Inducción con timoglobulina: ¿incrementa el riesgo hemorrágico en receptores renales sensibilizados? / Could thymoglobulin increase hemorrhagic risk in the perioperative transplantation period of sensitized kidney recipients?

Objetivo: Se ha descrito que la timoglobulina podría aumentar el riesgo de infecciones y neoplasias, en comparación con basiliximab. La leucocitopenia y la trombocitopenia también son más frecuentes en los primeros días tras el trasplante en los pacientes tratados con timoglobulina.Nuestro objetivo fue analizar las complicaciones hemorrágicas en este subconjunto de pacientes.Material y métodos: Se evaluaron las complicaciones hemorrágicas en 515 trasplantes renales realizados en nuestra institución entre 2012 y 2018. Se comparó a los pacientes tratados con timoglobulina (grupo 1, N=91) con los tratados con basiliximab (grupo 2, N=424).Resultados: Encontramos diferencias en cuanto al descenso plaquetario: 95.142,2 (55.339,6) en el grupo 1 y 52.364,3 (69.116,6) en el grupo 2 (p=0,001), número de pacientes con trombocitopenia grave (< 7.5000/mm3) (20,8% vs. 3,7%, p=0,001), número de concentrados de hematíes transfundidos (3,25 [0,572] vs. 2,2 [0,191], p=0,028) y porcentaje de pacientes que requirieron reintervención por sangrado (18,2% vs. 7,7%, p=0,046). En un análisis multivariable de regresión lineal múltiple (la variable dependiente fue el número de concentrado de hematíes transfundidos), solo la edad (OR 0,037, IC del 95%, 0,003-0,070) y el tipo de inmunosupresión (OR 1,592, IC del 95%, 1,38-2,84) tuvieron significación estadística.Conclusiones: El uso de timoglobulina en el período perioperatorio del trasplante podría aumentar las complicaciones hemorrágicas. En nuestra serie, la trombocitopenia grave y el sangrado activo que requirió reintervención, fueron 6 y 2,5 veces más frecuente, respectivamente, en el grupo de pacientes con timoglobulina. En lugar de suspender el uso de este agente inmunosupresor, se podría ajustar la dosis para continuar con el tratamiento.Se debe evaluar el uso de timoglobulina en el postoperatorio de estos pacientes (AU)

Objective: It has been described that thymoglobulin could increase the risk of infections and malignancies, in comparison to basiliximab. Leukopenia and thrombocytopenia are also more common within the first days after transplantation among thymoglobulin patients. Our objective was to analyze bleeding complications in this subset of patients.Material and methods: Bleeding complications were evaluated among 515 renal transplants carried out at our institution between 2012 and 2018. We compared patients treated with thymoglobulin (Group 1, N=91) with those treated with basiliximab (Group 2, N=424).Results: We found differences in platelet decrease:95142.2 (55,339.6) in Group 1 and 52,364.3 (69,116.6) in Group 2 (P=.001), number of patients with severe thrombocytopenia (<75,000/mm3) (20.8% vs. 3.7%, P=.001), number of blood units transfused (3.25 (0.572) vs. 2.2 (0.191, P=.028) and percentage of patients that required surgery due to bleeding (18.2% vs. 7.7%, P=.046). In a multiple lineal regression multivariable analysis (dependent variable was number of blood units transfused), only age [OR 0.037, 95% CI (0.003-0.070)] and type of immunosuppression [OR 1.592, 95% CI (1.38-2.84)] showed statistical significance.Conclusions: The use of thymoglobulin in the perioperative transplantation period could increase bleeding complications. In our series, in the group of patients with thymoglobulin, severe thrombocytopenia was 6 times more frequent, and active bleeding that required surgery was also 2.5 times more frequent. One way to continue with the use of this immunosuppression agent, might be to adjust the dose instead of discontinuing it. The use of thymoglobulin should be a factor to consider in the postoperative period of these patients (AU)

Could thymoglobulin increase hemorrhagic risk in the perioperative transplantation period of sensitized kidney recipients?

OBJECTIVE: It has been described that thymoglobulin could increase the risk of infections and malignancies, in comparison to basiliximab. Leukopenia and thrombocytopenia are also more common within the first days after transplantation among thymoglobulin patients. Our objective was to analyze bleeding complications in this subset of patients. MATERIAL AND METHODS: Bleeding complications were evaluated among 515 renal transplants carried out at our institution between 2012 and 2018. We compared patients treated with thymoglobulin (Group 1, N=91) with those treated with basiliximab (Group 2, N=424). RESULTS: We found differences in platelet decrease: 95,142.2 (55,339.6) in Group 1 and 52,364.3 (69,116.6) in Group 2 (P=0.001), number of patients with severe thrombocytopenia (<75,000/mm3) (20.8% vs. 3.7%, P=0.001), number of blood units transfused (3.25 (0.572) vs. 2.2 (0.191, P=0.028) and percentage of patients that required surgery due to bleeding (18.2% vs. 7.7%, P=0.046). In a multiple lineal regression multivariable analysis (dependent variable was number of blood units transfused), only age [OR 0.037, 95% CI (0.003-0.070)] and type of immunosuppression [OR 1.592, 95% CI (1.38-2.84)] showed statistical significance. CONCLUSIONS: The use of thymoglobulin in the perioperative transplantation period could increase bleeding complications. In our series, in the group of patients with thymoglobulin, severe thrombocytopenia was 6 times more frequent, and active bleeding that required surgery was also 2.5 times more frequent. One way to continue with the use of this immunosuppression agent, might be to adjust the dose instead of discontinuing it. The use of thymoglobulin should be a factor to consider in the postoperative period of these patients.

Weight loss and quality of life in patients surviving 2 years after gastric cancer resection.

BACKGROUND: Malnutrition is common in patients undergoing gastric cancer resection, leading to weight loss, although little is known about how this impacts on health-related quality of life (HRQL). This study aimed to explore the association between HRQL and weight loss in patients 2 years after curative gastric cancer resection. METHODS: Consecutive patients undergoing curative gastric cancer resection and surviving at least 2 years without disease recurrence were recruited. Patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the specific module for gastric cancer (STO22) before and 2 years postoperatively and associations between HRQL scores and patients with and without ≥ 10% body weight loss (BWL) were examined. RESULTS: A total of 76 patients were included, of whom 51 (67%) had BWL ≥10%. At 2 years postoperatively, BWL ≥10% was associated with deterioration of all functional aspects of quality of life, with persistent pain (21.6%), diarrhoea (13.7%) and nausea/vomiting (13.7%). By contrast, none of the patients with BWL <10% experienced severe nausea/vomiting, pain or diarrhoea. CONCLUSIONS: Disabling symptoms occurred more frequently in patients with ≥10% BWL than in those with <10% BWL, with a relevant negative impact on HRQL. A cause-effect relationship between weight loss and postoperative outcome remains unsolved.

[Subjective experience with antipsychotics: quantitative evaluation]. / La experiencia subjetiva con antipsicóticos: evaluación cuantitativa.

INTRODUCTION: The subjective experience of psychotic patients with neuroleptics has been the purpose of many studies, considering its importance in treatment adherence, quality of life and outcome. Many authors have developed measurement instruments applicable in everyday clinical practice. The scale objectives defer in hues, but have the subjective perspective in common. METHOD: Questionnaires designed for evaluating subjective experience with antipsychotics, appearing in PUBMED during the last 40 years, have been collected. RESULTS: Ten scales for evaluating the subjective experience with antipsychotics: NDS, DRI, DAI-30, DAI-10, ROMI, SWN, SWN (short version), MARS, ANT and PETiT, were found. Their advantages and limitations have been analyzed. CONCLUSIONS: We have checked out that the contents of each scale do not overlap. It is proposed to differentiate between ((dysphoria response to neuroleptics)) as an acute effect and the ((subjective experience)) as complex effect of long term compliance.

La experiencia subjetiva con antipsicóticos: evaluación cuantitativa / Subjective experience with antipsychotics: quantitative evaluation

Introducción. La experiencia subjetiva de los pacientes psicóticos con el tratamiento neuroléptico, ha sido objeto de estudio ante su importancia en el cumplimiento, calidad de vida y pronóstico. Diversos autores han creado instrumentos de medida aplicables en la práctica clínica diaria. Los objetivos perseguidos por las escalas difieren en matices, pero tienen en común la perspectiva subjetiva. Método. Se recogen los cuestionarios diseñados para la evaluación de la experiencia subjetiva con antipsicóticos, que han aparecido en Pubmed en los últimos 40 años. Resultados. Se encuentran 10 escalas para la evaluación de la experiencia subjetiva con antipsicóticos: NDS, DRI, DAI-30, DAI-10, ROMI, SWN, SWN (versión corta), MARS, ANT y PETiT. Se analizan las ventajas y limitaciones de las mismas. Conclusiones. Se comprueba que los contenidos que recogen cada una de las escalas no se superponen. Se propone diferenciar la «disforia a neurolépticos» como efecto agudo, de la «experiencia subjetiva» como efecto complejo del cumplimiento a largo plazo

Introduction. The subjective experience of psychotic patients with neuroleptics has been the purpose of many studies, considering its importance in treatment adherence, quality of life and outcome. Many authors have developed measurement instruments applicable in everyday clinical practice. The scale objectives defer in hues, but have the subjective perspective in common. Method. Questionnaires designed for evaluating subjective experience with antipsychotics, appearing in PUBMED during the last 40 years, have been collected. Results. Ten scales for evaluating the subjective experience with antipsychotics: NDS, DRI, DAI-30, DAI-10, ROMI, SWN, SWN (short version), MARS, ANT and PETiT, were found. Their advantages and limitations have been analyzed. Conclusions. We have cheked out that the contents of each scale do not overlap. It is proposed to differentiate between «dysphoria response to neuroleptics» as an acute effect and the «subjective experience» as complex effect of long term compliance

Nocardiosis encefálica en pacientes portadora de LES / Encephalic nocardiosis in a systemic lupus erythematosus

La finalidad del siguiente trabajo es mostrar una afección infectológica poco frecuente, por un germen oportunista como es la Nocardia en una paciente inmunodeprimida por su enfermedad de fondo (Lupus Eritematoso Sistérmico) y por el tratamiento realizado. La forma de presentación fue extrapulmonar con una localización encefálica y subcutánea. Se plantearon dificultades terapéuticas, dada su baja incidencia en nuestro medio

[Cardiopulmonary resuscitation in a general hospital]. / Reanimación cardiopulmonar en un hospital general.

The study presents a plan that is based on transferring the survival chain philosophy in hospital environments that directs the modern cardiopulmonary revival (CPR). The plan is based on an alarm system, starting the basic CPR by the nurse that identifies the sudden death, the fast arrival of the intensive care doctor, a nurse supervisor (who carries the defibrillator monitor to the scene) and the doctor responsible for the patient. During the first two years of performance (June 1993 to June 1995) 99 cases occurred with 73 confirmed stoppages. In 95% of the cases the alarm was tended in less than 5 minutes. Twenty one patients (33%) recovered their pulse and seven (11%) were sent home with a good brain recovery. The authors believe that appliances like the one introduced are useful in order to achieve efficient results in the CPR within the hospital.

Plásticas de uretra anterior / Reconstructive procedures of anterior urethra

Entre mayo de 1990 y setiembre de 1993, se realizaron en nuestro servicio 32 plásticas de uretra, de los cuales 25 fueron de uretra anterior co un rango de edad entre 16 y 79 años (X=61,6).Las estenosis de la uretra anterior estuvieron localizadas en la uretra pendular en 11 casos,bulbar en 10 y péndulobulbar en 4 casos. Su étiologia fue traumática en 20 pacientes, infecciosa en 2 y de origen desconocido en 3. La técnica empleada en la reparación de la uretra anterior fué cirugía con colgajo de piel de pene o escroto en 17 oportunidades, un colgajo más injerto de piel total, resección y anastomosis término-terminal en una ocasión y 6 cirugías en dos tiempos indicados a los pacientescon procesos infecciosos locales. Se registraron 4 reestenosis que se solucionaron fácilmente mediante uretrotomías internas. Actualmente todos los pacientes se encuentran con curvas flujométricas compatibles con la normalidad y urocultivos negativos seriados con un seguimiento entre 12 y 51 meses (X=37,2). La reconstrucción de la uretra anterior en un tiempo es un procedimiento relativamente sencillo,con buenos resultadosy no debe ser empleada en estrecheces uretrales complicadas con procesos infecciosos

Plásticas de uretra anterior / Reconstructive procedures of anterior urethra

Entre mayo de 1990 y setiembre de 1993, se realizaron en nuestro servicio 32 plásticas de uretra, de los cuales 25 fueron de uretra anterior co un rango de edad entre 16 y 79 años (X=61,6).Las estenosis de la uretra anterior estuvieron localizadas en la uretra pendular en 11 casos,bulbar en 10 y péndulobulbar en 4 casos. Su étiologia fue traumática en 20 pacientes, infecciosa en 2 y de origen desconocido en 3. La técnica empleada en la reparación de la uretra anterior fué cirugía con colgajo de piel de pene o escroto en 17 oportunidades, un colgajo más injerto de piel total, resección y anastomosis término-terminal en una ocasión y 6 cirugías en dos tiempos indicados a los pacientescon procesos infecciosos locales. Se registraron 4 reestenosis que se solucionaron fácilmente mediante uretrotomías internas. Actualmente todos los pacientes se encuentran con curvas flujométricas compatibles con la normalidad y urocultivos negativos seriados con un seguimiento entre 12 y 51 meses (X=37,2). La reconstrucción de la uretra anterior en un tiempo es un procedimiento relativamente sencillo,con buenos resultadosy no debe ser empleada en estrecheces uretrales complicadas con procesos infecciosos(AU)

[The attitudes of primary care professionals on mental patients and psychiatric care]. / Opiniones de los profesionales de atención primaria sobre los enfermos mentales y la asistencia psiquiátrica.

AIM: To describe the views of different primary care professionals regarding mental illness, psychiatric patients and mental health care. DESIGN: Crossover survey. SITE. Primary care centres in a health zone. PARTICIPANTS: All the primary care centre professionals and social service base teams. Out of 66 possible subjects, 61 answered the questionnaire. MEASUREMENTS AND RESULTS: A questionnaire composed by ourselves about peoples' opinions was given. The chi 2 test was then used to analyse the questionnaire, both item by item and by means of the distribution of frequencies and comparisons. On some items differences between Health Professionals and social service staff occurred. But there were no differences between doctors and nursing staff, nor between men and women (level of importance: 0.50). For 91% of those surveyed, mental health is an illness like any other. 87% believe psychiatry is a science; and 77% that psychiatry is related to the rest of medicine. 48% believe that the majority of mental disturbances are untreatable. 80% affirm that psychiatric admissions should be into special hospitals. CONCLUSION: The authors highlight the need to overcome the discrepancy between positive attitudes on the theoretical side and a reluctance to integrate those attitudes into practice.