Dolor crónico en fosa iliaca derecha por bario retenido Palabras clave: Apendicitis crónica. Apendicitis por bario. Bario retenido.
BackgroundThe major SARD have an increased mortality compared to the general population. It is well known that the main causes of death in Systemic Lupus Erythematosus (SLE) are infections (INF), cardiovascular events (CV), neoplasia (NEO) and disease activity. However, the compared mortality of Mixed Connective Tissue Disease (MCTD), Systemic Sclerosis (SSc), Poly/Dermatomyositis (PM/DM), overlap syndromes (OS), Sjögren's syndrome (SS), Antiphospholipid syndrome (APS), systemic vasculitis (SV), and undifferentiated or incomplete Connective Tissue Disease (UCTD) is poorly described.ObjectivesTo analyze the causes of death and the autoantibodies (AAB) profile among the SARD.MethodsThis was a single center, prospective and observational study. Mortality by all causes and relationship with AAB profile were analyzed in patients diagnosed of SLE, MCTD, SSc, PM/DM, OS (simultaneous or sequential criteria of 2 or more SARD), SS, APS, SV and UCTD or incomplete SARD (at least one clinical criterion of the classification criteria and a related antibody of any of the SARD). Data were obtained from the “Systemic Autoimmune Rheumatic Diseases Registry” of a tertiary referral hospital from 1986 to 2016. Patients with rheumatoid arthritis were excluded. The SARD registry counts with the institutional review board approval.Results1750 patients were included, of whom 1453 (83%) were women. Five hundred fifty six SLE, 125 SSc, 111 PM/DM, 91 OS, 90 MCTD, 250 SS, 71 APS, 211 SV, 117 UCTD and 128 losses to follow-up, the global follow up rate was 92.7%. A global mortality of 350 (20%) cases was observed: 101 INF (28,8%), 89 CV (25,4%), 51 NEO (14,5%), 45 due to disease activity (12,8%), 41 other causes (11,7%) and 23 from unknown causes (6,5%). Table 1 shows detailed mortality causes compared by diseases. A higher mortality was associated (p<0,05) with older patients (71 years, 20–96), SV (OR 3,65), male patients (OR 1,95), SSC/PM/DM (OR 1,76), MCTD (OR 1,6) and OS (OR 1,43). AAB to pANCA (OR 4,43), anti-topoisomerase I (OR 3,64), myositis-specific AAB (OR 3.0), cANCA (OR 2,19) and anticardiolipin (OR 1,89) were associated with poorer survival. A higher survival rate was observed in patients with SLE (OR 1,7), SS (OR 1,69) and UCTD (OR 15,57) (p<0,05).CAUSESSLE, %SSC, %MCTD, %SV, %PM/DM, %OS, %SS, %APS, % CV 30,86 27,02 42,3 25,5518,1816,1217,6421,4INF27,1621,623,84 36,66 33,33 45,16 23,5221,4NEO14,8113,5115,388,8818,189,67 26,47 14,28ACTIVITY9,8718,9119,2311,1112,1219,3511,76 28,57 OTHER8,6413,5111,5315,559,093,228,820.00UNKNOWN8,645,407,692,229,096,4511,7614,28ConclusionsThe main causes of death among SARD patients are CV (MCTD, SLE, and SSC), severe infections (OS, SV, and PM/DM), disease activity (APS) and neoplasia (SS). A higher mortality is observed among ANCA positive SV, anti-topoisomerase I positive SSC, MCTD, OS, anticardiolipin and myositis-specific positive patients.Disclosure of InterestNone declared
INTRODUÇÃO:Com 30 anos de existência, o Sistema Único de Saúde (SUS) atende mais de 190 milhões de pessoas. Para tanto, é organizado de forma descentralizada, a atenção secundária é formada pelos serviços em nível ambulatorial e hospitalar. OBJETIVO: Relatar a Vivência dos acadêmicos do curso de enfermagem dentro do SUS na UPA e compreender a organização das práticas de saúde durante um período de estágio supervisionado. RELATO DE EXPERIÊNCIA: A UPA é um complexo de atendimento de média complexibilidade isto é, um conjunto de atenção básica e hospitalar que se concentram em um atendimento por demanda espontânea, logo que o paciente chega já é recepcionado por nosso grupo de estagiários é gerado a classificação de risco pelo Protocolo de Manchester para priorizar o atendimento. Assim o paciente é enviado para consulta médica e a sala de medicamentos , exames se necessário, continuam em observação espperando alta. . A observação é dividida em leitos feminino e masculino separados para melhor privacidade no posto nós estagiários seguimos com os cuidados aos pacientes internados, higiene e conforto, aferição de sinais vitais todos em folha de choque, alimentação, curativos e qualquer intercorrência que venha existir e a SAE. Também acompanhamos a sala de emergência que é o local destinado a pacientes graves, ou suporte de vida artificial, tais como atendimento de primeiros socorros, monitorização de aparelhos e drogas vasoativas, alimentação por sonda, cuidados ao leito. Na sala de urgência e emergência também são recebido as ambulâncias da prefeitura, SAMU, ou ECO. DISCUSSÃO: Dada o texto sobre as práticas de saúde e estágio supervisionado conseguimos compreender e executar todos os processos da área da enfermagem, passando em todas as áreas e as rotinas dos enfermeiros, seguimos todas as orientação e ajudamos nas atividades recorrentes, o desenvolvimento do nosso grupo de profissionais na vivência nos ajudou a entender melhor os cuidados básicos e eventuais situações que possam vir ocorrer. Acreditamos que o estágio foi de inteiro aprendizado e concordamos que a UPA tem uma organização de saúde muito prática. CONCLUSÃO: Os ensinamentos aprendidos e somados a prática é um diferencial na qualificação no futuro profissional.
Background and Aims Peritoneal infections remain as a significant source of morbidity and mortality in PD patients. A steady decline of their incidence has been accompanied by changes in the etiologic spectrum of these infections, during the last decades. We have undertaken a review of trends in the compared incidence of PD-related peritonitis in our centre during a 30-year period, with a particular interest in streptococcal infections. Method Following an observational, retrospective design, we analyzed trends in the incidence and outcomes of peritoneal infections diagnosed in our centre between January 1990 and October 2019. We mainly focused on the incidence, risk factors and outcomes of streptococcal peritonitis. We excluded fungal peritonitis (very low incidence), surgical enteric infections and non-infectious peritonitis. Treatment failure was defined by transfer to hemodialysis for at least 3 months after the infection or death related to peritonitis. We applied Cox’s model to define clinical predictors of streptococcal infection, and stepwise logistic regression to investigate predictors of treatment failure. Results We recorded 1026 episodes of peritoneal infection in 878 patients, including 234 (22.8%) streptococcal infections, 57 (5.6%) infections by Staphylococcus aureus (SAu), 285 (27.8%) infections by coagulase-negative staphylococci (CNSt), 182 (17.7%) infections by gram-negative bacteria, 135 (13.2%) infections with 2 or more microorganisms and 133 (13.0%) culture-negative cases. Remarkably, streptococci were also main components in polimicrobial infections (present in 58.2% of cases). The incidence of peritonitis decreased during the observation period, from 0.91 (1990-94) to 0.47 episodes (2015-19) per patient and year This decline affected preferentially infections by SAu (0.068 to 0.006) and CNSt (0.361 to 0.067), while the incidence of infections by other etiologic agents remained essentially stable. As a consequence, the relative clinical spectrum moved to a predominance of streptococcal (10.7 to 23.3%), polimicrobial (8.0 to 15.7%) and culture-negative infections (4.7 to 16.2%). On multivariate analysis, patients suffering streptococcal infections were older (p=0.019), and presented lower albumin levels (p=0.004), than either patients suffering infections of other etiologies or presenting a peritonitis-free clinical course. After logistic regression analysis, older age, longer time on dialysis at the time of the infection, comorbidity, previous immunosuppression and plasma albumin were most consistent predictors of peritonitis-related mortality and treatment failure. Streptococcal peritonitis showed more benign outcomes than SAu (p<0,001) or gramnegative infections (p=0.032), with rates of treatment failure comparable to those observed for CNSt, non-enteric polimicrobial or culture-negative infections. Conclusion Streptococcal and polimicrobial (often including streptococci) infections have become dominant in the clinical spectrum of PD-related peritonitis, after the decline in the incidence of staphylococcal infections. The clinical aggressiveness of these infections appears intermediate between that observed in Staphylococcus aureus and CNSt infections.
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