Subject(s)
Tissue and Organ Procurement/ethics , Transplantation/ethics , Cadaver , Caribbean Region , Commodification , Global Health , Government Regulation , Health Services Accessibility , Humans , Immunosuppression Therapy/adverse effects , Immunosuppression Therapy/standards , Latin America , Patient Rights , Tissue Donors/ethics , Tissue Donors/supply & distribution , Tissue and Organ Harvesting/legislation & jurisprudence , Tissue and Organ Procurement/legislation & jurisprudence , Tissue and Organ Procurement/organization & administration , Tissue and Organ Procurement/standards , Transplantation/legislation & jurisprudence , Transplantation/standards , TravelABSTRACT
BACKGROUND: Iron overload can affect cardiac structure and function by the production of free radicals in addition to iron deposits in heart muscle. The purpose of this study was to compare traditional and non-traditional cardiovascular risk factors (CVRF) in children and adolescents on renal replacement with and without iron overload. Also, we evaluated the relationships between iron overload and left ventricular mass (LVM). METHODS: First, in a cross-sectional study, we evaluated traditional and non-traditional CVRF in 143 children and adolescents, 48 on peritoneal dialysis (PD), 53 on hemodialysis (HD) and 42 after renal transplantation according to iron overload. In a second phase with a case-control study, we measured LVM in 12 case patients and 12 matched controls. RESULTS: Iron overload was identified in 15 patients (10.5%), 11 in HD and 4 in PD (P = 0.002). The group with iron overload had lower body mass index (17 versus 19; P = 0.01), total cholesterol (132 versus 165 mg/dL; P = 0.03) and hemoglobin (8.5 versus 10.6 g/dL; P = 0.003) but higher interleukin (IL)-6 levels (4.8 versus 3.6 ng/L; P = 0.04) and hypertension diagnosis (79 versus 48%; P < 0.001) than those without iron overload. Ferritin showed a positive correlation with C-reactive protein (CRP) and IL-6 levels. In a subgroup of 24 patients (12 with and 12 without iron overload), LVM was not different. However, ferritin levels showed a borderline positive correlation (r = 0.44, P = 0.05) with LVM. CONCLUSION: Children and adolescents with iron overload show more CVRFs, especially if they received replacement therapy with HD. Ferritin is related to CRP and IL-6 levels.
Subject(s)
Cardiovascular Diseases/etiology , Iron Overload/etiology , Kidney Failure, Chronic/complications , Kidney Transplantation , Renal Dialysis/adverse effects , Adolescent , C-Reactive Protein/metabolism , Case-Control Studies , Child , Child, Preschool , Cross-Sectional Studies , Female , Ferritins/blood , Humans , Interleukin-6/blood , Kidney Failure, Chronic/therapy , Male , Prognosis , Risk FactorsABSTRACT
Enfermería debe disponer de una herramienta que facilite la cumplimentación de los Registros Enfermeros. Se ha elaborado, entre diciembre de 2005 y marzo de 2006 un documento para el registro enfermero de las sesiones de hemodiálisis en una unidad acreditada según la norma ISO9001:2005, teniendo en cuenta el modelo de enfermería utilizado en la institución y usando las medidas externas de control de la calidad que establece dicha normativa. El proceso se dividió en tres fases: a) descriptiva: en las que se encuestó al equipo de enfermería sobre adecuación del registro anterior y aspectos a mejorar b) elaboración del documento y c) fase de control externo, en el que se realizaron, a propuesta del equipo, los cambios pertinentes, y se puso en marcha el documento, para ser sometido a control, a través de auditoria externa. Se sugirieron pequeños cambios para uso definitivo del documento que ha sido concebido como guía para la prestación de cuidados (AU)
Nursing should have a tool to facilitate the completionof Nursing Records. Between December2005 and March 2006, a document was drawn up for keeping nursing records of the haemodialysis sessions in a unit with ISO 9001:2005 recognition, taking into account the nursing model used in the institution and using the external quality control measures established by the above-mentioned standard. The process was divided into three phases: a) descriptive: in which a survey of the nursing team was carried out about the suitability of the previous record system and aspects to be improved b) preparation of the document and c) external control phase, in which the pertinent changes were made, at the teams proposal, and the document was brought into use, to be subjected to control through external audit. Minor changes were suggested for the definitive use of the document which has been devised as a guide for the provision of care (AU)
Subject(s)
Humans , Nursing Records , Renal Dialysis/standards , Nursing Care/standards , 51924 , Renal Insufficiency, Chronic/therapy , Quality Indicators, Health CareABSTRACT
Recent studies considered that an increase in sympathetic activity (SA) may be responsible for left ventricular hypertrophy (LVH). Before and after renal transplantation (RT), we evaluated changes on left ventricular mass (LVM) and SA in 40 end-stage renal disease patients between 8 and 35 years old. Hypertension (95.0% vs. 71.0%; p=0.005), use of combined antihypertensive drugs (57.5% vs. 30.0%; p=0.01), and LVH (77.5% vs. 52.5%; p=0.01) significantly decreased after RT whereas low-to-high frequency ratio (LF/HF), which represents SA, increased (3.1 vs. 5.3; p=0.0001). However, LVM regressors (with decrease on LVM index more than 20%) showed a trend of lower change on LF/HF ratio (1.6 vs. 2.4; p= 0.09) than nonregressors. Living-donor graft, baseline LVM, use of antihypertensive drugs, lower change on LF/HF ratio, and lower systolic blood pressure levels were associated with LVM regression in the simple correlation analysis. However, in the logistic regression analysis, only baseline LVM and donor type remained in the model (R(2)=0.35; p=0.0003). Thus, LVH decreased after RT and was related to baseline LVM and living-donor type. However, it is possible that the higher persistence of LVH after RT could be explained at least in part by increase in heart sympathetic activity and use of immunosuppressors.
Subject(s)
Heart Ventricles/pathology , Heart/innervation , Hypertrophy, Left Ventricular/pathology , Kidney Transplantation , Postoperative Complications , Sympathetic Nervous System/physiology , Adolescent , Adult , Antihypertensive Agents/therapeutic use , Child , Cohort Studies , Echocardiography , Female , Heart/physiopathology , Humans , Hypertension/complications , Hypertension/drug therapy , Hypertension/physiopathology , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/etiology , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/surgery , Living Donors , Logistic Models , Male , Sympathetic Nervous System/drug effectsABSTRACT
El dolor es un síntoma frecuente en los pacientes sometidos a hemodiálisis (HD), afectando directamente su calidad de vida. Sin embargo, sus características en este tipo de pacientes son poco conocidas y no existen publicaciones previas a este estudio en las que se valore de forma exclusiva el dolor durante una sesión de hemodiálisis. El presente estudio evalúa las características del dolor intradiálisis, incluyendo su prevalencia, intensidad, características cualitativas y medidas aplicadas para su control. Se utilizan para ello escalas de valoración validadas y ampliamente usadas en el control del dolor oncológico, que fueron ampliadas con una encuesta específica en la que se valoran aspectos del dolor relacionados con la propia diálisis, incluyendo temporalidad, frecuencia o influencia de los parámetros del tratamiento. Todo el proceso de recogida de información se realizó durante las sesiones de hemodiálisis. La prevalencia de dolor en HD fue de un 92,1%, sólo en 3 casos (7,89%) el nivel de dolor fue 0. Un 28,9% de los pacientes identificaron el propio procedimiento como causa del dolor, segunda causa más frecuente tras el dolor de origen isquémico. El Índice de Manejo del Dolor (PMI) indicó un claro infra-tratamiento, tanto más acentuado cuanto más intenso era el dolor descrito por el paciente. Sin embargo, las medidas llevadas a cabo durante la hemodiálisis para el control delos episodios de dolor detectados fueron eficaces en un porcentaje razonable, lo que indica que la mayor parte delos episodios de dolor pasan desapercibidos ante nuestros ojos
Pain is a frequent symptom in patients who under go haemodialysis (HD), directly affecting their quality of life. However, its characteristics in this type of patient are not well known and there are no publications prior to this study dedicated exclusively to assessing pain during a haemodialysis session. This study assesses the characteristics of intradialysis pain, including its prevalence, intensity, qualitative characteristics and measures applied to control it. For these purposes, validated valuation scales widely used in the control of oncological pain were used, which were extended with a specific survey that evaluated aspects of pain related to the dialysis itself, including timing, frequency or influence of the treatment parameters. The entire information compilation process took place during the haemodialysis sessions. The prevalence of pain in HD was 92.1%, only in 3 cases (7.89%) was the pain level zero. 28.9% of patients identified the procedure itself as the cause of the pain, the second most frequent cause after pain of ischemic origin. The Pain Management Index (PMI) showed clear under-treatment, which was most marked the more intense the pain described by the patient. However, the measures taken during haemodialysis for the control of the episodes of pain detected were efficient in a reasonable percentage of cases, which indicates that most of the pain episodes are not perceived by us
Subject(s)
Humans , Pain/epidemiology , Renal Dialysis/adverse effects , Pain Measurement , Quality of Life , Epidemiology, Descriptive , Surveys and Questionnaires , Renal Insufficiency, Chronic/therapyABSTRACT
In patients with renal anemia, iron therapy can be administered intermittently or regularly at a low dose. We performed a randomized clinical trial in pediatric patients with end-stage renal failure on hemodialysis and absolute or functional iron deficiency. The study group received maintenance iron therapy according to the ferritin serum levels and the control group received intermittent 10-weekly doses. Success was defined as stabilization of ferritin levels between 100 and 800 microg/l and transferrin saturation (TSAT) between 20% and 50%, in addition to an increase in the hemoglobin level. The major reason for exclusion was iron overload. The study group received 6 mg/kg per month of parenteral iron [95% confidence interval (CI) 3.3-8.8] and the control group 14.4 mg/kg per month (95% CI 12-16.8) ( P<0.001). After 4 months of treatment, ferritin levels increased to 66 microg/l (95% CI 69-200) in the study group and to 334 microg/l (95% CI 145-522) in the control group ( P=0.009). Maintenance therapy and intermittent weekly doses were successful in 73% and 38%, respectively. After 3 months of treatment, hemoglobin levels increased to 10 g/dl, with no difference between the groups. However, in the control group the increase in hemoglobin levels was unsustained, and 3 patients needed transfusion. Patients in the control group had a higher risk of iron overload than patients in the study group (70% vs. 19%). Thus, the regimen based on assessment of serum ferritin levels was more efficient than the intermittent regimen because it increased and maintained the hemoglobin levels with lower iron doses and a lower risk of iron overload.
Subject(s)
Anemia, Iron-Deficiency/drug therapy , Anemia, Iron-Deficiency/etiology , Iron/administration & dosage , Iron/blood , Kidney Failure, Chronic/complications , Adolescent , Child , Drug Administration Schedule , Female , Ferritins/blood , Hemoglobins/metabolism , Humans , Injections, Intravenous , Male , Transferrin/metabolism , Treatment OutcomeABSTRACT
Se revisaron los expedientes clínicos de todos los niños con transplantes de riñon en el Hospital de Ginecopediatría, Centro Médico Nacioanl en León, Guanajuato, a partir del inicio del programa de transplante. Entre junio de 1989 y marzo de 1993 se han realizado trasplantes a 19 niños, trece hombres y seis mujeres. Las edades han variado entre cinco y 16 años. La etiología de enfermedad renal terminal identificada con mayor frecuencia fue glomerulonefritis crónica. Al momento del transplante 17 pacientes se encontraban en programas de diálisis peritoneal y dos en hemodiálisis. En 13 niños el órgano se obtuvo de donador vivo y en seis de cadáver. Después de un seguimiento de tres a 44 meses con media de 19, la tasa de sobrevida de pacientes es de 84.2 por ciento, y la de órganos de 63.2 por ciento. El trasplante es una alternativa de tratamiento que requiere de la integración de un equipo multidisciplinario con experiencia en la atención del paciente en edad pediátrica. Los resultados iniciales en este hospital parecen alentadores
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Tissue Donors/classification , Kidney Transplantation/adverse effects , Glomerulonephritis/complications , Kidney Diseases/physiopathology , Peritoneal Dialysis, Continuous Ambulatory , Renal Dialysis , Renal Insufficiency, Chronic/etiologyABSTRACT
Se presenta el caso de una paciente de 14 años de edad con diagnóstico de teratoma quístico mixto del tipo II del cóccix. Se mencionan el protocolo de diagnóstico y la técnica quirúrgica que se recomienda en la actualidad, lo mismo que algunos aspectos de interés para el tratamiento de estos tumores.
