Epidemiología de la peritonitis en pacientes bajo tratamiento con diálisis peritoneal atendidos en el Hospital Carlos Andrade Marín / Epidemiology of peritonitis in patients on peritoneal dialysis treated at the Hospital Carlos Andrade Marín

Contexto La peritonitis es una de las principales complicaciones en los pacientes con enfermedad renal crónica tratados con diálisis peritoneal. Objetivo Describir el perfil epidemiológico y los factores de riesgo asociados a la peritonitis en pacientes con diálisis peritoneal. Diseño Caso control anidado en cohorte retrospectiva Lugar y sujetos 230 pacientes con enfermedad renal crónica (ERC) terminal, ingresados en el programa de diálisis peritoneal del Hospital Carlos Andrade Marín (HCAM), durante el período enero de 2008 a diciembre de 2010. Mediciones principales Datos demográficos y clínicos, autonomía funcional del paciente, desa- rrollo de peritonitis, agentes microbiológicos, tratamiento y egreso. Resultados El 43.9% de los pacientes dentro de la cohorte presentaron peritonitis, con un total de 197 eventos. El 58.4% fueron de sexo masculino. Las principales causas de la ERC fueron nefropatía diabética (43%) y nefroangioesclerosis (40%). El 28.7% tenían alguna limitación física y el 44.6% aplicaban por sí mismos la diálisis peritoneal. No hubo diferencias significativas entre los casos y los controles en sus características demográficas, etiología de la ERC y autonomía funcional. Ninguno de los factores investigados se asoció con la peritonitis. En la cohorte la incidencia de peritonitis fue de 0.60 episodios/año (un evento cada 20 meses). Las bacterias predominantes fueron Estafilococo epidermidis (14%) y aureus (12%), E. coli (8%), Acine- tobacter y enterobacter (2%). Los antibióticos más utilizados fueron van- comicina, ceftazidima y ciprofloxacina. Las principales causas de egreso del programa de diálisis fueron la trasferencia a hemodiálisis y exitus letalis. De ocho defunciones, tres se asociaron al evento de peritonitis. Conclusión Los resultados permiten conocer más sobre la epidemiología de la peritonitis secundaria a diálisis peritoneal y deben realizarse estudios similares en otros centros hospitalarios del país. Las medidas preventivas se deben reforzar respecto a la técnica usada por los pacientes y sus familiares, pero también en los profesionales de salud encargados del cuidado de los pacientes.

Peritonitis is a major complication un patients with chronic renal disease treated with peritoneal dialysis. Objective To describe the epidemiological profile and risk factors associated with peritonitis in peritoneal dialysis patients. Design Nested case control study. Subjects and setting 230 patients with chronic renal failure (CRF) admitted to the peritoneal dialysis program at Carlos Andrade Marín Hospital (Quito-Ecuador) during the period January 2008 to December 2010. Main measurements Demographic and clinical data, patient functional autonomy, deve- lopment of peritonitis, microbiological agents, treatment and discharge. Results 44% of patients had peritonitis, with a total of 197 events. 58.4% were male. The main causes of CRF were diabetic nephropathy (43%) and nephrosclerosis (40%). 28.7% had a physical disability and 44.6% applied themselves peritoneal dialysis. There were no significant differences between cases and controls on demographics, etiology of CRF and functional autonomy. None of the factors investigated was associated with peritonitis. In the cohort the incidence of peritonitis was 0.60 episodes / year (one event every 20 months). The predominant bacteria were Staphylococcus epidermidis (14%), S. aureus (12%), E. coli (8%), Acine- tobacter and Enterobacter (2%). The most commonly used antibiotics were vancomycin, ceftazidime and ciprofloxacin. The leading causes of discharge from the dialysis program were the transfer to hemodialysis and exitus letalis. There were eight deaths and three were associated with peritonitis. Conclusion The results allow us to know more about the epidemiology of peritonitis secondary to peritoneal dialysis and similar studies should be conducted in other hospitals in Ecuador. Preventive measures should be strengthened with respect to the technique used by patients and their families, but also in health professionals responsible for the care of patients.

Tradução e validação da escala Knee Society Score: KSS para a Língua Portuguesa / Translation and validation of the Knee Society Score: KSS for Brazilian Portuguese

OBJETIVO: Traduzir, adaptar culturalmente e validar o "Knee Society Score" (KSS) para a língua portuguesa e verificar suas propriedades de medida, reprodutibilidade e validade. MÉTODO: Avaliados 70 pacientes de ambos os sexos, em estudo clínico transversal, idade entre 55 e 85 anos, osteoartrose primária submetidos a artroplastia total de joelho, com o questionário KSS pelo avaliador 1 (inglês) e após 30 minutos pelo avaliador 2 (português) no pré- operatório e após três e seis meses de pós-operatório. RESULTADOS: O índice alfa de Cronbach e a diagramação de Bland-Altman não detectaram diferença entre as médias das duas avaliações no pré-operatório (p=1,000), com três meses (p=0,991) e seis meses de pós-operatório (p=0,985) na pontuação do joelho e na nota da função do joelho, p=1,000 nos três períodos. CONCLUSÃO: A versão brasileira do Knee Society Score, o Escore da Sociedade do Joelho, mostrou ser um instrumento de fácil compreensão e aplicação; válido e confiável para medir a pontuação e função do joelho de pacientes brasileiros submetidos a ATJ. Nível de Evidências: Estudos diagnósticos - Nivel de Evidência I, Teste de critérios diagnósticos desenvolvidos anteriormente em pacientes consecutivos (com padrão de referência "ouro" aplicado).

OBJECTIVE: To translate, culturally adapt and validate the "Knee Society Score" (KSS) for the Portuguese language and determine its measurement properties, reproducibility and validity. METHOD: We analyzed 70 patients of both sexes, aged ages between 55 and 85 years, in a cross-sectional clinical trial, with diagnosis of primary osteoarthritis, undergoing total knee arthroplasty surgery. We assessed the patients with the English version of the KSS questionnaire and after 30 minutes with the Portuguese version of the KSS questionnaire, done by a different evaluator. All the patients were assessed preoperatively, and again at three, and six months postoperatively. RESULTS: There was no statistical difference, using Cronbach's alpha index and the Bland-Altman graphical analysis, for the knee score during the preoperative period (p = 1), and at three months (p = 0.991) and six months postoperatively (p = 0.985). There was no statistical difference for knee function score for all three periods (p = 1.0). CONCLUSION The Brazilian version of the Knee Society Score is easy to apply, as well providing as a valid and reliable instrument for measuring the knee score and function of Brazilian patients undergoing TKA. Level of Evidence: Level I - Diagnostic Studies- Investigating a Diagnostic Test - Testing of previously developed diagnostic criteria on consecutive patients (with universally applied 'gold' reference standard).