Inhibidor de bomba de protones como factor asociado de peritonitis bacteriana espontánea en cirróticos con ascitis. Hospital Lazarte Essalud. Trujillo. 2009 - 2014

En la presente investigación se buscó determinar si el uso del inhibidor de bomba de protones (IBP) constituye un factor asociado de peritonitis bacteriana espontanea (PBE) en pacientes cirróticos con ascitis en el Hospital Víctor Lazarte Echegaray en el periodo 2009-2014 Se realizó un estudio observacional, analítico, retrospectivo, de casos y controle, donde se evaluó a 238 historias clínicas de pacientes cirróticos con ascitis, 119 con peritonitis bacteriana espontánea y 119 sin presencia de peritonitis bacteriana espontánea pareados de 1:1, de acuerdo a edad, sexo y escala de Child-Pugh, en el período de estudio que fue de del año 2009 al 2014, se obtuvieron los datos de las historias clínicas de pacientes hospitalizados en el servició de gastroenterología del Hospital Víctor Lazarte Echegaray de Trujillo. Se utilizó x2 para evaluación estadística, además se calculó el OR. Se observó que de los pacientes cirróticos con ascitis que presentaron PBE en un 70.6% utilizaron IBP, mientras que el 29.4% no recibieron dicho tratamiento. Así mismo de los pacientes cirróticos con ascitis que no presentaron PBE en un 37.0% recibieron IBP, mientras que el 63.0% no lo recibieron. Se encontró un OR de 4.09 [IC del95% 2.37 a 7.034]; encontrando asociación significativa entre estas dos variables (p=0.0001), lo que indica que en los pacientes que usaron IBP aumenta en 4.09 veces la posibilidad de presentar peritonitis bacteriana espontánea, en relación a los pacientes cirróticos que no reciben IBP. Se concluyó que existe asociación estadísticamente significativa ente el uso de inhibidor de bomba de protones y peritonitis bacteriana espontánea en cirróticos con ascitis.In the present investigation sought to determine whether the use of proton pump inhibitor (PPI) is a factor associated with spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites in Victor Lazarte Echegaray Hospital in 2009-2014 An observational, analytical, retrospective, case-control study, where 238 medical records of cirrhotic patients with ascites, 119 spontaneous bacterial peritonitis and 119 without the presence of spontaneous bacterial peritonitis was evaluated 1:1, according to age, sex and Child-Pugh scale in the study period was from 2009 to 2014, data from the medical records of patients hospitalized in the Gastroenterology Service of Victor Lazarte Echegaray Hospital Trujillo were obtained x2 for statistical evaluation was used, besides the OR was calculated. It was observed that of cirrhotic patients with ascites who had PBE 70.6% used IBP, while 29.4% did not receive such treatment. Also of cirrhotic patients with ascites showed no PBE in 37.0% received IBP, while 63.0% did not. An OR of 4.09 [CI 2.37 to 7,034 del95%] was found; finding significant association between these two variables (p = 0.0001), indicating that patients who used PPIs increases 4.09 times the possibility of presenting spontaneous bacterial peritonitis in cirrhotic patients regarding not receiving PPIs. It was concluded that there is a statistically significant association entity using proton pump inhibitor and spontaneous bacterial peritonitis in cirrhotic patients with ascites.Tesi

Evidence in chronic kidney disease–mineral and bone disorder guidelines: is it time to treat or time to wait?

Chronic kidney disease\u2013mineral and bone disorder (CKD\u2013MBD) is one of the many important complications associated with CKD and may at least partially explain the extremely high morbidity and mortality among CKD patients. The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline document was based on the best information available at that time and was designed not only to provide information but also to assist in decision-making. In addition to the international KDIGO Work Group, which included worldwide experts, an independent Evidence Review Team was assembled to ensure rigorous review and grading of the existing evidence. Based on the evidence from new clinical trials, an updated Clinical Practice Guideline was published in 2017. In this review, we focus on the conceptual and practical evolution of clinical guidelines (from eMinence-based medicine to eVidence-based medicine and \u2018living\u2019 guidelines), highlight some of the current important CKD\u2013MBD-related changes, and underline the poor or extremely poor level of evidence present in those guidelines (as well as in other areas of nephrology). Finally, we emphasize the importance of individualization of treatments and shared decision-making (based on important ethical considerations and the \u2018best available evidence\u2019), which may prove useful in the face of the uncertainty over the decision whether \u2018to treat\u2019 or \u2018to wait\u2019

Clinical Approach to Vascular Calcification in Patients With Non-dialysis Dependent Chronic Kidney Disease : Mineral-Bone Disorder-Related Aspects

Chronic kidney disease (CKD) is associated with a very high morbimortality, mainly from cardiovascular origin, and CKD is currently considered in the high- or very high risk- cardiovascular risk category. CKD-mineral and bone disorders (CKD-MBDs), including vascular and/or valvular calcifications, are also associated with these poor outcomes. Vascular calcification (VC) is very prevalent (both intimal and medial), even in non-dialysis dependent patients, with a greater severity and more rapid progression. Simple X-ray based-scores such as Adragão's (AS) are useful prognostic tools and AS (even AS based on hand-X-ray only) may be superior to the classic Kauppila's score when evaluating non-dialysis CKD patients. Thus, in this mini-review, we briefly review CKD-MBD-related aspects of VC and its complex pathophysiology including the vast array of contributors and inhibitors. Furthermore, although VC is a surrogate marker and is not yet considered a treatment target, we consider that the presence of VC may be relevant in guiding therapeutic interventions, unless all patients are treated with the mindset of reducing the incidence or progression of VC with the currently available armamentarium. Avoiding phosphate loading, restricting calcium-based phosphate binders and high doses of vitamin D, and avoiding normalizing (within the normal limits for the assay) parathyroid hormone levels seem logical approaches. The availability of new drugs and future studies, including patients in early stages of CKD, may lead to significant improvements not only in patient risk stratification but also in attenuating the accelerated progression of VC in CKD