Infarto renal. Diagnóstico por ¿qué imagen?, y tratamiento / Renal infarction: Which imaging technique?, and its treatment

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[Functional dependency evaluation of hemodialysis patients: a multicentric study]. / Valoración del grado de dependencia funcional de los pacientes en hemodiálisis (HD): estudio multicéntrico.

BACKGROUND: There has been a change in the hemodialysis population characteristics over the last years with a progressive increase in patient,s age and associated comorbility and mortality. This older hemodialysis population are more functionally and medically dependent increasing the time taken to perform nursing work. The objective of this study was to evaluate the degree of functional dependency on hemodialysis patients and the need of care by nursing workload. METHODS: A transversal descriptive study was done during 1 month (april 2005) on 586 patients from 10 HD Units in Spain. No exclusion criteria were used. The Delta Test, who was used to evaluate the patients dependency needs, is a workload measure instrument base on three subscales: dependency, Physical Deficiency and mental deficiency. The indicators are measure on a scale of one to three with each level representing an increasing demand on nursing time. The results obtained from the Delta Test were analyzed taking into account the following variables: age, average time in dialysis, Charlson comorbidity Index, geographic location and HD unit. RESULTS: 46% of the patients show some degree of dependency, of these 12.8% were moderated and 8.1% severe; the subscale analysis showed that 19.6% and 6.7% had, respectively, a moderate to severe physical and mental health deficiency. The dependency degree varied significantly between HD Units and geographic location with a range of 0% to 59.8%. The degree of dependency were statistically associated with age and CCI. The higher CCI (r: 0,21; p < 0.001) and age (r: 0,26; p < 0.001) the higher was the Delta Test Score for dependency level. Patients times of initiation on dialysis were not associated with an increase in the degree of dependency. The aspects evaluated by the Delta Test that showed a higher score were those related to patients mobility. The patients assistance requirements during the HD session are basically related to a lack of mobility due to musculoskeletal disease and to a lesser extent to behavior alterations. CONCLUSIONS: HD units are attending patients with an important degree of dependency which impose and added workload to the healthcare personnel. In occasions, it is very difficult to attend and give proper care with the current legally established nurse to patient ratio which. This suggests the need to implement a better staffing policy. The Delta Test provides an objective, adaptable and standardized instrument for measuring degree of dependency of HD patients.

Valoración del grado de dependencia funcional de los pacientes en hemodiálisis (HD): estudio multicéntrico / Functional dependency evaluation of hemofialysis patients. A multicentric study

Introducción: Las características de los pacientes que se incluyen en hemodiálisis (HD) han cambiado en los últimos años, habiendo aumentado la edad y la comorbilidad, lo que tiene implicaciones sobre aspectos funcionales, dada la necesidad de ayuda que requieren estos pacientes. El objetivo de este estudio ha sido analizar el grado de dependencia funcional del paciente en HD. Métodos: Estudio transversal y descriptivo en 586 pacientes dializados en abril de 2005 en 10 unidades de HD ubicadas en la Comunidad Valenciana, Andalucía y Castilla-León. Para valorar el grado de dependencia se utilizó el «Test Delta», que consta de tres subescalas que miden: Dependencia: (puntuación máxima 30), Deficiencia física: (puntuación máxima 15) y Deficiencia psíquica: (puntuación máxima 15). Los ítems se puntúan de 0 a 3, de menor a mayor severidad. Se analizaron los resultados obtenidos de acuerdo con las siguientes variables: Edad, tiempo medio en hemodiálisis, Índice de Comorbilidad de Charlson (ICC), Provincias y Unidades. Resultados: El 45,6% de los pacientes presentaba algún tipo de dependencia (un 12,8% en grado moderado y un 8,1% en grado severo). El análisis por sub-escalas mostró una Deficiencia física moderada-severa en el 19,6%, y en el 6,7% una Deficiencia psíquica. Este grado de dependencia variaba significativamente de unas unidades a otras (0%- 59,8%), y según áreas geográficas. La edad y el ICC mostraron asociación estadísticamente significativa con el grado de dependencia, de modo que a mayor edad (r: 0,26; p < 0,001) y mayor puntuación en el ICC (r: 0,21; p < 0,001) mayor grado de dependencia, sin embargo el tiempo de permanencia en hemodiálisis no mostró asociación. Los aspectos evaluados en el Test Delta que mostraron mayor puntuación fueron los relacionados con la movilidad del paciente. Los requerimientos de ayuda se deben fundamentalmente a falta de autonomía en la movilidad por alteraciones del aparato locomotor y, en menor medida, a trastornos de conducta. En conclusión, los centros de hemodiálisis están atendiendo a pacientes con un importante grado de dependencia, lo que supone una mayor carga de trabajo para el personal sanitario y muy especialmente el de enfermería. En ocasiones es imposible atender a este tipo de pacientes con el ratio de personal asignado actualmente por los conciertos vigentes, y se requiere una mayor dotación de enfermería. La existencia de parámetros que de manera objetiva permitan valorar tales circunstancias, hacen aconsejable aprobar un instrumento de valoración común, que sea sencillo, universal y rápido en la valoración y que, además, pueda adaptarse a las necesidades cambiantes de la población a la que va destinado

Background: There has been a change in the hemodialysis population characteristics over the last years with a progressive increase in patient,s age and associated comorbility and mortality. This older hemodialysis population are more functionally and medically dependent increasing the time taken to perform nursing work. The objective of this study was to evaluate the degree of functional dependency on hemodialysis patients and the need of care by nursing workload. Methods: A transversal descriptive study was done during 1 month (april 2005) on 586 patients from 10 HD Units in Spain. No exclusion criteria were used. The Delta Test, who was used to evaluate the patients dependency needs, is a workload measure instrument base on three subscales: dependency, Physical Deficiency and mental deficiency. The indicators are measure on a scale of one to three with each level representing an increasing demand on nursing time. The results obtained from the Delta Test were analyzed taking into account the following variables: age, average time in dialysis, Charlson comorbidity Index, geographic location and HD unit. Results: 46% of the patients show some degree of dependency, of these 12.8% were moderated and 8.1% severe; the subscale analysis showed that 19.6% and 6.7% had, respectively, a moderate to severe physical and mental health deficiency. The dependency degree varied significantly between HD Units and geographic location with a range of 0% to 59.8%. The degree of dependency were statistically associated with age and CCI. The higher CCI (r: 0,21; p < 0.001) and age (r: 0,26; p < 0.001) the higher was the Delta Test Score for dependency level. Patients times of initiation on dialysis were not associated with an increase in the degree of dependency. The aspects evaluated by the Delta Test that showed a higher score were those related to patients mobility. The patients assistance requirements during the HD session are basically related to a lack of mobility due to musculoskeletal disease and to a lesser extent to behavior alterations. Conclusions: HD units are attending patients with an important degree of dependency which impose and added workload to the healthcare personnel. In occasions, it is very difficult to attend and give proper care with the current legally established nurse to patient ratio which. This suggests the need to implement a better staffing policy. The Delta Test provides an objective, adaptable and standardized instrument for measuring degree of dependency of HD patients

[Ileocecal tuberculosis during hemodialysis simulating carcinoma of the colon]. / Tuberculosis ileocecal en hemodiálisis simulando un carcinoma de colon.

Extrapulmonary tuberculosis is more frequent in hemodialysis patients than in the general population but intestinal localization is an unusual presentation of this infectious disease. We report a 60 year old patient on regular hemodialysis with intestinal tuberculosis masquerading as colon cancer. The patient presented with rectal bleeding, abdominal pain and fever and the radiological findings were compatible with ileocecal carcinoma. After surgery histological examination showed non-caseating granulomas but mycobacterial culture was not available. We performed a colonoscopy and obtained a biopsy of colonic mucosa for culture and other analyses. We identified acid-fast bacilli with Ziehl-Neelsen staining of formaldehyde preserved, paraffin-embedded tissue from the hemicolectomy and the colonic mucosal biopsy. Treatment with isoniazid, rifampicin and pyrazinamide for nine months was successful and well tolerated. Intestinal tuberculosis is a rare entity that we must keep in mind in a patient with abdominal pain, unexplained fever, digestive bleeding and particularly with a positive tuberculin reaction. When culture is not possible we can obtain intestinal samples by colonoscopy and use appropriate staining of paraffin-embedded tissues.

Tuberculosis ileocecal en hemodiálisis simulando un carcinoma de colon / Pseudotomoral ileocecal tuberculosis mimicking a colon carcinoma in a hemodialysis patient

La tuberculosis de localización extrapulmonar es más frecuente en pacientes en hemodiálisis que en la población general. Presentamos un caso de tuberculosis intestinal ileocecal que debutó con rectorragia y posteriormente con fiebre y dolor abdominal. En la exploración radiológica se encontró una tumoración en ciego y fue intervenido con el diagnóstico de carcinoma de colon, no remitiendo por tanto muestras para cultivo. El examen anatomopatológico reveló la presencia de granulomas no caseosos de aspecto tuberculoide. La tinción de Ziehl-Neelsen permitió orientar la etiología al descubrir bacilos ácido-alcohol resistentes en muestras quirúrgicas conservadas en parafina y en muestras de mucosa obtenidas por colonoscopia. El tratamiento con isoniacida, rifampicina y pirazinamida fue bien tolerado, dejando libre de síntomas a la paciente.Si bien la localización intestinal es rara se debe plantear como diagnóstico diferencial ante un paciente con rectorragia, masa intestinal, antígenos tumorales normales y Mantoux positivo. La realización de biopsias mediante colonoscopia, con búsqueda de micobacterias mediante tinciones apropiadas permitirá un diagnóstico correcto. (AU)