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1.
Rev Med Chil ; 149(6): 934-938, 2021 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-34751354

RESUMO

Acute phosphate nephropathy (APN) is an acute renal failure secondary to the use of oral sodium phosphate (OSP) laxatives, with a high risk of progression to chronicity. We report a 60-year-old woman with mixed connective tissue disease whose serum creatinine increased up to 2.0 mg/dL in her regular control tests, without an evident causative factor. Kidney biopsy showed numerous intratubular calcium phosphate deposits, consistent with APN. She had a history of OSP laxative intake, and a sodium phosphate enema was used before a colonoscopy performed six months earlier. The temporal association between the use of OSP laxatives and acute kidney injury, should lead to the suspicion of APN. The urine sediment is generally normal or with mild to moderate proteinuria. The diagnosis is confirmed with a kidney biopsy. Until now, there is no specific treatment for APN, thus prevention is essential. In high-risk patients for developing APN, the administration of these laxatives should be avoided.


Assuntos
Injúria Renal Aguda , Laxantes , Catárticos/efeitos adversos , Feminino , Humanos , Laxantes/efeitos adversos , Pessoa de Meia-Idade , Fosfatos/efeitos adversos
2.
Arch Argent Pediatr ; 119(6): 414-420, 2021 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34813235

RESUMO

Renal involvement among pediatric patients with coronavirus disease 2019 (COVID-19) ranges between 10% and 80%. Given the limited information about its prognosis, the objective of this study was to describe the short-term course of patients in whom renal involvement was detected during hospitalization due to COVID-19. This was an observational, cross-sectional study in patients aged 1 month to 18 years who had COVID-19 and renal involvement. Those with a known kidney disease were excluded. A total of 27 patients with renal involvement were identified; 14 of them were followed-up to study their disease course for 3 months after diagnosis. All of the patients had achieved normal plasma creatinine levels during hospitalization and, at the time of outpatient follow-up, which took place 145 days (92-193) later, all had normal blood pressure and urinary values, except for 1 patient who continued with microscopic hematuria. Course was favorable; in most patients, renal involvement had fully resolved.


Assuntos
Injúria Renal Aguda , COVID-19 , Criança , Hematúria , Humanos , Prognóstico , SARS-CoV-2
3.
Arch Argent Pediatr ; 119(6): e626-e630, 2021 12.
Artigo em Espanhol | MEDLINE | ID: mdl-34813244

RESUMO

Neuroblastoma is a neural crest-derived tumor and the most common malignant tumor in neonates. Its clinical presentation can be quite variable. In some cases, it presents as an aggressive metastatic disease whilst in others it is a finding in scans performed for other reasons. The following report presents the case of a premature newborn, diagnosed postnatally with metastatic congenital neuroblastoma, with an atypical and torpid course, including severe renal injury and dialysis requirement.


Assuntos
Neoplasias das Glândulas Suprarrenais , Neuroblastoma , Neoplasias das Glândulas Suprarrenais/diagnóstico , Humanos , Recém-Nascido , Rim
4.
Cad Saude Publica ; 37(10): e00049821, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34644749

RESUMO

In a context of community transmission and shortage of vaccines, COVID-19 vaccination should focus on directly reducing the morbidity and mortality caused by the disease. It was thus essential to define priority groups for vaccination by the Brazilian National Immunization Program (PNI in Portuguese), based on the risk of hospitalization and death from the disease. We calculated overrisk according to sex, age group, and comorbidities using hospitalization and death records from severe acute respiratory illness with confirmation of COVID-19 (SARI-COVID) in all of Brazil in the first 6 months of the epidemic. Higher overrisk was associated with male sex (hospitalization = 1.1 and death = 1.2), age over 45 years for hospitalization (OvRag ranging from 1.1 to 8.5), and age over 55 year for death (OvRag ranging from 1.5 to 18.3). In the groups with comorbidities, chronic kidney disease, diabetes mellitus, cardiovascular disease, and chronic lung disease were associated with overrisk, while there was no such evidence for asthma. Chronic kidney disease or diabetes and age over 60 showed an even stronger association, reaching overrisk of death 14 and 10 times greater than in the general population, respectively. For all the comorbidities, there was higher overrisk at older ages, with a downward gradient in the oldest age groups. This pattern was reversed when examining overrisk in the general population, for both hospitalization and death. The current study provided evidence of overrisk of hospitalization and death from SARI-COVID, assisting the definition of priority groups for COVID-19 vaccination.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Idoso , Brasil/epidemiologia , Comorbidade , Hospitalização , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Vacinação
5.
Actas Urol Esp (Engl Ed) ; 45(9): 587-596, 2021 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34697007

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of the retrohepatic inferior vena cava control through an anterior approach (RIVCA) technique in renal cell carcinoma (RCC) with level IIIa tumor thrombus. PATIENTS AND METHODS: Initial series of 6 cases presenting RCC and level IIIa tumor thrombus who underwent radical nephrectomy and tumor thrombectomy using the RIVCA technique between 2018-2019. RIVCA technique aims to gain complete control of the retrohepatic inferior vena cava above the cranial end of the tumor thrombus, but excluding the major hepatic veins in order to preserve the natural hepato-caval shunt. A step-by-step description of the procedure is provided. Disease features, operative characteristics, and surgical outcomes were registered prospectively. RESULTS: Radical nephrectomy and tumor thrombectomy were completed in all cases. RIVCA technique did not increase operative time significantly (range: 14-22 min). Mean estimated blood loss was 325 cc (range: 250-400). Blood transfusion was not required intraoperatively in any of the cases. Mean postoperative transfusion rate was 1.3 red blood cells packed units (range: 0-2). There were no cases of intraoperative pulmonary embolism or major complications (Clavien-Dindo III-V) in the period of 30 days postoperatively. Median postoperative length of stay was 8 days (range: 5-11). CONCLUSIONS: The RIVCA technique applied to cases of RCC and level IIIa tumor thrombus provides complete control of the retrohepatic inferior vena cava above the tumor thrombus cranial end, while prevents intraoperative hemodynamic instability by maintaining cardiac preload through the porto-caval shunt. This technique may limit operative morbidity (intraoperative pulmonary embolism and massive hemorrhage), thus becoming a helpful adjunct to be used in cases of RCC with level IIIa tumor thrombus.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Trombose , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Nefrectomia , Trombose/cirurgia , Veia Cava Inferior/cirurgia
6.
Medwave ; 21(9): e8474, 2021 Oct 20.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-34669690

RESUMO

Introduction: Patients with chronic kidney disease usually have anemia secondary to an erythropoietin deficit. The emergence of biosimilar drugs of erythro-poiesis-stimulating agents ensures broader access to these treatments. Objective: This study analyzes the effectiveness of an epoetin α biosimilar drug in chronic kidney disease patients with anemia. Methods: This observational retrospective study enrolled 111 consecutive outpatients with chronic kidney disease and anemia and criteria for using eryth-ropoietin-stimulating agents. We collected baseline epidemiological and comorbidity data, as well as hematological and renal function infor-mation. We analyzed the effectiveness of the biosimilar agent in naïve patients and those who already had other erythropoiesis-stimulating agents. Results: The 111 included patients had a mean age of 83 ± 8 years, and 54% were males. We found that patients who previously received erythropoiesis-stimulating agents, maintained hemoglobin values at two months of treatment with the biosimilar, while the naïve group significantly raised their hemoglobin values (P < 0.001). Renal function remained stable within the whole sample. The cost of using erythropoiesis-stimulating agents was reduced by a mean of 82 ± 17% with the biosimilar drug. Conclusion: Using a biosimilar of epoetin α is effective in patients with chronic kidney disease and anemia and significantly reduces costs.


Assuntos
Anemia/tratamento farmacológico , Medicamentos Biossimilares/uso terapêutico , Hematínicos/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Feminino , Humanos , Masculino , Proteínas Recombinantes , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos
7.
Enferm Clin ; 31: S55-S61, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34629851

RESUMO

The SARS-CoV-2 pandemic, which affects the entire population in general, poses a special risk for patients with chronic kidney disease because of their immunosuppression status, advanced age and the coexistence of significant comorbidity.Renal patients undergoing hemodialysis run the risk not only of suffering but also of transmitting and spreading COVID-19 due to multiple factors, both procedural and logistical, associated with the process. These include the long duration of the technique, collective transfer to and from the centres, and the waiting time before performing the technique, aspects that make strict isolation difficult and therefore increase not only the risk of contagion between patients but also between specialist health professionals, which makes it more difficult to replace professionals.Prevention, protection, detection, isolation and distribution measures are essential in the management of the epidemic and must be taken from the initial stage. For this to be possible, it is necessary to draw up protocols to guide the actions of both the patient and the professionals in the different stages of chronic renal disease.


Assuntos
COVID-19 , Falência Renal Crônica , Insuficiência Renal Crônica , Humanos , Pandemias , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , SARS-CoV-2
8.
Rev Col Bras Cir ; 48: e20213042, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34586206

RESUMO

The intense use of resources to combat COVID-19 causes concern in the entire transplant community because, in addition to physical limitations such as ICU beds, lack of homogeneous treatment protocols and uncertainties about the effects of immunosuppression on viral progression have significant impact on transplant surgeries. The aim of the present study is to comparatively assess the number of solid organ transplants performed in 2019 and 2020, as well as the impact of the COVID-19 pandemic on organ donation and transplant surgeries in Brazil. The last 10 years have shown increasing trend in the number of solid organ transplants, which have significantly decreased in 2020. Lung transplantations were mostly affected by the pandemic; these surgeries have been carried out only in Rio Grande do Sul and São Paulo states. Liver transplantations were the least affected ones, since the number of surgeries have only decreased by 10.8% in the first three quarters of 2020, in comparison to 2019. The number of active patients on the waiting list for heart and kidney transplantation has increased in 2020. Therefore, it is necessary developing strategies to keep the structure necessary for organ transplantation processes active and, consequently, to reduce the impacts of the pandemic on these patients.


Assuntos
COVID-19 , Obtenção de Tecidos e Órgãos , Brasil/epidemiologia , Humanos , Pandemias , SARS-CoV-2
9.
Arq Bras Cardiol ; 117(2): 378-384, 2021 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495236

RESUMO

BACKGROUND: Hyperuricemia is a frequent finding in patients with arterial hypertension, and there is increasing evidence that this entity is also a risk factor for cardiovascular disease. OBJECTIVE: In the context of an aging population, this study aims to evaluate serum uric acid levels and arterial hypertension prevalence and control in a subgroup of Romanian adults (>65 years), concerning the influence of age on these parameters. METHOD: The study sample consists of 1,920 adults included in SEPHAR III survey, of whom 447 were elderly patients (>65 years of age). During the two study visits, three blood pressure (BP) measurements were performed at 1-min intervals and serum uric acid levels, kidney function by estimated glomerular filtration rate, blood pressure, and intima media thickness measurements were conducted. Hypertension and controls were defined according to the current guidelines. Intima-media thickness evaluation was assessed by B-mode Doppler ultrasound evaluation. A significance level p < 0.05 was adopted for the statistical analysis. RESULTS: Adult patients had a significant lower serum uric acid levels, compared to elderly patients, regardless of glomerular filtration rate levels. Adult patients showed a significantly lower intima-media thickness levels, when compared to elderly patients. CONCLUSION: Similar to previous studies, in the present study, age represented one of the factors contributing to the increased level of serum uric acid. An increasing prevalence of arterial hypertension with age, together with a poor control of blood pressure, was also obtained.


Assuntos
Hipertensão , Hiperuricemia , Adulto , Idoso , Pressão Sanguínea , Espessura Intima-Media Carotídea , Humanos , Hipertensão/epidemiologia , Hiperuricemia/epidemiologia , Fatores de Risco , Ácido Úrico
10.
Arq Bras Cardiol ; 117(2): 385-391, 2021 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495237

RESUMO

BACKGROUND: Type 1 cardiorenal syndrome is associated with higher mortality in heart failure patients. However, few studies have compared the diagnostic criteria of acute kidney injury (AKI) in this population. OBJECTIVE: To assess clinical and functional features and factors associated AKI in patients with heart failure. METHOD: Retrospective, cohort study on patients with decompensated heart failure or recent acute myocardial infarction, conducted in a tertiary hospital in a low-income region of Brazil. Clinical, laboratory and echocardiographic features were compared between patients with and without AKI according to the Acute Kidney Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The level of statistical significance was set at p < 0.05. RESULTS: Of 81 patients, 61.73% had AKI. Mean creatinine and urea levels were 1.79±1.0 mg/dL and 81.5±46.0 mg/dL, respectively, and higher in the group with AKI (p < 0.05). No evidence of a relationship between cardiac changes and reduced renal function. Chronic renal disease was associated with higher prevalence of AKI. Higher mortality was observed in patients with AKI than in patients without AKI (32.0% vs. 9.8%, p = 0.04, OR 8.187 ad 95% confidence interval 1.402-17.190, p = 0.020). CONCLUSION: In this population of patients with heart failure, AKI was highly prevalent and considered an independent risk factor for mortality. Cardiac changes were not associated with AKI, and the KDIGO and AKIN criteria showed similar performance.


Assuntos
Injúria Renal Aguda , Síndrome Cardiorrenal , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Brasil/epidemiologia , Síndrome Cardiorrenal/epidemiologia , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Incidência , Rim/fisiologia , Diálise Renal , Estudos Retrospectivos , Fatores de Risco
11.
Rev Med Chil ; 149(2): 187-195, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34479262

RESUMO

BACKGROUND: Glomerular filtration rate (GFR) estimation in older adults using a creatinine clearance/24-hour (CrCl) or an equation based on serum creatinine, are often considered equivalent by clinicians. AIM: To compare GFR estimated (eGFR) with the available equations and measured CrCl in patients ≥ 70 years. A secondary aim was to know the differences in chronic kidney disease (CKD) classification, when using the different eGFR formulas. PATIENTS AND METHODS: In 144 patients aged 77 ± 5 years (58% men), CrCl was measured and GFR was estimated using MDRD, CKD-EPI, BIS-1 and FAS formulas. The eGFR and the stage of CKD were compared according to the different equations used. RESULTS: GFR estimated by MDRD and CKD-EPI equations was 7.8 and 8.4 mL/min/1.73 m2 lower than 24-hour ClCr, respectively. This difference was even greater using the BIS-1 and FAS equations. Twenty-four-hour CrCl classified 47.2% of the patients in a category of renal function > 60 mL/min/1.73 m2, while MDRD and CKD-EPI equations classified just over a third, and BIS-1 and FAS formulas around 20% of the patients. CONCLUSIONS: The practice of considering equivalent the GFR estimation using the creatinine-based equations with measured creatinine clearance in older adults should be reconsidered, because their results differ markedly.


Assuntos
Insuficiência Renal Crônica , Idoso , Creatinina , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Insuficiência Renal Crônica/diagnóstico
12.
Rev Med Chil ; 149(3): 409-421, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-34479320

RESUMO

The evaluation of renal function in older adults is usually carried out with a creatinine clearance or an estimation of glomerular filtration rate using formulas such as Cockcroft-Gault, MDRD or CKD-EPI. The results obtained with these formulas are often regarded as equivalent. However, in adults older than 70 years, the Cockcroft-Gault formula frequently underestimates the glomerular filtration rate with respect to reference methods and the MDRD formula overestimates it. CKD-EPI has a more unpredictable behavior. This leads to erroneously classifying patients in the stages of chronic kidney disease (CKD), artificially increasing the prevalence of this condition, overloading health systems and generating emotional disorders in patients mistakenly classified as carriers of CKD. Also, when kidney function is overestimated, CKD patients are prevented from receiving the treatments appropriate for their condition. In recent years, new formulas have been proposed (FAS, BIS) with a greater accuracy to estimate glomerular filtration rate in older adults. This review describes the behavior of these formulas in a significant number of older adults, from various countries, and proposes using those equations with the best performance in older adults.


Assuntos
Insuficiência Renal Crônica , Idoso , Creatinina , Taxa de Filtração Glomerular , Humanos , Rim , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia
14.
Arch Argent Pediatr ; 119(5): e480-e486, 2021 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34569748

RESUMO

A low birth weight (LBW, < 2500 g), intrauterine growth restriction (IUGR), and preterm birth (PB, < 37 weeks of gestational age) are the most common clinical factors for an altered programming of nephron number and are associated with a greater risk for hypertension, proteinuria, and kidney disease later in life. At present, an indirect assessment of total nephron number based on postnatal markers is the most important approach to evaluate the risk for future kidney disorders in newborn infants with a LBW, IUGR or PB. Here we describe advances made in animal experiments and biochemical markers in humans, and the recommendations for the prevention of preconception kidney injury, including social factors and chronic diseases. According to the evidence, IUGR and prematurity alone can modulate nephrogenesis and kidney function, and, if occurring simultaneously, their effects tend to be cumulative.


Assuntos
Nefropatias , Nascimento Prematuro , Adulto , Animais , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Rim , Nefropatias/epidemiologia , Nefropatias/etiologia , Néfrons , Gravidez
15.
Rev Med Chil ; 149(4): 641-647, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-34479354

RESUMO

SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.


Assuntos
Injúria Renal Aguda , COVID-19 , Rabdomiólise , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/virologia , Adulto , COVID-19/complicações , Feminino , Humanos , Terapia de Substituição Renal , Rabdomiólise/diagnóstico , Rabdomiólise/virologia
16.
Rev. méd. Urug ; 37(3): e37315, set. 2021. tab, graf
Artigo em Espanhol | LILACS, BNUY | ID: biblio-1341563

RESUMO

Resumen: La falla intestinal crónica (FIC) o tipo III es una condición invalidante, y la nutrición parenteral crónica (NPC) domiciliaria es el tratamiento que permite a estos pacientes mantenerse con vida. Sin embargo, solamente uno de cada tres países latinoamericanos cuentan con ese recurso, y sus complicaciones no son infrecuentes. Estas complicaciones son las principales indicaciones para trasplante intestinal, un procedimiento que en la mayoría de los países de ingresos medios no se ha desarrollado y no ha presentado los resultados esperados. En los últimos años, la rehabilitación intestinal a nivel mundial ha mejorado sustancialmente con el uso de análogos semisintéticos del péptido 2 similares al glucagón, existiendo cada vez mayor evidencia que demuestra la posibilidad de rehabilitación intestinal e independencia de la NPC con este fármaco, incluso en pacientes con anatomía desfavorable. Estos resultados han permitido mejorar la supervivencia y la calidad de vida de pacientes con FIC y, en muchas ocasiones, prescindir del trasplante. El paciente del caso que presentamos es el primero en recibir esta terapéutica en nuestro país. En este artículo analizamos la respuesta precoz favorable al tratamiento y sus perspectivas a futuro.


Abstract: Long-term home parenteral nutrition (HPN) is a life-saving treatment for patients with chronic intestinal failure, an invalidating condition. However, only 1 out of 3 countries can rely on this treatment and complications associated to chronic parenteral nutrition are rather frequent. The latter constitute the main indication for intestinal transplantion, a procedure that in most middle-income countries has not yet developed and has not shown the expected outcome. In recent years, intestinal rehabilitation has significantly improved at the global level with the use of GLP2, based on the growing evidence that proves the possibility of intestinal rehabilitation and independence from parenteral nutrition with Teduglutide, even in the case of patients with unfavorable anatomy. These results have caused a positive impact on survival and the quality of life of patients with chronic renal failure, and they can often abstain from transplant. The patient of the case study is the first one who received this therapy in our country and this article analyses his favorable early response to treatment and future perspectives.


Resumo: A insuficiência intestinal crônica (CIF) ou tipo III é uma condição incapacitante e a nutrição parenteral crônica (NPC) domiciliar é o tratamento que permite a sobrevida desses pacientes. No entanto, apenas 1 em cada 3 países latino-americanos dispõe desse recurso e as complicações da NPC não são raras. Essas complicações são as principais indicações para o transplante intestinal, procedimento que na maioria dos países de renda média não foi desenvolvido ou não apresentou os resultados esperados. Nos últimos anos, a reabilitação intestinal em todo o mundo tem melhorado substancialmente com o uso de sGLP2, com um número cada vez maior de evidências que mostram a possibilidade de reabilitação intestinal e independência da NPC, mesmo em pacientes com anatomia desfavorável. Esses resultados têm possibilitado prolongar a sobrevida e melhorar a qualidade de vida dos pacientes com CIF e, em muitos casos, dispensar o transplante. O paciente do caso que apresentamos é o primeiro a receber essa terapia em nosso país. Neste artigo, analisamos a resposta favorável ao tratamento precoce e suas perspectivas futuras.


Assuntos
Humanos , Masculino , Adulto , Síndrome do Intestino Curto/terapia , Peptídeo 2 Semelhante ao Glucagon/uso terapêutico , Falência Renal Crônica/terapia , Nutrição Parenteral no Domicílio
17.
Int. j. med. surg. sci. (Print) ; 8(3): 1-15, sept. 2021. tab
Artigo em Espanhol | LILACS | ID: biblio-1292440

RESUMO

En la COVID-19 un porcentaje de los enfermos desarrolla cuadros severos, con una elevada mortalidad, siendo necesario el estudio de sus características con el objetivo de frenar la progresión de la enfermedad. Se realizó un estudio retrospectivo en una cohorte de 150 pacientes adultos atendidos en el hospital Manuel Fajardo de Villa Clara, Cuba, en el período de marzo a junio de 2020. Se analizaron variables demográficas, clínicas, de laboratorio, gasométricas y radiológicas medidas al ingreso hospitalario; definiéndose dos grupos de pacientes según la evolución clínica: severos y no severos. Para la comparación de los grupos se realizó un análisis bivariado con el objetivo de determinar aquellas variables con asociación significativa a la severidad. Del total de pacientes, 26 (17,3%) evolucionaron a la severidad y 124 (83.7%), evolucionó satisfactoriamente. Los pacientes severos se caracterizaron por tener edad avanzada (media: 83 años) y presentar comorbilidades; siendo las más significativas: hipertensión arterial, diabetes mellitus, cardiopatía, enfermedad renal crónica y cáncer (p<0.0001). La polipnea y diarrea fueron las manifestaciones clínicas con mayor asociación a la severidad (p<0.0001), seguido por la fiebre (p=0.0157). La escala pronóstica quick SOFA mostró ser un instrumento útil para evaluar a los pacientes al ingreso. Las variables de laboratorio: neutrófilos, linfocitos, índice neutrófilos/linfocitos, hemoglobina. y lactato deshidrogenasa fueron las que mayor asociación tuvieron con la severidad (p<0.0001). Los leucocitos, lactato, dímero D, proteína C reactiva, glicemia y calcio también mostraron resultados significativos (p< 0.05). De las variables gasométricas, la presión y saturación arterial de oxígeno fueron las más significativamente asociadas a la severidad; así como la presencia de infiltrados o consolidación pulmonar en la radiografía de tórax (p <0.0001). El estudio permitió identificar variables al ingreso hospitalario, asociadas a progresión hacia formas severas de la enfermedad


In COVID-19, a percentage of patients develop severe disease, with high mortality, since has been necessary to study its characteristics to stop the progression of the disease. A retrospective study was carried out in a cohort of 150 adult patients attended at Manuel Fajardo Hospital in Villa Clara, Cuba, from March to June 2020. Demographic, clinical, laboratory, gasometric and radiological variables measured at hospital admission were analyzed, defining two groups of patients according to clinical evolution: severe and non-severe. For the comparison of the groups a bivariate analysis was performed, with the objective of determining those variables with a significant association to severity. Of the total number of patients, 26 (17.3%) evolved to severity and 124 (83.7%) evolved satisfactorily. Severe patients were characterized by advanced age (mean: 83 years) and comorbidities; the most significant being hypertension, diabetes mellitus, heart disease, chronic kidney disease and cancer (p< 0.0001). Polypnea and diarrhea were the clinical manifestations with the highest association with severity (p<0.0001), followed by fever (p=0.0157). The quick SOFA prognostic scale proved to be a useful instrument to evaluate patients at admission. Laboratory variables: neutrophils, lymphocytes, neutrophil/lymphocyte ratio, hemoglobin and lactate dehydrogenase were the most associated with severity (p<0.0001). Leukocytes, lactate, D-dimer, C-reactive protein, glycemia and calcium also showed significant results (p<0.05). Of the gasometric variables, arterial oxygen pressure and saturation were the most significantly associated with severity; as well as the presence of pulmonary infiltrates or consolidation in the chest X-ray (p<0.0001). The study allowed us to identify variables at hospital admission associated with progression to severe forms of the disease.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Índice de Gravidade de Doença , Infecções por Coronavirus , COVID-19 , Pneumonia Viral , Estudos Retrospectivos , Diabetes Mellitus , Betacoronavirus , Hipertensão
18.
Int. j. med. surg. sci. (Print) ; 8(3): 1-11, sept. 2021. tab
Artigo em Espanhol | LILACS | ID: biblio-1292472

RESUMO

El intervencionismo coronario se asocia a la aparición de nefropatía inducida por contraste. El propósito del estudio fue evaluar el riesgo de desarrollar nefropatía inducida por contraste (NIC) en pacientes con obstrucción coronaria significativa y su relación con factores de riesgo conocidos para esta nefropatía. Se diseñó un estudio de cohorte prospectiva con 160 pacientes atendidos en el cardiocentro del hospital "Hermanos Ameijeiras", Cuba, a los cuales se les realizó una coronariografía invasiva, entre enero 2016 y julio 2017. La edad promedio fue de 61,6 ± 9,2 años; el 70,6% eran hombres. Predominaron los antecedentes patológicos personales de cardiopatía isquémica (85,6%), y de hipertensión arterial (75,6%). El 75% de los casos presentó una oclusión coronaria significativa. La frecuencia de nefropatía por contraste fue de 42,5%. Los factores que guardaron importante relación estadística con la presencia de oclusión arterial significativa fueron la cardiopatía isquémica conocida (p<0,001), el intervencionismo coronario percutáneo previo (p=0,007), la creatinina después (p=0,043) y la NIC (p=0,016) así como el volumen de contraste administrado (p=0,006). En el subgrupo de pacientes con oclusión significativa el hematocrito bajo (p=0,025) y el intervencionismo coronario percutáneo de urgencia (p=0,007) fueron los factores más influyentes. Se concluye que los pacientes con oclusión coronaria significativa tienen un riesgo aumentado para el desarrollo de la nefropatía por contraste. La corrección de aquellos factores de riesgo que sean modificables (como el hematocrito bajo) y la correcta aplicación del protocolo de hidratación son esenciales para prevenir esta complicación.


Coronary intervention is associated with the appearance of contrast-induced nephropathy. The purpose of the study was to assess the risk of developing contrast-induced nephropathy in patients with significant coronary obstruction and its relationship with known risk factors for this nephropathy. A prospective cohort study was designed with 160 patients treated at the cardiocenter of the "Hermanos Ameijeiras" hospital, Cuba, who underwent invasive coronary angiography, between January 2016 and July 2017. The average age was 61.6 ± 9 ,2 years; 70.6% were men. The personal pathological history of ischemic heart disease (85.6%) and arterial hypertension (75.6%) predominated. 75% of the cases presented a significant coronary occlusion. The frequency of contrast nephropathy was 42.5%. The factors that had an important statistical relationship with the presence of significant arterial occlusion were known ischemic heart disease (p <0.001), previous percutaneous coronary intervention (p = 0.007), creatinine after the procedure (p = 0.043) and CIN (p = 0.016) as well as the volume of contrast administered (p = 0.006). In the subgroup of patients with significant occlusion, low hematocrit (p = 0.025) and emergency percutaneous coronary intervention (p = 0.007) were the most influential factors. It is concluded that patients with significant coronary occlusion have an increased risk for the development of contrast nephropathy. The correction of those risk factors that are modifiable (such as low hematocrit) and the correct application of the hydration protocol are essential to prevent this complication


Assuntos
Humanos , Masculino , Feminino , Meios de Contraste/efeitos adversos , Oclusão Coronária , Injúria Renal Aguda , Estudos Prospectivos , Fatores de Risco
19.
Rev Esc Enferm USP ; 55: e20200368, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34435610

RESUMO

OBJECTIVE: To evaluate the effect of prayer on religious/spiritual coping and on the hope of patients with chronic kidney disease undergoing hemodialysis. METHOD: Randomized, controlled and blinded clinical trial, carried out in a dialysis unit, with a total of 62 patients undergoing hemodialysis - 31 participants in intervention group and 31 in the control group. Intercession prayer was applied three times, in alternate weeks, during hemodialysis sessions. Differences between groups in the outcome of the effect of prayer on religious/spiritual coping and hope were analyzed. RESULTS: Participants used positive coping at high mean scores in both groups (control - 3.62 and intervention - 3.26) and negative coping had little use (control - 1.66 and intervention - 1.47). The use of total coping was between 2.35 and 2.48 in the intervention group (p = 0.015). Hope variables were better in the intervention group: optimism (p = 0.001), short- and long-term plans (p = 0.004), remembering happy moments (p = 0.039) and valuing life (p = 0.050). CONCLUSION: The use of prayer promotes an increase in religious/spiritual coping and hope. Brazilian Registry of Clinical Trials: RBR-4pphkf.


Assuntos
Adaptação Psicológica , Insuficiência Renal Crônica , Esperança , Humanos , Religião , Diálise Renal , Insuficiência Renal Crônica/terapia
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