A multicenter prospective study of 515 febrile neutropenia episodes in Argentina during a 5-year period.

For better management of patients with febrile neutropenia, our study investigated the epidemiologic, microbiologic, and clinical characteristics of adult inpatients with febrile neutropenia and their mortality-associated factors. To this end, we carried out a prospective, observational, multicenter study in 28 Argentinian hospitals between 2007 and 2012. We included 515 episodes of febrile neutropenia from 346 patients, median age 49 years. Neutropenia followed chemotherapy in 77% of cases, half of the cases due to hematological malignancies. Most episodes were classified as high-risk according to MASCC criteria, and 53.6% of patients were already hospitalized at the onset of febrile neutropenia. Bloodstream infections were detected in 14% episodes; whereas an infectious source of fever was identified in 80% of cases. Mortality rate achieved to 14.95%. The binary regression analysis showed that persistence of fever at day 7, or neutropenia at day 14, dehydration and tachycardia at the onset of febrile neutropenia as well as prior infections were significantly associated with mortality. In addition to expanding our current knowledge on the features of adult patients with febrile neutropenia, present findings provide useful information for better management of them in Argentina, given the appropriate representativeness of centers participating in the study.

Seguimiento del paciente con enfermedad renal crónica en el primer nivel de atención de la salud / Monitoring of chronic kidney disease patients in primary health care

La enfermedad renal crónica (ERC) se caracteriza por disminución progresiva de la tasa de filtrado glomerular (TFG) y/o albuminuria persistente. En concordancia a lo registrado en otros países latinoamericanos, en Argentina este padecimiento gana protagonismo y frecuencia como problema de salud pública. Desde el año 1995 existe una ley nacional que obliga a informar al Instituto Central Único Coordinador de Ablación en Implante (INCUCAI) los pacientes que ingresan o egresan de diálisis crónica. Ese organismo se ha constituído en la principal fuente de información sobre epidemiología local de la ERC. En aquellos en riesgo de padecer ERC (mayores de 60 años, hipertensos, diabéticos, pacientes con enfermedad cardiovascular, entre otros), se recomienda llevar a cabo un cribado que consiste en evaluar la TFG y la albuminuria al menos una vez al año. Los pacientes con ERC, de forma similar a quienes padecen otras enfermedades crónicas, necesitan cuidados contínuos, priorizando la prevención secundaria en pos de enlentecer la progresión o minimizar la aparición de complicaciones y/o comorbilidades asociadas. Para ello, los servicios de salud deben organizarse pensando en ofrecer condiciones de accesibilidad sostenida contemplando las realidades particulares de los diferentes colectivos poblacionales que contienen a los pacientes con enfermedades crónicas.

Chronic kidney disease (CKD) is characterized by a progressive decrease of the glomerular filtration rate (GFR) and/or persisten albuminuria. In concordance with what's been registered in other Latin American countries, in Argentina this ailment is gaining prominence and frecuency as public helath problem. Since 1995, there is a law in Argentina wich makes it mandatory for doctors to inform the National Central Coordinating Institute of Ablation and Implants (INCUCAI is its acronym in Spanish) about patients entering or leaving chronic dialysis programs. INCUCAI has become the main source of information about the local epidemiology of CKD. For those at risk of suffering CKD (people older than 60 years, hypertensive or diabetic patients, among others), screening is recommended , wich consists of estimating GFR and albuminuria at least once year. Patients with CKD, like those who suffer from other chronic diseases, need constant care, prioritizing secondary prevention in the pursuit of slowing down disease progression or minimizing the appearance of complications and/or associated comorbidities. For this purpose , health services should offer sustained accesibility conditions, considering the singularities of the different population groups.

Seguimiento del paciente con enfermedad renal crónica en el primer nivel de atención de la salud / Monitoring of chronic kidney disease patients in primary health care

La enfermedad renal crónica (ERC) se caracteriza por disminución progresiva de la tasa de filtrado glomerular (TFG) y/o albuminuria persistente. En concordancia a lo registrado en otros países latinoamericanos, en Argentina este padecimiento gana protagonismo y frecuencia como problema de salud pública. Desde el año 1995 existe una ley nacional que obliga a informar al Instituto Central Unico Coordinador de Ablación en Implante (INCUCAI) los pacientes que ingresan o egresan de diálisis crónica. Ese organismo se ha constituído en la principal fuente de información sobre epidemiología local de la ERC. En aquellos en riesgo de padecer ERC (mayores de 60 años, hipertensos, diabéticos, pacientes con enfermedad cardiovascular, entre otros), se recomienda llevar a cabo un cribado que consiste en evaluar la TFG y la albuminuria al menos una vez al año. Los pacientes con ERC, de forma similar a quienes padecen otras enfermedades crónicas, necesitan cuidados contínuos, priorizando la prevención secundaria en pos de enlentecer la progresión o minimizar la aparición de complicaciones y/o comorbilidades asociadas. Para ello, los servicios de salud deben organizarse pensando en ofrecer condiciones de accesibilidad sostenida contemplando las realidades particulares de los diferentes colectivos poblacionales que contienen a los pacientes con enfermedades crónicas.(AU)

Chronic kidney disease (CKD) is characterized by a progressive decrease of the glomerular filtration rate (GFR) and/or persisten albuminuria. In concordance with whats been registered in other Latin American countries, in Argentina this ailment is gaining prominence and frecuency as public helath problem. Since 1995, there is a law in Argentina wich makes it mandatory for doctors to inform the National Central Coordinating Institute of Ablation and Implants (INCUCAI is its acronym in Spanish) about patients entering or leaving chronic dialysis programs. INCUCAI has become the main source of information about the local epidemiology of CKD. For those at risk of suffering CKD (people older than 60 years, hypertensive or diabetic patients, among others), screening is recommended , wich consists of estimating GFR and albuminuria at least once year. Patients with CKD, like those who suffer from other chronic diseases, need constant care, prioritizing secondary prevention in the pursuit of slowing down disease progression or minimizing the appearance of complications and/or associated comorbidities. For this purpose , health services should offer sustained accesibility conditions, considering the singularities of the different population groups.(AU)