RESUMO
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 Pâ¯<â¯.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 (Pâ¯=â¯.005), qSOFAâ¯≥â¯2 (Pâ¯=â¯.003), hypoalbuminemia (Pâ¯=â¯.02), and early nephrectomy (Pâ¯=â¯.002) were associated with intensive care admission. Huang scale 4 (Pâ¯=â¯.006) and early nephrectomy (Pâ¯=â¯.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, qSOFAâ¯≥â¯2, Huang scale ≥3, and early nephrectomy are associated with poor prognosis.
Assuntos
Enfisema , Hipoalbuminemia , Pielonefrite , Adulto , Idoso , Enfisema/epidemiologia , Enfisema/etiologia , Enfisema/terapia , Feminino , Humanos , Hipoalbuminemia/complicações , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pielonefrite/epidemiologia , Pielonefrite/terapia , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
Several textile dyes were individually exposed to electrochemical treatment. Chromaticity variation and the formation of degradation products were followed using a UV spectrophotometer and HPLC with diode array detection. Dyes studied belong to the azo (color index, C.I. 15,510), methine (C.I. 48,013), indigo (C.I. 73,040), natural (C.I. 75,760) and arylmethane (C.I. 42,000) classes. Aliquots of the solutions treated at constant potential were analyzed and compared with control dye solutions. The final electrolysis solutions obtained by using different electrode materials: Pt, Ti and diamond presented different chromatograms. It was found that the novel (in this application) diamond electrode is efficient in studying the degradation of various dyes. Possible fragmentation and molecule moiety rearrangement are proposed as a result of the electrochemical treatment.