Self-perception of oral health among tertiary-care users: quanti-qualitative analysis with chronic kidney disease patients

Chronic kidney disease (CKD) has become a global public health challenge. The objective of this study was to analyze the relationship between self-perception of oral health and clinical condition among patients with CKD. This isa quanti-qualitative survey conducted in a CKD specialized service. The sample consisted of 60 patients who underwent oral examinations to have their severity of caries (DMFT) and need for dental prosthesis checked. Age, sex, time on dialysis, marital status, skin color, education and pre-existing diseases were also analyzed. Among the kidney patients who agreed to undergo the clinical examinations and showed communication skills, some were selected, and three focus groups were created, with the participation of a moderator and six to 10 kidney patients in each group. Their speeches were processed in the IRAMUTEQ software and analyzed through the similarity analysis and word cloud techniques. As for profile, the patients were aged 60.23 ± 10.87 years old; were male (73.33%); were on dialysis for 41.90 ± 56.57 months; were married (61.67%); were white (76.67%); had incomplete primary education (41.66%); had arterial hypertension (76.67%); had a DMFT index of 22.55 ± 8.39; 43.33% needed an upper complete denture; and 30.00% needed a lower complete denture. The similarity analysis revealed many doubts and uncertainties about current health services, which can be proven by the words 'no' and 'treatment'. The quanti-qualitative analysis showed a high rate of dental loss and the need for complete dentures and suggests inequities in oral health care for chronic kidney disease patients, especially in tertiary care. There was a positive representation regarding oral health, but the lexicographical analyses of the textual corpusconfirmed the self-perception of lack of dental care.

Incidents related to the Hickman® catheter: identification of damages / Incidentes relacionados con el catéter de Hickman®: identificación del daño / Incidentes relacionados ao cateter de Hickman®: identificação de dano

ABSTRACT Objective: to identify damages resulting from incidents with the Hickman® catheter. Method: descriptive, retrospective, qualitative approach. The source of data were the notifications of incidents that occurred between January 2012 and May 2015, as well as the information available on the medical records of patients involved in incidents with the Hickman® catheter. Results: the incidents related to the Hickman® catheter with the greatest impact on patient care were obstruction, fracture and traction. All incidents caused damage to patients, in a greater or lesser degree, in the dimensions of physical damage and subjective damage. Final considerations: damage or potential risk of damage was present in all incidents analyzed. The need to revise cleaning and obstruction protocols for the maintenance of the permeability of Hickman® catheters was demonstrated.

RESUMEN Objetivo: identificar el acaecimiento de daños en incidentes relacionados con el catéter de Hickman®. Método: investigación descriptiva, retrospectiva, de abordaje cualitativo. Como fuente de datos, se utilizaron fichas de notificación de incidentes ocurridos entre enero de 2012 y mayo de 2015, además de informaciones relatadas en los prontuarios de los pacientes involucrados en los incidentes relacionados con el catéter de Hickman®. Resultados: los incidentes de impacto más importantes en la atención al paciente, relacionados con el catéter de Hickman®, fueron la obstrucción, la fractura y la tracción. Todos los incidentes generaron, en mayor o menor grado, daños a los pacientes en las dimensiones física y subjetiva. Consideraciones finales: se encontraba presente en todos los incidentes analizados, el daño en sí mismo o el riesgo potencial para el daño. Quedó en evidencia la necesidad de revisar los protocolos de lavado y bloqueo del catéter de Hickman® para el mantenimiento de su permeabilidad.

RESUMO Objetivo: identificar a ocorrência de danos nos incidentes relacionados ao cateter de Hickman®. Método: pesquisa descritiva, retrospectiva, de abordagem qualitativa. Como fonte dos dados, foram utilizadas as fichas de notificação de incidentes ocorridos entre janeiro de 2012 e maio de 2015, além de informações dos prontuários dos pacientes envolvidos com incidentes relacionados ao cateter de Hickman®. Resultados: os incidentes, relacionados ao cateter de Hickman®, de maior impacto para a assistência ao paciente foram a obstrução, fratura e tração. Todos os incidentes geraram dano aos pacientes, de maior ou menor grau, nas dimensões de dano físico e danos subjetivos. Considerações finais: dano ou risco potencial para dano esteve presente em todos os incidentes analisados. Evidenciou-se a necessidade de revisar os protocolos de lavagem e bloqueio para a manutenção da permeabilidade do cateter de Hickman®.

Analysis of complications related to dialysis catheters in cancer patients

Background: Data on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) and how these factors influence the efficiency of dialysis and the outcomes of these patients are scarce. We aim to describe the predictive clinical characteristics of hemodialysis catheter-related complications in critically ill cancer patients with acute kidney injury. Methods: This is a retrospective cohort study of 62 cancer patients subjected to short-term hemodialysis catheter implants. We evaluated the clinical characteristics of patients and the complications related to catheter implantation: mild malfunction, characterized by reversal of access lines; infections; and catheter replacement due to severe malfunction or infections. The outcomes analyzed were recovery of renal function, discharge from the ICU, and death. Results: The most frequent complications were related to mild malfunction, which justified dialysis line reversal in 21.3% of the patients. The complication rate was higher in patients undergoing conventional hemodialysis, in those with coronary disease, and in those who had more than three dialysis sessions. The presence of metastasis was more frequently related to catheter reversals. Patients with mild or severe malfunction were more likely to be hospitalized for more than 18 days in the ICU. All patients with mild malfunction had hospitalization times greater than 28 days. Conclusions: Hemodialysis catheter-related complications were associated with longer ICU and hospital stays in cancer patients with AKI. Mild malfunction of the hemodialysis catheter was the most frequent complication. Patients with metastasis and sepsis, who used diuretics, and who used intermittent dialysis methods had milder catheter malfunctions

Satisfacción de los pacientes en tratamiento de diálisis: Hospital Militar Córdoba. Servicio de Diálisis

La evaluación de la Satisfacción de los pacientes en tratamiento Dialítico, es una herramientaútil para conocer las necesidades del paciente; eje sobre el cuál se articulan las prestacionesasistenciales. A su vez permite identificar aquellas áreas deficitarias. Los Objetivos planteadosfueron:a) Conocer las opiniones de los pacientes sobre el servicio que se les brinda en cadauna de las áreas de atención; b) Analizar el perfil de satisfacción de los pacientes quemanifestaron estar globalmente insatisfechos.Material y método: Estudio prospectivo,descriptivo realizado en la Unidad de Diálisis del Hospital Militar Córdoba, ATERYM SRL,realizado entre 15/11/2014 al 15/12/2014. Criterios de Inclusión: Todos los pacientes atendidosen el servicio, que recibieron algún tipo de Diálisis (Hemodiálisis-Diálisis Peritoneal) en dichoperíodo. Criterios de Exclusión: a) Diagnóstico de Demencia cognitiva, b) Llevar menos de tresmeses de tratamiento, c) No estar en condiciones psicológicas y físicas para responder laencuesta. Se aplicó una encuesta cualitativa, estructurada semi-abierta, voluntaria y anónima.Las variables que se utilizaron para valorar fueron: 1. Tiempo de diálisis. 2. Grado deSatisfacción General con el Servicio. 3. Ambiente Físico de la Sala de Espera. 4. AmbienteFísico de la Sala de Diálisis. 5. Atención de los Profesionales. 6. Valoración de la Cantidad yCalidad de la Colación recibida. 7. Evaluación del Transporte: Puntualidad y Comodidad. 8.Suministro de la Medicación. 9. Evaluación de la Información Recibida sobre el Tratamiento. 10.Evaluación de la Información Recibida sobre Trasplante. 11. Ponderación de la Experiencia conla Guardia Médica. 12. Expresión del paciente sobre el Servicio (Pregunta abierta). 13. Datossociodemográficos: Edad, Sexo, Estado Civil, Nivel de Estudios, Conformación del GrupoFamiliar, Ocupación e Ingresos. Los pacientes completaron la encuesta, previa informaciónrealizado por personal de enfermería...

The assessment of the satisfaction of patients in dialysis, is a useful tool to meet patient needs;axis on which the care service is based. In turn it allows to identify the deficient areas. Theobjectives were: a) To know the views of patients about the services that are given in each ofthe areas of focus; b) To analyze the profile of satisfaction of patients expressed their overalldissatisfaction. Material and Methods: A prospective, descriptive study in the dialysis unit of theMilitary Hospital Córdoba, ATERYM SRL, conducted between 15/11/2014 to 12/15/2014.Inclusion criteria: All patients attending the service, which received some form of dialysis(hemodialysis-PD) in that period. Exclusion criteria: a) Diagnosis of cognitive dementia, b)Carrying less than three months of treatment, c) not be in psychological and physical conditionsto answer the survey. A qualitative survey, semi-structured open, voluntary and anonymousapplied.The variables were used to assess: 1. Time dialysis. 2. overall satisfaction with the service. 3.Physical Environment of the Waiting Room. 4. Physical Environment of the dialysis room. 5.Care Professionals. 6. Assessment of Quantity and Quality of Collation received. 7. Evaluationof Transport: Punctuality and Comfort. 8. Medication Supply. 9. Evaluation of the informationreceived on the treatment. 10. Evaluation of the information received on Transplantation. 11.Weighting of experience with the Medical Guard. 12. Expression of the patient on the service(open question). 13. Sociodemographic data: age, sex, marital status, education level,Conformation Family Group, Employment and Income. Patients completed the survey priorinformation by nurses...

Indicação de revascularização miocárdica em pacientes dialíticos / Indication myocardial revascularization in dialysis patients

Fundamentos: Pacientes dialíticos apresentam alto risco aterosclerótico, sendo previsto aumento nas indicações de revascularização miocárdica (RM) nesse grupo.Objetivos: Avaliar características clínicas, laboratoriais, ecoDopplercardiográficas e cineangiocoronariográficas de pacientes dialíticos e do subgrupo com indicação de RM.Métodos: Foram analisados 94 pacientes dialíticos submetidos à cineangiocoronariografia, estratificados em dois grupos: com e sem doença coronariana (DAC). Resultados: 94 pacientes, 57,4 % homens, média de idade 53,9±10,1 anos, 95,7 % hemodialíticos, mediana do tempo diálise 60,0 meses. Ao ecoDopplercardiograma a fração de ejeção média foi 61,07±12,06 % (n=84); função diastólica normal em 16,9 %, tipo I em 63,9 %, tipo II em 12,0 % e tipo III em 7,2 %. A população estudada foi estratificada em dois grupos: com DAC (n=47) e sem DAC (n=47). No grupo com DAC, 27,7 % eram triarteriais, 12,8 % uniarteriais e 9,6 % biarteriais, sendo mais frequente: DAC prévia (17,0 % vs. 2,1 %; p=0,003), calcificação parietal à cineangiocoronariografia (76,6 % vs. 10,6 %; p<0,001) e uso prévio de betabloqueadores (55,3 % vs. 27,7 %; p=0,007). Nos pacientes não diabéticos, aqueles com disfunção diastólica tiveram quatro vezes mais chance de coronariopatia (OR 4,26 IC 1,03-23,55; p=0,048). Houve elevada indicação de RM nos coronariopatas (61,7 %), com indicação cirúrgica em 51,7 % dos revascularizáveis. Conclusões: DAC prévia, calcificação parietal na cineangiocoronariografia e uso prévio de betabloqueadores foram mais frequentes nos coronariopatas. Disfunção diastólica ao ecoDopplercardiograma foi o único preditor independente para DAC em pacientes dialíticos. Indicação de RM foi elevada nos coronariopatas.

Background: Dialysis patients are at high risk for atherosclerosis, with increased indications for myocardial revascularization (MR) in this group. Objectives: To assess clinical, laboratory, echoDoppercardiographic and coronary angiography parameters among dialysis patients and in a subgroup with MR indications. Methods: 94 dialysis patients undergoing coronary angiography were analyzed and divided into two groups: with and without coronary artery disease (CAD). Results: 94 patients; 57.4% men, mean age 53.9±10.1 years, 95.7% on hemodialysis, median dialysis time of 60.0 months. Mean ejection fraction in echocardiography: 61.07±12.06% (n=84), normal diastolic function in 16.9%, type I diastolic dysfunction in 63.9%, type II in 12.0% and type III in 7.2%. The population was divided into two groups: with CAD (n = 47) and without CAD (n = 47). In the CAD group, 27.7% had three-vessel, 12.8% one-vessel and 9.6% two-vessel disease, with prior CAD (17.0% vs. 2.1%; p=0.003), parietal calcification in coronary angiography (76.6% vs. 10.6%; p<0.001), with prior use of beta-blockers (55.3% vs. 27.7%; p=0.007) being more frequent in the CAD group. Among non-diabetic patients, those with diastolic dysfunction were four times more likely to have CAD (OR 4.26 CI 1.03–23.55; p=0.048). There was a high level (61.7%) of MR indications among CAD patients, with surgery indicated for 51.7% of those suitable for revascularization. Conclusions: Prior CAD, parietal calcification in coronary angiography and prior use of beta-blockers were more frequent in the CAD group. Diastolic dysfunction in the echoDopplercardiograms was the only independent CAD predictor among dialysis patients, with MR indications high for coronary heart disease patients.

Implante Valve-in-Valve: uma opção / Valve-in-valve implant: an option

Os relatos de implante de valve-in-valve no Brasil são escassos, mas têm aumentado de frequência nos países desenvolvidos. Relata-se o caso de paciente feminina, 73 anos, que se submeteu a implante transcutâneo de prótese aórtica valve-in-valve há quatro anos. A paciente havia implantado bioprótese aórtica por cirurgia há 24 anos, evoluindo com degeneração da prótese, tendo recusado a troca valvar por nova cirurgia aberta. Após avaliação de equipe multidisciplinar foi indicado o implante transcutâneo de prótese aórtica valve-in-valve. Após quatro anos, a paciente apresentou melhora da classe funcional de insuficiência cardíaca e a durabilidade da prótese tem sido satisfatória.

Although valve-in-valve implantation reports are still sparse in Brazil, they are becoming more frequent in the developed countries. This case report addresses a 73-year-old female patient who underwent a transcutaneous aortic valve-in-valve prosthesis implant four years ago, subsequent to an aortic bioprosthesis implant operation 24 years earlier that degenerated, with the patient refusing to replace the valve through a further open surgery. After evaluation, a multidisciplinary team recommended a transcutaneous aortic valve-in-valve prosthesis implant. Four years later, the functional class of her heart failure has improved and the durability of the prosthesis has been satisfactory.

Planned posterior assisted levitation in severe subluxated cataract: Surgical technique and clinical results.

We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

Hemodialysis; plea of availability versus adequecy gezira experience

Objectives: This is a prospective cross sectional study carried out in Gezira Hospital for Renal Diseases and Surgery (Sudan) to assess the adequacy of hemodialysis in 206 patients with end stage kidney disease on regular hemodialysis twice per week using. Methods: Pre and post hemodialysis blood sample were obtained from the study group, spKt/V and urea reduction ratio were calculated. Results: Mean Kt/v was found to be 1.19 and urea reduction ratio was 59.55%. None of the patients in this study group achieved the National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) recommendations for adequate hemodialyis, since it requires three hemodialyis sessions per week and our patients are receiving two sessions per week. Conclusion: In order to improve the situation herewith we recommended increased number of sessions from two to three times per week and /or increase the duration of hemodialysis session, increase blood flow rate and dialysate flow rate. Moreover, decrease the number of patients on regular hemodialysis by encouraging the patients to take the other renal replacement therapy (peritoneal dialysis and renal transplantations)

Adequação de um sistema de hemodiálise em eqüinos / Adequacy of hemodialysis system in horses

Realizou-se a adequação da técnica de hemodiálise com eqüinos, distribuídos em quatro grupos experimentais de seis animais cada. Os animais do grupo I foram submetidos a cateterismo central unilateral (grupo-controle); os do grupo II foram submetidos a cateterismo central unilateral com cateter duplo-lúmen e a uma sessão de hemodiálise de seis horas; os do grupo III a cateterismo central unilateral com cateter duplo-lúmen e duas sessões de hemodiálise de seis horas e os do grupo IV a cateterismo central bilateral com cateter monolúmen e a uma sessão de hemodiálise de seis horas. Empregaram-se xilazina 10 por cento (0,4mg/kg) e acepromazina 2 por cento (0,008mg/kg) via intravenosa para sedação. Foram utilizados dois hemodialisadores conectados em série, do tipo fibras ocas, baixo fluxo, membrana de polissulfona e área de 1,8m². O fluxo sangüíneo médio foi de 319,18±97,41ml/minuto, associado a um fluxo de dialisato de 500ml/min. A anticoagulação foi feita com heparina sódica em 100UI/kg para primming, repetida na dose de 53,86±18,61UI/kg/hora. Foram avaliados: tempo de coagulação, tempo de protrombina, tempo de tromboplastina parcial ativada e contagem plaquetária, e verificado trombocitopenia nos grupos dialisados. O melhor acesso vascular foi proporcionado pelo cateterismo unilateral com cateter lúmen-duplo (Grupos II e III), podendo a técnica de hemodiálise ser empregada na espécie eqüina, com dialisadores de alta eficiência, em sessão de seis horas de diálise.

Hemodialysis adequacy was studied in four groups with six horses in each: the treatments: group I animals were submitted to unilateral central venous catheter (control group); group II animals were submitted to unilateral central venous double lumen catheter and one six-hour session of hemodialysis; group III horses were submitted to unilateral central venous double lumen catheter and to two six-hour session of hemodialysis, and group IV horses were submitted to bilateral central venous mono lumen catheter and to one six-hour session of hemodialysis. Xilazine 10 percent (0.4mg/kg) and acepromazine 2 percent (0.008 mg/kg) were iv administrated for sedation. Two hollow fiber, 1.8m² low flux polyssulfone hemodialysis apparatus were used in a connected serie. The mean blood flux was 319.18±97.41ml/min with a dialisate flux of 500ml/min. Anticoagulation was performed with sodium heparin, 100UI/kg for priming at the dose of 53.86±18.61UI/kg/h. Anticoagulation monitoring was performed by clotting time, protrombin time, tromboplastin activated time, and platelet number. Decrease in platelet number was detected in groups submitted to dialysis. The best vascular access was performed with double lumen catheter and the hemodialysis may be used in equine practice, with high performance dialyze used in six- hour session.

Composición y aporte potencial de hierro, calcio y zinc de panes y fideos elaborados con harinas de trigo y amaranto / Composition and potential contribution of iron, calcium and zinc of bread and pasta made with wheat and amaranth flours]

Amaranth, a traditional american crop that is nowadays given renewed importance, has good food potential value. The minerals contributed by the grain are quantitatively important. However, as the flour is obtained by total grinding of the grain, this process leads to the presence of anti-nutritional components, such as fitates, and therefore, the evaluation of the actual availability of the minerals of nutritional interest becomes necessary. The process of bread fermentation, plus the addition of fitases and enhancers of mineral availability such as citric and ascorbic acid, might improve mineral bioavailability. The objective of this work was to assess protein, ash, lipids and total dietary fiber content and evaluate the concentration and dialyzability of Fe, Zn and Ca (as mineral bioavailability indicator) in bread and pasta 100% wheat, and bread and pasta obtained by replacing 20% wheat flour (WF) with whole amaranth flour (WAF). Ascorbic acid (AA), citric acid (CA) and fitase were used as mineral bioavailability enhancers. The potential contribution of each mineral (PC) was calculated as each mineral concentration times its dialyzability. In 80:20 bread an increase of total dietary fiber and minerals, compared to 100% wheat products was observed. A maximum FePC in 80:20 bread was obtained with CA and fitase (0.55mg%). In pasta, the maximum effect was observed with CA (0.07 mg%). The CaPC was maximum in 80:20 pasta with CA (16.72 mg%). The greatest ZnPC was found in 80:20 bread with CA and fitase (0.40 mg%). The introduction of the WAF in fermented baked products with addition of CA and fitase allows to obtain nutritional advantages.

El amaranto es un cultivo americano autóctono actualmente revalorizado por su elevado potencial alimentario. Los minerales aportados por el grano son cuantitativamente importantes. Sin embargo, la presencia de fitatos en los tegumentos externos del grano hace necesaria la evaluación de la biodisponibilidad de los minerales de interés nutricional pues la harina se obtiene por molienda integral. El proceso de fermentación del pan, sumado al agregado de fitasas y promotores de la dializabilidad mineral, podría mejorar la biodisponibilidad mineral. El objetivo del trabajo fue establecer el porcentaje de proteínas, cenizas, lípidos, fibra dietaria total (FDT), Fe, Zn y Ca y estudiar la dializabilidad de esos minerales - como indicadora de su biodisponibilidad - en panes y fideos elaborados con 100% harina de trigo (HT) y con 20% de reemplazo de HT por harina integral de amaranto (HIA). Como promotores de la biodisponibilidad mineral se utilizaron ácidos ascórbico (AA) y cítrico (AC) y fitasa. Se estableció el aporte potencial (AP) de cada mineral como el producto de su concentración y dializabilidad. En los panes 80:20 se observó un incremento sustancial del contenido de FDT y minerales. El máximo APFe se obtuvo en panes 80:20 con AC y fitasa (0,55 mg%). En fideos, el máximo efecto se observó con AC (0,07 mg%). El APCa fue máximo en fideos 80:20 con AC (16,72 mg%). El mayor APZn se evidenció en pan 80:20 con AC y fitasa (0,40 mg%). La introducción de la HIA en productos panificados fermentados con adición de AC y fitasas permite obtener ventajas nutricionales.

Tratamento da hipertensão na doença renal crônica / Hypertension treatment in chronic renal disease

A hipertensão é condição prevalente na doença renal crônica, e ambas são coadjuvantes numa relação de causa e efeito, e sinérgicas em relação ao risco cardiorrenal. O controle da hipertensão, embora aquém do desejado nessas populações, assim como a redução da proteinúria e da ativação sistema renina-angiotensina-aldosterona, mostram-se fundamentais quando se visa à proteção tanto cardiovascular como renal no paciente nefropata. O emprego da terapia anti-hipertensiva combinada, em geral com duas a três drogas, particularmente com os bloqueadores do sistema renina-angiotensina-aldosterona, tem sido preconizado para se obter metas pressóricas mais estreitas (pressão arterial < 130/80 mmHg), assim como redução da microalbuminúria e da proteinúria, e constitui a estratégia terapêutica no paciente renal diabético ou não. Soma-se a isso o controle de outros fatores tradicionais e aqueles relacionados à doença renal, como o diabetes, a dislipidemia, e os distúrbios do metabolismo cálcio-fósforo, que também são impactantes na doença cardiorrenal. A hipertensão é também prevalente e relevante nas populações de pacientes submetidos a transplante e a diálise, e seu controle provê proteção ao enxerto renal e diminuição de eventos cardiovasculares nessas populações. Os alvos terapêuticos, embora não totalmente estabelecidos, giram ao redor de 130-140/80-90 mmHg, devendo-se atentar às medidas pré/pós-diálise e à monitorização ambulatorial interdiálise. Por ora, a opção é de livre escolha dentre os anti-hipertensivos, embora haja preferência para o uso dos antagonistas de canais de cálcio nessas duas populações e uma indicação, não formal, para os bloqueadores do sistema renina-angiotensina-aldosterona nos pacientes sob diálise. Novos métodos dialíticos ainda têm sido preconizados no intuito de melhorar o componente hidrossalino no paciente dialítico.

Hypertension is a high prevalent condition in chronic renal disease and both are coadjuvants in a cause-effect relantionship, which is also synergic towards cardiorenal risk. Hypertension control, despite not ideal in this population, as so as microalbuminuria/ proteinuria reduction and blockade of the renin angiotensin system, are fundamental tools in terms of cardiovascular and renal protection. Combined antihypertensive therapy, in general with two or three drugs, particularly including a renin angiotensin system blocker, has been recommended in order to obtain a more strict blood pressure control and proteinuria regression in diabetic and non diabetic patients. Traditional and renal disease related cardiovascular risk factors, like as diabetes, dislipidemia, calcium-phosphate disturbances, must also be controlled together, since are contributors to cardiorenal disease. Hypertension is also highly prevalent in transplanted and dialysis patients, and its control provides allograft protection as so as cardiovascular events reduction in this populations. Although not yet established, advised therapeutic blood pressure goals are beyond 130-140/80-90 mmHg. Particular attention is recommended in the pre and post dialysis time, as so as in the interdialytic period. Until now, all first line antihypertensive drugs may be equally employed, although there is a general preference for calcium channel blockers in these populations and a not formal recommendation for the use of renin angiotensin system blockers in dialysis patients. Also, new dialytic methods have been employed in order to improve water and salt balance in dialytic patients.

Doença arterial coronariana e doença renal crônica / Coronary artery disease and chronic kidney disease

A doença renal crônica é uma condição cada vez mais prevalente. À medida que as epidemias de obesidade e diabetes melito se agravam, que a taxa de controle adequado da hipertensão permanece abaixo de 30% e que a expectativa de vida aumenta, é muito provável que a incidência e a prevalência da doença renal crônica também continuem aumentando. A doença renal crônica aumenta muito o risco para eventos cardiovasculares e vários dos principais fatores de risco para doença arterial coronariana são também fatores de risco para doença renal crônica. A maior gravidade da doença arterial coronariana em pacientes com doença renal crônica se traduz em maior mortalidade precoce e tardia de todos os eventos clínicos e na resposta terapêutica uniformemente inferior a todas as intervenções farmacológicas e não-farmacológicas. A maioria dos pacientes com doença renal crônica em estágio de 1 a 4 evolui para óbito cardiovascular antes de alcançar o estágio 5 (taxa de filtração glomerular < 15 ml/min ou diálise). Assim, a principal razão para o diagnóstico precoce da doença renal crônica é a prevenção do óbito cardiovascular. A prevalência da doença renal crônica estágio 5 no Brasil tem aumentado a uma taxa de 8% por ano: em 2005, havia cerca de 70 mil pacientes em programa de diálise e cerca de 3.500 transplantes renais estão sendo realizados anualmente. Assim, no Brasil, como na maioria dos outros países, considerando todos os estágios da doença, 25% a 30% de pacientes da prática médica cardiológica têm doença renal crônica, o que exige conscientização e preparo do especialista.

Chronic kidney disease prevalence is increasing. As obesity and diabetes mellitus epidemics get worse, hypertension well-controlled rate remains below 30% and life expectation continually increases, it’s very likely that chronic kidney disease prevalence will increase even more. Chronic kidney disease increases the risk for cardiovascular events and most of the cardiovascular risk factors are also risk factors for chronic kidney disease. Coronary artery disease in patients with chronic kidney disease is usually worse than in non chronic kidney disease patients. This can be seen in the coronary events higher mortality and in the inferior response to pharmacological and non pharmacological interventions. The majority of patients with chronic kidney disease stages 1 to 4 have cardiovascular death before they reach stage 5 (glomerular filtration rate <15 ml/min or dialysis). Therefore, the main reason for early chronic kidney disease diagnosis is to prevent cardiovascular death. Stage 5 chronic kidney disease in Brazil increases at the rate of 8% per year. In 2005, there were close to 70,000 patients on dialysis and 3,500 renal transplants are being performed annually. In Brazil, as in most of the other countries, taking into account all stages of the disease, 25% to 30% of patients in the clinical cardiology practice have chronic kidney disease, what warrant awareness and specific clinical skills.

A propósito de la diálisis en la urgencia: Presentación de un caso / With regard to the dialysis in the urgency: A case report

Indicaciones para la atención de pacientes con valores alterados de la función renal por parte de los servicios de emergencia, especialmente en los casos en que es necesario indicar hemodiálisis de urgencia.

Binding of diclofenac sodium with bovine serum albumin at different temperatures, pH and ionic strengths.

The study was designed to examine the binding of diclofenac sodium with bovine serum albumin (BSA) at different temperatures (20 degrees, 30 degrees and 40 degrees C), pH (6.4, 7.4 and 8.4) and ionic strengths (micro = 0.1, 0.2 and 0.3) by means of equilibrium dialysis method. The concentration of diclofenac sodium was maintained at wider range from 15 to 900 micromole/l and BSA concentration was maintained at 61.5 micromole/l. The data obtained were interpreted by nonlinear regression method using Graphpad prism software. The analysis showed that the interaction between diclofenac sodium with BSA results in two-site saturable binding. A decrease in association constant was observed with increasing temperature. The average standard free energy change (deltaGdegrees) value was -7.07 (site I) and -4.2 (site II) Kcal/mol. The standard enthalpy change (deltaHdegrees) and the standard entropy change (deltaSdegrees) were -7.8 Kcal/mole, -2.35 cal/mole (site I) and -7.4 Kcal/mole, -10.5 cal/mole (site II), respectively. The negative enthalpy change suggested the binding between diclofenac sodium and the binding sites of BSA were spontaneous and exothermic. The negative value of deltaHdegrees and deltaSdegrees indicated hydrogen bonding and van der Waal's force was the major mechanism for diclofenac sodium and BSA interaction. Increase in pH and ionic strength also caused decrease in association constant of diclofenac sodium and BSA binding.

Manejo de falla hepática fulminante con MARS (diálisis hepática con albúmina) / Sudden liver failure handling with MARS (hepatic dialysis with albumin)

Clínica Las Condes tiene un activo programa de trasplante hepático. Como parte de éste nos vemos enfrentados cada vez con mayor frecuencia a manejar pacientes con insuficiencias hepáticas fulminantes(IHF). Esta condición aún mantiene elevadísimos niveles de mortalidad. Ultimamente se han desarrollado nuevos procedimientos que buscan remover las toxinas involucradas en esta condición clínica, y así permitirle al paciente ganar tiempo vital a la espera de que su hígado se recupere o bien pueda ser reemplazado por otro órgano. Como parte de ellas se desarrolló el MARS (Molecular Adsorbent Recirculating System), que consiste en someter a la sangre del paciente a una diálisis con Albúmina, para así depurar las toxinas que se acumulan en las IHF. El presente artículo pretende, a través de una experiencia clínica vivida en nuestra institución, revisar el tema de la IHF, las técnicas actualmente disponibles para su manejo y comunicar al resto del equipo médico que contamos con una valiosa herramienta para manejar a los pacientes que no sean referidos con esta grave condición.

Adequação de diálise em insuficiência renal aguda / Dialysis adequacy in acute renal failure

O reconhecimento de que morbidade e mortalidade estão inversamente relacionadas à dose de diálise em pacientes com insuficiência renal crônica gerou significativas mudanças na prática clínica. Entre diversos fatores, a persistência da elevada mortalidade de pacientes com insuficiência renal aguda poderia estar relacionada ao recebimento de dose insuficiente de diálise.A adequação de diálise em insuficiência renal aguda envolve o método, início e dose de diálise. O início e o método de diálise ainda não estão claramente estabelecidos. Entretanto, dados recentes sugerem que a sobrevida de pacientes com insuficiência renal aguda está diretamente relacionada à dose de diálise recebida.

Avaliação In vitro e histológica da interação do cloreto de cetiltrimetilamônio com peles de diferentes etnias / In vitro evaluation and histological of the interaction of cetiltrimetilamus chloride with skins of different colors

Com o advento do século XXI e a globalização, o conceito de beleza tornou-se uma fronteira sem limites. A utilização da engenharia genética, a reestruturação do genoma, da tecnologia virtual, visual e a nanotecnologia, inseriu na indústria cosmética e cosmecêutica uma nova visão de competitividade e exigência de um mercado, que poderia denominar-se de "sensorial/digital". O grande modelo responsável por este processo inovador, é sem dúvida alguma a pele, a imagem da aparência externa somados aos mecanismos internos da homeostasia, identifica a arquitetura humana e performance social...

Desarrollo de un instrumento para medir la calidad de vida en pacientes con insuficiencia renal crónica y diálisis. Una experiencia en Honduras / Development of an instrument to measure quality of life in patients with chronic renal failure and dialysis. An experience in Honduras

ANTECEDENTES. La insuficiencia renal crónica (IRC) impacta severamente en la calidad de vida del paciente, sin embargo no existe un instrumento uniforme que la evalúe. OBJETIVO. Determinar el impacto de la IRC en la vida de los pacientes hospitalizados para diálisis peritoneal en el Hospital Escuela durante el primer semestre del año 2000. El instrumento evalúa 11 áreas de la vida (emocional, social, laboral, económica, familiar, conyugal, independencia, función cognitiva, energía, efectos secundarios de la diálisis y calidad de vida en general). se siguió los lineamientos de la Organización Mundial de la Salud para el diseño de las escalas de calidad de vida, así como otros parámetros de otras escalas utilizadas internacionalmente para otras enfermedades. RESULTADOS. Se encontró que la IRC impacta todos los aspectos evaluados, especialmente en las áreas social (83), laboral (77), económica y cognitiva (75 cada una) y emocional (73). eL 30.2 calificó su calidad de vida en el último mes como mala, el 41.5 la calificó como regular, el 26.4 de buena y el 1.9 como muy buena. La vida familiar se afecta importantemente en varios aspectos. CONCLUSION. Se encontro que el cuestionario fue comprensible e internamente consistente. La mayoría de los pacientes manifestó afectación en importantes áreas de su vida, por lo que se requiere un manejo integral del problema.