[Epidemiological events related to decompensated heart failure]. / Factores epidemiológicos asociados a la hospitalización por descompensación de la insuficiencia cardiaca.

OBJECTIVE: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. METHODS: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. RESULTS: 209 patients were collected (average age: 78.6 +/- 9.1; male: 52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology of systolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. CONCLUSIONS: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful.

Integral equation procedure based on tailored orthogonal functions for the XY spin fluid in an external magnetic field.

The classical XY model describes particles in three-dimensional space that carry magnetic moments or spins whose motion is restricted to rotations in a plane. Introduction of an external magnetic field lying in the same plane then generates a system that is anisotropic in the azimuthal angle phi . We use numerical simulations and integral equation techniques to study this system, producing in the latter case a formalism that is identical to that of the simpler isotropic version having no external field. The basis for this simplification is a generalization Em(phi) of the ordinary exponential basis set eimphi that restores orthogonality in the presence of the external field. We display results of sample calculations obtained with two integral equation closures, reference hypernetted-chain and soft mean-spherical approximation, both coupled to the Lovett-Mou-Buff-Wertheim relation, along with results from the numerical simulations for comparison. Construction of the Em(phi) is described in an Appendix.

[Epidemiology of heart failure. Ratio of epidemic]. / Epidemiología de la insuficiencia cardiaca. Proporciones de epidemia.

The Heart Failure is a complex sindrom with a high prevalence in the population, being about 10% in older than 70 years and it is continuosly increasing . Its incidence in persons older than 65 years is about 1% per year. In developed countries it is the first cause of hospitalitation in older than 65 years, supposing the 5% of total admissions and it is increasing every year. The most of authors recognise that the numbers reach values of epidemic, although it is true that it is difficult to determine and cuantify due to its complexity. Although the supervivence has improved in last years, it continues being in a bad pronostic with a mortality about 50% after 5 years approximately of the diagnostic . In order to its high prevalence and its high rate of admissions-readmissions it supposes a problem of public health due to high assistance work. Globally it is estimated that the direct costs of heart failure suppose 1-2 % of healthy cost of developed countries.

Phase behavior of a hard sphere Maier-Saupe nematogenic system in three dimensions.

We present a detailed computer simulation and integral equation study of the phase behavior of a nematogenic system composed of hard spheres with embedded three-dimensional Maier-Saupe spins. For this well-known system, we map the gas-liquid equilibrium, which is coupled to a first-order isotropic-nematic transition. The anisotropic integral equation theory is found to yield excellent agreement with the simulation data within the fluid regime. Additionally, we determine the fluid-solid equilibrium transition by means of computer simulation.

[Pacemaker endocarditis]. / Endocarditis del marcapasos.

Pacemaker endocarditis is a rare but serious complication of permanent transvenous pacing. The most common presentation is fever syndrome or gram positive bacteremia. For the diagnostic it is important to performed blood cultures and an echocardiography. A retrospective study included the cases of pacemaker endocarditis diagnosed in the Internal Medicine Department of our Hospital between 1989-2003. Six patients were included. Repeated manipulation of the system and diabetes were the most frequent risk factors. The most frequently detected causative microorganisms were Staphylococci. In spite of the low sensitivity of the transthoracic echocardiography in expert hands it can improve, in this series it places in 66 %. Surgical treatment with cardiopulmonary bypass and implantation of a new system was performed in the same intervention in all patients. None relapsed and the overall mortality was 17%.

[Tumor necrosis factor blocking agents: a review. Part I: Clinical efficacy evaluation]. / Lugar en terapéutica de los medicamentos antagonistas del factor de necrosis tumoral. Parte I: evaluación clínica.

Blockade of tumor necrosis factor with monoclonal antibodies, has emerged as one of the most promising therapies in some autoimmune conditions as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and Crohn s disease. They have shown effectiveness on reducing symptoms and modifying the progression of the disease. However, they disrupt the balance of inflammatory and immune responses and some risks associated with TNF-blockers have become apparent. The purpose of this article is to review the evidence about benefits and risk associated with the use of TNF-blockers in approved indications and to provide practical recommendations for its use in the management of these conditions.

[Pacemaker endocarditis]. / Endocarditis del marcapasos.

In the last years an increment has taken place in the pacemaker and implantable cardioverter-defibrillator indications that will have as consequence an increase of the prevalence of endocarditis associated to intravascular devices, for what acquires special relevance for the clinician to know this entity and to include it in his differential diagnoses. The objective of this article is to describe the epidemiology, clinic characteristics, diagnosis, treatment and outcome of the pacemaker endocarditis.

[Tumor necrosis factor blocking agents: a review. Part II: safety and recommendations]. / Lugar en terapéutica de los medicamentos antagonistas del factor de necrosis tumoral. (2da de dos partes): de los efectos indeseados y recomendaciones.

Blockade of tumor necrosis factor with monoclonal antibodies, has emerged as one of the most promising therapies in some autoimmune conditions as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and Crohn's disease. They have shown effectiveness on reducing symptoms and modifying the progression of the disease. However, they disrupt the balance of inflammatory and immune responses and some risks associated with TNF-blockers have become apparent. The purpose of this article is to review the evidence about benefits and risk associated with the use of TNF-blockers in approved indications and to provide practical recommendations for its use in the management of this conditions.

[Splenic abscess: presentation of nine cases]. / Abscesos esplénicos: presentación de nueve casos.

Relatively rare, splenic abscess is difficult to diagnose and often fatal if left untreated. The disease is thought to be growing in frequency because of the increasing number of inmunocompromised patients. Several mechanisms for the development of splenic abscess may exist. Some studies demonstrate that prior splenic injury in addition to bacteraemia is required for a splenic abscess to occur. In our series, 9 non immunocompromised patients were identified to have this disease during a 6 years period. Pathogens isolated included Salmonella sp, Staphylococcus sp and Enterococcus sp. Splenectomy was performed in three patients; in another a percutaneous drainage was done. One patient died. In summary, though rare, splenic abscess presents with high morbidity and mortality. In our experience, risk factors as immunocompromise seem not to be so prevalent in patients with splenic abscess and therefore this diagnosis should be considered in all patients with fever of unknown origin.

Simulation study of the phase behavior of a planar Maier-Saupe nematogenic liquid.

Using extensive Monte Carlo simulations and a simple approximation in density functional theory, we study the phase behavior of a fluid of nematogenic molecules with centers of mass constrained to lie in a plane but with axes free to rotate in any direction, both with and without an external disorienting field perpendicular to the plane. We find that simulation predicts the existence of an order-disorder phase transition belonging to the Berezinskii-Kosterlitz-Thouless type, along with a low temperature gas-liquid transition. In contrast to the simulation results, density functional theory predicts a first-order orientational phase transition coupled continuously with a first-order gas-liquid transition. The approximate theoretical approach qualitatively reproduces the field dependence of the order-disorder and gas-liquid transitions but is far from quantitative.

[Partial bilateral rupture of the Achilles tendon associated to levofloxacin]. / Rotura parcial bilateral aquílea asociada a levofloxacino.

Fluoroquinolones-associated tendonitis and tendon rupture are well described in the literature but these are not frequently observed and related to the new agents of this group, as levofloxacin. This is probably due to the recent introduction and expansion. Although epidemiological studies are needed to know the frequency of that levofloxacin-induced tendinopathies, case-report could alert to the physicians about this possible severe adverse reaction. We present a case of bilateral Achilles tendonitis with partial spontaneous rupture probably associated to levofloxacin.

[Controversies in infective endocarditis]. / Controversias en endocarditis infecciosas.

The infective endocarditis is defined mainly as the infection of the internal surface of the heart, affecting to the cardiac valves although it can also do it to the septos, the tendinosas cords or endocardio mural. Around the origin, the diagnosis and the treatment of the disease, a considerable controversy has taken place. In this sense, basic criteria exist that they define to the infective endocarditis; however, particular situations are appraised in which the meticulous study is essential from the patient, doing special reference to the origin agents and, more in particular, to the fungal endocarditis.

[Drug interactions in the prescription of medical patients at hospital discharge]. / Interacciones entre medicamentos prescritos al alta en un Servicio de Medicina Interna.

OBJECTIVES: To detect and evaluate the clinical significance of drugs interactions in patients discharged from hospital. MATERIAL AND METHODS: We retrospectively screened the medication for potential drug interactions of 412 patients discharged. Interactions were catalogued according to clinical importance following the Hansten and Horn's classification. RESULTS: Three hundred twenty-nine potential interactions were detected. The 39.9% of the patients had at least one potentially interacting drug combination. The 52.6% of the interactions were catalogued as Class 3, bearing in mind minimizing the risk of the interaction. We did not find any Class 1 or 2 interactions, which have potentially major severity. Oral anticoagulants and digoxin were the most frequently implicated drugs. The patient monitoring was well done in the 100% of the interactions of Oral anticoagulants with other drug, but in the interactions of digoxin with another, this control was not done adequately. One patient was rehospitalised due to high levels of digoxin, he had been discharged with two potential interactions. CONCLUSIONS: The frequently of potential drug interactions in medical patients at hospital discharged was high, but the clinical significance appear to be low.

[Spondylodiskitis caused by Candida albicans. Report of two new cases]. / Espondilodiscitis por Candida albicans. Aportación de dos nuevos casos.

Recently, candidiasis infection is on the increase and several factors have been associated, such us immunodepression, catheters, weakening diseases, prolonged antibiotherapy, HIV infection and IDU. Spondylodiskitis due to Candida sp. is a rare entity. Two cases of spondylodiskitis due to Candida albicans were diagnosed: a 29 year old man and a 35 year old woman. Both were IDUs with a previous history of HIV infection. The most prominent clinical features in both cases were pain, fever and constitutional syndrome. We describe the clinical, diagnostic, and therapeutic features of both cases.

Central motor loop oscillations in parkinsonian resting tremor revealed by magnetoencephalography.

A variety of clinical and experimental findings suggest that parkinsonian resting tremor results from the involuntary activation of a central mechanism normally used for the production of rapid voluntary alternating movements. However, such central motor loop oscillations have never been directly demonstrated in parkinsonian patients. Using magnetoencephalography, we recorded synchronized and tremor-related neuromagnetic activity over wide areas of the frontal and parietal cortex. The spatial and temporal organization of this activity was studied in seven patients suffering from early-stage idiopathic Parkinson's disease (PD). Single equivalent current dipole (ECD) analysis and fully three-dimensional distributed source solutions (magnetic field tomography, MFT) were used in this analysis. ECD and MFT solutions were superimposed on high-resolution MRI. The findings indicate that 3 to 6 Hz tremor in PD is accompanied by rhythmic subsequent electrical activation at the diencephalic level and in lateral premotor, somatomotor, and somatosensory cortex. Tremor-evoked magnetic activity can be attributed to source generators that were previously described for voluntary movements. The interference of such slow central motor loop oscillations with voluntary motor activity may therefore constitute a pathophysiologic link between tremor and bradykinesia in PD.

The spectrum of neuropsychiatric abnormalities associated with electrical status epilepticus in sleep.

Electrical status epilepticus in sleep (ESES) is an electrographic pattern consisting of an almost continuous presence of spike-wave discharges in slow wave sleep. ESES is frequently encountered in pediatric syndromes associated with epilepsy or cognitive and language dysfunction. It can be present in various evolutionary stages of a spectrum of diseases, the prototypes of which are the 'continuous spikes and waves during slow wave sleep' syndrome (CSWS), the Landau-Kleffner syndrome (LKS), as well as in patients initially presenting as benign childhood epilepsy with centrotemporal spikes (BECTS). The purpose of this article is to review the literature data on the semiology, electrographic findings, prognosis, therapeutic options, as well as the current theories on the pathophysiology of these disorders. The frequent overlap of CSWS, LKS, and BECTS urges an increased level of awareness for the occasional transition from benign conditions such as BECTS to more devastating syndromes such as LKS and CSWS. Identification of atypical signs and symptoms, such as high discharge rates, prolonged duration of ESES, neuropsychiatric and cognitive dysfunction, lack of responsiveness to medications, and pre-existing neurologic conditions is of paramount importance in order to initiate the appropriate diagnostic measures. Prolonged and if needed repetitive sleep electroencephalographs (EEGs) are warranted for proper diagnosis.

[Risk of tuberculosis in a cohort of HIV positive IVDA patients in relation to the degree of immunodeficiency and tuberculosis skin test]. / Riesgo de tuberculosis en una cohorte de pacientes UDVP VIH+ en relación con el grado de inmunodeficiencia y la prueba de la tuberculina.

OBJECTIVE: The aim of this study was to assess risk for developed active tuberculosis in HIV infected IDU oblation and relate with immunodeficiency degree. METHODS: Longitudinal follow-up was realized, the period of study was 9 years, in HIV seropositive IDU patients. Control group was HIV seronegative IDU. CD4+ lymphocytes count and cutaneous test (PPd and DHT) were performed at baseline and each three months, them screening from active tuberculosis. RESULTS: Study's population was 165 patients and control group was 69. The average age was 26 and 23.8 respectively. The medium follow-up was 25 months. Active tuberculosis was developed in 9.26 cases per one hundred persons and year from follow-up. It was between 4.92 in cases with more than 500 CD4+ lymphocytes and 3.08 for them with lymphocytes between 50 and 200 per mm3. The incidence tests was 3.99 in PPD negative normoergic patients and 15.87 in PPD negative anergic patients. CONCLUSIONS: Risk from active tuberculosis was relactioned with latent infection and immunodeficiency degree. We constated high risk in low CD4+ lymphocytes counts; and degrees from DHT let an approach to tuberculosis production mechanism.

[Nitrendipine in the treatment of mild-moderate essential arterial hypertension. Ambulatory study in Primary Care]. / Nitrendipino en el tratamiento de la hipertensión arterial esencial ligera-moderada. Estudio ambulatorio en Atención Primaria.

A non-comparative open clinical pharmacological surveillance study was conducted, in which 427 patients from both sexes with diagnosis of light to moderate essential arterial hypertension were included. All patients were treated with nitrenpine, a dihydropyridinic calcium antagonist during a 28-week period. The initial dosage was 10 mg/day, increasing such dosage to 20 and 40 mg/day and associating it with a thiazidic diuretic in those patients showing no antihypertensive response (diastolic arterial pressure (DAP) of 90 mmHg or a reduction of 10 mmHg in baseline figures). A significant decrease was observed in systolic arterial pressure (from 159.3 +/- 12.6 to 149.2 +/- 12.2 mmHg) and in Dap (from 94.8 +/- 9.6 to 86.7 +/- 10.5 mmHg), p < 0.001, with effectivity in 66.3% of patients (65% receiving monotherapy; 10.3% combined therapy: nitrendipine and diuretic). No modifications were observed in heart rate nor in the biological-metabolic parameters under study. Side effects had a low incidence (15.9% of patients, with a 4.7% of drop-outs) and were well-tolerated in most cases. Given these results, we can conclude that nitrendipine is an effective and safe drug for the treatment of light to moderate arterial hypertension.

[Syphilis: current therapeutic perspectives]. / Sífilis: perspectivas terapéuticas actuales.

Despite many years of study questions regarding the appropriate therapy for syphilis still remain. Alternatives to penicillin for the treatment of syphilis continue to be sought. This article examines the studies relating to syphilis treatment published during the last years and also the new treatment guidelines for every stage of this sexually transmitted disease.

[Starch-induced granulomatous peritonitis]. / Peritonitis granulomatosa por almidón.

A case of granulomatous peritonitis produced by starch is presented. This is a rare pathology caused by abdominal contamination with starch from surgical gloves during an operation. The symptoms can be very similar to acute abdomen, therefore, it is sometimes necessary to carry out a second operation in order to confirm the diagnosis. A peritoneal biopsy or cytology of the ascitic liquid usually provides the correct diagnosis as the typical starch granules show up. With non-steroid analgesics, or steroids in some cases, the process can controlled.