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( Hector Raul Ibarra Sifuentes ),( Carlos Javier Rodriguez Alvarez ),( Erick Joel Rendon Ramirez ),( Perla Rocio Colunga Pedraza ),( Iris Jazmin Colunga Pedraza ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: The Glasgow-Blatchford scale has been used to classify patients into low or high risk and the need for medical or endoscopic treatment Methods: A cross-sectional study, which retrospectively Blatchford scale is calculated for patients with nVUGIB, requiring blood transfusion, to determine the likelihood of blood transfusion, using Pearson correlation applying SPSS Statistics 18; in a period beginning from January 1, 2009 to December 31, 2013 Results: 42 patients with diagnosis of nVUGIB were studied, of which 26 patients (61.9%) required blood transfusion. By sex the highest percentage was 65% for men (17 men and 9 women). 95.3% of the patients had a Blatchford scored greater than 0 and 61.9% required blood transfusion. A Pearson correlation index of 0.815 was found. Conclusions: The Pearson correlation showed a positive relationship between the variables, finding that the Blatchford scale was useful in determining which patients required blood transfusion when a cutoff 3 was used.
( Hector Raul Ibarra Sifuentes ),( Victor Ivan Segura Huicochea ),( Perla Rocio Colunga Pedraza ),( Miguel Angel Flores Caballero ),( Jose Guadalupe Martinez Jimenez ),( Concepcion Sanchez Martinez ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Patients on hemodialysis have a death rate adjusted for age four to fi ve times higher than the general population, so early nephrology referral affects survival, also the presence of hypoalbuminemia, hyperphosphatemia, and anemia. Methods: Descriptive, observational, prospective, Unicentric Trial, involved patients with ESRD who entered the emergency area in a teaching hospital, indicating Interventional Hemodialysis (HI), which were studied for 90 days; Demographic, clinical and laboratory data were collected. Patients were followed by phone call and meeting at 30, 60 and 90 post-HI days. Statistical analysis were realized with SPSS 18 for Windows, performed descriptive statistics and survival by Kaplan-Meier was conducted. Results: In this trial were included 41 patients, mean age 50.59 years (range 17-76 years), 23 men (56.1%). The rating for nephrologist was recorded in 9 (22%). The data results were Albumin, 2.88 ± 0.57 mg/dL, phosphate, 9.48 ± 2.90 mg/dL, Hemoglobin 7.22 ± 1.42 g/dL. From the total of patients, 15 (36.6%) died within 90 days; of which 9 (60.9%) were men; Albumin levels were lower in those who died when compare with the living (2.79 vs 2.93), phosphate levels were higher when compare to living (9.97 vs 9.20); and the level of Hb was higher in those who died (7.5 vs 7.0). Survival rates at 30, 60 and 90 days were 92.7%, 85.4% and 63.4% respectively. Conclusions: Mortality found in this study is high compared with reported worldwide. When the nephrologist referral was analyzed, patients who died were the same as the number of patients without prior reference. Hypoalbuminemia and hyperphosphatemia correlate with mortality, as demonstrated in previous studies. Importantly, in our population, patients who died, had a higher hemoglobin level when compare with survivors.
( Hector Raul Ibarra Sifuentes ),( Guillermo Ruben Garcia Delgado ),( Roberto Monreal Robles ),( Daniel Gallegos Arguijo ),( Perla Rocio Colunga Pedraza ),( Luis Javier Marfil Rivera ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
A 50-years-old woman came to the emergency room due to uremic syndrome; she was referred to start renal replacement therapy. Her past medical history was signifi - cant for long-standing type 2 diabetes and hypertension (evolving over 4 years), both conditions irregularly treated. On the night of her admission, a right femoral Mahurkar catheter was placed through an ultrasonography guided technique, and hemodialysis was thus started. Unfractionated heparin (UFH) was used as a bolus at the start of the session, subcutaneous UFH was also used as thromboprophylaxis during her hospital stay. On day 4 the second hemodialysis was performed. She clinically improved after 6 days of hospitalization, and was switched from hemodialysis to peritoneal dialysis. At admission, moderate thrombocytopenia (118 K/uL) was found, which was exhaustively investigated without identifying its cause. On day 10, showed at the physical examination painful, pitting edema, and limitation in walking. Deep venous thrombosis was then diagnosed by color Doppler ultrasonography, and anticoagulation with UFH and warfarin was started. The next day platelet count (PC) fell by 67% (absolute PC: 23. 6 K/uL), so early-onset HIT was suspected. According to the 4Ts score, our patient had a high pretest probability for HIT, therefore UFH and warfarin were discontinued. Treatment options were discussed with the patient in detail; we obtained an informed consent from her, and started her on apixaban. On day 15 her PC improved to 75 K/uL; and on day 18 to 128 K/uL. A low-dose warfarin (5 mg qd) was started together with apixaban for fi ve days. The INR was maintained within the therapeutic range during her hospital stay. On day 22 apixaban was discontinued, and she continued solely on warfarin. Prior to discharge her PC was entirely recovered (231 K/uL).