A quality improvement intervention on surgical prophylaxis impact in antibiotic consumption and cost in selected surgical procedures.

BACKGROUND: Improper compliance with antibiotic prophylaxis (AP) in surgery is associated with an increased risk of surgical site infection (SSI), and impacts the efficiency of healthcare. OBJECTIVE: Evaluate the impact of an intervention in compliance with AP in selected surgical procedures and its effect on antibiotic consumption and cost. METHODS: A prospective interventional study was performed in a community hospital from January to December 2022. The baseline period was considered January-April 2022 and the intervention period May-December 2022. All patients who underwent cesarean section, appendectomies, hernia surgery, open reduction and internal fixation (ORIF), abdominoplasty, and cholecystectomy during the study period were selected. The intervention includes staff education, pharmacy interventions, monitoring the quality of prescriptions and feedback, and improved role of anesthesia staff, and department champions. RESULTS: The study involved 192 and 617 surgical procedures in the baseline and intervention periods respectively. The compliance with timing, selection, dose, and discontinuation achieved 100%, 99.2%, and 97.6% from baseline figures of 92.7%, 95.8%, and 81.3%, respectively. The antibiotic consumption was reduced by 55.1% during the intervention with a higher contribution of other antibiotics (94.1% reduction) in comparison with antibiotics as per policy (31.2% reduction). The cost was reduced by 47.2% (antibiotic as per policy 31.9%, other antibiotics 94.2%). CONCLUSION: The implemented strategy was effective in improving the quality of antibiotic prophylaxis with a significant impact in reducing antibiotic consumption and cost.

Effect of a quality improvement intervention to reduce the length of stay in appendicitis.

AIM: Determine the effect of an intervention to reduce the length of stay (LOS) in appendectomies. METHODS: A four-quarter quality improvement initiative was developed after approval by the facility Quality Management Department, including educational sessions about the best practices regarding the hospital care for patients with appendicitis and recommendations to limit the LOS for no complicated appendicitis unless associated conditions were present, monitoring of the LOS and feedback to the staff and leaders. RESULTS: 692 appendectomies were performed, 365 (52.7%)) of them during the intervention. The mean LOS was 3.94 days with a decreasing trend during the study period. The complicated appendicitis had a mean LOS of 6.42 days (SD, 3.85) during the baseline and 5.27 days (SD 2.50) during the intervention (p=0.03), representing a 17.9% reduction. The not complicated appendicitis during baseline had LOS of 3.82 days (SD 4.17) with a subsequent reduction to 2.95 days (SD 1.53) in the intervention. The total saving bed days during the intervention were 338.04 days, which 254.04 days (75.2%) were in non complicated appendectomies. One patient required readmission during the intervention because of an organ space surgical site infection, with proper recovery after antibiotic treatment. CONCLUSION: Our study provides evidence about the possibility to optimize the bed use with a simple educational intervention, and should be considered a step to achieve additional reductions in the hospital stay of patients who undergo laparoscopic appendectomies.

Improving the screening of tuberculosis in patient admitted in a secondary care hospital of La Habana.

INTRODUCTION: The reduction of tuberculosis reported in admitted patients in a community hospital in La Habana (Cuba) was identified as a quality gap and priority for action. The objective was to increase by 50% the number of bacilloscopies and smear-positive tuberculosis confirmed by December 2017. PATIENTS AND METHODS: A quality improvement initiative was conducted from January 2017 to December 2017 in a 300-bed secondary care teaching hospital. The improvement project was addressed to patients admitted with respiratory infections (upper or lower). The baseline was considered the period from January to December 2016. The intervention period was from January 2017 to June 2018. The intervention includes training activities for medical staff, monthly monitoring of bacilloscopies performed and feedback and analysis with leaders and departments. RESULTS: During the baseline period seven patients were confirmed with pulmonary tuberculosis and 160 bacilloscopies were performed (mean 40 bacilloscopies/quarter). During the intervention period were confirmed 22 cases of tuberculosis and 577 bacilloscopies were performed (mean 96 bacilloscopies/quarter). CONCLUSIONS: The number of bacilloscopies and sputum smear tuberculosis was successfully increased in admitted patients using the staff education, monitoring, and feedback as intervention measures. The next steps of the project will be focused in achieve the sustainability of the intervention, evaluation of educational needs of medical staff and design training activities accordingly and, screening of latent tuberculosis infections using of tuberculin skin test in selected high risk admitted patients.

Seroprotection against Vaccine-Preventable Diseases amongst Health Care Workers in a Community Hospital, Qatar.

BACKGROUND: Health care workers (HCW) are at high risk of contracting various infectious diseases and play a dual role in the transmission of infections in health care facilities. OBJECTIVE: To determine the seroprotection against hepatitis B, measles, rubella, and varicella among HCWs in a community hospital in Qatar. METHODS: This is a cross-sectional survey conducted in a 75-bed community hospital in Dukhan, Qatar. From August 2012 to December 2015, 705 HCWs were tested for the presence of IgG antibodies for measles, rubella, and varicella, and also for hepatitis B surface antigen (HBsAg). They were also asked about previous history of hepatitis B vaccination. RESULTS: 595 (84.4%) HCWs received a full hepatitis B vaccination schedule; 110 (15.6%) received a single dose. The full schedule was reported with higher frequency by nurses (90.2%) compared to physicians (74.1%) or technicians (79.7%). Those aged ≥30 years (90.4%) and <20 years of work experience had received a full vaccination schedule more frequently than younger and less experienced HCWs. Female HCWs (87.8%) received full schedule more frequently than males (78.8%). 73.4% of the staff had seroprotection against heaptitis B, with the lowest anti-HBsAg titers observed in physicians (58.8%) compared with other categories; males (64.9%) were less protected than females. The seropositivity was 85.6%(95% CI 82.4% to 88.4%) for measles, 94.7% (95% CI 92.2% to 97.3%) for rubella, and 92.2% (95% CI 89.7% to 94.7%) for varicella. CONCLUSION: HCWs, particularly physicians, are not enough protected against hepatitis B. The seroprotection against measles, rubella, and varicella.

Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

Device-associated infection rates in adult intensive care units of Cuban university hospitals: International Nosocomial Infection Control Consortium (INICC) findings.

OBJECTIVES: To determine the rate of device-associated healthcare-associated infection (DA-HAI), microbiological profile, length of stay (LOS), extra mortality, and hand hygiene compliance in two intensive care units (ICUs) of two hospital members of the International Infection Control Consortium (INICC) of Havana, Cuba. METHODS: An open label, prospective cohort, active DA-HAI surveillance study was conducted on adults admitted to two tertiary-care ICUs in Cuba from May 2006 to December 2009, implementing the methodology developed by INICC. Data collection was performed in the participating ICUs, and data were uploaded and analyzed at the INICC headquarters on proprietary software. DA-HAI rates were registered by applying the definitions of the US Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed the mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI) rates, microorganism profile, extra length of stay (ELOS), extra mortality, and hand hygiene compliance. RESULTS: During 14 512 days of hospitalization, 1982 patients acquired 444 DA-HAIs, an overall rate of 22.4% (95% CI 20.6-24.3) or 30.6 (95% CI 27.8-33.5) DA-HAIs per 1000 ICU-days. The CLA-BSI rate was 2.0 (95% CI 1.2-3.1) per 1000 central line-days, the VAP rate was 52.5 (95% CI 47.2-58.3) per 1000 ventilator-days, and the CAUTI rate was 8.1 (95% CI 6.5-10.0) per 1000 catheter-days. LOS of patients was 4.9 days for those without DA-HAI, 23.3 days for those with CLA-BSI, and 23.8 days for those with VAP. CAUTI LOS was not calculated due to the lack of data. Extra mortality was 47% (relative risk (RR) 2.42; p=0.0693) for VAP and 17% (RR 1.52; p=0.5552) for CLA-BSI. The only patient with CAUTI died, but there was too little mortality data regarding this infection type to consider this significant. Escherichia coli was the most commonly isolated microorganism. The overall hand hygiene compliance was 48.6% (95% CI 42.8-54.3). CONCLUSIONS: DA-HAI rates, LOS, and mortality were found to be high, and hand hygiene low. It is of primary importance that infection control programs that include outcome and process surveillance are implemented in Cuba.

[Cancer trends in hospital morbidity and lethality]. / Tendencias de la morbilidad y letalidad hospitalaria por cáncer.

OBJECTIVE: Describe trends in morbidity and lethality of cancer in University Hospital Joaquín Albarrán (La Habana, Cuba). METHOD: Carry out a temporal series studies of patients admitted from january 1999 to december 2005. We obtain information about admission, total and for cancer, deceased patients and lethality rates (deceased for cancer/admission for cancer x 100). From the 2005 admission we obtain age, sex, cause of admission, and if the diagnostic of cancer was doing during this admission or before. RESULTS: Trend of cancer's admission have continuous increase during 1999-2005 period, with 3% of admission in 1999 to 7.99% in 2005. Lethality rates have an irregular behavior with smaller rate in 1999 (12.7%) and bigger in 2001 (27.86%). Internal Medicine service gave care to 60.71% of cancer admission, with less frequency in general surgery service (26.81%). 44% of patients were diagnosed during this admission, and 56% the diagnosis was doing in previous admission, of which 42.1% were admitted to treatment (surgical and drugs) and 53.5% for cancer complications. CONCLUSIONS: We show a continuous increased trend in hospital cancer morbidity. It is a commit to modify healthcare's strategies of cancer patient addressed to guarantee the quality of services in front of the increased demand.

Tendencias de la morbilidad y letalidad hospitalaria por cáncer / Cancer trends in hospital morbidity and lethality

Objetivo: Describir la tendencia en la morbilidad y letalidad por cáncer en el Hospital Universitario “Joaquín Albarrán” (La Habana, Cuba). Método: Realizamos un estudio de series temporales de los ingresos por cáncer (enero 1999-diciembre 2005). Se obtuvo la información de los ingresos totales y por cáncer, las defunciones, y las tasas de letalidad (fallecidos por cáncer/ingresos por cáncer x 100). De los ingresos ocurridos durante el 2005 se registró la edad (media y desviación standard), sexo, la causa de la admisión, y se precisó el momento del diagnóstico de cáncer. Resultados: Se demuestra un sostenido incremento de la proporción de ingresos por cáncer, con la menor de 3% (año 1999) y la mayor de 7,99% (año 2005). Las tasas de letalidad tuvieron un comportamiento irregular con la menor en el 1999 (12,7%) y la mayor en el 2001 (27,86%). El servicio de medicina interna atendió la mayoría de los pacientes (60,71%), seguidos por cirugía general (26,81%). Al 44% de los pacientes se les diagnosticó cáncer durante el ingreso, mientras que el 56% se diagnóstico previamente, de los cuales el 42,1% ingresaron para tratamiento (quirúrgico o quimioterapia antineoplásica) y el 53,5% por complicaciones propias del proceso maligno. Conclusión: Se ha demostrado una tendencia ascendente en la morbilidad hospitalaria por cáncer, lo que obliga a modificar las estrategias de atención de estos pacientes que aseguren la calidad de los servicios ante el incremento de la demanda

Objetive: Describe trends in morbidity and lethality of cancer in University Hospital “Joaquín Albarrán” (La Habana, Cuba). Method: Carry out a temporal series studies of patients admited from january 1999 to december 2005. We obtain informationa about admission, total and for cancer, deceased patients and letality rates (deceased for cancer/admission for cancer x 100). From the 2005’s admission we obtain age, sex, cause of admission, and if the diagnostic of cancer was doing during this admission or before. Results: Trend of cancer’s admision have continuous increase during 1999-2005 period, with 3% of admission in 1999 to 7.99% in 2005. Lethality rates have an irregular behavior with smaller rate in 1999 (12.7%) and bigger in 2001 (27.86%). Internal Medicine service gave care to 60.71% of cancer admission, with less frecuency in general surgery service (26.81%). 44% of patients were diagnosis during this admission, and 56% the diagnosis was doing in previous admission, of wich 42.1% were admited to treatment (surgical and drugs) and 53.5% for cancer complications. Conclusions: We show a continuous increased trend in hospital cancer morbidity. It is a commit to modify healthcare’s strategies of cancer patient adressed to guarante the quality of services in front of the incresed demand

[Prevalence of nosocomial infections in University Hospital of Habana]. / Prevalencia de infección nosocomial en hospitales universitarios de La Habana, Cuba.

OBJECTIVE: Determine nosocomial infection (NI) prevalence in seven University Hospitals of Havana. METHOD: A cross sectional survey was carry out in university hospital with more than 100 beds. Presence of NI was determined by an active screening procedure in all patients admitted in hospitals. Technical statistics of frequency distribution was used. Rates of NI were estimated for each hospital and in the special case of procedure, Odds Ratio and its confidence interval at 95 % were calculated (CI 95 %). RESULTS: Prevalence of NI was 9.2 %. The most frequent localization were: cardiovascular system (55 patients), surgical site (50 patients) and urinary tract (42 patients ). The 19.7 % of studied patient showed intravascular device. All patients showed NI associated with procedures, the highest intensity was association with an endotracheal tube (OR 7.83, IC 95 % 3.32-11.52). CONCLUSION: Nosocomial infections in this hospital is a serious health problem; it is necessary to focus our medical work in this regard for the prevention and control of NI.

Prevalencia de infección nosocomial en hospitales universitario de La Habana, Cuba / Prevalence of nosocomial infections in university hospital of Havana

Objetivo: Determinar la prevalencia de infección nosocomial (IN) en siete Hospitales Clínico Quirúrgicos de Ciudad de La Habana. Método: Realizamos un estudio descriptivo de corte transversal de los hospitales universitarios con número de camas superior a 100. La presencia de IN, se determinó mediante la realización de pesquizaje activo en la totalidad de los pacientes ingresados. Se utilizó la técnica estadística de análisis de distribución de frecuencias. Fueron calculadas tasas de IN, por hospital y servicio de atención. También se calculó Odds Ratio puntual y por intervalos. Resultados: La prevalencia global de IN resultó ser de 9,2 por cada 100 pacientes. Las localizaciones más frecuentes correspondieron a: el sistema cardiovascular (55 casos), el sitio quirúrgico (50 casos) y el tracto urinario (42 casos). El 19,7 % de los pacientes estudiados, tenían algún dispositivo intravascular colocado. Todos ellos fueron encontrados asociados a la presencia de infección nosocomial. La mayor intensidad resultó ser con la entubación endotraqueal (OR 7.83 IC 95 % 3,32-11,52). Conclusión: La prevalencia de infecciones nosocomiales en los Hospitales Clínico Quirúrgicos de Ciudad de la Habana hacen necesario fortalecer las actividades de prevención y control, con especial énfasis en su vigilancia

Objective: Determine nosocomial infection (NI) prevalence in seven University Hospitals of Havana. Method: A cross sectional survey was carry out in university hospital with more than 100 beds. Presence of NI was determined by an active screening procedure in all patients admited in hospitals. Technical statistics of frequency distribution was used. Rates of NI were estimated for each hospital and in the special case of procedure, Odds Ratio and its confidence interval at 95 % were calculated (CI 95 %). Results: Prevalence of NI was 9.2 %. The most frequent localization were: cardiovascular system (55 patients), surgical site (50 patients) and urinary tract (42 patients ). The 19.7 % of studied patient showed intravascular device. All patients showed NI associated with procedures, the highest intensity was association with an endotracheal tube (OR 7.83, IC 95 % 3.32-11.52). Conclusion: Nosocomial infections in this hospital is a serious health problem; it is necessary to focus our medical work in this regard for the prevention and control of NI

[Association of carpal tunnel syndrome and tuberculosis]. / Asociación de síndrome del túnel del carpo y tuberculosis.

Extrapulmonary tuberculosis, and especially articular, is less frequent than their pulmonary form. We report a 59 year-old men that requests medical attention for suggestive symptoms of carpal tunnel syndrome, of which is operated, being demonstrated in the carpo a granulomatous tissue including the median nerve suggestive of sarcoidosis or tuberculosis. In sputum the presence of Micobacterium tuberculosis was demonstrated. The respiratory symptoms of pulmonary tuberculosis were for the patient less excellent symptoms in relation to those produced by compression of the median nerve. The relationship between the tuberculosis and the carpal tunnel syndrome is demonstrated.

Asociación de síndrome del túnel del carpo y tuberculosis / Association of carpal tunnel syndrome and tuberculosis

La tuberculosis de localización extrapulmonar, y especialmente articular, es menos frecuente que su forma pulmonar. Reportamos un paciente varón de 59 años que solicita atención médica por síntomas sugestivos de síndrome del tunel del carpo, del cual es operado demostrándose en el carpo un tejido granulomatoso englobando el nervio mediano sugestivo de sarcoidosis o tuberculosis. Mediante estudio del esputo se demuestra la presencia de Micobacterium tuberculosis. Se destaca que los síntomas respiratorios sugestivos de tuberculosis pulmonar fueron para el paciente síntomas menos relevantes en relación a aquellos producidos por compresión del nervio mediano. Se demuestra la relación entre la tuberculosis y el síndrome del tunel del carpo (AU)

Factores de riesgo de la Diabetes mellitus tipo 2 en población mayor de 35 años

Con el objetivo de identificar los factores de riesgo (FR) para Diabetes mellitus tipo 2, realizamos un estudio observacional descriptivo de corte transversal de la población >= 35 años atendida en el Policlínico 1° de Enero (Municipio Playa, La Habana) en el período Enero - Diciembre / 2000. En dicha área habitan 15.600 individuos con edades >= 35 años, de los cuales fueron seleccionados al azar 219, a los que se les realizó interrogatorio dirigido a la identificación de FR, y la determinación del peso corporal y la talla. Se determinó la frecuencia relativa (IC 95 por ciento) de los FR. Para demostrar diferencias entre los sexos se utilizó prueba de independencia de chi cuadrado. Las mujeres tuvieron 3,0 ( ñ 1,4) FR, mientras los hombres tuvieron 2,1 (+ 1,1) FR, asimismo fueron más obesas (57,6 por ciento vs 34,15 por ciento) (p < 0,001), además que 29,6 por ciento tuvieron hijos macrosómicos y el 8 por ciento tuvieron diabetes durante el embarazo. El 36,3 por ciento de los individuos tenia antecedentes familiares de diabetes, y la presencia de hipertensión arterial con la obesidad (22,0 por ciento) y con antecedentes familiares de diabetes (16,2 por ciento) fueron las que más coincidieron en los pacientes. Fue evidente que la combinación de obesidad con el antecedente familiar de diabetes fue más frecuente en mujeres (25,6 por ciento vs 11,9 por ciento) (p < 0,001). Conclusión: Nuestros resultados han demostrado que el riesgo para desarrollar diabetes tipo 2 en la población estudiada es elevado, en la cual se requiere la elaboración e implementación de medidas preventivas (AU)

Infección nosocomial en el Servicio de Geriatría del Hospital"Joaquín Albarrán", 1990-2001 / Nosocomial infection in Geriatric service of "Joaquín Albarrán" Hospital, 1990-2001

Los ancianos constituyen una proporción importante de los pacientes atendidos en instituciones de salud, y constituyen un grupo altamente susceptible de adquirir infecciones nosocomiales. Con el objetivo de describir el comportamiento de las infecciones nosocomiales en el servicio de geriatría del Hospital "Joaquín Albarrán" en el periodo de 1990 al 2001, realizamos un estudio observacional descriptivo. Se analizó la tendencia secular de la infección nosocomial mediante el método gráfico de suavizamiento de datos mediante medianas móviles y la localización y la etiología de las infecciones nosocomiales mediante la técnica estadística de análisis de distribución de frecuencias. En el Servicio de Geriatría se observó decremento marcado en la tasa de infección nosocomial a partir del año 1995, que se mantuvo hasta 1997, un predominio de las infecciones venosas (58,9 por ciento) sobre el resto de las localizaciones (tracto urinario (19,2 por ciento) y las del tracto respiratorio bajo (15,1 por ciento).Los principales gérmenes aislados resultaron ser: Klebsiella spp (34 por ciento), Pseudomona spp (23 por ciento), y con frecuencias bastante similares, Estafilococo spp (18,5 por ciento) y Proteus spp (17 por ciento). Se constata la magnitud e importancia que tienen las infecciones nosocomiales como problema de salud en los ancianos atendidos en el servicio de geriatría, y la necesidad de aplicar enfoques adecuados dirigidos a la prevención y control de estas infecciones (AU)

Factores asociados al pie diabético en pacientes egresados del Hospital 'Joaquín Albarrán'

Se realizó un estudio observacional analítico de tipo casos y controles para identificar los factores asociados al pie diabético.Diseño: Se estudiaron 208 casos (hospitalarios), e igual cantidad de controles (comunitarios). Se tomaron como casos, a aquellos pacientes diabéticos conocidos atendidos en los Servicios de Angiología o Medicina, que presentaran cualquier forma clínica de la afección; quedando definidos como controles a aquellos pacientes diabéticos libres de la complicación. A la totalidad de dichos pacientes se les realizó interrogatorio y examen físico. Análisis: Para el análisis de la información se utilizó la prueba t para la comparación de medias y el test de homogeneidad. También se determinó odds ratio puntual y por intervalos. En una segunda fase se utilizó la regresión logística para evaluar el efecto puro de cada una de las variables. Resultados: Se demostró que el tiempo de diagnóstico de la diabetes mellitus, incrementa el riesgo de padecer pie de diabético (para cada año OR 1,04; IC 95 por ciento 1,01-1,06). Además que el riesgo de enfermar es casi dos veces mayor en el sexo masculino (OR 1,92; IC 95 por ciento1,17-3,16. También se encontró que la presencia de neuropatía o la ausencia de puso tibial posterior, son condiciones que incrementan de manera importante el riesgo de padecer este síndrome clínico (AU)

Diabetes mellitus en el anciano: problemática en la atención primaria / Diabetes mellitus in the elderly: primary attention problem

La diabetes mellitus en los ancianos es una enfermedad de elevada prevalencia, morbilidad y mortalidad. Con el objetivo de conocer la problemática de esta enfermedad en ancianos atendidos en el Policlínico "Puentes Grandes" se seleccionaron a 246 por muestreo simple aleatorioen una sola etapa, de los 1,581 ancianos que se atienden en dicha área. A los mismos se les realizó interrogatorio para conocer aspectos generales, demográficos, historia médica, funcionamiento físico, hábitos tóxicos, uso de medicamentos y servicios de salud, niveles de tensión arterial y se evaluó su capacidad funcional. Los datos obtenidos fueron introducidos en una aplicación realizada en Foxpro 2.0 para DOS y analizadas en el paquete EPI-INFO 6.0 (CDC-Atlanta). Para analizar variables cualitativas se realizó una prueba de independencia de chi cuadrado o Prueba de Fisher. Para analizar las variables cuantitativas se realizó comparación de medidas en grupos independientes. El 16,6 porciento de los ancianos refirieron ser diabéticos y en ellos predominaron, cuando se les camparó con los ancianos no diabéticos, loa antecedentes de enfermedades de etiología aterosclerótica, la hipertensión arterial, las dificultades para la visión cercana, y la presencia de discapacidades funcionales. Asimismo tuvieron edades medias mayores, y habían usado con mayor frecuencia los servicios de salud. Se concluye que la elevada prevalencia de casos conocidos y su morbilidad, además de la alta frecuencia de discapacidades hacen de la Diabetes mellitus un problema de salud en los ancianos estudiados (AU)

Miocarditis de células gigantes idiopáticas / Gigant idiopatic cell myocarditis

La miocarditis de células gigantes es una enfermedad infrecuente y de elevada letalidad. Reportamos un anciano de 66 años que falleció por arritmias cardíacas graves, y como hallazgo necrópsico se demostró la presencia de necrosis de fibras miocárdicas, infiltrado inflamatorio crónico predominantemente mononuclear, con eosinófilos y abundantes células gigantes. Discutimos los hallazgos histopatológicos encontrados, y algunos aspectos de interés acerca de su diagnóstico y tratamiento (AU)

Prevalencia del hipotiroidismo del anciano en un área de atención primaria de Ciudad de La Habana / Prevalence of hyperthyroidism in the elderly in a primary attention area of the city of Havana

El hipotiroidismo constituye un problema prevalente y subvalorado en los ancianos, y por no conocer la frecuencia de esta enfermedad en población general cubana, decidimos realizar el presente estudio. Entre los pacientes atendidos en un Grupo Básica de Trabajo del policlínico "Alumna Aleida Fernández Chardiet" (Municipio Lisa-Ciudad de La Habana) que atiende 1 912 ancianos, se seleccionaron 71 por muestreo simple aleatorio monoetápico, a los cuales se le realizaron determinaciones de hormonas tiroideas por radioinmunoanálisis (Kits diagnósticos del Instituto Nacional de Endocrinología, Ciudad de La Habana, Cuba). Los resultados fueron incluidos en una aplicación realizada en Foxpro 2.0 para DOS y analizados en Epi-info 6.04 (CDC-Atlanta). El 30,9 porciento de los ancianos presentó hipotiroidismo, lo cual es muy superior a lo señalado en otros estudios. El 1.3 porciento de los ancianos presentó hipotiroidismo clínico, con predominio de pacientes del sexo femenino (p<0.001). La prevalencia del hipotiroidismo en ancianos atendidos en el nivel primario fue significativamente elevada, con amplio predominio de casos subclínicos y del sexo femenino. Se requieren estudios que profundicen en el conocimiento de esta enfermedad en los ancianos cubanos (AU)