RESUMEN
OBJECTIVES: There is limited knowledge regarding the specific interrelationships between urgent coronary artery bypass graft (U-CABG) surgery and postoperative acute kidney injury (AKI). We aimed to (1) analyze the impact of urgent CABG (U-CABG) on the incidence and severity of postoperative AKI, (2) estimate the influence of AKI after UCABG or elective CABG (E-CABG) on mortality and (3) identify risk factors for AKI depending on the urgency of operation. RESULTS: UCABG patients showed a higher incidence of AKI (49.8% vs. ECABG: 39.7%; pâ¯= 0.026), especially for higher AKI stages 2â¯+ 3. In-hospital mortality was higher in UCABG patients (12.6%) compared to ECABG patients (2.3%; pâ¯<â¯0.001). The impact of AKI on mortality did not differ, but showed a strong coherency between higher AKI stages (2â¯+ 3) and mortality (stage 1: OR 2.409, 95% CI 1.017-5.706; pâ¯= 0.046 vs. stage 2â¯+ 3: OR 5.577; 95% CI 2.033-15.3; pâ¯= 0.001). Univariate logistic regression analysis revealed that preoperative renal impairment, peripheral vascular disease and transfusion of more than two red blood cell concentrates were predictors for postoperative AKI in both groups. CONCLUSIONS: UCABG is a risk factor for postoperative AKI and even "mild" AKI leads to a significantly higher mortality. Hence, the prevention of modifiable risk factors might reduce the incidence of postoperative AKI and thus improve outcome.
Asunto(s)
Lesión Renal Aguda , Complicaciones Posoperatorias , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Estudios de Cohortes , Puente de Arteria Coronaria/efectos adversos , Humanos , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de RiesgoAsunto(s)
Estenosis de la Válvula Aórtica/terapia , Cateterismo Cardíaco , Implantación de Prótesis de Válvulas Cardíacas/métodos , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Cateterismo , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Diseño de Prótesis , Radiografía Intervencional , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: The expenses of health insurances are continuously raising. With implementation of evidence-based medicine resulting in polypharmacy, compliance is decreasing and patients as well as physicians are facing unintentional drug interactions. Furthermore the arbitrary use of additional drugs apart from prescribed medication has to be considered. The objective of this study was to analyse polypharmacy, compliance and utilisation patterns for non-prescription medications (OTC) in patients with cardiovascular diseases. METHODS: 100 patients with cardiovascular diseases (45 women, 55 men, 58 - 87 years) were interviewed using a questionnaire. The compliance was determined by the Morisky-Score. RESULTS: 78 % of the patients received more than four pills every day (median 8.34). Most common products were beta-blockers (89 %), ACE-Inhibitors/Sartans (69 %) and aspirin (65 %). Only 52 % of the patients knew the indications of their medication. Although 83 % of the patients claimed to be absolutely compliant concerning their medication, the Morisky-Score revealed a high compliance only in 52 %. The compliance decreased significantly if the number of prescribed medication increased to more than four pills a day. 48 % of the patients took regularly non-prescription products, 35 % more than three additional products daily. Most commonly multivitamins, minerals, herbals and non-steroidal anti-inflammatory drugs were used. This non-prescription medication did not affect the compliance of the patients. CONCLUSIONS: Polypharmacy with more than four pills daily leads to a lower compliance and can therefore influence the implementation of guideline-medicine. Non-prescription medication is widely used and should be considered because of their potential side-effects and drug interactions.
Asunto(s)
Enfermedades Cardiovasculares/tratamiento farmacológico , Medicamentos sin Prescripción/uso terapéutico , Cooperación del Paciente , Polifarmacia , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Anciano de 80 o más Años , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/uso terapéutico , Interacciones Farmacológicas , Femenino , Fibrinolíticos/uso terapéutico , Alemania , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Minerales/uso terapéutico , Medicamentos sin Prescripción/efectos adversos , Fitoterapia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Guías de Práctica Clínica como Asunto , Encuestas y Cuestionarios , Vitaminas/uso terapéuticoRESUMEN
METHOD: By a telephone poll conducted among 143 selected representative urologists in private practice throughout the west German Länder. BASIC REMARKS: Via a search for carcinoma in situ of the testicles (CIS, or testicular intra-epithelial neoplasia, TIN), active early detection of testicular germ cell tumors is now possible. RESULTS: Among 143 urologists questioned, 62 claimed to be familiar with testicular CIS. However, only 52% were able correctly to answer one question as to its significance, and only 33% could correctly answer a question on the diagnosis of CIS. Only 28% of all those questioned were able to answer correctly 2 questions about CIS. Knowledge about CIS proved to be inversely correlated with the interval in years since obtaining a licence to practice as a specialist. CONCLUSION: The poll reveals that, at the present time, too few urologists are familiar with carcinoma in situ of the testicles, and the possibilities of active early detection of testicular tumors.