was read the article
array:20 [ "pii" => "X2013251412001380" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Mar.11402" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:552-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7552 "formatos" => array:3 [ "EPUB" => 343 "HTML" => 6440 "PDF" => 769 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699512001383" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2012.Mar.11402" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2012;32:552-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11384 "formatos" => array:3 [ "EPUB" => 361 "HTML" => 10226 "PDF" => 797 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Mujer de 31 años con síndrome de Munchausen en hemodiálisis. Reporte de un caso y revisión de la literatura" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "552" "paginaFinal" => "553" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "31 year old woman with Munchausen syndrome in haemodialysis. Case report and literature review" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11402_108_27531_es_11402_t1.jpg" "Alto" => 527 "Ancho" => 600 "Tamanyo" => 311308 ] ] "descripcion" => array:1 [ "es" => "Principales observaciones que hacen sospechar los trastornos facticios y de fingimiento" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alain Cruz-Portelles, Bernardo E. Fernández-Chelala, Yuliet Peña-Castillo" "autores" => array:6 [ 0 => null 1 => null 2 => array:2 [ "nombre" => "Alain" "apellidos" => "Cruz-Portelles" ] 3 => array:2 [ "nombre" => "Alain" "apellidos" => "Cruz-Portelles" ] 4 => array:2 [ "nombre" => "Bernardo E." "apellidos" => "Fernández-Chelala" ] 5 => array:2 [ "nombre" => "Yuliet" "apellidos" => "Peña-Castillo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251412001380" "doi" => "10.3265/Nefrologia.pre2012.Mar.11402" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001380?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001383?idApp=UINPBA000064" "url" => "/02116995/0000003200000004/v0_201502091347/X0211699512001383/v0_201502091348/es/main.assets" ] ] "itemAnterior" => array:17 [ "pii" => "X2013251412001399" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Jun.11489" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:551-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4859 "formatos" => array:3 [ "EPUB" => 322 "HTML" => 3914 "PDF" => 623 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Pleuroperitoneal communication in peritoneal dialysis patient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "551" "paginaFinal" => "552" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comunicación pleuroperitoneal en paciente en diálisis peritoneal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11489_16025_33488_en_f1_1311489.jpg" "Alto" => 982 "Ancho" => 1392 "Tamanyo" => 460315 ] ] "descripcion" => array:1 [ "en" => "Peritoneal scintigraphy with 99mTc-MAA" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz García-Maldonado, Manuel Guerrero-Ortiz, J. Ramón Gómez-Fuentes, Remedios Garófano-López, M. Carmen Prados-Soler, M. Dolores Del Pino y Pino" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "García-Maldonado" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Guerrero-Ortiz" ] 2 => array:2 [ "nombre" => "J. Ramón" "apellidos" => "Gómez-Fuentes" ] 3 => array:2 [ "nombre" => "Remedios" "apellidos" => "Garófano-López" ] 4 => array:2 [ "nombre" => "M. Carmen" "apellidos" => "Prados-Soler" ] 5 => array:2 [ "nombre" => "M. Dolores" "apellidos" => "Del Pino y Pino" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699512001391" "doi" => "10.3265/Nefrologia.pre2012.Jun.11489" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001391?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001399?idApp=UINPBA000064" "url" => "/20132514/0000003200000004/v0_201502091610/X2013251412001399/v0_201502091610/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "31 year old woman with Munchausen syndrome in haemodialysis. Case report and literature review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "552" "paginaFinal" => "553" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Alain Cruz-Portelles, Bernardo E. Fernández-Chelala, Yuliet Peña-Castillo" "autores" => array:6 [ 0 => null 1 => null 2 => array:3 [ "nombre" => "Alain" "apellidos" => "Cruz-Portelles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 3 => array:4 [ "nombre" => "Alain" "apellidos" => "Cruz-Portelles" "email" => array:1 [ 0 => "alain@hvil.hlg.sld.cu" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 4 => array:3 [ "nombre" => "Bernardo E." "apellidos" => "Fernández-Chelala" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 5 => array:3 [ "nombre" => "Yuliet" "apellidos" => "Peña-Castillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Terapia Intensiva, Hospital General Universitario V. I. Lenin, Holguín, Cuba, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 1 => array:3 [ "entidad" => "Servicio de Psicología Clínica, Hospital General Universitario V. I. Lenin, Holguín, Cuba, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mujer de 31 años con síndrome de Munchausen en hemodiálisis. Reporte de un caso y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11402_16025_33480_en_t111402_i.jpg" "Alto" => 1135 "Ancho" => 1440 "Tamanyo" => 573358 ] ] "descripcion" => array:1 [ "en" => "Main observations that point towards malingering and factitious disorders" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor,</span></p><p class="elsevierStylePara">Factitious disorders (FD) and malingering (M) include people who, deliberately, pretend or produce diseases to assume the role of sick, portraying symptoms or signs that may be physical, psychological or both.<span class="elsevierStyleSup">1</span> On FD there is no demonstrable external incentive and this practice is more predominant in women. Malingering patients look for a secondary gain and it is more frequent in men.<span class="elsevierStyleSup">2</span> Both disorders may be difficult to distinguish and overlap. Sometimes they are called Munchausen syndrome (SM)<span class="elsevierStyleSup">3</span> and, although the syndrome has not been formally included as a mental disorder,<span class="elsevierStyleSup">1</span> it is widely known in medicine. It includes: 1) A factitious chronic disease, which can be severe and disabling; 2) the pilgrimage: individuals change hospitals, cities or country when their objectives are unsuccessful or discovered; 3) <span class="elsevierStyleItalic">pseudologia fantastica</span>: amazing stories are described with complete certainty. Cases have been described in which parents have made their children sick to reap benefits.<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">We present the case of a 31-year-old nurse on haemodialysis with a permanent pacemaker due to tachycardia/bradycardia syndrome and chronic kidney disease with not well-defined cause, who had been diagnosed a year prior. She checked in at the emergency department reporting fever with chills, anuria and general discomfort.</p><p class="elsevierStylePara">Physical examination confirmed absence of blood pressure (BP) or pulse in the upper limbs, skin pallor and signs of mild dehydration. Heart rate: 118 beats/min, respiratory rate: 24 breaths/min and temperature of 38.5°C. The haemodialysis catheter showed signs of infection in the insertion site (it was withdrawn and cultured). The rest of the physical examination was normal, with a preliminary diagnosis of septic shock by catheter infection. The treatment included vasopressors and antimicrobials and patient was moved to the intensive care unit (ICU).</p><p class="elsevierStylePara">Upon arrival to the ICU the adequate skin perfusion contrasted with the diagnosed<span class="elsevierStyleItalic"> </span><span class="elsevierStyleItalic">septic shock</span>. There was no BP in the upper limbs, since arteriovenous fistulae had been created in the forearms without reaching flow, but the lower limps showed a BP of 150/90mm Hg, so the vasopressor treatment was terminated. The patient refused to have a bladder catheter placed. The initially diminished central venous pressure was normalised with hydration and a wide and clear diuresis was recovered.</p><p class="elsevierStylePara">The analysed found: leukocytosis (18x10<span class="elsevierStyleSup">9</span>/l), anaemia (108g/l) and high serum creatinine (158µmol/l). Other complementary studies, including arterial blood gasometry, ionogram, glycaemia and urine sediment, gave results within the normal limits. The ultrasound showed kidneys and urinary tract of normal size and echogenicity. On the third day, creatinine levels had already reached normal values and there was no evidence of kidney disease. Blood cultures with<span class="elsevierStyleItalic"> </span><span class="elsevierStyleItalic">methicillin-resistant Staphylococcus aureus </span><span class="elsevierStyleItalic">were performed</span>.</p><p class="elsevierStylePara">Faced with the evidence, MS was strongly suspected and psychological assessment was requested. In the interview, the patient cooperated but refused to undergo a psychometric evaluation and denied having faked the symptoms or altered samples.</p><p class="elsevierStylePara">The patient's profession (nursing) allowed her to carry blood samples to the laboratory, where she supposedly would add a few drops of urine to raise the levels of creatinine significantly. On many occasions haemodialysis was not concluded due to "discomfort". Patient always refused to undergo a renal biopsy, despite it being appropiate.<span class="elsevierStyleSup">5</span> It is speculated that the dysrhythmia could have been caused by self-prescription heart-rate altering drugs and that arteriovenous fistulae were damaged by the patient.</p><p class="elsevierStylePara">Days later, she was withdrawn from the haemodialysis programme. To date, she remains asymptomatic and has re-joined social life. Motives could not be determined with certainty.</p><p class="elsevierStylePara">There are certain criteria that allow us to suspect MS (Table). The diagnosis must be done with caution, because a mistake can be fatal. Psychological treatment depends on personality type and the likely aetiology, although in most cases the patients evade treatment.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Mortality rates may be high due to body self-manipulation, complications of procedures, and hiding important medical information; besides, when they really become ill, these patients can be ignored because of their history.<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">In conclusion, MS should be considered in any patient with inconsistencies between their symptoms and the clinical tests. Although it is a rare disease, its diagnosis is essential for the serious consequences that it can cause on the patient.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/11402_16025_33480_en_t111402_i.jpg" class="elsevierStyleCrossRefs"><img src="11402_16025_33480_en_t111402_i.jpg" alt="Main observations that point towards malingering and factitious disorders"></img></a></p><p class="elsevierStylePara">Table 1. Main observations that point towards malingering and factitious disorders</p>" "pdfFichero" => "P1-E541-S3640-A11402-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11402_16025_33480_en_t111402_i.jpg" "Alto" => 1135 "Ancho" => 1440 "Tamanyo" => 573358 ] ] "descripcion" => array:1 [ "en" => "Main observations that point towards malingering and factitious disorders" ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000004/v0_201502091610/X2013251412001380/v0_201502091610/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000004/v0_201502091610/X2013251412001380/v0_201502091610/en/P1-E541-S3640-A11402-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001380?idApp=UINPBA000064" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 14 | 6 | 20 |
2024 October | 115 | 37 | 152 |
2024 September | 100 | 48 | 148 |
2024 August | 137 | 58 | 195 |
2024 July | 86 | 34 | 120 |
2024 June | 94 | 59 | 153 |
2024 May | 123 | 47 | 170 |
2024 April | 145 | 34 | 179 |
2024 March | 137 | 25 | 162 |
2024 February | 117 | 59 | 176 |
2024 January | 108 | 24 | 132 |
2023 December | 93 | 34 | 127 |
2023 November | 127 | 46 | 173 |
2023 October | 199 | 40 | 239 |
2023 September | 358 | 33 | 391 |
2023 August | 326 | 23 | 349 |
2023 July | 171 | 42 | 213 |
2023 June | 243 | 22 | 265 |
2023 May | 192 | 41 | 233 |
2023 April | 102 | 23 | 125 |
2023 March | 150 | 32 | 182 |
2023 February | 146 | 32 | 178 |
2023 January | 93 | 29 | 122 |
2022 December | 175 | 59 | 234 |
2022 November | 180 | 56 | 236 |
2022 October | 159 | 69 | 228 |
2022 September | 129 | 36 | 165 |
2022 August | 111 | 57 | 168 |
2022 July | 103 | 50 | 153 |
2022 June | 116 | 34 | 150 |
2022 May | 185 | 39 | 224 |
2022 April | 187 | 79 | 266 |
2022 March | 195 | 61 | 256 |
2022 February | 204 | 47 | 251 |
2022 January | 208 | 38 | 246 |
2021 December | 165 | 60 | 225 |
2021 November | 163 | 34 | 197 |
2021 October | 233 | 48 | 281 |
2021 September | 160 | 49 | 209 |
2021 August | 167 | 40 | 207 |
2021 July | 213 | 42 | 255 |
2021 June | 183 | 37 | 220 |
2021 May | 275 | 41 | 316 |
2021 April | 635 | 70 | 705 |
2021 March | 350 | 46 | 396 |
2021 February | 189 | 29 | 218 |
2021 January | 212 | 25 | 237 |
2020 December | 199 | 35 | 234 |
2020 November | 180 | 19 | 199 |
2020 October | 139 | 24 | 163 |
2020 September | 129 | 21 | 150 |
2020 August | 136 | 20 | 156 |
2020 July | 129 | 13 | 142 |
2020 June | 137 | 20 | 157 |
2020 May | 156 | 8 | 164 |
2020 April | 123 | 22 | 145 |
2020 March | 145 | 18 | 163 |
2020 February | 207 | 13 | 220 |
2020 January | 188 | 30 | 218 |
2019 December | 166 | 21 | 187 |
2019 November | 152 | 30 | 182 |
2019 October | 134 | 15 | 149 |
2019 September | 177 | 24 | 201 |
2019 August | 80 | 16 | 96 |
2019 July | 132 | 34 | 166 |
2019 June | 155 | 19 | 174 |
2019 May | 141 | 22 | 163 |
2019 April | 194 | 31 | 225 |
2019 March | 155 | 24 | 179 |
2019 February | 109 | 19 | 128 |
2019 January | 105 | 23 | 128 |
2018 December | 168 | 44 | 212 |
2018 November | 166 | 17 | 183 |
2018 October | 146 | 14 | 160 |
2018 September | 137 | 27 | 164 |
2018 August | 90 | 37 | 127 |
2018 July | 84 | 19 | 103 |
2018 June | 99 | 27 | 126 |
2018 May | 80 | 20 | 100 |
2018 April | 106 | 9 | 115 |
2018 March | 101 | 22 | 123 |
2018 February | 85 | 5 | 90 |
2018 January | 76 | 12 | 88 |
2017 December | 95 | 13 | 108 |
2017 November | 67 | 13 | 80 |
2017 October | 60 | 9 | 69 |
2017 September | 62 | 10 | 72 |
2017 August | 61 | 12 | 73 |
2017 July | 65 | 11 | 76 |
2017 June | 55 | 7 | 62 |
2017 May | 100 | 19 | 119 |
2017 April | 57 | 18 | 75 |
2017 March | 61 | 11 | 72 |
2017 February | 111 | 8 | 119 |
2017 January | 43 | 12 | 55 |
2016 December | 70 | 10 | 80 |
2016 November | 88 | 14 | 102 |
2016 October | 142 | 19 | 161 |
2016 September | 212 | 4 | 216 |
2016 August | 195 | 5 | 200 |
2016 July | 139 | 3 | 142 |
2016 June | 153 | 0 | 153 |
2016 May | 146 | 0 | 146 |
2016 April | 131 | 0 | 131 |
2016 March | 88 | 0 | 88 |
2016 February | 123 | 0 | 123 |
2016 January | 101 | 0 | 101 |
2015 December | 125 | 0 | 125 |
2015 November | 86 | 0 | 86 |
2015 October | 112 | 0 | 112 |
2015 September | 85 | 0 | 85 |
2015 August | 83 | 0 | 83 |
2015 July | 67 | 0 | 67 |
2015 June | 53 | 0 | 53 |
2015 May | 54 | 0 | 54 |
2015 April | 5 | 0 | 5 |