[Efficiency of the information given at discharge and adherence of polymedicated patients]. / Eficacia de la información al alta en la adherencia del paciente polimedicado.

OBJECTIVE: To evaluate the utility of a post-discharge pharmaceutical care programme. METHOD: Three-month prospective study where patients were randomised into two groups according to whether or not they received verbal and written information about their treatment at hospital discharge. Treatment compliance was assessed by the Morisky Green test at discharge and at 30-50 days via a telephone interview, also collecting information on patient medication. RESULTS: A total of 59 patients were included, 30 in the control group and 29 in the experimental group. 42.1 ± 9.6days had elapsed between discharge and the telephone interview. While a higher percentage of patients were adherent to treatment at discharge in the control group (83.3 versus 62.1%, OR=0.33, 95% CI: 0.1-1.1, P=.07), in the telephone interview the percentage in the experimental group was greater (62.5 versus 88.5%, OR=4.6, 95% CI: 1.1-19.8, P=.03). The differences between the two groups for the rest of the variables (deaths, visits to emergency department and hospital readmissions) were not statistically significant. In the telephone interview, 70% of patients' treatment was changed in some way since hospital discharge. CONCLUSION: A post-discharge pharmaceutical care programme is a tool to improve treatment compliance, which needs continuity due to the large number of treatment changes suffered by these patients.

[Subclinical Crohn disease in acquired immunodeficiency syndrome]. / Enfermedad de Crohn subclínica en el síndrome de inmunodeficiencia adquirida.

We report the case of a patient suffering from acquired immunodeficiency syndrome and hepatitis B and D virus-related cirrhosis of the liver who was diagnosed as subclinical Crohn's disease. We attribute this clinical course to abnormality of intestinal immune system induced by the human immunodeficiency virus. Concomitant hepatitis B and D virus infection may have contributed. This observation supports the hypothesis of helper-inducer T cells (CD4 T cells) having a critical role in the immunopathogenesis of Crohn's disease and its clinical expression.

[Epidemiology of acute poisoning: a study of 851 cases detected in the southern area of the Madrid community in 1990]. / Epidemiología de la intoxicación aguda: estudio de 851 casos habidos en 1990 en el área sur de la Comunidad de Madrid.

Epidemiology of acute intoxication (AI) must be reviewed periodically to know its trends, therefore, following a line of RESEARCH, we have studied the AI's attended on the Emergency Ward of Internal Medicine at Hospital Doce de Octubre (Madrid). We found that most of them are voluntary (93%): in females being predominant the suicide attempt and in males the AI secondary to illegal drugs use. Toxic drugs have been used in 96% on suicide attempts; the relative incidence of each drug does not vary, but AI with more than one toxic diminish. Within the non-drug toxics, illegal drugs come first, followed by alcohol. Drug-addiction is the numerically most frequent antecedent; depression is predominant in suicide attempts, alcoholism is infrequent in ethyl AI. ICU admissions represent an intermediate figure in our country, mortality (most of them due to overdose) is similar to those of non-Spanish series.

[An epidemiological and immunological study of human immunodeficiency virus infection in the southern area of Madrid]. / Estudio epidemiológico e inmunológico de la infección por virus de la inmunodeficiencia humana en la zona sur de Madrid.

The clinical characteristics and immunological parameters are characterized in different groups of infection by human immunodeficiency virus (HIV) in patients infected by HIV, and the prognostic markers of survival in patients diagnosed of acquired immunodeficiency syndrome (AIDS). This study was carried out in 312 patients from June 1984 to March 1989. The most common risk group was intravenous drug addicts (IVDA) 80.9%. We observed that during the last years there was an increase in the number of cases of heterosexual transmission. Through follow up, 17.6% of patients developed acquired immunodeficiency (AIDS). The incidence rate for AIDS was higher amongst homosexuals than IVDA (35.4/14.6). Esophageal candidiasis and extrapulmonary tuberculosis were the AIDS indicators most frequently encountered. Once the study period was over, with a follow up of 19.3 +/- 3.4 months, the probability of survival after 12 months was 70 +/- 0.07% and after 24 months was 42% +/- 0.09%. The risk group (homosexuals), the appearance of a neoplasia as the first diagnosis of AIDS, and the immunological parameters (CD3 less than 500, CD4 less than 400, CD4/CD8 ratio less than 0.5 and total lymphocyte count of less than 1700 were the markers with worst prognosis which correlated with survival rates (p less than 0.01). We confirmed that when comparing immunologic parameters amongst HIV infection groups, IgA levels were higher (p less than 0.05); the total number of lymphocytes, the number of helper lymphocytes and the CD4/CD8 ratio were lower (p less than 0.01) in IV and AIDS group with respect to group II and III, in patients with AIDS with respect to group IV-non-AIDS and in those who died with relation to AIDS.

[The prognostic factors and evolution of the quality of life in primary biliary cirrhosis]. / Factores pronósticos y evolución de la calidad de vida en la cirrosis biliar primaria.

The prognostic factors and the evolution of the quality of life were evaluated in 38 patients with primary biliary cirrhosis (94.7% females, mean age 52.6 +/- 2.0 years) followed up for more than 36 months (mean 65.3 +/- 3.7 months). Karnofsky's index significantly declined during follow up (p less than 0.05) in a parallel fashion to modified Child's hepatic functional class (p less than 0.05) and to the days of hospital readmission (p less than 0.05). Eleven patients (28.9%) died, and the median survival was 88.7 months. The comparison of the actuarial curves showed the following to be significant poor prognostic factors at the time of diagnosis: a) clinical: more than one associated autoimmune disease, weight loss of more than 10% of the ideal weight, jaundice, upper gastrointestinal hemorrhage associated with portal hypertension, portal-systemic encephalopathy and a modified Child's hepatic functional class of 9 or more; b) biochemical: serum albumin lower than 3.5 g/dl and bilirubin higher than 2 mg/dl; c) histological: Total histological activity index of 10 or more and erosive necrosis index of 2 or more (Knodell et al.), lobular granulomas, and stage IV (Ludwig et al). A significant correlation was found (p less than 0.001) between the R index of the Mayo Clinic and the mean survival time of our patients. As a temporary policy, we indicate hepatic transplant when R is 9.2 or higher (life expectancy lower than 24 months), awaiting our own probabilistic prognostic model with the inclusion of quality of life criteria.

[Cavitated pneumonia and toxic shock syndrome: presentation of a case]. / Neumonía cavitada y síndrome del shock tóxico: presentación de un caso.

Toxic shock syndrome (TSS) is a potentially fatal acute disease preferentially affecting menstruating women and is related to the use of vaginal tampons seems to be due to an specific exotoxin produced by some Staphylococcus aureus strains. We present here the case of a male patients suffering cavitated pneumonia who developed a systemic clinical picture comparable to TSS. This unusual form of presentation is discussed as well as the diagnostic criteria which define this entity.

[Acute submassive cholestatic hepatitis after treatment with carbimazole. Presentation of a new case and review of the literature]. / Hepatitis colestásica aguda submasiva tras tratamiento con carbimazol. Aportación de un caso y revisión de la literatura.

Carbimazole, an antithyroid agent of the thioimidazole group, can induce unpredictable liver alterations, presumably by hypersensitivity. We describe the case of a hyperthyroid woman who suffered acute submassive cholestatic hepatitis in the course of treatment with this drug. We also review the other seven cases of carbimazole hepatotoxicity previously communicated in the literature.