ABSTRACT
OBJETIVO: Conocer la prevalencia de trastornos depresivos y sus variables asociadas en ancianos ingresados en una unidad de convalecencia. Validación de una versión en castellano de la escala de depresión geriátrica de Yesavage de 15 preguntas (GDS-15). MATERIAL Y MÉTODO: El diagnóstico de depresión se efectuó mediante entrevista aplicando los criterios de trastornos depresivos del DSM IV. A todos los pacientes se les practicó la GDS-15, y posteriormente se calculó la sensibilidad y especificidad para cada una de las puntuaciones obtenidas, con respecto al diagnóstico de depresión según DSM IV. Se registró también: edad, sexo, diagnóstico principal, enfermedades crónicas (índice de comorbilidad de Charlson), capacidad funcional al ingreso (índice de Barthel), grado de pérdida de capacidad funcional (diferencia entre el Barthel previo y al ingreso), función cognitiva (mini-mental de Folstein), escolarización y situación social (escala de valoración socio-familiar de Gijón modificada). RESULTADOS: De los 131 pacientes estudiados, 41 (31,3 por ciento) presentaron trastornos depresivos según DSM IV, de ellos 33 (80,4 por ciento) eran trastornos adaptativos. La edad media de los pacientes con depresión fue de 71,7 (DE 9,8) y la de los restantes 75,9 (DE 11) (p= 5 de la versión utilizada en castellano de la GDS-15, mostró una sensibilidad del 85,3 por ciento y una especificidad del 85,5 por ciento, respecto al diagnóstico de trastorno depresivo según DSM IV. CONCLUSIONES: La prevalencia de trastornos depresivos en una unidad de convalecencia ha sido alta y únicamente se ha visto asociada a tener una menor edad. La versión traducida de la GDS-15 de Yesavage ha mostrado una buena sensibilidad y especificidad en nuestro medio, para la detección de trastornos depresivos en el anciano (AU)
Subject(s)
Aged , Female , Male , Humans , Mental Status Schedule , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Halfway Houses , Prevalence , Spain/epidemiology , Follow-Up Studies , Sensitivity and Specificity , Age Factors , Depressive Disorder/etiology , Socioeconomic Factors , Predictive Value of TestsABSTRACT
BACKGROUND: The identification of predictors of return home and nursing home placement in elderly patients, at the moment of admission to a Geriatric Convalescence Unit, may allow to make a discharge planning for these patients, and also may improve efficiency in the unit. PATIENTS AND METHODS: A number of 445 patients over 65 years were consecutively admitted to the unit. Analyzed variables at admission were; age, sex, diagnostic, comorbidity, functional status prior to admission, degree of independence in activities of daily living (Barthel index), cognitive function (Folstein Mini-Mental) and social support (modified version of social-familiar evaluation scale of Gijón). All these variables were used in two models of logistic regression analysis: 1 [symbol: see text] (dependent variable: return home after discharge versus other destinations), and 2 [symbol: see text] (dependent variable: nursing home placement on discharge versus other destinations). RESULTS: The variables significatively associated with greater probability of at home discharge were: moderate dependency for activities of daily living (Barthel index = 31-59), odds ratio (OR) = 2.46 (95% confidence interval: 1.43-4.22); mild dependency (Barthel index > or = 60), OR = 3.67 (1.96-6.87); normal cognitive function (Mini-Mental > or = 21), OR = 3.14 (1.76-5.60), and a favourable social support (social-familiar scale < 12), OR = 7.33 (3.18-16.91). The only variable significatively associated with the probability of nursing home placement after discharge was an impaired social function (social-familiar scale > or = 12), OR = 4.53 (2.25-9.12). CONCLUSIONS: Probability of return home after discharge is associated with functional status, cognitive function and social support. Definitively nursing home placement was only related with de degree of familiar support.
Subject(s)
Aged , Geriatric Assessment , Home Nursing , Patient Discharge , Activities of Daily Living , Age Factors , Aged, 80 and over , Brief Psychiatric Rating Scale , Female , Humans , Male , Nursing Homes , Social SupportABSTRACT
Fundamento: La identificación de aquellos factores relacionados con la probabilidad de ser dado de alta al domicilio, en una Unidad Geriátrica de Convalecencia, permitiría planificar el alta de estos pacientes y mejorar la eficiencia en la gestión de las camas. Pacientes y métodos: Se analizaron 445 pacientes con edad =65 años, que ingresaron de forma consecutiva en la unidad. Las variables estudiadas en el momento del ingreso fueron: edad, sexo, diagnóstico, comorbilidad, situación funcional antes del ingreso actual, nivel de independencia para las actividades de la vida diaria (índice de Barthel), función cognitiva (Mini-Mental de Folstein) y la situación social (escala de valoración socio-familiar de Gijón modificada). Todas estas variables se introdujeron en dos modelos de regresión logística múltiple: 1º (variable dependiente: alta a domicilio versus otros destinos) y 2º (variable dependiente: alta a una institución versus otros destinos). Resultados: Variables significativas asociadas con mayor probabilidad de retorno al domicilio : dependencia moderada para actividades de la vida diaria (índice de Barthel=31-59), odds ratio (OR)=2,46 (intervalo de confianza al 95%: 1,43-4,22); dependencia leve (índice de Barthel =60), OR =3,67 (1,96-6,87); función cognitiva conservada (Mini-Mental =21), OR= 3,14 (1,76-5,60) y situación social favorable (escala socio-familiar<12), OR=7,33 (3,18-16,91). La única variable significativa asociada con mayor probabilidad de institucionalización definitiva tras el alta fue la situación social deteriorada (escala socio-familiar =12), OR=4,53 (2,25-9,12). Conclusiones: La probabilidad de retorno al domicilio esta relacionada con la capacidad funcional, la función cognitiva y la situación social. El ingreso definitivo en una institución, está relacionado únicamente con el grado de soporte familiar (AU)
Subject(s)
Female , Male , Aged, 80 and over , Aged , Humans , Activities of Daily Living , Age Factors , Brief Psychiatric Rating Scale , Social Support , Home Nursing , Geriatric Assessment , Patient Discharge , Home NursingABSTRACT
BACKGROUND: Clostridium difficile is considered as one of the principal enteropathogens of nosocomial origin in developed countries in the last decade. No nosocomial outbreaks have been described in Spain. METHODS: A descriptive study of a nosocomial outbreak of diarrhea by C. difficile (DCD) which was produced during two months in a general hospital of 250 beds was carried out. The risk factors, clinical and analytical characteristics were compared with the cases of diarrhea associated to the use of antibiotics (DAA) produced during the same period. RESULTS: Of the 23 diarrheas studied, 17 (74%) corresponded to DAA and 6 (26%) to DCD, four of which were of nosocomial origin and were detected in the department of Nephrology. The incidence of DAA was 44/1000 patients who received antibiotic treatment per month and the incidence of DCD was 15.5/1000 patients/month. The patients with DAA received a mean of 1.82 antimicrobians per patient and in DCD 2.16 per patient (p: NS). The only differences found between DAA and DCD were: length of the symptoms (16.5 days in DCD, 8.5 days in DAA, p < 0.01) and the presence of blood in the feces (66.6% in DCD and 0 in DAA p < 0.01). No differences were observed in age, sex, base disease, mucous diarrhea, fever, mortality, high VSG and leucocytosis. Surveillance and control measures were effective in combating the epidemic outbreak. CONCLUSIONS: The diagnosis of diarrhea by C. difficile requires a high index of suspicion given the difficulty in differentiating the same from diarrhea associated to antibiotic use. The clinical profile and risk factors do not differ to those described in other geographic areas. The isolation and/or detection of toxins of C. difficile is recommended in patients submitted to antibiotic treatment and diarrhea of more than 72 hours of evolution.
Subject(s)
Anti-Bacterial Agents/adverse effects , Cross Infection/etiology , Diarrhea/etiology , Disease Outbreaks , Enterocolitis, Pseudomembranous/epidemiology , Aged , Clostridioides difficile , Cross Infection/epidemiology , Diarrhea/epidemiology , Enterocolitis, Pseudomembranous/complications , Female , Humans , Male , Middle Aged , SpainABSTRACT
We report a chronic hemodialyzed patient with bladder involvement of a secondary amyloidosis that presented as isolated hematuria evolving quickly to a massive hemorrhage and vesical rupture. We believe that this is the first report of bladder amyloidosis involvement in the course of hemodialysis. This knowledge may help in managing dialysis patients with hematuria.
Subject(s)
Amyloidosis/complications , Hemorrhage/etiology , Renal Dialysis/adverse effects , Urinary Bladder Diseases/complications , Aged , Humans , Male , Rupture, Spontaneous/etiology , Urinary Bladder Diseases/etiologyABSTRACT
Serum creatinine levels were determined prospectively every 2 to 3 months in 40 patients with diabetic nephropathy for a global observation period of 864 months. The monthly creatinine increasing rate was significantly lower in normotensive periods, mean arterial pressure (MAP) less than 115 mmHg, when compared with hypertensive periods, MAP greater than 125 mmHg. No significant difference was shown in periods with borderline hypertension (MAP between 115-124 mmHg). The mean creatinine increases were of 0.036 mg/dl/month, 0.3 mg/dl/month and 0.046 mg/dl/month respectively. Normotension was associated with a slowing down of the rate of decline in renal function in this group of moderate kidney failure with an initial mean serum creatinine of 2.26 mg/dl. The exposure of patients to nephrotoxics (aminoglycosides, and possibly anesthesia) significantly accelerated the decline in renal function: 0.39 mg/dl/month and 0.17 mg/dl/month respectively according to the concomitance or not of toxics and hypertension. The reported protective effect of diabetes against aminoglycosides nephrotoxicity in experimental conditions was not reflected in our clinical results. On the contrary, we suggest a possible enhanced sensibility of the diabetic patient with diabetic nephropathy to aminoglycosides leading to an acceleration of the progression of renal failure.
Subject(s)
Diabetic Nephropathies/diagnosis , Hypertension, Renal/diagnosis , Kidney Failure, Chronic/diagnosis , Kidney Function Tests , Adult , Aged , Aminoglycosides/adverse effects , Anesthetics/adverse effects , Blood Glucose/metabolism , Blood Pressure/drug effects , Creatinine/blood , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 2/diagnosis , Female , Follow-Up Studies , Glomerular Filtration Rate/drug effects , Humans , Kidney Failure, Chronic/chemically induced , Male , Middle AgedABSTRACT
The first study compared two groups on dialysis: 25 patients with diabetes mellitus and 25 matched non-diabetic patients, in relation to the presence of signs of hyperparathyroidism, to assess the reported low incidence of hyperparathyroidism in these patients. The diabetic group showed significantly lower values of PTH, Alk phosphatase, percentage of patients requiring vitamin D treatment, and less evidence of hyperparathyroidism on X-ray and in bone histomorphometry. In the second study 16 patients with chronic renal failure due to diabetic nephropathy were compared to 27 patients with the same degree of renal failure of other origin, the diabetic nephropathy group showed no increase in PTH, with falling creatinine clearance. Despite this low PTH, the phosphaturia was higher in the diabetic nephropathy group (Tm PO4/C Cr: 1.94 +/- 0.43 vs 2.5 +/- 0.68). In conclusion, patients with diabetes mellitus are less prone to develop hyperparathyroidism in progressive renal failure. This could be due to a relative increase in phosphaturia during declining function.
Subject(s)
Diabetic Nephropathies/complications , Hyperparathyroidism, Secondary/etiology , Kidney Failure, Chronic/complications , Humans , Parathyroid Hormone/blood , Phosphates/urine , Renal DialysisSubject(s)
Kidney Transplantation , Listeriosis/etiology , Female , Humans , Middle Aged , PrognosisABSTRACT
The effect of oral Cimetidine compared to a classic antihistaminic and to a placebo was evaluated, under the double hypothesis of its anti-PTH and anti-pruritus action, in a population of patients recently included in Hemodialysis that were asked about the incidence and intensity of pruritus according to a scored questionnaire made for this purpose. No different efficacy of Cimetidine versus the antihistaminic classic and the placebo was observed in our study.
