Utilidad de la fórmula HUGE para el diagnóstico de enfermedad renal crónica en el anciano / Usefulness of the HUGE formula for the diagnosis of chronic kidney disease in the elderly

INTRODUCCIÓN: La enfermedad renal crónica se encuentra en ascenso.Prevenir o retardar su progresión mediante la aplicación de estrategias dirigidas al diagnóstico precoz es esencial. OBJETIVO: Evaluar la utilidad de la fórmula HUGE para el diagnóstico de Enfermedad Renal Crónica en el anciano. MATERIAL Y MÉTODO: Se realizó un estudio observacional descriptivo prospectivo y de corte longitudinal en 260 adultos mayores que ingresaron en los servicios de Geriatría y Medicina Interna del Hospital Clínico Quirúrgico "Hermanos Ameijeiras" en el período enero de 2019 y junio de 2020. RESULTADOS: El 58,5% de la muestra de estudio fueron mujeres. La edad promedio fue de 77,1 ± 7,3 años. La enfermedad renal crónica estuvo presente en el 64,2% de los pacientes. Se observó mayor frecuencia de pacientes con daño renal (32,7%) al emplear la formula CKD­ EPI en comparación con los identificados al emplear la fórmula HUGE (25,0%). Al estimar la concordancia entre ambas fórmulas se observó un estadístico kappa (k) de 0,814 (IC de 95%:0,7370 - 0,8909; p < 0,001). La sensibilidad de la fórmula de HUGE fue de un 76,5% (IC de 95%: 66,9% - 86,1%) y la especificidad de un 100% (99,7% - 100%). El valor predictivo positivo fue de 100 % (IC de 95%: 99,2% - 100%) y el negativo de 89,7% (85,2% - 94,2%). CONCLUSIONES: La fórmula CKD-EPI identifica daño renal en mayor porcentaje, en estadios precoces. Por el contrario, la fórmula de HUGE, detecta el daño renal en un porcentaje mayor en estadios más avanzados.La concordancia para diagnosticar daño renal entre la fórmula CKD-EPI y HUGE fue muy buena. La fórmula HUGE es útil, sensible y específica para evaluar la enfermedad renal crónica en los adultos mayores.

INTRODUCTION: Chronic kidney disease is on the rise. Preventing or delaying its progression through the application of strategies aimed at early diagnosis is essential. OBJECTIVE: To evaluate the usefulness of the HUGE formula for the diagnosis of Chronic Kidney Disease in the elderly. MATERIAL AND METHOD: A prospective, descriptive and longitudinal observational study was carried out in 260 older adults who were admitted to the Geriatrics and Internal Medicine services of the "Hermanos Ameijeiras" Surgical Clinical Hospital between January 2019 and June 2020. RESULTS: 58.5% of the study sample was women. The mean age was 77.1 ± 7.3 years. CKD was present in 64.2% of the patients. A higher frequency of patients with kidney damage (32.7%) was observed when using the CKD ­ EPI formula compared to those identified when using the HUGE (25.0%). When estimating the concordance between both formulas, a kappa statistic (k) of 0.814 (95% CI: 0.7370 - 0.8909; p < 0.001) was observed. The sensitivity of the HUGE formula was 76.5% (95% CI: 66.9% - 86.1%) and the specificity was 100% (99.7% - 100%). The positive predictive value was 100% (95% CI: 99.2% - 100%) and the negative predictive value was 89.7% (85.2% - 94.2%). CONCLUSIONS: The CKD-EPI formula identifies kidney damage in a higher percentage, in early stages. On the contrary, the HUGE formula detects kidney damage in a higher percentage in more advanced stages. The concordance to diagnose kidney damage between the CKD-EPI and HUGE formula was very good. The HUGE formula is useful, sensitive, and specific for evaluating chronic kidney disease in older adults.

Marcadores angiográficos negativos en la intervención coronaria percutánea de las oclusiones totales crónicas / Negative angiographic markers in percutaneous coronary intervention of chronic total occlusions

Resumen Objetivos: El objetivo de este estudio es evaluar variables angiográficas predictivas negativas y la presencia de la rama lateral en la proximidad de la capa distal de la oclusión en el resultado de la intervención coronaria percutánea de las oclusiones totales crónicas. Método: Las variables angiográficas potencialmente negativas fueron evaluadas retrospectivamente en 156 oclusiones totales crónicas sometidas a intervención coronaria percutánea. Se utilizó regresión logística binaria con una finalidad predictiva para identificar un modelo de variables que en su conjunto puedan predecir satisfactoriamente el resultado negativo de la intervención. Resultados: Las variables asociadas de forma independiente al fracaso de procedimiento fueron la enfermedad multivaso (odds ratio = 5,12; intervalo de confianza del 95%, 1,94-13,5; P = 0.001), la presencia de muñón ambiguo (odds ratio = 5,08; IC intervalo de confianza del 95%, 2,22- 11,63; P < 0.001), longitud de la oclusión ≥20 mm (odds ratio = 3,7; IC intervalo de confianza del 95%, 1,37-9,97; P = 0.01) y la localización ostial de la oclusión (odds ratio = 6,53; intervalo de confianza del 95%, 1,67-25,63; P = 0.007). La rama lateral en la proximidad de la capa distal no permaneció en el modelo predictivo. Conclusión: La enfermedad multivaso, muñón ambiguo, una longitud ≥20 mm y la localización ostial son factores independientes y predictivos de un resultado desfavorable de la angioplastia. La rama lateral en la capa distal de la oclusión no se asoció al fracaso de la intervención. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Objective: The purpose of this study is to identify negative angiographic predictive variables and the presence of a side branch close to the distal cap of the occlusion in the chronic total occlusion percutaneous coronary intervention outcome. Methods: Potential negative angiographic variables were retrospectively evaluated in 156 chronic total occlusions that had undergone a percutaneous coronary intervention. Binary logistic regression with predictive purpose was used to identify a model of variables which, all in all, could successfully predict a negative intervention result. Results: Variables independently associated with the procedural failure were multivessel disease (odds ratio = 5.12; 95% confidence interval (CI); 1.94-13.5; P = .001), ambiguous stump presence (odds ratio = 5.08; 95% CI; 2.22-11.63 P < .001), occlusion length ≥20 mm (odds ratio = 3.7; 95% CI; 1.37-9.97 P = .01), and ostial location (odds ratio = 6.53; 95% CI; 1.67-25.63; P = .007). Side branch at distal cap proximity did not remain in the predictive model. Conclusions: Multivessel disease, ambiguous stump, a length ≥20 mm, and an ostial location of a chronic total occlusion are independent predictive factors of an unfavourable angioplasty result. A side branch at occlusion distal cap was not associated with the procedural failure. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Braquioplastia em pacientes ex-obesos mórbidos submetidos a gastroplastia redutora / Brachioplasty after bariatric surgery

Introdução: A obesidade é uma doença metabólica de prevalência crescente, sendo aobesidade mórbida uma condição crônica de difícil controle. A cirurgia bariátrica é umaforma de tratamento desta população, que tem como consequência um emagrecimentoacentuado, refletindo em dermocalásia de vários segmentos, alterando o contorno corporal.A braquioplastia foi descrita, em 1954, por Correa e Fernandez. No entanto, significantesinovações na técnica ocorreram na década de setenta, despertando novos interesses noassunto. Embora suportada por estudos e várias propostas técnicas, a braquioplastia podeapresentar em alguns casos resultados pouco satisfatórios. As maiores complicações estãorelacionadas a cicatriz patológica, deformidades de contorno do braço, edema persistentee possíveis lesões do sistema linfático. Método: Para avaliar o efeito da dermolipectomiabraquial na drenagem linfática dos membros superiores, estudaram-se nove pacientes, totalizando18 membros superiores. Estas foram submetidas ao exame linfocintilográfico nomomento pré-operatório, realizada a braquioplastia, e avaliado o exame linfocintilográficono pós-operatório seis meses. O critério de exclusão foi paciente com exame clínico oulinfocintilográfico alterado no pré-operatório. Os dezoito membros superiores avaliadosforam submetidos a análise estatística, com nível de significância de 5%. Resultados: Oresultado foi estatisticamente significante, mostrando que o procedimento cirúrgico alteraa drenagem linfática dos membros superiores de acordo com as linfocintilografias, exameeste considerado padrão-ouro no estudo do sistema linfático.

Introduction: Obesity is a metabolic disease with an increased incidence, being morbidobesity a chronic condition of difficult control. The bariatric surgery is a form of treatment forthis group which leads to sizeable weight loss, hence reflecting in redundant tissue at severalbody segments, altering the body profile. The brachioplasty was firstly described in 1954 byCorrea and Fernandez. Nevertheless significant innovation in the technique have occurredin the seventies decade, gathering increased interest on this subject. Although supported bystudies and technical proposals, the brachioplasty may present in some cases, unsatisfactoryresults. The majority of the complications are related to scar sequelae, problems of shapingthe form of the arm, persistent swelling and likely injury to the lymphatic system. Methods:In order to appraise the dermolipectomy effect on lymphatic drainage of the arms, nine patientswere studied. They were evaluated by lymphoscintigraphy prior to surgery, submittedto the brachioplasty and again evaluated by lymphoscintigraphy, six month postoperative.The exclusion criteria were patients with altered clinic or lymphocintigraphy before surgery.The evaluated eighteen arms were the subject of statistic analysis with 5% significance level.Results: The result was statistically validated hence demonstrating the brachioplasty alterthe lymphatic drainage of the arms, according to lymphocintigraphy. This exam is a goldstandard to evaluate the lymphatic system.