Mortality in a cohort of complex patients with chronic illnesses and multimorbidity: a descriptive longitudinal study.

BACKGROUND: Certain advanced chronic conditions (heart failure, chronic lung disease) are associated with high mortality. Nevertheless, most of the time, patients with these conditions are not given the same level of attention or palliative care as those with cancer. The objective of this study was to assess mortality and its association with other variables in a cohort of complex multimorbid patients with heart failure and/or lung disease from two consecutive telemonitoring studies. METHODS: This multicentre longitudinal study was conducted between 2010 and 2015. We included 83 patients (27 without telemonitoring) with heart failure and/or lung disease with > 1 hospital admission in the previous year and great difficulties leaving home or were housebound. The following variables were indicators of their complex clinical condition: old age (mean: 81 years), comorbidity (Charlson Comorbidity Index score ≥ 2: 86.2%), both conditions concurrently (54.2%) and home oxygen therapy (52%). We assessed mortality (rate, cause and place of death) and its association with: age, sex, telemonitoring, functional status (Barthel score), quality of life (EQ-5D visual analogue scale), number of medications, and all-cause and condition-specific (due to conditions prompting inclusion) admissions during the previous year. Uni- and bivariate analysis and logistic regression were performed, considering p < 0.05 significant. RESULTS: A total of 61 patients died within 5 years, representing 31.2%/year (95% CI: 23-40.1%), considering the overall follow-up (sum of individual follow-up days). Of these, 81% of deaths (95% CI: 69.1-89-1%) were due to the condition prompting inclusion, and 83.3% (95% CI: 72-90.7%) died in hospital (median: 8.5 days). Mortality was lower among those under telemonitoring (p = 0.027), and with fewer condition-specific admissions the previous year (p = 0.006); the latter also showed the strongest association in the multivariate analysis (Exp(B) = 6.115). CONCLUSIONS: Complex patients with multimorbidity had a high mortality rate, generally dying due to the condition for which they had been included, and in hospital (83.3%). New approaches for managing such patients should be considered, introducing palliative care as required, and using more comprehensive predictors of mortality (functional status and quality of life), together with those related to the illness itself (previous admissions, progression and symptoms).

Large changes in Pluto's atmosphere as revealed by recent stellar occultations.

Pluto's tenuous nitrogen atmosphere was first detected by the imprint left on the light curve of a star that was occulted by the planet in 1985 (ref. 1), and studied more extensively during a second occultation event in 1988 (refs 2-6). These events are, however, quite rare and Pluto's atmosphere remains poorly understood, as in particular the planet has not yet been visited by a spacecraft. Here we report data from the first occultations by Pluto since 1988. We find that, during the intervening 14 years, there seems to have been a doubling of the atmospheric pressure, a probable seasonal effect on Pluto.

[Congenital pancreatic cyst]. / Quistes malformativos del páncreas.

A case of a congenital cyst of the pancreas occurring in an adult woman and successfully treated by resection, is reported. The presence of cylindrical epithelium in the cystic cavity, the high amylase contents of the cyst and the ERCP examination made the diagnosis.

[Caroli's disease: congenital cystic and segmentary dilatation of the intrahepatic bile ducts]. / Enfermedad de Caroli: dilatación quística congénita y segmentaria de las vías biliares intrahepáticas.

Congenital cystic segmentary dilatation of the intrahepatic biliary ducts is a rare disease. Although several cases has been described in medical literature, its occurrence such as it was originally referred is exceptional. Some cases coexist with congenital hepatic fibrosis and portal hypertension. A characteristic phenomenon is the formation of stones and canalicular infection. In this article, three cases of Caroli disease (females, 57, 53 and 58 years old) are described. Case n 1 was a complex malformation including: a) cystic and segmentary dilatations of the intrahepatic biliar ducts; b) intra and extrahepatic lithiasis and recurrent infections; c) fusion of the choledocus and gallbladder in a common sac; d) hepatic cavernosus hemangioma and a supernumerarious lobe. Case n 2 showed: a) cystic and segmentary dilatation of the intrahepatic biliar ducts; b) portal fibrosis; c) polycystic kidneys; d) portal hypertension. Case n 3 showed: a) cystic and segmentary dilatation of the intrahepatic biliar ducts; b) portal fibrosis; c) polycystic kidneys and spleen; d) portal hypertension. Prognostic of this patients is variable and depends on the recurrent infections and the coexistence of other malformations which are frequently severe. Surgery is the only treatment for the disease although there are no definite conclusions concerning the long-term results.

Histerectomia obstétrica de emergencia

Se realizó un estudio retrospectivo en 43 pacientes ingresadas en el Servicio de Obstetricia del Hospital Carlos Andrade Marín, desde enero de 1987 a enero de 1993, para determinar la incidencia de cesárea más histerectomía y la morbi-mortalidad de la misma, la etiología predominante así como el tipo de histerectomía realizada. Se realizó histerectomía obstétrica en 43 pacientes de las cuales el 9.3 por ciento fallecieron y el 88 por ciento evolucionaron favorablemente. Los rangos de incidencia varían entre 31 a 40 años. La edad gestacional de terminación de los ambarazos se sitúa en el 56 por ciento entre las 37 a 41 semanas. Las causas de histerectomia fueron desordenes placentarios en el 38 por ciento, hipotonía uterina en el 25 por ciento, otras (miomatosis, endometritis, pelviperitonitis, hematoma de ligamento ancho, polipo cervical, CA. de cervix y de ovario en el 25 por ciento, rotura uterina en el 10 por ciento y no se encontró dato en el 10 por ciento. El tipo de histerectomia realizada fue total y subtotal. De los 31 a 40 años la placenta previa es la mayor causa de histerectomia, en tanto que de los 20 a 25 años son rotura uterina e hipotonía.

Comunicación interpersonal y consejería para la calidad de los servicios de salud reproductiva / Interpersonal communication and conserjeria for the quality of the services of reproductive health

Proyecto sobre la Comunicación Interpersonal y Conserjería para la Calidad de los Servicios de Salud Reproductiva, que tiene como objetivo contribuir a la disminución de la mortalidad materna e infantil con el mejoramiento de la calidad en la atención de salud reproductiva a través de los prestadores de servicios capacitados en la comunicación con los usuarios de este servicio en todo el Paraguay