ABSTRACT

Objetivo: La estrechez uretral es cualquier estrechamiento de la uretra, genere o no alteración en el flujo de orina. Dentro de las opciones de manejo, la reconstrucción uretral por medio de uretroplastia se ha catalogado como el método de referencia. Buscamos demostrar los resultados funcionales en el patrón miccional de los pacientes con diagnóstico de estrechez uretral sometidos a reconstrucción uretral. Método: Cohorte ambispectiva de los pacientes sometidos a reconstrucción uretral por medio de uretroplastia operados en la clínica Foscal entre 2013 y 2021. Se realizó la recolección de variables sociodemográficas, describimos las complicaciones postoperatorias, evaluamos el patrón miccional, el grado de disfunción eréctil asociado, la calidad de vida y el grado de satisfacción postoperatorio, y analizamos los factores asociados con fracaso del procedimiento. Resultados: Ciento veinte uretroplastias en 110 pacientes, 53 escisión y anastomosis (EPA, excision and primary anastomosis) y 67 con injerto. La media de edad fue 56 años, el 89% habían sido sometidos a tratamientos previos, principalmente dilataciones uretrales (46,6%) y uretrotomía interna (35,83%). La principal localización fue bulbar y la principal etiología traumática. Se presentó reestenosis en el 24,5% de las EPA y el 43,28% de los injertos. El 86% reportó satisfacción con el procedimiento. Las complicaciones fueron mayores en el grupo de injerto (31,34 vs. 24,53%). Conclusiones: Nuestros resultados muestran los resultados funcionales de la reconstrucción uretral con ambas técnicas, habiendo una mayor reestenosis en el grupo de injerto. La mayoría de los pacientes se encuentran satisfechos con el resultado.

Objective: Urethral stricture is any narrowing of the urethra that may or may not cause alterations in urine flow. Among the management options, urethral reconstruction through urethroplasty has been classified as the gold standard. We sought to demonstrate the functional results in the voiding pattern of patients with a diagnosis of urethral stricture undergoing urethral reconstruction. Method: Ambispective cohort of patients undergoing urethral reconstruction through urethroplasty operated in clinica Foscal between 2013 and 2021. Sociodemographic variables were collected. We described postoperative complications, we evaluated the voiding pattern, the degree of associated erectile dysfunction, the quality of life and the degree of postoperative satisfaction, and we analyzed the factors associated with failure of the procedure. Results: One hundred and twenty urethroplasties in 110 patients, 53 with excision and primary anastomosis (EPA) and 67 with graft. The average age was 56 years, 89% had undergone previous treatments, mainly urethral dilations (46.6%) and internal urethrotomy (35.83%). The main location was bulbar, and the main etiology was traumatic. Re-stenosis occurred in 24.5% of EPA and in 43.28% of grafts. Eighty six percent reported satisfaction with the procedure. Complications were higher in the graft group (31.34 vs. 24.53%). Conclusions: Our results demonstrate the functional results of urethral reconstruction with both techniques, with greater restenosis in the graft group. Most patients are satisfied with the results.

ABSTRACT

Objetivo: Describir las prácticas de médicos especialistas en urología e infectología con práctica clínica en Colombia para el manejo de la bacteriuria asintomática (BA) preoperatoria de pacientes candidatos a cirugía de cálculos urinarios. Método: Estudio de corte transversal, con recolección de datos por medio de instrumento tipo encuesta, diligenciada por especialistas en urología e infectología en Colombia. Se excluyeron las encuestas con respuestas incompletas o participantes con práctica clínica fuera de Colombia. El análisis estadístico se realizó en SPSS v25.0. Se consideró significativa una p < 0,05. Resultados: Se incluyeron 187 participantes, 85% urólogos y 15% infectólogos. La conducta prequirúrgica más frecuente en el manejo de la BA preoperatoria fue iniciar tratamiento antibiótico dirigido por urocultivo 72 horas antes del procedimiento quirúrgico y llevar al paciente a cirugía dentro de los siguientes tres días. Se evidenciaron diferencias en la práctica clínica (uso de antibiótico postoperatorio, tratamiento de la BA en pacientes con derivación urinaria, tiempo de validez del urocultivo preoperatorio, recomendación de diferir procedimiento hasta tener urocultivo negativo) según la especialidad y el volumen asistencial. Conclusiones: Se ha identificado heterogeneidad en el manejo de la BA previo a cirugía endourológica en Colombia. Se abre una oportunidad para desarrollar recomendaciones colombianas para el manejo de la BA preoperatoria en urolitiasis

Objective: To describe practices from Colombian specialists in urology and infectology for the handling of preoperative asymptomatic bacteriuria (AB) in patients that are candidates for endourological surgery of urolithiasis. Method: Cross-sectional study, with data collection through a survey-type instrument completed by specialists in urology and infectology in Colombia. Surveys with incomplete responses or participants with clinical practice outside of Colombia were excluded. Statistical analysis was performed in SPSS v25.0. A p < 0.05 was considered significant. Results: One hundred eighty-seven participants were included, of which 85% were urologists and 15% were infectologists. The most frequent presurgical behavior in the management of preoperative AB was to start targeted antibiotic treatment 72 hours before the procedure and take the patient to surgery within the next three days. Differences were evident in clinical practice (use of postoperative antibiotics, treatment of AB in patients with urinary diversion, validity period of the preoperative urine culture, recommendation to defer the procedure until a negative urine culture is obtained) depending on the specialty and surgical or clinical volume. Conclusions: The present study has identified heterogeneity in the management of AB prior to endourological surgery in Colombia. An opportunity opens up for the development of Colombian recommendations for the management of preoperative AB in urinary lithiasi

ABSTRACT

Resumo Este estudo teve por objetivo compreender como ocorreu o processo de treinamento esfincteriano de crianças autistas. Trata-se de um estudo retrospectivo, descritivo, de análise qualitativa. Foram realizadas entrevistas semiestruturadas com sete cuidadoras de crianças com diagnóstico de TEA, entre 2 e 6 anos, que já haviam concluído este treino. As entrevistas foram transcritas e submetidas à análise de conteúdo. A análise dos dados permitiu identificar quatro categorias: treinamento de controle esfincteriano para evacuação, treinamento de controle esfincteriano para urinar, estratégias auxiliares e dificuldades no processo. Os resultados indicaram maior dificuldade das crianças com TEA para controlar as fezes e, em geral, o desfralde diurno e noturno ocorreu em duas etapas. Foram utilizados acessórios e recursos lúdicos como facilitadores do processo, além de estratégias de reforço positivo, punição positiva e punição negativa. Existiram dificuldades, das próprias cuidadoras, de ordem emocional e física, e estas não receberam ajuda profissional. Este estudo avança no conhecimento acerca do treinamento de controle esfincteriano de crianças com TEA, indicando estratégias que facilitem esse processo, tanto para cuidadores quanto para crianças, contribuindo para a capacitação dos profissionais que atuam com essa população.

Abstract This study aimed to understand how the process of toilet training occurred in autistic children. This is a retrospective, descriptive study with qualitative analysis. Semi-structured interviews were carried out with seven caregivers of children diagnosed with Autism Spectrum Disorder (ASD), aged between 2 and 6 years old, who had already completed this training. The interviews were transcribed and subjected to content analysis. Data analysis allowed us to identify four categories: toilet training for evacuation, toilet training for urination, supporting strategies, and difficulties in the process. The results indicated greater difficulty for children with ASD to control their feces and, in general, daytime and nighttime toilet training occurred in two stages. Accessories and playful resources were used to facilitate the process, in addition to positive reinforcement, positive punishment and negative punishment strategies. There were emotional and physical difficulties for the caregivers themselves, and they did not receive professional help. This study advances knowledge about toilet training for children with ASD, indicating strategies that facilitate this process, both for caregivers and children, contributing to the training of professionals who work with this population.

ABSTRACT

Introducción: la infección del tracto urinario es la segunda causa de compromiso bacteriano en niños, genera altos costos para el sistema de salud, puede ser la primera manifestación de una anomalía en la vía urinaria y es un factor de riesgo para múltiples patologías. Objetivo: caracterizar el perfil epidemiológico y microbiológico de la primera infección del tracto urinario en la población pediátrica de un centro de referencia en Pereira, Colombia. Métodos: estudio de corte transversal que incluyó pacientes entre 2 meses y 10 años de edad, con la primera infección urinaria según los criterios de la Academia Americana de Pediatría, entre 2016 y 2017. Las resistencias bacterianas fueron definidas según las guías CLSI vigentes (Clinical and Laboratory Standards Institute). Se utilizó estadística descriptiva y las guías STROBE para el reporte del estudio. Resultados: se incluyeron 81 pacientes, 28% de sexo masculino, la mayor parte estaban entre 2 y 12 meses de vida (40%), 49% cursaron con nitritos positivos, 39% hematuria y 37% proteinuria, 87% el gram de orina fue positivo, 18% presentaron anomalías ecográficas; los uropatógenos más frecuentes fueron Escherichia coli (86%), Proteus mirabilis (5%) y Klebsiella pneumoniae (5%). La E. coli fue resistente en 51,4%, 32,8% y 17,1% a trimetoprim-sulfametoxazol, ampicilina-sulbactam y cefalotina. La presencia de betalactamasas de espectro extendido fue de 2,8%, la mediana de tratamiento empírico fue de 3 días y el tratamiento total de 10 días. Discusión: se observó alta prevalencia de resistencia antibiótica a ampicilina, ampicilina-sulbactam y trimetoprim-sulfametoxazol, lo que desaconseja su empleo. La buena sensibilidad del E coli reportada en este estudio a la cefalotina y la amikacina, favorecen su uso como primeras elecciones terapéuticas empíricas en nuestro medio. Conclusión: se recomienda la ecografía urinaria en los pacientes con primera infección urinaria febril, debido a la alta prevalencia de anomalías urinarias identificadas.

Introduction: urinary tract infection (UTI) is the second cause of bacterial infection in children, generates high costs for the health system, may be the first manifestation of urinary tract anomalies and is a risk factor for multiple pathologies. Objective: to characterize the epidemiological and microbiological profile of the first UTI episode in the pediatric population of a referral center in Pereira, Colombia. Methods: a cross-sectional study, conducted during 2016- 2017, including patients aged 2 months to 10 years, with their first UTI episode, based on the American Academy of Pediatrics criteria. Bacterial resistance was defined using current CLSI (Clinical and Laboratory Standards Institute) guidelines. Descriptive statistics and STROBE guidelines were used for reporting this study results. Results: 81 patients were included, 28% were males, most were aged 2 to 12 months (40%), 49% were nitrite-positive, 39% had hematuria and 37% proteinuria, and 87% had a positive Gram stain. Ultrasound imaging revealed urinary tract anomalies in 18%; the most common uropathogens were: Escherichia coli (86%), Proteus mirabilis (5%) and Klebsiella pneumoniae (5%). E. coli showed resistance for trimethoprim-sulfamethoxazole, ampicillin-sulbactam and cephalothin in 51.4%, 32.8% and 17.1%, respectively; 2.8% were extended-spectrum betalactamase/ESBL-positive. The median time of empiric management was 3 days and full treatment was of 10 days. Discussion: high resistance rates were recorded for ampicillin, ampicillin-sulbactam and trimethoprim-sulfamethoxazole, which discourage their use. The sensitivity of E coli to cephalothin and amikacin, reported in this study, favors their use as first empirical therapeutic choices in our setting. Conclusion: ultrasound examination of the urinary tract is recommended in patients experiencing their first febrile UTI episode, due to the high prevalence of urinary anomalies identified.

ABSTRACT

INTRODUCCIÓN: El absceso renal es infrecuente en pediatría, con clínica y laboratorio inespecíficos. Ante su sospecha, es necesario realizar imágenes para establecer diagnóstico. Objetivo: Describir las características clínico-epidemiológicas, microbiológicas, diagnósticas y terapéuticas de abscesos renales en pediatría. PACIENTES Y MÉTODOS: Estudio retrospectivo, descriptivo, de pacientes internados con absceso renal, en seguimiento por Infectología del Hospital de Niños Ricardo Gutiérrez, durante 9 años. RESULTADOS: 15 pacientes (67% varones), mediana de edad 9 años (rango [r] 0,7-17). Cuatro pacientes con comorbilidades. El síntoma más frecuente fue fiebre seguido por dolor lumbar. El recuento medio de leucocitos en sangre fue de 15.700/mm3 (r: 7.100-45.000) y la PCR de 193 mg/L (r: 1-362). Cuatro pacientes presentaron urocultivo positivo: dos Escherichia coli, uno Klebsiella pneumoniae y E. coli y otro Candida albicans y K. pneumoniae. Ningún paciente presentó bacteriemia. El diagnóstico se confirmó por ecografía. Se realizó drenaje en siete pacientes, con aislamiento de Staphylococcus aureus en dos y Pseudomonas aeruginosa en uno. El tratamiento incluyó terapia combinada en 67%. Mediana de antibioterapia intravenosa fue 16 días (r: 7-49), total de 28 (r: 14-91). Un paciente requirió terapia intensiva y dos, nefrectomía. CONCLUSIÓN: Los abscesos renales son infrecuentes, con gran morbimortalidad. Sospechar en paciente con infección del tracto urinario (ITU) de evolución tórpida que persiste febril. En nuestro estudio, la alta sensibilidad de la ecografía renal permitió su diagnóstico precoz.

BACKGROUND: Renal abscesses are infrequent in pediatrics, with nonspecific clinical and laboratory findings. When suspected, imaging is essential to establish the diagnosis. Aim: To describe the clinical-epidemiological, microbiological, diagnostic and therapeutic characteristics of renal abscesses in pediatrics. METHODS: Retrospective and descriptive study of hospitalized patients with renal abscess, followed by Infectious Diseases Department of Ricardo Gutiérrez Children's Hospital during 9 years. Statistical analysis: Epi Info 7.2.2.6. RESULTS: 15 patients (67% male), median age 9 years (range [r] 0.7-17) were included. Four patients had underlying disease. The most frequent symptom was fever, with a median duration of 10 days (r:1-36), followed by lumbar pain. The median white blood cell count was 15,700/mm3 (r: 7,100-45,000) and CRP 193mg/L (r: 1-362). Four patients presented positive urine culture: 2 Escherichia coli, 1 Klebsiella pneumoniae and E. coli and 1 Candida albicans and K. pneumoniae. No patient had bacteremia. The diagnosis of abscess was confirmed by ultrasound. Surgical drainage was performed in 7 patients, with isolation of Staphylococcus aureus in 2 and Pseudomonas aeruginosa in 1. Empirical treatment included 3rd generation cephalosporin, combined in 67% of cases. The median of intravenous antibiotic therapy was 16 days (r: 7-49) with a total of 28 days (r:14-91). One patient required transfer to intensive care unit and 2 nephrectomy. CONCLUSION: Renal abscesses are infrecuent in pediatrics, but they present significant morbidity and mortality. It should be suspected in patients with urinary tract infection (UTI)with torpid evolution that persists with fever without antibiotic response. In our study, the high sensitivity of renal ultrasound allowed early diagnosis.

ABSTRACT

La urolitiasis en niños y adolescentes es etiológicamente multifactorial, incluyendo bajo volumen urinario o desequilibrio entre factores promotores e inhibidores de la cristalización urinaria. La hipocitraturia es una alteración bioquímica relacionada con pH urinario acido y dietas ricas en proteínas o deficientes en frutas y hortalizas. Objetivos: determinar los valores urinarios de citrato y de algunos promotores de la cristalización (calcio, ácido úrico y fósforo) en pacientes menores de 18 años con urolitiasis. Métodos: se incluyeron 68 pacientes menores de 18 años con diagnóstico de urolitiasis en quienes se realizaron los siguientes estudios: examen general de orina (muestra aislada), calcio, fosforo, ácido úrico y citrato (recolección de 24 horas), gases venosos, electrolitos séricos y ecosonograma renovesical. En los pacientes hipocitratúricos también se determinó la citraturia después de seis meses de tratamiento con citrato de potasio. Los pacientes se dividieron en dos grupos: grupo A, pacientes normocitratúricos y grupo B, pacientes hipocitratúricos. Resultados: cuarenta y tres pacientes (63%) presentaron antecedentes familiares de litiasis. valores de citraturia (mgs/24hrs): grupo total: X:280±108,8; grupo A: 488,503±112,4; grupo B: X:169,5±95,2. Se evidenció hipocitraturia en 44 pacientes (64,71%). Alteraciones asociadas (n/%): acidosis metabólica (23/33%), de los cuales 20 pacientes (87%) tuvieron hipocitraturia; hiperuricosuria (16/23,52%); hipercalciuria (15/22,05%); hiperfosfaturia (09/13,23%); pH urinario ácido (35/51%) y alcalino o neutro (33/49%); pH urinario persistentemente acido (18/41%). en 28 pacientes (41,17%) se encontraron alteraciones metabólicas mixtas. Conclusiones: la hipocitraturia se encontró en más de la mitad de los pacientes estudiados y se asoció de manera significativa con otras alteraciones metabólicas litogénicas(AU)

Urolithiasis in children and adolescents is etiologically multifactorial, including low urinary volume or imbalance between urinary crystallization promoting and inhibiting factors. Hypocitraturia is a biochemical alteration related to urinary acid pH and diets high in protein or low in fruits and vegetables. Objectives: to determine urinary values of citrate and crystallization promoters (calcium, uric acid and phosphorus) in patients less than 18 years of age with urolithiasis. Methods: sixty-eight patients under 18 years of age with a diagnosis of urolithiasis were submitted to the following studies: urinalysis (isolated urine sample), calcium, phosphorus, uric acid and citrate (24-hour collection), venous gases, serum electrolytes and abdominal ultrasonogram. In hypocytraturic patients, citraturia was also determined after six months of treatment with potassium citrate. Patients were divided into two groups: group A, normocytraturic patients, and group B, hypocytraturic patients. Results:. Forty-three patients (63%) had a family history of urolithiasis. urinary citrate values (mgs/24hrs): total group: X:280±108.8; group A: 488,503±112.4; group B: X:169.5±95.2. hypocitraturia was observed in 44 patients (64.71%). Associated alterations (n/%): metabolic acidosis (23/33%), of which 20 patients (87%) had hypocitraturia; hyperuricosuria (16/23.52%); hypercalciuria 15/22.05%; hyperphosphaturia 9/13.23%; urinary acid pH (35/51%) and alkaline or neutral (33/49%); persistently urinary acid pH (18/41%). Mixed metabolic alterations were found in 28 patients (41.17%). Conclusions: hypocitraturia was found in more than half of the patients and was significantly associated with other lithogenic metabolic alterations(AU)

ABSTRACT

Objective: To explore the value of paraquat (PQ) intake, urine protein and myocardial enzyme indexes in judging the prognosis of patients with acute PQ poisoning. Methods: From September to December 2021, all 201 patients with acute PQ poisoning admitted to Guangzhou Twelfth People's Hospital from January 2010 to December 2019 were selected as the research objects. Based on follow-up results 60 days after poisoning, the research objects were divided into survival group (n=78) and death group (n=123) . The differences in information about poisoning, treatment plan, PQ intake, urine protein, creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase between the two groups of patients were compared and analyzed. Logistic regression and Cox regression were used to analyze the correlation between poisoning outcome and PQ intake, urine protein and myocardial enzymes. ROC curve and principal component analysis were used to explore high-efficiency indicators for predicting the outcome of acute PQ poisoning. Results: The PQ intake[50 (20, 100) ml], urine protein (total rank 15570.50) , creatine kinase[ (336.36±261.96) U/L], creatine kinase isoenzyme[ (43.91±43.74) U/L], lactate dehydrogenase [ (346.01±196.50) U/L], α-hydroxybutyrate dehydrogenase content[ (271.23±11.92) U/L] of patients in the death group were all higher than the survival group[15 (10, 20) ml, 4730.50, (187.78±178.06) U/L, (18.88±15.50) U/L, (190.92±60.50) U/L, (152.60±48.34) U/L, respectively] (P<0.05) . The outcome of acute PQ poisoning was positively correlated with PQ intake, urine protein, creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase (P<0.05) . Multivariate logistic regression and multivariate Cox regression analysis showed that creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase and α-hydroxybutyrate dehydrogenase was positively correlated with the prognosis of patients with acute PQ poisoning (P<0.05) . ROC curve analysis and principal component analysis showed that the combined indexes of PQ intake, urine protein and myocardial enzymes had the highest efficacy and weight in judging the prognosis of patients (AUC=0.91, weight coefficient=0.19, sensitivity=0.76, specificity=0.89) . When the combined score was ≥4, the probability of accurately predicting the death of patients was as high as 91% (positive predictive value=0.91) . Conclusion: PQ intake, urine protein combined with creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase has high value in predicting the prognosis of patients with acute PQ poisoning.

ABSTRACT

Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p =0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP

ABSTRACT

Abstract In the present study, the application of ultra-high performance liquid chromatography-tandem mass spectrometry allowed us to study of known-as well as hitherto unknown-trimetazidine (TMZ) metabolites in human urine and to propose their renal excretion profiles. Urine samples from a healthy volunteer were analyzed at baseline and at 0-4 h, 4-8 h, 8-12 h, and 12-24 h after a single dose of TMZ. A dilute-and-shoot procedure was used as sample treatment before separation. Full-scan spectra of possible metabolites were acquired. Additionally, product ion scan spectra of precursor ions of interest were also acquired at two collision energies. Intact TMZ was a major excretion product, with a maximum concentration at 4-8 h after administration. Moreover, five minor metabolites were observed, namely trimetazidine-N-oxide (M1), N-formyl trimetazidine (M2), desmethyl-trimetazidine O-sulfate (M3), desmethyl-trimetazidine O-glucuronide (M4), and desmethyl-trimetazidine-N-oxide-O-glucuronide (M5). Metabolite M5 has not previously been reported. Excretion curves were constructed based on the chromatographic peak areas of specific mass transitions (precursor ion > product ion) related to each of the detected metabolites

ABSTRACT

A litíase úrica tem seu número em crescente nas últimas décadas, contando mais de 10% dos tipos de cálculos. É também bem desenhado o mecanismo etiopatogênico que leva a sua formação, que necessita de um ambiente com pH inferior a 5,5 para seu desenvolvimento. Outros fatores que contribuem para sua formação são a hiperuricosúria e o baixo volume urinário. É também bem estabelecido o perfil dos indivíduos formadores de cálculos de ácido úrico na literatura, que conta com indivíduos com obesidade e diabetes mellitus. O objetivo do estudo foi estabelecer o perfil clínico-metabólico dos indivíduos formadores de litíase úrica confirmada por análise morfoconstitucional e cristalográfica e objetivo secundário, observar mudança no perfil após alcalinização urinária. Na amostra de 47 indivíduos, 82% eram portadores de sobrepeso ou obesidade, 62% eram hipertensos e 30%, diabéticos. A recorrência foi encontrada em 98%, sendo necessária ureterolitotripsia flexível em 85%, nefrolitotripsia percutânea em 19%. As alterações urinárias mais relevantes foram 100% dos indivíduos com pH < 5,5, sendo 40% com pH < 5,0, hipernatriúria (65%) e hiperfosfatúria (52%). A hiperuricosúria estava presente em 19% da amostra estudada. O tratamento de alcalinização urinária foi realizado em 89% com citrato de potássio e 19% com bicarbonato de sódio. o pH urinário acima de 6,2 foi encontrado em 62% em consulta ambulatorial, sendo apenas 1 indivíduo com pH acima de 7,0. As alterações observadas na urina de 24h com p < 0,05 foram a melhora da citratúria, caliúria, uricosúria e melhora do pH urinário.(AU)

In recent decades, the incidence of uric acid nephrolithiasis has been on the rise, with more than 10% of kidney calculi cases. The etiopathogenic mechanism of these types of calculi requires pH lower than 5.5. Additionally, factors such as hyperuricosuria and low urinary volume can contribute to their development. The literature has established a clear profile of individuals who are prone to forming uric acid stones, including those with obesity, diabetes mellitus. The aim of this study was to determine the clinical and metabolic characteristics of individuals with uric acid nephrolithiasis, which was confirmed by analyzing their morpho-constitutional and crystallographic data. A secondary objective was to observe any change in the profile of individuals after undergoing urine alkalization treatment. The sample size of 47 individuals revealed that 82% were overweight or obese, 62% were hypertensive, and 30% had diabetes. Recurrence was observed in 98% of cases with 85% requiring flexible ureterolithotripsy and 19% requiring percutaneous nephrolithotripsy. Furthermore, 59% of the calculi were larger than 10 mm. Urinary alterations were prevalent in the studied sample, with 100% of the individuals exhibiting a pH lower than 5.5 and 40% exhibiting a pH lower than 5.0. Moreover, 65% had hypernatriuria and 52% had hyperphosphaturia. Hyperuricosuria was present in 19% of the sample. Urinary alkalinization treatment was administered to 89% of individuals using potassium citrate and 19% using sodium bicarbonate. The pH above 6.2 was successfully achieved in 62% of individuals through outpatient consultation.(AU)

ABSTRACT

A amiloidose hereditária por mutação da transtirretina (ATTRv) é uma doença sistêmica, progressiva e incapacitante de caráter autossômico dominante e penetrância variável. É a forma mais comum de amiloidose hereditária (familiar). A apresentação clínica é predominantemente neurológica e cardíaca, mas já foi comprovado depósito amiloide nos compartimentos glomerular e tubulointersticial dos rins. Portanto, distúrbios de acidificação urinária como a acidose tubular renal (ATR) podem ser manifestações precoces de acometimento renal nesta população. O objetivo deste estudo foi avaliar a prevalência de ATR subclínica em indivíduos portadores de ATTRv que fazem parte do Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), situado no Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Incluímos em caráter seccional indivíduos acompanhados ambulatorialmente já sintomáticos da ATTRv e também carreadores assintomáticos, maiores de 18 anos, com TFG>45 ml/min/1,73m² (estimada pela equação CKD-EPI), sem acidose metabólica sistêmica. Após 12h de restrição hídrica (TRH), coletamos amostras de sangue venoso para bioquímica, gasometria e amostras de urina para análise por fita reagente, gasometria, pH urinário (pHu) por potenciometria (0h, 1h, 2h, 3h e 4h), amônio urinário (NH4+) por espectrofotometria e acidez titulável (AT) por NaOH (0h e 4h, respectivamente). Protocolo de acidificação urinária foi realizado com furosemida e fludrocortisona. Acidose Tubular Proximal (ATRp) foi diagnosticada se FEHCO3>10%. Acidose Tubular Distal (ATRd) forma incompleta foi diagnosticada se pHu>5,3 em todas as medidas com ausência de aumento de NH4+ ou AT. Análise estatística foi realizada através de testes de Wilcoxon, Friedman, correlação linear simples e curva ROC. Avaliamos 49 indivíduos, 40(35,5-56,5) anos, 63% mulheres, 84% caucasianos, IMC 24,9±4,9kg/m2, TFG 85,5±20,5ml/min/1.73m2, ausência de proteinúria patológica ou acidose metabólica. 94% apresentavam variante genética Val50Met. 57% dos indivíduos eram sintomáticos. A prevalência de ATRp foi de 2% (n=1). A prevalência de ATRd forma incompleta foi de 16,3% (n=8) com curva de pHu com as seguintes medianas: 0h 6,0; 1h 6,2; 2h 6,3; 3h 5,7; 4h 6,1 (p=0,477). No subgrupo com ATRd não houve aumento significativo nas excreções urinárias de NH4+ e AT: NH4+ de 46,2(28,4-75,4) µEq/min/1,73m2 para 64,3(28,3-84,2) µEq/min/1,73m2, (p=0,742) e AT de 18,1(15,1-23,6) µEq/min/1,73m2 para 17,7(15,9-24,5) µEq/min/1,73m² (p=0,945). Observamos boa correlação entre pHu por potenciometria versus pHu fita reagente (Spearman's Rho 0,797, R2 0,827; p<0,0001). O pHu<5,5 na fita reagente teve 100% de sensibilidade e VPN para afastar ATRd forma incompleta (AUC 0,909; p<0,001). Portanto, este é o primeiro trabalho a demonstrar ATR em indivíduos portadores de ATTRv. O pHu na fita reagente após TRH teve boa acurácia para triagem de ATRd forma incompleta. Novos estudos são necessários para avaliar o impacto do diagnóstico e tratamento precoces de ATR nesta população.(AU)

Hereditary transthyretin amyloidosis (ATTRv) is a systemic, progressive, disabling disease of autosomal dominant character and variable penetrance. It is the most common form of inherited (familial) amyloidosis. The clinical presentation is predominantly neurological and cardiac, but amyloid deposition has been proven in the glomerular and tubulointerstitial compartments of the kidneys. Therefore, urinary acidification disorders such as renal tubular acidosis (RTA) may be early manifestations of renal involvement in this population. This study aimed to evaluate the prevalence of subclinical RTA in patients with ATTRv who part of the Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), located at the University Hospital Clementino Fraga Filho from Federal University of Rio de Janeiro. We included outpatients with ATTRv, older than 18 years, with GFR>45 ml/min/1.73m² (estimated by the CKD-EPI equation), without systemic metabolic acidosis. After 12h of water deprivation (WDT), we collected venous blood samples for biochemistry, blood gas and urine samples for analysis by dipstick, urinary pH (UpH) by potentiometry (0h, 1h, 2h, 3h and 4h), urinary ammonium (NH4+) by spectrophotometry and titratable acidity (TA) by NaOH (0h and 4h, respectively). Urinary acidification protocol was performed with furosemide and fludrocortisone. Proximal Tubular Acidosis (pRTA) was diagnosed if FEHCO3>10%. Incomplete form distal tubular acidosis (dRTA) was diagnosed if UpH>5.3 in all measurements with absence of increased NH4+ or TA. Statistical analysis was performed using Wilcoxon test, Friedman test, simple linear correlation, and ROC curve. We evaluated 49 patients, 40(35.5-56.5) years old, 63% female, 84% Caucasian, BMI 24.9±4.9kg/m2, GFR 85.5±20.5ml/min/1.73m2, absence of pathological proteinuria or metabolic acidosis. 94% had Val50Met genetic variant. 57% of patients were symptomatic. The prevalence of pRTA was 2% (n=1). The prevalence of incomplete form dRTA was 16.3% (n=8) with UpH curve with the following medians: 0h 6.0; 1h 6.2; 2h 6.3; 3h 5.7; 4h 6.1 (p=0.477). In the subgroup with dRTA there was no significant increase in urinary excretions of NH4+ and TA: NH4+ from 46.2(28.4-75.4)µEq/min/1.73m2 to 64.3(28.3-84.2)µEq/min/1.73m2, (p=0.742) and TA from 18.1(15.1-23.6)µEq/min/1.73m2 to 17.7(15.9-24.5)µEq/min/1.73m² (p=0.945). We observed good correlation between UpH by potentiometry versus UpH dipstick (Spearman's Rho 0.797, R2 0.827; p<0.0001). The UpH<5.5 on the dipstick had 100% sensitivity and NPV to rule out dRTA (AUC 0.909; p<0.001). Therefore, this is the first study to demonstrate RTA in patients with ATTRv. The UpH on the dipstick after WDT had good accuracy for screening for dRTA. Further studies are needed to evaluate the impact of early diagnosis and treatment of RTA in this population.(AU)

ABSTRACT

Despite numerous studies related to dehydration there is still a lack of scientific literature presenting hydration status and fluid intake of judo athletes during different periods. Therefore, the aim of this study was to investigate, fluid intake, hydration status and body weight changes of young judo athletes during a typical day of training in preparation period. Twenty-two young judo athletes (age: 12 ± 0.7 y, experience: 3.5 ± 1.1) voluntarily participated in this study. Hydration status and weight were examined in the morning, before and immediately after the training. All athletes trained 90 min and they consumed fluids ad libitum during the exercise. According to morning urine specific gravity (USG) values, 81.2% of the athletes were dehydrated while only 18.8% of the athletes were euhydrated. Pre-training urine measurements showed that 63.64% of the athletes presented dehydration and 77.27% of the athletes completed the training in dehydrated condition despite fluid availability during the training. Mean body weight loss during training was -0.64 ± 0.66%. It can be concluded that young judo athletes presented high prevalence of dehydration as indicated by USG values. Most of the athletes were dehydrated during a typical training day and completed the training in more dehydrated conditions compared to pre training values despite ad libitum fluid intake. It is of great importance to evaluate hydration status of the athletes before training to refrain from common practice of fluid restriction for weight loss and adverse effects of a persistent state of fluid deficit on physical and health related state.

ABSTRACT

Background: In low-resource settings, antimicrobial resistance (AMR) is detected by traditional culture-based methods and ensuring the quality of such services is a challenge. The AMR Scorecard provides laboratories with a technical assessment tool for strengthening the quality of bacterial culture, identification, and antimicrobial testing procedures. Objective: To evaluate the performance of the AMR Scorecard in 11 pilot laboratory evaluations in three countries also assessed with the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist.Methods: Pilot laboratory evaluations were conducted in Cameroon, Ethiopia and Kenya between February 2019 and March 2019. Assessors with previous SLIPTA and microbiology experience were trained. Assessors performed the laboratory assessments using the SLIPTA and AMR Scorecard tools.Results: Weaknesses in technical procedures and the quality management systems were identified in all areas and all laboratories. Safety had the highest mean performance score (SLIPTA: 68%; AMR Scorecard: 73%) while management review had the lowest (SLIPTA: 32%; AMR Scorecard: 8%) across all laboratories. The AMR Scorecard scores were generally consistent with SLIPTA scores. The AMR Scorecard identified technical weaknesses in AMR testing, and SLIPTA identified weaknesses in the quality management systems in the laboratories.Conclusion: Since the AMR Scorecard identified important gaps in AMR testing not detected by SLIPTA, it is recommended that microbiology laboratories use SLIPTA and the AMR Scorecard in parallel when preparing for accreditation. Expanding the use of the AMR Scorecard is a priority to address the need for quality clinical microbiology laboratory services in support of optimal patient care and AMR surveillance.

ABSTRACT

O número de pessoas utilizando substâncias ilícitas de forma recreativa aumenta a cada ano, chamando a atenção de estudiosos de diversas áreas do conhecimento. Com isso, a demanda de exames toxicológicos exigida para trabalhadores, vítimas de crimes e esportistas também tem crescido. A amostra biológica mais utilizada para análises toxicológicas continua sendo a urina, visto que sua obtenção é menos invasiva, possibilita coletar grande volume de amostra e pode-se detectar substâncias até dias após ter ocorrido a exposição ou consumo. Entretanto, estas amostras necessitam de um grande volume físico para serem armazenadas e transportadas aos laboratórios, devendo ser mantidas em temperatura baixa e controlada para conservação. Outro ponto a se considerar é a quantidade de amostra insuficientemente coletada, ou extravasamento do conteúdo, contaminando outras amostras e muitas vezes, inviabilizando a análise. Uma alternativa recente para tais problemas é utilizar a técnica chamada de dried urine spots (DUS), onde poucos microlitros de urina são colocados em um papel absorvente e secos sob temperatura ambiente, preservando de agentes degradantes os componentes presentes na urina. Assim, o objetivo deste trabalho é avaliar a estabilidade das substâncias do presente estudo em alta temperatura, temperatura ambiente e em temperaturas de 4°C e -20°C. Para este fim, foi necessário desenvolver, validar e aplicar métodos de extração e determinação de anfetaminas e produtos de biotransformação de cocaína e tetraidrocanabinol carboxílico (THCCOOH) em amostras dried urine spot, utilizando cromatografia líquida acoplada à espectrometria de massas. Os picos foram identificados por UPLC-ESI-MS/MS, com tempo total de 5 mins utilizando fase A- água, formiato de amônio e 0,1% ácido fórmico, e B- metanol: acetonitrila (6:4) + 0,1% de ácido fórmico. A extração foi feita utilizando acetonitrila: metanol: acetona (1:1:1) +ácido fórmico 0,1%. Não foi possível iniciar a validação de THCCOOH, visto uma possível complexação do analito com o papel. Para as outras substâncias, o método cromatográfico desenvolvido se mostrou eficiente e seletivo, com LOD e LOQ de 10 ng/mL para todos os analitos, sendo linear até 1000 ng/mL, atendeu as especificações de precisão e exatidão e carryover. As amostras permaneceram estáveis ao longo de 32 dias nas temperaturas estudadas, demonstrando a segurança em se utilizar a técnica de DUS para armazenamento e transporte de amostras biológicas dentro da faixa de temperatura do estudo até 32 dias

The number of people using illegal substances in a recreational way increases each year, drawing the attention of scholars from different areas of knowledge. As a result, the demand for workplaces drug tests, toxicological tests for victims of crimes and dopping has also grown. The biological sample most used for toxicological tests remains urine, since obtaining it is less invasive, it is possible to collect a large volume of sample and it is possible to detect substances up to days after exposure or consumption has occurred. However, these samples require a large physical volume to be stored and transported to the laboratories, and must be kept at a low temperature for conservation. Another point to consider is the amount of sample insufficiently collected, or leakage of the content, causing contamination of other samples and often making the analysis unfeasible. A recent alternative to such problems is to use "dried urine spots" (DUS), where few microliters of urine are placed on absorbent paper and dried at room temperature, preserving the components present in the urine from degrading agents. Thus, the objective of this work is to evaluate the stability of the substances in this study at high temperature, room temperature and at temperatures of 4°C and -20°C. For this purpose, it was necessary to develop, validate and apply methods of extraction and determination of amphetamines and biotransformation products of cocaine and carboxylic tetrahydrocannabinol (THCCOOH) in dried urine spot samples, using liquid chromatography coupled to mass spectrometry (LC-MS). The peaks were identified liquid chromatography coupled to a mass spectrometer (UPLC-ESI-MS/MS), with a total time of 5 mins using phase A- water, ammonium formate and 0.1% formic acid, and B- methanol: acetonitrile (6:4) + 0.1% formic acid. Extraction was done using acetonitrile: methanol: acetone (1:1:1) + 0.1% formic acid. It was not possible to perform the validation of THCCOOH, given a possible complexation of the analyte with the paper. To the others substances, the chromatographic method developed proved to be efficient and selective, with LOD and LOQ of 10 ng/mL for all analytes, being linear up to 1000 ng/mL, meeting the specifications of precision and accuracy and carryover. The samples remained stable for 32 days at the temperatures studied, demonstrating the safety of using the DUS technique for storage and transport of biological samples until 32 days on temperature range studied

ABSTRACT

A plataforma de ELISA (ensaio de imunoabsorção por ligação enzimática) tem sido amplamente utilizada para detectar anticorpos anti-SARS-CoV-2 gerados após a exposição ao vírus ou à vacinação. A amostra comumente utilizada para a realização do teste é o soro. Até o momento, nenhum estudo havia investigado a urina do paciente como amostra para detectar anticorpos específicos para o vírus SARS-CoV-2. A urina é um espécime biológico que traz vantagens significativas inerentes ao tipo de amostra, que compreende coleta não invasiva, de fácil manuseio e armazenamento. Neste trabalho, propomos um ELISA indireto in house baseado no uso de urina e proteínas recombinantes do Nucleocapsídeo (N) ou da Spike (S) do vírus SARS-CoV-2. As proteínas recombinantes (r) de SARS-CoV-2, N e as subunidades da proteína S (S-Glic, S1-NGlic e RBD-NGlic), foram avaliadas usando um painel composto por aproximadamente 200 amostras de urina e de soro. A presença de anticorpos anti-SARS-CoV-2 na urina foi detectada com sensibilidade e especificidade similares ou superiores ao soro, nas quais foram obtidos valores de sensibilidade de 94,0%, 75,0%, 81,38% e 89,66%, e especificidade de 100%, 96,0%, 96,77% e 96,77%, frente às proteínas rSARS-CoV-2 N, S-Glic, S1-NGlic e RBDNGlic, respectivamente. Dessa forma, os dados apresentados sugerem que a urina poderia ser considerada como uma potencial amostra biológica para aplicação em plataformas de imunodiagnóstico para a infecção por SARS-CoV-2, trazendo benefícios tanto no contexto individual quanto populacional.

The Enzyme-linked immunosorbent assay (ELISA) method has been widely used to detect anti-SARS-CoV-2 antibodies generated after exposure to the virus or vaccination. The sample usually used to perform the test is the serum. Thus far, no study has investigated the urine of patients as biological sample to detect specific SARS-CoV-2 antibodies. Urine is a biological specimen with significant advantages inherent to the type of sample, which comprises non-invasive collection, easy handling and storage. In this work, we propose an in house urine-based indirect ELISA using recombinant proteins from Nucleocapsid (N) and Spike (S) of the SARSCoV-2 virus. SARS-CoV-2 recombinant N and S protein subunits (Gly-S, NonGly-S1 and NonGly-RBD) were evaluated in an ELISA platform with a panel composed about 200 urine and serum samples. The presence of anti-SARS-CoV-2 antibodies in urine was detected with similar or superior sensitivity and specificity to serum, in which sensitivity values of 94.0%, 75.0%, 81.38% and 89.66% were obtained, while specificity values were of 100.0%, 96.0%, 96.77% and 96.77%, respectively, against rSARS-CoV-2 N, S-Glic, S1-NGlic and RBD-NGlic proteins. In conclusion, the data presented suggest that urine could be considered as a potential biological sample for application in immunodiagnostic platforms for SARS-CoV-2 infection, with benefits to the individual and population context.

ABSTRACT

O número de pessoas utilizando substâncias ilícitas de forma recreativa aumenta a cada ano, chamando a atenção de estudiosos de diversas áreas do conhecimento. Com isso, a demanda de exames toxicológicos exigida para trabalhadores, vítimas de crimes e esportistas também tem crescido. A amostra biológica mais utilizada para análises toxicológicas continua sendo a urina, visto que sua obtenção é menos invasiva, possibilita coletar grande volume de amostra e pode-se detectar substâncias até dias após ter ocorrido a exposição ou consumo. Entretanto, estas amostras necessitam de um grande volume físico para serem armazenadas e transportadas aos laboratórios, devendo ser mantidas em temperatura baixa e controlada para conservação. Outro ponto a se considerar é a quantidade de amostra insuficientemente coletada, ou extravasamento do conteúdo, contaminando outras amostras e muitas vezes, inviabilizando a análise. Uma alternativa recente para tais problemas é utilizar a técnica chamada de dried urine spots (DUS), onde poucos microlitros de urina são colocados em um papel absorvente e secos sob temperatura ambiente, preservando de agentes degradantes os componentes presentes na urina. Assim, o objetivo deste trabalho é avaliar a estabilidade das substâncias do presente estudo em alta temperatura, temperatura ambiente e em temperaturas de 4°C e -20°C. Para este fim, foi necessário desenvolver, validar e aplicar métodos de extração e determinação de anfetaminas e produtos de biotransformação de cocaína e tetraidrocanabinol carboxílico (THCCOOH) em amostras dried urine spot, utilizando cromatografia líquida acoplada à espectrometria de massas. Os picos foram identificados por UPLC-ESI-MS/MS, com tempo total de 5 mins utilizando fase A- água, formiato de amônio e 0,1% ácido fórmico, e B- metanol: acetonitrila (6:4) + 0,1% de ácido fórmico. A extração foi feita utilizando acetonitrila: metanol: acetona (1:1:1) +ácido fórmico 0,1%. Não foi possível iniciar a validação de THCCOOH, visto uma possível complexação do analito com o papel. Para as outras substâncias, o método cromatográfico desenvolvido se mostrou eficiente e seletivo, com LOD e LOQ de 10 ng/mL para todos os analitos, sendo linear até 1000 ng/mL, atendeu as especificações de precisão e exatidão e carryover. As amostras permaneceram estáveis ao longo de 32 dias nas temperaturas estudadas, demonstrando a segurança em se utilizar a técnica de DUS para armazenamento e transporte de amostras biológicas dentro da faixa de temperatura do estudo até 32 dias

The number of people using illegal substances in a recreational way increases each year, drawing the attention of scholars from different areas of knowledge. As a result, the demand for workplaces drug tests, toxicological tests for victims of crimes and dopping has also grown. The biological sample most used for toxicological tests remains urine, since obtaining it is less invasive, it is possible to collect a large volume of sample and it is possible to detect substances up to days after exposure or consumption has occurred. However, these samples require a large physical volume to be stored and transported to the laboratories, and must be kept at a low temperature for conservation. Another point to consider is the amount of sample insufficiently collected, or leakage of the content, causing contamination of other samples and often making the analysis unfeasible. A recent alternative to such problems is to use "dried urine spots" (DUS), where few microliters of urine are placed on absorbent paper and dried at room temperature, preserving the components present in the urine from degrading agents. Thus, the objective of this work is to evaluate the stability of the substances in this study at high temperature, room temperature and at temperatures of 4°C and -20°C. For this purpose, it was necessary to develop, validate and apply methods of extraction and determination of amphetamines and biotransformation products of cocaine and carboxylic tetrahydrocannabinol (THCCOOH) in dried urine spot samples, using liquid chromatography coupled to mass spectrometry (LC-MS). The peaks were identified liquid chromatography coupled to a mass spectrometer (UPLC-ESI-MS/MS), with a total time of 5 mins using phase A- water, ammonium formate and 0.1% formic acid, and B- methanol: acetonitrile (6:4) + 0.1% formic acid. Extraction was done using acetonitrile: methanol: acetone (1:1:1) + 0.1% formic acid. It was not possible to perform the validation of THCCOOH, given a possible complexation of the analyte with the paper. To the others substances, the chromatographic method developed proved to be efficient and selective, with LOD and LOQ of 10 ng/mL for all analytes, being linear up to 1000 ng/mL, meeting the specifications of precision and accuracy and carryover. The samples remained stable for 32 days at the temperatures studied, demonstrating the safety of using the DUS technique for storage and transport of biological samples until 32 days on temperature range studied

ABSTRACT

RESUMEN El síndrome de la bolsa de orina púrpura es una entidad poco frecuente, con una prevalencia hasta de un 8% en pacientes con catéteres permanentes crónicos por más de 2 años. Esta condición se presenta en portadores de sonda vesical, siendo su principal signo clínico la aparición de orina de color púrpura, debida a la producción de sulfatasas y fosfatasas por enterobacterias. Se presenta un caso de una mujer de 63 años con diagnóstico de vejiga neurogénica, antecedente de enfermedad cerebrovascular y secuelas motoras debidas a neoplasia cerebral, quien consultó por presentar el color característico, con síntomas de infección del tracto urinario inferior. Se trató con nitrofurantoína y tuvo normalización del color urinario al quinto día de tratamiento. El diagnóstico de este síndrome implica un reto para el médico, y deben detectarse los factores de riesgo para proveer un adecuado manejo antimicrobiano y evitar el uso de recursos diagnósticos innecesarios. MÉD.UIS.2021;34(2): 83-8.

ABSTRACT Purple urine bag syndrome is a rare entity, with a prevalence of up to 8% in patients with chronic indwelling catheters for more than 2 years. This condition occurs in bladder catheter carriers, being the main clinical sign the appearance of purple urine, due to the production of sulphatases and phosphatases by Enterobacteriaceae. We present a clinical case of a 63-year-old woman with a diagnosis of neurogenic bladder and a history of cerebrovascular disease and motor sequelae due to brain neoplasia, who consulted for presenting that urine characteristic color, with symptoms of lower urinary tract infection. She was treated with nitrofurantoin and she had normalization of urinary color on the fifth day of treatment. The diagnosis of this syndrome implies a challenge for the physician, and risk factors must be detected to provide adequate antimicrobial management and avoid the use of unnecessary diagnostic resources. MÉD.UIS.2021;34(2): 83-8.

ABSTRACT

Objetivo: La incidencia de intoxicaciones en el servicio de urgencias viene en aumento en Colombia. En el abordaje inicial se solicitan paraclínicos de rutina, en ocasiones sin una correlación entre el xenobiótico, la fisiopatología y el riesgo clínico. El objetivo de esta investigación es describir el uso de las ayudas diagnósticas en el paciente intoxicado en el servicio de urgencias de un hospital de alta complejidad. Metodología: Estudio descriptivo transversal con disponibilidad de datos para el periodo 2014-2016. Se recopiló información de los registros de las historias clínica de los pacientes que acudieron al servicio de urgencias con diagnósticos relacionados con intoxicaciones. Resultados: El 55.4% de la población fue de sexo femenino, el 54.5% eran menores de 25 años y la mayoría pertenencia al área urbana (77.7%). La intencionalidad en el 68.9% fue suicida. Se reportó el toxídrome en el 17.6% de los casos, donde el sedante fue el más común (9.2%). Las sustancias más usadas fueron los psicofármacos (22.8%), siendo los antidepresivos tricíclicos más comunes con un 10.9%; seguidos de los plaguicidas (19.1%), donde los organofosforados fueron los más comunes (8.8%). Las ayudas diagnósticas más solicitadas fueron el hemograma en un 94.3% de los casos, seguido de la creatinina en un 90.2%. El electrocardiograma se realizó en el 49.7% de los casos y los tóxicos en orina en el 7.8%. Conclusión: Se evidencia un uso rutinario de ayudas diagnósticas en el servicio de urgencias; se requieren estudios adicionales que evalúen la pertinencia de ayudas diagnósticas en este escenario.

Objective: The incidence of poisoning in the emergency department is increasing in Colombia. In the initial approach, paraclinical routines are requested, sometimes without a correlation between xenobiotic, pathophysiology and clinical risk. The objective of this research is to describe the use of diagnostic aids in poisoned patients in the emergency department of a high-complexity hospital. Methodology: Descriptive cross-sectional study with retrospective data availability for the 2014-2016 period. Information was collected from the medical records of patients who came to the emergency department with diagnoses related to poisoning. Results: 55.4 % of the population was female, 54.5 % were under the age of 25, the majority belonging to the urban area (77%). The intentionality in 68.9% of them was suicidal. Toxidrome was reported in 17.6% of cases, the sedative being the most common (9.2%). Psychotropic drugs were the most commonly used substances (22.8%), the tricyclic anti-depressant being the most used with 10.9%, followed by pesticides with 19.1%, among which organophosphates were the most common (8.8%). The most requested diagnostic aids were the hemogram in 94.3% of the cases, followed by creatinine in 90.2%. The electrocardiogram was performed in 49.7% of the cases and the toxic in urine in 7.8%. Conclusions: A routine use of diagnostic aids is evidenced in the emergency department. Therefore, additional studies are required to evaluate the relevance of diagnostic aids in this setting.

Objetivo: A incidência de intoxicações no setor de emergência está aumentando na Colômbia. Na abordagem inicial, são solicitadas paraclínicas de rotina, às vezes sem correlação entre o xenobiótico, a fisiopatologia e o risco clínico. O objetivo desta pesquisa é descrever a utilização de meios auxiliares de diagnóstico em pacientes intoxicados no pronto-socorro de um hospital de alta complexidade. Metodologia: Estudo transversal descritivo com disponibilidade de dados para o período 2014-2016. As informações foram coletadas nos prontuários dos pacientes que compareceram ao pronto-socorro com diagnóstico de intoxicação. Resultados: 55,4% da população era do sexo feminino, 54,5% tinham menos de 25 anos e a maioria pertencia à zona urbana (77,7%). A intencionalidade em 68,9% foi suicida. Toxidromia foi relatada em 17,6% dos casos, sendo o sedativo o mais comum (9,2%). As substâncias mais utilizadas foram os psicotrópicos (22,8%), sendo os antidepressivos tricíclicos mais comuns com 10,9%; seguido por agrotóxicos (19,1%), onde os organo-fosforados foram os mais comuns (8,8%). Os meios diagnósticos mais solicitados foram o hemograma em 94,3% dos casos, seguido da creatinina em 90,2%. O eletrocardiograma foi realizado em 49,7% dos casos e a urina tóxica em 7,8%. Conclusão: Evidencia-se o uso rotineiro de meios auxiliares de diagnóstico no pronto-socorro; Estudos adicionais são necessários para avaliar a relevância dos auxiliares de diagnóstico neste cenário.