Objective-To determine the precision and agreement of synovial fluid (SF) cell counts done manually and with automated counters, and to determine the degree of variability of the counts in SF samples, kept in the tubes used for routine white blood cell (WBC) counts-which use liquid EDTA as anticoagulant-at 24 and 48 hours at 4°C, and at room temperature. Methods-To determine precision, cell counts were repeated 10 times-both manually and by an automated counter-in a SF sample of low, medium, and high cellularity. The variances were calculated to determine the interobserver variation in two manual (M1,M2) and two automated cell counts (C1,C2). The agreement between a manual (M1) and automated counter (C1) results, was analysed by the Bland and Altman method and the diVerence against the mean of the two methods was plotted. Then, the mean diVerence between the two methods was estimated and the standard deviation of the diVerence. To determine the eVects of storage, SF samples were kept in a refrigerator at 4°C, and at room temperature; cell counts were done manually (M1) and automatically (C1) at 24 and 48 hours and the changes analysed by the Bland and Altman method. The variances were compared using an F test. Results-(1) Precision. With the manual technique, the coeYcients of variation were 27.9%, 14%, and 10.7% when used for counting the SF with low (270), medium (6200), and high cellularities (25 000). With the automated technique the coeYcients of variation were 20%, 3.4%, and 2.9% in the same SF samples. In the fluids of medium and high cellularity, the variances of the automated cell counts were significatively lower (F test, p<0.002) than those of the manual counts. (Ann Rheum Dis 1997;56:622-626) The white blood cell (WBC) count in synovial fluid provides information about the amount of inflammation present in the joints, and is the basis for the classification of synovial fluids (SF) into the categories of non-inflammatory, inflammatory, and septic.1-3 The WBC count is generally performed manually, using saline as a diluent to avoid the formation of a mucin clot, which would result from the use of haematological diluents containing acetic acid. 4 DiVerent problems have been found in relation to the performance of the WBC counts in the SF; a poor reproducibility of manual WBC counts, 5 as well as contradictory results in relation to the stability of the SF have been reported, emphasising the need of performing the procedure without delay. 6 Counting by means of automatic counters has occasionally been done, but problems such as the error produced by fat globules have been found when the counts are performed by such a method. 7Our aim is to determine the precision and reproducibility of WBC counts of SF
RESUMENIntroducción y objetivos: La vida de los pacientes en hemodiálisis está sometida a diferentes situaciones estresantes y amenazantes. Esto hace que un porcentaje nada despreciable de pacientes presente trastornos ansiosos y depresivos como respuesta normal a estas situaciones que pueden pasar desapercibidos al personal de salud que les atiende. Por otra parte, estos trastornos afectivos pueden influir en la percepción de su propio estado de salud. El objetivo del trabajo es conocer la prevalencia de estos trastornos ansiosos y depresivos en nuestros pacientes hemodializados y ver su influencia en la calidad de vida (CVRS).Metodología: Se realiza el estudio con 75 pacientes, 50 varones. Se excluyeron los pacientes mayores de 65 años y con menos de 6 meses de permanencia en programa de HD, o que presentaran trastornos psicóticos, neurológicos o descompensación del estado físico. La depresión se ha medido con dos escalas: Inventario de Beck (BDI) y la Escala de Hamilton (HDRS). La ansiedad se midió con la Escala de Hamilton para ansiedad (HARS) y la CVRS con la versión española de las láminas CO-OP/WONCA.Resultados: La sintomatología depresiva estaba presente en un porcentaje bastante elevado de nuestros pacientes: 53,3% con la HDRS y un 44% con el BDI y la ansiosa en un 46,6%. Al analizar los resultados observamos que las variables sociodemográficas, así como las relacionadas con el proceso dialítico no han resultado factores predisponentes de la ansiedad y la depresión. Encontramos un buen nivel de correlación (C. de Pearson) entre la CVRS medida con el COOP/WONCA y los estados de ansiedad (r = 0,52(HARS), p<0,001) y depresión (r = 0,64 (BDI) y 0,75 (HDRS); p<0,001). Conclusiones:Existe una elevada prevalencia de sintomatología ansiosa y depresiva en nuestros pacientes asociada a factores relacionados con la CVRS y su capacidad funcional. STUDY OF THE PREVALENCE OF ANXIOUS AND DEPRESSIVE DISORDERS IN PATIENTS UNDER HAEMODIALYSIS ABSTRACTIntroduction and objectives: The lives of patients under haemodialysis are subject to different stressful, threatening situations. This means that a not inconsiderable percentage of patients suffer anxious and depressive disorders as a normal reaction to such situations, which might be unnoticed by the health personnel attending them. Furthermore, these affective disorders may influence the perception of their state of health. The aim of the work is to discover the prevalence of these anxious and depressive disorders in our patients under haemodialysis and see the influence on their quality of life (CVRS).
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