Injury/prevention & control , Acute Kidney Injury/therapy , Hospital Mortality , Hospitals, State/statistics & numerical data , Renal Dialysis , Risk Factors , Length of Stay/statistics & numerical dataABSTRACT
We report a 72 years old hypertensive female, treated with enalapril 10 mg/day and hydrochlorothiazide 25 mg/day during three years. She presented a depressive disorder and cytalopram was prescribed in a dose of 10 mg/day. Two weeks before admission, a serum electrolyte analysis disclosed normal results and the cytalopram dose was increased to 20 mg/day. The patient was admitted with a hyponatremic encephalopathy with a plasma sodium of 100 mEq/L and a plasma potassium of 2.0 mEq/L. cytalopram, enalapril and hydrochlorothiazide were discontinued, hypertonic NaCl and KCl were administered. The patient had a favorable evolution with a remarkable improvement of her symptoms
Subject(s)
Humans , Female , Aged , Hypokalemia/diagnosis , Hypokalemia/chemically induced , Hypokalemia/drug therapy , Hyponatremia/diagnosis , Hyponatremia/chemically induced , Hyponatremia/drug therapy , Potassium Chloride/therapeutic use , Enalapril/adverse effects , Enalapril/pharmacology , Sodium Chloride/therapeutic use , Citalopram/adverse effects , Citalopram/pharmacology , Depressive Disorder/drug therapy , Drug Interactions , Hydrochlorothiazide/adverse effects , Hydrochlorothiazide/pharmacologyABSTRACT
Sao analisados 51 casos de incontinencia urinaria de esforco, tratados pela tecnica de Burch, no periodo compreendido entre 1975 e 1979 no Departamento de Tocoginecologia do Hospital de Clinicas da Universidade Federal do Parana. A idade das pacientes variou entre 30 e 49 anos e a maioria era de multiparas. O sintoma mais constante foi a perda de urina aos esforcos, existindo tambem disuria e polaciuria. O teste de Bonney e a uretrocistografia miccional foram poucas vezes excutados (27% o primeiro e 14% o segundo). Concomitantemente, foram realizados 28 perineoplastias, 7 laqueaduras e 3 histerectomias. Por ocasiao da alta, todas as pacientes estavam assintomaticas. Durante o seguimento houve recidiva da incontinencia urinaria em 6 casos (12%) e a cura efetuou-se em 45 pacientes (88%). As complicacoes foram em numero reduzido: alem da recidiva em 6 casos, ocorreram 13 casos de infeccao urinaria e 2 casos com infeccao de sutura da pele