[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.

[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.

[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 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.

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 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.

[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.

[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.

[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.

[Tuberculosis and human immunodeficiency virus infection: clinical manifestations and performance of diagnostic procedures according to distinct forms of the localization of disease]. / Tuberculosis e infección por el virus de la inmunodeficiencia humana: manifestaciones clínicas y rendimiento de procedimientos diagnósticos según las distintas formas de localización de la enfermedad.

OBJECTIVES: To analyse the clinical manifestations and performance of the diagnosis methods in tuberculosis (TB) diagnosed in patients with human immunodeficiency virus infection (HIV), according to the location forms of disease (LF). MATERIAL AND METHODS: We revised 80 cases of TB diagnosed in patients with infection by HIV. The data were gathered in relation to TB location, the clinical data and the microbiological and histological diagnosed studies. In the statistic analysis the values p < 0.05 were taken into account. RESULTS: The prevalence of LF was: 1) pulmonary forms (PF) 32 (40%), of which 12 were typical pulmonary (TP) and 20 atypical pulmonary (AP); 2) mixed forms (MF) 21 (26%); 3) extrapulmonary forms (EF) 19 (24%), of which 17 were lymphadenitis; 4) miliary tuberculosis (MT) 8 cases (10%). The prevailing symptoms were: fever (71%) mainly in MF and MT, cough (69%), with less frequency in AP, EF and MT (p < 0.05) and adenomegalies especially in EF and MF. The diagnosis was based on the study of the sputum smears and lymph node. The bacilloscope of the spontaneous sputum was 53% with a minor performance in the AP (p < 0.05), while in lymph node the smear for AFB was positive in 78% cases and caseous granulomas were observed in 87%. CONCLUSIONS: In our study the major confirmed locations were pulmonary and lymph node, the most important clinical symptoms were fever, cough and adenomegalies. The diagnosis was based, in the most of cases, on the microbiologic and histologic examination of bronchial secretion and lymph node samples.

[Usefulness of skin tests (tuberculin and delayed-type hypersensitivity reaction) in patients with HIV infection]. / Utilidad de los tests cutáneos (mantoux y prueba de hipersensibilidad retardada) en la infección por el VIH.

The aim of this study is to asses the management and application of skin tests (tuberculin and delayed-type hypersensitivity reaction) in patients with HIV-infection.

[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.

[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.

[Oral anticoagulation]. / Anticoagulación oral.

The use of oral anticoagulants in the prevention of thrombotics processes, has experienced a considerable increase. In addition, there are a growing experience on the medical and socials consequences of the use of this drug. This has originated a much more pragmatic vision of the daily handling of the anticoagulated patient. In this article, we made are vision about the indications and the practical use, including some useful advices and criteria for the concomitant drug selection.

[Captopril in single dose in the treatment of essential arterial hypertension]. / Captopril en dosis única en el tratamiento de la hipertension arterial esencial.

Seventy one mild to moderate essential hypertensive patients receiving out-patient treatment with Captopril--inhibitor of the conversion enzyme--during a period of six months, are studied. The therapeutic goal (DAP less than 95 mm Hg.) was reached in 88% of the cases, with just a single Captopril dose of 50 mg/day in 42 patients (59.1%). AP decreased from 174.2/100.2 mm Hg. to 149.2/84.0 mm Hg. (p less than 0.001). Any significant changes in heart rate nor in body weight were observed. Side effects were rare (just in two patients), although their intensity determined in both cases the interruption of treatment. Finally, and improvement in the metabolic profile of patients was observed, with reduction in glucose, cholesterol, triglycerides and uric acid at the end of the study.

[The efficacy of nicardipine in treating arterial hypertension in elderly patients. A multicenter outpatient study]. / Eficacia de la nicardipina en el tratamiento de la hipertensión arterial en pacientes ancianos. Estudio multicéntrico en régimen de ambulatorio.

In this open study, 210 patients from both sexes, age above 60 years and diagnosis of AHT, were included. All patients were treated, following the washing-out phase, with a calcium antagonist dihydropyridine: nicardipine, at a doses of 60 mg/day for 12 weeks. A significant reduction in SAP (from 168.97 to 152.25 mm Hg.) and DAP (from 98.17 to 87.63 mm Hg.) was observed, without modifications in the cardiac rate. In addition, a low incidence of adverse effects and a high biological tolerance of the drug has been demonstrated during the whole study.

[Tuberculosis in elderly patients. Presentation forms]. / Tuberculosis en pacientes ancianos. Formas de presentación.

OBJECTIVE: To analyse the distribution of the forms of presentation of tuberculosis (TPF) in elderly patients. MATERIAL AND METHODS: The medical records of patients diagnosed with tuberculosis attending the Tuberculosis Prevention and Control Unit of the Santiago Health District were reviewed over of six years period. The classification of TPF was: pulmonary forms (P), disease confined to the lung; extrapulmonary forms (EF), disease outside the lung; mixed forms (MF), the presence of both pulmonary and extrapulmonary tuberculosis; disseminated forms (DF), the presence of two or more extrapulmonary locations; and miliary TB, which was defined by a diffuse pulmonary radiographic pattern or diagnosis was undertaken by necropsy. RESULTS: A total of 278 tuberculosis infected patients were observed, 156 (56.2%) were men and 122 (43.8%) women, their mean age was 75.3 years (range 65-95). The distribution of TPF was: 155 (55.8%) P forms; 66 (23.7%) EF, of which 27 (41.0%) were ganglionary location, 12 (18.2%) bone and joint, 8 (12.0%) intestinal, 6 (9.1%) peritoneal, 5 (7.6%) meningeal, and other locations 8 (12.1%); MF 47 cases (16.9%); miliary TB 7 cases (2.5%) and. DF 3 cases (1.1%). None case was observed of HIV infected patient. CONCLUSIONS: Our findings confirm high incidence of extrapulmonary TB in elderly patients. Our experience shows a modification to the classical presentation of the disease, and thus the need for sensitivity in locating the disease.

[Correlation between CD4 lymphocytes and viral load in patients with HIV and tuberculosis]. / Correlación entre linfocitos CD4 y carga viral en pacientes infectados por el virus de la inmunodeficiencia humana con tuberculosis.

OBJECTIVE: A retrospective study of the correlation between CD4 lymphocytes and the viral load in 16 HIV-patients with tuberculosis. MATERIAL AND METHODS: The clinical forms of presentation of tuberculosis were classified according to the location/s of the disease into: pulmonary, distinguishing between typical pulmonary and atypical according to the radiological pattern; extrapulmonary; mixed forms: pulmonary and extrapulmonary; and miliary tuberculosis. RESULTS: Tuberculosis was exclusively pulmonary in 7 cases (44%), all were atypical; extrapulmonary 6 (38%); mixed 2 (12%); and miliary 1 (6%). The mean CD4 lymphocyte count was 111.1 (range 5-360), in 11 (69%) the counts were below 200 cells/mm3. The lowest CD4 count was in the mixed forms with a mean of 45 cells/mm3 whilst the highest was obtained in pulmonary forms with a mean of 128.3 cells/mm3. The mean viral load was 4.82 log (range, 0-5.93), the highest load was for mixed forms with a mean 5.69 log, whereas the lowest load was for pulmonary forms with a mean of 4.19 log. No significant correlation was observed between CD4 lymphocytes and viral load (correlation coefficient--0.1163). CONCLUSIONS: Though no significant correlation was observed, a high CD4 was associated to a low viral load and inversely a low CD4 with a high viral load.