Risk factors for mortality after surgery of osteoporotic hip fracture in patients over 65 years of age. / Factores de riesgo de mortalidad tras intervención quirúrgica de fractura de cadera osteoporótica en pacientes mayores.

OBJECTIVE: To evaluate, from a clinical perspective, and with easily identifiable variables, those factors that influence the survival of patients admitted to a care unit designed for the comprehensive treatment of patients with hip fracture after being surgically treated. MATERIAL AND METHODS: A prospective study was conducted on a cohort of patients (n=202) aged 65 years or older with a low impact hip fracture, who were surgically intervened in a tertiary hospital. An analysis was performed to determine mortality at 90 days, and at one and 2years after surgery using demographic, clinical, analytical, and functional variables. RESULTS: The independent risk factors of mortality in the 3periods analysed were age (P=.047, P=.016, and P=.000 at 90 days, 1, and 2 years, respectively) and a low Barthel index (P=.014, P=.005, and P=.004 to 90 days, 1, and 2 years, respectively). Male sex (P=.004) and a high risk for anaesthesia (P=.011) were only independent risk factors of mortality at 2years after surgery. DISCUSSION AND CONCLUSION: Age and dependency were the major determining factors of mortality at 30 days, 1, and 2 years after surgery for hip fracture. Both are easily measurable to identify patients susceptible to poor outcomes, and could benefit from a more thorough care plan.

[Chronic Salmonella typhimurium diarrhea in an immunocompetent patient]. / Diarrea crónica por Salmonella typhimuriumen paciente inmunocompentente.

Chronic diarrhea caused by infection in immunocompetent patients is an infrequent condition in developed countries, although certain pathogens,generally parasites (Giardia lamblia, Isospora belli,Cryptosporidium, Cyclospora, Strongyloides, Ameba,Trichuris and Schistosoma) and some bacteria (Aeromonas,Plesiomonas, Campylobacter, Clostridium difficile, Salmonella or Mycobacterium tuberculosis)can cause persistent diarrhea.We present the case of a patient who showed Salmonella typhimurium in his stool culture and recovered following treatment with levofloxacin for 7 days.

Multiple hospitalizations at the Department of Internal Medicine of a tertiary hospital. / Multiingreso en el Servicio de Medicina Interna de un hospital terciario.

BACKGROUND AND OBJECTIVES: Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. PATIENTS AND METHODS: A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. RESULTS: When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. CONCLUSIONS: Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.