Short-term outcomes of patients with a long stay in an internal medicine service.

OBJECTIVE: To describe the characteristics and short-term prognostic factors of patients with prolonged stay in internal medicine. MATERIAL AND METHODS: Retrospective case series study including patients admitted to an Internal Medicine service of a university hospital with lengths of stay greater than 30 days during 5 years. Information was obtained from the Minimum Basic Data Set. Outcome variables were a very long length of stay, in-hospital mortality, and adverse outcomes in the first 30 days after discharge. RESULTS: Out of 11,948 patients, 335 (2.8%) cases had a prolonged stay. The total length of stay was 15,271 days (15% of the total length of stay of the service). The mean age was 74.5 (±13.9) years, 180 (53.7%) were male. The median length of stay was 39 (RIC 34-49) days. Intensive Care Unit admission (OR = 2.5; 95%CI 1.4-4.7; p = 0.003) and receiving a geriatric assessment (OR = 0.3; 95%CI 0.8-0.9; p = 0.042) were independent factors with an effect on very long length of stay. Having an admission in the previous year was an independent factor for an adverse outcome 30 days after discharge (OR = 2.2; 95%CI 1.0-4.8). CONCLUSIONS: The percentage of patients with prolonged length of stay is less than 3%, but they have a high impact on the activity of an internal medicine service. There are factors associated with a very long length of stay and with the presence of an early adverse outcome after discharge.

[Hepatitis C: New diagnosis and seroconversions in a Madrid sexually transmitted diseases clinic]. / Hepatitis C: nuevos diagnósticos y seroconversiones en una clínica de infecciones de transmisión sexual en Madrid.

OBJECTIVE: The aim of this study was to evaluate the incidence of new hepatitis C virus (HCV) infections, based on their sexual orientation, human immunodeficiency virus (HIV) status, geographical regions and coinfection with other sexually transmitted diseases (STDs). METHODS: This study was carried out at the Sandoval Health Center, reference clinic of Sexually Transmitted Diseases (STDs) in Madrid. All HCV seronegative individuals who were reanalyzed for this virus were included, between January 2010 and December 2016. RESULTS: A total of 59 new diagnoses of HCV were diagnosed. The proportion of men who have sex with men (MSM) diagnosed with HCV was 37% in 2010 and 75% in 2016 and was even higher in the group of coinfected with HIV/HCV (94%). A total of 67 seroconverters for HCV were detected (1.2%) of which 100% were MSM. The proportion of HCV seroconverters with HIV was 89%. CONCLUSIONS: HCV infection continues to be a current health problem, especially in HIV-positive MSM.

Molecular epidemiology of drug-resistant Salmonella Typhimurium in Spain.

One hundred and forty-seven Salmonella serotype Typhimurium strains isolated in three provinces in the midwest of Spain were studied. Of these, 93.6% were drug resistant. There were two predominant resistance phenotypes: 43 isolates (29.3%) were resistant to amoxicillin, tetracyclines, chloramphenicol, streptomycin and sulphamethoxazole and 27 isolates (18.4%) to amoxicillin, amoxicillin/clavulanic acid, tetracyclines, chloramphenicol, streptomycin and sulphamethoxazole. Randomly amplified polymorphic DNA (RAPD) analysis and pulsed field gel electrophoresis (PFGE) were performed for molecular typing. Thirty-six DNA band profiles were differentiated by RAPD, and 38 by PFGE. We found a high level of clonality; 27% of strains were identical by both methods. There were additional smaller clonal lines within every area. The highest discriminatory power was obtained with PFGE, but the greatest degree of genetic diversity was observed among Salmonella Typhimurium using both RAPD and PFGE.

[Antimicrobial drug resistance in non-typhi Salmonellae in Castilla y Leon]. / Resistencia a antimicrobianos en Salmonella no typhi en Castilla y León.

We studied the antibiotic susceptibility of 309 Salmonella isolates obtained from three hospitals serving the provinces of Salamanca, Avila and Zamora in the region of Castilla y Leon (mid-west Spain). The susceptibility to 18 antibiotics was studied using the agar dilution method, according to NCCLS guidelines, and the most common multiresistance phenotypes were determined for each province. We observed clear susceptibility differences between the two main serotypes found, S. enteritidis and S. typhimurium. Seventy percent of S. typhimurium were resistant to amoxicillin. In 44% of these isolates, amoxicillin resistance was associated with resistance to streptomycin, sulfonamides, tetracyclines and chloramphenicol. S. enteritidis was susceptible to most antibiotics tested; amoxicillin resistance was observed in 23.3%, and nalidixic acid resistance in 49.6%. Resistance to nalidixic acid was higher in S. enteritidis than in any other serotypes. According to NCCLS breakpoints, no strain was resistant to fluoroquinolones. However, according to MENSURA criteria, 9% of S. typhimurium isolates were resistant to ciprofloxacin. Resistance to cotrimazole and gentamicin was less than 10% for all the serotypes tested. The results indicate that S. typhimurium showed greater resistance and a high multidrug resistance rate. Conversely, S. enteritidis showed high resistance only to amoxicillin and nalidixic acid, though in most cases there was no correlation between this resistance and reduced susceptibility to fluoroquinolones.

[Hematologic aspects of alcoholism (author's transl)]. / Aspectos hematológicos del alcoholismo.

Alcohol causes different hematologic alterations on each of the three bone marrow cellular series. Its effect on the red series leads to the appearance of megaloblastic disturbances, erythroblastic vacuolization, iron metabolism abnormalities, and hemolytic syndromes. Megaloblastic disturbances may arise as a consequence of folic acid or vitamin B12 deficiency or of a direct toxic effect of ethanol on the erythroblasts. Iron metabolism alterations include reversible sideroblastic anemia, and hemosiderosis. The three hemolytic syndromes related to the consumption of ethanol are: acanthocytosis, stomatocytosis, and Zieve's syndrome. Alcohol induces leukopenia and functional deffects of the leukocytes; these facts explain the frequent susceptibility of chronic alcoholics to infection. Ethanol may act upon the megakaryocytic series to produce reversible thrombopenia and various alterations in platelet function. Thus alcohol exerts toxic effects on bone marrow, which interfere with the proliferation, maturation, release and survival of the three cellular series, either directly or by means of complex mechanisms related to the metabolism of folic acid, vitamin B12, pyridoxine, or iron. Alcoholism should therefore be considered as a possible cause whenever an obscure hematological condition comes under scrutiny.

[Syphilitic penile pseudotumor. Report of a case]. / Pseudotumor peneano luético. Presentación de un caso.

The syphilis is a venereal disease of sexual transmission that incidence is increasing in several groups populations. We report a case of a patient with secondary syphilis who consulted for an atypical solid mass to penile. The clinical evolution, histological examination and analytical tests confirmed the diagnosis of genital syphilis having a satisfactory response to specific antibiotic treatment. The epidemiological, clinical, diagnostic aspects and therapeutic of the genital ulcer disease are discussed.

Resultados a corto plazo de los pacientes con tiempo de estancia prolongada en un servicio de Medicina Interna / Short-term outcomes of patients with a long stay in an internal medicine service

Objetivo Describir las características y los factores pronósticos a corto plazo de los pacientes con estancia prolongada en Medicina Interna. Material y métodos Estudio retrospectivo de una serie de casos que incluyó pacientes ingresados en un servicio de Medicina Interna de un hospital universitario con tiempos de estancia mayor de 30 días durante cinco años. La información se obtuvo del Conjunto Mínimo Básico de Datos. Las variables de resultado fueron tiempo de estancia muy prolongada, mortalidad intrahospitalaria y resultados adversos en los primeros 30 días tras el alta. Resultados De un total de 11.948 pacientes, 335 (2,8%) tuvieron una estancia prolongada. El tiempo total de estancia fue de 15.271 días (15% del total de tiempo de estancia del servicio). La edad media fue de 74,5 (±13,9) años, siendo 180 (53,7%) varones. La mediana de tiempo de estancia fue de 39 (RIC 34-49) días. El ingreso en la Unidad de Cuidados Intensivos (UCI) (OR = 2,5; IC 95% 1,4-4,7; p = 0,003) y recibir una valoración geriátrica (OR = 0,3; IC 95% 0,8-0,9; p = 0,042) fueron factores independientes con efecto en el tiempo de estancia muy prolongado. Un ingreso hospitalario en año previo fue un factor independiente de un resultado adverso a los 30 días tras el alta (OR = 2,2; IC 95% 1,0-4,8). Conclusiones El porcentaje de pacientes con estancias prolongadas es menor de un 3%, pero tienen un alto impacto en la actividad de un servicio de Medicina Interna. Existen factores asociados con el tiempo de estancia muy prolongada y con la presencia de un resultado adverso precoz tras el alta (AU)

Objective To describe the characteristics and short-term prognostic factors of patients with prolonged stay in internal medicine. Material and methods Retrospective case series study including patients admitted to an Internal Medicine service of a university hospital with lengths of stay greater than 30 days during 5 years. Information was obtained from the Minimum Basic Data Set. Outcome variables were a very long length of stay, in-hospital mortality, and adverse outcomes in the first 30 days after discharge. Results Out of 11,948 patients, 335 (2.8%) cases had a prolonged stay. The total length of stay was 15,271 days (15% of the total length of stay of the service). The mean age was 74.5 (±13.9) years, 180 (53.7%) were male. The median length of stay was 39 (RIC 34-49) days. Intensive Care Unit admission (OR = 2.5; 95%CI 1.4-4.7; p = 0.003) and receiving a geriatric assessment (OR = 0.3; 95%CI 0.8-0.9; p = 0.042) were independent factors with an effect on very long length of stay. Having an admission in the previous year was an independent factor for an adverse outcome 30 days after discharge (OR = 2.2; 95%CI 1.0-4.8). Conclusions The percentage of patients with prolonged length of stay is less than 3%, but they have a high impact on the activity of an internal medicine service. There are factors associated with a very long length of stay and with the presence of an early adverse outcome after discharge (AU)

Pancreatic infection with Candida parapsilosis.

Candida species other than C. albicans have been implicated as pathogens in intravascular (bloodstream, intravascular devices, endocarditis) and extravascular (arthritis, osteomielitis, endophtalmitis) infections. C. parapsilosis, however, is rarely implicated in intra-abdominal infections (peritonitis during peritoneal dialysis, complicating surgery or solid-organ transplantation). We describe a case of a 48-y-old male with acute pancreatitis who had a pancreatic abscess produced by primary C. parapsilosis infection. Although he received adequate treatment with antifungal medication and surgical drainage, the outcome was fatal. Because the clinical findings are indistinguishable from bacterial abscesses, Candida species should be considered in cases of complicated pancreatitis, in order to establish a prompt adequate treatment.