¿Son necesarias las consultas específicas prediálisis? Objetivo: cuidado integral del paciente con Enfermedad Renal Crónica (ERC) / Are specific pre-dialysis clinical visit necessary? Objective: comprehensive care of patients with Chronic Renal disease (CRD)

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Necesidad de una información responsable sobre las modalidades de tratamiento renal sustitutivo / Need of responsible information on modalities of renal replacement therapy

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[Evaluation of osteodystrophy parameters in a pre-dialysis unit]. / Valoración de parámetros de osteodistrofia en una unidad de prediálisis.

A cross-sectional study was developed with 100 of the first-time pre-dialysis patients visiting the Princesa University Hospital's Advanced Chronic Kidney Disease (ACKD) unit, with the aim of analysing various parameters of osteodystrophy at this time. Parameters evaluated were: age, gender, renal function, osteodystrophy serum parameters, comorbidity index (ICED) and the patients' origin to establish correlations between these parameters. Mean iPTH levels were higher irrespective of the patients' origin, and were significantly higher in men than in women, the former also having poorer renal function and higher comorbidity score. The mean levels of calcium, phosphorous, alkaline phosphatase and CO2 did not justify this rise in iPTH. Nutritional parameters NPNA and albumin were adequate in spite of ageing. At early stages of ESRD, iPTH could be elevated and ACKD units play an important part its early detection and subsequent treatment.

Valoración de parámetros de osteodistrofia en una unidad de prediálisis / Osteodystrophy parameters evaluation in a predialysis unit

Se estudia mediante un corte transversal como llegan 100 pacientes a la Unidad de Enfermedad Renal Crónica Avanzada (ERCA) (prediálisis) del Hospital Universitario de la Princesa analizando parámetros de osteodistrofia. Se analizan edad, sexo, grado de función renal, comorbilidad y procedencia de los pacientes para intentar establecer correlaciones entre ellos. La media de PTHi es elevada independientemente de la procedencia siendo significativamente mayor en hombres que en mujeres, si bien los hombres tenían menor función renal y mayor comorbilidad. Medias de calcio, P, fosfatasa alcalina o CO2 total no justifican la elevación. A pesar de la edad avanzada el NPNA y albúmina indican nivel de nutrición adecuado. La PTHi puede estar elevada desde estadios precoces de Enfermedad Renal Avanzada (ERC) y en la detección y tratamiento las Unidades de ERCA tienen un papel decisivo (AU)

A cross-sectional study was developed with 100 of the first-time pre-dialysis patients visiting the Princesa University Hospital’s Advanced Chronic Kidney Disease (ACKD) unit, with the aim of analysing various parameters of osteodystrophy at this time. Parameters evaluated were: age, gender, renal function, osteodystrophy serum parameters, comorbidity index (ICED) and the patients’ origin to establish correlations between these parameters. Mean iPTH levels were higher irrespective of the patients’ origin, and were significantly higher in men than in women, the former also having poorer renal function and higher comorbidity score. The mean levels of calcium, phosphorous, alkaline phosphatase and CO2 did not justify this rise in iPTH. Nutritional parameters NPNA and albumin were adequate in spite of ageing. At early stages of ESRD, iPTH could be elevated and ACKD units play an important part its early detection and subsequent treatment (AU)

Primary care in Bosnia and Herzegovina. Health care and health status in general practice ambulatory care centres.

OBJECTIVE: To assess the health care and health status of patients attending primary care clinics in Bosnia and Herzegovina. DESIGN: Assisted administration patient survey. SETTING: Two ambulatory care clinics (ambulantas) in each of three cities in Bosnia and Herzegovina: Tuzla, Mostar, and Banja Luka. PARTICIPANTS: Patients attending the ambulantas during a 1-week period in March 1999; 885 answered questionnaires. MAIN OUTCOME MEASURES: Each patient listed demographic characteristics and answered questions on satisfaction with health care and with the physical and financial accessibility of health care services and medications. A validated health status questionnaire (EuroQoL), previously used in parts of the former Yugoslavia, was administered. RESULTS: Only 22% of patients were employed; 57% could not pay the nominal fee to see a physician; 71% walked to the clinic; mean distance from patients' homes to the clinics was 2.3 km; 63% could not get the medications prescribed (in 85% of cases because of cost, not availability); 80% to 90% of answers to satisfaction questions suggested high satisfaction with the care patients received from their doctors; 67% of the time patients were referred to a specialist by general practitioners; 33% had problems walking; 17% had problems with self-care; 36% had problems with usual daily activities; 72% had at least some pain or discomfort; and 62% described at least some anxiety or depression. The three cities showed significant differences; patients in Tuzla generally had lower health status and more problems with health care. CONCLUSION: Unemployment and financial considerations reduced health care access in Bosnia and Herzegovina. While only one third of patients had physical difficulties, two thirds had emotional problems or pain. Satisfaction with physicians' care was high.

An unlikely pregnancy and its consequences.

This commentary illustrates the case of a young married woman (who will be referred to as Debbie), who presented requesting a tubal ligation, but after a joint discussion with her husband (who will be referred to as Boyd), it was decided that he would have a vasectomy. Shortly after the operation, Debbie became pregnant. The importance of full discussion of medical procedures with patients and their families so that informed decisions can be made and a close working relationship established will be highlighted.