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Introduction/aim: Hyperphosphatemia is a mortality risk factor in dialysis patients; however, low phosphorus levels too. Diabetes and malnutrition are strongly associated with mortality and with reduced serum phosphorus. This study analyzed the pattern of serum phosphorus in patients on Peritoneal Dialysis (PD) and its association with mortality. Methods: A Secondary analysis was performed on a multicenter cohort study in peritoneal dialysis patients from two previous studies done by our group. Results: Six hundred fifty-four patients were included. Serum phosphorus was <3.6 mg/dL in 28.29% of patients, 3.6 to 5.2 mg/dL in 48.16%, and >5.2 mg/dL in 23.55%. In logistic regression analysis; education, age, and hypoalbuminemia were risk factors for low P levels. In multivariate Cox analysis P < 3.6 mg/dL, age, and low albumin were predictors for all-cause mortality. When lower P and lower albumin were combined, this group had the highest risk for all cause and cardiovascular mortality. Conclusion: The frequency of patients with reduced serum phosphorus was higher in the Mexican population than in Europe or Asia. Low serum phosphorus levels, older age and hypoalbuminemia were risk factors for all-cause mortality. Low phosphorus combined with low albumin levels were the highest risk factor for all-cause and cardiovascular mortality.
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OBJECTIVE: Takayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA. METHODS: This is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021. RESULTS: In twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful. CONCLUSION: Although there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients.
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Hipertensão , Pré-Eclâmpsia , Complicações Cardiovasculares na Gravidez , Arterite de Takayasu , Gravidez , Humanos , Feminino , Recém-Nascido , Adulto , Resultado da Gravidez/epidemiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gestantes , Estudos Retrospectivos , Arterite de Takayasu/diagnóstico , Brasil/epidemiologia , Estudos Transversais , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/etiologiaRESUMO
Objetivo: compreender o conhecimento e a percepção de enfermeiros quanto à sedação paliativa em oncologia. Método: estudo qualitativo, exploratório e descritivo, com delineamento transversal. Participaram do estudo 16 enfermeiros atuantes na oncologia de um hospital de referência localizado ao norte do Rio Grande do Sul. A coleta de dados ocorreu por meio de entrevista gravada com duração de aproximadamente 10 minutos, sendo aplicado um roteiro de perguntas fechadas com a finalidade de caracterizar os enfermeiros participantes da pesquisa, e perguntas abertas e específicas para contemplar o objetivo do estudo. O método utilizado para o diagnóstico e verificação dos dados da pesquisa foi a análise de conteúdo de Bardin. Os dados foram analisados e codificados por meio do software NVivo 10, que gerou categorias de similaridade e correlações. Resultados: surgiram cinco categorias intituladas "Conhecimento sobre sedação paliativa; Percepção sobre sedação paliativa na oncologia; Sentimentos em relação à sedação paliativa aos pacientes oncológicos; Vivência em relação à sedação paliativa em pacientes oncológicos e Participação do enfermeiro no procedimento de sedação paliativa". Conclusão: o enfermeiro atua de forma efetiva e fundamental na prestação do cuidado e na avaliação do paciente em sedação paliativa, mas ainda encontram-se diversos obstáculos relacionados à participação na tomada de decisões. Evidencia-se a importância de novas pesquisas sobre a temática, como também a implementação de protocolos que subsidiem na indicação da sedação paliativa.(AU)
Objective: to understand the knowledge and perception of nurses dealing with palliative sedation in oncology. Method: this is a qualitative, exploratory, and descriptive study, with a cross-sectional design. The study included 16 nurses working in oncology at a reference hospital located in the north of Rio Grande do Sul. Data were collected through recorded interviews lasting approximately 10 minutes, with a script of closed questions being applied to characterize the nurses participating in the research, and open and specific questions, to contemplate the objective of the study. The method used for the diagnosis and verification of research data was Bardin's content analysis. Data were analyzed and coded using the NVivo 10 software, which generated categories of similarity and correlations. Results: five categories emerged: (i) Knowledge about palliative sedation; (ii) Perception of palliative sedation in oncology; (iii) Feelings regarding palliative sedation in cancer patients; (iv) Experience with palliative sedation in cancer patients; and (v) Participation of the nurse in the palliative sedation procedure. Conclusion: nurses act effectively and fundamentally in providing care and evaluating patients undergoing palliative sedation, but there are still several obstacles related to their participation in decision-making. The importance of new research on the subject is evident, as well as the implementation of protocols that support the indication of palliative sedation.(AU)
Objetivo: comprender el conocimiento y la percepción de los enfermeros sobre la sedación paliativa en oncología. Método: estudio cualitativo, exploratorio y descriptivo, con diseño transversal. El estudio abarcó 16 enfermeros que trabajaban en oncología en un hospital de referencia localizado en el norte de Rio Grande do Sul. La colecta de datos ocurrió por medio de entrevista grabada con duración aproximada de 10 minutos, siendo aplicado un guión de preguntas cerradas con la finalidad de caracterizar los enfermeros participantes de la investigación, y preguntas abiertas y específicas para contemplar el objetivo del estudio. El método utilizado para el diagnóstico y verificación de los datos de la investigación fue el análisis de contenido de Bardin. Los datos fueron analizados y codificados utilizando el software NVivo 10, que generó categorías de similitud y correlaciones. Resultados: surgieron cinco categorías tituladas "Conocimientos sobre sedación paliativa; Percepción de la sedación paliativa en oncología; Sentimientos con respecto a la sedación paliativa para pacientes con cáncer; Experiencia con sedación paliativa en pacientes oncológicos y participación de Enfermeros en el procedimiento de sedación paliativa". Conclusión: el enfermero actúa de forma eficaz y fundamental en la prestación del cuidado y en la evaluación del paciente en sedación paliativa, pero aún existen varios obstáculos relacionados con la participación en la toma de decisiones. Es evidente la importancia de seguir investigando sobre el tema, así como la implementación de protocolos que sustenten la indicación de la sedación paliativa.(AU)
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Humanos , Masculino , Feminino , Adulto , Enfermagem Oncológica , Cuidados Paliativos , Sedação Consciente/enfermagem , Sedação Profunda/enfermagem , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Analgesia , Neoplasias/tratamento farmacológico , Inquéritos e Questionários , Tomada de Decisão Clínica , Autonomia Relacional , Enfermeiras e EnfermeirosRESUMO
Abstract Objective Takayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA. Methods This is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021. Results In twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful. Conclusion Although there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients.
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The purpose of this study was to compare vascular calcification (VC), serum osteoprotegerin (OPG) levels, and other biochemical markers to determine their value as available predictors of all-cause and cardiovascular (CV) mortality in patients on peritoneal dialysis (PD). A total of 197 patients were recruited from seven dialysis centers in Mexico City. VC was assessed with multi-slice computed tomography, measured using the calcification score (CaSc). OPG, albumin, calcium, hsC-reactive protein, phosphorous, osteocalcin, total alkaline phosphatase, and intact parathormone were also analyzed. Follow-up and mortality analyses were assessed using the Cox regression model. The mean age was 43.9 ± 12.9 years, 64% were males, and 53% were diabetics. The median OPG was 11.28 (IQR: 7.6−17.4 pmol/L), and 42% of cases had cardiovascular calcifications. The median VC was 424 (IQR:101−886). During follow-up (23 ± 7 months), there were 34 deaths, and 44% were cardiovascular in origin. In multivariable analysis, OPG was a significant predictor for all-cause (HR 1.08; p < 0.002) and CV mortality (HR 1.09; p < 0.013), and performed better than VC (HR 1.00; p < 0.62 for all-cause mortality and HR 1.00; p < 0.16 for CV mortality). For each mg/dL of albumin-corrected calcium, there was an increased risk for CV mortality, and each g/dL of albumin decreased the risk factor for all-cause mortality. OPG levels above 14.37 and 13.57 pmol/L showed the highest predictive value for all-cause and CV mortality in incident PD patients and performed better than VC.
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Doenças Cardiovasculares , Diálise Peritoneal , Calcificação Vascular , Adulto , Albuminas , Biomarcadores , Cálcio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoprotegerina , Diálise Peritoneal/efeitos adversos , Fatores de RiscoRESUMO
Traumatic brain injury (TBI) is the leading cause of death and disability for children and young adults. The Glasgow Coma Scale allows to classify TBI as mild, moderate and severe. Imaging studies show the heterogeneity of the diagnosis. Primary injury is caused by mechanical impact. Secondary injury contributes significantly to prognosis by exacerbating hypoperfusion and intracranial hypertension. Even in the absence of extracranial lesions, many patients with severe TBI present significant organ dysfunction, which transforms TBI into a multisystemic pathology. Most relevant systems compromised include cardiovascular, autonomic, respiratory and coagulation. The main aims of anesthetic management are: early decompression together with prevention, early detection, and management of determinants of secondary injury. To date, there are no techniques or drugs showing a significant impact on the outcome of TBI patients. On the other hand, maintaining good hemodynamic stability, adequate oxygenation and normocarbia all contribute to a better outcome.
El trauma encéfalocraneano (TEC) es la causa más importante de muerte y discapacidad de niños y adultos jóvenes. La escala de Glasgow permite clasificarlo en leve, moderado y severo. La imagenología da cuenta de la heterogeneidad del diagnóstico. La injuria primaria es la causada por el impacto mecánico. La injuria secundaria contribuye significativamente al pronóstico al exacerbar la hipoperfusión y la hipertensión endocraneana. Aun en ausencia de lesiones extracraneales, gran parte de los pacientes con TEC severo presenta disfunción orgánica significativa, lo que lo transforma en una patología multisistémica. Destacan el compromiso cardiovascular, autonómico, respiratorio y trastornos de la coagulación, entre otros. Los objetivos del manejo anestésico son: la descompresión precoz junto con la prevención, detección temprana y manejo de factores determinantes de injuria secundaria. No existe evidencia respecto de técnicas ni fármacos que hayan demostrado un impacto significativo en el manejo del TEC, más bien, impacta positivamente el mantener la estabilidad hemodinámica, una adecuada oxigenación y normocarbia.
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Humanos , Lesões Encefálicas Traumáticas/terapia , Anestesia/métodos , Glicemia , Temperatura Corporal , Cuidados Pré-Operatórios , Manuseio das Vias Aéreas , Lesões Encefálicas Traumáticas/classificação , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Hemodinâmica , Monitorização Fisiológica , Anticonvulsivantes/uso terapêuticoRESUMO
Resumen La sororidad engloba las prácticas de colaboración y soporte en las relaciones entre mujeres y es el espacio propicio para la construcción de nuevas formas de significar la vejez femenina. El objetivo de este estudio cualitativo fue describir y categorizar los tipos de configuraciones vinculares que se mantienen y los que se han transformado en pro a la sororidad en los procesos de envejecimiento femenino, por medio del análisis narrativo de una entrevista profunda grupal. Los resultados muestran la necesidad de implementar políticas y acciones en aras de disminuir el ageism con relación al envejecimiento de mujeres. La construcción de la sororidad ayuda en el empoderamiento colectivo en pro de su género. La sexualidad de la mujer mayor sigue siendo un tema pendiente en la agenda de la investigación y la discusión en los estudios feministas, lo que nos lleva a concluir que, a pesar de la existencia de diferencias individuales en los propios procesos de envejecimiento, las mujeres se experimentan y comparten en una misma condición histórica, por ello es en colectivo que la acción de la sororidad se pronuncia como vía en la generación de nuevas narrativas preferidas por las mujeres. Finalmente, se expone una propuesta para trabajar la percepción del cuerpo femenino en el proceso de envejecer, y la construcción de la sororidad, desde las prácticas narrativas de White y Epston.
Abstract Sorority encompasses the practices of collaboration and support in relations between women and is the propitious space for the construction of new ways to signify female old age. We present results of a qualitative study using focus groups, which aimed to describe and categorize the types of relational configurations that remain unchanged or change towards sorority in the female aging process. Findings describe the need to implement actions to reduce ageism, not only in terms of the experiences women go through, but also towards aging in general. One of the measures we can take is undoubtedly the construction of women circle sorority, which leads to collective empowerment of gender. The female body is a focus of attention in terms of what it lives and experiences, and the right to have love and sexuality throughout life is also highlighted. We then created an intervention proposal to work on the perception of the female body and its experience in the aging process. The proposed intervention is a workshop, based on the narrative model of Michael White and David Epston.
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BACKGROUND: Arterial calcification (AC) is frequent in patients with end stage renal disease and is also considered a risk factor for later morbidity and mortality. However, long-term factors associated with the process are not well known. We analyzed the trends over time of biomarkers related with development and progression of AC in incident patients on peritoneal dialysis (PD). METHODS: We performed a prospective study with 186 patients on PD followed up for 1 year. We analyzed the progression of AC in the abdominal aorta and pelvic vessels by calcification score (CaSc), using16-cut computerized multidetector tomography at baseline and 1 year. Variables related with PD treatment, inflammation, and mineral metabolism were measured at baseline, 6, and 12 months of follow-up. Changes in biochemical variables were analyzed for their relationship with changes in AC. RESULTS: Over 1 year, the number of patients with AC increased from 47 to 56%, and CaSc from 355 (interquartile range [IQR] 75-792) to 529 (IQR 185-1632). A total of 43.5% of patients remained free of calcification, 11.7% had new calcifications, and 44.8% had progression of calcification. Older age, diabetes, high systolic blood pressure, body mass index, cholesterol, and osteoprotegerin (OPG), as well as lower levels of albumin, serum creatinine, and osteocalcin, were associated with development of new, and rapid progression of, calcification. In multivariate logistic analysis, OPG remained the most significant (OR 1.27, 95% CI 1.11-1.47, p < 0.001). CONCLUSION: OPG was the strongest risk factor associated with new development and rapid progression of AC in incident PD patients.
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Falência Renal Crônica/terapia , Osteoprotegerina/sangue , Diálise Peritoneal/efeitos adversos , Calcificação Vascular/sangue , Adulto , Fatores Etários , Aorta Abdominal/patologia , Biomarcadores/sangue , Diabetes Mellitus/sangue , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia , Calcificação Vascular/etiologia , Adulto JovemRESUMO
BACKGROUND/AIMS: Diastolic dysfunction (DD) and low levels of thyroid hormones (TH) are frequent found in chronic kidney disease; both are associated with all-cause and cardiovascular mortality. However, a link between them has not yet been established. The aim of this study was to analyze DD as a surrogate marker of fibrosis and its association with TH in incident patients on peritoneal dialysis (PD). METHODS: A cross-sectional study with 183 incident patients on PD with preserved ejection fraction was performed. Clinical and demographic data were registered. Serum total and free (t/f) triiodothyronine (T3), thyroxin (T4), and thyroid stimulating hormone levels were determined by RIA kits, albumin and high-sensitivity C-reactive protein by conventional assays. Transthoracic 2D echocardiogram was performed for evaluation of left ventricular (LV) mass and ejection fraction. DD was evaluated using pulsed-wave tissue Doppler imaging. RESULTS: Patients were 43 ± 12, 42% with diabetes mellitus (DM). Some degree of DD was found in 62% of patients; 18% had grade I DD, 8% grade II DD and 36% grade III DD. Patients with grade III DD were more likely to have diabetes, older, high LV mass and low serum albumin, t/fT3 and tT4 levels. In logistic multivariate regression analysis, it was found that diabetes (B = -0.86, 95% CI 0.182-0.992, p < 0.05), hypertension (B = -0.95, 95% CI 0.184-0.817, p = 0.01) and tT3 (B = -1.94, 95% CI 0.023-0.876, p < 0.05) were associated with grade III DD. CONCLUSIONS: High prevalence of grade III DD was found in incident patients on PD. In addition to DM and hypertension, tT3 was found to be an independent risk factor for grade III DD and more studies are needed to understand the reasons as to why this association is present.