Retracted: Risks of avian influenza (H5) in duck farms in the Ayeyarwaddy Delta region, Myanmar.

The Ayeyarwaddy delta region in the south-west of Myanmar is the main agricultural and rice-growing area. The region has a high density of duck and backyard chicken populations with low biosecurity. The objective of this study was to analyse risk factors for avian influenza (H5) in the Ayeyarwaddy delta region, Myanmar. A case­control risk factor study was conducted from April to June 2010 by individual interviews including risk factor questionnaires given to duck farmers (n = 50) in five townships in the Ayeyarwaddy delta region, Myanmar. Risk factor analyses were conducted using univariate analysis and multivariate logistic regression model with backward stepwise (wald) method. The results showed significant risk factors for AI (H5) sero-positivity in ducks were wooden egg box containers (OR = 52.7, 95% CI = 2.34-1188, P = 0.013) and water sourced from wetlands (OR = 30.7, 95% CI = 1.96-481.6, P = 0.015). Conversely, the cleaning of reusable egg containers was determined as a protective factor (OR = 0.03, 95% CI = 0.00-0.42, P = 0.01). In conclusion, this study identified risk factors for AI (H5) in duck farms and the importance of avian influenza prevention and control.

[Clinical and biochemical characteristics of predialysis patients in terms of 25 hydroxy vitamin D levels]. / Características clínicas y bioquímicas de pacientes en prediálisis con respecto a los niveles de 25 hidroxivitamina D.

INTRODUCTION: Decreased levels of 25 hydroxyvitamin D (25[OH]D) have been reported in patients with chronic kidney disease (CKD). The pleiotropic effects of vitamin D are known to go beyond mineral metabolism. OBJECTIVES: The aims of this study were to: 1) Determine the 25(OH)D levels in predialysis outpatients. 2) Find out the clinical and biochemical characteristics of patients with 25(OH)D deficiency, and predictive factors for the deficiency. PATIENTS AND METHODS: An observational study in 79 predialysis outpatients was performed. Clinical and biochemical parameters were analysed in terms of nutrition, inflammation and mineral metabolism in relation to serum levels of 25(OH)D. Levels of 25(OH)D lower than 15ng/ml were considered to be deficient. RESULTS: Serum levels of 25(OH)D were deficient in 41 patients (52%). The comparative study regarding levels of vitamin 25(OH)D showed the group of patients with a deficiency, i.e. those with less than 15ng/ml, were older (70 ± 11.97 vs. 61 ± 14.5; p = 0.005), had a greater body mass index, BMI, (30±4.06 vs. 27.1 ± 5.08; p = 0.003) and increased proteinuria (1.42g/24h (0.53-2.96) vs. 0.51 (0.20-1.48), p = 0.009). This group included a greater number of diabetic patients: 20 (76.9%) vs. 6 (23%), p = 0.002. They had a higher level of parathyroid hormone (PTH): 359 (239-658) vs. 233 (129-323), p = 0.000; and more patients were under treatment with Calcitriol: 28 (62.2%) vs. 17 (37.8%), p = 0.024. In the multivariate analysis, high levels of PTH (OR 13.38; CI 95% [2.94-60.89]; p=0.001), increased proteinuria (OR 4.41; CI 95% [1.12-17.25]; p = 0.033); and being diabetic (OR 5.713; CI 95% [1.43-22.77]; p = 0.014) were independent predictor factors for patients with 25(OH)D deficiency. CONCLUSIONS: In our study, we observed a high prevalence of 25(OH)D deficiency among patients with CKD. The increased levels of PTH, the increase of proteinuria and the presence of diabetes were independent predictors for 25(OH)D deficiency.

Características clínicas y bioquímicas de pacientes en prediálisis con respecto a los niveles de 25 hidroxivitamina D / Clinical and biochemical characteristics of predialysis patients in terms of 25 hydroxy vitamin D levels

Introducción: Se ha descrito una disminución de los niveles de 25 hidroxivitamina D (25[OH]D) en los pacientes con enfermedad renal crónica (ERC). Conocemos que el efecto pleiotrópico de la vitamina D va más allá del metabolismo mineral. Objetivos: Los objetivos del estudio fueron: 1) determinar los niveles de 25(OH) D en pacientes con ERC seguidos en consulta de prediálisis, y 2) analizar características clínicas y bioquímicas de los pacientes con respecto a los niveles de 25(OH)D y los posibles factores predictivos de la deficiencia en 25(OH)D. Pacientes y métodos: Realizamos un estudio observacional en 79 pacientes con ERC. Analizamos datos clínicos y parámetros bioquímicos en cuanto a nutrición, inflamación y metabolismo mineral en relación con los niveles de 25(..) (AU)

Introduction: Decreased levels of 25 hydroxyvitamin D (25[OH]D) have been reported in patients with chronic kidney disease (CKD). The pleiotropic effects of vitamin D are known to go beyond mineral metabolism. Objetives: The aims of this study were to: 1) Determine the 25(OH)D levels in predialysis outpatients. 2) Find out the clinical and biochemical characteristics of patients with 25(OH)D deficiency, and predictive factors for the deficiency. Patients and methods: An observational study in 79 predialysis outpatients was performed. Clinical and biochemical parameters were analysed in terms of nutrition, inflammation and mineral metabolism in relation to serum levels of 25(OH)D. Levels of 25(OH)D lower than 15ng/ml were considered to be deficient. Results: Serum levels of 25(OH)D were deficient in 41 patients (52%). The comparative study regarding levels of vitamin 25(OH)D showed the group of patients with a deficiency, i.e. those with less than 15ng/ml, were older (70 ± 11.97 vs. 61 ± 14.5; p = 0.005), had a greater body mass index, BMI, (30±4.06 vs. 27.1 ± 5.08; p = 0.003) and increased proteinuria (1.42g/24h (..) (AU)

[The importance of comorbidity in nephrologists' assessment of acute renal failure]. / La importancia de la comorbilidad en el fracaso renal agudo valorado por los nefrólogos.

AIMS: To study the features of acute renal failure (ARF) in our hospital and to determine prognosis and mortality associated factors. METHODS: Retrospective study of ARF episodes during a two years period (2005-2007). ARF was considered when a sudden rise in serum creatinine concentration was more than 0,5 mg/dl in patients with normal renal function and more than 1 mg/dl in patients with previous mild to moderate chronic renal failure. We analyzed epidemiologic, clinical, laboratories results, therapeutics and prognosis factors. RESULTS: Two hundred and one patients were evaluated (62,7% males; Age= 67,35 16,38 years (63,68%>65 years); Comorbility Index of Charlson 3,49 2,43). 115 episodes presented in patients with previous renal failure. ARF was pre-renal in 52,7%, renal in 34,8% and post-renal in 8,5%. 35,8% of ARF patients had oliguria or anuria. The mean duration of ARF/hospitalization was 22,47 days (22,47 21,83). The percentage of resolved ARF was 70,1%. Mortality was 30,8%. The univariated analysis showed comorbility Index of Charlson, oliguria, low serum albumin and cholesterol, and anemia were significantly associated with mortality (p<0,05). The lineal regression analysis found three factors associated to the mortality rate: Comorbility Index of Charlson, oliguria and low serum cholesterol. Mortality predictive model was carried out. CONCLUSION: Highest basal comorbility of patients, oliguria and malnutrition-inflammation dates are princess prognosis and mortality factors in ARF today A new approach is needed in ARF because this new type/class of population.

La importancia de la comorbilidad en el fracaso renal agudo valorado por los nefrólogos / No disponible

Objetivo: analizar las características del fracaso renal agudo(FRA) en nuestro centro y determinar su influencia en el pronóstico del mismo y en la mortalidad. Material y métodos: estudio retrospectivo de los episodios de FRA valorados por nuestro Servicio durante un período de dos años (2005-2007). Los criterios de inclusión fueron: elevación de la creatinina sérica0,5 mg/dl en pacientes con función renal previa normal y de 1 mg/dl en aquéllos con insuficiencia renal crónica previa. Se registraron factores epidemiológicos, clínicos, analíticos, terapéuticos y pronósticos. Resultados: valoramos 201 episodios de FRA. El 62,7% 16,38 (63,68% ±) eran varones. La edad media fue de 67,35 >65 años). El índice de comorbilidad de Charlson (ICCH) mostraba unos valores de 3,49 ± 2,43. Ciento quince pacientes tenían IRC previa al ingreso. El 52,7% fueron prerrenales, el 34,8% parenquimatosos y el 8,5% obstructivos. El 35,8%cursaron con oligoanuria. El tiempo medio de ingreso fue de22,47 ± 21,3 días. El 70,1% de los pacientes recuperaron función renal al alta. La mortalidad fue del 30,8%. En el estudio univariante se asociaron significativamente con la mortalidad(p <0,05): ICCH, oliguria, hipoalbuminemia, niveles bajos de colesterol y anemia. En el análisis de regresión lineal múltiple, los factores que mejor la explicaban fueron: ICCH, oliguria y niveles bajos de colesterol. Realizamos un modelo predictivo de mortalidad con estos factores. Conclusión: la mayor complejidad clínica basal de los pacientes, el desarrollo de oliguria y la presencia de datos de malnutrición-inflamación aparecen como los principales factores pronósticos y de mortalidad en el FRA que valoramos los nefrólogos en el momento actual (AU)

Aims: To study the features of acute renal failure (ARF) in our hospital and to determine prognosis and mortality associated factors. Methods: This is a retrospective study analyzing the ARF episodes observed in our center during a two years period (2005-2007). ARF was considered when a sudden rise in serum creatinine concentration was more than0, 5 mg/dl in patients with normal renal function and more than 1 mg/dl in patients with previous mild to moderate chronic renal failure. We analyzed epidemiologic, clinical, laboratories results, therapeutics and prognosis factors. Results: Two hundred and one patients were evaluated (62,7% males; Age= 67,35 ± 16,38 years (63,68% >65 años); Comorbility Index of Charlson was 3,49 ± 2,43). 115 ARF episodes occurred in patients with previous renal failure. ARF was pre-renal in 52, 7%, renal in 34,8% and post-renal in8,5%. 35,8% of ARF patients had oliguria or anuria. The mean duration of ARF/hospitalization was 22,47 days (22,47± 21,83). The percentage of resolved ARF was 70, 1%.Mortality was 30, 8%. The univariate analysis showed that comorbility Index of Charlson, oliguria, low serum albumin, low cholesterol and anemia were significantly associated with mortality (p <0,05). However, only Charlson Index,oliguria and low serum cholesterol were independent predictors of mortality in multivariate analysis. Mortality predictive model was carried out. Conclusion: Highest basal comorbility of patients, oliguria and malnutrition inflamation dates are independent predictors of mortality in patients with acute renal failure (AU)

Continuing day treatment programs promote recovery in schizophrenia: a case-based study.

Continuing day treatment programs focus on community stabilization through comprehensive individualized rehabilitation. They promote recovery through a variety of practical clinical therapeutic interventions. This empirically based report describes a continuing day treatment program's rehabilitation of four clients with schizophrenia, chronic type in a western New York mental health clinic who were in each of the specialty services: a two-phase program, a program for seniors, and a program for co-occurring substance dependence. Some particularly difficult psychiatric symptoms of schizophrenia were successfully treated in this continuing day treatment program. Each of these clients showed improvements in their symptoms and overall community adjustment that may well have been unobtainable with less intensive outpatient treatment.

Peritonitis esclerosante: una amenaza latente. Cambio de actitud en el tratamiento quirúrgico / Sclerosing encapsulating peritonitis: A latent threat. Changes of attitude in surgery treatment

La Peritonitis Esclerosante (PE) es una entidad grave que puede aparecer en pacientes en Diálisis Peritoneal (DP) con una morbi-mortalidad elevada. Describimos nuestra experiencia con pacientes diagnosticados de PE, sus características y evolución clínica. De 190 pacientes en DP durante un periodo de 17 años, hubo ocho casos de PE. Edad media 45 ± 14 años (rango 29-64), cuatro eran varones. Tiempo en DP 72 ± 29 meses.Todos presentaron episodios de peritonitis previa (media 3 ± 1 episodios). Se observó un cambio en las características de transporte peritoneal (D/P Cr 4);media de 0,6 ± 0,1 al año de DP, frente a 0,82 ± 0,08 al final de DP (p < 0,001). Incremento en el uso debolsas hipertónicas: 53% ± 28 al inicio frente 91% ± 27 al final (p < 0,009). Cinco pacientes (62,5%) recibieron un injerto renal previo: uno con pérdida de función precoz por trombosis y dos por rechazo agudo. Seis pacientes (75%) tuvieron cirugía abdominal previa, en todos fue extraperitoneal. El diagnóstico de PE fue clínico en todos los casos, con datos radiológicos sugestivos y confirmación laparoscópica e histológica (fibrosis y calcificación peritoneal) en cuatro casos. Seis pacientes fueron intervenidos: tres de forma urgente (éxitus en todos) y tres de forma programada (uno falleció). En seis pacientes se realizó tratamiento médico (tamoxifeno y/o esteroides), asociado connutrición parenteral en dos y nutrición enteral en uno. Cuatro de esos seis pacientes necesitaron además tratamiento quirúrgico. Causas de éxitus: tres por sepsis, uno por peritonitis post-perforación intestinal y uno por malnutrición severa. Media de supervivenciade los tres pacientes que viven es de 38 ± 17 meses, dos de ellos habían sido intervenidos y el tercero era una trasplantada que se optó por tratamiento conservador.Conclusión: La PE es una entidad severa con mortalidad elevada. Aunque nuestra escasa experiencia no permite recomendar una pauta terapéutica concreta, nuestra impresión es que la cirugía precoz cuando existe obstrucción (PE encapsulante) seguida detratamiento esteroideo puede mejorar el pronóstico

Sclerosing Encapsulating Peritonitis (SEP) is a rare but serious complication of continuous ambulatory peritoneal dialysis (CAPD) with a high morbi-mortality. We describe our experience with patients was diagnostic of SEP, their characteristics in CAPD and their clinic evolution after diagnosis. 190 CAPD patients were follow-upduring 17 years. Eight patients (4,2%) developed SEP. Average age 45 ± 14 years (range 29-64 years), four was male. Time in CAPD was 72 ± 29 months (range 24-120 months). All patients have peritonitis previously (mean 3 ± 1). We observe a change in peritoneum characteristics (D/P Cr 4), with an average of 0.6 ± 0.1 at one year of CAPD, versus 0.82 ± 0.08 at the end of CAPD, with statistic significance (p < 0.001). There are increases in use of hypertonic bags: 53% ± 28 at beginning versus 91% ± 27 at end, with statistic significance (p < 0.009). All patients show tendencyto hyperphosphoremia (mean 6.7 ± 0.7 mg/dl), with product calcium-phosphorus 68.4 ± 8.3. Five patients (62.5%) have a previous renal transplant, one lost due toearly graft thrombosis and two lost due to acute rejection. Six patients (75%) have a previous abdominal surgery, although was extra peritoneal in all cases. The diagnosis of SEP was clinic suspicion in all cases, suggestive radiological data (intestinal handlegroup) and laparoscopy showing SEP (cocoon) with histological confirmation (fibrosis and peritoneal calcification) in four cases. The treatment was medical in six cases associated with surgery in four of them. The medical treatment was tamoxifen and/or corticosteroids, associated with total parenteral nutrition in two patients and enteral nutrition in one. Surgery in six patients: three as urgent surgery (all died) and three as programme surgery (two live still). Etiology of died was: three for sepsis, one for peritonitis after bowel perforation, one for severe problems of nutrition. The average survival of three patients alive was 38 ± 17 months, two of them had programme surgery, and one with functioning transplant we opt for conservative treatment. The actuarial survival at 24 months was 51%. Conclusion: The SEP is a serious entity with high mortality. Although our short experience doesn’t can indicate a concrete treatment, our personal impression is that early surgery associated with corticosteroidstreatment may improve the prognostic

[Sclerosing encapsulating peritonitis: a latent threat. Changes of posture in surgery treatment]. / Peritonitis esclerosante: una amenaza latente. Cambio de actitud en el tratamiento quirúrgico.

UNLABELLED: Sclerosing Encapsulating Peritonitis (SEP) is a rare but serious complication of continuous ambulatory peritoneal dialysis (CAPD) with a high morbi-mortality. We describe our experience with patients was diagnostic of SEP, their characteristics in CAPD and their clinic evolution after diagnosis. 190 CAPD patients were follow-up during 17 years. Eight patients (4.2%) developed SEP. Average age 45+/-14 years (range 29-64 years), four was male. Time in CAPD was 72+/-29 months (range 24-120 months). All patients have peritonitis previously (mean 3+/-1). We observe a change in peritoneum characteristics (D/P Cr 4), with an average of 0.6+/-0.1 at one year of CAPD, versus 0.82+/-0.08 at the end of CAPD, with statistic significance (p<0.001). There are increases in use of hypertonic bags: 53%+/-28 at beginning versus 91%+/-27 at end, with statistic significance (p<0.009). All patients show tendency to hyperphosphoremia (mean 6.7+/-0.7 mg/dl), with product calcium-phosphorus 68.4+/-8.3. Five patients (62.5%) have a previous renal transplant, one lost due to early graft thrombosis and two lost due to acute rejection. Six patients (75%) have a previous abdominal surgery, although was extra peritoneal in all cases. The diagnosis of SEP was clinic suspicion in all cases, suggestive radiological data (intestinal handle group) and laparoscopy showing SEP (cocoon) with histological confirmation (fibrosis and peritoneal calcification) in four cases. The treatment was medical in six cases associated with surgery in four of them. The medical treatment was tamoxifen and/or corticosteroids, associated with total parenteral nutrition in two patients and enteral nutrition in one. Surgery in six patients: three as urgent surgery (all died) and three as programme surgery (two live still). Etiology of died was: three for sepsis, one for peritonitis after bowel perforation, one for severe problems of nutrition. The average survival of three patients alive was 38+/-17 months, two of them had programme surgery, and one with functioning transplant we opt for conservative treatment. The actuarial survival at 24 months was 51%. CONCLUSION: The SEP is a serious entity with high mortality. Although our short experience doesn't can indicate a concrete treatment, our personal impression is that early surgery associated with corticosteroids treatment may improve the prognostic.

Treatment of hirudin overdosage in a dialysis patient with heparin-induced thrombocytopenia with mixed hemodialysis and hemofiltration treatment.

We report a patient who developed type II heparin-induced thrombocytopenia (HIT) and accidentally received a recombinant hirudin (r-hirudin) overdosage. Treatment with hemodialysis (HD) using high-flux polysulfone dialyzer and hemofiltration was performed. Length of treatment was adjusted, monitoring activated partial thromboplastin time (aPTT) to 1.5-2.5 times the mean of the normal range. She developed deep venous thrombosis and occlusion of vascular access. Only after cessation of heparin lock catheter, platelet count began to increase. After one year of treatment with acenocoumarol and additional low-dose r-hirudin, neither bleeding nor thrombotic episodes have been reported.

[Telemedicine and follow up of peritoneal dialysis patients]. / Utilidad de la telemedicina en el seguimiento de los pacientes en diálisis peritoneal.

UNLABELLED: Mean-term experience in the use of Telemedicine in Peritoneal Dialisis (PD) patients is limited as well as its cost-benefit. The main objective of this work is to evaluate Telemedicine utility in mean-long term control of stable PD patients, analyzing if the televisit (TV) could substitute 50% of the programed inhospital consults (HC) the time spent in both visit modalities, the quality of patient-personel contact as well as how image and sound have been perceived. Visit resolution was analyzed taking into account the need of HC after a TV; We also have studied if it would be possible to retrain patients in the dialisis technique with telemedicine, and we have checked the patient perceived quality and calculate the real and social costs. METHODS: during 18 months, the system has been implanted to 19 patients with 7 +/- 4 follow up (range 3-17). A Falcon videoconference kit at patient's place was used, connected to the home television set. In the hospital there was a computer with a videoconference card, webcam and software meeting point which permits the control of patient's camera from the hospital. Both are connected by a 3RDSI line system. A monthly programmed HC or TV has been made. If more controls had been required, they have been made by TV Time spent was recorded on each TV and patients and staff questionary were inquired. RESULTS: (a) PATIENTS: mean age 44 +/- 8 years, 13 (68%) male. 12 (63%) had elemental educational level and 7 (37%) mean-superior. 17 (89%) were actively working. The PD technique was: CAPD 6 (32%) and APD13 (68%). (b) Televisits: 103 TV have been made. 22 +/- 9 minutes were spent on each TV less than in the HC, 33 +/- 8 minutes (p < 0.01). There were technical problems related with lines in 21 TV, but only in 4 the connection was not possible. 92 TV (89%) were made on time, 99 (96%) had a good image quality and 96 (93%) had a correct sound. 100% of patients perceived TV as close to HC. In 90 TV (87%) medical treatment was modified. Only in 4 cases (3.9%) patients needed an hospital visit. According to patient's valuation, TV replaced correctly to HC in 97 instances (94%) and in 97 (97%) in staff opinion. In all cases (100%) catheter exit site could be evaluated as well as edema presence. Retraining was possible in all cases. There was a save in nurse's time and patient's time and also, a save in physical hospital space. Initial investment apart, the daily cost increment was scarce (1.5 Euro) taking into account that there is a save in time for patients and personnel, save in physical space in hospital and in sanitary transport. CONCLUSION: Telemedicine is useful from the clinical point of view in the mean-term for stable patients in PD. Daily cost increment is scarce and there is a save in time for patients and personnel, save in physical space in hospital and in sanitary transport.

Variabilidad clínica del síndrome de Gitelman / Clinical variability of Gitelman´s syndrome

No disponible

Utilidad de la telemedicina en el seguimiento de los pacientes en diálisis peritoneal / Telemedicine and follow up of peritoneal dialysis patients

La experiencia a medio plazo del uso de la Telemedicina en pacientes en DiálisisPeritoneal (DP) es escasa y está poco clara la relación coste-beneficio.El Objetivo del presente trabajo es analizar si la Televisita (TV) puede sustituiral 50% de las Consultas hospitalarias (CH) de los pacientes estables en DP amedio plazo, si es posible el re-entrenamiento de los pacientes en la técnica contelemedicina, la calidad percibida por los pacientes y los costes reales y sociales.Métodos: a lo largo de 18 meses, el sistema se ha implantado a 19 pacientescon un seguimiento de 7 ± 4 meses (Rango 3-17 meses). Se ha utilizado en eldomicilio del paciente un equipo de videoconferencia Falcon (Vcon), conectadoa la televisión del paciente y en el hospital, un ordenador con tarjeta de videoconferencia,webcam y software meeting point, que permite el control desde elhospital de la cámara del paciente. Ambos se conectan mediante 3 líneas de RDSI.Se ha realizado de forma programada cada mes una CH o una TV. Si ha sido necesariomayor control, este se ha realizado por TV. En cada TV se contabiliza eltiempo empleado y se encuesta al paciente y al personal.Resultados: a) Pacientes: Edad media: 44 ± 8 años, 13 (68%) varones. Nivel deestudios: 12 primarios (63%) y 7 de grado medio-superior (37%). Están laboralmenteactivos 17 (89%). Se dializan con DPCA 6 (32%) y con DPA 13 (68%).b) Televisitas: Se han realizado un total de 103 TV. El tiempo medio de la TVes 22 ± 9 minutos, inferior al de la CH: 33 ± 8 minutos (p < 001). En 21 (20%)hubo problemas técnicos relacionados con las líneas, pero sólo en 4 ocasionesfue imposible la conexión. En 92 (89%) la conexión fue puntual, en 99 (96%) lacalidad de la imagen fue buena y en 96 (93%) lo fue la calidad del sonido. El100% percibió la TV como muy cercana al hospital. En 90 TV (87%) se modificóa distancia el tratamiento médico y sólo en 4 de ellas (3,9%) fue necesarioque el paciente acudiera para ello al hospital. A juicio del paciente, la TV ha sustituidocorrectamente a la CH en 97 oasiones (94%) y en 97 (97%) a juicio delpersonal. En el 100% se pudo evaluar a distancia el orificio de salida del catétery la existencia de edemas. El re-entrenamiento en la técnica fue posible en el100%. Independientemente de la inversión inicial, el gasto diario sobre el costede la diálisis peritoneal se incrementó en 1,5 €, ahorrándose tiempo al personalsanitario y al paciente, espacio físico en el hospital y transporte sanitario.Conclusión: La Telemedicina es útil desde el punto de vista clínico en el seguimientoa medio plazo del paciente estable en Diálisis Peritoneal, requiriendo un incrementodiscreto en el coste de la técnica con un ahorro significativo de tiempo depersonal y del paciente, de espacio físico en el hospital y de transporte sanitario

Mean-term experience in the use of Telemedicine in Peritoneal Dialisis (PD) patientsis limited as well as its cost-benefit.The main objective of this work is to evaluate Telemedicine utility in mean-longterm control of stable PD patients, analyzing if the televisit (TV) could substitute50% of the programed inhospital consults (HC) the time spent in both visit modalities,the quality of patient-personel contact as well as how image and soundhave been perceived. Visit resolution was alalyzed taking into account the needof HC after a TV; We also have studied if it would be possible to retrain patientsin the dialisis technique with telemedicine, and we have checked the patient perceivedquality and calculate the real and social costs.Methods: during 18 months, the system has been implanted to 19 patients with7 ± 4 follow up (range 3-17). A Falcon videoconference kit at patient’s place wasused, connected to the home television set. In the hospital there was a computerwith a videoconference card, webcam and software meeting point which permitsthe control of patient’s camera from the hospital. Both are connected by a 3RDSIline system. A monthly programmed HC or TV has been made. If more controlshad been required, they have been made by TV. Time spent was recorded on eachTV and patients and staff questionary were inquired.Results: a) Patients: mean age 44 ± 8 years, 13 (68%) male. 12 (63%) hadelemental educational level and 7 (37%) mean-superior. 17 (89%) were activelyworking. The PD technique was: CAPD 6 (32%) and APD13 (68%).b) Televisits: 103 TV have been made. 22 ± 9 minutes were spent on each TV,less than in the HC, 33 ± 8 minutes (p < 0.01). There were technical problemsrelated with lines in 21 TV, but only in 4 the connection was not possible. 92 TV(89%) were made on time, 99 (96%) had a good image quality and 96 (93%)had a correct sound. 100% of patients perceived TV as close to HC. In 90 TV(87%) medical treatment was modified. Only in 4 cases (3,9%) patients neededan hospital visit. According to patient’s valuation, TV replaced correctly to HC in97 instances (94%) and in 97 (97%) in staff opinion. In all cases (100%) catheterexit site could be evaluated as well as edema presence. Retraining was possiblein all cases. There was a save in nurse’stime and patient’time and also, asave in physical hospital space. Initial investment apart, the daily cost incrementwas scarce (1.5 €) taking into account that there is a save in time for patientsand personnel, save in physical space in hospital and in sanitary transport.Conclusion: Telemedicine is useful from the clinical point of view in the meantermfor stable patients in PD. Daily cost increment is scarce and there is a savein time for patients and personnel, save in physical space in hospital and in sanitarytransport

Valor de la troponina T en pacientes con insuficiencia renal crónica avanzada. Evolución tras el inicio de hemodiálisis / No disponible

No disponible

Ambulatory blood pressure monitoring in patients with hyperthyroidism before and after control of thyroid function.

BACKGROUND AND OBJECTIVE: Thyroid hormones have pronounced effects on the cardiovascular system. Thyrotoxicosis affects blood pressure (BP), modifying both diastolic (DBP) and systolic (SBP) pressures. There are no studies examining BP with ambulatory blood pressure monitoring (ABPM) in hyperthyroidism before and after control of thyroid function. Our aims were (1) to analyse ABPM in a group of normotensive hyperthyroid patients before and after normalizing circulating thyroid hormones and (2) to compare these results with those obtained in a group of euthyroid subjects. PATIENTS AND MEASUREMENTS: We studied 20 normotensive hyperthyroid subjects [18 women; age (mean +/- SEM) 49.0 +/- 3.0 years] and 15 healthy subjects. Patients were evaluated by ABPM over 24 h, at diagnosis and after therapy (n = 18). RESULTS: The average 24-h, daytime and night-time SBP was significantly greater in hyperthyroid patients than in controls with no significant differences in DBP. Circadian BP rhythm, estimated by the difference between mean values of SBP, DBP and mean BP during daytime and night-time, was unchanged. The average 24-h and daytime SBP significantly decreased after normalizing thyroid function in the 18 hyperthyroid evaluated patients. Daytime SBP and DBP were higher than night-time values both before and after control of thyroid function. However, no differences in circadian BP rhythm were observed. CONCLUSIONS: Normotensive hyperthyroid patients exhibit higher ambulatory SBP throughout 24 h than normotensive euthyroid subjects. Control of hyperthyroidism decreases ambulatory SBP values. Mean nocturnal fall in BP is comparable in normotensive hyperthyroid patients and control subjects.

[Tubulointerstitial nephritis associated with treatment with selective Cox-2 inhibitors, celecoxib and rofecoxib]. / Nefritis tubulointersticial asociada al tratamiento con inhibidores de la Cox-2, celecoxib y rofecoxib.

The nephrotoxic effect of nonselective nonsteroidal anti-inflamatory drugs (NSAIDS) has been widely described. The main benefit of the Cox-2 inhibitors in relation to the NSAIDS is the production of a very similar analgesic effect, but with fewer gastrointestinal side effects. However, their effects on renal function are little known as yet and their long-term safety is still pending definition. The use of selective Cox-2 inhibitors as anti-inflamatory analgesic is becoming more and more common in our environment. We report two cases of tubulointersticial nephritis confirmed by renal biopsy, associated with administration of the two Cox-2 inhibitors currently available on the market, celecoxib and rofecoxib. In both cases, we were talking about elderly women, with deterioration of the general condition and acute renal failure. In the former case, renal biopsy showed an acute tubulo-intersticial nephritis (TIN) so highly "variegated" in its histologic expression. In the second case, was associated with strong indications of chronicity. Treatment with steroid was initiated in both patients and improvement of renal function was observed.

Biometría placentaria en la predicción de complicaciones de la gestación / The usefulness of placental biometry in predicting complications during pregnancy

Se ha establecido la relación entre biometría placentaria y diferentes complicaciones de la gestación; sin embargo, estas medidas son complejas, consumen tiempo y no forman parte del estudio ecográfico rutinario. Con el objeto de evaluar la utilidad de la biometría placentaria para la identificación precoz de las gestaciones que van a desarrollar preeclampsia o crecimiento intrauterino retardado, se realiza un estudio prospectivo en 319 gestantes no seleccionadas a la semana 20, midiendo el espesor, el diámetro y el área de una sección de corte placentaria. Asimismo, y dada la escasez de referencias bibliográficas, se aportan nuestros normogramas biométricos placentarios para esta edad gestacional. Aunque hubo tendencia a encontrar placentas más pequeñas en estas complicaciones (menor diámetro y menor área de sección), las diferencias no tienen la suficiente significación, y ésta sólo se alcanzó para menores áreas en el grupo de crecimiento intrauterino retardado (p = 0,001; IC del 95%, 1,049-3,213). En los casos que asociaron preeclampsia grave y crecimiento retardado por debajo del percentil 5, las placentas a la semana 20 tendían a ser más gruesas, con menor diámetro y menor área de sección, pero el escaso número de casos (4) no nos permite sacar conclusiones. El estudio Doppler de arterias uterinas es un mejor predictor. No puede incorporarse a la práctica diaria la obtención de una biometría placentaria detallada, aunque algunos autores proponen la medición sistemática del espesor placentario, pues una placenta gruesa se relaciona con mayor morbimortalidad perinatal (AU)

The relationship between placental biometry and different complications of pregnancy has been established. However, these measures are complex, time consuming, and they are not a part of U/S examination routine. The objective was to assess the value of placental biometry in the early identification of those pregnancies that will develop pre-eclampsia or fetal growth retardation. A prospective study of an unselected population of 319 in the 20th gestational week was made, measuring the thickness, diameter and area of a placental section. As bibliographical references are scarce, our placental biometric charts are provided. Although there was a tendency to find smaller placentas with these complications (a smaller diameter and section area), the differences were not significant, and the difference was only significant in the in the lowest area in the fetal growth retardation group (p = 0.001; 95% CI, 1.049-3.213). In those cases associated to serious pre-eclampsia and fetal growth retardation under the 5th percentile, the placenta tends to be thicker at 20 weeks, with a lower diameter and section area. However, we could not make any conclusions as the number of cases was too low (4). Uterine artery Doppler is a better predictor. Detailed placentary biometry cannot be incorporated into daily practice, however the measurement of placental thickness has been proposed by some authors as routine, because a large placenta is related to greater perinatal morbidity and mortality (AU)

Nefritis tubulointersticial asociada al tratamiento con inhibidores de la Cox-2, celecoxib y rofecoxib / Tubulointerstitial nephritis associated with treatment with selective cox-2 inhibitors, celecoxib and rofecoxib

El efecto nefrotóxico de los inhibidores selectivos de la Cox-2 es poco conocido. Elprincipal beneficio de los inhibidores de la Cox-2 con respecto a los AINES clásicos esla producción de un efecto analgésico muy similar, pero con menos efectos secundariosa nivel gastrointestinal. Sin embargo, sus efectos sobre la función renal son pococonocidos todavía y su seguridad a largo plazo está todavía por definir. El uso de inhibidoresselectivos de la Cox-2 como analgésicos y antiinflamatorios es cada vez másfrecuente en nuestro medio. Nosotros referimos dos casos de nefritis tubulointersticialconfirmadas por biopsia renal, asociadas a la toma de los dos inhibidores de la Cox-2comercializados en la actualidad, celecoxib y rofecoxib. Ambos se presentaron enmujeres de edad avanzada, cursaron con importante afectación del estado general yfracaso renal agudo. En el primer caso, la biopsia renal mostró una nefritis tubulointersticialaguda (NTI) muy abigarrada en su expresión histológica. En el segundo, seasoció con importantes datos de cronicidad. Los dos casos se trataron con esteroidescon buena evolución de la función renal

The nephrotoxic effect of nonselective nonsteroidal anti-inflamatory drugs(NSAIDS) has been widely described. The main benefit of the Cox-2 inhibitors in relationto the NSAIDS is the production of a very similar analgesic effect, but with fewergastrointestinal side effects.However, their effects on renal function are little known asyet and their long-term safety is still pending definition. The use of selective Cox-2 inhibitorsas anti-inflamatory analgesic is becoming more and more common in our environment. We report two cases of tubulointersticial nephritis confirmed by renalbiopsy, associated with administration of the two Cox-2 inhibitors currently availableon the market, celecoxib and rofecoxib. In both cases, we were talking about elderlywomen, with deterioration of the general condition and acute renal failure. In the formercase, renal biopsy showed an acute tubulo-intersticial nephritis (TIN) so highly«variegated» in its histologic expression. In the second case, was associated withstrong indications of chronicity. Treatment with steroid was initiated in both patientsand improvement of renal function was observed