Factores predictivos de mortalidad e ingreso en la unidad de cuidados intensivos en pacientes con pielonefritis enfisematosa: experiencia de 5 años en un hospital terciario / Predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis: 5-year experience in a tertiary care hospital

Introduction and objectivesEmphysematous pyelonephritis is a life-threatening infection of the kidney and surrounding tissues associated with a high mortality rate. The aim of this study was to determine predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis, and to propose a therapeutic algorithm based on current literature and our experience.MethodsA retrospective study was done including patients with emphysematous pyelonephritis in a single center in the north of Mexico from 2011-2016. Demographic, clinical, microbiological and biochemical parameters, therapeutic management, and outcomes were assessed. Factors associated with admission to intensive care unit and mortality were determined. Comparison was assessed using χ2 test for categorical variables, and T-test for numerical variables. Univariate and multivariate logistic regression analyses were performed. Statistical significance was set at p<0.05.ResultsA total of 63 patients were included, of which 55(87.3%) were females, with a mean age of 55.5±12.2 years. The most common comorbidities were diabetes and hypertension. Escherichia coli was the most common isolated microorganism (51.7%) and extended-spectrum beta-lactamase-producing agents were reported in 31.7%. Conservative therapy was provided to 38.7%, double J stent 42.9%, open/percutaneous drainage 12.7%, and nephrectomy 25.3%. Overall mortality and intensive care admission were 20.6% and 36.5%, respectively. In the multivariate analysis, hemodynamic instability (p=0.005), qSOFA≥2 (p=0.003), hypoalbuminemia (p=0.02), and early nephrectomy (p=0.002) were associated with intensive care admission. Huang scale 4 (p=0.006) and early nephrectomy (p=0.001) were associated to mortality.ConclusionsEmphysematous pyelonephritis is a life-threatening disease and evidence of management is based in small case series due to the low incidence of this condition.

Introducción y objetivosLa pielonefritis enfisematosa es una infección del riñón y los tejidos circundantes que pone en riesgo la vida del paciente y se asocia a una elevada tasa de mortalidad. El objetivo de este estudio fue determinar los factores predictivos de mortalidad e ingreso en la unidad de cuidados intensivos en pacientes con pielonefritis enfisematosa, y proponer un algoritmo terapéutico basado en la literatura actual y en nuestra experiencia.MétodosSe realizó un estudio retrospectivo incluyendo los pacientes con pielonefritis enfisematosa en un solo centro del norte de México entre 2011 y 2016. Se evaluaron parámetros demográficos, clínicos, microbiológicos y bioquímicos, el manejo terapéutico y los resultados. Se determinaron los factores asociados con el ingreso a la unidad de cuidados intensivos y la mortalidad. La comparación se evaluó mediante la prueba de chi cuadrado para las variables categóricas, y la prueba t de Student para las variables numéricas. Se realizaron análisis de regresión logística univariante y multivariante. La significación estadística se fijó en p<0,05.ResultadosSe incluyeron 63 pacientes, de los cuales 55 (87,3%) eran mujeres, con una edad media de 55,5±12,2 años. Las comorbilidades más frecuentes fueron la diabetes y la hipertensión. Escherichia coli fue el microorganismo más comúnmente aislado (51,7%) y los agentes productores de betalactamasas de espectro extendido se registraron en el 31,7%. Se administró tratamiento conservador al 38,7%, el uso de catéter doble J en el 42,9%, drenaje abierto/percutáneo en el 12,7% y nefrectomía en el 25,3%. La mortalidad global y el ingreso en cuidados intensivos fueron del 20,6% y el 36,5%, respectivamente. En el análisis multivariante, la inestabilidad hemodinámica (p=0,005), la escala qSOFA≥2 (p=0,003), la hipoalbuminemia (p=0,02) y la nefrectomía temprana (p=0,002) se asociaron con el ingreso en cuidados intensivo

Predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis: 5-year experience in a tertiary care hospital.

INTRODUCTION AND OBJECTIVES: Emphysematous pyelonephritis is a life-threatening infection of the kidney and surrounding tissues associated with a high mortality rate. The aim of this study was to determine predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis, and to propose a therapeutic algorithm based on current literature and our experience. METHODS: A retrospective study was done including patients with emphysematous pyelonephritis in a single center in the north of Mexico from 2011 to 2016. Demographic, clinical, microbiological and biochemical parameters, therapeutic management, and outcomes were assessed. Factors associated with admission to intensive care unit and mortality were determined. Comparison was assessed using X2 test for categorical variables, and T-test for numerical variables. Univariate and multivariate logistic regression analyses were performed. Statistical significance was set at P < .05. RESULTS: A total of 63 patients were included, of which 55 (87.3%) were females, with a mean age of 55.5 ±â€¯12.2 years. The most common comorbidities were diabetes and hypertension. Escherichia coli was the most common isolated microorganism (51.7%) and extended-spectrum beta-lactamase-producing agents were reported in 31.7%. Conservative therapy was provided to 38.7%, double J stent 42.9%, open/percutaneous drainage 12.7%, and nephrectomy 25.3%. Overall mortality and intensive care admission were 20.6% and 36.5%, respectively. In the multivariate analysis, hemodynamic instability (P = .005), qSOFA ≥ 2 (P = .003), hypoalbuminemia (P = .02), and early nephrectomy (P = .002) were associated with intensive care admission. Huang scale 4 (P = .006) and early nephrectomy (P = .001) were associated to mortality. CONCLUSIONS: Emphysematous pyelonephritis is a life-threatening disease and evidence of management is based in small case series due to the low incidence of this condition. Hemodynamic instability, hypoalbuminemia, qSOFA ≥ 2, Huang scale ≥3, and early nephrectomy are associated with poor prognosis.

Oral Health: Validation of a questionnaire of self-perception and self-care habits in Diabetes Mellitus 2, hypertensive and obese patients. The UISESS-B scale.

OBJECTIVES: To develop and to evaluate a questionnaire of self-perception and self-care habits on oral health on a first level population. METHODS: A descriptive, observational study was performed to validate a questionnaire on oral health self-perception (UISESS-B). After non-probabilistic sampling, 94 users, 30-59 years of age, with either diabetes mellitus 2, hypertension or obesity were included. Duration of disease was lesser than 10 years. Pearson's r, Cornbach's , factorial analysis, chi-square and Snedecor's F tests were employed. RESULTS: A Pearson's r of 0.7 and Cronbach's of 0.82 was observed on the pre-post values of the global questionnaire. In the factorial analysis, the variance explained more than 60% for a first factor. A punctuation of very high risk for the three groups with the scale UISESSS-B that coincides with the index CPO-D and the index UISESS-F was observed. CONCLUSIONS: The UISESS-B scale shows significant validity and reliability, suggesting its use as a sensitive instrument for the measurement of oral health in people with chronic illnesses such as diabetes, hypertension and obesity.

Effect of age of feed restriction and microelement supplementation to control ascites on production and carcass characteristics of broilers.

Three experiments were conducted, from January until September 2001, to estimate the optimized age to apply feed restriction to control mortality from ascites, with no negative effects on production and carcass characteristics of broilers. For each experiment, 1,200 1-d-old mixed Ross x Peterson chicks were reared in floor pens (50 chicks in each) and fed commercial feed. Feed restriction was applied for 8 h/d for 14 d at 21 or 28 d of age in experiment 1, 14 or 21 d in experiment 2, and 7 or 14 d in experiment 3. In experiments 2 and 3, a microelement supplement (without or with) was tested; the control groups received feed ad libitum and no supplement. Body weight gain, feed conversion, total mortality, and mortality from ascites, leg problems, and carcass characteristics were considered at the end of each experiment. The data were analyzed as a completely randomized design, or as a 2 x 2 factorial to estimate main and interaction effects (experiments 2 and 3). Additional analyses, including the control, were done; means comparisons were by orthogonal contrasts. The production and carcass characteristics of the restricted groups were lower than the control but were not statistically different in experiments 2 and 3, although the optimized age for feed restriction was at 7 d. Total mortality and mortality from ascites decreased by restriction, but leg problems increased without supplement. The results indicated that quantitative feed restriction and microelement supplementation at 7 d of age reduced mortality from ascites and leg problems and permitted compensatory growth sufficient to equal the production characteristics of the control group at 49 d of age. However, it is necessary to determine the specific microelements to be supplemented and to estimate the effects of season and genetic line.

Treatment of adult acute lymphoblastic leukemia with adriamycin, vincristine, and prednisone.

At the present time, it is possible to achieve up to a 95% complete remission in childhood acute lymphoblastic leukemia, using the combination of vincristine and prednisone. Nevertheless, it has not been possible to reproduce these results in the adult. For this reason, a third drug, in this case adriamycin in a low dose, was added to the vincristine-prednisone combination in the treatment of adult acute lymphoblastic leukemia (ALL). Complete remission was achieved in 45 of the 50 patients (90%). The median duration of remission was 23 months and the median survival time in this group was 31 months. The complications were minimal and the tolerance was good. From the point of view of our results and others reported in the literature, we consider that the combination of vincristine, prednisone, and adriamycin is a useful method for induction of remission of adult ALL.