RESUMEN
BACKGROUND: The aim of this randomized clinical trial follow-up at three months was to evaluate the effectiveness of an educational intervention with a focus on diet and physical activity (PA) to change the amount of PA, body mass index (BMI) and the waist circumference (WC) in patients with severe mental illness. METHODS: We recruited 332 outpatients with severe mental disorders undergoing treatment with antipsychotic medication from Mental Healthcare Centers of Barcelona. They were randomly assigned to an intervention or a control group. The patients in the intervention group participated in a group PA and diet educational program. The blinded measurements at 0 and 3 months were: the level of PA (IPAQ questionnaire), BMI, WC, blood pressure, dietary habits (PREDIMED questionnaire), quality of life (SF-36 questionnaire) and laboratory parameters (cholesterol, triglycerides, glucose). RESULTS: The average age was 46.7 years and 55% were males. Schizophrenia had been diagnosed in 67.1% of them. At 3 months, the average weekly walking METs rose significantly in the IG 266.05 METs (95%CI: 16.86 to 515.25; P=0.036). The total MET average also rose although not significantly: 191.38 METs (95%CI: 1.38 to 381.38; P=0.086). However, the BMI decreased significantly more in the CG, by 0.26kg/m(2) (95%CI: 0.02 to 0.51; P=0.038), than in the IG. There were no significant differences in the WC. CONCLUSIONS: The short-term results suggest that the intervention increases the level of PA, but does not improve physical or laboratory parameters. TRIAL REGISTRATION: Clinicaltrials.gov NCT01729650 (effectiveness of a physical activity and diet program in patients with psychotic disorder [CAPiCOR]).
Asunto(s)
Antipsicóticos/uso terapéutico , Enfermedades Cardiovasculares , Dietoterapia/métodos , Terapia por Ejercicio/métodos , Trastornos Psicóticos , Calidad de Vida , Adulto , Índice de Masa Corporal , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/psicología , Enfermedades Cardiovasculares/terapia , Colesterol/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora/fisiología , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/fisiopatología , Trastornos Psicóticos/terapia , Encuestas y Cuestionarios , Resultado del Tratamiento , Triglicéridos/sangre , Circunferencia de la CinturaRESUMEN
A 65-year-old man who received a deceased renal allograft in September 2001. The donor of the allograft was a 54-year-old hypertensive man who expired from intracerebral hemorrhage. Atheroma with hard plaques was present in both renal arteries and aortic patches. After vascular anastomosis and clamp release, the allograft recoloration was inadequate, and the patient remained anuric. Computerized tomography scan demonstrated disseminated infarction areas, suggesting cholesterol emboli, which was confirmed later by a graft biopsy. As approximately 50% of the renal parenchyma was perfused, graft nephrectomy was not indicated and dialysis was restarted. Diuresis was over 3000 ml/day and serum creatinine decreased and stabilized at 360 micromol/L by the 32nd postoperative day. The allograft supported the patient for only two years, and he eventually was successfully retransplanted in June 2003. We believe that delayed graft function due to cholesterol emboli disease may be reversible if areas of infarction are not too large.
Asunto(s)
Embolia por Colesterol/cirugía , Trasplante de Riñón/efectos adversos , Adulto , Anciano , Cadáver , Carcinoma Papilar/cirugía , Embolia por Colesterol/diagnóstico por imagen , Embolia por Colesterol/patología , Humanos , Neoplasias Renales/cirugía , Persona de Mediana Edad , Donantes de Tejidos , Tomografía Computarizada por Rayos X , Trasplante Homólogo , Resultado del TratamientoRESUMEN
INTRODUCTION: The catastrophic antiphospholipid syndrome (CAPS) is a rare expression of the antiphospholipid syndrome (APLS). The all predicting factors of happening of CAPS are not yet discovered. Some women presenting an APLS with infertility have recourse to ovulation induction (OI). EXEGESIS: After an OI, a woman is admitted for acute renal failure, hypertension, seizures, respiratory failure. History and immunologic tests are in favour of APLS. Renal biopsy highlights a thrombotic microangiopathy. Diagnosis of CAPS is made. Patient improves after respiratory assistance, parenteral treatment for hypertension and anticoagulant therapy. CONCLUSION: IO seems to be on of the factors which leads to CAPS. To avoid such consequences, it's essential to know the history and the immunological status of the patients having recourse to this treatment to take care of these risked pregnancies.
Asunto(s)
Síndrome Antifosfolípido/etiología , Inducción de la Ovulación/efectos adversos , Enfermedad Aguda , Adulto , Anticoagulantes/uso terapéutico , Biopsia , Femenino , Humanos , Hipertensión/etiología , Infertilidad Femenina/terapia , Riñón/patología , Insuficiencia Renal/etiología , Convulsiones/etiología , Resultado del TratamientoRESUMEN
In our series of 1374 renal transplantations performed between February 1970 and December 2002, we observed 6 cases of infection due to Nocardia asteroides. There were 4 males and 2 females, aged 49.8 +/- 12 years (29 to 63 years). One patient received his first transplantation and the 5 others retransplants. Three patients had PRA > 80%, one 28% and one 40%. One patient was diabetic and two had HCV infection. Two of 6 patients experienced acute rejection episodes. Nocardiosis localisation was pulmonary in 5 cases, cerebral in two and mediastinal in one. All patients recovered after reduction of immunosuppression and appropriate antibiotherapy with trimethoprim-sulfamethoxasole (TMP-SMX). When we analyzed the role of immunosuppression, we observed that only two cases were observed in the 933 recipients transplanted between 1985 and 2002 and receiving cyclosporin, contrasting with 4 cases among 174 recipients transplanted between 1996 and 2002 and receiving tacrolimus. Our data suggest that high immunologic risk patients, heavy immunosuppression, and perhaps tacrolimus-based immunosuppression are risk factors of nocardial infection. Early diagnosis of this severe infection, reduction of immunosuppression and appropriate therapy with TMP-SMX resulted in complete recovery in all our patients.
Asunto(s)
Inmunosupresores/efectos adversos , Trasplante de Riñón , Ácido Micofenólico/análogos & derivados , Nocardiosis/epidemiología , Nocardia asteroides/aislamiento & purificación , Complicaciones Posoperatorias/epidemiología , Tacrolimus/efectos adversos , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Adulto , Anciano , Suero Antilinfocítico/efectos adversos , Suero Antilinfocítico/uso terapéutico , Azatioprina/efectos adversos , Azatioprina/uso terapéutico , Ciclosporina/efectos adversos , Ciclosporina/uso terapéutico , Complicaciones de la Diabetes , Susceptibilidad a Enfermedades , Femenino , Rechazo de Injerto , Hepatitis C Crónica/complicaciones , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Ácido Micofenólico/efectos adversos , Ácido Micofenólico/uso terapéutico , Nocardiosis/tratamiento farmacológico , Nocardiosis/etiología , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Reoperación , Factores de Riesgo , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoAsunto(s)
Ciclosporina/uso terapéutico , Hipertensión/epidemiología , Trasplante de Riñón/fisiología , Tacrolimus/uso terapéutico , Presión Sanguínea , Creatinina/sangre , Ciclosporina/efectos adversos , Quimioterapia Combinada , Humanos , Incidencia , Complicaciones Posoperatorias/epidemiología , Tacrolimus/efectos adversosRESUMEN
Este trabajo tiene como objetivo conocer cuál es la tensión arterial (TA) intradiálisis que mejor orienta sobre la obtención del "peso seco" de un paciente sometido a hemodiálisis crónica. Se ha determinado, en un grupo de 72 pacientes en hemodiálisis crónica, la TA medida ambulatoriamente: el día intermedio entre la 1ª y la 2ª sesión y entre la 2ª y 3ª sesión de hemodiálisis de la semana (cuando el paciente ha alcanzado su peso seco estimado) y se han comparado con la TA medida en distintos momentos de la sesión de hemodiálisis del día intermedio de la semana. Las mediciones de la TA se realizaron: 5 minutos antes de conectar al paciente, inmediatamente tras la conexión, cada hora durante la hemodiálisis, inmediatamente antes de la desconexión y 5 minutos después de la misma. Los resultados obtenidos difieren dependiendo de si el paciente tomaba o no medicación hipotensora. En el grupo no medicado la TA sistólica de la 2ª hora tras la conexión es la que mejor se correlaciona con su peso seco. En el grupo que tomaba medicación la TA sistólica más significativa es la de la primera hora después de la conexión. La ganancia ponderal media y el control tensional del conjunto de pacientes se consideraron adecuados (AU)
Asunto(s)
Adulto , Anciano , Femenino , Masculino , Persona de Mediana Edad , Humanos , Aumento de Peso , Diálisis Renal/efectos adversos , Pacientes Ambulatorios , Presión Sanguínea , Presión Sanguínea/fisiología , Hipotensión/tratamiento farmacológico , Hipotensión/etiología , Diálisis Renal/métodosRESUMEN
A female dialysis patient with a consistently high serum calcium phosphate product presented with large necrotic skin lesions with ulcers. The clinical course was highly suggestive of calciphylaxis. Parathyroidectomy was followed by the healing of the lesions. New skin lesions appeared following relapse of hyperparathyroidism. Her clinical records included a long past of hypertension, which was the cause of her renal failure. She had a limited walking range and previously had presented bilateral ulcers of vascular origin. This case presents a type of lesion which bears a serious prognosis in dialysis patients. The clinical context and the presentation of the lesions are compatible with multiple etiology: vascular lesions and calciphylaxis. The documented longitudinal follow-up illustrates the importance of treating the different factors known to participate in the appearance of skin lesions in dialysis patients. Particularly, it stresses the benefit of performing parathyroidectomy, even if the parathyroid hormone level is not in the range normally accepted as requiring surgical removal of parathyroid glands.