[Epidemiological study on chronic renal failure elderly patients on hemodialysis]. / Estudio epidemiológico de pacientes ancianos con insuficiencia renal crónica en hemodiálisis.

Hemodialysis shows an increased prevalence in elderly patients, a population which often presents poor nutrition, high prevalence of cardiovascular, neurological and osteoarticular diseases and psycho-social problems. The objective of this epidemiological, cross-sectional and multicenter study, in patients older than 65 years (n 625) and >75 years (n 558) from 29 Spanish medical institutions was to perform an epidemiological analysis It included demographic information, as well as data regarding chronic renal failure, functional and psychological abilities (Katz Index, Lawton and Karnofsky Scales), dialysis logistics and clinical parameters. The study analyzed data from 1,183 patients (678 female), mean age 75.4+/-5.5 years; mean duration of dialysis 4.3+/-5.1 years (57.7% were referred by the GP: general practitioner). The most frequent etiologies were diabetic nephropathy (21.2%) and vascular renal disease (20.9%). The main comorbilites were high blood pressure (75.6%), Diabetes Mellitus (32.9%) and vascular (29.0%) and osteoarticular (27.3%) diseases. The great majority of patients lived at their family home (85.0%), travelled to their dialysis units alone (80.8%) and by ambulance (56.7%), and it took them less than an hour to arrive (87.5%). Over 75% of patients were fully functional (79.4% under 75 years and 71.6% over 75); meanwhile 10.5% were partially impaired and 13,8% severely impaired. Karnofsky performance scale scored less than 70 in 59.4% of the patients. Analytical parameters rated Hb >or= 11 g/dL for 81.7% of patients; ferritin >or= 100 ng/dL for 98.5%; PTH 150-300 pg/mL for 31.9%; albumin >3.5 g/dL for 75.6%; and serum phosphor <5.5 mg/dL for 70.6%. For the dialysis Kt/V the mean value was 1.4+/-0.3 with a mean duration of dialysis session of 11.7+/-4.0 hours/week. High permeability membranes were used in 52.3% of patients and internal arteriovenous fistula in 74.0%. Around 75% of elderly patients on hemodialysis fulfill age-suitable daily living activities and display adequate dialysis quality parameters.

[Outbreak of meningitis caused by echovirus type 30]. / Brote epidémico de meningitis por echovirus tipo 30.

OBJECTIVES: In the cold months of 1994-1995, we detected in our hospital an epidemic outbreak of acute enteroviral meningitis caused by echovirus type 30 (Echo 30). Until now, these outbreaks of viral epidemics had not been detected in Spain. PATIENTS AND METHODS: We reviewed retrospectively 46 clinical histories of patients who were admitted to our hospital between September 1994 and January 1995 with the diagnosis of acute lymphocytic meningitis, analyzing the clinical outbreak, epidemiological and laboratory characteristics, and how the outbreak spread. RESULTS: Regarding the patients, there was a prevalence in males, with an average age of 6 years and a range of 2 to 13 years of age. The most constant symptom was severe frontal headache, with signs of meningitis in only 50% of the cases. In the CSF, we found a predominance of PMN in the differential cell count in 63% of the cases, with the time of evolution before spinal puncture less than 24 hours in the majority of the patients. Viral cultures were performed on CSF, stool and throat scrapings in 16 patients with Echo 30 being isolated in 15 cases, which suggests 32.6% of the total cases. CONCLUSIONS: We detected in our environment an epidemic outbreak of viral meningitis caused by an agent not found previously in Spain, which presented epidemiological, clinical and laboratory characteristics similar to those reported in the literature. Its appearance during the cold months contrasts to what normally occurs.