[Assessment of pulmonary complications in renal transplantation through the use of radiography]. / Evaluación de complicaciones pulmonares en trasplante renal a partir de imagen radiológica.

BACKGROUND: Lower respiratory tract infections are the most common complications in kidney transplant patients in the first six months and they are associated with high mortality. Other complications include pulmonary edema, pulmonary embolism, and pulmonary hemorrhage. The aim of this study was to evaluate pulmonary complications in kidney transplant patients by using chest radiography. METHODS: We analyzed a total of 516 chest X-rays of 150 patients who received a kidney transplant in 2014. Chest radiographs were performed in the preoperative and in the postoperative assessments, as well as within the next 48 hours after the surgery, and from 3 to 7, 8-15, 16-30, 31-90, 91-180 and 180 days. For the radiographic study of the lung parenchyma, chest was divided into four quadrants by assigning a value of 1 to each radiographic pattern: reticular, nodular alveolar occupation; lobar or segmental; atelectasis; and ground-glass. Lung parenchyma obtained a minimum value of 0 and a maximum value of 16 points. Also, we assessed variables such as gender, age, associated comorbidity, and type of renal transplantation. RESULTS: We obtained data from a total of 150 patients; 19 patients had pulmonary complications in the first 24 to 48 hours and 15 patients between 90 and 180 days after the kidney transplantation. The most frequent complications were acute pulmonary edema in early stage and infections in late stage. CONCLUSION: The prevalence of complications diagnosed by chest radiograph was low and it was observed more often in early and late stages.

Introducción: las infecciones del tracto respiratorio inferior son la complicación más frecuente en pacientes trasplantados de riñón en los primeros seis meses y están asociadas a alta mortalidad. Otras complicaciones pulmonares incluyen edema, embolia y hemorragia pulmonar. Se buscó evaluar las complicaciones pulmonares en los pacientes trasplantados de riñón utilizando la radiografía de tórax. Métodos: se analizaron 516 radiografías de tórax de 150 pacientes que recibieron trasplante renal en el 2014. Las radiografías se tomaron en la valoración preoperatoria, postoperatoria dentro de las 48 horas posteriores, 3 a 7, 8 a 15, 16 a 30, 31 a 90, 91 a 180 y más de 180 días. Para el estudio del parénquima pulmonar se dividió el tórax en cuatro cuadrantes asignando un valor de 1 a cada patrón radiográfico que se encontrara: reticulonodular o de ocupación alveolar, lobar o segmentario, atelectasia y vidrio deslustrado; el parénquima pulmonar obtuvo un valor mínimo de 0 y un mayor de 16 puntos. También se evaluó género, edad, comorbilidad asociada y tipo de trasplante renal. Resultados: se obtuvo la información de un total de 150 pacientes; 19 presentaron complicaciones pulmonares en las primeras 24-48 horas y 15 entre los 90 y los 180 días posteriores al trasplante renal. Las complicaciones más frecuentes fueron edema agudo pulmonar en la etapa temprana e infecciones en la etapa tardía. Conclusión: la prevalencia de complicaciones diagnosticadas por radiografía de tórax fue baja y se observó más en la etapa temprana y tardía.

Is COPD a Risk Factor for Hip Fracture?

This study aimed to describe trends in the incidence of hip fracture hospitalizations, use of surgical procedures, and hospital outcomes among elderly patients with and without chronic obstructive pulmonary disease (COPD) in Spain (2004-2013). We selected all patients with a discharge primary diagnosis of hip fracture using the Spanish national hospital discharge database. Discharges were grouped by COPD status. From 2004 to 2013, 432,760 discharges with hip fracture were identified (6.9% suffered COPD). Incidence among COPD men increased by 2.63% per year from 2004 to 2013. There were no significant changes in tendency in the incidence among women with COPD during the study period. COPD women have almost three times higher incidence than COPD men. Incidences and hospital complications were higher among patients with COPD beside sex. The proportion of patients who underwent internal fixation increased for all groups of patients and the open reduction decreased. After multivariate analysis, in-hospital mortality (IHM) has improved over the study period for all patients. Suffering COPD was associated with higher IHM in men (odds ratio 1.45; 95% confidence interval 1.33-1.58) than women. In conclusion, hip fracture incidence is higher in subjects with than without COPD and is much higher among women than men. In COPD patients, incidence rates increased significantly in men from 2004 to 2013, but not in women. For all groups, the use of internal fixation has increased overtime and open reduction, IHM, and length of hospital stay have decreased from 2004 to 2013.

Readmissions following an initial hospitalization by COPD exacerbation in Spain from 2006 to 2012.

BACKGROUND AND OBJECTIVE: Hospitalizations are not isolated events in COPD patients. A significant percentage of patients are readmitted during the first month after their discharge. The aim of this study was to elucidate changes in the incidence, comorbidity, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients readmitted following an initial hospitalization by acute exacerbation of COPD (AE-COPD). METHODS: We selected all patients ≥40 years, hospitalized for AE-COPD between 2006 and 2012 in Spain using the National Hospital Discharge Database. Patient readmissions were defined as inpatient re-hospitalization within 30 days of discharge for AE-COPD. RESULTS: We identified 301 794 discharges of patients having hospital admissions for AE-COPD as their primary diagnosis (82.47% first admissions, 17.53% hospital readmissions). The risk of re-hospitalization was higher in patients aged 65 to 84 years, males, with comorbidities, malnutrition, not obese, respiratory acidosis, treated with non-invasive ventilation (NIV) or discharged to a health/social institutions. Factors associated with IHM among patients readmitted were: older age, increased Charlson Index, malnutrition, not being obese, respiratory acidosis and treatment with NIV. The IHM and hospital costs were significantly higher in readmissions compared with first admissions. We observed that the incidence and mortality of readmissions had significantly decreased from 2006 to 2012. CONCLUSION: Hospital readmissions within 30 days of discharge for AE-COPD are common in Spain. They have a high impact for COPD patients and health system. However, we have found a downward trend in incidence and mortality of readmissions from 2006 to 2012.

Chiapas e o Zapatismo: da humilhação à dignidade / Chiapas and the Zapatismo: from humiliation to dignity

O tema central do presente trabalho é o Zapatismo em Chiapas, México. Através desta análise, chamo a atenção para os seguintes pontos: 1) Os Movimentos Sociais constituem fenômenos compostos por elementos que correspondem tanto às instâncias de índole objetiva, coletiva, racional, como as de natureza subjetiva, individual, emocional. Por isso, é indispensável que as abordagens que se realizem sobre eles, visando à sua verdadeira compreensão, de fato assim os considerem, a fim de não perpetuarem a antiga cisão estabelecida entre estas esferas, pelo conhecimento tradicional. 2) O Movimento Zapatista é um excelente exemplo de como fatores de caráter afetivo dão consistência a uma poderosa força capaz de motivar, manter e desenvolver a existência de uma organização social. 3) No caso do EZLN, esses aspectos de ordem emocional, transitaram por um processo que abrange desde a experiência (secular a partir dos antepassados dos seus membros e ainda presente para estes) de ter sofrido uma humilhação com raízes e faces múltiplas, até a vivência de fazer valer sua dignidade humana. 4) Essa dinâmica é expressa tanto na prática como no discurso do EZ, através das vias do confronto ou da solidariedade, conforme o lugar que os outros sujeitos com os quais se relaciona ocupam na estrutura social. Conseqüentemente essa posição orienta por sua vez a atitude que eles adotam em relação aos Zapatistas e viceversa, bem como a qualidade da afetividade possível entre eles (AU)

Uma abordagem da psicologia social a respeito dos movimentos populares

Estuda uma aproximação aos novos movimentos populares através da psicologia social, e a mobilização dos moradores de um bairro periférico da Grande São Paulo, no contexto da pré-escola de 1985 a 1988. Explora o papel do sujeito e do psicólogo na dinâmica de um movimento popular, onde a maioria dos Ss são mães que buscam captar suas vivências a respeito desse movimento. Fundamenta-se em concepções básicas da pesquisa participante, em conceitos da pesquisa qualitativa, e como recurso, na informação viva. Conclui que: na mobilização existem diversas modalidades de participação, que vão de uma ativa a outra distante até a quase indiferente; também encontra a não participação, a qual aparece como um dado mais inquietante do que se espera; a cada um destes modos diferentes de participar, correspondem peculiares histórias de vida, motivações, percepções, atitudes e lembranças; por trás dessas últimas questões, se vislumbram elementos psicológicos mais profundos tanto quanto decisivos: representação social, auto-estima e afeto, os quais são bastante complexos e requerem uma pesquisa própria, da qual esta pode ser o ponto de partida (AU)