RESUMO
The aim of the study was to describe the clinical and epidemiological characteristics of the central nervous system (CNS) infection by varicella zoster virus (VZV) in patients older than 65 years in a tertiary community hospital. We retrospectively analysed the results of cerebrospinal fluid (CSF) testing in patients older than 65 years between 2007 and 2014 with clinically suspected VZV infection with CNS involvement. Patients whose CSF samples were positive for VZV DNA were included, as were those with negative results who simultaneously presented herpes zoster and CSF or magnetic resonance imaging findings suggestive of CNS infection, and in whom other possible aetiologies had been ruled out. The study included 280 patients. The disease was considered to be caused by a VZV infection in 32 patients (11.4%), of which 23 cases were virologically confirmed (detection of VZV DNA in CSF). The most frequent diagnosis of the patients with VZV CNS infection was encephalitis (83.3%), followed by meningitis (13.3%) and cerebellitis (3.3%). The mean annual incidence of VZV CNS infection was 3.0 cases per 100,000 inhabitants. VZV was the most common cause of encephalitis and viral meningitis, ahead of herpes simplex virus (n = 9). At the time of discharge, 12 (40%) patients showed neurological sequelae. Five patients (20%) died during hospitalization, all with encephalitis. Patients with a fatal outcome had significantly higher median age and longer delay before initiating acyclovir. In conclusion, VZV was the first cause of encephalitis in our elderly population. Despite acyclovir treatment, there was a high rate of case fatality and sequelae at discharge.
Assuntos
DNA Viral/líquido cefalorraquidiano , Encefalite por Varicela Zoster/epidemiologia , Herpesvirus Humano 3/patogenicidade , Meningite Viral/epidemiologia , Infecção pelo Vírus da Varicela-Zoster/epidemiologia , Aciclovir/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Sistema Nervoso Central/patologia , Sistema Nervoso Central/virologia , Encefalite por Varicela Zoster/diagnóstico por imagem , Encefalite por Varicela Zoster/tratamento farmacológico , Encefalite por Varicela Zoster/mortalidade , Feminino , Herpesvirus Humano 3/efeitos dos fármacos , Herpesvirus Humano 3/fisiologia , Humanos , Incidência , Imageamento por Ressonância Magnética , Masculino , Meningite Viral/diagnóstico por imagem , Meningite Viral/tratamento farmacológico , Meningite Viral/mortalidade , Estudos Retrospectivos , Espanha/epidemiologia , Análise de Sobrevida , Infecção pelo Vírus da Varicela-Zoster/diagnóstico por imagem , Infecção pelo Vírus da Varicela-Zoster/tratamento farmacológico , Infecção pelo Vírus da Varicela-Zoster/mortalidadeRESUMO
BACKGROUND: Infective endocarditis (IE) caused by anaerobic bacteria is a rare and poorly characterized disease. Most data reported in the literature are from case reports [1-3]. Therefore, we assessed the situation of anaerobic IE (AIE) in Spain using the database of the Spanish Collaboration on Endocarditis (GAMES). METHODS: We performed a prospective study from 2008 to 2016 in 26 Spanish centers. We included 2491 consecutive cases of definite IE (Duke criteria). RESULTS: Anaerobic bacteria caused 22 cases (0.9%) of definite IE. Median age was 66 years (IQR, 56-73), and 19 (86.4%) patients were men. Most patients (14 [63.6%]) had prosthetic valve IE and all episodes were left-sided: aortic valves, 12 (54.5%); and mitral valves, 8 (36.4%). The most common pathogens were Propionibacterium acnes (14 [63.6%]), Lactobacillus spp (3 [13.63%]), and Clostridium spp. (2 [9.0%]), and the infection was mainly odontogenic. Fifteen of the 22 patients (68.2%) underwent cardiac surgery. Mortality was 18.2% during admission and 5.5% after 1 year of follow-up. When patients with AIE were compared with the rest of the cohort, we found that although those with AIE had a similar age and Charlson comorbidity index, they were more likely to have community-acquired IE (86.4% vs. 60.9%, p = 0.01), have undergone cardiac surgery (68.2% vs 48.7% p = 0.06), and have had lower mortality rates during admission (18.2% vs. 27.3%). CONCLUSION: IE due to anaerobic bacteria is an uncommon disease that affects mainly prosthetic valves and frequently requires surgery. Otherwise, there are no major differences between AIE and IE caused by other microorganisms.
Assuntos
Bactérias Anaeróbias/classificação , Bactérias Anaeróbias/isolamento & purificação , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/microbiologia , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Espanha/epidemiologiaRESUMO
OBJECTIVES: A high proportion of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia die within a few days of the onset of infection. However, predictive factors for early mortality (EM) have barely been examined. The aim of this study was to determine the predictive factors for EM in patients with MRSA bacteraemia. METHODS: All episodes of MRSA bacteraemia were prospectively followed in 21 Spanish hospitals from June 2008 to December 2009. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed in a central laboratory. Mortality was defined as death from any cause occurring in the 30 days after the onset of MRSA bacteraemia. EM was defined as patients who died within the first 2 days, and late mortality (LM) for patients who died after this period. Multivariate analyses were performed by using logistic regression models. RESULTS: A total of 579 episodes were recorded. Mortality was observed in 179 patients (31%): it was early in 49 (8.5%) patients and late in 130 (22.5%). Independent risk factors for EM were [OR (95% CI)] initial Pitt score >3 [3.99 (1.72-3.24)], previous rapid fatal disease [3.67 (1.32-10.24)], source of infection lower respiratory tract or unknown [3.76 (1.31-10.83) and 2.83 (1.11-7.21)], non-nosocomial acquisition [2.59 (1.16-5.77)] and inappropriate initial antibiotic therapy [3.59 (1.63-7.89)]. When predictive factors for EM and LM were compared, inappropriate initial antibiotic therapy was the only distinctive predictor of EM, while endocarditis and lower respiratory tract sources both predicted LM. CONCLUSIONS: In our large cohort of patients several factors were related to EM, but the only distinctive predictor of EM was inappropriate initial antibiotic therapy.
Assuntos
Bacteriemia/mortalidade , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/mortalidade , Fatores Etários , Idoso , Bacteriemia/microbiologia , Estudos de Coortes , Farmacorresistência Bacteriana , Feminino , Humanos , Modelos Logísticos , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Fatores Sexuais , Infecções Estafilocócicas/microbiologia , Resultado do TratamentoRESUMO
ABSTRACT: Current data on the frequency and efficacy of linezolid (LNZ) in infective endocarditis (IE) are based on small retrospective series. We used a national database to evaluate the effectiveness of LNZ in IE.This is a retrospective study of IE patients in the Spanish GAMES database who received LNZ. We defined 3 levels of therapeutic impact: LNZâ<â7âdays, LNZ high-impact (≥ 7âdays, > 50% of the total treatment, and > 50% of the LNZ doses prescribed in the first weeks of treatment), and LNZ ≥ 7âdays not fulfilling the high-impact criteria (LNZ-NHI). Effectiveness of LNZ was assessed using propensity score matching and multivariate analysis of high-impact cases in comparison to patients not treated with LNZ from the GAMES database matched for age-adjusted comorbidity Charlson index, heart failure, renal failure, prosthetic and intracardiac IE device, left-sided IE, and Staphylococcus aureus. Primary outcomes were in-hospital mortality and one-year mortality. Secondary outcomes included IE complications and relapses.From 3467 patients included in the GAMES database, 295 (8.5%) received LNZ. After excluding 3 patients, 292 were grouped as follows for the analyses: 99 (33.9%) patients in LNZâ<â7âdays, 11 (3.7%) in LNZ high-impact, and 178 (61%) in LNZ-NHI. In-hospital mortality was 51.5%, 54.4%, and 19.1% respectively. In the propensity analysis, LNZ high-impact group presented with respect to matched controls not treated with LNZ higher in-hospital mortality (54.5% vs 18.2%, Pâ=â.04). The multivariate analysis showed an independent relationship of LNZ use with in-hospital mortality (odds ratio 9.06, 95% confidence interval 1.15--71.08, Pâ=â.03).Treatment with LNZ is relatively frequent, but most cases do not fulfill our high-impact criteria. Our data suggest that the use of LNZ as definitive treatment in IE may be associated with higher in-hospital mortality.
Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Linezolida/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Idoso , Endocardite/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Resultado do TratamentoRESUMO
OBJECTIVE: The incidence of infective endocarditis is progressively increasing, especially in elderly patients. Outpatient parenteral antibiotic therapy (OPAT) is being an excellent alternative for treatment, but advanced age is one of the relative contraindications. The aim of this study is to compare the characteristics and prognosis of patients less or more than 80 years, treated with OPAT. METHODS: One hundred and ninety four patients were included between 1996 and 2015, 31 of them older than 80 years. RESULTS: The most frequently affected valve is the aortic one, mainly native valves. Most used antibiotics are ceftriaxone, ampicillin, cloxacillin and daptomycin. Differences in surgery (39.9% vs 9.7%, p=0.001) and use of infusion pump (55.2% vs 35.5%; p= 0.044) were observed, under 80 years and older respectively. No differences in readmissions and mortality were observed. CONCLUSIONS: OPAT could be considered an effective alternative for appropriately-selected elderly patients with infective endocarditis.
Assuntos
Idoso de 80 Anos ou mais , Assistência Ambulatorial/métodos , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Endocardite/tratamento farmacológico , Idoso , Envelhecimento , Valva Aórtica/microbiologia , Endocardite/microbiologia , Endocardite/mortalidade , Feminino , Doenças das Valvas Cardíacas/tratamento farmacológico , Doenças das Valvas Cardíacas/microbiologia , Doenças das Valvas Cardíacas/mortalidade , Humanos , Bombas de Infusão , Infusões Parenterais , Masculino , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Espanha/epidemiologia , Resultado do TratamentoRESUMO
GOAL: To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2003. MATERIAL AND METHODS: The data were collected through a closed questionnaire included in the web site of the Working Group (www.nadya-senpe.com) available only by the authorized users. Variable included were: epidemiological information, the indication to prescribe this treatment, the access path, the specific nutritional formula used, the treatment duration, the complications and hospital readmission related to the nutritional treatment, the follow-up and the quality of life. RESULTS: We register 3,858 patients that belong to twenty-one hospitals. Mean age from those adults 66.2 +/- 18.9 years, and from those younger than 14, 6.0 +/- 4.3 years. Neurological and neoplasic diseases were the diagnostics more frequents (38.9% and 37.4%, respectively). Oral nutrition was the preferential rout used for the enteral nutrition (54.7%) followed by naso-enteral tube (26.6%), and only in 17.6% we used ostomy tubes. Polymeric was the enteral formula mainly utilized (80.1%). The mean time on HEN was 6.6 +/- 4.3 months; the 28.8% of patients stayed in the treatment for less than 3 months, 21.2 % between 3 and 6 months, and 50.0% more than 6 months. Patients were followed mainly by Nutritional Support Unit from the reference hospital (73.1%). While the reference hospital supplies the material (62.4%), reference hospital pharmacy (46.8%) and public pharmacies (32.0%) provides the enteral formula. Complications related to enteral nutrition included change of enteral tube (44.5%), gastrointestinal complications (30.5%), mechanical complications (21.7%), and the metabolic one (3.3%). These complications were followed by 0.02 hospitalizations/patient. At the end of the year, 54.7% of patients were in the HEN programme, and in 35.2 % HEN was finish due to accept oral conventional alimentation (49.2%) or by deceased of patients (40.9%). While 26.6% of the patients were confined to bed or armchair, 19.7 % no or light discapacity degree was observed. CONCLUSIONS: We found a persistence of these treatment in our country. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment.
Assuntos
Nutrição Enteral , Serviços de Assistência Domiciliar , Sistema de Registros , Adolescente , Adulto , Idoso , Nutrição Enteral/métodos , Nutrição Enteral/estatística & dados numéricos , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , EspanhaRESUMO
The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications.
Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Infecções Relacionadas a Cateter/terapia , Cateterismo Periférico/efeitos adversos , Consenso , Adulto , Infecções Relacionadas a Cateter/diagnóstico , Cateterismo Periférico/métodos , Catéteres , Remoção de Dispositivo , Contaminação de Equipamentos , Medicina Baseada em Evidências , HumanosRESUMO
GOAL: The NADYA-SENPE Working Group analyzed the registered data of patients on Home Enteral Nutrition (HEN) in our country, during year 2001. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were processed and analyzed by the coordinating team. RESULTS: Twenty two hospitals participated and 3,458 patients, aged 5.6 +/- 4.0 y for those younger than 14 y, and 67.1 +/- 19.5 y for those older than 14 y, were enrolled. Of these patients, 43.4% were diagnosed with neurological diseases and 33.5% with cancer. The mean time on HEN was 6.5 +/- 4.5 months. Oral nutrition was the preferential route (54.5%), followed by nasoenteral tube (32.3%), and in 13.3% ostomy tubes were placed. Polymeric was the formula composition mainly used (85.9%). Patients were followed (71.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included mainly the gastrointestinal (0.16 complications/patient), and the mechanical one (0.15 complications/patient). At the end for the year, 48.3% of the patients were in the HEN program, and in 33.3% HEN was finish due to different reasons. In 22.9% of the patients no, o light, discapacity degree was found. CONCLUSIONS: Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients, as previous years, were feed with ostomy tube. Due to the few complications observed, HEN is a safe treatment in our country.
Assuntos
Nutrição Enteral , Serviços de Assistência Domiciliar , Sistema de Registros , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Inquéritos e QuestionáriosRESUMO
The case of a 60-year-old patient who was repeatedly admitted for ascitic decompensation secondary to hyperflow portal hypertension provoked by congenital arteriovenous malformation of the superior mesenteric artery is presented. Diagnosis was performed by arteriography. Surgical treatment was conducted with total resection of the malformation thereby achieving complete resolution and normalization of portal pressure. The literature is reviewed and the pathophysiologic mechanism as well as the clinical manifestations, diagnosis and treatment are discussed.
Assuntos
Malformações Arteriovenosas , Hipertensão Portal/etiologia , Artéria Mesentérica Superior/anormalidades , Veias Mesentéricas/anormalidades , Angiografia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Feminino , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/cirurgia , Pessoa de Meia-IdadeRESUMO
Mortality related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for mortality we conducted a prospective study in a large cohort of patients with MRSA-BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs (V-MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex (CC)5 and carried SCCmecIV and agr2. Microdilution V-MIC50 and V-MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years (HR 1.88), previous fatal disease (HR 2.16), Pitt score >1 (HR 3.45), high-risk source (HR 1.85) and inappropriate initial treatment (HR 1.39) as independent predictive factors for mortality. CC5 and CC22 (HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ≥1.5 did not have a significant impact on mortality, regardless of the method used to assess it.
Assuntos
Bacteriemia/microbiologia , Bacteriemia/mortalidade , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Eletroforese em Gel de Campo Pulsado , Feminino , Genótipo , Hospitais , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem Molecular , Estudos Prospectivos , Fatores de Risco , Espanha , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Análise de Sobrevida , Resultado do Tratamento , Vancomicina/farmacologiaRESUMO
Although mucocutaneous candidiasis is a common occurrence in HIV-infected patients, candidal meningitis is uncommon. We report 3 cases of candidal meningitis in HIV-positive patients, all intravenous drug abusers, and we discuss the clinical course and outcome, the treatment with fluconazole and possible prophylaxis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Fluconazol/uso terapêutico , Meningite Fúngica/tratamento farmacológico , Adulto , Feminino , Humanos , MasculinoAssuntos
Antibacterianos/uso terapêutico , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Humanos , Infusões Intravenosas , Injeções Intramusculares , Pessoa de Meia-Idade , EspanhaAssuntos
Antibacterianos/administração & dosagem , Serviços de Assistência Domiciliar , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Assistência Domiciliar , Humanos , Infusões Intravenosas/instrumentação , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/tratamento farmacológicoAssuntos
Bacteriemia/microbiologia , Infecções por Enterobacteriaceae/microbiologia , Providencia/patogenicidade , Adulto , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Ciprofloxacina/uso terapêutico , Suscetibilidade a Doenças , Resistência Microbiana a Medicamentos , Quimioterapia Combinada/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/etiologia , Gentamicinas/uso terapêutico , Humanos , Masculino , Esclerose Múltipla/complicações , Ofloxacino/uso terapêutico , Providencia/efeitos dos fármacos , Providencia/isolamento & purificação , Incontinência Urinária/etiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologiaRESUMO
El objetivo de esta revisión es establecer la necesidad de incluir la edad de los pacientes y los estudios citogenéticos como criterios pronósticos en la clasificación diagnóstica de leucemias agudas en adultos. El sistema de clasificación del Grupo Cooperativo Francés-Americano-Británico (FAB) ha unificado criterios diagnósticos de leucemia aguda al aportar definiciones reproducibles, pero es parco en cuanto al rendimiento de información pronostica y terapéutica. Parece ser el momento de poner en manifiesto las limitaciones de dicho sistema de clasificación y plantear la aceptación de posibles modificaciones sugeridas por la clasificación de la Organización Mundial de la Salud (WHO), consenso de un panel internacional de expertos, que establece la existencia de evidencia que soporta el cambio de la clasificación FAB para leucemia mieloide aguda que permite una mejor identificación de subgrupos biológicamente distintivos de pacientes, entre ellos los pacientes viejos
Assuntos
Idoso , Leucemia MieloideRESUMO
Objetivo: Responder a la pregunta de por qué se requiere de un marco de práctica clínica que de significado cuantitativo al lenguaje médico, ejemplificando su ejecución mediante la evaluación del grado de concordancia entre el diagnóstico de mieloma múltiple (MM) basado en el reconocimiento clínico de patrones de enfermedad y en los criterios simplificados (mayores y menores) aceptados como de confirmación diagnóstica. Tipo de estudio: Serie de casos, descriptivo y de concordancia. Lugar y tiempo de estudio: Unidad de Hematología de la Facultad de Medicina de la Universidad Nacional de Colombia con sede en el Hospital San Juan de Dios de Santafé de Bogotá entre enero de 1994 y diciembre de 1999. Material y métodos: El diagnóstico definitivo de MM al momento de la predicción clínica era desconocido. Tras la valoración clínica inicial del paciente, el médico hematólogo consignaba la probabilidad en números con la cual él creía que sus impresiones diagnósticas iban a ser confirmadas por el subsiguiente estudio paraclínico, el cual incluía los criterios simplificados (mayores y menores) para MM. Para la medición de la exactitud de la predicción se empleó el coeficiente de exactitud promedio de predicción (Q) expresado en porcentaje. Resultados: Se incluyeron 16 pacientes en el estudio. El coeficiente de exactitud promedio de predicción (Q) de la evaluación clínica inicial en pacientes afectados de MM fue de 46 por ciento. Doce pacientes fueron hombres y cuatro mujeres. La mediana de edad para el grupo total fue 60.5 años, con límites inferior y superior del rango intercuartil de 50 años y 65 años, respectivamente. Las manifestaciones clínicas de mayor frecuencia al momento de la consulta, cada una acusada en cinco pacientes, fueron dolor lumbar, dolores osteomusculares generalizados y pérdida de peso. Los diagnósticos diferenciales de mayor frecuencia de consignación al momento de la valoración, además del de MM, fueron carcinoma metastásico en siete pacientes y linfoma y tuberculosis ósea, cada uno en tres pacientes. Discusión: La habilidad médica para hacer predicciones diagnósticas de MM en este estudio es mediana. En MM se requiere siempre falsear el diangóstico a posteriori mediante investigaciones de laboratorio rutinarias. La mejor forma de cuantificar la incertidumbre del acto médico es el empleo del lenguaje de la probabalidad...